"BusinessYear","StateCode","IssuerId","SourceName","VersionNum","ImportDate","BenefitPackageId","IssuerId2","StateCode2","MarketCoverage","DentalOnlyPlan","TIN","StandardComponentId","PlanMarketingName","HIOSProductId","HPID","NetworkId","ServiceAreaId","FormularyId","IsNewPlan","PlanType","MetalLevel","UniquePlanDesign","QHPNonQHPTypeId","IsNoticeRequiredForPregnancy","IsReferralRequiredForSpecialist","SpecialistRequiringReferral","PlanLevelExclusions","IndianPlanVariationEstimatedAdvancedPaymentAmountPerEnrollee","CompositeRatingOffered","ChildOnlyOffering","ChildOnlyPlanId","WellnessProgramOffered","DiseaseManagementProgramsOffered","EHBPercentTotalPremium","EHBPediatricDentalApportionmentQuantity","IsGuaranteedRate","SpecialtyDrugMaximumCoinsurance","InpatientCopaymentMaximumDays","BeginPrimaryCareCostSharingAfterNumberOfVisits","BeginPrimaryCareDeductibleCoinsuranceAfterNumberOfCopays","PlanEffictiveDate","PlanExpirationDate","OutOfCountryCoverage","OutOfCountryCoverageDescription","OutOfServiceAreaCoverage","OutOfServiceAreaCoverageDescription","NationalNetwork","URLForEnrollmentPayment","FormularyURL","PlanId","CSRVariationType","IssuerActuarialValue","AVCalculatorOutputNumber","MedicalDrugDeductiblesIntegrated","MedicalDrugMaximumOutofPocketIntegrated","MultipleInNetworkTiers","FirstTierUtilization","SecondTierUtilization","SBCHavingaBabyDeductible","SBCHavingaBabyCopayment","SBCHavingaBabyCoinsurance","SBCHavingaBabyLimit","SBCHavingDiabetesDeductible","SBCHavingDiabetesCopayment","SBCHavingDiabetesCoinsurance","SBCHavingDiabetesLimit","MEHBInnTier1IndividualMOOP","MEHBInnTier1FamilyPerPersonMOOP","MEHBInnTier1FamilyPerGroupMOOP","MEHBInnTier2IndividualMOOP","MEHBInnTier2FamilyPerPersonMOOP","MEHBInnTier2FamilyPerGroupMOOP","MEHBOutOfNetIndividualMOOP","MEHBOutOfNetFamilyPerPersonMOOP","MEHBOutOfNetFamilyPerGroupMOOP","MEHBCombInnOonIndividualMOOP","MEHBCombInnOonFamilyPerPersonMOOP","MEHBCombInnOonFamilyPerGroupMOOP","DEHBInnTier1IndividualMOOP","DEHBInnTier1FamilyPerPersonMOOP","DEHBInnTier1FamilyPerGroupMOOP","DEHBInnTier2IndividualMOOP","DEHBInnTier2FamilyPerPersonMOOP","DEHBInnTier2FamilyPerGroupMOOP","DEHBOutOfNetIndividualMOOP","DEHBOutOfNetFamilyPerPersonMOOP","DEHBOutOfNetFamilyPerGroupMOOP","DEHBCombInnOonIndividualMOOP","DEHBCombInnOonFamilyPerPersonMOOP","DEHBCombInnOonFamilyPerGroupMOOP","TEHBInnTier1IndividualMOOP","TEHBInnTier1FamilyPerPersonMOOP","TEHBInnTier1FamilyPerGroupMOOP","TEHBInnTier2IndividualMOOP","TEHBInnTier2FamilyPerPersonMOOP","TEHBInnTier2FamilyPerGroupMOOP","TEHBOutOfNetIndividualMOOP","TEHBOutOfNetFamilyPerPersonMOOP","TEHBOutOfNetFamilyPerGroupMOOP","TEHBCombInnOonIndividualMOOP","TEHBCombInnOonFamilyPerPersonMOOP","TEHBCombInnOonFamilyPerGroupMOOP","MEHBDedInnTier1Individual","MEHBDedInnTier1FamilyPerPerson","MEHBDedInnTier1FamilyPerGroup","MEHBDedInnTier1Coinsurance","MEHBDedInnTier2Individual","MEHBDedInnTier2FamilyPerPerson","MEHBDedInnTier2FamilyPerGroup","MEHBDedInnTier2Coinsurance","MEHBDedOutOfNetIndividual","MEHBDedOutOfNetFamilyPerPerson","MEHBDedOutOfNetFamilyPerGroup","MEHBDedCombInnOonIndividual","MEHBDedCombInnOonFamilyPerPerson","MEHBDedCombInnOonFamilyPerGroup","DEHBDedInnTier1Individual","DEHBDedInnTier1FamilyPerPerson","DEHBDedInnTier1FamilyPerGroup","DEHBDedInnTier1Coinsurance","DEHBDedInnTier2Individual","DEHBDedInnTier2FamilyPerPerson","DEHBDedInnTier2FamilyPerGroup","DEHBDedInnTier2Coinsurance","DEHBDedOutOfNetIndividual","DEHBDedOutOfNetFamilyPerPerson","DEHBDedOutOfNetFamilyPerGroup","DEHBDedCombInnOonIndividual","DEHBDedCombInnOonFamilyPerPerson","DEHBDedCombInnOonFamilyPerGroup","TEHBDedInnTier1Individual","TEHBDedInnTier1FamilyPerPerson","TEHBDedInnTier1FamilyPerGroup","TEHBDedInnTier1Coinsurance","TEHBDedInnTier2Individual","TEHBDedInnTier2FamilyPerPerson","TEHBDedInnTier2FamilyPerGroup","TEHBDedInnTier2Coinsurance","TEHBDedOutOfNetIndividual","TEHBDedOutOfNetFamilyPerPerson","TEHBDedOutOfNetFamilyPerGroup","TEHBDedCombInnOonIndividual","TEHBDedCombInnOonFamilyPerPerson","TEHBDedCombInnOonFamilyPerGroup","IsHSAEligible","HSAOrHRAEmployerContribution","HSAOrHRAEmployerContributionAmount","URLForSummaryofBenefitsCoverage","PlanBrochure","RowNumber"
"2016","AK","21989","HIOS","4","2015-08-22 15:09:32","1","21989","AK","SHOP (Small Group)","Yes","93-0438772","21989AK0080001","Delta Dental Premier Advance Plan 1000","21989AK008",,"AKN001","AKS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$49.42","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network","Yes",,"","21989AK0080001-00","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_DeltaDentalPremierAdvancePlan1000_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_DeltaDentalPremierAdvancePlan1000_SG_2016_AK.pdf","4"
"2016","AK","21989","HIOS","4","2015-08-22 15:09:32","1","21989","AK","Individual","Yes","93-0438772","21989AK0030001","Delta Dental Premier Plan","21989AK003",,"AKN001","AKS001",,"Existing","Indemnity","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network","Yes",,"","21989AK0030001-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPremierPlan_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPremierPlan_2016_AK.pdf","4"
"2016","AK","21989","HIOS","4","2015-08-22 15:09:32","1","21989","AK","Individual","Yes","93-0438772","21989AK0030001","Delta Dental Premier Plan","21989AK003",,"AKN001","AKS001",,"Existing","Indemnity","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network","Yes",,"","21989AK0030001-01","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPremierPlan_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPremierPlan_2016_AK.pdf","5"
"2016","AK","21989","HIOS","4","2015-08-22 15:09:32","2","21989","AK","Individual","Yes","93-0438772","21989AK0050001","Delta Dental PPO 1000 Plan","21989AK005",,"AKN002","AKS002",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network","Yes",,"","21989AK0050001-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO1000Plan_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO1000Plan_2016_AK.pdf","4"
"2016","AK","21989","HIOS","4","2015-08-22 15:09:32","2","21989","AK","SHOP (Small Group)","Yes","93-0438772","21989AK0080002","Delta Dental Premier Advance Plan 1500","21989AK008",,"AKN001","AKS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$49.42","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network","Yes",,"","21989AK0080002-00","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_DeltaDentalPremierAdvancePlan1500_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_DeltaDentalPremierAdvancePlan1500_SG_2016_AK.pdf","4"
"2016","AK","21989","HIOS","4","2015-08-22 15:09:32","2","21989","AK","Individual","Yes","93-0438772","21989AK0050001","Delta Dental PPO 1000 Plan","21989AK005",,"AKN002","AKS002",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network","Yes",,"","21989AK0050001-01","Standard High On Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO1000Plan_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO1000Plan_2016_AK.pdf","5"
"2016","AK","21989","HIOS","4","2015-08-22 15:09:32","3","21989","AK","Individual","Yes","93-0438772","21989AK0050002","Delta Dental PPO 1500 Plan","21989AK005",,"AKN002","AKS002",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network","Yes",,"","21989AK0050002-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO1500Plan_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO1500Plan_2016_AK.pdf","4"
"2016","AK","21989","HIOS","4","2015-08-22 15:09:32","3","21989","AK","SHOP (Small Group)","Yes","93-0438772","21989AK0090001","Delta Dental Premier Practical Plan 1000","21989AK009",,"AKN001","AKS001",,"New","Indemnity","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$49.42","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network","Yes",,"","21989AK0090001-01","Standard High On Exchange Plan","86.30%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_DeltaDentalPremierPracticalPlan1000_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_DeltaDentalPremierPracticalPlan1000_SG_2016_AK.pdf","4"
"2016","AK","21989","HIOS","4","2015-08-22 15:09:32","3","21989","AK","Individual","Yes","93-0438772","21989AK0050002","Delta Dental PPO 1500 Plan","21989AK005",,"AKN002","AKS002",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network","Yes",,"","21989AK0050002-01","Standard High On Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO1500Plan_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO1500Plan_2016_AK.pdf","5"
"2016","AK","21989","HIOS","4","2015-08-22 15:09:32","4","21989","AK","Individual","Yes","93-0438772","21989AK0070001","Delta Dental Premier Healthy Smiles","21989AK007",,"AKN001","AKS001",,"New","Indemnity","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network","Yes",,"","21989AK0070001-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPremierBrightSmilesPlan_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPremierBrightSmilesPlan_2016_AK.pdf","4"
"2016","AK","21989","HIOS","4","2015-08-22 15:09:32","4","21989","AK","SHOP (Small Group)","Yes","93-0438772","21989AK0090002","Delta Dental Premier Practical Plan 1500","21989AK009",,"AKN001","AKS001",,"New","Indemnity","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$49.42","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network","Yes",,"","21989AK0090002-01","Standard High On Exchange Plan","86.30%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_DeltaDentalPremierPracticalPlan1500_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_DeltaDentalPremierPracticalPlan1500_SG_2016_AK.pdf","4"
"2016","AK","21989","HIOS","4","2015-08-22 15:09:32","5","21989","AK","SHOP (Small Group)","Yes","93-0438772","21989AK0100001","Delta Dental PPO Prosperous Plan 1000","21989AK010",,"AKN002","AKS002",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.94","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network","Yes",,"","21989AK0100001-00","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_DeltaDentalPPOProsperousPlan1000_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_DeltaDentalPPOProsperousPlan1000_SG_2016_AK.pdf","4"
"2016","AK","21989","HIOS","4","2015-08-22 15:09:32","6","21989","AK","SHOP (Small Group)","Yes","93-0438772","21989AK0100002","Delta Dental PPO Prosperous Plan 1500","21989AK010",,"AKN002","AKS002",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.94","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network","Yes",,"","21989AK0100002-00","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_DeltaDentalPPOProsperousPlan1500_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_DeltaDentalPPOProsperousPlan1500_SG_2016_AK.pdf","4"
"2016","AK","21989","HIOS","4","2015-08-22 15:09:32","7","21989","AK","SHOP (Small Group)","Yes","93-0438772","21989AK0110001","Delta Dental Premier Child Only","21989AK011",,"AKN001","AKS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$49.42","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network","Yes",,"","21989AK0110001-00","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_DeltaDentalPremierRadiantSmilesPlan_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_DeltaDentalPremierRadiantSmilesPlan_SG_2016_AK.pdf","4"
"2016","AK","21989","HIOS","4","2015-08-22 15:09:32","8","21989","AK","SHOP (Small Group)","Yes","93-0438772","21989AK0120001","Delta Dental PPO Child Only","21989AK012",,"AKN002","AKS002",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$34.94","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network","Yes",,"","21989AK0120001-00","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AK","38344","HIOS","10","2015-08-25 05:06:23","1","38344","AK","SHOP (Small Group)","Yes","91-0499247","38344AK1020001","Balance Kids' Dental","38344AK102",,"AKN002","AKS002",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$33.55","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","The out of country provision applies if the member is outside of the US.  For all providers, the member has to pay the provider at the time of service, and send the claim to the insurer along with any other supporting documents.  The insurer provides benefits at the out-of-network benefit level.","Yes","If the member is outside of Washington or Alaska, but still in the US, and visits a dentist not in the nationwide network, the insurer pays out of network.  Member has to pay the provider in full, and submit a claim for reimbursement.","Yes",,"","38344AK1020001-00","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.premera.com/documents/031144_2016.pdf","https://www.premera.com/documents/031120_2016.pdf","4"
"2016","AK","38344","HIOS","10","2015-08-25 05:06:23","1","38344","AK","SHOP (Small Group)","Yes","91-0499247","38344AK1020001","Balance Kids' Dental","38344AK102",,"AKN002","AKS002",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$33.55","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","The out of country provision applies if the member is outside of the US.  For all providers, the member has to pay the provider at the time of service, and send the claim to the insurer along with any other supporting documents.  The insurer provides benefits at the out-of-network benefit level.","Yes","If the member is outside of Washington or Alaska, but still in the US, and visits a dentist not in the nationwide network, the insurer pays out of network.  Member has to pay the provider in full, and submit a claim for reimbursement.","Yes",,"","38344AK1020001-01","Standard High On Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$40","$40 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.premera.com/documents/031144_2016.pdf","https://www.premera.com/documents/031120_2016.pdf","5"
"2016","AK","47904","HIOS","2","2015-07-10 02:19:03","1","47904","AK","Individual","Yes","47-0397286","47904AK0080001","Renaissance Individual Dental PPO, EHB Certified","47904AK008",,"AKN001","AKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$48.20","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","47904AK0080001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","AK","47904","HIOS","2","2015-07-10 02:19:03","1","47904","AK","Individual","Yes","47-0397286","47904AK0080002","Renaissance Individual Dental PPO, EHB Certified","47904AK008",,"AKN001","AKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.12","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","47904AK0080002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","AK","45858","HIOS","1","2015-05-01 02:23:41","1","45858","AK","SHOP (Small Group)","Yes","47-0098400","45858AK0040002","EHB High PPO","45858AK004",,"AKN001","AKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$65.94","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","45858AK0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","AK","45858","HIOS","1","2015-05-01 02:23:41","1","45858","AK","SHOP (Small Group)","Yes","47-0098400","45858AK0040001","EHB Low PPO","45858AK004",,"AKN001","AKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.69","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","45858AK0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","AK","45858","HIOS","1","2015-05-01 02:23:41","1","45858","AK","SHOP (Small Group)","Yes","47-0098400","45858AK0030002","EHB High Passive","45858AK003",,"AKN001","AKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$76.00","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","45858AK0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","AK","45858","HIOS","1","2015-05-01 02:23:41","1","45858","AK","SHOP (Small Group)","Yes","47-0098400","45858AK0030001","EHB Low Passive","45858AK003",,"AKN001","AKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$52.26","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","45858AK0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","AK","47904","HIOS","2","2015-07-10 02:19:03","1","47904","AK","Individual","Yes","47-0397286","47904AK0070001","Delta Dental Individual PPO, EHB Certified","47904AK007",,"AKN002","AKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.54","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","47904AK0070001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AK","47904","HIOS","2","2015-07-10 02:19:03","1","47904","AK","SHOP (Small Group)","Yes","47-0397286","47904AK0090001","Renaissance Group Dental PPO, EHB Certified","47904AK009",,"AKN001","AKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$45.13","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","47904AK0090001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AK","47904","HIOS","2","2015-07-10 02:19:03","1","47904","AK","SHOP (Small Group)","Yes","47-0397286","47904AK0090002","Renaissance Group Dental PPO, EHB Certified","47904AK009",,"AKN001","AKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.75","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","47904AK0090002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","AK","47904","HIOS","2","2015-07-10 02:19:03","1","47904","AK","Individual","Yes","47-0397286","47904AK0070002","Delta Dental Individual PPO, EHB Certified","47904AK007",,"AKN002","AKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.66","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","47904AK0070002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","AK","58670","HIOS","2","2015-07-08 02:47:08","1","58670","AK","SHOP (Small Group)","Yes","57-0523959","58670AK0020001","Group Dental Policy","58670AK002",,"AKN001","AKS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$76.97","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","58670AK0020001-00","Standard High Off Exchange Plan","86.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","Individual","No","93-0989307","73836AK0850001","Moda Health Select Be Secure","73836AK085",,"AKN001","AKS001","AKF001","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0850001-00","Standard Bronze Off Exchange Plan",,"0.619440078735352","Yes","Yes","No","100%",,"$4,470","$0","$1,100","$200","$1,270","$800","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","40%",,,,,"$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeSecure_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeSecure_2016_AK.pdf","4"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0700001","PPO 500 (Providence)","73836AK070",,"AKN002","AKS001","AKF008","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700001-00","Standard Gold Off Exchange Plan",,"0.816086649894714","Yes","Yes","No","100%",,"$500","$20","$1,400","$200","$500","$600","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_PPO500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_PPO500_SG_2016_AK.pdf","4"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0700001","PPO 500 (Providence)","73836AK070",,"AKN002","AKS001","AKF008","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700001-01","Standard Gold On Exchange Plan",,"0.816086649894714","Yes","Yes","No","100%",,"$500","$20","$1,400","$200","$500","$600","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_PPO500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_PPO500_SG_2016_AK.pdf","5"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","Individual","No","93-0989307","73836AK0850001","Moda Health Select Be Secure","73836AK085",,"AKN001","AKS001","AKF001","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0850001-01","Standard Bronze On Exchange Plan",,"0.619440078735352","Yes","Yes","No","100%",,"$4,470","$0","$1,100","$200","$1,270","$800","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","40%",,,,,"$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeSecure_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeSecure_2016_AK.pdf","5"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","Individual","No","93-0989307","73836AK0850001","Moda Health Select Be Secure","73836AK085",,"AKN001","AKS001","AKF001","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0850001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeSecure_CSV0_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeSecure_CSV0_2016_AK.pdf","6"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0700002","PPO 1000 (Providence)","73836AK070",,"AKN002","AKS001","AKF008","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700002-00","Standard Gold Off Exchange Plan",,"0.797592520713806","Yes","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$600","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_PPO1000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_PPO1000_SG_2016_AK.pdf","6"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0700002","PPO 1000 (Providence)","73836AK070",,"AKN002","AKS001","AKF008","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700002-01","Standard Gold On Exchange Plan",,"0.797592520713806","Yes","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$600","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_PPO1000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_PPO1000_SG_2016_AK.pdf","7"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","Individual","No","93-0989307","73836AK0850001","Moda Health Select Be Secure","73836AK085",,"AKN001","AKS001","AKF001","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0850001-03","Limited Cost Sharing Plan Variation",,"0.619440078735352","Yes","Yes","No","100%",,"$4,470","$0","$1,100","$200","$1,270","$800","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","40%",,,,,"$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeSecure_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeSecure_2016_AK.pdf","7"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","Yes","39-1263473","44580AL0380001","Humana Dental Smart Choice","44580AL038",,"ALN003","ALS003",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.94","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","44580AL0380001-00","Standard Low Off Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612818","4"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","Yes","39-1263473","44580AL0380001","Humana Dental Smart Choice","44580AL038",,"ALN003","ALS003",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.94","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","44580AL0380001-01","Standard Low On Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612818","5"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","Individual","No","93-0989307","73836AK0850002","Moda Health Providence Be Secure","73836AK085",,"AKN002","AKS001","AKF001","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0850002-00","Standard Bronze Off Exchange Plan",,"0.619440078735352","Yes","Yes","No","100%",,"$4,470","$0","$1,100","$200","$1,270","$800","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","40%",,,,,"$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeSecure_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeSecure_2016_AK.pdf","8"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0700003","PPO 1500 (Providence)","73836AK070",,"AKN002","AKS001","AKF008","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700003-00","Standard Gold Off Exchange Plan",,"0.784716427326202","Yes","Yes","No","100%",,"$1,500","$20","$1,200","$200","$1,270","$600","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_PPO1500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_PPO1500_SG_2016_AK.pdf","8"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0700003","PPO 1500 (Providence)","73836AK070",,"AKN002","AKS001","AKF008","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700003-01","Standard Gold On Exchange Plan",,"0.784716427326202","Yes","Yes","No","100%",,"$1,500","$20","$1,200","$200","$1,270","$600","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_PPO1500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_PPO1500_SG_2016_AK.pdf","9"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","Individual","No","93-0989307","73836AK0850002","Moda Health Providence Be Secure","73836AK085",,"AKN002","AKS001","AKF001","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0850002-01","Standard Bronze On Exchange Plan",,"0.619440078735352","Yes","Yes","No","100%",,"$4,470","$0","$1,100","$200","$1,270","$800","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","40%",,,,,"$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeSecure_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeSecure_2016_AK.pdf","9"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","Individual","No","93-0989307","73836AK0850002","Moda Health Providence Be Secure","73836AK085",,"AKN002","AKS001","AKF001","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0850002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeSecure_CSV0_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeSecure_CSV0_2016_AK.pdf","10"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0700004","PPO 2500 (Providence)","73836AK070",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700004-00","Standard Silver Off Exchange Plan",,"0.719912827014923","Yes","Yes","No","100%",,"$2,500","$20","$1,200","$200","$1,270","$1,100","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_PPO2500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_PPO2500_SG_2016_AK.pdf","10"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0700004","PPO 2500 (Providence)","73836AK070",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700004-01","Standard Silver On Exchange Plan",,"0.719912827014923","Yes","Yes","No","100%",,"$2,500","$20","$1,200","$200","$1,270","$1,100","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_PPO2500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_PPO2500_SG_2016_AK.pdf","11"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","Individual","No","93-0989307","73836AK0850002","Moda Health Providence Be Secure","73836AK085",,"AKN002","AKS001","AKF001","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9986",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0850002-03","Limited Cost Sharing Plan Variation",,"0.619440078735352","Yes","Yes","No","100%",,"$4,470","$0","$1,100","$200","$1,270","$800","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","40%",,,,,"$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeSecure_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeSecure_2016_AK.pdf","11"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0700005","PPO 3000 (Providence)","73836AK070",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700005-00","Standard Silver Off Exchange Plan",,"0.717009902000427","Yes","Yes","No","100%",,"$3,000","$20","$1,100","$200","$1,270","$1,100","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_PPO3000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_PPO3000_SG_2016_AK.pdf","12"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0700005","PPO 3000 (Providence)","73836AK070",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700005-01","Standard Silver On Exchange Plan",,"0.717009902000427","Yes","Yes","No","100%",,"$3,000","$20","$1,100","$200","$1,270","$1,100","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_PPO3000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_PPO3000_SG_2016_AK.pdf","13"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0700006","PPO 500 (Select)","73836AK070",,"AKN001","AKS001","AKF008","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700006-00","Standard Gold Off Exchange Plan",,"0.816086649894714","Yes","Yes","No","100%",,"$500","$20","$1,400","$200","$500","$600","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_PPO500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_PPO500_SG_2016_AK.pdf","14"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0700006","PPO 500 (Select)","73836AK070",,"AKN001","AKS001","AKF008","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700006-01","Standard Gold On Exchange Plan",,"0.816086649894714","Yes","Yes","No","100%",,"$500","$20","$1,400","$200","$500","$600","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_PPO500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_PPO500_SG_2016_AK.pdf","15"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0700007","PPO 1000 (Select)","73836AK070",,"AKN001","AKS001","AKF008","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700007-00","Standard Gold Off Exchange Plan",,"0.797592520713806","Yes","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$600","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_PPO1000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_PPO1000_SG_2016_AK.pdf","16"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0700007","PPO 1000 (Select)","73836AK070",,"AKN001","AKS001","AKF008","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700007-01","Standard Gold On Exchange Plan",,"0.797592520713806","Yes","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$600","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_PPO1000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_PPO1000_SG_2016_AK.pdf","17"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0700008","PPO 1500 (Select)","73836AK070",,"AKN001","AKS001","AKF008","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700008-00","Standard Gold Off Exchange Plan",,"0.784716427326202","Yes","Yes","No","100%",,"$1,500","$20","$1,200","$200","$1,270","$600","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_PPO1500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_PPO1500_SG_2016_AK.pdf","18"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0700008","PPO 1500 (Select)","73836AK070",,"AKN001","AKS001","AKF008","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700008-01","Standard Gold On Exchange Plan",,"0.784716427326202","Yes","Yes","No","100%",,"$1,500","$20","$1,200","$200","$1,270","$600","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_PPO1500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_PPO1500_SG_2016_AK.pdf","19"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0700009","PPO 2500 (Select)","73836AK070",,"AKN001","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700009-00","Standard Silver Off Exchange Plan",,"0.719912827014923","Yes","Yes","No","100%",,"$2,500","$20","$1,200","$200","$1,270","$1,100","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_PPO2500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_PPO2500_SG_2016_AK.pdf","20"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0700009","PPO 2500 (Select)","73836AK070",,"AKN001","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700009-01","Standard Silver On Exchange Plan",,"0.719912827014923","Yes","Yes","No","100%",,"$2,500","$20","$1,200","$200","$1,270","$1,100","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_PPO2500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_PPO2500_SG_2016_AK.pdf","21"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0700010","PPO 3000 (Select)","73836AK070",,"AKN001","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700010-00","Standard Silver Off Exchange Plan",,"0.717009902000427","Yes","Yes","No","100%",,"$3,000","$20","$1,100","$200","$1,270","$1,100","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_PPO3000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_PPO3000_SG_2016_AK.pdf","22"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0700010","PPO 3000 (Select)","73836AK070",,"AKN001","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0700010-01","Standard Silver On Exchange Plan",,"0.717009902000427","Yes","Yes","No","100%",,"$3,000","$20","$1,100","$200","$1,270","$1,100","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_PPO3000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_PPO3000_SG_2016_AK.pdf","23"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","2","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0880001","Moda Health Select HSA 2000","73836AK088",,"AKN001","AKS001","AKF006","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880001-00","Standard Silver Off Exchange Plan",,"0.698095142841339","Yes","Yes","No","100%",,"$2,000","$0","$1,300","$200","$2,000","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","25%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_HSA2000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_HSA2000_SG_2016_AK.pdf","4"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","2","73836","AK","Individual","No","93-0989307","73836AK0860001","Moda Health Select Be Safeguarded","73836AK086",,"AKN001","AKS001","AKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0860001-00","Standard Bronze Off Exchange Plan",,"0.61944454908371","Yes","Yes","No","100%",,"$4,470","$20","$1,000","$200","$1,270","$600","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","35%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeSafeguarded_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeSafeguarded_2016_AK.pdf","4"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","2","73836","AK","Individual","No","93-0989307","73836AK0860001","Moda Health Select Be Safeguarded","73836AK086",,"AKN001","AKS001","AKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0860001-01","Standard Bronze On Exchange Plan",,"0.61944454908371","Yes","Yes","No","100%",,"$4,470","$20","$1,000","$200","$1,270","$600","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","35%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeSafeguarded_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeSafeguarded_2016_AK.pdf","5"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","2","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0880001","Moda Health Select HSA 2000","73836AK088",,"AKN001","AKS001","AKF006","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880001-01","Standard Silver On Exchange Plan",,"0.698095142841339","Yes","Yes","No","100%",,"$2,000","$0","$1,300","$200","$2,000","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","25%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_HSA2000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_HSA2000_SG_2016_AK.pdf","5"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","2","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0880002","Moda Health Select HSA 2500","73836AK088",,"AKN001","AKS001","AKF006","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880002-00","Standard Silver Off Exchange Plan",,"0.680117964744568","Yes","Yes","No","100%",,"$2,500","$0","$1,200","$200","$2,500","$0","$800","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","25%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_HSA2500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_HSA2500_SG_2016_AK.pdf","6"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","2","73836","AK","Individual","No","93-0989307","73836AK0860001","Moda Health Select Be Safeguarded","73836AK086",,"AKN001","AKS001","AKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0860001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeSafeguarded_CSV0_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeSafeguarded_CSV0_2016_AK.pdf","6"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","2","73836","AK","Individual","No","93-0989307","73836AK0860001","Moda Health Select Be Safeguarded","73836AK086",,"AKN001","AKS001","AKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0860001-03","Limited Cost Sharing Plan Variation",,"0.61944454908371","Yes","Yes","No","100%",,"$4,470","$20","$1,000","$200","$1,270","$600","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","35%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeSafeguarded_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeSafeguarded_2016_AK.pdf","7"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","2","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0880002","Moda Health Select HSA 2500","73836AK088",,"AKN001","AKS001","AKF006","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880002-01","Standard Silver On Exchange Plan",,"0.680117964744568","Yes","Yes","No","100%",,"$2,500","$0","$1,200","$200","$2,500","$0","$800","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","25%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_HSA2500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_HSA2500_SG_2016_AK.pdf","7"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","2","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0880003","Moda Health Providence HSA 2000","73836AK088",,"AKN002","AKS001","AKF006","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880003-00","Standard Silver Off Exchange Plan",,"0.698095142841339","Yes","Yes","No","100%",,"$2,000","$0","$1,300","$200","$2,000","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","25%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_HSA2000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_HSA2000_SG_2016_AK.pdf","8"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","2","73836","AK","Individual","No","93-0989307","73836AK0860002","Moda Health Providence Be Safeguarded","73836AK086",,"AKN002","AKS001","AKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0860002-00","Standard Bronze Off Exchange Plan",,"0.61944454908371","Yes","Yes","No","100%",,"$4,470","$20","$1,000","$200","$1,270","$600","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","35%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeSafeguarded_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeSafeguarded_2016_AK.pdf","8"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","2","73836","AK","Individual","No","93-0989307","73836AK0860002","Moda Health Providence Be Safeguarded","73836AK086",,"AKN002","AKS001","AKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0860002-01","Standard Bronze On Exchange Plan",,"0.61944454908371","Yes","Yes","No","100%",,"$4,470","$20","$1,000","$200","$1,270","$600","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","35%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeSafeguarded_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeSafeguarded_2016_AK.pdf","9"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","2","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0880003","Moda Health Providence HSA 2000","73836AK088",,"AKN002","AKS001","AKF006","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880003-01","Standard Silver On Exchange Plan",,"0.698095142841339","Yes","Yes","No","100%",,"$2,000","$0","$1,300","$200","$2,000","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","25%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_HSA2000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_HSA2000_SG_2016_AK.pdf","9"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","2","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0880004","Moda Health Providence HSA 2500","73836AK088",,"AKN002","AKS001","AKF006","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880004-00","Standard Silver Off Exchange Plan",,"0.680117964744568","Yes","Yes","No","100%",,"$2,500","$0","$1,200","$200","$2,500","$0","$800","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","25%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_HSA2500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_HSA2500_SG_2016_AK.pdf","10"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","2","73836","AK","Individual","No","93-0989307","73836AK0860002","Moda Health Providence Be Safeguarded","73836AK086",,"AKN002","AKS001","AKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0860002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeSafeguarded_CSV0_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeSafeguarded_CSV0_2016_AK.pdf","10"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","2","73836","AK","Individual","No","93-0989307","73836AK0860002","Moda Health Providence Be Safeguarded","73836AK086",,"AKN002","AKS001","AKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0860002-03","Limited Cost Sharing Plan Variation",,"0.61944454908371","Yes","Yes","No","100%",,"$4,470","$20","$1,000","$200","$1,270","$600","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","35%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeSafeguarded_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeSafeguarded_2016_AK.pdf","11"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","2","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0880004","Moda Health Providence HSA 2500","73836AK088",,"AKN002","AKS001","AKF006","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0880004-01","Standard Silver On Exchange Plan",,"0.680117964744568","Yes","Yes","No","100%",,"$2,500","$0","$1,200","$200","$2,500","$0","$800","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","25%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_HSA2500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_HSA2500_SG_2016_AK.pdf","11"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0810001","Moda Health Select Vital 6000","73836AK081",,"AKN001","AKS001","AKF009","New","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0810001-00","Standard Bronze Off Exchange Plan",,"0.614679932594299","Yes","Yes","No","100%",,"$6,000","$0","$600","$200","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_Vital6000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_Vital6000_SG_2016_AK.pdf","4"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750001","Be Prosperous (Providence)","73836AK075",,"AKN002","AKS001","AKF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750001-00","Standard Gold Off Exchange Plan",,"0.816846072673798","Yes","Yes","No","100%",,"$750","$20","$1,000","$200","$750","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","15%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeProsperous_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeProsperous_2016_AK.pdf","4"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750001","Be Prosperous (Providence)","73836AK075",,"AKN002","AKS001","AKF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750001-01","Standard Gold On Exchange Plan",,"0.816846072673798","Yes","Yes","No","100%",,"$750","$20","$1,000","$200","$750","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","15%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeProsperous_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeProsperous_2016_AK.pdf","5"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0810001","Moda Health Select Vital 6000","73836AK081",,"AKN001","AKS001","AKF009","New","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0810001-01","Standard Bronze On Exchange Plan",,"0.614679932594299","Yes","Yes","No","100%",,"$6,000","$0","$600","$200","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_Vital6000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_Vital6000_SG_2016_AK.pdf","5"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0810002","Moda Health Providence Vital 6000","73836AK081",,"AKN002","AKS001","AKF009","New","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0810002-00","Standard Bronze Off Exchange Plan",,"0.614679932594299","Yes","Yes","No","100%",,"$6,000","$0","$600","$200","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_Vital6000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_Vital6000_SG_2016_AK.pdf","6"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750001","Be Prosperous (Providence)","73836AK075",,"AKN002","AKS001","AKF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeProsperous_CSV0_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeProsperous_CSV0_2016_AK.pdf","6"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750001","Be Prosperous (Providence)","73836AK075",,"AKN002","AKS001","AKF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750001-03","Limited Cost Sharing Plan Variation",,"0.816846072673798","Yes","Yes","No","100%",,"$750","$20","$1,000","$200","$750","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","15%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeProsperous_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeProsperous_2016_AK.pdf","7"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0810002","Moda Health Providence Vital 6000","73836AK081",,"AKN002","AKS001","AKF009","New","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0810002-01","Standard Bronze On Exchange Plan",,"0.614679932594299","Yes","Yes","No","100%",,"$6,000","$0","$600","$200","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_Vital6000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_Vital6000_SG_2016_AK.pdf","7"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750002","Be Prosperous (Select)","73836AK075",,"AKN001","AKS001","AKF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750002-00","Standard Gold Off Exchange Plan",,"0.816846072673798","Yes","Yes","No","100%",,"$750","$20","$1,000","$200","$750","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","15%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeProsperous_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeProsperous_2016_AK.pdf","8"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750002","Be Prosperous (Select)","73836AK075",,"AKN001","AKS001","AKF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750002-01","Standard Gold On Exchange Plan",,"0.816846072673798","Yes","Yes","No","100%",,"$750","$20","$1,000","$200","$750","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","15%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeProsperous_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeProsperous_2016_AK.pdf","9"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750002","Be Prosperous (Select)","73836AK075",,"AKN001","AKS001","AKF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeProsperous_CSV0_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeProsperous_CSV0_2016_AK.pdf","10"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750002","Be Prosperous (Select)","73836AK075",,"AKN001","AKS001","AKF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9991",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750002-03","Limited Cost Sharing Plan Variation",,"0.816846072673798","Yes","Yes","No","100%",,"$750","$20","$1,000","$200","$750","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","15%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeProsperous_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeProsperous_2016_AK.pdf","11"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750003","Be Equipped (Providence)","73836AK075",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750003-00","Standard Silver Off Exchange Plan",,"0.71902060508728","Yes","Yes","No","100%",,"$1,750","$20","$1,700","$200","$1,270","$1,100","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","30%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeEquipped_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeEquipped_2016_AK.pdf","12"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750003","Be Equipped (Providence)","73836AK075",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750003-01","Standard Silver On Exchange Plan",,"0.71902060508728","Yes","Yes","No","100%",,"$1,750","$20","$1,700","$200","$1,270","$1,100","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","30%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeEquipped_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeEquipped_2016_AK.pdf","13"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750003","Be Equipped (Providence)","73836AK075",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeEquipped_CSV0_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeEquipped_CSV0_2016_AK.pdf","14"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750003","Be Equipped (Providence)","73836AK075",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750003-03","Limited Cost Sharing Plan Variation",,"0.71902060508728","Yes","Yes","No","100%",,"$1,750","$20","$1,700","$200","$1,270","$1,100","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","30%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeEquipped_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeEquipped_2016_AK.pdf","15"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750003","Be Equipped (Providence)","73836AK075",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750003-04","73% AV Level Silver Plan",,"0.739552021026611","Yes","Yes","No","100%",,"$1,750","$20","$1,700","$200","$1,270","$1,100","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","30%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeEquipped_CSV1_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeEquipped_CSV1_2016_AK.pdf","16"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750003","Be Equipped (Providence)","73836AK075",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750003-05","87% AV Level Silver Plan",,"0.872306764125824","Yes","Yes","No","100%",,"$500","$0","$1,000","$200","$500","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeEquipped_CSV2_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeEquipped_CSV2_2016_AK.pdf","17"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750003","Be Equipped (Providence)","73836AK075",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750003-06","94% AV Level Silver Plan",,"0.943866848945618","Yes","Yes","No","100%",,"$100","$0","$400","$200","$100","$300","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","30%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeEquipped_CSV3_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeEquipped_CSV3_2016_AK.pdf","18"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750004","Be Equipped (Select)","73836AK075",,"AKN001","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750004-00","Standard Silver Off Exchange Plan",,"0.71902060508728","Yes","Yes","No","100%",,"$1,750","$20","$1,700","$200","$1,270","$1,100","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","30%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeEquipped_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeEquipped_2016_AK.pdf","19"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750004","Be Equipped (Select)","73836AK075",,"AKN001","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750004-01","Standard Silver On Exchange Plan",,"0.71902060508728","Yes","Yes","No","100%",,"$1,750","$20","$1,700","$200","$1,270","$1,100","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","30%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeEquipped_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeEquipped_2016_AK.pdf","20"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750004","Be Equipped (Select)","73836AK075",,"AKN001","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeEquipped_CSV0_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeEquipped_CSV0_2016_AK.pdf","21"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750004","Be Equipped (Select)","73836AK075",,"AKN001","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750004-03","Limited Cost Sharing Plan Variation",,"0.71902060508728","Yes","Yes","No","100%",,"$1,750","$20","$1,700","$200","$1,270","$1,100","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","30%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeEquipped_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeEquipped_2016_AK.pdf","22"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750004","Be Equipped (Select)","73836AK075",,"AKN001","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750004-04","73% AV Level Silver Plan",,"0.739552021026611","Yes","Yes","No","100%",,"$1,750","$20","$1,700","$200","$1,270","$1,100","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","30%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeEquipped_CSV1_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeEquipped_CSV1_2016_AK.pdf","23"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750004","Be Equipped (Select)","73836AK075",,"AKN001","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750004-05","87% AV Level Silver Plan",,"0.872306764125824","Yes","Yes","No","100%",,"$500","$0","$1,000","$200","$500","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeEquipped_CSV2_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeEquipped_CSV2_2016_AK.pdf","24"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","3","73836","AK","Individual","No","93-0989307","73836AK0750004","Be Equipped (Select)","73836AK075",,"AKN001","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9989",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0750004-06","94% AV Level Silver Plan",,"0.943866848945618","Yes","Yes","No","100%",,"$100","$0","$400","$200","$100","$300","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","30%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeEquipped_CSV3_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeEquipped_CSV3_2016_AK.pdf","25"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","4","73836","AK","Individual","No","93-0989307","73836AK0840001","Moda Health Select Be Vigorous","73836AK084",,"AKN001","AKS001","AKF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0840001-00","Standard Silver Off Exchange Plan",,"0.717218816280365","Yes","Yes","No","100%",,"$2,500","$20","$1,700","$200","$1,270","$600","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeVigorous_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeVigorous_2016_AK.pdf","4"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","4","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0710006","Value 2000 (Select)","73836AK071",,"AKN001","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710006-00","Standard Silver Off Exchange Plan",,"0.713992536067963","Yes","Yes","No","100%",,"$2,000","$20","$1,600","$200","$1,270","$1,200","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_Value2000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_Value2000_SG_2016_AK.pdf","4"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","4","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0710006","Value 2000 (Select)","73836AK071",,"AKN001","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710006-01","Standard Silver On Exchange Plan",,"0.713992536067963","Yes","Yes","No","100%",,"$2,000","$20","$1,600","$200","$1,270","$1,200","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_Value2000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_Value2000_SG_2016_AK.pdf","5"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","4","73836","AK","Individual","No","93-0989307","73836AK0840001","Moda Health Select Be Vigorous","73836AK084",,"AKN001","AKS001","AKF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0840001-01","Standard Silver On Exchange Plan",,"0.717218816280365","Yes","Yes","No","100%",,"$2,500","$20","$1,700","$200","$1,270","$600","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeVigorous_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeVigorous_2016_AK.pdf","5"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","4","73836","AK","Individual","No","93-0989307","73836AK0840001","Moda Health Select Be Vigorous","73836AK084",,"AKN001","AKS001","AKF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0840001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeVigorous_CSV0_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeVigorous_CSV0_2016_AK.pdf","6"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","4","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0710002","Value 2000 (Providence)","73836AK071",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710002-00","Standard Silver Off Exchange Plan",,"0.713992536067963","Yes","Yes","No","100%",,"$2,000","$20","$1,600","$200","$1,270","$1,200","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_Value2000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_Value2000_SG_2016_AK.pdf","6"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","4","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0710002","Value 2000 (Providence)","73836AK071",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710002-01","Standard Silver On Exchange Plan",,"0.713992536067963","Yes","Yes","No","100%",,"$2,000","$20","$1,600","$200","$1,270","$1,200","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_Value2000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_Value2000_SG_2016_AK.pdf","7"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","4","73836","AK","Individual","No","93-0989307","73836AK0840001","Moda Health Select Be Vigorous","73836AK084",,"AKN001","AKS001","AKF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0840001-03","Limited Cost Sharing Plan Variation",,"0.717218816280365","Yes","Yes","No","100%",,"$2,500","$20","$1,700","$200","$1,270","$600","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeVigorous_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeVigorous_2016_AK.pdf","7"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","4","73836","AK","Individual","No","93-0989307","73836AK0840001","Moda Health Select Be Vigorous","73836AK084",,"AKN001","AKS001","AKF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0840001-04","73% AV Level Silver Plan",,"0.738996922969818","Yes","Yes","No","100%",,"$2,500","$20","$1,700","$200","$1,270","$600","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeVigorous_CSV1_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeVigorous_CSV1_2016_AK.pdf","8"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","4","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0710007","Value 3000 (Select)","73836AK071",,"AKN001","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710007-00","Standard Silver Off Exchange Plan",,"0.70694637298584","Yes","Yes","No","100%",,"$3,000","$20","$1,300","$200","$1,270","$1,200","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_Value3000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_Value3000_SG_2016_AK.pdf","8"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","4","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0710007","Value 3000 (Select)","73836AK071",,"AKN001","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710007-01","Standard Silver On Exchange Plan",,"0.70694637298584","Yes","Yes","No","100%",,"$3,000","$20","$1,300","$200","$1,270","$1,200","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_Value3000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_Value3000_SG_2016_AK.pdf","9"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","4","73836","AK","Individual","No","93-0989307","73836AK0840001","Moda Health Select Be Vigorous","73836AK084",,"AKN001","AKS001","AKF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0840001-05","87% AV Level Silver Plan",,"0.873547911643982","Yes","Yes","No","100%",,"$750","$0","$500","$200","$750","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeVigorous_CSV2_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeVigorous_CSV2_2016_AK.pdf","9"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","4","73836","AK","Individual","No","93-0989307","73836AK0840001","Moda Health Select Be Vigorous","73836AK084",,"AKN001","AKS001","AKF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9988",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0840001-06","94% AV Level Silver Plan",,"0.935418128967285","Yes","Yes","No","100%",,"$250","$0","$300","$200","$250","$60","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeVigorous_CSV3_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeVigorous_CSV3_2016_AK.pdf","10"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","4","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0710003","Value 3000 (Providence)","73836AK071",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710003-00","Standard Silver Off Exchange Plan",,"0.70694637298584","Yes","Yes","No","100%",,"$3,000","$20","$1,300","$200","$1,270","$1,200","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_Value3000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_Value3000_SG_2016_AK.pdf","10"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","4","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0710003","Value 3000 (Providence)","73836AK071",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710003-01","Standard Silver On Exchange Plan",,"0.70694637298584","Yes","Yes","No","100%",,"$3,000","$20","$1,300","$200","$1,270","$1,200","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_Value3000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_Value3000_SG_2016_AK.pdf","11"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","4","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0710008","Value 4000 (Select)","73836AK071",,"AKN001","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9983",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710008-00","Standard Silver Off Exchange Plan",,"0.705193161964417","Yes","Yes","No","100%",,"$4,000","$20","$1,000","$200","$1,270","$1,200","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_Value4000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_Value4000_SG_2016_AK.pdf","12"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","4","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0710008","Value 4000 (Select)","73836AK071",,"AKN001","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9983",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710008-01","Standard Silver On Exchange Plan",,"0.705193161964417","Yes","Yes","No","100%",,"$4,000","$20","$1,000","$200","$1,270","$1,200","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_Value4000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_Value4000_SG_2016_AK.pdf","13"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","4","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0710004","Value 4000 (Providence)","73836AK071",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9983",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710004-00","Standard Silver Off Exchange Plan",,"0.705193161964417","Yes","Yes","No","100%",,"$4,000","$20","$1,000","$200","$1,270","$1,200","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_Value4000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_Value4000_SG_2016_AK.pdf","14"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","4","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0710004","Value 4000 (Providence)","73836AK071",,"AKN002","AKS001","AKF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9983",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0710004-01","Standard Silver On Exchange Plan",,"0.705193161964417","Yes","Yes","No","100%",,"$4,000","$20","$1,000","$200","$1,270","$1,200","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_Value4000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_Value4000_SG_2016_AK.pdf","15"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","5","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0800001","Moda Health Select Caliber 2000","73836AK080",,"AKN001","AKS001","AKF004","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0800001-00","Standard Silver Off Exchange Plan",,"0.713736891746521","Yes","Yes","No","100%",,"$2,000","$20","$1,800","$200","$1,270","$800","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_Caliber2000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_Caliber2000_SG_2016_AK.pdf","4"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","5","73836","AK","Individual","No","93-0989307","73836AK0790001","Be Rugged (Providence)","73836AK079",,"AKN002","AKS001","AKF007","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,,"0","0","3","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0790001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$4,470","$0","$0","$200","$1,270","$135","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeRugged_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeRugged_2016_AK.pdf","4"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","5","73836","AK","Individual","No","93-0989307","73836AK0790001","Be Rugged (Providence)","73836AK079",,"AKN002","AKS001","AKF007","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,,"0","0","3","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0790001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$4,470","$0","$0","$200","$1,270","$135","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeRugged_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Providence_BeRugged_2016_AK.pdf","5"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","5","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0800001","Moda Health Select Caliber 2000","73836AK080",,"AKN001","AKS001","AKF004","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0800001-01","Standard Silver On Exchange Plan",,"0.713736891746521","Yes","Yes","No","100%",,"$2,000","$20","$1,800","$200","$1,270","$800","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_Caliber2000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_Caliber2000_SG_2016_AK.pdf","5"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","5","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0800003","Moda Health Providence Caliber 2000","73836AK080",,"AKN002","AKS001","AKF004","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0800003-00","Standard Silver Off Exchange Plan",,"0.713736891746521","Yes","Yes","No","100%",,"$2,000","$20","$1,800","$200","$1,270","$800","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_Caliber2000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_Caliber2000_SG_2016_AK.pdf","6"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","5","73836","AK","Individual","No","93-0989307","73836AK0790002","Be Rugged (Select)","73836AK079",,"AKN001","AKS001","AKF007","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,,"0","0","3","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0790002-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$4,470","$0","$0","$200","$1,270","$135","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeRugged_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeRugged_2016_AK.pdf","6"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","5","73836","AK","Individual","No","93-0989307","73836AK0790002","Be Rugged (Select)","73836AK079",,"AKN001","AKS001","AKF007","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,,"0","0","3","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0790002-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$4,470","$0","$0","$200","$1,270","$135","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeRugged_SBC_2016_AK.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Select_BeRugged_2016_AK.pdf","7"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","5","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0800003","Moda Health Providence Caliber 2000","73836AK080",,"AKN002","AKS001","AKF004","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9985",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0800003-01","Standard Silver On Exchange Plan",,"0.713736891746521","Yes","Yes","No","100%",,"$2,000","$20","$1,800","$200","$1,270","$800","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_Caliber2000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_Caliber2000_SG_2016_AK.pdf","7"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","5","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0800002","Moda Health Select Caliber 2500","73836AK080",,"AKN001","AKS001","AKF004","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0800002-00","Standard Silver Off Exchange Plan",,"0.709728240966797","Yes","Yes","No","100%",,"$2,500","$20","$1,700","$200","$1,270","$800","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_Caliber2500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_Caliber2500_SG_2016_AK.pdf","8"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","5","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0800002","Moda Health Select Caliber 2500","73836AK080",,"AKN001","AKS001","AKF004","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0800002-01","Standard Silver On Exchange Plan",,"0.709728240966797","Yes","Yes","No","100%",,"$2,500","$20","$1,700","$200","$1,270","$800","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_Caliber2500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_Caliber2500_SG_2016_AK.pdf","9"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","5","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0800004","Moda Health Providence Caliber 2500","73836AK080",,"AKN002","AKS001","AKF004","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0800004-00","Standard Silver Off Exchange Plan",,"0.709728240966797","Yes","Yes","No","100%",,"$2,500","$20","$1,700","$200","$1,270","$800","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_Caliber2500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_Caliber2500_SG_2016_AK.pdf","10"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","5","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0800004","Moda Health Providence Caliber 2500","73836AK080",,"AKN002","AKS001","AKF004","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9984",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0800004-01","Standard Silver On Exchange Plan",,"0.709728240966797","Yes","Yes","No","100%",,"$2,500","$20","$1,700","$200","$1,270","$800","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_Caliber2500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_Caliber2500_SG_2016_AK.pdf","11"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","6","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0820001","Moda Health Select Expedition 3500","73836AK082",,"AKN001","AKS001","AKF001","New","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820001-00","Standard Bronze Off Exchange Plan",,"0.613391697406769","Yes","Yes","No","100%",,"$3,500","$0","$1,900","$200","$3,500","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_Expedition3500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_Expedition3500_SG_2016_AK.pdf","4"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","6","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0820001","Moda Health Select Expedition 3500","73836AK082",,"AKN001","AKS001","AKF001","New","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820001-01","Standard Bronze On Exchange Plan",,"0.613391697406769","Yes","Yes","No","100%",,"$3,500","$0","$1,900","$200","$3,500","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_Expedition3500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_Expedition3500_SG_2016_AK.pdf","5"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","6","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0820003","Moda Health Providence Expedition 3500","73836AK082",,"AKN002","AKS001","AKF001","New","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820003-00","Standard Bronze Off Exchange Plan",,"0.613391697406769","Yes","Yes","No","100%",,"$3,500","$0","$1,900","$200","$3,500","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_Expedition3500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_Expedition3500_SG_2016_AK.pdf","6"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","6","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0820003","Moda Health Providence Expedition 3500","73836AK082",,"AKN002","AKS001","AKF001","New","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820003-01","Standard Bronze On Exchange Plan",,"0.613391697406769","Yes","Yes","No","100%",,"$3,500","$0","$1,900","$200","$3,500","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_Expedition3500_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_Expedition3500_SG_2016_AK.pdf","7"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","6","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0820002","Moda Health Select Expedition 5000","73836AK082",,"AKN001","AKS001","AKF001","New","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820002-00","Standard Bronze Off Exchange Plan",,"0.596636772155762","Yes","Yes","No","100%",,"$5,000","$0","$1,100","$200","$500","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_Expedition5000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_Expedition5000_SG_2016_AK.pdf","8"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","6","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0820002","Moda Health Select Expedition 5000","73836AK082",,"AKN001","AKS001","AKF001","New","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820002-01","Standard Bronze On Exchange Plan",,"0.596636772155762","Yes","Yes","No","100%",,"$5,000","$0","$1,100","$200","$500","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Select_Expedition5000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Select_Expedition5000_SG_2016_AK.pdf","9"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","6","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0820004","Moda Health Providence Expedition 5000","73836AK082",,"AKN002","AKS001","AKF001","New","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820004-00","Standard Bronze Off Exchange Plan",,"0.596636772155762","Yes","Yes","No","100%",,"$5,000","$0","$1,100","$200","$500","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_Expedition5000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_Expedition5000_SG_2016_AK.pdf","10"
"2016","AK","73836","HIOS","6","2016-04-04 11:25:42","6","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0820004","Moda Health Providence Expedition 5000","73836AK082",,"AKN002","AKS001","AKF001","New","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9981",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=SG&state=AK","73836AK0820004-01","Standard Bronze On Exchange Plan",,"0.596636772155762","Yes","Yes","No","100%",,"$5,000","$0","$1,100","$200","$500","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.modahealth.com/pdfs/sbcs/ak/160101/Moda_Providence_Expedition5000_SBC_SG_2016_AK.pdf","https://www.modahealth.com/pdfs/ben_sum/AK/160101/Moda_Providence_Expedition5000_SG_2016_AK.pdf","11"
"2016","AK","74819","HIOS","3","2015-08-27 11:14:25","1","74819","AK","Individual","Yes","95-6042390","74819AK0020003","BESTOne Advantage Gold","74819AK002",,"AKN001","AKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$70.10","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AK/2016/AK_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","AK","74819","HIOS","3","2015-08-27 11:14:25","1","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010007","BESTDental Premium","74819AK001",,"AKN001","AKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$56.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AK/2016/AK_BESTDental_Premium_Plan.pdf","4"
"2016","AK","74819","HIOS","3","2015-08-27 11:14:25","1","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010007","BESTDental Premium","74819AK001",,"AKN001","AKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$56.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AK/2016/AK_BESTDental_Premium_Plan.pdf","5"
"2016","AK","74819","HIOS","3","2015-08-27 11:14:25","1","74819","AK","Individual","Yes","95-6042390","74819AK0020003","BESTOne Advantage Gold","74819AK002",,"AKN001","AKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$70.10","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AK/2016/AK_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","AK","74819","HIOS","3","2015-08-27 11:14:25","1","74819","AK","Individual","Yes","95-6042390","74819AK0020004","BESTOne Plus Gold","74819AK002",,"AKN001","AKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$70.10","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AK/2016/AK_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","AK","74819","HIOS","3","2015-08-27 11:14:25","1","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010008","BESTDental Standard - H","74819AK001",,"AKN001","AKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$56.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AK/2016/AK_BESTDental_Standard-H_Plan.pdf","6"
"2016","AK","74819","HIOS","3","2015-08-27 11:14:25","1","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010008","BESTDental Standard - H","74819AK001",,"AKN001","AKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$56.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AK/2016/AK_BESTDental_Standard-H_Plan.pdf","7"
"2016","AK","74819","HIOS","3","2015-08-27 11:14:25","1","74819","AK","Individual","Yes","95-6042390","74819AK0020004","BESTOne Plus Gold","74819AK002",,"AKN001","AKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$70.10","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AK/2016/AK_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","AK","74819","HIOS","3","2015-08-27 11:14:25","1","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010010","BESTDental Choice - H","74819AK001",,"AKN001","AKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$56.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AK/2016/AK_BESTDental_Choice-H_Plan.pdf","8"
"2016","AK","74819","HIOS","3","2015-08-27 11:14:25","1","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010010","BESTDental Choice - H","74819AK001",,"AKN001","AKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$56.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AK/2016/AK_BESTDental_Choice-H_Plan.pdf","9"
"2016","AK","74819","HIOS","3","2015-08-27 11:14:25","2","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010009","BESTDental Standard - L","74819AK001",,"AKN001","AKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AK/2016/AK_BESTDental_Standard-L_Plan.pdf","4"
"2016","AK","74819","HIOS","3","2015-08-27 11:14:25","2","74819","AK","Individual","Yes","95-6042390","74819AK0020005","BESTOne Plus Silver","74819AK002",,"AKN001","AKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$54.25","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AK/2016/AK_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","AK","74819","HIOS","3","2015-08-27 11:14:25","2","74819","AK","Individual","Yes","95-6042390","74819AK0020005","BESTOne Plus Silver","74819AK002",,"AKN001","AKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$54.25","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AK/2016/AK_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","AK","74819","HIOS","3","2015-08-27 11:14:25","2","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010009","BESTDental Standard - L","74819AK001",,"AKN001","AKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AK/2016/AK_BESTDental_Standard-L_Plan.pdf","5"
"2016","AK","74819","HIOS","3","2015-08-27 11:14:25","2","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010011","BESTDental Choice - L","74819AK001",,"AKN001","AKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AK/2016/AK_BESTDental_Choice-L_Plan.pdf","6"
"2016","AK","74819","HIOS","3","2015-08-27 11:14:25","2","74819","AK","Individual","Yes","95-6042390","74819AK0020006","BESTOne Basic Silver","74819AK002",,"AKN001","AKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$54.25","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AK/2016/AK_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","AK","74819","HIOS","3","2015-08-27 11:14:25","2","74819","AK","Individual","Yes","95-6042390","74819AK0020006","BESTOne Basic Silver","74819AK002",,"AKN001","AKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$54.25","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AK/2016/AK_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","AK","74819","HIOS","3","2015-08-27 11:14:25","2","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010011","BESTDental Choice - L","74819AK001",,"AKN001","AKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AK/2016/AK_BESTDental_Choice-L_Plan.pdf","7"
"2016","AK","74819","HIOS","3","2015-08-27 11:14:25","2","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010012","BESTDental Value","74819AK001",,"AKN001","AKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AK/2016/AK_BESTDental_Value_Plan.pdf","8"
"2016","AK","74819","HIOS","3","2015-08-27 11:14:25","2","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010012","BESTDental Value","74819AK001",,"AKN001","AKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","74819AK0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AK/2016/AK_BESTDental_Value_Plan.pdf","9"
"2016","AK","81761","HIOS","1","2015-05-01 02:23:41","1","81761","AK","SHOP (Small Group)","Yes","36-0883760","81761AK0040002","EHB High PPO","81761AK004",,"AKN001","AKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$66.86","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","81761AK0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","AK","81761","HIOS","1","2015-05-01 02:23:41","1","81761","AK","SHOP (Small Group)","Yes","36-0883760","81761AK0040001","EHB Low PPO","81761AK004",,"AKN001","AKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.25","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","81761AK0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","AL","39951","HIOS","2","2015-07-09 13:17:42","1","39951","AL","SHOP (Small Group)","Yes","81-0170040","39951AL0010001","Assurant Dental ACAFFO High","39951AL001",,"ALN001","ALS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$33.97","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","39951AL0010001-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AL","39951","HIOS","2","2015-07-09 13:17:42","1","39951","AL","SHOP (Small Group)","Yes","81-0170040","39951AL0010002","Assurant Dental ACAFFO Low","39951AL001",,"ALN001","ALS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$28.28","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","39951AL0010002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360003","Humana Silver 3800/Birmingham PPOx","44580AL036",,"ALN001","ALS001","ALF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360003-00","Standard Silver Off Exchange Plan","68.21%","0.687039494514465","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601404","http://apps.humana.com/marketing/documents.asp?file=2591095","4"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360003","Humana Silver 3800/Birmingham PPOx","44580AL036",,"ALN001","ALS001","ALF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601417","http://apps.humana.com/marketing/documents.asp?file=2591095","6"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360003","Humana Silver 3800/Birmingham PPOx","44580AL036",,"ALN001","ALS001","ALF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360003-03","Limited Cost Sharing Plan Variation","68.21%","0.687039494514465","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601469","http://apps.humana.com/marketing/documents.asp?file=2591095","7"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360015","Humana Platinum 500/Huntsville PPOx","44580AL036",,"ALN002","ALS002","ALF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601833","http://apps.humana.com/marketing/documents.asp?file=2591186","32"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360015","Humana Platinum 500/Huntsville PPOx","44580AL036",,"ALN002","ALS002","ALF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360015-03","Limited Cost Sharing Plan Variation","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601859","http://apps.humana.com/marketing/documents.asp?file=2591186","33"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","2","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0340001","Blue Access Gold for Business","46944AL034","7346243505","ALN001","ALS001","ALF004","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Standard.pdf","46944AL0340001-00","Standard Gold Off Exchange Plan","79.69%",,"No","Yes","Yes","95%","5%","$600","$400","$0","$200","$20","$1,200","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","20%","$600","$600 per person","$1200 per group","20%","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AlabamaBlue.com/b2016BlueAccessGold","https://www.AlabamaBlue.com/b2016BlueAccessGold","4"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","2","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0340001","Blue Access Gold for Business","46944AL034","7346243505","ALN001","ALS001","ALF004","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Standard.pdf","46944AL0340001-01","Standard Gold On Exchange Plan","79.69%",,"No","Yes","Yes","95%","5%","$600","$400","$0","$200","$20","$1,200","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","20%","$600","$600 per person","$1200 per group","20%","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AlabamaBlue.com/b2016BlueAccessGold","https://www.AlabamaBlue.com/b2016BlueAccessGold","5"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360003","Humana Silver 3800/Birmingham PPOx","44580AL036",,"ALN001","ALS001","ALF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360003-01","Standard Silver On Exchange Plan","68.21%","0.687039494514465","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601404","http://apps.humana.com/marketing/documents.asp?file=2591095","5"
"2016","AK","81761","HIOS","1","2015-05-01 02:23:41","1","81761","AK","SHOP (Small Group)","Yes","36-0883760","81761AK0030002","EHB High Passive","81761AK003",,"AKN001","AKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$77.07","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","81761AK0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","AK","81761","HIOS","1","2015-05-01 02:23:41","1","81761","AK","SHOP (Small Group)","Yes","36-0883760","81761AK0030001","EHB Low Passive","81761AK003",,"AKN001","AKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$52.99","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","81761AK0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","AK","84394","HIOS","2","2015-07-10 02:19:03","1","84394","AK","SHOP (Small Group)","Yes","42-0127290","84394AK0050001","Principal Plan Dental 70","84394AK005",,"AKN001","AKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$32.35","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","84394AK0050001-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AK","84394","HIOS","2","2015-07-10 02:19:03","1","84394","AK","SHOP (Small Group)","Yes","42-0127290","84394AK0050002","Principal Plan Dental 85","84394AK005",,"AKN001","AKS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$37.04","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","84394AK0050002-00","Standard High Off Exchange Plan","83.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","AK","84859","HIOS","1","2015-05-01 02:23:41","1","84859","AK","SHOP (Small Group)","Yes","93-0242990","84859AK0040002","EHB High PPO","84859AK004",,"AKN001","AKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$67.06","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","84859AK0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","AK","84859","HIOS","1","2015-05-01 02:23:41","1","84859","AK","SHOP (Small Group)","Yes","93-0242990","84859AK0040001","EHB Low PPO","84859AK004",,"AKN001","AKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.37","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","84859AK0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","AK","84859","HIOS","1","2015-05-01 02:23:41","1","84859","AK","SHOP (Small Group)","Yes","93-0242990","84859AK0030002","EHB High Passive","84859AK003",,"AKN001","AKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$77.29","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","84859AK0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","AK","84859","HIOS","1","2015-05-01 02:23:41","1","84859","AK","SHOP (Small Group)","Yes","93-0242990","84859AK0030001","EHB Low Passive","84859AK003",,"AKN001","AKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$53.15","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","84859AK0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","AL","12538","HIOS","3","2015-08-27 11:14:25","1","12538","AL","Individual","Yes","95-6042390","12538AL0020003","BESTOne Advantage Gold","12538AL002",,"ALN001","ALS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.14","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AL/2016/AL_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","AL","12538","HIOS","3","2015-08-27 11:14:25","1","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010007","BESTDental Premium","12538AL001",,"ALN001","ALS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AL/2016/AL_BESTDental_Premium_Plan.pdf","4"
"2016","AL","12538","HIOS","3","2015-08-27 11:14:25","1","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010007","BESTDental Premium","12538AL001",,"ALN001","ALS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AL/2016/AL_BESTDental_Premium_Plan.pdf","5"
"2016","AL","12538","HIOS","3","2015-08-27 11:14:25","1","12538","AL","Individual","Yes","95-6042390","12538AL0020003","BESTOne Advantage Gold","12538AL002",,"ALN001","ALS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.14","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AL/2016/AL_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","AL","12538","HIOS","3","2015-08-27 11:14:25","1","12538","AL","Individual","Yes","95-6042390","12538AL0020004","BESTOne Plus Gold","12538AL002",,"ALN001","ALS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.14","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AL/2016/AL_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","AL","12538","HIOS","3","2015-08-27 11:14:25","1","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010008","BESTDental Standard - H","12538AL001",,"ALN001","ALS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AL/2016/AL_BESTDental_Standard-H_Plan.pdf","6"
"2016","AL","12538","HIOS","3","2015-08-27 11:14:25","1","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010008","BESTDental Standard - H","12538AL001",,"ALN001","ALS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AL/2016/AL_BESTDental_Standard-H_Plan.pdf","7"
"2016","AL","12538","HIOS","3","2015-08-27 11:14:25","1","12538","AL","Individual","Yes","95-6042390","12538AL0020004","BESTOne Plus Gold","12538AL002",,"ALN001","ALS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.14","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AL/2016/AL_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","AL","12538","HIOS","3","2015-08-27 11:14:25","1","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010010","BESTDental Choice - H","12538AL001",,"ALN001","ALS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AL/2016/AL_BESTDental_Choice-H_Plan.pdf","8"
"2016","AL","12538","HIOS","3","2015-08-27 11:14:25","1","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010010","BESTDental Choice - H","12538AL001",,"ALN001","ALS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AL/2016/AL_BESTDental_Choice-H_Plan.pdf","9"
"2016","AL","12538","HIOS","3","2015-08-27 11:14:25","2","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010009","BESTDental Standard - L","12538AL001",,"ALN001","ALS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.92","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AL/2016/AL_BESTDental_Standard-L_Plan.pdf","4"
"2016","AL","12538","HIOS","3","2015-08-27 11:14:25","2","12538","AL","Individual","Yes","95-6042390","12538AL0020005","BESTOne Plus Silver","12538AL002",,"ALN001","ALS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.88","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AL/2016/AL_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","AL","12538","HIOS","3","2015-08-27 11:14:25","2","12538","AL","Individual","Yes","95-6042390","12538AL0020005","BESTOne Plus Silver","12538AL002",,"ALN001","ALS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.88","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AL/2016/AL_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","AL","12538","HIOS","3","2015-08-27 11:14:25","2","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010009","BESTDental Standard - L","12538AL001",,"ALN001","ALS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.92","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AL/2016/AL_BESTDental_Standard-L_Plan.pdf","5"
"2016","AL","12538","HIOS","3","2015-08-27 11:14:25","2","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010011","BESTDental Choice - L","12538AL001",,"ALN001","ALS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.92","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AL/2016/AL_BESTDental_Choice-L_Plan.pdf","6"
"2016","AL","12538","HIOS","3","2015-08-27 11:14:25","2","12538","AL","Individual","Yes","95-6042390","12538AL0020006","BESTOne Basic Silver","12538AL002",,"ALN001","ALS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.88","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AL/2016/AL_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","AL","12538","HIOS","3","2015-08-27 11:14:25","2","12538","AL","Individual","Yes","95-6042390","12538AL0020006","BESTOne Basic Silver","12538AL002",,"ALN001","ALS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.88","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AL/2016/AL_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","AL","12538","HIOS","3","2015-08-27 11:14:25","2","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010011","BESTDental Choice - L","12538AL001",,"ALN001","ALS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.92","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AL/2016/AL_BESTDental_Choice-L_Plan.pdf","7"
"2016","AL","12538","HIOS","3","2015-08-27 11:14:25","2","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010012","BESTDental Value","12538AL001",,"ALN001","ALS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.92","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AL/2016/AL_BESTDental_Value_Plan.pdf","8"
"2016","AL","12538","HIOS","3","2015-08-27 11:14:25","2","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010012","BESTDental Value","12538AL001",,"ALN001","ALS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.92","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","12538AL0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AL/2016/AL_BESTDental_Value_Plan.pdf","9"
"2016","AL","17017","HIOS","3","2015-08-18 03:25:03","1","17017","AL","SHOP (Small Group)","Yes","57-0523959","17017AL0020001","Group Dental Policy","17017AL002",,"ALN001","ALS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.04","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","17017AL0020001-00","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AL","17540","HIOS","2","2015-05-09 02:20:02","1","17540","AL","SHOP (Small Group)","Yes","13-5123390","17540AL0010003","Guardian Pediatric Advantage","17540AL001",,"ALN001","ALS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$25.29","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","17540AL0010003-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","AL","17540","HIOS","2","2015-05-09 02:20:02","1","17540","AL","SHOP (Small Group)","Yes","13-5123390","17540AL0020003","Guardian Pediatric Essentials","17540AL002",,"ALN001","ALS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$19.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","17540AL0020003-00","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","AL","17540","HIOS","2","2015-05-09 02:20:02","2","17540","AL","SHOP (Small Group)","Yes","13-5123390","17540AL0040003","Guardian Family Advantage","17540AL004",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.29","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","17540AL0040003-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","AL","17540","HIOS","2","2015-05-09 02:20:02","2","17540","AL","SHOP (Small Group)","Yes","13-5123390","17540AL0040003","Guardian Family Advantage","17540AL004",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.29","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","17540AL0040003-01","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","AL","17540","HIOS","2","2015-05-09 02:20:02","2","17540","AL","SHOP (Small Group)","Yes","13-5123390","17540AL0060003","Guardian Family Essentials","17540AL006",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","17540AL0060003-00","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","AL","17540","HIOS","2","2015-05-09 02:20:02","2","17540","AL","SHOP (Small Group)","Yes","13-5123390","17540AL0060003","Guardian Family Essentials","17540AL006",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","17540AL0060003-01","Standard Low On Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","AL","18756","HIOS","3","2015-07-09 13:17:42","1","18756","AL","SHOP (Small Group)","Yes","13-5581829","18756AL0140001","EHB Basic Dental Plan (Low)","18756AL014",,"ALN001","ALS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$16.48","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","18756AL0140001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AL","28725","HIOS","2","2015-07-11 04:19:24","1","28725","AL","Individual","Yes","47-0397286","28725AL0080001","Delta Dental Individual PPO, EHB Certified","28725AL008",,"ALN002","ALS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.28","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28725AL0080001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AL","28725","HIOS","2","2015-07-11 04:19:24","1","28725","AL","SHOP (Small Group)","Yes","47-0397286","28725AL0090001","Renaissance Group Dental PPO, EHB Certified","28725AL009",,"ALN001","ALS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.37","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28725AL0090001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AL","28725","HIOS","2","2015-07-11 04:19:24","1","28725","AL","SHOP (Small Group)","Yes","47-0397286","28725AL0090002","Renaissance Group Dental PPO, EHB Certified","28725AL009",,"ALN001","ALS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.53","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28725AL0090002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","AL","28725","HIOS","2","2015-07-11 04:19:24","1","28725","AL","Individual","Yes","47-0397286","28725AL0080002","Delta Dental Individual PPO, EHB Certified","28725AL008",,"ALN002","ALS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.46","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28725AL0080002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","AL","28725","HIOS","2","2015-07-11 04:19:24","1","28725","AL","Individual","Yes","47-0397286","28725AL0100001","Renaissance Individual Dental PPO, EHB Certified","28725AL010",,"ALN001","ALS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.74","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28725AL0100001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","AL","28725","HIOS","2","2015-07-11 04:19:24","1","28725","AL","Individual","Yes","47-0397286","28725AL0100002","Renaissance Individual Dental PPO, EHB Certified","28725AL010",,"ALN001","ALS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.32","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28725AL0100002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","AL","28732","HIOS","1","2015-05-01 02:23:41","1","28732","AL","SHOP (Small Group)","Yes","36-0883760","28732AL0040002","EHB High PPO","28732AL004",,"ALN001","ALS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.28","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","28732AL0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","AL","28732","HIOS","1","2015-05-01 02:23:41","1","28732","AL","SHOP (Small Group)","Yes","36-0883760","28732AL0040001","EHB Low PPO","28732AL004",,"ALN001","ALS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.56","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","28732AL0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","AL","28732","HIOS","1","2015-05-01 02:23:41","1","28732","AL","SHOP (Small Group)","Yes","36-0883760","28732AL0030002","EHB High Passive","28732AL003",,"ALN001","ALS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.16","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","28732AL0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","AL","28732","HIOS","1","2015-05-01 02:23:41","1","28732","AL","SHOP (Small Group)","Yes","36-0883760","28732AL0030001","EHB Low Passive","28732AL003",,"ALN001","ALS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.17","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","28732AL0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","AL","28899","HIOS","1","2015-05-01 02:23:41","1","28899","AL","SHOP (Small Group)","Yes","47-0098400","28899AL0040002","EHB High PPO","28899AL004",,"ALN001","ALS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.82","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","28899AL0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","AL","28899","HIOS","1","2015-05-01 02:23:41","1","28899","AL","SHOP (Small Group)","Yes","47-0098400","28899AL0040001","EHB Low PPO","28899AL004",,"ALN001","ALS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.34","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","28899AL0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","AL","28899","HIOS","1","2015-05-01 02:23:41","1","28899","AL","SHOP (Small Group)","Yes","47-0098400","28899AL0030002","EHB High Passive","28899AL003",,"ALN001","ALS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.67","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","28899AL0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","AL","28899","HIOS","1","2015-05-01 02:23:41","1","28899","AL","SHOP (Small Group)","Yes","47-0098400","28899AL0030001","EHB Low Passive","28899AL003",,"ALN001","ALS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.90","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","28899AL0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360003","Humana Silver 3800/Birmingham PPOx","44580AL036",,"ALN001","ALS001","ALF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360003-04","73% AV Level Silver Plan","72.87%","0.732456624507904","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601482","http://apps.humana.com/marketing/documents.asp?file=2622269","8"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360003","Humana Silver 3800/Birmingham PPOx","44580AL036",,"ALN001","ALS001","ALF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360003-05","87% AV Level Silver Plan","87.86%","0.881017088890076","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601521","http://apps.humana.com/marketing/documents.asp?file=2622282","9"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360003","Humana Silver 3800/Birmingham PPOx","44580AL036",,"ALN001","ALS001","ALF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360003-06","94% AV Level Silver Plan","93.14%","0.932067096233368","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601534","http://apps.humana.com/marketing/documents.asp?file=2622295","10"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360004","Humana Gold 2250/Birmingham PPOx","44580AL036",,"ALN001","ALS001","ALF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360004-00","Standard Gold Off Exchange Plan","78.03%","0.784799635410309","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601547","http://apps.humana.com/marketing/documents.asp?file=2591108","11"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360004","Humana Gold 2250/Birmingham PPOx","44580AL036",,"ALN001","ALS001","ALF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360004-01","Standard Gold On Exchange Plan","78.03%","0.784799635410309","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601547","http://apps.humana.com/marketing/documents.asp?file=2591108","12"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360004","Humana Gold 2250/Birmingham PPOx","44580AL036",,"ALN001","ALS001","ALF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601560","http://apps.humana.com/marketing/documents.asp?file=2591108","13"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360004","Humana Gold 2250/Birmingham PPOx","44580AL036",,"ALN001","ALS001","ALF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360004-03","Limited Cost Sharing Plan Variation","78.03%","0.784799635410309","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601573","http://apps.humana.com/marketing/documents.asp?file=2591108","14"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360005","Humana Platinum 500/Birmingham PPOx","44580AL036",,"ALN001","ALS001","ALF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360005-00","Standard Platinum Off Exchange Plan","88.47%","0.888415515422821","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601586","http://apps.humana.com/marketing/documents.asp?file=2591121","15"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360005","Humana Platinum 500/Birmingham PPOx","44580AL036",,"ALN001","ALS001","ALF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360005-01","Standard Platinum On Exchange Plan","88.47%","0.888415515422821","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601586","http://apps.humana.com/marketing/documents.asp?file=2591121","16"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360005","Humana Platinum 500/Birmingham PPOx","44580AL036",,"ALN001","ALS001","ALF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601599","http://apps.humana.com/marketing/documents.asp?file=2591121","17"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360005","Humana Platinum 500/Birmingham PPOx","44580AL036",,"ALN001","ALS001","ALF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360005-03","Limited Cost Sharing Plan Variation","88.47%","0.888415515422821","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601612","http://apps.humana.com/marketing/documents.asp?file=2591121","18"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360013","Humana Silver 3800/Huntsville PPOx","44580AL036",,"ALN002","ALS002","ALF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360013-00","Standard Silver Off Exchange Plan","68.21%","0.687039494514465","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601677","http://apps.humana.com/marketing/documents.asp?file=2591160","19"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360013","Humana Silver 3800/Huntsville PPOx","44580AL036",,"ALN002","ALS002","ALF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360013-01","Standard Silver On Exchange Plan","68.21%","0.687039494514465","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601677","http://apps.humana.com/marketing/documents.asp?file=2591160","20"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360013","Humana Silver 3800/Huntsville PPOx","44580AL036",,"ALN002","ALS002","ALF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360013-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601690","http://apps.humana.com/marketing/documents.asp?file=2591160","21"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360013","Humana Silver 3800/Huntsville PPOx","44580AL036",,"ALN002","ALS002","ALF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360013-03","Limited Cost Sharing Plan Variation","68.21%","0.687039494514465","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601703","http://apps.humana.com/marketing/documents.asp?file=2591160","22"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360013","Humana Silver 3800/Huntsville PPOx","44580AL036",,"ALN002","ALS002","ALF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360013-04","73% AV Level Silver Plan","72.87%","0.732456624507904","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601716","http://apps.humana.com/marketing/documents.asp?file=2622308","23"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360013","Humana Silver 3800/Huntsville PPOx","44580AL036",,"ALN002","ALS002","ALF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360013-05","87% AV Level Silver Plan","87.86%","0.881017088890076","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601729","http://apps.humana.com/marketing/documents.asp?file=2622321","24"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360013","Humana Silver 3800/Huntsville PPOx","44580AL036",,"ALN002","ALS002","ALF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360013-06","94% AV Level Silver Plan","93.14%","0.932067096233368","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601742","http://apps.humana.com/marketing/documents.asp?file=2622334","25"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360014","Humana Gold 2250/Huntsville PPOx","44580AL036",,"ALN002","ALS002","ALF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360014-00","Standard Gold Off Exchange Plan","78.03%","0.784799635410309","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601755","http://apps.humana.com/marketing/documents.asp?file=2591173","26"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360014","Humana Gold 2250/Huntsville PPOx","44580AL036",,"ALN002","ALS002","ALF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360014-01","Standard Gold On Exchange Plan","78.03%","0.784799635410309","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601755","http://apps.humana.com/marketing/documents.asp?file=2591173","27"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360014","Humana Gold 2250/Huntsville PPOx","44580AL036",,"ALN002","ALS002","ALF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360014-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601794","http://apps.humana.com/marketing/documents.asp?file=2591173","28"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360014","Humana Gold 2250/Huntsville PPOx","44580AL036",,"ALN002","ALS002","ALF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360014-03","Limited Cost Sharing Plan Variation","78.03%","0.784799635410309","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601807","http://apps.humana.com/marketing/documents.asp?file=2591173","29"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360015","Humana Platinum 500/Huntsville PPOx","44580AL036",,"ALN002","ALS002","ALF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360015-00","Standard Platinum Off Exchange Plan","88.47%","0.888415515422821","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601820","http://apps.humana.com/marketing/documents.asp?file=2591186","30"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","1","44580","AL","Individual","No","39-1263473","44580AL0360015","Humana Platinum 500/Huntsville PPOx","44580AL036",,"ALN002","ALS002","ALF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44580AL0360015-01","Standard Platinum On Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601820","http://apps.humana.com/marketing/documents.asp?file=2591186","31"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","2","44580","AL","Individual","No","39-1263473","44580AL0360001","Humana Basic 6850/Birmingham PPOx","44580AL036",,"ALN001","ALS001","ALF001","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44580AL0360001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2601300","http://apps.humana.com/marketing/documents.asp?file=2591056","4"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","2","44580","AL","Individual","No","39-1263473","44580AL0360001","Humana Basic 6850/Birmingham PPOx","44580AL036",,"ALN001","ALS001","ALF001","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44580AL0360001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2601300","http://apps.humana.com/marketing/documents.asp?file=2591056","5"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","2","44580","AL","Individual","No","39-1263473","44580AL0360011","Humana Basic 6850/Huntsville PPOx","44580AL036",,"ALN002","ALS002","ALF001","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44580AL0360011-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2601625","http://apps.humana.com/marketing/documents.asp?file=2591134","6"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","2","44580","AL","Individual","No","39-1263473","44580AL0360011","Humana Basic 6850/Huntsville PPOx","44580AL036",,"ALN002","ALS002","ALF001","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44580AL0360011-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2601625","http://apps.humana.com/marketing/documents.asp?file=2591134","7"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","3","44580","AL","Individual","No","39-1263473","44580AL0360002","Humana Bronze 6450/Birmingham PPOx","44580AL036",,"ALN001","ALS001","ALF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44580AL0360002-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2601313","http://apps.humana.com/marketing/documents.asp?file=2591069","4"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","3","44580","AL","Individual","No","39-1263473","44580AL0360002","Humana Bronze 6450/Birmingham PPOx","44580AL036",,"ALN001","ALS001","ALF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44580AL0360002-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2601313","http://apps.humana.com/marketing/documents.asp?file=2591069","5"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","3","44580","AL","Individual","No","39-1263473","44580AL0360002","Humana Bronze 6450/Birmingham PPOx","44580AL036",,"ALN001","ALS001","ALF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44580AL0360002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2601326","http://apps.humana.com/marketing/documents.asp?file=2591069","6"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","3","44580","AL","Individual","No","39-1263473","44580AL0360002","Humana Bronze 6450/Birmingham PPOx","44580AL036",,"ALN001","ALS001","ALF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44580AL0360002-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2601352","http://apps.humana.com/marketing/documents.asp?file=2591069","7"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","3","44580","AL","Individual","No","39-1263473","44580AL0360012","Humana Bronze 6450/Huntsville PPOx","44580AL036",,"ALN002","ALS002","ALF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44580AL0360012-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2601638","http://apps.humana.com/marketing/documents.asp?file=2591147","8"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","3","44580","AL","Individual","No","39-1263473","44580AL0360012","Humana Bronze 6450/Huntsville PPOx","44580AL036",,"ALN002","ALS002","ALF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44580AL0360012-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2601638","http://apps.humana.com/marketing/documents.asp?file=2591147","9"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","3","44580","AL","Individual","No","39-1263473","44580AL0360012","Humana Bronze 6450/Huntsville PPOx","44580AL036",,"ALN002","ALS002","ALF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44580AL0360012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2601651","http://apps.humana.com/marketing/documents.asp?file=2591147","10"
"2016","AL","44580","HIOS","8","2015-08-22 15:09:32","3","44580","AL","Individual","No","39-1263473","44580AL0360012","Humana Bronze 6450/Huntsville PPOx","44580AL036",,"ALN002","ALS002","ALF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44580AL0360012-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2601664","http://apps.humana.com/marketing/documents.asp?file=2591147","11"
"2016","AL","44785","HIOS","4","2015-08-22 15:09:32","1","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0110001","Smile for Health - Certified Optimum Coverage","44785AL011",,"ALN001","ALS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","44785AL0110001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AL","44785","HIOS","4","2015-08-22 15:09:32","2","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0110002","Smile for Health - Certified Optimum Coverage","44785AL011",,"ALN002","ALS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","44785AL0110002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AL","44785","HIOS","4","2015-08-22 15:09:32","3","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0110003","Smile for Health - Certified Optimum Coverage","44785AL011",,"ALN003","ALS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","44785AL0110003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AL","44785","HIOS","4","2015-08-22 15:09:32","4","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0110004","Smile for Health - Certified Optimum Coverage","44785AL011",,"ALN001","ALS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","44785AL0110004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AL","44785","HIOS","4","2015-08-22 15:09:32","5","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0110005","Smile for Health - Certified Optimum Coverage","44785AL011",,"ALN002","ALS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","44785AL0110005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AL","44785","HIOS","4","2015-08-22 15:09:32","6","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0110006","Smile for Health - Certified Optimum Coverage","44785AL011",,"ALN003","ALS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","44785AL0110006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AL","44785","HIOS","4","2015-08-22 15:09:32","7","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0120001","Smile for Health - Certified High Option","44785AL012",,"ALN001","ALS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","44785AL0120001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AL","44785","HIOS","4","2015-08-22 15:09:32","8","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0120002","Smile for Health - Certified High Option","44785AL012",,"ALN002","ALS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","44785AL0120002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AL","44785","HIOS","4","2015-08-22 15:09:32","9","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0120003","Smile for Health - Certified High Option","44785AL012",,"ALN003","ALS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","44785AL0120003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AL","44785","HIOS","4","2015-08-22 15:09:32","10","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0120004","Smile for Health - Certified High Option Plus","44785AL012",,"ALN001","ALS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","44785AL0120004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AL","44785","HIOS","4","2015-08-22 15:09:32","11","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0120005","Smile for Health - Certified High Option Plus","44785AL012",,"ALN002","ALS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","44785AL0120005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AL","44785","HIOS","4","2015-08-22 15:09:32","12","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0120006","Smile for Health - Certified High Option Plus","44785AL012",,"ALN003","ALS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","44785AL0120006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","1","46944","AL","Individual","No","63-0103830","46944AL0460001","Blue Saver Bronze","46944AL046","7346243505","ALN001","ALS001","ALF011","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0460001-00","Standard Bronze Off Exchange Plan","61.87%",,"Yes","Yes","No","100%",,"$6,850","$0","$0","$200","$1,600","$700","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibcbsal.com/sbc/2016sbi.pdf","https://www.ibcbsal.com/bb/2016sbi.pdf","4"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","1","46944","AL","Individual","Yes","63-0103830","46944AL0500001","Dental Blue Plus","46944AL050","7346243505","ALN002","ALS002",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.00","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Benefits are paid toward the lesser of the allowed amount or the dentist's actual charge for the service.","No","https://sso.bcbsal.org/sp/ACS.saml2","","46944AL0500001-01","Standard Low On Exchange Plan","69.34%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.AlabamaBlue.com/DentalBluePlus2016","4"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","1","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0280001","Blue Choice Platinum for Business","46944AL028","7346243505","ALN001","ALS001","ALF002","Existing","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,,"5","0","0","2016-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Standard.pdf","46944AL0280001-00","Standard Platinum Off Exchange Plan","90.45%",,"No","Yes","No","100%",,"$0","$300","$0","$200","$20","$800","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AlabamaBlue.com/b2016BlueChoicePlatinum","https://www.AlabamaBlue.com/b2016BlueChoicePlatinum","4"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","1","46944","AL","SHOP (Small Group)","Yes","63-0103830","46944AL0530001","Dental Blue Plus for Business","46944AL053","7346243505","ALN002","ALS002",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Benefits are paid toward the lesser of the allowed amount or the dentist's actual charge for the service.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","","46944AL0530001-01","Standard Low On Exchange Plan","69.34%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.AlabamaBlue.com/b2016DentalBluePlus","4"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","1","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0280001","Blue Choice Platinum for Business","46944AL028","7346243505","ALN001","ALS001","ALF002","Existing","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.997",,,,"5","0","0","2016-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Standard.pdf","46944AL0280001-01","Standard Platinum On Exchange Plan","90.45%",,"No","Yes","No","100%",,"$0","$300","$0","$200","$20","$800","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AlabamaBlue.com/b2016BlueChoicePlatinum","https://www.AlabamaBlue.com/b2016BlueChoicePlatinum","5"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","1","46944","AL","Individual","No","63-0103830","46944AL0460001","Blue Saver Bronze","46944AL046","7346243505","ALN001","ALS001","ALF011","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0460001-01","Standard Bronze On Exchange Plan","61.87%",,"Yes","Yes","No","100%",,"$6,850","$0","$0","$200","$1,600","$700","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibcbsal.com/sbc/2016sbi.pdf","https://www.ibcbsal.com/bb/2016sbi.pdf","5"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","1","46944","AL","Individual","No","63-0103830","46944AL0460001","Blue Saver Bronze","46944AL046","7346243505","ALN001","ALS001","ALF011","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0460001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.ibcbsal.com/sbc/2016sbi-nocost.pdf","https://www.ibcbsal.com/bb/2016sbi-nocost.pdf","6"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","1","46944","AL","Individual","No","63-0103830","46944AL0460001","Blue Saver Bronze","46944AL046","7346243505","ALN001","ALS001","ALF011","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0460001-03","Limited Cost Sharing Plan Variation","61.87%",,"Yes","Yes","No","100%",,"$6,850","$0","$0","$200","$1,600","$700","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibcbsal.com/sbc/2016sbi-limited.pdf","https://www.ibcbsal.com/bb/2016sbi-limited.pdf","7"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","3","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0310001","Blue HSA Gold for Business","46944AL031","7346243505","ALN001","ALS001","ALF006","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Standard.pdf","46944AL0310001-00","Standard Gold Off Exchange Plan",,"0.781829297542572","Yes","Yes","No","100%",,"$1,600","$0","$600","$200","$1,600","$0","$300","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","10%",,,,,"$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AlabamaBlue.com/b2016BlueHSAGold","https://www.AlabamaBlue.com/b2016BlueHSAGold","4"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","3","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0310001","Blue HSA Gold for Business","46944AL031","7346243505","ALN001","ALS001","ALF006","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Standard.pdf","46944AL0310001-01","Standard Gold On Exchange Plan",,"0.781829297542572","Yes","Yes","No","100%",,"$1,600","$0","$600","$200","$1,600","$0","$300","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","10%",,,,,"$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AlabamaBlue.com/b2016BlueHSAGold","https://www.AlabamaBlue.com/b2016BlueHSAGold","5"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","9","46944","AL","Individual","No","63-0103830","46944AL0420001","Blue Saver Silver","46944AL042","7346243505","ALN001","ALS001","ALF009","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0420001-05","87% AV Level Silver Plan","87.88%",,"No","Yes","No","100%",,"$600","$20","$700","$200","$200","$600","$20","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016ssi-87.pdf","https://www.ibcbsal.com/bb/2016ssi-87.pdf","9"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","9","46944","AL","Individual","No","63-0103830","46944AL0420001","Blue Saver Silver","46944AL042","7346243505","ALN001","ALS001","ALF009","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0420001-06","94% AV Level Silver Plan","94.89%",,"No","Yes","No","100%",,"$100","$20","$400","$200","$100","$600","$40","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","5%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016ssi-94.pdf","https://www.ibcbsal.com/bb/2016ssi-94.pdf","10"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","10","46944","AL","Individual","No","63-0103830","46944AL0470001","Blue Protect","46944AL047","7346243505","ALN001","ALS001","ALF012","Existing","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0470001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$200","$4,600","$200","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibcbsal.com/sbc/2016bpi.pdf","https://www.ibcbsal.com/bb/2016bpi.pdf","4"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","10","46944","AL","Individual","No","63-0103830","46944AL0470001","Blue Protect","46944AL047","7346243505","ALN001","ALS001","ALF012","Existing","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0470001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$200","$4,600","$200","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibcbsal.com/sbc/2016bpi.pdf","https://www.ibcbsal.com/bb/2016bpi.pdf","5"
"2016","AL","60075","HIOS","6","2015-10-20 04:38:50","1","60075","AL","Individual","Yes","36-3757528","60075AL0010001","TruAssure Basic Adult or Child Dental Plan","60075AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.53","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","60075AL0010001-00","Standard Low Off Exchange Plan","68.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AL","https://www.truassure.com/brochure?state=AL","4"
"2016","AL","60075","HIOS","6","2015-10-20 04:38:50","1","60075","AL","SHOP (Small Group)","Yes","36-3757528","60075AL0030001","TruAssure Dental Small Group Basic Plan","60075AL003",,"ALN001","ALS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.56","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","60075AL0030001-00","Standard High Off Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AL","60075","HIOS","6","2015-10-20 04:38:50","1","60075","AL","SHOP (Small Group)","Yes","36-3757528","60075AL0040001","TruAssure Dental Small Group Preferred Plan","60075AL004",,"ALN001","ALS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.56","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","60075AL0040001-00","Standard High Off Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","AL","60075","HIOS","6","2015-10-20 04:38:50","1","60075","AL","Individual","Yes","36-3757528","60075AL0010001","TruAssure Basic Adult or Child Dental Plan","60075AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.53","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","60075AL0010001-01","Standard Low On Exchange Plan","68.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AL","https://www.truassure.com/brochure?state=AL","5"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","1","68259","AL","Individual","No","63-0899562","68259AL0040005","Silver Compass HSA 3600","68259AL004",,"ALN002","ALS002","ALF003","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040005-00","Standard Silver Off Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=al0007&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","4"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","1","68259","AL","Individual","No","63-0899562","68259AL0040005","Silver Compass HSA 3600","68259AL004",,"ALN002","ALS002","ALF003","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040005-01","Standard Silver On Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=al0007&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","5"
"2016","AL","60075","HIOS","6","2015-10-20 04:38:50","2","60075","AL","Individual","Yes","36-3757528","60075AL0020001","TruAssure Preferred Adult or Child Dental Plan","60075AL002",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.93","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","60075AL0020001-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AL","https://www.truassure.com/brochure?state=AL","4"
"2016","AL","60075","HIOS","6","2015-10-20 04:38:50","2","60075","AL","Individual","Yes","36-3757528","60075AL0020001","TruAssure Preferred Adult or Child Dental Plan","60075AL002",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.93","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","60075AL0020001-01","Standard High On Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AL","https://www.truassure.com/brochure?state=AL","5"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040008","Bronze Compass 6400","68259AL004",,"ALN002","ALS002","ALF002","New","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040008-03","Limited Cost Sharing Plan Variation",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0027&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","29"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040009","Catastrophic Compass 6850","68259AL004",,"ALN002","ALS002","ALF003","New","HMO","Catastrophic","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040009-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,800","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=al0028&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","30"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040009","Catastrophic Compass 6850","68259AL004",,"ALN002","ALS002","ALF003","New","HMO","Catastrophic","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040009-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,800","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=al0028&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","31"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","4","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0380001","Blue Secure Silver for Business","46944AL038","7346243505","ALN001","ALS001","ALF008","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0380001-00","Standard Silver Off Exchange Plan","69.01%",,"No","Yes","Yes","95%","5%","$2,200","$700","$0","$200","$20","$1,700","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","20%","$2,200","$2200 per person","$4400 per group","20%","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AlabamaBlue.com/b2016BlueSecureSilver","https://www.AlabamaBlue.com/b2016BlueSecureSilver","4"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","4","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0380001","Blue Secure Silver for Business","46944AL038","7346243505","ALN001","ALS001","ALF008","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0380001-01","Standard Silver On Exchange Plan","69.01%",,"No","Yes","Yes","95%","5%","$2,200","$700","$0","$200","$20","$1,700","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","20%","$2,200","$2200 per person","$4400 per group","20%","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.AlabamaBlue.com/b2016BlueSecureSilver","https://www.AlabamaBlue.com/b2016BlueSecureSilver","5"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","5","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0430001","Blue Saver Bronze for Business","46944AL043","7346243505","ALN001","ALS001","ALF010","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0430001-00","Standard Bronze Off Exchange Plan","61.87%",,"Yes","Yes","No","100%",,"$6,850","$0","$0","$200","$1,600","$700","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.AlabamaBlue.com/b2016BlueSaverBronze","https://www.AlabamaBlue.com/b2016BlueSaverBronze","4"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","5","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0430001","Blue Saver Bronze for Business","46944AL043","7346243505","ALN001","ALS001","ALF010","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0430001-01","Standard Bronze On Exchange Plan","61.87%",,"Yes","Yes","No","100%",,"$6,850","$0","$0","$200","$1,600","$700","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.AlabamaBlue.com/b2016BlueSaverBronze","https://www.AlabamaBlue.com/b2016BlueSaverBronze","5"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","6","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0570001","Blue HSA Bronze for Business","46944AL057","7346243505","ALN001","ALS001","ALF016","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0570001-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$200","$5,000","$0","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AlabamaBlue.com/b2016BlueHSABronze","https://www.AlabamaBlue.com/b2016BlueHSABronze","4"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","6","46944","AL","Individual","No","63-0103830","46944AL0560001","Blue HSA Bronze","46944AL056","7346243505","ALN001","ALS001","ALF015","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0560001-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$200","$5,000","$0","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.ibcbsal.com/sbc/2016hbi.pdf","https://www.ibcbsal.com/bb/2016hbi.pdf","4"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","6","46944","AL","Individual","No","63-0103830","46944AL0560001","Blue HSA Bronze","46944AL056","7346243505","ALN001","ALS001","ALF015","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0560001-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$200","$5,000","$0","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.ibcbsal.com/sbc/2016hbi.pdf","https://www.ibcbsal.com/bb/2016hbi.pdf","5"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","6","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0570001","Blue HSA Bronze for Business","46944AL057","7346243505","ALN001","ALS001","ALF016","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0570001-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$200","$5,000","$0","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.AlabamaBlue.com/b2016BlueHSABronze","https://www.AlabamaBlue.com/b2016BlueHSABronze","5"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","6","46944","AL","Individual","No","63-0103830","46944AL0560001","Blue HSA Bronze","46944AL056","7346243505","ALN001","ALS001","ALF015","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0560001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.ibcbsal.com/sbc/2016hbi-nocost.pdf","https://www.ibcbsal.com/bb/2016hbi-nocost.pdf","6"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","6","46944","AL","Individual","No","63-0103830","46944AL0560001","Blue HSA Bronze","46944AL056","7346243505","ALN001","ALS001","ALF015","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0560001-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$200","$5,000","$0","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibcbsal.com/sbc/2016hbi-limited.pdf","https://www.ibcbsal.com/bb/2016hbi-limited.pdf","7"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","7","46944","AL","Individual","No","63-0103830","46944AL0370001","Blue Value Gold","46944AL037","7346243505","ALN001","ALS001","ALF005","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Standard.pdf","46944AL0370001-00","Standard Gold Off Exchange Plan","78.09%",,"No","Yes","Yes","95%","5%","$750","$400","$0","$200","$20","$1,300","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%","$750","$750 per person","$1500 per group","20%","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016vgi.pdf","https://www.ibcbsal.com/bb/2016vgi.pdf","4"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","7","46944","AL","Individual","No","63-0103830","46944AL0370001","Blue Value Gold","46944AL037","7346243505","ALN001","ALS001","ALF005","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Standard.pdf","46944AL0370001-01","Standard Gold On Exchange Plan","78.09%",,"No","Yes","Yes","95%","5%","$750","$400","$0","$200","$20","$1,300","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%","$750","$750 per person","$1500 per group","20%","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016vgi.pdf","https://www.ibcbsal.com/bb/2016vgi.pdf","5"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","7","46944","AL","Individual","No","63-0103830","46944AL0370001","Blue Value Gold","46944AL037","7346243505","ALN001","ALS001","ALF005","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Standard.pdf","46944AL0370001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","95%","5%","$0","$0","$0","$200","$0","$0","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016vgi-nocost.pdf","https://www.ibcbsal.com/bb/2016vgi-nocost.pdf","6"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","7","46944","AL","Individual","No","63-0103830","46944AL0370001","Blue Value Gold","46944AL037","7346243505","ALN001","ALS001","ALF005","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Standard.pdf","46944AL0370001-03","Limited Cost Sharing Plan Variation","78.09%",,"No","Yes","Yes","95%","5%","$750","$400","$0","$200","$20","$1,300","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%","$750","$750 per person","$1500 per group","20%","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016vgi-limited.pdf","https://www.ibcbsal.com/bb/2016vgi-limited.pdf","7"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","8","46944","AL","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041","7346243505","ALN001","ALS001","ALF007","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0410001-00","Standard Silver Off Exchange Plan","68.08%",,"No","Yes","Yes","95%","5%","$2,600","$700","$0","$200","$20","$1,900","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","20%","$2,600","$2600 per person","$5200 per group","20%","$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016vsi.pdf","https://www.ibcbsal.com/bb/2016vsi.pdf","4"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","8","46944","AL","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041","7346243505","ALN001","ALS001","ALF007","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0410001-01","Standard Silver On Exchange Plan","68.08%",,"No","Yes","Yes","95%","5%","$2,600","$700","$0","$200","$20","$1,900","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","20%","$2,600","$2600 per person","$5200 per group","20%","$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016vsi.pdf","https://www.ibcbsal.com/bb/2016vsi.pdf","5"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","8","46944","AL","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041","7346243505","ALN001","ALS001","ALF007","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0410001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","95%","5%","$0","$0","$0","$200","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016vsi-nocost.pdf","https://www.ibcbsal.com/bb/2016vsi-nocost.pdf","6"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","8","46944","AL","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041","7346243505","ALN001","ALS001","ALF007","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0410001-03","Limited Cost Sharing Plan Variation","68.08%",,"No","Yes","Yes","95%","5%","$2,600","$700","$0","$200","$20","$1,900","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","20%","$2,600","$2600 per person","$5200 per group","20%","$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016vsi-limited.pdf","https://www.ibcbsal.com/bb/2016vsi-limited.pdf","7"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","8","46944","AL","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041","7346243505","ALN001","ALS001","ALF007","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0410001-04","73% AV Level Silver Plan","73.77%",,"No","Yes","Yes","95%","5%","$1,750","$600","$0","$200","$20","$1,700","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$4,250","$4250 per person","$8500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20%","$1,750","$1750 per person","$3500 per group","20%","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016vsi-73.pdf","https://www.ibcbsal.com/bb/2016vsi-73.pdf","8"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","8","46944","AL","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041","7346243505","ALN001","ALS001","ALF007","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0410001-05","87% AV Level Silver Plan","87.54%",,"No","Yes","Yes","95%","5%","$400","$600","$0","$200","$20","$1,000","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","20%","$400","$400 per person","$800 per group","20%","$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016vsi-87.pdf","https://www.ibcbsal.com/bb/2016vsi-87.pdf","9"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","8","46944","AL","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041","7346243505","ALN001","ALS001","ALF007","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0410001-06","94% AV Level Silver Plan","93.80%",,"No","Yes","Yes","95%","5%","$100","$200","$0","$200","$20","$500","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%","$100","$100 per person","$200 per group","10%","$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016vsi-94.pdf","https://www.ibcbsal.com/bb/2016vsi-94.pdf","10"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","9","46944","AL","Individual","No","63-0103830","46944AL0420001","Blue Saver Silver","46944AL042","7346243505","ALN001","ALS001","ALF009","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0420001-00","Standard Silver Off Exchange Plan","68.02%",,"No","Yes","No","100%",,"$3,000","$20","$900","$200","$600","$1,200","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016ssi.pdf","https://www.ibcbsal.com/bb/2016ssi.pdf","4"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","9","46944","AL","Individual","No","63-0103830","46944AL0420001","Blue Saver Silver","46944AL042","7346243505","ALN001","ALS001","ALF009","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0420001-01","Standard Silver On Exchange Plan","68.02%",,"No","Yes","No","100%",,"$3,000","$20","$900","$200","$600","$1,200","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016ssi.pdf","https://www.ibcbsal.com/bb/2016ssi.pdf","5"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","9","46944","AL","Individual","No","63-0103830","46944AL0420001","Blue Saver Silver","46944AL042","7346243505","ALN001","ALS001","ALF009","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0420001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016ssi-nocost.pdf","https://www.ibcbsal.com/bb/2016ssi-nocost.pdf","6"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","9","46944","AL","Individual","No","63-0103830","46944AL0420001","Blue Saver Silver","46944AL042","7346243505","ALN001","ALS001","ALF009","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0420001-03","Limited Cost Sharing Plan Variation","68.02%",,"No","Yes","No","100%",,"$3,000","$20","$900","$200","$600","$1,200","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016ssi-limited.pdf","https://www.ibcbsal.com/bb/2016ssi-limited.pdf","7"
"2016","AL","46944","HIOS","5","2015-10-21 05:00:18","9","46944","AL","Individual","No","63-0103830","46944AL0420001","Blue Saver Silver","46944AL042","7346243505","ALN001","ALS001","ALF009","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0420001-04","73% AV Level Silver Plan","73.90%",,"No","Yes","No","100%",,"$2,500","$20","$700","$200","$500","$600","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","15%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016ssi-73.pdf","https://www.ibcbsal.com/bb/2016ssi-73.pdf","8"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","1","68259","AL","Individual","No","63-0899562","68259AL0040005","Silver Compass HSA 3600","68259AL004",,"ALN002","ALS002","ALF003","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=al0008&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","6"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","1","68259","AL","Individual","No","63-0899562","68259AL0040005","Silver Compass HSA 3600","68259AL004",,"ALN002","ALS002","ALF003","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040005-03","Limited Cost Sharing Plan Variation",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=al0009&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","7"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","1","68259","AL","Individual","No","63-0899562","68259AL0040005","Silver Compass HSA 3600","68259AL004",,"ALN002","ALS002","ALF003","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040005-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$3,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=al0010&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","8"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","1","68259","AL","Individual","No","63-0899562","68259AL0040005","Silver Compass HSA 3600","68259AL004",,"ALN002","ALS002","ALF003","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040005-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$200","$1,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=al0011&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","9"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","1","68259","AL","Individual","No","63-0899562","68259AL0040005","Silver Compass HSA 3600","68259AL004",,"ALN002","ALS002","ALF003","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040005-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=al0012&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","10"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040004","Gold Compass 1000","68259AL004",,"ALN002","ALS002","ALF001","New","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040004-00","Standard Gold Off Exchange Plan",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0004&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","8"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040004","Gold Compass 1000","68259AL004",,"ALN002","ALS002","ALF001","New","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040004-01","Standard Gold On Exchange Plan",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0004&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","9"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040004","Gold Compass 1000","68259AL004",,"ALN002","ALS002","ALF001","New","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0005&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","10"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040004","Gold Compass 1000","68259AL004",,"ALN002","ALS002","ALF001","New","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040004-03","Limited Cost Sharing Plan Variation",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0006&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","11"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040006","Silver Compass 4000","68259AL004",,"ALN002","ALS002","ALF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040006-00","Standard Silver Off Exchange Plan",,"0.697066605091095","No","Yes","No","100%",,"$4,000","$20","$200","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0013&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","12"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040006","Silver Compass 4000","68259AL004",,"ALN002","ALS002","ALF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040006-01","Standard Silver On Exchange Plan",,"0.697066605091095","No","Yes","No","100%",,"$4,000","$20","$200","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0013&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","13"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040006","Silver Compass 4000","68259AL004",,"ALN002","ALS002","ALF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0014&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","14"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040006","Silver Compass 4000","68259AL004",,"ALN002","ALS002","ALF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040006-03","Limited Cost Sharing Plan Variation",,"0.697066605091095","No","Yes","No","100%",,"$4,000","$20","$200","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0015&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","15"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040006","Silver Compass 4000","68259AL004",,"ALN002","ALS002","ALF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040006-04","73% AV Level Silver Plan",,"0.737395048141479","No","Yes","No","100%",,"$3,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0016&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","16"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040006","Silver Compass 4000","68259AL004",,"ALN002","ALS002","ALF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040006-05","87% AV Level Silver Plan",,"0.87861156463623","No","Yes","No","100%",,"$900","$10","$500","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0017&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","17"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040006","Silver Compass 4000","68259AL004",,"ALN002","ALS002","ALF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040006-06","94% AV Level Silver Plan",,"0.946469008922577","No","Yes","No","100%",,"$0","$0","$500","$200","$0","$500","$20","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0018&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","18"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040007","Silver Compass 5000","68259AL004",,"ALN002","ALS002","ALF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040007-00","Standard Silver Off Exchange Plan",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0019&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","19"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040007","Silver Compass 5000","68259AL004",,"ALN002","ALS002","ALF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040007-01","Standard Silver On Exchange Plan",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0019&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","20"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040007","Silver Compass 5000","68259AL004",,"ALN002","ALS002","ALF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0020&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","21"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040007","Silver Compass 5000","68259AL004",,"ALN002","ALS002","ALF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040007-03","Limited Cost Sharing Plan Variation",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0021&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","22"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040007","Silver Compass 5000","68259AL004",,"ALN002","ALS002","ALF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040007-04","73% AV Level Silver Plan",,"0.728041231632233","No","Yes","No","100%",,"$3,600","$20","$500","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0022&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","23"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040007","Silver Compass 5000","68259AL004",,"ALN002","ALS002","ALF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040007-05","87% AV Level Silver Plan",,"0.871982634067535","No","Yes","No","100%",,"$800","$0","$800","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0023&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","24"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040007","Silver Compass 5000","68259AL004",,"ALN002","ALS002","ALF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040007-06","94% AV Level Silver Plan",,"0.949420213699341","No","Yes","No","100%",,"$0","$0","$500","$200","$0","$500","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0024&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","25"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040008","Bronze Compass 6400","68259AL004",,"ALN002","ALS002","ALF002","New","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040008-00","Standard Bronze Off Exchange Plan",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0025&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","26"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040008","Bronze Compass 6400","68259AL004",,"ALN002","ALS002","ALF002","New","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040008-01","Standard Bronze On Exchange Plan",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0025&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","27"
"2016","AL","68259","HIOS","6","2015-08-26 09:56:12","2","68259","AL","Individual","No","63-0899562","68259AL0040008","Bronze Compass 6400","68259AL004",,"ALN002","ALS002","ALF002","New","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9955",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=al0030&st=al","68259AL0040008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=al0026&st=al","http://www.uhc.com/iex/doc?id=al0029&st=al","28"
"2016","AL","68707","HIOS","1","2015-05-01 02:23:41","1","68707","AL","SHOP (Small Group)","Yes","93-0242990","68707AL0040002","EHB High PPO","68707AL004",,"ALN001","ALS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.38","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","68707AL0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","AZ","17454","HIOS","1","2015-04-29 10:59:03","3","17454","AZ","SHOP (Small Group)","Yes","13-5123390","17454AZ0040003","Guardian Family Advantage","17454AZ004",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.06","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","17454AZ0040003-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","AZ","17454","HIOS","1","2015-04-29 10:59:03","3","17454","AZ","SHOP (Small Group)","Yes","13-5123390","17454AZ0060003","Guardian Family Essentials","17454AZ006",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.39","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","17454AZ0060003-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","AZ","17454","HIOS","1","2015-04-29 10:59:03","3","17454","AZ","SHOP (Small Group)","Yes","13-5123390","17454AZ0060003","Guardian Family Essentials","17454AZ006",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.39","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","17454AZ0060003-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","AZ","18156","HIOS","3","2015-08-21 03:45:06","1","18156","AZ","SHOP (Small Group)","Yes","35-0472300","18156AZ0010001","Lincoln DentalConnect®","18156AZ001","7063415294","AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.19","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","18156AZ0010001-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","18156","HIOS","3","2015-08-21 03:45:06","1","18156","AZ","SHOP (Small Group)","Yes","35-0472300","18156AZ0010002","Lincoln DentalConnect®","18156AZ001","7063415294","AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.11","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","18156AZ0010002-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","AZ","18156","HIOS","3","2015-08-21 03:45:06","1","18156","AZ","SHOP (Small Group)","Yes","35-0472300","18156AZ0010003","Lincoln DentalConnect®","18156AZ001","7063415294","AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.39","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","18156AZ0010003-00","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","AZ","18156","HIOS","3","2015-08-21 03:45:06","1","18156","AZ","SHOP (Small Group)","Yes","35-0472300","18156AZ0010004","Lincoln DentalConnect®","18156AZ001","7063415294","AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.83","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","18156AZ0010004-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","AZ","18156","HIOS","3","2015-08-21 03:45:06","1","18156","AZ","SHOP (Small Group)","Yes","35-0472300","18156AZ0010005","Lincoln DentalConnect®","18156AZ001","7063415294","AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.52","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","18156AZ0010005-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","AZ","18156","HIOS","3","2015-08-21 03:45:06","1","18156","AZ","SHOP (Small Group)","Yes","35-0472300","18156AZ0010006","Lincoln DentalConnect®","18156AZ001","7063415294","AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.77","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","18156AZ0010006-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","AZ","18156","HIOS","3","2015-08-21 03:45:06","1","18156","AZ","SHOP (Small Group)","Yes","35-0472300","18156AZ0010007","Lincoln DentalConnect®","18156AZ001","7063415294","AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.24","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","18156AZ0010007-00","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2016","AZ","18156","HIOS","3","2015-08-21 03:45:06","1","18156","AZ","SHOP (Small Group)","Yes","35-0472300","18156AZ0010008","Lincoln DentalConnect®","18156AZ001","7063415294","AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.19","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","18156AZ0010008-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2016","AZ","20128","HIOS","2","2015-07-02 02:19:22","1","20128","AZ","SHOP (Small Group)","Yes","57-0523959","20128AZ0030001","Group Dental Policy","20128AZ003",,"AZN001","AZS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","20128AZ0030001-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","1","23307","AZ","Individual","No","61-1013183","23307AZ0400001","Humana Basic 6850/Phoenix HMOx","23307AZ040",,"AZN001","AZS001","AZF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","23307AZ0400001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2601885","http://apps.humana.com/marketing/documents.asp?file=2591199","5"
"2016","AL","68707","HIOS","1","2015-05-01 02:23:41","1","68707","AL","SHOP (Small Group)","Yes","93-0242990","68707AL0040001","EHB Low PPO","68707AL004",,"ALN001","ALS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.60","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","68707AL0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","AZ","21463","HIOS","2","2015-07-10 02:19:03","1","21463","AZ","SHOP (Small Group)","Yes","42-0127290","21463AZ0040001","Principal Plan Dental 70","21463AZ004",,"AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$29.11","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as all other","Yes","Same as all other","Yes",,"","21463AZ0040001-00","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","21463","HIOS","2","2015-07-10 02:19:03","1","21463","AZ","SHOP (Small Group)","Yes","42-0127290","21463AZ0040002","Principal Plan Dental 85","21463AZ004",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$30.78","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as all other","Yes","Same as all other","Yes",,"","21463AZ0040002-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","1","23307","AZ","Individual","No","61-1013183","23307AZ0400001","Humana Basic 6850/Phoenix HMOx","23307AZ040",,"AZN001","AZS001","AZF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","23307AZ0400001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2601885","http://apps.humana.com/marketing/documents.asp?file=2591199","4"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400013","Humana Silver 3800/Tucson HMOx","23307AZ040",,"AZN002","AZS002","AZF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400013-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602197","http://apps.humana.com/marketing/documents.asp?file=2591290","19"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400013","Humana Silver 3800/Tucson HMOx","23307AZ040",,"AZN002","AZS002","AZF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400013-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602197","http://apps.humana.com/marketing/documents.asp?file=2591290","20"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400013","Humana Silver 3800/Tucson HMOx","23307AZ040",,"AZN002","AZS002","AZF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400013-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602210","http://apps.humana.com/marketing/documents.asp?file=2591290","21"
"2016","AL","68707","HIOS","1","2015-05-01 02:23:41","1","68707","AL","SHOP (Small Group)","Yes","93-0242990","68707AL0030002","EHB High Passive","68707AL003",,"ALN001","ALS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.26","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","68707AL0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","AL","68707","HIOS","1","2015-05-01 02:23:41","1","68707","AL","SHOP (Small Group)","Yes","93-0242990","68707AL0030001","EHB Low Passive","68707AL003",,"ALN001","ALS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.22","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","68707AL0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","AL","77233","HIOS","9","2015-10-21 05:00:18","1","77233","AL","Individual","Yes","75-1233841","77233AL0010001","Dentegra Dental PPO Pediatric Basic Plan","77233AL001",,"ALN001","ALS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","77233AL0010001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/al/77233al0010001-16","4"
"2016","AL","77233","HIOS","9","2015-10-21 05:00:18","1","77233","AL","SHOP (Small Group)","Yes","75-1233841","77233AL0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","77233AL002",,"ALN001","ALS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.04","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","77233AL0020001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/al/77233al0020001-16","4"
"2016","AL","77233","HIOS","9","2015-10-21 05:00:18","2","77233","AL","SHOP (Small Group)","Yes","75-1233841","77233AL0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","77233AL002",,"ALN001","ALS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","77233AL0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/al/77233al0020004-16","4"
"2016","AL","77233","HIOS","9","2015-10-21 05:00:18","2","77233","AL","Individual","Yes","75-1233841","77233AL0010004","Dentegra Dental PPO Family Preferred Plan","77233AL001",,"ALN001","ALS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.06","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","77233AL0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/al/77233al0010004-16","4"
"2016","AL","77233","HIOS","9","2015-10-21 05:00:18","2","77233","AL","Individual","Yes","75-1233841","77233AL0010004","Dentegra Dental PPO Family Preferred Plan","77233AL001",,"ALN001","ALS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.06","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","77233AL0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/al/77233al0010004-16","5"
"2016","AL","77233","HIOS","9","2015-10-21 05:00:18","2","77233","AL","SHOP (Small Group)","Yes","75-1233841","77233AL0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","77233AL002",,"ALN001","ALS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","77233AL0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/al/77233al0020004-16","5"
"2016","AL","77233","HIOS","9","2015-10-21 05:00:18","3","77233","AL","SHOP (Small Group)","Yes","75-1233841","77233AL0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","77233AL002",,"ALN001","ALS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.04","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","77233AL0020006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/al/77233al0020006-16","4"
"2016","AL","77233","HIOS","9","2015-10-21 05:00:18","3","77233","AL","Individual","Yes","75-1233841","77233AL0010006","Dentegra Dental PPO Family Basic Plan","77233AL001",,"ALN001","ALS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","77233AL0010006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/al/77233al0010006-16","4"
"2016","AL","77233","HIOS","9","2015-10-21 05:00:18","3","77233","AL","Individual","Yes","75-1233841","77233AL0010006","Dentegra Dental PPO Family Basic Plan","77233AL001",,"ALN001","ALS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","77233AL0010006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/al/77233al0010006-16","5"
"2016","AL","77233","HIOS","9","2015-10-21 05:00:18","3","77233","AL","SHOP (Small Group)","Yes","75-1233841","77233AL0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","77233AL002",,"ALN001","ALS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.04","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","77233AL0020006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/al/77233al0020006-16","5"
"2016","AL","82285","HIOS","5","2015-07-10 02:19:03","1","82285","AL","Individual","Yes","94-2761537","82285AL0010002","Delta Dental PPO Pediatric Preferred Plan","82285AL001",,"ALN001","ALS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","82285AL0010002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","$25","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/al/82285al0010002-16","4"
"2016","AL","82285","HIOS","5","2015-07-10 02:19:03","1","82285","AL","SHOP (Small Group)","Yes","94-2761537","82285AL0020002","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","82285AL002",,"ALN001","ALS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","82285AL0020002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","$25","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/al/82285al0020002-16","4"
"2016","AL","82285","HIOS","5","2015-07-10 02:19:03","1","82285","AL","Individual","Yes","94-2761537","82285AL0010001","Delta Dental PPO Pediatric Basic Plan","82285AL001",,"ALN001","ALS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","82285AL0010001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/al/82285al0010001-16","5"
"2016","AL","82285","HIOS","5","2015-07-10 02:19:03","1","82285","AL","SHOP (Small Group)","Yes","94-2761537","82285AL0020001","Delta Dental PPO Pediatric Basic Plan for Small Businesses","82285AL002",,"ALN001","ALS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","82285AL0020001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/al/82285al0020001-16","5"
"2016","AL","82285","HIOS","5","2015-07-10 02:19:03","2","82285","AL","SHOP (Small Group)","Yes","94-2761537","82285AL0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","82285AL002",,"ALN001","ALS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","82285AL0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","$25","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/al/82285al0020004-16","4"
"2016","AL","82285","HIOS","5","2015-07-10 02:19:03","2","82285","AL","Individual","Yes","94-2761537","82285AL0010004","Delta Dental PPO Preferred Plan for Families","82285AL001",,"ALN001","ALS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","82285AL0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","$25","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/al/82285al0010004-16","4"
"2016","AL","82285","HIOS","5","2015-07-10 02:19:03","2","82285","AL","Individual","Yes","94-2761537","82285AL0010004","Delta Dental PPO Preferred Plan for Families","82285AL001",,"ALN001","ALS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","82285AL0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","$25","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/al/82285al0010004-16","5"
"2016","AL","82285","HIOS","5","2015-07-10 02:19:03","2","82285","AL","SHOP (Small Group)","Yes","94-2761537","82285AL0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","82285AL002",,"ALN001","ALS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","82285AL0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","$25","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/al/82285al0020004-16","5"
"2016","AL","82285","HIOS","5","2015-07-10 02:19:03","3","82285","AL","SHOP (Small Group)","Yes","94-2761537","82285AL0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","82285AL002",,"ALN001","ALS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","82285AL0020006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/al/82285al0020006-16","4"
"2016","AL","82285","HIOS","5","2015-07-10 02:19:03","3","82285","AL","Individual","Yes","94-2761537","82285AL0010006","Delta Dental PPO Basic Plan for Families","82285AL001",,"ALN001","ALS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","82285AL0010006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/al/82285al0010006-16","4"
"2016","AL","82285","HIOS","5","2015-07-10 02:19:03","3","82285","AL","Individual","Yes","94-2761537","82285AL0010006","Delta Dental PPO Basic Plan for Families","82285AL001",,"ALN001","ALS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","82285AL0010006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/al/82285al0010006-16","5"
"2016","AL","82285","HIOS","5","2015-07-10 02:19:03","3","82285","AL","SHOP (Small Group)","Yes","94-2761537","82285AL0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","82285AL002",,"ALN001","ALS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","82285AL0020006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/al/82285al0020006-16","5"
"2016","AZ","12303","HIOS","3","2015-07-11 04:19:24","1","12303","AZ","SHOP (Small Group)","Yes","59-0397210","12303AZ0020003","DentaQuest PPO Family High","12303AZ002",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.46","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","12303AZ0020003-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/","4"
"2016","AZ","12303","HIOS","3","2015-07-11 04:19:24","1","12303","AZ","Individual","Yes","59-0397210","12303AZ0010001","DentaQuest PPO  Pediatric High","12303AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$34.15","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","12303AZ0010001-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/","4"
"2016","AZ","12303","HIOS","3","2015-07-11 04:19:24","1","12303","AZ","Individual","Yes","59-0397210","12303AZ0010001","DentaQuest PPO  Pediatric High","12303AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$34.15","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","12303AZ0010001-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/","5"
"2016","AZ","12303","HIOS","3","2015-07-11 04:19:24","1","12303","AZ","SHOP (Small Group)","Yes","59-0397210","12303AZ0020003","DentaQuest PPO Family High","12303AZ002",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.46","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","12303AZ0020003-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/","5"
"2016","AZ","12303","HIOS","3","2015-07-11 04:19:24","1","12303","AZ","SHOP (Small Group)","Yes","59-0397210","12303AZ0020004","DentaQuest PPO Family Low","12303AZ002",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.51","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","12303AZ0020004-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/","6"
"2016","AZ","12303","HIOS","3","2015-07-11 04:19:24","1","12303","AZ","SHOP (Small Group)","Yes","59-0397210","12303AZ0020004","DentaQuest PPO Family Low","12303AZ002",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.51","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","12303AZ0020004-01","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/","7"
"2016","AZ","12303","HIOS","3","2015-07-11 04:19:24","2","12303","AZ","Individual","Yes","59-0397210","12303AZ0010003","DentaQuest PPO Family High","12303AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.15","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","12303AZ0010003-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/","4"
"2016","AZ","12303","HIOS","3","2015-07-11 04:19:24","2","12303","AZ","Individual","Yes","59-0397210","12303AZ0010003","DentaQuest PPO Family High","12303AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.15","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","12303AZ0010003-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/","5"
"2016","AZ","12303","HIOS","3","2015-07-11 04:19:24","2","12303","AZ","Individual","Yes","59-0397210","12303AZ0010004","DentaQuest PPO Family Low","12303AZ001",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.05","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","12303AZ0010004-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/","6"
"2016","AZ","12303","HIOS","3","2015-07-11 04:19:24","2","12303","AZ","Individual","Yes","59-0397210","12303AZ0010004","DentaQuest PPO Family Low","12303AZ001",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.05","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","12303AZ0010004-01","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/az/","http://www.dentaquest.com/marketplace/az/","7"
"2016","AZ","13576","HIOS","2","2015-07-09 13:17:42","1","13576","AZ","SHOP (Small Group)","Yes","81-0170040","13576AZ0010001","Assurant Dental ACAFFO High","13576AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$40.96","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","13576AZ0010001-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","13576","HIOS","2","2015-07-09 13:17:42","1","13576","AZ","SHOP (Small Group)","Yes","81-0170040","13576AZ0010002","Assurant Dental ACAFFO Low","13576AZ001",,"AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$34.18","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","13576AZ0010002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","AZ","17100","HIOS","4","2015-08-21 03:45:06","1","17100","AZ","SHOP (Small Group)","Yes","13-5581829","17100AZ0160001","EHB Basic Dental Plan (Low)","17100AZ016",,"AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$20.98","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","17100AZ0160001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","17100","HIOS","4","2015-08-21 03:45:06","2","17100","AZ","SHOP (Small Group)","Yes","13-5581829","17100AZ0180001","Family Basic Dental Plan (Low)","17100AZ018",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$20.98","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","17100AZ0180001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49068","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49067","4"
"2016","AZ","17100","HIOS","4","2015-08-21 03:45:06","2","17100","AZ","SHOP (Small Group)","Yes","13-5581829","17100AZ0180001","Family Basic Dental Plan (Low)","17100AZ018",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$20.98","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","17100AZ0180001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49068","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49067","5"
"2016","AZ","17100","HIOS","4","2015-08-21 03:45:06","3","17100","AZ","SHOP (Small Group)","Yes","13-5581829","17100AZ0190001","Family Enhanced Dental Plan (High)","17100AZ019",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$25.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","17100AZ0190001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49070","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49069","4"
"2016","AZ","17100","HIOS","4","2015-08-21 03:45:06","3","17100","AZ","SHOP (Small Group)","Yes","13-5581829","17100AZ0190001","Family Enhanced Dental Plan (High)","17100AZ019",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$25.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","17100AZ0190001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49070","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49069","5"
"2016","AZ","17454","HIOS","1","2015-04-29 10:59:03","1","17454","AZ","SHOP (Small Group)","Yes","13-5123390","17454AZ0010002","Guardian Pediatric Advantage","17454AZ001",,"AZN001","AZS002",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$30.06","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","17454AZ0010002-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","AZ","17454","HIOS","1","2015-04-29 10:59:03","1","17454","AZ","SHOP (Small Group)","Yes","13-5123390","17454AZ0020002","Guardian Pediatric Essentials","17454AZ002",,"AZN001","AZS002",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$22.39","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","17454AZ0020002-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","AZ","17454","HIOS","1","2015-04-29 10:59:03","2","17454","AZ","SHOP (Small Group)","Yes","13-5123390","17454AZ0040002","Guardian Family Advantage","17454AZ004",,"AZN001","AZS002",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.06","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","17454AZ0040002-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","AZ","17454","HIOS","1","2015-04-29 10:59:03","2","17454","AZ","SHOP (Small Group)","Yes","13-5123390","17454AZ0060002","Guardian Family Essentials","17454AZ006",,"AZN001","AZS002",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.39","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","17454AZ0060002-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","AZ","17454","HIOS","1","2015-04-29 10:59:03","3","17454","AZ","SHOP (Small Group)","Yes","13-5123390","17454AZ0040003","Guardian Family Advantage","17454AZ004",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.06","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","17454AZ0040003-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","1","23307","AZ","Individual","No","61-1013183","23307AZ0400011","Humana Basic 6850/Tucson HMOx","23307AZ040",,"AZN002","AZS002","AZF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","23307AZ0400011-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2602145","http://apps.humana.com/marketing/documents.asp?file=2591264","6"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","1","23307","AZ","Individual","No","61-1013183","23307AZ0400011","Humana Basic 6850/Tucson HMOx","23307AZ040",,"AZN002","AZS002","AZF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","23307AZ0400011-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2602145","http://apps.humana.com/marketing/documents.asp?file=2591264","7"
"2016","AZ","51485","HIOS","7","2016-01-27 05:35:40","1","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160004","PPO Gold 500 with pediatric dental","51485AZ016",,"AZN001","AZS001","AZF008","Existing","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","1","0","2016-01-01",,"No",,"Yes","Services provided outside network when appropriate","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","51485AZ0160004-00","Standard Gold Off Exchange Plan",,"0.817482233047485","No","Yes","No","100%",,"$500","$20","$1,100","$200","$500","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_gold_500_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_gold_500.pdf","6"
"2016","AZ","51485","HIOS","7","2016-01-27 05:35:40","1","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160004","PPO Gold 500 with pediatric dental","51485AZ016",,"AZN001","AZS001","AZF008","Existing","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","1","0","2016-01-01",,"No",,"Yes","Services provided outside network when appropriate","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","51485AZ0160004-01","Standard Gold On Exchange Plan",,"0.817482233047485","No","Yes","No","100%",,"$500","$20","$1,100","$200","$500","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_gold_500_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_gold_500.pdf","7"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400014","Humana Gold 2250/Tucson HMOx","23307AZ040",,"AZN002","AZS002","AZF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400014-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$220","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602275","http://apps.humana.com/marketing/documents.asp?file=2591303","26"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400014","Humana Gold 2250/Tucson HMOx","23307AZ040",,"AZN002","AZS002","AZF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400014-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$220","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602275","http://apps.humana.com/marketing/documents.asp?file=2591303","27"
"2016","AZ","51485","HIOS","7","2016-01-27 05:35:40","3","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160008","PPO Silver 2000 with pediatric dental","51485AZ016",,"AZN001","AZS001","AZF010","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","1","0","2016-01-01",,"No",,"Yes","Services provided outside network when appropriate","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","51485AZ0160008-00","Standard Silver Off Exchange Plan",,"0.681166648864746","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$1,300","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_silver_2000_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_silver_2000.pdf","6"
"2016","AZ","51485","HIOS","7","2016-01-27 05:35:40","3","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160008","PPO Silver 2000 with pediatric dental","51485AZ016",,"AZN001","AZS001","AZF010","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","1","0","2016-01-01",,"No",,"Yes","Services provided outside network when appropriate","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","51485AZ0160008-01","Standard Silver On Exchange Plan",,"0.681166648864746","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$1,300","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_silver_2000_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_silver_2000.pdf","7"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","2","23307","AZ","Individual","No","61-1013183","23307AZ0400002","Humana Bronze 6450/Phoenix HMOx","23307AZ040",,"AZN001","AZS001","AZF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","23307AZ0400002-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2601911","http://apps.humana.com/marketing/documents.asp?file=2591212","4"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","2","23307","AZ","Individual","No","61-1013183","23307AZ0400002","Humana Bronze 6450/Phoenix HMOx","23307AZ040",,"AZN001","AZS001","AZF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","23307AZ0400002-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2601911","http://apps.humana.com/marketing/documents.asp?file=2591212","5"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","2","23307","AZ","Individual","No","61-1013183","23307AZ0400002","Humana Bronze 6450/Phoenix HMOx","23307AZ040",,"AZN001","AZS001","AZF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","23307AZ0400002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2601924","http://apps.humana.com/marketing/documents.asp?file=2591212","6"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","2","23307","AZ","Individual","No","61-1013183","23307AZ0400002","Humana Bronze 6450/Phoenix HMOx","23307AZ040",,"AZN001","AZS001","AZF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","23307AZ0400002-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2601937","http://apps.humana.com/marketing/documents.asp?file=2591212","7"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","2","23307","AZ","Individual","No","61-1013183","23307AZ0400012","Humana Bronze 6450/Tucson HMOx","23307AZ040",,"AZN002","AZS002","AZF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","23307AZ0400012-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2602158","http://apps.humana.com/marketing/documents.asp?file=2591277","8"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","2","23307","AZ","Individual","No","61-1013183","23307AZ0400012","Humana Bronze 6450/Tucson HMOx","23307AZ040",,"AZN002","AZS002","AZF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","23307AZ0400012-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2602158","http://apps.humana.com/marketing/documents.asp?file=2591277","9"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","2","23307","AZ","Individual","No","61-1013183","23307AZ0400012","Humana Bronze 6450/Tucson HMOx","23307AZ040",,"AZN002","AZS002","AZF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","23307AZ0400012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2602171","http://apps.humana.com/marketing/documents.asp?file=2591277","10"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","2","23307","AZ","Individual","No","61-1013183","23307AZ0400012","Humana Bronze 6450/Tucson HMOx","23307AZ040",,"AZN002","AZS002","AZF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","23307AZ0400012-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2602184","http://apps.humana.com/marketing/documents.asp?file=2591277","11"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400003","Humana Silver 3800/Phoenix HMOx","23307AZ040",,"AZN001","AZS001","AZF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400003-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601950","http://apps.humana.com/marketing/documents.asp?file=2591225","4"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400003","Humana Silver 3800/Phoenix HMOx","23307AZ040",,"AZN001","AZS001","AZF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400003-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601950","http://apps.humana.com/marketing/documents.asp?file=2591225","5"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400003","Humana Silver 3800/Phoenix HMOx","23307AZ040",,"AZN001","AZS001","AZF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601963","http://apps.humana.com/marketing/documents.asp?file=2591225","6"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400003","Humana Silver 3800/Phoenix HMOx","23307AZ040",,"AZN001","AZS001","AZF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400003-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2601989","http://apps.humana.com/marketing/documents.asp?file=2591225","7"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400003","Humana Silver 3800/Phoenix HMOx","23307AZ040",,"AZN001","AZS001","AZF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400003-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602002","http://apps.humana.com/marketing/documents.asp?file=2622360","8"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400003","Humana Silver 3800/Phoenix HMOx","23307AZ040",,"AZN001","AZS001","AZF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400003-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602015","http://apps.humana.com/marketing/documents.asp?file=2622373","9"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400003","Humana Silver 3800/Phoenix HMOx","23307AZ040",,"AZN001","AZS001","AZF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400003-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602041","http://apps.humana.com/marketing/documents.asp?file=2622386","10"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400004","Humana Gold 2250/Phoenix HMOx","23307AZ040",,"AZN001","AZS001","AZF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400004-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$220","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602054","http://apps.humana.com/marketing/documents.asp?file=2591238","11"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400004","Humana Gold 2250/Phoenix HMOx","23307AZ040",,"AZN001","AZS001","AZF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400004-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$220","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602054","http://apps.humana.com/marketing/documents.asp?file=2591238","12"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400004","Humana Gold 2250/Phoenix HMOx","23307AZ040",,"AZN001","AZS001","AZF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602067","http://apps.humana.com/marketing/documents.asp?file=2591238","13"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400004","Humana Gold 2250/Phoenix HMOx","23307AZ040",,"AZN001","AZS001","AZF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400004-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$220","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602080","http://apps.humana.com/marketing/documents.asp?file=2591238","14"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400005","Humana Platinum 500/Phoenix HMOx","23307AZ040",,"AZN001","AZS001","AZF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400005-00","Standard Platinum Off Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602093","http://apps.humana.com/marketing/documents.asp?file=2591251","15"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400005","Humana Platinum 500/Phoenix HMOx","23307AZ040",,"AZN001","AZS001","AZF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400005-01","Standard Platinum On Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602093","http://apps.humana.com/marketing/documents.asp?file=2591251","16"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400005","Humana Platinum 500/Phoenix HMOx","23307AZ040",,"AZN001","AZS001","AZF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602119","http://apps.humana.com/marketing/documents.asp?file=2591251","17"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400005","Humana Platinum 500/Phoenix HMOx","23307AZ040",,"AZN001","AZS001","AZF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400005-03","Limited Cost Sharing Plan Variation","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602132","http://apps.humana.com/marketing/documents.asp?file=2591251","18"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400013","Humana Silver 3800/Tucson HMOx","23307AZ040",,"AZN002","AZS002","AZF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400013-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602223","http://apps.humana.com/marketing/documents.asp?file=2591290","22"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400013","Humana Silver 3800/Tucson HMOx","23307AZ040",,"AZN002","AZS002","AZF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400013-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602236","http://apps.humana.com/marketing/documents.asp?file=2622399","23"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400013","Humana Silver 3800/Tucson HMOx","23307AZ040",,"AZN002","AZS002","AZF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400013-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602249","http://apps.humana.com/marketing/documents.asp?file=2622412","24"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400013","Humana Silver 3800/Tucson HMOx","23307AZ040",,"AZN002","AZS002","AZF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400013-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602262","http://apps.humana.com/marketing/documents.asp?file=2622425","25"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400014","Humana Gold 2250/Tucson HMOx","23307AZ040",,"AZN002","AZS002","AZF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400014-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602288","http://apps.humana.com/marketing/documents.asp?file=2591303","28"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400014","Humana Gold 2250/Tucson HMOx","23307AZ040",,"AZN002","AZS002","AZF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400014-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$220","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602301","http://apps.humana.com/marketing/documents.asp?file=2591303","29"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400015","Humana Platinum 500/Tucson HMOx","23307AZ040",,"AZN002","AZS002","AZF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400015-00","Standard Platinum Off Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602314","http://apps.humana.com/marketing/documents.asp?file=2591316","30"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400015","Humana Platinum 500/Tucson HMOx","23307AZ040",,"AZN002","AZS002","AZF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400015-01","Standard Platinum On Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602314","http://apps.humana.com/marketing/documents.asp?file=2591316","31"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400015","Humana Platinum 500/Tucson HMOx","23307AZ040",,"AZN002","AZS002","AZF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602327","http://apps.humana.com/marketing/documents.asp?file=2591316","32"
"2016","AZ","23307","HIOS","10","2016-01-22 04:00:42","3","23307","AZ","Individual","No","61-1013183","23307AZ0400015","Humana Platinum 500/Tucson HMOx","23307AZ040",,"AZN002","AZS002","AZF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","23307AZ0400015-03","Limited Cost Sharing Plan Variation","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2602340","http://apps.humana.com/marketing/documents.asp?file=2591316","33"
"2016","AZ","24106","HIOS","5","2015-10-20 04:38:50","1","24106","AZ","Individual","Yes","36-3757528","24106AZ0010001","TruAssure Basic Adult or Child Dental Plan","24106AZ001",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.34","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","24106AZ0010001-00","Standard Low Off Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$120","$120 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AZ","https://www.truassure.com/brochure?state=AZ","4"
"2016","AZ","24106","HIOS","5","2015-10-20 04:38:50","1","24106","AZ","SHOP (Small Group)","Yes","36-3757528","24106AZ0030001","TruAssure Dental Small Group Basic Plan","24106AZ003",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.69","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","24106AZ0030001-00","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","24106","HIOS","5","2015-10-20 04:38:50","1","24106","AZ","SHOP (Small Group)","Yes","36-3757528","24106AZ0040001","TruAssure Dental Small Group Preferred Plan","24106AZ004",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.69","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","24106AZ0040001-00","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","AZ","24106","HIOS","5","2015-10-20 04:38:50","1","24106","AZ","Individual","Yes","36-3757528","24106AZ0010001","TruAssure Basic Adult or Child Dental Plan","24106AZ001",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.34","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","24106AZ0010001-01","Standard Low On Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$120","$120 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AZ","https://www.truassure.com/brochure?state=AZ","5"
"2016","AZ","24106","HIOS","5","2015-10-20 04:38:50","2","24106","AZ","Individual","Yes","36-3757528","24106AZ0020001","TruAssure Preferred Adult or Child Dental Plan","24106AZ002",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.79","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","24106AZ0020001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AZ","https://www.truassure.com/brochure?state=AZ","4"
"2016","AZ","24106","HIOS","5","2015-10-20 04:38:50","2","24106","AZ","Individual","Yes","36-3757528","24106AZ0020001","TruAssure Preferred Adult or Child Dental Plan","24106AZ002",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.79","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","24106AZ0020001-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=AZ","https://www.truassure.com/brochure?state=AZ","5"
"2016","AZ","30045","HIOS","5","2016-01-29 04:56:16","1","30045","AZ","SHOP (Small Group)","Yes","86-0274899","30045AZ0020020","Delta Dental Pediatric Plan","30045AZ002",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.",,"No","Allows Child-Only",,,,,"$34.12","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0020020-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalaz.com/SHOP","https://www.deltadentalaz.com/SHOP","4"
"2016","AZ","30045","HIOS","5","2016-01-29 04:56:16","1","30045","AZ","Individual","Yes","86-0274899","30045AZ0010020","Delta Dental Pediatric Plan","30045AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,"Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.",,"No","Allows Child-Only",,,,,"$35.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0010020-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/AZ%20Pediatric%20Off2016%2000631%20002.000.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/AZ%20Pediatric%20Off2016%2000631%20002.000.pdf","4"
"2016","AZ","30045","HIOS","5","2016-01-29 04:56:16","1","30045","AZ","Individual","Yes","86-0274899","30045AZ0010020","Delta Dental Pediatric Plan","30045AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,"Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.",,"No","Allows Child-Only",,,,,"$35.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0010020-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/AZ%20Pediatric%20Off2016%2000631%20002.000.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/AZ%20Pediatric%20Off2016%2000631%20002.000.pdf","5"
"2016","AZ","30045","HIOS","5","2016-01-29 04:56:16","2","30045","AZ","Individual","Yes","86-0274899","30045AZ0010021","Delta Dental Family Essential Plan","30045AZ001",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,"No","Allows Adult and Child-Only",,,,,"$30.45","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0010021-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","80%","20%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/AZ%20Essential%20Off2016%2000632%20002.000.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/AZ%20Essential%20Off2016%2000632%20002.000.pdf","4"
"2016","AZ","30045","HIOS","5","2016-01-29 04:56:16","2","30045","AZ","SHOP (Small Group)","Yes","86-0274899","30045AZ0020021","Delta Dental Family Essential Plan","30045AZ002",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,"No","Allows Adult and Child-Only",,,,,"$28.94","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0020021-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","80%","20%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalaz.com/SHOP","https://www.deltadentalaz.com/SHOP","4"
"2016","AZ","30045","HIOS","5","2016-01-29 04:56:16","2","30045","AZ","SHOP (Small Group)","Yes","86-0274899","30045AZ0020021","Delta Dental Family Essential Plan","30045AZ002",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,"No","Allows Adult and Child-Only",,,,,"$28.94","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0020021-01","Standard Low On Exchange Plan","70.00%",,,,"Yes","80%","20%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalaz.com/SHOP","https://www.deltadentalaz.com/SHOP","5"
"2016","AZ","30045","HIOS","5","2016-01-29 04:56:16","2","30045","AZ","Individual","Yes","86-0274899","30045AZ0010021","Delta Dental Family Essential Plan","30045AZ001",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,"No","Allows Adult and Child-Only",,,,,"$30.45","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0010021-01","Standard Low On Exchange Plan","70.00%",,,,"Yes","80%","20%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/AZ%20Essential%20Off2016%2000632%20002.000.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/AZ%20Essential%20Off2016%2000632%20002.000.pdf","5"
"2016","AZ","30045","HIOS","5","2016-01-29 04:56:16","3","30045","AZ","Individual","Yes","86-0274899","30045AZ0010022","Delta Dental Family Select Plan","30045AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,"No","Allows Adult and Child-Only",,,,,"$35.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0010022-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","80%","20%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/AZ%20Select%20Off2016%2000633%20002.000.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/AZ%20Select%20Off2016%2000633%20002.000.pdf","4"
"2016","AZ","30045","HIOS","5","2016-01-29 04:56:16","3","30045","AZ","SHOP (Small Group)","Yes","86-0274899","30045AZ0020022","Delta Dental Family Select Plan","30045AZ002",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,"No","Allows Adult and Child-Only",,,,,"$34.12","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0020022-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","80%","20%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalaz.com/SHOP","https://www.deltadentalaz.com/SHOP","4"
"2016","AZ","30045","HIOS","5","2016-01-29 04:56:16","3","30045","AZ","SHOP (Small Group)","Yes","86-0274899","30045AZ0020022","Delta Dental Family Select Plan","30045AZ002",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,"No","Allows Adult and Child-Only",,,,,"$34.12","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0020022-01","Standard High On Exchange Plan","85.00%",,,,"Yes","80%","20%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalaz.com/SHOP","https://www.deltadentalaz.com/SHOP","5"
"2016","AZ","30045","HIOS","5","2016-01-29 04:56:16","3","30045","AZ","Individual","Yes","86-0274899","30045AZ0010022","Delta Dental Family Select Plan","30045AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,"No","Allows Adult and Child-Only",,,,,"$35.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","https://auth.deltadentalaz.com/sp/ACS.saml2","","30045AZ0010022-01","Standard High On Exchange Plan","85.00%",,,,"Yes","80%","20%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/AZ%20Select%20Off2016%2000633%20002.000.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/AZ%20Select%20Off2016%2000633%20002.000.pdf","5"
"2016","AZ","31957","HIOS","3","2015-07-11 04:19:24","1","31957","AZ","SHOP (Small Group)","Yes","47-0322111","31957AZ0010001","Certified Dental Plan 1","31957AZ001",,"AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.80","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","31957AZ0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","31957","HIOS","3","2015-07-11 04:19:24","1","31957","AZ","SHOP (Small Group)","Yes","47-0322111","31957AZ0010002","Certified Dental Plan 2","31957AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.29","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","31957AZ0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","AZ","31957","HIOS","3","2015-07-11 04:19:24","1","31957","AZ","SHOP (Small Group)","Yes","47-0322111","31957AZ0010003","Certified Dental Plan 3","31957AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.19","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","31957AZ0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","AZ","31957","HIOS","3","2015-07-11 04:19:24","1","31957","AZ","SHOP (Small Group)","Yes","47-0322111","31957AZ0010004","Certified Dental Plan 4","31957AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.56","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","31957AZ0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","AZ","33851","HIOS","3","2016-01-22 04:00:42","1","33851","AZ","Individual","Yes","91-1857813","33851AZ0110007","PLUS Family Plan with LOW EHB","33851AZ011",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"See Schedule of Benefits for Limitations and Exclusions.",,"No","Allows Adult and Child-Only",,,,,"$28.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes",,"","33851AZ0110007-00","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.premierlife.com/exchangeplans","https://www.premierlife.com/exchangeplans","4"
"2016","AZ","33851","HIOS","3","2016-01-22 04:00:42","1","33851","AZ","Individual","Yes","91-1857813","33851AZ0110007","PLUS Family Plan with LOW EHB","33851AZ011",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"See Schedule of Benefits for Limitations and Exclusions.",,"No","Allows Adult and Child-Only",,,,,"$28.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes",,"","33851AZ0110007-01","Standard Low On Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.premierlife.com/exchangeplans","https://www.premierlife.com/exchangeplans","5"
"2016","AZ","51485","HIOS","7","2016-01-27 05:35:40","1","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160003","PPO Platinum 750 with pediatric dental","51485AZ016",,"AZN001","AZS001","AZF004","Existing","PPO","Platinum","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","1","0","2016-01-01",,"No",,"Yes","Services provided outside network when appropriate","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","51485AZ0160003-00","Standard Platinum Off Exchange Plan",,"0.880515933036804","No","Yes","No","100%",,"$800","$20","$1,100","$200","$800","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_platinum_750_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_platinum_750.pdf","4"
"2016","AZ","51485","HIOS","7","2016-01-27 05:35:40","1","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160003","PPO Platinum 750 with pediatric dental","51485AZ016",,"AZN001","AZS001","AZF004","Existing","PPO","Platinum","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","1","0","2016-01-01",,"No",,"Yes","Services provided outside network when appropriate","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","51485AZ0160003-01","Standard Platinum On Exchange Plan",,"0.880515933036804","No","Yes","No","100%",,"$800","$20","$1,100","$200","$800","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_platinum_750_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_platinum_750.pdf","5"
"2016","AZ","51485","HIOS","7","2016-01-27 05:35:40","1","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160005","PPO Gold 1000 with pediatric dental","51485AZ016",,"AZN001","AZS001","AZF008","Existing","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","1","0","2016-01-01",,"No",,"Yes","Services provided outside network when appropriate","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","51485AZ0160005-00","Standard Gold Off Exchange Plan",,"0.788273572921753","No","Yes","No","100%",,"$1,000","$20","$1,100","$200","$1,000","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_gold_1000_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_gold_1000.pdf","8"
"2016","AZ","51485","HIOS","7","2016-01-27 05:35:40","1","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160005","PPO Gold 1000 with pediatric dental","51485AZ016",,"AZN001","AZS001","AZF008","Existing","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","1","0","2016-01-01",,"No",,"Yes","Services provided outside network when appropriate","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","51485AZ0160005-01","Standard Gold On Exchange Plan",,"0.788273572921753","No","Yes","No","100%",,"$1,000","$20","$1,100","$200","$1,000","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_gold_1000_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_gold_1000.pdf","9"
"2016","AZ","51485","HIOS","7","2016-01-27 05:35:40","3","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160007","PPO Silver 1500 with pediatric dental","51485AZ016",,"AZN001","AZS001","AZF010","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","1","0","2016-01-01",,"No",,"Yes","Services provided outside network when appropriate","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","51485AZ0160007-00","Standard Silver Off Exchange Plan",,"0.704559445381165","No","Yes","No","100%",,"$1,500","$20","$1,100","$200","$1,300","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_silver_1500_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_silver_1500.pdf","4"
"2016","AZ","51485","HIOS","7","2016-01-27 05:35:40","3","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160007","PPO Silver 1500 with pediatric dental","51485AZ016",,"AZN001","AZS001","AZF010","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","1","0","2016-01-01",,"No",,"Yes","Services provided outside network when appropriate","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","51485AZ0160007-01","Standard Silver On Exchange Plan",,"0.704559445381165","No","Yes","No","100%",,"$1,500","$20","$1,100","$200","$1,300","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_silver_1500_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_silver_1500.pdf","5"
"2016","AZ","51485","HIOS","7","2016-01-27 05:35:40","3","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160031","PPO Silver HSA 2600 with pediatric dental","51485AZ016",,"AZN001","AZS001","AZF005","New","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01",,"No",,"Yes","Services provided outside network when appropriate","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","51485AZ0160031-00","Standard Silver Off Exchange Plan",,"0.684682667255402","Yes","Yes","No","100%",,"$2,600","$20","$900","$200","$2,600","$700","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_silver_hsa_2600_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_silver_hsa_2600.pdf","8"
"2016","AZ","51485","HIOS","7","2016-01-27 05:35:40","3","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160031","PPO Silver HSA 2600 with pediatric dental","51485AZ016",,"AZN001","AZS001","AZF005","New","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01",,"No",,"Yes","Services provided outside network when appropriate","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","51485AZ0160031-01","Standard Silver On Exchange Plan",,"0.684682667255402","Yes","Yes","No","100%",,"$2,600","$20","$900","$200","$2,600","$700","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_silver_hsa_2600_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_silver_hsa_2600.pdf","9"
"2016","AZ","51485","HIOS","7","2016-01-27 05:35:40","3","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160032","PPO Bronze 5500 with pediatric dental","51485AZ016",,"AZN001","AZS001","AZF011","New","PPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","1","0","2016-01-01",,"No",,"Yes","Services provided outside network when appropriate","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","51485AZ0160032-00","Standard Bronze Off Exchange Plan",,"0.606150686740875","Yes","Yes","No","100%",,"$5,500","$0","$900","$200","$1,300","$0","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_bronze_5500_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_bronze_5500.pdf","10"
"2016","AZ","51485","HIOS","7","2016-01-27 05:35:40","3","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160032","PPO Bronze 5500 with pediatric dental","51485AZ016",,"AZN001","AZS001","AZF011","New","PPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","1","0","2016-01-01",,"No",,"Yes","Services provided outside network when appropriate","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","51485AZ0160032-01","Standard Bronze On Exchange Plan",,"0.606150686740875","Yes","Yes","No","100%",,"$5,500","$0","$900","$200","$1,300","$0","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_bronze_5500_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_ppo_bronze_5500.pdf","11"
"2016","AZ","52147","HIOS","3","2015-08-27 11:14:25","1","52147","AZ","SHOP (Small Group)","Yes","93-0242990","52147AZ0040002","EHB High PPO","52147AZ004",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.68","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","52147AZ0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","AZ","52147","HIOS","3","2015-08-27 11:14:25","1","52147","AZ","SHOP (Small Group)","Yes","93-0242990","52147AZ0040001","EHB Low PPO","52147AZ004",,"AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.53","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","52147AZ0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1080004","EverydayHealth HMO 6000 - Alliance Network","53901AZ108",,"AZN002","AZS002","AZF003","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1080004-03","Limited Cost Sharing Plan Variation",,"0.617739677429199","No","Yes","No","100%",,"$5,170","$110","$0","$150","$310","$1,870","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth6000Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","18"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1140001","Portfolio HSA HMO 1500 - Alliance Network","53901AZ114",,"AZN002","AZS002","AZF004","Existing","HMO","Gold","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1140001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$1,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio1500AllianceZero","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","6"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1140001","Portfolio HSA HMO 1500 - Alliance Network","53901AZ114",,"AZN002","AZS002","AZF004","Existing","HMO","Gold","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1140001-03","Limited Cost Sharing Plan Variation",,"0.781040787696838","Yes","Yes","No","100%",,"$1,500","$0","$580","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio1500Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","7"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1140003","Portfolio HSA HMO 3250 - Alliance Network","53901AZ114",,"AZN002","AZS002","AZF005","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1140003-00","Standard Silver Off Exchange Plan",,"0.681848526000977","Yes","Yes","No","100%",,"$3,250","$0","$400","$150","$3,250","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio3250Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","8"
"2016","AZ","52147","HIOS","3","2015-08-27 11:14:25","1","52147","AZ","SHOP (Small Group)","Yes","93-0242990","52147AZ0030002","EHB High Passive","52147AZ003",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$47.59","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","52147AZ0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","AZ","52147","HIOS","3","2015-08-27 11:14:25","1","52147","AZ","SHOP (Small Group)","Yes","93-0242990","52147AZ0030001","EHB Low Passive","52147AZ003",,"AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.81","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","52147AZ0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","AZ","53613","HIOS","4","2016-01-29 04:56:16","1","53613","AZ","Individual","Yes","20-4023720","53613AZ0010001","EMI Health Choice PPO (High)","53613AZ001",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.77","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","PPO network or out-of-network coverage at PPO fee","Yes","http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx","","53613AZ0010001-00","Standard High Off Exchange Plan","83.00%",,,,"Yes","55%","45%",,,,,,,,,"$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,"$25","$25 per person","$75 per group",,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx","http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx","4"
"2016","AZ","53613","HIOS","4","2016-01-29 04:56:16","1","53613","AZ","Individual","Yes","20-4023720","53613AZ0010001","EMI Health Choice PPO (High)","53613AZ001",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.77","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","PPO network or out-of-network coverage at PPO fee","Yes","http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx","","53613AZ0010001-01","Standard High On Exchange Plan","83.00%",,,,"Yes","55%","45%",,,,,,,,,"$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,"$25","$25 per person","$75 per group",,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx","http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx","5"
"2016","AZ","53613","HIOS","4","2016-01-29 04:56:16","1","53613","AZ","Individual","Yes","20-4023720","53613AZ0020001","EMI Health Choice PPO (Low)","53613AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.80","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","PPO network or out-of-network coverage at PPO fee","Yes","http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx","","53613AZ0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"Yes","60%","40%",,,,,,,,,"$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,"$75","$75 per person","$225 per group",,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx","http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx","6"
"2016","AZ","53613","HIOS","4","2016-01-29 04:56:16","1","53613","AZ","Individual","Yes","20-4023720","53613AZ0020001","EMI Health Choice PPO (Low)","53613AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.80","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","PPO network or out-of-network coverage at PPO fee","Yes","http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx","","53613AZ0020001-01","Standard Low On Exchange Plan","71.00%",,,,"Yes","60%","40%",,,,,,,,,"$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,"$75","$75 per person","$225 per group",,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx","http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx","7"
"2016","AZ","53613","HIOS","4","2016-01-29 04:56:16","1","53613","AZ","Individual","Yes","20-4023720","53613AZ0030001","EMI Health Advantage Co-Pay","53613AZ003",,"AZN002","AZS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.42","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","PPO network or out-of-network coverage at PPO fee","Yes","http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx","","53613AZ0030001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx","http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx","8"
"2016","AZ","53613","HIOS","4","2016-01-29 04:56:16","1","53613","AZ","Individual","Yes","20-4023720","53613AZ0030001","EMI Health Advantage Co-Pay","53613AZ003",,"AZN002","AZS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.42","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","PPO network or out-of-network coverage at PPO fee","Yes","http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx","","53613AZ0030001-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx","http://www.emihealth.com/emi/products/arizona-products/federal-marketplace-dental.aspx","9"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1080001","EverydayHealth HMO 1000 - Alliance Network","53901AZ108",,"AZN002","AZS002","AZF001","Existing","HMO","Gold","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1080001-00","Standard Gold Off Exchange Plan",,"0.78300017118454","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth1000Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","4"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","SHOP (Small Group)","No","86-0004538","53901AZ0790001","EverydayHealth PPO 1000 - Statewide Network","53901AZ079",,"AZN005","AZS004","AZF009","Existing","PPO","Gold","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9954",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0790001-00","Standard Gold Off Exchange Plan",,"0.782011985778809","No","Yes","No","100%",,"$1,000","$70","$830","$150","$140","$1,450","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.azblue.com/2016plans/EverydayHealth1000SHOP","http://www.azblue.com/2016brochure/SmallGroupBrochure","4"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","SHOP (Small Group)","No","86-0004538","53901AZ0790001","EverydayHealth PPO 1000 - Statewide Network","53901AZ079",,"AZN005","AZS004","AZF009","Existing","PPO","Gold","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9954",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0790001-01","Standard Gold On Exchange Plan",,"0.782011985778809","No","Yes","No","100%",,"$1,000","$70","$830","$150","$140","$1,450","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.azblue.com/2016plans/EverydayHealth1000SHOP","http://www.azblue.com/2016brochure/SmallGroupBrochure","5"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1080001","EverydayHealth HMO 1000 - Alliance Network","53901AZ108",,"AZN002","AZS002","AZF001","Existing","HMO","Gold","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1080001-01","Standard Gold On Exchange Plan",,"0.78300017118454","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth1000Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","5"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1080001","EverydayHealth HMO 1000 - Alliance Network","53901AZ108",,"AZN002","AZS002","AZF001","Existing","HMO","Gold","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1080001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth1000AllianceZero","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","6"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","SHOP (Small Group)","No","86-0004538","53901AZ0790002","EverydayHealth PPO 2000 - Statewide Network","53901AZ079",,"AZN005","AZS004","AZF010","Existing","PPO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9954",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0790002-00","Standard Silver Off Exchange Plan",,"0.717046856880188","No","Yes","No","100%",,"$2,000","$80","$630","$150","$140","$1,600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.azblue.com/2016plans/EverydayHealth2000SHOP","http://www.azblue.com/2016brochure/SmallGroupBrochure","6"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","SHOP (Small Group)","No","86-0004538","53901AZ0790002","EverydayHealth PPO 2000 - Statewide Network","53901AZ079",,"AZN005","AZS004","AZF010","Existing","PPO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9954",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0790002-01","Standard Silver On Exchange Plan",,"0.717046856880188","No","Yes","No","100%",,"$2,000","$80","$630","$150","$140","$1,600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.azblue.com/2016plans/EverydayHealth2000SHOP","http://www.azblue.com/2016brochure/SmallGroupBrochure","7"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1090004","EverydayHealth HMO 6000 - Select Network","53901AZ109",,"AZN003","AZS002","AZF003","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1090004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth6000SelectZero","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","32"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1090004","EverydayHealth HMO 6000 - Select Network","53901AZ109",,"AZN003","AZS002","AZF003","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1090004-03","Limited Cost Sharing Plan Variation",,"0.617739677429199","No","Yes","No","100%",,"$5,170","$110","$0","$150","$310","$1,870","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth6000Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","33"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1080001","EverydayHealth HMO 1000 - Alliance Network","53901AZ108",,"AZN002","AZS002","AZF001","Existing","HMO","Gold","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1080001-03","Limited Cost Sharing Plan Variation",,"0.78300017118454","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth1000Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","7"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1080003","EverydayHealth HMO 4000 - Alliance Network","53901AZ108",,"AZN002","AZS002","AZF002","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1080003-00","Standard Silver Off Exchange Plan",,"0.681271374225616","No","Yes","No","100%",,"$4,000","$70","$230","$150","$310","$1,080","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth4000Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","8"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","SHOP (Small Group)","No","86-0004538","53901AZ0790004","EverydayHealth PPO  6000 - Statewide Network","53901AZ079",,"AZN005","AZS004","AZF011","Existing","PPO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9954",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0790004-00","Standard Bronze Off Exchange Plan",,"0.617714464664459","No","Yes","No","100%",,"$5,170","$110","$0","$150","$140","$2,520","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.azblue.com/2016plans/EverydayHealth6000SHOP","http://www.azblue.com/2016brochure/SmallGroupBrochure","8"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","SHOP (Small Group)","No","86-0004538","53901AZ0790004","EverydayHealth PPO  6000 - Statewide Network","53901AZ079",,"AZN005","AZS004","AZF011","Existing","PPO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.",,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9954",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0790004-01","Standard Bronze On Exchange Plan",,"0.617714464664459","No","Yes","No","100%",,"$5,170","$110","$0","$150","$140","$2,520","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.azblue.com/2016plans/EverydayHealth6000SHOP","http://www.azblue.com/2016brochure/SmallGroupBrochure","9"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1080003","EverydayHealth HMO 4000 - Alliance Network","53901AZ108",,"AZN002","AZS002","AZF002","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1080003-01","Standard Silver On Exchange Plan",,"0.681271374225616","No","Yes","No","100%",,"$4,000","$70","$230","$150","$310","$1,080","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth4000Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","9"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1080003","EverydayHealth HMO 4000 - Alliance Network","53901AZ108",,"AZN002","AZS002","AZF002","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1080003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth4000AllianceZero","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","10"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1080003","EverydayHealth HMO 4000 - Alliance Network","53901AZ108",,"AZN002","AZS002","AZF002","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1080003-03","Limited Cost Sharing Plan Variation",,"0.681271374225616","No","Yes","No","100%",,"$4,000","$70","$230","$150","$310","$1,080","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth4000Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","11"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1080003","EverydayHealth HMO 4000 - Alliance Network","53901AZ108",,"AZN002","AZS002","AZF002","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1080003-04","73% AV Level Silver Plan",,"0.721900641918182","No","Yes","No","100%",,"$3,000","$70","$430","$150","$310","$1,080","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth4000Alliance73","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","12"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1080003","EverydayHealth HMO 4000 - Alliance Network","53901AZ108",,"AZN002","AZS002","AZF002","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1080003-05","87% AV Level Silver Plan",,"0.861765682697296","No","Yes","No","100%",,"$1,000","$30","$420","$150","$310","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth4000Alliance87","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","13"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1080003","EverydayHealth HMO 4000 - Alliance Network","53901AZ108",,"AZN002","AZS002","AZF002","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1080003-06","94% AV Level Silver Plan",,"0.930576205253601","No","Yes","No","100%",,"$75","$30","$510","$150","$125","$570","$5","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth4000Alliance94","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","14"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1080004","EverydayHealth HMO 6000 - Alliance Network","53901AZ108",,"AZN002","AZS002","AZF003","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1080004-00","Standard Bronze Off Exchange Plan",,"0.617739677429199","No","Yes","No","100%",,"$5,170","$110","$0","$150","$310","$1,870","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth6000Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","15"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1080004","EverydayHealth HMO 6000 - Alliance Network","53901AZ108",,"AZN002","AZS002","AZF003","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1080004-01","Standard Bronze On Exchange Plan",,"0.617739677429199","No","Yes","No","100%",,"$5,170","$110","$0","$150","$310","$1,870","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth6000Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","16"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1080004","EverydayHealth HMO 6000 - Alliance Network","53901AZ108",,"AZN002","AZS002","AZF003","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1080004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth6000AllianceZero","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","17"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1090001","EverydayHealth HMO 1000 - Select Network","53901AZ109",,"AZN003","AZS002","AZF001","Existing","HMO","Gold","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1090001-00","Standard Gold Off Exchange Plan",,"0.78300017118454","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth1000Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","19"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1090001","EverydayHealth HMO 1000 - Select Network","53901AZ109",,"AZN003","AZS002","AZF001","Existing","HMO","Gold","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1090001-01","Standard Gold On Exchange Plan",,"0.78300017118454","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth1000Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","20"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1090001","EverydayHealth HMO 1000 - Select Network","53901AZ109",,"AZN003","AZS002","AZF001","Existing","HMO","Gold","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1090001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth1000SelectZero","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","21"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1090001","EverydayHealth HMO 1000 - Select Network","53901AZ109",,"AZN003","AZS002","AZF001","Existing","HMO","Gold","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1090001-03","Limited Cost Sharing Plan Variation",,"0.78300017118454","No","Yes","No","100%",,"$1,000","$60","$830","$150","$310","$980","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth1000Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","22"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1090003","EverydayHealth HMO 4000 - Select Network","53901AZ109",,"AZN003","AZS002","AZF002","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1090003-00","Standard Silver Off Exchange Plan",,"0.681271374225616","No","Yes","No","100%",,"$4,000","$70","$230","$150","$310","$1,080","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth4000Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","23"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1090003","EverydayHealth HMO 4000 - Select Network","53901AZ109",,"AZN003","AZS002","AZF002","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1090003-01","Standard Silver On Exchange Plan",,"0.681271374225616","No","Yes","No","100%",,"$4,000","$70","$230","$150","$310","$1,080","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth4000Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","24"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1090003","EverydayHealth HMO 4000 - Select Network","53901AZ109",,"AZN003","AZS002","AZF002","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1090003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth4000SelectZero","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","25"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1090003","EverydayHealth HMO 4000 - Select Network","53901AZ109",,"AZN003","AZS002","AZF002","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1090003-03","Limited Cost Sharing Plan Variation",,"0.681271374225616","No","Yes","No","100%",,"$4,000","$70","$230","$150","$310","$1,080","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth4000Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","26"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1090003","EverydayHealth HMO 4000 - Select Network","53901AZ109",,"AZN003","AZS002","AZF002","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1090003-04","73% AV Level Silver Plan",,"0.721900641918182","No","Yes","No","100%",,"$3,000","$70","$430","$150","$310","$1,080","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth4000Select73","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","27"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1090003","EverydayHealth HMO 4000 - Select Network","53901AZ109",,"AZN003","AZS002","AZF002","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1090003-05","87% AV Level Silver Plan",,"0.861765682697296","No","Yes","No","100%",,"$1,000","$30","$420","$150","$310","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth4000Select87","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","28"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1090003","EverydayHealth HMO 4000 - Select Network","53901AZ109",,"AZN003","AZS002","AZF002","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1090003-06","94% AV Level Silver Plan",,"0.930576205253601","No","Yes","No","100%",,"$75","$30","$510","$150","$125","$570","$5","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth4000Select94","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","29"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1090004","EverydayHealth HMO 6000 - Select Network","53901AZ109",,"AZN003","AZS002","AZF003","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1090004-00","Standard Bronze Off Exchange Plan",,"0.617739677429199","No","Yes","No","100%",,"$5,170","$110","$0","$150","$310","$1,870","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth6000Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","30"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1090004","EverydayHealth HMO 6000 - Select Network","53901AZ109",,"AZN003","AZS002","AZF003","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1090004-01","Standard Bronze On Exchange Plan",,"0.617739677429199","No","Yes","No","100%",,"$5,170","$110","$0","$150","$310","$1,870","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth6000Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","31"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1140003","Portfolio HSA HMO 3250 - Alliance Network","53901AZ114",,"AZN002","AZS002","AZF005","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1140003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio3250AllianceZero","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","10"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1140003","Portfolio HSA HMO 3250 - Alliance Network","53901AZ114",,"AZN002","AZS002","AZF005","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1140003-03","Limited Cost Sharing Plan Variation",,"0.681848526000977","Yes","Yes","No","100%",,"$3,250","$0","$400","$150","$3,250","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio3250Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","11"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1140003","Portfolio HSA HMO 3250 - Alliance Network","53901AZ114",,"AZN002","AZS002","AZF005","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1140003-04","73% AV Level Silver Plan",,"0.722281992435455","Yes","Yes","No","100%",,"$2,750","$0","$450","$150","$2,750","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio3250Alliance73","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","12"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1340001","EverydayHealth HMO 4000 - Statewide Network","53901AZ134",,"AZN001","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340001-00","Standard Silver Off Exchange Plan",,"0.681271374225616","No","Yes","No","100%",,"$4,000","$70","$230","$150","$310","$1,080","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth4000Statewide","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","49"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1340001","EverydayHealth HMO 4000 - Statewide Network","53901AZ134",,"AZN001","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340001-01","Standard Silver On Exchange Plan",,"0.681271374225616","No","Yes","No","100%",,"$4,000","$70","$230","$150","$310","$1,080","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth4000Statewide","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","50"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1340001","EverydayHealth HMO 4000 - Statewide Network","53901AZ134",,"AZN001","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth4000StatewideZero","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","51"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1340001","EverydayHealth HMO 4000 - Statewide Network","53901AZ134",,"AZN001","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340001-03","Limited Cost Sharing Plan Variation",,"0.681271374225616","No","Yes","No","100%",,"$4,000","$70","$230","$150","$310","$1,080","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth4000Statewide","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","52"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1340001","EverydayHealth HMO 4000 - Statewide Network","53901AZ134",,"AZN001","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340001-04","73% AV Level Silver Plan",,"0.721900641918182","No","Yes","No","100%",,"$3,000","$70","$430","$150","$310","$1,080","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth4000Statewide73","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","53"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1340001","EverydayHealth HMO 4000 - Statewide Network","53901AZ134",,"AZN001","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340001-05","87% AV Level Silver Plan",,"0.861765682697296","No","Yes","No","100%",,"$1,000","$30","$420","$150","$310","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth4000Statewide87","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","54"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1340001","EverydayHealth HMO 4000 - Statewide Network","53901AZ134",,"AZN001","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340001-06","94% AV Level Silver Plan",,"0.930576205253601","No","Yes","No","100%",,"$75","$30","$510","$150","$125","$570","$5","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth4000Statewide94","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","55"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1340002","EverydayHealth HMO 6000 - Statewide Network","53901AZ134",,"AZN001","AZS001","AZF003","New","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340002-00","Standard Bronze Off Exchange Plan",,"0.617739677429199","No","Yes","No","100%",,"$5,170","$110","$0","$150","$310","$1,870","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth6000Statewide","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","56"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1340002","EverydayHealth HMO 6000 - Statewide Network","53901AZ134",,"AZN001","AZS001","AZF003","New","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340002-01","Standard Bronze On Exchange Plan",,"0.617739677429199","No","Yes","No","100%",,"$5,170","$110","$0","$150","$310","$1,870","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth6000Statewide","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","57"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1340002","EverydayHealth HMO 6000 - Statewide Network","53901AZ134",,"AZN001","AZS001","AZF003","New","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth6000StatewideZero","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","58"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","1","53901","AZ","Individual","No","86-0004538","53901AZ1340002","EverydayHealth HMO 6000 - Statewide Network","53901AZ134",,"AZN001","AZS001","AZF003","New","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ1340002-03","Limited Cost Sharing Plan Variation",,"0.617739677429199","No","Yes","No","100%",,"$5,170","$110","$0","$150","$310","$1,870","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.azblue.com/2016plans/EverydayHealth6000Statewide","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","59"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1140001","Portfolio HSA HMO 1500 - Alliance Network","53901AZ114",,"AZN002","AZS002","AZF004","Existing","HMO","Gold","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1140001-00","Standard Gold Off Exchange Plan",,"0.781040787696838","Yes","Yes","No","100%",,"$1,500","$0","$580","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio1500Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","4"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1140001","Portfolio HSA HMO 1500 - Alliance Network","53901AZ114",,"AZN002","AZS002","AZF004","Existing","HMO","Gold","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1140001-01","Standard Gold On Exchange Plan",,"0.781040787696838","Yes","Yes","No","100%",,"$1,500","$0","$580","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio1500Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","5"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1140003","Portfolio HSA HMO 3250 - Alliance Network","53901AZ114",,"AZN002","AZS002","AZF005","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1140003-01","Standard Silver On Exchange Plan",,"0.681848526000977","Yes","Yes","No","100%",,"$3,250","$0","$400","$150","$3,250","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio3250Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","9"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1140003","Portfolio HSA HMO 3250 - Alliance Network","53901AZ114",,"AZN002","AZS002","AZF005","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1140003-05","87% AV Level Silver Plan",,"0.863364398479462","Yes","Yes","No","100%",,"$750","$0","$650","$150","$750","$0","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio3250Alliance87","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","13"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1140003","Portfolio HSA HMO 3250 - Alliance Network","53901AZ114",,"AZN002","AZS002","AZF005","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1140003-06","94% AV Level Silver Plan",,"0.932114243507385","Yes","Yes","No","100%",,"$300","$0","$400","$150","$300","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio3250Alliance94","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","14"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1140004","Portfolio HSA HMO 5500 - Alliance Network","53901AZ114",,"AZN002","AZS002","AZF006","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1140004-00","Standard Bronze Off Exchange Plan",,"0.612292349338531","Yes","Yes","No","100%",,"$5,500","$0","$180","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio5500Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","15"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1140004","Portfolio HSA HMO 5500 - Alliance Network","53901AZ114",,"AZN002","AZS002","AZF006","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1140004-01","Standard Bronze On Exchange Plan",,"0.612292349338531","Yes","Yes","No","100%",,"$5,500","$0","$180","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio5500Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","16"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1140004","Portfolio HSA HMO 5500 - Alliance Network","53901AZ114",,"AZN002","AZS002","AZF006","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1140004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio5500AllianceZero","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","17"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1140004","Portfolio HSA HMO 5500 - Alliance Network","53901AZ114",,"AZN002","AZS002","AZF006","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1140004-03","Limited Cost Sharing Plan Variation",,"0.612292349338531","Yes","Yes","No","100%",,"$5,500","$0","$180","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio5500Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","18"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1140005","Portfolio HSA HMO 6550 - Alliance Network","53901AZ114",,"AZN002","AZS002","AZF007","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1140005-00","Standard Bronze Off Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio6850Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","19"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1140005","Portfolio HSA HMO 6550 - Alliance Network","53901AZ114",,"AZN002","AZS002","AZF007","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1140005-01","Standard Bronze On Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio6850Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","20"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1140005","Portfolio HSA HMO 6550 - Alliance Network","53901AZ114",,"AZN002","AZS002","AZF007","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1140005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio6850AllianceZero","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","21"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1140005","Portfolio HSA HMO 6550 - Alliance Network","53901AZ114",,"AZN002","AZS002","AZF007","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1140005-03","Limited Cost Sharing Plan Variation",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio6850Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","22"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1150001","Portfolio HSA HMO 1500 - Select Network","53901AZ115",,"AZN003","AZS002","AZF004","Existing","HMO","Gold","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1150001-00","Standard Gold Off Exchange Plan",,"0.781040787696838","Yes","Yes","No","100%",,"$1,500","$0","$580","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio1550Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","23"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1150001","Portfolio HSA HMO 1500 - Select Network","53901AZ115",,"AZN003","AZS002","AZF004","Existing","HMO","Gold","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1150001-01","Standard Gold On Exchange Plan",,"0.781040787696838","Yes","Yes","No","100%",,"$1,500","$0","$580","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio1550Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","24"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1150001","Portfolio HSA HMO 1500 - Select Network","53901AZ115",,"AZN003","AZS002","AZF004","Existing","HMO","Gold","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1150001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$1,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio1550SelectZero","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","25"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1150001","Portfolio HSA HMO 1500 - Select Network","53901AZ115",,"AZN003","AZS002","AZF004","Existing","HMO","Gold","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1150001-03","Limited Cost Sharing Plan Variation",,"0.781040787696838","Yes","Yes","No","100%",,"$1,500","$0","$580","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio1550Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","26"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1150003","Portfolio HSA HMO 3250 - Select Network","53901AZ115",,"AZN003","AZS002","AZF005","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1150003-00","Standard Silver Off Exchange Plan",,"0.681848526000977","Yes","Yes","No","100%",,"$3,250","$0","$400","$150","$3,250","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio3250Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","27"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1150003","Portfolio HSA HMO 3250 - Select Network","53901AZ115",,"AZN003","AZS002","AZF005","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1150003-01","Standard Silver On Exchange Plan",,"0.681848526000977","Yes","Yes","No","100%",,"$3,250","$0","$400","$150","$3,250","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio3250Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","28"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1150003","Portfolio HSA HMO 3250 - Select Network","53901AZ115",,"AZN003","AZS002","AZF005","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1150003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio3250SelectZero","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","29"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1150003","Portfolio HSA HMO 3250 - Select Network","53901AZ115",,"AZN003","AZS002","AZF005","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1150003-03","Limited Cost Sharing Plan Variation",,"0.681848526000977","Yes","Yes","No","100%",,"$3,250","$0","$400","$150","$3,250","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio3250Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","30"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1150003","Portfolio HSA HMO 3250 - Select Network","53901AZ115",,"AZN003","AZS002","AZF005","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1150003-04","73% AV Level Silver Plan",,"0.722281992435455","Yes","Yes","No","100%",,"$2,750","$0","$450","$150","$2,750","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio3250Select73","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","31"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1150003","Portfolio HSA HMO 3250 - Select Network","53901AZ115",,"AZN003","AZS002","AZF005","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1150003-05","87% AV Level Silver Plan",,"0.863364398479462","Yes","Yes","No","100%",,"$750","$0","$650","$150","$750","$0","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio3250Select87","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","32"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1150003","Portfolio HSA HMO 3250 - Select Network","53901AZ115",,"AZN003","AZS002","AZF005","Existing","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1150003-06","94% AV Level Silver Plan",,"0.932114243507385","Yes","Yes","No","100%",,"$300","$0","$400","$150","$300","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio3250Select94","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","33"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1150004","Portfolio HSA HMO 5500 - Select Network","53901AZ115",,"AZN003","AZS002","AZF006","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1150004-00","Standard Bronze Off Exchange Plan",,"0.612292349338531","Yes","Yes","No","100%",,"$5,500","$0","$180","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio5500Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","34"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1150004","Portfolio HSA HMO 5500 - Select Network","53901AZ115",,"AZN003","AZS002","AZF006","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1150004-01","Standard Bronze On Exchange Plan",,"0.612292349338531","Yes","Yes","No","100%",,"$5,500","$0","$180","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio5500Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","35"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1150004","Portfolio HSA HMO 5500 - Select Network","53901AZ115",,"AZN003","AZS002","AZF006","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1150004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio5500SelectZero","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","36"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1150004","Portfolio HSA HMO 5500 - Select Network","53901AZ115",,"AZN003","AZS002","AZF006","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1150004-03","Limited Cost Sharing Plan Variation",,"0.612292349338531","Yes","Yes","No","100%",,"$5,500","$0","$180","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio5500Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","37"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1150005","Portfolio HSA HMO 6550 - Select Network","53901AZ115",,"AZN003","AZS002","AZF007","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1150005-00","Standard Bronze Off Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio6850Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","38"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1150005","Portfolio HSA HMO 6550 - Select Network","53901AZ115",,"AZN003","AZS002","AZF007","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1150005-01","Standard Bronze On Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio6850Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","39"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1150005","Portfolio HSA HMO 6550 - Select Network","53901AZ115",,"AZN003","AZS002","AZF007","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1150005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio6850SelectZero","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","40"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","2","53901","AZ","Individual","No","86-0004538","53901AZ1150005","Portfolio HSA HMO 6550 - Select Network","53901AZ115",,"AZN003","AZS002","AZF007","Existing","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1150005-03","Limited Cost Sharing Plan Variation",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio6850Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","41"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","3","53901","AZ","Individual","No","86-0004538","53901AZ1350001","Portfolio HSA HMO 3250 - Statewide Network","53901AZ135",,"AZN001","AZS001","AZF005","New","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes",,"http://azblue.com/BlueExchangeSelectFormulary","53901AZ1350001-00","Standard Silver Off Exchange Plan",,"0.681848526000977","Yes","Yes","No","100%",,"$3,250","$0","$400","$150","$3,250","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio3250Statewide","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","23"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","3","53901","AZ","Individual","No","86-0004538","53901AZ1350001","Portfolio HSA HMO 3250 - Statewide Network","53901AZ135",,"AZN001","AZS001","AZF005","New","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes",,"http://azblue.com/BlueExchangeSelectFormulary","53901AZ1350001-01","Standard Silver On Exchange Plan",,"0.681848526000977","Yes","Yes","No","100%",,"$3,250","$0","$400","$150","$3,250","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio3250Statewide","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","24"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","3","53901","AZ","Individual","No","86-0004538","53901AZ1350001","Portfolio HSA HMO 3250 - Statewide Network","53901AZ135",,"AZN001","AZS001","AZF005","New","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes",,"http://azblue.com/BlueExchangeSelectFormulary","53901AZ1350001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio3250StatewideZero","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","25"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","3","53901","AZ","Individual","No","86-0004538","53901AZ1350001","Portfolio HSA HMO 3250 - Statewide Network","53901AZ135",,"AZN001","AZS001","AZF005","New","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes",,"http://azblue.com/BlueExchangeSelectFormulary","53901AZ1350001-03","Limited Cost Sharing Plan Variation",,"0.681848526000977","Yes","Yes","No","100%",,"$3,250","$0","$400","$150","$3,250","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio3250Statewide","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","26"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","3","53901","AZ","Individual","No","86-0004538","53901AZ1350001","Portfolio HSA HMO 3250 - Statewide Network","53901AZ135",,"AZN001","AZS001","AZF005","New","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes",,"http://azblue.com/BlueExchangeSelectFormulary","53901AZ1350001-04","73% AV Level Silver Plan",,"0.722281992435455","Yes","Yes","No","100%",,"$2,750","$0","$450","$150","$2,750","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio3250Statewide73","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","27"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","3","53901","AZ","Individual","No","86-0004538","53901AZ1350001","Portfolio HSA HMO 3250 - Statewide Network","53901AZ135",,"AZN001","AZS001","AZF005","New","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes",,"http://azblue.com/BlueExchangeSelectFormulary","53901AZ1350001-05","87% AV Level Silver Plan",,"0.863364398479462","Yes","Yes","No","100%",,"$750","$0","$650","$150","$750","$0","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio3250Statewide87","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","28"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","3","53901","AZ","Individual","No","86-0004538","53901AZ1350001","Portfolio HSA HMO 3250 - Statewide Network","53901AZ135",,"AZN001","AZS001","AZF005","New","HMO","Silver","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes",,"http://azblue.com/BlueExchangeSelectFormulary","53901AZ1350001-06","94% AV Level Silver Plan",,"0.932114243507385","Yes","Yes","No","100%",,"$300","$0","$400","$150","$300","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio3250Statewide94","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","29"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","3","53901","AZ","Individual","No","86-0004538","53901AZ1350002","Portfolio HSA HMO 5500 - Statewide Network","53901AZ135",,"AZN001","AZS001","AZF006","New","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes",,"http://azblue.com/BlueExchangeSelectFormulary","53901AZ1350002-00","Standard Bronze Off Exchange Plan",,"0.612292349338531","Yes","Yes","No","100%",,"$5,500","$0","$180","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio5500Statewide","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","30"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","3","53901","AZ","Individual","No","86-0004538","53901AZ1350002","Portfolio HSA HMO 5500 - Statewide Network","53901AZ135",,"AZN001","AZS001","AZF006","New","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes",,"http://azblue.com/BlueExchangeSelectFormulary","53901AZ1350002-01","Standard Bronze On Exchange Plan",,"0.612292349338531","Yes","Yes","No","100%",,"$5,500","$0","$180","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio5500Statewide","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","31"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","3","53901","AZ","Individual","No","86-0004538","53901AZ1350002","Portfolio HSA HMO 5500 - Statewide Network","53901AZ135",,"AZN001","AZS001","AZF006","New","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes",,"http://azblue.com/BlueExchangeSelectFormulary","53901AZ1350002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio5500StatewideZero","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","32"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","3","53901","AZ","Individual","No","86-0004538","53901AZ1350002","Portfolio HSA HMO 5500 - Statewide Network","53901AZ135",,"AZN001","AZS001","AZF006","New","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes",,"http://azblue.com/BlueExchangeSelectFormulary","53901AZ1350002-03","Limited Cost Sharing Plan Variation",,"0.612292349338531","Yes","Yes","No","100%",,"$5,500","$0","$180","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio5500Statewide","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","33"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","3","53901","AZ","Individual","No","86-0004538","53901AZ1350003","Portfolio HSA HMO 6550 - Statewide Network","53901AZ135",,"AZN001","AZS001","AZF007","New","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes",,"http://azblue.com/BlueExchangeSelectFormulary","53901AZ1350003-00","Standard Bronze Off Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio6850Statewide","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","34"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","3","53901","AZ","Individual","No","86-0004538","53901AZ1350003","Portfolio HSA HMO 6550 - Statewide Network","53901AZ135",,"AZN001","AZS001","AZF007","New","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes",,"http://azblue.com/BlueExchangeSelectFormulary","53901AZ1350003-01","Standard Bronze On Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.azblue.com/2016plans/Portfolio6850Statewide","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","35"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","3","53901","AZ","Individual","No","86-0004538","53901AZ1350003","Portfolio HSA HMO 6550 - Statewide Network","53901AZ135",,"AZN001","AZS001","AZF007","New","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes",,"http://azblue.com/BlueExchangeSelectFormulary","53901AZ1350003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio6850StatewideZero","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","36"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","3","53901","AZ","Individual","No","86-0004538","53901AZ1350003","Portfolio HSA HMO 6550 - Statewide Network","53901AZ135",,"AZN001","AZS001","AZF007","New","HMO","Bronze","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes",,"http://azblue.com/BlueExchangeSelectFormulary","53901AZ1350003-03","Limited Cost Sharing Plan Variation",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/Portfolio6850Statewide","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","37"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","4","53901","AZ","Individual","No","86-0004538","53901AZ1170001","SimpleHealth HMO 6850 - Alliance Network","53901AZ117",,"AZN002","AZS002","AZF008","Existing","HMO","Catastrophic","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","3","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1170001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/SimpleHealth6850Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","4"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","4","53901","AZ","Individual","No","86-0004538","53901AZ1170001","SimpleHealth HMO 6850 - Alliance Network","53901AZ117",,"AZN002","AZS002","AZF008","Existing","HMO","Catastrophic","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","3","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1170001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/SimpleHealth6850Alliance","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","5"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","4","53901","AZ","Individual","No","86-0004538","53901AZ1180001","SimpleHealth HMO 6850 - Select Network","53901AZ118",,"AZN003","AZS002","AZF008","Existing","HMO","Catastrophic","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","3","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1180001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/SimpleHealth6850Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","6"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","4","53901","AZ","Individual","No","86-0004538","53901AZ1180001","SimpleHealth HMO 6850 - Select Network","53901AZ118",,"AZN003","AZS002","AZF008","Existing","HMO","Catastrophic","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","3","2016-01-01",,"Yes","Emergencies Only","Yes","Emergencies and Authorized Follow-up Care","No","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1180001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/SimpleHealth6850Select","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","7"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","4","53901","AZ","Individual","No","86-0004538","53901AZ1360001","SimpleHealth HMO 6850 - Statewide Network","53901AZ136",,"AZN001","AZS001","AZF008","New","HMO","Catastrophic","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","3","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1360001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/SimpleHealth6850Statewide","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","10"
"2016","AZ","53901","HIOS","5","2015-10-18 12:35:12","4","53901","AZ","Individual","No","86-0004538","53901AZ1360001","SimpleHealth HMO 6850 - Statewide Network","53901AZ136",,"AZN001","AZS001","AZF008","New","HMO","Catastrophic","No","Both","Yes","No",,"Non-covered services and any services related to or associated with non-covered services, non-medically necessary services, and all other benefit specific and general exclusions and limitations listed in the Summary of Benefits and Coverage.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9961",,,,"0","0","3","2016-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","http://www.azblue.com/payment","http://azblue.com/BlueExchangeSelectFormulary","53901AZ1360001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.azblue.com/2016plans/SimpleHealth6850Statewide","http://www.azblue.com/2016ShoppersGuide/IndividualandFamily","11"
"2016","AZ","58292","HIOS","8","2015-09-02 08:31:46","1","58292","AZ","Individual","Yes","75-1233841","58292AZ0010001","Dentegra Dental PPO Pediatric Basic Plan","58292AZ001",,"AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.91","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","58292AZ0010001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/az/58292az0010001-16","4"
"2016","AZ","58292","HIOS","8","2015-09-02 08:31:46","1","58292","AZ","SHOP (Small Group)","Yes","75-1233841","58292AZ0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","58292AZ002",,"AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.05","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","58292AZ0020001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/az/58292az0020001-16","4"
"2016","AZ","58292","HIOS","8","2015-09-02 08:31:46","2","58292","AZ","SHOP (Small Group)","Yes","75-1233841","58292AZ0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","58292AZ002",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.03","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","58292AZ0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/az/58292az0020004-16","4"
"2016","AZ","58292","HIOS","8","2015-09-02 08:31:46","2","58292","AZ","Individual","Yes","75-1233841","58292AZ0010004","Dentegra Dental PPO Family Preferred Plan","58292AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.84","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","58292AZ0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/az/58292az0010004-16","4"
"2016","AZ","58292","HIOS","8","2015-09-02 08:31:46","2","58292","AZ","Individual","Yes","75-1233841","58292AZ0010004","Dentegra Dental PPO Family Preferred Plan","58292AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.84","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","58292AZ0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/az/58292az0010004-16","5"
"2016","AZ","58292","HIOS","8","2015-09-02 08:31:46","2","58292","AZ","SHOP (Small Group)","Yes","75-1233841","58292AZ0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","58292AZ002",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.03","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","58292AZ0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/az/58292az0020004-16","5"
"2016","AZ","58292","HIOS","8","2015-09-02 08:31:46","3","58292","AZ","SHOP (Small Group)","Yes","75-1233841","58292AZ0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","58292AZ002",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.05","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","58292AZ0020006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/az/58292az0020006-16","4"
"2016","AZ","58292","HIOS","8","2015-09-02 08:31:46","3","58292","AZ","Individual","Yes","75-1233841","58292AZ0010006","Dentegra Dental PPO Family Basic Plan","58292AZ001",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.91","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","58292AZ0010006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/az/58292az0010006-16","4"
"2016","AZ","58292","HIOS","8","2015-09-02 08:31:46","3","58292","AZ","Individual","Yes","75-1233841","58292AZ0010006","Dentegra Dental PPO Family Basic Plan","58292AZ001",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.91","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","58292AZ0010006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/az/58292az0010006-16","5"
"2016","AZ","58292","HIOS","8","2015-09-02 08:31:46","3","58292","AZ","SHOP (Small Group)","Yes","75-1233841","58292AZ0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","58292AZ002",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.05","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","58292AZ0020006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/az/58292az0020006-16","5"
"2016","AZ","59748","HIOS","2","2015-07-11 04:19:24","1","59748","AZ","SHOP (Small Group)","Yes","44-0308260","59748AZ0010001","KCL EHB Low PPO","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$39.59","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010001-00","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","59748","HIOS","2","2015-07-11 04:19:24","1","59748","AZ","SHOP (Small Group)","Yes","44-0308260","59748AZ0010003","KCL EHB Low MAC","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$34.41","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010003-00","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","AZ","59748","HIOS","2","2015-07-11 04:19:24","1","59748","AZ","SHOP (Small Group)","Yes","44-0308260","59748AZ0010005","KCL Fam Low PPO","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$39.59","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010005-00","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","AZ","59748","HIOS","2","2015-07-11 04:19:24","1","59748","AZ","SHOP (Small Group)","Yes","44-0308260","59748AZ0010007","KCL Fam Low MAC","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$34.41","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010007-00","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","AZ","59748","HIOS","2","2015-07-11 04:19:24","2","59748","AZ","SHOP (Small Group)","Yes","44-0308260","59748AZ0010002","KCL EHB High PPO","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$49.59","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010002-00","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","59748","HIOS","2","2015-07-11 04:19:24","2","59748","AZ","SHOP (Small Group)","Yes","44-0308260","59748AZ0010004","KCL EHB High MAC","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$43.85","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010004-00","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","AZ","59748","HIOS","2","2015-07-11 04:19:24","2","59748","AZ","SHOP (Small Group)","Yes","44-0308260","59748AZ0010006","KCL Fam High PPO","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$49.59","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010006-00","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","AZ","59748","HIOS","2","2015-07-11 04:19:24","2","59748","AZ","SHOP (Small Group)","Yes","44-0308260","59748AZ0010008","KCL Fam High MAC","59748AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$43.85","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","59748AZ0010008-00","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0050001","Phoenix Choice Gold HMO","65441AZ005",,"AZN001","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0050001-00","Standard Gold Off Exchange Plan",,"0.781598269939423","No","Yes","No","100%",,"$1,800","$320","$890","$150","$1,800","$270","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/GoldW","https://www.phxchoice.com/brochure","4"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0050001","Phoenix Choice Gold HMO","65441AZ005",,"AZN001","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0050001-01","Standard Gold On Exchange Plan",,"0.781598269939423","No","Yes","No","100%",,"$1,800","$320","$890","$150","$1,800","$270","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/GoldW","https://www.phxchoice.com/brochure","5"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0050001","Phoenix Choice Gold HMO","65441AZ005",,"AZN001","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0050001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/GoldZCSW","https://www.phxchoice.com/brochure","6"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0050001","Phoenix Choice Gold HMO","65441AZ005",,"AZN001","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0050001-03","Limited Cost Sharing Plan Variation",,"0.781598269939423","No","Yes","No","100%",,"$1,800","$320","$890","$150","$1,800","$270","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/GoldLCSW","https://www.phxchoice.com/brochure","7"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0070001","Phoenix Choice Gold HMO Abrazo and Phoenix Children's Hospital","65441AZ007",,"AZN003","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0070001-00","Standard Gold Off Exchange Plan",,"0.781598269939423","No","Yes","No","100%",,"$1,800","$320","$890","$150","$1,800","$270","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/GoldAPCH","https://www.phxchoice.com/brochure","8"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0070001","Phoenix Choice Gold HMO Abrazo and Phoenix Children's Hospital","65441AZ007",,"AZN003","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0070001-01","Standard Gold On Exchange Plan",,"0.781598269939423","No","Yes","No","100%",,"$1,800","$320","$890","$150","$1,800","$270","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/GoldAPCH","https://www.phxchoice.com/brochure","9"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0070001","Phoenix Choice Gold HMO Abrazo and Phoenix Children's Hospital","65441AZ007",,"AZN003","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0070001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/GoldZCSAPCH","https://www.phxchoice.com/brochure","10"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0070001","Phoenix Choice Gold HMO Abrazo and Phoenix Children's Hospital","65441AZ007",,"AZN003","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0070001-03","Limited Cost Sharing Plan Variation",,"0.781598269939423","No","Yes","No","100%",,"$1,800","$320","$890","$150","$1,800","$270","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/GoldLCSAPCH","https://www.phxchoice.com/brochure","11"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0090001","Phoenix Choice Gold HMO Abrazo","65441AZ009",,"AZN005","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0090001-00","Standard Gold Off Exchange Plan",,"0.781598269939423","No","Yes","No","100%",,"$1,800","$320","$890","$150","$1,800","$270","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/GoldA","https://www.phxchoice.com/brochure","12"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0090001","Phoenix Choice Gold HMO Abrazo","65441AZ009",,"AZN005","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0090001-01","Standard Gold On Exchange Plan",,"0.781598269939423","No","Yes","No","100%",,"$1,800","$320","$890","$150","$1,800","$270","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/GoldA","https://www.phxchoice.com/brochure","13"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0090001","Phoenix Choice Gold HMO Abrazo","65441AZ009",,"AZN005","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0090001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/GoldZCSA","https://www.phxchoice.com/brochure","14"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0090001","Phoenix Choice Gold HMO Abrazo","65441AZ009",,"AZN005","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0090001-03","Limited Cost Sharing Plan Variation",,"0.781598269939423","No","Yes","No","100%",,"$1,800","$320","$890","$150","$1,800","$270","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/GoldLCSA","https://www.phxchoice.com/brochure","15"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0050002","Phoenix Choice Silver HMO","65441AZ005",,"AZN001","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0050002-00","Standard Silver Off Exchange Plan",,"0.680884540081024","No","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$170","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/SilverW","https://www.phxchoice.com/brochure","16"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0050002","Phoenix Choice Silver HMO","65441AZ005",,"AZN001","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0050002-01","Standard Silver On Exchange Plan",,"0.680884540081024","No","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$170","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/SilverW","https://www.phxchoice.com/brochure","17"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0050002","Phoenix Choice Silver HMO","65441AZ005",,"AZN001","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0050002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/SilverZCSW","https://www.phxchoice.com/brochure","18"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0050002","Phoenix Choice Silver HMO","65441AZ005",,"AZN001","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0050002-03","Limited Cost Sharing Plan Variation",,"0.680884540081024","No","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$170","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/SilverLCSW","https://www.phxchoice.com/brochure","19"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0050002","Phoenix Choice Silver HMO","65441AZ005",,"AZN001","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0050002-04","73% AV Level Silver Plan",,"0.730632066726685","No","Yes","No","100%",,"$2,600","$120","$1,340","$150","$2,600","$320","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/Silver73W","https://www.phxchoice.com/brochure","20"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0050002","Phoenix Choice Silver HMO","65441AZ005",,"AZN001","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0050002-05","87% AV Level Silver Plan",,"0.873557269573212","No","Yes","No","100%",,"$850","$330","$420","$150","$850","$380","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/Silver87W","https://www.phxchoice.com/brochure","21"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0050002","Phoenix Choice Silver HMO","65441AZ005",,"AZN001","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0050002-06","94% AV Level Silver Plan",,"0.945600628852844","No","Yes","No","100%",,"$250","$210","$40","$150","$250","$210","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/Silver94W","https://www.phxchoice.com/brochure","22"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0070002","Phoenix Choice Silver HMO Abrazo and Phoenix Children's Hospital","65441AZ007",,"AZN003","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0070002-00","Standard Silver Off Exchange Plan",,"0.680884540081024","No","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$170","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/SIlverAPCH","https://www.phxchoice.com/brochure","23"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0070002","Phoenix Choice Silver HMO Abrazo and Phoenix Children's Hospital","65441AZ007",,"AZN003","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0070002-01","Standard Silver On Exchange Plan",,"0.680884540081024","No","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$170","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/SIlverAPCH","https://www.phxchoice.com/brochure","24"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0070002","Phoenix Choice Silver HMO Abrazo and Phoenix Children's Hospital","65441AZ007",,"AZN003","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0070002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/SIlverZCSAPCH","https://www.phxchoice.com/brochure","25"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0070002","Phoenix Choice Silver HMO Abrazo and Phoenix Children's Hospital","65441AZ007",,"AZN003","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0070002-03","Limited Cost Sharing Plan Variation",,"0.680884540081024","No","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$170","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/SIlverLCSAPCH","https://www.phxchoice.com/brochure","26"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0070002","Phoenix Choice Silver HMO Abrazo and Phoenix Children's Hospital","65441AZ007",,"AZN003","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0070002-04","73% AV Level Silver Plan",,"0.730632066726685","No","Yes","No","100%",,"$2,600","$120","$1,340","$150","$2,600","$320","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/SIlver73APCH","https://www.phxchoice.com/brochure","27"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0070002","Phoenix Choice Silver HMO Abrazo and Phoenix Children's Hospital","65441AZ007",,"AZN003","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0070002-05","87% AV Level Silver Plan",,"0.873557269573212","No","Yes","No","100%",,"$850","$330","$420","$150","$850","$380","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/SIlver87APCH","https://www.phxchoice.com/brochure","28"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0070002","Phoenix Choice Silver HMO Abrazo and Phoenix Children's Hospital","65441AZ007",,"AZN003","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0070002-06","94% AV Level Silver Plan",,"0.945600628852844","No","Yes","No","100%",,"$250","$210","$40","$150","$250","$210","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/SIlver94APCH","https://www.phxchoice.com/brochure","29"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0090002","Phoenix Choice Silver HMO Abrazo","65441AZ009",,"AZN005","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0090002-00","Standard Silver Off Exchange Plan",,"0.680884540081024","No","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$170","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/SilverA","https://www.phxchoice.com/brochure","30"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0090002","Phoenix Choice Silver HMO Abrazo","65441AZ009",,"AZN005","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0090002-01","Standard Silver On Exchange Plan",,"0.680884540081024","No","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$170","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/SilverA","https://www.phxchoice.com/brochure","31"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0090002","Phoenix Choice Silver HMO Abrazo","65441AZ009",,"AZN005","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0090002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/SilverZCSA","https://www.phxchoice.com/brochure","32"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0090002","Phoenix Choice Silver HMO Abrazo","65441AZ009",,"AZN005","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0090002-03","Limited Cost Sharing Plan Variation",,"0.680884540081024","No","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$170","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/SilverLCSA","https://www.phxchoice.com/brochure","33"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0090002","Phoenix Choice Silver HMO Abrazo","65441AZ009",,"AZN005","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0090002-04","73% AV Level Silver Plan",,"0.730632066726685","No","Yes","No","100%",,"$2,600","$120","$1,340","$150","$2,600","$320","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/Silver73A","https://www.phxchoice.com/brochure","34"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0090002","Phoenix Choice Silver HMO Abrazo","65441AZ009",,"AZN005","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0090002-05","87% AV Level Silver Plan",,"0.873557269573212","No","Yes","No","100%",,"$850","$330","$420","$150","$850","$380","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/Silver87A","https://www.phxchoice.com/brochure","35"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","1","65441","AZ","Individual","No","20-2706634","65441AZ0090002","Phoenix Choice Silver HMO Abrazo","65441AZ009",,"AZN005","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0090002-06","94% AV Level Silver Plan",,"0.945600628852844","No","Yes","No","100%",,"$250","$210","$40","$150","$250","$210","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/Silver94A","https://www.phxchoice.com/brochure","36"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","2","65441","AZ","Individual","No","20-2706634","65441AZ0050003","Phoenix Choice Bronze HMO","65441AZ005",,"AZN001","AZS001","AZF003","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9998",,,,"0","0","2","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0050003-00","Standard Bronze Off Exchange Plan",,"0.608420789241791","Yes","Yes","No","100%",,"$6,150","$20","$390","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phxchoice.com/BronzeW","https://www.phxchoice.com/brochure","4"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","2","65441","AZ","Individual","No","20-2706634","65441AZ0050003","Phoenix Choice Bronze HMO","65441AZ005",,"AZN001","AZS001","AZF003","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9998",,,,"0","0","2","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0050003-01","Standard Bronze On Exchange Plan",,"0.608420789241791","Yes","Yes","No","100%",,"$6,150","$20","$390","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phxchoice.com/BronzeW","https://www.phxchoice.com/brochure","5"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","2","65441","AZ","Individual","No","20-2706634","65441AZ0050003","Phoenix Choice Bronze HMO","65441AZ005",,"AZN001","AZS001","AZF003","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9998",,,,"0","0","2","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0050003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phxchoice.com/BronzeZCSW","https://www.phxchoice.com/brochure","6"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","2","65441","AZ","Individual","No","20-2706634","65441AZ0050003","Phoenix Choice Bronze HMO","65441AZ005",,"AZN001","AZS001","AZF003","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9998",,,,"0","0","2","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0050003-03","Limited Cost Sharing Plan Variation",,"0.608420789241791","Yes","Yes","No","100%",,"$6,150","$20","$390","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phxchoice.com/BronzeLCSW","https://www.phxchoice.com/brochure","7"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","2","65441","AZ","Individual","No","20-2706634","65441AZ0070003","Phoenix Choice Bronze HMO Abrazo and Phoenix Children's Hospital","65441AZ007",,"AZN003","AZS001","AZF003","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9998",,,,"0","0","2","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0070003-00","Standard Bronze Off Exchange Plan",,"0.608420789241791","Yes","Yes","No","100%",,"$6,150","$20","$390","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phxchoice.com/BronzeAPCH","https://www.phxchoice.com/brochure","8"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","2","65441","AZ","Individual","No","20-2706634","65441AZ0070003","Phoenix Choice Bronze HMO Abrazo and Phoenix Children's Hospital","65441AZ007",,"AZN003","AZS001","AZF003","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9998",,,,"0","0","2","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0070003-01","Standard Bronze On Exchange Plan",,"0.608420789241791","Yes","Yes","No","100%",,"$6,150","$20","$390","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phxchoice.com/BronzeAPCH","https://www.phxchoice.com/brochure","9"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","2","65441","AZ","Individual","No","20-2706634","65441AZ0070003","Phoenix Choice Bronze HMO Abrazo and Phoenix Children's Hospital","65441AZ007",,"AZN003","AZS001","AZF003","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9998",,,,"0","0","2","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0070003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phxchoice.com/BronzeZCSAPCH","https://www.phxchoice.com/brochure","10"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","2","65441","AZ","Individual","No","20-2706634","65441AZ0070003","Phoenix Choice Bronze HMO Abrazo and Phoenix Children's Hospital","65441AZ007",,"AZN003","AZS001","AZF003","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9998",,,,"0","0","2","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0070003-03","Limited Cost Sharing Plan Variation",,"0.608420789241791","Yes","Yes","No","100%",,"$6,150","$20","$390","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phxchoice.com/BronzeLCSAPCH","https://www.phxchoice.com/brochure","11"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","2","65441","AZ","Individual","No","20-2706634","65441AZ0090003","Phoenix Choice Bronze HMO Abrazo","65441AZ009",,"AZN005","AZS001","AZF003","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9998",,,,"0","0","2","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0090003-00","Standard Bronze Off Exchange Plan",,"0.608420789241791","Yes","Yes","No","100%",,"$6,150","$20","$390","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phxchoice.com/BronzeA","https://www.phxchoice.com/brochure","12"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","2","65441","AZ","Individual","No","20-2706634","65441AZ0090003","Phoenix Choice Bronze HMO Abrazo","65441AZ009",,"AZN005","AZS001","AZF003","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9998",,,,"0","0","2","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0090003-01","Standard Bronze On Exchange Plan",,"0.608420789241791","Yes","Yes","No","100%",,"$6,150","$20","$390","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phxchoice.com/BronzeA","https://www.phxchoice.com/brochure","13"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","2","65441","AZ","Individual","No","20-2706634","65441AZ0090003","Phoenix Choice Bronze HMO Abrazo","65441AZ009",,"AZN005","AZS001","AZF003","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9998",,,,"0","0","2","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0090003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phxchoice.com/BronzeZCSA","https://www.phxchoice.com/brochure","14"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","2","65441","AZ","Individual","No","20-2706634","65441AZ0090003","Phoenix Choice Bronze HMO Abrazo","65441AZ009",,"AZN005","AZS001","AZF003","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9998",,,,"0","0","2","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0090003-03","Limited Cost Sharing Plan Variation",,"0.608420789241791","Yes","Yes","No","100%",,"$6,150","$20","$390","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phxchoice.com/BronzeLCSA","https://www.phxchoice.com/brochure","15"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","3","65441","AZ","Individual","No","20-2706634","65441AZ0050004","Phoenix Choice Catastrophic HMO","65441AZ005",,"AZN001","AZS001","AZF004","New","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9997",,,,"0","0","3","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0050004-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phxchoice.com/CatastrophicW","https://www.phxchoice.com/brochure","4"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","3","65441","AZ","Individual","No","20-2706634","65441AZ0050004","Phoenix Choice Catastrophic HMO","65441AZ005",,"AZN001","AZS001","AZF004","New","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9997",,,,"0","0","3","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0050004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phxchoice.com/CatastrophicW","https://www.phxchoice.com/brochure","5"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","3","65441","AZ","Individual","No","20-2706634","65441AZ0070004","Phoenix Choice Catastrophic HMO Abrazo and Phoenix Children's Hospital","65441AZ007",,"AZN003","AZS001","AZF004","New","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9997",,,,"0","0","3","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0070004-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phxchoice.com/CatastrophicAPCH","https://www.phxchoice.com/brochure","6"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","3","65441","AZ","Individual","No","20-2706634","65441AZ0070004","Phoenix Choice Catastrophic HMO Abrazo and Phoenix Children's Hospital","65441AZ007",,"AZN003","AZS001","AZF004","New","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9997",,,,"0","0","3","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0070004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phxchoice.com/CatastrophicAPCH","https://www.phxchoice.com/brochure","7"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","3","65441","AZ","Individual","No","20-2706634","65441AZ0090004","Phoenix Choice Catastrophic HMO Abrazo","65441AZ009",,"AZN005","AZS001","AZF004","New","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,,"0","0","3","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0090004-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phxchoice.com/CatastrophicA","https://www.phxchoice.com/brochure","8"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","3","65441","AZ","Individual","No","20-2706634","65441AZ0090004","Phoenix Choice Catastrophic HMO Abrazo","65441AZ009",,"AZN005","AZS001","AZF004","New","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9996",,,,"0","0","3","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0090004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phxchoice.com/CatastrophicA","https://www.phxchoice.com/brochure","9"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0060001","Phoenix Choice Gold HMO + Dental/Vision","65441AZ006",,"AZN002","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.969",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0060001-00","Standard Gold Off Exchange Plan",,"0.781598269939423","No","Yes","No","100%",,"$1,800","$320","$890","$150","$1,800","$270","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusGoldW","https://www.phxchoice.com/brochure","4"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0060001","Phoenix Choice Gold HMO + Dental/Vision","65441AZ006",,"AZN002","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.969",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0060001-01","Standard Gold On Exchange Plan",,"0.781598269939423","No","Yes","No","100%",,"$1,800","$320","$890","$150","$1,800","$270","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusGoldW","https://www.phxchoice.com/brochure","5"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0060001","Phoenix Choice Gold HMO + Dental/Vision","65441AZ006",,"AZN002","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.969",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0060001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusGoldZCSW","https://www.phxchoice.com/brochure","6"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0060001","Phoenix Choice Gold HMO + Dental/Vision","65441AZ006",,"AZN002","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.969",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0060001-03","Limited Cost Sharing Plan Variation",,"0.781598269939423","No","Yes","No","100%",,"$1,800","$320","$890","$150","$1,800","$270","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusGoldLCSW","https://www.phxchoice.com/brochure","7"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0080001","Phoenix Choice Gold HMO Abrazo and Phoenix Children’s Hospital + Dental/Vision","65441AZ008",,"AZN004","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9679",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0080001-00","Standard Gold Off Exchange Plan",,"0.781598269939423","No","Yes","No","100%",,"$1,800","$320","$890","$150","$1,800","$270","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusGoldAPCH","https://www.phxchoice.com/brochure","8"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0080001","Phoenix Choice Gold HMO Abrazo and Phoenix Children’s Hospital + Dental/Vision","65441AZ008",,"AZN004","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9679",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0080001-01","Standard Gold On Exchange Plan",,"0.781598269939423","No","Yes","No","100%",,"$1,800","$320","$890","$150","$1,800","$270","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusGoldAPCH","https://www.phxchoice.com/brochure","9"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0080001","Phoenix Choice Gold HMO Abrazo and Phoenix Children’s Hospital + Dental/Vision","65441AZ008",,"AZN004","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9679",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0080001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusGoldZCSAPCH","https://www.phxchoice.com/brochure","10"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0080001","Phoenix Choice Gold HMO Abrazo and Phoenix Children’s Hospital + Dental/Vision","65441AZ008",,"AZN004","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9679",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0080001-03","Limited Cost Sharing Plan Variation",,"0.781598269939423","No","Yes","No","100%",,"$1,800","$320","$890","$150","$1,800","$270","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusGoldLCSAPCH","https://www.phxchoice.com/brochure","11"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0100001","Phoenix Choice Gold HMO Abrazo + Dental/Vision","65441AZ010",,"AZN006","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9674",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0100001-00","Standard Gold Off Exchange Plan",,"0.781598269939423","No","Yes","No","100%",,"$1,800","$320","$890","$150","$1,800","$270","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusGoldA","https://www.phxchoice.com/brochure","12"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0100001","Phoenix Choice Gold HMO Abrazo + Dental/Vision","65441AZ010",,"AZN006","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9674",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0100001-01","Standard Gold On Exchange Plan",,"0.781598269939423","No","Yes","No","100%",,"$1,800","$320","$890","$150","$1,800","$270","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusGoldA","https://www.phxchoice.com/brochure","13"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0100001","Phoenix Choice Gold HMO Abrazo + Dental/Vision","65441AZ010",,"AZN006","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9674",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0100001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusGoldZCSA","https://www.phxchoice.com/brochure","14"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0100001","Phoenix Choice Gold HMO Abrazo + Dental/Vision","65441AZ010",,"AZN006","AZS001","AZF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9674",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0100001-03","Limited Cost Sharing Plan Variation",,"0.781598269939423","No","Yes","No","100%",,"$1,800","$320","$890","$150","$1,800","$270","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusGoldLCSA","https://www.phxchoice.com/brochure","15"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0060002","Phoenix Choice Silver HMO + Dental/Vision","65441AZ006",,"AZN002","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.964",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0060002-00","Standard Silver Off Exchange Plan",,"0.680884540081024","No","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$170","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusSilverW","https://www.phxchoice.com/brochure","16"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0060002","Phoenix Choice Silver HMO + Dental/Vision","65441AZ006",,"AZN002","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.964",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0060002-01","Standard Silver On Exchange Plan",,"0.680884540081024","No","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$170","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusSilverW","https://www.phxchoice.com/brochure","17"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0060002","Phoenix Choice Silver HMO + Dental/Vision","65441AZ006",,"AZN002","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.964",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0060002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusSilverZCSW","https://www.phxchoice.com/brochure","18"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0060002","Phoenix Choice Silver HMO + Dental/Vision","65441AZ006",,"AZN002","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.964",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0060002-03","Limited Cost Sharing Plan Variation",,"0.680884540081024","No","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$170","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusSilverLCSW","https://www.phxchoice.com/brochure","19"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0060002","Phoenix Choice Silver HMO + Dental/Vision","65441AZ006",,"AZN002","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.964",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0060002-04","73% AV Level Silver Plan",,"0.730632066726685","No","Yes","No","100%",,"$2,600","$120","$1,340","$150","$2,600","$320","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusSilver73W","https://www.phxchoice.com/brochure","20"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0060002","Phoenix Choice Silver HMO + Dental/Vision","65441AZ006",,"AZN002","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.964",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0060002-05","87% AV Level Silver Plan",,"0.873557269573212","No","Yes","No","100%",,"$850","$330","$420","$150","$850","$380","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusSilver87W","https://www.phxchoice.com/brochure","21"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0060002","Phoenix Choice Silver HMO + Dental/Vision","65441AZ006",,"AZN002","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.964",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0060002-06","94% AV Level Silver Plan",,"0.945600628852844","No","Yes","No","100%",,"$250","$210","$40","$150","$250","$210","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusSilver94W","https://www.phxchoice.com/brochure","22"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0080002","Phoenix Choice Silver HMO Abrazo and Phoenix Children's Hospital + Dental/Vision","65441AZ008",,"AZN004","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9628",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0080002-00","Standard Silver Off Exchange Plan",,"0.680884540081024","No","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$170","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusSilverAPCH","https://www.phxchoice.com/brochure","23"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0080002","Phoenix Choice Silver HMO Abrazo and Phoenix Children's Hospital + Dental/Vision","65441AZ008",,"AZN004","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9628",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0080002-01","Standard Silver On Exchange Plan",,"0.680884540081024","No","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$170","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusSilverAPCH","https://www.phxchoice.com/brochure","24"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0080002","Phoenix Choice Silver HMO Abrazo and Phoenix Children's Hospital + Dental/Vision","65441AZ008",,"AZN004","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9628",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0080002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusSilverZCSAPCH","https://www.phxchoice.com/brochure","25"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0080002","Phoenix Choice Silver HMO Abrazo and Phoenix Children's Hospital + Dental/Vision","65441AZ008",,"AZN004","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9628",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0080002-03","Limited Cost Sharing Plan Variation",,"0.680884540081024","No","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$170","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusSilverLCSAPCH","https://www.phxchoice.com/brochure","26"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0080002","Phoenix Choice Silver HMO Abrazo and Phoenix Children's Hospital + Dental/Vision","65441AZ008",,"AZN004","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9628",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0080002-04","73% AV Level Silver Plan",,"0.730632066726685","No","Yes","No","100%",,"$2,600","$120","$1,340","$150","$2,600","$320","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusSilver73APCH","https://www.phxchoice.com/brochure","27"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0080002","Phoenix Choice Silver HMO Abrazo and Phoenix Children's Hospital + Dental/Vision","65441AZ008",,"AZN004","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9628",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0080002-05","87% AV Level Silver Plan",,"0.873557269573212","No","Yes","No","100%",,"$850","$330","$420","$150","$850","$380","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusSilver87APCH","https://www.phxchoice.com/brochure","28"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0080002","Phoenix Choice Silver HMO Abrazo and Phoenix Children's Hospital + Dental/Vision","65441AZ008",,"AZN004","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9628",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0080002-06","94% AV Level Silver Plan",,"0.945600628852844","No","Yes","No","100%",,"$250","$210","$40","$150","$250","$210","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusSilver94APCH","https://www.phxchoice.com/brochure","29"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0100002","Phoenix Choice Silver HMO Abrazo + Dental/Vision","65441AZ010",,"AZN006","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9621",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0100002-00","Standard Silver Off Exchange Plan",,"0.680884540081024","No","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$170","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusSilverA","https://www.phxchoice.com/brochure","30"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0100002","Phoenix Choice Silver HMO Abrazo + Dental/Vision","65441AZ010",,"AZN006","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9621",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0100002-01","Standard Silver On Exchange Plan",,"0.680884540081024","No","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$170","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusSilverA","https://www.phxchoice.com/brochure","31"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0100002","Phoenix Choice Silver HMO Abrazo + Dental/Vision","65441AZ010",,"AZN006","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9621",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0100002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusSilverZCSA","https://www.phxchoice.com/brochure","32"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0100002","Phoenix Choice Silver HMO Abrazo + Dental/Vision","65441AZ010",,"AZN006","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9621",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0100002-03","Limited Cost Sharing Plan Variation",,"0.680884540081024","No","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$170","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusSilverLCSA","https://www.phxchoice.com/brochure","33"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0100002","Phoenix Choice Silver HMO Abrazo + Dental/Vision","65441AZ010",,"AZN006","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9621",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0100002-04","73% AV Level Silver Plan",,"0.730632066726685","No","Yes","No","100%",,"$2,600","$120","$1,340","$150","$2,600","$320","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusSilver73A","https://www.phxchoice.com/brochure","34"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0100002","Phoenix Choice Silver HMO Abrazo + Dental/Vision","65441AZ010",,"AZN006","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9621",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0100002-05","87% AV Level Silver Plan",,"0.873557269573212","No","Yes","No","100%",,"$850","$330","$420","$150","$850","$380","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusSilver87A","https://www.phxchoice.com/brochure","35"
"2016","AZ","65441","HIOS","4","2015-08-23 12:37:12","4","65441","AZ","Individual","No","20-2706634","65441AZ0100002","Phoenix Choice Silver HMO Abrazo + Dental/Vision","65441AZ010",,"AZN006","AZS001","AZF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, High Blood Pressure & High Cholesterol, Pregnancy","0.9621",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=AZ","https://www.phxchoice.com/Formulary","65441AZ0100002-06","94% AV Level Silver Plan",,"0.945600628852844","No","Yes","No","100%",,"$250","$210","$40","$150","$250","$210","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.phxchoice.com/PlusSilver94A","https://www.phxchoice.com/brochure","36"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","15","70239","AZ","Individual","No","46-2210067","70239AZ0010059","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS005","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010059-03","Limited Cost Sharing Plan Variation",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","19","70239","AZ","Individual","No","46-2210067","70239AZ0010063","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS007","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010063-00","Standard Gold Off Exchange Plan",,"0.781999826431274","Yes","Yes","No","100%",,"$1,500","$0","$1,208","$0","$1,500","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","66105","HIOS","6","2015-08-20 09:36:54","1","66105","AZ","Individual","Yes","39-1263473","66105AZ0620001","Humana Dental Smart Choice","66105AZ062",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.75","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","66105AZ0620001-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","per person not applicable","per group not applicable",,,,,,"$90","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612831","4"
"2016","AZ","66105","HIOS","6","2015-08-20 09:36:54","1","66105","AZ","Individual","Yes","39-1263473","66105AZ0620001","Humana Dental Smart Choice","66105AZ062",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.75","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","66105AZ0620001-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","per person not applicable","per group not applicable",,,,,,"$90","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612831","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","8","70239","AZ","Individual","No","46-2210067","70239AZ0010052","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS003","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010052-06","94% AV Level Silver Plan",,"0.93012934923172","Yes","Yes","No","100%",,"$100","$0","$744","$0","$100","$208","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$1,100","$1100 per person","$2200 per group","$1,100","$1100 per person","$2200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilver94.pdf","http://www.healthchoiceessential.com/members","10"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","9","70239","AZ","Individual","No","46-2210067","70239AZ0010053","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS003","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010053-00","Standard Bronze Off Exchange Plan",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","9","70239","AZ","Individual","No","46-2210067","70239AZ0010053","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS003","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010053-01","Standard Bronze On Exchange Plan",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","9","70239","AZ","Individual","No","46-2210067","70239AZ0010053","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS003","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010053-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","21","70239","AZ","Individual","No","46-2210067","70239AZ0010065","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS007","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010065-00","Standard Bronze Off Exchange Plan",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","21","70239","AZ","Individual","No","46-2210067","70239AZ0010065","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS007","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010065-01","Standard Bronze On Exchange Plan",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","21","70239","AZ","Individual","No","46-2210067","70239AZ0010065","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS007","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010065-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","21","70239","AZ","Individual","No","46-2210067","70239AZ0010065","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS007","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010065-03","Limited Cost Sharing Plan Variation",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","22","70239","AZ","Individual","No","46-2210067","70239AZ0010066","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS008","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010066-00","Standard Silver Off Exchange Plan",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","22","70239","AZ","Individual","No","46-2210067","70239AZ0010066","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS008","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010066-01","Standard Silver On Exchange Plan",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","66915","HIOS","3","2015-08-27 11:14:25","1","66915","AZ","SHOP (Small Group)","Yes","36-0883760","66915AZ0040002","EHB High PPO","66915AZ004",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.54","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","66915AZ0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","AZ","66915","HIOS","3","2015-08-27 11:14:25","1","66915","AZ","SHOP (Small Group)","Yes","36-0883760","66915AZ0040001","EHB Low PPO","66915AZ004",,"AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.47","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","66915AZ0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","AZ","66915","HIOS","3","2015-08-27 11:14:25","1","66915","AZ","SHOP (Small Group)","Yes","36-0883760","66915AZ0030002","EHB High Passive","66915AZ003",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$47.44","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","66915AZ0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","AZ","66915","HIOS","3","2015-08-27 11:14:25","1","66915","AZ","SHOP (Small Group)","Yes","36-0883760","66915AZ0030001","EHB Low Passive","66915AZ003",,"AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.73","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","66915AZ0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","1","70239","AZ","Individual","No","46-2210067","70239AZ0010045","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS001","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010045-00","Standard Gold Off Exchange Plan",,"0.781999826431274","Yes","Yes","No","100%",,"$1,500","$0","$1,208","$0","$1,500","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","1","70239","AZ","Individual","No","46-2210067","70239AZ0010045","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS001","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010045-01","Standard Gold On Exchange Plan",,"0.781999826431274","Yes","Yes","No","100%",,"$1,500","$0","$1,208","$0","$1,500","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","1","70239","AZ","Individual","No","46-2210067","70239AZ0010045","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS001","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010045-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","1","70239","AZ","Individual","No","46-2210067","70239AZ0010045","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS001","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010045-03","Limited Cost Sharing Plan Variation",,"0.781999826431274","Yes","Yes","No","100%",,"$1,500","$0","$1,208","$0","$1,500","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","2","70239","AZ","Individual","No","46-2210067","70239AZ0010046","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS001","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010046-00","Standard Silver Off Exchange Plan",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","2","70239","AZ","Individual","No","46-2210067","70239AZ0010046","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS001","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010046-01","Standard Silver On Exchange Plan",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","2","70239","AZ","Individual","No","46-2210067","70239AZ0010046","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS001","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010046-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","2","70239","AZ","Individual","No","46-2210067","70239AZ0010046","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS001","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010046-03","Limited Cost Sharing Plan Variation",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","2","70239","AZ","Individual","No","46-2210067","70239AZ0010046","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS001","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010046-04","73% AV Level Silver Plan",,"0.720103919506073","Yes","Yes","No","100%",,"$2,400","$0","$1,028","$0","$2,400","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$2,400","$2400 per person","$4800 per group","$2,400","$2400 per person","$4800 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilver73.pdf","http://www.healthchoiceessential.com/members","8"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","2","70239","AZ","Individual","No","46-2210067","70239AZ0010046","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS001","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010046-05","87% AV Level Silver Plan",,"0.860382437705994","Yes","Yes","No","100%",,"$600","$0","$1,388","$0","$600","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"$2,200","$2200 per person","$4400 per group","$2,200","$2200 per person","$4400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20%",,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilver87.pdf","http://www.healthchoiceessential.com/members","9"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","2","70239","AZ","Individual","No","46-2210067","70239AZ0010046","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS001","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010046-06","94% AV Level Silver Plan",,"0.93012934923172","Yes","Yes","No","100%",,"$100","$0","$744","$0","$100","$208","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$1,100","$1100 per person","$2200 per group","$1,100","$1100 per person","$2200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilver94.pdf","http://www.healthchoiceessential.com/members","10"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","3","70239","AZ","Individual","No","46-2210067","70239AZ0010047","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS001","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010047-00","Standard Bronze Off Exchange Plan",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","3","70239","AZ","Individual","No","46-2210067","70239AZ0010047","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS001","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010047-01","Standard Bronze On Exchange Plan",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","3","70239","AZ","Individual","No","46-2210067","70239AZ0010047","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS001","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010047-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","3","70239","AZ","Individual","No","46-2210067","70239AZ0010047","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS001","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010047-03","Limited Cost Sharing Plan Variation",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","4","70239","AZ","Individual","No","46-2210067","70239AZ0010048","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS002","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010048-00","Standard Gold Off Exchange Plan",,"0.781999826431274","Yes","Yes","No","100%",,"$1,500","$0","$1,208","$0","$1,500","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","4","70239","AZ","Individual","No","46-2210067","70239AZ0010048","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS002","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010048-01","Standard Gold On Exchange Plan",,"0.781999826431274","Yes","Yes","No","100%",,"$1,500","$0","$1,208","$0","$1,500","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","4","70239","AZ","Individual","No","46-2210067","70239AZ0010048","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS002","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010048-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","4","70239","AZ","Individual","No","46-2210067","70239AZ0010048","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS002","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010048-03","Limited Cost Sharing Plan Variation",,"0.781999826431274","Yes","Yes","No","100%",,"$1,500","$0","$1,208","$0","$1,500","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","5","70239","AZ","Individual","No","46-2210067","70239AZ0010049","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS002","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010049-00","Standard Silver Off Exchange Plan",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","5","70239","AZ","Individual","No","46-2210067","70239AZ0010049","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS002","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010049-01","Standard Silver On Exchange Plan",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","5","70239","AZ","Individual","No","46-2210067","70239AZ0010049","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS002","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010049-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","5","70239","AZ","Individual","No","46-2210067","70239AZ0010049","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS002","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010049-03","Limited Cost Sharing Plan Variation",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","5","70239","AZ","Individual","No","46-2210067","70239AZ0010049","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS002","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010049-04","73% AV Level Silver Plan",,"0.720103919506073","Yes","Yes","No","100%",,"$2,400","$0","$1,028","$0","$2,400","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$2,400","$2400 per person","$4800 per group","$2,400","$2400 per person","$4800 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilver73.pdf","http://www.healthchoiceessential.com/members","8"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","5","70239","AZ","Individual","No","46-2210067","70239AZ0010049","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS002","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010049-05","87% AV Level Silver Plan",,"0.860382437705994","Yes","Yes","No","100%",,"$600","$0","$1,388","$0","$600","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"$2,200","$2200 per person","$4400 per group","$2,200","$2200 per person","$4400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20%",,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilver87.pdf","http://www.healthchoiceessential.com/members","9"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","5","70239","AZ","Individual","No","46-2210067","70239AZ0010049","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS002","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010049-06","94% AV Level Silver Plan",,"0.93012934923172","Yes","Yes","No","100%",,"$100","$0","$744","$0","$100","$208","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$1,100","$1100 per person","$2200 per group","$1,100","$1100 per person","$2200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilver94.pdf","http://www.healthchoiceessential.com/members","10"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","6","70239","AZ","Individual","No","46-2210067","70239AZ0010050","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS002","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010050-00","Standard Bronze Off Exchange Plan",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","6","70239","AZ","Individual","No","46-2210067","70239AZ0010050","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS002","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010050-01","Standard Bronze On Exchange Plan",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","6","70239","AZ","Individual","No","46-2210067","70239AZ0010050","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS002","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010050-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","6","70239","AZ","Individual","No","46-2210067","70239AZ0010050","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS002","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010050-03","Limited Cost Sharing Plan Variation",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","7","70239","AZ","Individual","No","46-2210067","70239AZ0010051","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS003","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010051-00","Standard Gold Off Exchange Plan",,"0.781999826431274","Yes","Yes","No","100%",,"$1,500","$0","$1,208","$0","$1,500","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","7","70239","AZ","Individual","No","46-2210067","70239AZ0010051","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS003","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010051-01","Standard Gold On Exchange Plan",,"0.781999826431274","Yes","Yes","No","100%",,"$1,500","$0","$1,208","$0","$1,500","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","7","70239","AZ","Individual","No","46-2210067","70239AZ0010051","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS003","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010051-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","7","70239","AZ","Individual","No","46-2210067","70239AZ0010051","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS003","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010051-03","Limited Cost Sharing Plan Variation",,"0.781999826431274","Yes","Yes","No","100%",,"$1,500","$0","$1,208","$0","$1,500","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","8","70239","AZ","Individual","No","46-2210067","70239AZ0010052","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS003","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010052-00","Standard Silver Off Exchange Plan",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","8","70239","AZ","Individual","No","46-2210067","70239AZ0010052","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS003","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010052-01","Standard Silver On Exchange Plan",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","8","70239","AZ","Individual","No","46-2210067","70239AZ0010052","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS003","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010052-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","8","70239","AZ","Individual","No","46-2210067","70239AZ0010052","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS003","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010052-03","Limited Cost Sharing Plan Variation",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","8","70239","AZ","Individual","No","46-2210067","70239AZ0010052","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS003","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010052-04","73% AV Level Silver Plan",,"0.720103919506073","Yes","Yes","No","100%",,"$2,400","$0","$1,028","$0","$2,400","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$2,400","$2400 per person","$4800 per group","$2,400","$2400 per person","$4800 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilver73.pdf","http://www.healthchoiceessential.com/members","8"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","8","70239","AZ","Individual","No","46-2210067","70239AZ0010052","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS003","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010052-05","87% AV Level Silver Plan",,"0.860382437705994","Yes","Yes","No","100%",,"$600","$0","$1,388","$0","$600","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"$2,200","$2200 per person","$4400 per group","$2,200","$2200 per person","$4400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20%",,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilver87.pdf","http://www.healthchoiceessential.com/members","9"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","9","70239","AZ","Individual","No","46-2210067","70239AZ0010053","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS003","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010053-03","Limited Cost Sharing Plan Variation",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","10","70239","AZ","Individual","No","46-2210067","70239AZ0010054","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS004","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010054-00","Standard Gold Off Exchange Plan",,"0.781999826431274","Yes","Yes","No","100%",,"$1,500","$0","$1,208","$0","$1,500","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","10","70239","AZ","Individual","No","46-2210067","70239AZ0010054","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS004","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010054-01","Standard Gold On Exchange Plan",,"0.781999826431274","Yes","Yes","No","100%",,"$1,500","$0","$1,208","$0","$1,500","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","10","70239","AZ","Individual","No","46-2210067","70239AZ0010054","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS004","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010054-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","10","70239","AZ","Individual","No","46-2210067","70239AZ0010054","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS004","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010054-03","Limited Cost Sharing Plan Variation",,"0.781999826431274","Yes","Yes","No","100%",,"$1,500","$0","$1,208","$0","$1,500","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","11","70239","AZ","Individual","No","46-2210067","70239AZ0010055","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS004","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010055-00","Standard Silver Off Exchange Plan",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","11","70239","AZ","Individual","No","46-2210067","70239AZ0010055","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS004","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010055-01","Standard Silver On Exchange Plan",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","11","70239","AZ","Individual","No","46-2210067","70239AZ0010055","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS004","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010055-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","11","70239","AZ","Individual","No","46-2210067","70239AZ0010055","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS004","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010055-03","Limited Cost Sharing Plan Variation",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","11","70239","AZ","Individual","No","46-2210067","70239AZ0010055","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS004","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010055-04","73% AV Level Silver Plan",,"0.720103919506073","Yes","Yes","No","100%",,"$2,400","$0","$1,028","$0","$2,400","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$2,400","$2400 per person","$4800 per group","$2,400","$2400 per person","$4800 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilver73.pdf","http://www.healthchoiceessential.com/members","8"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","11","70239","AZ","Individual","No","46-2210067","70239AZ0010055","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS004","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010055-05","87% AV Level Silver Plan",,"0.860382437705994","Yes","Yes","No","100%",,"$600","$0","$1,388","$0","$600","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"$2,200","$2200 per person","$4400 per group","$2,200","$2200 per person","$4400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20%",,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilver87.pdf","http://www.healthchoiceessential.com/members","9"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","11","70239","AZ","Individual","No","46-2210067","70239AZ0010055","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS004","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010055-06","94% AV Level Silver Plan",,"0.93012934923172","Yes","Yes","No","100%",,"$100","$0","$744","$0","$100","$208","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$1,100","$1100 per person","$2200 per group","$1,100","$1100 per person","$2200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilver94.pdf","http://www.healthchoiceessential.com/members","10"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","12","70239","AZ","Individual","No","46-2210067","70239AZ0010056","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS004","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010056-00","Standard Bronze Off Exchange Plan",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","12","70239","AZ","Individual","No","46-2210067","70239AZ0010056","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS004","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010056-01","Standard Bronze On Exchange Plan",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","12","70239","AZ","Individual","No","46-2210067","70239AZ0010056","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS004","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010056-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","12","70239","AZ","Individual","No","46-2210067","70239AZ0010056","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS004","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010056-03","Limited Cost Sharing Plan Variation",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","13","70239","AZ","Individual","No","46-2210067","70239AZ0010057","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS005","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010057-00","Standard Gold Off Exchange Plan",,"0.781999826431274","Yes","Yes","No","100%",,"$1,500","$0","$1,208","$0","$1,500","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","13","70239","AZ","Individual","No","46-2210067","70239AZ0010057","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS005","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010057-01","Standard Gold On Exchange Plan",,"0.781999826431274","Yes","Yes","No","100%",,"$1,500","$0","$1,208","$0","$1,500","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","13","70239","AZ","Individual","No","46-2210067","70239AZ0010057","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS005","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010057-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","13","70239","AZ","Individual","No","46-2210067","70239AZ0010057","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS005","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010057-03","Limited Cost Sharing Plan Variation",,"0.781999826431274","Yes","Yes","No","100%",,"$1,500","$0","$1,208","$0","$1,500","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","14","70239","AZ","Individual","No","46-2210067","70239AZ0010058","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS005","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010058-00","Standard Silver Off Exchange Plan",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","14","70239","AZ","Individual","No","46-2210067","70239AZ0010058","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS005","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010058-01","Standard Silver On Exchange Plan",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","14","70239","AZ","Individual","No","46-2210067","70239AZ0010058","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS005","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010058-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","14","70239","AZ","Individual","No","46-2210067","70239AZ0010058","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS005","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010058-03","Limited Cost Sharing Plan Variation",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","14","70239","AZ","Individual","No","46-2210067","70239AZ0010058","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS005","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010058-04","73% AV Level Silver Plan",,"0.720103919506073","Yes","Yes","No","100%",,"$2,400","$0","$1,028","$0","$2,400","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$2,400","$2400 per person","$4800 per group","$2,400","$2400 per person","$4800 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilver73.pdf","http://www.healthchoiceessential.com/members","8"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","14","70239","AZ","Individual","No","46-2210067","70239AZ0010058","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS005","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010058-05","87% AV Level Silver Plan",,"0.860382437705994","Yes","Yes","No","100%",,"$600","$0","$1,388","$0","$600","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"$2,200","$2200 per person","$4400 per group","$2,200","$2200 per person","$4400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20%",,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilver87.pdf","http://www.healthchoiceessential.com/members","9"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","14","70239","AZ","Individual","No","46-2210067","70239AZ0010058","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS005","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010058-06","94% AV Level Silver Plan",,"0.93012934923172","Yes","Yes","No","100%",,"$100","$0","$744","$0","$100","$208","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$1,100","$1100 per person","$2200 per group","$1,100","$1100 per person","$2200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilver94.pdf","http://www.healthchoiceessential.com/members","10"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","15","70239","AZ","Individual","No","46-2210067","70239AZ0010059","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS005","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010059-00","Standard Bronze Off Exchange Plan",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","15","70239","AZ","Individual","No","46-2210067","70239AZ0010059","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS005","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010059-01","Standard Bronze On Exchange Plan",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","15","70239","AZ","Individual","No","46-2210067","70239AZ0010059","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS005","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010059-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","19","70239","AZ","Individual","No","46-2210067","70239AZ0010063","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS007","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010063-01","Standard Gold On Exchange Plan",,"0.781999826431274","Yes","Yes","No","100%",,"$1,500","$0","$1,208","$0","$1,500","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","19","70239","AZ","Individual","No","46-2210067","70239AZ0010063","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS007","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010063-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","19","70239","AZ","Individual","No","46-2210067","70239AZ0010063","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS007","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010063-03","Limited Cost Sharing Plan Variation",,"0.781999826431274","Yes","Yes","No","100%",,"$1,500","$0","$1,208","$0","$1,500","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialGoldLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","20","70239","AZ","Individual","No","46-2210067","70239AZ0010064","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS007","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010064-00","Standard Silver Off Exchange Plan",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","34","70239","AZ","Individual","No","46-2210067","70239AZ0010078","Health Choice Value Bronze","70239AZ001",,"AZN002","AZS008","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010078-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016ValueBronzeZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","34","70239","AZ","Individual","No","46-2210067","70239AZ0010078","Health Choice Value Bronze","70239AZ001",,"AZN002","AZS008","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010078-03","Limited Cost Sharing Plan Variation",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016ValueBronzeLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","35","70239","AZ","Individual","No","46-2210067","70239AZ0010079","Health Choice Value Basic","70239AZ001",,"AZN002","AZS008","AZF004","New","HMO","Catastrophic","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010079-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016ValueBasic.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","35","70239","AZ","Individual","No","46-2210067","70239AZ0010079","Health Choice Value Basic","70239AZ001",,"AZN002","AZS008","AZF004","New","HMO","Catastrophic","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010079-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016ValueBasic.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","36","70239","AZ","Individual","No","46-2210067","70239AZ0010080","Health Choice Total Wellness Silver","70239AZ001",,"AZN002","AZS008","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010080-00","Standard Silver Off Exchange Plan",,"0.686304926872253","Yes","Yes","No","100%",,"$3,100","$0","$888","$0","$3,100","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","20%",,,,,"$3,100","$3100 per person","$6200 per group","$3,100","$3100 per person","$6200 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016TotalWellnessSilverStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","36","70239","AZ","Individual","No","46-2210067","70239AZ0010080","Health Choice Total Wellness Silver","70239AZ001",,"AZN002","AZS008","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010080-01","Standard Silver On Exchange Plan",,"0.686304926872253","Yes","Yes","No","100%",,"$3,100","$0","$888","$0","$3,100","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","20%",,,,,"$3,100","$3100 per person","$6200 per group","$3,100","$3100 per person","$6200 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016TotalWellnessSilverStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","4","78611","AZ","Individual","No","23-2169745","78611AZ0060001","Aetna Leap Everyday – Banner","78611AZ006",,"AZN001","AZS001","AZF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060001-05","87% AV Level Silver Plan","86.03%",,"Yes","Yes","No","100%",,"$1,600","$0","$0","$200","$1,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,570","$1570 per person","$3140 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,570","$1570 per person","$3140 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/SilverBasicCSR87.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","9"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","4","78611","AZ","Individual","No","23-2169745","78611AZ0060001","Aetna Leap Everyday – Banner","78611AZ006",,"AZN001","AZS001","AZF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060001-06","94% AV Level Silver Plan","93.09%",,"Yes","Yes","No","100%",,"$700","$0","$0","$200","$600","$40","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$680","$680 per person","$1360 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$680","$680 per person","$1360 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/SilverBasicCSR94.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","10"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","5","78611","AZ","Individual","No","23-2169745","78611AZ0060002","Aetna Leap Everyday Plus – Banner","78611AZ006",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060002-00","Standard Silver Off Exchange Plan","71.79%",,"Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,510","$4510 per person","$9020 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,510","$4510 per person","$9020 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/banner/SilverPlus.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/banner.pdf","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","20","70239","AZ","Individual","No","46-2210067","70239AZ0010064","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS007","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010064-01","Standard Silver On Exchange Plan",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","20","70239","AZ","Individual","No","46-2210067","70239AZ0010064","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS007","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010064-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","20","70239","AZ","Individual","No","46-2210067","70239AZ0010064","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS007","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010064-03","Limited Cost Sharing Plan Variation",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","20","70239","AZ","Individual","No","46-2210067","70239AZ0010064","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS007","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010064-04","73% AV Level Silver Plan",,"0.720103919506073","Yes","Yes","No","100%",,"$2,400","$0","$1,028","$0","$2,400","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$2,400","$2400 per person","$4800 per group","$2,400","$2400 per person","$4800 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilver73.pdf","http://www.healthchoiceessential.com/members","8"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","20","70239","AZ","Individual","No","46-2210067","70239AZ0010064","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS007","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010064-05","87% AV Level Silver Plan",,"0.860382437705994","Yes","Yes","No","100%",,"$600","$0","$1,388","$0","$600","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"$2,200","$2200 per person","$4400 per group","$2,200","$2200 per person","$4400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20%",,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilver87.pdf","http://www.healthchoiceessential.com/members","9"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","20","70239","AZ","Individual","No","46-2210067","70239AZ0010064","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS007","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010064-06","94% AV Level Silver Plan",,"0.93012934923172","Yes","Yes","No","100%",,"$100","$0","$744","$0","$100","$208","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$1,100","$1100 per person","$2200 per group","$1,100","$1100 per person","$2200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilver94.pdf","http://www.healthchoiceessential.com/members","10"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","22","70239","AZ","Individual","No","46-2210067","70239AZ0010066","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS008","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010066-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","22","70239","AZ","Individual","No","46-2210067","70239AZ0010066","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS008","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010066-03","Limited Cost Sharing Plan Variation",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilverLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","22","70239","AZ","Individual","No","46-2210067","70239AZ0010066","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS008","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010066-04","73% AV Level Silver Plan",,"0.720103919506073","Yes","Yes","No","100%",,"$2,400","$0","$1,028","$0","$2,400","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$2,400","$2400 per person","$4800 per group","$2,400","$2400 per person","$4800 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilver73.pdf","http://www.healthchoiceessential.com/members","8"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","22","70239","AZ","Individual","No","46-2210067","70239AZ0010066","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS008","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010066-05","87% AV Level Silver Plan",,"0.860382437705994","Yes","Yes","No","100%",,"$600","$0","$1,388","$0","$600","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"$2,200","$2200 per person","$4400 per group","$2,200","$2200 per person","$4400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20%",,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilver87.pdf","http://www.healthchoiceessential.com/members","9"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","22","70239","AZ","Individual","No","46-2210067","70239AZ0010066","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS008","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010066-06","94% AV Level Silver Plan",,"0.93012934923172","Yes","Yes","No","100%",,"$100","$0","$744","$0","$100","$208","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$1,100","$1100 per person","$2200 per group","$1,100","$1100 per person","$2200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialSilver94.pdf","http://www.healthchoiceessential.com/members","10"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","23","70239","AZ","Individual","No","46-2210067","70239AZ0010067","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS008","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010067-00","Standard Bronze Off Exchange Plan",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","23","70239","AZ","Individual","No","46-2210067","70239AZ0010067","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS008","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010067-01","Standard Bronze On Exchange Plan",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","23","70239","AZ","Individual","No","46-2210067","70239AZ0010067","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS008","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010067-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","23","70239","AZ","Individual","No","46-2210067","70239AZ0010067","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS008","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010067-03","Limited Cost Sharing Plan Variation",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBronzeLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","24","70239","AZ","Individual","No","46-2210067","70239AZ0010068","Health Choice Essential Basic","70239AZ001",,"AZN001","AZS001","AZF004","New","HMO","Catastrophic","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010068-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBasic.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","24","70239","AZ","Individual","No","46-2210067","70239AZ0010068","Health Choice Essential Basic","70239AZ001",,"AZN001","AZS001","AZF004","New","HMO","Catastrophic","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010068-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBasic.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","25","70239","AZ","Individual","No","46-2210067","70239AZ0010069","Health Choice Essential Basic","70239AZ001",,"AZN001","AZS002","AZF004","New","HMO","Catastrophic","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010069-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBasic.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","25","70239","AZ","Individual","No","46-2210067","70239AZ0010069","Health Choice Essential Basic","70239AZ001",,"AZN001","AZS002","AZF004","New","HMO","Catastrophic","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010069-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBasic.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","26","70239","AZ","Individual","No","46-2210067","70239AZ0010070","Health Choice Essential Basic","70239AZ001",,"AZN001","AZS003","AZF004","New","HMO","Catastrophic","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010070-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBasic.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","26","70239","AZ","Individual","No","46-2210067","70239AZ0010070","Health Choice Essential Basic","70239AZ001",,"AZN001","AZS003","AZF004","New","HMO","Catastrophic","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010070-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBasic.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","27","70239","AZ","Individual","No","46-2210067","70239AZ0010071","Health Choice Essential Basic","70239AZ001",,"AZN001","AZS004","AZF004","New","HMO","Catastrophic","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010071-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBasic.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","27","70239","AZ","Individual","No","46-2210067","70239AZ0010071","Health Choice Essential Basic","70239AZ001",,"AZN001","AZS004","AZF004","New","HMO","Catastrophic","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010071-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBasic.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","28","70239","AZ","Individual","No","46-2210067","70239AZ0010072","Health Choice Essential Basic","70239AZ001",,"AZN001","AZS005","AZF004","New","HMO","Catastrophic","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010072-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBasic.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","28","70239","AZ","Individual","No","46-2210067","70239AZ0010072","Health Choice Essential Basic","70239AZ001",,"AZN001","AZS005","AZF004","New","HMO","Catastrophic","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010072-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBasic.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","30","70239","AZ","Individual","No","46-2210067","70239AZ0010074","Health Choice Essential Basic","70239AZ001",,"AZN001","AZS007","AZF004","New","HMO","Catastrophic","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010074-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBasic.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","30","70239","AZ","Individual","No","46-2210067","70239AZ0010074","Health Choice Essential Basic","70239AZ001",,"AZN001","AZS007","AZF004","New","HMO","Catastrophic","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010074-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBasic.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","31","70239","AZ","Individual","No","46-2210067","70239AZ0010075","Health Choice Essential Basic","70239AZ001",,"AZN001","AZS008","AZF004","New","HMO","Catastrophic","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010075-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBasic.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","31","70239","AZ","Individual","No","46-2210067","70239AZ0010075","Health Choice Essential Basic","70239AZ001",,"AZN001","AZS008","AZF004","New","HMO","Catastrophic","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010075-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016EssentialBasic.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","32","70239","AZ","Individual","No","46-2210067","70239AZ0010076","Health Choice Value Gold","70239AZ001",,"AZN002","AZS008","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010076-00","Standard Gold Off Exchange Plan",,"0.781999826431274","Yes","Yes","No","100%",,"$1,500","$0","$1,208","$0","$1,500","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016ValueGoldStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","32","70239","AZ","Individual","No","46-2210067","70239AZ0010076","Health Choice Value Gold","70239AZ001",,"AZN002","AZS008","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010076-01","Standard Gold On Exchange Plan",,"0.781999826431274","Yes","Yes","No","100%",,"$1,500","$0","$1,208","$0","$1,500","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016ValueGoldStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","32","70239","AZ","Individual","No","46-2210067","70239AZ0010076","Health Choice Value Gold","70239AZ001",,"AZN002","AZS008","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010076-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016ValueGoldZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","32","70239","AZ","Individual","No","46-2210067","70239AZ0010076","Health Choice Value Gold","70239AZ001",,"AZN002","AZS008","AZF003","New","HMO","Gold","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010076-03","Limited Cost Sharing Plan Variation",,"0.781999826431274","Yes","Yes","No","100%",,"$1,500","$0","$1,208","$0","$1,500","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016ValueGoldLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","33","70239","AZ","Individual","No","46-2210067","70239AZ0010077","Health Choice Value Silver","70239AZ001",,"AZN002","AZS008","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010077-00","Standard Silver Off Exchange Plan",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016ValueSilverStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","33","70239","AZ","Individual","No","46-2210067","70239AZ0010077","Health Choice Value Silver","70239AZ001",,"AZN002","AZS008","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010077-01","Standard Silver On Exchange Plan",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016ValueSilverStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","33","70239","AZ","Individual","No","46-2210067","70239AZ0010077","Health Choice Value Silver","70239AZ001",,"AZN002","AZS008","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010077-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016ValueSilverZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","33","70239","AZ","Individual","No","46-2210067","70239AZ0010077","Health Choice Value Silver","70239AZ001",,"AZN002","AZS008","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010077-03","Limited Cost Sharing Plan Variation",,"0.696381568908691","Yes","Yes","No","100%",,"$2,500","$0","$1,008","$0","$2,500","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016ValueSilverLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","33","70239","AZ","Individual","No","46-2210067","70239AZ0010077","Health Choice Value Silver","70239AZ001",,"AZN002","AZS008","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010077-04","73% AV Level Silver Plan",,"0.720103919506073","Yes","Yes","No","100%",,"$2,400","$0","$1,028","$0","$2,400","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$2,400","$2400 per person","$4800 per group","$2,400","$2400 per person","$4800 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016ValueSilver73.pdf","http://www.healthchoiceessential.com/members","8"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","33","70239","AZ","Individual","No","46-2210067","70239AZ0010077","Health Choice Value Silver","70239AZ001",,"AZN002","AZS008","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010077-05","87% AV Level Silver Plan",,"0.860382437705994","Yes","Yes","No","100%",,"$600","$0","$1,388","$0","$600","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"$2,200","$2200 per person","$4400 per group","$2,200","$2200 per person","$4400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20%",,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016ValueSilver87.pdf","http://www.healthchoiceessential.com/members","9"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","33","70239","AZ","Individual","No","46-2210067","70239AZ0010077","Health Choice Value Silver","70239AZ001",,"AZN002","AZS008","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010077-06","94% AV Level Silver Plan",,"0.93012934923172","Yes","Yes","No","100%",,"$100","$0","$744","$0","$100","$208","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$1,100","$1100 per person","$2200 per group","$1,100","$1100 per person","$2200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016ValueSilver94.pdf","http://www.healthchoiceessential.com/members","10"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","34","70239","AZ","Individual","No","46-2210067","70239AZ0010078","Health Choice Value Bronze","70239AZ001",,"AZN002","AZS008","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010078-00","Standard Bronze Off Exchange Plan",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016ValueBronzeStandard.pdf","http://www.healthchoiceessential.com/members","4"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","34","70239","AZ","Individual","No","46-2210067","70239AZ0010078","Health Choice Value Bronze","70239AZ001",,"AZN002","AZS008","AZF001","New","HMO","Bronze","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010078-01","Standard Bronze On Exchange Plan",,"0.61807519197464","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016ValueBronzeStandard.pdf","http://www.healthchoiceessential.com/members","5"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","36","70239","AZ","Individual","No","46-2210067","70239AZ0010080","Health Choice Total Wellness Silver","70239AZ001",,"AZN002","AZS008","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010080-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016TotalWellnessSilverZeroCost.pdf","http://www.healthchoiceessential.com/members","6"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","36","70239","AZ","Individual","No","46-2210067","70239AZ0010080","Health Choice Total Wellness Silver","70239AZ001",,"AZN002","AZS008","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010080-03","Limited Cost Sharing Plan Variation",,"0.686304926872253","Yes","Yes","No","100%",,"$3,100","$0","$888","$0","$3,100","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","20%",,,,,"$3,100","$3100 per person","$6200 per group","$3,100","$3100 per person","$6200 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016TotalWellnessSilverLimitedCost.pdf","http://www.healthchoiceessential.com/members","7"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","36","70239","AZ","Individual","No","46-2210067","70239AZ0010080","Health Choice Total Wellness Silver","70239AZ001",,"AZN002","AZS008","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010080-04","73% AV Level Silver Plan",,"0.721306324005127","Yes","Yes","No","100%",,"$2,450","$0","$1,058","$0","$2,450","$420","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","20%",,,,,"$2,450","$2450 per person","$4900 per group","$2,450","$2450 per person","$4900 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016TotalWellnessSilver73.pdf","http://www.healthchoiceessential.com/members","8"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","36","70239","AZ","Individual","No","46-2210067","70239AZ0010080","Health Choice Total Wellness Silver","70239AZ001",,"AZN002","AZS008","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010080-05","87% AV Level Silver Plan",,"0.860382437705994","Yes","Yes","No","100%",,"$600","$0","$1,388","$0","$600","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"$2,200","$2200 per person","$4400 per group","$2,200","$2200 per person","$4400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20%",,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016TotalWellnessSilver87.pdf","http://www.healthchoiceessential.com/members","9"
"2016","AZ","70239","HIOS","8","2016-01-28 05:11:31","36","70239","AZ","Individual","No","46-2210067","70239AZ0010080","Health Choice Total Wellness Silver","70239AZ001",,"AZN002","AZS008","AZF002","New","HMO","Silver","No","Both","No","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010080-06","94% AV Level Silver Plan",,"0.93012934923172","Yes","Yes","No","100%",,"$100","$0","$744","$0","$100","$208","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$1,100","$1100 per person","$2200 per group","$1,100","$1100 per person","$2200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group","No",,,"http://www.healthchoiceessential.com/docs/members/benefits/SBC2016TotalWellnessSilver94.pdf","http://www.healthchoiceessential.com/members","10"
"2016","AZ","77352","HIOS","3","2015-08-27 11:14:25","1","77352","AZ","Individual","Yes","95-6042390","77352AZ0020003","BESTOne Advantage Gold","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.19","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2016/AZ_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","AZ","77352","HIOS","3","2015-08-27 11:14:25","1","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010007","BESTDental Premium","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.35","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2016/AZ_BESTDental_Premium_Plan.pdf","4"
"2016","AZ","77352","HIOS","3","2015-08-27 11:14:25","1","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010007","BESTDental Premium","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.35","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2016/AZ_BESTDental_Premium_Plan.pdf","5"
"2016","AZ","77352","HIOS","3","2015-08-27 11:14:25","1","77352","AZ","Individual","Yes","95-6042390","77352AZ0020003","BESTOne Advantage Gold","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.19","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2016/AZ_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","AZ","77352","HIOS","3","2015-08-27 11:14:25","1","77352","AZ","Individual","Yes","95-6042390","77352AZ0020004","BESTOne Plus Gold","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.19","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2016/AZ_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","AZ","77352","HIOS","3","2015-08-27 11:14:25","1","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010008","BESTDental Standard - H","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.35","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2016/AZ_BESTDental_Standard-H_Plan.pdf","6"
"2016","AZ","77352","HIOS","3","2015-08-27 11:14:25","1","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010008","BESTDental Standard - H","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.35","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2016/AZ_BESTDental_Standard-H_Plan.pdf","7"
"2016","AZ","77352","HIOS","3","2015-08-27 11:14:25","1","77352","AZ","Individual","Yes","95-6042390","77352AZ0020004","BESTOne Plus Gold","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.19","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2016/AZ_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","AZ","77352","HIOS","3","2015-08-27 11:14:25","1","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010010","BESTDental Choice - H","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.35","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2016/AZ_BESTDental_Choice-H_Plan.pdf","8"
"2016","AZ","77352","HIOS","3","2015-08-27 11:14:25","1","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010010","BESTDental Choice - H","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.35","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2016/AZ_BESTDental_Choice-H_Plan.pdf","9"
"2016","AZ","77352","HIOS","3","2015-08-27 11:14:25","2","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010009","BESTDental Standard - L","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.26","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2016/AZ_BESTDental_Standard-L_Plan.pdf","4"
"2016","AZ","77352","HIOS","3","2015-08-27 11:14:25","2","77352","AZ","Individual","Yes","95-6042390","77352AZ0020005","BESTOne Plus Silver","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.33","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2016/AZ_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","AZ","77352","HIOS","3","2015-08-27 11:14:25","2","77352","AZ","Individual","Yes","95-6042390","77352AZ0020005","BESTOne Plus Silver","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.33","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2016/AZ_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","AZ","77352","HIOS","3","2015-08-27 11:14:25","2","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010009","BESTDental Standard - L","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.26","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2016/AZ_BESTDental_Standard-L_Plan.pdf","5"
"2016","AZ","77352","HIOS","3","2015-08-27 11:14:25","2","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010011","BESTDental Choice - L","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.26","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2016/AZ_BESTDental_Choice-L_Plan.pdf","6"
"2016","AZ","77352","HIOS","3","2015-08-27 11:14:25","2","77352","AZ","Individual","Yes","95-6042390","77352AZ0020006","BESTOne Basic Silver","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.33","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2016/AZ_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","AZ","77352","HIOS","3","2015-08-27 11:14:25","2","77352","AZ","Individual","Yes","95-6042390","77352AZ0020006","BESTOne Basic Silver","77352AZ002",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.33","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2016/AZ_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","AZ","77352","HIOS","3","2015-08-27 11:14:25","2","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010011","BESTDental Choice - L","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.26","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2016/AZ_BESTDental_Choice-L_Plan.pdf","7"
"2016","AZ","77352","HIOS","3","2015-08-27 11:14:25","2","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010012","BESTDental Value","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.26","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2016/AZ_BESTDental_Value_Plan.pdf","8"
"2016","AZ","77352","HIOS","3","2015-08-27 11:14:25","2","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010012","BESTDental Value","77352AZ001",,"AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.26","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","77352AZ0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/AZ/2016/AZ_BESTDental_Value_Plan.pdf","9"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","1","78611","AZ","Individual","No","23-2169745","78611AZ0060004","Aetna Leap Basic – Banner","78611AZ006",,"AZN001","AZS001","AZF004","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060004-00","Standard Bronze Off Exchange Plan","59.02%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/banner/BronzeBasic.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/banner.pdf","4"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","1","78611","AZ","Individual","No","23-2169745","78611AZ0060004","Aetna Leap Basic – Banner","78611AZ006",,"AZN001","AZS001","AZF004","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060004-01","Standard Bronze On Exchange Plan","59.02%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/BronzeBasic.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","5"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","1","78611","AZ","Individual","No","23-2169745","78611AZ0060004","Aetna Leap Basic – Banner","78611AZ006",,"AZN001","AZS001","AZF004","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/BronzeBasicAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","6"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","1","78611","AZ","Individual","No","23-2169745","78611AZ0060004","Aetna Leap Basic – Banner","78611AZ006",,"AZN001","AZS001","AZF004","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060004-03","Limited Cost Sharing Plan Variation","59.02%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/BronzeBasicAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","7"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","2","78611","AZ","Individual","No","23-2169745","78611AZ0060005","Aetna Leap Basic HSA – Banner","78611AZ006",,"AZN001","AZS001","AZF005","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060005-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/banner/BronzeHSA.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/banner.pdf","4"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","2","78611","AZ","Individual","No","23-2169745","78611AZ0060005","Aetna Leap Basic HSA – Banner","78611AZ006",,"AZN001","AZS001","AZF005","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060005-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/BronzeHSA.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","5"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","2","78611","AZ","Individual","No","23-2169745","78611AZ0060005","Aetna Leap Basic HSA – Banner","78611AZ006",,"AZN001","AZS001","AZF005","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/BronzeHSAAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","6"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","2","78611","AZ","Individual","No","23-2169745","78611AZ0060005","Aetna Leap Basic HSA – Banner","78611AZ006",,"AZN001","AZS001","AZF005","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060005-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/BronzeHSAAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","7"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","3","78611","AZ","Individual","No","23-2169745","78611AZ0060003","Aetna Leap Basic Plus – Banner","78611AZ006",,"AZN001","AZS001","AZF003","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060003-00","Standard Bronze Off Exchange Plan","60.81%",,"Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/banner/BronzePlus.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/banner.pdf","4"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","3","78611","AZ","Individual","No","23-2169745","78611AZ0060003","Aetna Leap Basic Plus – Banner","78611AZ006",,"AZN001","AZS001","AZF003","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060003-01","Standard Bronze On Exchange Plan","60.81%",,"Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/BronzePlus.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","5"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","3","78611","AZ","Individual","No","23-2169745","78611AZ0060003","Aetna Leap Basic Plus – Banner","78611AZ006",,"AZN001","AZS001","AZF003","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/BronzePlusAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","6"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","3","78611","AZ","Individual","No","23-2169745","78611AZ0060003","Aetna Leap Basic Plus – Banner","78611AZ006",,"AZN001","AZS001","AZF003","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060003-03","Limited Cost Sharing Plan Variation","60.81%",,"Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/BronzePlusAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","7"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","4","78611","AZ","Individual","No","23-2169745","78611AZ0060001","Aetna Leap Everyday – Banner","78611AZ006",,"AZN001","AZS001","AZF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060001-00","Standard Silver Off Exchange Plan","68.09%",,"Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/banner/SilverBasic.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/banner.pdf","4"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","4","78611","AZ","Individual","No","23-2169745","78611AZ0060001","Aetna Leap Everyday – Banner","78611AZ006",,"AZN001","AZS001","AZF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060001-01","Standard Silver On Exchange Plan","68.09%",,"Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/SilverBasic.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","5"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","4","78611","AZ","Individual","No","23-2169745","78611AZ0060001","Aetna Leap Everyday – Banner","78611AZ006",,"AZN001","AZS001","AZF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/SilverBasicAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","6"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","4","78611","AZ","Individual","No","23-2169745","78611AZ0060001","Aetna Leap Everyday – Banner","78611AZ006",,"AZN001","AZS001","AZF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060001-03","Limited Cost Sharing Plan Variation","68.09%",,"Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/SilverBasicAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","7"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","4","78611","AZ","Individual","No","23-2169745","78611AZ0060001","Aetna Leap Everyday – Banner","78611AZ006",,"AZN001","AZS001","AZF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060001-04","73% AV Level Silver Plan","72.06%",,"Yes","Yes","No","100%",,"$4,200","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,210","$4210 per person","$8420 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,210","$4210 per person","$8420 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/SilverBasicCSR73.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","8"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","5","78611","AZ","Individual","No","23-2169745","78611AZ0060002","Aetna Leap Everyday Plus – Banner","78611AZ006",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060002-01","Standard Silver On Exchange Plan","71.79%",,"Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,510","$4510 per person","$9020 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,510","$4510 per person","$9020 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/SilverPlus.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","5"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","5","78611","AZ","Individual","No","23-2169745","78611AZ0060002","Aetna Leap Everyday Plus – Banner","78611AZ006",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/SilverPlusAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","6"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","5","78611","AZ","Individual","No","23-2169745","78611AZ0060002","Aetna Leap Everyday Plus – Banner","78611AZ006",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060002-03","Limited Cost Sharing Plan Variation","71.79%",,"Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,510","$4510 per person","$9020 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,510","$4510 per person","$9020 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/SilverPlusAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","7"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","5","78611","AZ","Individual","No","23-2169745","78611AZ0060002","Aetna Leap Everyday Plus – Banner","78611AZ006",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060002-04","73% AV Level Silver Plan","73.83%",,"Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/SilverPlusCSR73.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","8"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","5","78611","AZ","Individual","No","23-2169745","78611AZ0060002","Aetna Leap Everyday Plus – Banner","78611AZ006",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060002-05","87% AV Level Silver Plan","86.00%",,"Yes","Yes","No","100%",,"$1,700","$0","$0","$200","$1,500","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/SilverPlusCSR87.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","9"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","5","78611","AZ","Individual","No","23-2169745","78611AZ0060002","Aetna Leap Everyday Plus – Banner","78611AZ006",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060002-06","94% AV Level Silver Plan","94.38%",,"Yes","Yes","No","100%",,"$600","$0","$0","$200","$500","$40","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/SilverPlusCSR94.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","10"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","6","78611","AZ","Individual","No","23-2169745","78611AZ0060007","Aetna Leap Diabetes – Banner","78611AZ006",,"AZN001","AZS001","AZF007","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060007-00","Standard Gold Off Exchange Plan","78.36%",,"Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/banner/GoldDiabetes.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/banner.pdf","4"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","6","78611","AZ","Individual","No","23-2169745","78611AZ0060007","Aetna Leap Diabetes – Banner","78611AZ006",,"AZN001","AZS001","AZF007","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060007-01","Standard Gold On Exchange Plan","78.36%",,"Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/GoldDiabetes.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","5"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","6","78611","AZ","Individual","No","23-2169745","78611AZ0060007","Aetna Leap Diabetes – Banner","78611AZ006",,"AZN001","AZS001","AZF007","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060007-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/GoldDiabetesAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","6"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","6","78611","AZ","Individual","No","23-2169745","78611AZ0060007","Aetna Leap Diabetes – Banner","78611AZ006",,"AZN001","AZS001","AZF007","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060007-03","Limited Cost Sharing Plan Variation","78.36%",,"Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/GoldDiabetesAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","7"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","7","78611","AZ","Individual","No","23-2169745","78611AZ0060006","Aetna Leap Specialty – Banner","78611AZ006",,"AZN001","AZS001","AZF006","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060006-00","Standard Gold Off Exchange Plan","78.34%",,"Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/banner/GoldBasic.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/banner.pdf","4"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","7","78611","AZ","Individual","No","23-2169745","78611AZ0060006","Aetna Leap Specialty – Banner","78611AZ006",,"AZN001","AZS001","AZF006","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060006-01","Standard Gold On Exchange Plan","78.34%",,"Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/GoldBasic.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","5"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","7","78611","AZ","Individual","No","23-2169745","78611AZ0060006","Aetna Leap Specialty – Banner","78611AZ006",,"AZN001","AZS001","AZF006","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/GoldBasicAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","6"
"2016","AZ","78611","HIOS","7","2015-08-26 09:56:12","7","78611","AZ","Individual","No","23-2169745","78611AZ0060006","Aetna Leap Specialty – Banner","78611AZ006",,"AZN001","AZS001","AZF006","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0634405625","78611AZ0060006-03","Limited Cost Sharing Plan Variation","78.34%",,"Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/banner/GoldBasicAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/banner.pdf","7"
"2016","AZ","79500","HIOS","5","2015-07-09 13:17:42","1","79500","AZ","SHOP (Small Group)","Yes","41-0808596","79500AZ0010002","Plan 2. Passive PPO $1000 Annual Maximum, Ortho","79500AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","79500AZ0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","79500","HIOS","5","2015-07-09 13:17:42","1","79500","AZ","SHOP (Small Group)","Yes","41-0808596","79500AZ0010005","Plan 5. Passive PPO, $2000 Annaul Maximum, Ortho","79500AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","79500AZ0010005-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","AZ","79500","HIOS","5","2015-07-09 13:17:42","1","79500","AZ","SHOP (Small Group)","Yes","41-0808596","79500AZ0010006","Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho","79500AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","79500AZ0010006-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","AZ","79500","HIOS","5","2015-07-09 13:17:42","1","79500","AZ","SHOP (Small Group)","Yes","41-0808596","79500AZ0010009","Plan 9. MAC PPO, $1500 Annual Maximum, Ortho","79500AZ001",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$20.18","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","79500AZ0010009-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","AZ","90264","HIOS","3","2015-08-27 11:14:25","1","90264","AZ","SHOP (Small Group)","Yes","47-0098400","90264AZ0040001","EHB Low PPO","90264AZ004",,"AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.17","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","90264AZ0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","AZ","90264","HIOS","3","2015-08-27 11:14:25","1","90264","AZ","SHOP (Small Group)","Yes","47-0098400","90264AZ0030002","EHB High Passive","90264AZ003",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$46.79","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","90264AZ0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","5","91450","AZ","Individual","No","36-3097810","91450AZ0080030","CommunityCare HMO Silver $30/$50/$4500 without Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080030-03","Limited Cost Sharing Plan Variation",,"0.69350266456604","No","Yes","No","100%",,"$4,500","$20","$600","$200","$1,300","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_30_50_4500_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_30_50_4500.pdf","7"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","5","91450","AZ","Individual","No","36-3097810","91450AZ0080030","CommunityCare HMO Silver $30/$50/$4500 without Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080030-04","73% AV Level Silver Plan",,"0.739651441574097","No","Yes","No","100%",,"$1,600","$20","$1,100","$200","$1,300","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_74_csr_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_74_csr.pdf","8"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","5","91450","AZ","Individual","No","36-3097810","91450AZ0080030","CommunityCare HMO Silver $30/$50/$4500 without Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080030-05","87% AV Level Silver Plan",,"0.873884677886963","No","Yes","No","100%",,"$500","$70","$800","$200","$500","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_87_csr_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_87_csr.pdf","9"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","5","91450","AZ","Individual","No","36-3097810","91450AZ0080030","CommunityCare HMO Silver $30/$50/$4500 without Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080030-06","94% AV Level Silver Plan",,"0.948922276496887","No","Yes","No","100%",,"$0","$80","$600","$200","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_94_csr_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_94_csr.pdf","10"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","6","91450","AZ","Individual","No","36-3097810","91450AZ0080032","CommunityCare HMO Bronze  40%/40%/$5750 without Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080032-00","Standard Bronze Off Exchange Plan",,"0.617232084274292","Yes","Yes","No","100%",,"$5,800","$20","$200","$200","$1,300","$3,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_bronze_40_40_5750_sbc.pdf","https://www.healthnet.com/static/broker/unprotected/pdfs/az/ifp/2016_az_ifp_cc_hmo_bronze_40_40_5750.pdf","4"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","6","91450","AZ","Individual","No","36-3097810","91450AZ0080032","CommunityCare HMO Bronze  40%/40%/$5750 without Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080032-01","Standard Bronze On Exchange Plan",,"0.617232084274292","Yes","Yes","No","100%",,"$5,800","$20","$200","$200","$1,300","$3,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_bronze_40_40_5750_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_bronze_40_40_5750.pdf","5"
"2016","AZ","83130","HIOS","3","2015-07-11 04:19:24","1","83130","AZ","SHOP (Small Group)","Yes","47-0397286","83130AZ0060001","Renaissance Group Dental PPO, EHB Certified","83130AZ006",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.78","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","83130AZ0060001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","83130","HIOS","3","2015-07-11 04:19:24","1","83130","AZ","Individual","Yes","47-0397286","83130AZ0040001","Delta Dental Individual PPO, EHB Certified","83130AZ004",,"AZN002","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.92","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","83130AZ0040001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","83130","HIOS","3","2015-07-11 04:19:24","1","83130","AZ","Individual","Yes","47-0397286","83130AZ0040002","Delta Dental Individual PPO, EHB Certified","83130AZ004",,"AZN002","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.99","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","83130AZ0040002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","AZ","83130","HIOS","3","2015-07-11 04:19:24","1","83130","AZ","SHOP (Small Group)","Yes","47-0397286","83130AZ0060002","Renaissance Group Dental PPO, EHB Certified","83130AZ006",,"AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.35","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","83130AZ0060002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","AZ","83130","HIOS","3","2015-07-11 04:19:24","1","83130","AZ","Individual","Yes","47-0397286","83130AZ0050001","Renaissance Individual Dental PPO, EHB Certified","83130AZ005",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.99","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","83130AZ0050001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","AZ","83130","HIOS","3","2015-07-11 04:19:24","1","83130","AZ","Individual","Yes","47-0397286","83130AZ0050002","Renaissance Individual Dental PPO, EHB Certified","83130AZ005",,"AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.82","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","83130AZ0050002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","AZ","86830","HIOS","4","2015-08-20 09:36:54","1","86830","AZ","Individual","Yes","59-1031071","86830AZ0050001","Cigna Dental Pediatric","86830AZ005","7730182962","AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$30.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","All Services","Yes",,"","86830AZ0050001-00","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/individuals-families/2016-plans/sob/arizona/dental-pediatric","4"
"2016","AZ","86830","HIOS","4","2015-08-20 09:36:54","1","86830","AZ","Individual","Yes","59-1031071","86830AZ0050001","Cigna Dental Pediatric","86830AZ005","7730182962","AZN001","AZS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$30.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","All Services","Yes",,"","86830AZ0050001-01","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/individuals-families/2016-plans/sob/arizona/dental-pediatric","5"
"2016","AZ","86830","HIOS","4","2015-08-20 09:36:54","2","86830","AZ","Individual","Yes","59-1031071","86830AZ0050002","Cigna Dental Family + Pediatric","86830AZ005","7730182962","AZN001","AZS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","All Services","Yes",,"","86830AZ0050002-01","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/individuals-families/2016-plans/sob/arizona/dental-family-ped","4"
"2016","AZ","90264","HIOS","3","2015-08-27 11:14:25","1","90264","AZ","SHOP (Small Group)","Yes","47-0098400","90264AZ0040002","EHB High PPO","90264AZ004",,"AZN001","AZS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.94","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","90264AZ0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","6","91450","AZ","Individual","No","36-3097810","91450AZ0080032","CommunityCare HMO Bronze  40%/40%/$5750 without Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080032-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_bronze_40_40_5750_trbl_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_bronze_40_40_5750_trbl.pdf","6"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","6","91450","AZ","Individual","No","36-3097810","91450AZ0080032","CommunityCare HMO Bronze  40%/40%/$5750 without Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080032-03","Limited Cost Sharing Plan Variation",,"0.617232084274292","Yes","Yes","No","100%",,"$5,800","$20","$200","$200","$1,300","$3,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_bronze_40_40_5750_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_bronze_40_40_5750.pdf","7"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","1","97667","AZ","Individual","No","86-0334392","97667AZ0110003","Cigna Connect HSA Bronze 6000","97667AZ011",,"AZN001","AZS001","AZF001","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110003-00","Standard Bronze Off Exchange Plan",,"0.61153781414032","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,030","$0","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/connect-hsa-bronze-6000","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/connect-hsa-bronze-6000","4"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","1","97667","AZ","Individual","No","86-0334392","97667AZ0110003","Cigna Connect HSA Bronze 6000","97667AZ011",,"AZN001","AZS001","AZF001","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110003-01","Standard Bronze On Exchange Plan",,"0.61153781414032","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,030","$0","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/connect-hsa-bronze-6000","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/connect-hsa-bronze-6000","5"
"2016","AZ","90264","HIOS","3","2015-08-27 11:14:25","1","90264","AZ","SHOP (Small Group)","Yes","47-0098400","90264AZ0030001","EHB Low Passive","90264AZ003",,"AZN001","AZS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.38","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","90264AZ0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","1","91450","AZ","Individual","No","36-3097810","91450AZ0080026","CommunityCare HMO Gold $30/$60/$6000/$375 with Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF005","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"3","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080026-00","Standard Gold Off Exchange Plan",,"0.789929449558258","No","Yes","No","100%",,"$500","$1,500","$0","$200","$500","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_gold_30_60_6000_375_ped_sbc.pdf","https://www.healthnet.com/static/broker/unprotected/pdfs/az/ifp/2016_az_ifp_cc_hmo_gold_30_60_6000_375.pdf","4"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","1","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160005","HMO Gold 1000 with pediatric dental","91450AZ016",,"AZN002","AZS002","AZF004","Existing","HMO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","1","0","2016-01-01",,"No",,"Yes","Emergent services covered","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0160005-00","Standard Gold Off Exchange Plan",,"0.788273572921753","No","Yes","No","100%",,"$1,000","$20","$1,100","$200","$1,000","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_hmo_gold_1000_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_hmo_gold_1000.pdf","4"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","1","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160005","HMO Gold 1000 with pediatric dental","91450AZ016",,"AZN002","AZS002","AZF004","Existing","HMO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","1","0","2016-01-01",,"No",,"Yes","Emergent services covered","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0160005-01","Standard Gold On Exchange Plan",,"0.788273572921753","No","Yes","No","100%",,"$1,000","$20","$1,100","$200","$1,000","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_hmo_gold_1000_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_hmo_gold_1000.pdf","5"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","1","91450","AZ","Individual","No","36-3097810","91450AZ0080026","CommunityCare HMO Gold $30/$60/$6000/$375 with Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF005","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"3","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080026-01","Standard Gold On Exchange Plan",,"0.789929449558258","No","Yes","No","100%",,"$500","$1,500","$0","$200","$500","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_gold_30_60_6000_375_ped_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_gold_30_60_6000_375.pdf","5"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","1","91450","AZ","Individual","No","36-3097810","91450AZ0080026","CommunityCare HMO Gold $30/$60/$6000/$375 with Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF005","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"3","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080026-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_gold_30_60_6000_375_trbl_ped_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_gold_30_60_6000_375_trbl.pdf","6"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","1","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160019","HMO Silver 3000 with pediatric dental","91450AZ016",,"AZN002","AZS002","AZF008","New","HMO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","1","0","2016-01-01",,"No",,"Yes","Emergent services covered","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0160019-00","Standard Silver Off Exchange Plan",,"0.684774279594421","No","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_hmo_silver_3000_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_hmo_silver_3000.pdf","6"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","1","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160019","HMO Silver 3000 with pediatric dental","91450AZ016",,"AZN002","AZS002","AZF008","New","HMO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","1","0","2016-01-01",,"No",,"Yes","Emergent services covered","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0160019-01","Standard Silver On Exchange Plan",,"0.684774279594421","No","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_hmo_silver_3000_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_hmo_silver_3000.pdf","7"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","1","91450","AZ","Individual","No","36-3097810","91450AZ0080026","CommunityCare HMO Gold $30/$60/$6000/$375 with Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF005","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"3","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080026-03","Limited Cost Sharing Plan Variation",,"0.789929449558258","No","Yes","No","100%",,"$500","$1,500","$0","$200","$500","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_gold_30_60_6000_375_ped_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_gold_30_60_6000_375.pdf","7"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","1","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090025","CommunityCare Gold 1000 with pediatric dental","91450AZ009",,"AZN001","AZS001","AZF004","New","HMO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","1","0","2016-01-01",,"No",,"Yes","Emergent services covered","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0090025-00","Standard Gold Off Exchange Plan",,"0.788273572921753","No","Yes","No","100%",,"$1,000","$20","$1,100","$200","$1,000","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_cc_hmo_gold_1000_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_cc_hmo_gold_1000.pdf","8"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","1","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090025","CommunityCare Gold 1000 with pediatric dental","91450AZ009",,"AZN001","AZS001","AZF004","New","HMO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","1","0","2016-01-01",,"No",,"Yes","Emergent services covered","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0090025-01","Standard Gold On Exchange Plan",,"0.788273572921753","No","Yes","No","100%",,"$1,000","$20","$1,100","$200","$1,000","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_cc_hmo_gold_1000_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_cc_hmo_gold_1000.pdf","9"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","1","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090026","CommunityCare Silver 3000 with pediatric dental","91450AZ009",,"AZN001","AZS001","AZF008","New","HMO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","1","0","2016-01-01",,"No",,"Yes","Emergent services covered","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0090026-00","Standard Silver Off Exchange Plan",,"0.684774279594421","No","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_cc_hmo_silver_3000_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_cc_hmo_silver_3000.pdf","10"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","1","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090026","CommunityCare Silver 3000 with pediatric dental","91450AZ009",,"AZN001","AZS001","AZF008","New","HMO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","1","0","2016-01-01",,"No",,"Yes","Emergent services covered","No",,"https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0090026-01","Standard Silver On Exchange Plan",,"0.684774279594421","No","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_cc_hmo_silver_3000_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/sbg/2016_az_sbg_cc_hmo_silver_3000.pdf","11"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","2","91450","AZ","Individual","No","36-3097810","91450AZ0080027","CommunityCare HMO Silver $30/$50/$4500 with Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080027-00","Standard Silver Off Exchange Plan",,"0.69350266456604","No","Yes","No","100%",,"$4,500","$20","$600","$200","$1,300","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_30_50_4500_ped_sbc.pdf","https://www.healthnet.com/static/broker/unprotected/pdfs/az/ifp/2016_az_ifp_cc_hmo_silver_30_50_4500.pdf","4"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","2","91450","AZ","Individual","No","36-3097810","91450AZ0080027","CommunityCare HMO Silver $30/$50/$4500 with Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080027-01","Standard Silver On Exchange Plan",,"0.69350266456604","No","Yes","No","100%",,"$4,500","$20","$600","$200","$1,300","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_30_50_4500_ped_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_30_50_4500.pdf","5"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","2","91450","AZ","Individual","No","36-3097810","91450AZ0080027","CommunityCare HMO Silver $30/$50/$4500 with Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080027-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_30_50_4500_trbl_ped_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_30_50_4500_trbl.pdf","6"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","2","91450","AZ","Individual","No","36-3097810","91450AZ0080027","CommunityCare HMO Silver $30/$50/$4500 with Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080027-03","Limited Cost Sharing Plan Variation",,"0.69350266456604","No","Yes","No","100%",,"$4,500","$20","$600","$200","$1,300","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_30_50_4500_ped_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_30_50_4500.pdf","7"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","2","91450","AZ","Individual","No","36-3097810","91450AZ0080027","CommunityCare HMO Silver $30/$50/$4500 with Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080027-04","73% AV Level Silver Plan",,"0.739651441574097","No","Yes","No","100%",,"$1,600","$20","$1,100","$200","$1,300","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_74_csr_ped_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_74_csr.pdf","8"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","2","91450","AZ","Individual","No","36-3097810","91450AZ0080027","CommunityCare HMO Silver $30/$50/$4500 with Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080027-05","87% AV Level Silver Plan",,"0.873884677886963","No","Yes","No","100%",,"$500","$70","$800","$200","$500","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_87_csr_ped_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_87_csr.pdf","9"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","2","91450","AZ","Individual","No","36-3097810","91450AZ0080027","CommunityCare HMO Silver $30/$50/$4500 with Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080027-06","94% AV Level Silver Plan",,"0.948922276496887","No","Yes","No","100%",,"$0","$80","$600","$200","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_94_csr_ped_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_94_csr.pdf","10"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","3","91450","AZ","Individual","No","36-3097810","91450AZ0080031","CommunityCare HMO Bronze  40%/40%/$5750 with Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080031-00","Standard Bronze Off Exchange Plan",,"0.617232084274292","Yes","Yes","No","100%",,"$5,800","$20","$200","$200","$1,300","$3,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_bronze_40_40_5750_ped_sbc.pdf","https://www.healthnet.com/static/broker/unprotected/pdfs/az/ifp/2016_az_ifp_cc_hmo_bronze_40_40_5750.pdf","4"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","3","91450","AZ","Individual","No","36-3097810","91450AZ0080031","CommunityCare HMO Bronze  40%/40%/$5750 with Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080031-01","Standard Bronze On Exchange Plan",,"0.617232084274292","Yes","Yes","No","100%",,"$5,800","$20","$200","$200","$1,300","$3,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_bronze_40_40_5750_ped_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_bronze_40_40_5750.pdf","5"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","3","91450","AZ","Individual","No","36-3097810","91450AZ0080031","CommunityCare HMO Bronze  40%/40%/$5750 with Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080031-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_bronze_40_40_5750_trbl_ped_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_bronze_40_40_5750_trbl.pdf","6"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","3","91450","AZ","Individual","No","36-3097810","91450AZ0080031","CommunityCare HMO Bronze  40%/40%/$5750 with Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080031-03","Limited Cost Sharing Plan Variation",,"0.617232084274292","Yes","Yes","No","100%",,"$5,800","$20","$200","$200","$1,300","$3,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_bronze_40_40_5750_ped_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_bronze_40_40_5750.pdf","7"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","4","91450","AZ","Individual","No","36-3097810","91450AZ0080029","CommunityCare HMO Gold $30/$60/$6000/$375 without Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF005","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"3","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080029-00","Standard Gold Off Exchange Plan",,"0.789929449558258","No","Yes","No","100%",,"$500","$1,500","$0","$200","$500","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_gold_30_60_6000_375_sbc.pdf","https://www.healthnet.com/static/broker/unprotected/pdfs/az/ifp/2016_az_ifp_cc_hmo_gold_30_60_6000_375.pdf","4"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","4","91450","AZ","Individual","No","36-3097810","91450AZ0080029","CommunityCare HMO Gold $30/$60/$6000/$375 without Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF005","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"3","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080029-01","Standard Gold On Exchange Plan",,"0.789929449558258","No","Yes","No","100%",,"$500","$1,500","$0","$200","$500","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_gold_30_60_6000_375_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_gold_30_60_6000_375.pdf","5"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","4","91450","AZ","Individual","No","36-3097810","91450AZ0080029","CommunityCare HMO Gold $30/$60/$6000/$375 without Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF005","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"3","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080029-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_gold_30_60_6000_375_trbl_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_gold_30_60_6000_375_trbl.pdf","6"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","4","91450","AZ","Individual","No","36-3097810","91450AZ0080029","CommunityCare HMO Gold $30/$60/$6000/$375 without Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF005","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"3","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080029-03","Limited Cost Sharing Plan Variation",,"0.789929449558258","No","Yes","No","100%",,"$500","$1,500","$0","$200","$500","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_gold_30_60_6000_375_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_gold_30_60_6000_375.pdf","7"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","5","91450","AZ","Individual","No","36-3097810","91450AZ0080030","CommunityCare HMO Silver $30/$50/$4500 without Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080030-00","Standard Silver Off Exchange Plan",,"0.69350266456604","No","Yes","No","100%",,"$4,500","$20","$600","$200","$1,300","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_30_50_4500_sbc.pdf","https://www.healthnet.com/static/broker/unprotected/pdfs/az/ifp/2016_az_ifp_cc_hmo_silver_30_50_4500.pdf","4"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","5","91450","AZ","Individual","No","36-3097810","91450AZ0080030","CommunityCare HMO Silver $30/$50/$4500 without Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080030-01","Standard Silver On Exchange Plan",,"0.69350266456604","No","Yes","No","100%",,"$4,500","$20","$600","$200","$1,300","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_30_50_4500_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_30_50_4500.pdf","5"
"2016","AZ","91450","HIOS","11","2016-01-27 05:35:40","5","91450","AZ","Individual","No","36-3097810","91450AZ0080030","CommunityCare HMO Silver $30/$50/$4500 without Pediatric Dental","91450AZ008",,"AZN004","AZS004","AZF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.996",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/portal/shopping/FFMsaml2assertionconsumer.action","https://www.healthnet.com/static/general/unprotected/pdfs/national/az_essential_rx_list.pdf","91450AZ0080030-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_30_50_4500_trbl_sbc.pdf","https://www.healthnet.com/static/shopping/unprotected/pdfs/marketplace/az/ifp/2016_az_iex_cc_hmo_silver_30_50_4500_trbl.pdf","6"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","1","97667","AZ","Individual","No","86-0334392","97667AZ0110003","Cigna Connect HSA Bronze 6000","97667AZ011",,"AZN001","AZS001","AZF001","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/naan-300b","6"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","1","97667","AZ","Individual","No","86-0334392","97667AZ0110003","Cigna Connect HSA Bronze 6000","97667AZ011",,"AZN001","AZS001","AZF001","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110003-03","Limited Cost Sharing Plan Variation",,"0.61153781414032","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,030","$0","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/connect-hsa-bronze-6000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/connect-hsa-bronze-6000-naan-300a","7"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","1","97667","AZ","Individual","No","86-0334392","97667AZ0110005","Cigna Connect HSA Silver 2700","97667AZ011",,"AZN001","AZS001","AZF003","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110005-00","Standard Silver Off Exchange Plan",,"0.680516302585602","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$350","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/hsa-silver-2700","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/hsa-silver-2700","8"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","1","97667","AZ","Individual","No","86-0334392","97667AZ0110005","Cigna Connect HSA Silver 2700","97667AZ011",,"AZN001","AZS001","AZF003","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110005-01","Standard Silver On Exchange Plan",,"0.680516302585602","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$350","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/hsa-silver-2700","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/hsa-silver-2700","9"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","1","97667","AZ","Individual","No","86-0334392","97667AZ0110005","Cigna Connect HSA Silver 2700","97667AZ011",,"AZN001","AZS001","AZF003","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/naan-300b","10"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","1","97667","AZ","Individual","No","86-0334392","97667AZ0110005","Cigna Connect HSA Silver 2700","97667AZ011",,"AZN001","AZS001","AZF003","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110005-03","Limited Cost Sharing Plan Variation",,"0.680516302585602","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$350","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/hsa-silver-2700-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/hsa-silver-2700-naan-300a","11"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","1","97667","AZ","Individual","No","86-0334392","97667AZ0110005","Cigna Connect HSA Silver 2700","97667AZ011",,"AZN001","AZS001","AZF003","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110005-04","73% AV Level Silver Plan",,"0.720354199409485","Yes","Yes","No","100%",,"$2,100","$0","$800","$30","$2,100","$0","$440","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/hsa-silver-2700-250","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/hsa-silver-2700-250","12"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","1","97667","AZ","Individual","No","86-0334392","97667AZ0110005","Cigna Connect HSA Silver 2700","97667AZ011",,"AZN001","AZS001","AZF003","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110005-05","87% AV Level Silver Plan",,"0.860987782478333","Yes","Yes","No","100%",,"$500","$0","$1,040","$30","$500","$0","$680","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/hsa-silver-2700-200","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/hsa-silver-2700-200","13"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","1","97667","AZ","Individual","No","86-0334392","97667AZ0110005","Cigna Connect HSA Silver 2700","97667AZ011",,"AZN001","AZS001","AZF003","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110005-06","94% AV Level Silver Plan",,"0.9306760430336","Yes","Yes","No","100%",,"$100","$0","$730","$30","$100","$0","$490","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/hsa-silver-2700-150","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/hsa-silver-2700-150","14"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","2","97667","AZ","Individual","No","86-0334392","97667AZ0110004","Cigna Connect Flex Bronze 6400","97667AZ011",,"AZN001","AZS001","AZF002","New","HMO","Bronze","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110004-00","Standard Bronze Off Exchange Plan","61.89%","0.633075952529907","Yes","Yes","No","100%",,"$5,170","$90","$330","$30","$140","$880","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/flex-bronze-6400","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/flex-bronze-6400","4"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","2","97667","AZ","Individual","No","86-0334392","97667AZ0110004","Cigna Connect Flex Bronze 6400","97667AZ011",,"AZN001","AZS001","AZF002","New","HMO","Bronze","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110004-01","Standard Bronze On Exchange Plan","61.89%","0.633075952529907","Yes","Yes","No","100%",,"$5,170","$90","$330","$30","$140","$880","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/flex-bronze-6400","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/flex-bronze-6400","5"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","2","97667","AZ","Individual","No","86-0334392","97667AZ0110004","Cigna Connect Flex Bronze 6400","97667AZ011",,"AZN001","AZS001","AZF002","New","HMO","Bronze","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sob/arizona/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/naan-300b","6"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","2","97667","AZ","Individual","No","86-0334392","97667AZ0110004","Cigna Connect Flex Bronze 6400","97667AZ011",,"AZN001","AZS001","AZF002","New","HMO","Bronze","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110004-03","Limited Cost Sharing Plan Variation","61.89%","0.633075952529907","Yes","Yes","No","100%",,"$5,170","$90","$330","$30","$140","$880","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/flex-bronze-6400-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/flex-bronze-6400-naan-300a","7"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110006","Cigna Connect Flex Silver 3000","97667AZ011",,"AZN001","AZS001","AZF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110006-00","Standard Silver Off Exchange Plan","70.47%","0.706750154495239","Yes","Yes","No","100%",,"$3,000","$70","$850","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/flex-silver-3000","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/flex-silver-3000","4"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110006","Cigna Connect Flex Silver 3000","97667AZ011",,"AZN001","AZS001","AZF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110006-01","Standard Silver On Exchange Plan","70.47%","0.706750154495239","Yes","Yes","No","100%",,"$3,000","$70","$850","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/flex-silver-3000","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/flex-silver-3000","5"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110006","Cigna Connect Flex Silver 3000","97667AZ011",,"AZN001","AZS001","AZF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/naan-300b","6"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110006","Cigna Connect Flex Silver 3000","97667AZ011",,"AZN001","AZS001","AZF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110006-03","Limited Cost Sharing Plan Variation","70.47%","0.706750154495239","Yes","Yes","No","100%",,"$3,000","$70","$850","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sob/arizona/flex-silver-3000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/flex-silver-3000-naan-300a","7"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110006","Cigna Connect Flex Silver 3000","97667AZ011",,"AZN001","AZS001","AZF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110006-04","73% AV Level Silver Plan","73.48%","0.737458050251007","Yes","Yes","No","100%",,"$2,300","$70","$990","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/flex-silver-3000-250","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/flex-silver-3000-250","8"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110006","Cigna Connect Flex Silver 3000","97667AZ011",,"AZN001","AZS001","AZF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110006-05","87% AV Level Silver Plan","87.07%","0.875951588153839","Yes","Yes","No","100%",,"$180","$40","$1,060","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/flex-silver-3000-200","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/flex-silver-3000-200","9"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110006","Cigna Connect Flex Silver 3000","97667AZ011",,"AZN001","AZS001","AZF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110006-06","94% AV Level Silver Plan","93.66%","0.940258026123047","Yes","Yes","No","100%",,"$0","$30","$360","$30","$0","$360","$10","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/flex-silver-3000-150","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/flex-silver-3000-150","10"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110007","Cigna Connect Flex Silver 4000","97667AZ011",,"AZN001","AZS001","AZF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110007-00","Standard Silver Off Exchange Plan","68.28%","0.683739721775055","Yes","Yes","No","100%",,"$4,000","$70","$970","$30","$140","$760","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/connect-flex-silver-4000","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/connect-flex-silver-4000","11"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110007","Cigna Connect Flex Silver 4000","97667AZ011",,"AZN001","AZS001","AZF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110007-01","Standard Silver On Exchange Plan","68.28%","0.683739721775055","Yes","Yes","No","100%",,"$4,000","$70","$970","$30","$140","$760","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/connect-flex-silver-4000","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/connect-flex-silver-4000","12"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110007","Cigna Connect Flex Silver 4000","97667AZ011",,"AZN001","AZS001","AZF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/naan-300b","13"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110007","Cigna Connect Flex Silver 4000","97667AZ011",,"AZN001","AZS001","AZF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110007-03","Limited Cost Sharing Plan Variation","68.28%","0.683739721775055","Yes","Yes","No","100%",,"$4,000","$70","$970","$30","$140","$760","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/connect-flex-silver-4000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/connect-flex-silver-4000-naan-300a","14"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110007","Cigna Connect Flex Silver 4000","97667AZ011",,"AZN001","AZS001","AZF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110007-04","73% AV Level Silver Plan","72.19%","0.723649740219116","Yes","Yes","No","100%",,"$2,500","$70","$1,420","$30","$140","$760","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/connect-flex-silver-4000-250","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/connect-flex-silver-4000-250","15"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110007","Cigna Connect Flex Silver 4000","97667AZ011",,"AZN001","AZS001","AZF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110007-05","87% AV Level Silver Plan","86.22%","0.865179359912872","Yes","Yes","No","100%",,"$200","$40","$1,410","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/connect-flex-silver-4000-200","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/connect-flex-silver-4000-200","16"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110007","Cigna Connect Flex Silver 4000","97667AZ011",,"AZN001","AZS001","AZF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110007-06","94% AV Level Silver Plan","93.17%","0.935309290885925","Yes","Yes","No","100%",,"$0","$40","$360","$30","$0","$400","$10","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sob/arizona/connect-flex-silver-4000-150","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/connect-flex-silver-4000-150","17"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110008","Cigna Connect Flex Silver 5000","97667AZ011",,"AZN001","AZS001","AZF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110008-00","Standard Silver Off Exchange Plan","68.09%","0.681535065174103","Yes","Yes","No","100%",,"$5,000","$70","$450","$30","$140","$760","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/flex-silver-5000","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/flex-silver-5000","18"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110008","Cigna Connect Flex Silver 5000","97667AZ011",,"AZN001","AZS001","AZF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110008-01","Standard Silver On Exchange Plan","68.09%","0.681535065174103","Yes","Yes","No","100%",,"$5,000","$70","$450","$30","$140","$760","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/flex-silver-5000","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/flex-silver-5000","19"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110008","Cigna Connect Flex Silver 5000","97667AZ011",,"AZN001","AZS001","AZF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/naan-300b","20"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110008","Cigna Connect Flex Silver 5000","97667AZ011",,"AZN001","AZS001","AZF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110008-03","Limited Cost Sharing Plan Variation","68.09%","0.681535065174103","Yes","Yes","No","100%",,"$5,000","$70","$450","$30","$140","$760","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/flex-silver-5000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/flex-silver-5000-naan-300a","21"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110008","Cigna Connect Flex Silver 5000","97667AZ011",,"AZN001","AZS001","AZF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110008-04","73% AV Level Silver Plan","72.08%","0.722389280796051","Yes","Yes","No","100%",,"$3,100","$70","$830","$30","$140","$760","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/flex-silver-5000-250","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/flex-silver-5000-250","22"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110008","Cigna Connect Flex Silver 5000","97667AZ011",,"AZN001","AZS001","AZF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110008-05","87% AV Level Silver Plan","86.19%","0.866109788417816","Yes","Yes","No","100%",,"$350","$50","$1,030","$30","$140","$480","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/flex-silver-5000-200","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/flex-silver-5000-200","23"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110008","Cigna Connect Flex Silver 5000","97667AZ011",,"AZN001","AZS001","AZF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110008-06","94% AV Level Silver Plan","93.09%","0.934635162353516","Yes","Yes","No","100%",,"$100","$40","$360","$30","$100","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/flex-silver-5000-150","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/flex-silver-5000-150","24"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110009","Cigna Connect Flex Gold 1500","97667AZ011",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110009-00","Standard Gold Off Exchange Plan","78.38%","0.78561943769455","Yes","Yes","No","100%",,"$1,500","$40","$1,150","$30","$140","$400","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/connect-flex-gold-1500","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/connect-flex-gold-1500","25"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110009","Cigna Connect Flex Gold 1500","97667AZ011",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110009-01","Standard Gold On Exchange Plan","78.38%","0.78561943769455","Yes","Yes","No","100%",,"$1,500","$40","$1,150","$30","$140","$400","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/connect-flex-gold-1500","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/connect-flex-gold-1500","26"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110009","Cigna Connect Flex Gold 1500","97667AZ011",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/naan-300b","27"
"2016","AZ","97667","HIOS","5","2016-01-22 04:00:42","3","97667","AZ","Individual","No","86-0334392","97667AZ0110009","Cigna Connect Flex Gold 1500","97667AZ011",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","97667AZ0110009-03","Limited Cost Sharing Plan Variation","78.38%","0.78561943769455","Yes","Yes","No","100%",,"$1,500","$40","$1,150","$30","$140","$400","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/arizona/connect-flex-gold-1500-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/arizona/connect-flex-gold-1500-naan-300a","28"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","SHOP (Small Group)","No","36-1665915","98971AZ0010065","Gold Choice Plus 500","98971AZ001",,"AZN001","AZS001","AZF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=az0003&st=az","98971AZ0010065-00","Standard Gold Off Exchange Plan","80.07%",,"No","Yes","Yes","50%","50%","$500","$20","$1,500","$200","$200","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%","$500","$500 per person","$1000 per group","30%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=az0001&st=az",,"4"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","Individual","No","35-1665915","98971AZ0020002","Bronze Compass Plus HSA 5500","98971AZ002",,"AZN002","AZS002","AZF008","Existing","PPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020002-00","Standard Bronze Off Exchange Plan","61.50%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=az0043&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","4"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","Individual","No","35-1665915","98971AZ0020002","Bronze Compass Plus HSA 5500","98971AZ002",,"AZN002","AZS002","AZF008","Existing","PPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020002-01","Standard Bronze On Exchange Plan","61.50%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=az0043&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","5"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","SHOP (Small Group)","No","36-1665915","98971AZ0010065","Gold Choice Plus 500","98971AZ001",,"AZN001","AZS001","AZF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=az0003&st=az","98971AZ0010065-01","Standard Gold On Exchange Plan","80.07%",,"No","Yes","Yes","50%","50%","$500","$20","$1,500","$200","$200","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%","$500","$500 per person","$1000 per group","30%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=az0001&st=az",,"5"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","SHOP (Small Group)","No","36-1665915","98971AZ0010066","Silver Choice Plus 3500","98971AZ001",,"AZN001","AZS001","AZF009","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=az0003&st=az","98971AZ0010066-00","Standard Silver Off Exchange Plan","70.10%",,"No","Yes","Yes","50%","50%","$3,500","$20","$300","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10%","$3,500","$3500 per person","$7000 per group","10%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=az0002&st=az",,"6"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","Individual","No","35-1665915","98971AZ0020002","Bronze Compass Plus HSA 5500","98971AZ002",,"AZN002","AZS002","AZF008","Existing","PPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=az0044&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","6"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","Individual","No","35-1665915","98971AZ0020002","Bronze Compass Plus HSA 5500","98971AZ002",,"AZN002","AZS002","AZF008","Existing","PPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020002-03","Limited Cost Sharing Plan Variation","61.50%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=az0045&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","7"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","SHOP (Small Group)","No","36-1665915","98971AZ0010066","Silver Choice Plus 3500","98971AZ001",,"AZN001","AZS001","AZF009","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=az0003&st=az","98971AZ0010066-01","Standard Silver On Exchange Plan","70.10%",,"No","Yes","Yes","50%","50%","$3,500","$20","$300","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10%","$3,500","$3500 per person","$7000 per group","10%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=az0002&st=az",,"7"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","Individual","No","35-1665915","98971AZ0020008","Silver Compass Plus HSA 3000","98971AZ002",,"AZN002","AZS002","AZF005","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020008-00","Standard Silver Off Exchange Plan","69.70%",,"Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=az0013&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","8"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","Individual","No","35-1665915","98971AZ0020008","Silver Compass Plus HSA 3000","98971AZ002",,"AZN002","AZS002","AZF005","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020008-01","Standard Silver On Exchange Plan","69.70%",,"Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=az0013&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","9"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","Individual","No","35-1665915","98971AZ0020008","Silver Compass Plus HSA 3000","98971AZ002",,"AZN002","AZS002","AZF005","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020008-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.uhc.com/iex/doc?id=az0014&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","10"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","Individual","No","35-1665915","98971AZ0020008","Silver Compass Plus HSA 3000","98971AZ002",,"AZN002","AZS002","AZF005","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020008-03","Limited Cost Sharing Plan Variation","69.70%",,"Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=az0015&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","11"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","Individual","No","35-1665915","98971AZ0020008","Silver Compass Plus HSA 3000","98971AZ002",,"AZN002","AZS002","AZF005","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020008-04","73% AV Level Silver Plan","72.60%",,"Yes","Yes","No","100%",,"$2,500","$10","$0","$200","$2,500","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=az0016&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","12"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","Individual","No","35-1665915","98971AZ0020008","Silver Compass Plus HSA 3000","98971AZ002",,"AZN002","AZS002","AZF005","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020008-05","87% AV Level Silver Plan","86.00%",,"Yes","Yes","No","100%",,"$800","$10","$0","$200","$800","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0%",,,,,"$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=az0017&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","13"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","Individual","No","35-1665915","98971AZ0020008","Silver Compass Plus HSA 3000","98971AZ002",,"AZN002","AZS002","AZF005","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020008-06","94% AV Level Silver Plan","93.60%",,"Yes","Yes","No","100%",,"$300","$10","$0","$200","$300","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=az0018&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","14"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","Individual","No","35-1665915","98971AZ0020010","Silver Compass Plus 2000-1","98971AZ002",,"AZN002","AZS002","AZF008","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020010-00","Standard Silver Off Exchange Plan","71.10%",,"Yes","Yes","No","100%",,"$2,000","$1,300","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=az0019&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","15"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","Individual","No","35-1665915","98971AZ0020010","Silver Compass Plus 2000-1","98971AZ002",,"AZN002","AZS002","AZF008","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020010-01","Standard Silver On Exchange Plan","71.10%",,"Yes","Yes","No","100%",,"$2,000","$1,300","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=az0019&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","16"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","Individual","No","35-1665915","98971AZ0020010","Silver Compass Plus 2000-1","98971AZ002",,"AZN002","AZS002","AZF008","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020010-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=az0020&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","17"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","Individual","No","35-1665915","98971AZ0020010","Silver Compass Plus 2000-1","98971AZ002",,"AZN002","AZS002","AZF008","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020010-03","Limited Cost Sharing Plan Variation","71.10%",,"Yes","Yes","No","100%",,"$2,000","$1,300","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=az0021&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","18"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","Individual","No","35-1665915","98971AZ0020010","Silver Compass Plus 2000-1","98971AZ002",,"AZN002","AZS002","AZF008","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020010-04","73% AV Level Silver Plan","73.20%",,"Yes","Yes","No","100%",,"$1,800","$1,300","$0","$200","$1,800","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","0%",,,,,"$3,800","$3800 per person","$7600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=az0022&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","19"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020011","Gold Compass Plus 0","98971AZ002",,"AZN002","AZS002","AZF003","New","PPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020011-01","Standard Gold On Exchange Plan","79.3%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0010&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","37"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020011","Gold Compass Plus 0","98971AZ002",,"AZN002","AZS002","AZF003","New","PPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020011-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0011&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","38"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020011","Gold Compass Plus 0","98971AZ002",,"AZN002","AZS002","AZF003","New","PPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020011-03","Limited Cost Sharing Plan Variation","79.3%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0012&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","39"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020012","Silver Compass Plus 4500","98971AZ002",,"AZN002","AZS002","AZF006","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020012-00","Standard Silver Off Exchange Plan","68.3%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0037&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","40"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020012","Silver Compass Plus 4500","98971AZ002",,"AZN002","AZS002","AZF006","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020012-01","Standard Silver On Exchange Plan","68.3%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0037&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","41"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020012","Silver Compass Plus 4500","98971AZ002",,"AZN002","AZS002","AZF006","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020012-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0038&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","42"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020012","Silver Compass Plus 4500","98971AZ002",,"AZN002","AZS002","AZF006","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020012-03","Limited Cost Sharing Plan Variation","68.3%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0039&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","43"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","Individual","No","35-1665915","98971AZ0020010","Silver Compass Plus 2000-1","98971AZ002",,"AZN002","AZS002","AZF008","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020010-05","87% AV Level Silver Plan","86.30%",,"Yes","Yes","No","100%",,"$600","$800","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"$1,100","$1100 per person","$2200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=az0023&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","20"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","1","98971","AZ","Individual","No","35-1665915","98971AZ0020010","Silver Compass Plus 2000-1","98971AZ002",,"AZN002","AZS002","AZF008","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020010-06","94% AV Level Silver Plan","93.20%",,"Yes","Yes","No","100%",,"$200","$500","$0","$200","$200","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","0%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=az0024&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","21"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020001","Bronze Compass Plus 6500","98971AZ002",,"AZN002","AZS002","AZF008","Existing","PPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020001-00","Standard Bronze Off Exchange Plan","61.94%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=az0046&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","4"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020001","Bronze Compass Plus 6500","98971AZ002",,"AZN002","AZS002","AZF008","Existing","PPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020001-01","Standard Bronze On Exchange Plan","61.94%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=az0046&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","5"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020001","Bronze Compass Plus 6500","98971AZ002",,"AZN002","AZS002","AZF008","Existing","PPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020001-02","Zero Cost Sharing Plan Variation","100.0%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=az0047&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","6"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020001","Bronze Compass Plus 6500","98971AZ002",,"AZN002","AZS002","AZF008","Existing","PPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020001-03","Limited Cost Sharing Plan Variation","61.94%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=az0048&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","7"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020003","Catastrophic Compass Plus 6850","98971AZ002",,"AZN002","AZS002","AZF011","Existing","PPO","Catastrophic","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","3","3","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020003-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,800","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=az0049&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","8"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020003","Catastrophic Compass Plus 6850","98971AZ002",,"AZN002","AZS002","AZF011","Existing","PPO","Catastrophic","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","3","3","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020003-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,800","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=az0049&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","9"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020004","Gold Compass Plus 1000","98971AZ002",,"AZN002","AZS002","AZF002","Existing","PPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020004-00","Standard Gold Off Exchange Plan","78.0%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0004&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","10"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020004","Gold Compass Plus 1000","98971AZ002",,"AZN002","AZS002","AZF002","Existing","PPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020004-01","Standard Gold On Exchange Plan","78.0%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0004&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","11"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020004","Gold Compass Plus 1000","98971AZ002",,"AZN002","AZS002","AZF002","Existing","PPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020004-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0005&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","12"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020004","Gold Compass Plus 1000","98971AZ002",,"AZN002","AZS002","AZF002","Existing","PPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020004-03","Limited Cost Sharing Plan Variation","78.0%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0006&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","13"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020005","Gold Compass Plus 500","98971AZ002",,"AZN002","AZS002","AZF004","Existing","PPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020005-00","Standard Gold Off Exchange Plan","78.1%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"$250","$250 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0007&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","14"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020005","Gold Compass Plus 500","98971AZ002",,"AZN002","AZS002","AZF004","Existing","PPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020005-01","Standard Gold On Exchange Plan","78.1%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"$250","$250 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0007&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","15"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020005","Gold Compass Plus 500","98971AZ002",,"AZN002","AZS002","AZF004","Existing","PPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020005-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0008&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","16"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020005","Gold Compass Plus 500","98971AZ002",,"AZN002","AZS002","AZF004","Existing","PPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020005-03","Limited Cost Sharing Plan Variation","78.1%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"$250","$250 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0009&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","17"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020007","Silver Compass Plus 2000","98971AZ002",,"AZN002","AZS002","AZF007","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020007-00","Standard Silver Off Exchange Plan","69.4%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0025&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","22"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020007","Silver Compass Plus 2000","98971AZ002",,"AZN002","AZS002","AZF007","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020007-01","Standard Silver On Exchange Plan","69.4%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0025&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","23"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020007","Silver Compass Plus 2000","98971AZ002",,"AZN002","AZS002","AZF007","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020007-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0026&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","24"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020007","Silver Compass Plus 2000","98971AZ002",,"AZN002","AZS002","AZF007","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020007-03","Limited Cost Sharing Plan Variation","69.4%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0027&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","25"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","2","16842","FL","Individual","No","59-2015694","16842FL0070108","BlueOptions Everyday Health 1416","16842FL007","7700889661","FLN001","FLS001","FLF003","Existing","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070108-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1416U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1416U.pdf","6"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","2","16842","FL","Individual","No","59-2015694","16842FL0070108","BlueOptions Everyday Health 1416","16842FL007","7700889661","FLN001","FLS001","FLF003","Existing","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070108-03","Limited Cost Sharing Plan Variation","61.91%","0","Yes","Yes","No","100%",,"$3,600","$200","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$26,800","$26800 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","50%",,,,,"$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1416O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1416O.pdf","7"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","2","16842","FL","Individual","No","59-2015694","16842FL0120068","BlueSelect Everyday Health 1449","16842FL012","7700889661","FLN002","FLS002","FLF012","Existing","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120068-00","Standard Bronze Off Exchange Plan","61.91%","0","Yes","Yes","No","100%",,"$3,600","$200","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$26,800","$26800 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","50%",,,,,"$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1449.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1449.pdf","8"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020007","Silver Compass Plus 2000","98971AZ002",,"AZN002","AZS002","AZF007","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020007-04","73% AV Level Silver Plan","73.6%",,"No","Yes","No","100%",,"$1,200","$20","$1,500","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","30%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0028&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","26"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020007","Silver Compass Plus 2000","98971AZ002",,"AZN002","AZS002","AZF007","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020007-05","87% AV Level Silver Plan","88.0%",,"No","Yes","No","100%",,"$200","$10","$600","$200","$200","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"$250","$250 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0029&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","27"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020007","Silver Compass Plus 2000","98971AZ002",,"AZN002","AZS002","AZF007","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020007-06","94% AV Level Silver Plan","94.0%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0030&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","28"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020009","Silver Compass Plus 3500","98971AZ002",,"AZN002","AZS002","AZF006","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020009-00","Standard Silver Off Exchange Plan","68.1%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0031&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","29"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020009","Silver Compass Plus 3500","98971AZ002",,"AZN002","AZS002","AZF006","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020009-01","Standard Silver On Exchange Plan","68.1%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0031&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","30"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020009","Silver Compass Plus 3500","98971AZ002",,"AZN002","AZS002","AZF006","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020009-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0032&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","31"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020009","Silver Compass Plus 3500","98971AZ002",,"AZN002","AZS002","AZF006","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020009-03","Limited Cost Sharing Plan Variation","68.1%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0033&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","32"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020009","Silver Compass Plus 3500","98971AZ002",,"AZN002","AZS002","AZF006","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020009-04","73% AV Level Silver Plan","72.6%",,"No","Yes","No","100%",,"$2,500","$10","$800","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0034&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","33"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020009","Silver Compass Plus 3500","98971AZ002",,"AZN002","AZS002","AZF006","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020009-05","87% AV Level Silver Plan","88.0%",,"No","Yes","No","100%",,"$200","$10","$600","$200","$200","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"$250","$250 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0035&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","34"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020009","Silver Compass Plus 3500","98971AZ002",,"AZN002","AZS002","AZF006","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020009-06","94% AV Level Silver Plan","94.0%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0036&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","35"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020011","Gold Compass Plus 0","98971AZ002",,"AZN002","AZS002","AZF003","New","PPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020011-00","Standard Gold Off Exchange Plan","79.3%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0010&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","36"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020012","Silver Compass Plus 4500","98971AZ002",,"AZN002","AZS002","AZF006","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020012-04","73% AV Level Silver Plan","72.6%",,"No","Yes","No","100%",,"$3,200","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0040&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","44"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020012","Silver Compass Plus 4500","98971AZ002",,"AZN002","AZS002","AZF006","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020012-05","87% AV Level Silver Plan","86.2%",,"No","Yes","No","100%",,"$600","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","0%",,,,,"$1,200","$1200 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"$250","$250 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0041&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","45"
"2016","AZ","98971","HIOS","10","2015-11-18 07:25:09","2","98971","AZ","Individual","No","35-1665915","98971AZ0020012","Silver Compass Plus 4500","98971AZ002",,"AZN002","AZS002","AZF006","Existing","PPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=az0051&st=az","98971AZ0020012-06","94% AV Level Silver Plan","93.4%",,"No","Yes","No","100%",,"$100","$10","$0","$200","$100","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=az0042&st=az","http://www.uhc.com/iex/doc?id=az0050&st=az","46"
"2016","AZ","99180","HIOS","3","2015-08-22 15:09:32","1","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0270001","Smile for Health - Certified Optimum Coverage","99180AZ027",,"AZN001","AZS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","99180AZ0270001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","99180","HIOS","3","2015-08-22 15:09:32","2","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0270002","Smile for Health - Certified Optimum Coverage","99180AZ027",,"AZN002","AZS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","99180AZ0270002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","1","16842","FL","Individual","No","59-2015694","16842FL0120072","BlueSelect Everyday Health 1443","16842FL012","7700889661","FLN002","FLS002","FLF011","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120072-00","Standard Silver Off Exchange Plan",,"0.680478096008301","Yes","Yes","No","100%",,"$6,100","$90","$0","$200","$600","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","30%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1443.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1443.pdf","11"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","1","16842","FL","Individual","No","59-2015694","16842FL0120072","BlueSelect Everyday Health 1443","16842FL012","7700889661","FLN002","FLS002","FLF011","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120072-01","Standard Silver On Exchange Plan",,"0.680478096008301","Yes","Yes","No","100%",,"$6,100","$90","$0","$200","$600","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","30%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1443.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1443.pdf","12"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","1","16842","FL","Individual","No","59-2015694","16842FL0120072","BlueSelect Everyday Health 1443","16842FL012","7700889661","FLN002","FLS002","FLF011","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120072-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1443U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1443U.pdf","13"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","1","16842","FL","Individual","No","59-2015694","16842FL0120072","BlueSelect Everyday Health 1443","16842FL012","7700889661","FLN002","FLS002","FLF011","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120072-03","Limited Cost Sharing Plan Variation",,"0.680478096008301","Yes","Yes","No","100%",,"$6,100","$90","$0","$200","$600","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","30%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1443O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1443O.pdf","14"
"2016","AZ","99180","HIOS","3","2015-08-22 15:09:32","3","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0270003","Smile for Health - Certified Optimum Coverage","99180AZ027",,"AZN003","AZS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","99180AZ0270003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","99180","HIOS","3","2015-08-22 15:09:32","4","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0270004","Smile for Health - Certified Optimum Coverage","99180AZ027",,"AZN001","AZS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","99180AZ0270004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","99180","HIOS","3","2015-08-22 15:09:32","5","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0270005","Smile for Health - Certified Optimum Coverage","99180AZ027",,"AZN002","AZS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","99180AZ0270005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","99180","HIOS","3","2015-08-22 15:09:32","6","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0270006","Smile for Health - Certified Optimum Coverage","99180AZ027",,"AZN003","AZS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","99180AZ0270006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","99180","HIOS","3","2015-08-22 15:09:32","7","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0280001","Smile for Health - Certified High Option","99180AZ028",,"AZN001","AZS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","99180AZ0280001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","99180","HIOS","3","2015-08-22 15:09:32","8","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0280002","Smile for Health - Certified High Option","99180AZ028",,"AZN002","AZS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","99180AZ0280002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","99180","HIOS","3","2015-08-22 15:09:32","9","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0280003","Smile for Health - Certified High Option","99180AZ028",,"AZN003","AZS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","99180AZ0280003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","99180","HIOS","3","2015-08-22 15:09:32","10","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0280004","Smile for Health - Certified High Option Plus","99180AZ028",,"AZN001","AZS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","99180AZ0280004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","99180","HIOS","3","2015-08-22 15:09:32","11","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0280005","Smile for Health - Certified High Option Plus","99180AZ028",,"AZN002","AZS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","99180AZ0280005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AZ","99180","HIOS","3","2015-08-22 15:09:32","12","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0280006","Smile for Health - Certified High Option Plus","99180AZ028",,"AZN003","AZS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","99180AZ0280006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","FL","12438","HIOS","2","2015-07-09 13:17:42","1","12438","FL","SHOP (Small Group)","Yes","81-0170040","12438FL0010001","Assurant Dental ACAFFO High","12438FL001",,"FLN001","FLS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$35.10","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","12438FL0010001-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","FL","12438","HIOS","2","2015-07-09 13:17:42","1","12438","FL","SHOP (Small Group)","Yes","81-0170040","12438FL0010002","Assurant Dental ACAFFO Low","12438FL001",,"FLN001","FLS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$29.45","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","12438FL0010002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","FL","15833","HIOS","4","2015-08-18 03:25:03","1","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0090003","Managed DentalGuard FL10 Family Plan","15833FL009",,"FLN002","FLS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$9.61","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","15833FL0090003-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","FL","15833","HIOS","4","2015-08-18 03:25:03","1","15833","FL","Individual","Yes","13-5123390","15833FL0120002","Managed DentalGuard FL Essentials 1","15833FL012",,"FLN004","FLS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$11.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","15833FL0120002-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","4"
"2016","FL","15833","HIOS","4","2015-08-18 03:25:03","1","15833","FL","Individual","Yes","13-5123390","15833FL0120002","Managed DentalGuard FL Essentials 1","15833FL012",,"FLN004","FLS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$11.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","15833FL0120002-01","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","5"
"2016","FL","15833","HIOS","4","2015-08-18 03:25:03","1","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0090003","Managed DentalGuard FL10 Family Plan","15833FL009",,"FLN002","FLS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$9.61","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","15833FL0090003-01","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","FL","15833","HIOS","4","2015-08-18 03:25:03","1","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0100003","Managed DentalGuard FL20 Family Plan","15833FL010",,"FLN002","FLS001",,"Existing","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$9.35","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","15833FL0100003-00","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","FL","15833","HIOS","4","2015-08-18 03:25:03","1","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0110003","Managed DentalGuard FL30 Family Plan","15833FL011",,"FLN002","FLS001",,"Existing","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$10.25","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","15833FL0110003-00","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","FL","15833","HIOS","4","2015-08-18 03:25:03","2","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0010003","Guardian Pediatric Advantage","15833FL001",,"FLN001","FLS002",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$24.09","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","15833FL0010003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","FL","15833","HIOS","4","2015-08-18 03:25:03","2","15833","FL","Individual","Yes","13-5123390","15833FL0130001","Guardian Family Essentials","15833FL013",,"FLN003","FLS002",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","15833FL0130001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","4"
"2016","FL","15833","HIOS","4","2015-08-18 03:25:03","2","15833","FL","Individual","Yes","13-5123390","15833FL0130001","Guardian Family Essentials","15833FL013",,"FLN003","FLS002",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","15833FL0130001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","5"
"2016","FL","15833","HIOS","4","2015-08-18 03:25:03","2","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0020003","Guardian Pediatric Essentials","15833FL002",,"FLN001","FLS002",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$18.55","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","15833FL0020003-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","FL","15833","HIOS","4","2015-08-18 03:25:03","3","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0040003","Guardian Family Advantage","15833FL004",,"FLN001","FLS002",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.09","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","15833FL0040003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","FL","15833","HIOS","4","2015-08-18 03:25:03","3","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0040003","Guardian Family Advantage","15833FL004",,"FLN001","FLS002",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.09","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","15833FL0040003-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","FL","15833","HIOS","4","2015-08-18 03:25:03","3","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0060003","Guardian Family Essentials","15833FL006",,"FLN001","FLS002",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.55","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","15833FL0060003-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","FL","15833","HIOS","4","2015-08-18 03:25:03","3","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0060003","Guardian Family Essentials","15833FL006",,"FLN001","FLS002",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.55","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","15833FL0060003-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","FL","15980","HIOS","5","2015-08-20 09:36:54","1","15980","FL","Individual","Yes","39-1263473","15980FL0160001","Humana Dental Smart Choice","15980FL016",,"FLN001","FLS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.86","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","15980FL0160001-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612844","4"
"2016","FL","15980","HIOS","5","2015-08-20 09:36:54","1","15980","FL","Individual","Yes","39-1263473","15980FL0160001","Humana Dental Smart Choice","15980FL016",,"FLN001","FLS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.86","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","15980FL0160001-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612844","5"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","1","16842","FL","Individual","No","59-2015694","16842FL0070114","BlueOptions Everyday Health 1410","16842FL007","7700889661","FLN001","FLS001","FLF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070114-00","Standard Silver Off Exchange Plan",,"0.680478096008301","Yes","Yes","No","100%",,"$6,100","$90","$0","$200","$600","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","30%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1410.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1410.pdf","4"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","1","16842","FL","SHOP (Small Group)","No","59-2015694","16842FL0010001","BlueOptions Essential Health S1400","16842FL001","7700889661","FLN001","FLS001","FLF001","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0010001-00","Standard Silver Off Exchange Plan",,"0.711081624031067","No","Yes","No","100%",,"$2,000","$0","$900","$200","$1,200","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/S1400.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/S1400.pdf","4"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","1","16842","FL","SHOP (Small Group)","No","59-2015694","16842FL0010001","BlueOptions Essential Health S1400","16842FL001","7700889661","FLN001","FLS001","FLF001","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0010001-01","Standard Silver On Exchange Plan",,"0.711081624031067","No","Yes","No","100%",,"$2,000","$0","$900","$200","$1,200","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/S1400.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/S1400.pdf","5"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","1","16842","FL","Individual","No","59-2015694","16842FL0070114","BlueOptions Everyday Health 1410","16842FL007","7700889661","FLN001","FLS001","FLF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070114-01","Standard Silver On Exchange Plan",,"0.680478096008301","Yes","Yes","No","100%",,"$6,100","$90","$0","$200","$600","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","30%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1410.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1410.pdf","5"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","1","16842","FL","Individual","No","59-2015694","16842FL0070114","BlueOptions Everyday Health 1410","16842FL007","7700889661","FLN001","FLS001","FLF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070114-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1410U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1410U.pdf","6"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","1","16842","FL","SHOP (Small Group)","No","59-2015694","16842FL0010002","BlueOptions Essential Health S1401","16842FL001","7700889661","FLN001","FLS001","FLF001","Existing","EPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0010002-00","Standard Gold Off Exchange Plan",,"0.797176897525787","No","Yes","No","100%",,"$1,000","$0","$1,100","$200","$1,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/S1401.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/S1401.pdf","6"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","1","16842","FL","SHOP (Small Group)","No","59-2015694","16842FL0010002","BlueOptions Essential Health S1401","16842FL001","7700889661","FLN001","FLS001","FLF001","Existing","EPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0010002-01","Standard Gold On Exchange Plan",,"0.797176897525787","No","Yes","No","100%",,"$1,000","$0","$1,100","$200","$1,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/S1401.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/S1401.pdf","7"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","1","16842","FL","Individual","No","59-2015694","16842FL0070114","BlueOptions Everyday Health 1410","16842FL007","7700889661","FLN001","FLS001","FLF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070114-03","Limited Cost Sharing Plan Variation",,"0.680478096008301","Yes","Yes","No","100%",,"$6,100","$90","$0","$200","$600","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","30%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1410O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1410O.pdf","7"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","1","16842","FL","Individual","No","59-2015694","16842FL0070114","BlueOptions Everyday Health 1410","16842FL007","7700889661","FLN001","FLS001","FLF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070114-04","73% AV Level Silver Plan",,"0.736551940441132","Yes","Yes","No","100%",,"$3,600","$200","$0","$200","$0","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","30%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1410A.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1410A.pdf","8"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","1","16842","FL","Individual","No","59-2015694","16842FL0070114","BlueOptions Everyday Health 1410","16842FL007","7700889661","FLN001","FLS001","FLF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070114-05","87% AV Level Silver Plan",,"0.878278017044067","Yes","Yes","No","100%",,"$0","$50","$1,100","$200","$0","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1410B.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1410B.pdf","9"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","1","16842","FL","Individual","No","59-2015694","16842FL0070114","BlueOptions Everyday Health 1410","16842FL007","7700889661","FLN001","FLS001","FLF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070114-06","94% AV Level Silver Plan",,"0.936994969844818","Yes","Yes","No","100%",,"$0","$10","$900","$200","$0","$60","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1410C.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1410C.pdf","10"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","1","16842","FL","Individual","No","59-2015694","16842FL0120072","BlueSelect Everyday Health 1443","16842FL012","7700889661","FLN002","FLS002","FLF011","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120072-04","73% AV Level Silver Plan",,"0.736551940441132","Yes","Yes","No","100%",,"$3,600","$200","$0","$200","$0","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","30%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1443A.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1443A.pdf","15"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","1","16842","FL","Individual","No","59-2015694","16842FL0120072","BlueSelect Everyday Health 1443","16842FL012","7700889661","FLN002","FLS002","FLF011","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120072-05","87% AV Level Silver Plan",,"0.878278017044067","Yes","Yes","No","100%",,"$0","$50","$1,100","$200","$0","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1443B.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1443B.pdf","16"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","5","16842","FL","Individual","No","59-2015694","16842FL0120033","BlueSelect Everyday Health 1456","16842FL012","7700889661","FLN002","FLS002","FLF016","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120033-00","Standard Silver Off Exchange Plan","68.25%","0","No","Yes","No","100%",,"$3,600","$400","$0","$200","$3,000","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1456.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1456.pdf","11"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","5","16842","FL","Individual","No","59-2015694","16842FL0120033","BlueSelect Everyday Health 1456","16842FL012","7700889661","FLN002","FLS002","FLF016","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120033-01","Standard Silver On Exchange Plan","68.25%","0","No","Yes","No","100%",,"$3,600","$400","$0","$200","$3,000","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1456.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1456.pdf","12"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","5","16842","FL","Individual","No","59-2015694","16842FL0120033","BlueSelect Everyday Health 1456","16842FL012","7700889661","FLN002","FLS002","FLF016","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120033-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1456U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1456U.pdf","13"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","5","16842","FL","Individual","No","59-2015694","16842FL0120033","BlueSelect Everyday Health 1456","16842FL012","7700889661","FLN002","FLS002","FLF016","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120033-03","Limited Cost Sharing Plan Variation","68.25%","0","No","Yes","No","100%",,"$3,600","$400","$0","$200","$3,000","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1456O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1456O.pdf","14"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","5","16842","FL","Individual","No","59-2015694","16842FL0120033","BlueSelect Everyday Health 1456","16842FL012","7700889661","FLN002","FLS002","FLF016","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120033-04","73% AV Level Silver Plan","73.95%","0","No","Yes","No","100%",,"$3,600","$300","$0","$200","$3,000","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1456A.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1456A.pdf","15"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","5","16842","FL","Individual","No","59-2015694","16842FL0120033","BlueSelect Everyday Health 1456","16842FL012","7700889661","FLN002","FLS002","FLF016","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120033-05","87% AV Level Silver Plan","87.21%","0","No","Yes","No","100%",,"$0","$500","$0","$200","$0","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1456B.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1456B.pdf","16"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","1","16842","FL","Individual","No","59-2015694","16842FL0120072","BlueSelect Everyday Health 1443","16842FL012","7700889661","FLN002","FLS002","FLF011","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120072-06","94% AV Level Silver Plan",,"0.936994969844818","Yes","Yes","No","100%",,"$0","$10","$900","$200","$0","$60","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"$12,200","$12200 per person","$24400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1443C.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1443C.pdf","17"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","2","16842","FL","Individual","No","59-2015694","16842FL0070108","BlueOptions Everyday Health 1416","16842FL007","7700889661","FLN001","FLS001","FLF003","Existing","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070108-00","Standard Bronze Off Exchange Plan","61.91%","0","Yes","Yes","No","100%",,"$3,600","$200","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$26,800","$26800 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","50%",,,,,"$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1416.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1416.pdf","4"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","2","16842","FL","Individual","No","59-2015694","16842FL0070108","BlueOptions Everyday Health 1416","16842FL007","7700889661","FLN001","FLS001","FLF003","Existing","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070108-01","Standard Bronze On Exchange Plan","61.91%","0","Yes","Yes","No","100%",,"$3,600","$200","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$26,800","$26800 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","50%",,,,,"$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1416.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1416.pdf","5"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","2","16842","FL","Individual","No","59-2015694","16842FL0120068","BlueSelect Everyday Health 1449","16842FL012","7700889661","FLN002","FLS002","FLF012","Existing","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120068-01","Standard Bronze On Exchange Plan","61.91%","0","Yes","Yes","No","100%",,"$3,600","$200","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$26,800","$26800 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","50%",,,,,"$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1449.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1449.pdf","9"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","2","16842","FL","Individual","No","59-2015694","16842FL0120068","BlueSelect Everyday Health 1449","16842FL012","7700889661","FLN002","FLS002","FLF012","Existing","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120068-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1449U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1449U.pdf","10"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","2","16842","FL","Individual","No","59-2015694","16842FL0120068","BlueSelect Everyday Health 1449","16842FL012","7700889661","FLN002","FLS002","FLF012","Existing","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120068-03","Limited Cost Sharing Plan Variation","61.91%","0","Yes","Yes","No","100%",,"$3,600","$200","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$26,800","$26800 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","50%",,,,,"$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1449O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1449O.pdf","11"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","3","16842","FL","Individual","No","59-2015694","16842FL0070102","BlueOptions Everyday Health 1418","16842FL007","7700889661","FLN001","FLS001","FLF004","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070102-00","Standard Platinum Off Exchange Plan",,"0.889939486980438","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1418.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1418.pdf","4"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","3","16842","FL","Individual","No","59-2015694","16842FL0070102","BlueOptions Everyday Health 1418","16842FL007","7700889661","FLN001","FLS001","FLF004","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070102-01","Standard Platinum On Exchange Plan",,"0.889939486980438","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1418.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1418.pdf","5"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","3","16842","FL","Individual","No","59-2015694","16842FL0070102","BlueOptions Everyday Health 1418","16842FL007","7700889661","FLN001","FLS001","FLF004","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070102-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1418U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1418U.pdf","6"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","3","16842","FL","Individual","No","59-2015694","16842FL0070102","BlueOptions Everyday Health 1418","16842FL007","7700889661","FLN001","FLS001","FLF004","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070102-03","Limited Cost Sharing Plan Variation",,"0.889939486980438","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1418O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1418O.pdf","7"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","6","16842","FL","Individual","No","59-2015694","16842FL0120070","BlueSelect All Copay 1457","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120070-00","Standard Platinum Off Exchange Plan","89.02%","0","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1457.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1457.pdf","8"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","3","16842","FL","Individual","No","59-2015694","16842FL0120062","BlueSelect Everyday Health 1451","16842FL012","7700889661","FLN002","FLS002","FLF013","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120062-00","Standard Platinum Off Exchange Plan",,"0.889939486980438","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1451.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1451.pdf","8"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","3","16842","FL","Individual","No","59-2015694","16842FL0120062","BlueSelect Everyday Health 1451","16842FL012","7700889661","FLN002","FLS002","FLF013","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120062-01","Standard Platinum On Exchange Plan",,"0.889939486980438","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1451.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1451.pdf","9"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","3","16842","FL","Individual","No","59-2015694","16842FL0120062","BlueSelect Everyday Health 1451","16842FL012","7700889661","FLN002","FLS002","FLF013","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120062-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1451U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1451U.pdf","10"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","3","16842","FL","Individual","No","59-2015694","16842FL0120062","BlueSelect Everyday Health 1451","16842FL012","7700889661","FLN002","FLS002","FLF013","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120062-03","Limited Cost Sharing Plan Variation",,"0.889939486980438","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1451O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1451O.pdf","11"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","4","16842","FL","Individual","No","59-2015694","16842FL0070084","BlueOptions Essential 1419","16842FL007","7700889661","FLN001","FLS001","FLF006","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070084-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1419.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1419.pdf","4"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","4","16842","FL","Individual","No","59-2015694","16842FL0070084","BlueOptions Essential 1419","16842FL007","7700889661","FLN001","FLS001","FLF006","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070084-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1419.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1419.pdf","5"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","4","16842","FL","Individual","No","59-2015694","16842FL0070084","BlueOptions Essential 1419","16842FL007","7700889661","FLN001","FLS001","FLF006","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070084-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1419U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1419U.pdf","6"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","4","16842","FL","Individual","No","59-2015694","16842FL0070084","BlueOptions Essential 1419","16842FL007","7700889661","FLN001","FLS001","FLF006","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070084-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1419O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1419O.pdf","7"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","4","16842","FL","Individual","No","59-2015694","16842FL0120044","BlueSelect Essential 1452","16842FL012","7700889661","FLN002","FLS002","FLF015","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120044-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1452.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1452.pdf","8"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","4","16842","FL","Individual","No","59-2015694","16842FL0120044","BlueSelect Essential 1452","16842FL012","7700889661","FLN002","FLS002","FLF015","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120044-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1452.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1452.pdf","9"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","4","16842","FL","Individual","No","59-2015694","16842FL0120044","BlueSelect Essential 1452","16842FL012","7700889661","FLN002","FLS002","FLF015","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120044-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1452U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1452U.pdf","10"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","4","16842","FL","Individual","No","59-2015694","16842FL0120044","BlueSelect Essential 1452","16842FL012","7700889661","FLN002","FLS002","FLF015","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120044-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1452O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1452O.pdf","11"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","5","16842","FL","Individual","No","59-2015694","16842FL0070073","BlueOptions Everyday Health 1423","16842FL007","7700889661","FLN001","FLS001","FLF007","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070073-00","Standard Silver Off Exchange Plan","68.25%","0","No","Yes","No","100%",,"$3,600","$400","$0","$200","$3,000","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1423.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1423.pdf","4"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","5","16842","FL","Individual","No","59-2015694","16842FL0070073","BlueOptions Everyday Health 1423","16842FL007","7700889661","FLN001","FLS001","FLF007","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070073-01","Standard Silver On Exchange Plan","68.25%","0","No","Yes","No","100%",,"$3,600","$400","$0","$200","$3,000","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1423.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1423.pdf","5"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","5","16842","FL","Individual","No","59-2015694","16842FL0070073","BlueOptions Everyday Health 1423","16842FL007","7700889661","FLN001","FLS001","FLF007","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070073-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1423U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1423U.pdf","6"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","5","16842","FL","Individual","No","59-2015694","16842FL0070073","BlueOptions Everyday Health 1423","16842FL007","7700889661","FLN001","FLS001","FLF007","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070073-03","Limited Cost Sharing Plan Variation","68.25%","0","No","Yes","No","100%",,"$3,600","$400","$0","$200","$3,000","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1423O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1423O.pdf","7"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","5","16842","FL","Individual","No","59-2015694","16842FL0070073","BlueOptions Everyday Health 1423","16842FL007","7700889661","FLN001","FLS001","FLF007","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070073-04","73% AV Level Silver Plan","73.95%","0","No","Yes","No","100%",,"$3,600","$300","$0","$200","$3,000","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1423A.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1423A.pdf","8"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","5","16842","FL","Individual","No","59-2015694","16842FL0070073","BlueOptions Everyday Health 1423","16842FL007","7700889661","FLN001","FLS001","FLF007","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070073-05","87% AV Level Silver Plan","87.21%","0","No","Yes","No","100%",,"$0","$500","$0","$200","$0","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1423B.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1423B.pdf","9"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","5","16842","FL","Individual","No","59-2015694","16842FL0070073","BlueOptions Everyday Health 1423","16842FL007","7700889661","FLN001","FLS001","FLF007","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070073-06","94% AV Level Silver Plan","94.17%","0","No","Yes","No","100%",,"$0","$400","$0","$200","$0","$60","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1423C.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1423C.pdf","10"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","5","16842","FL","Individual","No","59-2015694","16842FL0120033","BlueSelect Everyday Health 1456","16842FL012","7700889661","FLN002","FLS002","FLF016","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120033-06","94% AV Level Silver Plan","94.17%","0","No","Yes","No","100%",,"$0","$400","$0","$200","$0","$60","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1456C.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1456C.pdf","17"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","9","16842","FL","Individual","No","59-2015694","16842FL0070106","BlueOptions Everyday Health Premier 1418V","16842FL007","7700889661","FLN001","FLS001","FLF005","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9589",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070106-00","Standard Platinum Off Exchange Plan",,"0.889939486980438","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1418V.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1418V.pdf","4"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","9","16842","FL","Individual","No","59-2015694","16842FL0070106","BlueOptions Everyday Health Premier 1418V","16842FL007","7700889661","FLN001","FLS001","FLF005","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9589",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070106-01","Standard Platinum On Exchange Plan",,"0.889939486980438","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1418V.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1418V.pdf","5"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","9","16842","FL","Individual","No","59-2015694","16842FL0070106","BlueOptions Everyday Health Premier 1418V","16842FL007","7700889661","FLN001","FLS001","FLF005","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9589",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070106-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1418UV.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1418UV.pdf","6"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","9","16842","FL","Individual","No","59-2015694","16842FL0070106","BlueOptions Everyday Health Premier 1418V","16842FL007","7700889661","FLN001","FLS001","FLF005","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9589",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070106-03","Limited Cost Sharing Plan Variation",,"0.889939486980438","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1418OV.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1418OV.pdf","7"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","9","16842","FL","Individual","No","59-2015694","16842FL0120066","BlueSelect Everyday Health Premier 1451V","16842FL012","7700889661","FLN002","FLS002","FLF014","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9589",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120066-00","Standard Platinum Off Exchange Plan",,"0.889939486980438","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1451V.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1451V.pdf","8"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","9","16842","FL","Individual","No","59-2015694","16842FL0120066","BlueSelect Everyday Health Premier 1451V","16842FL012","7700889661","FLN002","FLS002","FLF014","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9589",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120066-01","Standard Platinum On Exchange Plan",,"0.889939486980438","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1451V.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1451V.pdf","9"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","9","16842","FL","Individual","No","59-2015694","16842FL0120066","BlueSelect Everyday Health Premier 1451V","16842FL012","7700889661","FLN002","FLS002","FLF014","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9589",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120066-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1451UV.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1451UV.pdf","10"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","6","16842","FL","Individual","No","59-2015694","16842FL0070110","BlueOptions All Copay 1424","16842FL007","7700889661","FLN001","FLS001","FLF008","Existing","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070110-00","Standard Platinum Off Exchange Plan","89.02%","0","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1424.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1424.pdf","4"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","6","16842","FL","Individual","No","59-2015694","16842FL0070110","BlueOptions All Copay 1424","16842FL007","7700889661","FLN001","FLS001","FLF008","Existing","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070110-01","Standard Platinum On Exchange Plan","89.02%","0","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1424.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1424.pdf","5"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","6","16842","FL","Individual","No","59-2015694","16842FL0070110","BlueOptions All Copay 1424","16842FL007","7700889661","FLN001","FLS001","FLF008","Existing","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070110-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1424U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1424U.pdf","6"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","6","16842","FL","Individual","No","59-2015694","16842FL0070110","BlueOptions All Copay 1424","16842FL007","7700889661","FLN001","FLS001","FLF008","Existing","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070110-03","Limited Cost Sharing Plan Variation","89.02%","0","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1424O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1424O.pdf","7"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","6","16842","FL","Individual","No","59-2015694","16842FL0120070","BlueSelect All Copay 1457","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120070-01","Standard Platinum On Exchange Plan","89.02%","0","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1457.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1457.pdf","9"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","6","16842","FL","Individual","No","59-2015694","16842FL0120070","BlueSelect All Copay 1457","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120070-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1457U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1457U.pdf","10"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","6","16842","FL","Individual","No","59-2015694","16842FL0120070","BlueSelect All Copay 1457","16842FL012","7700889661","FLN002","FLS002","FLF017","Existing","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120070-03","Limited Cost Sharing Plan Variation","89.02%","0","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1457O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1457O.pdf","11"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","7","16842","FL","Individual","No","59-2015694","16842FL0070120","BlueOptions All Copay 1505","16842FL007","7700889661","FLN001","FLS001","FLF010","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070120-00","Standard Gold Off Exchange Plan","80.84%","0","Yes","Yes","No","100%",,"$0","$700","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1505.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1505.pdf","4"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","7","16842","FL","Individual","No","59-2015694","16842FL0070120","BlueOptions All Copay 1505","16842FL007","7700889661","FLN001","FLS001","FLF010","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070120-01","Standard Gold On Exchange Plan","80.84%","0","Yes","Yes","No","100%",,"$0","$700","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1505.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1505.pdf","5"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","7","16842","FL","Individual","No","59-2015694","16842FL0070120","BlueOptions All Copay 1505","16842FL007","7700889661","FLN001","FLS001","FLF010","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070120-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1505U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1505U.pdf","6"
"2016","FL","18628","HIOS","10","2015-10-18 12:35:12","1","18628","FL","Individual","No","59-2411584","18628FL0120001","Aetna Bronze $15 Copay Savings Plus HMO","18628FL012",,"FLN001","FLS001","FLF008","Existing","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8437578186","18628FL0120001-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/FL/FL_SBC_708724.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/fl-on-booklet01-16.pdf","7"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","7","16842","FL","Individual","No","59-2015694","16842FL0070120","BlueOptions All Copay 1505","16842FL007","7700889661","FLN001","FLS001","FLF010","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070120-03","Limited Cost Sharing Plan Variation","80.84%","0","Yes","Yes","No","100%",,"$0","$700","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1505O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1505O.pdf","7"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","7","16842","FL","Individual","No","59-2015694","16842FL0120076","BlueSelect All Copay 1535","16842FL012","7700889661","FLN002","FLS002","FLF019","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120076-00","Standard Gold Off Exchange Plan","80.84%","0","Yes","Yes","No","100%",,"$0","$700","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1535.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1535.pdf","8"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","7","16842","FL","Individual","No","59-2015694","16842FL0120076","BlueSelect All Copay 1535","16842FL012","7700889661","FLN002","FLS002","FLF019","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120076-01","Standard Gold On Exchange Plan","80.84%","0","Yes","Yes","No","100%",,"$0","$700","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1535.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1535.pdf","9"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","7","16842","FL","Individual","No","59-2015694","16842FL0120076","BlueSelect All Copay 1535","16842FL012","7700889661","FLN002","FLS002","FLF019","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120076-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1535U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1535U.pdf","10"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","7","16842","FL","Individual","No","59-2015694","16842FL0120076","BlueSelect All Copay 1535","16842FL012","7700889661","FLN002","FLS002","FLF019","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120076-03","Limited Cost Sharing Plan Variation","80.84%","0","Yes","Yes","No","100%",,"$0","$700","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1535O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1535O.pdf","11"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","8","16842","FL","Individual","No","59-2015694","16842FL0070100","BlueOptions Everyday Health 1431","16842FL007","7700889661","FLN001","FLS001","FLF009","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070100-00","Standard Silver Off Exchange Plan",,"0.698374092578888","No","Yes","No","100%",,"$3,600","$100","$0","$200","$0","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1431.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1431.pdf","4"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","8","16842","FL","Individual","No","59-2015694","16842FL0070100","BlueOptions Everyday Health 1431","16842FL007","7700889661","FLN001","FLS001","FLF009","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070100-01","Standard Silver On Exchange Plan",,"0.698374092578888","No","Yes","No","100%",,"$3,600","$100","$0","$200","$0","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1431.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1431.pdf","5"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","8","16842","FL","Individual","No","59-2015694","16842FL0070100","BlueOptions Everyday Health 1431","16842FL007","7700889661","FLN001","FLS001","FLF009","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070100-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1431U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1431U.pdf","6"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","8","16842","FL","Individual","No","59-2015694","16842FL0070100","BlueOptions Everyday Health 1431","16842FL007","7700889661","FLN001","FLS001","FLF009","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070100-03","Limited Cost Sharing Plan Variation",,"0.698374092578888","No","Yes","No","100%",,"$3,600","$100","$0","$200","$0","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1431O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1431O.pdf","7"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","8","16842","FL","Individual","No","59-2015694","16842FL0070100","BlueOptions Everyday Health 1431","16842FL007","7700889661","FLN001","FLS001","FLF009","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070100-04","73% AV Level Silver Plan",,"0.735831022262573","No","Yes","No","100%",,"$3,500","$100","$10","$200","$0","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1431A.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1431A.pdf","8"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","8","16842","FL","Individual","No","59-2015694","16842FL0070100","BlueOptions Everyday Health 1431","16842FL007","7700889661","FLN001","FLS001","FLF009","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070100-05","87% AV Level Silver Plan",,"0.863704741001129","No","Yes","No","100%",,"$1,500","$80","$0","$200","$0","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1431B.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1431B.pdf","9"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","8","16842","FL","Individual","No","59-2015694","16842FL0070100","BlueOptions Everyday Health 1431","16842FL007","7700889661","FLN001","FLS001","FLF009","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0070100-06","94% AV Level Silver Plan",,"0.936406075954437","No","Yes","No","100%",,"$500","$20","$0","$200","$0","$60","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1431C.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1431C.pdf","10"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","8","16842","FL","Individual","No","59-2015694","16842FL0120060","BlueSelect Everyday Health 1464","16842FL012","7700889661","FLN002","FLS002","FLF018","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120060-00","Standard Silver Off Exchange Plan",,"0.698374092578888","No","Yes","No","100%",,"$3,600","$100","$0","$200","$0","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1464.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1464.pdf","11"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","8","16842","FL","Individual","No","59-2015694","16842FL0120060","BlueSelect Everyday Health 1464","16842FL012","7700889661","FLN002","FLS002","FLF018","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120060-01","Standard Silver On Exchange Plan",,"0.698374092578888","No","Yes","No","100%",,"$3,600","$100","$0","$200","$0","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1464.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1464.pdf","12"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","8","16842","FL","Individual","No","59-2015694","16842FL0120060","BlueSelect Everyday Health 1464","16842FL012","7700889661","FLN002","FLS002","FLF018","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120060-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1464U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1464U.pdf","13"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","8","16842","FL","Individual","No","59-2015694","16842FL0120060","BlueSelect Everyday Health 1464","16842FL012","7700889661","FLN002","FLS002","FLF018","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120060-03","Limited Cost Sharing Plan Variation",,"0.698374092578888","No","Yes","No","100%",,"$3,600","$100","$0","$200","$0","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1464O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1464O.pdf","14"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","8","16842","FL","Individual","No","59-2015694","16842FL0120060","BlueSelect Everyday Health 1464","16842FL012","7700889661","FLN002","FLS002","FLF018","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120060-04","73% AV Level Silver Plan",,"0.735831022262573","No","Yes","No","100%",,"$3,500","$100","$10","$200","$0","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1464A.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1464A.pdf","15"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","8","16842","FL","Individual","No","59-2015694","16842FL0120060","BlueSelect Everyday Health 1464","16842FL012","7700889661","FLN002","FLS002","FLF018","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120060-05","87% AV Level Silver Plan",,"0.863704741001129","No","Yes","No","100%",,"$1,500","$80","$0","$200","$0","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1464B.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1464B.pdf","16"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","8","16842","FL","Individual","No","59-2015694","16842FL0120060","BlueSelect Everyday Health 1464","16842FL012","7700889661","FLN002","FLS002","FLF018","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120060-06","94% AV Level Silver Plan",,"0.936406075954437","No","Yes","No","100%",,"$500","$20","$0","$200","$0","$60","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1464C.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1464C.pdf","17"
"2016","FL","16842","HIOS","10","2016-07-08 07:33:42","9","16842","FL","Individual","No","59-2015694","16842FL0120066","BlueSelect Everyday Health Premier 1451V","16842FL012","7700889661","FLN002","FLS002","FLF014","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","0.9589",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Covered services as outlined in the member contract.","Yes","Covered services as outlined in the member contract.","Yes","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","16842FL0120066-03","Limited Cost Sharing Plan Variation",,"0.889939486980438","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1451OV.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1451OV.pdf","11"
"2016","FL","18628","HIOS","10","2015-10-18 12:35:12","1","18628","FL","Individual","No","59-2411584","18628FL0120001","Aetna Bronze $15 Copay Savings Plus HMO","18628FL012",,"FLN001","FLS001","FLF008","Existing","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8437578186","18628FL0120001-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/FL/FL_SBC_708722.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/fl-on-booklet01-16.pdf","4"
"2016","FL","18628","HIOS","10","2015-10-18 12:35:12","1","18628","FL","Individual","No","59-2411584","18628FL0120001","Aetna Bronze $15 Copay Savings Plus HMO","18628FL012",,"FLN001","FLS001","FLF008","Existing","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8437578186","18628FL0120001-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/FL/FL_SBC_708722.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/fl-on-booklet01-16.pdf","5"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130003","Ambetter Balanced Care 2 (2016)","21663FL013",,"FLN001","FLS001","FLF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130003-01","Standard Silver On Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130003-01.pdf","https://api.centene.com/Brochures/2016/21663FL0130003-01.pdf","16"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130003","Ambetter Balanced Care 2 (2016)","21663FL013",,"FLN001","FLS001","FLF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130003-02.pdf","https://api.centene.com/Brochures/2016/21663FL0130003-02.pdf","17"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130003","Ambetter Balanced Care 2 (2016)","21663FL013",,"FLN001","FLS001","FLF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130003-03","Limited Cost Sharing Plan Variation",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130003-03.pdf","https://api.centene.com/Brochures/2016/21663FL0130003-03.pdf","18"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130003","Ambetter Balanced Care 2 (2016)","21663FL013",,"FLN001","FLS001","FLF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130003-04","73% AV Level Silver Plan",,"0.739638686180115","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130003-04.pdf","https://api.centene.com/Brochures/2016/21663FL0130003-04.pdf","19"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130003","Ambetter Balanced Care 2 (2016)","21663FL013",,"FLN001","FLS001","FLF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130003-05","87% AV Level Silver Plan",,"0.873916625976563","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,700","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130003-05.pdf","https://api.centene.com/Brochures/2016/21663FL0130003-05.pdf","20"
"2016","FL","18628","HIOS","10","2015-10-18 12:35:12","1","18628","FL","Individual","No","59-2411584","18628FL0120001","Aetna Bronze $15 Copay Savings Plus HMO","18628FL012",,"FLN001","FLS001","FLF008","Existing","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8437578186","18628FL0120001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/FL/FL_SBC_708725.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/fl-on-booklet01-16.pdf","6"
"2016","FL","18628","HIOS","10","2015-10-18 12:35:12","3","18628","FL","Individual","No","59-2411584","18628FL0120002","Aetna Bronze Ded Only HSA Eligible Savings Plus HMO","18628FL012",,"FLN001","FLS001","FLF009","Existing","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8437578186","18628FL0120002-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/FL/FL_SBC_708727.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/fl-on-booklet01-16.pdf","4"
"2016","FL","18628","HIOS","10","2015-10-18 12:35:12","3","18628","FL","Individual","No","59-2411584","18628FL0120002","Aetna Bronze Ded Only HSA Eligible Savings Plus HMO","18628FL012",,"FLN001","FLS001","FLF009","Existing","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8437578186","18628FL0120002-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/FL/FL_SBC_708727.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/fl-on-booklet01-16.pdf","5"
"2016","FL","18628","HIOS","10","2015-10-18 12:35:12","3","18628","FL","Individual","No","59-2411584","18628FL0120002","Aetna Bronze Ded Only HSA Eligible Savings Plus HMO","18628FL012",,"FLN001","FLS001","FLF009","Existing","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8437578186","18628FL0120002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/FL/FL_SBC_708730.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/fl-on-booklet01-16.pdf","6"
"2016","FL","18628","HIOS","10","2015-10-18 12:35:12","3","18628","FL","Individual","No","59-2411584","18628FL0120002","Aetna Bronze Ded Only HSA Eligible Savings Plus HMO","18628FL012",,"FLN001","FLS001","FLF009","Existing","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8437578186","18628FL0120002-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/FL/FL_SBC_708729.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/fl-on-booklet01-16.pdf","7"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130002","Ambetter Balanced Care 1 (2016)","21663FL013",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130002-03","Limited Cost Sharing Plan Variation",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130002-03.pdf","https://api.centene.com/Brochures/2016/21663FL0130002-03.pdf","11"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130002","Ambetter Balanced Care 1 (2016)","21663FL013",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130002-04","73% AV Level Silver Plan",,"0.737546384334564","Yes","Yes","No","100%",,"$3,500","$10","$300","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130002-04.pdf","https://api.centene.com/Brochures/2016/21663FL0130002-04.pdf","12"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130002","Ambetter Balanced Care 1 (2016)","21663FL013",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130002-05","87% AV Level Silver Plan",,"0.879890024662018","Yes","Yes","No","100%",,"$400","$10","$1,000","$200","$400","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130002-05.pdf","https://api.centene.com/Brochures/2016/21663FL0130002-05.pdf","13"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130002","Ambetter Balanced Care 1 (2016)","21663FL013",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130002-06","94% AV Level Silver Plan",,"0.948710560798645","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130002-06.pdf","https://api.centene.com/Brochures/2016/21663FL0130002-06.pdf","14"
"2016","FL","18628","HIOS","10","2015-10-18 12:35:12","8","18628","FL","Individual","No","59-2411584","18628FL0120006","Aetna Silver $10 Copay 2750 Savings Plus HMO","18628FL012",,"FLN001","FLS001","FLF012","Existing","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8435155900","18628FL0120006-00","Standard Silver Off Exchange Plan","68.19%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/FL/FL_SBC_708713.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/fl-on-booklet01-16.pdf","4"
"2016","FL","18628","HIOS","10","2015-10-18 12:35:12","8","18628","FL","Individual","No","59-2411584","18628FL0120006","Aetna Silver $10 Copay 2750 Savings Plus HMO","18628FL012",,"FLN001","FLS001","FLF012","Existing","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8435155900","18628FL0120006-01","Standard Silver On Exchange Plan","68.19%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/FL/FL_SBC_708713.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/fl-on-booklet01-16.pdf","5"
"2016","FL","18628","HIOS","10","2015-10-18 12:35:12","8","18628","FL","Individual","No","59-2411584","18628FL0120006","Aetna Silver $10 Copay 2750 Savings Plus HMO","18628FL012",,"FLN001","FLS001","FLF012","Existing","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8435155900","18628FL0120006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/FL/FL_SBC_708717.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/fl-on-booklet01-16.pdf","6"
"2016","FL","18628","HIOS","10","2015-10-18 12:35:12","8","18628","FL","Individual","No","59-2411584","18628FL0120006","Aetna Silver $10 Copay 2750 Savings Plus HMO","18628FL012",,"FLN001","FLS001","FLF012","Existing","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8435155900","18628FL0120006-03","Limited Cost Sharing Plan Variation","68.19%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/FL/FL_SBC_708716.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/fl-on-booklet01-16.pdf","7"
"2016","FL","18628","HIOS","10","2015-10-18 12:35:12","8","18628","FL","Individual","No","59-2411584","18628FL0120006","Aetna Silver $10 Copay 2750 Savings Plus HMO","18628FL012",,"FLN001","FLS001","FLF012","Existing","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8435155900","18628FL0120006-04","73% AV Level Silver Plan","72.09%",,"Yes","Yes","No","100%",,"$2,500","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/FL/FL_SBC_708720.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/fl-on-booklet01-16.pdf","8"
"2016","FL","18628","HIOS","10","2015-10-18 12:35:12","8","18628","FL","Individual","No","59-2411584","18628FL0120006","Aetna Silver $10 Copay 2750 Savings Plus HMO","18628FL012",,"FLN001","FLS001","FLF012","Existing","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8435155900","18628FL0120006-05","87% AV Level Silver Plan","86.26%",,"Yes","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/FL/FL_SBC_708719.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/fl-on-booklet01-16.pdf","9"
"2016","FL","18628","HIOS","10","2015-10-18 12:35:12","8","18628","FL","Individual","No","59-2411584","18628FL0120006","Aetna Silver $10 Copay 2750 Savings Plus HMO","18628FL012",,"FLN001","FLS001","FLF012","Existing","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8435155900","18628FL0120006-06","94% AV Level Silver Plan","93.13%",,"Yes","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/FL/FL_SBC_708718.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/fl-on-booklet01-16.pdf","10"
"2016","FL","18628","HIOS","10","2015-10-18 12:35:12","12","18628","FL","Individual","No","59-2411584","18628FL0120004","Aetna Gold $10 Copay Savings Plus HMO","18628FL012",,"FLN001","FLS001","FLF011","Existing","HMO","Gold","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8435155900","18628FL0120004-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/FL/FL_SBC_708700.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/fl-on-booklet01-16.pdf","4"
"2016","FL","18628","HIOS","10","2015-10-18 12:35:12","12","18628","FL","Individual","No","59-2411584","18628FL0120004","Aetna Gold $10 Copay Savings Plus HMO","18628FL012",,"FLN001","FLS001","FLF011","Existing","HMO","Gold","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8435155900","18628FL0120004-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/FL/FL_SBC_708700.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/fl-on-booklet01-16.pdf","5"
"2016","FL","18628","HIOS","10","2015-10-18 12:35:12","12","18628","FL","Individual","No","59-2411584","18628FL0120004","Aetna Gold $10 Copay Savings Plus HMO","18628FL012",,"FLN001","FLS001","FLF011","Existing","HMO","Gold","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8435155900","18628FL0120004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/FL/FL_SBC_708704.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/fl-on-booklet01-16.pdf","6"
"2016","FL","18628","HIOS","10","2015-10-18 12:35:12","12","18628","FL","Individual","No","59-2411584","18628FL0120004","Aetna Gold $10 Copay Savings Plus HMO","18628FL012",,"FLN001","FLS001","FLF011","Existing","HMO","Gold","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8435155900","18628FL0120004-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/FL/FL_SBC_708703.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/fl-on-booklet01-16.pdf","7"
"2016","FL","18628","HIOS","10","2015-10-18 12:35:12","15","18628","FL","Individual","No","59-2411584","18628FL0120003","Aetna Catastrophic Savings Plus HMO","18628FL012",,"FLN001","FLS001","FLF010","Existing","HMO","Catastrophic","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8437578186","18628FL0120003-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/FL/FL_SBC_709882.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/fl-on-booklet01-16.pdf","4"
"2016","FL","18628","HIOS","10","2015-10-18 12:35:12","15","18628","FL","Individual","No","59-2411584","18628FL0120003","Aetna Catastrophic Savings Plus HMO","18628FL012",,"FLN001","FLS001","FLF010","Existing","HMO","Catastrophic","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8437578186","18628FL0120003-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/FL/FL_SBC_709882.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/fl-on-booklet01-16.pdf","5"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","21663FL013",,"FLN001","FLS001","FLF001","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130001-00","Standard Gold Off Exchange Plan",,"0.788068652153015","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/86382FL0010018-00.pdf","https://api.centene.com/Brochures/2016/86382FL0010018-00.pdf","4"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","21663FL013",,"FLN001","FLS001","FLF001","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130001-01","Standard Gold On Exchange Plan",,"0.788068652153015","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/21663FL0130001-00.pdf","https://api.centene.com/Brochures/2016/21663FL0130001-00.pdf","5"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","21663FL013",,"FLN001","FLS001","FLF001","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/21663FL0130001-01.pdf","https://api.centene.com/Brochures/2016/21663FL0130001-01.pdf","6"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","21663FL013",,"FLN001","FLS001","FLF001","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130001-03","Limited Cost Sharing Plan Variation",,"0.788068652153015","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/21663FL0130001-02.pdf","https://api.centene.com/Brochures/2016/21663FL0130001-02.pdf","7"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130002","Ambetter Balanced Care 1 (2016)","21663FL013",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130002-00","Standard Silver Off Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130001-03.pdf","https://api.centene.com/Brochures/2016/21663FL0130001-03.pdf","8"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130002","Ambetter Balanced Care 1 (2016)","21663FL013",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130002-01","Standard Silver On Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130002-01.pdf","https://api.centene.com/Brochures/2016/21663FL0130002-01.pdf","9"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130002","Ambetter Balanced Care 1 (2016)","21663FL013",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130002-02.pdf","https://api.centene.com/Brochures/2016/21663FL0130002-02.pdf","10"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130003","Ambetter Balanced Care 2 (2016)","21663FL013",,"FLN001","FLS001","FLF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130003-00","Standard Silver Off Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130003-00.pdf","https://api.centene.com/Brochures/2016/21663FL0130003-00.pdf","15"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130003","Ambetter Balanced Care 2 (2016)","21663FL013",,"FLN001","FLS001","FLF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130003-06","94% AV Level Silver Plan",,"0.9492227435112","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130003-06.pdf","https://api.centene.com/Brochures/2016/21663FL0130003-06.pdf","21"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130005","Ambetter Balanced Care 10 (2016)","21663FL013",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130005-00","Standard Silver Off Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130005-00.pdf","https://api.centene.com/Brochures/2016/21663FL0130005-00.pdf","29"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130005","Ambetter Balanced Care 10 (2016)","21663FL013",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130005-01","Standard Silver On Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130005-01.pdf","https://api.centene.com/Brochures/2016/21663FL0130005-01.pdf","30"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130005","Ambetter Balanced Care 10 (2016)","21663FL013",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130005-02.pdf","https://api.centene.com/Brochures/2016/21663FL0130005-02.pdf","31"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130005","Ambetter Balanced Care 10 (2016)","21663FL013",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130005-03","Limited Cost Sharing Plan Variation",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130005-03.pdf","https://api.centene.com/Brochures/2016/21663FL0130005-03.pdf","32"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130005","Ambetter Balanced Care 10 (2016)","21663FL013",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130005-04","73% AV Level Silver Plan",,"0.738659501075745","Yes","Yes","No","100%",,"$4,000","$10","$200","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130005-04.pdf","https://api.centene.com/Brochures/2016/21663FL0130005-04.pdf","33"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130005","Ambetter Balanced Care 10 (2016)","21663FL013",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130005-05","87% AV Level Silver Plan",,"0.874480485916138","Yes","Yes","No","100%",,"$1,000","$0","$800","$200","$1,000","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130005-05.pdf","https://api.centene.com/Brochures/2016/21663FL0130005-05.pdf","34"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130005","Ambetter Balanced Care 10 (2016)","21663FL013",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130005-06","94% AV Level Silver Plan",,"0.946612775325775","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130005-06.pdf","https://api.centene.com/Brochures/2016/21663FL0130005-06.pdf","35"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130006","Ambetter Essential Care 1 (2016)","21663FL013",,"FLN001","FLS001","FLF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130006-00","Standard Bronze Off Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130006-00.pdf","https://api.centene.com/Brochures/2016/21663FL0130006-00.pdf","36"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130006","Ambetter Essential Care 1 (2016)","21663FL013",,"FLN001","FLS001","FLF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130006-01","Standard Bronze On Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130006-01.pdf","https://api.centene.com/Brochures/2016/21663FL0130006-01.pdf","37"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130006","Ambetter Essential Care 1 (2016)","21663FL013",,"FLN001","FLS001","FLF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130006-02.pdf","https://api.centene.com/Brochures/2016/21663FL0130006-02.pdf","38"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130006","Ambetter Essential Care 1 (2016)","21663FL013",,"FLN001","FLS001","FLF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130006-03","Limited Cost Sharing Plan Variation",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130006-03.pdf","https://api.centene.com/Brochures/2016/21663FL0130006-03.pdf","39"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130007","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","21663FL013",,"FLN001","FLS001","FLF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130007-00","Standard Bronze Off Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130007-00.pdf","https://api.centene.com/Brochures/2016/21663FL0130007-00.pdf","40"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130007","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","21663FL013",,"FLN001","FLS001","FLF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130007-01","Standard Bronze On Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130007-01.pdf","https://api.centene.com/Brochures/2016/21663FL0130007-01.pdf","41"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130007","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","21663FL013",,"FLN001","FLS001","FLF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130007-02.pdf","https://api.centene.com/Brochures/2016/21663FL0130007-02.pdf","42"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","1","21663","FL","Individual","No","06-0641618","21663FL0130007","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","21663FL013",,"FLN001","FLS001","FLF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0130007-03","Limited Cost Sharing Plan Variation",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0130007-03.pdf","https://api.centene.com/Brochures/2016/21663FL0130007-03.pdf","43"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140001","Ambetter Balanced Care 1 (2016) + Vision","21663FL014",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9798",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140001-00","Standard Silver Off Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140001-00.pdf","https://api.centene.com/Brochures/2016/21663FL0140001-00.pdf","4"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140001","Ambetter Balanced Care 1 (2016) + Vision","21663FL014",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9798",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140001-01","Standard Silver On Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140001-01.pdf","https://api.centene.com/Brochures/2016/21663FL0140001-01.pdf","5"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140001","Ambetter Balanced Care 1 (2016) + Vision","21663FL014",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9798",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140001-02.pdf","https://api.centene.com/Brochures/2016/21663FL0140001-02.pdf","6"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140001","Ambetter Balanced Care 1 (2016) + Vision","21663FL014",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9798",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140001-03","Limited Cost Sharing Plan Variation",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140001-03.pdf","https://api.centene.com/Brochures/2016/21663FL0140001-03.pdf","7"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140001","Ambetter Balanced Care 1 (2016) + Vision","21663FL014",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9798",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140001-04","73% AV Level Silver Plan",,"0.737546384334564","Yes","Yes","No","100%",,"$3,500","$10","$300","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140001-04.pdf","https://api.centene.com/Brochures/2016/21663FL0140001-04.pdf","8"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140001","Ambetter Balanced Care 1 (2016) + Vision","21663FL014",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9798",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140001-05","87% AV Level Silver Plan",,"0.879890024662018","Yes","Yes","No","100%",,"$400","$10","$1,000","$200","$400","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140001-05.pdf","https://api.centene.com/Brochures/2016/21663FL0140001-05.pdf","9"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140001","Ambetter Balanced Care 1 (2016) + Vision","21663FL014",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9798",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140001-06","94% AV Level Silver Plan",,"0.948710560798645","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140001-06.pdf","https://api.centene.com/Brochures/2016/21663FL0140001-06.pdf","10"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140002","Ambetter Balanced Care 2 (2016)+ Vision","21663FL014",,"FLN001","FLS001","FLF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9798",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140002-00","Standard Silver Off Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140002-00.pdf","https://api.centene.com/Brochures/2016/21663FL0140002-00.pdf","11"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140002","Ambetter Balanced Care 2 (2016)+ Vision","21663FL014",,"FLN001","FLS001","FLF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9798",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140002-01","Standard Silver On Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140002-01.pdf","https://api.centene.com/Brochures/2016/21663FL0140002-01.pdf","12"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140002","Ambetter Balanced Care 2 (2016)+ Vision","21663FL014",,"FLN001","FLS001","FLF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9798",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140002-02.pdf","https://api.centene.com/Brochures/2016/21663FL0140002-02.pdf","13"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140002","Ambetter Balanced Care 2 (2016)+ Vision","21663FL014",,"FLN001","FLS001","FLF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9798",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140002-03","Limited Cost Sharing Plan Variation",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140002-03.pdf","https://api.centene.com/Brochures/2016/21663FL0140002-03.pdf","14"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140002","Ambetter Balanced Care 2 (2016)+ Vision","21663FL014",,"FLN001","FLS001","FLF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9798",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140002-04","73% AV Level Silver Plan",,"0.739638686180115","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140002-04.pdf","https://api.centene.com/Brochures/2016/21663FL0140002-04.pdf","15"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140002","Ambetter Balanced Care 2 (2016)+ Vision","21663FL014",,"FLN001","FLS001","FLF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9798",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140002-05","87% AV Level Silver Plan",,"0.873916625976563","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,700","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140002-05.pdf","https://api.centene.com/Brochures/2016/21663FL0140002-05.pdf","16"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140002","Ambetter Balanced Care 2 (2016)+ Vision","21663FL014",,"FLN001","FLS001","FLF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9798",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140002-06","94% AV Level Silver Plan",,"0.9492227435112","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140002-06.pdf","https://api.centene.com/Brochures/2016/21663FL0140002-06.pdf","17"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140003","Ambetter Balanced Care 10 (2016) + Vision","21663FL014",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9798",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140003-00","Standard Silver Off Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140003-00.pdf","https://api.centene.com/Brochures/2016/21663FL0140003-00.pdf","18"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140003","Ambetter Balanced Care 10 (2016) + Vision","21663FL014",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9798",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140003-01","Standard Silver On Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140003-01.pdf","https://api.centene.com/Brochures/2016/21663FL0140003-01.pdf","19"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140003","Ambetter Balanced Care 10 (2016) + Vision","21663FL014",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9798",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140003-02.pdf","https://api.centene.com/Brochures/2016/21663FL0140003-02.pdf","20"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140003","Ambetter Balanced Care 10 (2016) + Vision","21663FL014",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9798",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140003-03","Limited Cost Sharing Plan Variation",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140003-03.pdf","https://api.centene.com/Brochures/2016/21663FL0140003-03.pdf","21"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140003","Ambetter Balanced Care 10 (2016) + Vision","21663FL014",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9798",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140003-04","73% AV Level Silver Plan",,"0.738659501075745","Yes","Yes","No","100%",,"$4,000","$10","$200","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140003-04.pdf","https://api.centene.com/Brochures/2016/21663FL0140003-04.pdf","22"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140003","Ambetter Balanced Care 10 (2016) + Vision","21663FL014",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9798",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140003-05","87% AV Level Silver Plan",,"0.874480485916138","Yes","Yes","No","100%",,"$1,000","$0","$800","$200","$1,000","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140003-05.pdf","https://api.centene.com/Brochures/2016/21663FL0140003-05.pdf","23"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140003","Ambetter Balanced Care 10 (2016) + Vision","21663FL014",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9798",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140003-06","94% AV Level Silver Plan",,"0.946612775325775","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140003-06.pdf","https://api.centene.com/Brochures/2016/21663FL0140003-06.pdf","24"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140004","Ambetter Essential Care 1 (2016) + Vision","21663FL014",,"FLN001","FLS001","FLF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9788",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140004-00","Standard Bronze Off Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140004-00.pdf","https://api.centene.com/Brochures/2016/21663FL0140004-00.pdf","25"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140004","Ambetter Essential Care 1 (2016) + Vision","21663FL014",,"FLN001","FLS001","FLF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9788",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140004-01","Standard Bronze On Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140004-01.pdf","https://api.centene.com/Brochures/2016/21663FL0140004-01.pdf","26"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140004","Ambetter Essential Care 1 (2016) + Vision","21663FL014",,"FLN001","FLS001","FLF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9788",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140004-02.pdf","https://api.centene.com/Brochures/2016/21663FL0140004-02.pdf","27"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140004","Ambetter Essential Care 1 (2016) + Vision","21663FL014",,"FLN001","FLS001","FLF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9788",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140004-03","Limited Cost Sharing Plan Variation",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140004-03.pdf","https://api.centene.com/Brochures/2016/21663FL0140004-03.pdf","28"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","21663FL014",,"FLN001","FLS001","FLF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9788",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140005-00","Standard Bronze Off Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140005-00.pdf","https://api.centene.com/Brochures/2016/21663FL0140005-00.pdf","29"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","21663FL014",,"FLN001","FLS001","FLF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9788",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140005-01","Standard Bronze On Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140005-01.pdf","https://api.centene.com/Brochures/2016/21663FL0140005-01.pdf","30"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","21663FL014",,"FLN001","FLS001","FLF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9788",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140005-02.pdf","https://api.centene.com/Brochures/2016/21663FL0140005-02.pdf","31"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","2","21663","FL","Individual","No","06-0641618","21663FL0140005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","21663FL014",,"FLN001","FLS001","FLF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9788",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0140005-03","Limited Cost Sharing Plan Variation",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0140005-03.pdf","https://api.centene.com/Brochures/2016/21663FL0140005-03.pdf","32"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9488",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150001-00","Standard Silver Off Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150001-00.pdf","https://api.centene.com/Brochures/2016/21663FL0150001-00.pdf","4"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9488",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150001-01","Standard Silver On Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150001-01.pdf","https://api.centene.com/Brochures/2016/21663FL0150001-01.pdf","5"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9488",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150001-02.pdf","https://api.centene.com/Brochures/2016/21663FL0150001-02.pdf","6"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9488",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150001-03","Limited Cost Sharing Plan Variation",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150001-03.pdf","https://api.centene.com/Brochures/2016/21663FL0150001-03.pdf","7"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9488",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150001-04","73% AV Level Silver Plan",,"0.737546384334564","Yes","Yes","No","100%",,"$3,500","$10","$300","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150001-04.pdf","https://api.centene.com/Brochures/2016/21663FL0150001-04.pdf","8"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9488",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150001-05","87% AV Level Silver Plan",,"0.879890024662018","Yes","Yes","No","100%",,"$400","$10","$1,000","$200","$400","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150001-05.pdf","https://api.centene.com/Brochures/2016/21663FL0150001-05.pdf","9"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9488",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150001-06","94% AV Level Silver Plan",,"0.948710560798645","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150001-06.pdf","https://api.centene.com/Brochures/2016/21663FL0150001-06.pdf","10"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9489",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150002-00","Standard Silver Off Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150002-00.pdf","https://api.centene.com/Brochures/2016/21663FL0150002-00.pdf","11"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9489",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150002-01","Standard Silver On Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150002-01.pdf","https://api.centene.com/Brochures/2016/21663FL0150002-01.pdf","12"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9489",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150002-02.pdf","https://api.centene.com/Brochures/2016/21663FL0150002-02.pdf","13"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9489",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150002-03","Limited Cost Sharing Plan Variation",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150002-03.pdf","https://api.centene.com/Brochures/2016/21663FL0150002-03.pdf","14"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9489",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150002-04","73% AV Level Silver Plan",,"0.739638686180115","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150002-04.pdf","https://api.centene.com/Brochures/2016/21663FL0150002-04.pdf","15"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9489",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150002-05","87% AV Level Silver Plan",,"0.873916625976563","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,700","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150002-05.pdf","https://api.centene.com/Brochures/2016/21663FL0150002-05.pdf","16"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9489",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150002-06","94% AV Level Silver Plan",,"0.9492227435112","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150002-06.pdf","https://api.centene.com/Brochures/2016/21663FL0150002-06.pdf","17"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150003","Ambetter Balanced Care 10 (2016) + Vision +Adult dental","21663FL015",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9488",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150003-00","Standard Silver Off Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150003-00.pdf","https://api.centene.com/Brochures/2016/21663FL0150003-00.pdf","18"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150003","Ambetter Balanced Care 10 (2016) + Vision +Adult dental","21663FL015",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9488",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150003-01","Standard Silver On Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150003-01.pdf","https://api.centene.com/Brochures/2016/21663FL0150003-01.pdf","19"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150003","Ambetter Balanced Care 10 (2016) + Vision +Adult dental","21663FL015",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9488",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150003-02.pdf","https://api.centene.com/Brochures/2016/21663FL0150003-02.pdf","20"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150003","Ambetter Balanced Care 10 (2016) + Vision +Adult dental","21663FL015",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9488",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150003-03","Limited Cost Sharing Plan Variation",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150003-03.pdf","https://api.centene.com/Brochures/2016/21663FL0150003-03.pdf","21"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150003","Ambetter Balanced Care 10 (2016) + Vision +Adult dental","21663FL015",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9488",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150003-04","73% AV Level Silver Plan",,"0.738659501075745","Yes","Yes","No","100%",,"$4,000","$10","$200","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150003-04.pdf","https://api.centene.com/Brochures/2016/21663FL0150003-04.pdf","22"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150003","Ambetter Balanced Care 10 (2016) + Vision +Adult dental","21663FL015",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9488",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150003-05","87% AV Level Silver Plan",,"0.874480485916138","Yes","Yes","No","100%",,"$1,000","$0","$800","$200","$1,000","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150003-05.pdf","https://api.centene.com/Brochures/2016/21663FL0150003-05.pdf","23"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150003","Ambetter Balanced Care 10 (2016) + Vision +Adult dental","21663FL015",,"FLN001","FLS001","FLF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9488",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150003-06","94% AV Level Silver Plan",,"0.946612775325775","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150003-06.pdf","https://api.centene.com/Brochures/2016/21663FL0150003-06.pdf","24"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150004","Ambetter Essential Care 1 (2016) + Vision +Adult Dental","21663FL015",,"FLN001","FLS001","FLF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9464",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150004-00","Standard Bronze Off Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150004-00.pdf","https://api.centene.com/Brochures/2016/21663FL0150004-00.pdf","25"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150004","Ambetter Essential Care 1 (2016) + Vision +Adult Dental","21663FL015",,"FLN001","FLS001","FLF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9464",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150004-01","Standard Bronze On Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150004-01.pdf","https://api.centene.com/Brochures/2016/21663FL0150004-01.pdf","26"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150004","Ambetter Essential Care 1 (2016) + Vision +Adult Dental","21663FL015",,"FLN001","FLS001","FLF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9464",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150004-02.pdf","https://api.centene.com/Brochures/2016/21663FL0150004-02.pdf","27"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150004","Ambetter Essential Care 1 (2016) + Vision +Adult Dental","21663FL015",,"FLN001","FLS001","FLF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9464",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150004-03","Limited Cost Sharing Plan Variation",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150004-03.pdf","https://api.centene.com/Brochures/2016/21663FL0150004-03.pdf","28"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150005","Ambetter Essential Care 5 (2016) With 3 Free PCP Visits + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9464",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150005-00","Standard Bronze Off Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150005-00.pdf","https://api.centene.com/Brochures/2016/21663FL0150005-00.pdf","29"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150005","Ambetter Essential Care 5 (2016) With 3 Free PCP Visits + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9464",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150005-01","Standard Bronze On Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150005-01.pdf","https://api.centene.com/Brochures/2016/21663FL0150005-01.pdf","30"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150005","Ambetter Essential Care 5 (2016) With 3 Free PCP Visits + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9464",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150005-02.pdf","https://api.centene.com/Brochures/2016/21663FL0150005-02.pdf","31"
"2016","FL","21663","HIOS","6","2015-10-19 10:47:49","3","21663","FL","Individual","No","06-0641618","21663FL0150005","Ambetter Essential Care 5 (2016) With 3 Free PCP Visits + Vision + Adult Dental","21663FL015",,"FLN001","FLS001","FLF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9464",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/formulary","21663FL0150005-03","Limited Cost Sharing Plan Variation",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/21663FL0150005-03.pdf","https://api.centene.com/Brochures/2016/21663FL0150005-03.pdf","32"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","1","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840021","Health First Gold HMO 50 5144","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9659",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840021-00","Standard Gold Off Exchange Plan","80.26%",,"No","Yes","No","100%",,"$700","$940","$0","$150","$1,000","$560","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5144","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","1","27357","FL","Individual","No","59-3315064","27357FL1820028","Health First Platinum HMO 100 1300","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.975",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820028-00","Standard Platinum Off Exchange Plan","88.02%",,"No","Yes","No","100%",,"$800","$35","$0","$150","$800","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1300","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","1","27357","FL","Individual","No","59-3315064","27357FL1820028","Health First Platinum HMO 100 1300","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.975",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820028-01","Standard Platinum On Exchange Plan","88.02%",,"No","Yes","No","100%",,"$800","$35","$0","$150","$800","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1300","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","1","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840021","Health First Gold HMO 50 5144","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9659",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840021-01","Standard Gold On Exchange Plan","80.26%",,"No","Yes","No","100%",,"$700","$940","$0","$150","$1,000","$560","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5144","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","1","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860021","Florida Hospital Gold HMO 50 5150","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9659",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860021-00","Standard Gold Off Exchange Plan","80.26%",,"No","Yes","No","100%",,"$700","$940","$0","$150","$1,000","$560","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5150","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","1","27357","FL","Individual","No","59-3315064","27357FL1820028","Health First Platinum HMO 100 1300","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.975",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820028-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1300_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","1","27357","FL","Individual","No","59-3315064","27357FL1820028","Health First Platinum HMO 100 1300","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.975",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820028-03","Limited Cost Sharing Plan Variation","88.02%",,"No","Yes","No","100%",,"$800","$35","$0","$150","$800","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1300","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","1","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860021","Florida Hospital Gold HMO 50 5150","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9659",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860021-01","Standard Gold On Exchange Plan","80.26%",,"No","Yes","No","100%",,"$700","$940","$0","$150","$1,000","$560","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5150","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","1","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840023","Health First Gold HMO 50 5160","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9661",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840023-00","Standard Gold Off Exchange Plan","81.48%",,"No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5160","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","1","27357","FL","Individual","No","59-3315064","27357FL1880001","Florida Hospital Platinum HMO 100 1500","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.975",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880001-00","Standard Platinum Off Exchange Plan","88.02%",,"No","Yes","No","100%",,"$800","$35","$0","$150","$800","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1500","http://www.myFHCA.org/FHMHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","1","27357","FL","Individual","No","59-3315064","27357FL1880001","Florida Hospital Platinum HMO 100 1500","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.975",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880001-01","Standard Platinum On Exchange Plan","88.02%",,"No","Yes","No","100%",,"$800","$35","$0","$150","$800","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1500","http://www.myFHCA.org/FHMHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","1","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840023","Health First Gold HMO 50 5160","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9661",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840023-01","Standard Gold On Exchange Plan","81.48%",,"No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5160","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","1","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860023","Florida Hospital Gold HMO 50 5166","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9661",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860023-00","Standard Gold Off Exchange Plan","81.48%",,"No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5166","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","1","27357","FL","Individual","No","59-3315064","27357FL1880001","Florida Hospital Platinum HMO 100 1500","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.975",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1500_0","http://www.myFHCA.org/FHMHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","1","27357","FL","Individual","No","59-3315064","27357FL1880001","Florida Hospital Platinum HMO 100 1500","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.975",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880001-03","Limited Cost Sharing Plan Variation","88.02%",,"No","Yes","No","100%",,"$800","$35","$0","$150","$800","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1500","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","1","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860023","Florida Hospital Gold HMO 50 5166","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9661",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860023-01","Standard Gold On Exchange Plan","81.48%",,"No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5166","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","2","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850021","Health First Gold POS 50 5145","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9669",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850021-00","Standard Gold Off Exchange Plan","80.26%",,"No","Yes","No","100%",,"$700","$940","$0","$150","$1,000","$560","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5145","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","2","27357","FL","Individual","No","59-3315064","27357FL1820029","Health First Platinum HMO 90 1301","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.975",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820029-00","Standard Platinum Off Exchange Plan","90.34%",,"No","Yes","No","100%",,"$750","$20","$390","$150","$750","$215","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1301","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","2","27357","FL","Individual","No","59-3315064","27357FL1820029","Health First Platinum HMO 90 1301","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.975",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820029-01","Standard Platinum On Exchange Plan","90.34%",,"No","Yes","No","100%",,"$750","$20","$390","$150","$750","$215","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1301","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","2","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850021","Health First Gold POS 50 5145","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9669",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850021-01","Standard Gold On Exchange Plan","80.26%",,"No","Yes","No","100%",,"$700","$940","$0","$150","$1,000","$560","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5145","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","2","27357","FL","Individual","No","59-3315064","27357FL1820029","Health First Platinum HMO 90 1301","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.975",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820029-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1301_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","2","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870021","Florida Hospital Gold POS 50 5151","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9669",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870021-00","Standard Gold Off Exchange Plan","80.26%",,"No","Yes","No","100%",,"$700","$940","$0","$150","$1,000","$560","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5151","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","2","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870021","Florida Hospital Gold POS 50 5151","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9669",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870021-01","Standard Gold On Exchange Plan","80.26%",,"No","Yes","No","100%",,"$700","$940","$0","$150","$1,000","$560","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5151","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","2","27357","FL","Individual","No","59-3315064","27357FL1820029","Health First Platinum HMO 90 1301","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.975",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820029-03","Limited Cost Sharing Plan Variation","90.34%",,"No","Yes","No","100%",,"$750","$20","$390","$150","$750","$215","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1301","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","2","27357","FL","Individual","No","59-3315064","27357FL1880002","Florida Hospital Platinum HMO 90 1501","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.975",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880002-00","Standard Platinum Off Exchange Plan","90.34%",,"No","Yes","No","100%",,"$750","$20","$390","$150","$750","$215","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1501","http://www.myFHCA.org/FHMHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","2","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850023","Health First Gold POS 50 5161","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9672",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850023-00","Standard Gold Off Exchange Plan","81.48%",,"No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5161","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","2","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850023","Health First Gold POS 50 5161","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9672",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850023-01","Standard Gold On Exchange Plan","81.48%",,"No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5161","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","2","27357","FL","Individual","No","59-3315064","27357FL1880002","Florida Hospital Platinum HMO 90 1501","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.975",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880002-01","Standard Platinum On Exchange Plan","90.34%",,"No","Yes","No","100%",,"$750","$20","$390","$150","$750","$215","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1501","http://www.myFHCA.org/FHMHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","2","27357","FL","Individual","No","59-3315064","27357FL1880002","Florida Hospital Platinum HMO 90 1501","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.975",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1501_0","http://www.myFHCA.org/FHMHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","2","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870023","Florida Hospital Gold POS 50 5167","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9672",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870023-00","Standard Gold Off Exchange Plan","81.48%",,"No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5167","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","2","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870023","Florida Hospital Gold POS 50 5167","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9672",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870023-01","Standard Gold On Exchange Plan","81.48%",,"No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5167","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","2","27357","FL","Individual","No","59-3315064","27357FL1880002","Florida Hospital Platinum HMO 90 1501","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.975",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880002-03","Limited Cost Sharing Plan Variation","90.34%",,"No","Yes","No","100%",,"$750","$20","$390","$150","$750","$215","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1501","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","3","27357","FL","Individual","No","59-3315064","27357FL1820030","Health First Platinum HMO 80 1302","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.975",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820030-00","Standard Platinum Off Exchange Plan","90.45%",,"No","Yes","No","100%",,"$450","$20","$840","$150","$450","$220","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1302","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","3","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840024","Health First Gold HMO 70 5169","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9666",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840024-00","Standard Gold Off Exchange Plan","81.32%",,"No","Yes","No","100%",,"$750","$45","$1,170","$150","$750","$450","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5169","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","3","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840024","Health First Gold HMO 70 5169","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9666",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840024-01","Standard Gold On Exchange Plan","81.32%",,"No","Yes","No","100%",,"$750","$45","$1,170","$150","$750","$450","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5169","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","3","27357","FL","Individual","No","59-3315064","27357FL1820030","Health First Platinum HMO 80 1302","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.975",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820030-01","Standard Platinum On Exchange Plan","90.45%",,"No","Yes","No","100%",,"$450","$20","$840","$150","$450","$220","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1302","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","3","27357","FL","Individual","No","59-3315064","27357FL1820030","Health First Platinum HMO 80 1302","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.975",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820030-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1302_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","3","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860024","Florida Hospital Gold HMO 70 5173","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9666",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860024-00","Standard Gold Off Exchange Plan","81.32%",,"No","Yes","No","100%",,"$750","$45","$1,170","$150","$750","$450","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5173","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","3","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860024","Florida Hospital Gold HMO 70 5173","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9666",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860024-01","Standard Gold On Exchange Plan","81.32%",,"No","Yes","No","100%",,"$750","$45","$1,170","$150","$750","$450","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5173","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","3","27357","FL","Individual","No","59-3315064","27357FL1820030","Health First Platinum HMO 80 1302","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.975",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820030-03","Limited Cost Sharing Plan Variation","90.45%",,"No","Yes","No","100%",,"$450","$20","$840","$150","$450","$220","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1302","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","3","27357","FL","Individual","No","59-3315064","27357FL1880003","Florida Hospital Platinum HMO 80 1502","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.975",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880003-00","Standard Platinum Off Exchange Plan","90.45%",,"No","Yes","No","100%",,"$450","$20","$840","$150","$450","$220","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1502","http://www.myFHCA.org/FHMHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","3","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840016","Health First Gold HMO 80 5109","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9657",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840016-00","Standard Gold Off Exchange Plan","80.56%",,"No","Yes","No","100%",,"$750","$45","$780","$150","$750","$450","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5109","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","3","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840016","Health First Gold HMO 80 5109","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9657",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840016-01","Standard Gold On Exchange Plan","80.56%",,"No","Yes","No","100%",,"$750","$45","$780","$150","$750","$450","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5109","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","3","27357","FL","Individual","No","59-3315064","27357FL1880003","Florida Hospital Platinum HMO 80 1502","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.975",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880003-01","Standard Platinum On Exchange Plan","90.45%",,"No","Yes","No","100%",,"$450","$20","$840","$150","$450","$220","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1502","http://www.myFHCA.org/FHMHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","3","27357","FL","Individual","No","59-3315064","27357FL1880003","Florida Hospital Platinum HMO 80 1502","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.975",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1502_0","http://www.myFHCA.org/FHMHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","3","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860016","Florida Hospital Gold HMO 80 5113","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9657",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860016-00","Standard Gold Off Exchange Plan","80.56%",,"No","Yes","No","100%",,"$750","$45","$780","$150","$750","$450","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5113","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","3","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860016","Florida Hospital Gold HMO 80 5113","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9657",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860016-01","Standard Gold On Exchange Plan","80.56%",,"No","Yes","No","100%",,"$750","$45","$780","$150","$750","$450","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5113","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","3","27357","FL","Individual","No","59-3315064","27357FL1880003","Florida Hospital Platinum HMO 80 1502","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.975",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880003-03","Limited Cost Sharing Plan Variation","90.45%",,"No","Yes","No","100%",,"$450","$20","$840","$150","$450","$220","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1502","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","4","27357","FL","Individual","No","59-3315064","27357FL1820001","Health First Gold HMO 100 1002","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9706",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820001-00","Standard Gold Off Exchange Plan","80.29%",,"No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1002","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","4","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850024","Health First Gold POS 70 5170","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9675",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850024-00","Standard Gold Off Exchange Plan","81.32%",,"No","Yes","No","100%",,"$750","$45","$1,170","$150","$750","$450","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5170","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","4","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850024","Health First Gold POS 70 5170","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9675",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850024-01","Standard Gold On Exchange Plan","81.32%",,"No","Yes","No","100%",,"$750","$45","$1,170","$150","$750","$450","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5170","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","4","27357","FL","Individual","No","59-3315064","27357FL1820001","Health First Gold HMO 100 1002","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9706",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820001-01","Standard Gold On Exchange Plan","80.29%",,"No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1002","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","4","27357","FL","Individual","No","59-3315064","27357FL1820001","Health First Gold HMO 100 1002","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9706",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1002_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","4","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870024","Florida Hospital Gold POS 70 5174","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9675",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870024-00","Standard Gold Off Exchange Plan","81.32%",,"No","Yes","No","100%",,"$750","$45","$1,170","$150","$750","$450","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5174","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","4","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870024","Florida Hospital Gold POS 70 5174","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9675",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870024-01","Standard Gold On Exchange Plan","81.32%",,"No","Yes","No","100%",,"$750","$45","$1,170","$150","$750","$450","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5174","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","4","27357","FL","Individual","No","59-3315064","27357FL1820001","Health First Gold HMO 100 1002","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9706",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820001-03","Limited Cost Sharing Plan Variation","80.29%",,"No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1002","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","4","27357","FL","Individual","No","59-3315064","27357FL1880004","Florida Hospital Gold HMO 100 1503","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9706",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880004-00","Standard Gold Off Exchange Plan","80.29%",,"No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1503","http://www.myFHCA.org/FHMHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","4","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850016","Health First Gold POS 80 5110","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9667",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850016-00","Standard Gold Off Exchange Plan","80.56%",,"No","Yes","No","100%",,"$750","$45","$780","$150","$750","$450","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5110","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","4","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850016","Health First Gold POS 80 5110","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9667",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850016-01","Standard Gold On Exchange Plan","80.56%",,"No","Yes","No","100%",,"$750","$45","$780","$150","$750","$450","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5110","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","4","27357","FL","Individual","No","59-3315064","27357FL1880004","Florida Hospital Gold HMO 100 1503","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9706",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880004-01","Standard Gold On Exchange Plan","80.29%",,"No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1503","http://www.myFHCA.org/FHMHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","4","27357","FL","Individual","No","59-3315064","27357FL1880004","Florida Hospital Gold HMO 100 1503","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9706",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1503_0","http://www.myFHCA.org/FHMHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","4","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870016","Florida Hospital Gold POS 80 5114","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9667",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870016-00","Standard Gold Off Exchange Plan","80.56%",,"No","Yes","No","100%",,"$750","$45","$780","$150","$750","$450","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5114","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","6","27357","FL","Individual","No","59-3315064","27357FL1880006","Florida Hospital Gold HMO 80 1507","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9718",,,,"0","0","5","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880006-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1507_0","http://www.myFHCA.org/FHMHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","6","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870030","Florida Hospital Gold POS 80 5216","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870030-00","Standard Gold Off Exchange Plan","79.98%",,"No","Yes","No","100%",,"$1,000","$40","$830","$150","$1,000","$440","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5216","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","6","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870030","Florida Hospital Gold POS 80 5216","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870030-01","Standard Gold On Exchange Plan","79.98%",,"No","Yes","No","100%",,"$1,000","$40","$830","$150","$1,000","$440","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5216","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","6","27357","FL","Individual","No","59-3315064","27357FL1880006","Florida Hospital Gold HMO 80 1507","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9718",,,,"0","0","5","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880006-03","Limited Cost Sharing Plan Variation","79.32%",,"No","Yes","No","100%",,"$700","$630","$0","$150","$1,500","$215","$72","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1507","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","7","27357","FL","Individual","No","59-3315064","27357FL1830004","Health First Gold POS 80 1013","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9725",,,,"0","0","5","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830004-00","Standard Gold Off Exchange Plan","79.32%",,"No","Yes","No","100%",,"$700","$630","$0","$150","$1,500","$215","$72","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1013","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","4","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870016","Florida Hospital Gold POS 80 5114","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9667",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870016-01","Standard Gold On Exchange Plan","80.56%",,"No","Yes","No","100%",,"$750","$45","$780","$150","$750","$450","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5114","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","4","27357","FL","Individual","No","59-3315064","27357FL1880004","Florida Hospital Gold HMO 100 1503","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9706",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880004-03","Limited Cost Sharing Plan Variation","80.29%",,"No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1503","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","5","27357","FL","Individual","No","59-3315064","27357FL1830001","Health First Gold POS 100 1003","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9714",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830001-00","Standard Gold Off Exchange Plan","80.29%",,"No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1003","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","5","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840018","Health First Gold HMO 80 5120","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840018-00","Standard Gold Off Exchange Plan","80.34%",,"No","Yes","No","100%",,"$750","$60","$780","$150","$750","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5120","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","5","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840018","Health First Gold HMO 80 5120","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840018-01","Standard Gold On Exchange Plan","80.34%",,"No","Yes","No","100%",,"$750","$60","$780","$150","$750","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5120","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","5","27357","FL","Individual","No","59-3315064","27357FL1830001","Health First Gold POS 100 1003","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9714",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830001-01","Standard Gold On Exchange Plan","80.29%",,"No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1003","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","5","27357","FL","Individual","No","59-3315064","27357FL1830001","Health First Gold POS 100 1003","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9714",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1003_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","5","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860018","Florida Hospital Gold HMO 80 5131","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860018-00","Standard Gold Off Exchange Plan","80.34%",,"No","Yes","No","100%",,"$750","$60","$780","$150","$750","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5131","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","5","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860018","Florida Hospital Gold HMO 80 5131","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860018-01","Standard Gold On Exchange Plan","80.34%",,"No","Yes","No","100%",,"$750","$60","$780","$150","$750","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5131","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","5","27357","FL","Individual","No","59-3315064","27357FL1830001","Health First Gold POS 100 1003","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9714",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830001-03","Limited Cost Sharing Plan Variation","80.29%",,"No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1003","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","5","27357","FL","Individual","No","59-3315064","27357FL1890001","Florida Hospital Gold POS 100 1504","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9714",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890001-00","Standard Gold Off Exchange Plan","80.29%",,"No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1504","http://www.myFHCA.org/FHMHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","5","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840030","Health First Gold HMO 80 5211","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9647",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840030-00","Standard Gold Off Exchange Plan","79.98%",,"No","Yes","No","100%",,"$1,000","$40","$830","$150","$1,000","$440","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5211","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","5","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840030","Health First Gold HMO 80 5211","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9647",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840030-01","Standard Gold On Exchange Plan","79.98%",,"No","Yes","No","100%",,"$1,000","$40","$830","$150","$1,000","$440","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5211","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","7","27357","FL","Individual","No","59-3315064","27357FL1890003","Florida Hospital Gold POS 80 1508","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9725",,,,"0","0","5","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1508_0","http://www.myFHCA.org/FHMHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","7","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860028","Florida Hospital Gold HMO 80 5201","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9649",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860028-00","Standard Gold Off Exchange Plan","79.99%",,"No","Yes","No","100%",,"$2,500","$45","$530","$150","$1,410","$470","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5201","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","5","27357","FL","Individual","No","59-3315064","27357FL1890001","Florida Hospital Gold POS 100 1504","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9714",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890001-01","Standard Gold On Exchange Plan","80.29%",,"No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1504","http://www.myFHCA.org/FHMHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","5","27357","FL","Individual","No","59-3315064","27357FL1890001","Florida Hospital Gold POS 100 1504","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9714",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1504_0","http://www.myFHCA.org/FHMHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","5","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860030","Florida Hospital Gold HMO 80 5215","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9647",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860030-00","Standard Gold Off Exchange Plan","79.98%",,"No","Yes","No","100%",,"$1,000","$40","$830","$150","$1,000","$440","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5215","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","5","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860030","Florida Hospital Gold HMO 80 5215","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9647",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860030-01","Standard Gold On Exchange Plan","79.98%",,"No","Yes","No","100%",,"$1,000","$40","$830","$150","$1,000","$440","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5215","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","5","27357","FL","Individual","No","59-3315064","27357FL1890001","Florida Hospital Gold POS 100 1504","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9714",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890001-03","Limited Cost Sharing Plan Variation","80.29%",,"No","Yes","No","100%",,"$2,500","$40","$0","$150","$1,410","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1504","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","6","27357","FL","Individual","No","59-3315064","27357FL1820004","Health First Gold HMO 80 1012","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9718",,,,"0","0","5","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820004-00","Standard Gold Off Exchange Plan","79.32%",,"No","Yes","No","100%",,"$700","$630","$0","$150","$1,500","$215","$72","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1012","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","6","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850018","Health First Gold POS 80 5121","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9664",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850018-00","Standard Gold Off Exchange Plan","80.34%",,"No","Yes","No","100%",,"$750","$60","$780","$150","$750","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5121","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","6","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850018","Health First Gold POS 80 5121","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9664",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850018-01","Standard Gold On Exchange Plan","80.34%",,"No","Yes","No","100%",,"$750","$60","$780","$150","$750","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5121","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","6","27357","FL","Individual","No","59-3315064","27357FL1820004","Health First Gold HMO 80 1012","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9718",,,,"0","0","5","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820004-01","Standard Gold On Exchange Plan","79.32%",,"No","Yes","No","100%",,"$700","$630","$0","$150","$1,500","$215","$72","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1012","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","6","27357","FL","Individual","No","59-3315064","27357FL1820004","Health First Gold HMO 80 1012","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9718",,,,"0","0","5","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1012_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","6","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870018","Florida Hospital Gold POS 80 5133","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9664",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870018-00","Standard Gold Off Exchange Plan","80.34%",,"No","Yes","No","100%",,"$750","$60","$780","$150","$750","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5133","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","6","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870018","Florida Hospital Gold POS 80 5133","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9664",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870018-01","Standard Gold On Exchange Plan","80.34%",,"No","Yes","No","100%",,"$750","$60","$780","$150","$750","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5133","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","6","27357","FL","Individual","No","59-3315064","27357FL1820004","Health First Gold HMO 80 1012","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9718",,,,"0","0","5","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820004-03","Limited Cost Sharing Plan Variation","79.32%",,"No","Yes","No","100%",,"$700","$630","$0","$150","$1,500","$215","$72","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1012","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","6","27357","FL","Individual","No","59-3315064","27357FL1880006","Florida Hospital Gold HMO 80 1507","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9718",,,,"0","0","5","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880006-00","Standard Gold Off Exchange Plan","79.32%",,"No","Yes","No","100%",,"$700","$630","$0","$150","$1,500","$215","$72","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1507","http://www.myFHCA.org/FHMHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","6","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850030","Health First Gold POS 80 5212","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850030-00","Standard Gold Off Exchange Plan","79.98%",,"No","Yes","No","100%",,"$1,000","$40","$830","$150","$1,000","$440","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5212","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","6","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850030","Health First Gold POS 80 5212","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850030-01","Standard Gold On Exchange Plan","79.98%",,"No","Yes","No","100%",,"$1,000","$40","$830","$150","$1,000","$440","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5212","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","6","27357","FL","Individual","No","59-3315064","27357FL1880006","Florida Hospital Gold HMO 80 1507","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9718",,,,"0","0","5","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880006-01","Standard Gold On Exchange Plan","79.32%",,"No","Yes","No","100%",,"$700","$630","$0","$150","$1,500","$215","$72","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1507","http://www.myFHCA.org/FHMHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","7","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840029","Health First Gold HMO 80 5204","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9651",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840029-00","Standard Gold Off Exchange Plan","78.82%",,"No","Yes","No","100%",,"$1,500","$45","$730","$150","$1,410","$470","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5204","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","7","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840029","Health First Gold HMO 80 5204","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9651",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840029-01","Standard Gold On Exchange Plan","78.82%",,"No","Yes","No","100%",,"$1,500","$45","$730","$150","$1,410","$470","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5204","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","7","27357","FL","Individual","No","59-3315064","27357FL1830004","Health First Gold POS 80 1013","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9725",,,,"0","0","5","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830004-01","Standard Gold On Exchange Plan","79.32%",,"No","Yes","No","100%",,"$700","$630","$0","$150","$1,500","$215","$72","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1013","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","7","27357","FL","Individual","No","59-3315064","27357FL1830004","Health First Gold POS 80 1013","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9725",,,,"0","0","5","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1013_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","7","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860029","Florida Hospital Gold HMO 80 5208","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9651",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860029-00","Standard Gold Off Exchange Plan","78.82%",,"No","Yes","No","100%",,"$1,500","$45","$730","$150","$1,410","$470","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5208","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","7","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860029","Florida Hospital Gold HMO 80 5208","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9651",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860029-01","Standard Gold On Exchange Plan","78.82%",,"No","Yes","No","100%",,"$1,500","$45","$730","$150","$1,410","$470","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5208","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","7","27357","FL","Individual","No","59-3315064","27357FL1830004","Health First Gold POS 80 1013","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9725",,,,"0","0","5","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830004-03","Limited Cost Sharing Plan Variation","79.32%",,"No","Yes","No","100%",,"$700","$630","$0","$150","$1,500","$215","$72","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1013","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","7","27357","FL","Individual","No","59-3315064","27357FL1890003","Florida Hospital Gold POS 80 1508","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9725",,,,"0","0","5","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890003-00","Standard Gold Off Exchange Plan","79.32%",,"No","Yes","No","100%",,"$700","$630","$0","$150","$1,500","$215","$72","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1508","http://www.myFHCA.org/FHMHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","7","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840028","Health First Gold HMO 80 5197","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9649",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840028-00","Standard Gold Off Exchange Plan","79.99%",,"No","Yes","No","100%",,"$2,500","$45","$530","$150","$1,410","$470","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5197","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","7","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840028","Health First Gold HMO 80 5197","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9649",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840028-01","Standard Gold On Exchange Plan","79.99%",,"No","Yes","No","100%",,"$2,500","$45","$530","$150","$1,410","$470","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5197","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","7","27357","FL","Individual","No","59-3315064","27357FL1890003","Florida Hospital Gold POS 80 1508","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9725",,,,"0","0","5","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890003-01","Standard Gold On Exchange Plan","79.32%",,"No","Yes","No","100%",,"$700","$630","$0","$150","$1,500","$215","$72","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1508","http://www.myFHCA.org/FHMHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","7","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860028","Florida Hospital Gold HMO 80 5201","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9649",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860028-01","Standard Gold On Exchange Plan","79.99%",,"No","Yes","No","100%",,"$2,500","$45","$530","$150","$1,410","$470","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5201","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","7","27357","FL","Individual","No","59-3315064","27357FL1890003","Florida Hospital Gold POS 80 1508","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9725",,,,"0","0","5","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890003-03","Limited Cost Sharing Plan Variation","79.32%",,"No","Yes","No","100%",,"$700","$630","$0","$150","$1,500","$215","$72","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1508","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","8","27357","FL","Individual","No","59-3315064","27357FL1820006","Health First Gold HMO 80 1020","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9714",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820006-00","Standard Gold Off Exchange Plan","81.74%",,"No","Yes","No","100%",,"$1,000","$0","$830","$150","$1,000","$220","$233","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1020","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","8","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850029","Health First Gold POS 80 5205","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.966",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850029-00","Standard Gold Off Exchange Plan","78.82%",,"No","Yes","No","100%",,"$1,500","$45","$730","$150","$1,410","$470","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5205","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","8","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850029","Health First Gold POS 80 5205","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.966",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850029-01","Standard Gold On Exchange Plan","78.82%",,"No","Yes","No","100%",,"$1,500","$45","$730","$150","$1,410","$470","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5205","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","8","27357","FL","Individual","No","59-3315064","27357FL1820006","Health First Gold HMO 80 1020","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9714",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820006-01","Standard Gold On Exchange Plan","81.74%",,"No","Yes","No","100%",,"$1,000","$0","$830","$150","$1,000","$220","$233","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1020","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","8","27357","FL","Individual","No","59-3315064","27357FL1820006","Health First Gold HMO 80 1020","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9714",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820006-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1020_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","8","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870029","Florida Hospital Gold POS 80 5209","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.966",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870029-00","Standard Gold Off Exchange Plan","78.82%",,"No","Yes","No","100%",,"$1,500","$45","$730","$150","$1,410","$470","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5209","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","8","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870029","Florida Hospital Gold POS 80 5209","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.966",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870029-01","Standard Gold On Exchange Plan","78.82%",,"No","Yes","No","100%",,"$1,500","$45","$730","$150","$1,410","$470","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5209","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","8","27357","FL","Individual","No","59-3315064","27357FL1820006","Health First Gold HMO 80 1020","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9714",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820006-03","Limited Cost Sharing Plan Variation","81.74%",,"No","Yes","No","100%",,"$1,000","$0","$830","$150","$1,000","$220","$233","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1020","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","8","27357","FL","Individual","No","59-3315064","27357FL1880007","Florida Hospital Gold HMO 80 1509","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9714",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880007-00","Standard Gold Off Exchange Plan","81.74%",,"No","Yes","No","100%",,"$1,000","$0","$830","$150","$1,000","$220","$233","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1509","http://www.myFHCA.org/FHMHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","8","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850028","Health First Gold POS 80 5198","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.966",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850028-00","Standard Gold Off Exchange Plan","79.99%",,"No","Yes","No","100%",,"$2,500","$45","$530","$150","$1,410","$470","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5198","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","8","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850028","Health First Gold POS 80 5198","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.966",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850028-01","Standard Gold On Exchange Plan","79.99%",,"No","Yes","No","100%",,"$2,500","$45","$530","$150","$1,410","$470","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5198","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","8","27357","FL","Individual","No","59-3315064","27357FL1880007","Florida Hospital Gold HMO 80 1509","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9714",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880007-01","Standard Gold On Exchange Plan","81.74%",,"No","Yes","No","100%",,"$1,000","$0","$830","$150","$1,000","$220","$233","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1509","http://www.myFHCA.org/FHMHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","8","27357","FL","Individual","No","59-3315064","27357FL1880007","Florida Hospital Gold HMO 80 1509","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9714",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1509_0","http://www.myFHCA.org/FHMHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","8","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870028","Florida Hospital Gold POS 80 5202","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.966",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870028-00","Standard Gold Off Exchange Plan","79.99%",,"No","Yes","No","100%",,"$2,500","$45","$530","$150","$1,410","$470","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5202","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","8","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870028","Florida Hospital Gold POS 80 5202","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.966",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870028-01","Standard Gold On Exchange Plan","79.99%",,"No","Yes","No","100%",,"$2,500","$45","$530","$150","$1,410","$470","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5202","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","8","27357","FL","Individual","No","59-3315064","27357FL1880007","Florida Hospital Gold HMO 80 1509","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9714",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880007-03","Limited Cost Sharing Plan Variation","81.74%",,"No","Yes","No","100%",,"$1,000","$0","$830","$150","$1,000","$220","$233","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1509","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","9","27357","FL","Individual","No","59-3315064","27357FL1820007","Health First Gold HMO 80 1024","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9705",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820007-00","Standard Gold Off Exchange Plan","78.07%",,"No","Yes","No","100%",,"$2,000","$30","$530","$150","$1,270","$320","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1024","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","9","27357","FL","Individual","No","59-3315064","27357FL1820007","Health First Gold HMO 80 1024","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9705",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820007-01","Standard Gold On Exchange Plan","78.07%",,"No","Yes","No","100%",,"$2,000","$30","$530","$150","$1,270","$320","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1024","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","9","27357","FL","Individual","No","59-3315064","27357FL1820007","Health First Gold HMO 80 1024","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9705",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1024_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","9","27357","FL","Individual","No","59-3315064","27357FL1820007","Health First Gold HMO 80 1024","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9705",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820007-03","Limited Cost Sharing Plan Variation","78.07%",,"No","Yes","No","100%",,"$2,000","$30","$530","$150","$1,270","$320","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1024","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","9","27357","FL","Individual","No","59-3315064","27357FL1880008","Florida Hospital Gold HMO 80 1510","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9705",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880008-00","Standard Gold Off Exchange Plan","78.07%",,"No","Yes","No","100%",,"$2,000","$30","$530","$150","$1,270","$320","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1510","http://www.myFHCA.org/FHMHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","9","27357","FL","Individual","No","59-3315064","27357FL1880008","Florida Hospital Gold HMO 80 1510","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9705",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880008-01","Standard Gold On Exchange Plan","78.07%",,"No","Yes","No","100%",,"$2,000","$30","$530","$150","$1,270","$320","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1510","http://www.myFHCA.org/FHMHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","9","27357","FL","Individual","No","59-3315064","27357FL1880008","Florida Hospital Gold HMO 80 1510","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9705",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880008-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1510_0","http://www.myFHCA.org/FHMHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","9","27357","FL","Individual","No","59-3315064","27357FL1880008","Florida Hospital Gold HMO 80 1510","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9705",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880008-03","Limited Cost Sharing Plan Variation","78.07%",,"No","Yes","No","100%",,"$2,000","$30","$530","$150","$1,270","$320","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1510","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","10","27357","FL","Individual","No","59-3315064","27357FL1830007","Health First Gold POS 80 1025","27357FL183",,"FLN001","FLS001","FLF008","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9712",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830007-00","Standard Gold Off Exchange Plan","78.07%",,"No","Yes","No","100%",,"$2,000","$30","$530","$150","$1,270","$320","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1025","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","10","27357","FL","Individual","No","59-3315064","27357FL1830007","Health First Gold POS 80 1025","27357FL183",,"FLN001","FLS001","FLF008","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9712",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830007-01","Standard Gold On Exchange Plan","78.07%",,"No","Yes","No","100%",,"$2,000","$30","$530","$150","$1,270","$320","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1025","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","12","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850045","Health First Silver POS 50 5335","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9587",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850045-01","Standard Silver On Exchange Plan","69.48%",,"No","Yes","No","100%",,"$2,200","$50","$0","$150","$1,860","$335","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","50%",,,,,"$4,400","$4400 per person","$8800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5335","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","12","27357","FL","Individual","No","59-3315064","27357FL1890005","Florida Hospital Gold POS 70 1513","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.972",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890005-01","Standard Gold On Exchange Plan","79.33%",,"No","Yes","No","100%",,"$1,000","$50","$1,090","$150","$1,000","$415","$135","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1513","http://www.myFHCA.org/FHMHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","12","27357","FL","Individual","No","59-3315064","27357FL1890005","Florida Hospital Gold POS 70 1513","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.972",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890005-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1513_0","http://www.myFHCA.org/FHMHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","12","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870045","Florida Hospital Silver POS 50 5339","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9587",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870045-00","Standard Silver Off Exchange Plan","69.48%",,"No","Yes","No","100%",,"$2,200","$50","$0","$150","$1,860","$335","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","50%",,,,,"$4,400","$4400 per person","$8800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5339","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","10","27357","FL","Individual","No","59-3315064","27357FL1830007","Health First Gold POS 80 1025","27357FL183",,"FLN001","FLS001","FLF008","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9712",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1025_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","10","27357","FL","Individual","No","59-3315064","27357FL1830007","Health First Gold POS 80 1025","27357FL183",,"FLN001","FLS001","FLF008","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9712",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830007-03","Limited Cost Sharing Plan Variation","78.07%",,"No","Yes","No","100%",,"$2,000","$30","$530","$150","$1,270","$320","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1025","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","10","27357","FL","Individual","No","59-3315064","27357FL1890004","Florida Hospital Gold POS 80 1511","27357FL189",,"FLN002","FLS002","FLF017","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9712",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890004-00","Standard Gold Off Exchange Plan","78.07%",,"No","Yes","No","100%",,"$2,000","$30","$530","$150","$1,270","$320","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1511","http://www.myFHCA.org/FHMHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","10","27357","FL","Individual","No","59-3315064","27357FL1890004","Florida Hospital Gold POS 80 1511","27357FL189",,"FLN002","FLS002","FLF017","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9712",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890004-01","Standard Gold On Exchange Plan","78.07%",,"No","Yes","No","100%",,"$2,000","$30","$530","$150","$1,270","$320","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1511","http://www.myFHCA.org/FHMHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","10","27357","FL","Individual","No","59-3315064","27357FL1890004","Florida Hospital Gold POS 80 1511","27357FL189",,"FLN002","FLS002","FLF017","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9712",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1511_0","http://www.myFHCA.org/FHMHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","10","27357","FL","Individual","No","59-3315064","27357FL1890004","Florida Hospital Gold POS 80 1511","27357FL189",,"FLN002","FLS002","FLF017","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9712",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890004-03","Limited Cost Sharing Plan Variation","78.07%",,"No","Yes","No","100%",,"$2,000","$30","$530","$150","$1,270","$320","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1511","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","11","27357","FL","Individual","No","59-3315064","27357FL1820009","Health First Gold HMO 70 1035","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9712",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820009-00","Standard Gold Off Exchange Plan","79.33%",,"No","Yes","No","100%",,"$1,000","$50","$1,090","$150","$1,000","$415","$135","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1035","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","11","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840043","Health First Silver HMO 50 5316","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9587",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840043-00","Standard Silver Off Exchange Plan","70.03%",,"No","Yes","No","100%",,"$2,000","$50","$1,590","$150","$2,000","$265","$88","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5316","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","11","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840043","Health First Silver HMO 50 5316","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9587",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840043-01","Standard Silver On Exchange Plan","70.03%",,"No","Yes","No","100%",,"$2,000","$50","$1,590","$150","$2,000","$265","$88","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5316","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","11","27357","FL","Individual","No","59-3315064","27357FL1820009","Health First Gold HMO 70 1035","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9712",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820009-01","Standard Gold On Exchange Plan","79.33%",,"No","Yes","No","100%",,"$1,000","$50","$1,090","$150","$1,000","$415","$135","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1035","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","11","27357","FL","Individual","No","59-3315064","27357FL1820009","Health First Gold HMO 70 1035","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9712",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820009-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1035_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","11","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860043","Florida Hospital Silver HMO 50 5322","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9587",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860043-00","Standard Silver Off Exchange Plan","70.03%",,"No","Yes","No","100%",,"$2,000","$50","$1,590","$150","$2,000","$265","$88","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5322","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","11","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860043","Florida Hospital Silver HMO 50 5322","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9587",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860043-01","Standard Silver On Exchange Plan","70.03%",,"No","Yes","No","100%",,"$2,000","$50","$1,590","$150","$2,000","$265","$88","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5322","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","11","27357","FL","Individual","No","59-3315064","27357FL1820009","Health First Gold HMO 70 1035","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9712",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820009-03","Limited Cost Sharing Plan Variation","79.33%",,"No","Yes","No","100%",,"$1,000","$50","$1,090","$150","$1,000","$415","$135","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1035","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","11","27357","FL","Individual","No","59-3315064","27357FL1880009","Florida Hospital Gold HMO 70 1512","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9712",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880009-00","Standard Gold Off Exchange Plan","79.33%",,"No","Yes","No","100%",,"$1,000","$50","$1,090","$150","$1,000","$415","$135","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1512","http://www.myFHCA.org/FHMHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","11","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840045","Health First Silver HMO 50 5334","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9578",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840045-00","Standard Silver Off Exchange Plan","69.48%",,"No","Yes","No","100%",,"$2,200","$50","$1,490","$150","$2,200","$335","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5334","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","11","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840045","Health First Silver HMO 50 5334","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9578",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840045-01","Standard Silver On Exchange Plan","69.48%",,"No","Yes","No","100%",,"$2,200","$50","$1,490","$150","$2,200","$335","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5334","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","11","27357","FL","Individual","No","59-3315064","27357FL1880009","Florida Hospital Gold HMO 70 1512","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9712",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880009-01","Standard Gold On Exchange Plan","79.33%",,"No","Yes","No","100%",,"$1,000","$50","$1,090","$150","$1,000","$415","$135","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1512","http://www.myFHCA.org/FHMHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","11","27357","FL","Individual","No","59-3315064","27357FL1880009","Florida Hospital Gold HMO 70 1512","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9712",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880009-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1512_0","http://www.myFHCA.org/FHMHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","11","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860045","Florida Hospital Silver HMO 50 5338","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9578",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860045-00","Standard Silver Off Exchange Plan","69.48%",,"No","Yes","No","100%",,"$2,200","$50","$1,490","$150","$2,200","$335","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5338","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","11","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860045","Florida Hospital Silver HMO 50 5338","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9578",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860045-01","Standard Silver On Exchange Plan","69.48%",,"No","Yes","No","100%",,"$2,200","$50","$1,490","$150","$2,200","$335","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5338","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","11","27357","FL","Individual","No","59-3315064","27357FL1880009","Florida Hospital Gold HMO 70 1512","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9712",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880009-03","Limited Cost Sharing Plan Variation","79.33%",,"No","Yes","No","100%",,"$1,000","$50","$1,090","$150","$1,000","$415","$135","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1512","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","Individual","No","59-3315064","27357FL1880010","Florida Hospital Silver HMO 100 1514","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9655",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880010-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1514_0","http://www.myFHCA.org/FHMHI_2016","13"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","Individual","No","59-3315064","27357FL1880010","Florida Hospital Silver HMO 100 1514","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9655",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880010-03","Limited Cost Sharing Plan Variation","68.90%",,"No","Yes","No","100%",,"$4,400","$0","$0","$150","$1,410","$280","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1514","http://www.myFHCA.org/FHMHI_2016","14"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","12","27357","FL","Individual","No","59-3315064","27357FL1830009","Health First Gold POS 70 1036","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.972",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830009-00","Standard Gold Off Exchange Plan","79.33%",,"No","Yes","No","100%",,"$1,000","$50","$1,090","$150","$1,000","$415","$135","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1036","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","12","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850043","Health First Silver POS 50 5317","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9596",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850043-00","Standard Silver Off Exchange Plan","70.03%",,"No","Yes","No","100%",,"$2,000","$50","$1,590","$150","$2,000","$265","$88","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5317","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","12","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850043","Health First Silver POS 50 5317","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9596",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850043-01","Standard Silver On Exchange Plan","70.03%",,"No","Yes","No","100%",,"$2,000","$50","$1,590","$150","$2,000","$265","$88","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5317","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","12","27357","FL","Individual","No","59-3315064","27357FL1830009","Health First Gold POS 70 1036","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.972",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830009-01","Standard Gold On Exchange Plan","79.33%",,"No","Yes","No","100%",,"$1,000","$50","$1,090","$150","$1,000","$415","$135","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1036","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","12","27357","FL","Individual","No","59-3315064","27357FL1830009","Health First Gold POS 70 1036","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.972",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830009-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1036_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","12","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870043","Florida Hospital Silver POS 50 5323","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9596",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870043-00","Standard Silver Off Exchange Plan","70.03%",,"No","Yes","No","100%",,"$2,000","$50","$1,590","$150","$2,000","$265","$88","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5323","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","12","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870043","Florida Hospital Silver POS 50 5323","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9596",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870043-01","Standard Silver On Exchange Plan","70.03%",,"No","Yes","No","100%",,"$2,000","$50","$1,590","$150","$2,000","$265","$88","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5323","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","12","27357","FL","Individual","No","59-3315064","27357FL1830009","Health First Gold POS 70 1036","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.972",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830009-03","Limited Cost Sharing Plan Variation","79.33%",,"No","Yes","No","100%",,"$1,000","$50","$1,090","$150","$1,000","$415","$135","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1036","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","12","27357","FL","Individual","No","59-3315064","27357FL1890005","Florida Hospital Gold POS 70 1513","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.972",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890005-00","Standard Gold Off Exchange Plan","79.33%",,"No","Yes","No","100%",,"$1,000","$50","$1,090","$150","$1,000","$415","$135","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1513","http://www.myFHCA.org/FHMHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","12","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850045","Health First Silver POS 50 5335","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9587",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850045-00","Standard Silver Off Exchange Plan","69.48%",,"No","Yes","No","100%",,"$2,200","$50","$0","$150","$1,860","$335","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","50%",,,,,"$4,400","$4400 per person","$8800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5335","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","12","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870045","Florida Hospital Silver POS 50 5339","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9587",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870045-01","Standard Silver On Exchange Plan","69.48%",,"No","Yes","No","100%",,"$2,200","$50","$0","$150","$1,860","$335","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","50%",,,,,"$4,400","$4400 per person","$8800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5339","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","12","27357","FL","Individual","No","59-3315064","27357FL1890005","Florida Hospital Gold POS 70 1513","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.972",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890005-03","Limited Cost Sharing Plan Variation","79.33%",,"No","Yes","No","100%",,"$1,000","$50","$1,090","$150","$1,000","$415","$135","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1513","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","Individual","No","59-3315064","27357FL1820011","Health First Silver HMO 100 1046","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9655",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820011-00","Standard Silver Off Exchange Plan","68.90%",,"No","Yes","No","100%",,"$4,400","$0","$0","$150","$1,410","$280","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1046","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840041","Health First Silver HMO 50 5298","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9572",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840041-00","Standard Silver Off Exchange Plan","70.89%",,"No","Yes","No","100%",,"$2,000","$0","$1,320","$150","$1,270","$220","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5298","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840041","Health First Silver HMO 50 5298","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9572",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840041-01","Standard Silver On Exchange Plan","70.89%",,"No","Yes","No","100%",,"$2,000","$0","$1,320","$150","$1,270","$220","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5298","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","Individual","No","59-3315064","27357FL1820011","Health First Silver HMO 100 1046","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9655",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820011-01","Standard Silver On Exchange Plan","68.90%",,"No","Yes","No","100%",,"$4,400","$0","$0","$150","$1,410","$280","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1046","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","Individual","No","59-3315064","27357FL1820011","Health First Silver HMO 100 1046","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9655",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820011-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1046_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860041","Florida Hospital Silver HMO 50 5304","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9572",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860041-00","Standard Silver Off Exchange Plan","70.89%",,"No","Yes","No","100%",,"$2,000","$0","$1,320","$150","$1,270","$220","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5304","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860041","Florida Hospital Silver HMO 50 5304","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9572",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860041-01","Standard Silver On Exchange Plan","70.89%",,"No","Yes","No","100%",,"$2,000","$0","$1,320","$150","$1,270","$220","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5304","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","Individual","No","59-3315064","27357FL1820011","Health First Silver HMO 100 1046","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9655",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820011-03","Limited Cost Sharing Plan Variation","68.90%",,"No","Yes","No","100%",,"$4,400","$0","$0","$150","$1,410","$280","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1046","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","Individual","No","59-3315064","27357FL1820011","Health First Silver HMO 100 1046","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9655",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820011-04","73% AV Level Silver Plan","72.21%",,"No","Yes","No","100%",,"$3,200","$0","$0","$150","$1,410","$280","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1047","http://www.myHFHP.org/MHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840044","Health First Silver HMO 70 5325","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.958",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840044-00","Standard Silver Off Exchange Plan","70.50%",,"No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5325","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840044","Health First Silver HMO 70 5325","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.958",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840044-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5325","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","Individual","No","59-3315064","27357FL1820011","Health First Silver HMO 100 1046","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9655",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820011-05","87% AV Level Silver Plan","86.83%",,"No","Yes","No","100%",,"$900","$0","$0","$150","$900","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1048","http://www.myHFHP.org/MHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","Individual","No","59-3315064","27357FL1820011","Health First Silver HMO 100 1046","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9655",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820011-06","94% AV Level Silver Plan","94.25%",,"No","Yes","No","100%",,"$150","$0","$0","$150","$150","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1049","http://www.myHFHP.org/MHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860044","Florida Hospital Silver HMO 70 5331","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.958",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860044-00","Standard Silver Off Exchange Plan","70.50%",,"No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5331","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860044","Florida Hospital Silver HMO 70 5331","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.958",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860044-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5331","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","Individual","No","59-3315064","27357FL1880010","Florida Hospital Silver HMO 100 1514","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9655",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880010-00","Standard Silver Off Exchange Plan","68.90%",,"No","Yes","No","100%",,"$4,400","$0","$0","$150","$1,410","$280","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1514","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","Individual","No","59-3315064","27357FL1880010","Florida Hospital Silver HMO 100 1514","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9655",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880010-01","Standard Silver On Exchange Plan","68.90%",,"No","Yes","No","100%",,"$4,400","$0","$0","$150","$1,410","$280","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1514","http://www.myFHCA.org/FHMHI_2016","12"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","Individual","No","59-3315064","27357FL1880010","Florida Hospital Silver HMO 100 1514","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9655",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880010-04","73% AV Level Silver Plan","72.21%",,"No","Yes","No","100%",,"$3,200","$0","$0","$150","$1,410","$280","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1516","http://www.myFHCA.org/FHMHI_2016","15"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","Individual","No","59-3315064","27357FL1880010","Florida Hospital Silver HMO 100 1514","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9655",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880010-05","87% AV Level Silver Plan","86.83%",,"No","Yes","No","100%",,"$900","$0","$0","$150","$900","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1518","http://www.myFHCA.org/FHMHI_2016","16"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","13","27357","FL","Individual","No","59-3315064","27357FL1880010","Florida Hospital Silver HMO 100 1514","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9655",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880010-06","94% AV Level Silver Plan","94.25%",,"No","Yes","No","100%",,"$150","$0","$0","$150","$150","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1520","http://www.myFHCA.org/FHMHI_2016","17"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","Individual","No","59-3315064","27357FL1830011","Health First Silver POS 100 1050","27357FL183",,"FLN001","FLS001","FLF008","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9663",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830011-00","Standard Silver Off Exchange Plan","68.90%",,"No","Yes","No","100%",,"$4,400","$0","$0","$150","$1,410","$280","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"$9,200","$9200 per person","$18400 per group","Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","0%",,,,,"$8,800","$8800 per person","$17600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1050","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850041","Health First Silver POS 50 5299","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9582",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850041-00","Standard Silver Off Exchange Plan","70.89%",,"No","Yes","No","100%",,"$2,000","$0","$1,320","$150","$1,270","$220","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5299","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850041","Health First Silver POS 50 5299","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9582",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850041-01","Standard Silver On Exchange Plan","70.89%",,"No","Yes","No","100%",,"$2,000","$0","$1,320","$150","$1,270","$220","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5299","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","Individual","No","59-3315064","27357FL1830011","Health First Silver POS 100 1050","27357FL183",,"FLN001","FLS001","FLF008","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9663",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830011-01","Standard Silver On Exchange Plan","68.90%",,"No","Yes","No","100%",,"$4,400","$0","$0","$150","$1,410","$280","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"$9,200","$9200 per person","$18400 per group","Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","0%",,,,,"$8,800","$8800 per person","$17600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1050","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","Individual","No","59-3315064","27357FL1830011","Health First Silver POS 100 1050","27357FL183",,"FLN001","FLS001","FLF008","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9663",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830011-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1050_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870041","Florida Hospital Silver POS 50 5305","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9582",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870041-00","Standard Silver Off Exchange Plan","70.89%",,"No","Yes","No","100%",,"$2,000","$0","$1,320","$150","$1,270","$220","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5305","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870041","Florida Hospital Silver POS 50 5305","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9582",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870041-01","Standard Silver On Exchange Plan","70.89%",,"No","Yes","No","100%",,"$2,000","$0","$1,320","$150","$1,270","$220","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5305","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","Individual","No","59-3315064","27357FL1830011","Health First Silver POS 100 1050","27357FL183",,"FLN001","FLS001","FLF008","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9663",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830011-03","Limited Cost Sharing Plan Variation","68.90%",,"No","Yes","No","100%",,"$4,400","$0","$0","$150","$1,410","$280","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"$9,200","$9200 per person","$18400 per group","Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","0%",,,,,"$8,800","$8800 per person","$17600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1050","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","Individual","No","59-3315064","27357FL1830011","Health First Silver POS 100 1050","27357FL183",,"FLN001","FLS001","FLF008","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9663",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830011-04","73% AV Level Silver Plan","72.21%",,"No","Yes","No","100%",,"$3,200","$0","$0","$150","$1,410","$280","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"$9,200","$9200 per person","$18400 per group","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","0%",,,,,"$8,800","$8800 per person","$17600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1051","http://www.myHFHP.org/MHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850044","Health First Silver POS 70 5326","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.959",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850044-00","Standard Silver Off Exchange Plan","70.50%",,"No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5326","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850044","Health First Silver POS 70 5326","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.959",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850044-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5326","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","Individual","No","59-3315064","27357FL1830011","Health First Silver POS 100 1050","27357FL183",,"FLN001","FLS001","FLF008","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9663",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830011-05","87% AV Level Silver Plan","86.83%",,"No","Yes","No","100%",,"$900","$0","$0","$150","$900","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$9,200","$9200 per person","$18400 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%",,,,,"$8,800","$8800 per person","$17600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1052","http://www.myHFHP.org/MHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","Individual","No","59-3315064","27357FL1830011","Health First Silver POS 100 1050","27357FL183",,"FLN001","FLS001","FLF008","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9663",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830011-06","94% AV Level Silver Plan","94.25%",,"No","Yes","No","100%",,"$150","$0","$0","$150","$150","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$9,200","$9200 per person","$18400 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0%",,,,,"$8,800","$8800 per person","$17600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1053","http://www.myHFHP.org/MHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","Individual","No","59-3315064","27357FL1880011","Florida Hospital Silver HMO 100 1522","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880011-04","73% AV Level Silver Plan","73.28%",,"No","Yes","No","100%",,"$2,900","$0","$0","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1523","http://www.myFHCA.org/FHMHI_2016","15"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","Individual","No","59-3315064","27357FL1880011","Florida Hospital Silver HMO 100 1522","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880011-05","87% AV Level Silver Plan","86.08%",,"No","Yes","No","100%",,"$900","$50","$0","$150","$900","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1524","http://www.myFHCA.org/FHMHI_2016","16"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","Individual","No","59-3315064","27357FL1880011","Florida Hospital Silver HMO 100 1522","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880011-06","94% AV Level Silver Plan","94.78%",,"No","Yes","No","100%",,"$100","$50","$0","$150","$100","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1525","http://www.myFHCA.org/FHMHI_2016","17"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","Individual","No","59-3315064","27357FL1820013","Health First Silver HMO 90 1070","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9658",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820013-00","Standard Silver Off Exchange Plan","68.10%",,"No","Yes","No","100%",,"$3,900","$50","$130","$150","$2,014","$180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1070","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850034","Health First Silver POS 80 5242","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9617",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850034-00","Standard Silver Off Exchange Plan","69.91%",,"No","Yes","No","100%",,"$4,650","$75","$0","$150","$4,120","$630","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5242","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850034","Health First Silver POS 80 5242","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9617",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850034-01","Standard Silver On Exchange Plan","69.91%",,"No","Yes","No","100%",,"$4,650","$75","$0","$150","$4,120","$630","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5242","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870044","Florida Hospital Silver POS 70 5332","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.959",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870044-00","Standard Silver Off Exchange Plan","70.50%",,"No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5332","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870044","Florida Hospital Silver POS 70 5332","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.959",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870044-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5332","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","Individual","No","59-3315064","27357FL1890006","Florida Hospital Silver POS 100 1515","27357FL189",,"FLN002","FLS002","FLF017","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9663",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890006-00","Standard Silver Off Exchange Plan","68.90%",,"No","Yes","No","100%",,"$4,400","$0","$0","$150","$1,410","$280","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"$9,200","$9200 per person","$18400 per group","Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","0%",,,,,"$8,800","$8800 per person","$17600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1515","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","Individual","No","59-3315064","27357FL1890006","Florida Hospital Silver POS 100 1515","27357FL189",,"FLN002","FLS002","FLF017","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9663",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890006-01","Standard Silver On Exchange Plan","68.90%",,"No","Yes","No","100%",,"$4,400","$0","$0","$150","$1,410","$280","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"$9,200","$9200 per person","$18400 per group","Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","0%",,,,,"$8,800","$8800 per person","$17600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1515","http://www.myFHCA.org/FHMHI_2016","12"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","Individual","No","59-3315064","27357FL1890006","Florida Hospital Silver POS 100 1515","27357FL189",,"FLN002","FLS002","FLF017","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9663",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890006-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1515_0","http://www.myFHCA.org/FHMHI_2016","13"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","Individual","No","59-3315064","27357FL1890006","Florida Hospital Silver POS 100 1515","27357FL189",,"FLN002","FLS002","FLF017","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9663",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890006-03","Limited Cost Sharing Plan Variation","68.90%",,"No","Yes","No","100%",,"$4,400","$0","$0","$150","$1,410","$280","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"$9,200","$9200 per person","$18400 per group","Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","0%",,,,,"$8,800","$8800 per person","$17600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1515","http://www.myFHCA.org/FHMHI_2016","14"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","Individual","No","59-3315064","27357FL1820013","Health First Silver HMO 90 1070","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9658",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820013-03","Limited Cost Sharing Plan Variation","68.10%",,"No","Yes","No","100%",,"$3,900","$50","$130","$150","$2,014","$180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1070","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","Individual","No","59-3315064","27357FL1820013","Health First Silver HMO 90 1070","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9658",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820013-04","73% AV Level Silver Plan","73.40%",,"No","Yes","No","100%",,"$2,500","$50","$270","$150","$2,014","$180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1071","http://www.myHFHP.org/MHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850040","Health First Silver POS 50 5290","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9581",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850040-00","Standard Silver Off Exchange Plan","70.58%",,"No","Yes","No","100%",,"$2,650","$0","$1,000","$150","$1,270","$220","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","50%",,,,,"$5,300","$5300 per person","$10600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5290","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850040","Health First Silver POS 50 5290","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9581",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850040-01","Standard Silver On Exchange Plan","70.58%",,"No","Yes","No","100%",,"$2,650","$0","$1,000","$150","$1,270","$220","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","50%",,,,,"$5,300","$5300 per person","$10600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5290","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","Individual","No","59-3315064","27357FL1890006","Florida Hospital Silver POS 100 1515","27357FL189",,"FLN002","FLS002","FLF017","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9663",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890006-04","73% AV Level Silver Plan","72.21%",,"No","Yes","No","100%",,"$3,200","$0","$0","$150","$1,410","$280","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"$9,200","$9200 per person","$18400 per group","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","0%",,,,,"$8,800","$8800 per person","$17600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1517","http://www.myFHCA.org/FHMHI_2016","15"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","Individual","No","59-3315064","27357FL1890006","Florida Hospital Silver POS 100 1515","27357FL189",,"FLN002","FLS002","FLF017","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9663",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890006-05","87% AV Level Silver Plan","86.83%",,"No","Yes","No","100%",,"$900","$0","$0","$150","$900","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$9,200","$9200 per person","$18400 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%",,,,,"$8,800","$8800 per person","$17600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1519","http://www.myFHCA.org/FHMHI_2016","16"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","14","27357","FL","Individual","No","59-3315064","27357FL1890006","Florida Hospital Silver POS 100 1515","27357FL189",,"FLN002","FLS002","FLF017","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9663",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890006-06","94% AV Level Silver Plan","94.25%",,"No","Yes","No","100%",,"$150","$0","$0","$150","$150","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$9,200","$9200 per person","$18400 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0%",,,,,"$8,800","$8800 per person","$17600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1521","http://www.myFHCA.org/FHMHI_2016","17"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","Individual","No","59-3315064","27357FL1820012","Health First Silver HMO 100 1058","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820012-00","Standard Silver Off Exchange Plan","68.38%",,"No","Yes","No","100%",,"$3,800","$0","$0","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1058","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840034","Health First Silver HMO 80 5241","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.961",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840034-00","Standard Silver Off Exchange Plan","69.91%",,"No","Yes","No","100%",,"$4,650","$75","$0","$150","$4,120","$630","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5241","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840034","Health First Silver HMO 80 5241","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.961",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840034-01","Standard Silver On Exchange Plan","69.91%",,"No","Yes","No","100%",,"$4,650","$75","$0","$150","$4,120","$630","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5241","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","Individual","No","59-3315064","27357FL1820012","Health First Silver HMO 100 1058","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820012-01","Standard Silver On Exchange Plan","68.38%",,"No","Yes","No","100%",,"$3,800","$0","$0","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1058","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","Individual","No","59-3315064","27357FL1820012","Health First Silver HMO 100 1058","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820012-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1058_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860034","Florida Hospital Silver HMO 80 5245","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.961",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860034-00","Standard Silver Off Exchange Plan","69.91%",,"No","Yes","No","100%",,"$4,650","$75","$0","$150","$4,120","$630","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5245","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860034","Florida Hospital Silver HMO 80 5245","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.961",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860034-01","Standard Silver On Exchange Plan","69.91%",,"No","Yes","No","100%",,"$4,650","$75","$0","$150","$4,120","$630","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5245","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","Individual","No","59-3315064","27357FL1820012","Health First Silver HMO 100 1058","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820012-03","Limited Cost Sharing Plan Variation","68.38%",,"No","Yes","No","100%",,"$3,800","$0","$0","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1058","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","Individual","No","59-3315064","27357FL1820012","Health First Silver HMO 100 1058","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820012-04","73% AV Level Silver Plan","73.28%",,"No","Yes","No","100%",,"$2,900","$0","$0","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1059","http://www.myHFHP.org/MHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840040","Health First Silver HMO 50 5289","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9572",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840040-00","Standard Silver Off Exchange Plan","70.58%",,"No","Yes","No","100%",,"$2,650","$0","$1,000","$150","$1,270","$220","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5289","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840040","Health First Silver HMO 50 5289","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9572",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840040-01","Standard Silver On Exchange Plan","70.58%",,"No","Yes","No","100%",,"$2,650","$0","$1,000","$150","$1,270","$220","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5289","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","Individual","No","59-3315064","27357FL1820012","Health First Silver HMO 100 1058","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820012-05","87% AV Level Silver Plan","86.08%",,"No","Yes","No","100%",,"$900","$50","$0","$150","$900","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1060","http://www.myHFHP.org/MHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","Individual","No","59-3315064","27357FL1820012","Health First Silver HMO 100 1058","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820012-06","94% AV Level Silver Plan","94.78%",,"No","Yes","No","100%",,"$100","$50","$0","$150","$100","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1061","http://www.myHFHP.org/MHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860040","Florida Hospital Silver HMO 50 5295","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9572",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860040-00","Standard Silver Off Exchange Plan","70.58%",,"No","Yes","No","100%",,"$2,650","$0","$1,000","$150","$1,270","$220","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5295","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860040","Florida Hospital Silver HMO 50 5295","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9572",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860040-01","Standard Silver On Exchange Plan","70.58%",,"No","Yes","No","100%",,"$2,650","$0","$1,000","$150","$1,270","$220","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5295","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","Individual","No","59-3315064","27357FL1880011","Florida Hospital Silver HMO 100 1522","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880011-00","Standard Silver Off Exchange Plan","68.38%",,"No","Yes","No","100%",,"$3,800","$0","$0","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1522","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","Individual","No","59-3315064","27357FL1880011","Florida Hospital Silver HMO 100 1522","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880011-01","Standard Silver On Exchange Plan","68.38%",,"No","Yes","No","100%",,"$3,800","$0","$0","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1522","http://www.myFHCA.org/FHMHI_2016","12"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","Individual","No","59-3315064","27357FL1880011","Florida Hospital Silver HMO 100 1522","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880011-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1522_0","http://www.myFHCA.org/FHMHI_2016","13"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","15","27357","FL","Individual","No","59-3315064","27357FL1880011","Florida Hospital Silver HMO 100 1522","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9656",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880011-03","Limited Cost Sharing Plan Variation","68.38%",,"No","Yes","No","100%",,"$3,800","$0","$0","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1522","http://www.myFHCA.org/FHMHI_2016","14"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","Individual","No","59-3315064","27357FL1820013","Health First Silver HMO 90 1070","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9658",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820013-01","Standard Silver On Exchange Plan","68.10%",,"No","Yes","No","100%",,"$3,900","$50","$130","$150","$2,014","$180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1070","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","Individual","No","59-3315064","27357FL1820013","Health First Silver HMO 90 1070","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9658",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820013-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1070_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870034","Florida Hospital Silver POS 80 5246","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9617",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870034-00","Standard Silver Off Exchange Plan","69.91%",,"No","Yes","No","100%",,"$4,650","$75","$0","$150","$4,120","$630","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5246","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870034","Florida Hospital Silver POS 80 5246","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9617",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870034-01","Standard Silver On Exchange Plan","69.91%",,"No","Yes","No","100%",,"$4,650","$75","$0","$150","$4,120","$630","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5246","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","Individual","No","59-3315064","27357FL1820013","Health First Silver HMO 90 1070","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9658",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820013-05","87% AV Level Silver Plan","87.47%",,"No","Yes","No","100%",,"$350","$50","$480","$150","$350","$400","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1072","http://www.myHFHP.org/MHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","Individual","No","59-3315064","27357FL1820013","Health First Silver HMO 90 1070","27357FL182",,"FLN001","FLS001","FLF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9658",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820013-06","94% AV Level Silver Plan","94.58%",,"No","Yes","No","100%",,"$0","$50","$520","$150","$0","$400","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1073","http://www.myHFHP.org/MHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870040","Florida Hospital Silver POS 50 5296","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9581",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870040-00","Standard Silver Off Exchange Plan","70.58%",,"No","Yes","No","100%",,"$2,650","$0","$1,000","$150","$1,270","$220","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","50%",,,,,"$5,300","$5300 per person","$10600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5296","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870040","Florida Hospital Silver POS 50 5296","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9581",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870040-01","Standard Silver On Exchange Plan","70.58%",,"No","Yes","No","100%",,"$2,650","$0","$1,000","$150","$1,270","$220","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","50%",,,,,"$5,300","$5300 per person","$10600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5296","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","Individual","No","59-3315064","27357FL1880012","Florida Hospital Silver HMO 90 1526","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9658",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880012-00","Standard Silver Off Exchange Plan","68.10%",,"No","Yes","No","100%",,"$3,900","$50","$130","$150","$2,014","$180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1526","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","Individual","No","59-3315064","27357FL1880012","Florida Hospital Silver HMO 90 1526","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9658",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880012-01","Standard Silver On Exchange Plan","68.10%",,"No","Yes","No","100%",,"$3,900","$50","$130","$150","$2,014","$180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1526","http://www.myFHCA.org/FHMHI_2016","12"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","Individual","No","59-3315064","27357FL1880012","Florida Hospital Silver HMO 90 1526","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9658",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880012-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1526_0","http://www.myFHCA.org/FHMHI_2016","13"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","Individual","No","59-3315064","27357FL1880012","Florida Hospital Silver HMO 90 1526","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9658",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880012-03","Limited Cost Sharing Plan Variation","68.10%",,"No","Yes","No","100%",,"$3,900","$50","$130","$150","$2,014","$180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1526","http://www.myFHCA.org/FHMHI_2016","14"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","Individual","No","59-3315064","27357FL1880012","Florida Hospital Silver HMO 90 1526","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9658",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880012-04","73% AV Level Silver Plan","73.40%",,"No","Yes","No","100%",,"$2,500","$50","$270","$150","$2,014","$180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1528","http://www.myFHCA.org/FHMHI_2016","15"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","Individual","No","59-3315064","27357FL1880012","Florida Hospital Silver HMO 90 1526","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9658",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880012-05","87% AV Level Silver Plan","87.47%",,"No","Yes","No","100%",,"$350","$50","$480","$150","$350","$400","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1530","http://www.myFHCA.org/FHMHI_2016","16"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","16","27357","FL","Individual","No","59-3315064","27357FL1880012","Florida Hospital Silver HMO 90 1526","27357FL188",,"FLN002","FLS002","FLF017","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9658",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880012-06","94% AV Level Silver Plan","94.58%",,"No","Yes","No","100%",,"$0","$50","$520","$150","$0","$400","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1532","http://www.myFHCA.org/FHMHI_2016","17"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","Individual","No","59-3315064","27357FL1830013","Health First Silver POS 90 1074","27357FL183",,"FLN001","FLS001","FLF008","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9665",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830013-00","Standard Silver Off Exchange Plan","68.10%",,"No","Yes","No","100%",,"$3,900","$50","$130","$150","$2,014","$180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","10%",,,,,"$7,800","$7800 per person","$15600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1074","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840008","Health First Platinum HMO 80 5051","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9702",,,,"5","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840008-00","Standard Platinum Off Exchange Plan","89.85%",,"No","Yes","No","100%",,"$0","$540","$40","$150","$0","$420","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5051","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840008","Health First Platinum HMO 80 5051","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9702",,,,"5","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840008-01","Standard Platinum On Exchange Plan","89.85%",,"No","Yes","No","100%",,"$0","$540","$40","$150","$0","$420","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5051","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","Individual","No","59-3315064","27357FL1830013","Health First Silver POS 90 1074","27357FL183",,"FLN001","FLS001","FLF008","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9665",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830013-01","Standard Silver On Exchange Plan","68.10%",,"No","Yes","No","100%",,"$3,900","$50","$130","$150","$2,014","$180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","10%",,,,,"$7,800","$7800 per person","$15600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1074","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","Individual","No","59-3315064","27357FL1830013","Health First Silver POS 90 1074","27357FL183",,"FLN001","FLS001","FLF008","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9665",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830013-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1074_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860008","Florida Hospital Platinum HMO 80 5055","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9702",,,,"5","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860008-00","Standard Platinum Off Exchange Plan","89.85%",,"No","Yes","No","100%",,"$0","$540","$40","$150","$0","$420","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5055","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860008","Florida Hospital Platinum HMO 80 5055","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9702",,,,"5","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860008-01","Standard Platinum On Exchange Plan","89.85%",,"No","Yes","No","100%",,"$0","$540","$40","$150","$0","$420","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5055","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","Individual","No","59-3315064","27357FL1830013","Health First Silver POS 90 1074","27357FL183",,"FLN001","FLS001","FLF008","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9665",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830013-03","Limited Cost Sharing Plan Variation","68.10%",,"No","Yes","No","100%",,"$3,900","$50","$130","$150","$2,014","$180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","10%",,,,,"$7,800","$7800 per person","$15600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1074","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","Individual","No","59-3315064","27357FL1830013","Health First Silver POS 90 1074","27357FL183",,"FLN001","FLS001","FLF008","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9665",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830013-04","73% AV Level Silver Plan","73.40%",,"No","Yes","No","100%",,"$2,500","$50","$270","$150","$2,014","$180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1075","http://www.myHFHP.org/MHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840010","Health First Platinum HMO 90 5065","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9703",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840010-00","Standard Platinum Off Exchange Plan","90.65%",,"No","Yes","No","100%",,"$500","$20","$410","$150","$500","$300","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5065","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840010","Health First Platinum HMO 90 5065","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9703",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840010-01","Standard Platinum On Exchange Plan","90.65%",,"No","Yes","No","100%",,"$500","$20","$410","$150","$500","$300","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5065","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","Individual","No","59-3315064","27357FL1830013","Health First Silver POS 90 1074","27357FL183",,"FLN001","FLS001","FLF008","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9665",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830013-05","87% AV Level Silver Plan","87.47%",,"No","Yes","No","100%",,"$350","$50","$480","$150","$350","$400","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1076","http://www.myHFHP.org/MHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","Individual","No","59-3315064","27357FL1830013","Health First Silver POS 90 1074","27357FL183",,"FLN001","FLS001","FLF008","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9665",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830013-06","94% AV Level Silver Plan","94.58%",,"No","Yes","No","100%",,"$0","$50","$520","$150","$0","$400","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1077","http://www.myHFHP.org/MHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860010","Florida Hospital Platinum HMO 90 5069","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9703",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860010-00","Standard Platinum Off Exchange Plan","90.65%",,"No","Yes","No","100%",,"$500","$20","$410","$150","$500","$300","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5069","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860010","Florida Hospital Platinum HMO 90 5069","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9703",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860010-01","Standard Platinum On Exchange Plan","90.65%",,"No","Yes","No","100%",,"$500","$20","$410","$150","$500","$300","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5069","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","Individual","No","59-3315064","27357FL1890007","Florida Hospital Silver POS 90 1527","27357FL189",,"FLN002","FLS002","FLF017","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9665",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890007-00","Standard Silver Off Exchange Plan","68.10%",,"No","Yes","No","100%",,"$3,900","$50","$130","$150","$2,014","$180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","10%",,,,,"$7,800","$7800 per person","$15600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1527","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","Individual","No","59-3315064","27357FL1890007","Florida Hospital Silver POS 90 1527","27357FL189",,"FLN002","FLS002","FLF017","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9665",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890007-01","Standard Silver On Exchange Plan","68.10%",,"No","Yes","No","100%",,"$3,900","$50","$130","$150","$2,014","$180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","10%",,,,,"$7,800","$7800 per person","$15600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1527","http://www.myFHCA.org/FHMHI_2016","12"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","Individual","No","59-3315064","27357FL1890007","Florida Hospital Silver POS 90 1527","27357FL189",,"FLN002","FLS002","FLF017","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9665",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1527_0","http://www.myFHCA.org/FHMHI_2016","13"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","Individual","No","59-3315064","27357FL1890007","Florida Hospital Silver POS 90 1527","27357FL189",,"FLN002","FLS002","FLF017","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9665",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890007-03","Limited Cost Sharing Plan Variation","68.10%",,"No","Yes","No","100%",,"$3,900","$50","$130","$150","$2,014","$180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$3,900","$3900 per person","$7800 per group","10%",,,,,"$7,800","$7800 per person","$15600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1527","http://www.myFHCA.org/FHMHI_2016","14"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","Individual","No","59-3315064","27357FL1890007","Florida Hospital Silver POS 90 1527","27357FL189",,"FLN002","FLS002","FLF017","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9665",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890007-04","73% AV Level Silver Plan","73.40%",,"No","Yes","No","100%",,"$2,500","$50","$270","$150","$2,014","$180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1529","http://www.myFHCA.org/FHMHI_2016","15"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","Individual","No","59-3315064","27357FL1890007","Florida Hospital Silver POS 90 1527","27357FL189",,"FLN002","FLS002","FLF017","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9665",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890007-05","87% AV Level Silver Plan","87.47%",,"No","Yes","No","100%",,"$350","$50","$480","$150","$350","$400","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1531","http://www.myFHCA.org/FHMHI_2016","16"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","17","27357","FL","Individual","No","59-3315064","27357FL1890007","Florida Hospital Silver POS 90 1527","27357FL189",,"FLN002","FLS002","FLF017","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9665",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890007-06","94% AV Level Silver Plan","94.58%",,"No","Yes","No","100%",,"$0","$50","$520","$150","$0","$400","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1533","http://www.myFHCA.org/FHMHI_2016","17"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","Individual","No","59-3315064","27357FL1820015","Health First Silver HMO 80 1094","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9641",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820015-00","Standard Silver Off Exchange Plan","68.92%",,"No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1094","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850008","Health First Platinum POS 80 5052","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9715",,,,"5","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850008-00","Standard Platinum Off Exchange Plan","89.85%",,"No","Yes","No","100%",,"$0","$540","$40","$150","$0","$420","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5052","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850008","Health First Platinum POS 80 5052","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9715",,,,"5","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850008-01","Standard Platinum On Exchange Plan","89.85%",,"No","Yes","No","100%",,"$0","$540","$40","$150","$0","$420","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5052","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","Individual","No","59-3315064","27357FL1820015","Health First Silver HMO 80 1094","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9641",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820015-01","Standard Silver On Exchange Plan","68.92%",,"No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1094","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","Individual","No","59-3315064","27357FL1820015","Health First Silver HMO 80 1094","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9641",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820015-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1094_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870008","Florida Hospital Platinum POS 80 5056","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9715",,,,"5","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870008-00","Standard Platinum Off Exchange Plan","89.85%",,"No","Yes","No","100%",,"$0","$540","$40","$150","$0","$420","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5056","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870008","Florida Hospital Platinum POS 80 5056","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9715",,,,"5","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870008-01","Standard Platinum On Exchange Plan","89.85%",,"No","Yes","No","100%",,"$0","$540","$40","$150","$0","$420","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5056","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","Individual","No","59-3315064","27357FL1820015","Health First Silver HMO 80 1094","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9641",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820015-03","Limited Cost Sharing Plan Variation","68.92%",,"No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1094","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","Individual","No","59-3315064","27357FL1820015","Health First Silver HMO 80 1094","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9641",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820015-04","73% AV Level Silver Plan","72.45%",,"No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1095","http://www.myHFHP.org/MHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","Individual","No","59-3315064","27357FL1830015","Health First Silver POS 80 1098","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9651",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830015-05","87% AV Level Silver Plan","86.83%",,"No","Yes","No","100%",,"$500","$0","$750","$150","$500","$80","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1100","http://www.myHFHP.org/MHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","Individual","No","59-3315064","27357FL1830015","Health First Silver POS 80 1098","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9651",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830015-06","94% AV Level Silver Plan","93.18%",,"No","Yes","No","100%",,"$200","$0","$300","$150","$200","$40","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1101","http://www.myHFHP.org/MHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860005","Florida Hospital Platinum HMO 90 5034","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9708",,,,"5","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860005-00","Standard Platinum Off Exchange Plan","90.45%",,"No","Yes","No","100%",,"$0","$585","$0","$150","$500","$370","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5034","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860005","Florida Hospital Platinum HMO 90 5034","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9708",,,,"5","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860005-01","Standard Platinum On Exchange Plan","90.45%",,"No","Yes","No","100%",,"$0","$585","$0","$150","$500","$370","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5034","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","Individual","No","59-3315064","27357FL1890008","Florida Hospital Silver POS 80 1535","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9651",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890008-00","Standard Silver Off Exchange Plan","68.92%",,"No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1535","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850010","Health First Platinum POS 90 5066","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9715",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850010-00","Standard Platinum Off Exchange Plan","90.65%",,"No","Yes","No","100%",,"$500","$20","$410","$150","$500","$300","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5066","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850010","Health First Platinum POS 90 5066","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9715",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850010-01","Standard Platinum On Exchange Plan","90.65%",,"No","Yes","No","100%",,"$500","$20","$410","$150","$500","$300","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5066","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","Individual","No","59-3315064","27357FL1820015","Health First Silver HMO 80 1094","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9641",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820015-05","87% AV Level Silver Plan","86.83%",,"No","Yes","No","100%",,"$500","$0","$750","$150","$500","$80","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1096","http://www.myHFHP.org/MHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","Individual","No","59-3315064","27357FL1820015","Health First Silver HMO 80 1094","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9641",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820015-06","94% AV Level Silver Plan","93.18%",,"No","Yes","No","100%",,"$200","$0","$300","$150","$200","$40","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1097","http://www.myHFHP.org/MHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870010","Florida Hospital Platinum POS 90 5070","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9715",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870010-00","Standard Platinum Off Exchange Plan","90.65%",,"No","Yes","No","100%",,"$500","$20","$410","$150","$500","$300","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5070","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870010","Florida Hospital Platinum POS 90 5070","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9715",,,,"0","3","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870010-01","Standard Platinum On Exchange Plan","90.65%",,"No","Yes","No","100%",,"$500","$20","$410","$150","$500","$300","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5070","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","Individual","No","59-3315064","27357FL1880013","Florida Hospital Silver HMO 80 1534","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9641",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880013-00","Standard Silver Off Exchange Plan","68.92%",,"No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1534","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","Individual","No","59-3315064","27357FL1880013","Florida Hospital Silver HMO 80 1534","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9641",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880013-01","Standard Silver On Exchange Plan","68.92%",,"No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1534","http://www.myFHCA.org/FHMHI_2016","12"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","Individual","No","59-3315064","27357FL1880013","Florida Hospital Silver HMO 80 1534","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9641",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880013-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1534_0","http://www.myFHCA.org/FHMHI_2016","13"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","Individual","No","59-3315064","27357FL1880013","Florida Hospital Silver HMO 80 1534","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9641",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880013-03","Limited Cost Sharing Plan Variation","68.92%",,"No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1534","http://www.myFHCA.org/FHMHI_2016","14"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","Individual","No","59-3315064","27357FL1880013","Florida Hospital Silver HMO 80 1534","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9641",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880013-04","73% AV Level Silver Plan","72.45%",,"No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1536","http://www.myFHCA.org/FHMHI_2016","15"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","Individual","No","59-3315064","27357FL1880013","Florida Hospital Silver HMO 80 1534","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9641",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880013-05","87% AV Level Silver Plan","86.83%",,"No","Yes","No","100%",,"$500","$0","$750","$150","$500","$80","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1538","http://www.myFHCA.org/FHMHI_2016","16"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","18","27357","FL","Individual","No","59-3315064","27357FL1880013","Florida Hospital Silver HMO 80 1534","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9641",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880013-06","94% AV Level Silver Plan","93.18%",,"No","Yes","No","100%",,"$200","$0","$300","$150","$200","$40","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1540","http://www.myFHCA.org/FHMHI_2016","17"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","Individual","No","59-3315064","27357FL1830015","Health First Silver POS 80 1098","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9651",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830015-00","Standard Silver Off Exchange Plan","68.92%",,"No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1098","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840009","Health First Platinum HMO 100 5058","27357FL184",,"FLN003","FLS001","FLF008","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9705",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840009-00","Standard Platinum Off Exchange Plan","89.86%",,"No","Yes","No","100%",,"$900","$75","$0","$150","$900","$290","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5058","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840009","Health First Platinum HMO 100 5058","27357FL184",,"FLN003","FLS001","FLF008","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9705",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840009-01","Standard Platinum On Exchange Plan","89.86%",,"No","Yes","No","100%",,"$900","$75","$0","$150","$900","$290","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5058","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","Individual","No","59-3315064","27357FL1830015","Health First Silver POS 80 1098","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9651",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830015-01","Standard Silver On Exchange Plan","68.92%",,"No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1098","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","Individual","No","59-3315064","27357FL1880015","Florida Hospital Silver HMO 70 1546","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9648",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880015-00","Standard Silver Off Exchange Plan","68.51%",,"No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1546","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","Individual","No","59-3315064","27357FL1880015","Florida Hospital Silver HMO 70 1546","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9648",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880015-01","Standard Silver On Exchange Plan","68.51%",,"No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1546","http://www.myFHCA.org/FHMHI_2016","12"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","Individual","No","59-3315064","27357FL1880015","Florida Hospital Silver HMO 70 1546","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9648",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880015-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1546_0","http://www.myFHCA.org/FHMHI_2016","13"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","Individual","No","59-3315064","27357FL1880015","Florida Hospital Silver HMO 70 1546","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9648",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880015-03","Limited Cost Sharing Plan Variation","68.51%",,"No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1546","http://www.myFHCA.org/FHMHI_2016","14"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","Individual","No","59-3315064","27357FL1880015","Florida Hospital Silver HMO 70 1546","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9648",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880015-04","73% AV Level Silver Plan","72.64%",,"No","Yes","No","100%",,"$2,500","$50","$800","$150","$1,410","$520","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1548","http://www.myFHCA.org/FHMHI_2016","15"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","Individual","No","59-3315064","27357FL1880015","Florida Hospital Silver HMO 70 1546","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9648",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880015-05","87% AV Level Silver Plan","87.75%",,"No","Yes","No","100%",,"$800","$50","$700","$150","$800","$520","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1550","http://www.myFHCA.org/FHMHI_2016","16"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","Individual","No","59-3315064","27357FL1880015","Florida Hospital Silver HMO 70 1546","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9648",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880015-06","94% AV Level Silver Plan","94.35%",,"No","Yes","No","100%",,"$0","$50","$600","$150","$0","$350","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1552","http://www.myFHCA.org/FHMHI_2016","17"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","Individual","No","59-3315064","27357FL1830015","Health First Silver POS 80 1098","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9651",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830015-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1098_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860009","Florida Hospital Platinum HMO 100 5062","27357FL186",,"FLN004","FLS002","FLF017","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9705",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860009-00","Standard Platinum Off Exchange Plan","89.86%",,"No","Yes","No","100%",,"$900","$75","$0","$150","$900","$290","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5062","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860009","Florida Hospital Platinum HMO 100 5062","27357FL186",,"FLN004","FLS002","FLF017","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9705",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860009-01","Standard Platinum On Exchange Plan","89.86%",,"No","Yes","No","100%",,"$900","$75","$0","$150","$900","$290","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5062","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","Individual","No","59-3315064","27357FL1830015","Health First Silver POS 80 1098","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9651",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830015-03","Limited Cost Sharing Plan Variation","68.92%",,"No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1098","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","Individual","No","59-3315064","27357FL1830015","Health First Silver POS 80 1098","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9651",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830015-04","73% AV Level Silver Plan","72.45%",,"No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1099","http://www.myHFHP.org/MHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840005","Health First Platinum HMO 90 5030","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9708",,,,"5","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840005-00","Standard Platinum Off Exchange Plan","90.45%",,"No","Yes","No","100%",,"$0","$585","$0","$150","$500","$370","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5030","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840005","Health First Platinum HMO 90 5030","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9708",,,,"5","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840005-01","Standard Platinum On Exchange Plan","90.45%",,"No","Yes","No","100%",,"$0","$585","$0","$150","$500","$370","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5030","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","Individual","No","59-3315064","27357FL1890008","Florida Hospital Silver POS 80 1535","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9651",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890008-01","Standard Silver On Exchange Plan","68.92%",,"No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1535","http://www.myFHCA.org/FHMHI_2016","12"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","Individual","No","59-3315064","27357FL1890008","Florida Hospital Silver POS 80 1535","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9651",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890008-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1535_0","http://www.myFHCA.org/FHMHI_2016","13"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","Individual","No","59-3315064","27357FL1890008","Florida Hospital Silver POS 80 1535","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9651",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890008-03","Limited Cost Sharing Plan Variation","68.92%",,"No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1535","http://www.myFHCA.org/FHMHI_2016","14"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","Individual","No","59-3315064","27357FL1890008","Florida Hospital Silver POS 80 1535","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9651",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890008-04","73% AV Level Silver Plan","72.45%",,"No","Yes","No","100%",,"$2,500","$0","$530","$150","$2,420","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1537","http://www.myFHCA.org/FHMHI_2016","15"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","Individual","No","59-3315064","27357FL1890008","Florida Hospital Silver POS 80 1535","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9651",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890008-05","87% AV Level Silver Plan","86.83%",,"No","Yes","No","100%",,"$500","$0","$750","$150","$500","$80","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1539","http://www.myFHCA.org/FHMHI_2016","16"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","19","27357","FL","Individual","No","59-3315064","27357FL1890008","Florida Hospital Silver POS 80 1535","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9651",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890008-06","94% AV Level Silver Plan","93.18%",,"No","Yes","No","100%",,"$200","$0","$300","$150","$200","$40","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1541","http://www.myFHCA.org/FHMHI_2016","17"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","Individual","No","59-3315064","27357FL1820017","Health First Silver HMO 70 1126","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9648",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820017-00","Standard Silver Off Exchange Plan","68.51%",,"No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1126","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850009","Health First Platinum POS 100 5059","27357FL185",,"FLN003","FLS001","FLF008","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9716",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850009-00","Standard Platinum Off Exchange Plan","89.86%",,"No","Yes","No","100%",,"$900","$75","$0","$150","$900","$290","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%",,,,,"$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5059","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850009","Health First Platinum POS 100 5059","27357FL185",,"FLN003","FLS001","FLF008","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9716",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850009-01","Standard Platinum On Exchange Plan","89.86%",,"No","Yes","No","100%",,"$900","$75","$0","$150","$900","$290","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%",,,,,"$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5059","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","Individual","No","59-3315064","27357FL1820017","Health First Silver HMO 70 1126","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9648",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820017-01","Standard Silver On Exchange Plan","68.51%",,"No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1126","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","Individual","No","59-3315064","27357FL1820017","Health First Silver HMO 70 1126","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9648",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820017-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1126_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870009","Florida Hospital Platinum POS 100 5063","27357FL187",,"FLN004","FLS002","FLF017","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9716",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870009-00","Standard Platinum Off Exchange Plan","89.86%",,"No","Yes","No","100%",,"$900","$75","$0","$150","$900","$290","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%",,,,,"$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5063","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870009","Florida Hospital Platinum POS 100 5063","27357FL187",,"FLN004","FLS002","FLF017","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9716",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870009-01","Standard Platinum On Exchange Plan","89.86%",,"No","Yes","No","100%",,"$900","$75","$0","$150","$900","$290","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%",,,,,"$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5063","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","Individual","No","59-3315064","27357FL1820017","Health First Silver HMO 70 1126","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9648",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820017-03","Limited Cost Sharing Plan Variation","68.51%",,"No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1126","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","Individual","No","59-3315064","27357FL1820017","Health First Silver HMO 70 1126","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9648",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820017-04","73% AV Level Silver Plan","72.64%",,"No","Yes","No","100%",,"$2,500","$50","$800","$150","$1,410","$520","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1127","http://www.myHFHP.org/MHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850005","Health First Platinum POS 90 5031","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.972",,,,"5","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850005-00","Standard Platinum Off Exchange Plan","90.45%",,"No","Yes","No","100%",,"$0","$585","$0","$150","$500","$370","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5031","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850005","Health First Platinum POS 90 5031","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.972",,,,"5","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850005-01","Standard Platinum On Exchange Plan","90.45%",,"No","Yes","No","100%",,"$0","$585","$0","$150","$500","$370","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5031","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","Individual","No","59-3315064","27357FL1820017","Health First Silver HMO 70 1126","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9648",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820017-05","87% AV Level Silver Plan","87.75%",,"No","Yes","No","100%",,"$800","$50","$700","$150","$800","$520","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1128","http://www.myHFHP.org/MHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","Individual","No","59-3315064","27357FL1820017","Health First Silver HMO 70 1126","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9648",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820017-06","94% AV Level Silver Plan","94.35%",,"No","Yes","No","100%",,"$0","$50","$600","$150","$0","$350","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1129","http://www.myHFHP.org/MHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870005","Florida Hospital Platinum POS 90 5035","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.972",,,,"5","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870005-00","Standard Platinum Off Exchange Plan","90.45%",,"No","Yes","No","100%",,"$0","$585","$0","$150","$500","$370","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5035","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","20","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870005","Florida Hospital Platinum POS 90 5035","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.972",,,,"5","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870005-01","Standard Platinum On Exchange Plan","90.45%",,"No","Yes","No","100%",,"$0","$585","$0","$150","$500","$370","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5035","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","Individual","No","59-3315064","27357FL1830017","Health First Silver POS 70 1130","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9654",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830017-00","Standard Silver Off Exchange Plan","68.51%",,"No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1130","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840004","Health First Platinum HMO 100 5023","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9705",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840004-00","Standard Platinum Off Exchange Plan","91.01%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5023","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840004","Health First Platinum HMO 100 5023","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9705",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840004-01","Standard Platinum On Exchange Plan","91.01%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5023","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","Individual","No","59-3315064","27357FL1830017","Health First Silver POS 70 1130","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9654",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830017-01","Standard Silver On Exchange Plan","68.51%",,"No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1130","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","Individual","No","59-3315064","27357FL1830017","Health First Silver POS 70 1130","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9654",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830017-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1130_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860004","Florida Hospital Platinum HMO 100 5027","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9705",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860004-00","Standard Platinum Off Exchange Plan","91.01%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5027","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860004","Florida Hospital Platinum HMO 100 5027","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9705",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860004-01","Standard Platinum On Exchange Plan","91.01%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5027","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","Individual","No","59-3315064","27357FL1830017","Health First Silver POS 70 1130","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9654",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830017-03","Limited Cost Sharing Plan Variation","68.51%",,"No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1130","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","Individual","No","59-3315064","27357FL1830017","Health First Silver POS 70 1130","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9654",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830017-04","73% AV Level Silver Plan","72.64%",,"No","Yes","No","100%",,"$2,500","$50","$800","$150","$1,410","$520","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1131","http://www.myHFHP.org/MHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840003","Health First Platinum HMO 100 5016","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9707",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840003-00","Standard Platinum Off Exchange Plan","91.69%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5016","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840003","Health First Platinum HMO 100 5016","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9707",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840003-01","Standard Platinum On Exchange Plan","91.69%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5016","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","Individual","No","59-3315064","27357FL1830017","Health First Silver POS 70 1130","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9654",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830017-05","87% AV Level Silver Plan","87.75%",,"No","Yes","No","100%",,"$800","$50","$700","$150","$800","$520","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1132","http://www.myHFHP.org/MHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","Individual","No","59-3315064","27357FL1830017","Health First Silver POS 70 1130","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9654",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830017-06","94% AV Level Silver Plan","94.35%",,"No","Yes","No","100%",,"$0","$50","$600","$150","$0","$350","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1133","http://www.myHFHP.org/MHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860003","Florida Hospital Platinum HMO 100 5020","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9707",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860003-00","Standard Platinum Off Exchange Plan","91.69%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5020","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860003","Florida Hospital Platinum HMO 100 5020","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9707",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860003-01","Standard Platinum On Exchange Plan","91.69%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5020","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","Individual","No","59-3315064","27357FL1890009","Florida Hospital Silver POS 70 1547","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9654",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890009-00","Standard Silver Off Exchange Plan","68.51%",,"No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1547","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","Individual","No","59-3315064","27357FL1890009","Florida Hospital Silver POS 70 1547","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9654",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890009-01","Standard Silver On Exchange Plan","68.51%",,"No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1547","http://www.myFHCA.org/FHMHI_2016","12"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","23","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860020","Florida Hospital Gold HMO 50 5141","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9663",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860020-00","Standard Gold Off Exchange Plan","81.41%",,"No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5141","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","23","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860020","Florida Hospital Gold HMO 50 5141","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9663",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860020-01","Standard Gold On Exchange Plan","81.41%",,"No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5141","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","23","27357","FL","Individual","No","59-3315064","27357FL1830018","Health First Silver POS 70 1162","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9653",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830018-03","Limited Cost Sharing Plan Variation","69.50%",,"No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1162","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","23","27357","FL","Individual","No","59-3315064","27357FL1830018","Health First Silver POS 70 1162","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9653",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830018-04","73% AV Level Silver Plan","73.98%",,"No","Yes","No","100%",,"$1,200","$0","$1,190","$150","$1,200","$80","$370","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1163","http://www.myHFHP.org/MHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","Individual","No","59-3315064","27357FL1890009","Florida Hospital Silver POS 70 1547","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9654",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890009-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1547_0","http://www.myFHCA.org/FHMHI_2016","13"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","Individual","No","59-3315064","27357FL1890009","Florida Hospital Silver POS 70 1547","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9654",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890009-03","Limited Cost Sharing Plan Variation","68.51%",,"No","Yes","No","100%",,"$3,500","$50","$500","$150","$1,410","$520","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1547","http://www.myFHCA.org/FHMHI_2016","14"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","Individual","No","59-3315064","27357FL1890009","Florida Hospital Silver POS 70 1547","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9654",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890009-04","73% AV Level Silver Plan","72.64%",,"No","Yes","No","100%",,"$2,500","$50","$800","$150","$1,410","$520","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1549","http://www.myFHCA.org/FHMHI_2016","15"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","Individual","No","59-3315064","27357FL1890009","Florida Hospital Silver POS 70 1547","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9654",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890009-05","87% AV Level Silver Plan","87.75%",,"No","Yes","No","100%",,"$800","$50","$700","$150","$800","$520","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1551","http://www.myFHCA.org/FHMHI_2016","16"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","21","27357","FL","Individual","No","59-3315064","27357FL1890009","Florida Hospital Silver POS 70 1547","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9654",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890009-06","94% AV Level Silver Plan","94.35%",,"No","Yes","No","100%",,"$0","$50","$600","$150","$0","$350","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1553","http://www.myFHCA.org/FHMHI_2016","17"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","Individual","No","59-3315064","27357FL1820018","Health First Silver HMO 70 1158","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9643",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820018-00","Standard Silver Off Exchange Plan","69.50%",,"No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1158","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850004","Health First Platinum POS 100 5024","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9717",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850004-00","Standard Platinum Off Exchange Plan","91.01%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5024","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","23","27357","FL","Individual","No","59-3315064","27357FL1890010","Florida Hospital Silver POS 70 1555","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9653",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890010-01","Standard Silver On Exchange Plan","69.50%",,"No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1555","http://www.myFHCA.org/FHMHI_2016","12"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850004","Health First Platinum POS 100 5024","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9717",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850004-01","Standard Platinum On Exchange Plan","91.01%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5024","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","Individual","No","59-3315064","27357FL1820018","Health First Silver HMO 70 1158","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9643",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820018-01","Standard Silver On Exchange Plan","69.50%",,"No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1158","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","Individual","No","59-3315064","27357FL1820018","Health First Silver HMO 70 1158","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9643",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820018-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1158_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870004","Florida Hospital Platinum POS 100 5028","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9717",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870004-00","Standard Platinum Off Exchange Plan","91.01%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5028","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870004","Florida Hospital Platinum POS 100 5028","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9717",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870004-01","Standard Platinum On Exchange Plan","91.01%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5028","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","Individual","No","59-3315064","27357FL1820018","Health First Silver HMO 70 1158","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9643",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820018-03","Limited Cost Sharing Plan Variation","69.50%",,"No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1158","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","Individual","No","59-3315064","27357FL1820018","Health First Silver HMO 70 1158","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9643",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820018-04","73% AV Level Silver Plan","73.98%",,"No","Yes","No","100%",,"$1,200","$0","$1,190","$150","$1,200","$80","$370","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1159","http://www.myHFHP.org/MHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850003","Health First Platinum POS 100 5017","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9718",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850003-00","Standard Platinum Off Exchange Plan","91.69%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5017","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850003","Health First Platinum POS 100 5017","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9718",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850003-01","Standard Platinum On Exchange Plan","91.69%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5017","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","Individual","No","59-3315064","27357FL1820018","Health First Silver HMO 70 1158","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9643",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820018-05","87% AV Level Silver Plan","87.89%",,"No","Yes","No","100%",,"$0","$0","$1,550","$150","$0","$80","$730","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1160","http://www.myHFHP.org/MHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","Individual","No","59-3315064","27357FL1820018","Health First Silver HMO 70 1158","27357FL182",,"FLN001","FLS001","FLF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9643",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820018-06","94% AV Level Silver Plan","94.28%",,"No","Yes","No","100%",,"$0","$0","$600","$150","$0","$50","$550","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1161","http://www.myHFHP.org/MHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870003","Florida Hospital Platinum POS 100 5021","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9718",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870003-00","Standard Platinum Off Exchange Plan","91.69%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5021","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870003","Florida Hospital Platinum POS 100 5021","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9718",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870003-01","Standard Platinum On Exchange Plan","91.69%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5021","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","Individual","No","59-3315064","27357FL1880016","Florida Hospital Silver HMO 70 1554","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9643",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880016-00","Standard Silver Off Exchange Plan","69.50%",,"No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1554","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","Individual","No","59-3315064","27357FL1880016","Florida Hospital Silver HMO 70 1554","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9643",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880016-01","Standard Silver On Exchange Plan","69.50%",,"No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1554","http://www.myFHCA.org/FHMHI_2016","12"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","Individual","No","59-3315064","27357FL1880016","Florida Hospital Silver HMO 70 1554","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9643",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880016-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1554_0","http://www.myFHCA.org/FHMHI_2016","13"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","Individual","No","59-3315064","27357FL1880016","Florida Hospital Silver HMO 70 1554","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9643",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880016-03","Limited Cost Sharing Plan Variation","69.50%",,"No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1554","http://www.myFHCA.org/FHMHI_2016","14"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","Individual","No","59-3315064","27357FL1880016","Florida Hospital Silver HMO 70 1554","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9643",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880016-04","73% AV Level Silver Plan","73.98%",,"No","Yes","No","100%",,"$1,200","$0","$1,190","$150","$1,200","$80","$370","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1556","http://www.myFHCA.org/FHMHI_2016","15"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","Individual","No","59-3315064","27357FL1880016","Florida Hospital Silver HMO 70 1554","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9643",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880016-05","87% AV Level Silver Plan","87.89%",,"No","Yes","No","100%",,"$0","$0","$1,550","$150","$0","$80","$730","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1558","http://www.myFHCA.org/FHMHI_2016","16"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","22","27357","FL","Individual","No","59-3315064","27357FL1880016","Florida Hospital Silver HMO 70 1554","27357FL188",,"FLN002","FLS002","FLF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9643",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880016-06","94% AV Level Silver Plan","94.28%",,"No","Yes","No","100%",,"$0","$0","$600","$150","$0","$50","$550","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1560","http://www.myFHCA.org/FHMHI_2016","17"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","23","27357","FL","Individual","No","59-3315064","27357FL1830018","Health First Silver POS 70 1162","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9653",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830018-00","Standard Silver Off Exchange Plan","69.50%",,"No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1162","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","23","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840020","Health First Gold HMO 50 5137","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9663",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840020-00","Standard Gold Off Exchange Plan","81.41%",,"No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5137","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","23","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840020","Health First Gold HMO 50 5137","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9663",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840020-01","Standard Gold On Exchange Plan","81.41%",,"No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5137","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","23","27357","FL","Individual","No","59-3315064","27357FL1830018","Health First Silver POS 70 1162","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9653",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830018-01","Standard Silver On Exchange Plan","69.50%",,"No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1162","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","23","27357","FL","Individual","No","59-3315064","27357FL1830018","Health First Silver POS 70 1162","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9653",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830018-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1162_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","23","27357","FL","Individual","No","59-3315064","27357FL1830018","Health First Silver POS 70 1162","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9653",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830018-05","87% AV Level Silver Plan","87.89%",,"No","Yes","No","100%",,"$0","$0","$1,550","$150","$0","$80","$730","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1164","http://www.myHFHP.org/MHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","23","27357","FL","Individual","No","59-3315064","27357FL1830018","Health First Silver POS 70 1162","27357FL183",,"FLN001","FLS001","FLF009","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9653",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830018-06","94% AV Level Silver Plan","94.28%",,"No","Yes","No","100%",,"$0","$0","$600","$150","$0","$50","$550","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1165","http://www.myHFHP.org/MHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","23","27357","FL","Individual","No","59-3315064","27357FL1890010","Florida Hospital Silver POS 70 1555","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9653",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890010-00","Standard Silver Off Exchange Plan","69.50%",,"No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1555","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","23","27357","FL","Individual","No","59-3315064","27357FL1890010","Florida Hospital Silver POS 70 1555","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9653",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890010-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1555_0","http://www.myFHCA.org/FHMHI_2016","13"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","23","27357","FL","Individual","No","59-3315064","27357FL1890010","Florida Hospital Silver POS 70 1555","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9653",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890010-03","Limited Cost Sharing Plan Variation","69.50%",,"No","Yes","No","100%",,"$2,000","$0","$950","$150","$2,000","$80","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1555","http://www.myFHCA.org/FHMHI_2016","14"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","23","27357","FL","Individual","No","59-3315064","27357FL1890010","Florida Hospital Silver POS 70 1555","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9653",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890010-04","73% AV Level Silver Plan","73.98%",,"No","Yes","No","100%",,"$1,200","$0","$1,190","$150","$1,200","$80","$370","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1557","http://www.myFHCA.org/FHMHI_2016","15"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","23","27357","FL","Individual","No","59-3315064","27357FL1890010","Florida Hospital Silver POS 70 1555","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9653",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890010-05","87% AV Level Silver Plan","87.89%",,"No","Yes","No","100%",,"$0","$0","$1,550","$150","$0","$80","$730","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1559","http://www.myFHCA.org/FHMHI_2016","16"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","23","27357","FL","Individual","No","59-3315064","27357FL1890010","Florida Hospital Silver POS 70 1555","27357FL189",,"FLN002","FLS002","FLF018","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9653",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890010-06","94% AV Level Silver Plan","94.28%",,"No","Yes","No","100%",,"$0","$0","$600","$150","$0","$50","$550","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1561","http://www.myFHCA.org/FHMHI_2016","17"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","24","27357","FL","Individual","No","59-3315064","27357FL1820023","Health First Bronze HMO 90 1254","27357FL182",,"FLN001","FLS001","FLF007","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.96",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820023-00","Standard Bronze Off Exchange Plan","60.72%",,"No","Yes","No","100%",,"$5,170","$20","$0","$150","$2,014","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1254","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","24","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850020","Health First Gold POS 50 5138","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9674",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850020-00","Standard Gold Off Exchange Plan","81.41%",,"No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5138","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","24","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850020","Health First Gold POS 50 5138","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9674",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850020-01","Standard Gold On Exchange Plan","81.41%",,"No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5138","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","24","27357","FL","Individual","No","59-3315064","27357FL1820023","Health First Bronze HMO 90 1254","27357FL182",,"FLN001","FLS001","FLF007","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.96",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820023-01","Standard Bronze On Exchange Plan","60.72%",,"No","Yes","No","100%",,"$5,170","$20","$0","$150","$2,014","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1254","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","24","27357","FL","Individual","No","59-3315064","27357FL1820023","Health First Bronze HMO 90 1254","27357FL182",,"FLN001","FLS001","FLF007","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.96",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820023-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1254_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","24","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870020","Florida Hospital Gold POS 50 5142","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9674",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870020-00","Standard Gold Off Exchange Plan","81.41%",,"No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5142","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","24","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870020","Florida Hospital Gold POS 50 5142","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9674",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870020-01","Standard Gold On Exchange Plan","81.41%",,"No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5142","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","24","27357","FL","Individual","No","59-3315064","27357FL1820023","Health First Bronze HMO 90 1254","27357FL182",,"FLN001","FLS001","FLF007","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.96",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820023-03","Limited Cost Sharing Plan Variation","60.72%",,"No","Yes","No","100%",,"$5,170","$20","$0","$150","$2,014","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,"No",,,"http://www.myHFHP.org/2016_sbc_1254","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","24","27357","FL","Individual","No","59-3315064","27357FL1880018","Florida Hospital Bronze HMO 90 1564","27357FL188",,"FLN002","FLS002","FLF016","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.96",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880018-00","Standard Bronze Off Exchange Plan","60.72%",,"No","Yes","No","100%",,"$5,170","$20","$0","$150","$2,014","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1564","http://www.myFHCA.org/FHMHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","24","27357","FL","Individual","No","59-3315064","27357FL1880018","Florida Hospital Bronze HMO 90 1564","27357FL188",,"FLN002","FLS002","FLF016","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.96",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880018-01","Standard Bronze On Exchange Plan","60.72%",,"No","Yes","No","100%",,"$5,170","$20","$0","$150","$2,014","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1564","http://www.myFHCA.org/FHMHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","24","27357","FL","Individual","No","59-3315064","27357FL1880018","Florida Hospital Bronze HMO 90 1564","27357FL188",,"FLN002","FLS002","FLF016","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.96",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880018-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1564_0","http://www.myFHCA.org/FHMHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","24","27357","FL","Individual","No","59-3315064","27357FL1880018","Florida Hospital Bronze HMO 90 1564","27357FL188",,"FLN002","FLS002","FLF016","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.96",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880018-03","Limited Cost Sharing Plan Variation","60.72%",,"No","Yes","No","100%",,"$5,170","$20","$0","$150","$2,014","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,"No",,,"http://www.myFHCA.org/2016_sbc_1564","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","25","27357","FL","Individual","No","59-3315064","27357FL1820025","Health First Bronze HMO 70 1265","27357FL182",,"FLN001","FLS001","FLF005","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9567",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820025-00","Standard Bronze Off Exchange Plan","61.95%",,"Yes","Yes","No","100%",,"$5,170","$50","$1,680","$150","$4,260","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2016_sbc_1265","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","25","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840017","Health First Gold HMO 80 5116","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9653",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840017-00","Standard Gold Off Exchange Plan","80.77%",,"No","Yes","No","100%",,"$750","$40","$880","$150","$750","$400","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5116","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","25","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840017","Health First Gold HMO 80 5116","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9653",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840017-01","Standard Gold On Exchange Plan","80.77%",,"No","Yes","No","100%",,"$750","$40","$880","$150","$750","$400","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5116","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","25","27357","FL","Individual","No","59-3315064","27357FL1820025","Health First Bronze HMO 70 1265","27357FL182",,"FLN001","FLS001","FLF005","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9567",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820025-01","Standard Bronze On Exchange Plan","61.95%",,"Yes","Yes","No","100%",,"$5,170","$50","$1,680","$150","$4,260","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2016_sbc_1265","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","25","27357","FL","Individual","No","59-3315064","27357FL1820025","Health First Bronze HMO 70 1265","27357FL182",,"FLN001","FLS001","FLF005","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9567",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820025-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.myHFHP.org/2016_sbc_1265_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","25","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860017","Florida Hospital Gold HMO 80 5130","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9653",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860017-00","Standard Gold Off Exchange Plan","80.77%",,"No","Yes","No","100%",,"$750","$40","$880","$150","$750","$400","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5130","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","25","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860017","Florida Hospital Gold HMO 80 5130","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9653",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860017-01","Standard Gold On Exchange Plan","80.77%",,"No","Yes","No","100%",,"$750","$40","$880","$150","$750","$400","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5130","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","25","27357","FL","Individual","No","59-3315064","27357FL1820025","Health First Bronze HMO 70 1265","27357FL182",,"FLN001","FLS001","FLF005","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9567",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820025-03","Limited Cost Sharing Plan Variation","61.95%",,"Yes","Yes","No","100%",,"$5,170","$50","$1,680","$150","$4,260","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2016_sbc_1265","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","25","27357","FL","Individual","No","59-3315064","27357FL1880020","Florida Hospital Bronze HMO 70 1567","27357FL188",,"FLN002","FLS002","FLF014","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9567",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880020-00","Standard Bronze Off Exchange Plan","61.95%",,"Yes","Yes","No","100%",,"$5,170","$50","$1,680","$150","$4,260","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2016_sbc_1567","http://www.myFHCA.org/FHMHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","25","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840012","Health First Gold HMO 90 5079","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9664",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840012-00","Standard Gold Off Exchange Plan","80.63%",,"No","Yes","No","100%",,"$1,000","$60","$360","$150","$1,000","$600","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5079","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","25","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840012","Health First Gold HMO 90 5079","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9664",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840012-01","Standard Gold On Exchange Plan","80.63%",,"No","Yes","No","100%",,"$1,000","$60","$360","$150","$1,000","$600","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5079","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","25","27357","FL","Individual","No","59-3315064","27357FL1880020","Florida Hospital Bronze HMO 70 1567","27357FL188",,"FLN002","FLS002","FLF014","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9567",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880020-01","Standard Bronze On Exchange Plan","61.95%",,"Yes","Yes","No","100%",,"$5,170","$50","$1,680","$150","$4,260","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2016_sbc_1567","http://www.myFHCA.org/FHMHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","25","27357","FL","Individual","No","59-3315064","27357FL1880020","Florida Hospital Bronze HMO 70 1567","27357FL188",,"FLN002","FLS002","FLF014","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9567",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880020-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.myFHCA.org/2016_sbc_1567_0","http://www.myFHCA.org/FHMHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","25","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860012","Florida Hospital Gold HMO 90 5083","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9664",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860012-00","Standard Gold Off Exchange Plan","80.63%",,"No","Yes","No","100%",,"$1,000","$60","$360","$150","$1,000","$600","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5083","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","25","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860012","Florida Hospital Gold HMO 90 5083","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9664",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860012-01","Standard Gold On Exchange Plan","80.63%",,"No","Yes","No","100%",,"$1,000","$60","$360","$150","$1,000","$600","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5083","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","25","27357","FL","Individual","No","59-3315064","27357FL1880020","Florida Hospital Bronze HMO 70 1567","27357FL188",,"FLN002","FLS002","FLF014","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9567",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880020-03","Limited Cost Sharing Plan Variation","61.95%",,"Yes","Yes","No","100%",,"$5,170","$50","$1,680","$150","$4,260","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2016_sbc_1567","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","26","27357","FL","Individual","No","59-3315064","27357FL1830025","Health First Bronze POS 70 1266","27357FL183",,"FLN001","FLS001","FLF005","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9578",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830025-00","Standard Bronze Off Exchange Plan","61.95%",,"Yes","Yes","No","100%",,"$5,170","$0","$1,680","$150","$4,260","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","30%",,,,,"$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2016_sbc_1266","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","26","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850017","Health First Gold POS 80 5117","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9661",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850017-00","Standard Gold Off Exchange Plan","80.77%",,"No","Yes","No","100%",,"$750","$40","$880","$150","$750","$400","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5117","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","26","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850017","Health First Gold POS 80 5117","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9661",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850017-01","Standard Gold On Exchange Plan","80.77%",,"No","Yes","No","100%",,"$750","$40","$880","$150","$750","$400","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5117","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","26","27357","FL","Individual","No","59-3315064","27357FL1830025","Health First Bronze POS 70 1266","27357FL183",,"FLN001","FLS001","FLF005","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9578",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830025-01","Standard Bronze On Exchange Plan","61.95%",,"Yes","Yes","No","100%",,"$5,170","$0","$1,680","$150","$4,260","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","30%",,,,,"$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2016_sbc_1266","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","26","27357","FL","Individual","No","59-3315064","27357FL1830025","Health First Bronze POS 70 1266","27357FL183",,"FLN001","FLS001","FLF005","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9578",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830025-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.myHFHP.org/2016_sbc_1266_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","28","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850006","Health First Platinum POS 80 5038","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9717",,,,"5","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850006-01","Standard Platinum On Exchange Plan","89.09%",,"No","Yes","No","100%",,"$0","$540","$40","$150","$0","$400","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5038","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","28","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870006","Florida Hospital Platinum POS 80 5042","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9717",,,,"5","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870006-00","Standard Platinum Off Exchange Plan","89.09%",,"No","Yes","No","100%",,"$0","$540","$40","$150","$0","$400","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5042","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","28","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870006","Florida Hospital Platinum POS 80 5042","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9717",,,,"5","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870006-01","Standard Platinum On Exchange Plan","89.09%",,"No","Yes","No","100%",,"$0","$540","$40","$150","$0","$400","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5042","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","29","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840048","Health First Bronze HMO 50 5357","27357FL184",,"FLN003","FLS001","FLF006","Existing","HMO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9491",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840048-00","Standard Bronze Off Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$5,170","$100","$0","$150","$5,026","$140","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.myHFHP.org/2016_sbc_5357","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","29","27357","FL","Individual","No","59-3315064","27357FL1820002","Health First Gold HMO 90 1005","27357FL182",,"FLN001","FLS001","FLF002","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9696",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820002-00","Standard Gold Off Exchange Plan",,"0.789668560028076","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1005","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","29","27357","FL","Individual","No","59-3315064","27357FL1820002","Health First Gold HMO 90 1005","27357FL182",,"FLN001","FLS001","FLF002","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9696",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820002-01","Standard Gold On Exchange Plan",,"0.789668560028076","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1005","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","26","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870017","Florida Hospital Gold POS 80 5132","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9661",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870017-00","Standard Gold Off Exchange Plan","80.77%",,"No","Yes","No","100%",,"$750","$40","$880","$150","$750","$400","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5132","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","26","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870017","Florida Hospital Gold POS 80 5132","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9661",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870017-01","Standard Gold On Exchange Plan","80.77%",,"No","Yes","No","100%",,"$750","$40","$880","$150","$750","$400","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5132","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","26","27357","FL","Individual","No","59-3315064","27357FL1830025","Health First Bronze POS 70 1266","27357FL183",,"FLN001","FLS001","FLF005","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9578",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830025-03","Limited Cost Sharing Plan Variation","61.95%",,"Yes","Yes","No","100%",,"$5,170","$0","$1,680","$150","$4,260","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","30%",,,,,"$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2016_sbc_1266","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","26","27357","FL","Individual","No","59-3315064","27357FL1890013","Florida Hospital Bronze POS 70 1568","27357FL189",,"FLN002","FLS002","FLF014","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9578",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890013-00","Standard Bronze Off Exchange Plan","61.95%",,"Yes","Yes","No","100%",,"$5,170","$0","$1,680","$150","$4,260","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","30%",,,,,"$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2016_sbc_1568","http://www.myFHCA.org/FHMHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","26","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850012","Health First Gold POS 90 5080","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9672",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850012-00","Standard Gold Off Exchange Plan","80.63%",,"No","Yes","No","100%",,"$1,000","$60","$360","$150","$1,000","$600","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5080","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","29","27357","FL","Individual","No","59-3315064","27357FL1880005","Florida Hospital Gold HMO 90 1505","27357FL188",,"FLN002","FLS002","FLF011","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9696",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880005-01","Standard Gold On Exchange Plan",,"0.789668560028076","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1505","http://www.myFHCA.org/FHMHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","29","27357","FL","Individual","No","59-3315064","27357FL1880005","Florida Hospital Gold HMO 90 1505","27357FL188",,"FLN002","FLS002","FLF011","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9696",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.myFHCA.org/2016_sbc_1505_0","http://www.myFHCA.org/FHMHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","29","27357","FL","Individual","No","59-3315064","27357FL1880005","Florida Hospital Gold HMO 90 1505","27357FL188",,"FLN002","FLS002","FLF011","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9696",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880005-03","Limited Cost Sharing Plan Variation",,"0.789668560028076","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1505","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","30","27357","FL","Individual","No","59-3315064","27357FL1830002","Health First Gold POS 90 1006","27357FL183",,"FLN001","FLS001","FLF002","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9706",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830002-00","Standard Gold Off Exchange Plan",,"0.789668560028076","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1006","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","30","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850048","Health First Bronze POS 50 5358","27357FL185",,"FLN003","FLS001","FLF006","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9503",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850048-00","Standard Bronze Off Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$5,170","$100","$0","$150","$5,026","$140","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50%",,,,,"$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.myHFHP.org/2016_sbc_5358","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","30","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850048","Health First Bronze POS 50 5358","27357FL185",,"FLN003","FLS001","FLF006","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9503",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850048-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$5,170","$100","$0","$150","$5,026","$140","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50%",,,,,"$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.myHFHP.org/2016_sbc_5358","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","30","27357","FL","Individual","No","59-3315064","27357FL1830002","Health First Gold POS 90 1006","27357FL183",,"FLN001","FLS001","FLF002","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9706",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830002-01","Standard Gold On Exchange Plan",,"0.789668560028076","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1006","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","26","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850012","Health First Gold POS 90 5080","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9672",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850012-01","Standard Gold On Exchange Plan","80.63%",,"No","Yes","No","100%",,"$1,000","$60","$360","$150","$1,000","$600","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5080","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","26","27357","FL","Individual","No","59-3315064","27357FL1890013","Florida Hospital Bronze POS 70 1568","27357FL189",,"FLN002","FLS002","FLF014","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9578",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890013-01","Standard Bronze On Exchange Plan","61.95%",,"Yes","Yes","No","100%",,"$5,170","$0","$1,680","$150","$4,260","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","30%",,,,,"$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2016_sbc_1568","http://www.myFHCA.org/FHMHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","26","27357","FL","Individual","No","59-3315064","27357FL1890013","Florida Hospital Bronze POS 70 1568","27357FL189",,"FLN002","FLS002","FLF014","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9578",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890013-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.myFHCA.org/2016_sbc_1568_0","http://www.myFHCA.org/FHMHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","26","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870012","Florida Hospital Gold POS 90 5084","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9672",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870012-00","Standard Gold Off Exchange Plan","80.63%",,"No","Yes","No","100%",,"$1,000","$60","$360","$150","$1,000","$600","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5084","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","26","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870012","Florida Hospital Gold POS 90 5084","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9672",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870012-01","Standard Gold On Exchange Plan","80.63%",,"No","Yes","No","100%",,"$1,000","$60","$360","$150","$1,000","$600","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5084","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","26","27357","FL","Individual","No","59-3315064","27357FL1890013","Florida Hospital Bronze POS 70 1568","27357FL189",,"FLN002","FLS002","FLF014","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9578",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890013-03","Limited Cost Sharing Plan Variation","61.95%",,"Yes","Yes","No","100%",,"$5,170","$0","$1,680","$150","$4,260","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","30%",,,,,"$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2016_sbc_1568","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","27","27357","FL","Individual","No","59-3315064","27357FL1820026","Health First Catastrophic HMO 1268","27357FL182",,"FLN001","FLS001","FLF001","Existing","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9343",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820026-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$4,864","$105","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2016_sbc_1268","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","27","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840001","Health First Platinum HMO 100 5002","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9711",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840001-00","Standard Platinum Off Exchange Plan","91.95%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5002","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","27","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840001","Health First Platinum HMO 100 5002","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9711",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840001-01","Standard Platinum On Exchange Plan","91.95%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5002","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","27","27357","FL","Individual","No","59-3315064","27357FL1820026","Health First Catastrophic HMO 1268","27357FL182",,"FLN001","FLS001","FLF001","Existing","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9343",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820026-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$4,864","$105","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2016_sbc_1268","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","27","27357","FL","Individual","No","59-3315064","27357FL1880021","Florida Hospital Catastrophic HMO 1569","27357FL188",,"FLN002","FLS002","FLF010","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9343",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880021-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$4,864","$105","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2016_sbc_1569","http://www.myFHCA.org/FHMHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","27","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860001","Florida Hospital Platinum HMO 100 5006","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9711",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860001-00","Standard Platinum Off Exchange Plan","91.95%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5006","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","27","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860001","Florida Hospital Platinum HMO 100 5006","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9711",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860001-01","Standard Platinum On Exchange Plan","91.95%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5006","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","27","27357","FL","Individual","No","59-3315064","27357FL1880021","Florida Hospital Catastrophic HMO 1569","27357FL188",,"FLN002","FLS002","FLF010","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9343",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880021-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$4,864","$105","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2016_sbc_1569","http://www.myFHCA.org/FHMHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","27","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840006","Health First Platinum HMO 80 5037","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9704",,,,"5","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840006-00","Standard Platinum Off Exchange Plan","89.09%",,"No","Yes","No","100%",,"$0","$540","$40","$150","$0","$400","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5037","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","27","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840006","Health First Platinum HMO 80 5037","27357FL184",,"FLN003","FLS001","FLF009","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9704",,,,"5","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840006-01","Standard Platinum On Exchange Plan","89.09%",,"No","Yes","No","100%",,"$0","$540","$40","$150","$0","$400","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5037","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","27","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860006","Florida Hospital Platinum HMO 80 5041","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9704",,,,"5","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860006-00","Standard Platinum Off Exchange Plan","89.09%",,"No","Yes","No","100%",,"$0","$540","$40","$150","$0","$400","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5041","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","27","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860006","Florida Hospital Platinum HMO 80 5041","27357FL186",,"FLN004","FLS002","FLF018","Existing","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9704",,,,"5","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860006-01","Standard Platinum On Exchange Plan","89.09%",,"No","Yes","No","100%",,"$0","$540","$40","$150","$0","$400","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5041","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","28","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850001","Health First Platinum POS 100 5003","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9723",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850001-00","Standard Platinum Off Exchange Plan","91.95%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5003","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","28","27357","FL","Individual","No","59-3315064","27357FL1830026","Health First Catastrophic POS 1269","27357FL183",,"FLN001","FLS001","FLF001","Existing","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9358",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830026-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$4,864","$105","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2016_sbc_1269","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","28","27357","FL","Individual","No","59-3315064","27357FL1830026","Health First Catastrophic POS 1269","27357FL183",,"FLN001","FLS001","FLF001","Existing","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9358",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830026-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$4,864","$105","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2016_sbc_1269","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","28","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850001","Health First Platinum POS 100 5003","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9723",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850001-01","Standard Platinum On Exchange Plan","91.95%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5003","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","28","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870001","Florida Hospital Platinum POS 100 5007","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9723",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870001-00","Standard Platinum Off Exchange Plan","91.95%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5007","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","28","27357","FL","Individual","No","59-3315064","27357FL1890014","Florida Hospital Catastrophic POS 1570","27357FL189",,"FLN002","FLS002","FLF010","New","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9358",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890014-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$4,864","$105","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2016_sbc_1570","http://www.myFHCA.org/FHMHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","28","27357","FL","Individual","No","59-3315064","27357FL1890014","Florida Hospital Catastrophic POS 1570","27357FL189",,"FLN002","FLS002","FLF010","New","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9358",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890014-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$4,864","$105","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2016_sbc_1570","http://www.myFHCA.org/FHMHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","28","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870001","Florida Hospital Platinum POS 100 5007","27357FL187",,"FLN004","FLS002","FLF018","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9723",,,,"4","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870001-01","Standard Platinum On Exchange Plan","91.95%",,"No","Yes","No","100%",,"$0","$720","$0","$150","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myFHCA.org/2016_sbc_5007","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","28","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850006","Health First Platinum POS 80 5038","27357FL185",,"FLN003","FLS001","FLF009","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9717",,,,"5","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850006-00","Standard Platinum Off Exchange Plan","89.09%",,"No","Yes","No","100%",,"$0","$540","$40","$150","$0","$400","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5038","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","29","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840048","Health First Bronze HMO 50 5357","27357FL184",,"FLN003","FLS001","FLF006","Existing","HMO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9491",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840048-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$5,170","$100","$0","$150","$5,026","$140","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.myHFHP.org/2016_sbc_5357","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","29","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860048","Florida Hospital Bronze HMO 50 5361","27357FL186",,"FLN004","FLS002","FLF015","Existing","HMO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9491",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860048-00","Standard Bronze Off Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$5,170","$100","$0","$150","$5,026","$140","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.myFHCA.org/2016_sbc_5361","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","29","27357","FL","Individual","No","59-3315064","27357FL1820002","Health First Gold HMO 90 1005","27357FL182",,"FLN001","FLS001","FLF002","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9696",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.myHFHP.org/2016_sbc_1005_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","29","27357","FL","Individual","No","59-3315064","27357FL1820002","Health First Gold HMO 90 1005","27357FL182",,"FLN001","FLS001","FLF002","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9696",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820002-03","Limited Cost Sharing Plan Variation",,"0.789668560028076","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1005","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","29","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860048","Florida Hospital Bronze HMO 50 5361","27357FL186",,"FLN004","FLS002","FLF015","Existing","HMO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9491",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860048-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$5,170","$100","$0","$150","$5,026","$140","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.myFHCA.org/2016_sbc_5361","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","29","27357","FL","Individual","No","59-3315064","27357FL1880005","Florida Hospital Gold HMO 90 1505","27357FL188",,"FLN002","FLS002","FLF011","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9696",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880005-00","Standard Gold Off Exchange Plan",,"0.789668560028076","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1505","http://www.myFHCA.org/FHMHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","30","27357","FL","Individual","No","59-3315064","27357FL1830002","Health First Gold POS 90 1006","27357FL183",,"FLN001","FLS001","FLF002","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9706",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.myHFHP.org/2016_sbc_1006_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","30","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870048","Florida Hospital Bronze POS 50 5362","27357FL187",,"FLN004","FLS002","FLF015","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9503",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870048-00","Standard Bronze Off Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$5,170","$100","$0","$150","$5,026","$140","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50%",,,,,"$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.myFHCA.org/2016_sbc_5362","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","30","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870048","Florida Hospital Bronze POS 50 5362","27357FL187",,"FLN004","FLS002","FLF015","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9503",,,,"0","0","3","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870048-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$5,170","$100","$0","$150","$5,026","$140","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group","50%",,,,,"$10,600","$10600 per person","$21200 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.myFHCA.org/2016_sbc_5362","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","30","27357","FL","Individual","No","59-3315064","27357FL1830002","Health First Gold POS 90 1006","27357FL183",,"FLN001","FLS001","FLF002","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9706",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830002-03","Limited Cost Sharing Plan Variation",,"0.789668560028076","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1006","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","30","27357","FL","Individual","No","59-3315064","27357FL1890002","Florida Hospital Gold POS 90 1506","27357FL189",,"FLN002","FLS002","FLF011","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9706",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890002-00","Standard Gold Off Exchange Plan",,"0.789668560028076","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1506","http://www.myFHCA.org/FHMHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","30","27357","FL","Individual","No","59-3315064","27357FL1890002","Florida Hospital Gold POS 90 1506","27357FL189",,"FLN002","FLS002","FLF011","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9706",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890002-01","Standard Gold On Exchange Plan",,"0.789668560028076","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1506","http://www.myFHCA.org/FHMHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","30","27357","FL","Individual","No","59-3315064","27357FL1890002","Florida Hospital Gold POS 90 1506","27357FL189",,"FLN002","FLS002","FLF011","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9706",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.myFHCA.org/2016_sbc_1506_0","http://www.myFHCA.org/FHMHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","30","27357","FL","Individual","No","59-3315064","27357FL1890002","Florida Hospital Gold POS 90 1506","27357FL189",,"FLN002","FLS002","FLF011","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9706",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890002-03","Limited Cost Sharing Plan Variation",,"0.789668560028076","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1506","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","34","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850053","Health First Gold POS 90 5394","27357FL185",,"FLN003","FLS001","FLF002","New","POS","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9649",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850053-00","Standard Gold Off Exchange Plan",,"0.797690451145172","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5394","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","34","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850053","Health First Gold POS 90 5394","27357FL185",,"FLN003","FLS001","FLF002","New","POS","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9649",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850053-01","Standard Gold On Exchange Plan",,"0.797690451145172","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5394","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","31","27357","FL","Individual","No","59-3315064","27357FL1820016","Health First Silver HMO 80 1110","27357FL182",,"FLN001","FLS001","FLF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9644",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820016-00","Standard Silver Off Exchange Plan","68.73%","0.679944753646851","Yes","Yes","No","100%",,"$2,000","$0","$1,440","$150","$2,000","$0","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1110","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","31","27357","FL","Individual","No","59-3315064","27357FL1820016","Health First Silver HMO 80 1110","27357FL182",,"FLN001","FLS001","FLF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9644",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820016-01","Standard Silver On Exchange Plan","68.73%","0.679944753646851","Yes","Yes","No","100%",,"$2,000","$0","$1,440","$150","$2,000","$0","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1110","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","31","27357","FL","Individual","No","59-3315064","27357FL1820016","Health First Silver HMO 80 1110","27357FL182",,"FLN001","FLS001","FLF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9644",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820016-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.myHFHP.org/2016_sbc_1110_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","31","27357","FL","Individual","No","59-3315064","27357FL1820016","Health First Silver HMO 80 1110","27357FL182",,"FLN001","FLS001","FLF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9644",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820016-03","Limited Cost Sharing Plan Variation","68.73%","0.679944753646851","Yes","Yes","No","100%",,"$2,000","$0","$1,440","$150","$2,000","$0","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1110","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","31","27357","FL","Individual","No","59-3315064","27357FL1820016","Health First Silver HMO 80 1110","27357FL182",,"FLN001","FLS001","FLF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9644",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820016-04","73% AV Level Silver Plan","73.11%","0.725284814834595","Yes","Yes","No","100%",,"$2,000","$0","$1,440","$150","$2,000","$0","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1111","http://www.myHFHP.org/MHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","31","27357","FL","Individual","No","59-3315064","27357FL1820016","Health First Silver HMO 80 1110","27357FL182",,"FLN001","FLS001","FLF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9644",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820016-05","87% AV Level Silver Plan","87.24%","0.865987718105316","Yes","Yes","No","100%",,"$300","$0","$1,100","$150","$300","$0","$990","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2016_sbc_1112","http://www.myHFHP.org/MHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","31","27357","FL","Individual","No","59-3315064","27357FL1820016","Health First Silver HMO 80 1110","27357FL182",,"FLN001","FLS001","FLF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9644",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820016-06","94% AV Level Silver Plan","93.22%","0.930796325206757","Yes","Yes","No","100%",,"$0","$0","$880","$150","$0","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myHFHP.org/2016_sbc_1113","http://www.myHFHP.org/MHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","31","27357","FL","Individual","No","59-3315064","27357FL1880014","Florida Hospital Silver HMO 80 1542","27357FL188",,"FLN002","FLS002","FLF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9644",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880014-00","Standard Silver Off Exchange Plan","68.73%","0.679944753646851","Yes","Yes","No","100%",,"$2,000","$0","$1,440","$150","$2,000","$0","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1542","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","31","27357","FL","Individual","No","59-3315064","27357FL1880014","Florida Hospital Silver HMO 80 1542","27357FL188",,"FLN002","FLS002","FLF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9644",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880014-01","Standard Silver On Exchange Plan","68.73%","0.679944753646851","Yes","Yes","No","100%",,"$2,000","$0","$1,440","$150","$2,000","$0","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1542","http://www.myFHCA.org/FHMHI_2016","12"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","31","27357","FL","Individual","No","59-3315064","27357FL1880014","Florida Hospital Silver HMO 80 1542","27357FL188",,"FLN002","FLS002","FLF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9644",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880014-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.myFHCA.org/2016_sbc_1542_0","http://www.myFHCA.org/FHMHI_2016","13"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","31","27357","FL","Individual","No","59-3315064","27357FL1880014","Florida Hospital Silver HMO 80 1542","27357FL188",,"FLN002","FLS002","FLF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9644",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880014-03","Limited Cost Sharing Plan Variation","68.73%","0.679944753646851","Yes","Yes","No","100%",,"$2,000","$0","$1,440","$150","$2,000","$0","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1542","http://www.myFHCA.org/FHMHI_2016","14"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","31","27357","FL","Individual","No","59-3315064","27357FL1880014","Florida Hospital Silver HMO 80 1542","27357FL188",,"FLN002","FLS002","FLF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9644",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880014-04","73% AV Level Silver Plan","73.11%","0.725284814834595","Yes","Yes","No","100%",,"$2,000","$0","$1,440","$150","$2,000","$0","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1543","http://www.myFHCA.org/FHMHI_2016","15"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","31","27357","FL","Individual","No","59-3315064","27357FL1880014","Florida Hospital Silver HMO 80 1542","27357FL188",,"FLN002","FLS002","FLF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9644",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880014-05","87% AV Level Silver Plan","87.24%","0.865987718105316","Yes","Yes","No","100%",,"$300","$0","$1,100","$150","$300","$0","$990","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2016_sbc_1544","http://www.myFHCA.org/FHMHI_2016","16"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","31","27357","FL","Individual","No","59-3315064","27357FL1880014","Florida Hospital Silver HMO 80 1542","27357FL188",,"FLN002","FLS002","FLF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9644",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880014-06","94% AV Level Silver Plan","93.22%","0.930796325206757","Yes","Yes","No","100%",,"$0","$0","$880","$150","$0","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.myFHCA.org/2016_sbc_1545","http://www.myFHCA.org/FHMHI_2016","17"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","32","27357","FL","Individual","No","59-3315064","27357FL1820022","Health First Bronze HMO 100 1251","27357FL182",,"FLN001","FLS001","FLF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9572",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820022-00","Standard Bronze Off Exchange Plan",,"0.616010546684265","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1251","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","32","27357","FL","Individual","No","59-3315064","27357FL1820022","Health First Bronze HMO 100 1251","27357FL182",,"FLN001","FLS001","FLF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9572",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820022-01","Standard Bronze On Exchange Plan",,"0.616010546684265","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1251","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","32","27357","FL","Individual","No","59-3315064","27357FL1820022","Health First Bronze HMO 100 1251","27357FL182",,"FLN001","FLS001","FLF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9572",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820022-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.myHFHP.org/2016_sbc_1251_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","32","27357","FL","Individual","No","59-3315064","27357FL1820022","Health First Bronze HMO 100 1251","27357FL182",,"FLN001","FLS001","FLF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9572",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820022-03","Limited Cost Sharing Plan Variation",,"0.616010546684265","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1251","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","32","27357","FL","Individual","No","59-3315064","27357FL1880017","Florida Hospital Bronze HMO 100 1562","27357FL188",,"FLN002","FLS002","FLF010","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9572",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880017-00","Standard Bronze Off Exchange Plan",,"0.616010546684265","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1562","http://www.myFHCA.org/FHMHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","32","27357","FL","Individual","No","59-3315064","27357FL1880017","Florida Hospital Bronze HMO 100 1562","27357FL188",,"FLN002","FLS002","FLF010","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9572",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880017-01","Standard Bronze On Exchange Plan",,"0.616010546684265","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1562","http://www.myFHCA.org/FHMHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","32","27357","FL","Individual","No","59-3315064","27357FL1880017","Florida Hospital Bronze HMO 100 1562","27357FL188",,"FLN002","FLS002","FLF010","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9572",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.myFHCA.org/2016_sbc_1562_0","http://www.myFHCA.org/FHMHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","32","27357","FL","Individual","No","59-3315064","27357FL1880017","Florida Hospital Bronze HMO 100 1562","27357FL188",,"FLN002","FLS002","FLF010","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9572",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880017-03","Limited Cost Sharing Plan Variation",,"0.616010546684265","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1562","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","33","27357","FL","Individual","No","59-3315064","27357FL1830022","Health First Bronze POS 100 1252","27357FL183",,"FLN001","FLS001","FLF001","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9583",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830022-00","Standard Bronze Off Exchange Plan",,"0.616010546684265","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"$12,000","per person not applicable","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1252","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","33","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840053","Health First Gold HMO 90 5393","27357FL184",,"FLN003","FLS001","FLF002","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9637",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840053-00","Standard Gold Off Exchange Plan",,"0.797690451145172","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5393","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","33","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840053","Health First Gold HMO 90 5393","27357FL184",,"FLN003","FLS001","FLF002","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9637",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840053-01","Standard Gold On Exchange Plan",,"0.797690451145172","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5393","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","33","27357","FL","Individual","No","59-3315064","27357FL1830022","Health First Bronze POS 100 1252","27357FL183",,"FLN001","FLS001","FLF001","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9583",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830022-01","Standard Bronze On Exchange Plan",,"0.616010546684265","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"$12,000","per person not applicable","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1252","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","33","27357","FL","Individual","No","59-3315064","27357FL1830022","Health First Bronze POS 100 1252","27357FL183",,"FLN001","FLS001","FLF001","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9583",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830022-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.myHFHP.org/2016_sbc_1252_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","33","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860053","Florida Hospital Gold HMO 90 5395","27357FL186",,"FLN004","FLS002","FLF011","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9637",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860053-00","Standard Gold Off Exchange Plan",,"0.797690451145172","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5395","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","33","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860053","Florida Hospital Gold HMO 90 5395","27357FL186",,"FLN004","FLS002","FLF011","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9637",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860053-01","Standard Gold On Exchange Plan",,"0.797690451145172","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5395","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","33","27357","FL","Individual","No","59-3315064","27357FL1830022","Health First Bronze POS 100 1252","27357FL183",,"FLN001","FLS001","FLF001","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9583",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830022-03","Limited Cost Sharing Plan Variation",,"0.616010546684265","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"$12,000","per person not applicable","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1252","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","33","27357","FL","Individual","No","59-3315064","27357FL1890011","Florida Hospital Bronze POS 100 1563","27357FL189",,"FLN002","FLS002","FLF010","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9583",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890011-00","Standard Bronze Off Exchange Plan",,"0.616010546684265","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"$12,000","per person not applicable","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1563","http://www.myFHCA.org/FHMHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","33","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840054","Health First Gold HMO 90 5397","27357FL184",,"FLN003","FLS001","FLF002","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9631",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840054-00","Standard Gold Off Exchange Plan",,"0.785896837711334","Yes","Yes","No","100%",,"$1,750","$0","$690","$150","$1,750","$0","$350","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5397","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","33","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840054","Health First Gold HMO 90 5397","27357FL184",,"FLN003","FLS001","FLF002","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9631",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840054-01","Standard Gold On Exchange Plan",,"0.785896837711334","Yes","Yes","No","100%",,"$1,750","$0","$690","$150","$1,750","$0","$350","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5397","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","33","27357","FL","Individual","No","59-3315064","27357FL1890011","Florida Hospital Bronze POS 100 1563","27357FL189",,"FLN002","FLS002","FLF010","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9583",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890011-01","Standard Bronze On Exchange Plan",,"0.616010546684265","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"$12,000","per person not applicable","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1563","http://www.myFHCA.org/FHMHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","38","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870052","Florida Hospital Bronze POS 100 5390","27357FL187",,"FLN004","FLS002","FLF010","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9492",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870052-00","Standard Bronze Off Exchange Plan",,"0.616010546684265","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"$12,000","per person not applicable","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5390","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","38","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870052","Florida Hospital Bronze POS 100 5390","27357FL187",,"FLN004","FLS002","FLF010","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9492",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870052-01","Standard Bronze On Exchange Plan",,"0.616010546684265","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"$12,000","per person not applicable","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5390","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","39","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840047","Health First Bronze HMO 70 5350","27357FL184",,"FLN003","FLS001","FLF005","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9481",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840047-00","Standard Bronze Off Exchange Plan",,"0.614593505859375","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$4,500","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5350","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","39","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840047","Health First Bronze HMO 70 5350","27357FL184",,"FLN003","FLS001","FLF005","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9481",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840047-01","Standard Bronze On Exchange Plan",,"0.614593505859375","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$4,500","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5350","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","39","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860047","Florida Hospital Bronze HMO 70 5354","27357FL186",,"FLN004","FLS002","FLF014","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9481",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860047-00","Standard Bronze Off Exchange Plan",,"0.614593505859375","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$4,500","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5354","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","39","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860047","Florida Hospital Bronze HMO 70 5354","27357FL186",,"FLN004","FLS002","FLF014","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9481",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860047-01","Standard Bronze On Exchange Plan",,"0.614593505859375","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$4,500","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5354","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","39","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840042","Health First Silver HMO 90 5307","27357FL184",,"FLN003","FLS001","FLF002","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9574",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840042-00","Standard Silver Off Exchange Plan",,"0.70807820558548","Yes","Yes","No","100%",,"$2,500","$0","$770","$150","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5307","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","39","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840042","Health First Silver HMO 90 5307","27357FL184",,"FLN003","FLS001","FLF002","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9574",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840042-01","Standard Silver On Exchange Plan",,"0.70807820558548","Yes","Yes","No","100%",,"$2,500","$0","$770","$150","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5307","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","33","27357","FL","Individual","No","59-3315064","27357FL1890011","Florida Hospital Bronze POS 100 1563","27357FL189",,"FLN002","FLS002","FLF010","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9583",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.myFHCA.org/2016_sbc_1563_0","http://www.myFHCA.org/FHMHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","33","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860054","Florida Hospital Gold HMO 90 5399","27357FL186",,"FLN004","FLS002","FLF011","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9631",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860054-00","Standard Gold Off Exchange Plan",,"0.785896837711334","Yes","Yes","No","100%",,"$1,750","$0","$690","$150","$1,750","$0","$350","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5399","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","33","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860054","Florida Hospital Gold HMO 90 5399","27357FL186",,"FLN004","FLS002","FLF011","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9631",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860054-01","Standard Gold On Exchange Plan",,"0.785896837711334","Yes","Yes","No","100%",,"$1,750","$0","$690","$150","$1,750","$0","$350","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5399","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","33","27357","FL","Individual","No","59-3315064","27357FL1890011","Florida Hospital Bronze POS 100 1563","27357FL189",,"FLN002","FLS002","FLF010","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9583",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890011-03","Limited Cost Sharing Plan Variation",,"0.616010546684265","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"$12,000","per person not applicable","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1563","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","34","27357","FL","Individual","No","59-3315064","27357FL1820024","Health First Bronze HMO 70 1261","27357FL182",,"FLN001","FLS001","FLF005","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9573",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820024-00","Standard Bronze Off Exchange Plan",,"0.614593505859375","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$4,500","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1261","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","34","27357","FL","Individual","No","59-3315064","27357FL1820024","Health First Bronze HMO 70 1261","27357FL182",,"FLN001","FLS001","FLF005","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9573",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820024-01","Standard Bronze On Exchange Plan",,"0.614593505859375","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$4,500","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1261","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","34","27357","FL","Individual","No","59-3315064","27357FL1820024","Health First Bronze HMO 70 1261","27357FL182",,"FLN001","FLS001","FLF005","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9573",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820024-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.myHFHP.org/2016_sbc_1261_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","34","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870053","Florida Hospital Gold POS 90 5396","27357FL187",,"FLN004","FLS002","FLF011","New","POS","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9649",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870053-00","Standard Gold Off Exchange Plan",,"0.797690451145172","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5396","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","34","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870053","Florida Hospital Gold POS 90 5396","27357FL187",,"FLN004","FLS002","FLF011","New","POS","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9649",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870053-01","Standard Gold On Exchange Plan",,"0.797690451145172","Yes","Yes","No","100%",,"$1,500","$0","$670","$150","$1,500","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5396","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","34","27357","FL","Individual","No","59-3315064","27357FL1820024","Health First Bronze HMO 70 1261","27357FL182",,"FLN001","FLS001","FLF005","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9573",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1820024-03","Limited Cost Sharing Plan Variation",,"0.614593505859375","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$4,500","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1261","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","34","27357","FL","Individual","No","59-3315064","27357FL1880019","Florida Hospital Bronze HMO 70 1565","27357FL188",,"FLN002","FLS002","FLF014","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9573",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880019-00","Standard Bronze Off Exchange Plan",,"0.614593505859375","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$4,500","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1565","http://www.myFHCA.org/FHMHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","34","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850054","Health First Gold POS 90 5398","27357FL185",,"FLN003","FLS001","FLF002","New","POS","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9643",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850054-00","Standard Gold Off Exchange Plan",,"0.785896837711334","Yes","Yes","No","100%",,"$1,750","$0","$690","$150","$1,750","$0","$350","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","10%",,,,,"$3,500","per person not applicable","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5398","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","34","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850054","Health First Gold POS 90 5398","27357FL185",,"FLN003","FLS001","FLF002","New","POS","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9643",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850054-01","Standard Gold On Exchange Plan",,"0.785896837711334","Yes","Yes","No","100%",,"$1,750","$0","$690","$150","$1,750","$0","$350","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","10%",,,,,"$3,500","per person not applicable","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5398","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","34","27357","FL","Individual","No","59-3315064","27357FL1880019","Florida Hospital Bronze HMO 70 1565","27357FL188",,"FLN002","FLS002","FLF014","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9573",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880019-01","Standard Bronze On Exchange Plan",,"0.614593505859375","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$4,500","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1565","http://www.myFHCA.org/FHMHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","34","27357","FL","Individual","No","59-3315064","27357FL1880019","Florida Hospital Bronze HMO 70 1565","27357FL188",,"FLN002","FLS002","FLF014","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9573",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.myFHCA.org/2016_sbc_1565_0","http://www.myFHCA.org/FHMHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","34","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870054","Florida Hospital Gold POS 90 5400","27357FL187",,"FLN004","FLS002","FLF011","New","POS","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9643",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870054-00","Standard Gold Off Exchange Plan",,"0.785896837711334","Yes","Yes","No","100%",,"$1,750","$0","$690","$150","$1,750","$0","$350","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","10%",,,,,"$3,500","per person not applicable","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5400","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","34","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870054","Florida Hospital Gold POS 90 5400","27357FL187",,"FLN004","FLS002","FLF011","New","POS","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9643",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870054-01","Standard Gold On Exchange Plan",,"0.785896837711334","Yes","Yes","No","100%",,"$1,750","$0","$690","$150","$1,750","$0","$350","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","10%",,,,,"$3,500","per person not applicable","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5400","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","34","27357","FL","Individual","No","59-3315064","27357FL1880019","Florida Hospital Bronze HMO 70 1565","27357FL188",,"FLN002","FLS002","FLF014","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9573",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1880019-03","Limited Cost Sharing Plan Variation",,"0.614593505859375","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$4,500","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1565","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","35","27357","FL","Individual","No","59-3315064","27357FL1830024","Health First Bronze POS 70 1262","27357FL183",,"FLN001","FLS001","FLF005","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9584",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830024-00","Standard Bronze Off Exchange Plan",,"0.614593505859375","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$4,500","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"$9,000","per person not applicable","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1262","http://www.myHFHP.org/MHI_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","35","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840055","Health First Silver HMO 100 5401","27357FL184",,"FLN003","FLS001","FLF001","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9568",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840055-00","Standard Silver Off Exchange Plan",,"0.710606753826141","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5401","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","35","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840055","Health First Silver HMO 100 5401","27357FL184",,"FLN003","FLS001","FLF001","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9568",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840055-01","Standard Silver On Exchange Plan",,"0.710606753826141","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5401","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","35","27357","FL","Individual","No","59-3315064","27357FL1830024","Health First Bronze POS 70 1262","27357FL183",,"FLN001","FLS001","FLF005","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9584",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830024-01","Standard Bronze On Exchange Plan",,"0.614593505859375","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$4,500","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"$9,000","per person not applicable","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1262","http://www.myHFHP.org/MHI_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","35","27357","FL","Individual","No","59-3315064","27357FL1830024","Health First Bronze POS 70 1262","27357FL183",,"FLN001","FLS001","FLF005","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9584",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830024-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.myHFHP.org/2016_sbc_1262_0","http://www.myHFHP.org/MHI_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","35","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860055","Florida Hospital Silver HMO 100 5403","27357FL186",,"FLN004","FLS002","FLF010","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9568",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860055-00","Standard Silver Off Exchange Plan",,"0.710606753826141","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5403","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","35","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860055","Florida Hospital Silver HMO 100 5403","27357FL186",,"FLN004","FLS002","FLF010","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9568",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860055-01","Standard Silver On Exchange Plan",,"0.710606753826141","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5403","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","35","27357","FL","Individual","No","59-3315064","27357FL1830024","Health First Bronze POS 70 1262","27357FL183",,"FLN001","FLS001","FLF005","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9584",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayHFHP.Health-First.org","http://www.myHFHP.org/MP_formulary_2016","27357FL1830024-03","Limited Cost Sharing Plan Variation",,"0.614593505859375","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$4,500","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"$9,000","per person not applicable","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myHFHP.org/2016_sbc_1262","http://www.myHFHP.org/MHI_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","35","27357","FL","Individual","No","59-3315064","27357FL1890012","Florida Hospital Bronze POS 70 1566","27357FL189",,"FLN002","FLS002","FLF014","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9584",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890012-00","Standard Bronze Off Exchange Plan",,"0.614593505859375","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$4,500","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"$9,000","per person not applicable","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1566","http://www.myFHCA.org/FHMHI_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","35","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840056","Health First Bronze HMO 80 5405","27357FL184",,"FLN003","FLS001","FLF004","New","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.948",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840056-00","Standard Bronze Off Exchange Plan",,"0.612584233283997","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5405","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","35","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840056","Health First Bronze HMO 80 5405","27357FL184",,"FLN003","FLS001","FLF004","New","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.948",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840056-01","Standard Bronze On Exchange Plan",,"0.612584233283997","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5405","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","35","27357","FL","Individual","No","59-3315064","27357FL1890012","Florida Hospital Bronze POS 70 1566","27357FL189",,"FLN002","FLS002","FLF014","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9584",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890012-01","Standard Bronze On Exchange Plan",,"0.614593505859375","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$4,500","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"$9,000","per person not applicable","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1566","http://www.myFHCA.org/FHMHI_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","35","27357","FL","Individual","No","59-3315064","27357FL1890012","Florida Hospital Bronze POS 70 1566","27357FL189",,"FLN002","FLS002","FLF014","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9584",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.myFHCA.org/2016_sbc_1566_0","http://www.myFHCA.org/FHMHI_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","35","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860056","Florida Hospital Bronze HMO 80 5407","27357FL186",,"FLN004","FLS002","FLF013","New","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.948",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860056-00","Standard Bronze Off Exchange Plan",,"0.612584233283997","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5407","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","35","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860056","Florida Hospital Bronze HMO 80 5407","27357FL186",,"FLN004","FLS002","FLF013","New","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.948",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860056-01","Standard Bronze On Exchange Plan",,"0.612584233283997","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5407","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","35","27357","FL","Individual","No","59-3315064","27357FL1890012","Florida Hospital Bronze POS 70 1566","27357FL189",,"FLN002","FLS002","FLF014","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9584",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No","https://PayFHCA.Health-First.org","http://www.myFHCA.org/FHMP_formulary_2016","27357FL1890012-03","Limited Cost Sharing Plan Variation",,"0.614593505859375","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$4,500","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"$9,000","per person not applicable","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.myFHCA.org/2016_sbc_1566","http://www.myFHCA.org/FHMHI_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","36","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850055","Health First Silver POS 100 5402","27357FL185",,"FLN003","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9579",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850055-00","Standard Silver Off Exchange Plan",,"0.710606753826141","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$7000 per group","0%",,,,,"$7,000","per person not applicable","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5402","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","36","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850055","Health First Silver POS 100 5402","27357FL185",,"FLN003","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9579",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850055-01","Standard Silver On Exchange Plan",,"0.710606753826141","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$7000 per group","0%",,,,,"$7,000","per person not applicable","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5402","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","36","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870055","Florida Hospital Silver POS 100 5404","27357FL187",,"FLN004","FLS002","FLF010","New","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9579",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870055-00","Standard Silver Off Exchange Plan",,"0.710606753826141","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$7000 per group","0%",,,,,"$7,000","per person not applicable","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5404","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","36","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870055","Florida Hospital Silver POS 100 5404","27357FL187",,"FLN004","FLS002","FLF010","New","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9579",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870055-01","Standard Silver On Exchange Plan",,"0.710606753826141","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$7000 per group","0%",,,,,"$7,000","per person not applicable","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5404","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","36","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850056","Health First Bronze POS 80 5406","27357FL185",,"FLN003","FLS001","FLF004","New","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9492",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850056-00","Standard Bronze Off Exchange Plan",,"0.612584233283997","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5406","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","36","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850056","Health First Bronze POS 80 5406","27357FL185",,"FLN003","FLS001","FLF004","New","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9492",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850056-01","Standard Bronze On Exchange Plan",,"0.612584233283997","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5406","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","36","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870056","Florida Hospital Bronze POS 80 5408","27357FL187",,"FLN004","FLS002","FLF013","New","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9492",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870056-00","Standard Bronze Off Exchange Plan",,"0.612584233283997","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5408","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","36","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870056","Florida Hospital Bronze POS 80 5408","27357FL187",,"FLN004","FLS002","FLF013","New","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9492",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870056-01","Standard Bronze On Exchange Plan",,"0.612584233283997","Yes","Yes","No","100%",,"$5,000","$0","$1,500","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5408","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","37","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840051","Health First Bronze HMO 90 5378","27357FL184",,"FLN003","FLS001","FLF002","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9476",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840051-00","Standard Bronze Off Exchange Plan",,"0.609389364719391","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","per person not applicable","$11000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5378","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","37","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840051","Health First Bronze HMO 90 5378","27357FL184",,"FLN003","FLS001","FLF002","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9476",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840051-01","Standard Bronze On Exchange Plan",,"0.609389364719391","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","per person not applicable","$11000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5378","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","37","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860051","Florida Hospital Bronze HMO 90 5382","27357FL186",,"FLN004","FLS002","FLF011","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9476",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860051-00","Standard Bronze Off Exchange Plan",,"0.609389364719391","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","per person not applicable","$11000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5382","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","37","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860051","Florida Hospital Bronze HMO 90 5382","27357FL186",,"FLN004","FLS002","FLF011","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9476",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860051-01","Standard Bronze On Exchange Plan",,"0.609389364719391","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","per person not applicable","$11000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5382","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","37","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840052","Health First Bronze HMO 100 5385","27357FL184",,"FLN003","FLS001","FLF001","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.948",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840052-00","Standard Bronze Off Exchange Plan",,"0.616010546684265","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5385","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","37","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840052","Health First Bronze HMO 100 5385","27357FL184",,"FLN003","FLS001","FLF001","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.948",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840052-01","Standard Bronze On Exchange Plan",,"0.616010546684265","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5385","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","37","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860052","Florida Hospital Bronze HMO 100 5389","27357FL186",,"FLN004","FLS002","FLF010","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.948",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860052-00","Standard Bronze Off Exchange Plan",,"0.616010546684265","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5389","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","37","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860052","Florida Hospital Bronze HMO 100 5389","27357FL186",,"FLN004","FLS002","FLF010","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.948",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860052-01","Standard Bronze On Exchange Plan",,"0.616010546684265","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5389","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","38","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850051","Health First Bronze POS 90 5379","27357FL185",,"FLN003","FLS001","FLF002","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9489",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850051-00","Standard Bronze Off Exchange Plan",,"0.609389364719391","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","per person not applicable","$11000 per group","10%",,,,,"$11,000","per person not applicable","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5379","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","38","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850051","Health First Bronze POS 90 5379","27357FL185",,"FLN003","FLS001","FLF002","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9489",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850051-01","Standard Bronze On Exchange Plan",,"0.609389364719391","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","per person not applicable","$11000 per group","10%",,,,,"$11,000","per person not applicable","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5379","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","38","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870051","Florida Hospital Bronze POS 90 5383","27357FL187",,"FLN004","FLS002","FLF011","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9489",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870051-00","Standard Bronze Off Exchange Plan",,"0.609389364719391","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","per person not applicable","$11000 per group","10%",,,,,"$11,000","per person not applicable","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5383","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","38","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870051","Florida Hospital Bronze POS 90 5383","27357FL187",,"FLN004","FLS002","FLF011","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9489",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870051-01","Standard Bronze On Exchange Plan",,"0.609389364719391","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","per person not applicable","$11000 per group","10%",,,,,"$11,000","per person not applicable","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5383","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","38","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850052","Health First Bronze POS 100 5386","27357FL185",,"FLN003","FLS001","FLF001","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9492",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850052-00","Standard Bronze Off Exchange Plan",,"0.616010546684265","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"$12,000","per person not applicable","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5386","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","38","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850052","Health First Bronze POS 100 5386","27357FL185",,"FLN003","FLS001","FLF001","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9492",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850052-01","Standard Bronze On Exchange Plan",,"0.616010546684265","Yes","Yes","No","100%",,"$5,170","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"$12,000","per person not applicable","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5386","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","39","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860042","Florida Hospital Silver HMO 90 5313","27357FL186",,"FLN004","FLS002","FLF011","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9574",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860042-00","Standard Silver Off Exchange Plan",,"0.70807820558548","Yes","Yes","No","100%",,"$2,500","$0","$770","$150","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5313","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","39","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860042","Florida Hospital Silver HMO 90 5313","27357FL186",,"FLN004","FLS002","FLF011","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9574",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860042-01","Standard Silver On Exchange Plan",,"0.70807820558548","Yes","Yes","No","100%",,"$2,500","$0","$770","$150","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5313","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","1","30252","FL","Individual","No","59-2403696","30252FL0020070","BlueCare Everyday Health 1477","30252FL002","7346243208","FLN001","FLS001","FLF007","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020070-05","87% AV Level Silver Plan",,"0.878278017044067","Yes","Yes","No","100%",,"$0","$50","$1,100","$200","$0","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1477B.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1477B.pdf","9"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","1","30252","FL","Individual","No","59-2403696","30252FL0020070","BlueCare Everyday Health 1477","30252FL002","7346243208","FLN001","FLS001","FLF007","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020070-06","94% AV Level Silver Plan",,"0.936994969844818","Yes","Yes","No","100%",,"$0","$10","$900","$200","$0","$60","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1477C.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1477C.pdf","10"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","1","30252","FL","Individual","No","59-2403696","30252FL0070007","MyBlue Silver 1604","30252FL007","7346243208","FLN002","FLS002","FLF005","New","HMO","Silver","Yes","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070007-00","Standard Silver Off Exchange Plan","68.32%","0.683159530162811","Yes","Yes","No","100%",,"$6,100","$90","$0","$200","$600","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1604.pdf","https://www.floridablue.com/es/plans/myblue?type=silver4","11"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","1","30252","FL","Individual","No","59-2403696","30252FL0070007","MyBlue Silver 1604","30252FL007","7346243208","FLN002","FLS002","FLF005","New","HMO","Silver","Yes","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070007-01","Standard Silver On Exchange Plan","68.32%","0.683159530162811","Yes","Yes","No","100%",,"$6,100","$90","$0","$200","$600","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1604.pdf","https://www.floridablue.com/es/plans/myblue?type=silver4","12"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","1","30252","FL","Individual","No","59-2403696","30252FL0070007","MyBlue Silver 1604","30252FL007","7346243208","FLN002","FLS002","FLF005","New","HMO","Silver","Yes","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1604U.pdf","https://www.floridablue.com/es/plans/myblue?type=U","13"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","1","30252","FL","Individual","No","59-2403696","30252FL0070007","MyBlue Silver 1604","30252FL007","7346243208","FLN002","FLS002","FLF005","New","HMO","Silver","Yes","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070007-03","Limited Cost Sharing Plan Variation","68.32%","0.683159530162811","Yes","Yes","No","100%",,"$6,100","$90","$0","$200","$600","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1604O.pdf","https://www.floridablue.com/es/plans/myblue?type=silver4","14"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","1","30252","FL","Individual","No","59-2403696","30252FL0070007","MyBlue Silver 1604","30252FL007","7346243208","FLN002","FLS002","FLF005","New","HMO","Silver","Yes","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070007-04","73% AV Level Silver Plan","73.79%","0.737902998924255","Yes","Yes","No","100%",,"$3,600","$200","$0","$200","$0","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1604A.pdf","https://www.floridablue.com/es/plans/myblue?type=silver4a","15"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","40","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850047","Health First Bronze POS 70 5351","27357FL185",,"FLN003","FLS001","FLF005","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9494",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850047-00","Standard Bronze Off Exchange Plan",,"0.614593505859375","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$4,500","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"$9,000","per person not applicable","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5351","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","40","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850047","Health First Bronze POS 70 5351","27357FL185",,"FLN003","FLS001","FLF005","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9494",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850047-01","Standard Bronze On Exchange Plan",,"0.614593505859375","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$4,500","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"$9,000","per person not applicable","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5351","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","40","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870047","Florida Hospital Bronze POS 70 5355","27357FL187",,"FLN004","FLS002","FLF014","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9494",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870047-00","Standard Bronze Off Exchange Plan",,"0.614593505859375","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$4,500","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"$9,000","per person not applicable","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5355","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","40","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870047","Florida Hospital Bronze POS 70 5355","27357FL187",,"FLN004","FLS002","FLF014","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9494",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870047-01","Standard Bronze On Exchange Plan",,"0.614593505859375","Yes","Yes","No","100%",,"$4,500","$0","$2,000","$150","$4,500","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"$9,000","per person not applicable","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5355","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","40","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850042","Health First Silver POS 90 5308","27357FL185",,"FLN003","FLS001","FLF002","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9584",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850042-00","Standard Silver Off Exchange Plan",,"0.70807820558548","Yes","Yes","No","100%",,"$2,500","$0","$770","$150","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5308","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","40","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850042","Health First Silver POS 90 5308","27357FL185",,"FLN003","FLS001","FLF002","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9584",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850042-01","Standard Silver On Exchange Plan",,"0.70807820558548","Yes","Yes","No","100%",,"$2,500","$0","$770","$150","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5308","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","40","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870042","Florida Hospital Silver POS 90 5314","27357FL187",,"FLN004","FLS002","FLF011","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9584",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870042-00","Standard Silver Off Exchange Plan",,"0.70807820558548","Yes","Yes","No","100%",,"$2,500","$0","$770","$150","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5314","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","40","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870042","Florida Hospital Silver POS 90 5314","27357FL187",,"FLN004","FLS002","FLF011","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9584",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870042-01","Standard Silver On Exchange Plan",,"0.70807820558548","Yes","Yes","No","100%",,"$2,500","$0","$770","$150","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5314","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","41","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840036","Health First Silver HMO 90 5257","27357FL184",,"FLN003","FLS001","FLF002","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9555",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840036-00","Standard Silver Off Exchange Plan","68.79%","0.678093731403351","Yes","Yes","No","100%",,"$3,000","$0","$820","$150","$3,000","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5257","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","41","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840036","Health First Silver HMO 90 5257","27357FL184",,"FLN003","FLS001","FLF002","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9555",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840036-01","Standard Silver On Exchange Plan","68.79%","0.678093731403351","Yes","Yes","No","100%",,"$3,000","$0","$820","$150","$3,000","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5257","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","41","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860036","Florida Hospital Silver HMO 90 5261","27357FL186",,"FLN004","FLS002","FLF011","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9555",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860036-00","Standard Silver Off Exchange Plan","68.79%","0.678093731403351","Yes","Yes","No","100%",,"$3,000","$0","$820","$150","$3,000","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5261","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","41","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860036","Florida Hospital Silver HMO 90 5261","27357FL186",,"FLN004","FLS002","FLF011","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9555",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860036-01","Standard Silver On Exchange Plan","68.79%","0.678093731403351","Yes","Yes","No","100%",,"$3,000","$0","$820","$150","$3,000","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5261","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","41","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840038","Health First Silver HMO 70 5271","27357FL184",,"FLN003","FLS001","FLF005","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9571",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840038-00","Standard Silver Off Exchange Plan",,"0.714829087257385","Yes","Yes","No","100%",,"$2,000","$0","$2,160","$150","$2,000","$0","$980","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5271","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","41","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1840038","Health First Silver HMO 70 5271","27357FL184",,"FLN003","FLS001","FLF005","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9571",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1840038-01","Standard Silver On Exchange Plan",,"0.714829087257385","Yes","Yes","No","100%",,"$2,000","$0","$2,160","$150","$2,000","$0","$980","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5271","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","41","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860038","Florida Hospital Silver HMO 70 5277","27357FL186",,"FLN004","FLS002","FLF014","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9571",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860038-00","Standard Silver Off Exchange Plan",,"0.714829087257385","Yes","Yes","No","100%",,"$2,000","$0","$2,160","$150","$2,000","$0","$980","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5277","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","41","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1860038","Florida Hospital Silver HMO 70 5277","27357FL186",,"FLN004","FLS002","FLF014","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9571",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","Emergency & Urgent Care Only","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1860038-01","Standard Silver On Exchange Plan",,"0.714829087257385","Yes","Yes","No","100%",,"$2,000","$0","$2,160","$150","$2,000","$0","$980","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5277","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","42","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850036","Health First Silver POS 90 5258","27357FL185",,"FLN003","FLS001","FLF002","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9566",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850036-00","Standard Silver Off Exchange Plan","68.79%","0.678093731403351","Yes","Yes","No","100%",,"$3,000","$0","$820","$150","$3,000","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5258","http://www.myHFHP.org/MHS_2016","4"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","42","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850036","Health First Silver POS 90 5258","27357FL185",,"FLN003","FLS001","FLF002","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9566",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850036-01","Standard Silver On Exchange Plan","68.79%","0.678093731403351","Yes","Yes","No","100%",,"$3,000","$0","$820","$150","$3,000","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5258","http://www.myHFHP.org/MHS_2016","5"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","42","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870036","Florida Hospital Silver POS 90 5262","27357FL187",,"FLN004","FLS002","FLF011","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9566",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870036-00","Standard Silver Off Exchange Plan","68.79%","0.678093731403351","Yes","Yes","No","100%",,"$3,000","$0","$820","$150","$3,000","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5262","http://www.myFHCA.org/FHMHS_2016","6"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","42","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870036","Florida Hospital Silver POS 90 5262","27357FL187",,"FLN004","FLS002","FLF011","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9566",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870036-01","Standard Silver On Exchange Plan","68.79%","0.678093731403351","Yes","Yes","No","100%",,"$3,000","$0","$820","$150","$3,000","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5262","http://www.myFHCA.org/FHMHS_2016","7"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","42","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850038","Health First Silver POS 70 5272","27357FL185",,"FLN003","FLS001","FLF005","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9585",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850038-00","Standard Silver Off Exchange Plan",,"0.714829087257385","Yes","Yes","No","100%",,"$2,000","$0","$2,160","$150","$2,000","$0","$980","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5272","http://www.myHFHP.org/MHS_2016","8"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","42","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1850038","Health First Silver POS 70 5272","27357FL185",,"FLN003","FLS001","FLF005","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9585",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","27357FL1850038-01","Standard Silver On Exchange Plan",,"0.714829087257385","Yes","Yes","No","100%",,"$2,000","$0","$2,160","$150","$2,000","$0","$980","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5272","http://www.myHFHP.org/MHS_2016","9"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","42","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870038","Florida Hospital Silver POS 70 5278","27357FL187",,"FLN004","FLS002","FLF014","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9585",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870038-00","Standard Silver Off Exchange Plan",,"0.714829087257385","Yes","Yes","No","100%",,"$2,000","$0","$2,160","$150","$2,000","$0","$980","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5278","http://www.myFHCA.org/FHMHS_2016","10"
"2016","FL","27357","HIOS","4","2015-10-20 04:38:50","42","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1870038","Florida Hospital Silver POS 70 5278","27357FL187",,"FLN004","FLS002","FLF014","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9585",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myFHCA.org/FHMP_formulary_2016","27357FL1870038-01","Standard Silver On Exchange Plan",,"0.714829087257385","Yes","Yes","No","100%",,"$2,000","$0","$2,160","$150","$2,000","$0","$980","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myFHCA.org/2016_sbc_5278","http://www.myFHCA.org/FHMHS_2016","11"
"2016","FL","30115","HIOS","5","2015-08-21 03:45:06","1","30115","FL","Individual","Yes","59-2876465","30115FL0010001","BlueDental Copayment Q","30115FL001",,"FLN002","FLS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$21.55","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area benefits are available as defined in the policy but may have a higher cost share","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","","30115FL0010001-00","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$25","$25 per person","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/ BlueDental_Copayment_Q_Plan_Benefit_Summary.pdf","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Copayment_Q_Plan_Brochure.pdf","4"
"2016","FL","30115","HIOS","5","2015-08-21 03:45:06","1","30115","FL","Individual","Yes","59-2876465","30115FL0010001","BlueDental Copayment Q","30115FL001",,"FLN002","FLS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$21.55","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area benefits are available as defined in the policy but may have a higher cost share","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","","30115FL0010001-01","Standard Low On Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$25","$25 per person","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/ BlueDental_Copayment_Q_Plan_Benefit_Summary.pdf","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Copayment_Q_Plan_Brochure.pdf","5"
"2016","FL","30115","HIOS","5","2015-08-21 03:45:06","2","30115","FL","Individual","Yes","59-2876465","30115FL0020001","BlueDental Choice Q","30115FL002",,"FLN001","FLS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$36.04","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area benefits are available as defined in the policy but may have a higher cost share","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","","30115FL0020001-00","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_Q_Plan_Benefit_Summary.pdf","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_Q_Plan_Brochure.pdf","4"
"2016","FL","30115","HIOS","5","2015-08-21 03:45:06","2","30115","FL","Individual","Yes","59-2876465","30115FL0020001","BlueDental Choice Q","30115FL002",,"FLN001","FLS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$36.04","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area benefits are available as defined in the policy but may have a higher cost share","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","","30115FL0020001-01","Standard High On Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_Q_Plan_Benefit_Summary.pdf","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_Q_Plan_Brochure.pdf","5"
"2016","FL","30115","HIOS","5","2015-08-21 03:45:06","3","30115","FL","Individual","Yes","59-2876465","30115FL0040001","BlueDental Copayment QF","30115FL004",,"FLN002","FLS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.55","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area benefits are available as defined in the policy but may have a higher cost share","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","","30115FL0040001-00","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","$700 per group",,,,,,"$25","$25 per person","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/ BlueDental_Copayment_QF_Plan_Benefit_Summary.pdf","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Copayment_QF_Plan_Brochure.pdf","4"
"2016","FL","30115","HIOS","5","2015-08-21 03:45:06","3","30115","FL","Individual","Yes","59-2876465","30115FL0040001","BlueDental Copayment QF","30115FL004",,"FLN002","FLS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.55","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area benefits are available as defined in the policy but may have a higher cost share","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","","30115FL0040001-01","Standard Low On Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","$700 per group",,,,,,"$25","$25 per person","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/ BlueDental_Copayment_QF_Plan_Benefit_Summary.pdf","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Copayment_QF_Plan_Brochure.pdf","5"
"2016","FL","30115","HIOS","5","2015-08-21 03:45:06","4","30115","FL","Individual","Yes","59-2876465","30115FL0050001","BlueDental Choice QF","30115FL005",,"FLN001","FLS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.04","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area benefits are available as defined in the policy but may have a higher cost share","Yes",,"","30115FL0050001-00","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_QF_Plan_Benefit_Summary.pdf","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_QF_Plan_Brochure.pdf","4"
"2016","FL","30115","HIOS","5","2015-08-21 03:45:06","4","30115","FL","Individual","Yes","59-2876465","30115FL0050001","BlueDental Choice QF","30115FL005",,"FLN001","FLS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.04","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area benefits are available as defined in the policy but may have a higher cost share","Yes",,"","30115FL0050001-01","Standard High On Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_QF_Plan_Benefit_Summary.pdf","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_QF_Plan_Brochure.pdf","5"
"2016","FL","30219","HIOS","3","2015-08-21 03:45:06","1","30219","FL","SHOP (Small Group)","Yes","65-0073323","30219FL0030001","Family Basic Dental Plan (Low)","30219FL003",,"FLN001","FLS001",,"Existing","HMO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$10.46","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","30219FL0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48033","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48032","4"
"2016","FL","30219","HIOS","3","2015-08-21 03:45:06","1","30219","FL","SHOP (Small Group)","Yes","65-0073323","30219FL0030001","Family Basic Dental Plan (Low)","30219FL003",,"FLN001","FLS001",,"Existing","HMO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$10.46","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","30219FL0030001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48033","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48032","5"
"2016","FL","30219","HIOS","3","2015-08-21 03:45:06","2","30219","FL","SHOP (Small Group)","Yes","65-0073323","30219FL0040001","Family Enhanced Dental Plan (High)","30219FL004",,"FLN001","FLS001",,"Existing","HMO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$13.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","30219FL0040001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49074","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49073","4"
"2016","FL","30219","HIOS","3","2015-08-21 03:45:06","2","30219","FL","SHOP (Small Group)","Yes","65-0073323","30219FL0040001","Family Enhanced Dental Plan (High)","30219FL004",,"FLN001","FLS001",,"Existing","HMO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$13.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","30219FL0040001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49074","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49073","5"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","1","30252","FL","Individual","No","59-2403696","30252FL0020070","BlueCare Everyday Health 1477","30252FL002","7346243208","FLN001","FLS001","FLF007","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020070-00","Standard Silver Off Exchange Plan",,"0.680478096008301","Yes","Yes","No","100%",,"$6,100","$90","$0","$200","$600","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1477.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1477.pdf","4"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","1","30252","FL","SHOP (Small Group)","No","59-2403696","30252FL0010001","BlueCare Essential Health S1450","30252FL001","7346243208","FLN001","FLS001","FLF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0010001-00","Standard Silver Off Exchange Plan",,"0.711081624031067","No","Yes","No","100%",,"$2,000","$0","$900","$200","$1,200","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/S1450.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/S1450.pdf","4"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","1","30252","FL","SHOP (Small Group)","No","59-2403696","30252FL0010001","BlueCare Essential Health S1450","30252FL001","7346243208","FLN001","FLS001","FLF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0010001-01","Standard Silver On Exchange Plan",,"0.711081624031067","No","Yes","No","100%",,"$2,000","$0","$900","$200","$1,200","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/S1450.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/S1450.pdf","5"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","1","30252","FL","Individual","No","59-2403696","30252FL0020070","BlueCare Everyday Health 1477","30252FL002","7346243208","FLN001","FLS001","FLF007","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020070-01","Standard Silver On Exchange Plan",,"0.680478096008301","Yes","Yes","No","100%",,"$6,100","$90","$0","$200","$600","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1477.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1477.pdf","5"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","1","30252","FL","Individual","No","59-2403696","30252FL0020070","BlueCare Everyday Health 1477","30252FL002","7346243208","FLN001","FLS001","FLF007","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020070-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1477U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1477U.pdf","6"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","1","30252","FL","SHOP (Small Group)","No","59-2403696","30252FL0010002","BlueCare Essential Health S1451","30252FL001","7346243208","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0010002-00","Standard Gold Off Exchange Plan",,"0.797176897525787","No","Yes","No","100%",,"$1,000","$0","$1,100","$200","$1,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/S1451.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/S1451.pdf","6"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","1","30252","FL","SHOP (Small Group)","No","59-2403696","30252FL0010002","BlueCare Essential Health S1451","30252FL001","7346243208","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0010002-01","Standard Gold On Exchange Plan",,"0.797176897525787","No","Yes","No","100%",,"$1,000","$0","$1,100","$200","$1,000","$0","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/S1451.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/S1451.pdf","7"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","1","30252","FL","Individual","No","59-2403696","30252FL0020070","BlueCare Everyday Health 1477","30252FL002","7346243208","FLN001","FLS001","FLF007","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020070-03","Limited Cost Sharing Plan Variation",,"0.680478096008301","Yes","Yes","No","100%",,"$6,100","$90","$0","$200","$600","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1477O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1477O.pdf","7"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","1","30252","FL","Individual","No","59-2403696","30252FL0020070","BlueCare Everyday Health 1477","30252FL002","7346243208","FLN001","FLS001","FLF007","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020070-04","73% AV Level Silver Plan",,"0.736551940441132","Yes","Yes","No","100%",,"$3,600","$200","$0","$200","$0","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1477A.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1477A.pdf","8"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","1","30252","FL","Individual","No","59-2403696","30252FL0070007","MyBlue Silver 1604","30252FL007","7346243208","FLN002","FLS002","FLF005","New","HMO","Silver","Yes","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070007-05","87% AV Level Silver Plan","87.96%","0.880802035331726","Yes","Yes","No","100%",,"$0","$50","$1,100","$200","$0","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1604B.pdf","https://www.floridablue.com/es/plans/myblue?type=silver4b","16"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","1","30252","FL","Individual","No","59-2403696","30252FL0070007","MyBlue Silver 1604","30252FL007","7346243208","FLN002","FLS002","FLF005","New","HMO","Silver","Yes","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070007-06","94% AV Level Silver Plan","93.98%","0.937596082687378","Yes","Yes","No","100%",,"$0","$0","$900","$200","$0","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1604C.pdf","https://www.floridablue.com/es/plans/myblue?type=silver4c","17"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","2","30252","FL","Individual","No","59-2403696","30252FL0020066","BlueCare Everyday Health 1483","30252FL002","7346243208","FLN001","FLS001","FLF008","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020066-00","Standard Bronze Off Exchange Plan","61.91%","0","Yes","Yes","No","100%",,"$3,600","$200","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1483.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1483.pdf","4"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","2","30252","FL","Individual","No","59-2403696","30252FL0020066","BlueCare Everyday Health 1483","30252FL002","7346243208","FLN001","FLS001","FLF008","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020066-01","Standard Bronze On Exchange Plan","61.91%","0","Yes","Yes","No","100%",,"$3,600","$200","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1483.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1483.pdf","5"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","2","30252","FL","Individual","No","59-2403696","30252FL0020066","BlueCare Everyday Health 1483","30252FL002","7346243208","FLN001","FLS001","FLF008","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020066-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1483U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1483U.pdf","6"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","2","30252","FL","Individual","No","59-2403696","30252FL0020066","BlueCare Everyday Health 1483","30252FL002","7346243208","FLN001","FLS001","FLF008","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020066-03","Limited Cost Sharing Plan Variation","61.91%","0","Yes","Yes","No","100%",,"$3,600","$200","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1483O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1483O.pdf","7"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","2","30252","FL","Individual","No","59-2403696","30252FL0070001","MyBlue Bronze 1601","30252FL007","7346243208","FLN002","FLS002","FLF002","New","HMO","Bronze","Yes","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070001-00","Standard Bronze Off Exchange Plan","61.91%","0","Yes","Yes","No","100%",,"$3,600","$200","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1601.pdf","https://www.floridablue.com/es/plans/myblue?type=bronze1","8"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","2","30252","FL","Individual","No","59-2403696","30252FL0070001","MyBlue Bronze 1601","30252FL007","7346243208","FLN002","FLS002","FLF002","New","HMO","Bronze","Yes","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070001-01","Standard Bronze On Exchange Plan","61.91%","0","Yes","Yes","No","100%",,"$3,600","$200","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1601.pdf","https://www.floridablue.com/es/plans/myblue?type=bronze1","9"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","2","30252","FL","Individual","No","59-2403696","30252FL0070001","MyBlue Bronze 1601","30252FL007","7346243208","FLN002","FLS002","FLF002","New","HMO","Bronze","Yes","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1601U.pdf","https://www.floridablue.com/es/plans/myblue?type=U","10"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","2","30252","FL","Individual","No","59-2403696","30252FL0070001","MyBlue Bronze 1601","30252FL007","7346243208","FLN002","FLS002","FLF002","New","HMO","Bronze","Yes","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070001-03","Limited Cost Sharing Plan Variation","61.91%","0","Yes","Yes","No","100%",,"$3,600","$200","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1601O.pdf","https://www.floridablue.com/es/plans/myblue?type=bronze1","11"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","3","30252","FL","Individual","No","59-2403696","30252FL0020062","BlueCare Everyday Health 1485","30252FL002","7346243208","FLN001","FLS001","FLF009","Existing","HMO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020062-00","Standard Platinum Off Exchange Plan",,"0.889939486980438","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1485.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1485.pdf","4"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","3","30252","FL","Individual","No","59-2403696","30252FL0020062","BlueCare Everyday Health 1485","30252FL002","7346243208","FLN001","FLS001","FLF009","Existing","HMO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020062-01","Standard Platinum On Exchange Plan",,"0.889939486980438","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1485.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1485.pdf","5"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","3","30252","FL","Individual","No","59-2403696","30252FL0020062","BlueCare Everyday Health 1485","30252FL002","7346243208","FLN001","FLS001","FLF009","Existing","HMO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020062-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1485U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1485U.pdf","6"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","3","30252","FL","Individual","No","59-2403696","30252FL0020062","BlueCare Everyday Health 1485","30252FL002","7346243208","FLN001","FLS001","FLF009","Existing","HMO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020062-03","Limited Cost Sharing Plan Variation",,"0.889939486980438","No","Yes","No","100%",,"$800","$40","$300","$200","$0","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1485O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1485O.pdf","7"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","4","30252","FL","Individual","No","59-2403696","30252FL0020044","BlueCare Essential 1486","30252FL002","7346243208","FLN001","FLS001","FLF010","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020044-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1486.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1486.pdf","4"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","4","30252","FL","Individual","No","59-2403696","30252FL0020044","BlueCare Essential 1486","30252FL002","7346243208","FLN001","FLS001","FLF010","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020044-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1486.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1486.pdf","5"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","4","30252","FL","Individual","No","59-2403696","30252FL0020044","BlueCare Essential 1486","30252FL002","7346243208","FLN001","FLS001","FLF010","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020044-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1486U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1486U.pdf","6"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","4","30252","FL","Individual","No","59-2403696","30252FL0020044","BlueCare Essential 1486","30252FL002","7346243208","FLN001","FLS001","FLF010","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020044-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1486O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1486O.pdf","7"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","5","30252","FL","Individual","No","59-2403696","30252FL0020033","BlueCare Everyday Health 1490","30252FL002","7346243208","FLN001","FLS001","FLF011","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020033-00","Standard Silver Off Exchange Plan","68.25%","0","No","Yes","No","100%",,"$3,600","$400","$0","$200","$3,000","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1490.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1490.pdf","4"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","5","30252","FL","Individual","No","59-2403696","30252FL0020033","BlueCare Everyday Health 1490","30252FL002","7346243208","FLN001","FLS001","FLF011","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020033-01","Standard Silver On Exchange Plan","68.25%","0","No","Yes","No","100%",,"$3,600","$400","$0","$200","$3,000","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1490.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1490.pdf","5"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","5","30252","FL","Individual","No","59-2403696","30252FL0020033","BlueCare Everyday Health 1490","30252FL002","7346243208","FLN001","FLS001","FLF011","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020033-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1490U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1490U.pdf","6"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","5","30252","FL","Individual","No","59-2403696","30252FL0020033","BlueCare Everyday Health 1490","30252FL002","7346243208","FLN001","FLS001","FLF011","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020033-03","Limited Cost Sharing Plan Variation","68.25%","0","No","Yes","No","100%",,"$3,600","$400","$0","$200","$3,000","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1490O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1490O.pdf","7"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","5","30252","FL","Individual","No","59-2403696","30252FL0020033","BlueCare Everyday Health 1490","30252FL002","7346243208","FLN001","FLS001","FLF011","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020033-04","73% AV Level Silver Plan","73.95%","0","No","Yes","No","100%",,"$3,600","$300","$0","$200","$3,000","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1490A.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1490A.pdf","8"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","5","30252","FL","Individual","No","59-2403696","30252FL0020033","BlueCare Everyday Health 1490","30252FL002","7346243208","FLN001","FLS001","FLF011","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020033-05","87% AV Level Silver Plan","87.21%","0","No","Yes","No","100%",,"$0","$500","$0","$200","$0","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1490B.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1490B.pdf","9"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","5","30252","FL","Individual","No","59-2403696","30252FL0020033","BlueCare Everyday Health 1490","30252FL002","7346243208","FLN001","FLS001","FLF011","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020033-06","94% AV Level Silver Plan","94.17%","0","No","Yes","No","100%",,"$0","$400","$0","$200","$0","$60","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1490C.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1490C.pdf","10"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","5","30252","FL","Individual","No","59-2403696","30252FL0070005","MyBlue Silver 1603","30252FL007","7346243208","FLN002","FLS002","FLF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070005-00","Standard Silver Off Exchange Plan","68.25%","0","No","Yes","No","100%",,"$3,600","$400","$0","$200","$3,000","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1603.pdf","https://www.floridablue.com/es/plans/myblue?type=silver3","11"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","5","30252","FL","Individual","No","59-2403696","30252FL0070005","MyBlue Silver 1603","30252FL007","7346243208","FLN002","FLS002","FLF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070005-01","Standard Silver On Exchange Plan","68.25%","0","No","Yes","No","100%",,"$3,600","$400","$0","$200","$3,000","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1603.pdf","https://www.floridablue.com/es/plans/myblue?type=silver3","12"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1160002","Humana Bronze 6450/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160002-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2603328","http://apps.humana.com/marketing/documents.asp?file=2591511","9"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","Individual","No","61-1103898","35783FL1160015","Humana Bronze 4850/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160015-01","Standard Bronze On Exchange Plan","61.72%","0.588930368423462","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603640","http://apps.humana.com/marketing/documents.asp?file=2591602","13"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","Individual","No","61-1103898","35783FL1160015","Humana Bronze 4850/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603653","http://apps.humana.com/marketing/documents.asp?file=2591602","14"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","5","30252","FL","Individual","No","59-2403696","30252FL0070005","MyBlue Silver 1603","30252FL007","7346243208","FLN002","FLS002","FLF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1603U.pdf","https://www.floridablue.com/es/plans/myblue?type=U","13"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","1","35783","FL","Individual","No","61-1103898","35783FL1160001","Humana Basic 6850/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$30","$0","$150","$5,300","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2603315","http://apps.humana.com/marketing/documents.asp?file=2591498","6"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","1","35783","FL","SHOP (Small Group)","No","61-1103898","35783FL1030064","Humana Simplicity Gold 003/100 HMO Premier","35783FL103",,"FLN001","FLS008","FLF008","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB-FL","35783FL1030064-00","Standard Gold Off Exchange Plan","78.03%","0","No","Yes","No","100%",,"$0","$2,250","$0","$0","$0","$1,890","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645474","http://apps.humana.com/marketing/documents.asp?file=2653807","6"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","Individual","No","61-1103898","35783FL1160037","Humana Bronze 4850/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160037-01","Standard Bronze On Exchange Plan","61.72%","0.588930368423462","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603380","http://apps.humana.com/marketing/documents.asp?file=2591524","17"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","Individual","No","61-1103898","35783FL1160037","Humana Bronze 4850/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160037-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603393","http://apps.humana.com/marketing/documents.asp?file=2591524","18"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","5","30252","FL","Individual","No","59-2403696","30252FL0070005","MyBlue Silver 1603","30252FL007","7346243208","FLN002","FLS002","FLF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070005-03","Limited Cost Sharing Plan Variation","68.25%","0","No","Yes","No","100%",,"$3,600","$400","$0","$200","$3,000","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1603O.pdf","https://www.floridablue.com/es/plans/myblue?type=silver3","14"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","5","30252","FL","Individual","No","59-2403696","30252FL0070005","MyBlue Silver 1603","30252FL007","7346243208","FLN002","FLS002","FLF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070005-04","73% AV Level Silver Plan","73.95%","0","No","Yes","No","100%",,"$3,600","$300","$0","$200","$3,000","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1603A.pdf","https://www.floridablue.com/es/plans/myblue?type=silver3a","15"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","5","30252","FL","Individual","No","59-2403696","30252FL0070005","MyBlue Silver 1603","30252FL007","7346243208","FLN002","FLS002","FLF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070005-05","87% AV Level Silver Plan","87.36%","0","No","Yes","No","100%",,"$0","$400","$0","$200","$0","$90","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1603B.pdf","https://www.floridablue.com/es/plans/myblue?type=silver3b","16"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","5","30252","FL","Individual","No","59-2403696","30252FL0070005","MyBlue Silver 1603","30252FL007","7346243208","FLN002","FLS002","FLF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070005-06","94% AV Level Silver Plan","94.43%","0","No","Yes","No","100%",,"$0","$300","$0","$200","$0","$30","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1603C.pdf","https://www.floridablue.com/es/plans/myblue?type=silver3c","17"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","6","30252","FL","Individual","No","59-2403696","30252FL0020068","BlueCare All Copay 1491","30252FL002","7346243208","FLN001","FLS001","FLF012","Existing","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020068-00","Standard Platinum Off Exchange Plan","89.02%","0","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1491.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1491.pdf","4"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","6","30252","FL","Individual","No","59-2403696","30252FL0020068","BlueCare All Copay 1491","30252FL002","7346243208","FLN001","FLS001","FLF012","Existing","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020068-01","Standard Platinum On Exchange Plan","89.02%","0","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1491.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1491.pdf","5"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","6","30252","FL","Individual","No","59-2403696","30252FL0020068","BlueCare All Copay 1491","30252FL002","7346243208","FLN001","FLS001","FLF012","Existing","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020068-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1491U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1491U.pdf","6"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","6","30252","FL","Individual","No","59-2403696","30252FL0020068","BlueCare All Copay 1491","30252FL002","7346243208","FLN001","FLS001","FLF012","Existing","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020068-03","Limited Cost Sharing Plan Variation","89.02%","0","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1491O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1491O.pdf","7"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","7","30252","FL","Individual","No","59-2403696","30252FL0020074","BlueCare All Copay 1565","30252FL002","7346243208","FLN001","FLS001","FLF014","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020074-00","Standard Gold Off Exchange Plan","80.84%","0","Yes","Yes","No","100%",,"$0","$700","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1565.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1565.pdf","4"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","7","30252","FL","Individual","No","59-2403696","30252FL0020074","BlueCare All Copay 1565","30252FL002","7346243208","FLN001","FLS001","FLF014","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020074-01","Standard Gold On Exchange Plan","80.84%","0","Yes","Yes","No","100%",,"$0","$700","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1565.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1565.pdf","5"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","7","30252","FL","Individual","No","59-2403696","30252FL0020074","BlueCare All Copay 1565","30252FL002","7346243208","FLN001","FLS001","FLF014","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020074-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1565U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1565U.pdf","6"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","7","30252","FL","Individual","No","59-2403696","30252FL0020074","BlueCare All Copay 1565","30252FL002","7346243208","FLN001","FLS001","FLF014","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"3","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020074-03","Limited Cost Sharing Plan Variation","80.84%","0","Yes","Yes","No","100%",,"$0","$700","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1565O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1565O.pdf","7"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","8","30252","FL","Individual","No","59-2403696","30252FL0020060","BlueCare Everyday Health 1498","30252FL002","7346243208","FLN001","FLS001","FLF013","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020060-00","Standard Silver Off Exchange Plan",,"0.698374092578888","No","Yes","No","100%",,"$3,600","$100","$0","$200","$0","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1498.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1498.pdf","4"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","8","30252","FL","Individual","No","59-2403696","30252FL0020060","BlueCare Everyday Health 1498","30252FL002","7346243208","FLN001","FLS001","FLF013","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020060-01","Standard Silver On Exchange Plan",,"0.698374092578888","No","Yes","No","100%",,"$3,600","$100","$0","$200","$0","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1498.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1498.pdf","5"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","8","30252","FL","Individual","No","59-2403696","30252FL0020060","BlueCare Everyday Health 1498","30252FL002","7346243208","FLN001","FLS001","FLF013","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020060-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1498U.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1498U.pdf","6"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","8","30252","FL","Individual","No","59-2403696","30252FL0020060","BlueCare Everyday Health 1498","30252FL002","7346243208","FLN001","FLS001","FLF013","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020060-03","Limited Cost Sharing Plan Variation",,"0.698374092578888","No","Yes","No","100%",,"$3,600","$100","$0","$200","$0","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1498O.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1498O.pdf","7"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","8","30252","FL","Individual","No","59-2403696","30252FL0020060","BlueCare Everyday Health 1498","30252FL002","7346243208","FLN001","FLS001","FLF013","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020060-04","73% AV Level Silver Plan",,"0.735831022262573","No","Yes","No","100%",,"$3,500","$100","$10","$200","$0","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1498A.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1498A.pdf","8"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","8","30252","FL","Individual","No","59-2403696","30252FL0020060","BlueCare Everyday Health 1498","30252FL002","7346243208","FLN001","FLS001","FLF013","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020060-05","87% AV Level Silver Plan",,"0.863704741001129","No","Yes","No","100%",,"$1,500","$80","$0","$200","$0","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1498B.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1498B.pdf","9"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","8","30252","FL","Individual","No","59-2403696","30252FL0020060","BlueCare Everyday Health 1498","30252FL002","7346243208","FLN001","FLS001","FLF013","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_7T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0020060-06","94% AV Level Silver Plan",,"0.936406075954437","No","Yes","No","100%",,"$500","$20","$0","$200","$0","$60","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1498C.pdf","http://www.bcbsfl.com/DocumentLibrary/MiniSummary/2016/1498C.pdf","10"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","9","30252","FL","Individual","No","59-2403696","30252FL0070003","MyBlue Bronze 1602","30252FL007","7346243208","FLN002","FLS002","FLF003","New","HMO","Bronze","No","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070003-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1602.pdf","https://www.floridablue.com/es/plans/myblue?type=bronze2","4"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","9","30252","FL","Individual","No","59-2403696","30252FL0070003","MyBlue Bronze 1602","30252FL007","7346243208","FLN002","FLS002","FLF003","New","HMO","Bronze","No","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070003-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1602.pdf","https://www.floridablue.com/es/plans/myblue?type=bronze2","5"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","9","30252","FL","Individual","No","59-2403696","30252FL0070003","MyBlue Bronze 1602","30252FL007","7346243208","FLN002","FLS002","FLF003","New","HMO","Bronze","No","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1602U.pdf","https://www.floridablue.com/es/plans/myblue?type=U","6"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","9","30252","FL","Individual","No","59-2403696","30252FL0070003","MyBlue Bronze 1602","30252FL007","7346243208","FLN002","FLS002","FLF003","New","HMO","Bronze","No","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070003-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1602O.pdf","https://www.floridablue.com/es/plans/myblue?type=bronze2","7"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","10","30252","FL","Individual","No","59-2403696","30252FL0070009","MyBlue Gold 1605","30252FL007","7346243208","FLN002","FLS002","FLF006","New","HMO","Gold","No","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070009-00","Standard Gold Off Exchange Plan",,"0.79209566116333","Yes","Yes","No","100%",,"$900","$300","$400","$200","$0","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1605.pdf","https://www.floridablue.com/es/plans/myblue?type=gold5","4"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","10","30252","FL","Individual","No","59-2403696","30252FL0070009","MyBlue Gold 1605","30252FL007","7346243208","FLN002","FLS002","FLF006","New","HMO","Gold","No","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070009-01","Standard Gold On Exchange Plan",,"0.79209566116333","Yes","Yes","No","100%",,"$900","$300","$400","$200","$0","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1605.pdf","https://www.floridablue.com/es/plans/myblue?type=gold5","5"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","10","30252","FL","Individual","No","59-2403696","30252FL0070009","MyBlue Gold 1605","30252FL007","7346243208","FLN002","FLS002","FLF006","New","HMO","Gold","No","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1605U.pdf","https://www.floridablue.com/es/plans/myblue?type=U","6"
"2016","FL","30252","HIOS","9","2016-07-08 07:33:42","10","30252","FL","Individual","No","59-2403696","30252FL0070009","MyBlue Gold 1605","30252FL007","7346243208","FLN002","FLS002","FLF006","New","HMO","Gold","No","Both","No","Yes","All Specialist require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Accident and emergency services.","Yes","Accident and emergency services.","No","https://sso.flblue.guidewellconnect.com/sso/saml2/FFM/Billtrust","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_FL_5T_HealthInsuranceMarketplaceValueBased.pdf","30252FL0070009-03","Limited Cost Sharing Plan Variation",,"0.79209566116333","Yes","Yes","No","100%",,"$900","$300","$400","$200","$0","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1605O.pdf","https://www.floridablue.com/es/plans/myblue?type=gold5","7"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","1","35783","FL","Individual","No","61-1103898","35783FL1150001","Humana Basic 6850/HMO Premier","35783FL115",,"FLN001","FLS001","FLF001","Existing","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1150001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$30","$0","$150","$5,300","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2602964","http://apps.humana.com/marketing/documents.asp?file=2591420","4"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","1","35783","FL","SHOP (Small Group)","No","61-1103898","35783FL1030050","Humana Simplicity Gold 002/100 HMO Premier","35783FL103",,"FLN001","FLS008","FLF008","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB-FL","35783FL1030050-00","Standard Gold Off Exchange Plan","79.44%","0","No","Yes","No","100%",,"$0","$2,250","$0","$0","$0","$1,830","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645422","http://apps.humana.com/marketing/documents.asp?file=2653794","4"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","1","35783","FL","SHOP (Small Group)","No","61-1103898","35783FL1030050","Humana Simplicity Gold 002/100 HMO Premier","35783FL103",,"FLN001","FLS008","FLF008","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB-FL","35783FL1030050-01","Standard Gold On Exchange Plan","79.44%","0","No","Yes","No","100%",,"$0","$2,250","$0","$0","$0","$1,830","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645422","http://apps.humana.com/marketing/documents.asp?file=2653794","5"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","1","35783","FL","Individual","No","61-1103898","35783FL1150001","Humana Basic 6850/HMO Premier","35783FL115",,"FLN001","FLS001","FLF001","Existing","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1150001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$30","$0","$150","$5,300","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2602964","http://apps.humana.com/marketing/documents.asp?file=2591420","5"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","1","35783","FL","SHOP (Small Group)","No","61-1103898","35783FL1030064","Humana Simplicity Gold 003/100 HMO Premier","35783FL103",,"FLN001","FLS008","FLF008","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB-FL","35783FL1030064-01","Standard Gold On Exchange Plan","78.03%","0","No","Yes","No","100%",,"$0","$2,250","$0","$0","$0","$1,890","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645474","http://apps.humana.com/marketing/documents.asp?file=2653807","7"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","1","35783","FL","Individual","No","61-1103898","35783FL1160001","Humana Basic 6850/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$30","$0","$150","$5,300","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2603315","http://apps.humana.com/marketing/documents.asp?file=2591498","7"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","1","35783","FL","Individual","No","61-1103898","35783FL1160013","Humana Basic 6850/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160013-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$30","$0","$150","$5,300","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2603588","http://apps.humana.com/marketing/documents.asp?file=2591576","8"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","1","35783","FL","SHOP (Small Group)","No","61-1103898","35783FL1030065","Humana Simplicity Silver 004/100 HMO Premier","35783FL103",,"FLN001","FLS008","FLF009","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB-FL","35783FL1030065-00","Standard Silver Off Exchange Plan","71.37%","0","No","Yes","No","100%",,"$0","$2,250","$0","$0","$0","$2,250","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645747","http://apps.humana.com/marketing/documents.asp?file=2653820","8"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","1","35783","FL","SHOP (Small Group)","No","61-1103898","35783FL1030065","Humana Simplicity Silver 004/100 HMO Premier","35783FL103",,"FLN001","FLS008","FLF009","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB-FL","35783FL1030065-01","Standard Silver On Exchange Plan","71.37%","0","No","Yes","No","100%",,"$0","$2,250","$0","$0","$0","$2,250","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645747","http://apps.humana.com/marketing/documents.asp?file=2653820","9"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","1","35783","FL","Individual","No","61-1103898","35783FL1160013","Humana Basic 6850/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$30","$0","$150","$5,300","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2603588","http://apps.humana.com/marketing/documents.asp?file=2591576","9"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","1","35783","FL","Individual","No","61-1103898","35783FL1160030","Humana Basic 6850/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160030-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$30","$0","$150","$5,300","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2603848","http://apps.humana.com/marketing/documents.asp?file=2591654","10"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","1","35783","FL","Individual","No","61-1103898","35783FL1160030","Humana Basic 6850/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160030-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$30","$0","$150","$5,300","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2603848","http://apps.humana.com/marketing/documents.asp?file=2591654","11"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","1","35783","FL","Individual","No","61-1103898","35783FL1160035","Humana Basic 6850/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160035-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$30","$0","$150","$5,300","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2603315","http://apps.humana.com/marketing/documents.asp?file=2591498","12"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","1","35783","FL","Individual","No","61-1103898","35783FL1160035","Humana Basic 6850/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160035-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$30","$0","$150","$5,300","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2603315","http://apps.humana.com/marketing/documents.asp?file=2591498","13"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","1","35783","FL","Individual","No","61-1103898","35783FL1160041","Humana Basic 6850/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160041-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$30","$0","$150","$5,300","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2603315","http://apps.humana.com/marketing/documents.asp?file=2591498","14"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","1","35783","FL","Individual","No","61-1103898","35783FL1160041","Humana Basic 6850/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160041-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$30","$0","$150","$5,300","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2603315","http://apps.humana.com/marketing/documents.asp?file=2591498","15"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1150002","Humana Bronze 6450/HMO Premier","35783FL115",,"FLN001","FLS001","FLF001","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1150002-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2602977","http://apps.humana.com/marketing/documents.asp?file=2591433","4"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","SHOP (Small Group)","No","61-1103898","35783FL1030005","Humana Copay Gold 100/1000 HMO Premier","35783FL103",,"FLN001","FLS008","FLF010","Existing","HMO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB-FL","35783FL1030005-00","Standard Gold Off Exchange Plan",,"0.80921858549118","No","Yes","No","100%",,"$1,000","$140","$0","$0","$1,000","$1,170","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645799","http://apps.humana.com/marketing/documents.asp?file=2653833","4"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","SHOP (Small Group)","No","61-1103898","35783FL1030005","Humana Copay Gold 100/1000 HMO Premier","35783FL103",,"FLN001","FLS008","FLF010","Existing","HMO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB-FL","35783FL1030005-01","Standard Gold On Exchange Plan",,"0.80921858549118","No","Yes","No","100%",,"$1,000","$140","$0","$0","$1,000","$1,170","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645799","http://apps.humana.com/marketing/documents.asp?file=2653833","5"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1150002","Humana Bronze 6450/HMO Premier","35783FL115",,"FLN001","FLS001","FLF001","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1150002-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2602977","http://apps.humana.com/marketing/documents.asp?file=2591433","5"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1150002","Humana Bronze 6450/HMO Premier","35783FL115",,"FLN001","FLS001","FLF001","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1150002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2602990","http://apps.humana.com/marketing/documents.asp?file=2591433","6"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","SHOP (Small Group)","No","61-1103898","35783FL1030014","Humana Copay Silver 80/2000 HMO Premier","35783FL103",,"FLN001","FLS008","FLF011","Existing","HMO","Silver","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB-FL","35783FL1030014-00","Standard Silver Off Exchange Plan",,"0.71460348367691","No","Yes","No","100%",,"$2,000","$140","$920","$0","$2,000","$1,190","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645890","http://apps.humana.com/marketing/documents.asp?file=2653846","6"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","SHOP (Small Group)","No","61-1103898","35783FL1030014","Humana Copay Silver 80/2000 HMO Premier","35783FL103",,"FLN001","FLS008","FLF011","Existing","HMO","Silver","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB-FL","35783FL1030014-01","Standard Silver On Exchange Plan",,"0.71460348367691","No","Yes","No","100%",,"$2,000","$140","$920","$0","$2,000","$1,190","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645890","http://apps.humana.com/marketing/documents.asp?file=2653846","7"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1150002","Humana Bronze 6450/HMO Premier","35783FL115",,"FLN001","FLS001","FLF001","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1150002-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2603003","http://apps.humana.com/marketing/documents.asp?file=2591433","7"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1160002","Humana Bronze 6450/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160002-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2603328","http://apps.humana.com/marketing/documents.asp?file=2591511","8"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1160002","Humana Bronze 6450/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2603354","http://apps.humana.com/marketing/documents.asp?file=2591511","10"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1160002","Humana Bronze 6450/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160002-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2603367","http://apps.humana.com/marketing/documents.asp?file=2591511","11"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1160014","Humana Bronze 6450/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160014-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2603601","http://apps.humana.com/marketing/documents.asp?file=2591589","12"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1160014","Humana Bronze 6450/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160014-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2603601","http://apps.humana.com/marketing/documents.asp?file=2591589","13"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1160014","Humana Bronze 6450/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2603614","http://apps.humana.com/marketing/documents.asp?file=2591589","14"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1160014","Humana Bronze 6450/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160014-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2603627","http://apps.humana.com/marketing/documents.asp?file=2591589","15"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1160031","Humana Bronze 6450/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160031-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2603861","http://apps.humana.com/marketing/documents.asp?file=2591667","16"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1160031","Humana Bronze 6450/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160031-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2603861","http://apps.humana.com/marketing/documents.asp?file=2591667","17"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1160031","Humana Bronze 6450/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160031-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2603874","http://apps.humana.com/marketing/documents.asp?file=2591667","18"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1160031","Humana Bronze 6450/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160031-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2603887","http://apps.humana.com/marketing/documents.asp?file=2591667","19"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1160036","Humana Bronze 6450/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160036-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2603328","http://apps.humana.com/marketing/documents.asp?file=2591511","20"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1160036","Humana Bronze 6450/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160036-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2603328","http://apps.humana.com/marketing/documents.asp?file=2591511","21"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1160036","Humana Bronze 6450/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160036-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2603354","http://apps.humana.com/marketing/documents.asp?file=2591511","22"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1160036","Humana Bronze 6450/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160036-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2603367","http://apps.humana.com/marketing/documents.asp?file=2591511","23"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1160042","Humana Bronze 6450/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160042-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2603328","http://apps.humana.com/marketing/documents.asp?file=2591511","24"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1160042","Humana Bronze 6450/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160042-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2603328","http://apps.humana.com/marketing/documents.asp?file=2591511","25"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1160042","Humana Bronze 6450/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160042-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2603354","http://apps.humana.com/marketing/documents.asp?file=2591511","26"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","2","35783","FL","Individual","No","61-1103898","35783FL1160042","Humana Bronze 6450/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete-FL","35783FL1160042-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2603367","http://apps.humana.com/marketing/documents.asp?file=2591511","27"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","Individual","No","61-1103898","35783FL1150003","Humana Bronze 4850/HMO Premier","35783FL115",,"FLN001","FLS001","FLF002","Existing","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1150003-00","Standard Bronze Off Exchange Plan","61.72%","0.588930368423462","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603016","http://apps.humana.com/marketing/documents.asp?file=2591446","4"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","SHOP (Small Group)","No","61-1103898","35783FL1030042","Humana Copay Silver 50/5000 HMO Premier","35783FL103",,"FLN001","FLS008","FLF012","Existing","HMO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB-FL","35783FL1030042-00","Standard Silver Off Exchange Plan",,"0.683050513267517","No","Yes","No","100%",,"$5,010","$40","$840","$0","$4,040","$450","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645968","http://apps.humana.com/marketing/documents.asp?file=2653859","4"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","SHOP (Small Group)","No","61-1103898","35783FL1030042","Humana Copay Silver 50/5000 HMO Premier","35783FL103",,"FLN001","FLS008","FLF012","Existing","HMO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB-FL","35783FL1030042-01","Standard Silver On Exchange Plan",,"0.683050513267517","No","Yes","No","100%",,"$5,010","$40","$840","$0","$4,040","$450","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645968","http://apps.humana.com/marketing/documents.asp?file=2653859","5"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","Individual","No","61-1103898","35783FL1150003","Humana Bronze 4850/HMO Premier","35783FL115",,"FLN001","FLS001","FLF002","Existing","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1150003-01","Standard Bronze On Exchange Plan","61.72%","0.588930368423462","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603016","http://apps.humana.com/marketing/documents.asp?file=2591446","5"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","Individual","No","61-1103898","35783FL1150003","Humana Bronze 4850/HMO Premier","35783FL115",,"FLN001","FLS001","FLF002","Existing","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1150003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603029","http://apps.humana.com/marketing/documents.asp?file=2591446","6"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","Individual","No","61-1103898","35783FL1150003","Humana Bronze 4850/HMO Premier","35783FL115",,"FLN001","FLS001","FLF002","Existing","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1150003-03","Limited Cost Sharing Plan Variation","61.72%","0.588930368423462","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603042","http://apps.humana.com/marketing/documents.asp?file=2591446","7"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","Individual","No","61-1103898","35783FL1160043","Humana Bronze 4850/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160043-00","Standard Bronze Off Exchange Plan","61.72%","0.588930368423462","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603380","http://apps.humana.com/marketing/documents.asp?file=2591524","8"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","Individual","No","61-1103898","35783FL1160043","Humana Bronze 4850/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160043-01","Standard Bronze On Exchange Plan","61.72%","0.588930368423462","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603380","http://apps.humana.com/marketing/documents.asp?file=2591524","9"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","Individual","No","61-1103898","35783FL1160043","Humana Bronze 4850/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160043-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603393","http://apps.humana.com/marketing/documents.asp?file=2591524","10"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","Individual","No","61-1103898","35783FL1160043","Humana Bronze 4850/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160043-03","Limited Cost Sharing Plan Variation","61.72%","0.588930368423462","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603406","http://apps.humana.com/marketing/documents.asp?file=2591524","11"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","Individual","No","61-1103898","35783FL1160015","Humana Bronze 4850/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160015-00","Standard Bronze Off Exchange Plan","61.72%","0.588930368423462","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603640","http://apps.humana.com/marketing/documents.asp?file=2591602","12"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","Individual","No","61-1103898","35783FL1160015","Humana Bronze 4850/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160015-03","Limited Cost Sharing Plan Variation","61.72%","0.588930368423462","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603679","http://apps.humana.com/marketing/documents.asp?file=2591602","15"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160004","Humana Silver 3800/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160004-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603484","http://apps.humana.com/marketing/documents.asp?file=2622672","24"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160018","Humana Platinum 500/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160018-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603822","http://apps.humana.com/marketing/documents.asp?file=2591641","47"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160039","Humana Gold 2250/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160039-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603523","http://apps.humana.com/marketing/documents.asp?file=2591550","73"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160039","Humana Gold 2250/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160039-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603536","http://apps.humana.com/marketing/documents.asp?file=2591550","74"
"2016","FL","48129","HIOS","2","2015-05-08 02:15:08","1","48129","FL","Individual","Yes","47-0397286","48129FL0080002","Renaissance Individual Dental PPO, EHB Certified","48129FL008",,"FLN001","FLS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.27","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","48129FL0080002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","FL","48129","HIOS","2","2015-05-08 02:15:08","1","48129","FL","Individual","Yes","47-0397286","48129FL0130001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","48129FL013",,"FLN001","FLS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/48129","","48129FL0130001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/FL_EHB_High_2016","http://www.renaissancedental.com/FL_EHB_High_2016","8"
"2016","FL","48129","HIOS","2","2015-05-08 02:15:08","1","48129","FL","Individual","Yes","47-0397286","48129FL0130002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","48129FL013",,"FLN001","FLS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/48129","","48129FL0130002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/FL_EHB_Low_2016","http://www.renaissancedental.com/FL_EHB_Low_2016","9"
"2016","FL","48129","HIOS","2","2015-05-08 02:15:08","2","48129","FL","Individual","Yes","47-0397286","48129FL0110001","Renaissance Individual Dental Pediatric-Only, EHB Certified","48129FL011",,"FLN001","FLS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$33.10","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","48129FL0110001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","FL","48129","HIOS","2","2015-05-08 02:15:08","2","48129","FL","Individual","Yes","47-0397286","48129FL0110002","Renaissance Individual Dental Pediatric-Only, EHB Certified","48129FL011",,"FLN001","FLS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$25.68","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","48129FL0110002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","FL","48129","HIOS","2","2015-05-08 02:15:08","2","48129","FL","Individual","Yes","47-0397286","48129FL0150001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","48129FL015",,"FLN001","FLS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$33.10","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/48129","","48129FL0150001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/FL_Ped_High_2016","http://www.renaissancedental.com/FL_Ped_High_2016","6"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","Individual","No","61-1103898","35783FL1160037","Humana Bronze 4850/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160037-00","Standard Bronze Off Exchange Plan","61.72%","0.588930368423462","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603380","http://apps.humana.com/marketing/documents.asp?file=2591524","16"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","Individual","No","61-1103898","35783FL1160037","Humana Bronze 4850/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160037-03","Limited Cost Sharing Plan Variation","61.72%","0.588930368423462","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603406","http://apps.humana.com/marketing/documents.asp?file=2591524","19"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","Individual","No","61-1103898","35783FL1160003","Humana Bronze 4850/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160003-00","Standard Bronze Off Exchange Plan","61.72%","0.588930368423462","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603380","http://apps.humana.com/marketing/documents.asp?file=2591524","20"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","Individual","No","61-1103898","35783FL1160003","Humana Bronze 4850/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160003-01","Standard Bronze On Exchange Plan","61.72%","0.588930368423462","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603380","http://apps.humana.com/marketing/documents.asp?file=2591524","21"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","Individual","No","61-1103898","35783FL1160003","Humana Bronze 4850/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603393","http://apps.humana.com/marketing/documents.asp?file=2591524","22"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","3","35783","FL","Individual","No","61-1103898","35783FL1160003","Humana Bronze 4850/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160003-03","Limited Cost Sharing Plan Variation","61.72%","0.588930368423462","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603406","http://apps.humana.com/marketing/documents.asp?file=2591524","23"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1150004","Humana Silver 3800/HMO Premier","35783FL115",,"FLN001","FLS001","FLF003","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1150004-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603068","http://apps.humana.com/marketing/documents.asp?file=2591459","4"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1150004","Humana Silver 3800/HMO Premier","35783FL115",,"FLN001","FLS001","FLF003","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1150004-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603081","http://apps.humana.com/marketing/documents.asp?file=2591459","5"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1150004","Humana Silver 3800/HMO Premier","35783FL115",,"FLN001","FLS001","FLF003","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1150004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603081","http://apps.humana.com/marketing/documents.asp?file=2591459","6"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1150004","Humana Silver 3800/HMO Premier","35783FL115",,"FLN001","FLS001","FLF003","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1150004-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603094","http://apps.humana.com/marketing/documents.asp?file=2591459","7"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1150004","Humana Silver 3800/HMO Premier","35783FL115",,"FLN001","FLS001","FLF003","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1150004-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603133","http://apps.humana.com/marketing/documents.asp?file=2622620","8"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1150004","Humana Silver 3800/HMO Premier","35783FL115",,"FLN001","FLS001","FLF003","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1150004-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603159","http://apps.humana.com/marketing/documents.asp?file=2622633","9"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1150004","Humana Silver 3800/HMO Premier","35783FL115",,"FLN001","FLS001","FLF003","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1150004-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603198","http://apps.humana.com/marketing/documents.asp?file=2622646","10"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1150005","Humana Gold 2250/HMO Premier","35783FL115",,"FLN001","FLS001","FLF004","Existing","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1150005-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603237","http://apps.humana.com/marketing/documents.asp?file=2591472","11"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1150005","Humana Gold 2250/HMO Premier","35783FL115",,"FLN001","FLS001","FLF004","Existing","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1150005-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603237","http://apps.humana.com/marketing/documents.asp?file=2591472","12"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1150005","Humana Gold 2250/HMO Premier","35783FL115",,"FLN001","FLS001","FLF004","Existing","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1150005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603250","http://apps.humana.com/marketing/documents.asp?file=2591472","13"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1150005","Humana Gold 2250/HMO Premier","35783FL115",,"FLN001","FLS001","FLF004","Existing","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1150005-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603263","http://apps.humana.com/marketing/documents.asp?file=2591472","14"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1150006","Humana Platinum 500/HMO Premier","35783FL115",,"FLN001","FLS001","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1150006-00","Standard Platinum Off Exchange Plan","88.47%","0.888296604156494","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603276","http://apps.humana.com/marketing/documents.asp?file=2591485","15"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1150006","Humana Platinum 500/HMO Premier","35783FL115",,"FLN001","FLS001","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1150006-01","Standard Platinum On Exchange Plan","88.47%","0.888296604156494","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603276","http://apps.humana.com/marketing/documents.asp?file=2591485","16"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1150006","Humana Platinum 500/HMO Premier","35783FL115",,"FLN001","FLS001","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1150006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603289","http://apps.humana.com/marketing/documents.asp?file=2591485","17"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1150006","Humana Platinum 500/HMO Premier","35783FL115",,"FLN001","FLS001","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1150006-03","Limited Cost Sharing Plan Variation","88.47%","0.888296604156494","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603302","http://apps.humana.com/marketing/documents.asp?file=2591485","18"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160004","Humana Silver 3800/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160004-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603432","http://apps.humana.com/marketing/documents.asp?file=2591537","19"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160004","Humana Silver 3800/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160004-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603432","http://apps.humana.com/marketing/documents.asp?file=2591537","20"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160004","Humana Silver 3800/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603445","http://apps.humana.com/marketing/documents.asp?file=2591537","21"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160004","Humana Silver 3800/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160004-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603458","http://apps.humana.com/marketing/documents.asp?file=2591537","22"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160004","Humana Silver 3800/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160004-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603471","http://apps.humana.com/marketing/documents.asp?file=2622659","23"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160004","Humana Silver 3800/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160004-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603497","http://apps.humana.com/marketing/documents.asp?file=2622685","25"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160005","Humana Gold 2250/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160005-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603510","http://apps.humana.com/marketing/documents.asp?file=2591550","26"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160040","Humana Platinum 500/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160040-01","Standard Platinum On Exchange Plan","88.47%","0.888296604156494","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603549","http://apps.humana.com/marketing/documents.asp?file=2591563","76"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160040","Humana Platinum 500/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160040-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603562","http://apps.humana.com/marketing/documents.asp?file=2591563","77"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160040","Humana Platinum 500/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160040-03","Limited Cost Sharing Plan Variation","88.47%","0.888296604156494","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603575","http://apps.humana.com/marketing/documents.asp?file=2591563","78"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160005","Humana Gold 2250/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160005-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603510","http://apps.humana.com/marketing/documents.asp?file=2591550","27"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160005","Humana Gold 2250/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603523","http://apps.humana.com/marketing/documents.asp?file=2591550","28"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160005","Humana Gold 2250/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160005-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603536","http://apps.humana.com/marketing/documents.asp?file=2591550","29"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160006","Humana Platinum 500/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160006-00","Standard Platinum Off Exchange Plan","88.47%","0.888296604156494","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603549","http://apps.humana.com/marketing/documents.asp?file=2591563","30"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160006","Humana Platinum 500/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160006-01","Standard Platinum On Exchange Plan","88.47%","0.888296604156494","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603549","http://apps.humana.com/marketing/documents.asp?file=2591563","31"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160006","Humana Platinum 500/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603562","http://apps.humana.com/marketing/documents.asp?file=2591563","32"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160006","Humana Platinum 500/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS007","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160006-03","Limited Cost Sharing Plan Variation","88.47%","0.888296604156494","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603575","http://apps.humana.com/marketing/documents.asp?file=2591563","33"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160016","Humana Silver 3800/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160016-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603692","http://apps.humana.com/marketing/documents.asp?file=2591615","34"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160016","Humana Silver 3800/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160016-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603692","http://apps.humana.com/marketing/documents.asp?file=2591615","35"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160016","Humana Silver 3800/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160016-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603705","http://apps.humana.com/marketing/documents.asp?file=2591615","36"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160016","Humana Silver 3800/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160016-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603718","http://apps.humana.com/marketing/documents.asp?file=2591615","37"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160016","Humana Silver 3800/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160016-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603731","http://apps.humana.com/marketing/documents.asp?file=2622698","38"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160016","Humana Silver 3800/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160016-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603744","http://apps.humana.com/marketing/documents.asp?file=2622711","39"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160016","Humana Silver 3800/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160016-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603757","http://apps.humana.com/marketing/documents.asp?file=2622724","40"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160017","Humana Gold 2250/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160017-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603770","http://apps.humana.com/marketing/documents.asp?file=2591628","41"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160017","Humana Gold 2250/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160017-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603770","http://apps.humana.com/marketing/documents.asp?file=2591628","42"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160017","Humana Gold 2250/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160017-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603783","http://apps.humana.com/marketing/documents.asp?file=2591628","43"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160017","Humana Gold 2250/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160017-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603796","http://apps.humana.com/marketing/documents.asp?file=2591628","44"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160018","Humana Platinum 500/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160018-00","Standard Platinum Off Exchange Plan","88.47%","0.888296604156494","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603809","http://apps.humana.com/marketing/documents.asp?file=2591641","45"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160018","Humana Platinum 500/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160018-01","Standard Platinum On Exchange Plan","88.47%","0.888296604156494","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603809","http://apps.humana.com/marketing/documents.asp?file=2591641","46"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160018","Humana Platinum 500/Tampa Bay HUMx (HMOx)","35783FL116",,"FLN003","FLS003","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160018-03","Limited Cost Sharing Plan Variation","88.47%","0.888296604156494","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603835","http://apps.humana.com/marketing/documents.asp?file=2591641","48"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160032","Humana Silver 3800/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160032-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603900","http://apps.humana.com/marketing/documents.asp?file=2591680","49"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160032","Humana Silver 3800/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160032-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603900","http://apps.humana.com/marketing/documents.asp?file=2591680","50"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160032","Humana Silver 3800/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160032-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603913","http://apps.humana.com/marketing/documents.asp?file=2591680","51"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160032","Humana Silver 3800/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160032-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603926","http://apps.humana.com/marketing/documents.asp?file=2591680","52"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160032","Humana Silver 3800/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160032-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603939","http://apps.humana.com/marketing/documents.asp?file=2622737","53"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160032","Humana Silver 3800/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160032-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603952","http://apps.humana.com/marketing/documents.asp?file=2622750","54"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160032","Humana Silver 3800/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160032-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603965","http://apps.humana.com/marketing/documents.asp?file=2622763","55"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160033","Humana Gold 2250/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160033-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603978","http://apps.humana.com/marketing/documents.asp?file=2591693","56"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160033","Humana Gold 2250/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160033-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603978","http://apps.humana.com/marketing/documents.asp?file=2591693","57"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160033","Humana Gold 2250/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160033-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603991","http://apps.humana.com/marketing/documents.asp?file=2591693","58"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160033","Humana Gold 2250/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160033-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604004","http://apps.humana.com/marketing/documents.asp?file=2591693","59"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160034","Humana Platinum 500/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160034-00","Standard Platinum Off Exchange Plan","88.47%","0.888296604156494","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604017","http://apps.humana.com/marketing/documents.asp?file=2591706","60"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160034","Humana Platinum 500/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160034-01","Standard Platinum On Exchange Plan","88.47%","0.888296604156494","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604017","http://apps.humana.com/marketing/documents.asp?file=2591706","61"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160034","Humana Platinum 500/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160034-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604030","http://apps.humana.com/marketing/documents.asp?file=2591706","62"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160034","Humana Platinum 500/Volusia HUMx (HMOx)","35783FL116",,"FLN005","FLS005","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160034-03","Limited Cost Sharing Plan Variation","88.47%","0.888296604156494","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604043","http://apps.humana.com/marketing/documents.asp?file=2591706","63"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160038","Humana Silver 3800/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160038-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603432","http://apps.humana.com/marketing/documents.asp?file=2591537","64"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160038","Humana Silver 3800/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160038-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603432","http://apps.humana.com/marketing/documents.asp?file=2591537","65"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160038","Humana Silver 3800/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160038-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603445","http://apps.humana.com/marketing/documents.asp?file=2591537","66"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160038","Humana Silver 3800/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160038-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603458","http://apps.humana.com/marketing/documents.asp?file=2591537","67"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160038","Humana Silver 3800/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160038-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603471","http://apps.humana.com/marketing/documents.asp?file=2622659","68"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160038","Humana Silver 3800/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160038-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603484","http://apps.humana.com/marketing/documents.asp?file=2622672","69"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160038","Humana Silver 3800/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160038-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603497","http://apps.humana.com/marketing/documents.asp?file=2622685","70"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160039","Humana Gold 2250/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160039-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603510","http://apps.humana.com/marketing/documents.asp?file=2591550","71"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160039","Humana Gold 2250/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160039-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603510","http://apps.humana.com/marketing/documents.asp?file=2591550","72"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160040","Humana Platinum 500/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS006","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160040-00","Standard Platinum Off Exchange Plan","88.47%","0.888296604156494","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603549","http://apps.humana.com/marketing/documents.asp?file=2591563","75"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160044","Humana Silver 3800/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160044-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603432","http://apps.humana.com/marketing/documents.asp?file=2591537","79"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160044","Humana Silver 3800/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160044-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603432","http://apps.humana.com/marketing/documents.asp?file=2591537","80"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160044","Humana Silver 3800/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160044-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603445","http://apps.humana.com/marketing/documents.asp?file=2591537","81"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160044","Humana Silver 3800/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160044-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603458","http://apps.humana.com/marketing/documents.asp?file=2591537","82"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160044","Humana Silver 3800/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160044-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603471","http://apps.humana.com/marketing/documents.asp?file=2622659","83"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160044","Humana Silver 3800/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160044-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603484","http://apps.humana.com/marketing/documents.asp?file=2622672","84"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160044","Humana Silver 3800/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160044-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603497","http://apps.humana.com/marketing/documents.asp?file=2622685","85"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160045","Humana Gold 2250/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160045-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603510","http://apps.humana.com/marketing/documents.asp?file=2591550","86"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160045","Humana Gold 2250/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160045-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603510","http://apps.humana.com/marketing/documents.asp?file=2591550","87"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160045","Humana Gold 2250/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160045-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603523","http://apps.humana.com/marketing/documents.asp?file=2591550","88"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160045","Humana Gold 2250/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160045-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603536","http://apps.humana.com/marketing/documents.asp?file=2591550","89"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160046","Humana Platinum 500/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160046-00","Standard Platinum Off Exchange Plan","88.47%","0.888296604156494","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603549","http://apps.humana.com/marketing/documents.asp?file=2591563","90"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160046","Humana Platinum 500/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160046-01","Standard Platinum On Exchange Plan","88.47%","0.888296604156494","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603549","http://apps.humana.com/marketing/documents.asp?file=2591563","91"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160046","Humana Platinum 500/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160046-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603562","http://apps.humana.com/marketing/documents.asp?file=2591563","92"
"2016","FL","35783","HIOS","12","2016-02-03 05:57:02","4","35783","FL","Individual","No","61-1103898","35783FL1160046","Humana Platinum 500/South Florida HUMx (HMOx)","35783FL116",,"FLN004","FLS002","FLF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Chiropractors, Podiatrists, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete-FL","35783FL1160046-03","Limited Cost Sharing Plan Variation","88.47%","0.888296604156494","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2603575","http://apps.humana.com/marketing/documents.asp?file=2591563","93"
"2016","FL","38897","HIOS","3","2015-10-20 04:38:50","1","38897","FL","Individual","Yes","36-3757528","38897FL0010001","TruAssure Basic Adult or Child Dental Plan","38897FL001",,"FLN001","FLS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.83","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","38897FL0010001-00","Standard Low Off Exchange Plan","68.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$115","$115 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=FL","https://www.truassure.com/brochure?state=FL","4"
"2016","FL","38897","HIOS","3","2015-10-20 04:38:50","1","38897","FL","SHOP (Small Group)","Yes","36-3757528","38897FL0030001","TruAssure Dental Small Group Basic Plan","38897FL003",,"FLN001","FLS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.91","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","38897FL0030001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=FL","https://www.truassure.com/brochure?state=FL","4"
"2016","FL","38897","HIOS","3","2015-10-20 04:38:50","1","38897","FL","SHOP (Small Group)","Yes","36-3757528","38897FL0040001","TruAssure Dental Small Group Preferred Plan","38897FL004",,"FLN001","FLS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.91","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","38897FL0040001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=FL","https://www.truassure.com/brochure?state=FL","5"
"2016","FL","38897","HIOS","3","2015-10-20 04:38:50","1","38897","FL","Individual","Yes","36-3757528","38897FL0010001","TruAssure Basic Adult or Child Dental Plan","38897FL001",,"FLN001","FLS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.83","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","38897FL0010001-01","Standard Low On Exchange Plan","68.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$115","$115 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=FL","https://www.truassure.com/brochure?state=FL","5"
"2016","FL","38897","HIOS","3","2015-10-20 04:38:50","2","38897","FL","Individual","Yes","36-3757528","38897FL0020001","TruAssure Preferred Adult or Child Dental Plan","38897FL002",,"FLN001","FLS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.23","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","38897FL0020001-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=FL","https://www.truassure.com/brochure?state=FL","4"
"2016","FL","38897","HIOS","3","2015-10-20 04:38:50","2","38897","FL","Individual","Yes","36-3757528","38897FL0020001","TruAssure Preferred Adult or Child Dental Plan","38897FL002",,"FLN001","FLS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.23","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","38897FL0020001-01","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=FL","https://www.truassure.com/brochure?state=FL","5"
"2016","FL","43274","HIOS","3","2015-08-21 03:45:06","1","43274","FL","Individual","Yes","14-1917982","43274FL0010001","EssentialSmile Ped 221","43274FL001",,"FLN001","FLS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$24.77","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Available only for emergency services to treat an Emergency Condition.","Yes","National Network of providers is available and members may also receive services at out of network providers.","Yes","http://www.solsticecare.com/pay","","43274FL0010001-00","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","4"
"2016","FL","43274","HIOS","3","2015-08-21 03:45:06","1","43274","FL","SHOP (Small Group)","Yes","14-1917982","43274FL0020002","EssentialSmile 222","43274FL002",,"FLN001","FLS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.77","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Available only for emergency services to treat an Emergency Condition.","Yes","Out of network coverage is available to members at the out of network cost share levels.","Yes","http://www.solsticebenefits.com/paymybillcc/index.htm","","43274FL0020002-00","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","$70 per person","per group not applicable",,,,,,"$70","$70 per person","per group not applicable","$70","$70 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","4"
"2016","FL","43274","HIOS","3","2015-08-21 03:45:06","1","43274","FL","Individual","Yes","14-1917982","43274FL0010001","EssentialSmile Ped 221","43274FL001",,"FLN001","FLS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$24.77","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Available only for emergency services to treat an Emergency Condition.","Yes","National Network of providers is available and members may also receive services at out of network providers.","Yes","http://www.solsticecare.com/pay","","43274FL0010001-01","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","5"
"2016","FL","43274","HIOS","3","2015-08-21 03:45:06","2","43274","FL","Individual","Yes","14-1917982","43274FL0010002","EssentialSmile 221","43274FL001",,"FLN001","FLS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.17","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Available only for emergency services to treat an Emergency Condition.","Yes","National Network of providers is available and members may also receive services at out of network providers.","Yes","http://www.solsticecare.com/pay","","43274FL0010002-00","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","4"
"2016","FL","43274","HIOS","3","2015-08-21 03:45:06","2","43274","FL","SHOP (Small Group)","Yes","14-1917982","43274FL0040002","EssentialSmile 212","43274FL004",,"FLN002","FLS002",,"New","EPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$8.27","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Only for palliative care where a network provider is not available.","No","http://www.solsticebenefits.com/paymybillcc/index.htm","","43274FL0040002-00","Standard Low Off Exchange Plan","70.86%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","4"
"2016","FL","43274","HIOS","3","2015-08-21 03:45:06","2","43274","FL","Individual","Yes","14-1917982","43274FL0010002","EssentialSmile 221","43274FL001",,"FLN001","FLS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.17","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Available only for emergency services to treat an Emergency Condition.","Yes","National Network of providers is available and members may also receive services at out of network providers.","Yes","http://www.solsticecare.com/pay","","43274FL0010002-01","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","per group not applicable",,,,,,"$60","$60 per person","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","5"
"2016","FL","43274","HIOS","3","2015-08-21 03:45:06","3","43274","FL","Individual","Yes","14-1917982","43274FL0030002","EssentialSmile211","43274FL003",,"FLN002","FLS002",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$8.27","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Only for palliative care where a network provider is not available.","No","http://www.solsticecare.com/pay","","43274FL0030002-00","Standard Low Off Exchange Plan","70.86%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","4"
"2016","FL","43274","HIOS","3","2015-08-21 03:45:06","3","43274","FL","Individual","Yes","14-1917982","43274FL0030002","EssentialSmile211","43274FL003",,"FLN002","FLS002",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$8.27","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Only for palliative care where a network provider is not available.","No","http://www.solsticecare.com/pay","","43274FL0030002-01","Standard Low On Exchange Plan","70.86%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","http://www.solsticecare.com/summary-of-benefits.aspx?a=20XHGS0L15","5"
"2016","FL","48121","HIOS","8","2015-07-22 02:19:34","1","48121","FL","Individual","Yes","59-1031071","48121FL0030001","Cigna Dental Pediatric","48121FL003","7730182962","FLN002","FLS002",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$21.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Service Only","Yes","All Services","Yes",,"","48121FL0030001-00","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/individuals-families/2016-plans/sob/florida/dental-pediatric","4"
"2016","FL","48121","HIOS","8","2015-07-22 02:19:34","1","48121","FL","Individual","Yes","59-1031071","48121FL0030001","Cigna Dental Pediatric","48121FL003","7730182962","FLN002","FLS002",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$21.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Service Only","Yes","All Services","Yes",,"","48121FL0030001-01","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/individuals-families/2016-plans/sob/florida/dental-pediatric","5"
"2016","FL","48121","HIOS","8","2015-07-22 02:19:34","2","48121","FL","Individual","Yes","59-1031071","48121FL0030002","Cigna Dental Family + Pediatric","48121FL003","7730182962","FLN002","FLS002",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","All Services","Yes",,"","48121FL0030002-01","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/individuals-families/2016-plans/sob/florida/dental-family-ped","4"
"2016","FL","48129","HIOS","2","2015-05-08 02:15:08","1","48129","FL","SHOP (Small Group)","Yes","47-0397286","48129FL0100001","Renaissance Group Dental PPO, EHB Certified","48129FL010",,"FLN001","FLS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.74","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","48129FL0100001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","FL","48129","HIOS","2","2015-05-08 02:15:08","1","48129","FL","Individual","Yes","47-0397286","48129FL0070001","Delta Dental Individual PPO, EHB Certified","48129FL007",,"FLN002","FLS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.97","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","48129FL0070001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","FL","48129","HIOS","2","2015-05-08 02:15:08","1","48129","FL","Individual","Yes","47-0397286","48129FL0070002","Delta Dental Individual PPO, EHB Certified","48129FL007",,"FLN002","FLS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.10","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","48129FL0070002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","FL","48129","HIOS","2","2015-05-08 02:15:08","1","48129","FL","SHOP (Small Group)","Yes","47-0397286","48129FL0100002","Renaissance Group Dental PPO, EHB Certified","48129FL010",,"FLN001","FLS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.26","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","48129FL0100002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","FL","48129","HIOS","2","2015-05-08 02:15:08","1","48129","FL","Individual","Yes","47-0397286","48129FL0080001","Renaissance Individual Dental PPO, EHB Certified","48129FL008",,"FLN001","FLS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.00","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","48129FL0080001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","FL","48129","HIOS","2","2015-05-08 02:15:08","2","48129","FL","Individual","Yes","47-0397286","48129FL0150002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","48129FL015",,"FLN001","FLS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$25.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/48129","","48129FL0150002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/FL_Ped_Low_2016","http://www.renaissancedental.com/FL_Ped_Low_2016","7"
"2016","FL","49193","HIOS","6","2015-08-25 05:06:23","1","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0270001","Smile for Health - Certified Optimum Coverage","49193FL027",,"FLN001","FLS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49193FL0270001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","FL","54172","HIOS","5","2015-11-16 04:35:20","3","54172","FL","Individual","No","26-0155137","54172FL0010003","Molina Marketplace Bronze Plan","54172FL001",,"FLN001","FLS001","FLF003","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/fl/en/PDF/marketplace/formulary-2016.pdf","54172FL0010003-03","Limited Cost Sharing Plan Variation",,"0.618895947933197","Yes","Yes","No","100%",,"$5,000","$20","$900","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/summary-of-benefits-bronze-2016.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/brochure-2016.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","1","56503","FL","Individual","No","26-3238817","56503FL1300003","IND Essential Plus Catastrophic HMO 36","56503FL130","7265435496","FLN001","FLS001","FLF008","Existing","HMO","Catastrophic","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1300003-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1300003-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1300003-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","1","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1600002","SMAG Essential Plus Bronze HMO 41","56503FL160","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1600002-00","Standard Bronze Off Exchange Plan",,"0.608911752700806","Yes","Yes","No","100%",,"$4,470","$20","$1,670","$150","$2,850","$0","$1,450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1600002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1600002-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","1","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1600002","SMAG Essential Plus Bronze HMO 41","56503FL160","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1600002-01","Standard Bronze On Exchange Plan",,"0.608911752700806","Yes","Yes","No","100%",,"$4,470","$20","$1,670","$150","$2,850","$0","$1,450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1600002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1600002-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","1","56503","FL","Individual","No","26-3238817","56503FL1300003","IND Essential Plus Catastrophic HMO 36","56503FL130","7265435496","FLN001","FLS001","FLF008","Existing","HMO","Catastrophic","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1300003-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1300003-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1300003-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","2","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1600001","Gym Access SMAG Essential Plus Bronze HMO 41","56503FL160","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1600001-01","Standard Bronze On Exchange Plan",,"0.608911752700806","Yes","Yes","No","100%",,"$4,470","$20","$1,670","$150","$2,850","$0","$1,450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1600001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1600001-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2610002","Gym Access IND Platinum HMO BC 5841","56503FL261","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2610002-00","Standard Platinum Off Exchange Plan",,"0.88183057308197","No","Yes","No","100%",,"$800","$40","$380","$150","$0","$550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","per person not applicable","$1600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2610002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2610002-00.pdf","4"
"2016","FL","49193","HIOS","6","2015-08-25 05:06:23","2","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0270002","Smile for Health - Certified Optimum Coverage","49193FL027",,"FLN002","FLS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49193FL0270002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","FL","49193","HIOS","6","2015-08-25 05:06:23","3","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0270003","Smile for Health - Certified Optimum Coverage","49193FL027",,"FLN003","FLS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49193FL0270003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","FL","49193","HIOS","6","2015-08-25 05:06:23","4","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0270004","Smile for Health - Certified Optimum Coverage","49193FL027",,"FLN001","FLS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49193FL0270004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","FL","49193","HIOS","6","2015-08-25 05:06:23","5","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0270005","Smile for Health - Certified Optimum Coverage","49193FL027",,"FLN002","FLS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49193FL0270005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","FL","49193","HIOS","6","2015-08-25 05:06:23","6","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0270006","Smile for Health - Certified Optimum Coverage","49193FL027",,"FLN003","FLS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49193FL0270006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","FL","49193","HIOS","6","2015-08-25 05:06:23","7","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0280001","Smile for Health - Certified High Option","49193FL028",,"FLN001","FLS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49193FL0280001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","FL","49193","HIOS","6","2015-08-25 05:06:23","8","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0280002","Smile for Health - Certified High Option","49193FL028",,"FLN002","FLS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49193FL0280002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","FL","49193","HIOS","6","2015-08-25 05:06:23","9","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0280003","Smile for Health - Certified High Option","49193FL028",,"FLN003","FLS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49193FL0280003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","FL","49193","HIOS","6","2015-08-25 05:06:23","10","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0280004","Smile for Health - Certified High Option Plus","49193FL028",,"FLN001","FLS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49193FL0280004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","FL","49193","HIOS","6","2015-08-25 05:06:23","11","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0280005","Smile for Health - Certified High Option Plus","49193FL028",,"FLN002","FLS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49193FL0280005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","FL","49193","HIOS","6","2015-08-25 05:06:23","12","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0280006","Smile for Health - Certified High Option Plus","49193FL028",,"FLN003","FLS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49193FL0280006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","1","56503","FL","Individual","No","26-3238817","56503FL1320003","IND Essential Plus Catastrophic POS 37","56503FL132","7265435496","FLN001","FLS001","FLF008","Existing","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1320003-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,500","per person not applicable","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"$13,500","per person not applicable","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1320003-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1320003-00.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","1","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1680002","SMAG Essential Plus Bronze POS 42","56503FL168","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1680002-00","Standard Bronze Off Exchange Plan",,"0.609838604927063","Yes","Yes","No","100%",,"$4,470","$20","$1,530","$150","$2,850","$0","$1,330","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","55%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1680002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1680002-00.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","1","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1680002","SMAG Essential Plus Bronze POS 42","56503FL168","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1680002-01","Standard Bronze On Exchange Plan",,"0.609838604927063","Yes","Yes","No","100%",,"$4,470","$20","$1,530","$150","$2,850","$0","$1,330","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","55%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1680002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1680002-01.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","1","56503","FL","Individual","No","26-3238817","56503FL1320003","IND Essential Plus Catastrophic POS 37","56503FL132","7265435496","FLN001","FLS001","FLF008","Existing","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1320003-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,500","per person not applicable","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"$13,500","per person not applicable","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1320003-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1300003-01.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","2","56503","FL","Individual","No","26-3238817","56503FL1300001","Gym Access IND Essential Plus Catastrophic HMO 36","56503FL130","7265435496","FLN001","FLS001","FLF008","Existing","HMO","Catastrophic","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1300001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1300001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1300001-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","2","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1600001","Gym Access SMAG Essential Plus Bronze HMO 41","56503FL160","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1600001-00","Standard Bronze Off Exchange Plan",,"0.608911752700806","Yes","Yes","No","100%",,"$4,470","$20","$1,670","$150","$2,850","$0","$1,450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1600001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1600001-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","13","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2150002","SMAG Bronze POS HSA 4700/6450","56503FL215","7265435496","FLN001","FLS001","FLF006","Existing","POS","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2150002-01","Standard Bronze On Exchange Plan",,"0.618407964706421","Yes","Yes","No","100%",,"$4,700","$20","$770","$150","$4,700","$60","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","per person not applicable","$9400 per group","30%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2150002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2150002-01.pdf","11"
"2016","FL","54172","HIOS","5","2015-11-16 04:35:20","1","54172","FL","Individual","No","26-0155137","54172FL0010001","Molina Marketplace Gold Plan","54172FL001",,"FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/fl/en/PDF/marketplace/formulary-2016.pdf","54172FL0010001-00","Standard Gold Off Exchange Plan",,"0.801033437252045","No","Yes","No","100%",,"$500","$240","$890","$150","$500","$770","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/summary-of-benefits-gold-2016.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/brochure-2016.pdf","4"
"2016","FL","54172","HIOS","5","2015-11-16 04:35:20","1","54172","FL","Individual","No","26-0155137","54172FL0010001","Molina Marketplace Gold Plan","54172FL001",,"FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/fl/en/PDF/marketplace/formulary-2016.pdf","54172FL0010001-01","Standard Gold On Exchange Plan",,"0.801033437252045","No","Yes","No","100%",,"$500","$240","$890","$150","$500","$770","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/summary-of-benefits-gold-2016.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/brochure-2016.pdf","5"
"2016","FL","54172","HIOS","5","2015-11-16 04:35:20","1","54172","FL","Individual","No","26-0155137","54172FL0010001","Molina Marketplace Gold Plan","54172FL001",,"FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/fl/en/PDF/marketplace/formulary-2016.pdf","54172FL0010001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/summary-of-benefits-gold-aian-2016.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/brochure-2016.pdf","6"
"2016","FL","54172","HIOS","5","2015-11-16 04:35:20","1","54172","FL","Individual","No","26-0155137","54172FL0010001","Molina Marketplace Gold Plan","54172FL001",,"FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/fl/en/PDF/marketplace/formulary-2016.pdf","54172FL0010001-03","Limited Cost Sharing Plan Variation",,"0.801033437252045","No","Yes","No","100%",,"$500","$240","$890","$150","$500","$770","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/summary-of-benefits-gold-2016.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/brochure-2016.pdf","7"
"2016","FL","54172","HIOS","5","2015-11-16 04:35:20","2","54172","FL","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver Plan","54172FL001",,"FLN001","FLS001","FLF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/fl/en/PDF/marketplace/formulary-2016.pdf","54172FL0010002-00","Standard Silver Off Exchange Plan",,"0.714607775211334","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/summary-of-benefits-silver-250-2016.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/brochure-2016.pdf","4"
"2016","FL","54172","HIOS","5","2015-11-16 04:35:20","2","54172","FL","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver Plan","54172FL001",,"FLN001","FLS001","FLF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/fl/en/PDF/marketplace/formulary-2016.pdf","54172FL0010002-01","Standard Silver On Exchange Plan",,"0.714607775211334","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/summary-of-benefits-silver-250-2016.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/brochure-2016.pdf","5"
"2016","FL","54172","HIOS","5","2015-11-16 04:35:20","2","54172","FL","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver Plan","54172FL001",,"FLN001","FLS001","FLF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/fl/en/PDF/marketplace/formulary-2016.pdf","54172FL0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/summary-of-benefits-silver-aian-2016.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/brochure-2016.pdf","6"
"2016","FL","54172","HIOS","5","2015-11-16 04:35:20","2","54172","FL","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver Plan","54172FL001",,"FLN001","FLS001","FLF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/fl/en/PDF/marketplace/formulary-2016.pdf","54172FL0010002-03","Limited Cost Sharing Plan Variation",,"0.714607775211334","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/summary-of-benefits-silver-250-2016.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/brochure-2016.pdf","7"
"2016","FL","54172","HIOS","5","2015-11-16 04:35:20","2","54172","FL","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver Plan","54172FL001",,"FLN001","FLS001","FLF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/fl/en/PDF/marketplace/formulary-2016.pdf","54172FL0010002-04","73% AV Level Silver Plan",,"0.739822447299957","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/summary-of-benefits-silver-200-2016.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/brochure-2016.pdf","8"
"2016","FL","54172","HIOS","5","2015-11-16 04:35:20","2","54172","FL","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver Plan","54172FL001",,"FLN001","FLS001","FLF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/fl/en/PDF/marketplace/formulary-2016.pdf","54172FL0010002-05","87% AV Level Silver Plan",,"0.878527700901031","No","Yes","No","100%",,"$450","$180","$890","$150","$450","$320","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$450","$450 per person","$900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/summary-of-benefits-silver-150-2016.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/brochure-2016.pdf","9"
"2016","FL","54172","HIOS","5","2015-11-16 04:35:20","2","54172","FL","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver Plan","54172FL001",,"FLN001","FLS001","FLF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/fl/en/PDF/marketplace/formulary-2016.pdf","54172FL0010002-06","94% AV Level Silver Plan",,"0.947116374969482","No","Yes","No","100%",,"$0","$210","$450","$150","$0","$180","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/summary-of-benefits-silver-100-2016.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/brochure-2016.pdf","10"
"2016","FL","54172","HIOS","5","2015-11-16 04:35:20","3","54172","FL","Individual","No","26-0155137","54172FL0010003","Molina Marketplace Bronze Plan","54172FL001",,"FLN001","FLS001","FLF003","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/fl/en/PDF/marketplace/formulary-2016.pdf","54172FL0010003-00","Standard Bronze Off Exchange Plan",,"0.618895947933197","Yes","Yes","No","100%",,"$5,000","$20","$900","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/summary-of-benefits-bronze-2016.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/brochure-2016.pdf","4"
"2016","FL","54172","HIOS","5","2015-11-16 04:35:20","3","54172","FL","Individual","No","26-0155137","54172FL0010003","Molina Marketplace Bronze Plan","54172FL001",,"FLN001","FLS001","FLF003","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/fl/en/PDF/marketplace/formulary-2016.pdf","54172FL0010003-01","Standard Bronze On Exchange Plan",,"0.618895947933197","Yes","Yes","No","100%",,"$5,000","$20","$900","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/summary-of-benefits-bronze-2016.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/brochure-2016.pdf","5"
"2016","FL","54172","HIOS","5","2015-11-16 04:35:20","3","54172","FL","Individual","No","26-0155137","54172FL0010003","Molina Marketplace Bronze Plan","54172FL001",,"FLN001","FLS001","FLF003","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/fl/en/PDF/marketplace/formulary-2016.pdf","54172FL0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/summary-of-benefits-bronze-aian-2016.pdf","http://www.molinahealthcare.com/members/fl/en-US/PDF/marketplace/brochure-2016.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","2","56503","FL","Individual","No","26-3238817","56503FL1300001","Gym Access IND Essential Plus Catastrophic HMO 36","56503FL130","7265435496","FLN001","FLS001","FLF008","Existing","HMO","Catastrophic","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1300001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1300001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1300001-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","2","56503","FL","Individual","No","26-3238817","56503FL1320001","Gym Access IND Essential Plus Catastrophic POS 37","56503FL132","7265435496","FLN001","FLS001","FLF008","Existing","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1320001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,500","per person not applicable","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"$13,500","per person not applicable","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1320001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1320001-00.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","2","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1680001","Gym Access SMAG Essential Plus Bronze POS 42","56503FL168","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1680001-00","Standard Bronze Off Exchange Plan",,"0.609838604927063","Yes","Yes","No","100%",,"$4,470","$20","$1,530","$150","$2,850","$0","$1,330","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","55%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1680001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1680001-00.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","2","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1680001","Gym Access SMAG Essential Plus Bronze POS 42","56503FL168","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1680001-01","Standard Bronze On Exchange Plan",,"0.609838604927063","Yes","Yes","No","100%",,"$4,470","$20","$1,530","$150","$2,850","$0","$1,330","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","55%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1680001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1680001-01.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","2","56503","FL","Individual","No","26-3238817","56503FL1320001","Gym Access IND Essential Plus Catastrophic POS 37","56503FL132","7265435496","FLN001","FLS001","FLF008","Existing","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1320001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,500","per person not applicable","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"$13,500","per person not applicable","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1320001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1320001-01.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","3","56503","FL","Individual","No","26-3238817","56503FL1380002","IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1380002-00","Standard Bronze Off Exchange Plan",,"0.608911752700806","Yes","Yes","No","100%",,"$4,470","$20","$1,670","$150","$2,850","$0","$1,450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1380002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1380002-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","3","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1550002","SMAG Essential Plus Silver HMO 53","56503FL155","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1550002-00","Standard Silver Off Exchange Plan",,"0.715083658695221","No","No","No","100%",,"$1,720","$0","$2,220","$150","$400","$360","$970","$80","$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,700","per person not applicable","$3400 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","per person not applicable","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1550002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1550002-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","3","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1550002","SMAG Essential Plus Silver HMO 53","56503FL155","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1550002-01","Standard Silver On Exchange Plan",,"0.715083658695221","No","No","No","100%",,"$1,720","$0","$2,220","$150","$400","$360","$970","$80","$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,700","per person not applicable","$3400 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","per person not applicable","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1550002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1550002-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","3","56503","FL","Individual","No","26-3238817","56503FL1380002","IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1380002-01","Standard Bronze On Exchange Plan",,"0.608911752700806","Yes","Yes","No","100%",,"$4,470","$20","$1,670","$150","$2,850","$0","$1,450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1380002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1380002-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","3","56503","FL","Individual","No","26-3238817","56503FL1380002","IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1380002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1380002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL1380002-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","3","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1630002","SMAG Essential Plus Silver POS 54","56503FL163","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1630002-00","Standard Silver Off Exchange Plan",,"0.714591979980469","No","No","No","100%",,"$2,220","$0","$1,360","$150","$400","$360","$690","$80","$4,300","$4300 per person","$8600 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$400","per person not applicable","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1630002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1630002-00.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","3","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1630002","SMAG Essential Plus Silver POS 54","56503FL163","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1630002-01","Standard Silver On Exchange Plan",,"0.714591979980469","No","No","No","100%",,"$2,220","$0","$1,360","$150","$400","$360","$690","$80","$4,300","$4300 per person","$8600 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$400","per person not applicable","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1630002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1630002-01.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","3","56503","FL","Individual","No","26-3238817","56503FL1380002","IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1380002-03","Limited Cost Sharing Plan Variation",,"0.608911752700806","Yes","Yes","No","100%",,"$4,470","$20","$1,670","$150","$2,850","$0","$1,450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1380002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL1380002-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","3","56503","FL","Individual","No","26-3238817","56503FL1460002","IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1460002-00","Standard Bronze Off Exchange Plan",,"0.609838604927063","Yes","Yes","No","100%",,"$4,470","$20","$1,530","$150","$2,850","$0","$1,330","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","55%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1460002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1460002-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","3","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2290002","SMAG Silver HMO 6600","56503FL229","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2290002-00","Standard Silver Off Exchange Plan",,"0.688657462596893","No","Yes","No","100%",,"$4,470","$60","$40","$150","$1,270","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","per person not applicable","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2290002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2290002-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","3","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2290002","SMAG Silver HMO 6600","56503FL229","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2290002-01","Standard Silver On Exchange Plan",,"0.688657462596893","No","Yes","No","100%",,"$4,470","$60","$40","$150","$1,270","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","per person not applicable","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2290002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2290002-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","3","56503","FL","Individual","No","26-3238817","56503FL1460002","IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1460002-01","Standard Bronze On Exchange Plan",,"0.609838604927063","Yes","Yes","No","100%",,"$4,470","$20","$1,530","$150","$2,850","$0","$1,330","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","55%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1460002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1460002-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","3","56503","FL","Individual","No","26-3238817","56503FL1460002","IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1460002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","55%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1460002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL1460002-02.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","3","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2300002","SMAG Silver HMO 6400","56503FL230","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2300002-00","Standard Silver Off Exchange Plan",,"0.701627790927887","No","Yes","No","100%",,"$0","$640","$0","$150","$1,270","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2300002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2300002-00.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","3","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2300002","SMAG Silver HMO 6400","56503FL230","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2300002-01","Standard Silver On Exchange Plan",,"0.701627790927887","No","Yes","No","100%",,"$0","$640","$0","$150","$1,270","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2300002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2300002-01.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","3","56503","FL","Individual","No","26-3238817","56503FL1460002","IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1460002-03","Limited Cost Sharing Plan Variation",,"0.609838604927063","Yes","Yes","No","100%",,"$4,470","$20","$1,530","$150","$2,850","$0","$1,330","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","55%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1460002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL1460002-03.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","3","56503","FL","Individual","No","26-3238817","56503FL2080002","IND Bronze HMO 6850","56503FL208","7265435496","FLN001","FLS001","FLF007","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","3","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2080002-00","Standard Bronze Off Exchange Plan",,"0.618737280368805","Yes","Yes","No","100%",,"$4,470","$20","$2,260","$150","$1,270","$600","$1,010","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2080002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2080002-00.pdf","12"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","3","56503","FL","Individual","No","26-3238817","56503FL2080002","IND Bronze HMO 6850","56503FL208","7265435496","FLN001","FLS001","FLF007","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","3","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2080002-01","Standard Bronze On Exchange Plan",,"0.618737280368805","Yes","Yes","No","100%",,"$4,470","$20","$2,260","$150","$1,270","$600","$1,010","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2080002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2080002-01.pdf","13"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","3","56503","FL","Individual","No","26-3238817","56503FL2080002","IND Bronze HMO 6850","56503FL208","7265435496","FLN001","FLS001","FLF007","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","3","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2080002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2080002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2080002-02.pdf","14"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","3","56503","FL","Individual","No","26-3238817","56503FL2080002","IND Bronze HMO 6850","56503FL208","7265435496","FLN001","FLS001","FLF007","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","3","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2080002-03","Limited Cost Sharing Plan Variation",,"0.618737280368805","Yes","Yes","No","100%",,"$4,470","$20","$2,260","$150","$1,270","$600","$1,010","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2080002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2080002-03.pdf","15"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","4","56503","FL","Individual","No","26-3238817","56503FL1380001","Gym Access IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1380001-00","Standard Bronze Off Exchange Plan",,"0.608911752700806","Yes","Yes","No","100%",,"$4,470","$20","$1,670","$150","$2,850","$0","$1,450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1380001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1380001-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","4","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1550001","Gym Access SMAG Essential Plus Silver HMO 53","56503FL155","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1550001-00","Standard Silver Off Exchange Plan",,"0.715083658695221","No","No","No","100%",,"$1,720","$0","$2,220","$150","$400","$360","$970","$80","$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,700","per person not applicable","$3400 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","per person not applicable","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1550001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1550001-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","4","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1550001","Gym Access SMAG Essential Plus Silver HMO 53","56503FL155","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1550001-01","Standard Silver On Exchange Plan",,"0.715083658695221","No","No","No","100%",,"$1,720","$0","$2,220","$150","$400","$360","$970","$80","$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,700","per person not applicable","$3400 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","per person not applicable","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1550001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1550001-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","4","56503","FL","Individual","No","26-3238817","56503FL1380001","Gym Access IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1380001-01","Standard Bronze On Exchange Plan",,"0.608911752700806","Yes","Yes","No","100%",,"$4,470","$20","$1,670","$150","$2,850","$0","$1,450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1380001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1380001-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","4","56503","FL","Individual","No","26-3238817","56503FL1380001","Gym Access IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1380001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1380001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL1380001-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","4","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1630001","Gym Access SMAG Essential Plus Silver POS 54","56503FL163","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1630001-00","Standard Silver Off Exchange Plan",,"0.714591979980469","No","No","No","100%",,"$2,220","$0","$1,360","$150","$400","$360","$690","$80","$4,300","$4300 per person","$8600 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$400","per person not applicable","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1630001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1630001-00.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","4","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1630001","Gym Access SMAG Essential Plus Silver POS 54","56503FL163","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1630001-01","Standard Silver On Exchange Plan",,"0.714591979980469","No","No","No","100%",,"$2,220","$0","$1,360","$150","$400","$360","$690","$80","$4,300","$4300 per person","$8600 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$400","per person not applicable","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1630001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1630001-01.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","4","56503","FL","Individual","No","26-3238817","56503FL1380001","Gym Access IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1380001-03","Limited Cost Sharing Plan Variation",,"0.608911752700806","Yes","Yes","No","100%",,"$4,470","$20","$1,670","$150","$2,850","$0","$1,450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1380001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL1380001-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","4","56503","FL","Individual","No","26-3238817","56503FL1460001","Gym Access IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1460001-00","Standard Bronze Off Exchange Plan",,"0.609838604927063","Yes","Yes","No","100%",,"$4,470","$20","$1,530","$150","$2,850","$0","$1,330","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","55%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1460001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1460001-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","4","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2290001","Gym Access SMAG Silver HMO 6600","56503FL229","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2290001-00","Standard Silver Off Exchange Plan",,"0.688657462596893","No","Yes","No","100%",,"$4,470","$60","$40","$150","$1,270","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","per person not applicable","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2290001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2290001-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","4","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2290001","Gym Access SMAG Silver HMO 6600","56503FL229","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2290001-01","Standard Silver On Exchange Plan",,"0.688657462596893","No","Yes","No","100%",,"$4,470","$60","$40","$150","$1,270","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","per person not applicable","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2290001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2290001-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","4","56503","FL","Individual","No","26-3238817","56503FL1460001","Gym Access IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1460001-01","Standard Bronze On Exchange Plan",,"0.609838604927063","Yes","Yes","No","100%",,"$4,470","$20","$1,530","$150","$2,850","$0","$1,330","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","55%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1460001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1460001-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","4","56503","FL","Individual","No","26-3238817","56503FL1460001","Gym Access IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1460001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","55%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1460001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL1460001-02.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","4","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2300001","Gym Access SMAG Silver HMO 6400","56503FL230","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2300001-00","Standard Silver Off Exchange Plan",,"0.701627790927887","No","Yes","No","100%",,"$0","$640","$0","$150","$1,270","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL300001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2300001-00.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","4","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2300001","Gym Access SMAG Silver HMO 6400","56503FL230","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2300001-01","Standard Silver On Exchange Plan",,"0.701627790927887","No","Yes","No","100%",,"$0","$640","$0","$150","$1,270","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2300001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2300001-01.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","4","56503","FL","Individual","No","26-3238817","56503FL1460001","Gym Access IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF003","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1460001-03","Limited Cost Sharing Plan Variation",,"0.609838604927063","Yes","Yes","No","100%",,"$4,470","$20","$1,530","$150","$2,850","$0","$1,330","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$20,000","per person not applicable","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","55%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1460001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL1460001-03.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","4","56503","FL","Individual","No","26-3238817","56503FL2080001","Gym Access IND Bronze HMO 6850","56503FL208","7265435496","FLN001","FLS001","FLF007","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","3","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2080001-00","Standard Bronze Off Exchange Plan",,"0.618737280368805","Yes","Yes","No","100%",,"$4,470","$20","$2,260","$150","$1,270","$600","$1,010","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2080001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2080001-00.pdf","12"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","4","56503","FL","Individual","No","26-3238817","56503FL2080001","Gym Access IND Bronze HMO 6850","56503FL208","7265435496","FLN001","FLS001","FLF007","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","3","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2080001-01","Standard Bronze On Exchange Plan",,"0.618737280368805","Yes","Yes","No","100%",,"$4,470","$20","$2,260","$150","$1,270","$600","$1,010","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2080001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2080001-01.pdf","13"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","4","56503","FL","Individual","No","26-3238817","56503FL2080001","Gym Access IND Bronze HMO 6850","56503FL208","7265435496","FLN001","FLS001","FLF007","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","3","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2080001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2080001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2080001-02.pdf","14"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","4","56503","FL","Individual","No","26-3238817","56503FL2080001","Gym Access IND Bronze HMO 6850","56503FL208","7265435496","FLN001","FLS001","FLF007","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","3","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2080001-03","Limited Cost Sharing Plan Variation",,"0.618737280368805","Yes","Yes","No","100%",,"$4,470","$20","$2,260","$150","$1,270","$600","$1,010","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2080001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2080001-03.pdf","15"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL1330002","IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1330002-00","Standard Silver Off Exchange Plan",,"0.715083658695221","No","No","No","100%",,"$1,720","$0","$2,220","$150","$400","$360","$970","$80","$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,700","per person not applicable","$3400 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","per person not applicable","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1330002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1330002-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1690002","SMAG Essential Plus Gold POS 64","56503FL169","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1690002-00","Standard Gold Off Exchange Plan",,"0.818433821201324","No","No","No","100%",,"$1,600","$60","$300","$150","$1,270","$800","$0","$80","$3,500","$3500 per person","$7000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,600","per person not applicable","$3200 per group","10%",,,,,"$3,200","per person not applicable","$6400 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1690002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1690002-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1690002","SMAG Essential Plus Gold POS 64","56503FL169","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1690002-01","Standard Gold On Exchange Plan",,"0.818433821201324","No","No","No","100%",,"$1,600","$60","$300","$150","$1,270","$800","$0","$80","$3,500","$3500 per person","$7000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,600","per person not applicable","$3200 per group","10%",,,,,"$3,200","per person not applicable","$6400 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1690002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1690002-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL1330002","IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1330002-01","Standard Silver On Exchange Plan",,"0.715083658695221","No","No","No","100%",,"$1,720","$0","$2,220","$150","$400","$360","$970","$80","$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,700","per person not applicable","$3400 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","per person not applicable","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1330002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1330002-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL1330002","IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1330002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1330002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL1330002-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2280002","SMAG Gold HMO 4500","56503FL228","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2280002-00","Standard Gold Off Exchange Plan",,"0.803261697292328","No","Yes","No","100%",,"$0","$300","$20","$150","$0","$600","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2280002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2280002-00.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2280002","SMAG Gold HMO 4500","56503FL228","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2280002-01","Standard Gold On Exchange Plan",,"0.803261697292328","No","Yes","No","100%",,"$0","$300","$20","$150","$0","$600","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2280002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2280002-01.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL1330002","IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1330002-03","Limited Cost Sharing Plan Variation",,"0.715083658695221","No","No","No","100%",,"$1,720","$0","$2,220","$150","$400","$360","$970","$80","$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,700","per person not applicable","$3400 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","per person not applicable","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1330002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL1330002-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL1330002","IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1330002-04","73% AV Level Silver Plan",,"0.737517118453979","No","No","No","100%",,"$1,650","$0","$1,750","$150","$250","$390","$970","$80","$3,700","$3700 per person","$7400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,650","per person not applicable","$3300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","per person not applicable","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1330002-04.pdf","http://www.fhcp.com/ISOB/2016/56503FL1330002-04.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2310002","SMAG Gold HMO 5000","56503FL231","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2310002-00","Standard Gold Off Exchange Plan",,"0.81102043390274","No","Yes","No","100%",,"$1,500","$50","$590","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","per person not applicable","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2310002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2310002-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2310002","SMAG Gold HMO 5000","56503FL231","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2310002-01","Standard Gold On Exchange Plan",,"0.81102043390274","No","Yes","No","100%",,"$1,500","$50","$590","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","per person not applicable","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2310002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2310002-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL1330002","IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1330002-05","87% AV Level Silver Plan",,"0.876047730445862","No","No","No","100%",,"$250","$0","$1,500","$150","$150","$390","$970","$80","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$250","per person not applicable","$500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","per person not applicable","$300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1330002-05.pdf","http://www.fhcp.com/ISOB/2016/56503FL1330002-05.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL1330002","IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1330002-06","94% AV Level Silver Plan",,"0.937038838863373","No","No","No","100%",,"$50","$0","$450","$150","$30","$170","$310","$80","$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$50","per person not applicable","$100 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","per person not applicable","$50 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1330002-06.pdf","http://www.fhcp.com/ISOB/2016/56503FL1330002-06.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2320002","SMAG Gold POS 5000","56503FL232","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2320002-00","Standard Gold Off Exchange Plan",,"0.81102043390274","No","Yes","No","100%",,"$1,500","$50","$590","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","per person not applicable","$3000 per group","20%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2320002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2320002-00.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2320002","SMAG Gold POS 5000","56503FL232","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2320002-01","Standard Gold On Exchange Plan",,"0.81102043390274","No","Yes","No","100%",,"$1,500","$50","$590","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","per person not applicable","$3000 per group","20%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2320002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2320002-01.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL1410002","IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1410002-00","Standard Silver Off Exchange Plan",,"0.714591979980469","No","No","No","100%",,"$2,220","$0","$1,360","$150","$400","$360","$690","$80","$4,300","$4300 per person","$8600 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$400","per person not applicable","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1410002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1410002-00.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL1410002","IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1410002-01","Standard Silver On Exchange Plan",,"0.714591979980469","No","No","No","100%",,"$2,220","$0","$1,360","$150","$400","$360","$690","$80","$4,300","$4300 per person","$8600 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$400","per person not applicable","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1410002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1410002-01.pdf","12"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2330002","SMAG Gold HMO 5500","56503FL233","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2330002-00","Standard Gold Off Exchange Plan",,"0.794270575046539","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2330002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2330002-00.pdf","12"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2330002","SMAG Gold HMO 5500","56503FL233","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2330002-01","Standard Gold On Exchange Plan",,"0.794270575046539","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2330002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2330002-01.pdf","13"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL1410002","IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1410002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1410002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL1410002-02.pdf","13"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL1410002","IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1410002-03","Limited Cost Sharing Plan Variation",,"0.714591979980469","No","No","No","100%",,"$2,220","$0","$1,360","$150","$400","$360","$690","$80","$4,300","$4300 per person","$8600 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$400","per person not applicable","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1410002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL1410002-03.pdf","14"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2340002","SMAG Gold POS 5500","56503FL234","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2340002-00","Standard Gold Off Exchange Plan",,"0.794270575046539","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2340002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2340002-00.pdf","14"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2340002","SMAG Gold POS 5500","56503FL234","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2340002-01","Standard Gold On Exchange Plan",,"0.794270575046539","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2340002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2340002-01.pdf","15"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL1410002","IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1410002-04","73% AV Level Silver Plan",,"0.735887050628662","No","No","No","100%",,"$2,020","$0","$1,420","$150","$250","$390","$690","$80","$3,900","$3900 per person","$7800 per group",,,,"$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,900","per person not applicable","$3800 per group","30%",,,,,"$3,400","per person not applicable","$6800 per group","Not Applicable","per person not applicable","per group not applicable","$250","per person not applicable","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1410002-04.pdf","http://www.fhcp.com/ISOB/2016/56503FL1410002-04.pdf","15"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL1410002","IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1410002-05","87% AV Level Silver Plan",,"0.876545369625092","No","No","No","100%",,"$250","$0","$850","$150","$150","$390","$690","$80","$1,100","$1100 per person","$2200 per group",,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$250","per person not applicable","$500 per group","30%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$150","per person not applicable","$300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1410002-05.pdf","http://www.fhcp.com/ISOB/2016/56503FL1410002-05.pdf","16"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL1410002","IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1410002-06","94% AV Level Silver Plan",,"0.93961626291275","No","No","No","100%",,"$50","$0","$450","$150","$30","$300","$420","$80","$500","$500 per person","$1000 per group",,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$50","per person not applicable","$100 per group","20%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$25","per person not applicable","$50 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1410002-06.pdf","http://www.fhcp.com/ISOB/2016/56503FL1410002-06.pdf","17"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL2040002","IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2040002-00","Standard Silver Off Exchange Plan",,"0.701627790927887","No","Yes","No","100%",,"$0","$640","$0","$150","$1,270","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2040002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2040002-00.pdf","18"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL2040002","IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2040002-01","Standard Silver On Exchange Plan",,"0.701627790927887","No","Yes","No","100%",,"$0","$640","$0","$150","$1,270","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2040002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2040002-01.pdf","19"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL2040002","IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2040002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2040002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2040002-02.pdf","20"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL2040002","IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2040002-03","Limited Cost Sharing Plan Variation",,"0.701627790927887","No","Yes","No","100%",,"$0","$640","$0","$150","$1,270","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2040002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2040002-03.pdf","21"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL2040002","IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2040002-04","73% AV Level Silver Plan",,"0.726126194000244","No","Yes","No","100%",,"$0","$640","$0","$150","$1,270","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,200","per person not applicable","$8400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2040002-04.pdf","http://www.fhcp.com/ISOB/2016/56503FL2040002-04.pdf","22"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL2040002","IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2040002-05","87% AV Level Silver Plan",,"0.878377199172974","No","Yes","No","100%",,"$0","$600","$0","$150","$750","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","per person not applicable","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2040002-05.pdf","http://www.fhcp.com/ISOB/2016/56503FL2040002-05.pdf","23"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL2040002","IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2040002-06","94% AV Level Silver Plan",,"0.935647487640381","No","Yes","No","100%",,"$0","$500","$0","$150","$150","$270","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","per person not applicable","$300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2040002-06.pdf","http://www.fhcp.com/ISOB/2016/56503FL2040002-06.pdf","24"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL2060002","IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2060002-00","Standard Silver Off Exchange Plan",,"0.688657462596893","No","Yes","No","100%",,"$4,470","$60","$40","$150","$1,270","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","per person not applicable","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2060002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2060002-00.pdf","25"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL2060002","IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2060002-01","Standard Silver On Exchange Plan",,"0.688657462596893","No","Yes","No","100%",,"$4,470","$60","$40","$150","$1,270","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","per person not applicable","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2060002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2060002-01.pdf","26"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL2060002","IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2060002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2060002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2060002-02.pdf","27"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL2060002","IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2060002-03","Limited Cost Sharing Plan Variation",,"0.688657462596893","No","Yes","No","100%",,"$4,470","$60","$40","$150","$1,270","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","per person not applicable","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2060002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2060002-03.pdf","28"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL2060002","IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2060002-04","73% AV Level Silver Plan",,"0.728015244007111","No","Yes","No","100%",,"$4,470","$60","$40","$150","$1,270","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","per person not applicable","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","per person not applicable","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2060002-04.pdf","http://www.fhcp.com/ISOB/2016/56503FL2060002-04.pdf","29"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL2060002","IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2060002-05","87% AV Level Silver Plan",,"0.869154870510101","No","Yes","No","100%",,"$820","$40","$770","$150","$1,000","$590","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","per person not applicable","$1300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","per person not applicable","$400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2060002-05.pdf","http://www.fhcp.com/ISOB/2016/56503FL2060002-05.pdf","30"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","5","56503","FL","Individual","No","26-3238817","56503FL2060002","IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2060002-06","94% AV Level Silver Plan",,"0.939405918121338","No","Yes","No","100%",,"$150","$40","$340","$150","$200","$250","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","per person not applicable","$300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2060002-06.pdf","http://www.fhcp.com/ISOB/2016/56503FL2060002-06.pdf","31"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1330001-00","Standard Silver Off Exchange Plan",,"0.715083658695221","No","No","No","100%",,"$1,720","$0","$2,220","$150","$400","$360","$970","$80","$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,700","per person not applicable","$3400 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","per person not applicable","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1330001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1330001-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1690001","Gym Access SMAG Essential Plus Gold POS 64","56503FL169","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1690001-00","Standard Gold Off Exchange Plan",,"0.818433821201324","No","No","No","100%",,"$1,600","$60","$300","$150","$1,270","$800","$0","$80","$3,500","$3500 per person","$7000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,600","per person not applicable","$3200 per group","10%",,,,,"$3,200","per person not applicable","$6400 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1690001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1690001-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1690001","Gym Access SMAG Essential Plus Gold POS 64","56503FL169","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1690001-01","Standard Gold On Exchange Plan",,"0.818433821201324","No","No","No","100%",,"$1,600","$60","$300","$150","$1,270","$800","$0","$80","$3,500","$3500 per person","$7000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,600","per person not applicable","$3200 per group","10%",,,,,"$3,200","per person not applicable","$6400 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1690001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1690001-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1330001-01","Standard Silver On Exchange Plan",,"0.715083658695221","No","No","No","100%",,"$1,720","$0","$2,220","$150","$400","$360","$970","$80","$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,700","per person not applicable","$3400 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","per person not applicable","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1330001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1330001-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1330001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1330001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL1330001-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2280001","Gym Access SMAG Gold HMO 4500","56503FL228","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2280001-00","Standard Gold Off Exchange Plan",,"0.803261697292328","No","Yes","No","100%",,"$0","$300","$20","$150","$0","$600","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2280001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2280001-00.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2280001","Gym Access SMAG Gold HMO 4500","56503FL228","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2280001-01","Standard Gold On Exchange Plan",,"0.803261697292328","No","Yes","No","100%",,"$0","$300","$20","$150","$0","$600","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2280001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2280001-01.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1330001-03","Limited Cost Sharing Plan Variation",,"0.715083658695221","No","No","No","100%",,"$1,720","$0","$2,220","$150","$400","$360","$970","$80","$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,700","per person not applicable","$3400 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","per person not applicable","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1330001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL1330001-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1330001-04","73% AV Level Silver Plan",,"0.737517118453979","No","No","No","100%",,"$1,650","$0","$1,750","$150","$250","$390","$970","$80","$3,700","$3700 per person","$7400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,650","per person not applicable","$3300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","per person not applicable","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1330001-04.pdf","http://www.fhcp.com/ISOB/2016/56503FL1330001-04.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2310001","Gym Access SMAG Gold HMO 5000","56503FL231","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2310001-00","Standard Gold Off Exchange Plan",,"0.81102043390274","No","Yes","No","100%",,"$1,500","$50","$590","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","per person not applicable","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2310001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2310001-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2310001","Gym Access SMAG Gold HMO 5000","56503FL231","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2310001-01","Standard Gold On Exchange Plan",,"0.81102043390274","No","Yes","No","100%",,"$1,500","$50","$590","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","per person not applicable","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2310001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2310001-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1330001-05","87% AV Level Silver Plan",,"0.876047730445862","No","No","No","100%",,"$250","$0","$1,500","$150","$150","$390","$970","$80","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$250","per person not applicable","$500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","per person not applicable","$300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1330001-05.pdf","http://www.fhcp.com/ISOB/2016/56503FL1330001-05.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1330001-06","94% AV Level Silver Plan",,"0.937038838863373","No","No","No","100%",,"$50","$0","$450","$150","$30","$170","$310","$80","$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$50","per person not applicable","$100 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$25","per person not applicable","$50 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1330001-06.pdf","http://www.fhcp.com/ISOB/2016/56503FL1330001-06.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2320001","Gym Access SMAG Gold POS 5000","56503FL232","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2320001-00","Standard Gold Off Exchange Plan",,"0.81102043390274","No","Yes","No","100%",,"$1,500","$50","$590","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","per person not applicable","$3000 per group","20%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2320001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2320001-00.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2320001","Gym Access SMAG Gold POS 5000","56503FL232","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2320001-01","Standard Gold On Exchange Plan",,"0.81102043390274","No","Yes","No","100%",,"$1,500","$50","$590","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","per person not applicable","$3000 per group","20%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2320001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2320001-01.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1410001-00","Standard Silver Off Exchange Plan",,"0.714591979980469","No","No","No","100%",,"$2,220","$0","$1,360","$150","$400","$360","$690","$80","$4,300","$4300 per person","$8600 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$400","per person not applicable","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1410001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1410001-00.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1410001-01","Standard Silver On Exchange Plan",,"0.714591979980469","No","No","No","100%",,"$2,220","$0","$1,360","$150","$400","$360","$690","$80","$4,300","$4300 per person","$8600 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$400","per person not applicable","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1410001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1410001-01.pdf","12"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2330001","Gym Access SMAG Gold HMO 5500","56503FL233","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2330001-00","Standard Gold Off Exchange Plan",,"0.794270575046539","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2330001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2330001-00.pdf","12"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2330001","Gym Access SMAG Gold HMO 5500","56503FL233","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2330001-01","Standard Gold On Exchange Plan",,"0.794270575046539","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2330001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2330001-01.pdf","13"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1410001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1410001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL1410001-02.pdf","13"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1410001-03","Limited Cost Sharing Plan Variation",,"0.714591979980469","No","No","No","100%",,"$2,220","$0","$1,360","$150","$400","$360","$690","$80","$4,300","$4300 per person","$8600 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$400","per person not applicable","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1410001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL1410001-03.pdf","14"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2340001","Gym Access SMAG Gold POS 5500","56503FL234","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2340001-00","Standard Gold Off Exchange Plan",,"0.794270575046539","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2340001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2340001-00.pdf","14"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2340001","Gym Access SMAG Gold POS 5500","56503FL234","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2340001-01","Standard Gold On Exchange Plan",,"0.794270575046539","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2340001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2340001-01.pdf","15"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1410001-04","73% AV Level Silver Plan",,"0.735887050628662","No","No","No","100%",,"$2,020","$0","$1,420","$150","$250","$390","$690","$80","$3,900","$3900 per person","$7800 per group",,,,"$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,900","per person not applicable","$3800 per group","30%",,,,,"$3,400","per person not applicable","$6800 per group","Not Applicable","per person not applicable","per group not applicable","$250","per person not applicable","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1410001-04.pdf","http://www.fhcp.com/ISOB/2016/56503FL1410001-04.pdf","15"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1410001-05","87% AV Level Silver Plan",,"0.876545369625092","No","No","No","100%",,"$250","$0","$850","$150","$150","$390","$690","$80","$1,100","$1100 per person","$2200 per group",,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$250","per person not applicable","$500 per group","30%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$150","per person not applicable","$300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1410001-05.pdf","http://www.fhcp.com/ISOB/2016/56503FL1410001-05.pdf","16"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF003","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1410001-06","94% AV Level Silver Plan",,"0.93961626291275","No","No","No","100%",,"$50","$0","$450","$150","$30","$300","$420","$80","$500","$500 per person","$1000 per group",,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$50","per person not applicable","$100 per group","20%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$25","per person not applicable","$50 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1410001-06.pdf","http://www.fhcp.com/ISOB/2016/56503FL1410001-06.pdf","17"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL2040001","Gym Access IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2040001-00","Standard Silver Off Exchange Plan",,"0.701627790927887","No","Yes","No","100%",,"$0","$640","$0","$150","$1,270","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2040001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2040001-00.pdf","18"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL2040001","Gym Access IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2040001-01","Standard Silver On Exchange Plan",,"0.701627790927887","No","Yes","No","100%",,"$0","$640","$0","$150","$1,270","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2040001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2040001-01.pdf","19"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL2040001","Gym Access IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2040001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2040001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2040001-02.pdf","20"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL2040001","Gym Access IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2040001-03","Limited Cost Sharing Plan Variation",,"0.701627790927887","No","Yes","No","100%",,"$0","$640","$0","$150","$1,270","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2040001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2040001-03.pdf","21"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL2040001","Gym Access IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2040001-04","73% AV Level Silver Plan",,"0.726126194000244","No","Yes","No","100%",,"$0","$640","$0","$150","$1,270","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,200","per person not applicable","$8400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2040001-04.pdf","http://www.fhcp.com/ISOB/2016/56503FL2040001-04.pdf","22"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL2040001","Gym Access IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2040001-05","87% AV Level Silver Plan",,"0.878377199172974","No","Yes","No","100%",,"$0","$600","$0","$150","$750","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","per person not applicable","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2040001-05.pdf","http://www.fhcp.com/ISOB/2016/56503FL2040001-05.pdf","23"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL2040001","Gym Access IND Silver HMO 6400","56503FL204","7265435496","FLN001","FLS001","FLF004","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2040001-06","94% AV Level Silver Plan",,"0.935647487640381","No","Yes","No","100%",,"$0","$500","$0","$150","$150","$270","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","per person not applicable","$300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2040001-06.pdf","http://www.fhcp.com/ISOB/2016/56503FL2040001-06.pdf","24"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL2060001","Gym Access IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2060001-00","Standard Silver Off Exchange Plan",,"0.688657462596893","No","Yes","No","100%",,"$4,470","$60","$40","$150","$1,270","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","per person not applicable","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2060001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2060001-00.pdf","25"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL2060001","Gym Access IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2060001-01","Standard Silver On Exchange Plan",,"0.688657462596893","No","Yes","No","100%",,"$4,470","$60","$40","$150","$1,270","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","per person not applicable","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2060001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2060001-01.pdf","26"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL2060001","Gym Access IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2060001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2060001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2060001-02.pdf","27"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL2060001","Gym Access IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2060001-03","Limited Cost Sharing Plan Variation",,"0.688657462596893","No","Yes","No","100%",,"$4,470","$60","$40","$150","$1,270","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","per person not applicable","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2060001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2060001-03.pdf","28"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL2060001","Gym Access IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2060001-04","73% AV Level Silver Plan",,"0.728015244007111","No","Yes","No","100%",,"$4,470","$60","$40","$150","$1,270","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","per person not applicable","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","per person not applicable","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2060001-04.pdf","http://www.fhcp.com/ISOB/2016/56503FL2060001-04.pdf","29"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL2060001","Gym Access IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2060001-05","87% AV Level Silver Plan",,"0.869154870510101","No","Yes","No","100%",,"$820","$40","$770","$150","$1,000","$590","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","per person not applicable","$1300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","per person not applicable","$400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2060001-05.pdf","http://www.fhcp.com/ISOB/2016/56503FL2060001-05.pdf","30"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","6","56503","FL","Individual","No","26-3238817","56503FL2060001","Gym Access IND Silver HMO 6600","56503FL206","7265435496","FLN001","FLS001","FLF005","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2060001-06","94% AV Level Silver Plan",,"0.939405918121338","No","Yes","No","100%",,"$150","$40","$340","$150","$200","$250","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","per person not applicable","$300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2060001-06.pdf","http://www.fhcp.com/ISOB/2016/56503FL2060001-06.pdf","31"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","7","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1620002","SMAG Essential Plus Platinum HMO 65","56503FL162","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1620002-00","Standard Platinum Off Exchange Plan",,"0.910956144332886","No","No","No","100%",,"$0","$600","$0","$150","$0","$600","$190","$80","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","$0 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1620002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1620002-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","7","56503","FL","Individual","No","26-3238817","56503FL1470002","IND Essential Plus Gold POS 64","56503FL147","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1470002-00","Standard Gold Off Exchange Plan",,"0.818433821201324","No","No","No","100%",,"$1,600","$60","$300","$150","$1,270","$800","$0","$80","$3,500","$3500 per person","$7000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,600","per person not applicable","$3200 per group","10%",,,,,"$3,200","per person not applicable","$6400 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1470002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1470002-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","7","56503","FL","Individual","No","26-3238817","56503FL1470002","IND Essential Plus Gold POS 64","56503FL147","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1470002-01","Standard Gold On Exchange Plan",,"0.818433821201324","No","No","No","100%",,"$1,600","$60","$300","$150","$1,270","$800","$0","$80","$3,500","$3500 per person","$7000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,600","per person not applicable","$3200 per group","10%",,,,,"$3,200","per person not applicable","$6400 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1470002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1470002-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","7","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1620002","SMAG Essential Plus Platinum HMO 65","56503FL162","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1620002-01","Standard Platinum On Exchange Plan",,"0.910956144332886","No","No","No","100%",,"$0","$600","$0","$150","$0","$600","$190","$80","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","$0 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1620002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1620002-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","7","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1700002","SMAG Essential Plus Platinum POS 66","56503FL170","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1700002-00","Standard Platinum Off Exchange Plan",,"0.9175945520401","No","No","No","100%",,"$0","$50","$670","$150","$0","$600","$190","$80","$1,000","$1000 per person","$2000 per group",,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","$0 per group","15%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1700002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1700002-00.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","7","56503","FL","Individual","No","26-3238817","56503FL1470002","IND Essential Plus Gold POS 64","56503FL147","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1470002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1470002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL1470002-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","7","56503","FL","Individual","No","26-3238817","56503FL1470002","IND Essential Plus Gold POS 64","56503FL147","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1470002-03","Limited Cost Sharing Plan Variation",,"0.818433821201324","No","No","No","100%",,"$1,600","$60","$300","$150","$1,270","$800","$0","$80","$3,500","$3500 per person","$7000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,600","per person not applicable","$3200 per group","10%",,,,,"$3,200","per person not applicable","$6400 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1470002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL1470002-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","7","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1700002","SMAG Essential Plus Platinum POS 66","56503FL170","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1700002-01","Standard Platinum On Exchange Plan",,"0.9175945520401","No","No","No","100%",,"$0","$50","$670","$150","$0","$600","$190","$80","$1,000","$1000 per person","$2000 per group",,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","$0 per group","15%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1700002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1700002-01.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","7","56503","FL","Individual","No","26-3238817","56503FL1390002","IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1390002-00","Standard Gold Off Exchange Plan",,"0.817427396774292","No","No","No","100%",,"$1,000","$20","$1,250","$150","$800","$200","$200","$80","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","per person not applicable","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1390002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1390002-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","7","56503","FL","Individual","No","26-3238817","56503FL1390002","IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1390002-01","Standard Gold On Exchange Plan",,"0.817427396774292","No","No","No","100%",,"$1,000","$20","$1,250","$150","$800","$200","$200","$80","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","per person not applicable","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1390002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1390002-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","7","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2180002","SMAG Platinum HMO 3000","56503FL218","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2180002-00","Standard Platinum Off Exchange Plan","89.55%","0","Yes","Yes","No","100%",,"$0","$450","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2180002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2180002-00.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","7","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2180002","SMAG Platinum HMO 3000","56503FL218","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2180002-01","Standard Platinum On Exchange Plan","89.55%","0","Yes","Yes","No","100%",,"$0","$450","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2180002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2180002-01.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","7","56503","FL","Individual","No","26-3238817","56503FL1390002","IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1390002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1390002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL1390002-02.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","7","56503","FL","Individual","No","26-3238817","56503FL1390002","IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1390002-03","Limited Cost Sharing Plan Variation",,"0.817427396774292","No","No","No","100%",,"$1,000","$20","$1,250","$150","$800","$200","$200","$80","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","per person not applicable","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1390002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL1390002-03.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","7","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2190002","SMAG Platinum POS 3000","56503FL219","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2190002-00","Standard Platinum Off Exchange Plan","89.55%","0","Yes","Yes","No","100%",,"$0","$450","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","20%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2190002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2190002-00.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","7","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2190002","SMAG Platinum POS 3000","56503FL219","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2190002-01","Standard Platinum On Exchange Plan","89.55%","0","Yes","Yes","No","100%",,"$0","$450","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","20%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2190002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2190002-01.pdf","12"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","7","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2200002","SMAG Platinum HMO 4000","56503FL220","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2200002-00","Standard Platinum Off Exchange Plan","88.70%","0","Yes","Yes","No","100%",,"$0","$600","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2200002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2200002-00.pdf","13"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","7","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2200002","SMAG Platinum HMO 4000","56503FL220","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2200002-01","Standard Platinum On Exchange Plan","88.70%","0","Yes","Yes","No","100%",,"$0","$600","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2200002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2200002-01.pdf","14"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","7","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2210002","SMAG Platinum POS 4000","56503FL221","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2210002-00","Standard Platinum Off Exchange Plan","88.70%","0","Yes","Yes","No","100%",,"$0","$600","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2210002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2210002-00.pdf","15"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","7","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2210002","SMAG Platinum POS 4000","56503FL221","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2210002-01","Standard Platinum On Exchange Plan","88.70%","0","Yes","Yes","No","100%",,"$0","$600","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2210002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2210002-01.pdf","16"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","8","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1620001","Gym Access SMAG Essential Plus Platinum HMO 65","56503FL162","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1620001-00","Standard Platinum Off Exchange Plan",,"0.910956144332886","No","No","No","100%",,"$0","$600","$0","$150","$0","$600","$190","$80","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","$0 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1620001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1620001-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","8","56503","FL","Individual","No","26-3238817","56503FL1470001","Gym Access IND Essential Plus Gold POS 64","56503FL147","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1470001-00","Standard Gold Off Exchange Plan",,"0.818433821201324","No","No","No","100%",,"$1,600","$60","$300","$150","$1,270","$800","$0","$80","$3,500","$3500 per person","$7000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,600","per person not applicable","$3200 per group","10%",,,,,"$3,200","per person not applicable","$6400 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1470001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1470001-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","8","56503","FL","Individual","No","26-3238817","56503FL1470001","Gym Access IND Essential Plus Gold POS 64","56503FL147","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1470001-01","Standard Gold On Exchange Plan",,"0.818433821201324","No","No","No","100%",,"$1,600","$60","$300","$150","$1,270","$800","$0","$80","$3,500","$3500 per person","$7000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,600","per person not applicable","$3200 per group","10%",,,,,"$3,200","per person not applicable","$6400 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1470001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1470001-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","8","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1620001","Gym Access SMAG Essential Plus Platinum HMO 65","56503FL162","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1620001-01","Standard Platinum On Exchange Plan",,"0.910956144332886","No","No","No","100%",,"$0","$600","$0","$150","$0","$600","$190","$80","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","$0 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1620001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1620001-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","8","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1700001","GYM Access SMAG Essential Plus Platinum POS 66","56503FL170","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1700001-00","Standard Platinum Off Exchange Plan",,"0.9175945520401","No","No","No","100%",,"$0","$50","$670","$150","$0","$600","$190","$80","$1,000","$1000 per person","$2000 per group",,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","$0 per group","15%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1700001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1700001-00.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","8","56503","FL","Individual","No","26-3238817","56503FL1470001","Gym Access IND Essential Plus Gold POS 64","56503FL147","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1470001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1470001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL1470001-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","8","56503","FL","Individual","No","26-3238817","56503FL1470001","Gym Access IND Essential Plus Gold POS 64","56503FL147","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1470001-03","Limited Cost Sharing Plan Variation",,"0.818433821201324","No","No","No","100%",,"$1,600","$60","$300","$150","$1,270","$800","$0","$80","$3,500","$3500 per person","$7000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,600","per person not applicable","$3200 per group","10%",,,,,"$3,200","per person not applicable","$6400 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1470001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL1470001-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","8","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1700001","GYM Access SMAG Essential Plus Platinum POS 66","56503FL170","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1700001-01","Standard Platinum On Exchange Plan",,"0.9175945520401","No","No","No","100%",,"$0","$50","$670","$150","$0","$600","$190","$80","$1,000","$1000 per person","$2000 per group",,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","$0 per group","15%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.fhcp.com/ISBC/2016/56503FL1700001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1700001-01.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","8","56503","FL","Individual","No","26-3238817","56503FL1390001","Gym Access IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1390001-00","Standard Gold Off Exchange Plan",,"0.817427396774292","No","No","No","100%",,"$1,000","$20","$1,250","$150","$800","$200","$200","$80","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","per person not applicable","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1390001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1390001-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","8","56503","FL","Individual","No","26-3238817","56503FL1390001","Gym Access IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1390001-01","Standard Gold On Exchange Plan",,"0.817427396774292","No","No","No","100%",,"$1,000","$20","$1,250","$150","$800","$200","$200","$80","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","per person not applicable","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1390001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1390001-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","8","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2180001","Gym Access SMAG Platinum HMO 3000","56503FL218","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2180001-00","Standard Platinum Off Exchange Plan","89.55%","0","Yes","Yes","No","100%",,"$0","$450","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2180001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2180001-00.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","8","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2180001","Gym Access SMAG Platinum HMO 3000","56503FL218","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2180001-01","Standard Platinum On Exchange Plan","89.55%","0","Yes","Yes","No","100%",,"$0","$450","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2180001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2180001-01.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","8","56503","FL","Individual","No","26-3238817","56503FL1390001","Gym Access IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1390001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1390001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL1390001-02.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","8","56503","FL","Individual","No","26-3238817","56503FL1390001","Gym Access IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1390001-03","Limited Cost Sharing Plan Variation",,"0.817427396774292","No","No","No","100%",,"$1,000","$20","$1,250","$150","$800","$200","$200","$80","$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","per person not applicable","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1390001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL1390001-03.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","8","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2190001","Gym Access SMAG Platinum POS 3000","56503FL219","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2190001-00","Standard Platinum Off Exchange Plan","89.55%","0","Yes","Yes","No","100%",,"$0","$450","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","20%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2190001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2190001-00.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","8","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2190001","Gym Access SMAG Platinum POS 3000","56503FL219","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2190001-01","Standard Platinum On Exchange Plan","89.55%","0","Yes","Yes","No","100%",,"$0","$450","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","20%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2190001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2190001-01.pdf","12"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","8","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2200001","Gym Access SMAG Platinum HMO 4000","56503FL220","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2200001-00","Standard Platinum Off Exchange Plan","88.70%","0","Yes","Yes","No","100%",,"$0","$600","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2200001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2200001-00.pdf","13"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","8","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2200001","Gym Access SMAG Platinum HMO 4000","56503FL220","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2200001-01","Standard Platinum On Exchange Plan","88.70%","0","Yes","Yes","No","100%",,"$0","$600","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2200001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2200001-01.pdf","14"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","8","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2210001","Gym Access SMAG Platinum POS 4000","56503FL221","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2210001-00","Standard Platinum Off Exchange Plan","88.70%","0","Yes","Yes","No","100%",,"$0","$600","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2210001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2210001-00.pdf","15"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","8","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2210001","Gym Access SMAG Platinum POS 4000","56503FL221","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2210001-01","Standard Platinum On Exchange Plan","88.70%","0","Yes","Yes","No","100%",,"$0","$600","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.fhcp.com/ISBC/2016/56503FL2210001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2210001-01.pdf","16"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","9","56503","FL","Individual","No","26-3238817","56503FL1400002","IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1400002-00","Standard Platinum Off Exchange Plan",,"0.910956144332886","No","No","No","100%",,"$0","$600","$0","$150","$0","$600","$190","$80","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","$0 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1400002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1400002-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","9","56503","FL","Individual","No","26-3238817","56503FL1400002","IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1400002-01","Standard Platinum On Exchange Plan",,"0.910956144332886","No","No","No","100%",,"$0","$600","$0","$150","$0","$600","$190","$80","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","$0 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1400002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1400002-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","9","56503","FL","Individual","No","26-3238817","56503FL1400002","IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1400002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1400002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL1400002-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","9","56503","FL","Individual","No","26-3238817","56503FL1400002","IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1400002-03","Limited Cost Sharing Plan Variation",,"0.910956144332886","No","No","No","100%",,"$0","$600","$0","$150","$0","$600","$190","$80","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","$0 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1400002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL1400002-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","9","56503","FL","Individual","No","26-3238817","56503FL1480002","IND Essential Plus Platinum POS 66","56503FL148","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1480002-00","Standard Platinum Off Exchange Plan",,"0.9175945520401","No","No","No","100%",,"$0","$50","$670","$150","$0","$600","$190","$80","$1,000","$1000 per person","$2000 per group",,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","$0 per group","15%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1480002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1480002-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","9","56503","FL","Individual","No","26-3238817","56503FL1480002","IND Essential Plus Platinum POS 66","56503FL148","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1480002-01","Standard Platinum On Exchange Plan",,"0.9175945520401","No","No","No","100%",,"$0","$50","$670","$150","$0","$600","$190","$80","$1,000","$1000 per person","$2000 per group",,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","$0 per group","15%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1480002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1480002-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","9","56503","FL","Individual","No","26-3238817","56503FL1480002","IND Essential Plus Platinum POS 66","56503FL148","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1480002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","15%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1480002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL1480002-02.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","9","56503","FL","Individual","No","26-3238817","56503FL1480002","IND Essential Plus Platinum POS 66","56503FL148","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1480002-03","Limited Cost Sharing Plan Variation",,"0.9175945520401","No","No","No","100%",,"$0","$50","$670","$150","$0","$600","$190","$80","$1,000","$1000 per person","$2000 per group",,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","$0 per group","15%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1480002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL1480002-03.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","10","56503","FL","Individual","No","26-3238817","56503FL1400001","Gym Access IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1400001-00","Standard Platinum Off Exchange Plan",,"0.910054743289948","No","No","No","100%",,"$0","$600","$0","$150","$0","$600","$190","$80","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","$0 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1400001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1400001-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","10","56503","FL","Individual","No","26-3238817","56503FL1400001","Gym Access IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1400001-01","Standard Platinum On Exchange Plan",,"0.910054743289948","No","No","No","100%",,"$0","$600","$0","$150","$0","$600","$190","$80","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","$0 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1400001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1400001-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","10","56503","FL","Individual","No","26-3238817","56503FL1400001","Gym Access IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1400001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1400001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL1400001-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","10","56503","FL","Individual","No","26-3238817","56503FL1400001","Gym Access IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1400001-03","Limited Cost Sharing Plan Variation",,"0.910054743289948","No","No","No","100%",,"$0","$600","$0","$150","$0","$600","$190","$80","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","$0 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1400001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL1400001-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","10","56503","FL","Individual","No","26-3238817","56503FL1480001","Gym Access IND Essential Plus Platinum POS 66","56503FL148","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1480001-00","Standard Platinum Off Exchange Plan",,"0.9175945520401","No","No","No","100%",,"$0","$50","$670","$150","$0","$600","$190","$80","$1,000","$1000 per person","$2000 per group",,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","$0 per group","15%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1480001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1480001-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","10","56503","FL","Individual","No","26-3238817","56503FL1480001","Gym Access IND Essential Plus Platinum POS 66","56503FL148","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1480001-01","Standard Platinum On Exchange Plan",,"0.9175945520401","No","No","No","100%",,"$0","$50","$670","$150","$0","$600","$190","$80","$1,000","$1000 per person","$2000 per group",,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","$0 per group","15%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1480001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1480001-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","10","56503","FL","Individual","No","26-3238817","56503FL1480001","Gym Access IND Essential Plus Platinum POS 66","56503FL148","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1480001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","$0 per person","$0 per group","15%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1480001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL1480001-02.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","10","56503","FL","Individual","No","26-3238817","56503FL1480001","Gym Access IND Essential Plus Platinum POS 66","56503FL148","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1480001-03","Limited Cost Sharing Plan Variation",,"0.9175945520401","No","No","No","100%",,"$0","$50","$670","$150","$0","$600","$190","$80","$1,000","$1000 per person","$2000 per group",,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","$0 per group","15%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL1480001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL1480001-03.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","13","56503","FL","Individual","No","26-3238817","56503FL2000002","IND Gold HMO 5500","56503FL200","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2000002-00","Standard Gold Off Exchange Plan",,"0.794270575046539","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2000002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2000002-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","13","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2120002","SMAG Silver HMO HSA  2000/6450","56503FL212","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2120002-00","Standard Silver Off Exchange Plan",,"0.704771816730499","Yes","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$280","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2120002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2120002-01.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","13","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2120002","SMAG Silver HMO HSA  2000/6450","56503FL212","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2120002-01","Standard Silver On Exchange Plan",,"0.704771816730499","Yes","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$280","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2120002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2120002-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","13","56503","FL","Individual","No","26-3238817","56503FL2000002","IND Gold HMO 5500","56503FL200","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2000002-01","Standard Gold On Exchange Plan",,"0.794270575046539","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2000002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2000002-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","13","56503","FL","Individual","No","26-3238817","56503FL2000002","IND Gold HMO 5500","56503FL200","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2000002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2000002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2000002-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","13","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2130002","SMAG Silver POS HSA  2000/6450","56503FL213","7265435496","FLN001","FLS001","FLF006","Existing","POS","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2130002-00","Standard Silver Off Exchange Plan",,"0.704771816730499","Yes","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$280","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2130002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2130002-00.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","13","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2130002","SMAG Silver POS HSA  2000/6450","56503FL213","7265435496","FLN001","FLS001","FLF006","Existing","POS","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2130002-01","Standard Silver On Exchange Plan",,"0.704771816730499","Yes","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$280","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2130002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2130002-01.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","13","56503","FL","Individual","No","26-3238817","56503FL2000002","IND Gold HMO 5500","56503FL200","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2000002-03","Limited Cost Sharing Plan Variation",,"0.794270575046539","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2000002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2000002-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","13","56503","FL","Individual","No","26-3238817","56503FL2010002","IND Gold POS 5500","56503FL201","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2010002-00","Standard Gold Off Exchange Plan",,"0.794270575046539","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2010002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2010002-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","13","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2140002","SMAG Bronze HMO HSA 4700/6450","56503FL214","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2140002-00","Standard Bronze Off Exchange Plan",,"0.618407964706421","Yes","Yes","No","100%",,"$4,700","$20","$770","$150","$4,700","$60","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","per person not applicable","$9400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2140002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2140002-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","13","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2140002","SMAG Bronze HMO HSA 4700/6450","56503FL214","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2140002-01","Standard Bronze On Exchange Plan",,"0.618407964706421","Yes","Yes","No","100%",,"$4,700","$20","$770","$150","$4,700","$60","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","per person not applicable","$9400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2140002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2140002-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","13","56503","FL","Individual","No","26-3238817","56503FL2010002","IND Gold POS 5500","56503FL201","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2010002-01","Standard Gold On Exchange Plan",,"0.794270575046539","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2010002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2010002-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","13","56503","FL","Individual","No","26-3238817","56503FL2010002","IND Gold POS 5500","56503FL201","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2010002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2010002-02.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","13","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2150002","SMAG Bronze POS HSA 4700/6450","56503FL215","7265435496","FLN001","FLS001","FLF006","Existing","POS","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2150002-00","Standard Bronze Off Exchange Plan",,"0.618407964706421","Yes","Yes","No","100%",,"$4,700","$20","$770","$150","$4,700","$60","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","per person not applicable","$9400 per group","30%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2150002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2150002-00.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","13","56503","FL","Individual","No","26-3238817","56503FL2010002","IND Gold POS 5500","56503FL201","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2010002-03","Limited Cost Sharing Plan Variation",,"0.794270575046539","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2010002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2010002-03.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","21","56503","FL","Individual","No","26-3238817","56503FL2240002","IND Bronze HMO HSA 4700/6450","56503FL224","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2240002-00","Standard Bronze Off Exchange Plan",,"0.618407964706421","Yes","Yes","No","100%",,"$4,700","$20","$770","$150","$4,700","$60","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","per person not applicable","$9400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2016/56503FL2240002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2240002-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","21","56503","FL","Individual","No","26-3238817","56503FL2240002","IND Bronze HMO HSA 4700/6450","56503FL224","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2240002-01","Standard Bronze On Exchange Plan",,"0.618407964706421","Yes","Yes","No","100%",,"$4,700","$20","$770","$150","$4,700","$60","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","per person not applicable","$9400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2016/56503FL2240002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2240002-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","23","56503","FL","Individual","No","26-3238817","56503FL1990002","IND Platinum POS 4000","56503FL199","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1990002-00","Standard Platinum Off Exchange Plan","88.70%","0","Yes","Yes","No","100%",,"$0","$600","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1990002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1990002-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","23","56503","FL","Individual","No","26-3238817","56503FL1990002","IND Platinum POS 4000","56503FL199","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1990002-01","Standard Platinum On Exchange Plan","88.70%","0","Yes","Yes","No","100%",,"$0","$600","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1990002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1990002-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","13","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2160002","SMAG Bronze HMO HSA 6000/6450","56503FL216","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2160002-00","Standard Bronze Off Exchange Plan",,"0.60734236240387","Yes","Yes","No","100%",,"$6,000","$20","$70","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2160002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2160002-00.pdf","12"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","13","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2160002","SMAG Bronze HMO HSA 6000/6450","56503FL216","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2160002-01","Standard Bronze On Exchange Plan",,"0.60734236240387","Yes","Yes","No","100%",,"$6,000","$20","$70","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2160002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2160002-01.pdf","13"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","13","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2170002","SMAG Bronze POS HSA 6000/6450","56503FL217","7265435496","FLN001","FLS001","FLF006","Existing","POS","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2170002-00","Standard Bronze Off Exchange Plan",,"0.60734236240387","Yes","Yes","No","100%",,"$6,000","$20","$70","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","10%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2170002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2170002-00.pdf","14"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","13","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2170002","SMAG Bronze POS HSA 6000/6450","56503FL217","7265435496","FLN001","FLS001","FLF006","Existing","POS","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2170002-01","Standard Bronze On Exchange Plan",,"0.60734236240387","Yes","Yes","No","100%",,"$6,000","$20","$70","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","10%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2170002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2170002-01.pdf","15"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","14","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2120001","Gym Access SMAG Silver HMO HSA  2000/6450","56503FL212","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2120001-00","Standard Silver Off Exchange Plan",,"0.704771816730499","Yes","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$280","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2120001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2120001-01.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","14","56503","FL","Individual","No","26-3238817","56503FL2000001","Gym Access IND Gold HMO 5500","56503FL200","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2000001-00","Standard Gold Off Exchange Plan",,"0.794270575046539","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2000001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2000001-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","14","56503","FL","Individual","No","26-3238817","56503FL2000001","Gym Access IND Gold HMO 5500","56503FL200","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2000001-01","Standard Gold On Exchange Plan",,"0.794270575046539","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2000001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2000001-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","14","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2120001","Gym Access SMAG Silver HMO HSA  2000/6450","56503FL212","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2120001-01","Standard Silver On Exchange Plan",,"0.704771816730499","Yes","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$280","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2120001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2120001-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","14","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2130001","Gym Access SMAG Silver POS HSA  2000/6450","56503FL213","7265435496","FLN001","FLS001","FLF006","Existing","POS","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2130001-00","Standard Silver Off Exchange Plan",,"0.704771816730499","Yes","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$280","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2130001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2130001-00.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","14","56503","FL","Individual","No","26-3238817","56503FL2000001","Gym Access IND Gold HMO 5500","56503FL200","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2000001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2000001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2000001-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","14","56503","FL","Individual","No","26-3238817","56503FL2000001","Gym Access IND Gold HMO 5500","56503FL200","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2000001-03","Limited Cost Sharing Plan Variation",,"0.794270575046539","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2000001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2000001-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","14","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2130001","Gym Access SMAG Silver POS HSA  2000/6450","56503FL213","7265435496","FLN001","FLS001","FLF006","Existing","POS","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2130001-01","Standard Silver On Exchange Plan",,"0.704771816730499","Yes","Yes","No","100%",,"$2,000","$20","$950","$150","$2,000","$280","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2130001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2130001-01.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","14","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2140001","Gym Access SMAG Bronze HMO HSA 4700/6450","56503FL214","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2140001-00","Standard Bronze Off Exchange Plan",,"0.618407964706421","Yes","Yes","No","100%",,"$4,700","$20","$770","$150","$4,700","$60","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","per person not applicable","$9400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2140001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2140001-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","14","56503","FL","Individual","No","26-3238817","56503FL2010001","Gym Access IND Gold POS 5500","56503FL201","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2010001-00","Standard Gold Off Exchange Plan",,"0.794270575046539","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2010001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2010001-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","14","56503","FL","Individual","No","26-3238817","56503FL2010001","Gym Access IND Gold POS 5500","56503FL201","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2010001-01","Standard Gold On Exchange Plan",,"0.794270575046539","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2010001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2010001-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","14","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2140001","Gym Access SMAG Bronze HMO HSA 4700/6450","56503FL214","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2140001-01","Standard Bronze On Exchange Plan",,"0.618407964706421","Yes","Yes","No","100%",,"$4,700","$20","$770","$150","$4,700","$60","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","per person not applicable","$9400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2140001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2140001-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","14","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2150001","Gym Access SMAG Bronze POS HSA 4700/6450","56503FL215","7265435496","FLN001","FLS001","FLF006","Existing","POS","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2150001-00","Standard Bronze Off Exchange Plan",,"0.618407964706421","Yes","Yes","No","100%",,"$4,700","$20","$770","$150","$4,700","$60","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","per person not applicable","$9400 per group","30%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2150001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2150001-00.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","14","56503","FL","Individual","No","26-3238817","56503FL2010001","Gym Access IND Gold POS 5500","56503FL201","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2010001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2010001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2010001-02.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","14","56503","FL","Individual","No","26-3238817","56503FL2010001","Gym Access IND Gold POS 5500","56503FL201","7265435496","FLN001","FLS001","FLF001","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"5","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2010001-03","Limited Cost Sharing Plan Variation",,"0.794270575046539","No","Yes","No","100%",,"$0","$550","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2010001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2010001-03.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","14","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2150001","Gym Access SMAG Bronze POS HSA 4700/6450","56503FL215","7265435496","FLN001","FLS001","FLF006","Existing","POS","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2150001-01","Standard Bronze On Exchange Plan",,"0.618407964706421","Yes","Yes","No","100%",,"$4,700","$20","$770","$150","$4,700","$60","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","per person not applicable","$9400 per group","30%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2150001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2150001-01.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","14","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2160001","Gym Access SMAG Bronze HMO HSA 6000/6450","56503FL216","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2160001-00","Standard Bronze Off Exchange Plan",,"0.60734236240387","Yes","Yes","No","100%",,"$6,000","$20","$70","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2160001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2160001-00.pdf","12"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","14","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2160001","Gym Access SMAG Bronze HMO HSA 6000/6450","56503FL216","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2160001-01","Standard Bronze On Exchange Plan",,"0.60734236240387","Yes","Yes","No","100%",,"$6,000","$20","$70","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2160001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2160001-01.pdf","13"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","14","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2170001","Gym Access SMAG Bronze POS HSA 6000/6450","56503FL217","7265435496","FLN001","FLS001","FLF006","Existing","POS","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2170001-00","Standard Bronze Off Exchange Plan",,"0.60734236240387","Yes","Yes","No","100%",,"$6,000","$20","$70","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","10%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2170001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2170001-00.pdf","14"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","14","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL2170001","Gym Access SMAG Bronze POS HSA 6000/6450","56503FL217","7265435496","FLN001","FLS001","FLF006","Existing","POS","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2170001-01","Standard Bronze On Exchange Plan",,"0.60734236240387","Yes","Yes","No","100%",,"$6,000","$20","$70","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","10%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.fhcp.com/ISBC/2016/56503FL2170001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2170001-01.pdf","15"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","21","56503","FL","Individual","No","26-3238817","56503FL2240002","IND Bronze HMO HSA 4700/6450","56503FL224","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2240002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2240002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2240002-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","21","56503","FL","Individual","No","26-3238817","56503FL2240002","IND Bronze HMO HSA 4700/6450","56503FL224","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2240002-03","Limited Cost Sharing Plan Variation",,"0.618407964706421","Yes","Yes","No","100%",,"$4,700","$20","$770","$150","$4,700","$60","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","per person not applicable","$9400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2016/56503FL2240002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2240002-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","21","56503","FL","Individual","No","26-3238817","56503FL2260002","IND Bronze HMO HSA 6000/6450","56503FL226","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2260002-00","Standard Bronze Off Exchange Plan",,"0.60734236240387","Yes","Yes","No","100%",,"$6,000","$20","$70","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2016/56503FL2260002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2260002-00.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","21","56503","FL","Individual","No","26-3238817","56503FL2260002","IND Bronze HMO HSA 6000/6450","56503FL226","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2260002-01","Standard Bronze On Exchange Plan",,"0.60734236240387","Yes","Yes","No","100%",,"$6,000","$20","$70","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2016/56503FL2260002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2260002-01.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","21","56503","FL","Individual","No","26-3238817","56503FL2260002","IND Bronze HMO HSA 6000/6450","56503FL226","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2260002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2260002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2260002-02.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","21","56503","FL","Individual","No","26-3238817","56503FL2260002","IND Bronze HMO HSA 6000/6450","56503FL226","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2260002-03","Limited Cost Sharing Plan Variation",,"0.60734236240387","Yes","Yes","No","100%",,"$6,000","$20","$70","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2016/56503FL2260002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2260002-03.pdf","12"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","22","56503","FL","Individual","No","26-3238817","56503FL2240001","Gym Access IND Bronze HMO HSA 4700/6450","56503FL224","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2240001-00","Standard Bronze Off Exchange Plan",,"0.618407964706421","Yes","Yes","No","100%",,"$4,700","$20","$770","$150","$4,700","$60","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","per person not applicable","$9400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2016/56503FL2240001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2240001-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","22","56503","FL","Individual","No","26-3238817","56503FL2240001","Gym Access IND Bronze HMO HSA 4700/6450","56503FL224","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2240001-01","Standard Bronze On Exchange Plan",,"0.618407964706421","Yes","Yes","No","100%",,"$4,700","$20","$770","$150","$4,700","$60","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","per person not applicable","$9400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2016/56503FL2240001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2240001-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","22","56503","FL","Individual","No","26-3238817","56503FL2240001","Gym Access IND Bronze HMO HSA 4700/6450","56503FL224","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2240001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2240001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2240001-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","22","56503","FL","Individual","No","26-3238817","56503FL2240001","Gym Access IND Bronze HMO HSA 4700/6450","56503FL224","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2240001-03","Limited Cost Sharing Plan Variation",,"0.618407964706421","Yes","Yes","No","100%",,"$4,700","$20","$770","$150","$4,700","$60","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","per person not applicable","$9400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2016/56503FL2240001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2240001-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","22","56503","FL","Individual","No","26-3238817","56503FL2260001","Gym Access IND Bronze HMO HSA 6000/6450","56503FL226","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2260001-00","Standard Bronze Off Exchange Plan",,"0.60734236240387","Yes","Yes","No","100%",,"$6,000","$20","$70","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2016/56503FL2260001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2260001-00.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","22","56503","FL","Individual","No","26-3238817","56503FL2260001","Gym Access IND Bronze HMO HSA 6000/6450","56503FL226","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2260001-01","Standard Bronze On Exchange Plan",,"0.60734236240387","Yes","Yes","No","100%",,"$6,000","$20","$70","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2016/56503FL2260001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2260001-01.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","22","56503","FL","Individual","No","26-3238817","56503FL2260001","Gym Access IND Bronze HMO HSA 6000/6450","56503FL226","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2260001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2260001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2260001-02.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","22","56503","FL","Individual","No","26-3238817","56503FL2260001","Gym Access IND Bronze HMO HSA 6000/6450","56503FL226","7265435496","FLN001","FLS001","FLF006","Existing","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2260001-03","Limited Cost Sharing Plan Variation",,"0.60734236240387","Yes","Yes","No","100%",,"$6,000","$20","$70","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.fhcp.com/ISBC/2016/56503FL2260001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2260001-03.pdf","12"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","23","56503","FL","Individual","No","26-3238817","56503FL1980002","IND Platinum HMO 4000","56503FL198","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1980002-00","Standard Platinum Off Exchange Plan","88.70%","0","Yes","Yes","No","100%",,"$0","$600","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1980002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1980002-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","23","56503","FL","Individual","No","26-3238817","56503FL1980002","IND Platinum HMO 4000","56503FL198","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1980002-01","Standard Platinum On Exchange Plan","88.70%","0","Yes","Yes","No","100%",,"$0","$600","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1980002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1980002-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","23","56503","FL","Individual","No","26-3238817","56503FL1980002","IND Platinum HMO 4000","56503FL198","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1980002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1980002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL1980002-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","23","56503","FL","Individual","No","26-3238817","56503FL1980002","IND Platinum HMO 4000","56503FL198","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1980002-03","Limited Cost Sharing Plan Variation","88.70%","0","Yes","Yes","No","100%",,"$0","$600","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1980002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL1980002-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","23","56503","FL","Individual","No","26-3238817","56503FL1990002","IND Platinum POS 4000","56503FL199","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1990002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1990002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL1990002-02.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","23","56503","FL","Individual","No","26-3238817","56503FL1990002","IND Platinum POS 4000","56503FL199","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1990002-03","Limited Cost Sharing Plan Variation","88.70%","0","Yes","Yes","No","100%",,"$0","$600","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1990002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL1990002-03.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","24","56503","FL","Individual","No","26-3238817","56503FL1980001","Gym Access IND Platinum HMO 4000","56503FL198","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1980001-00","Standard Platinum Off Exchange Plan","88.70%","0","Yes","Yes","No","100%",,"$0","$600","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1980001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1980001-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","24","56503","FL","Individual","No","26-3238817","56503FL1980001","Gym Access IND Platinum HMO 4000","56503FL198","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1980001-01","Standard Platinum On Exchange Plan","88.70%","0","Yes","Yes","No","100%",,"$0","$600","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1980001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1980001-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","24","56503","FL","Individual","No","26-3238817","56503FL1980001","Gym Access IND Platinum HMO 4000","56503FL198","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1980001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1980001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL1980001-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","24","56503","FL","Individual","No","26-3238817","56503FL1980001","Gym Access IND Platinum HMO 4000","56503FL198","7265435496","FLN001","FLS001","FLF001","Existing","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1980001-03","Limited Cost Sharing Plan Variation","88.70%","0","Yes","Yes","No","100%",,"$0","$600","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1980001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL1980001-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","24","56503","FL","Individual","No","26-3238817","56503FL1990001","Gym Access Platinum POS 4000","56503FL199","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1990001-00","Standard Platinum Off Exchange Plan","88.70%","0","Yes","Yes","No","100%",,"$0","$600","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1990001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL1990001-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","24","56503","FL","Individual","No","26-3238817","56503FL1990001","Gym Access Platinum POS 4000","56503FL199","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1990001-01","Standard Platinum On Exchange Plan","88.70%","0","Yes","Yes","No","100%",,"$0","$600","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1990001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL1990001-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","24","56503","FL","Individual","No","26-3238817","56503FL1990001","Gym Access Platinum POS 4000","56503FL199","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1990001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1990001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL1990001-02.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","24","56503","FL","Individual","No","26-3238817","56503FL1990001","Gym Access Platinum POS 4000","56503FL199","7265435496","FLN001","FLS001","FLF001","Existing","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL1990001-03","Limited Cost Sharing Plan Variation","88.70%","0","Yes","Yes","No","100%",,"$0","$600","$0","$150","$0","$600","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL1990001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL1990001-03.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","25","56503","FL","Individual","No","26-3238817","56503FL2590002","Gym Access IND Gold HMO BC 5651","56503FL259","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2590002-00","Standard Gold Off Exchange Plan","81.33%","0","Yes","Yes","No","100%",,"$0","$1,380","$0","$150","$0","$650","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2590002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2590002-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","25","56503","FL","Individual","No","26-3238817","56503FL2590002","Gym Access IND Gold HMO BC 5651","56503FL259","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2590002-01","Standard Gold On Exchange Plan","81.33%","0","Yes","Yes","No","100%",,"$0","$1,380","$0","$150","$0","$650","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2590002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2590002-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","25","56503","FL","Individual","No","26-3238817","56503FL2590002","Gym Access IND Gold HMO BC 5651","56503FL259","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2590002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2590002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2590002-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","25","56503","FL","Individual","No","26-3238817","56503FL2590002","Gym Access IND Gold HMO BC 5651","56503FL259","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2590002-03","Limited Cost Sharing Plan Variation","81.33%","0","Yes","Yes","No","100%",,"$0","$1,380","$0","$150","$0","$650","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2590002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2590002-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","25","56503","FL","Individual","No","26-3238817","56503FL2600002","Gym Access IND Gold POS BC 5651","56503FL260","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2600002-00","Standard Gold Off Exchange Plan","81.33%","0","Yes","Yes","No","100%",,"$0","$1,380","$0","$150","$0","$650","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2600002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2600002-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","25","56503","FL","Individual","No","26-3238817","56503FL2600002","Gym Access IND Gold POS BC 5651","56503FL260","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2600002-01","Standard Gold On Exchange Plan","81.33%","0","Yes","Yes","No","100%",,"$0","$1,380","$0","$150","$0","$650","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2600002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2600002-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","25","56503","FL","Individual","No","26-3238817","56503FL2600002","Gym Access IND Gold POS BC 5651","56503FL260","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2600002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2600002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2600002-02.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","25","56503","FL","Individual","No","26-3238817","56503FL2600002","Gym Access IND Gold POS BC 5651","56503FL260","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2600002-03","Limited Cost Sharing Plan Variation","81.33%","0","Yes","Yes","No","100%",,"$0","$1,380","$0","$150","$0","$650","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2600002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2600002-03.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","26","56503","FL","Individual","No","26-3238817","56503FL2590001","IND Gold HMO BC 5651","56503FL259","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2590001-00","Standard Gold Off Exchange Plan","81.33%","0","Yes","Yes","No","100%",,"$0","$1,380","$0","$150","$0","$650","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2590001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2590001-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","26","56503","FL","Individual","No","26-3238817","56503FL2590001","IND Gold HMO BC 5651","56503FL259","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2590001-01","Standard Gold On Exchange Plan","81.33%","0","Yes","Yes","No","100%",,"$0","$1,380","$0","$150","$0","$650","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2590001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2590001-01.pdf","5"
"2016","FL","59667","HIOS","5","2015-07-16 02:22:15","2","59667","FL","Individual","Yes","65-0743731","59667FL0010003","DentaQuest EPO Family High","59667FL001","7891798028","FLN001","FLS001",,"Existing","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.31","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","59667FL0010003-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/","4"
"2016","FL","59667","HIOS","5","2015-07-16 02:22:15","2","59667","FL","Individual","Yes","65-0743731","59667FL0010003","DentaQuest EPO Family High","59667FL001","7891798028","FLN001","FLS001",,"Existing","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.31","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","59667FL0010003-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/","5"
"2016","FL","59667","HIOS","5","2015-07-16 02:22:15","2","59667","FL","Individual","Yes","65-0743731","59667FL0010004","DentaQuest EPO Family Low","59667FL001","7891798028","FLN001","FLS001",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.24","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","59667FL0010004-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/","6"
"2016","FL","59667","HIOS","5","2015-07-16 02:22:15","2","59667","FL","Individual","Yes","65-0743731","59667FL0010004","DentaQuest EPO Family Low","59667FL001","7891798028","FLN001","FLS001",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.24","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","59667FL0010004-01","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","26","56503","FL","Individual","No","26-3238817","56503FL2590001","IND Gold HMO BC 5651","56503FL259","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2590001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2590001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2590001-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","26","56503","FL","Individual","No","26-3238817","56503FL2590001","IND Gold HMO BC 5651","56503FL259","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2590001-03","Limited Cost Sharing Plan Variation","81.33%","0","Yes","Yes","No","100%",,"$0","$1,380","$0","$150","$0","$650","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2590001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2590001-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","26","56503","FL","Individual","No","26-3238817","56503FL2600001","IND Gold POS BC 5651","56503FL260","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2600001-00","Standard Gold Off Exchange Plan","81.33%","0","Yes","Yes","No","100%",,"$0","$1,380","$0","$150","$0","$650","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2600001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2600001-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","26","56503","FL","Individual","No","26-3238817","56503FL2600001","IND Gold POS BC 5651","56503FL260","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2600001-01","Standard Gold On Exchange Plan","81.33%","0","Yes","Yes","No","100%",,"$0","$1,380","$0","$150","$0","$650","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2600001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2600001-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","26","56503","FL","Individual","No","26-3238817","56503FL2600001","IND Gold POS BC 5651","56503FL260","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2600001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2600001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2600001-02.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","26","56503","FL","Individual","No","26-3238817","56503FL2600001","IND Gold POS BC 5651","56503FL260","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2600001-03","Limited Cost Sharing Plan Variation","81.33%","0","Yes","Yes","No","100%",,"$0","$1,380","$0","$150","$0","$650","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2600001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2600001-03.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2610002","Gym Access IND Platinum HMO BC 5841","56503FL261","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2610002-01","Standard Platinum On Exchange Plan",,"0.88183057308197","No","Yes","No","100%",,"$800","$40","$380","$150","$0","$550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","per person not applicable","$1600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2610002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2610002-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2610002","Gym Access IND Platinum HMO BC 5841","56503FL261","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2610002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2610002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2610002-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2610002","Gym Access IND Platinum HMO BC 5841","56503FL261","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2610002-03","Limited Cost Sharing Plan Variation",,"0.88183057308197","No","Yes","No","100%",,"$800","$40","$380","$150","$0","$550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","per person not applicable","$1600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2610002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2610002-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2620002","Gym Access IND Platinum POS BC 5841","56503FL262","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2620002-00","Standard Platinum Off Exchange Plan",,"0.88183057308197","No","Yes","No","100%",,"$800","$40","$380","$150","$0","$550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$800","per person not applicable","$1600 per group","10%",,,,,"$1,600","per person not applicable","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2620002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2620002-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2620002","Gym Access IND Platinum POS BC 5841","56503FL262","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2620002-01","Standard Platinum On Exchange Plan",,"0.88183057308197","No","Yes","No","100%",,"$800","$40","$380","$150","$0","$550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$800","per person not applicable","$1600 per group","10%",,,,,"$1,600","per person not applicable","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2620002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2620002-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2620002","Gym Access IND Platinum POS BC 5841","56503FL262","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2620002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2620002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2620002-02.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2620002","Gym Access IND Platinum POS BC 5841","56503FL262","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2620002-03","Limited Cost Sharing Plan Variation",,"0.88183057308197","No","Yes","No","100%",,"$800","$40","$380","$150","$0","$550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$800","per person not applicable","$1600 per group","10%",,,,,"$1,600","per person not applicable","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2620002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2620002-03.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2630002","Gym Access IND Platinum HMO BC 1941","56503FL263","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2630002-00","Standard Platinum Off Exchange Plan","89.55%","0","Yes","Yes","No","100%",,"$0","$810","$0","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2630002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2630002-00.pdf","12"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2630002","Gym Access IND Platinum HMO BC 1941","56503FL263","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2630002-01","Standard Platinum On Exchange Plan","89.55%","0","Yes","Yes","No","100%",,"$0","$810","$0","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2630002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2630002-01.pdf","13"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2630002","Gym Access IND Platinum HMO BC 1941","56503FL263","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2630002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2630002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2630002-02.pdf","14"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2630002","Gym Access IND Platinum HMO BC 1941","56503FL263","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2630002-03","Limited Cost Sharing Plan Variation","89.55%","0","Yes","Yes","No","100%",,"$0","$810","$0","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2630002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2630002-03.pdf","15"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2640002","Gym Access IND Platinum POS BC 1941","56503FL264","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2640002-00","Standard Platinum Off Exchange Plan","89.55%","0","Yes","Yes","No","100%",,"$0","$810","$0","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2640002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2640002-00.pdf","16"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2640002","Gym Access IND Platinum POS BC 1941","56503FL264","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2640002-01","Standard Platinum On Exchange Plan","89.55%","0","Yes","Yes","No","100%",,"$0","$810","$0","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2640002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2640002-01.pdf","17"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2640002","Gym Access IND Platinum POS BC 1941","56503FL264","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2640002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2640002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2640002-02.pdf","18"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2640002","Gym Access IND Platinum POS BC 1941","56503FL264","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2640002-03","Limited Cost Sharing Plan Variation","89.55%","0","Yes","Yes","No","100%",,"$0","$810","$0","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2640002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2640002-03.pdf","19"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2650002","Gym Access IND Platinum HMO 91","56503FL265","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2650002-00","Standard Platinum Off Exchange Plan","88.20%","0","No","Yes","No","100%",,"$0","$340","$0","$150","$250","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","per person not applicable","$750 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2650002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2650002-00.pdf","20"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2650002","Gym Access IND Platinum HMO 91","56503FL265","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2650002-01","Standard Platinum On Exchange Plan","88.20%","0","No","Yes","No","100%",,"$0","$340","$0","$150","$250","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","per person not applicable","$750 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2650002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2650002-01.pdf","21"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2650002","Gym Access IND Platinum HMO 91","56503FL265","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2650002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2650002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2650002-02.pdf","22"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2650002","Gym Access IND Platinum HMO 91","56503FL265","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2650002-03","Limited Cost Sharing Plan Variation","88.20%","0","No","Yes","No","100%",,"$0","$340","$0","$150","$250","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","per person not applicable","$750 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2650002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2650002-03.pdf","23"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2660002","Gym Acccess IND Platinum HMO 92","56503FL266","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2660002-00","Standard Platinum Off Exchange Plan","88.04%","0","No","Yes","No","100%",,"$500","$90","$400","$150","$500","$600","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","per person not applicable","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2660002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2660002-00.pdf","24"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2660002","Gym Acccess IND Platinum HMO 92","56503FL266","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2660002-01","Standard Platinum On Exchange Plan","88.04%","0","No","Yes","No","100%",,"$500","$90","$400","$150","$500","$600","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","per person not applicable","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2660002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2660002-01.pdf","25"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2660002","Gym Acccess IND Platinum HMO 92","56503FL266","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2660002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2660002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2660002-02.pdf","26"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","27","56503","FL","Individual","No","26-3238817","56503FL2660002","Gym Acccess IND Platinum HMO 92","56503FL266","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2660002-03","Limited Cost Sharing Plan Variation","88.04%","0","No","Yes","No","100%",,"$500","$90","$400","$150","$500","$600","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","per person not applicable","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2660002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2660002-03.pdf","27"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2610001","IND Platinum HMO BC 5841","56503FL261","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2610001-00","Standard Platinum Off Exchange Plan",,"0.88183057308197","No","Yes","No","100%",,"$800","$40","$380","$150","$0","$550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","per person not applicable","$1600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2610001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2610001-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2610001","IND Platinum HMO BC 5841","56503FL261","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2610001-01","Standard Platinum On Exchange Plan",,"0.88183057308197","No","Yes","No","100%",,"$800","$40","$380","$150","$0","$550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","per person not applicable","$1600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2610001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2610001-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2610001","IND Platinum HMO BC 5841","56503FL261","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2610001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2610001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2610001-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2610001","IND Platinum HMO BC 5841","56503FL261","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2610001-03","Limited Cost Sharing Plan Variation",,"0.88183057308197","No","Yes","No","100%",,"$800","$40","$380","$150","$0","$550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","per person not applicable","$1600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2610001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2610001-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2620001","IND Platinum POS BC 5841","56503FL262","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2620001-00","Standard Platinum Off Exchange Plan",,"0.88183057308197","No","Yes","No","100%",,"$800","$40","$380","$150","$0","$550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$800","per person not applicable","$1600 per group","10%",,,,,"$1,600","per person not applicable","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2620001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2620001-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2620001","IND Platinum POS BC 5841","56503FL262","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2620001-01","Standard Platinum On Exchange Plan",,"0.88183057308197","No","Yes","No","100%",,"$800","$40","$380","$150","$0","$550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$800","per person not applicable","$1600 per group","10%",,,,,"$1,600","per person not applicable","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2620001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2620001-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2620001","IND Platinum POS BC 5841","56503FL262","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2620001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2620001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2620001-02.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2620001","IND Platinum POS BC 5841","56503FL262","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2620001-03","Limited Cost Sharing Plan Variation",,"0.88183057308197","No","Yes","No","100%",,"$800","$40","$380","$150","$0","$550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$800","per person not applicable","$1600 per group","10%",,,,,"$1,600","per person not applicable","$3200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2620001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2620001-03.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2630001","IND Platinum HMO BC 1941","56503FL263","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2630001-00","Standard Platinum Off Exchange Plan","89.55%","0","Yes","Yes","No","100%",,"$0","$810","$0","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2630001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2630001-00.pdf","12"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2630001","IND Platinum HMO BC 1941","56503FL263","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2630001-01","Standard Platinum On Exchange Plan","89.55%","0","Yes","Yes","No","100%",,"$0","$810","$0","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2630001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2630001-01.pdf","13"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2630001","IND Platinum HMO BC 1941","56503FL263","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2630001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2630001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2630001-02.pdf","14"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2630001","IND Platinum HMO BC 1941","56503FL263","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2630001-03","Limited Cost Sharing Plan Variation","89.55%","0","Yes","Yes","No","100%",,"$0","$810","$0","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2630001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2630001-03.pdf","15"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2640001","IND Platinum POS BC 1941","56503FL264","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2640001-00","Standard Platinum Off Exchange Plan","89.55%","0","Yes","Yes","No","100%",,"$0","$810","$0","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2640001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2640001-00.pdf","16"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2640001","IND Platinum POS BC 1941","56503FL264","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2640001-01","Standard Platinum On Exchange Plan","89.55%","0","Yes","Yes","No","100%",,"$0","$810","$0","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2640001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2640001-01.pdf","17"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2640001","IND Platinum POS BC 1941","56503FL264","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2640001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2640001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2640001-02.pdf","18"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2640001","IND Platinum POS BC 1941","56503FL264","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2640001-03","Limited Cost Sharing Plan Variation","89.55%","0","Yes","Yes","No","100%",,"$0","$810","$0","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$500","per person not applicable","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2640001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2640001-03.pdf","19"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2650001","IND Platinum HMO 91","56503FL265","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2650001-00","Standard Platinum Off Exchange Plan","88.20%","0","No","Yes","No","100%",,"$0","$340","$0","$150","$250","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","per person not applicable","$750 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2650001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2650001-00.pdf","20"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","30","56503","FL","Individual","No","26-3238817","56503FL2560001","IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2560001-01","Standard Silver On Exchange Plan","68.71%","0","No","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,350","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2560001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2560001-01.pdf","12"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","30","56503","FL","Individual","No","26-3238817","56503FL2560001","IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2560001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2560001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2560001-02.pdf","13"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","30","56503","FL","Individual","No","26-3238817","56503FL2560001","IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2560001-03","Limited Cost Sharing Plan Variation","68.71%","0","No","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,350","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2560001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2560001-03.pdf","14"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","30","56503","FL","Individual","No","26-3238817","56503FL2560001","IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2560001-04","73% AV Level Silver Plan","73.88%","0","No","Yes","No","100%",,"$3,800","$200","$0","$150","$0","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2560001-04.pdf","http://www.fhcp.com/ISOB/2016/56503FL2560001-04.pdf","15"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","30","56503","FL","Individual","No","26-3238817","56503FL2560001","IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2560001-05","87% AV Level Silver Plan","86.37%","0","No","Yes","No","100%",,"$0","$470","$0","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2560001-05.pdf","http://www.fhcp.com/ISOB/2016/56503FL2560001-05.pdf","16"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","30","56503","FL","Individual","No","26-3238817","56503FL2560001","IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2560001-06","94% AV Level Silver Plan","93.29%","0","No","Yes","No","100%",,"$0","$350","$0","$150","$0","$450","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2560001-06.pdf","http://www.fhcp.com/ISOB/2016/56503FL2560001-06.pdf","17"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2650001","IND Platinum HMO 91","56503FL265","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2650001-01","Standard Platinum On Exchange Plan","88.20%","0","No","Yes","No","100%",,"$0","$340","$0","$150","$250","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","per person not applicable","$750 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2650001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2650001-01.pdf","21"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2650001","IND Platinum HMO 91","56503FL265","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2650001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2650001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2650001-02.pdf","22"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2650001","IND Platinum HMO 91","56503FL265","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2650001-03","Limited Cost Sharing Plan Variation","88.20%","0","No","Yes","No","100%",,"$0","$340","$0","$150","$250","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","per person not applicable","$750 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2650001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2650001-03.pdf","23"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2660001","IND Platinum HMO 92","56503FL266","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2660001-00","Standard Platinum Off Exchange Plan","88.04%","0","No","Yes","No","100%",,"$500","$90","$400","$150","$500","$600","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","per person not applicable","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2660001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2660001-00.pdf","24"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2660001","IND Platinum HMO 92","56503FL266","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2660001-01","Standard Platinum On Exchange Plan","88.04%","0","No","Yes","No","100%",,"$500","$90","$400","$150","$500","$600","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","per person not applicable","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2660001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2660001-01.pdf","25"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2660001","IND Platinum HMO 92","56503FL266","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2660001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2660001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2660001-02.pdf","26"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","28","56503","FL","Individual","No","26-3238817","56503FL2660001","IND Platinum HMO 92","56503FL266","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2660001-03","Limited Cost Sharing Plan Variation","88.04%","0","No","Yes","No","100%",,"$500","$90","$400","$150","$500","$600","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","per person not applicable","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2660001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2660001-03.pdf","27"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","29","56503","FL","Individual","No","26-3238817","56503FL2550002","Gym Access IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2550002-00","Standard Silver Off Exchange Plan","68.71%","0","No","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,350","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2550002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2550002-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","29","56503","FL","Individual","No","26-3238817","56503FL2550002","Gym Access IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2550002-01","Standard Silver On Exchange Plan","68.71%","0","No","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,350","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2550002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2550002-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","29","56503","FL","Individual","No","26-3238817","56503FL2550002","Gym Access IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2550002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2550002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2550002-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","29","56503","FL","Individual","No","26-3238817","56503FL2550002","Gym Access IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2550002-03","Limited Cost Sharing Plan Variation","68.71%","0","No","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,350","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2550002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2550002-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","29","56503","FL","Individual","No","26-3238817","56503FL2550002","Gym Access IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2550002-04","73% AV Level Silver Plan","73.88%","0","No","Yes","No","100%",,"$3,800","$200","$0","$150","$0","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2550002-04.pdf","http://www.fhcp.com/ISOB/2016/56503FL2550002-04.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","29","56503","FL","Individual","No","26-3238817","56503FL2550002","Gym Access IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2550002-05","87% AV Level Silver Plan","86.37%","0","No","Yes","No","100%",,"$0","$470","$0","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2550002-05.pdf","http://www.fhcp.com/ISOB/2016/56503FL2550002-05.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","29","56503","FL","Individual","No","26-3238817","56503FL2550002","Gym Access IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2550002-06","94% AV Level Silver Plan","93.29%","0","No","Yes","No","100%",,"$0","$350","$0","$150","$0","$450","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2550002-06.pdf","http://www.fhcp.com/ISOB/2016/56503FL2550002-06.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","29","56503","FL","Individual","No","26-3238817","56503FL2560002","Gym Access IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2560002-00","Standard Silver Off Exchange Plan","68.71%","0","No","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,350","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2560002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2560002-00.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","29","56503","FL","Individual","No","26-3238817","56503FL2560002","Gym Access IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2560002-01","Standard Silver On Exchange Plan","68.71%","0","No","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,350","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2560002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2560002-01.pdf","12"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","29","56503","FL","Individual","No","26-3238817","56503FL2560002","Gym Access IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2560002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2560002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2560002-02.pdf","13"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","29","56503","FL","Individual","No","26-3238817","56503FL2560002","Gym Access IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2560002-03","Limited Cost Sharing Plan Variation","68.71%","0","No","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,350","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2560002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2560002-03.pdf","14"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","29","56503","FL","Individual","No","26-3238817","56503FL2560002","Gym Access IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2560002-04","73% AV Level Silver Plan","73.88%","0","No","Yes","No","100%",,"$3,800","$200","$0","$150","$0","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2560002-04.pdf","http://www.fhcp.com/ISOB/2016/56503FL2560002-04.pdf","15"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","29","56503","FL","Individual","No","26-3238817","56503FL2560002","Gym Access IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2560002-05","87% AV Level Silver Plan","86.37%","0","No","Yes","No","100%",,"$0","$470","$0","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2560002-05.pdf","http://www.fhcp.com/ISOB/2016/56503FL2560002-05.pdf","16"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","29","56503","FL","Individual","No","26-3238817","56503FL2560002","Gym Access IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2560002-06","94% AV Level Silver Plan","93.29%","0","No","Yes","No","100%",,"$0","$350","$0","$150","$0","$450","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2560002-06.pdf","http://www.fhcp.com/ISOB/2016/56503FL2560002-06.pdf","17"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","30","56503","FL","Individual","No","26-3238817","56503FL2550001","IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2550001-00","Standard Silver Off Exchange Plan","68.71%","0","No","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,350","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2550001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2550001-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","30","56503","FL","Individual","No","26-3238817","56503FL2550001","IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2550001-01","Standard Silver On Exchange Plan","68.71%","0","No","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,350","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2550001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2550001-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","30","56503","FL","Individual","No","26-3238817","56503FL2550001","IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2550001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2550001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2550001-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","30","56503","FL","Individual","No","26-3238817","56503FL2550001","IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2550001-03","Limited Cost Sharing Plan Variation","68.71%","0","No","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,350","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2550001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2550001-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","30","56503","FL","Individual","No","26-3238817","56503FL2550001","IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2550001-04","73% AV Level Silver Plan","73.88%","0","No","Yes","No","100%",,"$3,800","$200","$0","$150","$0","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2550001-04.pdf","http://www.fhcp.com/ISOB/2016/56503FL2550001-04.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","30","56503","FL","Individual","No","26-3238817","56503FL2550001","IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2550001-05","87% AV Level Silver Plan","86.37%","0","No","Yes","No","100%",,"$0","$470","$0","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2550001-05.pdf","http://www.fhcp.com/ISOB/2016/56503FL2550001-05.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","30","56503","FL","Individual","No","26-3238817","56503FL2550001","IND Silver HMO BC 0941","56503FL255","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2550001-06","94% AV Level Silver Plan","93.29%","0","No","Yes","No","100%",,"$0","$350","$0","$150","$0","$450","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2550001-06.pdf","http://www.fhcp.com/ISOB/2016/56503FL2550001-06.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","30","56503","FL","Individual","No","26-3238817","56503FL2560001","IND Silver POS BC 0941","56503FL256","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2560001-00","Standard Silver Off Exchange Plan","68.71%","0","No","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,350","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","40%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.fhcp.com/ISBC/2016/56503FL2560001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2560001-00.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","31","56503","FL","Individual","No","26-3238817","56503FL2570002","Gym Access IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2570002-00","Standard Silver Off Exchange Plan",,"0.685866117477417","Yes","Yes","No","100%",,"$4,470","$130","$0","$150","$0","$1,130","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2570002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2570002-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","31","56503","FL","Individual","No","26-3238817","56503FL2570002","Gym Access IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2570002-01","Standard Silver On Exchange Plan",,"0.685866117477417","Yes","Yes","No","100%",,"$4,470","$130","$0","$150","$0","$1,130","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2570002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2570002-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","31","56503","FL","Individual","No","26-3238817","56503FL2570002","Gym Access IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2570002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2570002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2570002-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","31","56503","FL","Individual","No","26-3238817","56503FL2570002","Gym Access IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2570002-03","Limited Cost Sharing Plan Variation",,"0.685866117477417","Yes","Yes","No","100%",,"$4,470","$130","$0","$150","$0","$1,130","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2570002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2570002-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","31","56503","FL","Individual","No","26-3238817","56503FL2570002","Gym Access IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2570002-04","73% AV Level Silver Plan",,"0.737678647041321","Yes","Yes","No","100%",,"$4,300","$110","$50","$150","$0","$1,050","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2570002-04.pdf","http://www.fhcp.com/ISOB/2016/56503FL2570002-04.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","31","56503","FL","Individual","No","26-3238817","56503FL2570002","Gym Access IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2570002-05","87% AV Level Silver Plan",,"0.879651725292206","Yes","Yes","No","100%",,"$0","$50","$1,340","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2570002-05.pdf","http://www.fhcp.com/ISOB/2016/56503FL2570002-05.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","31","56503","FL","Individual","No","26-3238817","56503FL2570002","Gym Access IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2570002-06","94% AV Level Silver Plan",,"0.931843221187592","Yes","Yes","No","100%",,"$0","$20","$930","$150","$0","$450","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2570002-06.pdf","http://www.fhcp.com/ISOB/2016/56503FL2570002-06.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","31","56503","FL","Individual","No","26-3238817","56503FL2580002","Gym Access IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2580002-00","Standard Silver Off Exchange Plan",,"0.685866117477417","Yes","Yes","No","100%",,"$4,470","$130","$0","$150","$0","$1,130","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2580002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2580002-00.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","31","56503","FL","Individual","No","26-3238817","56503FL2580002","Gym Access IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2580002-01","Standard Silver On Exchange Plan",,"0.685866117477417","Yes","Yes","No","100%",,"$4,470","$130","$0","$150","$0","$1,130","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2580002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2580002-01.pdf","12"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","31","56503","FL","Individual","No","26-3238817","56503FL2580002","Gym Access IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2580002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2580002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2580002-02.pdf","13"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","31","56503","FL","Individual","No","26-3238817","56503FL2580002","Gym Access IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2580002-03","Limited Cost Sharing Plan Variation",,"0.685866117477417","Yes","Yes","No","100%",,"$4,470","$130","$0","$150","$0","$1,130","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2580002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2580002-03.pdf","14"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","31","56503","FL","Individual","No","26-3238817","56503FL2580002","Gym Access IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2580002-04","73% AV Level Silver Plan",,"0.737678647041321","Yes","Yes","No","100%",,"$4,300","$110","$50","$150","$0","$1,050","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2580002-04.pdf","http://www.fhcp.com/ISOB/2016/56503FL2580002-04.pdf","15"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","1","68398","FL","SHOP (Small Group)","No","59-1293865","68398FL0010052","Silver Navigate 2000","68398FL001",,"FLN002","FLS002","FLF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=fl0003&st=fl","68398FL0010052-01","Standard Silver On Exchange Plan","71.49%",,"No","Yes","No","100%",,"$2,500","$20","$1,300","$200","$200","$1,800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=fl0002&st=fl",,"7"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","1","68398","FL","Individual","No","59-1293865","68398FL0030005","Gold Compass HSA 1600","68398FL003",,"FLN001","FLS001","FLF004","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030005-03","Limited Cost Sharing Plan Variation",,"0.785858988761902","Yes","Yes","No","100%",,"$1,600","$0","$500","$200","$1,600","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$3200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=fl0009&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","7"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","1","68398","FL","Individual","No","59-1293865","68398FL0030007","Silver Compass HSA 3600","68398FL003",,"FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030007-00","Standard Silver Off Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=fl0016&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","8"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","1","68398","FL","SHOP (Small Group)","No","59-1293865","68398FL0010005","Gold Navigate 1500","68398FL001",,"FLN002","FLS003","FLF006","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=fl0003&st=fl","68398FL0010005-00","Standard Gold Off Exchange Plan","79.31%",,"No","Yes","No","100%",,"$1,800","$20","$400","$200","$200","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=fl0001&st=fl",,"8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","31","56503","FL","Individual","No","26-3238817","56503FL2580002","Gym Access IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2580002-05","87% AV Level Silver Plan",,"0.879651725292206","Yes","Yes","No","100%",,"$0","$50","$1,340","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2580002-05.pdf","http://www.fhcp.com/ISOB/2016/56503FL2580002-05.pdf","16"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","31","56503","FL","Individual","No","26-3238817","56503FL2580002","Gym Access IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2580002-06","94% AV Level Silver Plan",,"0.931843221187592","Yes","Yes","No","100%",,"$0","$20","$930","$150","$0","$450","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2580002-06.pdf","http://www.fhcp.com/ISOB/2016/56503FL2580002-06.pdf","17"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","32","56503","FL","Individual","No","26-3238817","56503FL2570001","IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2570001-00","Standard Silver Off Exchange Plan",,"0.685866117477417","Yes","Yes","No","100%",,"$4,470","$130","$0","$150","$0","$1,130","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2570001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2570001-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","32","56503","FL","Individual","No","26-3238817","56503FL2570001","IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2570001-01","Standard Silver On Exchange Plan",,"0.685866117477417","Yes","Yes","No","100%",,"$4,470","$130","$0","$150","$0","$1,130","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2570001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2570001-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","32","56503","FL","Individual","No","26-3238817","56503FL2570001","IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2570001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2570001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2570001-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","32","56503","FL","Individual","No","26-3238817","56503FL2570001","IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2570001-03","Limited Cost Sharing Plan Variation",,"0.685866117477417","Yes","Yes","No","100%",,"$4,470","$130","$0","$150","$0","$1,130","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2570001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2570001-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","32","56503","FL","Individual","No","26-3238817","56503FL2570001","IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2570001-04","73% AV Level Silver Plan",,"0.737678647041321","Yes","Yes","No","100%",,"$4,300","$110","$50","$150","$0","$1,050","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2570001-04.pdf","http://www.fhcp.com/ISOB/2016/56503FL2570001-04.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","32","56503","FL","Individual","No","26-3238817","56503FL2570001","IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2570001-05","87% AV Level Silver Plan",,"0.879651725292206","Yes","Yes","No","100%",,"$0","$50","$1,340","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2570001-05.pdf","http://www.fhcp.com/ISOB/2016/56503FL2570001-05.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","32","56503","FL","Individual","No","26-3238817","56503FL2570001","IND Silver HMO BC 7741","56503FL257","7265435496","FLN001","FLS001","FLF002","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2570001-06","94% AV Level Silver Plan",,"0.931843221187592","Yes","Yes","No","100%",,"$0","$20","$930","$150","$0","$450","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2570001-06.pdf","http://www.fhcp.com/ISOB/2016/56503FL2570001-06.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","32","56503","FL","Individual","No","26-3238817","56503FL2580001","IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2580001-00","Standard Silver Off Exchange Plan",,"0.685866117477417","Yes","Yes","No","100%",,"$4,470","$130","$0","$150","$0","$1,130","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2580001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2580001-00.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","32","56503","FL","Individual","No","26-3238817","56503FL2580001","IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2580001-01","Standard Silver On Exchange Plan",,"0.685866117477417","Yes","Yes","No","100%",,"$4,470","$130","$0","$150","$0","$1,130","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2580001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2580001-01.pdf","12"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","32","56503","FL","Individual","No","26-3238817","56503FL2580001","IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2580001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2580001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2580001-02.pdf","13"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","32","56503","FL","Individual","No","26-3238817","56503FL2580001","IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2580001-03","Limited Cost Sharing Plan Variation",,"0.685866117477417","Yes","Yes","No","100%",,"$4,470","$130","$0","$150","$0","$1,130","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2580001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2580001-03.pdf","14"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","32","56503","FL","Individual","No","26-3238817","56503FL2580001","IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2580001-04","73% AV Level Silver Plan",,"0.737678647041321","Yes","Yes","No","100%",,"$4,300","$110","$50","$150","$0","$1,050","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2580001-04.pdf","http://www.fhcp.com/ISOB/2016/56503FL2580001-04.pdf","15"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","32","56503","FL","Individual","No","26-3238817","56503FL2580001","IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2580001-05","87% AV Level Silver Plan",,"0.879651725292206","Yes","Yes","No","100%",,"$0","$50","$1,340","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2580001-05.pdf","http://www.fhcp.com/ISOB/2016/56503FL2580001-05.pdf","16"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","32","56503","FL","Individual","No","26-3238817","56503FL2580001","IND Silver POS BC 7741","56503FL258","7265435496","FLN001","FLS001","FLF002","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","2","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2580001-06","94% AV Level Silver Plan",,"0.931843221187592","Yes","Yes","No","100%",,"$0","$20","$930","$150","$0","$450","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2580001-06.pdf","http://www.fhcp.com/ISOB/2016/56503FL2580001-06.pdf","17"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","33","56503","FL","Individual","No","26-3238817","56503FL2530002","Gym Access IND Bronze HMO BC 3841","56503FL253","7265435496","FLN001","FLS001","FLF002","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2530002-00","Standard Bronze Off Exchange Plan",,"0.616186618804932","Yes","Yes","No","100%",,"$4,470","$100","$350","$150","$0","$900","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","per person not applicable","$13400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2530002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2530002-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","33","56503","FL","Individual","No","26-3238817","56503FL2530002","Gym Access IND Bronze HMO BC 3841","56503FL253","7265435496","FLN001","FLS001","FLF002","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2530002-01","Standard Bronze On Exchange Plan",,"0.616186618804932","Yes","Yes","No","100%",,"$4,470","$100","$350","$150","$0","$900","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","per person not applicable","$13400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2530002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2530002-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","33","56503","FL","Individual","No","26-3238817","56503FL2530002","Gym Access IND Bronze HMO BC 3841","56503FL253","7265435496","FLN001","FLS001","FLF002","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2530002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2530002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2530002-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","33","56503","FL","Individual","No","26-3238817","56503FL2530002","Gym Access IND Bronze HMO BC 3841","56503FL253","7265435496","FLN001","FLS001","FLF002","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2530002-03","Limited Cost Sharing Plan Variation",,"0.616186618804932","Yes","Yes","No","100%",,"$4,470","$100","$350","$150","$0","$900","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","per person not applicable","$13400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2530002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2530002-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","33","56503","FL","Individual","No","26-3238817","56503FL2540002","Gym Access IND Bronze POS BC 3841","56503FL254","7265435496","FLN001","FLS001","FLF002","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2540002-00","Standard Bronze Off Exchange Plan",,"0.616186618804932","Yes","Yes","No","100%",,"$4,470","$100","$350","$150","$0","$900","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","per person not applicable","$13400 per group","50%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2540002-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2540002-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","33","56503","FL","Individual","No","26-3238817","56503FL2540002","Gym Access IND Bronze POS BC 3841","56503FL254","7265435496","FLN001","FLS001","FLF002","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2540002-01","Standard Bronze On Exchange Plan",,"0.616186618804932","Yes","Yes","No","100%",,"$4,470","$100","$350","$150","$0","$900","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","per person not applicable","$13400 per group","50%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2540002-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2540002-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","33","56503","FL","Individual","No","26-3238817","56503FL2540002","Gym Access IND Bronze POS BC 3841","56503FL254","7265435496","FLN001","FLS001","FLF002","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2540002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2540002-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2540002-02.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","33","56503","FL","Individual","No","26-3238817","56503FL2540002","Gym Access IND Bronze POS BC 3841","56503FL254","7265435496","FLN001","FLS001","FLF002","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9874",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2540002-03","Limited Cost Sharing Plan Variation",,"0.616186618804932","Yes","Yes","No","100%",,"$4,470","$100","$350","$150","$0","$900","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","per person not applicable","$13400 per group","50%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2540002-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2540002-03.pdf","11"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","34","56503","FL","Individual","No","26-3238817","56503FL2530001","IND Bronze HMO BC 3841","56503FL253","7265435496","FLN001","FLS001","FLF002","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2530001-00","Standard Bronze Off Exchange Plan",,"0.616186618804932","Yes","Yes","No","100%",,"$4,470","$100","$350","$150","$0","$900","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","per person not applicable","$13400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2530001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2530001-00.pdf","4"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","34","56503","FL","Individual","No","26-3238817","56503FL2530001","IND Bronze HMO BC 3841","56503FL253","7265435496","FLN001","FLS001","FLF002","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2530001-01","Standard Bronze On Exchange Plan",,"0.616186618804932","Yes","Yes","No","100%",,"$4,470","$100","$350","$150","$0","$900","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","per person not applicable","$13400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2530001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2530001-01.pdf","5"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","34","56503","FL","Individual","No","26-3238817","56503FL2530001","IND Bronze HMO BC 3841","56503FL253","7265435496","FLN001","FLS001","FLF002","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2530001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2530001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2530001-02.pdf","6"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","34","56503","FL","Individual","No","26-3238817","56503FL2530001","IND Bronze HMO BC 3841","56503FL253","7265435496","FLN001","FLS001","FLF002","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2530001-03","Limited Cost Sharing Plan Variation",,"0.616186618804932","Yes","Yes","No","100%",,"$4,470","$100","$350","$150","$0","$900","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","per person not applicable","$13400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2530001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2530001-03.pdf","7"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","34","56503","FL","Individual","No","26-3238817","56503FL2540001","IND Bronze POS BC 3841","56503FL254","7265435496","FLN001","FLS001","FLF002","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2540001-00","Standard Bronze Off Exchange Plan",,"0.616186618804932","Yes","Yes","No","100%",,"$4,470","$100","$350","$150","$0","$900","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","per person not applicable","$13400 per group","50%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2540001-00.pdf","http://www.fhcp.com/ISOB/2016/56503FL2540001-00.pdf","8"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","34","56503","FL","Individual","No","26-3238817","56503FL2540001","IND Bronze POS BC 3841","56503FL254","7265435496","FLN001","FLS001","FLF002","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2540001-01","Standard Bronze On Exchange Plan",,"0.616186618804932","Yes","Yes","No","100%",,"$4,470","$100","$350","$150","$0","$900","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","per person not applicable","$13400 per group","50%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2540001-01.pdf","http://www.fhcp.com/ISOB/2016/56503FL2540001-01.pdf","9"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","34","56503","FL","Individual","No","26-3238817","56503FL2540001","IND Bronze POS BC 3841","56503FL254","7265435496","FLN001","FLS001","FLF002","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2540001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2540001-02.pdf","http://www.fhcp.com/ISOB/2016/56503FL2540001-02.pdf","10"
"2016","FL","56503","HIOS","8","2016-01-22 04:00:42","34","56503","FL","Individual","No","26-3238817","56503FL2540001","IND Bronze POS BC 3841","56503FL254","7265435496","FLN001","FLS001","FLF002","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","https://fhcp.softheon.com/Marketplace/","http://www.fhcp.com/members/plansAndBenefits/2016-exchange-formulary.pdf","56503FL2540001-03","Limited Cost Sharing Plan Variation",,"0.616186618804932","Yes","Yes","No","100%",,"$4,470","$100","$350","$150","$0","$900","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","per person not applicable","$13400 per group","50%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.fhcp.com/ISBC/2016/56503FL2540001-03.pdf","http://www.fhcp.com/ISOB/2016/56503FL2540001-03.pdf","11"
"2016","FL","57451","HIOS","10","2015-10-18 12:35:12","1","57451","FL","Individual","No","65-0986441","57451FL0070003","Coventry Bronze $15 Copay Carelink HMO","57451FL007",,"FLN001","FLS001","FLF002","Existing","HMO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8442609088","57451FL0070003-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/FL72705","http://www.coventryone.com/FLon2016","4"
"2016","FL","57451","HIOS","10","2015-10-18 12:35:12","1","57451","FL","Individual","No","65-0986441","57451FL0070003","Coventry Bronze $15 Copay Carelink HMO","57451FL007",,"FLN001","FLS001","FLF002","Existing","HMO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8442609088","57451FL0070003-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/FL72706","http://www.coventryone.com/FLon2016","5"
"2016","FL","57451","HIOS","10","2015-10-18 12:35:12","1","57451","FL","Individual","No","65-0986441","57451FL0070003","Coventry Bronze $15 Copay Carelink HMO","57451FL007",,"FLN001","FLS001","FLF002","Existing","HMO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8442609088","57451FL0070003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/FL72709","http://www.coventryone.com/FLon2016","6"
"2016","FL","57451","HIOS","10","2015-10-18 12:35:12","1","57451","FL","Individual","No","65-0986441","57451FL0070003","Coventry Bronze $15 Copay Carelink HMO","57451FL007",,"FLN001","FLS001","FLF002","Existing","HMO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8442609088","57451FL0070003-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/FL72708","http://www.coventryone.com/FLon2016","7"
"2016","FL","57451","HIOS","10","2015-10-18 12:35:12","4","57451","FL","Individual","No","65-0986441","57451FL0070004","Coventry Bronze Ded Only HSA Eligible Carelink HMO","57451FL007",,"FLN001","FLS001","FLF003","Existing","HMO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8442609088","57451FL0070004-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/FL72710","http://www.coventryone.com/FLon2016","4"
"2016","FL","57451","HIOS","10","2015-10-18 12:35:12","4","57451","FL","Individual","No","65-0986441","57451FL0070004","Coventry Bronze Ded Only HSA Eligible Carelink HMO","57451FL007",,"FLN001","FLS001","FLF003","Existing","HMO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8442609088","57451FL0070004-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/FL72711","http://www.coventryone.com/FLon2016","5"
"2016","FL","57451","HIOS","10","2015-10-18 12:35:12","4","57451","FL","Individual","No","65-0986441","57451FL0070004","Coventry Bronze Ded Only HSA Eligible Carelink HMO","57451FL007",,"FLN001","FLS001","FLF003","Existing","HMO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8442609088","57451FL0070004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/FL72714","http://www.coventryone.com/FLon2016","6"
"2016","FL","57451","HIOS","10","2015-10-18 12:35:12","4","57451","FL","Individual","No","65-0986441","57451FL0070004","Coventry Bronze Ded Only HSA Eligible Carelink HMO","57451FL007",,"FLN001","FLS001","FLF003","Existing","HMO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8442609088","57451FL0070004-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/FL72713","http://www.coventryone.com/FLon2016","7"
"2016","FL","57451","HIOS","10","2015-10-18 12:35:12","7","57451","FL","Individual","No","65-0986441","57451FL0070006","Coventry Silver $10 Copay 2750 Carelink HMO","57451FL007",,"FLN001","FLS001","FLF004","Existing","HMO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8440000472","57451FL0070006-00","Standard Silver Off Exchange Plan","68.05%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/FL72698","http://www.coventryone.com/FLon2016","4"
"2016","FL","57451","HIOS","10","2015-10-18 12:35:12","7","57451","FL","Individual","No","65-0986441","57451FL0070006","Coventry Silver $10 Copay 2750 Carelink HMO","57451FL007",,"FLN001","FLS001","FLF004","Existing","HMO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8440000472","57451FL0070006-01","Standard Silver On Exchange Plan","68.05%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/FL72697","http://www.coventryone.com/FLon2016","5"
"2016","FL","57451","HIOS","10","2015-10-18 12:35:12","7","57451","FL","Individual","No","65-0986441","57451FL0070006","Coventry Silver $10 Copay 2750 Carelink HMO","57451FL007",,"FLN001","FLS001","FLF004","Existing","HMO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8440000472","57451FL0070006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/FL72701","http://www.coventryone.com/FLon2016","6"
"2016","FL","57451","HIOS","10","2015-10-18 12:35:12","7","57451","FL","Individual","No","65-0986441","57451FL0070006","Coventry Silver $10 Copay 2750 Carelink HMO","57451FL007",,"FLN001","FLS001","FLF004","Existing","HMO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8440000472","57451FL0070006-03","Limited Cost Sharing Plan Variation","68.05%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/FL72700","http://www.coventryone.com/FLon2016","7"
"2016","FL","57451","HIOS","10","2015-10-18 12:35:12","7","57451","FL","Individual","No","65-0986441","57451FL0070006","Coventry Silver $10 Copay 2750 Carelink HMO","57451FL007",,"FLN001","FLS001","FLF004","Existing","HMO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8440000472","57451FL0070006-04","73% AV Level Silver Plan","72.18%",,"Yes","Yes","No","100%",,"$2,500","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/FL72704","http://www.coventryone.com/FLon2016","8"
"2016","FL","57451","HIOS","10","2015-10-18 12:35:12","7","57451","FL","Individual","No","65-0986441","57451FL0070006","Coventry Silver $10 Copay 2750 Carelink HMO","57451FL007",,"FLN001","FLS001","FLF004","Existing","HMO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8440000472","57451FL0070006-05","87% AV Level Silver Plan","86.24%",,"Yes","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/FL72703","http://www.coventryone.com/FLon2016","9"
"2016","FL","57451","HIOS","10","2015-10-18 12:35:12","7","57451","FL","Individual","No","65-0986441","57451FL0070006","Coventry Silver $10 Copay 2750 Carelink HMO","57451FL007",,"FLN001","FLS001","FLF004","Existing","HMO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8440000472","57451FL0070006-06","94% AV Level Silver Plan","93.06%",,"Yes","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/FL72702","http://www.coventryone.com/FLon2016","10"
"2016","FL","57451","HIOS","10","2015-10-18 12:35:12","10","57451","FL","Individual","No","65-0986441","57451FL0070001","Coventry Gold $10 Copay Carelink HMO","57451FL007",,"FLN001","FLS001","FLF001","Existing","HMO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8440000472","57451FL0070001-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/FL72693","http://www.coventryone.com/FLon2016","4"
"2016","FL","57451","HIOS","10","2015-10-18 12:35:12","10","57451","FL","Individual","No","65-0986441","57451FL0070001","Coventry Gold $10 Copay Carelink HMO","57451FL007",,"FLN001","FLS001","FLF001","Existing","HMO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8440000472","57451FL0070001-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/FL72692","http://www.coventryone.com/FLon2016","5"
"2016","FL","57451","HIOS","10","2015-10-18 12:35:12","10","57451","FL","Individual","No","65-0986441","57451FL0070001","Coventry Gold $10 Copay Carelink HMO","57451FL007",,"FLN001","FLS001","FLF001","Existing","HMO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8440000472","57451FL0070001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/FL72696","http://www.coventryone.com/FLon2016","6"
"2016","FL","57451","HIOS","10","2015-10-18 12:35:12","10","57451","FL","Individual","No","65-0986441","57451FL0070001","Coventry Gold $10 Copay Carelink HMO","57451FL007",,"FLN001","FLS001","FLF001","Existing","HMO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8440000472","57451FL0070001-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/FL72695","http://www.coventryone.com/FLon2016","7"
"2016","FL","57451","HIOS","10","2015-10-18 12:35:12","13","57451","FL","Individual","No","65-0986441","57451FL0070007","Coventry Catastrophic Carelink HMO","57451FL007",,"FLN001","FLS001","FLF005","New","HMO","Catastrophic","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8442609088","57451FL0070007-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/FL72724","http://www.coventryone.com/FLon2016","4"
"2016","FL","57451","HIOS","10","2015-10-18 12:35:12","13","57451","FL","Individual","No","65-0986441","57451FL0070007","Coventry Catastrophic Carelink HMO","57451FL007",,"FLN001","FLS001","FLF005","New","HMO","Catastrophic","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8442609088","57451FL0070007-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/FL72725","http://www.coventryone.com/FLon2016","5"
"2016","FL","59667","HIOS","5","2015-07-16 02:22:15","1","59667","FL","Individual","Yes","65-0743731","59667FL0010001","DentaQuest EPO Pediatric High","59667FL001","7891798028","FLN001","FLS001",,"Existing","EPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$23.31","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","59667FL0010001-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/","4"
"2016","FL","59667","HIOS","5","2015-07-16 02:22:15","1","59667","FL","SHOP (Small Group)","Yes","65-0743731","59667FL0020003","DentaQuest EPO Family High","59667FL002","7891798028","FLN001","FLS001",,"Existing","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","59667FL0020003-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/","4"
"2016","FL","59667","HIOS","5","2015-07-16 02:22:15","1","59667","FL","SHOP (Small Group)","Yes","65-0743731","59667FL0020003","DentaQuest EPO Family High","59667FL002","7891798028","FLN001","FLS001",,"Existing","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","59667FL0020003-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/","5"
"2016","FL","59667","HIOS","5","2015-07-16 02:22:15","1","59667","FL","Individual","Yes","65-0743731","59667FL0010001","DentaQuest EPO Pediatric High","59667FL001","7891798028","FLN001","FLS001",,"Existing","EPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$23.31","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","59667FL0010001-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/","5"
"2016","FL","59667","HIOS","5","2015-07-16 02:22:15","1","59667","FL","SHOP (Small Group)","Yes","65-0743731","59667FL0020004","DentaQuest EPO Family Low","59667FL002","7891798028","FLN001","FLS001",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.97","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","59667FL0020004-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/","6"
"2016","FL","59667","HIOS","5","2015-07-16 02:22:15","1","59667","FL","SHOP (Small Group)","Yes","65-0743731","59667FL0020004","DentaQuest EPO Family Low","59667FL002","7891798028","FLN001","FLS001",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.97","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","59667FL0020004-01","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/fl/","http://www.dentaquest.com/marketplace/fl/","7"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","1","68398","FL","SHOP (Small Group)","No","59-1293865","68398FL0010005","Gold Navigate 1500","68398FL001",,"FLN002","FLS003","FLF006","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=fl0003&st=fl","68398FL0010005-01","Standard Gold On Exchange Plan","79.31%",,"No","Yes","No","100%",,"$1,800","$20","$400","$200","$200","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=fl0001&st=fl",,"9"
"2016","FL","65476","HIOS","1","2015-05-01 02:23:41","1","65476","FL","SHOP (Small Group)","Yes","47-0098400","65476FL0040002","EHB High PPO","65476FL004",,"FLN001","FLS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.11","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","65476FL0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","FL","65476","HIOS","1","2015-05-01 02:23:41","1","65476","FL","SHOP (Small Group)","Yes","47-0098400","65476FL0040001","EHB Low PPO","65476FL004",,"FLN001","FLS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.74","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","65476FL0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","FL","65476","HIOS","1","2015-05-01 02:23:41","1","65476","FL","SHOP (Small Group)","Yes","47-0098400","65476FL0030002","EHB High Passive","65476FL003",,"FLN001","FLS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.17","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","65476FL0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","FL","65476","HIOS","1","2015-05-01 02:23:41","1","65476","FL","SHOP (Small Group)","Yes","47-0098400","65476FL0030001","EHB Low Passive","65476FL003",,"FLN001","FLS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.60","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","65476FL0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","1","68398","FL","Individual","No","59-1293865","68398FL0030005","Gold Compass HSA 1600","68398FL003",,"FLN001","FLS001","FLF004","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030005-00","Standard Gold Off Exchange Plan",,"0.785858988761902","Yes","Yes","No","100%",,"$1,600","$0","$500","$200","$1,600","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$3200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=fl0007&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","4"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","1","68398","FL","SHOP (Small Group)","No","59-1293865","68398FL0010074","Gold Navigate 1500","68398FL001",,"FLN002","FLS002","FLF006","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=fl0003&st=fl","68398FL0010074-00","Standard Gold Off Exchange Plan","79.31%",,"No","Yes","No","100%",,"$1,800","$20","$400","$200","$200","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=fl0001&st=fl",,"4"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","1","68398","FL","SHOP (Small Group)","No","59-1293865","68398FL0010074","Gold Navigate 1500","68398FL001",,"FLN002","FLS002","FLF006","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=fl0003&st=fl","68398FL0010074-01","Standard Gold On Exchange Plan","79.31%",,"No","Yes","No","100%",,"$1,800","$20","$400","$200","$200","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=fl0001&st=fl",,"5"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","1","68398","FL","Individual","No","59-1293865","68398FL0030005","Gold Compass HSA 1600","68398FL003",,"FLN001","FLS001","FLF004","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030005-01","Standard Gold On Exchange Plan",,"0.785858988761902","Yes","Yes","No","100%",,"$1,600","$0","$500","$200","$1,600","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$3200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=fl0007&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","5"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","1","68398","FL","Individual","No","59-1293865","68398FL0030005","Gold Compass HSA 1600","68398FL003",,"FLN001","FLS001","FLF004","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=fl0008&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","6"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","1","68398","FL","SHOP (Small Group)","No","59-1293865","68398FL0010052","Silver Navigate 2000","68398FL001",,"FLN002","FLS002","FLF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=fl0003&st=fl","68398FL0010052-00","Standard Silver Off Exchange Plan","71.49%",,"No","Yes","No","100%",,"$2,500","$20","$1,300","$200","$200","$1,800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=fl0002&st=fl",,"6"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","1","68398","FL","Individual","No","59-1293865","68398FL0030007","Silver Compass HSA 3600","68398FL003",,"FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030007-01","Standard Silver On Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=fl0016&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","9"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","1","68398","FL","Individual","No","59-1293865","68398FL0030007","Silver Compass HSA 3600","68398FL003",,"FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=fl0017&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","10"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","1","68398","FL","SHOP (Small Group)","No","59-1293865","68398FL0010059","Silver Navigate 2000","68398FL001",,"FLN002","FLS003","FLF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=fl0003&st=fl","68398FL0010059-00","Standard Silver Off Exchange Plan","71.49%",,"No","Yes","No","100%",,"$2,500","$20","$1,300","$200","$200","$1,800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=fl0002&st=fl",,"10"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","1","68398","FL","SHOP (Small Group)","No","59-1293865","68398FL0010059","Silver Navigate 2000","68398FL001",,"FLN002","FLS003","FLF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=fl0003&st=fl","68398FL0010059-01","Standard Silver On Exchange Plan","71.49%",,"No","Yes","No","100%",,"$2,500","$20","$1,300","$200","$200","$1,800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=fl0002&st=fl",,"11"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","1","68398","FL","Individual","No","59-1293865","68398FL0030007","Silver Compass HSA 3600","68398FL003",,"FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030007-03","Limited Cost Sharing Plan Variation",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=fl0018&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","11"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","1","68398","FL","Individual","No","59-1293865","68398FL0030007","Silver Compass HSA 3600","68398FL003",,"FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030007-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$3,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=fl0019&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","12"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","1","68398","FL","Individual","No","59-1293865","68398FL0030007","Silver Compass HSA 3600","68398FL003",,"FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030007-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$200","$1,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$2200 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=fl0020&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","13"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","1","68398","FL","Individual","No","59-1293865","68398FL0030007","Silver Compass HSA 3600","68398FL003",,"FLN001","FLS001","FLF003","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030007-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=fl0021&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","14"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","2","68398","FL","Individual","No","59-1293865","68398FL0030004","Gold Compass 1500","68398FL003",,"FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030004-00","Standard Gold Off Exchange Plan",,"0.800308048725128","No","Yes","No","100%",,"$1,500","$20","$30","$4,600","$300","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=fl0004&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","8"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","2","68398","FL","Individual","No","59-1293865","68398FL0030004","Gold Compass 1500","68398FL003",,"FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030004-01","Standard Gold On Exchange Plan",,"0.800308048725128","No","Yes","No","100%",,"$1,500","$500","$30","$200","$300","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=fl0004&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","9"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","2","68398","FL","Individual","No","59-1293865","68398FL0030004","Gold Compass 1500","68398FL003",,"FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=fl0005&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","10"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","2","68398","FL","Individual","No","59-1293865","68398FL0030004","Gold Compass 1500","68398FL003",,"FLN001","FLS001","FLF001","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030004-03","Limited Cost Sharing Plan Variation",,"0.800308048725128","No","Yes","No","100%",,"$1,500","$500","$30","$200","$300","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=fl0006&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","11"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","2","68398","FL","Individual","No","59-1293865","68398FL0030006","Silver Compass 4000","68398FL003",,"FLN001","FLS001","FLF001","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030006-00","Standard Silver Off Exchange Plan",,"0.697066605091095","No","Yes","No","100%",,"$4,000","$20","$200","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=fl0010&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","12"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","2","68398","FL","Individual","No","59-1293865","68398FL0030006","Silver Compass 4000","68398FL003",,"FLN001","FLS001","FLF001","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030006-01","Standard Silver On Exchange Plan",,"0.697066605091095","No","Yes","No","100%",,"$4,000","$20","$200","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=fl0010&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","13"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","2","68398","FL","Individual","No","59-1293865","68398FL0030006","Silver Compass 4000","68398FL003",,"FLN001","FLS001","FLF001","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=fl0011&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","14"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","2","68398","FL","Individual","No","59-1293865","68398FL0030006","Silver Compass 4000","68398FL003",,"FLN001","FLS001","FLF001","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030006-03","Limited Cost Sharing Plan Variation",,"0.697066605091095","No","Yes","No","100%",,"$4,000","$20","$200","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=fl0012&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","15"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","2","68398","FL","Individual","No","59-1293865","68398FL0030006","Silver Compass 4000","68398FL003",,"FLN001","FLS001","FLF001","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030006-04","73% AV Level Silver Plan",,"0.737395048141479","No","Yes","No","100%",,"$3,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=fl0013&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","16"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","2","68398","FL","Individual","No","59-1293865","68398FL0030006","Silver Compass 4000","68398FL003",,"FLN001","FLS001","FLF001","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030006-05","87% AV Level Silver Plan",,"0.87861156463623","No","Yes","No","100%",,"$900","$10","$500","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=fl0014&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","17"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","2","68398","FL","Individual","No","59-1293865","68398FL0030006","Silver Compass 4000","68398FL003",,"FLN001","FLS001","FLF001","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030006-06","94% AV Level Silver Plan",,"0.946469008922577","No","Yes","No","100%",,"$0","$0","$500","$200","$0","$500","$20","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=fl0015&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","18"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","2","68398","FL","Individual","No","59-1293865","68398FL0030008","Bronze Compass 4200","68398FL003",,"FLN001","FLS001","FLF002","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030008-00","Standard Bronze Off Exchange Plan",,"0.619571328163147","Yes","Yes","No","100%",,"$4,200","$0","$600","$200","$4,200","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=fl0022&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","19"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","2","68398","FL","Individual","No","59-1293865","68398FL0030008","Bronze Compass 4200","68398FL003",,"FLN001","FLS001","FLF002","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030008-01","Standard Bronze On Exchange Plan",,"0.619571328163147","Yes","Yes","No","100%",,"$4,200","$0","$600","$200","$4,200","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=fl0022&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","20"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","2","68398","FL","Individual","No","59-1293865","68398FL0030008","Bronze Compass 4200","68398FL003",,"FLN001","FLS001","FLF002","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=fl0023&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","21"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","2","68398","FL","Individual","No","59-1293865","68398FL0030008","Bronze Compass 4200","68398FL003",,"FLN001","FLS001","FLF002","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030008-03","Limited Cost Sharing Plan Variation",,"0.619571328163147","Yes","Yes","No","100%",,"$4,200","$0","$600","$200","$4,200","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=fl0024&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","22"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","2","68398","FL","Individual","No","59-1293865","68398FL0030009","Bronze Compass 6400","68398FL003",,"FLN001","FLS001","FLF001","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030009-00","Standard Bronze Off Exchange Plan",,"0.613963782787323","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=fl0025&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","23"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","2","68398","FL","Individual","No","59-1293865","68398FL0030009","Bronze Compass 6400","68398FL003",,"FLN001","FLS001","FLF001","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030009-01","Standard Bronze On Exchange Plan",,"0.613963782787323","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=fl0025&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","24"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","2","68398","FL","Individual","No","59-1293865","68398FL0030009","Bronze Compass 6400","68398FL003",,"FLN001","FLS001","FLF001","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=fl0026&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","25"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","2","68398","FL","Individual","No","59-1293865","68398FL0030009","Bronze Compass 6400","68398FL003",,"FLN001","FLS001","FLF001","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030009-03","Limited Cost Sharing Plan Variation",,"0.613963782787323","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=fl0027&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","26"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","2","68398","FL","Individual","No","59-1293865","68398FL0030010","Catastrophic Compass 6850","68398FL003",,"FLN001","FLS001","FLF003","Existing","HMO","Catastrophic","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030010-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,700","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=fl0028&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","27"
"2016","FL","68398","HIOS","7","2016-01-23 05:53:30","2","68398","FL","Individual","No","59-1293865","68398FL0030010","Catastrophic Compass 6850","68398FL003",,"FLN001","FLS001","FLF003","Existing","HMO","Catastrophic","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=fl0030&st=fl","68398FL0030010-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,700","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=fl0028&st=fl","http://www.uhc.com/iex/doc?id=fl0029&st=fl","28"
"2016","FL","71675","HIOS","2","2015-07-10 02:19:03","1","71675","FL","SHOP (Small Group)","Yes","42-0127290","71675FL0040001","Principal Plan Dental 70","71675FL004",,"FLN001","FLS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$26.19","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","71675FL0040001-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","FL","71675","HIOS","2","2015-07-10 02:19:03","1","71675","FL","SHOP (Small Group)","Yes","42-0127290","71675FL0040002","Principal Plan Dental 85","71675FL004",,"FLN001","FLS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$27.67","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","71675FL0040002-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","FL","75196","HIOS","1","2015-05-01 02:23:41","1","75196","FL","SHOP (Small Group)","Yes","93-0242990","75196FL0040002","EHB High PPO","75196FL004",,"FLN001","FLS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.79","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","75196FL0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","FL","75196","HIOS","1","2015-05-01 02:23:41","1","75196","FL","SHOP (Small Group)","Yes","93-0242990","75196FL0040001","EHB Low PPO","75196FL004",,"FLN001","FLS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.07","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","75196FL0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","FL","75196","HIOS","1","2015-05-01 02:23:41","1","75196","FL","SHOP (Small Group)","Yes","93-0242990","75196FL0030002","EHB High Passive","75196FL003",,"FLN001","FLS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.93","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","75196FL0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","FL","75196","HIOS","1","2015-05-01 02:23:41","1","75196","FL","SHOP (Small Group)","Yes","93-0242990","75196FL0030001","EHB Low Passive","75196FL003",,"FLN001","FLS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.02","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","75196FL0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","FL","77150","HIOS","3","2015-08-27 11:14:25","1","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL1110004","Health First Gold PPO 50 5146","77150FL111",,"FLN001","FLS001","FLF009","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9901",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","77150FL1110004-00","Standard Gold Off Exchange Plan","80.26%",,"No","Yes","No","100%",,"$700","$940","$0","$150","$1,000","$560","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5146","http://www.myHFHP.org/MPS_2016","4"
"2016","FL","77150","HIOS","3","2015-08-27 11:14:25","1","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL1110004","Health First Gold PPO 50 5146","77150FL111",,"FLN001","FLS001","FLF009","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9901",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","77150FL1110004-01","Standard Gold On Exchange Plan","80.26%",,"No","Yes","No","100%",,"$700","$940","$0","$150","$1,000","$560","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5146","http://www.myHFHP.org/MPS_2016","5"
"2016","FL","77150","HIOS","3","2015-08-27 11:14:25","1","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL1110005","Health First Gold PPO 50 5162","77150FL111",,"FLN001","FLS001","FLF009","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9902",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","77150FL1110005-00","Standard Gold Off Exchange Plan","81.48%",,"No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5162","http://www.myHFHP.org/MPS_2016","6"
"2016","FL","77150","HIOS","3","2015-08-27 11:14:25","1","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL1110005","Health First Gold PPO 50 5162","77150FL111",,"FLN001","FLS001","FLF009","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9902",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","77150FL1110005-01","Standard Gold On Exchange Plan","81.48%",,"No","Yes","No","100%",,"$500","$930","$100","$150","$500","$480","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5162","http://www.myHFHP.org/MPS_2016","7"
"2016","FL","77150","HIOS","3","2015-08-27 11:14:25","1","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL1110011","Health First Silver PPO 50 5300","77150FL111",,"FLN001","FLS001","FLF009","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","77150FL1110011-00","Standard Silver Off Exchange Plan","70.89%",,"No","Yes","No","100%",,"$2,000","$0","$1,320","$150","$1,270","$220","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5300","http://www.myHFHP.org/MPS_2016","8"
"2016","FL","77150","HIOS","3","2015-08-27 11:14:25","1","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL1110011","Health First Silver PPO 50 5300","77150FL111",,"FLN001","FLS001","FLF009","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","77150FL1110011-01","Standard Silver On Exchange Plan","70.89%",,"No","Yes","No","100%",,"$2,000","$0","$1,320","$150","$1,270","$220","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5300","http://www.myHFHP.org/MPS_2016","9"
"2016","FL","77150","HIOS","3","2015-08-27 11:14:25","1","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL1110002","Health First Gold PPO 80 5118","77150FL111",,"FLN001","FLS001","FLF009","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9898",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","77150FL1110002-00","Standard Gold Off Exchange Plan","80.25%",,"No","Yes","No","100%",,"$750","$40","$780","$150","$750","$400","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5118","http://www.myHFHP.org/MPS_2016","10"
"2016","FL","77150","HIOS","3","2015-08-27 11:14:25","1","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL1110002","Health First Gold PPO 80 5118","77150FL111",,"FLN001","FLS001","FLF009","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9898",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","77150FL1110002-01","Standard Gold On Exchange Plan","80.25%",,"No","Yes","No","100%",,"$750","$40","$780","$150","$750","$400","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5118","http://www.myHFHP.org/MPS_2016","11"
"2016","FL","77150","HIOS","3","2015-08-27 11:14:25","3","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL1110013","Health First Silver PPO 50 5318","77150FL111",,"FLN001","FLS001","FLF009","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9879",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","77150FL1110013-00","Standard Silver Off Exchange Plan","70.03%",,"No","Yes","No","100%",,"$2,000","$50","$1,590","$150","$2,000","$265","$88","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5318","http://www.myHFHP.org/MPS_2016","4"
"2016","FL","77150","HIOS","3","2015-08-27 11:14:25","3","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL1110013","Health First Silver PPO 50 5318","77150FL111",,"FLN001","FLS001","FLF009","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9879",,,,"0","0","4","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","77150FL1110013-01","Standard Silver On Exchange Plan","70.03%",,"No","Yes","No","100%",,"$2,000","$50","$1,590","$150","$2,000","$265","$88","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No","No",,"http://www.myHFHP.org/2016_sbc_5318","http://www.myHFHP.org/MPS_2016","5"
"2016","FL","77150","HIOS","3","2015-08-27 11:14:25","4","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL1110012","Health First Silver PPO 90 5309","77150FL111",,"FLN001","FLS001","FLF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9876",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","77150FL1110012-00","Standard Silver Off Exchange Plan",,"0.70807820558548","Yes","Yes","No","100%",,"$2,500","$0","$770","$150","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5309","http://www.myHFHP.org/MPS_2016","4"
"2016","FL","77150","HIOS","3","2015-08-27 11:14:25","4","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL1110012","Health First Silver PPO 90 5309","77150FL111",,"FLN001","FLS001","FLF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9876",,,,"0","0","0","2016-01-01",,"Yes","Emergency & Urgent Care Only","Yes","All covered services subject to copays and coinsurance.","No",,"http://www.myHFHP.org/MP_formulary_2016","77150FL1110012-01","Standard Silver On Exchange Plan",,"0.70807820558548","Yes","Yes","No","100%",,"$2,500","$0","$770","$150","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.myHFHP.org/2016_sbc_5309","http://www.myHFHP.org/MPS_2016","5"
"2016","FL","84141","HIOS","1","2015-05-01 02:23:41","1","84141","FL","SHOP (Small Group)","Yes","36-0883760","84141FL0040002","EHB High PPO","84141FL004",,"FLN001","FLS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.67","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","84141FL0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","GA","17382","HIOS","3","2015-08-18 03:25:03","1","17382","GA","SHOP (Small Group)","Yes","57-0523959","17382GA0020001","Group Dental Policy","17382GA002",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.67","Guaranteed Rate",,"0","0","0","2013-01-01",,"Yes","Traditional with inside limits","Yes","Traditional with inside limits","Yes",,"","17382GA0020001-00","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","19419","HIOS","2","2015-07-10 02:19:03","1","19419","GA","SHOP (Small Group)","Yes","44-0308260","19419GA0010001","KCL EHB Low PPO","19419GA001",,"GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$43.55","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","19419GA0010001-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","22500","HIOS","6","2015-10-18 12:35:12","1","22500","GA","SHOP (Small Group)","Yes","36-3757528","22500GA0030001","TruAssure Dental Small Group Basic Plan","22500GA003",,"GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.90","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","22500GA0030001-00","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","22500","HIOS","6","2015-10-18 12:35:12","1","22500","GA","Individual","Yes","36-3757528","22500GA0010001","TruAssure Basic Adult or Child Dental Plan","22500GA001",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.99","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","22500GA0010001-00","Standard Low Off Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$115","$115 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=GA","https://www.truassure.com/brochure?state=GA","4"
"2016","GA","22500","HIOS","6","2015-10-18 12:35:12","1","22500","GA","Individual","Yes","36-3757528","22500GA0010001","TruAssure Basic Adult or Child Dental Plan","22500GA001",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.99","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","22500GA0010001-01","Standard Low On Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$115","$115 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=GA","https://www.truassure.com/brochure?state=GA","5"
"2016","GA","22500","HIOS","6","2015-10-18 12:35:12","1","22500","GA","SHOP (Small Group)","Yes","36-3757528","22500GA0040001","TruAssure Dental Small Group Preferred Plan","22500GA004",,"GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.90","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","22500GA0040001-00","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","GA","22500","HIOS","6","2015-10-18 12:35:12","2","22500","GA","Individual","Yes","36-3757528","22500GA0020001","TruAssure Preferred Adult or Child Dental Plan","22500GA002",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.43","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","No","https://www.truassure.com/plan-information2?state=GA","","22500GA0020001-00","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$35","$35 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=GA","https://www.truassure.com/brochure?state=GA","4"
"2016","GA","22500","HIOS","6","2015-10-18 12:35:12","2","22500","GA","Individual","Yes","36-3757528","22500GA0020001","TruAssure Preferred Adult or Child Dental Plan","22500GA002",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.43","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","No","https://www.truassure.com/plan-information2?state=GA","","22500GA0020001-01","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$35","$35 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=GA","https://www.truassure.com/brochure?state=GA","5"
"2016","GA","28167","HIOS","11","2015-10-21 05:00:18","1","28167","GA","SHOP (Small Group)","Yes","75-1233841","28167GA0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","28167GA002",,"GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.59","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","28167GA0020001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ga/28167ga0020001-16","4"
"2016","GA","28167","HIOS","11","2015-10-21 05:00:18","1","28167","GA","Individual","Yes","75-1233841","28167GA0010001","Dentegra Dental PPO Pediatric Basic Plan","28167GA001",,"GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.42","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","28167GA0010001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ga/28167ga0010001-16","4"
"2016","FL","84141","HIOS","1","2015-05-01 02:23:41","1","84141","FL","SHOP (Small Group)","Yes","36-0883760","84141FL0040001","EHB Low PPO","84141FL004",,"FLN001","FLS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.02","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","84141FL0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","FL","84141","HIOS","1","2015-05-01 02:23:41","1","84141","FL","SHOP (Small Group)","Yes","36-0883760","84141FL0030002","EHB High Passive","84141FL003",,"FLN001","FLS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.79","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","84141FL0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","FL","84141","HIOS","1","2015-05-01 02:23:41","1","84141","FL","SHOP (Small Group)","Yes","36-0883760","84141FL0030001","EHB Low Passive","84141FL003",,"FLN001","FLS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.94","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","84141FL0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","FL","85019","HIOS","3","2015-07-11 04:19:24","1","85019","FL","SHOP (Small Group)","Yes","27-0963551","85019FL0010001","LIBERTY Dental Plan FL Pediatric Low with Adult Option","85019FL001",,"FLN001","FLS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$11.99","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","85019FL0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.libertydentalplan.com/Resources/Documents/LIBERTY_Dental_Plan_Florida_Pediatric_Low_With_Adult_Option.pdf","http://www.libertydentalplan.com/Resources/Documents/LIBERTY_Dental_Plan_Florida_Pediatric_Low_With_Adult_Option.pdf","4"
"2016","FL","85019","HIOS","3","2015-07-11 04:19:24","1","85019","FL","SHOP (Small Group)","Yes","27-0963551","85019FL0010001","LIBERTY Dental Plan FL Pediatric Low with Adult Option","85019FL001",,"FLN001","FLS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$11.99","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","85019FL0010001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.libertydentalplan.com/Resources/Documents/LIBERTY_Dental_Plan_Florida_Pediatric_Low_With_Adult_Option.pdf","http://www.libertydentalplan.com/Resources/Documents/LIBERTY_Dental_Plan_Florida_Pediatric_Low_With_Adult_Option.pdf","5"
"2016","FL","85543","HIOS","3","2015-07-10 02:19:03","1","85543","FL","SHOP (Small Group)","Yes","35-0472300","85543FL0010001","Lincoln DentalConnect®","85543FL001","7063415294","FLN001","FLS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.38","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","85543FL0010001-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","FL","85543","HIOS","3","2015-07-10 02:19:03","1","85543","FL","SHOP (Small Group)","Yes","35-0472300","85543FL0010002","Lincoln DentalConnect®","85543FL001","7063415294","FLN001","FLS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.38","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","85543FL0010002-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","FL","85543","HIOS","3","2015-07-10 02:19:03","1","85543","FL","SHOP (Small Group)","Yes","35-0472300","85543FL0010003","Lincoln DentalConnect®","85543FL001","7063415294","FLN001","FLS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.52","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","85543FL0010003-00","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","FL","85543","HIOS","3","2015-07-10 02:19:03","1","85543","FL","SHOP (Small Group)","Yes","35-0472300","85543FL0010004","Lincoln DentalConnect®","85543FL001","7063415294","FLN001","FLS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.63","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","85543FL0010004-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","FL","85543","HIOS","3","2015-07-10 02:19:03","1","85543","FL","SHOP (Small Group)","Yes","35-0472300","85543FL0010005","Lincoln DentalConnect®","85543FL001","7063415294","FLN001","FLS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.18","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","85543FL0010005-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","FL","85543","HIOS","3","2015-07-10 02:19:03","1","85543","FL","SHOP (Small Group)","Yes","35-0472300","85543FL0010006","Lincoln DentalConnect®","85543FL001","7063415294","FLN001","FLS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.78","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","85543FL0010006-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","FL","85543","HIOS","3","2015-07-10 02:19:03","1","85543","FL","SHOP (Small Group)","Yes","35-0472300","85543FL0010007","Lincoln DentalConnect®","85543FL001","7063415294","FLN001","FLS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.02","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","85543FL0010007-00","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2016","FL","85543","HIOS","3","2015-07-10 02:19:03","1","85543","FL","SHOP (Small Group)","Yes","35-0472300","85543FL0010008","Lincoln DentalConnect®","85543FL001","7063415294","FLN001","FLS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.73","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","85543FL0010008-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2016","FL","93299","HIOS","9","2016-01-30 06:15:26","1","93299","FL","Individual","Yes","45-2548158","93299FL0010001","FL Young Smiles","93299FL001",,"FLN001","FLS001",,"New","EPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$17.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://www.healthplex.com/member/activate","","93299FL0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/FLFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/FLFAMILYSMILES_BROCHURE","4"
"2016","FL","93299","HIOS","9","2016-01-30 06:15:26","1","93299","FL","SHOP (Small Group)","Yes","45-2548158","93299FL0020001","FL Affordable Smiles","93299FL002",,"FLN001","FLS001",,"New","EPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$1.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://www.healthplex.com/member/activate","","93299FL0020001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/FLAFFORDABLESMILES_BENEFITS","http://www.healthplex.com/doc/no/FLAFFORDABLESMILES_BROCHURE","4"
"2016","FL","93299","HIOS","9","2016-01-30 06:15:26","1","93299","FL","Individual","Yes","45-2548158","93299FL0010001","FL Young Smiles","93299FL001",,"FLN001","FLS001",,"New","EPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$17.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://www.healthplex.com/member/activate","","93299FL0010001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/FLFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/FLFAMILYSMILES_BROCHURE","5"
"2016","FL","93299","HIOS","9","2016-01-30 06:15:26","2","93299","FL","Individual","Yes","45-2548158","93299FL0010002","FL Family Smiles","93299FL001",,"FLN001","FLS001",,"New","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$1.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://www.healthplex.com/member/activate","","93299FL0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/FLFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/FLFAMILYSMILES_BROCHURE","4"
"2016","FL","93299","HIOS","9","2016-01-30 06:15:26","2","93299","FL","SHOP (Small Group)","Yes","45-2548158","93299FL0020002","FL Affordable Smiles","93299FL002",,"FLN001","FLS001",,"New","EPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$1.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://www.healthplex.com/member/activate","","93299FL0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/FLAFFORDABLESMILES_BENEFITS","http://www.healthplex.com/doc/no/FLAFFORDABLESMILES_BROCHURE","4"
"2016","FL","93299","HIOS","9","2016-01-30 06:15:26","2","93299","FL","Individual","Yes","45-2548158","93299FL0010002","FL Family Smiles","93299FL001",,"FLN001","FLS001",,"New","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$1.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://www.healthplex.com/member/activate","","93299FL0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/FLFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/FLFAMILYSMILES_BROCHURE","5"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","1","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0040002","DeltaCare USA Pediatric Preferred Plan for Small Businesses","97725FL004",,"FLN002","FLS001",,"Existing","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","97725FL0040002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0040002-16","4"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","1","97725","FL","Individual","Yes","94-2761537","97725FL0030002","DeltaCare USA Pediatric Preferred Plan","97725FL003",,"FLN002","FLS001",,"Existing","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","97725FL0030002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0030002-16","4"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","1","97725","FL","Individual","Yes","94-2761537","97725FL0030001","DeltaCare USA Pediatric Basic Plan","97725FL003",,"FLN002","FLS001",,"Existing","HMO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$14.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","97725FL0030001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0030001-16","5"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","1","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0040001","DeltaCare USA Pediatric Basic Plan for Small Businesses","97725FL004",,"FLN002","FLS001",,"Existing","HMO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$14.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","97725FL0040001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0040001-16","5"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","2","97725","FL","Individual","Yes","94-2761537","97725FL0030004","DeltaCare USA Preferred Plan for Families","97725FL003",,"FLN002","FLS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","97725FL0030004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0030004-16","4"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","2","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0040004","DeltaCare USA Preferred Plan for Families for Small Businesses","97725FL004",,"FLN002","FLS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","97725FL0040004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0040004-16","4"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","2","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0040004","DeltaCare USA Preferred Plan for Families for Small Businesses","97725FL004",,"FLN002","FLS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","97725FL0040004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0040004-16","5"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","2","97725","FL","Individual","Yes","94-2761537","97725FL0030004","DeltaCare USA Preferred Plan for Families","97725FL003",,"FLN002","FLS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","97725FL0030004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0030004-16","5"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","3","97725","FL","Individual","Yes","94-2761537","97725FL0030006","DeltaCare USA Basic Plan for Families","97725FL003",,"FLN002","FLS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$14.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","97725FL0030006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0030006-16","4"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","3","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0040006","DeltaCare USA Basic Plan for Families for Small Businesses","97725FL004",,"FLN002","FLS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$14.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","97725FL0040006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0040006-16","4"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","3","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0040006","DeltaCare USA Basic Plan for Families for Small Businesses","97725FL004",,"FLN002","FLS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$14.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","97725FL0040006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0040006-16","5"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","3","97725","FL","Individual","Yes","94-2761537","97725FL0030006","DeltaCare USA Basic Plan for Families","97725FL003",,"FLN002","FLS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$14.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","97725FL0030006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0030006-16","5"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","4","97725","FL","Individual","Yes","94-2761537","97725FL0010002","Delta Dental PPO Pediatric Preferred Plan","97725FL001",,"FLN001","FLS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.90","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0010002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0010002-16","4"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","4","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0020002","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","97725FL002",,"FLN001","FLS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.90","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0020002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0020002-16","4"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","4","97725","FL","Individual","Yes","94-2761537","97725FL0010001","Delta Dental PPO Pediatric Basic Plan","97725FL001",,"FLN001","FLS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.85","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0010001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0010001-16","5"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","4","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0020001","Delta Dental PPO Pediatric Basic Plan for Small Businesses","97725FL002",,"FLN001","FLS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.32","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0020001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0020001-16","5"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","5","97725","FL","Individual","Yes","94-2761537","97725FL0010004","Delta Dental PPO Preferred Plan for Families","97725FL001",,"FLN001","FLS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.90","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0010004-16","4"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","5","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","97725FL002",,"FLN001","FLS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.90","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0020004-16","4"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","5","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","97725FL002",,"FLN001","FLS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.90","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0020004-16","5"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","5","97725","FL","Individual","Yes","94-2761537","97725FL0010004","Delta Dental PPO Preferred Plan for Families","97725FL001",,"FLN001","FLS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.90","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0010004-16","5"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","6","97725","FL","Individual","Yes","94-2761537","97725FL0010006","Delta Dental PPO Basic Plan for Families","97725FL001",,"FLN001","FLS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.85","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0010006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0010006-16","4"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","6","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","97725FL002",,"FLN001","FLS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.32","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0020006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0020006-16","4"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","6","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","97725FL002",,"FLN001","FLS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.32","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0020006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0020006-16","5"
"2016","FL","97725","HIOS","9","2015-09-02 08:31:46","6","97725","FL","Individual","Yes","94-2761537","97725FL0010006","Delta Dental PPO Basic Plan for Families","97725FL001",,"FLN001","FLS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.85","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","97725FL0010006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/fl/97725fl0010006-16","5"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","1","43802","GA","Individual","No","58-1653544","43802GA0040005","Silver Compass HSA 3600","43802GA004",,"GAN001","GAS001","GAF005","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=ga0027&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","10"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","1","43802","GA","Individual","No","58-1653544","43802GA0040005","Silver Compass HSA 3600","43802GA004",,"GAN001","GAS001","GAF005","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040005-03","Limited Cost Sharing Plan Variation",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ga0026&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","11"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","1","43802","GA","Individual","No","58-1653544","43802GA0040005","Silver Compass HSA 3600","43802GA004",,"GAN001","GAS001","GAF005","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040005-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$3,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ga0023&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","12"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","1","43802","GA","Individual","No","58-1653544","43802GA0040005","Silver Compass HSA 3600","43802GA004",,"GAN001","GAS001","GAF005","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040005-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$200","$1,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ga0024&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","13"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","1","43802","GA","Individual","No","58-1653544","43802GA0040005","Silver Compass HSA 3600","43802GA004",,"GAN001","GAS001","GAF005","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040005-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ga0025&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","14"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","1","43802","GA","Individual","No","58-1653544","43802GA0040009","Bronze Compass HSA 5200","43802GA004",,"GAN001","GAS001","GAF003","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040009-00","Standard Bronze Off Exchange Plan",,"0.618971228599548","Yes","Yes","No","100%",,"$5,200","$0","$100","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ga0031&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","15"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","1","43802","GA","Individual","No","58-1653544","43802GA0040009","Bronze Compass HSA 5200","43802GA004",,"GAN001","GAS001","GAF003","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040009-01","Standard Bronze On Exchange Plan",,"0.618971228599548","Yes","Yes","No","100%",,"$5,200","$0","$100","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ga0031&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","16"
"2016","FL","98534","HIOS","3","2015-08-21 03:45:06","1","98534","FL","SHOP (Small Group)","Yes","13-5581829","98534FL0240001","Family Basic Dental Plan (Low)","98534FL024",,"FLN001","FLS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$18.47","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","98534FL0240001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48035","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48034","4"
"2016","FL","98534","HIOS","3","2015-08-21 03:45:06","1","98534","FL","SHOP (Small Group)","Yes","13-5581829","98534FL0240001","Family Basic Dental Plan (Low)","98534FL024",,"FLN001","FLS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$18.47","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","98534FL0240001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48035","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48034","5"
"2016","FL","98534","HIOS","3","2015-08-21 03:45:06","2","98534","FL","SHOP (Small Group)","Yes","13-5581829","98534FL0250001","Family Enhanced Dental Plan (High)","98534FL025",,"FLN001","FLS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$23.06","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","98534FL0250001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49072","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49071","4"
"2016","FL","98534","HIOS","3","2015-08-21 03:45:06","2","98534","FL","SHOP (Small Group)","Yes","13-5581829","98534FL0250001","Family Enhanced Dental Plan (High)","98534FL025",,"FLN001","FLS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$23.06","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","98534FL0250001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49072","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49071","5"
"2016","FL","99787","HIOS","8","2015-09-02 08:31:46","1","99787","FL","SHOP (Small Group)","Yes","75-1233841","99787FL0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","99787FL002",,"FLN001","FLS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","99787FL0020001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/fl/99787fl0020001-16","4"
"2016","FL","99787","HIOS","8","2015-09-02 08:31:46","1","99787","FL","Individual","Yes","75-1233841","99787FL0010001","Dentegra Dental PPO Pediatric Basic Plan","99787FL001",,"FLN001","FLS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.24","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","99787FL0010001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/fl/99787fl0010001-16","4"
"2016","FL","99787","HIOS","8","2015-09-02 08:31:46","2","99787","FL","Individual","Yes","75-1233841","99787FL0010004","Dentegra Dental PPO Family Preferred Plan","99787FL001",,"FLN001","FLS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","99787FL0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/fl/99787fl0010004-16","4"
"2016","FL","99787","HIOS","8","2015-09-02 08:31:46","2","99787","FL","SHOP (Small Group)","Yes","75-1233841","99787FL0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","99787FL002",,"FLN001","FLS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","99787FL0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/fl/99787fl0020004-16","4"
"2016","FL","99787","HIOS","8","2015-09-02 08:31:46","2","99787","FL","SHOP (Small Group)","Yes","75-1233841","99787FL0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","99787FL002",,"FLN001","FLS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","99787FL0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/fl/99787fl0020004-16","5"
"2016","FL","99787","HIOS","8","2015-09-02 08:31:46","2","99787","FL","Individual","Yes","75-1233841","99787FL0010004","Dentegra Dental PPO Family Preferred Plan","99787FL001",,"FLN001","FLS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","99787FL0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/fl/99787fl0010004-16","5"
"2016","FL","99787","HIOS","8","2015-09-02 08:31:46","3","99787","FL","Individual","Yes","75-1233841","99787FL0010006","Dentegra Dental PPO Family Basic Plan","99787FL001",,"FLN001","FLS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.24","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","99787FL0010006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/fl/99787fl0010006-16","4"
"2016","FL","99787","HIOS","8","2015-09-02 08:31:46","3","99787","FL","SHOP (Small Group)","Yes","75-1233841","99787FL0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","99787FL002",,"FLN001","FLS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","99787FL0020006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/fl/99787fl0020006-16","4"
"2016","FL","99787","HIOS","8","2015-09-02 08:31:46","3","99787","FL","SHOP (Small Group)","Yes","75-1233841","99787FL0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","99787FL002",,"FLN001","FLS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","99787FL0020006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/fl/99787fl0020006-16","5"
"2016","FL","99787","HIOS","8","2015-09-02 08:31:46","3","99787","FL","Individual","Yes","75-1233841","99787FL0010006","Dentegra Dental PPO Family Basic Plan","99787FL001",,"FLN001","FLS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.24","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","99787FL0010006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/fl/99787fl0010006-16","5"
"2016","GA","19419","HIOS","2","2015-07-10 02:19:03","1","19419","GA","SHOP (Small Group)","Yes","44-0308260","19419GA0010003","KCL EHB Low MAC","19419GA001",,"GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$33.35","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","19419GA0010003-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","GA","19419","HIOS","2","2015-07-10 02:19:03","1","19419","GA","SHOP (Small Group)","Yes","44-0308260","19419GA0010005","KCL Fam Low PPO","19419GA001",,"GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$43.55","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","19419GA0010005-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","GA","19419","HIOS","2","2015-07-10 02:19:03","1","19419","GA","SHOP (Small Group)","Yes","44-0308260","19419GA0010007","KCL Fam Low MAC","19419GA001",,"GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$33.35","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","19419GA0010007-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","GA","19419","HIOS","2","2015-07-10 02:19:03","2","19419","GA","SHOP (Small Group)","Yes","44-0308260","19419GA0010002","KCL EHB High PPO","19419GA001",,"GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$52.57","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","19419GA0010002-00","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","19419","HIOS","2","2015-07-10 02:19:03","2","19419","GA","SHOP (Small Group)","Yes","44-0308260","19419GA0010004","KCL EHB High MAC","19419GA001",,"GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$41.22","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","19419GA0010004-00","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","GA","19419","HIOS","2","2015-07-10 02:19:03","2","19419","GA","SHOP (Small Group)","Yes","44-0308260","19419GA0010006","KCL Fam High PPO","19419GA001",,"GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$52.57","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","19419GA0010006-00","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","GA","19419","HIOS","2","2015-07-10 02:19:03","2","19419","GA","SHOP (Small Group)","Yes","44-0308260","19419GA0010008","KCL Fam High MAC","19419GA001",,"GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$41.22","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","19419GA0010008-00","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","GA","28167","HIOS","11","2015-10-21 05:00:18","2","28167","GA","Individual","Yes","75-1233841","28167GA0010004","Dentegra Dental PPO Family Preferred Plan","28167GA001",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.61","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","28167GA0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ga/28167ga0010004-16","4"
"2016","GA","28167","HIOS","11","2015-10-21 05:00:18","2","28167","GA","SHOP (Small Group)","Yes","75-1233841","28167GA0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","28167GA002",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.85","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","28167GA0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ga/28167ga0020004-16","4"
"2016","GA","28167","HIOS","11","2015-10-21 05:00:18","2","28167","GA","SHOP (Small Group)","Yes","75-1233841","28167GA0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","28167GA002",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.85","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","28167GA0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ga/28167ga0020004-16","5"
"2016","GA","28167","HIOS","11","2015-10-21 05:00:18","2","28167","GA","Individual","Yes","75-1233841","28167GA0010004","Dentegra Dental PPO Family Preferred Plan","28167GA001",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.61","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","28167GA0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ga/28167ga0010004-16","5"
"2016","GA","28167","HIOS","11","2015-10-21 05:00:18","3","28167","GA","Individual","Yes","75-1233841","28167GA0010006","Dentegra Dental PPO Family Basic Plan","28167GA001",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.42","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","28167GA0010006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ga/28167ga0010006-16","4"
"2016","GA","28167","HIOS","11","2015-10-21 05:00:18","3","28167","GA","SHOP (Small Group)","Yes","75-1233841","28167GA0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","28167GA002",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.59","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","28167GA0020006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ga/28167ga0020006-16","4"
"2016","GA","28167","HIOS","11","2015-10-21 05:00:18","3","28167","GA","SHOP (Small Group)","Yes","75-1233841","28167GA0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","28167GA002",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.59","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","28167GA0020006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ga/28167ga0020006-16","5"
"2016","GA","28167","HIOS","11","2015-10-21 05:00:18","3","28167","GA","Individual","Yes","75-1233841","28167GA0010006","Dentegra Dental PPO Family Basic Plan","28167GA001",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.42","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","28167GA0010006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ga/28167ga0010006-16","5"
"2016","GA","31291","HIOS","2","2015-07-07 02:38:10","1","31291","GA","Individual","Yes","72-0977315","31291GA0050001","AlwaysCare All-Star Kids Dental Plan 2016","31291GA005",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$26.69","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","31291GA0050001-00","Standard High Off Exchange Plan","86.03%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","GA","31291","HIOS","2","2015-07-07 02:38:10","1","31291","GA","SHOP (Small Group)","Yes","72-0977315","31291GA0080001","AlwaysCare Small Group Dental – Child 2016","31291GA008",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$28.55","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","31291GA0080001-00","Standard High Off Exchange Plan","86.03%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040004","Silver Compass 2000","43802GA004",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040004-03","Limited Cost Sharing Plan Variation",,"0.714467763900757","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0020&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","18"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040004","Silver Compass 2000","43802GA004",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040004-04","73% AV Level Silver Plan",,"0.737353503704071","No","Yes","No","100%",,"$1,800","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0017&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","19"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040004","Silver Compass 2000","43802GA004",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040004-05","87% AV Level Silver Plan",,"0.877411782741547","No","Yes","No","100%",,"$400","$0","$1,000","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0018&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","20"
"2016","GA","31291","HIOS","2","2015-07-07 02:38:10","1","31291","GA","SHOP (Small Group)","Yes","72-0977315","31291GA0080002","AlwaysCare Small Group Dental – Child 2016","31291GA008",,"GAN001","GAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$23.49","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","31291GA0080002-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","GA","31291","HIOS","2","2015-07-07 02:38:10","2","31291","GA","SHOP (Small Group)","Yes","72-0977315","31291GA0070001","AlwaysCare Small Group Dental – Adults 2016","31291GA007",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$28.55","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","31291GA0070001-00","Standard High Off Exchange Plan","86.03%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","GA","31291","HIOS","2","2015-07-07 02:38:10","2","31291","GA","Individual","Yes","72-0977315","31291GA0060001","AlwaysCare All-Star Family Dental Plan 2016","31291GA006",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$26.69","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","31291GA0060001-00","Standard High Off Exchange Plan","86.03%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","GA","31291","HIOS","2","2015-07-07 02:38:10","2","31291","GA","SHOP (Small Group)","Yes","72-0977315","31291GA0070002","AlwaysCare Small Group Dental – Adults 2016","31291GA007",,"GAN001","GAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$23.49","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","31291GA0070002-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","GA","37001","HIOS","5","2015-08-20 09:36:54","1","37001","GA","Individual","Yes","39-1263473","37001GA0540001","Humana Dental Smart Choice","37001GA054",,"GAN002","GAS002",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","37001GA0540001-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612857","4"
"2016","GA","37001","HIOS","5","2015-08-20 09:36:54","1","37001","GA","Individual","Yes","39-1263473","37001GA0540001","Humana Dental Smart Choice","37001GA054",,"GAN002","GAS002",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","37001GA0540001-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612857","5"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","1","43802","GA","Individual","No","58-1653544","43802GA0040003","Gold Compass HSA 1600","43802GA004",,"GAN001","GAS001","GAF003","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040003-00","Standard Gold Off Exchange Plan",,"0.785858988761902","Yes","Yes","No","100%",,"$1,600","$0","$500","$200","$1,600","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$4800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ga0007&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","4"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","1","43802","GA","Individual","No","58-1653544","43802GA0040003","Gold Compass HSA 1600","43802GA004",,"GAN001","GAS001","GAF003","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040003-01","Standard Gold On Exchange Plan",,"0.785858988761902","Yes","Yes","No","100%",,"$1,600","$0","$500","$200","$1,600","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$4800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ga0007&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","5"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","1","43802","GA","Individual","No","58-1653544","43802GA0040003","Gold Compass HSA 1600","43802GA004",,"GAN001","GAS001","GAF003","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=ga0009&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","6"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","1","43802","GA","Individual","No","58-1653544","43802GA0040003","Gold Compass HSA 1600","43802GA004",,"GAN001","GAS001","GAF003","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040003-03","Limited Cost Sharing Plan Variation",,"0.785858988761902","Yes","Yes","No","100%",,"$1,600","$0","$500","$200","$1,600","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$4800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ga0008&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","7"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","1","43802","GA","Individual","No","58-1653544","43802GA0040005","Silver Compass HSA 3600","43802GA004",,"GAN001","GAS001","GAF005","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040005-00","Standard Silver Off Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ga0022&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","8"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","1","43802","GA","Individual","No","58-1653544","43802GA0040005","Silver Compass HSA 3600","43802GA004",,"GAN001","GAS001","GAF005","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040005-01","Standard Silver On Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ga0022&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","9"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","1","43802","GA","Individual","No","58-1653544","43802GA0040009","Bronze Compass HSA 5200","43802GA004",,"GAN001","GAS001","GAF003","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=ga0033&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","17"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","1","43802","GA","Individual","No","58-1653544","43802GA0040009","Bronze Compass HSA 5200","43802GA004",,"GAN001","GAS001","GAF003","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040009-03","Limited Cost Sharing Plan Variation",,"0.618971228599548","Yes","Yes","No","100%",,"$5,200","$0","$100","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ga0032&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","18"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040002","Gold Compass 1000","43802GA004",,"GAN001","GAS001","GAF001","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040002-00","Standard Gold Off Exchange Plan",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0004&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","4"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040002","Gold Compass 1000","43802GA004",,"GAN001","GAS001","GAF001","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040002-01","Standard Gold On Exchange Plan",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0004&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","5"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040002","Gold Compass 1000","43802GA004",,"GAN001","GAS001","GAF001","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0006&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","6"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040002","Gold Compass 1000","43802GA004",,"GAN001","GAS001","GAF001","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040002-03","Limited Cost Sharing Plan Variation",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0005&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","7"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040006","Silver Compass 5000","43802GA004",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040006-00","Standard Silver Off Exchange Plan",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0010&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","8"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040006","Silver Compass 5000","43802GA004",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040006-01","Standard Silver On Exchange Plan",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0010&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","9"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040006","Silver Compass 5000","43802GA004",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0015&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","10"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040006","Silver Compass 5000","43802GA004",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040006-03","Limited Cost Sharing Plan Variation",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0014&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","11"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040006","Silver Compass 5000","43802GA004",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040006-04","73% AV Level Silver Plan",,"0.728041231632233","No","Yes","No","100%",,"$3,600","$20","$500","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0011&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","12"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040006","Silver Compass 5000","43802GA004",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040006-05","87% AV Level Silver Plan",,"0.871982634067535","No","Yes","No","100%",,"$800","$0","$800","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0012&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","13"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040006","Silver Compass 5000","43802GA004",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040006-06","94% AV Level Silver Plan",,"0.949420213699341","No","Yes","No","100%",,"$0","$0","$500","$200","$0","$500","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0013&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","14"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040004","Silver Compass 2000","43802GA004",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040004-00","Standard Silver Off Exchange Plan",,"0.714467763900757","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0016&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","15"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040004","Silver Compass 2000","43802GA004",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040004-01","Standard Silver On Exchange Plan",,"0.714467763900757","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0016&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","16"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040004","Silver Compass 2000","43802GA004",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0021&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","17"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040004","Silver Compass 2000","43802GA004",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040004-06","94% AV Level Silver Plan",,"0.943426787853241","No","Yes","No","100%",,"$0","$0","$500","$200","$0","$500","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0019&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","21"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040007","Bronze Compass 4200","43802GA004",,"GAN001","GAS001","GAF002","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040007-00","Standard Bronze Off Exchange Plan",,"0.619571328163147","Yes","Yes","No","100%",,"$4,200","$0","$600","$200","$4,200","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ga0028&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","22"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040007","Bronze Compass 4200","43802GA004",,"GAN001","GAS001","GAF002","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040007-01","Standard Bronze On Exchange Plan",,"0.619571328163147","Yes","Yes","No","100%",,"$4,200","$0","$600","$200","$4,200","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ga0028&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","23"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040007","Bronze Compass 4200","43802GA004",,"GAN001","GAS001","GAF002","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=ga0030&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","24"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040007","Bronze Compass 4200","43802GA004",,"GAN001","GAS001","GAF002","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040007-03","Limited Cost Sharing Plan Variation",,"0.619571328163147","Yes","Yes","No","100%",,"$4,200","$0","$600","$200","$4,200","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ga0029&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","25"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040008","Bronze Compass 6400","43802GA004",,"GAN001","GAS001","GAF004","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040008-00","Standard Bronze Off Exchange Plan",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0034&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","26"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420005","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS003","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420005-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","27"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420006","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS004","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420006-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","28"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420006","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS004","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420006-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","29"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040008","Bronze Compass 6400","43802GA004",,"GAN001","GAS001","GAF004","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040008-01","Standard Bronze On Exchange Plan",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0034&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","27"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040008","Bronze Compass 6400","43802GA004",,"GAN001","GAS001","GAF004","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0036&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","28"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040008","Bronze Compass 6400","43802GA004",,"GAN001","GAS001","GAF004","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040008-03","Limited Cost Sharing Plan Variation",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ga0035&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","29"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040010","Catastrophic Compass 6850","43802GA004",,"GAN001","GAS001","GAF005","Existing","HMO","Catastrophic","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040010-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,800","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ga0037&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","30"
"2016","GA","43802","HIOS","10","2016-01-28 05:11:31","2","43802","GA","Individual","No","58-1653544","43802GA0040010","Catastrophic Compass 6850","43802GA004",,"GAN001","GAS001","GAF005","Existing","HMO","Catastrophic","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ga0039&st=ga","43802GA0040010-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,800","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ga0037&st=ga","http://www.uhc.com/iex/doc?id=ga0038&st=ga","31"
"2016","GA","48132","HIOS","2","2015-07-09 13:17:42","1","48132","GA","SHOP (Small Group)","Yes","81-0170040","48132GA0010001","Assurant Dental ACAFFO High","48132GA001",,"GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$38.43","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","48132GA0010001-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","48132","HIOS","2","2015-07-09 13:17:42","1","48132","GA","SHOP (Small Group)","Yes","81-0170040","48132GA0010002","Assurant Dental ACAFFO Low","48132GA001",,"GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$32.00","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","48132GA0010002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","Individual","No","58-1638390","49046GA0410014","BCBSHP Catastrophic Pathway X HMO 6850 0","49046GA041",,"GAN001","GAS001","GAF001","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9985",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410014-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,554","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5A","http://editiondigital.net/view/IU65/2016/OFF_HIX_GA_KIT_2016","4"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420016","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS014","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420016-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","4"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420016","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS014","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420016-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","5"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","Individual","No","58-1638390","49046GA0410014","BCBSHP Catastrophic Pathway X HMO 6850 0","49046GA041",,"GAN001","GAS001","GAF001","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9985",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410014-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,554","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G59","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","5"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420017","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS015","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420017-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","6"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420017","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS015","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420017-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","7"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420018","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS016","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420018-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","8"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420018","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS016","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420018-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","9"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420019","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS017","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420019-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","10"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420019","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS017","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420019-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","11"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420010","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS008","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420010-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","12"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420010","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS008","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420010-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","13"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420011","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS009","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420011-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","14"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420011","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS009","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420011-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","15"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420012","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS010","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420012-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","16"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420012","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS010","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420012-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","17"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420013","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS011","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420013-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","18"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420013","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS011","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420013-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","19"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420014","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS012","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420014-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","20"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420014","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS012","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420014-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","21"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420015","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS013","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420015-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","22"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420015","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS013","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420015-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","23"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420004","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS002","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420004-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","24"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420004","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS002","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420004-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","25"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420005","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS003","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420005-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","26"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420007","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS005","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420007-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","30"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420007","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS005","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420007-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","31"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420008","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS006","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420008-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","32"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420008","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS006","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420008-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","33"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420009","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS007","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420009-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","34"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420009","BCBSHP Gold Pathway X Enhanced POS 500 20  5000 Plus","49046GA042",,"GAN002","GAS007","GAF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420009-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT6","http://sgplans.bcbsga.com/brochure/","35"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410015","BCBSHP Bronze Pathway X HMO 0 for HSA","49046GA041",,"GAN001","GAS001","GAF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410015-00","Standard Bronze Off Exchange Plan","60.42%","0.604190468788147","Yes","Yes","No","100%",,"$6,400","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5D","http://editiondigital.net/view/IU65/2016/OFF_HIX_GA_KIT_2016","4"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420020","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS002","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420020-00","Standard Silver Off Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","4"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420020","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS002","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420020-01","Standard Silver On Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","5"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410015","BCBSHP Bronze Pathway X HMO 0 for HSA","49046GA041",,"GAN001","GAS001","GAF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410015-01","Standard Bronze On Exchange Plan","60.42%","0.604190468788147","Yes","Yes","No","100%",,"$6,400","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5B","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","5"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410015","BCBSHP Bronze Pathway X HMO 0 for HSA","49046GA041",,"GAN001","GAS001","GAF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5C","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","6"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420021","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS003","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420021-00","Standard Silver Off Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","6"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420021","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS003","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420021-01","Standard Silver On Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","7"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410015","BCBSHP Bronze Pathway X HMO 0 for HSA","49046GA041",,"GAN001","GAS001","GAF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410015-03","Limited Cost Sharing Plan Variation","60.42%","0.604190468788147","Yes","Yes","No","100%",,"$6,400","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5B","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","7"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410016","BCBSHP Bronze Pathway X HMO 20 for HSA","49046GA041",,"GAN001","GAS001","GAF004","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410016-00","Standard Bronze Off Exchange Plan","61.74%","0.618700385093689","Yes","Yes","No","100%",,"$4,700","$0","$382","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5G","http://editiondigital.net/view/IU65/2016/OFF_HIX_GA_KIT_2016","8"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420022","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS004","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420022-00","Standard Silver Off Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","8"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420022","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS004","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420022-01","Standard Silver On Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","9"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410016","BCBSHP Bronze Pathway X HMO 20 for HSA","49046GA041",,"GAN001","GAS001","GAF004","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410016-01","Standard Bronze On Exchange Plan","61.74%","0.618700385093689","Yes","Yes","No","100%",,"$4,700","$0","$382","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5E","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","9"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410016","BCBSHP Bronze Pathway X HMO 20 for HSA","49046GA041",,"GAN001","GAS001","GAF004","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410016-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5F","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","10"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420023","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS005","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420023-00","Standard Silver Off Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","10"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420023","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS005","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420023-01","Standard Silver On Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","11"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410016","BCBSHP Bronze Pathway X HMO 20 for HSA","49046GA041",,"GAN001","GAS001","GAF004","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410016-03","Limited Cost Sharing Plan Variation","61.74%","0.618700385093689","Yes","Yes","No","100%",,"$4,700","$0","$382","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5E","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","11"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410018","BCBSHP Silver Pathway X HMO 3500 0","49046GA041",,"GAN001","GAS001","GAF017","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410018-00","Standard Silver Off Exchange Plan","71.43%","0.722467184066772","Yes","Yes","No","100%",,"$3,500","$500","$0","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5R","http://editiondigital.net/view/IU65/2016/OFF_HIX_GA_KIT_2016","12"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420024","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS006","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420024-00","Standard Silver Off Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","12"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420024","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS006","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420024-01","Standard Silver On Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","13"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410018","BCBSHP Silver Pathway X HMO 3500 0","49046GA041",,"GAN001","GAS001","GAF017","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410018-01","Standard Silver On Exchange Plan","71.43%","0.722467184066772","Yes","Yes","No","100%",,"$3,500","$500","$0","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5L","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","13"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410018","BCBSHP Silver Pathway X HMO 3500 0","49046GA041",,"GAN001","GAS001","GAF017","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410018-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5Q","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","14"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420025","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS007","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420025-00","Standard Silver Off Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","14"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420025","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS007","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420025-01","Standard Silver On Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","15"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410018","BCBSHP Silver Pathway X HMO 3500 0","49046GA041",,"GAN001","GAS001","GAF017","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410018-03","Limited Cost Sharing Plan Variation","71.43%","0.722467184066772","Yes","Yes","No","100%",,"$3,500","$500","$0","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5L","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","15"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410018","BCBSHP Silver Pathway X HMO 3500 0","49046GA041",,"GAN001","GAS001","GAF017","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410018-04","73% AV Level Silver Plan","73.99%","0.745302200317383","Yes","Yes","No","100%",,"$3,400","$500","$0","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5M","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","16"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420026","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS008","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420026-00","Standard Silver Off Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","16"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420026","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS008","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420026-01","Standard Silver On Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","17"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410018","BCBSHP Silver Pathway X HMO 3500 0","49046GA041",,"GAN001","GAS001","GAF017","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410018-05","87% AV Level Silver Plan","87.96%","0.889590740203857","Yes","Yes","No","100%",,"$800","$250","$0","$0","$424","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5N","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","17"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410018","BCBSHP Silver Pathway X HMO 3500 0","49046GA041",,"GAN001","GAS001","GAF017","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9992",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410018-06","94% AV Level Silver Plan","93.91%","0.951001942157745","Yes","Yes","No","100%",,"$150","$100","$0","$0","$150","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5P","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","18"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420027","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS009","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420027-00","Standard Silver Off Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","18"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420027","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS009","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420027-01","Standard Silver On Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","19"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410019","BCBSHP Silver Pathway X HMO 10 for HSA","49046GA041",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410019-00","Standard Silver Off Exchange Plan","70.16%","0.701702415943146","Yes","Yes","No","100%",,"$3,200","$500","$291","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3400 per person","$6400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5X","http://editiondigital.net/view/IU65/2016/OFF_HIX_GA_KIT_2016","19"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410019","BCBSHP Silver Pathway X HMO 10 for HSA","49046GA041",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410019-01","Standard Silver On Exchange Plan","70.16%","0.701702415943146","Yes","Yes","No","100%",,"$3,200","$500","$291","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3400 per person","$6400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5S","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","20"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420028","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS010","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420028-00","Standard Silver Off Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","20"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420028","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS010","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420028-01","Standard Silver On Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","21"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410019","BCBSHP Silver Pathway X HMO 10 for HSA","49046GA041",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410019-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5W","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","21"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410019","BCBSHP Silver Pathway X HMO 10 for HSA","49046GA041",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410019-03","Limited Cost Sharing Plan Variation","70.16%","0.701702415943146","Yes","Yes","No","100%",,"$3,200","$500","$291","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3400 per person","$6400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5S","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","22"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420029","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS011","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420029-00","Standard Silver Off Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","22"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420029","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS011","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420029-01","Standard Silver On Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","23"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410019","BCBSHP Silver Pathway X HMO 10 for HSA","49046GA041",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410019-04","73% AV Level Silver Plan","72.49%","0.726563990116119","Yes","Yes","No","100%",,"$2,600","$500","$351","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,850","$3850 per person","$7700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G5T","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","23"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410019","BCBSHP Silver Pathway X HMO 10 for HSA","49046GA041",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410019-05","87% AV Level Silver Plan","87.01%","0.874577879905701","Yes","Yes","No","100%",,"$1,150","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5U","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","24"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420030","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS012","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420030-00","Standard Silver Off Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","24"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420030","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS012","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420030-01","Standard Silver On Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","25"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410019","BCBSHP Silver Pathway X HMO 10 for HSA","49046GA041",,"GAN001","GAS001","GAF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410019-06","94% AV Level Silver Plan","93.68%","0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$0","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5V","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","25"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410021","BCBSHP Bronze Pathway X HMO 30 for HSA","49046GA041",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410021-00","Standard Bronze Off Exchange Plan","60.85%","0.608002007007599","Yes","Yes","No","100%",,"$5,000","$0","$483","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G6F","http://editiondigital.net/view/IU65/2016/OFF_HIX_GA_KIT_2016","26"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420031","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS013","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420031-00","Standard Silver Off Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","26"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420031","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS013","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420031-01","Standard Silver On Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","27"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410021","BCBSHP Bronze Pathway X HMO 30 for HSA","49046GA041",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410021-01","Standard Bronze On Exchange Plan","60.85%","0.608002007007599","Yes","Yes","No","100%",,"$5,000","$0","$483","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G6D","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","27"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410021","BCBSHP Bronze Pathway X HMO 30 for HSA","49046GA041",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410021-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6E","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","28"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420032","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS014","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420032-00","Standard Silver Off Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","28"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420032","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS014","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420032-01","Standard Silver On Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","29"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410021","BCBSHP Bronze Pathway X HMO 30 for HSA","49046GA041",,"GAN001","GAS001","GAF006","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410021-03","Limited Cost Sharing Plan Variation","60.85%","0.608002007007599","Yes","Yes","No","100%",,"$5,000","$0","$483","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G6D","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","29"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410023","BCBSHP Silver Pathway X HMO 2000 25","49046GA041",,"GAN001","GAS001","GAF005","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410023-00","Standard Silver Off Exchange Plan","70.37%","0.707284808158875","Yes","Yes","No","100%",,"$2,000","$500","$1,028","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6Q","http://editiondigital.net/view/IU65/2016/OFF_HIX_GA_KIT_2016","30"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420033","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS015","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420033-00","Standard Silver Off Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","30"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420033","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS015","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420033-01","Standard Silver On Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","31"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410023","BCBSHP Silver Pathway X HMO 2000 25","49046GA041",,"GAN001","GAS001","GAF005","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410023-01","Standard Silver On Exchange Plan","70.37%","0.707284808158875","Yes","Yes","No","100%",,"$2,000","$500","$1,028","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6K","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","31"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410023","BCBSHP Silver Pathway X HMO 2000 25","49046GA041",,"GAN001","GAS001","GAF005","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410023-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6P","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","32"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420034","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS016","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420034-00","Standard Silver Off Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","32"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420034","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS016","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420034-01","Standard Silver On Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","33"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410023","BCBSHP Silver Pathway X HMO 2000 25","49046GA041",,"GAN001","GAS001","GAF005","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410023-03","Limited Cost Sharing Plan Variation","70.37%","0.707284808158875","Yes","Yes","No","100%",,"$2,000","$500","$1,028","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6K","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","33"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410023","BCBSHP Silver Pathway X HMO 2000 25","49046GA041",,"GAN001","GAS001","GAF005","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410023-04","73% AV Level Silver Plan","73.91%","0.740439057350159","Yes","Yes","No","100%",,"$1,750","$500","$1,090","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6L","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","34"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420035","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS017","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420035-00","Standard Silver Off Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","34"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420035","BCBSHP Silver Pathway X Enhanced POS 1500 30  5500 Plus","49046GA042",,"GAN002","GAS017","GAF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420035-01","Standard Silver On Exchange Plan","70.32%","0.730547726154327","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1ZT5","http://sgplans.bcbsga.com/brochure/","35"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410023","BCBSHP Silver Pathway X HMO 2000 25","49046GA041",,"GAN001","GAS001","GAF005","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410023-05","87% AV Level Silver Plan","87.88%","0.876347362995148","Yes","Yes","No","100%",,"$750","$250","$450","$0","$424","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6M","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","35"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","2","49046","GA","Individual","No","58-1638390","49046GA0410023","BCBSHP Silver Pathway X HMO 2000 25","49046GA041",,"GAN001","GAS001","GAF005","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410023-06","94% AV Level Silver Plan","93.49%","0.931152045726776","Yes","Yes","No","100%",,"$250","$200","$250","$0","$250","$20","$44","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6N","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","36"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","Individual","No","58-1638390","49046GA0410017","BCBSHP Bronze Pathway X HMO 5200 20","49046GA041",,"GAN001","GAS001","GAF004","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410017-00","Standard Bronze Off Exchange Plan","60.34%","0.619024157524109","Yes","Yes","No","100%",,"$5,200","$0","$282","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5K","http://editiondigital.net/view/IU65/2016/OFF_HIX_GA_KIT_2016","4"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420036","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS002","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420036-00","Standard Bronze Off Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","4"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420036","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS002","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420036-01","Standard Bronze On Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","5"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","Individual","No","58-1638390","49046GA0410017","BCBSHP Bronze Pathway X HMO 5200 20","49046GA041",,"GAN001","GAS001","GAF004","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410017-01","Standard Bronze On Exchange Plan","60.34%","0.619024157524109","Yes","Yes","No","100%",,"$5,200","$0","$282","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5H","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","5"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","Individual","No","58-1638390","49046GA0410017","BCBSHP Bronze Pathway X HMO 5200 20","49046GA041",,"GAN001","GAS001","GAF004","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410017-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5J","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","6"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420037","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS003","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420037-00","Standard Bronze Off Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","6"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420037","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS003","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420037-01","Standard Bronze On Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","7"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","Individual","No","58-1638390","49046GA0410017","BCBSHP Bronze Pathway X HMO 5200 20","49046GA041",,"GAN001","GAS001","GAF004","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.999",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410017-03","Limited Cost Sharing Plan Variation","60.34%","0.619024157524109","Yes","Yes","No","100%",,"$5,200","$0","$282","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5H","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","7"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","Individual","No","58-1638390","49046GA0410022","BCBSHP Bronze Pathway X HMO 5500 40","49046GA041",,"GAN001","GAS001","GAF008","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410022-00","Standard Bronze Off Exchange Plan","59.60%","0.607887506484985","Yes","Yes","No","100%",,"$5,500","$0","$444","$0","$1,049","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6J","http://editiondigital.net/view/IU65/2016/OFF_HIX_GA_KIT_2016","8"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420038","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS004","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420038-00","Standard Bronze Off Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","8"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420038","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS004","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420038-01","Standard Bronze On Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","9"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","Individual","No","58-1638390","49046GA0410022","BCBSHP Bronze Pathway X HMO 5500 40","49046GA041",,"GAN001","GAS001","GAF008","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410022-01","Standard Bronze On Exchange Plan","59.60%","0.607887506484985","Yes","Yes","No","100%",,"$5,500","$0","$444","$0","$1,049","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6G","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","9"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","Individual","No","58-1638390","49046GA0410022","BCBSHP Bronze Pathway X HMO 5500 40","49046GA041",,"GAN001","GAS001","GAF008","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410022-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6H","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","10"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420039","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS005","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420039-00","Standard Bronze Off Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","10"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420039","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS005","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420039-01","Standard Bronze On Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","11"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","Individual","No","58-1638390","49046GA0410022","BCBSHP Bronze Pathway X HMO 5500 40","49046GA041",,"GAN001","GAS001","GAF008","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9989",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410022-03","Limited Cost Sharing Plan Variation","59.60%","0.607887506484985","Yes","Yes","No","100%",,"$5,500","$0","$444","$0","$1,049","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G6G","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","11"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420040","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS006","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420040-00","Standard Bronze Off Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","12"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420040","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS006","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420040-01","Standard Bronze On Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","13"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420041","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS007","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420041-00","Standard Bronze Off Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","14"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420041","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS007","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420041-01","Standard Bronze On Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","15"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420042","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS008","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420042-00","Standard Bronze Off Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","16"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420042","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS008","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420042-01","Standard Bronze On Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","17"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420043","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS009","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420043-00","Standard Bronze Off Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","18"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420043","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS009","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420043-01","Standard Bronze On Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","19"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420044","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS010","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420044-00","Standard Bronze Off Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","20"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420044","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS010","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420044-01","Standard Bronze On Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","21"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420045","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS011","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420045-00","Standard Bronze Off Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","22"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420045","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS011","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420045-01","Standard Bronze On Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","23"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420046","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS012","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420046-00","Standard Bronze Off Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","24"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420046","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS012","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420046-01","Standard Bronze On Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","25"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420047","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS013","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420047-00","Standard Bronze Off Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","26"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420047","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS013","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420047-01","Standard Bronze On Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","27"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420048","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS014","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420048-00","Standard Bronze Off Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","28"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420048","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS014","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420048-01","Standard Bronze On Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","29"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420049","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS015","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420049-00","Standard Bronze Off Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","30"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420049","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS015","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420049-01","Standard Bronze On Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","31"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420050","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS016","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420050-00","Standard Bronze Off Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","32"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420050","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS016","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420050-01","Standard Bronze On Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","33"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420051","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS017","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420051-00","Standard Bronze Off Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","34"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","3","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420051","BCBSHP Bronze Pathway X Enhanced POS 5000 30  6850 Plus","49046GA042",,"GAN002","GAS017","GAF032","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","YES","Urgent/Emergent Coverage Only","YES","Follows OON Coverage","NO",,"https://www.bcbsga.com/GASelectdrugtier4","49046GA0420051-01","Standard Bronze On Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1KL2","http://sgplans.bcbsga.com/brochure/","35"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","4","49046","GA","Individual","No","58-1638390","49046GA0410024","BCBSHP Silver Pathway X HMO 3500 25","49046GA041",,"GAN001","GAS001","GAF016","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410024-00","Standard Silver Off Exchange Plan","68.01%","0.686997056007385","No","Yes","No","100%",,"$3,500","$500","$653","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1G6Q","http://editiondigital.net/view/IU65/2016/OFF_HIX_GA_KIT_2016","4"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","4","49046","GA","Individual","No","58-1638390","49046GA0410024","BCBSHP Silver Pathway X HMO 3500 25","49046GA041",,"GAN001","GAS001","GAF016","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410024-01","Standard Silver On Exchange Plan","68.01%","0.686997056007385","No","Yes","No","100%",,"$3,500","$500","$653","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1G6R","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","5"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","4","49046","GA","Individual","No","58-1638390","49046GA0410024","BCBSHP Silver Pathway X HMO 3500 25","49046GA041",,"GAN001","GAS001","GAF016","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410024-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1G6W","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","6"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","4","49046","GA","Individual","No","58-1638390","49046GA0410024","BCBSHP Silver Pathway X HMO 3500 25","49046GA041",,"GAN001","GAS001","GAF016","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410024-03","Limited Cost Sharing Plan Variation","68.01%","0.686997056007385","No","Yes","No","100%",,"$3,500","$500","$653","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1G6R","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","7"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","4","49046","GA","Individual","No","58-1638390","49046GA0410024","BCBSHP Silver Pathway X HMO 3500 25","49046GA041",,"GAN001","GAS001","GAF016","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410024-04","73% AV Level Silver Plan","72.05%","0.726867318153381","No","Yes","No","100%",,"$2,250","$500","$965","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1G6S","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","8"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","4","49046","GA","Individual","No","58-1638390","49046GA0410024","BCBSHP Silver Pathway X HMO 3500 25","49046GA041",,"GAN001","GAS001","GAF016","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410024-05","87% AV Level Silver Plan","87.14%","0.85139387845993","No","Yes","No","100%",,"$750","$250","$500","$0","$424","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1G6T","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","9"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","4","49046","GA","Individual","No","58-1638390","49046GA0410024","BCBSHP Silver Pathway X HMO 3500 25","49046GA041",,"GAN001","GAS001","GAF016","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410024-06","94% AV Level Silver Plan","93.96%","0.925385177135468","No","Yes","No","100%",,"$250","$150","$200","$0","$250","$20","$44","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1G6U","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","10"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","5","49046","GA","Individual","No","58-1638390","49046GA0410020","BCBSHP Silver Pathway X HMO 3000 10","49046GA041",,"GAN001","GAS001","GAF022","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410020-00","Standard Silver Off Exchange Plan","68.60%","0.713833451271057","Yes","Yes","No","100%",,"$3,000","$500","$311","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G63","http://editiondigital.net/view/IU65/2016/OFF_HIX_GA_KIT_2016","4"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","5","49046","GA","Individual","No","58-1638390","49046GA0410020","BCBSHP Silver Pathway X HMO 3000 10","49046GA041",,"GAN001","GAS001","GAF022","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410020-01","Standard Silver On Exchange Plan","68.60%","0.713833451271057","Yes","Yes","No","100%",,"$3,000","$500","$311","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5Y","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","5"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","5","49046","GA","Individual","No","58-1638390","49046GA0410020","BCBSHP Silver Pathway X HMO 3000 10","49046GA041",,"GAN001","GAS001","GAF022","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410020-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G62","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","6"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","5","49046","GA","Individual","No","58-1638390","49046GA0410020","BCBSHP Silver Pathway X HMO 3000 10","49046GA041",,"GAN001","GAS001","GAF022","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410020-03","Limited Cost Sharing Plan Variation","68.60%","0.713833451271057","Yes","Yes","No","100%",,"$3,000","$500","$311","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5Y","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","7"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","5","49046","GA","Individual","No","58-1638390","49046GA0410020","BCBSHP Silver Pathway X HMO 3000 10","49046GA041",,"GAN001","GAS001","GAF022","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410020-04","73% AV Level Silver Plan","72.48%","0.749987900257111","Yes","Yes","No","100%",,"$2,450","$500","$366","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G5Z","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","8"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","5","49046","GA","Individual","No","58-1638390","49046GA0410020","BCBSHP Silver Pathway X HMO 3000 10","49046GA041",,"GAN001","GAS001","GAF022","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410020-05","87% AV Level Silver Plan","87.05%","0.87801206111908","Yes","Yes","No","100%",,"$750","$250","$500","$0","$750","$20","$38","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G60","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","9"
"2016","GA","49046","HIOS","17","2016-01-23 05:53:30","5","49046","GA","Individual","No","58-1638390","49046GA0410020","BCBSHP Silver Pathway X HMO 3000 10","49046GA041",,"GAN001","GAS001","GAF022","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9991",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","https://www.bcbsga.com/GASelectdrugtier4","49046GA0410020-06","94% AV Level Silver Plan","94.04%","0.939049065113068","Yes","Yes","No","100%",,"$200","$100","$300","$0","$200","$20","$93","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G61","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","10"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","1","50491","GA","Individual","No","59-1031071","50491GA0020006","Cigna Health Flex 1000","50491GA002","7730182962","GAN001","GAS001","GAF005","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020006-00","Standard Gold Off Exchange Plan","78.35%","0.786589205265045","Yes","Yes","No","100%",,"$1,000","$40","$1,250","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-flex-1000","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-flex-1000","4"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","1","50491","GA","Individual","Yes","59-1031071","50491GA0030001","Cigna Dental Pediatric","50491GA003","7730182962","GAN002","GAS002",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$18.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","All Services","Yes",,"","50491GA0030001-00","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/individuals-families/2016-plans/sob/georgia-localplus/dental-pediatric","4"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","1","50491","GA","Individual","No","59-1031071","50491GA0020006","Cigna Health Flex 1000","50491GA002","7730182962","GAN001","GAS001","GAF005","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020006-01","Standard Gold On Exchange Plan","78.35%","0.786589205265045","Yes","Yes","No","100%",,"$1,000","$40","$1,250","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-flex-1000","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-flex-1000","5"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","1","50491","GA","Individual","No","59-1031071","50491GA0020006","Cigna Health Flex 1000","50491GA002","7730182962","GAN001","GAS001","GAF005","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/naan-300b","6"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","1","50491","GA","Individual","No","59-1031071","50491GA0020006","Cigna Health Flex 1000","50491GA002","7730182962","GAN001","GAS001","GAF005","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020006-03","Limited Cost Sharing Plan Variation","78.35%","0.786589205265045","Yes","Yes","No","100%",,"$1,000","$40","$1,250","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-flex-1000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-flex-1000-naan-300a","7"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","1","50491","GA","Individual","No","59-1031071","50491GA0020005","Cigna Health Flex 4000","50491GA002","7730182962","GAN001","GAS001","GAF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020005-00","Standard Silver Off Exchange Plan","68.10%","0.684553205966949","Yes","Yes","No","100%",,"$4,000","$80","$650","$30","$140","$800","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-flex-4000","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-flex-4000","8"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","1","50491","GA","Individual","No","59-1031071","50491GA0020005","Cigna Health Flex 4000","50491GA002","7730182962","GAN001","GAS001","GAF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020005-01","Standard Silver On Exchange Plan","68.10%","0.684553205966949","Yes","Yes","No","100%",,"$4,000","$80","$650","$30","$140","$800","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-flex-4000","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-flex-4000","9"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","1","50491","GA","Individual","No","59-1031071","50491GA0020005","Cigna Health Flex 4000","50491GA002","7730182962","GAN001","GAS001","GAF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/naan-300b","10"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","1","50491","GA","Individual","No","59-1031071","50491GA0020005","Cigna Health Flex 4000","50491GA002","7730182962","GAN001","GAS001","GAF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020005-03","Limited Cost Sharing Plan Variation","68.10%","0.684553205966949","Yes","Yes","No","100%",,"$4,000","$80","$650","$30","$140","$800","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-flex-4000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-flex-4000-naan-300a","11"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","1","50491","GA","Individual","No","59-1031071","50491GA0020005","Cigna Health Flex 4000","50491GA002","7730182962","GAN001","GAS001","GAF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020005-04","73% AV Level Silver Plan","72.19%","0.725856184959412","Yes","Yes","No","100%",,"$2,600","$80","$930","$30","$140","$800","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-flex-4000-250","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-flex-4000-250","12"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","1","50491","GA","Individual","No","59-1031071","50491GA0020005","Cigna Health Flex 4000","50491GA002","7730182962","GAN001","GAS001","GAF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020005-05","87% AV Level Silver Plan","86.05%","0.865680515766144","Yes","Yes","No","100%",,"$300","$50","$1,040","$30","$140","$480","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","15%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-flex-4000-200","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-flex-4000-200","13"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","1","50491","GA","Individual","No","59-1031071","50491GA0020005","Cigna Health Flex 4000","50491GA002","7730182962","GAN001","GAS001","GAF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020005-06","94% AV Level Silver Plan","93.03%","0.933501362800598","Yes","Yes","No","100%",,"$100","$40","$360","$30","$100","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-flex-4000-150","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-flex-4000-150","14"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","1","50491","GA","Individual","No","59-1031071","50491GA0020004","Cigna Health Flex 2000","50491GA002","7730182962","GAN001","GAS001","GAF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020004-00","Standard Silver Off Exchange Plan","70.44%","0.709135234355927","Yes","Yes","No","100%",,"$2,000","$80","$1,570","$30","$140","$800","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-flex-2000","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-flex-2000","15"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","1","50491","GA","Individual","No","59-1031071","50491GA0020004","Cigna Health Flex 2000","50491GA002","7730182962","GAN001","GAS001","GAF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020004-01","Standard Silver On Exchange Plan","70.44%","0.709135234355927","Yes","Yes","No","100%",,"$2,000","$80","$1,570","$30","$140","$800","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-flex-2000","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-flex-2000","16"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","1","50491","GA","Individual","No","59-1031071","50491GA0020004","Cigna Health Flex 2000","50491GA002","7730182962","GAN001","GAS001","GAF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/naan-300b","17"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","1","50491","GA","Individual","No","59-1031071","50491GA0020004","Cigna Health Flex 2000","50491GA002","7730182962","GAN001","GAS001","GAF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020004-03","Limited Cost Sharing Plan Variation","70.44%","0.709135234355927","Yes","Yes","No","100%",,"$2,000","$80","$1,570","$30","$140","$800","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-flex-2000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-flex-2000-naan-300a","18"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","1","50491","GA","Individual","No","59-1031071","50491GA0020004","Cigna Health Flex 2000","50491GA002","7730182962","GAN001","GAS001","GAF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020004-04","73% AV Level Silver Plan","72.77%","0.731947839260101","Yes","Yes","No","100%",,"$1,800","$80","$1,630","$30","$140","$800","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-flex-2000-250","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-flex-2000-250","19"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","1","50491","GA","Individual","No","59-1031071","50491GA0020004","Cigna Health Flex 2000","50491GA002","7730182962","GAN001","GAS001","GAF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020004-05","87% AV Level Silver Plan","86.18%","0.866176307201386","Yes","Yes","No","100%",,"$150","$50","$1,420","$30","$150","$480","$30","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-flex-2000-200","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-flex-2000-200","20"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","1","50491","GA","Individual","No","59-1031071","50491GA0020004","Cigna Health Flex 2000","50491GA002","7730182962","GAN001","GAS001","GAF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020004-06","94% AV Level Silver Plan","93.24%","0.93637216091156","Yes","Yes","No","100%",,"$0","$40","$360","$30","$0","$440","$10","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-flex-2000-150","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-flex-2000-150","21"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","2","50491","GA","Individual","No","59-1031071","50491GA0020002","Cigna Health Flex 6400","50491GA002","7730182962","GAN001","GAS001","GAF002","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020002-00","Standard Bronze Off Exchange Plan","61.71%","0.63626354932785","Yes","Yes","No","100%",,"$5,170","$90","$250","$30","$140","$880","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","30%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-flex-6400","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-flex-6400","4"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","2","50491","GA","Individual","No","59-1031071","50491GA0020002","Cigna Health Flex 6400","50491GA002","7730182962","GAN001","GAS001","GAF002","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020002-01","Standard Bronze On Exchange Plan","61.71%","0.63626354932785","Yes","Yes","No","100%",,"$5,170","$90","$250","$30","$140","$880","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","30%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-flex-6400","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-flex-6400","5"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","2","50491","GA","Individual","No","59-1031071","50491GA0020002","Cigna Health Flex 6400","50491GA002","7730182962","GAN001","GAS001","GAF002","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/naan-300b","6"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","2","50491","GA","Individual","No","59-1031071","50491GA0020002","Cigna Health Flex 6400","50491GA002","7730182962","GAN001","GAS001","GAF002","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020002-03","Limited Cost Sharing Plan Variation","61.71%","0.63626354932785","Yes","Yes","No","100%",,"$5,170","$90","$250","$30","$140","$880","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","30%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-flex-6400-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-flex-6400-naan-300a","7"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","3","50491","GA","Individual","No","59-1031071","50491GA0020001","Cigna Health Savings 6000","50491GA002","7730182962","GAN001","GAS001","GAF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020001-00","Standard Bronze Off Exchange Plan",,"0.612583756446838","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,030","$0","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-savings-6000","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-savings-6000","4"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","3","50491","GA","Individual","No","59-1031071","50491GA0020001","Cigna Health Savings 6000","50491GA002","7730182962","GAN001","GAS001","GAF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020001-01","Standard Bronze On Exchange Plan",,"0.612583756446838","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,030","$0","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-savings-6000","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-savings-6000","5"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","3","50491","GA","Individual","No","59-1031071","50491GA0020001","Cigna Health Savings 6000","50491GA002","7730182962","GAN001","GAS001","GAF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/naan-300b","6"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","3","50491","GA","Individual","No","59-1031071","50491GA0020001","Cigna Health Savings 6000","50491GA002","7730182962","GAN001","GAS001","GAF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020001-03","Limited Cost Sharing Plan Variation",,"0.612583756446838","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,030","$0","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-savings-6000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-savings-6000-naan-300a","7"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","3","50491","GA","Individual","No","59-1031071","50491GA0020003","Cigna Health Savings 3000","50491GA002","7730182962","GAN001","GAS001","GAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020003-00","Standard Silver Off Exchange Plan",,"0.683712661266327","Yes","Yes","No","100%",,"$3,000","$0","$440","$30","$3,000","$0","$200","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-savings-3000","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-savings-3000","8"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","3","50491","GA","Individual","No","59-1031071","50491GA0020003","Cigna Health Savings 3000","50491GA002","7730182962","GAN001","GAS001","GAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020003-01","Standard Silver On Exchange Plan",,"0.683712661266327","Yes","Yes","No","100%",,"$3,000","$0","$440","$30","$3,000","$0","$200","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-savings-3000","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-savings-3000","9"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","3","50491","GA","Individual","No","59-1031071","50491GA0020003","Cigna Health Savings 3000","50491GA002","7730182962","GAN001","GAS001","GAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/naan-300b","10"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","3","50491","GA","Individual","No","59-1031071","50491GA0020003","Cigna Health Savings 3000","50491GA002","7730182962","GAN001","GAS001","GAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020003-03","Limited Cost Sharing Plan Variation",,"0.683712661266327","Yes","Yes","No","100%",,"$3,000","$0","$440","$30","$3,000","$0","$200","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-savings-3000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-savings-3000-naan-300a","11"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","3","50491","GA","Individual","No","59-1031071","50491GA0020003","Cigna Health Savings 3000","50491GA002","7730182962","GAN001","GAS001","GAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020003-04","73% AV Level Silver Plan",,"0.721797585487366","Yes","Yes","No","100%",,"$2,350","$0","$510","$30","$2,350","$0","$270","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","10%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-savings-3000-250","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-savings-3000-250","12"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","3","50491","GA","Individual","No","59-1031071","50491GA0020003","Cigna Health Savings 3000","50491GA002","7730182962","GAN001","GAS001","GAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020003-05","87% AV Level Silver Plan",,"0.864059567451477","Yes","Yes","No","100%",,"$650","$0","$680","$30","$650","$0","$440","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","10%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-savings-3000-200","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-savings-3000-200","13"
"2016","GA","50491","HIOS","9","2016-01-27 05:35:40","3","50491","GA","Individual","No","59-1031071","50491GA0020003","Cigna Health Savings 3000","50491GA002","7730182962","GAN001","GAS001","GAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","50491GA0020003-06","94% AV Level Silver Plan",,"0.931260466575623","Yes","Yes","No","100%",,"$100","$0","$730","$30","$100","$0","$490","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/georgia/health-savings-3000-150","http://www.cigna.com/individuals-families/2016-plans/sob/georgia/health-savings-3000-150","14"
"2016","GA","50662","HIOS","2","2015-07-10 02:19:03","1","50662","GA","SHOP (Small Group)","Yes","35-0472300","50662GA0010001","Lincoln DentalConnect®","50662GA001","7063415294","GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.78","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","50662GA0010001-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","50662","HIOS","2","2015-07-10 02:19:03","1","50662","GA","SHOP (Small Group)","Yes","35-0472300","50662GA0010002","Lincoln DentalConnect®","50662GA001","7063415294","GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.67","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","50662GA0010002-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","GA","68806","HIOS","3","2015-07-08 02:47:08","1","68806","GA","SHOP (Small Group)","Yes","59-0397210","68806GA0020003","DentaQuest PPO Family High","68806GA002",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.78","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","68806GA0020003-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/","4"
"2016","GA","68806","HIOS","3","2015-07-08 02:47:08","1","68806","GA","SHOP (Small Group)","Yes","59-0397210","68806GA0020003","DentaQuest PPO Family High","68806GA002",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.78","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","68806GA0020003-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/","5"
"2016","GA","50662","HIOS","2","2015-07-10 02:19:03","1","50662","GA","SHOP (Small Group)","Yes","35-0472300","50662GA0010003","Lincoln DentalConnect®","50662GA001","7063415294","GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.97","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","50662GA0010003-00","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","GA","50662","HIOS","2","2015-07-10 02:19:03","1","50662","GA","SHOP (Small Group)","Yes","35-0472300","50662GA0010004","Lincoln DentalConnect®","50662GA001","7063415294","GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.23","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","50662GA0010004-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","GA","50662","HIOS","2","2015-07-10 02:19:03","1","50662","GA","SHOP (Small Group)","Yes","35-0472300","50662GA0010005","Lincoln DentalConnect®","50662GA001","7063415294","GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.57","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","50662GA0010005-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","GA","50662","HIOS","2","2015-07-10 02:19:03","1","50662","GA","SHOP (Small Group)","Yes","35-0472300","50662GA0010006","Lincoln DentalConnect®","50662GA001","7063415294","GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.02","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","50662GA0010006-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","GA","50662","HIOS","2","2015-07-10 02:19:03","1","50662","GA","SHOP (Small Group)","Yes","35-0472300","50662GA0010007","Lincoln DentalConnect®","50662GA001","7063415294","GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.30","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","50662GA0010007-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2016","GA","50988","HIOS","3","2015-08-25 05:06:23","1","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0270001","Smile for Health - Certified Optimum Coverage","50988GA027",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","50988GA0270001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010007","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","70893GA001",,"GAN001","GAS001","GAF006","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010007-01","Standard Bronze On Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010007-01.pdf","https://api.centene.com/Brochures/2016/70893GA0010007-01.pdf","41"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010007","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","70893GA001",,"GAN001","GAS001","GAF006","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010007-02.pdf","https://api.centene.com/Brochures/2016/70893GA0010007-02.pdf","42"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010007","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","70893GA001",,"GAN001","GAS001","GAF006","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010007-03","Limited Cost Sharing Plan Variation",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010007-03.pdf","https://api.centene.com/Brochures/2016/70893GA0010007-03.pdf","43"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020001","Ambetter Balanced Care 1 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9754",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020001-00","Standard Silver Off Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020001-00.pdf","https://api.centene.com/Brochures/2016/70893GA0020001-00.pdf","4"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020001","Ambetter Balanced Care 1 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9754",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020001-01","Standard Silver On Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020001-01.pdf","https://api.centene.com/Brochures/2016/70893GA0020001-01.pdf","5"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020001","Ambetter Balanced Care 1 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9754",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020001-02.pdf","https://api.centene.com/Brochures/2016/70893GA0020001-02.pdf","6"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020001","Ambetter Balanced Care 1 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9754",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020001-03","Limited Cost Sharing Plan Variation",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020001-03.pdf","https://api.centene.com/Brochures/2016/70893GA0020001-03.pdf","7"
"2016","GA","50988","HIOS","3","2015-08-25 05:06:23","2","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0270002","Smile for Health - Certified Optimum Coverage","50988GA027",,"GAN002","GAS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","50988GA0270002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","50988","HIOS","3","2015-08-25 05:06:23","3","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0270003","Smile for Health - Certified Optimum Coverage","50988GA027",,"GAN003","GAS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","50988GA0270003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","50988","HIOS","3","2015-08-25 05:06:23","4","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0270004","Smile for Health - Certified Optimum Coverage","50988GA027",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","50988GA0270004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","50988","HIOS","3","2015-08-25 05:06:23","5","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0270005","Smile for Health - Certified Optimum Coverage","50988GA027",,"GAN002","GAS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","50988GA0270005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","50988","HIOS","3","2015-08-25 05:06:23","6","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0270006","Smile for Health - Certified Optimum Coverage","50988GA027",,"GAN003","GAS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","50988GA0270006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","50988","HIOS","3","2015-08-25 05:06:23","7","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0280001","Smile for Health - Certified High Option","50988GA028",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","50988GA0280001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","50988","HIOS","3","2015-08-25 05:06:23","8","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0280002","Smile for Health - Certified High Option","50988GA028",,"GAN002","GAS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","50988GA0280002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","50988","HIOS","3","2015-08-25 05:06:23","9","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0280003","Smile for Health - Certified High Option","50988GA028",,"GAN003","GAS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","50988GA0280003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","50988","HIOS","3","2015-08-25 05:06:23","10","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0280004","Smile for Health - Certified High Option Plus","50988GA028",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","50988GA0280004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","50988","HIOS","3","2015-08-25 05:06:23","11","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0280005","Smile for Health - Certified High Option Plus","50988GA028",,"GAN002","GAS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","50988GA0280005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","50988","HIOS","3","2015-08-25 05:06:23","12","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0280006","Smile for Health - Certified High Option Plus","50988GA028",,"GAN003","GAS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","50988GA0280006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","55612","HIOS","5","2015-08-21 03:45:06","1","55612","GA","SHOP (Small Group)","Yes","13-5581829","55612GA0160001","EHB Basic Dental Plan (Low)","55612GA016",,"GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$16.91","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","55612GA0160001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","55612","HIOS","5","2015-08-21 03:45:06","2","55612","GA","SHOP (Small Group)","Yes","13-5581829","55612GA0180001","Family Basic Dental Plan (Low)","55612GA018",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$16.91","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","55612GA0180001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49078","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49077","4"
"2016","GA","55612","HIOS","5","2015-08-21 03:45:06","2","55612","GA","SHOP (Small Group)","Yes","13-5581829","55612GA0180001","Family Basic Dental Plan (Low)","55612GA018",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$16.91","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","55612GA0180001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49078","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49077","5"
"2016","GA","55612","HIOS","5","2015-08-21 03:45:06","3","55612","GA","SHOP (Small Group)","Yes","13-5581829","55612GA0190001","Family Enhanced Dental Plan (High)","55612GA019",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$21.43","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","55612GA0190001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49080","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49079","4"
"2016","GA","55612","HIOS","5","2015-08-21 03:45:06","3","55612","GA","SHOP (Small Group)","Yes","13-5581829","55612GA0190001","Family Enhanced Dental Plan (High)","55612GA019",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$21.43","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","55612GA0190001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49080","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49079","5"
"2016","GA","63411","HIOS","6","2015-08-22 15:09:32","1","63411","GA","Individual","Yes","58-0469845","63411GA0490003","BCBSGA Dental Pediatric","63411GA049",,"GAN001","GAS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$21.54","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","63411GA0490003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214666.pdf",,"4"
"2016","GA","63411","HIOS","6","2015-08-22 15:09:32","1","63411","GA","SHOP (Small Group)","Yes","58-0469845","63411GA0520003","BCBSGA Dental Pediatric","63411GA052",,"GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$21.54","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level","Yes",,"","63411GA0520003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214666.pdf",,"4"
"2016","GA","63411","HIOS","6","2015-08-22 15:09:32","1","63411","GA","Individual","Yes","58-0469845","63411GA0550003","BCBSGA Dental Pediatric","63411GA055",,"GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$21.54","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","63411GA0550003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214666.pdf",,"5"
"2016","GA","63411","HIOS","6","2015-08-22 15:09:32","2","63411","GA","Individual","Yes","58-0469845","63411GA0510003","BCBSGA Dental Family","63411GA051",,"GAN001","GAS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.05","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","63411GA0510003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214664.pdf",,"4"
"2016","GA","63411","HIOS","6","2015-08-22 15:09:32","2","63411","GA","SHOP (Small Group)","Yes","58-0469845","63411GA0480003","BCBSGA Dental Family","63411GA048",,"GAN001","GAS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.05","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","63411GA0480003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214664.pdf",,"4"
"2016","GA","63411","HIOS","6","2015-08-22 15:09:32","2","63411","GA","SHOP (Small Group)","Yes","58-0469845","63411GA0540003","BCBSGA Dental Family","63411GA054",,"GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.05","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","63411GA0540003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214664.pdf",,"5"
"2016","GA","63411","HIOS","6","2015-08-22 15:09:32","2","63411","GA","Individual","Yes","58-0469845","63411GA0570003","BCBSGA Dental Family","63411GA057",,"GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.05","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","63411GA0570003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214664.pdf",,"5"
"2016","GA","63411","HIOS","6","2015-08-22 15:09:32","3","63411","GA","Individual","Yes","58-0469845","63411GA0510004","BCBSGA Dental Family Enhanced","63411GA051",,"GAN001","GAS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.32","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","63411GA0510004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214665.pdf",,"4"
"2016","GA","63411","HIOS","6","2015-08-22 15:09:32","3","63411","GA","SHOP (Small Group)","Yes","58-0469845","63411GA0480004","BCBSGA Dental Family Enhanced","63411GA048",,"GAN001","GAS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.32","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","63411GA0480004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214665.pdf",,"4"
"2016","GA","63411","HIOS","6","2015-08-22 15:09:32","3","63411","GA","SHOP (Small Group)","Yes","58-0469845","63411GA0540004","BCBSGA Dental Family Enhanced","63411GA054",,"GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.32","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","63411GA0540004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214665.pdf",,"5"
"2016","GA","63411","HIOS","6","2015-08-22 15:09:32","3","63411","GA","Individual","Yes","58-0469845","63411GA0570004","BCBSGA Dental Family Enhanced","63411GA057",,"GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.32","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","63411GA0570004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e214665.pdf",,"5"
"2016","GA","63940","HIOS","4","2015-08-19 14:41:20","1","63940","GA","SHOP (Small Group)","Yes","13-5123390","63940GA0140003","Guardian Pediatric Advantage","63940GA014",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$28.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","63940GA0140003-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","GA","63940","HIOS","4","2015-08-19 14:41:20","1","63940","GA","Individual","Yes","13-5123390","63940GA0200001","Guardian Family Essentials","63940GA020",,"GAN002","GAS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is availabie outside of the service area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","63940GA0200001-00","Standard Low Off Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","4"
"2016","GA","63940","HIOS","4","2015-08-19 14:41:20","1","63940","GA","Individual","Yes","13-5123390","63940GA0200001","Guardian Family Essentials","63940GA020",,"GAN002","GAS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is availabie outside of the service area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","63940GA0200001-01","Standard Low On Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","5"
"2016","GA","63940","HIOS","4","2015-08-19 14:41:20","1","63940","GA","SHOP (Small Group)","Yes","13-5123390","63940GA0150003","Guardian Pediatric Essentials","63940GA015",,"GAN001","GAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$20.46","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","63940GA0150003-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","GA","63940","HIOS","4","2015-08-19 14:41:20","2","63940","GA","SHOP (Small Group)","Yes","13-5123390","63940GA0170003","Guardian Family Advantage","63940GA017",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","63940GA0170003-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","GA","63940","HIOS","4","2015-08-19 14:41:20","2","63940","GA","SHOP (Small Group)","Yes","13-5123390","63940GA0170003","Guardian Family Advantage","63940GA017",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","63940GA0170003-01","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","GA","63940","HIOS","4","2015-08-19 14:41:20","2","63940","GA","SHOP (Small Group)","Yes","13-5123390","63940GA0190003","Guardian Family Essentials","63940GA019",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.46","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","63940GA0190003-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","GA","63940","HIOS","4","2015-08-19 14:41:20","2","63940","GA","SHOP (Small Group)","Yes","13-5123390","63940GA0190003","Guardian Family Essentials","63940GA019",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.46","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","63940GA0190003-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","GA","68687","HIOS","2","2015-07-03 02:33:58","1","68687","GA","SHOP (Small Group)","Yes","36-0883760","68687GA0030002","EHB High Passive","68687GA003",,"GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.42","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","68687GA0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","GA","68687","HIOS","2","2015-07-03 02:33:58","1","68687","GA","SHOP (Small Group)","Yes","36-0883760","68687GA0030001","EHB Low Passive","68687GA003",,"GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.81","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","68687GA0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","GA","68806","HIOS","3","2015-07-08 02:47:08","1","68806","GA","Individual","Yes","59-0397210","68806GA0010001","DentaQuest PPO  Pediatric High","68806GA001",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$28.08","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","68806GA0010001-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/","4"
"2016","GA","68806","HIOS","3","2015-07-08 02:47:08","1","68806","GA","Individual","Yes","59-0397210","68806GA0010001","DentaQuest PPO  Pediatric High","68806GA001",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$28.08","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","68806GA0010001-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/","5"
"2016","GA","68806","HIOS","3","2015-07-08 02:47:08","1","68806","GA","SHOP (Small Group)","Yes","59-0397210","68806GA0020004","DentaQuest PPO Family Low","68806GA002",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.45","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","68806GA0020004-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/","6"
"2016","GA","68806","HIOS","3","2015-07-08 02:47:08","1","68806","GA","SHOP (Small Group)","Yes","59-0397210","68806GA0020004","DentaQuest PPO Family Low","68806GA002",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.45","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","68806GA0020004-01","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/","7"
"2016","GA","68806","HIOS","3","2015-07-08 02:47:08","2","68806","GA","Individual","Yes","59-0397210","68806GA0010003","DentaQuest PPO Family High","68806GA001",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.08","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","68806GA0010003-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/","4"
"2016","GA","68806","HIOS","3","2015-07-08 02:47:08","2","68806","GA","Individual","Yes","59-0397210","68806GA0010003","DentaQuest PPO Family High","68806GA001",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.08","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","68806GA0010003-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/","5"
"2016","GA","68806","HIOS","3","2015-07-08 02:47:08","2","68806","GA","Individual","Yes","59-0397210","68806GA0010004","DentaQuest PPO Family Low","68806GA001",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.10","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","68806GA0010004-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/","6"
"2016","GA","68806","HIOS","3","2015-07-08 02:47:08","2","68806","GA","Individual","Yes","59-0397210","68806GA0010004","DentaQuest PPO Family Low","68806GA001",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.10","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","68806GA0010004-01","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/ga/","http://www.dentaquest.com/marketplace/ga/","7"
"2016","GA","69677","HIOS","2","2015-07-03 02:33:58","1","69677","GA","SHOP (Small Group)","Yes","47-0098400","69677GA0030002","EHB High Passive","69677GA003",,"GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.81","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","69677GA0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010005","Ambetter Balanced Care 10 (2016)","70893GA001",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010005-05","87% AV Level Silver Plan",,"0.874480485916138","Yes","Yes","No","100%",,"$1,000","$0","$800","$200","$1,000","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010005-05.pdf","https://api.centene.com/Brochures/2016/70893GA0010005-05.pdf","34"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010005","Ambetter Balanced Care 10 (2016)","70893GA001",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010005-06","94% AV Level Silver Plan",,"0.946612775325775","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010005-06.pdf","https://api.centene.com/Brochures/2016/70893GA0010005-06.pdf","35"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010006","Ambetter Essential Care 1 (2016)","70893GA001",,"GAN001","GAS001","GAF005","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010006-00","Standard Bronze Off Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010006-00.pdf","https://api.centene.com/Brochures/2016/70893GA0010006-00.pdf","36"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010006","Ambetter Essential Care 1 (2016)","70893GA001",,"GAN001","GAS001","GAF005","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010006-01","Standard Bronze On Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010006-01.pdf","https://api.centene.com/Brochures/2016/70893GA0010006-01.pdf","37"
"2016","GA","69677","HIOS","2","2015-07-03 02:33:58","1","69677","GA","SHOP (Small Group)","Yes","47-0098400","69677GA0030001","EHB Low Passive","69677GA003",,"GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.46","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","69677GA0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","70893GA001",,"GAN001","GAS001","GAF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010001-00","Standard Gold Off Exchange Plan",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/70893GA0010001-00.pdf","https://api.centene.com/Brochures/2016/70893GA0010001-00.pdf","4"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","70893GA001",,"GAN001","GAS001","GAF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010001-01","Standard Gold On Exchange Plan",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/70893GA0010001-01.pdf","https://api.centene.com/Brochures/2016/70893GA0010001-01.pdf","5"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","70893GA001",,"GAN001","GAS001","GAF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/70893GA0010001-02.pdf","https://api.centene.com/Brochures/2016/70893GA0010001-02.pdf","6"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","70893GA001",,"GAN001","GAS001","GAF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010001-03","Limited Cost Sharing Plan Variation",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/70893GA0010001-03.pdf","https://api.centene.com/Brochures/2016/70893GA0010001-03.pdf","7"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010002","Ambetter Balanced Care 1 (2016)","70893GA001",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010002-00","Standard Silver Off Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010002-00.pdf","https://api.centene.com/Brochures/2016/70893GA0010002-00.pdf","8"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010002","Ambetter Balanced Care 1 (2016)","70893GA001",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010002-01","Standard Silver On Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010002-01.pdf","https://api.centene.com/Brochures/2016/70893GA0010002-01.pdf","9"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010002","Ambetter Balanced Care 1 (2016)","70893GA001",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010002-02.pdf","https://api.centene.com/Brochures/2016/70893GA0010002-02.pdf","10"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010002","Ambetter Balanced Care 1 (2016)","70893GA001",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010002-03","Limited Cost Sharing Plan Variation",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010002-03.pdf","https://api.centene.com/Brochures/2016/70893GA0010002-03.pdf","11"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010002","Ambetter Balanced Care 1 (2016)","70893GA001",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010002-04","73% AV Level Silver Plan",,"0.737546384334564","Yes","Yes","No","100%",,"$3,500","$10","$300","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010002-04.pdf","https://api.centene.com/Brochures/2016/70893GA0010002-04.pdf","12"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010002","Ambetter Balanced Care 1 (2016)","70893GA001",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010002-05","87% AV Level Silver Plan",,"0.879890024662018","Yes","Yes","No","100%",,"$400","$10","$1,000","$200","$400","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010002-05.pdf","https://api.centene.com/Brochures/2016/70893GA0010002-05.pdf","13"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010002","Ambetter Balanced Care 1 (2016)","70893GA001",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010002-06","94% AV Level Silver Plan",,"0.948710560798645","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010002-06.pdf","https://api.centene.com/Brochures/2016/70893GA0010002-06.pdf","14"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010003","Ambetter Balanced Care 2 (2016)","70893GA001",,"GAN001","GAS001","GAF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010003-00","Standard Silver Off Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010003-00.pdf","https://api.centene.com/Brochures/2016/70893GA0010003-00.pdf","15"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010003","Ambetter Balanced Care 2 (2016)","70893GA001",,"GAN001","GAS001","GAF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010003-01","Standard Silver On Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010003-01.pdf","https://api.centene.com/Brochures/2016/70893GA0010003-01.pdf","16"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010003","Ambetter Balanced Care 2 (2016)","70893GA001",,"GAN001","GAS001","GAF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010003-02.pdf","https://api.centene.com/Brochures/2016/70893GA0010003-02.pdf","17"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010003","Ambetter Balanced Care 2 (2016)","70893GA001",,"GAN001","GAS001","GAF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010003-03","Limited Cost Sharing Plan Variation",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010003-03.pdf","https://api.centene.com/Brochures/2016/70893GA0010003-03.pdf","18"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010003","Ambetter Balanced Care 2 (2016)","70893GA001",,"GAN001","GAS001","GAF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010003-04","73% AV Level Silver Plan",,"0.739638686180115","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010003-04.pdf","https://api.centene.com/Brochures/2016/70893GA0010003-04.pdf","19"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010003","Ambetter Balanced Care 2 (2016)","70893GA001",,"GAN001","GAS001","GAF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010003-05","87% AV Level Silver Plan",,"0.873916625976563","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,700","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010003-05.pdf","https://api.centene.com/Brochures/2016/70893GA0010003-05.pdf","20"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010003","Ambetter Balanced Care 2 (2016)","70893GA001",,"GAN001","GAS001","GAF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010003-06","94% AV Level Silver Plan",,"0.9492227435112","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010003-06.pdf","https://api.centene.com/Brochures/2016/70893GA0010003-06.pdf","21"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010005","Ambetter Balanced Care 10 (2016)","70893GA001",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010005-00","Standard Silver Off Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010005-00.pdf","https://api.centene.com/Brochures/2016/70893GA0010005-00.pdf","29"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010005","Ambetter Balanced Care 10 (2016)","70893GA001",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010005-01","Standard Silver On Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010005-01.pdf","https://api.centene.com/Brochures/2016/70893GA0010005-01.pdf","30"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010005","Ambetter Balanced Care 10 (2016)","70893GA001",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010005-02.pdf","https://api.centene.com/Brochures/2016/70893GA0010005-02.pdf","31"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010005","Ambetter Balanced Care 10 (2016)","70893GA001",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010005-03","Limited Cost Sharing Plan Variation",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010005-03.pdf","https://api.centene.com/Brochures/2016/70893GA0010005-03.pdf","32"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010005","Ambetter Balanced Care 10 (2016)","70893GA001",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010005-04","73% AV Level Silver Plan",,"0.738659501075745","Yes","Yes","No","100%",,"$4,000","$10","$200","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010005-04.pdf","https://api.centene.com/Brochures/2016/70893GA0010005-04.pdf","33"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010006","Ambetter Essential Care 1 (2016)","70893GA001",,"GAN001","GAS001","GAF005","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010006-02.pdf","https://api.centene.com/Brochures/2016/70893GA0010006-02.pdf","38"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010006","Ambetter Essential Care 1 (2016)","70893GA001",,"GAN001","GAS001","GAF005","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010006-03","Limited Cost Sharing Plan Variation",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010006-03.pdf","https://api.centene.com/Brochures/2016/70893GA0010006-03.pdf","39"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","1","70893","GA","Individual","No","36-4802632","70893GA0010007","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","70893GA001",,"GAN001","GAS001","GAF006","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0010007-00","Standard Bronze Off Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0010007-00.pdf","https://api.centene.com/Brochures/2016/70893GA0010007-00.pdf","40"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020001","Ambetter Balanced Care 1 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9754",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020001-04","73% AV Level Silver Plan",,"0.737546384334564","Yes","Yes","No","100%",,"$3,500","$10","$300","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020001-04.pdf","https://api.centene.com/Brochures/2016/70893GA0020001-04.pdf","8"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020001","Ambetter Balanced Care 1 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9754",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020001-05","87% AV Level Silver Plan",,"0.879890024662018","Yes","Yes","No","100%",,"$400","$10","$1,000","$200","$400","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020001-05.pdf","https://api.centene.com/Brochures/2016/70893GA0020001-05.pdf","9"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020001","Ambetter Balanced Care 1 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9754",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020001-06","94% AV Level Silver Plan",,"0.948710560798645","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020001-06.pdf","https://api.centene.com/Brochures/2016/70893GA0020001-06.pdf","10"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020002","Ambetter Balanced Care 2 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF003","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9755",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020002-00","Standard Silver Off Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020002-00.pdf","https://api.centene.com/Brochures/2016/70893GA0020002-00.pdf","11"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020002","Ambetter Balanced Care 2 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF003","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9755",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020002-01","Standard Silver On Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020002-01.pdf","https://api.centene.com/Brochures/2016/70893GA0020002-01.pdf","12"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020002","Ambetter Balanced Care 2 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF003","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9755",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020002-02.pdf","https://api.centene.com/Brochures/2016/70893GA0020002-02.pdf","13"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020002","Ambetter Balanced Care 2 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF003","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9755",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020002-03","Limited Cost Sharing Plan Variation",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020002-03.pdf","https://api.centene.com/Brochures/2016/70893GA0020002-03.pdf","14"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020002","Ambetter Balanced Care 2 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF003","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9755",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020002-04","73% AV Level Silver Plan",,"0.739638686180115","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020002-04.pdf","https://api.centene.com/Brochures/2016/70893GA0020002-04.pdf","15"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020002","Ambetter Balanced Care 2 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF003","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9755",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020002-05","87% AV Level Silver Plan",,"0.873916625976563","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,700","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020002-05.pdf","https://api.centene.com/Brochures/2016/70893GA0020002-05.pdf","16"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020002","Ambetter Balanced Care 2 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF003","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9755",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020002-06","94% AV Level Silver Plan",,"0.9492227435112","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020002-06.pdf","https://api.centene.com/Brochures/2016/70893GA0020002-06.pdf","17"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020003","Ambetter Balanced Care 10 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9755",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020003-00","Standard Silver Off Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020003-00.pdf","https://api.centene.com/Brochures/2016/70893GA0020003-00.pdf","18"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020003","Ambetter Balanced Care 10 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9755",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020003-01","Standard Silver On Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020003-01.pdf","https://api.centene.com/Brochures/2016/70893GA0020003-01.pdf","19"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020003","Ambetter Balanced Care 10 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9755",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020003-02.pdf","https://api.centene.com/Brochures/2016/70893GA0020003-02.pdf","20"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020003","Ambetter Balanced Care 10 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9755",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020003-03","Limited Cost Sharing Plan Variation",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020003-03.pdf","https://api.centene.com/Brochures/2016/70893GA0020003-03.pdf","21"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020003","Ambetter Balanced Care 10 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9755",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020003-04","73% AV Level Silver Plan",,"0.738659501075745","Yes","Yes","No","100%",,"$4,000","$10","$200","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020003-04.pdf","https://api.centene.com/Brochures/2016/70893GA0020003-04.pdf","22"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020003","Ambetter Balanced Care 10 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9755",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020003-05","87% AV Level Silver Plan",,"0.874480485916138","Yes","Yes","No","100%",,"$1,000","$0","$800","$200","$1,000","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020003-05.pdf","https://api.centene.com/Brochures/2016/70893GA0020003-05.pdf","23"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020003","Ambetter Balanced Care 10 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9755",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020003-06","94% AV Level Silver Plan",,"0.946612775325775","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020003-06.pdf","https://api.centene.com/Brochures/2016/70893GA0020003-06.pdf","24"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020004","Ambetter Essential Care 1 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF005","New","HMO","Bronze","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9741",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020004-00","Standard Bronze Off Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020004-00.pdf","https://api.centene.com/Brochures/2016/70893GA0020004-00.pdf","25"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020004","Ambetter Essential Care 1 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF005","New","HMO","Bronze","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9741",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020004-01","Standard Bronze On Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020004-01.pdf","https://api.centene.com/Brochures/2016/70893GA0020004-01.pdf","26"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020004","Ambetter Essential Care 1 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF005","New","HMO","Bronze","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9741",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020004-02.pdf","https://api.centene.com/Brochures/2016/70893GA0020004-02.pdf","27"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020004","Ambetter Essential Care 1 (2016) + Vision","70893GA002",,"GAN001","GAS001","GAF005","New","HMO","Bronze","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9741",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020004-03","Limited Cost Sharing Plan Variation",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020004-03.pdf","https://api.centene.com/Brochures/2016/70893GA0020004-03.pdf","28"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","70893GA002",,"GAN001","GAS001","GAF006","New","HMO","Bronze","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9741",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020005-00","Standard Bronze Off Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020005-00.pdf","https://api.centene.com/Brochures/2016/70893GA0020005-00.pdf","29"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","70893GA002",,"GAN001","GAS001","GAF006","New","HMO","Bronze","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9741",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020005-01","Standard Bronze On Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020005-01.pdf","https://api.centene.com/Brochures/2016/70893GA0020005-01.pdf","30"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","70893GA002",,"GAN001","GAS001","GAF006","New","HMO","Bronze","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9741",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020005-02.pdf","https://api.centene.com/Brochures/2016/70893GA0020005-02.pdf","31"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","2","70893","GA","Individual","No","36-4802632","70893GA0020005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","70893GA002",,"GAN001","GAS001","GAF006","New","HMO","Bronze","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9741",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0020005-03","Limited Cost Sharing Plan Variation",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0020005-03.pdf","https://api.centene.com/Brochures/2016/70893GA0020005-03.pdf","32"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.917",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030001-00","Standard Silver Off Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030001-00.pdf","https://api.centene.com/Brochures/2016/70893GA0030001-00.pdf","4"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.917",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030001-01","Standard Silver On Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030001-01.pdf","https://api.centene.com/Brochures/2016/70893GA0030001-01.pdf","5"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.917",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030001-02.pdf","https://api.centene.com/Brochures/2016/70893GA0030001-02.pdf","6"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.917",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030001-03","Limited Cost Sharing Plan Variation",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030001-03.pdf","https://api.centene.com/Brochures/2016/70893GA0030001-03.pdf","7"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.917",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030001-04","73% AV Level Silver Plan",,"0.737546384334564","Yes","Yes","No","100%",,"$3,500","$10","$300","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030001-04.pdf","https://api.centene.com/Brochures/2016/70893GA0030001-04.pdf","8"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.917",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030001-05","87% AV Level Silver Plan",,"0.879890024662018","Yes","Yes","No","100%",,"$400","$10","$1,000","$200","$400","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030001-05.pdf","https://api.centene.com/Brochures/2016/70893GA0030001-05.pdf","9"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.917",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030001-06","94% AV Level Silver Plan",,"0.948710560798645","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030001-06.pdf","https://api.centene.com/Brochures/2016/70893GA0030001-06.pdf","10"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF003","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9171",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030002-00","Standard Silver Off Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030002-00.pdf","https://api.centene.com/Brochures/2016/70893GA0030002-00.pdf","11"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF003","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9171",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030002-01","Standard Silver On Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030002-01.pdf","https://api.centene.com/Brochures/2016/70893GA0030002-01.pdf","12"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF003","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9171",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030002-02.pdf","https://api.centene.com/Brochures/2016/70893GA0030002-02.pdf","13"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF003","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9171",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030002-03","Limited Cost Sharing Plan Variation",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030002-03.pdf","https://api.centene.com/Brochures/2016/70893GA0030002-03.pdf","14"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF003","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9171",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030002-04","73% AV Level Silver Plan",,"0.739638686180115","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030002-04.pdf","https://api.centene.com/Brochures/2016/70893GA0030002-04.pdf","15"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF003","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9171",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030002-05","87% AV Level Silver Plan",,"0.873916625976563","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,700","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030002-05.pdf","https://api.centene.com/Brochures/2016/70893GA0030002-05.pdf","16"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF003","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9171",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030002-06","94% AV Level Silver Plan",,"0.9492227435112","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030002-06.pdf","https://api.centene.com/Brochures/2016/70893GA0030002-06.pdf","17"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030003","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9171",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030003-00","Standard Silver Off Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030003-00.pdf","https://api.centene.com/Brochures/2016/70893GA0030003-00.pdf","18"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030003","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9171",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030003-01","Standard Silver On Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030003-01.pdf","https://api.centene.com/Brochures/2016/70893GA0030003-01.pdf","19"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030003","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9171",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030003-02.pdf","https://api.centene.com/Brochures/2016/70893GA0030003-02.pdf","20"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030003","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9171",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030003-03","Limited Cost Sharing Plan Variation",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030003-03.pdf","https://api.centene.com/Brochures/2016/70893GA0030003-03.pdf","21"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030003","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9171",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030003-04","73% AV Level Silver Plan",,"0.738659501075745","Yes","Yes","No","100%",,"$4,000","$10","$200","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030003-04.pdf","https://api.centene.com/Brochures/2016/70893GA0030003-04.pdf","22"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030003","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9171",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030003-05","87% AV Level Silver Plan",,"0.874480485916138","Yes","Yes","No","100%",,"$1,000","$0","$800","$200","$1,000","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030003-05.pdf","https://api.centene.com/Brochures/2016/70893GA0030003-05.pdf","23"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030003","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF002","New","HMO","Silver","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9171",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030003-06","94% AV Level Silver Plan",,"0.946612775325775","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030003-06.pdf","https://api.centene.com/Brochures/2016/70893GA0030003-06.pdf","24"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030004","Ambetter Essential Care 1 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF001","New","HMO","Bronze","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9127",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030004-00","Standard Bronze Off Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030004-00.pdf","https://api.centene.com/Brochures/2016/70893GA0030004-00.pdf","25"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030004","Ambetter Essential Care 1 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF001","New","HMO","Bronze","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9127",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030004-01","Standard Bronze On Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030004-01.pdf","https://api.centene.com/Brochures/2016/70893GA0030004-01.pdf","26"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030004","Ambetter Essential Care 1 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF001","New","HMO","Bronze","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9127",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030004-02.pdf","https://api.centene.com/Brochures/2016/70893GA0030004-02.pdf","27"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030004","Ambetter Essential Care 1 (2016) + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF001","New","HMO","Bronze","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9127",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030004-03","Limited Cost Sharing Plan Variation",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030004-03.pdf","https://api.centene.com/Brochures/2016/70893GA0030004-03.pdf","28"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF006","New","HMO","Bronze","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9127",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030005-00","Standard Bronze Off Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030005-00.pdf","https://api.centene.com/Brochures/2016/70893GA0030005-00.pdf","29"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF006","New","HMO","Bronze","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9127",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030005-01","Standard Bronze On Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030005-01.pdf","https://api.centene.com/Brochures/2016/70893GA0030005-01.pdf","30"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF006","New","HMO","Bronze","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9127",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030005-02.pdf","https://api.centene.com/Brochures/2016/70893GA0030005-02.pdf","31"
"2016","GA","70893","HIOS","7","2015-11-14 04:47:21","3","70893","GA","Individual","No","36-4802632","70893GA0030005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision + Adult Dental","70893GA003",,"GAN001","GAS001","GAF006","New","HMO","Bronze","No","Both","yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9127",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/formulary","70893GA0030005-03","Limited Cost Sharing Plan Variation",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/70893GA0030005-03.pdf","https://api.centene.com/Brochures/2016/70893GA0030005-03.pdf","32"
"2016","GA","73231","HIOS","2","2015-07-07 02:38:10","1","73231","GA","Individual","Yes","47-0397286","73231GA0020001","Delta Dental Individual PPO, EHB Certified","73231GA002",,"GAN002","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,"Guaranteed Rate",,,"$28.81","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","73231GA0020001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","73231","HIOS","2","2015-07-07 02:38:10","1","73231","GA","SHOP (Small Group)","Yes","47-0397286","73231GA0040001","Renaissance Group Dental PPO, EHB Certified","73231GA004",,"GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.84","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","73231GA0040001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","73231","HIOS","2","2015-07-07 02:38:10","1","73231","GA","SHOP (Small Group)","Yes","47-0397286","73231GA0040002","Renaissance Group Dental PPO, EHB Certified","73231GA004",,"GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.86","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","73231GA0040002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","GA","73231","HIOS","2","2015-07-07 02:38:10","1","73231","GA","Individual","Yes","47-0397286","73231GA0020002","Delta Dental Individual PPO, EHB Certified","73231GA002",,"GAN002","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,"Guaranteed Rate",,,"$24.31","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","73231GA0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","GA","73231","HIOS","2","2015-07-07 02:38:10","1","73231","GA","Individual","Yes","47-0397286","73231GA0030001","Renaissance Individual Dental PPO, EHB Certified","73231GA003",,"GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.38","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","73231GA0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","GA","73231","HIOS","2","2015-07-07 02:38:10","1","73231","GA","SHOP (Small Group)","Yes","47-0397286","73231GA0090001","Renaissance Group Dental PPO, EHB Certified (Exchange)","73231GA009",,"GAN001","GAS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","73231GA0090001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/GA_EHB_Group_High_2016","http://www.renaissancedental.com/GA_EHB_Group_High_2016","6"
"2016","GA","73231","HIOS","2","2015-07-07 02:38:10","1","73231","GA","SHOP (Small Group)","Yes","47-0397286","73231GA0090002","Renaissance Group Dental PPO, EHB Certified (Exchange)","73231GA009",,"GAN001","GAS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","73231GA0090002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/GA_EHB_Group_Low_2016","http://www.renaissancedental.com/GA_EHB_Group_Low_2016","7"
"2016","GA","73231","HIOS","2","2015-07-07 02:38:10","1","73231","GA","Individual","Yes","47-0397286","73231GA0030002","Renaissance Individual Dental PPO, EHB Certified","73231GA003",,"GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.72","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","73231GA0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","GA","73231","HIOS","2","2015-07-07 02:38:10","1","73231","GA","Individual","Yes","47-0397286","73231GA0070001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","73231GA007",,"GAN001","GAS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.38","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/73231","","73231GA0070001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/GA_EHB_High_2016","http://www.renaissancedental.com/GA_EHB_High_2016","8"
"2016","GA","73231","HIOS","2","2015-07-07 02:38:10","1","73231","GA","SHOP (Small Group)","Yes","47-0397286","73231GA0090003","Renaissance Group Dental PPO, EHB Certified (Exchange)","73231GA009",,"GAN001","GAS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","73231GA0090003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/GA_50_50_High_2016","http://www.renaissancedental.com/GA_50_50_High_2016","8"
"2016","GA","73231","HIOS","2","2015-07-07 02:38:10","1","73231","GA","SHOP (Small Group)","Yes","47-0397286","73231GA0090004","Renaissance Group Dental PPO, EHB Certified (Exchange)","73231GA009",,"GAN001","GAS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","73231GA0090004-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/GA_50_50_Low_2016","http://www.renaissancedental.com/GA_50_50_Low_2016","9"
"2016","GA","73231","HIOS","2","2015-07-07 02:38:10","1","73231","GA","Individual","Yes","47-0397286","73231GA0070002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","73231GA007",,"GAN001","GAS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/73231","","73231GA0070002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/GA_EHB_Low_2016","http://www.renaissancedental.com/GA_EHB_Low_2016","9"
"2016","GA","73231","HIOS","2","2015-07-07 02:38:10","2","73231","GA","Individual","Yes","47-0397286","73231GA0060001","Renaissance Individual Dental Pediatric-Only, EHB Certified","73231GA006",,"GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$38.69","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","73231GA0060001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","73231","HIOS","2","2015-07-07 02:38:10","2","73231","GA","Individual","Yes","47-0397286","73231GA0060002","Renaissance Individual Dental Pediatric-Only, EHB Certified","73231GA006",,"GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$32.99","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","73231GA0060002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","GA","73231","HIOS","2","2015-07-07 02:38:10","2","73231","GA","Individual","Yes","47-0397286","73231GA0080001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","73231GA008",,"GAN001","GAS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$38.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/73231","","73231GA0080001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/GA_Ped_High_2016","http://www.renaissancedental.com/GA_Ped_High_2016","6"
"2016","GA","73231","HIOS","2","2015-07-07 02:38:10","2","73231","GA","Individual","Yes","47-0397286","73231GA0080002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","73231GA008",,"GAN001","GAS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$32.99","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/73231","","73231GA0080002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/GA_Ped_Low_2016","http://www.renaissancedental.com/GA_Ped_Low_2016","7"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100008","Coventry Silver $10 Copay 2750 HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF068","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100008-05","87% AV Level Silver Plan","86.26%",,"Yes","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51450","http://www.coventryone.com/GAon2016","64"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100008","Coventry Silver $10 Copay 2750 HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF068","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100008-06","94% AV Level Silver Plan","93.11%",,"Yes","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51451","http://www.coventryone.com/GAon2016","65"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100018","Coventry Silver $10 Copay 2750 HMO Columbus","82824GA010",,"GAN004","GAS004","GAF078","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100018-00","Standard Silver Off Exchange Plan","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51507","http://www.coventryone.com/GAon2016","66"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100018","Coventry Silver $10 Copay 2750 HMO Columbus","82824GA010",,"GAN004","GAS004","GAF078","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100018-01","Standard Silver On Exchange Plan","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51506","http://www.coventryone.com/GAon2016","67"
"2016","GA","78196","HIOS","2","2015-07-07 02:38:10","1","78196","GA","SHOP (Small Group)","Yes","93-0242990","78196GA0030002","EHB High Passive","78196GA003",,"GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.56","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","78196GA0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","GA","78196","HIOS","2","2015-07-07 02:38:10","1","78196","GA","SHOP (Small Group)","Yes","93-0242990","78196GA0030001","EHB Low Passive","78196GA003",,"GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.90","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","78196GA0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100029","Coventry Bronze $15 Copay HMO Albany","82824GA010",,"GAN006","GAS006","GAF089","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100029-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51577","http://www.coventryone.com/GAon2016","4"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100029","Coventry Bronze $15 Copay HMO Albany","82824GA010",,"GAN006","GAS006","GAF089","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100029-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51576","http://www.coventryone.com/GAon2016","5"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100029","Coventry Bronze $15 Copay HMO Albany","82824GA010",,"GAN006","GAS006","GAF089","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100029-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51580","http://www.coventryone.com/GAon2016","6"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100029","Coventry Bronze $15 Copay HMO Albany","82824GA010",,"GAN006","GAS006","GAF089","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100029-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51579","http://www.coventryone.com/GAon2016","7"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100009","Coventry Bronze $15 Copay HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF069","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100009-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51453","http://www.coventryone.com/GAon2016","8"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100009","Coventry Bronze $15 Copay HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF069","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100009-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51452","http://www.coventryone.com/GAon2016","9"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100009","Coventry Bronze $15 Copay HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF069","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100009-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51456","http://www.coventryone.com/GAon2016","10"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100009","Coventry Bronze $15 Copay HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF069","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100009-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51455","http://www.coventryone.com/GAon2016","11"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100019","Coventry Bronze $15 Copay HMO Columbus","82824GA010",,"GAN004","GAS004","GAF079","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100019-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51515","http://www.coventryone.com/GAon2016","12"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100019","Coventry Bronze $15 Copay HMO Columbus","82824GA010",,"GAN004","GAS004","GAF079","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100019-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51514","http://www.coventryone.com/GAon2016","13"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100019","Coventry Bronze $15 Copay HMO Columbus","82824GA010",,"GAN004","GAS004","GAF079","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100019-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51518","http://www.coventryone.com/GAon2016","14"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100019","Coventry Bronze $15 Copay HMO Columbus","82824GA010",,"GAN004","GAS004","GAF079","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100019-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51517","http://www.coventryone.com/GAon2016","15"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100004","Coventry Bronze $15 Copay HMO Hall","82824GA010",,"GAN003","GAS003","GAF064","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100004-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51422","http://www.coventryone.com/GAon2016","16"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100004","Coventry Bronze $15 Copay HMO Hall","82824GA010",,"GAN003","GAS003","GAF064","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100004-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51421","http://www.coventryone.com/GAon2016","17"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100004","Coventry Bronze $15 Copay HMO Hall","82824GA010",,"GAN003","GAS003","GAF064","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51425","http://www.coventryone.com/GAon2016","18"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100004","Coventry Bronze $15 Copay HMO Hall","82824GA010",,"GAN003","GAS003","GAF064","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100004-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51424","http://www.coventryone.com/GAon2016","19"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100014","Coventry Bronze $15 Copay HMO Savannah","82824GA010",,"GAN002","GAS002","GAF074","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100014-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51484","http://www.coventryone.com/GAon2016","20"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100014","Coventry Bronze $15 Copay HMO Savannah","82824GA010",,"GAN002","GAS002","GAF074","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100014-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51483","http://www.coventryone.com/GAon2016","21"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100014","Coventry Bronze $15 Copay HMO Savannah","82824GA010",,"GAN002","GAS002","GAF074","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100014-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51487","http://www.coventryone.com/GAon2016","22"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100014","Coventry Bronze $15 Copay HMO Savannah","82824GA010",,"GAN002","GAS002","GAF074","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100014-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51486","http://www.coventryone.com/GAon2016","23"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100024","Coventry Bronze $15 Copay HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF084","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100024-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51546","http://www.coventryone.com/GAon2016","24"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100024","Coventry Bronze $15 Copay HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF084","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100024-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51545","http://www.coventryone.com/GAon2016","25"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100024","Coventry Bronze $15 Copay HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF084","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100024-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51549","http://www.coventryone.com/GAon2016","26"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100024","Coventry Bronze $15 Copay HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF084","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100024-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51548","http://www.coventryone.com/GAon2016","27"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100030","Coventry Bronze Deductible Only HSA Eligible HMO Albany","82824GA010",,"GAN006","GAS006","GAF090","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100030-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51582","http://www.coventryone.com/GAon2016","28"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100030","Coventry Bronze Deductible Only HSA Eligible HMO Albany","82824GA010",,"GAN006","GAS006","GAF090","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100030-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51581","http://www.coventryone.com/GAon2016","29"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100030","Coventry Bronze Deductible Only HSA Eligible HMO Albany","82824GA010",,"GAN006","GAS006","GAF090","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100030-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51585","http://www.coventryone.com/GAon2016","30"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100030","Coventry Bronze Deductible Only HSA Eligible HMO Albany","82824GA010",,"GAN006","GAS006","GAF090","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100030-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51584","http://www.coventryone.com/GAon2016","31"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100010","Coventry Bronze Deductible Only HSA Eligible HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF070","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100010-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51458","http://www.coventryone.com/GAon2016","32"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100010","Coventry Bronze Deductible Only HSA Eligible HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF070","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100010-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51457","http://www.coventryone.com/GAon2016","33"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100010","Coventry Bronze Deductible Only HSA Eligible HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF070","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100010-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51461","http://www.coventryone.com/GAon2016","34"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100010","Coventry Bronze Deductible Only HSA Eligible HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF070","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100010-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51460","http://www.coventryone.com/GAon2016","35"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100020","Coventry Bronze Deductible Only HSA Eligible HMO Columbus","82824GA010",,"GAN004","GAS004","GAF080","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100020-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51520","http://www.coventryone.com/GAon2016","36"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100020","Coventry Bronze Deductible Only HSA Eligible HMO Columbus","82824GA010",,"GAN004","GAS004","GAF080","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100020-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51519","http://www.coventryone.com/GAon2016","37"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100020","Coventry Bronze Deductible Only HSA Eligible HMO Columbus","82824GA010",,"GAN004","GAS004","GAF080","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100020-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51523","http://www.coventryone.com/GAon2016","38"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100020","Coventry Bronze Deductible Only HSA Eligible HMO Columbus","82824GA010",,"GAN004","GAS004","GAF080","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100020-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51522","http://www.coventryone.com/GAon2016","39"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100005","Coventry Bronze Deductible Only HSA Eligible HMO Hall","82824GA010",,"GAN003","GAS003","GAF065","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100005-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51427","http://www.coventryone.com/GAon2016","40"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100005","Coventry Bronze Deductible Only HSA Eligible HMO Hall","82824GA010",,"GAN003","GAS003","GAF065","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100005-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51426","http://www.coventryone.com/GAon2016","41"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100005","Coventry Bronze Deductible Only HSA Eligible HMO Hall","82824GA010",,"GAN003","GAS003","GAF065","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51430","http://www.coventryone.com/GAon2016","42"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100005","Coventry Bronze Deductible Only HSA Eligible HMO Hall","82824GA010",,"GAN003","GAS003","GAF065","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100005-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51429","http://www.coventryone.com/GAon2016","43"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100015","Coventry Bronze Deductible Only HSA Eligible HMO Savannah","82824GA010",,"GAN002","GAS002","GAF075","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100015-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51489","http://www.coventryone.com/GAon2016","44"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100015","Coventry Bronze Deductible Only HSA Eligible HMO Savannah","82824GA010",,"GAN002","GAS002","GAF075","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100015-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51488","http://www.coventryone.com/GAon2016","45"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100015","Coventry Bronze Deductible Only HSA Eligible HMO Savannah","82824GA010",,"GAN002","GAS002","GAF075","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100015-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51492","http://www.coventryone.com/GAon2016","46"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100015","Coventry Bronze Deductible Only HSA Eligible HMO Savannah","82824GA010",,"GAN002","GAS002","GAF075","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100015-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51491","http://www.coventryone.com/GAon2016","47"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100025","Coventry Bronze Deductible Only HSA Eligible HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF085","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100025-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51551","http://www.coventryone.com/GAon2016","48"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100025","Coventry Bronze Deductible Only HSA Eligible HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF085","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100025-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51550","http://www.coventryone.com/GAon2016","49"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100025","Coventry Bronze Deductible Only HSA Eligible HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF085","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100025-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51554","http://www.coventryone.com/GAon2016","50"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100025","Coventry Bronze Deductible Only HSA Eligible HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF085","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100025-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51553","http://www.coventryone.com/GAon2016","51"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100028","Coventry Silver $10 Copay 2750 HMO Albany","82824GA010",,"GAN006","GAS006","GAF088","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100028-00","Standard Silver Off Exchange Plan","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51569","http://www.coventryone.com/GAon2016","52"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100028","Coventry Silver $10 Copay 2750 HMO Albany","82824GA010",,"GAN006","GAS006","GAF088","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100028-01","Standard Silver On Exchange Plan","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51568","http://www.coventryone.com/GAon2016","53"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100028","Coventry Silver $10 Copay 2750 HMO Albany","82824GA010",,"GAN006","GAS006","GAF088","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100028-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51572","http://www.coventryone.com/GAon2016","54"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100028","Coventry Silver $10 Copay 2750 HMO Albany","82824GA010",,"GAN006","GAS006","GAF088","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100028-03","Limited Cost Sharing Plan Variation","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51571","http://www.coventryone.com/GAon2016","55"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100028","Coventry Silver $10 Copay 2750 HMO Albany","82824GA010",,"GAN006","GAS006","GAF088","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100028-04","73% AV Level Silver Plan","72.09%",,"Yes","Yes","No","100%",,"$2,500","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51573","http://www.coventryone.com/GAon2016","56"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100028","Coventry Silver $10 Copay 2750 HMO Albany","82824GA010",,"GAN006","GAS006","GAF088","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100028-05","87% AV Level Silver Plan","86.26%",,"Yes","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51574","http://www.coventryone.com/GAon2016","57"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100028","Coventry Silver $10 Copay 2750 HMO Albany","82824GA010",,"GAN006","GAS006","GAF088","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100028-06","94% AV Level Silver Plan","93.11%",,"Yes","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51575","http://www.coventryone.com/GAon2016","58"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100008","Coventry Silver $10 Copay 2750 HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF068","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100008-00","Standard Silver Off Exchange Plan","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51445","http://www.coventryone.com/GAon2016","59"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100008","Coventry Silver $10 Copay 2750 HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF068","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100008-01","Standard Silver On Exchange Plan","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51444","http://www.coventryone.com/GAon2016","60"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100008","Coventry Silver $10 Copay 2750 HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF068","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100008-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51448","http://www.coventryone.com/GAon2016","61"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100008","Coventry Silver $10 Copay 2750 HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF068","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100008-03","Limited Cost Sharing Plan Variation","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51447","http://www.coventryone.com/GAon2016","62"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100008","Coventry Silver $10 Copay 2750 HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF068","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100008-04","73% AV Level Silver Plan","72.09%",,"Yes","Yes","No","100%",,"$2,500","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51449","http://www.coventryone.com/GAon2016","63"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100018","Coventry Silver $10 Copay 2750 HMO Columbus","82824GA010",,"GAN004","GAS004","GAF078","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100018-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51510","http://www.coventryone.com/GAon2016","68"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100018","Coventry Silver $10 Copay 2750 HMO Columbus","82824GA010",,"GAN004","GAS004","GAF078","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100018-03","Limited Cost Sharing Plan Variation","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51509","http://www.coventryone.com/GAon2016","69"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100018","Coventry Silver $10 Copay 2750 HMO Columbus","82824GA010",,"GAN004","GAS004","GAF078","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100018-04","73% AV Level Silver Plan","72.09%",,"Yes","Yes","No","100%",,"$2,500","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51511","http://www.coventryone.com/GAon2016","70"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100018","Coventry Silver $10 Copay 2750 HMO Columbus","82824GA010",,"GAN004","GAS004","GAF078","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100018-05","87% AV Level Silver Plan","86.26%",,"Yes","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51512","http://www.coventryone.com/GAon2016","71"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100018","Coventry Silver $10 Copay 2750 HMO Columbus","82824GA010",,"GAN004","GAS004","GAF078","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100018-06","94% AV Level Silver Plan","93.11%",,"Yes","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51513","http://www.coventryone.com/GAon2016","72"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100003","Coventry Silver $10 Copay 2750 HMO Hall","82824GA010",,"GAN003","GAS003","GAF063","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100003-00","Standard Silver Off Exchange Plan","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51414","http://www.coventryone.com/GAon2016","73"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100003","Coventry Silver $10 Copay 2750 HMO Hall","82824GA010",,"GAN003","GAS003","GAF063","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100003-01","Standard Silver On Exchange Plan","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51413","http://www.coventryone.com/GAon2016","74"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100003","Coventry Silver $10 Copay 2750 HMO Hall","82824GA010",,"GAN003","GAS003","GAF063","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51417","http://www.coventryone.com/GAon2016","75"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100003","Coventry Silver $10 Copay 2750 HMO Hall","82824GA010",,"GAN003","GAS003","GAF063","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100003-03","Limited Cost Sharing Plan Variation","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51416","http://www.coventryone.com/GAon2016","76"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100003","Coventry Silver $10 Copay 2750 HMO Hall","82824GA010",,"GAN003","GAS003","GAF063","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100003-04","73% AV Level Silver Plan","72.09%",,"Yes","Yes","No","100%",,"$2,500","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51418","http://www.coventryone.com/GAon2016","77"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100003","Coventry Silver $10 Copay 2750 HMO Hall","82824GA010",,"GAN003","GAS003","GAF063","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100003-05","87% AV Level Silver Plan","86.26%",,"Yes","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51419","http://www.coventryone.com/GAon2016","78"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100003","Coventry Silver $10 Copay 2750 HMO Hall","82824GA010",,"GAN003","GAS003","GAF063","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100003-06","94% AV Level Silver Plan","93.11%",,"Yes","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51420","http://www.coventryone.com/GAon2016","79"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100013","Coventry Silver $10 Copay 2750 HMO Savannah","82824GA010",,"GAN002","GAS002","GAF073","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100013-00","Standard Silver Off Exchange Plan","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51476","http://www.coventryone.com/GAon2016","80"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100013","Coventry Silver $10 Copay 2750 HMO Savannah","82824GA010",,"GAN002","GAS002","GAF073","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100013-01","Standard Silver On Exchange Plan","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51475","http://www.coventryone.com/GAon2016","81"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100013","Coventry Silver $10 Copay 2750 HMO Savannah","82824GA010",,"GAN002","GAS002","GAF073","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100013-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51479","http://www.coventryone.com/GAon2016","82"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100013","Coventry Silver $10 Copay 2750 HMO Savannah","82824GA010",,"GAN002","GAS002","GAF073","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100013-03","Limited Cost Sharing Plan Variation","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51478","http://www.coventryone.com/GAon2016","83"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100013","Coventry Silver $10 Copay 2750 HMO Savannah","82824GA010",,"GAN002","GAS002","GAF073","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100013-04","73% AV Level Silver Plan","72.09%",,"Yes","Yes","No","100%",,"$2,500","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51480","http://www.coventryone.com/GAon2016","84"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100013","Coventry Silver $10 Copay 2750 HMO Savannah","82824GA010",,"GAN002","GAS002","GAF073","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100013-05","87% AV Level Silver Plan","86.26%",,"Yes","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51481","http://www.coventryone.com/GAon2016","85"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100013","Coventry Silver $10 Copay 2750 HMO Savannah","82824GA010",,"GAN002","GAS002","GAF073","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100013-06","94% AV Level Silver Plan","93.11%",,"Yes","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51482","http://www.coventryone.com/GAon2016","86"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100023","Coventry Silver $10 Copay 2750 HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF083","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100023-00","Standard Silver Off Exchange Plan","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51538","http://www.coventryone.com/GAon2016","87"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100023","Coventry Silver $10 Copay 2750 HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF083","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100023-01","Standard Silver On Exchange Plan","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51537","http://www.coventryone.com/GAon2016","88"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100023","Coventry Silver $10 Copay 2750 HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF083","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100023-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51541","http://www.coventryone.com/GAon2016","89"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100023","Coventry Silver $10 Copay 2750 HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF083","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100023-03","Limited Cost Sharing Plan Variation","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51540","http://www.coventryone.com/GAon2016","90"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100023","Coventry Silver $10 Copay 2750 HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF083","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100023-04","73% AV Level Silver Plan","72.09%",,"Yes","Yes","No","100%",,"$2,500","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51542","http://www.coventryone.com/GAon2016","91"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100023","Coventry Silver $10 Copay 2750 HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF083","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100023-05","87% AV Level Silver Plan","86.26%",,"Yes","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51543","http://www.coventryone.com/GAon2016","92"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100023","Coventry Silver $10 Copay 2750 HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF083","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100023-06","94% AV Level Silver Plan","93.11%",,"Yes","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51544","http://www.coventryone.com/GAon2016","93"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100026","Coventry Gold $10 Copay HMO Albany","82824GA010",,"GAN006","GAS006","GAF086","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100026-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51556","http://www.coventryone.com/GAon2016","94"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100026","Coventry Gold $10 Copay HMO Albany","82824GA010",,"GAN006","GAS006","GAF086","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100026-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51555","http://www.coventryone.com/GAon2016","95"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100026","Coventry Gold $10 Copay HMO Albany","82824GA010",,"GAN006","GAS006","GAF086","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100026-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51558","http://www.coventryone.com/GAon2016","96"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100026","Coventry Gold $10 Copay HMO Albany","82824GA010",,"GAN006","GAS006","GAF086","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100026-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51559","http://www.coventryone.com/GAon2016","97"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100006","Coventry Gold $10 Copay HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF066","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100006-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51432","http://www.coventryone.com/GAon2016","98"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100006","Coventry Gold $10 Copay HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF066","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100006-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51431","http://www.coventryone.com/GAon2016","99"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100006","Coventry Gold $10 Copay HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF066","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100006-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51434","http://www.coventryone.com/GAon2016","100"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100006","Coventry Gold $10 Copay HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF066","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100006-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51435","http://www.coventryone.com/GAon2016","101"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100016","Coventry Gold $10 Copay HMO Columbus","82824GA010",,"GAN004","GAS004","GAF076","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100016-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51494","http://www.coventryone.com/GAon2016","102"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100016","Coventry Gold $10 Copay HMO Columbus","82824GA010",,"GAN004","GAS004","GAF076","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100016-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51493","http://www.coventryone.com/GAon2016","103"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100016","Coventry Gold $10 Copay HMO Columbus","82824GA010",,"GAN004","GAS004","GAF076","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100016-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51496","http://www.coventryone.com/GAon2016","104"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100016","Coventry Gold $10 Copay HMO Columbus","82824GA010",,"GAN004","GAS004","GAF076","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100016-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51497","http://www.coventryone.com/GAon2016","105"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100001","Coventry Gold $10 Copay HMO Hall","82824GA010",,"GAN003","GAS003","GAF061","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100001-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51401","http://www.coventryone.com/GAon2016","106"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100001","Coventry Gold $10 Copay HMO Hall","82824GA010",,"GAN003","GAS003","GAF061","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100001-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51400","http://www.coventryone.com/GAon2016","107"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100001","Coventry Gold $10 Copay HMO Hall","82824GA010",,"GAN003","GAS003","GAF061","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51403","http://www.coventryone.com/GAon2016","108"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100001","Coventry Gold $10 Copay HMO Hall","82824GA010",,"GAN003","GAS003","GAF061","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100001-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51404","http://www.coventryone.com/GAon2016","109"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100031","Coventry Gold $10 Copay HMO Macon","82824GA010",,"GAN008","GAS008","GAF091","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100031-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51587","http://www.coventryone.com/GAon2016","110"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100031","Coventry Gold $10 Copay HMO Macon","82824GA010",,"GAN008","GAS008","GAF091","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100031-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51586","http://www.coventryone.com/GAon2016","111"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100031","Coventry Gold $10 Copay HMO Macon","82824GA010",,"GAN008","GAS008","GAF091","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100031-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51589","http://www.coventryone.com/GAon2016","112"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100031","Coventry Gold $10 Copay HMO Macon","82824GA010",,"GAN008","GAS008","GAF091","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100031-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51590","http://www.coventryone.com/GAon2016","113"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100011","Coventry Gold $10 Copay HMO Savannah","82824GA010",,"GAN002","GAS002","GAF071","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100011-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51463","http://www.coventryone.com/GAon2016","114"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100011","Coventry Gold $10 Copay HMO Savannah","82824GA010",,"GAN002","GAS002","GAF071","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100011-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51462","http://www.coventryone.com/GAon2016","115"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100011","Coventry Gold $10 Copay HMO Savannah","82824GA010",,"GAN002","GAS002","GAF071","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100011-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51465","http://www.coventryone.com/GAon2016","116"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100011","Coventry Gold $10 Copay HMO Savannah","82824GA010",,"GAN002","GAS002","GAF071","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100011-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51466","http://www.coventryone.com/GAon2016","117"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100021","Coventry Gold $10 Copay HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF081","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100021-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51525","http://www.coventryone.com/GAon2016","118"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100021","Coventry Gold $10 Copay HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF081","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100021-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51524","http://www.coventryone.com/GAon2016","119"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100021","Coventry Gold $10 Copay HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF081","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100021-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51527","http://www.coventryone.com/GAon2016","120"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","5","82824","GA","Individual","No","58-1649568","82824GA0100021","Coventry Gold $10 Copay HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF081","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100021-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51528","http://www.coventryone.com/GAon2016","121"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100044","Coventry Bronze $15 Copay HMO Augusta","82824GA010",,"GAN009","GAS009","GAF104","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100044-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51670","http://www.coventryone.com/GAon2016","4"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100044","Coventry Bronze $15 Copay HMO Augusta","82824GA010",,"GAN009","GAS009","GAF104","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100044-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51669","http://www.coventryone.com/GAon2016","5"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100044","Coventry Bronze $15 Copay HMO Augusta","82824GA010",,"GAN009","GAS009","GAF104","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100044-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51673","http://www.coventryone.com/GAon2016","6"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100044","Coventry Bronze $15 Copay HMO Augusta","82824GA010",,"GAN009","GAS009","GAF104","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100044-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51672","http://www.coventryone.com/GAon2016","7"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100034","Coventry Bronze $15 Copay HMO Macon","82824GA010",,"GAN008","GAS008","GAF094","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100034-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51608","http://www.coventryone.com/GAon2016","8"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100034","Coventry Bronze $15 Copay HMO Macon","82824GA010",,"GAN008","GAS008","GAF094","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100034-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51607","http://www.coventryone.com/GAon2016","9"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100034","Coventry Bronze $15 Copay HMO Macon","82824GA010",,"GAN008","GAS008","GAF094","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100034-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51611","http://www.coventryone.com/GAon2016","10"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100034","Coventry Bronze $15 Copay HMO Macon","82824GA010",,"GAN008","GAS008","GAF094","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100034-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51610","http://www.coventryone.com/GAon2016","11"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100039","Coventry Bronze $15 Copay HMO SEGA","82824GA010",,"GAN007","GAS007","GAF099","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100039-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51639","http://www.coventryone.com/GAon2016","12"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100039","Coventry Bronze $15 Copay HMO SEGA","82824GA010",,"GAN007","GAS007","GAF099","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100039-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51638","http://www.coventryone.com/GAon2016","13"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100039","Coventry Bronze $15 Copay HMO SEGA","82824GA010",,"GAN007","GAS007","GAF099","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100039-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51642","http://www.coventryone.com/GAon2016","14"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100039","Coventry Bronze $15 Copay HMO SEGA","82824GA010",,"GAN007","GAS007","GAF099","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100039-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51641","http://www.coventryone.com/GAon2016","15"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100045","Coventry Bronze Deductible Only HSA Eligible HMO Augusta","82824GA010",,"GAN009","GAS009","GAF105","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100045-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51675","http://www.coventryone.com/GAon2016","16"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100045","Coventry Bronze Deductible Only HSA Eligible HMO Augusta","82824GA010",,"GAN009","GAS009","GAF105","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100045-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51674","http://www.coventryone.com/GAon2016","17"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100045","Coventry Bronze Deductible Only HSA Eligible HMO Augusta","82824GA010",,"GAN009","GAS009","GAF105","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100045-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51678","http://www.coventryone.com/GAon2016","18"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100045","Coventry Bronze Deductible Only HSA Eligible HMO Augusta","82824GA010",,"GAN009","GAS009","GAF105","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100045-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51677","http://www.coventryone.com/GAon2016","19"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100035","Coventry Bronze Deductible Only HSA Eligible HMO Macon","82824GA010",,"GAN008","GAS008","GAF095","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100035-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51613","http://www.coventryone.com/GAon2016","20"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100035","Coventry Bronze Deductible Only HSA Eligible HMO Macon","82824GA010",,"GAN008","GAS008","GAF095","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100035-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51612","http://www.coventryone.com/GAon2016","21"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100035","Coventry Bronze Deductible Only HSA Eligible HMO Macon","82824GA010",,"GAN008","GAS008","GAF095","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100035-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51616","http://www.coventryone.com/GAon2016","22"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100035","Coventry Bronze Deductible Only HSA Eligible HMO Macon","82824GA010",,"GAN008","GAS008","GAF095","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100035-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51615","http://www.coventryone.com/GAon2016","23"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100040","Coventry Bronze Deductible Only HSA Eligible HMO SEGA","82824GA010",,"GAN007","GAS007","GAF100","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100040-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51644","http://www.coventryone.com/GAon2016","24"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100040","Coventry Bronze Deductible Only HSA Eligible HMO SEGA","82824GA010",,"GAN007","GAS007","GAF100","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100040-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51643","http://www.coventryone.com/GAon2016","25"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100040","Coventry Bronze Deductible Only HSA Eligible HMO SEGA","82824GA010",,"GAN007","GAS007","GAF100","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100040-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51647","http://www.coventryone.com/GAon2016","26"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100040","Coventry Bronze Deductible Only HSA Eligible HMO SEGA","82824GA010",,"GAN007","GAS007","GAF100","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100040-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/GA51646","http://www.coventryone.com/GAon2016","27"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100043","Coventry Silver $10 Copay 2750 HMO Augusta","82824GA010",,"GAN009","GAS009","GAF103","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100043-00","Standard Silver Off Exchange Plan","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51662","http://www.coventryone.com/GAon2016","28"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100043","Coventry Silver $10 Copay 2750 HMO Augusta","82824GA010",,"GAN009","GAS009","GAF103","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100043-01","Standard Silver On Exchange Plan","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51661","http://www.coventryone.com/GAon2016","29"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100043","Coventry Silver $10 Copay 2750 HMO Augusta","82824GA010",,"GAN009","GAS009","GAF103","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100043-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51665","http://www.coventryone.com/GAon2016","30"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100043","Coventry Silver $10 Copay 2750 HMO Augusta","82824GA010",,"GAN009","GAS009","GAF103","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100043-03","Limited Cost Sharing Plan Variation","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51664","http://www.coventryone.com/GAon2016","31"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100043","Coventry Silver $10 Copay 2750 HMO Augusta","82824GA010",,"GAN009","GAS009","GAF103","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100043-04","73% AV Level Silver Plan","72.09%",,"Yes","Yes","No","100%",,"$2,500","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51666","http://www.coventryone.com/GAon2016","32"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100043","Coventry Silver $10 Copay 2750 HMO Augusta","82824GA010",,"GAN009","GAS009","GAF103","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100043-05","87% AV Level Silver Plan","86.26%",,"Yes","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51667","http://www.coventryone.com/GAon2016","33"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100043","Coventry Silver $10 Copay 2750 HMO Augusta","82824GA010",,"GAN009","GAS009","GAF103","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100043-06","94% AV Level Silver Plan","93.11%",,"Yes","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51668","http://www.coventryone.com/GAon2016","34"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100033","Coventry Silver $10 Copay 2750 HMO Macon","82824GA010",,"GAN008","GAS008","GAF093","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100033-00","Standard Silver Off Exchange Plan","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51600","http://www.coventryone.com/GAon2016","35"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100033","Coventry Silver $10 Copay 2750 HMO Macon","82824GA010",,"GAN008","GAS008","GAF093","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100033-01","Standard Silver On Exchange Plan","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51599","http://www.coventryone.com/GAon2016","36"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100033","Coventry Silver $10 Copay 2750 HMO Macon","82824GA010",,"GAN008","GAS008","GAF093","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100033-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51603","http://www.coventryone.com/GAon2016","37"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100033","Coventry Silver $10 Copay 2750 HMO Macon","82824GA010",,"GAN008","GAS008","GAF093","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100033-03","Limited Cost Sharing Plan Variation","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51602","http://www.coventryone.com/GAon2016","38"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100033","Coventry Silver $10 Copay 2750 HMO Macon","82824GA010",,"GAN008","GAS008","GAF093","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100033-04","73% AV Level Silver Plan","72.09%",,"Yes","Yes","No","100%",,"$2,500","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51604","http://www.coventryone.com/GAon2016","39"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100033","Coventry Silver $10 Copay 2750 HMO Macon","82824GA010",,"GAN008","GAS008","GAF093","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100033-05","87% AV Level Silver Plan","86.26%",,"Yes","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51605","http://www.coventryone.com/GAon2016","40"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100033","Coventry Silver $10 Copay 2750 HMO Macon","82824GA010",,"GAN008","GAS008","GAF093","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100033-06","94% AV Level Silver Plan","93.11%",,"Yes","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51606","http://www.coventryone.com/GAon2016","41"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100038","Coventry Silver $10 Copay 2750 HMO SEGA","82824GA010",,"GAN007","GAS007","GAF098","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100038-00","Standard Silver Off Exchange Plan","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51631","http://www.coventryone.com/GAon2016","42"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100038","Coventry Silver $10 Copay 2750 HMO SEGA","82824GA010",,"GAN007","GAS007","GAF098","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100038-01","Standard Silver On Exchange Plan","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51630","http://www.coventryone.com/GAon2016","43"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100038","Coventry Silver $10 Copay 2750 HMO SEGA","82824GA010",,"GAN007","GAS007","GAF098","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100038-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51634","http://www.coventryone.com/GAon2016","44"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100038","Coventry Silver $10 Copay 2750 HMO SEGA","82824GA010",,"GAN007","GAS007","GAF098","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100038-03","Limited Cost Sharing Plan Variation","68.07%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51633","http://www.coventryone.com/GAon2016","45"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100038","Coventry Silver $10 Copay 2750 HMO SEGA","82824GA010",,"GAN007","GAS007","GAF098","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100038-04","73% AV Level Silver Plan","72.09%",,"Yes","Yes","No","100%",,"$2,500","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51635","http://www.coventryone.com/GAon2016","46"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100038","Coventry Silver $10 Copay 2750 HMO SEGA","82824GA010",,"GAN007","GAS007","GAF098","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100038-05","87% AV Level Silver Plan","86.26%",,"Yes","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51636","http://www.coventryone.com/GAon2016","47"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100038","Coventry Silver $10 Copay 2750 HMO SEGA","82824GA010",,"GAN007","GAS007","GAF098","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100038-06","94% AV Level Silver Plan","93.11%",,"Yes","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51637","http://www.coventryone.com/GAon2016","48"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100041","Coventry Gold $10 Copay HMO Augusta","82824GA010",,"GAN009","GAS009","GAF101","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100041-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51649","http://www.coventryone.com/GAon2016","49"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100041","Coventry Gold $10 Copay HMO Augusta","82824GA010",,"GAN009","GAS009","GAF101","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100041-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51648","http://www.coventryone.com/GAon2016","50"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100041","Coventry Gold $10 Copay HMO Augusta","82824GA010",,"GAN009","GAS009","GAF101","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100041-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51651","http://www.coventryone.com/GAon2016","51"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100041","Coventry Gold $10 Copay HMO Augusta","82824GA010",,"GAN009","GAS009","GAF101","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100041-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51652","http://www.coventryone.com/GAon2016","52"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100036","Coventry Gold $10 Copay HMO SEGA","82824GA010",,"GAN007","GAS007","GAF096","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100036-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51618","http://www.coventryone.com/GAon2016","53"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100036","Coventry Gold $10 Copay HMO SEGA","82824GA010",,"GAN007","GAS007","GAF096","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100036-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51617","http://www.coventryone.com/GAon2016","54"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100036","Coventry Gold $10 Copay HMO SEGA","82824GA010",,"GAN007","GAS007","GAF096","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100036-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51620","http://www.coventryone.com/GAon2016","55"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","6","82824","GA","Individual","No","58-1649568","82824GA0100036","Coventry Gold $10 Copay HMO SEGA","82824GA010",,"GAN007","GAS007","GAF096","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100036-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51621","http://www.coventryone.com/GAon2016","56"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100027","Coventry Silver $10 Copay HMO Albany","82824GA010",,"GAN006","GAS006","GAF087","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100027-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51561","http://www.coventryone.com/GAon2016","4"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100027","Coventry Silver $10 Copay HMO Albany","82824GA010",,"GAN006","GAS006","GAF087","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100027-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51560","http://www.coventryone.com/GAon2016","5"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100027","Coventry Silver $10 Copay HMO Albany","82824GA010",,"GAN006","GAS006","GAF087","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100027-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51564","http://www.coventryone.com/GAon2016","6"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100027","Coventry Silver $10 Copay HMO Albany","82824GA010",,"GAN006","GAS006","GAF087","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100027-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51563","http://www.coventryone.com/GAon2016","7"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100027","Coventry Silver $10 Copay HMO Albany","82824GA010",,"GAN006","GAS006","GAF087","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100027-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51565","http://www.coventryone.com/GAon2016","8"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100027","Coventry Silver $10 Copay HMO Albany","82824GA010",,"GAN006","GAS006","GAF087","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100027-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51566","http://www.coventryone.com/GAon2016","9"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100027","Coventry Silver $10 Copay HMO Albany","82824GA010",,"GAN006","GAS006","GAF087","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100027-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51567","http://www.coventryone.com/GAon2016","10"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100007","Coventry Silver $10 Copay HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF067","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100007-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51437","http://www.coventryone.com/GAon2016","11"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100007","Coventry Silver $10 Copay HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF067","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100007-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51436","http://www.coventryone.com/GAon2016","12"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100007","Coventry Silver $10 Copay HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF067","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51440","http://www.coventryone.com/GAon2016","13"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100007","Coventry Silver $10 Copay HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF067","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100007-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51439","http://www.coventryone.com/GAon2016","14"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100007","Coventry Silver $10 Copay HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF067","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100007-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51441","http://www.coventryone.com/GAon2016","15"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100007","Coventry Silver $10 Copay HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF067","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100007-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51442","http://www.coventryone.com/GAon2016","16"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100007","Coventry Silver $10 Copay HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF067","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100007-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51443","http://www.coventryone.com/GAon2016","17"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100042","Coventry Silver $10 Copay HMO Augusta","82824GA010",,"GAN009","GAS009","GAF102","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100042-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51654","http://www.coventryone.com/GAon2016","18"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100042","Coventry Silver $10 Copay HMO Augusta","82824GA010",,"GAN009","GAS009","GAF102","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100042-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51653","http://www.coventryone.com/GAon2016","19"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100042","Coventry Silver $10 Copay HMO Augusta","82824GA010",,"GAN009","GAS009","GAF102","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100042-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51657","http://www.coventryone.com/GAon2016","20"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100042","Coventry Silver $10 Copay HMO Augusta","82824GA010",,"GAN009","GAS009","GAF102","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100042-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51656","http://www.coventryone.com/GAon2016","21"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100042","Coventry Silver $10 Copay HMO Augusta","82824GA010",,"GAN009","GAS009","GAF102","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100042-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51658","http://www.coventryone.com/GAon2016","22"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100042","Coventry Silver $10 Copay HMO Augusta","82824GA010",,"GAN009","GAS009","GAF102","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100042-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51659","http://www.coventryone.com/GAon2016","23"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100042","Coventry Silver $10 Copay HMO Augusta","82824GA010",,"GAN009","GAS009","GAF102","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100042-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51660","http://www.coventryone.com/GAon2016","24"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100017","Coventry Silver $10 Copay HMO Columbus","82824GA010",,"GAN004","GAS004","GAF077","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100017-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51499","http://www.coventryone.com/GAon2016","25"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100017","Coventry Silver $10 Copay HMO Columbus","82824GA010",,"GAN004","GAS004","GAF077","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100017-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51498","http://www.coventryone.com/GAon2016","26"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100017","Coventry Silver $10 Copay HMO Columbus","82824GA010",,"GAN004","GAS004","GAF077","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100017-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51502","http://www.coventryone.com/GAon2016","27"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100017","Coventry Silver $10 Copay HMO Columbus","82824GA010",,"GAN004","GAS004","GAF077","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100017-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51501","http://www.coventryone.com/GAon2016","28"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100017","Coventry Silver $10 Copay HMO Columbus","82824GA010",,"GAN004","GAS004","GAF077","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100017-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51503","http://www.coventryone.com/GAon2016","29"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100017","Coventry Silver $10 Copay HMO Columbus","82824GA010",,"GAN004","GAS004","GAF077","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100017-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51504","http://www.coventryone.com/GAon2016","30"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100017","Coventry Silver $10 Copay HMO Columbus","82824GA010",,"GAN004","GAS004","GAF077","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100017-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51505","http://www.coventryone.com/GAon2016","31"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100002","Coventry Silver $10 Copay HMO Hall","82824GA010",,"GAN003","GAS003","GAF062","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100002-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51406","http://www.coventryone.com/GAon2016","32"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100002","Coventry Silver $10 Copay HMO Hall","82824GA010",,"GAN003","GAS003","GAF062","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100002-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51405","http://www.coventryone.com/GAon2016","33"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100002","Coventry Silver $10 Copay HMO Hall","82824GA010",,"GAN003","GAS003","GAF062","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51409","http://www.coventryone.com/GAon2016","34"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100002","Coventry Silver $10 Copay HMO Hall","82824GA010",,"GAN003","GAS003","GAF062","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100002-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51408","http://www.coventryone.com/GAon2016","35"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100002","Coventry Silver $10 Copay HMO Hall","82824GA010",,"GAN003","GAS003","GAF062","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100002-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51410","http://www.coventryone.com/GAon2016","36"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100002","Coventry Silver $10 Copay HMO Hall","82824GA010",,"GAN003","GAS003","GAF062","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100002-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51411","http://www.coventryone.com/GAon2016","37"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100002","Coventry Silver $10 Copay HMO Hall","82824GA010",,"GAN003","GAS003","GAF062","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100002-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51412","http://www.coventryone.com/GAon2016","38"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100032","Coventry Silver $10 Copay HMO Macon","82824GA010",,"GAN008","GAS008","GAF092","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100032-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51592","http://www.coventryone.com/GAon2016","39"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100032","Coventry Silver $10 Copay HMO Macon","82824GA010",,"GAN008","GAS008","GAF092","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100032-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51591","http://www.coventryone.com/GAon2016","40"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100032","Coventry Silver $10 Copay HMO Macon","82824GA010",,"GAN008","GAS008","GAF092","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100032-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51595","http://www.coventryone.com/GAon2016","41"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100032","Coventry Silver $10 Copay HMO Macon","82824GA010",,"GAN008","GAS008","GAF092","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100032-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51594","http://www.coventryone.com/GAon2016","42"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100032","Coventry Silver $10 Copay HMO Macon","82824GA010",,"GAN008","GAS008","GAF092","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100032-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51596","http://www.coventryone.com/GAon2016","43"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100032","Coventry Silver $10 Copay HMO Macon","82824GA010",,"GAN008","GAS008","GAF092","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100032-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51597","http://www.coventryone.com/GAon2016","44"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100032","Coventry Silver $10 Copay HMO Macon","82824GA010",,"GAN008","GAS008","GAF092","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100032-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51598","http://www.coventryone.com/GAon2016","45"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100012","Coventry Silver $10 Copay HMO Savannah","82824GA010",,"GAN002","GAS002","GAF072","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100012-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51468","http://www.coventryone.com/GAon2016","46"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100012","Coventry Silver $10 Copay HMO Savannah","82824GA010",,"GAN002","GAS002","GAF072","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100012-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51467","http://www.coventryone.com/GAon2016","47"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100012","Coventry Silver $10 Copay HMO Savannah","82824GA010",,"GAN002","GAS002","GAF072","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100012-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51471","http://www.coventryone.com/GAon2016","48"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100012","Coventry Silver $10 Copay HMO Savannah","82824GA010",,"GAN002","GAS002","GAF072","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100012-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51470","http://www.coventryone.com/GAon2016","49"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100012","Coventry Silver $10 Copay HMO Savannah","82824GA010",,"GAN002","GAS002","GAF072","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100012-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51472","http://www.coventryone.com/GAon2016","50"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100012","Coventry Silver $10 Copay HMO Savannah","82824GA010",,"GAN002","GAS002","GAF072","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100012-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51473","http://www.coventryone.com/GAon2016","51"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100012","Coventry Silver $10 Copay HMO Savannah","82824GA010",,"GAN002","GAS002","GAF072","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100012-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51474","http://www.coventryone.com/GAon2016","52"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100037","Coventry Silver $10 Copay HMO SEGA","82824GA010",,"GAN007","GAS007","GAF097","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100037-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51623","http://www.coventryone.com/GAon2016","53"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100037","Coventry Silver $10 Copay HMO SEGA","82824GA010",,"GAN007","GAS007","GAF097","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100037-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51622","http://www.coventryone.com/GAon2016","54"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100037","Coventry Silver $10 Copay HMO SEGA","82824GA010",,"GAN007","GAS007","GAF097","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100037-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51626","http://www.coventryone.com/GAon2016","55"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100037","Coventry Silver $10 Copay HMO SEGA","82824GA010",,"GAN007","GAS007","GAF097","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100037-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51625","http://www.coventryone.com/GAon2016","56"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100037","Coventry Silver $10 Copay HMO SEGA","82824GA010",,"GAN007","GAS007","GAF097","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100037-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51627","http://www.coventryone.com/GAon2016","57"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100037","Coventry Silver $10 Copay HMO SEGA","82824GA010",,"GAN007","GAS007","GAF097","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100037-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51628","http://www.coventryone.com/GAon2016","58"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100037","Coventry Silver $10 Copay HMO SEGA","82824GA010",,"GAN007","GAS007","GAF097","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100037-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51629","http://www.coventryone.com/GAon2016","59"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100022","Coventry Silver $10 Copay HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF082","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100022-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51530","http://www.coventryone.com/GAon2016","60"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100022","Coventry Silver $10 Copay HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF082","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100022-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51529","http://www.coventryone.com/GAon2016","61"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100022","Coventry Silver $10 Copay HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF082","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100022-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51533","http://www.coventryone.com/GAon2016","62"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100022","Coventry Silver $10 Copay HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF082","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100022-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51532","http://www.coventryone.com/GAon2016","63"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100022","Coventry Silver $10 Copay HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF082","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100022-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51534","http://www.coventryone.com/GAon2016","64"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100022","Coventry Silver $10 Copay HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF082","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100022-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51535","http://www.coventryone.com/GAon2016","65"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","7","82824","GA","Individual","No","58-1649568","82824GA0100022","Coventry Silver $10 Copay HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF082","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8450062277","82824GA0100022-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/GA51536","http://www.coventryone.com/GAon2016","66"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","8","82824","GA","Individual","No","58-1649568","82824GA0100049","Coventry Catastrophic HMO Albany","82824GA010",,"GAN006","GAS006","GAF109","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100049-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51695","http://www.coventryone.com/GAon2016","4"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","8","82824","GA","Individual","No","58-1649568","82824GA0100049","Coventry Catastrophic HMO Albany","82824GA010",,"GAN006","GAS006","GAF109","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100049-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51694","http://www.coventryone.com/GAon2016","5"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","8","82824","GA","Individual","No","58-1649568","82824GA0100053","Coventry Catastrophic HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF113","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100053-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA72089","http://www.coventryone.com/GAon2016","6"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","8","82824","GA","Individual","No","58-1649568","82824GA0100053","Coventry Catastrophic HMO Atlanta","82824GA010",,"GAN001","GAS001","GAF113","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100053-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA72088","http://www.coventryone.com/GAon2016","7"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","8","82824","GA","Individual","No","58-1649568","82824GA0100046","Coventry Catastrophic HMO Augusta","82824GA010",,"GAN009","GAS009","GAF106","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100046-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51686","http://www.coventryone.com/GAon2016","8"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","8","82824","GA","Individual","No","58-1649568","82824GA0100046","Coventry Catastrophic HMO Augusta","82824GA010",,"GAN009","GAS009","GAF106","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100046-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51685","http://www.coventryone.com/GAon2016","9"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","8","82824","GA","Individual","No","58-1649568","82824GA0100051","Coventry Catastrophic HMO Columbus","82824GA010",,"GAN004","GAS004","GAF111","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100051-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA72083","http://www.coventryone.com/GAon2016","10"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","8","82824","GA","Individual","No","58-1649568","82824GA0100051","Coventry Catastrophic HMO Columbus","82824GA010",,"GAN004","GAS004","GAF111","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100051-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA72082","http://www.coventryone.com/GAon2016","11"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","8","82824","GA","Individual","No","58-1649568","82824GA0100054","Coventry Catastrophic HMO Hall","82824GA010",,"GAN003","GAS003","GAF114","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100054-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA72092","http://www.coventryone.com/GAon2016","12"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","8","82824","GA","Individual","No","58-1649568","82824GA0100054","Coventry Catastrophic HMO Hall","82824GA010",,"GAN003","GAS003","GAF114","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100054-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA72091","http://www.coventryone.com/GAon2016","13"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","8","82824","GA","Individual","No","58-1649568","82824GA0100048","Coventry Catastrophic HMO Macon","82824GA010",,"GAN008","GAS008","GAF108","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100048-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51692","http://www.coventryone.com/GAon2016","14"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","8","82824","GA","Individual","No","58-1649568","82824GA0100048","Coventry Catastrophic HMO Macon","82824GA010",,"GAN008","GAS008","GAF108","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100048-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51691","http://www.coventryone.com/GAon2016","15"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","8","82824","GA","Individual","No","58-1649568","82824GA0100052","Coventry Catastrophic HMO Savannah","82824GA010",,"GAN002","GAS002","GAF112","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100052-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA72086","http://www.coventryone.com/GAon2016","16"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","8","82824","GA","Individual","No","58-1649568","82824GA0100052","Coventry Catastrophic HMO Savannah","82824GA010",,"GAN002","GAS002","GAF112","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100052-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA72085","http://www.coventryone.com/GAon2016","17"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","8","82824","GA","Individual","No","58-1649568","82824GA0100047","Coventry Catastrophic HMO SEGA","82824GA010",,"GAN007","GAS007","GAF107","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100047-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51689","http://www.coventryone.com/GAon2016","18"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","8","82824","GA","Individual","No","58-1649568","82824GA0100047","Coventry Catastrophic HMO SEGA","82824GA010",,"GAN007","GAS007","GAF107","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100047-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51688","http://www.coventryone.com/GAon2016","19"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","8","82824","GA","Individual","No","58-1649568","82824GA0100050","Coventry Catastrophic HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF110","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100050-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51698","http://www.coventryone.com/GAon2016","20"
"2016","GA","82824","HIOS","8","2015-10-18 12:35:12","8","82824","GA","Individual","No","58-1649568","82824GA0100050","Coventry Catastrophic HMO Valdosta","82824GA010",,"GAN005","GAS005","GAF110","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8452484563","82824GA0100050-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/GA51697","http://www.coventryone.com/GAon2016","21"
"2016","GA","83495","HIOS","2","2015-07-10 02:19:03","1","83495","GA","SHOP (Small Group)","Yes","42-0127290","83495GA0040001","Principal Plan Dental 70","83495GA004",,"GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,"Allows Adult and Child-Only",,,"$29.35","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","83495GA0040001-00","Standard Low Off Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","83495","HIOS","2","2015-07-10 02:19:03","1","83495","GA","SHOP (Small Group)","Yes","42-0127290","83495GA0040002","Principal Plan Dental 85","83495GA004",,"GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,"Allows Adult and Child-Only",,,"$30.88","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","83495GA0040002-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","GA","83502","HIOS","3","2015-08-27 11:14:25","1","83502","GA","Individual","Yes","95-6042390","83502GA0020003","BESTOne Advantage Gold","83502GA002",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.03","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/GA/2016/GA_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","GA","83502","HIOS","3","2015-08-27 11:14:25","1","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010007","BESTDental Premium","83502GA001",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.03","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/GA/2016/GA_BESTDental_Premium_Plan.pdf","4"
"2016","GA","83502","HIOS","3","2015-08-27 11:14:25","1","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010007","BESTDental Premium","83502GA001",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.03","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/GA/2016/GA_BESTDental_Premium_Plan.pdf","5"
"2016","GA","83502","HIOS","3","2015-08-27 11:14:25","1","83502","GA","Individual","Yes","95-6042390","83502GA0020003","BESTOne Advantage Gold","83502GA002",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.03","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/GA/2016/GA_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","GA","83502","HIOS","3","2015-08-27 11:14:25","1","83502","GA","Individual","Yes","95-6042390","83502GA0020004","BESTOne Plus Gold","83502GA002",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.03","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/GA/2016/GA_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","GA","83502","HIOS","3","2015-08-27 11:14:25","1","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010008","BESTDental Standard - H","83502GA001",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.03","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/GA/2016/GA_BESTDental_Standard-H_Plan.pdf","6"
"2016","GA","83502","HIOS","3","2015-08-27 11:14:25","1","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010008","BESTDental Standard - H","83502GA001",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.03","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/GA/2016/GA_BESTDental_Standard-H_Plan.pdf","7"
"2016","GA","83502","HIOS","3","2015-08-27 11:14:25","1","83502","GA","Individual","Yes","95-6042390","83502GA0020004","BESTOne Plus Gold","83502GA002",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.03","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/GA/2016/GA_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","GA","83502","HIOS","3","2015-08-27 11:14:25","1","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010010","BESTDental Choice - H","83502GA001",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.03","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/GA/2016/GA_BESTDental_Choice-H_Plan.pdf","8"
"2016","GA","83502","HIOS","3","2015-08-27 11:14:25","1","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010010","BESTDental Choice - H","83502GA001",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.03","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/GA/2016/GA_BESTDental_Choice-H_Plan.pdf","9"
"2016","GA","83502","HIOS","3","2015-08-27 11:14:25","2","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010009","BESTDental Standard - L","83502GA001",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.22","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/GA/2016/GA_BESTDental_Standard-L_Plan.pdf","4"
"2016","GA","83502","HIOS","3","2015-08-27 11:14:25","2","83502","GA","Individual","Yes","95-6042390","83502GA0020005","BESTOne Plus Silver","83502GA002",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.52","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/GA/2016/GA_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","GA","83502","HIOS","3","2015-08-27 11:14:25","2","83502","GA","Individual","Yes","95-6042390","83502GA0020005","BESTOne Plus Silver","83502GA002",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.52","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/GA/2016/GA_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","GA","83502","HIOS","3","2015-08-27 11:14:25","2","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010009","BESTDental Standard - L","83502GA001",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.22","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/GA/2016/GA_BESTDental_Standard-L_Plan.pdf","5"
"2016","GA","83502","HIOS","3","2015-08-27 11:14:25","2","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010011","BESTDental Choice - L","83502GA001",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.22","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/GA/2016/GA_BESTDental_Choice-L_Plan.pdf","6"
"2016","GA","83502","HIOS","3","2015-08-27 11:14:25","2","83502","GA","Individual","Yes","95-6042390","83502GA0020006","BESTOne Basic Silver","83502GA002",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.52","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/GA/2016/GA_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","GA","83502","HIOS","3","2015-08-27 11:14:25","2","83502","GA","Individual","Yes","95-6042390","83502GA0020006","BESTOne Basic Silver","83502GA002",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.52","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/GA/2016/GA_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","GA","83502","HIOS","3","2015-08-27 11:14:25","2","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010011","BESTDental Choice - L","83502GA001",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.22","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/GA/2016/GA_BESTDental_Choice-L_Plan.pdf","7"
"2016","GA","83502","HIOS","3","2015-08-27 11:14:25","2","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010012","BESTDental Value","83502GA001",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.22","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/GA/2016/GA_BESTDental_Value_Plan.pdf","8"
"2016","GA","83502","HIOS","3","2015-08-27 11:14:25","2","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010012","BESTDental Value","83502GA001",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.22","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83502GA0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/GA/2016/GA_BESTDental_Value_Plan.pdf","9"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040002","SoloCare - 0040002","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040002-00","Standard Gold Off Exchange Plan",,"0.809285938739777","Yes","Yes","No","100%",,"$1,500","$50","$400","$150","$1,500","$420","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$9,000","$9000 per person","$18000 per group","$15,850","$15850 per person","$31700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","0%",,,,,"$4,500","$4500 per person","$9000 per group","$6,000","$6000 per person","$12000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040002002016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","4"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050001","SimpleCare-0050001","83761GA005",,"GAN001","GAS001","GAF011","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050001-00","Standard Gold Off Exchange Plan",,"0.811014950275421","Yes","Yes","No","100%",,"$750","$25","$0","$3,000","$750","$25","$0","$3,000",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$4,500","$4500 per person","$9000 per group","$5,250","$5250 per person","$10500 per group","No","No",,"www.AlliantPlans.com","www.AlliantPlans.com","4"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050015","SimpleCare-0050015","83761GA005",,"GAN001","GAS001","GAF014","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050015-01","Standard Silver On Exchange Plan",,"0.717144370079041","Yes","Yes","No","100%",,"$4,500","$25","$0","$6,850","$4,500","$25","$0","$6,850",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$10,500","$10500 per person","$21000 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","33"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040017","SoloCare - 0040017","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040017-00","Standard Silver Off Exchange Plan",,"0.713385820388794","Yes","Yes","No","100%",,"$4,500","$60","$400","$150","$4,500","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","$19,500","$19500 per person","$39000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040017002016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","33"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040017","SoloCare - 0040017","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040017-01","Standard Silver On Exchange Plan",,"0.713385820388794","Yes","Yes","No","100%",,"$4,500","$60","$400","$150","$4,500","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","$19,500","$19500 per person","$39000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040017012016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","34"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040017","SoloCare - 0040017","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040017022016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","35"
"2016","GA","86637","HIOS","6","2015-08-23 12:37:12","1","86637","GA","Individual","Yes","94-2761537","86637GA0010002","Delta Dental PPO Pediatric Preferred Plan","86637GA001",,"GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.28","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0010002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0010002-16","4"
"2016","GA","86637","HIOS","6","2015-08-23 12:37:12","1","86637","GA","SHOP (Small Group)","Yes","94-2761537","86637GA0020002","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","86637GA002",,"GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.75","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0020002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0020002-16","4"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050001","SimpleCare-0050001","83761GA005",,"GAN001","GAS001","GAF011","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050001-01","Standard Gold On Exchange Plan",,"0.811014950275421","Yes","Yes","No","100%",,"$750","$25","$0","$3,000","$750","$25","$0","$3,000",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$4,500","$4500 per person","$9000 per group","$5,250","$5250 per person","$10500 per group","No","No",,"www.AlliantPlans.com","www.AlliantPlans.com","5"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040002","SoloCare - 0040002","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040002-01","Standard Gold On Exchange Plan",,"0.809285938739777","Yes","Yes","No","100%",,"$1,500","$50","$400","$150","$1,500","$420","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$9,000","$9000 per person","$18000 per group","$15,850","$15850 per person","$31700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","0%",,,,,"$4,500","$4500 per person","$9000 per group","$6,000","$6000 per person","$12000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040002012016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","5"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040002","SoloCare - 0040002","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","100%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040002022016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","6"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050002","SimpleCare-0050002","83761GA005",,"GAN001","GAS001","GAF012","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050002-00","Standard Gold Off Exchange Plan",,"0.781582236289978","Yes","Yes","No","100%",,"$2,600","$20","$0","$2,600","$2,600","$20","$0","$2,600",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"$9,000","$9000 per person","$18000 per group","$11,600","$11600 per person","$23200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","0%",,,,,"$4,500","$4500 per person","$9000 per group","$7,100","$7100 per person","$14200 per group","No","No",,"www.AlliantPlans.com","www.AlliantPlans.com","6"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040019","SoloCare - 0040019","83761GA004",,"GAN001","GAS001","GAF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040019-00","Standard Bronze Off Exchange Plan",,"0.617465436458588","Yes","Yes","No","100%",,"$5,900","$125","$200","$150","$5,900","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","50%",,,,,"$15,000","$15000 per person","$30000 per group","$21,200","$21200 per person","$42400 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040019002016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","40"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040019","SoloCare - 0040019","83761GA004",,"GAN001","GAS001","GAF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040019-01","Standard Bronze On Exchange Plan",,"0.617465436458588","Yes","Yes","No","100%",,"$5,900","$125","$200","$150","$5,900","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","50%",,,,,"$15,000","$15000 per person","$30000 per group","$21,200","$21200 per person","$42400 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040019012016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","41"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040019","SoloCare - 0040019","83761GA004",,"GAN001","GAS001","GAF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","100%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040019022016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","42"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040019","SoloCare - 0040019","83761GA004",,"GAN001","GAS001","GAF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040019-03","Limited Cost Sharing Plan Variation",,"0.617465436458588","Yes","Yes","No","100%",,"$5,900","$125","$200","$150","$5,900","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","50%",,,,,"$15,000","$15000 per person","$30000 per group","$21,200","$21200 per person","$42400 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040019032016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","43"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040021","SoloCare - 0040021","83761GA004",,"GAN001","GAS001","GAF020","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040021-00","Standard Bronze Off Exchange Plan",,"0.605760395526886","Yes","Yes","No","100%",,"$6,850","$0","$200","$150","$1,000","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","$21,850","$21850 per person","$43700 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040021002016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","44"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040021","SoloCare - 0040021","83761GA004",,"GAN001","GAS001","GAF020","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040021-01","Standard Bronze On Exchange Plan",,"0.605760395526886","Yes","Yes","No","100%",,"$6,850","$0","$200","$150","$1,000","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","$21,850","$21850 per person","$43700 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040021012016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","45"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","1","89942","GA","Individual","No","58-1592076","89942GA0050002","KP GA Gold 500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"3","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050002-00","Standard Gold Off Exchange Plan","80.76%","0.813755929470062","No","Yes","No","100%",,"$500","$2,000","$100","$200","$0","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20100_001_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","1","89942","GA","Individual","No","58-1592076","89942GA0050002","KP GA Gold 500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"3","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050002-01","Standard Gold On Exchange Plan","80.76%","0.813755929470062","No","Yes","No","100%",,"$500","$2,000","$100","$200","$0","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20100_001_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","5"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","4","89942","GA","Individual","No","58-1592076","89942GA0050004","KP GA Silver 1500/30","89942GA005",,"GAN001","GAS002","GAF002","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050004-05","87% AV Level Silver Plan","87.80%","0.878721177577972","No","Yes","No","100%",,"$0","$20","$900","$200","$0","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20200_081_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","9"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","7","89942","GA","Individual","No","58-1592076","89942GA0050007","KP GA Bronze 4000/20","89942GA005",,"GAN001","GAS002","GAF004","Existing","HMO","Bronze","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","3","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050007-01","Standard Bronze On Exchange Plan","61.51%","0.63105434179306","No","Yes","No","100%",,"$4,000","$20","$400","$200","$100","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20300_001_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","5"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050002","SimpleCare-0050002","83761GA005",,"GAN001","GAS001","GAF012","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050002-01","Standard Gold On Exchange Plan",,"0.781582236289978","Yes","Yes","No","100%",,"$2,600","$20","$0","$2,600","$2,600","$20","$0","$2,600",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group",,,,"$9,000","$9000 per person","$18000 per group","$11,600","$11600 per person","$23200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","0%",,,,,"$4,500","$4500 per person","$9000 per group","$7,100","$7100 per person","$14200 per group","No","No",,"www.AlliantPlans.com","www.AlliantPlans.com","7"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040002","SoloCare - 0040002","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040002-03","Limited Cost Sharing Plan Variation",,"0.809285938739777","Yes","Yes","No","100%",,"$1,500","$50","$400","$150","$1,500","$420","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$9,000","$9000 per person","$18000 per group","$15,850","$15850 per person","$31700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","0%",,,,,"$4,500","$4500 per person","$9000 per group","$6,000","$6000 per person","$12000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040002032016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","7"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040003","SoloCare - 0040003","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040003-00","Standard Gold Off Exchange Plan",,"0.782365322113037","Yes","Yes","No","100%",,"$1,000","$60","$400","$150","$1,000","$420","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$9,000","$9000 per person","$18000 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","$4,000","$4000 per person","$8000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040003002016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","8"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050003","SimpleCare-0050003","83761GA005",,"GAN001","GAS001","GAF003","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050003-00","Standard Gold Off Exchange Plan",,"0.803241848945618","Yes","Yes","No","100%",,"$1,000","$25","$0","$4,000","$1,000","$25","$0","$4,000",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,000","$13000 per person","$26000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"$4,500","$4500 per person","$9000 per group","$5,500","$5500 per person","$11000 per group","No","No",,"www.AlliantPlans.com","www.AlliantPlans.com","8"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050003","SimpleCare-0050003","83761GA005",,"GAN001","GAS001","GAF003","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050003-01","Standard Gold On Exchange Plan",,"0.803241848945618","Yes","Yes","No","100%",,"$1,000","$25","$0","$4,000","$1,000","$25","$0","$4,000",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,000","$13000 per person","$26000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"$4,500","$4500 per person","$9000 per group","$5,500","$5500 per person","$11000 per group","No","No",,"www.AlliantPlans.com","www.AlliantPlans.com","9"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040003","SoloCare - 0040003","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040003-01","Standard Gold On Exchange Plan",,"0.782365322113037","Yes","Yes","No","100%",,"$1,000","$60","$400","$150","$1,000","$420","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$9,000","$9000 per person","$18000 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","$4,000","$4000 per person","$8000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040003012016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","9"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040003","SoloCare - 0040003","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","100%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040003022016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","10"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050004","SimpleCare-0050004","83761GA005",,"GAN001","GAS001","GAF014","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050004-00","Standard Gold Off Exchange Plan",,"0.804548382759094","Yes","Yes","No","100%",,"$1,500","$15","$0","$5,000","$1,500","$15","$0","$5,000",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$9,000","$9000 per person","$18000 per group","$14,000","$14000 per person","$28000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","0%",,,,,"$4,500","$4500 per person","$9000 per group","$6,000","$6000 per person","$12000 per group","No","No",,"www.AlliantPlans.com","www.AlliantPlans.com","10"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050004","SimpleCare-0050004","83761GA005",,"GAN001","GAS001","GAF014","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050004-01","Standard Gold On Exchange Plan",,"0.804548382759094","Yes","Yes","No","100%",,"$1,500","$15","$0","$5,000","$1,500","$15","$0","$5,000",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$9,000","$9000 per person","$18000 per group","$14,000","$14000 per person","$28000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","0%",,,,,"$4,500","$4500 per person","$9000 per group","$6,000","$6000 per person","$12000 per group","No","No",,"www.AlliantPlans.com","www.AlliantPlans.com","11"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040003","SoloCare - 0040003","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040003-03","Limited Cost Sharing Plan Variation",,"0.782365322113037","Yes","Yes","No","100%",,"$1,000","$60","$400","$150","$1,000","$420","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$9,000","$9000 per person","$18000 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","$4,000","$4000 per person","$8000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040003032016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","11"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040007","SoloCare - 0040007","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040007-00","Standard Silver Off Exchange Plan",,"0.705465734004974","Yes","Yes","No","100%",,"$1,750","$50","$400","$150","$1,750","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","45%",,,,,"$5,250","$5250 per person","$10500 per group","$7,000","$7000 per person","$14000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040007002016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","12"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050005","SimpleCare-0050005","83761GA005",,"GAN001","GAS001","GAF003","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050005-00","Standard Gold Off Exchange Plan",,"0.808510422706604","Yes","Yes","No","100%",,"$1,750","$15","$0","$3,000","$1,750","$15","$0","$3,000",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","20%",,,,,"$4,500","$4500 per person","$9000 per group","$6,250","$6250 per person","$12500 per group","No","No",,"www.AlliantPlans.com","www.AlliantPlans.com","12"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050005","SimpleCare-0050005","83761GA005",,"GAN001","GAS001","GAF003","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050005-01","Standard Gold On Exchange Plan",,"0.807733297348022","Yes","Yes","No","100%",,"$1,750","$15","$0","$3,000","$1,750","$15","$0","$3,000",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","20%",,,,,"$4,500","$4500 per person","$9000 per group","$6,250","$6250 per person","$12500 per group","No","No",,"www.AlliantPlans.com","www.AlliantPlans.com","13"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040007","SoloCare - 0040007","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040007-01","Standard Silver On Exchange Plan",,"0.705465734004974","Yes","Yes","No","100%",,"$1,750","$50","$400","$150","$1,750","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","45%",,,,,"$5,250","$5250 per person","$10500 per group","$7,000","$7000 per person","$14000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040007012016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","13"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040007","SoloCare - 0040007","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","100%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040007022016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","14"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050006","SimpleCare-0050006","83761GA005",,"GAN001","GAS001","GAF001","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050006-00","Standard Gold Off Exchange Plan",,"0.813724935054779","Yes","Yes","No","100%",,"$1,500","$15","$0","$3,500","$1,500","$15","$0","$3,500",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,500","$12500 per person","$25000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10%",,,,,"$4,500","$4500 per person","$9000 per group","$6,000","$6000 per person","$12000 per group","No","No",,"www.AlliantPlans.com","www.AlliantPlans.com","14"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050006","SimpleCare-0050006","83761GA005",,"GAN001","GAS001","GAF001","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050006-01","Standard Gold On Exchange Plan",,"0.813724935054779","Yes","Yes","No","100%",,"$1,500","$15","$0","$3,500","$1,500","$15","$0","$3,500",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,500","$12500 per person","$25000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10%",,,,,"$4,500","$4500 per person","$9000 per group","$6,000","$6000 per person","$12000 per group","No","No",,"www.AlliantPlans.com","www.AlliantPlans.com","15"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040007","SoloCare - 0040007","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040007-03","Limited Cost Sharing Plan Variation",,"0.705465734004974","Yes","Yes","No","100%",,"$1,750","$50","$400","$150","$1,750","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","45%",,,,,"$5,250","$5250 per person","$10500 per group","$7,000","$7000 per person","$14000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040007032016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","15"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040007","SoloCare - 0040007","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040007-04","73% AV Level Silver Plan",,"0.7294921875","Yes","Yes","No","100%",,"$1,750","$50","$400","$150","$1,750","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$18,000","$18000 per person","$36000 per group","$23,450","$23450 per person","$46900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","45%",,,,,"$5,250","$5250 per person","$10500 per group","$7,000","$7000 per person","$14000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040007042016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","16"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050007","SimpleCare-0050007","83761GA005",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050007-00","Standard Silver Off Exchange Plan",,"0.710643231868744","Yes","Yes","No","100%",,"$2,000","$20","$0","$6,850","$2,000","$20","$0","$6,850",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","45%",,,,,"$6,000","$6000 per person","$12000 per group","$8,000","$8000 per person","$16000 per group","No","No",,"www.AlliantPlans.com","www.AlliantPlans.com","16"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050007","SimpleCare-0050007","83761GA005",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050007-01","Standard Silver On Exchange Plan",,"0.710643231868744","Yes","Yes","No","100%",,"$2,000","$20","$0","$6,850","$2,000","$20","$0","$6,850",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","45%",,,,,"$6,000","$6000 per person","$12000 per group","$8,000","$8000 per person","$16000 per group","No","No",,"www.AlliantPlans.com","www.AlliantPlans.com","17"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040007","SoloCare - 0040007","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040007-05","87% AV Level Silver Plan",,"0.869397342205048","Yes","Yes","No","100%",,"$700","$50","$400","$150","$700","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$18,000","$18000 per person","$36000 per group","$19,100","$19100 per person","$38200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","45%",,,,,"$5,250","$5250 per person","$10500 per group","$5,950","$5950 per person","$11900 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040007052016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","17"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040007","SoloCare - 0040007","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040007-06","94% AV Level Silver Plan",,"0.935021936893463","Yes","Yes","No","100%",,"$250","$50","$400","$150","$250","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$18,000","$18000 per person","$36000 per group","$18,400","$18400 per person","$36800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","45%",,,,,"$5,250","$5250 per person","$10500 per group","$5,500","$5500 per person","$11000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040007062016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","18"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050008","SimpleCare-0050008","83761GA005",,"GAN001","GAS001","GAF016","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050008-00","Standard Silver Off Exchange Plan",,"0.713835716247559","Yes","Yes","No","100%",,"$2,300","$25","$0","$6,850","$2,300","$25","$0","$6,850",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$8,300","$8300 per person","$16600 per group","No","No",,"www.AlliantPlans.com","www.AlliantPlans.com","18"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050008","SimpleCare-0050008","83761GA005",,"GAN001","GAS001","GAF016","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050008-01","Standard Silver On Exchange Plan",,"0.713835716247559","Yes","Yes","No","100%",,"$2,300","$25","$0","$6,850","$2,300","$25","$0","$6,850",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$8,300","$8300 per person","$16600 per group","No","No",,"www.AlliantPlans.com","www.AlliantPlans.com","19"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040010","SoloCare - 0040010","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040010-00","Standard Silver Off Exchange Plan",,"0.71942549943924","Yes","Yes","No","100%",,"$2,500","$60","$400","$150","$2,500","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$8,500","$8500 per person","$17000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040010002016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","19"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040010","SoloCare - 0040010","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040010-01","Standard Silver On Exchange Plan",,"0.71942549943924","Yes","Yes","No","100%",,"$2,500","$60","$400","$150","$2,500","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$8,500","$8500 per person","$17000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040010012016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","20"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050009","SimpleCare-0050009","83761GA005",,"GAN001","GAS001","GAF004","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050009-00","Standard Silver Off Exchange Plan",,"0.719356179237366","Yes","Yes","No","100%",,"$2,750","$25","$0","$6,850","$2,750","$25","$0","$6,850",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$8,750","$8750 per person","$17500 per group","No","No",,"www.AlliantPlans.com","www.AlliantPlans.com","20"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050009","SimpleCare-0050009","83761GA005",,"GAN001","GAS001","GAF004","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050009-01","Standard Silver On Exchange Plan",,"0.719369351863861","Yes","Yes","No","100%",,"$2,750","$25","$0","$6,850","$2,750","$25","$0","$6,850",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$8,750","$8750 per person","$17500 per group","No","No",,"www.AlliantPlans.com","www.AlliantPlans.com","21"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040010","SoloCare - 0040010","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","100%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040010022016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","21"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040010","SoloCare - 0040010","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040010-03","Limited Cost Sharing Plan Variation",,"0.71942549943924","Yes","Yes","No","100%",,"$2,500","$60","$400","$150","$2,500","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$8,500","$8500 per person","$17000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040010032016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","22"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050010","SimpleCare-0050010","83761GA005",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050010-00","Standard Silver Off Exchange Plan",,"0.719804883003235","Yes","Yes","No","100%",,"$2,750","$30","$0","$6,850","$2,750","$30","$0","$6,850",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$8,750","$8750 per person","$17500 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","22"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050010","SimpleCare-0050010","83761GA005",,"GAN001","GAS001","GAF006","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050010-01","Standard Silver On Exchange Plan",,"0.719804883003235","Yes","Yes","No","100%",,"$2,750","$30","$0","$6,850","$2,750","$30","$0","$6,850",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$8,750","$8750 per person","$17500 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","23"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040010","SoloCare - 0040010","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040010-04","73% AV Level Silver Plan",,"0.739492118358612","Yes","Yes","No","100%",,"$2,500","$60","$400","$150","$2,500","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,180","$5180 per person","$10360 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,500","$24500 per person","$49000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$8,500","$8500 per person","$17000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040010042016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","23"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040010","SoloCare - 0040010","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040010-05","87% AV Level Silver Plan",,"0.878108739852905","Yes","Yes","No","100%",,"$800","$60","$400","$150","$800","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$18,000","$18000 per person","$36000 per group","$19,200","$19200 per person","$38400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$6,800","$6800 per person","$13600 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040010052016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","24"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050011","SimpleCare-0050011","83761GA005",,"GAN001","GAS001","GAF009","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050011-00","Standard Silver Off Exchange Plan",,"0.702099919319153","Yes","Yes","No","100%",,"$3,000","$25","$0","$6,850","$3,000","$25","$0","$6,850",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","$12,000","$12000 per person","$24000 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","24"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050011","SimpleCare-0050011","83761GA005",,"GAN001","GAS001","GAF009","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050011-01","Standard Silver On Exchange Plan",,"0.702099919319153","Yes","Yes","No","100%",,"$3,000","$25","$0","$6,850","$3,000","$25","$0","$6,850",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","$12,000","$12000 per person","$24000 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","25"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040010","SoloCare - 0040010","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040010-06","94% AV Level Silver Plan",,"0.938941240310669","Yes","Yes","No","100%",,"$250","$60","$400","$150","$250","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$18,000","$18000 per person","$36000 per group","$18,400","$18400 per person","$36800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$6,250","$6250 per person","$12500 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040010062016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","25"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040015","SoloCare - 0040015","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040015-00","Standard Silver Off Exchange Plan",,"0.709649622440338","Yes","Yes","No","100%",,"$3,000","$60","$400","$150","$3,000","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$12,000","$12000 per person","$24000 per group","$15,000","$15000 per person","$30000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040015002016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","26"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050012","SimpleCare-0050012","83761GA005",,"GAN001","GAS001","GAF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050012-00","Standard Silver Off Exchange Plan",,"0.719883739948273","Yes","Yes","No","100%",,"$2,500","$25","$0","$6,850","$2,500","$25","$0","$6,850",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","$8,500","$8500 per person","$17000 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","26"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050012","SimpleCare-0050012","83761GA005",,"GAN001","GAS001","GAF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050012-01","Standard Silver On Exchange Plan",,"0.719883739948273","Yes","Yes","No","100%",,"$2,500","$25","$0","$6,850","$2,500","$25","$0","$6,850",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","$8,500","$8500 per person","$17000 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","27"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040015","SoloCare - 0040015","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040015-01","Standard Silver On Exchange Plan",,"0.709649622440338","Yes","Yes","No","100%",,"$3,000","$60","$400","$150","$3,000","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$12,000","$12000 per person","$24000 per group","$15,000","$15000 per person","$30000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040015012016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","27"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040015","SoloCare - 0040015","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","100%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040015022016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","28"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050013","SimpleCare-0050013","83761GA005",,"GAN001","GAS001","GAF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050013-00","Standard Silver Off Exchange Plan",,"0.719416379928589","Yes","Yes","No","100%",,"$3,300","$25","$0","$6,850","$3,300","$25","$0","$6,850",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,300","$9300 per person","$18600 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","28"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050013","SimpleCare-0050013","83761GA005",,"GAN001","GAS001","GAF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050013-01","Standard Silver On Exchange Plan",,"0.719416379928589","Yes","Yes","No","100%",,"$3,300","$25","$0","$6,850","$3,300","$25","$0","$6,850",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$10,250","$10250 per person","$20500 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","29"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040015","SoloCare - 0040015","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040015-03","Limited Cost Sharing Plan Variation",,"0.709649622440338","Yes","Yes","No","100%",,"$3,000","$60","$400","$150","$3,000","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$12,000","$12000 per person","$24000 per group","$15,000","$15000 per person","$30000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040015032016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","29"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040015","SoloCare - 0040015","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040015-04","73% AV Level Silver Plan",,"0.737012922763824","Yes","Yes","No","100%",,"$2,500","$60","$400","$150","$2,500","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,000","$24000 per person","$48000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$12,000","$12000 per person","$24000 per group","$14,500","$14500 per person","$29000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040015042016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","30"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050014","SimpleCare-0050014","83761GA005",,"GAN001","GAS001","GAF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050014-00","Standard Silver Off Exchange Plan",,"0.706468045711517","Yes","Yes","No","100%",,"$4,500","$25","$0","$6,850","$4,500","$25","$0","$6,850",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$10,500","$10500 per person","$21000 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","30"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050014","SimpleCare-0050014","83761GA005",,"GAN001","GAS001","GAF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050014-01","Standard Silver On Exchange Plan",,"0.706468045711517","Yes","Yes","No","100%",,"$4,500","$25","$0","$6,850","$4,500","$25","$0","$6,850",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$10,500","$10500 per person","$21000 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","31"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040015","SoloCare - 0040015","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040015-05","87% AV Level Silver Plan",,"0.876720786094666","Yes","Yes","No","100%",,"$750","$60","$400","$150","$750","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"$18,000","$18000 per person","$36000 per group","$19,350","$19350 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$12,000","$12000 per person","$24000 per group","$12,750","$12750 per person","$25500 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040015052016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","31"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040015","SoloCare - 0040015","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040015-06","94% AV Level Silver Plan",,"0.932688534259796","Yes","Yes","No","100%",,"$200","$60","$400","$150","$200","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$18,000","$18000 per person","$36000 per group","$18,500","$18500 per person","$37000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"$12,000","$12000 per person","$24000 per group","$12,200","$12200 per person","$24400 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040015062016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","32"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050015","SimpleCare-0050015","83761GA005",,"GAN001","GAS001","GAF014","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050015-00","Standard Silver Off Exchange Plan",,"0.717144370079041","Yes","Yes","No","100%",,"$4,500","$25","$0","$6,850","$4,500","$25","$0","$6,850",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$10,500","$10500 per person","$21000 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","32"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040017","SoloCare - 0040017","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040017-03","Limited Cost Sharing Plan Variation",,"0.713385820388794","Yes","Yes","No","100%",,"$4,500","$60","$400","$150","$4,500","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","$19,500","$19500 per person","$39000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040017032016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","36"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040017","SoloCare - 0040017","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040017-04","73% AV Level Silver Plan",,"0.734364688396454","Yes","Yes","No","100%",,"$3,900","$60","$400","$150","$3,900","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$18,000","$18000 per person","$36000 per group","$23,450","$23450 per person","$46900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","$18,900","$18900 per person","$37800 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040017042016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","37"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040017","SoloCare - 0040017","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040017-05","87% AV Level Silver Plan",,"0.860419392585754","Yes","Yes","No","100%",,"$1,000","$60","$400","$150","$1,000","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$18,000","$18000 per person","$36000 per group","$20,000","$20000 per person","$40000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","$16,000","$16000 per person","$32000 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040017052016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","38"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040017","SoloCare - 0040017","83761GA004",,"GAN001","GAS001","GAF021","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040017-06","94% AV Level Silver Plan",,"0.931307733058929","Yes","Yes","No","100%",,"$350","$60","$400","$150","$350","$260","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$18,000","$18000 per person","$36000 per group","$18,700","$18700 per person","$37400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","$15,350","$15350 per person","$30700 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040017062016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","39"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040021","SoloCare - 0040021","83761GA004",,"GAN001","GAS001","GAF020","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","100%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040021022016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","46"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","1","83761","GA","Individual","No","58-2335921","83761GA0040021","SoloCare - 0040021","83761GA004",,"GAN001","GAS001","GAF020","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","In-Network Providers available in counties outside th service Area. Verify participating providers at AHPAssist.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0040021-03","Limited Cost Sharing Plan Variation",,"0.605760395526886","Yes","Yes","No","100%",,"$6,850","$0","$200","$150","$1,000","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","$21,850","$21850 per person","$43700 per group","No",,,"http://www.AlliantPlans.com/AlliantFilesWP/SoloCare2016/83761GA0040021032016.pdf","http://www.alliantplans.com/AlliantFilesWP/solocare-2016-brochure/","47"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","2","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050016","SimpleCare-0050016","83761GA005",,"GAN001","GAS001","GAF014","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AlliantPlans.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050016-00","Standard Silver Off Exchange Plan",,"0.701507866382599","Yes","Yes","No","100%",,"$5,500","$25","$0","$80","$1,000","$25","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$11,500","$11500 per person","$23000 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","4"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","2","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050016","SimpleCare-0050016","83761GA005",,"GAN001","GAS001","GAF014","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AlliantPlans.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050016-01","Standard Silver On Exchange Plan",,"0.701507866382599","Yes","Yes","No","100%",,"$5,500","$25","$0","$80","$1,000","$25","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$11,500","$11500 per person","$23000 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","5"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","2","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050017","SimpleCare-0050017","83761GA005",,"GAN001","GAS001","GAF019","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AlliantPlans.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050017-00","Standard Bronze Off Exchange Plan",,"0.619341731071472","Yes","Yes","No","100%",,"$6,000","$25","$0","$80","$1,000","$25","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"$9,000","$9000 per person","$18000 per group","$15,000","$15000 per person","$30000 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","6"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","2","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050017","SimpleCare-0050017","83761GA005",,"GAN001","GAS001","GAF019","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AlliantPlans.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050017-01","Standard Bronze On Exchange Plan",,"0.619341731071472","Yes","Yes","No","100%",,"$6,000","$25","$0","$80","$1,000","$25","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"$9,000","$9000 per person","$18000 per group","$15,000","$15000 per person","$30000 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","7"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","2","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050018","SimpleCare-0050018","83761GA005",,"GAN001","GAS001","GAF020","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AlliantPlans.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050018-00","Standard Bronze Off Exchange Plan",,"0.618289589881897","Yes","Yes","No","100%",,"$6,000","$0","$0","$80","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","$15,000","$15000 per person","$30000 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","8"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","2","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050018","SimpleCare-0050018","83761GA005",,"GAN001","GAS001","GAF020","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AlliantPlans.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050018-01","Standard Bronze On Exchange Plan",,"0.618289589881897","Yes","Yes","No","100%",,"$6,000","$0","$0","$80","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","$15,000","$15000 per person","$30000 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","9"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","2","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050019","SimpleCare-0050019","83761GA005",,"GAN001","GAS001","GAF020","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AlliantPlans.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050019-00","Standard Silver Off Exchange Plan",,"0.706923186779022","Yes","Yes","No","100%",,"$2,250","$0","$0","$80","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$8,250","$8250 per person","$16500 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","10"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","2","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050019","SimpleCare-0050019","83761GA005",,"GAN001","GAS001","GAF020","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AlliantPlans.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050019-01","Standard Silver On Exchange Plan",,"0.706923186779022","Yes","Yes","No","100%",,"$2,250","$0","$0","$80","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$8,250","$8250 per person","$16500 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","11"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","2","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050020","SimpleCare-0050020","83761GA005",,"GAN001","GAS001","GAF020","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AlliantPlans.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050020-00","Standard Silver Off Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$80","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$10,000","$10000 per person","$20000 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","12"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","2","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050020","SimpleCare-0050020","83761GA005",,"GAN001","GAS001","GAF020","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AlliantPlans.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050020-01","Standard Silver On Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$80","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$10,000","$10000 per person","$20000 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","13"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","2","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050021","SimpleCare-0050021","83761GA005",,"GAN001","GAS001","GAF020","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AlliantPlans.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050021-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$80","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$9,500","$9500 per person","$19000 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","14"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","2","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050021","SimpleCare-0050021","83761GA005",,"GAN001","GAS001","GAF020","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AlliantPlans.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050021-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$80","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,850","$18850 per person","$37700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$9,500","$9500 per person","$19000 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","15"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","2","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050022","SimpleCare-0050022","83761GA005",,"GAN001","GAS001","GAF020","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AlliantPlans.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050022-00","Standard Bronze Off Exchange Plan",,"0.607437133789063","Yes","Yes","No","100%",,"$6,300","$0","$0","$80","$1,000","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","$18,900","$18900 per person","$37800 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","16"
"2016","GA","83761","HIOS","8","2016-07-12 17:05:10","2","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050022","SimpleCare-0050022","83761GA005",,"GAN001","GAS001","GAF020","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Diabetes","0.99776280397402",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","In-Network providers available in certain Georgia and Tennessee counties outside the Service Area. Verify participating providers at AlliantPlans.com","No","https://enrollment.alliantplans.com/enrollmentweb/SAMLRedirect.aspx","http://www.alliantplans.com/formulary-lists/","83761GA0050022-01","Standard Bronze On Exchange Plan",,"0.607437133789063","Yes","Yes","No","100%",,"$6,300","$0","$0","$80","$1,000","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","$18,900","$18900 per person","$37800 per group","No","No",,"http://www.AlliantPlans.com","http://www.AlliantPlans.com","17"
"2016","GA","86637","HIOS","6","2015-08-23 12:37:12","1","86637","GA","Individual","Yes","94-2761537","86637GA0010001","Delta Dental PPO Pediatric Basic Plan","86637GA001",,"GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.13","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0010001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0010001-16","5"
"2016","GA","86637","HIOS","6","2015-08-23 12:37:12","1","86637","GA","SHOP (Small Group)","Yes","94-2761537","86637GA0020001","Delta Dental PPO Pediatric Basic Plan for Small Businesses","86637GA002",,"GAN001","GAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.13","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0020001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0020001-16","5"
"2016","GA","86637","HIOS","6","2015-08-23 12:37:12","2","86637","GA","SHOP (Small Group)","Yes","94-2761537","86637GA0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","86637GA002",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.75","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0020004-16","4"
"2016","GA","86637","HIOS","6","2015-08-23 12:37:12","2","86637","GA","Individual","Yes","94-2761537","86637GA0010004","Delta Dental PPO Preferred Plan for Families","86637GA001",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.28","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0010004-16","4"
"2016","GA","86637","HIOS","6","2015-08-23 12:37:12","2","86637","GA","Individual","Yes","94-2761537","86637GA0010004","Delta Dental PPO Preferred Plan for Families","86637GA001",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.28","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0010004-16","5"
"2016","GA","86637","HIOS","6","2015-08-23 12:37:12","2","86637","GA","SHOP (Small Group)","Yes","94-2761537","86637GA0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","86637GA002",,"GAN001","GAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.75","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0020004-16","5"
"2016","GA","86637","HIOS","6","2015-08-23 12:37:12","3","86637","GA","SHOP (Small Group)","Yes","94-2761537","86637GA0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","86637GA002",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.13","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0020006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0020006-16","4"
"2016","GA","86637","HIOS","6","2015-08-23 12:37:12","3","86637","GA","Individual","Yes","94-2761537","86637GA0010006","Delta Dental PPO Basic Plan for Families","86637GA001",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.13","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0010006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0010006-16","4"
"2016","GA","86637","HIOS","6","2015-08-23 12:37:12","3","86637","GA","Individual","Yes","94-2761537","86637GA0010006","Delta Dental PPO Basic Plan for Families","86637GA001",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.13","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0010006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0010006-16","5"
"2016","GA","86637","HIOS","6","2015-08-23 12:37:12","3","86637","GA","SHOP (Small Group)","Yes","94-2761537","86637GA0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","86637GA002",,"GAN001","GAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.13","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","86637GA0020006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ga/86637ga0020006-16","5"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","3","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060004","KP GA Silver 2500/25/40/S3","89942GA006",,"GAN001","GAS001","GAF012","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060004-01","Standard Silver On Exchange Plan","71.50%","0.706538558006287","No","Yes","No","100%",,"$2,500","$20","$500","$200","$0","$1,600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/KP%20SILVER%202500_25_40_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","5"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","6","89942","GA","Individual","No","58-1592076","89942GA0050006","KP GA Silver 2750/20%/HSA","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050006-00","Standard Silver Off Exchange Plan","68.77%","0.6830775141716","Yes","Yes","No","100%",,"$2,800","$20","$500","$200","$1,000","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20202_S01_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","9","89942","GA","Individual","No","58-1592076","89942GA0050009","KP GA Bronze 6000/40%/HSA","89942GA005",,"GAN001","GAS002","GAF006","Existing","HMO","Bronze","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050009-01","Standard Bronze On Exchange Plan","61.33%","0.602554678916931","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20302_S01_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","5"
"2016","GA","86681","HIOS","12","2015-10-18 12:35:12","1","86681","GA","SHOP (Small Group)","Yes","31-1185262","86681GA0020003","DentaSpan Family High Option","86681GA002","7083617077","GAN001","GAS001",,"New","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$26.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","86681GA0020003-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbga.dentalcareplus.com","https://hixsgsbga.dentalcareplus.com","4"
"2016","GA","86681","HIOS","12","2015-10-18 12:35:12","1","86681","GA","Individual","Yes","31-1185262","86681GA0010001","Georgia DentaTrust-PPO Pediatric High Option","86681GA001","7083617077","GAN001","GAS001",,"New","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Child-Only",,,,,"$30.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","86681GA0010001-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbga.dentalcareplus.com","https://hixindsbga.dentalcareplus.com","4"
"2016","GA","86681","HIOS","12","2015-10-18 12:35:12","1","86681","GA","Individual","Yes","31-1185262","86681GA0010001","Georgia DentaTrust-PPO Pediatric High Option","86681GA001","7083617077","GAN001","GAS001",,"New","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Child-Only",,,,,"$30.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","86681GA0010001-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbga.dentalcareplus.com","https://hixindsbga.dentalcareplus.com","5"
"2016","GA","86681","HIOS","12","2015-10-18 12:35:12","1","86681","GA","SHOP (Small Group)","Yes","31-1185262","86681GA0020003","DentaSpan Family High Option","86681GA002","7083617077","GAN001","GAS001",,"New","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$26.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","86681GA0020003-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbga.dentalcareplus.com","https://hixsgsbga.dentalcareplus.com","5"
"2016","GA","86681","HIOS","12","2015-10-18 12:35:12","1","86681","GA","SHOP (Small Group)","Yes","31-1185262","86681GA0020004","DentaSpan Family Low Option","86681GA002","7083617077","GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$23.43","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","86681GA0020004-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbga.dentalcareplus.com","https://hixsgsbga.dentalcareplus.com","6"
"2016","GA","86681","HIOS","12","2015-10-18 12:35:12","1","86681","GA","Individual","Yes","31-1185262","86681GA0010002","Georgia DentaTrust-PPO Pediatric Low Option","86681GA001","7083617077","GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Child-Only",,,,,"$26.90","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","86681GA0010002-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbga.dentalcareplus.com","https://hixindsbga.dentalcareplus.com","6"
"2016","GA","86681","HIOS","12","2015-10-18 12:35:12","1","86681","GA","Individual","Yes","31-1185262","86681GA0010002","Georgia DentaTrust-PPO Pediatric Low Option","86681GA001","7083617077","GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Child-Only",,,,,"$26.90","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","86681GA0010002-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbga.dentalcareplus.com","https://hixindsbga.dentalcareplus.com","7"
"2016","GA","86681","HIOS","12","2015-10-18 12:35:12","1","86681","GA","SHOP (Small Group)","Yes","31-1185262","86681GA0020004","DentaSpan Family Low Option","86681GA002","7083617077","GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$23.43","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","86681GA0020004-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbga.dentalcareplus.com","https://hixsgsbga.dentalcareplus.com","7"
"2016","GA","86681","HIOS","12","2015-10-18 12:35:12","1","86681","GA","SHOP (Small Group)","Yes","31-1185262","86681GA0030003","DentaSpan Dental-Family High Option-Off Exchange","86681GA003","7083617077","GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$18.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","86681GA0030003-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbga.dentalcareplus.com","https://hixsgsbga.dentalcareplus.com","8"
"2016","GA","86681","HIOS","12","2015-10-18 12:35:12","1","86681","GA","SHOP (Small Group)","Yes","31-1185262","86681GA0030004","DentaSpan Dental-Family Low Option-Off Exchange","86681GA003","7083617077","GAN001","GAS001",,"New","PPO","Low",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$16.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","86681GA0030004-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbga.dentalcareplus.com","https://hixsgsbga.dentalcareplus.com","9"
"2016","GA","86681","HIOS","12","2015-10-18 12:35:12","2","86681","GA","SHOP (Small Group)","Yes","31-1185262","86681GA0030001","DentaSpan Pediatric High Option","86681GA003","7083617077","GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$26.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","86681GA0030001-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","GA","86681","HIOS","12","2015-10-18 12:35:12","2","86681","GA","Individual","Yes","31-1185262","86681GA0010003","Georgia DentaTrust-PPO Family High Option","86681GA001","7083617077","GAN001","GAS001",,"New","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$21.24","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","86681GA0010003-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbga.dentalcareplus.com","https://hixindsbga.dentalcareplus.com","4"
"2016","GA","86681","HIOS","12","2015-10-18 12:35:12","2","86681","GA","Individual","Yes","31-1185262","86681GA0010003","Georgia DentaTrust-PPO Family High Option","86681GA001","7083617077","GAN001","GAS001",,"New","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$21.24","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","86681GA0010003-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbga.dentalcareplus.com","https://hixindsbga.dentalcareplus.com","5"
"2016","GA","86681","HIOS","12","2015-10-18 12:35:12","2","86681","GA","SHOP (Small Group)","Yes","31-1185262","86681GA0030002","DentaSpan Pediatric Low Option","86681GA003","7083617077","GAN001","GAS001",,"New","PPO","Low",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$23.43","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","86681GA0030002-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","GA","86681","HIOS","12","2015-10-18 12:35:12","2","86681","GA","Individual","Yes","31-1185262","86681GA0010004","Georgia DentaTrust-PPO Family Low Option","86681GA001","7083617077","GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$18.46","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","86681GA0010004-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbga.dentalcareplus.com","https://hixindsbga.dentalcareplus.com","6"
"2016","GA","86681","HIOS","12","2015-10-18 12:35:12","2","86681","GA","Individual","Yes","31-1185262","86681GA0010004","Georgia DentaTrust-PPO Family Low Option","86681GA001","7083617077","GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$18.46","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","86681GA0010004-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbga.dentalcareplus.com","https://hixindsbga.dentalcareplus.com","7"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","1","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060002","KP GA Gold 0/20/30/S3","89942GA006",,"GAN001","GAS001","GAF008","Existing","HMO","Gold","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060002-00","Standard Gold Off Exchange Plan","81.79%","0.821667313575745","No","Yes","No","100%",,"$0","$70","$900","$200","$0","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/KP%20GOLD%200_20_30_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","1","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060002","KP GA Gold 0/20/30/S3","89942GA006",,"GAN001","GAS001","GAF008","Existing","HMO","Gold","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060002-01","Standard Gold On Exchange Plan","81.79%","0.821667313575745","No","Yes","No","100%",,"$0","$70","$900","$200","$0","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/KP%20GOLD%200_20_30_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","5"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","1","89942","GA","Individual","No","58-1592076","89942GA0050002","KP GA Gold 500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"3","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20100_AZ1_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","6"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","1","89942","GA","Individual","No","58-1592076","89942GA0050002","KP GA Gold 500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"3","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050002-03","Limited Cost Sharing Plan Variation","80.76%","0.813755929470062","No","Yes","No","100%",,"$500","$2,000","$100","$200","$0","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20100_AZ1_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","7"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","2","89942","GA","Individual","No","58-1592076","89942GA0050003","KP GA Gold 1000/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050003-00","Standard Gold Off Exchange Plan","78.37%","0.786518692970276","No","Yes","No","100%",,"$1,000","$20","$700","$200","$0","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20101_001_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","2","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060003","KP GA Gold 1000/20/30/S3","89942GA006",,"GAN001","GAS001","GAF009","Existing","HMO","Gold","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060003-00","Standard Gold Off Exchange Plan","79.56%","0.798818171024323","No","Yes","No","100%",,"$1,000","$70","$500","$200","$0","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/KP%20GOLD%201000_20_30_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","2","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060003","KP GA Gold 1000/20/30/S3","89942GA006",,"GAN001","GAS001","GAF009","Existing","HMO","Gold","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060003-01","Standard Gold On Exchange Plan","79.56%","0.798818171024323","No","Yes","No","100%",,"$1,000","$70","$500","$200","$0","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/KP%20GOLD%201000_20_30_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","5"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","2","89942","GA","Individual","No","58-1592076","89942GA0050003","KP GA Gold 1000/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050003-01","Standard Gold On Exchange Plan","78.37%","0.786518692970276","No","Yes","No","100%",,"$1,000","$20","$700","$200","$0","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20101_001_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","5"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","2","89942","GA","Individual","No","58-1592076","89942GA0050003","KP GA Gold 1000/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20100_AZ1_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","6"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","2","89942","GA","Individual","No","58-1592076","89942GA0050003","KP GA Gold 1000/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050003-03","Limited Cost Sharing Plan Variation","78.37%","0.786518692970276","No","Yes","No","100%",,"$1,000","$20","$700","$200","$0","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20100_AZ1_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","7"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","3","89942","GA","Individual","No","58-1592076","89942GA0050012","KP GA Gold 1500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050012-00","Standard Gold Off Exchange Plan","78.37%","0.783883273601532","No","Yes","No","100%",,"$1,500","$20","$600","$200","$0","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20102_001_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","3","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060004","KP GA Silver 2500/25/40/S3","89942GA006",,"GAN001","GAS001","GAF012","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060004-00","Standard Silver Off Exchange Plan","71.50%","0.706538558006287","No","Yes","No","100%",,"$2,500","$20","$500","$200","$0","$1,600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/KP%20SILVER%202500_25_40_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","3","89942","GA","Individual","No","58-1592076","89942GA0050012","KP GA Gold 1500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050012-01","Standard Gold On Exchange Plan","78.37%","0.783883273601532","No","Yes","No","100%",,"$1,500","$20","$600","$200","$0","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20102_001_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","5"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","3","89942","GA","Individual","No","58-1592076","89942GA0050012","KP GA Gold 1500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050012-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20100_AZ1_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","6"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","3","89942","GA","Individual","No","58-1592076","89942GA0050012","KP GA Gold 1500/20","89942GA005",,"GAN001","GAS002","GAF001","Existing","HMO","Gold","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050012-03","Limited Cost Sharing Plan Variation","78.37%","0.783883273601532","No","Yes","No","100%",,"$1,500","$20","$600","$200","$0","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20100_AZ1_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","7"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","4","89942","GA","Individual","No","58-1592076","89942GA0050004","KP GA Silver 1500/30","89942GA005",,"GAN001","GAS002","GAF002","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050004-00","Standard Silver Off Exchange Plan","71.13%","0.711981654167175","No","Yes","No","100%",,"$1,500","$20","$1,100","$200","$100","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20200_001_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","4","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060005","KP GA Silver 2000/40/40/S3","89942GA006",,"GAN001","GAS001","GAF011","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060005-00","Standard Silver Off Exchange Plan","71.69%","0.710665047168732","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$0","$1,600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/KP%20SILVER%202000_40_40_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","4","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060005","KP GA Silver 2000/40/40/S3","89942GA006",,"GAN001","GAS001","GAF011","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060005-01","Standard Silver On Exchange Plan","71.69%","0.710665047168732","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$0","$1,600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/KP%20SILVER%202000_40_40_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","5"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","4","89942","GA","Individual","No","58-1592076","89942GA0050004","KP GA Silver 1500/30","89942GA005",,"GAN001","GAS002","GAF002","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050004-01","Standard Silver On Exchange Plan","71.13%","0.711981654167175","No","Yes","No","100%",,"$1,500","$20","$1,100","$200","$100","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20200_001_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","5"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","4","89942","GA","Individual","No","58-1592076","89942GA0050004","KP GA Silver 1500/30","89942GA005",,"GAN001","GAS002","GAF002","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20100_AZ1_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","6"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","4","89942","GA","Individual","No","58-1592076","89942GA0050004","KP GA Silver 1500/30","89942GA005",,"GAN001","GAS002","GAF002","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050004-03","Limited Cost Sharing Plan Variation","71.13%","0.711981654167175","No","Yes","No","100%",,"$1,500","$20","$1,100","$200","$100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20100_AZ1_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","7"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","4","89942","GA","Individual","No","58-1592076","89942GA0050004","KP GA Silver 1500/30","89942GA005",,"GAN001","GAS002","GAF002","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050004-04","73% AV Level Silver Plan","73.69%","0.735991179943085","No","Yes","No","100%",,"$1,500","$20","$600","$200","$0","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20200_071_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","8"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","4","89942","GA","Individual","No","58-1592076","89942GA0050004","KP GA Silver 1500/30","89942GA005",,"GAN001","GAS002","GAF002","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050004-06","94% AV Level Silver Plan","93.90%","0.940821349620819","No","Yes","No","100%",,"$0","$10","$200","$200","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20200_091_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","10"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","5","89942","GA","Individual","No","58-1592076","89942GA0050005","KP GA Silver 2500/30","89942GA005",,"GAN001","GAS002","GAF002","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050005-00","Standard Silver Off Exchange Plan","68.52%","0.685133457183838","No","Yes","No","100%",,"$2,500","$20","$600","$200","$100","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20201_001_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","5","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060006","KP GA Bronze 5000/30/40/S3","89942GA006",,"GAN001","GAS001","GAF015","Existing","HMO","Bronze","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","1","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060006-00","Standard Bronze Off Exchange Plan","61.80%","0.617754459381104","Yes","Yes","No","100%",,"$5,000","$20","$50","$200","$100","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/KP%20BRONZE%205000_30_40_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","5","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060006","KP GA Bronze 5000/30/40/S3","89942GA006",,"GAN001","GAS001","GAF015","Existing","HMO","Bronze","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","1","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060006-01","Standard Bronze On Exchange Plan","61.80%","0.617754459381104","Yes","Yes","No","100%",,"$5,000","$20","$50","$200","$100","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/KP%20BRONZE%205000_30_40_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","5"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","5","89942","GA","Individual","No","58-1592076","89942GA0050005","KP GA Silver 2500/30","89942GA005",,"GAN001","GAS002","GAF002","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050005-01","Standard Silver On Exchange Plan","68.52%","0.685133457183838","No","Yes","No","100%",,"$2,500","$20","$600","$200","$100","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20201_001_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","5"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","5","89942","GA","Individual","No","58-1592076","89942GA0050005","KP GA Silver 2500/30","89942GA005",,"GAN001","GAS002","GAF002","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20100_AZ1_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","6"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","5","89942","GA","Individual","No","58-1592076","89942GA0050005","KP GA Silver 2500/30","89942GA005",,"GAN001","GAS002","GAF002","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050005-03","Limited Cost Sharing Plan Variation","68.52%","0.685133457183838","No","Yes","No","100%",,"$2,500","$20","$600","$200","$100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20100_AZ1_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","7"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","5","89942","GA","Individual","No","58-1592076","89942GA0050005","KP GA Silver 2500/30","89942GA005",,"GAN001","GAS002","GAF002","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050005-04","73% AV Level Silver Plan","73.69%","0.735991179943085","No","Yes","No","100%",,"$1,500","$20","$600","$200","$0","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20200_071_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","8"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","5","89942","GA","Individual","No","58-1592076","89942GA0050005","KP GA Silver 2500/30","89942GA005",,"GAN001","GAS002","GAF002","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050005-05","87% AV Level Silver Plan","87.80%","0.878721177577972","No","Yes","No","100%",,"$0","$20","$900","$200","$0","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20200_081_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","9"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","5","89942","GA","Individual","No","58-1592076","89942GA0050005","KP GA Silver 2500/30","89942GA005",,"GAN001","GAS002","GAF002","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050005-06","94% AV Level Silver Plan","93.90%","0.940821349620819","No","Yes","No","100%",,"$0","$10","$200","$200","$0","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20200_091_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","10"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","6","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060007","KP GA Silver HDHP 2700/20/S3","89942GA006",,"GAN001","GAS001","GAF014","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060007-00","Standard Silver Off Exchange Plan","68.22%","0.682568311691284","Yes","Yes","No","100%",,"$2,700","$0","$500","$200","$2,700","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/HDHP%20SILVER%202700_20_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","6","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060007","KP GA Silver HDHP 2700/20/S3","89942GA006",,"GAN001","GAS001","GAF014","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060007-01","Standard Silver On Exchange Plan","68.22%","0.682568311691284","Yes","Yes","No","100%",,"$2,700","$0","$500","$200","$2,700","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/HDHP%20SILVER%202700_20_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","5"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","6","89942","GA","Individual","No","58-1592076","89942GA0050006","KP GA Silver 2750/20%/HSA","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050006-01","Standard Silver On Exchange Plan","68.77%","0.6830775141716","Yes","Yes","No","100%",,"$2,800","$20","$500","$200","$1,000","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20202_S01_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","5"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","6","89942","GA","Individual","No","58-1592076","89942GA0050006","KP GA Silver 2750/20%/HSA","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20100_AZ1_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","6"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","6","89942","GA","Individual","No","58-1592076","89942GA0050006","KP GA Silver 2750/20%/HSA","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050006-03","Limited Cost Sharing Plan Variation","68.77%","0.6830775141716","Yes","Yes","No","100%",,"$2,800","$20","$500","$200","$1,000","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20100_AZ1_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","7"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","6","89942","GA","Individual","No","58-1592076","89942GA0050006","KP GA Silver 2750/20%/HSA","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050006-04","73% AV Level Silver Plan","73.90%","0.739331066608429","Yes","Yes","No","100%",,"$1,400","$20","$800","$200","$1,000","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20202_S71_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","8"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","6","89942","GA","Individual","No","58-1592076","89942GA0050006","KP GA Silver 2750/20%/HSA","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050006-05","87% AV Level Silver Plan","87.80%","0.878378689289093","Yes","Yes","No","100%",,"$500","$10","$500","$200","$500","$400","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20202_181_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","9"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","6","89942","GA","Individual","No","58-1592076","89942GA0050006","KP GA Silver 2750/20%/HSA","89942GA005",,"GAN001","GAS002","GAF003","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050006-06","94% AV Level Silver Plan","94.32%","0.945015072822571","Yes","Yes","No","100%",,"$100","$10","$300","$200","$100","$400","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20202_191_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","10"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","7","89942","GA","Individual","No","58-1592076","89942GA0050007","KP GA Bronze 4000/20","89942GA005",,"GAN001","GAS002","GAF004","Existing","HMO","Bronze","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","3","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050007-00","Standard Bronze Off Exchange Plan","61.51%","0.63105434179306","No","Yes","No","100%",,"$4,000","$20","$400","$200","$100","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20300_001_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","7","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060008","KP GA Bronze HDHP/4000/40/S3","89942GA006",,"GAN001","GAS001","GAF010","Existing","HMO","Bronze","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060008-00","Standard Bronze Off Exchange Plan","61.77%","0.617886602878571","Yes","Yes","No","100%",,"$4,000","$0","$500","$200","$4,000","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/HDHP%20BRONZE%204000_40_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","7","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060008","KP GA Bronze HDHP/4000/40/S3","89942GA006",,"GAN001","GAS001","GAF010","Existing","HMO","Bronze","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060008-01","Standard Bronze On Exchange Plan","61.77%","0.617886602878571","Yes","Yes","No","100%",,"$4,000","$0","$500","$200","$4,000","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/HDHP%20BRONZE%204000_40_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","5"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","7","89942","GA","Individual","No","58-1592076","89942GA0050007","KP GA Bronze 4000/20","89942GA005",,"GAN001","GAS002","GAF004","Existing","HMO","Bronze","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","3","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20100_AZ1_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","6"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","7","89942","GA","Individual","No","58-1592076","89942GA0050007","KP GA Bronze 4000/20","89942GA005",,"GAN001","GAS002","GAF004","Existing","HMO","Bronze","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","3","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050007-03","Limited Cost Sharing Plan Variation","61.51%","0.63105434179306","No","Yes","No","100%",,"$4,000","$20","$400","$200","$100","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20100_AZ1_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","7"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","8","89942","GA","Individual","No","58-1592076","89942GA0050013","KP GA Bronze 5000/50","89942GA005",,"GAN001","GAS002","GAF005","New","HMO","Bronze","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","3","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050013-00","Standard Bronze Off Exchange Plan","61.55%","0.629768133163452","Yes","Yes","No","100%",,"$5,000","$20","$70","$200","$100","$1,600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20303_S01_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","8","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060009","KP GA Bronze HDHP/5000/40/S3","89942GA006",,"GAN001","GAS001","GAF010","Existing","HMO","Bronze","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060009-00","Standard Bronze Off Exchange Plan","60.78%","0.607851922512054","Yes","Yes","No","100%",,"$5,000","$0","$80","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/HDHP%20BRONZE%205000_40_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","8","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060009","KP GA Bronze HDHP/5000/40/S3","89942GA006",,"GAN001","GAS001","GAF010","Existing","HMO","Bronze","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060009-01","Standard Bronze On Exchange Plan","60.78%","0.607851922512054","Yes","Yes","No","100%",,"$5,000","$0","$80","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/HDHP%20BRONZE%205000_40_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","5"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","8","89942","GA","Individual","No","58-1592076","89942GA0050013","KP GA Bronze 5000/50","89942GA005",,"GAN001","GAS002","GAF005","New","HMO","Bronze","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","3","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050013-01","Standard Bronze On Exchange Plan","61.55%","0.629768133163452","Yes","Yes","No","100%",,"$5,000","$20","$70","$200","$100","$1,600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20303_S01_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","5"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","8","89942","GA","Individual","No","58-1592076","89942GA0050013","KP GA Bronze 5000/50","89942GA005",,"GAN001","GAS002","GAF005","New","HMO","Bronze","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","3","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20100_AZ1_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","6"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","8","89942","GA","Individual","No","58-1592076","89942GA0050013","KP GA Bronze 5000/50","89942GA005",,"GAN001","GAS002","GAF005","New","HMO","Bronze","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","3","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050013-03","Limited Cost Sharing Plan Variation","61.55%","0.629768133163452","Yes","Yes","No","100%",,"$5,000","$20","$70","$200","$100","$1,600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20100_AZ1_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","7"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","9","89942","GA","Individual","No","58-1592076","89942GA0050009","KP GA Bronze 6000/40%/HSA","89942GA005",,"GAN001","GAS002","GAF006","Existing","HMO","Bronze","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050009-00","Standard Bronze Off Exchange Plan","61.33%","0.602554678916931","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20302_S01_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","9","89942","GA","Individual","No","58-1592076","89942GA0050009","KP GA Bronze 6000/40%/HSA","89942GA005",,"GAN001","GAS002","GAF006","Existing","HMO","Bronze","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20100_AZ1_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","6"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","9","89942","GA","Individual","No","58-1592076","89942GA0050009","KP GA Bronze 6000/40%/HSA","89942GA005",,"GAN001","GAS002","GAF006","Existing","HMO","Bronze","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050009-03","Limited Cost Sharing Plan Variation","61.33%","0.602554678916931","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20100_AZ1_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","7"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","10","89942","GA","Individual","No","58-1592076","89942GA0050010","KP GA Catastrophic 6850/0","89942GA005",,"GAN001","GAS002","GAF016","Existing","HMO","Catastrophic","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","3","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050010-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20400_001_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","10","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060011","KP GA Silver HRA 2000/40/S3","89942GA006",,"GAN001","GAS001","GAF010","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060011-00","Standard Silver Off Exchange Plan","71.83%","0.718592047691345","Yes","Yes","No","100%",,"$2,000","$0","$1,300","$200","$2,000","$0","$1,200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","Yes","$500.00","http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/KP%20HRA%20SILVER%202000_40_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","10","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060011","KP GA Silver HRA 2000/40/S3","89942GA006",,"GAN001","GAS001","GAF010","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060011-01","Standard Silver On Exchange Plan","71.83%","0.718592047691345","Yes","Yes","No","100%",,"$2,000","$0","$1,300","$200","$2,000","$0","$1,200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","Yes","$500.00","http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/KP%20HRA%20SILVER%202000_40_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","5"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","10","89942","GA","Individual","No","58-1592076","89942GA0050010","KP GA Catastrophic 6850/0","89942GA005",,"GAN001","GAS002","GAF016","Existing","HMO","Catastrophic","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.994",,,,"0","3","0","2016-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0050010-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/georgia/individual/pdfs/On-Exchange2016/PLNSBC_GEO_20400_001_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/ga/60361911_PlanHighlights_KPIF_GA_2016_Final_ADA.pdf","5"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","11","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060012","KP GA Gold 1500/0/20/S3","89942GA006",,"GAN001","GAS001","GAF007","Existing","HMO","Gold","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060012-00","Standard Gold Off Exchange Plan","81.81%","0.820601224899292","No","Yes","No","100%",,"$1,500","$20","$0","$200","$0","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/KP%20GOLD%201500_0_20_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","11","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060012","KP GA Gold 1500/0/20/S3","89942GA006",,"GAN001","GAS001","GAF007","Existing","HMO","Gold","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060012-01","Standard Gold On Exchange Plan","81.81%","0.820601224899292","No","Yes","No","100%",,"$1,500","$20","$0","$200","$0","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/KP%20GOLD%201500_0_20_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","5"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","12","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060013","KP GA Silver 3000/20/40/S3","89942GA006",,"GAN001","GAS001","GAF013","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060013-00","Standard Silver Off Exchange Plan","69.38%","0.697193562984467","No","Yes","No","100%",,"$3,000","$70","$300","$200","$0","$1,800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/KP%20SILVER%203000_20_40_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","12","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060013","KP GA Silver 3000/20/40/S3","89942GA006",,"GAN001","GAS001","GAF013","Existing","HMO","Silver","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060013-01","Standard Silver On Exchange Plan","69.38%","0.697193562984467","No","Yes","No","100%",,"$3,000","$70","$300","$200","$0","$1,800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/KP%20SILVER%203000_20_40_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","5"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","13","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060014","KP GA Gold 500/20/25/S3","89942GA006",,"GAN001","GAS001","GAF007","New","HMO","Gold","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060014-00","Standard Gold Off Exchange Plan","80.09%","0.804284453392029","No","Yes","No","100%",,"$500","$70","$600","$200","$0","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/KP%20GOLD%20500_20_25_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","4"
"2016","GA","89942","HIOS","8","2016-01-22 04:00:42","13","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060014","KP GA Gold 500/20/25/S3","89942GA006",,"GAN001","GAS001","GAF007","New","HMO","Gold","Yes","Both","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.995",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/ga/ga_5tierbenefitformulary_2015.09.pdf","89942GA0060014-01","Standard Gold On Exchange Plan","80.09%","0.804284453392029","No","Yes","No","100%",,"$500","$70","$600","$200","$0","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/georgia/smallbusiness/pdfs/OnExchange2016/KP%20GOLD%20500_20_25_S3%20On.pdf","https://account.kp.org/static/bcssp/pdfs/shared/ga/2016/KP_GA_SB_Plan_Guide_Booklet_2016.pdf","5"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","1","93332","GA","Individual","No","58-2209549","93332GA0710001","Humana Basic 6850/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2604082","http://apps.humana.com/marketing/documents.asp?file=2591719","4"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","1","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0610046","Humana Simplicity Gold 002/100 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF008","New","POS","Gold","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB","93332GA0610046-00","Standard Gold Off Exchange Plan","79.44%","0","No","Yes","No","100%",,"$0","$2,250","$0","$0","$0","$1,830","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,000","$24000 per person","$48000 per group","$0","per person not applicable","per group not applicable","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2642588","http://apps.humana.com/marketing/documents.asp?file=2653872","4"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","1","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0610046","Humana Simplicity Gold 002/100 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF008","New","POS","Gold","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB","93332GA0610046-01","Standard Gold On Exchange Plan","79.44%","0","No","Yes","No","100%",,"$0","$2,250","$0","$0","$0","$1,830","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,000","$24000 per person","$48000 per group","$0","per person not applicable","per group not applicable","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2642588","http://apps.humana.com/marketing/documents.asp?file=2653872","5"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","2","93332","GA","Individual","No","58-2209549","93332GA0710016","Humana Bronze 6450/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710016-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2604368","http://apps.humana.com/marketing/documents.asp?file=2591810","8"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710004","Humana Silver 3800/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710004-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604173","http://apps.humana.com/marketing/documents.asp?file=2591758","5"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710004","Humana Silver 3800/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604186","http://apps.humana.com/marketing/documents.asp?file=2591758","6"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","1","17575","IN","SHOP (Small Group)","No","35-0781558","17575IN0720008","Anthem Silver Blue Preferred X HMO 3000 20  4500 Plus","17575IN072",,"INN003","INS001","INF026","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/INSelectdrugtier4","17575IN0720008-00","Standard Silver Off Exchange Plan","68.86%","0.70249342918396","No","Yes","No","100%",,"$3,000","$0","$417","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YSQ","http://sgplans.anthem.com/in/brochure/","4"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","1","17575","IN","SHOP (Small Group)","No","35-0781558","17575IN0720008","Anthem Silver Blue Preferred X HMO 3000 20  4500 Plus","17575IN072",,"INN003","INS001","INF026","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/INSelectdrugtier4","17575IN0720008-01","Standard Silver On Exchange Plan","68.86%","0.70249342918396","No","Yes","No","100%",,"$3,000","$0","$417","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YSQ","http://sgplans.anthem.com/in/brochure/","5"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","1","93332","GA","Individual","No","58-2209549","93332GA0710001","Humana Basic 6850/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2604082","http://apps.humana.com/marketing/documents.asp?file=2591719","5"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","1","93332","GA","Individual","No","58-2209549","93332GA0710015","Humana Basic 6850/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710015-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2604355","http://apps.humana.com/marketing/documents.asp?file=2591797","6"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","1","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0610047","Humana Simplicity Gold 003/100 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF008","New","POS","Gold","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB","93332GA0610047-00","Standard Gold Off Exchange Plan","78.30%","0","No","Yes","No","100%",,"$0","$2,250","$0","$0","$0","$1,890","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,000","$24000 per person","$48000 per group","$0","per person not applicable","per group not applicable","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2644525","http://apps.humana.com/marketing/documents.asp?file=2653898","6"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","1","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0610047","Humana Simplicity Gold 003/100 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF008","New","POS","Gold","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB","93332GA0610047-01","Standard Gold On Exchange Plan","78.30%","0","No","Yes","No","100%",,"$0","$2,250","$0","$0","$0","$1,890","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,000","$24000 per person","$48000 per group","$0","per person not applicable","per group not applicable","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2644525","http://apps.humana.com/marketing/documents.asp?file=2653898","7"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","1","93332","GA","Individual","No","58-2209549","93332GA0710015","Humana Basic 6850/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710015-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2604355","http://apps.humana.com/marketing/documents.asp?file=2591797","7"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","1","93332","GA","Individual","No","58-2209549","93332GA0710039","Humana Basic 6850/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710039-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2604654","http://apps.humana.com/marketing/documents.asp?file=2591875","8"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","1","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0610048","Humana Simplicity Silver 004/100 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF009","New","POS","Silver","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB","93332GA0610048-00","Standard Silver Off Exchange Plan","71.76%","0","No","Yes","No","100%",,"$0","$2,250","$0","$0","$0","$2,180","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","$27,400","$27400 per person","$54800 per group","$0","per person not applicable","per group not applicable","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645409","http://apps.humana.com/marketing/documents.asp?file=2653924","8"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","1","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0610048","Humana Simplicity Silver 004/100 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF009","New","POS","Silver","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB","93332GA0610048-01","Standard Silver On Exchange Plan","71.76%","0","No","Yes","No","100%",,"$0","$2,250","$0","$0","$0","$2,180","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","$27,400","$27400 per person","$54800 per group","$0","per person not applicable","per group not applicable","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645409","http://apps.humana.com/marketing/documents.asp?file=2653924","9"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","1","93332","GA","Individual","No","58-2209549","93332GA0710039","Humana Basic 6850/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710039-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2604654","http://apps.humana.com/marketing/documents.asp?file=2591875","9"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","1","93332","GA","Individual","No","58-2209549","93332GA0710044","Humana Basic 6850/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710044-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2605122","http://apps.humana.com/marketing/documents.asp?file=2592005","10"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","1","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0580046","Humana Simplicity Gold 002/100 Savannah HMOx","93332GA058",,"GAN005","GAS005","GAF013","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No",,"http://www.humana.com/2016-Rx4-EHB","93332GA0580046-00","Standard Gold Off Exchange Plan","79.44%","0","No","Yes","No","100%",,"$0","$2,250","$0","$0","$0","$1,830","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2644161","http://apps.humana.com/marketing/documents.asp?file=2653885","10"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","1","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0580046","Humana Simplicity Gold 002/100 Savannah HMOx","93332GA058",,"GAN005","GAS005","GAF013","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No",,"http://www.humana.com/2016-Rx4-EHB","93332GA0580046-01","Standard Gold On Exchange Plan","79.44%","0","No","Yes","No","100%",,"$0","$2,250","$0","$0","$0","$1,830","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2644161","http://apps.humana.com/marketing/documents.asp?file=2653885","11"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","1","93332","GA","Individual","No","58-2209549","93332GA0710044","Humana Basic 6850/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710044-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2605122","http://apps.humana.com/marketing/documents.asp?file=2592005","11"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","1","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0580047","Humana Simplicity Gold 003/100 Savannah HMOx","93332GA058",,"GAN005","GAS005","GAF013","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No",,"http://www.humana.com/2016-Rx4-EHB","93332GA0580047-00","Standard Gold Off Exchange Plan","78.30%","0","No","Yes","No","100%",,"$0","$2,250","$0","$0","$0","$1,890","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645383","http://apps.humana.com/marketing/documents.asp?file=2653911","12"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","3","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0580011","Humana Copay Silver 80/2000 Savannah HMOx","93332GA058",,"GAN005","GAS005","GAF016","Existing","HMO","Silver","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No",,"http://www.humana.com/2016-Rx4-EHB","93332GA0580011-01","Standard Silver On Exchange Plan",,"0.711402416229248","No","Yes","No","100%",,"$2,000","$140","$920","$0","$2,000","$1,190","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645708","http://apps.humana.com/marketing/documents.asp?file=2653963","7"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","3","93332","GA","Individual","No","58-2209549","93332GA0710003","Humana Bronze 4850/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710003-03","Limited Cost Sharing Plan Variation","61.72%","0.612140297889709","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604160","http://apps.humana.com/marketing/documents.asp?file=2591745","7"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","1","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0580047","Humana Simplicity Gold 003/100 Savannah HMOx","93332GA058",,"GAN005","GAS005","GAF013","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No",,"http://www.humana.com/2016-Rx4-EHB","93332GA0580047-01","Standard Gold On Exchange Plan","78.30%","0","No","Yes","No","100%",,"$0","$2,250","$0","$0","$0","$1,890","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645383","http://apps.humana.com/marketing/documents.asp?file=2653911","13"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","1","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0580048","Humana Simplicity Silver 004/100 Savannah HMOx","93332GA058",,"GAN005","GAS005","GAF014","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No",,"http://www.humana.com/2016-Rx4-EHB","93332GA0580048-00","Standard Silver Off Exchange Plan","71.76%","0","No","Yes","No","100%",,"$0","$2,250","$0","$0","$0","$2,180","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645435","http://apps.humana.com/marketing/documents.asp?file=2653937","14"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","1","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0580048","Humana Simplicity Silver 004/100 Savannah HMOx","93332GA058",,"GAN005","GAS005","GAF014","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"3","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No",,"http://www.humana.com/2016-Rx4-EHB","93332GA0580048-01","Standard Silver On Exchange Plan","71.76%","0","No","Yes","No","100%",,"$0","$2,250","$0","$0","$0","$2,180","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645435","http://apps.humana.com/marketing/documents.asp?file=2653937","15"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","2","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0610002","Humana Copay Gold 100/1000 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF010","Existing","POS","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB","93332GA0610002-00","Standard Gold Off Exchange Plan",,"0.80921858549118","No","Yes","No","100%",,"$1,000","$140","$0","$0","$1,000","$1,170","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","$16,000","$16000 per person","$32000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"$3,000","$3000 per person","$6000 per group","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645461","http://apps.humana.com/marketing/documents.asp?file=2653989","4"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","2","93332","GA","Individual","No","58-2209549","93332GA0710002","Humana Bronze 6450/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710002-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2604095","http://apps.humana.com/marketing/documents.asp?file=2591732","4"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","2","93332","GA","Individual","No","58-2209549","93332GA0710002","Humana Bronze 6450/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710002-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2604095","http://apps.humana.com/marketing/documents.asp?file=2591732","5"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","2","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0610002","Humana Copay Gold 100/1000 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF010","Existing","POS","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB","93332GA0610002-01","Standard Gold On Exchange Plan",,"0.80921858549118","No","Yes","No","100%",,"$1,000","$140","$0","$0","$1,000","$1,170","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","$16,000","$16000 per person","$32000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"$3,000","$3000 per person","$6000 per group","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645461","http://apps.humana.com/marketing/documents.asp?file=2653989","5"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","2","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0610011","Humana Copay Silver 80/2000 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF011","New","POS","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB","93332GA0610011-00","Standard Silver Off Exchange Plan",,"0.711402416229248","No","Yes","No","100%",,"$2,000","$140","$920","$0","$2,000","$1,190","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","$26,000","$26000 per person","$52000 per group","$2,000","$2000 per person","$4000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645695","http://apps.humana.com/marketing/documents.asp?file=2654002","6"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","2","93332","GA","Individual","No","58-2209549","93332GA0710002","Humana Bronze 6450/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2604108","http://apps.humana.com/marketing/documents.asp?file=2591732","6"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","2","93332","GA","Individual","No","58-2209549","93332GA0710002","Humana Bronze 6450/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710002-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2604121","http://apps.humana.com/marketing/documents.asp?file=2591732","7"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","2","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0610011","Humana Copay Silver 80/2000 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF011","New","POS","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-Rx4-EHB","93332GA0610011-01","Standard Silver On Exchange Plan",,"0.711402416229248","No","Yes","No","100%",,"$2,000","$140","$920","$0","$2,000","$1,190","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","$26,000","$26000 per person","$52000 per group","$2,000","$2000 per person","$4000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645695","http://apps.humana.com/marketing/documents.asp?file=2654002","7"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","2","93332","GA","Individual","No","58-2209549","93332GA0710016","Humana Bronze 6450/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710016-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2604368","http://apps.humana.com/marketing/documents.asp?file=2591810","9"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","2","93332","GA","Individual","No","58-2209549","93332GA0710016","Humana Bronze 6450/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2604381","http://apps.humana.com/marketing/documents.asp?file=2591810","10"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","2","93332","GA","Individual","No","58-2209549","93332GA0710016","Humana Bronze 6450/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710016-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2604407","http://apps.humana.com/marketing/documents.asp?file=2591810","11"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","2","93332","GA","Individual","No","58-2209549","93332GA0710040","Humana Bronze 6450/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710040-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2604667","http://apps.humana.com/marketing/documents.asp?file=2591888","12"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","2","93332","GA","Individual","No","58-2209549","93332GA0710040","Humana Bronze 6450/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710040-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2604667","http://apps.humana.com/marketing/documents.asp?file=2591888","13"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","2","93332","GA","Individual","No","58-2209549","93332GA0710040","Humana Bronze 6450/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710040-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2604693","http://apps.humana.com/marketing/documents.asp?file=2591888","14"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","2","93332","GA","Individual","No","58-2209549","93332GA0710040","Humana Bronze 6450/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710040-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2604706","http://apps.humana.com/marketing/documents.asp?file=2591888","15"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","2","93332","GA","Individual","No","58-2209549","93332GA0710045","Humana Bronze 6450/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710045-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2605135","http://apps.humana.com/marketing/documents.asp?file=2592018","16"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","2","93332","GA","Individual","No","58-2209549","93332GA0710045","Humana Bronze 6450/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710045-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2605135","http://apps.humana.com/marketing/documents.asp?file=2592018","17"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","2","93332","GA","Individual","No","58-2209549","93332GA0710045","Humana Bronze 6450/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710045-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2605161","http://apps.humana.com/marketing/documents.asp?file=2592018","18"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","2","93332","GA","Individual","No","58-2209549","93332GA0710045","Humana Bronze 6450/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0710045-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2605187","http://apps.humana.com/marketing/documents.asp?file=2592018","19"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","3","93332","GA","Individual","No","58-2209549","93332GA0710003","Humana Bronze 4850/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710003-00","Standard Bronze Off Exchange Plan","61.72%","0.612140297889709","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604134","http://apps.humana.com/marketing/documents.asp?file=2591745","4"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","3","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0580002","Humana Copay Gold 100/1000 Savannah HMOx","93332GA058",,"GAN005","GAS005","GAF015","Existing","HMO","Gold","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No",,"http://www.humana.com/2016-Rx4-EHB","93332GA0580002-00","Standard Gold Off Exchange Plan",,"0.80921858549118","No","Yes","No","100%",,"$1,000","$140","$0","$0","$1,000","$1,170","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645487","http://apps.humana.com/marketing/documents.asp?file=2653950","4"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","3","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0580002","Humana Copay Gold 100/1000 Savannah HMOx","93332GA058",,"GAN005","GAS005","GAF015","Existing","HMO","Gold","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No",,"http://www.humana.com/2016-Rx4-EHB","93332GA0580002-01","Standard Gold On Exchange Plan",,"0.80921858549118","No","Yes","No","100%",,"$1,000","$140","$0","$0","$1,000","$1,170","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645487","http://apps.humana.com/marketing/documents.asp?file=2653950","5"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","3","93332","GA","Individual","No","58-2209549","93332GA0710003","Humana Bronze 4850/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710003-01","Standard Bronze On Exchange Plan","61.72%","0.612140297889709","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604134","http://apps.humana.com/marketing/documents.asp?file=2591745","5"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","3","93332","GA","Individual","No","58-2209549","93332GA0710003","Humana Bronze 4850/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604147","http://apps.humana.com/marketing/documents.asp?file=2591745","6"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","3","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0580011","Humana Copay Silver 80/2000 Savannah HMOx","93332GA058",,"GAN005","GAS005","GAF016","Existing","HMO","Silver","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No",,"http://www.humana.com/2016-Rx4-EHB","93332GA0580011-00","Standard Silver Off Exchange Plan",,"0.711402416229248","No","Yes","No","100%",,"$2,000","$140","$920","$0","$2,000","$1,190","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645708","http://apps.humana.com/marketing/documents.asp?file=2653963","6"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","3","93332","GA","Individual","No","58-2209549","93332GA0710017","Humana Bronze 4850/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710017-00","Standard Bronze Off Exchange Plan","61.72%","0.612140297889709","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604420","http://apps.humana.com/marketing/documents.asp?file=2591823","8"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","3","93332","GA","Individual","No","58-2209549","93332GA0710017","Humana Bronze 4850/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710017-01","Standard Bronze On Exchange Plan","61.72%","0.612140297889709","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604420","http://apps.humana.com/marketing/documents.asp?file=2591823","9"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","3","93332","GA","Individual","No","58-2209549","93332GA0710017","Humana Bronze 4850/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710017-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604433","http://apps.humana.com/marketing/documents.asp?file=2591823","10"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","3","93332","GA","Individual","No","58-2209549","93332GA0710017","Humana Bronze 4850/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710017-03","Limited Cost Sharing Plan Variation","61.72%","0.612140297889709","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604446","http://apps.humana.com/marketing/documents.asp?file=2591823","11"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710041","Humana Silver 3800/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710041-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604719","http://apps.humana.com/marketing/documents.asp?file=2591901","27"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710041","Humana Silver 3800/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710041-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604732","http://apps.humana.com/marketing/documents.asp?file=2591901","28"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710041","Humana Silver 3800/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710041-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604758","http://apps.humana.com/marketing/documents.asp?file=2591901","29"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","7","93332","GA","Individual","No","58-2209549","93332GA0720004","Humana Silver 3800/National POS - OpenAccess","93332GA072",,"GAN006","GAS006","GAF006","Existing","POS","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0720004-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604953","http://apps.humana.com/marketing/documents.asp?file=2591966","4"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710004","Humana Silver 3800/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710004-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604173","http://apps.humana.com/marketing/documents.asp?file=2591758","4"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0580051","Humana Copay Silver 50/5000 Savannah HMOx","93332GA058",,"GAN005","GAS005","GAF017","New","HMO","Silver","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No",,"http://www.humana.com/2016-Rx4-EHB","93332GA0580051-00","Standard Silver Off Exchange Plan",,"0.688456594944","No","Yes","No","100%",,"$5,010","$40","$840","$0","$4,040","$450","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645734","http://apps.humana.com/marketing/documents.asp?file=2653976","4"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0580051","Humana Copay Silver 50/5000 Savannah HMOx","93332GA058",,"GAN005","GAS005","GAF017","New","HMO","Silver","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No",,"http://www.humana.com/2016-Rx4-EHB","93332GA0580051-01","Standard Silver On Exchange Plan",,"0.688456594944","No","Yes","No","100%",,"$5,010","$40","$840","$0","$4,040","$450","$0","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://apps.humana.com/marketing/documents.asp?file=2645734","http://apps.humana.com/marketing/documents.asp?file=2653976","5"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710004","Humana Silver 3800/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710004-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604199","http://apps.humana.com/marketing/documents.asp?file=2591758","7"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710004","Humana Silver 3800/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710004-04","73% AV Level Silver Plan","72.87%","0.690446317195892","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604225","http://apps.humana.com/marketing/documents.asp?file=2622776","8"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710004","Humana Silver 3800/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710004-05","87% AV Level Silver Plan","87.86%","0.691016793251038","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604238","http://apps.humana.com/marketing/documents.asp?file=2622789","9"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710004","Humana Silver 3800/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710004-06","94% AV Level Silver Plan","93.14%","0.688213407993317","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604251","http://apps.humana.com/marketing/documents.asp?file=2622802","10"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710006","Humana Gold 2250/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710006-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604264","http://apps.humana.com/marketing/documents.asp?file=2591771","11"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710006","Humana Gold 2250/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710006-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604264","http://apps.humana.com/marketing/documents.asp?file=2591771","12"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710006","Humana Gold 2250/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604277","http://apps.humana.com/marketing/documents.asp?file=2591771","13"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710006","Humana Gold 2250/Atlanta HMOx","93332GA071",,"GAN002","GAS001","GAF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710006-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604303","http://apps.humana.com/marketing/documents.asp?file=2591771","14"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710018","Humana Silver 3800/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710018-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604459","http://apps.humana.com/marketing/documents.asp?file=2591836","15"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710018","Humana Silver 3800/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710018-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604459","http://apps.humana.com/marketing/documents.asp?file=2591836","16"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710018","Humana Silver 3800/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710018-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604472","http://apps.humana.com/marketing/documents.asp?file=2591836","17"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710018","Humana Silver 3800/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710018-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604485","http://apps.humana.com/marketing/documents.asp?file=2591836","18"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710018","Humana Silver 3800/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710018-04","73% AV Level Silver Plan","72.87%","0.690446317195892","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604511","http://apps.humana.com/marketing/documents.asp?file=2622815","19"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710018","Humana Silver 3800/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710018-05","87% AV Level Silver Plan","87.86%","0.691016793251038","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604524","http://apps.humana.com/marketing/documents.asp?file=2622828","20"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710018","Humana Silver 3800/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710018-06","94% AV Level Silver Plan","93.14%","0.688213407993317","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604537","http://apps.humana.com/marketing/documents.asp?file=2622841","21"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710020","Humana Gold 2250/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710020-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604550","http://apps.humana.com/marketing/documents.asp?file=2591849","22"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710020","Humana Gold 2250/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710020-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604550","http://apps.humana.com/marketing/documents.asp?file=2591849","23"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710020","Humana Gold 2250/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710020-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604563","http://apps.humana.com/marketing/documents.asp?file=2591849","24"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710020","Humana Gold 2250/Columbus GA HMOx","93332GA071",,"GAN003","GAS003","GAF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710020-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604589","http://apps.humana.com/marketing/documents.asp?file=2591849","25"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710041","Humana Silver 3800/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710041-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604719","http://apps.humana.com/marketing/documents.asp?file=2591901","26"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710041","Humana Silver 3800/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710041-04","73% AV Level Silver Plan","72.87%","0.690446317195892","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604771","http://apps.humana.com/marketing/documents.asp?file=2622854","30"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710041","Humana Silver 3800/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710041-05","87% AV Level Silver Plan","87.86%","0.691016793251038","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604784","http://apps.humana.com/marketing/documents.asp?file=2622867","31"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710041","Humana Silver 3800/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710041-06","94% AV Level Silver Plan","93.14%","0.688213407993317","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604797","http://apps.humana.com/marketing/documents.asp?file=2622880","32"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710042","Humana Gold 2250/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710042-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604823","http://apps.humana.com/marketing/documents.asp?file=2591914","33"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710042","Humana Gold 2250/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710042-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604823","http://apps.humana.com/marketing/documents.asp?file=2591914","34"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710042","Humana Gold 2250/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710042-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604836","http://apps.humana.com/marketing/documents.asp?file=2591914","35"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710042","Humana Gold 2250/Macon HMOx","93332GA071",,"GAN004","GAS002","GAF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710042-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604849","http://apps.humana.com/marketing/documents.asp?file=2591914","36"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710046","Humana Silver 3800/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710046-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605200","http://apps.humana.com/marketing/documents.asp?file=2592031","37"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710046","Humana Silver 3800/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710046-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605200","http://apps.humana.com/marketing/documents.asp?file=2592031","38"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710046","Humana Silver 3800/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710046-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605213","http://apps.humana.com/marketing/documents.asp?file=2592031","39"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710046","Humana Silver 3800/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710046-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605226","http://apps.humana.com/marketing/documents.asp?file=2592031","40"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710046","Humana Silver 3800/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710046-04","73% AV Level Silver Plan","72.87%","0.690446317195892","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605252","http://apps.humana.com/marketing/documents.asp?file=2622932","41"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710046","Humana Silver 3800/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710046-05","87% AV Level Silver Plan","87.86%","0.691016793251038","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605265","http://apps.humana.com/marketing/documents.asp?file=2622945","42"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710046","Humana Silver 3800/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710046-06","94% AV Level Silver Plan","93.14%","0.688213407993317","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605278","http://apps.humana.com/marketing/documents.asp?file=2622958","43"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710047","Humana Gold 2250/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710047-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605291","http://apps.humana.com/marketing/documents.asp?file=2592044","44"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710047","Humana Gold 2250/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710047-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605291","http://apps.humana.com/marketing/documents.asp?file=2592044","45"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710047","Humana Gold 2250/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710047-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605304","http://apps.humana.com/marketing/documents.asp?file=2592044","46"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","4","93332","GA","Individual","No","58-2209549","93332GA0710047","Humana Gold 2250/Savannah HMOx","93332GA071",,"GAN005","GAS005","GAF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologists and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0710047-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605317","http://apps.humana.com/marketing/documents.asp?file=2592044","47"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","5","93332","GA","Individual","No","58-2209549","93332GA0720001","Humana Basic 6850/National POS - OpenAccess","93332GA072",,"GAN006","GAS006","GAF005","Existing","POS","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0720001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2604901","http://apps.humana.com/marketing/documents.asp?file=2591940","4"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","5","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0610037","Humana EHDHP Bronze 80/5000 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF012","Existing","POS","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-HDHP-EHB","93332GA0610037-00","Standard Bronze Off Exchange Plan",,"0.617450714111328","Yes","Yes","No","100%",,"$5,000","$0","$490","$150","$5,000","$0","$70","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","$25,400","$25400 per person","$50800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","$20,000","$20000 per person","$40000 per group","Yes","No",,"http://apps.humana.com/marketing/documents.asp?file=2645760","http://apps.humana.com/marketing/documents.asp?file=2654015","4"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","5","93332","GA","SHOP (Small Group)","No","58-2209549","93332GA0610037","Humana EHDHP Bronze 80/5000 National POS - Open Access","93332GA061",,"GAN006","GAS006","GAF012","Existing","POS","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Excludes coverage other than ER care from foreign providers.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,"http://www.humana.com/2016-HDHP-EHB","93332GA0610037-01","Standard Bronze On Exchange Plan",,"0.617450714111328","Yes","Yes","No","100%",,"$5,000","$0","$490","$150","$5,000","$0","$70","$20",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","$25,400","$25400 per person","$50800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","$20,000","$20000 per person","$40000 per group","Yes","No",,"http://apps.humana.com/marketing/documents.asp?file=2645760","http://apps.humana.com/marketing/documents.asp?file=2654015","5"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","5","93332","GA","Individual","No","58-2209549","93332GA0720001","Humana Basic 6850/National POS - OpenAccess","93332GA072",,"GAN006","GAS006","GAF005","Existing","POS","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0720001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2604901","http://apps.humana.com/marketing/documents.asp?file=2591940","5"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","6","93332","GA","Individual","No","58-2209549","93332GA0720002","Humana Bronze 6450/National POS - OpenAccess","93332GA072",,"GAN006","GAS006","GAF005","Existing","POS","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0720002-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2604914","http://apps.humana.com/marketing/documents.asp?file=2591953","4"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","6","93332","GA","Individual","No","58-2209549","93332GA0720002","Humana Bronze 6450/National POS - OpenAccess","93332GA072",,"GAN006","GAS006","GAF005","Existing","POS","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0720002-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2604914","http://apps.humana.com/marketing/documents.asp?file=2591953","5"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","6","93332","GA","Individual","No","58-2209549","93332GA0720002","Humana Bronze 6450/National POS - OpenAccess","93332GA072",,"GAN006","GAS006","GAF005","Existing","POS","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0720002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2604927","http://apps.humana.com/marketing/documents.asp?file=2591953","6"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","6","93332","GA","Individual","No","58-2209549","93332GA0720002","Humana Bronze 6450/National POS - OpenAccess","93332GA072",,"GAN006","GAS006","GAF005","Existing","POS","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","93332GA0720002-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2604940","http://apps.humana.com/marketing/documents.asp?file=2591953","7"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","7","93332","GA","Individual","No","58-2209549","93332GA0720004","Humana Silver 3800/National POS - OpenAccess","93332GA072",,"GAN006","GAS006","GAF006","Existing","POS","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0720004-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604953","http://apps.humana.com/marketing/documents.asp?file=2591966","5"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","7","93332","GA","Individual","No","58-2209549","93332GA0720004","Humana Silver 3800/National POS - OpenAccess","93332GA072",,"GAN006","GAS006","GAF006","Existing","POS","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0720004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604966","http://apps.humana.com/marketing/documents.asp?file=2591966","6"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","7","93332","GA","Individual","No","58-2209549","93332GA0720004","Humana Silver 3800/National POS - OpenAccess","93332GA072",,"GAN006","GAS006","GAF006","Existing","POS","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0720004-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604979","http://apps.humana.com/marketing/documents.asp?file=2591966","7"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","7","93332","GA","Individual","No","58-2209549","93332GA0720004","Humana Silver 3800/National POS - OpenAccess","93332GA072",,"GAN006","GAS006","GAF006","Existing","POS","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0720004-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2604992","http://apps.humana.com/marketing/documents.asp?file=2622893","8"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","7","93332","GA","Individual","No","58-2209549","93332GA0720004","Humana Silver 3800/National POS - OpenAccess","93332GA072",,"GAN006","GAS006","GAF006","Existing","POS","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0720004-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605005","http://apps.humana.com/marketing/documents.asp?file=2622906","9"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","7","93332","GA","Individual","No","58-2209549","93332GA0720004","Humana Silver 3800/National POS - OpenAccess","93332GA072",,"GAN006","GAS006","GAF006","Existing","POS","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0720004-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605031","http://apps.humana.com/marketing/documents.asp?file=2622919","10"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","7","93332","GA","Individual","No","58-2209549","93332GA0720006","Humana Gold 2250/National POS - OpenAccess","93332GA072",,"GAN006","GAS006","GAF007","Existing","POS","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0720006-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605018","http://apps.humana.com/marketing/documents.asp?file=2591979","11"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","7","93332","GA","Individual","No","58-2209549","93332GA0720006","Humana Gold 2250/National POS - OpenAccess","93332GA072",,"GAN006","GAS006","GAF007","Existing","POS","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0720006-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605018","http://apps.humana.com/marketing/documents.asp?file=2591979","12"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","7","93332","GA","Individual","No","58-2209549","93332GA0720006","Humana Gold 2250/National POS - OpenAccess","93332GA072",,"GAN006","GAS006","GAF007","Existing","POS","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0720006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605044","http://apps.humana.com/marketing/documents.asp?file=2591979","13"
"2016","GA","93332","HIOS","17","2016-01-28 05:11:31","7","93332","GA","Individual","No","58-2209549","93332GA0720006","Humana Gold 2250/National POS - OpenAccess","93332GA072",,"GAN006","GAS006","GAF007","Existing","POS","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","93332GA0720006-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605057","http://apps.humana.com/marketing/documents.asp?file=2591979","14"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010003","Care Gold I","95852GA001",,"GAN001","GAS001","GAF002","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010003-00","Standard Gold Off Exchange Plan","78.29%",,"No","Yes","Yes","73%","27%","$1,700","$10","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0%","$3,500","$3500 per person","$7000 per group","0%","$7,000","$7000 per person","$14000 per group","$12,250","$12250 per person","$24500 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareGoldIInd.pdf",,"12"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010003","Care Gold I","95852GA001",,"GAN001","GAS001","GAF002","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010003-01","Standard Gold On Exchange Plan","78.29%",,"No","Yes","Yes","73%","27%","$1,700","$10","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0%","$3,500","$3500 per person","$7000 per group","0%","$7,000","$7000 per person","$14000 per group","$12,250","$12250 per person","$24500 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareGoldIInd.pdf",,"13"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010003","Care Gold I","95852GA001",,"GAN001","GAS001","GAF002","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","73%","27%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareGoldI-AIZInd.pdf",,"14"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010003","Care Gold I","95852GA001",,"GAN001","GAS001","GAF002","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010003-03","Limited Cost Sharing Plan Variation","78.29%",,"No","Yes","Yes","73%","27%","$1,700","$10","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0%","$3,500","$3500 per person","$7000 per group","0%","$7,000","$7000 per person","$14000 per group","$12,250","$12250 per person","$24500 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareGoldI-AILInd.pdf",,"15"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010004","Care Gold II","95852GA001",,"GAN001","GAS001","GAF002","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010004-00","Standard Gold Off Exchange Plan","81.17%",,"No","Yes","Yes","73%","27%","$1,400","$10","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","$2,750","$2750 per person","$5500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,375","$1375 per person","$2750 per group","0%","$2,750","$2750 per person","$5500 per group","0%","$5,500","$5500 per person","$11000 per group","$9,625","$9625 per person","$19250 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareGoldIIInd.pdf",,"16"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010004","Care Gold II","95852GA001",,"GAN001","GAS001","GAF002","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010004-01","Standard Gold On Exchange Plan","81.17%",,"No","Yes","Yes","73%","27%","$1,400","$10","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","$2,750","$2750 per person","$5500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,375","$1375 per person","$2750 per group","0%","$2,750","$2750 per person","$5500 per group","0%","$5,500","$5500 per person","$11000 per group","$9,625","$9625 per person","$19250 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareGoldIIInd.pdf",,"17"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010004","Care Gold II","95852GA001",,"GAN001","GAS001","GAF002","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","73%","27%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareGoldII-AIZInd.pdf",,"18"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010004","Care Gold II","95852GA001",,"GAN001","GAS001","GAF002","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010004-03","Limited Cost Sharing Plan Variation","81.17%",,"No","Yes","Yes","73%","27%","$1,400","$10","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","$2,750","$2750 per person","$5500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,375","$1375 per person","$2750 per group","0%","$2,750","$2750 per person","$5500 per group","0%","$5,500","$5500 per person","$11000 per group","$9,625","$9625 per person","$19250 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareGoldII-AILInd.pdf",,"19"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010005","Care Silver I","95852GA001",,"GAN001","GAS001","GAF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010005-00","Standard Silver Off Exchange Plan","68.26%",,"No","Yes","Yes","73%","27%","$3,700","$20","$0","$200","$600","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","0%","$6,200","$6200 per person","$12400 per group","0%","$12,400","$12400 per person","$24800 per group","$22,350","$22350 per person","$44700 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareSilverIInd.pdf",,"20"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010005","Care Silver I","95852GA001",,"GAN001","GAS001","GAF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010005-01","Standard Silver On Exchange Plan","68.26%",,"No","Yes","Yes","73%","27%","$3,700","$20","$0","$200","$600","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","0%","$6,200","$6200 per person","$12400 per group","0%","$12,400","$12400 per person","$24800 per group","$22,350","$22350 per person","$44700 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareSilverIInd.pdf",,"21"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010005","Care Silver I","95852GA001",,"GAN001","GAS001","GAF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010005-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","73%","27%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareSilverI-AIZInd.pdf",,"22"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010005","Care Silver I","95852GA001",,"GAN001","GAS001","GAF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010005-03","Limited Cost Sharing Plan Variation","68.26%",,"No","Yes","Yes","73%","27%","$3,700","$20","$0","$200","$600","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","0%","$6,200","$6200 per person","$12400 per group","0%","$12,400","$12400 per person","$24800 per group","$22,350","$22350 per person","$44700 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareSilverI-AILInd.pdf",,"23"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010005","Care Silver I","95852GA001",,"GAN001","GAS001","GAF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010005-04","73% AV Level Silver Plan","72.50%",,"No","Yes","Yes","73%","27%","$2,600","$10","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","0%","$5,200","$5200 per person","$10400 per group","0%","$10,400","$10400 per person","$20800 per group","$18,200","$18200 per person","$36400 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareSilverI-CSR73Ind.pdf",,"24"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010005","Care Silver I","95852GA001",,"GAN001","GAS001","GAF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010005-05","87% AV Level Silver Plan","86.49%",,"No","Yes","Yes","73%","27%","$800","$10","$0","$200","$800","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","0%","$1,600","$1600 per person","$3200 per group","0%","$5,000","$5000 per person","$10000 per group","$7,400","$7400 per person","$14800 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareSilverI-CSR87Ind.pdf",,"25"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010005","Care Silver I","95852GA001",,"GAN001","GAS001","GAF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010005-06","94% AV Level Silver Plan","93.22%",,"No","Yes","Yes","73%","27%","$300","$10","$0","$200","$300","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%","$600","$600 per person","$1200 per group","0%","$5,000","$5000 per person","$10000 per group","$5,900","$5900 per person","$11800 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareSilverI-CSR94Ind.pdf",,"26"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010006","Care Silver II","95852GA001",,"GAN001","GAS001","GAF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010006-00","Standard Silver Off Exchange Plan","70.46%",,"No","Yes","Yes","73%","27%","$3,000","$20","$0","$200","$600","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%","$6,000","$6000 per person","$12000 per group","0%","$12,000","$12000 per person","$24000 per group","$21,000","$21000 per person","$42000 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareSilverIIInd.pdf",,"27"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010006","Care Silver II","95852GA001",,"GAN001","GAS001","GAF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010006-01","Standard Silver On Exchange Plan","70.46%",,"No","Yes","Yes","73%","27%","$3,000","$20","$0","$200","$600","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%","$6,000","$6000 per person","$12000 per group","0%","$12,000","$12000 per person","$24000 per group","$21,000","$21000 per person","$42000 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareSilverIIInd.pdf",,"28"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010006","Care Silver II","95852GA001",,"GAN001","GAS001","GAF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010006-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","73%","27%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareSilverII-AIZInd.pdf",,"29"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010006","Care Silver II","95852GA001",,"GAN001","GAS001","GAF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010006-03","Limited Cost Sharing Plan Variation","70.46%",,"No","Yes","Yes","73%","27%","$3,000","$20","$0","$200","$600","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%","$6,000","$6000 per person","$12000 per group","0%","$12,000","$12000 per person","$24000 per group","$21,000","$21000 per person","$42000 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareSilverII-AILInd.pdf",,"30"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010006","Care Silver II","95852GA001",,"GAN001","GAS001","GAF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010006-04","73% AV Level Silver Plan","73.03%",,"No","Yes","Yes","73%","27%","$2,500","$20","$0","$200","$600","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%","$5,000","$5000 per person","$10000 per group","0%","$10,000","$10000 per person","$20000 per group","$17,500","$17500 per person","$35000 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareSilverII-CSR73Ind.pdf",,"31"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010006","Care Silver II","95852GA001",,"GAN001","GAS001","GAF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010006-05","87% AV Level Silver Plan","87.56%",,"No","Yes","Yes","73%","27%","$700","$20","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","$1,400","$1400 per person","$2800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","0%","$1,400","$1400 per person","$2800 per group","0%","$5,000","$5000 per person","$10000 per group","$7,100","$7100 per person","$14200 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareSilverII-CSR87Ind.pdf",,"32"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010006","Care Silver II","95852GA001",,"GAN001","GAS001","GAF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010006-06","94% AV Level Silver Plan","94.08%",,"No","Yes","Yes","73%","27%","$300","$10","$0","$200","$200","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$500","$500 per person","$1000 per group","0%","$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareSilverII-CSR94Ind.pdf",,"33"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010007","Care Bronze","95852GA001",,"GAN001","GAS001","GAF004","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010007-00","Standard Bronze Off Exchange Plan","61.76%",,"No","Yes","Yes","73%","27%","$6,300","$0","$0","$200","$4,700","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%","$6,850","$6850 per person","$13700 per group","0%","$13,700","$13700 per person","$27400 per group","$27,400","$27400 per person","$54800 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareBronzeInd.pdf",,"34"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010007","Care Bronze","95852GA001",,"GAN001","GAS001","GAF004","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010007-01","Standard Bronze On Exchange Plan","61.76%",,"No","Yes","Yes","73%","27%","$6,300","$0","$0","$200","$4,700","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%","$6,850","$6850 per person","$13700 per group","0%","$13,700","$13700 per person","$27400 per group","$27,400","$27400 per person","$54800 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareBronzeInd.pdf",,"35"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010007","Care Bronze","95852GA001",,"GAN001","GAS001","GAF004","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","73%","27%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareBronze-AIZInd.pdf",,"36"
"2016","GA","95852","HIOS","6","2015-08-26 09:56:12","1","95852","GA","Individual","No","35-1279304","95852GA0010007","Care Bronze","95852GA001",,"GAN001","GAS001","GAF004","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","95852GA0010007-03","Limited Cost Sharing Plan Variation","61.76%",,"No","Yes","Yes","73%","27%","$6,300","$0","$0","$200","$4,700","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%","$6,850","$6850 per person","$13700 per group","0%","$13,700","$13700 per person","$27400 per group","$27,400","$27400 per person","$54800 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/GACareBronze-AILInd.pdf",,"37"
"2016","GA","98239","HIOS","2","2015-07-09 13:17:42","1","98239","GA","SHOP (Small Group)","Yes","41-0808596","98239GA0010004","Plan 9. MAC PPO, $1500 Annual Maximum, Ortho","98239GA001",,"GAN001","GAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$20.18","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","98239GA0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","10064","HIOS","2","2015-07-10 02:19:03","1","10064","IN","SHOP (Small Group)","Yes","42-0127290","10064IN0050001","Principal Plan Dental 70","10064IN005",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$28.21","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","10064IN0050001-00","Standard Low Off Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","10064","HIOS","2","2015-07-10 02:19:03","1","10064","IN","SHOP (Small Group)","Yes","42-0127290","10064IN0050002","Principal Plan Dental 85","10064IN005",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$29.83","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","10064IN0050002-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","1","17575","IN","Individual","No","35-0781558","17575IN0700020","Anthem Bronze Pathway X 6250 20","17575IN070",,"INN001","INS001","INF024","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700020-00","Standard Bronze Off Exchange Plan","61.95%","0.628046154975891","Yes","Yes","No","100%",,"$6,250","$0","$72","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J78","http://editiondigital.net/view/IU65/2016/OFF_HIX_IN_KIT_2016","4"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","1","17575","IN","Individual","Yes","35-0781558","17575IN0840003","Anthem Dental Pediatric","17575IN084",,"INN005","INS019",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$19.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","17575IN0840003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e213900.pdf",,"4"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","1","17575","IN","SHOP (Small Group)","Yes","35-0781558","17575IN0870003","Anthem Dental Pediatric","17575IN087",,"INN005","INS019",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$19.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","17575IN0870003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e213900.pdf",,"4"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","1","17575","IN","Individual","Yes","35-0781558","17575IN0900003","Anthem Dental Pediatric","17575IN090",,"INN005","INS019",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$19.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","17575IN0900003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e213900.pdf",,"5"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","1","17575","IN","Individual","No","35-0781558","17575IN0700020","Anthem Bronze Pathway X 6250 20","17575IN070",,"INN001","INS001","INF024","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700020-01","Standard Bronze On Exchange Plan","61.95%","0.628046154975891","Yes","Yes","No","100%",,"$6,250","$0","$72","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GEU","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","5"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","1","17575","IN","Individual","No","35-0781558","17575IN0700020","Anthem Bronze Pathway X 6250 20","17575IN070",,"INN001","INS001","INF024","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700020-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GFT","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","6"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","1","17575","IN","SHOP (Small Group)","No","35-0781558","17575IN0720009","Anthem Silver Blue Preferred X HMO 2000 30  5500 Plus","17575IN072",,"INN003","INS001","INF026","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/INSelectdrugtier4","17575IN0720009-00","Standard Silver Off Exchange Plan","69.03%","0.712234795093536","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YRW","http://sgplans.anthem.com/in/brochure/","6"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","1","17575","IN","SHOP (Small Group)","No","35-0781558","17575IN0720009","Anthem Silver Blue Preferred X HMO 2000 30  5500 Plus","17575IN072",,"INN003","INS001","INF026","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/INSelectdrugtier4","17575IN0720009-01","Standard Silver On Exchange Plan","69.03%","0.712234795093536","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YRW","http://sgplans.anthem.com/in/brochure/","7"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","1","17575","IN","Individual","No","35-0781558","17575IN0700020","Anthem Bronze Pathway X 6250 20","17575IN070",,"INN001","INS001","INF024","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700020-03","Limited Cost Sharing Plan Variation","61.95%","0.628046154975891","Yes","Yes","No","100%",,"$6,250","$0","$72","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GEU","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","7"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","1","17575","IN","Individual","No","35-0781558","17575IN0700021","Anthem Bronze Pathway X 4850 20","17575IN070",,"INN001","INS001","INF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700021-00","Standard Bronze Off Exchange Plan","61.94%","0.624456286430359","Yes","Yes","No","100%",,"$4,850","$0","$352","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J7B","http://editiondigital.net/view/IU65/2016/OFF_HIX_IN_KIT_2016","8"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","1","17575","IN","Individual","No","35-0781558","17575IN0700021","Anthem Bronze Pathway X 4850 20","17575IN070",,"INN001","INS001","INF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700021-01","Standard Bronze On Exchange Plan","61.94%","0.624456286430359","Yes","Yes","No","100%",,"$4,850","$0","$352","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GEX","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","9"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","1","17575","IN","Individual","No","35-0781558","17575IN0700021","Anthem Bronze Pathway X 4850 20","17575IN070",,"INN001","INS001","INF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700021-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GFW","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","10"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","1","17575","IN","Individual","No","35-0781558","17575IN0700021","Anthem Bronze Pathway X 4850 20","17575IN070",,"INN001","INS001","INF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700021-03","Limited Cost Sharing Plan Variation","61.94%","0.624456286430359","Yes","Yes","No","100%",,"$4,850","$0","$352","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GEX","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","11"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","1","17575","IN","Individual","No","35-0781558","17575IN0700023","Anthem Bronze Pathway X 6400 30","17575IN070",,"INN001","INS001","INF023","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700023-00","Standard Bronze Off Exchange Plan","61.89%","0.628613293170929","Yes","Yes","No","100%",,"$6,400","$0","$63","$0","$1,049","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J77","http://editiondigital.net/view/IU65/2016/OFF_HIX_IN_KIT_2016","12"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","1","17575","IN","Individual","No","35-0781558","17575IN0700023","Anthem Bronze Pathway X 6400 30","17575IN070",,"INN001","INS001","INF023","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700023-01","Standard Bronze On Exchange Plan","61.89%","0.628613293170929","Yes","Yes","No","100%",,"$6,400","$0","$63","$0","$1,049","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GET","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","13"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","1","17575","IN","Individual","No","35-0781558","17575IN0700023","Anthem Bronze Pathway X 6400 30","17575IN070",,"INN001","INS001","INF023","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700023-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd11GFS","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","14"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","1","17575","IN","Individual","No","35-0781558","17575IN0700023","Anthem Bronze Pathway X 6400 30","17575IN070",,"INN001","INS001","INF023","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700023-03","Limited Cost Sharing Plan Variation","61.89%","0.628613293170929","Yes","Yes","No","100%",,"$6,400","$0","$63","$0","$1,049","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GET","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","15"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700024","Anthem Bronze Pathway X 0 for HSA","17575IN070",,"INN001","INS001","INF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700024-00","Standard Bronze Off Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$6,300","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J76","http://editiondigital.net/view/IU65/2016/OFF_HIX_IN_KIT_2016","4"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","Yes","35-0781558","17575IN0860003","Anthem Dental Family","17575IN086",,"INN005","INS019",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","17575IN0860003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e213898.pdf",,"4"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","SHOP (Small Group)","Yes","35-0781558","17575IN0830003","Anthem Dental Family","17575IN083",,"INN005","INS019",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","17575IN0830003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e213898.pdf",,"4"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","SHOP (Small Group)","Yes","35-0781558","17575IN0890003","Anthem Dental Family","17575IN089",,"INN005","INS019",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","17575IN0890003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e213898.pdf",,"5"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","Yes","35-0781558","17575IN0920003","Anthem Dental Family","17575IN092",,"INN005","INS019",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","17575IN0920003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e213898.pdf",,"5"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700033","Anthem Bronze Pathway X 6850 0","17575IN070",,"INN001","INS001","INF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700033-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1XAH","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","36"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700033","Anthem Bronze Pathway X 6850 0","17575IN070",,"INN001","INS001","INF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700033-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAG","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","37"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","3","17575","IN","Individual","Yes","35-0781558","17575IN0860004","Anthem Dental Family Enhanced","17575IN086",,"INN005","INS019",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","17575IN0860004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e213899.pdf",,"4"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","3","17575","IN","Individual","No","35-0781558","17575IN0700034","Anthem Silver Pathway X 4250 30","17575IN070",,"INN001","INS001","INF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700034-00","Standard Silver Off Exchange Plan","68.20%","0.683814525604248","No","Yes","No","100%",,"$4,250","$65","$688","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XAK","http://editiondigital.net/view/IU65/2016/OFF_HIX_IN_KIT_2016","4"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","3","17575","IN","SHOP (Small Group)","Yes","35-0781558","17575IN0830004","Anthem Dental Family Enhanced","17575IN083",,"INN005","INS019",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","17575IN0830004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e213899.pdf",,"4"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","3","17575","IN","SHOP (Small Group)","No","35-0781558","17575IN0720012","Anthem Gold Blue Preferred X HMO 1000 10  6850 Plus","17575IN072",,"INN003","INS001","INF026","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/INSelectdrugtier4","17575IN0720012-00","Standard Gold Off Exchange Plan","79.51%","0.785064518451691","No","Yes","No","100%",,"$1,000","$0","$408","$0","$424","$30","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$1,000","$1000 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","per person not applicable","$500 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1PQB","http://sgplans.anthem.com/in/brochure/","4"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","3","17575","IN","SHOP (Small Group)","No","35-0781558","17575IN0720012","Anthem Gold Blue Preferred X HMO 1000 10  6850 Plus","17575IN072",,"INN003","INS001","INF026","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/INSelectdrugtier4","17575IN0720012-01","Standard Gold On Exchange Plan","79.51%","0.785064518451691","No","Yes","No","100%",,"$1,000","$0","$408","$0","$424","$30","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$1,000","$1000 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","per person not applicable","$500 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1PQB","http://sgplans.anthem.com/in/brochure/","5"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700024","Anthem Bronze Pathway X 0 for HSA","17575IN070",,"INN001","INS001","INF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700024-01","Standard Bronze On Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$6,300","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GES","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","5"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700024","Anthem Bronze Pathway X 0 for HSA","17575IN070",,"INN001","INS001","INF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700024-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GFR","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","6"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700024","Anthem Bronze Pathway X 0 for HSA","17575IN070",,"INN001","INS001","INF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700024-03","Limited Cost Sharing Plan Variation",,"0.607437193393707","Yes","Yes","No","100%",,"$6,300","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GES","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","7"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700025","Anthem Bronze Pathway X 20 for HSA","17575IN070",,"INN001","INS001","INF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700025-00","Standard Bronze Off Exchange Plan","61.75%","0.627034485340118","Yes","Yes","No","100%",,"$4,500","$0","$422","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J7A","http://editiondigital.net/view/IU65/2016/OFF_HIX_IN_KIT_2016","8"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700025","Anthem Bronze Pathway X 20 for HSA","17575IN070",,"INN001","INS001","INF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700025-01","Standard Bronze On Exchange Plan","61.75%","0.627034485340118","Yes","Yes","No","100%",,"$4,500","$0","$422","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GEW","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","9"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700025","Anthem Bronze Pathway X 20 for HSA","17575IN070",,"INN001","INS001","INF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700025-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GFV","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","10"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700025","Anthem Bronze Pathway X 20 for HSA","17575IN070",,"INN001","INS001","INF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700025-03","Limited Cost Sharing Plan Variation","61.75%","0.627034485340118","Yes","Yes","No","100%",,"$4,500","$0","$422","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GEW","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","11"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700026","Anthem Silver Pathway X 3500 0","17575IN070",,"INN001","INS001","INF019","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700026-00","Standard Silver Off Exchange Plan",,"0.719427406787872","Yes","Yes","No","100%",,"$3,500","$500","$0","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J7C","http://editiondigital.net/view/IU65/2016/OFF_HIX_IN_KIT_2016","12"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700026","Anthem Silver Pathway X 3500 0","17575IN070",,"INN001","INS001","INF019","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700026-01","Standard Silver On Exchange Plan",,"0.719427406787872","Yes","Yes","No","100%",,"$3,500","$500","$0","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GEY","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","13"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700026","Anthem Silver Pathway X 3500 0","17575IN070",,"INN001","INS001","INF019","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GFX","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","14"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700026","Anthem Silver Pathway X 3500 0","17575IN070",,"INN001","INS001","INF019","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700026-03","Limited Cost Sharing Plan Variation",,"0.719427406787872","Yes","Yes","No","100%",,"$3,500","$500","$0","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GEY","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","15"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700026","Anthem Silver Pathway X 3500 0","17575IN070",,"INN001","INS001","INF019","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700026-04","73% AV Level Silver Plan",,"0.73946338891983","Yes","Yes","No","100%",,"$3,400","$500","$0","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GEZ","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","16"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700026","Anthem Silver Pathway X 3500 0","17575IN070",,"INN001","INS001","INF019","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700026-05","87% AV Level Silver Plan",,"0.879276812076569","Yes","Yes","No","100%",,"$900","$250","$0","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GF0","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","17"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700026","Anthem Silver Pathway X 3500 0","17575IN070",,"INN001","INS001","INF019","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700026-06","94% AV Level Silver Plan",,"0.948595941066742","Yes","Yes","No","100%",,"$200","$100","$0","$0","$200","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GF1","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","18"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700028","Anthem Silver Pathway X 10 for HSA","17575IN070",,"INN001","INS001","INF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700028-00","Standard Silver Off Exchange Plan","70.52%","0.708523213863373","Yes","Yes","No","100%",,"$3,000","$500","$311","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J7D","http://editiondigital.net/view/IU65/2016/OFF_HIX_IN_KIT_2016","19"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700028","Anthem Silver Pathway X 10 for HSA","17575IN070",,"INN001","INS001","INF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700028-01","Standard Silver On Exchange Plan","70.52%","0.708523213863373","Yes","Yes","No","100%",,"$3,000","$500","$311","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GF2","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","20"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700028","Anthem Silver Pathway X 10 for HSA","17575IN070",,"INN001","INS001","INF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700028-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GFY","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","21"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700028","Anthem Silver Pathway X 10 for HSA","17575IN070",,"INN001","INS001","INF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700028-03","Limited Cost Sharing Plan Variation","70.52%","0.708523213863373","Yes","Yes","No","100%",,"$3,000","$500","$311","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GF2","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","22"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700028","Anthem Silver Pathway X 10 for HSA","17575IN070",,"INN001","INS001","INF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700028-04","73% AV Level Silver Plan","72.53%","0.728984713554382","Yes","Yes","No","100%",,"$2,600","$500","$351","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GF3","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","23"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700028","Anthem Silver Pathway X 10 for HSA","17575IN070",,"INN001","INS001","INF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700028-05","87% AV Level Silver Plan","87.46%","0.874577879905701","Yes","Yes","No","100%",,"$1,150","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GF4","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","24"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700028","Anthem Silver Pathway X 10 for HSA","17575IN070",,"INN001","INS001","INF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700028-06","94% AV Level Silver Plan","93.96%","0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$0","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GF5","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","25"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700031","Anthem Bronze Pathway X 5850 35","17575IN070",,"INN001","INS001","INF005","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700031-00","Standard Bronze Off Exchange Plan","58.05%","0.585495233535767","Yes","Yes","No","100%",,"$5,850","$0","$266","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAM","http://editiondigital.net/view/IU65/2016/OFF_HIX_IN_KIT_2016","26"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700031","Anthem Bronze Pathway X 5850 35","17575IN070",,"INN001","INS001","INF005","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700031-01","Standard Bronze On Exchange Plan","58.05%","0.585495233535767","Yes","Yes","No","100%",,"$5,850","$0","$266","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAB","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","27"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700031","Anthem Bronze Pathway X 5850 35","17575IN070",,"INN001","INS001","INF005","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700031-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1XAC","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","28"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700031","Anthem Bronze Pathway X 5850 35","17575IN070",,"INN001","INS001","INF005","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700031-03","Limited Cost Sharing Plan Variation","58.05%","0.585495233535767","Yes","Yes","No","100%",,"$5,850","$0","$266","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAB","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","29"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700032","Anthem Bronze Pathway X 4950 50","17575IN070",,"INN001","INS001","INF007","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700032-00","Standard Bronze Off Exchange Plan","58.07%","0.582850992679596","Yes","Yes","No","100%",,"$4,950","$0","$830","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAN","http://editiondigital.net/view/IU65/2016/OFF_HIX_IN_KIT_2016","30"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700032","Anthem Bronze Pathway X 4950 50","17575IN070",,"INN001","INS001","INF007","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700032-01","Standard Bronze On Exchange Plan","58.07%","0.582850992679596","Yes","Yes","No","100%",,"$4,950","$0","$830","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAE","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","31"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700032","Anthem Bronze Pathway X 4950 50","17575IN070",,"INN001","INS001","INF007","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700032-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1XAF","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","32"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700032","Anthem Bronze Pathway X 4950 50","17575IN070",,"INN001","INS001","INF007","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700032-03","Limited Cost Sharing Plan Variation","58.07%","0.582850992679596","Yes","Yes","No","100%",,"$4,950","$0","$830","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAE","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","33"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700033","Anthem Bronze Pathway X 6850 0","17575IN070",,"INN001","INS001","INF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700033-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAP","http://editiondigital.net/view/IU65/2016/OFF_HIX_IN_KIT_2016","34"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","2","17575","IN","Individual","No","35-0781558","17575IN0700033","Anthem Bronze Pathway X 6850 0","17575IN070",,"INN001","INS001","INF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700033-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAG","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","35"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","3","17575","IN","SHOP (Small Group)","Yes","35-0781558","17575IN0890004","Anthem Dental Family Enhanced","17575IN089",,"INN005","INS019",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","17575IN0890004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e213899.pdf",,"5"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","3","17575","IN","Individual","No","35-0781558","17575IN0700034","Anthem Silver Pathway X 4250 30","17575IN070",,"INN001","INS001","INF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700034-01","Standard Silver On Exchange Plan","68.20%","0.683814525604248","No","Yes","No","100%",,"$4,250","$65","$688","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XA2","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","5"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","3","17575","IN","Individual","Yes","35-0781558","17575IN0920004","Anthem Dental Family Enhanced","17575IN092",,"INN005","INS019",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","17575IN0920004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/in/f0/s0/t0/pw_e213899.pdf",,"5"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","3","17575","IN","Individual","No","35-0781558","17575IN0700034","Anthem Silver Pathway X 4250 30","17575IN070",,"INN001","INS001","INF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700034-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XA6","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","6"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","3","17575","IN","Individual","No","35-0781558","17575IN0700034","Anthem Silver Pathway X 4250 30","17575IN070",,"INN001","INS001","INF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700034-03","Limited Cost Sharing Plan Variation","68.20%","0.683814525604248","No","Yes","No","100%",,"$4,250","$65","$688","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XA2","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","7"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","3","17575","IN","Individual","No","35-0781558","17575IN0700034","Anthem Silver Pathway X 4250 30","17575IN070",,"INN001","INS001","INF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700034-04","73% AV Level Silver Plan","72.11%","0.715724647045136","No","Yes","No","100%",,"$3,200","$500","$500","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XA3","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","8"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","3","17575","IN","Individual","No","35-0781558","17575IN0700034","Anthem Silver Pathway X 4250 30","17575IN070",,"INN001","INS001","INF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700034-05","87% AV Level Silver Plan","86.08%","0.866668999195099","No","Yes","No","100%",,"$1,000","$250","$400","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XA4","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","9"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","3","17575","IN","Individual","No","35-0781558","17575IN0700034","Anthem Silver Pathway X 4250 30","17575IN070",,"INN001","INS001","INF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700034-06","94% AV Level Silver Plan","93.06%","0.924443304538727","No","Yes","No","100%",,"$250","$150","$250","$0","$250","$30","$52","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XA5","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","10"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","3","17575","IN","Individual","No","35-0781558","17575IN0700030","Anthem Gold Pathway X 1500 25","17575IN070",,"INN001","INS001","INF016","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700030-00","Standard Gold Off Exchange Plan","78.02%","0.771963894367218","No","Yes","No","100%",,"$1,500","$500","$1,153","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,450","$3450 per person","$6900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XAL","http://editiondigital.net/view/IU65/2016/OFF_HIX_IN_KIT_2016","11"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","3","17575","IN","Individual","No","35-0781558","17575IN0700030","Anthem Gold Pathway X 1500 25","17575IN070",,"INN001","INS001","INF016","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700030-01","Standard Gold On Exchange Plan","78.02%","0.771963894367218","No","Yes","No","100%",,"$1,500","$500","$1,153","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,450","$3450 per person","$6900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XA8","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","12"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","3","17575","IN","Individual","No","35-0781558","17575IN0700030","Anthem Gold Pathway X 1500 25","17575IN070",,"INN001","INS001","INF016","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700030-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XA9","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","13"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","3","17575","IN","Individual","No","35-0781558","17575IN0700030","Anthem Gold Pathway X 1500 25","17575IN070",,"INN001","INS001","INF016","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700030-03","Limited Cost Sharing Plan Variation","78.02%","0.771963894367218","No","Yes","No","100%",,"$1,500","$500","$1,153","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,450","$3450 per person","$6900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XA8","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","14"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","4","17575","IN","Individual","No","35-0781558","17575IN0700029","Anthem Catastrophic Pathway X 6850 0","17575IN070",,"INN001","INS001","INF001","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700029-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,554","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GER","http://editiondigital.net/view/IU65/2016/OFF_HIX_IN_KIT_2016","4"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","4","17575","IN","SHOP (Small Group)","No","35-0781558","17575IN0730003","Anthem Bronze Blue Preferred X POS 6000 30  6850 Plus","17575IN073",,"INN003","INS001","INF027","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","Yes",,"https://www.anthem.com/INSelectdrugtier4","17575IN0730003-00","Standard Bronze Off Exchange Plan","59.70%","0","No","Yes","No","100%",,"$5,048","$0","$0","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$6,000","$6000 per person","$12000 per group","30%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YS5","http://sgplans.anthem.com/in/brochure/","4"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","4","17575","IN","SHOP (Small Group)","No","35-0781558","17575IN0730003","Anthem Bronze Blue Preferred X POS 6000 30  6850 Plus","17575IN073",,"INN003","INS001","INF027","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","Yes",,"https://www.anthem.com/INSelectdrugtier4","17575IN0730003-01","Standard Bronze On Exchange Plan","59.70%","0","No","Yes","No","100%",,"$5,048","$0","$0","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$6,000","$6000 per person","$12000 per group","30%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YS5","http://sgplans.anthem.com/in/brochure/","5"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","4","17575","IN","Individual","No","35-0781558","17575IN0700029","Anthem Catastrophic Pathway X 6850 0","17575IN070",,"INN001","INS001","INF001","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700029-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,554","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GEQ","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","5"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","4","17575","IN","Individual","No","35-0781558","17575IN0700027","Anthem Silver Pathway X 2500 10","17575IN070",,"INN001","INS001","INF020","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700027-00","Standard Silver Off Exchange Plan","71.01%","0.723753929138184","Yes","Yes","No","100%",,"$2,500","$500","$361","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GER","http://editiondigital.net/view/IU65/2016/OFF_HIX_IN_KIT_2016","6"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","4","17575","IN","Individual","No","35-0781558","17575IN0700027","Anthem Silver Pathway X 2500 10","17575IN070",,"INN001","INS001","INF020","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700027-01","Standard Silver On Exchange Plan","71.01%","0.723753929138184","Yes","Yes","No","100%",,"$2,500","$500","$361","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GF6","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","7"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","4","17575","IN","Individual","No","35-0781558","17575IN0700027","Anthem Silver Pathway X 2500 10","17575IN070",,"INN001","INS001","INF020","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700027-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GFZ","http://editiondigital.net/view/IU65/2016/OFF_HIX_IN_KIT_2016","8"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","4","17575","IN","Individual","No","35-0781558","17575IN0700027","Anthem Silver Pathway X 2500 10","17575IN070",,"INN001","INS001","INF020","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700027-03","Limited Cost Sharing Plan Variation","71.01%","0.723753929138184","Yes","Yes","No","100%",,"$2,500","$500","$361","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GF6","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","9"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","4","17575","IN","Individual","No","35-0781558","17575IN0700027","Anthem Silver Pathway X 2500 10","17575IN070",,"INN001","INS001","INF020","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700027-04","73% AV Level Silver Plan","73.82%","0.747634410858154","Yes","Yes","No","100%",,"$2,450","$500","$366","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GF7","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","10"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","4","17575","IN","Individual","No","35-0781558","17575IN0700027","Anthem Silver Pathway X 2500 10","17575IN070",,"INN001","INS001","INF020","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700027-05","87% AV Level Silver Plan","87.63%","0.87580668926239","Yes","Yes","No","100%",,"$750","$250","$561","$0","$750","$50","$35","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GF8","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","11"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","4","17575","IN","Individual","No","35-0781558","17575IN0700027","Anthem Silver Pathway X 2500 10","17575IN070",,"INN001","INS001","INF020","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0700027-06","94% AV Level Silver Plan","93.78%","0.935248494148254","Yes","Yes","No","100%",,"$200","$150","$350","$0","$200","$20","$93","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GF9","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","12"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","5","17575","IN","Individual","No","35-0781558","17575IN0760002","Anthem Bronze Pathway X POS 5000 40","17575IN076",,"INN001","INS001","INF006","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0760002-00","Standard Bronze Off Exchange Plan","60.95%","0.611077845096588","Yes","Yes","No","100%",,"$5,000","$0","$644","$0","$1,049","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$30,000","$30000 per person","$60000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J79","http://editiondigital.net/view/IU65/2016/OFF_HIX_IN_KIT_2016","4"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","5","17575","IN","Individual","No","35-0781558","17575IN0760002","Anthem Bronze Pathway X POS 5000 40","17575IN076",,"INN001","INS001","INF006","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0760002-01","Standard Bronze On Exchange Plan","60.95%","0.611077845096588","Yes","Yes","No","100%",,"$5,000","$0","$644","$0","$1,049","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$30,000","$30000 per person","$60000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GEV","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","5"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","5","17575","IN","Individual","No","35-0781558","17575IN0760002","Anthem Bronze Pathway X POS 5000 40","17575IN076",,"INN001","INS001","INF006","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0760002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GFU","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","6"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","5","17575","IN","Individual","No","35-0781558","17575IN0760002","Anthem Bronze Pathway X POS 5000 40","17575IN076",,"INN001","INS001","INF006","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","https://www.anthem.com/INSelectdrugtier4","17575IN0760002-03","Limited Cost Sharing Plan Variation","60.95%","0.611077845096588","Yes","Yes","No","100%",,"$5,000","$0","$644","$0","$1,049","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$30,000","$30000 per person","$60000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GEV","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","7"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","10","17575","IN","SHOP (Small Group)","No","35-0781558","17575IN0720010","Anthem Bronze Blue Preferred X HMO 6000 30  6850 Plus","17575IN072",,"INN003","INS001","INF026","Existing","HMO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/INSelectdrugtier4","17575IN0720010-00","Standard Bronze Off Exchange Plan","59.70%","0","No","Yes","No","100%",,"$5,084","$0","$0","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$6,000","$6000 per person","$12000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YSM","http://sgplans.anthem.com/in/brochure/","4"
"2016","IN","17575","HIOS","8","2016-07-07 07:50:21","10","17575","IN","SHOP (Small Group)","No","35-0781558","17575IN0720010","Anthem Bronze Blue Preferred X HMO 6000 30  6850 Plus","17575IN072",,"INN003","INS001","INF026","Existing","HMO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/INSelectdrugtier4","17575IN0720010-01","Standard Bronze On Exchange Plan","59.70%","0","No","Yes","No","100%",,"$5,084","$0","$0","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$6,000","$6000 per person","$12000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YSM","http://sgplans.anthem.com/in/brochure/","5"
"2016","IN","21029","HIOS","2","2015-07-09 13:17:42","1","21029","IN","SHOP (Small Group)","Yes","81-0170040","21029IN0010001","Assurant Dental ACAFFO High","21029IN001",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$39.93","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","21029IN0010001-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","21029","HIOS","2","2015-07-09 13:17:42","1","21029","IN","SHOP (Small Group)","Yes","81-0170040","21029IN0010002","Assurant Dental ACAFFO Low","21029IN001",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$33.23","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","21029IN0010002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IN","28856","HIOS","2","2015-06-24 02:34:55","1","28856","IN","Individual","Yes","35-1545647","28856IN0160001","Delta Dental Individual PPO, EHB Certified","28856IN016",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.54","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28856IN0160001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","28856","HIOS","2","2015-06-24 02:34:55","1","28856","IN","SHOP (Small Group)","Yes","35-1545647","28856IN0190001","Delta Dental Group PPO, EHB Certified","28856IN019",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.37","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28856IN0190001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","28856","HIOS","2","2015-06-24 02:34:55","1","28856","IN","SHOP (Small Group)","Yes","35-1545647","28856IN0190002","Delta Dental Group PPO, EHB Certified","28856IN019",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.34","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28856IN0190002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IN","28856","HIOS","2","2015-06-24 02:34:55","1","28856","IN","Individual","Yes","35-1545647","28856IN0160002","Delta Dental Individual PPO, EHB Certified","28856IN016",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.59","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28856IN0160002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IN","28856","HIOS","2","2015-06-24 02:34:55","1","28856","IN","Individual","Yes","35-1545647","28856IN0220001","Delta Dental Individual PPO, EHB Certified (Exchange)","28856IN022",,"INN001","INS001",,"New","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28856","","28856IN0220001-01","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalin.com/IN_EHB_High_2016","http://www.deltadentalin.com/IN_EHB_High_2016","6"
"2016","IN","28856","HIOS","2","2015-06-24 02:34:55","1","28856","IN","SHOP (Small Group)","Yes","35-1545647","28856IN0190003","Delta Dental Group PPO, EHB Certified","28856IN019",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.32","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28856IN0190003-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","IN","28856","HIOS","2","2015-06-24 02:34:55","1","28856","IN","SHOP (Small Group)","Yes","35-1545647","28856IN0190004","Delta Dental Group PPO, EHB Certified","28856IN019",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.60","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28856IN0190004-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","IN","28856","HIOS","2","2015-06-24 02:34:55","1","28856","IN","Individual","Yes","35-1545647","28856IN0220002","Delta Dental Individual PPO, EHB Certified (Exchange)","28856IN022",,"INN001","INS001",,"New","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28856","","28856IN0220002-01","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalin.com/IN_EHB_Low_2016","http://www.deltadentalin.com/IN_EHB_Low_2016","7"
"2016","IN","28856","HIOS","2","2015-06-24 02:34:55","1","28856","IN","SHOP (Small Group)","Yes","35-1545647","28856IN0240001","Delta Dental Group PPO, EHB Certified (Exchange)","28856IN024",,"INN001","INS001",,"New","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.11","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28856IN0240001-01","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalin.com/IN_EHB_Group_High_2016","http://www.deltadentalin.com/IN_EHB_Group_High_2016","8"
"2016","IN","28856","HIOS","2","2015-06-24 02:34:55","1","28856","IN","SHOP (Small Group)","Yes","35-1545647","28856IN0240002","Delta Dental Group PPO, EHB Certified (Exchange)","28856IN024",,"INN001","INS001",,"New","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28856IN0240002-01","Standard High On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalin.com/IN_EHB_Group_Low_2016","http://www.deltadentalin.com/IN_EHB_Group_Low_2016","9"
"2016","IN","28856","HIOS","2","2015-06-24 02:34:55","2","28856","IN","SHOP (Small Group)","Yes","35-1545647","28856IN0180001","Delta Dental Group Pediatric-Only PPO, EHB Certified","28856IN018",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$26.32","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28856IN0180001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","28856","HIOS","2","2015-06-24 02:34:55","2","28856","IN","Individual","Yes","35-1545647","28856IN0170001","Delta Dental Individual Pediatric-Only PPO, EHB Certified","28856IN017",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$31.54","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28856IN0170001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","28856","HIOS","2","2015-06-24 02:34:55","2","28856","IN","Individual","Yes","35-1545647","28856IN0170002","Delta Dental Individual Pediatric-Only PPO, EHB Certified","28856IN017",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$26.59","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28856IN0170002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IN","28856","HIOS","2","2015-06-24 02:34:55","2","28856","IN","SHOP (Small Group)","Yes","35-1545647","28856IN0180002","Delta Dental Group Pediatric-Only PPO, EHB Certified","28856IN018",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$21.60","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28856IN0180002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IN","28856","HIOS","2","2015-06-24 02:34:55","2","28856","IN","SHOP (Small Group)","Yes","35-1545647","28856IN0180003","Delta Dental Group Pediatric-Only PPO, EHB Certified","28856IN018",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$24.37","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28856IN0180003-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","IN","28856","HIOS","2","2015-06-24 02:34:55","2","28856","IN","Individual","Yes","35-1545647","28856IN0230001","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","28856IN023",,"INN001","INS001",,"New","PPO","High",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$26.82","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28856","","28856IN0230001-01","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalin.com/IN_Ped_High_2016","http://www.deltadentalin.com/IN_Ped_High_2016","6"
"2016","IN","28856","HIOS","2","2015-06-24 02:34:55","2","28856","IN","Individual","Yes","35-1545647","28856IN0230002","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","28856IN023",,"INN001","INS001",,"New","PPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$20.87","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28856","","28856IN0230002-01","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalin.com/IN_Ped_Low_2016","http://www.deltadentalin.com/IN_Ped_Low_2016","7"
"2016","IN","28856","HIOS","2","2015-06-24 02:34:55","2","28856","IN","SHOP (Small Group)","Yes","35-1545647","28856IN0180004","Delta Dental Group Pediatric-Only PPO, EHB Certified","28856IN018",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$20.34","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28856IN0180004-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020001","IU Health Plans Gold Value","33380IN002",,"INN001","INS001","INF005","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020001-00","Standard Gold Off Exchange Plan",,"0.800967574119568","Yes","Yes","No","100%",,"$750","$510","$410","$150","$750","$520","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/gold-value-off-exchange","http://iuhealth.org/healthplans/gold-value-off-exchange-brochure","4"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020001","IU Health Plans Gold Value","33380IN002",,"INN001","INS001","INF005","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020001-01","Standard Gold On Exchange Plan",,"0.800967574119568","Yes","Yes","No","100%",,"$750","$510","$410","$150","$750","$520","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/gold-value-on-exchange","http://iuhealth.org/healthplans/gold-value-on-exchange-brochure","5"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020001","IU Health Plans Gold Value","33380IN002",,"INN001","INS001","INF005","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://iuhealth.org/healthplans/gold-value-zero-cost","http://iuhealth.org/healthplans/gold-value-zero-cost-brochure","6"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020001","IU Health Plans Gold Value","33380IN002",,"INN001","INS001","INF005","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020001-03","Limited Cost Sharing Plan Variation",,"0.800967574119568","Yes","Yes","No","100%",,"$750","$510","$410","$150","$750","$520","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/gold-value-limited-cost","http://iuhealth.org/healthplans/gold-value-limited-cost-brochure","7"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020002","IU Health Plans Silver HSA","33380IN002",,"INN001","INS001","INF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020002-00","Standard Silver Off Exchange Plan",,"0.684082090854645","Yes","Yes","No","100%",,"$3,000","$760","$0","$150","$3,000","$180","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://iuhealth.org/healthplans/silver-hsa-off-exchange","http://iuhealth.org/healthplans/silver-hsa-off-exchange-brochure","8"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020002","IU Health Plans Silver HSA","33380IN002",,"INN001","INS001","INF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020002-01","Standard Silver On Exchange Plan",,"0.684082090854645","Yes","Yes","No","100%",,"$3,000","$760","$0","$150","$3,000","$180","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://iuhealth.org/healthplans/silver-hsa-on-exchange","http://iuhealth.org/healthplans/silver-hsa-on-exchange-brochure","9"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020002","IU Health Plans Silver HSA","33380IN002",,"INN001","INS001","INF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://iuhealth.org/healthplans/silver-hsa-zero-cost","http://iuhealth.org/healthplans/silver-hsa-zero-cost-brochure","10"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020002","IU Health Plans Silver HSA","33380IN002",,"INN001","INS001","INF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020002-03","Limited Cost Sharing Plan Variation",,"0.684082090854645","Yes","Yes","No","100%",,"$3,000","$760","$0","$150","$3,000","$180","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://iuhealth.org/healthplans/silver-hsa-limited-cost","http://iuhealth.org/healthplans/silver-hsa-limited-cost-brochure","11"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020002","IU Health Plans Silver HSA","33380IN002",,"INN001","INS001","INF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020002-04","73% AV Level Silver Plan",,"0.737911522388458","Yes","Yes","No","100%",,"$2,000","$760","$160","$150","$2,000","$260","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://iuhealth.org/healthplans/silver-hsa-73-av","http://iuhealth.org/healthplans/silver-hsa-73-av-brochure","12"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020002","IU Health Plans Silver HSA","33380IN002",,"INN001","INS001","INF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020002-05","87% AV Level Silver Plan",,"0.879264891147614","Yes","Yes","No","100%",,"$700","$290","$210","$150","$700","$310","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-hsa-87-av","http://iuhealth.org/healthplans/silver-hsa-87-av-brochure","13"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020002","IU Health Plans Silver HSA","33380IN002",,"INN001","INS001","INF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020002-06","94% AV Level Silver Plan",,"0.946878433227539","Yes","Yes","No","100%",,"$150","$90","$260","$150","$150","$190","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-hsa-94-av","http://iuhealth.org/healthplans/silver-hsa-94-av-brochure","14"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020003","IU Health Plans Silver Value","33380IN002",,"INN001","INS001","INF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020003-00","Standard Silver Off Exchange Plan",,"0.695235192775726","Yes","Yes","No","100%",,"$2,500","$760","$90","$150","$2,500","$380","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-value-off-exchange","http://iuhealth.org/healthplans/silver-value-off-exchange-brochure","15"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020003","IU Health Plans Silver Value","33380IN002",,"INN001","INS001","INF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020003-01","Standard Silver On Exchange Plan",,"0.695235192775726","Yes","Yes","No","100%",,"$2,500","$760","$90","$150","$2,500","$380","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-value-on-exchange","http://iuhealth.org/healthplans/silver-value-on-exchange-brochure","16"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020003","IU Health Plans Silver Value","33380IN002",,"INN001","INS001","INF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://iuhealth.org/healthplans/silver-value-zero-cost","http://iuhealth.org/healthplans/silver-value-zero-cost-brochure","17"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020003","IU Health Plans Silver Value","33380IN002",,"INN001","INS001","INF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020003-03","Limited Cost Sharing Plan Variation",,"0.695235192775726","Yes","Yes","No","100%",,"$2,500","$760","$90","$150","$2,500","$380","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-value-limited-cost","http://iuhealth.org/healthplans/silver-value-limited-cost-brochure","18"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020003","IU Health Plans Silver Value","33380IN002",,"INN001","INS001","INF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020003-04","73% AV Level Silver Plan",,"0.735545456409454","Yes","Yes","No","100%",,"$2,500","$760","$60","$150","$2,500","$300","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-value-73-av","http://iuhealth.org/healthplans/silver-value-73-av-brochure","19"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020003","IU Health Plans Silver Value","33380IN002",,"INN001","INS001","INF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020003-05","87% AV Level Silver Plan",,"0.875867784023285","Yes","Yes","No","100%",,"$750","$550","$200","$150","$750","$520","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-value-87-av","http://iuhealth.org/healthplans/silver-value-87-av-brochure","20"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020003","IU Health Plans Silver Value","33380IN002",,"INN001","INS001","INF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020003-06","94% AV Level Silver Plan",,"0.940244376659393","Yes","Yes","No","100%",,"$200","$140","$260","$150","$200","$320","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-value-94-av","http://iuhealth.org/healthplans/silver-value-94-av-brochure","21"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020004","IU Health Plans Silver Enhanced","33380IN002",,"INN001","INS001","INF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020004-00","Standard Silver Off Exchange Plan",,"0.719566822052002","Yes","Yes","No","100%",,"$2,000","$760","$240","$150","$2,000","$410","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-enhanced-off-exchange","http://iuhealth.org/healthplans/silver-enhanced-off-exchange-brochure","22"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020004","IU Health Plans Silver Enhanced","33380IN002",,"INN001","INS001","INF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020004-01","Standard Silver On Exchange Plan",,"0.719566822052002","Yes","Yes","No","100%",,"$2,000","$760","$240","$150","$2,000","$410","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-enhanced-on-exchange","http://iuhealth.org/healthplans/silver-enhanced-on-exchange-brochure","23"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020004","IU Health Plans Silver Enhanced","33380IN002",,"INN001","INS001","INF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://iuhealth.org/healthplans/silver-enhanced-zero-cost","http://iuhealth.org/healthplans/silver-enhanced-zero-cost-brochure","24"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020004","IU Health Plans Silver Enhanced","33380IN002",,"INN001","INS001","INF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020004-03","Limited Cost Sharing Plan Variation",,"0.719566822052002","Yes","Yes","No","100%",,"$2,000","$760","$240","$150","$2,000","$410","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-enhanced-limited-cost","http://iuhealth.org/healthplans/silver-enhanced-limited-cost-brochure","25"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020004","IU Health Plans Silver Enhanced","33380IN002",,"INN001","INS001","INF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020004-04","73% AV Level Silver Plan",,"0.739671885967255","Yes","Yes","No","100%",,"$1,950","$760","$250","$150","$1,950","$410","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-enhanced-73-av","http://iuhealth.org/healthplans/silver-enhanced-73-av-brochure","26"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020004","IU Health Plans Silver Enhanced","33380IN002",,"INN001","INS001","INF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020004-05","87% AV Level Silver Plan",,"0.877996683120728","Yes","Yes","No","100%",,"$750","$510","$200","$150","$750","$420","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-enhanced-87-av","http://iuhealth.org/healthplans/silver-enhanced-87-av-brochure","27"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020004","IU Health Plans Silver Enhanced","33380IN002",,"INN001","INS001","INF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020004-06","94% AV Level Silver Plan",,"0.948334634304047","Yes","Yes","No","100%",,"$150","$90","$260","$150","$150","$280","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-enhanced-94-av","http://iuhealth.org/healthplans/silver-enhanced-94-av-brochure","28"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020009","IU Health Plans Silver Copay","33380IN002",,"INN001","INS001","INF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020009-00","Standard Silver Off Exchange Plan",,"0.7152498960495","Yes","Yes","No","100%",,"$2,500","$880","$50","$150","$2,500","$380","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-copay-off-exchange","http://iuhealth.org/healthplans/silver-copay-off-exchange-brochure","29"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020009","IU Health Plans Silver Copay","33380IN002",,"INN001","INS001","INF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020009-01","Standard Silver On Exchange Plan",,"0.7152498960495","Yes","Yes","No","100%",,"$2,500","$880","$50","$150","$2,500","$380","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-copay-on-exchange","http://iuhealth.org/healthplans/silver-copay-on-exchange-brochure","30"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020009","IU Health Plans Silver Copay","33380IN002",,"INN001","INS001","INF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://iuhealth.org/healthplans/silver-copay-zero-cost","http://iuhealth.org/healthplans/silver-copay-zero-cost-brochure","31"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020009","IU Health Plans Silver Copay","33380IN002",,"INN001","INS001","INF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020009-03","Limited Cost Sharing Plan Variation",,"0.7152498960495","Yes","Yes","No","100%",,"$2,500","$880","$50","$150","$2,500","$380","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-copay-limited-cost","http://iuhealth.org/healthplans/silver-copay-limited-cost-brochure","32"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020009","IU Health Plans Silver Copay","33380IN002",,"INN001","INS001","INF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020009-04","73% AV Level Silver Plan",,"0.738203644752502","Yes","Yes","No","100%",,"$1,950","$1,100","$120","$150","$1,950","$450","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-copay-73-av","http://iuhealth.org/healthplans/silver-copay-73-av-brochure","33"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020009","IU Health Plans Silver Copay","33380IN002",,"INN001","INS001","INF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020009-05","87% AV Level Silver Plan",,"0.878720879554749","Yes","Yes","No","100%",,"$500","$380","$370","$150","$500","$580","$170","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-copay-87-av","http://iuhealth.org/healthplans/silver-copay-87-av-brochure","34"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020009","IU Health Plans Silver Copay","33380IN002",,"INN001","INS001","INF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020009-06","94% AV Level Silver Plan",,"0.944558918476105","Yes","Yes","No","100%",,"$150","$150","$200","$150","$150","$310","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-copay-94-av","http://iuhealth.org/healthplans/silver-copay-94-av-brochure","35"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020005","IU Health Plans Bronze HSA","33380IN002",,"INN001","INS001","INF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020005-00","Standard Bronze Off Exchange Plan",,"0.619419932365417","Yes","Yes","No","100%",,"$4,500","$770","$0","$150","$4,500","$140","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://iuhealth.org/healthplans/bronze-hsa-off-exchange","http://iuhealth.org/healthplans/bronze-hsa-off-exchange-brochure","36"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020005","IU Health Plans Bronze HSA","33380IN002",,"INN001","INS001","INF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020005-01","Standard Bronze On Exchange Plan",,"0.619419932365417","Yes","Yes","No","100%",,"$4,500","$770","$0","$150","$4,500","$140","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://iuhealth.org/healthplans/bronze-hsa-on-exchange","http://iuhealth.org/healthplans/bronze-hsa-on-exchange-brochure","37"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020005","IU Health Plans Bronze HSA","33380IN002",,"INN001","INS001","INF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://iuhealth.org/healthplans/bronze-hsa-zero-cost","http://iuhealth.org/healthplans/bronze-hsa-zero-cost-brochure","38"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020005","IU Health Plans Bronze HSA","33380IN002",,"INN001","INS001","INF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020005-03","Limited Cost Sharing Plan Variation",,"0.619419932365417","Yes","Yes","No","100%",,"$4,500","$770","$0","$150","$4,500","$140","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://iuhealth.org/healthplans/bronze-hsa-limited-cost","http://iuhealth.org/healthplans/bronze-hsa-limited-cost-brochure","39"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020006","IU Health Plans Bronze Value","33380IN002",,"INN001","INS001","INF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","4","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020006-00","Standard Bronze Off Exchange Plan",,"0.619259476661682","Yes","Yes","No","100%",,"$6,000","$850","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/bronze-value-off-exchange","http://iuhealth.org/healthplans/bronze-value-off-exchange-brochure","40"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020006","IU Health Plans Bronze Value","33380IN002",,"INN001","INS001","INF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","4","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020006-01","Standard Bronze On Exchange Plan",,"0.619259476661682","Yes","Yes","No","100%",,"$6,000","$850","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/bronze-value-on-exchange","http://iuhealth.org/healthplans/bronze-value-on-exchange-brochure","41"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020006","IU Health Plans Bronze Value","33380IN002",,"INN001","INS001","INF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","4","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://iuhealth.org/healthplans/bronze-value-zero-cost","http://iuhealth.org/healthplans/bronze-value-zero-cost-brochure","42"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020006","IU Health Plans Bronze Value","33380IN002",,"INN001","INS001","INF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","4","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020006-03","Limited Cost Sharing Plan Variation",,"0.619259476661682","Yes","Yes","No","100%",,"$6,000","$850","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/bronze-value-limited-cost","http://iuhealth.org/healthplans/bronze-value-limited-cost-brochure","43"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020011","IU Health Plans Bronze Simple HSA","33380IN002",,"INN001","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020011-00","Standard Bronze Off Exchange Plan",,"0.600919127464294","Yes","Yes","No","100%",,"$6,500","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://iuhealth.org/healthplans/bronze-simple-hsa-off-exchange","http://iuhealth.org/healthplans/bronze-simple-hsa-off-exchange-brochure","44"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020011","IU Health Plans Bronze Simple HSA","33380IN002",,"INN001","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020011-01","Standard Bronze On Exchange Plan",,"0.600919127464294","Yes","Yes","No","100%",,"$6,500","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://iuhealth.org/healthplans/bronze-simple-hsa-on-exchange","http://iuhealth.org/healthplans/bronze-simple-hsa-on-exchange-brochure","45"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020011","IU Health Plans Bronze Simple HSA","33380IN002",,"INN001","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://iuhealth.org/healthplans/bronze-simple-hsa-zero-cost","http://iuhealth.org/healthplans/bronze-simple-hsa-zero-cost-brochure","46"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","1","33380","IN","Individual","No","26-2127080","33380IN0020011","IU Health Plans Bronze Simple HSA","33380IN002",,"INN001","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","1",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0020011-03","Limited Cost Sharing Plan Variation",,"0.600919127464294","Yes","Yes","No","100%",,"$6,500","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://iuhealth.org/healthplans/bronze-simple-hsa-limited-cost","http://iuhealth.org/healthplans/bronze-simple-hsa-limited-cost-brochure","47"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","2","33380","IN","Individual","No","26-2127080","33380IN0040001","IU Health Plans Gold Value Plus Dental & Vision","33380IN004",,"INN002","INS001","INF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9573",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0040001-00","Standard Gold Off Exchange Plan",,"0.800967574119568","Yes","Yes","No","100%",,"$750","$510","$410","$150","$750","$520","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/gold-value-dv-off-exchange","http://iuhealth.org/healthplans/gold-value-dv-off-exchange-brochure","4"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","2","33380","IN","Individual","No","26-2127080","33380IN0040001","IU Health Plans Gold Value Plus Dental & Vision","33380IN004",,"INN002","INS001","INF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9573",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0040001-01","Standard Gold On Exchange Plan",,"0.800967574119568","Yes","Yes","No","100%",,"$750","$510","$410","$150","$750","$520","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/gold-value-dv-on-exchange","http://iuhealth.org/healthplans/gold-value-dv-on-exchange-brochure","5"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","2","33380","IN","Individual","No","26-2127080","33380IN0040001","IU Health Plans Gold Value Plus Dental & Vision","33380IN004",,"INN002","INS001","INF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9573",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0040001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://iuhealth.org/healthplans/gold-value-dv-zero-cost","http://iuhealth.org/healthplans/gold-value-dv-zero-cost-brochure","6"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","2","33380","IN","Individual","No","26-2127080","33380IN0040001","IU Health Plans Gold Value Plus Dental & Vision","33380IN004",,"INN002","INS001","INF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9573",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0040001-03","Limited Cost Sharing Plan Variation",,"0.800967574119568","Yes","Yes","No","100%",,"$750","$510","$410","$150","$750","$520","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/gold-value-dv-limited-cost","http://iuhealth.org/healthplans/gold-value-dv-limited-cost-brochure","7"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","2","33380","IN","Individual","No","26-2127080","33380IN0040002","IU Health Plans Silver Enhanced Plus Dental & Vision","33380IN004",,"INN002","INS001","INF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9481",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0040002-00","Standard Silver Off Exchange Plan",,"0.719566822052002","Yes","Yes","No","100%",,"$2,000","$760","$240","$150","$2,000","$410","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-enhanced-dv-off-exchange","http://iuhealth.org/healthplans/silver-enhanced-dv-off-exchange-brochure","8"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","2","33380","IN","Individual","No","26-2127080","33380IN0040002","IU Health Plans Silver Enhanced Plus Dental & Vision","33380IN004",,"INN002","INS001","INF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9481",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0040002-01","Standard Silver On Exchange Plan",,"0.719566822052002","Yes","Yes","No","100%",,"$2,000","$760","$240","$150","$2,000","$410","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-enhanced-dv-on-exchange","http://iuhealth.org/healthplans/silver-enhanced-dv-on-exchange-brochure","9"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","2","33380","IN","Individual","No","26-2127080","33380IN0040002","IU Health Plans Silver Enhanced Plus Dental & Vision","33380IN004",,"INN002","INS001","INF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9481",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0040002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://iuhealth.org/healthplans/silver-enhanced-dv-zero-cost","http://iuhealth.org/healthplans/silver-enhanced-dv-zero-cost-brochure","10"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","2","33380","IN","Individual","No","26-2127080","33380IN0040002","IU Health Plans Silver Enhanced Plus Dental & Vision","33380IN004",,"INN002","INS001","INF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9481",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0040002-03","Limited Cost Sharing Plan Variation",,"0.719566822052002","Yes","Yes","No","100%",,"$2,000","$760","$240","$150","$2,000","$410","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-enhanced-dv-limited-cost","http://iuhealth.org/healthplans/silver-enhanced-dv-limited-cost-brochure","11"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","2","33380","IN","Individual","No","26-2127080","33380IN0040002","IU Health Plans Silver Enhanced Plus Dental & Vision","33380IN004",,"INN002","INS001","INF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9481",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0040002-04","73% AV Level Silver Plan",,"0.739671885967255","Yes","Yes","No","100%",,"$1,950","$760","$250","$150","$1,950","$410","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-enhanced-dv-73-av","http://iuhealth.org/healthplans/silver-enhanced-dv-73-av-brochure","12"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","2","33380","IN","Individual","No","26-2127080","33380IN0040002","IU Health Plans Silver Enhanced Plus Dental & Vision","33380IN004",,"INN002","INS001","INF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9481",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0040002-05","87% AV Level Silver Plan",,"0.877996683120728","Yes","Yes","No","100%",,"$750","$510","$200","$150","$750","$420","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-enhanced-dv-87-av","http://iuhealth.org/healthplans/silver-enhanced-dv-87-av-brochure","13"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","2","33380","IN","Individual","No","26-2127080","33380IN0040002","IU Health Plans Silver Enhanced Plus Dental & Vision","33380IN004",,"INN002","INS001","INF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9481",,,,"0","0","0","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0040002-06","94% AV Level Silver Plan",,"0.948334634304047","Yes","Yes","No","100%",,"$150","$90","$260","$150","$150","$280","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/silver-enhanced-dv-94-av","http://iuhealth.org/healthplans/silver-enhanced-dv-94-av-brochure","14"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","2","33380","IN","Individual","No","26-2127080","33380IN0040003","IU Health Plans Bronze Value Plus Dental & Vision","33380IN004",,"INN002","INS001","INF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9341",,,,"0","0","4","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0040003-00","Standard Bronze Off Exchange Plan",,"0.619259476661682","Yes","Yes","No","100%",,"$6,000","$850","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/bronze-value-dv-off-exchange","http://iuhealth.org/healthplans/bronze-value-dv-off-exchange-brochure","15"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","2","33380","IN","Individual","No","26-2127080","33380IN0040003","IU Health Plans Bronze Value Plus Dental & Vision","33380IN004",,"INN002","INS001","INF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9341",,,,"0","0","4","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0040003-01","Standard Bronze On Exchange Plan",,"0.619259476661682","Yes","Yes","No","100%",,"$6,000","$850","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/bronze-value-dv-on-exchange","http://iuhealth.org/healthplans/bronze-value-dv-on-exchange-brochure","16"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","2","33380","IN","Individual","No","26-2127080","33380IN0040003","IU Health Plans Bronze Value Plus Dental & Vision","33380IN004",,"INN002","INS001","INF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9341",,,,"0","0","4","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0040003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://iuhealth.org/healthplans/bronze-value-dv-zero-cost","http://iuhealth.org/healthplans/bronze-value-dv-zero-cost-brochure","17"
"2016","IN","33380","HIOS","3","2015-08-26 09:56:12","2","33380","IN","Individual","No","26-2127080","33380IN0040003","IU Health Plans Bronze Value Plus Dental & Vision","33380IN004",,"INN002","INS001","INF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes","0.9341",,,,"0","0","4","2016-01-01",,"No",,"No","Emergency Care Only","No","https://iuhealth.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://iuhealth.org/healthplans/individuals/","33380IN0040003-03","Limited Cost Sharing Plan Variation",,"0.619259476661682","Yes","Yes","No","100%",,"$6,000","$850","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://iuhealth.org/healthplans/bronze-value-dv-limited-cost","http://iuhealth.org/healthplans/bronze-value-dv-limited-cost-brochure","18"
"2016","IN","34537","HIOS","2","2015-07-09 13:17:42","1","34537","IN","SHOP (Small Group)","Yes","41-0808596","34537IN0010002","Plan 2. Passive PPO $1000 Annual Maximum, Ortho","34537IN001",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","34537IN0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","34537","HIOS","2","2015-07-09 13:17:42","1","34537","IN","SHOP (Small Group)","Yes","41-0808596","34537IN0010005","Plan 5. Passive PPO, $2000 Annaul Maximum, Ortho","34537IN001",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","34537IN0010005-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020005","Silver Choice 4500","36373IN002",,"INN001","INS001","INF004","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020005-01","Standard Silver On Exchange Plan","68.3%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0031&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","23"
"2016","IN","34537","HIOS","2","2015-07-09 13:17:42","1","34537","IN","SHOP (Small Group)","Yes","41-0808596","34537IN0010006","Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho","34537IN001",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","34537IN0010006-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","IN","34537","HIOS","2","2015-07-09 13:17:42","1","34537","IN","SHOP (Small Group)","Yes","41-0808596","34537IN0010009","Plan 9. MAC PPO, $1500 Annual Maximum, Ortho","34537IN001",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$20.18","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","34537IN0010009-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","1","36373","IN","Individual","No","35-1665915","36373IN0020002","Silver Choice HSA 3000","36373IN002",,"INN001","INS001","INF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020002-00","Standard Silver Off Exchange Plan",,"0.708311021327972","Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=in0007&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","4"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","1","36373","IN","Individual","No","35-1665915","36373IN0020002","Silver Choice HSA 3000","36373IN002",,"INN001","INS001","INF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020002-01","Standard Silver On Exchange Plan",,"0.708311021327972","Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=in0007&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","5"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","1","36373","IN","Individual","No","35-1665915","36373IN0020002","Silver Choice HSA 3000","36373IN002",,"INN001","INS001","INF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=in0008&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","6"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","1","36373","IN","Individual","No","35-1665915","36373IN0020002","Silver Choice HSA 3000","36373IN002",,"INN001","INS001","INF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020002-03","Limited Cost Sharing Plan Variation",,"0.708311021327972","Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=in0009&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","7"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","1","36373","IN","Individual","No","35-1665915","36373IN0020002","Silver Choice HSA 3000","36373IN002",,"INN001","INS001","INF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020002-04","73% AV Level Silver Plan",,"0.737914025783539","Yes","Yes","No","100%",,"$2,500","$10","$0","$200","$2,500","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=in0010&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","8"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","1","36373","IN","Individual","No","35-1665915","36373IN0020002","Silver Choice HSA 3000","36373IN002",,"INN001","INS001","INF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020002-05","87% AV Level Silver Plan",,"0.877197504043579","Yes","Yes","No","100%",,"$800","$10","$0","$200","$800","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=in0011&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","9"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","1","36373","IN","Individual","No","35-1665915","36373IN0020002","Silver Choice HSA 3000","36373IN002",,"INN001","INS001","INF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020002-06","94% AV Level Silver Plan",,"0.942080080509186","Yes","Yes","No","100%",,"$300","$10","$0","$200","$300","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=in0012&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","10"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","1","36373","IN","Individual","No","35-1665915","36373IN0020006","Bronze Choice HSA 5500","36373IN002",,"INN001","INS001","INF005","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020006-00","Standard Bronze Off Exchange Plan",,"0.618041276931763","Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=in0037&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","11"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","1","36373","IN","Individual","No","35-1665915","36373IN0020006","Bronze Choice HSA 5500","36373IN002",,"INN001","INS001","INF005","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020006-01","Standard Bronze On Exchange Plan",,"0.618041276931763","Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=in0037&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","12"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","1","36373","IN","Individual","No","35-1665915","36373IN0020006","Bronze Choice HSA 5500","36373IN002",,"INN001","INS001","INF005","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=in0038&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","13"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","1","36373","IN","Individual","No","35-1665915","36373IN0020006","Bronze Choice HSA 5500","36373IN002",,"INN001","INS001","INF005","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020006-03","Limited Cost Sharing Plan Variation",,"0.618041276931763","Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=in0039&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","14"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020001","Gold Choice 1000","36373IN002",,"INN001","INS001","INF001","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020001-00","Standard Gold Off Exchange Plan","78.29%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0001&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","4"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020001","Gold Choice 1000","36373IN002",,"INN001","INS001","INF001","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020001-01","Standard Gold On Exchange Plan","78.29%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0001&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","5"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020001","Gold Choice 1000","36373IN002",,"INN001","INS001","INF001","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020001-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0002&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","6"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020001","Gold Choice 1000","36373IN002",,"INN001","INS001","INF001","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020001-03","Limited Cost Sharing Plan Variation","78.29%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0003&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","7"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020003","Silver Choice 2000","36373IN002",,"INN001","INS001","INF003","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020003-00","Standard Silver Off Exchange Plan","69.3%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0019&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","8"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020003","Silver Choice 2000","36373IN002",,"INN001","INS001","INF003","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020003-01","Standard Silver On Exchange Plan","69.3%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0019&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","9"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020003","Silver Choice 2000","36373IN002",,"INN001","INS001","INF003","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020003-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0020&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","10"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020003","Silver Choice 2000","36373IN002",,"INN001","INS001","INF003","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020003-03","Limited Cost Sharing Plan Variation","69.3%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0021&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","11"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020003","Silver Choice 2000","36373IN002",,"INN001","INS001","INF003","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020003-04","73% AV Level Silver Plan","73.4%",,"No","Yes","No","100%",,"$1,200","$20","$1,500","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0022&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","12"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020003","Silver Choice 2000","36373IN002",,"INN001","INS001","INF003","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020003-05","87% AV Level Silver Plan","87.9%",,"No","Yes","No","100%",,"$300","$10","$600","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0023&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","13"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020003","Silver Choice 2000","36373IN002",,"INN001","INS001","INF003","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020003-06","94% AV Level Silver Plan","93.9%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0024&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","14"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020004","Silver Choice 3500","36373IN002",,"INN001","INS001","INF004","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020004-00","Standard Silver Off Exchange Plan","68.0%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0025&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","15"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020004","Silver Choice 3500","36373IN002",,"INN001","INS001","INF004","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020004-01","Standard Silver On Exchange Plan","68.0%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0025&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","16"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020004","Silver Choice 3500","36373IN002",,"INN001","INS001","INF004","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020004-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0026&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","17"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020004","Silver Choice 3500","36373IN002",,"INN001","INS001","INF004","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020004-03","Limited Cost Sharing Plan Variation","68.0%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0027&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","18"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020004","Silver Choice 3500","36373IN002",,"INN001","INS001","INF004","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020004-04","73% AV Level Silver Plan","72.5%",,"No","Yes","No","100%",,"$2,500","$10","$800","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0028&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","19"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020004","Silver Choice 3500","36373IN002",,"INN001","INS001","INF004","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020004-05","87% AV Level Silver Plan","87.9%",,"No","Yes","No","100%",,"$300","$10","$600","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0029&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","20"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020004","Silver Choice 3500","36373IN002",,"INN001","INS001","INF004","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020004-06","94% AV Level Silver Plan","93.9%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0030&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","21"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020005","Silver Choice 4500","36373IN002",,"INN001","INS001","INF004","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020005-00","Standard Silver Off Exchange Plan","68.3%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0031&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","22"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020005","Silver Choice 4500","36373IN002",,"INN001","INS001","INF004","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020005-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0032&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","24"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020005","Silver Choice 4500","36373IN002",,"INN001","INS001","INF004","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020005-03","Limited Cost Sharing Plan Variation","68.3%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0033&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","25"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020005","Silver Choice 4500","36373IN002",,"INN001","INS001","INF004","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020005-04","73% AV Level Silver Plan","72.5%",,"No","Yes","No","100%",,"$3,300","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0034&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","26"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020005","Silver Choice 4500","36373IN002",,"INN001","INS001","INF004","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020005-05","87% AV Level Silver Plan","86.1%",,"No","Yes","No","100%",,"$600","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0035&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","27"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020005","Silver Choice 4500","36373IN002",,"INN001","INS001","INF004","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020005-06","94% AV Level Silver Plan","93.3%",,"No","Yes","No","100%",,"$100","$10","$0","$200","$100","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0036&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","28"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020007","Bronze Choice 6500","36373IN002",,"INN001","INS001","INF005","Existing","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020007-00","Standard Bronze Off Exchange Plan","61.9%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=in0040&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","29"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020007","Bronze Choice 6500","36373IN002",,"INN001","INS001","INF005","Existing","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020007-01","Standard Bronze On Exchange Plan","61.9%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=in0040&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","30"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020007","Bronze Choice 6500","36373IN002",,"INN001","INS001","INF005","Existing","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020007-02","Zero Cost Sharing Plan Variation","100.0%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=in0041&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","31"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020007","Bronze Choice 6500","36373IN002",,"INN001","INS001","INF005","Existing","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020007-03","Limited Cost Sharing Plan Variation","61.9%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=in0042&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","32"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020008","Gold Choice 0","36373IN002",,"INN001","INS001","INF006","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020008-00","Standard Gold Off Exchange Plan","79.1%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0004&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","33"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020008","Gold Choice 0","36373IN002",,"INN001","INS001","INF006","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020008-01","Standard Gold On Exchange Plan","79.1%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0004&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","34"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020008","Gold Choice 0","36373IN002",,"INN001","INS001","INF006","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020008-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0005&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","35"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020008","Gold Choice 0","36373IN002",,"INN001","INS001","INF006","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020008-03","Limited Cost Sharing Plan Variation","79.1%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=in0006&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","36"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020009","Silver Choice 2000 1","36373IN002",,"INN001","INS001","INF007","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020009-00","Standard Silver Off Exchange Plan","70.95%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=in0013&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","37"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020009","Silver Choice 2000 1","36373IN002",,"INN001","INS001","INF007","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020009-01","Standard Silver On Exchange Plan","70.95%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=in0013&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","38"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020009","Silver Choice 2000 1","36373IN002",,"INN001","INS001","INF007","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020009-02","Zero Cost Sharing Plan Variation","100.0%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=in0014&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","39"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020009","Silver Choice 2000 1","36373IN002",,"INN001","INS001","INF007","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020009-03","Limited Cost Sharing Plan Variation","70.95%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=in0015&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","40"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020009","Silver Choice 2000 1","36373IN002",,"INN001","INS001","INF007","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020009-04","73% AV Level Silver Plan","72.98%",,"Yes","Yes","No","100%",,"$1,800","$1,500","$0","$200","$1,800","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=in0016&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","41"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020009","Silver Choice 2000 1","36373IN002",,"INN001","INS001","INF007","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020009-05","87% AV Level Silver Plan","86.2%",,"Yes","Yes","No","100%",,"$600","$800","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=in0017&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","42"
"2016","IN","36373","HIOS","9","2015-11-17 13:45:28","2","36373","IN","Individual","No","35-1665915","36373IN0020009","Silver Choice 2000 1","36373IN002",,"INN001","INS001","INF007","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=in0044&st=in","36373IN0020009-06","94% AV Level Silver Plan","93.1%",,"Yes","Yes","No","100%",,"$200","$500","$0","$200","$200","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=in0018&st=in","http://www.uhc.com/iex/doc?id=in0043&st=in","43"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0200001","Marquee Silver 2000","50816IN020","7831192068","INN001","INS001","INF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200001-00","Standard Silver Off Exchange Plan",,"0.719861388206482","Yes","Yes","No","100%",,"$2,000","$500","$1,000","$200","$800","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=ISTHS-02000E00SD16","http://www.phpni.com/marketplace/individualbrochure2016","4"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0200001","Marquee Silver 2000","50816IN020","7831192068","INN001","INS001","INF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200001-01","Standard Silver On Exchange Plan",,"0.719861388206482","Yes","Yes","No","100%",,"$2,000","$500","$1,000","$200","$800","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MSTHS-02000E00SD16","http://www.phpni.com/marketplace/individualbrochure2016","5"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0200001","Marquee Silver 2000","50816IN020","7831192068","INN001","INS001","INF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MSTHS-02000E00ZD16","http://www.phpni.com/marketplace/individualbrochure2016","6"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0200001","Marquee Silver 2000","50816IN020","7831192068","INN001","INS001","INF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200001-03","Limited Cost Sharing Plan Variation",,"0.719861388206482","Yes","Yes","No","100%",,"$2,000","$500","$1,000","$200","$800","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MSTHS-02000E00LD16","http://www.phpni.com/marketplace/individualbrochure2016","7"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0200001","Marquee Silver 2000","50816IN020","7831192068","INN001","INS001","INF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200001-04","73% AV Level Silver Plan",,"0.739941298961639","Yes","Yes","No","100%",,"$1,800","$500","$1,000","$200","$800","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,810","$1810 per person","$3620 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MSTHS-02000E007D16","http://www.phpni.com/marketplace/individualbrochure2016","8"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0200001","Marquee Silver 2000","50816IN020","7831192068","INN001","INS001","INF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200001-05","87% AV Level Silver Plan",,"0.860407769680023","Yes","Yes","No","100%",,"$800","$500","$600","$200","$700","$1,200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MSTHS-02000E008D16","http://www.phpni.com/marketplace/individualbrochure2016","9"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0200001","Marquee Silver 2000","50816IN020","7831192068","INN001","INS001","INF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200001-06","94% AV Level Silver Plan",,"0.931060016155243","Yes","Yes","No","100%",,"$300","$400","$0","$200","$300","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MSTHS-02000E009D16","http://www.phpni.com/marketplace/individualbrochure2016","10"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0200004","Marquee Silver 2500","50816IN020","7831192068","INN001","INS001","INF011","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200004-00","Standard Silver Off Exchange Plan",,"0.699563026428223","Yes","Yes","No","100%",,"$2,500","$0","$1,400","$200","$800","$1,200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=ISTHS-02500E00SD16","http://www.phpni.com/marketplace/individualbrochure2016","11"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0200004","Marquee Silver 2500","50816IN020","7831192068","INN001","INS001","INF011","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200004-01","Standard Silver On Exchange Plan",,"0.699563026428223","Yes","Yes","No","100%",,"$2,500","$0","$1,400","$200","$800","$1,200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MSTHS-02500E00SD16","http://www.phpni.com/marketplace/individualbrochure2016","12"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0200004","Marquee Silver 2500","50816IN020","7831192068","INN001","INS001","INF011","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MSTHS-02500E00ZD16","http://www.phpni.com/marketplace/individualbrochure2016","13"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0200004","Marquee Silver 2500","50816IN020","7831192068","INN001","INS001","INF011","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200004-03","Limited Cost Sharing Plan Variation",,"0.699563026428223","Yes","Yes","No","100%",,"$2,500","$0","$1,400","$200","$800","$1,200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MSTHS-02500E00LD16","http://www.phpni.com/marketplace/individualbrochure2016","14"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0200004","Marquee Silver 2500","50816IN020","7831192068","INN001","INS001","INF011","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200004-04","73% AV Level Silver Plan",,"0.720293521881104","Yes","Yes","No","100%",,"$2,500","$0","$1,400","$200","$800","$1,200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MSTHS-02500E007D16","http://www.phpni.com/marketplace/individualbrochure2016","15"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0200004","Marquee Silver 2500","50816IN020","7831192068","INN001","INS001","INF011","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200004-05","87% AV Level Silver Plan",,"0.86004900932312","Yes","Yes","No","100%",,"$800","$0","$600","$200","$800","$1,200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MSTHS-02500E008D16","http://www.phpni.com/marketplace/individualbrochure2016","16"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0200004","Marquee Silver 2500","50816IN020","7831192068","INN001","INS001","INF011","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200004-06","94% AV Level Silver Plan",,"0.930019617080688","Yes","Yes","No","100%",,"$300","$0","$500","$200","$300","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$725","$725 per person","$1450 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$275","$275 per person","$550 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MSTHS-02500E009D16","http://www.phpni.com/marketplace/individualbrochure2016","17"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0200013","Marquee Bronze 5000","50816IN020","7831192068","INN001","INS001","INF009","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200013-00","Standard Bronze Off Exchange Plan",,"0.619452774524689","Yes","Yes","No","100%",,"$5,000","$500","$900","$200","$900","$2,200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=IBTHS-05000E00SD16","http://www.phpni.com/marketplace/individualbrochure2016","18"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0200013","Marquee Bronze 5000","50816IN020","7831192068","INN001","INS001","INF009","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200013-01","Standard Bronze On Exchange Plan",,"0.619452774524689","Yes","Yes","No","100%",,"$5,000","$500","$900","$200","$900","$2,200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MBTHS-05000E00SD16","http://www.phpni.com/marketplace/individualbrochure2016","19"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0200013","Marquee Bronze 5000","50816IN020","7831192068","INN001","INS001","INF009","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MBTHS-05000E00ZD16","http://www.phpni.com/marketplace/individualbrochure2016","20"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0200013","Marquee Bronze 5000","50816IN020","7831192068","INN001","INS001","INF009","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200013-03","Limited Cost Sharing Plan Variation",,"0.619452774524689","Yes","Yes","No","100%",,"$5,000","$500","$900","$200","$900","$2,200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MBTHS-05000E00LD16","http://www.phpni.com/marketplace/individualbrochure2016","21"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0230010","Marquee Bronze 5000 POS","50816IN023","7831192068","INN001","INS001","INF009","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Details in plan brochure","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0230010-00","Standard Bronze Off Exchange Plan",,"0.619452774524689","Yes","Yes","No","100%",,"$5,000","$500","$900","$200","$900","$2,200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=IBTPS-05000E00SD16","http://www.phpni.com/marketplace/individualbrochure2016","24"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0230010","Marquee Bronze 5000 POS","50816IN023","7831192068","INN001","INS001","INF009","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Details in plan brochure","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0230010-01","Standard Bronze On Exchange Plan",,"0.619452774524689","Yes","Yes","No","100%",,"$5,000","$500","$900","$200","$900","$2,200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MBTPS-05000E00SD16","http://www.phpni.com/marketplace/individualbrochure2016","25"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0230010","Marquee Bronze 5000 POS","50816IN023","7831192068","INN001","INS001","INF009","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Details in plan brochure","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0230010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MBTPS-05000E00ZD16","http://www.phpni.com/marketplace/individualbrochure2016","26"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","1","50816","IN","Individual","No","31-1069321","50816IN0230010","Marquee Bronze 5000 POS","50816IN023","7831192068","INN001","INS001","INF009","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Details in plan brochure","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0230010-03","Limited Cost Sharing Plan Variation",,"0.619452774524689","Yes","Yes","No","100%",,"$5,000","$500","$900","$200","$900","$2,200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MBTPS-05000E00LD16","http://www.phpni.com/marketplace/individualbrochure2016","27"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","2","50816","IN","Individual","No","31-1069321","50816IN0200007","Marquee HSA Silver 3500","50816IN020","7831192068","INN001","INS001","INF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200007-00","Standard Silver Off Exchange Plan",,"0.705997884273529","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.phpni.com/marketplace/individual/sbc?planid=ISQHS-03500E00SD16","http://www.phpni.com/marketplace/individualbrochure2016","4"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","2","50816","IN","Individual","No","31-1069321","50816IN0200007","Marquee HSA Silver 3500","50816IN020","7831192068","INN001","INS001","INF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200007-01","Standard Silver On Exchange Plan",,"0.705997884273529","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MSQHS-03500E00SD16","http://www.phpni.com/marketplace/individualbrochure2016","5"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","2","50816","IN","Individual","No","31-1069321","50816IN0200007","Marquee HSA Silver 3500","50816IN020","7831192068","INN001","INS001","INF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MSQHS-03500E00ZD16","http://www.phpni.com/marketplace/individualbrochure2016","6"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","2","50816","IN","Individual","No","31-1069321","50816IN0200007","Marquee HSA Silver 3500","50816IN020","7831192068","INN001","INS001","INF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200007-03","Limited Cost Sharing Plan Variation",,"0.705997884273529","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MSQHS-03500E00LD16","http://www.phpni.com/marketplace/individualbrochure2016","7"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","2","50816","IN","Individual","No","31-1069321","50816IN0200007","Marquee HSA Silver 3500","50816IN020","7831192068","INN001","INS001","INF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200007-04","73% AV Level Silver Plan",,"0.727334141731262","Yes","Yes","No","100%",,"$3,100","$0","$0","$200","$3,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MSQHS-03500E007D16","http://www.phpni.com/marketplace/individualbrochure2016","8"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","2","50816","IN","Individual","No","31-1069321","50816IN0200007","Marquee HSA Silver 3500","50816IN020","7831192068","INN001","INS001","INF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200007-05","87% AV Level Silver Plan",,"0.862069964408875","Yes","Yes","No","100%",,"$1,200","$0","$0","$200","$1,200","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MSQHS-03500E008D16","http://www.phpni.com/marketplace/individualbrochure2016","9"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","2","50816","IN","Individual","No","31-1069321","50816IN0200007","Marquee HSA Silver 3500","50816IN020","7831192068","INN001","INS001","INF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200007-06","94% AV Level Silver Plan",,"0.93063348531723","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MSQHS-03500E009D16","http://www.phpni.com/marketplace/individualbrochure2016","10"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","2","50816","IN","Individual","No","31-1069321","50816IN0200010","Marquee HSA Bronze 3750","50816IN020","7831192068","INN001","INS001","INF012","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200010-00","Standard Bronze Off Exchange Plan",,"0.61981338262558","Yes","Yes","No","100%",,"$3,800","$0","$1,400","$200","$3,800","$0","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.phpni.com/marketplace/individual/sbc?planid=IBQHS-03750E00SD16","http://www.phpni.com/marketplace/individualbrochure2016","11"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","2","50816","IN","Individual","No","31-1069321","50816IN0200010","Marquee HSA Bronze 3750","50816IN020","7831192068","INN001","INS001","INF012","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200010-01","Standard Bronze On Exchange Plan",,"0.61981338262558","Yes","Yes","No","100%",,"$3,800","$0","$1,400","$200","$3,800","$0","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MBQHS-03750E00SD16","http://www.phpni.com/marketplace/individualbrochure2016","12"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","2","50816","IN","Individual","No","31-1069321","50816IN0200010","Marquee HSA Bronze 3750","50816IN020","7831192068","INN001","INS001","INF012","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MBQHS-03750E00ZD16","http://www.phpni.com/marketplace/individualbrochure2016","13"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","2","50816","IN","Individual","No","31-1069321","50816IN0200010","Marquee HSA Bronze 3750","50816IN020","7831192068","INN001","INS001","INF012","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200010-03","Limited Cost Sharing Plan Variation",,"0.61981338262558","Yes","Yes","No","100%",,"$3,800","$0","$1,400","$200","$3,800","$0","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MBQHS-03750E00LD16","http://www.phpni.com/marketplace/individualbrochure2016","14"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","2","50816","IN","Individual","No","31-1069321","50816IN0200016","Marquee HSA Bronze 6000","50816IN020","7831192068","INN001","INS001","INF006","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200016-00","Standard Bronze Off Exchange Plan",,"0.613524496555328","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.phpni.com/marketplace/individual/sbc?planid=IBQHS-06000E00SD16","http://www.phpni.com/marketplace/individualbrochure2016","15"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","2","50816","IN","Individual","No","31-1069321","50816IN0200016","Marquee HSA Bronze 6000","50816IN020","7831192068","INN001","INS001","INF006","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200016-01","Standard Bronze On Exchange Plan",,"0.613524496555328","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MBQHS-06000E00SD16","http://www.phpni.com/marketplace/individualbrochure2016","16"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","2","50816","IN","Individual","No","31-1069321","50816IN0200016","Marquee HSA Bronze 6000","50816IN020","7831192068","INN001","INS001","INF006","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MBQHS-06000E00ZD16","http://www.phpni.com/marketplace/individualbrochure2016","17"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","2","50816","IN","Individual","No","31-1069321","50816IN0200016","Marquee HSA Bronze 6000","50816IN020","7831192068","INN001","INS001","INF006","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200016-03","Limited Cost Sharing Plan Variation",,"0.613524496555328","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MBQHS-06000E00LD16","http://www.phpni.com/marketplace/individualbrochure2016","18"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","3","50816","IN","Individual","No","31-1069321","50816IN0200022","Marquee Gold 1250","50816IN020","7831192068","INN001","INS001","INF013","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200022-00","Standard Gold Off Exchange Plan",,"0.792136788368225","Yes","Yes","No","100%",,"$1,300","$500","$600","$200","$500","$1,800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=IGTHS-01250E00SD16","http://www.phpni.com/marketplace/individualbrochure2016","4"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","3","50816","IN","Individual","No","31-1069321","50816IN0200022","Marquee Gold 1250","50816IN020","7831192068","INN001","INS001","INF013","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200022-01","Standard Gold On Exchange Plan",,"0.792136788368225","Yes","Yes","No","100%",,"$1,300","$500","$600","$200","$500","$1,800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MGTHS-01250E00SD16","http://www.phpni.com/marketplace/individualbrochure2016","5"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","3","50816","IN","Individual","No","31-1069321","50816IN0200022","Marquee Gold 1250","50816IN020","7831192068","INN001","INS001","INF013","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200022-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MGTHS-01250E00ZD16","http://www.phpni.com/marketplace/individualbrochure2016","6"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","3","50816","IN","Individual","No","31-1069321","50816IN0200022","Marquee Gold 1250","50816IN020","7831192068","INN001","INS001","INF013","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200022-03","Limited Cost Sharing Plan Variation",,"0.792136788368225","Yes","Yes","No","100%",,"$1,300","$500","$600","$200","$500","$1,800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MGTHS-01250E00LD16","http://www.phpni.com/marketplace/individualbrochure2016","7"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","4","50816","IN","Individual","No","31-1069321","50816IN0200025","Marquee Catastrophic 6850","50816IN020","7831192068","INN001","INS001","INF006","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200025-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$200","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=ICCHS-06850E00SD16","http://www.phpni.com/marketplace/individualbrochure2016","4"
"2016","IN","50816","HIOS","7","2015-08-26 09:56:12","4","50816","IN","Individual","No","31-1069321","50816IN0200025","Marquee Catastrophic 6850","50816IN020","7831192068","INN001","INS001","INF006","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/pharmacy/pharmacy.aspx","50816IN0200025-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$200","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.phpni.com/marketplace/individual/sbc?planid=MCCHS-06850E00SD16","http://www.phpni.com/marketplace/individualbrochure2016","5"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","2","54192","IN","Individual","No","32-0121856","54192IN0010001","CareSource Just4Me Gold","54192IN001",,"INN001","INS001","INF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010001-00","Standard Gold Off Exchange Plan","81.64%","0.825493931770325","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-gold-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","4"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","2","54192","IN","Individual","No","32-0121856","54192IN0010001","CareSource Just4Me Gold","54192IN001",,"INN001","INS001","INF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010001-01","Standard Gold On Exchange Plan","81.64%","0.825493931770325","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-gold-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","5"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","2","54192","IN","Individual","No","32-0121856","54192IN0010001","CareSource Just4Me Gold","54192IN001",,"INN001","INS001","INF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-goldzero-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","6"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","2","54192","IN","Individual","No","32-0121856","54192IN0010001","CareSource Just4Me Gold","54192IN001",,"INN001","INS001","INF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010001-03","Limited Cost Sharing Plan Variation","81.64%","0.825493931770325","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-goldltd-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","7"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","2","54192","IN","Individual","No","32-0121856","54192IN0010002","CareSource Just4Me Gold","54192IN001",,"INN002","INS002","INF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010002-00","Standard Gold Off Exchange Plan","81.64%","0.825493931770325","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-gold-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","8"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","2","54192","IN","Individual","No","32-0121856","54192IN0010002","CareSource Just4Me Gold","54192IN001",,"INN002","INS002","INF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010002-01","Standard Gold On Exchange Plan","81.64%","0.825493931770325","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-gold-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","9"
"2016","IN","51303","HIOS","1","2015-05-06 02:44:46","1","51303","IN","SHOP (Small Group)","Yes","72-0977315","51303IN0080001","AlwaysCare Small Group Dental – Child 2016","51303IN008",,"INN001","INS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$26.99","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","51303IN0080001-00","Standard High Off Exchange Plan","86.08%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","IN","51303","HIOS","1","2015-05-06 02:44:46","1","51303","IN","Individual","Yes","72-0977315","51303IN0050001","AlwaysCare All-Star Kids Dental Plan 2016","51303IN005",,"INN001","INS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$21.75","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","51303IN0050001-00","Standard High Off Exchange Plan","86.08%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","IN","51303","HIOS","1","2015-05-06 02:44:46","1","51303","IN","Individual","Yes","72-0977315","51303IN0050002","AlwaysCare All-Star Kids Dental Plan 2016","51303IN005",,"INN001","INS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$17.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","51303IN0050002-00","Standard Low Off Exchange Plan","70.87%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","IN","51303","HIOS","1","2015-05-06 02:44:46","1","51303","IN","SHOP (Small Group)","Yes","72-0977315","51303IN0080002","AlwaysCare Small Group Dental – Child 2016","51303IN008",,"INN001","INS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$22.22","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","51303IN0080002-00","Standard Low Off Exchange Plan","70.87%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020003","CareSource Just4Me Silver with Dental and Vision","54192IN002",,"INN001","INS001","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9157",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020003-00","Standard Silver Off Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","4"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020003","CareSource Just4Me Silver with Dental and Vision","54192IN002",,"INN001","INS001","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9157",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020003-01","Standard Silver On Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","5"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020003","CareSource Just4Me Silver with Dental and Vision","54192IN002",,"INN001","INS001","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9157",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silverzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","6"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020003","CareSource Just4Me Silver with Dental and Vision","54192IN002",,"INN001","INS001","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9157",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020003-03","Limited Cost Sharing Plan Variation","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silverltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","7"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020003","CareSource Just4Me Silver with Dental and Vision","54192IN002",,"INN001","INS001","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9157",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020003-04","73% AV Level Silver Plan","73.37%","0.733690559864044","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silver1-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","8"
"2016","IN","51303","HIOS","1","2015-05-06 02:44:46","2","51303","IN","SHOP (Small Group)","Yes","72-0977315","51303IN0070001","AlwaysCare Small Group Dental – Adults 2016","51303IN007",,"INN001","INS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$26.99","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","51303IN0070001-00","Standard High Off Exchange Plan","86.08%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","IN","51303","HIOS","1","2015-05-06 02:44:46","2","51303","IN","Individual","Yes","72-0977315","51303IN0060001","AlwaysCare All-Star Family Dental Plan 2016","51303IN006",,"INN001","INS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$21.75","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","51303IN0060001-00","Standard High Off Exchange Plan","86.08%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","IN","51303","HIOS","1","2015-05-06 02:44:46","2","51303","IN","SHOP (Small Group)","Yes","72-0977315","51303IN0070002","AlwaysCare Small Group Dental – Adults 2016","51303IN007",,"INN001","INS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$22.22","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","51303IN0070002-00","Standard Low Off Exchange Plan","70.87%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","IN","51303","HIOS","1","2015-05-06 02:44:46","3","51303","IN","Individual","Yes","72-0977315","51303IN0060002","AlwaysCare All-Star Family Dental Plan 2016","51303IN006",,"INN001","INS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$17.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","51303IN0060002-00","Standard Low Off Exchange Plan","70.87%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","IN","52122","HIOS","5","2015-08-11 02:55:25","1","52122","IN","SHOP (Small Group)","Yes","86-0307623","52122IN0010001","Smile for Health - Certified Optimum Coverage","52122IN001",,"INN001","INS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","52122IN0010001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","52122","HIOS","5","2015-08-11 02:55:25","2","52122","IN","SHOP (Small Group)","Yes","86-0307623","52122IN0010002","Smile for Health - Certified Optimum Coverage","52122IN001",,"INN002","INS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","52122IN0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","52122","HIOS","5","2015-08-11 02:55:25","3","52122","IN","SHOP (Small Group)","Yes","86-0307623","52122IN0010003","Smile for Health - Certified Optimum Coverage","52122IN001",,"INN003","INS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","52122IN0010003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","52122","HIOS","5","2015-08-11 02:55:25","4","52122","IN","SHOP (Small Group)","Yes","86-0307623","52122IN0010004","Smile for Health - Certified Optimum Coverage","52122IN001",,"INN001","INS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","52122IN0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","52122","HIOS","5","2015-08-11 02:55:25","5","52122","IN","SHOP (Small Group)","Yes","86-0307623","52122IN0010005","Smile for Health - Certified Optimum Coverage","52122IN001",,"INN002","INS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","52122IN0010005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","52122","HIOS","5","2015-08-11 02:55:25","6","52122","IN","SHOP (Small Group)","Yes","86-0307623","52122IN0010006","Smile for Health - Certified Optimum Coverage","52122IN001",,"INN003","INS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","52122IN0010006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","52122","HIOS","5","2015-08-11 02:55:25","7","52122","IN","SHOP (Small Group)","Yes","86-0307623","52122IN0020001","Smile for Health - Certified High Option","52122IN002",,"INN001","INS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","52122IN0020001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","52122","HIOS","5","2015-08-11 02:55:25","8","52122","IN","SHOP (Small Group)","Yes","86-0307623","52122IN0020002","Smile for Health - Certified High Option","52122IN002",,"INN002","INS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","52122IN0020002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","52122","HIOS","5","2015-08-11 02:55:25","9","52122","IN","SHOP (Small Group)","Yes","86-0307623","52122IN0020003","Smile for Health - Certified High Option","52122IN002",,"INN003","INS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","52122IN0020003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","52122","HIOS","5","2015-08-11 02:55:25","10","52122","IN","SHOP (Small Group)","Yes","86-0307623","52122IN0020004","Smile for Health - Certified High Option Plus","52122IN002",,"INN001","INS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","52122IN0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","52122","HIOS","5","2015-08-11 02:55:25","11","52122","IN","SHOP (Small Group)","Yes","86-0307623","52122IN0020005","Smile for Health - Certified High Option Plus","52122IN002",,"INN002","INS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","52122IN0020005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","52122","HIOS","5","2015-08-11 02:55:25","12","52122","IN","SHOP (Small Group)","Yes","86-0307623","52122IN0020006","Smile for Health - Certified High Option Plus","52122IN002",,"INN003","INS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","52122IN0020006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","1","54192","IN","Individual","No","32-0121856","54192IN0020001","CareSource Just4Me Gold with Dental and Vision","54192IN002",,"INN001","INS001","INF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9313",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020001-00","Standard Gold Off Exchange Plan","81.64%","0.825493931770325","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","4"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","1","54192","IN","Individual","No","32-0121856","54192IN0020001","CareSource Just4Me Gold with Dental and Vision","54192IN002",,"INN001","INS001","INF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9313",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020001-01","Standard Gold On Exchange Plan","81.64%","0.825493931770325","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","5"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","1","54192","IN","Individual","No","32-0121856","54192IN0020001","CareSource Just4Me Gold with Dental and Vision","54192IN002",,"INN001","INS001","INF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9313",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-goldzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","6"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","1","54192","IN","Individual","No","32-0121856","54192IN0020001","CareSource Just4Me Gold with Dental and Vision","54192IN002",,"INN001","INS001","INF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9313",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020001-03","Limited Cost Sharing Plan Variation","81.64%","0.825493931770325","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-goldltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","7"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","1","54192","IN","Individual","No","32-0121856","54192IN0020002","CareSource Just4Me Gold with Dental and Vision","54192IN002",,"INN002","INS002","INF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9313",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020002-00","Standard Gold Off Exchange Plan","81.64%","0.825493931770325","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","8"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","1","54192","IN","Individual","No","32-0121856","54192IN0020002","CareSource Just4Me Gold with Dental and Vision","54192IN002",,"INN002","INS002","INF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9313",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020002-01","Standard Gold On Exchange Plan","81.64%","0.825493931770325","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","9"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","1","54192","IN","Individual","No","32-0121856","54192IN0020002","CareSource Just4Me Gold with Dental and Vision","54192IN002",,"INN002","INS002","INF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9313",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-goldzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","10"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","1","54192","IN","Individual","No","32-0121856","54192IN0020002","CareSource Just4Me Gold with Dental and Vision","54192IN002",,"INN002","INS002","INF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9313",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020002-03","Limited Cost Sharing Plan Variation","81.64%","0.825493931770325","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-goldltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","11"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","2","54192","IN","Individual","No","32-0121856","54192IN0010002","CareSource Just4Me Gold","54192IN001",,"INN002","INS002","INF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-goldzero-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","10"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","2","54192","IN","Individual","No","32-0121856","54192IN0010002","CareSource Just4Me Gold","54192IN001",,"INN002","INS002","INF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010002-03","Limited Cost Sharing Plan Variation","81.64%","0.825493931770325","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-goldltd-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","11"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020003","CareSource Just4Me Silver with Dental and Vision","54192IN002",,"INN001","INS001","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9157",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020003-05","87% AV Level Silver Plan","87.97%","0.880108594894409","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silver2-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","9"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020003","CareSource Just4Me Silver with Dental and Vision","54192IN002",,"INN001","INS001","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9157",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020003-06","94% AV Level Silver Plan","94.58%","0.94583922624588","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silver3-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","10"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020004","CareSource Just4Me Silver with Dental and Vision","54192IN002",,"INN002","INS002","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9157",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020004-00","Standard Silver Off Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","11"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020004","CareSource Just4Me Silver with Dental and Vision","54192IN002",,"INN002","INS002","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9157",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020004-01","Standard Silver On Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","12"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020004","CareSource Just4Me Silver with Dental and Vision","54192IN002",,"INN002","INS002","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9157",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silverzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","13"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020004","CareSource Just4Me Silver with Dental and Vision","54192IN002",,"INN002","INS002","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9157",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020004-03","Limited Cost Sharing Plan Variation","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silverltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","14"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020004","CareSource Just4Me Silver with Dental and Vision","54192IN002",,"INN002","INS002","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9157",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020004-04","73% AV Level Silver Plan","73.37%","0.733690559864044","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silver1-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","15"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020004","CareSource Just4Me Silver with Dental and Vision","54192IN002",,"INN002","INS002","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9157",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020004-05","87% AV Level Silver Plan","87.97%","0.880108594894409","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silver2-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","16"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020004","CareSource Just4Me Silver with Dental and Vision","54192IN002",,"INN002","INS002","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9157",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020004-06","94% AV Level Silver Plan","94.58%","0.94583922624588","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silver3-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","17"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020005","CareSource Just4Me Bronze with Dental and Vision","54192IN002",,"INN001","INS001","INF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9015",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020005-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-in-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","18"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020005","CareSource Just4Me Bronze with Dental and Vision","54192IN002",,"INN001","INS001","INF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9015",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020005-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-in-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","19"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020005","CareSource Just4Me Bronze with Dental and Vision","54192IN002",,"INN001","INS001","INF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9015",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-in-bronzezero-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","20"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020005","CareSource Just4Me Bronze with Dental and Vision","54192IN002",,"INN001","INS001","INF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9015",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020005-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-in-bronzeltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","21"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020006","CareSource Just4Me Bronze with Dental and Vision","54192IN002",,"INN002","INS002","INF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9015",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020006-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-in-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","22"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020006","CareSource Just4Me Bronze with Dental and Vision","54192IN002",,"INN002","INS002","INF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9015",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020006-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-in-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","23"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020006","CareSource Just4Me Bronze with Dental and Vision","54192IN002",,"INN002","INS002","INF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9015",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-in-bronzezero-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","24"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","3","54192","IN","Individual","No","32-0121856","54192IN0020006","CareSource Just4Me Bronze with Dental and Vision","54192IN002",,"INN002","INS002","INF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9015",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0020006-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-in-bronzeltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","25"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010003","CareSource Just4Me Silver","54192IN001",,"INN001","INS001","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010003-00","Standard Silver Off Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silver-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","4"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010003","CareSource Just4Me Silver","54192IN001",,"INN001","INS001","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010003-01","Standard Silver On Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silver-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","5"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010003","CareSource Just4Me Silver","54192IN001",,"INN001","INS001","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silverzero-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","6"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010003","CareSource Just4Me Silver","54192IN001",,"INN001","INS001","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010003-03","Limited Cost Sharing Plan Variation","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silverltd-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","7"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010003","CareSource Just4Me Silver","54192IN001",,"INN001","INS001","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010003-04","73% AV Level Silver Plan","73.37%","0.733690559864044","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silver1-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","8"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010003","CareSource Just4Me Silver","54192IN001",,"INN001","INS001","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010003-05","87% AV Level Silver Plan","87.97%","0.880108594894409","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silver2-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","9"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010003","CareSource Just4Me Silver","54192IN001",,"INN001","INS001","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010003-06","94% AV Level Silver Plan","94.58%","0.94583922624588","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silver3-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","10"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010004","CareSource Just4Me Silver","54192IN001",,"INN002","INS002","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010004-00","Standard Silver Off Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silver-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","11"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010004","CareSource Just4Me Silver","54192IN001",,"INN002","INS002","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010004-01","Standard Silver On Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silver-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","12"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010004","CareSource Just4Me Silver","54192IN001",,"INN002","INS002","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silverzero-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","13"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010004","CareSource Just4Me Silver","54192IN001",,"INN002","INS002","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010004-03","Limited Cost Sharing Plan Variation","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silverltd-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","14"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010004","CareSource Just4Me Silver","54192IN001",,"INN002","INS002","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010004-04","73% AV Level Silver Plan","73.37%","0.733690559864044","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silver1-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","15"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010004","CareSource Just4Me Silver","54192IN001",,"INN002","INS002","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010004-05","87% AV Level Silver Plan","87.97%","0.880108594894409","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silver2-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","16"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010004","CareSource Just4Me Silver","54192IN001",,"INN002","INS002","INF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010004-06","94% AV Level Silver Plan","94.58%","0.94583922624588","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-in-silver3-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","17"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010005","CareSource Just4Me Bronze","54192IN001",,"INN001","INS001","INF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010005-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-in-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","18"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010005","CareSource Just4Me Bronze","54192IN001",,"INN001","INS001","INF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010005-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-in-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","19"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010005","CareSource Just4Me Bronze","54192IN001",,"INN001","INS001","INF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-in-bronzezero-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","20"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010005","CareSource Just4Me Bronze","54192IN001",,"INN001","INS001","INF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010005-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-in-bronzeltd-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","21"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010006","CareSource Just4Me Bronze","54192IN001",,"INN002","INS002","INF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010006-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-in-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","22"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010006","CareSource Just4Me Bronze","54192IN001",,"INN002","INS002","INF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010006-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-in-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","23"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010006","CareSource Just4Me Bronze","54192IN001",,"INN002","INS002","INF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-in-bronzezero-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","24"
"2016","IN","54192","HIOS","6","2015-10-21 05:00:18","4","54192","IN","Individual","No","32-0121856","54192IN0010006","CareSource Just4Me Bronze","54192IN001",,"INN002","INS002","INF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9999",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/in/pharmacy","54192IN0010006-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-in-bronzeltd-basic-sum","https://www.caresource.com/documents/j4m2016-in-plan-brochure","25"
"2016","IN","56340","HIOS","2","2015-07-10 02:19:03","1","56340","IN","SHOP (Small Group)","Yes","35-0472300","56340IN0010001","Lincoln DentalConnect®","56340IN001","7063415294","INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.95","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","56340IN0010001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","56340","HIOS","2","2015-07-10 02:19:03","1","56340","IN","SHOP (Small Group)","Yes","35-0472300","56340IN0010002","Lincoln DentalConnect®","56340IN001","7063415294","INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.06","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","56340IN0010002-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IN","56340","HIOS","2","2015-07-10 02:19:03","1","56340","IN","SHOP (Small Group)","Yes","35-0472300","56340IN0010003","Lincoln DentalConnect®","56340IN001","7063415294","INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.09","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","56340IN0010003-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","IN","56340","HIOS","2","2015-07-10 02:19:03","1","56340","IN","SHOP (Small Group)","Yes","35-0472300","56340IN0010004","Lincoln DentalConnect®","56340IN001","7063415294","INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.43","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","56340IN0010004-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","IN","56340","HIOS","2","2015-07-10 02:19:03","1","56340","IN","SHOP (Small Group)","Yes","35-0472300","56340IN0010005","Lincoln DentalConnect®","56340IN001","7063415294","INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.77","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","56340IN0010005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","IN","56340","HIOS","2","2015-07-10 02:19:03","1","56340","IN","SHOP (Small Group)","Yes","35-0472300","56340IN0010006","Lincoln DentalConnect®","56340IN001","7063415294","INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.50","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","56340IN0010006-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010031","MDwise Marketplace Silver Coinsurance","62033IN001",,"INN001","INS001","INF001","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010031-01","Standard Silver On Exchange Plan",,"0.699671149253845","Yes","Yes","No","100%",,"3,500.00","20.00","570.00","150.00","3,500.00","430.00","100.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_coinsurance_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","31"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010031","MDwise Marketplace Silver Coinsurance","62033IN001",,"INN001","INS001","INF001","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010031-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_coinsurance_zero_cost_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","32"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010031","MDwise Marketplace Silver Coinsurance","62033IN001",,"INN001","INS001","INF001","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010031-03","Limited Cost Sharing Plan Variation",,"0.699671149253845","Yes","Yes","No","100%",,"3,500.00","20.00","570.00","150.00","3,500.00","430.00","100.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_coinsurance_lcs_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","33"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010031","MDwise Marketplace Silver Coinsurance","62033IN001",,"INN001","INS001","INF001","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010031-04","73% AV Level Silver Plan",,"0.72986102104187","Yes","Yes","No","100%",,"2,750.00","20.00","680.00","150.00","2,750.00","460.00","150.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_coinsurance_73_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","34"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010031","MDwise Marketplace Silver Coinsurance","62033IN001",,"INN001","INS001","INF001","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010031-05","87% AV Level Silver Plan",,"0.8660027384758","Yes","Yes","No","100%",,"1,000.00","20.00","510.00","150.00","1,000.00","360.00","180.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_coinsurance_87_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","35"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010031","MDwise Marketplace Silver Coinsurance","62033IN001",,"INN001","INS001","INF001","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010031-06","94% AV Level Silver Plan",,"0.941473066806793","Yes","Yes","No","100%",,"600.00","$0","$0","150.00","600.00","$0","$0","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_coinsurance_94_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","36"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","2","62033","IN","Individual","No","46-5270582","62033IN0020001","MDwise Marketplace Bronze Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.976070160587017",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0020001-00","Standard Bronze Off Exchange Plan",,"0.619261085987091","Yes","Yes","No","100%",,"4,800.00","20.00","1,000.00","150.00","4,800.00","290.00","60.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_plus_vision_off_ex_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","4"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","2","62033","IN","Individual","No","46-5270582","62033IN0020001","MDwise Marketplace Bronze Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.976070160587017",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0020001-01","Standard Bronze On Exchange Plan",,"0.619261085987091","Yes","Yes","No","100%",,"4,800.00","20.00","1,000.00","150.00","4,800.00","290.00","60.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_plus_vision_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","5"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","2","62033","IN","Individual","No","46-5270582","62033IN0020001","MDwise Marketplace Bronze Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.976070160587017",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0020001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_plus_vision_zero_cost_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","6"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","2","62033","IN","Individual","No","46-5270582","62033IN0020001","MDwise Marketplace Bronze Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.976070160587017",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0020001-03","Limited Cost Sharing Plan Variation",,"0.619261085987091","Yes","Yes","No","100%",,"4,800.00","20.00","1,000.00","150.00","4,800.00","290.00","60.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_plus_vision_lcs_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","7"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","2","62033","IN","Individual","No","46-5270582","62033IN0020002","MDwise Marketplace Silver Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.979173231722979",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0020002-00","Standard Silver Off Exchange Plan",,"0.719040393829346","Yes","Yes","No","100%",,"2,500.00","270.00","670.00","150.00","2,500.00","700.00","110.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_vision_off_ex_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","8"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","2","62033","IN","Individual","No","46-5270582","62033IN0020002","MDwise Marketplace Silver Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.979173231722979",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0020002-01","Standard Silver On Exchange Plan",,"0.719040393829346","Yes","Yes","No","100%",,"2,500.00","270.00","670.00","150.00","2,500.00","700.00","110.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_vision_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","9"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","2","62033","IN","Individual","No","46-5270582","62033IN0020002","MDwise Marketplace Silver Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.979173231722979",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0020002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_vision_zero_cost_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","10"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","2","62033","IN","Individual","No","46-5270582","62033IN0020002","MDwise Marketplace Silver Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.979173231722979",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0020002-03","Limited Cost Sharing Plan Variation",,"0.719040393829346","Yes","Yes","No","100%",,"2,500.00","270.00","670.00","150.00","2,500.00","700.00","110.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_vision_lcs_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","11"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","2","62033","IN","Individual","No","46-5270582","62033IN0020002","MDwise Marketplace Silver Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.979173231722979",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0020002-04","73% AV Level Silver Plan",,"0.739183723926544","Yes","Yes","No","100%",,"2,200.00","490.00","670.00","150.00","2,200.00","630.00","120.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_vision_73_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","12"
"2016","IN","56340","HIOS","2","2015-07-10 02:19:03","1","56340","IN","SHOP (Small Group)","Yes","35-0472300","56340IN0010007","Lincoln DentalConnect®","56340IN001","7063415294","INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.22","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","56340IN0010007-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2016","IN","56340","HIOS","2","2015-07-10 02:19:03","1","56340","IN","SHOP (Small Group)","Yes","35-0472300","56340IN0010008","Lincoln DentalConnect®","56340IN001","7063415294","INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.32","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","56340IN0010008-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2016","IN","57874","HIOS","1","2015-05-07 07:54:20","1","57874","IN","SHOP (Small Group)","Yes","47-0397286","57874IN0060001","Renaissance Group Dental PPO, EHB Certified","57874IN006",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.79","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","57874IN0060001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","57874","HIOS","1","2015-05-07 07:54:20","1","57874","IN","Individual","Yes","47-0397286","57874IN0040001","Delta Dental Individual PPO, EHB Certified","57874IN004",,"INN002","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.56","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","57874IN0040001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","57874","HIOS","1","2015-05-07 07:54:20","1","57874","IN","Individual","Yes","47-0397286","57874IN0040002","Delta Dental Individual PPO, EHB Certified","57874IN004",,"INN002","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.33","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","57874IN0040002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IN","57874","HIOS","1","2015-05-07 07:54:20","1","57874","IN","SHOP (Small Group)","Yes","47-0397286","57874IN0060002","Renaissance Group Dental PPO, EHB Certified","57874IN006",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.74","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","57874IN0060002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IN","57874","HIOS","1","2015-05-07 07:54:20","1","57874","IN","Individual","Yes","47-0397286","57874IN0050001","Renaissance Individual Dental PPO, EHB Certified","57874IN005",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.79","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","57874IN0050001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","IN","57874","HIOS","1","2015-05-07 07:54:20","1","57874","IN","Individual","Yes","47-0397286","57874IN0050002","Renaissance Individual Dental PPO, EHB Certified","57874IN005",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.04","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","57874IN0050002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","IN","59560","HIOS","3","2015-08-18 03:25:03","1","59560","IN","SHOP (Small Group)","Yes","13-5123390","59560IN0010002","Guardian Pediatric Advantage","59560IN001",,"INN001","INS002",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$21.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","59560IN0010002-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","IN","59560","HIOS","3","2015-08-18 03:25:03","1","59560","IN","Individual","Yes","13-5123390","59560IN0070001","Guardian Family Essentials","59560IN007",,"INN002","INS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","59560IN0070001-00","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","4"
"2016","IN","59560","HIOS","3","2015-08-18 03:25:03","1","59560","IN","Individual","Yes","13-5123390","59560IN0070001","Guardian Family Essentials","59560IN007",,"INN002","INS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","59560IN0070001-01","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","5"
"2016","IN","59560","HIOS","3","2015-08-18 03:25:03","1","59560","IN","SHOP (Small Group)","Yes","13-5123390","59560IN0020002","Guardian Pediatric Essentials","59560IN002",,"INN001","INS002",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$16.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","59560IN0020002-00","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","IN","59560","HIOS","3","2015-08-18 03:25:03","2","59560","IN","SHOP (Small Group)","Yes","13-5123390","59560IN0040002","Guardian Family Advantage","59560IN004",,"INN001","INS002",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","59560IN0040002-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","IN","59560","HIOS","3","2015-08-18 03:25:03","2","59560","IN","SHOP (Small Group)","Yes","13-5123390","59560IN0060002","Guardian Family Essentials","59560IN006",,"INN001","INS002",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","59560IN0060002-00","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","IN","59560","HIOS","3","2015-08-18 03:25:03","3","59560","IN","SHOP (Small Group)","Yes","13-5123390","59560IN0040003","Guardian Family Advantage","59560IN004",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","59560IN0040003-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","IN","59560","HIOS","3","2015-08-18 03:25:03","3","59560","IN","SHOP (Small Group)","Yes","13-5123390","59560IN0040003","Guardian Family Advantage","59560IN004",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","59560IN0040003-01","Standard High On Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","IN","59560","HIOS","3","2015-08-18 03:25:03","3","59560","IN","SHOP (Small Group)","Yes","13-5123390","59560IN0060003","Guardian Family Essentials","59560IN006",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","59560IN0060003-00","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","IN","59560","HIOS","3","2015-08-18 03:25:03","3","59560","IN","SHOP (Small Group)","Yes","13-5123390","59560IN0060003","Guardian Family Essentials","59560IN006",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","59560IN0060003-01","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010001","MDwise Marketplace Bronze Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010001-00","Standard Bronze Off Exchange Plan",,"0.619261085987091","Yes","Yes","No","100%",,"4,800.00","20.00","1,000.00","150.00","4,800.00","290.00","60.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_plus_off_ex_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","4"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010001","MDwise Marketplace Bronze Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010001-01","Standard Bronze On Exchange Plan",,"0.619261085987091","Yes","Yes","No","100%",,"4,800.00","20.00","1,000.00","150.00","4,800.00","290.00","60.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_plus_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","5"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010001","MDwise Marketplace Bronze Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_plus_zero_cost_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","6"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010001","MDwise Marketplace Bronze Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010001-03","Limited Cost Sharing Plan Variation",,"0.619261085987091","Yes","Yes","No","100%",,"4,800.00","20.00","1,000.00","150.00","4,800.00","290.00","60.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_plus_lcs_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","7"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010002","MDwise Marketplace Silver Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010002-00","Standard Silver Off Exchange Plan",,"0.719040393829346","Yes","Yes","No","100%",,"2,500.00","270.00","670.00","150.00","2,500.00","700.00","110.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_off_ex_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","8"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010002","MDwise Marketplace Silver Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010002-01","Standard Silver On Exchange Plan",,"0.719040393829346","Yes","Yes","No","100%",,"2,500.00","270.00","670.00","150.00","2,500.00","700.00","110.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","9"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010002","MDwise Marketplace Silver Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_zero_cost_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","10"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010002","MDwise Marketplace Silver Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010002-03","Limited Cost Sharing Plan Variation",,"0.719040393829346","Yes","Yes","No","100%",,"2,500.00","270.00","670.00","150.00","2,500.00","700.00","110.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_lcs_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","11"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010002","MDwise Marketplace Silver Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010002-04","73% AV Level Silver Plan",,"0.739183723926544","Yes","Yes","No","100%",,"2,200.00","490.00","670.00","150.00","2,200.00","630.00","120.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_73_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","12"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010002","MDwise Marketplace Silver Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010002-05","87% AV Level Silver Plan",,"0.879310488700867","Yes","Yes","No","100%",,"750.00","400.00","150.00","150.00","750.00","510.00","40.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_87_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","13"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010002","MDwise Marketplace Silver Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010002-06","94% AV Level Silver Plan",,"0.948940992355347","Yes","Yes","No","100%",,"500.00","$0","$0","150.00","500.00","$0","$0","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_94_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","14"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010003","MDwise Marketplace Gold Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010003-00","Standard Gold Off Exchange Plan",,"0.799524128437042","Yes","Yes","No","100%",,"150.00","380.00","450.00","150.00","150.00","890.00","110.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/gold_plus_off_ex_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","15"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010003","MDwise Marketplace Gold Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010003-01","Standard Gold On Exchange Plan",,"0.799524128437042","Yes","Yes","No","100%",,"150.00","380.00","450.00","150.00","150.00","890.00","110.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/gold_plus_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","16"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010003","MDwise Marketplace Gold Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/gold_plus_zero_cost_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","17"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010003","MDwise Marketplace Gold Plus","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010003-03","Limited Cost Sharing Plan Variation",,"0.799524128437042","Yes","Yes","No","100%",,"150.00","380.00","450.00","150.00","150.00","890.00","110.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/gold_plus_lcs_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","18"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010004","MDwise Marketplace Bronze Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010004-00","Standard Bronze Off Exchange Plan",,"0.585624873638153","Yes","Yes","No","100%",,"6,200.00","20.00","440.00","150.00","5,410.00","$0","$0","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_basic_off_ex_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","19"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010004","MDwise Marketplace Bronze Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010004-01","Standard Bronze On Exchange Plan",,"0.585624873638153","Yes","Yes","No","100%",,"6,200.00","20.00","440.00","150.00","5,410.00","$0","$0","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_basic_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","20"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010004","MDwise Marketplace Bronze Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_basic_zero_cost_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","21"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010004","MDwise Marketplace Bronze Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010004-03","Limited Cost Sharing Plan Variation",,"0.585624873638153","Yes","Yes","No","100%",,"6,200.00","20.00","440.00","150.00","5,410.00","$0","$0","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/bronze_basic_lcs_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","22"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010005","MDwise Marketplace Silver Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010005-00","Standard Silver Off Exchange Plan",,"0.680509090423584","Yes","Yes","No","100%",,"5,000.00","20.00","340.00","150.00","5,000.00","60.00","20.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_basic_off_ex_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","23"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010005","MDwise Marketplace Silver Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010005-01","Standard Silver On Exchange Plan",,"0.680509090423584","Yes","Yes","No","100%",,"5,000.00","20.00","340.00","150.00","5,000.00","60.00","20.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_basic_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","24"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010005","MDwise Marketplace Silver Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_basic_zero_cost_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","25"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010005","MDwise Marketplace Silver Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010005-03","Limited Cost Sharing Plan Variation",,"0.680509090423584","Yes","Yes","No","100%",,"5,000.00","20.00","340.00","150.00","5,000.00","60.00","20.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_basic_lcs_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","26"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010005","MDwise Marketplace Silver Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010005-04","73% AV Level Silver Plan",,"0.72079598903656","Yes","Yes","No","100%",,"3,350.00","20.00","590.00","150.00","3,350.00","310.00","90.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_basic_73_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","27"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010005","MDwise Marketplace Silver Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010005-05","87% AV Level Silver Plan",,"0.860769867897034","Yes","Yes","No","100%",,"1,200.00","370.00","130.00","150.00","1,200.00","410.00","90.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_basic_87_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","28"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010005","MDwise Marketplace Silver Basic","62033IN001",,"INN001","INS001","INF001","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010005-06","94% AV Level Silver Plan",,"0.930154740810394","Yes","Yes","No","100%",,"750.00","$0","$0","150.00","750.00","$0","$0","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_basic_94_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","29"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","1","62033","IN","Individual","No","46-5270582","62033IN0010031","MDwise Marketplace Silver Coinsurance","62033IN001",,"INN001","INS001","INF001","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0010031-00","Standard Silver Off Exchange Plan",,"0.699671149253845","Yes","Yes","No","100%",,"3,500.00","20.00","570.00","150.00","3,500.00","430.00","100.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_coinsurance_off_ex_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","30"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","2","62033","IN","Individual","No","46-5270582","62033IN0020002","MDwise Marketplace Silver Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.979173231722979",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0020002-05","87% AV Level Silver Plan",,"0.877805829048157","Yes","Yes","No","100%",,"750.00","400.00","150.00","150.00","750.00","510.00","40.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_vision_87_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","13"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","2","62033","IN","Individual","No","46-5270582","62033IN0020002","MDwise Marketplace Silver Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.979173231722979",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0020002-06","94% AV Level Silver Plan",,"0.948940992355347","Yes","Yes","No","100%",,"500.00","$0","$0","150.00","500.00","$0","$0","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/silver_plus_vision_94_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","14"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","2","62033","IN","Individual","No","46-5270582","62033IN0020003","MDwise Marketplace Gold Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.982988526416237",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0020003-00","Standard Gold Off Exchange Plan",,"0.799524128437042","Yes","Yes","No","100%",,"150.00","380.00","450.00","150.00","150.00","890.00","110.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/gold_plus_vision_off_ex_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","15"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","2","62033","IN","Individual","No","46-5270582","62033IN0020003","MDwise Marketplace Gold Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.982988526416237",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0020003-01","Standard Gold On Exchange Plan",,"0.799524128437042","Yes","Yes","No","100%",,"150.00","380.00","450.00","150.00","150.00","890.00","110.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/gold_plus_vision_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","16"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","2","62033","IN","Individual","No","46-5270582","62033IN0020003","MDwise Marketplace Gold Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.982988526416237",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0020003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/gold_plus_vision_zero_cost_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","17"
"2016","IN","62033","HIOS","6","2015-08-26 09:56:12","2","62033","IN","Individual","No","46-5270582","62033IN0020003","MDwise Marketplace Gold Plus with Adult Vision","62033IN002",,"INN001","INS001","INF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.982988526416237",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mdwise.softheon.com/payment","http://www.mdwise.org/find-a-drug/?referer=/for-members/mdwise-marketplace/benefits-and-services/pharmacy/find-a-drug/","62033IN0020003-03","Limited Cost Sharing Plan Variation",,"0.799524128437042","Yes","Yes","No","100%",,"150.00","380.00","450.00","150.00","150.00","890.00","110.00","80.00",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/gold_plus_vision_lcs_2016.pdf","http://www.mdwise.org/MediaLibraries/MDwise/Files/Become%20a%20Member/Marketplace_brochure.pdf","18"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510006","SIHO Marketplace","67920IN051",,"INN003","INS001","INF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510006-00","Standard Bronze Off Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,650","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOBronze100HSA.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","4"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510006","SIHO Marketplace","67920IN051",,"INN003","INS001","INF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510006-01","Standard Bronze On Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,650","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOBronze100HSA.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","5"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510006","SIHO Marketplace","67920IN051",,"INN003","INS001","INF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.siho.org/files/2016/SIHOBronze100HSA0CSR.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","6"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510006","SIHO Marketplace","67920IN051",,"INN003","INS001","INF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510006-03","Limited Cost Sharing Plan Variation",,"0.5993931889534","Yes","Yes","No","100%",,"$6,650","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOBronze100HSALimited.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","7"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510001","SIHO Marketplace","67920IN051",,"INN003","INS001","INF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510001-00","Standard Bronze Off Exchange Plan",,"0.619705200195313","Yes","Yes","No","100%",,"$4,750","$0","$500","$150","$4,750","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOBronzeHSA.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","8"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510001","SIHO Marketplace","67920IN051",,"INN003","INS001","INF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510001-01","Standard Bronze On Exchange Plan",,"0.619705200195313","Yes","Yes","No","100%",,"$4,750","$0","$500","$150","$4,750","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOBronzeHSA.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","9"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510001","SIHO Marketplace","67920IN051",,"INN003","INS001","INF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.siho.org/files/2016/SIHOBronzeHSA0CSR.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","10"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510001","SIHO Marketplace","67920IN051",,"INN003","INS001","INF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510001-03","Limited Cost Sharing Plan Variation",,"0.619705200195313","Yes","Yes","No","100%",,"$4,750","$0","$500","$150","$4,750","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOBronzeHSALimited.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","11"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510003","SIHO Marketplace","67920IN051",,"INN003","INS001","INF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510003-00","Standard Silver Off Exchange Plan",,"0.717685759067535","Yes","Yes","No","100%",,"$2,500","$0","$980","$150","$2,500","$0","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOSilverHSA.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","12"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510003","SIHO Marketplace","67920IN051",,"INN003","INS001","INF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510003-01","Standard Silver On Exchange Plan",,"0.717685759067535","Yes","Yes","No","100%",,"$2,500","$0","$980","$150","$2,500","$0","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOSilverHSA.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","13"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510003","SIHO Marketplace","67920IN051",,"INN003","INS001","INF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.siho.org/files/2016/SIHOSilverHSA0CSR.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","14"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510003","SIHO Marketplace","67920IN051",,"INN003","INS001","INF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510003-03","Limited Cost Sharing Plan Variation",,"0.717685759067535","Yes","Yes","No","100%",,"$2,500","$0","$980","$150","$2,500","$0","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOSilverHSALimited.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","15"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510003","SIHO Marketplace","67920IN051",,"INN003","INS001","INF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510003-04","73% AV Level Silver Plan",,"0.739546954631805","Yes","Yes","No","100%",,"$2,150","$0","$510","$150","$2,150","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOSilverHSA73CSR.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","16"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510003","SIHO Marketplace","67920IN051",,"INN003","INS001","INF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510003-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$150","$1,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOSilverHSA87CSR.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","17"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510003","SIHO Marketplace","67920IN051",,"INN003","INS001","INF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510003-06","94% AV Level Silver Plan",,"0.945099532604218","Yes","Yes","No","100%",,"$450","$0","$0","$150","$450","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOSilverHSA94CSR.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","18"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510007","SIHO Marketplace","67920IN051",,"INN003","INS001","INF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510007-00","Standard Silver Off Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$4,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOSilver100HSA.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","19"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510007","SIHO Marketplace","67920IN051",,"INN003","INS001","INF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510007-01","Standard Silver On Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$4,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOSilver100HSA.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","20"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510007","SIHO Marketplace","67920IN051",,"INN003","INS001","INF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.siho.org/files/2016/SIHOSilver100HSA0CSR.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","21"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510007","SIHO Marketplace","67920IN051",,"INN003","INS001","INF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510007-03","Limited Cost Sharing Plan Variation",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$4,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOSilver100HSALimited.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","22"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510007","SIHO Marketplace","67920IN051",,"INN003","INS001","INF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510007-04","73% AV Level Silver Plan",,"0.727658689022064","Yes","Yes","No","100%",,"$3,200","$0","$0","$150","$3,200","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOSilver100HSA73CSR.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","23"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510007","SIHO Marketplace","67920IN051",,"INN003","INS001","INF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510007-05","87% AV Level Silver Plan",,"0.870122313499451","Yes","Yes","No","100%",,"$1,200","$0","$0","$150","$1,200","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOSilver100HSA87CSR.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","24"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","1","67920","IN","Individual","No","47-2586982","67920IN0510007","SIHO Marketplace","67920IN051",,"INN003","INS001","INF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510007-06","94% AV Level Silver Plan",,"0.934249639511108","Yes","Yes","No","100%",,"$550","$0","$0","$150","$550","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOSilver100HSA94CSR.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","25"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","2","67920","IN","Individual","No","47-2586982","67920IN0510005","SIHO Marketplace","67920IN051",,"INN003","INS001","INF004","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510005-00","Standard Gold Off Exchange Plan","79.46%","0.815323054790497","Yes","Yes","No","100%",,"$750","$20","$650","$150","$750","$840","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOGold.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","4"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","2","67920","IN","Individual","No","47-2586982","67920IN0510005","SIHO Marketplace","67920IN051",,"INN003","INS001","INF004","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510005-01","Standard Gold On Exchange Plan","79.46%","0.815323054790497","Yes","Yes","No","100%",,"$750","$20","$650","$150","$750","$840","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOGold.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","5"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","2","67920","IN","Individual","No","47-2586982","67920IN0510005","SIHO Marketplace","67920IN051",,"INN003","INS001","INF004","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.siho.org/files/2016/SIHOGold0CSR.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","6"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","2","67920","IN","Individual","No","47-2586982","67920IN0510005","SIHO Marketplace","67920IN051",,"INN003","INS001","INF004","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510005-03","Limited Cost Sharing Plan Variation","79.46%","0.815323054790497","Yes","Yes","No","100%",,"$750","$20","$650","$150","$750","$840","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOGoldLimited.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","7"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","2","67920","IN","Individual","No","47-2586982","67920IN0510004","SIHO Marketplace","67920IN051",,"INN003","INS001","INF006","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510004-00","Standard Silver Off Exchange Plan","70.69%","0.724384963512421","Yes","Yes","No","100%",,"$2,250","$20","$1,040","$150","$2,050","$560","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOSilver.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","8"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","2","67920","IN","Individual","No","47-2586982","67920IN0510004","SIHO Marketplace","67920IN051",,"INN003","INS001","INF006","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510004-01","Standard Silver On Exchange Plan","70.69%","0.724384963512421","Yes","Yes","No","100%",,"$2,250","$20","$1,040","$150","$2,050","$560","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOSilver.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","9"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","2","67920","IN","Individual","No","47-2586982","67920IN0510004","SIHO Marketplace","67920IN051",,"INN003","INS001","INF006","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.siho.org/files/2016/SIHOSilver0CSR.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","10"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","2","67920","IN","Individual","No","47-2586982","67920IN0510004","SIHO Marketplace","67920IN051",,"INN003","INS001","INF006","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510004-03","Limited Cost Sharing Plan Variation","70.69%","0.724384963512421","Yes","Yes","No","100%",,"$2,250","$20","$1,040","$150","$2,050","$560","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOSilverLimited.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","11"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","2","67920","IN","Individual","No","47-2586982","67920IN0510004","SIHO Marketplace","67920IN051",,"INN003","INS001","INF006","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510004-04","73% AV Level Silver Plan","72.79%","0.744747698307037","Yes","Yes","No","100%",,"$2,050","$20","$1,040","$150","$2,050","$560","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,050","$2050 per person","$4100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOSilver73CSR.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","12"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","2","67920","IN","Individual","No","47-2586982","67920IN0510004","SIHO Marketplace","67920IN051",,"INN003","INS001","INF006","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510004-05","87% AV Level Silver Plan","87.28%","0.876204073429108","Yes","Yes","No","100%",,"$900","$0","$650","$150","$900","$460","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOSilver87CSR.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","13"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","2","67920","IN","Individual","No","47-2586982","67920IN0510004","SIHO Marketplace","67920IN051",,"INN003","INS001","INF006","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510004-06","94% AV Level Silver Plan","94.14%","0.938248693943024","Yes","Yes","No","100%",,"$200","$0","$400","$150","$200","$280","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOSilver94CSR.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","14"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","3","67920","IN","Individual","No","47-2586982","67920IN0510002","SIHO Marketplace","67920IN051",,"INN003","INS001","INF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510002-00","Standard Bronze Off Exchange Plan","61.65%","0.639884471893311","Yes","Yes","No","100%",,"$5,500","$20","$350","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOBronze.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","4"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","3","67920","IN","Individual","No","47-2586982","67920IN0510002","SIHO Marketplace","67920IN051",,"INN003","INS001","INF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510002-01","Standard Bronze On Exchange Plan","61.65%","0.639884471893311","Yes","Yes","No","100%",,"$5,500","$20","$350","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOBronze.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","5"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","3","67920","IN","Individual","No","47-2586982","67920IN0510002","SIHO Marketplace","67920IN051",,"INN003","INS001","INF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.siho.org/files/2016/SIHOBronze0CSR.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","6"
"2016","IN","67920","HIOS","7","2016-01-22 04:00:42","3","67920","IN","Individual","No","47-2586982","67920IN0510002","SIHO Marketplace","67920IN051",,"INN003","INS001","INF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://siho.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.siho.org/files/SIHO_DrugList.pdf","67920IN0510002-03","Limited Cost Sharing Plan Variation","61.65%","0.639884471893311","Yes","Yes","No","100%",,"$5,500","$20","$350","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.siho.org/files/2016/SIHOBronzeLimited.pdf","http://www.siho.org/files/2016/MarketplacePlanBrochure.pdf","7"
"2016","IN","69051","HIOS","2","2015-05-04 05:06:13","1","69051","IN","SHOP (Small Group)","Yes","13-5581829","69051IN0110001","EHB Basic Dental Plan (Low)","69051IN011",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$15.92","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","69051IN0110001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","69572","HIOS","1","2015-05-01 02:23:41","1","69572","IN","SHOP (Small Group)","Yes","93-0242990","69572IN0040002","EHB High PPO","69572IN004",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.38","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","69572IN0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","IN","69572","HIOS","1","2015-05-01 02:23:41","1","69572","IN","SHOP (Small Group)","Yes","93-0242990","69572IN0040001","EHB Low PPO","69572IN004",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.25","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","69572IN0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110005","Ambetter Balanced Care 10 (2016)","76179IN011",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110005-03","Limited Cost Sharing Plan Variation",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110005-03.pdf","https://api.centene.com/Brochures/2016/76179IN0110005-03.pdf","32"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110005","Ambetter Balanced Care 10 (2016)","76179IN011",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110005-04","73% AV Level Silver Plan",,"0.738659501075745","Yes","Yes","No","100%",,"$4,000","$10","$200","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110005-04.pdf","https://api.centene.com/Brochures/2016/76179IN0110005-04.pdf","33"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110005","Ambetter Balanced Care 10 (2016)","76179IN011",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110005-05","87% AV Level Silver Plan",,"0.874480485916138","Yes","Yes","No","100%",,"$1,000","$0","$800","$200","$1,000","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110005-05.pdf","https://api.centene.com/Brochures/2016/76179IN0110005-05.pdf","34"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110005","Ambetter Balanced Care 10 (2016)","76179IN011",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110005-06","94% AV Level Silver Plan",,"0.946612775325775","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110005-06.pdf","https://api.centene.com/Brochures/2016/76179IN0110005-06.pdf","35"
"2016","IN","69572","HIOS","1","2015-05-01 02:23:41","1","69572","IN","SHOP (Small Group)","Yes","93-0242990","69572IN0030002","EHB High Passive","69572IN003",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.64","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","69572IN0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","IN","69572","HIOS","1","2015-05-01 02:23:41","1","69572","IN","SHOP (Small Group)","Yes","93-0242990","69572IN0030001","EHB Low Passive","69572IN003",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.67","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","69572IN0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","IN","72074","HIOS","2","2015-07-09 13:17:42","1","72074","IN","SHOP (Small Group)","Yes","57-0523959","72074IN0020001","Group Dental Policy","72074IN002",,"INN001","INS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.92","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","72074IN0020001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","76179IN011",,"INN001","INS001","INF001","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110001-00","Standard Gold Off Exchange Plan",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/76179IN0110001-00.pdf","https://api.centene.com/Brochures/2016/76179IN0110001-00.pdf","4"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","76179IN011",,"INN001","INS001","INF001","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110001-01","Standard Gold On Exchange Plan",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/76179IN0110001-01.pdf","https://api.centene.com/Brochures/2016/76179IN0110001-01.pdf","5"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","76179IN011",,"INN001","INS001","INF001","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/76179IN0110001-02.pdf","https://api.centene.com/Brochures/2016/76179IN0110001-02.pdf","6"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","76179IN011",,"INN001","INS001","INF001","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110001-03","Limited Cost Sharing Plan Variation",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/76179IN0110001-03.pdf","https://api.centene.com/Brochures/2016/76179IN0110001-03.pdf","7"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110002","Ambetter Balanced Care 1(2016)","76179IN011",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110002-00","Standard Silver Off Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110002-00.pdf","https://api.centene.com/Brochures/2016/76179IN0110002-00.pdf","8"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110002","Ambetter Balanced Care 1(2016)","76179IN011",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110002-01","Standard Silver On Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110002-01.pdf","https://api.centene.com/Brochures/2016/76179IN0110002-01.pdf","9"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110002","Ambetter Balanced Care 1(2016)","76179IN011",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110002-02.pdf","https://api.centene.com/Brochures/2016/76179IN0110002-02.pdf","10"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110002","Ambetter Balanced Care 1(2016)","76179IN011",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110002-03","Limited Cost Sharing Plan Variation",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110002-03.pdf","https://api.centene.com/Brochures/2016/76179IN0110002-03.pdf","11"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110002","Ambetter Balanced Care 1(2016)","76179IN011",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110002-04","73% AV Level Silver Plan",,"0.737546384334564","Yes","Yes","No","100%",,"$3,500","$10","$300","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110002-04.pdf","https://api.centene.com/Brochures/2016/76179IN0110002-04.pdf","12"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110002","Ambetter Balanced Care 1(2016)","76179IN011",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110002-05","87% AV Level Silver Plan",,"0.879890024662018","Yes","Yes","No","100%",,"$400","$10","$1,000","$200","$400","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110002-05.pdf","https://api.centene.com/Brochures/2016/76179IN0110002-05.pdf","13"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110002","Ambetter Balanced Care 1(2016)","76179IN011",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110002-06","94% AV Level Silver Plan",,"0.948710560798645","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110002-06.pdf","https://api.centene.com/Brochures/2016/76179IN0110002-06.pdf","14"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110003","Ambetter Balanced Care 2 (2016)","76179IN011",,"INN001","INS001","INF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110003-00","Standard Silver Off Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110003-00.pdf","https://api.centene.com/Brochures/2016/76179IN0110003-00.pdf","15"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110003","Ambetter Balanced Care 2 (2016)","76179IN011",,"INN001","INS001","INF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110003-01","Standard Silver On Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110003-01.pdf","https://api.centene.com/Brochures/2016/76179IN0110003-01.pdf","16"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110003","Ambetter Balanced Care 2 (2016)","76179IN011",,"INN001","INS001","INF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110003-02.pdf","https://api.centene.com/Brochures/2016/76179IN0110003-02.pdf","17"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110003","Ambetter Balanced Care 2 (2016)","76179IN011",,"INN001","INS001","INF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110003-03","Limited Cost Sharing Plan Variation",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110003-03.pdf","https://api.centene.com/Brochures/2016/76179IN0110003-03.pdf","18"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110003","Ambetter Balanced Care 2 (2016)","76179IN011",,"INN001","INS001","INF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110003-04","73% AV Level Silver Plan",,"0.739638686180115","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110003-04.pdf","https://api.centene.com/Brochures/2016/76179IN0110003-04.pdf","19"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110003","Ambetter Balanced Care 2 (2016)","76179IN011",,"INN001","INS001","INF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110003-05","87% AV Level Silver Plan",,"0.873916625976563","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,700","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110003-05.pdf","https://api.centene.com/Brochures/2016/76179IN0110003-05.pdf","20"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110003","Ambetter Balanced Care 2 (2016)","76179IN011",,"INN001","INS001","INF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110003-06","94% AV Level Silver Plan",,"0.9492227435112","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110003-06.pdf","https://api.centene.com/Brochures/2016/76179IN0110003-06.pdf","21"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110005","Ambetter Balanced Care 10 (2016)","76179IN011",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110005-00","Standard Silver Off Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110005-00.pdf","https://api.centene.com/Brochures/2016/76179IN0110005-00.pdf","29"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110005","Ambetter Balanced Care 10 (2016)","76179IN011",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110005-01","Standard Silver On Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110005-01.pdf","https://api.centene.com/Brochures/2016/76179IN0110005-01.pdf","30"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110005","Ambetter Balanced Care 10 (2016)","76179IN011",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110005-02.pdf","https://api.centene.com/Brochures/2016/76179IN0110005-02.pdf","31"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110006","Ambetter Essential Care 1 (2016)","76179IN011",,"INN001","INS001","INF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110006-00","Standard Bronze Off Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110006-00.pdf","https://api.centene.com/Brochures/2016/76179IN0110006-00.pdf","36"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110006","Ambetter Essential Care 1 (2016)","76179IN011",,"INN001","INS001","INF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110006-01","Standard Bronze On Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110006-01.pdf","https://api.centene.com/Brochures/2016/76179IN0110006-01.pdf","37"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110006","Ambetter Essential Care 1 (2016)","76179IN011",,"INN001","INS001","INF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110006-02.pdf","https://api.centene.com/Brochures/2016/76179IN0110006-02.pdf","38"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110006","Ambetter Essential Care 1 (2016)","76179IN011",,"INN001","INS001","INF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110006-03","Limited Cost Sharing Plan Variation",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110006-03.pdf","https://api.centene.com/Brochures/2016/76179IN0110006-03.pdf","39"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110007","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","76179IN011",,"INN001","INS001","INF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110007-00","Standard Bronze Off Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110007-00.pdf","https://api.centene.com/Brochures/2016/76179IN0110007-00.pdf","40"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110007","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","76179IN011",,"INN001","INS001","INF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110007-01","Standard Bronze On Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110007-01.pdf","https://api.centene.com/Brochures/2016/76179IN0110007-01.pdf","41"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110007","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","76179IN011",,"INN001","INS001","INF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110007-02.pdf","https://api.centene.com/Brochures/2016/76179IN0110007-02.pdf","42"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","1","76179","IN","Individual","No","06-0641618","76179IN0110007","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","76179IN011",,"INN001","INS001","INF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0110007-03","Limited Cost Sharing Plan Variation",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0110007-03.pdf","https://api.centene.com/Brochures/2016/76179IN0110007-03.pdf","43"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120001","Ambetter Balanced Care 1 (2016) + Vision","76179IN012",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9799",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120001-00","Standard Silver Off Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120001-00.pdf","https://api.centene.com/Brochures/2016/76179IN0120001-00.pdf","4"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120001","Ambetter Balanced Care 1 (2016) + Vision","76179IN012",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9799",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120001-01","Standard Silver On Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120001-01.pdf","https://api.centene.com/Brochures/2016/76179IN0120001-01.pdf","5"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120001","Ambetter Balanced Care 1 (2016) + Vision","76179IN012",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9799",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120001-02.pdf","https://api.centene.com/Brochures/2016/76179IN0120001-02.pdf","6"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120001","Ambetter Balanced Care 1 (2016) + Vision","76179IN012",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9799",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120001-03","Limited Cost Sharing Plan Variation",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120001-03.pdf","https://api.centene.com/Brochures/2016/76179IN0120001-03.pdf","7"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120001","Ambetter Balanced Care 1 (2016) + Vision","76179IN012",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9799",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120001-04","73% AV Level Silver Plan",,"0.737546384334564","Yes","Yes","No","100%",,"$3,500","$10","$300","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120001-04.pdf","https://api.centene.com/Brochures/2016/76179IN0120001-04.pdf","8"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120001","Ambetter Balanced Care 1 (2016) + Vision","76179IN012",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9799",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120001-05","87% AV Level Silver Plan",,"0.879890024662018","Yes","Yes","No","100%",,"$400","$10","$1,000","$200","$400","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120001-05.pdf","https://api.centene.com/Brochures/2016/76179IN0120001-05.pdf","9"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120001","Ambetter Balanced Care 1 (2016) + Vision","76179IN012",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9799",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120001-06","94% AV Level Silver Plan",,"0.948710560798645","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120001-06.pdf","https://api.centene.com/Brochures/2016/76179IN0120001-06.pdf","10"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120002","Ambetter Balanced Care 2 (2016) + Vision","76179IN012",,"INN001","INS001","INF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9799",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120002-00","Standard Silver Off Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120002-00.pdf","https://api.centene.com/Brochures/2016/76179IN0120002-00.pdf","11"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120002","Ambetter Balanced Care 2 (2016) + Vision","76179IN012",,"INN001","INS001","INF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9799",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120002-01","Standard Silver On Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120002-01.pdf","https://api.centene.com/Brochures/2016/76179IN0120002-01.pdf","12"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120002","Ambetter Balanced Care 2 (2016) + Vision","76179IN012",,"INN001","INS001","INF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9799",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120002-02.pdf","https://api.centene.com/Brochures/2016/76179IN0120002-02.pdf","13"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120002","Ambetter Balanced Care 2 (2016) + Vision","76179IN012",,"INN001","INS001","INF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9799",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120002-03","Limited Cost Sharing Plan Variation",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120002-03.pdf","https://api.centene.com/Brochures/2016/76179IN0120002-03.pdf","14"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120002","Ambetter Balanced Care 2 (2016) + Vision","76179IN012",,"INN001","INS001","INF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9799",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120002-04","73% AV Level Silver Plan",,"0.739638686180115","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120002-04.pdf","https://api.centene.com/Brochures/2016/76179IN0120002-04.pdf","15"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120002","Ambetter Balanced Care 2 (2016) + Vision","76179IN012",,"INN001","INS001","INF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9799",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120002-05","87% AV Level Silver Plan",,"0.873916625976563","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,700","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120002-05.pdf","https://api.centene.com/Brochures/2016/76179IN0120002-05.pdf","16"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120002","Ambetter Balanced Care 2 (2016) + Vision","76179IN012",,"INN001","INS001","INF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9799",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120002-06","94% AV Level Silver Plan",,"0.9492227435112","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120002-06.pdf","https://api.centene.com/Brochures/2016/76179IN0120002-06.pdf","17"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120004","Ambetter Balanced Care 10 (2016) + Vision","76179IN012",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9799",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120004-00","Standard Silver Off Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120004-00.pdf","https://api.centene.com/Brochures/2016/76179IN0120004-00.pdf","18"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120004","Ambetter Balanced Care 10 (2016) + Vision","76179IN012",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9799",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120004-01","Standard Silver On Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120004-01.pdf","https://api.centene.com/Brochures/2016/76179IN0120004-01.pdf","19"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120004","Ambetter Balanced Care 10 (2016) + Vision","76179IN012",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9799",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120004-02.pdf","https://api.centene.com/Brochures/2016/76179IN0120004-02.pdf","20"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120004","Ambetter Balanced Care 10 (2016) + Vision","76179IN012",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9799",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120004-03","Limited Cost Sharing Plan Variation",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120004-03.pdf","https://api.centene.com/Brochures/2016/76179IN0120004-03.pdf","21"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120004","Ambetter Balanced Care 10 (2016) + Vision","76179IN012",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9799",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120004-04","73% AV Level Silver Plan",,"0.738659501075745","Yes","Yes","No","100%",,"$4,000","$10","$200","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120004-04.pdf","https://api.centene.com/Brochures/2016/76179IN0120004-04.pdf","22"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120004","Ambetter Balanced Care 10 (2016) + Vision","76179IN012",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9799",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120004-05","87% AV Level Silver Plan",,"0.874480485916138","Yes","Yes","No","100%",,"$1,000","$0","$800","$200","$1,000","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120004-05.pdf","https://api.centene.com/Brochures/2016/76179IN0120004-05.pdf","23"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120004","Ambetter Balanced Care 10 (2016) + Vision","76179IN012",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9799",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120004-06","94% AV Level Silver Plan",,"0.946612775325775","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120004-06.pdf","https://api.centene.com/Brochures/2016/76179IN0120004-06.pdf","24"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120005","Ambetter Essential Care 1 (2016) + Vision","76179IN012",,"INN001","INS001","INF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9787",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120005-00","Standard Bronze Off Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120005-00.pdf","https://api.centene.com/Brochures/2016/76179IN0120005-00.pdf","25"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120005","Ambetter Essential Care 1 (2016) + Vision","76179IN012",,"INN001","INS001","INF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9787",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120005-01","Standard Bronze On Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120005-01.pdf","https://api.centene.com/Brochures/2016/76179IN0120005-01.pdf","26"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120005","Ambetter Essential Care 1 (2016) + Vision","76179IN012",,"INN001","INS001","INF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9787",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120005-02.pdf","https://api.centene.com/Brochures/2016/76179IN0120005-02.pdf","27"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120005","Ambetter Essential Care 1 (2016) + Vision","76179IN012",,"INN001","INS001","INF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9787",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120005-03","Limited Cost Sharing Plan Variation",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120005-03.pdf","https://api.centene.com/Brochures/2016/76179IN0120005-03.pdf","28"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120006","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","76179IN012",,"INN001","INS001","INF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9787",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120006-00","Standard Bronze Off Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120006-00.pdf","https://api.centene.com/Brochures/2016/76179IN0120006-00.pdf","29"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120006","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","76179IN012",,"INN001","INS001","INF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9787",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120006-01","Standard Bronze On Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120006-01.pdf","https://api.centene.com/Brochures/2016/76179IN0120006-01.pdf","30"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120006","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","76179IN012",,"INN001","INS001","INF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9787",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120006-02.pdf","https://api.centene.com/Brochures/2016/76179IN0120006-02.pdf","31"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","2","76179","IN","Individual","No","06-0641618","76179IN0120006","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","76179IN012",,"INN001","INS001","INF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9787",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0120006-03","Limited Cost Sharing Plan Variation",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0120006-03.pdf","https://api.centene.com/Brochures/2016/76179IN0120006-03.pdf","32"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.916",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130001-00","Standard Silver Off Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130001-00.pdf","https://api.centene.com/Brochures/2016/76179IN0130001-00.pdf","4"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.916",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130001-01","Standard Silver On Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130001-01.pdf","https://api.centene.com/Brochures/2016/76179IN0130001-01.pdf","5"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.916",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130001-02.pdf","https://api.centene.com/Brochures/2016/76179IN0130001-02.pdf","6"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.916",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130001-03","Limited Cost Sharing Plan Variation",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130001-03.pdf","https://api.centene.com/Brochures/2016/76179IN0130001-03.pdf","7"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.916",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130001-04","73% AV Level Silver Plan",,"0.737546384334564","Yes","Yes","No","100%",,"$3,500","$10","$300","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130001-04.pdf","https://api.centene.com/Brochures/2016/76179IN0130001-04.pdf","8"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.916",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130001-05","87% AV Level Silver Plan",,"0.879890024662018","Yes","Yes","No","100%",,"$400","$10","$1,000","$200","$400","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130001-05.pdf","https://api.centene.com/Brochures/2016/76179IN0130001-05.pdf","9"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.916",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130001-06","94% AV Level Silver Plan",,"0.948710560798645","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130001-06.pdf","https://api.centene.com/Brochures/2016/76179IN0130001-06.pdf","10"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.916",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130002-00","Standard Silver Off Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130002-00.pdf","https://api.centene.com/Brochures/2016/76179IN0130002-00.pdf","11"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.916",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130002-01","Standard Silver On Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130002-01.pdf","https://api.centene.com/Brochures/2016/76179IN0130002-01.pdf","12"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.916",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130002-02.pdf","https://api.centene.com/Brochures/2016/76179IN0130002-02.pdf","13"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.916",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130002-03","Limited Cost Sharing Plan Variation",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130002-03.pdf","https://api.centene.com/Brochures/2016/76179IN0130002-03.pdf","14"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.916",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130002-04","73% AV Level Silver Plan",,"0.739638686180115","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130002-04.pdf","https://api.centene.com/Brochures/2016/76179IN0130002-04.pdf","15"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.916",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130002-05","87% AV Level Silver Plan",,"0.873916625976563","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,700","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130002-05.pdf","https://api.centene.com/Brochures/2016/76179IN0130002-05.pdf","16"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.916",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130002-06","94% AV Level Silver Plan",,"0.9492227435112","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130002-06.pdf","https://api.centene.com/Brochures/2016/76179IN0130002-06.pdf","17"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130004","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.916",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130004-00","Standard Silver Off Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130004-00.pdf","https://api.centene.com/Brochures/2016/76179IN0130004-00.pdf","18"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130004","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.916",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130004-01","Standard Silver On Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130004-01.pdf","https://api.centene.com/Brochures/2016/76179IN0130004-01.pdf","19"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130004","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.916",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130004-02.pdf","https://api.centene.com/Brochures/2016/76179IN0130004-02.pdf","20"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130004","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.916",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130004-03","Limited Cost Sharing Plan Variation",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130004-03.pdf","https://api.centene.com/Brochures/2016/76179IN0130004-03.pdf","21"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130004","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.916",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130004-04","73% AV Level Silver Plan",,"0.738659501075745","Yes","Yes","No","100%",,"$4,000","$10","$200","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130004-04.pdf","https://api.centene.com/Brochures/2016/76179IN0130004-04.pdf","22"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130004","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.916",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130004-05","87% AV Level Silver Plan",,"0.874480485916138","Yes","Yes","No","100%",,"$1,000","$0","$800","$200","$1,000","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130004-05.pdf","https://api.centene.com/Brochures/2016/76179IN0130004-05.pdf","23"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130004","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.916",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130004-06","94% AV Level Silver Plan",,"0.946612775325775","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130004-06.pdf","https://api.centene.com/Brochures/2016/76179IN0130004-06.pdf","24"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130005","Ambetter Essential Care 1 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF001","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9114",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130005-00","Standard Bronze Off Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130005-00.pdf","https://api.centene.com/Brochures/2016/76179IN0130005-00.pdf","25"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130005","Ambetter Essential Care 1 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF001","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9114",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130005-01","Standard Bronze On Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130005-01.pdf","https://api.centene.com/Brochures/2016/76179IN0130005-01.pdf","26"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130005","Ambetter Essential Care 1 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF001","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9114",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130005-02.pdf","https://api.centene.com/Brochures/2016/76179IN0130005-02.pdf","27"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130005","Ambetter Essential Care 1 (2016) + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF001","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9114",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130005-03","Limited Cost Sharing Plan Variation",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130005-03.pdf","https://api.centene.com/Brochures/2016/76179IN0130005-03.pdf","28"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130006","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9115",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130006-00","Standard Bronze Off Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130006-00.pdf","https://api.centene.com/Brochures/2016/76179IN0130006-00.pdf","29"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130006","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9115",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130006-01","Standard Bronze On Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130006-01.pdf","https://api.centene.com/Brochures/2016/76179IN0130006-01.pdf","30"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130006","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9115",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130006-02.pdf","https://api.centene.com/Brochures/2016/76179IN0130006-02.pdf","31"
"2016","IN","76179","HIOS","5","2015-10-22 04:38:36","3","76179","IN","Individual","No","06-0641618","76179IN0130006","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision + Adult Dental","76179IN013",,"INN001","INS001","INF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9115",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/formulary","76179IN0130006-03","Limited Cost Sharing Plan Variation",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/76179IN0130006-03.pdf","https://api.centene.com/Brochures/2016/76179IN0130006-03.pdf","32"
"2016","IN","79503","HIOS","9","2015-10-18 12:35:12","1","79503","IN","Individual","Yes","31-1185262","79503IN0010001","DentaTrust - PPO Enhanced Network Pediatric High Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$42.39","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010001-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbin.dentalcareplus.com","https://hixindsbin.dentalcareplus.com","4"
"2016","IN","79503","HIOS","9","2015-10-18 12:35:12","1","79503","IN","SHOP (Small Group)","Yes","31-1185262","79503IN0020003","DentaSpan Enhanced Network Family High Option","79503IN002","7083617077","INN001","INS001",,"Existing","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$36.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0020003-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbin.dentalcareplus.com","https://hixsgsbin.dentalcareplus.com","4"
"2016","IN","79503","HIOS","9","2015-10-18 12:35:12","1","79503","IN","SHOP (Small Group)","Yes","31-1185262","79503IN0020003","DentaSpan Enhanced Network Family High Option","79503IN002","7083617077","INN001","INS001",,"Existing","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$36.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0020003-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbin.dentalcareplus.com","https://hixsgsbin.dentalcareplus.com","5"
"2016","IN","79503","HIOS","9","2015-10-18 12:35:12","1","79503","IN","Individual","Yes","31-1185262","79503IN0010001","DentaTrust - PPO Enhanced Network Pediatric High Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$42.39","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010001-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbin.dentalcareplus.com","https://hixindsbin.dentalcareplus.com","5"
"2016","IN","79503","HIOS","9","2015-10-18 12:35:12","1","79503","IN","Individual","Yes","31-1185262","79503IN0010002","DentaTrust - PPO Enhanced Network Pediatric Low Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$36.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010002-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbin.dentalcareplus.com","https://hixindsbin.dentalcareplus.com","6"
"2016","IN","79503","HIOS","9","2015-10-18 12:35:12","1","79503","IN","SHOP (Small Group)","Yes","31-1185262","79503IN0020004","DentaSpan Enhanced Network Family Low Option","79503IN002","7083617077","INN001","INS001",,"Existing","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$31.17","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0020004-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbin.dentalcareplus.com","https://hixsgsbin.dentalcareplus.com","6"
"2016","IN","79503","HIOS","9","2015-10-18 12:35:12","1","79503","IN","SHOP (Small Group)","Yes","31-1185262","79503IN0020004","DentaSpan Enhanced Network Family Low Option","79503IN002","7083617077","INN001","INS001",,"Existing","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$31.17","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0020004-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbin.dentalcareplus.com","https://hixsgsbin.dentalcareplus.com","7"
"2016","IN","79503","HIOS","9","2015-10-18 12:35:12","1","79503","IN","Individual","Yes","31-1185262","79503IN0010002","DentaTrust - PPO Enhanced Network Pediatric Low Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$36.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010002-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbin.dentalcareplus.com","https://hixindsbin.dentalcareplus.com","7"
"2016","IN","79503","HIOS","9","2015-10-18 12:35:12","1","79503","IN","SHOP (Small Group)","Yes","31-1185262","79503IN0030003","DentaSpan Dental-Enhanced Network Family High Option-Off Exchange","79503IN003","7083617077","INN001","INS001",,"New","PPO","High",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$29.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0030003-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbin.dentalcareplus.com","https://hixsgsbin.dentalcareplus.com","8"
"2016","IN","79503","HIOS","9","2015-10-18 12:35:12","1","79503","IN","SHOP (Small Group)","Yes","31-1185262","79503IN0030004","DentaSpan Dental-Enhanced Network Family Low Option-Off Exchange","79503IN003","7083617077","INN001","INS001",,"New","PPO","Low",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$25.10","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0030004-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbin.dentalcareplus.com","https://hixsgsbin.dentalcareplus.com","9"
"2016","IN","97975","HIOS","1","2015-05-01 02:23:41","1","97975","IN","SHOP (Small Group)","Yes","47-0098400","97975IN0040002","EHB High PPO","97975IN004",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.69","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","97975IN0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","IN","97975","HIOS","1","2015-05-01 02:23:41","1","97975","IN","SHOP (Small Group)","Yes","47-0098400","97975IN0040001","EHB Low PPO","97975IN004",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.90","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","97975IN0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0230006","Community Blue 70/50 $4500","19636LA023",,"LAN007","LAS006","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0230006-03","Limited Cost Sharing Plan Variation",,"0.605891764163971","Yes","Yes","No","100%",,"$4,500","$0","$834","$150","$4,500","$0","$231","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230006-03&Year=2016","http://www.bcbsla.com/individual-communityblue-brochure2016","22"
"2016","IN","79503","HIOS","9","2015-10-18 12:35:12","2","79503","IN","SHOP (Small Group)","Yes","31-1185262","79503IN0030001","DentaSpan Pediatric Enhanced Network High Option","79503IN003","7083617077","INN001","INS001",,"New","PPO","High",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$36.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0030001-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","79503","HIOS","9","2015-10-18 12:35:12","2","79503","IN","Individual","Yes","31-1185262","79503IN0010003","DentaTrust - PPO Enhanced Network Family High Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$34.37","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010003-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbin.dentalcareplus.com","https://hixindsbin.dentalcareplus.com","4"
"2016","IN","79503","HIOS","9","2015-10-18 12:35:12","2","79503","IN","Individual","Yes","31-1185262","79503IN0010003","DentaTrust - PPO Enhanced Network Family High Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$34.37","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0010003-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbin.dentalcareplus.com","https://hixindsbin.dentalcareplus.com","5"
"2016","IN","79503","HIOS","9","2015-10-18 12:35:12","2","79503","IN","SHOP (Small Group)","Yes","31-1185262","79503IN0030002","DentaSpan Pediatric Enhanced Network Low Option","79503IN003","7083617077","INN001","INS001",,"New","PPO","Low",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$31.17","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","No","https://hixenroll.insxcloud.com/payment","","79503IN0030002-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IN","79503","HIOS","9","2015-10-18 12:35:12","2","79503","IN","Individual","Yes","31-1185262","79503IN0010004","DentaTrust - PPO Enhanced Network Family Low Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$29.04","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","79503IN0010004-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbin.dentalcareplus.com","https://hixindsbin.dentalcareplus.com","6"
"2016","IN","79503","HIOS","9","2015-10-18 12:35:12","2","79503","IN","Individual","Yes","31-1185262","79503IN0010004","DentaTrust - PPO Enhanced Network Family Low Option","79503IN001","7083617077","INN001","INS001",,"Existing","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$29.04","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out-of-Network coverage is available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","79503IN0010004-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbin.dentalcareplus.com","https://hixindsbin.dentalcareplus.com","7"
"2016","IN","83557","HIOS","3","2015-08-27 11:14:25","1","83557","IN","Individual","Yes","95-6042390","83557IN0020003","BESTOne Advantage Gold","83557IN002",,"INN001","INS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.73","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2016/IN_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","IN","83557","HIOS","3","2015-08-27 11:14:25","1","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010007","BESTDental Premium","83557IN001",,"INN001","INS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.17","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2016/IN_BESTDental_Premium_Plan.pdf","4"
"2016","IN","83557","HIOS","3","2015-08-27 11:14:25","1","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010007","BESTDental Premium","83557IN001",,"INN001","INS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.17","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2016/IN_BESTDental_Premium_Plan.pdf","5"
"2016","IN","83557","HIOS","3","2015-08-27 11:14:25","1","83557","IN","Individual","Yes","95-6042390","83557IN0020003","BESTOne Advantage Gold","83557IN002",,"INN001","INS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.73","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2016/IN_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","IN","83557","HIOS","3","2015-08-27 11:14:25","1","83557","IN","Individual","Yes","95-6042390","83557IN0020004","BESTOne Plus Gold","83557IN002",,"INN001","INS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.73","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2016/IN_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","IN","83557","HIOS","3","2015-08-27 11:14:25","1","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010008","BESTDental Standard - H","83557IN001",,"INN001","INS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.17","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2016/IN_BESTDental_Standard-H_Plan.pdf","6"
"2016","IN","83557","HIOS","3","2015-08-27 11:14:25","1","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010008","BESTDental Standard - H","83557IN001",,"INN001","INS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.17","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2016/IN_BESTDental_Standard-H_Plan.pdf","7"
"2016","IN","83557","HIOS","3","2015-08-27 11:14:25","1","83557","IN","Individual","Yes","95-6042390","83557IN0020004","BESTOne Plus Gold","83557IN002",,"INN001","INS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.73","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2016/IN_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","IN","83557","HIOS","3","2015-08-27 11:14:25","1","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010010","BESTDental Choice - H","83557IN001",,"INN001","INS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.17","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2016/IN_BESTDental_Choice-H_Plan.pdf","8"
"2016","IN","83557","HIOS","3","2015-08-27 11:14:25","1","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010010","BESTDental Choice - H","83557IN001",,"INN001","INS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.17","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2016/IN_BESTDental_Choice-H_Plan.pdf","9"
"2016","IN","83557","HIOS","3","2015-08-27 11:14:25","2","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010009","BESTDental Standard - L","83557IN001",,"INN001","INS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.37","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2016/IN_BESTDental_Standard-L_Plan.pdf","4"
"2016","IN","83557","HIOS","3","2015-08-27 11:14:25","2","83557","IN","Individual","Yes","95-6042390","83557IN0020005","BESTOne Plus Silver","83557IN002",,"INN001","INS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.20","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2016/IN_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","IN","83557","HIOS","3","2015-08-27 11:14:25","2","83557","IN","Individual","Yes","95-6042390","83557IN0020005","BESTOne Plus Silver","83557IN002",,"INN001","INS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.20","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2016/IN_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","IN","83557","HIOS","3","2015-08-27 11:14:25","2","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010009","BESTDental Standard - L","83557IN001",,"INN001","INS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.37","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2016/IN_BESTDental_Standard-L_Plan.pdf","5"
"2016","IN","83557","HIOS","3","2015-08-27 11:14:25","2","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010011","BESTDental Choice - L","83557IN001",,"INN001","INS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.37","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2016/IN_BESTDental_Choice-L_Plan.pdf","6"
"2016","IN","83557","HIOS","3","2015-08-27 11:14:25","2","83557","IN","Individual","Yes","95-6042390","83557IN0020006","BESTOne Basic Silver","83557IN002",,"INN001","INS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.20","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2016/IN_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","IN","83557","HIOS","3","2015-08-27 11:14:25","2","83557","IN","Individual","Yes","95-6042390","83557IN0020006","BESTOne Basic Silver","83557IN002",,"INN001","INS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.20","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2016/IN_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","IN","83557","HIOS","3","2015-08-27 11:14:25","2","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010011","BESTDental Choice - L","83557IN001",,"INN001","INS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.37","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2016/IN_BESTDental_Choice-L_Plan.pdf","7"
"2016","IN","83557","HIOS","3","2015-08-27 11:14:25","2","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010012","BESTDental Value","83557IN001",,"INN001","INS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.37","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2016/IN_BESTDental_Value_Plan.pdf","8"
"2016","IN","83557","HIOS","3","2015-08-27 11:14:25","2","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010012","BESTDental Value","83557IN001",,"INN001","INS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.37","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","83557IN0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IN/2016/IN_BESTDental_Value_Plan.pdf","9"
"2016","IN","87417","HIOS","3","2015-10-20 04:38:50","1","87417","IN","Individual","Yes","36-3757528","87417IN0010001","TruAssure Basic Adult or Child Dental Plan","87417IN001",,"INN001","INS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.94","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","87417IN0010001-00","Standard Low Off Exchange Plan","68.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IN","https://www.truassure.com/brochure?state=IN","4"
"2016","IN","87417","HIOS","3","2015-10-20 04:38:50","1","87417","IN","SHOP (Small Group)","Yes","36-3757528","87417IN0040001","TruAssure Dental Small Group Basic Plan","87417IN004",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.98","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","No","https://www.truassure.com/payment","","87417IN0040001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","87417","HIOS","3","2015-10-20 04:38:50","1","87417","IN","Individual","Yes","36-3757528","87417IN0010001","TruAssure Basic Adult or Child Dental Plan","87417IN001",,"INN001","INS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.94","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","87417IN0010001-01","Standard Low On Exchange Plan","68.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IN","https://www.truassure.com/brochure?state=IN","5"
"2016","IN","87417","HIOS","3","2015-10-20 04:38:50","1","87417","IN","SHOP (Small Group)","Yes","36-3757528","87417IN0030001","TruAssure Dental Small Group Preferred Plan","87417IN003",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.98","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","87417IN0030001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IN","87417","HIOS","3","2015-10-20 04:38:50","2","87417","IN","Individual","Yes","36-3757528","87417IN0020001","TruAssure Preferred Adult or Child Dental Plan","87417IN002",,"INN001","INS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.42","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","87417IN0020001-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IN","https://www.truassure.com/brochure?state=IN","4"
"2016","IN","87417","HIOS","3","2015-10-20 04:38:50","2","87417","IN","Individual","Yes","36-3757528","87417IN0020001","TruAssure Preferred Adult or Child Dental Plan","87417IN002",,"INN001","INS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.42","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","87417IN0020001-01","Standard High On Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IN","https://www.truassure.com/brochure?state=IN","5"
"2016","IN","90613","HIOS","1","2015-05-01 02:23:41","1","90613","IN","SHOP (Small Group)","Yes","36-0883760","90613IN0040002","EHB High PPO","90613IN004",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.26","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","90613IN0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","IN","90613","HIOS","1","2015-05-01 02:23:41","1","90613","IN","SHOP (Small Group)","Yes","36-0883760","90613IN0040001","EHB Low PPO","90613IN004",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.19","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","90613IN0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","IN","90613","HIOS","1","2015-05-01 02:23:41","1","90613","IN","SHOP (Small Group)","Yes","36-0883760","90613IN0030002","EHB High Passive","90613IN003",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.51","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","90613IN0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","IN","90613","HIOS","1","2015-05-01 02:23:41","1","90613","IN","SHOP (Small Group)","Yes","36-0883760","90613IN0030001","EHB Low Passive","90613IN003",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.59","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","90613IN0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","LA","18802","HIOS","5","2015-08-23 12:37:12","2","18802","LA","Individual","Yes","94-2761537","18802LA0010004","Delta Dental PPO Preferred Plan for Families","18802LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","$35","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0010004-16","4"
"2016","LA","18802","HIOS","5","2015-08-23 12:37:12","2","18802","LA","SHOP (Small Group)","Yes","94-2761537","18802LA0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","18802LA002",,"LAN001","LAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","$35","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0020004-16","4"
"2016","LA","18802","HIOS","5","2015-08-23 12:37:12","2","18802","LA","SHOP (Small Group)","Yes","94-2761537","18802LA0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","18802LA002",,"LAN001","LAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","$35","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0020004-16","5"
"2016","LA","18802","HIOS","5","2015-08-23 12:37:12","2","18802","LA","Individual","Yes","94-2761537","18802LA0010004","Delta Dental PPO Preferred Plan for Families","18802LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","$35","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0010004-16","5"
"2016","LA","18802","HIOS","5","2015-08-23 12:37:12","3","18802","LA","Individual","Yes","94-2761537","18802LA0010006","Delta Dental PPO Basic Plan for Families","18802LA001",,"LAN001","LAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0010006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0010006-16","4"
"2016","LA","18802","HIOS","5","2015-08-23 12:37:12","3","18802","LA","SHOP (Small Group)","Yes","94-2761537","18802LA0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","18802LA002",,"LAN001","LAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0020006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0020006-16","4"
"2016","IN","91920","HIOS","7","2015-08-23 12:37:12","1","91920","IN","Individual","Yes","75-1233841","91920IN0010001","Dentegra Dental PPO Pediatric Basic Plan","91920IN001",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.97","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","91920IN0010001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/in/91920in0010001-16","4"
"2016","IN","91920","HIOS","7","2015-08-23 12:37:12","1","91920","IN","SHOP (Small Group)","Yes","75-1233841","91920IN0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","91920IN002",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","91920IN0020001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/in/91920in0020001-16","4"
"2016","IN","91920","HIOS","7","2015-08-23 12:37:12","2","91920","IN","SHOP (Small Group)","Yes","75-1233841","91920IN0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","91920IN002",,"INN001","INS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","91920IN0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/in/91920in0020004-16","4"
"2016","IN","91920","HIOS","7","2015-08-23 12:37:12","2","91920","IN","Individual","Yes","75-1233841","91920IN0010004","Dentegra Dental PPO Family Preferred Plan","91920IN001",,"INN001","INS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.70","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","91920IN0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/in/91920in0010004-16","4"
"2016","IN","91920","HIOS","7","2015-08-23 12:37:12","2","91920","IN","Individual","Yes","75-1233841","91920IN0010004","Dentegra Dental PPO Family Preferred Plan","91920IN001",,"INN001","INS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.70","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","91920IN0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/in/91920in0010004-16","5"
"2016","IN","91920","HIOS","7","2015-08-23 12:37:12","2","91920","IN","SHOP (Small Group)","Yes","75-1233841","91920IN0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","91920IN002",,"INN001","INS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","91920IN0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/in/91920in0020004-16","5"
"2016","IN","91920","HIOS","7","2015-08-23 12:37:12","3","91920","IN","SHOP (Small Group)","Yes","75-1233841","91920IN0020009","Dentegra Dental PPO for Small Businesses Family Basic Plan","91920IN002",,"INN001","INS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","91920IN0020009-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/in/91920in0020009-16","4"
"2016","IN","91920","HIOS","7","2015-08-23 12:37:12","3","91920","IN","Individual","Yes","75-1233841","91920IN0010009","Dentegra Dental PPO Family Basic Plan","91920IN001",,"INN001","INS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.97","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","91920IN0010009-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/in/91920in0010009-16","4"
"2016","IN","91920","HIOS","7","2015-08-23 12:37:12","3","91920","IN","Individual","Yes","75-1233841","91920IN0010009","Dentegra Dental PPO Family Basic Plan","91920IN001",,"INN001","INS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.97","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","91920IN0010009-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/in/91920in0010009-16","5"
"2016","IN","91920","HIOS","7","2015-08-23 12:37:12","3","91920","IN","SHOP (Small Group)","Yes","75-1233841","91920IN0020009","Dentegra Dental PPO for Small Businesses Family Basic Plan","91920IN002",,"INN001","INS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","91920IN0020009-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/in/91920in0020009-16","5"
"2016","IN","97677","HIOS","1","2015-05-04 05:06:13","1","97677","IN","SHOP (Small Group)","Yes","44-0308260","97677IN0010001","KCL EHB Low PPO","97677IN001",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$38.83","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","97677IN0010001-00","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","97677","HIOS","1","2015-05-04 05:06:13","1","97677","IN","SHOP (Small Group)","Yes","44-0308260","97677IN0010003","KCL EHB Low MAC","97677IN001",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$28.05","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","97677IN0010003-00","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IN","97677","HIOS","1","2015-05-04 05:06:13","1","97677","IN","SHOP (Small Group)","Yes","44-0308260","97677IN0010005","KCL Fam Low PPO","97677IN001",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$38.83","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","97677IN0010005-00","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","IN","97677","HIOS","1","2015-05-04 05:06:13","1","97677","IN","SHOP (Small Group)","Yes","44-0308260","97677IN0010007","KCL Fam Low MAC","97677IN001",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$28.05","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","97677IN0010007-00","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","IN","97677","HIOS","1","2015-05-04 05:06:13","2","97677","IN","SHOP (Small Group)","Yes","44-0308260","97677IN0010002","KCL EHB High PPO","97677IN001",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$47.38","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","97677IN0010002-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IN","97677","HIOS","1","2015-05-04 05:06:13","2","97677","IN","SHOP (Small Group)","Yes","44-0308260","97677IN0010004","KCL EHB High MAC","97677IN001",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$35.27","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","97677IN0010004-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IN","97677","HIOS","1","2015-05-04 05:06:13","2","97677","IN","SHOP (Small Group)","Yes","44-0308260","97677IN0010006","KCL Fam High PPO","97677IN001",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$47.38","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","97677IN0010006-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","IN","97677","HIOS","1","2015-05-04 05:06:13","2","97677","IN","SHOP (Small Group)","Yes","44-0308260","97677IN0010008","KCL Fam High MAC","97677IN001",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$35.27","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","97677IN0010008-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","IN","97975","HIOS","1","2015-05-01 02:23:41","1","97975","IN","SHOP (Small Group)","Yes","47-0098400","97975IN0030002","EHB High Passive","97975IN003",,"INN001","INS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.89","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","97975IN0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","IN","97975","HIOS","1","2015-05-01 02:23:41","1","97975","IN","SHOP (Small Group)","Yes","47-0098400","97975IN0030001","EHB Low Passive","97975IN003",,"INN001","INS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.23","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","97975IN0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","LA","17940","HIOS","1","2015-05-01 02:23:41","1","17940","LA","SHOP (Small Group)","Yes","36-0883760","17940LA0030002","EHB High Passive","17940LA003",,"LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.04","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","17940LA0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","LA","17940","HIOS","1","2015-05-01 02:23:41","1","17940","LA","SHOP (Small Group)","Yes","36-0883760","17940LA0030001","EHB Low Passive","17940LA003",,"LAN001","LAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.69","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","17940LA0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","LA","18575","HIOS","1","2015-05-06 02:44:46","1","18575","LA","SHOP (Small Group)","Yes","72-0977315","18575LA0120001","AlwaysCare Small Group Dental – Child 2016","18575LA012",,"LAN001","LAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$26.96","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","18575LA0120001-00","Standard High Off Exchange Plan","86.01%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","LA","18575","HIOS","1","2015-05-06 02:44:46","1","18575","LA","Individual","Yes","72-0977315","18575LA0090001","AlwaysCare All-Star Kids Dental Plan 2016","18575LA009",,"LAN001","LAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$25.02","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","18575LA0090001-00","Standard High Off Exchange Plan","86.01%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","LA","18575","HIOS","1","2015-05-06 02:44:46","1","18575","LA","SHOP (Small Group)","Yes","72-0977315","18575LA0120002","AlwaysCare Small Group Dental – Child 2016","18575LA012",,"LAN001","LAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$22.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","18575LA0120002-00","Standard Low Off Exchange Plan","70.92%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","LA","18575","HIOS","1","2015-05-06 02:44:46","2","18575","LA","SHOP (Small Group)","Yes","72-0977315","18575LA0110001","AlwaysCare Small Group Dental – Adults 2016","18575LA011",,"LAN001","LAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$26.96","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","18575LA0110001-00","Standard High Off Exchange Plan","86.01%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","LA","18575","HIOS","1","2015-05-06 02:44:46","2","18575","LA","Individual","Yes","72-0977315","18575LA0100001","AlwaysCare All-Star Family Dental Plan 2016","18575LA010",,"LAN001","LAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$25.02","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","18575LA0100001-00","Standard High Off Exchange Plan","86.01%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","LA","18575","HIOS","1","2015-05-06 02:44:46","2","18575","LA","SHOP (Small Group)","Yes","72-0977315","18575LA0110002","AlwaysCare Small Group Dental – Adults 2016","18575LA011",,"LAN001","LAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$22.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","18575LA0110002-00","Standard Low Off Exchange Plan","70.92%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","LA","18802","HIOS","5","2015-08-23 12:37:12","1","18802","LA","Individual","Yes","94-2761537","18802LA0010002","Delta Dental PPO Pediatric Preferred Plan","18802LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0010002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","$35","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0010002-16","4"
"2016","LA","18802","HIOS","5","2015-08-23 12:37:12","1","18802","LA","SHOP (Small Group)","Yes","94-2761537","18802LA0020002","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","18802LA002",,"LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0020002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","$35","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0020002-16","4"
"2016","LA","18802","HIOS","5","2015-08-23 12:37:12","1","18802","LA","SHOP (Small Group)","Yes","94-2761537","18802LA0020001","Delta Dental PPO Pediatric Basic Plan for Small Businesses","18802LA002",,"LAN001","LAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0020001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0020001-16","5"
"2016","LA","18802","HIOS","5","2015-08-23 12:37:12","1","18802","LA","Individual","Yes","94-2761537","18802LA0010001","Delta Dental PPO Pediatric Basic Plan","18802LA001",,"LAN001","LAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0010001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0010001-16","5"
"2016","LA","18802","HIOS","5","2015-08-23 12:37:12","3","18802","LA","SHOP (Small Group)","Yes","94-2761537","18802LA0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","18802LA002",,"LAN001","LAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0020006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0020006-16","5"
"2016","LA","18802","HIOS","5","2015-08-23 12:37:12","3","18802","LA","Individual","Yes","94-2761537","18802LA0010006","Delta Dental PPO Basic Plan for Families","18802LA001",,"LAN001","LAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","18802LA0010006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/la/18802la0010006-16","5"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","SHOP (Small Group)","No","72-1071369","19636LA0250003","Blue POS copay 60/40 $3000","19636LA025",,"LAN005","LAS007","LAF001","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes",,"http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0250003-00","Standard Silver Off Exchange Plan",,"0.706111669540405","No","Yes","No","100%",,"$3,000","$75","$589","$150","$1,272","$1,000","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,000","$3000 per person","$9000 per group","40%",,,,,"$6,000","$6000 per person","$18000 per group","$9,000","$9000 per person","$27000 per group","$0","per person not applicable","per group not applicable","10%",,,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=19636LA0250003-00&Year=2016","http://www.bcbsla.com/smallgroup-solutions-brochure2016","4"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0220013","Blue POS 70/50 $4500","19636LA022",,"LAN005","LAS007","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0220013-00","Standard Bronze Off Exchange Plan",,"0.605891764163971","Yes","Yes","No","100%",,"$4,500","$0","$834","$150","$4,500","$0","$231","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220013-00&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","4"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0220013","Blue POS 70/50 $4500","19636LA022",,"LAN005","LAS007","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0220013-01","Standard Bronze On Exchange Plan",,"0.605891764163971","Yes","Yes","No","100%",,"$4,500","$0","$834","$150","$4,500","$0","$231","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220013-01&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","5"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","SHOP (Small Group)","No","72-1071369","19636LA0250003","Blue POS copay 60/40 $3000","19636LA025",,"LAN005","LAS007","LAF001","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes",,"http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0250003-01","Standard Silver On Exchange Plan",,"0.706111669540405","No","Yes","No","100%",,"$3,000","$75","$589","$150","$1,272","$1,000","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,000","$3000 per person","$9000 per group","40%",,,,,"$6,000","$6000 per person","$18000 per group","$9,000","$9000 per person","$27000 per group","$0","per person not applicable","per group not applicable","10%",,,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=19636LA0250003-01&Year=2016","http://www.bcbsla.com/smallgroup-solutions-brochure2016","5"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","SHOP (Small Group)","No","72-1071369","19636LA0250014","Blue POS copay 80/60 $1000A","19636LA025",,"LAN005","LAS007","LAF002","New","POS","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes",,"http://www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0250014-00","Standard Gold Off Exchange Plan",,"0.789889276027679","No","Yes","No","100%",,"$1,000","$62","$694","$150","$1,000","$630","$54","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$9000 per group","$0","per person not applicable","per group not applicable","10%",,,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=19636LA0250014-00&Year=2016","http://www.bcbsla.com/smallgroup-solutions-brochure2016","6"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0220013","Blue POS 70/50 $4500","19636LA022",,"LAN005","LAS007","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0220013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220013-02&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","6"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0220013","Blue POS 70/50 $4500","19636LA022",,"LAN005","LAS007","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0220013-03","Limited Cost Sharing Plan Variation",,"0.605891764163971","Yes","Yes","No","100%",,"$4,500","$0","$834","$150","$4,500","$0","$231","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220013-03&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","7"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","SHOP (Small Group)","No","72-1071369","19636LA0250014","Blue POS copay 80/60 $1000A","19636LA025",,"LAN005","LAS007","LAF002","New","POS","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes",,"http://www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0250014-01","Standard Gold On Exchange Plan",,"0.789889276027679","No","Yes","No","100%",,"$1,000","$62","$694","$150","$1,000","$630","$54","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$9000 per group","$0","per person not applicable","per group not applicable","10%",,,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=19636LA0250014-01&Year=2016","http://www.bcbsla.com/smallgroup-solutions-brochure2016","7"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0220012","Blue POS 60/40 $6500","19636LA022",,"LAN005","LAS007","LAF005","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0220012-00","Standard Bronze Off Exchange Plan",,"0.587533593177795","Yes","Yes","No","100%",,"$6,500","$0","$313","$150","$5,271","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","40%",,,,,"$13,000","$13000 per person","$27400 per group","$19,500","$19500 per person","$41100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220012-00&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","8"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0220012","Blue POS 60/40 $6500","19636LA022",,"LAN005","LAS007","LAF005","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0220012-01","Standard Bronze On Exchange Plan",,"0.587533593177795","Yes","Yes","No","100%",,"$6,500","$0","$313","$150","$5,271","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","40%",,,,,"$13,000","$13000 per person","$27400 per group","$19,500","$19500 per person","$41100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220012-01&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","9"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0220012","Blue POS 60/40 $6500","19636LA022",,"LAN005","LAS007","LAF005","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0220012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220012-02&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","10"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0220012","Blue POS 60/40 $6500","19636LA022",,"LAN005","LAS007","LAF005","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0220012-03","Limited Cost Sharing Plan Variation",,"0.587533593177795","Yes","Yes","No","100%",,"$6,500","$0","$313","$150","$5,271","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","40%",,,,,"$13,000","$13000 per person","$27400 per group","$19,500","$19500 per person","$41100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220012-03&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","11"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0220010","Blue POS 100/80 $3500","19636LA022",,"LAN005","LAS007","LAF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0220010-00","Standard Silver Off Exchange Plan",,"0.686174988746643","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$109","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220010-00&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","12"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0220010","Blue POS 100/80 $3500","19636LA022",,"LAN005","LAS007","LAF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0220010-01","Standard Silver On Exchange Plan",,"0.686174988746643","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$109","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220010-01&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","13"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0220010","Blue POS 100/80 $3500","19636LA022",,"LAN005","LAS007","LAF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0220010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220010-02&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","14"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0220010","Blue POS 100/80 $3500","19636LA022",,"LAN005","LAS007","LAF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0220010-03","Limited Cost Sharing Plan Variation",,"0.686174988746643","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$109","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220010-03&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","15"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0240002","Blue Connect copay 80/60 $1000","19636LA024",,"LAN006","LAS005","LAF002","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0240002-01","Standard Gold On Exchange Plan","79.17%","0.772588849067688","No","Yes","No","100%",,"$1,023","$60","$694","$150","$1,500","$245","$54","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$5,000","$5000 per person","$15000 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240002-01&Year=2016","http://www.bcbsla.com/individual-blueconnect-brochure2016","27"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0240002","Blue Connect copay 80/60 $1000","19636LA024",,"LAN006","LAS005","LAF002","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0240002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240002-02&Year=2016","http://www.bcbsla.com/individual-blueconnect-brochure2016","28"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0240002","Blue Connect copay 80/60 $1000","19636LA024",,"LAN006","LAS005","LAF002","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0240002-03","Limited Cost Sharing Plan Variation","79.17%","0.772588849067688","No","Yes","No","100%",,"$1,023","$60","$694","$150","$1,500","$245","$54","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$5,000","$5000 per person","$15000 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240002-03&Year=2016","http://www.bcbsla.com/individual-blueconnect-brochure2016","29"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0240003","Blue Connect copay 70/50 $3500","19636LA024",,"LAN006","LAS005","LAF001","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0240003-00","Standard Silver Off Exchange Plan","70.89%","0.693150043487549","No","Yes","No","100%",,"$3,523","$60","$291","$150","$1,772","$524","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$10500 per group","30%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-00&Year=2016","http://www.bcbsla.com/individual-blueconnect-brochure2016","30"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0240003","Blue Connect copay 70/50 $3500","19636LA024",,"LAN006","LAS005","LAF001","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0240003-01","Standard Silver On Exchange Plan","70.89%","0.693150043487549","No","Yes","No","100%",,"$3,523","$60","$291","$150","$1,772","$524","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$10500 per group","30%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-01&Year=2016","http://www.bcbsla.com/individual-blueconnect-brochure2016","31"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0220010","Blue POS 100/80 $3500","19636LA022",,"LAN005","LAS007","LAF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0220010-04","73% AV Level Silver Plan",,"0.736175239086151","Yes","Yes","No","100%",,"$2,600","$0","$0","$150","$2,600","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$13,700","$13700 per person","$27400 per group","$19,150","$19150 per person","$38300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7800 per group","0%",,,,,"$7,000","$7000 per person","$21000 per group","$9,600","$9600 per person","$28800 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220010-04&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","16"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0220010","Blue POS 100/80 $3500","19636LA022",,"LAN005","LAS007","LAF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0220010-05","87% AV Level Silver Plan",,"0.875686585903168","Yes","Yes","No","100%",,"$850","$0","$0","$150","$850","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$13,700","$13700 per person","$27400 per group","$15,950","$15950 per person","$31900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$2550 per group","0%",,,,,"$7,000","$7000 per person","$21000 per group","$7,850","$7850 per person","$23550 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220010-05&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","17"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0220010","Blue POS 100/80 $3500","19636LA022",,"LAN005","LAS007","LAF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0220010-06","94% AV Level Silver Plan",,"0.94365268945694","Yes","Yes","No","100%",,"$200","$0","$0","$150","$200","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$13,700","$13700 per person","$27400 per group","$15,950","$15950 per person","$31900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","0%",,,,,"$7,000","$7000 per person","$21000 per group","$7,200","$7200 per person","$21600 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220010-06&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","18"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0230006","Community Blue 70/50 $4500","19636LA023",,"LAN007","LAS006","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0230006-00","Standard Bronze Off Exchange Plan",,"0.605891764163971","Yes","Yes","No","100%",,"$4,500","$0","$834","$150","$4,500","$0","$231","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230006-00&Year=2016","http://www.bcbsla.com/individual-communityblue-brochure2016","19"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0230006","Community Blue 70/50 $4500","19636LA023",,"LAN007","LAS006","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0230006-01","Standard Bronze On Exchange Plan",,"0.605891764163971","Yes","Yes","No","100%",,"$4,500","$0","$834","$150","$4,500","$0","$231","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230006-01&Year=2016","http://www.bcbsla.com/individual-communityblue-brochure2016","20"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0230006","Community Blue 70/50 $4500","19636LA023",,"LAN007","LAS006","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0230006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230006-02&Year=2016","http://www.bcbsla.com/individual-communityblue-brochure2016","21"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0240006","Blue Connect 70/50 $4500","19636LA024",,"LAN006","LAS005","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0240006-00","Standard Bronze Off Exchange Plan",,"0.605891764163971","Yes","Yes","No","100%",,"$4,500","$0","$834","$150","$4,500","$0","$231","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240006-00&Year=2016","http://www.bcbsla.com/individual-blueconnect-brochure2016","23"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0240006","Blue Connect 70/50 $4500","19636LA024",,"LAN006","LAS005","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0240006-01","Standard Bronze On Exchange Plan",,"0.605891764163971","Yes","Yes","No","100%",,"$4,500","$0","$834","$150","$4,500","$0","$231","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240006-01&Year=2016","http://www.bcbsla.com/individual-blueconnect-brochure2016","24"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0240006","Blue Connect 70/50 $4500","19636LA024",,"LAN006","LAS005","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0240006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240006-02&Year=2016","http://www.bcbsla.com/individual-blueconnect-brochure2016","25"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","1","19636","LA","Individual","No","72-1071369","19636LA0240006","Blue Connect 70/50 $4500","19636LA024",,"LAN006","LAS005","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0240006-03","Limited Cost Sharing Plan Variation",,"0.605891764163971","Yes","Yes","No","100%",,"$4,500","$0","$834","$150","$4,500","$0","$231","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13500 per group","30%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240006-03&Year=2016","http://www.bcbsla.com/individual-blueconnect-brochure2016","26"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0220005","Blue POS copay 80/60 $1000","19636LA022",,"LAN005","LAS007","LAF002","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0220005-00","Standard Gold Off Exchange Plan","78.62%","0.774351716041565","No","Yes","No","100%",,"$1,023","$60","$694","$150","$1,500","$645","$54","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$9000 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220005-00&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","4"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0220005","Blue POS copay 80/60 $1000","19636LA022",,"LAN005","LAS007","LAF002","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0220005-01","Standard Gold On Exchange Plan","78.62%","0.774351716041565","No","Yes","No","100%",,"$1,023","$60","$694","$150","$1,500","$645","$54","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$9000 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220005-01&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","5"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0220005","Blue POS copay 80/60 $1000","19636LA022",,"LAN005","LAS007","LAF002","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0220005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220005-02&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","6"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0220005","Blue POS copay 80/60 $1000","19636LA022",,"LAN005","LAS007","LAF002","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0220005-03","Limited Cost Sharing Plan Variation","78.62%","0.774351716041565","No","Yes","No","100%",,"$1,023","$60","$694","$150","$1,500","$645","$54","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$9000 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220005-03&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","7"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0220007","Blue POS copay 70/50 $3000","19636LA022",,"LAN005","LAS007","LAF001","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0220007-00","Standard Silver Off Exchange Plan","71.23%","0.702939093112946","No","Yes","No","100%",,"$3,023","$60","$441","$150","$1,772","$924","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,000","$3000 per person","$9000 per group","30%",,,,,"$6,000","$6000 per person","$18000 per group","$9,000","$9000 per person","$27000 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-00&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","8"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0220007","Blue POS copay 70/50 $3000","19636LA022",,"LAN005","LAS007","LAF001","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0220007-01","Standard Silver On Exchange Plan","71.23%","0.702939093112946","No","Yes","No","100%",,"$3,023","$60","$441","$150","$1,772","$924","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,000","$3000 per person","$9000 per group","30%",,,,,"$6,000","$6000 per person","$18000 per group","$9,000","$9000 per person","$27000 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-01&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","9"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0220007","Blue POS copay 70/50 $3000","19636LA022",,"LAN005","LAS007","LAF001","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0220007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-02&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","10"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0220007","Blue POS copay 70/50 $3000","19636LA022",,"LAN005","LAS007","LAF001","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0220007-03","Limited Cost Sharing Plan Variation","71.23%","0.702939093112946","No","Yes","No","100%",,"$3,023","$60","$441","$150","$1,772","$924","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,000","$3000 per person","$9000 per group","30%",,,,,"$6,000","$6000 per person","$18000 per group","$9,000","$9000 per person","$27000 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-03&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","11"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0220007","Blue POS copay 70/50 $3000","19636LA022",,"LAN005","LAS007","LAF001","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0220007-04","73% AV Level Silver Plan","73.43%","0.716511428356171","No","Yes","No","100%",,"$2,723","$60","$354","$150","$1,772","$924","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$13,700","$13700 per person","$27400 per group","$19,150","$19150 per person","$38300 per group","$2,700","$2700 per person","$8100 per group","20%",,,,,"$6,000","$6000 per person","$18000 per group","$8,700","$8700 per person","$26100 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-04&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","12"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0220007","Blue POS copay 70/50 $3000","19636LA022",,"LAN005","LAS007","LAF001","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0220007-05","87% AV Level Silver Plan","87.47%","0.866791367530823","No","Yes","No","100%",,"$523","$35","$199","$150","$750","$423","$39","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$13,700","$13700 per person","$27400 per group","$15,950","$15950 per person","$31900 per group","$500","$500 per person","$1500 per group","5%",,,,,"$6,000","$6000 per person","$18000 per group","$6,500","$6500 per person","$19500 per group","$250","$250 per person","per group not applicable","10%",,,,,"$250","$250 per person","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-05&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","13"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0220007","Blue POS copay 70/50 $3000","19636LA022",,"LAN005","LAS007","LAF001","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0220007-06","94% AV Level Silver Plan","93.45%","0.929661095142365","No","Yes","No","100%",,"$48","$25","$0","$150","$125","$330","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$13,700","$13700 per person","$27400 per group","$15,950","$15950 per person","$31900 per group","$25","$25 per person","$75 per group","0%",,,,,"$6,000","$6000 per person","$18000 per group","$6,025","$6025 per person","$18075 per group","$100","$100 per person","per group not applicable","10%",,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-06&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","14"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","5","19636","LA","Individual","No","72-1071369","19636LA0240005","Blue Connect copay 80/60 $6750","19636LA024",,"LAN006","LAS005","LAF006","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0240005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240005-02&Year=2016","http://www.bcbsla.com/individual-blueconnect-brochure2016","10"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","5","19636","LA","Individual","No","72-1071369","19636LA0240005","Blue Connect copay 80/60 $6750","19636LA024",,"LAN006","LAS005","LAF006","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0240005-03","Limited Cost Sharing Plan Variation",,"0.608699023723602","Yes","Yes","No","100%",,"$6,578","$0","$0","$150","$4,121","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","20%",,,,,"$13,500","$13500 per person","$27400 per group","$20,250","$20250 per person","$41100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240005-03&Year=2016","http://www.bcbsla.com/individual-blueconnect-brochure2016","11"
"2016","LA","25551","HIOS","2","2015-07-09 13:17:42","1","25551","LA","SHOP (Small Group)","Yes","81-0170040","25551LA0010001","Assurant Dental ACAFFO High","25551LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$35.28","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","25551LA0010001-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","LA","25551","HIOS","2","2015-07-09 13:17:42","1","25551","LA","SHOP (Small Group)","Yes","81-0170040","25551LA0010002","Assurant Dental ACAFFO Low","25551LA001",,"LAN001","LAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$29.40","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","25551LA0010002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","LA","28419","HIOS","1","2015-05-05 11:48:23","1","28419","LA","Individual","Yes","47-0397286","28419LA0010001","Delta Dental Individual PPO, EHB Certified","28419LA001",,"LAN002","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28419LA0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","LA","28419","HIOS","1","2015-05-05 11:48:23","1","28419","LA","SHOP (Small Group)","Yes","47-0397286","28419LA0030001","Renaissance Group Dental PPO, EHB Certified","28419LA003",,"LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.76","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28419LA0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0230002","Community Blue copay 80/60 $1000","19636LA023",,"LAN007","LAS006","LAF002","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0230002-00","Standard Gold Off Exchange Plan","79.17%","0.772588849067688","No","Yes","No","100%",,"$1,023","$60","$694","$150","$1,500","$245","$54","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$5,000","$5000 per person","$15000 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230002-00&Year=2016","http://www.bcbsla.com/individual-communityblue-brochure2016","15"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0230002","Community Blue copay 80/60 $1000","19636LA023",,"LAN007","LAS006","LAF002","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0230002-01","Standard Gold On Exchange Plan","79.17%","0.772588849067688","No","Yes","No","100%",,"$1,023","$60","$694","$150","$1,500","$245","$54","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$5,000","$5000 per person","$15000 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230002-01&Year=2016","http://www.bcbsla.com/individual-communityblue-brochure2016","16"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0230002","Community Blue copay 80/60 $1000","19636LA023",,"LAN007","LAS006","LAF002","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0230002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230002-02&Year=2016","http://www.bcbsla.com/individual-communityblue-brochure2016","17"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0230002","Community Blue copay 80/60 $1000","19636LA023",,"LAN007","LAS006","LAF002","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0230002-03","Limited Cost Sharing Plan Variation","79.17%","0.772588849067688","No","Yes","No","100%",,"$1,023","$60","$694","$150","$1,500","$245","$54","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$5,000","$5000 per person","$15000 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230002-03&Year=2016","http://www.bcbsla.com/individual-communityblue-brochure2016","18"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0230003","Community Blue copay 70/50 $3500","19636LA023",,"LAN007","LAS006","LAF001","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0230003-00","Standard Silver Off Exchange Plan","70.89%","0.693150043487549","No","Yes","No","100%",,"$3,523","$60","$291","$150","$1,772","$524","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$10500 per group","30%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-00&Year=2016","http://www.bcbsla.com/individual-communityblue-brochure2016","19"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0230003","Community Blue copay 70/50 $3500","19636LA023",,"LAN007","LAS006","LAF001","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0230003-01","Standard Silver On Exchange Plan","70.89%","0.693150043487549","No","Yes","No","100%",,"$3,523","$60","$291","$150","$1,772","$524","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$10500 per group","30%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-01&Year=2016","http://www.bcbsla.com/individual-communityblue-brochure2016","20"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0230003","Community Blue copay 70/50 $3500","19636LA023",,"LAN007","LAS006","LAF001","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0230003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-02&Year=2016","http://www.bcbsla.com/individual-communityblue-brochure2016","21"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0230003","Community Blue copay 70/50 $3500","19636LA023",,"LAN007","LAS006","LAF001","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0230003-03","Limited Cost Sharing Plan Variation","70.89%","0.693150043487549","No","Yes","No","100%",,"$3,523","$60","$291","$150","$1,772","$524","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$10500 per group","30%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-03&Year=2016","http://www.bcbsla.com/individual-communityblue-brochure2016","22"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0230003","Community Blue copay 70/50 $3500","19636LA023",,"LAN007","LAS006","LAF001","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0230003-04","73% AV Level Silver Plan","72.89%","0.711281001567841","No","Yes","No","100%",,"$2,773","$60","$516","$150","$1,772","$524","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$13,700","$13700 per person","$27400 per group","$19,100","$19100 per person","$38200 per group","$2,750","$2750 per person","$8250 per group","30%",,,,,"$7,000","$7000 per person","$21000 per group","$9,750","$9750 per person","$29250 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-04&Year=2016","http://www.bcbsla.com/individual-communityblue-brochure2016","23"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0230003","Community Blue copay 70/50 $3500","19636LA023",,"LAN007","LAS006","LAF001","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0230003-05","87% AV Level Silver Plan","87.42%","0.864951610565186","No","Yes","No","100%",,"$523","$35","$199","$150","$750","$273","$39","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$13,700","$13700 per person","$27400 per group","$15,950","$15950 per person","$31900 per group","$500","$500 per person","$1500 per group","5%",,,,,"$7,000","$7000 per person","$21000 per group","$7,500","$7500 per person","$22500 per group","$250","$250 per person","per group not applicable","10%",,,,,"$250","$250 per person","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-05&Year=2016","http://www.bcbsla.com/individual-communityblue-brochure2016","24"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0230003","Community Blue copay 70/50 $3500","19636LA023",,"LAN007","LAS006","LAF001","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0230003-06","94% AV Level Silver Plan","93.38%","0.928215086460114","No","Yes","No","100%",,"$48","$25","$0","$150","$125","$280","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$13,700","$13700 per person","$27400 per group","$15,950","$15950 per person","$31900 per group","$25","$25 per person","$75 per group","0%",,,,,"$7,000","$7000 per person","$21000 per group","$7,025","$7025 per person","$21075 per group","$100","$100 per person","per group not applicable","10%",,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-06&Year=2016","http://www.bcbsla.com/individual-communityblue-brochure2016","25"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0240002","Blue Connect copay 80/60 $1000","19636LA024",,"LAN006","LAS005","LAF002","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0240002-00","Standard Gold Off Exchange Plan","79.17%","0.772588849067688","No","Yes","No","100%",,"$1,023","$60","$694","$150","$1,500","$245","$54","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$5,000","$5000 per person","$15000 per group","$6,000","$6000 per person","$18000 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240002-00&Year=2016","http://www.bcbsla.com/individual-blueconnect-brochure2016","26"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0240003","Blue Connect copay 70/50 $3500","19636LA024",,"LAN006","LAS005","LAF001","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0240003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-02&Year=2016","http://www.bcbsla.com/individual-blueconnect-brochure2016","32"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0240003","Blue Connect copay 70/50 $3500","19636LA024",,"LAN006","LAS005","LAF001","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0240003-03","Limited Cost Sharing Plan Variation","70.89%","0.693150043487549","No","Yes","No","100%",,"$3,523","$60","$291","$150","$1,772","$524","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$10500 per group","30%",,,,,"$7,000","$7000 per person","$21000 per group","$10,500","$10500 per person","$31500 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-03&Year=2016","http://www.bcbsla.com/individual-blueconnect-brochure2016","33"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0240003","Blue Connect copay 70/50 $3500","19636LA024",,"LAN006","LAS005","LAF001","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0240003-04","73% AV Level Silver Plan","72.89%","0.711281001567841","No","Yes","No","100%",,"$2,773","$60","$516","$150","$1,772","$524","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$13,700","$13700 per person","$27400 per group","$19,100","$19100 per person","$38200 per group","$2,750","$2750 per person","$8250 per group","30%",,,,,"$7,000","$7000 per person","$21000 per group","$9,750","$9750 per person","$29250 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-04&Year=2016","http://www.bcbsla.com/individual-blueconnect-brochure2016","34"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0240003","Blue Connect copay 70/50 $3500","19636LA024",,"LAN006","LAS005","LAF001","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0240003-05","87% AV Level Silver Plan","87.42%","0.864951610565186","No","Yes","No","100%",,"$523","$35","$199","$150","$750","$273","$39","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$13,700","$13700 per person","$27400 per group","$15,950","$15950 per person","$31900 per group","$500","$500 per person","$1500 per group","5%",,,,,"$7,000","$7000 per person","$21000 per group","$7,500","$7500 per person","$22500 per group","$250","$250 per person","per group not applicable","10%",,,,,"$250","$250 per person","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-05&Year=2016","http://www.bcbsla.com/individual-blueconnect-brochure2016","35"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0240003","Blue Connect copay 70/50 $3500","19636LA024",,"LAN006","LAS005","LAF001","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0240003-06","94% AV Level Silver Plan","93.38%","0.928215086460114","No","Yes","No","100%",,"$48","$25","$0","$150","$125","$280","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$13,700","$13700 per person","$27400 per group","$15,950","$15950 per person","$31900 per group","$25","$25 per person","$75 per group","0%",,,,,"$7,000","$7000 per person","$21000 per group","$7,025","$7025 per person","$21075 per group","$100","$100 per person","per group not applicable","10%",,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-06&Year=2016","http://www.bcbsla.com/individual-blueconnect-brochure2016","36"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0220011","Blue POS copay 80/60 $4500","19636LA022",,"LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0220011-00","Standard Silver Off Exchange Plan","68.69%","0.678765833377838","No","Yes","No","100%",,"$4,494","$60","$0","$150","$1,772","$924","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$4,500","$4500 per person","$13500 per group","20%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220011-00&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","37"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0220011","Blue POS copay 80/60 $4500","19636LA022",,"LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0220011-01","Standard Silver On Exchange Plan","68.69%","0.678765833377838","No","Yes","No","100%",,"$4,494","$60","$0","$150","$1,772","$924","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$4,500","$4500 per person","$13500 per group","20%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220011-01&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","38"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0220011","Blue POS copay 80/60 $4500","19636LA022",,"LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0220011-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220011-02&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","39"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0220011","Blue POS copay 80/60 $4500","19636LA022",,"LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0220011-03","Limited Cost Sharing Plan Variation","68.69%","0.678765833377838","No","Yes","No","100%",,"$4,494","$60","$0","$150","$1,772","$924","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$4,500","$4500 per person","$13500 per group","20%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$40500 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220011-03&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","40"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0220011","Blue POS copay 80/60 $4500","19636LA022",,"LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0220011-04","73% AV Level Silver Plan","73.53%","0.724559724330902","No","Yes","No","100%",,"$2,323","$60","$434","$150","$1,772","$924","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$13,700","$13700 per person","$27400 per group","$19,150","$19150 per person","$38300 per group","$2,300","$2300 per person","$6900 per group","20%",,,,,"$9,000","$9000 per person","$27000 per group","$11,300","$11300 per person","$33900 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220011-04&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","41"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0220011","Blue POS copay 80/60 $4500","19636LA022",,"LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0220011-05","87% AV Level Silver Plan","87.37%","0.867702424526215","No","Yes","No","100%",,"$323","$30","$417","$150","$550","$685","$97","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$13,700","$13700 per person","$27400 per group","$15,950","$15950 per person","$31900 per group","$300","$300 per person","$900 per group","10%",,,,,"$9,000","$9000 per person","$27000 per group","$9,300","$9300 per person","$27900 per group","$250","$250 per person","per group not applicable","10%",,,,,"$250","$250 per person","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220011-05&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","42"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","2","19636","LA","Individual","No","72-1071369","19636LA0220011","Blue POS copay 80/60 $4500","19636LA022",,"LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://:www.bcbsla.com/pharmacy-4tier-formulary2016","19636LA0220011-06","94% AV Level Silver Plan","93.45%","0.929661095142365","No","Yes","No","100%",,"$48","$25","$0","$150","$125","$330","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$13,700","$13700 per person","$27400 per group","$15,950","$15950 per person","$31900 per group","$25","$25 per person","$75 per group","0%",,,,,"$9,000","$9000 per person","$27000 per group","$9,025","$9025 per person","$27075 per group","$100","$100 per person","per group not applicable","10%",,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220011-06&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","43"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","5","19636","LA","Individual","No","72-1071369","19636LA0230005","Community Blue copay 80/60 $6750","19636LA023",,"LAN007","LAS006","LAF006","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0230005-00","Standard Bronze Off Exchange Plan",,"0.608699023723602","Yes","Yes","No","100%",,"$6,578","$0","$0","$150","$4,121","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","20%",,,,,"$13,500","$13500 per person","$27400 per group","$20,250","$20250 per person","$41100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230005-00&Year=2016","http://www.bcbsla.com/individual-communityblue-brochure2016","4"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","5","19636","LA","Individual","No","72-1071369","19636LA0230005","Community Blue copay 80/60 $6750","19636LA023",,"LAN007","LAS006","LAF006","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0230005-01","Standard Bronze On Exchange Plan",,"0.608699023723602","Yes","Yes","No","100%",,"$6,578","$0","$0","$150","$4,121","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","20%",,,,,"$13,500","$13500 per person","$27400 per group","$20,250","$20250 per person","$41100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230005-01&Year=2016","http://www.bcbsla.com/individual-communityblue-brochure2016","5"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","5","19636","LA","Individual","No","72-1071369","19636LA0230005","Community Blue copay 80/60 $6750","19636LA023",,"LAN007","LAS006","LAF006","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0230005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230005-02&Year=2016","http://www.bcbsla.com/individual-communityblue-brochure2016","6"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","5","19636","LA","Individual","No","72-1071369","19636LA0230005","Community Blue copay 80/60 $6750","19636LA023",,"LAN007","LAS006","LAF006","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0230005-03","Limited Cost Sharing Plan Variation",,"0.608699023723602","Yes","Yes","No","100%",,"$6,578","$0","$0","$150","$4,121","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","20%",,,,,"$13,500","$13500 per person","$27400 per group","$20,250","$20250 per person","$41100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230005-03&Year=2016","http://www.bcbsla.com/individual-communityblue-brochure2016","7"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","5","19636","LA","Individual","No","72-1071369","19636LA0240005","Blue Connect copay 80/60 $6750","19636LA024",,"LAN006","LAS005","LAF006","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0240005-00","Standard Bronze Off Exchange Plan",,"0.608699023723602","Yes","Yes","No","100%",,"$6,578","$0","$0","$150","$4,121","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","20%",,,,,"$13,500","$13500 per person","$27400 per group","$20,250","$20250 per person","$41100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240005-00&Year=2016","http://www.bcbsla.com/individual-blueconnect-brochure2016","8"
"2016","LA","19636","HIOS","7","2016-01-29 04:56:16","5","19636","LA","Individual","No","72-1071369","19636LA0240005","Blue Connect copay 80/60 $6750","19636LA024",,"LAN006","LAS005","LAF006","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","19636LA0240005-01","Standard Bronze On Exchange Plan",,"0.608699023723602","Yes","Yes","No","100%",,"$6,578","$0","$0","$150","$4,121","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","20%",,,,,"$13,500","$13500 per person","$27400 per group","$20,250","$20250 per person","$41100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240005-01&Year=2016","http://www.bcbsla.com/individual-blueconnect-brochure2016","9"
"2016","LA","28419","HIOS","1","2015-05-05 11:48:23","1","28419","LA","SHOP (Small Group)","Yes","47-0397286","28419LA0030002","Renaissance Group Dental PPO, EHB Certified","28419LA003",,"LAN001","LAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.28","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28419LA0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","LA","28419","HIOS","1","2015-05-05 11:48:23","1","28419","LA","Individual","Yes","47-0397286","28419LA0010002","Delta Dental Individual PPO, EHB Certified","28419LA001",,"LAN002","LAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.38","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28419LA0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","LA","28419","HIOS","1","2015-05-05 11:48:23","1","28419","LA","Individual","Yes","47-0397286","28419LA0020001","Renaissance Individual Dental PPO, EHB Certified","28419LA002",,"LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.46","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28419LA0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","LA","28419","HIOS","1","2015-05-05 11:48:23","1","28419","LA","Individual","Yes","47-0397286","28419LA0020002","Renaissance Individual Dental PPO, EHB Certified","28419LA002",,"LAN001","LAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.33","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","28419LA0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","LA","33001","HIOS","1","2015-05-12 02:20:37","1","33001","LA","SHOP (Small Group)","Yes","41-0808596","33001LA0010002","Plan 2. Passive PPO $1000 Annual Maximum, Ortho","33001LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","33001LA0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","LA","33001","HIOS","1","2015-05-12 02:20:37","1","33001","LA","SHOP (Small Group)","Yes","41-0808596","33001LA0010005","Plan 5. Passive PPO, $2000 Annaul Maximum, Ortho","33001LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","33001LA0010005-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","LA","33001","HIOS","1","2015-05-12 02:20:37","1","33001","LA","SHOP (Small Group)","Yes","41-0808596","33001LA0010006","Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho","33001LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","33001LA0010006-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","LA","33001","HIOS","1","2015-05-12 02:20:37","1","33001","LA","SHOP (Small Group)","Yes","41-0808596","33001LA0010009","Plan 9. MAC PPO, $1500 Annual Maximum, Ortho","33001LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$20.18","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","33001LA0010009-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","1","38499","LA","Individual","No","72-1074008","38499LA0040005","Silver Compass HSA 3600","38499LA004",,"LAN001","LAS001","LAF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040005-00","Standard Silver Off Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=la0018&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","4"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","1","38499","LA","Individual","No","72-1074008","38499LA0040005","Silver Compass HSA 3600","38499LA004",,"LAN001","LAS001","LAF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040005-01","Standard Silver On Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=la0018&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","5"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","1","38499","LA","Individual","No","72-1074008","38499LA0040005","Silver Compass HSA 3600","38499LA004",,"LAN001","LAS001","LAF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=la0019&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","6"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","1","38499","LA","Individual","No","72-1074008","38499LA0040005","Silver Compass HSA 3600","38499LA004",,"LAN001","LAS001","LAF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040005-03","Limited Cost Sharing Plan Variation",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=la0020&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","7"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","1","38499","LA","Individual","No","72-1074008","38499LA0040005","Silver Compass HSA 3600","38499LA004",,"LAN001","LAS001","LAF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040005-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$3,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=la0021&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","8"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","1","38499","LA","Individual","No","72-1074008","38499LA0040005","Silver Compass HSA 3600","38499LA004",,"LAN001","LAS001","LAF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040005-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$200","$1,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=la0022&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","9"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","1","38499","LA","Individual","No","72-1074008","38499LA0040005","Silver Compass HSA 3600","38499LA004",,"LAN001","LAS001","LAF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040005-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=la0023&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","10"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040004","Gold Compass 1000","38499LA004",,"LAN001","LAS001","LAF003","New","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040004-00","Standard Gold Off Exchange Plan",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0015&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","8"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040004","Gold Compass 1000","38499LA004",,"LAN001","LAS001","LAF003","New","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040004-01","Standard Gold On Exchange Plan",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0015&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","9"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040004","Gold Compass 1000","38499LA004",,"LAN001","LAS001","LAF003","New","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0016&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","10"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040004","Gold Compass 1000","38499LA004",,"LAN001","LAS001","LAF003","New","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040004-03","Limited Cost Sharing Plan Variation",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0017&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","11"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570029","Humana Gold 2250/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570029-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629679","http://apps.humana.com/marketing/documents.asp?file=2592694","43"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","1","44965","LA","Individual","No","72-1279235","44965LA0570001","Humana Basic 6850/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44965LA0570001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2629315","http://apps.humana.com/marketing/documents.asp?file=2592655","5"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040006","Silver Compass 4000","38499LA004",,"LAN001","LAS001","LAF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040006-00","Standard Silver Off Exchange Plan",,"0.697066605091095","No","Yes","No","100%",,"$4,000","$20","$200","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0024&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","12"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040006","Silver Compass 4000","38499LA004",,"LAN001","LAS001","LAF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040006-01","Standard Silver On Exchange Plan",,"0.697066605091095","No","Yes","No","100%",,"$4,000","$20","$200","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0024&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","13"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040006","Silver Compass 4000","38499LA004",,"LAN001","LAS001","LAF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0025&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","14"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040006","Silver Compass 4000","38499LA004",,"LAN001","LAS001","LAF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040006-03","Limited Cost Sharing Plan Variation",,"0.697066605091095","No","Yes","No","100%",,"$4,000","$20","$200","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0026&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","15"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040006","Silver Compass 4000","38499LA004",,"LAN001","LAS001","LAF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040006-04","73% AV Level Silver Plan",,"0.737395048141479","No","Yes","No","100%",,"$3,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0027&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","16"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040006","Silver Compass 4000","38499LA004",,"LAN001","LAS001","LAF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040006-05","87% AV Level Silver Plan",,"0.87861156463623","No","Yes","No","100%",,"$900","$10","$500","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0028&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","17"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040006","Silver Compass 4000","38499LA004",,"LAN001","LAS001","LAF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040006-06","94% AV Level Silver Plan",,"0.946469008922577","No","Yes","No","100%",,"$0","$0","$500","$200","$0","$500","$20","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0029&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","18"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040008","Bronze Compass 6400","38499LA004",,"LAN001","LAS001","LAF001","New","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040008-00","Standard Bronze Off Exchange Plan",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0036&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","19"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040008","Bronze Compass 6400","38499LA004",,"LAN001","LAS001","LAF001","New","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040008-01","Standard Bronze On Exchange Plan",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0036&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","20"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040008","Bronze Compass 6400","38499LA004",,"LAN001","LAS001","LAF001","New","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0037&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","21"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040008","Bronze Compass 6400","38499LA004",,"LAN001","LAS001","LAF001","New","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040008-03","Limited Cost Sharing Plan Variation",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0038&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","22"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040009","Catastrophic Compass 6850","38499LA004",,"LAN001","LAS001","LAF002","New","HMO","Catastrophic","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040009-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,800","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=la0039&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","23"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040009","Catastrophic Compass 6850","38499LA004",,"LAN001","LAS001","LAF002","New","HMO","Catastrophic","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040009-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,800","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=la0039&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","24"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040007","Silver Compass 5000","38499LA004",,"LAN001","LAS001","LAF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040007-00","Standard Silver Off Exchange Plan",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0030&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","25"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040007","Silver Compass 5000","38499LA004",,"LAN001","LAS001","LAF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040007-01","Standard Silver On Exchange Plan",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0030&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","26"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040007","Silver Compass 5000","38499LA004",,"LAN001","LAS001","LAF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0031&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","27"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040007","Silver Compass 5000","38499LA004",,"LAN001","LAS001","LAF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040007-03","Limited Cost Sharing Plan Variation",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0032&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","28"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040007","Silver Compass 5000","38499LA004",,"LAN001","LAS001","LAF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040007-04","73% AV Level Silver Plan",,"0.728041231632233","No","Yes","No","100%",,"$3,600","$20","$500","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0033&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","29"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040007","Silver Compass 5000","38499LA004",,"LAN001","LAS001","LAF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040007-05","87% AV Level Silver Plan",,"0.871982634067535","No","Yes","No","100%",,"$800","$0","$800","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0034&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","30"
"2016","LA","38499","HIOS","6","2015-08-27 11:14:25","2","38499","LA","Individual","No","72-1074008","38499LA0040007","Silver Compass 5000","38499LA004",,"LAN001","LAS001","LAF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=la0011&st=la","38499LA0040007-06","94% AV Level Silver Plan",,"0.949420213699341","No","Yes","No","100%",,"$0","$0","$500","$200","$0","$500","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=la0035&st=la","http://www.uhc.com/iex/doc?id=la0040&st=la","31"
"2016","LA","42544","HIOS","7","2015-08-23 12:37:12","1","42544","LA","Individual","Yes","75-1233841","42544LA0010001","Dentegra Dental PPO Pediatric Basic Plan","42544LA001",,"LAN001","LAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.48","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","42544LA0010001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/la/42544la0010001-16","4"
"2016","LA","42544","HIOS","7","2015-08-23 12:37:12","1","42544","LA","SHOP (Small Group)","Yes","75-1233841","42544LA0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","42544LA002",,"LAN001","LAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.65","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","42544LA0020001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/la/42544la0020001-16","4"
"2016","LA","42544","HIOS","7","2015-08-23 12:37:12","2","42544","LA","SHOP (Small Group)","Yes","75-1233841","42544LA0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","42544LA002",,"LAN001","LAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.24","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","42544LA0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/la/42544la0020004-16","4"
"2016","LA","42544","HIOS","7","2015-08-23 12:37:12","2","42544","LA","Individual","Yes","75-1233841","42544LA0010004","Dentegra Dental PPO Family Preferred Plan","42544LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","42544LA0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/la/42544la0010004-16","4"
"2016","LA","42544","HIOS","7","2015-08-23 12:37:12","2","42544","LA","Individual","Yes","75-1233841","42544LA0010004","Dentegra Dental PPO Family Preferred Plan","42544LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","42544LA0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/la/42544la0010004-16","5"
"2016","LA","42544","HIOS","7","2015-08-23 12:37:12","2","42544","LA","SHOP (Small Group)","Yes","75-1233841","42544LA0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","42544LA002",,"LAN001","LAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.24","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","42544LA0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/la/42544la0020004-16","5"
"2016","LA","42544","HIOS","7","2015-08-23 12:37:12","3","42544","LA","SHOP (Small Group)","Yes","75-1233841","42544LA0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","42544LA002",,"LAN001","LAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.65","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","42544LA0020006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/la/42544la0020006-16","4"
"2016","LA","42544","HIOS","7","2015-08-23 12:37:12","3","42544","LA","Individual","Yes","75-1233841","42544LA0010006","Dentegra Dental PPO Family Basic Plan","42544LA001",,"LAN001","LAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.48","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","42544LA0010006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/la/42544la0010006-16","4"
"2016","LA","42544","HIOS","7","2015-08-23 12:37:12","3","42544","LA","Individual","Yes","75-1233841","42544LA0010006","Dentegra Dental PPO Family Basic Plan","42544LA001",,"LAN001","LAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.48","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","42544LA0010006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/la/42544la0010006-16","5"
"2016","LA","42544","HIOS","7","2015-08-23 12:37:12","3","42544","LA","SHOP (Small Group)","Yes","75-1233841","42544LA0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","42544LA002",,"LAN001","LAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.65","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","42544LA0020006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/la/42544la0020006-16","5"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","1","44965","LA","Individual","No","72-1279235","44965LA0570001","Humana Basic 6850/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44965LA0570001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2629315","http://apps.humana.com/marketing/documents.asp?file=2592655","4"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","1","44965","LA","Individual","Yes","72-1279235","44965LA0590001","Humana Dental Smart Choice","44965LA059",,"LAN003","LAS003",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.47","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","44965LA0590001-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612909","4"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","1","44965","LA","Individual","Yes","72-1279235","44965LA0590001","Humana Dental Smart Choice","44965LA059",,"LAN003","LAS003",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.47","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","44965LA0590001-01","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612909","5"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570004","Humana Gold 2250/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570004-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$220","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629692","http://apps.humana.com/marketing/documents.asp?file=2592694","14"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570005","Humana Platinum 500/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570005-00","Standard Platinum Off Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629705","http://apps.humana.com/marketing/documents.asp?file=2592707","15"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570005","Humana Platinum 500/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570005-01","Standard Platinum On Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629705","http://apps.humana.com/marketing/documents.asp?file=2592707","16"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","1","44965","LA","Individual","No","72-1279235","44965LA0570021","Humana Basic 6850/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44965LA0570021-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2629315","http://apps.humana.com/marketing/documents.asp?file=2592655","6"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570023","Humana Silver 3800/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570023-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629367","http://apps.humana.com/marketing/documents.asp?file=2592681","19"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570023","Humana Silver 3800/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570023-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629367","http://apps.humana.com/marketing/documents.asp?file=2592681","20"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570030","Humana Platinum 500/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570030-03","Limited Cost Sharing Plan Variation","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629965","http://apps.humana.com/marketing/documents.asp?file=2592707","48"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090002","Vantage Individual Gold","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Gold","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090002-03","Limited Cost Sharing Plan Variation","79.40%","0.793992102146149","No","Yes","No","100%",,"$750","$2,290","$0","$150","$750","$1,030","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Gold_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","11"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090004","Vantage Individual Bronze","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090004-03","Limited Cost Sharing Plan Variation","61.20%","0.598918557167053","Yes","Yes","No","100%",,"$6,760","$0","$0","$150","$3,760","$520","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","22"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100010","Vantage Group Savings Plus","67243LA010","7821091072","LAN002","LAS002","LAF001","New","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction",,"No","Allows Adult and Child-Only",,"Yes",,"0.9864",,,,"0","0","0","2016-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0100010-00","Standard Bronze Off Exchange Plan","59.80%","0.583145201206207","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$4,910","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes","No",,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_HSA_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016HSAPlanFinder.pdf","22"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360013","Group Care copay 70/50 $2500","97176LA036",,"LAN001","LAS001","LAF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes",,"http://www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0360013-01","Standard Silver On Exchange Plan",,"0.705365478992462","No","Yes","No","100%",,"$2,500","$900","$591","$150","$1,272","$1,000","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,500","$2500 per person","$7500 per group","30%",,,,,"$5,000","$5000 per person","$15000 per group","$7,500","$7500 per person","$22500 per group","$0","$0 per person","per group not applicable","10%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0360013-01&Year=2016","http://www.bcbsla.com/smallgroup-solutions-brochure2016","7"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","1","44965","LA","Individual","No","72-1279235","44965LA0570021","Humana Basic 6850/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44965LA0570021-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2629315","http://apps.humana.com/marketing/documents.asp?file=2592655","7"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","1","44965","LA","Individual","No","72-1279235","44965LA0570026","Humana Basic 6850/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44965LA0570026-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2629315","http://apps.humana.com/marketing/documents.asp?file=2592655","8"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","1","44965","LA","Individual","No","72-1279235","44965LA0570026","Humana Basic 6850/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44965LA0570026-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2629315","http://apps.humana.com/marketing/documents.asp?file=2592655","9"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","2","44965","LA","Individual","No","72-1279235","44965LA0570002","Humana Bronze 6450/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44965LA0570002-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2629328","http://apps.humana.com/marketing/documents.asp?file=2592668","4"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","2","44965","LA","Individual","No","72-1279235","44965LA0570002","Humana Bronze 6450/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44965LA0570002-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2629328","http://apps.humana.com/marketing/documents.asp?file=2592668","5"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","2","44965","LA","Individual","No","72-1279235","44965LA0570002","Humana Bronze 6450/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44965LA0570002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2629341","http://apps.humana.com/marketing/documents.asp?file=2592668","6"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","2","44965","LA","Individual","No","72-1279235","44965LA0570002","Humana Bronze 6450/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44965LA0570002-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2629354","http://apps.humana.com/marketing/documents.asp?file=2592668","7"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","2","44965","LA","Individual","No","72-1279235","44965LA0570022","Humana Bronze 6450/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44965LA0570022-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2629328","http://apps.humana.com/marketing/documents.asp?file=2592668","8"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","2","44965","LA","Individual","No","72-1279235","44965LA0570022","Humana Bronze 6450/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44965LA0570022-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2629328","http://apps.humana.com/marketing/documents.asp?file=2592668","9"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","2","44965","LA","Individual","No","72-1279235","44965LA0570022","Humana Bronze 6450/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44965LA0570022-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2629341","http://apps.humana.com/marketing/documents.asp?file=2592668","10"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","2","44965","LA","Individual","No","72-1279235","44965LA0570022","Humana Bronze 6450/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44965LA0570022-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2629354","http://apps.humana.com/marketing/documents.asp?file=2592668","11"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","2","44965","LA","Individual","No","72-1279235","44965LA0570027","Humana Bronze 6450/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44965LA0570027-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2629328","http://apps.humana.com/marketing/documents.asp?file=2592668","12"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","2","44965","LA","Individual","No","72-1279235","44965LA0570027","Humana Bronze 6450/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44965LA0570027-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2629328","http://apps.humana.com/marketing/documents.asp?file=2592668","13"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","2","44965","LA","Individual","No","72-1279235","44965LA0570027","Humana Bronze 6450/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44965LA0570027-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2629341","http://apps.humana.com/marketing/documents.asp?file=2592668","14"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","2","44965","LA","Individual","No","72-1279235","44965LA0570027","Humana Bronze 6450/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","44965LA0570027-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2629354","http://apps.humana.com/marketing/documents.asp?file=2592668","15"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570003","Humana Silver 3800/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570003-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629367","http://apps.humana.com/marketing/documents.asp?file=2592681","4"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570003","Humana Silver 3800/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570003-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629367","http://apps.humana.com/marketing/documents.asp?file=2592681","5"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570003","Humana Silver 3800/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629588","http://apps.humana.com/marketing/documents.asp?file=2592681","6"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570003","Humana Silver 3800/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570003-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629601","http://apps.humana.com/marketing/documents.asp?file=2592681","7"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570003","Humana Silver 3800/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570003-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629627","http://apps.humana.com/marketing/documents.asp?file=2623361","8"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570003","Humana Silver 3800/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570003-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629640","http://apps.humana.com/marketing/documents.asp?file=2623374","9"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570003","Humana Silver 3800/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570003-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$0","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629653","http://apps.humana.com/marketing/documents.asp?file=2623387","10"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570004","Humana Gold 2250/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570004-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$220","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629666","http://apps.humana.com/marketing/documents.asp?file=2592694","11"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570004","Humana Gold 2250/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570004-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$220","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629666","http://apps.humana.com/marketing/documents.asp?file=2592694","12"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570004","Humana Gold 2250/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629679","http://apps.humana.com/marketing/documents.asp?file=2592694","13"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570005","Humana Platinum 500/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629952","http://apps.humana.com/marketing/documents.asp?file=2592707","17"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570005","Humana Platinum 500/Louisiana HMOx","44965LA057",,"LAN001","LAS001","LAF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570005-03","Limited Cost Sharing Plan Variation","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629965","http://apps.humana.com/marketing/documents.asp?file=2592707","18"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570023","Humana Silver 3800/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570023-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629588","http://apps.humana.com/marketing/documents.asp?file=2592681","21"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570023","Humana Silver 3800/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570023-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629601","http://apps.humana.com/marketing/documents.asp?file=2592681","22"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570023","Humana Silver 3800/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570023-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629627","http://apps.humana.com/marketing/documents.asp?file=2623361","23"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570023","Humana Silver 3800/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570023-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629640","http://apps.humana.com/marketing/documents.asp?file=2623374","24"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570023","Humana Silver 3800/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570023-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$0","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629653","http://apps.humana.com/marketing/documents.asp?file=2623387","25"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570024","Humana Gold 2250/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570024-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$220","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629666","http://apps.humana.com/marketing/documents.asp?file=2592694","26"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570024","Humana Gold 2250/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570024-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$220","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629666","http://apps.humana.com/marketing/documents.asp?file=2592694","27"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570024","Humana Gold 2250/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570024-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629679","http://apps.humana.com/marketing/documents.asp?file=2592694","28"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570024","Humana Gold 2250/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570024-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$220","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629692","http://apps.humana.com/marketing/documents.asp?file=2592694","29"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570025","Humana Platinum 500/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570025-00","Standard Platinum Off Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629666","http://apps.humana.com/marketing/documents.asp?file=2592707","30"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570025","Humana Platinum 500/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570025-01","Standard Platinum On Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629705","http://apps.humana.com/marketing/documents.asp?file=2592707","31"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570025","Humana Platinum 500/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570025-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629952","http://apps.humana.com/marketing/documents.asp?file=2592707","32"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570025","Humana Platinum 500/Louisiana HMOx","44965LA057",,"LAN001","LAS004","LAF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570025-03","Limited Cost Sharing Plan Variation","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629965","http://apps.humana.com/marketing/documents.asp?file=2592707","33"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570028","Humana Silver 3800/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570028-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629367","http://apps.humana.com/marketing/documents.asp?file=2592681","34"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570028","Humana Silver 3800/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570028-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629367","http://apps.humana.com/marketing/documents.asp?file=2592681","35"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570028","Humana Silver 3800/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570028-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629588","http://apps.humana.com/marketing/documents.asp?file=2592681","36"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570028","Humana Silver 3800/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570028-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629601","http://apps.humana.com/marketing/documents.asp?file=2592681","37"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570028","Humana Silver 3800/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570028-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629627","http://apps.humana.com/marketing/documents.asp?file=2623361","38"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570028","Humana Silver 3800/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570028-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629640","http://apps.humana.com/marketing/documents.asp?file=2623374","39"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570028","Humana Silver 3800/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570028-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$0","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629653","http://apps.humana.com/marketing/documents.asp?file=2623387","40"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570029","Humana Gold 2250/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570029-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$220","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629666","http://apps.humana.com/marketing/documents.asp?file=2592694","41"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570029","Humana Gold 2250/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570029-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$220","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629666","http://apps.humana.com/marketing/documents.asp?file=2592694","42"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570029","Humana Gold 2250/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570029-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$220","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629692","http://apps.humana.com/marketing/documents.asp?file=2592694","44"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570030","Humana Platinum 500/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570030-00","Standard Platinum Off Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629705","http://apps.humana.com/marketing/documents.asp?file=2592707","45"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570030","Humana Platinum 500/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570030-01","Standard Platinum On Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629705","http://apps.humana.com/marketing/documents.asp?file=2592707","46"
"2016","LA","44965","HIOS","10","2015-08-25 05:06:23","3","44965","LA","Individual","No","72-1279235","44965LA0570030","Humana Platinum 500/Louisiana HMOx","44965LA057",,"LAN001","LAS005","LAF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","44965LA0570030-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2629952","http://apps.humana.com/marketing/documents.asp?file=2592707","47"
"2016","LA","46441","HIOS","1","2015-05-06 02:44:46","1","46441","LA","SHOP (Small Group)","Yes","44-0308260","46441LA0010001","KCL EHB Low PPO","46441LA001",,"LAN001","LAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$35.79","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","46441LA0010001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","LA","46441","HIOS","1","2015-05-06 02:44:46","1","46441","LA","SHOP (Small Group)","Yes","44-0308260","46441LA0010003","KCL EHB Low MAC","46441LA001",,"LAN001","LAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$24.86","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","46441LA0010003-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","LA","46441","HIOS","1","2015-05-06 02:44:46","1","46441","LA","SHOP (Small Group)","Yes","44-0308260","46441LA0010005","KCL Fam Low PPO","46441LA001",,"LAN001","LAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$35.79","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","46441LA0010005-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","LA","46441","HIOS","1","2015-05-06 02:44:46","1","46441","LA","SHOP (Small Group)","Yes","44-0308260","46441LA0010007","KCL Fam Low MAC","46441LA001",,"LAN001","LAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$24.86","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","46441LA0010007-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","LA","46441","HIOS","1","2015-05-06 02:44:46","2","46441","LA","SHOP (Small Group)","Yes","44-0308260","46441LA0010002","KCL EHB High PPO","46441LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$44.05","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","46441LA0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","LA","46441","HIOS","1","2015-05-06 02:44:46","2","46441","LA","SHOP (Small Group)","Yes","44-0308260","46441LA0010004","KCL EHB High MAC","46441LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$31.74","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","46441LA0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","LA","46441","HIOS","1","2015-05-06 02:44:46","2","46441","LA","SHOP (Small Group)","Yes","44-0308260","46441LA0010006","KCL Fam High PPO","46441LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$44.05","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","46441LA0010006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","LA","46441","HIOS","1","2015-05-06 02:44:46","2","46441","LA","SHOP (Small Group)","Yes","44-0308260","46441LA0010008","KCL Fam High MAC","46441LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$31.74","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","46441LA0010008-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","LA","58302","HIOS","1","2015-05-01 02:23:41","1","58302","LA","SHOP (Small Group)","Yes","93-0242990","58302LA0030002","EHB High Passive","58302LA003",,"LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.14","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","58302LA0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","LA","58302","HIOS","1","2015-05-01 02:23:41","1","58302","LA","SHOP (Small Group)","Yes","93-0242990","58302LA0030001","EHB Low Passive","58302LA003",,"LAN001","LAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.75","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","58302LA0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","LA","65168","HIOS","1","2015-05-01 02:23:41","1","65168","LA","SHOP (Small Group)","Yes","47-0098400","65168LA0030002","EHB High Passive","65168LA003",,"LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.54","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","65168LA0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","LA","65168","HIOS","1","2015-05-01 02:23:41","1","65168","LA","SHOP (Small Group)","Yes","47-0098400","65168LA0030001","EHB Low Passive","65168LA003",,"LAN001","LAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.40","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","65168LA0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090001","Vantage Individual Platinum","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Platinum","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090001-00","Standard Platinum Off Exchange Plan","88.70%","0.891949117183685","No","Yes","No","100%",,"$0","$1,230","$0","$150","$0","$650","$340","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Platinum_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","4"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100001","Vantage Group Platinum","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Platinum","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction",,"No","Allows Adult and Child-Only",,"Yes",,"0.9864",,,,"0","0","0","2016-01-01",,"Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0100001-00","Standard Platinum Off Exchange Plan","88.80%","0.891847372055054","No","Yes","No","100%",,"$0","$1,230","$0","$150","$0","$650","$340","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/Platinum_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","4"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090003","Vantage Individual Silver","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090003-05","87% AV Level Silver Plan","86.88%","0.868795573711395","No","Yes","No","100%",,"$500","$1,830","$0","$150","$400","$510","$220","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Silver_Basic_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016SilverPlans_CSR.pdf","17"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090003","Vantage Individual Silver","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090003-06","94% AV Level Silver Plan","94.05%","0.940466344356537","No","Yes","No","100%",,"$100","$320","$0","$150","$100","$300","$110","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Silver_Value_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016SilverPlans_CSR.pdf","18"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100001","Vantage Group Platinum","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Platinum","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction",,"No","Allows Adult and Child-Only",,"Yes",,"0.9864",,,,"0","0","0","2016-01-01",,"Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0100001-01","Standard Platinum On Exchange Plan","88.80%","0.891847372055054","No","Yes","No","100%",,"$0","$1,230","$0","$150","$0","$650","$340","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/Platinum_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","5"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090001","Vantage Individual Platinum","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Platinum","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090001-01","Standard Platinum On Exchange Plan","88.70%","0.891949117183685","No","Yes","No","100%",,"$0","$1,230","$0","$150","$0","$650","$340","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Platinum_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","5"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090001","Vantage Individual Platinum","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Platinum","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Platinum_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","6"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100002","Vantage Group Gold","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Gold","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction",,"No","Allows Adult and Child-Only",,"Yes",,"0.9864",,,,"0","0","0","2016-01-01",,"Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0100002-00","Standard Gold Off Exchange Plan","79.50%","0.791977882385254","No","Yes","No","100%",,"$750","$2,290","$0","$150","$750","$1,030","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/Gold_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","6"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100002","Vantage Group Gold","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Gold","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction",,"No","Allows Adult and Child-Only",,"Yes",,"0.9864",,,,"0","0","0","2016-01-01",,"Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0100002-01","Standard Gold On Exchange Plan","79.50%","0.791977882385254","No","Yes","No","100%",,"$750","$2,290","$0","$150","$750","$1,030","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/Gold_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","7"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090001","Vantage Individual Platinum","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Platinum","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090001-03","Limited Cost Sharing Plan Variation","88.70%","0.891949117183685","No","Yes","No","100%",,"$0","$1,230","$0","$150","$0","$650","$340","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Platinum_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","7"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090002","Vantage Individual Gold","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Gold","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090002-00","Standard Gold Off Exchange Plan","79.40%","0.793992102146149","No","Yes","No","100%",,"$750","$2,290","$0","$150","$750","$1,030","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Gold_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","8"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100003","Vantage Group Silver","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction",,"No","Allows Adult and Child-Only",,"Yes",,"0.9864",,,,"0","0","0","2016-01-01",,"Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0100003-00","Standard Silver Off Exchange Plan","70.90%","0.697139620780945","No","Yes","No","100%",,"$2,030","$1,770","$0","$150","$1,240","$1,160","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/Silver_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","8"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100003","Vantage Group Silver","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction",,"No","Allows Adult and Child-Only",,"Yes",,"0.9864",,,,"0","0","0","2016-01-01",,"Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0100003-01","Standard Silver On Exchange Plan","70.90%","0.697139620780945","No","Yes","No","100%",,"$2,030","$1,770","$0","$150","$1,240","$1,160","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/Silver_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","9"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090002","Vantage Individual Gold","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Gold","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090002-01","Standard Gold On Exchange Plan","79.40%","0.793992102146149","No","Yes","No","100%",,"$750","$2,290","$0","$150","$750","$1,030","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Gold_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","9"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090002","Vantage Individual Gold","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Gold","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Gold_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","10"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100004","Vantage Group Bronze","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction",,"No","Allows Adult and Child-Only",,"Yes",,"0.9864",,,,"0","0","0","2016-01-01",,"Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0100004-00","Standard Bronze Off Exchange Plan","61.70%","0.598918557167053","Yes","Yes","No","100%",,"$6,760","$0","$0","$150","$3,760","$520","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","10"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100004","Vantage Group Bronze","67243LA010","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction",,"No","Allows Adult and Child-Only",,"Yes",,"0.9864",,,,"0","0","0","2016-01-01",,"Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0100004-01","Standard Bronze On Exchange Plan","61.70%","0.598918557167053","Yes","Yes","No","100%",,"$6,760","$0","$0","$150","$3,760","$520","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","11"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090003","Vantage Individual Silver","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090003-00","Standard Silver Off Exchange Plan","70.80%","0.703006207942963","No","Yes","No","100%",,"$2,030","$1,770","$0","$150","$1,240","$1,160","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Silver_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","12"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100005","Vantage Plus Group Platinum","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Platinum","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction",,"No","Allows Adult and Child-Only",,"Yes",,"0.9864",,,,"0","0","0","2016-01-01",,"Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0100005-00","Standard Platinum Off Exchange Plan","88.80%","0.891847372055054","No","Yes","No","100%",,"$0","$1,230","$0","$150","$0","$650","$340","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/Platinum_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","12"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100005","Vantage Plus Group Platinum","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Platinum","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction",,"No","Allows Adult and Child-Only",,"Yes",,"0.9864",,,,"0","0","0","2016-01-01",,"Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0100005-01","Standard Platinum On Exchange Plan","88.80%","0.891847372055054","No","Yes","No","100%",,"$0","$1,230","$0","$150","$0","$650","$340","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/Platinum_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","13"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090003","Vantage Individual Silver","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090003-01","Standard Silver On Exchange Plan","70.80%","0.703006207942963","No","Yes","No","100%",,"$2,030","$1,770","$0","$150","$1,240","$1,160","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Silver_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","13"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090003","Vantage Individual Silver","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Silver_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","14"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100006","Vantage Plus Group Gold","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Gold","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction",,"No","Allows Adult and Child-Only",,"Yes",,"0.9864",,,,"0","0","0","2016-01-01",,"Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0100006-00","Standard Gold Off Exchange Plan","79.50%","0.791977882385254","No","Yes","No","100%",,"$750","$2,290","$0","$150","$750","$1,030","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/Gold_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","14"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100006","Vantage Plus Group Gold","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Gold","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction",,"No","Allows Adult and Child-Only",,"Yes",,"0.9864",,,,"0","0","0","2016-01-01",,"Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0100006-01","Standard Gold On Exchange Plan","79.50%","0.791977882385254","No","Yes","No","100%",,"$750","$2,290","$0","$150","$750","$1,030","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/Gold_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","15"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090003","Vantage Individual Silver","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090003-03","Limited Cost Sharing Plan Variation","70.80%","0.703006207942963","No","Yes","No","100%",,"$2,030","$1,770","$0","$150","$1,240","$1,160","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Silver_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","15"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090003","Vantage Individual Silver","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090003-04","73% AV Level Silver Plan","73.01%","0.724989771842957","No","Yes","No","100%",,"$2,030","$1,770","$0","$150","$1,240","$1,160","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Silver_Select_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016SilverPlans_CSR.pdf","16"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100007","Vantage Plus Group Silver","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction",,"No","Allows Adult and Child-Only",,"Yes",,"0.9864",,,,"0","0","0","2016-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0100007-00","Standard Silver Off Exchange Plan","70.90%","0.697139620780945","No","Yes","No","100%",,"$2,030","$1,770","$0","$150","$1,240","$1,160","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/Silver_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","16"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100007","Vantage Plus Group Silver","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction",,"No","Allows Adult and Child-Only",,"Yes",,"0.9864",,,,"0","0","0","2016-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0100007-01","Standard Silver On Exchange Plan","70.90%","0.697139620780945","No","Yes","No","100%",,"$2,030","$1,770","$0","$150","$1,240","$1,160","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/Silver_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","17"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100008","Vantage Plus Group Bronze","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction",,"No","Allows Adult and Child-Only",,"Yes",,"0.9864",,,,"0","0","0","2016-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0100008-00","Standard Bronze Off Exchange Plan","61.70%","0.598918557167053","Yes","Yes","No","100%",,"$6,760","$0","$0","$150","$3,760","$520","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","18"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090007","Vantage Plus Individual Silver","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090007-06","94% AV Level Silver Plan","94.05%","0.940466344356537","No","Yes","No","100%",,"$100","$320","$0","$150","$100","$300","$110","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Silver_Value_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016SilverPlusPlans_CSR.pdf","37"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090008","Vantage Plus Individual Bronze","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090008-00","Standard Bronze Off Exchange Plan","61.20%","0.598918557167053","Yes","Yes","No","100%",,"$6,760","$0","$0","$150","$3,760","$520","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","38"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090008","Vantage Plus Individual Bronze","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090008-01","Standard Bronze On Exchange Plan","61.20%","0.598918557167053","Yes","Yes","No","100%",,"$6,760","$0","$0","$150","$3,760","$520","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","39"
"2016","LA","86868","HIOS","2","2015-07-10 02:19:03","1","86868","LA","SHOP (Small Group)","Yes","35-0472300","86868LA0010001","Lincoln DentalConnect®","86868LA001","7063415294","LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.35","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","86868LA0010001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","LA","86868","HIOS","2","2015-07-10 02:19:03","1","86868","LA","SHOP (Small Group)","Yes","35-0472300","86868LA0010002","Lincoln DentalConnect®","86868LA001","7063415294","LAN001","LAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.54","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","86868LA0010002-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","LA","86868","HIOS","2","2015-07-10 02:19:03","1","86868","LA","SHOP (Small Group)","Yes","35-0472300","86868LA0010003","Lincoln DentalConnect®","86868LA001","7063415294","LAN001","LAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.74","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","86868LA0010003-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","LA","86868","HIOS","2","2015-07-10 02:19:03","1","86868","LA","SHOP (Small Group)","Yes","35-0472300","86868LA0010004","Lincoln DentalConnect®","86868LA001","7063415294","LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.93","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","86868LA0010004-00","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","LA","86868","HIOS","2","2015-07-10 02:19:03","1","86868","LA","SHOP (Small Group)","Yes","35-0472300","86868LA0010005","Lincoln DentalConnect®","86868LA001","7063415294","LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.33","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","86868LA0010005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","LA","86868","HIOS","2","2015-07-10 02:19:03","1","86868","LA","SHOP (Small Group)","Yes","35-0472300","86868LA0010006","Lincoln DentalConnect®","86868LA001","7063415294","LAN001","LAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.18","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","86868LA0010006-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","LA","86868","HIOS","2","2015-07-10 02:19:03","1","86868","LA","SHOP (Small Group)","Yes","35-0472300","86868LA0010007","Lincoln DentalConnect®","86868LA001","7063415294","LAN001","LAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.01","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","86868LA0010007-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2016","LA","86868","HIOS","2","2015-07-10 02:19:03","1","86868","LA","SHOP (Small Group)","Yes","35-0472300","86868LA0010008","Lincoln DentalConnect®","86868LA001","7063415294","LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.84","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","86868LA0010008-00","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100008","Vantage Plus Group Bronze","67243LA010","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction",,"No","Allows Adult and Child-Only",,"Yes",,"0.9864",,,,"0","0","0","2016-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0100008-01","Standard Bronze On Exchange Plan","61.70%","0.598918557167053","Yes","Yes","No","100%",,"$6,760","$0","$0","$150","$3,760","$520","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","No","No",,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","19"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090004","Vantage Individual Bronze","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090004-00","Standard Bronze Off Exchange Plan","61.20%","0.598918557167053","Yes","Yes","No","100%",,"$6,760","$0","$0","$150","$3,760","$520","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","19"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090004","Vantage Individual Bronze","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090004-01","Standard Bronze On Exchange Plan","61.20%","0.598918557167053","Yes","Yes","No","100%",,"$6,760","$0","$0","$150","$3,760","$520","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","20"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100009","Vantage Group Savings","67243LA010","7821091072","LAN001","LAS001","LAF001","New","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction",,"No","Allows Adult and Child-Only",,"Yes",,"0.9864",,,,"0","0","0","2016-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0100009-00","Standard Bronze Off Exchange Plan","59.80%","0.583145201206207","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$4,910","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes","No",,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_HSA_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016HSAPlanFinder.pdf","20"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100009","Vantage Group Savings","67243LA010","7821091072","LAN001","LAS001","LAF001","New","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction",,"No","Allows Adult and Child-Only",,"Yes",,"0.9864",,,,"0","0","0","2016-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0100009-01","Standard Bronze On Exchange Plan","59.80%","0.583145201206207","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$4,910","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes","No",,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_HSA_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016HSAPlanFinder.pdf","21"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090004","Vantage Individual Bronze","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016MarketplacePlanFinder.pdf","21"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100010","Vantage Group Savings Plus","67243LA010","7821091072","LAN002","LAS002","LAF001","New","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction",,"No","Allows Adult and Child-Only",,"Yes",,"0.9864",,,,"0","0","0","2016-01-01",,"Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0100010-01","Standard Bronze On Exchange Plan","59.80%","0.583145201206207","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$4,910","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes","No",,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_HSA_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016HSAPlanFinder.pdf","23"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090005","Vantage Plus Individual Platinum","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Platinum","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090005-00","Standard Platinum Off Exchange Plan","88.70%","0.891949117183685","No","Yes","No","100%",,"$0","$1,230","$0","$150","$0","$650","$340","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Platinum_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","23"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090005","Vantage Plus Individual Platinum","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Platinum","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090005-01","Standard Platinum On Exchange Plan","88.70%","0.891949117183685","No","Yes","No","100%",,"$0","$1,230","$0","$150","$0","$650","$340","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Platinum_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","24"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090005","Vantage Plus Individual Platinum","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Platinum","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Platinum_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","25"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090005","Vantage Plus Individual Platinum","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Platinum","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090005-03","Limited Cost Sharing Plan Variation","88.70%","0.891949117183685","No","Yes","No","100%",,"$0","$1,230","$0","$150","$0","$650","$340","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Platinum_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","26"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090006","Vantage Plus Individual Gold","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Gold","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090006-00","Standard Gold Off Exchange Plan","79.40%","0.793992102146149","No","Yes","No","100%",,"$750","$2,290","$0","$150","$750","$1,030","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Gold_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","27"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090006","Vantage Plus Individual Gold","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Gold","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090006-01","Standard Gold On Exchange Plan","79.40%","0.793992102146149","No","Yes","No","100%",,"$750","$2,290","$0","$150","$750","$1,030","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Gold_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","28"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090006","Vantage Plus Individual Gold","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Gold","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Gold_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","29"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090006","Vantage Plus Individual Gold","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Gold","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090006-03","Limited Cost Sharing Plan Variation","79.40%","0.793992102146149","No","Yes","No","100%",,"$750","$2,290","$0","$150","$750","$1,030","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Gold_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","30"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090007","Vantage Plus Individual Silver","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090007-00","Standard Silver Off Exchange Plan","70.80%","0.703006207942963","No","Yes","No","100%",,"$2,030","$1,770","$0","$150","$1,240","$1,160","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Silver_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","31"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090007","Vantage Plus Individual Silver","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090007-01","Standard Silver On Exchange Plan","70.80%","0.703006207942963","No","Yes","No","100%",,"$2,030","$1,770","$0","$150","$1,240","$1,160","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Silver_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","32"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090007","Vantage Plus Individual Silver","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Silver_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","33"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090007","Vantage Plus Individual Silver","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090007-03","Limited Cost Sharing Plan Variation","70.80%","0.703006207942963","No","Yes","No","100%",,"$2,030","$1,770","$0","$150","$1,240","$1,160","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Silver_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","34"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090007","Vantage Plus Individual Silver","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090007-04","73% AV Level Silver Plan","73.01%","0.724989771842957","No","Yes","No","100%",,"$2,030","$1,770","$0","$150","$1,240","$1,160","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Silver_Select_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016SilverPlusPlans_CSR.pdf","35"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090007","Vantage Plus Individual Silver","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,"$150","3","0","0","2016-01-01","2016-12-31","Yes","Covered as out-of-network","Yes","Out-of-Network Deductible and Co-insurance","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090007-05","87% AV Level Silver Plan","86.88%","0.868795573711395","No","Yes","No","100%",,"$500","$1,830","$0","$150","$400","$510","$220","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Silver_Basic_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016SilverPlusPlans_CSR.pdf","36"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090008","Vantage Plus Individual Bronze","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","40"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090008","Vantage Plus Individual Bronze","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090008-03","Limited Cost Sharing Plan Variation","61.20%","0.598918557167053","Yes","Yes","No","100%",,"$6,760","$0","$0","$150","$3,760","$520","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","60%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016Marketplace_PlanFinder_PlusPlans.pdf","41"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090009","Vantage Savings","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090009-00","Standard Bronze Off Exchange Plan","59.80%","0.583145201206207","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$4,910","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_HSA_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016HSAPlanFinder.pdf","42"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090009","Vantage Savings","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090009-01","Standard Bronze On Exchange Plan","59.80%","0.583145201206207","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$4,910","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_HSA_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016HSAPlanFinder.pdf","43"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090009","Vantage Savings","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_HSA_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016HSAPlanFinder.pdf","44"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090009","Vantage Savings","67243LA009","7821091072","LAN001","LAS001","LAF001","Existing","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090009-03","Limited Cost Sharing Plan Variation","59.80%","0.583145201206207","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$4,910","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_HSA_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016HSAPlanFinder.pdf","45"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090010","Vantage Savings Plus","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090010-00","Standard Bronze Off Exchange Plan","59.80%","0.583145201206207","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$4,910","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_HSA_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016HSAPlanFinder.pdf","46"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090010","Vantage Savings Plus","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090010-01","Standard Bronze On Exchange Plan","59.80%","0.583145201206207","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$4,910","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_HSA_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016HSAPlanFinder.pdf","47"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090010","Vantage Savings Plus","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_HSA_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016HSAPlanFinder.pdf","48"
"2016","LA","67243","HIOS","6","2015-09-27 18:35:28","1","67243","LA","Individual","No","72-1285173","67243LA0090010","Vantage Savings Plus","67243LA009","7821091072","LAN002","LAS002","LAF001","Existing","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; Other exclusions as described in the Certificate of Coverage","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.9875",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to Emergency Services only.  Covered as in-network.","Yes","Limited to Emergency Services only.  Covered as in-network.","No","https://portal.vantagehealthplan.com/HIXPayment","https://www.vantagehealthplan.com/documents/Marketplace/Formulary.pdf","67243LA0090010-03","Limited Cost Sharing Plan Variation","59.80%","0.583145201206207","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$4,910","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.vantagehealthplan.com/documents/Marketplace/Bronze_HSA_Plus_Summary_of_Benefits_and_Coverage.pdf","https://www.vantagehealthplan.com/documents/Marketplace/2016HSAPlanFinder.pdf","49"
"2016","LA","72623","HIOS","2","2015-04-24 10:46:48","1","72623","LA","SHOP (Small Group)","Yes","47-0322111","72623LA0010001","Certified Dental Plan 1","72623LA001",,"LAN001","LAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.89","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","72623LA0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","LA","72623","HIOS","2","2015-04-24 10:46:48","1","72623","LA","SHOP (Small Group)","Yes","47-0322111","72623LA0010002","Certified Dental Plan 2","72623LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.63","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","72623LA0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","LA","72623","HIOS","2","2015-04-24 10:46:48","1","72623","LA","SHOP (Small Group)","Yes","47-0322111","72623LA0010003","Certified Dental Plan 3","72623LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.39","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","72623LA0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","LA","72623","HIOS","2","2015-04-24 10:46:48","1","72623","LA","SHOP (Small Group)","Yes","47-0322111","72623LA0010004","Certified Dental Plan 4","72623LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.81","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","72623LA0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","LA","74056","HIOS","3","2015-10-20 04:38:50","1","74056","LA","Individual","Yes","36-3757528","74056LA0010001","TruAssure Basic Adult or Child Dental Plan","74056LA001",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.24","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74056LA0010001-00","Standard Low Off Exchange Plan","68.40%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$95","$95 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=LA","https://www.truassure.com/brochure?state=LA","4"
"2016","LA","74056","HIOS","3","2015-10-20 04:38:50","1","74056","LA","SHOP (Small Group)","Yes","36-3757528","74056LA0030001","TruAssure Dental Small Group Basic Plan","74056LA003",,"LAN001","LAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.21","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74056LA0030001-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","LA","74056","HIOS","3","2015-10-20 04:38:50","1","74056","LA","SHOP (Small Group)","Yes","36-3757528","74056LA0040001","TruAssure Dental Small Group Preferred Plan","74056LA004",,"LAN001","LAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.21","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74056LA0040001-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","LA","74056","HIOS","3","2015-10-20 04:38:50","1","74056","LA","Individual","Yes","36-3757528","74056LA0010001","TruAssure Basic Adult or Child Dental Plan","74056LA001",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.24","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74056LA0010001-01","Standard Low On Exchange Plan","68.40%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$95","$95 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=LA","https://www.truassure.com/brochure?state=LA","5"
"2016","LA","74056","HIOS","3","2015-10-20 04:38:50","2","74056","LA","Individual","Yes","36-3757528","74056LA0020001","TruAssure Preferred Adult or Child Dental Plan","74056LA002",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.33","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74056LA0020001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=LA","https://www.truassure.com/brochure?state=LA","4"
"2016","LA","74056","HIOS","3","2015-10-20 04:38:50","2","74056","LA","Individual","Yes","36-3757528","74056LA0020001","TruAssure Preferred Adult or Child Dental Plan","74056LA002",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.33","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74056LA0020001-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=LA","https://www.truassure.com/brochure?state=LA","5"
"2016","LA","75321","HIOS","2","2015-05-29 02:42:57","1","75321","LA","SHOP (Small Group)","Yes","57-0523959","75321LA0020001","Group Dental Policy","75321LA002",,"LAN001","LAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.98","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","75321LA0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","LA","75409","HIOS","1","2015-05-05 11:48:23","1","75409","LA","SHOP (Small Group)","Yes","13-5581829","75409LA0150001","EHB Basic Dental Plan (Low)","75409LA015",,"LAN001","LAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$17.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","75409LA0150001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","LA","78461","HIOS","3","2015-08-27 11:14:25","1","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010007","BESTDental Premium","78461LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.11","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/LA/2016/LA_BESTDental_Premium_Plan.pdf","4"
"2016","LA","78461","HIOS","3","2015-08-27 11:14:25","1","78461","LA","Individual","Yes","95-6042390","78461LA0020003","BESTOne Dental Advantage - Gold","78461LA002",,"LAN001","LAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.89","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/LA/2016/LA_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","LA","78461","HIOS","3","2015-08-27 11:14:25","1","78461","LA","Individual","Yes","95-6042390","78461LA0020003","BESTOne Dental Advantage - Gold","78461LA002",,"LAN001","LAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.89","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/LA/2016/LA_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","LA","78461","HIOS","3","2015-08-27 11:14:25","1","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010007","BESTDental Premium","78461LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.11","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/LA/2016/LA_BESTDental_Premium_Plan.pdf","5"
"2016","LA","78461","HIOS","3","2015-08-27 11:14:25","1","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010008","BESTDental Standard - H","78461LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.11","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/LA/2016/LA_BESTDental_Standard-H_Plan.pdf","6"
"2016","LA","78461","HIOS","3","2015-08-27 11:14:25","1","78461","LA","Individual","Yes","95-6042390","78461LA0020004","BESTOne Dental Plus - Gold","78461LA002",,"LAN001","LAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.89","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/LA/2016/LA_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","LA","78461","HIOS","3","2015-08-27 11:14:25","1","78461","LA","Individual","Yes","95-6042390","78461LA0020004","BESTOne Dental Plus - Gold","78461LA002",,"LAN001","LAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.89","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/LA/2016/LA_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","LA","78461","HIOS","3","2015-08-27 11:14:25","1","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010008","BESTDental Standard - H","78461LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.11","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/LA/2016/LA_BESTDental_Standard-H_Plan.pdf","7"
"2016","LA","78461","HIOS","3","2015-08-27 11:14:25","1","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010010","BESTDental Choice - H","78461LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.11","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/LA/2016/LA_BESTDental_Choice-H_Plan.pdf","8"
"2016","LA","78461","HIOS","3","2015-08-27 11:14:25","1","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010010","BESTDental Choice - H","78461LA001",,"LAN001","LAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.11","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/LA/2016/LA_BESTDental_Choice-H_Plan.pdf","9"
"2016","LA","78461","HIOS","3","2015-08-27 11:14:25","2","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010009","BESTDental Standard - L","78461LA001",,"LAN001","LAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/LA/2016/LA_BESTDental_Standard-L_Plan.pdf","4"
"2016","LA","78461","HIOS","3","2015-08-27 11:14:25","2","78461","LA","Individual","Yes","95-6042390","78461LA0020005","BESTOne Plus Silver","78461LA002",,"LAN001","LAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.84","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/LA/2016/LA_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","LA","78461","HIOS","3","2015-08-27 11:14:25","2","78461","LA","Individual","Yes","95-6042390","78461LA0020005","BESTOne Plus Silver","78461LA002",,"LAN001","LAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.84","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/LA/2016/LA_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","LA","78461","HIOS","3","2015-08-27 11:14:25","2","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010009","BESTDental Standard - L","78461LA001",,"LAN001","LAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/LA/2016/LA_BESTDental_Standard-L_Plan.pdf","5"
"2016","LA","78461","HIOS","3","2015-08-27 11:14:25","2","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010011","BESTDental Choice - L","78461LA001",,"LAN001","LAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/LA/2016/LA_BESTDental_Choice-L_Plan.pdf","6"
"2016","LA","78461","HIOS","3","2015-08-27 11:14:25","2","78461","LA","Individual","Yes","95-6042390","78461LA0020006","BESTOne Basic Silver","78461LA002",,"LAN001","LAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.84","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/LA/2016/LA_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","LA","78461","HIOS","3","2015-08-27 11:14:25","2","78461","LA","Individual","Yes","95-6042390","78461LA0020006","BESTOne Basic Silver","78461LA002",,"LAN001","LAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.84","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/LA/2016/LA_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","LA","78461","HIOS","3","2015-08-27 11:14:25","2","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010011","BESTDental Choice - L","78461LA001",,"LAN001","LAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/LA/2016/LA_BESTDental_Choice-L_Plan.pdf","7"
"2016","LA","78461","HIOS","3","2015-08-27 11:14:25","2","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010012","BESTDental Value","78461LA001",,"LAN001","LAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/LA/2016/LA_BESTDental_Value_Plan.pdf","8"
"2016","LA","78461","HIOS","3","2015-08-27 11:14:25","2","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010012","BESTDental Value","78461LA001",,"LAN001","LAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","78461LA0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/LA/2016/LA_BESTDental_Value_Plan.pdf","9"
"2016","LA","87390","HIOS","4","2015-08-19 14:41:20","1","87390","LA","Individual","Yes","13-5123390","87390LA0070001","Guardian Family Essentials","87390LA007",,"LAN002","LAS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","87390LA0070001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","4"
"2016","LA","87390","HIOS","4","2015-08-19 14:41:20","1","87390","LA","SHOP (Small Group)","Yes","13-5123390","87390LA0010003","Guardian Pediatric Advantage","87390LA001",,"LAN001","LAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$25.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","87390LA0010003-00","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","LA","87390","HIOS","4","2015-08-19 14:41:20","1","87390","LA","SHOP (Small Group)","Yes","13-5123390","87390LA0020003","Guardian Pediatric Essentials","87390LA002",,"LAN001","LAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$19.94","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","87390LA0020003-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","LA","87390","HIOS","4","2015-08-19 14:41:20","1","87390","LA","Individual","Yes","13-5123390","87390LA0070001","Guardian Family Essentials","87390LA007",,"LAN002","LAS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","87390LA0070001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","5"
"2016","LA","87390","HIOS","4","2015-08-19 14:41:20","2","87390","LA","SHOP (Small Group)","Yes","13-5123390","87390LA0040003","Guardian Family Advantage","87390LA004",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","87390LA0040003-00","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","LA","87390","HIOS","4","2015-08-19 14:41:20","2","87390","LA","SHOP (Small Group)","Yes","13-5123390","87390LA0040003","Guardian Family Advantage","87390LA004",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","87390LA0040003-01","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","LA","87390","HIOS","4","2015-08-19 14:41:20","2","87390","LA","SHOP (Small Group)","Yes","13-5123390","87390LA0060003","Guardian Family Essentials","87390LA006",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.94","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","87390LA0060003-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","LA","87390","HIOS","4","2015-08-19 14:41:20","2","87390","LA","SHOP (Small Group)","Yes","13-5123390","87390LA0060003","Guardian Family Essentials","87390LA006",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.94","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","87390LA0060003-01","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350001","Blue Saver 100/80 $1700","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350001-00","Standard Gold Off Exchange Plan",,"0.799258232116699","Yes","Yes","No","100%",,"$1,700","$0","$0","$150","$1,700","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group",,,,"$12,900","$25800 per person","$25800 per group","$19,350","$32650 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","0%",,,,,"$3,400","$6800 per person","$6800 per group","$5,100","$10200 per person","$10200 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350001-00&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","4"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","Yes","23-7384555","97176LA0390001","Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 adult deductible, $50 child deductible","97176LA039",,"LAN002","LAS002",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","","97176LA0390001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/individual-bluedental-brochure2016","4"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360010","Group Care copay 80/60 $1000","97176LA036",,"LAN001","LAS001","LAF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes",,"http://www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0360010-00","Standard Gold Off Exchange Plan",,"0.792873382568359","No","Yes","No","100%",,"$1,000","$900","$694","$150","$1,000","$1,000","$54","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$9000 per group","$0","$0 per person","per group not applicable","10%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0360010-00&Year=2016","http://www.bcbsla.com/smallgroup-solutions-brochure2016","4"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","SHOP (Small Group)","Yes","23-7384555","97176LA0400001","Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50% coinsurance, $75 adult deductible, $50 child deductible","97176LA040",,"LAN002","LAS002",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.32","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage available for covered benefits","Yes",,"","97176LA0400001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/group-bluedental-brochure2016","4"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","SHOP (Small Group)","Yes","23-7384555","97176LA0400002","Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","97176LA040",,"LAN002","LAS002",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.32","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage available for covered benefits","Yes",,"","97176LA0400002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/group-bluedental-brochure2016","5"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360010","Group Care copay 80/60 $1000","97176LA036",,"LAN001","LAS001","LAF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes",,"http://www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0360010-01","Standard Gold On Exchange Plan",,"0.792873382568359","No","Yes","No","100%",,"$1,000","$900","$694","$150","$1,000","$1,000","$54","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$9000 per group","$0","$0 per person","per group not applicable","10%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0360010-01&Year=2016","http://www.bcbsla.com/smallgroup-solutions-brochure2016","5"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","Yes","23-7384555","97176LA0390001","Blue Dental Essential Certified- $1,000 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $75 adult deductible, $50 child deductible","97176LA039",,"LAN002","LAS002",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","","97176LA0390001-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/individual-bluedental-brochure2016","5"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350001","Blue Saver 100/80 $1700","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350001-01","Standard Gold On Exchange Plan",,"0.799258232116699","Yes","Yes","No","100%",,"$1,700","$0","$0","$150","$1,700","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group",,,,"$12,900","$25800 per person","$25800 per group","$19,350","$32650 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","0%",,,,,"$3,400","$6800 per person","$6800 per group","$5,100","$10200 per person","$10200 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350001-01&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","5"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350001","Blue Saver 100/80 $1700","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350001-02&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","6"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","Yes","23-7384555","97176LA0390002","Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","97176LA039",,"LAN002","LAS002",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","","97176LA0390002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/individual-bluedental-brochure2016","6"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360013","Group Care copay 70/50 $2500","97176LA036",,"LAN001","LAS001","LAF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes",,"http://www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0360013-00","Standard Silver Off Exchange Plan",,"0.705365478992462","No","Yes","No","100%",,"$2,500","$900","$591","$150","$1,272","$1,000","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,500","$2500 per person","$7500 per group","30%",,,,,"$5,000","$5000 per person","$15000 per group","$7,500","$7500 per person","$22500 per group","$0","$0 per person","per group not applicable","10%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0360013-00&Year=2016","http://www.bcbsla.com/smallgroup-solutions-brochure2016","6"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","SHOP (Small Group)","Yes","23-7384555","97176LA0400003","Blue Dental Preferred Plus Certified- $1,500 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","97176LA040",,"LAN002","LAS002",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.32","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage available for covered benefits","Yes",,"","97176LA0400003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/group-bluedental-brochure2016","6"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","SHOP (Small Group)","Yes","23-7384555","97176LA0400003","Blue Dental Preferred Plus Certified- $1,500 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","97176LA040",,"LAN002","LAS002",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.32","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage available for covered benefits","Yes",,"","97176LA0400003-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/group-bluedental-brochure2016","7"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","Yes","23-7384555","97176LA0390002","Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","97176LA039",,"LAN002","LAS002",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","","97176LA0390002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/individual-bluedental-brochure2016","7"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350001","Blue Saver 100/80 $1700","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350001-03","Limited Cost Sharing Plan Variation",,"0.799258232116699","Yes","Yes","No","100%",,"$1,700","$0","$0","$150","$1,700","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group",,,,"$12,900","$25800 per person","$25800 per group","$19,350","$32650 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per person","$3400 per group","0%",,,,,"$3,400","$6800 per person","$6800 per group","$5,100","$10200 per person","$10200 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350001-03&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","7"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","2","97176","LA","Individual","No","23-7384555","97176LA0340010","Blue Max copay 70/50 $2500","97176LA034",,"LAN001","LAS001","LAF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0340010-06","94% AV Level Silver Plan","93.16%","0.925941467285156","No","Yes","No","100%",,"$98","$400","$0","$150","$325","$373","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"$12,700","$12700 per person","$25400 per group","$14,850","$14850 per person","$29700 per group","$75","$75 per person","$225 per group","0%",,,,,"$5,000","$5000 per person","$15000 per group","$5,075","$5075 per person","$15225 per group","$250","$250 per person","per group not applicable","10%",,,,,"$250","$250 per person","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-06&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","10"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","3","97176","LA","Individual","No","23-7384555","97176LA0340016","Blue Max 80/60 $3000","97176LA034",,"LAN001","LAS001","LAF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0340016-00","Standard Silver Off Exchange Plan",,"0.689179837703705","No","Yes","No","100%",,"$3,023","$0","$852","$150","$2,672","$585","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$3,000","$3000 per person","$9000 per group","20%",,,,,"$6,000","$6000 per person","$18000 per group","$9,000","$9000 per person","$27000 per group","$250","$250 per person","per group not applicable","10%",,,,,"$250","$250 per person","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340016-00&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","4"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350002","Blue Saver 80/60 $1900","97176LA035",,"LAN001","LAS001","LAF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350002-00","Standard Silver Off Exchange Plan",,"0.716814160346985","Yes","Yes","No","100%",,"$1,900","$0","$1,076","$150","$1,900","$0","$674","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$6850 per person","$9200 per group",,,,"$9,200","$18400 per person","$18400 per group","$13,800","$25250 per person","$27600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$3800 per person","$3800 per group","20%",,,,,"$3,800","$7600 per person","$7600 per group","$5,700","$11400 per person","$11400 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350002-00&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","8"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350002","Blue Saver 80/60 $1900","97176LA035",,"LAN001","LAS001","LAF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350002-01","Standard Silver On Exchange Plan",,"0.716814160346985","Yes","Yes","No","100%",,"$1,900","$0","$1,076","$150","$1,900","$0","$674","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$6850 per person","$9200 per group",,,,"$9,200","$18400 per person","$18400 per group","$13,800","$25250 per person","$27600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$3800 per person","$3800 per group","20%",,,,,"$3,800","$7600 per person","$7600 per group","$5,700","$11400 per person","$11400 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350002-01&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","9"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350002","Blue Saver 80/60 $1900","97176LA035",,"LAN001","LAS001","LAF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350002-02&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","10"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350002","Blue Saver 80/60 $1900","97176LA035",,"LAN001","LAS001","LAF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350002-03","Limited Cost Sharing Plan Variation",,"0.716814160346985","Yes","Yes","No","100%",,"$1,900","$0","$1,076","$150","$1,900","$0","$674","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$6850 per person","$9200 per group",,,,"$9,200","$18400 per person","$18400 per group","$13,800","$25250 per person","$27600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$3800 per person","$3800 per group","20%",,,,,"$3,800","$7600 per person","$7600 per group","$5,700","$11400 per person","$11400 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350002-03&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","11"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350002","Blue Saver 80/60 $1900","97176LA035",,"LAN001","LAS001","LAF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350002-04","73% AV Level Silver Plan",,"0.737005174160004","Yes","Yes","No","100%",,"$1,900","$0","$1,076","$150","$1,900","$0","$674","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$5450 per person","$7200 per group",,,,"$9,200","$18400 per person","$18400 per group","$12,800","$23850 per person","$25600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$3800 per person","$3800 per group","20%",,,,,"$3,800","$7600 per person","$7600 per group","$5,700","$11400 per person","$11400 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350002-04&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","12"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350002","Blue Saver 80/60 $1900","97176LA035",,"LAN001","LAS001","LAF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350002-05","87% AV Level Silver Plan",,"0.87280285358429","Yes","Yes","No","100%",,"$400","$0","$1,200","$150","$400","$0","$974","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$2250 per person","$3200 per group",,,,"$9,200","$18400 per person","$18400 per group","$10,800","$20650 per person","$21600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$800 per person","$800 per group","20%",,,,,"$3,800","$7600 per person","$7600 per group","$4,200","$8400 per person","$8400 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350002-05&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","13"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350002","Blue Saver 80/60 $1900","97176LA035",,"LAN001","LAS001","LAF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350002-06","94% AV Level Silver Plan",,"0.946805655956268","Yes","Yes","No","100%",,"$0","$0","$364","$150","$0","$0","$264","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2250 per person","$2800 per group",,,,"$9,200","$18400 per person","$18400 per group","$10,600","$20650 per person","$21200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5%",,,,,"$3,800","$7600 per person","$7600 per group","$3,800","$7600 per person","$7600 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350002-06&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","14"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350003","Blue Saver 100/80 $3000","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350003-00","Standard Silver Off Exchange Plan",,"0.714609503746033","Yes","Yes","No","100%",,"$3,000","$0","$0","$150","$3,000","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6850 per person","$10000 per group",,,,"$10,000","$20000 per person","$20000 per group","$15,000","$26850 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","0%",,,,,"$6,000","$12000 per person","$12000 per group","$9,000","$18000 per person","$18000 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-00&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","15"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350003","Blue Saver 100/80 $3000","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350003-01","Standard Silver On Exchange Plan",,"0.714609503746033","Yes","Yes","No","100%",,"$3,000","$0","$0","$150","$3,000","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6850 per person","$10000 per group",,,,"$10,000","$20000 per person","$20000 per group","$15,000","$26850 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","0%",,,,,"$6,000","$12000 per person","$12000 per group","$9,000","$18000 per person","$18000 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-01&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","16"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350003","Blue Saver 100/80 $3000","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-02&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","17"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350003","Blue Saver 100/80 $3000","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350003-03","Limited Cost Sharing Plan Variation",,"0.714609503746033","Yes","Yes","No","100%",,"$3,000","$0","$0","$150","$3,000","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6850 per person","$10000 per group",,,,"$10,000","$20000 per person","$20000 per group","$15,000","$26850 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","0%",,,,,"$6,000","$12000 per person","$12000 per group","$9,000","$18000 per person","$18000 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-03&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","18"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350003","Blue Saver 100/80 $3000","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350003-04","73% AV Level Silver Plan",,"0.739094078540802","Yes","Yes","No","100%",,"$2,600","$0","$0","$150","$2,600","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$5450 per person","$8000 per group",,,,"$10,000","$20000 per person","$20000 per group","$14,000","$25450 per person","$28000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$5200 per person","$5200 per group","0%",,,,,"$6,000","$12000 per person","$12000 per group","$8,600","$17200 per person","$17200 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-04&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","19"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350003","Blue Saver 100/80 $3000","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350003-05","87% AV Level Silver Plan",,"0.871126353740692","Yes","Yes","No","100%",,"$900","$0","$0","$150","$900","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$10,000","$20000 per person","$20000 per group","$12,250","$22250 per person","$24500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$1800 per person","$1800 per group","0%",,,,,"$6,000","$12000 per person","$12000 per group","$6,900","$13800 per person","$13800 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-05&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","20"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350003","Blue Saver 100/80 $3000","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350003-06","94% AV Level Silver Plan",,"0.945228159427643","Yes","Yes","No","100%",,"$200","$0","$0","$150","$200","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$2250 per person","$3400 per group",,,,"$10,000","$20000 per person","$20000 per group","$11,700","$22250 per person","$23400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$400 per person","$400 per group","0%",,,,,"$6,000","$12000 per person","$12000 per group","$6,200","$12400 per person","$12400 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-06&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","21"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350004","Blue Saver 60/40 $3600","97176LA035",,"LAN001","LAS001","LAF008","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350004-00","Standard Bronze Off Exchange Plan",,"0.619749128818512","Yes","Yes","No","100%",,"$3,600","$0","$1,473","$150","$3,600","$0","$668","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group",,,,"$12,900","$25800 per person","$25800 per group","$19,350","$32650 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$6850 per person","$7200 per group","40%",,,,,"$7,200","$14400 per person","$14400 per group","$10,800","$21250 per person","$21600 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350004-00&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","22"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350004","Blue Saver 60/40 $3600","97176LA035",,"LAN001","LAS001","LAF008","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350004-01","Standard Bronze On Exchange Plan",,"0.619749128818512","Yes","Yes","No","100%",,"$3,600","$0","$1,473","$150","$3,600","$0","$668","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group",,,,"$12,900","$25800 per person","$25800 per group","$19,350","$32650 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$6850 per person","$7200 per group","40%",,,,,"$7,200","$14400 per person","$14400 per group","$10,800","$21250 per person","$21600 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350004-01&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","23"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350004","Blue Saver 60/40 $3600","97176LA035",,"LAN001","LAS001","LAF008","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350004-02&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","24"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350004","Blue Saver 60/40 $3600","97176LA035",,"LAN001","LAS001","LAF008","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350004-03","Limited Cost Sharing Plan Variation",,"0.619749128818512","Yes","Yes","No","100%",,"$3,600","$0","$1,473","$150","$3,600","$0","$668","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group",,,,"$12,900","$25800 per person","$25800 per group","$19,350","$32650 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$6850 per person","$7200 per group","40%",,,,,"$7,200","$14400 per person","$14400 per group","$10,800","$21250 per person","$21600 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350004-03&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","25"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350005","Blue Saver 100/80 $5550","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350005-00","Standard Bronze Off Exchange Plan",,"0.618928790092468","Yes","Yes","No","100%",,"$5,550","$0","$0","$150","$5,271","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group",,,,"$12,900","$25800 per person","$25800 per group","$19,350","$32650 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$6850 per person","$11100 per group","0%",,,,,"$11,100","$22200 per person","$22200 per group","$16,650","$29050 per person","$33300 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350005-00&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","26"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350005","Blue Saver 100/80 $5550","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350005-01","Standard Bronze On Exchange Plan",,"0.618928790092468","Yes","Yes","No","100%",,"$5,550","$0","$0","$150","$5,271","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group",,,,"$12,900","$25800 per person","$25800 per group","$19,350","$32650 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$6850 per person","$11100 per group","0%",,,,,"$11,100","$22200 per person","$22200 per group","$16,650","$29050 per person","$33300 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350005-01&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","27"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350005","Blue Saver 100/80 $5550","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350005-02&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","28"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350005","Blue Saver 100/80 $5550","97176LA035",,"LAN001","LAS001","LAF005","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350005-03","Limited Cost Sharing Plan Variation",,"0.618928790092468","Yes","Yes","No","100%",,"$5,550","$0","$0","$150","$5,271","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group",,,,"$12,900","$25800 per person","$25800 per group","$19,350","$32650 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$6850 per person","$11100 per group","0%",,,,,"$11,100","$22200 per person","$22200 per group","$16,650","$29050 per person","$33300 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350005-03&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","29"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","1","16049","MO","Individual","No","35-1665915","16049MO0030001","Silver Compass HSA 3000","16049MO003",,"MON001","MOS001","MOF006","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030001-04","73% AV Level Silver Plan","72.13%",,"Yes","Yes","No","100%",,"$2,500","$10","$0","$200","$2,500","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=mo0010&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","8"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0340015","Blue Max 100/80 $1800","97176LA034",,"LAN001","LAS001","LAF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0340015-00","Standard Gold Off Exchange Plan",,"0.791689574718475","Yes","Yes","No","100%",,"$1,800","$0","$0","$150","$1,800","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$5400 per group","0%",,,,,"$3,600","$3600 per person","$10800 per group","$5,400","$5400 per person","$16200 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340015-00&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","30"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0340015","Blue Max 100/80 $1800","97176LA034",,"LAN001","LAS001","LAF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0340015-01","Standard Gold On Exchange Plan",,"0.791689574718475","Yes","Yes","No","100%",,"$1,800","$0","$0","$150","$1,800","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$5400 per group","0%",,,,,"$3,600","$3600 per person","$10800 per group","$5,400","$5400 per person","$16200 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340015-01&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","31"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0340015","Blue Max 100/80 $1800","97176LA034",,"LAN001","LAS001","LAF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0340015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340015-02&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","32"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0340015","Blue Max 100/80 $1800","97176LA034",,"LAN001","LAS001","LAF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0340015-03","Limited Cost Sharing Plan Variation",,"0.791689574718475","Yes","Yes","No","100%",,"$1,800","$0","$0","$150","$1,800","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$5400 per group","0%",,,,,"$3,600","$3600 per person","$10800 per group","$5,400","$5400 per person","$16200 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340015-03&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","33"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0340019","Blue Max 100/100 $4000","97176LA034",,"LAN001","LAS001","LAF009","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0340019-00","Standard Silver Off Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$4,000","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group",,,,"$8,000","$8000 per person","$24000 per group","$12,000","$12000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","0%",,,,,"$8,000","$8000 per person","$24000 per group","$12,000","$12000 per person","$36000 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340019-00&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","34"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0340019","Blue Max 100/100 $4000","97176LA034",,"LAN001","LAS001","LAF009","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0340019-01","Standard Silver On Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$4,000","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group",,,,"$8,000","$8000 per person","$24000 per group","$12,000","$12000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","0%",,,,,"$8,000","$8000 per person","$24000 per group","$12,000","$12000 per person","$36000 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340019-01&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","35"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0340019","Blue Max 100/100 $4000","97176LA034",,"LAN001","LAS001","LAF009","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0340019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340019-02&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","36"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0340019","Blue Max 100/100 $4000","97176LA034",,"LAN001","LAS001","LAF009","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0340019-03","Limited Cost Sharing Plan Variation",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$4,000","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group",,,,"$8,000","$8000 per person","$24000 per group","$12,000","$12000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","0%",,,,,"$8,000","$8000 per person","$24000 per group","$12,000","$12000 per person","$36000 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340019-03&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","37"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0340019","Blue Max 100/100 $4000","97176LA034",,"LAN001","LAS001","LAF009","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0340019-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$150","$3,000","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group",,,,"$8,000","$8000 per person","$24000 per group","$11,000","$11000 per person","$33000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","0%",,,,,"$8,000","$8000 per person","$24000 per group","$11,000","$11000 per person","$33000 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340019-04&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","38"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0340019","Blue Max 100/100 $4000","97176LA034",,"LAN001","LAS001","LAF009","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0340019-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$150","$1,100","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$3300 per group",,,,"$8,000","$8000 per person","$24000 per group","$9,100","$9100 per person","$27300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$3300 per group","0%",,,,,"$8,000","$8000 per person","$24000 per group","$9,100","$9100 per person","$27300 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340019-05&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","39"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0340019","Blue Max 100/100 $4000","97176LA034",,"LAN001","LAS001","LAF009","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0340019-06","94% AV Level Silver Plan",,"0.934249639511108","Yes","Yes","No","100%",,"$550","$0","$0","$150","$550","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1650 per group",,,,"$8,000","$8000 per person","$24000 per group","$8,550","$8550 per person","$25650 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1650 per group","0%",,,,,"$8,000","$8000 per person","$24000 per group","$8,550","$8550 per person","$25650 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340019-06&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","40"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0340017","Blue Max 80/60 $5000","97176LA034",,"LAN001","LAS001","LAF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0340017-00","Standard Bronze Off Exchange Plan",,"0.60443788766861","Yes","Yes","No","100%",,"$5,000","$0","$456","$150","$5,000","$0","$54","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13700 per group","20%",,,,,"$10,000","$10000 per person","$27400 per group","$15,000","$15000 per person","$41100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340017-00&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","41"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0340017","Blue Max 80/60 $5000","97176LA034",,"LAN001","LAS001","LAF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0340017-01","Standard Bronze On Exchange Plan",,"0.60443788766861","Yes","Yes","No","100%",,"$5,000","$0","$456","$150","$5,000","$0","$54","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13700 per group","20%",,,,,"$10,000","$10000 per person","$27400 per group","$15,000","$15000 per person","$41100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340017-01&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","42"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0340017","Blue Max 80/60 $5000","97176LA034",,"LAN001","LAS001","LAF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0340017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340017-02&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","43"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0340017","Blue Max 80/60 $5000","97176LA034",,"LAN001","LAS001","LAF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0340017-03","Limited Cost Sharing Plan Variation",,"0.60443788766861","Yes","Yes","No","100%",,"$5,000","$0","$456","$150","$5,000","$0","$54","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$13700 per group","20%",,,,,"$10,000","$10000 per person","$27400 per group","$15,000","$15000 per person","$41100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340017-03&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","44"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350006","Blue Saver 100/100 $6450","97176LA035",,"LAN001","LAS001","LAF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350006-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,271","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group",,,,"$12,900","$25800 per person","$25800 per group","$19,350","$32650 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group","0%",,,,,"$12,900","$25800 per person","$25800 per group","$19,350","$32650 per person","$38700 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350006-00&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","45"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350006","Blue Saver 100/100 $6450","97176LA035",,"LAN001","LAS001","LAF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350006-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,271","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group",,,,"$12,900","$25800 per person","$25800 per group","$19,350","$32650 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group","0%",,,,,"$12,900","$25800 per person","$25800 per group","$19,350","$32650 per person","$38700 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350006-01&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","46"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350006","Blue Saver 100/100 $6450","97176LA035",,"LAN001","LAS001","LAF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350006-02&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","47"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","1","97176","LA","Individual","No","23-7384555","97176LA0350006","Blue Saver 100/100 $6450","97176LA035",,"LAN001","LAS001","LAF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0350006-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,271","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group",,,,"$12,900","$25800 per person","$25800 per group","$19,350","$32650 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group","0%",,,,,"$12,900","$25800 per person","$25800 per group","$19,350","$32650 per person","$38700 per group","Yes",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350006-03&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","48"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","2","97176","LA","Individual","No","23-7384555","97176LA0340010","Blue Max copay 70/50 $2500","97176LA034",,"LAN001","LAS001","LAF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0340010-00","Standard Silver Off Exchange Plan","71.59%","0.70592337846756","No","Yes","No","100%",,"$2,523","$880","$591","$150","$1,772","$924","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$2,500","$2500 per person","$7500 per group","30%",,,,,"$5,000","$5000 per person","$15000 per group","$7,500","$7500 per person","$22500 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-00&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","4"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","2","97176","LA","Individual","Yes","23-7384555","97176LA0390003","Blue Dental Value Certified- $500 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $0 adult deductible, $50 child deductible","97176LA039",,"LAN002","LAS002",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","","97176LA0390003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/individual-bluedental-brochure2016","4"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","2","97176","LA","Individual","Yes","23-7384555","97176LA0390003","Blue Dental Value Certified- $500 Annual Benefit Maximum per Adult, 100%/50%/50% coinsurance, $0 adult deductible, $50 child deductible","97176LA039",,"LAN002","LAS002",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","","97176LA0390003-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsla.com/individual-bluedental-brochure2016","5"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","2","97176","LA","Individual","No","23-7384555","97176LA0340010","Blue Max copay 70/50 $2500","97176LA034",,"LAN001","LAS001","LAF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0340010-01","Standard Silver On Exchange Plan","71.59%","0.70592337846756","No","Yes","No","100%",,"$2,523","$880","$591","$150","$1,772","$924","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$2,500","$2500 per person","$7500 per group","30%",,,,,"$5,000","$5000 per person","$15000 per group","$7,500","$7500 per person","$22500 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-01&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","5"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","2","97176","LA","Individual","No","23-7384555","97176LA0340010","Blue Max copay 70/50 $2500","97176LA034",,"LAN001","LAS001","LAF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0340010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-02&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","6"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","2","97176","LA","Individual","No","23-7384555","97176LA0340010","Blue Max copay 70/50 $2500","97176LA034",,"LAN001","LAS001","LAF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0340010-03","Limited Cost Sharing Plan Variation","71.59%","0.70592337846756","No","Yes","No","100%",,"$2,523","$880","$591","$150","$1,772","$924","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$2,500","$2500 per person","$7500 per group","30%",,,,,"$5,000","$5000 per person","$15000 per group","$7,500","$7500 per person","$22500 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-03&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","7"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","2","97176","LA","Individual","No","23-7384555","97176LA0340010","Blue Max copay 70/50 $2500","97176LA034",,"LAN001","LAS001","LAF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0340010-04","73% AV Level Silver Plan","73.62%","0.725885927677155","No","Yes","No","100%",,"$1,973","$880","$756","$150","$1,772","$924","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$12,700","$12700 per person","$25400 per group","$17,800","$17800 per person","$35600 per group","$1,950","$1950 per person","$5850 per group","30%",,,,,"$5,000","$5000 per person","$15000 per group","$6,950","$6950 per person","$20850 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-04&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","8"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","2","97176","LA","Individual","No","23-7384555","97176LA0340010","Blue Max copay 70/50 $2500","97176LA034",,"LAN001","LAS001","LAF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0340010-05","87% AV Level Silver Plan","86.71%","0.861467003822327","No","Yes","No","100%",,"$423","$560","$814","$150","$900","$445","$174","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"$12,700","$12700 per person","$25400 per group","$14,850","$14850 per person","$29700 per group","$400","$400 per person","$1200 per group","20%",,,,,"$5,000","$5000 per person","$15000 per group","$5,400","$5400 per person","$16200 per group","$500","$500 per person","per group not applicable","10%",,,,,"$500","$500 per person","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-05&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","9"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","3","97176","LA","Individual","No","23-7384555","97176LA0340016","Blue Max 80/60 $3000","97176LA034",,"LAN001","LAS001","LAF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0340016-01","Standard Silver On Exchange Plan",,"0.689179837703705","No","Yes","No","100%",,"$3,023","$0","$852","$150","$2,672","$585","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$3,000","$3000 per person","$9000 per group","20%",,,,,"$6,000","$6000 per person","$18000 per group","$9,000","$9000 per person","$27000 per group","$250","$250 per person","per group not applicable","10%",,,,,"$250","$250 per person","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340016-01&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","5"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","3","97176","LA","Individual","No","23-7384555","97176LA0340016","Blue Max 80/60 $3000","97176LA034",,"LAN001","LAS001","LAF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0340016-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340016-02&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","6"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","3","97176","LA","Individual","No","23-7384555","97176LA0340016","Blue Max 80/60 $3000","97176LA034",,"LAN001","LAS001","LAF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0340016-03","Limited Cost Sharing Plan Variation",,"0.689179837703705","No","Yes","No","100%",,"$3,023","$0","$852","$150","$2,672","$585","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$3,000","$3000 per person","$9000 per group","20%",,,,,"$6,000","$6000 per person","$18000 per group","$9,000","$9000 per person","$27000 per group","$250","$250 per person","per group not applicable","10%",,,,,"$250","$250 per person","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340016-03&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","7"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","3","97176","LA","Individual","No","23-7384555","97176LA0340016","Blue Max 80/60 $3000","97176LA034",,"LAN001","LAS001","LAF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0340016-04","73% AV Level Silver Plan",,"0.737092435359955","No","Yes","No","100%",,"$1,623","$0","$1,132","$150","$1,850","$585","$164","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,600","$1600 per person","$4800 per group","20%",,,,,"$6,000","$6000 per person","$18000 per group","$7,600","$7600 per person","$22800 per group","$250","$250 per person","per group not applicable","10%",,,,,"$250","$250 per person","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340016-04&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","8"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","3","97176","LA","Individual","No","23-7384555","97176LA0340016","Blue Max 80/60 $3000","97176LA034",,"LAN001","LAS001","LAF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0340016-05","87% AV Level Silver Plan",,"0.873183012008667","No","Yes","No","100%",,"$223","$0","$1,412","$150","$450","$585","$444","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$10,000","$10000 per person","$20000 per group","$11,700","$11700 per person","$23400 per group","$200","$200 per person","$600 per group","20%",,,,,"$6,000","$6000 per person","$18000 per group","$6,200","$6200 per person","$18600 per group","$250","$250 per person","per group not applicable","10%",,,,,"$250","$250 per person","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340016-05&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","9"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","3","97176","LA","Individual","No","23-7384555","97176LA0340016","Blue Max 80/60 $3000","97176LA034",,"LAN001","LAS001","LAF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0340016-06","94% AV Level Silver Plan",,"0.932966887950897","No","Yes","No","100%",,"$23","$0","$363","$150","$250","$273","$121","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$10,000","$10000 per person","$20000 per group","$11,700","$11700 per person","$23400 per group","$0","$0 per person","$0 per group","5%",,,,,"$6,000","$6000 per person","$18000 per group","$6,000","$6000 per person","$18000 per group","$250","$250 per person","per group not applicable","10%",,,,,"$250","$250 per person","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340016-06&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","10"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","4","97176","LA","Individual","No","23-7384555","97176LA0340018","Blue Max Copay 80/60 $6250","97176LA034",,"LAN001","LAS001","LAF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0340018-00","Standard Bronze Off Exchange Plan",,"0.613365232944489","Yes","Yes","No","100%",,"$6,250","$0","$66","$150","$4,121","$500","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","20%",,,,,"$12,500","$12500 per person","$27400 per group","$18,750","$18750 per person","$41100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340018-00&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","4"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","4","97176","LA","Individual","No","23-7384555","97176LA0340018","Blue Max Copay 80/60 $6250","97176LA034",,"LAN001","LAS001","LAF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0340018-01","Standard Bronze On Exchange Plan",,"0.613365232944489","Yes","Yes","No","100%",,"$6,250","$0","$66","$150","$4,121","$500","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","20%",,,,,"$12,500","$12500 per person","$27400 per group","$18,750","$18750 per person","$41100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340018-01&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","5"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","4","97176","LA","Individual","No","23-7384555","97176LA0340018","Blue Max Copay 80/60 $6250","97176LA034",,"LAN001","LAS001","LAF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0340018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340018-02&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","6"
"2016","LA","97176","HIOS","7","2016-01-29 04:56:16","4","97176","LA","Individual","No","23-7384555","97176LA0340018","Blue Max Copay 80/60 $6250","97176LA034",,"LAN001","LAS001","LAF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","http://www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0340018-03","Limited Cost Sharing Plan Variation",,"0.613365232944489","Yes","Yes","No","100%",,"$6,250","$0","$66","$150","$4,121","$500","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","20%",,,,,"$12,500","$12500 per person","$27400 per group","$18,750","$18750 per person","$41100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340018-03&Year=2016","http://www.bcbsla.com/individual-solutions-brochure2016","7"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","1","16049","MO","Individual","No","35-1665915","16049MO0030001","Silver Compass HSA 3000","16049MO003",,"MON001","MOS001","MOF006","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030001-00","Standard Silver Off Exchange Plan","69.20%",,"Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=mo0007&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","4"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","1","16049","MO","Individual","No","35-1665915","16049MO0030001","Silver Compass HSA 3000","16049MO003",,"MON001","MOS001","MOF006","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030001-01","Standard Silver On Exchange Plan","69.20%",,"Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=mo0007&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","5"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","1","16049","MO","Individual","No","35-1665915","16049MO0030001","Silver Compass HSA 3000","16049MO003",,"MON001","MOS001","MOF006","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=mo0008&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","6"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","1","16049","MO","Individual","No","35-1665915","16049MO0030001","Silver Compass HSA 3000","16049MO003",,"MON001","MOS001","MOF006","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030001-03","Limited Cost Sharing Plan Variation","69.20%",,"Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=mo0009&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","7"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","1","16049","MO","Individual","No","35-1665915","16049MO0030001","Silver Compass HSA 3000","16049MO003",,"MON001","MOS001","MOF006","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030001-05","87% AV Level Silver Plan","86.35%",,"Yes","Yes","No","100%",,"$800","$10","$0","$200","$800","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=mo0011&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","9"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","1","16049","MO","Individual","No","35-1665915","16049MO0030001","Silver Compass HSA 3000","16049MO003",,"MON001","MOS001","MOF006","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030001-06","94% AV Level Silver Plan","93.27%",,"Yes","Yes","No","100%",,"$300","$10","$0","$200","$300","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=mo0012&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","10"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","1","16049","MO","Individual","No","35-1665915","16049MO0030005","Bronze Compass HSA 5500","16049MO003",,"MON001","MOS001","MOF001","Existing","EPO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030005-00","Standard Bronze Off Exchange Plan",,"0.618041276931763","Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=mo0031&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","11"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","1","16049","MO","Individual","No","35-1665915","16049MO0030005","Bronze Compass HSA 5500","16049MO003",,"MON001","MOS001","MOF001","Existing","EPO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030005-01","Standard Bronze On Exchange Plan",,"0.618041276931763","Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=mo0031&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","12"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","1","16049","MO","Individual","No","35-1665915","16049MO0030005","Bronze Compass HSA 5500","16049MO003",,"MON001","MOS001","MOF001","Existing","EPO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=mo0032&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","13"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","1","16049","MO","Individual","No","35-1665915","16049MO0030005","Bronze Compass HSA 5500","16049MO003",,"MON001","MOS001","MOF001","Existing","EPO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030005-03","Limited Cost Sharing Plan Variation",,"0.618041276931763","Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=mo0033&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","14"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030002","Silver Compass 2000","16049MO003",,"MON001","MOS001","MOF005","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030002-00","Standard Silver Off Exchange Plan","69.3%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0013&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","4"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030002","Silver Compass 2000","16049MO003",,"MON001","MOS001","MOF005","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030002-01","Standard Silver On Exchange Plan","69.3%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0013&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","5"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030002","Silver Compass 2000","16049MO003",,"MON001","MOS001","MOF005","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030002-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0014&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","6"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030002","Silver Compass 2000","16049MO003",,"MON001","MOS001","MOF005","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030002-03","Limited Cost Sharing Plan Variation","69.3%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0015&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","7"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030002","Silver Compass 2000","16049MO003",,"MON001","MOS001","MOF005","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030002-04","73% AV Level Silver Plan","73.4%",,"No","Yes","No","100%",,"$1,200","$20","$1,500","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0016&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","8"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030002","Silver Compass 2000","16049MO003",,"MON001","MOS001","MOF005","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030002-05","87% AV Level Silver Plan","87.9%",,"No","Yes","No","100%",,"$300","$10","$600","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0017&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","9"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030002","Silver Compass 2000","16049MO003",,"MON001","MOS001","MOF005","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030002-06","94% AV Level Silver Plan","93.9%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0018&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","10"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030003","Silver Compass 3500","16049MO003",,"MON001","MOS001","MOF003","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030003-00","Standard Silver Off Exchange Plan","68.0%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0019&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","11"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030003","Silver Compass 3500","16049MO003",,"MON001","MOS001","MOF003","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030003-01","Standard Silver On Exchange Plan","68.0%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0019&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","12"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030003","Silver Compass 3500","16049MO003",,"MON001","MOS001","MOF003","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030003-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0020&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","13"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030003","Silver Compass 3500","16049MO003",,"MON001","MOS001","MOF003","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030003-03","Limited Cost Sharing Plan Variation","68.0%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0021&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","14"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030003","Silver Compass 3500","16049MO003",,"MON001","MOS001","MOF003","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030003-04","73% AV Level Silver Plan","72.5%",,"No","Yes","No","100%",,"$2,500","$10","$800","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0022&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","15"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030003","Silver Compass 3500","16049MO003",,"MON001","MOS001","MOF003","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030003-05","87% AV Level Silver Plan","87.9%",,"No","Yes","No","100%",,"$300","$10","$600","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0023&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","16"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030003","Silver Compass 3500","16049MO003",,"MON001","MOS001","MOF003","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030003-06","94% AV Level Silver Plan","93.9%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0024&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","17"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030004","Silver Compass 4500","16049MO003",,"MON001","MOS001","MOF003","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030004-00","Standard Silver Off Exchange Plan","68.3%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0025&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","18"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030004","Silver Compass 4500","16049MO003",,"MON001","MOS001","MOF003","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030004-01","Standard Silver On Exchange Plan","68.3%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0025&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","19"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030004","Silver Compass 4500","16049MO003",,"MON001","MOS001","MOF003","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030004-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0026&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","20"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030004","Silver Compass 4500","16049MO003",,"MON001","MOS001","MOF003","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030004-03","Limited Cost Sharing Plan Variation","68.3%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0027&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","21"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030004","Silver Compass 4500","16049MO003",,"MON001","MOS001","MOF003","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030004-04","73% AV Level Silver Plan","72.5%",,"No","Yes","No","100%",,"$3,300","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0028&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","22"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030004","Silver Compass 4500","16049MO003",,"MON001","MOS001","MOF003","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030004-05","87% AV Level Silver Plan","86.1%",,"No","Yes","No","100%",,"$600","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0029&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","23"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030004","Silver Compass 4500","16049MO003",,"MON001","MOS001","MOF003","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030004-06","94% AV Level Silver Plan","93.3%",,"No","Yes","No","100%",,"$100","$10","$0","$200","$100","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0030&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","24"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030006","Bronze Compass 6500","16049MO003",,"MON001","MOS001","MOF001","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030006-00","Standard Bronze Off Exchange Plan","61.9%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=mo0034&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","25"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030006","Bronze Compass 6500","16049MO003",,"MON001","MOS001","MOF001","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030006-01","Standard Bronze On Exchange Plan","61.9%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=mo0034&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","26"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030006","Bronze Compass 6500","16049MO003",,"MON001","MOS001","MOF001","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030006-02","Zero Cost Sharing Plan Variation","100.0%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=mo0035&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","27"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030006","Bronze Compass 6500","16049MO003",,"MON001","MOS001","MOF001","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030006-03","Limited Cost Sharing Plan Variation","61.9%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=mo0036&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","28"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030007","Gold Compass 500","16049MO003",,"MON001","MOS001","MOF002","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030007-00","Standard Gold Off Exchange Plan","78.62%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0001&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","29"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030007","Gold Compass 500","16049MO003",,"MON001","MOS001","MOF002","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030007-01","Standard Gold On Exchange Plan","78.62%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0001&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","30"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030007","Gold Compass 500","16049MO003",,"MON001","MOS001","MOF002","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030007-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0002&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","31"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030007","Gold Compass 500","16049MO003",,"MON001","MOS001","MOF002","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030007-03","Limited Cost Sharing Plan Variation","78.62%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0003&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","32"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030008","Gold Compass 0","16049MO003",,"MON001","MOS001","MOF004","New","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030008-00","Standard Gold Off Exchange Plan","79.1%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0004&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","33"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030008","Gold Compass 0","16049MO003",,"MON001","MOS001","MOF004","New","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030008-01","Standard Gold On Exchange Plan","79.1%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0004&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","34"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030008","Gold Compass 0","16049MO003",,"MON001","MOS001","MOF004","New","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030008-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0005&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","35"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570013","Humana Silver 3800/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570013-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607787","http://apps.humana.com/marketing/documents.asp?file=2592876","5"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","Yes","39-1263473","30613MO0560001","Humana Dental Smart Choice","30613MO056",,"MON001","MOS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.80","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","30613MO0560001-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612935","5"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570013","Humana Silver 3800/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570013-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607800","http://apps.humana.com/marketing/documents.asp?file=2592876","6"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570013","Humana Silver 3800/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570013-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607813","http://apps.humana.com/marketing/documents.asp?file=2592876","7"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570013","Humana Silver 3800/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570013-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$860","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607826","http://apps.humana.com/marketing/documents.asp?file=2623478","8"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","3","30613","MO","Individual","No","39-1263473","30613MO0570002","Humana Bronze 6450/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","30613MO0570002-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2607969","http://apps.humana.com/marketing/documents.asp?file=2592928","8"
"2016","MO","16049","HIOS","7","2015-10-18 12:35:12","2","16049","MO","Individual","No","35-1665915","16049MO0030008","Gold Compass 0","16049MO003",,"MON001","MOS001","MOF004","New","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=mo0038&st=mo","16049MO0030008-03","Limited Cost Sharing Plan Variation","79.1%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=mo0006&st=mo","http://www.uhc.com/iex/doc?id=mo0037&st=mo","36"
"2016","MO","28214","HIOS","2","2015-07-10 02:19:03","1","28214","MO","SHOP (Small Group)","Yes","44-0308260","28214MO0010001","KCL EHB Low PPO","28214MO001",,"MON001","MOS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$38.76","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","28214MO0010001-00","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","28214","HIOS","2","2015-07-10 02:19:03","1","28214","MO","SHOP (Small Group)","Yes","44-0308260","28214MO0010003","KCL EHB Low MAC","28214MO001",,"MON001","MOS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$30.33","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","28214MO0010003-00","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MO","28214","HIOS","2","2015-07-10 02:19:03","1","28214","MO","SHOP (Small Group)","Yes","44-0308260","28214MO0010005","KCL Fam Low PPO","28214MO001",,"MON001","MOS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$38.76","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","28214MO0010005-00","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","MO","28214","HIOS","2","2015-07-10 02:19:03","1","28214","MO","SHOP (Small Group)","Yes","44-0308260","28214MO0010007","KCL Fam Low MAC","28214MO001",,"MON001","MOS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$30.33","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","28214MO0010007-00","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","MO","28214","HIOS","2","2015-07-10 02:19:03","2","28214","MO","SHOP (Small Group)","Yes","44-0308260","28214MO0010002","KCL EHB High PPO","28214MO001",,"MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$47.15","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","28214MO0010002-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","28214","HIOS","2","2015-07-10 02:19:03","2","28214","MO","SHOP (Small Group)","Yes","44-0308260","28214MO0010004","KCL EHB High MAC","28214MO001",,"MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$37.71","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","28214MO0010004-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MO","28214","HIOS","2","2015-07-10 02:19:03","2","28214","MO","SHOP (Small Group)","Yes","44-0308260","28214MO0010006","KCL Fam High PPO","28214MO001",,"MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$47.15","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","28214MO0010006-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","MO","28214","HIOS","2","2015-07-10 02:19:03","2","28214","MO","SHOP (Small Group)","Yes","44-0308260","28214MO0010008","KCL Fam High MAC","28214MO001",,"MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$37.71","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","28214MO0010008-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","MO","29416","HIOS","3","2015-08-27 11:14:25","1","29416","MO","Individual","Yes","95-6042390","29416MO0020003","BESTOne Advantage Gold","29416MO002",,"MON001","MOS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.19","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MO/2016/MO_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","MO","29416","HIOS","3","2015-08-27 11:14:25","1","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010007","BESTDental Premium","29416MO001",,"MON001","MOS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MO/2016/MO_BESTDental_Premium_Plan.pdf","4"
"2016","MO","29416","HIOS","3","2015-08-27 11:14:25","1","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010007","BESTDental Premium","29416MO001",,"MON001","MOS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MO/2016/MO_BESTDental_Premium_Plan.pdf","5"
"2016","MO","29416","HIOS","3","2015-08-27 11:14:25","1","29416","MO","Individual","Yes","95-6042390","29416MO0020003","BESTOne Advantage Gold","29416MO002",,"MON001","MOS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.19","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MO/2016/MO_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","MO","29416","HIOS","3","2015-08-27 11:14:25","1","29416","MO","Individual","Yes","95-6042390","29416MO0020004","BESTOne Plus Gold","29416MO002",,"MON001","MOS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.19","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MO/2016/MO_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","MO","29416","HIOS","3","2015-08-27 11:14:25","1","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010008","BESTDental Standard - H","29416MO001",,"MON001","MOS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MO/2016/MO_BESTDental_Standard-H_Plan.pdf","6"
"2016","MO","29416","HIOS","3","2015-08-27 11:14:25","1","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010008","BESTDental Standard - H","29416MO001",,"MON001","MOS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MO/2016/MO_BESTDental_Standard-H_Plan.pdf","7"
"2016","MO","29416","HIOS","3","2015-08-27 11:14:25","1","29416","MO","Individual","Yes","95-6042390","29416MO0020004","BESTOne Plus Gold","29416MO002",,"MON001","MOS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.19","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MO/2016/MO_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","MO","29416","HIOS","3","2015-08-27 11:14:25","1","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010010","BESTDental Choice - H","29416MO001",,"MON001","MOS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MO/2016/MO_BESTDental_Choice-H_Plan.pdf","8"
"2016","MO","29416","HIOS","3","2015-08-27 11:14:25","1","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010010","BESTDental Choice - H","29416MO001",,"MON001","MOS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MO/2016/MO_BESTDental_Choice-H_Plan.pdf","9"
"2016","MO","29416","HIOS","3","2015-08-27 11:14:25","2","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010009","BESTDental Standard - L","29416MO001",,"MON001","MOS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MO/2016/MO_BESTDental_Standard-L_Plan.pdf","4"
"2016","MO","29416","HIOS","3","2015-08-27 11:14:25","2","29416","MO","Individual","Yes","95-6042390","29416MO0020005","BESTOne Plus Silver","29416MO002",,"MON001","MOS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.86","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MO/2016/MO_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","MO","29416","HIOS","3","2015-08-27 11:14:25","2","29416","MO","Individual","Yes","95-6042390","29416MO0020005","BESTOne Plus Silver","29416MO002",,"MON001","MOS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.86","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MO/2016/MO_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","MO","29416","HIOS","3","2015-08-27 11:14:25","2","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010009","BESTDental Standard - L","29416MO001",,"MON001","MOS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MO/2016/MO_BESTDental_Standard-L_Plan.pdf","5"
"2016","MO","29416","HIOS","3","2015-08-27 11:14:25","2","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010011","BESTDental Choice - L","29416MO001",,"MON001","MOS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MO/2016/MO_BESTDental_Choice-L_Plan.pdf","6"
"2016","MO","29416","HIOS","3","2015-08-27 11:14:25","2","29416","MO","Individual","Yes","95-6042390","29416MO0020006","BESTOne Basic Silver","29416MO002",,"MON001","MOS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.86","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MO/2016/MO_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","MO","29416","HIOS","3","2015-08-27 11:14:25","2","29416","MO","Individual","Yes","95-6042390","29416MO0020006","BESTOne Basic Silver","29416MO002",,"MON001","MOS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.86","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MO/2016/MO_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","MO","29416","HIOS","3","2015-08-27 11:14:25","2","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010011","BESTDental Choice - L","29416MO001",,"MON001","MOS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MO/2016/MO_BESTDental_Choice-L_Plan.pdf","7"
"2016","MO","29416","HIOS","3","2015-08-27 11:14:25","2","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010012","BESTDental Value","29416MO001",,"MON001","MOS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MO/2016/MO_BESTDental_Value_Plan.pdf","8"
"2016","MO","29416","HIOS","3","2015-08-27 11:14:25","2","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010012","BESTDental Value","29416MO001",,"MON001","MOS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","29416MO0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MO/2016/MO_BESTDental_Value_Plan.pdf","9"
"2016","MO","30494","HIOS","2","2015-08-25 05:06:23","1","30494","MO","SHOP (Small Group)","Yes","23-1661402","30494MO0010001","Smile for Health - Certified Optimum Coverage","30494MO001",,"MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","30494MO0010001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","30494","HIOS","2","2015-08-25 05:06:23","2","30494","MO","SHOP (Small Group)","Yes","23-1661402","30494MO0010002","Smile for Health - Certified Optimum Coverage","30494MO001",,"MON002","MOS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","30494MO0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","30494","HIOS","2","2015-08-25 05:06:23","3","30494","MO","SHOP (Small Group)","Yes","23-1661402","30494MO0010003","Smile for Health - Certified Optimum Coverage","30494MO001",,"MON003","MOS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","30494MO0010003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","30494","HIOS","2","2015-08-25 05:06:23","4","30494","MO","SHOP (Small Group)","Yes","23-1661402","30494MO0010004","Smile for Health - Certified Optimum Coverage","30494MO001",,"MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","30494MO0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","30494","HIOS","2","2015-08-25 05:06:23","5","30494","MO","SHOP (Small Group)","Yes","23-1661402","30494MO0010005","Smile for Health - Certified Optimum Coverage","30494MO001",,"MON002","MOS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","30494MO0010005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","30494","HIOS","2","2015-08-25 05:06:23","6","30494","MO","SHOP (Small Group)","Yes","23-1661402","30494MO0010006","Smile for Health - Certified Optimum Coverage","30494MO001",,"MON003","MOS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","30494MO0010006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","30494","HIOS","2","2015-08-25 05:06:23","7","30494","MO","SHOP (Small Group)","Yes","23-1661402","30494MO0020001","Smile for Health - Certified High Option","30494MO002",,"MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","30494MO0020001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","30494","HIOS","2","2015-08-25 05:06:23","8","30494","MO","SHOP (Small Group)","Yes","23-1661402","30494MO0020002","Smile for Health - Certified High Option","30494MO002",,"MON002","MOS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","30494MO0020002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","30494","HIOS","2","2015-08-25 05:06:23","9","30494","MO","SHOP (Small Group)","Yes","23-1661402","30494MO0020003","Smile for Health - Certified High Option","30494MO002",,"MON003","MOS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","30494MO0020003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","30494","HIOS","2","2015-08-25 05:06:23","10","30494","MO","SHOP (Small Group)","Yes","23-1661402","30494MO0020004","Smile for Health - Certified High Option Plus","30494MO002",,"MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","30494MO0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","30494","HIOS","2","2015-08-25 05:06:23","11","30494","MO","SHOP (Small Group)","Yes","23-1661402","30494MO0020005","Smile for Health - Certified High Option Plus","30494MO002",,"MON002","MOS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","30494MO0020005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","30494","HIOS","2","2015-08-25 05:06:23","12","30494","MO","SHOP (Small Group)","Yes","23-1661402","30494MO0020006","Smile for Health - Certified High Option Plus","30494MO002",,"MON003","MOS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","30494MO0020006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","Yes","39-1263473","30613MO0560001","Humana Dental Smart Choice","30613MO056",,"MON001","MOS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.80","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","30613MO0560001-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612935","4"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570013","Humana Silver 3800/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570013-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607787","http://apps.humana.com/marketing/documents.asp?file=2592876","4"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570005","Humana Platinum 500/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570005-03","Limited Cost Sharing Plan Variation","88.47%","0.8882697224617","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%","$0","per person not applicable","per group not applicable","50%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608164","http://apps.humana.com/marketing/documents.asp?file=2592967","33"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570008","Humana Silver 3800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570008-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608008","http://apps.humana.com/marketing/documents.asp?file=2592941","34"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570008","Humana Silver 3800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570008-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608008","http://apps.humana.com/marketing/documents.asp?file=2592941","35"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780010","Anthem Gold Blue Preferred X 1000 20  5500 Plus SelRx","32753MO078",,"MON002","MOS008","MOF028","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780010-01","Standard Gold On Exchange Plan","78.97%","0.793441295623779","No","Yes","No","100%",,"$1,000","$0","$817","$0","$424","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$7000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1Z0A","http://sgplans.anthem.com/mo/brochure/","17"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780025","Anthem Bronze Blue Preferred X 4500E 30  6550 Plus w HSA SelRx","32753MO078",,"MON002","MOS002","MOF027","New","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780025-00","Standard Bronze Off Exchange Plan","61.99%","0.621161282062531","Yes","Yes","No","100%",,"$4,500","$0","$175","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1PMF","http://sgplans.anthem.com/mo/brochure/","4"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570013","Humana Silver 3800/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570013-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607839","http://apps.humana.com/marketing/documents.asp?file=2623491","9"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570013","Humana Silver 3800/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570013-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607852","http://apps.humana.com/marketing/documents.asp?file=2623504","10"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570014","Humana Gold 2250/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570014-00","Standard Gold Off Exchange Plan","78.03%","0.784297227859497","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%","$0","per person not applicable","per group not applicable","50%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607865","http://apps.humana.com/marketing/documents.asp?file=2592889","11"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570014","Humana Gold 2250/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570014-01","Standard Gold On Exchange Plan","78.03%","0.784297227859497","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%","$0","per person not applicable","per group not applicable","50%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607865","http://apps.humana.com/marketing/documents.asp?file=2592889","12"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570014","Humana Gold 2250/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570014-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607878","http://apps.humana.com/marketing/documents.asp?file=2592889","13"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570014","Humana Gold 2250/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570014-03","Limited Cost Sharing Plan Variation","78.03%","0.784297227859497","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%","$0","per person not applicable","per group not applicable","50%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607891","http://apps.humana.com/marketing/documents.asp?file=2592889","14"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570015","Humana Platinum 500/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570015-00","Standard Platinum Off Exchange Plan","88.47%","0.8882697224617","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%","$0","per person not applicable","per group not applicable","50%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607904","http://apps.humana.com/marketing/documents.asp?file=2592902","15"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570015","Humana Platinum 500/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570015-01","Standard Platinum On Exchange Plan","88.47%","0.8882697224617","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%","$0","per person not applicable","per group not applicable","50%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607904","http://apps.humana.com/marketing/documents.asp?file=2592902","16"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570015","Humana Platinum 500/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607917","http://apps.humana.com/marketing/documents.asp?file=2592902","17"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570015","Humana Platinum 500/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570015-03","Limited Cost Sharing Plan Variation","88.47%","0.8882697224617","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%","$0","per person not applicable","per group not applicable","50%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607943","http://apps.humana.com/marketing/documents.asp?file=2592902","18"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570003","Humana Silver 3800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570003-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608008","http://apps.humana.com/marketing/documents.asp?file=2592941","19"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570003","Humana Silver 3800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570003-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608008","http://apps.humana.com/marketing/documents.asp?file=2592941","20"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570003","Humana Silver 3800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608021","http://apps.humana.com/marketing/documents.asp?file=2592941","21"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570003","Humana Silver 3800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570003-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608034","http://apps.humana.com/marketing/documents.asp?file=2592941","22"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570003","Humana Silver 3800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570003-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$860","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608047","http://apps.humana.com/marketing/documents.asp?file=2623517","23"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570003","Humana Silver 3800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570003-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608060","http://apps.humana.com/marketing/documents.asp?file=2623530","24"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570003","Humana Silver 3800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570003-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608073","http://apps.humana.com/marketing/documents.asp?file=2623543","25"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570004","Humana Gold 2250/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570004-00","Standard Gold Off Exchange Plan","78.03%","0.784297227859497","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%","$0","per person not applicable","per group not applicable","50%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608086","http://apps.humana.com/marketing/documents.asp?file=2592954","26"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570004","Humana Gold 2250/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570004-01","Standard Gold On Exchange Plan","78.03%","0.784297227859497","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%","$0","per person not applicable","per group not applicable","50%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608086","http://apps.humana.com/marketing/documents.asp?file=2592954","27"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570004","Humana Gold 2250/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608099","http://apps.humana.com/marketing/documents.asp?file=2592954","28"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570004","Humana Gold 2250/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570004-03","Limited Cost Sharing Plan Variation","78.03%","0.784297227859497","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%","$0","per person not applicable","per group not applicable","50%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608112","http://apps.humana.com/marketing/documents.asp?file=2592954","29"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570005","Humana Platinum 500/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570005-00","Standard Platinum Off Exchange Plan","88.47%","0.8882697224617","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%","$0","per person not applicable","per group not applicable","50%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608125","http://apps.humana.com/marketing/documents.asp?file=2592967","30"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570005","Humana Platinum 500/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570005-01","Standard Platinum On Exchange Plan","88.47%","0.8882697224617","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%","$0","per person not applicable","per group not applicable","50%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608125","http://apps.humana.com/marketing/documents.asp?file=2592967","31"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570005","Humana Platinum 500/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608138","http://apps.humana.com/marketing/documents.asp?file=2592967","32"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570008","Humana Silver 3800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608021","http://apps.humana.com/marketing/documents.asp?file=2592941","36"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570008","Humana Silver 3800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570008-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608034","http://apps.humana.com/marketing/documents.asp?file=2592941","37"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570008","Humana Silver 3800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570008-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$860","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608047","http://apps.humana.com/marketing/documents.asp?file=2623517","38"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570008","Humana Silver 3800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570008-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608060","http://apps.humana.com/marketing/documents.asp?file=2623530","39"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570008","Humana Silver 3800/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570008-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608073","http://apps.humana.com/marketing/documents.asp?file=2623543","40"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570009","Humana Gold 2250/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570009-00","Standard Gold Off Exchange Plan","78.03%","0.784297227859497","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%","$0","per person not applicable","per group not applicable","50%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608086","http://apps.humana.com/marketing/documents.asp?file=2592954","41"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570009","Humana Gold 2250/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570009-01","Standard Gold On Exchange Plan","78.03%","0.784297287464142","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%","$0","per person not applicable","per group not applicable","50%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608086","http://apps.humana.com/marketing/documents.asp?file=2592954","42"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570009","Humana Gold 2250/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608099","http://apps.humana.com/marketing/documents.asp?file=2592954","43"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570009","Humana Gold 2250/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570009-03","Limited Cost Sharing Plan Variation","78.03%","0.784297287464142","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%","$0","per person not applicable","per group not applicable","50%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608112","http://apps.humana.com/marketing/documents.asp?file=2592954","44"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570010","Humana Platinum 500/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570010-00","Standard Platinum Off Exchange Plan","88.47%","0.8882697224617","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%","$0","per person not applicable","per group not applicable","50%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608125","http://apps.humana.com/marketing/documents.asp?file=2592967","45"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570010","Humana Platinum 500/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570010-01","Standard Platinum On Exchange Plan","88.47%","0.8882697224617","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%","$0","per person not applicable","per group not applicable","50%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608125","http://apps.humana.com/marketing/documents.asp?file=2592967","46"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570010","Humana Platinum 500/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608138","http://apps.humana.com/marketing/documents.asp?file=2592967","47"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","1","30613","MO","Individual","No","39-1263473","30613MO0570010","Humana Platinum 500/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","30613MO0570010-03","Limited Cost Sharing Plan Variation","88.47%","0.8882697224617","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%","$0","per person not applicable","per group not applicable","50%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608164","http://apps.humana.com/marketing/documents.asp?file=2592967","48"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","2","30613","MO","Individual","No","39-1263473","30613MO0570011","Humana Basic 6850/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF001","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","30613MO0570011-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2607735","http://apps.humana.com/marketing/documents.asp?file=2592850","4"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","2","30613","MO","Individual","No","39-1263473","30613MO0570011","Humana Basic 6850/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF001","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","30613MO0570011-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2607735","http://apps.humana.com/marketing/documents.asp?file=2592850","5"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","2","30613","MO","Individual","No","39-1263473","30613MO0570001","Humana Basic 6850/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF001","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","30613MO0570001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2607956","http://apps.humana.com/marketing/documents.asp?file=2592915","6"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","2","30613","MO","Individual","No","39-1263473","30613MO0570001","Humana Basic 6850/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF001","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","30613MO0570001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2607956","http://apps.humana.com/marketing/documents.asp?file=2592915","7"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","2","30613","MO","Individual","No","39-1263473","30613MO0570006","Humana Basic 6850/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF001","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","30613MO0570006-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2607956","http://apps.humana.com/marketing/documents.asp?file=2592915","8"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","2","30613","MO","Individual","No","39-1263473","30613MO0570006","Humana Basic 6850/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF001","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","30613MO0570006-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2607956","http://apps.humana.com/marketing/documents.asp?file=2592915","9"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","3","30613","MO","Individual","No","39-1263473","30613MO0570012","Humana Bronze 6450/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","30613MO0570012-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2607748","http://apps.humana.com/marketing/documents.asp?file=2592863","4"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","3","30613","MO","Individual","No","39-1263473","30613MO0570012","Humana Bronze 6450/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","30613MO0570012-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2607748","http://apps.humana.com/marketing/documents.asp?file=2592863","5"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","3","30613","MO","Individual","No","39-1263473","30613MO0570012","Humana Bronze 6450/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","30613MO0570012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2607761","http://apps.humana.com/marketing/documents.asp?file=2592863","6"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","3","30613","MO","Individual","No","39-1263473","30613MO0570012","Humana Bronze 6450/Kansas City PPOx","30613MO057",,"MON002","MOS002","MOF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","30613MO0570012-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2607774","http://apps.humana.com/marketing/documents.asp?file=2592863","7"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","3","30613","MO","Individual","No","39-1263473","30613MO0570002","Humana Bronze 6450/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","30613MO0570002-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2607969","http://apps.humana.com/marketing/documents.asp?file=2592928","9"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","3","30613","MO","Individual","No","39-1263473","30613MO0570002","Humana Bronze 6450/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","30613MO0570002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2607982","http://apps.humana.com/marketing/documents.asp?file=2592928","10"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","3","30613","MO","Individual","No","39-1263473","30613MO0570002","Humana Bronze 6450/S.W. Missouri PPOx","30613MO057",,"MON003","MOS003","MOF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","30613MO0570002-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2607995","http://apps.humana.com/marketing/documents.asp?file=2592928","11"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","SHOP (Small Group)","Yes","86-0257201","32753MO0830003","Anthem Dental Family","32753MO083",,"MON003","MOS009",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.81","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","32753MO0830003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214658.pdf",,"4"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770017","Anthem Bronze Pathway X 0 for HSA","32753MO077",,"MON001","MOS001","MOF001","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770017-00","Standard Bronze Off Exchange Plan","59.94%","0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GJ5","http://editiondigital.net/view/IU65/2016/OFF_HIX_MO_KIT_2016","4"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","Yes","86-0257201","32753MO0860003","Anthem Dental Family","32753MO086",,"MON003","MOS009",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.81","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","32753MO0860003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214658.pdf",,"4"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","Yes","86-0257201","32753MO0920003","Anthem Dental Family","32753MO092",,"MON003","MOS009",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.81","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","32753MO0920003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214658.pdf",,"5"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770017","Anthem Bronze Pathway X 0 for HSA","32753MO077",,"MON001","MOS001","MOF001","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770017-01","Standard Bronze On Exchange Plan","59.94%","0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GJ3","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","5"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","SHOP (Small Group)","Yes","86-0257201","32753MO0890003","Anthem Dental Family","32753MO089",,"MON003","MOS009",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.81","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","32753MO0890003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214658.pdf",,"5"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780025","Anthem Bronze Blue Preferred X 4500E 30  6550 Plus w HSA SelRx","32753MO078",,"MON002","MOS002","MOF027","New","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780025-01","Standard Bronze On Exchange Plan","61.99%","0.621161282062531","Yes","Yes","No","100%",,"$4,500","$0","$175","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1PMF","http://sgplans.anthem.com/mo/brochure/","5"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","3","30613","MO","Individual","No","39-1263473","30613MO0570007","Humana Bronze 6450/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","30613MO0570007-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2607969","http://apps.humana.com/marketing/documents.asp?file=2592928","12"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","3","30613","MO","Individual","No","39-1263473","30613MO0570007","Humana Bronze 6450/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","30613MO0570007-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2607969","http://apps.humana.com/marketing/documents.asp?file=2592928","13"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","3","30613","MO","Individual","No","39-1263473","30613MO0570007","Humana Bronze 6450/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","30613MO0570007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2607982","http://apps.humana.com/marketing/documents.asp?file=2592928","14"
"2016","MO","30613","HIOS","14","2016-01-22 04:00:42","3","30613","MO","Individual","No","39-1263473","30613MO0570007","Humana Bronze 6450/S.W. Missouri PPOx","30613MO057",,"MON003","MOS005","MOF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","30613MO0570007-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2607995","http://apps.humana.com/marketing/documents.asp?file=2592928","15"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770026","Anthem Gold Pathway X 1100 10","32753MO077",,"MON001","MOS001","MOF020","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770026-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GKC","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","28"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770026","Anthem Gold Pathway X 1100 10","32753MO077",,"MON001","MOS001","MOF020","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770026-03","Limited Cost Sharing Plan Variation","78.45%","0.807085156440735","Yes","Yes","No","100%",,"$1,100","$500","$501","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","10%",,,,,"$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GKB","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","29"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","Individual","Yes","86-0257201","32753MO0840003","Anthem Dental Pediatric","32753MO084",,"MON003","MOS009",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$18.20","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","32753MO0840003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214660.pdf",,"4"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","Individual","No","86-0257201","32753MO0770015","Anthem Bronze Pathway X 5850 20","32753MO077",,"MON001","MOS001","MOF025","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770015-00","Standard Bronze Off Exchange Plan","61.98%","0.63654237985611","Yes","Yes","No","100%",,"$5,850","$0","$152","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","20%",,,,,"$11,700","$11700 per person","$23400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GHZ","http://editiondigital.net/view/IU65/2016/OFF_HIX_MO_KIT_2016","4"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780004","Anthem Gold Blue Preferred X 1000 20  5500 Plus SelRx","32753MO078",,"MON002","MOS002","MOF028","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780004-00","Standard Gold Off Exchange Plan","78.97%","0.793441295623779","No","Yes","No","100%",,"$1,000","$0","$817","$0","$424","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$7000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1Z0A","http://sgplans.anthem.com/mo/brochure/","4"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","SHOP (Small Group)","Yes","86-0257201","32753MO0870003","Anthem Dental Pediatric","32753MO087",,"MON003","MOS009",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$18.20","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","32753MO0870003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214660.pdf",,"4"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780004","Anthem Gold Blue Preferred X 1000 20  5500 Plus SelRx","32753MO078",,"MON002","MOS002","MOF028","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780004-01","Standard Gold On Exchange Plan","78.97%","0.793441295623779","No","Yes","No","100%",,"$1,000","$0","$817","$0","$424","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$7000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1Z0A","http://sgplans.anthem.com/mo/brochure/","5"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","Individual","No","86-0257201","32753MO0770015","Anthem Bronze Pathway X 5850 20","32753MO077",,"MON001","MOS001","MOF025","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770015-01","Standard Bronze On Exchange Plan","61.98%","0.63654237985611","Yes","Yes","No","100%",,"$5,850","$0","$152","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","20%",,,,,"$11,700","$11700 per person","$23400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GHX","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","5"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","Individual","Yes","86-0257201","32753MO0900003","Anthem Dental Pediatric","32753MO090",,"MON003","MOS009",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$18.20","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","32753MO0900003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214660.pdf",,"5"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","Individual","No","86-0257201","32753MO0770015","Anthem Bronze Pathway X 5850 20","32753MO077",,"MON001","MOS001","MOF025","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GHY","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","6"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780005","Anthem Gold Blue Preferred X 1000 20  5500 Plus SelRx","32753MO078",,"MON002","MOS003","MOF028","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780005-00","Standard Gold Off Exchange Plan","78.97%","0.793441295623779","No","Yes","No","100%",,"$1,000","$0","$817","$0","$424","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$7000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1Z0A","http://sgplans.anthem.com/mo/brochure/","6"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780005","Anthem Gold Blue Preferred X 1000 20  5500 Plus SelRx","32753MO078",,"MON002","MOS003","MOF028","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780005-01","Standard Gold On Exchange Plan","78.97%","0.793441295623779","No","Yes","No","100%",,"$1,000","$0","$817","$0","$424","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$7000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1Z0A","http://sgplans.anthem.com/mo/brochure/","7"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","Individual","No","86-0257201","32753MO0770015","Anthem Bronze Pathway X 5850 20","32753MO077",,"MON001","MOS001","MOF025","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770015-03","Limited Cost Sharing Plan Variation","61.98%","0.63654237985611","Yes","Yes","No","100%",,"$5,850","$0","$152","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","20%",,,,,"$11,700","$11700 per person","$23400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GHX","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","7"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","Individual","No","86-0257201","32753MO0770016","Anthem Bronze Pathway X 6050 25","32753MO077",,"MON001","MOS001","MOF026","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770016-00","Standard Bronze Off Exchange Plan","61.63%","0.632185161113739","Yes","Yes","No","100%",,"$6,050","$0","$140","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group","25%",,,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJ2","http://editiondigital.net/view/IU65/2016/OFF_HIX_MO_KIT_2016","8"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780006","Anthem Gold Blue Preferred X 1000 20  5500 Plus SelRx","32753MO078",,"MON002","MOS004","MOF028","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780006-00","Standard Gold Off Exchange Plan","78.97%","0.793441295623779","No","Yes","No","100%",,"$1,000","$0","$817","$0","$424","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$7000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1Z0A","http://sgplans.anthem.com/mo/brochure/","8"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780006","Anthem Gold Blue Preferred X 1000 20  5500 Plus SelRx","32753MO078",,"MON002","MOS004","MOF028","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780006-01","Standard Gold On Exchange Plan","78.97%","0.793441295623779","No","Yes","No","100%",,"$1,000","$0","$817","$0","$424","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$7000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1Z0A","http://sgplans.anthem.com/mo/brochure/","9"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","Individual","No","86-0257201","32753MO0770016","Anthem Bronze Pathway X 6050 25","32753MO077",,"MON001","MOS001","MOF026","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770016-01","Standard Bronze On Exchange Plan","61.63%","0.632185161113739","Yes","Yes","No","100%",,"$6,050","$0","$140","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group","25%",,,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJ0","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","9"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","Individual","No","86-0257201","32753MO0770016","Anthem Bronze Pathway X 6050 25","32753MO077",,"MON001","MOS001","MOF026","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770016-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GJ1","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","10"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780007","Anthem Gold Blue Preferred X 1000 20  5500 Plus SelRx","32753MO078",,"MON002","MOS005","MOF028","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780007-00","Standard Gold Off Exchange Plan","78.97%","0.793441295623779","No","Yes","No","100%",,"$1,000","$0","$817","$0","$424","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$7000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1Z0A","http://sgplans.anthem.com/mo/brochure/","10"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780007","Anthem Gold Blue Preferred X 1000 20  5500 Plus SelRx","32753MO078",,"MON002","MOS005","MOF028","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780007-01","Standard Gold On Exchange Plan","78.97%","0.793441295623779","No","Yes","No","100%",,"$1,000","$0","$817","$0","$424","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$7000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1Z0A","http://sgplans.anthem.com/mo/brochure/","11"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","Individual","No","86-0257201","32753MO0770016","Anthem Bronze Pathway X 6050 25","32753MO077",,"MON001","MOS001","MOF026","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770016-03","Limited Cost Sharing Plan Variation","61.63%","0.632185161113739","Yes","Yes","No","100%",,"$6,050","$0","$140","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group","25%",,,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJ0","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","11"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","Individual","No","86-0257201","32753MO0770019","Anthem Bronze Pathway X 4350 20","32753MO077",,"MON001","MOS001","MOF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770019-00","Standard Bronze Off Exchange Plan","61.59%","0.636640965938568","Yes","Yes","No","100%",,"$4,350","$0","$452","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,350","$4350 per person","$8700 per group","20%",,,,,"$8,700","$8700 per person","$17400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJB","http://editiondigital.net/view/IU65/2016/OFF_HIX_MO_KIT_2016","12"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780008","Anthem Gold Blue Preferred X 1000 20  5500 Plus SelRx","32753MO078",,"MON002","MOS006","MOF028","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780008-00","Standard Gold Off Exchange Plan","78.97%","0.793441295623779","No","Yes","No","100%",,"$1,000","$0","$817","$0","$424","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$7000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1Z0A","http://sgplans.anthem.com/mo/brochure/","12"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780008","Anthem Gold Blue Preferred X 1000 20  5500 Plus SelRx","32753MO078",,"MON002","MOS006","MOF028","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780008-01","Standard Gold On Exchange Plan","78.97%","0.793441295623779","No","Yes","No","100%",,"$1,000","$0","$817","$0","$424","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$7000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1Z0A","http://sgplans.anthem.com/mo/brochure/","13"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","Individual","No","86-0257201","32753MO0770019","Anthem Bronze Pathway X 4350 20","32753MO077",,"MON001","MOS001","MOF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770019-01","Standard Bronze On Exchange Plan","61.59%","0.636640965938568","Yes","Yes","No","100%",,"$4,350","$0","$452","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,350","$4350 per person","$8700 per group","20%",,,,,"$8,700","$8700 per person","$17400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJ9","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","13"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","Individual","No","86-0257201","32753MO0770019","Anthem Bronze Pathway X 4350 20","32753MO077",,"MON001","MOS001","MOF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770019-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GJA","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","14"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780009","Anthem Gold Blue Preferred X 1000 20  5500 Plus SelRx","32753MO078",,"MON002","MOS007","MOF028","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780009-00","Standard Gold Off Exchange Plan","78.97%","0.793441295623779","No","Yes","No","100%",,"$1,000","$0","$817","$0","$424","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$7000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1Z0A","http://sgplans.anthem.com/mo/brochure/","14"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780009","Anthem Gold Blue Preferred X 1000 20  5500 Plus SelRx","32753MO078",,"MON002","MOS007","MOF028","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780009-01","Standard Gold On Exchange Plan","78.97%","0.793441295623779","No","Yes","No","100%",,"$1,000","$0","$817","$0","$424","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$7000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1Z0A","http://sgplans.anthem.com/mo/brochure/","15"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","Individual","No","86-0257201","32753MO0770019","Anthem Bronze Pathway X 4350 20","32753MO077",,"MON001","MOS001","MOF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770019-03","Limited Cost Sharing Plan Variation","61.59%","0.636640965938568","Yes","Yes","No","100%",,"$4,350","$0","$452","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,350","$4350 per person","$8700 per group","20%",,,,,"$8,700","$8700 per person","$17400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJ9","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","15"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","1","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780010","Anthem Gold Blue Preferred X 1000 20  5500 Plus SelRx","32753MO078",,"MON002","MOS008","MOF028","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780010-00","Standard Gold Off Exchange Plan","78.97%","0.793441295623779","No","Yes","No","100%",,"$1,000","$0","$817","$0","$424","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$7000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1Z0A","http://sgplans.anthem.com/mo/brochure/","16"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780026","Anthem Bronze Blue Preferred X 4500E 30  6550 Plus w HSA SelRx","32753MO078",,"MON002","MOS003","MOF027","New","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780026-00","Standard Bronze Off Exchange Plan","61.99%","0.621161282062531","Yes","Yes","No","100%",,"$4,500","$0","$175","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1PMF","http://sgplans.anthem.com/mo/brochure/","6"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770017","Anthem Bronze Pathway X 0 for HSA","32753MO077",,"MON001","MOS001","MOF001","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770017-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GJ4","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","6"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770017","Anthem Bronze Pathway X 0 for HSA","32753MO077",,"MON001","MOS001","MOF001","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770017-03","Limited Cost Sharing Plan Variation","59.94%","0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GJ3","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","7"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780026","Anthem Bronze Blue Preferred X 4500E 30  6550 Plus w HSA SelRx","32753MO078",,"MON002","MOS003","MOF027","New","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780026-01","Standard Bronze On Exchange Plan","61.99%","0.621161282062531","Yes","Yes","No","100%",,"$4,500","$0","$175","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1PMF","http://sgplans.anthem.com/mo/brochure/","7"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780020","Anthem Silver Blue Preferred X 1500 30  6850 Plus SelRx","32753MO078",,"MON002","MOS004","MOF028","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780020-01","Standard Silver On Exchange Plan","70.74%","0.729625284671783","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YZZ","http://sgplans.anthem.com/mo/brochure/","9"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","Individual","No","86-0257201","32753MO0770021","Anthem Silver Pathway X 1850 20","32753MO077",,"MON001","MOS001","MOF024","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770021-05","87% AV Level Silver Plan","87.74%","0.881420731544495","Yes","Yes","No","100%",,"$700","$250","$400","$0","$700","$30","$84","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20%",,,,,"$3,700","$3700 per person","$7400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GK0","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","9"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","Individual","No","86-0257201","32753MO0770021","Anthem Silver Pathway X 1850 20","32753MO077",,"MON001","MOS001","MOF024","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770021-06","94% AV Level Silver Plan","94.58%","0.942281365394592","Yes","Yes","No","100%",,"$150","$150","$250","$0","$150","$20","$196","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","20%",,,,,"$3,700","$3700 per person","$7400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GK1","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","10"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780027","Anthem Bronze Blue Preferred X 4500E 30  6550 Plus w HSA SelRx","32753MO078",,"MON002","MOS004","MOF027","New","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780027-00","Standard Bronze Off Exchange Plan","61.99%","0.621161282062531","Yes","Yes","No","100%",,"$4,500","$0","$175","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1PMF","http://sgplans.anthem.com/mo/brochure/","8"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770018","Anthem Bronze Pathway X 20 for HSA","32753MO077",,"MON001","MOS001","MOF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770018-00","Standard Bronze Off Exchange Plan","61.67%","0.619567692279816","Yes","Yes","No","100%",,"$4,650","$0","$392","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group","20%",,,,,"$9,300","$9300 per person","$18600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GJ8","http://editiondigital.net/view/IU65/2016/OFF_HIX_MO_KIT_2016","8"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","Individual","No","86-0257201","32753MO0770022","Anthem Silver Pathway X 2500 10","32753MO077",,"MON001","MOS001","MOF023","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770022-00","Standard Silver Off Exchange Plan","69.61%","0.728391945362091","Yes","Yes","No","100%",,"$2,500","$500","$361","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJL","http://editiondigital.net/view/IU65/2016/OFF_HIX_MO_KIT_2016","11"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","Individual","No","43-1257251","34762MO0150004","First Select Silver","34762MO015","7023011258","MON002","MOS002","MOF002","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150004-03","Limited Cost Sharing Plan Variation",,"0.714237093925476","Yes","Yes","Yes","46%","54%","$5,100","$0","$0","$200","$300","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","$5,100","$5100 per person","$10200 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","0%","$5,100","$5100 per person","$10200 per group","0%","$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/firstselectsilver4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","15"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","4","44240","MO","Individual","No","75-1296086","44240MO0090009","Coventry Bronze $25 Copay KCPPO","44240MO009",,"MON002","MOS002","MOF008","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0090009-00","Standard Bronze Off Exchange Plan","61.87%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68612","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","4","44240","MO","Individual","No","75-1296086","44240MO0090009","Coventry Bronze $25 Copay KCPPO","44240MO009",,"MON002","MOS002","MOF008","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0090009-01","Standard Bronze On Exchange Plan","61.87%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68608","http://www.coventryone.com/WMOon2016","5"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770018","Anthem Bronze Pathway X 20 for HSA","32753MO077",,"MON001","MOS001","MOF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770018-01","Standard Bronze On Exchange Plan","61.67%","0.619567692279816","Yes","Yes","No","100%",,"$4,650","$0","$392","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group","20%",,,,,"$9,300","$9300 per person","$18600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GJ6","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","9"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780027","Anthem Bronze Blue Preferred X 4500E 30  6550 Plus w HSA SelRx","32753MO078",,"MON002","MOS004","MOF027","New","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780027-01","Standard Bronze On Exchange Plan","61.99%","0.621161282062531","Yes","Yes","No","100%",,"$4,500","$0","$175","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1PMF","http://sgplans.anthem.com/mo/brochure/","9"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780028","Anthem Bronze Blue Preferred X 4500E 30  6550 Plus w HSA SelRx","32753MO078",,"MON002","MOS005","MOF027","New","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780028-00","Standard Bronze Off Exchange Plan","61.99%","0.621161282062531","Yes","Yes","No","100%",,"$4,500","$0","$175","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1PMF","http://sgplans.anthem.com/mo/brochure/","10"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770018","Anthem Bronze Pathway X 20 for HSA","32753MO077",,"MON001","MOS001","MOF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770018-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GJ7","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","10"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770018","Anthem Bronze Pathway X 20 for HSA","32753MO077",,"MON001","MOS001","MOF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770018-03","Limited Cost Sharing Plan Variation","61.67%","0.619567692279816","Yes","Yes","No","100%",,"$4,650","$0","$392","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group","20%",,,,,"$9,300","$9300 per person","$18600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GJ6","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","11"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780028","Anthem Bronze Blue Preferred X 4500E 30  6550 Plus w HSA SelRx","32753MO078",,"MON002","MOS005","MOF027","New","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780028-01","Standard Bronze On Exchange Plan","61.99%","0.621161282062531","Yes","Yes","No","100%",,"$4,500","$0","$175","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1PMF","http://sgplans.anthem.com/mo/brochure/","11"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780029","Anthem Bronze Blue Preferred X 4500E 30  6550 Plus w HSA SelRx","32753MO078",,"MON002","MOS006","MOF027","New","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780029-00","Standard Bronze Off Exchange Plan","61.99%","0.621161282062531","Yes","Yes","No","100%",,"$4,500","$0","$175","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1PMF","http://sgplans.anthem.com/mo/brochure/","12"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770020","Anthem Silver Pathway X 3750 0","32753MO077",,"MON001","MOS001","MOF022","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770020-00","Standard Silver Off Exchange Plan","71.07%","0.7125124335289","Yes","Yes","No","100%",,"$3,750","$500","$0","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJE","http://editiondigital.net/view/IU65/2016/OFF_HIX_MO_KIT_2016","12"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770020","Anthem Silver Pathway X 3750 0","32753MO077",,"MON001","MOS001","MOF022","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770020-01","Standard Silver On Exchange Plan","71.07%","0.7125124335289","Yes","Yes","No","100%",,"$3,750","$500","$0","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJC","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","13"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780029","Anthem Bronze Blue Preferred X 4500E 30  6550 Plus w HSA SelRx","32753MO078",,"MON002","MOS006","MOF027","New","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780029-01","Standard Bronze On Exchange Plan","61.99%","0.621161282062531","Yes","Yes","No","100%",,"$4,500","$0","$175","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1PMF","http://sgplans.anthem.com/mo/brochure/","13"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780030","Anthem Bronze Blue Preferred X 4500E 30  6550 Plus w HSA SelRx","32753MO078",,"MON002","MOS007","MOF027","New","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780030-00","Standard Bronze Off Exchange Plan","61.99%","0.621161282062531","Yes","Yes","No","100%",,"$4,500","$0","$175","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1PMF","http://sgplans.anthem.com/mo/brochure/","14"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770020","Anthem Silver Pathway X 3750 0","32753MO077",,"MON001","MOS001","MOF022","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770020-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GJD","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","14"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770020","Anthem Silver Pathway X 3750 0","32753MO077",,"MON001","MOS001","MOF022","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770020-03","Limited Cost Sharing Plan Variation","71.07%","0.7125124335289","Yes","Yes","No","100%",,"$3,750","$500","$0","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJC","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","15"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780030","Anthem Bronze Blue Preferred X 4500E 30  6550 Plus w HSA SelRx","32753MO078",,"MON002","MOS007","MOF027","New","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780030-01","Standard Bronze On Exchange Plan","61.99%","0.621161282062531","Yes","Yes","No","100%",,"$4,500","$0","$175","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1PMF","http://sgplans.anthem.com/mo/brochure/","15"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780031","Anthem Bronze Blue Preferred X 4500E 30  6550 Plus w HSA SelRx","32753MO078",,"MON002","MOS008","MOF027","New","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780031-00","Standard Bronze Off Exchange Plan","61.99%","0.621161282062531","Yes","Yes","No","100%",,"$4,500","$0","$175","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1PMF","http://sgplans.anthem.com/mo/brochure/","16"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770020","Anthem Silver Pathway X 3750 0","32753MO077",,"MON001","MOS001","MOF022","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770020-04","73% AV Level Silver Plan","73.93%","0.740908145904541","Yes","Yes","No","100%",,"$3,250","$500","$0","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJF","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","16"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770020","Anthem Silver Pathway X 3750 0","32753MO077",,"MON001","MOS001","MOF022","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770020-05","87% AV Level Silver Plan","87.63%","0.877609193325043","Yes","Yes","No","100%",,"$800","$250","$0","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJG","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","17"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780031","Anthem Bronze Blue Preferred X 4500E 30  6550 Plus w HSA SelRx","32753MO078",,"MON002","MOS008","MOF027","New","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780031-01","Standard Bronze On Exchange Plan","61.99%","0.621161282062531","Yes","Yes","No","100%",,"$4,500","$0","$175","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1PMF","http://sgplans.anthem.com/mo/brochure/","17"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770020","Anthem Silver Pathway X 3750 0","32753MO077",,"MON001","MOS001","MOF022","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770020-06","94% AV Level Silver Plan","94.53%","0.946431159973145","Yes","Yes","No","100%",,"$200","$100","$0","$0","$200","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","0%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJH","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","18"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770023","Anthem Silver Pathway X 10 for HSA","32753MO077",,"MON001","MOS001","MOF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770023-00","Standard Silver Off Exchange Plan","68.57%","0.696548759937286","Yes","Yes","No","100%",,"$3,000","$500","$311","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GJS","http://editiondigital.net/view/IU65/2016/OFF_HIX_MO_KIT_2016","19"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770023","Anthem Silver Pathway X 10 for HSA","32753MO077",,"MON001","MOS001","MOF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770023-01","Standard Silver On Exchange Plan","68.57%","0.696548759937286","Yes","Yes","No","100%",,"$3,000","$500","$311","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GJQ","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","20"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770023","Anthem Silver Pathway X 10 for HSA","32753MO077",,"MON001","MOS001","MOF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770023-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GJR","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","21"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770023","Anthem Silver Pathway X 10 for HSA","32753MO077",,"MON001","MOS001","MOF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770023-03","Limited Cost Sharing Plan Variation","68.57%","0.696548759937286","Yes","Yes","No","100%",,"$3,000","$500","$311","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GJQ","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","22"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770023","Anthem Silver Pathway X 10 for HSA","32753MO077",,"MON001","MOS001","MOF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770023-04","73% AV Level Silver Plan","72.39%","0.728984713554382","Yes","Yes","No","100%",,"$2,600","$500","$351","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7400 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GJT","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","23"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770023","Anthem Silver Pathway X 10 for HSA","32753MO077",,"MON001","MOS001","MOF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770023-05","87% AV Level Silver Plan","87.46%","0.874577879905701","Yes","Yes","No","100%",,"$1,150","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJU","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","24"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770023","Anthem Silver Pathway X 10 for HSA","32753MO077",,"MON001","MOS001","MOF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770023-06","94% AV Level Silver Plan","93.96%","0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$0","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJV","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","25"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770026","Anthem Gold Pathway X 1100 10","32753MO077",,"MON001","MOS001","MOF020","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770026-00","Standard Gold Off Exchange Plan","78.45%","0.807085156440735","Yes","Yes","No","100%",,"$1,100","$500","$501","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","10%",,,,,"$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GKD","http://editiondigital.net/view/IU65/2016/OFF_HIX_MO_KIT_2016","26"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770026","Anthem Gold Pathway X 1100 10","32753MO077",,"MON001","MOS001","MOF020","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770026-01","Standard Gold On Exchange Plan","78.45%","0.807085156440735","Yes","Yes","No","100%",,"$1,100","$500","$501","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","10%",,,,,"$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GKB","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","27"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770027","Anthem Bronze Pathway X 40 for HSA","32753MO077",,"MON001","MOS001","MOF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770027-00","Standard Bronze Off Exchange Plan","60.62%","0.605196595191956","Yes","Yes","No","100%",,"$5,000","$0","$644","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd11XAQ","http://editiondigital.net/view/IU65/2016/OFF_HIX_MO_KIT_2016","30"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770027","Anthem Bronze Pathway X 40 for HSA","32753MO077",,"MON001","MOS001","MOF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770027-01","Standard Bronze On Exchange Plan","60.62%","0.605196595191956","Yes","Yes","No","100%",,"$5,000","$0","$644","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd11XAR","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","31"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770027","Anthem Bronze Pathway X 40 for HSA","32753MO077",,"MON001","MOS001","MOF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770027-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.sbc.anthem.com/dps/ccd1XAS","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","32"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770027","Anthem Bronze Pathway X 40 for HSA","32753MO077",,"MON001","MOS001","MOF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770027-03","Limited Cost Sharing Plan Variation","60.62%","0.605196595191956","Yes","Yes","No","100%",,"$5,000","$0","$644","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd11XAR","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","33"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770028","Anthem Bronze Pathway X 5450 30","32753MO077",,"MON001","MOS001","MOF004","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770028-00","Standard Bronze Off Exchange Plan","58.85%","0.591137230396271","Yes","Yes","No","100%",,"$5,450","$0","$348","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","30%",,,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAT","http://editiondigital.net/view/IU65/2016/OFF_HIX_MO_KIT_2016","34"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770028","Anthem Bronze Pathway X 5450 30","32753MO077",,"MON001","MOS001","MOF004","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770028-01","Standard Bronze On Exchange Plan","58.85%","0.591137230396271","Yes","Yes","No","100%",,"$5,450","$0","$348","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","30%",,,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAU","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","35"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770028","Anthem Bronze Pathway X 5450 30","32753MO077",,"MON001","MOS001","MOF004","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770028-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1XAV","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","36"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770028","Anthem Bronze Pathway X 5450 30","32753MO077",,"MON001","MOS001","MOF004","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770028-03","Limited Cost Sharing Plan Variation","58.85%","0.591137230396271","Yes","Yes","No","100%",,"$5,450","$0","$348","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","30%",,,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XAU","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","37"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770030","Anthem Bronze Pathway X 4950 50","32753MO077",,"MON001","MOS001","MOF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770030-00","Standard Bronze Off Exchange Plan","58.07%","0.582850992679596","Yes","Yes","No","100%",,"$4,950","$0","$830","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","50%",,,,,"$9,900","$9900 per person","$19800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XB2","http://editiondigital.net/view/IU65/2016/OFF_HIX_MO_KIT_2016","38"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770030","Anthem Bronze Pathway X 4950 50","32753MO077",,"MON001","MOS001","MOF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770030-01","Standard Bronze On Exchange Plan","58.07%","0.582850992679596","Yes","Yes","No","100%",,"$4,950","$0","$830","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","50%",,,,,"$9,900","$9900 per person","$19800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XB3","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","39"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770030","Anthem Bronze Pathway X 4950 50","32753MO077",,"MON001","MOS001","MOF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770030-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1XB4","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","40"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770030","Anthem Bronze Pathway X 4950 50","32753MO077",,"MON001","MOS001","MOF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770030-03","Limited Cost Sharing Plan Variation","58.07%","0.582850992679596","Yes","Yes","No","100%",,"$4,950","$0","$830","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","50%",,,,,"$9,900","$9900 per person","$19800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XB3","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","41"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770031","Anthem Silver Pathway X 2250 50","32753MO077",,"MON001","MOS001","MOF021","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770031-00","Standard Silver Off Exchange Plan","68.12%","0.681784331798553","Yes","Yes","No","100%",,"$2,250","$500","$1,930","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","50%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XB5","http://editiondigital.net/view/IU65/2016/OFF_HIX_MO_KIT_2016","42"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770031","Anthem Silver Pathway X 2250 50","32753MO077",,"MON001","MOS001","MOF021","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770031-01","Standard Silver On Exchange Plan","68.12%","0.681784331798553","Yes","Yes","No","100%",,"$2,250","$500","$1,930","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","50%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XB6","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","43"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770031","Anthem Silver Pathway X 2250 50","32753MO077",,"MON001","MOS001","MOF021","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770031-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1XB7","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","44"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770031","Anthem Silver Pathway X 2250 50","32753MO077",,"MON001","MOS001","MOF021","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770031-03","Limited Cost Sharing Plan Variation","68.12%","0.681784331798553","Yes","Yes","No","100%",,"$2,250","$500","$1,930","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","50%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XB6","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","45"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770031","Anthem Silver Pathway X 2250 50","32753MO077",,"MON001","MOS001","MOF021","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770031-04","73% AV Level Silver Plan","72.33%","0.722039878368378","Yes","Yes","No","100%",,"$2,200","$500","$1,955","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","50%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XB8","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","46"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770031","Anthem Silver Pathway X 2250 50","32753MO077",,"MON001","MOS001","MOF021","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770031-05","87% AV Level Silver Plan","86.78%","0.860557615756989","Yes","Yes","No","100%",,"$850","$250","$250","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","50%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XB9","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","47"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","2","32753","MO","Individual","No","86-0257201","32753MO0770031","Anthem Silver Pathway X 2250 50","32753MO077",,"MON001","MOS001","MOF021","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770031-06","94% AV Level Silver Plan","93.68%","0.930711328983307","Yes","Yes","No","100%",,"$150","$150","$300","$0","$150","$30","$137","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$13,300","$13300 per person","$26600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","50%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XBA","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","48"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","Individual","No","86-0257201","32753MO0770021","Anthem Silver Pathway X 1850 20","32753MO077",,"MON001","MOS001","MOF024","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770021-00","Standard Silver Off Exchange Plan","69.77%","0.725125372409821","Yes","Yes","No","100%",,"$1,850","$500","$852","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20%",,,,,"$3,700","$3700 per person","$7400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJY","http://editiondigital.net/view/IU65/2016/OFF_HIX_MO_KIT_2016","4"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780018","Anthem Silver Blue Preferred X 1500 30  6850 Plus SelRx","32753MO078",,"MON002","MOS002","MOF028","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780018-00","Standard Silver Off Exchange Plan","70.74%","0.729625284671783","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YZZ","http://sgplans.anthem.com/mo/brochure/","4"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","SHOP (Small Group)","Yes","86-0257201","32753MO0830004","Anthem Dental Family Enhanced","32753MO083",,"MON003","MOS009",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.37","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","32753MO0830004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214659.pdf",,"4"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","Individual","Yes","86-0257201","32753MO0860004","Anthem Dental Family Enhanced","32753MO086",,"MON003","MOS009",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.37","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","32753MO0860004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214659.pdf",,"4"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","Individual","Yes","86-0257201","32753MO0920004","Anthem Dental Family Enhanced","32753MO092",,"MON003","MOS009",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.37","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","32753MO0920004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214659.pdf",,"5"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","SHOP (Small Group)","Yes","86-0257201","32753MO0890004","Anthem Dental Family Enhanced","32753MO089",,"MON003","MOS009",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.37","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","32753MO0890004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/mo/f0/s0/t0/pw_e214659.pdf",,"5"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780018","Anthem Silver Blue Preferred X 1500 30  6850 Plus SelRx","32753MO078",,"MON002","MOS002","MOF028","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780018-01","Standard Silver On Exchange Plan","70.74%","0.729625284671783","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YZZ","http://sgplans.anthem.com/mo/brochure/","5"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","Individual","No","86-0257201","32753MO0770021","Anthem Silver Pathway X 1850 20","32753MO077",,"MON001","MOS001","MOF024","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770021-01","Standard Silver On Exchange Plan","69.77%","0.725125372409821","Yes","Yes","No","100%",,"$1,850","$500","$852","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20%",,,,,"$3,700","$3700 per person","$7400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJW","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","5"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","Individual","No","86-0257201","32753MO0770021","Anthem Silver Pathway X 1850 20","32753MO077",,"MON001","MOS001","MOF024","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770021-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GJX","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","6"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780019","Anthem Silver Blue Preferred X 1500 30  6850 Plus SelRx","32753MO078",,"MON002","MOS003","MOF028","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780019-00","Standard Silver Off Exchange Plan","70.74%","0.729625284671783","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YZZ","http://sgplans.anthem.com/mo/brochure/","6"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780019","Anthem Silver Blue Preferred X 1500 30  6850 Plus SelRx","32753MO078",,"MON002","MOS003","MOF028","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780019-01","Standard Silver On Exchange Plan","70.74%","0.729625284671783","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YZZ","http://sgplans.anthem.com/mo/brochure/","7"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","Individual","No","86-0257201","32753MO0770021","Anthem Silver Pathway X 1850 20","32753MO077",,"MON001","MOS001","MOF024","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770021-03","Limited Cost Sharing Plan Variation","69.77%","0.725125372409821","Yes","Yes","No","100%",,"$1,850","$500","$852","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20%",,,,,"$3,700","$3700 per person","$7400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJW","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","7"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","Individual","No","86-0257201","32753MO0770021","Anthem Silver Pathway X 1850 20","32753MO077",,"MON001","MOS001","MOF024","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770021-04","73% AV Level Silver Plan","73.55%","0.754293203353882","Yes","Yes","No","100%",,"$1,700","$500","$882","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","20%",,,,,"$3,700","$3700 per person","$7400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJZ","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","8"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780020","Anthem Silver Blue Preferred X 1500 30  6850 Plus SelRx","32753MO078",,"MON002","MOS004","MOF028","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780020-00","Standard Silver Off Exchange Plan","70.74%","0.729625284671783","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YZZ","http://sgplans.anthem.com/mo/brochure/","8"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780021","Anthem Silver Blue Preferred X 1500 30  6850 Plus SelRx","32753MO078",,"MON002","MOS005","MOF028","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780021-00","Standard Silver Off Exchange Plan","70.74%","0.729625284671783","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YZZ","http://sgplans.anthem.com/mo/brochure/","10"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780021","Anthem Silver Blue Preferred X 1500 30  6850 Plus SelRx","32753MO078",,"MON002","MOS005","MOF028","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780021-01","Standard Silver On Exchange Plan","70.74%","0.729625284671783","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YZZ","http://sgplans.anthem.com/mo/brochure/","11"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","3","34762","MO","Individual","No","43-1257251","34762MO0140010","Classic PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF003","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140010-03","Limited Cost Sharing Plan Variation",,"0.683961093425751","No","Yes","Yes","30%","70%","$1,100","$1,100","$0","$200","$0","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","$6,200","$6200 per person","$12400 per group","$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/classicpcbsilver4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","6"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","4","34762","MO","Individual","No","43-1257251","34762MO0440001","Basic Select Silver","34762MO044","7023011258","MON004","MOS002","MOF019","Existing","EPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","2","2016-01-01","2016-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0440001-03","Limited Cost Sharing Plan Variation",,"0.686996161937714","No","Yes","No","100%",,"$3,500","$0","$1,500","$200","$500","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/basicselectsilver4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","4","44240","MO","Individual","No","75-1296086","44240MO0090009","Coventry Bronze $25 Copay KCPPO","44240MO009",,"MON002","MOS002","MOF008","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0090009-03","Limited Cost Sharing Plan Variation","61.87%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68609","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","5","44240","MO","Individual","No","75-1296086","44240MO0160005","Coventry Bronze $25 Copay OAEPO","44240MO016",,"MON003","MOS003","MOF023","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0160005-00","Standard Bronze Off Exchange Plan","61.87%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68605","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","5","44240","MO","Individual","No","75-1296086","44240MO0160005","Coventry Bronze $25 Copay OAEPO","44240MO016",,"MON003","MOS003","MOF023","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0160005-01","Standard Bronze On Exchange Plan","61.87%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68572","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","5","44240","MO","Individual","No","75-1296086","44240MO0160005","Coventry Bronze $25 Copay OAEPO","44240MO016",,"MON003","MOS003","MOF023","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0160005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68574","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","5","44240","MO","Individual","No","75-1296086","44240MO0160005","Coventry Bronze $25 Copay OAEPO","44240MO016",,"MON003","MOS003","MOF023","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0160005-03","Limited Cost Sharing Plan Variation","61.87%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68573","http://www.coventryone.com/WMOon2016","7"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","Individual","No","86-0257201","32753MO0770022","Anthem Silver Pathway X 2500 10","32753MO077",,"MON001","MOS001","MOF023","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770022-01","Standard Silver On Exchange Plan","69.61%","0.728391945362091","Yes","Yes","No","100%",,"$2,500","$500","$361","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJJ","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","12"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780022","Anthem Silver Blue Preferred X 1500 30  6850 Plus SelRx","32753MO078",,"MON002","MOS006","MOF028","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780022-00","Standard Silver Off Exchange Plan","70.74%","0.729625284671783","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YZZ","http://sgplans.anthem.com/mo/brochure/","12"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780022","Anthem Silver Blue Preferred X 1500 30  6850 Plus SelRx","32753MO078",,"MON002","MOS006","MOF028","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780022-01","Standard Silver On Exchange Plan","70.74%","0.729625284671783","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YZZ","http://sgplans.anthem.com/mo/brochure/","13"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","Individual","No","86-0257201","32753MO0770022","Anthem Silver Pathway X 2500 10","32753MO077",,"MON001","MOS001","MOF023","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770022-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GJK","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","13"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","Individual","No","86-0257201","32753MO0770022","Anthem Silver Pathway X 2500 10","32753MO077",,"MON001","MOS001","MOF023","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770022-03","Limited Cost Sharing Plan Variation","69.61%","0.728391945362091","Yes","Yes","No","100%",,"$2,500","$500","$361","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJJ","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","14"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780023","Anthem Silver Blue Preferred X 1500 30  6850 Plus SelRx","32753MO078",,"MON002","MOS007","MOF028","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780023-00","Standard Silver Off Exchange Plan","70.74%","0.729625284671783","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YZZ","http://sgplans.anthem.com/mo/brochure/","14"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780023","Anthem Silver Blue Preferred X 1500 30  6850 Plus SelRx","32753MO078",,"MON002","MOS007","MOF028","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780023-01","Standard Silver On Exchange Plan","70.74%","0.729625284671783","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YZZ","http://sgplans.anthem.com/mo/brochure/","15"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","Individual","No","86-0257201","32753MO0770022","Anthem Silver Pathway X 2500 10","32753MO077",,"MON001","MOS001","MOF023","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770022-04","73% AV Level Silver Plan","72.41%","0.752345979213715","Yes","Yes","No","100%",,"$2,450","$500","$366","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJM","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","15"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","Individual","No","86-0257201","32753MO0770022","Anthem Silver Pathway X 2500 10","32753MO077",,"MON001","MOS001","MOF023","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770022-05","87% AV Level Silver Plan","87.36%","0.878776907920837","Yes","Yes","No","100%",,"$750","$250","$500","$0","$750","$50","$35","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJN","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","16"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780024","Anthem Silver Blue Preferred X 1500 30  6850 Plus SelRx","32753MO078",,"MON002","MOS008","MOF028","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780024-00","Standard Silver Off Exchange Plan","70.74%","0.729625284671783","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YZZ","http://sgplans.anthem.com/mo/brochure/","16"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780024","Anthem Silver Blue Preferred X 1500 30  6850 Plus SelRx","32753MO078",,"MON002","MOS008","MOF028","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Coverage Only","Yes","Follows OON Coverage - which is limited to Urgent and Emergency care only","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0780024-01","Standard Silver On Exchange Plan","70.74%","0.729625284671783","No","Yes","No","100%",,"$1,500","$0","$1,075","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1YZZ","http://sgplans.anthem.com/mo/brochure/","17"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","Individual","No","86-0257201","32753MO0770022","Anthem Silver Pathway X 2500 10","32753MO077",,"MON001","MOS001","MOF023","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770022-06","94% AV Level Silver Plan","94.35%","0.940642952919006","Yes","Yes","No","100%",,"$200","$150","$250","$0","$200","$20","$93","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GJP","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","17"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","Individual","No","86-0257201","32753MO0770025","Anthem Catastrophic Pathway X 6850 0","32753MO077",,"MON001","MOS001","MOF001","Existing","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770025-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,554","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GHW","http://editiondigital.net/view/IU65/2016/OFF_HIX_MO_KIT_2016","18"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","3","32753","MO","Individual","No","86-0257201","32753MO0770025","Anthem Catastrophic Pathway X 6850 0","32753MO077",,"MON001","MOS001","MOF001","Existing","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","https://www.anthem.com/MOSelectdrugtier4","32753MO0770025-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,554","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GHV","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","19"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","4","32753","MO","Individual","No","86-0257201","32753MO0770029","Anthem Silver Pathway X 2900 25","32753MO077",,"MON001","MOS001","MOF016","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0770029-00","Standard Silver Off Exchange Plan","68.01%","0.699773132801056","No","Yes","No","100%",,"$2,900","$500","$803","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","25%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","25%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XAW","http://editiondigital.net/view/IU65/2016/OFF_HIX_MO_KIT_2016","4"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","4","32753","MO","Individual","No","86-0257201","32753MO0770029","Anthem Silver Pathway X 2900 25","32753MO077",,"MON001","MOS001","MOF016","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0770029-01","Standard Silver On Exchange Plan","68.01%","0.699773132801056","No","Yes","No","100%",,"$2,900","$500","$803","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","25%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","25%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XAX","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","5"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","4","32753","MO","Individual","No","86-0257201","32753MO0770029","Anthem Silver Pathway X 2900 25","32753MO077",,"MON001","MOS001","MOF016","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0770029-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XAY","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","6"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","4","32753","MO","Individual","No","86-0257201","32753MO0770029","Anthem Silver Pathway X 2900 25","32753MO077",,"MON001","MOS001","MOF016","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0770029-03","Limited Cost Sharing Plan Variation","68.01%","0.699773132801056","No","Yes","No","100%",,"$2,900","$500","$803","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","25%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","25%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XAX","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","7"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","4","32753","MO","Individual","No","86-0257201","32753MO0770029","Anthem Silver Pathway X 2900 25","32753MO077",,"MON001","MOS001","MOF016","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0770029-04","73% AV Level Silver Plan","72.08%","0.735392272472382","No","Yes","No","100%",,"$2,100","$500","$1,003","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","25%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","25%",,,,,"$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XAZ","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","8"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","4","32753","MO","Individual","No","86-0257201","32753MO0770029","Anthem Silver Pathway X 2900 25","32753MO077",,"MON001","MOS001","MOF016","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0770029-05","87% AV Level Silver Plan","87.08%","0.850095987319946","No","Yes","No","100%",,"$750","$250","$500","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","25%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XB0","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","9"
"2016","MO","32753","HIOS","15","2016-01-22 04:00:42","4","32753","MO","Individual","No","86-0257201","32753MO0770029","Anthem Silver Pathway X 2900 25","32753MO077",,"MON001","MOS001","MOF016","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No",,"https://www.anthem.com/MOSelectdrugtier4","32753MO0770029-06","94% AV Level Silver Plan","93.92%","0.92415851354599","No","Yes","No","100%",,"$250","$150","$200","$0","$250","$40","$44","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25%",,,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","25%",,,,,"$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1XB1","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","10"
"2016","MO","32904","HIOS","3","2015-08-18 03:25:03","1","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0210001","PPO - Basic","32904MO021","7306849531","MON001","MOS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,"No","Allows Child-Only",,,,,"$18.28","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same as in service area","Yes",,"","32904MO0210001-00","Standard Low Off Exchange Plan","69.57%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","32904","HIOS","3","2015-08-18 03:25:03","2","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0220001","PPO - Preferred","32904MO022","7306849531","MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,"No","Allows Child-Only",,,,,"$25.13","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same as in service area","Yes",,"","32904MO0220001-00","Standard High Off Exchange Plan","86.04%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","SHOP (Small Group)","No","43-1257251","34762MO0220001","First 1500 PCB Gold","34762MO022","7023011258","MON001","MOS001","MOF026","Existing","PPO","Gold","No","Both","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes",,"http://www.bluekc.com/qhp/modruglist.html","34762MO0220001-00","Standard Gold Off Exchange Plan",,"0.813390254974365","Yes","Yes","No","100%",,"$1,500","$10","$800","$200","$300","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","15%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bluekc.com/qhp/2016/sg/mo/firstpcbgold1500.html","http://www.bluekc.com/qhp/2016/sgbrochure.html","4"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","Individual","No","43-1257251","34762MO0140004","First PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF018","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140004-01","Standard Silver On Exchange Plan",,"0.716360986232758","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$300","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","0%",,,,,"$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/firstpcbsilver.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","4"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","Individual","No","43-1257251","34762MO0140004","First PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF018","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/firstpcbsilver3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","5"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","SHOP (Small Group)","No","43-1257251","34762MO0220001","First 1500 PCB Gold","34762MO022","7023011258","MON001","MOS001","MOF026","Existing","PPO","Gold","No","Both","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes",,"http://www.bluekc.com/qhp/modruglist.html","34762MO0220001-01","Standard Gold On Exchange Plan",,"0.813390254974365","Yes","Yes","No","100%",,"$1,500","$10","$800","$200","$300","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","15%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bluekc.com/qhp/2016/sg/mo/firstpcbgold1500.html","http://www.bluekc.com/qhp/2016/sgbrochure.html","5"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","SHOP (Small Group)","No","43-1257251","34762MO0220002","First 2200 PCB Silver","34762MO022","7023011258","MON001","MOS001","MOF025","Existing","PPO","Silver","No","Both","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes",,"http://www.bluekc.com/qhp/modruglist.html","34762MO0220002-00","Standard Silver Off Exchange Plan",,"0.710895478725433","Yes","Yes","No","100%",,"$2,200","$10","$1,500","$200","$300","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","30%",,,,,"$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bluekc.com/qhp/2016/sg/mo/firstpcbsilver2000.html","http://www.bluekc.com/qhp/2016/sgbrochure.html","6"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","Individual","No","43-1257251","34762MO0140004","First PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF018","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140004-03","Limited Cost Sharing Plan Variation",,"0.716360986232758","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$300","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","0%",,,,,"$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/firstpcbsilver4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","6"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","Individual","No","43-1257251","34762MO0140004","First PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF018","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140004-04","73% AV Level Silver Plan",,"0.73830908536911","Yes","Yes","No","100%",,"$4,600","$0","$0","$200","$300","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group","0%",,,,,"$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/firstpcbsilver5.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","7"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","SHOP (Small Group)","No","43-1257251","34762MO0220002","First 2200 PCB Silver","34762MO022","7023011258","MON001","MOS001","MOF025","Existing","PPO","Silver","No","Both","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes",,"http://www.bluekc.com/qhp/modruglist.html","34762MO0220002-01","Standard Silver On Exchange Plan",,"0.710895478725433","Yes","Yes","No","100%",,"$2,200","$10","$1,500","$200","$300","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","30%",,,,,"$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bluekc.com/qhp/2016/sg/mo/firstpcbsilver2000.html","http://www.bluekc.com/qhp/2016/sgbrochure.html","7"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","Individual","No","43-1257251","34762MO0140004","First PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF018","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140004-05","87% AV Level Silver Plan",,"0.876435101032257","Yes","Yes","No","100%",,"$1,500","$0","$0","$200","$300","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","0%",,,,,"$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/firstpcbsilver6.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","8"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","Individual","No","43-1257251","34762MO0140004","First PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF018","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140004-06","94% AV Level Silver Plan",,"0.933677196502686","Yes","Yes","No","100%",,"$600","$0","$0","$200","$300","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$625","$625 per person","$1250 per group",,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$625","$625 per person","$1250 per group","0%",,,,,"$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/firstpcbsilver7.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","9"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","Individual","No","43-1257251","34762MO0140006","First PCB Bronze","34762MO014","7023011258","MON001","MOS001","MOF007","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140006-01","Standard Bronze On Exchange Plan",,"0.619477808475494","Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/firstpcbbronze.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","10"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","Individual","No","43-1257251","34762MO0140006","First PCB Bronze","34762MO014","7023011258","MON001","MOS001","MOF007","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/firstpcbbronze3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","11"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","Individual","No","43-1257251","34762MO0140006","First PCB Bronze","34762MO014","7023011258","MON001","MOS001","MOF007","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140006-03","Limited Cost Sharing Plan Variation",,"0.619477808475494","Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/firstpcbbronze4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","12"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","Individual","No","43-1257251","34762MO0150004","First Select Silver","34762MO015","7023011258","MON002","MOS002","MOF002","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150004-01","Standard Silver On Exchange Plan",,"0.714237093925476","Yes","Yes","Yes","46%","54%","$5,100","$0","$0","$200","$300","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","$5,100","$5100 per person","$10200 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","0%","$5,100","$5100 per person","$10200 per group","0%","$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/firstselectsilver.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","13"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","Individual","No","43-1257251","34762MO0150004","First Select Silver","34762MO015","7023011258","MON002","MOS002","MOF002","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","46%","54%","$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/firstselectsilver3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","14"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","Individual","No","43-1257251","34762MO0150004","First Select Silver","34762MO015","7023011258","MON002","MOS002","MOF002","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150004-04","73% AV Level Silver Plan",,"0.736093878746033","Yes","Yes","Yes","46%","54%","$4,600","$0","$0","$200","$300","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group","$4,600","$4600 per person","$9200 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group","0%","$4,600","$4600 per person","$9200 per group","0%","$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/firstselectsilver5.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","16"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","Individual","No","43-1257251","34762MO0150004","First Select Silver","34762MO015","7023011258","MON002","MOS002","MOF002","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150004-05","87% AV Level Silver Plan",,"0.874118983745575","Yes","Yes","Yes","46%","54%","$1,500","$0","$0","$200","$300","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","0%","$1,500","$1500 per person","$3000 per group","0%","$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/firstselectsilver6.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","17"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","Individual","No","43-1257251","34762MO0150004","First Select Silver","34762MO015","7023011258","MON002","MOS002","MOF002","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150004-06","94% AV Level Silver Plan",,"0.936206042766571","Yes","Yes","Yes","46%","54%","$600","$0","$0","$200","$200","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$625","$625 per person","$1250 per group","$625","$625 per person","$1250 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$625","$625 per person","$1250 per group","0%","$625","$625 per person","$1250 per group","0%","$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/firstselectsilver7.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","18"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","Individual","No","43-1257251","34762MO0150006","First Select Bronze","34762MO015","7023011258","MON003","MOS002","MOF017","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150006-01","Standard Bronze On Exchange Plan",,"0.619477808475494","Yes","Yes","Yes","46%","54%","$6,300","$0","$0","$200","$4,500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$6,800","$6800 per person","$13600 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%","$6,800","$6800 per person","$13600 per group","0%","$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/firstselectbronze.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","19"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","Individual","No","43-1257251","34762MO0150006","First Select Bronze","34762MO015","7023011258","MON003","MOS002","MOF017","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","46%","54%","$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/firstselectbronze3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","20"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","1","34762","MO","Individual","No","43-1257251","34762MO0150006","First Select Bronze","34762MO015","7023011258","MON003","MOS002","MOF017","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150006-03","Limited Cost Sharing Plan Variation",,"0.619477808475494","Yes","Yes","Yes","46%","54%","$6,300","$0","$0","$200","$4,500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$6,800","$6800 per person","$13600 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%","$6,800","$6800 per person","$13600 per group","0%","$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/firstselectbronze4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","21"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0140012","Saver PCB Gold","34762MO014","7023011258","MON001","MOS001","MOF005","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140012-01","Standard Gold On Exchange Plan",,"0.814089894294739","Yes","Yes","No","100%",,"$1,500","$0","$500","$200","$1,500","$400","$20","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10%",,,,,"$1,500","$3000 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverpcbgold2.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","4"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0140012","Saver PCB Gold","34762MO014","7023011258","MON001","MOS001","MOF005","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverpcbgold3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","5"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0140012","Saver PCB Gold","34762MO014","7023011258","MON001","MOS001","MOF005","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140012-03","Limited Cost Sharing Plan Variation",,"0.814089894294739","Yes","Yes","No","100%",,"$1,500","$0","$500","$200","$1,500","$400","$20","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10%",,,,,"$1,500","$3000 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverpcbgold4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","6"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0140014","Saver PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF005","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140014-01","Standard Silver On Exchange Plan",,"0.687540888786316","Yes","Yes","No","100%",,"$3,000","$20","$400","$200","$3,000","$300","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverpcbsilver2.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","7"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0140014","Saver PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF005","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverpcbsilver3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","8"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0140014","Saver PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF005","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140014-03","Limited Cost Sharing Plan Variation",,"0.687540888786316","Yes","Yes","No","100%",,"$3,000","$20","$400","$200","$3,000","$300","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverpcbsilver4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","9"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0140014","Saver PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF005","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140014-04","73% AV Level Silver Plan",,"0.739414811134338","Yes","Yes","No","100%",,"$2,300","$20","$500","$200","$2,300","$400","$20","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverpcbsilver5.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","10"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0140014","Saver PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF005","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140014-05","87% AV Level Silver Plan",,"0.878548622131348","Yes","Yes","No","100%",,"$800","$0","$400","$200","$800","$200","$50","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverpcbsilver6.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","11"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0140014","Saver PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF005","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140014-06","94% AV Level Silver Plan",,"0.944807767868042","Yes","Yes","No","100%",,"$200","$0","$200","$200","$200","$100","$60","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverpcbsilver7.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","12"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0140016","Saver PCB Bronze","34762MO014","7023011258","MON001","MOS001","MOF005","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140016-01","Standard Bronze On Exchange Plan",,"0.619207799434662","Yes","Yes","No","100%",,"$5,000","$20","$200","$200","$5,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverpcbbronze2.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","13"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0140016","Saver PCB Bronze","34762MO014","7023011258","MON001","MOS001","MOF005","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverpcbbronze3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","14"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0140016","Saver PCB Bronze","34762MO014","7023011258","MON001","MOS001","MOF005","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140016-03","Limited Cost Sharing Plan Variation",,"0.619207799434662","Yes","Yes","No","100%",,"$5,000","$20","$200","$200","$5,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverpcbbronze4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","15"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0150012","Saver Select Gold","34762MO015","7023011258","MON002","MOS002","MOF006","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150012-01","Standard Gold On Exchange Plan",,"0.813801169395447","Yes","Yes","Yes","46%","54%","$1,500","$0","$500","$200","$1,500","$400","$20","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","$2,000","$4000 per person","$4000 per group","$25,000","$50000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10%","$1,500","$3000 per person","$3000 per group","10%","$1,500","$3000 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverselectgold2.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","16"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0150012","Saver Select Gold","34762MO015","7023011258","MON002","MOS002","MOF006","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","46%","54%","$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverselectgold3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","17"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0150012","Saver Select Gold","34762MO015","7023011258","MON002","MOS002","MOF006","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150012-03","Limited Cost Sharing Plan Variation",,"0.813801169395447","Yes","Yes","Yes","46%","54%","$1,500","$0","$500","$200","$1,500","$400","$20","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","$2,000","$4000 per person","$4000 per group","$25,000","$50000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10%","$1,500","$3000 per person","$3000 per group","10%","$1,500","$3000 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverselectgold4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","18"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0150014","Saver Select Silver","34762MO015","7023011258","MON002","MOS002","MOF006","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150014-01","Standard Silver On Exchange Plan",,"0.687657058238983","Yes","Yes","Yes","46%","54%","$3,000","$20","$400","$200","$3,000","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%","$3,000","$3000 per person","$6000 per group","10%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverselectsilver2.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","19"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0150014","Saver Select Silver","34762MO015","7023011258","MON002","MOS002","MOF006","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","46%","54%","$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverselectsilver3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","20"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0150014","Saver Select Silver","34762MO015","7023011258","MON002","MOS002","MOF006","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150014-03","Limited Cost Sharing Plan Variation",,"0.687657058238983","Yes","Yes","Yes","46%","54%","$3,000","$20","$400","$200","$3,000","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%","$3,000","$3000 per person","$6000 per group","10%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverselectsilver4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","21"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0150014","Saver Select Silver","34762MO015","7023011258","MON002","MOS002","MOF006","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150014-04","73% AV Level Silver Plan",,"0.739540636539459","Yes","Yes","Yes","46%","54%","$2,300","$20","$500","$200","$2,300","$500","$20","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group","$3,300","$3300 per person","$6600 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","10%","$2,300","$2300 per person","$4600 per group","10%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverselectsilver5.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","22"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0150014","Saver Select Silver","34762MO015","7023011258","MON002","MOS002","MOF006","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150014-05","87% AV Level Silver Plan",,"0.87752377986908","Yes","Yes","Yes","46%","54%","$800","$0","$400","$200","$800","$200","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","$1,200","$1200 per person","$2400 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","10%","$850","$850 per person","$1700 per group","10%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverselectsilver6.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","23"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0150014","Saver Select Silver","34762MO015","7023011258","MON002","MOS002","MOF006","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150014-06","94% AV Level Silver Plan",,"0.944097757339478","Yes","Yes","Yes","46%","54%","$200","$0","$200","$200","$200","$90","$50","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%","$250","$250 per person","$500 per group","10%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverselectsilver7.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","24"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0150016","Saver Select Bronze","34762MO015","7023011258","MON002","MOS002","MOF006","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150016-01","Standard Bronze On Exchange Plan",,"0.619244337081909","Yes","Yes","Yes","46%","54%","$5,000","$20","$200","$200","$5,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverselectbronze2.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","25"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0150016","Saver Select Bronze","34762MO015","7023011258","MON002","MOS002","MOF006","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","46%","54%","$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverselectbronze3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","26"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","2","34762","MO","Individual","No","43-1257251","34762MO0150016","Saver Select Bronze","34762MO015","7023011258","MON002","MOS002","MOF006","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150016-03","Limited Cost Sharing Plan Variation",,"0.619244337081909","Yes","Yes","Yes","46%","54%","$5,000","$20","$200","$200","$5,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/mo/saverselectbronze4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","27"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","3","34762","MO","Individual","No","43-1257251","34762MO0140010","Classic PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF003","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140010-01","Standard Silver On Exchange Plan",,"0.683961093425751","No","Yes","Yes","30%","70%","$1,100","$1,100","$0","$200","$0","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","$6,200","$6200 per person","$12400 per group","$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/classicpcbsilver.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","4"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","3","34762","MO","Individual","No","43-1257251","34762MO0140010","Classic PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF003","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","30%","70%","$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/classicpcbsilver3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","5"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","3","34762","MO","Individual","No","43-1257251","34762MO0140010","Classic PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF003","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140010-04","73% AV Level Silver Plan",,"0.725703775882721","No","Yes","Yes","30%","70%","$1,100","$900","$0","$200","$0","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","10%","$3,000","$3000 per person","$6000 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/classicpcbsilver5.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","7"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","3","34762","MO","Individual","No","43-1257251","34762MO0140010","Classic PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF003","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140010-05","87% AV Level Silver Plan",,"0.870948791503906","No","Yes","Yes","30%","70%","$1,000","$600","$10","$200","$0","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%","$1,000","$1000 per person","$2000 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/classicpcbsilver6.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","8"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","3","34762","MO","Individual","No","43-1257251","34762MO0140010","Classic PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF003","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0140010-06","94% AV Level Silver Plan",,"0.942816138267517","No","Yes","Yes","30%","70%","$200","$200","$80","$200","$0","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%","$250","$250 per person","$500 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/classicpcbsilver7.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","9"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","3","34762","MO","Individual","No","43-1257251","34762MO0150008","Classic Select Gold","34762MO015","7023011258","MON002","MOS002","MOF004","Existing","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150008-01","Standard Gold On Exchange Plan",,"0.792762160301209","No","Yes","Yes","46%","54%","$1,100","$900","$0","$200","$0","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%","$1,500","$1500 per person","$3000 per group","10%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/classicselectgold.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","10"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","3","34762","MO","Individual","No","43-1257251","34762MO0150008","Classic Select Gold","34762MO015","7023011258","MON002","MOS002","MOF004","Existing","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","46%","54%","$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/classicselectgold4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","11"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","3","34762","MO","Individual","No","43-1257251","34762MO0150008","Classic Select Gold","34762MO015","7023011258","MON002","MOS002","MOF004","Existing","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150008-03","Limited Cost Sharing Plan Variation",,"0.792762160301209","No","Yes","Yes","46%","54%","$1,100","$900","$0","$200","$0","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%","$1,500","$1500 per person","$3000 per group","10%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/classicselectgold5.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","12"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","3","34762","MO","Individual","No","43-1257251","34762MO0150010","Classic Select Silver","34762MO015","7023011258","MON002","MOS002","MOF004","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150010-01","Standard Silver On Exchange Plan",,"0.6811683177948","No","Yes","Yes","46%","54%","$1,100","$1,100","$0","$200","$0","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","$6,200","$6200 per person","$12400 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/classicselectsilver.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","13"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","3","34762","MO","Individual","No","43-1257251","34762MO0150010","Classic Select Silver","34762MO015","7023011258","MON002","MOS002","MOF004","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","46%","54%","$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/classicselectsilver3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","14"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","3","34762","MO","Individual","No","43-1257251","34762MO0150010","Classic Select Silver","34762MO015","7023011258","MON002","MOS002","MOF004","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150010-03","Limited Cost Sharing Plan Variation",,"0.6811683177948","No","Yes","Yes","46%","54%","$1,100","$1,100","$0","$200","$0","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","$6,200","$6200 per person","$12400 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/classicselectsilver4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","15"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","3","34762","MO","Individual","No","43-1257251","34762MO0150010","Classic Select Silver","34762MO015","7023011258","MON002","MOS002","MOF004","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150010-04","73% AV Level Silver Plan",,"0.72240686416626","No","Yes","Yes","46%","54%","$1,100","$900","$0","$200","$0","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","10%","$3,000","$3000 per person","$6000 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/classicselectsilver5.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","16"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","3","34762","MO","Individual","No","43-1257251","34762MO0150010","Classic Select Silver","34762MO015","7023011258","MON002","MOS002","MOF004","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150010-05","87% AV Level Silver Plan",,"0.86497575044632","No","Yes","Yes","46%","54%","$1,000","$700","$10","$200","$0","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%","$1,000","$1000 per person","$2000 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/classicselectsilver6.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","17"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","3","34762","MO","Individual","No","43-1257251","34762MO0150010","Classic Select Silver","34762MO015","7023011258","MON002","MOS002","MOF004","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0150010-06","94% AV Level Silver Plan",,"0.939846634864807","No","Yes","Yes","46%","54%","$200","$200","$80","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%","$250","$250 per person","$500 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/classicselectsilver7.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","18"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","4","34762","MO","Individual","No","43-1257251","34762MO0440001","Basic Select Silver","34762MO044","7023011258","MON004","MOS002","MOF019","Existing","EPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","2","2016-01-01","2016-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0440001-01","Standard Silver On Exchange Plan",,"0.686996161937714","No","Yes","No","100%",,"$3,500","$0","$1,500","$200","$500","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/basicselectsilver.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","4"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","4","34762","MO","Individual","No","43-1257251","34762MO0440001","Basic Select Silver","34762MO044","7023011258","MON004","MOS002","MOF019","Existing","EPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","2","2016-01-01","2016-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0440001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/basicselectsilver3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","5"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","4","34762","MO","Individual","No","43-1257251","34762MO0440001","Basic Select Silver","34762MO044","7023011258","MON004","MOS002","MOF019","Existing","EPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","2","2016-01-01","2016-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0440001-04","73% AV Level Silver Plan",,"0.725417912006378","No","Yes","No","100%",,"$2,600","$0","$1,400","$200","$500","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/basicselectsilver5.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","7"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","4","34762","MO","Individual","No","43-1257251","34762MO0440001","Basic Select Silver","34762MO044","7023011258","MON004","MOS002","MOF019","Existing","EPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","2","2016-01-01","2016-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0440001-05","87% AV Level Silver Plan",,"0.868391990661621","No","Yes","No","100%",,"$600","$0","$800","$200","$500","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/basicselectsilver6.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","8"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","4","34762","MO","Individual","No","43-1257251","34762MO0440001","Basic Select Silver","34762MO044","7023011258","MON004","MOS002","MOF019","Existing","EPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","2","2016-01-01","2016-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0440001-06","94% AV Level Silver Plan",,"0.931180119514465","No","Yes","No","100%",,"$300","$0","$200","$200","$300","$200","$50","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/basicselectsilver7.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","9"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","4","34762","MO","Individual","No","43-1257251","34762MO0440002","Basic Select Bronze","34762MO044","7023011258","MON004","MOS002","MOF020","Existing","EPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","2","2016-01-01","2016-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0440002-01","Standard Bronze On Exchange Plan",,"0.613014280796051","No","Yes","No","100%",,"$6,000","$0","$300","$200","$500","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/basicselectbronze.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","10"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","4","34762","MO","Individual","No","43-1257251","34762MO0440002","Basic Select Bronze","34762MO044","7023011258","MON004","MOS002","MOF020","Existing","EPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","2","2016-01-01","2016-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0440002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/basicselectbronze3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","11"
"2016","MO","34762","HIOS","3","2015-08-22 15:09:32","4","34762","MO","Individual","No","43-1257251","34762MO0440002","Basic Select Bronze","34762MO044","7023011258","MON004","MOS002","MOF020","Existing","EPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","2","2016-01-01","2016-12-31","No",,"No","Services are not provided out-of-network, except in an Emergency or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/modruglist.html","34762MO0440002-03","Limited Cost Sharing Plan Variation",,"0.613014280796051","No","Yes","No","100%",,"$6,000","$0","$300","$200","$500","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/mo/basicselectbronze4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","12"
"2016","MO","35853","HIOS","2","2015-07-11 04:19:24","1","35853","MO","SHOP (Small Group)","Yes","47-0397286","35853MO0030001","Renaissance Group Dental PPO, EHB Certified","35853MO003",,"MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.24","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","35853MO0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","35853","HIOS","2","2015-07-11 04:19:24","1","35853","MO","Individual","Yes","47-0397286","35853MO0010001","Delta Dental Individual PPO, EHB Certified","35853MO001",,"MON002","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.52","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","35853MO0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","35853","HIOS","2","2015-07-11 04:19:24","1","35853","MO","Individual","Yes","47-0397286","35853MO0010002","Delta Dental Individual PPO, EHB Certified","35853MO001",,"MON002","MOS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.25","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","35853MO0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MO","35853","HIOS","2","2015-07-11 04:19:24","1","35853","MO","SHOP (Small Group)","Yes","47-0397286","35853MO0030002","Renaissance Group Dental PPO, EHB Certified","35853MO003",,"MON001","MOS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.02","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","35853MO0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MO","35853","HIOS","2","2015-07-11 04:19:24","1","35853","MO","Individual","Yes","47-0397286","35853MO0020001","Renaissance Individual Dental PPO, EHB Certified","35853MO002",,"MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.79","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","35853MO0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","MO","35853","HIOS","2","2015-07-11 04:19:24","1","35853","MO","Individual","Yes","47-0397286","35853MO0020002","Renaissance Individual Dental PPO, EHB Certified","35853MO002",,"MON001","MOS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.98","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","35853MO0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","MO","40807","HIOS","3","2015-07-11 04:19:24","1","40807","MO","Individual","Yes","43-0908349","40807MO0380001","Delta Dental Individual and Family - Standard","40807MO038","7497758624","MON002","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,"No","Allows Adult and Child-Only",,,,,"$29.62","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes",,"","40807MO0380001-00","Standard Low Off Exchange Plan","70.97%",,,,"Yes","73%","27%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,"$100","per person not applicable","per group not applicable",,"$100","per person not applicable","per group not applicable","$100","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","40807","HIOS","3","2015-07-11 04:19:24","1","40807","MO","SHOP (Small Group)","Yes","43-0908349","40807MO0320001","Delta Dental - PPO Choice","40807MO032","7497758624","MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,"No","Allows Adult and Child-Only",,,,,"$20.89","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes",,"","40807MO0320001-00","Standard Low Off Exchange Plan","70.36%",,,,"Yes","48%","52%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,"$100","per person not applicable","per group not applicable",,"$100","per person not applicable","per group not applicable","$100","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","40807","HIOS","3","2015-07-11 04:19:24","1","40807","MO","SHOP (Small Group)","Yes","43-0908349","40807MO0330001","Delta Dental - PPO Choice Plus","40807MO033","7497758624","MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,"No","Allows Adult and Child-Only",,,,,"$25.35","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes",,"","40807MO0330001-00","Standard High Off Exchange Plan","86.01%",,,,"Yes","51%","49%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,"$100","per person not applicable","per group not applicable",,"$100","per person not applicable","per group not applicable","$100","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MO","40807","HIOS","3","2015-07-11 04:19:24","1","40807","MO","Individual","Yes","43-0908349","40807MO0390001","Delta Dental Individual and Family - Standard Plus","40807MO039","7497758624","MON002","MOS001",,"New","PPO","High",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,"No","Allows Adult and Child-Only",,,,,"$35.18","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes",,"","40807MO0390001-00","Standard High Off Exchange Plan","85.82%",,,,"Yes","77%","23%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","per group not applicable",,"$0","per person not applicable","per group not applicable",,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MO","40807","HIOS","3","2015-07-11 04:19:24","2","40807","MO","Individual","Yes","43-0908349","40807MO0360001","Delta Dental Individual and Family - FFM Basic","40807MO036","7497758624","MON002","MOS001",,"New","PPO","Low",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,"No","Allows Adult and Child-Only",,,,,"$31.43","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","https://Individual.deltadentalmo.com/marketplace/FFMBasic-2016","","40807MO0360001-01","Standard Low On Exchange Plan","70.73%",,,,"Yes","69%","31%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,"$75","per person not applicable","per group not applicable",,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://Individual.deltadentalmo.com/benefits/FFMBasic-2016","https://Individual.deltadentalmo.com/brochure/FFMBasic-2016","4"
"2016","MO","40807","HIOS","3","2015-07-11 04:19:24","2","40807","MO","SHOP (Small Group)","Yes","43-0908349","40807MO0340001","Delta Dental - FFM Exclusive","40807MO034","7497758624","MON002","MOS001",,"New","EPO","Low",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,"No","Allows Adult and Child-Only",,,,,"$18.80","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","http://www.deltadentalmo.com/FFMExclusive/MarketPlace-2016","","40807MO0340001-01","Standard Low On Exchange Plan","70.48%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmo.com/FFMExclusive/Benefits-2016","http://www.deltadentalmo.com/FFMExclusive/Brochure-2016","4"
"2016","MO","40807","HIOS","3","2015-07-11 04:19:24","3","40807","MO","SHOP (Small Group)","Yes","43-0908349","40807MO0350001","Delta Dental - FFM PPO","40807MO035","7497758624","MON002","MOS001",,"New","PPO","High",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,"No","Allows Adult and Child-Only",,,,,"$25.27","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","http://www.deltadentalmo.com/FFMPremier/MarketPlace-2016","","40807MO0350001-01","Standard High On Exchange Plan","83.49%",,,,"Yes","60%","40%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,"$25","per person not applicable","per group not applicable",,"$25","per person not applicable","per group not applicable","$25","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmo.com/FFMPremier/Benefits-2016","http://www.deltadentalmo.com/FFMPremier/Brochure-2016","4"
"2016","MO","40807","HIOS","3","2015-07-11 04:19:24","3","40807","MO","Individual","Yes","43-0908349","40807MO0370001","Delta Dental Individual and Family - FFM Preferred","40807MO037","7497758624","MON002","MOS001",,"New","PPO","Low",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,"No","Allows Adult and Child-Only",,,,,"$31.43","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","https://Individual.deltadentalmo.com/marketplace/FFMPreferred-2016","","40807MO0370001-01","Standard Low On Exchange Plan","70.73%",,,,"Yes","69%","31%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,"$75","per person not applicable","per group not applicable",,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://Individual.deltadentalmo.com/benefits/FFMPreferred-2016","https://Individual.deltadentalmo.com/brochure/FFMPreferred-2016","4"
"2016","MO","40807","HIOS","3","2015-07-11 04:19:24","4","40807","MO","Individual","Yes","43-0908349","40807MO0250001","Delta Dental Individual and Family - FFM Choice","40807MO025","7497758624","MON002","MOS001",,"Existing","PPO","High",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,"No","Allows Adult and Child-Only",,,,,"$41.09","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","https://Individual.deltadentalmo.com/marketplace/FFMChoice-2016","","40807MO0250001-01","Standard High On Exchange Plan","83.02%",,,,"Yes","73%","27%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,"$75","per person not applicable","per group not applicable",,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://Individual.deltadentalmo.com/benefits/FFMChoice-2016","https://Individual.deltadentalmo.com/brochure/FFMChoice-2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","1","44240","MO","Individual","No","75-1296086","44240MO0090003","Coventry Bronze $25 Copay","44240MO009",,"MON001","MOS001","MOF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0090003-00","Standard Bronze Off Exchange Plan","61.87%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68593","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","1","44240","MO","Individual","No","75-1296086","44240MO0090003","Coventry Bronze $25 Copay","44240MO009",,"MON001","MOS001","MOF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0090003-01","Standard Bronze On Exchange Plan","61.87%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68515","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","1","44240","MO","Individual","No","75-1296086","44240MO0090003","Coventry Bronze $25 Copay","44240MO009",,"MON001","MOS001","MOF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0090003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68517","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","1","44240","MO","Individual","No","75-1296086","44240MO0090003","Coventry Bronze $25 Copay","44240MO009",,"MON001","MOS001","MOF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0090003-03","Limited Cost Sharing Plan Variation","61.87%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68516","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","2","44240","MO","Individual","No","75-1296086","44240MO0160011","Coventry Bronze $25 Copay Joplin Preferred","44240MO016",,"MON005","MOS005","MOF029","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0160011-00","Standard Bronze Off Exchange Plan","61.87%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68605","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","2","44240","MO","Individual","No","75-1296086","44240MO0160011","Coventry Bronze $25 Copay Joplin Preferred","44240MO016",,"MON005","MOS005","MOF029","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0160011-01","Standard Bronze On Exchange Plan","61.87%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68572","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","2","44240","MO","Individual","No","75-1296086","44240MO0160011","Coventry Bronze $25 Copay Joplin Preferred","44240MO016",,"MON005","MOS005","MOF029","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0160011-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68574","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","2","44240","MO","Individual","No","75-1296086","44240MO0160011","Coventry Bronze $25 Copay Joplin Preferred","44240MO016",,"MON005","MOS005","MOF029","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0160011-03","Limited Cost Sharing Plan Variation","61.87%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68573","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","4","44240","MO","Individual","No","75-1296086","44240MO0090009","Coventry Bronze $25 Copay KCPPO","44240MO009",,"MON002","MOS002","MOF008","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0090009-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68610","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","8","44240","MO","Individual","No","75-1296086","44240MO0090004","Coventry Bronze Deductible Only HSA Eligible","44240MO009",,"MON001","MOS001","MOF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0090004-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/MO68594","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","8","44240","MO","Individual","No","75-1296086","44240MO0090004","Coventry Bronze Deductible Only HSA Eligible","44240MO009",,"MON001","MOS001","MOF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0090004-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/MO68518","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","8","44240","MO","Individual","No","75-1296086","44240MO0090004","Coventry Bronze Deductible Only HSA Eligible","44240MO009",,"MON001","MOS001","MOF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0090004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68520","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","8","44240","MO","Individual","No","75-1296086","44240MO0090004","Coventry Bronze Deductible Only HSA Eligible","44240MO009",,"MON001","MOS001","MOF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0090004-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/MO68519","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","9","44240","MO","Individual","No","75-1296086","44240MO0090010","Coventry Bronze Deductible Only HSA Eligible KCPPO","44240MO009",,"MON002","MOS002","MOF009","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0090010-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/MO68598","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","9","44240","MO","Individual","No","75-1296086","44240MO0090010","Coventry Bronze Deductible Only HSA Eligible KCPPO","44240MO009",,"MON002","MOS002","MOF009","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0090010-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/MO68536","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","9","44240","MO","Individual","No","75-1296086","44240MO0090010","Coventry Bronze Deductible Only HSA Eligible KCPPO","44240MO009",,"MON002","MOS002","MOF009","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0090010-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68538","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","9","44240","MO","Individual","No","75-1296086","44240MO0090010","Coventry Bronze Deductible Only HSA Eligible KCPPO","44240MO009",,"MON002","MOS002","MOF009","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0090010-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/MO68537","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","10","44240","MO","Individual","No","75-1296086","44240MO0160006","Coventry Bronze Deductible Only HSA Eligible OAEPO","44240MO016",,"MON003","MOS003","MOF024","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0160006-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/MO68606","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","10","44240","MO","Individual","No","75-1296086","44240MO0160006","Coventry Bronze Deductible Only HSA Eligible OAEPO","44240MO016",,"MON003","MOS003","MOF024","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0160006-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/MO68575","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","10","44240","MO","Individual","No","75-1296086","44240MO0160006","Coventry Bronze Deductible Only HSA Eligible OAEPO","44240MO016",,"MON003","MOS003","MOF024","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0160006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68577","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","10","44240","MO","Individual","No","75-1296086","44240MO0160006","Coventry Bronze Deductible Only HSA Eligible OAEPO","44240MO016",,"MON003","MOS003","MOF024","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0160006-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/MO68576","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","13","44240","MO","Individual","No","75-1296086","44240MO0160012","Coventry Bronze DeductibleOnly HSAEligible Joplin Preferred","44240MO016",,"MON005","MOS005","MOF030","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0160012-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/MO68606","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","13","44240","MO","Individual","No","75-1296086","44240MO0160012","Coventry Bronze DeductibleOnly HSAEligible Joplin Preferred","44240MO016",,"MON005","MOS005","MOF030","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0160012-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/MO68575","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","13","44240","MO","Individual","No","75-1296086","44240MO0160012","Coventry Bronze DeductibleOnly HSAEligible Joplin Preferred","44240MO016",,"MON005","MOS005","MOF030","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0160012-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68577","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","13","44240","MO","Individual","No","75-1296086","44240MO0160012","Coventry Bronze DeductibleOnly HSAEligible Joplin Preferred","44240MO016",,"MON005","MOS005","MOF030","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44240MO0160012-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/MO68576","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","15","44240","MO","Individual","No","75-1296086","44240MO0090002","Coventry Silver $10 Copay","44240MO009",,"MON001","MOS001","MOF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090002-00","Standard Silver Off Exchange Plan","68.10%",,"No","Yes","No","100%",,"$3,800","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","30%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68591","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","15","44240","MO","Individual","No","75-1296086","44240MO0090002","Coventry Silver $10 Copay","44240MO009",,"MON001","MOS001","MOF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090002-01","Standard Silver On Exchange Plan","68.10%",,"No","Yes","No","100%",,"$3,800","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","30%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68503","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","15","44240","MO","Individual","No","75-1296086","44240MO0090002","Coventry Silver $10 Copay","44240MO009",,"MON001","MOS001","MOF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68505","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","15","44240","MO","Individual","No","75-1296086","44240MO0090002","Coventry Silver $10 Copay","44240MO009",,"MON001","MOS001","MOF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090002-03","Limited Cost Sharing Plan Variation","68.10%",,"No","Yes","No","100%",,"$3,800","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","30%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68504","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","15","44240","MO","Individual","No","75-1296086","44240MO0090002","Coventry Silver $10 Copay","44240MO009",,"MON001","MOS001","MOF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090002-04","73% AV Level Silver Plan","72.04%",,"No","Yes","No","100%",,"$3,200","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","30%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68508","http://www.coventryone.com/WMOon2016","8"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","15","44240","MO","Individual","No","75-1296086","44240MO0090002","Coventry Silver $10 Copay","44240MO009",,"MON001","MOS001","MOF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090002-05","87% AV Level Silver Plan","86.05%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68507","http://www.coventryone.com/WMOon2016","9"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","15","44240","MO","Individual","No","75-1296086","44240MO0090002","Coventry Silver $10 Copay","44240MO009",,"MON001","MOS001","MOF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090002-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68506","http://www.coventryone.com/WMOon2016","10"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","16","44240","MO","Individual","No","75-1296086","44240MO0090012","Coventry Silver $10 Copay 2750 KCPPO","44240MO009",,"MON002","MOS002","MOF010","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090012-00","Standard Silver Off Exchange Plan","68.15%",,"Yes","Yes","Yes","90%","10%","$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%","$6,250","$6250 per person","$12500 per group","40%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68597","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","16","44240","MO","Individual","No","75-1296086","44240MO0090012","Coventry Silver $10 Copay 2750 KCPPO","44240MO009",,"MON002","MOS002","MOF010","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090012-01","Standard Silver On Exchange Plan","68.15%",,"Yes","Yes","Yes","90%","10%","$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%","$6,250","$6250 per person","$12500 per group","40%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68530","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","16","44240","MO","Individual","No","75-1296086","44240MO0090012","Coventry Silver $10 Copay 2750 KCPPO","44240MO009",,"MON002","MOS002","MOF010","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090012-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","90%","10%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68532","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","16","44240","MO","Individual","No","75-1296086","44240MO0090012","Coventry Silver $10 Copay 2750 KCPPO","44240MO009",,"MON002","MOS002","MOF010","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090012-03","Limited Cost Sharing Plan Variation","68.15%",,"Yes","Yes","Yes","90%","10%","$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%","$6,250","$6250 per person","$12500 per group","40%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68531","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","16","44240","MO","Individual","No","75-1296086","44240MO0090012","Coventry Silver $10 Copay 2750 KCPPO","44240MO009",,"MON002","MOS002","MOF010","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090012-04","73% AV Level Silver Plan","72.19%",,"Yes","Yes","Yes","90%","10%","$2,800","$10","$1,000","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,450","$5450 per person","$10900 per group","$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%","$4,500","$4500 per person","$9000 per group","40%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68535","http://www.coventryone.com/WMOon2016","8"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","16","44240","MO","Individual","No","75-1296086","44240MO0090012","Coventry Silver $10 Copay 2750 KCPPO","44240MO009",,"MON002","MOS002","MOF010","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090012-05","87% AV Level Silver Plan","86.03%",,"Yes","Yes","Yes","90%","10%","$0","$10","$2,100","$200","$0","$200","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","$2,250","$2250 per person","$4500 per group","$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%","$1,500","$1500 per person","$3000 per group","40%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68534","http://www.coventryone.com/WMOon2016","9"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","16","44240","MO","Individual","No","75-1296086","44240MO0090012","Coventry Silver $10 Copay 2750 KCPPO","44240MO009",,"MON002","MOS002","MOF010","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090012-06","94% AV Level Silver Plan","93.03%",,"Yes","Yes","Yes","90%","10%","$0","$10","$400","$200","$0","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,250","$2250 per person","$4500 per group","$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","20%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68533","http://www.coventryone.com/WMOon2016","10"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","17","44240","MO","Individual","No","75-1296086","44240MO0090006","Coventry Silver $10 Copay 2900","44240MO009",,"MON001","MOS001","MOF005","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090006-00","Standard Silver Off Exchange Plan","68.14%",,"Yes","Yes","No","100%",,"$2,900","$10","$900","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,125","$13125 per person","$26250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","40%",,,,,"$8,750","$8750 per person","$17500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68592","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","17","44240","MO","Individual","No","75-1296086","44240MO0090006","Coventry Silver $10 Copay 2900","44240MO009",,"MON001","MOS001","MOF005","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090006-01","Standard Silver On Exchange Plan","68.14%",,"Yes","Yes","No","100%",,"$2,900","$10","$900","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,125","$13125 per person","$26250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","40%",,,,,"$8,750","$8750 per person","$17500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68509","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","17","44240","MO","Individual","No","75-1296086","44240MO0090006","Coventry Silver $10 Copay 2900","44240MO009",,"MON001","MOS001","MOF005","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68511","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","17","44240","MO","Individual","No","75-1296086","44240MO0090006","Coventry Silver $10 Copay 2900","44240MO009",,"MON001","MOS001","MOF005","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090006-03","Limited Cost Sharing Plan Variation","68.14%",,"Yes","Yes","No","100%",,"$2,900","$10","$900","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,125","$13125 per person","$26250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","40%",,,,,"$8,750","$8750 per person","$17500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68510","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","17","44240","MO","Individual","No","75-1296086","44240MO0090006","Coventry Silver $10 Copay 2900","44240MO009",,"MON001","MOS001","MOF005","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090006-04","73% AV Level Silver Plan","72.14%",,"Yes","Yes","No","100%",,"$2,700","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$13,125","$13125 per person","$26250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","30%",,,,,"$8,750","$8750 per person","$17500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68514","http://www.coventryone.com/WMOon2016","8"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","17","44240","MO","Individual","No","75-1296086","44240MO0090006","Coventry Silver $10 Copay 2900","44240MO009",,"MON001","MOS001","MOF005","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090006-05","87% AV Level Silver Plan","86.01%",,"Yes","Yes","No","100%",,"$1,100","$10","$400","$200","$1,100","$100","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$13,125","$13125 per person","$26250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","10%",,,,,"$8,750","$8750 per person","$17500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68513","http://www.coventryone.com/WMOon2016","9"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","17","44240","MO","Individual","No","75-1296086","44240MO0090006","Coventry Silver $10 Copay 2900","44240MO009",,"MON001","MOS001","MOF005","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090006-06","94% AV Level Silver Plan","93.05%",,"Yes","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$13,125","$13125 per person","$26250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"$8,750","$8750 per person","$17500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68512","http://www.coventryone.com/WMOon2016","10"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","18","44240","MO","Individual","No","75-1296086","44240MO0160009","Coventry Silver $10 Copay 2900 Joplin Preferred","44240MO016",,"MON005","MOS005","MOF027","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160009-00","Standard Silver Off Exchange Plan","68.14%",,"Yes","Yes","No","100%",,"$2,900","$10","$900","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68603","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","18","44240","MO","Individual","No","75-1296086","44240MO0160009","Coventry Silver $10 Copay 2900 Joplin Preferred","44240MO016",,"MON005","MOS005","MOF027","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160009-01","Standard Silver On Exchange Plan","68.14%",,"Yes","Yes","No","100%",,"$2,900","$10","$900","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68560","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","18","44240","MO","Individual","No","75-1296086","44240MO0160009","Coventry Silver $10 Copay 2900 Joplin Preferred","44240MO016",,"MON005","MOS005","MOF027","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160009-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68562","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","18","44240","MO","Individual","No","75-1296086","44240MO0160009","Coventry Silver $10 Copay 2900 Joplin Preferred","44240MO016",,"MON005","MOS005","MOF027","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160009-03","Limited Cost Sharing Plan Variation","68.14%",,"Yes","Yes","No","100%",,"$2,900","$10","$900","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68561","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","18","44240","MO","Individual","No","75-1296086","44240MO0160009","Coventry Silver $10 Copay 2900 Joplin Preferred","44240MO016",,"MON005","MOS005","MOF027","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160009-04","73% AV Level Silver Plan","72.14%",,"Yes","Yes","No","100%",,"$2,700","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68565","http://www.coventryone.com/WMOon2016","8"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","18","44240","MO","Individual","No","75-1296086","44240MO0160009","Coventry Silver $10 Copay 2900 Joplin Preferred","44240MO016",,"MON005","MOS005","MOF027","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160009-05","87% AV Level Silver Plan","86.01%",,"Yes","Yes","No","100%",,"$1,100","$10","$400","$200","$1,100","$100","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68564","http://www.coventryone.com/WMOon2016","9"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","18","44240","MO","Individual","No","75-1296086","44240MO0160009","Coventry Silver $10 Copay 2900 Joplin Preferred","44240MO016",,"MON005","MOS005","MOF027","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160009-06","94% AV Level Silver Plan","93.05%",,"Yes","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68563","http://www.coventryone.com/WMOon2016","10"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","20","44240","MO","Individual","No","75-1296086","44240MO0160003","Coventry Silver $10 Copay 2900 OAEPO","44240MO016",,"MON003","MOS003","MOF021","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160003-00","Standard Silver Off Exchange Plan","68.14%",,"Yes","Yes","No","100%",,"$2,900","$10","$900","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68603","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","20","44240","MO","Individual","No","75-1296086","44240MO0160003","Coventry Silver $10 Copay 2900 OAEPO","44240MO016",,"MON003","MOS003","MOF021","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160003-01","Standard Silver On Exchange Plan","68.14%",,"Yes","Yes","No","100%",,"$2,900","$10","$900","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68560","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","20","44240","MO","Individual","No","75-1296086","44240MO0160003","Coventry Silver $10 Copay 2900 OAEPO","44240MO016",,"MON003","MOS003","MOF021","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68562","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","20","44240","MO","Individual","No","75-1296086","44240MO0160003","Coventry Silver $10 Copay 2900 OAEPO","44240MO016",,"MON003","MOS003","MOF021","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160003-03","Limited Cost Sharing Plan Variation","68.14%",,"Yes","Yes","No","100%",,"$2,900","$10","$900","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68561","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","20","44240","MO","Individual","No","75-1296086","44240MO0160003","Coventry Silver $10 Copay 2900 OAEPO","44240MO016",,"MON003","MOS003","MOF021","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160003-04","73% AV Level Silver Plan","72.14%",,"Yes","Yes","No","100%",,"$2,700","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68565","http://www.coventryone.com/WMOon2016","8"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","20","44240","MO","Individual","No","75-1296086","44240MO0160003","Coventry Silver $10 Copay 2900 OAEPO","44240MO016",,"MON003","MOS003","MOF021","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160003-05","87% AV Level Silver Plan","86.01%",,"Yes","Yes","No","100%",,"$1,100","$10","$400","$200","$1,100","$100","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68564","http://www.coventryone.com/WMOon2016","9"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","20","44240","MO","Individual","No","75-1296086","44240MO0160003","Coventry Silver $10 Copay 2900 OAEPO","44240MO016",,"MON003","MOS003","MOF021","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160003-06","94% AV Level Silver Plan","93.05%",,"Yes","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68563","http://www.coventryone.com/WMOon2016","10"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","23","44240","MO","Individual","No","75-1296086","44240MO0160015","Coventry Silver $10 Copay 2900 Springfield Preferred","44240MO016",,"MON004","MOS004","MOF033","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160015-00","Standard Silver Off Exchange Plan","68.14%",,"Yes","Yes","No","100%",,"$2,900","$10","$900","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68603","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","23","44240","MO","Individual","No","75-1296086","44240MO0160015","Coventry Silver $10 Copay 2900 Springfield Preferred","44240MO016",,"MON004","MOS004","MOF033","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160015-01","Standard Silver On Exchange Plan","68.14%",,"Yes","Yes","No","100%",,"$2,900","$10","$900","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68560","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","23","44240","MO","Individual","No","75-1296086","44240MO0160015","Coventry Silver $10 Copay 2900 Springfield Preferred","44240MO016",,"MON004","MOS004","MOF033","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160015-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68562","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","23","44240","MO","Individual","No","75-1296086","44240MO0160015","Coventry Silver $10 Copay 2900 Springfield Preferred","44240MO016",,"MON004","MOS004","MOF033","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160015-03","Limited Cost Sharing Plan Variation","68.14%",,"Yes","Yes","No","100%",,"$2,900","$10","$900","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68561","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","23","44240","MO","Individual","No","75-1296086","44240MO0160015","Coventry Silver $10 Copay 2900 Springfield Preferred","44240MO016",,"MON004","MOS004","MOF033","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160015-04","73% AV Level Silver Plan","72.14%",,"Yes","Yes","No","100%",,"$2,700","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68565","http://www.coventryone.com/WMOon2016","8"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","23","44240","MO","Individual","No","75-1296086","44240MO0160015","Coventry Silver $10 Copay 2900 Springfield Preferred","44240MO016",,"MON004","MOS004","MOF033","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160015-05","87% AV Level Silver Plan","86.01%",,"Yes","Yes","No","100%",,"$1,100","$10","$400","$200","$1,100","$100","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68564","http://www.coventryone.com/WMOon2016","9"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","23","44240","MO","Individual","No","75-1296086","44240MO0160015","Coventry Silver $10 Copay 2900 Springfield Preferred","44240MO016",,"MON004","MOS004","MOF033","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160015-06","94% AV Level Silver Plan","93.05%",,"Yes","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68563","http://www.coventryone.com/WMOon2016","10"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","25","44240","MO","Individual","No","75-1296086","44240MO0160008","Coventry Silver $10 Copay Joplin Preferred","44240MO016",,"MON005","MOS005","MOF026","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160008-00","Standard Silver Off Exchange Plan","68.10%",,"No","Yes","No","100%",,"$3,800","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68602","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","25","44240","MO","Individual","No","75-1296086","44240MO0160008","Coventry Silver $10 Copay Joplin Preferred","44240MO016",,"MON005","MOS005","MOF026","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160008-01","Standard Silver On Exchange Plan","68.10%",,"No","Yes","No","100%",,"$3,800","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68554","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","25","44240","MO","Individual","No","75-1296086","44240MO0160008","Coventry Silver $10 Copay Joplin Preferred","44240MO016",,"MON005","MOS005","MOF026","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160008-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68556","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","25","44240","MO","Individual","No","75-1296086","44240MO0160008","Coventry Silver $10 Copay Joplin Preferred","44240MO016",,"MON005","MOS005","MOF026","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160008-03","Limited Cost Sharing Plan Variation","68.10%",,"No","Yes","No","100%",,"$3,800","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68555","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","25","44240","MO","Individual","No","75-1296086","44240MO0160008","Coventry Silver $10 Copay Joplin Preferred","44240MO016",,"MON005","MOS005","MOF026","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160008-04","73% AV Level Silver Plan","72.04%",,"No","Yes","No","100%",,"$3,200","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68559","http://www.coventryone.com/WMOon2016","8"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","25","44240","MO","Individual","No","75-1296086","44240MO0160008","Coventry Silver $10 Copay Joplin Preferred","44240MO016",,"MON005","MOS005","MOF026","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160008-05","87% AV Level Silver Plan","86.05%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68558","http://www.coventryone.com/WMOon2016","9"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","25","44240","MO","Individual","No","75-1296086","44240MO0160008","Coventry Silver $10 Copay Joplin Preferred","44240MO016",,"MON005","MOS005","MOF026","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160008-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68557","http://www.coventryone.com/WMOon2016","10"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","27","44240","MO","Individual","No","75-1296086","44240MO0090008","Coventry Silver $10 Copay KCPPO","44240MO009",,"MON002","MOS002","MOF007","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090008-00","Standard Silver Off Exchange Plan","68.06%",,"No","Yes","Yes","90%","10%","$4,400","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,850","$6850 per person","$13700 per group","$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","20%","$6,000","$6000 per person","$12000 per group","40%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68596","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","27","44240","MO","Individual","No","75-1296086","44240MO0090008","Coventry Silver $10 Copay KCPPO","44240MO009",,"MON002","MOS002","MOF007","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090008-01","Standard Silver On Exchange Plan","68.06%",,"No","Yes","Yes","90%","10%","$4,400","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,850","$6850 per person","$13700 per group","$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","20%","$6,000","$6000 per person","$12000 per group","40%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68524","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","27","44240","MO","Individual","No","75-1296086","44240MO0090008","Coventry Silver $10 Copay KCPPO","44240MO009",,"MON002","MOS002","MOF007","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090008-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","90%","10%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68526","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","27","44240","MO","Individual","No","75-1296086","44240MO0090008","Coventry Silver $10 Copay KCPPO","44240MO009",,"MON002","MOS002","MOF007","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090008-03","Limited Cost Sharing Plan Variation","68.06%",,"No","Yes","Yes","90%","10%","$4,400","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,850","$6850 per person","$13700 per group","$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","20%","$6,000","$6000 per person","$12000 per group","40%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68525","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","27","44240","MO","Individual","No","75-1296086","44240MO0090008","Coventry Silver $10 Copay KCPPO","44240MO009",,"MON002","MOS002","MOF007","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090008-04","73% AV Level Silver Plan","72.00%",,"No","Yes","Yes","90%","10%","$4,000","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,450","$5450 per person","$10900 per group","$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%","$5,000","$5000 per person","$10000 per group","40%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68529","http://www.coventryone.com/WMOon2016","8"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","27","44240","MO","Individual","No","75-1296086","44240MO0090008","Coventry Silver $10 Copay KCPPO","44240MO009",,"MON002","MOS002","MOF007","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090008-05","87% AV Level Silver Plan","86.02%",,"No","Yes","Yes","90%","10%","$1,000","$10","$800","$200","$1,000","$100","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,250","$2250 per person","$4500 per group","$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%","$1,500","$1500 per person","$3000 per group","40%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68528","http://www.coventryone.com/WMOon2016","9"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","27","44240","MO","Individual","No","75-1296086","44240MO0090008","Coventry Silver $10 Copay KCPPO","44240MO009",,"MON002","MOS002","MOF007","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090008-06","94% AV Level Silver Plan","93.03%",,"No","Yes","Yes","90%","10%","$0","$10","$400","$200","$0","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,250","$2250 per person","$4500 per group","$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","20%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%","$0","$0 per person","per group not applicable","20%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68527","http://www.coventryone.com/WMOon2016","10"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","28","44240","MO","Individual","No","75-1296086","44240MO0160002","Coventry Silver $10 Copay OAEPO","44240MO016",,"MON003","MOS003","MOF020","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160002-00","Standard Silver Off Exchange Plan","68.10%",,"No","Yes","No","100%",,"$3,800","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68602","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","28","44240","MO","Individual","No","75-1296086","44240MO0160002","Coventry Silver $10 Copay OAEPO","44240MO016",,"MON003","MOS003","MOF020","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160002-01","Standard Silver On Exchange Plan","68.10%",,"No","Yes","No","100%",,"$3,800","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68554","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","28","44240","MO","Individual","No","75-1296086","44240MO0160002","Coventry Silver $10 Copay OAEPO","44240MO016",,"MON003","MOS003","MOF020","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68556","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","28","44240","MO","Individual","No","75-1296086","44240MO0160002","Coventry Silver $10 Copay OAEPO","44240MO016",,"MON003","MOS003","MOF020","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160002-03","Limited Cost Sharing Plan Variation","68.10%",,"No","Yes","No","100%",,"$3,800","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68555","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","28","44240","MO","Individual","No","75-1296086","44240MO0160002","Coventry Silver $10 Copay OAEPO","44240MO016",,"MON003","MOS003","MOF020","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160002-04","73% AV Level Silver Plan","72.04%",,"No","Yes","No","100%",,"$3,200","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68559","http://www.coventryone.com/WMOon2016","8"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","28","44240","MO","Individual","No","75-1296086","44240MO0160002","Coventry Silver $10 Copay OAEPO","44240MO016",,"MON003","MOS003","MOF020","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160002-05","87% AV Level Silver Plan","86.05%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68558","http://www.coventryone.com/WMOon2016","9"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","28","44240","MO","Individual","No","75-1296086","44240MO0160002","Coventry Silver $10 Copay OAEPO","44240MO016",,"MON003","MOS003","MOF020","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160002-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68557","http://www.coventryone.com/WMOon2016","10"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","31","44240","MO","Individual","No","75-1296086","44240MO0160014","Coventry Silver $10 Copay Springfield Preferred","44240MO016",,"MON004","MOS004","MOF032","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160014-00","Standard Silver Off Exchange Plan","68.10%",,"No","Yes","No","100%",,"$3,800","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68602","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","31","44240","MO","Individual","No","75-1296086","44240MO0160014","Coventry Silver $10 Copay Springfield Preferred","44240MO016",,"MON004","MOS004","MOF032","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160014-01","Standard Silver On Exchange Plan","68.10%",,"No","Yes","No","100%",,"$3,800","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68554","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","31","44240","MO","Individual","No","75-1296086","44240MO0160014","Coventry Silver $10 Copay Springfield Preferred","44240MO016",,"MON004","MOS004","MOF032","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160014-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68556","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","31","44240","MO","Individual","No","75-1296086","44240MO0160014","Coventry Silver $10 Copay Springfield Preferred","44240MO016",,"MON004","MOS004","MOF032","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160014-03","Limited Cost Sharing Plan Variation","68.10%",,"No","Yes","No","100%",,"$3,800","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68555","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","31","44240","MO","Individual","No","75-1296086","44240MO0160014","Coventry Silver $10 Copay Springfield Preferred","44240MO016",,"MON004","MOS004","MOF032","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160014-04","73% AV Level Silver Plan","72.04%",,"No","Yes","No","100%",,"$3,200","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68559","http://www.coventryone.com/WMOon2016","8"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","31","44240","MO","Individual","No","75-1296086","44240MO0160014","Coventry Silver $10 Copay Springfield Preferred","44240MO016",,"MON004","MOS004","MOF032","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160014-05","87% AV Level Silver Plan","86.05%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68558","http://www.coventryone.com/WMOon2016","9"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","31","44240","MO","Individual","No","75-1296086","44240MO0160014","Coventry Silver $10 Copay Springfield Preferred","44240MO016",,"MON004","MOS004","MOF032","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160014-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68557","http://www.coventryone.com/WMOon2016","10"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","33","44240","MO","Individual","No","75-1296086","44240MO0090001","Coventry Gold $10 Copay","44240MO009",,"MON001","MOS001","MOF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090001-00","Standard Gold Off Exchange Plan","78.19%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$8,625","$8625 per person","$17250 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68590","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","33","44240","MO","Individual","No","75-1296086","44240MO0090001","Coventry Gold $10 Copay","44240MO009",,"MON001","MOS001","MOF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090001-01","Standard Gold On Exchange Plan","78.19%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$8,625","$8625 per person","$17250 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68500","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","33","44240","MO","Individual","No","75-1296086","44240MO0090001","Coventry Gold $10 Copay","44240MO009",,"MON001","MOS001","MOF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68502","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","33","44240","MO","Individual","No","75-1296086","44240MO0090001","Coventry Gold $10 Copay","44240MO009",,"MON001","MOS001","MOF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090001-03","Limited Cost Sharing Plan Variation","78.19%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$8,625","$8625 per person","$17250 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68501","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","34","44240","MO","Individual","No","75-1296086","44240MO0160007","Coventry Gold $10 Copay Joplin Preferred","44240MO016",,"MON005","MOS005","MOF025","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160007-00","Standard Gold Off Exchange Plan","78.19%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68601","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","34","44240","MO","Individual","No","75-1296086","44240MO0160007","Coventry Gold $10 Copay Joplin Preferred","44240MO016",,"MON005","MOS005","MOF025","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160007-01","Standard Gold On Exchange Plan","78.19%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68551","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","34","44240","MO","Individual","No","75-1296086","44240MO0160007","Coventry Gold $10 Copay Joplin Preferred","44240MO016",,"MON005","MOS005","MOF025","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68553","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","34","44240","MO","Individual","No","75-1296086","44240MO0160007","Coventry Gold $10 Copay Joplin Preferred","44240MO016",,"MON005","MOS005","MOF025","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160007-03","Limited Cost Sharing Plan Variation","78.19%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68552","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","36","44240","MO","Individual","No","75-1296086","44240MO0160001","Coventry Gold $10 Copay OAEPO","44240MO016",,"MON003","MOS003","MOF019","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160001-00","Standard Gold Off Exchange Plan","78.19%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68601","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","36","44240","MO","Individual","No","75-1296086","44240MO0160001","Coventry Gold $10 Copay OAEPO","44240MO016",,"MON003","MOS003","MOF019","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160001-01","Standard Gold On Exchange Plan","78.19%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68551","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","36","44240","MO","Individual","No","75-1296086","44240MO0160001","Coventry Gold $10 Copay OAEPO","44240MO016",,"MON003","MOS003","MOF019","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68553","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","36","44240","MO","Individual","No","75-1296086","44240MO0160001","Coventry Gold $10 Copay OAEPO","44240MO016",,"MON003","MOS003","MOF019","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160001-03","Limited Cost Sharing Plan Variation","78.19%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68552","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","39","44240","MO","Individual","No","75-1296086","44240MO0160013","Coventry Gold $10 Copay Springfield Preferred","44240MO016",,"MON004","MOS004","MOF031","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160013-00","Standard Gold Off Exchange Plan","78.19%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68601","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","39","44240","MO","Individual","No","75-1296086","44240MO0160013","Coventry Gold $10 Copay Springfield Preferred","44240MO016",,"MON004","MOS004","MOF031","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160013-01","Standard Gold On Exchange Plan","78.19%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68551","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","39","44240","MO","Individual","No","75-1296086","44240MO0160013","Coventry Gold $10 Copay Springfield Preferred","44240MO016",,"MON004","MOS004","MOF031","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160013-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68553","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","39","44240","MO","Individual","No","75-1296086","44240MO0160013","Coventry Gold $10 Copay Springfield Preferred","44240MO016",,"MON004","MOS004","MOF031","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0160013-03","Limited Cost Sharing Plan Variation","78.19%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68552","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","41","44240","MO","Individual","No","75-1296086","44240MO0090007","Coventry Gold $5 Copay KCPPO","44240MO009",,"MON002","MOS002","MOF006","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090007-00","Standard Gold Off Exchange Plan","78.05%",,"No","Yes","Yes","90%","10%","$1,400","$10","$800","$200","$1,400","$100","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$6,600","$6600 per person","$13200 per group","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68595","http://www.coventryone.com/WMOon2016","4"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","41","44240","MO","Individual","No","75-1296086","44240MO0090007","Coventry Gold $5 Copay KCPPO","44240MO009",,"MON002","MOS002","MOF006","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090007-01","Standard Gold On Exchange Plan","78.05%",,"No","Yes","Yes","90%","10%","$1,400","$10","$800","$200","$1,400","$100","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$6,600","$6600 per person","$13200 per group","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68521","http://www.coventryone.com/WMOon2016","5"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","41","44240","MO","Individual","No","75-1296086","44240MO0090007","Coventry Gold $5 Copay KCPPO","44240MO009",,"MON002","MOS002","MOF006","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","90%","10%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68523","http://www.coventryone.com/WMOon2016","6"
"2016","MO","44240","HIOS","5","2015-08-26 09:56:12","41","44240","MO","Individual","No","75-1296086","44240MO0090007","Coventry Gold $5 Copay KCPPO","44240MO009",,"MON002","MOS002","MOF006","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44240MO0090007-03","Limited Cost Sharing Plan Variation","78.05%",,"No","Yes","Yes","90%","10%","$1,400","$10","$800","$200","$1,400","$100","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$6,600","$6600 per person","$13200 per group","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68522","http://www.coventryone.com/WMOon2016","7"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","1","44527","MO","Individual","No","75-1296086","44527MO0160003","Coventry Bronze $25 Copay Carelink","44527MO016",,"MON002","MOS002","MOF007","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0160003-00","Standard Bronze Off Exchange Plan","61.87%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68196","http://www.coventryone.com/EMOon2016","4"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","1","44527","MO","Individual","No","75-1296086","44527MO0160003","Coventry Bronze $25 Copay Carelink","44527MO016",,"MON002","MOS002","MOF007","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0160003-01","Standard Bronze On Exchange Plan","61.87%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68139","http://www.coventryone.com/EMOon2016","5"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","1","44527","MO","Individual","No","75-1296086","44527MO0160003","Coventry Bronze $25 Copay Carelink","44527MO016",,"MON002","MOS002","MOF007","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0160003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68141","http://www.coventryone.com/EMOon2016","6"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","1","44527","MO","Individual","No","75-1296086","44527MO0160003","Coventry Bronze $25 Copay Carelink","44527MO016",,"MON002","MOS002","MOF007","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0160003-03","Limited Cost Sharing Plan Variation","61.87%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68140","http://www.coventryone.com/EMOon2016","7"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","3","44527","MO","Individual","No","75-1296086","44527MO0150003","Coventry Bronze $30 Copay","44527MO015",,"MON001","MOS001","MOF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0150003-00","Standard Bronze Off Exchange Plan","61.69%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68180","http://www.coventryone.com/EMOon2016","4"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","3","44527","MO","Individual","No","75-1296086","44527MO0150003","Coventry Bronze $30 Copay","44527MO015",,"MON001","MOS001","MOF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0150003-01","Standard Bronze On Exchange Plan","61.69%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68109","http://www.coventryone.com/EMOon2016","5"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","3","44527","MO","Individual","No","75-1296086","44527MO0150003","Coventry Bronze $30 Copay","44527MO015",,"MON001","MOS001","MOF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0150003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68111","http://www.coventryone.com/EMOon2016","6"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","3","44527","MO","Individual","No","75-1296086","44527MO0150003","Coventry Bronze $30 Copay","44527MO015",,"MON001","MOS001","MOF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0150003-03","Limited Cost Sharing Plan Variation","61.69%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68110","http://www.coventryone.com/EMOon2016","7"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","4","44527","MO","Individual","No","75-1296086","44527MO0160006","Coventry Bronze $30 Copay FocusedCare HPN","44527MO016",,"MON003","MOS003","MOF009","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0160006-00","Standard Bronze Off Exchange Plan","61.69%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68188","http://www.coventryone.com/EMOon2016","4"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","4","44527","MO","Individual","No","75-1296086","44527MO0160006","Coventry Bronze $30 Copay FocusedCare HPN","44527MO016",,"MON003","MOS003","MOF009","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0160006-01","Standard Bronze On Exchange Plan","61.69%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68124","http://www.coventryone.com/EMOon2016","5"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","4","44527","MO","Individual","No","75-1296086","44527MO0160006","Coventry Bronze $30 Copay FocusedCare HPN","44527MO016",,"MON003","MOS003","MOF009","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0160006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68126","http://www.coventryone.com/EMOon2016","6"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","4","44527","MO","Individual","No","75-1296086","44527MO0160006","Coventry Bronze $30 Copay FocusedCare HPN","44527MO016",,"MON003","MOS003","MOF009","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0160006-03","Limited Cost Sharing Plan Variation","61.69%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68125","http://www.coventryone.com/EMOon2016","7"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","7","44527","MO","Individual","No","75-1296086","44527MO0160007","Coventry Bronze Ded Only HSA Eligible FocusedCare HPN","44527MO016",,"MON003","MOS003","MOF010","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0160007-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/MO68190","http://www.coventryone.com/EMOon2016","4"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","7","44527","MO","Individual","No","75-1296086","44527MO0160007","Coventry Bronze Ded Only HSA Eligible FocusedCare HPN","44527MO016",,"MON003","MOS003","MOF010","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0160007-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/MO68127","http://www.coventryone.com/EMOon2016","5"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","7","44527","MO","Individual","No","75-1296086","44527MO0160007","Coventry Bronze Ded Only HSA Eligible FocusedCare HPN","44527MO016",,"MON003","MOS003","MOF010","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0160007-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68129","http://www.coventryone.com/EMOon2016","6"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","7","44527","MO","Individual","No","75-1296086","44527MO0160007","Coventry Bronze Ded Only HSA Eligible FocusedCare HPN","44527MO016",,"MON003","MOS003","MOF010","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0160007-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/MO68128","http://www.coventryone.com/EMOon2016","7"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","9","44527","MO","Individual","No","75-1296086","44527MO0150004","Coventry Bronze Deductible Only HSA Eligible","44527MO015",,"MON001","MOS001","MOF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0150004-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/MO68182","http://www.coventryone.com/EMOon2016","4"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","9","44527","MO","Individual","No","75-1296086","44527MO0150004","Coventry Bronze Deductible Only HSA Eligible","44527MO015",,"MON001","MOS001","MOF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0150004-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/MO68112","http://www.coventryone.com/EMOon2016","5"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","9","44527","MO","Individual","No","75-1296086","44527MO0150004","Coventry Bronze Deductible Only HSA Eligible","44527MO015",,"MON001","MOS001","MOF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0150004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68114","http://www.coventryone.com/EMOon2016","6"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","9","44527","MO","Individual","No","75-1296086","44527MO0150004","Coventry Bronze Deductible Only HSA Eligible","44527MO015",,"MON001","MOS001","MOF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0150004-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/MO68113","http://www.coventryone.com/EMOon2016","7"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","10","44527","MO","Individual","No","75-1296086","44527MO0160004","Coventry Bronze Deductible Only HSA Eligible Carelink","44527MO016",,"MON002","MOS002","MOF008","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0160004-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/MO68198","http://www.coventryone.com/EMOon2016","4"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","10","44527","MO","Individual","No","75-1296086","44527MO0160004","Coventry Bronze Deductible Only HSA Eligible Carelink","44527MO016",,"MON002","MOS002","MOF008","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0160004-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/MO68142","http://www.coventryone.com/EMOon2016","5"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","10","44527","MO","Individual","No","75-1296086","44527MO0160004","Coventry Bronze Deductible Only HSA Eligible Carelink","44527MO016",,"MON002","MOS002","MOF008","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0160004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/MO68144","http://www.coventryone.com/EMOon2016","6"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","10","44527","MO","Individual","No","75-1296086","44527MO0160004","Coventry Bronze Deductible Only HSA Eligible Carelink","44527MO016",,"MON002","MOS002","MOF008","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5178671517","44527MO0160004-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/MO68143","http://www.coventryone.com/EMOon2016","7"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","13","44527","MO","Individual","No","75-1296086","44527MO0160002","Coventry Silver $10 Copay Carelink","44527MO016",,"MON002","MOS002","MOF006","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160002-00","Standard Silver Off Exchange Plan","68.10%",,"No","Yes","No","100%",,"$3,800","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","30%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68194","http://www.coventryone.com/EMOon2016","4"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","13","44527","MO","Individual","No","75-1296086","44527MO0160002","Coventry Silver $10 Copay Carelink","44527MO016",,"MON002","MOS002","MOF006","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160002-01","Standard Silver On Exchange Plan","68.10%",,"No","Yes","No","100%",,"$3,800","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","30%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68133","http://www.coventryone.com/EMOon2016","5"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","13","44527","MO","Individual","No","75-1296086","44527MO0160002","Coventry Silver $10 Copay Carelink","44527MO016",,"MON002","MOS002","MOF006","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68135","http://www.coventryone.com/EMOon2016","6"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","13","44527","MO","Individual","No","75-1296086","44527MO0160002","Coventry Silver $10 Copay Carelink","44527MO016",,"MON002","MOS002","MOF006","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160002-03","Limited Cost Sharing Plan Variation","68.10%",,"No","Yes","No","100%",,"$3,800","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","30%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68134","http://www.coventryone.com/EMOon2016","7"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","13","44527","MO","Individual","No","75-1296086","44527MO0160002","Coventry Silver $10 Copay Carelink","44527MO016",,"MON002","MOS002","MOF006","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160002-04","73% AV Level Silver Plan","72.04%",,"No","Yes","No","100%",,"$3,200","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","30%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68138","http://www.coventryone.com/EMOon2016","8"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","13","44527","MO","Individual","No","75-1296086","44527MO0160002","Coventry Silver $10 Copay Carelink","44527MO016",,"MON002","MOS002","MOF006","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160002-05","87% AV Level Silver Plan","86.05%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68137","http://www.coventryone.com/EMOon2016","9"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","13","44527","MO","Individual","No","75-1296086","44527MO0160002","Coventry Silver $10 Copay Carelink","44527MO016",,"MON002","MOS002","MOF006","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160002-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68136","http://www.coventryone.com/EMOon2016","10"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","15","44527","MO","Individual","No","75-1296086","44527MO0150002","Coventry Silver $15 Copay","44527MO015",,"MON001","MOS001","MOF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0150002-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68178","http://www.coventryone.com/EMOon2016","4"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","15","44527","MO","Individual","No","75-1296086","44527MO0150002","Coventry Silver $15 Copay","44527MO015",,"MON001","MOS001","MOF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0150002-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68103","http://www.coventryone.com/EMOon2016","5"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","15","44527","MO","Individual","No","75-1296086","44527MO0150002","Coventry Silver $15 Copay","44527MO015",,"MON001","MOS001","MOF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0150002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68105","http://www.coventryone.com/EMOon2016","6"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","15","44527","MO","Individual","No","75-1296086","44527MO0150002","Coventry Silver $15 Copay","44527MO015",,"MON001","MOS001","MOF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0150002-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68104","http://www.coventryone.com/EMOon2016","7"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","15","44527","MO","Individual","No","75-1296086","44527MO0150002","Coventry Silver $15 Copay","44527MO015",,"MON001","MOS001","MOF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0150002-04","73% AV Level Silver Plan","72.34%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68108","http://www.coventryone.com/EMOon2016","8"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","15","44527","MO","Individual","No","75-1296086","44527MO0150002","Coventry Silver $15 Copay","44527MO015",,"MON001","MOS001","MOF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0150002-05","87% AV Level Silver Plan","86.11%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68107","http://www.coventryone.com/EMOon2016","9"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","15","44527","MO","Individual","No","75-1296086","44527MO0150002","Coventry Silver $15 Copay","44527MO015",,"MON001","MOS001","MOF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0150002-06","94% AV Level Silver Plan","93.04%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68106","http://www.coventryone.com/EMOon2016","10"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","16","44527","MO","Individual","No","75-1296086","44527MO0160010","Coventry Silver $15 Copay FocusedCare HPN","44527MO016",,"MON003","MOS003","MOF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160010-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68186","http://www.coventryone.com/EMOon2016","4"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","16","44527","MO","Individual","No","75-1296086","44527MO0160010","Coventry Silver $15 Copay FocusedCare HPN","44527MO016",,"MON003","MOS003","MOF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160010-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68118","http://www.coventryone.com/EMOon2016","5"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","16","44527","MO","Individual","No","75-1296086","44527MO0160010","Coventry Silver $15 Copay FocusedCare HPN","44527MO016",,"MON003","MOS003","MOF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160010-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68120","http://www.coventryone.com/EMOon2016","6"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","16","44527","MO","Individual","No","75-1296086","44527MO0160010","Coventry Silver $15 Copay FocusedCare HPN","44527MO016",,"MON003","MOS003","MOF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160010-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68119","http://www.coventryone.com/EMOon2016","7"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","16","44527","MO","Individual","No","75-1296086","44527MO0160010","Coventry Silver $15 Copay FocusedCare HPN","44527MO016",,"MON003","MOS003","MOF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160010-04","73% AV Level Silver Plan","72.34%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68123","http://www.coventryone.com/EMOon2016","8"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","16","44527","MO","Individual","No","75-1296086","44527MO0160010","Coventry Silver $15 Copay FocusedCare HPN","44527MO016",,"MON003","MOS003","MOF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160010-05","87% AV Level Silver Plan","86.11%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68122","http://www.coventryone.com/EMOon2016","9"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","16","44527","MO","Individual","No","75-1296086","44527MO0160010","Coventry Silver $15 Copay FocusedCare HPN","44527MO016",,"MON003","MOS003","MOF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160010-06","94% AV Level Silver Plan","93.04%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68121","http://www.coventryone.com/EMOon2016","10"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","19","44527","MO","Individual","No","75-1296086","44527MO0160001","Coventry Gold $10 Copay Carelink","44527MO016",,"MON002","MOS002","MOF005","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160001-00","Standard Gold Off Exchange Plan","78.23%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$8,625","$8625 per person","$17250 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68192","http://www.coventryone.com/EMOon2016","4"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","19","44527","MO","Individual","No","75-1296086","44527MO0160001","Coventry Gold $10 Copay Carelink","44527MO016",,"MON002","MOS002","MOF005","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160001-01","Standard Gold On Exchange Plan","78.23%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$8,625","$8625 per person","$17250 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68130","http://www.coventryone.com/EMOon2016","5"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","19","44527","MO","Individual","No","75-1296086","44527MO0160001","Coventry Gold $10 Copay Carelink","44527MO016",,"MON002","MOS002","MOF005","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68132","http://www.coventryone.com/EMOon2016","6"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","19","44527","MO","Individual","No","75-1296086","44527MO0160001","Coventry Gold $10 Copay Carelink","44527MO016",,"MON002","MOS002","MOF005","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160001-03","Limited Cost Sharing Plan Variation","78.23%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$8,625","$8625 per person","$17250 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68131","http://www.coventryone.com/EMOon2016","7"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","21","44527","MO","Individual","No","75-1296086","44527MO0150001","Coventry Gold $15 Copay","44527MO015",,"MON004","MOS004","MOF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0150001-00","Standard Gold Off Exchange Plan","78.02%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$8,625","$8625 per person","$17250 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68176","http://www.coventryone.com/EMOon2016","4"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","21","44527","MO","Individual","No","75-1296086","44527MO0150001","Coventry Gold $15 Copay","44527MO015",,"MON004","MOS004","MOF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0150001-01","Standard Gold On Exchange Plan","78.02%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$8,625","$8625 per person","$17250 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68100","http://www.coventryone.com/EMOon2016","5"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","21","44527","MO","Individual","No","75-1296086","44527MO0150001","Coventry Gold $15 Copay","44527MO015",,"MON004","MOS004","MOF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0150001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68102","http://www.coventryone.com/EMOon2016","6"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","21","44527","MO","Individual","No","75-1296086","44527MO0150001","Coventry Gold $15 Copay","44527MO015",,"MON004","MOS004","MOF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0150001-03","Limited Cost Sharing Plan Variation","78.02%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$8,625","$8625 per person","$17250 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68101","http://www.coventryone.com/EMOon2016","7"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","22","44527","MO","Individual","No","75-1296086","44527MO0160008","Coventry Gold $15 Copay FocusedCare HPN","44527MO016",,"MON003","MOS003","MOF011","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160008-00","Standard Gold Off Exchange Plan","78.02%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$8,625","$8625 per person","$17250 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68184","http://www.coventryone.com/EMOon2016","4"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","22","44527","MO","Individual","No","75-1296086","44527MO0160008","Coventry Gold $15 Copay FocusedCare HPN","44527MO016",,"MON003","MOS003","MOF011","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160008-01","Standard Gold On Exchange Plan","78.02%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$8,625","$8625 per person","$17250 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68115","http://www.coventryone.com/EMOon2016","5"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","22","44527","MO","Individual","No","75-1296086","44527MO0160008","Coventry Gold $15 Copay FocusedCare HPN","44527MO016",,"MON003","MOS003","MOF011","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160008-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68117","http://www.coventryone.com/EMOon2016","6"
"2016","MO","44527","HIOS","3","2015-08-11 02:55:25","22","44527","MO","Individual","No","75-1296086","44527MO0160008","Coventry Gold $15 Copay FocusedCare HPN","44527MO016",,"MON003","MOS003","MOF011","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5176249231","44527MO0160008-03","Limited Cost Sharing Plan Variation","78.02%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$8,625","$8625 per person","$17250 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/MO68116","http://www.coventryone.com/EMOon2016","7"
"2016","MO","48616","HIOS","1","2015-05-01 02:23:41","1","48616","MO","SHOP (Small Group)","Yes","47-0098400","48616MO0030002","EHB High Passive","48616MO003",,"MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.95","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","48616MO0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","MO","48616","HIOS","1","2015-05-01 02:23:41","1","48616","MO","SHOP (Small Group)","Yes","47-0098400","48616MO0030001","EHB Low Passive","48616MO003",,"MON001","MOS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.90","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","48616MO0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","MO","48786","HIOS","1","2015-04-22 02:23:18","1","48786","MO","SHOP (Small Group)","Yes","13-5123390","48786MO0090002","Guardian Pediatric Advantage","48786MO009",,"MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$27.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","48786MO0090002-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","MO","48786","HIOS","1","2015-04-22 02:23:18","1","48786","MO","SHOP (Small Group)","Yes","13-5123390","48786MO0100002","Guardian Pediatric Essentials","48786MO010",,"MON001","MOS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$20.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","48786MO0100002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","MO","48786","HIOS","1","2015-04-22 02:23:18","2","48786","MO","SHOP (Small Group)","Yes","13-5123390","48786MO0120002","Guardian Family Advantage","48786MO012",,"MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","48786MO0120002-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","MO","48786","HIOS","1","2015-04-22 02:23:18","2","48786","MO","SHOP (Small Group)","Yes","13-5123390","48786MO0140002","Guardian Family Essentials","48786MO014",,"MON001","MOS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","48786MO0140002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","MO","48786","HIOS","1","2015-04-22 02:23:18","3","48786","MO","SHOP (Small Group)","Yes","13-5123390","48786MO0120003","Guardian Family Advantage","48786MO012",,"MON001","MOS002",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","48786MO0120003-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","MO","48786","HIOS","1","2015-04-22 02:23:18","3","48786","MO","SHOP (Small Group)","Yes","13-5123390","48786MO0120003","Guardian Family Advantage","48786MO012",,"MON001","MOS002",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","48786MO0120003-01","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","MO","48786","HIOS","1","2015-04-22 02:23:18","3","48786","MO","SHOP (Small Group)","Yes","13-5123390","48786MO0140003","Guardian Family Essentials","48786MO014",,"MON001","MOS002",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","48786MO0140003-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","MO","48786","HIOS","1","2015-04-22 02:23:18","3","48786","MO","SHOP (Small Group)","Yes","13-5123390","48786MO0140003","Guardian Family Essentials","48786MO014",,"MON001","MOS002",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","48786MO0140003-01","Standard Low On Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","MO","53204","HIOS","2","2015-07-09 13:17:42","1","53204","MO","SHOP (Small Group)","Yes","41-0808596","53204MO0010002","Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho","53204MO001",,"MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","53204MO0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","53204","HIOS","2","2015-07-09 13:17:42","1","53204","MO","SHOP (Small Group)","Yes","41-0808596","53204MO0010005","Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho","53204MO001",,"MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","53204MO0010005-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MO","53204","HIOS","2","2015-07-09 13:17:42","1","53204","MO","SHOP (Small Group)","Yes","41-0808596","53204MO0010007","Plan 9. MAC PPO, $1500 Annual Maximum, Ortho","53204MO001",,"MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$20.18","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","53204MO0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","MO","56603","HIOS","2","2015-07-09 13:17:42","1","56603","MO","SHOP (Small Group)","Yes","81-0170040","56603MO0010001","Assurant Dental ACAFFO High","56603MO001",,"MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$40.11","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","56603MO0010001-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","56603","HIOS","2","2015-07-09 13:17:42","1","56603","MO","SHOP (Small Group)","Yes","81-0170040","56603MO0010002","Assurant Dental ACAFFO Low","56603MO001",,"MON001","MOS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$33.41","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","56603MO0010002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MO","59976","HIOS","2","2015-07-10 02:19:03","1","59976","MO","SHOP (Small Group)","Yes","35-0472300","59976MO0010001","Lincoln DentalConnect®","59976MO001","7063415294","MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.23","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","59976MO0010001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","59976","HIOS","2","2015-07-10 02:19:03","1","59976","MO","SHOP (Small Group)","Yes","35-0472300","59976MO0010002","Lincoln DentalConnect®","59976MO001","7063415294","MON001","MOS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.83","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","59976MO0010002-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MO","59976","HIOS","2","2015-07-10 02:19:03","1","59976","MO","SHOP (Small Group)","Yes","35-0472300","59976MO0010003","Lincoln DentalConnect®","59976MO001","7063415294","MON001","MOS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.48","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","59976MO0010003-00","Standard Low Off Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","2","74483","MO","Individual","No","59-1031071","74483MO0040005","Cigna Connect Flex Silver 3000","74483MO004","7730182962","MON001","MOS001","MOF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040005-01","Standard Silver On Exchange Plan","70.68%","0.7088902592659","Yes","Yes","No","100%",,"$3,000","$70","$850","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-silver-3000","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-silver-3000","12"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","2","74483","MO","Individual","No","59-1031071","74483MO0040005","Cigna Connect Flex Silver 3000","74483MO004","7730182962","MON001","MOS001","MOF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/naan-300b","13"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","2","74483","MO","Individual","No","59-1031071","74483MO0040005","Cigna Connect Flex Silver 3000","74483MO004","7730182962","MON001","MOS001","MOF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040005-03","Limited Cost Sharing Plan Variation","70.68%","0.7088902592659","Yes","Yes","No","100%",,"$3,000","$70","$850","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-silver-3000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-silver-3000-naan-300a","14"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","2","74483","MO","Individual","No","59-1031071","74483MO0040005","Cigna Connect Flex Silver 3000","74483MO004","7730182962","MON001","MOS001","MOF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040005-04","73% AV Level Silver Plan","73.23%","0.734971523284912","Yes","Yes","No","100%",,"$2,500","$70","$950","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-silver-3000-250","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-silver-3000-250","15"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","2","74483","MO","Individual","No","59-1031071","74483MO0040005","Cigna Connect Flex Silver 3000","74483MO004","7730182962","MON001","MOS001","MOF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040005-05","87% AV Level Silver Plan","86.96%","0.873386561870575","Yes","Yes","No","100%",,"$200","$70","$1,060","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-silver-3000-200","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-silver-3000-200","16"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","2","74483","MO","Individual","No","59-1031071","74483MO0040005","Cigna Connect Flex Silver 3000","74483MO004","7730182962","MON001","MOS001","MOF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040005-06","94% AV Level Silver Plan","93.01%","0.934733331203461","Yes","Yes","No","100%",,"$0","$40","$360","$30","$0","$400","$10","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-silver-3000-150","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-silver-3000-150","17"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","2","74483","MO","Individual","No","59-1031071","74483MO0040007","Cigna Connect Flex Gold 1400","74483MO004","7730182962","MON001","MOS001","MOF005","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040007-00","Standard Gold Off Exchange Plan","78.07%","0.782174229621887","Yes","Yes","No","100%",,"$1,400","$30","$1,170","$30","$140","$320","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-gold-1400","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-gold-1400","18"
"2016","MO","59976","HIOS","2","2015-07-10 02:19:03","1","59976","MO","SHOP (Small Group)","Yes","35-0472300","59976MO0010004","Lincoln DentalConnect®","59976MO001","7063415294","MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.33","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","59976MO0010004-00","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","MO","59976","HIOS","2","2015-07-10 02:19:03","1","59976","MO","SHOP (Small Group)","Yes","35-0472300","59976MO0010005","Lincoln DentalConnect®","59976MO001","7063415294","MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.60","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","59976MO0010005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","MO","59976","HIOS","2","2015-07-10 02:19:03","1","59976","MO","SHOP (Small Group)","Yes","35-0472300","59976MO0010006","Lincoln DentalConnect®","59976MO001","7063415294","MON001","MOS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.72","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","59976MO0010006-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","MO","59976","HIOS","2","2015-07-10 02:19:03","1","59976","MO","SHOP (Small Group)","Yes","35-0472300","59976MO0010007","Lincoln DentalConnect®","59976MO001","7063415294","MON001","MOS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.49","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","59976MO0010007-00","Standard Low Off Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2016","MO","59976","HIOS","2","2015-07-10 02:19:03","1","59976","MO","SHOP (Small Group)","Yes","35-0472300","59976MO0010008","Lincoln DentalConnect®","59976MO001","7063415294","MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.87","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","59976MO0010008-00","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2016","MO","68265","HIOS","6","2015-10-22 04:38:36","1","68265","MO","Individual","Yes","75-1233841","68265MO0010007","Dentegra Dental PPO Pediatric Basic Plan","68265MO001",,"MON001","MOS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","68265MO0010007-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mo/68265mo0010007-16","4"
"2016","MO","68265","HIOS","6","2015-10-22 04:38:36","1","68265","MO","SHOP (Small Group)","Yes","75-1233841","68265MO0020007","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","68265MO002",,"MON001","MOS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.29","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","68265MO0020007-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mo/68265mo0020007-16","4"
"2016","MO","68265","HIOS","6","2015-10-22 04:38:36","2","68265","MO","SHOP (Small Group)","Yes","75-1233841","68265MO0020010","Dentegra Dental PPO for Small Businesses Family Preferred Plan","68265MO002",,"MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.39","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","68265MO0020010-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mo/68265mo0020010-16","4"
"2016","MO","68265","HIOS","6","2015-10-22 04:38:36","2","68265","MO","Individual","Yes","75-1233841","68265MO0010010","Dentegra Dental PPO Family Preferred Plan","68265MO001",,"MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","68265MO0010010-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mo/68265mo0010010-16","4"
"2016","MO","68265","HIOS","6","2015-10-22 04:38:36","3","68265","MO","Individual","Yes","75-1233841","68265MO0010009","Dentegra Dental PPO Family Basic Plan","68265MO001",,"MON001","MOS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","68265MO0010009-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mo/68265mo0010009-16","4"
"2016","MO","68265","HIOS","6","2015-10-22 04:38:36","3","68265","MO","SHOP (Small Group)","Yes","75-1233841","68265MO0020009","Dentegra Dental PPO for Small Businesses Family Basic Plan","68265MO002",,"MON001","MOS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.29","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","68265MO0020009-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mo/68265mo0020009-16","4"
"2016","MO","68265","HIOS","6","2015-10-22 04:38:36","3","68265","MO","SHOP (Small Group)","Yes","75-1233841","68265MO0020009","Dentegra Dental PPO for Small Businesses Family Basic Plan","68265MO002",,"MON001","MOS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.29","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","68265MO0020009-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mo/68265mo0020009-16","5"
"2016","MO","68265","HIOS","6","2015-10-22 04:38:36","3","68265","MO","Individual","Yes","75-1233841","68265MO0010009","Dentegra Dental PPO Family Basic Plan","68265MO001",,"MON001","MOS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","68265MO0010009-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mo/68265mo0010009-16","5"
"2016","MO","68396","HIOS","2","2015-08-13 03:14:50","1","68396","MO","SHOP (Small Group)","Yes","13-5581829","68396MO0190001","Family Basic Dental Plan (Low)","68396MO019",,"MON001","MOS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$15.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","68396MO0190001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48045","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48044","4"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","2","74483","MO","Individual","No","59-1031071","74483MO0040007","Cigna Connect Flex Gold 1400","74483MO004","7730182962","MON001","MOS001","MOF005","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040007-03","Limited Cost Sharing Plan Variation","78.07%","0.782174229621887","Yes","Yes","No","100%",,"$1,400","$30","$1,170","$30","$140","$320","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-gold-1400-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-gold-1400-naan-300a","21"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","3","74483","MO","Individual","No","59-1031071","74483MO0040006","Cigna Connect Flex Silver 2500","74483MO004","7730182962","MON001","MOS001","MOF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040006-00","Standard Silver Off Exchange Plan","71.76%","0.720958709716797","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$350","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-silver-2500","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-silver-2500","4"
"2016","MO","68396","HIOS","2","2015-08-13 03:14:50","1","68396","MO","SHOP (Small Group)","Yes","13-5581829","68396MO0190001","Family Basic Dental Plan (Low)","68396MO019",,"MON001","MOS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$15.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","68396MO0190001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48045","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48044","5"
"2016","MO","68396","HIOS","2","2015-08-13 03:14:50","2","68396","MO","SHOP (Small Group)","Yes","13-5581829","68396MO0200001","Family Enhanced Dental Plan (High)","68396MO020",,"MON001","MOS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$19.31","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","68396MO0200001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49094","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49093","4"
"2016","MO","68396","HIOS","2","2015-08-13 03:14:50","2","68396","MO","SHOP (Small Group)","Yes","13-5581829","68396MO0200001","Family Enhanced Dental Plan (High)","68396MO020",,"MON001","MOS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$19.31","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","68396MO0200001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49094","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49093","5"
"2016","MO","71691","HIOS","2","2015-07-10 02:19:03","1","71691","MO","SHOP (Small Group)","Yes","57-0523959","71691MO0030001","Group Dental Policy","71691MO003",,"MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.50","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","71691MO0030001-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","1","74483","MO","Individual","No","59-1031071","74483MO0040001","Cigna Connect  HSA Bronze 6000","74483MO004","7730182962","MON001","MOS001","MOF001","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040001-00","Standard Bronze Off Exchange Plan",,"0.61153781414032","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,030","$0","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/hsa-bronze-6000","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/hsa-bronze-6000","4"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","1","74483","MO","Individual","Yes","59-1031071","74483MO0030001","Cigna Dental Pediatric","74483MO003","7730182962","MON002","MOS002",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$20.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","All Services","Yes",,"","74483MO0030001-00","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","1","74483","MO","Individual","No","59-1031071","74483MO0040001","Cigna Connect  HSA Bronze 6000","74483MO004","7730182962","MON001","MOS001","MOF001","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040001-01","Standard Bronze On Exchange Plan",,"0.61153781414032","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,030","$0","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/hsa-bronze-6000","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/hsa-bronze-6000","5"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","1","74483","MO","Individual","No","59-1031071","74483MO0040001","Cigna Connect  HSA Bronze 6000","74483MO004","7730182962","MON001","MOS001","MOF001","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/naan-300b","6"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","1","74483","MO","Individual","No","59-1031071","74483MO0040001","Cigna Connect  HSA Bronze 6000","74483MO004","7730182962","MON001","MOS001","MOF001","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040001-03","Limited Cost Sharing Plan Variation",,"0.61153781414032","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,030","$0","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/hsa-bronze-6000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/hsa-bronze-6000-naan-300a","7"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","1","74483","MO","Individual","No","59-1031071","74483MO0040003","Cigna Connect HSA Silver 2700","74483MO004","7730182962","MON001","MOS001","MOF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040003-00","Standard Silver Off Exchange Plan",,"0.680516302585602","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$350","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/hsa-silver-2700","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/hsa-silver-2700","8"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","1","74483","MO","Individual","No","59-1031071","74483MO0040003","Cigna Connect HSA Silver 2700","74483MO004","7730182962","MON001","MOS001","MOF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040003-01","Standard Silver On Exchange Plan",,"0.680516302585602","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$350","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/hsa-silver-2700","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/hsa-silver-2700","9"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","1","74483","MO","Individual","No","59-1031071","74483MO0040003","Cigna Connect HSA Silver 2700","74483MO004","7730182962","MON001","MOS001","MOF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/naan-300b","10"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","1","74483","MO","Individual","No","59-1031071","74483MO0040003","Cigna Connect HSA Silver 2700","74483MO004","7730182962","MON001","MOS001","MOF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040003-03","Limited Cost Sharing Plan Variation",,"0.680516302585602","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$350","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/hsa-silver-2700-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/hsa-silver-2700-naan-300a","11"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","1","74483","MO","Individual","No","59-1031071","74483MO0040003","Cigna Connect HSA Silver 2700","74483MO004","7730182962","MON001","MOS001","MOF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040003-04","73% AV Level Silver Plan",,"0.720354199409485","Yes","Yes","No","100%",,"$2,100","$0","$800","$30","$2,100","$0","$440","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/hsa-silver-2700-250","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/hsa-silver-2700-250","12"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","1","74483","MO","Individual","No","59-1031071","74483MO0040003","Cigna Connect HSA Silver 2700","74483MO004","7730182962","MON001","MOS001","MOF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040003-05","87% AV Level Silver Plan",,"0.860987782478333","Yes","Yes","No","100%",,"$500","$0","$1,040","$30","$500","$0","$680","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/hsa-silver-2700-200","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/hsa-silver-2700-200","13"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","1","74483","MO","Individual","No","59-1031071","74483MO0040003","Cigna Connect HSA Silver 2700","74483MO004","7730182962","MON001","MOS001","MOF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040003-06","94% AV Level Silver Plan",,"0.9306760430336","Yes","Yes","No","100%",,"$100","$0","$730","$30","$100","$0","$490","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/hsa-silver-2700-150","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/hsa-silver-2700-150","14"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","2","74483","MO","Individual","No","59-1031071","74483MO0040004","Cigna Connect Flex Silver 4000","74483MO004","7730182962","MON001","MOS001","MOF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040004-00","Standard Silver Off Exchange Plan","68.46%","0.689324140548706","Yes","Yes","No","100%",,"$4,000","$70","$970","$30","$140","$760","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-silver-4000","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-silver-4000","4"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","2","74483","MO","Individual","No","59-1031071","74483MO0040004","Cigna Connect Flex Silver 4000","74483MO004","7730182962","MON001","MOS001","MOF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040004-01","Standard Silver On Exchange Plan","68.46%","0.689324140548706","Yes","Yes","No","100%",,"$4,000","$70","$970","$30","$140","$760","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-silver-4000","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-silver-4000","5"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","2","74483","MO","Individual","No","59-1031071","74483MO0040004","Cigna Connect Flex Silver 4000","74483MO004","7730182962","MON001","MOS001","MOF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/naan-300b","6"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","2","74483","MO","Individual","No","59-1031071","74483MO0040004","Cigna Connect Flex Silver 4000","74483MO004","7730182962","MON001","MOS001","MOF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040004-03","Limited Cost Sharing Plan Variation","68.46%","0.689324140548706","Yes","Yes","No","100%",,"$4,000","$70","$970","$30","$140","$760","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-silver-4000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-silver-4000-naan-300a","7"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","2","74483","MO","Individual","No","59-1031071","74483MO0040004","Cigna Connect Flex Silver 4000","74483MO004","7730182962","MON001","MOS001","MOF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040004-04","73% AV Level Silver Plan","72.10%","0.722746670246124","Yes","Yes","No","100%",,"$2,700","$70","$1,360","$30","$140","$760","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-silver-4000-250","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-silver-4000-250","8"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","2","74483","MO","Individual","No","59-1031071","74483MO0040004","Cigna Connect Flex Silver 4000","74483MO004","7730182962","MON001","MOS001","MOF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040004-05","87% AV Level Silver Plan","86.11%","0.863992750644684","Yes","Yes","No","100%",,"$250","$40","$1,440","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-silver-4000-200","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-silver-4000-200","9"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","2","74483","MO","Individual","No","59-1031071","74483MO0040004","Cigna Connect Flex Silver 4000","74483MO004","7730182962","MON001","MOS001","MOF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040004-06","94% AV Level Silver Plan","93.09%","0.93265026807785","Yes","Yes","No","100%",,"$100","$40","$360","$30","$100","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-silver-4000-150","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-silver-4000-150","10"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","2","74483","MO","Individual","No","59-1031071","74483MO0040005","Cigna Connect Flex Silver 3000","74483MO004","7730182962","MON001","MOS001","MOF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040005-00","Standard Silver Off Exchange Plan","70.68%","0.7088902592659","Yes","Yes","No","100%",,"$3,000","$70","$850","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-silver-3000","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-silver-3000","11"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","2","74483","MO","Individual","No","59-1031071","74483MO0040007","Cigna Connect Flex Gold 1400","74483MO004","7730182962","MON001","MOS001","MOF005","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040007-01","Standard Gold On Exchange Plan","78.07%","0.782174229621887","Yes","Yes","No","100%",,"$1,400","$30","$1,170","$30","$140","$320","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-gold-1400","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-gold-1400","19"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","2","74483","MO","Individual","No","59-1031071","74483MO0040007","Cigna Connect Flex Gold 1400","74483MO004","7730182962","MON001","MOS001","MOF005","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/naan-300b","20"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","3","74483","MO","Individual","No","59-1031071","74483MO0040006","Cigna Connect Flex Silver 2500","74483MO004","7730182962","MON001","MOS001","MOF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040006-01","Standard Silver On Exchange Plan","71.76%","0.720958709716797","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$350","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-silver-2500","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-silver-2500","5"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","3","74483","MO","Individual","No","59-1031071","74483MO0040006","Cigna Connect Flex Silver 2500","74483MO004","7730182962","MON001","MOS001","MOF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/naan-300b","6"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","3","74483","MO","Individual","No","59-1031071","74483MO0040006","Cigna Connect Flex Silver 2500","74483MO004","7730182962","MON001","MOS001","MOF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040006-03","Limited Cost Sharing Plan Variation","71.76%","0.720958709716797","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$350","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-silver-2500-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-silver-2500-naan-300a","7"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","3","74483","MO","Individual","No","59-1031071","74483MO0040006","Cigna Connect Flex Silver 2500","74483MO004","7730182962","MON001","MOS001","MOF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040006-04","73% AV Level Silver Plan","73.93%","0.742500305175781","Yes","Yes","No","100%",,"$2,100","$0","$800","$30","$2,100","$0","$440","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-silver-2500-250","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-silver-2500-250","8"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","3","74483","MO","Individual","No","59-1031071","74483MO0040006","Cigna Connect Flex Silver 2500","74483MO004","7730182962","MON001","MOS001","MOF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040006-05","87% AV Level Silver Plan","87.26%","0.876711249351501","Yes","Yes","No","100%",,"$500","$0","$1,040","$30","$500","$0","$680","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-silver-2500-200","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-silver-2500-200","9"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","3","74483","MO","Individual","No","59-1031071","74483MO0040006","Cigna Connect Flex Silver 2500","74483MO004","7730182962","MON001","MOS001","MOF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040006-06","94% AV Level Silver Plan","93.35%","0.937468945980072","Yes","Yes","No","100%",,"$100","$0","$730","$30","$100","$0","$490","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-silver-2500-150","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-silver-2500-150","10"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","3","74483","MO","Individual","No","59-1031071","74483MO0040008","Cigna Connect Flex Gold 1000","74483MO004","7730182962","MON001","MOS001","MOF006","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040008-00","Standard Gold Off Exchange Plan","78.65%","0.789743006229401","Yes","Yes","No","100%",,"$1,000","$30","$1,250","$30","$140","$320","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-gold-1000","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-gold-1000","11"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","3","74483","MO","Individual","No","59-1031071","74483MO0040008","Cigna Connect Flex Gold 1000","74483MO004","7730182962","MON001","MOS001","MOF006","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040008-01","Standard Gold On Exchange Plan","78.65%","0.789743006229401","Yes","Yes","No","100%",,"$1,000","$30","$1,250","$30","$140","$320","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-gold-1000","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-gold-1000","12"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","3","74483","MO","Individual","No","59-1031071","74483MO0040008","Cigna Connect Flex Gold 1000","74483MO004","7730182962","MON001","MOS001","MOF006","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/naan-300b","13"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","3","74483","MO","Individual","No","59-1031071","74483MO0040008","Cigna Connect Flex Gold 1000","74483MO004","7730182962","MON001","MOS001","MOF006","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040008-03","Limited Cost Sharing Plan Variation","78.65%","0.789743006229401","Yes","Yes","No","100%",,"$1,000","$30","$1,250","$30","$140","$320","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-gold-1000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-gold-1000-naan-300a","14"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","4","74483","MO","Individual","No","59-1031071","74483MO0040002","Cigna Connect Flex Bronze 6400","74483MO004","7730182962","MON001","MOS001","MOF002","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040002-00","Standard Bronze Off Exchange Plan","61.77%","0.637247323989868","Yes","Yes","No","100%",,"$5,170","$70","$340","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-bronze-6400","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-bronze-6400","4"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","4","74483","MO","Individual","No","59-1031071","74483MO0040002","Cigna Connect Flex Bronze 6400","74483MO004","7730182962","MON001","MOS001","MOF002","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040002-01","Standard Bronze On Exchange Plan","61.77%","0.637247323989868","Yes","Yes","No","100%",,"$5,170","$70","$340","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-bronze-6400","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-bronze-6400","5"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","4","74483","MO","Individual","No","59-1031071","74483MO0040002","Cigna Connect Flex Bronze 6400","74483MO004","7730182962","MON001","MOS001","MOF002","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/naan-300b","6"
"2016","MO","74483","HIOS","10","2016-01-29 04:56:16","4","74483","MO","Individual","No","59-1031071","74483MO0040002","Cigna Connect Flex Bronze 6400","74483MO004","7730182962","MON001","MOS001","MOF002","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","74483MO0040002-03","Limited Cost Sharing Plan Variation","61.77%","0.637247323989868","Yes","Yes","No","100%",,"$5,170","$70","$340","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/missouri/flex-bronze-6400-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/missouri/flex-bronze-6400-naan-300a","7"
"2016","MO","81313","HIOS","3","2015-07-11 04:19:24","1","81313","MO","Individual","Yes","72-0977315","81313MO0050001","AlwaysCare All-Star Kids Dental Plan 2016","81313MO005",,"MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$21.02","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","81313MO0050001-00","Standard High Off Exchange Plan","86.01%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","MO","81313","HIOS","3","2015-07-11 04:19:24","1","81313","MO","SHOP (Small Group)","Yes","72-0977315","81313MO0080001","AlwaysCare Small Group Dental – Child 2016","81313MO008",,"MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$26.38","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","81313MO0080001-00","Standard High Off Exchange Plan","86.01%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","MO","81313","HIOS","3","2015-07-11 04:19:24","1","81313","MO","SHOP (Small Group)","Yes","72-0977315","81313MO0080002","AlwaysCare Small Group Dental – Child 2016","81313MO008",,"MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$21.75","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","81313MO0080002-00","Standard Low Off Exchange Plan","70.92%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","MO","81313","HIOS","3","2015-07-11 04:19:24","1","81313","MO","Individual","Yes","72-0977315","81313MO0050002","AlwaysCare All-Star Kids Dental Plan 2016","81313MO005",,"MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$17.12","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","81313MO0050002-00","Standard Low Off Exchange Plan","70.92%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490014","Humana Gold 2250/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490014-00","Standard Gold Off Exchange Plan","78.03%","0.784799635410309","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608723","http://apps.humana.com/marketing/documents.asp?file=2593097","26"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490013","Humana Silver 3800/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490013-03","Limited Cost Sharing Plan Variation","68.21%","0.687039494514465","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608671","http://apps.humana.com/marketing/documents.asp?file=2593084","22"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500021","Humana Silver 4250/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF006","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500021-06","94% AV Level Silver Plan","93.10%","0.931573808193207","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2622256","http://apps.humana.com/marketing/documents.asp?file=2622178","18"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500023","Humana Silver 4250/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF006","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500023-00","Standard Silver Off Exchange Plan","68.55%","0.689791142940521","No","Yes","Yes","97%","3%","$4,250","$20","$180","$150","$4,250","$140","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","$6,250","$6250 per person","$12500 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","20%","$4,250","$4250 per person","$8500 per group","20%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608294","http://apps.humana.com/marketing/documents.asp?file=2593019","19"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010003","Ambetter Balanced Care 2 (2016)","90714MS001",,"MSN001","MSS001","MSF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010003-05","87% AV Level Silver Plan",,"0.873916625976563","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,700","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010003-05.pdf","https://api.centene.com/Brochures/2016/90714MS0010003-05.pdf","20"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010003","Ambetter Balanced Care 2 (2016)","90714MS001",,"MSN001","MSS001","MSF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010003-06","94% AV Level Silver Plan",,"0.9492227435112","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010003-06.pdf","https://api.centene.com/Brochures/2016/90714MS0010003-06.pdf","21"
"2016","MO","81313","HIOS","3","2015-07-11 04:19:24","2","81313","MO","Individual","Yes","72-0977315","81313MO0060001","AlwaysCare All-Star Family Dental Plan 2016","81313MO006",,"MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$21.02","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","81313MO0060001-00","Standard High Off Exchange Plan","86.01%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","MO","81313","HIOS","3","2015-07-11 04:19:24","2","81313","MO","SHOP (Small Group)","Yes","72-0977315","81313MO0070001","AlwaysCare Small Group Dental – Adults 2016","81313MO007",,"MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$26.38","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","81313MO0070001-00","Standard High Off Exchange Plan","86.01%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","MO","81313","HIOS","3","2015-07-11 04:19:24","2","81313","MO","SHOP (Small Group)","Yes","72-0977315","81313MO0070002","AlwaysCare Small Group Dental – Adults 2016","81313MO007",,"MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$21.75","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","81313MO0070002-00","Standard Low Off Exchange Plan","70.92%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","MO","81313","HIOS","3","2015-07-11 04:19:24","3","81313","MO","Individual","Yes","72-0977315","81313MO0060002","AlwaysCare All-Star Family Dental Plan 2016","81313MO006",,"MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$17.12","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","81313MO0060002-00","Standard Low Off Exchange Plan","70.92%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","MO","82905","HIOS","5","2015-10-20 04:38:50","1","82905","MO","SHOP (Small Group)","Yes","36-3757528","82905MO0030001","TruAssure Dental Small Group Basic Plan","82905MO003",,"MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.72","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","82905MO0030001-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","82905","HIOS","5","2015-10-20 04:38:50","1","82905","MO","Individual","Yes","36-3757528","82905MO0010001","TruAssure Basic Adult or Child Dental Plan","82905MO001",,"MON001","MOS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.25","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82905MO0010001-00","Standard Low Off Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$105","$105 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MO","https://www.truassure.com/brochure?state=MO","4"
"2016","MO","82905","HIOS","5","2015-10-20 04:38:50","1","82905","MO","Individual","Yes","36-3757528","82905MO0010001","TruAssure Basic Adult or Child Dental Plan","82905MO001",,"MON001","MOS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.25","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82905MO0010001-01","Standard Low On Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$105","$105 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MO","https://www.truassure.com/brochure?state=MO","5"
"2016","MO","82905","HIOS","5","2015-10-20 04:38:50","1","82905","MO","SHOP (Small Group)","Yes","36-3757528","82905MO0040001","TruAssure Dental Small Group Preferred Plan","82905MO004",,"MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.72","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","82905MO0040001-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MO","82905","HIOS","5","2015-10-20 04:38:50","2","82905","MO","Individual","Yes","36-3757528","82905MO0020001","TruAssure Preferred Adult or Child Dental Plan","82905MO002",,"MON001","MOS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.05","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82905MO0020001-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MO","https://www.truassure.com/brochure?state=MO","4"
"2016","MO","82905","HIOS","5","2015-10-20 04:38:50","2","82905","MO","Individual","Yes","36-3757528","82905MO0020001","TruAssure Preferred Adult or Child Dental Plan","82905MO002",,"MON001","MOS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.05","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82905MO0020001-01","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MO","https://www.truassure.com/brochure?state=MO","5"
"2016","MO","86182","HIOS","1","2015-05-01 02:23:41","1","86182","MO","SHOP (Small Group)","Yes","93-0242990","86182MO0030002","EHB High Passive","86182MO003",,"MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.66","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","86182MO0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","MO","86182","HIOS","1","2015-05-01 02:23:41","1","86182","MO","SHOP (Small Group)","Yes","93-0242990","86182MO0030001","EHB Low Passive","86182MO003",,"MON001","MOS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.30","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","86182MO0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","MO","86779","HIOS","2","2015-07-10 02:19:03","1","86779","MO","SHOP (Small Group)","Yes","42-0127290","86779MO0040001","Principal Plan Dental 70","86779MO004",,"MON001","MOS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$27.11","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","86779MO0040001-00","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MO","86779","HIOS","2","2015-07-10 02:19:03","1","86779","MO","SHOP (Small Group)","Yes","42-0127290","86779MO0040002","Principal Plan Dental 85","86779MO004",,"MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$28.65","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","86779MO0040002-00","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MO","94322","HIOS","1","2015-05-01 02:23:41","1","94322","MO","SHOP (Small Group)","Yes","36-0883760","94322MO0030002","EHB High Passive","94322MO003",,"MON001","MOS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.54","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","94322MO0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","MO","94322","HIOS","1","2015-05-01 02:23:41","1","94322","MO","SHOP (Small Group)","Yes","36-0883760","94322MO0030001","EHB Low Passive","94322MO003",,"MON001","MOS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.23","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","94322MO0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","MS","11324","HIOS","3","2015-08-27 11:14:25","1","11324","MS","Individual","Yes","95-6042390","11324MS0020003","BESTOne Advantage Gold","11324MS002",,"MSN001","MSS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.17","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MS/2016/MS_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","MS","11324","HIOS","3","2015-08-27 11:14:25","1","11324","MS","Individual","Yes","95-6042390","11324MS0020003","BESTOne Advantage Gold","11324MS002",,"MSN001","MSS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.17","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MS/2016/MS_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","MS","11324","HIOS","3","2015-08-27 11:14:25","1","11324","MS","Individual","Yes","95-6042390","11324MS0020004","BESTOne Plus Gold","11324MS002",,"MSN001","MSS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.17","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MS/2016/MS_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","MS","11324","HIOS","3","2015-08-27 11:14:25","1","11324","MS","Individual","Yes","95-6042390","11324MS0020004","BESTOne Plus Gold","11324MS002",,"MSN001","MSS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.17","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MS/2016/MS_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","MS","11324","HIOS","3","2015-08-27 11:14:25","2","11324","MS","Individual","Yes","95-6042390","11324MS0020005","BESTOne Plus Silver","11324MS002",,"MSN001","MSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.06","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MS/2016/MS_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","MS","11324","HIOS","3","2015-08-27 11:14:25","2","11324","MS","Individual","Yes","95-6042390","11324MS0020005","BESTOne Plus Silver","11324MS002",,"MSN001","MSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.06","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MS/2016/MS_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","MS","11324","HIOS","3","2015-08-27 11:14:25","2","11324","MS","Individual","Yes","95-6042390","11324MS0020006","BESTOne Basic Silver","11324MS002",,"MSN001","MSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.06","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MS/2016/MS_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","MS","11324","HIOS","3","2015-08-27 11:14:25","2","11324","MS","Individual","Yes","95-6042390","11324MS0020006","BESTOne Basic Silver","11324MS002",,"MSN001","MSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.06","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","11324MS0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MS/2016/MS_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","MS","46300","HIOS","1","2015-05-06 02:44:46","1","46300","MS","Individual","Yes","72-0977315","46300MS0090001","AlwaysCare All-Star Kids Dental Plan 2016","46300MS009",,"MSN001","MSS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$23.88","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","46300MS0090001-00","Standard High Off Exchange Plan","86.15%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","MS","46300","HIOS","1","2015-05-06 02:44:46","1","46300","MS","Individual","Yes","72-0977315","46300MS0090002","AlwaysCare All-Star Kids Dental Plan 2016","46300MS009",,"MSN001","MSS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$19.46","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","46300MS0090002-00","Standard Low Off Exchange Plan","70.82%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","MS","46300","HIOS","1","2015-05-06 02:44:46","2","46300","MS","Individual","Yes","72-0977315","46300MS0100001","AlwaysCare All-Star Family Dental Plan 2016","46300MS010",,"MSN001","MSS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$23.88","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","46300MS0100001-00","Standard High Off Exchange Plan","86.15%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","MS","46300","HIOS","1","2015-05-06 02:44:46","3","46300","MS","Individual","Yes","72-0977315","46300MS0100002","AlwaysCare All-Star Family Dental Plan 2016","46300MS010",,"MSN001","MSS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$17.74","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","46300MS0100002-00","Standard Low Off Exchange Plan","70.82%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","1","48963","MS","Individual","No","39-1263473","48963MS0490001","Humana Basic 6850/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF001","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","48963MS0490001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2608801","http://apps.humana.com/marketing/documents.asp?file=2593123","4"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","1","48963","MS","Individual","Yes","39-1263473","48963MS0510001","Humana Dental Smart Choice","48963MS051",,"MSN003","MSS003",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.90","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","48963MS0510001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612948","4"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","1","48963","MS","Individual","Yes","39-1263473","48963MS0510001","Humana Dental Smart Choice","48963MS051",,"MSN003","MSS003",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.90","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","48963MS0510001-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612948","5"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","1","48963","MS","Individual","No","39-1263473","48963MS0490001","Humana Basic 6850/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF001","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","48963MS0490001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2608801","http://apps.humana.com/marketing/documents.asp?file=2593123","5"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","1","48963","MS","Individual","No","39-1263473","48963MS0490011","Humana Basic 6850/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF001","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","48963MS0490011-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2608515","http://apps.humana.com/marketing/documents.asp?file=2593058","6"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","1","48963","MS","Individual","No","39-1263473","48963MS0490011","Humana Basic 6850/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF001","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","48963MS0490011-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2608515","http://apps.humana.com/marketing/documents.asp?file=2593058","7"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","2","48963","MS","Individual","No","39-1263473","48963MS0490002","Humana Bronze 6450/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","48963MS0490002-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2608814","http://apps.humana.com/marketing/documents.asp?file=2593136","4"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","2","48963","MS","Individual","No","39-1263473","48963MS0490002","Humana Bronze 6450/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","48963MS0490002-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2608814","http://apps.humana.com/marketing/documents.asp?file=2593136","5"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","2","48963","MS","Individual","No","39-1263473","48963MS0490002","Humana Bronze 6450/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","48963MS0490002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2608827","http://apps.humana.com/marketing/documents.asp?file=2593136","6"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","2","48963","MS","Individual","No","39-1263473","48963MS0490002","Humana Bronze 6450/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","48963MS0490002-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2608840","http://apps.humana.com/marketing/documents.asp?file=2593136","7"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490013","Humana Silver 3800/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490013-06","94% AV Level Silver Plan","93.14%","0.932067096233368","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608710","http://apps.humana.com/marketing/documents.asp?file=2623660","25"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490014","Humana Gold 2250/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490014-01","Standard Gold On Exchange Plan","78.03%","0.784799635410309","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608723","http://apps.humana.com/marketing/documents.asp?file=2593097","27"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490014","Humana Gold 2250/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490014-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608736","http://apps.humana.com/marketing/documents.asp?file=2593097","28"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010002","Ambetter Balanced Care 1 (2016)","90714MS001",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010002-03","Limited Cost Sharing Plan Variation",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010002-03.pdf","https://api.centene.com/Brochures/2016/90714MS0010002-03.pdf","11"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010002","Ambetter Balanced Care 1 (2016)","90714MS001",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010002-04","73% AV Level Silver Plan",,"0.737546384334564","Yes","Yes","No","100%",,"$3,500","$10","$300","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010002-04.pdf","https://api.centene.com/Brochures/2016/90714MS0010002-04.pdf","12"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","2","48963","MS","Individual","No","39-1263473","48963MS0490012","Humana Bronze 6450/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","48963MS0490012-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2608541","http://apps.humana.com/marketing/documents.asp?file=2593071","8"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","2","48963","MS","Individual","No","39-1263473","48963MS0490012","Humana Bronze 6450/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","48963MS0490012-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2608541","http://apps.humana.com/marketing/documents.asp?file=2593071","9"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","2","48963","MS","Individual","No","39-1263473","48963MS0490012","Humana Bronze 6450/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","48963MS0490012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2608606","http://apps.humana.com/marketing/documents.asp?file=2593071","10"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","2","48963","MS","Individual","No","39-1263473","48963MS0490012","Humana Bronze 6450/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","48963MS0490012-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2608619","http://apps.humana.com/marketing/documents.asp?file=2593071","11"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490003","Humana Silver 3800/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490003-00","Standard Silver Off Exchange Plan","68.21%","0.687039494514465","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608853","http://apps.humana.com/marketing/documents.asp?file=2593149","4"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490003","Humana Silver 3800/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490003-01","Standard Silver On Exchange Plan","68.21%","0.687039494514465","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608853","http://apps.humana.com/marketing/documents.asp?file=2593149","5"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490003","Humana Silver 3800/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608866","http://apps.humana.com/marketing/documents.asp?file=2593149","6"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490003","Humana Silver 3800/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490003-03","Limited Cost Sharing Plan Variation","68.21%","0.687039494514465","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608879","http://apps.humana.com/marketing/documents.asp?file=2593149","7"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490003","Humana Silver 3800/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490003-04","73% AV Level Silver Plan","72.87%","0.732456624507904","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608892","http://apps.humana.com/marketing/documents.asp?file=2623673","8"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490003","Humana Silver 3800/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490003-05","87% AV Level Silver Plan","87.86%","0.881017088890076","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608918","http://apps.humana.com/marketing/documents.asp?file=2623686","9"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490003","Humana Silver 3800/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490003-06","94% AV Level Silver Plan","93.14%","0.932067096233368","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608931","http://apps.humana.com/marketing/documents.asp?file=2623699","10"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490004","Humana Gold 2250/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490004-00","Standard Gold Off Exchange Plan","78.03%","0.784799635410309","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608944","http://apps.humana.com/marketing/documents.asp?file=2593162","11"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490004","Humana Gold 2250/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490004-01","Standard Gold On Exchange Plan","78.03%","0.784799635410309","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608944","http://apps.humana.com/marketing/documents.asp?file=2593162","12"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490004","Humana Gold 2250/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608957","http://apps.humana.com/marketing/documents.asp?file=2593162","13"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490004","Humana Gold 2250/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490004-03","Limited Cost Sharing Plan Variation","78.03%","0.784799635410309","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608983","http://apps.humana.com/marketing/documents.asp?file=2593162","14"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490005","Humana Platinum 500/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490005-00","Standard Platinum Off Exchange Plan","88.47%","0.888415515422821","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608996","http://apps.humana.com/marketing/documents.asp?file=2593175","15"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490005","Humana Platinum 500/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490005-01","Standard Platinum On Exchange Plan","88.47%","0.888415515422821","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608996","http://apps.humana.com/marketing/documents.asp?file=2593175","16"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490005","Humana Platinum 500/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609009","http://apps.humana.com/marketing/documents.asp?file=2593175","17"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490005","Humana Platinum 500/Memphis PPOx","48963MS049",,"MSN002","MSS002","MSF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490005-03","Limited Cost Sharing Plan Variation","88.47%","0.888415515422821","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609022","http://apps.humana.com/marketing/documents.asp?file=2593175","18"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490013","Humana Silver 3800/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490013-00","Standard Silver Off Exchange Plan","68.21%","0.687039494514465","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608632","http://apps.humana.com/marketing/documents.asp?file=2593084","19"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490013","Humana Silver 3800/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490013-01","Standard Silver On Exchange Plan","68.21%","0.687039494514465","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608632","http://apps.humana.com/marketing/documents.asp?file=2593084","20"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490013","Humana Silver 3800/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490013-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608645","http://apps.humana.com/marketing/documents.asp?file=2593084","21"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490013","Humana Silver 3800/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490013-04","73% AV Level Silver Plan","72.87%","0.732456624507904","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608684","http://apps.humana.com/marketing/documents.asp?file=2623634","23"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490013","Humana Silver 3800/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490013-05","87% AV Level Silver Plan","87.86%","0.881017088890076","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608697","http://apps.humana.com/marketing/documents.asp?file=2623647","24"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490014","Humana Gold 2250/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490014-03","Limited Cost Sharing Plan Variation","78.03%","0.784799635410309","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608749","http://apps.humana.com/marketing/documents.asp?file=2593097","29"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490015","Humana Platinum 500/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490015-00","Standard Platinum Off Exchange Plan","88.47%","0.888415515422821","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608762","http://apps.humana.com/marketing/documents.asp?file=2593110","30"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490015","Humana Platinum 500/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490015-01","Standard Platinum On Exchange Plan","88.47%","0.888415515422821","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608762","http://apps.humana.com/marketing/documents.asp?file=2593110","31"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490015","Humana Platinum 500/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608775","http://apps.humana.com/marketing/documents.asp?file=2593110","32"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","3","48963","MS","Individual","No","39-1263473","48963MS0490015","Humana Platinum 500/Jackson PPOx","48963MS049",,"MSN001","MSS001","MSF003","Existing","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","48963MS0490015-03","Limited Cost Sharing Plan Variation","88.47%","0.888415515422821","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608788","http://apps.humana.com/marketing/documents.asp?file=2593110","33"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","4","48963","MS","Individual","No","39-1263473","48963MS0500007","Humana Basic 6850/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF004","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500007-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2608190","http://apps.humana.com/marketing/documents.asp?file=2592980","4"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","4","48963","MS","Individual","No","39-1263473","48963MS0500007","Humana Basic 6850/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF004","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500007-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2608190","http://apps.humana.com/marketing/documents.asp?file=2592980","5"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","4","48963","MS","Individual","No","39-1263473","48963MS0500013","Humana Basic 6850/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF004","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500013-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2609035","http://apps.humana.com/marketing/documents.asp?file=2593188","6"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","4","48963","MS","Individual","No","39-1263473","48963MS0500013","Humana Basic 6850/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF004","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2609035","http://apps.humana.com/marketing/documents.asp?file=2593188","7"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500008","Humana Bronze 6450/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF004","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500008-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2608203","http://apps.humana.com/marketing/documents.asp?file=2592993","4"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500008","Humana Bronze 6450/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF004","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500008-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2608203","http://apps.humana.com/marketing/documents.asp?file=2592993","5"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500008","Humana Bronze 6450/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF004","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2608216","http://apps.humana.com/marketing/documents.asp?file=2592993","6"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500008","Humana Bronze 6450/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF004","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500008-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2608242","http://apps.humana.com/marketing/documents.asp?file=2592993","7"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500011","Humana Silver 4125/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF004","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500011-00","Standard Silver Off Exchange Plan",,"0.680907964706421","Yes","Yes","No","100%",,"$4,125","$0","$0","$150","$4,125","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group","0%",,,,,"$8,250","$8250 per person","$16500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2608372","http://apps.humana.com/marketing/documents.asp?file=2593032","8"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500011","Humana Silver 4125/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF004","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500011-01","Standard Silver On Exchange Plan",,"0.680907964706421","Yes","Yes","No","100%",,"$4,125","$0","$0","$150","$4,125","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group","0%",,,,,"$8,250","$8250 per person","$16500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2608372","http://apps.humana.com/marketing/documents.asp?file=2593032","9"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500011","Humana Silver 4125/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF004","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2608385","http://apps.humana.com/marketing/documents.asp?file=2593032","10"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500011","Humana Silver 4125/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF004","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500011-03","Limited Cost Sharing Plan Variation",,"0.680907964706421","Yes","Yes","No","100%",,"$4,125","$0","$0","$150","$4,125","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group","0%",,,,,"$8,250","$8250 per person","$16500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2608398","http://apps.humana.com/marketing/documents.asp?file=2593032","11"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500011","Humana Silver 4125/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF004","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500011-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$150","$3,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$8,250","$8250 per person","$16500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2608424","http://apps.humana.com/marketing/documents.asp?file=2593032","12"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500011","Humana Silver 4125/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF004","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500011-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$150","$1,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0%",,,,,"$8,250","$8250 per person","$16500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2608437","http://apps.humana.com/marketing/documents.asp?file=2593032","13"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500011","Humana Silver 4125/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF004","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500011-06","94% AV Level Silver Plan",,"0.94233250617981","Yes","Yes","No","100%",,"$475","$0","$0","$150","$475","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$475","$475 per person","$950 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$475","$475 per person","$950 per group","0%",,,,,"$8,250","$8250 per person","$16500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2608463","http://apps.humana.com/marketing/documents.asp?file=2593032","14"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500014","Humana Bronze 6450/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF004","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500014-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609048","http://apps.humana.com/marketing/documents.asp?file=2593201","15"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500014","Humana Bronze 6450/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF004","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500014-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609048","http://apps.humana.com/marketing/documents.asp?file=2593201","16"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500014","Humana Bronze 6450/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF004","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2609061","http://apps.humana.com/marketing/documents.asp?file=2593201","17"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500014","Humana Bronze 6450/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF004","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500014-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609074","http://apps.humana.com/marketing/documents.asp?file=2593201","18"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500017","Humana Silver 4125/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF004","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500017-00","Standard Silver Off Exchange Plan",,"0.680907964706421","Yes","Yes","No","100%",,"$4,125","$0","$0","$150","$4,125","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group","0%",,,,,"$8,250","$8250 per person","$16500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609126","http://apps.humana.com/marketing/documents.asp?file=2593227","19"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500017","Humana Silver 4125/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF004","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500017-01","Standard Silver On Exchange Plan",,"0.680907964706421","Yes","Yes","No","100%",,"$4,125","$0","$0","$150","$4,125","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group","0%",,,,,"$8,250","$8250 per person","$16500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609126","http://apps.humana.com/marketing/documents.asp?file=2593227","20"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500017","Humana Silver 4125/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF004","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2609139","http://apps.humana.com/marketing/documents.asp?file=2593227","21"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500017","Humana Silver 4125/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF004","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500017-03","Limited Cost Sharing Plan Variation",,"0.680907964706421","Yes","Yes","No","100%",,"$4,125","$0","$0","$150","$4,125","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group","0%",,,,,"$8,250","$8250 per person","$16500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609152","http://apps.humana.com/marketing/documents.asp?file=2593227","22"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500017","Humana Silver 4125/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF004","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500017-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$150","$3,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$8,250","$8250 per person","$16500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609165","http://apps.humana.com/marketing/documents.asp?file=2593227","23"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500017","Humana Silver 4125/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF004","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500017-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$150","$1,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0%",,,,,"$8,250","$8250 per person","$16500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2609178","http://apps.humana.com/marketing/documents.asp?file=2593227","24"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","5","48963","MS","Individual","No","39-1263473","48963MS0500017","Humana Silver 4125/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF004","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-EHB","48963MS0500017-06","94% AV Level Silver Plan",,"0.94233250617981","Yes","Yes","No","100%",,"$475","$0","$0","$150","$475","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$475","$475 per person","$950 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$475","$475 per person","$950 per group","0%",,,,,"$8,250","$8250 per person","$16500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2609204","http://apps.humana.com/marketing/documents.asp?file=2593227","25"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","6","48963","MS","Individual","No","39-1263473","48963MS0500009","Humana Bronze 4850/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF005","Existing","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500009-00","Standard Bronze Off Exchange Plan","61.73%","0.613858461380005","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$25,400","$25400 per person","$50800 per group","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","$9,700","$9700 per person","$19400 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608255","http://apps.humana.com/marketing/documents.asp?file=2593006","4"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","6","48963","MS","Individual","No","39-1263473","48963MS0500009","Humana Bronze 4850/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF005","Existing","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500009-01","Standard Bronze On Exchange Plan","61.73%","0.613858461380005","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$25,400","$25400 per person","$50800 per group","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","$9,700","$9700 per person","$19400 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608255","http://apps.humana.com/marketing/documents.asp?file=2593006","5"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","6","48963","MS","Individual","No","39-1263473","48963MS0500009","Humana Bronze 4850/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF005","Existing","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608268","http://apps.humana.com/marketing/documents.asp?file=2593006","6"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","6","48963","MS","Individual","No","39-1263473","48963MS0500009","Humana Bronze 4850/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF005","Existing","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500009-03","Limited Cost Sharing Plan Variation","61.73%","0.613858461380005","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$25,400","$25400 per person","$50800 per group","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","$9,700","$9700 per person","$19400 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608281","http://apps.humana.com/marketing/documents.asp?file=2593006","7"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","6","48963","MS","Individual","No","39-1263473","48963MS0500015","Humana Bronze 4850/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF005","Existing","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500015-00","Standard Bronze Off Exchange Plan","61.73%","0.613858461380005","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$25,400","$25400 per person","$50800 per group","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","$9,700","$9700 per person","$19400 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609087","http://apps.humana.com/marketing/documents.asp?file=2593214","8"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","6","48963","MS","Individual","No","39-1263473","48963MS0500015","Humana Bronze 4850/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF005","Existing","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500015-01","Standard Bronze On Exchange Plan","61.73%","0.613858461380005","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$25,400","$25400 per person","$50800 per group","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","$9,700","$9700 per person","$19400 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609087","http://apps.humana.com/marketing/documents.asp?file=2593214","9"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","6","48963","MS","Individual","No","39-1263473","48963MS0500015","Humana Bronze 4850/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF005","Existing","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609100","http://apps.humana.com/marketing/documents.asp?file=2593214","10"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","6","48963","MS","Individual","No","39-1263473","48963MS0500015","Humana Bronze 4850/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF005","Existing","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500015-03","Limited Cost Sharing Plan Variation","61.73%","0.613858461380005","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$25,400","$25400 per person","$50800 per group","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","$9,700","$9700 per person","$19400 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609113","http://apps.humana.com/marketing/documents.asp?file=2593214","11"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500012","Humana Gold 2250/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF007","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500012-00","Standard Gold Off Exchange Plan","78.70%","0.790790021419525","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608476","http://apps.humana.com/marketing/documents.asp?file=2593045","4"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500012","Humana Gold 2250/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF007","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500012-01","Standard Gold On Exchange Plan","78.70%","0.790790021419525","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608476","http://apps.humana.com/marketing/documents.asp?file=2593045","5"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500012","Humana Gold 2250/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF007","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500012-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608489","http://apps.humana.com/marketing/documents.asp?file=2593045","6"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500012","Humana Gold 2250/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF007","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500012-03","Limited Cost Sharing Plan Variation","78.70%","0.790790021419525","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608502","http://apps.humana.com/marketing/documents.asp?file=2593045","7"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500018","Humana Gold 2250/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF007","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500018-00","Standard Gold Off Exchange Plan","78.70%","0.790790021419525","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609217","http://apps.humana.com/marketing/documents.asp?file=2593240","8"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500018","Humana Gold 2250/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF007","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500018-01","Standard Gold On Exchange Plan","78.70%","0.790790021419525","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609217","http://apps.humana.com/marketing/documents.asp?file=2593240","9"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500018","Humana Gold 2250/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF007","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500018-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609230","http://apps.humana.com/marketing/documents.asp?file=2593240","10"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500018","Humana Gold 2250/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF007","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500018-03","Limited Cost Sharing Plan Variation","78.70%","0.790790021419525","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609243","http://apps.humana.com/marketing/documents.asp?file=2593240","11"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500021","Humana Silver 4250/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF006","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500021-00","Standard Silver Off Exchange Plan","68.55%","0.689791142940521","No","Yes","Yes","97%","3%","$4,250","$20","$180","$150","$4,250","$140","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","$6,250","$6250 per person","$12500 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","20%","$4,250","$4250 per person","$8500 per group","20%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2622191","http://apps.humana.com/marketing/documents.asp?file=2622139","12"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500021","Humana Silver 4250/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF006","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500021-01","Standard Silver On Exchange Plan","68.55%","0.689791142940521","No","Yes","Yes","97%","3%","$4,250","$20","$180","$150","$4,250","$140","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","$6,250","$6250 per person","$12500 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","20%","$4,250","$4250 per person","$8500 per group","20%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2622191","http://apps.humana.com/marketing/documents.asp?file=2622139","13"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500021","Humana Silver 4250/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF006","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500021-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2622204","http://apps.humana.com/marketing/documents.asp?file=2622139","14"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500021","Humana Silver 4250/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF006","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500021-03","Limited Cost Sharing Plan Variation","68.55%","0.689791142940521","No","Yes","Yes","97%","3%","$4,250","$20","$180","$150","$4,250","$140","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","$6,250","$6250 per person","$12500 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","20%","$4,250","$4250 per person","$8500 per group","20%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2622217","http://apps.humana.com/marketing/documents.asp?file=2622139","15"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500021","Humana Silver 4250/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF006","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500021-04","73% AV Level Silver Plan","73.73%","0.740572214126587","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2622230","http://apps.humana.com/marketing/documents.asp?file=2622152","16"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500021","Humana Silver 4250/Mississippi PPOx","48963MS050",,"MSN005","MSS005","MSF006","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500021-05","87% AV Level Silver Plan","87.93%","0.88136088848114","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2622243","http://apps.humana.com/marketing/documents.asp?file=2622165","17"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500023","Humana Silver 4250/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF006","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500023-01","Standard Silver On Exchange Plan","68.55%","0.689791142940521","No","Yes","Yes","97%","3%","$4,250","$20","$180","$150","$4,250","$140","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","$6,250","$6250 per person","$12500 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","20%","$4,250","$4250 per person","$8500 per group","20%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608294","http://apps.humana.com/marketing/documents.asp?file=2593019","20"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500023","Humana Silver 4250/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF006","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500023-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608307","http://apps.humana.com/marketing/documents.asp?file=2593019","21"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500023","Humana Silver 4250/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF006","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500023-03","Limited Cost Sharing Plan Variation","68.55%","0.689791142940521","No","Yes","Yes","97%","3%","$4,250","$20","$180","$150","$4,250","$140","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","$6,250","$6250 per person","$12500 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","20%","$4,250","$4250 per person","$8500 per group","20%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608320","http://apps.humana.com/marketing/documents.asp?file=2593019","22"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500023","Humana Silver 4250/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF006","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500023-04","73% AV Level Silver Plan","73.73%","0.740572214126587","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608333","http://apps.humana.com/marketing/documents.asp?file=2623556","23"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500023","Humana Silver 4250/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF006","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500023-05","87% AV Level Silver Plan","87.93%","0.88136088848114","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608346","http://apps.humana.com/marketing/documents.asp?file=2623569","24"
"2016","MS","48963","HIOS","7","2015-08-27 11:14:25","7","48963","MS","Individual","No","39-1263473","48963MS0500023","Humana Silver 4250/ChoiceCare PPO","48963MS050",,"MSN004","MSS004","MSF006","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx4-EHB","48963MS0500023-06","94% AV Level Silver Plan","93.10%","0.931573808193207","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2608359","http://apps.humana.com/marketing/documents.asp?file=2623582","25"
"2016","MS","49374","HIOS","7","2015-08-25 05:06:23","1","49374","MS","Individual","Yes","94-2761537","49374MS0010002","Delta Dental PPO Pediatric Preferred Plan","49374MS001",,"MSN001","MSS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.42","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","49374MS0010002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ms/49374ms0010002-16","4"
"2016","MS","49374","HIOS","7","2015-08-25 05:06:23","1","49374","MS","Individual","Yes","94-2761537","49374MS0010001","Delta Dental PPO Pediatric Basic Plan","49374MS001",,"MSN001","MSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.44","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","49374MS0010001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ms/49374ms0010001-16","5"
"2016","MS","49374","HIOS","7","2015-08-25 05:06:23","2","49374","MS","Individual","Yes","94-2761537","49374MS0010004","Delta Dental PPO Preferred Plan for Families","49374MS001",,"MSN001","MSS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.42","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","49374MS0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ms/49374ms0010004-16","4"
"2016","MS","49374","HIOS","7","2015-08-25 05:06:23","2","49374","MS","Individual","Yes","94-2761537","49374MS0010004","Delta Dental PPO Preferred Plan for Families","49374MS001",,"MSN001","MSS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.42","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","49374MS0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ms/49374ms0010004-16","5"
"2016","MS","49374","HIOS","7","2015-08-25 05:06:23","3","49374","MS","Individual","Yes","94-2761537","49374MS0010006","Delta Dental PPO Basic Plan for Families","49374MS001",,"MSN001","MSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.44","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","49374MS0010006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ms/49374ms0010006-16","4"
"2016","MS","49374","HIOS","7","2015-08-25 05:06:23","3","49374","MS","Individual","Yes","94-2761537","49374MS0010006","Delta Dental PPO Basic Plan for Families","49374MS001",,"MSN001","MSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.44","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","49374MS0010006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ms/49374ms0010006-16","5"
"2016","MS","60328","HIOS","8","2015-08-25 05:06:23","1","60328","MS","Individual","Yes","75-1233841","60328MS0010001","Dentegra Dental PPO Pediatric Basic Plan","60328MS001",,"MSN001","MSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.81","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","60328MS0010001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ms/60328ms0010001-16","4"
"2016","MS","60328","HIOS","8","2015-08-25 05:06:23","2","60328","MS","Individual","Yes","75-1233841","60328MS0010004","Dentegra Dental PPO Family Preferred Plan","60328MS001",,"MSN001","MSS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.30","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","60328MS0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ms/60328ms0010004-16","4"
"2016","MS","60328","HIOS","8","2015-08-25 05:06:23","2","60328","MS","Individual","Yes","75-1233841","60328MS0010004","Dentegra Dental PPO Family Preferred Plan","60328MS001",,"MSN001","MSS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.30","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","60328MS0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ms/60328ms0010004-16","5"
"2016","MS","60328","HIOS","8","2015-08-25 05:06:23","3","60328","MS","Individual","Yes","75-1233841","60328MS0010006","Dentegra Dental PPO Family Basic Plan","60328MS001",,"MSN001","MSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.81","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","60328MS0010006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ms/60328ms0010006-16","4"
"2016","MS","60328","HIOS","8","2015-08-25 05:06:23","3","60328","MS","Individual","Yes","75-1233841","60328MS0010006","Dentegra Dental PPO Family Basic Plan","60328MS001",,"MSN001","MSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.81","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","60328MS0010006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ms/60328ms0010006-16","5"
"2016","MS","74718","HIOS","4","2015-10-20 04:38:50","1","74718","MS","Individual","Yes","36-3757528","74718MS0010001","TruAssure Basic Adult or Child Dental Plan","74718MS001",,"MSN001","MSS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.07","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74718MS0010001-00","Standard Low Off Exchange Plan","68.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MS","https://www.truassure.com/brochure?state=MS","4"
"2016","MS","74718","HIOS","4","2015-10-20 04:38:50","1","74718","MS","Individual","Yes","36-3757528","74718MS0010001","TruAssure Basic Adult or Child Dental Plan","74718MS001",,"MSN001","MSS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.07","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74718MS0010001-01","Standard Low On Exchange Plan","68.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MS","https://www.truassure.com/brochure?state=MS","5"
"2016","MS","74718","HIOS","4","2015-10-20 04:38:50","2","74718","MS","Individual","Yes","36-3757528","74718MS0020001","TruAssure Preferred Adult or Child Dental Plan","74718MS002",,"MSN001","MSS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.60","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74718MS0020001-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MS","https://www.truassure.com/brochure?state=MS","4"
"2016","MS","74718","HIOS","4","2015-10-20 04:38:50","2","74718","MS","Individual","Yes","36-3757528","74718MS0020001","TruAssure Preferred Adult or Child Dental Plan","74718MS002",,"MSN001","MSS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.60","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","74718MS0020001-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MS","https://www.truassure.com/brochure?state=MS","5"
"2016","MS","84254","HIOS","1","2015-05-07 07:54:20","1","84254","MS","Individual","Yes","47-0397286","84254MS0010001","Delta Dental Individual PPO, EHB Certified","84254MS001",,"MSN002","MSS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.81","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","84254MS0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MS","84254","HIOS","1","2015-05-07 07:54:20","1","84254","MS","Individual","Yes","47-0397286","84254MS0010002","Delta Dental Individual PPO, EHB Certified","84254MS001",,"MSN002","MSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.51","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","84254MS0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MS","84254","HIOS","1","2015-05-07 07:54:20","1","84254","MS","Individual","Yes","47-0397286","84254MS0020001","Renaissance Individual Dental PPO, EHB Certified","84254MS002",,"MSN001","MSS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.59","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","84254MS0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","MS","84254","HIOS","1","2015-05-07 07:54:20","1","84254","MS","Individual","Yes","47-0397286","84254MS0020002","Renaissance Individual Dental PPO, EHB Certified","84254MS002",,"MSN001","MSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.15","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","84254MS0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","90714MS001",,"MSN001","MSS001","MSF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010001-00","Standard Gold Off Exchange Plan",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/90714MS0010001-00.pdf","https://api.centene.com/Brochures/2016/90714MS0010001-00.pdf","4"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","90714MS001",,"MSN001","MSS001","MSF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010001-01","Standard Gold On Exchange Plan",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/90714MS0010001-01.pdf","https://api.centene.com/Brochures/2016/90714MS0010001-01.pdf","5"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","90714MS001",,"MSN001","MSS001","MSF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/90714MS0010001-02.pdf","https://api.centene.com/Brochures/2016/90714MS0010001-02.pdf","6"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","90714MS001",,"MSN001","MSS001","MSF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010001-03","Limited Cost Sharing Plan Variation",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/90714MS0010001-03.pdf","https://api.centene.com/Brochures/2016/90714MS0010001-03.pdf","7"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010002","Ambetter Balanced Care 1 (2016)","90714MS001",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010002-00","Standard Silver Off Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010002-00.pdf","https://api.centene.com/Brochures/2016/90714MS0010002-00.pdf","8"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010002","Ambetter Balanced Care 1 (2016)","90714MS001",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010002-01","Standard Silver On Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010002-01.pdf","https://api.centene.com/Brochures/2016/90714MS0010002-01.pdf","9"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010002","Ambetter Balanced Care 1 (2016)","90714MS001",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010002-02.pdf","https://api.centene.com/Brochures/2016/90714MS0010002-02.pdf","10"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010002","Ambetter Balanced Care 1 (2016)","90714MS001",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010002-05","87% AV Level Silver Plan",,"0.879890024662018","Yes","Yes","No","100%",,"$400","$10","$1,000","$200","$400","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010002-05.pdf","https://api.centene.com/Brochures/2016/90714MS0010002-05.pdf","13"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010002","Ambetter Balanced Care 1 (2016)","90714MS001",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010002-06","94% AV Level Silver Plan",,"0.948710560798645","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010002-06.pdf","https://api.centene.com/Brochures/2016/90714MS0010002-06.pdf","14"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010003","Ambetter Balanced Care 2 (2016)","90714MS001",,"MSN001","MSS001","MSF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010003-00","Standard Silver Off Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010003-00.pdf","https://api.centene.com/Brochures/2016/90714MS0010003-00.pdf","15"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010003","Ambetter Balanced Care 2 (2016)","90714MS001",,"MSN001","MSS001","MSF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010003-01","Standard Silver On Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010003-01.pdf","https://api.centene.com/Brochures/2016/90714MS0010003-01.pdf","16"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010003","Ambetter Balanced Care 2 (2016)","90714MS001",,"MSN001","MSS001","MSF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010003-02.pdf","https://api.centene.com/Brochures/2016/90714MS0010003-02.pdf","17"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010003","Ambetter Balanced Care 2 (2016)","90714MS001",,"MSN001","MSS001","MSF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010003-03","Limited Cost Sharing Plan Variation",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010003-03.pdf","https://api.centene.com/Brochures/2016/90714MS0010003-03.pdf","18"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010003","Ambetter Balanced Care 2 (2016)","90714MS001",,"MSN001","MSS001","MSF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010003-04","73% AV Level Silver Plan",,"0.739638686180115","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010003-04.pdf","https://api.centene.com/Brochures/2016/90714MS0010003-04.pdf","19"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010005","Ambetter Balanced Care 10 (2016)","90714MS001",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010005-00","Standard Silver Off Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010005-00.pdf","https://api.centene.com/Brochures/2016/90714MS0010005-00.pdf","29"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010005","Ambetter Balanced Care 10 (2016)","90714MS001",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010005-01","Standard Silver On Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010005-01.pdf","https://api.centene.com/Brochures/2016/90714MS0010005-01.pdf","30"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010005","Ambetter Balanced Care 10 (2016)","90714MS001",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010005-02.pdf","https://api.centene.com/Brochures/2016/90714MS0010005-02.pdf","31"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010005","Ambetter Balanced Care 10 (2016)","90714MS001",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010005-03","Limited Cost Sharing Plan Variation",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010005-03.pdf","https://api.centene.com/Brochures/2016/90714MS0010005-03.pdf","32"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010005","Ambetter Balanced Care 10 (2016)","90714MS001",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010005-04","73% AV Level Silver Plan",,"0.738659501075745","Yes","Yes","No","100%",,"$4,000","$10","$200","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010005-04.pdf","https://api.centene.com/Brochures/2016/90714MS0010005-04.pdf","33"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010005","Ambetter Balanced Care 10 (2016)","90714MS001",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010005-05","87% AV Level Silver Plan",,"0.874480485916138","Yes","Yes","No","100%",,"$1,000","$0","$800","$200","$1,000","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010005-05.pdf","https://api.centene.com/Brochures/2016/90714MS0010005-05.pdf","34"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010005","Ambetter Balanced Care 10 (2016)","90714MS001",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010005-06","94% AV Level Silver Plan",,"0.946612775325775","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010005-06.pdf","https://api.centene.com/Brochures/2016/90714MS0010005-06.pdf","35"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010006","Ambetter Essential Care 1 (2016)","90714MS001",,"MSN001","MSS001","MSF005","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010006-00","Standard Bronze Off Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010006-00.pdf","https://api.centene.com/Brochures/2016/90714MS0010006-00.pdf","36"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010006","Ambetter Essential Care 1 (2016)","90714MS001",,"MSN001","MSS001","MSF005","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010006-01","Standard Bronze On Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010006-01.pdf","https://api.centene.com/Brochures/2016/90714MS0010006-01.pdf","37"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010006","Ambetter Essential Care 1 (2016)","90714MS001",,"MSN001","MSS001","MSF005","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010006-02.pdf","https://api.centene.com/Brochures/2016/90714MS0010006-02.pdf","38"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010006","Ambetter Essential Care 1 (2016)","90714MS001",,"MSN001","MSS001","MSF005","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010006-03","Limited Cost Sharing Plan Variation",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010006-03.pdf","https://api.centene.com/Brochures/2016/90714MS0010006-03.pdf","39"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010007","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","90714MS001",,"MSN001","MSS001","MSF006","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010007-00","Standard Bronze Off Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010007-00.pdf","https://api.centene.com/Brochures/2016/90714MS0010007-00.pdf","40"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010007","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","90714MS001",,"MSN001","MSS001","MSF006","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010007-01","Standard Bronze On Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010007-01.pdf","https://api.centene.com/Brochures/2016/90714MS0010007-01.pdf","41"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010007","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","90714MS001",,"MSN001","MSS001","MSF006","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010007-02.pdf","https://api.centene.com/Brochures/2016/90714MS0010007-02.pdf","42"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","1","90714","MS","Individual","No","35-2525384","90714MS0010007","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","90714MS001",,"MSN001","MSS001","MSF006","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0010007-03","Limited Cost Sharing Plan Variation",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0010007-03.pdf","https://api.centene.com/Brochures/2016/90714MS0010007-03.pdf","43"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020001","Ambetter Balanced Care 1 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9749",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020001-00","Standard Silver Off Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020001-00.pdf","https://api.centene.com/Brochures/2016/90714MS0020001-00.pdf","4"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020001","Ambetter Balanced Care 1 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9749",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020001-01","Standard Silver On Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020001-01.pdf","https://api.centene.com/Brochures/2016/90714MS0020001-01.pdf","5"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020001","Ambetter Balanced Care 1 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9749",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020001-02.pdf","https://api.centene.com/Brochures/2016/90714MS0020001-02.pdf","6"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020001","Ambetter Balanced Care 1 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9749",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020001-03","Limited Cost Sharing Plan Variation",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020001-03.pdf","https://api.centene.com/Brochures/2016/90714MS0020001-03.pdf","7"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020001","Ambetter Balanced Care 1 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9749",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020001-04","73% AV Level Silver Plan",,"0.737546384334564","Yes","Yes","No","100%",,"$3,500","$10","$300","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020001-04.pdf","https://api.centene.com/Brochures/2016/90714MS0020001-04.pdf","8"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020001","Ambetter Balanced Care 1 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9749",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020001-05","87% AV Level Silver Plan",,"0.879890024662018","Yes","Yes","No","100%",,"$400","$10","$1,000","$200","$400","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020001-05.pdf","https://api.centene.com/Brochures/2016/90714MS0020001-05.pdf","9"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020001","Ambetter Balanced Care 1 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9749",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020001-06","94% AV Level Silver Plan",,"0.948710560798645","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020001-06.pdf","https://api.centene.com/Brochures/2016/90714MS0020001-06.pdf","10"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020002","Ambetter Balanced Care 2 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9749",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020002-00","Standard Silver Off Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020002-00.pdf","https://api.centene.com/Brochures/2016/90714MS0020002-00.pdf","11"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020002","Ambetter Balanced Care 2 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9749",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020002-01","Standard Silver On Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020002-01.pdf","https://api.centene.com/Brochures/2016/90714MS0020002-01.pdf","12"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020002","Ambetter Balanced Care 2 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9749",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020002-02.pdf","https://api.centene.com/Brochures/2016/90714MS0020002-02.pdf","13"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020002","Ambetter Balanced Care 2 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9749",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020002-03","Limited Cost Sharing Plan Variation",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020002-03.pdf","https://api.centene.com/Brochures/2016/90714MS0020002-03.pdf","14"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020002","Ambetter Balanced Care 2 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9749",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020002-04","73% AV Level Silver Plan",,"0.739638686180115","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020002-04.pdf","https://api.centene.com/Brochures/2016/90714MS0020002-04.pdf","15"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020002","Ambetter Balanced Care 2 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9749",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020002-05","87% AV Level Silver Plan",,"0.873916625976563","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,700","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020002-05.pdf","https://api.centene.com/Brochures/2016/90714MS0020002-05.pdf","16"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020002","Ambetter Balanced Care 2 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9749",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020002-06","94% AV Level Silver Plan",,"0.9492227435112","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020002-06.pdf","https://api.centene.com/Brochures/2016/90714MS0020002-06.pdf","17"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020003","Ambetter Balanced Care 10 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9749",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020003-00","Standard Silver Off Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020003-00.pdf","https://api.centene.com/Brochures/2016/90714MS0020003-00.pdf","18"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020003","Ambetter Balanced Care 10 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9749",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020003-01","Standard Silver On Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020003-01.pdf","https://api.centene.com/Brochures/2016/90714MS0020003-01.pdf","19"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020003","Ambetter Balanced Care 10 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9749",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020003-02.pdf","https://api.centene.com/Brochures/2016/90714MS0020003-02.pdf","20"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020003","Ambetter Balanced Care 10 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9749",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020003-03","Limited Cost Sharing Plan Variation",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020003-03.pdf","https://api.centene.com/Brochures/2016/90714MS0020003-03.pdf","21"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020003","Ambetter Balanced Care 10 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9749",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020003-04","73% AV Level Silver Plan",,"0.738659501075745","Yes","Yes","No","100%",,"$4,000","$10","$200","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020003-04.pdf","https://api.centene.com/Brochures/2016/90714MS0020003-04.pdf","22"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020003","Ambetter Balanced Care 10 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9749",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020003-05","87% AV Level Silver Plan",,"0.874480485916138","Yes","Yes","No","100%",,"$1,000","$0","$800","$200","$1,000","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020003-05.pdf","https://api.centene.com/Brochures/2016/90714MS0020003-05.pdf","23"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020003","Ambetter Balanced Care 10 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9749",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020003-06","94% AV Level Silver Plan",,"0.946612775325775","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020003-06.pdf","https://api.centene.com/Brochures/2016/90714MS0020003-06.pdf","24"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020004","Ambetter Essential Care 1 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF005","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9739",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020004-00","Standard Bronze Off Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020004-00.pdf","https://api.centene.com/Brochures/2016/90714MS0020004-00.pdf","25"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020004","Ambetter Essential Care 1 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF005","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9739",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020004-01","Standard Bronze On Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020004-01.pdf","https://api.centene.com/Brochures/2016/90714MS0020004-01.pdf","26"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020004","Ambetter Essential Care 1 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF005","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9739",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020004-02.pdf","https://api.centene.com/Brochures/2016/90714MS0020004-02.pdf","27"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020004","Ambetter Essential Care 1 (2016) + Vision","90714MS002",,"MSN001","MSS001","MSF005","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9739",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020004-03","Limited Cost Sharing Plan Variation",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020004-03.pdf","https://api.centene.com/Brochures/2016/90714MS0020004-03.pdf","28"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","90714MS002",,"MSN001","MSS001","MSF006","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9739",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020005-00","Standard Bronze Off Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020005-00.pdf","https://api.centene.com/Brochures/2016/90714MS0020005-00.pdf","29"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","90714MS002",,"MSN001","MSS001","MSF006","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9739",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020005-01","Standard Bronze On Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020005-01.pdf","https://api.centene.com/Brochures/2016/90714MS0020005-01.pdf","30"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","90714MS002",,"MSN001","MSS001","MSF006","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9739",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020005-02.pdf","https://api.centene.com/Brochures/2016/90714MS0020005-02.pdf","31"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","2","90714","MS","Individual","No","35-2525384","90714MS0020005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","90714MS002",,"MSN001","MSS001","MSF006","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9739",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0020005-03","Limited Cost Sharing Plan Variation",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0020005-03.pdf","https://api.centene.com/Brochures/2016/90714MS0020005-03.pdf","32"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9256",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030001-00","Standard Silver Off Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030001-00.pdf","https://api.centene.com/Brochures/2016/90714MS0030001-00.pdf","4"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9256",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030001-01","Standard Silver On Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030001-01.pdf","https://api.centene.com/Brochures/2016/90714MS0030001-01.pdf","5"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9256",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030001-02.pdf","https://api.centene.com/Brochures/2016/90714MS0030001-02.pdf","6"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9256",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030001-03","Limited Cost Sharing Plan Variation",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030001-03.pdf","https://api.centene.com/Brochures/2016/90714MS0030001-03.pdf","7"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9256",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030001-04","73% AV Level Silver Plan",,"0.737546384334564","Yes","Yes","No","100%",,"$3,500","$10","$300","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030001-04.pdf","https://api.centene.com/Brochures/2016/90714MS0030001-04.pdf","8"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9256",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030001-05","87% AV Level Silver Plan",,"0.879890024662018","Yes","Yes","No","100%",,"$400","$10","$1,000","$200","$400","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030001-05.pdf","https://api.centene.com/Brochures/2016/90714MS0030001-05.pdf","9"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030001","Ambetter Balanced Care 1 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9256",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030001-06","94% AV Level Silver Plan",,"0.948710560798645","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030001-06.pdf","https://api.centene.com/Brochures/2016/90714MS0030001-06.pdf","10"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9256",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030002-00","Standard Silver Off Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030002-00.pdf","https://api.centene.com/Brochures/2016/90714MS0030002-00.pdf","11"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9256",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030002-01","Standard Silver On Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030002-01.pdf","https://api.centene.com/Brochures/2016/90714MS0030002-01.pdf","12"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9256",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030002-02.pdf","https://api.centene.com/Brochures/2016/90714MS0030002-02.pdf","13"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9256",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030002-03","Limited Cost Sharing Plan Variation",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030002-03.pdf","https://api.centene.com/Brochures/2016/90714MS0030002-03.pdf","14"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9256",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030002-04","73% AV Level Silver Plan",,"0.739638686180115","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030002-04.pdf","https://api.centene.com/Brochures/2016/90714MS0030002-04.pdf","15"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9256",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030002-05","87% AV Level Silver Plan",,"0.873916625976563","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,700","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030002-05.pdf","https://api.centene.com/Brochures/2016/90714MS0030002-05.pdf","16"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9256",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030002-06","94% AV Level Silver Plan",,"0.9492227435112","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030002-06.pdf","https://api.centene.com/Brochures/2016/90714MS0030002-06.pdf","17"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030003","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9256",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030003-00","Standard Silver Off Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030003-00.pdf","https://api.centene.com/Brochures/2016/90714MS0030003-00.pdf","18"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030003","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9256",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030003-01","Standard Silver On Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030003-01.pdf","https://api.centene.com/Brochures/2016/90714MS0030003-01.pdf","19"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030003","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9256",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030003-02.pdf","https://api.centene.com/Brochures/2016/90714MS0030003-02.pdf","20"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030003","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9256",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030003-03","Limited Cost Sharing Plan Variation",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030003-03.pdf","https://api.centene.com/Brochures/2016/90714MS0030003-03.pdf","21"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030003","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9256",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030003-04","73% AV Level Silver Plan",,"0.738659501075745","Yes","Yes","No","100%",,"$4,000","$10","$200","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030003-04.pdf","https://api.centene.com/Brochures/2016/90714MS0030003-04.pdf","22"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030003","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9256",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030003-05","87% AV Level Silver Plan",,"0.874480485916138","Yes","Yes","No","100%",,"$1,000","$0","$800","$200","$1,000","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030003-05.pdf","https://api.centene.com/Brochures/2016/90714MS0030003-05.pdf","23"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030003","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9256",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030003-06","94% AV Level Silver Plan",,"0.946612775325775","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030003-06.pdf","https://api.centene.com/Brochures/2016/90714MS0030003-06.pdf","24"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030004","Ambetter Essential Care 1 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF005","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9225",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030004-00","Standard Bronze Off Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030004-00.pdf","https://api.centene.com/Brochures/2016/90714MS0030004-00.pdf","25"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030004","Ambetter Essential Care 1 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF005","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9225",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030004-01","Standard Bronze On Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030004-01.pdf","https://api.centene.com/Brochures/2016/90714MS0030004-01.pdf","26"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030004","Ambetter Essential Care 1 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF005","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9225",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030004-02.pdf","https://api.centene.com/Brochures/2016/90714MS0030004-02.pdf","27"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030004","Ambetter Essential Care 1 (2016) + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF005","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9225",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030004-03","Limited Cost Sharing Plan Variation",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030004-03.pdf","https://api.centene.com/Brochures/2016/90714MS0030004-03.pdf","28"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF006","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9226",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030005-00","Standard Bronze Off Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030005-00.pdf","https://api.centene.com/Brochures/2016/90714MS0030005-00.pdf","29"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF006","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9226",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030005-01","Standard Bronze On Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030005-01.pdf","https://api.centene.com/Brochures/2016/90714MS0030005-01.pdf","30"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF006","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9226",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030005-02.pdf","https://api.centene.com/Brochures/2016/90714MS0030005-02.pdf","31"
"2016","MS","90714","HIOS","8","2015-08-27 11:14:25","3","90714","MS","Individual","No","35-2525384","90714MS0030005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision + Adult Dental","90714MS003",,"MSN001","MSS001","MSF006","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9226",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/formulary","90714MS0030005-03","Limited Cost Sharing Plan Variation",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/90714MS0030005-03.pdf","https://api.centene.com/Brochures/2016/90714MS0030005-03.pdf","32"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","1","97560","MS","Individual","No","63-1036817","97560MS0040005","Silver Compass HSA 3600","97560MS004",,"MSN002","MSS002","MSF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040005-00","Standard Silver Off Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ms0018&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","4"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","1","97560","MS","Individual","No","63-1036817","97560MS0040005","Silver Compass HSA 3600","97560MS004",,"MSN002","MSS002","MSF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040005-01","Standard Silver On Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ms0018&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","5"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","1","97560","MS","Individual","No","63-1036817","97560MS0040005","Silver Compass HSA 3600","97560MS004",,"MSN002","MSS002","MSF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ms0019&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","6"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","1","97560","MS","Individual","No","63-1036817","97560MS0040005","Silver Compass HSA 3600","97560MS004",,"MSN002","MSS002","MSF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040005-03","Limited Cost Sharing Plan Variation",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ms0020&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","7"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","1","97560","MS","Individual","No","63-1036817","97560MS0040005","Silver Compass HSA 3600","97560MS004",,"MSN002","MSS002","MSF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040005-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$3,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ms0021&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","8"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","1","97560","MS","Individual","No","63-1036817","97560MS0040005","Silver Compass HSA 3600","97560MS004",,"MSN002","MSS002","MSF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040005-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$200","$1,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ms0022&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","9"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","1","97560","MS","Individual","No","63-1036817","97560MS0040005","Silver Compass HSA 3600","97560MS004",,"MSN002","MSS002","MSF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040005-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ms0023&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","10"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040008","Bronze Compass 6400","97560MS004",,"MSN002","MSS002","MSF001","New","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040008-00","Standard Bronze Off Exchange Plan",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0036&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","4"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040008","Bronze Compass 6400","97560MS004",,"MSN002","MSS002","MSF001","New","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040008-01","Standard Bronze On Exchange Plan",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0036&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","5"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0020105","Blue Options Gold 1500 CX","11512NC002",,"NCN001","NCS001","NCF005","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$100","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceEnhanced.pdf","11512NC0020105-00","Standard Gold Off Exchange Plan","78.83%","0.77909654378891","No","Yes","No","100%",,"$1,500","$30","$1,100","$200","$600","$400","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_Gold_1500_CX",,"8"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0020105","Blue Options Gold 1500 CX","11512NC002",,"NCN001","NCS001","NCF005","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$100","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceEnhanced.pdf","11512NC0020105-01","Standard Gold On Exchange Plan","78.83%","0.77909654378891","No","Yes","No","100%",,"$1,500","$30","$1,100","$200","$600","$400","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_Gold_1500_CX",,"9"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060018","Blue Advantage 1000 (broad network)","11512NC006",,"NCN001","NCS009","NCF013","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060018-01","Standard Gold On Exchange Plan",,"0.80511349439621","No","Yes","No","100%",,"$1,000","$40","$1,200","$200","$600","$500","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_1000_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","9"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060018","Blue Advantage 1000 (broad network)","11512NC006",,"NCN001","NCS009","NCF013","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060018-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_100_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","10"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0130055","Blue Value Silver 2000 CX","11512NC013",,"NCN002","NCS002","NCF008","New","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$200","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0130055-00","Standard Silver Off Exchange Plan",,"0.692378222942352","No","Yes","No","100%",,"$2,000","$80","$1,400","$200","$600","$1,200","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2000_CX",,"10"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0130055","Blue Value Silver 2000 CX","11512NC013",,"NCN002","NCS002","NCF008","New","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$200","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0130055-01","Standard Silver On Exchange Plan",,"0.692378222942352","No","Yes","No","100%",,"$2,000","$80","$1,400","$200","$600","$1,200","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2000_CX",,"11"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040008","Bronze Compass 6400","97560MS004",,"MSN002","MSS002","MSF001","New","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0037&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","6"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040008","Bronze Compass 6400","97560MS004",,"MSN002","MSS002","MSF001","New","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040008-03","Limited Cost Sharing Plan Variation",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0038&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","7"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040009","Catastrophic Compass 6850","97560MS004",,"MSN002","MSS002","MSF002","New","HMO","Catastrophic","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040009-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,700","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ms0039&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","8"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040009","Catastrophic Compass 6850","97560MS004",,"MSN002","MSS002","MSF002","New","HMO","Catastrophic","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040009-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,700","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ms0039&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","9"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040004","Gold Compass 1000","97560MS004",,"MSN002","MSS002","MSF003","New","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040004-00","Standard Gold Off Exchange Plan",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$20","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0015&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","10"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040004","Gold Compass 1000","97560MS004",,"MSN002","MSS002","MSF003","New","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040004-01","Standard Gold On Exchange Plan",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$20","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0015&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","11"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040004","Gold Compass 1000","97560MS004",,"MSN002","MSS002","MSF003","New","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0016&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","12"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040004","Gold Compass 1000","97560MS004",,"MSN002","MSS002","MSF003","New","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040004-03","Limited Cost Sharing Plan Variation",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$20","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0017&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","13"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040006","Silver Compass 4000","97560MS004",,"MSN002","MSS002","MSF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040006-00","Standard Silver Off Exchange Plan",,"0.697066605091095","No","Yes","No","100%",,"$4,000","$20","$200","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0024&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","18"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040006","Silver Compass 4000","97560MS004",,"MSN002","MSS002","MSF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040006-01","Standard Silver On Exchange Plan",,"0.697066605091095","No","Yes","No","100%",,"$4,000","$20","$200","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0024&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","19"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040006","Silver Compass 4000","97560MS004",,"MSN002","MSS002","MSF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0025&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","20"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040006","Silver Compass 4000","97560MS004",,"MSN002","MSS002","MSF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040006-03","Limited Cost Sharing Plan Variation",,"0.697066605091095","No","Yes","No","100%",,"$4,000","$20","$200","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0026&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","21"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040006","Silver Compass 4000","97560MS004",,"MSN002","MSS002","MSF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040006-04","73% AV Level Silver Plan",,"0.737395048141479","No","Yes","No","100%",,"$3,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0027&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","22"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040006","Silver Compass 4000","97560MS004",,"MSN002","MSS002","MSF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040006-05","87% AV Level Silver Plan",,"0.87861156463623","No","Yes","No","100%",,"$900","$10","$500","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0028&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","23"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040006","Silver Compass 4000","97560MS004",,"MSN002","MSS002","MSF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040006-06","94% AV Level Silver Plan",,"0.946469008922577","No","Yes","No","100%",,"$0","$0","$500","$200","$0","$500","$20","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0029&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","24"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040007","Silver Compass 5000","97560MS004",,"MSN002","MSS002","MSF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040007-00","Standard Silver Off Exchange Plan",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0030&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","25"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040007","Silver Compass 5000","97560MS004",,"MSN002","MSS002","MSF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040007-01","Standard Silver On Exchange Plan",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0030&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","26"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040007","Silver Compass 5000","97560MS004",,"MSN002","MSS002","MSF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0031&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","27"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040007","Silver Compass 5000","97560MS004",,"MSN002","MSS002","MSF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040007-03","Limited Cost Sharing Plan Variation",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0032&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","28"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040007","Silver Compass 5000","97560MS004",,"MSN002","MSS002","MSF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040007-04","73% AV Level Silver Plan",,"0.728041231632233","No","Yes","No","100%",,"$3,600","$20","$500","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0033&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","29"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040007","Silver Compass 5000","97560MS004",,"MSN002","MSS002","MSF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040007-05","87% AV Level Silver Plan",,"0.871982634067535","No","Yes","No","100%",,"$800","$0","$800","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0034&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","30"
"2016","MS","97560","HIOS","8","2015-11-17 13:45:28","2","97560","MS","Individual","No","63-1036817","97560MS0040007","Silver Compass 5000","97560MS004",,"MSN002","MSS002","MSF001","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ms0011&st=ms","97560MS0040007-06","94% AV Level Silver Plan",,"0.949420213699341","No","Yes","No","100%",,"$0","$0","$500","$200","$0","$500","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ms0035&st=ms","http://www.uhc.com/iex/doc?id=ms0040&st=ms","31"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060017","Blue Advantage 500 (broad network)","11512NC006",,"NCN001","NCS009","NCF012","Existing","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060017-00","Standard Platinum Off Exchange Plan","88.33%","0.879242718219757","No","Yes","No","100%",,"$500","$10","$600","$200","$500","$200","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$200","$200 per person","per group not applicable","10%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Platinum_500_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","4"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0020069","Blue Options Platinum 500 CX","11512NC002",,"NCN001","NCS001","NCF005","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$100","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceEnhanced.pdf","11512NC0020069-00","Standard Platinum Off Exchange Plan",,"0.88940155506134","No","Yes","No","100%",,"$500","$10","$1,000","$200","$500","$200","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_Platinum_500_CX",,"4"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0020069","Blue Options Platinum 500 CX","11512NC002",,"NCN001","NCS001","NCF005","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$100","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceEnhanced.pdf","11512NC0020069-01","Standard Platinum On Exchange Plan",,"0.88940155506134","No","Yes","No","100%",,"$500","$10","$1,000","$200","$500","$200","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_Platinum_500_CX",,"5"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060017","Blue Advantage 500 (broad network)","11512NC006",,"NCN001","NCS009","NCF012","Existing","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060017-01","Standard Platinum On Exchange Plan","88.33%","0.879242718219757","No","Yes","No","100%",,"$500","$10","$600","$200","$500","$200","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$200","$200 per person","per group not applicable","10%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Platinum_500_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","5"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060017","Blue Advantage 500 (broad network)","11512NC006",,"NCN001","NCS009","NCF012","Existing","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060017-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_100_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","6"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0020078","Blue Options Silver 2000 CX","11512NC002",,"NCN001","NCS001","NCF003","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$200","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceEnhanced.pdf","11512NC0020078-00","Standard Silver Off Exchange Plan",,"0.692378222942352","No","Yes","No","100%",,"$2,000","$80","$1,400","$200","$600","$1,200","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_Silver_2000_CX",,"6"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0020078","Blue Options Silver 2000 CX","11512NC002",,"NCN001","NCS001","NCF003","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$200","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceEnhanced.pdf","11512NC0020078-01","Standard Silver On Exchange Plan",,"0.692378222942352","No","Yes","No","100%",,"$2,000","$80","$1,400","$200","$600","$1,200","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_Silver_2000_CX",,"7"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060017","Blue Advantage 500 (broad network)","11512NC006",,"NCN001","NCS009","NCF012","Existing","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060017-03","Limited Cost Sharing Plan Variation","88.33%","0.879242718219757","No","Yes","No","100%",,"$500","$10","$600","$200","$500","$200","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$200","$200 per person","per group not applicable","10%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Platinum_500_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","7"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060018","Blue Advantage 1000 (broad network)","11512NC006",,"NCN001","NCS009","NCF013","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060018-00","Standard Gold Off Exchange Plan",,"0.80511349439621","No","Yes","No","100%",,"$1,000","$40","$1,200","$200","$600","$500","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_1000_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","8"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060018","Blue Advantage 1000 (broad network)","11512NC006",,"NCN001","NCS009","NCF013","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060018-03","Limited Cost Sharing Plan Variation",,"0.80511349439621","No","Yes","No","100%",,"$1,000","$40","$1,200","$200","$600","$500","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_1000_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","11"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060019","Blue Advantage 2500 (broad network)","11512NC006",,"NCN001","NCS009","NCF014","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060019-00","Standard Silver Off Exchange Plan",,"0.699069321155548","No","Yes","No","100%",,"$2,500","$50","$1,300","$200","$600","$700","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2500_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","12"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0130056","Blue Value Silver 2000 CX","11512NC013",,"NCN002","NCS003","NCF008","New","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$200","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0130056-00","Standard Silver Off Exchange Plan",,"0.692378222942352","No","Yes","No","100%",,"$2,000","$80","$1,400","$200","$600","$1,200","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2000_CX",,"12"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0130056","Blue Value Silver 2000 CX","11512NC013",,"NCN002","NCS003","NCF008","New","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$200","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0130056-01","Standard Silver On Exchange Plan",,"0.692378222942352","No","Yes","No","100%",,"$2,000","$80","$1,400","$200","$600","$1,200","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2000_CX",,"13"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060019","Blue Advantage 2500 (broad network)","11512NC006",,"NCN001","NCS009","NCF014","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060019-01","Standard Silver On Exchange Plan",,"0.699069321155548","No","Yes","No","100%",,"$2,500","$50","$1,300","$200","$600","$700","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2500_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","13"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060019","Blue Advantage 2500 (broad network)","11512NC006",,"NCN001","NCS009","NCF014","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060019-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_100_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","14"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0130057","Blue Value Gold 1500 CX","11512NC013",,"NCN002","NCS002","NCF010","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$100","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0130057-00","Standard Gold Off Exchange Plan","78.83%","0.77909654378891","No","Yes","No","100%",,"$1,500","$30","$1,100","$200","$600","$400","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1500_CX",,"14"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0130057","Blue Value Gold 1500 CX","11512NC013",,"NCN002","NCS002","NCF010","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$100","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0130057-01","Standard Gold On Exchange Plan","78.83%","0.77909654378891","No","Yes","No","100%",,"$1,500","$30","$1,100","$200","$600","$400","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1500_CX",,"15"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060019","Blue Advantage 2500 (broad network)","11512NC006",,"NCN001","NCS009","NCF014","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060019-03","Limited Cost Sharing Plan Variation",,"0.699069321155548","No","Yes","No","100%",,"$2,500","$50","$1,300","$200","$600","$700","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2500_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","15"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060019","Blue Advantage 2500 (broad network)","11512NC006",,"NCN001","NCS009","NCF014","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060019-04","73% AV Level Silver Plan",,"0.725858449935913","No","Yes","No","100%",,"$2,500","$50","$1,300","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Enhanced_2500_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","16"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0130058","Blue Value Gold 1500 CX","11512NC013",,"NCN002","NCS003","NCF010","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$100","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0130058-00","Standard Gold Off Exchange Plan","78.83%","0.77909654378891","No","Yes","No","100%",,"$1,500","$30","$1,100","$200","$600","$400","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1500_CX",,"16"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0130058","Blue Value Gold 1500 CX","11512NC013",,"NCN002","NCS003","NCF010","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$100","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0130058-01","Standard Gold On Exchange Plan","78.83%","0.77909654378891","No","Yes","No","100%",,"$1,500","$30","$1,100","$200","$600","$400","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1500_CX",,"17"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060019","Blue Advantage 2500 (broad network)","11512NC006",,"NCN001","NCS009","NCF014","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060019-05","87% AV Level Silver Plan",,"0.870140850543976","No","Yes","No","100%",,"$700","$10","$1,300","$200","$600","$400","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$700","$700 per person","$1400 per group","30%",,,,,"$1,400","$1400 per person","$2800 per group","$2,100","$2100 per person","$4200 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Enhanced_700_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","17"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060019","Blue Advantage 2500 (broad network)","11512NC006",,"NCN001","NCS009","NCF014","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060019-06","94% AV Level Silver Plan",,"0.945307612419128","No","Yes","No","100%",,"$400","$10","$200","$200","$400","$70","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$1,200","$1200 per person","$2400 per group","$1,800","$1800 per person","$3600 per group","$400","$400 per person","$800 per group","30%",,,,,"$800","$800 per person","$1600 per group","$1,200","$1200 per person","$2400 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Enhanced_400_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","18"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0130059","Blue Value Platinum 500 CX","11512NC013",,"NCN002","NCS002","NCF010","New","POS","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$100","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0130059-00","Standard Platinum Off Exchange Plan",,"0.88940155506134","No","Yes","No","100%",,"$500","$10","$1,000","$200","$500","$200","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_CX",,"18"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0130059","Blue Value Platinum 500 CX","11512NC013",,"NCN002","NCS002","NCF010","New","POS","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$100","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0130059-01","Standard Platinum On Exchange Plan",,"0.88940155506134","No","Yes","No","100%",,"$500","$10","$1,000","$200","$500","$200","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_CX",,"19"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060020","Blue Advantage 3500 (broad network)","11512NC006",,"NCN001","NCS009","NCF014","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060020-00","Standard Silver Off Exchange Plan",,"0.686747848987579","No","Yes","No","100%",,"$3,500","$50","$1,000","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","19"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060020","Blue Advantage 3500 (broad network)","11512NC006",,"NCN001","NCS009","NCF014","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060020-01","Standard Silver On Exchange Plan",,"0.686747848987579","No","Yes","No","100%",,"$3,500","$50","$1,000","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","20"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0130060","Blue Value Platinum 500 CX","11512NC013",,"NCN002","NCS003","NCF010","New","POS","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$100","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0130060-00","Standard Platinum Off Exchange Plan",,"0.88940155506134","No","Yes","No","100%",,"$500","$10","$1,000","$200","$500","$200","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_CX",,"20"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0130060","Blue Value Platinum 500 CX","11512NC013",,"NCN002","NCS003","NCF010","New","POS","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$100","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0130060-01","Standard Platinum On Exchange Plan",,"0.88940155506134","No","Yes","No","100%",,"$500","$10","$1,000","$200","$500","$200","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_CX",,"21"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060020","Blue Advantage 3500 (broad network)","11512NC006",,"NCN001","NCS009","NCF014","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060020-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_100_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","21"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060020","Blue Advantage 3500 (broad network)","11512NC006",,"NCN001","NCS009","NCF014","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060020-03","Limited Cost Sharing Plan Variation",,"0.686747848987579","No","Yes","No","100%",,"$3,500","$50","$1,000","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","22"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060020","Blue Advantage 3500 (broad network)","11512NC006",,"NCN001","NCS009","NCF014","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060020-04","73% AV Level Silver Plan",,"0.721278786659241","No","Yes","No","100%",,"$2,800","$50","$1,200","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group","$2,800","$2800 per person","$5600 per group","30%",,,,,"$5,600","$5600 per person","$11200 per group","$8,400","$8400 per person","$16800 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Enhanced_2800_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","23"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060020","Blue Advantage 3500 (broad network)","11512NC006",,"NCN001","NCS009","NCF014","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060020-05","87% AV Level Silver Plan",,"0.8682701587677","No","Yes","No","100%",,"$800","$10","$1,200","$200","$600","$400","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$800","$800 per person","$1600 per group","30%",,,,,"$1,600","$1600 per person","$3200 per group","$2,400","$2400 per person","$4800 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Enhanced_800_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","24"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060020","Blue Advantage 3500 (broad network)","11512NC006",,"NCN001","NCS009","NCF014","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060020-06","94% AV Level Silver Plan",,"0.939053058624268","No","Yes","No","100%",,"$500","$10","$200","$200","$500","$80","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"$1,300","$1300 per person","$2600 per group","$1,950","$1950 per person","$3900 per group","$450","$450 per person","$900 per group","30%",,,,,"$900","$900 per person","$1800 per group","$1,350","$1350 per person","$2700 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Enhanced_450_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","25"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060028","Blue Advantage 5000 (broad network)","11512NC006",,"NCN001","NCS009","NCF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060028-00","Standard Silver Off Exchange Plan","68.96%","0.672687351703644","No","Yes","No","100%",,"$5,000","$50","$500","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$300","$300 per person","per group not applicable","30%",,,,,"$300","$300 per person","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","26"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060028","Blue Advantage 5000 (broad network)","11512NC006",,"NCN001","NCS009","NCF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060028-01","Standard Silver On Exchange Plan","68.96%","0.672687351703644","No","Yes","No","100%",,"$5,000","$50","$500","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$300","$300 per person","per group not applicable","30%",,,,,"$300","$300 per person","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","27"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060028","Blue Advantage 5000 (broad network)","11512NC006",,"NCN001","NCS009","NCF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060028-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_100_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","28"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060028","Blue Advantage 5000 (broad network)","11512NC006",,"NCN001","NCS009","NCF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060028-03","Limited Cost Sharing Plan Variation","68.96%","0.672687351703644","No","Yes","No","100%",,"$5,000","$50","$500","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$300","$300 per person","per group not applicable","30%",,,,,"$300","$300 per person","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","29"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060028","Blue Advantage 5000 (broad network)","11512NC006",,"NCN001","NCS009","NCF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060028-04","73% AV Level Silver Plan","73.23%","0.71853643655777","No","Yes","No","100%",,"$3,000","$50","$1,100","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Enhanced_3000_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","30"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060028","Blue Advantage 5000 (broad network)","11512NC006",,"NCN001","NCS009","NCF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060028-05","87% AV Level Silver Plan","87.05%","0.86516261100769","No","Yes","No","100%",,"$1,000","$10","$1,000","$200","$600","$400","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$1,000","$1000 per person","$2000 per group","30%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Enhanced_1000_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","31"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0060028","Blue Advantage 5000 (broad network)","11512NC006",,"NCN001","NCS009","NCF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060028-06","94% AV Level Silver Plan","93.50%","0.937231659889221","No","Yes","No","100%",,"$500","$10","$200","$200","$500","$80","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$1,400","$1400 per person","$2800 per group","$2,100","$2100 per person","$4200 per group","$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_Enhanced_500_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","32"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100021","Blue Value 500 (limited network)","11512NC010",,"NCN002","NCS002","NCF012","Existing","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100021-00","Standard Platinum Off Exchange Plan","88.33%","0.879242718219757","No","Yes","No","100%",,"$500","$10","$600","$200","$500","$200","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$200","$200 per person","per group not applicable","10%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","33"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100021","Blue Value 500 (limited network)","11512NC010",,"NCN002","NCS002","NCF012","Existing","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100021-01","Standard Platinum On Exchange Plan","88.33%","0.879242718219757","No","Yes","No","100%",,"$500","$10","$600","$200","$500","$200","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$200","$200 per person","per group not applicable","10%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","34"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100021","Blue Value 500 (limited network)","11512NC010",,"NCN002","NCS002","NCF012","Existing","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100021-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","35"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100021","Blue Value 500 (limited network)","11512NC010",,"NCN002","NCS002","NCF012","Existing","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100021-03","Limited Cost Sharing Plan Variation","88.33%","0.879242718219757","No","Yes","No","100%",,"$500","$10","$600","$200","$500","$200","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$200","$200 per person","per group not applicable","10%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","36"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100022","Blue Value 1000 (limited network)","11512NC010",,"NCN002","NCS002","NCF013","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100022-00","Standard Gold Off Exchange Plan",,"0.80511349439621","No","Yes","No","100%",,"$1,000","$40","$1,200","$200","$600","$500","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","37"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100022","Blue Value 1000 (limited network)","11512NC010",,"NCN002","NCS002","NCF013","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100022-01","Standard Gold On Exchange Plan",,"0.80511349439621","No","Yes","No","100%",,"$1,000","$40","$1,200","$200","$600","$500","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","38"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100022","Blue Value 1000 (limited network)","11512NC010",,"NCN002","NCS002","NCF013","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100022-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","39"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100022","Blue Value 1000 (limited network)","11512NC010",,"NCN002","NCS002","NCF013","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100022-03","Limited Cost Sharing Plan Variation",,"0.80511349439621","No","Yes","No","100%",,"$1,000","$40","$1,200","$200","$600","$500","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","40"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100023","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS002","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100023-00","Standard Silver Off Exchange Plan",,"0.699069321155548","No","Yes","No","100%",,"$2,500","$50","$1,300","$200","$600","$700","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","41"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100023","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS002","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100023-01","Standard Silver On Exchange Plan",,"0.699069321155548","No","Yes","No","100%",,"$2,500","$50","$1,300","$200","$600","$700","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","42"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100023","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS002","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100023-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","43"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100023","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS002","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100023-03","Limited Cost Sharing Plan Variation",,"0.699069321155548","No","Yes","No","100%",,"$2,500","$50","$1,300","$200","$600","$700","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","44"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100023","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS002","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100023-04","73% AV Level Silver Plan",,"0.725858449935913","No","Yes","No","100%",,"$2,500","$50","$1,300","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_2500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","45"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100023","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS002","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100023-05","87% AV Level Silver Plan",,"0.870140850543976","No","Yes","No","100%",,"$700","$10","$1,300","$200","$600","$400","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$700","$700 per person","$1400 per group","30%",,,,,"$1,400","$1400 per person","$2800 per group","$2,100","$2100 per person","$4200 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_700_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","46"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100023","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS002","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100023-06","94% AV Level Silver Plan",,"0.945307612419128","No","Yes","No","100%",,"$400","$10","$200","$200","$400","$70","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$1,200","$1200 per person","$2400 per group","$1,800","$1800 per person","$3600 per group","$400","$400 per person","$800 per group","30%",,,,,"$800","$800 per person","$1600 per group","$1,200","$1200 per person","$2400 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_400_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","47"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100024","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS002","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100024-00","Standard Silver Off Exchange Plan",,"0.686747848987579","No","Yes","No","100%",,"$3,500","$50","$1,000","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","48"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100024","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS002","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100024-01","Standard Silver On Exchange Plan",,"0.686747848987579","No","Yes","No","100%",,"$3,500","$50","$1,000","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","49"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100024","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS002","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100024-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","50"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100024","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS002","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100024-03","Limited Cost Sharing Plan Variation",,"0.686747848987579","No","Yes","No","100%",,"$3,500","$50","$1,000","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","51"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100024","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS002","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100024-04","73% AV Level Silver Plan",,"0.721278786659241","No","Yes","No","100%",,"$2,800","$50","$1,200","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group","$2,800","$2800 per person","$5600 per group","30%",,,,,"$5,600","$5600 per person","$11200 per group","$8,400","$8400 per person","$16800 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_2800_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","52"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100024","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS002","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100024-05","87% AV Level Silver Plan",,"0.8682701587677","No","Yes","No","100%",,"$800","$10","$1,200","$200","$600","$400","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$800","$800 per person","$1600 per group","30%",,,,,"$1,600","$1600 per person","$3200 per group","$2,400","$2400 per person","$4800 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_800_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","53"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100024","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS002","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100024-06","94% AV Level Silver Plan",,"0.939053058624268","No","Yes","No","100%",,"$500","$10","$200","$200","$500","$80","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"$1,300","$1300 per person","$2600 per group","$1,950","$1950 per person","$3900 per group","$450","$450 per person","$900 per group","30%",,,,,"$900","$900 per person","$1800 per group","$1,350","$1350 per person","$2700 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_450_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","54"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100032","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS002","NCF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100032-00","Standard Silver Off Exchange Plan","68.96%","0.672687351703644","No","Yes","No","100%",,"$5,000","$50","$500","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$300","$300 per person","per group not applicable","30%",,,,,"$300","$300 per person","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","55"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100032","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS002","NCF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100032-01","Standard Silver On Exchange Plan","68.96%","0.672687351703644","No","Yes","No","100%",,"$5,000","$50","$500","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$300","$300 per person","per group not applicable","30%",,,,,"$300","$300 per person","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","56"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100032","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS002","NCF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100032-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","57"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100032","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS002","NCF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100032-03","Limited Cost Sharing Plan Variation","68.96%","0.672687351703644","No","Yes","No","100%",,"$5,000","$50","$500","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$300","$300 per person","per group not applicable","30%",,,,,"$300","$300 per person","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","58"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100032","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS002","NCF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100032-04","73% AV Level Silver Plan","73.23%","0.71853643655777","No","Yes","No","100%",,"$3,000","$50","$1,100","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_3000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","59"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100032","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS002","NCF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100032-05","87% AV Level Silver Plan","87.05%","0.86516261100769","No","Yes","No","100%",,"$1,000","$10","$1,000","$200","$600","$400","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$1,000","$1000 per person","$2000 per group","30%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_1000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","60"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100032","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS002","NCF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100032-06","94% AV Level Silver Plan","93.50%","0.937231659889221","No","Yes","No","100%",,"$500","$10","$200","$200","$500","$80","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$1,400","$1400 per person","$2800 per group","$2,100","$2100 per person","$4200 per group","$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","61"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100033","Blue Value 500 (limited network)","11512NC010",,"NCN002","NCS003","NCF012","Existing","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100033-00","Standard Platinum Off Exchange Plan","88.33%","0.879242718219757","No","Yes","No","100%",,"$500","$10","$600","$200","$500","$200","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$200","$200 per person","per group not applicable","10%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","62"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100033","Blue Value 500 (limited network)","11512NC010",,"NCN002","NCS003","NCF012","Existing","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100033-01","Standard Platinum On Exchange Plan","88.33%","0.879242718219757","No","Yes","No","100%",,"$500","$10","$600","$200","$500","$200","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$200","$200 per person","per group not applicable","10%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","63"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100033","Blue Value 500 (limited network)","11512NC010",,"NCN002","NCS003","NCF012","Existing","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100033-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","64"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100033","Blue Value 500 (limited network)","11512NC010",,"NCN002","NCS003","NCF012","Existing","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100033-03","Limited Cost Sharing Plan Variation","88.33%","0.879242718219757","No","Yes","No","100%",,"$500","$10","$600","$200","$500","$200","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$200","$200 per person","per group not applicable","10%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","65"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100034","Blue Value 1000 (limited network)","11512NC010",,"NCN002","NCS003","NCF013","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100034-00","Standard Gold Off Exchange Plan",,"0.80511349439621","No","Yes","No","100%",,"$1,000","$40","$1,200","$200","$600","$500","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","66"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100034","Blue Value 1000 (limited network)","11512NC010",,"NCN002","NCS003","NCF013","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100034-01","Standard Gold On Exchange Plan",,"0.80511349439621","No","Yes","No","100%",,"$1,000","$40","$1,200","$200","$600","$500","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","67"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100034","Blue Value 1000 (limited network)","11512NC010",,"NCN002","NCS003","NCF013","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100034-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","68"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100034","Blue Value 1000 (limited network)","11512NC010",,"NCN002","NCS003","NCF013","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100034-03","Limited Cost Sharing Plan Variation",,"0.80511349439621","No","Yes","No","100%",,"$1,000","$40","$1,200","$200","$600","$500","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","69"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100035","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS003","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100035-00","Standard Silver Off Exchange Plan",,"0.699069321155548","No","Yes","No","100%",,"$2,500","$50","$1,300","$200","$600","$700","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","70"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100035","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS003","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100035-01","Standard Silver On Exchange Plan",,"0.699069321155548","No","Yes","No","100%",,"$2,500","$50","$1,300","$200","$600","$700","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","71"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100035","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS003","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100035-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","72"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100035","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS003","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100035-03","Limited Cost Sharing Plan Variation",,"0.699069321155548","No","Yes","No","100%",,"$2,500","$50","$1,300","$200","$600","$700","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","73"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100035","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS003","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100035-04","73% AV Level Silver Plan",,"0.725858449935913","No","Yes","No","100%",,"$2,500","$50","$1,300","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_2500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","74"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100035","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS003","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100035-05","87% AV Level Silver Plan",,"0.870140850543976","No","Yes","No","100%",,"$700","$10","$1,300","$200","$600","$400","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$700","$700 per person","$1400 per group","30%",,,,,"$1,400","$1400 per person","$2800 per group","$2,100","$2100 per person","$4200 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_700_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","75"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100035","Blue Value 2500 (limited network)","11512NC010",,"NCN002","NCS003","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100035-06","94% AV Level Silver Plan",,"0.945307612419128","No","Yes","No","100%",,"$400","$10","$200","$200","$400","$70","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$1,200","$1200 per person","$2400 per group","$1,800","$1800 per person","$3600 per group","$400","$400 per person","$800 per group","30%",,,,,"$800","$800 per person","$1600 per group","$1,200","$1200 per person","$2400 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_400_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","76"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100036","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS003","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100036-00","Standard Silver Off Exchange Plan",,"0.686747848987579","No","Yes","No","100%",,"$3,500","$50","$1,000","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","77"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100036","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS003","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100036-01","Standard Silver On Exchange Plan",,"0.686747848987579","No","Yes","No","100%",,"$3,500","$50","$1,000","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","78"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100036","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS003","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100036-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","79"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100036","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS003","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100036-03","Limited Cost Sharing Plan Variation",,"0.686747848987579","No","Yes","No","100%",,"$3,500","$50","$1,000","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","80"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100036","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS003","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100036-04","73% AV Level Silver Plan",,"0.721278786659241","No","Yes","No","100%",,"$2,800","$50","$1,200","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group","$2,800","$2800 per person","$5600 per group","30%",,,,,"$5,600","$5600 per person","$11200 per group","$8,400","$8400 per person","$16800 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_2800_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","81"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100036","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS003","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100036-05","87% AV Level Silver Plan",,"0.8682701587677","No","Yes","No","100%",,"$800","$10","$1,200","$200","$600","$400","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$800","$800 per person","$1600 per group","30%",,,,,"$1,600","$1600 per person","$3200 per group","$2,400","$2400 per person","$4800 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_800_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","82"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100036","Blue Value 3500 (limited network)","11512NC010",,"NCN002","NCS003","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100036-06","94% AV Level Silver Plan",,"0.939053058624268","No","Yes","No","100%",,"$500","$10","$200","$200","$500","$80","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"$1,300","$1300 per person","$2600 per group","$1,950","$1950 per person","$3900 per group","$450","$450 per person","$900 per group","30%",,,,,"$900","$900 per person","$1800 per group","$1,350","$1350 per person","$2700 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_450_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","83"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100044","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS003","NCF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100044-00","Standard Silver Off Exchange Plan","68.96%","0.672687351703644","No","Yes","No","100%",,"$5,000","$50","$500","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$300","$300 per person","per group not applicable","30%",,,,,"$300","$300 per person","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","84"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100044","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS003","NCF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100044-01","Standard Silver On Exchange Plan","68.96%","0.672687351703644","No","Yes","No","100%",,"$5,000","$50","$500","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$300","$300 per person","per group not applicable","30%",,,,,"$300","$300 per person","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","85"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100044","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS003","NCF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100044-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","86"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100044","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS003","NCF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100044-03","Limited Cost Sharing Plan Variation","68.96%","0.672687351703644","No","Yes","No","100%",,"$5,000","$50","$500","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$300","$300 per person","per group not applicable","30%",,,,,"$300","$300 per person","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","87"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100044","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS003","NCF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100044-04","73% AV Level Silver Plan","73.23%","0.71853643655777","No","Yes","No","100%",,"$3,000","$50","$1,100","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_3000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","88"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100044","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS003","NCF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100044-05","87% AV Level Silver Plan","87.05%","0.86516261100769","No","Yes","No","100%",,"$1,000","$10","$1,000","$200","$600","$400","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$1,000","$1000 per person","$2000 per group","30%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_1000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","89"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0100044","Blue Value 5000 (limited network)","11512NC010",,"NCN002","NCS003","NCF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100044-06","94% AV Level Silver Plan","93.50%","0.937231659889221","No","Yes","No","100%",,"$500","$10","$200","$200","$500","$80","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$1,400","$1400 per person","$2800 per group","$2,100","$2100 per person","$4200 per group","$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_Enhanced_500_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","90"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140001","Blue Local 500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF012","Existing","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140001-00","Standard Platinum Off Exchange Plan","88.33%","0.879242718219757","No","Yes","No","100%",,"$500","$10","$600","$200","$500","$200","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$200","$200 per person","per group not applicable","10%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Platinum_500_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","91"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140001","Blue Local 500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF012","Existing","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140001-01","Standard Platinum On Exchange Plan","88.33%","0.879242718219757","No","Yes","No","100%",,"$500","$10","$600","$200","$500","$200","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$200","$200 per person","per group not applicable","10%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Platinum_500_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","92"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140001","Blue Local 500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF012","Existing","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_100_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","93"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140001","Blue Local 500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF012","Existing","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140001-03","Limited Cost Sharing Plan Variation","88.33%","0.879242718219757","No","Yes","No","100%",,"$500","$10","$600","$200","$500","$200","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$200","$200 per person","per group not applicable","10%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Platinum_500_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","94"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140002","Blue Local 1000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF013","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140002-00","Standard Gold Off Exchange Plan",,"0.80511349439621","No","Yes","No","100%",,"$1,000","$40","$1,200","$200","$600","$500","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Gold_1000_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","95"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140002","Blue Local 1000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF013","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140002-01","Standard Gold On Exchange Plan",,"0.80511349439621","No","Yes","No","100%",,"$1,000","$40","$1,200","$200","$600","$500","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Gold_1000_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","96"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140002","Blue Local 1000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF013","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_100_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","97"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140002","Blue Local 1000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF013","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140002-03","Limited Cost Sharing Plan Variation",,"0.80511349439621","No","Yes","No","100%",,"$1,000","$40","$1,200","$200","$600","$500","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Gold_1000_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","98"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140003","Blue Local 3500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140003-00","Standard Silver Off Exchange Plan",,"0.686747848987579","No","Yes","No","100%",,"$3,500","$50","$1,000","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Silver_3500_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","99"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140003","Blue Local 3500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140003-01","Standard Silver On Exchange Plan",,"0.686747848987579","No","Yes","No","100%",,"$3,500","$50","$1,000","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Silver_3500_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","100"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140003","Blue Local 3500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_100_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","101"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140003","Blue Local 3500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140003-03","Limited Cost Sharing Plan Variation",,"0.686747848987579","No","Yes","No","100%",,"$3,500","$50","$1,000","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Silver_3500_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","102"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140003","Blue Local 3500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140003-04","73% AV Level Silver Plan",,"0.721278786659241","No","Yes","No","100%",,"$2,800","$50","$1,200","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group","$2,800","$2800 per person","$5600 per group","30%",,,,,"$5,600","$5600 per person","$11200 per group","$8,400","$8400 per person","$16800 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Silver_Enhanced_2800_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","103"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140003","Blue Local 3500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140003-05","87% AV Level Silver Plan",,"0.8682701587677","No","Yes","No","100%",,"$800","$10","$1,200","$200","$600","$400","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$800","$800 per person","$1600 per group","30%",,,,,"$1,600","$1600 per person","$3200 per group","$2,400","$2400 per person","$4800 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Silver_Enhanced_800_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","104"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140003","Blue Local 3500 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF014","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140003-06","94% AV Level Silver Plan",,"0.939053058624268","No","Yes","No","100%",,"$500","$10","$200","$200","$500","$80","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"$1,300","$1300 per person","$2600 per group","$1,950","$1950 per person","$3900 per group","$450","$450 per person","$900 per group","30%",,,,,"$900","$900 per person","$1800 per group","$1,350","$1350 per person","$2700 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Silver_Enhanced_450_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","105"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140004","Blue Local 5000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140004-00","Standard Silver Off Exchange Plan","68.96%","0.672687351703644","No","Yes","No","100%",,"$5,000","$50","$500","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$300","$300 per person","per group not applicable","30%",,,,,"$300","$300 per person","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Silver_5000_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","106"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140004","Blue Local 5000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140004-01","Standard Silver On Exchange Plan","68.96%","0.672687351703644","No","Yes","No","100%",,"$5,000","$50","$500","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$300","$300 per person","per group not applicable","30%",,,,,"$300","$300 per person","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Silver_5000_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","107"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140004","Blue Local 5000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_100_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","108"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140004","Blue Local 5000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140004-03","Limited Cost Sharing Plan Variation","68.96%","0.672687351703644","No","Yes","No","100%",,"$5,000","$50","$500","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$300","$300 per person","per group not applicable","30%",,,,,"$300","$300 per person","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Silver_5000_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","109"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140004","Blue Local 5000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140004-04","73% AV Level Silver Plan","73.23%","0.71853643655777","No","Yes","No","100%",,"$3,000","$50","$1,100","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Silver_Enhanced_3000_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","110"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140004","Blue Local 5000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140004-05","87% AV Level Silver Plan","87.05%","0.86516261100769","No","Yes","No","100%",,"$1,000","$10","$1,000","$200","$600","$400","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$1,000","$1000 per person","$2000 per group","30%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Silver_Enhanced_1000_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","111"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0140004","Blue Local 5000 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140004-06","94% AV Level Silver Plan","93.50%","0.937231659889221","No","Yes","No","100%",,"$500","$10","$200","$200","$500","$80","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$1,400","$1400 per person","$2800 per group","$2,100","$2100 per person","$4200 per group","$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Silver_Enhanced_500_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","112"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170001","Blue Local 500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF012","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170001-00","Standard Platinum Off Exchange Plan","88.33%","0.879242718219757","No","Yes","No","100%",,"$500","$10","$600","$200","$500","$200","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$200","$200 per person","per group not applicable","10%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Platinum_500_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","113"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170001","Blue Local 500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF012","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170001-01","Standard Platinum On Exchange Plan","88.33%","0.879242718219757","No","Yes","No","100%",,"$500","$10","$600","$200","$500","$200","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$200","$200 per person","per group not applicable","10%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Platinum_500_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","114"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170001","Blue Local 500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF012","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_100_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","115"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170001","Blue Local 500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF012","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170001-03","Limited Cost Sharing Plan Variation","88.33%","0.879242718219757","No","Yes","No","100%",,"$500","$10","$600","$200","$500","$200","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$200","$200 per person","per group not applicable","10%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Platinum_500_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","116"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170002","Blue Local 1000 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF013","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170002-00","Standard Gold Off Exchange Plan",,"0.80511349439621","No","Yes","No","100%",,"$1,000","$40","$1,200","$200","$600","$500","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Gold_1000_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","117"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170002","Blue Local 1000 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF013","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170002-01","Standard Gold On Exchange Plan",,"0.80511349439621","No","Yes","No","100%",,"$1,000","$40","$1,200","$200","$600","$500","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Gold_1000_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","118"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170002","Blue Local 1000 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF013","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_100_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","119"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170002","Blue Local 1000 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF013","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170002-03","Limited Cost Sharing Plan Variation",,"0.80511349439621","No","Yes","No","100%",,"$1,000","$40","$1,200","$200","$600","$500","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","20%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Gold_1000_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","120"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170003","Blue Local 3500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF014","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170003-00","Standard Silver Off Exchange Plan",,"0.686747848987579","No","Yes","No","100%",,"$3,500","$50","$1,000","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Silver_3500_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","121"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170003","Blue Local 3500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF014","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170003-01","Standard Silver On Exchange Plan",,"0.686747848987579","No","Yes","No","100%",,"$3,500","$50","$1,000","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Silver_3500_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","122"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170003","Blue Local 3500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF014","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_100_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","123"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170003","Blue Local 3500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF014","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170003-03","Limited Cost Sharing Plan Variation",,"0.686747848987579","No","Yes","No","100%",,"$3,500","$50","$1,000","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","$200","$200 per person","per group not applicable","30%",,,,,"$200","$200 per person","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Silver_3500_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","124"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170003","Blue Local 3500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF014","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170003-04","73% AV Level Silver Plan",,"0.721278786659241","No","Yes","No","100%",,"$2,800","$50","$1,200","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group","$2,800","$2800 per person","$5600 per group","30%",,,,,"$5,600","$5600 per person","$11200 per group","$8,400","$8400 per person","$16800 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Silver_Enhanced_2800_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","125"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170003","Blue Local 3500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF014","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170003-05","87% AV Level Silver Plan",,"0.8682701587677","No","Yes","No","100%",,"$800","$10","$1,200","$200","$600","$400","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$800","$800 per person","$1600 per group","30%",,,,,"$1,600","$1600 per person","$3200 per group","$2,400","$2400 per person","$4800 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Silver_Enhanced_800_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","126"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170003","Blue Local 3500 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF014","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170003-06","94% AV Level Silver Plan",,"0.939053058624268","No","Yes","No","100%",,"$500","$10","$200","$200","$500","$80","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"$1,300","$1300 per person","$2600 per group","$1,950","$1950 per person","$3900 per group","$450","$450 per person","$900 per group","30%",,,,,"$900","$900 per person","$1800 per group","$1,350","$1350 per person","$2700 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Silver_Enhanced_450_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","127"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170004","Blue Local 5000 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF014","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170004-00","Standard Silver Off Exchange Plan","68.96%","0.672687351703644","No","Yes","No","100%",,"$5,000","$50","$500","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$300","$300 per person","per group not applicable","30%",,,,,"$300","$300 per person","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Silver_5000_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","128"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170004","Blue Local 5000 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF014","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170004-01","Standard Silver On Exchange Plan","68.96%","0.672687351703644","No","Yes","No","100%",,"$5,000","$50","$500","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$300","$300 per person","per group not applicable","30%",,,,,"$300","$300 per person","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Silver_5000_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","129"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170004","Blue Local 5000 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF014","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_100_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","130"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170004","Blue Local 5000 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF014","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170004-03","Limited Cost Sharing Plan Variation","68.96%","0.672687351703644","No","Yes","No","100%",,"$5,000","$50","$500","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$300","$300 per person","per group not applicable","30%",,,,,"$300","$300 per person","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Silver_5000_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","131"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170004","Blue Local 5000 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF014","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170004-04","73% AV Level Silver Plan","73.23%","0.71853643655777","No","Yes","No","100%",,"$3,000","$50","$1,100","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Silver_Enhanced_3000_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","132"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170004","Blue Local 5000 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF014","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170004-05","87% AV Level Silver Plan","87.05%","0.86516261100769","No","Yes","No","100%",,"$1,000","$10","$1,000","$200","$600","$400","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$1,000","$1000 per person","$2000 per group","30%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Silver_Enhanced_1000_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","133"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","1","11512","NC","Individual","No","56-0894904","11512NC0170004","Blue Local 5000 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF014","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170004-06","94% AV Level Silver Plan","93.50%","0.937231659889221","No","Yes","No","100%",,"$500","$10","$200","$200","$500","$80","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$1,400","$1400 per person","$2800 per group","$2,100","$2100 per person","$4200 per group","$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","30%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Silver_Enhanced_500_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","134"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","Individual","No","56-0894904","11512NC0060026","Blue Advantage 6850 (broad network)","11512NC006",,"NCN001","NCS009","NCF017","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060026-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$3,800","$0","$0","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$14,950","$14950 per person","$28650 per group","$21,800","$21800 per person","$42350 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_6850_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","4"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0110013","Blue Select Gold 1500 CX","11512NC011",,"NCN005","NCS004","NCF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$100","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0110013-00","Standard Gold Off Exchange Plan","78.74%","0.777190148830414","No","Yes","Yes","85%","15%","$1,500","$30","$1,100","$200","$600","$400","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,500","$1500 per person","$3000 per group","20%","$1,500","$1500 per person","$3000 per group","20%","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1500_CX",,"4"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0110013","Blue Select Gold 1500 CX","11512NC011",,"NCN005","NCS004","NCF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$100","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0110013-01","Standard Gold On Exchange Plan","78.74%","0.777190148830414","No","Yes","Yes","85%","15%","$1,500","$30","$1,100","$200","$600","$400","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,500","$1500 per person","$3000 per group","20%","$1,500","$1500 per person","$3000 per group","20%","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1500_CX",,"5"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","Individual","No","56-0894904","11512NC0060026","Blue Advantage 6850 (broad network)","11512NC006",,"NCN001","NCS009","NCF017","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060026-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$3,800","$0","$0","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$14,950","$14950 per person","$28650 per group","$21,800","$21800 per person","$42350 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_6850_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","5"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","Individual","No","56-0894904","11512NC0060026","Blue Advantage 6850 (broad network)","11512NC006",,"NCN001","NCS009","NCF017","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_100_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","6"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0110014","Blue Select Gold 1500 CX","11512NC011",,"NCN005","NCS005","NCF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$100","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0110014-00","Standard Gold Off Exchange Plan","78.74%","0.777190148830414","No","Yes","Yes","85%","15%","$1,500","$30","$1,100","$200","$600","$400","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,500","$1500 per person","$3000 per group","20%","$1,500","$1500 per person","$3000 per group","20%","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1500_CX",,"6"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0110014","Blue Select Gold 1500 CX","11512NC011",,"NCN005","NCS005","NCF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$100","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0110014-01","Standard Gold On Exchange Plan","78.74%","0.777190148830414","No","Yes","Yes","85%","15%","$1,500","$30","$1,100","$200","$600","$400","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,500","$1500 per person","$3000 per group","20%","$1,500","$1500 per person","$3000 per group","20%","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1500_CX",,"7"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","Individual","No","56-0894904","11512NC0060026","Blue Advantage 6850 (broad network)","11512NC006",,"NCN001","NCS009","NCF017","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060026-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$3,800","$0","$0","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$14,950","$14950 per person","$28650 per group","$21,800","$21800 per person","$42350 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_6850_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","7"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","Individual","No","56-0894904","11512NC0100030","Blue Value 6850 (limited network)","11512NC010",,"NCN002","NCS002","NCF017","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100030-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$3,800","$0","$0","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$14,950","$14950 per person","$28650 per group","$21,800","$21800 per person","$42350 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_6850_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","8"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0110019","Blue Select Silver 2000 CX","11512NC011",,"NCN005","NCS004","NCF008","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$200","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0110019-00","Standard Silver Off Exchange Plan",,"0.689144849777222","No","Yes","Yes","85%","15%","$2,000","$80","$1,400","$200","$600","$1,200","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,000","$2000 per person","$4000 per group","30%","$2,000","$2000 per person","$4000 per group","30%","$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","per group not applicable","30%","$0","$0 per person","per group not applicable","30%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_2000_CX",,"8"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0110019","Blue Select Silver 2000 CX","11512NC011",,"NCN005","NCS004","NCF008","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$200","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0110019-01","Standard Silver On Exchange Plan",,"0.689144849777222","No","Yes","Yes","85%","15%","$2,000","$80","$1,400","$200","$600","$1,200","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,000","$2000 per person","$4000 per group","30%","$2,000","$2000 per person","$4000 per group","30%","$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","per group not applicable","30%","$0","$0 per person","per group not applicable","30%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_2000_CX",,"9"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","Individual","No","56-0894904","11512NC0100030","Blue Value 6850 (limited network)","11512NC010",,"NCN002","NCS002","NCF017","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100030-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$3,800","$0","$0","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$14,950","$14950 per person","$28650 per group","$21,800","$21800 per person","$42350 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_6850_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","9"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","Individual","No","56-0894904","11512NC0100030","Blue Value 6850 (limited network)","11512NC010",,"NCN002","NCS002","NCF017","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100030-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","10"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0110020","Blue Select Silver 2000 CX","11512NC011",,"NCN005","NCS005","NCF008","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$200","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0110020-00","Standard Silver Off Exchange Plan",,"0.689144849777222","No","Yes","Yes","85%","15%","$2,000","$80","$1,400","$200","$600","$1,200","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,000","$2000 per person","$4000 per group","30%","$2,000","$2000 per person","$4000 per group","30%","$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","per group not applicable","30%","$0","$0 per person","per group not applicable","30%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_2000_CX",,"10"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0110020","Blue Select Silver 2000 CX","11512NC011",,"NCN005","NCS005","NCF008","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$200","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0110020-01","Standard Silver On Exchange Plan",,"0.689144849777222","No","Yes","Yes","85%","15%","$2,000","$80","$1,400","$200","$600","$1,200","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,000","$2000 per person","$4000 per group","30%","$2,000","$2000 per person","$4000 per group","30%","$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","per group not applicable","30%","$0","$0 per person","per group not applicable","30%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_2000_CX",,"11"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","Individual","No","56-0894904","11512NC0100030","Blue Value 6850 (limited network)","11512NC010",,"NCN002","NCS002","NCF017","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100030-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$3,800","$0","$0","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$14,950","$14950 per person","$28650 per group","$21,800","$21800 per person","$42350 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_6850_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","11"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","Individual","No","56-0894904","11512NC0100042","Blue Value 6850 (limited network)","11512NC010",,"NCN002","NCS003","NCF017","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100042-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$3,800","$0","$0","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$14,950","$14950 per person","$28650 per group","$21,800","$21800 per person","$42350 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_6850_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","12"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0110023","Blue Select Platinum 500 CX","11512NC011",,"NCN005","NCS004","NCF010","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$100","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0110023-00","Standard Platinum Off Exchange Plan",,"0.888390481472015","No","Yes","Yes","85%","15%","$500","$10","$1,000","$200","$500","$200","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Platinum_500_CX",,"12"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0110023","Blue Select Platinum 500 CX","11512NC011",,"NCN005","NCS004","NCF010","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$100","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0110023-01","Standard Platinum On Exchange Plan",,"0.888390481472015","No","Yes","Yes","85%","15%","$500","$10","$1,000","$200","$500","$200","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Platinum_500_CX",,"13"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","Individual","No","56-0894904","11512NC0100042","Blue Value 6850 (limited network)","11512NC010",,"NCN002","NCS003","NCF017","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100042-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$3,800","$0","$0","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$14,950","$14950 per person","$28650 per group","$21,800","$21800 per person","$42350 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_6850_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","13"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","Individual","No","56-0894904","11512NC0100042","Blue Value 6850 (limited network)","11512NC010",,"NCN002","NCS003","NCF017","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100042-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","14"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0110024","Blue Select Platinum 500 CX","11512NC011",,"NCN005","NCS005","NCF010","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$100","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0110024-00","Standard Platinum Off Exchange Plan",,"0.888390481472015","No","Yes","Yes","85%","15%","$500","$10","$1,000","$200","$500","$200","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Platinum_500_CX",,"14"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0110024","Blue Select Platinum 500 CX","11512NC011",,"NCN005","NCS005","NCF010","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,"$100","0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0110024-01","Standard Platinum On Exchange Plan",,"0.888390481472015","No","Yes","Yes","85%","15%","$500","$10","$1,000","$200","$500","$200","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Platinum_500_CX",,"15"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","Individual","No","56-0894904","11512NC0100042","Blue Value 6850 (limited network)","11512NC010",,"NCN002","NCS003","NCF017","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100042-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$3,800","$0","$0","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$14,950","$14950 per person","$28650 per group","$21,800","$21800 per person","$42350 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_6850_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","15"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","Individual","No","56-0894904","11512NC0140006","Blue Local 6850 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF017","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140006-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$3,800","$0","$0","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$14,950","$14950 per person","$28650 per group","$21,800","$21800 per person","$42350 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Bronze_6850_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","16"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","Individual","No","56-0894904","11512NC0140006","Blue Local 6850 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF017","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140006-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$3,800","$0","$0","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$14,950","$14950 per person","$28650 per group","$21,800","$21800 per person","$42350 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Bronze_6850_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","17"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","Individual","No","56-0894904","11512NC0140006","Blue Local 6850 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF017","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_100_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","18"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","Individual","No","56-0894904","11512NC0140006","Blue Local 6850 (local network with Carolinas HealthCare System)","11512NC014",,"NCN003","NCS006","NCF017","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140006-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$3,800","$0","$0","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$14,950","$14950 per person","$28650 per group","$21,800","$21800 per person","$42350 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Bronze_6850_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","19"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","Individual","No","56-0894904","11512NC0170005","Blue Local 6850 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF017","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170005-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$3,800","$0","$0","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$14,950","$14950 per person","$28650 per group","$21,800","$21800 per person","$42350 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Bronze_6850_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","20"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","Individual","No","56-0894904","11512NC0170005","Blue Local 6850 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF017","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170005-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$3,800","$0","$0","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$14,950","$14950 per person","$28650 per group","$21,800","$21800 per person","$42350 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Bronze_6850_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","21"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","Individual","No","56-0894904","11512NC0170005","Blue Local 6850 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF017","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_100_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","22"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","2","11512","NC","Individual","No","56-0894904","11512NC0170005","Blue Local 6850 (local network with Duke Medicine and WakeMed)","11512NC017",,"NCN004","NCS007","NCF017","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170005-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$3,800","$0","$0","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$14,950","$14950 per person","$28650 per group","$21,800","$21800 per person","$42350 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Bronze_6850_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","23"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120001","Blue Select 1000 (tiered network)","11512NC012",,"NCN005","NCS008","NCF013","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120001-00","Standard Gold Off Exchange Plan",,"0.803265571594238","No","Yes","Yes","85%","15%","$1,000","$40","$1,200","$200","$600","$500","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$2000 per group","20%","$1,000","$1000 per person","$2000 per group","40%","$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","4"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0040021","Blue Options HSA Silver 2000 X","11512NC004",,"NCN001","NCS001","NCF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceEnhanced.pdf","11512NC0040021-00","Standard Silver Off Exchange Plan",,"0.707190811634064","Yes","Yes","No","100%",,"$2,000","$0","$1,000","$200","$2,000","$0","$600","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6550 per person","$12000 per group",,,,"$12,000","$13100 per person","$24000 per group","$18,000","$19650 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","20%",,,,,"$4,000","$8000 per person","$8000 per group","$6,000","$12000 per person","$12000 per group","Yes","Yes","$0.00","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_HSA_Silver_2000_X",,"4"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0040021","Blue Options HSA Silver 2000 X","11512NC004",,"NCN001","NCS001","NCF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceEnhanced.pdf","11512NC0040021-01","Standard Silver On Exchange Plan",,"0.707190811634064","Yes","Yes","No","100%",,"$2,000","$0","$1,000","$200","$2,000","$0","$600","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6550 per person","$12000 per group",,,,"$12,000","$13100 per person","$24000 per group","$18,000","$19650 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","20%",,,,,"$4,000","$8000 per person","$8000 per group","$6,000","$12000 per person","$12000 per group","Yes","Yes","$0.00","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_HSA_Silver_2000_X",,"5"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120001","Blue Select 1000 (tiered network)","11512NC012",,"NCN005","NCS008","NCF013","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120001-01","Standard Gold On Exchange Plan",,"0.803265571594238","No","Yes","Yes","85%","15%","$1,000","$40","$1,200","$200","$600","$500","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$2000 per group","20%","$1,000","$1000 per person","$2000 per group","40%","$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","5"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120001","Blue Select 1000 (tiered network)","11512NC012",,"NCN005","NCS008","NCF013","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_100_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","6"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0040032","Blue Options HSA Bronze 5000 X","11512NC004",,"NCN001","NCS001","NCF001","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceEnhanced.pdf","11512NC0040032-00","Standard Bronze Off Exchange Plan",,"0.613701462745667","Yes","Yes","No","100%",,"$5,000","$0","$400","$200","$4,700","$0","$20","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$10,000","$13100 per person","$20000 per group","$15,000","$19650 per person","$30000 per group","Yes","Yes","$0.00","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_HSA_Bronze_5000_X",,"6"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0040032","Blue Options HSA Bronze 5000 X","11512NC004",,"NCN001","NCS001","NCF001","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceEnhanced.pdf","11512NC0040032-01","Standard Bronze On Exchange Plan",,"0.613701462745667","Yes","Yes","No","100%",,"$5,000","$0","$400","$200","$4,700","$0","$20","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$10,000","$13100 per person","$20000 per group","$15,000","$19650 per person","$30000 per group","Yes","Yes","$0.00","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_HSA_Bronze_5000_X",,"7"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120001","Blue Select 1000 (tiered network)","11512NC012",,"NCN005","NCS008","NCF013","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120001-03","Limited Cost Sharing Plan Variation",,"0.803265571594238","No","Yes","Yes","85%","15%","$1,000","$40","$1,200","$200","$600","$500","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$2000 per group","20%","$1,000","$1000 per person","$2000 per group","40%","$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","7"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120002","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS008","NCF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120002-00","Standard Silver Off Exchange Plan","68.74%","0.670427143573761","No","Yes","Yes","85%","15%","$5,000","$50","$500","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%","$5,000","$5000 per person","$10000 per group","50%","$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$300","$300 per person","per group not applicable","30%","$300","$300 per person","per group not applicable","30%","$300","$300 per person","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_5000_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","8"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120002","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS008","NCF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120002-01","Standard Silver On Exchange Plan","68.74%","0.670427143573761","No","Yes","Yes","85%","15%","$5,000","$50","$500","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%","$5,000","$5000 per person","$10000 per group","50%","$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$300","$300 per person","per group not applicable","30%","$300","$300 per person","per group not applicable","30%","$300","$300 per person","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_5000_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","9"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120002","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS008","NCF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_100_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","10"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120002","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS008","NCF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120002-03","Limited Cost Sharing Plan Variation","68.74%","0.670427143573761","No","Yes","Yes","85%","15%","$5,000","$50","$500","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%","$5,000","$5000 per person","$10000 per group","50%","$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$300","$300 per person","per group not applicable","30%","$300","$300 per person","per group not applicable","30%","$300","$300 per person","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_5000_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","11"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120002","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS008","NCF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120002-04","73% AV Level Silver Plan","73.42%","0.718123853206635","No","Yes","Yes","85%","15%","$3,000","$50","$1,100","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group","$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group","$3,000","$3000 per person","$6000 per group","30%","$3,000","$3000 per person","$6000 per group","50%","$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$0","$0 per person","per group not applicable","30%","$0","$0 per person","per group not applicable","30%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_Enhanced_3000_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","12"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120002","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS008","NCF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120002-05","87% AV Level Silver Plan","87.40%","0.865172564983368","No","Yes","Yes","85%","15%","$1,000","$10","$1,000","$200","$600","$400","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$1,000","$1000 per person","$2000 per group","30%","$1,000","$1000 per person","$2000 per group","50%","$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","30%","$0","$0 per person","per group not applicable","30%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_Enhanced_1000_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","13"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120002","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS008","NCF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120002-06","94% AV Level Silver Plan","94.31%","0.93620640039444","No","Yes","Yes","85%","15%","$500","$10","$200","$200","$500","$80","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","$1,400","$1400 per person","$2800 per group","$2,100","$2100 per person","$4200 per group","$500","$500 per person","$1000 per group","30%","$500","$500 per person","$1000 per group","50%","$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","30%","$0","$0 per person","per group not applicable","30%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_Enhanced_500_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","14"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120003","Blue Select 1000 (tiered network)","11512NC012",,"NCN005","NCS005","NCF013","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120003-00","Standard Gold Off Exchange Plan",,"0.803265571594238","No","Yes","Yes","85%","15%","$1,000","$40","$1,200","$200","$600","$500","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$2000 per group","20%","$1,000","$1000 per person","$2000 per group","40%","$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","15"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120003","Blue Select 1000 (tiered network)","11512NC012",,"NCN005","NCS005","NCF013","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120003-01","Standard Gold On Exchange Plan",,"0.803265571594238","No","Yes","Yes","85%","15%","$1,000","$40","$1,200","$200","$600","$500","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$2000 per group","20%","$1,000","$1000 per person","$2000 per group","40%","$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","16"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120003","Blue Select 1000 (tiered network)","11512NC012",,"NCN005","NCS005","NCF013","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_100_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","17"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120003","Blue Select 1000 (tiered network)","11512NC012",,"NCN005","NCS005","NCF013","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120003-03","Limited Cost Sharing Plan Variation",,"0.803265571594238","No","Yes","Yes","85%","15%","$1,000","$40","$1,200","$200","$600","$500","$200","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group","$1,000","$1000 per person","$2000 per group","20%","$1,000","$1000 per person","$2000 per group","40%","$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","18"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120004","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS005","NCF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120004-00","Standard Silver Off Exchange Plan","68.74%","0.670427143573761","No","Yes","Yes","85%","15%","$5,000","$50","$500","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%","$5,000","$5000 per person","$10000 per group","50%","$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$300","$300 per person","per group not applicable","30%","$300","$300 per person","per group not applicable","30%","$300","$300 per person","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_5000_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","19"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120004","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS005","NCF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120004-01","Standard Silver On Exchange Plan","68.74%","0.670427143573761","No","Yes","Yes","85%","15%","$5,000","$50","$500","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%","$5,000","$5000 per person","$10000 per group","50%","$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$300","$300 per person","per group not applicable","30%","$300","$300 per person","per group not applicable","30%","$300","$300 per person","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_5000_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","20"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120004","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS005","NCF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_100_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","21"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120004","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS005","NCF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120004-03","Limited Cost Sharing Plan Variation","68.74%","0.670427143573761","No","Yes","Yes","85%","15%","$5,000","$50","$500","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$5,000","$5000 per person","$10000 per group","30%","$5,000","$5000 per person","$10000 per group","50%","$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$300","$300 per person","per group not applicable","30%","$300","$300 per person","per group not applicable","30%","$300","$300 per person","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_5000_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","22"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120004","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS005","NCF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120004-04","73% AV Level Silver Plan","73.42%","0.718123853206635","No","Yes","Yes","85%","15%","$3,000","$50","$1,100","$200","$600","$600","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group","$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group","$3,000","$3000 per person","$6000 per group","30%","$3,000","$3000 per person","$6000 per group","50%","$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$0","$0 per person","per group not applicable","30%","$0","$0 per person","per group not applicable","30%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_Enhanced_3000_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","23"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120004","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS005","NCF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120004-05","87% AV Level Silver Plan","87.40%","0.865172564983368","No","Yes","Yes","85%","15%","$1,000","$10","$1,000","$200","$600","$400","$300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$1,000","$1000 per person","$2000 per group","30%","$1,000","$1000 per person","$2000 per group","50%","$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","30%","$0","$0 per person","per group not applicable","30%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_Enhanced_1000_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","24"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","3","11512","NC","Individual","No","56-0894904","11512NC0120004","Blue Select 5000 (tiered network)","11512NC012",,"NCN005","NCS005","NCF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0120004-06","94% AV Level Silver Plan","94.31%","0.93620640039444","No","Yes","Yes","85%","15%","$500","$10","$200","$200","$500","$80","$100","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","$1,400","$1400 per person","$2800 per group","$2,100","$2100 per person","$4200 per group","$500","$500 per person","$1000 per group","30%","$500","$500 per person","$1000 per group","50%","$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","30%","$0","$0 per person","per group not applicable","30%","$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_Enhanced_500_2016.pdf","http://www.bcbsnc.com/bsplanbrochure_2016","25"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","4","11512","NC","Individual","No","56-0894904","11512NC0060024","Blue Advantage 5000 (broad network, HSA eligible)","11512NC006",,"NCN001","NCS009","NCF018","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060024-00","Standard Bronze Off Exchange Plan",,"0.613701462745667","Yes","Yes","No","100%",,"$5,000","$0","$400","$200","$4,700","$0","$20","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$10,000","$13100 per person","$20000 per group","$15,000","$19650 per person","$30000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5000_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","4"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","4","11512","NC","Individual","No","56-0894904","11512NC0060024","Blue Advantage 5000 (broad network, HSA eligible)","11512NC006",,"NCN001","NCS009","NCF018","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060024-01","Standard Bronze On Exchange Plan",,"0.613701462745667","Yes","Yes","No","100%",,"$5,000","$0","$400","$200","$4,700","$0","$20","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$10,000","$13100 per person","$20000 per group","$15,000","$19650 per person","$30000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5000_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","5"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","4","11512","NC","Individual","No","56-0894904","11512NC0060024","Blue Advantage 5000 (broad network, HSA eligible)","11512NC006",,"NCN001","NCS009","NCF018","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060024-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_100_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","6"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","4","11512","NC","Individual","No","56-0894904","11512NC0060024","Blue Advantage 5000 (broad network, HSA eligible)","11512NC006",,"NCN001","NCS009","NCF018","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060024-03","Limited Cost Sharing Plan Variation",,"0.613701462745667","Yes","Yes","No","100%",,"$5,000","$0","$400","$200","$4,700","$0","$20","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$10,000","$13100 per person","$20000 per group","$15,000","$19650 per person","$30000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5000_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","7"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","4","11512","NC","Individual","No","56-0894904","11512NC0100028","Blue Value 5000 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS002","NCF018","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100028-00","Standard Bronze Off Exchange Plan",,"0.613701462745667","Yes","Yes","No","100%",,"$5,000","$0","$400","$200","$4,700","$0","$20","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$10,000","$13100 per person","$20000 per group","$15,000","$19650 per person","$30000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","8"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","4","11512","NC","Individual","No","56-0894904","11512NC0100028","Blue Value 5000 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS002","NCF018","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100028-01","Standard Bronze On Exchange Plan",,"0.613701462745667","Yes","Yes","No","100%",,"$5,000","$0","$400","$200","$4,700","$0","$20","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$10,000","$13100 per person","$20000 per group","$15,000","$19650 per person","$30000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","9"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","4","11512","NC","Individual","No","56-0894904","11512NC0100028","Blue Value 5000 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS002","NCF018","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100028-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","10"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","4","11512","NC","Individual","No","56-0894904","11512NC0100028","Blue Value 5000 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS002","NCF018","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100028-03","Limited Cost Sharing Plan Variation",,"0.613701462745667","Yes","Yes","No","100%",,"$5,000","$0","$400","$200","$4,700","$0","$20","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$10,000","$13100 per person","$20000 per group","$15,000","$19650 per person","$30000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","11"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","4","11512","NC","Individual","No","56-0894904","11512NC0100040","Blue Value 5000 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS003","NCF018","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100040-00","Standard Bronze Off Exchange Plan",,"0.613701462745667","Yes","Yes","No","100%",,"$5,000","$0","$400","$200","$4,700","$0","$20","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$10,000","$13100 per person","$20000 per group","$15,000","$19650 per person","$30000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","12"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","4","11512","NC","Individual","No","56-0894904","11512NC0100040","Blue Value 5000 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS003","NCF018","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100040-01","Standard Bronze On Exchange Plan",,"0.613701462745667","Yes","Yes","No","100%",,"$5,000","$0","$400","$200","$4,700","$0","$20","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$10,000","$13100 per person","$20000 per group","$15,000","$19650 per person","$30000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","13"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","4","11512","NC","Individual","No","56-0894904","11512NC0100040","Blue Value 5000 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS003","NCF018","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100040-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$5,000","$0","$400","$200","$4,700","$0","$20","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_100_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","14"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","4","11512","NC","Individual","No","56-0894904","11512NC0100040","Blue Value 5000 (limited network, HSA eligible)","11512NC010",,"NCN002","NCS003","NCF018","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100040-03","Limited Cost Sharing Plan Variation",,"0.613701462745667","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$10,000","$13100 per person","$20000 per group","$15,000","$19650 per person","$30000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","15"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","4","11512","NC","Individual","No","56-0894904","11512NC0140005","Blue Local 5000 (local network with Carolinas HealthCare System, HSA eligible)","11512NC014",,"NCN003","NCS006","NCF018","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140005-00","Standard Bronze Off Exchange Plan",,"0.613701462745667","Yes","Yes","No","100%",,"$5,000","$0","$400","$200","$4,700","$0","$20","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$10,000","$13100 per person","$20000 per group","$15,000","$19650 per person","$30000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Bronze_5000_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","16"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","4","11512","NC","Individual","No","56-0894904","11512NC0140005","Blue Local 5000 (local network with Carolinas HealthCare System, HSA eligible)","11512NC014",,"NCN003","NCS006","NCF018","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140005-01","Standard Bronze On Exchange Plan",,"0.613701462745667","Yes","Yes","No","100%",,"$5,000","$0","$400","$200","$4,700","$0","$20","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$10,000","$13100 per person","$20000 per group","$15,000","$19650 per person","$30000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Bronze_5000_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","17"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","4","11512","NC","Individual","No","56-0894904","11512NC0140005","Blue Local 5000 (local network with Carolinas HealthCare System, HSA eligible)","11512NC014",,"NCN003","NCS006","NCF018","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_100_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","18"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","4","11512","NC","Individual","No","56-0894904","11512NC0140005","Blue Local 5000 (local network with Carolinas HealthCare System, HSA eligible)","11512NC014",,"NCN003","NCS006","NCF018","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0140005-03","Limited Cost Sharing Plan Variation",,"0.613701462745667","Yes","Yes","No","100%",,"$5,000","$0","$400","$200","$4,700","$0","$20","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$10,000","$13100 per person","$20000 per group","$15,000","$19650 per person","$30000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_CHS_Bronze_5000_2016.pdf","http://www.bcbsnc.com/blplanbrochure_2016","19"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","4","11512","NC","Individual","No","56-0894904","11512NC0170006","Blue Local 5000 (local network with Duke Medicine and WakeMed, HSA eligible)","11512NC017",,"NCN004","NCS007","NCF018","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170006-00","Standard Bronze Off Exchange Plan",,"0.613701462745667","Yes","Yes","No","100%",,"$5,000","$0","$400","$200","$4,700","$0","$20","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$10,000","$13100 per person","$20000 per group","$15,000","$19650 per person","$30000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Bronze_5000_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","20"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","4","11512","NC","Individual","No","56-0894904","11512NC0170006","Blue Local 5000 (local network with Duke Medicine and WakeMed, HSA eligible)","11512NC017",,"NCN004","NCS007","NCF018","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170006-01","Standard Bronze On Exchange Plan",,"0.613701462745667","Yes","Yes","No","100%",,"$5,000","$0","$400","$200","$4,700","$0","$20","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$10,000","$13100 per person","$20000 per group","$15,000","$19650 per person","$30000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Bronze_5000_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","21"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","4","11512","NC","Individual","No","56-0894904","11512NC0170006","Blue Local 5000 (local network with Duke Medicine and WakeMed, HSA eligible)","11512NC017",,"NCN004","NCS007","NCF018","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_100_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","22"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","4","11512","NC","Individual","No","56-0894904","11512NC0170006","Blue Local 5000 (local network with Duke Medicine and WakeMed, HSA eligible)","11512NC017",,"NCN004","NCS007","NCF018","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0170006-03","Limited Cost Sharing Plan Variation",,"0.613701462745667","Yes","Yes","No","100%",,"$5,000","$0","$400","$200","$4,700","$0","$20","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$10,000","$13100 per person","$20000 per group","$15,000","$19650 per person","$30000 per group","Yes",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Local_dkwm_Bronze_5000_2016.pdf","http://www.bcbsnc.com/bldkwmplanbrochure_2016","23"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","5","11512","NC","Individual","No","56-0894904","11512NC0060027","Blue Advantage Catastrophic (broad network)","11512NC006",,"NCN001","NCS009","NCF017","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060027-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$40","$0","$200","$2,700","$400","$0","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Catastrophic_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","4"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","5","11512","NC","Individual","No","56-0894904","11512NC0060027","Blue Advantage Catastrophic (broad network)","11512NC006",,"NCN001","NCS009","NCF017","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0060027-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$40","$0","$200","$2,700","$400","$0","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Catastrophic_2016.pdf","http://www.bcbsnc.com/baplanbrochure_2016","5"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","5","11512","NC","Individual","No","56-0894904","11512NC0100031","Blue Value Catastrophic (limited network)","11512NC010",,"NCN002","NCS002","NCF017","Existing","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100031-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$40","$0","$200","$2,700","$400","$0","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Catastrophic_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","6"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","5","11512","NC","Individual","No","56-0894904","11512NC0100031","Blue Value Catastrophic (limited network)","11512NC010",,"NCN002","NCS002","NCF017","Existing","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100031-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$40","$0","$200","$2,700","$400","$0","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Catastrophic_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","7"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","5","11512","NC","Individual","No","56-0894904","11512NC0100043","Blue Value Catastrophic (limited network)","11512NC010",,"NCN002","NCS003","NCF017","Existing","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100043-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$40","$0","$200","$2,700","$400","$0","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Catastrophic_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","8"
"2016","NC","11512","HIOS","10","2015-08-26 09:56:12","5","11512","NC","Individual","No","56-0894904","11512NC0100043","Blue Value Catastrophic (limited network)","11512NC010",,"NCN002","NCS003","NCF017","Existing","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0100043-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$40","$0","$200","$2,700","$400","$0","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Catastrophic_2016.pdf","http://www.bcbsnc.com/bvplanbrochure_2016","9"
"2016","NC","12465","HIOS","2","2015-07-09 13:17:42","1","12465","NC","SHOP (Small Group)","Yes","81-0170040","12465NC0010001","Assurant Dental ACAFFO High","12465NC001",,"NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$44.99","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","12465NC0010001-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","12465","HIOS","2","2015-07-09 13:17:42","1","12465","NC","SHOP (Small Group)","Yes","81-0170040","12465NC0010002","Assurant Dental ACAFFO Low","12465NC001",,"NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$37.35","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","12465NC0010002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NC","14125","HIOS","2","2015-07-10 02:19:03","1","14125","NC","SHOP (Small Group)","Yes","35-0472300","14125NC0010001","Lincoln DentalConnect®","14125NC001","7063415294","NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.99","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","14125NC0010001-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","14125","HIOS","2","2015-07-10 02:19:03","1","14125","NC","SHOP (Small Group)","Yes","35-0472300","14125NC0010002","Lincoln DentalConnect®","14125NC001","7063415294","NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.44","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","14125NC0010002-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NC","14125","HIOS","2","2015-07-10 02:19:03","1","14125","NC","SHOP (Small Group)","Yes","35-0472300","14125NC0010003","Lincoln DentalConnect®","14125NC001","7063415294","NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.08","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","14125NC0010003-00","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","NC","14125","HIOS","2","2015-07-10 02:19:03","1","14125","NC","SHOP (Small Group)","Yes","35-0472300","14125NC0010004","Lincoln DentalConnect®","14125NC001","7063415294","NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.16","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","14125NC0010004-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","NC","14125","HIOS","2","2015-07-10 02:19:03","1","14125","NC","SHOP (Small Group)","Yes","35-0472300","14125NC0010005","Lincoln DentalConnect®","14125NC001","7063415294","NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.79","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","14125NC0010005-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","NC","14125","HIOS","2","2015-07-10 02:19:03","1","14125","NC","SHOP (Small Group)","Yes","35-0472300","14125NC0010006","Lincoln DentalConnect®","14125NC001","7063415294","NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.87","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","14125NC0010006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","NC","14125","HIOS","2","2015-07-10 02:19:03","1","14125","NC","SHOP (Small Group)","Yes","35-0472300","14125NC0010007","Lincoln DentalConnect®","14125NC001","7063415294","NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.55","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","14125NC0010007-00","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2016","NC","14125","HIOS","2","2015-07-10 02:19:03","1","14125","NC","SHOP (Small Group)","Yes","35-0472300","14125NC0010008","Lincoln DentalConnect®","14125NC001","7063415294","NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.28","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","14125NC0010008-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2016","NC","15220","HIOS","2","2015-07-09 13:17:42","1","15220","NC","SHOP (Small Group)","Yes","41-0808596","15220NC0010002","Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho","15220NC001",,"NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are the same in and out of network","Yes",,"","15220NC0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","15220","HIOS","2","2015-07-09 13:17:42","1","15220","NC","SHOP (Small Group)","Yes","41-0808596","15220NC0010005","Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho","15220NC001",,"NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are the same in and out of network","Yes",,"","15220NC0010005-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NC","15220","HIOS","2","2015-07-09 13:17:42","1","15220","NC","SHOP (Small Group)","Yes","41-0808596","15220NC0010006","Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho","15220NC001",,"NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are the same in and out of network","Yes",,"","15220NC0010006-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","NC","23521","HIOS","2","2015-07-10 02:19:03","1","23521","NC","SHOP (Small Group)","Yes","42-0127290","23521NC0060001","Principal Plan Dental 70","23521NC006",,"NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$30.78","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","23521NC0060001-00","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","23521","HIOS","2","2015-07-10 02:19:03","1","23521","NC","SHOP (Small Group)","Yes","42-0127290","23521NC0060002","Principal Plan Dental 85","23521NC006",,"NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$32.52","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","23521NC0060002-00","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NC","24112","HIOS","3","2015-08-27 11:14:25","1","24112","NC","SHOP (Small Group)","Yes","47-0098400","24112NC0040002","EHB High PPO","24112NC004",,"NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$46.83","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","24112NC0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","NC","24112","HIOS","3","2015-08-27 11:14:25","1","24112","NC","SHOP (Small Group)","Yes","47-0098400","24112NC0040001","EHB Low PPO","24112NC004",,"NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.95","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","24112NC0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","NC","24112","HIOS","3","2015-08-27 11:14:25","1","24112","NC","SHOP (Small Group)","Yes","47-0098400","24112NC0030002","EHB High Passive","24112NC003",,"NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$48.11","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","24112NC0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","1","54332","NC","Individual","No","56-1461010","54332NC0030005","Silver Compass HSA 3600","54332NC003",,"NCN001","NCS001","NCF004","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=nc0021&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","10"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","1","54332","NC","Individual","No","56-1461010","54332NC0030005","Silver Compass HSA 3600","54332NC003",,"NCN001","NCS001","NCF004","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030005-03","Limited Cost Sharing Plan Variation",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=nc0020&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","11"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","1","54332","NC","Individual","No","56-1461010","54332NC0030005","Silver Compass HSA 3600","54332NC003",,"NCN001","NCS001","NCF004","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030005-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$1,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=nc0017&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","12"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","1","54332","NC","Individual","No","56-1461010","54332NC0030005","Silver Compass HSA 3600","54332NC003",,"NCN001","NCS001","NCF004","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030005-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$200","$1,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=nc0018&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","13"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","1","54332","NC","Individual","No","56-1461010","54332NC0030005","Silver Compass HSA 3600","54332NC003",,"NCN001","NCS001","NCF004","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030005-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=nc0019&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","14"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","1","54332","NC","Individual","No","56-1461010","54332NC0030008","Bronze Compass HSA 5200","54332NC003",,"NCN001","NCS001","NCF002","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030008-00","Standard Bronze Off Exchange Plan",,"0.618971228599548","Yes","Yes","No","100%",,"$5,200","$0","$100","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=nc0028&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","15"
"2016","NC","24112","HIOS","3","2015-08-27 11:14:25","1","24112","NC","SHOP (Small Group)","Yes","47-0098400","24112NC0030001","EHB Low Passive","24112NC003",,"NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.20","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","24112NC0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","NC","25741","HIOS","4","2015-07-11 04:19:24","1","25741","NC","Individual","Yes","47-0397286","25741NC0010001","Delta Dental Individual PPO, EHB Certified","25741NC001",,"NCN002","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.86","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","25741NC0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","25741","HIOS","4","2015-07-11 04:19:24","1","25741","NC","SHOP (Small Group)","Yes","47-0397286","25741NC0030001","Renaissance Group Dental PPO, EHB Certified","25741NC003",,"NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.51","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","25741NC0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","25741","HIOS","4","2015-07-11 04:19:24","1","25741","NC","SHOP (Small Group)","Yes","47-0397286","25741NC0030002","Renaissance Group Dental PPO, EHB Certified","25741NC003",,"NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.07","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","25741NC0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NC","25741","HIOS","4","2015-07-11 04:19:24","1","25741","NC","Individual","Yes","47-0397286","25741NC0010002","Delta Dental Individual PPO, EHB Certified","25741NC001",,"NCN002","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.48","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","25741NC0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NC","25741","HIOS","4","2015-07-11 04:19:24","1","25741","NC","Individual","Yes","47-0397286","25741NC0020001","Renaissance Individual Dental PPO, EHB Certified","25741NC002",,"NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.42","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","25741NC0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","NC","25741","HIOS","4","2015-07-11 04:19:24","1","25741","NC","SHOP (Small Group)","Yes","47-0397286","25741NC0050001","Renaissance Group Dental Indemnity, EHB Certified","25741NC005",,"NCN001","NCS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.51","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","25741NC0050001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","NC","25741","HIOS","4","2015-07-11 04:19:24","1","25741","NC","SHOP (Small Group)","Yes","47-0397286","25741NC0050002","Renaissance Group Dental Indemnity, EHB Certified","25741NC005",,"NCN001","NCS001",,"Existing","Indemnity","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.07","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","25741NC0050002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","NC","25741","HIOS","4","2015-07-11 04:19:24","1","25741","NC","Individual","Yes","47-0397286","25741NC0020002","Renaissance Individual Dental PPO, EHB Certified","25741NC002",,"NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.52","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","25741NC0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","NC","25741","HIOS","4","2015-07-11 04:19:24","1","25741","NC","Individual","Yes","47-0397286","25741NC0060001","Delta Dental Individual PPO, EHB Certified (Exchange)","25741NC006",,"NCN002","NCS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.86","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/25741","","25741NC0060001-01","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnc.com/NC_EHB_High_2016","http://www.deltadentalnc.com/NC_EHB_High_2016","8"
"2016","NC","25741","HIOS","4","2015-07-11 04:19:24","1","25741","NC","Individual","Yes","47-0397286","25741NC0060002","Delta Dental Individual PPO, EHB Certified (Exchange)","25741NC006",,"NCN002","NCS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.48","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/25741","","25741NC0060002-01","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnc.com/NC_EHB_Low_2016","http://www.deltadentalnc.com/NC_EHB_Low_2016","9"
"2016","NC","25741","HIOS","4","2015-07-11 04:19:24","2","25741","NC","Individual","Yes","47-0397286","25741NC0070001","Delta Dental Individual Pediatric-Only PPO, EHB Certified","25741NC007",,"NCN002","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$33.36","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","25741NC0070001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","25741","HIOS","4","2015-07-11 04:19:24","2","25741","NC","Individual","Yes","47-0397286","25741NC0070002","Delta Dental Individual Pediatric-Only PPO, EHB Certified","25741NC007",,"NCN002","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$25.90","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","25741NC0070002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NC","25741","HIOS","4","2015-07-11 04:19:24","2","25741","NC","Individual","Yes","47-0397286","25741NC0080001","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","25741NC008",,"NCN002","NCS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$33.36","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/25741","","25741NC0080001-01","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnc.com/NC_Ped_High_2016","http://www.deltadentalnc.com/NC_Ped_High_2016","6"
"2016","NC","25741","HIOS","4","2015-07-11 04:19:24","2","25741","NC","Individual","Yes","47-0397286","25741NC0080002","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","25741NC008",,"NCN002","NCS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$25.90","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/25741","","25741NC0080002-01","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnc.com/NC_Ped_Low_2016","http://www.deltadentalnc.com/NC_Ped_Low_2016","7"
"2016","NC","25741","HIOS","4","2015-07-11 04:19:24","3","25741","NC","Individual","Yes","47-0397286","25741NC0040001","Renaissance Individual Dental Indemnity, EHB Certified","25741NC004",,"NCN001","NCS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.42","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","25741NC0040001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","25741","HIOS","4","2015-07-11 04:19:24","3","25741","NC","Individual","Yes","47-0397286","25741NC0040002","Renaissance Individual Dental Indemnity, EHB Certified","25741NC004",,"NCN001","NCS001",,"Existing","Indemnity","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.52","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","25741NC0040002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030002","Gold Compass 1000","54332NC003",,"NCN001","NCS001","NCF001","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030002-01","Standard Gold On Exchange Plan",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0004&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","9"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030002","Gold Compass 1000","54332NC003",,"NCN001","NCS001","NCF001","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0006&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","10"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030002","Gold Compass 1000","54332NC003",,"NCN001","NCS001","NCF001","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030002-03","Limited Cost Sharing Plan Variation",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0005&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","11"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030006","Silver Compass 5000","54332NC003",,"NCN001","NCS001","NCF003","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030006-00","Standard Silver Off Exchange Plan",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0010&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","12"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030006","Silver Compass 5000","54332NC003",,"NCN001","NCS001","NCF003","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030006-01","Standard Silver On Exchange Plan",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0010&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","13"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030006","Silver Compass 5000","54332NC003",,"NCN001","NCS001","NCF003","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0015&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","14"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030006","Silver Compass 5000","54332NC003",,"NCN001","NCS001","NCF003","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030006-03","Limited Cost Sharing Plan Variation",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0014&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","15"
"2016","NC","36256","HIOS","2","2015-07-02 02:19:22","1","36256","NC","SHOP (Small Group)","Yes","57-0523959","36256NC0020001","Group Dental Policy","36256NC002",,"NCN001","NCS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$48.29","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","36256NC0020001-00","Standard High Off Exchange Plan","86.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","37576","HIOS","7","2015-08-22 15:09:32","1","37576","NC","SHOP (Small Group)","Yes","75-1233841","37576NC0020007","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","37576NC002",,"NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","37576NC0020007-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nc/37576nc0010007-16","4"
"2016","NC","37576","HIOS","7","2015-08-22 15:09:32","1","37576","NC","Individual","Yes","75-1233841","37576NC0010007","Dentegra Dental PPO Pediatric Basic Plan","37576NC001",,"NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.20","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","37576NC0010007-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nc/37576nc0010007-16","4"
"2016","NC","37576","HIOS","7","2015-08-22 15:09:32","2","37576","NC","Individual","Yes","75-1233841","37576NC0010010","Dentegra Dental PPO Family Preferred Plan","37576NC001",,"NCN001","NCS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","37576NC0010010-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nc/37576nc0010010-16","4"
"2016","NC","37576","HIOS","7","2015-08-22 15:09:32","2","37576","NC","SHOP (Small Group)","Yes","75-1233841","37576NC0020010","Dentegra Dental PPO for Small Businesses Family Preferred Plan","37576NC002",,"NCN001","NCS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.01","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","37576NC0020010-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nc/37576nc0010010-16","4"
"2016","NC","37576","HIOS","7","2015-08-22 15:09:32","3","37576","NC","SHOP (Small Group)","Yes","75-1233841","37576NC0020009","Dentegra Dental PPO for Small Businesses Family Basic Plan","37576NC002",,"NCN001","NCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","37576NC0020009-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nc/37576nc0010009-16","4"
"2016","NC","37576","HIOS","7","2015-08-22 15:09:32","3","37576","NC","Individual","Yes","75-1233841","37576NC0010009","Dentegra Dental PPO Family Basic Plan","37576NC001",,"NCN001","NCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.20","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","37576NC0010009-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nc/37576nc0010009-16","4"
"2016","NC","37576","HIOS","7","2015-08-22 15:09:32","3","37576","NC","Individual","Yes","75-1233841","37576NC0010009","Dentegra Dental PPO Family Basic Plan","37576NC001",,"NCN001","NCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.20","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","37576NC0010009-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nc/37576nc0010009-16","5"
"2016","NC","37576","HIOS","7","2015-08-22 15:09:32","3","37576","NC","SHOP (Small Group)","Yes","75-1233841","37576NC0020009","Dentegra Dental PPO for Small Businesses Family Basic Plan","37576NC002",,"NCN001","NCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","37576NC0020009-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nc/37576nc0010009-16","5"
"2016","NC","40411","HIOS","2","2015-08-19 14:41:20","1","40411","NC","Individual","Yes","59-1031071","40411NC0030001","Cigna Dental Pediatric","40411NC003","7730182962","NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$18.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes",,"","40411NC0030001-00","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/individuals-families/2016-plans/sob/north-carolina/dental-pediatric","4"
"2016","NC","40435","HIOS","3","2015-08-21 03:45:06","1","40435","NC","SHOP (Small Group)","Yes","13-5581829","40435NC0170001","EHB Basic Dental Plan (Low)","40435NC017",,"NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$19.32","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","40435NC0170001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","40435","HIOS","3","2015-08-21 03:45:06","2","40435","NC","SHOP (Small Group)","Yes","13-5581829","40435NC0190001","Family Basic Dental Plan (Low)","40435NC019",,"NCN001","NCS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$19.32","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","40435NC0190001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49098","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49097","4"
"2016","NC","40435","HIOS","3","2015-08-21 03:45:06","2","40435","NC","SHOP (Small Group)","Yes","13-5581829","40435NC0190001","Family Basic Dental Plan (Low)","40435NC019",,"NCN001","NCS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$19.32","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","40435NC0190001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49098","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49097","5"
"2016","NC","40435","HIOS","3","2015-08-21 03:45:06","3","40435","NC","SHOP (Small Group)","Yes","13-5581829","40435NC0200001","Family Enhanced Dental Plan (High)","40435NC020",,"NCN001","NCS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$24.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","40435NC0200001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49100","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49099","4"
"2016","NC","40435","HIOS","3","2015-08-21 03:45:06","3","40435","NC","SHOP (Small Group)","Yes","13-5581829","40435NC0200001","Family Enhanced Dental Plan (High)","40435NC020",,"NCN001","NCS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$24.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","40435NC0200001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49100","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49099","5"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","1","54332","NC","Individual","No","56-1461010","54332NC0030003","Gold Compass HSA 1600","54332NC003",,"NCN001","NCS001","NCF002","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030003-00","Standard Gold Off Exchange Plan",,"0.785858988761902","Yes","Yes","No","100%",,"$1,600","$0","$500","$200","$1,600","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$4800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=nc0008&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","4"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","1","54332","NC","Individual","No","56-1461010","54332NC0030003","Gold Compass HSA 1600","54332NC003",,"NCN001","NCS001","NCF002","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030003-01","Standard Gold On Exchange Plan",,"0.785858988761902","Yes","Yes","No","100%",,"$1,600","$0","$500","$200","$1,600","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$4800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=nc0008&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","5"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","1","54332","NC","Individual","No","56-1461010","54332NC0030003","Gold Compass HSA 1600","54332NC003",,"NCN001","NCS001","NCF002","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=nc0007&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","6"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","1","54332","NC","Individual","No","56-1461010","54332NC0030003","Gold Compass HSA 1600","54332NC003",,"NCN001","NCS001","NCF002","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030003-03","Limited Cost Sharing Plan Variation",,"0.785858988761902","Yes","Yes","No","100%",,"$1,600","$0","$500","$200","$1,600","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$4800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=nc0009&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","7"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","1","54332","NC","Individual","No","56-1461010","54332NC0030005","Silver Compass HSA 3600","54332NC003",,"NCN001","NCS001","NCF004","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030005-00","Standard Silver Off Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=nc0016&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","8"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","1","54332","NC","Individual","No","56-1461010","54332NC0030005","Silver Compass HSA 3600","54332NC003",,"NCN001","NCS001","NCF004","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030005-01","Standard Silver On Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=nc0016&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","9"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","1","54332","NC","Individual","No","56-1461010","54332NC0030008","Bronze Compass HSA 5200","54332NC003",,"NCN001","NCS001","NCF002","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030008-01","Standard Bronze On Exchange Plan",,"0.618971228599548","Yes","Yes","No","100%",,"$5,200","$0","$100","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=nc0028&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","16"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","1","54332","NC","Individual","No","56-1461010","54332NC0030008","Bronze Compass HSA 5200","54332NC003",,"NCN001","NCS001","NCF002","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=nc0030&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","17"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","1","54332","NC","Individual","No","56-1461010","54332NC0030008","Bronze Compass HSA 5200","54332NC003",,"NCN001","NCS001","NCF002","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030008-03","Limited Cost Sharing Plan Variation",,"0.618971228599548","Yes","Yes","No","100%",,"$5,200","$0","$100","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=nc0029&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","18"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030002","Gold Compass 1000","54332NC003",,"NCN001","NCS001","NCF001","Existing","HMO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030002-00","Standard Gold Off Exchange Plan",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0004&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","8"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030006","Silver Compass 5000","54332NC003",,"NCN001","NCS001","NCF003","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030006-04","73% AV Level Silver Plan",,"0.728041231632233","No","Yes","No","100%",,"$3,600","$20","$500","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0011&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","16"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030006","Silver Compass 5000","54332NC003",,"NCN001","NCS001","NCF003","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030006-05","87% AV Level Silver Plan",,"0.871982634067535","No","Yes","No","100%",,"$800","$0","$800","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0012&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","17"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030006","Silver Compass 5000","54332NC003",,"NCN001","NCS001","NCF003","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030006-06","94% AV Level Silver Plan",,"0.949420213699341","No","Yes","No","100%",,"$0","$0","$500","$200","$0","$500","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0013&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","18"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060009","Aetna Leap Basic Plus – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF009","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060009-01","Standard Bronze On Exchange Plan","61.94%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,335","$6335 per person","$12670 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,335","$6335 per person","$12670 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/BronzePlusCaroMontHealth.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","17"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060009","Aetna Leap Basic Plus – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF009","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060009-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/BronzePlusCaroMontHealthAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","18"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030004","Silver Compass 2000","54332NC003",,"NCN001","NCS001","NCF003","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030004-00","Standard Silver Off Exchange Plan",,"0.714467763900757","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0022&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","19"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030004","Silver Compass 2000","54332NC003",,"NCN001","NCS001","NCF003","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030004-01","Standard Silver On Exchange Plan",,"0.714467763900757","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0022&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","20"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030004","Silver Compass 2000","54332NC003",,"NCN001","NCS001","NCF003","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0027&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","21"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030004","Silver Compass 2000","54332NC003",,"NCN001","NCS001","NCF003","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030004-03","Limited Cost Sharing Plan Variation",,"0.714467763900757","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0026&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","22"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030004","Silver Compass 2000","54332NC003",,"NCN001","NCS001","NCF003","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030004-04","73% AV Level Silver Plan",,"0.737353503704071","No","Yes","No","100%",,"$1,800","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0023&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","23"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030004","Silver Compass 2000","54332NC003",,"NCN001","NCS001","NCF003","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030004-05","87% AV Level Silver Plan",,"0.877411782741547","No","Yes","No","100%",,"$400","$0","$1,000","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0024&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","24"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030004","Silver Compass 2000","54332NC003",,"NCN001","NCS001","NCF003","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030004-06","94% AV Level Silver Plan",,"0.943426787853241","No","Yes","No","100%",,"$0","$0","$500","$200","$0","$500","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0025&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","25"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030009","Bronze Compass  6400","54332NC003",,"NCN001","NCS001","NCF003","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030009-00","Standard Bronze Off Exchange Plan",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0031&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","26"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030009","Bronze Compass  6400","54332NC003",,"NCN001","NCS001","NCF003","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030009-01","Standard Bronze On Exchange Plan",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0031&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","27"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030009","Bronze Compass  6400","54332NC003",,"NCN001","NCS001","NCF003","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0036&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","28"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030009","Bronze Compass  6400","54332NC003",,"NCN001","NCS001","NCF003","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030009-03","Limited Cost Sharing Plan Variation",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nc0032&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","29"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030007","Bronze Compass 4200","54332NC003",,"NCN001","NCS001","NCF005","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030007-00","Standard Bronze Off Exchange Plan",,"0.619571328163147","Yes","Yes","No","100%",,"$4,200","$0","$600","$200","$4,200","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=nc0033&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","30"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030007","Bronze Compass 4200","54332NC003",,"NCN001","NCS001","NCF005","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030007-01","Standard Bronze On Exchange Plan",,"0.619571328163147","Yes","Yes","No","100%",,"$4,200","$0","$600","$200","$4,200","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=nc0033&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","31"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030007","Bronze Compass 4200","54332NC003",,"NCN001","NCS001","NCF005","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=nc0035&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","32"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030007","Bronze Compass 4200","54332NC003",,"NCN001","NCS001","NCF005","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030007-03","Limited Cost Sharing Plan Variation",,"0.619571328163147","Yes","Yes","No","100%",,"$4,200","$0","$600","$200","$4,200","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=nc0034&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","33"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030010","Catastrophic Compass 6850","54332NC003",,"NCN001","NCS001","NCF004","Existing","HMO","Catastrophic","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030010-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,800","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=nc0037&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","34"
"2016","NC","54332","HIOS","6","2015-08-27 11:14:25","2","54332","NC","Individual","No","56-1461010","54332NC0030010","Catastrophic Compass 6850","54332NC003",,"NCN001","NCS001","NCF004","Existing","HMO","Catastrophic","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nc0039&st=nc","54332NC0030010-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,800","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=nc0037&st=nc","http://www.uhc.com/iex/doc?id=nc0038&st=nc","35"
"2016","NC","55440","HIOS","5","2015-08-19 14:41:20","1","55440","NC","SHOP (Small Group)","Yes","13-5123390","55440NC0150003","Guardian Pediatric Advantage","55440NC015",,"NCN001","NCS002",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$24.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","55440NC0150003-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","NC","55440","HIOS","5","2015-08-19 14:41:20","1","55440","NC","Individual","Yes","13-5123390","55440NC0210001","Guardian Family Essentials","55440NC021",,"NCN002","NCS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.26","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","55440NC0210001-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","4"
"2016","NC","55440","HIOS","5","2015-08-19 14:41:20","1","55440","NC","Individual","Yes","13-5123390","55440NC0210001","Guardian Family Essentials","55440NC021",,"NCN002","NCS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.26","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","55440NC0210001-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","5"
"2016","NC","55440","HIOS","5","2015-08-19 14:41:20","1","55440","NC","SHOP (Small Group)","Yes","13-5123390","55440NC0160003","Guardian Pediatric Essentials","55440NC016",,"NCN001","NCS002",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$17.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","55440NC0160003-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","NC","55440","HIOS","5","2015-08-19 14:41:20","2","55440","NC","SHOP (Small Group)","Yes","13-5123390","55440NC0180003","Guardian Family Advantage","55440NC018",,"NCN001","NCS002",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","55440NC0180003-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","NC","55440","HIOS","5","2015-08-19 14:41:20","2","55440","NC","SHOP (Small Group)","Yes","13-5123390","55440NC0200003","Guardian Family Essentials","55440NC020",,"NCN001","NCS002",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","55440NC0200003-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","NC","55440","HIOS","5","2015-08-19 14:41:20","3","55440","NC","SHOP (Small Group)","Yes","13-5123390","55440NC0180004","Guardian Family Advantage","55440NC018",,"NCN001","NCS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","55440NC0180004-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","NC","55440","HIOS","5","2015-08-19 14:41:20","3","55440","NC","SHOP (Small Group)","Yes","13-5123390","55440NC0180004","Guardian Family Advantage","55440NC018",,"NCN001","NCS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","55440NC0180004-01","Standard High On Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","NC","55440","HIOS","5","2015-08-19 14:41:20","3","55440","NC","SHOP (Small Group)","Yes","13-5123390","55440NC0200004","Guardian Family Essentials","55440NC020",,"NCN001","NCS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","55440NC0200004-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","NC","55440","HIOS","5","2015-08-19 14:41:20","3","55440","NC","SHOP (Small Group)","Yes","13-5123390","55440NC0200004","Guardian Family Essentials","55440NC020",,"NCN001","NCS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","55440NC0200004-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","NC","56891","HIOS","5","2015-08-18 03:25:03","1","56891","NC","Individual","Yes","56-1018068","56891NC0030001","Delta Dental Individual and Family Plans, EHB Certified","56891NC003",,"NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.66","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","56891NC0030001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","56891","HIOS","5","2015-08-18 03:25:03","1","56891","NC","SHOP (Small Group)","Yes","56-1018068","56891NC0050001","Delta Dental Group PPO, EHB Certified","56891NC005",,"NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.46","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","56891NC0050001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","56891","HIOS","5","2015-08-18 03:25:03","1","56891","NC","SHOP (Small Group)","Yes","56-1018068","56891NC0050002","Delta Dental Group PPO, EHB Certified","56891NC005",,"NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.92","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","56891NC0050002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NC","56891","HIOS","5","2015-08-18 03:25:03","1","56891","NC","Individual","Yes","56-1018068","56891NC0030002","Delta Dental Individual and Family Plans, EHB Certified","56891NC003",,"NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.94","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","56891NC0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NC","56891","HIOS","5","2015-08-18 03:25:03","1","56891","NC","Individual","Yes","56-1018068","56891NC0030003","Delta Dental Individual and Family Plans, EHB Certified","56891NC003",,"NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.94","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","56891NC0030003-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","NC","56891","HIOS","5","2015-08-18 03:25:03","1","56891","NC","SHOP (Small Group)","Yes","56-1018068","56891NC0050003","Delta Dental Group PPO, EHB Certified","56891NC005",,"NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.75","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","56891NC0050003-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","NC","56891","HIOS","5","2015-08-18 03:25:03","1","56891","NC","SHOP (Small Group)","Yes","56-1018068","56891NC0050004","Delta Dental Group PPO, EHB Certified","56891NC005",,"NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.95","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","56891NC0050004-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","NC","56891","HIOS","5","2015-08-18 03:25:03","1","56891","NC","Individual","Yes","56-1018068","56891NC0030004","Delta Dental Individual and Family Plans, EHB Certified","56891NC003",,"NCN001","NCS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.66","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","56891NC0030004-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","NC","56891","HIOS","5","2015-08-18 03:25:03","1","56891","NC","SHOP (Small Group)","Yes","56-1018068","56891NC0070001","Delta Dental Group PPO, EHB Certified (Exchange)","56891NC007",,"NCN001","NCS001",,"New","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.75","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","56891NC0070001-01","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnc.com/NC_EHB_SHOP_High_2016.aspx","http://www.deltadentalnc.com/NC_EHB_SHOP_High_2016.aspx","8"
"2016","NC","56891","HIOS","5","2015-08-18 03:25:03","1","56891","NC","SHOP (Small Group)","Yes","56-1018068","56891NC0070002","Delta Dental Group PPO , EHB Certified (Exchange)","56891NC007",,"NCN001","NCS001",,"New","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.92","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","56891NC0070002-01","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnc.com/NC_EHB_SHOP_Low_2016.aspx","http://www.deltadentalnc.com/NC_EHB_SHOP_Low_2016.aspx","9"
"2016","NC","56891","HIOS","5","2015-08-18 03:25:03","2","56891","NC","SHOP (Small Group)","Yes","56-1018068","56891NC0060001","Delta Dental Group Pediatric-Only, EHB Certified","56891NC006",,"NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$30.46","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","56891NC0060001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","56891","HIOS","5","2015-08-18 03:25:03","2","56891","NC","Individual","Yes","56-1018068","56891NC0040001","Delta Dental Individual Pediatric-Only, EHB Certified","56891NC004",,"NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$33.27","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","56891NC0040001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","56891","HIOS","5","2015-08-18 03:25:03","2","56891","NC","Individual","Yes","56-1018068","56891NC0040002","Delta Dental Individual Pediatric-Only, EHB Certified","56891NC004",,"NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$25.88","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","56891NC0040002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NC","56891","HIOS","5","2015-08-18 03:25:03","2","56891","NC","SHOP (Small Group)","Yes","56-1018068","56891NC0060002","Delta Dental Group Pediatric-Only, EHB Certified","56891NC006",,"NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$24.92","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","56891NC0060002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NC","56891","HIOS","5","2015-08-18 03:25:03","2","56891","NC","SHOP (Small Group)","Yes","56-1018068","56891NC0060003","Delta Dental Group Pediatric-Only, EHB Certified","56891NC006",,"NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$32.75","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","56891NC0060003-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","NC","56891","HIOS","5","2015-08-18 03:25:03","2","56891","NC","SHOP (Small Group)","Yes","56-1018068","56891NC0060004","Delta Dental Group Pediatric-Only, EHB Certified","56891NC006",,"NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$26.95","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","No","Same Benefit Level","Yes",,"","56891NC0060004-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","NC","56964","HIOS","3","2015-08-27 11:14:25","1","56964","NC","SHOP (Small Group)","Yes","93-0242990","56964NC0040002","EHB High PPO","56964NC004",,"NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$47.63","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","56964NC0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","NC","56964","HIOS","3","2015-08-27 11:14:25","1","56964","NC","SHOP (Small Group)","Yes","93-0242990","56964NC0040001","EHB Low PPO","56964NC004",,"NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.38","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","56964NC0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","NC","56964","HIOS","3","2015-08-27 11:14:25","1","56964","NC","SHOP (Small Group)","Yes","93-0242990","56964NC0030002","EHB High Passive","56964NC003",,"NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$48.92","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","56964NC0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","NC","56964","HIOS","3","2015-08-27 11:14:25","1","56964","NC","SHOP (Small Group)","Yes","93-0242990","56964NC0030001","EHB Low Passive","56964NC003",,"NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.69","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","56964NC0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060001","Aetna Leap Everyday – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060001-03","Limited Cost Sharing Plan Variation","68.36%",,"Yes","Yes","Yes","86%","14%","$4,800","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverBasicCarolinasHealthCareSystemAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","23"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060001","Aetna Leap Everyday – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060001-04","73% AV Level Silver Plan","72.09%",,"Yes","Yes","Yes","86%","14%","$3,900","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","$5,350","$5350 per person","$10700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","0%","$5,350","$5350 per person","$10700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverBasicCarolinasHealthCareSystemCSR73.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","24"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060001","Aetna Leap Everyday – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060001-05","87% AV Level Silver Plan","86.76%",,"Yes","Yes","Yes","86%","14%","$1,300","$0","$0","$200","$1,200","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%","$2,250","$2250 per person","$4500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverBasicCarolinasHealthCareSystemCSR87.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","25"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060001","Aetna Leap Everyday – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060001-06","94% AV Level Silver Plan","93.88%",,"Yes","Yes","Yes","86%","14%","$500","$0","$0","$200","$400","$40","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","$1,300","$1300 per person","$2600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0%","$1,300","$1300 per person","$2600 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverBasicCarolinasHealthCareSystemCSR94.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","26"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060007","Aetna Leap Everyday – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF007","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060007-00","Standard Silver Off Exchange Plan","68.36%",,"Yes","Yes","Yes","86%","14%","$4,800","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/NC/SilverBasicCaroMontHealth.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/NC.pdf","27"
"2016","NC","60734","HIOS","5","2015-08-25 05:06:23","1","60734","NC","SHOP (Small Group)","Yes","23-1661402","60734NC0010001","Smile for Health - Certified Optimum Coverage","60734NC001",,"NCN001","NCS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","60734NC0010001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","60734","HIOS","5","2015-08-25 05:06:23","2","60734","NC","SHOP (Small Group)","Yes","23-1661402","60734NC0010002","Smile for Health - Certified Optimum Coverage","60734NC001",,"NCN002","NCS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","60734NC0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","60734","HIOS","5","2015-08-25 05:06:23","3","60734","NC","SHOP (Small Group)","Yes","23-1661402","60734NC0010003","Smile for Health - Certified Optimum Coverage","60734NC001",,"NCN003","NCS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","60734NC0010003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","60734","HIOS","5","2015-08-25 05:06:23","4","60734","NC","SHOP (Small Group)","Yes","23-1661402","60734NC0010004","Smile for Health - Certified Optimum Coverage","60734NC001",,"NCN001","NCS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","60734NC0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","60734","HIOS","5","2015-08-25 05:06:23","5","60734","NC","SHOP (Small Group)","Yes","23-1661402","60734NC0010005","Smile for Health - Certified Optimum Coverage","60734NC001",,"NCN002","NCS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","60734NC0010005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","60734","HIOS","5","2015-08-25 05:06:23","6","60734","NC","SHOP (Small Group)","Yes","23-1661402","60734NC0010006","Smile for Health - Certified Optimum Coverage","60734NC001",,"NCN003","NCS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","60734NC0010006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","60734","HIOS","5","2015-08-25 05:06:23","7","60734","NC","SHOP (Small Group)","Yes","23-1661402","60734NC0020001","Smile for Health - Certified High Option","60734NC002",,"NCN001","NCS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","60734NC0020001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","60734","HIOS","5","2015-08-25 05:06:23","8","60734","NC","SHOP (Small Group)","Yes","23-1661402","60734NC0020002","Smile for Health - Certified High Option","60734NC002",,"NCN002","NCS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","60734NC0020002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","60734","HIOS","5","2015-08-25 05:06:23","9","60734","NC","SHOP (Small Group)","Yes","23-1661402","60734NC0020003","Smile for Health - Certified High Option","60734NC002",,"NCN003","NCS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","60734NC0020003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","60734","HIOS","5","2015-08-25 05:06:23","10","60734","NC","SHOP (Small Group)","Yes","23-1661402","60734NC0020004","Smile for Health - Certified High Option Plus","60734NC002",,"NCN001","NCS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","60734NC0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","60734","HIOS","5","2015-08-25 05:06:23","11","60734","NC","SHOP (Small Group)","Yes","23-1661402","60734NC0020005","Smile for Health - Certified High Option Plus","60734NC002",,"NCN002","NCS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","60734NC0020005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","60734","HIOS","5","2015-08-25 05:06:23","12","60734","NC","SHOP (Small Group)","Yes","23-1661402","60734NC0020006","Smile for Health - Certified High Option Plus","60734NC002",,"NCN003","NCS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","60734NC0020006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060004","Aetna Leap Basic HSA – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF004","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060004-00","Standard Bronze Off Exchange Plan","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/NC/BronzeHSACarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/NC.pdf","4"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060004","Aetna Leap Basic HSA – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF004","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060004-01","Standard Bronze On Exchange Plan","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/BronzeHSACarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","5"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060004","Aetna Leap Basic HSA – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF004","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/BronzeHSACarolinasHealthCareSystemAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","6"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060004","Aetna Leap Basic HSA – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF004","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060004-03","Limited Cost Sharing Plan Variation","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/BronzeHSACarolinasHealthCareSystemAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","7"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060010","Aetna Leap Basic HSA – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF010","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060010-00","Standard Bronze Off Exchange Plan","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/NC/BronzeHSACaroMontHealth.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/NC.pdf","8"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060010","Aetna Leap Basic HSA – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF010","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060010-01","Standard Bronze On Exchange Plan","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/BronzeHSACaroMontHealth.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","9"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060010","Aetna Leap Basic HSA – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF010","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060010-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/BronzeHSACaroMontHealthAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","10"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060010","Aetna Leap Basic HSA – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF010","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060010-03","Limited Cost Sharing Plan Variation","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/BronzeHSACaroMontHealthAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","11"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060003","Aetna Leap Basic Plus – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF003","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060003-00","Standard Bronze Off Exchange Plan","61.94%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,335","$6335 per person","$12670 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,335","$6335 per person","$12670 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/NC/BronzePlusCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/NC.pdf","12"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060003","Aetna Leap Basic Plus – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF003","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060003-01","Standard Bronze On Exchange Plan","61.94%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,335","$6335 per person","$12670 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,335","$6335 per person","$12670 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/BronzePlusCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","13"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060003","Aetna Leap Basic Plus – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF003","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/BronzePlusCarolinasHealthCareSystemAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","14"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060003","Aetna Leap Basic Plus – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF003","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060003-03","Limited Cost Sharing Plan Variation","61.94%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,335","$6335 per person","$12670 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,335","$6335 per person","$12670 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/BronzePlusCarolinasHealthCareSystemAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","15"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060009","Aetna Leap Basic Plus – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF009","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060009-00","Standard Bronze Off Exchange Plan","61.94%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,335","$6335 per person","$12670 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,335","$6335 per person","$12670 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/NC/BronzePlusCaroMontHealth.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/NC.pdf","16"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060009","Aetna Leap Basic Plus – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF009","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060009-03","Limited Cost Sharing Plan Variation","61.94%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,335","$6335 per person","$12670 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,335","$6335 per person","$12670 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/BronzePlusCaroMontHealthAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","19"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060001","Aetna Leap Everyday – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060001-00","Standard Silver Off Exchange Plan","68.36%",,"Yes","Yes","Yes","86%","14%","$4,800","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/NC/SilverBasicCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/NC.pdf","20"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060001","Aetna Leap Everyday – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060001-01","Standard Silver On Exchange Plan","68.36%",,"Yes","Yes","Yes","86%","14%","$4,800","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverBasicCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","21"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060001","Aetna Leap Everyday – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","86%","14%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverBasicCarolinasHealthCareSystemAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","22"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060007","Aetna Leap Everyday – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF007","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060007-01","Standard Silver On Exchange Plan","68.36%",,"Yes","Yes","Yes","86%","14%","$4,800","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverBasicCaroMontHealth.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","28"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060007","Aetna Leap Everyday – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF007","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060007-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","86%","14%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverBasicCaroMontHealthAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","29"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060007","Aetna Leap Everyday – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF007","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060007-03","Limited Cost Sharing Plan Variation","68.36%",,"Yes","Yes","Yes","86%","14%","$4,800","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverBasicCaroMontHealthAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","30"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060007","Aetna Leap Everyday – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF007","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060007-04","73% AV Level Silver Plan","72.09%",,"Yes","Yes","Yes","86%","14%","$3,900","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","$5,350","$5350 per person","$10700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","0%","$5,350","$5350 per person","$10700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverBasicCaroMontHealthCSR73.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","31"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060007","Aetna Leap Everyday – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF007","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060007-05","87% AV Level Silver Plan","86.76%",,"Yes","Yes","Yes","86%","14%","$1,300","$0","$0","$200","$1,200","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%","$2,250","$2250 per person","$4500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverBasicCaroMontHealthCSR87.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","32"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060007","Aetna Leap Everyday – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF007","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060007-06","94% AV Level Silver Plan","93.88%",,"Yes","Yes","Yes","86%","14%","$500","$0","$0","$200","$400","$40","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","$1,300","$1300 per person","$2600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0%","$1,300","$1300 per person","$2600 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverBasicCaroMontHealthCSR94.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","33"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060002","Aetna Leap Everyday Plus – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060002-00","Standard Silver Off Exchange Plan","71.85%",,"Yes","Yes","Yes","86%","14%","$4,000","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,010","$4010 per person","$8020 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,010","$4010 per person","$8020 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/NC/SilverPlusCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/NC.pdf","34"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060002","Aetna Leap Everyday Plus – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060002-01","Standard Silver On Exchange Plan","71.85%",,"Yes","Yes","Yes","86%","14%","$4,000","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,010","$4010 per person","$8020 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,010","$4010 per person","$8020 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverPlusCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","35"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060002","Aetna Leap Everyday Plus – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","86%","14%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverPlusCarolinasHealthCareSystemAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","36"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060002","Aetna Leap Everyday Plus – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060002-03","Limited Cost Sharing Plan Variation","71.85%",,"Yes","Yes","Yes","86%","14%","$4,000","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,010","$4010 per person","$8020 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,010","$4010 per person","$8020 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverPlusCarolinasHealthCareSystemAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","37"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060002","Aetna Leap Everyday Plus – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060002-04","73% AV Level Silver Plan","73.86%",,"Yes","Yes","Yes","86%","14%","$3,600","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,610","$3610 per person","$7220 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,610","$3610 per person","$7220 per group","0%","$5,450","$5450 per person","$10900 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverPlusCarolinasHealthCareSystemCSR73.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","38"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060002","Aetna Leap Everyday Plus – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060002-05","87% AV Level Silver Plan","86.52%",,"Yes","Yes","Yes","86%","14%","$1,400","$0","$0","$200","$1,300","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","0%","$2,250","$2250 per person","$4500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverPlusCarolinasHealthCareSystemCSR87.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","39"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060002","Aetna Leap Everyday Plus – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060002-06","94% AV Level Silver Plan","93.56%",,"Yes","Yes","Yes","86%","14%","$500","$0","$0","$200","$500","$40","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$1,325","$1325 per person","$2650 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%","$1,325","$1325 per person","$2650 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverPlusCarolinasHealthCareSystemCSR94.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","40"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060008","Aetna Leap Everyday Plus – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060008-00","Standard Silver Off Exchange Plan","71.85%",,"Yes","Yes","Yes","86%","14%","$4,000","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,010","$4010 per person","$8020 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,010","$4010 per person","$8020 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/NC/SilverPlusCaroMontHealth.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/NC.pdf","41"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060008","Aetna Leap Everyday Plus – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060008-01","Standard Silver On Exchange Plan","71.85%",,"Yes","Yes","Yes","86%","14%","$4,000","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,010","$4010 per person","$8020 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,010","$4010 per person","$8020 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverPlusCaroMontHealth.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","42"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060008","Aetna Leap Everyday Plus – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060008-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","86%","14%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverPlusCaroMontHealthAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","43"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060008","Aetna Leap Everyday Plus – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060008-03","Limited Cost Sharing Plan Variation","71.85%",,"Yes","Yes","Yes","86%","14%","$4,000","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,010","$4010 per person","$8020 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,010","$4010 per person","$8020 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverPlusCaroMontHealthAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","44"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060008","Aetna Leap Everyday Plus – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060008-04","73% AV Level Silver Plan","73.86%",,"Yes","Yes","Yes","86%","14%","$3,600","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,610","$3610 per person","$7220 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,610","$3610 per person","$7220 per group","0%","$5,450","$5450 per person","$10900 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverPlusCaroMontHealthCSR73.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","45"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060008","Aetna Leap Everyday Plus – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060008-05","87% AV Level Silver Plan","86.52%",,"Yes","Yes","Yes","86%","14%","$1,400","$0","$0","$200","$1,300","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","0%","$2,250","$2250 per person","$4500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverPlusCaroMontHealthCSR87.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","46"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060008","Aetna Leap Everyday Plus – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060008-06","94% AV Level Silver Plan","93.56%",,"Yes","Yes","Yes","86%","14%","$500","$0","$0","$200","$500","$40","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$1,325","$1325 per person","$2650 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%","$1,325","$1325 per person","$2650 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/SilverPlusCaroMontHealthCSR94.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","47"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060006","Aetna Leap Diabetes – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF006","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060006-00","Standard Gold Off Exchange Plan","79.19%",,"Yes","Yes","Yes","90%","10%","$2,900","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/NC/GoldDiabetesCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/NC.pdf","48"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060006","Aetna Leap Diabetes – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF006","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060006-01","Standard Gold On Exchange Plan","79.19%",,"Yes","Yes","Yes","90%","10%","$2,900","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/GoldDiabetesCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","49"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060006","Aetna Leap Diabetes – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF006","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","90%","10%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/GoldDiabetesCarolinasHealthCareSystemAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","50"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060006","Aetna Leap Diabetes – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF006","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060006-03","Limited Cost Sharing Plan Variation","79.19%",,"Yes","Yes","Yes","90%","10%","$2,900","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/GoldDiabetesCarolinasHealthCareSystemAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","51"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060012","Aetna Leap Diabetes – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF012","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060012-00","Standard Gold Off Exchange Plan","79.19%",,"Yes","Yes","Yes","90%","10%","$2,900","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/NC/GoldDiabetesCaroMontHealth.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/NC.pdf","52"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060012","Aetna Leap Diabetes – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF012","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060012-01","Standard Gold On Exchange Plan","79.19%",,"Yes","Yes","Yes","90%","10%","$2,900","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/GoldDiabetesCaroMontHealth.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","53"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060012","Aetna Leap Diabetes – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF012","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060012-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","90%","10%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/GoldDiabetesCaroMontHealthAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","54"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060012","Aetna Leap Diabetes – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF012","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060012-03","Limited Cost Sharing Plan Variation","79.19%",,"Yes","Yes","Yes","90%","10%","$2,900","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/GoldDiabetesCaroMontHealthAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","55"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060005","Aetna Leap Specialty – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF005","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060005-00","Standard Gold Off Exchange Plan","79.65%",,"Yes","Yes","Yes","90%","10%","$2,800","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/NC/GoldBasicCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/NC.pdf","56"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060005","Aetna Leap Specialty – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF005","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060005-01","Standard Gold On Exchange Plan","79.65%",,"Yes","Yes","Yes","90%","10%","$2,800","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/GoldBasicCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","57"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060005","Aetna Leap Specialty – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF005","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","90%","10%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/GoldBasicCarolinasHealthCareSystemAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","58"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060005","Aetna Leap Specialty – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF005","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060005-03","Limited Cost Sharing Plan Variation","79.65%",,"Yes","Yes","Yes","90%","10%","$2,800","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/GoldBasicCarolinasHealthCareSystemAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","59"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060011","Aetna Leap Specialty – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF011","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060011-00","Standard Gold Off Exchange Plan","79.65%",,"Yes","Yes","Yes","90%","10%","$2,800","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/NC/GoldBasicCaroMontHealth.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/NC.pdf","60"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060011","Aetna Leap Specialty – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF011","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060011-01","Standard Gold On Exchange Plan","79.65%",,"Yes","Yes","Yes","90%","10%","$2,800","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/GoldBasicCaroMontHealth.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","61"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060011","Aetna Leap Specialty – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF011","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060011-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","90%","10%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/GoldBasicCaroMontHealthAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","62"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","1","61671","NC","Individual","No","23-2169745","61671NC0060011","Aetna Leap Specialty – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF011","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060011-03","Limited Cost Sharing Plan Variation","79.65%",,"Yes","Yes","Yes","90%","10%","$2,800","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/GoldBasicCaroMontHealthAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","63"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","2","61671","NC","Individual","No","23-2169745","61671NC0060013","Aetna Leap Catastrophic – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF013","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060013-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/NC/CatastrophicCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/NC.pdf","4"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","2","61671","NC","Individual","No","23-2169745","61671NC0060013","Aetna Leap Catastrophic – Carolinas HealthCare System","61671NC006",,"NCN004","NCS004","NCF013","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/CatastrophicCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","5"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","2","61671","NC","Individual","No","23-2169745","61671NC0060014","Aetna Leap Catastrophic – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF014","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060014-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/NC/CatastrophicCaroMontHealth.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/NC.pdf","6"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","2","61671","NC","Individual","No","23-2169745","61671NC0060014","Aetna Leap Catastrophic – CaroMont Health","61671NC006",,"NCN005","NCS005","NCF014","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8517699962","61671NC0060014-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/NC/CatastrophicCaroMontHealth.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/NC.pdf","7"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070004","Coventry Bronze $15 Copay","61671NC007",,"NCN003","NCS003","NCF018","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070004-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49215","http://www.coventryone.com/NCon2016","4"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070004","Coventry Bronze $15 Copay","61671NC007",,"NCN003","NCS003","NCF018","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070004-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49077","http://www.coventryone.com/NCon2016","5"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070004","Coventry Bronze $15 Copay","61671NC007",,"NCN003","NCS003","NCF018","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49086","http://www.coventryone.com/NCon2016","6"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070004","Coventry Bronze $15 Copay","61671NC007",,"NCN003","NCS003","NCF018","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070004-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49078","http://www.coventryone.com/NCon2016","7"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070005","Coventry Bronze Ded Only HSA Eligible","61671NC007",,"NCN003","NCS003","NCF019","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070005-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NC49216","http://www.coventryone.com/NCon2016","8"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070005","Coventry Bronze Ded Only HSA Eligible","61671NC007",,"NCN003","NCS003","NCF019","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070005-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NC49079","http://www.coventryone.com/NCon2016","9"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070005","Coventry Bronze Ded Only HSA Eligible","61671NC007",,"NCN003","NCS003","NCF019","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49080","http://www.coventryone.com/NCon2016","10"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070005","Coventry Bronze Ded Only HSA Eligible","61671NC007",,"NCN003","NCS003","NCF019","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070005-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NC49081","http://www.coventryone.com/NCon2016","11"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070018","Coventry Bronze Ded Only HSA Eligible Cornerstone","61671NC007",,"NCN001","NCS001","NCF032","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070018-00","Standard Bronze Off Exchange Plan","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NC49229","http://www.coventryone.com/NCon2016","12"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070018","Coventry Bronze Ded Only HSA Eligible Cornerstone","61671NC007",,"NCN001","NCS001","NCF032","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070018-01","Standard Bronze On Exchange Plan","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49133","http://www.coventryone.com/NCon2016","13"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070018","Coventry Bronze Ded Only HSA Eligible Cornerstone","61671NC007",,"NCN001","NCS001","NCF032","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070018-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49134","http://www.coventryone.com/NCon2016","14"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070018","Coventry Bronze Ded Only HSA Eligible Cornerstone","61671NC007",,"NCN001","NCS001","NCF032","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070018-03","Limited Cost Sharing Plan Variation","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NC49135","http://www.coventryone.com/NCon2016","15"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070016","Coventry Bronze Ded Only HSA Eligible Duke Medicine","61671NC007",,"NCN002","NCS002","NCF030","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070016-00","Standard Bronze Off Exchange Plan","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NC49234","http://www.coventryone.com/NCon2016","16"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070016","Coventry Bronze Ded Only HSA Eligible Duke Medicine","61671NC007",,"NCN002","NCS002","NCF030","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070016-01","Standard Bronze On Exchange Plan","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NC49155","http://www.coventryone.com/NCon2016","17"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070016","Coventry Bronze Ded Only HSA Eligible Duke Medicine","61671NC007",,"NCN002","NCS002","NCF030","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070016-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49156","http://www.coventryone.com/NCon2016","18"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070016","Coventry Bronze Ded Only HSA Eligible Duke Medicine","61671NC007",,"NCN002","NCS002","NCF030","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070016-03","Limited Cost Sharing Plan Variation","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NC49157","http://www.coventryone.com/NCon2016","19"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070003","Coventry Silver $10 Copay 2750","61671NC007",,"NCN003","NCS003","NCF017","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070003-00","Standard Silver Off Exchange Plan","68.19%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49212","http://www.coventryone.com/NCon2016","20"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070003","Coventry Silver $10 Copay 2750","61671NC007",,"NCN003","NCS003","NCF017","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070003-01","Standard Silver On Exchange Plan","68.19%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49071","http://www.coventryone.com/NCon2016","21"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070003","Coventry Silver $10 Copay 2750","61671NC007",,"NCN003","NCS003","NCF017","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49072","http://www.coventryone.com/NCon2016","22"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070003","Coventry Silver $10 Copay 2750","61671NC007",,"NCN003","NCS003","NCF017","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070003-03","Limited Cost Sharing Plan Variation","68.19%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49073","http://www.coventryone.com/NCon2016","23"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070003","Coventry Silver $10 Copay 2750","61671NC007",,"NCN003","NCS003","NCF017","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070003-04","73% AV Level Silver Plan","72.09%",,"Yes","Yes","No","100%",,"$2,500","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49076","http://www.coventryone.com/NCon2016","24"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070003","Coventry Silver $10 Copay 2750","61671NC007",,"NCN003","NCS003","NCF017","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070003-05","87% AV Level Silver Plan","86.26%",,"Yes","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49075","http://www.coventryone.com/NCon2016","25"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070003","Coventry Silver $10 Copay 2750","61671NC007",,"NCN003","NCS003","NCF017","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070003-06","94% AV Level Silver Plan","93.13%",,"Yes","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49074","http://www.coventryone.com/NCon2016","26"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070013","Coventry Silver $10 Copay 2750 Cornerstone","61671NC007",,"NCN001","NCS001","NCF027","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070013-00","Standard Silver Off Exchange Plan","68.15%",,"Yes","Yes","Yes","80%","20%","$2,800","$10","$700","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49231","http://www.coventryone.com/NCon2016","27"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070013","Coventry Silver $10 Copay 2750 Cornerstone","61671NC007",,"NCN001","NCS001","NCF027","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070013-01","Standard Silver On Exchange Plan","68.15%",,"Yes","Yes","Yes","80%","20%","$2,800","$10","$700","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49145","http://www.coventryone.com/NCon2016","28"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070013","Coventry Silver $10 Copay 2750 Cornerstone","61671NC007",,"NCN001","NCS001","NCF027","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070013-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","80%","20%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49146","http://www.coventryone.com/NCon2016","29"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070013","Coventry Silver $10 Copay 2750 Cornerstone","61671NC007",,"NCN001","NCS001","NCF027","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070013-03","Limited Cost Sharing Plan Variation","68.15%",,"Yes","Yes","Yes","80%","20%","$2,800","$10","$700","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49147","http://www.coventryone.com/NCon2016","30"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070013","Coventry Silver $10 Copay 2750 Cornerstone","61671NC007",,"NCN001","NCS001","NCF027","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070013-04","73% AV Level Silver Plan","72.11%",,"Yes","Yes","Yes","80%","20%","$2,500","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%","$4,500","$4500 per person","$9000 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49150","http://www.coventryone.com/NCon2016","31"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070013","Coventry Silver $10 Copay 2750 Cornerstone","61671NC007",,"NCN001","NCS001","NCF027","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070013-05","87% AV Level Silver Plan","86.04%",,"Yes","Yes","Yes","80%","20%","$0","$10","$1,600","$200","$0","$200","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$1,500","$1500 per person","$3000 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49149","http://www.coventryone.com/NCon2016","32"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070013","Coventry Silver $10 Copay 2750 Cornerstone","61671NC007",,"NCN001","NCS001","NCF027","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070013-06","94% AV Level Silver Plan","93.22%",,"Yes","Yes","Yes","80%","20%","$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","20%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49148","http://www.coventryone.com/NCon2016","33"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070009","Coventry Silver $10 Copay 2750 Duke Medicine","61671NC007",,"NCN002","NCS002","NCF023","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070009-00","Standard Silver Off Exchange Plan","68.15%",,"Yes","Yes","Yes","80%","20%","$2,800","$10","$700","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49236","http://www.coventryone.com/NCon2016","34"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070009","Coventry Silver $10 Copay 2750 Duke Medicine","61671NC007",,"NCN002","NCS002","NCF023","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070009-01","Standard Silver On Exchange Plan","68.15%",,"Yes","Yes","Yes","80%","20%","$2,800","$10","$700","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49167","http://www.coventryone.com/NCon2016","35"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070009","Coventry Silver $10 Copay 2750 Duke Medicine","61671NC007",,"NCN002","NCS002","NCF023","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070009-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","80%","20%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49168","http://www.coventryone.com/NCon2016","36"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070009","Coventry Silver $10 Copay 2750 Duke Medicine","61671NC007",,"NCN002","NCS002","NCF023","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070009-03","Limited Cost Sharing Plan Variation","68.15%",,"Yes","Yes","Yes","80%","20%","$2,800","$10","$700","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49169","http://www.coventryone.com/NCon2016","37"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070009","Coventry Silver $10 Copay 2750 Duke Medicine","61671NC007",,"NCN002","NCS002","NCF023","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070009-04","73% AV Level Silver Plan","72.11%",,"Yes","Yes","Yes","80%","20%","$2,500","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%","$4,500","$4500 per person","$9000 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49172","http://www.coventryone.com/NCon2016","38"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070009","Coventry Silver $10 Copay 2750 Duke Medicine","61671NC007",,"NCN002","NCS002","NCF023","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070009-05","87% AV Level Silver Plan","86.04%",,"Yes","Yes","Yes","80%","20%","$0","$10","$1,600","$200","$0","$200","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$1,500","$1500 per person","$3000 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49171","http://www.coventryone.com/NCon2016","39"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070009","Coventry Silver $10 Copay 2750 Duke Medicine","61671NC007",,"NCN002","NCS002","NCF023","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070009-06","94% AV Level Silver Plan","93.22%",,"Yes","Yes","Yes","80%","20%","$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","20%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49170","http://www.coventryone.com/NCon2016","40"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070001","Coventry Gold $10","61671NC007",,"NCN003","NCS003","NCF015","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070001-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49213","http://www.coventryone.com/NCon2016","41"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070001","Coventry Gold $10","61671NC007",,"NCN003","NCS003","NCF015","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070001-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49083","http://www.coventryone.com/NCon2016","42"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070001","Coventry Gold $10","61671NC007",,"NCN003","NCS003","NCF015","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49065","http://www.coventryone.com/NCon2016","43"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070001","Coventry Gold $10","61671NC007",,"NCN003","NCS003","NCF015","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070001-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49066","http://www.coventryone.com/NCon2016","44"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070011","Coventry Gold $5 Copay Cornerstone","61671NC007",,"NCN001","NCS001","NCF025","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070011-00","Standard Gold Off Exchange Plan","78.19%",,"No","Yes","Yes","80%","20%","$1,300","$10","$800","$200","$1,300","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49227","http://www.coventryone.com/NCon2016","45"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070011","Coventry Gold $5 Copay Cornerstone","61671NC007",,"NCN001","NCS001","NCF025","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070011-01","Standard Gold On Exchange Plan","78.19%",,"No","Yes","Yes","80%","20%","$1,300","$10","$800","$200","$1,300","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49136","http://www.coventryone.com/NCon2016","46"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070011","Coventry Gold $5 Copay Cornerstone","61671NC007",,"NCN001","NCS001","NCF025","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070011-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49137","http://www.coventryone.com/NCon2016","47"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070011","Coventry Gold $5 Copay Cornerstone","61671NC007",,"NCN001","NCS001","NCF025","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070011-03","Limited Cost Sharing Plan Variation","78.19%",,"No","Yes","Yes","80%","20%","$1,300","$10","$800","$200","$1,300","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49138","http://www.coventryone.com/NCon2016","48"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070007","Coventry Gold $5 Copay Duke Medicine","61671NC007",,"NCN002","NCS002","NCF021","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070007-00","Standard Gold Off Exchange Plan","78.19%",,"No","Yes","Yes","80%","20%","$1,300","$10","$800","$200","$1,300","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49235","http://www.coventryone.com/NCon2016","49"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070007","Coventry Gold $5 Copay Duke Medicine","61671NC007",,"NCN002","NCS002","NCF021","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070007-01","Standard Gold On Exchange Plan","78.19%",,"No","Yes","Yes","80%","20%","$1,300","$10","$800","$200","$1,300","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49158","http://www.coventryone.com/NCon2016","50"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070007","Coventry Gold $5 Copay Duke Medicine","61671NC007",,"NCN002","NCS002","NCF021","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49159","http://www.coventryone.com/NCon2016","51"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","3","61671","NC","Individual","No","23-2169745","61671NC0070007","Coventry Gold $5 Copay Duke Medicine","61671NC007",,"NCN002","NCS002","NCF021","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070007-03","Limited Cost Sharing Plan Variation","78.19%",,"No","Yes","Yes","80%","20%","$1,300","$10","$800","$200","$1,300","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49160","http://www.coventryone.com/NCon2016","52"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","4","61671","NC","Individual","No","23-2169745","61671NC0070002","Coventry Silver $10 Copay","61671NC007",,"NCN003","NCS003","NCF016","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070002-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49214","http://www.coventryone.com/NCon2016","4"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","4","61671","NC","Individual","No","23-2169745","61671NC0070002","Coventry Silver $10 Copay","61671NC007",,"NCN003","NCS003","NCF016","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070002-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49084","http://www.coventryone.com/NCon2016","5"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","4","61671","NC","Individual","No","23-2169745","61671NC0070002","Coventry Silver $10 Copay","61671NC007",,"NCN003","NCS003","NCF016","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49067","http://www.coventryone.com/NCon2016","6"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","4","61671","NC","Individual","No","23-2169745","61671NC0070002","Coventry Silver $10 Copay","61671NC007",,"NCN003","NCS003","NCF016","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070002-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49068","http://www.coventryone.com/NCon2016","7"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","4","61671","NC","Individual","No","23-2169745","61671NC0070002","Coventry Silver $10 Copay","61671NC007",,"NCN003","NCS003","NCF016","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070002-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49085","http://www.coventryone.com/NCon2016","8"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","4","61671","NC","Individual","No","23-2169745","61671NC0070002","Coventry Silver $10 Copay","61671NC007",,"NCN003","NCS003","NCF016","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070002-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49070","http://www.coventryone.com/NCon2016","9"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","4","61671","NC","Individual","No","23-2169745","61671NC0070002","Coventry Silver $10 Copay","61671NC007",,"NCN003","NCS003","NCF016","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070002-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49069","http://www.coventryone.com/NCon2016","10"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","4","61671","NC","Individual","No","23-2169745","61671NC0070012","Coventry Silver $10 Copay Cornerstone","61671NC007",,"NCN001","NCS001","NCF026","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070012-00","Standard Silver Off Exchange Plan","68.14%",,"No","Yes","Yes","75%","25%","$3,500","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49230","http://www.coventryone.com/NCon2016","11"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","4","61671","NC","Individual","No","23-2169745","61671NC0070012","Coventry Silver $10 Copay Cornerstone","61671NC007",,"NCN001","NCS001","NCF026","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070012-01","Standard Silver On Exchange Plan","68.14%",,"No","Yes","Yes","75%","25%","$3,500","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49139","http://www.coventryone.com/NCon2016","12"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","4","61671","NC","Individual","No","23-2169745","61671NC0070012","Coventry Silver $10 Copay Cornerstone","61671NC007",,"NCN001","NCS001","NCF026","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070012-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49140","http://www.coventryone.com/NCon2016","13"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","4","61671","NC","Individual","No","23-2169745","61671NC0070012","Coventry Silver $10 Copay Cornerstone","61671NC007",,"NCN001","NCS001","NCF026","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070012-03","Limited Cost Sharing Plan Variation","68.14%",,"No","Yes","Yes","75%","25%","$3,500","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49141","http://www.coventryone.com/NCon2016","14"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","4","61671","NC","Individual","No","23-2169745","61671NC0070012","Coventry Silver $10 Copay Cornerstone","61671NC007",,"NCN001","NCS001","NCF026","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070012-04","73% AV Level Silver Plan","72.06%",,"No","Yes","Yes","75%","25%","$3,200","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","20%","$4,500","$4500 per person","$9000 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49144","http://www.coventryone.com/NCon2016","15"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","4","61671","NC","Individual","No","23-2169745","61671NC0070012","Coventry Silver $10 Copay Cornerstone","61671NC007",,"NCN001","NCS001","NCF026","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070012-05","87% AV Level Silver Plan","86.19%",,"No","Yes","Yes","75%","25%","$500","$10","$900","$200","$500","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$1,500","$1500 per person","$3000 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49143","http://www.coventryone.com/NCon2016","16"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","4","61671","NC","Individual","No","23-2169745","61671NC0070012","Coventry Silver $10 Copay Cornerstone","61671NC007",,"NCN001","NCS001","NCF026","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070012-06","94% AV Level Silver Plan","93.22%",,"No","Yes","Yes","75%","25%","$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","20%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%","$0","$0 per person","per group not applicable","20%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49142","http://www.coventryone.com/NCon2016","17"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","4","61671","NC","Individual","No","23-2169745","61671NC0070008","Coventry Silver $10 Copay Duke Medicine","61671NC007",,"NCN002","NCS002","NCF022","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070008-00","Standard Silver Off Exchange Plan","68.14%",,"No","Yes","Yes","75%","25%","$3,500","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49232","http://www.coventryone.com/NCon2016","18"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","4","61671","NC","Individual","No","23-2169745","61671NC0070008","Coventry Silver $10 Copay Duke Medicine","61671NC007",,"NCN002","NCS002","NCF022","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070008-01","Standard Silver On Exchange Plan","68.14%",,"No","Yes","Yes","75%","25%","$3,500","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49161","http://www.coventryone.com/NCon2016","19"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","4","61671","NC","Individual","No","23-2169745","61671NC0070008","Coventry Silver $10 Copay Duke Medicine","61671NC007",,"NCN002","NCS002","NCF022","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070008-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49162","http://www.coventryone.com/NCon2016","20"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","4","61671","NC","Individual","No","23-2169745","61671NC0070008","Coventry Silver $10 Copay Duke Medicine","61671NC007",,"NCN002","NCS002","NCF022","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070008-03","Limited Cost Sharing Plan Variation","68.14%",,"No","Yes","Yes","75%","25%","$3,500","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49163","http://www.coventryone.com/NCon2016","21"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","4","61671","NC","Individual","No","23-2169745","61671NC0070008","Coventry Silver $10 Copay Duke Medicine","61671NC007",,"NCN002","NCS002","NCF022","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070008-04","73% AV Level Silver Plan","72.06%",,"No","Yes","Yes","75%","25%","$3,200","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","20%","$4,500","$4500 per person","$9000 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49166","http://www.coventryone.com/NCon2016","22"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","4","61671","NC","Individual","No","23-2169745","61671NC0070008","Coventry Silver $10 Copay Duke Medicine","61671NC007",,"NCN002","NCS002","NCF022","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070008-05","87% AV Level Silver Plan","86.19%",,"No","Yes","Yes","75%","25%","$500","$10","$900","$200","$500","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$1,500","$1500 per person","$3000 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49165","http://www.coventryone.com/NCon2016","23"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","4","61671","NC","Individual","No","23-2169745","61671NC0070008","Coventry Silver $10 Copay Duke Medicine","61671NC007",,"NCN002","NCS002","NCF022","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8487328219","61671NC0070008-06","94% AV Level Silver Plan","93.22%",,"No","Yes","Yes","75%","25%","$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","20%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%","$0","$0 per person","per group not applicable","20%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NC49164","http://www.coventryone.com/NCon2016","24"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","5","61671","NC","Individual","No","23-2169745","61671NC0070006","Coventry Catastrophic 100%","61671NC007",,"NCN003","NCS003","NCF020","New","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070006-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49211","http://www.coventryone.com/NCon2016","4"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","5","61671","NC","Individual","No","23-2169745","61671NC0070006","Coventry Catastrophic 100%","61671NC007",,"NCN003","NCS003","NCF020","New","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070006-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49082","http://www.coventryone.com/NCon2016","5"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","5","61671","NC","Individual","No","23-2169745","61671NC0070017","Coventry Catastrophic Cornerstone 100%","61671NC007",,"NCN001","NCS001","NCF031","New","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070017-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49228","http://www.coventryone.com/NCon2016","6"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","5","61671","NC","Individual","No","23-2169745","61671NC0070017","Coventry Catastrophic Cornerstone 100%","61671NC007",,"NCN001","NCS001","NCF031","New","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070017-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC714993","http://www.coventryone.com/NCon2016","7"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","5","61671","NC","Individual","No","23-2169745","61671NC0070015","Coventry Catastrophic Duke Medicine 100%","61671NC007",,"NCN002","NCS002","NCF029","New","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070015-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49233","http://www.coventryone.com/NCon2016","8"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","5","61671","NC","Individual","No","23-2169745","61671NC0070015","Coventry Catastrophic Duke Medicine 100%","61671NC007",,"NCN002","NCS002","NCF029","New","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070015-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49154","http://www.coventryone.com/NCon2016","9"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","6","61671","NC","Individual","No","23-2169745","61671NC0070014","Coventry Bronze $35 Copay Cornerstone","61671NC007",,"NCN001","NCS001","NCF028","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070014-00","Standard Bronze Off Exchange Plan","61.99%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%","$6,750","$6750 per person","$13500 per group","0%","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49151","http://www.coventryone.com/NCon2016","4"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","6","61671","NC","Individual","No","23-2169745","61671NC0070014","Coventry Bronze $35 Copay Cornerstone","61671NC007",,"NCN001","NCS001","NCF028","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070014-01","Standard Bronze On Exchange Plan","61.99%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%","$6,750","$6750 per person","$13500 per group","0%","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49202","http://www.coventryone.com/NCon2016","5"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","6","61671","NC","Individual","No","23-2169745","61671NC0070014","Coventry Bronze $35 Copay Cornerstone","61671NC007",,"NCN001","NCS001","NCF028","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070014-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49152","http://www.coventryone.com/NCon2016","6"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","6","61671","NC","Individual","No","23-2169745","61671NC0070014","Coventry Bronze $35 Copay Cornerstone","61671NC007",,"NCN001","NCS001","NCF028","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070014-03","Limited Cost Sharing Plan Variation","61.99%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%","$6,750","$6750 per person","$13500 per group","0%","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49153","http://www.coventryone.com/NCon2016","7"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","6","61671","NC","Individual","No","23-2169745","61671NC0070010","Coventry Bronze $35 Copay Duke Medicine","61671NC007",,"NCN002","NCS002","NCF024","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070010-00","Standard Bronze Off Exchange Plan","61.99%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%","$6,750","$6750 per person","$13500 per group","0%","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49173","http://www.coventryone.com/NCon2016","8"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","6","61671","NC","Individual","No","23-2169745","61671NC0070010","Coventry Bronze $35 Copay Duke Medicine","61671NC007",,"NCN002","NCS002","NCF024","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070010-01","Standard Bronze On Exchange Plan","61.99%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%","$6,750","$6750 per person","$13500 per group","0%","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49209","http://www.coventryone.com/NCon2016","9"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","6","61671","NC","Individual","No","23-2169745","61671NC0070010","Coventry Bronze $35 Copay Duke Medicine","61671NC007",,"NCN002","NCS002","NCF024","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070010-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49174","http://www.coventryone.com/NCon2016","10"
"2016","NC","61671","HIOS","11","2016-01-26 05:20:14","6","61671","NC","Individual","No","23-2169745","61671NC0070010","Coventry Bronze $35 Copay Duke Medicine","61671NC007",,"NCN002","NCS002","NCF024","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8489750505","61671NC0070010-03","Limited Cost Sharing Plan Variation","61.99%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%","$6,750","$6750 per person","$13500 per group","0%","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NC49175","http://www.coventryone.com/NCon2016","11"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","3","27882","ND","Individual","Yes","41-0952670","27882ND0030001","Pediatric Dental A + Adult B","27882ND003",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-a-adult-b",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","3","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0190001","Pediatric Dental A + Adult B","27882ND019",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0190001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/",,"4"
"2016","NC","72839","HIOS","3","2015-08-25 05:06:23","1","72839","NC","Individual","Yes","72-0977315","72839NC0050001","AlwaysCare All-Star Kids Dental Plan 2016","72839NC005",,"NCN001","NCS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$29.01","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","72839NC0050001-00","Standard High Off Exchange Plan","86.13%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","8","27882","ND","Individual","Yes","41-0952670","27882ND0080001","Pediatric Dental A + Adult G","27882ND008",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0080001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-a-adult-g",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","8","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0240001","Pediatric Dental A + Adult G","27882ND024",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0240001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","8","27882","ND","Individual","Yes","41-0952670","27882ND0080001","Pediatric Dental A + Adult G","27882ND008",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0080001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-a-adult-g",,"5"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","9","27882","ND","Individual","Yes","41-0952670","27882ND0090001","Pediatric Dental B","27882ND009",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0090001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-b",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","9","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0250001","Pediatric Dental B","27882ND025",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0250001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","9","27882","ND","Individual","Yes","41-0952670","27882ND0090001","Pediatric Dental B","27882ND009",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0090001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-b",,"5"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","10","27882","ND","Individual","Yes","41-0952670","27882ND0100001","Pediatric Dental B + Adult A","27882ND010",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0100001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-b-adult-a",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","10","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0260001","Pediatric Dental B + Adult A","27882ND026",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0260001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","10","27882","ND","Individual","Yes","41-0952670","27882ND0100001","Pediatric Dental B + Adult A","27882ND010",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0100001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-b-adult-a",,"5"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","11","27882","ND","Individual","Yes","41-0952670","27882ND0110001","Pediatric Dental B + Adult B","27882ND011",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0110001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-b-adult-b",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","11","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0270001","Pediatric Dental B + Adult B","27882ND027",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0270001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","11","27882","ND","Individual","Yes","41-0952670","27882ND0110001","Pediatric Dental B + Adult B","27882ND011",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0110001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-b-adult-b",,"5"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","12","27882","ND","Individual","Yes","41-0952670","27882ND0120001","Pediatric Dental B + Adult C","27882ND012",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0120001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-b-adult-c",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","12","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0280001","Pediatric Dental B + Adult C","27882ND028",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0280001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/",,"4"
"2016","NC","72839","HIOS","3","2015-08-25 05:06:23","1","72839","NC","SHOP (Small Group)","Yes","72-0977315","72839NC0080001","AlwaysCare Small Group Dental – Child 2016","72839NC008",,"NCN001","NCS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$33.16","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","72839NC0080001-00","Standard High Off Exchange Plan","86.13%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","NC","72839","HIOS","3","2015-08-25 05:06:23","1","72839","NC","SHOP (Small Group)","Yes","72-0977315","72839NC0080002","AlwaysCare Small Group Dental – Child 2016","72839NC008",,"NCN001","NCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$27.12","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","72839NC0080002-00","Standard Low Off Exchange Plan","70.52%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","NC","72839","HIOS","3","2015-08-25 05:06:23","2","72839","NC","SHOP (Small Group)","Yes","72-0977315","72839NC0070001","AlwaysCare Small Group Dental – Adults 2016","72839NC007",,"NCN001","NCS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$33.16","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","72839NC0070001-00","Standard High Off Exchange Plan","86.13%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","NC","72839","HIOS","3","2015-08-25 05:06:23","2","72839","NC","Individual","Yes","72-0977315","72839NC0060001","AlwaysCare All-Star Family Dental Plan 2016","72839NC006",,"NCN001","NCS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$29.01","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","72839NC0060001-00","Standard High Off Exchange Plan","86.13%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","NC","72839","HIOS","3","2015-08-25 05:06:23","2","72839","NC","SHOP (Small Group)","Yes","72-0977315","72839NC0070002","AlwaysCare Small Group Dental – Adults 2016","72839NC007",,"NCN001","NCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.12","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","72839NC0070002-00","Standard Low Off Exchange Plan","70.52%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","NC","76994","HIOS","3","2015-08-27 11:14:25","1","76994","NC","SHOP (Small Group)","Yes","36-0883760","76994NC0040002","EHB High PPO","76994NC004",,"NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$47.49","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","76994NC0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","NC","76994","HIOS","3","2015-08-27 11:14:25","1","76994","NC","SHOP (Small Group)","Yes","36-0883760","76994NC0040001","EHB Low PPO","76994NC004",,"NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.31","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","76994NC0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","NC","76994","HIOS","3","2015-08-27 11:14:25","1","76994","NC","SHOP (Small Group)","Yes","36-0883760","76994NC0030002","EHB High Passive","76994NC003",,"NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$48.78","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","76994NC0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","NC","76994","HIOS","3","2015-08-27 11:14:25","1","76994","NC","SHOP (Small Group)","Yes","36-0883760","76994NC0030001","EHB Low Passive","76994NC003",,"NCN001","NCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.60","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","76994NC0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","NC","82612","HIOS","5","2015-10-20 04:38:50","1","82612","NC","Individual","Yes","36-3757528","82612NC0010001","TruAssure Basic Adult or Child Dental Plan","82612NC001",,"NCN001","NCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.96","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82612NC0010001-00","Standard Low Off Exchange Plan","68.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$155","$155 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NC","https://www.truassure.com/brochure?state=NC","4"
"2016","NC","82612","HIOS","5","2015-10-20 04:38:50","1","82612","NC","SHOP (Small Group)","Yes","36-3757528","82612NC0030001","TruAssure Dental Small Group Basic Plan","82612NC003",,"NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$47.56","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","82612NC0030001-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NC","82612","HIOS","5","2015-10-20 04:38:50","1","82612","NC","SHOP (Small Group)","Yes","36-3757528","82612NC0040001","TruAssure Dental Small Group Preferred Plan","82612NC004",,"NCN001","NCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$47.56","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","82612NC0040001-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NC","82612","HIOS","5","2015-10-20 04:38:50","1","82612","NC","Individual","Yes","36-3757528","82612NC0010001","TruAssure Basic Adult or Child Dental Plan","82612NC001",,"NCN001","NCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.96","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82612NC0010001-01","Standard Low On Exchange Plan","68.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$155","$155 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NC","https://www.truassure.com/brochure?state=NC","5"
"2016","NC","82612","HIOS","5","2015-10-20 04:38:50","2","82612","NC","Individual","Yes","36-3757528","82612NC0020001","TruAssure Preferred Adult or Child Dental Plan","82612NC002",,"NCN001","NCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.43","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82612NC0020001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NC","https://www.truassure.com/brochure?state=NC","4"
"2016","NC","82612","HIOS","5","2015-10-20 04:38:50","2","82612","NC","Individual","Yes","36-3757528","82612NC0020001","TruAssure Preferred Adult or Child Dental Plan","82612NC002",,"NCN001","NCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.43","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","82612NC0020001-01","Standard High On Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NC","https://www.truassure.com/brochure?state=NC","5"
"2016","NC","94482","HIOS","3","2015-08-27 11:14:25","1","94482","NC","Individual","Yes","95-6042390","94482NC0020003","BESTOne Advantage Gold","94482NC002",,"NCN001","NCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.76","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2016/NC_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","NC","94482","HIOS","3","2015-08-27 11:14:25","1","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010007","BESTDental Premium","94482NC001",,"NCN001","NCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2016/NC_BESTDental_Premium_Plan.pdf","4"
"2016","NC","94482","HIOS","3","2015-08-27 11:14:25","1","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010007","BESTDental Premium","94482NC001",,"NCN001","NCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2016/NC_BESTDental_Premium_Plan.pdf","5"
"2016","NC","94482","HIOS","3","2015-08-27 11:14:25","1","94482","NC","Individual","Yes","95-6042390","94482NC0020003","BESTOne Advantage Gold","94482NC002",,"NCN001","NCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.76","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2016/NC_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","NC","94482","HIOS","3","2015-08-27 11:14:25","1","94482","NC","Individual","Yes","95-6042390","94482NC0020004","BESTOne Plus Gold","94482NC002",,"NCN001","NCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.76","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2016/NC_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","NC","94482","HIOS","3","2015-08-27 11:14:25","1","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010008","BESTDental Standard - H","94482NC001",,"NCN001","NCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2016/NC_BESTDental_Standard-H_Plan.pdf","6"
"2016","NC","94482","HIOS","3","2015-08-27 11:14:25","1","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010008","BESTDental Standard - H","94482NC001",,"NCN001","NCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2016/NC_BESTDental_Standard-H_Plan.pdf","7"
"2016","NC","94482","HIOS","3","2015-08-27 11:14:25","1","94482","NC","Individual","Yes","95-6042390","94482NC0020004","BESTOne Plus Gold","94482NC002",,"NCN001","NCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.76","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2016/NC_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","NC","94482","HIOS","3","2015-08-27 11:14:25","1","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010010","BESTDental Choice - H","94482NC001",,"NCN001","NCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2016/NC_BESTDental_Choice-H_Plan.pdf","8"
"2016","NC","94482","HIOS","3","2015-08-27 11:14:25","1","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010010","BESTDental Choice - H","94482NC001",,"NCN001","NCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2016/NC_BESTDental_Choice-H_Plan.pdf","9"
"2016","NC","94482","HIOS","3","2015-08-27 11:14:25","2","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010009","BESTDental Standard - L","94482NC001",,"NCN001","NCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.36","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2016/NC_BESTDental_Standard-L_Plan.pdf","4"
"2016","NC","94482","HIOS","3","2015-08-27 11:14:25","2","94482","NC","Individual","Yes","95-6042390","94482NC0020005","BESTOne Plus Silver","94482NC002",,"NCN001","NCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.20","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2016/NC_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","NC","94482","HIOS","3","2015-08-27 11:14:25","2","94482","NC","Individual","Yes","95-6042390","94482NC0020005","BESTOne Plus Silver","94482NC002",,"NCN001","NCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.20","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2016/NC_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","NC","94482","HIOS","3","2015-08-27 11:14:25","2","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010009","BESTDental Standard - L","94482NC001",,"NCN001","NCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.36","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2016/NC_BESTDental_Standard-L_Plan.pdf","5"
"2016","NC","94482","HIOS","3","2015-08-27 11:14:25","2","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010011","BESTDental Choice - L","94482NC001",,"NCN001","NCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.36","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2016/NC_BESTDental_Choice-L_Plan.pdf","6"
"2016","NC","94482","HIOS","3","2015-08-27 11:14:25","2","94482","NC","Individual","Yes","95-6042390","94482NC0020006","BESTOne Basic Silver","94482NC002",,"NCN001","NCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.20","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2016/NC_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","NC","94482","HIOS","3","2015-08-27 11:14:25","2","94482","NC","Individual","Yes","95-6042390","94482NC0020006","BESTOne Basic Silver","94482NC002",,"NCN001","NCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.20","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2016/NC_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","NC","94482","HIOS","3","2015-08-27 11:14:25","2","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010011","BESTDental Choice - L","94482NC001",,"NCN001","NCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.36","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2016/NC_BESTDental_Choice-L_Plan.pdf","7"
"2016","NC","94482","HIOS","3","2015-08-27 11:14:25","2","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010012","BESTDental Value","94482NC001",,"NCN001","NCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.36","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2016/NC_BESTDental_Value_Plan.pdf","8"
"2016","NC","94482","HIOS","3","2015-08-27 11:14:25","2","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010012","BESTDental Value","94482NC001",,"NCN001","NCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.36","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","94482NC0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/NC/2016/NC_BESTDental_Value_Plan.pdf","9"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","1","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0170001","Pediatric Dental A","27882ND017",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0170001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","1","27882","ND","Individual","Yes","41-0952670","27882ND0010001","Pediatric Dental A","27882ND001",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-a",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","1","27882","ND","Individual","Yes","41-0952670","27882ND0010001","Pediatric Dental A","27882ND001",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0010001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-a",,"5"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","2","27882","ND","Individual","Yes","41-0952670","27882ND0020001","Pediatric Dental A + Adult A","27882ND002",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0020001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-a-adult-a",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","2","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0180001","Pediatric Dental A + Adult A","27882ND018",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0180001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","2","27882","ND","Individual","Yes","41-0952670","27882ND0020001","Pediatric Dental A + Adult A","27882ND002",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0020001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-a-adult-a",,"5"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","3","27882","ND","Individual","Yes","41-0952670","27882ND0030001","Pediatric Dental A + Adult B","27882ND003",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0030001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-a-adult-b",,"5"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","4","27882","ND","Individual","Yes","41-0952670","27882ND0040001","Pediatric Dental A + Adult C","27882ND004",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-a-adult-c",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","4","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0200001","Pediatric Dental A + Adult C","27882ND020",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0200001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","4","27882","ND","Individual","Yes","41-0952670","27882ND0040001","Pediatric Dental A + Adult C","27882ND004",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0040001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-a-adult-c",,"5"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","5","27882","ND","Individual","Yes","41-0952670","27882ND0050001","Pediatric Dental A + Adult D","27882ND005",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0050001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-a-adult-d",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","5","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0210001","Pediatric Dental A + Adult D","27882ND021",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0210001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","5","27882","ND","Individual","Yes","41-0952670","27882ND0050001","Pediatric Dental A + Adult D","27882ND005",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0050001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-a-adult-d",,"5"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","6","27882","ND","Individual","Yes","41-0952670","27882ND0060001","Pediatric Dental A + Adult E","27882ND006",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0060001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-a-adult-e",,"4"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0080019","Medica Applause Gold Copay Plus","73751ND008",,"NDN002","NDS002","NDF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080019-03","Limited Cost Sharing Plan Variation",,"0.785466134548187","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1AGPCNDL&uid=FFM",,"15"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0080007","Medica Applause Gold H S A","73751ND008",,"NDN002","NDS002","NDF004","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080007-00","Standard Gold Off Exchange Plan",,"0.788612484931946","Yes","Yes","No","100%",,"$1,300","$0","$1,200","$1,000","$1,300","$0","$1,200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7050 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3AGHND&uid=FFM",,"16"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0080007","Medica Applause Gold H S A","73751ND008",,"NDN002","NDS002","NDF004","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080007-01","Standard Gold On Exchange Plan",,"0.788612484931946","Yes","Yes","No","100%",,"$1,300","$0","$1,200","$1,000","$1,300","$0","$1,200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7050 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3AGHND&uid=FFM",,"17"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0080007","Medica Applause Gold H S A","73751ND008",,"NDN002","NDS002","NDF004","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3AGHNDZ&uid=FFM",,"18"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","6","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0220001","Pediatric Dental A + Adult E","27882ND022",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0220001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","6","27882","ND","Individual","Yes","41-0952670","27882ND0060001","Pediatric Dental A + Adult E","27882ND006",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0060001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-a-adult-e",,"5"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","7","27882","ND","Individual","Yes","41-0952670","27882ND0070001","Pediatric Dental A + Adult F","27882ND007",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0070001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-a-adult-f",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","7","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0230001","Pediatric Dental A + Adult F","27882ND023",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0230001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","7","27882","ND","Individual","Yes","41-0952670","27882ND0070001","Pediatric Dental A + Adult F","27882ND007",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.85","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0070001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-a-adult-f",,"5"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","12","27882","ND","Individual","Yes","41-0952670","27882ND0120001","Pediatric Dental B + Adult C","27882ND012",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0120001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-b-adult-c",,"5"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","13","27882","ND","Individual","Yes","41-0952670","27882ND0130001","Pediatric Dental B + Adult D","27882ND013",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0130001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-b-adult-d",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","13","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0290001","Pediatric Dental B + Adult D","27882ND029",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0290001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","13","27882","ND","Individual","Yes","41-0952670","27882ND0130001","Pediatric Dental B + Adult D","27882ND013",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0130001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-b-adult-d",,"5"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","14","27882","ND","Individual","Yes","41-0952670","27882ND0140001","Pediatric Dental B + Adult E","27882ND014",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0140001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-b-adult-e",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","14","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0300001","Pediatric Dental B + Adult E","27882ND030",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0300001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","14","27882","ND","Individual","Yes","41-0952670","27882ND0140001","Pediatric Dental B + Adult E","27882ND014",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0140001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-b-adult-e",,"5"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","15","27882","ND","Individual","Yes","41-0952670","27882ND0150001","Pediatric Dental B + Adult F","27882ND015",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0150001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-b-adult-f",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","15","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0310001","Pediatric Dental B + Adult F","27882ND031",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0310001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","15","27882","ND","Individual","Yes","41-0952670","27882ND0150001","Pediatric Dental B + Adult F","27882ND015",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0150001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-b-adult-f",,"5"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","16","27882","ND","Individual","Yes","41-0952670","27882ND0160001","Pediatric Dental B + Adult G","27882ND016",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0160001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-b-adult-g",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","16","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0320001","Pediatric Dental B + Adult G","27882ND032",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0320001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmn.org/",,"4"
"2016","ND","27882","HIOS","6","2015-08-25 05:06:23","16","27882","ND","Individual","Yes","41-0952670","27882ND0160001","Pediatric Dental B + Adult G","27882ND016",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.70","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","27882ND0160001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$50 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalmn.org/individual-and-family-plans/hcr/nd/ped-b-adult-g",,"5"
"2016","ND","29278","HIOS","3","2015-08-27 11:14:25","1","29278","ND","SHOP (Small Group)","Yes","36-0883760","29278ND0040002","EHB High PPO","29278ND004",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.64","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","29278ND0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0100017","Altru Prime by Medica Gold Copay 100","73751ND010",,"NDN003","NDS003","NDF002","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100017-01","Standard Gold On Exchange Plan",,"0.818332970142365","Yes","Yes","No","100%",,"$2,400","$0","$0","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APG100CND&uid=FFM",,"25"
"2016","ND","29278","HIOS","3","2015-08-27 11:14:25","1","29278","ND","SHOP (Small Group)","Yes","36-0883760","29278ND0040001","EHB Low PPO","29278ND004",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.85","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","29278ND0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","ND","29278","HIOS","3","2015-08-27 11:14:25","1","29278","ND","SHOP (Small Group)","Yes","36-0883760","29278ND0030002","EHB High Passive","29278ND003",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$48.45","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","29278ND0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","ND","29278","HIOS","3","2015-08-27 11:14:25","1","29278","ND","SHOP (Small Group)","Yes","36-0883760","29278ND0030001","EHB Low Passive","29278ND003",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.65","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","29278ND0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","ND","33011","HIOS","3","2015-08-27 11:14:25","1","33011","ND","SHOP (Small Group)","Yes","93-0242990","33011ND0040002","EHB High PPO","33011ND004",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.76","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","33011ND0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","ND","33011","HIOS","3","2015-08-27 11:14:25","1","33011","ND","SHOP (Small Group)","Yes","93-0242990","33011ND0040001","EHB Low PPO","33011ND004",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.92","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","33011ND0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","ND","33011","HIOS","3","2015-08-27 11:14:25","1","33011","ND","SHOP (Small Group)","Yes","93-0242990","33011ND0030002","EHB High Passive","33011ND003",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$48.58","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","33011ND0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","ND","33011","HIOS","3","2015-08-27 11:14:25","1","33011","ND","SHOP (Small Group)","Yes","93-0242990","33011ND0030001","EHB Low Passive","33011ND003",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.74","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","33011ND0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","1","37160","ND","Individual","No","45-0173185","37160ND2410002","BlueCare Silver 70","37160ND241","7194728540","NDN001","NDS001","NDF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410002-00","Standard Silver Off Exchange Plan",,"0.691120624542236","Yes","Yes","No","100%",,"$2,800","$20","$1,300","$200","$200","$1,000","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","30%",,,,,"$5,600","$5600 per person","$11200 per group","$8,400","$8400 per person","$16800 per group","No",,,"https://www.bcbsnd.com/bluecare-70-2800-silver","https://www.bcbsnd.com/2016-ind-bluecare-brochure","4"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440001","BlueDirect Gold 100","37160ND244","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2440001-00","Standard Gold Off Exchange Plan",,"0.785342574119568","Yes","Yes","No","100%",,"$2,300","$0","$0","$200","$2,300","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group",,,,"$6,900","$13800 per person","$13800 per group","$9,200","$18400 per person","$18400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group","0%",,,,,"$4,600","$9200 per person","$9200 per group","$6,900","$13800 per person","$13800 per group","Yes","No",,"https://www.bcbsnd.com/bluedirect-100-2300-gold","https://www.bcbsnd.com/2016-grp-bluedirect-brochure","4"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440001","BlueDirect Gold 100","37160ND244","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2440001-01","Standard Gold On Exchange Plan",,"0.785342574119568","Yes","Yes","No","100%",,"$2,300","$0","$0","$200","$2,300","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group",,,,"$6,900","$13800 per person","$13800 per group","$9,200","$18400 per person","$18400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group","0%",,,,,"$4,600","$9200 per person","$9200 per group","$6,900","$13800 per person","$13800 per group","Yes","No",,"https://www.bcbsnd.com/bluedirect-100-2300-gold","https://www.bcbsnd.com/2016-grp-bluedirect-brochure","5"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","1","37160","ND","Individual","No","45-0173185","37160ND2410002","BlueCare Silver 70","37160ND241","7194728540","NDN001","NDS001","NDF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410002-01","Standard Silver On Exchange Plan",,"0.691120624542236","Yes","Yes","No","100%",,"$2,800","$20","$1,300","$200","$200","$1,000","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","30%",,,,,"$5,600","$5600 per person","$11200 per group","$8,400","$8400 per person","$16800 per group","No",,,"https://www.bcbsnd.com/bluecare-70-2800-silver","https://www.bcbsnd.com/2016-ind-bluecare-brochure","5"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","1","37160","ND","Individual","No","45-0173185","37160ND2410002","BlueCare Silver 70","37160ND241","7194728540","NDN001","NDS001","NDF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/bcbs-ai-ak-native-under-300-fpl","https://www.bcbsnd.com/2016-ind-american-indian/alaska-native-300minus-1-brochure","6"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440004","BlueDirect Silver 80","37160ND244","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2440004-00","Standard Silver Off Exchange Plan",,"0.680429399013519","Yes","Yes","No","100%",,"$2,600","$0","$900","$200","$2,600","$0","$500","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"$11,800","$11800 per person","$23600 per group","$17,700","$17700 per person","$35400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","$7,800","$7800 per person","$15600 per group","Yes","No",,"https://www.bcbsnd.com/bluedirect-80-2600-silver","https://www.bcbsnd.com/2016-grp-bluedirect-brochure","6"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440004","BlueDirect Silver 80","37160ND244","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2440004-01","Standard Silver On Exchange Plan",,"0.680429399013519","Yes","Yes","No","100%",,"$2,600","$0","$900","$200","$2,600","$0","$500","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"$11,800","$11800 per person","$23600 per group","$17,700","$17700 per person","$35400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","$7,800","$7800 per person","$15600 per group","Yes","No",,"https://www.bcbsnd.com/bluedirect-80-2600-silver","https://www.bcbsnd.com/2016-grp-bluedirect-brochure","7"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","1","37160","ND","Individual","No","45-0173185","37160ND2410002","BlueCare Silver 70","37160ND241","7194728540","NDN001","NDS001","NDF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410002-03","Limited Cost Sharing Plan Variation",,"0.691120624542236","Yes","Yes","No","100%",,"$2,800","$20","$1,300","$200","$200","$1,000","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","30%",,,,,"$5,600","$5600 per person","$11200 per group","$8,400","$8400 per person","$16800 per group","No",,,"https://www.bcbsnd.com/bluecare-70-2800-silver-ihs","https://www.bcbsnd.com/2016-ind-american-indian/alaska-native-bluecare-300plus-2-brochure","7"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","1","37160","ND","Individual","No","45-0173185","37160ND2410002","BlueCare Silver 70","37160ND241","7194728540","NDN001","NDS001","NDF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410002-04","73% AV Level Silver Plan",,"0.720812618732452","Yes","Yes","No","100%",,"$2,800","$20","$900","$200","$200","$1,000","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20%",,,,,"$5,600","$5600 per person","$11200 per group","$8,400","$8400 per person","$16800 per group","No",,,"https://www.bcbsnd.com/bluecare-80-2800-csr-73-silver","https://www.bcbsnd.com/2016-ind-bluecare-csr-73-percent-silver-at-a-glance","8"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","1","37160","ND","Individual","No","45-0173185","37160ND2410002","BlueCare Silver 70","37160ND241","7194728540","NDN001","NDS001","NDF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410002-05","87% AV Level Silver Plan",,"0.861899316310883","Yes","Yes","No","100%",,"$500","$20","$1,100","$200","$200","$1,000","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$3,200","$3200 per person","$6400 per group","$4,800","$4800 per person","$9600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","No",,,"https://www.bcbsnd.com/bluecare-80-500-csr-87-silver","https://www.bcbsnd.com/2016-ind-bluecare-csr-87-percent-silver-at-a-glance","9"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","1","37160","ND","Individual","No","45-0173185","37160ND2410002","BlueCare Silver 70","37160ND241","7194728540","NDN001","NDS001","NDF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410002-06","94% AV Level Silver Plan",,"0.930519938468933","Yes","Yes","No","100%",,"$0","$20","$700","$200","$0","$740","$10","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$1,500","$1500 per person","$3000 per group","$2,250","$2250 per person","$4500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/bluecare-90-0-csr-94-silver","https://www.bcbsnd.com/2016-ind-bluecare-csr-94-percent-silver-at-a-glance","10"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","1","37160","ND","Individual","No","45-0173185","37160ND2410005","BlueCare Gold 70","37160ND241","7194728540","NDN001","NDS001","NDF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410005-00","Standard Gold Off Exchange Plan",,"0.781265676021576","Yes","Yes","No","100%",,"$500","$20","$2,000","$200","$200","$560","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","No",,,"https://www.bcbsnd.com/bluecare-70-500-gold","https://www.bcbsnd.com/2016-ind-bluecare-brochure","11"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","1","37160","ND","Individual","No","45-0173185","37160ND2410005","BlueCare Gold 70","37160ND241","7194728540","NDN001","NDS001","NDF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410005-01","Standard Gold On Exchange Plan",,"0.781265676021576","Yes","Yes","No","100%",,"$500","$20","$2,000","$200","$200","$560","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","No",,,"https://www.bcbsnd.com/bluecare-70-500-gold","https://www.bcbsnd.com/2016-ind-bluecare-brochure","12"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","1","37160","ND","Individual","No","45-0173185","37160ND2410005","BlueCare Gold 70","37160ND241","7194728540","NDN001","NDS001","NDF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/bcbs-ai-ak-native-under-300-fpl","https://www.bcbsnd.com/2016-ind-american-indian/alaska-native-300minus-1-brochure","13"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","1","37160","ND","Individual","No","45-0173185","37160ND2410005","BlueCare Gold 70","37160ND241","7194728540","NDN001","NDS001","NDF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410005-03","Limited Cost Sharing Plan Variation",,"0.781265676021576","Yes","Yes","No","100%",,"$500","$20","$2,000","$200","$200","$560","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","No",,,"https://www.bcbsnd.com/bluecare-70-500-gold-ihs","https://www.bcbsnd.com/2016-ind-american-indian/alaska-native-bluecare-300plus-2-brochure","14"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","2","37160","ND","Individual","No","45-0173185","37160ND2410014","BlueDirect Silver 80","37160ND241","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410014-00","Standard Silver Off Exchange Plan",,"0.680429399013519","Yes","Yes","No","100%",,"$2,600","$0","$900","$200","$2,600","$0","$500","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"$11,800","$11800 per person","$23600 per group","$17,700","$17700 per person","$35400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","$7,800","$7800 per person","$15600 per group","Yes",,,"https://www.bcbsnd.com/bluedirect-80-2600-silver-ind","https://www.bcbsnd.com/2016-ind-bluedirect-brochure","4"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","2","37160","ND","Individual","No","45-0173185","37160ND2410014","BlueDirect Silver 80","37160ND241","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410014-01","Standard Silver On Exchange Plan",,"0.680429399013519","Yes","Yes","No","100%",,"$2,600","$0","$900","$200","$2,600","$0","$500","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"$11,800","$11800 per person","$23600 per group","$17,700","$17700 per person","$35400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","$7,800","$7800 per person","$15600 per group","Yes",,,"https://www.bcbsnd.com/bluedirect-80-2600-silver-ind","https://www.bcbsnd.com/2016-ind-bluedirect-brochure","5"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","2","37160","ND","Individual","No","45-0173185","37160ND2410014","BlueDirect Silver 80","37160ND241","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/bcbs-ai-ak-native-under-300-fpl","https://www.bcbsnd.com/2016-ind-american-indian/alaska-native-300minus-1-brochure","6"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","2","37160","ND","Individual","No","45-0173185","37160ND2410014","BlueDirect Silver 80","37160ND241","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410014-03","Limited Cost Sharing Plan Variation",,"0.680429399013519","Yes","Yes","No","100%",,"$2,600","$0","$900","$200","$2,600","$0","$500","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"$11,800","$11800 per person","$23600 per group","$17,700","$17700 per person","$35400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","$7,800","$7800 per person","$15600 per group","No",,,"https://www.bcbsnd.com/bluedirect-80-2600-silver-ind-ihs","https://www.bcbsnd.com/2016-ind-american-indian/alaska-native-bluedirect-300plus-3-brochure","7"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","2","37160","ND","Individual","No","45-0173185","37160ND2410014","BlueDirect Silver 80","37160ND241","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410014-04","73% AV Level Silver Plan",,"0.722387552261353","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$200","$1,800","$0","$700","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20%",,,,,"$3,600","$3600 per person","$7200 per group","$5,400","$5400 per person","$10800 per group","No",,,"https://www.bcbsnd.com/bluedirect-80-1800-csr-73-silver","https://www.bcbsnd.com/2016-ind-bluedirect-csr-73-percent-silver-at-a-glance","8"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","2","37160","ND","Individual","No","45-0173185","37160ND2410014","BlueDirect Silver 80","37160ND241","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410014-05","87% AV Level Silver Plan",,"0.863358855247498","Yes","Yes","No","100%",,"$700","$0","$600","$200","$700","$0","$400","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$4,500","$4500 per person","$9000 per group","$6,750","$6750 per person","$13500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","10%",,,,,"$1,400","$1400 per person","$2800 per group","$2,100","$2100 per person","$4200 per group","No",,,"https://www.bcbsnd.com/bluedirect-90-700-csr-87-silver","https://www.bcbsnd.com/2016-ind-bluedriect-csr-87-percent-silver-at-a-glance","9"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","2","37160","ND","Individual","No","45-0173185","37160ND2410014","BlueDirect Silver 80","37160ND241","7194728540","NDN001","NDS001","NDF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410014-06","94% AV Level Silver Plan",,"0.930854320526123","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$0","$500","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$4,200","$4200 per person","$8400 per group","$6,300","$6300 per person","$12600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/bluedirect-90-0-csr-94-silver","https://www.bcbsnd.com/2016-ind-bluedirect-csr-94-percent-silver-at-a-glance","10"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","2","37160","ND","Individual","No","45-0173185","37160ND2410018","BlueDirect Gold 100","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410018-00","Standard Gold Off Exchange Plan",,"0.785342574119568","Yes","Yes","No","100%",,"$2,300","$0","$0","$200","$2,300","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group",,,,"$6,900","$13800 per person","$13800 per group","$9,200","$18400 per person","$18400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group","0%",,,,,"$4,600","$9200 per person","$9200 per group","$6,900","$13800 per person","$13800 per group","Yes",,,"https://www.bcbsnd.com/bluedirect-100-2300-gold-ind","https://www.bcbsnd.com/2016-ind-bluedirect-brochure","11"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","2","37160","ND","Individual","No","45-0173185","37160ND2410018","BlueDirect Gold 100","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410018-01","Standard Gold On Exchange Plan",,"0.785342574119568","Yes","Yes","No","100%",,"$2,300","$0","$0","$200","$2,300","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group",,,,"$6,900","$13800 per person","$13800 per group","$9,200","$18400 per person","$18400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group","0%",,,,,"$4,600","$9200 per person","$9200 per group","$6,900","$13800 per person","$13800 per group","Yes",,,"https://www.bcbsnd.com/bluedirect-100-2300-gold-ind","https://www.bcbsnd.com/2016-ind-bluedirect-brochure","12"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","2","37160","ND","Individual","No","45-0173185","37160ND2410018","BlueDirect Gold 100","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/bcbs-ai-ak-native-under-300-fpl","https://www.bcbsnd.com/2016-ind-american-indian/alaska-native-300minus-1-brochure","13"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","2","37160","ND","Individual","No","45-0173185","37160ND2410018","BlueDirect Gold 100","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410018-03","Limited Cost Sharing Plan Variation",,"0.785342574119568","Yes","Yes","No","100%",,"$2,300","$0","$0","$200","$2,300","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group",,,,"$6,900","$13800 per person","$13800 per group","$9,200","$18400 per person","$18400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group","0%",,,,,"$4,600","$9200 per person","$9200 per group","$6,900","$13800 per person","$13800 per group","No",,,"https://www.bcbsnd.com/bluedirect-100-2300-gold-ind-ihs","https://www.bcbsnd.com/2016-ind-american-indian/alaska-native-bluedirect-300plus-3-brochure","14"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","2","37160","ND","Individual","No","45-0173185","37160ND2410020","BlueDirect Bronze100","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410020-00","Standard Bronze Off Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$200","$5,110","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","$26,200","$26200 per person","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group","Yes",,,"https://www.bcbsnd.com/bluedirect-100-6550-bronze","https://www.bcbsnd.com/2016-ind-bluedirect-brochure","15"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","2","37160","ND","Individual","No","45-0173185","37160ND2410020","BlueDirect Bronze100","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410020-01","Standard Bronze On Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$200","$5,110","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","$26,200","$26200 per person","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group","Yes",,,"https://www.bcbsnd.com/bluedirect-100-6550-bronze","https://www.bcbsnd.com/2016-ind-bluedirect-brochure","16"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","2","37160","ND","Individual","No","45-0173185","37160ND2410020","BlueDirect Bronze100","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410020-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bcbsnd.com/bcbs-ai-ak-native-under-300-fpl","https://www.bcbsnd.com/2016-ind-american-indian/alaska-native-300minus-1-brochure","17"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","2","37160","ND","Individual","No","45-0173185","37160ND2410020","BlueDirect Bronze100","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410020-03","Limited Cost Sharing Plan Variation",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$200","$5,110","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$19,650","$19650 per person","$39300 per group","$26,200","$26200 per person","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group","No",,,"https://www.bcbsnd.com/bluedirect-100-6550-bronze-ihs","https://www.bcbsnd.com/2016-ind-american-indian/alaska-native-bluedirect-300plus-3-brochure","18"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","3","37160","ND","Individual","No","45-0173185","37160ND2410021","BlueEssential 100","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","3","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410021-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,560","$150","$0","$200","$4,800","$150","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","$27,400","$27400 per person","$54800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"https://www.bcbsnd.com/blue-essential","https://www.bcbsnd.com/2016-ind-blueessential-brochure","4"
"2016","ND","37160","HIOS","4","2016-07-08 07:33:42","3","37160","ND","Individual","No","45-0173185","37160ND2410021","BlueEssential 100","37160ND241","7194728540","NDN001","NDS001","NDF001","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","3","2016-01-01",,"Yes","Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.","Yes","Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.","Yes","https://www.bcbsnd.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_ND_4T_HealthInsuranceMarketplaceEssential.pdf","37160ND2410021-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,560","$150","$0","$200","$4,800","$150","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","$27,400","$27400 per person","$54800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"https://www.bcbsnd.com/blue-essential","https://www.bcbsnd.com/2016-ind-blueessential-brochure","5"
"2016","ND","54993","HIOS","2","2015-07-11 04:19:24","1","54993","ND","SHOP (Small Group)","Yes","47-0397286","54993ND0030001","Renaissance Group Dental PPO, EHB Certified","54993ND003",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.67","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","54993ND0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ND","54993","HIOS","2","2015-07-11 04:19:24","1","54993","ND","Individual","Yes","47-0397286","54993ND0010001","Delta Dental Individual PPO, EHB Certified","54993ND001",,"NDN002","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.27","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","54993ND0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ND","54993","HIOS","2","2015-07-11 04:19:24","1","54993","ND","Individual","Yes","47-0397286","54993ND0010002","Delta Dental Individual PPO, EHB Certified","54993ND001",,"NDN002","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.76","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","54993ND0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","ND","54993","HIOS","2","2015-07-11 04:19:24","1","54993","ND","SHOP (Small Group)","Yes","47-0397286","54993ND0030002","Renaissance Group Dental PPO, EHB Certified","54993ND003",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.59","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","54993ND0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","ND","54993","HIOS","2","2015-07-11 04:19:24","1","54993","ND","Individual","Yes","47-0397286","54993ND0020001","Renaissance Individual Dental PPO, EHB Certified","54993ND002",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.66","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","54993ND0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","ND","54993","HIOS","2","2015-07-11 04:19:24","1","54993","ND","Individual","Yes","47-0397286","54993ND0020002","Renaissance Individual Dental PPO, EHB Certified","54993ND002",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.88","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","54993ND0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","ND","57390","HIOS","2","2015-07-11 04:19:24","1","57390","ND","SHOP (Small Group)","Yes","44-0308260","57390ND0010001","KCL EHB Low PPO","57390ND001",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$39.66","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","57390ND0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ND","57390","HIOS","2","2015-07-11 04:19:24","1","57390","ND","SHOP (Small Group)","Yes","44-0308260","57390ND0010003","KCL EHB Low MAC","57390ND001",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$29.76","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","57390ND0010003-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","ND","57390","HIOS","2","2015-07-11 04:19:24","1","57390","ND","SHOP (Small Group)","Yes","44-0308260","57390ND0010005","KCL Fam Low PPO","57390ND001",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$39.66","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","57390ND0010005-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","ND","57390","HIOS","2","2015-07-11 04:19:24","1","57390","ND","SHOP (Small Group)","Yes","44-0308260","57390ND0010007","KCL Fam Low MAC","57390ND001",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$29.76","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","57390ND0010007-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","ND","57390","HIOS","2","2015-07-11 04:19:24","2","57390","ND","SHOP (Small Group)","Yes","44-0308260","57390ND0010002","KCL EHB High PPO","57390ND001",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$48.53","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","57390ND0010002-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ND","57390","HIOS","2","2015-07-11 04:19:24","2","57390","ND","SHOP (Small Group)","Yes","44-0308260","57390ND0010004","KCL EHB High MAC","57390ND001",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$36.96","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","57390ND0010004-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","ND","57390","HIOS","2","2015-07-11 04:19:24","2","57390","ND","SHOP (Small Group)","Yes","44-0308260","57390ND0010006","KCL Fam High PPO","57390ND001",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$48.53","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","57390ND0010006-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","ND","57390","HIOS","2","2015-07-11 04:19:24","2","57390","ND","SHOP (Small Group)","Yes","44-0308260","57390ND0010008","KCL Fam High MAC","57390ND001",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$36.96","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","57390ND0010008-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","ND","71860","HIOS","4","2015-07-09 13:17:42","1","71860","ND","SHOP (Small Group)","Yes","57-0523959","71860ND0020001","Group Dental Policy","71860ND002",,"NDN001","NDS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.51","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","71860ND0020001-00","Standard High Off Exchange Plan","85.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0080001","Medica Applause Gold Copay","73751ND008",,"NDN002","NDS002","NDF001","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080001-00","Standard Gold Off Exchange Plan",,"0.795177459716797","Yes","Yes","No","100%",,"$300","$20","$1,500","$1,000","$300","$600","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3AGCND&uid=FFM",,"4"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0080001","Medica Applause Gold Copay","73751ND008",,"NDN002","NDS002","NDF001","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080001-01","Standard Gold On Exchange Plan",,"0.795177459716797","Yes","Yes","No","100%",,"$300","$20","$1,500","$1,000","$300","$600","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3AGCND&uid=FFM",,"5"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0080001","Medica Applause Gold Copay","73751ND008",,"NDN002","NDS002","NDF001","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3AGCNDZ&uid=FFM",,"6"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0080001","Medica Applause Gold Copay","73751ND008",,"NDN002","NDS002","NDF001","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080001-03","Limited Cost Sharing Plan Variation",,"0.795177459716797","Yes","Yes","No","100%",,"$300","$20","$1,500","$1,000","$300","$600","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3AGCNDL&uid=FFM",,"7"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0080017","Medica Applause Gold Copay 100","73751ND008",,"NDN002","NDS002","NDF002","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080017-00","Standard Gold Off Exchange Plan",,"0.818332970142365","Yes","Yes","No","100%",,"$2,400","$0","$0","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2AG100CND&uid=FFM",,"8"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0080017","Medica Applause Gold Copay 100","73751ND008",,"NDN002","NDS002","NDF002","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080017-01","Standard Gold On Exchange Plan",,"0.818332970142365","Yes","Yes","No","100%",,"$2,400","$0","$0","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2AG100CND&uid=FFM",,"9"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0080017","Medica Applause Gold Copay 100","73751ND008",,"NDN002","NDS002","NDF002","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2AG100CNDZ&uid=FFM",,"10"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0080017","Medica Applause Gold Copay 100","73751ND008",,"NDN002","NDS002","NDF002","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080017-03","Limited Cost Sharing Plan Variation",,"0.818332970142365","Yes","Yes","No","100%",,"$2,400","$0","$0","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2AG100CNDL&uid=FFM",,"11"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0080019","Medica Applause Gold Copay Plus","73751ND008",,"NDN002","NDS002","NDF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080019-00","Standard Gold Off Exchange Plan",,"0.785466134548187","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1AGPCND&uid=FFM",,"12"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0080019","Medica Applause Gold Copay Plus","73751ND008",,"NDN002","NDS002","NDF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080019-01","Standard Gold On Exchange Plan",,"0.785466134548187","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1AGPCND&uid=FFM",,"13"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0080019","Medica Applause Gold Copay Plus","73751ND008",,"NDN002","NDS002","NDF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1AGPCNDZ&uid=FFM",,"14"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0080007","Medica Applause Gold H S A","73751ND008",,"NDN002","NDS002","NDF004","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080007-03","Limited Cost Sharing Plan Variation",,"0.788612484931946","Yes","Yes","No","100%",,"$1,300","$0","$1,200","$1,000","$1,300","$0","$1,200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7050 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3AGHNDL&uid=FFM",,"19"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0100001","Altru Prime by Medica Gold Copay","73751ND010",,"NDN003","NDS003","NDF001","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100001-00","Standard Gold Off Exchange Plan",,"0.795177459716797","Yes","Yes","No","100%",,"$300","$20","$1,500","$1,000","$300","$600","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APGCND&uid=FFM",,"20"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0100001","Altru Prime by Medica Gold Copay","73751ND010",,"NDN003","NDS003","NDF001","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100001-01","Standard Gold On Exchange Plan",,"0.795177459716797","Yes","Yes","No","100%",,"$300","$20","$1,500","$1,000","$300","$600","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APGCND&uid=FFM",,"21"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0100001","Altru Prime by Medica Gold Copay","73751ND010",,"NDN003","NDS003","NDF001","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APGCNDZ&uid=FFM",,"22"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0100001","Altru Prime by Medica Gold Copay","73751ND010",,"NDN003","NDS003","NDF001","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100001-03","Limited Cost Sharing Plan Variation",,"0.795177459716797","Yes","Yes","No","100%",,"$300","$20","$1,500","$1,000","$300","$600","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APGCNDL&uid=FFM",,"23"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0100017","Altru Prime by Medica Gold Copay 100","73751ND010",,"NDN003","NDS003","NDF002","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100017-00","Standard Gold Off Exchange Plan",,"0.818332970142365","Yes","Yes","No","100%",,"$2,400","$0","$0","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APG100CND&uid=FFM",,"24"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0100017","Altru Prime by Medica Gold Copay 100","73751ND010",,"NDN003","NDS003","NDF002","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APG100CNDZ&uid=FFM",,"26"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0100017","Altru Prime by Medica Gold Copay 100","73751ND010",,"NDN003","NDS003","NDF002","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100017-03","Limited Cost Sharing Plan Variation",,"0.818332970142365","Yes","Yes","No","100%",,"$2,400","$0","$0","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APG100CNDL&uid=FFM",,"27"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0100019","Altru Prime by Medica Gold Copay Plus","73751ND010",,"NDN003","NDS003","NDF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100019-00","Standard Gold Off Exchange Plan",,"0.785466134548187","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APGPCND&uid=FFM",,"28"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0100019","Altru Prime by Medica Gold Copay Plus","73751ND010",,"NDN003","NDS003","NDF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100019-01","Standard Gold On Exchange Plan",,"0.785466134548187","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APGPCND&uid=FFM",,"29"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0100019","Altru Prime by Medica Gold Copay Plus","73751ND010",,"NDN003","NDS003","NDF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APGPCNDZ&uid=FFM",,"30"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0100019","Altru Prime by Medica Gold Copay Plus","73751ND010",,"NDN003","NDS003","NDF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100019-03","Limited Cost Sharing Plan Variation",,"0.785466134548187","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APGPCNDL&uid=FFM",,"31"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0100007","Altru Prime by Medica Gold H S A","73751ND010",,"NDN003","NDS003","NDF004","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100007-00","Standard Gold Off Exchange Plan",,"0.788612484931946","Yes","Yes","No","100%",,"$1,300","$0","$1,200","$1,000","$1,300","$0","$1,200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7050 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APGHND&uid=FFM",,"32"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0100007","Altru Prime by Medica Gold H S A","73751ND010",,"NDN003","NDS003","NDF004","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100007-01","Standard Gold On Exchange Plan",,"0.788612484931946","Yes","Yes","No","100%",,"$1,300","$0","$1,200","$1,000","$1,300","$0","$1,200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7050 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APGHND&uid=FFM",,"33"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0100007","Altru Prime by Medica Gold H S A","73751ND010",,"NDN003","NDS003","NDF004","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APGHNDZ&uid=FFM",,"34"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","1","73751","ND","Individual","No","41-1242261","73751ND0100007","Altru Prime by Medica Gold H S A","73751ND010",,"NDN003","NDS003","NDF004","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100007-03","Limited Cost Sharing Plan Variation",,"0.788612484931946","Yes","Yes","No","100%",,"$1,300","$0","$1,200","$1,000","$1,300","$0","$1,200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7050 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APGHNDL&uid=FFM",,"35"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0080003","Medica Applause Silver Copay","73751ND008",,"NDN002","NDS002","NDF005","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080003-00","Standard Silver Off Exchange Plan",,"0.69723379611969","Yes","Yes","No","100%",,"$2,600","$20","$1,100","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ASCND&uid=FFM",,"4"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0080003","Medica Applause Silver Copay","73751ND008",,"NDN002","NDS002","NDF005","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080003-01","Standard Silver On Exchange Plan",,"0.69723379611969","Yes","Yes","No","100%",,"$2,600","$20","$1,100","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ASCND&uid=FFM",,"5"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0080003","Medica Applause Silver Copay","73751ND008",,"NDN002","NDS002","NDF005","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ASCNDZ&uid=FFM",,"6"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0080003","Medica Applause Silver Copay","73751ND008",,"NDN002","NDS002","NDF005","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080003-03","Limited Cost Sharing Plan Variation",,"0.69723379611969","Yes","Yes","No","100%",,"$2,600","$20","$1,100","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ASCNDL&uid=FFM",,"7"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0080003","Medica Applause Silver Copay","73751ND008",,"NDN002","NDS002","NDF005","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080003-04","73% AV Level Silver Plan",,"0.730964839458466","Yes","Yes","No","100%",,"$2,400","$20","$900","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ASCND73&uid=FFM",,"8"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0080003","Medica Applause Silver Copay","73751ND008",,"NDN002","NDS002","NDF005","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080003-05","87% AV Level Silver Plan",,"0.873378396034241","Yes","Yes","No","100%",,"$400","$20","$1,000","$1,000","$400","$600","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","per person not applicable","$1200 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ASCND87&uid=FFM",,"9"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0080003","Medica Applause Silver Copay","73751ND008",,"NDN002","NDS002","NDF005","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080003-06","94% AV Level Silver Plan",,"0.946734488010406","Yes","Yes","No","100%",,"$50","$20","$300","$1,000","$50","$600","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","$150 per group","5%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ASCND94&uid=FFM",,"10"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0080021","Medica Applause Silver Copay Plus","73751ND008",,"NDN002","NDS002","NDF006","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080021-00","Standard Silver Off Exchange Plan",,"0.686831414699554","Yes","Yes","No","100%",,"$2,500","$800","$50","$1,000","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","35%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ASPCND&uid=FFM",,"11"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0080021","Medica Applause Silver Copay Plus","73751ND008",,"NDN002","NDS002","NDF006","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080021-01","Standard Silver On Exchange Plan",,"0.686831414699554","Yes","Yes","No","100%",,"$2,500","$800","$50","$1,000","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","35%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ASPCND&uid=FFM",,"12"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0080021","Medica Applause Silver Copay Plus","73751ND008",,"NDN002","NDS002","NDF006","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ASPCNDZ&uid=FFM",,"13"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0080021","Medica Applause Silver Copay Plus","73751ND008",,"NDN002","NDS002","NDF006","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080021-03","Limited Cost Sharing Plan Variation",,"0.686831414699554","Yes","Yes","No","100%",,"$2,500","$800","$50","$1,000","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","35%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ASPCNDL&uid=FFM",,"14"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0080021","Medica Applause Silver Copay Plus","73751ND008",,"NDN002","NDS002","NDF006","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080021-04","73% AV Level Silver Plan",,"0.722007930278778","Yes","Yes","No","100%",,"$1,500","$800","$400","$1,000","$1,500","$900","$30","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$4500 per group","35%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ASPCND73&uid=FFM",,"15"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0080021","Medica Applause Silver Copay Plus","73751ND008",,"NDN002","NDS002","NDF006","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080021-05","87% AV Level Silver Plan",,"0.867308914661407","Yes","Yes","No","100%",,"$100","$700","$200","$1,000","$100","$700","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$300 per group","15%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ASPCND87&uid=FFM",,"16"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0080021","Medica Applause Silver Copay Plus","73751ND008",,"NDN002","NDS002","NDF006","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080021-06","94% AV Level Silver Plan",,"0.932673752307892","Yes","Yes","No","100%",,"$0","$700","$50","$1,000","$0","$700","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","5%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ASPCND94&uid=FFM",,"17"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0080009","Medica Applause Silver H S A","73751ND008",,"NDN002","NDS002","NDF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080009-00","Standard Silver Off Exchange Plan",,"0.697753369808197","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ASHND&uid=FFM",,"18"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0080009","Medica Applause Silver H S A","73751ND008",,"NDN002","NDS002","NDF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080009-01","Standard Silver On Exchange Plan",,"0.697753369808197","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ASHND&uid=FFM",,"19"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0080009","Medica Applause Silver H S A","73751ND008",,"NDN002","NDS002","NDF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ASHNDZ&uid=FFM",,"20"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0080009","Medica Applause Silver H S A","73751ND008",,"NDN002","NDS002","NDF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080009-03","Limited Cost Sharing Plan Variation",,"0.697753369808197","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ASHNDL&uid=FFM",,"21"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0080009","Medica Applause Silver H S A","73751ND008",,"NDN002","NDS002","NDF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080009-04","73% AV Level Silver Plan",,"0.736685276031494","Yes","Yes","No","100%",,"$1,050","$0","$1,300","$1,000","$1,050","$0","$1,300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","per person not applicable","$3150 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ASHND73&uid=FFM",,"22"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0080009","Medica Applause Silver H S A","73751ND008",,"NDN002","NDS002","NDF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080009-05","87% AV Level Silver Plan",,"0.870106041431427","Yes","Yes","No","100%",,"$250","$0","$1,000","$1,000","$250","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","per person not applicable","$750 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ASHND87&uid=FFM",,"23"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0080009","Medica Applause Silver H S A","73751ND008",,"NDN002","NDS002","NDF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080009-06","94% AV Level Silver Plan",,"0.939850509166718","Yes","Yes","No","100%",,"$150","$0","$300","$1,000","$150","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","per person not applicable","$450 per group","5%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ASHND94&uid=FFM",,"24"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0100003","Altru Prime by Medica Silver Copay","73751ND010",,"NDN003","NDS003","NDF005","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100003-00","Standard Silver Off Exchange Plan",,"0.69723379611969","Yes","Yes","No","100%",,"$2,600","$20","$1,100","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APSCND&uid=FFM",,"25"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0100003","Altru Prime by Medica Silver Copay","73751ND010",,"NDN003","NDS003","NDF005","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100003-01","Standard Silver On Exchange Plan",,"0.69723379611969","Yes","Yes","No","100%",,"$2,600","$20","$1,100","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APSCND&uid=FFM",,"26"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0100003","Altru Prime by Medica Silver Copay","73751ND010",,"NDN003","NDS003","NDF005","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APSCNDZ&uid=FFM",,"27"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0100003","Altru Prime by Medica Silver Copay","73751ND010",,"NDN003","NDS003","NDF005","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100003-03","Limited Cost Sharing Plan Variation",,"0.69723379611969","Yes","Yes","No","100%",,"$2,600","$20","$1,100","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APSCNDL&uid=FFM",,"28"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0100003","Altru Prime by Medica Silver Copay","73751ND010",,"NDN003","NDS003","NDF005","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100003-04","73% AV Level Silver Plan",,"0.730964839458466","Yes","Yes","No","100%",,"$2,400","$20","$900","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APSCND73&uid=FFM",,"29"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0100003","Altru Prime by Medica Silver Copay","73751ND010",,"NDN003","NDS003","NDF005","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100003-05","87% AV Level Silver Plan",,"0.873378396034241","Yes","Yes","No","100%",,"$400","$20","$1,000","$1,000","$400","$600","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","per person not applicable","$1200 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APSCND87&uid=FFM",,"30"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0100003","Altru Prime by Medica Silver Copay","73751ND010",,"NDN003","NDS003","NDF005","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100003-06","94% AV Level Silver Plan",,"0.946734488010406","Yes","Yes","No","100%",,"$50","$20","$300","$1,000","$50","$600","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","$150 per group","5%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APSCND94&uid=FFM",,"31"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0100021","Altru Prime by Medica Silver Copay Plus","73751ND010",,"NDN003","NDS003","NDF006","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100021-00","Standard Silver Off Exchange Plan",,"0.686831414699554","Yes","Yes","No","100%",,"$2,500","$800","$50","$1,000","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","35%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APSPCND&uid=FFM",,"32"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0100021","Altru Prime by Medica Silver Copay Plus","73751ND010",,"NDN003","NDS003","NDF006","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100021-01","Standard Silver On Exchange Plan",,"0.686831414699554","Yes","Yes","No","100%",,"$2,500","$800","$50","$1,000","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","35%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APSPCND&uid=FFM",,"33"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0100021","Altru Prime by Medica Silver Copay Plus","73751ND010",,"NDN003","NDS003","NDF006","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APSPCNDZ&uid=FFM",,"34"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0100021","Altru Prime by Medica Silver Copay Plus","73751ND010",,"NDN003","NDS003","NDF006","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100021-03","Limited Cost Sharing Plan Variation",,"0.686831414699554","Yes","Yes","No","100%",,"$2,500","$800","$50","$1,000","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","35%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APSPCNDL&uid=FFM",,"35"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0100021","Altru Prime by Medica Silver Copay Plus","73751ND010",,"NDN003","NDS003","NDF006","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100021-04","73% AV Level Silver Plan",,"0.722007930278778","Yes","Yes","No","100%",,"$1,500","$800","$400","$1,000","$1,500","$900","$30","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$4500 per group","35%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APSPCND73&uid=FFM",,"36"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0100021","Altru Prime by Medica Silver Copay Plus","73751ND010",,"NDN003","NDS003","NDF006","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100021-05","87% AV Level Silver Plan",,"0.867308914661407","Yes","Yes","No","100%",,"$100","$700","$200","$1,000","$100","$700","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$300 per group","15%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APSPCND87&uid=FFM",,"37"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0100021","Altru Prime by Medica Silver Copay Plus","73751ND010",,"NDN003","NDS003","NDF006","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100021-06","94% AV Level Silver Plan",,"0.932673752307892","Yes","Yes","No","100%",,"$0","$700","$50","$1,000","$0","$700","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","5%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APSPCND94&uid=FFM",,"38"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0100009","Altru Prime by Medica Silver H S A","73751ND010",,"NDN003","NDS003","NDF007","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100009-00","Standard Silver Off Exchange Plan",,"0.697753369808197","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APSHND&uid=FFM",,"39"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0100009","Altru Prime by Medica Silver H S A","73751ND010",,"NDN003","NDS003","NDF007","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100009-01","Standard Silver On Exchange Plan",,"0.697753369808197","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APSHND&uid=FFM",,"40"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0100009","Altru Prime by Medica Silver H S A","73751ND010",,"NDN003","NDS003","NDF007","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APSHNDZ&uid=FFM",,"41"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0100009","Altru Prime by Medica Silver H S A","73751ND010",,"NDN003","NDS003","NDF007","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100009-03","Limited Cost Sharing Plan Variation",,"0.697753369808197","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APSHNDL&uid=FFM",,"42"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0100009","Altru Prime by Medica Silver H S A","73751ND010",,"NDN003","NDS003","NDF007","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100009-04","73% AV Level Silver Plan",,"0.736685276031494","Yes","Yes","No","100%",,"$1,050","$0","$1,300","$1,000","$1,050","$0","$1,300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","per person not applicable","$3150 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APSHND73&uid=FFM",,"43"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0100009","Altru Prime by Medica Silver H S A","73751ND010",,"NDN003","NDS003","NDF007","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100009-05","87% AV Level Silver Plan",,"0.870106041431427","Yes","Yes","No","100%",,"$250","$0","$1,000","$1,000","$250","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","per person not applicable","$750 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APSHND87&uid=FFM",,"44"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","2","73751","ND","Individual","No","41-1242261","73751ND0100009","Altru Prime by Medica Silver H S A","73751ND010",,"NDN003","NDS003","NDF007","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100009-06","94% AV Level Silver Plan",,"0.939850509166718","Yes","Yes","No","100%",,"$150","$0","$300","$1,000","$150","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","per person not applicable","$450 per group","5%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APSHND94&uid=FFM",,"45"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","3","73751","ND","Individual","No","41-1242261","73751ND0080005","Medica Applause Bronze Copay","73751ND008",,"NDN002","NDS002","NDF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080005-00","Standard Bronze Off Exchange Plan",,"0.617384314537048","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ABCND&uid=FFM",,"4"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","3","73751","ND","Individual","No","41-1242261","73751ND0080005","Medica Applause Bronze Copay","73751ND008",,"NDN002","NDS002","NDF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080005-01","Standard Bronze On Exchange Plan",,"0.617384314537048","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ABCND&uid=FFM",,"5"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","3","73751","ND","Individual","No","41-1242261","73751ND0080005","Medica Applause Bronze Copay","73751ND008",,"NDN002","NDS002","NDF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ABCNDZ&uid=FFM",,"6"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","3","73751","ND","Individual","No","41-1242261","73751ND0080005","Medica Applause Bronze Copay","73751ND008",,"NDN002","NDS002","NDF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080005-03","Limited Cost Sharing Plan Variation",,"0.617384314537048","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ABCNDL&uid=FFM",,"7"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","3","73751","ND","Individual","No","41-1242261","73751ND0080011","Medica Applause Bronze H S A","73751ND008",,"NDN002","NDS002","NDF009","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080011-00","Standard Bronze Off Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","per person not applicable","$12700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ABHND&uid=FFM",,"8"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","3","73751","ND","Individual","No","41-1242261","73751ND0080011","Medica Applause Bronze H S A","73751ND008",,"NDN002","NDS002","NDF009","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080011-01","Standard Bronze On Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","per person not applicable","$12700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ABHND&uid=FFM",,"9"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","3","73751","ND","Individual","No","41-1242261","73751ND0080011","Medica Applause Bronze H S A","73751ND008",,"NDN002","NDS002","NDF009","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ABHNDZ&uid=FFM",,"10"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","3","73751","ND","Individual","No","41-1242261","73751ND0080011","Medica Applause Bronze H S A","73751ND008",,"NDN002","NDS002","NDF009","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080011-03","Limited Cost Sharing Plan Variation",,"0.607437193393707","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","per person not applicable","$12700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ABHNDL&uid=FFM",,"11"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","3","73751","ND","Individual","No","41-1242261","73751ND0100005","Altru Prime by Medica Bronze Copay","73751ND010",,"NDN003","NDS003","NDF008","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100005-00","Standard Bronze Off Exchange Plan",,"0.617384314537048","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APBCND&uid=FFM",,"12"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","3","73751","ND","Individual","No","41-1242261","73751ND0100005","Altru Prime by Medica Bronze Copay","73751ND010",,"NDN003","NDS003","NDF008","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100005-01","Standard Bronze On Exchange Plan",,"0.617384314537048","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APBCND&uid=FFM",,"13"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","3","73751","ND","Individual","No","41-1242261","73751ND0100005","Altru Prime by Medica Bronze Copay","73751ND010",,"NDN003","NDS003","NDF008","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APBCNDZ&uid=FFM",,"14"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","3","73751","ND","Individual","No","41-1242261","73751ND0100005","Altru Prime by Medica Bronze Copay","73751ND010",,"NDN003","NDS003","NDF008","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100005-03","Limited Cost Sharing Plan Variation",,"0.617384314537048","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APBCNDL&uid=FFM",,"15"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","3","73751","ND","Individual","No","41-1242261","73751ND0100011","Altru Prime by Medica Bronze H S A","73751ND010",,"NDN003","NDS003","NDF009","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100011-00","Standard Bronze Off Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","per person not applicable","$12700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APBHND&uid=FFM",,"16"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","3","73751","ND","Individual","No","41-1242261","73751ND0100011","Altru Prime by Medica Bronze H S A","73751ND010",,"NDN003","NDS003","NDF009","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100011-01","Standard Bronze On Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","per person not applicable","$12700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APBHND&uid=FFM",,"17"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","3","73751","ND","Individual","No","41-1242261","73751ND0100011","Altru Prime by Medica Bronze H S A","73751ND010",,"NDN003","NDS003","NDF009","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APBHNDZ&uid=FFM",,"18"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","3","73751","ND","Individual","No","41-1242261","73751ND0100011","Altru Prime by Medica Bronze H S A","73751ND010",,"NDN003","NDS003","NDF009","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100011-03","Limited Cost Sharing Plan Variation",,"0.607437193393707","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","per person not applicable","$12700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APBHNDL&uid=FFM",,"19"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","4","73751","ND","Individual","No","41-1242261","73751ND0080013","Medica Applause Catastrophic","73751ND008",,"NDN002","NDS002","NDF010","Existing","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080013-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ACND&uid=FFM",,"4"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","4","73751","ND","Individual","No","41-1242261","73751ND0080013","Medica Applause Catastrophic","73751ND008",,"NDN002","NDS002","NDF010","Existing","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0080013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=3ACND&uid=FFM",,"5"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","4","73751","ND","Individual","No","41-1242261","73751ND0100013","Altru Prime by Medica Catastrophic","73751ND010",,"NDN003","NDS003","NDF010","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100013-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APCND&uid=FFM",,"6"
"2016","ND","73751","HIOS","11","2016-01-22 04:00:42","4","73751","ND","Individual","No","41-1242261","73751ND0100013","Altru Prime by Medica Catastrophic","73751ND010",,"NDN003","NDS003","NDF010","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/IFBPharmacy","73751ND0100013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1APCND&uid=FFM",,"7"
"2016","ND","75329","HIOS","3","2015-08-27 11:14:25","1","75329","ND","Individual","Yes","95-6042390","75329ND0020003","BESTOne Advantage Gold","75329ND002",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.30","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/ND/2016/ND_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","ND","75329","HIOS","3","2015-08-27 11:14:25","1","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010007","BESTDental Premium","75329ND001",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.84","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/ND/2016/ND_BESTDental_Premium_Plan.pdf","4"
"2016","ND","75329","HIOS","3","2015-08-27 11:14:25","1","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010007","BESTDental Premium","75329ND001",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.84","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/ND/2016/ND_BESTDental_Premium_Plan.pdf","5"
"2016","ND","75329","HIOS","3","2015-08-27 11:14:25","1","75329","ND","Individual","Yes","95-6042390","75329ND0020003","BESTOne Advantage Gold","75329ND002",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.30","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/ND/2016/ND_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","ND","75329","HIOS","3","2015-08-27 11:14:25","1","75329","ND","Individual","Yes","95-6042390","75329ND0020004","BESTOne Plus Gold","75329ND002",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.30","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/ND/2016/ND_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","ND","75329","HIOS","3","2015-08-27 11:14:25","1","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010008","BESTDental Standard - H","75329ND001",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.84","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/ND/2016/ND_BESTDental_Standard-H_Plan.pdf","6"
"2016","ND","75329","HIOS","3","2015-08-27 11:14:25","1","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010008","BESTDental Standard - H","75329ND001",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.84","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/ND/2016/ND_BESTDental_Standard-H_Plan.pdf","7"
"2016","ND","75329","HIOS","3","2015-08-27 11:14:25","1","75329","ND","Individual","Yes","95-6042390","75329ND0020004","BESTOne Plus Gold","75329ND002",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.30","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/ND/2016/ND_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","ND","75329","HIOS","3","2015-08-27 11:14:25","1","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010010","BESTDental Choice - H","75329ND001",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.84","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/ND/2016/ND_BESTDental_Choice-H_Plan.pdf","8"
"2016","ND","75329","HIOS","3","2015-08-27 11:14:25","1","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010010","BESTDental Choice - H","75329ND001",,"NDN001","NDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.84","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/ND/2016/ND_BESTDental_Choice-H_Plan.pdf","9"
"2016","ND","75329","HIOS","3","2015-08-27 11:14:25","2","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010009","BESTDental Standard - L","75329ND001",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/ND/2016/ND_BESTDental_Standard-L_Plan.pdf","4"
"2016","ND","75329","HIOS","3","2015-08-27 11:14:25","2","75329","ND","Individual","Yes","95-6042390","75329ND0020005","BESTOne Plus Silver","75329ND002",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.78","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/ND/2016/ND_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","ND","75329","HIOS","3","2015-08-27 11:14:25","2","75329","ND","Individual","Yes","95-6042390","75329ND0020005","BESTOne Plus Silver","75329ND002",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.78","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/ND/2016/ND_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","ND","75329","HIOS","3","2015-08-27 11:14:25","2","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010009","BESTDental Standard - L","75329ND001",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/ND/2016/ND_BESTDental_Standard-L_Plan.pdf","5"
"2016","ND","75329","HIOS","3","2015-08-27 11:14:25","2","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010011","BESTDental Choice - L","75329ND001",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/ND/2016/ND_BESTDental_Choice-L_Plan.pdf","6"
"2016","ND","75329","HIOS","3","2015-08-27 11:14:25","2","75329","ND","Individual","Yes","95-6042390","75329ND0020006","BESTOne Basic Silver","75329ND002",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.78","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/ND/2016/ND_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","ND","75329","HIOS","3","2015-08-27 11:14:25","2","75329","ND","Individual","Yes","95-6042390","75329ND0020006","BESTOne Basic Silver","75329ND002",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.78","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75329ND0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/ND/2016/ND_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","ND","75329","HIOS","3","2015-08-27 11:14:25","2","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010011","BESTDental Choice - L","75329ND001",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/ND/2016/ND_BESTDental_Choice-L_Plan.pdf","7"
"2016","ND","75329","HIOS","3","2015-08-27 11:14:25","2","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010012","BESTDental Value","75329ND001",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/ND/2016/ND_BESTDental_Value_Plan.pdf","8"
"2016","ND","75329","HIOS","3","2015-08-27 11:14:25","2","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010012","BESTDental Value","75329ND001",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75329ND0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/ND/2016/ND_BESTDental_Value_Plan.pdf","9"
"2016","ND","76852","HIOS","2","2015-07-09 13:17:42","1","76852","ND","SHOP (Small Group)","Yes","41-0808596","76852ND0010002","Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho","76852ND001",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","76852ND0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ND","76852","HIOS","2","2015-07-09 13:17:42","1","76852","ND","SHOP (Small Group)","Yes","41-0808596","76852ND0010005","Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho","76852ND001",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","76852ND0010005-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","ND","76852","HIOS","2","2015-07-09 13:17:42","1","76852","ND","SHOP (Small Group)","Yes","41-0808596","76852ND0010006","Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho","76852ND001",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","76852ND0010006-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","ND","76852","HIOS","2","2015-07-09 13:17:42","1","76852","ND","SHOP (Small Group)","Yes","41-0808596","76852ND0010009","Plan 9. MAC PPO, $1500 Annual Maximum, Ortho","76852ND001",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$20.18","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","76852ND0010009-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","1","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100008","Sanford Simplicity $6,000 Copay","89364ND010",,"NDN001","NDS001","NDF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100008-00","Standard Bronze Off Exchange Plan",,"0.619145750999451","Yes","Yes","No","100%",,"$3,600","$50","$300","$200","$600","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,000","$16000 per person","$24000 per group","$16,000","$16000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/sg_nd_simplicity_6000.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","4"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","1","89364","ND","Individual","No","91-1842494","89364ND0090003","Sanford Simplicity $5,000 HDHP","89364ND009",,"NDN001","NDS001","NDF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090003-00","Standard Bronze Off Exchange Plan",,"0.610491871833801","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$4,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_5000_HDHP.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","4"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","1","89364","ND","Individual","No","91-1842494","89364ND0090003","Sanford Simplicity $5,000 HDHP","89364ND009",,"NDN001","NDS001","NDF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090003-01","Standard Bronze On Exchange Plan",,"0.610491871833801","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$4,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_5000_HDHP.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","5"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","1","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100008","Sanford Simplicity $6,000 Copay","89364ND010",,"NDN001","NDS001","NDF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100008-01","Standard Bronze On Exchange Plan",,"0.619145750999451","Yes","Yes","No","100%",,"$3,600","$50","$300","$200","$600","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,000","$16000 per person","$24000 per group","$16,000","$16000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/sg_nd_simplicity_6000.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","5"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","1","89364","ND","Individual","No","91-1842494","89364ND0090003","Sanford Simplicity $5,000 HDHP","89364ND009",,"NDN001","NDS001","NDF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_5000_HDHP_ZCS.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","6"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","1","89364","ND","Individual","No","91-1842494","89364ND0090003","Sanford Simplicity $5,000 HDHP","89364ND009",,"NDN001","NDS001","NDF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090003-03","Limited Cost Sharing Plan Variation",,"0.610491871833801","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$4,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_5000_HDHP_LCS.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","7"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","1","89364","ND","Individual","No","91-1842494","89364ND0090009","Sanford TRUE $5,000 HDHP","89364ND009",,"NDN002","NDS002","NDF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090009-00","Standard Bronze Off Exchange Plan",,"0.610491871833801","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$4,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_5000_HDHP.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","8"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","1","89364","ND","Individual","No","91-1842494","89364ND0090009","Sanford TRUE $5,000 HDHP","89364ND009",,"NDN002","NDS002","NDF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090009-01","Standard Bronze On Exchange Plan",,"0.610491871833801","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$4,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_5000_HDHP.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","9"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","1","89364","ND","Individual","No","91-1842494","89364ND0090009","Sanford TRUE $5,000 HDHP","89364ND009",,"NDN002","NDS002","NDF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_5000_HDHP_ZCS.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","10"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","1","89364","ND","Individual","No","91-1842494","89364ND0090009","Sanford TRUE $5,000 HDHP","89364ND009",,"NDN002","NDS002","NDF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090009-03","Limited Cost Sharing Plan Variation",,"0.610491871833801","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$4,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_5000_HDHP_LCS.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","11"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","1","89364","ND","Individual","No","91-1842494","89364ND0090010","Sanford TRUE $3,500 HDHP","89364ND009",,"NDN002","NDS002","NDF009","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090010-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_3500_HDHP.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","12"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","1","89364","ND","Individual","No","91-1842494","89364ND0090010","Sanford TRUE $3,500 HDHP","89364ND009",,"NDN002","NDS002","NDF009","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090010-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_3500_HDHP.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","13"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","1","89364","ND","Individual","No","91-1842494","89364ND0090010","Sanford TRUE $3,500 HDHP","89364ND009",,"NDN002","NDS002","NDF009","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_3500_HDHP_ZCS.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","14"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","1","89364","ND","Individual","No","91-1842494","89364ND0090010","Sanford TRUE $3,500 HDHP","89364ND009",,"NDN002","NDS002","NDF009","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090010-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_3500_HDHP_LCS.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","15"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","1","89364","ND","Individual","No","91-1842494","89364ND0090010","Sanford TRUE $3,500 HDHP","89364ND009",,"NDN002","NDS002","NDF009","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090010-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$3,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_3500_HDHP_73.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","16"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","1","89364","ND","Individual","No","91-1842494","89364ND0090010","Sanford TRUE $3,500 HDHP","89364ND009",,"NDN002","NDS002","NDF009","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090010-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_3500_HDHP_87.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","17"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","1","89364","ND","Individual","No","91-1842494","89364ND0090010","Sanford TRUE $3,500 HDHP","89364ND009",,"NDN002","NDS002","NDF009","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090010-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_3500_HDHP_94.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","18"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","2","89364","ND","Individual","No","91-1842494","89364ND0090005","Sanford Simplicity $6,000 Copay","89364ND009",,"NDN001","NDS001","NDF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090005-00","Standard Bronze Off Exchange Plan",,"0.619145750999451","Yes","Yes","No","100%",,"$3,600","$50","$300","$200","$600","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_6000.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","4"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","2","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100004","Sanford Simplicity $3,500","89364ND010",,"NDN001","NDS001","NDF004","New","HMO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100004-00","Standard Bronze Off Exchange Plan",,"0.618949711322784","Yes","Yes","No","100%",,"$3,500","$0","$400","$200","$3,500","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","40%",,,,,"$7,000","$7000 per person","$10500 per group","$7,000","$7000 per person","$10500 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/sg_nd_simplicity_3500_HDHP.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","4"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","2","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100004","Sanford Simplicity $3,500","89364ND010",,"NDN001","NDS001","NDF004","New","HMO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100004-01","Standard Bronze On Exchange Plan",,"0.618949711322784","Yes","Yes","No","100%",,"$3,500","$0","$400","$200","$3,500","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","40%",,,,,"$7,000","$7000 per person","$10500 per group","$7,000","$7000 per person","$10500 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/sg_nd_simplicity_3500_HDHP.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","5"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","2","89364","ND","Individual","No","91-1842494","89364ND0090005","Sanford Simplicity $6,000 Copay","89364ND009",,"NDN001","NDS001","NDF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090005-01","Standard Bronze On Exchange Plan",,"0.619145750999451","Yes","Yes","No","100%",,"$3,600","$50","$300","$200","$600","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_6000.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","5"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","2","89364","ND","Individual","No","91-1842494","89364ND0090005","Sanford Simplicity $6,000 Copay","89364ND009",,"NDN001","NDS001","NDF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_6000_ZCS.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","6"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","2","89364","ND","Individual","No","91-1842494","89364ND0090005","Sanford Simplicity $6,000 Copay","89364ND009",,"NDN001","NDS001","NDF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090005-03","Limited Cost Sharing Plan Variation",,"0.619145750999451","Yes","Yes","No","100%",,"$3,600","$50","$300","$200","$600","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_6000_LCS.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","7"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","2","89364","ND","Individual","No","91-1842494","89364ND0090007","Sanford TRUE $6,000 Copay","89364ND009",,"NDN002","NDS002","NDF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090007-00","Standard Bronze Off Exchange Plan",,"0.619145750999451","Yes","Yes","No","100%",,"$3,600","$50","$300","$200","$600","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,000","$16000 per person","$24000 per group","$16,000","$16000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_6000.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","8"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","2","89364","ND","Individual","No","91-1842494","89364ND0090007","Sanford TRUE $6,000 Copay","89364ND009",,"NDN002","NDS002","NDF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090007-01","Standard Bronze On Exchange Plan",,"0.619145750999451","Yes","Yes","No","100%",,"$3,600","$50","$300","$200","$600","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,000","$16000 per person","$24000 per group","$16,000","$16000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_6000.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","9"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","2","89364","ND","Individual","No","91-1842494","89364ND0090007","Sanford TRUE $6,000 Copay","89364ND009",,"NDN002","NDS002","NDF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_6000_ZCS.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","10"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","2","89364","ND","Individual","No","91-1842494","89364ND0090007","Sanford TRUE $6,000 Copay","89364ND009",,"NDN002","NDS002","NDF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090007-03","Limited Cost Sharing Plan Variation",,"0.619145750999451","Yes","Yes","No","100%",,"$3,600","$50","$300","$200","$600","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,000","$16000 per person","$24000 per group","$16,000","$16000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_6000_LCS.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","11"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090001","Sanford Simplicity $1,500","89364ND009",,"NDN001","NDS001","NDF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090001-00","Standard Gold Off Exchange Plan",,"0.800386011600494","No","Yes","No","100%",,"$1,500","$30","$600","$200","$400","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_6000_LCS.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","4"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100001","Sanford Simplicity $500","89364ND010",,"NDN001","NDS001","NDF006","Existing","HMO","Platinum","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100001-00","Standard Platinum Off Exchange Plan",,"0.899335086345673","No","Yes","No","100%",,"$500","$0","$500","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/sg_nd_simplicity_500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","4"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100001","Sanford Simplicity $500","89364ND010",,"NDN001","NDS001","NDF006","Existing","HMO","Platinum","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100001-01","Standard Platinum On Exchange Plan",,"0.899335086345673","No","Yes","No","100%",,"$500","$0","$500","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/sg_nd_simplicity_500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","5"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090001","Sanford Simplicity $1,500","89364ND009",,"NDN001","NDS001","NDF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090001-01","Standard Gold On Exchange Plan",,"0.800386011600494","No","Yes","No","100%",,"$1,500","$30","$600","$200","$400","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_6000_LCS.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","5"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090001","Sanford Simplicity $1,500","89364ND009",,"NDN001","NDS001","NDF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_1500_ZCS.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","6"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","4","89364","ND","Individual","No","91-1842494","89364ND0090004","Sanford Simplicity $6,850","89364ND009",,"NDN001","NDS001","NDF009","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$4,900","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_6850.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","5"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","5","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100009","Sanford Simplicity $2,000 HDHP","89364ND010",,"NDN001","NDS001","NDF007","New","HMO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100009-00","Standard Silver Off Exchange Plan",,"0.718817114830017","Yes","Yes","No","100%",,"$2,000","$0","$700","$200","$2,000","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/sg_nd_simplicity_2000_HDHP.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","4"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","5","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100009","Sanford Simplicity $2,000 HDHP","89364ND010",,"NDN001","NDS001","NDF007","New","HMO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100009-01","Standard Silver On Exchange Plan",,"0.718817114830017","Yes","Yes","No","100%",,"$2,000","$0","$700","$200","$2,000","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/sg_nd_simplicity_2000_HDHP.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","5"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","2","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0140001","Health Republic Full Access Solid Bronze","10191NJ014",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.994",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0140001-00","Standard Bronze Off Exchange Plan",,"0.619395911693573","Yes","Yes","No","100%",,"$2,450","$1,000","$975","$150","$2,450","$0","$1,385","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-solid-bronze-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-shop-plan-brochure","4"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","2","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0140001","Health Republic Full Access Solid Bronze","10191NJ014",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.994",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0140001-01","Standard Bronze On Exchange Plan",,"0.619395911693573","Yes","Yes","No","100%",,"$2,450","$1,000","$975","$150","$2,450","$0","$1,385","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-solid-bronze-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-shop-plan-brochure","5"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","2","10191","NJ","Individual","No","45-3262003","10191NJ0070001","Health Republic Full Access Solid Bronze","10191NJ007",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9956",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0070001-01","Standard Bronze On Exchange Plan",,"0.619395911693573","Yes","Yes","No","100%",,"$2,450","$1,000","$975","$150","$2,450","$0","$1,385","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-solid-bronze-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","5"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100002","Sanford Simplicity $1,500","89364ND010",,"NDN001","NDS001","NDF001","Existing","HMO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100002-00","Standard Gold Off Exchange Plan",,"0.800386011600494","No","Yes","No","100%",,"$1,500","$30","$600","$200","$400","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/sg_nd_simplicity_1500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","6"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100002","Sanford Simplicity $1,500","89364ND010",,"NDN001","NDS001","NDF001","Existing","HMO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100002-01","Standard Gold On Exchange Plan",,"0.800386011600494","No","Yes","No","100%",,"$1,500","$30","$600","$200","$400","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/sg_nd_simplicity_1500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","7"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090001","Sanford Simplicity $1,500","89364ND009",,"NDN001","NDS001","NDF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090001-03","Limited Cost Sharing Plan Variation",,"0.800386011600494","No","Yes","No","100%",,"$1,500","$30","$600","$200","$400","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_1500_LCS.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","7"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090002","Sanford Simplicity $2,500","89364ND009",,"NDN001","NDS001","NDF011","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090002-00","Standard Silver Off Exchange Plan",,"0.701222121715546","No","Yes","No","100%",,"$2,500","$30","$800","$200","$400","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,000","$10000 per person","$16000 per group","$10,000","$10000 per person","$16000 per group","$2,500","$2500 per person","$5000 per group","40%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_2500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","8"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100003","Sanford Simplicity $2,000","89364ND010",,"NDN001","NDS001","NDF002","Existing","HMO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100003-00","Standard Silver Off Exchange Plan",,"0.718453586101532","No","Yes","No","100%",,"$2,000","$30","$1,000","$200","$400","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,000","$10000 per person","$16000 per group","$10,000","$10000 per person","$16000 per group","$2,000","$2000 per person","$4000 per group","40%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/sg_nd_simplicity_2000.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","8"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100003","Sanford Simplicity $2,000","89364ND010",,"NDN001","NDS001","NDF002","Existing","HMO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100003-01","Standard Silver On Exchange Plan",,"0.718453586101532","No","Yes","No","100%",,"$2,000","$30","$1,000","$200","$400","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,000","$10000 per person","$16000 per group","$10,000","$10000 per person","$16000 per group","$2,000","$2000 per person","$4000 per group","40%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/sg_nd_simplicity_2000.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","9"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090002","Sanford Simplicity $2,500","89364ND009",,"NDN001","NDS001","NDF011","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090002-01","Standard Silver On Exchange Plan",,"0.701222121715546","No","Yes","No","100%",,"$2,500","$30","$800","$200","$400","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,000","$10000 per person","$16000 per group","$10,000","$10000 per person","$16000 per group","$2,500","$2500 per person","$5000 per group","40%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_2500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","9"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090002","Sanford Simplicity $2,500","89364ND009",,"NDN001","NDS001","NDF011","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_2500_ZCS.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","10"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100006","Sanford Simplicity $1,000","89364ND010",,"NDN001","NDS001","NDF005","Existing","HMO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100006-00","Standard Gold Off Exchange Plan",,"0.814424216747284","No","Yes","No","100%",,"$1,000","$20","$700","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/sg_nd_simplicity_1000.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","10"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100006","Sanford Simplicity $1,000","89364ND010",,"NDN001","NDS001","NDF005","Existing","HMO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100006-01","Standard Gold On Exchange Plan",,"0.814424216747284","No","Yes","No","100%",,"$1,000","$20","$700","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/sg_nd_simplicity_1000.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","11"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090002","Sanford Simplicity $2,500","89364ND009",,"NDN001","NDS001","NDF011","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090002-03","Limited Cost Sharing Plan Variation",,"0.701222121715546","No","Yes","No","100%",,"$2,500","$30","$800","$200","$400","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,000","$10000 per person","$16000 per group","$10,000","$10000 per person","$16000 per group","$2,500","$2500 per person","$5000 per group","40%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_2500_LCS.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","11"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090002","Sanford Simplicity $2,500","89364ND009",,"NDN001","NDS001","NDF011","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090002-04","73% AV Level Silver Plan",,"0.733876168727875","No","Yes","No","100%",,"$1,500","$30","$600","$200","$400","$1,600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_2500_73.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","12"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090002","Sanford Simplicity $2,500","89364ND009",,"NDN001","NDS001","NDF011","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090002-05","87% AV Level Silver Plan",,"0.878047585487366","No","Yes","No","100%",,"$600","$0","$400","$200","$300","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$600","$600 per person","$1200 per group","20%",,,,,"$1,200","$1200 per person","$2400 per group","$1,200","$1200 per person","$2400 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_2500_87.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","13"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090002","Sanford Simplicity $2,500","89364ND009",,"NDN001","NDS001","NDF011","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090002-06","94% AV Level Silver Plan",,"0.949147522449493","No","Yes","No","100%",,"$300","$0","$300","$200","$200","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$250","$250 per person","$500 per group","20%",,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_2500_94.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","14"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090006","Sanford Simplicity $3,500","89364ND009",,"NDN001","NDS001","NDF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090006-00","Standard Silver Off Exchange Plan",,"0.700566470623016","No","Yes","No","100%",,"$3,500","$20","$300","$200","$400","$1,100","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$14,000","$14000 per person","$20000 per group","$14,000","$14000 per person","$20000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_3500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","15"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090006","Sanford Simplicity $3,500","89364ND009",,"NDN001","NDS001","NDF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090006-01","Standard Silver On Exchange Plan",,"0.700566470623016","No","Yes","No","100%",,"$3,500","$20","$300","$200","$400","$1,100","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$14,000","$14000 per person","$20000 per group","$14,000","$14000 per person","$20000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_3500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","16"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090006","Sanford Simplicity $3,500","89364ND009",,"NDN001","NDS001","NDF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","per person not applicable","per group not applicable","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_3500_ZCS.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","17"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090006","Sanford Simplicity $3,500","89364ND009",,"NDN001","NDS001","NDF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090006-03","Limited Cost Sharing Plan Variation",,"0.700566470623016","No","Yes","No","100%",,"$3,500","$20","$300","$200","$400","$1,100","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$14,000","$14000 per person","$20000 per group","$14,000","$14000 per person","$20000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_3500_LCS.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","18"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090006","Sanford Simplicity $3,500","89364ND009",,"NDN001","NDS001","NDF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090006-04","73% AV Level Silver Plan",,"0.734143972396851","No","Yes","No","100%",,"$3,000","$20","$400","$200","$400","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_3500_73.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","19"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090006","Sanford Simplicity $3,500","89364ND009",,"NDN001","NDS001","NDF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090006-05","87% AV Level Silver Plan",,"0.875889778137207","No","Yes","No","100%",,"$500","$20","$800","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_3500_87.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","20"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090006","Sanford Simplicity $3,500","89364ND009",,"NDN001","NDS001","NDF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090006-06","94% AV Level Silver Plan",,"0.949147522449493","No","Yes","No","100%",,"$300","$0","$300","$200","$200","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$250","$250 per person","$500 per group","20%",,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_3500_94.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","21"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090008","Sanford TRUE $3,500","89364ND009",,"NDN002","NDS002","NDF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090008-00","Standard Silver Off Exchange Plan",,"0.700566470623016","No","Yes","No","100%",,"$3,500","$20","$300","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_3500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","22"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090008","Sanford TRUE $3,500","89364ND009",,"NDN002","NDS002","NDF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090008-01","Standard Silver On Exchange Plan",,"0.700566470623016","No","Yes","No","100%",,"$3,500","$20","$300","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_3500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","23"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090008","Sanford TRUE $3,500","89364ND009",,"NDN002","NDS002","NDF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","per person not applicable","per group not applicable","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_3500_ZCS.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","24"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090008","Sanford TRUE $3,500","89364ND009",,"NDN002","NDS002","NDF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090008-03","Limited Cost Sharing Plan Variation",,"0.700566470623016","No","Yes","No","100%",,"$3,500","$20","$300","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_3500_LCS.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","25"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090008","Sanford TRUE $3,500","89364ND009",,"NDN002","NDS002","NDF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090008-04","73% AV Level Silver Plan",,"0.734143972396851","No","Yes","No","100%",,"$3,000","$20","$400","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_3500_73.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","26"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090008","Sanford TRUE $3,500","89364ND009",,"NDN002","NDS002","NDF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090008-05","87% AV Level Silver Plan",,"0.875889778137207","No","Yes","No","100%",,"$500","$20","$800","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_3500_87.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","27"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","3","89364","ND","Individual","No","91-1842494","89364ND0090008","Sanford TRUE $3,500","89364ND009",,"NDN002","NDS002","NDF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090008-06","94% AV Level Silver Plan",,"0.949147522449493","No","Yes","No","100%",,"$300","$0","$300","$200","$200","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_true_3500_94.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","28"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","4","89364","ND","Individual","No","91-1842494","89364ND0090004","Sanford Simplicity $6,850","89364ND009",,"NDN001","NDS001","NDF009","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0090004-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$4,900","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/i_nd_simplicity_6850.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","4"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","4","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100007","Sanford Simplicity $2,500","89364ND010",,"NDN001","NDS001","NDF005","Existing","HMO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100007-00","Standard Silver Off Exchange Plan",,"0.717057228088379","No","Yes","No","100%",,"$2,500","$20","$600","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/sg_nd_simplicity_2500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","4"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","4","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100007","Sanford Simplicity $2,500","89364ND010",,"NDN001","NDS001","NDF005","Existing","HMO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100007-01","Standard Silver On Exchange Plan",,"0.717057228088379","No","Yes","No","100%",,"$2,500","$20","$600","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/sg_nd_simplicity_2500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","5"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","6","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100005","Sanford Simplicity $0","89364ND010",,"NDN001","NDS001","NDF012","Existing","HMO","Platinum","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100005-00","Standard Platinum Off Exchange Plan",,"0.881100833415985","No","Yes","No","100%",,"$0","$300","$0","$200","$0","$1,600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$0","$0 per person","per group not applicable","0%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","0%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/sg_nd_simplicity_0.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","4"
"2016","ND","89364","HIOS","9","2016-06-06 12:06:06","6","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100005","Sanford Simplicity $0","89364ND010",,"NDN001","NDS001","NDF012","Existing","HMO","Platinum","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","89364ND0100005-01","Standard Platinum On Exchange Plan",,"0.881100833415985","No","Yes","No","100%",,"$0","$300","$0","$200","$0","$1,600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$0","$0 per person","per group not applicable","0%",,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$0","$0 per person","per group not applicable","0%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/ND/sg_nd_simplicity_0.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","5"
"2016","ND","90106","HIOS","7","2015-08-25 05:06:23","1","90106","ND","SHOP (Small Group)","Yes","75-1233841","90106ND0020007","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","90106ND002",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","90106ND0020007-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nd/90106nd0020007-16","4"
"2016","ND","90106","HIOS","7","2015-08-25 05:06:23","1","90106","ND","Individual","Yes","75-1233841","90106ND0010007","Dentegra Dental PPO Pediatric Basic Plan","90106ND001",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.54","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","90106ND0010007-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nd/90106nd0010007-16","4"
"2016","ND","90106","HIOS","7","2015-08-25 05:06:23","2","90106","ND","Individual","Yes","75-1233841","90106ND0010010","Dentegra Dental PPO Family Preferred Plan","90106ND001",,"NDN001","NDS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.44","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","90106ND0010010-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nd/90106nd0010010-16","4"
"2016","ND","90106","HIOS","7","2015-08-25 05:06:23","2","90106","ND","SHOP (Small Group)","Yes","75-1233841","90106ND0020010","Dentegra Dental PPO for Small Businesses Family Preferred Plan","90106ND002",,"NDN001","NDS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","90106ND0020010-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nd/90106nd0020010-16","4"
"2016","ND","90106","HIOS","7","2015-08-25 05:06:23","3","90106","ND","SHOP (Small Group)","Yes","75-1233841","90106ND0020009","Dentegra Dental PPO for Small Businesses Family Basic Plan","90106ND002",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","90106ND0020009-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nd/90106nd0020009-16","4"
"2016","ND","90106","HIOS","7","2015-08-25 05:06:23","3","90106","ND","Individual","Yes","75-1233841","90106ND0010009","Dentegra Dental PPO Family Basic Plan","90106ND001",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.54","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","90106ND0010009-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nd/90106nd0010009-16","4"
"2016","ND","90106","HIOS","7","2015-08-25 05:06:23","3","90106","ND","Individual","Yes","75-1233841","90106ND0010009","Dentegra Dental PPO Family Basic Plan","90106ND001",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.54","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","90106ND0010009-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nd/90106nd0010009-16","5"
"2016","ND","90106","HIOS","7","2015-08-25 05:06:23","3","90106","ND","SHOP (Small Group)","Yes","75-1233841","90106ND0020009","Dentegra Dental PPO for Small Businesses Family Basic Plan","90106ND002",,"NDN001","NDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","90106ND0020009-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nd/90106nd0020009-16","5"
"2016","ND","93236","HIOS","3","2015-08-27 11:14:25","1","93236","ND","SHOP (Small Group)","Yes","47-0098400","93236ND0040002","EHB High PPO","93236ND004",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.02","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","93236ND0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","ND","93236","HIOS","3","2015-08-27 11:14:25","1","93236","ND","SHOP (Small Group)","Yes","47-0098400","93236ND0040001","EHB Low PPO","93236ND004",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.52","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","93236ND0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","ND","93236","HIOS","3","2015-08-27 11:14:25","1","93236","ND","SHOP (Small Group)","Yes","47-0098400","93236ND0030002","EHB High Passive","93236ND003",,"NDN001","NDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$47.78","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","93236ND0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","ND","93236","HIOS","3","2015-08-27 11:14:25","1","93236","ND","SHOP (Small Group)","Yes","47-0098400","93236ND0030001","EHB Low Passive","93236ND003",,"NDN001","NDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.16","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","93236ND0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","1","10191","NJ","Individual","No","45-3262003","10191NJ0030001","Health Republic Full Access Prime Bronze","10191NJ003",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9955",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0030001-00","Standard Bronze Off Exchange Plan",,"0.615193128585815","Yes","Yes","No","100%",,"$2,450","$1,000","$975","$150","$2,450","$500","$895","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-prime-bronze-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","4"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","1","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0100001","Health Republic Full Access Prime Bronze","10191NJ010",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9938",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0100001-00","Standard Bronze Off Exchange Plan",,"0.615193128585815","Yes","Yes","No","100%",,"$2,450","$1,000","$975","$150","$2,450","$500","$895","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-prime-bronze-plan","https://newjersey.healthrepublic.us/sec_docs/hrinj-shop-plan-brochure","4"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","1","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0100001","Health Republic Full Access Prime Bronze","10191NJ010",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9938",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0100001-01","Standard Bronze On Exchange Plan",,"0.615193128585815","Yes","Yes","No","100%",,"$2,450","$1,000","$975","$150","$2,450","$500","$895","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-prime-bronze-plan01","https://newjersey.healthrepublic.us/sec_docs/hrinj-shop-plan-brochure","5"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","1","10191","NJ","Individual","No","45-3262003","10191NJ0030001","Health Republic Full Access Prime Bronze","10191NJ003",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9955",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0030001-01","Standard Bronze On Exchange Plan",,"0.615193128585815","Yes","Yes","No","100%",,"$2,450","$1,000","$975","$150","$2,450","$500","$895","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-prime-bronze-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","5"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","1","10191","NJ","Individual","No","45-3262003","10191NJ0030001","Health Republic Full Access Prime Bronze","10191NJ003",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9955",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0030001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-prime-bronze-plan02","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","6"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","1","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0100002","Health Republic Full Access Prime Silver","10191NJ010",,"NJN001","NJS001","NJF010","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9946",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0100002-00","Standard Silver Off Exchange Plan",,"0.688464760780334","Yes","Yes","No","100%",,"$2,000","$0","$2,140","$150","$2,000","$500","$488","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-prime-silver-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","6"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","1","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0100002","Health Republic Full Access Prime Silver","10191NJ010",,"NJN001","NJS001","NJF010","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9946",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0100002-01","Standard Silver On Exchange Plan",,"0.688464760780334","Yes","Yes","No","100%",,"$2,000","$0","$2,140","$150","$2,000","$500","$488","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-prime-silver-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","7"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","1","10191","NJ","Individual","No","45-3262003","10191NJ0030001","Health Republic Full Access Prime Bronze","10191NJ003",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9955",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0030001-03","Limited Cost Sharing Plan Variation",,"0.615193128585815","Yes","Yes","No","100%",,"$2,450","$1,000","$975","$150","$2,450","$500","$895","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-prime-bronze-plan03","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","7"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","1","10191","NJ","Individual","No","45-3262003","10191NJ0030002","Health Republic Full Access Prime Silver","10191NJ003",,"NJN001","NJS001","NJF010","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.996",,,,"0","4","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0030002-00","Standard Silver Off Exchange Plan",,"0.71649295091629","Yes","Yes","No","100%",,"$2,000","$0","$2,140","$150","$2,000","$500","$488","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-prime-silver-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","8"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","1","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0100003","Health Republic Full Access Prime Gold","10191NJ010",,"NJN001","NJS001","NJF015","Existing","EPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0100003-00","Standard Gold Off Exchange Plan",,"0.790370881557465","Yes","Yes","No","100%",,"$1,500","$0","$1,500","$150","$1,500","$300","$366","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-prime-gold-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","8"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","1","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0100003","Health Republic Full Access Prime Gold","10191NJ010",,"NJN001","NJS001","NJF015","Existing","EPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0100003-01","Standard Gold On Exchange Plan",,"0.790370881557465","Yes","Yes","No","100%",,"$1,500","$0","$1,500","$150","$1,500","$300","$366","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-prime-gold-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","9"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","1","10191","NJ","Individual","No","45-3262003","10191NJ0030002","Health Republic Full Access Prime Silver","10191NJ003",,"NJN001","NJS001","NJF010","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.996",,,,"0","4","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0030002-01","Standard Silver On Exchange Plan",,"0.71649295091629","Yes","Yes","No","100%",,"$2,000","$0","$2,140","$150","$2,000","$500","$488","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-prime-silver-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","9"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","1","10191","NJ","Individual","No","45-3262003","10191NJ0030002","Health Republic Full Access Prime Silver","10191NJ003",,"NJN001","NJS001","NJF010","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.996",,,,"0","4","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0030002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-prime-silver-plan02","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","10"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","1","10191","NJ","Individual","No","45-3262003","10191NJ0030002","Health Republic Full Access Prime Silver","10191NJ003",,"NJN001","NJS001","NJF010","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.996",,,,"0","4","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0030002-03","Limited Cost Sharing Plan Variation",,"0.71649295091629","Yes","Yes","No","100%",,"$2,000","$0","$2,140","$150","$2,000","$500","$488","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-prime-silver-plan03","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","11"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","1","10191","NJ","Individual","No","45-3262003","10191NJ0030002","Health Republic Full Access Prime Silver","10191NJ003",,"NJN001","NJS001","NJF010","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.996",,,,"0","4","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0030002-04","73% AV Level Silver Plan",,"0.737224698066711","Yes","Yes","No","100%",,"$1,250","$0","$2,440","$150","$1,250","$750","$488","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-prime-silver-plan04","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","12"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","1","10191","NJ","Individual","No","45-3262003","10191NJ0030002","Health Republic Full Access Prime Silver","10191NJ003",,"NJN001","NJS001","NJF010","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.996",,,,"0","4","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0030002-05","87% AV Level Silver Plan",,"0.868498623371124","Yes","Yes","No","100%",,"$500","$50","$950","$150","$500","$850","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-prime-silver-plan05","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","13"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","1","10191","NJ","Individual","No","45-3262003","10191NJ0030002","Health Republic Full Access Prime Silver","10191NJ003",,"NJN001","NJS001","NJF010","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.996",,,,"0","4","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0030002-06","94% AV Level Silver Plan",,"0.94711434841156","Yes","Yes","No","100%",,"$0","$50","$450","$150","$0","$460","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-prime-silver-plan06","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","14"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","2","10191","NJ","Individual","No","45-3262003","10191NJ0070001","Health Republic Full Access Solid Bronze","10191NJ007",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9956",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0070001-00","Standard Bronze Off Exchange Plan",,"0.619395911693573","Yes","Yes","No","100%",,"$2,450","$1,000","$975","$150","$2,450","$0","$1,385","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-solid-bronze-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","4"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","2","10191","NJ","Individual","No","45-3262003","10191NJ0070001","Health Republic Full Access Solid Bronze","10191NJ007",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9956",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0070001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-solid-bronze-plan02","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","6"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","2","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0140002","Health Republic Full Access Solid Silver","10191NJ014",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9945",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0140002-00","Standard Silver Off Exchange Plan",,"0.68200820684433","Yes","Yes","No","100%",,"$2,000","$0","$2,140","$150","$2,000","$0","$1,288","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-solid-silver-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-shop-plan-brochure","6"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","2","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0140002","Health Republic Full Access Solid Silver","10191NJ014",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9945",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0140002-01","Standard Silver On Exchange Plan",,"0.68200820684433","Yes","Yes","No","100%",,"$2,000","$0","$2,140","$150","$2,000","$0","$1,288","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-solid-silver-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-shop-plan-brochure","7"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","2","10191","NJ","Individual","No","45-3262003","10191NJ0070001","Health Republic Full Access Solid Bronze","10191NJ007",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9956",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0070001-03","Limited Cost Sharing Plan Variation",,"0.619395911693573","Yes","Yes","No","100%",,"$2,450","$1,000","$975","$150","$2,450","$0","$1,385","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-solid-bronze-plan03","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","7"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","2","10191","NJ","Individual","No","45-3262003","10191NJ0070002","Health Republic Full Access Solid Silver","10191NJ007",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.996",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0070002-00","Standard Silver Off Exchange Plan",,"0.68200820684433","Yes","Yes","No","100%",,"$2,000","$0","$2,140","$150","$2,000","$0","$1,288","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-solid-silver-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","8"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","2","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0140003","Health Republic Full Access Solid Gold","10191NJ014",,"NJN001","NJS001","NJF003","Existing","EPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9956",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0140003-00","Standard Gold Off Exchange Plan",,"0.801348447799683","Yes","Yes","No","100%",,"$1,000","$0","$1,500","$150","$1,000","$0","$1,266","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-solid-gold-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-shop-plan-brochure","8"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","2","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0140003","Health Republic Full Access Solid Gold","10191NJ014",,"NJN001","NJS001","NJF003","Existing","EPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9956",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0140003-01","Standard Gold On Exchange Plan",,"0.801348447799683","Yes","Yes","No","100%",,"$1,000","$0","$1,500","$150","$1,000","$0","$1,266","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-solid-gold-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-shop-plan-brochure","9"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","2","10191","NJ","Individual","No","45-3262003","10191NJ0070002","Health Republic Full Access Solid Silver","10191NJ007",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.996",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0070002-01","Standard Silver On Exchange Plan",,"0.68200820684433","Yes","Yes","No","100%",,"$2,000","$0","$2,140","$150","$2,000","$0","$1,288","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-solid-silver-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","9"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","2","10191","NJ","Individual","No","45-3262003","10191NJ0070002","Health Republic Full Access Solid Silver","10191NJ007",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.996",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0070002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-solid-silver-plan02","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","10"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","2","10191","NJ","Individual","No","45-3262003","10191NJ0070002","Health Republic Full Access Solid Silver","10191NJ007",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.996",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0070002-03","Limited Cost Sharing Plan Variation",,"0.68200820684433","Yes","Yes","No","100%",,"$2,000","$0","$2,140","$150","$2,000","$0","$1,288","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-solid-silver-plan03","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","11"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","2","10191","NJ","Individual","No","45-3262003","10191NJ0070002","Health Republic Full Access Solid Silver","10191NJ007",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.996",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0070002-04","73% AV Level Silver Plan",,"0.735357344150543","Yes","Yes","No","100%",,"$2,000","$0","$1,250","$150","$2,000","$0","$1,250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-solid-silver-plan04","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","12"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","2","10191","NJ","Individual","No","45-3262003","10191NJ0070002","Health Republic Full Access Solid Silver","10191NJ007",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.996",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0070002-05","87% AV Level Silver Plan",,"0.876730442047119","Yes","Yes","No","100%",,"$500","$0","$700","$150","$500","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-solid-silver-plan05","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","13"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","2","10191","NJ","Individual","No","45-3262003","10191NJ0070002","Health Republic Full Access Solid Silver","10191NJ007",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.996",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0070002-06","94% AV Level Silver Plan",,"0.945033550262451","Yes","Yes","No","100%",,"$0","$0","$500","$150","$0","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-solid-silver-plan06","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","14"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","2","10191","NJ","Individual","No","45-3262003","10191NJ0070003","Health Republic Full Access Solid Gold","10191NJ007",,"NJN001","NJS001","NJF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9968",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0070003-00","Standard Gold Off Exchange Plan",,"0.801348447799683","Yes","Yes","No","100%",,"$1,000","$0","$1,500","$150","$1,000","$0","$1,266","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-solid-gold-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","15"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","2","10191","NJ","Individual","No","45-3262003","10191NJ0070003","Health Republic Full Access Solid Gold","10191NJ007",,"NJN001","NJS001","NJF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9968",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0070003-01","Standard Gold On Exchange Plan",,"0.801348447799683","Yes","Yes","No","100%",,"$1,000","$0","$1,500","$150","$1,000","$0","$1,266","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-solid-gold-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","16"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","2","10191","NJ","Individual","No","45-3262003","10191NJ0070003","Health Republic Full Access Solid Gold","10191NJ007",,"NJN001","NJS001","NJF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9968",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0070003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-solid-gold-plan02","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","17"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","2","10191","NJ","Individual","No","45-3262003","10191NJ0070003","Health Republic Full Access Solid Gold","10191NJ007",,"NJN001","NJS001","NJF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9968",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0070003-03","Limited Cost Sharing Plan Variation",,"0.801348447799683","Yes","Yes","No","100%",,"$1,000","$0","$1,500","$150","$1,000","$0","$1,266","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-solid-gold-plan03","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","18"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","Individual","No","45-3262003","10191NJ0290001","Health Republic Full Access Pure Bronze","10191NJ029",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9956",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0290001-00","Standard Bronze Off Exchange Plan",,"0.619167566299438","Yes","Yes","No","100%",,"$2,500","$1,000","$975","$150","$2,500","$500","$860","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-pure-bronze-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","4"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0300001","Health Republic Full Access Pure Bronze","10191NJ030",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.994",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0300001-00","Standard Bronze Off Exchange Plan",,"0.619032502174377","Yes","Yes","No","100%",,"$2,500","$1,000","$975","$150","$2,500","$500","$860","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-pure-bronze-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","4"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0300001","Health Republic Full Access Pure Bronze","10191NJ030",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.994",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0300001-01","Standard Bronze On Exchange Plan",,"0.619032502174377","Yes","Yes","No","100%",,"$2,500","$1,000","$975","$150","$2,500","$500","$860","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-pure-bronze-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","5"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","Individual","No","45-3262003","10191NJ0290001","Health Republic Full Access Pure Bronze","10191NJ029",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9956",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0290001-01","Standard Bronze On Exchange Plan",,"0.619167566299438","Yes","Yes","No","100%",,"$2,500","$1,000","$975","$150","$2,500","$500","$860","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-pure-bronze-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","5"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","Individual","No","45-3262003","10191NJ0290001","Health Republic Full Access Pure Bronze","10191NJ029",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9956",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0290001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-pure-bronze-plan02","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","6"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0300002","Health Republic Full Access Pure Silver","10191NJ030",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0300002-00","Standard Silver Off Exchange Plan",,"0.713167488574982","Yes","Yes","No","100%",,"$2,000","$375","$1,860","$150","$2,000","$325","$848","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-pure-silver-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","6"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0300002","Health Republic Full Access Pure Silver","10191NJ030",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0300002-01","Standard Silver On Exchange Plan",,"0.713167488574982","Yes","Yes","No","100%",,"$2,000","$375","$1,860","$150","$2,000","$325","$848","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-pure-silver-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","7"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","Individual","No","45-3262003","10191NJ0290001","Health Republic Full Access Pure Bronze","10191NJ029",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9956",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0290001-03","Limited Cost Sharing Plan Variation",,"0.619167566299438","Yes","Yes","No","100%",,"$2,500","$1,000","$975","$150","$2,500","$500","$860","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-pure-bronze-plan03","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","7"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","Individual","No","45-3262003","10191NJ0290002","Health Republic Full Access Pure Silver","10191NJ029",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9963",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0290002-00","Standard Silver Off Exchange Plan",,"0.713167488574982","Yes","Yes","No","100%",,"$2,000","$375","$1,860","$150","$2,000","$325","$848","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-pure-silver-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","8"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0300003","Health Republic Full Access Pure Gold","10191NJ030",,"NJN001","NJS001","NJF008","Existing","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9958",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0300003-00","Standard Gold Off Exchange Plan","79.73%","0","Yes","Yes","No","100%",,"$1,800","$270","$930","$150","$1,300","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-pure-gold-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","8"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0300003","Health Republic Full Access Pure Gold","10191NJ030",,"NJN001","NJS001","NJF008","Existing","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9958",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0300003-01","Standard Gold On Exchange Plan","79.73%","0","Yes","Yes","No","100%",,"$1,800","$270","$930","$150","$1,300","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-pure-gold-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","9"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","Individual","No","45-3262003","10191NJ0290002","Health Republic Full Access Pure Silver","10191NJ029",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9963",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0290002-01","Standard Silver On Exchange Plan",,"0.713167488574982","Yes","Yes","No","100%",,"$2,000","$375","$1,860","$150","$2,000","$325","$848","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-pure-silver-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","9"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","Individual","No","45-3262003","10191NJ0290002","Health Republic Full Access Pure Silver","10191NJ029",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9963",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0290002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-pure-silver-plan02","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","10"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0300004","Health Republic Full Access Pure Platinum","10191NJ030",,"NJN001","NJS001","NJF009","Existing","EPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0300004-00","Standard Platinum Off Exchange Plan","89.77%","0","Yes","Yes","No","100%",,"$0","$135","$1,290","$150","$0","$325","$244","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-pure-platinum-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","10"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0300004","Health Republic Full Access Pure Platinum","10191NJ030",,"NJN001","NJS001","NJF009","Existing","EPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0300004-01","Standard Platinum On Exchange Plan","89.77%","0","Yes","Yes","No","100%",,"$0","$135","$1,290","$150","$0","$325","$244","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-pure-platinum-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","11"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","Individual","No","45-3262003","10191NJ0290002","Health Republic Full Access Pure Silver","10191NJ029",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9963",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0290002-03","Limited Cost Sharing Plan Variation",,"0.713167488574982","Yes","Yes","No","100%",,"$2,000","$375","$1,860","$150","$2,000","$325","$848","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-pure-silver-plan03","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","11"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","Individual","No","45-3262003","10191NJ0290002","Health Republic Full Access Pure Silver","10191NJ029",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9963",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0290002-04","73% AV Level Silver Plan",,"0.733193218708038","Yes","Yes","No","100%",,"$1,500","$375","$2,060","$150","$1,500","$325","$1,048","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-pure-silver-plan04","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","12"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","Individual","No","45-3262003","10191NJ0290002","Health Republic Full Access Pure Silver","10191NJ029",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9963",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0290002-05","87% AV Level Silver Plan",,"0.877763032913208","Yes","Yes","No","100%",,"$500","$375","$125","$150","$500","$75","$425","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-pure-silver-plan05","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","13"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","Individual","No","45-3262003","10191NJ0290002","Health Republic Full Access Pure Silver","10191NJ029",,"NJN001","NJS001","NJF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9963",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0290002-06","94% AV Level Silver Plan",,"0.943244695663452","Yes","Yes","No","100%",,"$0","$375","$125","$150","$0","$75","$425","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-pure-silver-plan06","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","14"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","Individual","No","45-3262003","10191NJ0290003","Health Republic Full Access Pure Gold","10191NJ029",,"NJN001","NJS001","NJF008","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9969",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0290003-00","Standard Gold Off Exchange Plan","79.73%","0","Yes","Yes","No","100%",,"$1,800","$270","$930","$150","$1,300","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-pure-gold-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","15"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","Individual","No","45-3262003","10191NJ0290003","Health Republic Full Access Pure Gold","10191NJ029",,"NJN001","NJS001","NJF008","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9969",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0290003-01","Standard Gold On Exchange Plan","79.73%","0","Yes","Yes","No","100%",,"$1,800","$270","$930","$150","$1,300","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-pure-gold-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","16"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","Individual","No","45-3262003","10191NJ0290003","Health Republic Full Access Pure Gold","10191NJ029",,"NJN001","NJS001","NJF008","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9969",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0290003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-pure-gold-plan02","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","17"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","Individual","No","45-3262003","10191NJ0290003","Health Republic Full Access Pure Gold","10191NJ029",,"NJN001","NJS001","NJF008","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9969",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0290003-03","Limited Cost Sharing Plan Variation","79.73%","0","Yes","Yes","No","100%",,"$1,800","$270","$930","$150","$1,300","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-pure-gold-plan03","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","18"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","Individual","No","45-3262003","10191NJ0290004","Health Republic Full Access Pure Platinum","10191NJ029",,"NJN001","NJS001","NJF009","Existing","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9971",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0290004-00","Standard Platinum Off Exchange Plan","89.77%","0","Yes","Yes","No","100%",,"$0","$135","$1,290","$150","$0","$325","$244","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-pure-platinum-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","19"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","Individual","No","45-3262003","10191NJ0290004","Health Republic Full Access Pure Platinum","10191NJ029",,"NJN001","NJS001","NJF009","Existing","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9971",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0290004-01","Standard Platinum On Exchange Plan","89.77%","0","Yes","Yes","No","100%",,"$0","$135","$1,290","$150","$0","$325","$244","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-pure-platinum-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","20"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","Individual","No","45-3262003","10191NJ0290004","Health Republic Full Access Pure Platinum","10191NJ029",,"NJN001","NJS001","NJF009","Existing","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9971",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0290004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-pure-platinum-plan02","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","21"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","3","10191","NJ","Individual","No","45-3262003","10191NJ0290004","Health Republic Full Access Pure Platinum","10191NJ029",,"NJN001","NJS001","NJF009","Existing","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9971",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0290004-03","Limited Cost Sharing Plan Variation","89.77%","0","Yes","Yes","No","100%",,"$0","$135","$1,290","$150","$0","$325","$244","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-pure-platinum-plan03","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","22"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","4","10191","NJ","Individual","No","45-3262003","10191NJ0050001","Health Republic Full Access Core Silver","10191NJ005",,"NJN001","NJS001","NJF005","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9962",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0050001-00","Standard Silver Off Exchange Plan","71.97%","0.719360113143921","Yes","Yes","No","100%",,"$2,500","$300","$1,580","$150","$1,220","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-core-silver-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","4"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","4","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0120001","Health Republic Full Access Core Silver","10191NJ012",,"NJN001","NJS001","NJF005","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0120001-00","Standard Silver Off Exchange Plan",,"0.719360113143921","Yes","Yes","No","100%",,"$2,500","$300","$1,580","$150","$1,220","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-core-silver-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","4"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","4","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0120001","Health Republic Full Access Core Silver","10191NJ012",,"NJN001","NJS001","NJF005","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0120001-01","Standard Silver On Exchange Plan",,"0.719360113143921","Yes","Yes","No","100%",,"$2,500","$300","$1,580","$150","$1,220","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-core-silver-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","5"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","4","10191","NJ","Individual","No","45-3262003","10191NJ0050001","Health Republic Full Access Core Silver","10191NJ005",,"NJN001","NJS001","NJF005","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9962",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0050001-01","Standard Silver On Exchange Plan","71.97%","0.719360113143921","Yes","Yes","No","100%",,"$2,500","$300","$1,580","$150","$1,220","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-core-silver-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","5"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","4","10191","NJ","Individual","No","45-3262003","10191NJ0050001","Health Republic Full Access Core Silver","10191NJ005",,"NJN001","NJS001","NJF005","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9962",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0050001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-core-silver-plan02","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","6"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","4","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0120002","Health Republic Full Access Core Gold","10191NJ012",,"NJN001","NJS001","NJF006","Existing","EPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9954",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0120002-00","Standard Gold Off Exchange Plan",,"0.796359419822693","Yes","Yes","No","100%",,"$1,500","$145","$1,440","$150","$1,220","$525","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-core-gold-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","6"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","4","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0120002","Health Republic Full Access Core Gold","10191NJ012",,"NJN001","NJS001","NJF006","Existing","EPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9954",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0120002-01","Standard Gold On Exchange Plan",,"0.796359419822693","Yes","Yes","No","100%",,"$1,500","$145","$1,440","$150","$1,220","$525","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-core-gold-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","7"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","4","10191","NJ","Individual","No","45-3262003","10191NJ0050001","Health Republic Full Access Core Silver","10191NJ005",,"NJN001","NJS001","NJF005","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9962",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0050001-03","Limited Cost Sharing Plan Variation","71.97%","0.719360113143921","Yes","Yes","No","100%",,"$2,500","$300","$1,580","$150","$1,220","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-core-silver-plan03","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","7"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","4","10191","NJ","Individual","No","45-3262003","10191NJ0050001","Health Republic Full Access Core Silver","10191NJ005",,"NJN001","NJS001","NJF005","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9962",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0050001-04","73% AV Level Silver Plan","73.97%","0.739598393440247","Yes","Yes","No","100%",,"$1,200","$300","$2,100","$150","$1,200","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-core-silver-plan04","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","8"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","4","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0120003","Health Republic Full Access Core Platinum","10191NJ012",,"NJN001","NJS001","NJF007","Existing","EPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0120003-00","Standard Platinum Off Exchange Plan",,"0.884644091129303","Yes","Yes","No","100%",,"$750","$135","$615","$150","$750","$275","$94","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-core-platinum-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","8"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","4","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0120003","Health Republic Full Access Core Platinum","10191NJ012",,"NJN001","NJS001","NJF007","Existing","EPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0120003-01","Standard Platinum On Exchange Plan",,"0.884644091129303","Yes","Yes","No","100%",,"$750","$135","$615","$150","$750","$275","$94","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-core-platinum-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","9"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","4","10191","NJ","Individual","No","45-3262003","10191NJ0050001","Health Republic Full Access Core Silver","10191NJ005",,"NJN001","NJS001","NJF005","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9962",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0050001-05","87% AV Level Silver Plan","86.60%","0.866006791591644","Yes","Yes","No","100%",,"$500","$300","$200","$150","$500","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-core-silver-plan05","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","9"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","4","10191","NJ","Individual","No","45-3262003","10191NJ0050001","Health Republic Full Access Core Silver","10191NJ005",,"NJN001","NJS001","NJF005","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9962",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0050001-06","94% AV Level Silver Plan","93.92%","0.939244568347931","Yes","Yes","No","100%",,"$0","$300","$200","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-core-silver-plan06","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","10"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","4","10191","NJ","Individual","No","45-3262003","10191NJ0050002","Health Republic Full Access Core Gold","10191NJ005",,"NJN001","NJS001","NJF006","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9967",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0050002-00","Standard Gold Off Exchange Plan",,"0.796359419822693","Yes","Yes","No","100%",,"$1,500","$145","$1,440","$150","$1,220","$525","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-core-gold-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","11"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","4","10191","NJ","Individual","No","45-3262003","10191NJ0050002","Health Republic Full Access Core Gold","10191NJ005",,"NJN001","NJS001","NJF006","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9967",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0050002-01","Standard Gold On Exchange Plan",,"0.796359419822693","Yes","Yes","No","100%",,"$1,500","$145","$1,440","$150","$1,220","$525","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-core-gold-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","12"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","4","10191","NJ","Individual","No","45-3262003","10191NJ0050002","Health Republic Full Access Core Gold","10191NJ005",,"NJN001","NJS001","NJF006","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9967",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0050002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-core-gold-plan02","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","13"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","4","10191","NJ","Individual","No","45-3262003","10191NJ0050002","Health Republic Full Access Core Gold","10191NJ005",,"NJN001","NJS001","NJF006","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9967",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0050002-03","Limited Cost Sharing Plan Variation",,"0.796359419822693","Yes","Yes","No","100%",,"$1,500","$145","$1,440","$150","$1,220","$525","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-core-gold-plan03","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","14"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","4","10191","NJ","Individual","No","45-3262003","10191NJ0050003","Health Republic Full Access Core Platinum","10191NJ005",,"NJN001","NJS001","NJF007","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0050003-00","Standard Platinum Off Exchange Plan",,"0.884644091129303","Yes","Yes","No","100%",,"$750","$135","$615","$150","$750","$275","$94","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-core-platinum-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","15"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","4","10191","NJ","Individual","No","45-3262003","10191NJ0050003","Health Republic Full Access Core Platinum","10191NJ005",,"NJN001","NJS001","NJF007","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0050003-01","Standard Platinum On Exchange Plan",,"0.884644091129303","Yes","Yes","No","100%",,"$750","$135","$615","$150","$750","$275","$94","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-core-platinum-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","16"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","4","10191","NJ","Individual","No","45-3262003","10191NJ0050003","Health Republic Full Access Core Platinum","10191NJ005",,"NJN001","NJS001","NJF007","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0050003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-core-platinum-plan02","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","17"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","4","10191","NJ","Individual","No","45-3262003","10191NJ0050003","Health Republic Full Access Core Platinum","10191NJ005",,"NJN001","NJS001","NJF007","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9972",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0050003-03","Limited Cost Sharing Plan Variation",,"0.884644091129303","Yes","Yes","No","100%",,"$750","$135","$615","$150","$750","$275","$94","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-core-platinum-plan03","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","18"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","5","10191","NJ","Individual","No","45-3262003","10191NJ0180001","Health Republic CentraState Community Plan Bronze","10191NJ018",,"NJN003","NJS003","NJF022","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9948",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0180001-00","Standard Bronze Off Exchange Plan",,"0.619193613529205","Yes","Yes","Yes","70%","30%","$2,500","$1,000","$1,050","$150","$2,500","$675","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%","$2,500","$2500 per person","$5000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-monmouth-bronze-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","4"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","5","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0210001","Health Republic CentraState Community Plan Bronze","10191NJ021",,"NJN003","NJS003","NJF022","Existing","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9929",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0210001-00","Standard Bronze Off Exchange Plan",,"0.619193613529205","Yes","Yes","Yes","70%","30%","$2,500","$1,000","$1,050","$150","$2,500","$675","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%","$2,500","$2500 per person","$5000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-monmouth-bronze-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","4"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","5","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0210001","Health Republic CentraState Community Plan Bronze","10191NJ021",,"NJN003","NJS003","NJF022","Existing","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9929",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0210001-01","Standard Bronze On Exchange Plan",,"0.619193613529205","Yes","Yes","Yes","70%","30%","$2,500","$1,000","$1,050","$150","$2,500","$675","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%","$2,500","$2500 per person","$5000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-monmouth-bronze-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","5"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","5","10191","NJ","Individual","No","45-3262003","10191NJ0180001","Health Republic CentraState Community Plan Bronze","10191NJ018",,"NJN003","NJS003","NJF022","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9948",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0180001-01","Standard Bronze On Exchange Plan",,"0.619193613529205","Yes","Yes","Yes","70%","30%","$2,500","$1,000","$1,050","$150","$2,500","$675","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%","$2,500","$2500 per person","$5000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-monmouth-bronze-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","5"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","5","10191","NJ","Individual","No","45-3262003","10191NJ0180001","Health Republic CentraState Community Plan Bronze","10191NJ018",,"NJN003","NJS003","NJF022","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9948",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0180001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-monmouth-bronze-plan02","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","6"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","5","10191","NJ","Individual","No","45-3262003","10191NJ0180001","Health Republic CentraState Community Plan Bronze","10191NJ018",,"NJN003","NJS003","NJF022","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9948",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0180001-03","Limited Cost Sharing Plan Variation",,"0.619193613529205","Yes","Yes","Yes","70%","30%","$2,500","$1,000","$1,050","$150","$2,500","$675","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%","$2,500","$2500 per person","$5000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-monmouth-bronze-plan03","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","7"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","6","10191","NJ","Individual","No","45-3262003","10191NJ0190001","Health Republic Active Access Spotlight Bronze","10191NJ019",,"NJN004","NJS004","NJF014","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9949",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0190001-00","Standard Bronze Off Exchange Plan",,"0.614586651325226","Yes","Yes","Yes","80%","20%","$2,500","$1,050","$975","$150","$2,320","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%","$2,500","$2500 per person","$5000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-spotlight-bronze-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","4"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","6","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0220001","Health Republic Active Access Spotlight Bronze","10191NJ022",,"NJN004","NJS004","NJF014","Existing","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9931",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0220001-00","Standard Bronze Off Exchange Plan",,"0.614751160144806","Yes","Yes","Yes","80%","20%","$2,500","$1,050","$975","$150","$2,320","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%","$2,500","$2500 per person","$5000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-spotlight-bronze-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-shop-plan-brochure","4"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","6","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0220001","Health Republic Active Access Spotlight Bronze","10191NJ022",,"NJN004","NJS004","NJF014","Existing","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9931",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0220001-01","Standard Bronze On Exchange Plan",,"0.614751160144806","Yes","Yes","Yes","80%","20%","$2,500","$1,050","$975","$150","$2,320","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%","$2,500","$2500 per person","$5000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-spotlight-bronze-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-shop-plan-brochure","5"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","6","10191","NJ","Individual","No","45-3262003","10191NJ0190001","Health Republic Active Access Spotlight Bronze","10191NJ019",,"NJN004","NJS004","NJF014","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9949",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0190001-01","Standard Bronze On Exchange Plan",,"0.614586651325226","Yes","Yes","Yes","80%","20%","$2,500","$1,050","$975","$150","$2,320","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%","$2,500","$2500 per person","$5000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-spotlight-bronze-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","5"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","6","10191","NJ","Individual","No","45-3262003","10191NJ0190001","Health Republic Active Access Spotlight Bronze","10191NJ019",,"NJN004","NJS004","NJF014","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9949",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0190001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","80%","20%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-spotlight-bronze-plan02","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","6"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","6","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0220002","Health Republic  Active Access Spotlight Silver","10191NJ022",,"NJN004","NJS004","NJF019","Existing","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9943",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0220002-00","Standard Silver Off Exchange Plan","71.69%","0","Yes","Yes","Yes","80%","20%","$2,000","$1,100","$180","$150","$1,320","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%","$2,000","$2000 per person","$4000 per group","40%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-spotlight-silver-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-shop-plan-brochure","6"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","6","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0220002","Health Republic  Active Access Spotlight Silver","10191NJ022",,"NJN004","NJS004","NJF019","Existing","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9943",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0220002-01","Standard Silver On Exchange Plan","71.69%","0","Yes","Yes","Yes","80%","20%","$2,000","$1,100","$180","$150","$1,320","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%","$2,000","$2000 per person","$4000 per group","40%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-spotlight-silver-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-shop-plan-brochure","7"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","6","10191","NJ","Individual","No","45-3262003","10191NJ0190001","Health Republic Active Access Spotlight Bronze","10191NJ019",,"NJN004","NJS004","NJF014","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9949",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0190001-03","Limited Cost Sharing Plan Variation",,"0.614586651325226","Yes","Yes","Yes","80%","20%","$2,500","$1,050","$975","$150","$2,320","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%","$2,500","$2500 per person","$5000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-spotlight-bronze-plan03","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","7"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","6","10191","NJ","Individual","No","45-3262003","10191NJ0190002","Health Republic Active Access Spotlight Silver","10191NJ019",,"NJN004","NJS004","NJF019","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9958",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0190002-00","Standard Silver Off Exchange Plan","71.04%","0","Yes","Yes","Yes","80%","20%","$2,000","$1,100","$180","$150","$1,320","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%","$2,000","$2000 per person","$4000 per group","40%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-spotlight-silver-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","8"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","6","10191","NJ","Individual","No","45-3262003","10191NJ0190002","Health Republic Active Access Spotlight Silver","10191NJ019",,"NJN004","NJS004","NJF019","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9958",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0190002-01","Standard Silver On Exchange Plan","71.04%","0","Yes","Yes","Yes","80%","20%","$2,000","$1,100","$180","$150","$1,320","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%","$2,000","$2000 per person","$4000 per group","40%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-spotlight-silver-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","9"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","6","10191","NJ","Individual","No","45-3262003","10191NJ0190002","Health Republic Active Access Spotlight Silver","10191NJ019",,"NJN004","NJS004","NJF019","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9958",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0190002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","80%","20%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-spotlight-silver-plan02","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","10"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","6","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0220004","Health Republic Active Access Spotlight Platinum","10191NJ022",,"NJN004","NJS004","NJF017","Existing","EPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9956",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0220004-00","Standard Platinum Off Exchange Plan","90.84%","0","Yes","Yes","Yes","80%","20%","$0","$260","$390","$150","$0","$310","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-spotlight-platinum-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-shop-plan-brochure","10"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","6","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0220004","Health Republic Active Access Spotlight Platinum","10191NJ022",,"NJN004","NJS004","NJF017","Existing","EPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9956",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0220004-01","Standard Platinum On Exchange Plan","90.84%","0","Yes","Yes","Yes","80%","20%","$0","$260","$390","$150","$0","$310","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-small-group-spotlight-platinum-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-shop-plan-brochure","11"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","6","10191","NJ","Individual","No","45-3262003","10191NJ0190002","Health Republic Active Access Spotlight Silver","10191NJ019",,"NJN004","NJS004","NJF019","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9958",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0190002-03","Limited Cost Sharing Plan Variation","71.04%","0","Yes","Yes","Yes","80%","20%","$2,000","$1,100","$180","$150","$1,320","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%","$2,000","$2000 per person","$4000 per group","40%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-spotlight-silver-plan03","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","11"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","6","10191","NJ","Individual","No","45-3262003","10191NJ0190002","Health Republic Active Access Spotlight Silver","10191NJ019",,"NJN004","NJS004","NJF019","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9958",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0190002-04","73% AV Level Silver Plan","73.27%","0","Yes","Yes","Yes","80%","20%","$1,250","$1,100","$480","$150","$1,250","$1,100","$28","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","40%","$1,250","$1250 per person","$2500 per group","40%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-spotlight-silver-plan04","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","12"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","6","10191","NJ","Individual","No","45-3262003","10191NJ0190002","Health Republic Active Access Spotlight Silver","10191NJ019",,"NJN004","NJS004","NJF019","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9958",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0190002-05","87% AV Level Silver Plan","87.57%","0","Yes","Yes","Yes","80%","20%","$250","$400","$100","$150","$100","$650","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","40%","$250","$250 per person","$500 per group","40%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-spotlight-silver-plan05","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","13"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","6","10191","NJ","Individual","No","45-3262003","10191NJ0190002","Health Republic Active Access Spotlight Silver","10191NJ019",,"NJN004","NJS004","NJF019","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9958",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0190002-06","94% AV Level Silver Plan","93.69%","0","Yes","Yes","Yes","80%","20%","$0","$200","$200","$150","$0","$360","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%","$0","$0 per person","$0 per group","40%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-spotlight-silver-plan06","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","14"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","6","10191","NJ","Individual","No","45-3262003","10191NJ0190004","Health Republic Active Access Spotlight Platinum","10191NJ019",,"NJN004","NJS004","NJF017","Existing","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9968",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0190004-00","Standard Platinum Off Exchange Plan","90.84%","0","Yes","Yes","Yes","80%","20%","$0","$260","$390","$150","$0","$310","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-spotlight-platinum-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","19"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","6","10191","NJ","Individual","No","45-3262003","10191NJ0190004","Health Republic Active Access Spotlight Platinum","10191NJ019",,"NJN004","NJS004","NJF017","Existing","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9968",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0190004-01","Standard Platinum On Exchange Plan","90.84%","0","Yes","Yes","Yes","80%","20%","$0","$260","$390","$150","$0","$310","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-spotlight-platinum-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","20"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","6","10191","NJ","Individual","No","45-3262003","10191NJ0190004","Health Republic Active Access Spotlight Platinum","10191NJ019",,"NJN004","NJS004","NJF017","Existing","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9968",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0190004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","80%","20%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-spotlight-platinum-plan02","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","21"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","6","10191","NJ","Individual","No","45-3262003","10191NJ0190004","Health Republic Active Access Spotlight Platinum","10191NJ019",,"NJN004","NJS004","NJF017","Existing","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9968",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0190004-03","Limited Cost Sharing Plan Variation","90.84%","0","Yes","Yes","Yes","80%","20%","$0","$260","$390","$150","$0","$310","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-individual-spotlight-platinum-plan03","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","22"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","9","10191","NJ","Individual","No","45-3262003","10191NJ0150001","Health Republic Vital","10191NJ015",,"NJN001","NJS001","NJF004","Existing","EPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9894",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0150001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$4,920","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-vital-plan","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","4"
"2016","NJ","10191","HIOS","8","2016-07-07 07:50:21","9","10191","NJ","Individual","No","45-3262003","10191NJ0150001","Health Republic Vital","10191NJ015",,"NJN001","NJS001","NJF004","Existing","EPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Weight Loss Programs","0.9894",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey.healthrepublic.us/make-a-payment/","https://newjersey.healthrepublic.us/sec_docs/nj-formulary","10191NJ0150001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$4,920","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://newjersey.healthrepublic.us/sec_docs/2016-nj-vital-plan01","https://newjersey.healthrepublic.us/sec_docs/2016-hrinj-generic-plan-brochure","5"
"2016","NJ","15720","HIOS","2","2015-06-20 02:24:16","1","15720","NJ","Individual","Yes","47-0397286","15720NJ0010001","Delta Dental Individual PPO, EHB Certified","15720NJ001",,"NJN002","NJS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.58","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","15720NJ0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","15720","HIOS","2","2015-06-20 02:24:16","1","15720","NJ","SHOP (Small Group)","Yes","47-0397286","15720NJ0030001","Renaissance Group Dental PPO, EHB Certified","15720NJ003",,"NJN001","NJS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.63","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","15720NJ0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","15720","HIOS","2","2015-06-20 02:24:16","1","15720","NJ","SHOP (Small Group)","Yes","47-0397286","15720NJ0030002","Renaissance Group Dental PPO, EHB Certified","15720NJ003",,"NJN001","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.87","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","15720NJ0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NJ","15720","HIOS","2","2015-06-20 02:24:16","1","15720","NJ","Individual","Yes","47-0397286","15720NJ0010002","Delta Dental Individual PPO, EHB Certified","15720NJ001",,"NJN002","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.01","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","15720NJ0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NJ","15720","HIOS","2","2015-06-20 02:24:16","1","15720","NJ","Individual","Yes","47-0397286","15720NJ0020001","Renaissance Individual Dental PPO, EHB Certified","15720NJ002",,"NJN001","NJS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.49","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","15720NJ0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","NJ","15720","HIOS","2","2015-06-20 02:24:16","1","15720","NJ","Individual","Yes","47-0397286","15720NJ0020002","Renaissance Individual Dental PPO, EHB Certified","15720NJ002",,"NJN001","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.44","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","15720NJ0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","NJ","15720","HIOS","2","2015-06-20 02:24:16","1","15720","NJ","Individual","Yes","47-0397286","15720NJ0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","15720NJ004",,"NJN001","NJS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/15720","","15720NJ0040001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/NJ_EHB_High_2016","http://www.renaissancedental.com/NJ_EHB_High_2016","8"
"2016","NJ","15720","HIOS","2","2015-06-20 02:24:16","1","15720","NJ","Individual","Yes","47-0397286","15720NJ0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","15720NJ004",,"NJN001","NJS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.44","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/15720","","15720NJ0040002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/NJ_EHB_Low_2016","http://www.renaissancedental.com/NJ_EHB_Low_2016","9"
"2016","NJ","15720","HIOS","2","2015-06-20 02:24:16","2","15720","NJ","Individual","Yes","47-0397286","15720NJ0050001","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)","15720NJ005",,"NJN001","NJS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$48.35","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/15720","","15720NJ0050001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/NJ_Ped_High_2016","http://www.renaissancedental.com/NJ_Ped_High_2016","4"
"2016","NJ","15720","HIOS","2","2015-06-20 02:24:16","2","15720","NJ","Individual","Yes","47-0397286","15720NJ0050002","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)","15720NJ005",,"NJN001","NJS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$38.23","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/15720","","15720NJ0050002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/NJ_Ped_Low_2016","http://www.renaissancedental.com/NJ_Ped_Low_2016","5"
"2016","NJ","15720","HIOS","2","2015-06-20 02:24:16","2","15720","NJ","Individual","Yes","47-0397286","15720NJ0060001","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified","15720NJ006",,"NJN001","NJS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$48.35","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","15720NJ0060001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","NJ","15720","HIOS","2","2015-06-20 02:24:16","2","15720","NJ","Individual","Yes","47-0397286","15720NJ0060002","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified","15720NJ006",,"NJN001","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$38.23","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","15720NJ0060002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080003","Gold Compass 500","48834NJ008",,"NJN001","NJS001","NJF005","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080003-00","Standard Gold Off Exchange Plan","80.80%",,"No","Yes","No","100%",,"$500","$20","$1,200","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0007&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","12"
"2016","NJ","40704","HIOS","2","2015-07-03 02:33:58","1","40704","NJ","SHOP (Small Group)","Yes","47-0098400","40704NJ0040002","EHB High PPO","40704NJ004",,"NJN001","NJS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$51.61","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","40704NJ0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","NJ","40704","HIOS","2","2015-07-03 02:33:58","1","40704","NJ","SHOP (Small Group)","Yes","47-0098400","40704NJ0040001","EHB Low PPO","40704NJ004",,"NJN001","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.66","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","40704NJ0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080004","Silver Compass 2500","48834NJ008",,"NJN001","NJS001","NJF006","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080004-06","94% AV Level Silver Plan","94.88%",,"No","Yes","No","100%",,"$100","$20","$0","$200","$100","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0015&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","22"
"2016","NJ","40704","HIOS","2","2015-07-03 02:33:58","1","40704","NJ","SHOP (Small Group)","Yes","47-0098400","40704NJ0030002","EHB High Passive","40704NJ003",,"NJN001","NJS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$57.56","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","40704NJ0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","NJ","40704","HIOS","2","2015-07-03 02:33:58","1","40704","NJ","SHOP (Small Group)","Yes","47-0098400","40704NJ0030001","EHB Low Passive","40704NJ003",,"NJN001","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.90","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","40704NJ0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","NJ","44811","HIOS","3","2015-08-18 03:25:03","1","44811","NJ","Individual","Yes","22-3849572","44811NJ0120001","Managed DentalGuard NJ Essentials 1","44811NJ012",,"NJN002","NJS002",,"New","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","44811NJ0120001-00","Standard Low Off Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","4"
"2016","NJ","44811","HIOS","3","2015-08-18 03:25:03","1","44811","NJ","SHOP (Small Group)","Yes","22-3849572","44811NJ0050003","Managed DentalGuard NJ 10 Family Plan","44811NJ005",,"NJN001","NJS001",,"Existing","HMO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.46","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","44811NJ0050003-00","Standard Low Off Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","NJ","44811","HIOS","3","2015-08-18 03:25:03","1","44811","NJ","SHOP (Small Group)","Yes","22-3849572","44811NJ0070003","Managed DentalGuard NJ 20 Family Plan","44811NJ007",,"NJN001","NJS001",,"Existing","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.83","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","44811NJ0070003-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","NJ","44811","HIOS","3","2015-08-18 03:25:03","1","44811","NJ","Individual","Yes","22-3849572","44811NJ0120001","Managed DentalGuard NJ Essentials 1","44811NJ012",,"NJN002","NJS002",,"New","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","44811NJ0120001-01","Standard Low On Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","5"
"2016","NJ","44811","HIOS","3","2015-08-18 03:25:03","1","44811","NJ","SHOP (Small Group)","Yes","22-3849572","44811NJ0080003","Managed DentalGuard NJ 30 Family Plan","44811NJ008",,"NJN001","NJS001",,"Existing","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.41","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","44811NJ0080003-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","NJ","44811","HIOS","3","2015-08-18 03:25:03","1","44811","NJ","SHOP (Small Group)","Yes","22-3849572","44811NJ0050004","Managed DentalGuard NJ 10 Family Plan","44811NJ005",,"NJN001","NJS002",,"New","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.46","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","44811NJ0050004-00","Standard Low Off Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","NJ","44811","HIOS","3","2015-08-18 03:25:03","1","44811","NJ","SHOP (Small Group)","Yes","22-3849572","44811NJ0050004","Managed DentalGuard NJ 10 Family Plan","44811NJ005",,"NJN001","NJS002",,"New","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.46","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","44811NJ0050004-01","Standard Low On Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","8"
"2016","NJ","48608","HIOS","5","2015-08-25 05:06:23","1","48608","NJ","Individual","Yes","75-1233841","48608NJ0010001","Dentegra Dental PPO Pediatric Basic Plan","48608NJ001",,"NJN001","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","48608NJ0010001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nj/48608nj0010001-16","4"
"2016","NJ","48608","HIOS","5","2015-08-25 05:06:23","1","48608","NJ","SHOP (Small Group)","Yes","75-1233841","48608NJ0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","48608NJ002",,"NJN001","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.63","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","48608NJ0020001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nj/48608nj0020001-16","4"
"2016","NJ","48608","HIOS","5","2015-08-25 05:06:23","2","48608","NJ","SHOP (Small Group)","Yes","75-1233841","48608NJ0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","48608NJ002",,"NJN001","NJS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","48608NJ0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nj/48608nj0020004-16","4"
"2016","NJ","48608","HIOS","5","2015-08-25 05:06:23","2","48608","NJ","Individual","Yes","75-1233841","48608NJ0010004","Dentegra Dental PPO Family Preferred Plan","48608NJ001",,"NJN001","NJS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.60","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","48608NJ0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nj/48608nj0010004-16","4"
"2016","NJ","48608","HIOS","5","2015-08-25 05:06:23","2","48608","NJ","Individual","Yes","75-1233841","48608NJ0010004","Dentegra Dental PPO Family Preferred Plan","48608NJ001",,"NJN001","NJS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.60","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","48608NJ0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nj/48608nj0010004-16","5"
"2016","NJ","48608","HIOS","5","2015-08-25 05:06:23","2","48608","NJ","SHOP (Small Group)","Yes","75-1233841","48608NJ0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","48608NJ002",,"NJN001","NJS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","48608NJ0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nj/48608nj0020004-16","5"
"2016","NJ","48608","HIOS","5","2015-08-25 05:06:23","3","48608","NJ","SHOP (Small Group)","Yes","75-1233841","48608NJ0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","48608NJ002",,"NJN001","NJS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.63","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","48608NJ0020006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nj/48608nj0020006-16","4"
"2016","NJ","48608","HIOS","5","2015-08-25 05:06:23","3","48608","NJ","Individual","Yes","75-1233841","48608NJ0010006","Dentegra Dental PPO Family Basic Plan","48608NJ001",,"NJN001","NJS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","48608NJ0010006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nj/48608nj0010006-16","4"
"2016","NJ","48608","HIOS","5","2015-08-25 05:06:23","3","48608","NJ","Individual","Yes","75-1233841","48608NJ0010006","Dentegra Dental PPO Family Basic Plan","48608NJ001",,"NJN001","NJS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","48608NJ0010006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nj/48608nj0010006-16","5"
"2016","NJ","48608","HIOS","5","2015-08-25 05:06:23","3","48608","NJ","SHOP (Small Group)","Yes","75-1233841","48608NJ0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","48608NJ002",,"NJN001","NJS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.63","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","48608NJ0020006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nj/48608nj0020006-16","5"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","1","48834","NJ","Individual","No","22-2745725","48834NJ0080005","Silver Compass HSA 2000","48834NJ008",,"NJN001","NJS001","NJF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080005-00","Standard Silver Off Exchange Plan","71.30%",,"Yes","Yes","No","100%",,"$2,000","$20","$900","$200","$2,000","$900","$20","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$5500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=nj0016&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","4"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","1","48834","NJ","Individual","No","22-2745725","48834NJ0080005","Silver Compass HSA 2000","48834NJ008",,"NJN001","NJS001","NJF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080005-01","Standard Silver On Exchange Plan","71.30%",,"Yes","Yes","No","100%",,"$2,000","$20","$900","$200","$2,000","$900","$20","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$5500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=nj0016&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","5"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","1","48834","NJ","Individual","No","22-2745725","48834NJ0080005","Silver Compass HSA 2000","48834NJ008",,"NJN001","NJS001","NJF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.uhc.com/iex/doc?id=nj0017&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","6"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","1","48834","NJ","Individual","No","22-2745725","48834NJ0080005","Silver Compass HSA 2000","48834NJ008",,"NJN001","NJS001","NJF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080005-03","Limited Cost Sharing Plan Variation","71.30%",,"Yes","Yes","No","100%",,"$2,000","$20","$900","$200","$2,000","$900","$20","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$5500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=nj0018&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","7"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","1","48834","NJ","Individual","No","22-2745725","48834NJ0080005","Silver Compass HSA 2000","48834NJ008",,"NJN001","NJS001","NJF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080005-04","73% AV Level Silver Plan","73.60%",,"Yes","Yes","No","100%",,"$2,000","$20","$900","$200","$2,000","$900","$20","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=nj0019&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","8"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","1","48834","NJ","Individual","No","22-2745725","48834NJ0080005","Silver Compass HSA 2000","48834NJ008",,"NJN001","NJS001","NJF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080005-05","87% AV Level Silver Plan","88.00%",,"Yes","Yes","No","100%",,"$500","$0","$700","$200","$500","$700","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=nj0020&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","9"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","1","48834","NJ","Individual","No","22-2745725","48834NJ0080005","Silver Compass HSA 2000","48834NJ008",,"NJN001","NJS001","NJF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080005-06","94% AV Level Silver Plan","94.40%",,"Yes","Yes","No","100%",,"$200","$20","$0","$200","$200","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","per person not applicable","$400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=nj0021&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","10"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","1","48834","NJ","Individual","No","22-2745725","48834NJ0080006","Bronze Compass HSA 2500","48834NJ008",,"NJN001","NJS001","NJF002","Existing","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"5","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080006-00","Standard Bronze Off Exchange Plan","62.00%",,"Yes","Yes","No","100%",,"$2,500","$500","$10","$200","$2,500","$60","$1,200","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=nj0028&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","11"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","1","48834","NJ","Individual","No","22-2745725","48834NJ0080006","Bronze Compass HSA 2500","48834NJ008",,"NJN001","NJS001","NJF002","Existing","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"5","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080006-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,"$2,500","$500","$10","$200","$2,500","$60","$1,200","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=nj0028&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","12"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","1","48834","NJ","Individual","No","22-2745725","48834NJ0080006","Bronze Compass HSA 2500","48834NJ008",,"NJN001","NJS001","NJF002","Existing","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"5","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.uhc.com/iex/doc?id=nj0029&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","13"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","1","48834","NJ","Individual","No","22-2745725","48834NJ0080006","Bronze Compass HSA 2500","48834NJ008",,"NJN001","NJS001","NJF002","Existing","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"5","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080006-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,"$2,500","$500","$10","$200","$2,500","$60","$1,200","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=nj0030&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","14"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080002","Gold Compass 1200","48834NJ008",,"NJN001","NJS001","NJF004","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"5","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080002-00","Standard Gold Off Exchange Plan","81.60%",,"No","Yes","No","100%",,"$1,200","$200","$60","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0004&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","8"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080002","Gold Compass 1200","48834NJ008",,"NJN001","NJS001","NJF004","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"5","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080002-01","Standard Gold On Exchange Plan","81.60%",,"No","Yes","No","100%",,"$1,200","$200","$60","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0004&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","9"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080002","Gold Compass 1200","48834NJ008",,"NJN001","NJS001","NJF004","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"5","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0005&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","10"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080002","Gold Compass 1200","48834NJ008",,"NJN001","NJS001","NJF004","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"5","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080002-03","Limited Cost Sharing Plan Variation","81.60%",,"No","Yes","No","100%",,"$1,200","$200","$60","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0006&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","11"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080003","Gold Compass 500","48834NJ008",,"NJN001","NJS001","NJF005","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080003-01","Standard Gold On Exchange Plan","80.80%",,"No","Yes","No","100%",,"$500","$20","$1,200","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0007&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","13"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080003","Gold Compass 500","48834NJ008",,"NJN001","NJS001","NJF005","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0008&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","14"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080003","Gold Compass 500","48834NJ008",,"NJN001","NJS001","NJF005","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080003-03","Limited Cost Sharing Plan Variation","80.80%",,"No","Yes","No","100%",,"$500","$20","$1,200","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0009&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","15"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080004","Silver Compass 2500","48834NJ008",,"NJN001","NJS001","NJF006","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080004-00","Standard Silver Off Exchange Plan","70.75%",,"No","Yes","No","100%",,"$2,500","$20","$1,900","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0010&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","16"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080004","Silver Compass 2500","48834NJ008",,"NJN001","NJS001","NJF006","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080004-01","Standard Silver On Exchange Plan","70.75%",,"No","Yes","No","100%",,"$2,500","$20","$1,900","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0010&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","17"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080004","Silver Compass 2500","48834NJ008",,"NJN001","NJS001","NJF006","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0011&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","18"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080004","Silver Compass 2500","48834NJ008",,"NJN001","NJS001","NJF006","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080004-03","Limited Cost Sharing Plan Variation","70.75%",,"No","Yes","No","100%",,"$2,500","$20","$1,900","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0012&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","19"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080004","Silver Compass 2500","48834NJ008",,"NJN001","NJS001","NJF006","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080004-04","73% AV Level Silver Plan","73.72%",,"No","Yes","No","100%",,"$2,500","$20","$1,500","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0013&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","20"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080004","Silver Compass 2500","48834NJ008",,"NJN001","NJS001","NJF006","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080004-05","87% AV Level Silver Plan","87.59%",,"No","Yes","No","100%",,"$800","$0","$500","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0014&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","21"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080007","Silver Compass 2450","48834NJ008",,"NJN001","NJS001","NJF006","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080007-00","Standard Silver Off Exchange Plan","71.90%",,"No","Yes","No","100%",,"$2,500","$400","$800","$200","$200","$1,600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0022&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","23"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080007","Silver Compass 2450","48834NJ008",,"NJN001","NJS001","NJF006","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080007-01","Standard Silver On Exchange Plan","71.90%",,"No","Yes","No","100%",,"$2,500","$400","$800","$200","$200","$1,600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0022&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","24"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080007","Silver Compass 2450","48834NJ008",,"NJN001","NJS001","NJF006","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0023&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","25"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080007","Silver Compass 2450","48834NJ008",,"NJN001","NJS001","NJF006","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080007-03","Limited Cost Sharing Plan Variation","71.90%",,"No","Yes","No","100%",,"$2,500","$400","$800","$200","$200","$1,600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0024&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","26"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080007","Silver Compass 2450","48834NJ008",,"NJN001","NJS001","NJF006","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080007-04","73% AV Level Silver Plan","73.92%",,"No","Yes","No","100%",,"$2,500","$400","$800","$200","$200","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0025&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","27"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0050001","Oscar Classic+ Gold","50221NJ005",,"NJN001","NJS001","NJF006","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.998",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0050001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF006","50221NJ0050001-01","Standard Gold On Exchange Plan","80.20%",,"Yes","Yes","No","100%",,"$1,500","$0","$1,500","$200","$100","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0050001-01","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0050001-01","23"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0050001","Oscar Classic+ Gold","50221NJ005",,"NJN001","NJS001","NJF006","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.998",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0050001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF006","50221NJ0050001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0050001-02","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0050001-02","24"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0050001","Oscar Classic+ Gold","50221NJ005",,"NJN001","NJS001","NJF006","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.998",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0050001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF006","50221NJ0050001-03","Limited Cost Sharing Plan Variation","80.20%",,"Yes","Yes","No","100%",,"$1,500","$0","$1,500","$200","$100","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0050001-03","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0050001-03","25"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","4","50221","NJ","Individual","No","47-1142944","50221NJ0080001","Oscar Market Secure","50221NJ008",,"NJN001","NJS001","NJF007","Existing","EPO","Catastrophic","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9974",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0080001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF007","50221NJ0080001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$200","$4,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0080001-00","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0080001-00","4"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080007","Silver Compass 2450","48834NJ008",,"NJN001","NJS001","NJF006","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080007-05","87% AV Level Silver Plan","87.43%",,"No","Yes","No","100%",,"$500","$400","$1,300","$200","$200","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0026&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","28"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080007","Silver Compass 2450","48834NJ008",,"NJN001","NJS001","NJF006","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080007-06","94% AV Level Silver Plan","93.60%",,"No","Yes","No","100%",,"$200","$60","$200","$200","$80","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=nj0027&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","29"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080008","Bronze Compass 3000","48834NJ008",,"NJN001","NJS001","NJF002","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080008-00","Standard Bronze Off Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$3,000","$0","$1,700","$200","$3,000","$0","$1,100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$6750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=nj0031&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","30"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080008","Bronze Compass 3000","48834NJ008",,"NJN001","NJS001","NJF002","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080008-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$3,000","$0","$1,700","$200","$3,000","$0","$1,100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$6750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=nj0031&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","31"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080008","Bronze Compass 3000","48834NJ008",,"NJN001","NJS001","NJF002","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080008-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=nj0032&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","32"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080008","Bronze Compass 3000","48834NJ008",,"NJN001","NJS001","NJF002","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080008-03","Limited Cost Sharing Plan Variation","61.90%",,"Yes","Yes","No","100%",,"$3,000","$0","$1,700","$200","$3,000","$0","$1,100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$6750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=nj0033&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","33"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080009","Catastrophic Compass 6850","48834NJ008",,"NJN001","NJS001","NJF001","New","HMO","Catastrophic","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080009-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=nj0034&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","34"
"2016","NJ","48834","HIOS","9","2015-11-14 04:47:21","2","48834","NJ","Individual","No","22-2745725","48834NJ0080009","Catastrophic Compass 6850","48834NJ008",,"NJN001","NJS001","NJF001","New","HMO","Catastrophic","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=nj0036&st=nj","48834NJ0080009-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=nj0034&st=nj","http://www.uhc.com/iex/doc?id=nj0035&st=nj","35"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","1","50221","NJ","Individual","No","47-1142944","50221NJ0160001","Oscar Market Bronze","50221NJ016",,"NJN001","NJS001","NJF007","Existing","EPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0160001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF007","50221NJ0160001-00","Standard Bronze Off Exchange Plan","61.60%",,"Yes","Yes","No","100%",,"$3,000","$500","$600","$200","$3,000","$0","$1,000","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0160001-00","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0160001-00","4"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","1","50221","NJ","Individual","No","47-1142944","50221NJ0160001","Oscar Market Bronze","50221NJ016",,"NJN001","NJS001","NJF007","Existing","EPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0160001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF007","50221NJ0160001-01","Standard Bronze On Exchange Plan","61.60%",,"Yes","Yes","No","100%",,"$3,000","$500","$600","$200","$3,000","$0","$1,000","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0160001-01","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0160001-01","5"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","1","50221","NJ","Individual","No","47-1142944","50221NJ0160001","Oscar Market Bronze","50221NJ016",,"NJN001","NJS001","NJF007","Existing","EPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0160001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF007","50221NJ0160001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0160001-02","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0160001-02","6"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","1","50221","NJ","Individual","No","47-1142944","50221NJ0160001","Oscar Market Bronze","50221NJ016",,"NJN001","NJS001","NJF007","Existing","EPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0160001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF007","50221NJ0160001-03","Limited Cost Sharing Plan Variation","61.60%",,"Yes","Yes","No","100%",,"$3,000","$500","$600","$200","$3,000","$0","$1,000","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0160001-03","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0160001-03","7"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","1","50221","NJ","Individual","No","47-1142944","50221NJ0020001","Oscar Share Silver","50221NJ002",,"NJN001","NJS001","NJF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0020001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0020001-00","Standard Silver Off Exchange Plan","70.80%",,"Yes","Yes","No","100%",,"$0","$0","$2,700","$200","$0","$0","$2,500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0020001-00","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0020001-00","8"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","1","50221","NJ","Individual","No","47-1142944","50221NJ0020001","Oscar Share Silver","50221NJ002",,"NJN001","NJS001","NJF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0020001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0020001-01","Standard Silver On Exchange Plan","70.80%",,"Yes","Yes","No","100%",,"$0","$0","$2,700","$200","$0","$0","$2,500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0020001-01","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0020001-01","9"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","1","50221","NJ","Individual","No","47-1142944","50221NJ0020001","Oscar Share Silver","50221NJ002",,"NJN001","NJS001","NJF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0020001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0020001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0020001-02","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0020001-02","10"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","1","50221","NJ","Individual","No","47-1142944","50221NJ0020001","Oscar Share Silver","50221NJ002",,"NJN001","NJS001","NJF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0020001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0020001-03","Limited Cost Sharing Plan Variation","70.80%",,"Yes","Yes","No","100%",,"$0","$0","$2,700","$200","$0","$0","$2,500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0020001-03","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0020001-03","11"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","1","50221","NJ","Individual","No","47-1142944","50221NJ0020001","Oscar Share Silver","50221NJ002",,"NJN001","NJS001","NJF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0020001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0020001-04","73% AV Level Silver Plan","73.90%",,"Yes","Yes","No","100%",,"$0","$0","$2,700","$200","$0","$0","$2,500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,200","$5200 per person","$10400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0020001-04","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0020001-04","12"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","1","50221","NJ","Individual","No","47-1142944","50221NJ0020001","Oscar Share Silver","50221NJ002",,"NJN001","NJS001","NJF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0020001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0020001-05","87% AV Level Silver Plan","87.50%",,"Yes","Yes","No","100%",,"$0","$0","$1,400","$200","$0","$0","$1,400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0020001-05","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0020001-05","13"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","1","50221","NJ","Individual","No","47-1142944","50221NJ0020001","Oscar Share Silver","50221NJ002",,"NJN001","NJS001","NJF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0020001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0020001-06","94% AV Level Silver Plan","94.50%",,"Yes","Yes","No","100%",,"$0","$0","$1,000","$200","$0","$0","$1,000","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0020001-06","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0020001-06","14"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","1","50221","NJ","Individual","No","47-1142944","50221NJ0300001","Oscar Share Gold","50221NJ030",,"NJN001","NJS001","NJF005","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.998",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0300001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0300001-00","Standard Gold Off Exchange Plan","78.90%",,"Yes","Yes","No","100%",,"$0","$0","$2,160","$200","$0","$0","$2,000","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0300001-00","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0300001-00","15"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","1","50221","NJ","Individual","No","47-1142944","50221NJ0300001","Oscar Share Gold","50221NJ030",,"NJN001","NJS001","NJF005","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.998",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0300001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0300001-01","Standard Gold On Exchange Plan","78.90%",,"Yes","Yes","No","100%",,"$0","$0","$2,160","$200","$0","$0","$2,000","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0300001-01","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0300001-01","16"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","1","50221","NJ","Individual","No","47-1142944","50221NJ0300001","Oscar Share Gold","50221NJ030",,"NJN001","NJS001","NJF005","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.998",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0300001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0300001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0300001-02","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0300001-02","17"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","1","50221","NJ","Individual","No","47-1142944","50221NJ0300001","Oscar Share Gold","50221NJ030",,"NJN001","NJS001","NJF005","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.998",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0300001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0300001-03","Limited Cost Sharing Plan Variation","78.90%",,"Yes","Yes","No","100%",,"$0","$0","$2,160","$200","$0","$0","$2,000","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0300001-03","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0300001-03","18"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","2","50221","NJ","Individual","No","47-1142944","50221NJ0230001","Oscar Market Silver","50221NJ023",,"NJN001","NJS001","NJF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0230001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0230001-00","Standard Silver Off Exchange Plan","68.00%",,"Yes","Yes","No","100%",,"$2,500","$0","$1,400","$200","$700","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0230001-00","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0230001-00","4"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","2","50221","NJ","Individual","No","47-1142944","50221NJ0230001","Oscar Market Silver","50221NJ023",,"NJN001","NJS001","NJF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0230001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0230001-01","Standard Silver On Exchange Plan","68.00%",,"Yes","Yes","No","100%",,"$2,500","$0","$1,400","$200","$700","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0230001-01","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0230001-01","5"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","2","50221","NJ","Individual","No","47-1142944","50221NJ0230001","Oscar Market Silver","50221NJ023",,"NJN001","NJS001","NJF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0230001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0230001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0230001-02","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0230001-02","6"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","2","50221","NJ","Individual","No","47-1142944","50221NJ0230001","Oscar Market Silver","50221NJ023",,"NJN001","NJS001","NJF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0230001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0230001-03","Limited Cost Sharing Plan Variation","68.00%",,"Yes","Yes","No","100%",,"$2,500","$0","$1,400","$200","$700","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0230001-03","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0230001-03","7"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","2","50221","NJ","Individual","No","47-1142944","50221NJ0230001","Oscar Market Silver","50221NJ023",,"NJN001","NJS001","NJF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0230001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0230001-04","73% AV Level Silver Plan","73.20%",,"Yes","Yes","No","100%",,"$1,200","$0","$2,100","$200","$700","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0230001-04","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0230001-04","8"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","2","50221","NJ","Individual","No","47-1142944","50221NJ0230001","Oscar Market Silver","50221NJ023",,"NJN001","NJS001","NJF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0230001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0230001-05","87% AV Level Silver Plan","86.90%",,"Yes","Yes","No","100%",,"$150","$0","$1,400","$200","$150","$1,100","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0230001-05","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0230001-05","9"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","2","50221","NJ","Individual","No","47-1142944","50221NJ0230001","Oscar Market Silver","50221NJ023",,"NJN001","NJS001","NJF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0230001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0230001-06","94% AV Level Silver Plan","93.40%",,"Yes","Yes","No","100%",,"$0","$0","$500","$200","$0","$300","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0230001-06","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0230001-06","10"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0220001","Oscar Classic Silver","50221NJ022",,"NJN001","NJS001","NJF007","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0220001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF007","50221NJ0220001-00","Standard Silver Off Exchange Plan","68.10%",,"Yes","Yes","No","100%",,"$2,500","$0","$1,400","$200","$2,500","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0220001-00","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0220001-00","4"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0220001","Oscar Classic Silver","50221NJ022",,"NJN001","NJS001","NJF007","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0220001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF007","50221NJ0220001-01","Standard Silver On Exchange Plan","68.10%",,"Yes","Yes","No","100%",,"$2,500","$0","$1,400","$200","$2,500","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0220001-01","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0220001-01","5"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0220001","Oscar Classic Silver","50221NJ022",,"NJN001","NJS001","NJF007","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0220001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF007","50221NJ0220001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0220001-02","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0220001-02","6"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0220001","Oscar Classic Silver","50221NJ022",,"NJN001","NJS001","NJF007","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0220001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF007","50221NJ0220001-03","Limited Cost Sharing Plan Variation","68.10%",,"Yes","Yes","No","100%",,"$2,500","$0","$1,400","$200","$2,500","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0220001-03","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0220001-03","7"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0220001","Oscar Classic Silver","50221NJ022",,"NJN001","NJS001","NJF007","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0220001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF007","50221NJ0220001-04","73% AV Level Silver Plan","73.20%",,"Yes","Yes","No","100%",,"$2,500","$0","$1,300","$200","$2,500","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0220001-04","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0220001-04","8"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0220001","Oscar Classic Silver","50221NJ022",,"NJN001","NJS001","NJF007","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0220001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF007","50221NJ0220001-05","87% AV Level Silver Plan","86.90%",,"Yes","Yes","No","100%",,"$1,600","$0","$0","$200","$1,600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0220001-05","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0220001-05","9"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0220001","Oscar Classic Silver","50221NJ022",,"NJN001","NJS001","NJF007","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0220001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF007","50221NJ0220001-06","94% AV Level Silver Plan","93.40%",,"Yes","Yes","No","100%",,"$700","$0","$0","$200","$700","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0220001-06","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0220001-06","10"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0200001","Oscar Classic Gold","50221NJ020",,"NJN001","NJS001","NJF005","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.998",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0200001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0200001-00","Standard Gold Off Exchange Plan","79.00%",,"Yes","Yes","No","100%",,"$1,500","$0","$1,500","$200","$1,500","$0","$1,000","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0200001-00","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0200001-00","11"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0200001","Oscar Classic Gold","50221NJ020",,"NJN001","NJS001","NJF005","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.998",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0200001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0200001-01","Standard Gold On Exchange Plan","79.00%",,"Yes","Yes","No","100%",,"$1,500","$0","$1,500","$200","$1,500","$0","$1,000","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0200001-01","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0200001-01","12"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0200001","Oscar Classic Gold","50221NJ020",,"NJN001","NJS001","NJF005","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.998",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0200001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0200001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0200001-02","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0200001-02","13"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0200001","Oscar Classic Gold","50221NJ020",,"NJN001","NJS001","NJF005","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.998",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0200001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0200001-03","Limited Cost Sharing Plan Variation","79.00%",,"Yes","Yes","No","100%",,"$1,500","$0","$1,500","$200","$1,500","$0","$1,000","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0200001-03","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0200001-03","14"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0340001","Oscar Classic+ Silver","50221NJ034",,"NJN001","NJS001","NJF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0340001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0340001-00","Standard Silver Off Exchange Plan","70.50%",,"Yes","Yes","No","100%",,"$2,500","$0","$1,400","$200","$100","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0340001-00","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0340001-00","15"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0340001","Oscar Classic+ Silver","50221NJ034",,"NJN001","NJS001","NJF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0340001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0340001-01","Standard Silver On Exchange Plan","70.50%",,"Yes","Yes","No","100%",,"$2,500","$0","$1,400","$200","$100","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0340001-01","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0340001-01","16"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0340001","Oscar Classic+ Silver","50221NJ034",,"NJN001","NJS001","NJF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0340001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0340001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0340001-02","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0340001-02","17"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0340001","Oscar Classic+ Silver","50221NJ034",,"NJN001","NJS001","NJF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0340001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0340001-03","Limited Cost Sharing Plan Variation","70.50%",,"Yes","Yes","No","100%",,"$2,500","$0","$1,400","$200","$100","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0340001-03","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0340001-03","18"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0340001","Oscar Classic+ Silver","50221NJ034",,"NJN001","NJS001","NJF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0340001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0340001-04","73% AV Level Silver Plan","73.90%",,"Yes","Yes","No","100%",,"$2,500","$0","$1,400","$200","$100","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0340001-04","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0340001-04","19"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0340001","Oscar Classic+ Silver","50221NJ034",,"NJN001","NJS001","NJF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0340001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0340001-05","87% AV Level Silver Plan","87.90%",,"Yes","Yes","No","100%",,"$1,600","$0","$0","$200","$100","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0340001-05","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0340001-05","20"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0340001","Oscar Classic+ Silver","50221NJ034",,"NJN001","NJS001","NJF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0340001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF005","50221NJ0340001-06","94% AV Level Silver Plan","93.70%",,"Yes","Yes","No","100%",,"$700","$0","$0","$200","$95","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0340001-06","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0340001-06","21"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","3","50221","NJ","Individual","No","47-1142944","50221NJ0050001","Oscar Classic+ Gold","50221NJ005",,"NJN001","NJS001","NJF006","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.998",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0050001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF006","50221NJ0050001-00","Standard Gold Off Exchange Plan","80.20%",,"Yes","Yes","No","100%",,"$1,500","$0","$1,500","$200","$100","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0050001-00","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0050001-00","22"
"2016","NJ","50221","HIOS","7","2015-10-19 10:47:49","4","50221","NJ","Individual","No","47-1142944","50221NJ0080001","Oscar Market Secure","50221NJ008",,"NJN001","NJS001","NJF007","Existing","EPO","Catastrophic","Yes","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9974",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=nj&year=2016&hios=50221NJ0080001","https://www.hioscar.com/hx/formulary?state=nj&year=2016&formulary=NJF007","50221NJ0080001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$200","$4,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"https://www.hioscar.com/hx/sbc?state=nj&year=2016&hios=50221NJ0080001-01","https://www.hioscar.com/hx/brochure?state=nj&year=2016&hios=50221NJ0080001-01","5"
"2016","NJ","51152","HIOS","2","2015-07-10 02:19:03","1","51152","NJ","SHOP (Small Group)","Yes","35-0472300","51152NJ0010001","Lincoln DentalConnect®","51152NJ001","7063415294","NJN001","NJS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$47.15","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","51152NJ0010001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","51152","HIOS","2","2015-07-10 02:19:03","1","51152","NJ","SHOP (Small Group)","Yes","35-0472300","51152NJ0010002","Lincoln DentalConnect®","51152NJ001","7063415294","NJN001","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.80","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","51152NJ0010002-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NJ","51152","HIOS","2","2015-07-10 02:19:03","1","51152","NJ","SHOP (Small Group)","Yes","35-0472300","51152NJ0010003","Lincoln DentalConnect®","51152NJ001","7063415294","NJN001","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.17","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","51152NJ0010003-00","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","NJ","51152","HIOS","2","2015-07-10 02:19:03","1","51152","NJ","SHOP (Small Group)","Yes","35-0472300","51152NJ0010004","Lincoln DentalConnect®","51152NJ001","7063415294","NJN001","NJS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.83","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","51152NJ0010004-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","1","77606","NJ","Individual","No","23-2314460","77606NJ0040065","IHC Silver HMO Regional Preferred $50/$75","77606NJ004",,"NJN001","NJS001","NJF001","Existing","HMO","Silver","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040065-06","94% AV Level Silver Plan",,"0.938091814517975","No","Yes","No","100%",,"$275","$50","$1,217","$150","$0","$60","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$275","$275 per person","$550 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC217V94.pdf",,"17"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","2","77606","NJ","Individual","No","23-2314460","77606NJ0040002","IHC Gold HMO Local Value $15/$30","77606NJ004",,"NJN002","NJS002","NJF002","Existing","HMO","Gold","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040002-00","Standard Gold Off Exchange Plan",,"0.788791358470917","No","Yes","No","100%",,"$2,000","$70","$989","$150","$0","$200","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC316V_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","4"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","2","77606","NJ","SHOP (Small Group)","No","23-2314460","77606NJ0050001","SEH Silver HMO Local Value$50/$75","77606NJ005",,"NJN002","NJS002","NJF001","Existing","HMO","Silver","No","Both","Yes","Yes","All Specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0050001-00","Standard Silver Off Exchange Plan",,"0.706461727619171","No","Yes","No","100%",,"$2,000","$50","$476","$150","$153","$245","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH216V_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","2","77606","NJ","SHOP (Small Group)","No","23-2314460","77606NJ0050001","SEH Silver HMO Local Value$50/$75","77606NJ005",,"NJN002","NJS002","NJF001","Existing","HMO","Silver","No","Both","Yes","Yes","All Specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0050001-01","Standard Silver On Exchange Plan",,"0.706461727619171","No","Yes","No","100%",,"$2,000","$50","$476","$150","$153","$245","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH216V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","51152","HIOS","2","2015-07-10 02:19:03","1","51152","NJ","SHOP (Small Group)","Yes","35-0472300","51152NJ0010005","Lincoln DentalConnect®","51152NJ001","7063415294","NJN001","NJS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.21","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","51152NJ0010005-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","NJ","51152","HIOS","2","2015-07-10 02:19:03","1","51152","NJ","SHOP (Small Group)","Yes","35-0472300","51152NJ0010006","Lincoln DentalConnect®","51152NJ001","7063415294","NJN001","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.30","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","51152NJ0010006-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","NJ","51152","HIOS","2","2015-07-10 02:19:03","1","51152","NJ","SHOP (Small Group)","Yes","35-0472300","51152NJ0010007","Lincoln DentalConnect®","51152NJ001","7063415294","NJN001","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.30","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","51152NJ0010007-00","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2016","NJ","51152","HIOS","2","2015-07-10 02:19:03","1","51152","NJ","SHOP (Small Group)","Yes","35-0472300","51152NJ0010008","Lincoln DentalConnect®","51152NJ001","7063415294","NJN001","NJS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$45.77","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","51152NJ0010008-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2016","NJ","51791","HIOS","2","2015-07-08 02:47:08","1","51791","NJ","SHOP (Small Group)","Yes","93-0242990","51791NJ0040002","EHB High PPO","51791NJ004",,"NJN001","NJS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$52.48","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","51791NJ0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","NJ","51791","HIOS","2","2015-07-08 02:47:08","1","51791","NJ","SHOP (Small Group)","Yes","93-0242990","51791NJ0040001","EHB Low PPO","51791NJ004",,"NJN001","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.12","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","51791NJ0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","2","77606","NJ","Individual","No","23-2314460","77606NJ0040002","IHC Gold HMO Local Value $15/$30","77606NJ004",,"NJN002","NJS002","NJF002","Existing","HMO","Gold","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040002-03","Limited Cost Sharing Plan Variation",,"0.788791358470917","No","Yes","No","100%",,"$2,000","$70","$989","$150","$0","$200","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC316VLTD.pdf",,"7"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","2","77606","NJ","Individual","No","23-2314460","77606NJ0040066","IHC Gold HMO Regional Preferred $15/$30","77606NJ004",,"NJN001","NJS001","NJF002","Existing","HMO","Gold","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040066-01","Standard Gold On Exchange Plan",,"0.788791358470917","No","Yes","No","100%",,"$2,000","$70","$989","$150","$0","$200","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC316P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","8"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","2","77606","NJ","Individual","No","23-2314460","77606NJ0040066","IHC Gold HMO Regional Preferred $15/$30","77606NJ004",,"NJN001","NJS001","NJF002","Existing","HMO","Gold","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040066-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC316PZERO316.pdf",,"9"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","2","77606","NJ","Individual","No","23-2314460","77606NJ0040066","IHC Gold HMO Regional Preferred $15/$30","77606NJ004",,"NJN001","NJS001","NJF002","Existing","HMO","Gold","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040066-03","Limited Cost Sharing Plan Variation",,"0.788791358470917","No","Yes","No","100%",,"$2,000","$70","$989","$150","$0","$200","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC316PLTD.pdf",,"10"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","2","77606","NJ","Individual","No","23-2314460","77606NJ0040066","IHC Gold HMO Regional Preferred $15/$30","77606NJ004",,"NJN001","NJS001","NJF002","Existing","HMO","Gold","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040066-00","Standard Gold Off Exchange Plan",,"0.788791358470917","No","Yes","No","100%",,"$2,000","$70","$989","$150","$0","$200","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC316P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","11"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","3","77606","NJ","SHOP (Small Group)","No","23-2314460","77606NJ0050017","SEH Platinum HMO Local Value $15/$30","77606NJ005",,"NJN002","NJS002","NJF002","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All Specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0050017-00","Standard Platinum Off Exchange Plan","89.376%",,"No","Yes","No","100%",,"$0","$660","$0","$150","$0","$200","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH404V_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","51791","HIOS","2","2015-07-08 02:47:08","1","51791","NJ","SHOP (Small Group)","Yes","93-0242990","51791NJ0030002","EHB High Passive","51791NJ003",,"NJN001","NJS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$58.54","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","51791NJ0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","NJ","51791","HIOS","2","2015-07-08 02:47:08","1","51791","NJ","SHOP (Small Group)","Yes","93-0242990","51791NJ0030001","EHB Low Passive","51791NJ003",,"NJN001","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.49","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","51791NJ0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","NJ","52095","HIOS","8","2016-01-30 06:15:26","1","52095","NJ","SHOP (Small Group)","Yes","22-2321226","52095NJ0020001","NJ Affordable Smiles","52095NJ002",,"NJN001","NJS001",,"New","EPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$1.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.healthplex.com/member/activate","","52095NJ0020001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/NJAFFORDABLESMILES_BENEFITS","http://www.healthplex.com/doc/no/NJAFFORDABLESMILES_BROCHURE","4"
"2016","NJ","52095","HIOS","8","2016-01-30 06:15:26","1","52095","NJ","Individual","Yes","22-2321226","52095NJ0010001","NJ Young Smiles","52095NJ001",,"NJN001","NJS001",,"New","EPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$19.70","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://www.healthplex.com/member/activate","","52095NJ0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/NJFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/NJFAMILYSMILES_BROCHURE","4"
"2016","NJ","52095","HIOS","8","2016-01-30 06:15:26","1","52095","NJ","Individual","Yes","22-2321226","52095NJ0010001","NJ Young Smiles","52095NJ001",,"NJN001","NJS001",,"New","EPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$19.70","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://www.healthplex.com/member/activate","","52095NJ0010001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/NJFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/NJFAMILYSMILES_BROCHURE","5"
"2016","NJ","52095","HIOS","8","2016-01-30 06:15:26","2","52095","NJ","Individual","Yes","22-2321226","52095NJ0010002","NJ Family Smiles","52095NJ001",,"NJN001","NJS001",,"New","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$1.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://www.healthplex.com/member/activate","","52095NJ0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/NJFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/NJFAMILYSMILES_BROCHURE","4"
"2016","NJ","52095","HIOS","8","2016-01-30 06:15:26","2","52095","NJ","SHOP (Small Group)","Yes","22-2321226","52095NJ0020002","NJ Affordable Smiles","52095NJ002",,"NJN001","NJS001",,"New","EPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$1.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No",,"","52095NJ0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/NJAFFORDABLESMILES_BENEFITS","http://www.healthplex.com/doc/no/NJAFFORDABLESMILES_BROCHURE","4"
"2016","NJ","52095","HIOS","8","2016-01-30 06:15:26","2","52095","NJ","Individual","Yes","22-2321226","52095NJ0010002","NJ Family Smiles","52095NJ001",,"NJN001","NJS001",,"New","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$1.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://www.healthplex.com/member/activate","","52095NJ0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.healthplex.com/doc/no/NJFAMILYSMILES_BENEFITS","http://www.healthplex.com/doc/no/NJFAMILYSMILES_BROCHURE","5"
"2016","NJ","53877","HIOS","3","2015-08-21 03:45:06","1","53877","NJ","SHOP (Small Group)","Yes","13-5581829","53877NJ0230001","EHB Basic Dental Plan (Low)","53877NJ023",,"NJN001","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$25.55","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","53877NJ0230001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","53877","HIOS","3","2015-08-21 03:45:06","2","53877","NJ","SHOP (Small Group)","Yes","13-5581829","53877NJ0210001","Family Basic Dental Plan (Low)","53877NJ021",,"NJN001","NJS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$25.55","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","53877NJ0210001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49104","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49103","4"
"2016","NJ","53877","HIOS","3","2015-08-21 03:45:06","2","53877","NJ","SHOP (Small Group)","Yes","13-5581829","53877NJ0210001","Family Basic Dental Plan (Low)","53877NJ021",,"NJN001","NJS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$25.55","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","53877NJ0210001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49104","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49103","5"
"2016","NJ","53877","HIOS","3","2015-08-21 03:45:06","3","53877","NJ","SHOP (Small Group)","Yes","13-5581829","53877NJ0220001","Family Enhanced Dental Plan (High)","53877NJ022",,"NJN001","NJS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$31.81","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","53877NJ0220001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49106","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49105","4"
"2016","NJ","53877","HIOS","3","2015-08-21 03:45:06","3","53877","NJ","SHOP (Small Group)","Yes","13-5581829","53877NJ0220001","Family Enhanced Dental Plan (High)","53877NJ022",,"NJN001","NJS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$31.81","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","53877NJ0220001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49106","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49105","5"
"2016","NJ","67275","HIOS","2","2015-07-09 13:17:42","1","67275","NJ","SHOP (Small Group)","Yes","81-0170040","67275NJ0010001","Assurant Dental ACAFFO High","67275NJ001",,"NJN001","NJS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$52.95","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","67275NJ0010001-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","67275","HIOS","2","2015-07-09 13:17:42","1","67275","NJ","SHOP (Small Group)","Yes","81-0170040","67275NJ0010002","Assurant Dental ACAFFO Low","67275NJ001",,"NJN001","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$44.16","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","67275NJ0010002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NJ","72667","HIOS","2","2015-07-10 02:19:03","1","72667","NJ","SHOP (Small Group)","Yes","36-0883760","72667NJ0040002","EHB High PPO","72667NJ004",,"NJN001","NJS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$52.33","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","72667NJ0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","NJ","72667","HIOS","2","2015-07-10 02:19:03","1","72667","NJ","SHOP (Small Group)","Yes","36-0883760","72667NJ0040001","EHB Low PPO","72667NJ004",,"NJN001","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.04","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","72667NJ0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","NJ","72667","HIOS","2","2015-07-10 02:19:03","1","72667","NJ","SHOP (Small Group)","Yes","36-0883760","72667NJ0030002","EHB High Passive","72667NJ003",,"NJN001","NJS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$58.36","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","72667NJ0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","NJ","72667","HIOS","2","2015-07-10 02:19:03","1","72667","NJ","SHOP (Small Group)","Yes","36-0883760","72667NJ0030001","EHB Low Passive","72667NJ003",,"NJN001","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.39","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","72667NJ0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","1","77606","NJ","SHOP (Small Group)","No","23-2314460","77606NJ0050016","SEH Gold HMO Local Value $15/$30","77606NJ005",,"NJN002","NJS002","NJF002","Existing","HMO","Gold","No","Both","Yes","Yes","All Specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0050016-00","Standard Gold Off Exchange Plan",,"0.788791358470917","No","Yes","No","100%",,"$2,000","$70","$989","$150","$0","$200","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH316V_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","1","77606","NJ","Individual","No","23-2314460","77606NJ0040001","IHC Silver HMO Local Value $50/$75","77606NJ004",,"NJN002","NJS002","NJF001","Existing","HMO","Silver","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040001-00","Standard Silver Off Exchange Plan",,"0.707967042922974","No","Yes","No","100%",,"$2,500","$50","$476","$150","$0","$175","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC217V_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","4"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","1","77606","NJ","Individual","No","23-2314460","77606NJ0040001","IHC Silver HMO Local Value $50/$75","77606NJ004",,"NJN002","NJS002","NJF001","Existing","HMO","Silver","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040001-01","Standard Silver On Exchange Plan",,"0.707967042922974","No","Yes","No","100%",,"$2,500","$50","$476","$150","$0","$175","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC217V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","5"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","1","77606","NJ","SHOP (Small Group)","No","23-2314460","77606NJ0050016","SEH Gold HMO Local Value $15/$30","77606NJ005",,"NJN002","NJS002","NJF002","Existing","HMO","Gold","No","Both","Yes","Yes","All Specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0050016-01","Standard Gold On Exchange Plan",,"0.788791358470917","No","Yes","No","100%",,"$2,000","$70","$989","$150","$0","$200","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH316V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","1","77606","NJ","Individual","No","23-2314460","77606NJ0040001","IHC Silver HMO Local Value $50/$75","77606NJ004",,"NJN002","NJS002","NJF001","Existing","HMO","Silver","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCVZERO217.pdf",,"6"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","1","77606","NJ","Individual","No","23-2314460","77606NJ0040001","IHC Silver HMO Local Value $50/$75","77606NJ004",,"NJN002","NJS002","NJF001","Existing","HMO","Silver","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040001-03","Limited Cost Sharing Plan Variation",,"0.707967042922974","No","Yes","No","100%",,"$2,500","$50","$476","$150","$0","$175","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC217VLTD.pdf",,"7"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","1","77606","NJ","Individual","No","23-2314460","77606NJ0040001","IHC Silver HMO Local Value $50/$75","77606NJ004",,"NJN002","NJS002","NJF001","Existing","HMO","Silver","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040001-04","73% AV Level Silver Plan",,"0.730519473552704","No","Yes","No","100%",,"$2,500","$50","$476","$150","$0","$175","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC217V73.pdf",,"8"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","1","77606","NJ","Individual","No","23-2314460","77606NJ0040001","IHC Silver HMO Local Value $50/$75","77606NJ004",,"NJN002","NJS002","NJF001","Existing","HMO","Silver","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040001-05","87% AV Level Silver Plan",,"0.872149646282196","No","Yes","No","100%",,"$2,500","$50","$476","$150","$0","$175","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC217V87.pdf",,"9"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","1","77606","NJ","Individual","No","23-2314460","77606NJ0040001","IHC Silver HMO Local Value $50/$75","77606NJ004",,"NJN002","NJS002","NJF001","Existing","HMO","Silver","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040001-06","94% AV Level Silver Plan",,"0.938091814517975","No","Yes","No","100%",,"$275","$50","$1,217","$150","$0","$60","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$275","$275 per person","$550 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC217V94.pdf",,"10"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","1","77606","NJ","Individual","No","23-2314460","77606NJ0040065","IHC Silver HMO Regional Preferred $50/$75","77606NJ004",,"NJN001","NJS001","NJF001","Existing","HMO","Silver","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040065-00","Standard Silver Off Exchange Plan",,"0.707967042922974","No","Yes","No","100%",,"$2,500","$50","$476","$150","$0","$175","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC217V_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","11"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","1","77606","NJ","Individual","No","23-2314460","77606NJ0040065","IHC Silver HMO Regional Preferred $50/$75","77606NJ004",,"NJN001","NJS001","NJF001","Existing","HMO","Silver","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040065-01","Standard Silver On Exchange Plan",,"0.707967042922974","No","Yes","No","100%",,"$2,500","$50","$476","$150","$0","$175","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC217V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","12"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","1","77606","NJ","Individual","No","23-2314460","77606NJ0040065","IHC Silver HMO Regional Preferred $50/$75","77606NJ004",,"NJN001","NJS001","NJF001","Existing","HMO","Silver","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040065-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCVZERO217.pdf",,"13"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","1","77606","NJ","Individual","No","23-2314460","77606NJ0040065","IHC Silver HMO Regional Preferred $50/$75","77606NJ004",,"NJN001","NJS001","NJF001","Existing","HMO","Silver","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040065-03","Limited Cost Sharing Plan Variation",,"0.707967042922974","No","Yes","No","100%",,"$2,500","$50","$476","$150","$0","$175","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC217VLTD.pdf",,"14"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","1","77606","NJ","Individual","No","23-2314460","77606NJ0040065","IHC Silver HMO Regional Preferred $50/$75","77606NJ004",,"NJN001","NJS001","NJF001","Existing","HMO","Silver","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040065-04","73% AV Level Silver Plan",,"0.730519473552704","No","Yes","No","100%",,"$2,500","$50","$476","$150","$0","$175","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC217V73.pdf",,"15"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","1","77606","NJ","Individual","No","23-2314460","77606NJ0040065","IHC Silver HMO Regional Preferred $50/$75","77606NJ004",,"NJN001","NJS001","NJF001","Existing","HMO","Silver","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040065-05","87% AV Level Silver Plan",,"0.872149646282196","No","Yes","No","100%",,"$2,500","$50","$476","$150","$0","$175","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC217V87.pdf",,"16"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","2","77606","NJ","Individual","No","23-2314460","77606NJ0040002","IHC Gold HMO Local Value $15/$30","77606NJ004",,"NJN002","NJS002","NJF002","Existing","HMO","Gold","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040002-01","Standard Gold On Exchange Plan",,"0.788791358470917","No","Yes","No","100%",,"$2,000","$70","$989","$150","$0","$200","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC316V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","5"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","2","77606","NJ","Individual","No","23-2314460","77606NJ0040002","IHC Gold HMO Local Value $15/$30","77606NJ004",,"NJN002","NJS002","NJF002","Existing","HMO","Gold","No","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCVZERO316.pdf",,"6"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","3","77606","NJ","Individual","No","23-2314460","77606NJ0040057","IHC Platinum HMO Regional Preferred $15/$30","77606NJ004",,"NJN001","NJS001","NJF002","Existing","HMO","Platinum","Yes","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"5","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040057-01","Standard Platinum On Exchange Plan","89.37%","0","No","Yes","No","100%",,"$0","$660","$0","$150","$0","$200","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC404P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","4"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","3","77606","NJ","Individual","No","23-2314460","77606NJ0040057","IHC Platinum HMO Regional Preferred $15/$30","77606NJ004",,"NJN001","NJS001","NJF002","Existing","HMO","Platinum","Yes","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"5","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040057-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCPZERO404.pdf",,"5"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","3","77606","NJ","SHOP (Small Group)","No","23-2314460","77606NJ0050017","SEH Platinum HMO Local Value $15/$30","77606NJ005",,"NJN002","NJS002","NJF002","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All Specialists",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0050017-01","Standard Platinum On Exchange Plan","89.376%",,"No","Yes","No","100%",,"$0","$660","$0","$150","$0","$200","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH404V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","3","77606","NJ","Individual","No","23-2314460","77606NJ0040057","IHC Platinum HMO Regional Preferred $15/$30","77606NJ004",,"NJN001","NJS001","NJF002","Existing","HMO","Platinum","Yes","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"5","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040057-03","Limited Cost Sharing Plan Variation","89.37%","0","No","Yes","No","100%",,"$0","$660","$0","$150","$0","$200","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC404PLTD.pdf",,"6"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","3","77606","NJ","Individual","No","23-2314460","77606NJ0040057","IHC Platinum HMO Regional Preferred $15/$30","77606NJ004",,"NJN001","NJS001","NJF002","Existing","HMO","Platinum","Yes","Both","Yes","Yes","ALL specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"5","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040057-00","Standard Platinum Off Exchange Plan","89.37%","0","No","Yes","No","100%",,"$0","$660","$0","$150","$0","$200","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC404P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","7"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","4","77606","NJ","Individual","No","23-2314460","77606NJ0040069","IHC Silver HMO Regional Preferred $50/$75, Rx $7/50% up to $125 max","77606NJ004",,"NJN001","NJS001","NJF003","New","HMO","Silver","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040069-00","Standard Silver Off Exchange Plan",,"0.685449779033661","No","Yes","No","100%",,"$2,500","$14","$1,074","$150","$153","$195","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC293P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","3","91661","NJ","Individual","No","22-0999690","91661NJ2270003","Horizon Advantage EPO Gold","91661NJ227",,"NJN001","NJS001","NJF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2270003-01","Standard Gold On Exchange Plan",,"0.792489051818848","No","Yes","No","100%",,"$1,000","$20","$690","$150","$1,000","$540","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2016/sbc-advantage-epo-gold-standard","http://horizonblue.com/2016/brochure-advantage-epo-gold","5"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","3","91661","NJ","Individual","No","22-0999690","91661NJ2270003","Horizon Advantage EPO Gold","91661NJ227",,"NJN001","NJS001","NJF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2270003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2016/sbc-advantage-epo-gold-zero-cost","http://horizonblue.com/2016/brochure-advantage-epo-gold-zero","6"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","4","77606","NJ","Individual","No","23-2314460","77606NJ0040069","IHC Silver HMO Regional Preferred $50/$75, Rx $7/50% up to $125 max","77606NJ004",,"NJN001","NJS001","NJF003","New","HMO","Silver","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040069-01","Standard Silver On Exchange Plan",,"0.685449779033661","No","Yes","No","100%",,"$2,500","$14","$1,074","$150","$153","$195","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC293P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","5"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","4","77606","NJ","Individual","No","23-2314460","77606NJ0040069","IHC Silver HMO Regional Preferred $50/$75, Rx $7/50% up to $125 max","77606NJ004",,"NJN001","NJS001","NJF003","New","HMO","Silver","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040069-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCPZERO293.pdf",,"6"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","4","77606","NJ","Individual","No","23-2314460","77606NJ0040069","IHC Silver HMO Regional Preferred $50/$75, Rx $7/50% up to $125 max","77606NJ004",,"NJN001","NJS001","NJF003","New","HMO","Silver","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040069-03","Limited Cost Sharing Plan Variation",,"0.685449779033661","No","Yes","No","100%",,"$2,500","$14","$1,074","$150","$153","$195","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC293PLTD.pdf",,"7"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","4","77606","NJ","Individual","No","23-2314460","77606NJ0040069","IHC Silver HMO Regional Preferred $50/$75, Rx $7/50% up to $125 max","77606NJ004",,"NJN001","NJS001","NJF003","New","HMO","Silver","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040069-04","73% AV Level Silver Plan",,"0.725673198699951","No","Yes","No","100%",,"$2,500","$14","$1,074","$150","$153","$195","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC293P73.pdf",,"8"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","4","77606","NJ","Individual","No","23-2314460","77606NJ0040069","IHC Silver HMO Regional Preferred $50/$75, Rx $7/50% up to $125 max","77606NJ004",,"NJN001","NJS001","NJF003","New","HMO","Silver","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040069-05","87% AV Level Silver Plan",,"0.865513563156128","No","Yes","No","100%",,"$750","$14","$1,949","$150","$0","$170","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC293P87.pdf",,"9"
"2016","NJ","77606","HIOS","11","2016-01-23 05:53:30","4","77606","NJ","Individual","No","23-2314460","77606NJ0040069","IHC Silver HMO Regional Preferred $50/$75, Rx $7/50% up to $125 max","77606NJ004",,"NJN001","NJS001","NJF003","New","HMO","Silver","No","Both","Yes","Yes","All Specialist",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","No","https://apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","77606NJ0040069-06","94% AV Level Silver Plan",,"0.9309983253479","No","Yes","No","100%",,"$150","$14","$2,249","$150","$0","$130","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC293P94.pdf",,"10"
"2016","NJ","79370","HIOS","3","2015-08-26 09:56:12","1","79370","NJ","SHOP (Small Group)","Yes","42-0127290","79370NJ0040001","Principal Plan Dental 70","79370NJ004",,"NJN001","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$35.85","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","79370NJ0040001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","79370","HIOS","3","2015-08-26 09:56:12","1","79370","NJ","SHOP (Small Group)","Yes","42-0127290","79370NJ0040002","Principal Plan Dental 85","79370NJ004",,"NJN001","NJS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$38.04","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","79370NJ0040002-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NJ","79422","HIOS","5","2015-08-21 03:45:06","1","79422","NJ","SHOP (Small Group)","Yes","33-0733552","79422NJ0010001","EHB Basic Dental Plan (Low)","79422NJ001",,"NJN001","NJS001",,"Existing","HMO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$10.99","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","79422NJ0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","79422","HIOS","5","2015-08-21 03:45:06","2","79422","NJ","SHOP (Small Group)","Yes","33-0733552","79422NJ0030001","Family Basic Dental Plan (Low)","79422NJ003",,"NJN001","NJS001",,"Existing","HMO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$10.99","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","79422NJ0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49110","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49109","4"
"2016","NJ","79422","HIOS","5","2015-08-21 03:45:06","2","79422","NJ","SHOP (Small Group)","Yes","33-0733552","79422NJ0030001","Family Basic Dental Plan (Low)","79422NJ003",,"NJN001","NJS001",,"Existing","HMO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$10.99","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","79422NJ0030001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49110","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49109","5"
"2016","NJ","79422","HIOS","5","2015-08-21 03:45:06","3","79422","NJ","SHOP (Small Group)","Yes","33-0733552","79422NJ0040001","Family Enhanced Dental Plan (High)","79422NJ004",,"NJN001","NJS001",,"Existing","HMO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$12.60","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","79422NJ0040001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49112","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49111","4"
"2016","NJ","79422","HIOS","5","2015-08-21 03:45:06","3","79422","NJ","SHOP (Small Group)","Yes","33-0733552","79422NJ0040001","Family Enhanced Dental Plan (High)","79422NJ004",,"NJN001","NJS001",,"Existing","HMO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$12.60","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","79422NJ0040001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49112","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49111","5"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","1","91661","NJ","Individual","Yes","22-0999690","91661NJ2310001","Horizon Young Grins","91661NJ231",,"NJN003","NJS002",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$20.59","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","91661NJ2310001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","1","91661","NJ","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF004","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2270001-00","Standard Silver Off Exchange Plan",,"0.708439350128174","No","Yes","No","100%",,"$2,000","$20","$990","$150","$2,000","$620","$350","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2016/sbc-advantage-epo-silver-standard","http://horizonblue.com/2016/brochure-advantage-epo-silver","4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","1","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2290002","Direct Access Gold 100/80/60 BlueCard","91661NJ229",,"NJN001","NJS001","NJF007","Existing","POS","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Offers out of network coverage","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2290002-00","Standard Gold Off Exchange Plan",,"0.806014835834503","Yes","Yes","No","100%",,"$1,500","$20","$590","$150","$1,130","$600","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","20%",,,,,"$2,500","per person not applicable","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2016/sbc-advantage-Direct-access-100-80-60","http://horizonblue.com/2016/brochure-advantage-Direct-access-100-80-60","4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","1","91661","NJ","SHOP (Small Group)","Yes","22-0999690","91661NJ2330001","Horizon Young Grins","91661NJ233",,"NJN003","NJS002",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$21.38","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","91661NJ2330001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","1","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2290002","Direct Access Gold 100/80/60 BlueCard","91661NJ229",,"NJN001","NJS001","NJF007","Existing","POS","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Offers out of network coverage","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2290002-01","Standard Gold On Exchange Plan",,"0.806014835834503","Yes","Yes","No","100%",,"$1,500","$20","$590","$150","$1,130","$600","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","20%",,,,,"$2,500","per person not applicable","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2016/sbc-advantage-Direct-access-100-80-60","http://horizonblue.com/2016/brochure-advantage-Direct-access-100-80-60","5"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","1","91661","NJ","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF004","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2270001-01","Standard Silver On Exchange Plan",,"0.708439350128174","No","Yes","No","100%",,"$2,000","$20","$990","$150","$2,000","$620","$350","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2016/sbc-advantage-epo-silver-standard","http://horizonblue.com/2016/brochure-advantage-epo-silver","5"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","1","91661","NJ","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF004","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2270001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2016/sbc-advantage-epo-silver-Zero-cost","http://horizonblue.com/2016/brochure-advantage-epo-silver-zero","6"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","1","91661","NJ","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF004","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2270001-03","Limited Cost Sharing Plan Variation",,"0.708439350128174","No","Yes","No","100%",,"$2,000","$0","$2,040","$150","$2,000","$0","$1,320","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2016/sbc-advantage-epo-silver-limited-cost","http://horizonblue.com/2016/brochure-advantage-epo-silver","7"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","1","91661","NJ","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF004","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2270001-04","73% AV Level Silver Plan",,"0.732773303985596","No","Yes","No","100%",,"$2,000","$50","$1,790","$150","$2,000","$620","$350","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2016/sbc-advantage-epo-silver-73av-level","http://horizonblue.com/2016/brochure-advantage-epo-silver-73","8"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","1","91661","NJ","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF004","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2270001-05","87% AV Level Silver Plan",,"0.868894636631012","No","Yes","No","100%",,"$750","$10","$740","$150","$750","$360","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","per person not applicable","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2016/sbc-advantage-epo-silver-87av-level","http://horizonblue.com/2016/brochure-advantage-epo-silver-87","9"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","1","91661","NJ","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF004","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2270001-06","94% AV Level Silver Plan",,"0.933953464031219","No","Yes","No","100%",,"$0","$40","$450","$150","$0","$400","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2016/sbc-advantage-epo-silver-94av-level","http://horizonblue.com/2016/brochure-advantage-epo-silver-94","10"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","2","91661","NJ","Individual","No","22-0999690","91661NJ2270002","Horizon Advantage EPO Bronze","91661NJ227",,"NJN001","NJS001","NJF005","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2270002-00","Standard Bronze Off Exchange Plan",,"0.618665218353271","Yes","Yes","No","100%",,"$3,000","$0","$1,000","$150","$3,000","$0","$1,320","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2016/sbc-advantage-epo-bronze-standard","http://horizonblue.com/2016/brochure-advantage-epo-bronze","4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","2","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300001","Advantage EPO Gold 100  $20/$40","91661NJ230",,"NJN001","NJS001","NJF008","Existing","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2300001-00","Standard Gold Off Exchange Plan","81.12%","0.811230182647705","No","Yes","No","100%",,"$0","$320","$0","$150","$0","$800","$640","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://horizonblue.com/2016/sbc-advantage-epo-100-20-40","http://horizonblue.com/2016/brochure-advantage-epo-100-20-40","4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","2","91661","NJ","SHOP (Small Group)","Yes","22-0999690","91661NJ2330003","Horizon Family Grins","91661NJ233",,"NJN003","NJS002",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.18","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","91661NJ2330003-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","2","91661","NJ","Individual","Yes","22-0999690","91661NJ2310003","Horizon Family Grins","91661NJ231",,"NJN003","NJS002",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.30","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","91661NJ2310003-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","2","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300001","Advantage EPO Gold 100  $20/$40","91661NJ230",,"NJN001","NJS001","NJF008","Existing","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2300001-01","Standard Gold On Exchange Plan","81.12%","0.811230182647705","No","Yes","No","100%",,"$0","$320","$0","$150","$0","$800","$640","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://horizonblue.com/2016/sbc-advantage-epo-100-20-40","http://horizonblue.com/2016/brochure-advantage-epo-100-20-40","5"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","2","91661","NJ","Individual","No","22-0999690","91661NJ2270002","Horizon Advantage EPO Bronze","91661NJ227",,"NJN001","NJS001","NJF005","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2270002-01","Standard Bronze On Exchange Plan",,"0.618665218353271","Yes","Yes","No","100%",,"$3,000","$0","$1,000","$150","$3,000","$0","$1,320","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2016/sbc-advantage-epo-bronze-standard","http://horizonblue.com/2016/brochure-advantage-epo-bronze","5"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","2","91661","NJ","Individual","No","22-0999690","91661NJ2270002","Horizon Advantage EPO Bronze","91661NJ227",,"NJN001","NJS001","NJF005","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2270002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2016/sbc-advantage-epo-bronze-zero-cost","http://horizonblue.com/2016/brochure-advantage-epo-bronze-zero","6"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","2","91661","NJ","Individual","No","22-0999690","91661NJ2270002","Horizon Advantage EPO Bronze","91661NJ227",,"NJN001","NJS001","NJF005","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2270002-03","Limited Cost Sharing Plan Variation",,"0.618665218353271","Yes","Yes","No","100%",,"$3,000","$0","$2,040","$150","$3,000","$0","$1,320","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2016/sbc-advantage-epo-bronze-limited-cost","http://horizonblue.com/2016/brochure-advantage-epo-bronze","7"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","3","91661","NJ","Individual","No","22-0999690","91661NJ2270003","Horizon Advantage EPO Gold","91661NJ227",,"NJN001","NJS001","NJF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2270003-00","Standard Gold Off Exchange Plan",,"0.792489051818848","No","Yes","No","100%",,"$1,000","$20","$690","$150","$1,000","$540","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2016/sbc-advantage-epo-gold-standard","http://horizonblue.com/2016/brochure-advantage-epo-gold","4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","3","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300003","Advantage EPO Gold 100/80","91661NJ230",,"NJN001","NJS001","NJF009","Existing","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2300003-00","Standard Gold Off Exchange Plan","80.07%","0.800677299499512","Yes","Yes","No","100%",,"$1,000","$20","$690","$150","$770","$480","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2016/sbc-advantage-epo-100-80","http://horizonblue.com/2016/brochure-advantage-epo-100-80","4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","3","91661","NJ","SHOP (Small Group)","Yes","22-0999690","91661NJ2330004","Horizon Family Grins Plus","91661NJ233",,"NJN003","NJS002",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.18","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","91661NJ2330004-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","3","91661","NJ","Individual","Yes","22-0999690","91661NJ2310004","Horizon Family Grins Plus","91661NJ231",,"NJN003","NJS002",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.30","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","91661NJ2310004-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","3","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300003","Advantage EPO Gold 100/80","91661NJ230",,"NJN001","NJS001","NJF009","Existing","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2300003-01","Standard Gold On Exchange Plan","80.07%","0.800677299499512","Yes","Yes","No","100%",,"$1,000","$20","$690","$150","$770","$480","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2016/sbc-advantage-epo-100-80","http://horizonblue.com/2016/brochure-advantage-epo-100-80","5"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","3","91661","NJ","Individual","No","22-0999690","91661NJ2270003","Horizon Advantage EPO Gold","91661NJ227",,"NJN001","NJS001","NJF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2270003-03","Limited Cost Sharing Plan Variation",,"0.792489051818848","No","Yes","No","100%",,"$1,000","$20","$690","$150","$1,000","$540","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2016/sbc-advantage-epo-gold-limited-cost","http://horizonblue.com/2016/brochure-advantage-epo-gold","7"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","4","91661","NJ","Individual","No","22-0999690","91661NJ2340001","OMNIA Bronze","91661NJ234",,"NJN002","NJS001","NJF005","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340001-00","Standard Bronze Off Exchange Plan",,"0.612074494361877","Yes","Yes","Yes","47%","53%","$3,000","$500","$10","$150","$3,000","$0","$1,070","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50%","$3,000","per person not applicable","$6000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2016/sbc-omnia-bronze-standard","http://horizonblue.com/2016/brochure-omnia-bronze","4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","4","91661","NJ","Individual","No","22-0999690","91661NJ2340001","OMNIA Bronze","91661NJ234",,"NJN002","NJS001","NJF005","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340001-01","Standard Bronze On Exchange Plan",,"0.612074494361877","Yes","Yes","Yes","47%","53%","$3,000","$500","$10","$150","$3,000","$0","$1,070","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50%","$3,000","per person not applicable","$6000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2016/sbc-omnia-bronze-standard","http://horizonblue.com/2016/brochure-omnia-bronze","5"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","4","91661","NJ","Individual","No","22-0999690","91661NJ2340001","OMNIA Bronze","91661NJ234",,"NJN002","NJS001","NJF005","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","47%","53%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2016/sbc-omnia-bronze-zero-cost","http://horizonblue.com/2016/brochure-omnia-bronze-zero","6"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","4","91661","NJ","Individual","No","22-0999690","91661NJ2340001","OMNIA Bronze","91661NJ234",,"NJN002","NJS001","NJF005","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340001-03","Limited Cost Sharing Plan Variation",,"0.612074494361877","Yes","Yes","Yes","47%","53%","$3,000","$500","$10","$150","$3,000","$0","$1,070","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50%","$3,000","per person not applicable","$6000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2016/sbc-omnia-bronze-limited-cost","http://horizonblue.com/2016/brochure-omnia-bronze","7"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","5","91661","NJ","Individual","No","22-0999690","91661NJ2340002","OMNIA Silver","91661NJ234",,"NJN002","NJS001","NJF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340002-00","Standard Silver Off Exchange Plan","70.46%","0.704957127571106","No","Yes","Yes","52%","48%","$0","$520","$0","$330","$0","$900","$1,270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","per person not applicable","$1000 per group","0%","$2,500","per person not applicable","$5000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2016/sbc-omnia-silver-standard","http://horizonblue.com/2016/brochure-omnia-silver","4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","5","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300007","Advantage EPO HSA Bronze 100 Compatible","91661NJ230",,"NJN001","NJS001","NJF005","Existing","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2300007-00","Standard Bronze Off Exchange Plan",,"0.614730417728424","Yes","Yes","No","100%",,"$3,000","$500","$10","$150","$3,000","$230","$1,420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://horizonblue.com/2016/sbc-advantage-epo-100-30-50-bronze","http://horizonblue.com/2016/brochure-advantage-epo-100-30-50-bronze","4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","5","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300007","Advantage EPO HSA Bronze 100 Compatible","91661NJ230",,"NJN001","NJS001","NJF005","Existing","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2300007-01","Standard Bronze On Exchange Plan",,"0.614730417728424","Yes","Yes","No","100%",,"$3,000","$500","$10","$150","$3,000","$230","$1,420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://horizonblue.com/2016/sbc-advantage-epo-100-30-50-bronze","http://horizonblue.com/2016/brochure-advantage-epo-100-30-50-bronze","5"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","5","91661","NJ","Individual","No","22-0999690","91661NJ2340002","OMNIA Silver","91661NJ234",,"NJN002","NJS001","NJF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340002-01","Standard Silver On Exchange Plan","70.46%","0.698804974555969","No","Yes","Yes","52%","48%","$0","$520","$0","$330","$0","$900","$1,270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","per person not applicable","$1000 per group","0%","$2,500","per person not applicable","$5000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2016/sbc-omnia-silver-standard","http://horizonblue.com/2016/brochure-omnia-silver","5"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","5","91661","NJ","Individual","No","22-0999690","91661NJ2340002","OMNIA Silver","91661NJ234",,"NJN002","NJS001","NJF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","52%","48%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2016/sbc-omnia-silver-zero-cost","http://horizonblue.com/2016/brochure-omnia-silver-zero","6"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","5","91661","NJ","Individual","No","22-0999690","91661NJ2340002","OMNIA Silver","91661NJ234",,"NJN002","NJS001","NJF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340002-03","Limited Cost Sharing Plan Variation","70.46%","0.698804974555969","No","Yes","Yes","52%","48%","$0","$520","$0","$330","$0","$900","$1,270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","per person not applicable","$1000 per group","0%","$2,500","per person not applicable","$5000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2016/sbc-omnia-silver-limited-cost","http://horizonblue.com/2016/brochure-omnia-silver","7"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","5","91661","NJ","Individual","No","22-0999690","91661NJ2340002","OMNIA Silver","91661NJ234",,"NJN002","NJS001","NJF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340002-04","73% AV Level Silver Plan","73.79%","0.734896063804626","No","Yes","Yes","52%","48%","$0","$520","$0","$150","$0","$800","$1,270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","per person not applicable","$1000 per group","0%","$2,250","per person not applicable","$4500 per group","40%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40%","$0","$0 per person","$0 per group","40%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2016/sbc-omnia-silver-73av-level","http://horizonblue.com/2016/brochure-omnia-silver-73","8"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","5","91661","NJ","Individual","No","22-0999690","91661NJ2340002","OMNIA Silver","91661NJ234",,"NJN002","NJS001","NJF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340002-05","87% AV Level Silver Plan","87.58%","0.879769802093506","No","Yes","Yes","52%","48%","$0","$260","$0","$150","$0","$250","$1,270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%","$2,250","per person not applicable","$4500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2016/sbc-omnia-silver-87av-level","http://horizonblue.com/2016/brochure-omnia-silver-87","9"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","5","91661","NJ","Individual","No","22-0999690","91661NJ2340002","OMNIA Silver","91661NJ234",,"NJN002","NJS001","NJF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340002-06","94% AV Level Silver Plan","94.23%","0.939237058162689","No","Yes","Yes","52%","48%","$0","$160","$0","$150","$0","$70","$430","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%","$750","per person not applicable","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://horizonblue.com/2016/sbc-omnia-silver-94av-level","http://horizonblue.com/2016/brochure-omnia-silver-94","10"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","6","91661","NJ","Individual","No","22-0999690","91661NJ2340003","OMNIA Silver HSA","91661NJ234",,"NJN002","NJS001","NJF002","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340003-00","Standard Silver Off Exchange Plan",,"0.71085125207901","Yes","Yes","Yes","52%","48%","$1,500","$0","$310","$150","$1,500","$60","$1,200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%","$2,500","per person not applicable","$5000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://horizonblue.com/2016/sbc-omnia-silver-hsa-standard","http://horizonblue.com/2016/brochure-omnia-silver-hsa","4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","6","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300015","Advantage EPO HSA Silver 100 Compatible $750 Contrib.","91661NJ230",,"NJN001","NJS001","NJF005","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2300015-00","Standard Silver Off Exchange Plan",,"0.69704282283783","Yes","Yes","No","100%",,"$3,000","$500","$10","$150","$3,000","$230","$1,420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$750","http://horizonblue.com/2016/sbc-advantage-epo-100-30-50-silver","http://horizonblue.com/2016/brochure-advantage-epo-100-30-50-silver","4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","6","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300015","Advantage EPO HSA Silver 100 Compatible $750 Contrib.","91661NJ230",,"NJN001","NJS001","NJF005","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2300015-01","Standard Silver On Exchange Plan",,"0.69704282283783","Yes","Yes","No","100%",,"$3,000","$500","$10","$150","$3,000","$230","$1,420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$750","http://horizonblue.com/2016/sbc-advantage-epo-100-30-50-silver","http://horizonblue.com/2016/brochure-advantage-epo-100-30-50-silver","5"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","6","91661","NJ","Individual","No","22-0999690","91661NJ2340003","OMNIA Silver HSA","91661NJ234",,"NJN002","NJS001","NJF002","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340003-01","Standard Silver On Exchange Plan",,"0.71085125207901","Yes","Yes","Yes","52%","48%","$1,500","$0","$310","$150","$1,500","$60","$1,200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%","$2,500","per person not applicable","$5000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://horizonblue.com/2016/sbc-omnia-silver-hsa-standard","http://horizonblue.com/2016/brochure-omnia-silver-hsa","5"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","6","91661","NJ","Individual","No","22-0999690","91661NJ2340003","OMNIA Silver HSA","91661NJ234",,"NJN002","NJS001","NJF002","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","52%","48%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://horizonblue.com/2016/sbc-omnia-silver-hsa-zero-cost","http://horizonblue.com/2016/brochure-omnia-silver-hsa-zero","6"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","6","91661","NJ","Individual","No","22-0999690","91661NJ2340003","OMNIA Silver HSA","91661NJ234",,"NJN002","NJS001","NJF002","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340003-03","Limited Cost Sharing Plan Variation",,"0.71085125207901","Yes","Yes","Yes","52%","48%","$1,500","$0","$310","$150","$1,500","$60","$1,200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%","$2,500","per person not applicable","$5000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://horizonblue.com/2016/sbc-omnia-silver-hsa-limited-cost","http://horizonblue.com/2016/brochure-omnia-silver-hsa","7"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","6","91661","NJ","Individual","No","22-0999690","91661NJ2340003","OMNIA Silver HSA","91661NJ234",,"NJN002","NJS001","NJF002","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340003-04","73% AV Level Silver Plan",,"0.738474369049072","Yes","Yes","Yes","52%","48%","$1,200","$0","$340","$150","$1,200","$80","$1,210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","per person not applicable","$2400 per group","10%","$2,000","per person not applicable","$4000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://horizonblue.com/2016/sbc-omnia-silver-hsa-73av-level","http://horizonblue.com/2016/brochure-omnia-silver-hsa-73","8"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","6","91661","NJ","Individual","No","22-0999690","91661NJ2340003","OMNIA Silver HSA","91661NJ234",,"NJN002","NJS001","NJF002","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340003-05","87% AV Level Silver Plan",,"0.869422852993011","Yes","Yes","Yes","52%","48%","$500","$0","$400","$150","$500","$110","$390","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","10%","$1,000","per person not applicable","$2000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://horizonblue.com/2016/sbc-omnia-silver-hsa-87av-level","http://horizonblue.com/2016/brochure-omnia-silver-hsa-87","9"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","6","91661","NJ","Individual","No","22-0999690","91661NJ2340003","OMNIA Silver HSA","91661NJ234",,"NJN002","NJS001","NJF002","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340003-06","94% AV Level Silver Plan",,"0.935770809650421","Yes","Yes","Yes","52%","48%","$250","$0","$150","$150","$250","$80","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","per person not applicable","$500 per group","10%","$500","per person not applicable","$1000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://horizonblue.com/2016/sbc-omnia-silver-hsa-94av-level","http://horizonblue.com/2016/brochure-omnia-silver-hsa-94","10"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","6","91661","NJ","Individual","No","22-0999690","91661NJ2340004","OMNIA Gold","91661NJ234",,"NJN002","NJS001","NJF003","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340004-00","Standard Gold Off Exchange Plan","81.15%","0","Yes","Yes","Yes","57%","43%","$0","$500","$0","$150","$0","$100","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$2,500","per person not applicable","$5000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2016/sbc-omnia-gold-standard","http://horizonblue.com/2016/brochure-omnia-gold","11"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","6","91661","NJ","Individual","No","22-0999690","91661NJ2340004","OMNIA Gold","91661NJ234",,"NJN002","NJS001","NJF003","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340004-01","Standard Gold On Exchange Plan","81.15%","0","Yes","Yes","Yes","57%","43%","$0","$500","$0","$150","$0","$100","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$2,500","per person not applicable","$5000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2016/sbc-omnia-gold-standard","http://horizonblue.com/2016/brochure-omnia-gold","12"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","6","91661","NJ","Individual","No","22-0999690","91661NJ2340004","OMNIA Gold","91661NJ234",,"NJN002","NJS001","NJF003","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","57%","43%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2016/sbc-omnia-gold-zero-cost","http://horizonblue.com/2016/brochure-omnia-gold-zero","13"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","6","91661","NJ","Individual","No","22-0999690","91661NJ2340004","OMNIA Gold","91661NJ234",,"NJN002","NJS001","NJF003","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340004-03","Limited Cost Sharing Plan Variation","81.15%","0","Yes","Yes","Yes","57%","43%","$0","$500","$0","$150","$0","$100","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$2,500","per person not applicable","$5000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2016/sbc-omnia-gold-limited-cost","http://horizonblue.com/2016/brochure-omnia-gold","14"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","6","91661","NJ","Individual","No","22-0999690","91661NJ2340005","OMNIA Platinum","91661NJ234",,"NJN002","NJS001","NJF001","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340005-00","Standard Platinum Off Exchange Plan","90.56%","0","Yes","Yes","Yes","62%","38%","$0","$310","$0","$150","$0","$250","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","0%","$1,000","per person not applicable","$2000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2016/sbc-omnia-platinum-standard","http://horizonblue.com/2016/brochure-omnia-platinum","15"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","6","91661","NJ","Individual","No","22-0999690","91661NJ2340005","OMNIA Platinum","91661NJ234",,"NJN002","NJS001","NJF001","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340005-01","Standard Platinum On Exchange Plan","90.56%","0","Yes","Yes","Yes","62%","38%","$0","$310","$0","$150","$0","$250","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","0%","$1,000","per person not applicable","$2000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2016/sbc-omnia-platinum-standard","http://horizonblue.com/2016/brochure-omnia-platinum","16"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","6","91661","NJ","Individual","No","22-0999690","91661NJ2340005","OMNIA Platinum","91661NJ234",,"NJN002","NJS001","NJF001","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","62%","38%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2016/sbc-omnia-platinum-zero-cost","http://horizonblue.com/2016/brochure-omnia-platinum-zero","17"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","6","91661","NJ","Individual","No","22-0999690","91661NJ2340005","OMNIA Platinum","91661NJ234",,"NJN002","NJS001","NJF001","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.9995",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2340005-03","Limited Cost Sharing Plan Variation","90.56%","0","Yes","Yes","Yes","62%","38%","$0","$310","$0","$150","$0","$250","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","0%","$1,000","per person not applicable","$2000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2016/sbc-omnia-platinum-limited-cost","http://horizonblue.com/2016/brochure-omnia-platinum","18"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","8","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300018","Patient Centered Advantage EPO Silver 20/30/70%","91661NJ230",,"NJN001","NJS001","NJF011","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2300018-00","Standard Silver Off Exchange Plan",,"0.718899965286255","Yes","Yes","No","100%",,"$2,000","$20","$740","$150","$2,000","$400","$440","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2016/sbc-patient-centered-advantage-epo-silver","http://horizonblue.com/2016/brochure-patient-centered-advantage-epo-silver","4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","8","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300018","Patient Centered Advantage EPO Silver 20/30/70%","91661NJ230",,"NJN001","NJS001","NJF011","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2300018-01","Standard Silver On Exchange Plan",,"0.718899965286255","Yes","Yes","No","100%",,"$2,000","$20","$740","$150","$2,000","$400","$440","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2016/sbc-patient-centered-advantage-epo-silver","http://horizonblue.com/2016/brochure-patient-centered-advantage-epo-silver","5"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","9","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300019","Patient Centered Advantage EPO Gold 5/20/40","91661NJ230",,"NJN001","NJS001","NJF003","Existing","EPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2300019-00","Standard Gold Off Exchange Plan",,"0.792804300785065","No","Yes","No","100%",,"$1,000","$20","$690","$150","$1,000","$430","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://horizonblue.com/2016/sbc-patient-centered-advantage-epo-gold","http://horizonblue.com/2016/brochure-patient-centered-advantage-epo-gold","4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","9","91661","NJ","Individual","No","22-0999690","91661NJ2280001","Horizon Advantage EPO Essentials","91661NJ228",,"NJN001","NJS001","NJF006","Existing","EPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2280001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,600","$0","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2016/sbc-advantage-epo-catastrophic","http://horizonblue.com/2016/brochure-advantage-epo-catastrophic","4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","9","91661","NJ","Individual","No","22-0999690","91661NJ2280001","Horizon Advantage EPO Essentials","91661NJ228",,"NJN001","NJS001","NJF006","Existing","EPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"No",,"No",,"No","https://shop.horizonblue.com/payment/651908c0-412a-4923-8567-37d33dfb51f7","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2280001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,600","$0","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://horizonblue.com/2016/sbc-advantage-epo-catastrophic","http://horizonblue.com/2016/brochure-advantage-epo-catastrophic","5"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","9","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300019","Patient Centered Advantage EPO Gold 5/20/40","91661NJ230",,"NJN001","NJS001","NJF003","Existing","EPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2300019-01","Standard Gold On Exchange Plan",,"0.792804300785065","No","Yes","No","100%",,"$1,000","$20","$690","$150","$1,000","$430","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://horizonblue.com/2016/sbc-patient-centered-advantage-epo-gold","http://horizonblue.com/2016/brochure-patient-centered-advantage-epo-gold","5"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","10","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300004","Advantage EPO Silver 100/70","91661NJ230",,"NJN001","NJS001","NJF010","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2300004-00","Standard Silver Off Exchange Plan",,"0.717572152614594","Yes","Yes","No","100%",,"$1,500","$20","$890","$150","$1,120","$680","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2016/sbc-advantage-epo-100-70","http://horizonblue.com/2016/brochure-advantage-epo-100-70","4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","10","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300004","Advantage EPO Silver 100/70","91661NJ230",,"NJN001","NJS001","NJF010","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2300004-01","Standard Silver On Exchange Plan",,"0.717572152614594","Yes","Yes","No","100%",,"$1,500","$20","$890","$150","$1,120","$680","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2016/sbc-advantage-epo-100-70","http://horizonblue.com/2016/brochure-advantage-epo-100-70","5"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","11","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2350001","OMNIA Bronze","91661NJ235",,"NJN002","NJS001","NJF005","New","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2350001-00","Standard Bronze Off Exchange Plan",,"0.612074494361877","Yes","Yes","Yes","47%","53%","$3,000","$500","$10","$150","$3,000","$0","$1,070","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50%","$3,000","per person not applicable","$6000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2016/sbc-omnia-bronze-standard-sg","http://horizonblue.com/2016/brochure-omnia-bronze-standard-sg","4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","11","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2350001","OMNIA Bronze","91661NJ235",,"NJN002","NJS001","NJF005","New","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2350001-01","Standard Bronze On Exchange Plan",,"0.612074494361877","Yes","Yes","Yes","47%","53%","$3,000","$500","$10","$150","$3,000","$0","$1,070","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","50%","$3,000","per person not applicable","$6000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2016/sbc-omnia-bronze-standard-sg","http://horizonblue.com/2016/brochure-omnia-bronze-standard-sg","5"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","12","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2350002","OMNIA Silver","91661NJ235",,"NJN002","NJS001","NJF004","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2350002-00","Standard Silver Off Exchange Plan","71.09%","0.707294821739197","No","Yes","Yes","52%","48%","$0","$520","$0","$330","$0","$900","$1,270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","per person not applicable","$1000 per group","0%","$2,500","per person not applicable","$5000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://horizonblue.com/2016/sbc-omnia-silver-standard-sg","http://horizonblue.com/2016/brochure-omnia-silver-standard-sg","4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","12","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2350002","OMNIA Silver","91661NJ235",,"NJN002","NJS001","NJF004","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2350002-01","Standard Silver On Exchange Plan","71.09%","0.707294821739197","No","Yes","Yes","52%","48%","$0","$520","$0","$330","$0","$900","$1,270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","per person not applicable","$1000 per group","0%","$2,500","per person not applicable","$5000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://horizonblue.com/2016/sbc-omnia-silver-standard-sg","http://horizonblue.com/2016/brochure-omnia-silver-standard-sg","5"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","13","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2350003","OMNIA Silver HSA","91661NJ235",,"NJN002","NJS001","NJF002","New","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2350003-00","Standard Silver Off Exchange Plan",,"0.710442662239075","Yes","Yes","Yes","52%","48%","$1,500","$0","$310","$150","$1,500","$60","$1,200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%","$2,500","per person not applicable","$5000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2016/sbc-omnia-silver-hsa-standard-sg","http://horizonblue.com/2016/brochure-omnia-silver-hsa-standard-sg","4"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","13","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2350003","OMNIA Silver HSA","91661NJ235",,"NJN002","NJS001","NJF002","New","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2350003-01","Standard Silver On Exchange Plan",,"0.710442662239075","Yes","Yes","Yes","52%","48%","$1,500","$0","$310","$150","$1,500","$60","$1,200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%","$2,500","per person not applicable","$5000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2016/sbc-omnia-silver-hsa-standard-sg","http://horizonblue.com/2016/brochure-omnia-silver-hsa-standard-sg","5"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","13","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2350004","OMNIA Gold","91661NJ235",,"NJN002","NJS001","NJF003","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2350004-00","Standard Gold Off Exchange Plan","81.15%","0.811510622501373","Yes","Yes","Yes","57%","43%","$0","$500","$0","$150","$0","$100","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$2,500","per person not applicable","$5000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2016/sbc-omnia-gold-standard-sg","http://horizonblue.com/2016/brochure-omnia-gold-standard-sg","6"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","13","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2350004","OMNIA Gold","91661NJ235",,"NJN002","NJS001","NJF003","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2350004-01","Standard Gold On Exchange Plan","81.15%","0.811510622501373","Yes","Yes","Yes","57%","43%","$0","$500","$0","$150","$0","$100","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$2,500","per person not applicable","$5000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2016/sbc-omnia-gold-standard-sg","http://horizonblue.com/2016/brochure-omnia-gold-standard-sg","7"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","13","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2350005","OMNIA Platinum","91661NJ235",,"NJN002","NJS001","NJF001","New","EPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2350005-00","Standard Platinum Off Exchange Plan","90.56%","0.905606031417847","Yes","Yes","Yes","62%","38%","$0","$310","$0","$150","$0","$250","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","0%","$1,000","per person not applicable","$2000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2016/sbc-omnia-platinum-standard-sg","http://horizonblue.com/2016/brochure-omnia-platinum-standard-sg","8"
"2016","NJ","91661","HIOS","10","2016-01-23 05:53:30","13","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2350005","OMNIA Platinum","91661NJ235",,"NJN002","NJS001","NJF001","New","EPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"No",,"No",,"No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NJ_3T_HealthInsuranceMarketplaceAdvantage.pdf","91661NJ2350005-01","Standard Platinum On Exchange Plan","90.56%","0.905606031417847","Yes","Yes","Yes","62%","38%","$0","$310","$0","$150","$0","$250","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","0%","$1,000","per person not applicable","$2000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://horizonblue.com/2016/sbc-omnia-platinum-standard-sg","http://horizonblue.com/2016/brochure-omnia-platinum-standard-sg","9"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","1","91762","NJ","Individual","No","22-3338404","91762NJ0070001","IHC Bronze EPO H.S.A Local Value  $50/$75","91762NJ007",,"NJN002","NJS002","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070001-00","Standard Bronze Off Exchange Plan",,"0.612155139446259","Yes","Yes","No","100%",,"$2,500","$500","$11","$150","$390","$175","$82","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC102V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","1","91762","NJ","Individual","Yes","22-3338404","91762NJ0120001","IHC Pediatric Dental","91762NJ012",,"NJN005","NJS006",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$26.29","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","91762NJ0120001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","1","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080001","SEH Bronze EPO H.S.A Local Value  $50/$75","91762NJ008",,"NJN002","NJS002","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080001-00","Standard Bronze Off Exchange Plan",,"0.612210392951965","Yes","Yes","No","100%",,"$2,500","$500","$11","$150","$390","$175","$82","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH102V_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","4","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080019","SEH Silver EPO Community Advantage  $15/$35","91762NJ008",,"NJN004","NJS004","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080019-01","Standard Silver On Exchange Plan",,"0.711044132709503","No","Yes","Yes","50%","50%","$2,000","$14","$530","$150","$84","$120","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH265CA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","4","91762","NJ","Individual","No","22-3338404","91762NJ0070097","IHC Bronze EPO AmeriHealth Advantage  $25/$50","91762NJ007",,"NJN004","NJS005","NJF001","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070097-01","Standard Bronze On Exchange Plan",,"0.618296682834625","Yes","Yes","Yes","50%","50%","$2,500","$250","$11","$150","$889","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%","$3,000","$3000 per person","$6000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC166MA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","4","91762","NJ","Individual","No","22-3338404","91762NJ0070097","IHC Bronze EPO AmeriHealth Advantage  $25/$50","91762NJ007",,"NJN004","NJS005","NJF001","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070097-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","50%","50%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCMAZERO.pdf",,"6"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","4","91762","NJ","Individual","No","22-3338404","91762NJ0070097","IHC Bronze EPO AmeriHealth Advantage  $25/$50","91762NJ007",,"NJN004","NJS005","NJF001","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070097-03","Limited Cost Sharing Plan Variation",,"0.618296682834625","Yes","Yes","Yes","50%","50%","$2,500","$250","$11","$150","$889","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%","$3,000","$3000 per person","$6000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC166MALTD.pdf",,"7"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","4","91762","NJ","Individual","No","22-3338404","91762NJ0070097","IHC Bronze EPO AmeriHealth Advantage  $25/$50","91762NJ007",,"NJN004","NJS005","NJF001","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070097-00","Standard Bronze Off Exchange Plan",,"0.618296682834625","Yes","Yes","Yes","50%","50%","$2,500","$250","$11","$150","$889","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%","$3,000","$3000 per person","$6000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC166MA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","4","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080019","SEH Silver EPO Community Advantage  $15/$35","91762NJ008",,"NJN004","NJS004","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080019-00","Standard Silver Off Exchange Plan",,"0.711044132709503","No","Yes","Yes","50%","50%","$2,000","$14","$530","$150","$84","$120","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH265CA_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","5","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080023","SEH Gold EPO Regional Preferred $30/$50; 80% Coins","91762NJ008",,"NJN001","NJS001","NJF002","Existing","EPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080023-01","Standard Gold On Exchange Plan",,"0.79499363899231","No","Yes","No","100%",,"$1,000","$70","$694","$150","$0","$250","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH304P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","5","91762","NJ","Individual","No","22-3338404","91762NJ0070082","IHC Gold EPO Community Advantage  $10/$20","91762NJ007",,"NJN004","NJS004","NJF002","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070082-01","Standard Gold On Exchange Plan",,"0.815857887268066","No","Yes","Yes","60%","40%","$1,000","$70","$347","$150","$0","$180","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$4,250","$4250 per person","$8500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%","$1,000","$1000 per person","$2000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC365CA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","5","91762","NJ","Individual","No","22-3338404","91762NJ0070082","IHC Gold EPO Community Advantage  $10/$20","91762NJ007",,"NJN004","NJS004","NJF002","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070082-00","Standard Gold Off Exchange Plan",,"0.815857887268066","No","Yes","Yes","60%","40%","$1,000","$70","$347","$150","$0","$180","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$4,250","$4250 per person","$8500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%","$1,000","$1000 per person","$2000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC365CA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","5","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080023","SEH Gold EPO Regional Preferred $30/$50; 80% Coins","91762NJ008",,"NJN001","NJS001","NJF002","Existing","EPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080023-00","Standard Gold Off Exchange Plan",,"0.79499363899231","No","Yes","No","100%",,"$1,000","$70","$694","$150","$0","$250","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH304P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","1","91762","NJ","SHOP (Small Group)","Yes","22-3338404","91762NJ0130001","SEH Pediatric Dental","91762NJ013",,"NJN005","NJS006",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$26.29","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","91762NJ0130001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","1","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080001","SEH Bronze EPO H.S.A Local Value  $50/$75","91762NJ008",,"NJN002","NJS002","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080001-01","Standard Bronze On Exchange Plan",,"0.612210392951965","Yes","Yes","No","100%",,"$2,500","$500","$11","$150","$390","$175","$82","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH102V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","1","91762","NJ","Individual","No","22-3338404","91762NJ0070001","IHC Bronze EPO H.S.A Local Value  $50/$75","91762NJ007",,"NJN002","NJS002","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070001-01","Standard Bronze On Exchange Plan",,"0.612155139446259","Yes","Yes","No","100%",,"$2,500","$500","$11","$150","$390","$175","$82","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC102V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","1","91762","NJ","Individual","No","22-3338404","91762NJ0070001","IHC Bronze EPO H.S.A Local Value  $50/$75","91762NJ007",,"NJN002","NJS002","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCVZERO.pdf",,"6"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","1","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080002","SEH Bronze EPO H.S.A Regional Preferred $50/$75","91762NJ008",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080002-00","Standard Bronze Off Exchange Plan",,"0.612210392951965","Yes","Yes","No","100%",,"$2,500","$500","$11","$150","$390","$175","$82","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH102P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","6"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","1","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080002","SEH Bronze EPO H.S.A Regional Preferred $50/$75","91762NJ008",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080002-01","Standard Bronze On Exchange Plan",,"0.612210392951965","Yes","Yes","No","100%",,"$2,500","$500","$11","$150","$390","$175","$82","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH102P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","7"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","1","91762","NJ","Individual","No","22-3338404","91762NJ0070001","IHC Bronze EPO H.S.A Local Value  $50/$75","91762NJ007",,"NJN002","NJS002","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070001-03","Limited Cost Sharing Plan Variation",,"0.612155139446259","Yes","Yes","No","100%",,"$2,500","$500","$11","$150","$390","$175","$82","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC102VLTD.pdf",,"7"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","1","91762","NJ","Individual","No","22-3338404","91762NJ0070002","IHC Bronze EPO H.S.A Regional Preferred $50/$75","91762NJ007",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070002-00","Standard Bronze Off Exchange Plan",,"0.612155139446259","Yes","Yes","No","100%",,"$2,500","$500","$11","$150","$390","$175","$82","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC102P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","8"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","1","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080003","SEH Bronze EPO H.S.A National Access $50/$75","91762NJ008",,"NJN003","NJS003","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080003-00","Standard Bronze Off Exchange Plan",,"0.612210392951965","Yes","Yes","No","100%",,"$2,500","$500","$11","$150","$390","$175","$82","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH102N_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","8"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","1","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080003","SEH Bronze EPO H.S.A National Access $50/$75","91762NJ008",,"NJN003","NJS003","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080003-01","Standard Bronze On Exchange Plan",,"0.612210392951965","Yes","Yes","No","100%",,"$2,500","$500","$11","$150","$390","$175","$82","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH102N.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","9"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","1","91762","NJ","Individual","No","22-3338404","91762NJ0070002","IHC Bronze EPO H.S.A Regional Preferred $50/$75","91762NJ007",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070002-01","Standard Bronze On Exchange Plan",,"0.612155139446259","Yes","Yes","No","100%",,"$2,500","$500","$11","$150","$390","$175","$82","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC102P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","9"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","1","91762","NJ","Individual","No","22-3338404","91762NJ0070002","IHC Bronze EPO H.S.A Regional Preferred $50/$75","91762NJ007",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCPZERO.pdf",,"10"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","1","91762","NJ","Individual","No","22-3338404","91762NJ0070002","IHC Bronze EPO H.S.A Regional Preferred $50/$75","91762NJ007",,"NJN001","NJS001","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070002-03","Limited Cost Sharing Plan Variation",,"0.612155139446259","Yes","Yes","No","100%",,"$2,500","$500","$11","$150","$390","$175","$82","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC102PLTD.pdf",,"11"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","1","91762","NJ","Individual","No","22-3338404","91762NJ0070003","IHC Bronze EPO H.S.A National Access $50/$75","91762NJ007",,"NJN003","NJS003","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070003-00","Standard Bronze Off Exchange Plan",,"0.612155139446259","Yes","Yes","No","100%",,"$2,500","$500","$11","$150","$390","$175","$82","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC102N.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","12"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","1","91762","NJ","Individual","No","22-3338404","91762NJ0070003","IHC Bronze EPO H.S.A National Access $50/$75","91762NJ007",,"NJN003","NJS003","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070003-01","Standard Bronze On Exchange Plan",,"0.612155139446259","Yes","Yes","No","100%",,"$2,500","$500","$11","$150","$390","$175","$82","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC102N.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","13"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","1","91762","NJ","Individual","No","22-3338404","91762NJ0070003","IHC Bronze EPO H.S.A National Access $50/$75","91762NJ007",,"NJN003","NJS003","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCNZERO.pdf",,"14"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","1","91762","NJ","Individual","No","22-3338404","91762NJ0070003","IHC Bronze EPO H.S.A National Access $50/$75","91762NJ007",,"NJN003","NJS003","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070003-03","Limited Cost Sharing Plan Variation",,"0.612155139446259","Yes","Yes","No","100%",,"$2,500","$500","$11","$150","$390","$175","$82","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC102NLTD.pdf",,"15"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","2","91762","NJ","Individual","No","22-3338404","91762NJ0070004","IHC Bronze EPO Tier 1 Advantage  $50/$75","91762NJ007",,"NJN002","NJS002","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070004-00","Standard Bronze Off Exchange Plan",,"0.616746604442596","Yes","Yes","Yes","50%","50%","$2,500","$0","$11","$150","$889","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%","$3,000","$3000 per person","$6000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC151TIER.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","2","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080004","SEH Bronze EPO Tier 1 Advantage  $50/$75","91762NJ008",,"NJN002","NJS002","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080004-00","Standard Bronze Off Exchange Plan",,"0.616746604442596","Yes","Yes","Yes","50%","50%","$2,500","$0","$11","$150","$889","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%","$3,000","$3000 per person","$6000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH151TIER_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","2","91762","NJ","Individual","Yes","22-3338404","91762NJ0120002","IHC Pediatric Dental with Adult Preventative","91762NJ012",,"NJN005","NJS006",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$26.29","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","91762NJ0120002-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","2","91762","NJ","SHOP (Small Group)","Yes","22-3338404","91762NJ0130002","SEH Pediatric Dental with Adult Preventative","91762NJ013",,"NJN005","NJS006",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$26.29","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","91762NJ0130002-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","2","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080004","SEH Bronze EPO Tier 1 Advantage  $50/$75","91762NJ008",,"NJN002","NJS002","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080004-01","Standard Bronze On Exchange Plan",,"0.616746604442596","Yes","Yes","Yes","50%","50%","$2,500","$0","$11","$150","$889","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%","$3,000","$3000 per person","$6000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH151TIER.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","2","91762","NJ","Individual","No","22-3338404","91762NJ0070004","IHC Bronze EPO Tier 1 Advantage  $50/$75","91762NJ007",,"NJN002","NJS002","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070004-01","Standard Bronze On Exchange Plan",,"0.616746604442596","Yes","Yes","Yes","50%","50%","$2,500","$0","$11","$150","$889","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%","$3,000","$3000 per person","$6000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC151TIER.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","2","91762","NJ","Individual","No","22-3338404","91762NJ0070004","IHC Bronze EPO Tier 1 Advantage  $50/$75","91762NJ007",,"NJN002","NJS002","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","50%","50%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCTIERZERO.pdf",,"6"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","2","91762","NJ","Individual","No","22-3338404","91762NJ0070004","IHC Bronze EPO Tier 1 Advantage  $50/$75","91762NJ007",,"NJN002","NJS002","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070004-03","Limited Cost Sharing Plan Variation",,"0.616746604442596","Yes","Yes","Yes","50%","50%","$2,500","$0","$11","$150","$889","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%","$3,000","$3000 per person","$6000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC151TIERLTD.pdf",,"7"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","3","91762","NJ","Individual","No","22-3338404","91762NJ0070081","IHC Bronze EPO Community Advantage  $25/$50","91762NJ007",,"NJN004","NJS004","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070081-00","Standard Bronze Off Exchange Plan",,"0.618296682834625","Yes","Yes","Yes","50%","50%","$2,500","$250","$11","$150","$889","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%","$3,000","$3000 per person","$6000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC165CA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","3","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080018","SEH Silver EPO H.S.A Tier 1 Advantage  $50/$75","91762NJ008",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080018-00","Standard Silver Off Exchange Plan",,"0.6856889128685","Yes","Yes","Yes","60%","40%","$1,341","$14","$306","$150","$733","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","50%","$1,350","$2700 per person","$2700 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH251TIER_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","3","91762","NJ","SHOP (Small Group)","Yes","22-3338404","91762NJ0130003","SEH Family Dental Plan","91762NJ013",,"NJN005","NJS006",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$26.29","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","91762NJ0130003-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","3","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080018","SEH Silver EPO H.S.A Tier 1 Advantage  $50/$75","91762NJ008",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080018-01","Standard Silver On Exchange Plan",,"0.6856889128685","Yes","Yes","Yes","60%","40%","$1,341","$14","$306","$150","$733","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","50%","$1,350","$2700 per person","$2700 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH251TIER.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","3","91762","NJ","Individual","No","22-3338404","91762NJ0070081","IHC Bronze EPO Community Advantage  $25/$50","91762NJ007",,"NJN004","NJS004","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070081-01","Standard Bronze On Exchange Plan",,"0.618296682834625","Yes","Yes","Yes","50%","50%","$2,500","$250","$11","$150","$889","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%","$3,000","$3000 per person","$6000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC165CA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","3","91762","NJ","Individual","No","22-3338404","91762NJ0070081","IHC Bronze EPO Community Advantage  $25/$50","91762NJ007",,"NJN004","NJS004","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070081-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","50%","50%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCCAZERO.pdf",,"6"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","3","91762","NJ","Individual","No","22-3338404","91762NJ0070081","IHC Bronze EPO Community Advantage  $25/$50","91762NJ007",,"NJN004","NJS004","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070081-03","Limited Cost Sharing Plan Variation",,"0.618296682834625","Yes","Yes","Yes","50%","50%","$2,500","$250","$11","$150","$889","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%","$3,000","$3000 per person","$6000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC165CALTD.pdf",,"7"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","5","91762","NJ","Individual","No","22-3338404","91762NJ0070082","IHC Gold EPO Community Advantage  $10/$20","91762NJ007",,"NJN004","NJS004","NJF002","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070082-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","60%","40%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCCAZERO.pdf",,"6"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","9","91762","NJ","Individual","No","22-3338404","91762NJ0070007","IHC Silver EPO H.S.A. Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070007-05","87% AV Level Silver Plan",,"0.870682299137115","Yes","Yes","Yes","60%","40%","$300","$14","$535","$150","$240","$88","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10%","$300","$300 per person","$600 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC251TIER87.pdf",,"9"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","9","91762","NJ","Individual","No","22-3338404","91762NJ0070007","IHC Silver EPO H.S.A. Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070007-06","94% AV Level Silver Plan",,"0.936441600322723","Yes","Yes","Yes","60%","40%","$50","$14","$535","$150","$168","$87","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","10%","$50","$50 per person","$100 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC251TIER94.pdf",,"10"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","14","91762","NJ","Individual","No","22-3338404","91762NJ0110001","IHC Platinum POS Plus National Access $15/$25","91762NJ011",,"NJN003","NJS003","NJF002","Existing","POS","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0110001-01","Standard Platinum On Exchange Plan","89.53%",,"No","Yes","No","100%",,"$0","$645","$0","$150","$0","$195","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC606N.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","14","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080050","SEH Silver EPO H.S.A Local Value 100%/100%","91762NJ008",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080050-01","Standard Silver On Exchange Plan",,"0.717892825603485","Yes","Yes","No","100%",,"$2,350","$14","$0","$150","$1,042","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$4700 per person","$4700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH299V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","14","91762","NJ","Individual","No","22-3338404","91762NJ0110001","IHC Platinum POS Plus National Access $15/$25","91762NJ011",,"NJN003","NJS003","NJF002","Existing","POS","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0110001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCNZERO.pdf",,"6"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050002","Gold Compass 1000","45480OK005",,"OKN001","OKS001","OKF004","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0005&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","10"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050002","Gold Compass 1000","45480OK005",,"OKN001","OKS001","OKF004","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050002-03","Limited Cost Sharing Plan Variation","78.10%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0006&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","11"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","5","91762","NJ","Individual","No","22-3338404","91762NJ0070082","IHC Gold EPO Community Advantage  $10/$20","91762NJ007",,"NJN004","NJS004","NJF002","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070082-03","Limited Cost Sharing Plan Variation",,"0.815857887268066","No","Yes","Yes","60%","40%","$1,000","$70","$347","$150","$0","$180","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$4,250","$4250 per person","$8500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%","$1,000","$1000 per person","$2000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC365CALTD.pdf",,"7"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","6","91762","NJ","Individual","No","22-3338404","91762NJ0070096","IHC Gold EPO AmeriHealth Advantage  $10/$20","91762NJ007",,"NJN004","NJS005","NJF002","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070096-00","Standard Gold Off Exchange Plan",,"0.815857887268066","No","Yes","Yes","60%","40%","$1,000","$70","$347","$150","$0","$180","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$4,250","$4250 per person","$8500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%","$1,000","$1000 per person","$2000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC366MA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","6","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080052","SEH Bronze EPO Community Advantage  $25/$50","91762NJ008",,"NJN004","NJS004","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080052-00","Standard Bronze Off Exchange Plan",,"0.618296682834625","Yes","Yes","Yes","50%","50%","$2,500","$250","$11","$150","$889","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%","$3,000","$3000 per person","$6000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH165CA_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","6","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080052","SEH Bronze EPO Community Advantage  $25/$50","91762NJ008",,"NJN004","NJS004","NJF001","Existing","EPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080052-01","Standard Bronze On Exchange Plan",,"0.618296682834625","Yes","Yes","Yes","50%","50%","$2,500","$250","$11","$150","$889","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%","$3,000","$3000 per person","$6000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH165CA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","6","91762","NJ","Individual","No","22-3338404","91762NJ0070096","IHC Gold EPO AmeriHealth Advantage  $10/$20","91762NJ007",,"NJN004","NJS005","NJF002","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070096-01","Standard Gold On Exchange Plan",,"0.815857887268066","No","Yes","Yes","60%","40%","$1,000","$70","$347","$150","$0","$180","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$4,250","$4250 per person","$8500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%","$1,000","$1000 per person","$2000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC366MA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","6","91762","NJ","Individual","No","22-3338404","91762NJ0070096","IHC Gold EPO AmeriHealth Advantage  $10/$20","91762NJ007",,"NJN004","NJS005","NJF002","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070096-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","60%","40%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCMAZERO.pdf",,"6"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","6","91762","NJ","Individual","No","22-3338404","91762NJ0070096","IHC Gold EPO AmeriHealth Advantage  $10/$20","91762NJ007",,"NJN004","NJS005","NJF002","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070096-03","Limited Cost Sharing Plan Variation",,"0.815857887268066","No","Yes","Yes","60%","40%","$1,000","$70","$347","$150","$0","$180","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$4,250","$4250 per person","$8500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%","$1,000","$1000 per person","$2000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC366MALTD.pdf",,"7"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","7","91762","NJ","Individual","No","22-3338404","91762NJ0070093","IHC Silver EPO AmeriHealth Advantage $15/$35","91762NJ007",,"NJN004","NJS005","NJF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070093-00","Standard Silver Off Exchange Plan",,"0.711044132709503","No","Yes","Yes","50%","50%","$2,000","$14","$530","$150","$0","$120","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC266MA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","7","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080053","SEH Gold EPO Community Advantage  $10/$20","91762NJ008",,"NJN004","NJS004","NJF002","Existing","EPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080053-00","Standard Gold Off Exchange Plan",,"0.815857887268066","No","Yes","Yes","60%","40%","$1,000","$70","$347","$150","$0","$180","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$4,250","$4250 per person","$8500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%","$1,000","$1000 per person","$2000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH365CA_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","7","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080053","SEH Gold EPO Community Advantage  $10/$20","91762NJ008",,"NJN004","NJS004","NJF002","Existing","EPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080053-01","Standard Gold On Exchange Plan",,"0.815857887268066","No","Yes","Yes","60%","40%","$1,000","$70","$347","$150","$0","$180","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$4,250","$4250 per person","$8500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%","$1,000","$1000 per person","$2000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH365CA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","7","91762","NJ","Individual","No","22-3338404","91762NJ0070093","IHC Silver EPO AmeriHealth Advantage $15/$35","91762NJ007",,"NJN004","NJS005","NJF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070093-01","Standard Silver On Exchange Plan",,"0.711044132709503","No","Yes","Yes","50%","50%","$2,000","$14","$530","$150","$0","$120","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC266MA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","7","91762","NJ","Individual","No","22-3338404","91762NJ0070093","IHC Silver EPO AmeriHealth Advantage $15/$35","91762NJ007",,"NJN004","NJS005","NJF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070093-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","50%","50%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCMAZERO.pdf",,"6"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","7","91762","NJ","Individual","No","22-3338404","91762NJ0070093","IHC Silver EPO AmeriHealth Advantage $15/$35","91762NJ007",,"NJN004","NJS005","NJF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070093-03","Limited Cost Sharing Plan Variation",,"0.711044132709503","No","Yes","Yes","50%","50%","$2,000","$14","$530","$150","$0","$120","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC266MALTD.pdf",,"7"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","7","91762","NJ","Individual","No","22-3338404","91762NJ0070093","IHC Silver EPO AmeriHealth Advantage $15/$35","91762NJ007",,"NJN004","NJS005","NJF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070093-04","73% AV Level Silver Plan",,"0.731761574745178","No","Yes","Yes","50%","50%","$2,000","$14","$530","$150","$0","$120","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC266MA73.pdf",,"8"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","7","91762","NJ","Individual","No","22-3338404","91762NJ0070093","IHC Silver EPO AmeriHealth Advantage $15/$35","91762NJ007",,"NJN004","NJS005","NJF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070093-05","87% AV Level Silver Plan",,"0.862999498844147","No","Yes","Yes","50%","50%","$300","$14","$713","$150","$153","$120","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","20%","$300","$300 per person","$600 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC266MA87.pdf",,"9"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","7","91762","NJ","Individual","No","22-3338404","91762NJ0070093","IHC Silver EPO AmeriHealth Advantage $15/$35","91762NJ007",,"NJN004","NJS005","NJF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070093-06","94% AV Level Silver Plan",,"0.933737516403198","No","Yes","Yes","50%","50%","$100","$14","$447","$150","$0","$110","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","$650","$650 per person","$1300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%","$100","$100 per person","$200 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC266MA94.pdf",,"10"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","8","91762","NJ","Individual","No","22-3338404","91762NJ0070006","IHC Silver EPO H.S.A Local Value $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070006-00","Standard Silver Off Exchange Plan",,"0.685693502426147","Yes","Yes","No","100%",,"$1,800","$1,014","$0","$150","$808","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC220V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","8","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080064","SEH Bronze EPO AmeriHealth Advantage $25/$50","91762NJ008",,"NJN004","NJS005","NJF001","New","EPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080064-00","Standard Bronze Off Exchange Plan",,"0.618296682834625","Yes","Yes","Yes","50%","50%","$2,500","$250","$11","$150","$889","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%","$3,000","$3000 per person","$6000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH166MA_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","8","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080064","SEH Bronze EPO AmeriHealth Advantage $25/$50","91762NJ008",,"NJN004","NJS005","NJF001","New","EPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080064-01","Standard Bronze On Exchange Plan",,"0.618296682834625","Yes","Yes","Yes","50%","50%","$2,500","$250","$11","$150","$889","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%","$3,000","$3000 per person","$6000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH166MA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","8","91762","NJ","Individual","No","22-3338404","91762NJ0070006","IHC Silver EPO H.S.A Local Value $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070006-01","Standard Silver On Exchange Plan",,"0.685693502426147","Yes","Yes","No","100%",,"$1,800","$1,014","$0","$150","$808","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC220V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","8","91762","NJ","Individual","No","22-3338404","91762NJ0070006","IHC Silver EPO H.S.A Local Value $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCVZERO.pdf",,"6"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","8","91762","NJ","Individual","No","22-3338404","91762NJ0070006","IHC Silver EPO H.S.A Local Value $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070006-03","Limited Cost Sharing Plan Variation",,"0.685693502426147","Yes","Yes","No","100%",,"$1,800","$1,014","$0","$150","$808","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC220VLTD.pdf",,"7"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","8","91762","NJ","Individual","No","22-3338404","91762NJ0070006","IHC Silver EPO H.S.A Local Value $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070006-04","73% AV Level Silver Plan",,"0.736673951148987","Yes","Yes","No","100%",,"$1,500","$1,014","$0","$150","$808","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC220V73.pdf",,"8"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","8","91762","NJ","Individual","No","22-3338404","91762NJ0070006","IHC Silver EPO H.S.A Local Value $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070006-05","87% AV Level Silver Plan",,"0.866242051124573","Yes","Yes","No","100%",,"$400","$764","$0","$150","$400","$116","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC220V87.pdf",,"9"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","8","91762","NJ","Individual","No","22-3338404","91762NJ0070006","IHC Silver EPO H.S.A Local Value $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070006-06","94% AV Level Silver Plan",,"0.941607773303986","Yes","Yes","No","100%",,"$150","$464","$0","$150","$150","$80","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC220V94.pdf",,"10"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","9","91762","NJ","Individual","No","22-3338404","91762NJ0070007","IHC Silver EPO H.S.A. Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070007-00","Standard Silver Off Exchange Plan",,"0.6856889128685","Yes","Yes","Yes","60%","40%","$1,341","$14","$306","$150","$733","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","50%","$1,350","$2700 per person","$2700 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC251TIER.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","9","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080065","SEH Silver EPO AmeriHealth Advantage $15/$35","91762NJ008",,"NJN004","NJS005","NJF003","New","EPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080065-00","Standard Silver Off Exchange Plan",,"0.711044132709503","No","Yes","Yes","50%","50%","$2,000","$14","$530","$150","$0","$120","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH266MA_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","9","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080065","SEH Silver EPO AmeriHealth Advantage $15/$35","91762NJ008",,"NJN004","NJS005","NJF003","New","EPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080065-01","Standard Silver On Exchange Plan",,"0.711044132709503","No","Yes","Yes","50%","50%","$2,000","$14","$530","$150","$0","$120","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH266MA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","9","91762","NJ","Individual","No","22-3338404","91762NJ0070007","IHC Silver EPO H.S.A. Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070007-01","Standard Silver On Exchange Plan",,"0.6856889128685","Yes","Yes","Yes","60%","40%","$1,341","$14","$306","$150","$733","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","50%","$1,350","$2700 per person","$2700 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC251TIER.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","9","91762","NJ","Individual","No","22-3338404","91762NJ0070007","IHC Silver EPO H.S.A. Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCTIERZERO.pdf",,"6"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","9","91762","NJ","Individual","No","22-3338404","91762NJ0070007","IHC Silver EPO H.S.A. Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070007-03","Limited Cost Sharing Plan Variation",,"0.6856889128685","Yes","Yes","Yes","60%","40%","$1,341","$14","$306","$150","$733","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","$5,750","$5750 per person","$11500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","50%","$1,350","$2700 per person","$2700 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC251TIERLTD.pdf",,"7"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","9","91762","NJ","Individual","No","22-3338404","91762NJ0070007","IHC Silver EPO H.S.A. Tier 1 Advantage $50/$75","91762NJ007",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070007-04","73% AV Level Silver Plan",,"0.736296713352203","Yes","Yes","Yes","60%","40%","$1,300","$14","$311","$150","$733","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$2600 per person","$2600 per group","10%","$1,300","$2600 per person","$2600 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC251TIER73.pdf",,"8"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","10","91762","NJ","Individual","No","22-3338404","91762NJ0070008","IHC Silver EPO Community Advantage $15/$35","91762NJ007",,"NJN004","NJS004","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070008-00","Standard Silver Off Exchange Plan",,"0.711044132709503","No","Yes","Yes","50%","50%","$2,000","$14","$530","$150","$84","$120","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC265CA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","10","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080090","SEH Gold EPO AmeriHealth Advantage  $10/$20","91762NJ008",,"NJN004","NJS005","NJF002","New","EPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080090-00","Standard Gold Off Exchange Plan",,"0.815857887268066","No","Yes","Yes","60%","40%","$1,000","$70","$347","$150","$0","$180","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$4,250","$4250 per person","$8500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%","$1,000","$1000 per person","$2000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH366MA_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","10","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080090","SEH Gold EPO AmeriHealth Advantage  $10/$20","91762NJ008",,"NJN004","NJS005","NJF002","New","EPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080090-01","Standard Gold On Exchange Plan",,"0.815857887268066","No","Yes","Yes","60%","40%","$1,000","$70","$347","$150","$0","$180","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$4,250","$4250 per person","$8500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%","$1,000","$1000 per person","$2000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH366MA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","10","91762","NJ","Individual","No","22-3338404","91762NJ0070008","IHC Silver EPO Community Advantage $15/$35","91762NJ007",,"NJN004","NJS004","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070008-01","Standard Silver On Exchange Plan",,"0.711044132709503","No","Yes","Yes","50%","50%","$2,000","$14","$530","$150","$84","$120","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC265CA.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","10","91762","NJ","Individual","No","22-3338404","91762NJ0070008","IHC Silver EPO Community Advantage $15/$35","91762NJ007",,"NJN004","NJS004","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","50%","50%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCCAZERO.pdf",,"6"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","10","91762","NJ","Individual","No","22-3338404","91762NJ0070008","IHC Silver EPO Community Advantage $15/$35","91762NJ007",,"NJN004","NJS004","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070008-03","Limited Cost Sharing Plan Variation",,"0.711044132709503","No","Yes","Yes","50%","50%","$2,000","$14","$530","$150","$84","$120","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC265CALTD.pdf",,"7"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","10","91762","NJ","Individual","No","22-3338404","91762NJ0070008","IHC Silver EPO Community Advantage $15/$35","91762NJ007",,"NJN004","NJS004","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070008-04","73% AV Level Silver Plan",,"0.731761574745178","No","Yes","Yes","50%","50%","$2,000","$14","$530","$150","$84","$120","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC265CA73.pdf",,"8"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","10","91762","NJ","Individual","No","22-3338404","91762NJ0070008","IHC Silver EPO Community Advantage $15/$35","91762NJ007",,"NJN004","NJS004","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070008-05","87% AV Level Silver Plan",,"0.862999498844147","No","Yes","Yes","50%","50%","$300","$14","$834","$150","$0","$120","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","20%","$300","$300 per person","$600 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC265CA87.pdf",,"9"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","10","91762","NJ","Individual","No","22-3338404","91762NJ0070008","IHC Silver EPO Community Advantage $15/$35","91762NJ007",,"NJN004","NJS004","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070008-06","94% AV Level Silver Plan",,"0.933737516403198","No","Yes","Yes","50%","50%","$100","$14","$894","$150","$100","$110","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","$650","$650 per person","$1300 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%","$100","$100 per person","$200 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC265CA94.pdf",,"10"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","11","91762","NJ","Individual","No","22-3338404","91762NJ0070010","IHC Gold EPO Regional Preferred $30/$50;80% coins","91762NJ007",,"NJN001","NJS001","NJF002","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070010-00","Standard Gold Off Exchange Plan",,"0.79499363899231","No","Yes","No","100%",,"$1,000","$70","$694","$150","$0","$250","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC304P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","11","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0100005","SEH Silver POS Plus National Access $50/$75","91762NJ010",,"NJN003","NJS003","NJF003","Existing","POS","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0100005-00","Standard Silver Off Exchange Plan",,"0.716813206672668","No","Yes","No","100%",,"$2,000","$64","$476","$150","$260","$70","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH213N_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","11","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0100005","SEH Silver POS Plus National Access $50/$75","91762NJ010",,"NJN003","NJS003","NJF003","Existing","POS","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0100005-01","Standard Silver On Exchange Plan",,"0.716813206672668","No","Yes","No","100%",,"$2,000","$64","$476","$150","$260","$70","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH213N.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","11","91762","NJ","Individual","No","22-3338404","91762NJ0070010","IHC Gold EPO Regional Preferred $30/$50;80% coins","91762NJ007",,"NJN001","NJS001","NJF002","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070010-01","Standard Gold On Exchange Plan",,"0.79499363899231","No","Yes","No","100%",,"$1,000","$70","$694","$150","$0","$250","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC304P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","11","91762","NJ","Individual","No","22-3338404","91762NJ0070010","IHC Gold EPO Regional Preferred $30/$50;80% coins","91762NJ007",,"NJN001","NJS001","NJF002","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCPZERO.pdf",,"6"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","16","91762","NJ","Individual","No","22-3338404","91762NJ0070015","IHC Regional Preferred Simple Saver","91762NJ007",,"NJN001","NJS001","NJF005","Existing","EPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","3","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070015-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,239","$0","$0","$150","$786","$30","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC501PSMPS.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","6"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","16","91762","NJ","Individual","No","22-3338404","91762NJ0070015","IHC Regional Preferred Simple Saver","91762NJ007",,"NJN001","NJS001","NJF005","Existing","EPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","3","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070015-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,239","$0","$0","$150","$786","$30","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC501PSMPS.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","7"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","17","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080091","SEH Platinum EPO Regional Preferred $20/$40","91762NJ008",,"NJN001","NJS001","NJF006","New","EPO","Platinum","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080091-00","Standard Platinum Off Exchange Plan","88.92%","0.899027526378632","No","Yes","No","100%",,"$0","$64","$0","$150","$0","$185","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH409P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","11","91762","NJ","Individual","No","22-3338404","91762NJ0070010","IHC Gold EPO Regional Preferred $30/$50;80% coins","91762NJ007",,"NJN001","NJS001","NJF002","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070010-03","Limited Cost Sharing Plan Variation",,"0.79499363899231","No","Yes","No","100%",,"$1,000","$70","$694","$150","$0","$250","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC304PLTD.pdf",,"7"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","11","91762","NJ","Individual","No","22-3338404","91762NJ0070080","IHC Gold EPO National Access $30/$50; 80% coins","91762NJ007",,"NJN003","NJS003","NJF002","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070080-00","Standard Gold Off Exchange Plan",,"0.79499363899231","No","Yes","No","100%",,"$1,000","$70","$694","$150","$0","$250","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC304N.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","8"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","11","91762","NJ","Individual","No","22-3338404","91762NJ0070080","IHC Gold EPO National Access $30/$50; 80% coins","91762NJ007",,"NJN003","NJS003","NJF002","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070080-01","Standard Gold On Exchange Plan",,"0.79499363899231","No","Yes","No","100%",,"$1,000","$70","$694","$150","$0","$250","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC304N.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","9"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","11","91762","NJ","Individual","No","22-3338404","91762NJ0070080","IHC Gold EPO National Access $30/$50; 80% coins","91762NJ007",,"NJN003","NJS003","NJF002","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070080-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCNZERO.pdf",,"10"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","11","91762","NJ","Individual","No","22-3338404","91762NJ0070080","IHC Gold EPO National Access $30/$50; 80% coins","91762NJ007",,"NJN003","NJS003","NJF002","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070080-03","Limited Cost Sharing Plan Variation",,"0.79499363899231","No","Yes","No","100%",,"$1,000","$70","$694","$150","$0","$250","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC304NLTD.pdf",,"11"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","12","91762","NJ","Individual","No","22-3338404","91762NJ0070012","IHC Gold EPO H.S.A. Local Value 80%/80%","91762NJ007",,"NJN002","NJS002","NJF002","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070012-00","Standard Gold Off Exchange Plan",,"0.798657834529877","Yes","Yes","No","100%",,"$1,300","$20","$774","$150","$1,042","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$2600 per person","$2600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC305V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","12","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0100018","SEH Gold POS Plus Regional Preferred  $20/$40","91762NJ010",,"NJN001","NJS001","NJF006","New","POS","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0100018-00","Standard Gold Off Exchange Plan",,"0.807149589061737","No","Yes","No","100%",,"$1,500","$54","$594","$150","$0","$185","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH318P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","12","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0100018","SEH Gold POS Plus Regional Preferred  $20/$40","91762NJ010",,"NJN001","NJS001","NJF006","New","POS","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0100018-01","Standard Gold On Exchange Plan",,"0.807149589061737","No","Yes","No","100%",,"$1,500","$54","$594","$150","$0","$185","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH318P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","12","91762","NJ","Individual","No","22-3338404","91762NJ0070012","IHC Gold EPO H.S.A. Local Value 80%/80%","91762NJ007",,"NJN002","NJS002","NJF002","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070012-01","Standard Gold On Exchange Plan",,"0.798657834529877","Yes","Yes","No","100%",,"$1,300","$20","$774","$150","$1,042","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$2600 per person","$2600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC305V.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","12","91762","NJ","Individual","No","22-3338404","91762NJ0070012","IHC Gold EPO H.S.A. Local Value 80%/80%","91762NJ007",,"NJN002","NJS002","NJF002","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCVZERO.pdf",,"6"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","12","91762","NJ","Individual","No","22-3338404","91762NJ0070012","IHC Gold EPO H.S.A. Local Value 80%/80%","91762NJ007",,"NJN002","NJS002","NJF002","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070012-03","Limited Cost Sharing Plan Variation",,"0.798657834529877","Yes","Yes","No","100%",,"$1,300","$20","$774","$150","$1,042","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$2600 per person","$2600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC305VLTD.pdf",,"7"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","13","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080060","SEH Silver EPO H.S.A Regional Preferred 90%/90%","91762NJ008",,"NJN001","NJS001","NJF002","New","EPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080060-00","Standard Silver Off Exchange Plan",,"0.71896892786026","Yes","Yes","No","100%",,"$2,200","$20","$297","$150","$897","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$4400 per person","$4400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH298P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","13","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080060","SEH Silver EPO H.S.A Regional Preferred 90%/90%","91762NJ008",,"NJN001","NJS001","NJF002","New","EPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080060-01","Standard Silver On Exchange Plan",,"0.71896892786026","Yes","Yes","No","100%",,"$2,200","$20","$297","$150","$897","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$4400 per person","$4400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH298P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","14","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080050","SEH Silver EPO H.S.A Local Value 100%/100%","91762NJ008",,"NJN002","NJS002","NJF003","Existing","EPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080050-00","Standard Silver Off Exchange Plan",,"0.717892825603485","Yes","Yes","No","100%",,"$2,350","$14","$0","$150","$1,042","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$4700 per person","$4700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH299V_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","14","91762","NJ","Individual","No","22-3338404","91762NJ0110001","IHC Platinum POS Plus National Access $15/$25","91762NJ011",,"NJN003","NJS003","NJF002","Existing","POS","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0110001-00","Standard Platinum Off Exchange Plan","89.53%",,"No","Yes","No","100%",,"$0","$645","$0","$150","$0","$195","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC606N.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","14","91762","NJ","Individual","No","22-3338404","91762NJ0110001","IHC Platinum POS Plus National Access $15/$25","91762NJ011",,"NJN003","NJS003","NJF002","Existing","POS","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0110001-03","Limited Cost Sharing Plan Variation","89.53%",,"No","Yes","No","100%",,"$0","$645","$0","$150","$0","$195","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC606NLTD.pdf",,"7"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","15","91762","NJ","Individual","No","22-3338404","91762NJ0110002","IHC Silver POS Plus National Access $40/$50","91762NJ011",,"NJN003","NJS003","NJF001","Existing","POS","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0110002-00","Standard Silver Off Exchange Plan",,"0.709468364715576","No","Yes","No","100%",,"$2,500","$0","$656","$150","$0","$130","$248","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC618N.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","15","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0100001","SEH Gold POS Plus National Access $30/$50","91762NJ010",,"NJN003","NJS003","NJF003","Existing","POS","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0100001-00","Standard Gold Off Exchange Plan",,"0.818033337593079","No","Yes","No","100%",,"$1,000","$64","$694","$150","$0","$180","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group",,,,"$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH317N_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","15","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0100001","SEH Gold POS Plus National Access $30/$50","91762NJ010",,"NJN003","NJS003","NJF003","Existing","POS","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0100001-01","Standard Gold On Exchange Plan",,"0.818033337593079","No","Yes","No","100%",,"$1,000","$64","$694","$150","$0","$180","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group",,,,"$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH317N.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","15","91762","NJ","Individual","No","22-3338404","91762NJ0110002","IHC Silver POS Plus National Access $40/$50","91762NJ011",,"NJN003","NJS003","NJF001","Existing","POS","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0110002-01","Standard Silver On Exchange Plan",,"0.709468364715576","No","Yes","No","100%",,"$2,500","$0","$656","$150","$0","$130","$248","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC618N.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","15","91762","NJ","Individual","No","22-3338404","91762NJ0110002","IHC Silver POS Plus National Access $40/$50","91762NJ011",,"NJN003","NJS003","NJF001","Existing","POS","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0110002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHCNZERO.pdf",,"6"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","15","91762","NJ","Individual","No","22-3338404","91762NJ0110002","IHC Silver POS Plus National Access $40/$50","91762NJ011",,"NJN003","NJS003","NJF001","Existing","POS","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0110002-03","Limited Cost Sharing Plan Variation",,"0.709468364715576","No","Yes","No","100%",,"$2,500","$0","$656","$150","$0","$130","$248","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC618NLTD.pdf",,"7"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","15","91762","NJ","Individual","No","22-3338404","91762NJ0110002","IHC Silver POS Plus National Access $40/$50","91762NJ011",,"NJN003","NJS003","NJF001","Existing","POS","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0110002-04","73% AV Level Silver Plan",,"0.737743020057678","No","Yes","No","100%",,"$2,000","$50","$753","$150","$0","$130","$248","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC618N73.pdf",,"8"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","15","91762","NJ","Individual","No","22-3338404","91762NJ0110002","IHC Silver POS Plus National Access $40/$50","91762NJ011",,"NJN003","NJS003","NJF001","Existing","POS","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0110002-05","87% AV Level Silver Plan",,"0.876333117485046","No","Yes","No","100%",,"$200","$50","$1,293","$150","$0","$100","$248","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC618N87.pdf",,"9"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","15","91762","NJ","Individual","No","22-3338404","91762NJ0110002","IHC Silver POS Plus National Access $40/$50","91762NJ011",,"NJN003","NJS003","NJF001","Existing","POS","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0110002-06","94% AV Level Silver Plan",,"0.938908994197845","No","Yes","No","100%",,"$100","$50","$1,323","$150","$0","$60","$248","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC618N94.pdf",,"10"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","16","91762","NJ","Individual","No","22-3338404","91762NJ0070014","IHC Local Value Saver Plan","91762NJ007",,"NJN002","NJS002","NJF005","Existing","EPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","3","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070014-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,239","$0","$0","$150","$786","$30","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC501VSMPS.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","16","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080075","SEH Gold EPO H.S.A Regional Preferred 100%/100%","91762NJ008",,"NJN001","NJS001","NJF002","New","EPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080075-00","Standard Gold Off Exchange Plan",,"0.819105446338654","Yes","Yes","No","100%",,"$1,400","$20","$0","$150","$912","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH320P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","16","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080075","SEH Gold EPO H.S.A Regional Preferred 100%/100%","91762NJ008",,"NJN001","NJS001","NJF002","New","EPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080075-01","Standard Gold On Exchange Plan",,"0.819105446338654","Yes","Yes","No","100%",,"$1,400","$20","$0","$150","$912","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH320P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","16","91762","NJ","Individual","No","22-3338404","91762NJ0070014","IHC Local Value Saver Plan","91762NJ007",,"NJN002","NJS002","NJF005","Existing","EPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.998",,,,"0","3","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_ihc.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0070014-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,239","$0","$0","$150","$786","$30","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC501VSMPS.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/IHC_BAAGS_2016.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","17","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080091","SEH Platinum EPO Regional Preferred $20/$40","91762NJ008",,"NJN001","NJS001","NJF006","New","EPO","Platinum","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080091-01","Standard Platinum On Exchange Plan","88.92%","0.899027526378632","No","Yes","No","100%",,"$0","$64","$0","$150","$0","$185","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH409P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","17","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080092","SEH Platinum EPO National Access $20/$40","91762NJ008",,"NJN003","NJS003","NJF006","New","EPO","Platinum","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080092-00","Standard Platinum Off Exchange Plan","88.92%","0.899027526378632","No","Yes","No","100%",,"$0","$64","$0","$150","$0","$185","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH409N_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","6"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","17","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080092","SEH Platinum EPO National Access $20/$40","91762NJ008",,"NJN003","NJS003","NJF006","New","EPO","Platinum","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080092-01","Standard Platinum On Exchange Plan","88.92%","0.899027526378632","No","Yes","No","100%",,"$0","$64","$0","$150","$0","$185","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH409N.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","7"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","18","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0100023","SEH Platinum POS Plus Regional Preferred $30/$40","91762NJ010",,"NJN001","NJS001","NJF006","New","POS","Platinum","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0100023-00","Standard Platinum Off Exchange Plan","88.51%","0","No","Yes","No","100%",,"$0","654","$0","$150","$0","$205","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH410P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","18","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0100023","SEH Platinum POS Plus Regional Preferred $30/$40","91762NJ010",,"NJN001","NJS001","NJF006","New","POS","Platinum","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"5","0","0","2016-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0100023-01","Standard Platinum On Exchange Plan","88.51%","0","No","Yes","No","100%",,"$0","654","$0","$150","$0","$205","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH410P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","19","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080069","SEH Silver EPO Regional Preferred $30/$50/50% Coins","91762NJ008",,"NJN001","NJS001","NJF003","New","EPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080069-00","Standard Silver Off Exchange Plan",,"0.710974276065826","No","Yes","No","100%",,"$2,500","$64","$394","$150","$0","$180","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH296P_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","19","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080069","SEH Silver EPO Regional Preferred $30/$50/50% Coins","91762NJ008",,"NJN001","NJS001","NJF003","New","EPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,"$125","0","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","No","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0080069-01","Standard Silver On Exchange Plan",,"0.710974276065826","No","Yes","No","100%",,"$2,500","$64","$394","$150","$0","$180","$77","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH296P.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","20","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0100002","SEH Platinum POS Plus National Access $10/$25","91762NJ010",,"NJN003","NJS003","NJF002","Existing","POS","Platinum","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"5","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0100002-00","Standard Platinum Off Exchange Plan","90.28%","0","No","Yes","No","100%",,"$0","$645","$0","$150","$0","$185","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH406N_OFFX.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","4"
"2016","NJ","91762","HIOS","10","2016-01-23 05:53:30","20","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0100002","SEH Platinum POS Plus National Access $10/$25","91762NJ010",,"NJN003","NJS003","NJF002","Existing","POS","Platinum","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9982",,,,"5","0","0","2016-01-01",,"No",,"Yes","Emergency care is covered outside of the service area","Yes","http://www.amerihealthnj.com/html/custom/market/purchase_shop.html","http://www.amerihealthnj.com/html/custom/ffm/formulary.html","91762NJ0100002-01","Standard Platinum On Exchange Plan","90.28%","0","No","Yes","No","100%",,"$0","$645","$0","$150","$0","$185","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH406N.pdf","http://www.amerihealthnj.com/Resources/pdfs/sbcs/SEH.pdf","5"
"2016","NJ","93627","HIOS","5","2015-08-18 03:25:03","1","93627","NJ","SHOP (Small Group)","Yes","13-5123390","93627NJ0020002","Guardian Pediatric Advantage","93627NJ002",,"NJN001","NJS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$30.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","93627NJ0020002-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","NJ","93627","HIOS","5","2015-08-18 03:25:03","1","93627","NJ","Individual","Yes","13-5123390","93627NJ0140001","Guardian Family Essentials","93627NJ014",,"NJN002","NJS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.35","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","93627NJ0140001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","4"
"2016","NJ","93627","HIOS","5","2015-08-18 03:25:03","1","93627","NJ","Individual","Yes","13-5123390","93627NJ0140001","Guardian Family Essentials","93627NJ014",,"NJN002","NJS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.35","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","93627NJ0140001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","5"
"2016","NJ","93627","HIOS","5","2015-08-18 03:25:03","1","93627","NJ","SHOP (Small Group)","Yes","13-5123390","93627NJ0030002","Guardian Pediatric Essentials","93627NJ003",,"NJN001","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$22.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","93627NJ0030002-00","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","NJ","93627","HIOS","5","2015-08-18 03:25:03","2","93627","NJ","SHOP (Small Group)","Yes","13-5123390","93627NJ0050002","Guardian Family Advantage","93627NJ005",,"NJN001","NJS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","93627NJ0050002-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","NJ","93627","HIOS","5","2015-08-18 03:25:03","2","93627","NJ","SHOP (Small Group)","Yes","13-5123390","93627NJ0050002","Guardian Family Advantage","93627NJ005",,"NJN001","NJS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","93627NJ0050002-01","Standard High On Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","NJ","93627","HIOS","5","2015-08-18 03:25:03","2","93627","NJ","SHOP (Small Group)","Yes","13-5123390","93627NJ0070002","Guardian Family Essentials","93627NJ007",,"NJN001","NJS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","93627NJ0070002-00","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","NJ","93627","HIOS","5","2015-08-18 03:25:03","2","93627","NJ","SHOP (Small Group)","Yes","13-5123390","93627NJ0070002","Guardian Family Essentials","93627NJ007",,"NJN001","NJS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","93627NJ0070002-01","Standard Low On Exchange Plan","69.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","NJ","97057","HIOS","4","2015-08-22 15:09:32","1","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0380001","Smile for Health - Certified Optimum Coverage","97057NJ038",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97057NJ0380001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","97057","HIOS","4","2015-08-22 15:09:32","2","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0380002","Smile for Health - Certified Optimum Coverage","97057NJ038",,"NJN002","NJS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97057NJ0380002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","97057","HIOS","4","2015-08-22 15:09:32","3","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0380003","Smile for Health - Certified Optimum Coverage","97057NJ038",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97057NJ0380003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","97057","HIOS","4","2015-08-22 15:09:32","4","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0380004","Smile for Health - Certified Optimum Coverage","97057NJ038",,"NJN002","NJS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97057NJ0380004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","97057","HIOS","4","2015-08-22 15:09:32","5","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0390001","Smile for Health - Certified High Option","97057NJ039",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97057NJ0390001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","97057","HIOS","4","2015-08-22 15:09:32","6","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0390002","Smile for Health - Certified High Option","97057NJ039",,"NJN002","NJS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97057NJ0390002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","97057","HIOS","4","2015-08-22 15:09:32","7","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0390003","Smile for Health - Certified High Option Plus","97057NJ039",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97057NJ0390003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","97057","HIOS","4","2015-08-22 15:09:32","8","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0390004","Smile for Health - Certified High Option Plus","97057NJ039",,"NJN002","NJS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97057NJ0390004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NJ","97057","HIOS","4","2015-08-22 15:09:32","10","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0400002","Smile for Health - Family Premier PPO","97057NJ040",,"NJN002","NJS002",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$31.08","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97057NJ0400002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.unitedconcordia.com/docs/hcr/benefits-summary-nj-sfh-family-premier-ppo.pdf","https://www.unitedconcordia.com/docs/hcr/product-brochure-nj-sfh-family-premier-ppo.pdf","4"
"2016","NJ","97057","HIOS","4","2015-08-22 15:09:32","10","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0400002","Smile for Health - Family Premier PPO","97057NJ040",,"NJN002","NJS002",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$31.08","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97057NJ0400002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.unitedconcordia.com/docs/hcr/benefits-summary-nj-sfh-family-premier-ppo.pdf","https://www.unitedconcordia.com/docs/hcr/product-brochure-nj-sfh-family-premier-ppo.pdf","5"
"2016","NJ","97057","HIOS","4","2015-08-22 15:09:32","12","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0410002","Smile for Health - Family Value PPO","97057NJ041",,"NJN002","NJS002",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$31.08","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97057NJ0410002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.unitedconcordia.com/docs/hcr/benefits-summary-nj-sfh-family-value-ppo.pdf","https://www.unitedconcordia.com/docs/hcr/product-brochure-nj-sfh-family-value-ppo.pdf","4"
"2016","NJ","97057","HIOS","4","2015-08-22 15:09:32","12","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0410002","Smile for Health - Family Value PPO","97057NJ041",,"NJN002","NJS002",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$31.08","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97057NJ0410002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.unitedconcordia.com/docs/hcr/benefits-summary-nj-sfh-family-value-ppo.pdf","https://www.unitedconcordia.com/docs/hcr/product-brochure-nj-sfh-family-value-ppo.pdf","5"
"2016","NJ","97057","HIOS","4","2015-08-22 15:09:32","14","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0420002","Smile for Health - Family Core PPO","97057NJ042",,"NJN002","NJS002",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$26.29","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97057NJ0420002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.unitedconcordia.com/docs/hcr/benefits-summary-nj-sfh-family-core-ppo.pdf","https://www.unitedconcordia.com/docs/hcr/product-brochure-nj-sfh-family-core-ppo.pdf","4"
"2016","NJ","97057","HIOS","4","2015-08-22 15:09:32","14","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0420002","Smile for Health - Family Core PPO","97057NJ042",,"NJN002","NJS002",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$26.29","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97057NJ0420002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.unitedconcordia.com/docs/hcr/benefits-summary-nj-sfh-family-core-ppo.pdf","https://www.unitedconcordia.com/docs/hcr/product-brochure-nj-sfh-family-core-ppo.pdf","5"
"2016","NJ","99708","HIOS","7","2015-09-02 08:31:46","1","99708","NJ","Individual","Yes","22-1896118","99708NJ0120020","Delta Dental Individual-Basic PPO Pediatric Essential Health Benefit","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$34.45","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120020-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","$360 per group",,,,,,"$120","$120 per person","$360 per group","$120","$120 per person","$360 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2015_pedbasic.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans","4"
"2016","NJ","99708","HIOS","7","2015-09-02 08:31:46","1","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0130017","Delta Dental -Basic PPO Pediatric Essential Health Benefit Addendum","99708NJ013",,"NJN002","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$30.56","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0130017-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","$360 per group",,,,,,"$120","$120 per person","$360 per group","$120","$120 per person","$360 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com","4"
"2016","NJ","99708","HIOS","7","2015-09-02 08:31:46","1","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0130018","Delta Dental-Enhanced PPO Pediatric Essential Health Benefit Addendum","99708NJ013",,"NJN002","NJS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$35.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0130018-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com","5"
"2016","NJ","99708","HIOS","7","2015-09-02 08:31:46","1","99708","NJ","Individual","Yes","22-1896118","99708NJ0120020","Delta Dental Individual-Basic PPO Pediatric Essential Health Benefit","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$34.45","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120020-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","$360 per group",,,,,,"$120","$120 per person","$360 per group","$120","$120 per person","$360 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2015_pedbasic.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans","5"
"2016","NJ","99708","HIOS","7","2015-09-02 08:31:46","1","99708","NJ","Individual","Yes","22-1896118","99708NJ0120021","Delta Dental Individual-Enhanced PPO Pediatric Essential Health Benefit","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$39.68","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120021-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2015_pedenh.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans","6"
"2016","NJ","99708","HIOS","7","2015-09-02 08:31:46","1","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0140013","Delta Dental -Basic PPO Plus Premier Pediatric Essential Health Benefit Addendum","99708NJ014",,"NJN001","NJS001",,"Existing","POS","Low",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$39.29","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0140013-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$140","$140 per person","$420 per group",,,,,,"$140","$140 per person","$420 per group","$140","$140 per person","$420 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com","6"
"2016","NJ","99708","HIOS","7","2015-09-02 08:31:46","1","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0140014","Delta Dental-Enhanced PPO Plus Premier Pediatric Essential Health Benefit Addendum","99708NJ014",,"NJN001","NJS001",,"Existing","POS","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$44.53","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0140014-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com","7"
"2016","NJ","99708","HIOS","7","2015-09-02 08:31:46","1","99708","NJ","Individual","Yes","22-1896118","99708NJ0120021","Delta Dental Individual-Enhanced PPO Pediatric Essential Health Benefit","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$39.68","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120021-01","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2015_pedenh.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans","7"
"2016","NJ","99708","HIOS","7","2015-09-02 08:31:46","2","99708","NJ","Individual","Yes","22-1896118","99708NJ0120022","Delta Dental Individual - Basic Family PPO Plan I","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.58","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120022-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","$360 per group",,,,,,"$120","$120 per person","$360 per group","$120","$120 per person","$360 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2015_famI.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans","4"
"2016","NJ","99708","HIOS","7","2015-09-02 08:31:46","2","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0130019","Delta Dental - Basic Family PPO Plan I","99708NJ013",,"NJN002","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$18.24","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0130019-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","$360 per group",,,,,,"$120","$120 per person","$360 per group","$120","$120 per person","$360 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com","4"
"2016","NJ","99708","HIOS","7","2015-09-02 08:31:46","2","99708","NJ","Individual","Yes","22-1896118","99708NJ0120022","Delta Dental Individual - Basic Family PPO Plan I","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.58","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120022-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","$360 per group",,,,,,"$120","$120 per person","$360 per group","$120","$120 per person","$360 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2015_famI.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans","5"
"2016","NJ","99708","HIOS","7","2015-09-02 08:31:46","3","99708","NJ","Individual","Yes","22-1896118","99708NJ0120023","Delta Dental Individual - Basic Family PPO Plan II","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.02","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120023-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","$360 per group",,,,,,"$120","$120 per person","$360 per group","$120","$120 per person","$360 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2015_famII.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans","4"
"2016","NJ","99708","HIOS","7","2015-09-02 08:31:46","3","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0130020","Delta Dental  - Basic Family PPO Plan II","99708NJ013",,"NJN002","NJS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$28.49","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0130020-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","$360 per group",,,,,,"$120","$120 per person","$360 per group","$120","$120 per person","$360 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com","4"
"2016","NJ","99708","HIOS","7","2015-09-02 08:31:46","3","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0130021","Delta Dental  - Enhanced Family PPO Plan III","99708NJ013",,"NJN002","NJS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$35.33","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage is available throughout the United States","Yes",,"","99708NJ0130021-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com","http://www.deltadentalnj.com","5"
"2016","NJ","99708","HIOS","7","2015-09-02 08:31:46","3","99708","NJ","Individual","Yes","22-1896118","99708NJ0120023","Delta Dental Individual - Basic Family PPO Plan II","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.02","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120023-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","$360 per group",,,,,,"$120","$120 per person","$360 per group","$120","$120 per person","$360 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2015_famII.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans","5"
"2016","NJ","99708","HIOS","7","2015-09-02 08:31:46","3","99708","NJ","Individual","Yes","22-1896118","99708NJ0120024","Delta Dental Individual - Enhanced Family PPO Plan III","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.31","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120024-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2015_famIII.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans","6"
"2016","NJ","99708","HIOS","7","2015-09-02 08:31:46","3","99708","NJ","Individual","Yes","22-1896118","99708NJ0120024","Delta Dental Individual - Enhanced Family PPO Plan III","99708NJ012",,"NJN002","NJS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.31","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Coverage is available throughout the United States","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","99708NJ0120024-01","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnj.com/products/individual_aca_2015_famIII.pdf","https://www.deltadentalcoversme.com/plan-options/nj-plans","7"
"2016","OK","12513","HIOS","6","2015-10-20 04:38:50","1","12513","OK","Individual","Yes","36-3757528","12513OK0010001","TruAssure Basic Adult or Child Dental Plan","12513OK001",,"OKN001","OKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.13","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12513OK0010001-00","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OK","https://www.truassure.com/brochure?state=OK","4"
"2016","OK","12513","HIOS","6","2015-10-20 04:38:50","1","12513","OK","SHOP (Small Group)","Yes","36-3757528","12513OK0030001","TruAssure Dental Small Group Basic Plan","12513OK003",,"OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.01","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","12513OK0030001-00","Standard High Off Exchange Plan","83.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","12513","HIOS","6","2015-10-20 04:38:50","1","12513","OK","SHOP (Small Group)","Yes","36-3757528","12513OK0040001","TruAssure Dental Small Group Preferred Plan","12513OK004",,"OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.01","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","12513OK0040001-00","Standard High Off Exchange Plan","83.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OK","12513","HIOS","6","2015-10-20 04:38:50","1","12513","OK","Individual","Yes","36-3757528","12513OK0010001","TruAssure Basic Adult or Child Dental Plan","12513OK001",,"OKN001","OKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.13","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12513OK0010001-01","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OK","https://www.truassure.com/brochure?state=OK","5"
"2016","OK","12513","HIOS","6","2015-10-20 04:38:50","2","12513","OK","Individual","Yes","36-3757528","12513OK0020001","TruAssure Preferred Adult or Child Dental Plan","12513OK002",,"OKN001","OKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12513OK0020001-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OK","https://www.truassure.com/brochure?state=OK","4"
"2016","OK","12513","HIOS","6","2015-10-20 04:38:50","2","12513","OK","Individual","Yes","36-3757528","12513OK0020001","TruAssure Preferred Adult or Child Dental Plan","12513OK002",,"OKN001","OKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12513OK0020001-01","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OK","https://www.truassure.com/brochure?state=OK","5"
"2016","OK","12530","HIOS","2","2015-07-10 02:19:03","1","12530","OK","SHOP (Small Group)","Yes","42-0127290","12530OK0040001","Principal Plan Dental 70","12530OK004",,"OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$26.68","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","12530OK0040001-00","Standard Low Off Exchange Plan","69.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","12530","HIOS","2","2015-07-10 02:19:03","1","12530","OK","SHOP (Small Group)","Yes","42-0127290","12530OK0040002","Principal Plan Dental 85","12530OK004",,"OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$29.19","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","12530OK0040002-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OK","13711","HIOS","2","2015-07-11 04:19:24","1","13711","OK","Individual","Yes","47-0397286","13711OK0010001","Delta Dental Individual PPO, EHB Certified","13711OK001",,"OKN002","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.85","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","13711OK0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","13711","HIOS","2","2015-07-11 04:19:24","1","13711","OK","SHOP (Small Group)","Yes","47-0397286","13711OK0030001","Renaissance Group Dental PPO, EHB Certified","13711OK003",,"OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.57","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","13711OK0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","13711","HIOS","2","2015-07-11 04:19:24","1","13711","OK","SHOP (Small Group)","Yes","47-0397286","13711OK0030002","Renaissance Group Dental PPO, EHB Certified","13711OK003",,"OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.72","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","13711OK0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OK","13711","HIOS","2","2015-07-11 04:19:24","1","13711","OK","Individual","Yes","47-0397286","13711OK0010002","Delta Dental Individual PPO, EHB Certified","13711OK001",,"OKN002","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.36","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","13711OK0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OK","13711","HIOS","2","2015-07-11 04:19:24","1","13711","OK","Individual","Yes","47-0397286","13711OK0020001","Renaissance Individual Dental PPO, EHB Certified","13711OK002",,"OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.25","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","13711OK0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","OK","13711","HIOS","2","2015-07-11 04:19:24","1","13711","OK","Individual","Yes","47-0397286","13711OK0020002","Renaissance Individual Dental PPO, EHB Certified","13711OK002",,"OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.13","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","13711OK0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","OK","13711","HIOS","2","2015-07-11 04:19:24","1","13711","OK","Individual","Yes","47-0397286","13711OK0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","13711OK004",,"OKN001","OKS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.25","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/13711","","13711OK0040001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/OK_EHB_High_2016","http://www.renaissancedental.com/OK_EHB_High_2016","8"
"2016","OK","13711","HIOS","2","2015-07-11 04:19:24","1","13711","OK","Individual","Yes","47-0397286","13711OK0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","13711OK004",,"OKN001","OKS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.13","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/13711","","13711OK0040002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/OK_EHB_Low_2016","http://www.renaissancedental.com/OK_EHB_Low_2016","9"
"2016","OK","13711","HIOS","2","2015-07-11 04:19:24","2","13711","OK","Individual","Yes","47-0397286","13711OK0050001","Renaissance Individual Pediatric-Only Dental PPO,EHB Certified (Exchange)","13711OK005",,"OKN001","OKS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$36.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/13711","","13711OK0050001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/OK_Ped_High_2016","http://www.renaissancedental.com/OK_Ped_High_2016","4"
"2016","OK","13711","HIOS","2","2015-07-11 04:19:24","2","13711","OK","Individual","Yes","47-0397286","13711OK0050002","Renaissance Individual Pediatric-Only Dental PPO,EHB Certified (Exchange)","13711OK005",,"OKN001","OKS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$28.82","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/13711","","13711OK0050002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/OK_Ped_Low_2016","http://www.renaissancedental.com/OK_Ped_Low_2016","5"
"2016","OK","13711","HIOS","2","2015-07-11 04:19:24","2","13711","OK","Individual","Yes","47-0397286","13711OK0060001","Renaissance Individual Pediatric-Only Dental PPO,EHB Certified","13711OK006",,"OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$36.72","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","13711OK0060001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","OK","13711","HIOS","2","2015-07-11 04:19:24","2","13711","OK","Individual","Yes","47-0397286","13711OK0060002","Renaissance Individual Pediatric-Only Dental PPO,EHB Certified","13711OK006",,"OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$28.82","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","13711OK0060002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","OK","17595","HIOS","3","2015-08-18 03:25:03","1","17595","OK","SHOP (Small Group)","Yes","57-0523959","17595OK0020001","Group Dental Policy","17595OK002",,"OKN001","OKS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.38","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","17595OK0020001-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","31125","HIOS","3","2015-08-27 11:14:25","1","31125","OK","SHOP (Small Group)","Yes","47-0098400","31125OK0040002","EHB High PPO","31125OK004",,"OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.14","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","31125OK0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","OK","31125","HIOS","3","2015-08-27 11:14:25","1","31125","OK","SHOP (Small Group)","Yes","47-0098400","31125OK0040001","EHB Low PPO","31125OK004",,"OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.32","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","31125OK0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","OK","31125","HIOS","3","2015-08-27 11:14:25","1","31125","OK","SHOP (Small Group)","Yes","47-0098400","31125OK0030002","EHB High Passive","31125OK003",,"OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.14","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","31125OK0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","OK","31125","HIOS","3","2015-08-27 11:14:25","1","31125","OK","SHOP (Small Group)","Yes","47-0098400","31125OK0030001","EHB Low Passive","31125OK003",,"OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.53","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","31125OK0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","OK","36845","HIOS","3","2015-08-27 11:14:25","1","36845","OK","SHOP (Small Group)","Yes","36-0083760","36845OK0040002","EHB High PPO","36845OK004",,"OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.64","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","36845OK0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","OK","36845","HIOS","3","2015-08-27 11:14:25","1","36845","OK","SHOP (Small Group)","Yes","36-0083760","36845OK0040001","EHB Low PPO","36845OK004",,"OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.58","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","36845OK0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","OK","36845","HIOS","3","2015-08-27 11:14:25","1","36845","OK","SHOP (Small Group)","Yes","36-0083760","36845OK0030002","EHB High Passive","36845OK003",,"OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.68","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","36845OK0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","OK","36845","HIOS","3","2015-08-27 11:14:25","1","36845","OK","SHOP (Small Group)","Yes","36-0083760","36845OK0030001","EHB Low Passive","36845OK003",,"OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.84","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","36845OK0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","OK","40254","HIOS","3","2015-08-27 11:14:25","1","40254","OK","Individual","Yes","95-6042390","40254OK0020003","BESTOne Advantage Gold","40254OK002",,"OKN001","OKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.25","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OK/2016/OK_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","OK","40254","HIOS","3","2015-08-27 11:14:25","1","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010007","BESTDental Premium","40254OK001",,"OKN001","OKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OK/2016/OK_BESTDental_Premium_Plan.pdf","4"
"2016","OK","40254","HIOS","3","2015-08-27 11:14:25","1","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010007","BESTDental Premium","40254OK001",,"OKN001","OKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OK/2016/OK_BESTDental_Premium_Plan.pdf","5"
"2016","OK","40254","HIOS","3","2015-08-27 11:14:25","1","40254","OK","Individual","Yes","95-6042390","40254OK0020003","BESTOne Advantage Gold","40254OK002",,"OKN001","OKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.25","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OK/2016/OK_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","OK","40254","HIOS","3","2015-08-27 11:14:25","1","40254","OK","Individual","Yes","95-6042390","40254OK0020004","BESTOne Plus Gold","40254OK002",,"OKN001","OKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.25","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OK/2016/OK_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","OK","40254","HIOS","3","2015-08-27 11:14:25","1","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010008","BESTDental Standard - H","40254OK001",,"OKN001","OKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OK/2016/OK_BESTDental_Standard-H_Plan.pdf","6"
"2016","OK","40254","HIOS","3","2015-08-27 11:14:25","1","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010008","BESTDental Standard - H","40254OK001",,"OKN001","OKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OK/2016/OK_BESTDental_Standard-H_Plan.pdf","7"
"2016","OK","40254","HIOS","3","2015-08-27 11:14:25","1","40254","OK","Individual","Yes","95-6042390","40254OK0020004","BESTOne Plus Gold","40254OK002",,"OKN001","OKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.25","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OK/2016/OK_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","OK","40254","HIOS","3","2015-08-27 11:14:25","1","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010010","BESTDental Choice - H","40254OK001",,"OKN001","OKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OK/2016/OK_BESTDental_Choice-H_Plan.pdf","8"
"2016","OK","40254","HIOS","3","2015-08-27 11:14:25","1","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010010","BESTDental Choice - H","40254OK001",,"OKN001","OKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OK/2016/OK_BESTDental_Choice-H_Plan.pdf","9"
"2016","OK","40254","HIOS","3","2015-08-27 11:14:25","2","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010009","BESTDental Standard - L","40254OK001",,"OKN001","OKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OK/2016/OK_BESTDental_Standard-L_Plan.pdf","4"
"2016","OK","40254","HIOS","3","2015-08-27 11:14:25","2","40254","OK","Individual","Yes","95-6042390","40254OK0020005","BESTOne Plus Silver","40254OK002",,"OKN001","OKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.48","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OK/2016/OK_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","OK","40254","HIOS","3","2015-08-27 11:14:25","2","40254","OK","Individual","Yes","95-6042390","40254OK0020005","BESTOne Plus Silver","40254OK002",,"OKN001","OKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.48","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OK/2016/OK_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","OK","40254","HIOS","3","2015-08-27 11:14:25","2","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010009","BESTDental Standard - L","40254OK001",,"OKN001","OKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OK/2016/OK_BESTDental_Standard-L_Plan.pdf","5"
"2016","OK","40254","HIOS","3","2015-08-27 11:14:25","2","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010011","BESTDental Choice - L","40254OK001",,"OKN001","OKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OK/2016/OK_BESTDental_Choice-L_Plan.pdf","6"
"2016","OK","40254","HIOS","3","2015-08-27 11:14:25","2","40254","OK","Individual","Yes","95-6042390","40254OK0020006","BESTOne Basic Silver","40254OK002",,"OKN001","OKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.48","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OK/2016/OK_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","OK","40254","HIOS","3","2015-08-27 11:14:25","2","40254","OK","Individual","Yes","95-6042390","40254OK0020006","BESTOne Basic Silver","40254OK002",,"OKN001","OKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.48","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OK/2016/OK_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","OK","40254","HIOS","3","2015-08-27 11:14:25","2","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010011","BESTDental Choice - L","40254OK001",,"OKN001","OKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OK/2016/OK_BESTDental_Choice-L_Plan.pdf","7"
"2016","OK","40254","HIOS","3","2015-08-27 11:14:25","2","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010012","BESTDental Value","40254OK001",,"OKN001","OKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OK/2016/OK_BESTDental_Value_Plan.pdf","8"
"2016","OK","40254","HIOS","3","2015-08-27 11:14:25","2","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010012","BESTDental Value","40254OK001",,"OKN001","OKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","40254OK0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OK/2016/OK_BESTDental_Value_Plan.pdf","9"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","1","45480","OK","Individual","No","33-0115166","45480OK0050005","Silver  Compass HSA 3000","45480OK005",,"OKN001","OKS001","OKF001","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050005-00","Standard Silver Off Exchange Plan","69.26%",,"Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ok0013&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","4"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","1","45480","OK","Individual","No","33-0115166","45480OK0050005","Silver  Compass HSA 3000","45480OK005",,"OKN001","OKS001","OKF001","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050005-01","Standard Silver On Exchange Plan","69.26%",,"Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ok0013&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","5"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","1","45480","OK","Individual","No","33-0115166","45480OK0050005","Silver  Compass HSA 3000","45480OK005",,"OKN001","OKS001","OKF001","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ok0014&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","6"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","1","45480","OK","Individual","No","33-0115166","45480OK0050005","Silver  Compass HSA 3000","45480OK005",,"OKN001","OKS001","OKF001","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050005-03","Limited Cost Sharing Plan Variation","69.26%",,"Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ok0015&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","7"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","1","45480","OK","Individual","No","33-0115166","45480OK0050005","Silver  Compass HSA 3000","45480OK005",,"OKN001","OKS001","OKF001","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050005-04","73% AV Level Silver Plan","72.30%",,"Yes","Yes","No","100%",,"$2,500","$10","$0","$200","$2,500","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ok0016&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","8"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","1","45480","OK","Individual","No","33-0115166","45480OK0050005","Silver  Compass HSA 3000","45480OK005",,"OKN001","OKS001","OKF001","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050005-05","87% AV Level Silver Plan","86.39%",,"Yes","Yes","No","100%",,"$800","$10","$0","$200","$800","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ok0017&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","9"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","1","45480","OK","Individual","No","33-0115166","45480OK0050005","Silver  Compass HSA 3000","45480OK005",,"OKN001","OKS001","OKF001","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050005-06","94% AV Level Silver Plan","93.29%",,"Yes","Yes","No","100%",,"$200","$10","$0","$200","$200","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ok0018&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","10"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","1","45480","OK","Individual","No","33-0115166","45480OK0050006","Silver Compass 2000 1","45480OK005",,"OKN001","OKS001","OKF002","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050006-00","Standard Silver Off Exchange Plan","71.30%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ok0019&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","11"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","1","45480","OK","Individual","No","33-0115166","45480OK0050006","Silver Compass 2000 1","45480OK005",,"OKN001","OKS001","OKF002","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050006-01","Standard Silver On Exchange Plan","71.30%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ok0019&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","12"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","1","45480","OK","Individual","No","33-0115166","45480OK0050006","Silver Compass 2000 1","45480OK005",,"OKN001","OKS001","OKF002","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ok0020&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","13"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","1","45480","OK","Individual","No","33-0115166","45480OK0050006","Silver Compass 2000 1","45480OK005",,"OKN001","OKS001","OKF002","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050006-03","Limited Cost Sharing Plan Variation","71.30%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ok0021&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","14"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","1","45480","OK","Individual","No","33-0115166","45480OK0050006","Silver Compass 2000 1","45480OK005",,"OKN001","OKS001","OKF002","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050006-04","73% AV Level Silver Plan","73.30%",,"Yes","Yes","No","100%",,"$1,800","$1,500","$0","$200","$1,800","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ok0022&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","15"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","1","45480","OK","Individual","No","33-0115166","45480OK0050006","Silver Compass 2000 1","45480OK005",,"OKN001","OKS001","OKF002","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050006-05","87% AV Level Silver Plan","86.35%",,"Yes","Yes","No","100%",,"$500","$800","$0","$200","$500","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ok0023&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","16"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","1","45480","OK","Individual","No","33-0115166","45480OK0050006","Silver Compass 2000 1","45480OK005",,"OKN001","OKS001","OKF002","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050006-06","94% AV Level Silver Plan","93.14%",,"Yes","Yes","No","100%",,"$200","$500","$0","$200","$200","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ok0024&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","17"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","1","45480","OK","Individual","No","33-0115166","45480OK0050010","Bronze Compass HSA 5500","45480OK005",,"OKN001","OKS001","OKF003","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050010-00","Standard Bronze Off Exchange Plan","61.30%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ok0043&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","18"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","1","45480","OK","Individual","No","33-0115166","45480OK0050010","Bronze Compass HSA 5500","45480OK005",,"OKN001","OKS001","OKF003","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050010-01","Standard Bronze On Exchange Plan","61.30%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ok0043&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","19"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","1","45480","OK","Individual","No","33-0115166","45480OK0050010","Bronze Compass HSA 5500","45480OK005",,"OKN001","OKS001","OKF003","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050010-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ok0044&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","20"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","1","45480","OK","Individual","No","33-0115166","45480OK0050010","Bronze Compass HSA 5500","45480OK005",,"OKN001","OKS001","OKF003","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050010-03","Limited Cost Sharing Plan Variation","61.30%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ok0045&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","21"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050009","Silver Compass 4500","45480OK005",,"OKN001","OKS001","OKF008","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050009-01","Standard Silver On Exchange Plan","68.30%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0037&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","35"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050009","Silver Compass 4500","45480OK005",,"OKN001","OKS001","OKF008","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050009-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0038&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","36"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050002","Gold Compass 1000","45480OK005",,"OKN001","OKS001","OKF004","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050002-00","Standard Gold Off Exchange Plan","78.10%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0004&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","8"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050002","Gold Compass 1000","45480OK005",,"OKN001","OKS001","OKF004","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050002-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0004&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","9"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050003","Gold Compass 500","45480OK005",,"OKN001","OKS001","OKF005","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050003-00","Standard Gold Off Exchange Plan","78.30%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0007&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","12"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050003","Gold Compass 500","45480OK005",,"OKN001","OKS001","OKF005","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050003-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0007&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","13"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050003","Gold Compass 500","45480OK005",,"OKN001","OKS001","OKF005","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0008&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","14"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050003","Gold Compass 500","45480OK005",,"OKN001","OKS001","OKF005","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050003-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0009&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","15"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050004","Gold Compass 0","45480OK005",,"OKN001","OKS001","OKF006","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050004-00","Standard Gold Off Exchange Plan","79.10%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0010&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","16"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050004","Gold Compass 0","45480OK005",,"OKN001","OKS001","OKF006","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050004-01","Standard Gold On Exchange Plan","79.10%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0010&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","17"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050004","Gold Compass 0","45480OK005",,"OKN001","OKS001","OKF006","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0011&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","18"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050004","Gold Compass 0","45480OK005",,"OKN001","OKS001","OKF006","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050004-03","Limited Cost Sharing Plan Variation","79.10%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0012&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","19"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050007","Silver Compass 2000","45480OK005",,"OKN001","OKS001","OKF007","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050007-00","Standard Silver Off Exchange Plan","69.30%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0025&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","20"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050007","Silver Compass 2000","45480OK005",,"OKN001","OKS001","OKF007","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050007-01","Standard Silver On Exchange Plan","69.30%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0025&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","21"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050007","Silver Compass 2000","45480OK005",,"OKN001","OKS001","OKF007","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0026&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","22"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050007","Silver Compass 2000","45480OK005",,"OKN001","OKS001","OKF007","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050007-03","Limited Cost Sharing Plan Variation","69.30%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0027&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","23"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050007","Silver Compass 2000","45480OK005",,"OKN001","OKS001","OKF007","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050007-04","73% AV Level Silver Plan","73.40%",,"No","Yes","No","100%",,"$1,200","$20","$1,500","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0028&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","24"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050007","Silver Compass 2000","45480OK005",,"OKN001","OKS001","OKF007","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050007-05","87% AV Level Silver Plan","87.90%",,"No","Yes","No","100%",,"$200","$10","$600","$200","$200","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0029&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","25"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050007","Silver Compass 2000","45480OK005",,"OKN001","OKS001","OKF007","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050007-06","94% AV Level Silver Plan","93.90%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0030&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","26"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050008","Silver Compass 3500","45480OK005",,"OKN001","OKS001","OKF008","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050008-00","Standard Silver Off Exchange Plan","68.00%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0031&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","27"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050008","Silver Compass 3500","45480OK005",,"OKN001","OKS001","OKF008","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050008-01","Standard Silver On Exchange Plan","68.00%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0031&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","28"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050008","Silver Compass 3500","45480OK005",,"OKN001","OKS001","OKF008","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050008-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0032&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","29"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050008","Silver Compass 3500","45480OK005",,"OKN001","OKS001","OKF008","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050008-03","Limited Cost Sharing Plan Variation","68.00%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0033&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","30"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050008","Silver Compass 3500","45480OK005",,"OKN001","OKS001","OKF008","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050008-04","73% AV Level Silver Plan","72.50%",,"No","Yes","No","100%",,"$2,500","$10","$800","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0034&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","31"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050008","Silver Compass 3500","45480OK005",,"OKN001","OKS001","OKF008","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050008-05","87% AV Level Silver Plan","87.90%",,"No","Yes","No","100%",,"$200","$10","$600","$200","$200","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0035&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","32"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050008","Silver Compass 3500","45480OK005",,"OKN001","OKS001","OKF008","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050008-06","94% AV Level Silver Plan","93.90%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0036&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","33"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050009","Silver Compass 4500","45480OK005",,"OKN001","OKS001","OKF008","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050009-00","Standard Silver Off Exchange Plan","68.30%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0037&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","34"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050009","Silver Compass 4500","45480OK005",,"OKN001","OKS001","OKF008","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050009-03","Limited Cost Sharing Plan Variation","68.30%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0039&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","37"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050009","Silver Compass 4500","45480OK005",,"OKN001","OKS001","OKF008","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050009-04","73% AV Level Silver Plan","72.50%",,"No","Yes","No","100%",,"$3,200","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0040&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","38"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050009","Silver Compass 4500","45480OK005",,"OKN001","OKS001","OKF008","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050009-05","87% AV Level Silver Plan","86.10%",,"No","Yes","No","100%",,"$600","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0041&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","39"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050009","Silver Compass 4500","45480OK005",,"OKN001","OKS001","OKF008","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050009-06","94% AV Level Silver Plan","93.30%",,"No","Yes","No","100%",,"$100","$10","$0","$200","$100","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ok0042&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","40"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050011","Bronze Compass 6500","45480OK005",,"OKN001","OKS001","OKF003","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050011-00","Standard Bronze Off Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ok0046&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","41"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050011","Bronze Compass 6500","45480OK005",,"OKN001","OKS001","OKF003","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050011-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ok0046&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","42"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050011","Bronze Compass 6500","45480OK005",,"OKN001","OKS001","OKF003","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050011-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ok0047&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","43"
"2016","OK","45480","HIOS","4","2015-08-27 11:14:25","2","45480","OK","Individual","No","33-0115166","45480OK0050011","Bronze Compass 6500","45480OK005",,"OKN001","OKS001","OKF003","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ok0050&st=ok","45480OK0050011-03","Limited Cost Sharing Plan Variation","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ok0048&st=ok","http://www.uhc.com/iex/doc?id=ok0049&st=ok","44"
"2016","OK","45689","HIOS","7","2015-08-25 05:06:23","1","45689","OK","SHOP (Small Group)","Yes","75-1233841","45689OK0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","45689OK002",,"OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.87","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","45689OK0020001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ok/45689ok0020001-16","4"
"2016","OK","45689","HIOS","7","2015-08-25 05:06:23","1","45689","OK","Individual","Yes","75-1233841","45689OK0010001","Dentegra Dental PPO Pediatric Basic Plan","45689OK001",,"OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","45689OK0010001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ok/45689ok0010001-16","4"
"2016","OK","45689","HIOS","7","2015-08-25 05:06:23","2","45689","OK","Individual","Yes","75-1233841","45689OK0010004","Dentegra Dental PPO Family Preferred Plan","45689OK001",,"OKN001","OKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.42","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","45689OK0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","per person not applicable","per group not applicable",,,,,,"$30","per person not applicable","per group not applicable","$30","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ok/45689ok0010004-16","4"
"2016","OK","45689","HIOS","7","2015-08-25 05:06:23","2","45689","OK","SHOP (Small Group)","Yes","75-1233841","45689OK0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","45689OK002",,"OKN001","OKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.61","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","45689OK0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","per person not applicable","per group not applicable",,,,,,"$30","per person not applicable","per group not applicable","$30","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ok/45689ok0020004-16","4"
"2016","OK","45689","HIOS","7","2015-08-25 05:06:23","2","45689","OK","SHOP (Small Group)","Yes","75-1233841","45689OK0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","45689OK002",,"OKN001","OKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.61","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","45689OK0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","per person not applicable","per group not applicable",,,,,,"$30","per person not applicable","per group not applicable","$30","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ok/45689ok0020004-16","5"
"2016","OK","45689","HIOS","7","2015-08-25 05:06:23","2","45689","OK","Individual","Yes","75-1233841","45689OK0010004","Dentegra Dental PPO Family Preferred Plan","45689OK001",,"OKN001","OKS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.42","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","45689OK0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","per person not applicable","per group not applicable",,,,,,"$30","per person not applicable","per group not applicable","$30","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ok/45689ok0010004-16","5"
"2016","OK","45689","HIOS","7","2015-08-25 05:06:23","3","45689","OK","Individual","Yes","75-1233841","45689OK0010006","Dentegra Dental PPO Family Basic Plan","45689OK001",,"OKN001","OKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","45689OK0010006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ok/45689ok0010006-16","4"
"2016","OK","45689","HIOS","7","2015-08-25 05:06:23","3","45689","OK","SHOP (Small Group)","Yes","75-1233841","45689OK0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","45689OK002",,"OKN001","OKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.87","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","45689OK0020006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ok/45689ok0020006-16","4"
"2016","OK","45689","HIOS","7","2015-08-25 05:06:23","3","45689","OK","SHOP (Small Group)","Yes","75-1233841","45689OK0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","45689OK002",,"OKN001","OKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.87","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","45689OK0020006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ok/45689ok0020006-16","5"
"2016","OK","45689","HIOS","7","2015-08-25 05:06:23","3","45689","OK","Individual","Yes","75-1233841","45689OK0010006","Dentegra Dental PPO Family Basic Plan","45689OK001",,"OKN001","OKS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","45689OK0010006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ok/45689ok0010006-16","5"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","Individual","No","36-1236610","87571OK0350043","Blue Advantage Bronze PPO?  105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS042","OKF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350043-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350029-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","14"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","Individual","No","36-1236610","87571OK0350043","Blue Advantage Bronze PPO?  105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS042","OKF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350043-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$20,400","$20400 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350029-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","15"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330001","Blue Preferred Gold PPO? 001","87571OK033",,"OKN011","OKS031","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330001-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330001-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","15"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330016","Blue Preferred Gold PPO? 002","87571OK033",,"OKN011","OKS051","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330016-01","Standard Gold On Exchange Plan","80.19%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330002-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","37"
"2016","OK","50184","HIOS","2","2015-07-11 04:19:24","1","50184","OK","SHOP (Small Group)","Yes","44-0308260","50184OK0010001","KCL EHB Low PPO","50184OK001",,"OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$33.88","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010001-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","50184","HIOS","2","2015-07-11 04:19:24","1","50184","OK","SHOP (Small Group)","Yes","44-0308260","50184OK0010003","KCL EHB Low MAC","50184OK001",,"OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$25.50","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010003-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OK","50184","HIOS","2","2015-07-11 04:19:24","1","50184","OK","SHOP (Small Group)","Yes","44-0308260","50184OK0010005","KCL Fam Low PPO","50184OK001",,"OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$33.88","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010005-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","OK","50184","HIOS","2","2015-07-11 04:19:24","1","50184","OK","SHOP (Small Group)","Yes","44-0308260","50184OK0010007","KCL Fam Low MAC","50184OK001",,"OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$25.50","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010007-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","OK","50184","HIOS","2","2015-07-11 04:19:24","2","50184","OK","SHOP (Small Group)","Yes","44-0308260","50184OK0010002","KCL EHB High PPO","50184OK001",,"OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$40.05","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010002-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","50184","HIOS","2","2015-07-11 04:19:24","2","50184","OK","SHOP (Small Group)","Yes","44-0308260","50184OK0010004","KCL EHB High MAC","50184OK001",,"OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$30.61","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010004-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OK","50184","HIOS","2","2015-07-11 04:19:24","2","50184","OK","SHOP (Small Group)","Yes","44-0308260","50184OK0010006","KCL Fam High PPO","50184OK001",,"OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$40.05","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010006-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","OK","50184","HIOS","2","2015-07-11 04:19:24","2","50184","OK","SHOP (Small Group)","Yes","44-0308260","50184OK0010008","KCL Fam High MAC","50184OK001",,"OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$30.61","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","50184OK0010008-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","OK","60283","HIOS","3","2015-07-09 13:17:42","1","60283","OK","SHOP (Small Group)","Yes","13-5581829","60283OK0130001","EHB Basic Dental Plan (Low)","60283OK013",,"OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$17.38","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","60283OK0130001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","61390","HIOS","3","2015-08-27 11:14:25","1","61390","OK","Individual","Yes","95-2371728","61390OK0010001","PPO MAC","61390OK001",,"OKN001","OKS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$36.89","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Any service received outside of the state of Oklahoma","Yes",,"","61390OK0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","61390","HIOS","3","2015-08-27 11:14:25","1","61390","OK","SHOP (Small Group)","Yes","95-2371728","61390OK0020001","PPO MAC","61390OK002",,"OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$27.26","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Any service received outside of the state of Oklahoma","Yes",,"","61390OK0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","61390","HIOS","3","2015-08-27 11:14:25","1","61390","OK","SHOP (Small Group)","Yes","95-2371728","61390OK0020002","PPO MAC","61390OK002",,"OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$21.30","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Any service received outside of the state of Oklahoma","Yes",,"","61390OK0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OK","61390","HIOS","3","2015-08-27 11:14:25","1","61390","OK","Individual","Yes","95-2371728","61390OK0010002","PPO MAC","61390OK001",,"OKN001","OKS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$30.41","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Any service received outside of the state of Oklahoma","Yes",,"","61390OK0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OK","61390","HIOS","3","2015-08-27 11:14:25","2","61390","OK","Individual","Yes","95-2371728","61390OK0010003","PPO MAC","61390OK001",,"OKN001","OKS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$38.04","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Any service received outside of the state of Okalahoma","Yes",,"","61390OK0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","61390","HIOS","3","2015-08-27 11:14:25","2","61390","OK","SHOP (Small Group)","Yes","95-2371728","61390OK0020003","PPO MAC","61390OK002",,"OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$28.10","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Any service received outside of the state of Oklahoma","Yes",,"","61390OK0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","61858","HIOS","3","2015-08-27 11:14:25","1","61858","OK","SHOP (Small Group)","Yes","93-0242990","61858OK0040002","EHB High PPO","61858OK004",,"OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.74","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","61858OK0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","OK","61858","HIOS","3","2015-08-27 11:14:25","1","61858","OK","SHOP (Small Group)","Yes","93-0242990","61858OK0040001","EHB Low PPO","61858OK004",,"OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.63","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","61858OK0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","OK","61858","HIOS","3","2015-08-27 11:14:25","1","61858","OK","SHOP (Small Group)","Yes","93-0242990","61858OK0030002","EHB High Passive","61858OK003",,"OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.79","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","61858OK0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","OK","61858","HIOS","3","2015-08-27 11:14:25","1","61858","OK","SHOP (Small Group)","Yes","93-0242990","61858OK0030001","EHB Low Passive","61858OK003",,"OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.91","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","61858OK0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","OK","77760","HIOS","7","2015-08-22 15:09:32","1","77760","OK","Individual","Yes","23-7322578","77760OK0010003","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK001",,"OKN001","OKS001",,"Existing","PPO","High",,"Both",,,,"For covered persons over the age 18 there is a 6 month wait on Basic services and 12 month wait on Major services. MOOP only applies to covered persons age 0 through 18.",,"No","Allows Adult and Child-Only",,,,,"$34.50","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","All benefits that are offered on the plan are available out of country.","Yes","All benefits that are offered on the plan are available out of the service area.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","77760OK0010003-00","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$25","$25 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/Individual/Combined/High2016","https://www.deltadentalok.org/client/marketplace/Brochure/Individual2016","4"
"2016","OK","77760","HIOS","7","2015-08-22 15:09:32","1","77760","OK","SHOP (Small Group)","Yes","23-7322578","77760OK0020003","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK002",,"OKN002","OKS001",,"Existing","PPO","High",,"Both",,,,"For covered persons over the age 18 there is a 6 month wait on Type B services and 12 month wait on Type C services. MOOP only applies to covered persons age 0 through 18.",,"No","Allows Adult and Child-Only",,,,,"$30.51","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes",,"","77760OK0020003-00","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$25","$25 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/SHOP/Combined/High2016","https://www.deltadentalok.org/client/marketplace/Brochure/SHOP2016","4"
"2016","OK","77760","HIOS","7","2015-08-22 15:09:32","1","77760","OK","SHOP (Small Group)","Yes","23-7322578","77760OK0020003","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK002",,"OKN002","OKS001",,"Existing","PPO","High",,"Both",,,,"For covered persons over the age 18 there is a 6 month wait on Type B services and 12 month wait on Type C services. MOOP only applies to covered persons age 0 through 18.",,"No","Allows Adult and Child-Only",,,,,"$30.51","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes",,"","77760OK0020003-01","Standard High On Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$25","$25 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/SHOP/Combined/High2016","https://www.deltadentalok.org/client/marketplace/Brochure/SHOP2016","5"
"2016","OK","77760","HIOS","7","2015-08-22 15:09:32","1","77760","OK","Individual","Yes","23-7322578","77760OK0010003","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK001",,"OKN001","OKS001",,"Existing","PPO","High",,"Both",,,,"For covered persons over the age 18 there is a 6 month wait on Basic services and 12 month wait on Major services. MOOP only applies to covered persons age 0 through 18.",,"No","Allows Adult and Child-Only",,,,,"$34.50","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","All benefits that are offered on the plan are available out of country.","Yes","All benefits that are offered on the plan are available out of the service area.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","77760OK0010003-01","Standard High On Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$25","$25 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/Individual/Combined/High2016","https://www.deltadentalok.org/client/marketplace/Brochure/Individual2016","5"
"2016","OK","77760","HIOS","7","2015-08-22 15:09:32","2","77760","OK","Individual","Yes","23-7322578","77760OK0010004","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK001",,"OKN001","OKS001",,"Existing","PPO","Low",,"Both",,,,"For covered persons over the age 18 there is a 6 month wait on Basic services and 12 month wait on Major services. MOOP only applies to covered persons age 0 through 18.",,"No","Allows Adult and Child-Only",,,,,"$21.30","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","All benefits that are offered on the plan are available out of country.","Yes","All benefits that are offered on the plan are available out of the service area.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","77760OK0010004-00","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/Individual/Combined/Low2016","https://www.deltadentalok.org/client/marketplace/Brochure/Individual2016","4"
"2016","OK","77760","HIOS","7","2015-08-22 15:09:32","2","77760","OK","SHOP (Small Group)","Yes","23-7322578","77760OK0020004","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK002",,"OKN002","OKS001",,"Existing","PPO","Low",,"Both",,,,"For covered persons over the age 18 there is a 6 month wait on Type B services and 12 month wait on Type C services. MOOP only applies to covered persons age 0 through 18.",,"No","Allows Adult and Child-Only",,,,,"$18.80","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes",,"","77760OK0020004-00","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/SHOP/Combined/Low2016","https://www.deltadentalok.org/client/marketplace/Brochure/SHOP2016","4"
"2016","OK","77760","HIOS","7","2015-08-22 15:09:32","2","77760","OK","SHOP (Small Group)","Yes","23-7322578","77760OK0020004","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK002",,"OKN002","OKS001",,"Existing","PPO","Low",,"Both",,,,"For covered persons over the age 18 there is a 6 month wait on Type B services and 12 month wait on Type C services. MOOP only applies to covered persons age 0 through 18.",,"No","Allows Adult and Child-Only",,,,,"$18.80","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes",,"","77760OK0020004-01","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/SHOP/Combined/Low2016","https://www.deltadentalok.org/client/marketplace/Brochure/SHOP2016","5"
"2016","OK","77760","HIOS","7","2015-08-22 15:09:32","2","77760","OK","Individual","Yes","23-7322578","77760OK0010004","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK001",,"OKN001","OKS001",,"Existing","PPO","Low",,"Both",,,,"For covered persons over the age 18 there is a 6 month wait on Basic services and 12 month wait on Major services. MOOP only applies to covered persons age 0 through 18.",,"No","Allows Adult and Child-Only",,,,,"$21.30","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","All benefits that are offered on the plan are available out of country.","Yes","All benefits that are offered on the plan are available out of the service area.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","77760OK0010004-01","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/Individual/Combined/Low2016","https://www.deltadentalok.org/client/marketplace/Brochure/Individual2016","5"
"2016","OK","77760","HIOS","7","2015-08-22 15:09:32","3","77760","OK","SHOP (Small Group)","Yes","23-7322578","77760OK0040003","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK004",,"OKN002","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,"This plan covers children ages 0-18 only.",,"No","Allows Child-Only",,,,,"$30.51","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes",,"","77760OK0040003-00","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$25","$25 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/SHOP/Pedo/High2016","https://www.deltadentalok.org/client/marketplace/Brochure/SHOP2016","4"
"2016","OK","77760","HIOS","7","2015-08-22 15:09:32","4","77760","OK","SHOP (Small Group)","Yes","23-7322578","77760OK0040004","Delta Dental PPO Plus Premier - Federally Compliant Plan","77760OK004",,"OKN002","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"This plan covers children ages 0-18 only.",,"No","Allows Child-Only",,,,,"$18.80","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes",,"","77760OK0040004-00","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalok.org/client/marketplace/SBC/SHOP/Pedo/Low2016","https://www.deltadentalok.org/client/marketplace/Brochure/SHOP2016","4"
"2016","OK","79147","HIOS","4","2015-08-25 05:06:23","1","79147","OK","SHOP (Small Group)","Yes","86-0307623","79147OK0010001","Smile for Health - Certified Optimum Coverage","79147OK001",,"OKN001","OKS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","79147OK0010001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","79147","HIOS","4","2015-08-25 05:06:23","2","79147","OK","SHOP (Small Group)","Yes","86-0307623","79147OK0010002","Smile for Health - Certified Optimum Coverage","79147OK001",,"OKN002","OKS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","79147OK0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","79147","HIOS","4","2015-08-25 05:06:23","3","79147","OK","SHOP (Small Group)","Yes","86-0307623","79147OK0010003","Smile for Health - Certified Optimum Coverage","79147OK001",,"OKN003","OKS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","79147OK0010003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","79147","HIOS","4","2015-08-25 05:06:23","4","79147","OK","SHOP (Small Group)","Yes","86-0307623","79147OK0010004","Smile for Health - Certified Optimum Coverage","79147OK001",,"OKN001","OKS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","79147OK0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","79147","HIOS","4","2015-08-25 05:06:23","5","79147","OK","SHOP (Small Group)","Yes","86-0307623","79147OK0010005","Smile for Health - Certified Optimum Coverage","79147OK001",,"OKN002","OKS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","79147OK0010005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","79147","HIOS","4","2015-08-25 05:06:23","6","79147","OK","SHOP (Small Group)","Yes","86-0307623","79147OK0010006","Smile for Health - Certified Optimum Coverage","79147OK001",,"OKN003","OKS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","79147OK0010006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","79147","HIOS","4","2015-08-25 05:06:23","7","79147","OK","SHOP (Small Group)","Yes","86-0307623","79147OK0020001","Smile for Health - Certified High Option","79147OK002",,"OKN001","OKS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","79147OK0020001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","79147","HIOS","4","2015-08-25 05:06:23","8","79147","OK","SHOP (Small Group)","Yes","86-0307623","79147OK0020002","Smile for Health - Certified High Option","79147OK002",,"OKN002","OKS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","79147OK0020002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","79147","HIOS","4","2015-08-25 05:06:23","9","79147","OK","SHOP (Small Group)","Yes","86-0307623","79147OK0020003","Smile for Health - Certified High Option","79147OK002",,"OKN003","OKS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","79147OK0020003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","79147","HIOS","4","2015-08-25 05:06:23","10","79147","OK","SHOP (Small Group)","Yes","86-0307623","79147OK0020004","Smile for Health - Certified High Option Plus","79147OK002",,"OKN001","OKS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","79147OK0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","79147","HIOS","4","2015-08-25 05:06:23","11","79147","OK","SHOP (Small Group)","Yes","86-0307623","79147OK0020005","Smile for Health - Certified High Option Plus","79147OK002",,"OKN002","OKS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","79147OK0020005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","79147","HIOS","4","2015-08-25 05:06:23","12","79147","OK","SHOP (Small Group)","Yes","86-0307623","79147OK0020006","Smile for Health - Certified High Option Plus","79147OK002",,"OKN003","OKS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","79147OK0020006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","81457","HIOS","1","2015-04-24 10:46:48","1","81457","OK","SHOP (Small Group)","Yes","13-5123390","81457OK0010002","Guardian Pediatric Advantage","81457OK001",,"OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$22.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","81457OK0010002-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","OK","81457","HIOS","1","2015-04-24 10:46:48","1","81457","OK","SHOP (Small Group)","Yes","13-5123390","81457OK0020002","Guardian Pediatric Essentials","81457OK002",,"OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$17.55","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","81457OK0020002-00","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","OK","81457","HIOS","1","2015-04-24 10:46:48","2","81457","OK","SHOP (Small Group)","Yes","13-5123390","81457OK0040002","Guardian Family Advantage","81457OK004",,"OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","81457OK0040002-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","OK","81457","HIOS","1","2015-04-24 10:46:48","2","81457","OK","SHOP (Small Group)","Yes","13-5123390","81457OK0060002","Guardian Family Essentials","81457OK006",,"OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.55","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","81457OK0060002-00","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","OK","81457","HIOS","1","2015-04-24 10:46:48","3","81457","OK","SHOP (Small Group)","Yes","13-5123390","81457OK0040003","Guardian Family Advantage","81457OK004",,"OKN001","OKS002",,"New","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the Service Area.","Yes",,"","81457OK0040003-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","OK","81457","HIOS","1","2015-04-24 10:46:48","3","81457","OK","SHOP (Small Group)","Yes","13-5123390","81457OK0060003","Guardian Family Essesntials","81457OK006",,"OKN001","OKS002",,"New","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.55","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the Service Area.","Yes",,"","81457OK0060003-01","Standard Low On Exchange Plan","69.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","Individual","Yes","36-1236610","87571OK0390001","BlueCare Dental? 1A","87571OK039",,"OKN004","OKS004",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.97","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390001-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsok.com/pdf/bluecare-dental-individuals-and-families-ok.pdf","4"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300001","Blue Choice Gold PPO? 001","87571OK030",,"OKN013","OKS003","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0300001-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,500","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0300001-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","4"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","Individual","No","36-1236610","87571OK0350029","Blue Advantage Bronze PPO?  105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS022","OKF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350029-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$20,400","$20400 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350029-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","4"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","Individual","No","36-1236610","87571OK0350029","Blue Advantage Bronze PPO?  105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS022","OKF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350029-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$20,400","$20400 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350029-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","5"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300001","Blue Choice Gold PPO? 001","87571OK030",,"OKN013","OKS003","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0300001-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,500","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0300001-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","5"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","Individual","Yes","36-1236610","87571OK0390001","BlueCare Dental? 1A","87571OK039",,"OKN004","OKS004",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.97","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390001-01","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsok.com/pdf/bluecare-dental-individuals-and-families-ok.pdf","5"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300002","Blue Choice Gold PPO? 002","87571OK030",,"OKN013","OKS003","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0300002-00","Standard Gold Off Exchange Plan","80.19%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0300002-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","6"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","Individual","No","36-1236610","87571OK0350029","Blue Advantage Bronze PPO?  105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS022","OKF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350029-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350029-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","6"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","Individual","No","36-1236610","87571OK0350029","Blue Advantage Bronze PPO?  105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS022","OKF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350029-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$20,400","$20400 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350029-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","7"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300002","Blue Choice Gold PPO? 002","87571OK030",,"OKN013","OKS003","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0300002-01","Standard Gold On Exchange Plan","80.19%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0300002-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","7"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300003","Blue Choice Silver PPO? 003","87571OK030",,"OKN013","OKS003","OKF006","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0300003-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0300003-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","8"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","Individual","No","36-1236610","87571OK0350042","Blue Advantage Bronze PPO?  105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS032","OKF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350042-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$20,400","$20400 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350029-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","8"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","Individual","No","36-1236610","87571OK0350042","Blue Advantage Bronze PPO?  105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS032","OKF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350042-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$20,400","$20400 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350029-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","9"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300003","Blue Choice Silver PPO? 003","87571OK030",,"OKN013","OKS003","OKF006","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0300003-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0300003-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","9"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300004","Blue Choice Silver PPO? 004","87571OK030",,"OKN013","OKS003","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0300004-00","Standard Silver Off Exchange Plan","70.42%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0300004-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","10"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","Individual","No","36-1236610","87571OK0350042","Blue Advantage Bronze PPO?  105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS032","OKF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350042-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350029-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","10"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","Individual","No","36-1236610","87571OK0350042","Blue Advantage Bronze PPO?  105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS032","OKF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350042-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$20,400","$20400 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350029-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","11"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300004","Blue Choice Silver PPO? 004","87571OK030",,"OKN013","OKS003","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0300004-01","Standard Silver On Exchange Plan","70.42%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0300004-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","11"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300016","Blue Choice Silver PPO? 016","87571OK030",,"OKN013","OKS003","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0300016-00","Standard Silver Off Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0300016-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","12"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","Individual","No","36-1236610","87571OK0350043","Blue Advantage Bronze PPO?  105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS042","OKF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350043-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$20,400","$20400 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350029-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","12"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","Individual","No","36-1236610","87571OK0350043","Blue Advantage Bronze PPO?  105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS042","OKF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350043-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$20,400","$20400 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350029-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","13"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300016","Blue Choice Silver PPO? 016","87571OK030",,"OKN013","OKS003","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0300016-01","Standard Silver On Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0300016-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","13"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330001","Blue Preferred Gold PPO? 001","87571OK033",,"OKN011","OKS031","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330001-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330001-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","14"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330002","Blue Preferred Gold PPO? 002","87571OK033",,"OKN011","OKS031","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330002-00","Standard Gold Off Exchange Plan","80.18%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330002-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","16"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","Individual","No","36-1236610","87571OK0350044","Blue Advantage Bronze PPO?  105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS052","OKF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350044-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$20,400","$20400 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350029-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","16"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","Individual","No","36-1236610","87571OK0350044","Blue Advantage Bronze PPO?  105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS052","OKF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350044-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$20,400","$20400 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350029-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","17"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330002","Blue Preferred Gold PPO? 002","87571OK033",,"OKN011","OKS031","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330002-01","Standard Gold On Exchange Plan","80.18%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330002-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","17"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330003","Blue Preferred Silver PPO? 003","87571OK033",,"OKN011","OKS031","OKF006","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330003-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330003-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","18"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","Individual","No","36-1236610","87571OK0350044","Blue Advantage Bronze PPO?  105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS052","OKF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350044-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350029-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","18"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","Individual","No","36-1236610","87571OK0350044","Blue Advantage Bronze PPO?  105 - One $0 PCP Visit","87571OK035",,"OKN002","OKS052","OKF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350044-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$20,400","$20400 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350029-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","19"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330003","Blue Preferred Silver PPO? 003","87571OK033",,"OKN011","OKS031","OKF006","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330003-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330003-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","19"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330017","Blue Preferred Silver PPO? 003","87571OK033",,"OKN011","OKS021","OKF006","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330017-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330003-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","39"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330037","Blue Preferred Silver PPO? 008","87571OK033",,"OKN011","OKS021","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330037-01","Standard Silver On Exchange Plan","70.62%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330008-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","13"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330038","Blue Preferred Silver PPO? 008","87571OK033",,"OKN011","OKS011","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330038-00","Standard Silver Off Exchange Plan","70.62%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330008-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","14"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320066","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS021","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320066-03","Limited Cost Sharing Plan Variation","69.82%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","14"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320066","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS021","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320066-04","73% AV Level Silver Plan","72.92%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-04.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","15"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320068","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS041","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320068-04","73% AV Level Silver Plan","72.92%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-04.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","29"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330004","Blue Preferred Silver PPO? 004","87571OK033",,"OKN011","OKS031","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330004-00","Standard Silver Off Exchange Plan","70.40%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330004-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","20"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330004","Blue Preferred Silver PPO? 004","87571OK033",,"OKN011","OKS031","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330004-01","Standard Silver On Exchange Plan","70.40%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330004-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","21"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330008","Blue Preferred Silver PPO? 008","87571OK033",,"OKN011","OKS031","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330008-00","Standard Silver Off Exchange Plan","70.62%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330008-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","22"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330008","Blue Preferred Silver PPO? 008","87571OK033",,"OKN011","OKS031","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330008-01","Standard Silver On Exchange Plan","70.62%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330008-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","23"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330010","Blue Preferred Gold PPO? 001","87571OK033",,"OKN011","OKS011","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330010-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330001-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","24"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330010","Blue Preferred Gold PPO? 001","87571OK033",,"OKN011","OKS011","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330010-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330001-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","25"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330011","Blue Preferred Gold PPO? 001","87571OK033",,"OKN011","OKS041","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330011-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330001-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","26"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330011","Blue Preferred Gold PPO? 001","87571OK033",,"OKN011","OKS041","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330011-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330001-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","27"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330012","Blue Preferred Gold PPO? 001","87571OK033",,"OKN011","OKS051","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330012-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330001-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","28"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330012","Blue Preferred Gold PPO? 001","87571OK033",,"OKN011","OKS051","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330012-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330001-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","29"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330013","Blue Preferred Gold PPO? 002","87571OK033",,"OKN011","OKS021","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330013-00","Standard Gold Off Exchange Plan","80.19%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330002-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","30"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330013","Blue Preferred Gold PPO? 002","87571OK033",,"OKN011","OKS021","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330013-01","Standard Gold On Exchange Plan","80.19%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330002-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","31"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330014","Blue Preferred Gold PPO? 002","87571OK033",,"OKN011","OKS011","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330014-00","Standard Gold Off Exchange Plan","80.19%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330002-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","32"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330014","Blue Preferred Gold PPO? 002","87571OK033",,"OKN011","OKS011","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330014-01","Standard Gold On Exchange Plan","80.19%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330002-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","33"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330015","Blue Preferred Gold PPO? 002","87571OK033",,"OKN011","OKS041","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330015-00","Standard Gold Off Exchange Plan","80.19%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330002-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","34"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330015","Blue Preferred Gold PPO? 002","87571OK033",,"OKN011","OKS041","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330015-01","Standard Gold On Exchange Plan","80.19%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330002-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","35"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330016","Blue Preferred Gold PPO? 002","87571OK033",,"OKN011","OKS051","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330016-00","Standard Gold Off Exchange Plan","80.19%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330002-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","36"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330017","Blue Preferred Silver PPO? 003","87571OK033",,"OKN011","OKS021","OKF006","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330017-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330003-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","38"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330024","Blue Preferred Silver PPO? 004","87571OK033",,"OKN011","OKS051","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330024-01","Standard Silver On Exchange Plan","70.40%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330004-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","11"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330037","Blue Preferred Silver PPO? 008","87571OK033",,"OKN011","OKS021","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330037-00","Standard Silver Off Exchange Plan","70.62%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330008-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","12"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320066","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS021","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320066-01","Standard Silver On Exchange Plan","69.82%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","12"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360003","Blue Advantage Silver PPO? 003","87571OK036",,"OKN012","OKS022","OKF006","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360003-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360003-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","25"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360004","Blue Advantage Silver PPO? 004","87571OK036",,"OKN012","OKS022","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360004-00","Standard Silver Off Exchange Plan","70.38%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360004-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","26"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","No","36-1236610","87571OK0320049","Blue Preferred Bronze PPO?  103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS011","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320049-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","$20,250","$20250 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320049-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","5"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","No","36-1236610","87571OK0320049","Blue Preferred Bronze PPO?  103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS011","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320049-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320049-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","6"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330018","Blue Preferred Silver PPO? 003","87571OK033",,"OKN011","OKS011","OKF006","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330018-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330003-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","40"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330018","Blue Preferred Silver PPO? 003","87571OK033",,"OKN011","OKS011","OKF006","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330018-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330003-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","41"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330019","Blue Preferred Silver PPO? 003","87571OK033",,"OKN011","OKS041","OKF006","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330019-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330003-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","42"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330019","Blue Preferred Silver PPO? 003","87571OK033",,"OKN011","OKS041","OKF006","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330019-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330003-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","43"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330020","Blue Preferred Silver PPO? 003","87571OK033",,"OKN011","OKS051","OKF006","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330020-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330003-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","44"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330020","Blue Preferred Silver PPO? 003","87571OK033",,"OKN011","OKS051","OKF006","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330020-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330003-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","45"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330021","Blue Preferred Silver PPO? 004","87571OK033",,"OKN011","OKS021","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330021-00","Standard Silver Off Exchange Plan","70.40%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330004-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","4"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","Yes","36-1236610","87571OK0390003","BlueCare Dental 4 Kids? 1A","87571OK039",,"OKN004","OKS004",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$42.97","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390003-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsok.com/pdf/bluecare-dental-individuals-and-families-ok.pdf","4"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320047","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS011","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320047-00","Standard Silver Off Exchange Plan","69.82%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","4"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320047","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS011","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320047-01","Standard Silver On Exchange Plan","69.82%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","5"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","Yes","36-1236610","87571OK0390003","BlueCare Dental 4 Kids? 1A","87571OK039",,"OKN004","OKS004",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$42.97","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390003-01","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsok.com/pdf/bluecare-dental-individuals-and-families-ok.pdf","5"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330021","Blue Preferred Silver PPO? 004","87571OK033",,"OKN011","OKS021","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330021-01","Standard Silver On Exchange Plan","70.40%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330004-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","5"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330022","Blue Preferred Silver PPO? 004","87571OK033",,"OKN011","OKS011","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330022-00","Standard Silver Off Exchange Plan","70.40%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330004-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","6"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320047","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS011","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320047-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","6"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320047","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS011","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320047-03","Limited Cost Sharing Plan Variation","69.82%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","7"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330022","Blue Preferred Silver PPO? 004","87571OK033",,"OKN011","OKS011","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330022-01","Standard Silver On Exchange Plan","70.40%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330004-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","7"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330023","Blue Preferred Silver PPO? 004","87571OK033",,"OKN011","OKS041","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330023-00","Standard Silver Off Exchange Plan","70.40%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330004-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","8"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320047","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS011","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320047-04","73% AV Level Silver Plan","72.92%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-04.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","8"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320047","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS011","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320047-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-05.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","9"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330023","Blue Preferred Silver PPO? 004","87571OK033",,"OKN011","OKS041","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330023-01","Standard Silver On Exchange Plan","70.40%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330004-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","9"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330024","Blue Preferred Silver PPO? 004","87571OK033",,"OKN011","OKS051","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330024-00","Standard Silver Off Exchange Plan","70.40%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330004-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","10"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320047","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS011","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320047-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$500","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-06.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","10"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320066","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS021","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320066-00","Standard Silver Off Exchange Plan","69.82%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","11"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320066","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS021","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320066-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","13"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330038","Blue Preferred Silver PPO? 008","87571OK033",,"OKN011","OKS011","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330038-01","Standard Silver On Exchange Plan","70.62%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330008-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","15"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330039","Blue Preferred Silver PPO? 008","87571OK033",,"OKN011","OKS041","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330039-00","Standard Silver Off Exchange Plan","70.62%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330008-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","16"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320066","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS021","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320066-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-05.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","16"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320066","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS021","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320066-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$500","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-06.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","17"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330039","Blue Preferred Silver PPO? 008","87571OK033",,"OKN011","OKS041","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330039-01","Standard Silver On Exchange Plan","70.62%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330008-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","17"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330040","Blue Preferred Silver PPO? 008","87571OK033",,"OKN011","OKS051","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330040-00","Standard Silver Off Exchange Plan","70.62%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330008-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","18"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320067","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS031","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320067-00","Standard Silver Off Exchange Plan","69.82%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","18"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320067","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS031","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320067-01","Standard Silver On Exchange Plan","69.82%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","19"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330040","Blue Preferred Silver PPO? 008","87571OK033",,"OKN011","OKS051","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330040-01","Standard Silver On Exchange Plan","70.62%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330008-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","19"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360001","Blue Advantage Gold PPO? 001","87571OK036",,"OKN012","OKS022","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360001-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360001-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","20"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320067","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS031","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320067-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","20"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320067","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS031","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320067-03","Limited Cost Sharing Plan Variation","69.82%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","21"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360001","Blue Advantage Gold PPO? 001","87571OK036",,"OKN012","OKS022","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360001-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360001-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","21"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360002","Blue Advantage Gold PPO? 002","87571OK036",,"OKN012","OKS032","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360002-00","Standard Gold Off Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360002-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","22"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320067","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS031","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320067-04","73% AV Level Silver Plan","72.92%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-04.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","22"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320067","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS031","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320067-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-05.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","23"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360002","Blue Advantage Gold PPO? 002","87571OK036",,"OKN012","OKS032","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360002-01","Standard Gold On Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360002-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","23"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360003","Blue Advantage Silver PPO? 003","87571OK036",,"OKN012","OKS022","OKF006","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360003-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360003-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","24"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320067","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS031","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320067-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$500","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-06.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","24"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320068","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS041","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320068-00","Standard Silver Off Exchange Plan","69.82%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","25"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320068","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS041","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320068-01","Standard Silver On Exchange Plan","69.82%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","26"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320068","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS041","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320068-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","27"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360004","Blue Advantage Silver PPO? 004","87571OK036",,"OKN012","OKS022","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360004-01","Standard Silver On Exchange Plan","70.38%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360004-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","27"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360007","Blue Advantage Silver PPO? 007","87571OK036",,"OKN012","OKS022","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360007-00","Standard Silver Off Exchange Plan","70.59%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360007-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","28"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320068","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS041","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320068-03","Limited Cost Sharing Plan Variation","69.82%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","28"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360007","Blue Advantage Silver PPO? 007","87571OK036",,"OKN012","OKS022","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360007-01","Standard Silver On Exchange Plan","70.59%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360007-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","29"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360008","Blue Advantage Gold PPO? 001","87571OK036",,"OKN012","OKS032","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360008-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360001-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","30"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320068","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS041","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320068-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-05.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","30"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320068","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS041","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320068-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$500","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-06.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","31"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360008","Blue Advantage Gold PPO? 001","87571OK036",,"OKN012","OKS032","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360008-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360001-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","31"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360009","Blue Advantage Gold PPO? 001","87571OK036",,"OKN012","OKS042","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360009-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360001-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","32"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320069","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS051","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320069-00","Standard Silver Off Exchange Plan","69.82%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","32"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320069","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS051","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320069-01","Standard Silver On Exchange Plan","69.82%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","33"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360009","Blue Advantage Gold PPO? 001","87571OK036",,"OKN012","OKS042","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360009-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360001-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","33"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320069","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS051","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320069-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","34"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320069","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS051","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320069-03","Limited Cost Sharing Plan Variation","69.82%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$9,750","$9750 per person","$29250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","35"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320069","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS051","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320069-04","73% AV Level Silver Plan","72.92%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-04.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","36"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320069","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS051","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320069-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-05.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","37"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","2","87571","OK","Individual","No","36-1236610","87571OK0320069","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","87571OK032",,"OKN001","OKS051","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320069-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$500","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320047-06.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","38"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","No","36-1236610","87571OK0320049","Blue Preferred Bronze PPO?  103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS011","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320049-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","$20,250","$20250 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320049-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","4"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360010","Blue Advantage Gold PPO? 001","87571OK036",,"OKN012","OKS052","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360010-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360001-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","4"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","Yes","36-1236610","87571OK0390002","BlueCare Dental? 1B","87571OK039",,"OKN004","OKS004",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.26","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390002-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsok.com/pdf/bluecare-dental-individuals-and-families-ok.pdf","4"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","Yes","36-1236610","87571OK0390002","BlueCare Dental? 1B","87571OK039",,"OKN004","OKS004",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.26","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390002-01","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsok.com/pdf/bluecare-dental-individuals-and-families-ok.pdf","5"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360010","Blue Advantage Gold PPO? 001","87571OK036",,"OKN012","OKS052","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360010-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360001-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","5"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360011","Blue Advantage Gold PPO? 002","87571OK036",,"OKN012","OKS022","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360011-00","Standard Gold Off Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360002-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","6"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360011","Blue Advantage Gold PPO? 002","87571OK036",,"OKN012","OKS022","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360011-01","Standard Gold On Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360002-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","7"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","No","36-1236610","87571OK0320049","Blue Preferred Bronze PPO?  103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS011","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320049-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","$20,250","$20250 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320049-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","7"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","No","36-1236610","87571OK0320074","Blue Preferred Bronze PPO?  103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS021","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320074-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","$20,250","$20250 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320049-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","8"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360012","Blue Advantage Gold PPO? 002","87571OK036",,"OKN012","OKS042","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360012-00","Standard Gold Off Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360002-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","8"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360012","Blue Advantage Gold PPO? 002","87571OK036",,"OKN012","OKS042","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360012-01","Standard Gold On Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360002-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","9"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","No","36-1236610","87571OK0320074","Blue Preferred Bronze PPO?  103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS021","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320074-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","$20,250","$20250 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320049-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","9"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","No","36-1236610","87571OK0320074","Blue Preferred Bronze PPO?  103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS021","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320074-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320049-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","10"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360013","Blue Advantage Gold PPO? 002","87571OK036",,"OKN012","OKS052","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360013-00","Standard Gold Off Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360002-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","10"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360018","Blue Advantage Silver PPO? 004","87571OK036",,"OKN012","OKS042","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360018-00","Standard Silver Off Exchange Plan","70.38%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360004-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","20"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","Individual","No","36-1236610","87571OK0320064","Blue Preferred Security PPO?  100","87571OK032",,"OKN001","OKS041","OKF004","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320064-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320046-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","11"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360025","Blue Advantage Bronze PPO? 006","87571OK036",,"OKN012","OKS052","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360025-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360006-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","34"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","5","87571","OK","Individual","No","36-1236610","87571OK0350027","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS022","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350027-06","94% AV Level Silver Plan","93.97%","0","Yes","Yes","Yes","60%","40%","$300","$0","$400","$200","$300","$100","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$750 per group","20%","$250","$250 per person","$750 per group","20%","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-06.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","21"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350030","Blue Advantage Gold PPO?  101","87571OK035",,"OKN002","OKS032","OKF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350030-03","Limited Cost Sharing Plan Variation","78.43%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350025-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","7"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360013","Blue Advantage Gold PPO? 002","87571OK036",,"OKN012","OKS052","OKF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360013-01","Standard Gold On Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$0","$1,100","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360002-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","11"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","No","36-1236610","87571OK0320074","Blue Preferred Bronze PPO?  103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS021","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320074-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","$20,250","$20250 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320049-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","11"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","No","36-1236610","87571OK0320075","Blue Preferred Bronze PPO?  103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS031","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320075-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","$20,250","$20250 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320049-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","12"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360014","Blue Advantage Silver PPO? 003","87571OK036",,"OKN012","OKS032","OKF006","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360014-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360003-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","12"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360014","Blue Advantage Silver PPO? 003","87571OK036",,"OKN012","OKS032","OKF006","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360014-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360003-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","13"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","No","36-1236610","87571OK0320075","Blue Preferred Bronze PPO?  103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS031","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320075-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","$20,250","$20250 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320049-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","13"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","No","36-1236610","87571OK0320075","Blue Preferred Bronze PPO?  103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS031","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320075-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320049-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","14"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360015","Blue Advantage Silver PPO? 003","87571OK036",,"OKN012","OKS042","OKF006","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360015-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360003-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","14"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360015","Blue Advantage Silver PPO? 003","87571OK036",,"OKN012","OKS042","OKF006","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360015-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360003-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","15"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","No","36-1236610","87571OK0320075","Blue Preferred Bronze PPO?  103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS031","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320075-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","$20,250","$20250 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320049-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","15"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","No","36-1236610","87571OK0320076","Blue Preferred Bronze PPO?  103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS041","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320076-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","$20,250","$20250 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320049-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","16"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360016","Blue Advantage Silver PPO? 003","87571OK036",,"OKN012","OKS052","OKF006","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360016-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360003-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","16"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360016","Blue Advantage Silver PPO? 003","87571OK036",,"OKN012","OKS052","OKF006","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360016-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360003-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","17"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","No","36-1236610","87571OK0320076","Blue Preferred Bronze PPO?  103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS041","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320076-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","$20,250","$20250 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320049-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","17"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","No","36-1236610","87571OK0320076","Blue Preferred Bronze PPO?  103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS041","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320076-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320049-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","18"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360017","Blue Advantage Silver PPO? 004","87571OK036",,"OKN012","OKS032","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360017-00","Standard Silver Off Exchange Plan","70.38%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360004-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","18"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360017","Blue Advantage Silver PPO? 004","87571OK036",,"OKN012","OKS032","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360017-01","Standard Silver On Exchange Plan","70.38%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360004-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","19"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","No","36-1236610","87571OK0320076","Blue Preferred Bronze PPO?  103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS041","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320076-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","$20,250","$20250 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320049-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","19"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","Individual","No","36-1236610","87571OK0320063","Blue Preferred Security PPO?  100","87571OK032",,"OKN001","OKS031","OKF004","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320063-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320046-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","9"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360030","Blue Advantage Bronze PPO? 011","87571OK036",,"OKN012","OKS022","OKF008","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360030-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360030-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","36"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360030","Blue Advantage Bronze PPO? 011","87571OK036",,"OKN012","OKS022","OKF008","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360030-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360030-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","37"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350030","Blue Advantage Gold PPO?  101","87571OK035",,"OKN002","OKS032","OKF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350030-00","Standard Gold Off Exchange Plan","78.43%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350025-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","4"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350030","Blue Advantage Gold PPO?  101","87571OK035",,"OKN002","OKS032","OKF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350030-01","Standard Gold On Exchange Plan","78.43%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350025-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","5"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350030","Blue Advantage Gold PPO?  101","87571OK035",,"OKN002","OKS032","OKF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350030-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350025-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","6"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","No","36-1236610","87571OK0320077","Blue Preferred Bronze PPO?  103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS051","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320077-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","$20,250","$20250 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320049-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","20"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360018","Blue Advantage Silver PPO? 004","87571OK036",,"OKN012","OKS042","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360018-01","Standard Silver On Exchange Plan","70.38%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360004-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","21"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","No","36-1236610","87571OK0320077","Blue Preferred Bronze PPO?  103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS051","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320077-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","$20,250","$20250 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320049-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","21"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","No","36-1236610","87571OK0320077","Blue Preferred Bronze PPO?  103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS051","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320077-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320049-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","22"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360019","Blue Advantage Silver PPO? 004","87571OK036",,"OKN012","OKS052","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360019-00","Standard Silver Off Exchange Plan","70.38%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360004-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","22"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360019","Blue Advantage Silver PPO? 004","87571OK036",,"OKN012","OKS052","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360019-01","Standard Silver On Exchange Plan","70.38%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360004-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","23"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","Individual","No","36-1236610","87571OK0320077","Blue Preferred Bronze PPO?  103 - Two $40 PCP Visits","87571OK032",,"OKN001","OKS051","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320077-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","$20,250","$20250 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320049-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","23"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360026","Blue Advantage Silver PPO? 007","87571OK036",,"OKN012","OKS032","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360026-00","Standard Silver Off Exchange Plan","70.59%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360007-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","24"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360026","Blue Advantage Silver PPO? 007","87571OK036",,"OKN012","OKS032","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360026-01","Standard Silver On Exchange Plan","70.59%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360007-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","25"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360027","Blue Advantage Silver PPO? 007","87571OK036",,"OKN012","OKS042","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360027-00","Standard Silver Off Exchange Plan","70.59%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360007-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","26"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360027","Blue Advantage Silver PPO? 007","87571OK036",,"OKN012","OKS042","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360027-01","Standard Silver On Exchange Plan","70.59%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360007-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","27"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360028","Blue Advantage Silver PPO? 007","87571OK036",,"OKN012","OKS052","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360028-00","Standard Silver Off Exchange Plan","70.59%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360007-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","28"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360028","Blue Advantage Silver PPO? 007","87571OK036",,"OKN012","OKS052","OKF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360028-01","Standard Silver On Exchange Plan","70.59%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360007-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","29"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300006","Blue Choice Bronze PPO? 006","87571OK030",,"OKN013","OKS003","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0300006-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0300006-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","4"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","Individual","Yes","36-1236610","87571OK0390004","BlueCare Dental 4 Kids? 1B","87571OK039",,"OKN004","OKS004",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$33.26","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390004-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsok.com/pdf/bluecare-dental-individuals-and-families-ok.pdf","4"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","Individual","No","36-1236610","87571OK0320046","Blue Preferred Security PPO?  100","87571OK032",,"OKN001","OKS011","OKF004","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320046-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320046-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","4"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","Individual","No","36-1236610","87571OK0320046","Blue Preferred Security PPO?  100","87571OK032",,"OKN001","OKS011","OKF004","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320046-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320046-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","5"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","Individual","Yes","36-1236610","87571OK0390004","BlueCare Dental 4 Kids? 1B","87571OK039",,"OKN004","OKS004",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$33.26","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","","87571OK0390004-01","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsok.com/pdf/bluecare-dental-individuals-and-families-ok.pdf","5"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300006","Blue Choice Bronze PPO? 006","87571OK030",,"OKN013","OKS003","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0300006-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0300006-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","5"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300019","Blue Choice Bronze PPO? 023","87571OK030",,"OKN013","OKS003","OKF008","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0300019-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0300019-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","6"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","Individual","No","36-1236610","87571OK0320062","Blue Preferred Security PPO?  100","87571OK032",,"OKN001","OKS021","OKF004","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320062-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320046-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","6"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","Individual","No","36-1236610","87571OK0320062","Blue Preferred Security PPO?  100","87571OK032",,"OKN001","OKS021","OKF004","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320062-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320046-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","7"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300019","Blue Choice Bronze PPO? 023","87571OK030",,"OKN013","OKS003","OKF008","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0300019-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0300019-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","7"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330006","Blue Preferred Bronze PPO? 006","87571OK033",,"OKN011","OKS031","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330006-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330006-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","8"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","Individual","No","36-1236610","87571OK0320063","Blue Preferred Security PPO?  100","87571OK032",,"OKN001","OKS031","OKF004","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320063-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320046-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","8"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330006","Blue Preferred Bronze PPO? 006","87571OK033",,"OKN011","OKS031","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330006-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330006-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","9"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330029","Blue Preferred Bronze PPO? 006","87571OK033",,"OKN011","OKS021","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330029-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330006-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","10"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","Individual","No","36-1236610","87571OK0320064","Blue Preferred Security PPO?  100","87571OK032",,"OKN001","OKS041","OKF004","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320064-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320046-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","10"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330029","Blue Preferred Bronze PPO? 006","87571OK033",,"OKN011","OKS021","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330029-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330006-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","11"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330030","Blue Preferred Bronze PPO? 006","87571OK033",,"OKN011","OKS011","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330030-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330006-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","12"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","Individual","No","36-1236610","87571OK0320065","Blue Preferred Security PPO?  100","87571OK032",,"OKN001","OKS051","OKF004","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320065-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320046-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","12"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","Individual","No","36-1236610","87571OK0320065","Blue Preferred Security PPO?  100","87571OK032",,"OKN001","OKS051","OKF004","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320065-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320046-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","13"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330030","Blue Preferred Bronze PPO? 006","87571OK033",,"OKN011","OKS011","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330030-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330006-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","13"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330031","Blue Preferred Bronze PPO? 006","87571OK033",,"OKN011","OKS041","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330031-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330006-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","14"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330031","Blue Preferred Bronze PPO? 006","87571OK033",,"OKN011","OKS041","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330031-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330006-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","15"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330032","Blue Preferred Bronze PPO? 006","87571OK033",,"OKN011","OKS051","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330032-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330006-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","16"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330032","Blue Preferred Bronze PPO? 006","87571OK033",,"OKN011","OKS051","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330032-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330006-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","17"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330042","Blue Preferred Bronze PPO? 022","87571OK033",,"OKN011","OKS011","OKF008","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330042-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330042-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","18"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330042","Blue Preferred Bronze PPO? 022","87571OK033",,"OKN011","OKS011","OKF008","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330042-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330042-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","19"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330047","Blue Preferred Bronze PPO? 022","87571OK033",,"OKN011","OKS021","OKF008","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330047-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330042-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","20"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330047","Blue Preferred Bronze PPO? 022","87571OK033",,"OKN011","OKS021","OKF008","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330047-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330042-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","21"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330048","Blue Preferred Bronze PPO? 022","87571OK033",,"OKN011","OKS031","OKF008","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330048-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330042-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","22"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330048","Blue Preferred Bronze PPO? 022","87571OK033",,"OKN011","OKS031","OKF008","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330048-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330042-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","23"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330049","Blue Preferred Bronze PPO? 022","87571OK033",,"OKN011","OKS041","OKF008","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330049-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330042-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","24"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330049","Blue Preferred Bronze PPO? 022","87571OK033",,"OKN011","OKS041","OKF008","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330049-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330042-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","25"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330050","Blue Preferred Bronze PPO? 022","87571OK033",,"OKN011","OKS051","OKF008","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330050-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330042-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","26"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330050","Blue Preferred Bronze PPO? 022","87571OK033",,"OKN011","OKS051","OKF008","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0330050-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0330042-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","27"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360006","Blue Advantage Bronze PPO? 006","87571OK036",,"OKN012","OKS022","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360006-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360006-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","28"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360006","Blue Advantage Bronze PPO? 006","87571OK036",,"OKN012","OKS022","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360006-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360006-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","29"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360023","Blue Advantage Bronze PPO? 006","87571OK036",,"OKN012","OKS032","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360023-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360006-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","30"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360023","Blue Advantage Bronze PPO? 006","87571OK036",,"OKN012","OKS032","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360023-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360006-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","31"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360024","Blue Advantage Bronze PPO? 006","87571OK036",,"OKN012","OKS042","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360024-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360006-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","32"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360024","Blue Advantage Bronze PPO? 006","87571OK036",,"OKN012","OKS042","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360024-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360006-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","33"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360025","Blue Advantage Bronze PPO? 006","87571OK036",,"OKN012","OKS052","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360025-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360006-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","35"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360034","Blue Advantage Bronze PPO? 011","87571OK036",,"OKN012","OKS032","OKF008","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360034-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360030-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","38"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360034","Blue Advantage Bronze PPO? 011","87571OK036",,"OKN012","OKS032","OKF008","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360034-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360030-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","39"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360035","Blue Advantage Bronze PPO? 011","87571OK036",,"OKN012","OKS042","OKF008","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360035-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360030-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","40"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360035","Blue Advantage Bronze PPO? 011","87571OK036",,"OKN012","OKS042","OKF008","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360035-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360030-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","41"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360036","Blue Advantage Bronze PPO? 011","87571OK036",,"OKN012","OKS052","OKF008","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360036-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360030-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","42"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360036","Blue Advantage Bronze PPO? 011","87571OK036",,"OKN012","OKS052","OKF008","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0360036-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsok.com/PDF/sbc/87571OK0360030-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","43"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","5","87571","OK","Individual","No","36-1236610","87571OK0350025","Blue Advantage Gold PPO?  101","87571OK035",,"OKN002","OKS022","OKF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350025-00","Standard Gold Off Exchange Plan","78.43%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350025-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","4"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","5","87571","OK","Individual","No","36-1236610","87571OK0350025","Blue Advantage Gold PPO?  101","87571OK035",,"OKN002","OKS022","OKF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350025-01","Standard Gold On Exchange Plan","78.43%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350025-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","5"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","5","87571","OK","Individual","No","36-1236610","87571OK0350025","Blue Advantage Gold PPO?  101","87571OK035",,"OKN002","OKS022","OKF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350025-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350025-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","6"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","5","87571","OK","Individual","No","36-1236610","87571OK0350025","Blue Advantage Gold PPO?  101","87571OK035",,"OKN002","OKS022","OKF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350025-03","Limited Cost Sharing Plan Variation","78.43%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350025-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","7"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","5","87571","OK","Individual","No","36-1236610","87571OK0350026","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS022","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350026-00","Standard Silver Off Exchange Plan","71.22%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","8"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","5","87571","OK","Individual","No","36-1236610","87571OK0350026","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS022","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350026-01","Standard Silver On Exchange Plan","71.22%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","9"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","5","87571","OK","Individual","No","36-1236610","87571OK0350026","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS022","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350026-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","10"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","5","87571","OK","Individual","No","36-1236610","87571OK0350026","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS022","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350026-03","Limited Cost Sharing Plan Variation","71.22%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","11"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","5","87571","OK","Individual","No","36-1236610","87571OK0350026","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS022","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350026-04","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-04.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","12"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","5","87571","OK","Individual","No","36-1236610","87571OK0350026","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS022","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350026-05","87% AV Level Silver Plan","86.41%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-05.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","13"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","5","87571","OK","Individual","No","36-1236610","87571OK0350026","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS022","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350026-06","94% AV Level Silver Plan","93.28%","0","Yes","Yes","Yes","60%","40%","$0","$0","$7","$200","$0","$100","$4","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","$500","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-06.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","14"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","5","87571","OK","Individual","No","36-1236610","87571OK0350027","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS022","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350027-00","Standard Silver Off Exchange Plan","69.98%","0","Yes","Yes","Yes","60%","40%","$4,300","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20%","$4,000","$4000 per person","$12000 per group","20%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","15"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","5","87571","OK","Individual","No","36-1236610","87571OK0350027","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS022","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350027-01","Standard Silver On Exchange Plan","69.98%","0","Yes","Yes","Yes","60%","40%","$4,300","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20%","$4,000","$4000 per person","$12000 per group","20%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","16"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","5","87571","OK","Individual","No","36-1236610","87571OK0350027","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS022","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350027-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","17"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","5","87571","OK","Individual","No","36-1236610","87571OK0350027","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS022","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350027-03","Limited Cost Sharing Plan Variation","69.98%","0","Yes","Yes","Yes","60%","40%","$4,300","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20%","$4,000","$4000 per person","$12000 per group","20%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","18"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","5","87571","OK","Individual","No","36-1236610","87571OK0350027","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS022","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350027-04","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-04.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","19"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","5","87571","OK","Individual","No","36-1236610","87571OK0350027","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS022","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350027-05","87% AV Level Silver Plan","86.70%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,400","$200","$500","$90","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-05.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","20"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350031","Blue Advantage Gold PPO?  101","87571OK035",,"OKN002","OKS042","OKF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350031-00","Standard Gold Off Exchange Plan","78.43%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350025-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","8"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350031","Blue Advantage Gold PPO?  101","87571OK035",,"OKN002","OKS042","OKF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350031-01","Standard Gold On Exchange Plan","78.43%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350025-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","9"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350035","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS052","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350035-00","Standard Silver Off Exchange Plan","71.22%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","30"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","7","87571","OK","Individual","No","36-1236610","87571OK0350038","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS052","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350038-04","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-04.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","8"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","7","87571","OK","Individual","No","36-1236610","87571OK0350038","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS052","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350038-05","87% AV Level Silver Plan","86.70%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,400","$200","$500","$90","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-05.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","9"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","7","87571","OK","Individual","No","36-1236610","87571OK0350038","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS052","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350038-06","94% AV Level Silver Plan","93.97%","0","Yes","Yes","Yes","60%","40%","$300","$0","$400","$200","$300","$100","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$750 per group","20%","$250","$250 per person","$750 per group","20%","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-06.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","10"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","8","87571","OK","Individual","No","36-1236610","87571OK0320070","Blue Preferred Bronze PPO?  102","87571OK032",,"OKN001","OKS021","OKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320070-01","Standard Bronze On Exchange Plan",,"0.616152584552765","Yes","Yes","Yes","60%","40%","$6,000","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","30%","$6,000","$6000 per person","$13700 per group","30%","$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320048-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","9"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350022","Blue Advantage Bronze PPO?  006","87571OK035",,"OKN002","OKS022","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350022-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350006-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","8"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","8","87571","OK","Individual","No","36-1236610","87571OK0320048","Blue Preferred Bronze PPO?  102","87571OK032",,"OKN001","OKS011","OKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320048-00","Standard Bronze Off Exchange Plan",,"0.616152584552765","Yes","Yes","Yes","60%","40%","$6,000","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","30%","$6,000","$6000 per person","$13700 per group","30%","$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320048-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","4"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","8","87571","OK","Individual","No","36-1236610","87571OK0320048","Blue Preferred Bronze PPO?  102","87571OK032",,"OKN001","OKS011","OKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320048-01","Standard Bronze On Exchange Plan",,"0.616152584552765","Yes","Yes","Yes","60%","40%","$6,000","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","30%","$6,000","$6000 per person","$13700 per group","30%","$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320048-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","5"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","8","87571","OK","Individual","No","36-1236610","87571OK0320048","Blue Preferred Bronze PPO?  102","87571OK032",,"OKN001","OKS011","OKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320048-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320048-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","6"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","8","87571","OK","Individual","No","36-1236610","87571OK0320048","Blue Preferred Bronze PPO?  102","87571OK032",,"OKN001","OKS011","OKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320048-03","Limited Cost Sharing Plan Variation",,"0.616152584552765","Yes","Yes","Yes","60%","40%","$6,000","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","30%","$6,000","$6000 per person","$13700 per group","30%","$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320048-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","7"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","8","87571","OK","Individual","No","36-1236610","87571OK0320070","Blue Preferred Bronze PPO?  102","87571OK032",,"OKN001","OKS021","OKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320070-00","Standard Bronze Off Exchange Plan",,"0.616152584552765","Yes","Yes","Yes","60%","40%","$6,000","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","30%","$6,000","$6000 per person","$13700 per group","30%","$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320048-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","8"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350031","Blue Advantage Gold PPO?  101","87571OK035",,"OKN002","OKS042","OKF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350031-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350025-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","10"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350031","Blue Advantage Gold PPO?  101","87571OK035",,"OKN002","OKS042","OKF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350031-03","Limited Cost Sharing Plan Variation","78.43%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350025-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","11"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350032","Blue Advantage Gold PPO?  101","87571OK035",,"OKN002","OKS052","OKF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350032-00","Standard Gold Off Exchange Plan","78.43%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350025-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","12"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350032","Blue Advantage Gold PPO?  101","87571OK035",,"OKN002","OKS052","OKF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350032-01","Standard Gold On Exchange Plan","78.43%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350025-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","13"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350032","Blue Advantage Gold PPO?  101","87571OK035",,"OKN002","OKS052","OKF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350032-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350025-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","14"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350032","Blue Advantage Gold PPO?  101","87571OK035",,"OKN002","OKS052","OKF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350032-03","Limited Cost Sharing Plan Variation","78.43%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350025-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","15"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350033","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS032","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350033-00","Standard Silver Off Exchange Plan","71.22%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","16"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350033","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS032","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350033-01","Standard Silver On Exchange Plan","71.22%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","17"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350033","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS032","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350033-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","18"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350033","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS032","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350033-03","Limited Cost Sharing Plan Variation","71.22%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","19"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350033","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS032","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350033-04","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-04.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","20"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350033","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS032","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350033-05","87% AV Level Silver Plan","86.41%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-05.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","21"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350033","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS032","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350033-06","94% AV Level Silver Plan","93.28%","0","Yes","Yes","Yes","60%","40%","$0","$0","$7","$200","$0","$100","$4","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","$500","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-06.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","22"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350034","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS042","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350034-00","Standard Silver Off Exchange Plan","71.22%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","23"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350034","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS042","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350034-01","Standard Silver On Exchange Plan","71.22%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","24"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350034","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS042","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350034-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","25"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350034","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS042","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350034-03","Limited Cost Sharing Plan Variation","71.22%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","26"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350034","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS042","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350034-04","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-04.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","27"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350034","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS042","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350034-05","87% AV Level Silver Plan","86.41%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-05.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","28"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350034","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS042","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350034-06","94% AV Level Silver Plan","93.28%","0","Yes","Yes","Yes","60%","40%","$0","$0","$7","$200","$0","$100","$4","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","$500","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-06.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","29"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350035","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS052","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350035-01","Standard Silver On Exchange Plan","71.22%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","31"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350035","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS052","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350035-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","32"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350035","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS052","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350035-03","Limited Cost Sharing Plan Variation","71.22%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","33"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350035","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS052","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350035-04","73% AV Level Silver Plan","73.25%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-04.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","34"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350035","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS052","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350035-05","87% AV Level Silver Plan","86.41%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-05.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","35"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350035","Blue Advantage Silver PPO?  102","87571OK035",,"OKN002","OKS052","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350035-06","94% AV Level Silver Plan","93.28%","0","Yes","Yes","Yes","60%","40%","$0","$0","$7","$200","$0","$100","$4","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","$500","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350026-06.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","36"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350036","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS032","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350036-00","Standard Silver Off Exchange Plan","69.98%","0","Yes","Yes","Yes","60%","40%","$4,300","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20%","$4,000","$4000 per person","$12000 per group","20%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","37"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350036","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS032","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350036-01","Standard Silver On Exchange Plan","69.98%","0","Yes","Yes","Yes","60%","40%","$4,300","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20%","$4,000","$4000 per person","$12000 per group","20%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","38"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350036","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS032","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350036-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","39"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350036","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS032","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350036-03","Limited Cost Sharing Plan Variation","69.98%","0","Yes","Yes","Yes","60%","40%","$4,300","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20%","$4,000","$4000 per person","$12000 per group","20%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","40"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350036","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS032","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350036-04","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-04.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","41"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350036","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS032","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350036-05","87% AV Level Silver Plan","86.70%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,400","$200","$500","$90","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-05.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","42"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350036","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS032","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350036-06","94% AV Level Silver Plan","93.97%","0","Yes","Yes","Yes","60%","40%","$300","$0","$400","$200","$300","$100","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$750 per group","20%","$250","$250 per person","$750 per group","20%","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-06.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","43"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350037","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS042","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350037-00","Standard Silver Off Exchange Plan","69.98%","0","Yes","Yes","Yes","60%","40%","$4,300","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20%","$4,000","$4000 per person","$12000 per group","20%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","44"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350037","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS042","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350037-01","Standard Silver On Exchange Plan","69.98%","0","Yes","Yes","Yes","60%","40%","$4,300","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20%","$4,000","$4000 per person","$12000 per group","20%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","45"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350037","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS042","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350037-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","46"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350037","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS042","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350037-03","Limited Cost Sharing Plan Variation","69.98%","0","Yes","Yes","Yes","60%","40%","$4,300","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20%","$4,000","$4000 per person","$12000 per group","20%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","47"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350037","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS042","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350037-04","73% AV Level Silver Plan","73.37%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$9,000","$9000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-04.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","48"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350037","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS042","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350037-05","87% AV Level Silver Plan","86.70%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,400","$200","$500","$90","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-05.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","49"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","6","87571","OK","Individual","No","36-1236610","87571OK0350037","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS042","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350037-06","94% AV Level Silver Plan","93.97%","0","Yes","Yes","Yes","60%","40%","$300","$0","$400","$200","$300","$100","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$750 per group","20%","$250","$250 per person","$750 per group","20%","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-06.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","50"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","7","87571","OK","Individual","No","36-1236610","87571OK0350038","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS052","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350038-00","Standard Silver Off Exchange Plan","69.98%","0","Yes","Yes","Yes","60%","40%","$4,300","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20%","$4,000","$4000 per person","$12000 per group","20%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","4"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","7","87571","OK","Individual","No","36-1236610","87571OK0350038","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS052","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350038-01","Standard Silver On Exchange Plan","69.98%","0","Yes","Yes","Yes","60%","40%","$4,300","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20%","$4,000","$4000 per person","$12000 per group","20%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","5"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","7","87571","OK","Individual","No","36-1236610","87571OK0350038","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS052","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350038-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","6"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","7","87571","OK","Individual","No","36-1236610","87571OK0350038","Blue Advantage Silver PPO?  103","87571OK035",,"OKN002","OKS052","OKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350038-03","Limited Cost Sharing Plan Variation","69.98%","0","Yes","Yes","Yes","60%","40%","$4,300","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group","20%","$4,000","$4000 per person","$12000 per group","20%","$12,000","$12000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350027-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","7"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350023","Blue Advantage Bronze PPO?  006","87571OK035",,"OKN002","OKS042","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350023-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350006-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","15"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350024","Blue Advantage Bronze PPO?  006","87571OK035",,"OKN002","OKS052","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350024-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350006-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","16"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0320030","Blue Preferred Bronze PPO?  006","87571OK032",,"OKN001","OKS021","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320030-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320006-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","42"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0320030","Blue Preferred Bronze PPO?  006","87571OK032",,"OKN001","OKS021","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320030-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320006-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","43"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","9","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090010","CommunityCare PPO Silver 5000 Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090010-00","Standard Silver Off Exchange Plan",,"0.709805727005005","Yes","Yes","No","100%",,"$5,900","$20","$300","$200","$400","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","45%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090010-00&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090010-00","4"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","9","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090010","CommunityCare PPO Silver 5000 Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090010-01","Standard Silver On Exchange Plan",,"0.709805727005005","Yes","Yes","No","100%",,"$5,900","$20","$300","$200","$400","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","45%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090010-01&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090010-01","5"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","10","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090013","CommunityCare PPO Silver 6000 Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090013-00","Standard Silver Off Exchange Plan",,"0.719748854637146","Yes","Yes","No","100%",,"$6,600","$20","$0","$200","$0","$600","$70","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","15%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090013-00&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090013-00","4"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","8","87571","OK","Individual","No","36-1236610","87571OK0320070","Blue Preferred Bronze PPO?  102","87571OK032",,"OKN001","OKS021","OKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320070-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320048-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","10"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","8","87571","OK","Individual","No","36-1236610","87571OK0320070","Blue Preferred Bronze PPO?  102","87571OK032",,"OKN001","OKS021","OKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320070-03","Limited Cost Sharing Plan Variation",,"0.616152584552765","Yes","Yes","Yes","60%","40%","$6,000","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","30%","$6,000","$6000 per person","$13700 per group","30%","$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320048-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","11"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","8","87571","OK","Individual","No","36-1236610","87571OK0320071","Blue Preferred Bronze PPO?  102","87571OK032",,"OKN001","OKS031","OKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320071-00","Standard Bronze Off Exchange Plan",,"0.616152584552765","Yes","Yes","Yes","60%","40%","$6,000","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","30%","$6,000","$6000 per person","$13700 per group","30%","$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320048-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","12"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","8","87571","OK","Individual","No","36-1236610","87571OK0320071","Blue Preferred Bronze PPO?  102","87571OK032",,"OKN001","OKS031","OKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320071-01","Standard Bronze On Exchange Plan",,"0.616152584552765","Yes","Yes","Yes","60%","40%","$6,000","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","30%","$6,000","$6000 per person","$13700 per group","30%","$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320048-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","13"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","8","87571","OK","Individual","No","36-1236610","87571OK0320071","Blue Preferred Bronze PPO?  102","87571OK032",,"OKN001","OKS031","OKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320071-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320048-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","14"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","8","87571","OK","Individual","No","36-1236610","87571OK0320071","Blue Preferred Bronze PPO?  102","87571OK032",,"OKN001","OKS031","OKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320071-03","Limited Cost Sharing Plan Variation",,"0.616152584552765","Yes","Yes","Yes","60%","40%","$6,000","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","30%","$6,000","$6000 per person","$13700 per group","30%","$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320048-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","15"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","8","87571","OK","Individual","No","36-1236610","87571OK0320072","Blue Preferred Bronze PPO?  102","87571OK032",,"OKN001","OKS041","OKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320072-00","Standard Bronze Off Exchange Plan",,"0.616152584552765","Yes","Yes","Yes","60%","40%","$6,000","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","30%","$6,000","$6000 per person","$13700 per group","30%","$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320048-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","16"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","8","87571","OK","Individual","No","36-1236610","87571OK0320072","Blue Preferred Bronze PPO?  102","87571OK032",,"OKN001","OKS041","OKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320072-01","Standard Bronze On Exchange Plan",,"0.616152584552765","Yes","Yes","Yes","60%","40%","$6,000","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","30%","$6,000","$6000 per person","$13700 per group","30%","$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320048-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","17"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","8","87571","OK","Individual","No","36-1236610","87571OK0320072","Blue Preferred Bronze PPO?  102","87571OK032",,"OKN001","OKS041","OKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320072-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320048-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","18"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","8","87571","OK","Individual","No","36-1236610","87571OK0320072","Blue Preferred Bronze PPO?  102","87571OK032",,"OKN001","OKS041","OKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320072-03","Limited Cost Sharing Plan Variation",,"0.616152584552765","Yes","Yes","Yes","60%","40%","$6,000","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","30%","$6,000","$6000 per person","$13700 per group","30%","$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320048-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","19"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","8","87571","OK","Individual","No","36-1236610","87571OK0320073","Blue Preferred Bronze PPO?  102","87571OK032",,"OKN001","OKS051","OKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320073-00","Standard Bronze Off Exchange Plan",,"0.616152584552765","Yes","Yes","Yes","60%","40%","$6,000","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","30%","$6,000","$6000 per person","$13700 per group","30%","$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320048-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","20"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","8","87571","OK","Individual","No","36-1236610","87571OK0320073","Blue Preferred Bronze PPO?  102","87571OK032",,"OKN001","OKS051","OKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320073-01","Standard Bronze On Exchange Plan",,"0.616152584552765","Yes","Yes","Yes","60%","40%","$6,000","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","30%","$6,000","$6000 per person","$13700 per group","30%","$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320048-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","21"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","8","87571","OK","Individual","No","36-1236610","87571OK0320073","Blue Preferred Bronze PPO?  102","87571OK032",,"OKN001","OKS051","OKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320073-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320048-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","22"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","8","87571","OK","Individual","No","36-1236610","87571OK0320073","Blue Preferred Bronze PPO?  102","87571OK032",,"OKN001","OKS051","OKF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320073-03","Limited Cost Sharing Plan Variation",,"0.616152584552765","Yes","Yes","Yes","60%","40%","$6,000","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","30%","$6,000","$6000 per person","$13700 per group","30%","$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320048-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","23"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350006","Blue Advantage Bronze PPO?  006","87571OK035",,"OKN002","OKS032","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350006-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350006-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","4"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350006","Blue Advantage Bronze PPO?  006","87571OK035",,"OKN002","OKS032","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350006-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350006-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","5"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350006","Blue Advantage Bronze PPO?  006","87571OK035",,"OKN002","OKS032","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350006-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","6"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350006","Blue Advantage Bronze PPO?  006","87571OK035",,"OKN002","OKS032","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350006-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350006-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","7"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350022","Blue Advantage Bronze PPO?  006","87571OK035",,"OKN002","OKS022","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350022-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350006-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","9"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350022","Blue Advantage Bronze PPO?  006","87571OK035",,"OKN002","OKS022","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350022-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350006-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","10"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350022","Blue Advantage Bronze PPO?  006","87571OK035",,"OKN002","OKS022","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350022-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350006-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","11"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0320006","Blue Preferred Bronze PPO?  006","87571OK032",,"OKN001","OKS051","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320006-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","38"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0320006","Blue Preferred Bronze PPO?  006","87571OK032",,"OKN001","OKS051","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320006-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320006-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","39"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0320030","Blue Preferred Bronze PPO?  006","87571OK032",,"OKN001","OKS021","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320030-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320006-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","40"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0320030","Blue Preferred Bronze PPO?  006","87571OK032",,"OKN001","OKS021","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320030-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320006-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","41"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","10","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090013","CommunityCare PPO Silver 6000 Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090013-01","Standard Silver On Exchange Plan",,"0.719748854637146","Yes","Yes","No","100%",,"$6,600","$20","$0","$200","$0","$600","$70","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","15%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090013-01&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090013-01","5"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350023","Blue Advantage Bronze PPO?  006","87571OK035",,"OKN002","OKS042","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350023-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350006-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","12"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350023","Blue Advantage Bronze PPO?  006","87571OK035",,"OKN002","OKS042","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350023-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350006-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","13"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350023","Blue Advantage Bronze PPO?  006","87571OK035",,"OKN002","OKS042","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350023-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350006-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","14"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350024","Blue Advantage Bronze PPO?  006","87571OK035",,"OKN002","OKS052","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350024-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350006-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","17"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350024","Blue Advantage Bronze PPO?  006","87571OK035",,"OKN002","OKS052","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350024-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350006-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","18"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350024","Blue Advantage Bronze PPO?  006","87571OK035",,"OKN002","OKS052","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350024-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350006-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","19"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350028","Blue Advantage Bronze PPO?  104","87571OK035",,"OKN002","OKS022","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350028-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$13,500","$13500 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350028-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","20"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350028","Blue Advantage Bronze PPO?  104","87571OK035",,"OKN002","OKS022","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350028-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$13,500","$13500 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350028-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","21"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350028","Blue Advantage Bronze PPO?  104","87571OK035",,"OKN002","OKS022","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350028-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350028-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","22"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350028","Blue Advantage Bronze PPO?  104","87571OK035",,"OKN002","OKS022","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350028-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$13,500","$13500 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350028-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","23"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350039","Blue Advantage Bronze PPO?  104","87571OK035",,"OKN002","OKS032","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350039-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$13,500","$13500 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350028-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","24"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350039","Blue Advantage Bronze PPO?  104","87571OK035",,"OKN002","OKS032","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350039-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$13,500","$13500 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350028-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","25"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350039","Blue Advantage Bronze PPO?  104","87571OK035",,"OKN002","OKS032","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350039-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350028-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","26"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350039","Blue Advantage Bronze PPO?  104","87571OK035",,"OKN002","OKS032","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350039-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$13,500","$13500 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350028-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","27"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350040","Blue Advantage Bronze PPO?  104","87571OK035",,"OKN002","OKS042","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350040-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$13,500","$13500 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350028-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","28"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350040","Blue Advantage Bronze PPO?  104","87571OK035",,"OKN002","OKS042","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350040-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$13,500","$13500 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350028-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","29"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350040","Blue Advantage Bronze PPO?  104","87571OK035",,"OKN002","OKS042","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350040-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350028-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","30"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350040","Blue Advantage Bronze PPO?  104","87571OK035",,"OKN002","OKS042","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350040-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$13,500","$13500 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350028-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","31"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350041","Blue Advantage Bronze PPO?  104","87571OK035",,"OKN002","OKS052","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350041-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$13,500","$13500 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350028-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","32"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350041","Blue Advantage Bronze PPO?  104","87571OK035",,"OKN002","OKS052","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350041-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$13,500","$13500 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350028-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","33"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350041","Blue Advantage Bronze PPO?  104","87571OK035",,"OKN002","OKS052","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350041-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350028-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","34"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0350041","Blue Advantage Bronze PPO?  104","87571OK035",,"OKN002","OKS052","OKF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0350041-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$13,500","$13500 per person","$40500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0350028-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","35"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0320006","Blue Preferred Bronze PPO?  006","87571OK032",,"OKN001","OKS051","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320006-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320006-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","36"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0320006","Blue Preferred Bronze PPO?  006","87571OK032",,"OKN001","OKS051","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320006-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320006-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","37"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0320031","Blue Preferred Bronze PPO?  006","87571OK032",,"OKN001","OKS031","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320031-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320006-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","44"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0320031","Blue Preferred Bronze PPO?  006","87571OK032",,"OKN001","OKS031","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320031-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320006-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","45"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0320031","Blue Preferred Bronze PPO?  006","87571OK032",,"OKN001","OKS031","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320031-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320006-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","46"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0320031","Blue Preferred Bronze PPO?  006","87571OK032",,"OKN001","OKS031","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320031-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320006-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","47"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0320032","Blue Preferred Bronze PPO?  006","87571OK032",,"OKN001","OKS041","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320032-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320006-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","48"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0320032","Blue Preferred Bronze PPO?  006","87571OK032",,"OKN001","OKS041","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320032-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320006-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","49"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0320032","Blue Preferred Bronze PPO?  006","87571OK032",,"OKN001","OKS041","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320032-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320006-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","50"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","9","87571","OK","Individual","No","36-1236610","87571OK0320032","Blue Preferred Bronze PPO?  006","87571OK032",,"OKN001","OKS041","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320032-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320006-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","51"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","10","87571","OK","Individual","No","36-1236610","87571OK0320033","Blue Preferred Bronze PPO?  006","87571OK032",,"OKN001","OKS011","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320033-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320006-00.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","4"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","10","87571","OK","Individual","No","36-1236610","87571OK0320033","Blue Preferred Bronze PPO?  006","87571OK032",,"OKN001","OKS011","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320033-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320006-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","5"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","10","87571","OK","Individual","No","36-1236610","87571OK0320033","Blue Preferred Bronze PPO?  006","87571OK032",,"OKN001","OKS011","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320033-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320006-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","6"
"2016","OK","87571","HIOS","12","2016-04-04 11:25:42","10","87571","OK","Individual","No","36-1236610","87571OK0320033","Blue Preferred Bronze PPO?  006","87571OK032",,"OKN001","OKS011","OKF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0320033-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$18,000","$18000 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0320006-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","7"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","1","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090004","CommunityCare PPO Platinum 500 Select","87698OK009","7912900140","OKN001","OKS001","OKF001","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090004-00","Standard Platinum Off Exchange Plan",,"0.89203554391861","No","Yes","No","100%",,"$1,000","$20","$1,100","$200","$0","$500","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201687698OK0090004-00&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090004-00","4"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","1","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090004","CommunityCare PPO Platinum 500 Select","87698OK009","7912900140","OKN001","OKS001","OKF001","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090004-01","Standard Platinum On Exchange Plan",,"0.89203554391861","No","Yes","No","100%",,"$1,000","$20","$1,100","$200","$0","$500","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201687698OK0090004-01&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090004-01","5"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","2","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090009","CommunityCare PPO Gold 900 Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090009-00","Standard Gold Off Exchange Plan",,"0.817715764045715","Yes","Yes","No","100%",,"$1,800","$20","$1,400","$200","$0","$700","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","30%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090009-00&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090009-00","4"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","2","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090009","CommunityCare PPO Gold 900 Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090009-01","Standard Gold On Exchange Plan",,"0.817715764045715","Yes","Yes","No","100%",,"$1,800","$20","$1,400","$200","$0","$700","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","30%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090009-01&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090009-01","5"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","3","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090008","CommunityCare PPO Gold 1000 Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090008-00","Standard Gold Off Exchange Plan",,"0.816081523895264","Yes","Yes","No","100%",,"$1,900","$20","$1,400","$200","$0","$700","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090008-00&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090008-00","4"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","3","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090008","CommunityCare PPO Gold 1000 Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090008-01","Standard Gold On Exchange Plan",,"0.816081523895264","Yes","Yes","No","100%",,"$1,900","$20","$1,400","$200","$0","$700","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090008-01&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090008-01","5"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","4","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090007","CommunityCare PPO Gold 1500 Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090007-00","Standard Gold Off Exchange Plan",,"0.806287348270416","Yes","Yes","No","100%",,"$2,400","$20","$1,300","$200","$0","$500","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090007-00&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090007-00","4"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","4","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090007","CommunityCare PPO Gold 1500 Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090007-01","Standard Gold On Exchange Plan",,"0.806287348270416","Yes","Yes","No","100%",,"$2,400","$20","$1,300","$200","$0","$500","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090007-01&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090007-01","5"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","5","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090006","CommunityCare PPO Gold 2000 Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090006-00","Standard Gold Off Exchange Plan",,"0.80144602060318","Yes","Yes","No","100%",,"$2,900","$20","$1,100","$200","$0","$600","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090006-00&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090006-00","4"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","5","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090006","CommunityCare PPO Gold 2000 Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090006-01","Standard Gold On Exchange Plan",,"0.80144602060318","Yes","Yes","No","100%",,"$2,900","$20","$1,100","$200","$0","$600","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090006-01&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090006-01","5"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","6","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090005","CommunityCare PPO Gold 2500 Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090005-00","Standard Gold Off Exchange Plan",,"0.79939216375351","Yes","Yes","No","100%",,"$3,400","$20","$600","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090005-00&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090005-00","4"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","6","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090005","CommunityCare PPO Gold 2500 Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090005-01","Standard Gold On Exchange Plan",,"0.79939216375351","Yes","Yes","No","100%",,"$3,400","$20","$600","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090005-01&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090005-01","5"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","7","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090012","CommunityCare PPO Silver 3500 Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","No","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090012-00","Standard Silver Off Exchange Plan",,"0.71681797504425","Yes","Yes","No","100%",,"$4,400","$20","$800","$200","$0","$600","$200","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","35%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090012-00&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090012-00","4"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","7","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090012","CommunityCare PPO Silver 3500 Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","No","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090012-01","Standard Silver On Exchange Plan",,"0.71681797504425","Yes","Yes","No","100%",,"$4,400","$20","$800","$200","$0","$600","$200","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","35%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090012-01&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090012-01","5"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","8","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090011","CommunityCare PPO Silver 4000 Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090011-00","Standard Silver Off Exchange Plan",,"0.718945443630219","Yes","Yes","No","100%",,"$4,900","$20","$500","$200","$0","$600","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090011-00&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090011-00","4"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","8","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090011","CommunityCare PPO Silver 4000 Select","87698OK009","7912900140","OKN001","OKS001","OKF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090011-01","Standard Silver On Exchange Plan",,"0.718945443630219","Yes","Yes","No","100%",,"$4,900","$20","$500","$200","$0","$600","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090011-01&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090011-01","5"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","11","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090016","CommunityCare PPO Bronze 4000 Select","87698OK009","7912900140","OKN001","OKS001","OKF003","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090016-00","Standard Bronze Off Exchange Plan",,"0.619213402271271","Yes","Yes","No","100%",,"$4,900","$20","$800","$200","$4,000","$100","$30","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","35%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090016-00&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090016-00","4"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","11","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090016","CommunityCare PPO Bronze 4000 Select","87698OK009","7912900140","OKN001","OKS001","OKF003","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090016-01","Standard Bronze On Exchange Plan",,"0.619213402271271","Yes","Yes","No","100%",,"$4,900","$20","$800","$200","$4,000","$100","$30","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","35%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090016-01&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090016-01","5"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","12","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090015","CommunityCare PPO Bronze 5000 Select","87698OK009","7912900140","OKN001","OKS001","OKF003","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090015-00","Standard Bronze Off Exchange Plan",,"0.611634075641632","Yes","Yes","No","100%",,"$5,900","$20","$400","$200","$4,800","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090015-00&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090015-00","4"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","12","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090015","CommunityCare PPO Bronze 5000 Select","87698OK009","7912900140","OKN001","OKS001","OKF003","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090015-01","Standard Bronze On Exchange Plan",,"0.611634075641632","Yes","Yes","No","100%",,"$5,900","$20","$400","$200","$4,800","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090015-01&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090015-01","5"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","13","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090014","CommunityCare PPO Bronze 6000 Select","87698OK009","7912900140","OKN001","OKS001","OKF003","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090014-00","Standard Bronze Off Exchange Plan",,"0.60815703868866","Yes","Yes","No","100%",,"$6,900","$20","$0","$200","$4,800","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201687698OK0090014-00&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090014-00","4"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","13","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090014","CommunityCare PPO Bronze 6000 Select","87698OK009","7912900140","OKN001","OKS001","OKF003","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090014-01","Standard Bronze On Exchange Plan",,"0.60815703868866","Yes","Yes","No","100%",,"$6,900","$20","$0","$200","$4,800","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201687698OK0090014-01&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090014-01","5"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","14","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090017","CommunityCare PPO Gold 750 Select","87698OK009","7912900140","OKN001","OKS001","OKF002","New","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090017-00","Standard Gold Off Exchange Plan",,"0.816283702850342","Yes","Yes","No","100%",,"$1,500","$20","$1,500","$200","$0","$600","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090017-00&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090017-00","4"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","14","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090017","CommunityCare PPO Gold 750 Select","87698OK009","7912900140","OKN001","OKS001","OKF002","New","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090017-01","Standard Gold On Exchange Plan",,"0.816283702850342","Yes","Yes","No","100%",,"$1,500","$20","$1,500","$200","$0","$600","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090017-01&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090017-01","5"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","15","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090018","CommunityCare PPO Gold 1000a Select","87698OK009","7912900140","OKN001","OKS001","OKF002","New","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090018-00","Standard Gold Off Exchange Plan",,"0.818124890327454","Yes","Yes","No","100%",,"$1,900","$20","$900","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090018-00&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090018-00","4"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","15","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090018","CommunityCare PPO Gold 1000a Select","87698OK009","7912900140","OKN001","OKS001","OKF002","New","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090018-01","Standard Gold On Exchange Plan",,"0.818124890327454","Yes","Yes","No","100%",,"$1,900","$20","$900","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090018-01&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090018-01","5"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","16","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090019","CommunityCare PPO Gold 1500a Select","87698OK009","7912900140","OKN001","OKS001","OKF002","New","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090019-00","Standard Gold Off Exchange Plan",,"0.802692413330078","Yes","Yes","No","100%",,"$2,400","$20","$800","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090019-00&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090019-00","4"
"2016","OK","87698","HIOS","5","2015-08-20 09:36:54","16","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090019","CommunityCare PPO Gold 1500a Select","87698OK009","7912900140","OKN001","OKS001","OKF002","New","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","87698OK0090019-01","Standard Gold On Exchange Plan",,"0.802692413330078","Yes","Yes","No","100%",,"$2,400","$20","$800","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201687698OK0090019-01&type=sbc","http://marketplace.ccok.com?plan=201687698OK0090019-01","5"
"2016","OK","89953","HIOS","2","2015-07-09 13:17:42","1","89953","OK","SHOP (Small Group)","Yes","81-0170040","89953OK0010001","Assurant Dental ACAFFO High","89953OK001",,"OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$38.35","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","89953OK0010001-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","89953","HIOS","2","2015-07-09 13:17:42","1","89953","OK","SHOP (Small Group)","Yes","81-0170040","89953OK0010002","Assurant Dental ACAFFO Low","89953OK001",,"OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$32.02","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","89953OK0010002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OK","91848","HIOS","2","2015-07-10 02:19:03","1","91848","OK","SHOP (Small Group)","Yes","35-0472300","91848OK0010001","Lincoln DentalConnect®","91848OK001","7063415294","OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.64","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","91848OK0010001-00","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OK","91848","HIOS","2","2015-07-10 02:19:03","1","91848","OK","SHOP (Small Group)","Yes","35-0472300","91848OK0010002","Lincoln DentalConnect®","91848OK001","7063415294","OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.91","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","91848OK0010002-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OK","91848","HIOS","2","2015-07-10 02:19:03","1","91848","OK","SHOP (Small Group)","Yes","35-0472300","91848OK0010003","Lincoln DentalConnect®","91848OK001","7063415294","OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.80","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","91848OK0010003-00","Standard Low Off Exchange Plan","69.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","OK","91848","HIOS","2","2015-07-10 02:19:03","1","91848","OK","SHOP (Small Group)","Yes","35-0472300","91848OK0010004","Lincoln DentalConnect®","91848OK001","7063415294","OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.24","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","91848OK0010004-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","OK","91848","HIOS","2","2015-07-10 02:19:03","1","91848","OK","SHOP (Small Group)","Yes","35-0472300","91848OK0010005","Lincoln DentalConnect®","91848OK001","7063415294","OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.94","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","91848OK0010005-00","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","OK","91848","HIOS","2","2015-07-10 02:19:03","1","91848","OK","SHOP (Small Group)","Yes","35-0472300","91848OK0010006","Lincoln DentalConnect®","91848OK001","7063415294","OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.00","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","91848OK0010006-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","OK","91848","HIOS","2","2015-07-10 02:19:03","1","91848","OK","SHOP (Small Group)","Yes","35-0472300","91848OK0010007","Lincoln DentalConnect®","91848OK001","7063415294","OKN001","OKS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.65","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","91848OK0010007-00","Standard Low Off Exchange Plan","69.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2016","OK","91848","HIOS","2","2015-07-10 02:19:03","1","91848","OK","SHOP (Small Group)","Yes","35-0472300","91848OK0010008","Lincoln DentalConnect®","91848OK001","7063415294","OKN001","OKS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.82","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","91848OK0010008-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","1","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170027","CommunityCare Platinum Premier Select","98905OK017","7003819233","OKN001","OKS001","OKF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170027-00","Standard Platinum Off Exchange Plan",,"0.917335033416748","No","Yes","No","100%",,"$0","$40","$500","$200","$0","$600","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170027-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170027-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","1","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170027","CommunityCare Platinum Premier Select","98905OK017","7003819233","OKN001","OKS001","OKF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170027-01","Standard Platinum On Exchange Plan",,"0.917335033416748","No","Yes","No","100%",,"$0","$40","$500","$200","$0","$600","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170027-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170027-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","1","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170047","CommunityCare Platinum Premier Classic","98905OK017","7003819233","OKN002","OKS002","OKF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170047-00","Standard Platinum Off Exchange Plan",,"0.917335033416748","No","Yes","No","100%",,"$0","$40","$500","$200","$0","$600","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170047-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170047-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","1","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170047","CommunityCare Platinum Premier Classic","98905OK017","7003819233","OKN002","OKS002","OKF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170047-01","Standard Platinum On Exchange Plan",,"0.917335033416748","No","Yes","No","100%",,"$0","$40","$500","$200","$0","$600","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170047-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170047-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","2","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170025","CommunityCare Platinum 250 Select","98905OK017","7003819233","OKN001","OKS001","OKF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170025-00","Standard Platinum Off Exchange Plan",,"0.901594817638397","No","Yes","No","100%",,"$500","$200","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170025-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170025-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","2","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170025","CommunityCare Platinum 250 Select","98905OK017","7003819233","OKN001","OKS001","OKF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170025-01","Standard Platinum On Exchange Plan",,"0.901594817638397","No","Yes","No","100%",,"$500","$200","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170025-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170025-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","2","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170045","CommunityCare Platinum 250 Classic","98905OK017","7003819233","OKN002","OKS002","OKF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170045-00","Standard Platinum Off Exchange Plan",,"0.901594817638397","No","Yes","No","100%",,"$500","$200","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170045-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170045-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","2","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170045","CommunityCare Platinum 250 Classic","98905OK017","7003819233","OKN002","OKS002","OKF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170045-01","Standard Platinum On Exchange Plan",,"0.901594817638397","No","Yes","No","100%",,"$500","$200","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170045-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170045-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","3","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170026","CommunityCare Platinum 750 Select","98905OK017","7003819233","OKN001","OKS001","OKF003","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170026-00","Standard Platinum Off Exchange Plan",,"0.890378355979919","No","Yes","No","100%",,"$1,500","$400","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170026-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170026-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","3","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170026","CommunityCare Platinum 750 Select","98905OK017","7003819233","OKN001","OKS001","OKF003","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170026-01","Standard Platinum On Exchange Plan",,"0.890378355979919","No","Yes","No","100%",,"$1,500","$400","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170026-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170026-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","3","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170046","CommunityCare Platinum 750 Classic","98905OK017","7003819233","OKN002","OKS002","OKF003","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170046-00","Standard Platinum Off Exchange Plan",,"0.890378355979919","No","Yes","No","100%",,"$1,500","$400","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170046-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170046-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","3","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170046","CommunityCare Platinum 750 Classic","98905OK017","7003819233","OKN002","OKS002","OKF003","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170046-01","Standard Platinum On Exchange Plan",,"0.890378355979919","No","Yes","No","100%",,"$1,500","$400","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170046-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170046-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","4","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170033","CommunityCare Gold 750 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170033-00","Standard Gold Off Exchange Plan",,"0.81924706697464","Yes","Yes","No","100%",,"$1,500","$60","$900","$200","$0","$700","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170033-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170033-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","4","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170033","CommunityCare Gold 750 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170033-01","Standard Gold On Exchange Plan",,"0.81924706697464","Yes","Yes","No","100%",,"$1,500","$60","$900","$200","$0","$700","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170033-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170033-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","4","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170053","CommunityCare Gold 750 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170053-00","Standard Gold Off Exchange Plan",,"0.81924706697464","Yes","Yes","No","100%",,"$1,500","$60","$900","$200","$0","$700","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170053-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170053-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","4","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170053","CommunityCare Gold 750 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170053-01","Standard Gold On Exchange Plan",,"0.81924706697464","Yes","Yes","No","100%",,"$1,500","$60","$900","$200","$0","$700","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170053-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170053-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","5","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170034","CommunityCare Gold 1000c Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170034-00","Standard Gold Off Exchange Plan",,"0.818960547447205","Yes","Yes","No","100%",,"$1,900","$50","$800","$200","$0","$600","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170034-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170034-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","5","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170034","CommunityCare Gold 1000c Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170034-01","Standard Gold On Exchange Plan",,"0.818960547447205","Yes","Yes","No","100%",,"$1,900","$50","$800","$200","$0","$600","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170034-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170034-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","5","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170054","CommunityCare Gold 1000c Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170054-00","Standard Gold Off Exchange Plan",,"0.818960547447205","Yes","Yes","No","100%",,"$1,900","$50","$800","$200","$0","$600","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170054-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170054-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","5","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170054","CommunityCare Gold 1000c Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170054-01","Standard Gold On Exchange Plan",,"0.818960547447205","Yes","Yes","No","100%",,"$1,900","$50","$800","$200","$0","$600","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170054-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170054-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","6","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170032","CommunityCare Gold 1000b Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170032-00","Standard Gold Off Exchange Plan",,"0.817386627197266","Yes","Yes","No","100%",,"$1,900","$40","$500","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170032-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170032-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","6","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170032","CommunityCare Gold 1000b Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170032-01","Standard Gold On Exchange Plan",,"0.817386627197266","Yes","Yes","No","100%",,"$1,900","$40","$500","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170032-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170032-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","6","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170052","CommunityCare Gold 1000b Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170052-00","Standard Gold Off Exchange Plan",,"0.817386627197266","Yes","Yes","No","100%",,"$1,900","$40","$500","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170052-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170052-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","6","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170052","CommunityCare Gold 1000b Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170052-01","Standard Gold On Exchange Plan",,"0.817386627197266","Yes","Yes","No","100%",,"$1,900","$40","$500","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170052-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170052-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","7","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170029","CommunityCare Gold 1000a Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170029-00","Standard Gold Off Exchange Plan",,"0.800942420959473","Yes","Yes","No","100%",,"$1,900","$50","$500","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170029-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170029-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","7","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170029","CommunityCare Gold 1000a Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170029-01","Standard Gold On Exchange Plan",,"0.800942420959473","Yes","Yes","No","100%",,"$1,900","$50","$500","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170029-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170029-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","7","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170049","CommunityCare Gold 1000a Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170049-00","Standard Gold Off Exchange Plan",,"0.800942420959473","Yes","Yes","No","100%",,"$1,900","$50","$500","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170049-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170049-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","7","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170049","CommunityCare Gold 1000a Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170049-01","Standard Gold On Exchange Plan",,"0.800942420959473","Yes","Yes","No","100%",,"$1,900","$50","$500","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170049-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170049-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","8","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170030","CommunityCare Gold 1500a Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170030-00","Standard Gold Off Exchange Plan",,"0.802692413330078","Yes","Yes","No","100%",,"$2,400","$40","$400","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170030-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170030-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","8","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170030","CommunityCare Gold 1500a Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170030-01","Standard Gold On Exchange Plan",,"0.802692413330078","Yes","Yes","No","100%",,"$2,400","$40","$400","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170030-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170030-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","8","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170050","CommunityCare Gold 1500a Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170050-00","Standard Gold Off Exchange Plan",,"0.802692413330078","Yes","Yes","No","100%",,"$2,400","$40","$400","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170050-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170050-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","8","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170050","CommunityCare Gold 1500a Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170050-01","Standard Gold On Exchange Plan",,"0.802692413330078","Yes","Yes","No","100%",,"$2,400","$40","$400","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170050-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170050-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","9","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170031","CommunityCare Gold 1500b Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170031-00","Standard Gold Off Exchange Plan",,"0.819069445133209","Yes","Yes","No","100%",,"$2,400","$30","$200","$200","$0","$500","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170031-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170031-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","9","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170031","CommunityCare Gold 1500b Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170031-01","Standard Gold On Exchange Plan",,"0.819069445133209","Yes","Yes","No","100%",,"$2,400","$30","$200","$200","$0","$500","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170031-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170031-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","9","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170051","CommunityCare Gold 1500b Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170051-00","Standard Gold Off Exchange Plan",,"0.819069445133209","Yes","Yes","No","100%",,"$2,400","$30","$200","$200","$0","$500","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170051-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170051-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","9","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170051","CommunityCare Gold 1500b Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170051-01","Standard Gold On Exchange Plan",,"0.819069445133209","Yes","Yes","No","100%",,"$2,400","$30","$200","$200","$0","$500","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170051-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170051-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","10","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170035","CommunityCare Gold 2000b Select","98905OK017","7003819233","OKN001","OKS001","OKF003","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"4","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170035-00","Standard Gold Off Exchange Plan",,"0.806496858596802","No","Yes","No","100%",,"$2,900","$600","$0","$200","$0","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170035-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170035-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","10","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170035","CommunityCare Gold 2000b Select","98905OK017","7003819233","OKN001","OKS001","OKF003","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"4","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170035-01","Standard Gold On Exchange Plan",,"0.806496858596802","No","Yes","No","100%",,"$2,900","$600","$0","$200","$0","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170035-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170035-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","10","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170055","CommunityCare Gold 2000b Classic","98905OK017","7003819233","OKN002","OKS002","OKF003","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"4","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170055-00","Standard Gold Off Exchange Plan",,"0.806496858596802","No","Yes","No","100%",,"$2,900","$600","$0","$200","$0","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170055-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170055-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","10","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170055","CommunityCare Gold 2000b Classic","98905OK017","7003819233","OKN002","OKS002","OKF003","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"4","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170055-01","Standard Gold On Exchange Plan",,"0.806496858596802","No","Yes","No","100%",,"$2,900","$600","$0","$200","$0","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170055-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170055-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","11","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170028","CommunityCare Gold 2000a Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170028-00","Standard Gold Off Exchange Plan",,"0.795602440834045","Yes","Yes","No","100%",,"$2,900","$40","$300","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170028-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170028-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","11","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170028","CommunityCare Gold 2000a Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170028-01","Standard Gold On Exchange Plan",,"0.795602440834045","Yes","Yes","No","100%",,"$2,900","$40","$300","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170028-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170028-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","11","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170048","CommunityCare Gold 2000a Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170048-00","Standard Gold Off Exchange Plan",,"0.795602440834045","Yes","Yes","No","100%",,"$2,900","$40","$300","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170048-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170048-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","11","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170048","CommunityCare Gold 2000a Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170048-01","Standard Gold On Exchange Plan",,"0.795602440834045","Yes","Yes","No","100%",,"$2,900","$40","$300","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170048-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170048-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","12","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170037","CommunityCare Silver 2000 Select","98905OK017","7003819233","OKN001","OKS001","OKF004","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170037-00","Standard Silver Off Exchange Plan",,"0.702177345752716","No","Yes","No","100%",,"$2,900","$90","$500","$200","$0","$1,000","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170037-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170037-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","12","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170037","CommunityCare Silver 2000 Select","98905OK017","7003819233","OKN001","OKS001","OKF004","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170037-01","Standard Silver On Exchange Plan",,"0.702177345752716","No","Yes","No","100%",,"$2,900","$90","$500","$200","$0","$1,000","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170037-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170037-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","12","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170057","CommunityCare Silver 2000 Classic","98905OK017","7003819233","OKN002","OKS002","OKF004","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170057-00","Standard Silver Off Exchange Plan",,"0.702177345752716","No","Yes","No","100%",,"$2,900","$90","$500","$200","$0","$1,000","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170057-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170057-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","12","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170057","CommunityCare Silver 2000 Classic","98905OK017","7003819233","OKN002","OKS002","OKF004","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170057-01","Standard Silver On Exchange Plan",,"0.702177345752716","No","Yes","No","100%",,"$2,900","$90","$500","$200","$0","$1,000","$100","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170057-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170057-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","13","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170040","CommunityCare Silver 3500 Select","98905OK017","7003819233","OKN001","OKS001","OKF005","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170040-00","Standard Silver Off Exchange Plan",,"0.697291195392609","No","Yes","No","100%",,"$4,400","$100","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170040-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170040-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","13","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170040","CommunityCare Silver 3500 Select","98905OK017","7003819233","OKN001","OKS001","OKF005","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170040-01","Standard Silver On Exchange Plan",,"0.697291195392609","No","Yes","No","100%",,"$4,400","$100","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170040-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170040-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","13","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170060","CommunityCare Silver 3500 Classic","98905OK017","7003819233","OKN002","OKS002","OKF005","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170060-00","Standard Silver Off Exchange Plan",,"0.697291195392609","No","Yes","No","100%",,"$4,400","$100","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170060-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170060-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","13","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170060","CommunityCare Silver 3500 Classic","98905OK017","7003819233","OKN002","OKS002","OKF005","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170060-01","Standard Silver On Exchange Plan",,"0.697291195392609","No","Yes","No","100%",,"$4,400","$100","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170060-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170060-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","14","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170038","CommunityCare Silver 4500 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170038-00","Standard Silver Off Exchange Plan",,"0.713552355766296","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$100","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170038-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170038-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","14","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170038","CommunityCare Silver 4500 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170038-01","Standard Silver On Exchange Plan",,"0.713552355766296","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$100","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170038-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170038-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","14","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170058","CommunityCare Silver 4500 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170058-00","Standard Silver Off Exchange Plan",,"0.713552355766296","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$100","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170058-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170058-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","14","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170058","CommunityCare Silver 4500 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170058-01","Standard Silver On Exchange Plan",,"0.713552355766296","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$100","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170058-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170058-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","15","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170036","CommunityCare Silver 6000 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170036-00","Standard Silver Off Exchange Plan",,"0.705271899700165","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$100","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170036-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170036-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","15","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170036","CommunityCare Silver 6000 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170036-01","Standard Silver On Exchange Plan",,"0.705271899700165","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$100","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170036-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170036-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","15","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170056","CommunityCare Silver 6000 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170056-00","Standard Silver Off Exchange Plan",,"0.705271899700165","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$100","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170056-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170056-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","15","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170056","CommunityCare Silver 6000 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170056-01","Standard Silver On Exchange Plan",,"0.705271899700165","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$100","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170056-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170056-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","16","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170044","CommunityCare Bronze 4000 Select","98905OK017","7003819233","OKN001","OKS001","OKF006","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170044-00","Standard Bronze Off Exchange Plan",,"0.619213402271271","Yes","Yes","No","100%",,"$4,900","$20","$800","$200","$4,000","$100","$30","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170044-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170044-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","16","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170044","CommunityCare Bronze 4000 Select","98905OK017","7003819233","OKN001","OKS001","OKF006","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170044-01","Standard Bronze On Exchange Plan",,"0.619213402271271","Yes","Yes","No","100%",,"$4,900","$20","$800","$200","$4,000","$100","$30","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170044-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170044-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","16","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170064","CommunityCare Bronze 4000 Classic","98905OK017","7003819233","OKN002","OKS002","OKF006","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170064-00","Standard Bronze Off Exchange Plan",,"0.619213402271271","Yes","Yes","No","100%",,"$4,900","$20","$800","$200","$4,000","$100","$30","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170064-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170064-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","16","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170064","CommunityCare Bronze 4000 Classic","98905OK017","7003819233","OKN002","OKS002","OKF006","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170064-01","Standard Bronze On Exchange Plan",,"0.619213402271271","Yes","Yes","No","100%",,"$4,900","$20","$800","$200","$4,000","$100","$30","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170064-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170064-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","17","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170043","CommunityCare Bronze 5000 Select","98905OK017","7003819233","OKN001","OKS001","OKF006","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170043-00","Standard Bronze Off Exchange Plan",,"0.609648823738098","Yes","Yes","No","100%",,"$5,900","$40","$0","$200","$4,800","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170043-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170043-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","17","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170043","CommunityCare Bronze 5000 Select","98905OK017","7003819233","OKN001","OKS001","OKF006","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170043-01","Standard Bronze On Exchange Plan",,"0.609648823738098","Yes","Yes","No","100%",,"$5,900","$40","$0","$200","$4,800","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170043-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170043-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","17","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170063","CommunityCare Bronze 5000 Classic","98905OK017","7003819233","OKN002","OKS002","OKF006","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170063-00","Standard Bronze Off Exchange Plan",,"0.609648823738098","Yes","Yes","No","100%",,"$5,900","$40","$0","$200","$4,800","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170063-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170063-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","17","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170063","CommunityCare Bronze 5000 Classic","98905OK017","7003819233","OKN002","OKS002","OKF006","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170063-01","Standard Bronze On Exchange Plan",,"0.609648823738098","Yes","Yes","No","100%",,"$5,900","$40","$0","$200","$4,800","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170063-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170063-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","18","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170042","CommunityCare Bronze 6000 Select","98905OK017","7003819233","OKN001","OKS001","OKF006","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170042-00","Standard Bronze Off Exchange Plan",,"0.60815703868866","Yes","Yes","No","100%",,"$6,900","$30","$0","$200","$4,800","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201698905OK0170042-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170042-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","18","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170042","CommunityCare Bronze 6000 Select","98905OK017","7003819233","OKN001","OKS001","OKF006","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170042-01","Standard Bronze On Exchange Plan",,"0.60815703868866","Yes","Yes","No","100%",,"$6,900","$30","$0","$200","$4,800","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201698905OK0170042-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170042-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","18","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170062","CommunityCare Bronze 6000 Classic","98905OK017","7003819233","OKN002","OKS002","OKF006","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170062-00","Standard Bronze Off Exchange Plan",,"0.60815703868866","Yes","Yes","No","100%",,"$6,900","$30","$0","$200","$4,800","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201698905OK0170062-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170062-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","18","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170062","CommunityCare Bronze 6000 Classic","98905OK017","7003819233","OKN002","OKS002","OKF006","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170062-01","Standard Bronze On Exchange Plan",,"0.60815703868866","Yes","Yes","No","100%",,"$6,900","$30","$0","$200","$4,800","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://marketplace.ccok.com?plan=201698905OK0170062-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170062-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","24","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170070","CommunityCare Silver 5000 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170070-00","Standard Silver Off Exchange Plan",,"0.719857156276703","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$100","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170070-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170070-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","24","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170070","CommunityCare Silver 5000 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170070-01","Standard Silver On Exchange Plan",,"0.719857156276703","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$100","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170070-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170070-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","24","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170080","CommunityCare Silver 5000 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170080-00","Standard Silver Off Exchange Plan",,"0.719857156276703","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$100","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170080-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170080-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","24","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170080","CommunityCare Silver 5000 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170080-01","Standard Silver On Exchange Plan",,"0.719857156276703","Yes","Yes","No","100%",,"$5,200","$50","$0","$200","$100","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170080-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170080-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","25","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170071","CommunityCare Silver 5500 Select","98905OK017","7003819233","OKN001","OKS001","OKF005","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170071-00","Standard Silver Off Exchange Plan",,"0.680044531822205","Yes","Yes","No","100%",,"$4,500","$50","$0","$200","$0","$600","$200","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170071-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170071-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","25","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170071","CommunityCare Silver 5500 Select","98905OK017","7003819233","OKN001","OKS001","OKF005","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170071-01","Standard Silver On Exchange Plan",,"0.680044531822205","Yes","Yes","No","100%",,"$4,500","$50","$0","$200","$0","$600","$200","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170071-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170071-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","25","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170081","CommunityCare Silver 5500 Classic","98905OK017","7003819233","OKN002","OKS002","OKF005","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170081-00","Standard Silver Off Exchange Plan",,"0.680044531822205","Yes","Yes","No","100%",,"$4,500","$50","$0","$200","$0","$600","$200","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170081-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170081-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","25","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170081","CommunityCare Silver 5500 Classic","98905OK017","7003819233","OKN002","OKS002","OKF005","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170081-01","Standard Silver On Exchange Plan",,"0.680044531822205","Yes","Yes","No","100%",,"$4,500","$50","$0","$200","$0","$600","$200","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170081-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170081-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","26","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170072","CommunityCare Silver 6200 Select","98905OK017","7003819233","OKN001","OKS001","OKF005","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170072-00","Standard Silver Off Exchange Plan",,"0.680432200431824","Yes","Yes","No","100%",,"$4,500","$50","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170072-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170072-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","26","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170072","CommunityCare Silver 6200 Select","98905OK017","7003819233","OKN001","OKS001","OKF005","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170072-01","Standard Silver On Exchange Plan",,"0.680432200431824","Yes","Yes","No","100%",,"$4,500","$50","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170072-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170072-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","26","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170082","CommunityCare Silver 6200 Classic","98905OK017","7003819233","OKN002","OKS002","OKF005","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170082-00","Standard Silver Off Exchange Plan",,"0.680432200431824","Yes","Yes","No","100%",,"$4,500","$50","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170082-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170082-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","26","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170082","CommunityCare Silver 6200 Classic","98905OK017","7003819233","OKN002","OKS002","OKF005","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170082-01","Standard Silver On Exchange Plan",,"0.680432200431824","Yes","Yes","No","100%",,"$4,500","$50","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170082-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170082-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","27","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170073","CommunityCare Silver 6000a Select","98905OK017","7003819233","OKN001","OKS001","OKF008","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170073-00","Standard Silver Off Exchange Plan",,"0.680946946144104","No","Yes","No","100%",,"$5,200","$50","$0","$200","$100","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170073-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170073-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","27","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170073","CommunityCare Silver 6000a Select","98905OK017","7003819233","OKN001","OKS001","OKF008","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170073-01","Standard Silver On Exchange Plan",,"0.680946946144104","No","Yes","No","100%",,"$5,200","$50","$0","$200","$100","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170073-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170073-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","27","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170083","CommunityCare Silver 6000a Classic","98905OK017","7003819233","OKN002","OKS002","OKF008","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170083-00","Standard Silver Off Exchange Plan",,"0.680946946144104","No","Yes","No","100%",,"$5,200","$50","$0","$200","$100","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170083-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170083-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","27","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170083","CommunityCare Silver 6000a Classic","98905OK017","7003819233","OKN002","OKS002","OKF008","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170083-01","Standard Silver On Exchange Plan",,"0.680946946144104","No","Yes","No","100%",,"$5,200","$50","$0","$200","$100","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170083-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170083-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","28","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170065","CommunityCare Platinum 500a Select","98905OK017","7003819233","OKN001","OKS001","OKF003","New","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170065-00","Standard Platinum Off Exchange Plan",,"0.902081370353699","No","Yes","No","100%",,"$1,000","$400","$0","$200","$0","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170065-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170065-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","28","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170065","CommunityCare Platinum 500a Select","98905OK017","7003819233","OKN001","OKS001","OKF003","New","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170065-01","Standard Platinum On Exchange Plan",,"0.902081370353699","No","Yes","No","100%",,"$1,000","$400","$0","$200","$0","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170065-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170065-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","28","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170075","CommunityCare Platinum 500a Classic","98905OK017","7003819233","OKN002","OKS002","OKF003","New","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170075-00","Standard Platinum Off Exchange Plan",,"0.902081370353699","No","Yes","No","100%",,"$1,000","$400","$0","$200","$0","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170075-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170075-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","28","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170075","CommunityCare Platinum 500a Classic","98905OK017","7003819233","OKN002","OKS002","OKF003","New","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170075-01","Standard Platinum On Exchange Plan",,"0.902081370353699","No","Yes","No","100%",,"$1,000","$400","$0","$200","$0","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170075-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170075-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","29","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170066","CommunityCare Platinum 500b Select","98905OK017","7003819233","OKN001","OKS001","OKF002","New","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170066-00","Standard Platinum Off Exchange Plan",,"0.880006849765778","Yes","Yes","No","100%",,"$1,000","$40","$1,100","$200","$400","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170066-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170066-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","29","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170066","CommunityCare Platinum 500b Select","98905OK017","7003819233","OKN001","OKS001","OKF002","New","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170066-01","Standard Platinum On Exchange Plan",,"0.880006849765778","Yes","Yes","No","100%",,"$1,000","$40","$1,100","$200","$400","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170066-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170066-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","29","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170076","CommunityCare Platinum 500b Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","New","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170076-00","Standard Platinum Off Exchange Plan",,"0.880006849765778","Yes","Yes","No","100%",,"$1,000","$40","$1,100","$200","$400","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170076-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170076-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","29","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170076","CommunityCare Platinum 500b Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","New","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170076-01","Standard Platinum On Exchange Plan",,"0.880006849765778","Yes","Yes","No","100%",,"$1,000","$40","$1,100","$200","$400","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170076-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170076-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","30","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170067","CommunityCare Gold 2500a Select","98905OK017","7003819233","OKN001","OKS001","OKF002","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"4","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170067-00","Standard Gold Off Exchange Plan",,"0.814901828765869","Yes","Yes","No","100%",,"$3,400","$500","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170067-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170067-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","30","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170067","CommunityCare Gold 2500a Select","98905OK017","7003819233","OKN001","OKS001","OKF002","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"4","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170067-01","Standard Gold On Exchange Plan",,"0.814901828765869","Yes","Yes","No","100%",,"$3,400","$500","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170067-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170067-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","30","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170077","CommunityCare Gold 2500a Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"4","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170077-00","Standard Gold Off Exchange Plan",,"0.814901828765869","Yes","Yes","No","100%",,"$3,400","$500","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170077-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170077-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","30","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170077","CommunityCare Gold 2500a Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"4","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170077-01","Standard Gold On Exchange Plan",,"0.814901828765869","Yes","Yes","No","100%",,"$3,400","$500","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170077-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170077-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","31","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170068","CommunityCare Gold 2500b Select","98905OK017","7003819233","OKN001","OKS001","OKF002","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170068-00","Standard Gold Off Exchange Plan",,"0.78879714012146","Yes","Yes","No","100%",,"$3,400","$40","$200","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170068-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170068-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","31","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170068","CommunityCare Gold 2500b Select","98905OK017","7003819233","OKN001","OKS001","OKF002","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170068-01","Standard Gold On Exchange Plan",,"0.78879714012146","Yes","Yes","No","100%",,"$3,400","$40","$200","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170068-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170068-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","31","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170078","CommunityCare Gold 2500b Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170078-00","Standard Gold Off Exchange Plan",,"0.78879714012146","Yes","Yes","No","100%",,"$3,400","$40","$200","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170078-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170078-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","31","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170078","CommunityCare Gold 2500b Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170078-01","Standard Gold On Exchange Plan",,"0.78879714012146","Yes","Yes","No","100%",,"$3,400","$40","$200","$200","$0","$600","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://marketplace.ccok.com?plan=201698905OK0170078-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170078-01","7"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","32","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170069","CommunityCare Silver 3000 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170069-00","Standard Silver Off Exchange Plan",,"0.715735197067261","No","Yes","No","100%",,"$3,900","$600","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170069-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170069-00","4"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","32","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170069","CommunityCare Silver 3000 Select","98905OK017","7003819233","OKN001","OKS001","OKF002","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170069-01","Standard Silver On Exchange Plan",,"0.715735197067261","No","Yes","No","100%",,"$3,900","$600","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170069-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170069-01","5"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","32","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170079","CommunityCare Silver 3000 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170079-00","Standard Silver Off Exchange Plan",,"0.715735197067261","No","Yes","No","100%",,"$3,900","$600","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170079-00&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170079-00","6"
"2016","OK","98905","HIOS","7","2015-09-02 08:31:46","32","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170079","CommunityCare Silver 3000 Classic","98905OK017","7003819233","OKN002","OKS002","OKF002","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Emergency Services","No","https://ccok.softheon.com/payment","http://marketplace.ccok.com?rxFormulary=2","98905OK0170079-01","Standard Silver On Exchange Plan",,"0.715735197067261","No","Yes","No","100%",,"$3,900","$600","$0","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://marketplace.ccok.com?plan=201698905OK0170079-01&type=sbc","http://marketplace.ccok.com?plan=201698905OK0170079-01","7"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","1","15614","PA","Individual","Yes","54-1808292","15614PA0020005","PPO Elite Basic Kids","15614PA002",,"PAN003","PAS003",,"New","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$14.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020005-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBLINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBLINDFAMEHB.PDF","4"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","1","15614","PA","SHOP (Small Group)","Yes","54-1808292","15614PA0040004","Access PPO Basic","15614PA004",,"PAN002","PAS002",,"New","PPO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$14.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","15614PA0040004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBLSMGFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBLSMGFAMEHB.PDF","4"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070015","UPMC Small Business Advantage Silver EPO $2,500 $20/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF001","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070015-01","Standard Silver On Exchange Plan","71.46%","0.75622546672821","No","Yes","No","100%",,"$2,500","$600","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001501","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001501","13"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070016","UPMC Small Business Advantage Silver EPO $3,000 $10/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF001","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070016-00","Standard Silver Off Exchange Plan","71.40%","0.729817390441895","No","Yes","No","100%",,"$3,000","$1,200","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001600","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001600","14"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","1","15614","PA","SHOP (Small Group)","Yes","54-1808292","15614PA0040004","Access PPO Basic","15614PA004",,"PAN002","PAS002",,"New","PPO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$14.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","15614PA0040004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBLSMGFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBLSMGFAMEHB.PDF","5"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","1","15614","PA","Individual","Yes","54-1808292","15614PA0020005","PPO Elite Basic Kids","15614PA002",,"PAN003","PAS003",,"New","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$14.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020005-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBLINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBLINDFAMEHB.PDF","5"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","1","15614","PA","SHOP (Small Group)","Yes","54-1808292","15614PA0040005","Access PPO Premium","15614PA004",,"PAN002","PAS002",,"New","PPO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$17.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","15614PA0040005-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBHSMGFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBHSMGFAMEHB.PDF","6"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","1","15614","PA","Individual","Yes","54-1808292","15614PA0020003","PPO Elite Premium Kids","15614PA002",,"PAN003","PAS003",,"New","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$17.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020003-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBHINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBHINDFAMEHB.PDF","6"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","1","15614","PA","Individual","Yes","54-1808292","15614PA0020003","PPO Elite Premium Kids","15614PA002",,"PAN003","PAS003",,"New","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$17.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020003-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBHINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBHINDFAMEHB.PDF","7"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","1","15614","PA","SHOP (Small Group)","Yes","54-1808292","15614PA0040005","Access PPO Premium","15614PA004",,"PAN002","PAS002",,"New","PPO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$17.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","15614PA0040005-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBHSMGFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBHSMGFAMEHB.PDF","7"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","1","15614","PA","Individual","Yes","54-1808292","15614PA0010003","Select Plan Basic Kids","15614PA001",,"PAN001","PAS001",,"Existing","HMO","Low",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"$8.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010003-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16DBLINDPEDEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16DBLINDPEDEHB.PDF","8"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","1","15614","PA","Individual","Yes","54-1808292","15614PA0010003","Select Plan Basic Kids","15614PA001",,"PAN001","PAS001",,"Existing","HMO","Low",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"$8.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010003-01","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16DBLINDPEDEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16DBLINDPEDEHB.PDF","9"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","1","15614","PA","Individual","Yes","54-1808292","15614PA0010005","Select Plan Premium Kids","15614PA001",,"PAN001","PAS001",,"New","HMO","High",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"$13.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010005-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16DBHINDPEDEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16DBHINDPEDEHB.PDF","10"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","1","15614","PA","Individual","Yes","54-1808292","15614PA0010005","Select Plan Premium Kids","15614PA001",,"PAN001","PAS001",,"New","HMO","High",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"$13.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010005-01","Standard High On Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16DBHINDPEDEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16DBHINDPEDEHB.PDF","11"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","2","15614","PA","Individual","Yes","54-1808292","15614PA0020004","PPO Elite Basic","15614PA002",,"PAN003","PAS003",,"New","PPO","Low",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$14.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020004-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBLINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBLINDFAMEHB.PDF","4"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","2","15614","PA","SHOP (Small Group)","Yes","54-1808292","15614PA0030004","Select Plan  Premium","15614PA003",,"PAN001","PAS001",,"New","HMO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"$13.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0030004-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16DBHSMGFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16DBHSMGFAMEHB.PDF","4"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070020","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF003","New","EPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070020-01","Standard Platinum On Exchange Plan","88.36%","0.890426158905029","No","Yes","No","100%",,"$500","$400","$0","$200","$500","$500","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007002001","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007002001","23"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070021","UPMC Small Business Advantage Gold EPO $1,500 $10/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF003","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070021-00","Standard Gold Off Exchange Plan","78.59%","0.800931811332703","No","Yes","No","100%",,"$1,500","$400","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007002100","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007002100","24"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070021","UPMC Small Business Advantage Gold EPO $1,500 $10/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF003","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070021-01","Standard Gold On Exchange Plan","78.59%","0.800931811332703","No","Yes","No","100%",,"$1,500","$400","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007002101","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007002101","25"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","2","15614","PA","SHOP (Small Group)","Yes","54-1808292","15614PA0030004","Select Plan  Premium","15614PA003",,"PAN001","PAS001",,"New","HMO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"$13.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0030004-01","Standard High On Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16DBHSMGFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16DBHSMGFAMEHB.PDF","5"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","2","15614","PA","Individual","Yes","54-1808292","15614PA0020004","PPO Elite Basic","15614PA002",,"PAN003","PAS003",,"New","PPO","Low",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$14.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020004-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBLINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBLINDFAMEHB.PDF","5"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","2","15614","PA","Individual","Yes","54-1808292","15614PA0020006","PPO Elite Premium","15614PA002",,"PAN003","PAS003",,"New","PPO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$17.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020006-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBHINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBHINDFAMEHB.PDF","6"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","2","15614","PA","Individual","Yes","54-1808292","15614PA0020006","PPO Elite Premium","15614PA002",,"PAN003","PAS003",,"New","PPO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$17.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020006-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBHINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBHINDFAMEHB.PDF","7"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","3","15614","PA","Individual","Yes","54-1808292","15614PA0020007","PPO Elite Plus","15614PA002",,"PAN003","PAS003",,"New","PPO","Low",,"Off the Exchange",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$14.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","15614PA0020007-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","4","15614","PA","Individual","Yes","54-1808292","15614PA0010004","Select Plan Basic","15614PA001",,"PAN001","PAS001",,"Existing","HMO","Low",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"$8.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010004-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16DBLINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16DBLINDFAMEHB.PDF","4"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","4","15614","PA","Individual","Yes","54-1808292","15614PA0010004","Select Plan Basic","15614PA001",,"PAN001","PAS001",,"Existing","HMO","Low",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"$8.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010004-01","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16DBLINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16DBLINDFAMEHB.PDF","5"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","4","15614","PA","Individual","Yes","54-1808292","15614PA0010006","Select Plan Premium","15614PA001",,"PAN001","PAS001",,"New","HMO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"$13.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010006-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBHINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBHINDFAMEHB.PDF","6"
"2016","PA","15614","HIOS","4","2015-10-21 05:00:18","4","15614","PA","Individual","Yes","54-1808292","15614PA0010006","Select Plan Premium","15614PA001",,"PAN001","PAS001",,"New","HMO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"$13.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","15614PA0010006-01","Standard High On Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBHINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSPA16SBHINDFAMEHB.PDF","7"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","Individual","No","46-2824626","16322PA0040026","UPMC Advantage Catastrophic $6,850/$0 - Premium Network","16322PA004",,"PAN003","PAS003","PAF005","New","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040026-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$4,900","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002600","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002600","4"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070011","UPMC Small Business Advantage Silver EPO $1,750/20% - Premium Network","16322PA007",,"PAN004","PAS003","PAF001","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070011-00","Standard Silver Off Exchange Plan","71.40%","0.725339233875275","No","Yes","No","100%",,"$1,800","$20","$1,100","$200","$1,800","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001100","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001100","4"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070011","UPMC Small Business Advantage Silver EPO $1,750/20% - Premium Network","16322PA007",,"PAN004","PAS003","PAF001","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070011-01","Standard Silver On Exchange Plan","71.40%","0.725339233875275","No","Yes","No","100%",,"$1,800","$20","$1,100","$200","$1,800","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001101","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001101","5"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","Individual","No","46-2824626","16322PA0040026","UPMC Advantage Catastrophic $6,850/$0 - Premium Network","16322PA004",,"PAN003","PAS003","PAF005","New","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040026-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$4,900","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002601","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002601","5"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","Individual","No","46-2824626","16322PA0050111","UPMC Advantage Catastrophic $6,850/$0 -Partner Network","16322PA005",,"PAN001","PAS001","PAF005","New","EPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050111-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$4,900","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005011100","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005011100","6"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070012","UPMC Small Business Advantage Platinum EPO $10/$25 - Premium Network","16322PA007",,"PAN004","PAS003","PAF001","New","EPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070012-00","Standard Platinum Off Exchange Plan","90.06%","0.909460425376892","No","Yes","No","100%",,"$0","$500","$0","$200","$0","$800","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001200","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001200","6"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070012","UPMC Small Business Advantage Platinum EPO $10/$25 - Premium Network","16322PA007",,"PAN004","PAS003","PAF001","New","EPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070012-01","Standard Platinum On Exchange Plan","90.06%","0.909460425376892","No","Yes","No","100%",,"$0","$500","$0","$200","$0","$800","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001201","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001201","7"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","Individual","No","46-2824626","16322PA0050111","UPMC Advantage Catastrophic $6,850/$0 -Partner Network","16322PA005",,"PAN001","PAS001","PAF005","New","EPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050111-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$4,900","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005011101","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005011101","7"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","Individual","No","46-2824626","16322PA0050112","UPMC Advantage Catastrophic $6,850/$0 - Select Network","16322PA005",,"PAN002","PAS002","PAF005","New","EPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050112-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$4,900","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005011200","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005011200","8"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070013","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF001","New","EPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070013-00","Standard Platinum Off Exchange Plan","88.00%","0.888960182666779","No","Yes","No","100%",,"$500","$400","$0","$200","$500","$500","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001300","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001300","8"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070013","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF001","New","EPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070013-01","Standard Platinum On Exchange Plan","88.00%","0.888960182666779","No","Yes","No","100%",,"$500","$400","$0","$200","$500","$500","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001301","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001301","9"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","Individual","No","46-2824626","16322PA0050112","UPMC Advantage Catastrophic $6,850/$0 - Select Network","16322PA005",,"PAN002","PAS002","PAF005","New","EPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050112-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$4,900","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005011201","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005011201","9"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070014","UPMC Small Business Advantage Gold EPO $1,500 $10/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF001","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070014-00","Standard Gold Off Exchange Plan","78.26%","0.797656953334808","No","Yes","No","100%",,"$1,500","$400","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001400","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001400","10"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070014","UPMC Small Business Advantage Gold EPO $1,500 $10/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF001","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070014-01","Standard Gold On Exchange Plan","78.26%","0.797656953334808","No","Yes","No","100%",,"$1,500","$400","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001401","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001401","11"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070015","UPMC Small Business Advantage Silver EPO $2,500 $20/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF001","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070015-00","Standard Silver Off Exchange Plan","71.46%","0.75622546672821","No","Yes","No","100%",,"$2,500","$600","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001500","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001500","12"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070016","UPMC Small Business Advantage Silver EPO $3,000 $10/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF001","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070016-01","Standard Silver On Exchange Plan","71.40%","0.729817390441895","No","Yes","No","100%",,"$3,000","$1,200","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001601","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001601","15"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070017","UPMC Small Business Advantage Silver EPO $5,000 $10/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF001","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070017-00","Standard Silver Off Exchange Plan","68.19%","0.695834398269653","No","Yes","No","100%",,"$5,000","$1,200","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001700","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001700","16"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070017","UPMC Small Business Advantage Silver EPO $5,000 $10/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF001","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070017-01","Standard Silver On Exchange Plan","68.19%","0.695834398269653","No","Yes","No","100%",,"$5,000","$1,200","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001701","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001701","17"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070018","UPMC Small Business Advantage Silver EPO $1,750/20% - Premium Network","16322PA007",,"PAN004","PAS003","PAF003","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070018-00","Standard Silver Off Exchange Plan","71.35%","0.732171356678009","No","Yes","No","100%",,"$1,800","$20","$1,100","$200","$1,800","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001800","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001800","18"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070018","UPMC Small Business Advantage Silver EPO $1,750/20% - Premium Network","16322PA007",,"PAN004","PAS003","PAF003","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070018-01","Standard Silver On Exchange Plan","71.35%","0.732171356678009","No","Yes","No","100%",,"$1,800","$20","$1,100","$200","$1,800","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001801","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001801","19"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070019","UPMC Small Business Advantage Platinum EPO $10/$25 - Premium Network","16322PA007",,"PAN004","PAS003","PAF003","New","EPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070019-00","Standard Platinum Off Exchange Plan","90.21%","0.910936057567596","No","Yes","No","100%",,"$0","$500","$0","$200","$0","$800","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001900","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001900","20"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070019","UPMC Small Business Advantage Platinum EPO $10/$25 - Premium Network","16322PA007",,"PAN004","PAS003","PAF003","New","EPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070019-01","Standard Platinum On Exchange Plan","90.21%","0.910936057567596","No","Yes","No","100%",,"$0","$500","$0","$200","$0","$800","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001901","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007001901","21"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070020","UPMC Small Business Advantage Platinum EPO $500 $20/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF003","New","EPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070020-00","Standard Platinum Off Exchange Plan","88.36%","0.890426158905029","No","Yes","No","100%",,"$500","$400","$0","$200","$500","$500","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007002000","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007002000","22"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070022","UPMC Small Business Advantage Silver EPO $2,500 $20/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF003","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070022-00","Standard Silver Off Exchange Plan","71.98%","0.760625123977661","No","Yes","No","100%",,"$2,500","$600","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007002200","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007002200","26"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070022","UPMC Small Business Advantage Silver EPO $2,500 $20/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF003","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070022-01","Standard Silver On Exchange Plan","71.98%","0.760625123977661","No","Yes","No","100%",,"$2,500","$600","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007002201","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007002201","27"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070023","UPMC Small Business Advantage Silver EPO $3,000 $10/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF003","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070023-00","Standard Silver Off Exchange Plan","71.88%","0.733896315097809","No","Yes","No","100%",,"$3,000","$1,200","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007002300","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007002300","28"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070023","UPMC Small Business Advantage Silver EPO $3,000 $10/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF003","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070023-01","Standard Silver On Exchange Plan","71.88%","0.733896315097809","No","Yes","No","100%",,"$3,000","$1,200","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007002301","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007002301","29"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070024","UPMC Small Business Advantage Silver EPO $5,000 $10/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF003","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070024-00","Standard Silver Off Exchange Plan","68.45%","0.698118627071381","No","Yes","No","100%",,"$5,000","$1,200","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007002400","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007002400","30"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","1","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0070024","UPMC Small Business Advantage Silver EPO $5,000 $10/$40 - Premium Network","16322PA007",,"PAN004","PAS003","PAF003","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.95",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0070024-01","Standard Silver On Exchange Plan","68.45%","0.698118627071381","No","Yes","No","100%",,"$5,000","$1,200","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007002401","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA007002401","31"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060051","UPMC Small Business Advantage Gold PPO $2,000/10% $20/$40 - Premium Network","16322PA006",,"PAN006","PAS003","PAF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060051-00","Standard Gold Off Exchange Plan","80.92%","0.792920053005219","No","Yes","No","100%",,"$2,000","$400","$500","$200","$1,300","$11","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005100","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005100","4"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","Individual","No","46-2824626","16322PA0040024","UPMC Advantage Bronze $6,200/$35 - Premium Network","16322PA004",,"PAN003","PAS003","PAF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040024-00","Standard Bronze Off Exchange Plan","62.00%","0.623750627040863","Yes","Yes","No","100%",,"$6,200","$20","$0","$200","$3,300","$900","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002400","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002400","4"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","Individual","No","46-2824626","16322PA0040024","UPMC Advantage Bronze $6,200/$35 - Premium Network","16322PA004",,"PAN003","PAS003","PAF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040024-01","Standard Bronze On Exchange Plan","62.00%","0.623750627040863","Yes","Yes","No","100%",,"$6,200","$20","$0","$200","$3,300","$900","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002401","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002401","5"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060051","UPMC Small Business Advantage Gold PPO $2,000/10% $20/$40 - Premium Network","16322PA006",,"PAN006","PAS003","PAF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060051-01","Standard Gold On Exchange Plan","80.92%","0.792920053005219","No","Yes","No","100%",,"$2,000","$400","$500","$200","$1,300","$11","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005101","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005101","5"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060052","UPMC Small Business Advantage Silver PPO $5,000 $10/$40 - Premium Network","16322PA006",,"PAN006","PAS003","PAF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060052-00","Standard Silver Off Exchange Plan","68.19%","0.695830464363098","No","Yes","No","100%",,"$5,000","$1,200","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005200","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005200","6"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","Individual","No","46-2824626","16322PA0040024","UPMC Advantage Bronze $6,200/$35 - Premium Network","16322PA004",,"PAN003","PAS003","PAF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040024-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002402","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002402","6"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","Individual","No","46-2824626","16322PA0040024","UPMC Advantage Bronze $6,200/$35 - Premium Network","16322PA004",,"PAN003","PAS003","PAF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040024-03","Limited Cost Sharing Plan Variation","62.00%","0.623750627040863","Yes","Yes","No","100%",,"$6,200","$20","$0","$200","$3,300","$900","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002403","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002403","7"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060052","UPMC Small Business Advantage Silver PPO $5,000 $10/$40 - Premium Network","16322PA006",,"PAN006","PAS003","PAF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060052-01","Standard Silver On Exchange Plan","68.19%","0.695830464363098","No","Yes","No","100%",,"$5,000","$1,200","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005201","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005201","7"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060053","UPMC Small Business Advantage Platinum PPO $10/$25 - Premium Network","16322PA006",,"PAN006","PAS003","PAF001","New","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060053-00","Standard Platinum Off Exchange Plan","90.06%","0.909460425376892","No","Yes","No","100%",,"$0","$500","$0","$200","$0","$800","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005300","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005300","8"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","Individual","No","46-2824626","16322PA0050100","UPMC Advantage Bronze $6,200/$35 - Partner Network","16322PA005",,"PAN001","PAS001","PAF006","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050100-00","Standard Bronze Off Exchange Plan","62.00%","0.623750627040863","Yes","Yes","No","100%",,"$6,200","$20","$0","$200","$3,300","$900","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010000","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010000","8"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","Individual","No","46-2824626","16322PA0050100","UPMC Advantage Bronze $6,200/$35 - Partner Network","16322PA005",,"PAN001","PAS001","PAF006","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050100-01","Standard Bronze On Exchange Plan","62.00%","0.623750627040863","Yes","Yes","No","100%",,"$6,200","$20","$0","$200","$3,300","$900","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010001","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010001","9"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060053","UPMC Small Business Advantage Platinum PPO $10/$25 - Premium Network","16322PA006",,"PAN006","PAS003","PAF001","New","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060053-01","Standard Platinum On Exchange Plan","90.06%","0.909460425376892","No","Yes","No","100%",,"$0","$500","$0","$200","$0","$800","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005301","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005301","9"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060054","UPMC Small Business Advantage Gold PPO $1,000 $20/$40 - Premium Network","16322PA006",,"PAN006","PAS003","PAF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060054-00","Standard Gold Off Exchange Plan","79.54%","0.813606023788452","No","Yes","No","100%",,"$1,000","$400","$0","$200","$1,000","$1,100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005400","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005400","10"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","Individual","No","46-2824626","16322PA0050100","UPMC Advantage Bronze $6,200/$35 - Partner Network","16322PA005",,"PAN001","PAS001","PAF006","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050100-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010002","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010002","10"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","Individual","No","46-2824626","16322PA0050100","UPMC Advantage Bronze $6,200/$35 - Partner Network","16322PA005",,"PAN001","PAS001","PAF006","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050100-03","Limited Cost Sharing Plan Variation","62.00%","0.623750627040863","Yes","Yes","No","100%",,"$6,200","$20","$0","$200","$3,300","$900","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010003","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010003","11"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060054","UPMC Small Business Advantage Gold PPO $1,000 $20/$40 - Premium Network","16322PA006",,"PAN006","PAS003","PAF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060054-01","Standard Gold On Exchange Plan","79.54%","0.813606023788452","No","Yes","No","100%",,"$1,000","$400","$0","$200","$1,000","$1,100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005401","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005401","11"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060059","UPMC Small Business Advantage Gold PPO $2,000/10% $20/$40 - Premium Network","16322PA006",,"PAN006","PAS003","PAF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060059-00","Standard Gold Off Exchange Plan","80.92%","0.794601559638977","No","Yes","No","100%",,"$2,000","$400","$500","$200","$1,300","$11","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005900","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005900","12"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","Individual","No","46-2824626","16322PA0050101","UPMC Advantage Bronze $6,200/$35 - Select Network","16322PA005",,"PAN002","PAS002","PAF006","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050101-00","Standard Bronze Off Exchange Plan","62.00%","0.623750627040863","Yes","Yes","No","100%",,"$6,200","$20","$0","$200","$3,300","$900","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010100","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010100","12"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","Individual","No","46-2824626","16322PA0050101","UPMC Advantage Bronze $6,200/$35 - Select Network","16322PA005",,"PAN002","PAS002","PAF006","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050101-01","Standard Bronze On Exchange Plan","62.00%","0.623750627040863","Yes","Yes","No","100%",,"$6,200","$20","$0","$200","$3,300","$900","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010101","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010101","13"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060059","UPMC Small Business Advantage Gold PPO $2,000/10% $20/$40 - Premium Network","16322PA006",,"PAN006","PAS003","PAF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060059-01","Standard Gold On Exchange Plan","80.92%","0.794601559638977","No","Yes","No","100%",,"$2,000","$400","$500","$200","$1,300","$11","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005901","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005901","13"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060060","UPMC Small Business Advantage Silver PPO $5,000 $10/$40 - Premium Network","16322PA006",,"PAN006","PAS003","PAF003","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060060-00","Standard Silver Off Exchange Plan","68.45%","0.698115825653076","No","Yes","No","100%",,"$5,000","$1,200","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006000","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006000","14"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060058","UPMC Consumer Advantage Gold HSA PPO $1,350/10% - Premium Network","16322PA006",,"PAN006","PAS003","PAF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060058-00","Standard Gold Off Exchange Plan","79.97%","0.791882991790771","Yes","Yes","No","100%",,"$1,400","$20","$600","$200","$1,400","$800","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","10%",,,,,"$2,700","per person not applicable","$5400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005800","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005800","16"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","Individual","No","46-2824626","16322PA0050105","UPMC Advantage Silver HSA $2,600/20% - Partner Network","16322PA005",,"PAN001","PAS001","PAF012","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050105-05","87% AV Level Silver Plan","88.00%","0.87111634016037","Yes","Yes","No","100%",,"$600","$10","$1,300","$200","$600","$300","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010505","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010505","16"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","Individual","No","46-2824626","16322PA0050105","UPMC Advantage Silver HSA $2,600/20% - Partner Network","16322PA005",,"PAN001","PAS001","PAF012","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050105-06","94% AV Level Silver Plan","93.98%","0.934409260749817","Yes","Yes","No","100%",,"$100","$0","$700","$200","$100","$200","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010506","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010506","17"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060058","UPMC Consumer Advantage Gold HSA PPO $1,350/10% - Premium Network","16322PA006",,"PAN006","PAS003","PAF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060058-01","Standard Gold On Exchange Plan","79.97%","0.791882991790771","Yes","Yes","No","100%",,"$1,400","$20","$600","$200","$1,400","$800","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","10%",,,,,"$2,700","per person not applicable","$5400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005801","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005801","17"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060062","UPMC Consumer Advantage Gold HSA PPO $1,400 - Premium Network","16322PA006",,"PAN006","PAS003","PAF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060062-00","Standard Gold Off Exchange Plan","81.95%","0.825922608375549","Yes","Yes","No","100%",,"$1,400","$20","$0","$200","$1,400","$800","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","per person not applicable","$2800 per group","0%",,,,,"$2,800","per person not applicable","$5600 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006200","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006200","18"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","Individual","No","46-2824626","16322PA0050101","UPMC Advantage Bronze $6,200/$35 - Select Network","16322PA005",,"PAN002","PAS002","PAF006","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050101-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010102","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010102","14"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","Individual","No","46-2824626","16322PA0050101","UPMC Advantage Bronze $6,200/$35 - Select Network","16322PA005",,"PAN002","PAS002","PAF006","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050101-03","Limited Cost Sharing Plan Variation","62.00%","0.623750627040863","Yes","Yes","No","100%",,"$6,200","$20","$0","$200","$3,300","$900","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010103","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010103","15"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060060","UPMC Small Business Advantage Silver PPO $5,000 $10/$40 - Premium Network","16322PA006",,"PAN006","PAS003","PAF003","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060060-01","Standard Silver On Exchange Plan","68.45%","0.698115825653076","No","Yes","No","100%",,"$5,000","$1,200","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006001","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006001","15"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060067","UPMC Small Business Advantage Platinum PPO $10/$25 - Premium Network","16322PA006",,"PAN006","PAS003","PAF003","New","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060067-00","Standard Platinum Off Exchange Plan","90.21%","0.910936057567596","No","Yes","No","100%",,"$0","$500","$0","$200","$0","$800","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006700","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006700","16"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060067","UPMC Small Business Advantage Platinum PPO $10/$25 - Premium Network","16322PA006",,"PAN006","PAS003","PAF003","New","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060067-01","Standard Platinum On Exchange Plan","90.21%","0.910936057567596","No","Yes","No","100%",,"$0","$500","$0","$200","$0","$800","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006701","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006701","17"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060068","UPMC Small Business Advantage Gold PPO $1,000 $20/$40 - Premium Network","16322PA006",,"PAN006","PAS003","PAF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060068-00","Standard Gold Off Exchange Plan","79.90%","0.817066371440887","No","Yes","No","100%",,"$1,000","$400","$0","$200","$1,000","$1,100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006800","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006800","18"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","2","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060068","UPMC Small Business Advantage Gold PPO $1,000 $20/$40 - Premium Network","16322PA006",,"PAN006","PAS003","PAF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060068-01","Standard Gold On Exchange Plan","79.90%","0.817066371440887","No","Yes","No","100%",,"$1,000","$400","$0","$200","$1,000","$1,100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006801","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006801","19"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060041","UPMC Consumer Advantage Silver HSA PPO $3,000 - Premium Network","16322PA006",,"PAN006","PAS003","PAF019","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060041-00","Standard Silver Off Exchange Plan","70.43%","0.726366281509399","Yes","Yes","No","100%",,"$3,000","$20","$0","$200","$3,000","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004100","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004100","4"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","Individual","No","46-2824626","16322PA0040025","UPMC Advantage Silver HSA $2,600/20% - Premium Network","16322PA004",,"PAN003","PAS003","PAF012","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040025-00","Standard Silver Off Exchange Plan","71.85%","0.720737278461456","Yes","Yes","No","100%",,"$2,600","$20","$900","$200","$2,600","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002500","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002500","4"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","Individual","No","46-2824626","16322PA0040025","UPMC Advantage Silver HSA $2,600/20% - Premium Network","16322PA004",,"PAN003","PAS003","PAF012","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040025-01","Standard Silver On Exchange Plan","71.85%","0.720737278461456","Yes","Yes","No","100%",,"$2,600","$20","$900","$200","$2,600","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002501","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002501","5"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060041","UPMC Consumer Advantage Silver HSA PPO $3,000 - Premium Network","16322PA006",,"PAN006","PAS003","PAF019","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060041-01","Standard Silver On Exchange Plan","70.43%","0.726366281509399","Yes","Yes","No","100%",,"$3,000","$20","$0","$200","$3,000","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004101","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004101","5"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060042","UPMC Consumer Advantage Gold HSA PPO $1,750 - Premium Network","16322PA006",,"PAN006","PAS003","PAF002","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060042-00","Standard Gold Off Exchange Plan","78.98%","0.797787308692932","Yes","Yes","No","100%",,"$1,800","$20","$0","$200","$1,800","$800","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","0%",,,,,"$3,500","per person not applicable","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004200","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004200","6"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","Individual","No","46-2824626","16322PA0040025","UPMC Advantage Silver HSA $2,600/20% - Premium Network","16322PA004",,"PAN003","PAS003","PAF012","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040025-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002502","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002502","6"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","Individual","No","46-2824626","16322PA0040025","UPMC Advantage Silver HSA $2,600/20% - Premium Network","16322PA004",,"PAN003","PAS003","PAF012","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040025-03","Limited Cost Sharing Plan Variation","71.85%","0.720737278461456","Yes","Yes","No","100%",,"$2,600","$20","$900","$200","$2,600","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002503","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002503","7"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060042","UPMC Consumer Advantage Gold HSA PPO $1,750 - Premium Network","16322PA006",,"PAN006","PAS003","PAF002","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060042-01","Standard Gold On Exchange Plan","78.98%","0.797787308692932","Yes","Yes","No","100%",,"$1,800","$20","$0","$200","$1,800","$800","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","0%",,,,,"$3,500","per person not applicable","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004201","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004201","7"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060043","UPMC Consumer Advantage Gold HSA PPO $1,350/10% - Premium Network","16322PA006",,"PAN006","PAS003","PAF002","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060043-00","Standard Gold Off Exchange Plan","80.02%","0.787791669368744","Yes","Yes","No","100%",,"$1,400","$20","$600","$200","$1,400","$800","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","10%",,,,,"$2,700","per person not applicable","$5400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004300","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004300","8"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","Individual","No","46-2824626","16322PA0040025","UPMC Advantage Silver HSA $2,600/20% - Premium Network","16322PA004",,"PAN003","PAS003","PAF012","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040025-04","73% AV Level Silver Plan","73.89%","0.739968061447144","Yes","Yes","No","100%",,"$2,600","$0","$600","$200","$2,600","$500","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002504","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002504","8"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","Individual","No","46-2824626","16322PA0040025","UPMC Advantage Silver HSA $2,600/20% - Premium Network","16322PA004",,"PAN003","PAS003","PAF012","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040025-05","87% AV Level Silver Plan","88.00%","0.87111634016037","Yes","Yes","No","100%",,"$600","$10","$1,300","$200","$600","$300","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","20%",,,,,"$1,100","$1100 per person","$2200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002505","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002505","9"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060043","UPMC Consumer Advantage Gold HSA PPO $1,350/10% - Premium Network","16322PA006",,"PAN006","PAS003","PAF002","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060043-01","Standard Gold On Exchange Plan","80.02%","0.787791669368744","Yes","Yes","No","100%",,"$1,400","$20","$600","$200","$1,400","$800","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","10%",,,,,"$2,700","per person not applicable","$5400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004301","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004301","9"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060044","UPMC Consumer Advantage Gold HSA PPO $1,400 - Premium Network","16322PA006",,"PAN006","PAS003","PAF002","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060044-00","Standard Gold Off Exchange Plan","81.60%","0.82138866186142","Yes","Yes","No","100%",,"$1,400","$20","$0","$200","$1,400","$800","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","per person not applicable","$2800 per group","0%",,,,,"$2,800","per person not applicable","$5600 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004400","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004400","10"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","Individual","No","46-2824626","16322PA0040025","UPMC Advantage Silver HSA $2,600/20% - Premium Network","16322PA004",,"PAN003","PAS003","PAF012","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040025-06","94% AV Level Silver Plan","93.98%","0.934409260749817","Yes","Yes","No","100%",,"$100","$0","$700","$200","$100","$200","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20%",,,,,"$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002506","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004002506","10"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","Individual","No","46-2824626","16322PA0050105","UPMC Advantage Silver HSA $2,600/20% - Partner Network","16322PA005",,"PAN001","PAS001","PAF012","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050105-00","Standard Silver Off Exchange Plan","71.85%","0.72935289144516","Yes","Yes","No","100%",,"$2,600","$20","$900","$200","$2,600","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010500","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010500","11"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060044","UPMC Consumer Advantage Gold HSA PPO $1,400 - Premium Network","16322PA006",,"PAN006","PAS003","PAF002","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060044-01","Standard Gold On Exchange Plan","81.60%","0.82138866186142","Yes","Yes","No","100%",,"$1,400","$20","$0","$200","$1,400","$800","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","per person not applicable","$2800 per group","0%",,,,,"$2,800","per person not applicable","$5600 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004401","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004401","11"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060056","UPMC Consumer Advantage Silver HSA PPO $3,000 - Premium Network","16322PA006",,"PAN006","PAS003","PAF020","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060056-00","Standard Silver Off Exchange Plan","70.84%","0.731411457061768","Yes","Yes","No","100%",,"$3,000","$20","$0","$200","$3,000","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005600","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005600","12"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","Individual","No","46-2824626","16322PA0050105","UPMC Advantage Silver HSA $2,600/20% - Partner Network","16322PA005",,"PAN001","PAS001","PAF012","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050105-01","Standard Silver On Exchange Plan","71.85%","0.72935289144516","Yes","Yes","No","100%",,"$2,600","$20","$900","$200","$2,600","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010501","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010501","12"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","Individual","No","46-2824626","16322PA0050105","UPMC Advantage Silver HSA $2,600/20% - Partner Network","16322PA005",,"PAN001","PAS001","PAF012","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050105-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010502","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010502","13"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060056","UPMC Consumer Advantage Silver HSA PPO $3,000 - Premium Network","16322PA006",,"PAN006","PAS003","PAF020","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060056-01","Standard Silver On Exchange Plan","70.84%","0.731411457061768","Yes","Yes","No","100%",,"$3,000","$20","$0","$200","$3,000","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005601","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005601","13"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060057","UPMC Consumer Advantage Gold HSA PPO $1,750 - Premium Network","16322PA006",,"PAN006","PAS003","PAF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060057-00","Standard Gold Off Exchange Plan","79.33%","0.802161753177643","Yes","Yes","No","100%",,"$1,800","$20","$0","$200","$1,800","$800","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","0%",,,,,"$3,500","per person not applicable","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005700","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005700","14"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","Individual","No","46-2824626","16322PA0050105","UPMC Advantage Silver HSA $2,600/20% - Partner Network","16322PA005",,"PAN001","PAS001","PAF012","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050105-03","Limited Cost Sharing Plan Variation","71.85%","0.735737383365631","Yes","Yes","No","100%",,"$2,600","$20","$900","$200","$2,600","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010503","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010503","14"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","Individual","No","46-2824626","16322PA0050105","UPMC Advantage Silver HSA $2,600/20% - Partner Network","16322PA005",,"PAN001","PAS001","PAF012","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050105-04","73% AV Level Silver Plan","73.89%","0.739968061447144","Yes","Yes","No","100%",,"$2,600","$0","$600","$200","$2,600","$500","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010504","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010504","15"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060057","UPMC Consumer Advantage Gold HSA PPO $1,750 - Premium Network","16322PA006",,"PAN006","PAS003","PAF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060057-01","Standard Gold On Exchange Plan","79.33%","0.802161753177643","Yes","Yes","No","100%",,"$1,800","$20","$0","$200","$1,800","$800","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","per person not applicable","$3500 per group","0%",,,,,"$3,500","per person not applicable","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005701","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005701","15"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","Individual","No","46-2824626","16322PA0050108","UPMC Advantage Silver HSA $2,600/20% - Select Network","16322PA005",,"PAN002","PAS002","PAF012","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050108-00","Standard Silver Off Exchange Plan","71.85%","0.72935289144516","Yes","Yes","No","100%",,"$2,600","$20","$900","$200","$2,600","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010800","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010800","18"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","Individual","No","46-2824626","16322PA0050108","UPMC Advantage Silver HSA $2,600/20% - Select Network","16322PA005",,"PAN002","PAS002","PAF012","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050108-01","Standard Silver On Exchange Plan","71.85%","0.72935289144516","Yes","Yes","No","100%",,"$2,600","$20","$900","$200","$2,600","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010801","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010801","19"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060062","UPMC Consumer Advantage Gold HSA PPO $1,400 - Premium Network","16322PA006",,"PAN006","PAS003","PAF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060062-01","Standard Gold On Exchange Plan","81.95%","0.825922608375549","Yes","Yes","No","100%",,"$1,400","$20","$0","$200","$1,400","$800","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","per person not applicable","$2800 per group","0%",,,,,"$2,800","per person not applicable","$5600 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006201","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006201","19"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","Individual","No","46-2824626","16322PA0050108","UPMC Advantage Silver HSA $2,600/20% - Select Network","16322PA005",,"PAN002","PAS002","PAF012","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050108-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010802","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010802","20"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","Individual","No","46-2824626","16322PA0050108","UPMC Advantage Silver HSA $2,600/20% - Select Network","16322PA005",,"PAN002","PAS002","PAF012","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050108-03","Limited Cost Sharing Plan Variation","71.85%","0.72935289144516","Yes","Yes","No","100%",,"$2,600","$20","$900","$200","$2,600","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010803","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010803","21"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","Individual","No","46-2824626","16322PA0050103","UPMC Advantage Silver $1,750/$30 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050103-06","94% AV Level Silver Plan","93.86%","0.938610076904297","No","Yes","No","100%",,"$80","$200","$700","$200","$80","$400","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010306","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010306","24"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","Individual","No","46-2824626","16322PA0040008","UPMC Advantage Silver $3,250/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040008-00","Standard Silver Off Exchange Plan","70.56%","0.710058927536011","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000800","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000800","4"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060047","UPMC Inside Advantage Platinum PPO $250 $20/$40 - Premium Network","16322PA006",,"PAN005","PAS004","PAF001","New","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060047-00","Standard Platinum Off Exchange Plan","88.14%","0.893579185009003","No","Yes","Yes","90%","10%","$300","$400","$0","$200","$300","$600","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$500","$500 per person","$1000 per group","35%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004700","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004700","4"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060047","UPMC Inside Advantage Platinum PPO $250 $20/$40 - Premium Network","16322PA006",,"PAN005","PAS004","PAF001","New","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060047-01","Standard Platinum On Exchange Plan","88.14%","0.893579185009003","No","Yes","Yes","90%","10%","$300","$400","$0","$200","$300","$600","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$500","$500 per person","$1000 per group","35%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004701","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004701","5"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","Individual","No","46-2824626","16322PA0050108","UPMC Advantage Silver HSA $2,600/20% - Select Network","16322PA005",,"PAN002","PAS002","PAF012","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050108-04","73% AV Level Silver Plan","73.89%","0.739968061447144","Yes","Yes","No","100%",,"$2,600","$0","$600","$200","$2,600","$500","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010804","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010804","22"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","Individual","No","46-2824626","16322PA0050108","UPMC Advantage Silver HSA $2,600/20% - Select Network","16322PA005",,"PAN002","PAS002","PAF012","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050108-05","87% AV Level Silver Plan","88.00%","0.87111634016037","Yes","Yes","No","100%",,"$600","$10","$1,300","$200","$600","$300","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010805","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010805","23"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","3","16322","PA","Individual","No","46-2824626","16322PA0050108","UPMC Advantage Silver HSA $2,600/20% - Select Network","16322PA005",,"PAN002","PAS002","PAF012","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050108-06","94% AV Level Silver Plan","93.98%","0.934409260749817","Yes","Yes","No","100%",,"$100","$0","$700","$200","$100","$200","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010806","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010806","24"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","Individual","No","46-2824626","16322PA0040007","UPMC Advantage Silver $1750/$30 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040007-00","Standard Silver Off Exchange Plan","71.72%","0.717151880264282","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000700","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000700","4"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060045","UPMC HealthyU Platinum HIA PPO $1,350/10% - Premium Network","16322PA006",,"PAN006","PAS003","PAF002","New","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060045-00","Standard Platinum Off Exchange Plan","88.35%","0.8195641040802","Yes","Yes","No","100%",,"$1,400","$20","$600","$200","$1,400","$500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","10%",,,,,"$2,700","per person not applicable","$5400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004500","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004500","4"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060045","UPMC HealthyU Platinum HIA PPO $1,350/10% - Premium Network","16322PA006",,"PAN006","PAS003","PAF002","New","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060045-01","Standard Platinum On Exchange Plan","88.35%","0.8195641040802","Yes","Yes","No","100%",,"$1,400","$20","$600","$200","$1,400","$500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","10%",,,,,"$2,700","per person not applicable","$5400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004501","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004501","5"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","Individual","No","46-2824626","16322PA0040007","UPMC Advantage Silver $1750/$30 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040007-01","Standard Silver On Exchange Plan","71.72%","0.717151880264282","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000701","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000701","5"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","Individual","No","46-2824626","16322PA0040007","UPMC Advantage Silver $1750/$30 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000702","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000702","6"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060046","UPMC HealthyU Gold HIA PPO $2,500/10% - Premium Network","16322PA006",,"PAN006","PAS003","PAF002","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060046-00","Standard Gold Off Exchange Plan","79.90%","0.734780013561249","Yes","Yes","No","100%",,"$2,500","$20","$500","$200","$2,500","$700","$200","$800",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004600","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004600","6"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060046","UPMC HealthyU Gold HIA PPO $2,500/10% - Premium Network","16322PA006",,"PAN006","PAS003","PAF002","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060046-01","Standard Gold On Exchange Plan","79.90%","0.734780013561249","Yes","Yes","No","100%",,"$2,500","$20","$500","$200","$2,500","$700","$200","$800",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004601","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004601","7"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","Individual","No","46-2824626","16322PA0040007","UPMC Advantage Silver $1750/$30 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040007-03","Limited Cost Sharing Plan Variation","71.72%","0.717151880264282","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000703","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000703","7"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","Individual","No","46-2824626","16322PA0040007","UPMC Advantage Silver $1750/$30 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040007-04","73% AV Level Silver Plan","73.81%","0.738092005252838","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000704","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000704","8"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060055","UPMC HealthyU Platinum HIA PPO $1,350/10% - Premium Network","16322PA006",,"PAN006","PAS003","PAF004","New","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060055-00","Standard Platinum Off Exchange Plan","88.31%","0.821027755737305","Yes","Yes","No","100%",,"$1,400","$20","$600","$200","$1,400","$500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","10%",,,,,"$2,700","per person not applicable","$5400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005500","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005500","8"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060055","UPMC HealthyU Platinum HIA PPO $1,350/10% - Premium Network","16322PA006",,"PAN006","PAS003","PAF004","New","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060055-01","Standard Platinum On Exchange Plan","88.31%","0.821027755737305","Yes","Yes","No","100%",,"$1,400","$20","$600","$200","$1,400","$500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","10%",,,,,"$2,700","per person not applicable","$5400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005501","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005501","9"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","Individual","No","46-2824626","16322PA0040007","UPMC Advantage Silver $1750/$30 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040007-05","87% AV Level Silver Plan","87.42%","0.874220192432404","No","Yes","No","100%",,"$500","$300","$1,200","$200","$500","$600","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000705","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000705","9"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","Individual","No","46-2824626","16322PA0040007","UPMC Advantage Silver $1750/$30 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040007-06","94% AV Level Silver Plan","93.86%","0.938610076904297","No","Yes","No","100%",,"$80","$200","$700","$200","$80","$400","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","20%",,,,,"$150","$150 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000706","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000706","10"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060061","UPMC HealthyU Gold HIA PPO $2,500/10% - Premium Network","16322PA006",,"PAN006","PAS003","PAF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060061-00","Standard Gold Off Exchange Plan","79.87%","0.736659049987793","Yes","Yes","No","100%",,"$2,500","$20","$500","$200","$2,500","$700","$200","$800",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006100","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006100","10"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060061","UPMC HealthyU Gold HIA PPO $2,500/10% - Premium Network","16322PA006",,"PAN006","PAS003","PAF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060061-01","Standard Gold On Exchange Plan","79.87%","0.736659049987793","Yes","Yes","No","100%",,"$2,500","$20","$500","$200","$2,500","$700","$200","$800",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$3425 per person","$6850 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006101","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006101","11"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","Individual","No","46-2824626","16322PA0050030","UPMC Advantage Silver $1,750/$30 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050030-00","Standard Silver Off Exchange Plan","71.72%","0.717151880264282","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003000","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003000","11"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","Individual","No","46-2824626","16322PA0050030","UPMC Advantage Silver $1,750/$30 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050030-01","Standard Silver On Exchange Plan","71.72%","0.717151880264282","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003001","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003001","12"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","Individual","No","46-2824626","16322PA0050030","UPMC Advantage Silver $1,750/$30 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050030-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003002","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003002","13"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","Individual","No","46-2824626","16322PA0050030","UPMC Advantage Silver $1,750/$30 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050030-03","Limited Cost Sharing Plan Variation","71.72%","0.717151880264282","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003003","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003003","14"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","Individual","No","46-2824626","16322PA0050030","UPMC Advantage Silver $1,750/$30 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050030-04","73% AV Level Silver Plan","73.81%","0.738092005252838","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003004","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003004","15"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","Individual","No","46-2824626","16322PA0050030","UPMC Advantage Silver $1,750/$30 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050030-05","87% AV Level Silver Plan","87.42%","0.874220192432404","No","Yes","No","100%",,"$500","$300","$1,200","$200","$500","$600","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003005","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003005","16"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","Individual","No","46-2824626","16322PA0050030","UPMC Advantage Silver $1,750/$30 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050030-06","94% AV Level Silver Plan","93.86%","0.938610076904297","No","Yes","No","100%",,"$80","$200","$700","$200","$80","$400","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003006","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003006","17"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","Individual","No","46-2824626","16322PA0050103","UPMC Advantage Silver $1,750/$30 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050103-00","Standard Silver Off Exchange Plan","71.72%","0.717151880264282","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010300","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010300","18"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","Individual","No","46-2824626","16322PA0050103","UPMC Advantage Silver $1,750/$30 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050103-01","Standard Silver On Exchange Plan","71.72%","0.717151880264282","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010301","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010301","19"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","Individual","No","46-2824626","16322PA0050103","UPMC Advantage Silver $1,750/$30 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050103-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010302","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010302","20"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","Individual","No","46-2824626","16322PA0050103","UPMC Advantage Silver $1,750/$30 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050103-03","Limited Cost Sharing Plan Variation","71.72%","0.717151880264282","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010303","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010303","21"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","Individual","No","46-2824626","16322PA0050103","UPMC Advantage Silver $1,750/$30 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050103-04","73% AV Level Silver Plan","73.81%","0.738092005252838","No","Yes","No","100%",,"$1,800","$400","$1,000","$200","$1,300","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010304","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010304","22"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","4","16322","PA","Individual","No","46-2824626","16322PA0050103","UPMC Advantage Silver $1,750/$30 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050103-05","87% AV Level Silver Plan","87.42%","0.874220192432404","No","Yes","No","100%",,"$500","$300","$1,200","$200","$500","$600","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010305","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010305","23"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","Individual","No","46-2824626","16322PA0040008","UPMC Advantage Silver $3,250/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040008-01","Standard Silver On Exchange Plan","70.56%","0.710058927536011","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000801","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000801","5"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","Individual","No","46-2824626","16322PA0040008","UPMC Advantage Silver $3,250/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000802","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000802","6"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060048","UPMC Inside Advantage Gold PPO $1,250 $20/$40 - Premium Network","16322PA006",,"PAN005","PAS004","PAF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060048-00","Standard Gold Off Exchange Plan","79.78%","0.815782308578491","No","Yes","Yes","90%","10%","$1,300","$400","$0","$200","$1,300","$1,100","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0%","$2,500","$2500 per person","$5000 per group","35%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004800","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004800","6"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060048","UPMC Inside Advantage Gold PPO $1,250 $20/$40 - Premium Network","16322PA006",,"PAN005","PAS004","PAF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060048-01","Standard Gold On Exchange Plan","79.78%","0.815782308578491","No","Yes","Yes","90%","10%","$1,300","$400","$0","$200","$1,300","$1,100","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0%","$2,500","$2500 per person","$5000 per group","35%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004801","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004801","7"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","Individual","No","46-2824626","16322PA0040008","UPMC Advantage Silver $3,250/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040008-03","Limited Cost Sharing Plan Variation","70.56%","0.710058927536011","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000803","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000803","7"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","Individual","No","46-2824626","16322PA0040008","UPMC Advantage Silver $3,250/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040008-04","73% AV Level Silver Plan","72.60%","0.726731538772583","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000804","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000804","8"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060049","UPMC Inside Advantage Silver PPO $3,000 $20/$40 - Premium Network","16322PA006",,"PAN005","PAS004","PAF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060049-00","Standard Silver Off Exchange Plan","71.46%","0.735051155090332","No","Yes","Yes","90%","10%","$3,000","$400","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%","$6,000","$6000 per person","$12000 per group","35%","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004900","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004900","8"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060049","UPMC Inside Advantage Silver PPO $3,000 $20/$40 - Premium Network","16322PA006",,"PAN005","PAS004","PAF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060049-01","Standard Silver On Exchange Plan","71.46%","0.735051155090332","No","Yes","Yes","90%","10%","$3,000","$400","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%","$6,000","$6000 per person","$12000 per group","35%","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004901","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006004901","9"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","Individual","No","46-2824626","16322PA0040008","UPMC Advantage Silver $3,250/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040008-05","87% AV Level Silver Plan","87.86%","0.879866659641266","No","Yes","No","100%",,"$900","$300","$0","$200","$900","$500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","0%",,,,,"$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000805","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000805","9"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","Individual","No","46-2824626","16322PA0040008","UPMC Advantage Silver $3,250/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040008-06","94% AV Level Silver Plan","94.84%","0.948389887809753","No","Yes","No","100%",,"$100","$200","$0","$200","$100","$400","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000806","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000806","10"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060050","UPMC Inside Advantage Silver PPO $5,000 $20/$40 - Premium Network","16322PA006",,"PAN005","PAS004","PAF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060050-00","Standard Silver Off Exchange Plan","69.12%","0.700170934200287","No","Yes","Yes","90%","10%","$5,000","$400","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0%","$6,350","$6350 per person","$12700 per group","35%","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005000","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005000","10"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060050","UPMC Inside Advantage Silver PPO $5,000 $20/$40 - Premium Network","16322PA006",,"PAN005","PAS004","PAF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060050-01","Standard Silver On Exchange Plan","69.12%","0.700170934200287","No","Yes","Yes","90%","10%","$5,000","$400","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0%","$6,350","$6350 per person","$12700 per group","35%","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005001","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006005001","11"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","Individual","No","46-2824626","16322PA0050031","UPMC Advantage Silver $3,250/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050031-00","Standard Silver Off Exchange Plan","70.56%","0.710058927536011","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003100","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003100","11"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","Individual","No","46-2824626","16322PA0050031","UPMC Advantage Silver $3,250/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050031-01","Standard Silver On Exchange Plan","70.56%","0.710058927536011","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003101","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003101","12"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060063","UPMC Inside Advantage Platinum PPO $250 $20/$40 - Premium Network","16322PA006",,"PAN005","PAS004","PAF003","New","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060063-00","Standard Platinum Off Exchange Plan","88.18%","0.893740296363831","No","Yes","Yes","90%","10%","$300","$400","$0","$200","$300","$600","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$500","$500 per person","$1000 per group","35%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006300","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006300","12"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060063","UPMC Inside Advantage Platinum PPO $250 $20/$40 - Premium Network","16322PA006",,"PAN005","PAS004","PAF003","New","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060063-01","Standard Platinum On Exchange Plan","88.18%","0.893740296363831","No","Yes","Yes","90%","10%","$300","$400","$0","$200","$300","$600","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$500","$500 per person","$1000 per group","35%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006301","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006301","13"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","Individual","No","46-2824626","16322PA0050031","UPMC Advantage Silver $3,250/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050031-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003102","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003102","13"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","Individual","No","46-2824626","16322PA0050031","UPMC Advantage Silver $3,250/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050031-03","Limited Cost Sharing Plan Variation","70.56%","0.710058927536011","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003103","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003103","14"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060064","UPMC Inside Advantage Gold PPO $1,250 $20/$40 - Premium Network","16322PA006",,"PAN005","PAS004","PAF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060064-00","Standard Gold Off Exchange Plan","80.09%","0.818717002868652","No","Yes","Yes","90%","10%","$1,300","$400","$0","$200","$1,300","$1,100","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0%","$2,500","$2500 per person","$5000 per group","35%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006400","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006400","14"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060064","UPMC Inside Advantage Gold PPO $1,250 $20/$40 - Premium Network","16322PA006",,"PAN005","PAS004","PAF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060064-01","Standard Gold On Exchange Plan","80.09%","0.818717002868652","No","Yes","Yes","90%","10%","$1,300","$400","$0","$200","$1,300","$1,100","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0%","$2,500","$2500 per person","$5000 per group","35%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006401","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006401","15"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","Individual","No","46-2824626","16322PA0050031","UPMC Advantage Silver $3,250/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050031-04","73% AV Level Silver Plan","72.60%","0.726731538772583","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003104","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003104","15"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","Individual","No","46-2824626","16322PA0050031","UPMC Advantage Silver $3,250/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050031-05","87% AV Level Silver Plan","87.86%","0.879866659641266","No","Yes","No","100%",,"$900","$300","$0","$200","$900","$500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003105","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003105","16"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060065","UPMC Inside Advantage Silver PPO $3,000 $20/$40 - Premium Network","16322PA006",,"PAN005","PAS004","PAF003","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060065-00","Standard Silver Off Exchange Plan","71.97%","0.73922735452652","No","Yes","Yes","90%","10%","$3,000","$400","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%","$6,000","$6000 per person","$12000 per group","35%","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006500","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006500","16"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060065","UPMC Inside Advantage Silver PPO $3,000 $20/$40 - Premium Network","16322PA006",,"PAN005","PAS004","PAF003","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060065-01","Standard Silver On Exchange Plan","71.97%","0.73922735452652","No","Yes","Yes","90%","10%","$3,000","$400","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%","$6,000","$6000 per person","$12000 per group","35%","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006501","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006501","17"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","Individual","No","46-2824626","16322PA0050031","UPMC Advantage Silver $3,250/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050031-06","94% AV Level Silver Plan","94.84%","0.948389887809753","No","Yes","No","100%",,"$100","$200","$0","$200","$100","$400","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003106","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003106","17"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","7","16322","PA","Individual","No","46-2824626","16322PA0040010","UPMC Advantage Gold $750/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040010-01","Standard Gold On Exchange Plan","81.58%","0.81575334072113","No","Yes","No","100%",,"$800","$400","$600","$200","$800","$1,200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004001001","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004001001","5"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","7","16322","PA","Individual","No","46-2824626","16322PA0040010","UPMC Advantage Gold $750/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004001002","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004001002","6"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","7","16322","PA","Individual","No","46-2824626","16322PA0040010","UPMC Advantage Gold $750/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040010-03","Limited Cost Sharing Plan Variation","81.58%","0.81575334072113","No","Yes","No","100%",,"$800","$400","$600","$200","$800","$1,200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004001003","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004001003","7"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","7","16322","PA","Individual","No","46-2824626","16322PA0050033","UPMC Advantage Gold $750/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050033-00","Standard Gold Off Exchange Plan","81.58%","0.81575334072113","No","Yes","No","100%",,"$800","$400","$600","$200","$800","$1,200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003300","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003300","8"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","7","16322","PA","Individual","No","46-2824626","16322PA0050033","UPMC Advantage Gold $750/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050033-01","Standard Gold On Exchange Plan","81.58%","0.81575334072113","No","Yes","No","100%",,"$800","$400","$600","$200","$800","$1,200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003301","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003301","9"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","7","16322","PA","Individual","No","46-2824626","16322PA0050033","UPMC Advantage Gold $750/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050033-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003302","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003302","10"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","7","16322","PA","Individual","No","46-2824626","16322PA0050033","UPMC Advantage Gold $750/$10 - Select Network","16322PA005",,"PAN002","PAS002","PAF011","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050033-03","Limited Cost Sharing Plan Variation","81.58%","0.81575334072113","No","Yes","No","100%",,"$800","$400","$600","$200","$800","$1,200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003303","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003303","11"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","Individual","No","46-2824626","16322PA0050104","UPMC Advantage Silver $3,250/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050104-00","Standard Silver Off Exchange Plan","70.56%","0.710058927536011","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010400","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010400","18"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060066","UPMC Inside Advantage Silver PPO $5,000 $20/$40 - Premium Network","16322PA006",,"PAN005","PAS004","PAF003","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060066-00","Standard Silver Off Exchange Plan","69.35%","0.702302157878876","No","Yes","Yes","90%","10%","$5,000","$400","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0%","$6,350","$6350 per person","$12700 per group","35%","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006600","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006600","18"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","SHOP (Small Group)","No","46-2824626","16322PA0060066","UPMC Inside Advantage Silver PPO $5,000 $20/$40 - Premium Network","16322PA006",,"PAN005","PAS004","PAF003","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9953",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0060066-01","Standard Silver On Exchange Plan","69.35%","0.702302157878876","No","Yes","Yes","90%","10%","$5,000","$400","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","0%","$6,350","$6350 per person","$12700 per group","35%","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006601","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_16322PA006006601","19"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","Individual","No","46-2824626","16322PA0050104","UPMC Advantage Silver $3,250/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050104-01","Standard Silver On Exchange Plan","70.56%","0.710058927536011","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010401","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010401","19"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","Individual","No","46-2824626","16322PA0050104","UPMC Advantage Silver $3,250/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050104-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010402","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010402","20"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","Individual","No","46-2824626","16322PA0050104","UPMC Advantage Silver $3,250/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050104-03","Limited Cost Sharing Plan Variation","70.56%","0.710058927536011","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010403","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010403","21"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","Individual","No","46-2824626","16322PA0050104","UPMC Advantage Silver $3,250/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050104-04","73% AV Level Silver Plan","72.60%","0.726731538772583","No","Yes","No","100%",,"$3,300","$600","$0","$200","$1,300","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010404","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010404","22"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","Individual","No","46-2824626","16322PA0050104","UPMC Advantage Silver $3,250/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050104-05","87% AV Level Silver Plan","87.86%","0.879866659641266","No","Yes","No","100%",,"$900","$300","$0","$200","$900","$500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010405","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010405","23"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","5","16322","PA","Individual","No","46-2824626","16322PA0050104","UPMC Advantage Silver $3,250/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050104-06","94% AV Level Silver Plan","94.84%","0.948389887809753","No","Yes","No","100%",,"$100","$200","$0","$200","$100","$400","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010406","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010406","24"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","6","16322","PA","Individual","No","46-2824626","16322PA0040006","UPMC Advantage Silver $0/$50 - Premium Network","16322PA004",,"PAN003","PAS003","PAF008","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040006-00","Standard Silver Off Exchange Plan","71.98%","0.719798982143402","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000600","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000600","4"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","6","16322","PA","Individual","No","46-2824626","16322PA0040006","UPMC Advantage Silver $0/$50 - Premium Network","16322PA004",,"PAN003","PAS003","PAF008","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040006-01","Standard Silver On Exchange Plan","71.98%","0.719798982143402","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000601","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000601","5"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","6","16322","PA","Individual","No","46-2824626","16322PA0040006","UPMC Advantage Silver $0/$50 - Premium Network","16322PA004",,"PAN003","PAS003","PAF008","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$500","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000602","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000602","6"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","6","16322","PA","Individual","No","46-2824626","16322PA0040006","UPMC Advantage Silver $0/$50 - Premium Network","16322PA004",,"PAN003","PAS003","PAF008","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040006-03","Limited Cost Sharing Plan Variation","71.98%","0.719798982143402","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000603","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000603","7"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","6","16322","PA","Individual","No","46-2824626","16322PA0040006","UPMC Advantage Silver $0/$50 - Premium Network","16322PA004",,"PAN003","PAS003","PAF008","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040006-04","73% AV Level Silver Plan","73.99%","0.739851951599121","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000604","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000604","8"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","6","16322","PA","Individual","No","46-2824626","16322PA0040006","UPMC Advantage Silver $0/$50 - Premium Network","16322PA004",,"PAN003","PAS003","PAF008","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040006-05","87% AV Level Silver Plan","87.89%","0.878883361816406","No","Yes","No","100%",,"$0","$1,500","$0","$200","$0","$600","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000605","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000605","9"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","6","16322","PA","Individual","No","46-2824626","16322PA0040006","UPMC Advantage Silver $0/$50 - Premium Network","16322PA004",,"PAN003","PAS003","PAF008","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040006-06","94% AV Level Silver Plan","93.81%","0.938053369522095","No","Yes","No","100%",,"$0","$800","$0","$200","$0","$400","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000606","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004000606","10"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","6","16322","PA","Individual","No","46-2824626","16322PA0050029","UPMC Advantage Silver $0/$50 - Select Network","16322PA005",,"PAN002","PAS002","PAF008","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050029-00","Standard Silver Off Exchange Plan","71.98%","0.719798982143402","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005002900","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005002900","11"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","6","16322","PA","Individual","No","46-2824626","16322PA0050029","UPMC Advantage Silver $0/$50 - Select Network","16322PA005",,"PAN002","PAS002","PAF008","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050029-01","Standard Silver On Exchange Plan","71.98%","0.719798982143402","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005002901","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005002901","12"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","1","22444","PA","Individual","No","23-2311553","22444PA0010006","Geisinger Health Plan Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS001","PAF008","Existing","HMO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010006-01","Standard Gold On Exchange Plan","78.16%","0","No","Yes","No","100%",,"$3,900","$256","$0","$30","$3,000","$222","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001000601.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","5"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","1","22444","PA","Individual","No","23-2311553","22444PA0010006","Geisinger Health Plan Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS001","PAF008","Existing","HMO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001000602.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","6"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","1","22444","PA","Individual","No","23-2311553","22444PA0010006","Geisinger Health Plan Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS001","PAF008","Existing","HMO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010006-03","Limited Cost Sharing Plan Variation","78.16%","0","No","Yes","No","100%",,"$3,900","$256","$0","$30","$3,000","$222","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001000603.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","7"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","11","22444","PA","Individual","No","23-2311553","22444PA0040059","Geisinger Health Plan Marketplace POS 25/50/2500","22444PA004",,"PAN001","PAS005","PAF003","New","POS","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040059-06","94% AV Level Silver Plan","94.09%","0.938810527324677","No","Yes","No","100%",,"$600","$0","$0","$30","$300","$22","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA004005906.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","24"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","1","22444","PA","Individual","No","23-2311553","22444PA0010016","Geisinger Health Plan Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS005","PAF008","New","HMO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010016-00","Standard Gold Off Exchange Plan","78.16%","0","No","Yes","No","100%",,"$3,900","$256","$0","$30","$3,000","$222","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001001600.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","12"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","1","22444","PA","Individual","No","23-2311553","22444PA0010016","Geisinger Health Plan Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS005","PAF008","New","HMO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010016-01","Standard Gold On Exchange Plan","78.16%","0","No","Yes","No","100%",,"$3,900","$256","$0","$30","$3,000","$222","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001001601.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","13"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","6","16322","PA","Individual","No","46-2824626","16322PA0050029","UPMC Advantage Silver $0/$50 - Select Network","16322PA005",,"PAN002","PAS002","PAF008","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050029-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$500","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005002902","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005002902","13"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","6","16322","PA","Individual","No","46-2824626","16322PA0050029","UPMC Advantage Silver $0/$50 - Select Network","16322PA005",,"PAN002","PAS002","PAF008","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050029-03","Limited Cost Sharing Plan Variation","71.98%","0.719798982143402","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005002903","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005002903","14"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","6","16322","PA","Individual","No","46-2824626","16322PA0050029","UPMC Advantage Silver $0/$50 - Select Network","16322PA005",,"PAN002","PAS002","PAF008","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050029-04","73% AV Level Silver Plan","73.99%","0.739851951599121","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005002904","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005002904","15"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","6","16322","PA","Individual","No","46-2824626","16322PA0050029","UPMC Advantage Silver $0/$50 - Select Network","16322PA005",,"PAN002","PAS002","PAF008","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050029-05","87% AV Level Silver Plan","87.89%","0.878883361816406","No","Yes","No","100%",,"$0","$1,500","$0","$200","$0","$600","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005002905","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005002905","16"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","6","16322","PA","Individual","No","46-2824626","16322PA0050029","UPMC Advantage Silver $0/$50 - Select Network","16322PA005",,"PAN002","PAS002","PAF008","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050029-06","94% AV Level Silver Plan","93.81%","0.938053369522095","No","Yes","No","100%",,"$0","$800","$0","$200","$0","$400","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005002906","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005002906","17"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","6","16322","PA","Individual","No","46-2824626","16322PA0050102","UPMC Advantage Silver $0/$50 - Partner Network","16322PA005",,"PAN001","PAS001","PAF008","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050102-00","Standard Silver Off Exchange Plan","71.98%","0.719798982143402","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010200","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010200","18"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","6","16322","PA","Individual","No","46-2824626","16322PA0050102","UPMC Advantage Silver $0/$50 - Partner Network","16322PA005",,"PAN001","PAS001","PAF008","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050102-01","Standard Silver On Exchange Plan","71.98%","0.719798982143402","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010201","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010201","19"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","6","16322","PA","Individual","No","46-2824626","16322PA0050102","UPMC Advantage Silver $0/$50 - Partner Network","16322PA005",,"PAN001","PAS001","PAF008","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050102-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$500","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010202","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010202","20"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","6","16322","PA","Individual","No","46-2824626","16322PA0050102","UPMC Advantage Silver $0/$50 - Partner Network","16322PA005",,"PAN001","PAS001","PAF008","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050102-03","Limited Cost Sharing Plan Variation","71.98%","0.719798982143402","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010203","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010203","21"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","6","16322","PA","Individual","No","46-2824626","16322PA0050102","UPMC Advantage Silver $0/$50 - Partner Network","16322PA005",,"PAN001","PAS001","PAF008","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050102-04","73% AV Level Silver Plan","73.99%","0.739851951599121","No","Yes","No","100%",,"$0","$4,200","$0","$200","$0","$1,600","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010204","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010204","22"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","6","16322","PA","Individual","No","46-2824626","16322PA0050102","UPMC Advantage Silver $0/$50 - Partner Network","16322PA005",,"PAN001","PAS001","PAF008","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050102-05","87% AV Level Silver Plan","87.89%","0.878883361816406","No","Yes","No","100%",,"$0","$1,500","$0","$200","$0","$600","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010205","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010205","23"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","6","16322","PA","Individual","No","46-2824626","16322PA0050102","UPMC Advantage Silver $0/$50 - Partner Network","16322PA005",,"PAN001","PAS001","PAF008","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050102-06","94% AV Level Silver Plan","93.81%","0.938053369522095","No","Yes","No","100%",,"$0","$800","$0","$200","$0","$400","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010206","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010206","24"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","7","16322","PA","Individual","No","46-2824626","16322PA0040010","UPMC Advantage Gold $750/$10 - Premium Network","16322PA004",,"PAN003","PAS003","PAF011","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040010-00","Standard Gold Off Exchange Plan","81.58%","0.81575334072113","No","Yes","No","100%",,"$800","$400","$600","$200","$800","$1,200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004001000","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004001000","4"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","7","16322","PA","Individual","No","46-2824626","16322PA0050106","UPMC Advantage Gold $750/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050106-00","Standard Gold Off Exchange Plan","81.58%","0.81575334072113","No","Yes","No","100%",,"$800","$400","$600","$200","$800","$1,200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010600","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010600","12"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","7","16322","PA","Individual","No","46-2824626","16322PA0050106","UPMC Advantage Gold $750/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050106-01","Standard Gold On Exchange Plan","81.58%","0.81575334072113","No","Yes","No","100%",,"$800","$400","$600","$200","$800","$1,200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010601","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010601","13"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","7","16322","PA","Individual","No","46-2824626","16322PA0050106","UPMC Advantage Gold $750/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050106-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010602","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010602","14"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","7","16322","PA","Individual","No","46-2824626","16322PA0050106","UPMC Advantage Gold $750/$10 - Partner Network","16322PA005",,"PAN001","PAS001","PAF011","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050106-03","Limited Cost Sharing Plan Variation","81.58%","0.81575334072113","No","Yes","No","100%",,"$800","$400","$600","$200","$800","$1,200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010603","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010603","15"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","8","16322","PA","Individual","No","46-2824626","16322PA0040012","UPMC Advantage Platinum $250/$20 - Premium Network","16322PA004",,"PAN003","PAS003","PAF013","Existing","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040012-00","Standard Platinum Off Exchange Plan","90.42%","0.904288351535797","Yes","Yes","No","100%",,"$300","$20","$700","$200","$300","$800","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004001200","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004001200","4"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","8","16322","PA","Individual","No","46-2824626","16322PA0040012","UPMC Advantage Platinum $250/$20 - Premium Network","16322PA004",,"PAN003","PAS003","PAF013","Existing","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040012-01","Standard Platinum On Exchange Plan","90.42%","0.904288351535797","Yes","Yes","No","100%",,"$300","$20","$700","$200","$300","$800","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004001201","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004001201","5"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","8","16322","PA","Individual","No","46-2824626","16322PA0040012","UPMC Advantage Platinum $250/$20 - Premium Network","16322PA004",,"PAN003","PAS003","PAF013","Existing","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004001202","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004001202","6"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","8","16322","PA","Individual","No","46-2824626","16322PA0040012","UPMC Advantage Platinum $250/$20 - Premium Network","16322PA004",,"PAN003","PAS003","PAF013","Existing","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9942",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0040012-03","Limited Cost Sharing Plan Variation","90.42%","0.904288351535797","Yes","Yes","No","100%",,"$300","$20","$700","$200","$300","$800","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004001203","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA004001203","7"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","8","16322","PA","Individual","No","46-2824626","16322PA0050035","UPMC Advantage Platinum $250/$20 - Select Network","16322PA005",,"PAN002","PAS002","PAF013","Existing","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050035-00","Standard Platinum Off Exchange Plan","90.42%","0.904243469238281","Yes","Yes","No","100%",,"$300","$20","$700","$200","$300","$800","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003500","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003500","8"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","8","16322","PA","Individual","No","46-2824626","16322PA0050035","UPMC Advantage Platinum $250/$20 - Select Network","16322PA005",,"PAN002","PAS002","PAF013","Existing","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050035-01","Standard Platinum On Exchange Plan","90.42%","0.904243469238281","Yes","Yes","No","100%",,"$300","$20","$700","$200","$300","$800","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003501","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003501","9"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","8","16322","PA","Individual","No","46-2824626","16322PA0050035","UPMC Advantage Platinum $250/$20 - Select Network","16322PA005",,"PAN002","PAS002","PAF013","Existing","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050035-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003502","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003502","10"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","8","16322","PA","Individual","No","46-2824626","16322PA0050035","UPMC Advantage Platinum $250/$20 - Select Network","16322PA005",,"PAN002","PAS002","PAF013","Existing","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050035-03","Limited Cost Sharing Plan Variation","90.42%","0.904243469238281","Yes","Yes","No","100%",,"$300","$20","$700","$200","$300","$800","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003503","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005003503","11"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","8","16322","PA","Individual","No","46-2824626","16322PA0050107","UPMC Advantage Platinum $250/$20 - Partner Network","16322PA005",,"PAN001","PAS001","PAF013","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050107-00","Standard Platinum Off Exchange Plan","90.42%","0.904243469238281","Yes","Yes","No","100%",,"$300","$20","$700","$200","$300","$800","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010700","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010700","12"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","8","16322","PA","Individual","No","46-2824626","16322PA0050107","UPMC Advantage Platinum $250/$20 - Partner Network","16322PA005",,"PAN001","PAS001","PAF013","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050107-01","Standard Platinum On Exchange Plan","90.42%","0.904243469238281","Yes","Yes","No","100%",,"$300","$20","$700","$200","$300","$800","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010701","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010701","13"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","8","16322","PA","Individual","No","46-2824626","16322PA0050107","UPMC Advantage Platinum $250/$20 - Partner Network","16322PA005",,"PAN001","PAS001","PAF013","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050107-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010702","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010702","14"
"2016","PA","16322","HIOS","3","2015-08-26 09:56:12","8","16322","PA","Individual","No","46-2824626","16322PA0050107","UPMC Advantage Platinum $250/$20 - Partner Network","16322PA005",,"PAN001","PAS001","PAF013","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","16322PA0050107-03","Limited Cost Sharing Plan Variation","90.42%","0.904243469238281","Yes","Yes","No","100%",,"$300","$20","$700","$200","$300","$800","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010703","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_IND_16322PA005010703","15"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","1","22444","PA","Individual","No","23-2311553","22444PA0010006","Geisinger Health Plan Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS001","PAF008","Existing","HMO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010006-00","Standard Gold Off Exchange Plan","78.16%","0","No","Yes","No","100%",,"$3,900","$256","$0","$30","$3,000","$222","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001000600.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","4"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","1","22444","PA","Individual","No","23-2311553","22444PA0010016","Geisinger Health Plan Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS005","PAF008","New","HMO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010016-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001001602.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","14"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","10","22444","PA","Individual","No","23-2311553","22444PA0010021","Geisinger Health Plan Marketplace Extra 10/50/500","22444PA001",,"PAN001","PAS002","PAF003","New","HMO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010021-03","Limited Cost Sharing Plan Variation","80.82%","0.822549641132355","No","Yes","Yes","65%","35%","$1,000","$900","$0","$30","$353","$312","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001002103.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","19"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","11","22444","PA","Individual","No","23-2311553","22444PA0040010","Geisinger Health Plan Marketplace POS 25/50/2500","22444PA004",,"PAN001","PAS001","PAF003","Existing","POS","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040010-00","Standard Silver Off Exchange Plan","71.31%","0.719878196716309","No","Yes","No","100%",,"$3,400","$0","$774","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444pa004001000.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","4"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","12","22444","PA","Individual","No","23-2311553","22444PA0040062","Geisinger Health Plan Marketplace Value","22444PA004",,"PAN001","PAS005","PAF011","New","POS","Catastrophic","No","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040062-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,320","$0","$0","$30","$5,016","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA004006200.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","8"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","12","22444","PA","Individual","No","23-2311553","22444PA0040062","Geisinger Health Plan Marketplace Value","22444PA004",,"PAN001","PAS005","PAF011","New","POS","Catastrophic","No","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040062-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,320","$0","$0","$30","$5,016","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA004006201.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","9"
"2016","PA","23489","HIOS","6","2015-08-26 09:56:12","1","23489","PA","SHOP (Small Group)","No","36-2739571","23489PA0010056","Platinum Navigate Plus 0","23489PA001",,"PAN001","PAS001","PAF002","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=pa0005&st=pa","23489PA0010056-00","Standard Platinum Off Exchange Plan","89.30%",,"No","Yes","No","100%",,"$0","$20","$0","$200","$0","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable","0%",,,,,"$50","$50 per person","$50 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=pa0003&st=pa",,"4"
"2016","PA","23489","HIOS","6","2015-08-26 09:56:12","1","23489","PA","SHOP (Small Group)","No","36-2739571","23489PA0010056","Platinum Navigate Plus 0","23489PA001",,"PAN001","PAS001","PAF002","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=pa0005&st=pa","23489PA0010056-01","Standard Platinum On Exchange Plan","89.30%",,"No","Yes","No","100%",,"$0","$20","$0","$200","$0","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable","0%",,,,,"$50","$50 per person","$50 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=pa0003&st=pa",,"5"
"2016","PA","23489","HIOS","6","2015-08-26 09:56:12","1","23489","PA","SHOP (Small Group)","No","36-2739571","23489PA0010059","Gold Navigate Plus 1000","23489PA001",,"PAN001","PAS001","PAF001","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=pa0005&st=pa","23489PA0010059-00","Standard Gold Off Exchange Plan","79.30%",,"No","Yes","No","100%",,"$1,000","$20","$500","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=pa0001&st=pa",,"6"
"2016","PA","23489","HIOS","6","2015-08-26 09:56:12","1","23489","PA","SHOP (Small Group)","No","36-2739571","23489PA0010059","Gold Navigate Plus 1000","23489PA001",,"PAN001","PAS001","PAF001","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=pa0005&st=pa","23489PA0010059-01","Standard Gold On Exchange Plan","79.30%",,"No","Yes","No","100%",,"$1,000","$20","$500","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=pa0001&st=pa",,"7"
"2016","PA","23489","HIOS","6","2015-08-26 09:56:12","1","23489","PA","SHOP (Small Group)","No","36-2739571","23489PA0010063","Gold Navigate Plus 1500","23489PA001",,"PAN001","PAS001","PAF002","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=pa0005&st=pa","23489PA0010063-00","Standard Gold Off Exchange Plan","78.60%",,"No","Yes","No","100%",,"$1,500","$20","$1,000","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"$100","$100 per person","$100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=pa0002&st=pa",,"8"
"2016","PA","23489","HIOS","6","2015-08-26 09:56:12","1","23489","PA","SHOP (Small Group)","No","36-2739571","23489PA0010063","Gold Navigate Plus 1500","23489PA001",,"PAN001","PAS001","PAF002","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=pa0005&st=pa","23489PA0010063-01","Standard Gold On Exchange Plan","78.60%",,"No","Yes","No","100%",,"$1,500","$20","$1,000","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"$100","$100 per person","$100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=pa0002&st=pa",,"9"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","1","22444","PA","Individual","No","23-2311553","22444PA0010016","Geisinger Health Plan Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS005","PAF008","New","HMO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010016-03","Limited Cost Sharing Plan Variation","78.16%","0","No","Yes","No","100%",,"$3,900","$256","$0","$30","$3,000","$222","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001001603.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","15"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","1","22444","PA","Individual","No","23-2311553","22444PA0010018","Geisinger Health Plan Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS006","PAF008","New","HMO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010018-00","Standard Gold Off Exchange Plan","78.16%","0","No","Yes","No","100%",,"$3,900","$256","$0","$30","$3,000","$222","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001001800.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","16"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","1","22444","PA","Individual","No","23-2311553","22444PA0010018","Geisinger Health Plan Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS006","PAF008","New","HMO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010018-01","Standard Gold On Exchange Plan","78.16%","0","No","Yes","No","100%",,"$3,900","$256","$0","$30","$3,000","$222","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001001801.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","17"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","1","22444","PA","Individual","No","23-2311553","22444PA0010018","Geisinger Health Plan Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS006","PAF008","New","HMO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010018-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001001802.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","18"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","1","22444","PA","Individual","No","23-2311553","22444PA0010018","Geisinger Health Plan Marketplace HMO 20/40/3000","22444PA001",,"PAN001","PAS006","PAF008","New","HMO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010018-03","Limited Cost Sharing Plan Variation","78.16%","0","No","Yes","No","100%",,"$3,900","$256","$0","$30","$3,000","$222","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001001803.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","19"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","9","22444","PA","Individual","No","23-2311553","22444PA0010003","Geisinger Health Plan Marketplace Extra 10/50/2000","22444PA001",,"PAN001","PAS003","PAF003","Existing","HMO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010003-00","Standard Silver Off Exchange Plan","71.63%","0.726545751094818","No","Yes","Yes","65%","35%","$2,900","$0","$1,311","$30","$353","$312","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%","$2,000","$2000 per person","$4000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001000300.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","4"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","9","22444","PA","Individual","No","23-2311553","22444PA0010003","Geisinger Health Plan Marketplace Extra 10/50/2000","22444PA001",,"PAN001","PAS003","PAF003","Existing","HMO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010003-01","Standard Silver On Exchange Plan","71.63%","0.726545751094818","No","Yes","Yes","65%","35%","$2,900","$0","$1,311","$30","$353","$312","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%","$2,000","$2000 per person","$4000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001000301.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","5"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","9","22444","PA","Individual","No","23-2311553","22444PA0010003","Geisinger Health Plan Marketplace Extra 10/50/2000","22444PA001",,"PAN001","PAS003","PAF003","Existing","HMO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001000302.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","6"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","9","22444","PA","Individual","No","23-2311553","22444PA0010003","Geisinger Health Plan Marketplace Extra 10/50/2000","22444PA001",,"PAN001","PAS003","PAF003","Existing","HMO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010003-03","Limited Cost Sharing Plan Variation","71.63%","0.726545751094818","No","Yes","Yes","65%","35%","$2,900","$0","$1,311","$30","$353","$312","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%","$2,000","$2000 per person","$4000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001000303.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","7"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","9","22444","PA","Individual","No","23-2311553","22444PA0010003","Geisinger Health Plan Marketplace Extra 10/50/2000","22444PA001",,"PAN001","PAS003","PAF003","Existing","HMO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010003-04","73% AV Level Silver Plan","73.77%","0.747627198696136","No","Yes","Yes","65%","35%","$2,950","$0","$1,311","$30","$603","$287","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%","$2,000","$2000 per person","$4000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001000304.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","8"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","9","22444","PA","Individual","No","23-2311553","22444PA0010003","Geisinger Health Plan Marketplace Extra 10/50/2000","22444PA001",,"PAN001","PAS003","PAF003","Existing","HMO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010003-05","87% AV Level Silver Plan","87.82%","0.885895490646362","No","Yes","Yes","65%","35%","$800","$6","$0","$30","$353","$267","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","0%","$400","$400 per person","$800 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001000305.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","9"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","9","22444","PA","Individual","No","23-2311553","22444PA0010003","Geisinger Health Plan Marketplace Extra 10/50/2000","22444PA001",,"PAN001","PAS003","PAF003","Existing","HMO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010003-06","94% AV Level Silver Plan","93.26%","0.930673360824585","No","Yes","Yes","65%","35%","$800","$0","$0","$30","$353","$22","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","0%","$400","$400 per person","$800 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001000306.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","10"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","9","22444","PA","Individual","No","23-2311553","22444PA0010022","Geisinger Health Plan Marketplace Extra 10/50/2000","22444PA001",,"PAN001","PAS002","PAF003","New","HMO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010022-00","Standard Silver Off Exchange Plan","71.63%","0.726545751094818","No","Yes","Yes","65%","35%","$2,900","$0","$1,311","$30","$353","$312","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%","$2,000","$2000 per person","$4000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001002200.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","11"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","9","22444","PA","Individual","No","23-2311553","22444PA0010022","Geisinger Health Plan Marketplace Extra 10/50/2000","22444PA001",,"PAN001","PAS002","PAF003","New","HMO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010022-01","Standard Silver On Exchange Plan","71.63%","0.726545751094818","No","Yes","Yes","65%","35%","$2,900","$0","$1,311","$30","$353","$312","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%","$2,000","$2000 per person","$4000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001002201.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","12"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","9","22444","PA","Individual","No","23-2311553","22444PA0010022","Geisinger Health Plan Marketplace Extra 10/50/2000","22444PA001",,"PAN001","PAS002","PAF003","New","HMO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010022-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001002202.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","13"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","9","22444","PA","Individual","No","23-2311553","22444PA0010022","Geisinger Health Plan Marketplace Extra 10/50/2000","22444PA001",,"PAN001","PAS002","PAF003","New","HMO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010022-03","Limited Cost Sharing Plan Variation","71.63%","0.726545751094818","No","Yes","Yes","65%","35%","$2,900","$0","$1,311","$30","$353","$312","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%","$2,000","$2000 per person","$4000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001002203.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","14"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","9","22444","PA","Individual","No","23-2311553","22444PA0010022","Geisinger Health Plan Marketplace Extra 10/50/2000","22444PA001",,"PAN001","PAS002","PAF003","New","HMO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010022-04","73% AV Level Silver Plan","73.77%","0.747627198696136","No","Yes","Yes","65%","35%","$2,950","$0","$1,311","$30","$603","$287","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%","$2,000","$2000 per person","$4000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001002204.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","15"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","9","22444","PA","Individual","No","23-2311553","22444PA0010022","Geisinger Health Plan Marketplace Extra 10/50/2000","22444PA001",,"PAN001","PAS002","PAF003","New","HMO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010022-05","87% AV Level Silver Plan","87.82%","0.885895490646362","No","Yes","Yes","65%","35%","$800","$6","$0","$30","$353","$267","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","0%","$400","$400 per person","$800 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001002205.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","16"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","9","22444","PA","Individual","No","23-2311553","22444PA0010022","Geisinger Health Plan Marketplace Extra 10/50/2000","22444PA001",,"PAN001","PAS002","PAF003","New","HMO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010022-06","94% AV Level Silver Plan","93.26%","0.930673360824585","No","Yes","Yes","65%","35%","$800","$0","$0","$30","$353","$22","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","0%","$400","$400 per person","$800 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001002206.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","17"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","10","22444","PA","Individual","No","23-2311553","22444PA0010002","Geisinger Health Plan Marketplace Extra 10/50/500","22444PA001",,"PAN001","PAS003","PAF003","Existing","HMO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010002-00","Standard Gold Off Exchange Plan","80.82%","0.822549641132355","No","Yes","Yes","65%","35%","$1,000","$900","$0","$30","$353","$312","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001000200.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","12"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","10","22444","PA","Individual","No","23-2311553","22444PA0010002","Geisinger Health Plan Marketplace Extra 10/50/500","22444PA001",,"PAN001","PAS003","PAF003","Existing","HMO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010002-01","Standard Gold On Exchange Plan","80.82%","0.822549641132355","No","Yes","Yes","65%","35%","$1,000","$900","$0","$30","$353","$312","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001000201.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","13"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","10","22444","PA","Individual","No","23-2311553","22444PA0010002","Geisinger Health Plan Marketplace Extra 10/50/500","22444PA001",,"PAN001","PAS003","PAF003","Existing","HMO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001000202.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","14"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","10","22444","PA","Individual","No","23-2311553","22444PA0010002","Geisinger Health Plan Marketplace Extra 10/50/500","22444PA001",,"PAN001","PAS003","PAF003","Existing","HMO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010002-03","Limited Cost Sharing Plan Variation","80.82%","0.822549641132355","No","Yes","Yes","65%","35%","$1,000","$900","$0","$30","$353","$312","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001000203.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","15"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","10","22444","PA","Individual","No","23-2311553","22444PA0010021","Geisinger Health Plan Marketplace Extra 10/50/500","22444PA001",,"PAN001","PAS002","PAF003","New","HMO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010021-00","Standard Gold Off Exchange Plan","80.82%","0.822549641132355","No","Yes","Yes","65%","35%","$1,000","$900","$0","$30","$353","$312","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001002100.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","16"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","10","22444","PA","Individual","No","23-2311553","22444PA0010021","Geisinger Health Plan Marketplace Extra 10/50/500","22444PA001",,"PAN001","PAS002","PAF003","New","HMO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010021-01","Standard Gold On Exchange Plan","80.82%","0.822549641132355","No","Yes","Yes","65%","35%","$1,000","$900","$0","$30","$353","$312","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001002101.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","17"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","10","22444","PA","Individual","No","23-2311553","22444PA0010021","Geisinger Health Plan Marketplace Extra 10/50/500","22444PA001",,"PAN001","PAS002","PAF003","New","HMO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0010021-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA001002102.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","18"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","11","22444","PA","Individual","No","23-2311553","22444PA0040010","Geisinger Health Plan Marketplace POS 25/50/2500","22444PA004",,"PAN001","PAS001","PAF003","Existing","POS","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040010-01","Standard Silver On Exchange Plan","71.31%","0.719878196716309","No","Yes","No","100%",,"$3,400","$0","$774","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444pa004001001.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","5"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","11","22444","PA","Individual","No","23-2311553","22444PA0040010","Geisinger Health Plan Marketplace POS 25/50/2500","22444PA004",,"PAN001","PAS001","PAF003","Existing","POS","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444pa004001002.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","6"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","11","22444","PA","Individual","No","23-2311553","22444PA0040010","Geisinger Health Plan Marketplace POS 25/50/2500","22444PA004",,"PAN001","PAS001","PAF003","Existing","POS","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040010-03","Limited Cost Sharing Plan Variation","71.31%","0.719878196716309","No","Yes","No","100%",,"$3,400","$0","$774","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444pa004001003.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","7"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","11","22444","PA","Individual","No","23-2311553","22444PA0040010","Geisinger Health Plan Marketplace POS 25/50/2500","22444PA004",,"PAN001","PAS001","PAF003","Existing","POS","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040010-04","73% AV Level Silver Plan","73.36%","0.739408671855927","No","Yes","No","100%",,"$3,400","$0","$774","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444pa004001004.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","8"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","11","22444","PA","Individual","No","23-2311553","22444PA0040010","Geisinger Health Plan Marketplace POS 25/50/2500","22444PA004",,"PAN001","PAS001","PAF003","Existing","POS","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040010-05","87% AV Level Silver Plan","87.39%","0.878736674785614","No","Yes","No","100%",,"$1,000","$6","$0","$30","$0","$307","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444pa004001005.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","9"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","11","22444","PA","Individual","No","23-2311553","22444PA0040010","Geisinger Health Plan Marketplace POS 25/50/2500","22444PA004",,"PAN001","PAS001","PAF003","Existing","POS","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040010-06","94% AV Level Silver Plan","94.09%","0.938810527324677","No","Yes","No","100%",,"$600","$0","$0","$30","$300","$22","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444pa004001006.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","10"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","11","22444","PA","Individual","No","23-2311553","22444PA0040059","Geisinger Health Plan Marketplace POS 25/50/2500","22444PA004",,"PAN001","PAS005","PAF003","New","POS","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040059-00","Standard Silver Off Exchange Plan","71.31%","0.719878196716309","No","Yes","No","100%",,"$3,400","$0","$774","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA004005900.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","18"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","11","22444","PA","Individual","No","23-2311553","22444PA0040059","Geisinger Health Plan Marketplace POS 25/50/2500","22444PA004",,"PAN001","PAS005","PAF003","New","POS","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040059-01","Standard Silver On Exchange Plan","71.31%","0.719878196716309","No","Yes","No","100%",,"$3,400","$0","$774","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA004005901.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","19"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","11","22444","PA","Individual","No","23-2311553","22444PA0040059","Geisinger Health Plan Marketplace POS 25/50/2500","22444PA004",,"PAN001","PAS005","PAF003","New","POS","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040059-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA004005902.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","20"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","11","22444","PA","Individual","No","23-2311553","22444PA0040059","Geisinger Health Plan Marketplace POS 25/50/2500","22444PA004",,"PAN001","PAS005","PAF003","New","POS","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040059-03","Limited Cost Sharing Plan Variation","71.31%","0.719878196716309","No","Yes","No","100%",,"$3,400","$0","$774","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA004005903.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","21"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","11","22444","PA","Individual","No","23-2311553","22444PA0040059","Geisinger Health Plan Marketplace POS 25/50/2500","22444PA004",,"PAN001","PAS005","PAF003","New","POS","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040059-04","73% AV Level Silver Plan","73.36%","0.739408671855927","No","Yes","No","100%",,"$3,400","$0","$774","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA004005904.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","22"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","11","22444","PA","Individual","No","23-2311553","22444PA0040059","Geisinger Health Plan Marketplace POS 25/50/2500","22444PA004",,"PAN001","PAS005","PAF003","New","POS","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040059-05","87% AV Level Silver Plan","87.39%","0.878736674785614","No","Yes","No","100%",,"$1,000","$6","$0","$30","$0","$307","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA004005905.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","23"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","11","22444","PA","Individual","No","23-2311553","22444PA0040066","Geisinger Health Plan Marketplace POS 25/50/2500","22444PA004",,"PAN001","PAS006","PAF003","New","POS","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040066-00","Standard Silver Off Exchange Plan","71.31%","0.719878196716309","No","Yes","No","100%",,"$3,400","$0","$774","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA004006600.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","25"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","11","22444","PA","Individual","No","23-2311553","22444PA0040066","Geisinger Health Plan Marketplace POS 25/50/2500","22444PA004",,"PAN001","PAS006","PAF003","New","POS","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040066-01","Standard Silver On Exchange Plan","71.31%","0.719878196716309","No","Yes","No","100%",,"$3,400","$0","$774","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA004006601.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","26"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","11","22444","PA","Individual","No","23-2311553","22444PA0040066","Geisinger Health Plan Marketplace POS 25/50/2500","22444PA004",,"PAN001","PAS006","PAF003","New","POS","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040066-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA004006602.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","27"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","12","22444","PA","Individual","No","23-2311553","22444PA0040069","Geisinger Health Plan Marketplace Value","22444PA004",,"PAN001","PAS006","PAF011","New","POS","Catastrophic","No","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040069-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,320","$0","$0","$30","$5,016","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA004006900.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","10"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","12","22444","PA","Individual","No","23-2311553","22444PA0040069","Geisinger Health Plan Marketplace Value","22444PA004",,"PAN001","PAS006","PAF011","New","POS","Catastrophic","No","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040069-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,320","$0","$0","$30","$5,016","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA004006901.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","11"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","1","24872","PA","Individual","No","25-1756858","24872PA0010004","Silver Compass HSA 2000-1","24872PA001",,"PAN001","PAS001","PAF004","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010004-04","73% AV Level Silver Plan","73.20%",,"Yes","Yes","No","100%",,"$1,800","$1,500","$0","$200","$1,800","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$5450 per person","$5450 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","per person not applicable","$5400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=pa0010&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","8"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","11","22444","PA","Individual","No","23-2311553","22444PA0040066","Geisinger Health Plan Marketplace POS 25/50/2500","22444PA004",,"PAN001","PAS006","PAF003","New","POS","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040066-03","Limited Cost Sharing Plan Variation","71.31%","0.719878196716309","No","Yes","No","100%",,"$3,400","$0","$774","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA004006603.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","28"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","11","22444","PA","Individual","No","23-2311553","22444PA0040066","Geisinger Health Plan Marketplace POS 25/50/2500","22444PA004",,"PAN001","PAS006","PAF003","New","POS","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040066-04","73% AV Level Silver Plan","73.36%","0.739408671855927","No","Yes","No","100%",,"$3,400","$0","$774","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA004006604.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","29"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","11","22444","PA","Individual","No","23-2311553","22444PA0040066","Geisinger Health Plan Marketplace POS 25/50/2500","22444PA004",,"PAN001","PAS006","PAF003","New","POS","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040066-05","87% AV Level Silver Plan","87.39%","0.878736674785614","No","Yes","No","100%",,"$1,000","$6","$0","$30","$0","$307","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA004006605.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","30"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","11","22444","PA","Individual","No","23-2311553","22444PA0040066","Geisinger Health Plan Marketplace POS 25/50/2500","22444PA004",,"PAN001","PAS006","PAF003","New","POS","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040066-06","94% AV Level Silver Plan","94.09%","0.938810527324677","No","Yes","No","100%",,"$600","$0","$0","$30","$300","$22","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA004006606.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","31"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","12","22444","PA","Individual","No","23-2311553","22444PA0040019","Geisinger Health Plan Marketplace Value","22444PA004",,"PAN001","PAS001","PAF011","Existing","POS","Catastrophic","No","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040019-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,320","$0","$0","$30","$5,016","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444pa004001900.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","4"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","12","22444","PA","Individual","No","23-2311553","22444PA0040019","Geisinger Health Plan Marketplace Value","22444PA004",,"PAN001","PAS001","PAF011","Existing","POS","Catastrophic","No","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040019-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,320","$0","$0","$30","$5,016","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444pa004001901.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","5"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","12","22444","PA","Individual","No","23-2311553","22444PA0040053","Geisinger Health Plan Marketplace Value","22444PA004",,"PAN001","PAS002","PAF011","New","POS","Catastrophic","No","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040053-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,320","$0","$0","$30","$5,016","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA004005300.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","6"
"2016","PA","22444","HIOS","7","2015-10-23 02:29:38","12","22444","PA","Individual","No","23-2311553","22444PA0040053","Geisinger Health Plan Marketplace Value","22444PA004",,"PAN001","PAS002","PAF011","New","POS","Catastrophic","No","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","22444PA0040053-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,320","$0","$0","$30","$5,016","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/22444PA004005301.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","7"
"2016","PA","23489","HIOS","6","2015-08-26 09:56:12","1","23489","PA","SHOP (Small Group)","No","36-2739571","23489PA0010070","Silver Navigate Plus 1600","23489PA001",,"PAN001","PAS001","PAF003","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=pa0005&st=pa","23489PA0010070-00","Standard Silver Off Exchange Plan","70.80%",,"No","Yes","No","100%",,"$1,600","$20","$1,400","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"$500","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=pa0004&st=pa",,"10"
"2016","PA","23489","HIOS","6","2015-08-26 09:56:12","1","23489","PA","SHOP (Small Group)","No","36-2739571","23489PA0010070","Silver Navigate Plus 1600","23489PA001",,"PAN001","PAS001","PAF003","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=pa0005&st=pa","23489PA0010070-01","Standard Silver On Exchange Plan","70.80%",,"No","Yes","No","100%",,"$1,600","$20","$1,400","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"$500","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=pa0004&st=pa",,"11"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","1","24872","PA","Individual","No","25-1756858","24872PA0010004","Silver Compass HSA 2000-1","24872PA001",,"PAN001","PAS001","PAF004","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010004-00","Standard Silver Off Exchange Plan","71.13%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=pa0007&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","4"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","1","24872","PA","Individual","No","25-1756858","24872PA0010004","Silver Compass HSA 2000-1","24872PA001",,"PAN001","PAS001","PAF004","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010004-01","Standard Silver On Exchange Plan","71.13%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=pa0007&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","5"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","1","24872","PA","Individual","No","25-1756858","24872PA0010004","Silver Compass HSA 2000-1","24872PA001",,"PAN001","PAS001","PAF004","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=pa0008&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","6"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","1","24872","PA","Individual","No","25-1756858","24872PA0010004","Silver Compass HSA 2000-1","24872PA001",,"PAN001","PAS001","PAF004","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010004-03","Limited Cost Sharing Plan Variation","71.13%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=pa0009&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","7"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","1","24872","PA","Individual","No","25-1756858","24872PA0010004","Silver Compass HSA 2000-1","24872PA001",,"PAN001","PAS001","PAF004","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010004-05","87% AV Level Silver Plan","86.20%",,"Yes","Yes","No","100%",,"$600","$750","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$2250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","per person not applicable","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=pa0011&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","9"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","1","24872","PA","Individual","No","25-1756858","24872PA0010004","Silver Compass HSA 2000-1","24872PA001",,"PAN001","PAS001","PAF004","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010004-06","94% AV Level Silver Plan","93.10%",,"Yes","Yes","No","100%",,"$200","$700","$0","$200","$200","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","per person not applicable","$400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=pa0012&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","10"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","1","24872","PA","Individual","No","25-1756858","24872PA0010016","Bronze Compass HSA 5500-1","24872PA001",,"PAN001","PAS001","PAF004","Existing","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010016-00","Standard Bronze Off Exchange Plan","61.30%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=pa0019&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","11"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","1","24872","PA","Individual","No","25-1756858","24872PA0010016","Bronze Compass HSA 5500-1","24872PA001",,"PAN001","PAS001","PAF004","Existing","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010016-01","Standard Bronze On Exchange Plan","61.30%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=pa0019&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","12"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","1","24872","PA","Individual","No","25-1756858","24872PA0010016","Bronze Compass HSA 5500-1","24872PA001",,"PAN001","PAS001","PAF004","Existing","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010016-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=pa0020&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","13"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","1","24872","PA","Individual","No","25-1756858","24872PA0010016","Bronze Compass HSA 5500-1","24872PA001",,"PAN001","PAS001","PAF004","Existing","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010016-03","Limited Cost Sharing Plan Variation","61.30%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=pa0021&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","14"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","2","24872","PA","Individual","No","25-1756858","24872PA0010001","Gold Compass 1000-1","24872PA001",,"PAN001","PAS001","PAF001","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010001-00","Standard Gold Off Exchange Plan","78.10%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=pa0004&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","4"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","2","24872","PA","Individual","No","25-1756858","24872PA0010001","Gold Compass 1000-1","24872PA001",,"PAN001","PAS001","PAF001","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010001-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=pa0004&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","5"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","2","24872","PA","Individual","No","25-1756858","24872PA0010001","Gold Compass 1000-1","24872PA001",,"PAN001","PAS001","PAF001","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=pa0005&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","6"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","2","24872","PA","Individual","No","25-1756858","24872PA0010001","Gold Compass 1000-1","24872PA001",,"PAN001","PAS001","PAF001","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010001-03","Limited Cost Sharing Plan Variation","78.10%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=pa0006&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","7"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","2","24872","PA","Individual","No","25-1756858","24872PA0010002","Gold Compass0-1","24872PA001",,"PAN001","PAS001","PAF002","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010002-00","Standard Gold Off Exchange Plan","79.10%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=pa0001&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","8"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","2","24872","PA","Individual","No","25-1756858","24872PA0010002","Gold Compass0-1","24872PA001",,"PAN001","PAS001","PAF002","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010002-01","Standard Gold On Exchange Plan","79.10%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=pa0001&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","9"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","2","24872","PA","Individual","No","25-1756858","24872PA0010002","Gold Compass0-1","24872PA001",,"PAN001","PAS001","PAF002","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=pa0002&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","10"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","2","24872","PA","Individual","No","25-1756858","24872PA0010002","Gold Compass0-1","24872PA001",,"PAN001","PAS001","PAF002","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010002-03","Limited Cost Sharing Plan Variation","79.10%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=pa0003&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","11"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","2","24872","PA","Individual","No","25-1756858","24872PA0010010","Silver Compass 4500-1","24872PA001",,"PAN001","PAS001","PAF003","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010010-00","Standard Silver Off Exchange Plan","68.3%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=pa0013&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","12"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","2","24872","PA","Individual","No","25-1756858","24872PA0010010","Silver Compass 4500-1","24872PA001",,"PAN001","PAS001","PAF003","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010010-01","Standard Silver On Exchange Plan","68.3%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=pa0013&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","13"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","2","24872","PA","Individual","No","25-1756858","24872PA0010010","Silver Compass 4500-1","24872PA001",,"PAN001","PAS001","PAF003","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010010-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=pa0014&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","14"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","2","24872","PA","Individual","No","25-1756858","24872PA0010010","Silver Compass 4500-1","24872PA001",,"PAN001","PAS001","PAF003","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010010-03","Limited Cost Sharing Plan Variation","68.3%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=pa0015&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","15"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","2","24872","PA","Individual","No","25-1756858","24872PA0010010","Silver Compass 4500-1","24872PA001",,"PAN001","PAS001","PAF003","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010010-04","73% AV Level Silver Plan","72.50%",,"No","Yes","No","100%",,"$3,200","$10","$0","$200","$700","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=pa0016&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","16"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","2","24872","PA","Individual","No","25-1756858","24872PA0010010","Silver Compass 4500-1","24872PA001",,"PAN001","PAS001","PAF003","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010010-05","87% AV Level Silver Plan","86.1%",,"No","Yes","No","100%",,"$600","$10","$0","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=pa0017&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","17"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","4","31609","PA","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF015","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9887",,,"$700","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070003-06","94% AV Level Silver Plan","93.68%",,"No","Yes","No","100%",,"$0","$23","$465","$150","$0","$60","$31","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/pposilver94CSR2016","https://www.ibx4you.com/ffm/brochure","9"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","2","24872","PA","Individual","No","25-1756858","24872PA0010010","Silver Compass 4500-1","24872PA001",,"PAN001","PAS001","PAF003","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010010-06","94% AV Level Silver Plan","93.30%",,"No","Yes","No","100%",,"$100","$10","$0","$200","$100","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=pa0018&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","18"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","2","24872","PA","Individual","No","25-1756858","24872PA0010019","Bronze Compass 6500-1","24872PA001",,"PAN001","PAS001","PAF004","Existing","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010019-00","Standard Bronze Off Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,800","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=pa0022&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","19"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","2","24872","PA","Individual","No","25-1756858","24872PA0010019","Bronze Compass 6500-1","24872PA001",,"PAN001","PAS001","PAF004","Existing","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010019-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,800","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=pa0022&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","20"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","2","24872","PA","Individual","No","25-1756858","24872PA0010019","Bronze Compass 6500-1","24872PA001",,"PAN001","PAS001","PAF004","Existing","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010019-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=pa0023&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","21"
"2016","PA","24872","HIOS","8","2015-08-26 09:56:12","2","24872","PA","Individual","No","25-1756858","24872PA0010019","Bronze Compass 6500-1","24872PA001",,"PAN001","PAS001","PAF004","Existing","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=pa0026&st=pa","24872PA0010019-03","Limited Cost Sharing Plan Variation","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,800","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=pa0024&st=pa","http://www.uhc.com/iex/doc?id=pa0025&st=pa","22"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","1","31609","PA","Individual","No","23-2184623","31609PA0070009","Personal Choice PPO Platinum Complete","31609PA007",,"PAN001","PAS001","PAF025","Existing","PPO","Platinum","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9688",,,"$700","5","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0070009-01","Standard Platinum On Exchange Plan","90.05%",,"No","Yes","No","100%",,"$0","$690","$0","$150","$0","$120","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/ppoplatinumcomplete2016","https://www.ibx4you.com/ffm/brochure","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","1","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150001","Personal Choice PPO Platinum Preferred $10/$20/$150","31609PA015",,"PAN001","PAS001","PAF001","Existing","PPO","Platinum","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","5","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","31609PA0150001-01","Standard Platinum On Exchange Plan","89.75%",,"No","Yes","No","100%",,"$0","$394","$0","$150","$0","$150","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","1","31609","PA","Individual","No","23-2184623","31609PA0070009","Personal Choice PPO Platinum Complete","31609PA007",,"PAN001","PAS001","PAF025","Existing","PPO","Platinum","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9688",,,"$700","5","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0070009-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/ppoplatinumcompleteZeroCost2016","https://www.ibx4you.com/ffm/brochure","5"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","1","31609","PA","Individual","No","23-2184623","31609PA0070009","Personal Choice PPO Platinum Complete","31609PA007",,"PAN001","PAS001","PAF025","Existing","PPO","Platinum","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9688",,,"$700","5","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0070009-03","Limited Cost Sharing Plan Variation","90.05%",,"No","Yes","No","100%",,"$0","$690","$0","$150","$0","$120","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/ppoplatinumcompleteLimitedCost2016","https://www.ibx4you.com/ffm/brochure","6"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560023","Premier Balance PPO $1500 A a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560023-00","Standard Gold Off Exchange Plan","78.73%",,"No","Yes","Yes","93%","7%","$1,500","$200","$0","$0","$1,500","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group","$3,300","$3300 per person","$6600 per group","$9,900","$9900 per person","$19800 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%","$3,000","$3000 per person","$6000 per group","30%","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","20"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","4","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0640003","Health Savings PPO Embedded $5500 a Community Blue Flex Plan","33709PA064",,"PAN001","PAS001","PAF011","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0640003-01","Standard Bronze On Exchange Plan",,"0.617362022399902","Yes","Yes","Yes","93%","7%","$5,500","$10","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$19,350","$19350 per person","$38700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%","$5,500","$5500 per person","$11000 per group","30%","$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","9"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","4","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0640004","Health Savings PPO Embedded $5500 a Community Blue Flex Plan","33709PA064",,"PAN001","PAS002","PAF011","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0640004-00","Standard Bronze Off Exchange Plan",,"0.617581725120544","Yes","Yes","Yes","96%","4%","$5,500","$10","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$19,350","$19350 per person","$38700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%","$5,500","$5500 per person","$11000 per group","30%","$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","10"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","4","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0640004","Health Savings PPO Embedded $5500 a Community Blue Flex Plan","33709PA064",,"PAN001","PAS002","PAF011","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0640004-01","Standard Bronze On Exchange Plan",,"0.617581725120544","Yes","Yes","Yes","96%","4%","$5,500","$10","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$19,350","$19350 per person","$38700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%","$5,500","$5500 per person","$11000 per group","30%","$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","11"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","8","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0630004","Connect Blue EPO $500 a Community Blue Plan","33709PA063",,"PAN001","PAS010","PAF011","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0630004-00","Standard Gold Off Exchange Plan","79.88%","0","No","Yes","Yes","81%","19%","$0","$400","$0","$0","$500","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$2,000","$2000 per person","$4000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","8"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","2","31609","PA","Individual","No","23-2184623","31609PA0070001","Personal Choice PPO Platinum","31609PA007",,"PAN001","PAS001","PAF013","Existing","PPO","Platinum","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9984",,,"$700","5","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0070001-01","Standard Platinum On Exchange Plan","88.78%",,"No","Yes","No","100%",,"$0","$690","$0","$150","$0","$130","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/ppoplatinum2016","https://www.ibx4you.com/ffm/brochure","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","2","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150002","Personal Choice PPO Platinum Preferred $20/$40/$150","31609PA015",,"PAN001","PAS001","PAF002","Existing","PPO","Platinum","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","5","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","31609PA0150002-01","Standard Platinum On Exchange Plan","88.02%",,"No","Yes","No","100%",,"$0","$404","$0","$150","$0","$195","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","2","31609","PA","Individual","No","23-2184623","31609PA0070001","Personal Choice PPO Platinum","31609PA007",,"PAN001","PAS001","PAF013","Existing","PPO","Platinum","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9984",,,"$700","5","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0070001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/ppoplatinumZeroCost2016","https://www.ibx4you.com/ffm/brochure","5"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","2","31609","PA","Individual","No","23-2184623","31609PA0070001","Personal Choice PPO Platinum","31609PA007",,"PAN001","PAS001","PAF013","Existing","PPO","Platinum","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9984",,,"$700","5","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0070001-03","Limited Cost Sharing Plan Variation","88.78%",,"No","Yes","No","100%",,"$0","$690","$0","$150","$0","$130","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/ppoplatinumLimitedCost2016","https://www.ibx4you.com/ffm/brochure","6"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","3","31609","PA","Individual","No","23-2184623","31609PA0070002","Personal Choice PPO Gold","31609PA007",,"PAN001","PAS001","PAF014","Existing","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9984",,,"$700","5","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070002-01","Standard Gold On Exchange Plan","80.65%",,"No","Yes","No","100%",,"$0","$1,628","$0","$150","$0","$130","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/ppogold2016","https://www.ibx4you.com/ffm/brochure","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","3","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150003","Personal Choice PPO Gold Preferred $35/$70/$600","31609PA015",,"PAN001","PAS001","PAF003","Existing","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","5","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","31609PA0150003-01","Standard Gold On Exchange Plan","81.33%",,"No","Yes","No","100%",,"$0","$1,319","$0","$150","$0","$260","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","3","31609","PA","Individual","No","23-2184623","31609PA0070002","Personal Choice PPO Gold","31609PA007",,"PAN001","PAS001","PAF014","Existing","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9984",,,"$700","5","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/ppogoldZeroCost2016","https://www.ibx4you.com/ffm/brochure","5"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","3","31609","PA","Individual","No","23-2184623","31609PA0070002","Personal Choice PPO Gold","31609PA007",,"PAN001","PAS001","PAF014","Existing","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9984",,,"$700","5","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070002-03","Limited Cost Sharing Plan Variation","80.65%",,"No","Yes","No","100%",,"$0","$1,640","$0","$150","$0","$180","$61","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/ppogoldLimitedCost2016","https://www.ibx4you.com/ffm/brochure","6"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","4","31609","PA","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF015","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9887",,,"$700","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070003-01","Standard Silver On Exchange Plan","70.04%",,"No","Yes","No","100%",,"$2,000","$100","$741","$150","$81","$250","$76","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/pposilver2016","https://www.ibx4you.com/ffm/brochure","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","4","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150004","Personal Choice PPO Gold Classic $1,000 $15/$30/80%","31609PA015",,"PAN001","PAS001","PAF003","Existing","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","31609PA0150004-01","Standard Gold On Exchange Plan","78.29%",,"No","Yes","No","100%",,"$1,000","$49","$730","$150","$0","$180","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","4","31609","PA","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF015","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9887",,,"$700","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/pposilverZeroCost2016","https://www.ibx4you.com/ffm/brochure","5"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","4","31609","PA","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF015","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9887",,,"$700","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070003-03","Limited Cost Sharing Plan Variation","70.04%",,"No","Yes","No","100%",,"$2,000","$100","$741","$150","$81","$250","$76","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/pposilverLimitedCost2016","https://www.ibx4you.com/ffm/brochure","6"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","4","31609","PA","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF015","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9887",,,"$700","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070003-04","73% AV Level Silver Plan","73.85%",,"No","Yes","No","100%",,"$2,000","$80","$794","$150","$0","$190","$46","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/pposilver73CSR2016","https://www.ibx4you.com/ffm/brochure","7"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","4","31609","PA","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF015","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9887",,,"$700","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070003-05","87% AV Level Silver Plan","87.24%",,"No","Yes","No","100%",,"$0","$38","$465","$150","$0","$80","$46","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/pposilver87CSR2016","https://www.ibx4you.com/ffm/brochure","8"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","5","31609","PA","Individual","No","23-2184623","31609PA0070004","Personal Choice PPO Bronze","31609PA007",,"PAN001","PAS001","PAF016","Existing","PPO","Bronze","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9984",,,,"0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070004-01","Standard Bronze On Exchange Plan","61.46%",,"Yes","Yes","No","100%",,"$4,500","$30","$741","$150","$724","$50","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/ffm/ppobronze2016","https://www.ibx4you.com/ffm/brochure","4"
"2016","PA","32561","HIOS","3","2015-08-18 03:25:03","2","32561","PA","SHOP (Small Group)","Yes","13-5123390","32561PA0140002","Guardian Family Essentials","32561PA014",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","32561PA0140002-00","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","PA","32561","HIOS","3","2015-08-18 03:25:03","2","32561","PA","SHOP (Small Group)","Yes","13-5123390","32561PA0140002","Guardian Family Essentials","32561PA014",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","32561PA0140002-01","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690003","Connect Blue EPO 250, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF001","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","33709PA0690003-00","Standard Gold Off Exchange Plan","79.85%","0","No","Yes","Yes","75%","25%","$0","$700","$0","$0","$250","$300","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%","$750","$750 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2095170320_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","4"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560007","Premier Balance PPO $0 Platinum A a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560007-00","Standard Platinum Off Exchange Plan","90.37%",,"No","Yes","Yes","93%","7%","$0","$100","$0","$0","$0","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$500","$500 per person","$1000 per group","30%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","4"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560007","Premier Balance PPO $0 Platinum A a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560007-01","Standard Platinum On Exchange Plan","90.37%",,"No","Yes","Yes","93%","7%","$0","$100","$0","$0","$0","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$500","$500 per person","$1000 per group","30%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","5"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690001","Connect Blue EPO 750, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF001","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","33709PA0690001-01","Standard Silver On Exchange Plan","71.27%","0","No","Yes","Yes","75%","25%","$0","$1,300","$0","$0","$750","$400","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%","$4,000","$4000 per person","$8000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097234280_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","16"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690001","Connect Blue EPO 750, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF001","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","33709PA0690001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","75%","25%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097364311_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","17"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560019","Premier Balance PPO $1000 A a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560019-01","Standard Gold On Exchange Plan","79.61%",,"No","Yes","Yes","93%","7%","$1,000","$200","$0","$0","$1,000","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%","$2,000","$2000 per person","$4000 per group","30%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","17"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","5","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150005","Personal Choice PPO Silver Classic $2,500 $30/$60/80%","31609PA015",,"PAN001","PAS001","PAF004","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","31609PA0150005-01","Standard Silver On Exchange Plan","70.03%",,"No","Yes","No","100%",,"$2,500","$44","$0","$150","$0","$190","$76","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","5","31609","PA","Individual","No","23-2184623","31609PA0070004","Personal Choice PPO Bronze","31609PA007",,"PAN001","PAS001","PAF016","Existing","PPO","Bronze","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9984",,,,"0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.ibx4you.com/ffm/ppobronzeZeroCost2016","https://www.ibx4you.com/ffm/brochure","5"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","5","31609","PA","Individual","No","23-2184623","31609PA0070004","Personal Choice PPO Bronze","31609PA007",,"PAN001","PAS001","PAF016","Existing","PPO","Bronze","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9984",,,,"0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0070004-03","Limited Cost Sharing Plan Variation","61.46%",,"Yes","Yes","No","100%",,"$4,500","$30","$741","$150","$671","$50","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/ffm/ppobronzeLimitedCost2016","https://www.ibx4you.com/ffm/brochure","6"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","6","31609","PA","Individual","No","23-2184623","31609PA0070006","Personal Choice PPO Bronze Reserve","31609PA007",,"PAN001","PAS001","PAF022","Existing","PPO","Bronze","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9984",,,,"0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0070006-01","Standard Bronze On Exchange Plan",,"0.604190468788147","Yes","Yes","No","100%",,"$6,400","$0","$0","$150","$740","$0","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.ibx4you.com/ffm/ppobronzereserve2016","https://www.ibx4you.com/ffm/brochure","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","6","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150006","Personal Choice PPO Platinum HSA-50 $1,500/100%","31609PA015",,"PAN001","PAS001","PAF005","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","31609PA0150006-01","Standard Platinum On Exchange Plan",,"0.885875701904297","Yes","Yes","No","100%",,"$1,500","$14","$0","$150","$651","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$750.00","https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","6","31609","PA","Individual","No","23-2184623","31609PA0070006","Personal Choice PPO Bronze Reserve","31609PA007",,"PAN001","PAS001","PAF022","Existing","PPO","Bronze","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9984",,,,"0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0070006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.ibx4you.com/ffm/ppobronzereserveZeroCost2016","https://www.ibx4you.com/ffm/brochure","5"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","6","31609","PA","Individual","No","23-2184623","31609PA0070006","Personal Choice PPO Bronze Reserve","31609PA007",,"PAN001","PAS001","PAF022","Existing","PPO","Bronze","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9984",,,,"0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0070006-03","Limited Cost Sharing Plan Variation",,"0.604190468788147","Yes","Yes","No","100%",,"$6,400","$0","$0","$150","$740","$0","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.ibx4you.com/ffm/ppobronzereserveLimitedCost2016","https://www.ibx4you.com/ffm/brochure","6"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","7","31609","PA","Individual","No","23-2184623","31609PA0070010","Personal Choice Bronze Basic","31609PA007",,"PAN001","PAS001","PAF024","Existing","EPO","Bronze","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery,Dental Care(Paediatric), Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9984",,,,"0","0","3","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0070010-01","Standard Bronze On Exchange Plan",,"0.609253346920013","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$570","$0","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/ffm/ppobronzebasic2016","https://www.ibx4you.com/ffm/brochure","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","7","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150007","Personal Choice PPO Gold HSA-25 $2,200/100%","31609PA015",,"PAN001","PAS001","PAF006","Existing","PPO","Gold","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","31609PA0150007-01","Standard Gold On Exchange Plan",,"0.818227767944336","Yes","Yes","No","100%",,"$2,200","$14","$0","$150","$651","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","per person not applicable","$4400 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$550.00","https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","7","31609","PA","Individual","No","23-2184623","31609PA0070010","Personal Choice Bronze Basic","31609PA007",,"PAN001","PAS001","PAF024","Existing","EPO","Bronze","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery,Dental Care(Paediatric), Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9984",,,,"0","0","3","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0070010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.ibx4you.com/ffm/ppobronzebasicZeroCost2016","https://www.ibx4you.com/ffm/brochure","5"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","7","31609","PA","Individual","No","23-2184623","31609PA0070010","Personal Choice Bronze Basic","31609PA007",,"PAN001","PAS001","PAF024","Existing","EPO","Bronze","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery,Dental Care(Paediatric), Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9984",,,,"0","0","3","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0070010-03","Limited Cost Sharing Plan Variation",,"0.609253346920013","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$570","$40","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/ffm/ppobronzebasicLimitedCost2016","https://www.ibx4you.com/ffm/brochure","6"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","8","31609","PA","Individual","No","23-2184623","31609PA0070007","Personal Choice Catastrophic","31609PA007",,"PAN001","PAS001","PAF024","Existing","EPO","Catastrophic","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9984",,,,"0","0","3","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","31609PA0070007-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$570","$50","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/ffm/ppocatastrophic2016","https://www.ibx4you.com/ffm/brochure","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","8","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150008","Personal Choice PPO Gold HSA-0 $1,700/100%","31609PA015",,"PAN001","PAS001","PAF005","Existing","PPO","Gold","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","31609PA0150008-01","Standard Gold On Exchange Plan",,"0.784707307815552","Yes","Yes","No","100%",,"$1,700","$14","$0","$150","$651","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","per person not applicable","$3400 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","9","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150009","Personal Choice PPO Gold HSA-50 $2,200/70%","31609PA015",,"PAN001","PAS001","PAF006","Existing","PPO","Gold","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","31609PA0150009-01","Standard Gold On Exchange Plan",,"0.790039598941803","Yes","Yes","No","100%",,"$2,200","$14","$876","$150","$651","$0","$24","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","per person not applicable","$4400 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$1,100.00","https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","10","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150010","Personal Choice PPO Silver HSA-25 $2,400/50%","31609PA015",,"PAN001","PAS001","PAF007","Existing","PPO","Silver","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","31609PA0150010-01","Standard Silver On Exchange Plan",,"0.712759375572205","Yes","Yes","No","100%",,"$2,400","$14","$1,333","$150","$731","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$4800 per group","50%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$600.00","https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","11","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150011","Personal Choice PPO Silver HSA-0 $2,400/90%","31609PA015",,"PAN001","PAS001","PAF007","Existing","PPO","Silver","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","31609PA0150011-01","Standard Silver On Exchange Plan",,"0.700086414813995","Yes","Yes","No","100%",,"$2,400","$14","$1,333","$150","$731","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$4800 per group","10%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","12","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150012","Personal Choice PPO Bronze HSA-0 $4,000/50%","31609PA015",,"PAN001","PAS001","PAF008","Existing","PPO","Bronze","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","31609PA0150012-01","Standard Bronze On Exchange Plan",,"0.616534292697906","Yes","Yes","No","100%",,"$4,000","$14","$533","$150","$731","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","per person not applicable","$8000 per group","50%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","13","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150013","Personal Choice PPO Bronze HSA-0 $6,550/100%","31609PA015",,"PAN001","PAS001","PAF009","Existing","PPO","Bronze","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","31609PA0150013-01","Standard Bronze On Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$731","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","per person not applicable","$13100 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","14","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150014","Personal Choice PPO Platinum HRA-50 $1,500/100%","31609PA015",,"PAN001","PAS001","PAF010","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","31609PA0150014-01","Standard Platinum On Exchange Plan",,"0.885875701904297","Yes","Yes","No","100%",,"$1,500","$14","$0","$150","$889","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","Yes","$750.00","https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","15","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150015","Personal Choice PPO Gold HRA-25 $2,200/100%","31609PA015",,"PAN001","PAS001","PAF011","Existing","PPO","Gold","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","31609PA0150015-01","Standard Gold On Exchange Plan",,"0.818227767944336","Yes","Yes","No","100%",,"$2,200","$14","$0","$150","$731","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","Yes","$550.00","https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","16","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150017","Personal Choice PPO Gold HRA-50 $2,200/70%","31609PA015",,"PAN001","PAS001","PAF011","Existing","PPO","Gold","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","31609PA0150017-01","Standard Gold On Exchange Plan",,"0.790039598941803","Yes","Yes","No","100%",,"$2,200","$14","$1,485","$150","$731","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","Yes","$1,100.00","https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","17","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150018","Personal Choice PPO Silver HRA-25 $2,400/50%","31609PA015",,"PAN001","PAS001","PAF012","Existing","PPO","Silver","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","31609PA0150018-01","Standard Silver On Exchange Plan",,"0.712759375572205","Yes","Yes","No","100%",,"$2,400","$14","$1,444","$150","$731","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","Yes","$600.00","https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","18","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150022","Personal Choice PPO Gold Classic $2,000 $40/$80/100%","31609PA015",,"PAN001","PAS001","PAF008","New","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","31609PA0150022-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$2,000","$119","$0","$150","$0","$280","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","19","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150024","Personal Choice PPO Silver Secure $3,000 $30/$60/$600","31609PA015",,"PAN001","PAS001","PAF028","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","5","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","31609PA0150024-01","Standard Silver On Exchange Plan","68.71%",,"No","Yes","No","100%",,"$3,000","$1,314","$0","$150","$0","$250","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","20","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150023","Personal Choice PPO Silver Classic $3,300 $40/$80/100%","31609PA015",,"PAN001","PAS001","PAF029","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","31609PA0150023-01","Standard Silver On Exchange Plan","68.98%",,"No","Yes","No","100%",,"$3,300","$114","$0","$150","$0","$290","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$3,300","$3300 per person","$6600 per group","0%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","31609","HIOS","9","2016-01-23 05:53:30","21","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150046","Personal Choice PPO Silver HSA-0 $2,700/100%","31609PA015",,"PAN001","PAS001","PAF030","New","PPO","Silver","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","31609PA0150046-01","Standard Silver On Exchange Plan",,"0.71659654378891","Yes","Yes","No","100%",,"$2,700","$14","$0","$150","$651","$0","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","per person not applicable","$5400 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","32561","HIOS","3","2015-08-18 03:25:03","1","32561","PA","Individual","Yes","13-5123390","32561PA0200001","Guardian Family Essentials","32561PA020",,"PAN002","PAS002",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","32561PA0200001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","4"
"2016","PA","32561","HIOS","3","2015-08-18 03:25:03","1","32561","PA","SHOP (Small Group)","Yes","13-5123390","32561PA0090002","Guardian Pediatric Advantage","32561PA009",,"PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$25.61","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","32561PA0090002-00","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","PA","32561","HIOS","3","2015-08-18 03:25:03","1","32561","PA","SHOP (Small Group)","Yes","13-5123390","32561PA0100002","Guardian Pediatric Essentials","32561PA010",,"PAN001","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$19.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","32561PA0100002-00","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","PA","32561","HIOS","3","2015-08-18 03:25:03","1","32561","PA","Individual","Yes","13-5123390","32561PA0200001","Guardian Family Essentials","32561PA020",,"PAN002","PAS002",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","32561PA0200001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","5"
"2016","PA","32561","HIOS","3","2015-08-18 03:25:03","2","32561","PA","SHOP (Small Group)","Yes","13-5123390","32561PA0120002","Guardian Family Advantage","32561PA012",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.61","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","32561PA0120002-00","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","PA","32561","HIOS","3","2015-08-18 03:25:03","2","32561","PA","SHOP (Small Group)","Yes","13-5123390","32561PA0120002","Guardian Family Advantage","32561PA012",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.61","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","32561PA0120002-01","Standard High On Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690003","Connect Blue EPO 250, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF001","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","33709PA0690003-01","Standard Gold On Exchange Plan","79.85%","0","No","Yes","Yes","75%","25%","$0","$700","$0","$0","$250","$300","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%","$750","$750 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2095170320_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","5"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690003","Connect Blue EPO 250, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF001","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","33709PA0690003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","75%","25%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2095366061_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","6"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560009","Premier Balance PPO $250 Platinum A a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560009-00","Standard Platinum Off Exchange Plan","89.10%",,"No","Yes","Yes","93%","7%","$250","$100","$0","$0","$250","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","$1,300","$1300 per person","$2600 per group","$3,900","$3900 per person","$7800 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$750","$750 per person","$1500 per group","30%","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","6"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560009","Premier Balance PPO $250 Platinum A a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560009-01","Standard Platinum On Exchange Plan","89.10%",,"No","Yes","Yes","93%","7%","$250","$100","$0","$0","$250","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","$1,300","$1300 per person","$2600 per group","$3,900","$3900 per person","$7800 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$750","$750 per person","$1500 per group","30%","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","7"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690003","Connect Blue EPO 250, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF001","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","33709PA0690003-03","Limited Cost Sharing Plan Variation","79.85%","0","No","Yes","Yes","75%","25%","$0","$700","$0","$0","$250","$300","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%","$750","$750 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2095269499_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","7"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560011","Premier Balance PPO $0 Gold a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560011-00","Standard Gold Off Exchange Plan","80.65%",,"No","Yes","Yes","93%","7%","$0","$600","$0","$0","$0","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$5,000","$5000 per person","$10000 per group","70%","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","8"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690002","Connect Blue EPO 2500, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF001","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","33709PA0690002-00","Standard Silver Off Exchange Plan","69.38%","0","No","Yes","Yes","75%","25%","$0","$700","$0","$0","$1,600","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%","$4,000","$4000 per person","$8000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2095264439_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","8"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690002","Connect Blue EPO 2500, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF001","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","33709PA0690002-01","Standard Silver On Exchange Plan","69.38%","0","No","Yes","Yes","75%","25%","$0","$700","$0","$0","$1,600","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%","$4,000","$4000 per person","$8000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2095264439_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","9"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560011","Premier Balance PPO $0 Gold a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560011-01","Standard Gold On Exchange Plan","80.65%",,"No","Yes","Yes","93%","7%","$0","$600","$0","$0","$0","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$5,000","$5000 per person","$10000 per group","70%","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","9"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560013","Premier Balance PPO $250 Gold A a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560013-00","Standard Gold Off Exchange Plan","81.89%",,"No","Yes","Yes","93%","7%","$250","$200","$0","$0","$250","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$750","$750 per person","$1500 per group","30%","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","10"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690002","Connect Blue EPO 2500, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF001","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","33709PA0690002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","75%","25%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2095279610_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","10"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690002","Connect Blue EPO 2500, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF001","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","33709PA0690002-03","Limited Cost Sharing Plan Variation","69.38%","0","No","Yes","Yes","75%","25%","$0","$700","$0","$0","$1,600","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%","$4,000","$4000 per person","$8000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2095299209_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","11"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560013","Premier Balance PPO $250 Gold A a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560013-01","Standard Gold On Exchange Plan","81.89%",,"No","Yes","Yes","93%","7%","$250","$200","$0","$0","$250","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$750","$750 per person","$1500 per group","30%","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","11"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560015","Premier Balance PPO $500 A a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560015-00","Standard Gold Off Exchange Plan","81.64%",,"No","Yes","Yes","93%","7%","$500","$200","$0","$0","$500","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","$3,400","$3400 per person","$6800 per group","$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$1,500","$1500 per person","$3000 per group","30%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","12"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690002","Connect Blue EPO 2500, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF001","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","33709PA0690002-04","73% AV Level Silver Plan","73.52%","0","No","Yes","Yes","75%","25%","$0","$700","$0","$0","$1,500","$400","$10","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%","$4,000","$4000 per person","$8000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2095429616_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","12"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690002","Connect Blue EPO 2500, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF001","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","33709PA0690002-05","87% AV Level Silver Plan","87.18%","0","No","Yes","Yes","75%","25%","$0","$300","$0","$0","$500","$300","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%","$1,000","$1000 per person","$2000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2095383054_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","13"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560015","Premier Balance PPO $500 A a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560015-01","Standard Gold On Exchange Plan","81.64%",,"No","Yes","Yes","93%","7%","$500","$200","$0","$0","$500","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","$3,400","$3400 per person","$6800 per group","$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$1,500","$1500 per person","$3000 per group","30%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","13"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560017","Premier Balance PPO $750 A a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560017-00","Standard Gold Off Exchange Plan","80.62%",,"No","Yes","Yes","93%","7%","$750","$200","$0","$0","$750","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","$3,400","$3400 per person","$6800 per group","$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%","$1,500","$1500 per person","$3000 per group","30%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","14"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690002","Connect Blue EPO 2500, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF001","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","33709PA0690002-06","94% AV Level Silver Plan","94.26%","0","No","Yes","Yes","75%","25%","$0","$200","$0","$0","$100","$300","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%","$250","$250 per person","$500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2095304746_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","14"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690001","Connect Blue EPO 750, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF001","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","33709PA0690001-00","Standard Silver Off Exchange Plan","71.27%","0","No","Yes","Yes","75%","25%","$0","$1,300","$0","$0","$750","$400","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%","$4,000","$4000 per person","$8000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097234280_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","15"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560017","Premier Balance PPO $750 A a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560017-01","Standard Gold On Exchange Plan","80.62%",,"No","Yes","Yes","93%","7%","$750","$200","$0","$0","$750","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","$3,400","$3400 per person","$6800 per group","$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%","$1,500","$1500 per person","$3000 per group","30%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","15"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560019","Premier Balance PPO $1000 A a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560019-00","Standard Gold Off Exchange Plan","79.61%",,"No","Yes","Yes","93%","7%","$1,000","$200","$0","$0","$1,000","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%","$2,000","$2000 per person","$4000 per group","30%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","16"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560021","Premier Balance PPO $1250 A a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560021-00","Standard Gold Off Exchange Plan","78.86%",,"No","Yes","Yes","93%","7%","$1,250","$200","$0","$0","$1,250","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0%","$2,500","$2500 per person","$5000 per group","30%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","18"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690001","Connect Blue EPO 750, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF001","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","33709PA0690001-03","Limited Cost Sharing Plan Variation","71.27%","0","No","Yes","Yes","75%","25%","$0","$1,300","$0","$0","$750","$400","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%","$4,000","$4000 per person","$8000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097257186_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","18"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690001","Connect Blue EPO 750, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF001","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","33709PA0690001-04","73% AV Level Silver Plan","73.97%","0","No","Yes","Yes","75%","25%","$0","$1,300","$0","$0","$750","$400","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%","$4,000","$4000 per person","$8000 per group","40%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097257498_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","19"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560021","Premier Balance PPO $1250 A a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560021-01","Standard Gold On Exchange Plan","78.86%",,"No","Yes","Yes","93%","7%","$1,250","$200","$0","$0","$1,250","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0%","$2,500","$2500 per person","$5000 per group","30%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","19"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690001","Connect Blue EPO 750, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF001","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","33709PA0690001-05","87% AV Level Silver Plan","86.89%","0","No","Yes","Yes","75%","25%","$0","$700","$0","$0","$500","$300","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","40%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097313044_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","20"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690001","Connect Blue EPO 750, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF001","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","33709PA0690001-06","94% AV Level Silver Plan","94.29%","0","No","Yes","Yes","75%","25%","$0","$200","$0","$0","$100","$300","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%","$200","$200 per person","$400 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097315233_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","21"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560023","Premier Balance PPO $1500 A a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560023-01","Standard Gold On Exchange Plan","78.73%",,"No","Yes","Yes","93%","7%","$1,500","$200","$0","$0","$1,500","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group","$3,300","$3300 per person","$6600 per group","$9,900","$9900 per person","$19800 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%","$3,000","$3000 per person","$6000 per group","30%","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","21"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560027","Premier Balance PPO $2000 A a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560027-00","Standard Gold Off Exchange Plan","78.33%",,"No","Yes","Yes","93%","7%","$2,000","$200","$0","$0","$1,600","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","$3,200","$3200 per person","$6400 per group","$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%","$3,000","$3000 per person","$6000 per group","30%","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","22"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690004","Connect Blue EPO 5500, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF005","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0690004-00","Standard Bronze Off Exchange Plan","61.96%","0","No","Yes","Yes","75%","25%","$0","$2,800","$0","$0","$1,600","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","30%","$6,500","$6500 per person","$13000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2098239398_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","22"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690004","Connect Blue EPO 5500, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF005","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0690004-01","Standard Bronze On Exchange Plan","61.96%","0","No","Yes","Yes","75%","25%","$0","$2,800","$0","$0","$1,600","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","30%","$6,500","$6500 per person","$13000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2098207362_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","23"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560027","Premier Balance PPO $2000 A a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560027-01","Standard Gold On Exchange Plan","78.33%",,"No","Yes","Yes","93%","7%","$2,000","$200","$0","$0","$1,600","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","$3,200","$3200 per person","$6400 per group","$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%","$3,000","$3000 per person","$6000 per group","30%","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","23"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690004","Connect Blue EPO 5500, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF005","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0690004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","75%","25%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2098239789_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","24"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","1","33709","PA","Individual","No","23-1294723","33709PA0690004","Connect Blue EPO 5500, a Community Blue Flex Plan","33709PA069",,"PAN001","PAS010","PAF005","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9984",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0690004-03","Limited Cost Sharing Plan Variation","61.96%","0","No","Yes","Yes","75%","25%","$0","$2,800","$0","$0","$1,600","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","30%","$6,500","$6500 per person","$13000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2098239398_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","25"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","2","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0450004","Health Savings PPO $1500 a Community Blue Flex Plan","33709PA045",,"PAN001","PAS001","PAF010","New","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0450004-00","Standard Gold Off Exchange Plan",,"0.780466735363007","Yes","Yes","Yes","93%","7%","$1,500","$10","$0","$0","$1,500","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","$3,200","$3200 per person","$6400 per group","$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","0%","$1,500","$1500 per person","$3000 per group","30%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","4"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","2","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0450004","Health Savings PPO $1500 a Community Blue Flex Plan","33709PA045",,"PAN001","PAS001","PAF010","New","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0450004-01","Standard Gold On Exchange Plan",,"0.780466735363007","Yes","Yes","Yes","93%","7%","$1,500","$10","$0","$0","$1,500","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","$3,200","$3200 per person","$6400 per group","$9,600","$9600 per person","$19200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","0%","$1,500","$1500 per person","$3000 per group","30%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","5"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","3","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0570004","Balance PPO $1750 A a Community Blue Flex Plan","33709PA057",,"PAN001","PAS001","PAF012","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0570004-00","Standard Silver Off Exchange Plan",,"0.71516340970993","No","Yes","Yes","93%","7%","$1,750","$300","$500","$0","$1,600","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","10%","$5,250","$5250 per person","$10500 per group","30%","$15,700","$15700 per person","$31400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","4"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","3","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0570004","Balance PPO $1750 A a Community Blue Flex Plan","33709PA057",,"PAN001","PAS001","PAF012","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0570004-01","Standard Silver On Exchange Plan",,"0.71516340970993","No","Yes","Yes","93%","7%","$1,750","$300","$500","$0","$1,600","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","10%","$5,250","$5250 per person","$10500 per group","30%","$15,700","$15700 per person","$31400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","5"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","3","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0570006","Balance PPO $2000 A a Community Blue Flex Plan","33709PA057",,"PAN001","PAS001","PAF012","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0570006-00","Standard Silver Off Exchange Plan",,"0.709322094917297","No","Yes","Yes","93%","7%","$2,000","$300","$500","$0","$1,600","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10%","$6,000","$6000 per person","$12000 per group","30%","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","6"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","3","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0570006","Balance PPO $2000 A a Community Blue Flex Plan","33709PA057",,"PAN001","PAS001","PAF012","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0570006-01","Standard Silver On Exchange Plan",,"0.709322094917297","No","Yes","Yes","93%","7%","$2,000","$300","$500","$0","$1,600","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10%","$6,000","$6000 per person","$12000 per group","30%","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","7"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","3","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0570007","Balance PPO $1000 a Community Blue Flex Plan","33709PA057",,"PAN001","PAS001","PAF012","New","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0570007-00","Standard Silver Off Exchange Plan",,"0.716091394424438","No","Yes","Yes","93%","7%","$1,000","$300","$600","$0","$1,000","$600","$60","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%","$5,000","$5000 per person","$10000 per group","30%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","8"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","3","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0570007","Balance PPO $1000 a Community Blue Flex Plan","33709PA057",,"PAN001","PAS001","PAF012","New","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0570007-01","Standard Silver On Exchange Plan",,"0.716091394424438","No","Yes","Yes","93%","7%","$1,000","$300","$600","$0","$1,000","$600","$60","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%","$5,000","$5000 per person","$10000 per group","30%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","9"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","4","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0640001","Health Savings PPO Embedded $2600 a Community Blue Flex Plan","33709PA064",,"PAN001","PAS001","PAF011","New","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0640001-00","Standard Silver Off Exchange Plan",,"0.692388832569122","Yes","Yes","Yes","93%","7%","$2,600","$10","$0","$0","$2,600","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","0%","$2,600","$2600 per person","$5200 per group","30%","$7,800","$7800 per person","$15600 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","4"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","4","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0640001","Health Savings PPO Embedded $2600 a Community Blue Flex Plan","33709PA064",,"PAN001","PAS001","PAF011","New","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0640001-01","Standard Silver On Exchange Plan",,"0.692388832569122","Yes","Yes","Yes","93%","7%","$2,600","$10","$0","$0","$2,600","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","$6,400","$6400 per person","$12800 per group","$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","0%","$2,600","$2600 per person","$5200 per group","30%","$7,800","$7800 per person","$15600 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","5"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","4","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0640002","Health Savings PPO Embedded $3000 a Community Blue Flex Plan","33709PA064",,"PAN001","PAS001","PAF011","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0640002-00","Standard Silver Off Exchange Plan","68.46%","0.678824782371521","Yes","Yes","Yes","93%","7%","$3,000","$10","$0","$0","$3,000","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$19,350","$19350 per person","$38700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%","$3,000","$3000 per person","$6000 per group","30%","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","6"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","4","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0640002","Health Savings PPO Embedded $3000 a Community Blue Flex Plan","33709PA064",,"PAN001","PAS001","PAF011","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0640002-01","Standard Silver On Exchange Plan","68.46%","0.678824782371521","Yes","Yes","Yes","93%","7%","$3,000","$10","$0","$0","$3,000","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$19,350","$19350 per person","$38700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%","$3,000","$3000 per person","$6000 per group","30%","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","7"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","8","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0630003","Connect Blue EPO $250 a Community Blue Plan","33709PA063",,"PAN001","PAS010","PAF011","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0630003-01","Standard Gold On Exchange Plan","81.77%","0","No","Yes","Yes","81%","19%","$0","$400","$0","$0","$250","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$1,000","$1000 per person","$2000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","7"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","8","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0630004","Connect Blue EPO $500 a Community Blue Plan","33709PA063",,"PAN001","PAS010","PAF011","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0630004-01","Standard Gold On Exchange Plan","79.88%","0","No","Yes","Yes","81%","19%","$0","$400","$0","$0","$500","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$2,000","$2000 per person","$4000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","9"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","8","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0630005","Connect Blue EPO $750 a Community Blue Plan","33709PA063",,"PAN001","PAS010","PAF011","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0630005-00","Standard Gold Off Exchange Plan","78.73%","0","No","Yes","Yes","81%","19%","$0","$400","$0","$0","$750","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%","$3,000","$3000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","10"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","4","33871","PA","Individual","No","23-2405376","33871PA0040004","Keystone HMO Bronze","33871PA004",,"PAN001","PAS001","PAF016","Existing","HMO","Bronze","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040004-01","Standard Bronze On Exchange Plan","61.65%",,"Yes","Yes","No","100%",,"$5,033","$190","$0","$150","$735","$150","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/ffm/hmobronze2016","https://www.ibx4you.com/ffm/brochure","4"
"2016","PA","38086","HIOS","2","2015-07-10 02:19:03","1","38086","PA","Individual","Yes","47-0397286","38086PA0020002","Renaissance Individual Dental PPO, EHB Certified","38086PA002",,"PAN001","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.34","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","38086PA0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","PA","38086","HIOS","2","2015-07-10 02:19:03","1","38086","PA","SHOP (Small Group)","Yes","47-0397286","38086PA0050002","Renaissance Group Dental Indemnity, EHB Certified","38086PA005",,"PAN001","PAS001",,"Existing","Indemnity","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.64","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","38086PA0050002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","4","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0640003","Health Savings PPO Embedded $5500 a Community Blue Flex Plan","33709PA064",,"PAN001","PAS001","PAF011","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0640003-00","Standard Bronze Off Exchange Plan",,"0.617362022399902","Yes","Yes","Yes","93%","7%","$5,500","$10","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$19,350","$19350 per person","$38700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%","$5,500","$5500 per person","$11000 per group","30%","$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","8"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","4","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0640005","Health Savings PPO Embedded $6000 a Community Blue Flex Plan","33709PA064",,"PAN001","PAS001","PAF011","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0640005-00","Standard Bronze Off Exchange Plan",,"0.608092129230499","Yes","Yes","Yes","93%","7%","$6,000","$10","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$19,350","$19350 per person","$38700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%","$6,000","$6000 per person","$12000 per group","30%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","12"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","4","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0640005","Health Savings PPO Embedded $6000 a Community Blue Flex Plan","33709PA064",,"PAN001","PAS001","PAF011","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0640005-01","Standard Bronze On Exchange Plan",,"0.608092129230499","Yes","Yes","Yes","93%","7%","$6,000","$10","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$19,350","$19350 per person","$38700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%","$6,000","$6000 per person","$12000 per group","30%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","13"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","5","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0460007","Flex PPO $500/$1500 Penn Highlands Region a Community Blue Plan","33709PA046",,"PAN001","PAS008","PAF009","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0460007-00","Standard Gold Off Exchange Plan","80.65%","0.825073421001434","No","Yes","Yes","86%","14%","$500","$200","$0","$0","$500","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group","$4,600","$4600 per person","$9200 per group","$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$1,500","$1500 per person","$3000 per group","30%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","4"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","5","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0460007","Flex PPO $500/$1500 Penn Highlands Region a Community Blue Plan","33709PA046",,"PAN001","PAS008","PAF009","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0460007-01","Standard Gold On Exchange Plan","80.65%","0.825073421001434","No","Yes","Yes","86%","14%","$500","$200","$0","$0","$500","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group","$4,600","$4600 per person","$9200 per group","$13,800","$13800 per person","$27600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$1,500","$1500 per person","$3000 per group","30%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","5"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","5","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0460008","Flex PPO PA Mountains Healthcare Region $500/$1500 a Community Blue Plan","33709PA046",,"PAN001","PAS007","PAF009","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0460008-00","Standard Gold Off Exchange Plan","80.26%","0.820066094398499","No","Yes","Yes","80%","20%","$500","$200","$0","$0","$500","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$1,500","$1500 per person","$3000 per group","30%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","6"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","5","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0460008","Flex PPO PA Mountains Healthcare Region $500/$1500 a Community Blue Plan","33709PA046",,"PAN001","PAS007","PAF009","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0460008-01","Standard Gold On Exchange Plan","80.26%","0.820066094398499","No","Yes","Yes","80%","20%","$500","$200","$0","$0","$500","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$1,500","$1500 per person","$3000 per group","30%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","7"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","5","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0460012","Flex PPO $500 Total Health a Community Blue Flex Plan","33709PA046",,"PAN001","PAS001","PAF009","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0460012-00","Standard Gold Off Exchange Plan","81.20%","0.833649635314941","No","Yes","Yes","93%","7%","$500","$200","$0","$0","$500","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$1,500","$1500 per person","$3000 per group","30%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","8"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","5","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0460012","Flex PPO $500 Total Health a Community Blue Flex Plan","33709PA046",,"PAN001","PAS001","PAF009","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0460012-01","Standard Gold On Exchange Plan","81.20%","0.833649635314941","No","Yes","Yes","93%","7%","$500","$200","$0","$0","$500","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$1,500","$1500 per person","$3000 per group","30%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","9"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","5","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0460013","Flex PPO $500 Total Health a Community Blue Flex Plan","33709PA046",,"PAN001","PAS002","PAF009","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0460013-00","Standard Gold Off Exchange Plan","81.37%","0.833649635314941","No","Yes","Yes","93%","7%","$500","$200","$0","$0","$500","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$1,500","$1500 per person","$3000 per group","30%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","10"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","5","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0460013","Flex PPO $500 Total Health a Community Blue Flex Plan","33709PA046",,"PAN001","PAS002","PAF009","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0460013-01","Standard Gold On Exchange Plan","81.37%","0.833649635314941","No","Yes","Yes","93%","7%","$500","$200","$0","$0","$500","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$1,500","$1500 per person","$3000 per group","30%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","11"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","6","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0440009","Premier Balance PPO $750 IP A a Community Blue Flex Plan","33709PA044",,"PAN001","PAS002","PAF009","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0440009-00","Standard Gold Off Exchange Plan",,"0.807611525058746","No","Yes","Yes","96%","4%","$0","$700","$0","$0","$750","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7400 per group","$3,700","$3700 per person","$7400 per group","$11,100","$11100 per person","$22200 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%","$1,500","$1500 per person","$3000 per group","30%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","4"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","6","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0440009","Premier Balance PPO $750 IP A a Community Blue Flex Plan","33709PA044",,"PAN001","PAS002","PAF009","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0440009-01","Standard Gold On Exchange Plan",,"0.807611525058746","No","Yes","Yes","96%","4%","$0","$700","$0","$0","$750","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7400 per group","$3,700","$3700 per person","$7400 per group","$11,100","$11100 per person","$22200 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%","$1,500","$1500 per person","$3000 per group","30%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","5"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","6","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0440013","Premier Balance PPO $1500 IP A a Community Blue Flex Plan","33709PA044",,"PAN001","PAS002","PAF011","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0440013-00","Standard Silver Off Exchange Plan","71.93%","0.735219657421112","No","Yes","Yes","96%","4%","$0","$1,100","$0","$0","$1,500","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%","$4,500","$4500 per person","$9000 per group","30%","$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","6"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","6","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0440013","Premier Balance PPO $1500 IP A a Community Blue Flex Plan","33709PA044",,"PAN001","PAS002","PAF011","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0440013-01","Standard Silver On Exchange Plan","71.93%","0.735219657421112","No","Yes","Yes","96%","4%","$0","$1,100","$0","$0","$1,500","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%","$4,500","$4500 per person","$9000 per group","30%","$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","7"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","6","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0440014","Premier Balance PPO $250 IP A a Community Blue Flex Plan","33709PA044",,"PAN001","PAS002","PAF009","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0440014-00","Standard Gold Off Exchange Plan","81.68%","0.830383658409119","No","Yes","Yes","96%","4%","$0","$700","$0","$0","$250","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$750","$750 per person","$1500 per group","30%","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","8"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","6","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0440014","Premier Balance PPO $250 IP A a Community Blue Flex Plan","33709PA044",,"PAN001","PAS002","PAF009","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0440014-01","Standard Gold On Exchange Plan","81.68%","0.830383658409119","No","Yes","Yes","96%","4%","$0","$700","$0","$0","$250","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$750","$750 per person","$1500 per group","30%","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","9"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","7","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560029","Premier Balance PPO $1400 A a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560029-00","Standard Silver Off Exchange Plan","71.97%","0.742558181285858","No","Yes","Yes","93%","7%","$1,400","$300","$0","$0","$1,400","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","0%","$5,000","$5000 per person","$10000 per group","30%","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","4"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","7","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0560029","Premier Balance PPO $1400 A a Community Blue Flex Plan","33709PA056",,"PAN001","PAS001","PAF010","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0560029-01","Standard Silver On Exchange Plan","71.97%","0.742558181285858","No","Yes","Yes","93%","7%","$1,400","$300","$0","$0","$1,400","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","0%","$5,000","$5000 per person","$10000 per group","30%","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","5"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","8","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0630002","Connect Blue EPO $100 a Community Blue Plan","33709PA063",,"PAN001","PAS010","PAF011","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0630002-00","Standard Gold Off Exchange Plan","81.06%","0","No","Yes","Yes","81%","19%","$0","$400","$0","$0","$100","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%","$1,000","$1000 per person","$2000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","4"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","8","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0630002","Connect Blue EPO $100 a Community Blue Plan","33709PA063",,"PAN001","PAS010","PAF011","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0630002-01","Standard Gold On Exchange Plan","81.06%","0","No","Yes","Yes","81%","19%","$0","$400","$0","$0","$100","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%","$1,000","$1000 per person","$2000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","5"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","8","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0630003","Connect Blue EPO $250 a Community Blue Plan","33709PA063",,"PAN001","PAS010","PAF011","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0630003-00","Standard Gold Off Exchange Plan","81.77%","0","No","Yes","Yes","81%","19%","$0","$400","$0","$0","$250","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$1,000","$1000 per person","$2000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","6"
"2016","PA","38086","HIOS","2","2015-07-10 02:19:03","2","38086","PA","Individual","Yes","47-0397286","38086PA0040001","Renaissance Individual Dental Indemnity, EHB Certified","38086PA004",,"PAN001","PAS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.82","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefits","Yes",,"","38086PA0040001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","38086","HIOS","2","2015-07-10 02:19:03","2","38086","PA","Individual","Yes","47-0397286","38086PA0040002","Renaissance Individual Dental Indemnity, EHB Certified","38086PA004",,"PAN001","PAS001",,"Existing","Indemnity","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.10","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefits","Yes",,"","38086PA0040002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","1","45127","PA","Individual","Yes","45-5492167","45127PA0050002","Healthy Dental Select Pediatric 702xs","45127PA005",,"PAN001","PAS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$20.42","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency","Yes","Emergency","No","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0050002-00","Standard Low Off Exchange Plan","70.52%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2016/45127PA0050002-2016.pdf","4"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","1","45127","PA","SHOP (Small Group)","No","45-5492167","45127PA0010146","Healthy Benefits PPO 0.0 40 EX","45127PA001","7588667726","PAN002","PAS002","PAF012","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,"$200","5","0","0","2016-01-01","2016-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0010146-00","Standard Silver Off Exchange Plan","71.71%",,"No","Yes","Yes","40%","60%","$20","$800","$0","$200","$500","$2,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/45127PA001014601.pdf","https://www.capbluecross.com/wps/wcm/connect/0a2d9143-b685-4177-8127-4f04317115ee/C-239.pdf?MOD=AJPERES","4"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","1","45127","PA","Individual","No","45-5492167","45127PA0020007","Healthy Benefits PPO 6300.50","45127PA002","7588667726","PAN004","PAS002","PAF001","Existing","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020007-00","Standard Bronze Off Exchange Plan","61.97%","0.621985912322998","Yes","Yes","Yes","40%","60%","$6,300","$0","$500","$200","$4,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50%","$6,300","$6300 per person","$12600 per group","50%","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002000700_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","4"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","1","45127","PA","Individual","No","45-5492167","45127PA0020007","Healthy Benefits PPO 6300.50","45127PA002","7588667726","PAN004","PAS002","PAF001","Existing","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020007-01","Standard Bronze On Exchange Plan","61.97%","0.621985912322998","Yes","Yes","Yes","40%","60%","$6,300","$0","$500","$200","$4,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50%","$6,300","$6300 per person","$12600 per group","50%","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002000701_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","5"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","1","45127","PA","SHOP (Small Group)","No","45-5492167","45127PA0010146","Healthy Benefits PPO 0.0 40 EX","45127PA001","7588667726","PAN002","PAS002","PAF012","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,"$200","5","0","0","2016-01-01","2016-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0010146-01","Standard Silver On Exchange Plan","71.71%",,"No","Yes","Yes","40%","60%","$20","$800","$0","$200","$500","$2,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/45127PA001014601.pdf","https://www.capbluecross.com/wps/wcm/connect/0a2d9143-b685-4177-8127-4f04317115ee/C-239.pdf?MOD=AJPERES","5"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","1","45127","PA","Individual","Yes","45-5492167","45127PA0050002","Healthy Dental Select Pediatric 702xs","45127PA005",,"PAN001","PAS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$20.42","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency","Yes","Emergency","No","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0050002-01","Standard Low On Exchange Plan","70.52%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2016/45127PA0050002-2016.pdf","5"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","1","45127","PA","Individual","No","45-5492167","45127PA0020007","Healthy Benefits PPO 6300.50","45127PA002","7588667726","PAN004","PAS002","PAF001","Existing","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002000702_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","6"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","1","45127","PA","Individual","No","45-5492167","45127PA0020007","Healthy Benefits PPO 6300.50","45127PA002","7588667726","PAN004","PAS002","PAF001","Existing","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020007-03","Limited Cost Sharing Plan Variation","61.97%","0.621985912322998","Yes","Yes","Yes","40%","60%","$6,300","$0","$500","$200","$4,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50%","$6,300","$6300 per person","$12600 per group","50%","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002000703_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","7"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","8","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0630005","Connect Blue EPO $750 a Community Blue Plan","33709PA063",,"PAN001","PAS010","PAF011","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0630005-01","Standard Gold On Exchange Plan","78.73%","0","No","Yes","Yes","81%","19%","$0","$400","$0","$0","$750","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%","$3,000","$3000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","11"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","8","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0630006","Connect Blue EPO $900 a Community Blue Plan","33709PA063",,"PAN001","PAS010","PAF011","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0630006-00","Standard Gold Off Exchange Plan","78.73%","0","No","Yes","Yes","81%","19%","$0","$400","$0","$0","$900","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%","$3,600","$3600 per person","$7200 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","12"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","8","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0630006","Connect Blue EPO $900 a Community Blue Plan","33709PA063",,"PAN001","PAS010","PAF011","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0630006-01","Standard Gold On Exchange Plan","78.73%","0","No","Yes","Yes","81%","19%","$0","$400","$0","$0","$900","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%","$3,600","$3600 per person","$7200 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","13"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","8","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0630007","Connect Blue EPO $2500 a Community Blue Plan","33709PA063",,"PAN001","PAS010","PAF011","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0630007-00","Standard Silver Off Exchange Plan","71.92%","0","No","Yes","Yes","81%","19%","$0","$700","$0","$0","$1,600","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%","$5,000","$5000 per person","$10000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","14"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","8","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0630007","Connect Blue EPO $2500 a Community Blue Plan","33709PA063",,"PAN001","PAS010","PAF011","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","33709PA0630007-01","Standard Silver On Exchange Plan","71.92%","0","No","Yes","Yes","81%","19%","$0","$700","$0","$0","$1,600","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%","$5,000","$5000 per person","$10000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","15"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","9","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0480003","Comprehensive Care EPO $2000 A Community Blue Plan","33709PA048",,"PAN001","PAS001","PAF005","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0480003-00","Standard Silver Off Exchange Plan",,"0.70345664024353","Yes","Yes","No","100%",,"$2,000","$0","$1,600","$0","$2,000","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","4"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","9","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0480003","Comprehensive Care EPO $2000 A Community Blue Plan","33709PA048",,"PAN001","PAS001","PAF005","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0480003-01","Standard Silver On Exchange Plan",,"0.70345664024353","Yes","Yes","No","100%",,"$2,000","$0","$1,600","$0","$2,000","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","5"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","9","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0480004","Comprehensive Care EPO $2000 A Community Blue Plan","33709PA048",,"PAN001","PAS002","PAF005","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0480004-00","Standard Silver Off Exchange Plan",,"0.70345664024353","Yes","Yes","No","100%",,"$2,000","$0","$1,600","$0","$2,000","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","6"
"2016","PA","33709","HIOS","10","2016-01-22 04:00:42","9","33709","PA","SHOP (Small Group)","No","23-1294723","33709PA0480004","Comprehensive Care EPO $2000 A Community Blue Plan","33709PA048",,"PAN001","PAS002","PAF005","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","33709PA0480004-01","Standard Silver On Exchange Plan",,"0.70345664024353","Yes","Yes","No","100%",,"$2,000","$0","$1,600","$0","$2,000","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","7"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","1","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100001","Keystone HMO Platinum Preferred $10/$20/$100","33871PA010",,"PAN001","PAS001","PAF001","Existing","HMO","Platinum","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","33871PA0100001-01","Standard Platinum On Exchange Plan","91.25%",,"No","Yes","No","100%",,"$0","$244","$0","$150","$0","$150","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","1","33871","PA","Individual","No","23-2405376","33871PA0040001","Keystone HMO Platinum","33871PA004",,"PAN001","PAS001","PAF013","Existing","HMO","Platinum","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","33871PA0040001-01","Standard Platinum On Exchange Plan","89.56%",,"No","Yes","No","100%",,"$0","$920","$0","$150","$0","$350","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmoplatinum2016","https://www.ibx4you.com/ffm/brochure","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","1","33871","PA","Individual","No","23-2405376","33871PA0040001","Keystone HMO Platinum","33871PA004",,"PAN001","PAS001","PAF013","Existing","HMO","Platinum","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","33871PA0040001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmoplatinumZeroCost2016","https://www.ibx4you.com/ffm/brochure","5"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","1","33871","PA","Individual","No","23-2405376","33871PA0040001","Keystone HMO Platinum","33871PA004",,"PAN001","PAS001","PAF013","Existing","HMO","Platinum","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary4s","33871PA0040001-03","Limited Cost Sharing Plan Variation","89.56%",,"No","Yes","No","100%",,"$0","$920","$0","$150","$0","$350","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmoplatinumLimitedCost2016","https://www.ibx4you.com/ffm/brochure","6"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","2","33871","PA","Individual","No","23-2405376","33871PA0040002","Keystone HMO Gold","33871PA004",,"PAN001","PAS001","PAF014","Existing","HMO","Gold","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040002-01","Standard Gold On Exchange Plan","80.93%",,"No","Yes","No","100%",,"$0","$1,640","$0","$150","$0","$185","$61","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmogold2016","https://www.ibx4you.com/ffm/brochure","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","2","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100002","Keystone HMO Platinum Preferred $20/$40/$150","33871PA010",,"PAN001","PAS001","PAF002","Existing","HMO","Platinum","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","33871PA0100002-01","Standard Platinum On Exchange Plan","88.01%",,"No","Yes","No","100%",,"$0","$364","$0","$150","$0","$195","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","2","33871","PA","Individual","No","23-2405376","33871PA0040002","Keystone HMO Gold","33871PA004",,"PAN001","PAS001","PAF014","Existing","HMO","Gold","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmogoldZeroCost2016","https://www.ibx4you.com/ffm/brochure","5"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","2","33871","PA","Individual","No","23-2405376","33871PA0040002","Keystone HMO Gold","33871PA004",,"PAN001","PAS001","PAF014","Existing","HMO","Gold","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040002-03","Limited Cost Sharing Plan Variation","80.93%",,"No","Yes","No","100%",,"$0","$1,640","$0","$150","$0","$185","$61","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmogoldLimitedCost2016","https://www.ibx4you.com/ffm/brochure","6"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","3","33871","PA","Individual","No","23-2405376","33871PA0040003","Keystone HMO Silver","33871PA004",,"PAN001","PAS001","PAF015","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","0","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040003-01","Standard Silver On Exchange Plan",,"0.703206539154053","No","Yes","No","100%",,"$2,000","$160","$741","$150","$81","$250","$77","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmosilver2016","https://www.ibx4you.com/ffm/brochure","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","3","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100003","Keystone HMO Gold Preferred $30/$60/$600","33871PA010",,"PAN001","PAS001","PAF003","Existing","HMO","Gold","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","33871PA0100003-01","Standard Gold On Exchange Plan","81.43%",,"No","Yes","No","100%",,"$0","$1,304","$0","$150","$0","$240","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","3","33871","PA","Individual","No","23-2405376","33871PA0040003","Keystone HMO Silver","33871PA004",,"PAN001","PAS001","PAF015","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","0","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmosilverZeroCost2016","https://www.ibx4you.com/ffm/brochure","5"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","3","33871","PA","Individual","No","23-2405376","33871PA0040003","Keystone HMO Silver","33871PA004",,"PAN001","PAS001","PAF015","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","0","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040003-03","Limited Cost Sharing Plan Variation",,"0.703206539154053","No","Yes","No","100%",,"$2,000","$160","$741","$150","$81","$250","$77","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmosilverLimitedCost2016","https://www.ibx4you.com/ffm/brochure","6"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","3","33871","PA","Individual","No","23-2405376","33871PA0040003","Keystone HMO Silver","33871PA004",,"PAN001","PAS001","PAF015","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","0","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040003-04","73% AV Level Silver Plan",,"0.736422300338745","No","Yes","No","100%",,"$2,000","$150","$741","$150","$81","$240","$61","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmosilver73CSR2016","https://www.ibx4you.com/ffm/brochure","7"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","3","33871","PA","Individual","No","23-2405376","33871PA0040003","Keystone HMO Silver","33871PA004",,"PAN001","PAS001","PAF015","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","0","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040003-05","87% AV Level Silver Plan",,"0.869603931903839","No","Yes","No","100%",,"$1,000","$38","$524","$150","$81","$60","$31","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmosilver87CSR2016","https://www.ibx4you.com/ffm/brochure","8"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","3","33871","PA","Individual","No","23-2405376","33871PA0040003","Keystone HMO Silver","33871PA004",,"PAN001","PAS001","PAF015","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","0","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040003-06","94% AV Level Silver Plan",,"0.943338811397552","No","Yes","No","100%",,"$0","$28","$438","$150","$0","$55","$31","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmosilver94CSR2016","https://www.ibx4you.com/ffm/brochure","9"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","4","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100004","Keystone HMO Gold Classic $1,000 $25/$50/90%","33871PA010",,"PAN001","PAS001","PAF003","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","33871PA0100004-01","Standard Gold On Exchange Plan",,"0.780183851718903","No","Yes","No","100%",,"$1,000","$79","$347","$150","$0","$220","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","4","33871","PA","Individual","No","23-2405376","33871PA0040004","Keystone HMO Bronze","33871PA004",,"PAN001","PAS001","PAF016","Existing","HMO","Bronze","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.ibx4you.com/ffm/hmobronzeZeroCost2016","https://www.ibx4you.com/ffm/brochure","5"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","4","33871","PA","Individual","No","23-2405376","33871PA0040004","Keystone HMO Bronze","33871PA004",,"PAN001","PAS001","PAF016","Existing","HMO","Bronze","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040004-03","Limited Cost Sharing Plan Variation","61.65%",,"Yes","Yes","No","100%",,"$5,033","$190","$0","$150","$735","$150","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.ibx4you.com/ffm/hmobronzeLimitedCost2016","https://www.ibx4you.com/ffm/brochure","6"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","5","33871","PA","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF022","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040006-01","Standard Silver On Exchange Plan","71.51%",,"No","Yes","Yes","49%","51%","$0","$1,150","$0","$150","$0","$240","$77","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$5,000","$5000 per person","$10000 per group","5%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmosilverproactive2016","https://www.ibx4you.com/ffm/brochure","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","5","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100005","Keystone HMO Silver Classic $2,000 $25/$50/70%","33871PA010",,"PAN001","PAS001","PAF004","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","33871PA0100005-01","Standard Silver On Exchange Plan",,"0.716715335845947","No","Yes","No","100%",,"$2,000","$99","$0","$150","$0","$170","$76","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","5","33871","PA","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF022","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040006-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","49%","51%","$0","$0","$0","$150","$0","$0","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmosilverproactiveZeroCost2016","https://www.ibx4you.com/ffm/brochure","5"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","5","33871","PA","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF022","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040006-03","Limited Cost Sharing Plan Variation","71.51%",,"No","Yes","Yes","49%","51%","$0","$1,150","$0","$150","$0","$240","$77","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$5,000","$5000 per person","$10000 per group","5%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmosilverproactiveLimitedCost2016","https://www.ibx4you.com/ffm/brochure","6"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","5","33871","PA","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF022","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040006-04","73% AV Level Silver Plan","73.77%",,"No","Yes","Yes","49%","51%","$0","$950","$0","$150","$0","$240","$77","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$5,000","$5000 per person","$10000 per group","5%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmosilverproactive73CSR2016","https://www.ibx4you.com/ffm/brochure","7"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","5","33871","PA","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF022","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040006-05","87% AV Level Silver Plan","86.64%",,"No","Yes","Yes","49%","51%","$0","$178","$0","$150","$0","$70","$46","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$1,000","$1000 per person","$2000 per group","5%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmosilverproactive87CSR2016","https://www.ibx4you.com/ffm/brochure","8"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","5","33871","PA","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF022","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040006-06","94% AV Level Silver Plan","94.50%",,"No","Yes","Yes","49%","51%","$0","$118","$0","$150","$0","$65","$15","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$100","$100 per person","$200 per group","5%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmosilverproactive94CSR2016","https://www.ibx4you.com/ffm/brochure","9"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","6","33871","PA","Individual","No","23-2405376","33871PA0040005","Keystone HMO Gold Proactive","33871PA004",,"PAN001","PAS001","PAF021","Existing","HMO","Gold","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040005-01","Standard Gold On Exchange Plan","78.44%",,"No","Yes","Yes","49%","51%","$0","$830","$0","$150","$0","$205","$77","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%","$0","per person not applicable","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmogoldproactive2016","https://www.ibx4you.com/ffm/brochure","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","6","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100006","Keystone HMO Silver Classic $2,500 $30/$60/50%","33871PA010",,"PAN001","PAS001","PAF004","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","33871PA0100006-01","Standard Silver On Exchange Plan",,"0.704100608825684","No","Yes","No","100%",,"$2,500","$104","$986","$150","$343","$120","$76","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","6","33871","PA","Individual","No","23-2405376","33871PA0040005","Keystone HMO Gold Proactive","33871PA004",,"PAN001","PAS001","PAF021","Existing","HMO","Gold","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040005-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","49%","51%","$0","$0","$0","$150","$0","$0","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmogoldproactiveZeroCost2016","https://www.ibx4you.com/ffm/brochure","5"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","6","33871","PA","Individual","No","23-2405376","33871PA0040005","Keystone HMO Gold Proactive","33871PA004",,"PAN001","PAS001","PAF021","Existing","HMO","Gold","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040005-03","Limited Cost Sharing Plan Variation","78.44%",,"No","Yes","Yes","49%","51%","$0","$830","$0","$150","$0","$205","$77","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%","$0","per person not applicable","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmogoldproactiveLimitedCost2016","https://www.ibx4you.com/ffm/brochure","6"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","7","33871","PA","Individual","No","23-2405376","33871PA0040007","Keystone HMO Silver Proactive Value","33871PA004",,"PAN001","PAS001","PAF022","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040007-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","Yes","49%","51%","$1,500","$650","$0","$150","$0","$240","$77","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%","$5,000","$5000 per person","$10000 per group","5%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmosilverproactivevalue2016","https://www.ibx4you.com/ffm/brochure","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","7","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100010","Keystone DPOS Platinum Preferred $10/$20/$100","33871PA010",,"PAN001","PAS001","PAF008","Existing","HMO","Platinum","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","33871PA0100010-01","Standard Platinum On Exchange Plan","91.25%",,"No","Yes","No","100%",,"$0","$244","$0","$150","$0","$150","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","7","33871","PA","Individual","No","23-2405376","33871PA0040007","Keystone HMO Silver Proactive Value","33871PA004",,"PAN001","PAS001","PAF022","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","49%","51%","$0","$0","$0","$150","$0","$0","$0","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmosilverproactivevalueZeroCost2016","https://www.ibx4you.com/ffm/brochure","5"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","7","33871","PA","Individual","No","23-2405376","33871PA0040007","Keystone HMO Silver Proactive Value","33871PA004",,"PAN001","PAS001","PAF022","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040007-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","Yes","49%","51%","$1,500","$650","$0","$150","$0","$240","$77","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%","$5,000","$5000 per person","$10000 per group","5%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmosilverproactivevalueLimitedCost2016","https://www.ibx4you.com/ffm/brochure","6"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","7","33871","PA","Individual","No","23-2405376","33871PA0040007","Keystone HMO Silver Proactive Value","33871PA004",,"PAN001","PAS001","PAF022","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040007-04","73% AV Level Silver Plan","72.41%",,"No","Yes","Yes","49%","51%","$1,500","$250","$0","$150","$0","$240","$77","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%","$3,000","$3000 per person","$6000 per group","5%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmosilverproactivevalue73CSR2016","https://www.ibx4you.com/ffm/brochure","7"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","7","33871","PA","Individual","No","23-2405376","33871PA0040007","Keystone HMO Silver Proactive Value","33871PA004",,"PAN001","PAS001","PAF022","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040007-05","87% AV Level Silver Plan","86.97%",,"No","Yes","Yes","49%","51%","$500","$178","$0","$150","$0","$70","$46","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$1,000","$1000 per person","$2000 per group","5%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmosilverproactivevalue87CSR2016","https://www.ibx4you.com/ffm/brochure","8"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","7","33871","PA","Individual","No","23-2405376","33871PA0040007","Keystone HMO Silver Proactive Value","33871PA004",,"PAN001","PAS001","PAF022","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$700","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","33871PA0040007-06","94% AV Level Silver Plan","93.91%",,"No","Yes","Yes","49%","51%","$0","$108","$0","$150","$0","$55","$15","$169",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$500","$500 per person","$1000 per group","5%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/hmosilverproactivevalue94CSR2016","https://www.ibx4you.com/ffm/brochure","9"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","8","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100011","Keystone DPOS Platinum Preferred $20/$40/$150","33871PA010",,"PAN001","PAS001","PAF009","Existing","HMO","Platinum","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","33871PA0100011-01","Standard Platinum On Exchange Plan","88.01%",,"No","Yes","No","100%",,"$0","$364","$0","$150","$0","$195","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","9","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100012","Keystone DPOS Gold Preferred $30/$60/$600","33871PA010",,"PAN001","PAS001","PAF010","Existing","HMO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","33871PA0100012-01","Standard Gold On Exchange Plan","81.43%",,"No","Yes","No","100%",,"$0","$1,304","$0","$150","$0","$240","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","10","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100013","Keystone DPOS Gold Classic $1,000 $25/$50/90%","33871PA010",,"PAN001","PAS001","PAF010","Existing","HMO","Gold","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","33871PA0100013-01","Standard Gold On Exchange Plan",,"0.780183851718903","No","Yes","No","100%",,"$1,000","$79","$347","$150","$0","$220","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","11","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100014","Keystone DPOS Silver Classic $2,000 $25/$50/70%","33871PA010",,"PAN001","PAS001","PAF011","Existing","HMO","Silver","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","33871PA0100014-01","Standard Silver On Exchange Plan",,"0.716715335845947","No","Yes","No","100%",,"$2,000","$99","$741","$150","$0","$170","$76","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","12","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100015","Keystone DPOS Silver Classic $2,500 $30/$60/50%","33871PA010",,"PAN001","PAS001","PAF011","Existing","HMO","Silver","No","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","33871PA0100015-01","Standard Silver On Exchange Plan",,"0.704100608825684","No","Yes","No","100%",,"$2,500","$104","$986","$150","$0","$190","$76","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","13","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100016","Keystone DPOS Bronze Essential $6,000 $50/$100/$700","33871PA010",,"PAN001","PAS001","PAF012","Existing","HMO","Bronze","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","33871PA0100016-01","Standard Bronze On Exchange Plan","61.64%",,"Yes","Yes","No","100%",,"$4,494","$1,510","$0","$150","$343","$200","$76","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","14","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100008","Keystone HMO Gold Proactive","33871PA010",,"PAN001","PAS001","PAF006","Existing","HMO","Gold","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary5s","33871PA0100008-01","Standard Gold On Exchange Plan","78.37%",,"No","Yes","Yes","49%","51%","$0","$830","$0","$150","$0","$220","$76","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","15","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100009","Keystone HMO Silver Proactive","33871PA010",,"PAN001","PAS001","PAF007","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary5s","33871PA0100009-01","Standard Silver On Exchange Plan","71.46%",,"No","Yes","Yes","49%","51%","$0","$1,150","$0","$150","$0","$270","$76","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$5,000","$5000 per person","$10000 per group","5%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","16","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100035","Keystone HMO Gold Classic $2,000 $40/$80/100%","33871PA010",,"PAN001","PAS001","PAF003","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","33871PA0100035-01","Standard Gold On Exchange Plan","78.49%",,"No","Yes","No","100%",,"$2,000","$114","$0","$150","$0","$280","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","17","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100037","Keystone HMO Silver Secure $3,500 $40/$80/$600","33871PA010",,"PAN001","PAS001","PAF005","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","33871PA0100037-01","Standard Silver On Exchange Plan","68.03%",,"No","Yes","No","100%",,"$3,500","$1,300","$0","$150","$0","$290","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","18","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100036","Keystone HMO Silver Classic $4,250 $40/$80/100%","33871PA010",,"PAN001","PAS001","PAF005","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","33871PA0100036-01","Standard Silver On Exchange Plan","68.04%",,"No","Yes","No","100%",,"$4,250","$114","$0","$150","$0","$290","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","19","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100018","Keystone DPOS Gold Classic $2,000 $40/$80/100%","33871PA010",,"PAN001","PAS001","PAF028","New","HMO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","33871PA0100018-01","Standard Gold On Exchange Plan","78.49%",,"No","Yes","No","100%",,"$2,000","$114","$0","$150","$0","$280","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","20","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100034","Keystone DPOS Silver Secure $3,500 $40/$80/$600","33871PA010",,"PAN001","PAS001","PAF029","New","HMO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","33871PA0100034-01","Standard Silver On Exchange Plan","68.03%",,"No","Yes","No","100%",,"$3,500","$1,314","$0","$150","$0","$290","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","21","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100019","Keystone DPOS Silver Classic $4,250 $40/$80/100%","33871PA010",,"PAN001","PAS001","PAF029","New","HMO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","0","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","33871PA0100019-01","Standard Silver On Exchange Plan","68.04%",,"No","Yes","No","100%",,"$4,250","$1,314","$0","$150","$0","$290","$0","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","0%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","33871","HIOS","10","2016-01-23 05:53:30","22","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100007","Keystone HMO Bronze Essential $6,000 $50/$100/$700","33871PA010",,"PAN001","PAS001","PAF012","Existing","HMO","Bronze","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9913",,,"$1,000","5","0","0","2016-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","https://www.ibx.com/market/SHOP","http://www.ibx.com/ffm/formulary4s","33871PA0100007-01","Standard Bronze On Exchange Plan","61.64%",,"Yes","Yes","No","100%",,"$4,471","$1,540","$0","$150","$343","$200","$76","$11",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.ibx.com/ffm/shop2016","https://www.ibx.com/ffm/shop/brochure2016","4"
"2016","PA","36247","HIOS","9","2016-01-22 04:00:42","1","36247","PA","Individual","No","20-2353206","36247PA0060002","Alliance Flex Blue PPO 1000","36247PA006",,"PAN001","PAS011","PAF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9987",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","36247PA0060002-00","Standard Gold Off Exchange Plan",,"0.790386319160461","No","Yes","Yes","85%","15%","$1,000","$600","$1,000","$0","$1,000","$300","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%","$2,000","$2000 per person","$4000 per group","40%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2097735251_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","4"
"2016","PA","36247","HIOS","9","2016-01-22 04:00:42","1","36247","PA","Individual","No","20-2353206","36247PA0060002","Alliance Flex Blue PPO 1000","36247PA006",,"PAN001","PAS011","PAF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9987",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","36247PA0060002-01","Standard Gold On Exchange Plan",,"0.790386319160461","No","Yes","Yes","85%","15%","$1,000","$600","$1,000","$0","$1,000","$300","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%","$2,000","$2000 per person","$4000 per group","40%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2097735251_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","5"
"2016","PA","36247","HIOS","9","2016-01-22 04:00:42","1","36247","PA","Individual","No","20-2353206","36247PA0060002","Alliance Flex Blue PPO 1000","36247PA006",,"PAN001","PAS011","PAF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9987",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","36247PA0060002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2097747308_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","6"
"2016","PA","36247","HIOS","9","2016-01-22 04:00:42","1","36247","PA","Individual","No","20-2353206","36247PA0060002","Alliance Flex Blue PPO 1000","36247PA006",,"PAN001","PAS011","PAF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9987",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","36247PA0060002-03","Limited Cost Sharing Plan Variation",,"0.790386319160461","No","Yes","Yes","85%","15%","$1,000","$600","$1,000","$0","$1,000","$300","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%","$2,000","$2000 per person","$4000 per group","40%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2097746841_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","7"
"2016","PA","36247","HIOS","9","2016-01-22 04:00:42","1","36247","PA","Individual","No","20-2353206","36247PA0060001","Alliance Flex Blue PPO 2100","36247PA006",,"PAN001","PAS011","PAF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9987",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","36247PA0060001-00","Standard Silver Off Exchange Plan",,"0.699642896652222","No","Yes","Yes","85%","15%","$2,100","$1,100","$1,100","$0","$1,600","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","30%","$4,200","$4200 per person","$8400 per group","50%","$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2095192442_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","8"
"2016","PA","36247","HIOS","9","2016-01-22 04:00:42","1","36247","PA","Individual","No","20-2353206","36247PA0060001","Alliance Flex Blue PPO 2100","36247PA006",,"PAN001","PAS011","PAF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9987",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","36247PA0060001-01","Standard Silver On Exchange Plan",,"0.699642896652222","No","Yes","Yes","85%","15%","$2,100","$1,100","$1,100","$0","$1,600","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","30%","$4,200","$4200 per person","$8400 per group","50%","$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2095192442_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","9"
"2016","PA","36247","HIOS","9","2016-01-22 04:00:42","1","36247","PA","Individual","No","20-2353206","36247PA0060001","Alliance Flex Blue PPO 2100","36247PA006",,"PAN001","PAS011","PAF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9987",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","36247PA0060001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","85%","15%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2095299861_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","10"
"2016","PA","36247","HIOS","9","2016-01-22 04:00:42","1","36247","PA","Individual","No","20-2353206","36247PA0060001","Alliance Flex Blue PPO 2100","36247PA006",,"PAN001","PAS011","PAF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9987",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","36247PA0060001-03","Limited Cost Sharing Plan Variation",,"0.699642896652222","No","Yes","Yes","85%","15%","$2,100","$1,100","$1,100","$0","$1,600","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","30%","$4,200","$4200 per person","$8400 per group","50%","$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2095278224_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","11"
"2016","PA","36247","HIOS","9","2016-01-22 04:00:42","1","36247","PA","Individual","No","20-2353206","36247PA0060001","Alliance Flex Blue PPO 2100","36247PA006",,"PAN001","PAS011","PAF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9987",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","36247PA0060001-04","73% AV Level Silver Plan",,"0.730535805225372","No","Yes","Yes","85%","15%","$2,100","$1,100","$1,100","$0","$1,600","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","30%","$4,200","$4200 per person","$8400 per group","50%","$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2095274853_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","12"
"2016","PA","36247","HIOS","9","2016-01-22 04:00:42","1","36247","PA","Individual","No","20-2353206","36247PA0060001","Alliance Flex Blue PPO 2100","36247PA006",,"PAN001","PAS011","PAF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9987",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","36247PA0060001-05","87% AV Level Silver Plan",,"0.869721353054047","No","Yes","Yes","85%","15%","$500","$700","$1,100","$0","$500","$300","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$1,000","$1000 per person","$2000 per group","40%","$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2095262972_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","13"
"2016","PA","36247","HIOS","9","2016-01-22 04:00:42","1","36247","PA","Individual","No","20-2353206","36247PA0060001","Alliance Flex Blue PPO 2100","36247PA006",,"PAN001","PAS011","PAF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9987",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","36247PA0060001-06","94% AV Level Silver Plan",,"0.945048689842224","No","Yes","Yes","85%","15%","$100","$200","$200","$0","$100","$200","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20%","$250","$250 per person","$500 per group","40%","$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2095250201_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","14"
"2016","PA","38086","HIOS","2","2015-07-10 02:19:03","1","38086","PA","SHOP (Small Group)","Yes","47-0397286","38086PA0030001","Renaissance Group Dental PPO, EHB Certified","38086PA003",,"PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.90","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","38086PA0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","38086","HIOS","2","2015-07-10 02:19:03","1","38086","PA","Individual","Yes","47-0397286","38086PA0010001","Delta Dental Individual PPO, EHB Certified","38086PA001",,"PAN002","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","38086PA0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","38086","HIOS","2","2015-07-10 02:19:03","1","38086","PA","Individual","Yes","47-0397286","38086PA0010002","Delta Dental Individual PPO, EHB Certified","38086PA001",,"PAN002","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.73","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","38086PA0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","PA","38086","HIOS","2","2015-07-10 02:19:03","1","38086","PA","SHOP (Small Group)","Yes","47-0397286","38086PA0030002","Renaissance Group Dental PPO, EHB Certified","38086PA003",,"PAN001","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.64","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","38086PA0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","PA","38086","HIOS","2","2015-07-10 02:19:03","1","38086","PA","SHOP (Small Group)","Yes","47-0397286","38086PA0050001","Renaissance Group Dental Indemnity, EHB Certified","38086PA005",,"PAN001","PAS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.90","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","38086PA0050001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","PA","38086","HIOS","2","2015-07-10 02:19:03","1","38086","PA","Individual","Yes","47-0397286","38086PA0020001","Renaissance Individual Dental PPO, EHB Certified","38086PA002",,"PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.14","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","38086PA0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020008","Healthy Benefits PPO 4500.0","45127PA002","7588667726","PAN004","PAS002","PAF005","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020008-00","Standard Silver Off Exchange Plan",,"0.699142456054688","Yes","Yes","Yes","40%","60%","$4,500","$10","$0","$200","$4,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%","$4,500","$4500 per person","$9000 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002000800_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","4"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","Yes","45-5492167","45127PA0050001","Healthy Dental Select Basic","45127PA005",,"PAN001","PAS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.42","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency","Yes","Emergency","No","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0050001-00","Standard Low Off Exchange Plan","70.52%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2016/45127PA0050001-2016.pdf","4"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","SHOP (Small Group)","No","45-5492167","45127PA0010136","Healthy Benefits PPO 6000.0 EX","45127PA001","7588667726","PAN002","PAS002","PAF013","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,"$200","5","0","0","2016-01-01","2016-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0010136-00","Standard Silver Off Exchange Plan","68.10%","0.673444449901581","No","Yes","Yes","40%","60%","$6,000","$0","$0","$200","$600","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","0%","$6,000","$6000 per person","$12000 per group","0%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%","$100","$100 per person","$200 per group","0%","$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/45127PA001013601.pdf","https://www.capbluecross.com/wps/wcm/connect/0a2d9143-b685-4177-8127-4f04317115ee/C-239.pdf?MOD=AJPERES","4"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","SHOP (Small Group)","No","45-5492167","45127PA0010136","Healthy Benefits PPO 6000.0 EX","45127PA001","7588667726","PAN002","PAS002","PAF013","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,"$200","5","0","0","2016-01-01","2016-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0010136-01","Standard Silver On Exchange Plan","68.10%","0.673444449901581","No","Yes","Yes","40%","60%","$6,000","$0","$0","$200","$600","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","0%","$6,000","$6000 per person","$12000 per group","0%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%","$100","$100 per person","$200 per group","0%","$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/45127PA001013601.pdf","https://www.capbluecross.com/wps/wcm/connect/0a2d9143-b685-4177-8127-4f04317115ee/C-239.pdf?MOD=AJPERES","5"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","Yes","45-5492167","45127PA0050001","Healthy Dental Select Basic","45127PA005",,"PAN001","PAS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.42","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency","Yes","Emergency","No","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0050001-01","Standard Low On Exchange Plan","70.52%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2016/45127PA0050001-2016.pdf","5"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020008","Healthy Benefits PPO 4500.0","45127PA002","7588667726","PAN004","PAS002","PAF005","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020008-01","Standard Silver On Exchange Plan",,"0.699142456054688","Yes","Yes","Yes","40%","60%","$4,500","$10","$0","$200","$4,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%","$4,500","$4500 per person","$9000 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002000801_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","5"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020008","Healthy Benefits PPO 4500.0","45127PA002","7588667726","PAN004","PAS002","PAF005","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002000802_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","6"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","SHOP (Small Group)","No","45-5492167","45127PA0010147","Healthy Benefits PPO 3000.0 EX","45127PA001","7588667726","PAN002","PAS002","PAF013","New","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,"$200","5","0","0","2016-01-01","2016-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0010147-00","Standard Silver Off Exchange Plan",,"0.706317186355591","No","Yes","Yes","40%","60%","$3,000","$0","$0","$200","$600","$1,800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%","$3,000","$3000 per person","$6000 per group","0%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%","$100","$100 per person","$200 per group","0%","$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/45127PA001014701.pdf","https://www.capbluecross.com/wps/wcm/connect/0a2d9143-b685-4177-8127-4f04317115ee/C-239.pdf?MOD=AJPERES","6"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","SHOP (Small Group)","No","45-5492167","45127PA0010147","Healthy Benefits PPO 3000.0 EX","45127PA001","7588667726","PAN002","PAS002","PAF013","New","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,"$200","5","0","0","2016-01-01","2016-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0010147-01","Standard Silver On Exchange Plan",,"0.706317186355591","No","Yes","Yes","40%","60%","$3,000","$0","$0","$200","$600","$1,800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%","$3,000","$3000 per person","$6000 per group","0%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%","$100","$100 per person","$200 per group","0%","$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/45127PA001014701.pdf","https://www.capbluecross.com/wps/wcm/connect/0a2d9143-b685-4177-8127-4f04317115ee/C-239.pdf?MOD=AJPERES","7"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020008","Healthy Benefits PPO 4500.0","45127PA002","7588667726","PAN004","PAS002","PAF005","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020008-03","Limited Cost Sharing Plan Variation",,"0.699142456054688","Yes","Yes","Yes","40%","60%","$4,500","$10","$0","$200","$4,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%","$4,500","$4500 per person","$9000 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002000803_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","7"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020008","Healthy Benefits PPO 4500.0","45127PA002","7588667726","PAN004","PAS002","PAF005","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020008-04","73% AV Level Silver Plan",,"0.723888397216797","Yes","Yes","Yes","40%","60%","$4,000","$10","$0","$200","$4,000","$90","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%","$4,000","$4000 per person","$8000 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002000804_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","8"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","SHOP (Small Group)","No","45-5492167","45127PA0010137","Healthy Benefits PPO 1000.0 EX","45127PA001","7588667726","PAN002","PAS002","PAF011","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,"$200","5","0","0","2016-01-01","2016-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0010137-00","Standard Gold Off Exchange Plan","79.91%","0.814650118350983","No","Yes","Yes","40%","60%","$1,000","$0","$0","$200","$600","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%","$100","$100 per person","$200 per group","0%","$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/45127PA001013701.pdf","https://www.capbluecross.com/wps/wcm/connect/0a2d9143-b685-4177-8127-4f04317115ee/C-239.pdf?MOD=AJPERES","8"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","SHOP (Small Group)","No","45-5492167","45127PA0010137","Healthy Benefits PPO 1000.0 EX","45127PA001","7588667726","PAN002","PAS002","PAF011","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,"$200","5","0","0","2016-01-01","2016-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0010137-01","Standard Gold On Exchange Plan","79.91%","0.814650118350983","No","Yes","Yes","40%","60%","$1,000","$0","$0","$200","$600","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%","$100","$100 per person","$200 per group","0%","$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/45127PA001013701.pdf","https://www.capbluecross.com/wps/wcm/connect/0a2d9143-b685-4177-8127-4f04317115ee/C-239.pdf?MOD=AJPERES","9"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020008","Healthy Benefits PPO 4500.0","45127PA002","7588667726","PAN004","PAS002","PAF005","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020008-05","87% AV Level Silver Plan",,"0.875805556774139","Yes","Yes","Yes","40%","60%","$1,000","$10","$0","$200","$1,000","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002000805_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","9"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020008","Healthy Benefits PPO 4500.0","45127PA002","7588667726","PAN004","PAS002","PAF005","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020008-06","94% AV Level Silver Plan",,"0.942583918571472","Yes","Yes","Yes","40%","60%","$300","$0","$0","$200","$300","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002000806_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","10"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020009","Healthy Benefits PPO 3500.0","45127PA002","7588667726","PAN004","PAS002","PAF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020009-00","Standard Silver Off Exchange Plan",,"0.714335739612579","Yes","Yes","Yes","40%","60%","$3,500","$0","$0","$200","$3,500","$50","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%","$3,500","$3500 per person","$7000 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002000900_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","11"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020009","Healthy Benefits PPO 3500.0","45127PA002","7588667726","PAN004","PAS002","PAF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020009-01","Standard Silver On Exchange Plan",,"0.714335739612579","Yes","Yes","Yes","40%","60%","$3,500","$0","$0","$200","$3,500","$50","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%","$3,500","$3500 per person","$7000 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002000901_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","12"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020009","Healthy Benefits PPO 3500.0","45127PA002","7588667726","PAN004","PAS002","PAF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002000902_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","13"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020009","Healthy Benefits PPO 3500.0","45127PA002","7588667726","PAN004","PAS002","PAF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020009-03","Limited Cost Sharing Plan Variation",,"0.714335739612579","Yes","Yes","Yes","40%","60%","$3,500","$0","$0","$200","$3,500","$50","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%","$3,500","$3500 per person","$7000 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002000903_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","14"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020009","Healthy Benefits PPO 3500.0","45127PA002","7588667726","PAN004","PAS002","PAF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020009-04","73% AV Level Silver Plan",,"0.736997604370117","Yes","Yes","Yes","40%","60%","$3,300","$0","$0","$200","$3,300","$30","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0%","$3,250","$3250 per person","$6500 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002000904_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","15"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020009","Healthy Benefits PPO 3500.0","45127PA002","7588667726","PAN004","PAS002","PAF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020009-05","87% AV Level Silver Plan",,"0.868068695068359","Yes","Yes","Yes","40%","60%","$1,300","$0","$0","$200","$1,300","$50","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%","$1,250","$1250 per person","$2500 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002000905_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","16"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020009","Healthy Benefits PPO 3500.0","45127PA002","7588667726","PAN004","PAS002","PAF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020009-06","94% AV Level Silver Plan",,"0.935489058494568","Yes","Yes","Yes","40%","60%","$500","$0","$0","$200","$500","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002000906_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","17"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020018","Healthy Benefits PPO HSA 3000.10","45127PA002","7588667726","PAN004","PAS002","PAF007","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020018-00","Standard Silver Off Exchange Plan",,"0.708217144012451","Yes","Yes","No","100%",,"$3,000","$0","$400","$200","$3,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001800_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","18"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020018","Healthy Benefits PPO HSA 3000.10","45127PA002","7588667726","PAN004","PAS002","PAF007","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020018-01","Standard Silver On Exchange Plan",,"0.708217144012451","Yes","Yes","No","100%",,"$3,000","$0","$400","$200","$3,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001801_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","19"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020018","Healthy Benefits PPO HSA 3000.10","45127PA002","7588667726","PAN004","PAS002","PAF007","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001802_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","20"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020018","Healthy Benefits PPO HSA 3000.10","45127PA002","7588667726","PAN004","PAS002","PAF007","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020018-03","Limited Cost Sharing Plan Variation",,"0.708217144012451","Yes","Yes","No","100%",,"$3,000","$0","$400","$200","$3,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001803_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","21"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020018","Healthy Benefits PPO HSA 3000.10","45127PA002","7588667726","PAN004","PAS002","PAF007","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020018-04","73% AV Level Silver Plan",,"0.728936076164246","Yes","Yes","No","100%",,"$2,500","$0","$500","$200","$2,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001804_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","22"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020018","Healthy Benefits PPO HSA 3000.10","45127PA002","7588667726","PAN004","PAS002","PAF007","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020018-05","87% AV Level Silver Plan",,"0.862989962100983","Yes","Yes","No","100%",,"$700","$0","$700","$200","$700","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001805_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","23"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020018","Healthy Benefits PPO HSA 3000.10","45127PA002","7588667726","PAN004","PAS002","PAF007","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020018-06","94% AV Level Silver Plan",,"0.938378155231476","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001806_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","24"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020011","Healthy Benefits PPO 2500.0","45127PA002","7588667726","PAN004","PAS002","PAF004","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020011-00","Standard Silver Off Exchange Plan",,"0.717433631420136","Yes","Yes","Yes","40%","60%","$2,500","$20","$0","$200","$2,500","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%","$2,500","$2500 per person","$5000 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001100_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","25"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020011","Healthy Benefits PPO 2500.0","45127PA002","7588667726","PAN004","PAS002","PAF004","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020011-01","Standard Silver On Exchange Plan",,"0.717433631420136","Yes","Yes","Yes","40%","60%","$2,500","$20","$0","$200","$2,500","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%","$2,500","$2500 per person","$5000 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001101_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","26"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020011","Healthy Benefits PPO 2500.0","45127PA002","7588667726","PAN004","PAS002","PAF004","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001102_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","27"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020011","Healthy Benefits PPO 2500.0","45127PA002","7588667726","PAN004","PAS002","PAF004","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020011-03","Limited Cost Sharing Plan Variation",,"0.717433631420136","Yes","Yes","Yes","40%","60%","$2,500","$20","$0","$200","$2,500","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%","$2,500","$2500 per person","$5000 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001103_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","28"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020011","Healthy Benefits PPO 2500.0","45127PA002","7588667726","PAN004","PAS002","PAF004","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020011-04","73% AV Level Silver Plan",,"0.738784909248352","Yes","Yes","Yes","40%","60%","$2,400","$20","$0","$200","$2,400","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","0%","$2,400","$2400 per person","$4800 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001104_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","29"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020011","Healthy Benefits PPO 2500.0","45127PA002","7588667726","PAN004","PAS002","PAF004","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020011-05","87% AV Level Silver Plan",,"0.873042404651642","Yes","Yes","Yes","40%","60%","$800","$20","$0","$200","$800","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0%","$750","$750 per person","$1500 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001105_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","30"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020011","Healthy Benefits PPO 2500.0","45127PA002","7588667726","PAN004","PAS002","PAF004","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020011-06","94% AV Level Silver Plan",,"0.936065196990967","Yes","Yes","Yes","40%","60%","$300","$10","$0","$200","$300","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001106_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","31"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020019","Healthy Benefits PPO 1500.30","45127PA002","7588667726","PAN004","PAS002","PAF006","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020019-00","Standard Silver Off Exchange Plan",,"0.689864039421082","Yes","Yes","Yes","40%","60%","$1,500","$0","$1,700","$200","$1,500","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%","$1,500","$1500 per person","$3000 per group","30%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001900_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","32"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020019","Healthy Benefits PPO 1500.30","45127PA002","7588667726","PAN004","PAS002","PAF006","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020019-01","Standard Silver On Exchange Plan",,"0.689864039421082","Yes","Yes","Yes","40%","60%","$1,500","$0","$1,700","$200","$1,500","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%","$1,500","$1500 per person","$3000 per group","30%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001901_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","33"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020019","Healthy Benefits PPO 1500.30","45127PA002","7588667726","PAN004","PAS002","PAF006","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001902_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","34"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020019","Healthy Benefits PPO 1500.30","45127PA002","7588667726","PAN004","PAS002","PAF006","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020019-03","Limited Cost Sharing Plan Variation",,"0.689864039421082","Yes","Yes","Yes","40%","60%","$1,500","$0","$1,700","$200","$1,500","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%","$1,500","$1500 per person","$3000 per group","30%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001903_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","35"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020019","Healthy Benefits PPO 1500.30","45127PA002","7588667726","PAN004","PAS002","PAF006","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020019-04","73% AV Level Silver Plan",,"0.728535711765289","Yes","Yes","Yes","40%","60%","$1,400","$0","$1,500","$200","$1,400","$0","$800","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","25%","$1,400","$1400 per person","$2800 per group","25%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001904_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","36"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020019","Healthy Benefits PPO 1500.30","45127PA002","7588667726","PAN004","PAS002","PAF006","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020019-05","87% AV Level Silver Plan",,"0.870826542377472","Yes","Yes","Yes","40%","60%","$500","$0","$700","$200","$500","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%","$500","$500 per person","$1000 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001905_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","37"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020019","Healthy Benefits PPO 1500.30","45127PA002","7588667726","PAN004","PAS002","PAF006","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020019-06","94% AV Level Silver Plan",,"0.932785928249359","Yes","Yes","Yes","40%","60%","$200","$0","$2,300","$200","$200","$0","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","5%","$150","$150 per person","$300 per group","5%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001906_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","38"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020015","Healthy Benefits PPO 0.0","45127PA002","7588667726","PAN004","PAS002","PAF003","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020015-00","Standard Silver Off Exchange Plan","71.75%","0","Yes","Yes","Yes","40%","60%","$0","$800","$0","$200","$0","$2,800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001500_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","39"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020015","Healthy Benefits PPO 0.0","45127PA002","7588667726","PAN004","PAS002","PAF003","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020015-01","Standard Silver On Exchange Plan","71.75%","0","Yes","Yes","Yes","40%","60%","$0","$800","$0","$200","$0","$2,800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001501_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","40"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020015","Healthy Benefits PPO 0.0","45127PA002","7588667726","PAN004","PAS002","PAF003","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001502_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","41"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020015","Healthy Benefits PPO 0.0","45127PA002","7588667726","PAN004","PAS002","PAF003","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020015-03","Limited Cost Sharing Plan Variation","71.75%","0","Yes","Yes","Yes","40%","60%","$0","$800","$0","$200","$0","$2,800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001503_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","42"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020015","Healthy Benefits PPO 0.0","45127PA002","7588667726","PAN004","PAS002","PAF003","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020015-04","73% AV Level Silver Plan","73.96%","0","Yes","Yes","Yes","40%","60%","$0","$800","$0","$200","$0","$2,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001504_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","43"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020015","Healthy Benefits PPO 0.0","45127PA002","7588667726","PAN004","PAS002","PAF003","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020015-05","87% AV Level Silver Plan","86.23%","0","Yes","Yes","Yes","40%","60%","$0","$300","$0","$200","$0","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001505_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","44"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","2","45127","PA","Individual","No","45-5492167","45127PA0020015","Healthy Benefits PPO 0.0","45127PA002","7588667726","PAN004","PAS002","PAF003","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020015-06","94% AV Level Silver Plan","93.44%","0","Yes","Yes","Yes","40%","60%","$0","$60","$0","$200","$0","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001506_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","45"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","3","45127","PA","Individual","No","45-5492167","45127PA0020013","Healthy Benefits PPO 1000.0","45127PA002","7588667726","PAN004","PAS002","PAF009","Existing","PPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020013-00","Standard Gold Off Exchange Plan",,"0.807802796363831","No","Yes","Yes","40%","60%","$1,000","$0","$0","$200","$800","$2,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001300_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","4"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","3","45127","PA","Individual","Yes","45-5492167","45127PA0030004","Healthy Dental PPO Pediatric","45127PA003",,"PAN003","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$24.23","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0030004-00","Standard Low Off Exchange Plan","71.98%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2016/45127PA0030004-2016.pdf","4"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","3","45127","PA","SHOP (Small Group)","No","45-5492167","45127PA0010148","Healthy Benefits PPO HSA 6350.0","45127PA001","7588667726","PAN002","PAS002","PAF002","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0010148-00","Standard Bronze Off Exchange Plan",,"0.605813801288605","Yes","Yes","Yes","40%","60%","$6,400","$0","$0","$200","$4,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0%","$6,350","per person not applicable","$12700 per group","0%","$6,350","per person not applicable","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/45127PA001014801.pdf","https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/employers/findgroupplan/healthplans/smallgrouppages/simplyselecthsa","4"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","3","45127","PA","SHOP (Small Group)","No","45-5492167","45127PA0010148","Healthy Benefits PPO HSA 6350.0","45127PA001","7588667726","PAN002","PAS002","PAF002","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0010148-01","Standard Bronze On Exchange Plan",,"0.605813801288605","Yes","Yes","Yes","40%","60%","$6,400","$0","$0","$200","$4,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","per person not applicable","$12700 per group","0%","$6,350","per person not applicable","$12700 per group","0%","$6,350","per person not applicable","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/45127PA001014801.pdf","https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/employers/findgroupplan/healthplans/smallgrouppages/simplyselecthsa","5"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","3","45127","PA","Individual","Yes","45-5492167","45127PA0030004","Healthy Dental PPO Pediatric","45127PA003",,"PAN003","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$24.23","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0030004-01","Standard Low On Exchange Plan","71.98%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2016/45127PA0030004-2016.pdf","5"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","3","45127","PA","Individual","No","45-5492167","45127PA0020013","Healthy Benefits PPO 1000.0","45127PA002","7588667726","PAN004","PAS002","PAF009","Existing","PPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020013-01","Standard Gold On Exchange Plan",,"0.807802796363831","No","Yes","Yes","40%","60%","$1,000","$0","$0","$200","$800","$2,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001301_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","5"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","3","45127","PA","Individual","No","45-5492167","45127PA0020013","Healthy Benefits PPO 1000.0","45127PA002","7588667726","PAN004","PAS002","PAF009","Existing","PPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020013-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001302_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","6"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","3","45127","PA","Individual","No","45-5492167","45127PA0020013","Healthy Benefits PPO 1000.0","45127PA002","7588667726","PAN004","PAS002","PAF009","Existing","PPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020013-03","Limited Cost Sharing Plan Variation",,"0.807802796363831","No","Yes","Yes","40%","60%","$1,000","$0","$0","$200","$800","$2,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001303_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","7"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","3","45127","PA","Individual","No","45-5492167","45127PA0020014","Healthy Benefits PPO 500.0","45127PA002","7588667726","PAN004","PAS002","PAF008","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020014-00","Standard Gold Off Exchange Plan","82.00%","0.8205925822258","No","Yes","Yes","40%","60%","$500","$0","$0","$200","$500","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001400_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","8"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","3","45127","PA","Individual","No","45-5492167","45127PA0020014","Healthy Benefits PPO 500.0","45127PA002","7588667726","PAN004","PAS002","PAF008","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020014-01","Standard Gold On Exchange Plan","82.00%","0.8205925822258","No","Yes","Yes","40%","60%","$500","$0","$0","$200","$500","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001401_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","9"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","3","45127","PA","Individual","No","45-5492167","45127PA0020014","Healthy Benefits PPO 500.0","45127PA002","7588667726","PAN004","PAS002","PAF008","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020014-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001402_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","10"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","3","45127","PA","Individual","No","45-5492167","45127PA0020014","Healthy Benefits PPO 500.0","45127PA002","7588667726","PAN004","PAS002","PAF008","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020014-03","Limited Cost Sharing Plan Variation","82.00%","0.8205925822258","No","Yes","Yes","40%","60%","$500","$0","$0","$200","$500","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001403_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","11"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","4","45127","PA","Individual","No","45-5492167","45127PA0020017","Healthy Benefits PPO 0.0.10","45127PA002","7588667726","PAN004","PAS002","PAF010","Existing","PPO","Platinum","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020017-00","Standard Platinum Off Exchange Plan",,"0.917162597179413","Yes","Yes","Yes","40%","60%","$0","$10","$0","$200","$0","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001700_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","4"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","4","45127","PA","Individual","Yes","45-5492167","45127PA0030001","Healthy Dental PPO Plan 1","45127PA003",,"PAN003","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.23","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0030001-00","Standard Low Off Exchange Plan","71.98%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2016/45127PA0030001-2016.pdf","4"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","4","45127","PA","Individual","Yes","45-5492167","45127PA0030001","Healthy Dental PPO Plan 1","45127PA003",,"PAN003","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.23","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0030001-01","Standard Low On Exchange Plan","71.98%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2016/45127PA0030001-2016.pdf","5"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","4","45127","PA","Individual","No","45-5492167","45127PA0020017","Healthy Benefits PPO 0.0.10","45127PA002","7588667726","PAN004","PAS002","PAF010","Existing","PPO","Platinum","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020017-01","Standard Platinum On Exchange Plan",,"0.917162597179413","Yes","Yes","Yes","40%","60%","$0","$10","$0","$200","$0","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001701_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","5"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","4","45127","PA","Individual","No","45-5492167","45127PA0020017","Healthy Benefits PPO 0.0.10","45127PA002","7588667726","PAN004","PAS002","PAF010","Existing","PPO","Platinum","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001701_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","6"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","4","45127","PA","Individual","No","45-5492167","45127PA0020017","Healthy Benefits PPO 0.0.10","45127PA002","7588667726","PAN004","PAS002","PAF010","Existing","PPO","Platinum","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","45127PA0020017-03","Limited Cost Sharing Plan Variation",,"0.917162597179413","Yes","Yes","Yes","40%","60%","$0","$10","$0","$200","$0","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/45127PA002001703_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","7"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","5","45127","PA","Individual","Yes","45-5492167","45127PA0030002","Healthy Dental PPO Plan 2","45127PA003",,"PAN003","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.23","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0030002-00","Standard Low Off Exchange Plan","71.98%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2016/45127PA0030002-2016.pdf","4"
"2016","PA","45127","HIOS","8","2016-01-28 05:11:31","6","45127","PA","Individual","Yes","45-5492167","45127PA0030003","Healthy Dental PPO Plan 3","45127PA003",,"PAN003","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.23","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes","https://w2.capbluecross.com/sp/ACS.saml2","","45127PA0030003-00","Standard Low Off Exchange Plan","71.98%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.capbluecross.com/pdf/benefits_summary/dental/2016/45127PA0030003-2016.pdf","4"
"2016","PA","46518","HIOS","8","2015-08-26 09:56:12","1","46518","PA","Individual","Yes","75-1233841","46518PA0010001","Dentegra Dental PPO Pediatric Basic Plan","46518PA001",,"PAN001","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.44","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","46518PA0010001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/pa/46518pa0010001-16","4"
"2016","PA","46518","HIOS","8","2015-08-26 09:56:12","1","46518","PA","SHOP (Small Group)","Yes","75-1233841","46518PA0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","46518PA002",,"PAN001","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.65","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","46518PA0020001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/pa/46518pa0020001-16","4"
"2016","PA","46518","HIOS","8","2015-08-26 09:56:12","2","46518","PA","SHOP (Small Group)","Yes","75-1233841","46518PA0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","46518PA002",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.44","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","46518PA0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/pa/46518pa0020004-16","4"
"2016","PA","46518","HIOS","8","2015-08-26 09:56:12","2","46518","PA","Individual","Yes","75-1233841","46518PA0010004","Dentegra Dental PPO Family Preferred Plan","46518PA001",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.22","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","46518PA0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/pa/46518pa0010004-16","4"
"2016","PA","46518","HIOS","8","2015-08-26 09:56:12","2","46518","PA","Individual","Yes","75-1233841","46518PA0010004","Dentegra Dental PPO Family Preferred Plan","46518PA001",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.22","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","46518PA0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/pa/46518pa0010004-16","5"
"2016","PA","46518","HIOS","8","2015-08-26 09:56:12","2","46518","PA","SHOP (Small Group)","Yes","75-1233841","46518PA0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","46518PA002",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.44","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","46518PA0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/pa/46518pa0020004-16","5"
"2016","PA","46518","HIOS","8","2015-08-26 09:56:12","3","46518","PA","SHOP (Small Group)","Yes","75-1233841","46518PA0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","46518PA002",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.65","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","46518PA0020006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/pa/46518pa0020006-16","4"
"2016","PA","46518","HIOS","8","2015-08-26 09:56:12","3","46518","PA","Individual","Yes","75-1233841","46518PA0010006","Dentegra Dental PPO Family Basic Plan","46518PA001",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.44","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","46518PA0010006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/pa/46518pa0010006-16","4"
"2016","PA","46518","HIOS","8","2015-08-26 09:56:12","3","46518","PA","Individual","Yes","75-1233841","46518PA0010006","Dentegra Dental PPO Family Basic Plan","46518PA001",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.44","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","46518PA0010006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/pa/46518pa0010006-16","5"
"2016","PA","46518","HIOS","8","2015-08-26 09:56:12","3","46518","PA","SHOP (Small Group)","Yes","75-1233841","46518PA0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","46518PA002",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.65","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","46518PA0020006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/pa/46518pa0020006-16","5"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","Individual","No","23-2399845","53789PA0110004","Healthy Benefits Value HMO 6850.0","53789PA011","7205839443","PAN001","PAS001","PAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110004-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","40%","60%","$6,800","$0","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011000400_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","6"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080003","Healthy Benefits Value HMO 500.0 EX","53789PA008","7205839443","PAN003","PAS001","PAF010","Existing","HMO","Gold","No","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080003-00","Standard Gold Off Exchange Plan",,"0.814222753047943","Yes","Yes","Yes","40%","60%","$500","$10","$0","$200","$500","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008000301.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","6"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080003","Healthy Benefits Value HMO 500.0 EX","53789PA008","7205839443","PAN003","PAS001","PAF010","Existing","HMO","Gold","No","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080003-01","Standard Gold On Exchange Plan",,"0.814222753047943","Yes","Yes","Yes","40%","60%","$500","$10","$0","$200","$500","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008000301.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","7"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","Individual","No","23-2399845","53789PA0110004","Healthy Benefits Value HMO 6850.0","53789PA011","7205839443","PAN001","PAS001","PAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","40%","60%","$6,800","$0","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011000401_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","7"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","Individual","No","23-2399845","53789PA0110017","Healthy Benefits Value HMO 6850.0","53789PA011","7205839443","PAN001","PAS004","PAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110017-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","40%","60%","$6,800","$0","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001700_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","8"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080006","Healthy Benefits Value HMO 500.0 EX","53789PA008","7205839443","PAN003","PAS004","PAF010","Existing","HMO","Gold","No","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080006-00","Standard Gold Off Exchange Plan",,"0.814222753047943","Yes","Yes","Yes","40%","60%","$500","$10","$0","$200","$500","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008000601.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","8"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080006","Healthy Benefits Value HMO 500.0 EX","53789PA008","7205839443","PAN003","PAS004","PAF010","Existing","HMO","Gold","No","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080006-01","Standard Gold On Exchange Plan",,"0.814222753047943","Yes","Yes","Yes","40%","60%","$500","$10","$0","$200","$500","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008000601.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","9"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","1","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0380001","Smile for Health - Certified Optimum Coverage","49275PA038",,"PAN004","PAS004",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0380001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","2","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0380002","Smile for Health - Certified Optimum Coverage","49275PA038",,"PAN001","PAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0380002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","3","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0380003","Smile for Health - Certified Optimum Coverage","49275PA038",,"PAN002","PAS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0380003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","4","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0380004","Smile for Health - Certified Optimum Coverage","49275PA038",,"PAN003","PAS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0380004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","5","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0380005","Smile for Health - Certified Optimum Coverage","49275PA038",,"PAN004","PAS004",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0380005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","6","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0380006","Smile for Health - Certified Optimum Coverage","49275PA038",,"PAN001","PAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0380006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","7","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0380007","Smile for Health - Certified Optimum Coverage","49275PA038",,"PAN002","PAS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0380007-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","8","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0380008","Smile for Health - Certified Optimum Coverage","49275PA038",,"PAN003","PAS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0380008-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","9","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0390001","Smile for Health - Certified High Option","49275PA039",,"PAN004","PAS004",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0390001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","10","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0390002","Smile for Health - Certified High Option","49275PA039",,"PAN001","PAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0390002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","11","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0390003","Smile for Health - Certified High Option","49275PA039",,"PAN002","PAS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0390003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","12","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0390004","Smile for Health - Certified High Option","49275PA039",,"PAN003","PAS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0390004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","13","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0390005","Smile for Health - Certified High Option Plus","49275PA039",,"PAN004","PAS004",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0390005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","14","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0390006","Smile for Health - Certified High Option Plus","49275PA039",,"PAN001","PAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0390006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","15","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0390007","Smile for Health - Certified High Option Plus","49275PA039",,"PAN002","PAS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0390007-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","16","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0390008","Smile for Health - Certified High Option Plus","49275PA039",,"PAN003","PAS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0390008-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","17","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0410001","Smile for Health - Family Premier PPO","49275PA041",,"PAN004","PAS004",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$23.92","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0410001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.unitedconcordia.com/docs/hcr/benefits-summary-pa-sfh-family-premier-ppo.pdf","https://www.unitedconcordia.com/docs/hcr/product-brochure-pa-sfh-family-premier-ppo.pdf","4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","17","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0410001","Smile for Health - Family Premier PPO","49275PA041",,"PAN004","PAS004",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$23.92","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0410001-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.unitedconcordia.com/docs/hcr/benefits-summary-pa-sfh-family-premier-ppo.pdf","https://www.unitedconcordia.com/docs/hcr/product-brochure-pa-sfh-family-premier-ppo.pdf","5"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","18","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0420001","Smile for Health - Family Value PPO","49275PA042",,"PAN004","PAS004",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$23.92","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0420001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.unitedconcordia.com/docs/hcr/benefits-summary-pa-sfh-family-value-ppo.pdf","https://www.unitedconcordia.com/docs/hcr/product-brochure-pa-sfh-family-value-ppo.pdf","4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","18","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0420001","Smile for Health - Family Value PPO","49275PA042",,"PAN004","PAS004",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$23.92","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0420001-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.unitedconcordia.com/docs/hcr/benefits-summary-pa-sfh-family-value-ppo.pdf","https://www.unitedconcordia.com/docs/hcr/product-brochure-pa-sfh-family-value-ppo.pdf","5"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","19","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0430001","Smile for Health - Family Core PPO","49275PA043",,"PAN004","PAS004",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$19.88","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0430001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.unitedconcordia.com/docs/hcr/benefits-summary-pa-sfh-family-core-ppo.pdf","https://www.unitedconcordia.com/docs/hcr/product-brochure-pa-sfh-family-core-ppo.pdf","4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","19","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0430001","Smile for Health - Family Core PPO","49275PA043",,"PAN004","PAS004",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$19.88","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0430001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.unitedconcordia.com/docs/hcr/benefits-summary-pa-sfh-family-core-ppo.pdf","https://www.unitedconcordia.com/docs/hcr/product-brochure-pa-sfh-family-core-ppo.pdf","5"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","20","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0440001","NEPA 5","49275PA044",,"PAN001","PAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$23.92","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0440001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","21","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0440002","NEPA 6","49275PA044",,"PAN001","PAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$23.92","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0440002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","22","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0450001","NEPA 7","49275PA045",,"PAN001","PAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$23.92","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0450001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","49275","HIOS","7","2015-08-22 15:09:32","23","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0450002","NEPA 8","49275PA045",,"PAN001","PAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$23.92","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","49275PA0450002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","53210","HIOS","2","2015-07-09 13:17:42","1","53210","PA","SHOP (Small Group)","Yes","41-0808596","53210PA0010002","Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho","53210PA001",,"PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are the same in and out of network","Yes",,"","53210PA0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","53210","HIOS","2","2015-07-09 13:17:42","1","53210","PA","SHOP (Small Group)","Yes","41-0808596","53210PA0010005","Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho","53210PA001",,"PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are the same in and out of network","Yes",,"","53210PA0010005-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","PA","53210","HIOS","2","2015-07-09 13:17:42","1","53210","PA","SHOP (Small Group)","Yes","41-0808596","53210PA0010006","Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho","53210PA001",,"PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are the same in and out of network","Yes",,"","53210PA0010006-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","PA","53210","HIOS","2","2015-07-09 13:17:42","1","53210","PA","SHOP (Small Group)","Yes","41-0808596","53210PA0010009","Plan 9. MAC PPO, $1500 Annual Maximum, Ortho","53210PA001",,"PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$20.18","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are the same in and out of network","Yes",,"","53210PA0010009-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","Individual","No","23-2399845","53789PA0100004","Healthy Benefits HMO 6850.0","53789PA010","7205839443","PAN002","PAS002","PAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100004-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","40%","60%","$6,800","$0","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010000400_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","4"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0070003","Healthy Benefits HMO 500.0 EX","53789PA007","7205839443","PAN004","PAS003","PAF010","Existing","HMO","Gold","No","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0070003-00","Standard Gold Off Exchange Plan",,"0.814222753047943","Yes","Yes","Yes","40%","60%","$500","$10","$0","$200","$500","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA007000301.pdf","https://www.capbluecross.com/wps/wcm/connect/43f654d3-3a93-4a5b-ae45-b60d71f390a9/NF-92.pdf?MOD=AJPERES","4"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0070003","Healthy Benefits HMO 500.0 EX","53789PA007","7205839443","PAN004","PAS003","PAF010","Existing","HMO","Gold","No","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0070003-01","Standard Gold On Exchange Plan",,"0.814222753047943","Yes","Yes","Yes","40%","60%","$500","$10","$0","$200","$500","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA007000301.pdf","https://www.capbluecross.com/wps/wcm/connect/43f654d3-3a93-4a5b-ae45-b60d71f390a9/NF-92.pdf?MOD=AJPERES","5"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","Individual","No","23-2399845","53789PA0100004","Healthy Benefits HMO 6850.0","53789PA010","7205839443","PAN002","PAS002","PAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","40%","60%","$6,800","$0","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010000401_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","5"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","Individual","No","23-2399845","53789PA0110017","Healthy Benefits Value HMO 6850.0","53789PA011","7205839443","PAN001","PAS004","PAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110017-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","40%","60%","$6,800","$0","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001701_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","9"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","Individual","No","23-2399845","53789PA0110018","Healthy Benefits Value HMO 6850.0","53789PA011","7205839443","PAN001","PAS005","PAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110018-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","40%","60%","$6,800","$0","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001800_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","10"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080009","Healthy Benefits Value HMO 500.0 EX","53789PA008","7205839443","PAN003","PAS005","PAF010","Existing","HMO","Gold","No","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080009-00","Standard Gold Off Exchange Plan",,"0.814222753047943","Yes","Yes","Yes","40%","60%","$500","$10","$0","$200","$500","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008000901.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","10"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080009","Healthy Benefits Value HMO 500.0 EX","53789PA008","7205839443","PAN003","PAS005","PAF010","Existing","HMO","Gold","No","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080009-01","Standard Gold On Exchange Plan",,"0.814222753047943","Yes","Yes","Yes","40%","60%","$500","$10","$0","$200","$500","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008000901.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","11"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","Individual","No","23-2399845","53789PA0110018","Healthy Benefits Value HMO 6850.0","53789PA011","7205839443","PAN001","PAS005","PAF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110018-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","40%","60%","$6,800","$0","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001801_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","11"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0070004","Healthy Benefits HMO 2000.0 EX","53789PA007","7205839443","PAN004","PAS003","PAF010","New","HMO","Gold","No","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0070004-00","Standard Gold Off Exchange Plan",,"0.785808145999908","No","Yes","Yes","40%","60%","$2,000","$0","$0","$200","$400","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%","$2,000","$2000 per person","$4000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%","$100","$100 per person","$200 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA007000401.pdf","https://www.capbluecross.com/wps/wcm/connect/43f654d3-3a93-4a5b-ae45-b60d71f390a9/NF-92.pdf?MOD=AJPERES","12"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0070004","Healthy Benefits HMO 2000.0 EX","53789PA007","7205839443","PAN004","PAS003","PAF010","New","HMO","Gold","No","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0070004-01","Standard Gold On Exchange Plan",,"0.785808145999908","No","Yes","Yes","40%","60%","$2,000","$0","$0","$200","$400","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%","$2,000","$2000 per person","$4000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%","$100","$100 per person","$200 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA007000401.pdf","https://www.capbluecross.com/wps/wcm/connect/43f654d3-3a93-4a5b-ae45-b60d71f390a9/NF-92.pdf?MOD=AJPERES","13"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080010","Healthy Benefits Value HMO 2000.0 EX","53789PA008","7205839443","PAN003","PAS001","PAF010","New","HMO","Gold","No","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080010-00","Standard Gold Off Exchange Plan",,"0.785808145999908","No","Yes","Yes","40%","60%","$2,000","$0","$0","$200","$400","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%","$2,000","$2000 per person","$4000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%","$100","$100 per person","$200 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008001001.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","14"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080010","Healthy Benefits Value HMO 2000.0 EX","53789PA008","7205839443","PAN003","PAS001","PAF010","New","HMO","Gold","No","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080010-01","Standard Gold On Exchange Plan",,"0.785808145999908","No","Yes","Yes","40%","60%","$2,000","$0","$0","$200","$400","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%","$2,000","$2000 per person","$4000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%","$100","$100 per person","$200 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008001001.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","15"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080011","Healthy Benefits Value HMO 2000.0 EX","53789PA008","7205839443","PAN003","PAS004","PAF010","New","HMO","Gold","No","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080011-00","Standard Gold Off Exchange Plan",,"0.785808145999908","No","Yes","Yes","40%","60%","$2,000","$0","$0","$200","$400","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%","$2,000","$2000 per person","$4000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%","$100","$100 per person","$200 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008001101.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","16"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080011","Healthy Benefits Value HMO 2000.0 EX","53789PA008","7205839443","PAN003","PAS004","PAF010","New","HMO","Gold","No","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080011-01","Standard Gold On Exchange Plan",,"0.785808145999908","No","Yes","Yes","40%","60%","$2,000","$0","$0","$200","$400","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%","$2,000","$2000 per person","$4000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%","$100","$100 per person","$200 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008001101.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","17"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080012","Healthy Benefits Value HMO 2000.0 EX","53789PA008","7205839443","PAN003","PAS005","PAF010","New","HMO","Gold","No","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080012-00","Standard Gold Off Exchange Plan",,"0.785808145999908","No","Yes","Yes","40%","60%","$2,000","$0","$0","$200","$400","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%","$2,000","$2000 per person","$4000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%","$100","$100 per person","$200 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008001201.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","18"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","1","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080012","Healthy Benefits Value HMO 2000.0 EX","53789PA008","7205839443","PAN003","PAS005","PAF010","New","HMO","Gold","No","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080012-01","Standard Gold On Exchange Plan",,"0.785808145999908","No","Yes","Yes","40%","60%","$2,000","$0","$0","$200","$400","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%","$2,000","$2000 per person","$4000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%","$100","$100 per person","$200 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008001201.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","19"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0070002","Healthy Benefits HMO 0.50 EX","53789PA007","7205839443","PAN004","PAS003","PAF011","Existing","HMO","Silver","Yes","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0070002-00","Standard Silver Off Exchange Plan","71.60%","0.734508275985718","No","Yes","Yes","40%","60%","$0","$0","$3,400","$200","$0","$200","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA007000201.pdf","https://www.capbluecross.com/wps/wcm/connect/43f654d3-3a93-4a5b-ae45-b60d71f390a9/NF-92.pdf?MOD=AJPERES","4"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","Individual","No","23-2399845","53789PA0100008","Healthy Benefits HMO 6300.50","53789PA010","7205839443","PAN002","PAS002","PAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100008-00","Standard Bronze Off Exchange Plan","61.97%","0.621985912322998","Yes","Yes","Yes","40%","60%","$6,300","$0","$200","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50%","$6,300","$6300 per person","$12600 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010000800_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","4"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","Individual","No","23-2399845","53789PA0100008","Healthy Benefits HMO 6300.50","53789PA010","7205839443","PAN002","PAS002","PAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100008-01","Standard Bronze On Exchange Plan","61.97%","0.621985912322998","Yes","Yes","Yes","40%","60%","$6,300","$0","$200","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50%","$6,300","$6300 per person","$12600 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010000801_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","5"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0070002","Healthy Benefits HMO 0.50 EX","53789PA007","7205839443","PAN004","PAS003","PAF011","Existing","HMO","Silver","Yes","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0070002-01","Standard Silver On Exchange Plan","71.60%","0.734508275985718","No","Yes","Yes","40%","60%","$0","$0","$3,400","$200","$0","$200","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA007000201.pdf","https://www.capbluecross.com/wps/wcm/connect/43f654d3-3a93-4a5b-ae45-b60d71f390a9/NF-92.pdf?MOD=AJPERES","5"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080002","Healthy Benefits Value HMO 0.50 EX","53789PA008","7205839443","PAN003","PAS001","PAF011","Existing","HMO","Silver","Yes","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080002-00","Standard Silver Off Exchange Plan","71.60%","0.734508275985718","No","Yes","Yes","40%","60%","$0","$0","$3,400","$200","$0","$200","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008000201.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","6"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","Individual","No","23-2399845","53789PA0100008","Healthy Benefits HMO 6300.50","53789PA010","7205839443","PAN002","PAS002","PAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010000802_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","6"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","Individual","No","23-2399845","53789PA0100008","Healthy Benefits HMO 6300.50","53789PA010","7205839443","PAN002","PAS002","PAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100008-03","Limited Cost Sharing Plan Variation","61.97%","0.621985912322998","Yes","Yes","Yes","40%","60%","$6,300","$0","$200","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50%","$6,300","$6300 per person","$12600 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010000803_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","7"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080002","Healthy Benefits Value HMO 0.50 EX","53789PA008","7205839443","PAN003","PAS001","PAF011","Existing","HMO","Silver","Yes","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080002-01","Standard Silver On Exchange Plan","71.60%","0.734508275985718","No","Yes","Yes","40%","60%","$0","$0","$3,400","$200","$0","$200","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008000201.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","7"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080005","Healthy Benefits Value HMO 0.50 EX","53789PA008","7205839443","PAN003","PAS004","PAF011","Existing","HMO","Silver","Yes","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080005-00","Standard Silver Off Exchange Plan","71.60%","0.734508275985718","No","Yes","Yes","40%","60%","$0","$0","$3,400","$200","$0","$200","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008000501.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","8"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","Individual","No","23-2399845","53789PA0110008","Healthy Benefits Value HMO 6300.50","53789PA011","7205839443","PAN001","PAS001","PAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110008-00","Standard Bronze Off Exchange Plan","61.97%","0.621985912322998","Yes","Yes","Yes","40%","60%","$6,300","$0","$200","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50%","$6,300","$6300 per person","$12600 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011000800_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","8"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","Individual","No","23-2399845","53789PA0110008","Healthy Benefits Value HMO 6300.50","53789PA011","7205839443","PAN001","PAS001","PAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110008-01","Standard Bronze On Exchange Plan","61.97%","0.621985912322998","Yes","Yes","Yes","40%","60%","$6,300","$0","$200","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50%","$6,300","$6300 per person","$12600 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011000801_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","9"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080005","Healthy Benefits Value HMO 0.50 EX","53789PA008","7205839443","PAN003","PAS004","PAF011","Existing","HMO","Silver","Yes","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080005-01","Standard Silver On Exchange Plan","71.60%","0.734508275985718","No","Yes","Yes","40%","60%","$0","$0","$3,400","$200","$0","$200","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008000501.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","9"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080008","Healthy Benefits Value HMO 0.50 EX","53789PA008","7205839443","PAN003","PAS005","PAF011","Existing","HMO","Silver","Yes","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080008-00","Standard Silver Off Exchange Plan","71.60%","0.734508275985718","No","Yes","Yes","40%","60%","$0","$0","$3,400","$200","$0","$200","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008000801.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","10"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","Individual","No","23-2399845","53789PA0110008","Healthy Benefits Value HMO 6300.50","53789PA011","7205839443","PAN001","PAS001","PAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011000802_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","10"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","Individual","No","23-2399845","53789PA0110008","Healthy Benefits Value HMO 6300.50","53789PA011","7205839443","PAN001","PAS001","PAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110008-03","Limited Cost Sharing Plan Variation","61.97%","0.621985912322998","Yes","Yes","Yes","40%","60%","$6,300","$0","$200","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50%","$6,300","$6300 per person","$12600 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011000803_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","11"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080008","Healthy Benefits Value HMO 0.50 EX","53789PA008","7205839443","PAN003","PAS005","PAF011","Existing","HMO","Silver","Yes","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080008-01","Standard Silver On Exchange Plan","71.60%","0.734508275985718","No","Yes","Yes","40%","60%","$0","$0","$3,400","$200","$0","$200","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008000801.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","11"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0070001","Healthy Benefits HMO 4750.50 EX","53789PA007","7205839443","PAN004","PAS003","PAF002","Existing","HMO","Bronze","Yes","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0070001-00","Standard Bronze Off Exchange Plan","62.00%","0.625345051288605","Yes","Yes","Yes","40%","60%","$4,800","$0","$1,000","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","50%","$4,750","$4750 per person","$9500 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA007000101.pdf","https://www.capbluecross.com/wps/wcm/connect/43f654d3-3a93-4a5b-ae45-b60d71f390a9/NF-92.pdf?MOD=AJPERES","12"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","Individual","No","23-2399845","53789PA0110019","Healthy Benefits Value HMO 6300.50","53789PA011","7205839443","PAN001","PAS004","PAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110019-00","Standard Bronze Off Exchange Plan","61.97%","0.621985912322998","Yes","Yes","Yes","40%","60%","$6,300","$0","$200","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50%","$6,300","$6300 per person","$12600 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001900_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","12"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","Individual","No","23-2399845","53789PA0110019","Healthy Benefits Value HMO 6300.50","53789PA011","7205839443","PAN001","PAS004","PAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110019-01","Standard Bronze On Exchange Plan","61.97%","0.621985912322998","Yes","Yes","Yes","40%","60%","$6,300","$0","$200","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50%","$6,300","$6300 per person","$12600 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001901_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","13"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0070001","Healthy Benefits HMO 4750.50 EX","53789PA007","7205839443","PAN004","PAS003","PAF002","Existing","HMO","Bronze","Yes","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0070001-01","Standard Bronze On Exchange Plan","62.00%","0.625345051288605","Yes","Yes","Yes","40%","60%","$4,800","$0","$1,000","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","50%","$4,750","$4750 per person","$9500 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA007000101.pdf","https://www.capbluecross.com/wps/wcm/connect/43f654d3-3a93-4a5b-ae45-b60d71f390a9/NF-92.pdf?MOD=AJPERES","13"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080001","Healthy Benefits Value HMO 4750.50 EX","53789PA008","7205839443","PAN003","PAS001","PAF002","Existing","HMO","Bronze","Yes","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080001-00","Standard Bronze Off Exchange Plan","62.00%","0.625345051288605","Yes","Yes","Yes","40%","60%","$4,800","$0","$1,000","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","50%","$4,750","$4750 per person","$9500 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008000101.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","14"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","Individual","No","23-2399845","53789PA0110019","Healthy Benefits Value HMO 6300.50","53789PA011","7205839443","PAN001","PAS004","PAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110019-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001902_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","14"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","Individual","No","23-2399845","53789PA0110019","Healthy Benefits Value HMO 6300.50","53789PA011","7205839443","PAN001","PAS004","PAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110019-03","Limited Cost Sharing Plan Variation","61.97%","0.621985912322998","Yes","Yes","Yes","40%","60%","$6,300","$0","$200","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50%","$6,300","$6300 per person","$12600 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001903_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","15"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080001","Healthy Benefits Value HMO 4750.50 EX","53789PA008","7205839443","PAN003","PAS001","PAF002","Existing","HMO","Bronze","Yes","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080001-01","Standard Bronze On Exchange Plan","62.00%","0.625345051288605","Yes","Yes","Yes","40%","60%","$4,800","$0","$1,000","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","50%","$4,750","$4750 per person","$9500 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008000101.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","15"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080004","Healthy Benefits Value HMO 4750.50 EX","53789PA008","7205839443","PAN003","PAS004","PAF002","Existing","HMO","Bronze","Yes","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080004-00","Standard Bronze Off Exchange Plan","62.00%","0.625345051288605","Yes","Yes","Yes","40%","60%","$4,800","$0","$1,000","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","50%","$4,750","$4750 per person","$9500 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008000401.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","16"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","Individual","No","23-2399845","53789PA0110020","Healthy Benefits Value HMO 6300.50","53789PA011","7205839443","PAN001","PAS005","PAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110020-00","Standard Bronze Off Exchange Plan","61.97%","0.621985912322998","Yes","Yes","Yes","40%","60%","$6,300","$0","$200","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50%","$6,300","$6300 per person","$12600 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002000_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","16"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","Individual","No","23-2399845","53789PA0110020","Healthy Benefits Value HMO 6300.50","53789PA011","7205839443","PAN001","PAS005","PAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110020-01","Standard Bronze On Exchange Plan","61.97%","0.621985912322998","Yes","Yes","Yes","40%","60%","$6,300","$0","$200","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50%","$6,300","$6300 per person","$12600 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002001_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","17"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080004","Healthy Benefits Value HMO 4750.50 EX","53789PA008","7205839443","PAN003","PAS004","PAF002","Existing","HMO","Bronze","Yes","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080004-01","Standard Bronze On Exchange Plan","62.00%","0.625345051288605","Yes","Yes","Yes","40%","60%","$4,800","$0","$1,000","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","50%","$4,750","$4750 per person","$9500 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008000401.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","17"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080007","Healthy Benefits Value HMO 4750.50 EX","53789PA008","7205839443","PAN003","PAS005","PAF002","Existing","HMO","Bronze","Yes","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080007-00","Standard Bronze Off Exchange Plan","62.00%","0.625345051288605","Yes","Yes","Yes","40%","60%","$4,800","$0","$1,000","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","50%","$4,750","$4750 per person","$9500 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008000701.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","18"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","Individual","No","23-2399845","53789PA0110020","Healthy Benefits Value HMO 6300.50","53789PA011","7205839443","PAN001","PAS005","PAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110020-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002002_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","18"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","Individual","No","23-2399845","53789PA0110020","Healthy Benefits Value HMO 6300.50","53789PA011","7205839443","PAN001","PAS005","PAF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110020-03","Limited Cost Sharing Plan Variation","61.97%","0.621985912322998","Yes","Yes","Yes","40%","60%","$6,300","$0","$200","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50%","$6,300","$6300 per person","$12600 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002003_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","19"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","2","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080007","Healthy Benefits Value HMO 4750.50 EX","53789PA008","7205839443","PAN003","PAS005","PAF002","Existing","HMO","Bronze","Yes","Both","No","Yes","All except OBGYN",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0080007-01","Standard Bronze On Exchange Plan","62.00%","0.625345051288605","Yes","Yes","Yes","40%","60%","$4,800","$0","$1,000","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","50%","$4,750","$4750 per person","$9500 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.capbluecross.com/pdf/benefits_summary/sg/2016/53789PA008000701.pdf","https://www.capbluecross.com/wps/wcm/connect/b5548a8f-e347-4dcb-8549-6cc3a643c2fe/HM-3.pdf?MOD=AJPERES","19"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100009","Healthy Benefits HMO 4500.0","53789PA010","7205839443","PAN002","PAS002","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100009-00","Standard Silver Off Exchange Plan",,"0.699142456054688","Yes","Yes","Yes","40%","60%","$4,500","$10","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%","$4,500","$4500 per person","$9000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010000900_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","4"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100009","Healthy Benefits HMO 4500.0","53789PA010","7205839443","PAN002","PAS002","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100009-01","Standard Silver On Exchange Plan",,"0.699142456054688","Yes","Yes","Yes","40%","60%","$4,500","$10","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%","$4,500","$4500 per person","$9000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010000901_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","5"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100009","Healthy Benefits HMO 4500.0","53789PA010","7205839443","PAN002","PAS002","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010000902_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","6"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100009","Healthy Benefits HMO 4500.0","53789PA010","7205839443","PAN002","PAS002","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100009-03","Limited Cost Sharing Plan Variation",,"0.699142456054688","Yes","Yes","Yes","40%","60%","$4,500","$10","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%","$4,500","$4500 per person","$9000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010000903_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","7"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100009","Healthy Benefits HMO 4500.0","53789PA010","7205839443","PAN002","PAS002","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100009-04","73% AV Level Silver Plan",,"0.723888397216797","Yes","Yes","Yes","40%","60%","$4,000","$10","$0","$200","$4,000","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%","$4,000","$4000 per person","$8000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010000904_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","8"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100009","Healthy Benefits HMO 4500.0","53789PA010","7205839443","PAN002","PAS002","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100009-05","87% AV Level Silver Plan",,"0.875805556774139","Yes","Yes","Yes","40%","60%","$1,000","$10","$0","$200","$1,000","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010000905_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","9"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100009","Healthy Benefits HMO 4500.0","53789PA010","7205839443","PAN002","PAS002","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100009-06","94% AV Level Silver Plan",,"0.942583918571472","Yes","Yes","Yes","40%","60%","$300","$0","$0","$200","$300","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010000906_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","10"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110009","Healthy Benefits Value HMO 4500.0","53789PA011","7205839443","PAN001","PAS001","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110009-00","Standard Silver Off Exchange Plan",,"0.699142456054688","Yes","Yes","Yes","40%","60%","$4,500","$10","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%","$4,500","$4500 per person","$9000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011000900_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","11"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110009","Healthy Benefits Value HMO 4500.0","53789PA011","7205839443","PAN001","PAS001","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110009-01","Standard Silver On Exchange Plan",,"0.699142456054688","Yes","Yes","Yes","40%","60%","$4,500","$10","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%","$4,500","$4500 per person","$9000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011000901_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","12"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110009","Healthy Benefits Value HMO 4500.0","53789PA011","7205839443","PAN001","PAS001","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011000902_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","13"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110009","Healthy Benefits Value HMO 4500.0","53789PA011","7205839443","PAN001","PAS001","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110009-03","Limited Cost Sharing Plan Variation",,"0.699142456054688","Yes","Yes","Yes","40%","60%","$4,500","$10","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%","$4,500","$4500 per person","$9000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011000903_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","14"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110009","Healthy Benefits Value HMO 4500.0","53789PA011","7205839443","PAN001","PAS001","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110009-04","73% AV Level Silver Plan",,"0.723888397216797","Yes","Yes","Yes","40%","60%","$4,000","$10","$0","$200","$4,000","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%","$4,000","$4000 per person","$8000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011000904_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","15"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110009","Healthy Benefits Value HMO 4500.0","53789PA011","7205839443","PAN001","PAS001","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110009-05","87% AV Level Silver Plan",,"0.875805556774139","Yes","Yes","Yes","40%","60%","$1,000","$10","$0","$200","$1,000","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011000905_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","16"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110009","Healthy Benefits Value HMO 4500.0","53789PA011","7205839443","PAN001","PAS001","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110009-06","94% AV Level Silver Plan",,"0.942583918571472","Yes","Yes","Yes","40%","60%","$300","$0","$0","$200","$300","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011000906_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","17"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110021","Healthy Benefits Value HMO 4500.0","53789PA011","7205839443","PAN001","PAS004","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110021-00","Standard Silver Off Exchange Plan",,"0.699142456054688","Yes","Yes","Yes","40%","60%","$4,500","$10","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%","$4,500","$4500 per person","$9000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002100_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","18"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110021","Healthy Benefits Value HMO 4500.0","53789PA011","7205839443","PAN001","PAS004","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110021-01","Standard Silver On Exchange Plan",,"0.699142456054688","Yes","Yes","Yes","40%","60%","$4,500","$10","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%","$4,500","$4500 per person","$9000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002101_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","19"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110021","Healthy Benefits Value HMO 4500.0","53789PA011","7205839443","PAN001","PAS004","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002102_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","20"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110021","Healthy Benefits Value HMO 4500.0","53789PA011","7205839443","PAN001","PAS004","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110021-03","Limited Cost Sharing Plan Variation",,"0.699142456054688","Yes","Yes","Yes","40%","60%","$4,500","$10","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%","$4,500","$4500 per person","$9000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002103_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","21"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110021","Healthy Benefits Value HMO 4500.0","53789PA011","7205839443","PAN001","PAS004","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110021-04","73% AV Level Silver Plan",,"0.723888397216797","Yes","Yes","Yes","40%","60%","$4,000","$10","$0","$200","$4,000","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%","$4,000","$4000 per person","$8000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002104_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","22"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110021","Healthy Benefits Value HMO 4500.0","53789PA011","7205839443","PAN001","PAS004","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110021-05","87% AV Level Silver Plan",,"0.875805556774139","Yes","Yes","Yes","40%","60%","$1,000","$10","$0","$200","$1,000","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002105_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","23"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110021","Healthy Benefits Value HMO 4500.0","53789PA011","7205839443","PAN001","PAS004","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110021-06","94% AV Level Silver Plan",,"0.942583918571472","Yes","Yes","Yes","40%","60%","$300","$0","$0","$200","$300","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002106_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","24"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110022","Healthy Benefits Value HMO 4500.0","53789PA011","7205839443","PAN001","PAS005","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110022-00","Standard Silver Off Exchange Plan",,"0.699142456054688","Yes","Yes","Yes","40%","60%","$4,500","$10","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%","$4,500","$4500 per person","$9000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002200_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","25"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110022","Healthy Benefits Value HMO 4500.0","53789PA011","7205839443","PAN001","PAS005","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110022-01","Standard Silver On Exchange Plan",,"0.699142456054688","Yes","Yes","Yes","40%","60%","$4,500","$10","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%","$4,500","$4500 per person","$9000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002201_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","26"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110022","Healthy Benefits Value HMO 4500.0","53789PA011","7205839443","PAN001","PAS005","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110022-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002202_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","27"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110022","Healthy Benefits Value HMO 4500.0","53789PA011","7205839443","PAN001","PAS005","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110022-03","Limited Cost Sharing Plan Variation",,"0.699142456054688","Yes","Yes","Yes","40%","60%","$4,500","$10","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%","$4,500","$4500 per person","$9000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002203_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","28"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110022","Healthy Benefits Value HMO 4500.0","53789PA011","7205839443","PAN001","PAS005","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110022-04","73% AV Level Silver Plan",,"0.723888397216797","Yes","Yes","Yes","40%","60%","$4,000","$10","$0","$200","$4,000","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%","$4,000","$4000 per person","$8000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002204_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","29"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110022","Healthy Benefits Value HMO 4500.0","53789PA011","7205839443","PAN001","PAS005","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110022-05","87% AV Level Silver Plan",,"0.875805556774139","Yes","Yes","Yes","40%","60%","$1,000","$10","$0","$200","$1,000","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002205_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","30"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110022","Healthy Benefits Value HMO 4500.0","53789PA011","7205839443","PAN001","PAS005","PAF005","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110022-06","94% AV Level Silver Plan",,"0.942583918571472","Yes","Yes","Yes","40%","60%","$300","$0","$0","$200","$300","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002206_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","31"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100010","Healthy Benefits HMO 3500.0","53789PA010","7205839443","PAN002","PAS002","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100010-00","Standard Silver Off Exchange Plan",,"0.714544355869293","Yes","Yes","Yes","40%","60%","$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%","$3,500","$3500 per person","$7000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001000_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","32"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100010","Healthy Benefits HMO 3500.0","53789PA010","7205839443","PAN002","PAS002","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100010-01","Standard Silver On Exchange Plan",,"0.714544355869293","Yes","Yes","Yes","40%","60%","$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%","$3,500","$3500 per person","$7000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001001_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","33"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100010","Healthy Benefits HMO 3500.0","53789PA010","7205839443","PAN002","PAS002","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001002_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","34"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100010","Healthy Benefits HMO 3500.0","53789PA010","7205839443","PAN002","PAS002","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100010-03","Limited Cost Sharing Plan Variation",,"0.714544355869293","Yes","Yes","Yes","40%","60%","$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%","$3,500","$3500 per person","$7000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001003_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","35"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100010","Healthy Benefits HMO 3500.0","53789PA010","7205839443","PAN002","PAS002","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100010-04","73% AV Level Silver Plan",,"0.736997604370117","Yes","Yes","Yes","40%","60%","$3,300","$0","$0","$200","$3,300","$30","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0%","$3,250","$3250 per person","$6500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001004_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","36"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100010","Healthy Benefits HMO 3500.0","53789PA010","7205839443","PAN002","PAS002","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100010-05","87% AV Level Silver Plan",,"0.868068695068359","Yes","Yes","Yes","40%","60%","$1,300","$0","$0","$200","$1,300","$50","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%","$1,250","$1250 per person","$2500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001005_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","37"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100010","Healthy Benefits HMO 3500.0","53789PA010","7205839443","PAN002","PAS002","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100010-06","94% AV Level Silver Plan",,"0.935489058494568","Yes","Yes","Yes","40%","60%","$500","$0","$0","$200","$500","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001006_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","38"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110010","Healthy Benefits Value HMO 3500.0","53789PA011","7205839443","PAN001","PAS001","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110010-00","Standard Silver Off Exchange Plan",,"0.714544355869293","Yes","Yes","Yes","40%","60%","$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%","$3,500","$3500 per person","$7000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001000_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","39"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110010","Healthy Benefits Value HMO 3500.0","53789PA011","7205839443","PAN001","PAS001","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110010-01","Standard Silver On Exchange Plan",,"0.714544355869293","Yes","Yes","Yes","40%","60%","$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%","$3,500","$3500 per person","$7000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001001_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","40"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110010","Healthy Benefits Value HMO 3500.0","53789PA011","7205839443","PAN001","PAS001","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001002_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","41"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110010","Healthy Benefits Value HMO 3500.0","53789PA011","7205839443","PAN001","PAS001","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110010-03","Limited Cost Sharing Plan Variation",,"0.714544355869293","Yes","Yes","Yes","40%","60%","$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%","$3,500","$3500 per person","$7000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001003_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","42"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110010","Healthy Benefits Value HMO 3500.0","53789PA011","7205839443","PAN001","PAS001","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110010-04","73% AV Level Silver Plan",,"0.736997604370117","Yes","Yes","Yes","40%","60%","$3,300","$0","$0","$200","$3,300","$30","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0%","$3,250","$3250 per person","$6500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001004_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","43"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110010","Healthy Benefits Value HMO 3500.0","53789PA011","7205839443","PAN001","PAS001","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110010-05","87% AV Level Silver Plan",,"0.868068695068359","Yes","Yes","Yes","40%","60%","$1,300","$0","$0","$200","$1,300","$50","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%","$1,250","$1250 per person","$2500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001005_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","44"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110010","Healthy Benefits Value HMO 3500.0","53789PA011","7205839443","PAN001","PAS001","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110010-06","94% AV Level Silver Plan",,"0.935489058494568","Yes","Yes","Yes","40%","60%","$500","$0","$0","$200","$500","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001006_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","45"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110023","Healthy Benefits Value HMO 3500.0","53789PA011","7205839443","PAN001","PAS004","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110023-00","Standard Silver Off Exchange Plan",,"0.714544355869293","Yes","Yes","Yes","40%","60%","$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%","$3,500","$3500 per person","$7000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002300_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","46"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110023","Healthy Benefits Value HMO 3500.0","53789PA011","7205839443","PAN001","PAS004","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110023-01","Standard Silver On Exchange Plan",,"0.714544355869293","Yes","Yes","Yes","40%","60%","$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%","$3,500","$3500 per person","$7000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002301_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","47"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110023","Healthy Benefits Value HMO 3500.0","53789PA011","7205839443","PAN001","PAS004","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110023-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002302_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","48"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110023","Healthy Benefits Value HMO 3500.0","53789PA011","7205839443","PAN001","PAS004","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110023-03","Limited Cost Sharing Plan Variation",,"0.714544355869293","Yes","Yes","Yes","40%","60%","$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%","$3,500","$3500 per person","$7000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002303_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","49"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110023","Healthy Benefits Value HMO 3500.0","53789PA011","7205839443","PAN001","PAS004","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110023-04","73% AV Level Silver Plan",,"0.736997604370117","Yes","Yes","Yes","40%","60%","$3,300","$0","$0","$200","$3,300","$30","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0%","$3,250","$3250 per person","$6500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002304_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","50"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110023","Healthy Benefits Value HMO 3500.0","53789PA011","7205839443","PAN001","PAS004","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110023-05","87% AV Level Silver Plan",,"0.868068695068359","Yes","Yes","Yes","40%","60%","$1,300","$0","$0","$200","$1,300","$50","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%","$1,250","$1250 per person","$2500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002305_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","51"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110023","Healthy Benefits Value HMO 3500.0","53789PA011","7205839443","PAN001","PAS004","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110023-06","94% AV Level Silver Plan",,"0.935489058494568","Yes","Yes","Yes","40%","60%","$500","$0","$0","$200","$500","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002306_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","52"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110024","Healthy Benefits Value HMO 3500.0","53789PA011","7205839443","PAN001","PAS005","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110024-00","Standard Silver Off Exchange Plan",,"0.714544355869293","Yes","Yes","Yes","40%","60%","$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%","$3,500","$3500 per person","$7000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002400_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","53"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110024","Healthy Benefits Value HMO 3500.0","53789PA011","7205839443","PAN001","PAS005","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110024-01","Standard Silver On Exchange Plan",,"0.714544355869293","Yes","Yes","Yes","40%","60%","$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%","$3,500","$3500 per person","$7000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002401_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","54"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110024","Healthy Benefits Value HMO 3500.0","53789PA011","7205839443","PAN001","PAS005","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110024-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002402_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","55"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110024","Healthy Benefits Value HMO 3500.0","53789PA011","7205839443","PAN001","PAS005","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110024-03","Limited Cost Sharing Plan Variation",,"0.714544355869293","Yes","Yes","Yes","40%","60%","$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%","$3,500","$3500 per person","$7000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002403_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","56"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110024","Healthy Benefits Value HMO 3500.0","53789PA011","7205839443","PAN001","PAS005","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110024-04","73% AV Level Silver Plan",,"0.736997604370117","Yes","Yes","Yes","40%","60%","$3,300","$0","$0","$200","$3,300","$30","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0%","$3,250","$3250 per person","$6500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002404_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","57"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110024","Healthy Benefits Value HMO 3500.0","53789PA011","7205839443","PAN001","PAS005","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110024-05","87% AV Level Silver Plan",,"0.868068695068359","Yes","Yes","Yes","40%","60%","$1,300","$0","$0","$200","$1,300","$50","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%","$1,250","$1250 per person","$2500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002405_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","58"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110024","Healthy Benefits Value HMO 3500.0","53789PA011","7205839443","PAN001","PAS005","PAF001","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110024-06","94% AV Level Silver Plan",,"0.935489058494568","Yes","Yes","Yes","40%","60%","$500","$0","$0","$200","$500","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002406_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","59"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100006","Healthy Benefits HMO 2500.0","53789PA010","7205839443","PAN002","PAS002","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100006-00","Standard Silver Off Exchange Plan",,"0.717433631420136","Yes","Yes","Yes","40%","60%","$2,500","$20","$0","$200","$2,500","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%","$2,500","$2500 per person","$5000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010000600_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","60"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100006","Healthy Benefits HMO 2500.0","53789PA010","7205839443","PAN002","PAS002","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100006-01","Standard Silver On Exchange Plan",,"0.717433631420136","Yes","Yes","Yes","40%","60%","$2,500","$20","$0","$200","$2,500","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%","$2,500","$2500 per person","$5000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010000601_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","61"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100006","Healthy Benefits HMO 2500.0","53789PA010","7205839443","PAN002","PAS002","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010000602_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","62"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100006","Healthy Benefits HMO 2500.0","53789PA010","7205839443","PAN002","PAS002","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100006-03","Limited Cost Sharing Plan Variation",,"0.717433631420136","Yes","Yes","Yes","40%","60%","$2,500","$20","$0","$200","$2,500","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%","$2,500","$2500 per person","$5000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010000603_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","63"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100006","Healthy Benefits HMO 2500.0","53789PA010","7205839443","PAN002","PAS002","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100006-04","73% AV Level Silver Plan",,"0.738784909248352","Yes","Yes","Yes","40%","60%","$2,400","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","0%","$2,400","$2400 per person","$4800 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010000604_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","64"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100006","Healthy Benefits HMO 2500.0","53789PA010","7205839443","PAN002","PAS002","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100006-05","87% AV Level Silver Plan",,"0.873042404651642","Yes","Yes","Yes","40%","60%","$800","$20","$0","$200","$800","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0%","$750","$750 per person","$1500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010000605_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","65"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100006","Healthy Benefits HMO 2500.0","53789PA010","7205839443","PAN002","PAS002","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100006-06","94% AV Level Silver Plan",,"0.936065196990967","Yes","Yes","Yes","40%","60%","$300","$10","$0","$200","$300","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010000606_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","66"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110006","Healthy Benefits Value HMO 2500.0","53789PA011","7205839443","PAN001","PAS001","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110006-00","Standard Silver Off Exchange Plan",,"0.717433631420136","Yes","Yes","Yes","40%","60%","$2,500","$20","$0","$200","$2,500","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%","$2,500","$2500 per person","$5000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011000600_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","67"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110006","Healthy Benefits Value HMO 2500.0","53789PA011","7205839443","PAN001","PAS001","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110006-01","Standard Silver On Exchange Plan",,"0.717433631420136","Yes","Yes","Yes","40%","60%","$2,500","$20","$0","$200","$2,500","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%","$2,500","$2500 per person","$5000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011000601_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","68"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110006","Healthy Benefits Value HMO 2500.0","53789PA011","7205839443","PAN001","PAS001","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011000602_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","69"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110006","Healthy Benefits Value HMO 2500.0","53789PA011","7205839443","PAN001","PAS001","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110006-03","Limited Cost Sharing Plan Variation",,"0.717433631420136","Yes","Yes","Yes","40%","60%","$2,500","$20","$0","$200","$2,500","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%","$2,500","$2500 per person","$5000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011000603_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","70"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110006","Healthy Benefits Value HMO 2500.0","53789PA011","7205839443","PAN001","PAS001","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110006-04","73% AV Level Silver Plan",,"0.738784909248352","Yes","Yes","Yes","40%","60%","$2,400","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","0%","$2,400","$2400 per person","$4800 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011000604_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","71"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110006","Healthy Benefits Value HMO 2500.0","53789PA011","7205839443","PAN001","PAS001","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110006-05","87% AV Level Silver Plan",,"0.873042404651642","Yes","Yes","Yes","40%","60%","$800","$20","$0","$200","$800","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0%","$750","$750 per person","$1500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011000605_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","72"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110006","Healthy Benefits Value HMO 2500.0","53789PA011","7205839443","PAN001","PAS001","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110006-06","94% AV Level Silver Plan",,"0.936065196990967","Yes","Yes","Yes","40%","60%","$300","$10","$0","$200","$300","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011000606_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","73"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110027","Healthy Benefits Value HMO 2500.0","53789PA011","7205839443","PAN001","PAS004","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110027-00","Standard Silver Off Exchange Plan",,"0.717433631420136","Yes","Yes","Yes","40%","60%","$2,500","$20","$0","$200","$2,500","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%","$2,500","$2500 per person","$5000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002700_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","74"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110027","Healthy Benefits Value HMO 2500.0","53789PA011","7205839443","PAN001","PAS004","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110027-01","Standard Silver On Exchange Plan",,"0.717433631420136","Yes","Yes","Yes","40%","60%","$2,500","$20","$0","$200","$2,500","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%","$2,500","$2500 per person","$5000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002701_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","75"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110027","Healthy Benefits Value HMO 2500.0","53789PA011","7205839443","PAN001","PAS004","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110027-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002702_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","76"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110027","Healthy Benefits Value HMO 2500.0","53789PA011","7205839443","PAN001","PAS004","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110027-03","Limited Cost Sharing Plan Variation",,"0.717433631420136","Yes","Yes","Yes","40%","60%","$2,500","$20","$0","$200","$2,500","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%","$2,500","$2500 per person","$5000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002703_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","77"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110027","Healthy Benefits Value HMO 2500.0","53789PA011","7205839443","PAN001","PAS004","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110027-04","73% AV Level Silver Plan",,"0.738784909248352","Yes","Yes","Yes","40%","60%","$2,400","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","0%","$2,400","$2400 per person","$4800 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002704_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","78"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110027","Healthy Benefits Value HMO 2500.0","53789PA011","7205839443","PAN001","PAS004","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110027-05","87% AV Level Silver Plan",,"0.873042404651642","Yes","Yes","Yes","40%","60%","$800","$20","$0","$200","$800","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0%","$750","$750 per person","$1500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002705_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","79"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110027","Healthy Benefits Value HMO 2500.0","53789PA011","7205839443","PAN001","PAS004","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110027-06","94% AV Level Silver Plan",,"0.936065196990967","Yes","Yes","Yes","40%","60%","$300","$10","$0","$200","$300","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002706_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","80"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110028","Healthy Benefits Value HMO 2500.0","53789PA011","7205839443","PAN001","PAS005","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110028-00","Standard Silver Off Exchange Plan",,"0.717433631420136","Yes","Yes","Yes","40%","60%","$2,500","$20","$0","$200","$2,500","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%","$2,500","$2500 per person","$5000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002800_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","81"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110028","Healthy Benefits Value HMO 2500.0","53789PA011","7205839443","PAN001","PAS005","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110028-01","Standard Silver On Exchange Plan",,"0.717433631420136","Yes","Yes","Yes","40%","60%","$2,500","$20","$0","$200","$2,500","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%","$2,500","$2500 per person","$5000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002801_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","82"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110028","Healthy Benefits Value HMO 2500.0","53789PA011","7205839443","PAN001","PAS005","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110028-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002802_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","83"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110028","Healthy Benefits Value HMO 2500.0","53789PA011","7205839443","PAN001","PAS005","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110028-03","Limited Cost Sharing Plan Variation",,"0.717433631420136","Yes","Yes","Yes","40%","60%","$2,500","$20","$0","$200","$2,500","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%","$2,500","$2500 per person","$5000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002803_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","84"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110028","Healthy Benefits Value HMO 2500.0","53789PA011","7205839443","PAN001","PAS005","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110028-04","73% AV Level Silver Plan",,"0.738784909248352","Yes","Yes","Yes","40%","60%","$2,400","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","0%","$2,400","$2400 per person","$4800 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002804_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","85"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110028","Healthy Benefits Value HMO 2500.0","53789PA011","7205839443","PAN001","PAS005","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110028-05","87% AV Level Silver Plan",,"0.873042404651642","Yes","Yes","Yes","40%","60%","$800","$20","$0","$200","$800","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0%","$750","$750 per person","$1500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002805_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","86"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110028","Healthy Benefits Value HMO 2500.0","53789PA011","7205839443","PAN001","PAS005","PAF004","Existing","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110028-06","94% AV Level Silver Plan",,"0.936065196990967","Yes","Yes","Yes","40%","60%","$300","$10","$0","$200","$300","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011002806_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","87"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100017","Healthy Benefits HMO 1500.30","53789PA010","7205839443","PAN002","PAS002","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100017-00","Standard Silver Off Exchange Plan",,"0.689864039421082","Yes","Yes","Yes","40%","60%","$1,500","$0","$1,600","$200","$1,500","$0","$800","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%","$1,500","$1500 per person","$3000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001700_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","88"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100017","Healthy Benefits HMO 1500.30","53789PA010","7205839443","PAN002","PAS002","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100017-01","Standard Silver On Exchange Plan",,"0.689864039421082","Yes","Yes","Yes","40%","60%","$1,500","$0","$1,600","$200","$1,500","$0","$800","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%","$1,500","$1500 per person","$3000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001701_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","89"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100017","Healthy Benefits HMO 1500.30","53789PA010","7205839443","PAN002","PAS002","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001702_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","90"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100017","Healthy Benefits HMO 1500.30","53789PA010","7205839443","PAN002","PAS002","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100017-03","Limited Cost Sharing Plan Variation",,"0.689864039421082","Yes","Yes","Yes","40%","60%","$1,500","$0","$1,600","$200","$1,500","$0","$800","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%","$1,500","$1500 per person","$3000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001703_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","91"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100017","Healthy Benefits HMO 1500.30","53789PA010","7205839443","PAN002","PAS002","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100017-04","73% AV Level Silver Plan",,"0.728535711765289","Yes","Yes","Yes","40%","60%","$1,400","$0","$1,300","$200","$1,400","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","25%","$1,400","$1400 per person","$2800 per group","25%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001704_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","92"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100017","Healthy Benefits HMO 1500.30","53789PA010","7205839443","PAN002","PAS002","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100017-05","87% AV Level Silver Plan",,"0.870826542377472","Yes","Yes","Yes","40%","60%","$500","$0","$600","$200","$500","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%","$500","$500 per person","$1000 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001705_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","93"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100017","Healthy Benefits HMO 1500.30","53789PA010","7205839443","PAN002","PAS002","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100017-06","94% AV Level Silver Plan",,"0.932785928249359","Yes","Yes","Yes","40%","60%","$200","$0","$2,100","$200","$200","$0","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","5%","$150","$150 per person","$300 per group","5%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001706_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","94"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110041","Healthy Benefits Value HMO 1500.30","53789PA011","7205839443","PAN001","PAS001","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110041-00","Standard Silver Off Exchange Plan",,"0.689864039421082","Yes","Yes","Yes","40%","60%","$1,500","$0","$1,600","$200","$1,500","$0","$800","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%","$1,500","$1500 per person","$3000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004100_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","95"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110041","Healthy Benefits Value HMO 1500.30","53789PA011","7205839443","PAN001","PAS001","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110041-01","Standard Silver On Exchange Plan",,"0.689864039421082","Yes","Yes","Yes","40%","60%","$1,500","$0","$1,600","$200","$1,500","$0","$800","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%","$1,500","$1500 per person","$3000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004101_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","96"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110041","Healthy Benefits Value HMO 1500.30","53789PA011","7205839443","PAN001","PAS001","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110041-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004102_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","97"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110041","Healthy Benefits Value HMO 1500.30","53789PA011","7205839443","PAN001","PAS001","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110041-03","Limited Cost Sharing Plan Variation",,"0.689864039421082","Yes","Yes","Yes","40%","60%","$1,500","$0","$1,600","$200","$1,500","$0","$800","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%","$1,500","$1500 per person","$3000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004103_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","98"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110041","Healthy Benefits Value HMO 1500.30","53789PA011","7205839443","PAN001","PAS001","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110041-04","73% AV Level Silver Plan",,"0.728535711765289","Yes","Yes","Yes","40%","60%","$1,400","$0","$1,300","$200","$1,400","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","25%","$1,400","$1400 per person","$2800 per group","25%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004104_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","99"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110041","Healthy Benefits Value HMO 1500.30","53789PA011","7205839443","PAN001","PAS001","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110041-05","87% AV Level Silver Plan",,"0.870826542377472","Yes","Yes","Yes","40%","60%","$500","$0","$600","$200","$500","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%","$500","$500 per person","$1000 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004105_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","100"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110041","Healthy Benefits Value HMO 1500.30","53789PA011","7205839443","PAN001","PAS001","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110041-06","94% AV Level Silver Plan",,"0.932785928249359","Yes","Yes","Yes","40%","60%","$200","$0","$2,100","$200","$200","$0","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","5%","$150","$150 per person","$300 per group","5%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004106_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","101"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110042","Healthy Benefits Value HMO 1500.30","53789PA011","7205839443","PAN001","PAS004","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110042-00","Standard Silver Off Exchange Plan",,"0.689864039421082","Yes","Yes","Yes","40%","60%","$1,500","$0","$1,600","$200","$1,500","$0","$800","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%","$1,500","$1500 per person","$3000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004200_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","102"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110042","Healthy Benefits Value HMO 1500.30","53789PA011","7205839443","PAN001","PAS004","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110042-01","Standard Silver On Exchange Plan",,"0.689864039421082","Yes","Yes","Yes","40%","60%","$1,500","$0","$1,600","$200","$1,500","$0","$800","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%","$1,500","$1500 per person","$3000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004201_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","103"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110042","Healthy Benefits Value HMO 1500.30","53789PA011","7205839443","PAN001","PAS004","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110042-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004202_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","104"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110042","Healthy Benefits Value HMO 1500.30","53789PA011","7205839443","PAN001","PAS004","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110042-03","Limited Cost Sharing Plan Variation",,"0.689864039421082","Yes","Yes","Yes","40%","60%","$1,500","$0","$1,600","$200","$1,500","$0","$800","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%","$1,500","$1500 per person","$3000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004203_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","105"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110042","Healthy Benefits Value HMO 1500.30","53789PA011","7205839443","PAN001","PAS004","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110042-04","73% AV Level Silver Plan",,"0.728535711765289","Yes","Yes","Yes","40%","60%","$1,400","$0","$1,300","$200","$1,400","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","25%","$1,400","$1400 per person","$2800 per group","25%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004204_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","106"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110042","Healthy Benefits Value HMO 1500.30","53789PA011","7205839443","PAN001","PAS004","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110042-05","87% AV Level Silver Plan",,"0.870826542377472","Yes","Yes","Yes","40%","60%","$500","$0","$600","$200","$500","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%","$500","$500 per person","$1000 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004205_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","107"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110042","Healthy Benefits Value HMO 1500.30","53789PA011","7205839443","PAN001","PAS004","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110042-06","94% AV Level Silver Plan",,"0.932785928249359","Yes","Yes","Yes","40%","60%","$200","$0","$2,100","$200","$200","$0","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","5%","$150","$150 per person","$300 per group","5%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004206_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","108"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110043","Healthy Benefits Value HMO 1500.30","53789PA011","7205839443","PAN001","PAS005","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110043-00","Standard Silver Off Exchange Plan",,"0.689864039421082","Yes","Yes","Yes","40%","60%","$1,500","$0","$1,600","$200","$1,500","$0","$800","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%","$1,500","$1500 per person","$3000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004300_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","109"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110043","Healthy Benefits Value HMO 1500.30","53789PA011","7205839443","PAN001","PAS005","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110043-01","Standard Silver On Exchange Plan",,"0.689864039421082","Yes","Yes","Yes","40%","60%","$1,500","$0","$1,600","$200","$1,500","$0","$800","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%","$1,500","$1500 per person","$3000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004301_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","110"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110043","Healthy Benefits Value HMO 1500.30","53789PA011","7205839443","PAN001","PAS005","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110043-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004302_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","111"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110043","Healthy Benefits Value HMO 1500.30","53789PA011","7205839443","PAN001","PAS005","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110043-03","Limited Cost Sharing Plan Variation",,"0.689864039421082","Yes","Yes","Yes","40%","60%","$1,500","$0","$1,600","$200","$1,500","$0","$800","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%","$1,500","$1500 per person","$3000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004303_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","112"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110043","Healthy Benefits Value HMO 1500.30","53789PA011","7205839443","PAN001","PAS005","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110043-04","73% AV Level Silver Plan",,"0.728535711765289","Yes","Yes","Yes","40%","60%","$1,400","$0","$1,300","$200","$1,400","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","25%","$1,400","$1400 per person","$2800 per group","25%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004304_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","113"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110043","Healthy Benefits Value HMO 1500.30","53789PA011","7205839443","PAN001","PAS005","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110043-05","87% AV Level Silver Plan",,"0.870826542377472","Yes","Yes","Yes","40%","60%","$500","$0","$600","$200","$500","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%","$500","$500 per person","$1000 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004305_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","114"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110043","Healthy Benefits Value HMO 1500.30","53789PA011","7205839443","PAN001","PAS005","PAF006","New","HMO","Silver","No","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110043-06","94% AV Level Silver Plan",,"0.932785928249359","Yes","Yes","Yes","40%","60%","$200","$0","$2,100","$200","$200","$0","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","5%","$150","$150 per person","$300 per group","5%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004306_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","115"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100015","Healthy Benefits HMO 0.0","53789PA010","7205839443","PAN002","PAS002","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100015-00","Standard Silver Off Exchange Plan","71.75%","0","Yes","Yes","Yes","40%","60%","$0","$800","$0","$200","$0","$2,800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001500_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","116"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100015","Healthy Benefits HMO 0.0","53789PA010","7205839443","PAN002","PAS002","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100015-01","Standard Silver On Exchange Plan","71.75%","0","Yes","Yes","Yes","40%","60%","$0","$800","$0","$200","$0","$2,800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001501_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","117"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100015","Healthy Benefits HMO 0.0","53789PA010","7205839443","PAN002","PAS002","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001502_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","118"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100015","Healthy Benefits HMO 0.0","53789PA010","7205839443","PAN002","PAS002","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100015-03","Limited Cost Sharing Plan Variation","71.75%","0","Yes","Yes","Yes","40%","60%","$0","$800","$0","$200","$0","$2,800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001503_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","119"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100015","Healthy Benefits HMO 0.0","53789PA010","7205839443","PAN002","PAS002","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100015-04","73% AV Level Silver Plan","73.96%","0","Yes","Yes","Yes","40%","60%","$0","$800","$0","$200","$0","$2,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001504_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","120"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100015","Healthy Benefits HMO 0.0","53789PA010","7205839443","PAN002","PAS002","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100015-05","87% AV Level Silver Plan","86.23%","0","Yes","Yes","Yes","40%","60%","$0","$300","$0","$200","$0","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001505_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","121"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0100015","Healthy Benefits HMO 0.0","53789PA010","7205839443","PAN002","PAS002","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100015-06","94% AV Level Silver Plan","93.44%","0","Yes","Yes","Yes","40%","60%","$0","$60","$0","$200","$0","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001506_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","122"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110015","Healthy Benefits Value HMO 0.0","53789PA011","7205839443","PAN001","PAS001","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110015-00","Standard Silver Off Exchange Plan","71.75%","0","Yes","Yes","Yes","40%","60%","$0","$800","$0","$200","$0","$2,800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001500_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","123"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110015","Healthy Benefits Value HMO 0.0","53789PA011","7205839443","PAN001","PAS001","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110015-01","Standard Silver On Exchange Plan","71.75%","0","Yes","Yes","Yes","40%","60%","$0","$800","$0","$200","$0","$2,800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001501_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","124"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110015","Healthy Benefits Value HMO 0.0","53789PA011","7205839443","PAN001","PAS001","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001502_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","125"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110015","Healthy Benefits Value HMO 0.0","53789PA011","7205839443","PAN001","PAS001","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110015-03","Limited Cost Sharing Plan Variation","71.75%","0","Yes","Yes","Yes","40%","60%","$0","$800","$0","$200","$0","$2,800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001503_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","126"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110015","Healthy Benefits Value HMO 0.0","53789PA011","7205839443","PAN001","PAS001","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110015-04","73% AV Level Silver Plan","73.96%","0","Yes","Yes","Yes","40%","60%","$0","$800","$0","$200","$0","$2,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001504_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","127"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110015","Healthy Benefits Value HMO 0.0","53789PA011","7205839443","PAN001","PAS001","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110015-05","87% AV Level Silver Plan","86.23%","0","Yes","Yes","Yes","40%","60%","$0","$300","$0","$200","$0","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001505_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","128"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110015","Healthy Benefits Value HMO 0.0","53789PA011","7205839443","PAN001","PAS001","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110015-06","94% AV Level Silver Plan","93.44%","0","Yes","Yes","Yes","40%","60%","$0","$60","$0","$200","$0","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001506_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","129"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110035","Healthy Benefits Value HMO 0.0","53789PA011","7205839443","PAN001","PAS004","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110035-00","Standard Silver Off Exchange Plan","71.75%","0","Yes","Yes","Yes","40%","60%","$0","$800","$0","$200","$0","$2,800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003500_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","130"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110035","Healthy Benefits Value HMO 0.0","53789PA011","7205839443","PAN001","PAS004","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110035-01","Standard Silver On Exchange Plan","71.75%","0","Yes","Yes","Yes","40%","60%","$0","$800","$0","$200","$0","$2,800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003501_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","131"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110035","Healthy Benefits Value HMO 0.0","53789PA011","7205839443","PAN001","PAS004","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110035-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003502_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","132"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110035","Healthy Benefits Value HMO 0.0","53789PA011","7205839443","PAN001","PAS004","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110035-03","Limited Cost Sharing Plan Variation","71.75%","0","Yes","Yes","Yes","40%","60%","$0","$800","$0","$200","$0","$2,800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003503_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","133"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110035","Healthy Benefits Value HMO 0.0","53789PA011","7205839443","PAN001","PAS004","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110035-04","73% AV Level Silver Plan","73.96%","0","Yes","Yes","Yes","40%","60%","$0","$800","$0","$200","$0","$2,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003504_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","134"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110035","Healthy Benefits Value HMO 0.0","53789PA011","7205839443","PAN001","PAS004","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110035-05","87% AV Level Silver Plan","86.23%","0","Yes","Yes","Yes","40%","60%","$0","$300","$0","$200","$0","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003505_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","135"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110035","Healthy Benefits Value HMO 0.0","53789PA011","7205839443","PAN001","PAS004","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110035-06","94% AV Level Silver Plan","93.44%","0","Yes","Yes","Yes","40%","60%","$0","$60","$0","$200","$0","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003506_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","136"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110036","Healthy Benefits Value HMO 0.0","53789PA011","7205839443","PAN001","PAS005","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110036-00","Standard Silver Off Exchange Plan","71.75%","0","Yes","Yes","Yes","40%","60%","$0","$800","$0","$200","$0","$2,800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003600_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","137"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110036","Healthy Benefits Value HMO 0.0","53789PA011","7205839443","PAN001","PAS005","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110036-01","Standard Silver On Exchange Plan","71.75%","0","Yes","Yes","Yes","40%","60%","$0","$800","$0","$200","$0","$2,800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003601_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","138"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110036","Healthy Benefits Value HMO 0.0","53789PA011","7205839443","PAN001","PAS005","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110036-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003602_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","139"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110036","Healthy Benefits Value HMO 0.0","53789PA011","7205839443","PAN001","PAS005","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110036-03","Limited Cost Sharing Plan Variation","71.75%","0","Yes","Yes","Yes","40%","60%","$0","$800","$0","$200","$0","$2,800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003603_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","140"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110036","Healthy Benefits Value HMO 0.0","53789PA011","7205839443","PAN001","PAS005","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110036-04","73% AV Level Silver Plan","73.96%","0","Yes","Yes","Yes","40%","60%","$0","$800","$0","$200","$0","$2,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003604_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","141"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110036","Healthy Benefits Value HMO 0.0","53789PA011","7205839443","PAN001","PAS005","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110036-05","87% AV Level Silver Plan","86.23%","0","Yes","Yes","Yes","40%","60%","$0","$300","$0","$200","$0","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003605_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","142"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","3","53789","PA","Individual","No","23-2399845","53789PA0110036","Healthy Benefits Value HMO 0.0","53789PA011","7205839443","PAN001","PAS005","PAF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All except OGBYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110036-06","94% AV Level Silver Plan","93.44%","0","Yes","Yes","Yes","40%","60%","$0","$60","$0","$200","$0","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003606_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","143"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0100013","Healthy Benefits HMO 1000.0","53789PA010","7205839443","PAN002","PAS002","PAF008","Existing","HMO","Gold","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100013-00","Standard Gold Off Exchange Plan",,"0.807802796363831","No","Yes","Yes","40%","60%","$1,000","$0","$0","$200","$600","$2,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%","$300","$300 per person","$600 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001300_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","4"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0100013","Healthy Benefits HMO 1000.0","53789PA010","7205839443","PAN002","PAS002","PAF008","Existing","HMO","Gold","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100013-01","Standard Gold On Exchange Plan",,"0.807802796363831","No","Yes","Yes","40%","60%","$1,000","$0","$0","$200","$600","$2,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%","$300","$300 per person","$600 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001301_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","5"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0100013","Healthy Benefits HMO 1000.0","53789PA010","7205839443","PAN002","PAS002","PAF008","Existing","HMO","Gold","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100013-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001302_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","6"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0100013","Healthy Benefits HMO 1000.0","53789PA010","7205839443","PAN002","PAS002","PAF008","Existing","HMO","Gold","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100013-03","Limited Cost Sharing Plan Variation",,"0.807802796363831","No","Yes","Yes","40%","60%","$1,000","$0","$0","$200","$600","$2,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%","$300","$300 per person","$600 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001303_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","7"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110013","Healthy Benefits Value HMO 1000.0","53789PA011","7205839443","PAN001","PAS001","PAF008","Existing","HMO","Gold","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110013-00","Standard Gold Off Exchange Plan",,"0.807802796363831","No","Yes","Yes","40%","60%","$1,000","$0","$0","$200","$600","$2,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%","$300","$300 per person","$600 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001300_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","8"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110013","Healthy Benefits Value HMO 1000.0","53789PA011","7205839443","PAN001","PAS001","PAF008","Existing","HMO","Gold","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110013-01","Standard Gold On Exchange Plan",,"0.807802796363831","No","Yes","Yes","40%","60%","$1,000","$0","$0","$200","$600","$2,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%","$300","$300 per person","$600 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001301_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","9"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110013","Healthy Benefits Value HMO 1000.0","53789PA011","7205839443","PAN001","PAS001","PAF008","Existing","HMO","Gold","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110013-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001302_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","10"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110013","Healthy Benefits Value HMO 1000.0","53789PA011","7205839443","PAN001","PAS001","PAF008","Existing","HMO","Gold","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110013-03","Limited Cost Sharing Plan Variation",,"0.807802796363831","No","Yes","Yes","40%","60%","$1,000","$0","$0","$200","$600","$2,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%","$300","$300 per person","$600 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001303_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","11"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110031","Healthy Benefits Value HMO 1000.0","53789PA011","7205839443","PAN001","PAS004","PAF008","Existing","HMO","Gold","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110031-00","Standard Gold Off Exchange Plan",,"0.807802796363831","No","Yes","Yes","40%","60%","$1,000","$0","$0","$200","$600","$2,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%","$300","$300 per person","$600 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003100_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","12"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110031","Healthy Benefits Value HMO 1000.0","53789PA011","7205839443","PAN001","PAS004","PAF008","Existing","HMO","Gold","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110031-01","Standard Gold On Exchange Plan",,"0.807802796363831","No","Yes","Yes","40%","60%","$1,000","$0","$0","$200","$600","$2,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%","$300","$300 per person","$600 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003101_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","13"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110031","Healthy Benefits Value HMO 1000.0","53789PA011","7205839443","PAN001","PAS004","PAF008","Existing","HMO","Gold","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110031-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003102_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","14"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110031","Healthy Benefits Value HMO 1000.0","53789PA011","7205839443","PAN001","PAS004","PAF008","Existing","HMO","Gold","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110031-03","Limited Cost Sharing Plan Variation",,"0.807802796363831","No","Yes","Yes","40%","60%","$1,000","$0","$0","$200","$600","$2,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%","$300","$300 per person","$600 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003103_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","15"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110032","Healthy Benefits Value HMO 1000.0","53789PA011","7205839443","PAN001","PAS005","PAF008","Existing","HMO","Gold","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110032-00","Standard Gold Off Exchange Plan",,"0.807802796363831","No","Yes","Yes","40%","60%","$1,000","$0","$0","$200","$600","$2,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%","$300","$300 per person","$600 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003200_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","16"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110032","Healthy Benefits Value HMO 1000.0","53789PA011","7205839443","PAN001","PAS005","PAF008","Existing","HMO","Gold","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110032-01","Standard Gold On Exchange Plan",,"0.807802796363831","No","Yes","Yes","40%","60%","$1,000","$0","$0","$200","$600","$2,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%","$300","$300 per person","$600 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003201_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","17"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110032","Healthy Benefits Value HMO 1000.0","53789PA011","7205839443","PAN001","PAS005","PAF008","Existing","HMO","Gold","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110032-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003202_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","18"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110032","Healthy Benefits Value HMO 1000.0","53789PA011","7205839443","PAN001","PAS005","PAF008","Existing","HMO","Gold","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110032-03","Limited Cost Sharing Plan Variation",,"0.807802796363831","No","Yes","Yes","40%","60%","$1,000","$0","$0","$200","$600","$2,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%","$300","$300 per person","$600 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003203_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","19"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0100014","Healthy Benefits HMO 500.0","53789PA010","7205839443","PAN002","PAS002","PAF007","Existing","HMO","Gold","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100014-00","Standard Gold Off Exchange Plan","82.00%","0.8205925822258","No","Yes","Yes","40%","60%","$500","$0","$0","$200","$400","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%","$50","$50 per person","$100 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001400_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","20"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0100014","Healthy Benefits HMO 500.0","53789PA010","7205839443","PAN002","PAS002","PAF007","Existing","HMO","Gold","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100014-01","Standard Gold On Exchange Plan","82.00%","0.8205925822258","No","Yes","Yes","40%","60%","$500","$0","$0","$200","$400","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%","$50","$50 per person","$100 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001401_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","21"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0100014","Healthy Benefits HMO 500.0","53789PA010","7205839443","PAN002","PAS002","PAF007","Existing","HMO","Gold","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100014-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001402_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","22"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0100014","Healthy Benefits HMO 500.0","53789PA010","7205839443","PAN002","PAS002","PAF007","Existing","HMO","Gold","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100014-03","Limited Cost Sharing Plan Variation","82.00%","0.8205925822258","No","Yes","Yes","40%","60%","$500","$0","$0","$200","$400","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%","$50","$50 per person","$100 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001403_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","23"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110014","Healthy Benefits Value HMO 500.0","53789PA011","7205839443","PAN001","PAS001","PAF007","Existing","HMO","Gold","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110014-00","Standard Gold Off Exchange Plan","82.00%","0.8205925822258","No","Yes","Yes","40%","60%","$500","$0","$0","$200","$400","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%","$50","$50 per person","$100 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001400_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","24"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110014","Healthy Benefits Value HMO 500.0","53789PA011","7205839443","PAN001","PAS001","PAF007","Existing","HMO","Gold","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110014-01","Standard Gold On Exchange Plan","82.00%","0.8205925822258","No","Yes","Yes","40%","60%","$500","$0","$0","$200","$400","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%","$50","$50 per person","$100 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001401_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","25"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110014","Healthy Benefits Value HMO 500.0","53789PA011","7205839443","PAN001","PAS001","PAF007","Existing","HMO","Gold","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110014-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001402_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","26"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110014","Healthy Benefits Value HMO 500.0","53789PA011","7205839443","PAN001","PAS001","PAF007","Existing","HMO","Gold","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110014-03","Limited Cost Sharing Plan Variation","82.00%","0.8205925822258","No","Yes","Yes","40%","60%","$500","$0","$0","$200","$400","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%","$50","$50 per person","$100 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001403_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","27"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110033","Healthy Benefits Value HMO 500.0","53789PA011","7205839443","PAN001","PAS004","PAF007","Existing","HMO","Gold","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110033-00","Standard Gold Off Exchange Plan","82.00%","0.8205925822258","No","Yes","Yes","40%","60%","$500","$0","$0","$200","$400","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%","$50","$50 per person","$100 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003300_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","28"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110033","Healthy Benefits Value HMO 500.0","53789PA011","7205839443","PAN001","PAS004","PAF007","Existing","HMO","Gold","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110033-01","Standard Gold On Exchange Plan","82.00%","0.8205925822258","No","Yes","Yes","40%","60%","$500","$0","$0","$200","$400","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%","$50","$50 per person","$100 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003301_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","29"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110033","Healthy Benefits Value HMO 500.0","53789PA011","7205839443","PAN001","PAS004","PAF007","Existing","HMO","Gold","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110033-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003302_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","30"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110033","Healthy Benefits Value HMO 500.0","53789PA011","7205839443","PAN001","PAS004","PAF007","Existing","HMO","Gold","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110033-03","Limited Cost Sharing Plan Variation","82.00%","0.8205925822258","No","Yes","Yes","40%","60%","$500","$0","$0","$200","$400","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%","$50","$50 per person","$100 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003303_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","31"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110034","Healthy Benefits Value HMO 500.0","53789PA011","7205839443","PAN001","PAS005","PAF007","Existing","HMO","Gold","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110034-00","Standard Gold Off Exchange Plan","82.00%","0.8205925822258","No","Yes","Yes","40%","60%","$500","$0","$0","$200","$400","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%","$50","$50 per person","$100 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003400_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","32"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110034","Healthy Benefits Value HMO 500.0","53789PA011","7205839443","PAN001","PAS005","PAF007","Existing","HMO","Gold","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110034-01","Standard Gold On Exchange Plan","82.00%","0.8205925822258","No","Yes","Yes","40%","60%","$500","$0","$0","$200","$400","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%","$50","$50 per person","$100 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003401_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","33"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110034","Healthy Benefits Value HMO 500.0","53789PA011","7205839443","PAN001","PAS005","PAF007","Existing","HMO","Gold","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110034-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003402_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","34"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","4","53789","PA","Individual","No","23-2399845","53789PA0110034","Healthy Benefits Value HMO 500.0","53789PA011","7205839443","PAN001","PAS005","PAF007","Existing","HMO","Gold","Yes","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110034-03","Limited Cost Sharing Plan Variation","82.00%","0.8205925822258","No","Yes","Yes","40%","60%","$500","$0","$0","$200","$400","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%","$50","$50 per person","$100 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003403_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","35"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","5","53789","PA","Individual","No","23-2399845","53789PA0100016","Healthy Benefits HMO 0.0.10","53789PA010","7205839443","PAN002","PAS002","PAF009","Existing","HMO","Platinum","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100016-00","Standard Platinum Off Exchange Plan",,"0.917162597179413","Yes","Yes","Yes","40%","60%","$0","$10","$0","$200","$0","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001600_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","4"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","5","53789","PA","Individual","No","23-2399845","53789PA0100016","Healthy Benefits HMO 0.0.10","53789PA010","7205839443","PAN002","PAS002","PAF009","Existing","HMO","Platinum","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100016-01","Standard Platinum On Exchange Plan",,"0.917162597179413","Yes","Yes","Yes","40%","60%","$0","$10","$0","$200","$0","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001601_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","5"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","5","53789","PA","Individual","No","23-2399845","53789PA0100016","Healthy Benefits HMO 0.0.10","53789PA010","7205839443","PAN002","PAS002","PAF009","Existing","HMO","Platinum","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001602_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","6"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","5","53789","PA","Individual","No","23-2399845","53789PA0100016","Healthy Benefits HMO 0.0.10","53789PA010","7205839443","PAN002","PAS002","PAF009","Existing","HMO","Platinum","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0100016-03","Limited Cost Sharing Plan Variation",,"0.917162597179413","Yes","Yes","Yes","40%","60%","$0","$10","$0","$200","$0","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA010001602_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","7"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","5","53789","PA","Individual","No","23-2399845","53789PA0110016","Healthy Benefits Value HMO 0.0.10","53789PA011","7205839443","PAN001","PAS001","PAF009","Existing","HMO","Platinum","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110016-00","Standard Platinum Off Exchange Plan",,"0.917162597179413","Yes","Yes","Yes","40%","60%","$0","$10","$0","$200","$0","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001600_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","8"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","5","53789","PA","Individual","No","23-2399845","53789PA0110016","Healthy Benefits Value HMO 0.0.10","53789PA011","7205839443","PAN001","PAS001","PAF009","Existing","HMO","Platinum","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110016-01","Standard Platinum On Exchange Plan",,"0.917162597179413","Yes","Yes","Yes","40%","60%","$0","$10","$0","$200","$0","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001601_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","9"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","5","53789","PA","Individual","No","23-2399845","53789PA0110016","Healthy Benefits Value HMO 0.0.10","53789PA011","7205839443","PAN001","PAS001","PAF009","Existing","HMO","Platinum","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001602_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","10"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","5","53789","PA","Individual","No","23-2399845","53789PA0110016","Healthy Benefits Value HMO 0.0.10","53789PA011","7205839443","PAN001","PAS001","PAF009","Existing","HMO","Platinum","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110016-03","Limited Cost Sharing Plan Variation",,"0.917162597179413","Yes","Yes","Yes","40%","60%","$0","$10","$0","$200","$0","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011001603_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","11"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","5","53789","PA","Individual","No","23-2399845","53789PA0110039","Healthy Benefits Value HMO 0.0.10","53789PA011","7205839443","PAN001","PAS004","PAF009","Existing","HMO","Platinum","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110039-00","Standard Platinum Off Exchange Plan",,"0.917162597179413","Yes","Yes","Yes","40%","60%","$0","$10","$0","$200","$0","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003900_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","12"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","5","53789","PA","Individual","No","23-2399845","53789PA0110039","Healthy Benefits Value HMO 0.0.10","53789PA011","7205839443","PAN001","PAS004","PAF009","Existing","HMO","Platinum","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110039-01","Standard Platinum On Exchange Plan",,"0.917162597179413","Yes","Yes","Yes","40%","60%","$0","$10","$0","$200","$0","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003901_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","13"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","5","53789","PA","Individual","No","23-2399845","53789PA0110039","Healthy Benefits Value HMO 0.0.10","53789PA011","7205839443","PAN001","PAS004","PAF009","Existing","HMO","Platinum","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110039-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011003902_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","14"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","5","53789","PA","Individual","No","23-2399845","53789PA0110039","Healthy Benefits Value HMO 0.0.10","53789PA011","7205839443","PAN001","PAS004","PAF009","Existing","HMO","Platinum","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110039-03","Limited Cost Sharing Plan Variation",,"0.917162597179413","Yes","Yes","Yes","40%","60%","$0","$10","$0","$200","$0","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA01100390_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","15"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","5","53789","PA","Individual","No","23-2399845","53789PA0110040","Healthy Benefits Value HMO 0.0.10","53789PA011","7205839443","PAN001","PAS005","PAF009","Existing","HMO","Platinum","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110040-00","Standard Platinum Off Exchange Plan",,"0.917162597179413","Yes","Yes","Yes","40%","60%","$0","$10","$0","$200","$0","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004000_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","16"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","5","53789","PA","Individual","No","23-2399845","53789PA0110040","Healthy Benefits Value HMO 0.0.10","53789PA011","7205839443","PAN001","PAS005","PAF009","Existing","HMO","Platinum","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110040-01","Standard Platinum On Exchange Plan",,"0.917162597179413","Yes","Yes","Yes","40%","60%","$0","$10","$0","$200","$0","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004001_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","17"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","5","53789","PA","Individual","No","23-2399845","53789PA0110040","Healthy Benefits Value HMO 0.0.10","53789PA011","7205839443","PAN001","PAS005","PAF009","Existing","HMO","Platinum","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110040-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004002_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","18"
"2016","PA","53789","HIOS","6","2016-01-28 05:11:31","5","53789","PA","Individual","No","23-2399845","53789PA0110040","Healthy Benefits Value HMO 0.0.10","53789PA011","7205839443","PAN001","PAS005","PAF009","Existing","HMO","Platinum","No","Both","Yes","Yes","All except OBGYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0110040-03","Limited Cost Sharing Plan Variation",,"0.917162597179413","Yes","Yes","Yes","40%","60%","$0","$10","$0","$200","$0","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA011004003_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","19"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","Individual","No","23-2905083","55957PA0320001","myBlue Choice LP $5,500","55957PA032",,"PAN002","PAS001","PAF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999724",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0320001-00","Standard Bronze Off Exchange Plan",,"0.617726624011993","Yes","Yes","No","100%",,"$5,500","$0","$0","$150","$1,440","$0","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6550 per person","$13000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094410710_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","4"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0270001","BlueCare PPO Platinum 1","55957PA027",,"PAN002","PAS001","PAF011","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0270001-00","Standard Platinum Off Exchange Plan",,"0.902621865272522","No","Yes","No","100%",,"$500","$0","$0","$150","$500","$80","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/PPO.aspx","4"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0270001","BlueCare PPO Platinum 1","55957PA027",,"PAN002","PAS001","PAF011","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0270001-01","Standard Platinum On Exchange Plan",,"0.902621865272522","No","Yes","No","100%",,"$500","$0","$0","$150","$500","$80","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/PPO.aspx","5"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","Individual","No","23-2905083","55957PA0320001","myBlue Choice LP $5,500","55957PA032",,"PAN002","PAS001","PAF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999724",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0320001-01","Standard Bronze On Exchange Plan",,"0.617726624011993","Yes","Yes","No","100%",,"$5,500","$0","$0","$150","$1,440","$0","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6550 per person","$13000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094410710_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","5"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","Individual","No","23-2905083","55957PA0320001","myBlue Choice LP $5,500","55957PA032",,"PAN002","PAS001","PAF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999724",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0320001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094410920_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","6"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0270007","BlueCare PPO Platinum 12","55957PA027",,"PAN002","PAS001","PAF011","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0270007-00","Standard Platinum Off Exchange Plan",,"0.917413890361786","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$160","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/PPO.aspx","6"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0270007","BlueCare PPO Platinum 12","55957PA027",,"PAN002","PAS001","PAF011","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0270007-01","Standard Platinum On Exchange Plan",,"0.917413890361786","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$160","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/PPO.aspx","7"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","Individual","No","23-2905083","55957PA0320001","myBlue Choice LP $5,500","55957PA032",,"PAN002","PAS001","PAF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999724",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0320001-03","Limited Cost Sharing Plan Variation",,"0.617726624011993","Yes","Yes","No","100%",,"$5,500","$0","$0","$150","$1,440","$0","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6550 per person","$13000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094411044_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","7"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","Individual","No","23-2905083","55957PA0330001","myBlue Access LP $4,600","55957PA033",,"PAN001","PAS001","PAF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0330001-00","Standard Bronze Off Exchange Plan",,"0.619461297988892","Yes","Yes","No","100%",,"$4,600","$0","$540","$150","$2,170","$0","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group","20%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094411337_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","8"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0270014","BlueCare PPO Gold 13","55957PA027",,"PAN002","PAS001","PAF015","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0270014-00","Standard Gold Off Exchange Plan",,"0.799820065498352","No","Yes","No","100%",,"$1,050","$0","$1,250","$150","$1,100","$80","$68","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/PPO.aspx","8"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0270014","BlueCare PPO Gold 13","55957PA027",,"PAN002","PAS001","PAF015","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0270014-01","Standard Gold On Exchange Plan",,"0.799820065498352","No","Yes","No","100%",,"$1,050","$0","$1,250","$150","$1,100","$80","$68","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$100","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/PPO.aspx","9"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","Individual","No","23-2905083","55957PA0330001","myBlue Access LP $4,600","55957PA033",,"PAN001","PAS001","PAF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0330001-01","Standard Bronze On Exchange Plan",,"0.619461297988892","Yes","Yes","No","100%",,"$4,600","$0","$540","$150","$2,170","$0","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group","20%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094411337_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","9"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","Individual","No","23-2905083","55957PA0330001","myBlue Access LP $4,600","55957PA033",,"PAN001","PAS001","PAF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0330001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094411511_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","10"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0270015","BlueCare PPO Silver 5","55957PA027",,"PAN002","PAS001","PAF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0270015-00","Standard Silver Off Exchange Plan",,"0.717431545257568","No","Yes","No","100%",,"$2,550","$0","$950","$150","$1,540","$200","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$100","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/PPO.aspx","10"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0270015","BlueCare PPO Silver 5","55957PA027",,"PAN002","PAS001","PAF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0270015-01","Standard Silver On Exchange Plan",,"0.717431545257568","No","Yes","No","100%",,"$2,550","$0","$950","$150","$1,540","$200","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$100","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/PPO.aspx","11"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","Individual","No","23-2905083","55957PA0330001","myBlue Access LP $4,600","55957PA033",,"PAN001","PAS001","PAF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0330001-03","Limited Cost Sharing Plan Variation",,"0.619461297988892","Yes","Yes","No","100%",,"$4,600","$0","$540","$150","$2,170","$0","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group","20%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094413072_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","11"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","Individual","No","23-2905083","55957PA0330002","myBlue Access LP $3,500","55957PA033",,"PAN001","PAS001","PAF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999724",,,"$2,500","0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0330002-00","Standard Silver Off Exchange Plan",,"0.702761054039001","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$1,440","$0","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6550 per person","$8000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","per person not applicable","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094426962_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","12"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0270016","BlueCare PPO Platinum 13","55957PA027",,"PAN002","PAS001","PAF011","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0270016-00","Standard Platinum Off Exchange Plan",,"0.888683140277863","No","Yes","No","100%",,"$250","$0","$0","$150","$250","$160","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/PPO.aspx","12"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0270016","BlueCare PPO Platinum 13","55957PA027",,"PAN002","PAS001","PAF011","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0270016-01","Standard Platinum On Exchange Plan",,"0.888683140277863","No","Yes","No","100%",,"$250","$0","$0","$150","$250","$160","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/PPO.aspx","13"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","Individual","No","23-2905083","55957PA0330002","myBlue Access LP $3,500","55957PA033",,"PAN001","PAS001","PAF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999724",,,"$2,500","0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0330002-01","Standard Silver On Exchange Plan",,"0.702761054039001","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$1,440","$0","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6550 per person","$8000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","per person not applicable","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094426962_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","13"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","Individual","No","23-2905083","55957PA0330002","myBlue Access LP $3,500","55957PA033",,"PAN001","PAS001","PAF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999724",,,"$2,500","0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0330002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094428541_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","14"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","Individual","No","23-2905083","55957PA0330002","myBlue Access LP $3,500","55957PA033",,"PAN001","PAS001","PAF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999724",,,"$2,500","0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0330002-03","Limited Cost Sharing Plan Variation",,"0.702761054039001","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$1,440","$0","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6550 per person","$8000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","per person not applicable","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094432980_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","15"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","Individual","No","23-2905083","55957PA0330002","myBlue Access LP $3,500","55957PA033",,"PAN001","PAS001","PAF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999724",,,"$2,500","0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0330002-04","73% AV Level Silver Plan",,"0.739247024059296","Yes","Yes","No","100%",,"$2,400","$0","$0","$150","$1,440","$0","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$5450 per person","$7000 per group",,,,"$7,000","per person not applicable","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","0%",,,,,"$5,600","per person not applicable","$11200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094433050_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","16"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","Individual","No","23-2905083","55957PA0330002","myBlue Access LP $3,500","55957PA033",,"PAN001","PAS001","PAF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999724",,,"$2,500","0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0330002-05","87% AV Level Silver Plan",,"0.879057228565216","Yes","Yes","No","100%",,"$800","$0","$0","$150","$800","$0","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2250 per person","$2500 per group",,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$2000 per person","$2000 per group","0%",,,,,"$2,000","per person not applicable","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094433075_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","17"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","Individual","No","23-2905083","55957PA0330002","myBlue Access LP $3,500","55957PA033",,"PAN001","PAS001","PAF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999724",,,"$2,500","0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0330002-06","94% AV Level Silver Plan",,"0.940607309341431","Yes","Yes","No","100%",,"$250","$0","$0","$150","$250","$0","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group",,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$800 per person","$800 per group","0%",,,,,"$800","per person not applicable","$1600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094433087_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","18"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","Individual","No","23-2905083","55957PA0330003","myBlue Access LP $1,500","55957PA033",,"PAN001","PAS001","PAF006","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0330003-00","Standard Gold Off Exchange Plan",,"0.81655615568161","Yes","Yes","No","100%",,"$1,500","$0","$0","$0","$1,440","$0","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group",,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$2600 per person","$3000 per group","0%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094434524_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","19"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","Individual","No","23-2905083","55957PA0330003","myBlue Access LP $1,500","55957PA033",,"PAN001","PAS001","PAF006","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0330003-01","Standard Gold On Exchange Plan",,"0.81655615568161","Yes","Yes","No","100%",,"$1,500","$0","$0","$0","$1,440","$0","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group",,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$2600 per person","$3000 per group","0%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094434524_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","20"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","Individual","No","23-2905083","55957PA0330003","myBlue Access LP $1,500","55957PA033",,"PAN001","PAS001","PAF006","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0330003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094434539_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","21"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","1","55957","PA","Individual","No","23-2905083","55957PA0330003","myBlue Access LP $1,500","55957PA033",,"PAN001","PAS001","PAF006","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9997",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0330003-03","Limited Cost Sharing Plan Variation",,"0.81655615568161","Yes","Yes","No","100%",,"$1,500","$0","$0","$0","$1,440","$0","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group",,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$2600 per person","$3000 per group","0%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094434549_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","22"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","2","55957","PA","Individual","No","23-2905083","55957PA0350005","myBlue Access $4,000","55957PA035",,"PAN001","PAS001","PAF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.922409551",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0350005-00","Standard Bronze Off Exchange Plan",,"0.610562384128571","No","Yes","No","100%",,"$4,000","$0","$990","$150","$2,170","$0","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094413190_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","4"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","2","55957","PA","Individual","No","23-2905083","55957PA0350005","myBlue Access $4,000","55957PA035",,"PAN001","PAS001","PAF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.922409551",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0350005-01","Standard Bronze On Exchange Plan",,"0.610562384128571","No","Yes","No","100%",,"$4,000","$0","$990","$150","$2,170","$0","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094413190_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","5"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","2","55957","PA","Individual","No","23-2905083","55957PA0350005","myBlue Access $4,000","55957PA035",,"PAN001","PAS001","PAF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.922409551",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0350005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094413400_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","6"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","2","55957","PA","Individual","No","23-2905083","55957PA0350005","myBlue Access $4,000","55957PA035",,"PAN001","PAS001","PAF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.922409551",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0350005-03","Limited Cost Sharing Plan Variation",,"0.610562384128571","No","Yes","No","100%",,"$4,000","$0","$990","$150","$2,170","$0","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094413587_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","7"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","3","55957","PA","Individual","No","23-2905083","55957PA0350001","myBlue Access $1,500","55957PA035",,"PAN001","PAS001","PAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.999724",,,"$2,500","0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0350001-00","Standard Silver Off Exchange Plan",,"0.714840173721313","No","Yes","No","100%",,"$1,500","$0","$1,160","$150","$1,440","$280","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2095353735_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","4"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","3","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0300001","AffordaBlue Platinum 1","55957PA030",,"PAN001","PAS001","PAF011","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0300001-00","Standard Platinum Off Exchange Plan",,"0.894266247749329","No","Yes","Yes","85%","15%","$250","$0","$0","$150","$250","$160","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$5,000","$5000 per person","$10000 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$750","$750 per person","$1500 per group","30%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%","$0","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/AffordaBlue.aspx","4"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","3","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0300001","AffordaBlue Platinum 1","55957PA030",,"PAN001","PAS001","PAF011","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0300001-01","Standard Platinum On Exchange Plan",,"0.894266247749329","No","Yes","Yes","85%","15%","$250","$0","$0","$150","$250","$160","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$5,000","$5000 per person","$10000 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$750","$750 per person","$1500 per group","30%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%","$0","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/AffordaBlue.aspx","5"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","3","55957","PA","Individual","No","23-2905083","55957PA0350001","myBlue Access $1,500","55957PA035",,"PAN001","PAS001","PAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.999724",,,"$2,500","0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0350001-01","Standard Silver On Exchange Plan",,"0.714840173721313","No","Yes","No","100%",,"$1,500","$0","$1,160","$150","$1,440","$280","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2095353735_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","5"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","3","55957","PA","Individual","No","23-2905083","55957PA0350001","myBlue Access $1,500","55957PA035",,"PAN001","PAS001","PAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.999724",,,"$2,500","0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0350001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094420814_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","6"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","3","55957","PA","Individual","No","23-2905083","55957PA0350001","myBlue Access $1,500","55957PA035",,"PAN001","PAS001","PAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.999724",,,"$2,500","0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0350001-03","Limited Cost Sharing Plan Variation",,"0.714840173721313","No","Yes","No","100%",,"$1,500","$0","$1,160","$150","$1,440","$280","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094420847_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","7"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","3","55957","PA","Individual","No","23-2905083","55957PA0350001","myBlue Access $1,500","55957PA035",,"PAN001","PAS001","PAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.999724",,,"$2,500","0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0350001-04","73% AV Level Silver Plan",,"0.736277163028717","No","Yes","No","100%",,"$1,500","$0","$1,160","$150","$1,440","$280","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094421032_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","8"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","3","55957","PA","Individual","No","23-2905083","55957PA0350001","myBlue Access $1,500","55957PA035",,"PAN001","PAS001","PAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.999724",,,"$2,500","0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0350001-05","87% AV Level Silver Plan",,"0.868282735347748","No","Yes","No","100%",,"$250","$0","$1,000","$150","$250","$280","$238","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094421125_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","9"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","3","55957","PA","Individual","No","23-2905083","55957PA0350001","myBlue Access $1,500","55957PA035",,"PAN001","PAS001","PAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.999724",,,"$2,500","0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0350001-06","94% AV Level Silver Plan",,"0.939091384410858","No","Yes","No","100%",,"$100","$0","$250","$150","$100","$280","$268","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094421153_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","10"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","4","55957","PA","Individual","No","23-2905083","55957PA0360003","myBlue Care - Gold","55957PA036",,"PAN001","PAS001","PAF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.944095",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0360003-00","Standard Gold Off Exchange Plan",,"0.797036290168762","No","Yes","Yes","80%","20%","$500","$0","$680","$150","$500","$120","$94","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$5,500","$5500 per person","$11000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%","$3,500","$3500 per person","$7000 per group","30%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094434551_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","4"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","4","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0290017","BlueCare Custom PPO Silver 2","55957PA029",,"PAN001","PAS001","PAF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0290017-00","Standard Silver Off Exchange Plan",,"0.716791212558746","No","Yes","No","100%",,"$1,800","$200","$1,650","$150","$1,590","$320","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$150","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx","4"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","4","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0290017","BlueCare Custom PPO Silver 2","55957PA029",,"PAN001","PAS001","PAF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0290017-01","Standard Silver On Exchange Plan",,"0.716791212558746","No","Yes","No","100%",,"$1,800","$200","$1,650","$150","$1,590","$320","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$150","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx","5"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","4","55957","PA","Individual","No","23-2905083","55957PA0360003","myBlue Care - Gold","55957PA036",,"PAN001","PAS001","PAF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.944095",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0360003-01","Standard Gold On Exchange Plan",,"0.797036290168762","No","Yes","Yes","80%","20%","$500","$0","$680","$150","$500","$120","$94","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$5,500","$5500 per person","$11000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%","$3,500","$3500 per person","$7000 per group","30%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094434551_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","5"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","4","55957","PA","Individual","No","23-2905083","55957PA0360003","myBlue Care - Gold","55957PA036",,"PAN001","PAS001","PAF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.944095",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0360003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","80%","20%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094437738_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","6"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","4","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0290001","BlueCare Custom PPO Platinum 1","55957PA029",,"PAN001","PAS001","PAF011","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0290001-00","Standard Platinum Off Exchange Plan",,"0.902621865272522","No","Yes","No","100%",,"$500","$0","$0","$150","$500","$80","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx","6"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","4","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0290001","BlueCare Custom PPO Platinum 1","55957PA029",,"PAN001","PAS001","PAF011","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0290001-01","Standard Platinum On Exchange Plan",,"0.902621865272522","No","Yes","No","100%",,"$500","$0","$0","$150","$500","$80","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx","7"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","4","55957","PA","Individual","No","23-2905083","55957PA0360003","myBlue Care - Gold","55957PA036",,"PAN001","PAS001","PAF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.944095",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0360003-03","Limited Cost Sharing Plan Variation",,"0.797036290168762","No","Yes","Yes","80%","20%","$500","$0","$680","$150","$500","$120","$94","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$5,500","$5500 per person","$11000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%","$3,500","$3500 per person","$7000 per group","30%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094437828_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","7"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","4","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0290019","BlueCare Custom PPO Silver 9","55957PA029",,"PAN001","PAS001","PAF004","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0290019-00","Standard Silver Off Exchange Plan",,"0.703484535217285","No","Yes","No","100%",,"$4,000","$0","$0","$150","$1,440","$160","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx","8"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","4","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0290019","BlueCare Custom PPO Silver 9","55957PA029",,"PAN001","PAS001","PAF004","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0290019-01","Standard Silver On Exchange Plan",,"0.703484535217285","No","Yes","No","100%",,"$4,000","$0","$0","$150","$1,440","$160","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx","9"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","4","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0290007","BlueCare Custom PPO Platinum 12","55957PA029",,"PAN001","PAS001","PAF011","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0290007-00","Standard Platinum Off Exchange Plan",,"0.917413890361786","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$160","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx","10"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","4","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0290007","BlueCare Custom PPO Platinum 12","55957PA029",,"PAN001","PAS001","PAF011","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0290007-01","Standard Platinum On Exchange Plan",,"0.917413890361786","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$160","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx","11"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","4","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0290008","BlueCare Custom PPO Platinum 13","55957PA029",,"PAN001","PAS001","PAF008","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0290008-00","Standard Platinum Off Exchange Plan",,"0.888683140277863","No","Yes","No","100%",,"$250","$0","$0","$150","$250","$160","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx","12"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","4","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0290008","BlueCare Custom PPO Platinum 13","55957PA029",,"PAN001","PAS001","PAF008","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0290008-01","Standard Platinum On Exchange Plan",,"0.888683140277863","No","Yes","No","100%",,"$250","$0","$0","$150","$250","$160","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://www.bcnepa.com/Products/Group/BlueCareCustomPPO.aspx","13"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","5","55957","PA","Individual","No","23-2905083","55957PA0350004","myBlue Access $6,850","55957PA035",,"PAN001","PAS001","PAF009","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.999724",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0350004-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$2,170","$0","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094438223_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","4"
"2016","PA","55957","HIOS","12","2016-01-23 05:53:30","5","55957","PA","Individual","No","23-2905083","55957PA0350004","myBlue Access $6,850","55957PA035",,"PAN001","PAS001","PAF009","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.999724",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","55957PA0350004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$2,170","$0","$0","$105",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2094438223_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/NEPA%202016%20Brochure.pdf","5"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","2","64844","PA","Individual","No","23-2169745","64844PA0120002","Aetna Leap Basic HSA","64844PA012",,"PAN003","PAS003","PAF002","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/BronzeHSAAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","6"
"2016","PA","55995","HIOS","11","2015-10-18 12:35:12","1","55995","PA","Individual","Yes","31-1185262","55995PA0010001","DentaTrust PPO - Pediatric High Option","55995PA001","7083617077","PAN001","PAS001",,"New","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$31.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","55995PA0010001-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbpa.dentalcareplus.com","https://hixindsbpa.dentalcareplus.com","4"
"2016","PA","55995","HIOS","11","2015-10-18 12:35:12","1","55995","PA","SHOP (Small Group)","Yes","31-1185262","55995PA0020003","DentaSpan Family High Option","55995PA002","7083617077","PAN001","PAS001",,"New","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$27.46","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","55995PA0020003-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbpa.dentalcareplus.com","https://hixsgsbpa.dentalcareplus.com","4"
"2016","PA","55995","HIOS","11","2015-10-18 12:35:12","1","55995","PA","SHOP (Small Group)","Yes","31-1185262","55995PA0020003","DentaSpan Family High Option","55995PA002","7083617077","PAN001","PAS001",,"New","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$27.46","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","55995PA0020003-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbpa.dentalcareplus.com","https://hixsgsbpa.dentalcareplus.com","5"
"2016","PA","55995","HIOS","11","2015-10-18 12:35:12","1","55995","PA","Individual","Yes","31-1185262","55995PA0010001","DentaTrust PPO - Pediatric High Option","55995PA001","7083617077","PAN001","PAS001",,"New","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$31.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","55995PA0010001-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbpa.dentalcareplus.com","https://hixindsbpa.dentalcareplus.com","5"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","3","64844","PA","Individual","No","23-2169745","64844PA0120001","Aetna Leap Basic Plus","64844PA012",,"PAN003","PAS003","PAF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120001-01","Standard Bronze On Exchange Plan","61.59%",,"Yes","Yes","Yes","75%","25%","$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/BronzePlus.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","5"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","3","64844","PA","Individual","No","23-2169745","64844PA0120001","Aetna Leap Basic Plus","64844PA012",,"PAN003","PAS003","PAF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/BronzePlusAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","6"
"2016","PA","55995","HIOS","11","2015-10-18 12:35:12","1","55995","PA","Individual","Yes","31-1185262","55995PA0010002","DentaTrust PPO - Pediatric Low Option","55995PA001","7083617077","PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$28.20","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","55995PA0010002-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbpa.dentalcareplus.com","https://hixindsbpa.dentalcareplus.com","6"
"2016","PA","55995","HIOS","11","2015-10-18 12:35:12","1","55995","PA","SHOP (Small Group)","Yes","31-1185262","55995PA0020004","DentaSpan Family Low Option","55995PA002","7083617077","PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$24.50","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","55995PA0020004-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbpa.dentalcareplus.com","https://hixsgsbpa.dentalcareplus.com","6"
"2016","PA","55995","HIOS","11","2015-10-18 12:35:12","1","55995","PA","SHOP (Small Group)","Yes","31-1185262","55995PA0020004","DentaSpan Family Low Option","55995PA002","7083617077","PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$24.50","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","55995PA0020004-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbpa.dentalcareplus.com","https://hixsgsbpa.dentalcareplus.com","7"
"2016","PA","55995","HIOS","11","2015-10-18 12:35:12","1","55995","PA","Individual","Yes","31-1185262","55995PA0010002","DentaTrust PPO - Pediatric Low Option","55995PA001","7083617077","PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$28.20","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","55995PA0010002-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbpa.dentalcareplus.com","https://hixindsbpa.dentalcareplus.com","7"
"2016","PA","55995","HIOS","11","2015-10-18 12:35:12","1","55995","PA","SHOP (Small Group)","Yes","31-1185262","55995PA0030003","DentaSpan Dental-Family High Option-Off Exchange","55995PA003","7083617077","PAN001","PAS001",,"New","PPO","High",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$20.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","55995PA0030003-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbpa.dentalcareplus.com","https://hixsgsbpa.dentalcareplus.com","8"
"2016","PA","55995","HIOS","11","2015-10-18 12:35:12","1","55995","PA","SHOP (Small Group)","Yes","31-1185262","55995PA0030004","DentaSpan Dental-Family Low Option-Off Exchange","55995PA003","7083617077","PAN001","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$17.59","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","55995PA0030004-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbpa.dentalcareplus.com","https://hixsgsbpa.dentalcareplus.com","9"
"2016","PA","55995","HIOS","11","2015-10-18 12:35:12","2","55995","PA","SHOP (Small Group)","Yes","31-1185262","55995PA0030001","DentaSpan Pediatric High Option","55995PA003","7083617077","PAN001","PAS001",,"New","PPO","High",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$27.46","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","55995PA0030001-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbpa.dentalcareplus.com","https://hixsgsbpa.dentalcareplus.com","4"
"2016","PA","55995","HIOS","11","2015-10-18 12:35:12","2","55995","PA","Individual","Yes","31-1185262","55995PA0010003","DentaTrust-PPO Family High Option","55995PA001","7083617077","PAN001","PAS001",,"New","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$23.03","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","55995PA0010003-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbpa.dentalcareplus.com","https://hixindsbpa.dentalcareplus.com","4"
"2016","PA","55995","HIOS","11","2015-10-18 12:35:12","2","55995","PA","Individual","Yes","31-1185262","55995PA0010003","DentaTrust-PPO Family High Option","55995PA001","7083617077","PAN001","PAS001",,"New","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$23.03","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","55995PA0010003-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbpa.dentalcareplus.com","https://hixindsbpa.dentalcareplus.com","5"
"2016","PA","55995","HIOS","11","2015-10-18 12:35:12","2","55995","PA","SHOP (Small Group)","Yes","31-1185262","55995PA0030002","DentaSpan Pediatric Low Option","55995PA003","7083617077","PAN001","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$24.50","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","55995PA0030002-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbpa.dentalcareplus.com","https://hixsgsbpa.dentalcareplus.com","5"
"2016","PA","55995","HIOS","11","2015-10-18 12:35:12","2","55995","PA","Individual","Yes","31-1185262","55995PA0010004","DentaTrust-PPO Family Low Option","55995PA001","7083617077","PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$19.91","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","55995PA0010004-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbpa.dentalcareplus.com","https://hixindsbpa.dentalcareplus.com","6"
"2016","PA","55995","HIOS","11","2015-10-18 12:35:12","2","55995","PA","Individual","Yes","31-1185262","55995PA0010004","DentaTrust-PPO Family Low Option","55995PA001","7083617077","PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$19.91","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","55995PA0010004-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbpa.dentalcareplus.com","https://hixindsbpa.dentalcareplus.com","7"
"2016","PA","59933","HIOS","2","2015-07-10 02:19:03","1","59933","PA","SHOP (Small Group)","Yes","42-0127290","59933PA0040001","Principal Plan Dental 70","59933PA004",,"PAN001","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$27.25","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","59933PA0040001-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","59933","HIOS","2","2015-07-10 02:19:03","1","59933","PA","SHOP (Small Group)","Yes","42-0127290","59933PA0040002","Principal Plan Dental 85","59933PA004",,"PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$28.80","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","59933PA0040002-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","PA","61775","HIOS","2","2015-07-10 02:19:03","1","61775","PA","SHOP (Small Group)","Yes","57-0523959","61775PA0020001","Group Dental Policy","61775PA002",,"PAN001","PAS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.79","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","61775PA0020001-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","62560","HIOS","4","2015-08-26 09:56:12","1","62560","PA","SHOP (Small Group)","No","46-2824537","62560PA0020053","UPMC Small Business Advantage Platinum HMO $20/$40 - Standard Network","62560PA002",,"PAN002","PAS002","PAF001","New","HMO","Platinum","Yes","Both","No","Yes","A PCP is required for specialist visits and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","62560PA0020053-00","Standard Platinum Off Exchange Plan","88.73%","0.887045860290527","No","Yes","No","100%",,"$0","$1,500","$0","$200","$0","$1,000","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002005300","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002005300","4"
"2016","PA","62560","HIOS","4","2015-08-26 09:56:12","1","62560","PA","SHOP (Small Group)","No","46-2824537","62560PA0020053","UPMC Small Business Advantage Platinum HMO $20/$40 - Standard Network","62560PA002",,"PAN002","PAS002","PAF001","New","HMO","Platinum","Yes","Both","No","Yes","A PCP is required for specialist visits and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","62560PA0020053-01","Standard Platinum On Exchange Plan","88.73%","0.887045860290527","No","Yes","No","100%",,"$0","$1,500","$0","$200","$0","$1,000","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002005301","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002005301","5"
"2016","PA","62560","HIOS","4","2015-08-26 09:56:12","1","62560","PA","SHOP (Small Group)","No","46-2824537","62560PA0020059","UPMC Small Business Advantage Platinum HMO $20/$40 - Standard Network","62560PA002",,"PAN002","PAS002","PAF002","New","HMO","Platinum","Yes","Both","No","Yes","A PCP is required for specialist visits and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","62560PA0020059-00","Standard Platinum Off Exchange Plan","88.87%","0.887202560901642","No","Yes","No","100%",,"$0","$1,500","$0","$200","$0","$1,000","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002005900","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002005900","6"
"2016","PA","62560","HIOS","4","2015-08-26 09:56:12","1","62560","PA","SHOP (Small Group)","No","46-2824537","62560PA0020059","UPMC Small Business Advantage Platinum HMO $20/$40 - Standard Network","62560PA002",,"PAN002","PAS002","PAF002","New","HMO","Platinum","Yes","Both","No","Yes","A PCP is required for specialist visits and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","62560PA0020059-01","Standard Platinum On Exchange Plan","88.87%","0.887202560901642","No","Yes","No","100%",,"$0","$1,500","$0","$200","$0","$1,000","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002005901","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002005901","7"
"2016","PA","62560","HIOS","4","2015-08-26 09:56:12","2","62560","PA","SHOP (Small Group)","No","46-2824537","62560PA0020054","UPMC Small Business Advantage Gold HMO $1,000 $10/$25 - Standard Network","62560PA002",,"PAN002","PAS002","PAF001","New","HMO","Gold","Yes","Both","No","Yes","A PCP is required for specialist visits and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","62560PA0020054-00","Standard Gold Off Exchange Plan","81.31%","0.83253425359726","No","Yes","No","100%",,"$1,000","$400","$0","$200","$1,000","$1,000","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002005400","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002005400","4"
"2016","PA","62560","HIOS","4","2015-08-26 09:56:12","2","62560","PA","SHOP (Small Group)","No","46-2824537","62560PA0020054","UPMC Small Business Advantage Gold HMO $1,000 $10/$25 - Standard Network","62560PA002",,"PAN002","PAS002","PAF001","New","HMO","Gold","Yes","Both","No","Yes","A PCP is required for specialist visits and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","62560PA0020054-01","Standard Gold On Exchange Plan","81.31%","0.83253425359726","No","Yes","No","100%",,"$1,000","$400","$0","$200","$1,000","$1,000","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002005401","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002005401","5"
"2016","PA","62560","HIOS","4","2015-08-26 09:56:12","2","62560","PA","SHOP (Small Group)","No","46-2824537","62560PA0020060","UPMC Small Business Advantage Gold HMO $1,000 $10/$25 - Standard Network","62560PA002",,"PAN002","PAS002","PAF002","New","HMO","Gold","Yes","Both","No","Yes","A PCP is required for specialist visits and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","62560PA0020060-00","Standard Gold Off Exchange Plan","81.73%","0.836502015590668","No","Yes","No","100%",,"$1,000","$400","$0","$200","$1,000","$1,000","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002006000","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002006000","6"
"2016","PA","62560","HIOS","4","2015-08-26 09:56:12","2","62560","PA","SHOP (Small Group)","No","46-2824537","62560PA0020060","UPMC Small Business Advantage Gold HMO $1,000 $10/$25 - Standard Network","62560PA002",,"PAN002","PAS002","PAF002","New","HMO","Gold","Yes","Both","No","Yes","A PCP is required for specialist visits and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","62560PA0020060-01","Standard Gold On Exchange Plan","81.73%","0.836502015590668","No","Yes","No","100%",,"$1,000","$400","$0","$200","$1,000","$1,000","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002006001","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002006001","7"
"2016","PA","62560","HIOS","4","2015-08-26 09:56:12","3","62560","PA","SHOP (Small Group)","No","46-2824537","62560PA0020055","UPMC Small Business Advantage Silver HMO $3,000 $10/$40 - Standard Network","62560PA002",,"PAN002","PAS002","PAF001","New","HMO","Silver","Yes","Both","No","Yes","A PCP is required for specialist visits and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","62560PA0020055-00","Standard Silver Off Exchange Plan","71.40%","0.727247595787048","No","Yes","No","100%",,"$3,000","$1,200","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002005500","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002005500","4"
"2016","PA","62560","HIOS","4","2015-08-26 09:56:12","3","62560","PA","SHOP (Small Group)","No","46-2824537","62560PA0020055","UPMC Small Business Advantage Silver HMO $3,000 $10/$40 - Standard Network","62560PA002",,"PAN002","PAS002","PAF001","New","HMO","Silver","Yes","Both","No","Yes","A PCP is required for specialist visits and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","62560PA0020055-01","Standard Silver On Exchange Plan","71.40%","0.727247595787048","No","Yes","No","100%",,"$3,000","$1,200","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002005501","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002005501","5"
"2016","PA","62560","HIOS","4","2015-08-26 09:56:12","3","62560","PA","SHOP (Small Group)","No","46-2824537","62560PA0020061","UPMC Small Business Advantage Silver HMO $3,000 $10/$40 - Standard Network","62560PA002",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","Both","No","Yes","A PCP is required for specialist visits and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","62560PA0020061-00","Standard Silver Off Exchange Plan","71.88%","0.731326520442963","No","Yes","No","100%",,"$3,000","$1,200","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002006100","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002006100","6"
"2016","PA","62560","HIOS","4","2015-08-26 09:56:12","3","62560","PA","SHOP (Small Group)","No","46-2824537","62560PA0020061","UPMC Small Business Advantage Silver HMO $3,000 $10/$40 - Standard Network","62560PA002",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","Both","No","Yes","A PCP is required for specialist visits and services. Referrals are not required for Pediatric Specialist visits (children under 21), Ob-gyns, and Mental Health Services.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/2016_rxlist.aspx","62560PA0020061-01","Standard Silver On Exchange Plan","71.88%","0.731326520442963","No","Yes","No","100%",,"$3,000","$1,200","$0","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002006101","http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_62560PA002006101","7"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","1","64844","PA","Individual","No","23-2169745","64844PA0120006","Aetna Leap Basic","64844PA012",,"PAN003","PAS003","PAF033","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120006-00","Standard Bronze Off Exchange Plan","59.95%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/SE-PA/BronzeBasic.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/SE-PA.pdf","4"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","1","64844","PA","Individual","No","23-2169745","64844PA0120006","Aetna Leap Basic","64844PA012",,"PAN003","PAS003","PAF033","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120006-01","Standard Bronze On Exchange Plan","59.95%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/BronzeBasic.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","5"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","1","64844","PA","Individual","No","23-2169745","64844PA0120006","Aetna Leap Basic","64844PA012",,"PAN003","PAS003","PAF033","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/BronzeBasicAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","6"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","1","64844","PA","Individual","No","23-2169745","64844PA0120006","Aetna Leap Basic","64844PA012",,"PAN003","PAS003","PAF033","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120006-03","Limited Cost Sharing Plan Variation","59.95%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/BronzeBasicAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","7"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","2","64844","PA","Individual","No","23-2169745","64844PA0120002","Aetna Leap Basic HSA","64844PA012",,"PAN003","PAS003","PAF002","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120002-00","Standard Bronze Off Exchange Plan","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/SE-PA/BronzeHSA.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/SE-PA.pdf","4"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","2","64844","PA","Individual","No","23-2169745","64844PA0120002","Aetna Leap Basic HSA","64844PA012",,"PAN003","PAS003","PAF002","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120002-01","Standard Bronze On Exchange Plan","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/BronzeHSA.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","5"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","2","64844","PA","Individual","No","23-2169745","64844PA0120002","Aetna Leap Basic HSA","64844PA012",,"PAN003","PAS003","PAF002","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120002-03","Limited Cost Sharing Plan Variation","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/BronzeHSAAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","7"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","3","64844","PA","Individual","No","23-2169745","64844PA0120001","Aetna Leap Basic Plus","64844PA012",,"PAN003","PAS003","PAF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120001-00","Standard Bronze Off Exchange Plan","61.59%",,"Yes","Yes","Yes","75%","25%","$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/SE-PA/BronzePlus.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/SE-PA.pdf","4"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","3","64844","PA","Individual","No","23-2169745","64844PA0120001","Aetna Leap Basic Plus","64844PA012",,"PAN003","PAS003","PAF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120001-03","Limited Cost Sharing Plan Variation","61.59%",,"Yes","Yes","Yes","75%","25%","$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/BronzePlusAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","7"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","4","64844","PA","Individual","No","23-2169745","64844PA0090003","Aetna PinnacleHealth Bronze $15 Copay","64844PA009",,"PAN002","PAS002","PAF007","New","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5208484271","64844PA0090003-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710856.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","4"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","4","64844","PA","Individual","No","23-2169745","64844PA0090003","Aetna PinnacleHealth Bronze $15 Copay","64844PA009",,"PAN002","PAS002","PAF007","New","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5208484271","64844PA0090003-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710856.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","5"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","4","64844","PA","Individual","No","23-2169745","64844PA0090003","Aetna PinnacleHealth Bronze $15 Copay","64844PA009",,"PAN002","PAS002","PAF007","New","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5208484271","64844PA0090003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710860.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","6"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","4","64844","PA","Individual","No","23-2169745","64844PA0090003","Aetna PinnacleHealth Bronze $15 Copay","64844PA009",,"PAN002","PAS002","PAF007","New","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5208484271","64844PA0090003-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710859.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","7"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","6","64844","PA","Individual","No","23-2169745","64844PA0090004","Aetna PinnacleHealth Bronze Deductible Only HSA Eligible","64844PA009",,"PAN002","PAS002","PAF008","New","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5208484271","64844PA0090004-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710861.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","4"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","6","64844","PA","Individual","No","23-2169745","64844PA0090004","Aetna PinnacleHealth Bronze Deductible Only HSA Eligible","64844PA009",,"PAN002","PAS002","PAF008","New","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5208484271","64844PA0090004-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710861.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","5"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","6","64844","PA","Individual","No","23-2169745","64844PA0090004","Aetna PinnacleHealth Bronze Deductible Only HSA Eligible","64844PA009",,"PAN002","PAS002","PAF008","New","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5208484271","64844PA0090004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710865.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","6"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","6","64844","PA","Individual","No","23-2169745","64844PA0090004","Aetna PinnacleHealth Bronze Deductible Only HSA Eligible","64844PA009",,"PAN002","PAS002","PAF008","New","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5208484271","64844PA0090004-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710864.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","7"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","8","64844","PA","Individual","No","23-2169745","64844PA0090007","Aetna Valley Preferred Bronze $15 Copay","64844PA009",,"PAN001","PAS001","PAF011","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5208484271","64844PA0090007-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710879.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","4"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","8","64844","PA","Individual","No","23-2169745","64844PA0090007","Aetna Valley Preferred Bronze $15 Copay","64844PA009",,"PAN001","PAS001","PAF011","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5208484271","64844PA0090007-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710879.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","5"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","8","64844","PA","Individual","No","23-2169745","64844PA0090007","Aetna Valley Preferred Bronze $15 Copay","64844PA009",,"PAN001","PAS001","PAF011","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5208484271","64844PA0090007-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710883.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","6"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","8","64844","PA","Individual","No","23-2169745","64844PA0090007","Aetna Valley Preferred Bronze $15 Copay","64844PA009",,"PAN001","PAS001","PAF011","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5208484271","64844PA0090007-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710882.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","7"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","10","64844","PA","Individual","No","23-2169745","64844PA0090008","Aetna Valley Preferred Bronze Deductible Only HSA Eligible","64844PA009",,"PAN001","PAS001","PAF012","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5208484271","64844PA0090008-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710884.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","4"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","10","64844","PA","Individual","No","23-2169745","64844PA0090008","Aetna Valley Preferred Bronze Deductible Only HSA Eligible","64844PA009",,"PAN001","PAS001","PAF012","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5208484271","64844PA0090008-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710884.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","5"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","10","64844","PA","Individual","No","23-2169745","64844PA0090008","Aetna Valley Preferred Bronze Deductible Only HSA Eligible","64844PA009",,"PAN001","PAS001","PAF012","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5208484271","64844PA0090008-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710888.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","6"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","10","64844","PA","Individual","No","23-2169745","64844PA0090008","Aetna Valley Preferred Bronze Deductible Only HSA Eligible","64844PA009",,"PAN001","PAS001","PAF012","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5208484271","64844PA0090008-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710887.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","7"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","12","64844","PA","Individual","No","23-2169745","64844PA0100003","Coventry Bronze $15 Copay OAHMO","64844PA010",,"PAN004","PAS004","PAF026","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2906323811","64844PA0100003-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/PA51046","http://www.coventryone.com/PAon2016","4"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","12","64844","PA","Individual","No","23-2169745","64844PA0100003","Coventry Bronze $15 Copay OAHMO","64844PA010",,"PAN004","PAS004","PAF026","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2906323811","64844PA0100003-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/PA51031","http://www.coventryone.com/PAon2016","5"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","12","64844","PA","Individual","No","23-2169745","64844PA0100003","Coventry Bronze $15 Copay OAHMO","64844PA010",,"PAN004","PAS004","PAF026","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2906323811","64844PA0100003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/PA51032","http://www.coventryone.com/PAon2016","6"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","12","64844","PA","Individual","No","23-2169745","64844PA0100003","Coventry Bronze $15 Copay OAHMO","64844PA010",,"PAN004","PAS004","PAF026","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2906323811","64844PA0100003-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/PA51033","http://www.coventryone.com/PAon2016","7"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","14","64844","PA","Individual","No","23-2169745","64844PA0100004","Coventry Bronze Deductible Only HSA Eligible OAHMO","64844PA010",,"PAN004","PAS004","PAF027","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2906323811","64844PA0100004-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/PA51048","http://www.coventryone.com/PAon2016","4"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","14","64844","PA","Individual","No","23-2169745","64844PA0100004","Coventry Bronze Deductible Only HSA Eligible OAHMO","64844PA010",,"PAN004","PAS004","PAF027","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2906323811","64844PA0100004-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/PA51034","http://www.coventryone.com/PAon2016","5"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","14","64844","PA","Individual","No","23-2169745","64844PA0100004","Coventry Bronze Deductible Only HSA Eligible OAHMO","64844PA010",,"PAN004","PAS004","PAF027","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2906323811","64844PA0100004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/PA51035","http://www.coventryone.com/PAon2016","6"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","14","64844","PA","Individual","No","23-2169745","64844PA0100004","Coventry Bronze Deductible Only HSA Eligible OAHMO","64844PA010",,"PAN004","PAS004","PAF027","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2906323811","64844PA0100004-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/PA51036","http://www.coventryone.com/PAon2016","7"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","16","64844","PA","Individual","No","23-2169745","64844PA0120004","Aetna Leap Everyday","64844PA012",,"PAN003","PAS003","PAF004","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120004-00","Standard Silver Off Exchange Plan","68.04%",,"Yes","Yes","Yes","86%","14%","$5,000","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/SE-PA/SilverBasic.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/SE-PA.pdf","4"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","16","64844","PA","Individual","No","23-2169745","64844PA0120004","Aetna Leap Everyday","64844PA012",,"PAN003","PAS003","PAF004","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120004-01","Standard Silver On Exchange Plan","68.04%",,"Yes","Yes","Yes","86%","14%","$5,000","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/SilverBasic.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","5"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","16","64844","PA","Individual","No","23-2169745","64844PA0120004","Aetna Leap Everyday","64844PA012",,"PAN003","PAS003","PAF004","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","86%","14%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/SilverBasicAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","6"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","16","64844","PA","Individual","No","23-2169745","64844PA0120004","Aetna Leap Everyday","64844PA012",,"PAN003","PAS003","PAF004","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120004-03","Limited Cost Sharing Plan Variation","68.04%",,"Yes","Yes","Yes","86%","14%","$5,000","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/SilverBasicAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","7"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","16","64844","PA","Individual","No","23-2169745","64844PA0120004","Aetna Leap Everyday","64844PA012",,"PAN003","PAS003","PAF004","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120004-04","73% AV Level Silver Plan","72.05%",,"Yes","Yes","Yes","86%","14%","$4,000","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$5,350","$5350 per person","$10700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%","$5,350","$5350 per person","$10700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/SilverBasicCSR73.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","8"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","16","64844","PA","Individual","No","23-2169745","64844PA0120004","Aetna Leap Everyday","64844PA012",,"PAN003","PAS003","PAF004","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120004-05","87% AV Level Silver Plan","86.34%",,"Yes","Yes","Yes","86%","14%","$1,400","$0","$0","$200","$1,300","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","0%","$2,250","$2250 per person","$4500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/SilverBasicCSR87.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","9"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","16","64844","PA","Individual","No","23-2169745","64844PA0120004","Aetna Leap Everyday","64844PA012",,"PAN003","PAS003","PAF004","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120004-06","94% AV Level Silver Plan","93.26%",,"Yes","Yes","Yes","86%","14%","$600","$0","$0","$200","$500","$40","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","$1,300","$1300 per person","$2600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%","$1,300","$1300 per person","$2600 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/SilverBasicCSR94.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","10"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","17","64844","PA","Individual","No","23-2169745","64844PA0120005","Aetna Leap Everyday Plus","64844PA012",,"PAN003","PAS003","PAF032","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120005-00","Standard Silver Off Exchange Plan","71.53%",,"Yes","Yes","Yes","86%","14%","$4,200","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,210","$4210 per person","$8420 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,210","$4210 per person","$8420 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/SE-PA/SilverPlus.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/SE-PA.pdf","4"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","17","64844","PA","Individual","No","23-2169745","64844PA0120005","Aetna Leap Everyday Plus","64844PA012",,"PAN003","PAS003","PAF032","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120005-01","Standard Silver On Exchange Plan","71.53%",,"Yes","Yes","Yes","86%","14%","$4,200","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,210","$4210 per person","$8420 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,210","$4210 per person","$8420 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/SilverPlus.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","5"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","17","64844","PA","Individual","No","23-2169745","64844PA0120005","Aetna Leap Everyday Plus","64844PA012",,"PAN003","PAS003","PAF032","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","86%","14%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/SilverPlusAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","6"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","17","64844","PA","Individual","No","23-2169745","64844PA0120005","Aetna Leap Everyday Plus","64844PA012",,"PAN003","PAS003","PAF032","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120005-03","Limited Cost Sharing Plan Variation","71.53%",,"Yes","Yes","Yes","86%","14%","$4,200","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,210","$4210 per person","$8420 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,210","$4210 per person","$8420 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/SilverPlusAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","7"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","17","64844","PA","Individual","No","23-2169745","64844PA0120005","Aetna Leap Everyday Plus","64844PA012",,"PAN003","PAS003","PAF032","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120005-04","73% AV Level Silver Plan","73.54%",,"Yes","Yes","Yes","86%","14%","$3,800","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","0%","$5,450","$5450 per person","$10900 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/SilverPlusCSR73.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","8"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","17","64844","PA","Individual","No","23-2169745","64844PA0120005","Aetna Leap Everyday Plus","64844PA012",,"PAN003","PAS003","PAF032","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120005-05","87% AV Level Silver Plan","86.33%",,"Yes","Yes","Yes","86%","14%","$1,500","$0","$0","$200","$1,300","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,475","$1475 per person","$2950 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,475","$1475 per person","$2950 per group","0%","$2,250","$2250 per person","$4500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/SilverPlusCSR87.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","9"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","17","64844","PA","Individual","No","23-2169745","64844PA0120005","Aetna Leap Everyday Plus","64844PA012",,"PAN003","PAS003","PAF032","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120005-06","94% AV Level Silver Plan","93.24%",,"Yes","Yes","Yes","86%","14%","$600","$0","$0","$200","$500","$40","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$570","$570 per person","$1140 per group","$1,325","$1325 per person","$2650 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$570","$570 per person","$1140 per group","0%","$1,325","$1325 per person","$2650 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/SilverPlusCSR94.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","10"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","18","64844","PA","Individual","No","23-2169745","64844PA0090002","Aetna PinnacleHealth Silver $10 Copay","64844PA009",,"PAN002","PAS002","PAF006","New","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090002-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710848.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","4"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","26","64844","PA","Individual","No","23-2169745","64844PA0090001","Aetna PinnacleHealth Gold $10 Copay","64844PA009",,"PAN002","PAS002","PAF005","New","HMO","Gold","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090001-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710843.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","4"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","26","64844","PA","Individual","No","23-2169745","64844PA0090001","Aetna PinnacleHealth Gold $10 Copay","64844PA009",,"PAN002","PAS002","PAF005","New","HMO","Gold","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090001-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710843.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","5"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","26","64844","PA","Individual","No","23-2169745","64844PA0090001","Aetna PinnacleHealth Gold $10 Copay","64844PA009",,"PAN002","PAS002","PAF005","New","HMO","Gold","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710847.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","6"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","18","64844","PA","Individual","No","23-2169745","64844PA0090002","Aetna PinnacleHealth Silver $10 Copay","64844PA009",,"PAN002","PAS002","PAF006","New","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090002-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710848.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","5"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","18","64844","PA","Individual","No","23-2169745","64844PA0090002","Aetna PinnacleHealth Silver $10 Copay","64844PA009",,"PAN002","PAS002","PAF006","New","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710855.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","6"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","18","64844","PA","Individual","No","23-2169745","64844PA0090002","Aetna PinnacleHealth Silver $10 Copay","64844PA009",,"PAN002","PAS002","PAF006","New","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090002-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710854.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","7"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","18","64844","PA","Individual","No","23-2169745","64844PA0090002","Aetna PinnacleHealth Silver $10 Copay","64844PA009",,"PAN002","PAS002","PAF006","New","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090002-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710851.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","8"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","18","64844","PA","Individual","No","23-2169745","64844PA0090002","Aetna PinnacleHealth Silver $10 Copay","64844PA009",,"PAN002","PAS002","PAF006","New","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090002-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710852.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","9"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","18","64844","PA","Individual","No","23-2169745","64844PA0090002","Aetna PinnacleHealth Silver $10 Copay","64844PA009",,"PAN002","PAS002","PAF006","New","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090002-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710853.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","10"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","20","64844","PA","Individual","No","23-2169745","64844PA0090006","Aetna Valley Preferred Silver $10 Copay","64844PA009",,"PAN001","PAS001","PAF010","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090006-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710871.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","4"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","20","64844","PA","Individual","No","23-2169745","64844PA0090006","Aetna Valley Preferred Silver $10 Copay","64844PA009",,"PAN001","PAS001","PAF010","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090006-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710871.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","5"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","20","64844","PA","Individual","No","23-2169745","64844PA0090006","Aetna Valley Preferred Silver $10 Copay","64844PA009",,"PAN001","PAS001","PAF010","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090006-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710878.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","6"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","20","64844","PA","Individual","No","23-2169745","64844PA0090006","Aetna Valley Preferred Silver $10 Copay","64844PA009",,"PAN001","PAS001","PAF010","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090006-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710877.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","7"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","20","64844","PA","Individual","No","23-2169745","64844PA0090006","Aetna Valley Preferred Silver $10 Copay","64844PA009",,"PAN001","PAS001","PAF010","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090006-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710874.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","8"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","20","64844","PA","Individual","No","23-2169745","64844PA0090006","Aetna Valley Preferred Silver $10 Copay","64844PA009",,"PAN001","PAS001","PAF010","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090006-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710875.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","9"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","20","64844","PA","Individual","No","23-2169745","64844PA0090006","Aetna Valley Preferred Silver $10 Copay","64844PA009",,"PAN001","PAS001","PAF010","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090006-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710876.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","10"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","22","64844","PA","Individual","No","23-2169745","64844PA0100002","Coventry Silver $10 Copay OAHMO","64844PA010",,"PAN004","PAS004","PAF025","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2903901524","64844PA0100002-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/PA51052","http://www.coventryone.com/PAon2016","4"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","22","64844","PA","Individual","No","23-2169745","64844PA0100002","Coventry Silver $10 Copay OAHMO","64844PA010",,"PAN004","PAS004","PAF025","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2903901524","64844PA0100002-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/PA51040","http://www.coventryone.com/PAon2016","5"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","22","64844","PA","Individual","No","23-2169745","64844PA0100002","Coventry Silver $10 Copay OAHMO","64844PA010",,"PAN004","PAS004","PAF025","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2903901524","64844PA0100002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/PA51044","http://www.coventryone.com/PAon2016","6"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","22","64844","PA","Individual","No","23-2169745","64844PA0100002","Coventry Silver $10 Copay OAHMO","64844PA010",,"PAN004","PAS004","PAF025","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2903901524","64844PA0100002-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/PA51045","http://www.coventryone.com/PAon2016","7"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","22","64844","PA","Individual","No","23-2169745","64844PA0100002","Coventry Silver $10 Copay OAHMO","64844PA010",,"PAN004","PAS004","PAF025","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2903901524","64844PA0100002-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/PA51041","http://www.coventryone.com/PAon2016","8"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","22","64844","PA","Individual","No","23-2169745","64844PA0100002","Coventry Silver $10 Copay OAHMO","64844PA010",,"PAN004","PAS004","PAF025","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2903901524","64844PA0100002-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/PA51042","http://www.coventryone.com/PAon2016","9"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","22","64844","PA","Individual","No","23-2169745","64844PA0100002","Coventry Silver $10 Copay OAHMO","64844PA010",,"PAN004","PAS004","PAF025","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2903901524","64844PA0100002-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/PA51043","http://www.coventryone.com/PAon2016","10"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","24","64844","PA","Individual","No","23-2169745","64844PA0120007","Aetna Leap Diabetes","64844PA012",,"PAN003","PAS003","PAF034","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120007-00","Standard Gold Off Exchange Plan","78.12%",,"Yes","Yes","Yes","90%","10%","$3,200","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/SE-PA/GoldDiabetes.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/SE-PA.pdf","4"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","24","64844","PA","Individual","No","23-2169745","64844PA0120007","Aetna Leap Diabetes","64844PA012",,"PAN003","PAS003","PAF034","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120007-01","Standard Gold On Exchange Plan","78.12%",,"Yes","Yes","Yes","90%","10%","$3,200","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/GoldDiabetes.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","5"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","24","64844","PA","Individual","No","23-2169745","64844PA0120007","Aetna Leap Diabetes","64844PA012",,"PAN003","PAS003","PAF034","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120007-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","90%","10%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/GoldDiabetesAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","6"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","24","64844","PA","Individual","No","23-2169745","64844PA0120007","Aetna Leap Diabetes","64844PA012",,"PAN003","PAS003","PAF034","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120007-03","Limited Cost Sharing Plan Variation","78.12%",,"Yes","Yes","Yes","90%","10%","$3,200","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/GoldDiabetesAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","7"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","25","64844","PA","Individual","No","23-2169745","64844PA0120003","Aetna Leap Specialty","64844PA012",,"PAN003","PAS003","PAF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120003-00","Standard Gold Off Exchange Plan","78.92%",,"Yes","Yes","Yes","90%","10%","$3,000","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/SE-PA/GoldBasic.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/SE-PA.pdf","4"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","25","64844","PA","Individual","No","23-2169745","64844PA0120003","Aetna Leap Specialty","64844PA012",,"PAN003","PAS003","PAF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120003-01","Standard Gold On Exchange Plan","78.92%",,"Yes","Yes","Yes","90%","10%","$3,000","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/GoldBasic.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","5"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","25","64844","PA","Individual","No","23-2169745","64844PA0120003","Aetna Leap Specialty","64844PA012",,"PAN003","PAS003","PAF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","90%","10%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/GoldBasicAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","6"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","25","64844","PA","Individual","No","23-2169745","64844PA0120003","Aetna Leap Specialty","64844PA012",,"PAN003","PAS003","PAF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0636827911","64844PA0120003-03","Limited Cost Sharing Plan Variation","78.92%",,"Yes","Yes","Yes","90%","10%","$3,000","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SE-PA/GoldBasicAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SE-PA.pdf","7"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","26","64844","PA","Individual","No","23-2169745","64844PA0090001","Aetna PinnacleHealth Gold $10 Copay","64844PA009",,"PAN002","PAS002","PAF005","New","HMO","Gold","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090001-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710846.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","7"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","28","64844","PA","Individual","No","23-2169745","64844PA0090005","Aetna Valley Preferred Gold $10 Copay","64844PA009",,"PAN001","PAS001","PAF009","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090005-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710866.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","4"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","28","64844","PA","Individual","No","23-2169745","64844PA0090005","Aetna Valley Preferred Gold $10 Copay","64844PA009",,"PAN001","PAS001","PAF009","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090005-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710866.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","5"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","28","64844","PA","Individual","No","23-2169745","64844PA0090005","Aetna Valley Preferred Gold $10 Copay","64844PA009",,"PAN001","PAS001","PAF009","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090005-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710870.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","6"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","28","64844","PA","Individual","No","23-2169745","64844PA0090005","Aetna Valley Preferred Gold $10 Copay","64844PA009",,"PAN001","PAS001","PAF009","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5206061985","64844PA0090005-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/PA/PA_SBC_710869.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/pa-on-booklet01-16.pdf","7"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","30","64844","PA","Individual","No","23-2169745","64844PA0100001","Coventry Gold $10 Copay OAHMO","64844PA010",,"PAN004","PAS004","PAF024","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2903901524","64844PA0100001-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/PA51050","http://www.coventryone.com/PAon2016","4"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","30","64844","PA","Individual","No","23-2169745","64844PA0100001","Coventry Gold $10 Copay OAHMO","64844PA010",,"PAN004","PAS004","PAF024","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2903901524","64844PA0100001-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/PA51037","http://www.coventryone.com/PAon2016","5"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","30","64844","PA","Individual","No","23-2169745","64844PA0100001","Coventry Gold $10 Copay OAHMO","64844PA010",,"PAN004","PAS004","PAF024","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2903901524","64844PA0100001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/PA51038","http://www.coventryone.com/PAon2016","6"
"2016","PA","64844","HIOS","7","2016-01-26 05:20:14","30","64844","PA","Individual","No","23-2169745","64844PA0100001","Coventry Gold $10 Copay OAHMO","64844PA010",,"PAN004","PAS004","PAF024","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2903901524","64844PA0100001-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/PA51039","http://www.coventryone.com/PAon2016","7"
"2016","PA","67430","HIOS","2","2015-07-10 02:19:03","1","67430","PA","SHOP (Small Group)","Yes","25-1844144","67430PA0040001","UPMC Dental Advantage Basic Plan","67430PA004",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$0.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is through contracted wrap network","Yes","http://www.upmchealthplan.com/marketplace/pay.aspx","","67430PA0040001-00","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_67430PA004000100","4"
"2016","PA","67430","HIOS","2","2015-07-10 02:19:03","1","67430","PA","SHOP (Small Group)","Yes","25-1844144","67430PA0040001","UPMC Dental Advantage Basic Plan","67430PA004",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$0.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is through contracted wrap network","Yes","http://www.upmchealthplan.com/marketplace/pay.aspx","","67430PA0040001-01","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_67430PA004000101","5"
"2016","PA","67430","HIOS","2","2015-07-10 02:19:03","2","67430","PA","SHOP (Small Group)","Yes","25-1844144","67430PA0040002","UPMC Dental Advantage Standard Plan","67430PA004",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$0.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is through contracted wrap network","Yes","http://www.upmchealthplan.com/marketplace/pay.aspx","","67430PA0040002-00","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_67430PA004000200","4"
"2016","PA","67430","HIOS","2","2015-07-10 02:19:03","2","67430","PA","SHOP (Small Group)","Yes","25-1844144","67430PA0040002","UPMC Dental Advantage Standard Plan","67430PA004",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$0.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is through contracted wrap network","Yes","http://www.upmchealthplan.com/marketplace/pay.aspx","","67430PA0040002-01","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_67430PA004000201","5"
"2016","PA","67430","HIOS","2","2015-07-10 02:19:03","2","67430","PA","SHOP (Small Group)","Yes","25-1844144","67430PA0040003","UPMC Dental Advantage Premium Plan","67430PA004",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$0.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is through contracted wrap network","Yes","http://www.upmchealthplan.com/marketplace/pay.aspx","","67430PA0040003-00","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_67430PA004000300","6"
"2016","PA","67430","HIOS","2","2015-07-10 02:19:03","2","67430","PA","SHOP (Small Group)","Yes","25-1844144","67430PA0040003","UPMC Dental Advantage Premium Plan","67430PA004",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$0.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is through contracted wrap network","Yes","http://www.upmchealthplan.com/marketplace/pay.aspx","","67430PA0040003-01","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.upmchealthplan.com/marketplace/details.aspx?plan=2016_SG_67430PA004000301","7"
"2016","PA","67499","HIOS","4","2015-08-20 09:36:54","1","67499","PA","Individual","Yes","39-1263473","67499PA0010001","Humana Dental Smart Choice","67499PA001",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.92","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","67499PA0010001-00","Standard Low Off Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612974","4"
"2016","PA","67499","HIOS","4","2015-08-20 09:36:54","1","67499","PA","Individual","Yes","39-1263473","67499PA0010001","Humana Dental Smart Choice","67499PA001",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.92","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","67499PA0010001-01","Standard Low On Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612974","5"
"2016","PA","68711","HIOS","5","2015-08-07 03:04:31","1","68711","PA","SHOP (Small Group)","Yes","59-0397210","68711PA0020003","DentaQuest EPO Family High","68711PA002",,"PAN002","PAS001",,"Existing","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.62","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","68711PA0020003-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/","4"
"2016","PA","68711","HIOS","5","2015-08-07 03:04:31","1","68711","PA","Individual","Yes","59-0397210","68711PA0030001","DentaQuest EPO Pediatric High","68711PA003",,"PAN002","PAS001",,"Existing","EPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$36.74","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","68711PA0030001-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/","4"
"2016","PA","68711","HIOS","5","2015-08-07 03:04:31","1","68711","PA","Individual","Yes","59-0397210","68711PA0030001","DentaQuest EPO Pediatric High","68711PA003",,"PAN002","PAS001",,"Existing","EPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$36.74","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","68711PA0030001-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/","5"
"2016","PA","68711","HIOS","5","2015-08-07 03:04:31","1","68711","PA","SHOP (Small Group)","Yes","59-0397210","68711PA0020003","DentaQuest EPO Family High","68711PA002",,"PAN002","PAS001",,"Existing","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.62","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","68711PA0020003-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/","5"
"2016","PA","68711","HIOS","5","2015-08-07 03:04:31","1","68711","PA","SHOP (Small Group)","Yes","59-0397210","68711PA0020004","DentaQuest EPO Family Low","68711PA002",,"PAN002","PAS001",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.91","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","68711PA0020004-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/","6"
"2016","PA","68711","HIOS","5","2015-08-07 03:04:31","1","68711","PA","SHOP (Small Group)","Yes","59-0397210","68711PA0020004","DentaQuest EPO Family Low","68711PA002",,"PAN002","PAS001",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.91","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","68711PA0020004-01","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/","7"
"2016","PA","68711","HIOS","5","2015-08-07 03:04:31","2","68711","PA","Individual","Yes","59-0397210","68711PA0030003","DentaQuest EPO Family High","68711PA003",,"PAN002","PAS001",,"Existing","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.74","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","68711PA0030003-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/","4"
"2016","PA","68711","HIOS","5","2015-08-07 03:04:31","2","68711","PA","Individual","Yes","59-0397210","68711PA0030003","DentaQuest EPO Family High","68711PA003",,"PAN002","PAS001",,"Existing","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.74","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","68711PA0030003-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/","5"
"2016","PA","68711","HIOS","5","2015-08-07 03:04:31","2","68711","PA","Individual","Yes","59-0397210","68711PA0030004","DentaQuest EPO Family Low","68711PA003",,"PAN002","PAS001",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.23","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","68711PA0030004-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/","6"
"2016","PA","68711","HIOS","5","2015-08-07 03:04:31","2","68711","PA","Individual","Yes","59-0397210","68711PA0030004","DentaQuest EPO Family Low","68711PA003",,"PAN002","PAS001",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.23","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","68711PA0030004-01","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/pa/","http://www.dentaquest.com/marketplace/pa/","7"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","5","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0210004","Flex EPO $1650 80%/70% A Community Blue Plan","70194PA021",,"PAN002","PAS005","PAF005","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0210004-00","Standard Silver Off Exchange Plan",,"0.715615272521973","No","Yes","Yes","85%","15%","$1,650","$20","$1,100","$0","$1,650","$900","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,650","$1650 per person","$3300 per group","20%","$1,650","$1650 per person","$3300 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa","4"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0180005","Health Savings Blue PPO 1400","70194PA018",,"PAN002","PAS006","PAF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0180005-01","Standard Gold On Exchange Plan",,"0.806579053401947","Yes","Yes","No","100%",,"$1,400","$0","$600","$0","$1,400","$0","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2098420620_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","24"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0180005","Health Savings Blue PPO 1400","70194PA018",,"PAN002","PAS006","PAF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0180005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2098438535_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","25"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","1","70194","PA","Individual","No","54-1637426","70194PA0140001","Shared Cost Blue PPO 6000","70194PA014",,"PAN001","PAS003","PAF006","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0140001-00","Standard Bronze Off Exchange Plan",,"0.619562804698944","Yes","Yes","No","100%",,"$6,000","$300","$200","$0","$4,500","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2098154669_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","4"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","1","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0490001","Alliance Flex Blue PPO $500","70194PA049",,"PAN002","PAS011","PAF011","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0490001-00","Standard Gold Off Exchange Plan","80.50%","0.823240578174591","No","Yes","Yes","82%","18%","$500","$100","$0","$0","$500","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$1,500","$1500 per person","$3000 per group","30%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa","4"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","1","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0490001","Alliance Flex Blue PPO $500","70194PA049",,"PAN002","PAS011","PAF011","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0490001-01","Standard Gold On Exchange Plan","80.50%","0.823240578174591","No","Yes","Yes","82%","18%","$500","$100","$0","$0","$500","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%","$1,500","$1500 per person","$3000 per group","30%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa","5"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","1","70194","PA","Individual","No","54-1637426","70194PA0140001","Shared Cost Blue PPO 6000","70194PA014",,"PAN001","PAS003","PAF006","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0140001-01","Standard Bronze On Exchange Plan",,"0.619562804698944","Yes","Yes","No","100%",,"$6,000","$300","$200","$0","$4,500","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2098154669_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","5"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","1","70194","PA","Individual","No","54-1637426","70194PA0140001","Shared Cost Blue PPO 6000","70194PA014",,"PAN001","PAS003","PAF006","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0140001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2098160969_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","6"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","1","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0490002","Alliance Flex Blue PPO $1250","70194PA049",,"PAN002","PAS011","PAF011","New","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0490002-00","Standard Gold Off Exchange Plan",,"0.797976851463318","No","Yes","Yes","82%","18%","$1,250","$100","$0","$0","$1,250","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0%","$3,750","$3750 per person","$7500 per group","30%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa","6"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","1","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0490002","Alliance Flex Blue PPO $1250","70194PA049",,"PAN002","PAS011","PAF011","New","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0490002-01","Standard Gold On Exchange Plan",,"0.797976851463318","No","Yes","Yes","82%","18%","$1,250","$100","$0","$0","$1,250","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0%","$3,750","$3750 per person","$7500 per group","30%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa","7"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","1","70194","PA","Individual","No","54-1637426","70194PA0140001","Shared Cost Blue PPO 6000","70194PA014",,"PAN001","PAS003","PAF006","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0140001-03","Limited Cost Sharing Plan Variation",,"0.619562804698944","Yes","Yes","No","100%",,"$6,000","$300","$200","$0","$4,500","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2098160730_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","7"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","1","70194","PA","Individual","No","54-1637426","70194PA0170001","Shared Cost Blue PPO 6000","70194PA017",,"PAN002","PAS006","PAF006","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0170001-00","Standard Bronze Off Exchange Plan",,"0.619562864303589","Yes","Yes","No","100%",,"$0","$300","$0","$0","$1,600","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2098336275_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","8"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","1","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0490003","Alliance Flex Blue PPO $2500","70194PA049",,"PAN002","PAS011","PAF011","New","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0490003-00","Standard Silver Off Exchange Plan",,"0.719609379768372","No","Yes","Yes","82%","18%","$2,500","$200","$0","$0","$1,600","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%","$5,000","$5000 per person","$10000 per group","30%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa","8"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","1","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0490003","Alliance Flex Blue PPO $2500","70194PA049",,"PAN002","PAS011","PAF011","New","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0490003-01","Standard Silver On Exchange Plan",,"0.719609379768372","No","Yes","Yes","82%","18%","$2,500","$200","$0","$0","$1,600","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%","$5,000","$5000 per person","$10000 per group","30%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa","9"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","1","70194","PA","Individual","No","54-1637426","70194PA0170001","Shared Cost Blue PPO 6000","70194PA017",,"PAN002","PAS006","PAF006","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0170001-01","Standard Bronze On Exchange Plan",,"0.619562864303589","Yes","Yes","No","100%",,"$0","$300","$0","$0","$1,600","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2098336275_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","9"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","1","70194","PA","Individual","No","54-1637426","70194PA0170001","Shared Cost Blue PPO 6000","70194PA017",,"PAN002","PAS006","PAF006","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0170001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2098411148_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","10"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","1","70194","PA","Individual","No","54-1637426","70194PA0170001","Shared Cost Blue PPO 6000","70194PA017",,"PAN002","PAS006","PAF006","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0170001-03","Limited Cost Sharing Plan Variation",,"0.619562864303589","Yes","Yes","No","100%",,"$0","$300","$0","$0","$1,600","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2098406853_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","11"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0150001","Health Savings Embedded Blue PPO 4500","70194PA015",,"PAN001","PAS003","PAF005","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0150001-00","Standard Bronze Off Exchange Plan",,"0.617401421070099","Yes","Yes","No","100%",,"$4,500","$0","$800","$0","$4,500","$0","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097905630_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","4"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0220006","Shared Cost PPO $1500","70194PA022",,"PAN001","PAS003","PAF009","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0220006-00","Standard Gold Off Exchange Plan",,"0.799973011016846","No","Yes","No","100%",,"$1,500","$200","$500","$0","$1,500","$400","$10","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","4"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0220006","Shared Cost PPO $1500","70194PA022",,"PAN001","PAS003","PAF009","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0220006-01","Standard Gold On Exchange Plan",,"0.799973011016846","No","Yes","No","100%",,"$1,500","$200","$500","$0","$1,500","$400","$10","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","5"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0150001","Health Savings Embedded Blue PPO 4500","70194PA015",,"PAN001","PAS003","PAF005","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0150001-01","Standard Bronze On Exchange Plan",,"0.617401421070099","Yes","Yes","No","100%",,"$4,500","$0","$800","$0","$4,500","$0","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097905630_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","5"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0150001","Health Savings Embedded Blue PPO 4500","70194PA015",,"PAN001","PAS003","PAF005","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0150001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097906501_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","6"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0240006","Shared Cost PPO $1500","70194PA024",,"PAN002","PAS006","PAF009","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0240006-00","Standard Gold Off Exchange Plan",,"0.799973011016846","No","Yes","No","100%",,"$1,500","$200","$500","$0","$1,500","$400","$10","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa","6"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","4","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0200004","Comprehensive Care EPO $2000 70% A Community Blue Plan","70194PA020",,"PAN001","PAS002","PAF005","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0200004-00","Standard Silver Off Exchange Plan",,"0.716605305671692","No","Yes","No","100%",,"$2,000","$20","$1,600","$0","$2,000","$900","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","6"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","4","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0200004","Comprehensive Care EPO $2000 70% A Community Blue Plan","70194PA020",,"PAN001","PAS002","PAF005","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0200004-01","Standard Silver On Exchange Plan",,"0.716605305671692","No","Yes","No","100%",,"$2,000","$20","$1,600","$0","$2,000","$900","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","7"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012611","Geisinger Choice Markeptlace PPO 25/50/1000","75729PA001",,"PAN001","PAS002","PAF006","Existing","PPO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012611-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261102.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","10"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012614","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS003","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012614-03","Limited Cost Sharing Plan Variation","71.02%","0.699622452259064","No","Yes","No","100%",,"$5,900","$6","$411","$30","$353","$392","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261403.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","37"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012614","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS003","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012614-04","73% AV Level Silver Plan","73.51%","0.736458778381348","No","Yes","No","100%",,"$5,900","$6","$411","$30","$4,474","$120","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261404.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","38"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0240006","Shared Cost PPO $1500","70194PA024",,"PAN002","PAS006","PAF009","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0240006-01","Standard Gold On Exchange Plan",,"0.799973011016846","No","Yes","No","100%",,"$1,500","$200","$500","$0","$1,500","$400","$10","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa","7"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0150001","Health Savings Embedded Blue PPO 4500","70194PA015",,"PAN001","PAS003","PAF005","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0150001-03","Limited Cost Sharing Plan Variation",,"0.617401421070099","Yes","Yes","No","100%",,"$4,500","$0","$800","$0","$4,500","$0","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097906280_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","7"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0150003","Health Savings Embedded Blue PPO 2700","70194PA015",,"PAN001","PAS003","PAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0150003-00","Standard Silver Off Exchange Plan",,"0.70792943239212","Yes","Yes","No","100%",,"$2,700","$0","$500","$0","$2,700","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097368369_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","8"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0150003","Health Savings Embedded Blue PPO 2700","70194PA015",,"PAN001","PAS003","PAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0150003-01","Standard Silver On Exchange Plan",,"0.70792943239212","Yes","Yes","No","100%",,"$2,700","$0","$500","$0","$2,700","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097368369_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","9"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0150003","Health Savings Embedded Blue PPO 2700","70194PA015",,"PAN001","PAS003","PAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0150003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097732621_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","10"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0150003","Health Savings Embedded Blue PPO 2700","70194PA015",,"PAN001","PAS003","PAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0150003-03","Limited Cost Sharing Plan Variation",,"0.70792943239212","Yes","Yes","No","100%",,"$2,700","$0","$500","$0","$2,700","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097369839_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","11"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0150003","Health Savings Embedded Blue PPO 2700","70194PA015",,"PAN001","PAS003","PAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0150003-04","73% AV Level Silver Plan",,"0.73458856344223","Yes","Yes","No","100%",,"$2,200","$0","$500","$0","$2,200","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","10%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097370604_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","12"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0150003","Health Savings Embedded Blue PPO 2700","70194PA015",,"PAN001","PAS003","PAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0150003-05","87% AV Level Silver Plan",,"0.87151837348938","Yes","Yes","No","100%",,"$600","$0","$700","$0","$600","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","10%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097372804_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","13"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0150003","Health Savings Embedded Blue PPO 2700","70194PA015",,"PAN001","PAS003","PAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0150003-06","94% AV Level Silver Plan",,"0.940684080123901","Yes","Yes","No","100%",,"$150","$0","$600","$0","$150","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","10%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097373923_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","14"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0150005","Health Savings Blue PPO 1400","70194PA015",,"PAN001","PAS003","PAF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0150005-00","Standard Gold Off Exchange Plan",,"0.806579053401947","Yes","Yes","No","100%",,"$1,400","$0","$600","$0","$1,400","$0","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2098480104_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","15"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0150005","Health Savings Blue PPO 1400","70194PA015",,"PAN001","PAS003","PAF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0150005-01","Standard Gold On Exchange Plan",,"0.806579053401947","Yes","Yes","No","100%",,"$1,400","$0","$600","$0","$1,400","$0","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2098480104_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","16"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0150005","Health Savings Blue PPO 1400","70194PA015",,"PAN001","PAS003","PAF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0150005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2098484861_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","17"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0150005","Health Savings Blue PPO 1400","70194PA015",,"PAN001","PAS003","PAF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0150005-03","Limited Cost Sharing Plan Variation",,"0.806579053401947","Yes","Yes","No","100%",,"$1,400","$0","$600","$0","$1,400","$0","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2098484680_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","18"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0180001","Health Savings Embedded Blue PPO 4500","70194PA018",,"PAN002","PAS006","PAF005","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0180001-00","Standard Bronze Off Exchange Plan",,"0.617401421070099","Yes","Yes","No","100%",,"$4,500","$0","$800","$0","$4,500","$0","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2098276235_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","19"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0180001","Health Savings Embedded Blue PPO 4500","70194PA018",,"PAN002","PAS006","PAF005","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0180001-01","Standard Bronze On Exchange Plan",,"0.617401421070099","Yes","Yes","No","100%",,"$4,500","$0","$800","$0","$4,500","$0","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2098276235_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","20"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0180001","Health Savings Embedded Blue PPO 4500","70194PA018",,"PAN002","PAS006","PAF005","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0180001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2098277276_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","21"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0180001","Health Savings Embedded Blue PPO 4500","70194PA018",,"PAN002","PAS006","PAF005","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0180001-03","Limited Cost Sharing Plan Variation",,"0.617401421070099","Yes","Yes","No","100%",,"$4,500","$0","$800","$0","$4,500","$0","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2098276759_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","22"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0180005","Health Savings Blue PPO 1400","70194PA018",,"PAN002","PAS006","PAF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0180005-00","Standard Gold Off Exchange Plan",,"0.806579053401947","Yes","Yes","No","100%",,"$1,400","$0","$600","$0","$1,400","$0","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2098420620_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","23"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0180005","Health Savings Blue PPO 1400","70194PA018",,"PAN002","PAS006","PAF003","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0180005-03","Limited Cost Sharing Plan Variation",,"0.806579053401947","Yes","Yes","No","100%",,"$1,400","$0","$600","$0","$1,400","$0","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2098438528_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","26"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0180003","Health Savings Embedded Blue PPO 2700","70194PA018",,"PAN002","PAS006","PAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0180003-00","Standard Silver Off Exchange Plan",,"0.70792943239212","Yes","Yes","No","100%",,"$2,700","$0","$500","$0","$2,700","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2098418428_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","27"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","4","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0200002","Comprehensive Care EPO $2000 70% A Community Blue Plan","70194PA020",,"PAN001","PAS001","PAF005","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0200002-01","Standard Silver On Exchange Plan",,"0.716605305671692","No","Yes","No","100%",,"$2,000","$20","$1,600","$0","$2,000","$900","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","5"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","5","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0210004","Flex EPO $1650 80%/70% A Community Blue Plan","70194PA021",,"PAN002","PAS005","PAF005","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0210004-01","Standard Silver On Exchange Plan",,"0.715615272521973","No","Yes","Yes","85%","15%","$1,650","$20","$1,100","$0","$1,650","$900","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,650","$1650 per person","$3300 per group","20%","$1,650","$1650 per person","$3300 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa","5"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","5","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0210002","Flex EPO $1650 80%/70% A Community Blue Plan","70194PA021",,"PAN002","PAS004","PAF005","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0210002-00","Standard Silver Off Exchange Plan",,"0.715615272521973","No","Yes","Yes","85%","15%","$1,650","$20","$1,100","$0","$1,650","$900","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,650","$1650 per person","$3300 per group","20%","$1,650","$1650 per person","$3300 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa","6"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012613","Geisinger Choice Markeptlace PPO 25/50/1000","75729PA001",,"PAN001","PAS003","PAF006","Existing","PPO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012613-01","Standard Gold On Exchange Plan","79.55%","0.802155077457428","No","Yes","No","100%",,"$1,900","$0","$1,074","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","$250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261301.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","13"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012613","Geisinger Choice Markeptlace PPO 25/50/1000","75729PA001",,"PAN001","PAS003","PAF006","Existing","PPO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012613-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261302.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","14"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012613","Geisinger Choice Markeptlace PPO 25/50/1000","75729PA001",,"PAN001","PAS003","PAF006","Existing","PPO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012613-03","Limited Cost Sharing Plan Variation","79.55%","0.802155077457428","No","Yes","No","100%",,"$1,900","$0","$1,074","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","$250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261303.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","15"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0180003","Health Savings Embedded Blue PPO 2700","70194PA018",,"PAN002","PAS006","PAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0180003-01","Standard Silver On Exchange Plan",,"0.70792943239212","Yes","Yes","No","100%",,"$2,700","$0","$500","$0","$2,700","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2098418428_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","28"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0180003","Health Savings Embedded Blue PPO 2700","70194PA018",,"PAN002","PAS006","PAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0180003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2098484801_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","29"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0180003","Health Savings Embedded Blue PPO 2700","70194PA018",,"PAN002","PAS006","PAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0180003-03","Limited Cost Sharing Plan Variation",,"0.70792943239212","Yes","Yes","No","100%",,"$2,700","$0","$500","$0","$2,700","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","10%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2098422032_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","30"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0180003","Health Savings Embedded Blue PPO 2700","70194PA018",,"PAN002","PAS006","PAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0180003-04","73% AV Level Silver Plan",,"0.73458856344223","Yes","Yes","No","100%",,"$2,200","$0","$500","$0","$2,200","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","10%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2098479390_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","31"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0180003","Health Savings Embedded Blue PPO 2700","70194PA018",,"PAN002","PAS006","PAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0180003-05","87% AV Level Silver Plan",,"0.87151837348938","Yes","Yes","No","100%",,"$600","$0","$700","$0","$600","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","10%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2098480252_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","32"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","2","70194","PA","Individual","No","54-1637426","70194PA0180003","Health Savings Embedded Blue PPO 2700","70194PA018",,"PAN002","PAS006","PAF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0180003-06","94% AV Level Silver Plan",,"0.940684080123901","Yes","Yes","No","100%",,"$150","$0","$600","$0","$150","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","10%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkblueshield.com/sbc/pdf/bs/I_2098480980_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/CPA_2016_ON%20EX_Product%20Brochure_508_11-18.PDF","33"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","3","70194","PA","Individual","No","54-1637426","70194PA0160001","Comprehensive Care Blue PPO 1500","70194PA016",,"PAN001","PAS003","PAF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0160001-00","Standard Silver Off Exchange Plan",,"0.692604601383209","No","Yes","No","100%",,"$1,500","$10","$1,200","$0","$1,500","$200","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097814603_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","4"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","3","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0230002","Health Savings PPO Embedded Q$4000","70194PA023",,"PAN001","PAS003","PAF006","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0230002-00","Standard Bronze Off Exchange Plan",,"0.617886602878571","Yes","Yes","No","100%",,"$4,000","$0","$1,300","$0","$4,000","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","4"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","3","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0230002","Health Savings PPO Embedded Q$4000","70194PA023",,"PAN001","PAS003","PAF006","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0230002-01","Standard Bronze On Exchange Plan",,"0.617886602878571","Yes","Yes","No","100%",,"$4,000","$0","$1,300","$0","$4,000","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","5"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","3","70194","PA","Individual","No","54-1637426","70194PA0160001","Comprehensive Care Blue PPO 1500","70194PA016",,"PAN001","PAS003","PAF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0160001-01","Standard Silver On Exchange Plan",,"0.692604601383209","No","Yes","No","100%",,"$1,500","$10","$1,200","$0","$1,500","$200","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097814603_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","5"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","3","70194","PA","Individual","No","54-1637426","70194PA0160001","Comprehensive Care Blue PPO 1500","70194PA016",,"PAN001","PAS003","PAF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0160001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097822360_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","6"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","3","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0250002","Health Savings PPO Embedded Q$4000","70194PA025",,"PAN002","PAS006","PAF006","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0250002-00","Standard Bronze Off Exchange Plan",,"0.617886602878571","Yes","Yes","No","100%",,"$4,000","$0","$1,300","$0","$4,000","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa","6"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","3","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0250002","Health Savings PPO Embedded Q$4000","70194PA025",,"PAN002","PAS006","PAF006","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0250002-01","Standard Bronze On Exchange Plan",,"0.617886602878571","Yes","Yes","No","100%",,"$4,000","$0","$1,300","$0","$4,000","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa","7"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","3","70194","PA","Individual","No","54-1637426","70194PA0160001","Comprehensive Care Blue PPO 1500","70194PA016",,"PAN001","PAS003","PAF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0160001-03","Limited Cost Sharing Plan Variation",,"0.692604601383209","No","Yes","No","100%",,"$1,500","$10","$1,200","$0","$1,500","$200","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097816077_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","7"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","3","70194","PA","Individual","No","54-1637426","70194PA0160001","Comprehensive Care Blue PPO 1500","70194PA016",,"PAN001","PAS003","PAF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0160001-04","73% AV Level Silver Plan",,"0.72230476140976","No","Yes","No","100%",,"$1,500","$10","$1,200","$0","$1,500","$200","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097816725_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","8"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","3","70194","PA","Individual","No","54-1637426","70194PA0160001","Comprehensive Care Blue PPO 1500","70194PA016",,"PAN001","PAS003","PAF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0160001-05","87% AV Level Silver Plan",,"0.866894364356995","No","Yes","No","100%",,"$500","$40","$700","$0","$500","$300","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097817573_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","9"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","3","70194","PA","Individual","No","54-1637426","70194PA0160001","Comprehensive Care Blue PPO 1500","70194PA016",,"PAN001","PAS003","PAF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0160001-06","94% AV Level Silver Plan",,"0.932730674743652","No","Yes","No","100%",,"$100","$30","$620","$0","$100","$200","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2097818458_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","10"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","3","70194","PA","Individual","No","54-1637426","70194PA0160003","Comprehensive Care Flex Blue PPO 500","70194PA016",,"PAN001","PAS003","PAF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0160003-00","Standard Platinum Off Exchange Plan",,"0.881313443183899","No","Yes","Yes","90%","10%","$500","$20","$700","$0","$500","$200","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","$1,650","$1650 per person","$3300 per group","$3,300","$3300 per person","$6600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%","$1,500","$1500 per person","$3000 per group","40%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2098154561_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","11"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","3","70194","PA","Individual","No","54-1637426","70194PA0160003","Comprehensive Care Flex Blue PPO 500","70194PA016",,"PAN001","PAS003","PAF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0160003-01","Standard Platinum On Exchange Plan",,"0.881313443183899","No","Yes","Yes","90%","10%","$500","$20","$700","$0","$500","$200","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","$1,650","$1650 per person","$3300 per group","$3,300","$3300 per person","$6600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%","$1,500","$1500 per person","$3000 per group","40%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2098154561_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","12"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","3","70194","PA","Individual","No","54-1637426","70194PA0160003","Comprehensive Care Flex Blue PPO 500","70194PA016",,"PAN001","PAS003","PAF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0160003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","90%","10%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2098174524_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","13"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","3","70194","PA","Individual","No","54-1637426","70194PA0160003","Comprehensive Care Flex Blue PPO 500","70194PA016",,"PAN001","PAS003","PAF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.999",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0160003-03","Limited Cost Sharing Plan Variation",,"0.881313443183899","No","Yes","Yes","90%","10%","$500","$20","$700","$0","$500","$200","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","$1,650","$1650 per person","$3300 per group","$3,300","$3300 per person","$6600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%","$1,500","$1500 per person","$3000 per group","40%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/pdf/bcbs/I_2098170724_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WPA_Product%20Brochure_ON%20EX_SP_R1-7-16_508.PDF","14"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","4","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0200002","Comprehensive Care EPO $2000 70% A Community Blue Plan","70194PA020",,"PAN001","PAS001","PAF005","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0200002-00","Standard Silver Off Exchange Plan",,"0.716605305671692","No","Yes","No","100%",,"$2,000","$20","$1,600","$0","$2,000","$900","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westernpa","4"
"2016","PA","70194","HIOS","11","2016-01-22 04:00:42","5","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0210002","Flex EPO $1650 80%/70% A Community Blue Plan","70194PA021",,"PAN002","PAS004","PAF005","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1788724309%20","70194PA0210002-01","Standard Silver On Exchange Plan",,"0.715615272521973","No","Yes","Yes","85%","15%","$1,650","$20","$1,100","$0","$1,650","$900","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,650","$1650 per person","$3300 per group","20%","$1,650","$1650 per person","$3300 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=centralpa","7"
"2016","PA","70406","HIOS","2","2015-07-03 02:33:58","1","70406","PA","SHOP (Small Group)","Yes","36-0883760","70406PA0040002","EHB High PPO","70406PA004",,"PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.02","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","70406PA0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","PA","70406","HIOS","2","2015-07-03 02:33:58","1","70406","PA","SHOP (Small Group)","Yes","36-0883760","70406PA0040001","EHB Low PPO","70406PA004",,"PAN001","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.41","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","70406PA0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","PA","70406","HIOS","2","2015-07-03 02:33:58","1","70406","PA","SHOP (Small Group)","Yes","36-0883760","70406PA0030002","EHB High Passive","70406PA003",,"PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.24","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","70406PA0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","PA","70406","HIOS","2","2015-07-03 02:33:58","1","70406","PA","SHOP (Small Group)","Yes","36-0883760","70406PA0030001","EHB Low Passive","70406PA003",,"PAN001","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.04","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","70406PA0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","PA","70533","HIOS","2","2015-07-10 02:19:03","1","70533","PA","SHOP (Small Group)","Yes","35-0472300","70533PA0010001","Lincoln DentalConnect®","70533PA001","7063415294","PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.84","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","70533PA0010001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","70533","HIOS","2","2015-07-10 02:19:03","1","70533","PA","SHOP (Small Group)","Yes","35-0472300","70533PA0010002","Lincoln DentalConnect®","70533PA001","7063415294","PAN001","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.26","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","70533PA0010002-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","PA","70533","HIOS","2","2015-07-10 02:19:03","1","70533","PA","SHOP (Small Group)","Yes","35-0472300","70533PA0010003","Lincoln DentalConnect®","70533PA001","7063415294","PAN001","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.50","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","70533PA0010003-00","Standard Low Off Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","PA","70533","HIOS","2","2015-07-10 02:19:03","1","70533","PA","SHOP (Small Group)","Yes","35-0472300","70533PA0010004","Lincoln DentalConnect®","70533PA001","7063415294","PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.56","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","70533PA0010004-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","PA","70533","HIOS","2","2015-07-10 02:19:03","1","70533","PA","SHOP (Small Group)","Yes","35-0472300","70533PA0010005","Lincoln DentalConnect®","70533PA001","7063415294","PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.55","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","70533PA0010005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","PA","70533","HIOS","2","2015-07-10 02:19:03","1","70533","PA","SHOP (Small Group)","Yes","35-0472300","70533PA0010006","Lincoln DentalConnect®","70533PA001","7063415294","PAN001","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.41","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","70533PA0010006-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","PA","70533","HIOS","2","2015-07-10 02:19:03","1","70533","PA","SHOP (Small Group)","Yes","35-0472300","70533PA0010007","Lincoln DentalConnect®","70533PA001","7063415294","PAN001","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.17","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","70533PA0010007-00","Standard Low Off Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2016","PA","70533","HIOS","2","2015-07-10 02:19:03","1","70533","PA","SHOP (Small Group)","Yes","35-0472300","70533PA0010008","Lincoln DentalConnect®","70533PA001","7063415294","PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.72","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","70533PA0010008-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2016","PA","71933","HIOS","3","2015-08-27 11:14:25","1","71933","PA","Individual","Yes","95-6042390","71933PA0020003","BESTOne Advantage Gold","71933PA002",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.00","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/PA/2016/PA_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","PA","71933","HIOS","3","2015-08-27 11:14:25","1","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010007","BESTDental Premium","71933PA001",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.38","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/PA/2016/PA_BESTDental_Premium_Plan.pdf","4"
"2016","PA","71933","HIOS","3","2015-08-27 11:14:25","1","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010007","BESTDental Premium","71933PA001",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.38","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/PA/2016/PA_BESTDental_Premium_Plan.pdf","5"
"2016","PA","71933","HIOS","3","2015-08-27 11:14:25","1","71933","PA","Individual","Yes","95-6042390","71933PA0020003","BESTOne Advantage Gold","71933PA002",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.00","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/PA/2016/PA_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","PA","71933","HIOS","3","2015-08-27 11:14:25","1","71933","PA","Individual","Yes","95-6042390","71933PA0020004","BESTOne Plus Gold","71933PA002",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.00","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/PA/2016/PA_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","PA","71933","HIOS","3","2015-08-27 11:14:25","1","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010008","BESTDental Standard - H","71933PA001",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.38","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/PA/2016/PA_BESTDental_Standard-H_Plan.pdf","6"
"2016","PA","71933","HIOS","3","2015-08-27 11:14:25","1","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010008","BESTDental Standard - H","71933PA001",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.38","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/PA/2016/PA_BESTDental_Standard-H_Plan.pdf","7"
"2016","PA","71933","HIOS","3","2015-08-27 11:14:25","1","71933","PA","Individual","Yes","95-6042390","71933PA0020004","BESTOne Plus Gold","71933PA002",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.00","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/PA/2016/PA_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","PA","71933","HIOS","3","2015-08-27 11:14:25","1","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010010","BESTDental Choice - H","71933PA001",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.38","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/PA/2016/PA_BESTDental_Choice-H_Plan.pdf","8"
"2016","PA","71933","HIOS","3","2015-08-27 11:14:25","1","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010010","BESTDental Choice - H","71933PA001",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.38","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/PA/2016/PA_BESTDental_Choice-H_Plan.pdf","9"
"2016","PA","71933","HIOS","3","2015-08-27 11:14:25","2","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010009","BESTDental Standard - L","71933PA001",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.15","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/PA/2016/PA_BESTDental_Standard-L_Plan.pdf","4"
"2016","PA","71933","HIOS","3","2015-08-27 11:14:25","2","71933","PA","Individual","Yes","95-6042390","71933PA0020005","BESTOne Plus Silver","71933PA002",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.28","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/PA/2016/PA_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","PA","71933","HIOS","3","2015-08-27 11:14:25","2","71933","PA","Individual","Yes","95-6042390","71933PA0020005","BESTOne Plus Silver","71933PA002",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.28","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/PA/2016/PA_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","PA","71933","HIOS","3","2015-08-27 11:14:25","2","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010009","BESTDental Standard - L","71933PA001",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.15","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/PA/2016/PA_BESTDental_Standard-L_Plan.pdf","5"
"2016","PA","71933","HIOS","3","2015-08-27 11:14:25","2","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010011","BESTDental Choice - L","71933PA001",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.15","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/PA/2016/PA_BESTDental_Choice-L_Plan.pdf","6"
"2016","PA","71933","HIOS","3","2015-08-27 11:14:25","2","71933","PA","Individual","Yes","95-6042390","71933PA0020006","BESTOne Basic Silver","71933PA002",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.28","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/PA/2016/PA_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","PA","71933","HIOS","3","2015-08-27 11:14:25","2","71933","PA","Individual","Yes","95-6042390","71933PA0020006","BESTOne Basic Silver","71933PA002",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.28","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/PA/2016/PA_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","PA","71933","HIOS","3","2015-08-27 11:14:25","2","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010011","BESTDental Choice - L","71933PA001",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.15","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/PA/2016/PA_BESTDental_Choice-L_Plan.pdf","7"
"2016","PA","71933","HIOS","3","2015-08-27 11:14:25","2","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010012","BESTDental Value","71933PA001",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.15","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/PA/2016/PA_BESTDental_Value_Plan.pdf","8"
"2016","PA","71933","HIOS","3","2015-08-27 11:14:25","2","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010012","BESTDental Value","71933PA001",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.15","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71933PA0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/PA/2016/PA_BESTDental_Value_Plan.pdf","9"
"2016","PA","72299","HIOS","6","2015-10-20 04:38:50","1","72299","PA","SHOP (Small Group)","Yes","36-3757528","72299PA0030001","TruAssure Dental Small Group Basic Plan","72299PA003",,"PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.29","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","72299PA0030001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","72299","HIOS","6","2015-10-20 04:38:50","1","72299","PA","Individual","Yes","36-3757528","72299PA0010001","TruAssure Basic Adult or Child Dental Plan","72299PA001",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.43","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72299PA0010001-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$120","$120 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=PA","https://www.truassure.com/brochure?state=PA","4"
"2016","PA","72299","HIOS","6","2015-10-20 04:38:50","1","72299","PA","Individual","Yes","36-3757528","72299PA0010001","TruAssure Basic Adult or Child Dental Plan","72299PA001",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.43","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72299PA0010001-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$120","$120 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=PA","https://www.truassure.com/brochure?state=PA","5"
"2016","PA","72299","HIOS","6","2015-10-20 04:38:50","1","72299","PA","SHOP (Small Group)","Yes","36-3757528","72299PA0040001","TruAssure Dental Small Group Preferred Plan","72299PA004",,"PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.29","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","72299PA0040001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","PA","72299","HIOS","6","2015-10-20 04:38:50","2","72299","PA","Individual","Yes","36-3757528","72299PA0020001","TruAssure Preferred Adult or Child Dental Plan","72299PA002",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.96","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72299PA0020001-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=PA","https://www.truassure.com/brochure?state=PA","4"
"2016","PA","72299","HIOS","6","2015-10-20 04:38:50","2","72299","PA","Individual","Yes","36-3757528","72299PA0020001","TruAssure Preferred Adult or Child Dental Plan","72299PA002",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.96","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72299PA0020001-01","Standard High On Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=PA","https://www.truassure.com/brochure?state=PA","5"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012596","Geisinger Choice Markeptlace PPO 25/50/1000","75729PA001",,"PAN001","PAS001","PAF006","Existing","PPO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012596-00","Standard Gold Off Exchange Plan","79.55%","0.802155077457428","No","Yes","No","100%",,"$1,900","$0","$1,074","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","$250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001259600.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","4"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012596","Geisinger Choice Markeptlace PPO 25/50/1000","75729PA001",,"PAN001","PAS001","PAF006","Existing","PPO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012596-01","Standard Gold On Exchange Plan","79.55%","0.802155077457428","No","Yes","No","100%",,"$1,900","$0","$1,074","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","$250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001259601.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","5"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012596","Geisinger Choice Markeptlace PPO 25/50/1000","75729PA001",,"PAN001","PAS001","PAF006","Existing","PPO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012596-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001259602.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","6"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012596","Geisinger Choice Markeptlace PPO 25/50/1000","75729PA001",,"PAN001","PAS001","PAF006","Existing","PPO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012596-03","Limited Cost Sharing Plan Variation","79.55%","0.802155077457428","No","Yes","No","100%",,"$1,900","$0","$1,074","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","$250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001259603.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","7"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012611","Geisinger Choice Markeptlace PPO 25/50/1000","75729PA001",,"PAN001","PAS002","PAF006","Existing","PPO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012611-00","Standard Gold Off Exchange Plan","79.55%","0.802155077457428","No","Yes","No","100%",,"$1,900","$0","$1,074","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","$250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261100.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","8"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012611","Geisinger Choice Markeptlace PPO 25/50/1000","75729PA001",,"PAN001","PAS002","PAF006","Existing","PPO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012611-01","Standard Gold On Exchange Plan","79.55%","0.802155077457428","No","Yes","No","100%",,"$1,900","$0","$1,074","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","$250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261101.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","9"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012611","Geisinger Choice Markeptlace PPO 25/50/1000","75729PA001",,"PAN001","PAS002","PAF006","Existing","PPO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012611-03","Limited Cost Sharing Plan Variation","79.55%","0.802155077457428","No","Yes","No","100%",,"$1,900","$0","$1,074","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","$250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261103.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","11"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012613","Geisinger Choice Markeptlace PPO 25/50/1000","75729PA001",,"PAN001","PAS003","PAF006","Existing","PPO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012613-00","Standard Gold Off Exchange Plan","79.55%","0.802155077457428","No","Yes","No","100%",,"$1,900","$0","$1,074","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","$250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261300.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","12"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012615","Geisinger Choice Markeptlace PPO 25/50/1000","75729PA001",,"PAN001","PAS004","PAF006","Existing","PPO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012615-00","Standard Gold Off Exchange Plan","79.55%","0.802155077457428","No","Yes","No","100%",,"$1,900","$0","$1,074","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","$250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261500.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","16"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012615","Geisinger Choice Markeptlace PPO 25/50/1000","75729PA001",,"PAN001","PAS004","PAF006","Existing","PPO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012615-01","Standard Gold On Exchange Plan","79.55%","0.802155077457428","No","Yes","No","100%",,"$1,900","$0","$1,074","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","$250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261501.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","17"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012615","Geisinger Choice Markeptlace PPO 25/50/1000","75729PA001",,"PAN001","PAS004","PAF006","Existing","PPO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012615-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261502.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","18"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012615","Geisinger Choice Markeptlace PPO 25/50/1000","75729PA001",,"PAN001","PAS004","PAF006","Existing","PPO","Gold","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012615-03","Limited Cost Sharing Plan Variation","79.55%","0.802155077457428","No","Yes","No","100%",,"$1,900","$0","$1,074","$30","$353","$372","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","$250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261503.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","19"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012603","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS001","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012603-00","Standard Silver Off Exchange Plan","71.02%","0.699622452259064","No","Yes","No","100%",,"$5,900","$6","$411","$30","$353","$392","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001260300.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","20"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012603","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS001","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012603-01","Standard Silver On Exchange Plan","71.02%","0.699622452259064","No","Yes","No","100%",,"$5,900","$6","$411","$30","$353","$392","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001260301.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","21"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012603","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS001","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012603-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001260302.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","22"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012603","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS001","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012603-03","Limited Cost Sharing Plan Variation","71.02%","0.699622452259064","No","Yes","No","100%",,"$5,900","$6","$411","$30","$353","$392","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001260303.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","23"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012603","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS001","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012603-04","73% AV Level Silver Plan","73.51%","0.736458778381348","No","Yes","No","100%",,"$5,900","$6","$411","$30","$4,474","$120","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001260304.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","24"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012603","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS001","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012603-05","87% AV Level Silver Plan","87.62%","0.881060123443604","No","Yes","No","100%",,"$1,000","$6","$0","$30","$353","$307","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001260305.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","25"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012603","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS001","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012603-06","94% AV Level Silver Plan","94.17%","0.939599871635437","No","Yes","No","100%",,"$600","$2","$0","$30","$300","$170","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001260306.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","26"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012612","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS002","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012612-00","Standard Silver Off Exchange Plan","71.02%","0.699622452259064","No","Yes","No","100%",,"$5,900","$6","$411","$30","$353","$392","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261200.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","27"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012612","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS002","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012612-01","Standard Silver On Exchange Plan","71.02%","0.699622452259064","No","Yes","No","100%",,"$5,900","$6","$411","$30","$353","$392","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261201.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","28"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012612","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS002","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012612-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261202.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","29"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012612","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS002","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012612-03","Limited Cost Sharing Plan Variation","71.02%","0.699622452259064","No","Yes","No","100%",,"$5,900","$6","$411","$30","$353","$392","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261203.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","30"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012612","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS002","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012612-04","73% AV Level Silver Plan","73.51%","0.736458778381348","No","Yes","No","100%",,"$5,900","$6","$411","$30","$4,474","$120","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261204.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","31"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012612","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS002","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012612-05","87% AV Level Silver Plan","87.62%","0.881060123443604","No","Yes","No","100%",,"$1,000","$6","$0","$30","$353","$307","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261205.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","32"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012612","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS002","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012612-06","94% AV Level Silver Plan","94.17%","0.939599871635437","No","Yes","No","100%",,"$600","$2","$0","$30","$300","$170","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261206.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","33"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012614","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS003","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012614-00","Standard Silver Off Exchange Plan","71.02%","0.699622452259064","No","Yes","No","100%",,"$5,900","$6","$411","$30","$353","$392","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261400.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","34"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012614","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS003","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012614-01","Standard Silver On Exchange Plan","71.02%","0.699622452259064","No","Yes","No","100%",,"$5,900","$6","$411","$30","$353","$392","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261401.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","35"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012614","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS003","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012614-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261402.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","36"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012614","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS003","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012614-05","87% AV Level Silver Plan","87.62%","0.881060123443604","No","Yes","No","100%",,"$1,000","$6","$0","$30","$353","$307","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261405.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","39"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012614","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS003","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012614-06","94% AV Level Silver Plan","94.17%","0.939599871635437","No","Yes","No","100%",,"$600","$2","$0","$30","$300","$170","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261406.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","40"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012616","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS004","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012616-00","Standard Silver Off Exchange Plan","71.02%","0.699622452259064","No","Yes","No","100%",,"$5,900","$6","$411","$30","$353","$392","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261600.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","41"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012616","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS004","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012616-01","Standard Silver On Exchange Plan","71.02%","0.699622452259064","No","Yes","No","100%",,"$5,900","$6","$411","$30","$353","$392","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261601.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","42"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012616","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS004","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012616-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261602.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","43"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012616","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS004","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012616-03","Limited Cost Sharing Plan Variation","71.02%","0.699622452259064","No","Yes","No","100%",,"$5,900","$6","$411","$30","$353","$392","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261603.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","44"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012616","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS004","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012616-04","73% AV Level Silver Plan","73.51%","0.736458778381348","No","Yes","No","100%",,"$5,900","$6","$411","$30","$4,474","$120","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261604.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","45"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","SHOP (Small Group)","No","57-0287419","26065SC0360001","Business BlueEssentials PPO Gold 1","26065SC036",,"SCN002","SCS001","SCF007","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/shop/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BusinessBlueEssentials","26065SC0360001-00","Standard Gold Off Exchange Plan",,"0.802471995353699","No","Yes","No","100%",,"$1,200","$20","$1,210","$150","$1,200","$450","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.SouthCarolinaBlues.com/links/metallic/2016/business/Gold1","https://www.SouthCarolinaBlues.com/links/metallic/2016/business/brochure","4"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","SHOP (Small Group)","No","57-0287419","26065SC0360001","Business BlueEssentials PPO Gold 1","26065SC036",,"SCN002","SCS001","SCF007","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/shop/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BusinessBlueEssentials","26065SC0360001-01","Standard Gold On Exchange Plan",,"0.802471995353699","No","Yes","No","100%",,"$1,200","$20","$1,210","$150","$1,200","$450","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.SouthCarolinaBlues.com/links/metallic/2016/business/Gold1","https://www.SouthCarolinaBlues.com/links/metallic/2016/business/brochure","5"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380001","BlueEssentials Gold 1","26065SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9965",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380001-01","Standard Gold On Exchange Plan",,"0.801498055458069","No","Yes","No","100%",,"$1,200","$20","$1,210","$150","$1,200","$450","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Gold1","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","5"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380001","BlueEssentials Gold 1","26065SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9965",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Gold1_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","6"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","SHOP (Small Group)","No","57-0287419","26065SC0360002","Business BlueEssentials PPO Silver 1","26065SC036",,"SCN002","SCS001","SCF008","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"$200","0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/shop/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BusinessBlueEssentials","26065SC0360002-00","Standard Silver Off Exchange Plan",,"0.71949827671051","No","Yes","No","100%",,"$2,250","$20","$1,000","$150","$2,250","$530","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.SouthCarolinaBlues.com/links/metallic/2016/business/Silver1","https://www.SouthCarolinaBlues.com/links/metallic/2016/business/brochure","6"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","SHOP (Small Group)","No","57-0287419","26065SC0360002","Business BlueEssentials PPO Silver 1","26065SC036",,"SCN002","SCS001","SCF008","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","1",,,"$200","0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/shop/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BusinessBlueEssentials","26065SC0360002-01","Standard Silver On Exchange Plan",,"0.71949827671051","No","Yes","No","100%",,"$2,250","$20","$1,000","$150","$2,250","$530","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.SouthCarolinaBlues.com/links/metallic/2016/business/Silver1","https://www.SouthCarolinaBlues.com/links/metallic/2016/business/brochure","7"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380001","BlueEssentials Gold 1","26065SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9965",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380001-03","Limited Cost Sharing Plan Variation",,"0.801498055458069","No","Yes","No","100%",,"$1,200","$20","$1,210","$150","$1,200","$450","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Gold1_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","7"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012616","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS004","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012616-05","87% AV Level Silver Plan","87.62%","0.881060123443604","No","Yes","No","100%",,"$1,000","$6","$0","$30","$353","$307","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261605.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","46"
"2016","PA","75729","HIOS","6","2015-09-25 04:20:25","1","75729","PA","Individual","No","20-4275139","75729PA0012616","Geisinger Choice Marketplace PPO 30/50/5000","75729PA001",,"PAN001","PAS004","PAF004","Existing","PPO","Silver","Yes","Both","No","Yes","All, excluding OB and Mental Health","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with precertification.","No","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","https://www.thehealthplan.com/pharmacy/pharmacy.aspx","75729PA0012616-06","94% AV Level Silver Plan","94.17%","0.939599871635437","No","Yes","No","100%",,"$600","$2","$0","$30","$300","$170","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://cdn.thehealthplan.com/static/pdf/sbc/2016/75729PA001261606.pdf","https://cdn.thehealthplan.com/static/pdf/marketplace/2016/AllPlansBrochureIndividual.pdf","47"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","1","82110","PA","Individual","Yes","75-1233841","82110PA0010002","Delta Dental PPO Pediatric Preferred Plan","82110PA001",,"PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.11","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0010002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0010002-16","4"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","1","82110","PA","SHOP (Small Group)","Yes","75-1233841","82110PA0020002","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","82110PA002",,"PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.32","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0020002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0020002-16","4"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","1","82110","PA","Individual","Yes","75-1233841","82110PA0010001","Delta Dental PPO Pediatric Basic Plan","82110PA001",,"PAN001","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$12.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0010001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0010001-16","5"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","1","82110","PA","SHOP (Small Group)","Yes","75-1233841","82110PA0020001","Delta Dental PPO Pediatric Basic Plan for Small Businesses","82110PA002",,"PAN001","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$12.18","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0020001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0020001-16","5"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","2","82110","PA","Individual","Yes","75-1233841","82110PA0010004","Delta Dental PPO Preferred Plan for Families","82110PA001",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.11","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0010004-16","4"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","2","82110","PA","SHOP (Small Group)","Yes","75-1233841","82110PA0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","82110PA002",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.32","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0020004-16","4"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","2","82110","PA","SHOP (Small Group)","Yes","75-1233841","82110PA0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","82110PA002",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.32","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0020004-16","5"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","2","82110","PA","Individual","Yes","75-1233841","82110PA0010004","Delta Dental PPO Preferred Plan for Families","82110PA001",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.11","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0010004-16","5"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","3","82110","PA","Individual","Yes","75-1233841","82110PA0010006","Delta Dental PPO Basic Plan for Families","82110PA001",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$12.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0010006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0010006-16","4"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","3","82110","PA","SHOP (Small Group)","Yes","75-1233841","82110PA0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","82110PA002",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$12.18","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0020006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0020006-16","4"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","3","82110","PA","SHOP (Small Group)","Yes","75-1233841","82110PA0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","82110PA002",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$12.18","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0020006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0020006-16","5"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","3","82110","PA","Individual","Yes","75-1233841","82110PA0010006","Delta Dental PPO Basic Plan for Families","82110PA001",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$12.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","82110PA0010006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0010006-16","5"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","4","82110","PA","Individual","Yes","75-1233841","82110PA0030002","DeltaCare USA Pediatric Preferred Plan","82110PA003",,"PAN002","PAS001",,"Existing","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.17","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","82110PA0030002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0030002-16","4"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","4","82110","PA","SHOP (Small Group)","Yes","75-1233841","82110PA0040002","DeltaCare USA Pediatric Preferred Plan for Small Businesses","82110PA004",,"PAN002","PAS001",,"Existing","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","82110PA0040002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0040002-16","4"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","4","82110","PA","Individual","Yes","75-1233841","82110PA0030001","DeltaCare USA Pediatric Basic Plan","82110PA003",,"PAN002","PAS001",,"Existing","HMO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","82110PA0030001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0030001-16","5"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","4","82110","PA","SHOP (Small Group)","Yes","75-1233841","82110PA0040001","DeltaCare USA Pediatric Basic Plan for Small Businesses","82110PA004",,"PAN002","PAS001",,"Existing","HMO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","82110PA0040001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0040001-16","5"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","5","82110","PA","Individual","Yes","75-1233841","82110PA0030004","DeltaCare USA Preferred Plan for Families","82110PA003",,"PAN002","PAS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.17","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","82110PA0030004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0030004-16","4"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","5","82110","PA","SHOP (Small Group)","Yes","75-1233841","82110PA0040004","DeltaCare USA Preferred Plan for Families for Small Businesses","82110PA004",,"PAN002","PAS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","82110PA0040004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0040004-16","4"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","5","82110","PA","SHOP (Small Group)","Yes","75-1233841","82110PA0040004","DeltaCare USA Preferred Plan for Families for Small Businesses","82110PA004",,"PAN002","PAS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","82110PA0040004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0040004-16","5"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","5","82110","PA","Individual","Yes","75-1233841","82110PA0030004","DeltaCare USA Preferred Plan for Families","82110PA003",,"PAN002","PAS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.17","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","82110PA0030004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0030004-16","5"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","6","82110","PA","Individual","Yes","75-1233841","82110PA0030006","DeltaCare USA Basic Plan for Families","82110PA003",,"PAN002","PAS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","82110PA0030006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0030006-16","4"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","6","82110","PA","SHOP (Small Group)","Yes","75-1233841","82110PA0040006","DeltaCare USA Basic Plan for Families for Small Businesses","82110PA004",,"PAN002","PAS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","82110PA0040006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0040006-16","4"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","6","82110","PA","SHOP (Small Group)","Yes","75-1233841","82110PA0040006","DeltaCare USA Basic Plan for Families for Small Businesses","82110PA004",,"PAN002","PAS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","82110PA0040006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0040006-16","5"
"2016","PA","82110","HIOS","7","2015-08-26 09:56:12","6","82110","PA","Individual","Yes","75-1233841","82110PA0030006","DeltaCare USA Basic Plan for Families","82110PA003",,"PAN002","PAS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","82110PA0030006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/pa/82110pa0030006-16","5"
"2016","PA","84496","HIOS","2","2015-07-03 02:33:58","1","84496","PA","SHOP (Small Group)","Yes","93-0242990","84496PA0040002","EHB High PPO","84496PA004",,"PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.13","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","84496PA0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","PA","84496","HIOS","2","2015-07-03 02:33:58","1","84496","PA","SHOP (Small Group)","Yes","93-0242990","84496PA0040001","EHB Low PPO","84496PA004",,"PAN001","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.47","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","84496PA0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9955",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver2_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","21"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9955",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380003-03","Limited Cost Sharing Plan Variation",,"0.697629868984222","Yes","Yes","No","100%",,"$2,000","$20","$2,100","$150","$1,150","$400","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver2_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","22"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9955",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380003-04","73% AV Level Silver Plan",,"0.735556185245514","Yes","Yes","No","100%",,"$1,300","$20","$2,380","$150","$1,150","$400","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver2_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","23"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9955",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380003-05","87% AV Level Silver Plan",,"0.87281608581543","Yes","Yes","No","100%",,"$200","$20","$1,410","$150","$200","$600","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver2_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","24"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9955",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380003-06","94% AV Level Silver Plan",,"0.939420104026794","Yes","Yes","No","100%",,"$0","$20","$360","$150","$0","$600","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver2_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","25"
"2016","PA","84496","HIOS","2","2015-07-03 02:33:58","1","84496","PA","SHOP (Small Group)","Yes","93-0242990","84496PA0030002","EHB High Passive","84496PA003",,"PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.37","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","84496PA0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","PA","84496","HIOS","2","2015-07-03 02:33:58","1","84496","PA","SHOP (Small Group)","Yes","93-0242990","84496PA0030001","EHB Low Passive","84496PA003",,"PAN001","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.12","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","84496PA0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","PA","94118","HIOS","1","2015-05-01 02:23:41","1","94118","PA","SHOP (Small Group)","Yes","47-0098400","94118PA0040002","EHB High PPO","94118PA004",,"PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.45","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","94118PA0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","PA","94118","HIOS","1","2015-05-01 02:23:41","1","94118","PA","SHOP (Small Group)","Yes","47-0098400","94118PA0040001","EHB Low PPO","94118PA004",,"PAN001","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.13","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","94118PA0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","PA","94118","HIOS","1","2015-05-01 02:23:41","1","94118","PA","SHOP (Small Group)","Yes","47-0098400","94118PA0030002","EHB High Passive","94118PA003",,"PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.63","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","94118PA0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","PA","94118","HIOS","1","2015-05-01 02:23:41","1","94118","PA","SHOP (Small Group)","Yes","47-0098400","94118PA0030001","EHB Low Passive","94118PA003",,"PAN001","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.70","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","94118PA0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","PA","94365","HIOS","2","2015-07-09 13:17:42","1","94365","PA","SHOP (Small Group)","Yes","81-0170040","94365PA0010001","Assurant Dental ACAFFO High","94365PA001",,"PAN001","PAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$33.37","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","94365PA0010001-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","94365","HIOS","2","2015-07-09 13:17:42","1","94365","PA","SHOP (Small Group)","Yes","81-0170040","94365PA0010002","Assurant Dental ACAFFO Low","94365PA001",,"PAN001","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.88","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","94365PA0010002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","PA","98060","HIOS","3","2015-08-21 03:45:06","1","98060","PA","SHOP (Small Group)","Yes","13-5581829","98060PA0170001","EHB Basic Dental Plan (Low)","98060PA017",,"PAN001","PAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$21.10","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","98060PA0170001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","PA","98060","HIOS","3","2015-08-21 03:45:06","2","98060","PA","SHOP (Small Group)","Yes","13-5581829","98060PA0190001","Family Basic Dental Plan (Low)","98060PA019",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$21.10","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","98060PA0190001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49122","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49121","4"
"2016","PA","98060","HIOS","3","2015-08-21 03:45:06","2","98060","PA","SHOP (Small Group)","Yes","13-5581829","98060PA0190001","Family Basic Dental Plan (Low)","98060PA019",,"PAN001","PAS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$21.10","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","98060PA0190001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49122","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49121","5"
"2016","PA","98060","HIOS","3","2015-08-21 03:45:06","3","98060","PA","SHOP (Small Group)","Yes","13-5581829","98060PA0200001","Family Enhanced Dental Plan (High)","98060PA020",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$25.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","98060PA0200001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49124","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49123","4"
"2016","PA","98060","HIOS","3","2015-08-21 03:45:06","3","98060","PA","SHOP (Small Group)","Yes","13-5581829","98060PA0200001","Family Enhanced Dental Plan (High)","98060PA020",,"PAN001","PAS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$25.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","98060PA0200001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49124","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49123","5"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380001","BlueEssentials Gold 1","26065SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9965",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380001-00","Standard Gold Off Exchange Plan",,"0.801498055458069","No","Yes","No","100%",,"$1,200","$20","$1,210","$150","$1,200","$450","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Gold1","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","4"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380007","BlueEssentials Gold 2","26065SC038",,"SCN001","SCS001","SCF015","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9966",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380007-00","Standard Gold Off Exchange Plan",,"0.815062582492828","No","Yes","No","100%",,"$800","$10","$1,940","$150","$800","$300","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Gold2","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","8"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380007","BlueEssentials Gold 2","26065SC038",,"SCN001","SCS001","SCF015","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9966",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380007-01","Standard Gold On Exchange Plan",,"0.815062582492828","No","Yes","No","100%",,"$800","$10","$1,940","$150","$800","$300","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Gold2","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","9"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380007","BlueEssentials Gold 2","26065SC038",,"SCN001","SCS001","SCF015","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9966",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Gold2_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","10"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380007","BlueEssentials Gold 2","26065SC038",,"SCN001","SCS001","SCF015","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9966",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380007-03","Limited Cost Sharing Plan Variation",,"0.815062582492828","No","Yes","No","100%",,"$800","$10","$1,940","$150","$800","$300","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Gold2_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","11"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380002-00","Standard Silver Off Exchange Plan",,"0.698560476303101","Yes","Yes","No","100%",,"$200","$20","$3,530","$150","$200","$1,470","$660","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver1","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","12"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380002-01","Standard Silver On Exchange Plan",,"0.698560476303101","Yes","Yes","No","100%",,"$200","$20","$3,530","$150","$200","$1,470","$660","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver1","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","13"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver1_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","14"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380002-03","Limited Cost Sharing Plan Variation",,"0.698560476303101","Yes","Yes","No","100%",,"$200","$20","$3,530","$150","$200","$1,470","$660","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver1_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","15"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380002-04","73% AV Level Silver Plan",,"0.728689312934875","Yes","Yes","No","100%",,"$200","$20","$3,530","$150","$200","$1,200","$660","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver1_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","16"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380002-05","87% AV Level Silver Plan",,"0.878068447113037","Yes","Yes","No","100%",,"$0","$20","$1,090","$150","$0","$1,200","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver1_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","17"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380002-06","94% AV Level Silver Plan",,"0.937708139419556","Yes","Yes","No","100%",,"$0","$20","$360","$150","$0","$400","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver1_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","18"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9955",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380003-00","Standard Silver Off Exchange Plan",,"0.697629868984222","Yes","Yes","No","100%",,"$2,000","$20","$2,100","$150","$1,150","$400","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver2","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","19"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9955",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380003-01","Standard Silver On Exchange Plan",,"0.697629868984222","Yes","Yes","No","100%",,"$2,000","$20","$2,100","$150","$1,150","$400","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver2","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","20"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380004-00","Standard Silver Off Exchange Plan",,"0.717822968959808","No","Yes","No","100%",,"$2,790","$20","$890","$150","$1,150","$480","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver3","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","26"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380004-01","Standard Silver On Exchange Plan",,"0.717822968959808","No","Yes","No","100%",,"$2,790","$20","$890","$150","$1,150","$480","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver3","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","27"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver3_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","28"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380004-03","Limited Cost Sharing Plan Variation",,"0.717822968959808","No","Yes","No","100%",,"$2,790","$20","$890","$150","$1,150","$480","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver3_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","29"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380004-04","73% AV Level Silver Plan",,"0.737850487232208","No","Yes","No","100%",,"$2,400","$20","$970","$150","$1,150","$480","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver3_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","30"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380004-05","87% AV Level Silver Plan",,"0.874850213527679","No","Yes","No","100%",,"$100","$20","$1,430","$150","$100","$630","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver3_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","31"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380004-06","94% AV Level Silver Plan",,"0.932157814502716","No","Yes","No","100%",,"$0","$0","$360","$150","$0","$0","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver3_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","32"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380009","BlueEssentials Silver 4","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9956",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380009-00","Standard Silver Off Exchange Plan",,"0.719215095043182","No","Yes","No","100%",,"$2,200","$20","$1,520","$150","$1,150","$480","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver4","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","33"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380009","BlueEssentials Silver 4","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9956",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380009-01","Standard Silver On Exchange Plan",,"0.719215095043182","No","Yes","No","100%",,"$2,200","$20","$1,520","$150","$1,150","$480","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver4","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","34"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380009","BlueEssentials Silver 4","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9956",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver4_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","35"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380009","BlueEssentials Silver 4","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9956",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380009-03","Limited Cost Sharing Plan Variation",,"0.719215095043182","No","Yes","No","100%",,"$2,200","$20","$1,520","$150","$1,150","$480","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver4_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","36"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380009","BlueEssentials Silver 4","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9956",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380009-04","73% AV Level Silver Plan",,"0.739352881908417","No","Yes","No","100%",,"$2,100","$20","$1,550","$150","$1,150","$480","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver4_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","37"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380009","BlueEssentials Silver 4","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9956",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380009-05","87% AV Level Silver Plan",,"0.87649405002594","No","Yes","No","100%",,"$50","$20","$1,440","$150","$50","$730","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver4_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","38"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380009","BlueEssentials Silver 4","26065SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9956",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380009-06","94% AV Level Silver Plan",,"0.932157814502716","No","Yes","No","100%",,"$0","$0","$360","$150","$0","$0","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver4_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","39"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380015","BlueEssentials Silver 7","26065SC038",,"SCN001","SCS001","SCF033","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380015-00","Standard Silver Off Exchange Plan",,"0.682274222373962","Yes","Yes","No","100%",,"$2,790","$10","$670","$150","$1,150","$240","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver7","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","40"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380015","BlueEssentials Silver 7","26065SC038",,"SCN001","SCS001","SCF033","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380015-01","Standard Silver On Exchange Plan",,"0.682274222373962","Yes","Yes","No","100%",,"$2,790","$10","$670","$150","$1,150","$240","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver7","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","41"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380015","BlueEssentials Silver 7","26065SC038",,"SCN001","SCS001","SCF033","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver7_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","42"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380015","BlueEssentials Silver 7","26065SC038",,"SCN001","SCS001","SCF033","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380015-03","Limited Cost Sharing Plan Variation",,"0.682274222373962","Yes","Yes","No","100%",,"$2,790","$10","$670","$150","$1,150","$240","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver7_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","43"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380015","BlueEssentials Silver 7","26065SC038",,"SCN001","SCS001","SCF033","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380015-04","73% AV Level Silver Plan",,"0.739681422710419","Yes","Yes","No","100%",,"$2,790","$0","$450","$150","$1,150","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver7_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","44"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380015","BlueEssentials Silver 7","26065SC038",,"SCN001","SCS001","SCF033","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380015-05","87% AV Level Silver Plan",,"0.863195836544037","Yes","Yes","No","100%",,"$1,000","$0","$630","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver7_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","45"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","1","26065","SC","Individual","No","57-0287419","26065SC0380015","BlueEssentials Silver 7","26065SC038",,"SCN001","SCS001","SCF033","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380015-06","94% AV Level Silver Plan",,"0.940580070018768","Yes","Yes","No","100%",,"$200","$0","$500","$150","$200","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver7_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","46"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","2","26065","SC","Individual","No","57-0287419","26065SC0380019","BlueEssentials Silver 11","26065SC038",,"SCN001","SCS001","SCF036","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380019-00","Standard Silver Off Exchange Plan",,"0.680123567581177","Yes","Yes","No","100%",,"$2,790","$0","$890","$150","$1,150","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver11","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","4"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","2","26065","SC","Individual","No","57-0287419","26065SC0380019","BlueEssentials Silver 11","26065SC038",,"SCN001","SCS001","SCF036","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380019-01","Standard Silver On Exchange Plan",,"0.680123567581177","Yes","Yes","No","100%",,"$2,790","$0","$890","$150","$1,150","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver11","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","5"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","2","26065","SC","Individual","No","57-0287419","26065SC0380019","BlueEssentials Silver 11","26065SC038",,"SCN001","SCS001","SCF036","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver11_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","6"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","2","26065","SC","Individual","No","57-0287419","26065SC0380019","BlueEssentials Silver 11","26065SC038",,"SCN001","SCS001","SCF036","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380019-03","Limited Cost Sharing Plan Variation",,"0.680123567581177","Yes","Yes","No","100%",,"$2,790","$0","$890","$150","$1,150","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver11_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","7"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","2","26065","SC","Individual","No","57-0287419","26065SC0380019","BlueEssentials Silver 11","26065SC038",,"SCN001","SCS001","SCF036","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380019-04","73% AV Level Silver Plan",,"0.720646619796753","Yes","Yes","No","100%",,"$2,790","$0","$890","$150","$1,150","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver11_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","8"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","2","26065","SC","Individual","No","57-0287419","26065SC0380019","BlueEssentials Silver 11","26065SC038",,"SCN001","SCS001","SCF036","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380019-05","87% AV Level Silver Plan",,"0.863253772258759","Yes","Yes","No","100%",,"$1,000","$0","$630","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver11_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","9"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","2","26065","SC","Individual","No","57-0287419","26065SC0380019","BlueEssentials Silver 11","26065SC038",,"SCN001","SCS001","SCF036","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9952",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380019-06","94% AV Level Silver Plan",,"0.930536210536957","Yes","Yes","No","100%",,"$0","$0","$730","$150","$0","$0","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver11_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","10"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","2","26065","SC","Individual","No","57-0287419","26065SC0380020","BlueEssentials Silver 12","26065SC038",,"SCN001","SCS001","SCF037","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9953",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380020-00","Standard Silver Off Exchange Plan",,"0.680581867694855","Yes","Yes","No","100%",,"$2,790","$0","$1,340","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver12","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","11"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","2","26065","SC","Individual","No","57-0287419","26065SC0380020","BlueEssentials Silver 12","26065SC038",,"SCN001","SCS001","SCF037","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9953",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380020-01","Standard Silver On Exchange Plan",,"0.680581867694855","Yes","Yes","No","100%",,"$2,790","$0","$1,340","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver12","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","12"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","2","26065","SC","Individual","No","57-0287419","26065SC0380020","BlueEssentials Silver 12","26065SC038",,"SCN001","SCS001","SCF037","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9953",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380020-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver12_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","13"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","2","26065","SC","Individual","No","57-0287419","26065SC0380020","BlueEssentials Silver 12","26065SC038",,"SCN001","SCS001","SCF037","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9953",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380020-03","Limited Cost Sharing Plan Variation",,"0.680581867694855","Yes","Yes","No","100%",,"$2,790","$0","$1,340","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver12_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","14"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","2","26065","SC","Individual","No","57-0287419","26065SC0380020","BlueEssentials Silver 12","26065SC038",,"SCN001","SCS001","SCF037","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9953",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380020-04","73% AV Level Silver Plan",,"0.727444112300873","Yes","Yes","No","100%",,"$2,790","$0","$1,340","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver12_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","15"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","2","26065","SC","Individual","No","57-0287419","26065SC0380020","BlueEssentials Silver 12","26065SC038",,"SCN001","SCS001","SCF037","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9953",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380020-05","87% AV Level Silver Plan",,"0.861270308494568","Yes","Yes","No","100%",,"$600","$0","$1,330","$150","$600","$0","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver12_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","16"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","2","26065","SC","Individual","No","57-0287419","26065SC0380020","BlueEssentials Silver 12","26065SC038",,"SCN001","SCS001","SCF037","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9953",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380020-06","94% AV Level Silver Plan",,"0.930426001548767","Yes","Yes","No","100%",,"$150","$0","$360","$150","$150","$0","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver12_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","17"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","3","26065","SC","Individual","No","57-0287419","26065SC0380016","BlueEssentials Silver 8","26065SC038",,"SCN001","SCS001","SCF034","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9955",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380016-00","Standard Silver Off Exchange Plan",,"0.684346973896027","No","Yes","Yes","50%","50%","$2,790","$0","$450","$150","$1,150","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver8","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","4"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","3","26065","SC","Individual","No","57-0287419","26065SC0380016","BlueEssentials Silver 8","26065SC038",,"SCN001","SCS001","SCF034","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9955",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380016-01","Standard Silver On Exchange Plan",,"0.684346973896027","No","Yes","Yes","50%","50%","$2,790","$0","$450","$150","$1,150","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver8","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","5"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","3","26065","SC","Individual","No","57-0287419","26065SC0380016","BlueEssentials Silver 8","26065SC038",,"SCN001","SCS001","SCF034","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9955",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380016-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","50%","50%","$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver8_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","6"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","3","26065","SC","Individual","No","57-0287419","26065SC0380016","BlueEssentials Silver 8","26065SC038",,"SCN001","SCS001","SCF034","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9955",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380016-03","Limited Cost Sharing Plan Variation",,"0.684346973896027","No","Yes","Yes","50%","50%","$2,790","$0","$450","$150","$1,150","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver8_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","7"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","3","26065","SC","Individual","No","57-0287419","26065SC0380016","BlueEssentials Silver 8","26065SC038",,"SCN001","SCS001","SCF034","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9955",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380016-04","73% AV Level Silver Plan",,"0.724670588970184","No","Yes","Yes","50%","50%","$2,790","$0","$450","$150","$1,150","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,700","$3700 per person","$7400 per group","10%","$3,700","$3700 per person","$7400 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver8_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","8"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","3","26065","SC","Individual","No","57-0287419","26065SC0380016","BlueEssentials Silver 8","26065SC038",,"SCN001","SCS001","SCF034","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9955",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380016-05","87% AV Level Silver Plan",,"0.864160358905792","No","Yes","Yes","50%","50%","$850","$0","$640","$150","$850","$80","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10%","$850","$850 per person","$1700 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver8_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","9"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","3","26065","SC","Individual","No","57-0287419","26065SC0380016","BlueEssentials Silver 8","26065SC038",,"SCN001","SCS001","SCF034","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9955",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380016-06","94% AV Level Silver Plan",,"0.938932061195374","No","Yes","Yes","50%","50%","$0","$0","$0","$150","$0","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver8_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","10"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","4","26065","SC","Individual","No","57-0287419","26065SC0380005","BlueEssentials Bronze 1","26065SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,,"0","0","4","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380005-00","Standard Bronze Off Exchange Plan",,"0.618231534957886","Yes","Yes","No","100%",,"$2,790","$20","$1,790","$150","$1,150","$1,000","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Bronze1","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","4"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","4","26065","SC","Individual","No","57-0287419","26065SC0380005","BlueEssentials Bronze 1","26065SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,,"0","0","4","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380005-01","Standard Bronze On Exchange Plan",,"0.618231534957886","Yes","Yes","No","100%",,"$2,790","$20","$1,790","$150","$1,150","$1,000","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Bronze1","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","5"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","4","26065","SC","Individual","No","57-0287419","26065SC0380005","BlueEssentials Bronze 1","26065SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,,"0","0","4","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Bronze1_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","6"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","4","26065","SC","Individual","No","57-0287419","26065SC0380005","BlueEssentials Bronze 1","26065SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,,"0","0","4","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380005-03","Limited Cost Sharing Plan Variation",,"0.618231534957886","Yes","Yes","No","100%",,"$2,790","$20","$1,790","$150","$1,150","$1,000","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Bronze1_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","7"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380006","BlueEssentials HD Bronze 2","26065SC038",,"SCN001","SCS001","SCF014","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9949",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380006-00","Standard Bronze Off Exchange Plan",,"0.589836835861206","Yes","Yes","No","100%",,"$2,790","$0","$2,250","$150","$1,150","$0","$2,060","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDBronze2","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","4"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380006","BlueEssentials HD Bronze 2","26065SC038",,"SCN001","SCS001","SCF014","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9949",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380006-01","Standard Bronze On Exchange Plan",,"0.589836835861206","Yes","Yes","No","100%",,"$2,790","$0","$2,250","$150","$1,150","$0","$2,060","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDBronze2","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","5"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380006","BlueEssentials HD Bronze 2","26065SC038",,"SCN001","SCS001","SCF014","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9949",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDBronze2_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","6"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380006","BlueEssentials HD Bronze 2","26065SC038",,"SCN001","SCS001","SCF014","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9949",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380006-03","Limited Cost Sharing Plan Variation",,"0.589836835861206","Yes","Yes","No","100%",,"$2,790","$0","$2,250","$150","$1,150","$0","$2,060","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDBronze2_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","7"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380012","BlueEssentials HD Bronze 3","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380012-00","Standard Bronze Off Exchange Plan",,"0.618767857551575","Yes","Yes","No","100%",,"$2,790","$0","$900","$150","$1,150","$0","$820","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDBronze3","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","8"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380012","BlueEssentials HD Bronze 3","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380012-01","Standard Bronze On Exchange Plan",,"0.618767857551575","Yes","Yes","No","100%",,"$2,790","$0","$900","$150","$1,150","$0","$820","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDBronze3","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","9"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380012","BlueEssentials HD Bronze 3","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDBronze3_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","10"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380012","BlueEssentials HD Bronze 3","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9951",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380012-03","Limited Cost Sharing Plan Variation",,"0.618767857551575","Yes","Yes","No","100%",,"$2,790","$0","$900","$150","$1,150","$0","$820","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDBronze3_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","11"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380013","BlueEssentials HD Bronze 4","26065SC038",,"SCN001","SCS001","SCF017","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380013-00","Standard Bronze Off Exchange Plan",,"0.608209848403931","Yes","Yes","No","100%",,"$2,790","$0","$1,350","$150","$1,150","$0","$1,240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDBronze4","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","12"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380013","BlueEssentials HD Bronze 4","26065SC038",,"SCN001","SCS001","SCF017","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380013-01","Standard Bronze On Exchange Plan",,"0.608209848403931","Yes","Yes","No","100%",,"$2,790","$0","$1,350","$150","$1,150","$0","$1,240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDBronze4","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","13"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380013","BlueEssentials HD Bronze 4","26065SC038",,"SCN001","SCS001","SCF017","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDBronze4_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","14"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380013","BlueEssentials HD Bronze 4","26065SC038",,"SCN001","SCS001","SCF017","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.995",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380013-03","Limited Cost Sharing Plan Variation",,"0.608209848403931","Yes","Yes","No","100%",,"$2,790","$0","$1,350","$150","$1,150","$0","$1,240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDBronze4_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","15"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380014","BlueEssentials HD Bronze 5","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9949",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380014-00","Standard Bronze Off Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDBronze5","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","16"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380014","BlueEssentials HD Bronze 5","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9949",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380014-01","Standard Bronze On Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDBronze5","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","17"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380014","BlueEssentials HD Bronze 5","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9949",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDBronze5_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","18"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380014","BlueEssentials HD Bronze 5","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9949",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380014-03","Limited Cost Sharing Plan Variation",,"0.5993931889534","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDBronze5_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","19"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380008","BlueEssentials HD Gold 3","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9966",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380008-00","Standard Gold Off Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$150","$1,150","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDGold3","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","20"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380008","BlueEssentials HD Gold 3","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9966",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380008-01","Standard Gold On Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$150","$1,150","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDGold3","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","21"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380008","BlueEssentials HD Gold 3","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9966",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDGold3_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","22"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380008","BlueEssentials HD Gold 3","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9966",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380008-03","Limited Cost Sharing Plan Variation",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$150","$1,150","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDGold3_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","23"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380010","BlueEssentials HD Silver 5","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380010-00","Standard Silver Off Exchange Plan",,"0.703916072845459","Yes","Yes","No","100%",,"$2,300","$0","$1,000","$150","$1,150","$0","$820","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDSilver5","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","24"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380010","BlueEssentials HD Silver 5","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380010-01","Standard Silver On Exchange Plan",,"0.703916072845459","Yes","Yes","No","100%",,"$2,300","$0","$1,000","$150","$1,150","$0","$820","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDSilver5","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","25"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380010","BlueEssentials HD Silver 5","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDSilver5_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","26"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380010","BlueEssentials HD Silver 5","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380010-03","Limited Cost Sharing Plan Variation",,"0.703916072845459","Yes","Yes","No","100%",,"$2,300","$0","$1,000","$150","$1,150","$0","$820","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDSilver5_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","27"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380010","BlueEssentials HD Silver 5","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380010-04","73% AV Level Silver Plan",,"0.737874805927277","Yes","Yes","No","100%",,"$1,600","$0","$1,140","$150","$1,150","$0","$820","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDSilver5_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","28"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380010","BlueEssentials HD Silver 5","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380010-05","87% AV Level Silver Plan",,"0.869724869728088","Yes","Yes","No","100%",,"$250","$0","$1,410","$150","$250","$0","$1,000","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDSilver5_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","29"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380010","BlueEssentials HD Silver 5","26065SC038",,"SCN001","SCS001","SCF016","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380010-06","94% AV Level Silver Plan",,"0.935133039951324","Yes","Yes","No","100%",,"$200","$0","$350","$150","$200","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDSilver5_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","30"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380011","BlueEssentials HD Silver 6","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380011-00","Standard Silver Off Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDSilver6","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","31"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380011","BlueEssentials HD Silver 6","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380011-01","Standard Silver On Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDSilver6","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","32"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380011","BlueEssentials HD Silver 6","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDSilver6_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","33"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380011","BlueEssentials HD Silver 6","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380011-03","Limited Cost Sharing Plan Variation",,"0.706476628780365","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDSilver6_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","34"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380011","BlueEssentials HD Silver 6","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380011-04","73% AV Level Silver Plan",,"0.727658689022064","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDSilver6_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","35"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380011","BlueEssentials HD Silver 6","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380011-05","87% AV Level Silver Plan",,"0.874577879905701","Yes","Yes","No","100%",,"$1,150","$0","$0","$150","$1,150","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDSilver6_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","36"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","5","26065","SC","Individual","No","57-0287419","26065SC0380011","BlueEssentials HD Silver 6","26065SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380011-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$150","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/HDSilver6_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","37"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","6","26065","SC","Individual","No","57-0287419","26065SC0390001","BlueEssentials Catastrophic 1","26065SC039",,"SCN001","SCS001","SCF006","Existing","EPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9942",,,,"0","0","3","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0390001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Catastrophic1","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","4"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","6","26065","SC","Individual","No","57-0287419","26065SC0390001","BlueEssentials Catastrophic 1","26065SC039",,"SCN001","SCS001","SCF006","Existing","EPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9942",,,,"0","0","3","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0390001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Catastrophic1","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","5"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","7","26065","SC","Individual","No","57-0287419","26065SC0380017","BlueEssentials Silver 9","26065SC038",,"SCN001","SCS001","SCF035","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9954",,,,"0","4","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380017-00","Standard Silver Off Exchange Plan",,"0.680458188056946","Yes","Yes","No","100%",,"$2,790","$0","$2,240","$150","$1,150","$0","$640","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver9","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","4"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","7","26065","SC","Individual","No","57-0287419","26065SC0380017","BlueEssentials Silver 9","26065SC038",,"SCN001","SCS001","SCF035","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9954",,,,"0","4","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380017-01","Standard Silver On Exchange Plan",,"0.680458188056946","Yes","Yes","No","100%",,"$2,790","$0","$2,240","$150","$1,150","$0","$640","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver9","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","5"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","7","26065","SC","Individual","No","57-0287419","26065SC0380017","BlueEssentials Silver 9","26065SC038",,"SCN001","SCS001","SCF035","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9954",,,,"0","4","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver9_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","6"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","7","26065","SC","Individual","No","57-0287419","26065SC0380017","BlueEssentials Silver 9","26065SC038",,"SCN001","SCS001","SCF035","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9954",,,,"0","4","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380017-03","Limited Cost Sharing Plan Variation",,"0.680458188056946","Yes","Yes","No","100%",,"$2,790","$0","$2,240","$150","$1,150","$0","$640","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver9_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","7"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","7","26065","SC","Individual","No","57-0287419","26065SC0380017","BlueEssentials Silver 9","26065SC038",,"SCN001","SCS001","SCF035","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9954",,,,"0","4","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380017-04","73% AV Level Silver Plan",,"0.720211386680603","Yes","Yes","No","100%",,"$2,790","$0","$2,240","$150","$1,150","$0","$640","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver9_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","8"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","7","26065","SC","Individual","No","57-0287419","26065SC0380017","BlueEssentials Silver 9","26065SC038",,"SCN001","SCS001","SCF035","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9954",,,,"0","4","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380017-05","87% AV Level Silver Plan",,"0.864510715007782","Yes","Yes","No","100%",,"$1,000","$0","$1,250","$150","$1,000","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver9_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","9"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","7","26065","SC","Individual","No","57-0287419","26065SC0380017","BlueEssentials Silver 9","26065SC038",,"SCN001","SCS001","SCF035","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9954",,,,"0","4","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380017-06","94% AV Level Silver Plan",,"0.931577503681183","Yes","Yes","No","100%",,"$300","$0","$350","$150","$300","$0","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver9_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","10"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","8","26065","SC","Individual","No","57-0287419","26065SC0380018","BlueEssentials Silver 10","26065SC038",,"SCN001","SCS001","SCF035","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9953",,,,"0","0","4","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380018-00","Standard Silver Off Exchange Plan",,"0.681495368480682","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver10","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","4"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","8","26065","SC","Individual","No","57-0287419","26065SC0380018","BlueEssentials Silver 10","26065SC038",,"SCN001","SCS001","SCF035","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9953",,,,"0","0","4","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380018-01","Standard Silver On Exchange Plan",,"0.681495368480682","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver10","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","5"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","8","26065","SC","Individual","No","57-0287419","26065SC0380018","BlueEssentials Silver 10","26065SC038",,"SCN001","SCS001","SCF035","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9953",,,,"0","0","4","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver10_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","6"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","8","26065","SC","Individual","No","57-0287419","26065SC0380018","BlueEssentials Silver 10","26065SC038",,"SCN001","SCS001","SCF035","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9953",,,,"0","0","4","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380018-03","Limited Cost Sharing Plan Variation",,"0.681495368480682","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver10_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","7"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","8","26065","SC","Individual","No","57-0287419","26065SC0380018","BlueEssentials Silver 10","26065SC038",,"SCN001","SCS001","SCF035","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9953",,,,"0","0","4","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380018-04","73% AV Level Silver Plan",,"0.721935212612152","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver10_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","8"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","8","26065","SC","Individual","No","57-0287419","26065SC0380018","BlueEssentials Silver 10","26065SC038",,"SCN001","SCS001","SCF035","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9953",,,,"0","0","4","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380018-05","87% AV Level Silver Plan",,"0.864169359207153","Yes","Yes","No","100%",,"$1,700","$0","$0","$150","$1,150","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver10_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","9"
"2016","SC","26065","HIOS","7","2015-09-25 04:20:25","8","26065","SC","Individual","No","57-0287419","26065SC0380018","BlueEssentials Silver 10","26065SC038",,"SCN001","SCS001","SCF035","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9953",,,,"0","0","4","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0380018-06","94% AV Level Silver Plan",,"0.946371078491211","Yes","Yes","No","100%",,"$200","$0","$0","$150","$200","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/Silver10_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2016/individual/brochure","10"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","17","38408","SC","Individual","No","23-2169745","38408SC0020024","Coventry Bronze Ded Only HSA Eligible Upstate","38408SC002",,"SCN002","SCS002","SCF031","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020024-01","Standard Bronze On Exchange Plan","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/SC51891","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","17","38408","SC","Individual","No","23-2169745","38408SC0020024","Coventry Bronze Ded Only HSA Eligible Upstate","38408SC002",,"SCN002","SCS002","SCF031","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020024-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51892","http://www.coventryone.com/SCon2016","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","17","38408","SC","Individual","No","23-2169745","38408SC0020024","Coventry Bronze Ded Only HSA Eligible Upstate","38408SC002",,"SCN002","SCS002","SCF031","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020024-03","Limited Cost Sharing Plan Variation","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/SC51893","http://www.coventryone.com/SCon2016","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","19","38408","SC","Individual","No","23-2169745","38408SC0010001","Aetna Leap Everyday – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010001-00","Standard Silver Off Exchange Plan","68.36%",,"Yes","Yes","Yes","86%","14%","$4,800","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/SC/SilverBasicCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/SC.pdf","4"
"2016","SC","32899","HIOS","1","2015-05-01 02:23:41","1","32899","SC","SHOP (Small Group)","Yes","36-0883760","32899SC0040002","EHB High PPO","32899SC004",,"SCN001","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.23","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","32899SC0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","SC","32899","HIOS","1","2015-05-01 02:23:41","1","32899","SC","SHOP (Small Group)","Yes","36-0883760","32899SC0040001","EHB Low PPO","32899SC004",,"SCN001","SCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.15","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","32899SC0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","SC","32899","HIOS","1","2015-05-01 02:23:41","1","32899","SC","SHOP (Small Group)","Yes","36-0883760","32899SC0030002","EHB High Passive","32899SC003",,"SCN001","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.99","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","32899SC0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","SC","32899","HIOS","1","2015-05-01 02:23:41","1","32899","SC","SHOP (Small Group)","Yes","36-0883760","32899SC0030001","EHB Low Passive","32899SC003",,"SCN001","SCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.50","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","32899SC0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","1","38408","SC","Individual","No","23-2169745","38408SC0010004","Aetna Leap Basic HSA – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF004","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010004-00","Standard Bronze Off Exchange Plan","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/SC/BronzeHSACarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/SC.pdf","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","1","38408","SC","Individual","No","23-2169745","38408SC0010004","Aetna Leap Basic HSA – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF004","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010004-01","Standard Bronze On Exchange Plan","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/BronzeHSACarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","1","38408","SC","Individual","No","23-2169745","38408SC0010004","Aetna Leap Basic HSA – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF004","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/BronzeHSACarolinasHealthCareSystemAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","1","38408","SC","Individual","No","23-2169745","38408SC0010004","Aetna Leap Basic HSA – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF004","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010004-03","Limited Cost Sharing Plan Variation","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/BronzeHSACarolinasHealthCareSystemAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","2","38408","SC","Individual","No","23-2169745","38408SC0010003","Aetna Leap Basic Plus – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF003","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010003-00","Standard Bronze Off Exchange Plan","61.94%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,335","$6335 per person","$12670 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,335","$6335 per person","$12670 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/SC/BronzePlusCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/SC.pdf","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","2","38408","SC","Individual","No","23-2169745","38408SC0010003","Aetna Leap Basic Plus – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF003","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010003-01","Standard Bronze On Exchange Plan","61.94%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,335","$6335 per person","$12670 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,335","$6335 per person","$12670 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/BronzePlusCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","2","38408","SC","Individual","No","23-2169745","38408SC0010003","Aetna Leap Basic Plus – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF003","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/BronzePlusCarolinasHealthCareSystemAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","2","38408","SC","Individual","No","23-2169745","38408SC0010003","Aetna Leap Basic Plus – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF003","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010003-03","Limited Cost Sharing Plan Variation","61.94%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,335","$6335 per person","$12670 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,335","$6335 per person","$12670 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/BronzePlusCarolinasHealthCareSystemAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","3","38408","SC","Individual","No","23-2169745","38408SC0020008","Coventry Bronze $15 Copay","38408SC002",,"SCN004","SCS004","SCF015","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020008-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51910","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","3","38408","SC","Individual","No","23-2169745","38408SC0020008","Coventry Bronze $15 Copay","38408SC002",,"SCN004","SCS004","SCF015","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020008-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51800","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","3","38408","SC","Individual","No","23-2169745","38408SC0020008","Coventry Bronze $15 Copay","38408SC002",,"SCN004","SCS004","SCF015","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020008-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51801","http://www.coventryone.com/SCon2016","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","3","38408","SC","Individual","No","23-2169745","38408SC0020008","Coventry Bronze $15 Copay","38408SC002",,"SCN004","SCS004","SCF015","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020008-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51802","http://www.coventryone.com/SCon2016","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","5","38408","SC","Individual","No","23-2169745","38408SC0020016","Coventry Bronze $35 Copay Midlands","38408SC002",,"SCN003","SCS003","SCF023","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020016-00","Standard Bronze Off Exchange Plan","61.99%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%","$6,750","$6750 per person","$13500 per group","0%","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51922","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","5","38408","SC","Individual","No","23-2169745","38408SC0020016","Coventry Bronze $35 Copay Midlands","38408SC002",,"SCN003","SCS003","SCF023","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020016-01","Standard Bronze On Exchange Plan","61.99%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%","$6,750","$6750 per person","$13500 per group","0%","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51822","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","5","38408","SC","Individual","No","23-2169745","38408SC0020016","Coventry Bronze $35 Copay Midlands","38408SC002",,"SCN003","SCS003","SCF023","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020016-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51823","http://www.coventryone.com/SCon2016","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","5","38408","SC","Individual","No","23-2169745","38408SC0020016","Coventry Bronze $35 Copay Midlands","38408SC002",,"SCN003","SCS003","SCF023","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020016-03","Limited Cost Sharing Plan Variation","61.99%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%","$6,750","$6750 per person","$13500 per group","0%","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51824","http://www.coventryone.com/SCon2016","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","7","38408","SC","Individual","No","23-2169745","38408SC0020004","Coventry Bronze $35 Copay Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF011","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020004-00","Standard Bronze Off Exchange Plan","61.99%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%","$6,750","$6750 per person","$13500 per group","0%","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51946","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","7","38408","SC","Individual","No","23-2169745","38408SC0020004","Coventry Bronze $35 Copay Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF011","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020004-01","Standard Bronze On Exchange Plan","61.99%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%","$6,750","$6750 per person","$13500 per group","0%","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51866","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","7","38408","SC","Individual","No","23-2169745","38408SC0020004","Coventry Bronze $35 Copay Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF011","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51867","http://www.coventryone.com/SCon2016","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","7","38408","SC","Individual","No","23-2169745","38408SC0020004","Coventry Bronze $35 Copay Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF011","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020004-03","Limited Cost Sharing Plan Variation","61.99%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%","$6,750","$6750 per person","$13500 per group","0%","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51868","http://www.coventryone.com/SCon2016","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","9","38408","SC","Individual","No","23-2169745","38408SC0020020","Coventry Bronze $35 Copay Upstate","38408SC002",,"SCN002","SCS002","SCF027","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020020-00","Standard Bronze Off Exchange Plan","61.99%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%","$6,750","$6750 per person","$13500 per group","0%","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51958","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","9","38408","SC","Individual","No","23-2169745","38408SC0020020","Coventry Bronze $35 Copay Upstate","38408SC002",,"SCN002","SCS002","SCF027","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020020-01","Standard Bronze On Exchange Plan","61.99%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%","$6,750","$6750 per person","$13500 per group","0%","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51888","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","9","38408","SC","Individual","No","23-2169745","38408SC0020020","Coventry Bronze $35 Copay Upstate","38408SC002",,"SCN002","SCS002","SCF027","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020020-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51889","http://www.coventryone.com/SCon2016","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","9","38408","SC","Individual","No","23-2169745","38408SC0020020","Coventry Bronze $35 Copay Upstate","38408SC002",,"SCN002","SCS002","SCF027","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020020-03","Limited Cost Sharing Plan Variation","61.99%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%","$6,750","$6750 per person","$13500 per group","0%","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51890","http://www.coventryone.com/SCon2016","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","11","38408","SC","Individual","No","23-2169745","38408SC0020009","Coventry Bronze Ded Only HSA Eligible","38408SC002",,"SCN004","SCS004","SCF016","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020009-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/SC51912","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","11","38408","SC","Individual","No","23-2169745","38408SC0020009","Coventry Bronze Ded Only HSA Eligible","38408SC002",,"SCN004","SCS004","SCF016","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020009-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/SC51803","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","11","38408","SC","Individual","No","23-2169745","38408SC0020009","Coventry Bronze Ded Only HSA Eligible","38408SC002",,"SCN004","SCS004","SCF016","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020009-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51804","http://www.coventryone.com/SCon2016","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","11","38408","SC","Individual","No","23-2169745","38408SC0020009","Coventry Bronze Ded Only HSA Eligible","38408SC002",,"SCN004","SCS004","SCF016","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020009-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/SC51805","http://www.coventryone.com/SCon2016","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","12","38408","SC","Individual","No","23-2169745","38408SC0020030","Coventry Bronze Ded Only HSA Eligible Midlands","38408SC002",,"SCN003","SCS003","SCF037","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020030-00","Standard Bronze Off Exchange Plan","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/SC51924","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","12","38408","SC","Individual","No","23-2169745","38408SC0020030","Coventry Bronze Ded Only HSA Eligible Midlands","38408SC002",,"SCN003","SCS003","SCF037","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020030-01","Standard Bronze On Exchange Plan","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/SC51825","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","12","38408","SC","Individual","No","23-2169745","38408SC0020030","Coventry Bronze Ded Only HSA Eligible Midlands","38408SC002",,"SCN003","SCS003","SCF037","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020030-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51826","http://www.coventryone.com/SCon2016","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","12","38408","SC","Individual","No","23-2169745","38408SC0020030","Coventry Bronze Ded Only HSA Eligible Midlands","38408SC002",,"SCN003","SCS003","SCF037","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020030-03","Limited Cost Sharing Plan Variation","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/SC51827","http://www.coventryone.com/SCon2016","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","15","38408","SC","Individual","No","23-2169745","38408SC0020026","Coventry Bronze Ded Only HSA Eligible Roper/St. Francis","38408SC002",,"SCN001","SCS001","SCF033","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020026-00","Standard Bronze Off Exchange Plan","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/SC51948","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","15","38408","SC","Individual","No","23-2169745","38408SC0020026","Coventry Bronze Ded Only HSA Eligible Roper/St. Francis","38408SC002",,"SCN001","SCS001","SCF033","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020026-01","Standard Bronze On Exchange Plan","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/SC51869","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","15","38408","SC","Individual","No","23-2169745","38408SC0020026","Coventry Bronze Ded Only HSA Eligible Roper/St. Francis","38408SC002",,"SCN001","SCS001","SCF033","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020026-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51870","http://www.coventryone.com/SCon2016","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","15","38408","SC","Individual","No","23-2169745","38408SC0020026","Coventry Bronze Ded Only HSA Eligible Roper/St. Francis","38408SC002",,"SCN001","SCS001","SCF033","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020026-03","Limited Cost Sharing Plan Variation","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/SC51871","http://www.coventryone.com/SCon2016","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","17","38408","SC","Individual","No","23-2169745","38408SC0020024","Coventry Bronze Ded Only HSA Eligible Upstate","38408SC002",,"SCN002","SCS002","SCF031","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020024-00","Standard Bronze Off Exchange Plan","61.83%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,825","$5825 per person","$11650 per group","0%","$6,450","$6450 per person","$12900 per group","0%","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/SC51960","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","19","38408","SC","Individual","No","23-2169745","38408SC0010001","Aetna Leap Everyday – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010001-01","Standard Silver On Exchange Plan","68.36%",,"Yes","Yes","Yes","86%","14%","$4,800","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/SilverBasicCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","19","38408","SC","Individual","No","23-2169745","38408SC0010001","Aetna Leap Everyday – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","86%","14%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/SilverBasicCarolinasHealthCareSystemAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","19","38408","SC","Individual","No","23-2169745","38408SC0010001","Aetna Leap Everyday – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010001-03","Limited Cost Sharing Plan Variation","68.36%",,"Yes","Yes","Yes","86%","14%","$4,800","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/SilverBasicCarolinasHealthCareSystemAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","19","38408","SC","Individual","No","23-2169745","38408SC0010001","Aetna Leap Everyday – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010001-04","73% AV Level Silver Plan","72.09%",,"Yes","Yes","Yes","86%","14%","$3,900","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","$5,350","$5350 per person","$10700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$7800 per group","0%","$5,350","$5350 per person","$10700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/SilverBasicCarolinasHealthCareSystemCSR73.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","8"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","19","38408","SC","Individual","No","23-2169745","38408SC0010001","Aetna Leap Everyday – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010001-05","87% AV Level Silver Plan","86.76%",,"Yes","Yes","Yes","86%","14%","$1,300","$0","$0","$200","$1,200","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%","$2,250","$2250 per person","$4500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/SilverBasicCarolinasHealthCareSystemCSR87.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","9"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","19","38408","SC","Individual","No","23-2169745","38408SC0010001","Aetna Leap Everyday – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010001-06","94% AV Level Silver Plan","93.88%",,"Yes","Yes","Yes","86%","14%","$500","$0","$0","$200","$400","$40","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","$1,300","$1300 per person","$2600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0%","$1,300","$1300 per person","$2600 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/SilverBasicCarolinasHealthCareSystemCSR94.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","10"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","20","38408","SC","Individual","No","23-2169745","38408SC0010002","Aetna Leap Everyday Plus – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010002-00","Standard Silver Off Exchange Plan","71.85%",,"Yes","Yes","Yes","86%","14%","$4,000","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,010","$4010 per person","$8020 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,010","$4010 per person","$8020 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/SC/SilverPlusCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/SC.pdf","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","20","38408","SC","Individual","No","23-2169745","38408SC0010002","Aetna Leap Everyday Plus – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010002-01","Standard Silver On Exchange Plan","71.85%",,"Yes","Yes","Yes","86%","14%","$4,000","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,010","$4010 per person","$8020 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,010","$4010 per person","$8020 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/SilverPlusCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","20","38408","SC","Individual","No","23-2169745","38408SC0010002","Aetna Leap Everyday Plus – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","86%","14%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/SilverPlusCarolinasHealthCareSystemAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","20","38408","SC","Individual","No","23-2169745","38408SC0010002","Aetna Leap Everyday Plus – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010002-03","Limited Cost Sharing Plan Variation","71.85%",,"Yes","Yes","Yes","86%","14%","$4,000","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,010","$4010 per person","$8020 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,010","$4010 per person","$8020 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/SilverPlusCarolinasHealthCareSystemAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","20","38408","SC","Individual","No","23-2169745","38408SC0010002","Aetna Leap Everyday Plus – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010002-04","73% AV Level Silver Plan","73.86%",,"Yes","Yes","Yes","86%","14%","$3,600","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,610","$3610 per person","$7220 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,610","$3610 per person","$7220 per group","0%","$5,450","$5450 per person","$10900 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/SilverPlusCarolinasHealthCareSystemCSR73.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","8"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","20","38408","SC","Individual","No","23-2169745","38408SC0010002","Aetna Leap Everyday Plus – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010002-05","87% AV Level Silver Plan","86.52%",,"Yes","Yes","Yes","86%","14%","$1,400","$0","$0","$200","$1,300","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","0%","$2,250","$2250 per person","$4500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/SilverPlusCarolinasHealthCareSystemCSR87.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","9"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","20","38408","SC","Individual","No","23-2169745","38408SC0010002","Aetna Leap Everyday Plus – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010002-06","94% AV Level Silver Plan","93.56%",,"Yes","Yes","Yes","86%","14%","$500","$0","$0","$200","$500","$40","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$1,325","$1325 per person","$2650 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%","$1,325","$1325 per person","$2650 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/SilverPlusCarolinasHealthCareSystemCSR94.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","10"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","21","38408","SC","Individual","No","23-2169745","38408SC0020003","Coventry Silver $10 Copay","38408SC002",,"SCN004","SCS004","SCF010","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020003-00","Standard Silver Off Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51918","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","21","38408","SC","Individual","No","23-2169745","38408SC0020003","Coventry Silver $10 Copay","38408SC002",,"SCN004","SCS004","SCF010","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020003-01","Standard Silver On Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51810","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","21","38408","SC","Individual","No","23-2169745","38408SC0020003","Coventry Silver $10 Copay","38408SC002",,"SCN004","SCS004","SCF010","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51820","http://www.coventryone.com/SCon2016","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","21","38408","SC","Individual","No","23-2169745","38408SC0020003","Coventry Silver $10 Copay","38408SC002",,"SCN004","SCS004","SCF010","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020003-03","Limited Cost Sharing Plan Variation","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51821","http://www.coventryone.com/SCon2016","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","21","38408","SC","Individual","No","23-2169745","38408SC0020003","Coventry Silver $10 Copay","38408SC002",,"SCN004","SCS004","SCF010","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020003-04","73% AV Level Silver Plan","72.09%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51817","http://www.coventryone.com/SCon2016","8"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","21","38408","SC","Individual","No","23-2169745","38408SC0020003","Coventry Silver $10 Copay","38408SC002",,"SCN004","SCS004","SCF010","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020003-05","87% AV Level Silver Plan","86.14%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51818","http://www.coventryone.com/SCon2016","9"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","21","38408","SC","Individual","No","23-2169745","38408SC0020003","Coventry Silver $10 Copay","38408SC002",,"SCN004","SCS004","SCF010","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020003-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51819","http://www.coventryone.com/SCon2016","10"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","22","38408","SC","Individual","No","23-2169745","38408SC0020005","Coventry Silver $10 Copay 2750","38408SC002",,"SCN004","SCS004","SCF012","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020005-00","Standard Silver Off Exchange Plan","68.05%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51919","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","22","38408","SC","Individual","No","23-2169745","38408SC0020005","Coventry Silver $10 Copay 2750","38408SC002",,"SCN004","SCS004","SCF012","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020005-01","Standard Silver On Exchange Plan","68.05%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51811","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","22","38408","SC","Individual","No","23-2169745","38408SC0020005","Coventry Silver $10 Copay 2750","38408SC002",,"SCN004","SCS004","SCF012","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51815","http://www.coventryone.com/SCon2016","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","22","38408","SC","Individual","No","23-2169745","38408SC0020005","Coventry Silver $10 Copay 2750","38408SC002",,"SCN004","SCS004","SCF012","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020005-03","Limited Cost Sharing Plan Variation","68.05%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51816","http://www.coventryone.com/SCon2016","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","22","38408","SC","Individual","No","23-2169745","38408SC0020005","Coventry Silver $10 Copay 2750","38408SC002",,"SCN004","SCS004","SCF012","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020005-04","73% AV Level Silver Plan","72.18%",,"Yes","Yes","No","100%",,"$2,500","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51812","http://www.coventryone.com/SCon2016","8"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","22","38408","SC","Individual","No","23-2169745","38408SC0020005","Coventry Silver $10 Copay 2750","38408SC002",,"SCN004","SCS004","SCF012","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020005-05","87% AV Level Silver Plan","86.24%",,"Yes","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51813","http://www.coventryone.com/SCon2016","9"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","22","38408","SC","Individual","No","23-2169745","38408SC0020005","Coventry Silver $10 Copay 2750","38408SC002",,"SCN004","SCS004","SCF012","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020005-06","94% AV Level Silver Plan","93.06%",,"Yes","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51814","http://www.coventryone.com/SCon2016","10"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","23","38408","SC","Individual","No","23-2169745","38408SC0020015","Coventry Silver $10 Copay 2750 Midlands","38408SC002",,"SCN003","SCS003","SCF022","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020015-00","Standard Silver Off Exchange Plan","68.12%",,"Yes","Yes","Yes","80%","20%","$2,800","$10","$700","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51930","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","23","38408","SC","Individual","No","23-2169745","38408SC0020015","Coventry Silver $10 Copay 2750 Midlands","38408SC002",,"SCN003","SCS003","SCF022","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020015-01","Standard Silver On Exchange Plan","68.12%",,"Yes","Yes","Yes","80%","20%","$2,800","$10","$700","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51832","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","23","38408","SC","Individual","No","23-2169745","38408SC0020015","Coventry Silver $10 Copay 2750 Midlands","38408SC002",,"SCN003","SCS003","SCF022","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020015-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","80%","20%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51836","http://www.coventryone.com/SCon2016","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","23","38408","SC","Individual","No","23-2169745","38408SC0020015","Coventry Silver $10 Copay 2750 Midlands","38408SC002",,"SCN003","SCS003","SCF022","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020015-03","Limited Cost Sharing Plan Variation","68.12%",,"Yes","Yes","Yes","80%","20%","$2,800","$10","$700","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51837","http://www.coventryone.com/SCon2016","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","23","38408","SC","Individual","No","23-2169745","38408SC0020015","Coventry Silver $10 Copay 2750 Midlands","38408SC002",,"SCN003","SCS003","SCF022","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020015-04","73% AV Level Silver Plan","72.08%",,"Yes","Yes","Yes","80%","20%","$2,500","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%","$4,500","$4500 per person","$9000 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51833","http://www.coventryone.com/SCon2016","8"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","23","38408","SC","Individual","No","23-2169745","38408SC0020015","Coventry Silver $10 Copay 2750 Midlands","38408SC002",,"SCN003","SCS003","SCF022","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020015-05","87% AV Level Silver Plan","86.04%",,"Yes","Yes","Yes","80%","20%","$0","$10","$1,600","$200","$0","$200","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$1,500","$1500 per person","$3000 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51834","http://www.coventryone.com/SCon2016","9"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","23","38408","SC","Individual","No","23-2169745","38408SC0020015","Coventry Silver $10 Copay 2750 Midlands","38408SC002",,"SCN003","SCS003","SCF022","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020015-06","94% AV Level Silver Plan","93.08%",,"Yes","Yes","Yes","80%","20%","$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","20%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51835","http://www.coventryone.com/SCon2016","10"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","26","38408","SC","Individual","No","23-2169745","38408SC0020001","Coventry Silver $10 Copay 2750 Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020001-00","Standard Silver Off Exchange Plan","68.12%",,"Yes","Yes","Yes","80%","20%","$2,800","$10","$700","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51954","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","26","38408","SC","Individual","No","23-2169745","38408SC0020001","Coventry Silver $10 Copay 2750 Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020001-01","Standard Silver On Exchange Plan","68.12%",,"Yes","Yes","Yes","80%","20%","$2,800","$10","$700","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51876","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","26","38408","SC","Individual","No","23-2169745","38408SC0020001","Coventry Silver $10 Copay 2750 Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","80%","20%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51880","http://www.coventryone.com/SCon2016","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","26","38408","SC","Individual","No","23-2169745","38408SC0020001","Coventry Silver $10 Copay 2750 Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020001-03","Limited Cost Sharing Plan Variation","68.12%",,"Yes","Yes","Yes","80%","20%","$2,800","$10","$700","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51881","http://www.coventryone.com/SCon2016","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","26","38408","SC","Individual","No","23-2169745","38408SC0020001","Coventry Silver $10 Copay 2750 Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020001-04","73% AV Level Silver Plan","72.08%",,"Yes","Yes","Yes","80%","20%","$2,500","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%","$4,500","$4500 per person","$9000 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51877","http://www.coventryone.com/SCon2016","8"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","26","38408","SC","Individual","No","23-2169745","38408SC0020001","Coventry Silver $10 Copay 2750 Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020001-05","87% AV Level Silver Plan","86.04%",,"Yes","Yes","Yes","80%","20%","$0","$10","$1,600","$200","$0","$200","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$1,500","$1500 per person","$3000 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51878","http://www.coventryone.com/SCon2016","9"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","26","38408","SC","Individual","No","23-2169745","38408SC0020001","Coventry Silver $10 Copay 2750 Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020001-06","94% AV Level Silver Plan","93.08%",,"Yes","Yes","Yes","80%","20%","$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","20%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51879","http://www.coventryone.com/SCon2016","10"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","28","38408","SC","Individual","No","23-2169745","38408SC0020019","Coventry Silver $10 Copay 2750 Upstate","38408SC002",,"SCN002","SCS002","SCF026","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020019-00","Standard Silver Off Exchange Plan","68.12%",,"Yes","Yes","Yes","80%","20%","$2,800","$10","$700","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51966","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","28","38408","SC","Individual","No","23-2169745","38408SC0020019","Coventry Silver $10 Copay 2750 Upstate","38408SC002",,"SCN002","SCS002","SCF026","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020019-01","Standard Silver On Exchange Plan","68.12%",,"Yes","Yes","Yes","80%","20%","$2,800","$10","$700","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51898","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","28","38408","SC","Individual","No","23-2169745","38408SC0020019","Coventry Silver $10 Copay 2750 Upstate","38408SC002",,"SCN002","SCS002","SCF026","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020019-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","80%","20%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51902","http://www.coventryone.com/SCon2016","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","28","38408","SC","Individual","No","23-2169745","38408SC0020019","Coventry Silver $10 Copay 2750 Upstate","38408SC002",,"SCN002","SCS002","SCF026","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020019-03","Limited Cost Sharing Plan Variation","68.12%",,"Yes","Yes","Yes","80%","20%","$2,800","$10","$700","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51903","http://www.coventryone.com/SCon2016","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","28","38408","SC","Individual","No","23-2169745","38408SC0020019","Coventry Silver $10 Copay 2750 Upstate","38408SC002",,"SCN002","SCS002","SCF026","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020019-04","73% AV Level Silver Plan","72.08%",,"Yes","Yes","Yes","80%","20%","$2,500","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%","$4,500","$4500 per person","$9000 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51899","http://www.coventryone.com/SCon2016","8"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","28","38408","SC","Individual","No","23-2169745","38408SC0020019","Coventry Silver $10 Copay 2750 Upstate","38408SC002",,"SCN002","SCS002","SCF026","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020019-05","87% AV Level Silver Plan","86.04%",,"Yes","Yes","Yes","80%","20%","$0","$10","$1,600","$200","$0","$200","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$1,500","$1500 per person","$3000 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51900","http://www.coventryone.com/SCon2016","9"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","28","38408","SC","Individual","No","23-2169745","38408SC0020019","Coventry Silver $10 Copay 2750 Upstate","38408SC002",,"SCN002","SCS002","SCF026","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020019-06","94% AV Level Silver Plan","93.08%",,"Yes","Yes","Yes","80%","20%","$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","20%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51901","http://www.coventryone.com/SCon2016","10"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","30","38408","SC","Individual","No","23-2169745","38408SC0020014","Coventry Silver $10 Copay Midlands","38408SC002",,"SCN003","SCS003","SCF021","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020014-00","Standard Silver Off Exchange Plan","68.08%",,"No","Yes","Yes","75%","25%","$3,500","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51932","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","30","38408","SC","Individual","No","23-2169745","38408SC0020014","Coventry Silver $10 Copay Midlands","38408SC002",,"SCN003","SCS003","SCF021","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020014-01","Standard Silver On Exchange Plan","68.08%",,"No","Yes","Yes","75%","25%","$3,500","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51838","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","30","38408","SC","Individual","No","23-2169745","38408SC0020014","Coventry Silver $10 Copay Midlands","38408SC002",,"SCN003","SCS003","SCF021","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020014-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51842","http://www.coventryone.com/SCon2016","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","30","38408","SC","Individual","No","23-2169745","38408SC0020014","Coventry Silver $10 Copay Midlands","38408SC002",,"SCN003","SCS003","SCF021","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020014-03","Limited Cost Sharing Plan Variation","68.08%",,"No","Yes","Yes","75%","25%","$3,500","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51843","http://www.coventryone.com/SCon2016","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","30","38408","SC","Individual","No","23-2169745","38408SC0020014","Coventry Silver $10 Copay Midlands","38408SC002",,"SCN003","SCS003","SCF021","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020014-04","73% AV Level Silver Plan","72.05%",,"No","Yes","Yes","75%","25%","$3,200","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","20%","$4,500","$4500 per person","$9000 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51839","http://www.coventryone.com/SCon2016","8"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","30","38408","SC","Individual","No","23-2169745","38408SC0020014","Coventry Silver $10 Copay Midlands","38408SC002",,"SCN003","SCS003","SCF021","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020014-05","87% AV Level Silver Plan","86.12%",,"No","Yes","Yes","75%","25%","$500","$10","$900","$200","$500","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$1,500","$1500 per person","$3000 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51840","http://www.coventryone.com/SCon2016","9"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","30","38408","SC","Individual","No","23-2169745","38408SC0020014","Coventry Silver $10 Copay Midlands","38408SC002",,"SCN003","SCS003","SCF021","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020014-06","94% AV Level Silver Plan","93.08%",,"No","Yes","Yes","75%","25%","$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","20%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%","$0","$0 per person","per group not applicable","20%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51841","http://www.coventryone.com/SCon2016","10"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","33","38408","SC","Individual","No","23-2169745","38408SC0020022","Coventry Silver $10 Copay Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF029","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020022-00","Standard Silver Off Exchange Plan","68.08%",,"No","Yes","Yes","75%","25%","$3,500","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51956","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","33","38408","SC","Individual","No","23-2169745","38408SC0020022","Coventry Silver $10 Copay Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF029","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020022-01","Standard Silver On Exchange Plan","68.08%",,"No","Yes","Yes","75%","25%","$3,500","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51882","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","33","38408","SC","Individual","No","23-2169745","38408SC0020022","Coventry Silver $10 Copay Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF029","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020022-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51886","http://www.coventryone.com/SCon2016","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","33","38408","SC","Individual","No","23-2169745","38408SC0020022","Coventry Silver $10 Copay Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF029","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020022-03","Limited Cost Sharing Plan Variation","68.08%",,"No","Yes","Yes","75%","25%","$3,500","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51887","http://www.coventryone.com/SCon2016","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","33","38408","SC","Individual","No","23-2169745","38408SC0020022","Coventry Silver $10 Copay Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF029","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020022-04","73% AV Level Silver Plan","72.05%",,"No","Yes","Yes","75%","25%","$3,200","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","20%","$4,500","$4500 per person","$9000 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51883","http://www.coventryone.com/SCon2016","8"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","33","38408","SC","Individual","No","23-2169745","38408SC0020022","Coventry Silver $10 Copay Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF029","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020022-05","87% AV Level Silver Plan","86.12%",,"No","Yes","Yes","75%","25%","$500","$10","$900","$200","$500","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$1,500","$1500 per person","$3000 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51884","http://www.coventryone.com/SCon2016","9"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","33","38408","SC","Individual","No","23-2169745","38408SC0020022","Coventry Silver $10 Copay Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF029","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020022-06","94% AV Level Silver Plan","93.08%",,"No","Yes","Yes","75%","25%","$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","20%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%","$0","$0 per person","per group not applicable","20%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51885","http://www.coventryone.com/SCon2016","10"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","35","38408","SC","Individual","No","23-2169745","38408SC0020018","Coventry Silver $10 Copay Upstate","38408SC002",,"SCN002","SCS002","SCF025","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020018-00","Standard Silver Off Exchange Plan","68.08%",,"No","Yes","Yes","75%","25%","$3,500","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51968","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","35","38408","SC","Individual","No","23-2169745","38408SC0020018","Coventry Silver $10 Copay Upstate","38408SC002",,"SCN002","SCS002","SCF025","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020018-01","Standard Silver On Exchange Plan","68.08%",,"No","Yes","Yes","75%","25%","$3,500","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51904","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","35","38408","SC","Individual","No","23-2169745","38408SC0020018","Coventry Silver $10 Copay Upstate","38408SC002",,"SCN002","SCS002","SCF025","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020018-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51908","http://www.coventryone.com/SCon2016","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","35","38408","SC","Individual","No","23-2169745","38408SC0020018","Coventry Silver $10 Copay Upstate","38408SC002",,"SCN002","SCS002","SCF025","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020018-03","Limited Cost Sharing Plan Variation","68.08%",,"No","Yes","Yes","75%","25%","$3,500","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51909","http://www.coventryone.com/SCon2016","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","35","38408","SC","Individual","No","23-2169745","38408SC0020018","Coventry Silver $10 Copay Upstate","38408SC002",,"SCN002","SCS002","SCF025","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020018-04","73% AV Level Silver Plan","72.05%",,"No","Yes","Yes","75%","25%","$3,200","$100","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","20%","$4,500","$4500 per person","$9000 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","20%","$500","$500 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51905","http://www.coventryone.com/SCon2016","8"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","35","38408","SC","Individual","No","23-2169745","38408SC0020018","Coventry Silver $10 Copay Upstate","38408SC002",,"SCN002","SCS002","SCF025","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020018-05","87% AV Level Silver Plan","86.12%",,"No","Yes","Yes","75%","25%","$500","$10","$900","$200","$500","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$1,500","$1500 per person","$3000 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51906","http://www.coventryone.com/SCon2016","9"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","35","38408","SC","Individual","No","23-2169745","38408SC0020018","Coventry Silver $10 Copay Upstate","38408SC002",,"SCN002","SCS002","SCF025","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020018-06","94% AV Level Silver Plan","93.08%",,"No","Yes","Yes","75%","25%","$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","20%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%","$0","$0 per person","per group not applicable","20%","$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51907","http://www.coventryone.com/SCon2016","10"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","37","38408","SC","Individual","No","23-2169745","38408SC0010006","Aetna Leap Diabetes – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF006","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010006-00","Standard Gold Off Exchange Plan","79.19%",,"Yes","Yes","Yes","90%","10%","$2,900","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/SC/GoldDiabetesCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/SC.pdf","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","37","38408","SC","Individual","No","23-2169745","38408SC0010006","Aetna Leap Diabetes – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF006","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010006-01","Standard Gold On Exchange Plan","79.19%",,"Yes","Yes","Yes","90%","10%","$2,900","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/GoldDiabetesCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","37","38408","SC","Individual","No","23-2169745","38408SC0010006","Aetna Leap Diabetes – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF006","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","90%","10%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/GoldDiabetesCarolinasHealthCareSystemAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","37","38408","SC","Individual","No","23-2169745","38408SC0010006","Aetna Leap Diabetes – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF006","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010006-03","Limited Cost Sharing Plan Variation","79.19%",,"Yes","Yes","Yes","90%","10%","$2,900","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/GoldDiabetesCarolinasHealthCareSystemAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","38","38408","SC","Individual","No","23-2169745","38408SC0010005","Aetna Leap Specialty – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF005","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010005-00","Standard Gold Off Exchange Plan","79.65%",,"Yes","Yes","Yes","90%","10%","$2,800","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/SC/GoldBasicCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/SC.pdf","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","38","38408","SC","Individual","No","23-2169745","38408SC0010005","Aetna Leap Specialty – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF005","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010005-01","Standard Gold On Exchange Plan","79.65%",,"Yes","Yes","Yes","90%","10%","$2,800","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/GoldBasicCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","38","38408","SC","Individual","No","23-2169745","38408SC0010005","Aetna Leap Specialty – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF005","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","90%","10%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/GoldBasicCarolinasHealthCareSystemAIAN0CS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","38","38408","SC","Individual","No","23-2169745","38408SC0010005","Aetna Leap Specialty – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF005","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010005-03","Limited Cost Sharing Plan Variation","79.65%",,"Yes","Yes","Yes","90%","10%","$2,800","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/GoldBasicCarolinasHealthCareSystemAIANLimitedCS.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","39","38408","SC","Individual","No","23-2169745","38408SC0020002","Coventry Gold $10","38408SC002",,"SCN004","SCS004","SCF009","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020002-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51916","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","39","38408","SC","Individual","No","23-2169745","38408SC0020002","Coventry Gold $10","38408SC002",,"SCN004","SCS004","SCF009","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020002-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51807","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","39","38408","SC","Individual","No","23-2169745","38408SC0020002","Coventry Gold $10","38408SC002",,"SCN004","SCS004","SCF009","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51808","http://www.coventryone.com/SCon2016","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","39","38408","SC","Individual","No","23-2169745","38408SC0020002","Coventry Gold $10","38408SC002",,"SCN004","SCS004","SCF009","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020002-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51809","http://www.coventryone.com/SCon2016","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","41","38408","SC","Individual","No","23-2169745","38408SC0020013","Coventry Gold $5 Copay Midlands","38408SC002",,"SCN003","SCS003","SCF020","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020013-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","Yes","80%","20%","$1,300","$10","$800","$200","$1,300","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51928","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","41","38408","SC","Individual","No","23-2169745","38408SC0020013","Coventry Gold $5 Copay Midlands","38408SC002",,"SCN003","SCS003","SCF020","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020013-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","Yes","80%","20%","$1,300","$10","$800","$200","$1,300","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51829","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","41","38408","SC","Individual","No","23-2169745","38408SC0020013","Coventry Gold $5 Copay Midlands","38408SC002",,"SCN003","SCS003","SCF020","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020013-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51830","http://www.coventryone.com/SCon2016","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","41","38408","SC","Individual","No","23-2169745","38408SC0020013","Coventry Gold $5 Copay Midlands","38408SC002",,"SCN003","SCS003","SCF020","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020013-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","Yes","80%","20%","$1,300","$10","$800","$200","$1,300","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51831","http://www.coventryone.com/SCon2016","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","43","38408","SC","Individual","No","23-2169745","38408SC0020021","Coventry Gold $5 Copay Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF028","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020021-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","Yes","80%","20%","$1,300","$10","$800","$200","$1,300","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51952","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","43","38408","SC","Individual","No","23-2169745","38408SC0020021","Coventry Gold $5 Copay Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF028","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020021-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","Yes","80%","20%","$1,300","$10","$800","$200","$1,300","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51873","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","43","38408","SC","Individual","No","23-2169745","38408SC0020021","Coventry Gold $5 Copay Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF028","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020021-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51874","http://www.coventryone.com/SCon2016","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","43","38408","SC","Individual","No","23-2169745","38408SC0020021","Coventry Gold $5 Copay Roper/St.Francis","38408SC002",,"SCN001","SCS001","SCF028","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020021-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","Yes","80%","20%","$1,300","$10","$800","$200","$1,300","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51875","http://www.coventryone.com/SCon2016","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","45","38408","SC","Individual","No","23-2169745","38408SC0020017","Coventry Gold $5 Copay Upstate","38408SC002",,"SCN002","SCS002","SCF024","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020017-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","Yes","80%","20%","$1,300","$10","$800","$200","$1,300","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51964","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","45","38408","SC","Individual","No","23-2169745","38408SC0020017","Coventry Gold $5 Copay Upstate","38408SC002",,"SCN002","SCS002","SCF024","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020017-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","Yes","80%","20%","$1,300","$10","$800","$200","$1,300","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51895","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","45","38408","SC","Individual","No","23-2169745","38408SC0020017","Coventry Gold $5 Copay Upstate","38408SC002",,"SCN002","SCS002","SCF024","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020017-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51896","http://www.coventryone.com/SCon2016","6"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","45","38408","SC","Individual","No","23-2169745","38408SC0020017","Coventry Gold $5 Copay Upstate","38408SC002",,"SCN002","SCS002","SCF024","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2908932427","38408SC0020017-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","Yes","80%","20%","$1,300","$10","$800","$200","$1,300","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","20%","$0","$0 per person","per group not applicable","40%","$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/SC51897","http://www.coventryone.com/SCon2016","7"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","47","38408","SC","Individual","No","23-2169745","38408SC0010007","Aetna Leap Catastrophic – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF007","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010007-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/OFF/SC/CatastrophicCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/OFF/SC.pdf","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","47","38408","SC","Individual","No","23-2169745","38408SC0010007","Aetna Leap Catastrophic – Carolinas HealthCare System","38408SC001",,"SCN005","SCS005","SCF007","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8520122249","38408SC0010007-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/CB/ON/SC/CatastrophicCarolinasHealthCareSystem.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/CB/ON/SC.pdf","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","48","38408","SC","Individual","No","23-2169745","38408SC0020010","Coventry Catastrophic 100%","38408SC002",,"SCN004","SCS004","SCF017","New","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020010-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51914","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","48","38408","SC","Individual","No","23-2169745","38408SC0020010","Coventry Catastrophic 100%","38408SC002",,"SCN004","SCS004","SCF017","New","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020010-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51806","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","50","38408","SC","Individual","No","23-2169745","38408SC0020029","Coventry Catastrophic Midlands100%","38408SC002",,"SCN003","SCS003","SCF036","New","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020029-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51926","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","50","38408","SC","Individual","No","23-2169745","38408SC0020029","Coventry Catastrophic Midlands100%","38408SC002",,"SCN003","SCS003","SCF036","New","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020029-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51858","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","52","38408","SC","Individual","No","23-2169745","38408SC0020025","Coventry Catastrophic Roper/St. Francis 100%","38408SC002",,"SCN001","SCS001","SCF032","New","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020025-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51950","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","52","38408","SC","Individual","No","23-2169745","38408SC0020025","Coventry Catastrophic Roper/St. Francis 100%","38408SC002",,"SCN001","SCS001","SCF032","New","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020025-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51872","http://www.coventryone.com/SCon2016","5"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","54","38408","SC","Individual","No","23-2169745","38408SC0020023","Coventry Catastrophic Upstate 100%","38408SC002",,"SCN002","SCS002","SCF030","New","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020023-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51962","http://www.coventryone.com/SCon2016","4"
"2016","SC","38408","HIOS","9","2016-03-03 04:57:49","54","38408","SC","Individual","No","23-2169745","38408SC0020023","Coventry Catastrophic Upstate 100%","38408SC002",,"SCN002","SCS002","SCF030","New","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=2911354713","38408SC0020023-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/SC51894","http://www.coventryone.com/SCon2016","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","5","49532","SC","Individual","No","57-0768835","49532SC0380022","Blue Option Bronze 6850","49532SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9918",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380022-03","Limited Cost Sharing Plan Variation",,"0.615859627723694","Yes","Yes","No","100%",,"$2,260","$323","$0","$150","$1,012","$1,200","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.blueoptionsc.com/Bronze6850base2016","http://www.blueoptionsc.com/bronzebrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","6","49532","SC","Individual","No","57-0768835","49532SC0380035","Blue Option Bronze 6500","49532SC038",,"SCN001","SCS001","SCF001","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9916",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380035-00","Standard Bronze Off Exchange Plan",,"0.586241543292999","Yes","Yes","No","100%",,"$2,260","$0","$2,247","$150","$1,012","$0","$2,061","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"http://www.blueoptionsc.com/Bronze6500base2016","http://www.blueoptionsc.com/bronzebrochure","4"
"2016","SC","45445","HIOS","1","2015-05-01 02:23:41","1","45445","SC","SHOP (Small Group)","Yes","47-0098400","45445SC0040002","EHB High PPO","45445SC004",,"SCN001","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.69","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","45445SC0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","SC","45445","HIOS","1","2015-05-01 02:23:41","1","45445","SC","SHOP (Small Group)","Yes","47-0098400","45445SC0040001","EHB Low PPO","45445SC004",,"SCN001","SCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.87","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","45445SC0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","6","49532","SC","Individual","No","57-0768835","49532SC0380035","Blue Option Bronze 6500","49532SC038",,"SCN001","SCS001","SCF001","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9916",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380035-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Bronze6500zcs2016","http://www.blueoptionsc.com/bronzebrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","6","49532","SC","Individual","No","57-0768835","49532SC0380035","Blue Option Bronze 6500","49532SC038",,"SCN001","SCS001","SCF001","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9916",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380035-03","Limited Cost Sharing Plan Variation",,"0.586241543292999","Yes","Yes","No","100%",,"$2,260","$0","$2,247","$150","$1,012","$0","$2,061","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"http://www.blueoptionsc.com/Bronze6500base2016","http://www.blueoptionsc.com/bronzebrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","Individual","No","57-0768835","49532SC0380009","Blue Option Silver 1500","49532SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver1500zcs2016","http://www.blueoptionsc.com/silverbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370013","Business Advantage Silver 3500 HD","49532SC037",,"SCN002","SCS001","SCF020","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9894",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370013-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Yes","No",,"http://www.bluechoicesc.com/basilver35002016","http://www.bluechoicesc.com/BASilverBrochure","6"
"2016","SC","45445","HIOS","1","2015-05-01 02:23:41","1","45445","SC","SHOP (Small Group)","Yes","47-0098400","45445SC0030002","EHB High Passive","45445SC003",,"SCN001","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.42","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","45445SC0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","SC","45445","HIOS","1","2015-05-01 02:23:41","1","45445","SC","SHOP (Small Group)","Yes","47-0098400","45445SC0030001","EHB Low Passive","45445SC003",,"SCN001","SCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.16","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","45445SC0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","SC","47973","HIOS","2","2015-07-02 02:19:22","1","47973","SC","Individual","Yes","57-0523959","47973SC0040001","Group Pediatric EHB Rider","47973SC004",,"SCN001","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$44.30","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","47973SC0040001-00","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","47973","HIOS","2","2015-07-02 02:19:22","1","47973","SC","SHOP (Small Group)","Yes","57-0523959","47973SC0050001","Group Dental Policy","47973SC005",,"SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.36","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","47973SC0050001-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","47973","HIOS","2","2015-07-02 02:19:22","1","47973","SC","Individual","Yes","57-0523959","47973SC0040002","Group Pediatric EHB Rider","47973SC004",,"SCN001","SCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$36.04","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","47973SC0040002-00","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","SC","47973","HIOS","2","2015-07-02 02:19:22","2","47973","SC","SHOP (Small Group)","Yes","57-0523959","47973SC0030001","Group Child Only EHB Policy","47973SC003",,"SCN001","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.35","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","47973SC0030001-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","1","49532","SC","Individual","No","57-0768835","49532SC0380001","Blue Option Bronze 5001 HD","49532SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9918",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380001-00","Standard Bronze Off Exchange Plan",,"0.601885557174683","Yes","Yes","No","100%",,"$2,260","$0","$2,247","$150","$1,012","$0","$2,061","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.blueoptionsc.com/Bronze5001base2016","http://www.blueoptionsc.com/bronzebrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","1","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370003","Business Advantage Bronze 5000","49532SC037",,"SCN002","SCS001","SCF018","Existing","PPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9875",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370003-00","Standard Bronze Off Exchange Plan",,"0.610745489597321","No","Yes","No","100%",,"$2,260","$500","$11","$150","$1,012","$0","$2,061","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bluechoicesc.com/babronze50002016","http://www.bluechoicesc.com/BABronzeBrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","1","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370003","Business Advantage Bronze 5000","49532SC037",,"SCN002","SCS001","SCF018","Existing","PPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9875",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370003-01","Standard Bronze On Exchange Plan",,"0.610745489597321","No","Yes","No","100%",,"$2,260","$500","$11","$150","$1,012","$0","$2,061","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bluechoicesc.com/babronze50002016","http://www.bluechoicesc.com/BABronzeBrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","1","49532","SC","Individual","No","57-0768835","49532SC0380001","Blue Option Bronze 5001 HD","49532SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9918",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380001-01","Standard Bronze On Exchange Plan",,"0.601885557174683","Yes","Yes","No","100%",,"$2,260","$0","$2,247","$150","$1,012","$0","$2,061","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.blueoptionsc.com/Bronze5001base2016","http://www.blueoptionsc.com/bronzebrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","1","49532","SC","Individual","No","57-0768835","49532SC0380001","Blue Option Bronze 5001 HD","49532SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9918",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Bronze5001zcs2016","http://www.blueoptionsc.com/bronzebrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","1","49532","SC","Individual","No","57-0768835","49532SC0380001","Blue Option Bronze 5001 HD","49532SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9918",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380001-03","Limited Cost Sharing Plan Variation",,"0.601885557174683","Yes","Yes","No","100%",,"$2,260","$0","$2,247","$150","$1,012","$0","$2,061","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.blueoptionsc.com/Bronze5001base2016","http://www.blueoptionsc.com/bronzebrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","2","49532","SC","Individual","No","57-0768835","49532SC0380003","Blue Option Bronze 6750","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9917",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380003-00","Standard Bronze Off Exchange Plan",,"0.614316701889038","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,750","$6750 per person","$13500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.blueoptionsc.com/Bronze6750base2016","http://www.blueoptionsc.com/bronzebrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","2","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370001","Business Advantage Bronze 3800","49532SC037",,"SCN002","SCS001","SCF019","Existing","PPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9872",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370001-00","Standard Bronze Off Exchange Plan",,"0.605021893978119","Yes","Yes","No","100%",,"$2,260","$0","$2,247","$150","$1,012","$0","$2,061","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","No","No",,"http://www.bluechoicesc.com/babronze38002016","http://www.bluechoicesc.com/BABronzeBrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","2","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370001","Business Advantage Bronze 3800","49532SC037",,"SCN002","SCS001","SCF019","Existing","PPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9872",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370001-01","Standard Bronze On Exchange Plan",,"0.605021893978119","Yes","Yes","No","100%",,"$2,260","$0","$2,247","$150","$1,012","$0","$2,061","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","No","No",,"http://www.bluechoicesc.com/babronze38002016","http://www.bluechoicesc.com/BABronzeBrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","2","49532","SC","Individual","No","57-0768835","49532SC0380003","Blue Option Bronze 6750","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9917",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380003-01","Standard Bronze On Exchange Plan",,"0.614316701889038","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,750","$6750 per person","$13500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.blueoptionsc.com/Bronze6750base2016","http://www.blueoptionsc.com/bronzebrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","2","49532","SC","Individual","No","57-0768835","49532SC0380003","Blue Option Bronze 6750","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9917",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Bronze6750zcs2016","http://www.blueoptionsc.com/bronzebrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","2","49532","SC","Individual","No","57-0768835","49532SC0380003","Blue Option Bronze 6750","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9917",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380003-03","Limited Cost Sharing Plan Variation",,"0.614316701889038","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,750","$6750 per person","$13500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.blueoptionsc.com/Bronze6750base2016","http://www.blueoptionsc.com/bronzebrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","3","49532","SC","Individual","No","57-0768835","49532SC0380020","Blue Option Bronze 4500","49532SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9918",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380020-00","Standard Bronze Off Exchange Plan",,"0.619739055633545","Yes","Yes","No","100%",,"$2,260","$300","$11","$150","$1,012","$0","$2,061","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","No",,,"http://www.blueoptionsc.com/Bronze4500base2016","http://www.blueoptionsc.com/bronzebrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","3","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370002","Business Advantage Bronze 6000 HD","49532SC037",,"SCN002","SCS001","SCF020","Existing","PPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370002-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes","No",,"http://www.bluechoicesc.com/babronze60002016","http://www.bluechoicesc.com/BABronzeBrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","3","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370002","Business Advantage Bronze 6000 HD","49532SC037",,"SCN002","SCS001","SCF020","Existing","PPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370002-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes","No",,"http://www.bluechoicesc.com/babronze60002016","http://www.bluechoicesc.com/BABronzeBrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","3","49532","SC","Individual","No","57-0768835","49532SC0380020","Blue Option Bronze 4500","49532SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9918",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380020-01","Standard Bronze On Exchange Plan",,"0.619739055633545","Yes","Yes","No","100%",,"$2,260","$300","$11","$150","$1,012","$0","$2,061","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","No",,,"http://www.blueoptionsc.com/Bronze4500base2016","http://www.blueoptionsc.com/bronzebrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","3","49532","SC","Individual","No","57-0768835","49532SC0380020","Blue Option Bronze 4500","49532SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9918",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380020-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Bronze4500zcs2016","http://www.blueoptionsc.com/bronzebrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","3","49532","SC","Individual","No","57-0768835","49532SC0380020","Blue Option Bronze 4500","49532SC038",,"SCN001","SCS001","SCF003","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9918",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380020-03","Limited Cost Sharing Plan Variation",,"0.619739055633545","Yes","Yes","No","100%",,"$2,260","$300","$11","$150","$1,012","$0","$2,061","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","No",,,"http://www.blueoptionsc.com/Bronze4500base2016","http://www.blueoptionsc.com/bronzebrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","4","49532","SC","Individual","No","57-0768835","49532SC0380021","Blue Option Bronze 6250 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9918",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380021-00","Standard Bronze Off Exchange Plan",,"0.609101891517639","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","Yes",,,"http://www.blueoptionsc.com/Bronze6250base2016","http://www.blueoptionsc.com/bronzebrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","4","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370011","Business Advantage Bronze 6300 HD","49532SC037",,"SCN002","SCS001","SCF020","Existing","PPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9872",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370011-00","Standard Bronze Off Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group","Yes","No",,"http://www.bluechoicesc.com/babronze63002016","http://www.bluechoicesc.com/BABronzeBrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","4","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370011","Business Advantage Bronze 6300 HD","49532SC037",,"SCN002","SCS001","SCF020","Existing","PPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9872",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370011-01","Standard Bronze On Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group","Yes","No",,"http://www.bluechoicesc.com/babronze63002016","http://www.bluechoicesc.com/BABronzeBrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","4","49532","SC","Individual","No","57-0768835","49532SC0380021","Blue Option Bronze 6250 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9918",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380021-01","Standard Bronze On Exchange Plan",,"0.609101891517639","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","Yes",,,"http://www.blueoptionsc.com/Bronze6250base2016","http://www.blueoptionsc.com/bronzebrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","4","49532","SC","Individual","No","57-0768835","49532SC0380021","Blue Option Bronze 6250 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9918",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.blueoptionsc.com/Bronze6250zcs2016","http://www.blueoptionsc.com/bronzebrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","4","49532","SC","Individual","No","57-0768835","49532SC0380021","Blue Option Bronze 6250 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9918",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380021-03","Limited Cost Sharing Plan Variation",,"0.609101891517639","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","Yes",,,"http://www.blueoptionsc.com/Bronze6250base2016","http://www.blueoptionsc.com/bronzebrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","5","49532","SC","Individual","No","57-0768835","49532SC0380022","Blue Option Bronze 6850","49532SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9918",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380022-00","Standard Bronze Off Exchange Plan",,"0.615859627723694","Yes","Yes","No","100%",,"$2,260","$323","$0","$150","$1,012","$1,200","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.blueoptionsc.com/Bronze6850base2016","http://www.blueoptionsc.com/bronzebrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","5","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370024","Business Advantage Bronze 6001","49532SC037",,"SCN002","SCS001","SCF021","New","PPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9871",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370024-00","Standard Bronze Off Exchange Plan",,"0.618268311023712","Yes","Yes","No","100%",,"$2,260","$23","$1,789","$150","$1,012","$1,200","$509","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No","No",,"http://www.bluechoicesc.com/babronze60012016","http://www.bluechoicesc.com/BABronzeBrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","5","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370024","Business Advantage Bronze 6001","49532SC037",,"SCN002","SCS001","SCF021","New","PPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9871",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370024-01","Standard Bronze On Exchange Plan",,"0.618268311023712","Yes","Yes","No","100%",,"$2,260","$23","$1,789","$150","$1,012","$1,200","$509","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No","No",,"http://www.bluechoicesc.com/babronze60012016","http://www.bluechoicesc.com/BABronzeBrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","5","49532","SC","Individual","No","57-0768835","49532SC0380022","Blue Option Bronze 6850","49532SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9918",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380022-01","Standard Bronze On Exchange Plan",,"0.615859627723694","Yes","Yes","No","100%",,"$2,260","$323","$0","$150","$1,012","$1,200","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.blueoptionsc.com/Bronze6850base2016","http://www.blueoptionsc.com/bronzebrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","5","49532","SC","Individual","No","57-0768835","49532SC0380022","Blue Option Bronze 6850","49532SC038",,"SCN001","SCS001","SCF004","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9918",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380022-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Bronze6850zcs2016","http://www.blueoptionsc.com/bronzebrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","6","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370025","Business Advantage Bronze 6850","49532SC037",,"SCN002","SCS001","SCF022","New","PPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9871",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370025-00","Standard Bronze Off Exchange Plan",,"0.612588763237","Yes","Yes","No","100%",,"$2,260","$323","$0","$150","$1,012","$2,472","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No","No",,"http://www.bluechoicesc.com/babronze68502016","http://www.bluechoicesc.com/BABronzeBrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","6","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370025","Business Advantage Bronze 6850","49532SC037",,"SCN002","SCS001","SCF022","New","PPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9871",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370025-01","Standard Bronze On Exchange Plan",,"0.612588763237","Yes","Yes","No","100%",,"$2,260","$323","$0","$150","$1,012","$2,472","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No","No",,"http://www.bluechoicesc.com/babronze68502016","http://www.bluechoicesc.com/BABronzeBrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","6","49532","SC","Individual","No","57-0768835","49532SC0380035","Blue Option Bronze 6500","49532SC038",,"SCN001","SCS001","SCF001","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9916",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380035-01","Standard Bronze On Exchange Plan",,"0.586241543292999","Yes","Yes","No","100%",,"$2,260","$0","$2,247","$150","$1,012","$0","$2,061","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"http://www.blueoptionsc.com/Bronze6500base2016","http://www.blueoptionsc.com/bronzebrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","7","49532","SC","Individual","No","57-0768835","49532SC0380004","Blue Option Catastrophic","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9905",,,,"0","0","3","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380004-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.blueoptionsc.com/Catastrophic2016","http://www.blueoptionsc.com/catastrophicbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","7","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370026","Business Advantage Bronze 3801","49532SC037",,"SCN002","SCS001","SCF023","New","PPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9875",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370026-00","Standard Bronze Off Exchange Plan",,"0.617097020149231","Yes","Yes","No","100%",,"$2,260","$23","$2,236","$150","$1,012","$1,200","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","No","No",,"http://www.bluechoicesc.com/babronze38012016","http://www.bluechoicesc.com/BABronzeBrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","7","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370026","Business Advantage Bronze 3801","49532SC037",,"SCN002","SCS001","SCF023","New","PPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9875",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370026-01","Standard Bronze On Exchange Plan",,"0.617097020149231","Yes","Yes","No","100%",,"$2,260","$23","$2,236","$150","$1,012","$1,200","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","No","No",,"http://www.bluechoicesc.com/babronze38012016","http://www.bluechoicesc.com/BABronzeBrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","7","49532","SC","Individual","No","57-0768835","49532SC0380004","Blue Option Catastrophic","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9905",,,,"0","0","3","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.blueoptionsc.com/Catastrophic2016","http://www.blueoptionsc.com/catastrophicbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","8","49532","SC","Individual","No","57-0768835","49532SC0380007","Blue Option Silver 2502","49532SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9927",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380007-00","Standard Silver Off Exchange Plan",,"0.702786982059479","No","Yes","No","100%",,"$2,260","$265","$0","$150","$1,012","$1,672","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver2502base2016","http://www.blueoptionsc.com/silverbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","8","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370009","Business Advantage Bronze 3500","49532SC037",,"SCN002","SCS001","SCF024","Existing","PPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370009-00","Standard Bronze Off Exchange Plan",,"0.614597141742706","Yes","Yes","No","100%",,"$2,260","$23","$2,236","$150","$1,012","$1,000","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No","No",,"http://www.bluechoicesc.com/babronze35002016","http://www.bluechoicesc.com/BABronzeBrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","8","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370009","Business Advantage Bronze 3500","49532SC037",,"SCN002","SCS001","SCF024","Existing","PPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9874",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370009-01","Standard Bronze On Exchange Plan",,"0.614597141742706","Yes","Yes","No","100%",,"$2,260","$23","$2,236","$150","$1,012","$1,000","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No","No",,"http://www.bluechoicesc.com/babronze35002016","http://www.bluechoicesc.com/BABronzeBrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","8","49532","SC","Individual","No","57-0768835","49532SC0380007","Blue Option Silver 2502","49532SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9927",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380007-01","Standard Silver On Exchange Plan",,"0.702786982059479","No","Yes","No","100%",,"$2,260","$265","$0","$150","$1,012","$1,672","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver2502base2016","http://www.blueoptionsc.com/silverbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","8","49532","SC","Individual","No","57-0768835","49532SC0380007","Blue Option Silver 2502","49532SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9927",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver2502zcs2016","http://www.blueoptionsc.com/silverbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","8","49532","SC","Individual","No","57-0768835","49532SC0380007","Blue Option Silver 2502","49532SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9927",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380007-03","Limited Cost Sharing Plan Variation",,"0.702786982059479","No","Yes","No","100%",,"$2,260","$265","$0","$150","$1,012","$1,672","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver2502base2016","http://www.blueoptionsc.com/silverbrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","8","49532","SC","Individual","No","57-0768835","49532SC0380007","Blue Option Silver 2502","49532SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9927",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380007-04","73% AV Level Silver Plan",,"0.737209975719452","No","Yes","No","100%",,"$2,000","$491","$0","$150","$1,012","$1,672","$0","$279",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,200","$5200 per person","$10400 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver2502CSRI2016","http://www.blueoptionsc.com/silverbrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","8","49532","SC","Individual","No","57-0768835","49532SC0380007","Blue Option Silver 2502","49532SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9927",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380007-05","87% AV Level Silver Plan",,"0.878263235092163","No","Yes","No","100%",,"$250","$491","$0","$150","$250","$1,847","$0","$279",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$250","$250 per person","$500 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver2502CSRII2016","http://www.blueoptionsc.com/silverbrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","8","49532","SC","Individual","No","57-0768835","49532SC0380007","Blue Option Silver 2502","49532SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9927",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380007-06","94% AV Level Silver Plan",,"0.943709194660187","No","Yes","No","100%",,"$250","$250","$0","$150","$229","$271","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver2502CSRIII2016","http://www.blueoptionsc.com/silverbrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","9","49532","SC","Individual","No","57-0768835","49532SC0380008","Blue Option Silver 1750","49532SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380008-00","Standard Silver Off Exchange Plan",,"0.705002307891846","No","Yes","No","100%",,"$1,750","$541","$0","$150","$1,012","$1,672","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$1,750","$1750 per person","$3500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver1750base2016","http://www.blueoptionsc.com/silverbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","9","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370010","Business Advantage Bronze 5500","49532SC037",,"SCN002","SCS001","SCF023","Existing","PPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9871",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370010-00","Standard Bronze Off Exchange Plan",,"0.619664072990417","Yes","Yes","No","100%",,"$2,260","$23","$2,236","$150","$1,012","$1,200","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","No","No",,"http://www.bluechoicesc.com/babronze55002016","http://www.bluechoicesc.com/BABronzeBrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","9","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370010","Business Advantage Bronze 5500","49532SC037",,"SCN002","SCS001","SCF023","Existing","PPO","Bronze","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9871",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370010-01","Standard Bronze On Exchange Plan",,"0.619664072990417","Yes","Yes","No","100%",,"$2,260","$23","$2,236","$150","$1,012","$1,200","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","No","No",,"http://www.bluechoicesc.com/babronze55002016","http://www.bluechoicesc.com/BABronzeBrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","9","49532","SC","Individual","No","57-0768835","49532SC0380008","Blue Option Silver 1750","49532SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380008-01","Standard Silver On Exchange Plan",,"0.705002307891846","No","Yes","No","100%",,"$1,750","$541","$0","$150","$1,012","$1,672","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$1,750","$1750 per person","$3500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver1750base2016","http://www.blueoptionsc.com/silverbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","9","49532","SC","Individual","No","57-0768835","49532SC0380008","Blue Option Silver 1750","49532SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver1750zcs2016","http://www.blueoptionsc.com/silverbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","9","49532","SC","Individual","No","57-0768835","49532SC0380008","Blue Option Silver 1750","49532SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380008-03","Limited Cost Sharing Plan Variation",,"0.705002307891846","No","Yes","No","100%",,"$1,750","$541","$0","$150","$1,012","$1,672","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$1,750","$1750 per person","$3500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver1750base2016","http://www.blueoptionsc.com/silverbrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","9","49532","SC","Individual","No","57-0768835","49532SC0380008","Blue Option Silver 1750","49532SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380008-04","73% AV Level Silver Plan",,"0.736019790172577","No","Yes","No","100%",,"$1,750","$541","$0","$150","$1,012","$1,672","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver1750CSRI2016","http://www.blueoptionsc.com/silverbrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","9","49532","SC","Individual","No","57-0768835","49532SC0380008","Blue Option Silver 1750","49532SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380008-05","87% AV Level Silver Plan",,"0.87772810459137","No","Yes","No","100%",,"$250","$541","$0","$150","$250","$1,500","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver1750CSRII2016","http://www.blueoptionsc.com/silverbrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","9","49532","SC","Individual","No","57-0768835","49532SC0380008","Blue Option Silver 1750","49532SC038",,"SCN001","SCS001","SCF005","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380008-06","94% AV Level Silver Plan",,"0.940968215465546","No","Yes","No","100%",,"$100","$350","$0","$150","$100","$350","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver1750CSRIII2016","http://www.blueoptionsc.com/silverbrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","Individual","No","57-0768835","49532SC0380009","Blue Option Silver 1500","49532SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380009-00","Standard Silver Off Exchange Plan",,"0.698479413986206","No","Yes","No","100%",,"$1,500","$20","$0","$150","$1,012","$600","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver1500base2016","http://www.blueoptionsc.com/silverbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370005","Business Advantage Silver 1750 HD","49532SC037",,"SCN002","SCS001","SCF029","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9892",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370005-00","Standard Silver Off Exchange Plan",,"0.698984444141388","Yes","Yes","No","100%",,"$1,750","$0","$1,251","$150","$1,012","$0","$1,030","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","No","No",,"http://www.bluechoicesc.com/basilver17502016","http://www.bluechoicesc.com/BASilverBrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370005","Business Advantage Silver 1750 HD","49532SC037",,"SCN002","SCS001","SCF029","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9892",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370005-01","Standard Silver On Exchange Plan",,"0.698984444141388","Yes","Yes","No","100%",,"$1,750","$0","$1,251","$150","$1,012","$0","$1,030","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","No","No",,"http://www.bluechoicesc.com/basilver17502016","http://www.bluechoicesc.com/BASilverBrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","Individual","No","57-0768835","49532SC0380009","Blue Option Silver 1500","49532SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380009-01","Standard Silver On Exchange Plan",,"0.698479413986206","No","Yes","No","100%",,"$1,500","$20","$0","$150","$1,012","$600","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver1500base2016","http://www.blueoptionsc.com/silverbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370013","Business Advantage Silver 3500 HD","49532SC037",,"SCN002","SCS001","SCF020","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9894",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370013-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Yes","No",,"http://www.bluechoicesc.com/basilver35002016","http://www.bluechoicesc.com/BASilverBrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","Individual","No","57-0768835","49532SC0380009","Blue Option Silver 1500","49532SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380009-03","Limited Cost Sharing Plan Variation",,"0.698479413986206","No","Yes","No","100%",,"$1,500","$20","$0","$150","$1,012","$600","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver1500base2016","http://www.blueoptionsc.com/silverbrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","Individual","No","57-0768835","49532SC0380009","Blue Option Silver 1500","49532SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380009-04","73% AV Level Silver Plan",,"0.736281514167786","No","Yes","No","100%",,"$1,500","$20","$0","$150","$1,012","$600","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,300","$5300 per person","$10600 per group","$1,500","$1500 per person","$3000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver1500CSRI2016","http://www.blueoptionsc.com/silverbrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370032","Business Advantage Silver 1200","49532SC037",,"SCN002","SCS001","SCF032","New","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9896",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370032-00","Standard Silver Off Exchange Plan",,"0.719154596328735","Yes","Yes","No","100%",,"$1,200","$23","$2,766","$150","$1,012","$1,000","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,200","$4200 per person","$8400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","No","No",,"http://www.bluechoicesc.com/basilver12002016","http://www.bluechoicesc.com/BASilverBrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370032","Business Advantage Silver 1200","49532SC037",,"SCN002","SCS001","SCF032","New","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9896",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370032-01","Standard Silver On Exchange Plan",,"0.719154596328735","Yes","Yes","No","100%",,"$1,200","$23","$2,766","$150","$1,012","$1,000","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,200","$4200 per person","$8400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","No","No",,"http://www.bluechoicesc.com/basilver12002016","http://www.bluechoicesc.com/BASilverBrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","Individual","No","57-0768835","49532SC0380009","Blue Option Silver 1500","49532SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380009-05","87% AV Level Silver Plan",,"0.872474849224091","No","Yes","No","100%",,"$250","$20","$0","$150","$250","$705","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver1500CSRII2016","http://www.blueoptionsc.com/silverbrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","Individual","No","57-0768835","49532SC0380009","Blue Option Silver 1500","49532SC038",,"SCN001","SCS001","SCF006","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380009-06","94% AV Level Silver Plan",,"0.937863111495972","No","Yes","No","100%",,"$100","$20","$0","$150","$100","$650","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver1500CSRIII2016","http://www.blueoptionsc.com/silverbrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370033","Business Advantage Silver 1501","49532SC037",,"SCN002","SCS001","SCF032","New","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9894",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370033-00","Standard Silver Off Exchange Plan",,"0.705539882183075","Yes","Yes","No","100%",,"$1,500","$23","$2,616","$150","$1,012","$1,000","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No","No",,"http://www.bluechoicesc.com/basilver15012016","http://www.bluechoicesc.com/BASilverBrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370033","Business Advantage Silver 1501","49532SC037",,"SCN002","SCS001","SCF032","New","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9894",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370033-01","Standard Silver On Exchange Plan",,"0.705539882183075","Yes","Yes","No","100%",,"$1,500","$23","$2,616","$150","$1,012","$1,000","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No","No",,"http://www.bluechoicesc.com/basilver15012016","http://www.bluechoicesc.com/BASilverBrochure","11"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370034","Business Advantage Silver 1502","49532SC037",,"SCN002","SCS001","SCF033","New","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9894",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370034-00","Standard Silver Off Exchange Plan",,"0.70321387052536","Yes","Yes","No","100%",,"$1,500","$23","$2,093","$150","$1,012","$1,000","$509","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No","No",,"http://www.bluechoicesc.com/basilver15022016","http://www.bluechoicesc.com/BASilverBrochure","12"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370034","Business Advantage Silver 1502","49532SC037",,"SCN002","SCS001","SCF033","New","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9894",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370034-01","Standard Silver On Exchange Plan",,"0.70321387052536","Yes","Yes","No","100%",,"$1,500","$23","$2,093","$150","$1,012","$1,000","$509","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No","No",,"http://www.bluechoicesc.com/basilver15022016","http://www.bluechoicesc.com/BASilverBrochure","13"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370035","Business Advantage Silver 2003","49532SC037",,"SCN002","SCS001","SCF032","New","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9895",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370035-00","Standard Silver Off Exchange Plan",,"0.714764058589935","Yes","Yes","No","100%",,"$2,000","$0","$2,000","$150","$1,012","$1,000","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No","No",,"http://www.bluechoicesc.com/basilver20032016","http://www.bluechoicesc.com/BASilverBrochure","14"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370035","Business Advantage Silver 2003","49532SC037",,"SCN002","SCS001","SCF032","New","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9895",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370035-01","Standard Silver On Exchange Plan",,"0.714764058589935","Yes","Yes","No","100%",,"$2,000","$0","$2,000","$150","$1,012","$1,000","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No","No",,"http://www.bluechoicesc.com/basilver20032016","http://www.bluechoicesc.com/BASilverBrochure","15"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370036","Business Advantage Silver 4001","49532SC037",,"SCN002","SCS001","SCF031","New","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9893",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370036-00","Standard Silver Off Exchange Plan",,"0.713806748390198","Yes","Yes","No","100%",,"$2,260","$15","$671","$150","$1,012","$400","$191","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","No","No",,"http://www.bluechoicesc.com/basilver40012016","http://www.bluechoicesc.com/BASilverBrochure","16"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370036","Business Advantage Silver 4001","49532SC037",,"SCN002","SCS001","SCF031","New","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9893",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370036-01","Standard Silver On Exchange Plan",,"0.713806748390198","Yes","Yes","No","100%",,"$2,260","$15","$671","$150","$1,012","$400","$191","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","No","No",,"http://www.bluechoicesc.com/basilver40012016","http://www.bluechoicesc.com/BASilverBrochure","17"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370015","Business Advantage Silver 4000","49532SC037",,"SCN002","SCS001","SCF034","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9893",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370015-00","Standard Silver Off Exchange Plan",,"0.714989900588989","Yes","Yes","No","100%",,"$2,260","$23","$0","$150","$1,012","$800","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","No","No",,"http://www.bluechoicesc.com/basilver40002016","http://www.bluechoicesc.com/BASilverBrochure","18"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370015","Business Advantage Silver 4000","49532SC037",,"SCN002","SCS001","SCF034","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9893",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370015-01","Standard Silver On Exchange Plan",,"0.714989900588989","Yes","Yes","No","100%",,"$2,260","$23","$0","$150","$1,012","$800","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","No","No",,"http://www.bluechoicesc.com/basilver40002016","http://www.bluechoicesc.com/BASilverBrochure","19"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370016","Business Advantage Silver 5000","49532SC037",,"SCN002","SCS001","SCF035","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9888",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370016-00","Standard Silver Off Exchange Plan",,"0.717333078384399","Yes","Yes","No","100%",,"$2,260","$15","$0","$150","$1,012","$400","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No","No",,"http://www.bluechoicesc.com/basilver50002016","http://www.bluechoicesc.com/BASilverBrochure","20"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","10","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370016","Business Advantage Silver 5000","49532SC037",,"SCN002","SCS001","SCF035","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9888",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370016-01","Standard Silver On Exchange Plan",,"0.717333078384399","Yes","Yes","No","100%",,"$2,260","$15","$0","$150","$1,012","$400","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No","No",,"http://www.bluechoicesc.com/basilver50002016","http://www.bluechoicesc.com/BASilverBrochure","21"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","11","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370006","Business Advantage Silver 2000","49532SC037",,"SCN002","SCS001","SCF030","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9891",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370006-00","Standard Silver Off Exchange Plan",,"0.709315538406372","No","Yes","No","100%",,"$2,000","$349","$53","$150","$1,012","$1,672","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bluechoicesc.com/basilver20002016","http://www.bluechoicesc.com/BASilverBrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","11","49532","SC","Individual","No","57-0768835","49532SC0380023","Blue Option Silver 2000","49532SC038",,"SCN001","SCS001","SCF007","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9928",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380023-00","Standard Silver Off Exchange Plan",,"0.717846095561981","Yes","Yes","No","100%",,"$2,000","$300","$130","$150","$1,012","$0","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No",,,"http://www.blueoptionsc.com/Silver2000base2016","http://www.blueoptionsc.com/silverbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","11","49532","SC","Individual","No","57-0768835","49532SC0380023","Blue Option Silver 2000","49532SC038",,"SCN001","SCS001","SCF007","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9928",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380023-01","Standard Silver On Exchange Plan",,"0.717846095561981","Yes","Yes","No","100%",,"$2,000","$300","$130","$150","$1,012","$0","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No",,,"http://www.blueoptionsc.com/Silver2000base2016","http://www.blueoptionsc.com/silverbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","11","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370006","Business Advantage Silver 2000","49532SC037",,"SCN002","SCS001","SCF030","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9891",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370006-01","Standard Silver On Exchange Plan",,"0.709315538406372","No","Yes","No","100%",,"$2,000","$349","$53","$150","$1,012","$1,672","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bluechoicesc.com/basilver20002016","http://www.bluechoicesc.com/BASilverBrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","11","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370004","Business Advantage Silver 2001","49532SC037",,"SCN002","SCS001","SCF031","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9889",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370004-00","Standard Silver Off Exchange Plan",,"0.695739150047302","Yes","Yes","No","100%",,"$2,000","$65","$2,324","$150","$1,012","$400","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No","No",,"http://www.bluechoicesc.com/basilver20012016","http://www.bluechoicesc.com/BASilverBrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","11","49532","SC","Individual","No","57-0768835","49532SC0380023","Blue Option Silver 2000","49532SC038",,"SCN001","SCS001","SCF007","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9928",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380023-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Silver2000zcs2016","http://www.blueoptionsc.com/silverbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","11","49532","SC","Individual","No","57-0768835","49532SC0380023","Blue Option Silver 2000","49532SC038",,"SCN001","SCS001","SCF007","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9928",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380023-03","Limited Cost Sharing Plan Variation",,"0.717846095561981","Yes","Yes","No","100%",,"$2,000","$300","$130","$150","$1,012","$0","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No",,,"http://www.blueoptionsc.com/Silver2000base2016","http://www.blueoptionsc.com/silverbrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","11","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370004","Business Advantage Silver 2001","49532SC037",,"SCN002","SCS001","SCF031","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9889",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370004-01","Standard Silver On Exchange Plan",,"0.695739150047302","Yes","Yes","No","100%",,"$2,000","$65","$2,324","$150","$1,012","$400","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No","No",,"http://www.bluechoicesc.com/basilver20012016","http://www.bluechoicesc.com/BASilverBrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","11","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370007","Business Advantage Silver 3000","49532SC037",,"SCN002","SCS001","SCF031","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9891",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370007-00","Standard Silver Off Exchange Plan",,"0.715179085731506","Yes","Yes","No","100%",,"$2,260","$15","$1,341","$150","$1,012","$400","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No","No",,"http://www.bluechoicesc.com/basilver30002016","http://www.bluechoicesc.com/BASilverBrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","11","49532","SC","Individual","No","57-0768835","49532SC0380023","Blue Option Silver 2000","49532SC038",,"SCN001","SCS001","SCF007","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9928",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380023-04","73% AV Level Silver Plan",,"0.739689230918884","Yes","Yes","No","100%",,"$1,750","$0","$2,491","$150","$1,012","$0","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,350","$4350 per person","$8700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,350","$4350 per person","$8700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","No",,,"http://www.blueoptionsc.com/Silver2000CSRI2016","http://www.blueoptionsc.com/silverbrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","11","49532","SC","Individual","No","57-0768835","49532SC0380023","Blue Option Silver 2000","49532SC038",,"SCN001","SCS001","SCF007","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9928",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380023-05","87% AV Level Silver Plan",,"0.872545003890991","Yes","Yes","No","100%",,"$500","$0","$1,000","$150","$500","$0","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","No",,,"http://www.blueoptionsc.com/Silver2000CSRII2016","http://www.blueoptionsc.com/silverbrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370023","Business Advantage Gold 2000","49532SC037",,"SCN002","SCS001","SCF037","Existing","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9907",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370023-01","Standard Gold On Exchange Plan",,"0.796829700469971","Yes","Yes","No","100%",,"$2,000","$60","$930","$150","$1,012","$400","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No","No",,"http://www.bluechoicesc.com/bagold20002016","http://www.bluechoicesc.com/BAGoldBrochure","25"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370043","Business Advantage Gold 2002","49532SC037",,"SCN002","SCS001","SCF037","New","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9908",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370043-00","Standard Gold Off Exchange Plan",,"0.813812911510468","Yes","Yes","No","100%",,"$2,000","$55","$0","$150","$1,012","$400","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No","No",,"http://www.bluechoicesc.com/bagold20022016","http://www.bluechoicesc.com/BAGoldBrochure","26"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","17","49532","SC","Individual","No","57-0768835","49532SC0380025","Blue Option Silver 3650 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.993",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380025-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Silver3650zcs2016","http://www.blueoptionsc.com/silverbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","17","49532","SC","Individual","No","57-0768835","49532SC0380025","Blue Option Silver 3650 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.993",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380025-03","Limited Cost Sharing Plan Variation",,"0.703956484794617","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,650","$3650 per person","$7300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,650","$3650 per person","$7300 per group","Yes",,,"http://www.blueoptionsc.com/Silver3650base2016","http://www.blueoptionsc.com/silverbrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","23","49532","SC","Individual","No","57-0768835","49532SC0380032","Blue Option Silver 6002","49532SC038",,"SCN001","SCS001","SCF016","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380032-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Silver6002zcs2016","http://www.blueoptionsc.com/silverbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","23","49532","SC","Individual","No","57-0768835","49532SC0380032","Blue Option Silver 6002","49532SC038",,"SCN001","SCS001","SCF016","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380032-03","Limited Cost Sharing Plan Variation",,"0.700431346893311","Yes","Yes","No","100%",,"$2,260","$315","$0","$150","$1,012","$400","$127","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No",,,"http://www.blueoptionsc.com/Silver6002base2016","http://www.blueoptionsc.com/silverbrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","16","49532","SC","Individual","No","57-0768835","49532SC0380016","Blue Option Silver 6000","49532SC038",,"SCN001","SCS001","SCF011","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380016-05","87% AV Level Silver Plan",,"0.873105525970459","Yes","Yes","No","100%",,"$1,000","$320","$18","$150","$1,000","$0","$127","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"http://www.blueoptionsc.com/Silver6000CSRII2016","http://www.blueoptionsc.com/silverbrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","16","49532","SC","Individual","No","57-0768835","49532SC0380016","Blue Option Silver 6000","49532SC038",,"SCN001","SCS001","SCF011","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380016-06","94% AV Level Silver Plan",,"0.945650637149811","Yes","Yes","No","100%",,"$300","$282","$18","$150","$300","$0","$127","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","No",,,"http://www.blueoptionsc.com/Silver6000CSRIII2016","http://www.blueoptionsc.com/silverbrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","17","49532","SC","Individual","No","57-0768835","49532SC0380025","Blue Option Silver 3650 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.993",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380025-00","Standard Silver Off Exchange Plan",,"0.703956484794617","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,650","$3650 per person","$7300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,650","$3650 per person","$7300 per group","Yes",,,"http://www.blueoptionsc.com/Silver3650base2016","http://www.blueoptionsc.com/silverbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","17","49532","SC","Individual","No","57-0768835","49532SC0380025","Blue Option Silver 3650 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.993",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380025-01","Standard Silver On Exchange Plan",,"0.703956484794617","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,650","$3650 per person","$7300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,650","$3650 per person","$7300 per group","Yes",,,"http://www.blueoptionsc.com/Silver3650base2016","http://www.blueoptionsc.com/silverbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","23","49532","SC","Individual","No","57-0768835","49532SC0380032","Blue Option Silver 6002","49532SC038",,"SCN001","SCS001","SCF016","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380032-04","73% AV Level Silver Plan",,"0.726943016052246","Yes","Yes","No","100%",,"$2,260","$315","$0","$150","$1,012","$400","$127","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.blueoptionsc.com/Silver6002CSRI2016","http://www.blueoptionsc.com/silverbrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","23","49532","SC","Individual","No","57-0768835","49532SC0380032","Blue Option Silver 6002","49532SC038",,"SCN001","SCS001","SCF016","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380032-05","87% AV Level Silver Plan",,"0.873105525970459","Yes","Yes","No","100%",,"$1,000","$320","$18","$150","$1,000","$0","$127","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"http://www.blueoptionsc.com/Silver6002CSRII2016","http://www.blueoptionsc.com/silverbrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","28","49532","SC","Individual","No","57-0768835","49532SC0380019","Blue Option Gold 2000 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9944",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380019-00","Standard Gold Off Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$4000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","Yes",,,"http://www.blueoptionsc.com/Gold2000base2016","http://www.blueoptionsc.com/goldbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","28","49532","SC","Individual","No","57-0768835","49532SC0380019","Blue Option Gold 2000 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9944",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380019-01","Standard Gold On Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$4000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","Yes",,,"http://www.blueoptionsc.com/Gold2000base2016","http://www.blueoptionsc.com/goldbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","28","49532","SC","Individual","No","57-0768835","49532SC0380019","Blue Option Gold 2000 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9944",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Gold2000zcs2016","http://www.blueoptionsc.com/goldbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","28","49532","SC","Individual","No","57-0768835","49532SC0380019","Blue Option Gold 2000 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9944",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380019-03","Limited Cost Sharing Plan Variation",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$4000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","Yes",,,"http://www.blueoptionsc.com/Gold2000base2016","http://www.blueoptionsc.com/goldbrochure","7"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060003","Silver Compass 5000","57860SC006",,"SCN001","SCS001","SCF003","New","EPO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0012&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","10"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060003","Silver Compass 5000","57860SC006",,"SCN001","SCS001","SCF003","New","EPO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060003-03","Limited Cost Sharing Plan Variation",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0011&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","11"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060001","Gold Compass 1000","57860SC006",,"SCN001","SCS001","SCF001","New","EPO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060001-00","Standard Gold Off Exchange Plan",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0001&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","4"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060001","Gold Compass 1000","57860SC006",,"SCN001","SCS001","SCF001","New","EPO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060001-01","Standard Gold On Exchange Plan",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0001&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","5"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060001","Gold Compass 1000","57860SC006",,"SCN001","SCS001","SCF001","New","EPO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0003&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","11","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370007","Business Advantage Silver 3000","49532SC037",,"SCN002","SCS001","SCF031","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9891",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370007-01","Standard Silver On Exchange Plan",,"0.715179085731506","Yes","Yes","No","100%",,"$2,260","$15","$1,341","$150","$1,012","$400","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No","No",,"http://www.bluechoicesc.com/basilver30002016","http://www.bluechoicesc.com/BASilverBrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","11","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370014","Business Advantage Silver 2501","49532SC037",,"SCN002","SCS001","SCF031","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9891",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370014-00","Standard Silver Off Exchange Plan",,"0.71109938621521","Yes","Yes","No","100%",,"$2,260","$15","$1,565","$150","$1,012","$400","$445","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No","No",,"http://www.bluechoicesc.com/basilver25012016","http://www.bluechoicesc.com/BASilverBrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","11","49532","SC","Individual","No","57-0768835","49532SC0380023","Blue Option Silver 2000","49532SC038",,"SCN001","SCS001","SCF007","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9928",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380023-06","94% AV Level Silver Plan",,"0.937271118164063","Yes","Yes","No","100%",,"$250","$0","$350","$150","$250","$0","$350","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","No",,,"http://www.blueoptionsc.com/Silver2000CSRIII2016","http://www.blueoptionsc.com/silverbrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","11","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370014","Business Advantage Silver 2501","49532SC037",,"SCN002","SCS001","SCF031","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9891",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370014-01","Standard Silver On Exchange Plan",,"0.71109938621521","Yes","Yes","No","100%",,"$2,260","$15","$1,565","$150","$1,012","$400","$445","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No","No",,"http://www.bluechoicesc.com/basilver25012016","http://www.bluechoicesc.com/BASilverBrochure","11"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","11","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370027","Business Advantage Silver 5001","49532SC037",,"SCN002","SCS001","SCF031","New","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9887",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370027-00","Standard Silver Off Exchange Plan",,"0.708550691604614","Yes","Yes","No","100%",,"$2,260","$15","$894","$150","$1,012","$400","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No","No",,"http://www.bluechoicesc.com/basilver50012016","http://www.bluechoicesc.com/BASilverBrochure","12"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","11","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370027","Business Advantage Silver 5001","49532SC037",,"SCN002","SCS001","SCF031","New","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9887",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370027-01","Standard Silver On Exchange Plan",,"0.708550691604614","Yes","Yes","No","100%",,"$2,260","$15","$894","$150","$1,012","$400","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No","No",,"http://www.bluechoicesc.com/basilver50012016","http://www.bluechoicesc.com/BASilverBrochure","13"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","11","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370031","Business Advantage Silver 6850","49532SC037",,"SCN002","SCS001","SCF031","New","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9885",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370031-00","Standard Silver Off Exchange Plan",,"0.712030649185181","Yes","Yes","No","100%",,"$2,260","$15","$0","$150","$1,012","$400","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No","No",,"http://www.bluechoicesc.com/basilver68502016","http://www.bluechoicesc.com/BASilverBrochure","14"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","11","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370031","Business Advantage Silver 6850","49532SC037",,"SCN002","SCS001","SCF031","New","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9885",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370031-01","Standard Silver On Exchange Plan",,"0.712030649185181","Yes","Yes","No","100%",,"$2,260","$15","$0","$150","$1,012","$400","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No","No",,"http://www.bluechoicesc.com/basilver68502016","http://www.bluechoicesc.com/BASilverBrochure","15"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","11","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370037","Business Advantage Silver 6002","49532SC037",,"SCN002","SCS001","SCF031","New","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9887",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370037-00","Standard Silver Off Exchange Plan",,"0.718519628047943","Yes","Yes","No","100%",,"$2,260","$15","$0","$150","$1,012","$400","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No","No",,"http://www.bluechoicesc.com/basilver60022016","http://www.bluechoicesc.com/BASilverBrochure","16"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","11","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370037","Business Advantage Silver 6002","49532SC037",,"SCN002","SCS001","SCF031","New","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9887",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370037-01","Standard Silver On Exchange Plan",,"0.718519628047943","Yes","Yes","No","100%",,"$2,260","$15","$0","$150","$1,012","$400","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No","No",,"http://www.bluechoicesc.com/basilver60022016","http://www.bluechoicesc.com/BASilverBrochure","17"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370008","Business Advantage Gold 1000","49532SC037",,"SCN002","SCS001","SCF036","Existing","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.991",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370008-00","Standard Gold Off Exchange Plan",,"0.785578191280365","No","Yes","No","100%",,"$2,000","$83","$465","$150","$1,012","$800","$127","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bluechoicesc.com/bagold10002016","http://www.bluechoicesc.com/BAGoldBrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","Individual","No","57-0768835","49532SC0380013","Blue Option Silver 3000","49532SC038",,"SCN001","SCS001","SCF008","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380013-00","Standard Silver Off Exchange Plan",,"0.710311770439148","Yes","Yes","No","100%",,"$2,260","$315","$0","$150","$1,012","$400","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.blueoptionsc.com/Silver3000base2016","http://www.blueoptionsc.com/silverbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","Individual","No","57-0768835","49532SC0380013","Blue Option Silver 3000","49532SC038",,"SCN001","SCS001","SCF008","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380013-01","Standard Silver On Exchange Plan",,"0.710311770439148","Yes","Yes","No","100%",,"$2,260","$315","$0","$150","$1,012","$400","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.blueoptionsc.com/Silver3000base2016","http://www.blueoptionsc.com/silverbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370008","Business Advantage Gold 1000","49532SC037",,"SCN002","SCS001","SCF036","Existing","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.991",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370008-01","Standard Gold On Exchange Plan",,"0.785578191280365","No","Yes","No","100%",,"$2,000","$83","$465","$150","$1,012","$800","$127","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.bluechoicesc.com/bagold10002016","http://www.bluechoicesc.com/BAGoldBrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370017","Business Advantage Gold 1001","49532SC037",,"SCN002","SCS001","SCF037","Existing","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9909",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370017-00","Standard Gold Off Exchange Plan",,"0.809621095657349","Yes","Yes","No","100%",,"$1,000","$45","$930","$150","$1,000","$412","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No","No",,"http://www.bluechoicesc.com/bagold10012016","http://www.bluechoicesc.com/BAGoldBrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","Individual","No","57-0768835","49532SC0380013","Blue Option Silver 3000","49532SC038",,"SCN001","SCS001","SCF008","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Silver3000zcs2016","http://www.blueoptionsc.com/silverbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","Individual","No","57-0768835","49532SC0380013","Blue Option Silver 3000","49532SC038",,"SCN001","SCS001","SCF008","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380013-03","Limited Cost Sharing Plan Variation",,"0.710311770439148","Yes","Yes","No","100%",,"$2,260","$315","$0","$150","$1,012","$400","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.blueoptionsc.com/Silver3000base2016","http://www.blueoptionsc.com/silverbrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370017","Business Advantage Gold 1001","49532SC037",,"SCN002","SCS001","SCF037","Existing","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9909",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370017-01","Standard Gold On Exchange Plan",,"0.809621095657349","Yes","Yes","No","100%",,"$1,000","$45","$930","$150","$1,000","$412","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No","No",,"http://www.bluechoicesc.com/bagold10012016","http://www.bluechoicesc.com/BAGoldBrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370018","Business Advantage Gold 1002","49532SC037",,"SCN002","SCS001","SCF037","Existing","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.991",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370018-00","Standard Gold Off Exchange Plan",,"0.812718331813812","Yes","Yes","No","100%",,"$1,000","$45","$930","$150","$1,000","$412","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No","No",,"http://www.bluechoicesc.com/bagold10022016","http://www.bluechoicesc.com/BAGoldBrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","Individual","No","57-0768835","49532SC0380013","Blue Option Silver 3000","49532SC038",,"SCN001","SCS001","SCF008","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380013-04","73% AV Level Silver Plan",,"0.737724423408508","Yes","Yes","No","100%",,"$2,260","$300","$0","$150","$1,012","$0","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,200","$5200 per person","$10400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.blueoptionsc.com/Silver3000CSRI2016","http://www.blueoptionsc.com/silverbrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","Individual","No","57-0768835","49532SC0380013","Blue Option Silver 3000","49532SC038",,"SCN001","SCS001","SCF008","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380013-05","87% AV Level Silver Plan",,"0.863743245601654","Yes","Yes","No","100%",,"$2,260","$315","$0","$150","$1,012","$400","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","No",,,"http://www.blueoptionsc.com/Silver3000CSRII2016","http://www.blueoptionsc.com/silverbrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370018","Business Advantage Gold 1002","49532SC037",,"SCN002","SCS001","SCF037","Existing","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.991",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370018-01","Standard Gold On Exchange Plan",,"0.812718331813812","Yes","Yes","No","100%",,"$1,000","$45","$930","$150","$1,000","$412","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No","No",,"http://www.bluechoicesc.com/bagold10022016","http://www.bluechoicesc.com/BAGoldBrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370021","Business Advantage Gold 1003","49532SC037",,"SCN002","SCS001","SCF037","Existing","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9908",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370021-00","Standard Gold Off Exchange Plan",,"0.795180797576904","Yes","Yes","No","100%",,"$1,000","$65","$930","$150","$1,000","$412","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No","No",,"http://www.bluechoicesc.com/bagold10032016","http://www.bluechoicesc.com/BAGoldBrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","Individual","No","57-0768835","49532SC0380013","Blue Option Silver 3000","49532SC038",,"SCN001","SCS001","SCF008","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380013-06","94% AV Level Silver Plan",,"0.936883866786957","Yes","Yes","No","100%",,"$300","$330","$18","$150","$300","$0","$127","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","No",,,"http://www.blueoptionsc.com/Silver3000CSRIII2016","http://www.blueoptionsc.com/silverbrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370021","Business Advantage Gold 1003","49532SC037",,"SCN002","SCS001","SCF037","Existing","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9908",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370021-01","Standard Gold On Exchange Plan",,"0.795180797576904","Yes","Yes","No","100%",,"$1,000","$65","$930","$150","$1,000","$412","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No","No",,"http://www.bluechoicesc.com/bagold10032016","http://www.bluechoicesc.com/BAGoldBrochure","11"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370050","Business Advantage Gold 1004","49532SC037",,"SCN002","SCS001","SCF037","New","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.991",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370050-00","Standard Gold Off Exchange Plan",,"0.814753174781799","Yes","Yes","No","100%",,"$1,000","$65","$930","$150","$1,000","$412","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No","No",,"http://www.bluechoicesc.com/bagold10042016","http://www.bluechoicesc.com/BAGoldBrochure","12"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370050","Business Advantage Gold 1004","49532SC037",,"SCN002","SCS001","SCF037","New","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.991",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370050-01","Standard Gold On Exchange Plan",,"0.814753174781799","Yes","Yes","No","100%",,"$1,000","$65","$930","$150","$1,000","$412","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No","No",,"http://www.bluechoicesc.com/bagold10042016","http://www.bluechoicesc.com/BAGoldBrochure","13"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370040","Business Advantage Gold 1012","49532SC037",,"SCN002","SCS001","SCF037","New","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9909",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370040-00","Standard Gold Off Exchange Plan",,"0.80513995885849","Yes","Yes","No","100%",,"$1,000","$65","$1,394","$150","$1,000","$412","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No","No",,"http://www.bluechoicesc.com/bagold10122016","http://www.bluechoicesc.com/BAGoldBrochure","14"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370040","Business Advantage Gold 1012","49532SC037",,"SCN002","SCS001","SCF037","New","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9909",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370040-01","Standard Gold On Exchange Plan",,"0.80513995885849","Yes","Yes","No","100%",,"$1,000","$65","$1,394","$150","$1,000","$412","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No","No",,"http://www.bluechoicesc.com/bagold10122016","http://www.bluechoicesc.com/BAGoldBrochure","15"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370041","Business Advantage Gold 1250","49532SC037",,"SCN002","SCS001","SCF037","New","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9909",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370041-00","Standard Gold Off Exchange Plan",,"0.805993437767029","Yes","Yes","No","100%",,"$1,250","$65","$930","$150","$1,012","$400","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No","No",,"http://www.bluechoicesc.com/bagold12502016","http://www.bluechoicesc.com/BAGoldBrochure","16"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370041","Business Advantage Gold 1250","49532SC037",,"SCN002","SCS001","SCF037","New","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9909",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370041-01","Standard Gold On Exchange Plan",,"0.805993437767029","Yes","Yes","No","100%",,"$1,250","$65","$930","$150","$1,012","$400","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No","No",,"http://www.bluechoicesc.com/bagold12502016","http://www.bluechoicesc.com/BAGoldBrochure","17"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370019","Business Advantage Gold 1850 HD","49532SC037",,"SCN002","SCS001","SCF020","Existing","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9911",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370019-00","Standard Gold Off Exchange Plan",,"0.817367315292358","Yes","Yes","No","100%",,"$1,850","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,850","$1850 per person","$3700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,850","$1850 per person","$3700 per group","Yes","No",,"http://www.bluechoicesc.com/bagold18502016","http://www.bluechoicesc.com/BAGoldBrochure","18"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370019","Business Advantage Gold 1850 HD","49532SC037",,"SCN002","SCS001","SCF020","Existing","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9911",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370019-01","Standard Gold On Exchange Plan",,"0.817367315292358","Yes","Yes","No","100%",,"$1,850","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,850","$1850 per person","$3700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,850","$1850 per person","$3700 per group","Yes","No",,"http://www.bluechoicesc.com/bagold18502016","http://www.bluechoicesc.com/BAGoldBrochure","19"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370020","Business Advantage Gold 2100 HD","49532SC037",,"SCN002","SCS001","SCF020","Existing","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9909",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370020-00","Standard Gold Off Exchange Plan",,"0.799147665500641","Yes","Yes","No","100%",,"$2,100","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","Yes","No",,"http://www.bluechoicesc.com/bagold21002016","http://www.bluechoicesc.com/BAGoldBrochure","20"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370020","Business Advantage Gold 2100 HD","49532SC037",,"SCN002","SCS001","SCF020","Existing","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9909",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370020-01","Standard Gold On Exchange Plan",,"0.799147665500641","Yes","Yes","No","100%",,"$2,100","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","Yes","No",,"http://www.bluechoicesc.com/bagold21002016","http://www.bluechoicesc.com/BAGoldBrochure","21"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370022","Business Advantage Gold 1502","49532SC037",,"SCN002","SCS001","SCF037","Existing","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9907",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370022-00","Standard Gold Off Exchange Plan",,"0.797447025775909","Yes","Yes","No","100%",,"$1,500","$55","$930","$150","$1,012","$400","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No","No",,"http://www.bluechoicesc.com/bagold15022016","http://www.bluechoicesc.com/BAGoldBrochure","22"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370022","Business Advantage Gold 1502","49532SC037",,"SCN002","SCS001","SCF037","Existing","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9907",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370022-01","Standard Gold On Exchange Plan",,"0.797447025775909","Yes","Yes","No","100%",,"$1,500","$55","$930","$150","$1,012","$400","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No","No",,"http://www.bluechoicesc.com/bagold15022016","http://www.bluechoicesc.com/BAGoldBrochure","23"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370023","Business Advantage Gold 2000","49532SC037",,"SCN002","SCS001","SCF037","Existing","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9907",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370023-00","Standard Gold Off Exchange Plan",,"0.796829700469971","Yes","Yes","No","100%",,"$2,000","$60","$930","$150","$1,012","$400","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No","No",,"http://www.bluechoicesc.com/bagold20002016","http://www.bluechoicesc.com/BAGoldBrochure","24"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370043","Business Advantage Gold 2002","49532SC037",,"SCN002","SCS001","SCF037","New","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9908",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370043-01","Standard Gold On Exchange Plan",,"0.813812911510468","Yes","Yes","No","100%",,"$2,000","$55","$0","$150","$1,012","$400","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No","No",,"http://www.bluechoicesc.com/bagold20022016","http://www.bluechoicesc.com/BAGoldBrochure","27"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370038","Business Advantage Gold 2503","49532SC037",,"SCN002","SCS001","SCF037","New","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9906",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370038-00","Standard Gold Off Exchange Plan",,"0.793912887573242","Yes","Yes","No","100%",,"$2,260","$0","$740","$150","$1,012","$400","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No","No",,"http://www.bluechoicesc.com/bagold25032016","http://www.bluechoicesc.com/BAGoldBrochure","28"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370038","Business Advantage Gold 2503","49532SC037",,"SCN002","SCS001","SCF037","New","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9906",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370038-01","Standard Gold On Exchange Plan",,"0.793912887573242","Yes","Yes","No","100%",,"$2,260","$0","$740","$150","$1,012","$400","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No","No",,"http://www.bluechoicesc.com/bagold25032016","http://www.bluechoicesc.com/BAGoldBrochure","29"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370042","Business Advantage Gold 2300 HD","49532SC037",,"SCN002","SCS001","SCF020","New","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9908",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370042-00","Standard Gold Off Exchange Plan",,"0.785342574119568","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,300","$2300 per person","$4600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,300","$2300 per person","$4600 per group","Yes","No",,"http://www.bluechoicesc.com/bagold23002016","http://www.bluechoicesc.com/BAGoldBrochure","30"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","12","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370042","Business Advantage Gold 2300 HD","49532SC037",,"SCN002","SCS001","SCF020","New","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9908",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370042-01","Standard Gold On Exchange Plan",,"0.785342574119568","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,300","$2300 per person","$4600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,300","$2300 per person","$4600 per group","Yes","No",,"http://www.bluechoicesc.com/bagold23002016","http://www.bluechoicesc.com/BAGoldBrochure","31"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","13","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370039","Business Advantage Gold 1011","49532SC037",,"SCN002","SCS001","SCF037","New","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.991",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370039-00","Standard Gold Off Exchange Plan",,"0.809713065624237","Yes","Yes","No","100%",,"$1,000","$65","$930","$150","$1,000","$412","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No","No",,"http://www.bluechoicesc.com/bagold10112016","http://www.bluechoicesc.com/BAGoldBrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","13","49532","SC","Individual","No","57-0768835","49532SC0380024","Blue Option Silver 3400 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380024-00","Standard Silver Off Exchange Plan",,"0.716870069503784","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,400","$3400 per person","$6800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,400","$3400 per person","$6800 per group","Yes",,,"http://www.blueoptionsc.com/Silver3400base2016","http://www.blueoptionsc.com/silverbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","13","49532","SC","Individual","No","57-0768835","49532SC0380024","Blue Option Silver 3400 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380024-01","Standard Silver On Exchange Plan",,"0.716870069503784","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,400","$3400 per person","$6800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,400","$3400 per person","$6800 per group","Yes",,,"http://www.blueoptionsc.com/Silver3400base2016","http://www.blueoptionsc.com/silverbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","13","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370039","Business Advantage Gold 1011","49532SC037",,"SCN002","SCS001","SCF037","New","PPO","Gold","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.991",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370039-01","Standard Gold On Exchange Plan",,"0.809713065624237","Yes","Yes","No","100%",,"$1,000","$65","$930","$150","$1,000","$412","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No","No",,"http://www.bluechoicesc.com/bagold10112016","http://www.bluechoicesc.com/BAGoldBrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","13","49532","SC","Individual","No","57-0768835","49532SC0380024","Blue Option Silver 3400 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380024-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Silver3400zcs2016","http://www.blueoptionsc.com/silverbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","13","49532","SC","Individual","No","57-0768835","49532SC0380024","Blue Option Silver 3400 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380024-03","Limited Cost Sharing Plan Variation",,"0.716870069503784","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,400","$3400 per person","$6800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,400","$3400 per person","$6800 per group","Yes",,,"http://www.blueoptionsc.com/Silver3400base2016","http://www.blueoptionsc.com/silverbrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","13","49532","SC","Individual","No","57-0768835","49532SC0380024","Blue Option Silver 3400 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380024-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes",,,"http://www.blueoptionsc.com/Silver3400CSRI2016","http://www.blueoptionsc.com/silverbrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","13","49532","SC","Individual","No","57-0768835","49532SC0380024","Blue Option Silver 3400 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380024-05","87% AV Level Silver Plan",,"0.874577879905701","Yes","Yes","No","100%",,"$1,150","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group","No",,,"http://www.blueoptionsc.com/Silver3400CSRII2016","http://www.blueoptionsc.com/silverbrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","13","49532","SC","Individual","No","57-0768835","49532SC0380024","Blue Option Silver 3400 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9931",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380024-06","94% AV Level Silver Plan",,"0.94233250617981","Yes","Yes","No","100%",,"$475","$0","$0","$150","$475","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$475","$475 per person","$950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$475","$475 per person","$950 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$475","$475 per person","$950 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$475","$475 per person","$950 per group","No",,,"http://www.blueoptionsc.com/Silver3400CSRIII2016","http://www.blueoptionsc.com/silverbrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","14","49532","SC","Individual","No","57-0768835","49532SC0380014","Blue Option Silver 3500","49532SC038",,"SCN001","SCS001","SCF009","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9927",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380014-00","Standard Silver Off Exchange Plan",,"0.719478666782379","Yes","Yes","No","100%",,"$2,260","$0","$1,341","$150","$1,012","$0","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.blueoptionsc.com/Silver3500base2016","http://www.blueoptionsc.com/silverbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","14","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370012","Business Advantage Silver 2500","49532SC037",,"SCN002","SCS001","SCF031","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9891",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370012-00","Standard Silver Off Exchange Plan",,"0.715506792068481","Yes","Yes","No","100%",,"$2,500","$65","$2,324","$150","$1,012","$400","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No","No",,"http://www.bluechoicesc.com/basilver25002016","http://www.bluechoicesc.com/BASilverBrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","14","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370012","Business Advantage Silver 2500","49532SC037",,"SCN002","SCS001","SCF031","Existing","PPO","Silver","No","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9891",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/BlueChoice%20Prescription%20Drug%20Information","49532SC0370012-01","Standard Silver On Exchange Plan",,"0.715506792068481","Yes","Yes","No","100%",,"$2,500","$65","$2,324","$150","$1,012","$400","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No","No",,"http://www.bluechoicesc.com/basilver25002016","http://www.bluechoicesc.com/BASilverBrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","14","49532","SC","Individual","No","57-0768835","49532SC0380014","Blue Option Silver 3500","49532SC038",,"SCN001","SCS001","SCF009","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9927",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380014-01","Standard Silver On Exchange Plan",,"0.719478666782379","Yes","Yes","No","100%",,"$2,260","$0","$1,341","$150","$1,012","$0","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.blueoptionsc.com/Silver3500base2016","http://www.blueoptionsc.com/silverbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","14","49532","SC","Individual","No","57-0768835","49532SC0380014","Blue Option Silver 3500","49532SC038",,"SCN001","SCS001","SCF009","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9927",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Silver3500zcs2016","http://www.blueoptionsc.com/silverbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","14","49532","SC","Individual","No","57-0768835","49532SC0380014","Blue Option Silver 3500","49532SC038",,"SCN001","SCS001","SCF009","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9927",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380014-03","Limited Cost Sharing Plan Variation",,"0.719478666782379","Yes","Yes","No","100%",,"$2,260","$0","$1,341","$150","$1,012","$0","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.blueoptionsc.com/Silver3500base2016","http://www.blueoptionsc.com/silverbrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","14","49532","SC","Individual","No","57-0768835","49532SC0380014","Blue Option Silver 3500","49532SC038",,"SCN001","SCS001","SCF009","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9927",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380014-04","73% AV Level Silver Plan",,"0.739591479301453","Yes","Yes","No","100%",,"$2,260","$0","$1,341","$150","$1,012","$0","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,350","$4350 per person","$8700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,350","$4350 per person","$8700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.blueoptionsc.com/Silver3500CSRI2016","http://www.blueoptionsc.com/silverbrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","14","49532","SC","Individual","No","57-0768835","49532SC0380014","Blue Option Silver 3500","49532SC038",,"SCN001","SCS001","SCF009","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9927",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380014-05","87% AV Level Silver Plan",,"0.867164611816406","Yes","Yes","No","100%",,"$750","$30","$930","$150","$750","$0","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","No",,,"http://www.blueoptionsc.com/Silver3500CSRII2016","http://www.blueoptionsc.com/silverbrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","14","49532","SC","Individual","No","57-0768835","49532SC0380014","Blue Option Silver 3500","49532SC038",,"SCN001","SCS001","SCF009","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9927",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380014-06","94% AV Level Silver Plan",,"0.932325482368469","Yes","Yes","No","100%",,"$500","$30","$220","$150","$500","$0","$127","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","No",,,"http://www.blueoptionsc.com/Silver3500CSRIII2016","http://www.blueoptionsc.com/silverbrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","15","49532","SC","Individual","No","57-0768835","49532SC0380015","Blue Option Silver 4000","49532SC038",,"SCN001","SCS001","SCF010","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9927",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380015-00","Standard Silver Off Exchange Plan",,"0.718266069889069","Yes","Yes","No","100%",,"$2,260","$320","$0","$150","$1,012","$600","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","No",,,"http://www.blueoptionsc.com/Silver4000base2016","http://www.blueoptionsc.com/silverbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","15","49532","SC","Individual","No","57-0768835","49532SC0380015","Blue Option Silver 4000","49532SC038",,"SCN001","SCS001","SCF010","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9927",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380015-01","Standard Silver On Exchange Plan",,"0.718266069889069","Yes","Yes","No","100%",,"$2,260","$320","$0","$150","$1,012","$600","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","No",,,"http://www.blueoptionsc.com/Silver4000base2016","http://www.blueoptionsc.com/silverbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","15","49532","SC","Individual","No","57-0768835","49532SC0380015","Blue Option Silver 4000","49532SC038",,"SCN001","SCS001","SCF010","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9927",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Silver4000zcs2016","http://www.blueoptionsc.com/silverbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","15","49532","SC","Individual","No","57-0768835","49532SC0380015","Blue Option Silver 4000","49532SC038",,"SCN001","SCS001","SCF010","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9927",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380015-03","Limited Cost Sharing Plan Variation",,"0.718266069889069","Yes","Yes","No","100%",,"$2,260","$320","$0","$150","$1,012","$600","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","No",,,"http://www.blueoptionsc.com/Silver4000base2016","http://www.blueoptionsc.com/silverbrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","15","49532","SC","Individual","No","57-0768835","49532SC0380015","Blue Option Silver 4000","49532SC038",,"SCN001","SCS001","SCF010","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9927",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380015-04","73% AV Level Silver Plan",,"0.738665580749512","Yes","Yes","No","100%",,"$2,260","$300","$0","$150","$1,012","$0","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","No",,,"http://www.blueoptionsc.com/Silver4000CSRI2016","http://www.blueoptionsc.com/silverbrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","15","49532","SC","Individual","No","57-0768835","49532SC0380015","Blue Option Silver 4000","49532SC038",,"SCN001","SCS001","SCF010","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9927",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380015-05","87% AV Level Silver Plan",,"0.869320094585419","Yes","Yes","No","100%",,"$1,000","$320","$53","$150","$1,000","$0","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"http://www.blueoptionsc.com/Silver4000CSRII2016","http://www.blueoptionsc.com/silverbrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","15","49532","SC","Individual","No","57-0768835","49532SC0380015","Blue Option Silver 4000","49532SC038",,"SCN001","SCS001","SCF010","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9927",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380015-06","94% AV Level Silver Plan",,"0.937431395053864","Yes","Yes","No","100%",,"$300","$247","$53","$150","$300","$0","$300","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","No",,,"http://www.blueoptionsc.com/Silver4000CSRIII2016","http://www.blueoptionsc.com/silverbrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","16","49532","SC","Individual","No","57-0768835","49532SC0380016","Blue Option Silver 6000","49532SC038",,"SCN001","SCS001","SCF011","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380016-00","Standard Silver Off Exchange Plan",,"0.704013168811798","Yes","Yes","No","100%",,"$2,260","$315","$0","$150","$1,012","$400","$127","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No",,,"http://www.blueoptionsc.com/Silver6000base2016","http://www.blueoptionsc.com/silverbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","16","49532","SC","Individual","No","57-0768835","49532SC0380016","Blue Option Silver 6000","49532SC038",,"SCN001","SCS001","SCF011","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380016-01","Standard Silver On Exchange Plan",,"0.704013168811798","Yes","Yes","No","100%",,"$2,260","$315","$0","$150","$1,012","$400","$127","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No",,,"http://www.blueoptionsc.com/Silver6000base2016","http://www.blueoptionsc.com/silverbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","16","49532","SC","Individual","No","57-0768835","49532SC0380016","Blue Option Silver 6000","49532SC038",,"SCN001","SCS001","SCF011","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Silver6000zcs2016","http://www.blueoptionsc.com/silverbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","16","49532","SC","Individual","No","57-0768835","49532SC0380016","Blue Option Silver 6000","49532SC038",,"SCN001","SCS001","SCF011","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380016-03","Limited Cost Sharing Plan Variation",,"0.704013168811798","Yes","Yes","No","100%",,"$2,260","$315","$0","$150","$1,012","$400","$127","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No",,,"http://www.blueoptionsc.com/Silver6000base2016","http://www.blueoptionsc.com/silverbrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","16","49532","SC","Individual","No","57-0768835","49532SC0380016","Blue Option Silver 6000","49532SC038",,"SCN001","SCS001","SCF011","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380016-04","73% AV Level Silver Plan",,"0.726943016052246","Yes","Yes","No","100%",,"$2,260","$315","$0","$150","$1,012","$400","$127","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.blueoptionsc.com/Silver6000CSRI2016","http://www.blueoptionsc.com/silverbrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","17","49532","SC","Individual","No","57-0768835","49532SC0380025","Blue Option Silver 3650 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.993",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380025-04","73% AV Level Silver Plan",,"0.733225047588348","Yes","Yes","No","100%",,"$2,260","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","Yes",,,"http://www.blueoptionsc.com/Silver3650CSRI2016","http://www.blueoptionsc.com/silverbrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","17","49532","SC","Individual","No","57-0768835","49532SC0380025","Blue Option Silver 3650 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.993",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380025-05","87% AV Level Silver Plan",,"0.874577879905701","Yes","Yes","No","100%",,"$1,150","$0","$0","$150","$1,012","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group","No",,,"http://www.blueoptionsc.com/Silver3650CSRII2016","http://www.blueoptionsc.com/silverbrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","17","49532","SC","Individual","No","57-0768835","49532SC0380025","Blue Option Silver 3650 HD","49532SC038",,"SCN001","SCS001","SCF002","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.993",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380025-06","94% AV Level Silver Plan",,"0.94233250617981","Yes","Yes","No","100%",,"$475","$0","$0","$150","$475","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$475","$475 per person","$950 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$475","$475 per person","$950 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$475","$475 per person","$950 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$475","$475 per person","$950 per group","No",,,"http://www.blueoptionsc.com/Silver3650CSRIII2016","http://www.blueoptionsc.com/silverbrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","18","49532","SC","Individual","No","57-0768835","49532SC0380026","Blue Option Silver 5001","49532SC038",,"SCN001","SCS001","SCF012","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380026-00","Standard Silver Off Exchange Plan",,"0.69044703245163","Yes","Yes","No","100%",,"$2,260","$15","$1,341","$150","$1,012","$400","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.blueoptionsc.com/Silver5001base2016","http://www.blueoptionsc.com/silverbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","18","49532","SC","Individual","No","57-0768835","49532SC0380026","Blue Option Silver 5001","49532SC038",,"SCN001","SCS001","SCF012","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380026-01","Standard Silver On Exchange Plan",,"0.69044703245163","Yes","Yes","No","100%",,"$2,260","$15","$1,341","$150","$1,012","$400","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.blueoptionsc.com/Silver5001base2016","http://www.blueoptionsc.com/silverbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","18","49532","SC","Individual","No","57-0768835","49532SC0380026","Blue Option Silver 5001","49532SC038",,"SCN001","SCS001","SCF012","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Silver5001zcs2016","http://www.blueoptionsc.com/silverbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","18","49532","SC","Individual","No","57-0768835","49532SC0380026","Blue Option Silver 5001","49532SC038",,"SCN001","SCS001","SCF012","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380026-03","Limited Cost Sharing Plan Variation",,"0.69044703245163","Yes","Yes","No","100%",,"$2,260","$15","$1,341","$150","$1,012","$400","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.blueoptionsc.com/Silver5001base2016","http://www.blueoptionsc.com/silverbrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","18","49532","SC","Individual","No","57-0768835","49532SC0380026","Blue Option Silver 5001","49532SC038",,"SCN001","SCS001","SCF012","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380026-04","73% AV Level Silver Plan",,"0.738899886608124","Yes","Yes","No","100%",,"$2,260","$15","$1,341","$150","$1,012","$400","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,800","$4800 per person","$9600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.blueoptionsc.com/Silver5001CSRI2016","http://www.blueoptionsc.com/silverbrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","18","49532","SC","Individual","No","57-0768835","49532SC0380026","Blue Option Silver 5001","49532SC038",,"SCN001","SCS001","SCF012","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380026-05","87% AV Level Silver Plan",,"0.874926269054413","Yes","Yes","No","100%",,"$800","$75","$325","$150","$796","$200","$204","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","No",,,"http://www.blueoptionsc.com/Silver5001CSRII2016","http://www.blueoptionsc.com/silverbrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","18","49532","SC","Individual","No","57-0768835","49532SC0380026","Blue Option Silver 5001","49532SC038",,"SCN001","SCS001","SCF012","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380026-06","94% AV Level Silver Plan",,"0.931215882301331","Yes","Yes","No","100%",,"$250","$75","$175","$150","$250","$174","$76","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","No",,,"http://www.blueoptionsc.com/Silver5001CSRIII2016","http://www.blueoptionsc.com/silverbrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","19","49532","SC","Individual","No","57-0768835","49532SC0380027","Blue Option Silver 6001","49532SC038",,"SCN001","SCS001","SCF013","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380027-00","Standard Silver Off Exchange Plan",,"0.691148817539215","Yes","Yes","No","100%",,"$2,260","$315","$0","$150","$1,012","$1,672","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No",,,"http://www.blueoptionsc.com/Silver6001base2016","http://www.blueoptionsc.com/silverbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","19","49532","SC","Individual","No","57-0768835","49532SC0380027","Blue Option Silver 6001","49532SC038",,"SCN001","SCS001","SCF013","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380027-01","Standard Silver On Exchange Plan",,"0.691148817539215","Yes","Yes","No","100%",,"$2,260","$315","$0","$150","$1,012","$1,672","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No",,,"http://www.blueoptionsc.com/Silver6001base2016","http://www.blueoptionsc.com/silverbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","19","49532","SC","Individual","No","57-0768835","49532SC0380027","Blue Option Silver 6001","49532SC038",,"SCN001","SCS001","SCF013","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380027-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Silver6001zcs2016","http://www.blueoptionsc.com/silverbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","19","49532","SC","Individual","No","57-0768835","49532SC0380027","Blue Option Silver 6001","49532SC038",,"SCN001","SCS001","SCF013","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380027-03","Limited Cost Sharing Plan Variation",,"0.691148817539215","Yes","Yes","No","100%",,"$2,260","$315","$0","$150","$1,012","$1,672","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No",,,"http://www.blueoptionsc.com/Silver6001base2016","http://www.blueoptionsc.com/silverbrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","19","49532","SC","Individual","No","57-0768835","49532SC0380027","Blue Option Silver 6001","49532SC038",,"SCN001","SCS001","SCF013","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380027-04","73% AV Level Silver Plan",,"0.739794850349426","Yes","Yes","No","100%",,"$2,260","$315","$0","$150","$1,012","$1,672","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,300","$4300 per person","$8600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,300","$4300 per person","$8600 per group","No",,,"http://www.blueoptionsc.com/Silver6001CSRI2016","http://www.blueoptionsc.com/silverbrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","19","49532","SC","Individual","No","57-0768835","49532SC0380027","Blue Option Silver 6001","49532SC038",,"SCN001","SCS001","SCF013","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380027-05","87% AV Level Silver Plan",,"0.866370856761932","Yes","Yes","No","100%",,"$1,500","$0","$0","$150","$664","$836","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"http://www.blueoptionsc.com/Silver6001CSRII2016","http://www.blueoptionsc.com/silverbrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","19","49532","SC","Individual","No","57-0768835","49532SC0380027","Blue Option Silver 6001","49532SC038",,"SCN001","SCS001","SCF013","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380027-06","94% AV Level Silver Plan",,"0.94587904214859","Yes","Yes","No","100%",,"$500","$0","$0","$150","$229","$271","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","No",,,"http://www.blueoptionsc.com/Silver6001CSRIII2016","http://www.blueoptionsc.com/silverbrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","20","49532","SC","Individual","No","57-0768835","49532SC0380028","Blue Option Silver 6850","49532SC038",,"SCN001","SCS001","SCF014","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380028-00","Standard Silver Off Exchange Plan",,"0.680799007415771","Yes","Yes","No","100%",,"$2,260","$15","$0","$150","$1,012","$400","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.blueoptionsc.com/Silver6850base2016","http://www.blueoptionsc.com/silverbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","20","49532","SC","Individual","No","57-0768835","49532SC0380028","Blue Option Silver 6850","49532SC038",,"SCN001","SCS001","SCF014","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380028-01","Standard Silver On Exchange Plan",,"0.680799007415771","Yes","Yes","No","100%",,"$2,260","$15","$0","$150","$1,012","$400","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.blueoptionsc.com/Silver6850base2016","http://www.blueoptionsc.com/silverbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","20","49532","SC","Individual","No","57-0768835","49532SC0380028","Blue Option Silver 6850","49532SC038",,"SCN001","SCS001","SCF014","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380028-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Silver6850zcs2016","http://www.blueoptionsc.com/silverbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","20","49532","SC","Individual","No","57-0768835","49532SC0380028","Blue Option Silver 6850","49532SC038",,"SCN001","SCS001","SCF014","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380028-03","Limited Cost Sharing Plan Variation",,"0.680799007415771","Yes","Yes","No","100%",,"$2,260","$15","$0","$150","$1,012","$400","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.blueoptionsc.com/Silver6850base2016","http://www.blueoptionsc.com/silverbrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","20","49532","SC","Individual","No","57-0768835","49532SC0380028","Blue Option Silver 6850","49532SC038",,"SCN001","SCS001","SCF014","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380028-04","73% AV Level Silver Plan",,"0.735082924365997","Yes","Yes","No","100%",,"$2,260","$15","$0","$150","$1,012","$400","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,800","$4800 per person","$9600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,800","$4800 per person","$9600 per group","No",,,"http://www.blueoptionsc.com/Silver6850CSRI2016","http://www.blueoptionsc.com/silverbrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","20","49532","SC","Individual","No","57-0768835","49532SC0380028","Blue Option Silver 6850","49532SC038",,"SCN001","SCS001","SCF014","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380028-05","87% AV Level Silver Plan",,"0.860663831233978","Yes","Yes","No","100%",,"$1,750","$0","$0","$150","$1,012","$400","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","No",,,"http://www.blueoptionsc.com/Silver6850CSRII2016","http://www.blueoptionsc.com/silverbrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","20","49532","SC","Individual","No","57-0768835","49532SC0380028","Blue Option Silver 6850","49532SC038",,"SCN001","SCS001","SCF014","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380028-06","94% AV Level Silver Plan",,"0.948987901210785","Yes","Yes","No","100%",,"$500","$0","$0","$150","$460","$40","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","No",,,"http://www.blueoptionsc.com/Silver6850CSRIII2016","http://www.blueoptionsc.com/silverbrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","21","49532","SC","Individual","No","57-0768835","49532SC0380005","Blue Option Silver 400","49532SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380005-00","Standard Silver Off Exchange Plan",,"0.692279994487762","Yes","Yes","No","100%",,"$400","$0","$3,177","$150","$400","$0","$2,367","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","No",,,"http://www.blueoptionsc.com/Silver400base2016","http://www.blueoptionsc.com/silverbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","21","49532","SC","Individual","No","57-0768835","49532SC0380005","Blue Option Silver 400","49532SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380005-01","Standard Silver On Exchange Plan",,"0.692279994487762","Yes","Yes","No","100%",,"$400","$0","$3,177","$150","$400","$0","$2,367","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","No",,,"http://www.blueoptionsc.com/Silver400base2016","http://www.blueoptionsc.com/silverbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","21","49532","SC","Individual","No","57-0768835","49532SC0380005","Blue Option Silver 400","49532SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Silver400zcs2016","http://www.blueoptionsc.com/silverbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","21","49532","SC","Individual","No","57-0768835","49532SC0380005","Blue Option Silver 400","49532SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380005-03","Limited Cost Sharing Plan Variation",,"0.692279994487762","Yes","Yes","No","100%",,"$400","$0","$3,177","$150","$400","$0","$2,367","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","No",,,"http://www.blueoptionsc.com/Silver400base2016","http://www.blueoptionsc.com/silverbrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","21","49532","SC","Individual","No","57-0768835","49532SC0380005","Blue Option Silver 400","49532SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380005-04","73% AV Level Silver Plan",,"0.736049473285675","Yes","Yes","No","100%",,"$100","$0","$3,327","$150","$100","$0","$2,517","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,100","$5100 per person","$10200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","No",,,"http://www.blueoptionsc.com/Silver400CSRI2016","http://www.blueoptionsc.com/silverbrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","21","49532","SC","Individual","No","57-0768835","49532SC0380005","Blue Option Silver 400","49532SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380005-05","87% AV Level Silver Plan",,"0.870936989784241","Yes","Yes","No","100%",,"$75","$0","$1,670","$150","$75","$0","$1,265","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","No",,,"http://www.blueoptionsc.com/Silver400CSRII2016","http://www.blueoptionsc.com/silverbrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","21","49532","SC","Individual","No","57-0768835","49532SC0380005","Blue Option Silver 400","49532SC038",,"SCN001","SCS001","SCF001","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380005-06","94% AV Level Silver Plan",,"0.934341847896576","Yes","Yes","No","100%",,"$75","$0","$775","$150","$75","$0","$759","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","No",,,"http://www.blueoptionsc.com/Silver400CSRIII2016","http://www.blueoptionsc.com/silverbrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","22","49532","SC","Individual","No","57-0768835","49532SC0380006","Blue Option Silver 2501 HD","49532SC038",,"SCN001","SCS001","SCF015","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380006-00","Standard Silver Off Exchange Plan",,"0.700443744659424","Yes","Yes","No","100%",,"$2,260","$0","$674","$150","$1,012","$0","$618","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,650","$5650 per person","$11300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Yes",,,"http://www.blueoptionsc.com/Silver2501base2016","http://www.blueoptionsc.com/silverbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","22","49532","SC","Individual","No","57-0768835","49532SC0380006","Blue Option Silver 2501 HD","49532SC038",,"SCN001","SCS001","SCF015","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380006-01","Standard Silver On Exchange Plan",,"0.700443744659424","Yes","Yes","No","100%",,"$2,260","$0","$674","$150","$1,012","$0","$618","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,650","$5650 per person","$11300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Yes",,,"http://www.blueoptionsc.com/Silver2501base2016","http://www.blueoptionsc.com/silverbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","22","49532","SC","Individual","No","57-0768835","49532SC0380006","Blue Option Silver 2501 HD","49532SC038",,"SCN001","SCS001","SCF015","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Silver2501zcs2016","http://www.blueoptionsc.com/silverbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","22","49532","SC","Individual","No","57-0768835","49532SC0380006","Blue Option Silver 2501 HD","49532SC038",,"SCN001","SCS001","SCF015","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380006-03","Limited Cost Sharing Plan Variation",,"0.700443744659424","Yes","Yes","No","100%",,"$2,260","$0","$674","$150","$1,012","$0","$618","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,650","$5650 per person","$11300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Yes",,,"http://www.blueoptionsc.com/Silver2501base2016","http://www.blueoptionsc.com/silverbrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","22","49532","SC","Individual","No","57-0768835","49532SC0380006","Blue Option Silver 2501 HD","49532SC038",,"SCN001","SCS001","SCF015","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380006-04","73% AV Level Silver Plan",,"0.738075137138367","Yes","Yes","No","100%",,"$1,850","$0","$736","$150","$1,012","$0","$618","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,150","$5150 per person","$10300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,850","$1850 per person","$3700 per group","No",,,"http://www.blueoptionsc.com/Silver2501CSRI2016","http://www.blueoptionsc.com/silverbrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","22","49532","SC","Individual","No","57-0768835","49532SC0380006","Blue Option Silver 2501 HD","49532SC038",,"SCN001","SCS001","SCF015","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380006-05","87% AV Level Silver Plan",,"0.873943686485291","Yes","Yes","No","100%",,"$750","$0","$600","$150","$750","$0","$438","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","No",,,"http://www.blueoptionsc.com/Silver2501CSRII2016","http://www.blueoptionsc.com/silverbrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","22","49532","SC","Individual","No","57-0768835","49532SC0380006","Blue Option Silver 2501 HD","49532SC038",,"SCN001","SCS001","SCF015","Existing","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380006-06","94% AV Level Silver Plan",,"0.936538875102997","Yes","Yes","No","100%",,"$250","$0","$425","$150","$250","$0","$425","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$675","$675 per person","$1350 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$675","$675 per person","$1350 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","No",,,"http://www.blueoptionsc.com/Silver2501CSRIII2016","http://www.blueoptionsc.com/silverbrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","23","49532","SC","Individual","No","57-0768835","49532SC0380032","Blue Option Silver 6002","49532SC038",,"SCN001","SCS001","SCF016","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380032-00","Standard Silver Off Exchange Plan",,"0.700431346893311","Yes","Yes","No","100%",,"$2,260","$315","$0","$150","$1,012","$400","$127","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No",,,"http://www.blueoptionsc.com/Silver6002base2016","http://www.blueoptionsc.com/silverbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","23","49532","SC","Individual","No","57-0768835","49532SC0380032","Blue Option Silver 6002","49532SC038",,"SCN001","SCS001","SCF016","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380032-01","Standard Silver On Exchange Plan",,"0.700431346893311","Yes","Yes","No","100%",,"$2,260","$315","$0","$150","$1,012","$400","$127","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No",,,"http://www.blueoptionsc.com/Silver6002base2016","http://www.blueoptionsc.com/silverbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","23","49532","SC","Individual","No","57-0768835","49532SC0380032","Blue Option Silver 6002","49532SC038",,"SCN001","SCS001","SCF016","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380032-06","94% AV Level Silver Plan",,"0.945650637149811","Yes","Yes","No","100%",,"$300","$282","$18","$150","$300","$0","$127","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","No",,,"http://www.blueoptionsc.com/Silver6002CSRIII2016","http://www.blueoptionsc.com/silverbrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","24","49532","SC","Individual","No","57-0768835","49532SC0380033","Blue Option Silver 1250","49532SC038",,"SCN001","SCS001","SCF017","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380033-00","Standard Silver Off Exchange Plan",,"0.716911196708679","No","Yes","No","100%",,"$1,250","$103","$2,324","$150","$1,012","$800","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver1250base2016","http://www.blueoptionsc.com/silverbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","24","49532","SC","Individual","No","57-0768835","49532SC0380033","Blue Option Silver 1250","49532SC038",,"SCN001","SCS001","SCF017","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380033-01","Standard Silver On Exchange Plan",,"0.716911196708679","No","Yes","No","100%",,"$1,250","$103","$2,324","$150","$1,012","$800","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver1250base2016","http://www.blueoptionsc.com/silverbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","24","49532","SC","Individual","No","57-0768835","49532SC0380033","Blue Option Silver 1250","49532SC038",,"SCN001","SCS001","SCF017","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380033-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver1250zcs2016","http://www.blueoptionsc.com/silverbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","24","49532","SC","Individual","No","57-0768835","49532SC0380033","Blue Option Silver 1250","49532SC038",,"SCN001","SCS001","SCF017","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380033-03","Limited Cost Sharing Plan Variation",,"0.716911196708679","No","Yes","No","100%",,"$1,250","$103","$2,324","$150","$1,012","$800","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver1250base2016","http://www.blueoptionsc.com/silverbrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","24","49532","SC","Individual","No","57-0768835","49532SC0380033","Blue Option Silver 1250","49532SC038",,"SCN001","SCS001","SCF017","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380033-04","73% AV Level Silver Plan",,"0.738268971443176","No","Yes","No","100%",,"$1,250","$93","$2,324","$150","$1,012","$800","$636","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,400","$5400 per person","$10800 per group","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver1250CSRI2016","http://www.blueoptionsc.com/silverbrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","24","49532","SC","Individual","No","57-0768835","49532SC0380033","Blue Option Silver 1250","49532SC038",,"SCN001","SCS001","SCF017","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380033-05","87% AV Level Silver Plan",,"0.861403346061707","No","Yes","No","100%",,"$750","$40","$1,210","$150","$750","$440","$509","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$750","$750 per person","$1500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver1250CSRII2016","http://www.blueoptionsc.com/silverbrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","24","49532","SC","Individual","No","57-0768835","49532SC0380033","Blue Option Silver 1250","49532SC038",,"SCN001","SCS001","SCF017","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380033-06","94% AV Level Silver Plan",,"0.938591837882996","No","Yes","No","100%",,"$250","$30","$470","$150","$250","$0","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver1250CSRIII2016","http://www.blueoptionsc.com/silverbrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","25","49532","SC","Individual","No","57-0768835","49532SC0380034","Blue Option Silver 3001","49532SC038",,"SCN001","SCS001","SCF016","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380034-00","Standard Silver Off Exchange Plan",,"0.684784233570099","No","Yes","No","100%",,"$2,260","$23","$1,341","$150","$1,012","$800","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver3001base2016","http://www.blueoptionsc.com/silverbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","25","49532","SC","Individual","No","57-0768835","49532SC0380034","Blue Option Silver 3001","49532SC038",,"SCN001","SCS001","SCF016","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380034-01","Standard Silver On Exchange Plan",,"0.684784233570099","No","Yes","No","100%",,"$2,260","$23","$1,341","$150","$1,012","$800","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver3001base2016","http://www.blueoptionsc.com/silverbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","25","49532","SC","Individual","No","57-0768835","49532SC0380034","Blue Option Silver 3001","49532SC038",,"SCN001","SCS001","SCF016","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380034-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver3001zcs2016","http://www.blueoptionsc.com/silverbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","25","49532","SC","Individual","No","57-0768835","49532SC0380034","Blue Option Silver 3001","49532SC038",,"SCN001","SCS001","SCF016","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380034-03","Limited Cost Sharing Plan Variation",,"0.684784233570099","No","Yes","No","100%",,"$2,260","$23","$1,341","$150","$1,012","$800","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver3001base2016","http://www.blueoptionsc.com/silverbrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","25","49532","SC","Individual","No","57-0768835","49532SC0380034","Blue Option Silver 3001","49532SC038",,"SCN001","SCS001","SCF016","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380034-04","73% AV Level Silver Plan",,"0.732761383056641","No","Yes","No","100%",,"$2,260","$15","$1,341","$150","$1,012","$400","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver3001CSRI2016","http://www.blueoptionsc.com/silverbrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","25","49532","SC","Individual","No","57-0768835","49532SC0380034","Blue Option Silver 3001","49532SC038",,"SCN001","SCS001","SCF016","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380034-05","87% AV Level Silver Plan",,"0.866889297962189","No","Yes","No","100%",,"$2,000","$0","$0","$150","$1,012","$0","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver3001CSRII2016","http://www.blueoptionsc.com/silverbrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","25","49532","SC","Individual","No","57-0768835","49532SC0380034","Blue Option Silver 3001","49532SC038",,"SCN001","SCS001","SCF016","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380034-06","94% AV Level Silver Plan",,"0.938075959682465","No","Yes","No","100%",,"$250","$25","$525","$150","$250","$0","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Silver3001CSRIII2016","http://www.blueoptionsc.com/silverbrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","26","49532","SC","Individual","No","57-0768835","49532SC0380011","Blue Option Gold 1000","49532SC038",,"SCN001","SCS001","SCF025","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380011-00","Standard Gold Off Exchange Plan",,"0.785578191280365","No","Yes","No","100%",,"$1,000","$83","$465","$150","$1,000","$812","$127","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Gold1000base2016","http://www.blueoptionsc.com/goldbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","26","49532","SC","Individual","No","57-0768835","49532SC0380011","Blue Option Gold 1000","49532SC038",,"SCN001","SCS001","SCF025","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380011-01","Standard Gold On Exchange Plan",,"0.785578191280365","No","Yes","No","100%",,"$1,000","$83","$465","$150","$1,000","$812","$127","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Gold1000base2016","http://www.blueoptionsc.com/goldbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","26","49532","SC","Individual","No","57-0768835","49532SC0380011","Blue Option Gold 1000","49532SC038",,"SCN001","SCS001","SCF025","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380011-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Gold1000zcs2016","http://www.blueoptionsc.com/goldbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","26","49532","SC","Individual","No","57-0768835","49532SC0380011","Blue Option Gold 1000","49532SC038",,"SCN001","SCS001","SCF025","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380011-03","Limited Cost Sharing Plan Variation",,"0.785578191280365","No","Yes","No","100%",,"$1,000","$83","$465","$150","$1,000","$812","$127","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.blueoptionsc.com/Gold1000base2016","http://www.blueoptionsc.com/goldbrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","27","49532","SC","Individual","No","57-0768835","49532SC0380017","Blue Option Gold 1100","49532SC038",,"SCN001","SCS001","SCF026","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9944",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380017-00","Standard Gold Off Exchange Plan",,"0.808862328529358","Yes","Yes","No","100%",,"$1,100","$383","$35","$150","$1,012","$800","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,100","$1100 per person","$2200 per group","No",,,"http://www.blueoptionsc.com/Gold1100base2016","http://www.blueoptionsc.com/goldbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","27","49532","SC","Individual","No","57-0768835","49532SC0380017","Blue Option Gold 1100","49532SC038",,"SCN001","SCS001","SCF026","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9944",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380017-01","Standard Gold On Exchange Plan",,"0.808862328529358","Yes","Yes","No","100%",,"$1,100","$383","$35","$150","$1,012","$800","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,100","$1100 per person","$2200 per group","No",,,"http://www.blueoptionsc.com/Gold1100base2016","http://www.blueoptionsc.com/goldbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","27","49532","SC","Individual","No","57-0768835","49532SC0380017","Blue Option Gold 1100","49532SC038",,"SCN001","SCS001","SCF026","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9944",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Gold1100zcs2016","http://www.blueoptionsc.com/goldbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","27","49532","SC","Individual","No","57-0768835","49532SC0380017","Blue Option Gold 1100","49532SC038",,"SCN001","SCS001","SCF026","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9944",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380017-03","Limited Cost Sharing Plan Variation",,"0.808862328529358","Yes","Yes","No","100%",,"$1,100","$383","$35","$150","$1,012","$800","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,100","$1100 per person","$2200 per group","No",,,"http://www.blueoptionsc.com/Gold1100base2016","http://www.blueoptionsc.com/goldbrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","27","49532","SC","Individual","No","57-0768835","49532SC0380018","Blue Option Gold 800","49532SC038",,"SCN001","SCS001","SCF027","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9944",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380018-00","Standard Gold Off Exchange Plan",,"0.804413497447968","Yes","Yes","No","100%",,"$800","$365","$53","$150","$800","$460","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","No",,,"http://www.blueoptionsc.com/Gold800base2016","http://www.blueoptionsc.com/goldbrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","27","49532","SC","Individual","No","57-0768835","49532SC0380018","Blue Option Gold 800","49532SC038",,"SCN001","SCS001","SCF027","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9944",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380018-01","Standard Gold On Exchange Plan",,"0.804413497447968","Yes","Yes","No","100%",,"$800","$365","$53","$150","$800","$460","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","No",,,"http://www.blueoptionsc.com/Gold800base2016","http://www.blueoptionsc.com/goldbrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","27","49532","SC","Individual","No","57-0768835","49532SC0380018","Blue Option Gold 800","49532SC038",,"SCN001","SCS001","SCF027","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9944",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Gold800zcs2016","http://www.blueoptionsc.com/goldbrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","27","49532","SC","Individual","No","57-0768835","49532SC0380018","Blue Option Gold 800","49532SC038",,"SCN001","SCS001","SCF027","Existing","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9944",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380018-03","Limited Cost Sharing Plan Variation",,"0.804413497447968","Yes","Yes","No","100%",,"$800","$365","$53","$150","$800","$460","$382","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","No",,,"http://www.blueoptionsc.com/Gold800base2016","http://www.blueoptionsc.com/goldbrochure","11"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","29","49532","SC","Individual","No","57-0768835","49532SC0380029","Blue Option Gold 1004","49532SC038",,"SCN001","SCS001","SCF028","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380029-00","Standard Gold Off Exchange Plan",,"0.817152380943298","Yes","Yes","No","100%",,"$1,000","$55","$930","$150","$1,000","$412","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"http://www.blueoptionsc.com/Gold1004base2016","http://www.blueoptionsc.com/goldbrochure","4"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","29","49532","SC","Individual","No","57-0768835","49532SC0380029","Blue Option Gold 1004","49532SC038",,"SCN001","SCS001","SCF028","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380029-01","Standard Gold On Exchange Plan",,"0.817152380943298","Yes","Yes","No","100%",,"$1,000","$55","$930","$150","$1,000","$412","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"http://www.blueoptionsc.com/Gold1004base2016","http://www.blueoptionsc.com/goldbrochure","5"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","29","49532","SC","Individual","No","57-0768835","49532SC0380029","Blue Option Gold 1004","49532SC038",,"SCN001","SCS001","SCF028","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380029-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Gold1004zcs2016","http://www.blueoptionsc.com/goldbrochure","6"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","29","49532","SC","Individual","No","57-0768835","49532SC0380029","Blue Option Gold 1004","49532SC038",,"SCN001","SCS001","SCF028","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380029-03","Limited Cost Sharing Plan Variation",,"0.817152380943298","Yes","Yes","No","100%",,"$1,000","$55","$930","$150","$1,000","$412","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"http://www.blueoptionsc.com/Gold1004base2016","http://www.blueoptionsc.com/goldbrochure","7"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","29","49532","SC","Individual","No","57-0768835","49532SC0380030","Blue Option Gold 2001","49532SC038",,"SCN001","SCS001","SCF028","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9941",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380030-00","Standard Gold Off Exchange Plan",,"0.781429171562195","Yes","Yes","No","100%",,"$2,000","$55","$930","$150","$1,012","$400","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No",,,"http://www.blueoptionsc.com/Gold2001base2016","http://www.blueoptionsc.com/goldbrochure","8"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","29","49532","SC","Individual","No","57-0768835","49532SC0380030","Blue Option Gold 2001","49532SC038",,"SCN001","SCS001","SCF028","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9941",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380030-01","Standard Gold On Exchange Plan",,"0.781429171562195","Yes","Yes","No","100%",,"$2,000","$55","$930","$150","$1,012","$400","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No",,,"http://www.blueoptionsc.com/Gold2001base2016","http://www.blueoptionsc.com/goldbrochure","9"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","29","49532","SC","Individual","No","57-0768835","49532SC0380030","Blue Option Gold 2001","49532SC038",,"SCN001","SCS001","SCF028","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9941",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380030-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.blueoptionsc.com/Gold2001zcs2016","http://www.blueoptionsc.com/goldbrochure","10"
"2016","SC","49532","HIOS","4","2015-08-22 15:09:32","29","49532","SC","Individual","No","57-0768835","49532SC0380030","Blue Option Gold 2001","49532SC038",,"SCN001","SCS001","SCF028","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9941",,,,"0","0","0","2016-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes",,"https://member.bluechoicesc.com/wps/wcm/connect/BlueChoice/Member/Content/Home/Non-Secure/Prescription%20Drug%20Information","49532SC0380030-03","Limited Cost Sharing Plan Variation",,"0.781429171562195","Yes","Yes","No","100%",,"$2,000","$55","$930","$150","$1,012","$400","$254","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No",,,"http://www.blueoptionsc.com/Gold2001base2016","http://www.blueoptionsc.com/goldbrochure","11"
"2016","SC","54362","HIOS","2","2015-08-19 14:41:20","1","54362","SC","Individual","Yes","59-1031071","54362SC0030001","Cigna Dental Pediatric","54362SC003","7730182962","SCN001","SCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$22.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","All Services","Yes",,"","54362SC0030001-00","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/individuals-families/2016-plans/sob/south-carolina/dental-pediatric","4"
"2016","SC","56571","HIOS","1","2015-05-06 02:44:46","1","56571","SC","Individual","Yes","72-0977315","56571SC0050001","AlwaysCare All-Star Kids Dental Plan 2016","56571SC005",,"SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$25.16","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","56571SC0050001-00","Standard High Off Exchange Plan","86.06%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","SC","56571","HIOS","1","2015-05-06 02:44:46","1","56571","SC","SHOP (Small Group)","Yes","72-0977315","56571SC0080001","AlwaysCare Small Group Dental – Child 2016","56571SC008",,"SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$30.72","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","56571SC0080001-00","Standard High Off Exchange Plan","86.06%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","SC","56571","HIOS","1","2015-05-06 02:44:46","1","56571","SC","SHOP (Small Group)","Yes","72-0977315","56571SC0080002","AlwaysCare Small Group Dental – Child 2016","56571SC008",,"SCN001","SCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$25.23","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","56571SC0080002-00","Standard Low Off Exchange Plan","70.67%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","SC","56571","HIOS","1","2015-05-06 02:44:46","1","56571","SC","Individual","Yes","72-0977315","56571SC0050002","AlwaysCare All-Star Kids Dental Plan 2016","56571SC005",,"SCN001","SCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$20.43","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","56571SC0050002-00","Standard Low Off Exchange Plan","70.67%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","SC","56571","HIOS","1","2015-05-06 02:44:46","2","56571","SC","Individual","Yes","72-0977315","56571SC0060001","AlwaysCare All-Star Family Dental Plan 2016","56571SC006",,"SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$25.23","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","56571SC0060001-00","Standard High Off Exchange Plan","86.06%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","SC","56571","HIOS","1","2015-05-06 02:44:46","2","56571","SC","SHOP (Small Group)","Yes","72-0977315","56571SC0070001","AlwaysCare Small Group Dental – Adults 2016","56571SC007",,"SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$30.72","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","56571SC0070001-00","Standard High Off Exchange Plan","86.06%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","SC","56571","HIOS","1","2015-05-06 02:44:46","2","56571","SC","SHOP (Small Group)","Yes","72-0977315","56571SC0070002","AlwaysCare Small Group Dental – Adults 2016","56571SC007",,"SCN001","SCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$25.23","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","56571SC0070002-00","Standard Low Off Exchange Plan","70.67%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","SC","56571","HIOS","1","2015-05-06 02:44:46","3","56571","SC","Individual","Yes","72-0977315","56571SC0060002","AlwaysCare All-Star Family Dental Plan 2016","56571SC006",,"SCN001","SCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$20.43","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","56571SC0060002-00","Standard Low Off Exchange Plan","70.67%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","1","57860","SC","Individual","No","36-2739571","57860SC0060002","Gold Compass HSA 1600","57860SC006",,"SCN001","SCS001","SCF002","New","EPO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060002-00","Standard Gold Off Exchange Plan",,"0.785858988761902","Yes","Yes","No","100%",,"$1,600","$0","$500","$200","$1,600","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$4800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=sc0004&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","4"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","1","57860","SC","Individual","No","36-2739571","57860SC0060002","Gold Compass HSA 1600","57860SC006",,"SCN001","SCS001","SCF002","New","EPO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060002-01","Standard Gold On Exchange Plan",,"0.785858988761902","Yes","Yes","No","100%",,"$1,600","$0","$500","$200","$1,600","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$4800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=sc0004&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","5"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","1","57860","SC","Individual","No","36-2739571","57860SC0060002","Gold Compass HSA 1600","57860SC006",,"SCN001","SCS001","SCF002","New","EPO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=sc0006&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","6"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","1","57860","SC","Individual","No","36-2739571","57860SC0060002","Gold Compass HSA 1600","57860SC006",,"SCN001","SCS001","SCF002","New","EPO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060002-03","Limited Cost Sharing Plan Variation",,"0.785858988761902","Yes","Yes","No","100%",,"$1,600","$0","$500","$200","$1,600","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$4800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=sc0005&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","7"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","1","57860","SC","Individual","No","36-2739571","57860SC0060006","Silver Compass HSA 3600","57860SC006",,"SCN001","SCS001","SCF005","New","EPO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060006-00","Standard Silver Off Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=sc0024&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","8"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","1","57860","SC","Individual","No","36-2739571","57860SC0060006","Silver Compass HSA 3600","57860SC006",,"SCN001","SCS001","SCF005","New","EPO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060006-01","Standard Silver On Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=sc0024&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","9"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","1","57860","SC","Individual","No","36-2739571","57860SC0060006","Silver Compass HSA 3600","57860SC006",,"SCN001","SCS001","SCF005","New","EPO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=sc0023&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","10"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","1","57860","SC","Individual","No","36-2739571","57860SC0060006","Silver Compass HSA 3600","57860SC006",,"SCN001","SCS001","SCF005","New","EPO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060006-03","Limited Cost Sharing Plan Variation",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=sc0022&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","11"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","1","57860","SC","Individual","No","36-2739571","57860SC0060006","Silver Compass HSA 3600","57860SC006",,"SCN001","SCS001","SCF005","New","EPO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060006-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$3,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=sc0025&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","12"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","1","57860","SC","Individual","No","36-2739571","57860SC0060006","Silver Compass HSA 3600","57860SC006",,"SCN001","SCS001","SCF005","New","EPO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060006-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$200","$1,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=sc0026&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","13"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","1","57860","SC","Individual","No","36-2739571","57860SC0060006","Silver Compass HSA 3600","57860SC006",,"SCN001","SCS001","SCF005","New","EPO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060006-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=sc0027&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","14"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","1","57860","SC","Individual","No","36-2739571","57860SC0060007","Bronze Compass HSA 5200","57860SC006",,"SCN001","SCS001","SCF002","New","EPO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060007-00","Standard Bronze Off Exchange Plan",,"0.618971228599548","Yes","Yes","No","100%",,"$5,200","$0","$100","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=sc0028&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","15"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","1","57860","SC","Individual","No","36-2739571","57860SC0060007","Bronze Compass HSA 5200","57860SC006",,"SCN001","SCS001","SCF002","New","EPO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060007-01","Standard Bronze On Exchange Plan",,"0.618971228599548","Yes","Yes","No","100%",,"$5,200","$0","$100","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=sc0028&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","16"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","1","57860","SC","Individual","No","36-2739571","57860SC0060007","Bronze Compass HSA 5200","57860SC006",,"SCN001","SCS001","SCF002","New","EPO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=sc0030&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","17"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","1","57860","SC","Individual","No","36-2739571","57860SC0060007","Bronze Compass HSA 5200","57860SC006",,"SCN001","SCS001","SCF002","New","EPO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060007-03","Limited Cost Sharing Plan Variation",,"0.618971228599548","Yes","Yes","No","100%",,"$5,200","$0","$100","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=sc0029&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","18"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060001","Gold Compass 1000","57860SC006",,"SCN001","SCS001","SCF001","New","EPO","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060001-03","Limited Cost Sharing Plan Variation",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0002&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","7"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060003","Silver Compass 5000","57860SC006",,"SCN001","SCS001","SCF003","New","EPO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060003-00","Standard Silver Off Exchange Plan",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0007&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","8"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060003","Silver Compass 5000","57860SC006",,"SCN001","SCS001","SCF003","New","EPO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060003-01","Standard Silver On Exchange Plan",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0007&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","9"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060003","Silver Compass 5000","57860SC006",,"SCN001","SCS001","SCF003","New","EPO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060003-04","73% AV Level Silver Plan",,"0.728041231632233","No","Yes","No","100%",,"$3,600","$20","$500","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0008&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","12"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060003","Silver Compass 5000","57860SC006",,"SCN001","SCS001","SCF003","New","EPO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060003-05","87% AV Level Silver Plan",,"0.871982634067535","No","Yes","No","100%",,"$800","$0","$800","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0009&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","13"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060003","Silver Compass 5000","57860SC006",,"SCN001","SCS001","SCF003","New","EPO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060003-06","94% AV Level Silver Plan",,"0.949420213699341","No","Yes","No","100%",,"$0","$0","$500","$200","$0","$500","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0010&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","14"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060004","Bronze Compass 4200","57860SC006",,"SCN001","SCS001","SCF004","New","EPO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060004-00","Standard Bronze Off Exchange Plan",,"0.619571328163147","Yes","Yes","No","100%",,"$4,200","$0","$600","$200","$4,200","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=sc0013&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","15"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060004","Bronze Compass 4200","57860SC006",,"SCN001","SCS001","SCF004","New","EPO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060004-01","Standard Bronze On Exchange Plan",,"0.619571328163147","Yes","Yes","No","100%",,"$4,200","$0","$600","$200","$4,200","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=sc0013&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","16"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060004","Bronze Compass 4200","57860SC006",,"SCN001","SCS001","SCF004","New","EPO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=sc0015&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","17"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060004","Bronze Compass 4200","57860SC006",,"SCN001","SCS001","SCF004","New","EPO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060004-03","Limited Cost Sharing Plan Variation",,"0.619571328163147","Yes","Yes","No","100%",,"$4,200","$0","$600","$200","$4,200","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=sc0014&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","18"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060005","Silver Compass 2000","57860SC006",,"SCN001","SCS001","SCF003","New","EPO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060005-00","Standard Silver Off Exchange Plan",,"0.714467763900757","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0016&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","19"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060005","Silver Compass 2000","57860SC006",,"SCN001","SCS001","SCF003","New","EPO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060005-01","Standard Silver On Exchange Plan",,"0.714467763900757","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0016&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","20"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060005","Silver Compass 2000","57860SC006",,"SCN001","SCS001","SCF003","New","EPO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0021&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","21"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060005","Silver Compass 2000","57860SC006",,"SCN001","SCS001","SCF003","New","EPO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060005-03","Limited Cost Sharing Plan Variation",,"0.714467763900757","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0020&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","22"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060005","Silver Compass 2000","57860SC006",,"SCN001","SCS001","SCF003","New","EPO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060005-04","73% AV Level Silver Plan",,"0.737353503704071","No","Yes","No","100%",,"$1,800","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0017&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","23"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060005","Silver Compass 2000","57860SC006",,"SCN001","SCS001","SCF003","New","EPO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060005-05","87% AV Level Silver Plan",,"0.877411782741547","No","Yes","No","100%",,"$400","$0","$1,000","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0018&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","24"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060005","Silver Compass 2000","57860SC006",,"SCN001","SCS001","SCF003","New","EPO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060005-06","94% AV Level Silver Plan",,"0.943426787853241","No","Yes","No","100%",,"$0","$0","$500","$200","$0","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0019&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","25"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060008","Bronze Compass 6400","57860SC006",,"SCN001","SCS001","SCF003","New","EPO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060008-00","Standard Bronze Off Exchange Plan",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0031&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","26"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060008","Bronze Compass 6400","57860SC006",,"SCN001","SCS001","SCF003","New","EPO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060008-01","Standard Bronze On Exchange Plan",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0031&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","27"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060008","Bronze Compass 6400","57860SC006",,"SCN001","SCS001","SCF003","New","EPO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0033&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","28"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060008","Bronze Compass 6400","57860SC006",,"SCN001","SCS001","SCF003","New","EPO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060008-03","Limited Cost Sharing Plan Variation",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=sc0032&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","29"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060009","Catastrophic Compass 6850","57860SC006",,"SCN001","SCS001","SCF005","New","EPO","Catastrophic","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060009-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,700","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=sc0034&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","30"
"2016","SC","57860","HIOS","5","2015-08-18 03:25:03","2","57860","SC","Individual","No","36-2739571","57860SC0060009","Catastrophic Compass 6850","57860SC006",,"SCN001","SCS001","SCF005","New","EPO","Catastrophic","No","Both","No","Yes","All, except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=sc0036&st=sc","57860SC0060009-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,700","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=sc0034&st=sc","http://www.uhc.com/iex/doc?id=sc0035&st=sc","31"
"2016","SC","72408","HIOS","2","2015-07-09 13:17:42","1","72408","SC","SHOP (Small Group)","Yes","81-0170040","72408SC0010001","Assurant Dental ACAFFO High","72408SC001",,"SCN001","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$38.70","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","72408SC0010001-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","72408","HIOS","2","2015-07-09 13:17:42","1","72408","SC","SHOP (Small Group)","Yes","81-0170040","72408SC0010002","Assurant Dental ACAFFO Low","72408SC001",,"SCN001","SCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$32.18","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","72408SC0010002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","SC","77305","HIOS","3","2015-07-11 04:19:24","1","77305","SC","Individual","Yes","43-0908349","77305SC0190001","Delta Dental Individual and Family - Standard","77305SC019","7497758624","SCN002","SCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,"No","Allows Adult and Child-Only",,,,,"$32.21","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes",,"","77305SC0190001-00","Standard Low Off Exchange Plan","71.73%",,,,"Yes","51%","49%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,"$100","per person not applicable","per group not applicable",,"$100","per person not applicable","per group not applicable","$100","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","77305","HIOS","3","2015-07-11 04:19:24","1","77305","SC","SHOP (Small Group)","Yes","43-0908349","77305SC0300001","Delta Dental - PPO Choice","77305SC030","7497758624","SCN001","SCS001",,"New","PPO","Low",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,"No","Allows Adult and Child-Only",,,,,"$23.01","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes",,"","77305SC0300001-00","Standard Low Off Exchange Plan","71.46%",,,,"Yes","23%","77%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","per person not applicable","per group not applicable",,"$125","per person not applicable","per group not applicable",,"$125","per person not applicable","per group not applicable","$125","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","89281","HIOS","3","2015-08-27 11:14:25","2","89281","SC","Individual","Yes","95-6042390","89281SC0020005","BESTOne Plus Silver","89281SC002",,"SCN001","SCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.29","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2016/SC_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","SC","89281","HIOS","3","2015-08-27 11:14:25","2","89281","SC","Individual","Yes","95-6042390","89281SC0020005","BESTOne Plus Silver","89281SC002",,"SCN001","SCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.29","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2016/SC_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","SC","89281","HIOS","3","2015-08-27 11:14:25","2","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010009","BESTDental Standard - L","89281SC001",,"SCN001","SCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.83","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2016/SC_BESTDental_Standard-L_Plan.pdf","5"
"2016","SC","89281","HIOS","3","2015-08-27 11:14:25","2","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010011","BESTDental Choice - L","89281SC001",,"SCN001","SCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.83","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2016/SC_BESTDental_Choice-L_Plan.pdf","6"
"2016","SC","89281","HIOS","3","2015-08-27 11:14:25","2","89281","SC","Individual","Yes","95-6042390","89281SC0020006","BESTOne Basic Silver","89281SC002",,"SCN001","SCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.29","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2016/SC_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","SC","89281","HIOS","3","2015-08-27 11:14:25","2","89281","SC","Individual","Yes","95-6042390","89281SC0020006","BESTOne Basic Silver","89281SC002",,"SCN001","SCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.29","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2016/SC_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","SC","77305","HIOS","3","2015-07-11 04:19:24","1","77305","SC","SHOP (Small Group)","Yes","43-0908349","77305SC0310001","Delta Dental - PPO Choice Plus","77305SC031","7497758624","SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,"No","Allows Adult and Child-Only",,,,,"$29.51","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes",,"","77305SC0310001-00","Standard High Off Exchange Plan","86.88%",,,,"Yes","23%","77%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,"$100","per person not applicable","per group not applicable",,"$100","per person not applicable","per group not applicable","$100","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","SC","77305","HIOS","3","2015-07-11 04:19:24","1","77305","SC","Individual","Yes","43-0908349","77305SC0200001","Delta Dental Individual and Family - Standard Plus","77305SC020","7497758624","SCN002","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,"No","Allows Adult and Child-Only",,,,,"$38.44","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes",,"","77305SC0200001-00","Standard High Off Exchange Plan","84.46%",,,,"Yes","51%","49%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","per group not applicable",,"$0","per person not applicable","per group not applicable",,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","SC","77305","HIOS","3","2015-07-11 04:19:24","2","77305","SC","Individual","Yes","43-0908349","77305SC0210001","Delta Dental Individual and Family - FFM Basic","77305SC021","7497758624","SCN002","SCS001",,"Existing","PPO","Low",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,"No","Allows Adult and Child-Only",,,,,"$36.53","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","https://Individual.deltadentalsc.com/marketplace/FFMBasic-2016","","77305SC0210001-01","Standard Low On Exchange Plan","71.25%",,,,"Yes","31%","69%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,"$50","per person not applicable","per group not applicable",,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://Individual.deltadentalsc.com/benefits/FFMBasic-2016","https://Individual.deltadentalsc.com/brochure/FFMBasic-2016","4"
"2016","SC","77305","HIOS","3","2015-07-11 04:19:24","2","77305","SC","SHOP (Small Group)","Yes","43-0908349","77305SC0280001","Delta Dental - FFM Exclusive","77305SC028","7497758624","SCN002","SCS001",,"New","EPO","Low",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,"No","Allows Adult and Child-Only",,,,,"$19.84","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","http://www.deltadentalsc.com/FFMExclusive/MarketPlace-2016","","77305SC0280001-01","Standard Low On Exchange Plan","70.85%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalsc.com/FFMExclusive/Benefits-2016","http://www.deltadentalsc.com/FFMExclusive/Brochure-2016","4"
"2016","SC","77305","HIOS","3","2015-07-11 04:19:24","3","77305","SC","SHOP (Small Group)","Yes","43-0908349","77305SC0290001","Delta Dental - FFM PPO","77305SC029","7497758624","SCN002","SCS001",,"New","PPO","High",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,"No","Allows Adult and Child-Only",,,,,"$27.15","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","http://www.deltadentalsc.com/FFMPremier/MarketPlace-2016","","77305SC0290001-01","Standard High On Exchange Plan","83.56%",,,,"Yes","35%","65%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","per group not applicable",,"$25","per person not applicable","per group not applicable",,"$25","per person not applicable","per group not applicable","$25","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmo.com/FFMPremier/Benefits-2016","http://www.deltadentalmo.com/FFMPremier/Brochure-2016","4"
"2016","SC","97325","HIOS","2","2015-06-30 02:19:14","1","97325","SC","SHOP (Small Group)","Yes","47-0397286","97325SC0030002","Renaissance Group Dental PPO, EHB Certified","97325SC003",,"SCN001","SCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.20","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","97325SC0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","SC","97325","HIOS","2","2015-06-30 02:19:14","1","97325","SC","SHOP (Small Group)","Yes","47-0397286","97325SC0080001","Renaissance Group Dental PPO, EHB Certified (Exchange)","97325SC008",,"SCN001","SCS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","97325SC0080001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/SC_EHB_Group_High_2016","http://www.renaissancedental.com/SC_EHB_Group_High_2016","6"
"2016","SC","97325","HIOS","2","2015-06-30 02:19:14","1","97325","SC","Individual","Yes","47-0397286","97325SC0020001","Renaissance Individual Dental PPO, EHB Certified","97325SC002",,"SCN001","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.47","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","97325SC0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","SC","97325","HIOS","2","2015-06-30 02:19:14","1","97325","SC","Individual","Yes","47-0397286","97325SC0020002","Renaissance Individual Dental PPO, EHB Certified","97325SC002",,"SCN001","SCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.74","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","97325SC0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","SC","97325","HIOS","2","2015-06-30 02:19:14","1","97325","SC","SHOP (Small Group)","Yes","47-0397286","97325SC0080002","Renaissance Group Dental PPO, EHB Certified (Exchange)","97325SC008",,"SCN001","SCS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.20","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","97325SC0080002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/SC_EHB_Group_Low_2016","http://www.renaissancedental.com/SC_EHB_Group_Low_2016","7"
"2016","SC","97325","HIOS","2","2015-06-30 02:19:14","1","97325","SC","SHOP (Small Group)","Yes","47-0397286","97325SC0080003","Renaissance Group Dental PPO, EHB Certified (Exchange)","97325SC008",,"SCN001","SCS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","97325SC0080003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/SC_50_50_High_2016","http://www.renaissancedental.com/SC_50_50_High_2016","8"
"2016","SC","97325","HIOS","2","2015-06-30 02:19:14","1","97325","SC","Individual","Yes","47-0397286","97325SC0060001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","97325SC006",,"SCN001","SCS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.47","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/97325","","97325SC0060001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/SC_EHB_High_2016","http://www.renaissancedental.com/SC_EHB_High_2016","8"
"2016","SC","97325","HIOS","2","2015-06-30 02:19:14","1","97325","SC","Individual","Yes","47-0397286","97325SC0060002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","97325SC006",,"SCN001","SCS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.74","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/97325","","97325SC0060002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/SC_EHB_Low_2016","http://www.renaissancedental.com/SC_EHB_Low_2016","9"
"2016","SC","97325","HIOS","2","2015-06-30 02:19:14","1","97325","SC","SHOP (Small Group)","Yes","47-0397286","97325SC0080004","Renaissance Group Dental PPO, EHB Certified (Exchange)","97325SC008",,"SCN001","SCS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.20","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","97325SC0080004-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/SC_50_50_Low_2016","http://www.renaissancedental.com/SC_50_50_Low_2016","9"
"2016","SC","97325","HIOS","2","2015-06-30 02:19:14","2","97325","SC","Individual","Yes","47-0397286","97325SC0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified","97325SC005",,"SCN001","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$35.51","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","97325SC0050001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","97325","HIOS","2","2015-06-30 02:19:14","2","97325","SC","Individual","Yes","47-0397286","97325SC0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified","97325SC005",,"SCN001","SCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$27.93","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","97325SC0050002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","SC","97325","HIOS","2","2015-06-30 02:19:14","2","97325","SC","Individual","Yes","47-0397286","97325SC0070001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","97325SC007",,"SCN001","SCS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$35.51","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/97325","","97325SC0070001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/SC_Ped_High_2016","http://www.renaissancedental.com/SC_Ped_High_2016","6"
"2016","SC","77305","HIOS","3","2015-07-11 04:19:24","3","77305","SC","Individual","Yes","43-0908349","77305SC0220001","Delta Dental Individual and Family - FFM Preferred","77305SC022","7497758624","SCN002","SCS001",,"Existing","PPO","Low",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,"No","Allows Adult and Child-Only",,,,,"$36.53","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","https://Individual.deltadentalsc.com/marketplace/FFMPreferred-2016","","77305SC0220001-01","Standard Low On Exchange Plan","71.25%",,,,"Yes","31%","69%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,"$50","per person not applicable","per group not applicable",,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://Individual.deltadentalsc.com/benefits/FFMPreferred-2016","https://Individual.deltadentalsc.com/brochure/FFMPreferred-2016","4"
"2016","SC","77305","HIOS","3","2015-07-11 04:19:24","4","77305","SC","Individual","Yes","43-0908349","77305SC0230001","Delta Dental Individual and Family - FFM Choice","77305SC023","7497758624","SCN002","SCS001",,"Existing","PPO","High",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,"No","Allows Adult and Child-Only",,,,,"$42.36","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","https://Individual.deltadentalsc.com/marketplace/FFMChoice-2016","","77305SC0230001-01","Standard High On Exchange Plan","86.09%",,,,"Yes","31%","69%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,"$75","per person not applicable","per group not applicable",,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://Individual.deltadentalsc.com/benefits/FFMChoice-2016","https://Individual.deltadentalsc.com/brochure/FFMChoice-2016","4"
"2016","SC","83876","HIOS","2","2015-07-09 13:17:42","1","83876","SC","SHOP (Small Group)","Yes","41-0808596","83876SC0010002","Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho","83876SC001",,"SCN001","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","benefits are the same in and out of network","Yes",,"","83876SC0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","83876","HIOS","2","2015-07-09 13:17:42","1","83876","SC","SHOP (Small Group)","Yes","41-0808596","83876SC0010005","Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho","83876SC001",,"SCN001","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","benefits are the same in and out of network","Yes",,"","83876SC0010005-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","SC","83876","HIOS","2","2015-07-09 13:17:42","1","83876","SC","SHOP (Small Group)","Yes","41-0808596","83876SC0010006","Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho","83876SC001",,"SCN001","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","benefits are the same in and out of network","Yes",,"","83876SC0010006-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","SC","83876","HIOS","2","2015-07-09 13:17:42","1","83876","SC","SHOP (Small Group)","Yes","41-0808596","83876SC0010009","Plan 9. MAC PPO, $1500 Annual Maximum, Ortho","83876SC001",,"SCN001","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$20.18","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","benefits are the same in and out of network","Yes",,"","83876SC0010009-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","SC","84589","HIOS","2","2015-07-10 02:19:03","1","84589","SC","SHOP (Small Group)","Yes","35-0472300","84589SC0010001","Lincoln DentalConnect®","84589SC001","7063415294","SCN001","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.94","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","84589SC0010001-00","Standard High Off Exchange Plan","83.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","84589","HIOS","2","2015-07-10 02:19:03","1","84589","SC","SHOP (Small Group)","Yes","35-0472300","84589SC0010002","Lincoln DentalConnect®","84589SC001","7063415294","SCN001","SCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.97","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","84589SC0010002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","SC","84589","HIOS","2","2015-07-10 02:19:03","1","84589","SC","SHOP (Small Group)","Yes","35-0472300","84589SC0010003","Lincoln DentalConnect®","84589SC001","7063415294","SCN001","SCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.64","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","84589SC0010003-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","SC","84589","HIOS","2","2015-07-10 02:19:03","1","84589","SC","SHOP (Small Group)","Yes","35-0472300","84589SC0010004","Lincoln DentalConnect®","84589SC001","7063415294","SCN001","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.16","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","84589SC0010004-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","SC","84589","HIOS","2","2015-07-10 02:19:03","1","84589","SC","SHOP (Small Group)","Yes","35-0472300","84589SC0010005","Lincoln DentalConnect®","84589SC001","7063415294","SCN001","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.85","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","84589SC0010005-00","Standard High Off Exchange Plan","83.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","SC","84589","HIOS","2","2015-07-10 02:19:03","1","84589","SC","SHOP (Small Group)","Yes","35-0472300","84589SC0010006","Lincoln DentalConnect®","84589SC001","7063415294","SCN001","SCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.64","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","84589SC0010006-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","SC","84589","HIOS","2","2015-07-10 02:19:03","1","84589","SC","SHOP (Small Group)","Yes","35-0472300","84589SC0010007","Lincoln DentalConnect®","84589SC001","7063415294","SCN001","SCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.86","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","84589SC0010007-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2016","SC","84589","HIOS","2","2015-07-10 02:19:03","1","84589","SC","SHOP (Small Group)","Yes","35-0472300","84589SC0010008","Lincoln DentalConnect®","84589SC001","7063415294","SCN001","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.12","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","84589SC0010008-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2016","SC","84939","HIOS","2","2015-08-04 02:44:40","1","84939","SC","SHOP (Small Group)","Yes","13-5123390","84939SC0110003","Guardian Pediatric Advantage","84939SC011",,"SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$23.13","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","84939SC0110003-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","SC","84939","HIOS","2","2015-08-04 02:44:40","1","84939","SC","SHOP (Small Group)","Yes","13-5123390","84939SC0120003","Guardian Pediatric Essentials","84939SC012",,"SCN001","SCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$17.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","84939SC0120003-00","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","SC","84939","HIOS","2","2015-08-04 02:44:40","2","84939","SC","SHOP (Small Group)","Yes","13-5123390","84939SC0140003","Guardian Family Advantage","84939SC014",,"SCN001","SCS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.13","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","84939SC0140003-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","SC","84939","HIOS","2","2015-08-04 02:44:40","2","84939","SC","SHOP (Small Group)","Yes","13-5123390","84939SC0140003","Guardian Family Advantage","84939SC014",,"SCN001","SCS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.13","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","84939SC0140003-01","Standard High On Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","SC","84939","HIOS","2","2015-08-04 02:44:40","2","84939","SC","SHOP (Small Group)","Yes","13-5123390","84939SC0160003","Guardian Family Essentials","84939SC016",,"SCN001","SCS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","84939SC0160003-00","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","SC","84939","HIOS","2","2015-08-04 02:44:40","2","84939","SC","SHOP (Small Group)","Yes","13-5123390","84939SC0160003","Guardian Family Essentials","84939SC016",,"SCN001","SCS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","84939SC0160003-01","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","SC","84966","HIOS","2","2015-05-05 11:48:23","1","84966","SC","SHOP (Small Group)","Yes","13-5581829","84966SC0120001","EHB Basic Dental Plan (Low)","84966SC012",,"SCN001","SCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$17.37","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","84966SC0120001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","88250","HIOS","1","2015-05-01 02:23:41","1","88250","SC","SHOP (Small Group)","Yes","93-0242990","88250SC0040002","EHB High PPO","88250SC004",,"SCN001","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.35","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","88250SC0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","SC","88250","HIOS","1","2015-05-01 02:23:41","1","88250","SC","SHOP (Small Group)","Yes","93-0242990","88250SC0040001","EHB Low PPO","88250SC004",,"SCN001","SCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.21","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","88250SC0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","SC","88250","HIOS","1","2015-05-01 02:23:41","1","88250","SC","SHOP (Small Group)","Yes","93-0242990","88250SC0030002","EHB High Passive","88250SC003",,"SCN001","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.10","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","88250SC0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","SC","88250","HIOS","1","2015-05-01 02:23:41","1","88250","SC","SHOP (Small Group)","Yes","93-0242990","88250SC0030001","EHB Low Passive","88250SC003",,"SCN001","SCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.57","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","88250SC0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","SC","89281","HIOS","3","2015-08-27 11:14:25","1","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010007","BESTDental Premium","89281SC001",,"SCN001","SCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2016/SC_BESTDental_Premium_Plan.pdf","4"
"2016","SC","89281","HIOS","3","2015-08-27 11:14:25","1","89281","SC","Individual","Yes","95-6042390","89281SC0020003","BESTOne Advantage Gold","89281SC002",,"SCN001","SCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.25","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2016/SC_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","SC","89281","HIOS","3","2015-08-27 11:14:25","1","89281","SC","Individual","Yes","95-6042390","89281SC0020003","BESTOne Advantage Gold","89281SC002",,"SCN001","SCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.25","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2016/SC_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","SC","89281","HIOS","3","2015-08-27 11:14:25","1","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010007","BESTDental Premium","89281SC001",,"SCN001","SCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2016/SC_BESTDental_Premium_Plan.pdf","5"
"2016","SC","89281","HIOS","3","2015-08-27 11:14:25","1","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010008","BESTDental Standard - H","89281SC001",,"SCN001","SCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2016/SC_BESTDental_Standard-H_Plan.pdf","6"
"2016","SC","89281","HIOS","3","2015-08-27 11:14:25","1","89281","SC","Individual","Yes","95-6042390","89281SC0020004","BESTOne Plus Gold","89281SC002",,"SCN001","SCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.25","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2016/SC_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","SC","89281","HIOS","3","2015-08-27 11:14:25","1","89281","SC","Individual","Yes","95-6042390","89281SC0020004","BESTOne Plus Gold","89281SC002",,"SCN001","SCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.25","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2016/SC_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","SC","89281","HIOS","3","2015-08-27 11:14:25","1","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010008","BESTDental Standard - H","89281SC001",,"SCN001","SCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2016/SC_BESTDental_Standard-H_Plan.pdf","7"
"2016","SC","89281","HIOS","3","2015-08-27 11:14:25","1","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010010","BESTDental Choice - H","89281SC001",,"SCN001","SCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2016/SC_BESTDental_Choice-H_Plan.pdf","8"
"2016","SC","89281","HIOS","3","2015-08-27 11:14:25","1","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010010","BESTDental Choice - H","89281SC001",,"SCN001","SCS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2016/SC_BESTDental_Choice-H_Plan.pdf","9"
"2016","SC","89281","HIOS","3","2015-08-27 11:14:25","2","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010009","BESTDental Standard - L","89281SC001",,"SCN001","SCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.83","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2016/SC_BESTDental_Standard-L_Plan.pdf","4"
"2016","SC","89281","HIOS","3","2015-08-27 11:14:25","2","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010011","BESTDental Choice - L","89281SC001",,"SCN001","SCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.83","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2016/SC_BESTDental_Choice-L_Plan.pdf","7"
"2016","SC","89281","HIOS","3","2015-08-27 11:14:25","2","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010012","BESTDental Value","89281SC001",,"SCN001","SCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.83","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2016/SC_BESTDental_Value_Plan.pdf","8"
"2016","SC","89281","HIOS","3","2015-08-27 11:14:25","2","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010012","BESTDental Value","89281SC001",,"SCN001","SCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.83","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","89281SC0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SC/2016/SC_BESTDental_Value_Plan.pdf","9"
"2016","SC","92498","HIOS","8","2015-08-26 09:56:12","1","92498","SC","Individual","Yes","75-1233841","92498SC0010007","Dentegra Dental PPO Pediatric Basic Plan","92498SC001",,"SCN001","SCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","92498SC0010007-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sc/92498sc0010007-16","4"
"2016","SC","92498","HIOS","8","2015-08-26 09:56:12","1","92498","SC","SHOP (Small Group)","Yes","75-1233841","92498SC0020007","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","92498SC002",,"SCN001","SCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.85","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","92498SC0020007-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sc/92498sc0020007-16","4"
"2016","SC","92498","HIOS","8","2015-08-26 09:56:12","2","92498","SC","SHOP (Small Group)","Yes","75-1233841","92498SC0020010","Dentegra Dental PPO for Small Businesses Family Preferred Plan","92498SC002",,"SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.51","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","92498SC0020010-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sc/92498sc0020010-16","4"
"2016","SC","92498","HIOS","8","2015-08-26 09:56:12","2","92498","SC","Individual","Yes","75-1233841","92498SC0010010","Dentegra Dental PPO Family Preferred Plan","92498SC001",,"SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.29","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","92498SC0010010-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sc/92498sc0010010-16","4"
"2016","SC","92498","HIOS","8","2015-08-26 09:56:12","3","92498","SC","Individual","Yes","75-1233841","92498SC0010009","Dentegra Dental PPO Family Basic Plan","92498SC001",,"SCN001","SCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","92498SC0010009-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sc/92498sc0010009-16","4"
"2016","SC","92498","HIOS","8","2015-08-26 09:56:12","3","92498","SC","SHOP (Small Group)","Yes","75-1233841","92498SC0020009","Dentegra Dental PPO for Small Businesses Family Basic Plan","92498SC002",,"SCN001","SCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.85","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","92498SC0020009-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sc/92498sc0020009-16","4"
"2016","SC","92498","HIOS","8","2015-08-26 09:56:12","3","92498","SC","SHOP (Small Group)","Yes","75-1233841","92498SC0020009","Dentegra Dental PPO for Small Businesses Family Basic Plan","92498SC002",,"SCN001","SCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.85","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","92498SC0020009-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sc/92498sc0020009-16","5"
"2016","SC","92498","HIOS","8","2015-08-26 09:56:12","3","92498","SC","Individual","Yes","75-1233841","92498SC0010009","Dentegra Dental PPO Family Basic Plan","92498SC001",,"SCN001","SCS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","92498SC0010009-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sc/92498sc0010009-16","5"
"2016","SC","97325","HIOS","2","2015-06-30 02:19:14","1","97325","SC","SHOP (Small Group)","Yes","47-0397286","97325SC0030001","Renaissance Group Dental PPO, EHB Certified","97325SC003",,"SCN001","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.71","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","97325SC0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","97325","HIOS","2","2015-06-30 02:19:14","1","97325","SC","Individual","Yes","47-0397286","97325SC0010001","Delta Dental Individual PPO, EHB Certified","97325SC001",,"SCN002","SCS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.90","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","97325SC0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","97325","HIOS","2","2015-06-30 02:19:14","1","97325","SC","Individual","Yes","47-0397286","97325SC0010002","Delta Dental Individual PPO, EHB Certified","97325SC001",,"SCN002","SCS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.51","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","97325SC0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","SC","97325","HIOS","2","2015-06-30 02:19:14","2","97325","SC","Individual","Yes","47-0397286","97325SC0070002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","97325SC007",,"SCN001","SCS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$27.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/97325","","97325SC0070002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/SC_Ped_Low_2016","http://www.renaissancedental.com/SC_Ped_Low_2016","7"
"2016","SC","98953","HIOS","5","2015-08-25 05:06:23","1","98953","SC","SHOP (Small Group)","Yes","86-0307623","98953SC0010001","Smile for Health - Certified Optimum Coverage","98953SC001",,"SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","98953SC0010001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190078","BlueCross SG Silver 17S","14002TN019",,"TNN002","TNS005","TNF014","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190078-00","Standard Silver Off Exchange Plan",,"0.703298926353455","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-17S","http://www.bcbst.com/SHOPbrochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190078","BlueCross SG Silver 17S","14002TN019",,"TNN002","TNS005","TNF014","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190078-01","Standard Silver On Exchange Plan",,"0.703298926353455","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-17S","http://www.bcbst.com/SHOPbrochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","Individual","No","62-0427913","14002TN0330046","Bronze B01E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330046-01","Standard Bronze On Exchange Plan",,"0.617518901824951","Yes","Yes","No","100%",,"$3,000","$0","$2,200","$30","$3,000","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/B01E_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","Individual","No","62-0427913","14002TN0330046","Bronze B01E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330046-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/B01E-AI1_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190079","BlueCross SG Silver 17S","14002TN019",,"TNN002","TNS006","TNF014","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190079-00","Standard Silver Off Exchange Plan",,"0.703298926353455","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-17S","http://www.bcbst.com/SHOPbrochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190079","BlueCross SG Silver 17S","14002TN019",,"TNN002","TNS006","TNF014","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190079-01","Standard Silver On Exchange Plan",,"0.703298926353455","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-17S","http://www.bcbst.com/SHOPbrochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","Individual","No","62-0427913","14002TN0330046","Bronze B01E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330046-03","Limited Cost Sharing Plan Variation",,"0.617518901824951","Yes","Yes","No","100%",,"$3,000","$0","$2,200","$30","$3,000","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/B01E-AI2_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190080","BlueCross SG Silver 17S","14002TN019",,"TNN002","TNS007","TNF014","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190080-00","Standard Silver Off Exchange Plan",,"0.703298926353455","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-17S","http://www.bcbst.com/SHOPbrochures","16"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190080","BlueCross SG Silver 17S","14002TN019",,"TNN002","TNS007","TNF014","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190080-01","Standard Silver On Exchange Plan",,"0.703298926353455","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-17S","http://www.bcbst.com/SHOPbrochures","17"
"2016","SC","98953","HIOS","5","2015-08-25 05:06:23","2","98953","SC","SHOP (Small Group)","Yes","86-0307623","98953SC0010002","Smile for Health - Certified Optimum Coverage","98953SC001",,"SCN002","SCS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","98953SC0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","98953","HIOS","5","2015-08-25 05:06:23","3","98953","SC","SHOP (Small Group)","Yes","86-0307623","98953SC0010003","Smile for Health - Certified Optimum Coverage","98953SC001",,"SCN003","SCS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","98953SC0010003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","98953","HIOS","5","2015-08-25 05:06:23","4","98953","SC","SHOP (Small Group)","Yes","86-0307623","98953SC0010004","Smile for Health - Certified Optimum Coverage","98953SC001",,"SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","98953SC0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","98953","HIOS","5","2015-08-25 05:06:23","5","98953","SC","SHOP (Small Group)","Yes","86-0307623","98953SC0010005","Smile for Health - Certified Optimum Coverage","98953SC001",,"SCN002","SCS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","98953SC0010005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","98953","HIOS","5","2015-08-25 05:06:23","6","98953","SC","SHOP (Small Group)","Yes","86-0307623","98953SC0010006","Smile for Health - Certified Optimum Coverage","98953SC001",,"SCN003","SCS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","98953SC0010006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","98953","HIOS","5","2015-08-25 05:06:23","7","98953","SC","SHOP (Small Group)","Yes","86-0307623","98953SC0020001","Smile for Health - Certified High Option","98953SC002",,"SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","98953SC0020001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","98953","HIOS","5","2015-08-25 05:06:23","8","98953","SC","SHOP (Small Group)","Yes","86-0307623","98953SC0020002","Smile for Health - Certified High Option","98953SC002",,"SCN002","SCS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","98953SC0020002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","98953","HIOS","5","2015-08-25 05:06:23","9","98953","SC","SHOP (Small Group)","Yes","86-0307623","98953SC0020003","Smile for Health - Certified High Option","98953SC002",,"SCN003","SCS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","98953SC0020003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","98953","HIOS","5","2015-08-25 05:06:23","10","98953","SC","SHOP (Small Group)","Yes","86-0307623","98953SC0020004","Smile for Health - Certified High Option Plus","98953SC002",,"SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","98953SC0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","98953","HIOS","5","2015-08-25 05:06:23","11","98953","SC","SHOP (Small Group)","Yes","86-0307623","98953SC0020005","Smile for Health - Certified High Option Plus","98953SC002",,"SCN002","SCS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","98953SC0020005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SC","98953","HIOS","5","2015-08-25 05:06:23","12","98953","SC","SHOP (Small Group)","Yes","86-0307623","98953SC0020006","Smile for Health - Certified High Option Plus","98953SC002",,"SCN003","SCS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","98953SC0020006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","Individual","No","62-0427913","14002TN0330040","Bronze B01S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330040-00","Standard Bronze Off Exchange Plan",,"0.617518901824951","Yes","Yes","No","100%",,"$3,000","$0","$2,200","$30","$3,000","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/B01S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190074","BlueCross SG Silver 17S","14002TN019",,"TNN002","TNS001","TNF014","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190074-00","Standard Silver Off Exchange Plan",,"0.703298926353455","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-17S","http://www.bcbst.com/SHOPbrochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190074","BlueCross SG Silver 17S","14002TN019",,"TNN002","TNS001","TNF014","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190074-01","Standard Silver On Exchange Plan",,"0.703298926353455","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-17S","http://www.bcbst.com/SHOPbrochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","Individual","No","62-0427913","14002TN0330040","Bronze B01S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330040-01","Standard Bronze On Exchange Plan",,"0.617518901824951","Yes","Yes","No","100%",,"$3,000","$0","$2,200","$30","$3,000","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/B01S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","Individual","No","62-0427913","14002TN0330040","Bronze B01S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330040-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/B01S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190075","BlueCross SG Silver 17S","14002TN019",,"TNN002","TNS002","TNF014","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190075-00","Standard Silver Off Exchange Plan",,"0.703298926353455","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-17S","http://www.bcbst.com/SHOPbrochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190075","BlueCross SG Silver 17S","14002TN019",,"TNN002","TNS002","TNF014","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190075-01","Standard Silver On Exchange Plan",,"0.703298926353455","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-17S","http://www.bcbst.com/SHOPbrochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","Individual","No","62-0427913","14002TN0330040","Bronze B01S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330040-03","Limited Cost Sharing Plan Variation",,"0.617518901824951","Yes","Yes","No","100%",,"$3,000","$0","$2,200","$30","$3,000","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/B01S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","Individual","No","62-0427913","14002TN0330043","Bronze B01E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330043-00","Standard Bronze Off Exchange Plan",,"0.617518901824951","Yes","Yes","No","100%",,"$3,000","$0","$2,200","$30","$3,000","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/B01E_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190076","BlueCross SG Silver 17S","14002TN019",,"TNN002","TNS003","TNF014","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190076-00","Standard Silver Off Exchange Plan",,"0.703298926353455","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-17S","http://www.bcbst.com/SHOPbrochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190076","BlueCross SG Silver 17S","14002TN019",,"TNN002","TNS003","TNF014","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190076-01","Standard Silver On Exchange Plan",,"0.703298926353455","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-17S","http://www.bcbst.com/SHOPbrochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","Individual","No","62-0427913","14002TN0330043","Bronze B01E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330043-01","Standard Bronze On Exchange Plan",,"0.617518901824951","Yes","Yes","No","100%",,"$3,000","$0","$2,200","$30","$3,000","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/B01E_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","Individual","No","62-0427913","14002TN0330043","Bronze B01E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330043-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/B01E-AI1_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190077","BlueCross SG Silver 17S","14002TN019",,"TNN002","TNS004","TNF014","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190077-00","Standard Silver Off Exchange Plan",,"0.703298926353455","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-17S","http://www.bcbst.com/SHOPbrochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190077","BlueCross SG Silver 17S","14002TN019",,"TNN002","TNS004","TNF014","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190077-01","Standard Silver On Exchange Plan",,"0.703298926353455","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-17S","http://www.bcbst.com/SHOPbrochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","Individual","No","62-0427913","14002TN0330043","Bronze B01E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330043-03","Limited Cost Sharing Plan Variation",,"0.617518901824951","Yes","Yes","No","100%",,"$3,000","$0","$2,200","$30","$3,000","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/B01E-AI2_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","Individual","No","62-0427913","14002TN0330046","Bronze B01E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330046-00","Standard Bronze Off Exchange Plan",,"0.617518901824951","Yes","Yes","No","100%",,"$3,000","$0","$2,200","$30","$3,000","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/B01E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190081","BlueCross SG Silver 17S","14002TN019",,"TNN002","TNS008","TNF014","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190081-00","Standard Silver Off Exchange Plan",,"0.703298926353455","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-17S","http://www.bcbst.com/SHOPbrochures","18"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190081","BlueCross SG Silver 17S","14002TN019",,"TNN002","TNS008","TNF014","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190081-01","Standard Silver On Exchange Plan",,"0.703298926353455","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-17S","http://www.bcbst.com/SHOPbrochures","19"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190082","BlueCross SG Silver 17P","14002TN019",,"TNN001","TNS010","TNF014","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190082-00","Standard Silver Off Exchange Plan",,"0.703298926353455","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-17P","http://www.bcbst.com/SHOPbrochures","20"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","1","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190082","BlueCross SG Silver 17P","14002TN019",,"TNN001","TNS010","TNF014","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190082-01","Standard Silver On Exchange Plan",,"0.703298926353455","No","Yes","No","100%",,"$5,000","$60","$300","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-17P","http://www.bcbst.com/SHOPbrochures","21"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190065","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS001","TNF030","Existing","PPO","Silver","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190065-00","Standard Silver Off Exchange Plan","69.85%","0.687932133674622","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","Individual","No","62-0427913","14002TN0330041","Bronze B02S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard Worldwide","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330041-00","Standard Bronze Off Exchange Plan",,"0.615840375423431","Yes","Yes","No","100%",,"$4,000","$0","$1,700","$30","$4,000","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/129800/B02S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","Individual","No","62-0427913","14002TN0330041","Bronze B02S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard Worldwide","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330041-01","Standard Bronze On Exchange Plan",,"0.615840375423431","Yes","Yes","No","100%",,"$4,000","$0","$1,700","$30","$4,000","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/127600/B02S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190065","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS001","TNF030","Existing","PPO","Silver","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190065-01","Standard Silver On Exchange Plan","69.85%","0.687932133674622","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190066","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS002","TNF030","Existing","PPO","Silver","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190066-00","Standard Silver Off Exchange Plan","69.85%","0.687932133674622","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","Individual","No","62-0427913","14002TN0330041","Bronze B02S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard Worldwide","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330041-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/B02S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","Individual","No","62-0427913","14002TN0330041","Bronze B02S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard Worldwide","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330041-03","Limited Cost Sharing Plan Variation",,"0.615840375423431","Yes","Yes","No","100%",,"$4,000","$0","$1,700","$30","$4,000","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/B02S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190066","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS002","TNF030","Existing","PPO","Silver","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190066-01","Standard Silver On Exchange Plan","69.85%","0.687932133674622","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190067","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS003","TNF030","Existing","PPO","Silver","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190067-00","Standard Silver Off Exchange Plan","69.85%","0.687932133674622","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","Individual","No","62-0427913","14002TN0330044","Bronze B02E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard Worldwide","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330044-00","Standard Bronze Off Exchange Plan",,"0.615840375423431","Yes","Yes","No","100%",,"$4,000","$0","$1,700","$30","$4,000","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/129800/B02E_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","Individual","No","62-0427913","14002TN0330044","Bronze B02E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard Worldwide","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330044-01","Standard Bronze On Exchange Plan",,"0.615840375423431","Yes","Yes","No","100%",,"$4,000","$0","$1,700","$30","$4,000","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/127600/B02E_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190067","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS003","TNF030","Existing","PPO","Silver","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190067-01","Standard Silver On Exchange Plan","69.85%","0.687932133674622","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190068","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS004","TNF030","Existing","PPO","Silver","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190068-00","Standard Silver Off Exchange Plan","69.85%","0.687932133674622","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","Individual","No","62-0427913","14002TN0330044","Bronze B02E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard Worldwide","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330044-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/B02E-AI1_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","Individual","No","62-0427913","14002TN0330044","Bronze B02E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard Worldwide","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330044-03","Limited Cost Sharing Plan Variation",,"0.615840375423431","Yes","Yes","No","100%",,"$4,000","$0","$1,700","$30","$4,000","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/B02E-AI2_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190068","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS004","TNF030","Existing","PPO","Silver","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190068-01","Standard Silver On Exchange Plan","69.85%","0.687932133674622","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190069","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS005","TNF030","Existing","PPO","Silver","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190069-00","Standard Silver Off Exchange Plan","69.85%","0.687932133674622","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","Individual","No","62-0427913","14002TN0330047","Bronze B02E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard Worldwide","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330047-00","Standard Bronze Off Exchange Plan",,"0.615840375423431","Yes","Yes","No","100%",,"$4,000","$0","$1,700","$30","$4,000","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/129800/B02E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","Individual","No","62-0427913","14002TN0330047","Bronze B02E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard Worldwide","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330047-01","Standard Bronze On Exchange Plan",,"0.615840375423431","Yes","Yes","No","100%",,"$4,000","$0","$1,700","$30","$4,000","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/127600/B02E_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190069","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS005","TNF030","Existing","PPO","Silver","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190069-01","Standard Silver On Exchange Plan","69.85%","0.687932133674622","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190070","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS006","TNF030","Existing","PPO","Silver","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190070-00","Standard Silver Off Exchange Plan","69.85%","0.687932133674622","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","Individual","No","62-0427913","14002TN0330047","Bronze B02E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard Worldwide","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330047-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/B02E-AI1_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","Individual","No","62-0427913","14002TN0330047","Bronze B02E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard Worldwide","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330047-03","Limited Cost Sharing Plan Variation",,"0.615840375423431","Yes","Yes","No","100%",,"$4,000","$0","$1,700","$30","$4,000","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/B02E-AI2_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190070","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS006","TNF030","Existing","PPO","Silver","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190070-01","Standard Silver On Exchange Plan","69.85%","0.687932133674622","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190071","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS007","TNF030","Existing","PPO","Silver","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190071-00","Standard Silver Off Exchange Plan","69.85%","0.687932133674622","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures","16"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190071","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS007","TNF030","Existing","PPO","Silver","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190071-01","Standard Silver On Exchange Plan","69.85%","0.687932133674622","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures","17"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190072","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS008","TNF030","Existing","PPO","Silver","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190072-00","Standard Silver Off Exchange Plan","69.85%","0.687932133674622","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures","18"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190072","BlueCross SG Silver 25S","14002TN019",,"TNN002","TNS008","TNF030","Existing","PPO","Silver","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190072-01","Standard Silver On Exchange Plan","69.85%","0.687932133674622","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-25S","http://www.bcbst.com/SHOPbrochures","19"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190073","BlueCross SG Silver 25P","14002TN019",,"TNN001","TNS010","TNF030","Existing","PPO","Silver","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190073-00","Standard Silver Off Exchange Plan","69.85%","0.687932133674622","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-25P","http://www.bcbst.com/SHOPbrochures","20"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","2","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190073","BlueCross SG Silver 25P","14002TN019",,"TNN001","TNS010","TNF030","Existing","PPO","Silver","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190073-01","Standard Silver On Exchange Plan","69.85%","0.687932133674622","Yes","Yes","No","100%",,"$2,700","$0","$900","$30","$2,700","$100","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbst.com/sbc/2016/Grp-Silver-25P","http://www.bcbst.com/SHOPbrochures","21"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190092","BlueCross SG Gold 19S","14002TN019",,"TNN002","TNS001","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190092-00","Standard Gold Off Exchange Plan",,"0.799546480178833","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-19S","http://www.bcbst.com/SHOPbrochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","Individual","No","62-0427913","14002TN0330042","Bronze B04S, Network S","14002TN033",,"TNN002","TNS010","TNF028","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330042-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/129800/B04S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","Individual","No","62-0427913","14002TN0330042","Bronze B04S, Network S","14002TN033",,"TNN002","TNS010","TNF028","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330042-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/127600/B04S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190092","BlueCross SG Gold 19S","14002TN019",,"TNN002","TNS001","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190092-01","Standard Gold On Exchange Plan",,"0.799546480178833","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-19S","http://www.bcbst.com/SHOPbrochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190093","BlueCross SG Gold 19S","14002TN019",,"TNN002","TNS002","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190093-00","Standard Gold Off Exchange Plan",,"0.799546480178833","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-19S","http://www.bcbst.com/SHOPbrochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","Individual","No","62-0427913","14002TN0330042","Bronze B04S, Network S","14002TN033",,"TNN002","TNS010","TNF028","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330042-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/B04S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","Individual","No","62-0427913","14002TN0330042","Bronze B04S, Network S","14002TN033",,"TNN002","TNS010","TNF028","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330042-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/B04S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190093","BlueCross SG Gold 19S","14002TN019",,"TNN002","TNS002","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190093-01","Standard Gold On Exchange Plan",,"0.799546480178833","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-19S","http://www.bcbst.com/SHOPbrochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190094","BlueCross SG Gold 19S","14002TN019",,"TNN002","TNS003","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190094-00","Standard Gold Off Exchange Plan",,"0.799546480178833","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-19S","http://www.bcbst.com/SHOPbrochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","Individual","No","62-0427913","14002TN0330045","Bronze B04E, Network E","14002TN033",,"TNN003","TNS009","TNF028","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330045-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/129800/B04E_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","Individual","No","62-0427913","14002TN0330045","Bronze B04E, Network E","14002TN033",,"TNN003","TNS009","TNF028","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330045-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/127600/B04E_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190094","BlueCross SG Gold 19S","14002TN019",,"TNN002","TNS003","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190094-01","Standard Gold On Exchange Plan",,"0.799546480178833","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-19S","http://www.bcbst.com/SHOPbrochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190095","BlueCross SG Gold 19S","14002TN019",,"TNN002","TNS004","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190095-00","Standard Gold Off Exchange Plan",,"0.799546480178833","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-19S","http://www.bcbst.com/SHOPbrochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","Individual","No","62-0427913","14002TN0330045","Bronze B04E, Network E","14002TN033",,"TNN003","TNS009","TNF028","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330045-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/B04E-AI1_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","Individual","No","62-0427913","14002TN0330045","Bronze B04E, Network E","14002TN033",,"TNN003","TNS009","TNF028","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330045-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/B04E-AI2_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190095","BlueCross SG Gold 19S","14002TN019",,"TNN002","TNS004","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190095-01","Standard Gold On Exchange Plan",,"0.799546480178833","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-19S","http://www.bcbst.com/SHOPbrochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190096","BlueCross SG Gold 19S","14002TN019",,"TNN002","TNS005","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190096-00","Standard Gold Off Exchange Plan",,"0.799546480178833","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-19S","http://www.bcbst.com/SHOPbrochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","Individual","No","62-0427913","14002TN0330048","Bronze B04E, Network E","14002TN033",,"TNN003","TNS004","TNF028","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330048-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/129800/B04E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","Individual","No","62-0427913","14002TN0330048","Bronze B04E, Network E","14002TN033",,"TNN003","TNS004","TNF028","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330048-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/127600/B04E_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190090","BlueCross SG Gold 27S","14002TN019",,"TNN002","TNS008","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190090-01","Standard Gold On Exchange Plan",,"0.818682014942169","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-27S","http://www.bcbst.com/SHOPbrochures","19"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190091","BlueCross SG Gold 27P","14002TN019",,"TNN001","TNS010","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190091-00","Standard Gold Off Exchange Plan",,"0.818682014942169","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-27P","http://www.bcbst.com/SHOPbrochures","20"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190096","BlueCross SG Gold 19S","14002TN019",,"TNN002","TNS005","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190096-01","Standard Gold On Exchange Plan",,"0.799546480178833","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-19S","http://www.bcbst.com/SHOPbrochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190097","BlueCross SG Gold 19S","14002TN019",,"TNN002","TNS006","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190097-00","Standard Gold Off Exchange Plan",,"0.799546480178833","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-19S","http://www.bcbst.com/SHOPbrochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","Individual","No","62-0427913","14002TN0330048","Bronze B04E, Network E","14002TN033",,"TNN003","TNS004","TNF028","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330048-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/B04E-AI1_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","Individual","No","62-0427913","14002TN0330048","Bronze B04E, Network E","14002TN033",,"TNN003","TNS004","TNF028","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330048-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/B04E-AI2_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190097","BlueCross SG Gold 19S","14002TN019",,"TNN002","TNS006","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190097-01","Standard Gold On Exchange Plan",,"0.799546480178833","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-19S","http://www.bcbst.com/SHOPbrochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190098","BlueCross SG Gold 19S","14002TN019",,"TNN002","TNS007","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190098-00","Standard Gold Off Exchange Plan",,"0.799546480178833","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-19S","http://www.bcbst.com/SHOPbrochures","16"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190098","BlueCross SG Gold 19S","14002TN019",,"TNN002","TNS007","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190098-01","Standard Gold On Exchange Plan",,"0.799546480178833","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-19S","http://www.bcbst.com/SHOPbrochures","17"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190099","BlueCross SG Gold 19S","14002TN019",,"TNN002","TNS008","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190099-00","Standard Gold Off Exchange Plan",,"0.799546480178833","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-19S","http://www.bcbst.com/SHOPbrochures","18"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190099","BlueCross SG Gold 19S","14002TN019",,"TNN002","TNS008","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190099-01","Standard Gold On Exchange Plan",,"0.799546480178833","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-19S","http://www.bcbst.com/SHOPbrochures","19"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190100","BlueCross SG Gold 19P","14002TN019",,"TNN001","TNS010","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190100-00","Standard Gold Off Exchange Plan",,"0.799546480178833","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-19P","http://www.bcbst.com/SHOPbrochures","20"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","3","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190100","BlueCross SG Gold 19P","14002TN019",,"TNN001","TNS010","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190100-01","Standard Gold On Exchange Plan",,"0.799546480178833","No","Yes","No","100%",,"$2,000","$60","$0","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-19P","http://www.bcbst.com/SHOPbrochures","21"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190083","BlueCross SG Gold 27S","14002TN019",,"TNN002","TNS001","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190083-00","Standard Gold Off Exchange Plan",,"0.818682014942169","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-27S","http://www.bcbst.com/SHOPbrochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","Individual","No","62-0427913","14002TN0330051","Bronze B07S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330051-00","Standard Bronze Off Exchange Plan",,"0.606040835380554","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/129800/B07S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","Individual","No","62-0427913","14002TN0330051","Bronze B07S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330051-01","Standard Bronze On Exchange Plan",,"0.606040835380554","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/127600/B07S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190083","BlueCross SG Gold 27S","14002TN019",,"TNN002","TNS001","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190083-01","Standard Gold On Exchange Plan",,"0.818682014942169","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-27S","http://www.bcbst.com/SHOPbrochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190084","BlueCross SG Gold 27S","14002TN019",,"TNN002","TNS002","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190084-00","Standard Gold Off Exchange Plan",,"0.818682014942169","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-27S","http://www.bcbst.com/SHOPbrochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","Individual","No","62-0427913","14002TN0330051","Bronze B07S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330051-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/B07S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","Individual","No","62-0427913","14002TN0330051","Bronze B07S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330051-03","Limited Cost Sharing Plan Variation",,"0.606040835380554","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/B07S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190084","BlueCross SG Gold 27S","14002TN019",,"TNN002","TNS002","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190084-01","Standard Gold On Exchange Plan",,"0.818682014942169","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-27S","http://www.bcbst.com/SHOPbrochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190085","BlueCross SG Gold 27S","14002TN019",,"TNN002","TNS003","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190085-00","Standard Gold Off Exchange Plan",,"0.818682014942169","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-27S","http://www.bcbst.com/SHOPbrochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","Individual","No","62-0427913","14002TN0330049","Bronze B07E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330049-00","Standard Bronze Off Exchange Plan",,"0.606040835380554","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/129800/B07E_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","Individual","No","62-0427913","14002TN0330049","Bronze B07E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330049-01","Standard Bronze On Exchange Plan",,"0.606040835380554","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/127600/B07E_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190085","BlueCross SG Gold 27S","14002TN019",,"TNN002","TNS003","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190085-01","Standard Gold On Exchange Plan",,"0.818682014942169","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-27S","http://www.bcbst.com/SHOPbrochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190086","BlueCross SG Gold 27S","14002TN019",,"TNN002","TNS004","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190086-00","Standard Gold Off Exchange Plan",,"0.818682014942169","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-27S","http://www.bcbst.com/SHOPbrochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","Individual","No","62-0427913","14002TN0330049","Bronze B07E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330049-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/B07E-AI1_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","Individual","No","62-0427913","14002TN0330049","Bronze B07E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330049-03","Limited Cost Sharing Plan Variation",,"0.606040835380554","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/B07E-AI2_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190086","BlueCross SG Gold 27S","14002TN019",,"TNN002","TNS004","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190086-01","Standard Gold On Exchange Plan",,"0.818682014942169","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-27S","http://www.bcbst.com/SHOPbrochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190087","BlueCross SG Gold 27S","14002TN019",,"TNN002","TNS005","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190087-00","Standard Gold Off Exchange Plan",,"0.818682014942169","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-27S","http://www.bcbst.com/SHOPbrochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","Individual","No","62-0427913","14002TN0330050","Bronze B07E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330050-00","Standard Bronze Off Exchange Plan",,"0.606040835380554","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/129800/B07E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","Individual","No","62-0427913","14002TN0330050","Bronze B07E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330050-01","Standard Bronze On Exchange Plan",,"0.606040835380554","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/127600/B07E_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190087","BlueCross SG Gold 27S","14002TN019",,"TNN002","TNS005","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190087-01","Standard Gold On Exchange Plan",,"0.818682014942169","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-27S","http://www.bcbst.com/SHOPbrochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190088","BlueCross SG Gold 27S","14002TN019",,"TNN002","TNS006","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190088-00","Standard Gold Off Exchange Plan",,"0.818682014942169","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-27S","http://www.bcbst.com/SHOPbrochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","Individual","No","62-0427913","14002TN0330050","Bronze B07E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330050-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/B07E-AI1_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","Individual","No","62-0427913","14002TN0330050","Bronze B07E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330050-03","Limited Cost Sharing Plan Variation",,"0.606040835380554","Yes","Yes","No","100%",,"$5,200","$0","$1,100","$30","$5,000","$0","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$19,200","$19200 per person","$38400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","50%",,,,,"$10,400","$10400 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/B07E-AI2_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190088","BlueCross SG Gold 27S","14002TN019",,"TNN002","TNS006","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190088-01","Standard Gold On Exchange Plan",,"0.818682014942169","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-27S","http://www.bcbst.com/SHOPbrochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190089","BlueCross SG Gold 27S","14002TN019",,"TNN002","TNS007","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190089-00","Standard Gold Off Exchange Plan",,"0.818682014942169","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-27S","http://www.bcbst.com/SHOPbrochures","16"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190089","BlueCross SG Gold 27S","14002TN019",,"TNN002","TNS007","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190089-01","Standard Gold On Exchange Plan",,"0.818682014942169","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-27S","http://www.bcbst.com/SHOPbrochures","17"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190090","BlueCross SG Gold 27S","14002TN019",,"TNN002","TNS008","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190090-00","Standard Gold Off Exchange Plan",,"0.818682014942169","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-27S","http://www.bcbst.com/SHOPbrochures","18"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","4","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190091","BlueCross SG Gold 27P","14002TN019",,"TNN001","TNS010","TNF014","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190091-01","Standard Gold On Exchange Plan",,"0.818682014942169","No","Yes","No","100%",,"$1,300","$60","$1,100","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","20%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Gold-27P","http://www.bcbst.com/SHOPbrochures","21"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190101","BlueCross SG Platinum 03S","14002TN019",,"TNN002","TNS001","TNF014","Existing","PPO","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190101-00","Standard Platinum Off Exchange Plan","89.83%","0","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Platinum-03S","http://www.bcbst.com/SHOPbrochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","Individual","No","62-0427913","14002TN0330001","Silver S01S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330001-00","Standard Silver Off Exchange Plan",,"0.719287216663361","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/S01S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","Individual","No","62-0427913","14002TN0330001","Silver S01S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330001-01","Standard Silver On Exchange Plan",,"0.719287216663361","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S01S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190101","BlueCross SG Platinum 03S","14002TN019",,"TNN002","TNS001","TNF014","Existing","PPO","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190101-01","Standard Platinum On Exchange Plan","89.83%","0","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Platinum-03S","http://www.bcbst.com/SHOPbrochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190102","BlueCross SG Platinum 03S","14002TN019",,"TNN002","TNS002","TNF014","Existing","PPO","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190102-00","Standard Platinum Off Exchange Plan","89.83%","0","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Platinum-03S","http://www.bcbst.com/SHOPbrochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","Individual","No","62-0427913","14002TN0330001","Silver S01S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S01S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","Individual","No","62-0427913","14002TN0330001","Silver S01S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330001-03","Limited Cost Sharing Plan Variation",,"0.719287216663361","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S01S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190102","BlueCross SG Platinum 03S","14002TN019",,"TNN002","TNS002","TNF014","Existing","PPO","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190102-01","Standard Platinum On Exchange Plan","89.83%","0","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Platinum-03S","http://www.bcbst.com/SHOPbrochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190103","BlueCross SG Platinum 03S","14002TN019",,"TNN002","TNS003","TNF014","Existing","PPO","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190103-00","Standard Platinum Off Exchange Plan","89.83%","0","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Platinum-03S","http://www.bcbst.com/SHOPbrochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","Individual","No","62-0427913","14002TN0330001","Silver S01S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330001-04","73% AV Level Silver Plan",,"0.739500224590302","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S01S-A_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","Individual","No","62-0427913","14002TN0330001","Silver S01S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330001-05","87% AV Level Silver Plan",,"0.870630919933319","Yes","Yes","No","100%",,"$0","$0","$1,400","$30","$0","$0","$1,400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S01S-B_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190103","BlueCross SG Platinum 03S","14002TN019",,"TNN002","TNS003","TNF014","Existing","PPO","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190103-01","Standard Platinum On Exchange Plan","89.83%","0","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Platinum-03S","http://www.bcbst.com/SHOPbrochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190104","BlueCross SG Platinum 03S","14002TN019",,"TNN002","TNS004","TNF014","Existing","PPO","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190104-00","Standard Platinum Off Exchange Plan","89.83%","0","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Platinum-03S","http://www.bcbst.com/SHOPbrochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","Individual","No","62-0427913","14002TN0330001","Silver S01S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330001-06","94% AV Level Silver Plan",,"0.938233137130737","Yes","Yes","No","100%",,"$0","$0","$500","$30","$0","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S01S-C_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","Individual","No","62-0427913","14002TN0330011","Silver S01E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330011-00","Standard Silver Off Exchange Plan",,"0.719287216663361","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/S01E_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190104","BlueCross SG Platinum 03S","14002TN019",,"TNN002","TNS004","TNF014","Existing","PPO","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190104-01","Standard Platinum On Exchange Plan","89.83%","0","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Platinum-03S","http://www.bcbst.com/SHOPbrochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190105","BlueCross SG Platinum 03S","14002TN019",,"TNN002","TNS005","TNF014","Existing","PPO","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190105-00","Standard Platinum Off Exchange Plan","89.83%","0","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Platinum-03S","http://www.bcbst.com/SHOPbrochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","Individual","No","62-0427913","14002TN0330011","Silver S01E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330011-01","Standard Silver On Exchange Plan",,"0.719287216663361","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S01E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","7","14002","TN","Individual","No","62-0427913","14002TN0330003","Silver S04S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330003-06","94% AV Level Silver Plan",,"0.938233137130737","Yes","Yes","No","100%",,"$0","$0","$500","$30","$0","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S04S-C_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","7","14002","TN","Individual","No","62-0427913","14002TN0330013","Silver S04E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330013-00","Standard Silver Off Exchange Plan",,"0.701862394809723","Yes","Yes","No","100%",,"$2,000","$0","$2,000","$30","$2,000","$0","$1,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/S04E_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","7","14002","TN","Individual","No","62-0427913","14002TN0330013","Silver S04E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330013-01","Standard Silver On Exchange Plan",,"0.701862394809723","Yes","Yes","No","100%",,"$2,000","$0","$2,000","$30","$2,000","$0","$1,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S04E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","7","14002","TN","Individual","No","62-0427913","14002TN0330013","Silver S04E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S04E-AI1_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","7","14002","TN","Individual","No","62-0427913","14002TN0330013","Silver S04E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330013-03","Limited Cost Sharing Plan Variation",,"0.701862394809723","Yes","Yes","No","100%",,"$2,000","$0","$2,000","$30","$2,000","$0","$1,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S04E-AI2_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","7","14002","TN","Individual","No","62-0427913","14002TN0330013","Silver S04E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330013-04","73% AV Level Silver Plan",,"0.737057030200958","Yes","Yes","No","100%",,"$1,000","$0","$2,700","$30","$1,000","$0","$2,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S04E-A_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","7","14002","TN","Individual","No","62-0427913","14002TN0330013","Silver S04E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330013-05","87% AV Level Silver Plan",,"0.870630919933319","Yes","Yes","No","100%",,"$0","$0","$1,400","$30","$0","$0","$1,400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S04E-B_SBC.pdf","www.bcbst.com/brochures","16"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","7","14002","TN","Individual","No","62-0427913","14002TN0330013","Silver S04E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330013-06","94% AV Level Silver Plan",,"0.938233137130737","Yes","Yes","No","100%",,"$0","$0","$500","$30","$0","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S04E-C_SBC.pdf","www.bcbst.com/brochures","17"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","7","14002","TN","Individual","No","62-0427913","14002TN0330023","Silver S04E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330023-00","Standard Silver Off Exchange Plan",,"0.701862394809723","Yes","Yes","No","100%",,"$2,000","$0","$2,000","$30","$2,000","$0","$1,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/S04E_SBC.pdf","www.bcbst.com/brochures","18"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","7","14002","TN","Individual","No","62-0427913","14002TN0330023","Silver S04E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330023-01","Standard Silver On Exchange Plan",,"0.701862394809723","Yes","Yes","No","100%",,"$2,000","$0","$2,000","$30","$2,000","$0","$1,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S04E_SBC.pdf","www.bcbst.com/brochures","19"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","Individual","No","62-0427913","14002TN0330011","Silver S01E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S01E-AI1_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190105","BlueCross SG Platinum 03S","14002TN019",,"TNN002","TNS005","TNF014","Existing","PPO","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190105-01","Standard Platinum On Exchange Plan","89.83%","0","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Platinum-03S","http://www.bcbst.com/SHOPbrochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190106","BlueCross SG Platinum 03S","14002TN019",,"TNN002","TNS006","TNF014","Existing","PPO","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190106-00","Standard Platinum Off Exchange Plan","89.83%","0","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Platinum-03S","http://www.bcbst.com/SHOPbrochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","Individual","No","62-0427913","14002TN0330011","Silver S01E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330011-03","Limited Cost Sharing Plan Variation",,"0.719287216663361","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S01E-AI2_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","Individual","No","62-0427913","14002TN0330011","Silver S01E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330011-04","73% AV Level Silver Plan",,"0.739500224590302","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S01E-A_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190106","BlueCross SG Platinum 03S","14002TN019",,"TNN002","TNS006","TNF014","Existing","PPO","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190106-01","Standard Platinum On Exchange Plan","89.83%","0","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Platinum-03S","http://www.bcbst.com/SHOPbrochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190107","BlueCross SG Platinum 03S","14002TN019",,"TNN002","TNS007","TNF014","Existing","PPO","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190107-00","Standard Platinum Off Exchange Plan","89.83%","0","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Platinum-03S","http://www.bcbst.com/SHOPbrochures","16"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","Individual","No","62-0427913","14002TN0330011","Silver S01E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330011-05","87% AV Level Silver Plan",,"0.870630919933319","Yes","Yes","No","100%",,"$0","$0","$1,400","$30","$0","$0","$1,400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S01E-B_SBC.pdf","www.bcbst.com/brochures","16"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","Individual","No","62-0427913","14002TN0330011","Silver S01E, Network E","14002TN033",,"TNN003","TNS009","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330011-06","94% AV Level Silver Plan",,"0.938233137130737","Yes","Yes","No","100%",,"$0","$0","$500","$30","$0","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S01E-C_SBC.pdf","www.bcbst.com/brochures","17"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190107","BlueCross SG Platinum 03S","14002TN019",,"TNN002","TNS007","TNF014","Existing","PPO","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190107-01","Standard Platinum On Exchange Plan","89.83%","0","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Platinum-03S","http://www.bcbst.com/SHOPbrochures","17"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190108","BlueCross SG Platinum 03S","14002TN019",,"TNN002","TNS008","TNF014","Existing","PPO","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190108-00","Standard Platinum Off Exchange Plan","89.83%","0","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Platinum-03S","http://www.bcbst.com/SHOPbrochures","18"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","Individual","No","62-0427913","14002TN0330021","Silver S01E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330021-00","Standard Silver Off Exchange Plan",,"0.719287216663361","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/S01E_SBC.pdf","www.bcbst.com/brochures","18"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","Individual","No","62-0427913","14002TN0330021","Silver S01E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330021-01","Standard Silver On Exchange Plan",,"0.719287216663361","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S01E_SBC.pdf","www.bcbst.com/brochures","19"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190108","BlueCross SG Platinum 03S","14002TN019",,"TNN002","TNS008","TNF014","Existing","PPO","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190108-01","Standard Platinum On Exchange Plan","89.83%","0","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Platinum-03S","http://www.bcbst.com/SHOPbrochures","19"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190109","BlueCross SG Platinum 03P","14002TN019",,"TNN001","TNS010","TNF014","Existing","PPO","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190109-00","Standard Platinum Off Exchange Plan","89.83%","0","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Platinum-03P","http://www.bcbst.com/SHOPbrochures","20"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","Individual","No","62-0427913","14002TN0330021","Silver S01E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S01E-AI1_SBC.pdf","www.bcbst.com/brochures","20"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","Individual","No","62-0427913","14002TN0330021","Silver S01E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330021-03","Limited Cost Sharing Plan Variation",,"0.719287216663361","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S01E-AI2_SBC.pdf","www.bcbst.com/brochures","21"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0190109","BlueCross SG Platinum 03P","14002TN019",,"TNN001","TNS010","TNF014","Existing","PPO","Platinum","Yes","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes",,"http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0190109-01","Standard Platinum On Exchange Plan","89.83%","0","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbst.com/sbc/2016/Grp-Platinum-03P","http://www.bcbst.com/SHOPbrochures","21"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","Individual","No","62-0427913","14002TN0330021","Silver S01E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330021-04","73% AV Level Silver Plan",,"0.739500224590302","Yes","Yes","No","100%",,"$0","$0","$3,700","$30","$0","$0","$2,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S01E-A_SBC.pdf","www.bcbst.com/brochures","22"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","Individual","No","62-0427913","14002TN0330021","Silver S01E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330021-05","87% AV Level Silver Plan",,"0.870630919933319","Yes","Yes","No","100%",,"$0","$0","$1,400","$30","$0","$0","$1,400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S01E-B_SBC.pdf","www.bcbst.com/brochures","23"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","5","14002","TN","Individual","No","62-0427913","14002TN0330021","Silver S01E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330021-06","94% AV Level Silver Plan",,"0.938233137130737","Yes","Yes","No","100%",,"$0","$0","$500","$30","$0","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S01E-C_SBC.pdf","www.bcbst.com/brochures","24"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","6","14002","TN","Individual","No","62-0427913","14002TN0330002","Silver S02S, Network S","14002TN033",,"TNN002","TNS010","TNF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330002-00","Standard Silver Off Exchange Plan",,"0.692950665950775","Yes","Yes","No","100%",,"$1,000","$20","$3,100","$30","$1,000","$90","$1,400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/S02S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","6","14002","TN","Individual","No","62-0427913","14002TN0330002","Silver S02S, Network S","14002TN033",,"TNN002","TNS010","TNF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330002-01","Standard Silver On Exchange Plan",,"0.692950665950775","Yes","Yes","No","100%",,"$1,000","$20","$3,100","$30","$1,000","$90","$1,400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S02S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","6","14002","TN","Individual","No","62-0427913","14002TN0330002","Silver S02S, Network S","14002TN033",,"TNN002","TNS010","TNF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S02S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","6","14002","TN","Individual","No","62-0427913","14002TN0330002","Silver S02S, Network S","14002TN033",,"TNN002","TNS010","TNF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330002-03","Limited Cost Sharing Plan Variation",,"0.692950665950775","Yes","Yes","No","100%",,"$1,000","$20","$3,100","$30","$1,000","$90","$1,400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S02S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","6","14002","TN","Individual","No","62-0427913","14002TN0330002","Silver S02S, Network S","14002TN033",,"TNN002","TNS010","TNF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330002-04","73% AV Level Silver Plan",,"0.733632981777191","Yes","Yes","No","100%",,"$1,000","$20","$3,100","$30","$1,000","$90","$1,400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S02S-A_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","6","14002","TN","Individual","No","62-0427913","14002TN0330002","Silver S02S, Network S","14002TN033",,"TNN002","TNS010","TNF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330002-05","87% AV Level Silver Plan",,"0.872005105018616","Yes","Yes","No","100%",,"$0","$10","$1,500","$30","$0","$60","$1,400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S02S-B_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","6","14002","TN","Individual","No","62-0427913","14002TN0330002","Silver S02S, Network S","14002TN033",,"TNN002","TNS010","TNF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330002-06","94% AV Level Silver Plan",,"0.93495100736618","Yes","Yes","No","100%",,"$0","$10","$600","$30","$0","$20","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S02S-C_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","6","14002","TN","Individual","No","62-0427913","14002TN0330012","Silver S02E, Network E","14002TN033",,"TNN003","TNS009","TNF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330012-00","Standard Silver Off Exchange Plan",,"0.692950665950775","Yes","Yes","No","100%",,"$1,000","$20","$3,100","$30","$1,000","$90","$1,400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/S02E_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","6","14002","TN","Individual","No","62-0427913","14002TN0330012","Silver S02E, Network E","14002TN033",,"TNN003","TNS009","TNF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330012-01","Standard Silver On Exchange Plan",,"0.692950665950775","Yes","Yes","No","100%",,"$1,000","$20","$3,100","$30","$1,000","$90","$1,400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S02E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","6","14002","TN","Individual","No","62-0427913","14002TN0330012","Silver S02E, Network E","14002TN033",,"TNN003","TNS009","TNF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S02E-AI1_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","6","14002","TN","Individual","No","62-0427913","14002TN0330012","Silver S02E, Network E","14002TN033",,"TNN003","TNS009","TNF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330012-03","Limited Cost Sharing Plan Variation",,"0.692950665950775","Yes","Yes","No","100%",,"$1,000","$20","$3,100","$30","$1,000","$90","$1,400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S02E-AI2_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","9","14002","TN","Individual","No","62-0427913","14002TN0330016","Silver S09E, Network E","14002TN033",,"TNN003","TNS009","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330016-01","Standard Silver On Exchange Plan",,"0.704136252403259","Yes","Yes","No","100%",,"$2,500","$0","$1,000","$30","$2,500","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S09E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","9","14002","TN","Individual","No","62-0427913","14002TN0330016","Silver S09E, Network E","14002TN033",,"TNN003","TNS009","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S09E-AI1_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","9","14002","TN","Individual","No","62-0427913","14002TN0330016","Silver S09E, Network E","14002TN033",,"TNN003","TNS009","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330016-03","Limited Cost Sharing Plan Variation",,"0.704136252403259","Yes","Yes","No","100%",,"$2,500","$0","$1,000","$30","$2,500","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S09E-AI2_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","9","14002","TN","Individual","No","62-0427913","14002TN0330016","Silver S09E, Network E","14002TN033",,"TNN003","TNS009","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330016-04","73% AV Level Silver Plan",,"0.7394158244133","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$30","$2,000","$0","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S09E-A_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","9","14002","TN","Individual","No","62-0427913","14002TN0330016","Silver S09E, Network E","14002TN033",,"TNN003","TNS009","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330016-05","87% AV Level Silver Plan",,"0.871699452400208","Yes","Yes","No","100%",,"$300","$0","$1,400","$30","$300","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S09E-B_SBC.pdf","www.bcbst.com/brochures","16"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","9","14002","TN","Individual","No","62-0427913","14002TN0330016","Silver S09E, Network E","14002TN033",,"TNN003","TNS009","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330016-06","94% AV Level Silver Plan",,"0.93526965379715","Yes","Yes","No","100%",,"$0","$0","$800","$30","$0","$0","$800","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S09E-C_SBC.pdf","www.bcbst.com/brochures","17"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","9","14002","TN","Individual","No","62-0427913","14002TN0330026","Silver S09E, Network E","14002TN033",,"TNN003","TNS004","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330026-00","Standard Silver Off Exchange Plan",,"0.704136252403259","Yes","Yes","No","100%",,"$2,500","$0","$1,000","$30","$2,500","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/S09E_SBC.pdf","www.bcbst.com/brochures","18"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","9","14002","TN","Individual","No","62-0427913","14002TN0330026","Silver S09E, Network E","14002TN033",,"TNN003","TNS004","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330026-01","Standard Silver On Exchange Plan",,"0.704136252403259","Yes","Yes","No","100%",,"$2,500","$0","$1,000","$30","$2,500","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S09E_SBC.pdf","www.bcbst.com/brochures","19"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","9","14002","TN","Individual","No","62-0427913","14002TN0330026","Silver S09E, Network E","14002TN033",,"TNN003","TNS004","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S09E-AI1_SBC.pdf","www.bcbst.com/brochures","20"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","9","14002","TN","Individual","No","62-0427913","14002TN0330026","Silver S09E, Network E","14002TN033",,"TNN003","TNS004","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330026-03","Limited Cost Sharing Plan Variation",,"0.704136252403259","Yes","Yes","No","100%",,"$2,500","$0","$1,000","$30","$2,500","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S09E-AI2_SBC.pdf","www.bcbst.com/brochures","21"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","9","14002","TN","Individual","No","62-0427913","14002TN0330026","Silver S09E, Network E","14002TN033",,"TNN003","TNS004","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330026-04","73% AV Level Silver Plan",,"0.7394158244133","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$30","$2,000","$0","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S09E-A_SBC.pdf","www.bcbst.com/brochures","22"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","9","14002","TN","Individual","No","62-0427913","14002TN0330026","Silver S09E, Network E","14002TN033",,"TNN003","TNS004","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330026-05","87% AV Level Silver Plan",,"0.871699452400208","Yes","Yes","No","100%",,"$300","$0","$1,400","$30","$300","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S09E-B_SBC.pdf","www.bcbst.com/brochures","23"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","6","14002","TN","Individual","No","62-0427913","14002TN0330012","Silver S02E, Network E","14002TN033",,"TNN003","TNS009","TNF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330012-04","73% AV Level Silver Plan",,"0.733632981777191","Yes","Yes","No","100%",,"$1,000","$20","$3,100","$30","$1,000","$90","$1,400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S02E-A_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","6","14002","TN","Individual","No","62-0427913","14002TN0330012","Silver S02E, Network E","14002TN033",,"TNN003","TNS009","TNF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330012-05","87% AV Level Silver Plan",,"0.872005105018616","Yes","Yes","No","100%",,"$0","$10","$1,500","$30","$0","$60","$1,400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S02E-B_SBC.pdf","www.bcbst.com/brochures","16"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","6","14002","TN","Individual","No","62-0427913","14002TN0330012","Silver S02E, Network E","14002TN033",,"TNN003","TNS009","TNF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330012-06","94% AV Level Silver Plan",,"0.93495100736618","Yes","Yes","No","100%",,"$0","$10","$600","$30","$0","$20","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S02E-C_SBC.pdf","www.bcbst.com/brochures","17"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","6","14002","TN","Individual","No","62-0427913","14002TN0330022","Silver S02E, Network E","14002TN033",,"TNN003","TNS004","TNF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330022-00","Standard Silver Off Exchange Plan",,"0.692950665950775","Yes","Yes","No","100%",,"$1,000","$20","$3,100","$30","$1,000","$90","$1,400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/S02E_SBC.pdf","www.bcbst.com/brochures","18"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","6","14002","TN","Individual","No","62-0427913","14002TN0330022","Silver S02E, Network E","14002TN033",,"TNN003","TNS004","TNF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330022-01","Standard Silver On Exchange Plan",,"0.692950665950775","Yes","Yes","No","100%",,"$1,000","$20","$3,100","$30","$1,000","$90","$1,400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S02E_SBC.pdf","www.bcbst.com/brochures","19"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","6","14002","TN","Individual","No","62-0427913","14002TN0330022","Silver S02E, Network E","14002TN033",,"TNN003","TNS004","TNF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330022-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S02E-AI1_SBC.pdf","www.bcbst.com/brochures","20"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","6","14002","TN","Individual","No","62-0427913","14002TN0330022","Silver S02E, Network E","14002TN033",,"TNN003","TNS004","TNF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330022-03","Limited Cost Sharing Plan Variation",,"0.692950665950775","Yes","Yes","No","100%",,"$1,000","$20","$3,100","$30","$1,000","$90","$1,400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S02E-AI2_SBC.pdf","www.bcbst.com/brochures","21"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","6","14002","TN","Individual","No","62-0427913","14002TN0330022","Silver S02E, Network E","14002TN033",,"TNN003","TNS004","TNF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330022-04","73% AV Level Silver Plan",,"0.733632981777191","Yes","Yes","No","100%",,"$1,000","$20","$3,100","$30","$1,000","$90","$1,400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S02E-A_SBC.pdf","www.bcbst.com/brochures","22"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","6","14002","TN","Individual","No","62-0427913","14002TN0330022","Silver S02E, Network E","14002TN033",,"TNN003","TNS004","TNF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330022-05","87% AV Level Silver Plan",,"0.872005105018616","Yes","Yes","No","100%",,"$0","$10","$1,500","$30","$0","$60","$1,400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S02E-B_SBC.pdf","www.bcbst.com/brochures","23"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","6","14002","TN","Individual","No","62-0427913","14002TN0330022","Silver S02E, Network E","14002TN033",,"TNN003","TNS004","TNF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330022-06","94% AV Level Silver Plan",,"0.93495100736618","Yes","Yes","No","100%",,"$0","$10","$600","$30","$0","$20","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S02E-C_SBC.pdf","www.bcbst.com/brochures","24"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","7","14002","TN","Individual","No","62-0427913","14002TN0330003","Silver S04S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330003-00","Standard Silver Off Exchange Plan",,"0.701862394809723","Yes","Yes","No","100%",,"$2,000","$0","$2,000","$30","$2,000","$0","$1,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/S04S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","7","14002","TN","Individual","No","62-0427913","14002TN0330003","Silver S04S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330003-01","Standard Silver On Exchange Plan",,"0.701862394809723","Yes","Yes","No","100%",,"$2,000","$0","$2,000","$30","$2,000","$0","$1,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S04S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","7","14002","TN","Individual","No","62-0427913","14002TN0330003","Silver S04S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S04S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","7","14002","TN","Individual","No","62-0427913","14002TN0330003","Silver S04S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330003-03","Limited Cost Sharing Plan Variation",,"0.701862394809723","Yes","Yes","No","100%",,"$2,000","$0","$2,000","$30","$2,000","$0","$1,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S04S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","7","14002","TN","Individual","No","62-0427913","14002TN0330003","Silver S04S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330003-04","73% AV Level Silver Plan",,"0.737057030200958","Yes","Yes","No","100%",,"$1,000","$0","$2,700","$30","$1,000","$0","$2,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S04S-A_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","7","14002","TN","Individual","No","62-0427913","14002TN0330003","Silver S04S, Network S","14002TN033",,"TNN002","TNS010","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330003-05","87% AV Level Silver Plan",,"0.870630919933319","Yes","Yes","No","100%",,"$0","$0","$1,400","$30","$0","$0","$1,400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S04S-B_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","7","14002","TN","Individual","No","62-0427913","14002TN0330023","Silver S04E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330023-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S04E-AI1_SBC.pdf","www.bcbst.com/brochures","20"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","7","14002","TN","Individual","No","62-0427913","14002TN0330023","Silver S04E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330023-03","Limited Cost Sharing Plan Variation",,"0.701862394809723","Yes","Yes","No","100%",,"$2,000","$0","$2,000","$30","$2,000","$0","$1,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S04E-AI2_SBC.pdf","www.bcbst.com/brochures","21"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","7","14002","TN","Individual","No","62-0427913","14002TN0330023","Silver S04E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330023-04","73% AV Level Silver Plan",,"0.737057030200958","Yes","Yes","No","100%",,"$1,000","$0","$2,700","$30","$1,000","$0","$2,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S04E-A_SBC.pdf","www.bcbst.com/brochures","22"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","7","14002","TN","Individual","No","62-0427913","14002TN0330023","Silver S04E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330023-05","87% AV Level Silver Plan",,"0.870630919933319","Yes","Yes","No","100%",,"$0","$0","$1,400","$30","$0","$0","$1,400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S04E-B_SBC.pdf","www.bcbst.com/brochures","23"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","7","14002","TN","Individual","No","62-0427913","14002TN0330023","Silver S04E, Network E","14002TN033",,"TNN003","TNS004","TNF022","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330023-06","94% AV Level Silver Plan",,"0.938233137130737","Yes","Yes","No","100%",,"$0","$0","$500","$30","$0","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S04E-C_SBC.pdf","www.bcbst.com/brochures","24"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","8","14002","TN","Individual","No","62-0427913","14002TN0330005","Silver S08S, Network S","14002TN033",,"TNN002","TNS010","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330005-00","Standard Silver Off Exchange Plan",,"0.717611312866211","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$30","$2,000","$0","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/S08S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","8","14002","TN","Individual","No","62-0427913","14002TN0330005","Silver S08S, Network S","14002TN033",,"TNN002","TNS010","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330005-01","Standard Silver On Exchange Plan",,"0.717611312866211","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$30","$2,000","$0","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S08S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","8","14002","TN","Individual","No","62-0427913","14002TN0330005","Silver S08S, Network S","14002TN033",,"TNN002","TNS010","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S08S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","8","14002","TN","Individual","No","62-0427913","14002TN0330005","Silver S08S, Network S","14002TN033",,"TNN002","TNS010","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330005-03","Limited Cost Sharing Plan Variation",,"0.717611312866211","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$30","$2,000","$0","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S08S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","8","14002","TN","Individual","No","62-0427913","14002TN0330005","Silver S08S, Network S","14002TN033",,"TNN002","TNS010","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330005-04","73% AV Level Silver Plan",,"0.7394158244133","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$30","$2,000","$0","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S08S-A_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","8","14002","TN","Individual","No","62-0427913","14002TN0330005","Silver S08S, Network S","14002TN033",,"TNN002","TNS010","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330005-05","87% AV Level Silver Plan",,"0.871699452400208","Yes","Yes","No","100%",,"$300","$0","$1,400","$30","$300","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S08S-B_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","8","14002","TN","Individual","No","62-0427913","14002TN0330005","Silver S08S, Network S","14002TN033",,"TNN002","TNS010","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330005-06","94% AV Level Silver Plan",,"0.93526965379715","Yes","Yes","No","100%",,"$0","$0","$800","$30","$0","$0","$800","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S08S-C_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","8","14002","TN","Individual","No","62-0427913","14002TN0330015","Silver S08E, Network E","14002TN033",,"TNN003","TNS009","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330015-00","Standard Silver Off Exchange Plan",,"0.717611312866211","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$30","$2,000","$0","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/S08E_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","8","14002","TN","Individual","No","62-0427913","14002TN0330015","Silver S08E, Network E","14002TN033",,"TNN003","TNS009","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330015-01","Standard Silver On Exchange Plan",,"0.717611312866211","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$30","$2,000","$0","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S08E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","8","14002","TN","Individual","No","62-0427913","14002TN0330015","Silver S08E, Network E","14002TN033",,"TNN003","TNS009","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S08E-AI1_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","8","14002","TN","Individual","No","62-0427913","14002TN0330015","Silver S08E, Network E","14002TN033",,"TNN003","TNS009","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330015-03","Limited Cost Sharing Plan Variation",,"0.717611312866211","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$30","$2,000","$0","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S08E-AI2_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","8","14002","TN","Individual","No","62-0427913","14002TN0330015","Silver S08E, Network E","14002TN033",,"TNN003","TNS009","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330015-04","73% AV Level Silver Plan",,"0.7394158244133","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$30","$2,000","$0","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S08E-A_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","8","14002","TN","Individual","No","62-0427913","14002TN0330015","Silver S08E, Network E","14002TN033",,"TNN003","TNS009","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330015-05","87% AV Level Silver Plan",,"0.871699452400208","Yes","Yes","No","100%",,"$300","$0","$1,400","$30","$300","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S08E-B_SBC.pdf","www.bcbst.com/brochures","16"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","10","14002","TN","Individual","No","62-0427913","14002TN0330027","Silver S11E, Network E","14002TN033",,"TNN003","TNS004","TNF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330027-06","94% AV Level Silver Plan",,"0.93783438205719","No","Yes","No","100%",,"$0","$30","$700","$30","$0","$600","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11E-C_SBC.pdf","www.bcbst.com/brochures","24"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","11","14002","TN","Individual","No","62-0427913","14002TN0330008","Silver S12S, Network S","14002TN033",,"TNN002","TNS010","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330008-00","Standard Silver Off Exchange Plan",,"0.707108318805695","Yes","Yes","No","100%",,"$4,000","$0","$600","$30","$4,000","$60","$40","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/S12S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","11","14002","TN","Individual","No","62-0427913","14002TN0330008","Silver S12S, Network S","14002TN033",,"TNN002","TNS010","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330008-01","Standard Silver On Exchange Plan",,"0.707108318805695","Yes","Yes","No","100%",,"$4,000","$0","$600","$30","$4,000","$60","$40","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S12S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","11","14002","TN","Individual","No","62-0427913","14002TN0330008","Silver S12S, Network S","14002TN033",,"TNN002","TNS010","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S12S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","11","14002","TN","Individual","No","62-0427913","14002TN0330008","Silver S12S, Network S","14002TN033",,"TNN002","TNS010","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330008-03","Limited Cost Sharing Plan Variation",,"0.707108318805695","Yes","Yes","No","100%",,"$4,000","$0","$600","$30","$4,000","$60","$40","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S12S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","11","14002","TN","Individual","No","62-0427913","14002TN0330008","Silver S12S, Network S","14002TN033",,"TNN002","TNS010","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330008-04","73% AV Level Silver Plan",,"0.735155284404755","Yes","Yes","No","100%",,"$3,000","$0","$800","$30","$3,000","$60","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S12S-A_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","11","14002","TN","Individual","No","62-0427913","14002TN0330008","Silver S12S, Network S","14002TN033",,"TNN002","TNS010","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330008-05","87% AV Level Silver Plan",,"0.866357207298279","Yes","Yes","No","100%",,"$800","$0","$1,200","$30","$800","$60","$700","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S12S-B_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","11","14002","TN","Individual","No","62-0427913","14002TN0330008","Silver S12S, Network S","14002TN033",,"TNN002","TNS010","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330008-06","94% AV Level Silver Plan",,"0.93218195438385","Yes","Yes","No","100%",,"$0","$0","$1,000","$30","$0","$60","$800","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S12S-C_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","11","14002","TN","Individual","No","62-0427913","14002TN0330018","Silver S12E, Network E","14002TN033",,"TNN003","TNS009","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330018-00","Standard Silver Off Exchange Plan",,"0.707108318805695","Yes","Yes","No","100%",,"$4,000","$0","$600","$30","$4,000","$60","$40","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/S12E_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","11","14002","TN","Individual","No","62-0427913","14002TN0330018","Silver S12E, Network E","14002TN033",,"TNN003","TNS009","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330018-01","Standard Silver On Exchange Plan",,"0.707108318805695","Yes","Yes","No","100%",,"$4,000","$0","$600","$30","$4,000","$60","$40","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S12E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","11","14002","TN","Individual","No","62-0427913","14002TN0330018","Silver S12E, Network E","14002TN033",,"TNN003","TNS009","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S12E-AI1_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","11","14002","TN","Individual","No","62-0427913","14002TN0330018","Silver S12E, Network E","14002TN033",,"TNN003","TNS009","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330018-03","Limited Cost Sharing Plan Variation",,"0.707108318805695","Yes","Yes","No","100%",,"$4,000","$0","$600","$30","$4,000","$60","$40","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S12E-AI2_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","11","14002","TN","Individual","No","62-0427913","14002TN0330018","Silver S12E, Network E","14002TN033",,"TNN003","TNS009","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330018-04","73% AV Level Silver Plan",,"0.735155284404755","Yes","Yes","No","100%",,"$3,000","$0","$800","$30","$3,000","$60","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S12E-A_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","8","14002","TN","Individual","No","62-0427913","14002TN0330015","Silver S08E, Network E","14002TN033",,"TNN003","TNS009","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330015-06","94% AV Level Silver Plan",,"0.93526965379715","Yes","Yes","No","100%",,"$0","$0","$800","$30","$0","$0","$800","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S08E-C_SBC.pdf","www.bcbst.com/brochures","17"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","8","14002","TN","Individual","No","62-0427913","14002TN0330025","Silver S08E, Network E","14002TN033",,"TNN003","TNS004","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330025-00","Standard Silver Off Exchange Plan",,"0.717611312866211","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$30","$2,000","$0","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/S08E_SBC.pdf","www.bcbst.com/brochures","18"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","8","14002","TN","Individual","No","62-0427913","14002TN0330025","Silver S08E, Network E","14002TN033",,"TNN003","TNS004","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330025-01","Standard Silver On Exchange Plan",,"0.717611312866211","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$30","$2,000","$0","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S08E_SBC.pdf","www.bcbst.com/brochures","19"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","8","14002","TN","Individual","No","62-0427913","14002TN0330025","Silver S08E, Network E","14002TN033",,"TNN003","TNS004","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330025-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S08E-AI1_SBC.pdf","www.bcbst.com/brochures","20"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","8","14002","TN","Individual","No","62-0427913","14002TN0330025","Silver S08E, Network E","14002TN033",,"TNN003","TNS004","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330025-03","Limited Cost Sharing Plan Variation",,"0.717611312866211","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$30","$2,000","$0","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S08E-AI2_SBC.pdf","www.bcbst.com/brochures","21"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","8","14002","TN","Individual","No","62-0427913","14002TN0330025","Silver S08E, Network E","14002TN033",,"TNN003","TNS004","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330025-04","73% AV Level Silver Plan",,"0.7394158244133","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$30","$2,000","$0","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S08E-A_SBC.pdf","www.bcbst.com/brochures","22"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","8","14002","TN","Individual","No","62-0427913","14002TN0330025","Silver S08E, Network E","14002TN033",,"TNN003","TNS004","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330025-05","87% AV Level Silver Plan",,"0.871699452400208","Yes","Yes","No","100%",,"$300","$0","$1,400","$30","$300","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S08E-B_SBC.pdf","www.bcbst.com/brochures","23"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","8","14002","TN","Individual","No","62-0427913","14002TN0330025","Silver S08E, Network E","14002TN033",,"TNN003","TNS004","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330025-06","94% AV Level Silver Plan",,"0.93526965379715","Yes","Yes","No","100%",,"$0","$0","$800","$30","$0","$0","$800","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S08E-C_SBC.pdf","www.bcbst.com/brochures","24"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","9","14002","TN","Individual","No","62-0427913","14002TN0330006","Silver S09S, Network S","14002TN033",,"TNN002","TNS010","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330006-00","Standard Silver Off Exchange Plan",,"0.704136252403259","Yes","Yes","No","100%",,"$2,500","$0","$1,000","$30","$2,500","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/S09S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","9","14002","TN","Individual","No","62-0427913","14002TN0330006","Silver S09S, Network S","14002TN033",,"TNN002","TNS010","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330006-01","Standard Silver On Exchange Plan",,"0.704136252403259","Yes","Yes","No","100%",,"$2,500","$0","$1,000","$30","$2,500","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S09S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","9","14002","TN","Individual","No","62-0427913","14002TN0330006","Silver S09S, Network S","14002TN033",,"TNN002","TNS010","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S09S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","9","14002","TN","Individual","No","62-0427913","14002TN0330006","Silver S09S, Network S","14002TN033",,"TNN002","TNS010","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330006-03","Limited Cost Sharing Plan Variation",,"0.704136252403259","Yes","Yes","No","100%",,"$2,500","$0","$1,000","$30","$2,500","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S09S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","9","14002","TN","Individual","No","62-0427913","14002TN0330006","Silver S09S, Network S","14002TN033",,"TNN002","TNS010","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330006-04","73% AV Level Silver Plan",,"0.7394158244133","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$30","$2,000","$0","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S09S-A_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","9","14002","TN","Individual","No","62-0427913","14002TN0330006","Silver S09S, Network S","14002TN033",,"TNN002","TNS010","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330006-05","87% AV Level Silver Plan",,"0.871699452400208","Yes","Yes","No","100%",,"$300","$0","$1,400","$30","$300","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S09S-B_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","9","14002","TN","Individual","No","62-0427913","14002TN0330006","Silver S09S, Network S","14002TN033",,"TNN002","TNS010","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330006-06","94% AV Level Silver Plan",,"0.93526965379715","Yes","Yes","No","100%",,"$0","$0","$800","$30","$0","$0","$800","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S09S-C_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","9","14002","TN","Individual","No","62-0427913","14002TN0330016","Silver S09E, Network E","14002TN033",,"TNN003","TNS009","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330016-00","Standard Silver Off Exchange Plan",,"0.704136252403259","Yes","Yes","No","100%",,"$2,500","$0","$1,000","$30","$2,500","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/S09E_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","9","14002","TN","Individual","No","62-0427913","14002TN0330026","Silver S09E, Network E","14002TN033",,"TNN003","TNS004","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330026-06","94% AV Level Silver Plan",,"0.93526965379715","Yes","Yes","No","100%",,"$0","$0","$800","$30","$0","$0","$800","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S09E-C_SBC.pdf","www.bcbst.com/brochures","24"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","10","14002","TN","Individual","No","62-0427913","14002TN0330007","Silver S11S, Network S","14002TN033",,"TNN002","TNS010","TNF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330007-00","Standard Silver Off Exchange Plan",,"0.706067264080048","No","Yes","No","100%",,"$2,500","$50","$900","$30","$800","$1,300","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/129800/S11S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","10","14002","TN","Individual","No","62-0427913","14002TN0330007","Silver S11S, Network S","14002TN033",,"TNN002","TNS010","TNF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330007-01","Standard Silver On Exchange Plan",,"0.706067264080048","No","Yes","No","100%",,"$2,500","$50","$900","$30","$800","$1,300","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","10","14002","TN","Individual","No","62-0427913","14002TN0330007","Silver S11S, Network S","14002TN033",,"TNN002","TNS010","TNF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","10","14002","TN","Individual","No","62-0427913","14002TN0330007","Silver S11S, Network S","14002TN033",,"TNN002","TNS010","TNF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330007-03","Limited Cost Sharing Plan Variation",,"0.706067264080048","No","Yes","No","100%",,"$2,500","$50","$900","$30","$800","$1,300","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","10","14002","TN","Individual","No","62-0427913","14002TN0330007","Silver S11S, Network S","14002TN033",,"TNN002","TNS010","TNF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330007-04","73% AV Level Silver Plan",,"0.726508617401123","No","Yes","No","100%",,"$2,500","$50","$900","$30","$800","$1,300","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11S-A_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","10","14002","TN","Individual","No","62-0427913","14002TN0330007","Silver S11S, Network S","14002TN033",,"TNN002","TNS010","TNF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330007-05","87% AV Level Silver Plan",,"0.874034881591797","No","Yes","No","100%",,"$500","$30","$1,000","$30","$500","$900","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11S-B_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","10","14002","TN","Individual","No","62-0427913","14002TN0330007","Silver S11S, Network S","14002TN033",,"TNN002","TNS010","TNF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330007-06","94% AV Level Silver Plan",,"0.93783438205719","No","Yes","No","100%",,"$0","$30","$700","$30","$0","$600","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11S-C_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","10","14002","TN","Individual","No","62-0427913","14002TN0330017","Silver S11E, Network E","14002TN033",,"TNN003","TNS009","TNF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330017-00","Standard Silver Off Exchange Plan",,"0.706067264080048","No","Yes","No","100%",,"$2,500","$50","$900","$30","$800","$1,300","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/129800/S11E_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","10","14002","TN","Individual","No","62-0427913","14002TN0330017","Silver S11E, Network E","14002TN033",,"TNN003","TNS009","TNF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330017-01","Standard Silver On Exchange Plan",,"0.706067264080048","No","Yes","No","100%",,"$2,500","$50","$900","$30","$800","$1,300","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","10","14002","TN","Individual","No","62-0427913","14002TN0330017","Silver S11E, Network E","14002TN033",,"TNN003","TNS009","TNF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330017-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11E-AI1_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","10","14002","TN","Individual","No","62-0427913","14002TN0330017","Silver S11E, Network E","14002TN033",,"TNN003","TNS009","TNF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330017-03","Limited Cost Sharing Plan Variation",,"0.706067264080048","No","Yes","No","100%",,"$2,500","$50","$900","$30","$800","$1,300","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11E-AI2_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","10","14002","TN","Individual","No","62-0427913","14002TN0330017","Silver S11E, Network E","14002TN033",,"TNN003","TNS009","TNF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330017-04","73% AV Level Silver Plan",,"0.726508617401123","No","Yes","No","100%",,"$2,500","$50","$900","$30","$800","$1,300","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11E-A_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","10","14002","TN","Individual","No","62-0427913","14002TN0330017","Silver S11E, Network E","14002TN033",,"TNN003","TNS009","TNF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330017-05","87% AV Level Silver Plan",,"0.874034881591797","No","Yes","No","100%",,"$500","$30","$1,000","$30","$500","$900","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11E-B_SBC.pdf","www.bcbst.com/brochures","16"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","12","14002","TN","Individual","No","62-0427913","14002TN0330029","Silver S14E, Network E","14002TN033",,"TNN003","TNS004","TNF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330029-00","Standard Silver Off Exchange Plan",,"0.70751678943634","No","Yes","No","100%",,"$5,500","$20","$200","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/129800/S14E_SBC.pdf","www.bcbst.com/brochures","18"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","12","14002","TN","Individual","No","62-0427913","14002TN0330029","Silver S14E, Network E","14002TN033",,"TNN003","TNS004","TNF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330029-01","Standard Silver On Exchange Plan",,"0.70751678943634","No","Yes","No","100%",,"$5,500","$20","$200","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S14E_SBC.pdf","www.bcbst.com/brochures","19"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","12","14002","TN","Individual","No","62-0427913","14002TN0330029","Silver S14E, Network E","14002TN033",,"TNN003","TNS004","TNF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330029-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S14E-AI1_SBC.pdf","www.bcbst.com/brochures","20"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","12","14002","TN","Individual","No","62-0427913","14002TN0330029","Silver S14E, Network E","14002TN033",,"TNN003","TNS004","TNF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330029-03","Limited Cost Sharing Plan Variation",,"0.70751678943634","No","Yes","No","100%",,"$5,500","$20","$200","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S14E-AI2_SBC.pdf","www.bcbst.com/brochures","21"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","12","14002","TN","Individual","No","62-0427913","14002TN0330029","Silver S14E, Network E","14002TN033",,"TNN003","TNS004","TNF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330029-04","73% AV Level Silver Plan",,"0.738651216030121","No","Yes","No","100%",,"$4,500","$20","$400","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S14E-A_SBC.pdf","www.bcbst.com/brochures","22"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","10","14002","TN","Individual","No","62-0427913","14002TN0330017","Silver S11E, Network E","14002TN033",,"TNN003","TNS009","TNF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330017-06","94% AV Level Silver Plan",,"0.93783438205719","No","Yes","No","100%",,"$0","$30","$700","$30","$0","$600","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11E-C_SBC.pdf","www.bcbst.com/brochures","17"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","10","14002","TN","Individual","No","62-0427913","14002TN0330027","Silver S11E, Network E","14002TN033",,"TNN003","TNS004","TNF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330027-00","Standard Silver Off Exchange Plan",,"0.706067264080048","No","Yes","No","100%",,"$2,500","$50","$900","$30","$800","$1,300","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/129800/S11E_SBC.pdf","www.bcbst.com/brochures","18"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","10","14002","TN","Individual","No","62-0427913","14002TN0330027","Silver S11E, Network E","14002TN033",,"TNN003","TNS004","TNF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330027-01","Standard Silver On Exchange Plan",,"0.706067264080048","No","Yes","No","100%",,"$2,500","$50","$900","$30","$800","$1,300","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11E_SBC.pdf","www.bcbst.com/brochures","19"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","10","14002","TN","Individual","No","62-0427913","14002TN0330027","Silver S11E, Network E","14002TN033",,"TNN003","TNS004","TNF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330027-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11E-AI1_SBC.pdf","www.bcbst.com/brochures","20"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","10","14002","TN","Individual","No","62-0427913","14002TN0330027","Silver S11E, Network E","14002TN033",,"TNN003","TNS004","TNF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330027-03","Limited Cost Sharing Plan Variation",,"0.706067264080048","No","Yes","No","100%",,"$2,500","$50","$900","$30","$800","$1,300","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11E-AI2_SBC.pdf","www.bcbst.com/brochures","21"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","10","14002","TN","Individual","No","62-0427913","14002TN0330027","Silver S11E, Network E","14002TN033",,"TNN003","TNS004","TNF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330027-04","73% AV Level Silver Plan",,"0.726508617401123","No","Yes","No","100%",,"$2,500","$50","$900","$30","$800","$1,300","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11E-A_SBC.pdf","www.bcbst.com/brochures","22"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","10","14002","TN","Individual","No","62-0427913","14002TN0330027","Silver S11E, Network E","14002TN033",,"TNN003","TNS004","TNF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330027-05","87% AV Level Silver Plan",,"0.874034881591797","No","Yes","No","100%",,"$500","$30","$1,000","$30","$500","$900","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11E-B_SBC.pdf","www.bcbst.com/brochures","23"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","11","14002","TN","Individual","No","62-0427913","14002TN0330018","Silver S12E, Network E","14002TN033",,"TNN003","TNS009","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330018-05","87% AV Level Silver Plan",,"0.866357207298279","Yes","Yes","No","100%",,"$800","$0","$1,200","$30","$800","$60","$700","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S12E-B_SBC.pdf","www.bcbst.com/brochures","16"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","11","14002","TN","Individual","No","62-0427913","14002TN0330018","Silver S12E, Network E","14002TN033",,"TNN003","TNS009","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330018-06","94% AV Level Silver Plan",,"0.93218195438385","Yes","Yes","No","100%",,"$0","$0","$1,000","$30","$0","$60","$800","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S12E-C_SBC.pdf","www.bcbst.com/brochures","17"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","11","14002","TN","Individual","No","62-0427913","14002TN0330028","Silver S12E, Network E","14002TN033",,"TNN003","TNS004","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330028-00","Standard Silver Off Exchange Plan",,"0.707108318805695","Yes","Yes","No","100%",,"$4,000","$0","$600","$30","$4,000","$60","$40","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/S12E_SBC.pdf","www.bcbst.com/brochures","18"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","11","14002","TN","Individual","No","62-0427913","14002TN0330028","Silver S12E, Network E","14002TN033",,"TNN003","TNS004","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330028-01","Standard Silver On Exchange Plan",,"0.707108318805695","Yes","Yes","No","100%",,"$4,000","$0","$600","$30","$4,000","$60","$40","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S12E_SBC.pdf","www.bcbst.com/brochures","19"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","11","14002","TN","Individual","No","62-0427913","14002TN0330028","Silver S12E, Network E","14002TN033",,"TNN003","TNS004","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330028-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S12E-AI1_SBC.pdf","www.bcbst.com/brochures","20"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","11","14002","TN","Individual","No","62-0427913","14002TN0330028","Silver S12E, Network E","14002TN033",,"TNN003","TNS004","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330028-03","Limited Cost Sharing Plan Variation",,"0.707108318805695","Yes","Yes","No","100%",,"$4,000","$0","$600","$30","$4,000","$60","$40","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S12E-AI2_SBC.pdf","www.bcbst.com/brochures","21"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","11","14002","TN","Individual","No","62-0427913","14002TN0330028","Silver S12E, Network E","14002TN033",,"TNN003","TNS004","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330028-04","73% AV Level Silver Plan",,"0.735155284404755","Yes","Yes","No","100%",,"$3,000","$0","$800","$30","$3,000","$60","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S12E-A_SBC.pdf","www.bcbst.com/brochures","22"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","11","14002","TN","Individual","No","62-0427913","14002TN0330028","Silver S12E, Network E","14002TN033",,"TNN003","TNS004","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330028-05","87% AV Level Silver Plan",,"0.866357207298279","Yes","Yes","No","100%",,"$800","$0","$1,200","$30","$800","$60","$700","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S12E-B_SBC.pdf","www.bcbst.com/brochures","23"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","11","14002","TN","Individual","No","62-0427913","14002TN0330028","Silver S12E, Network E","14002TN033",,"TNN003","TNS004","TNF026","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330028-06","94% AV Level Silver Plan",,"0.93218195438385","Yes","Yes","No","100%",,"$0","$0","$1,000","$30","$0","$60","$800","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S12E-C_SBC.pdf","www.bcbst.com/brochures","24"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","12","14002","TN","Individual","No","62-0427913","14002TN0330009","Silver S14S, Network S","14002TN033",,"TNN002","TNS010","TNF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330009-00","Standard Silver Off Exchange Plan",,"0.70751678943634","No","Yes","No","100%",,"$5,500","$20","$200","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/129800/S14S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","12","14002","TN","Individual","No","62-0427913","14002TN0330009","Silver S14S, Network S","14002TN033",,"TNN002","TNS010","TNF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330009-01","Standard Silver On Exchange Plan",,"0.70751678943634","No","Yes","No","100%",,"$5,500","$20","$200","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S14S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","12","14002","TN","Individual","No","62-0427913","14002TN0330009","Silver S14S, Network S","14002TN033",,"TNN002","TNS010","TNF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S14S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","12","14002","TN","Individual","No","62-0427913","14002TN0330009","Silver S14S, Network S","14002TN033",,"TNN002","TNS010","TNF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330009-03","Limited Cost Sharing Plan Variation",,"0.70751678943634","No","Yes","No","100%",,"$5,500","$20","$200","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S14S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","12","14002","TN","Individual","No","62-0427913","14002TN0330009","Silver S14S, Network S","14002TN033",,"TNN002","TNS010","TNF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330009-04","73% AV Level Silver Plan",,"0.738651216030121","No","Yes","No","100%",,"$4,500","$20","$400","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S14S-A_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","12","14002","TN","Individual","No","62-0427913","14002TN0330009","Silver S14S, Network S","14002TN033",,"TNN002","TNS010","TNF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330009-05","87% AV Level Silver Plan",,"0.871702313423157","No","Yes","No","100%",,"$800","$20","$1,200","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S14S-B_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","12","14002","TN","Individual","No","62-0427913","14002TN0330009","Silver S14S, Network S","14002TN033",,"TNN002","TNS010","TNF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330009-06","94% AV Level Silver Plan",,"0.938862144947052","No","Yes","No","100%",,"$0","$10","$800","$30","$0","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S14S-C_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","12","14002","TN","Individual","No","62-0427913","14002TN0330019","Silver S14E, Network E","14002TN033",,"TNN003","TNS009","TNF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330019-00","Standard Silver Off Exchange Plan",,"0.70751678943634","No","Yes","No","100%",,"$5,500","$20","$200","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/129800/S14E_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","12","14002","TN","Individual","No","62-0427913","14002TN0330019","Silver S14E, Network E","14002TN033",,"TNN003","TNS009","TNF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330019-01","Standard Silver On Exchange Plan",,"0.70751678943634","No","Yes","No","100%",,"$5,500","$20","$200","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S14E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","12","14002","TN","Individual","No","62-0427913","14002TN0330019","Silver S14E, Network E","14002TN033",,"TNN003","TNS009","TNF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330019-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S14E-AI1_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","12","14002","TN","Individual","No","62-0427913","14002TN0330019","Silver S14E, Network E","14002TN033",,"TNN003","TNS009","TNF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330019-03","Limited Cost Sharing Plan Variation",,"0.70751678943634","No","Yes","No","100%",,"$5,500","$20","$200","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S14E-AI2_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","12","14002","TN","Individual","No","62-0427913","14002TN0330019","Silver S14E, Network E","14002TN033",,"TNN003","TNS009","TNF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330019-04","73% AV Level Silver Plan",,"0.738651216030121","No","Yes","No","100%",,"$4,500","$20","$400","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S14E-A_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","12","14002","TN","Individual","No","62-0427913","14002TN0330019","Silver S14E, Network E","14002TN033",,"TNN003","TNS009","TNF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330019-05","87% AV Level Silver Plan",,"0.871702313423157","No","Yes","No","100%",,"$800","$20","$1,200","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S14E-B_SBC.pdf","www.bcbst.com/brochures","16"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","12","14002","TN","Individual","No","62-0427913","14002TN0330019","Silver S14E, Network E","14002TN033",,"TNN003","TNS009","TNF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330019-06","94% AV Level Silver Plan",,"0.938862144947052","No","Yes","No","100%",,"$0","$10","$800","$30","$0","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S14E-C_SBC.pdf","www.bcbst.com/brochures","17"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","12","14002","TN","Individual","No","62-0427913","14002TN0330029","Silver S14E, Network E","14002TN033",,"TNN003","TNS004","TNF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330029-05","87% AV Level Silver Plan",,"0.871702313423157","No","Yes","No","100%",,"$800","$20","$1,200","$30","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S14E-B_SBC.pdf","www.bcbst.com/brochures","23"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","12","14002","TN","Individual","No","62-0427913","14002TN0330029","Silver S14E, Network E","14002TN033",,"TNN003","TNS004","TNF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330029-06","94% AV Level Silver Plan",,"0.938862144947052","No","Yes","No","100%",,"$0","$10","$800","$30","$0","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S14E-C_SBC.pdf","www.bcbst.com/brochures","24"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","13","14002","TN","Individual","No","62-0427913","14002TN0330010","Silver S16S, Network S","14002TN033",,"TNN002","TNS010","TNF028","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330010-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/129800/S16S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","13","14002","TN","Individual","No","62-0427913","14002TN0330010","Silver S16S, Network S","14002TN033",,"TNN002","TNS010","TNF028","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330010-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/127600/S16S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","13","14002","TN","Individual","No","62-0427913","14002TN0330010","Silver S16S, Network S","14002TN033",,"TNN002","TNS010","TNF028","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S16S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","13","14002","TN","Individual","No","62-0427913","14002TN0330010","Silver S16S, Network S","14002TN033",,"TNN002","TNS010","TNF028","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330010-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S16S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","13","14002","TN","Individual","No","62-0427913","14002TN0330010","Silver S16S, Network S","14002TN033",,"TNN002","TNS010","TNF028","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330010-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$30","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/127600/S16S-A_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","13","14002","TN","Individual","No","62-0427913","14002TN0330010","Silver S16S, Network S","14002TN033",,"TNN002","TNS010","TNF028","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330010-05","87% AV Level Silver Plan",,"0.874577879905701","Yes","Yes","No","100%",,"$1,200","$0","$0","$30","$1,200","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S16S-B_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","13","14002","TN","Individual","No","62-0427913","14002TN0330010","Silver S16S, Network S","14002TN033",,"TNN002","TNS010","TNF028","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330010-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S16S-C_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","13","14002","TN","Individual","No","62-0427913","14002TN0330020","Silver S16E, Network E","14002TN033",,"TNN003","TNS009","TNF028","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330020-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/129800/S16E_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","13","14002","TN","Individual","No","62-0427913","14002TN0330020","Silver S16E, Network E","14002TN033",,"TNN003","TNS009","TNF028","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330020-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/127600/S16E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","13","14002","TN","Individual","No","62-0427913","14002TN0330020","Silver S16E, Network E","14002TN033",,"TNN003","TNS009","TNF028","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330020-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S16E-AI1_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","13","14002","TN","Individual","No","62-0427913","14002TN0330020","Silver S16E, Network E","14002TN033",,"TNN003","TNS009","TNF028","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330020-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S16E-AI2_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","13","14002","TN","Individual","No","62-0427913","14002TN0330020","Silver S16E, Network E","14002TN033",,"TNN003","TNS009","TNF028","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330020-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$30","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/127600/S16E-A_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","16","14002","TN","Individual","No","62-0427913","14002TN0330058","Gold G06E, Network E","14002TN033",,"TNN003","TNS009","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330058-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G06E-AI1_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","16","14002","TN","Individual","No","62-0427913","14002TN0330058","Gold G06E, Network E","14002TN033",,"TNN003","TNS009","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330058-03","Limited Cost Sharing Plan Variation",,"0.800518870353699","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G06E-AI2_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","16","14002","TN","Individual","No","62-0427913","14002TN0330063","Gold G06E, Network E","14002TN033",,"TNN003","TNS004","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330063-00","Standard Gold Off Exchange Plan",,"0.800518870353699","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/129800/G06E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","16","14002","TN","Individual","No","62-0427913","14002TN0330063","Gold G06E, Network E","14002TN033",,"TNN003","TNS004","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330063-01","Standard Gold On Exchange Plan",,"0.800518870353699","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G06E_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","16","14002","TN","Individual","No","62-0427913","14002TN0330063","Gold G06E, Network E","14002TN033",,"TNN003","TNS004","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330063-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G06E-AI1_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","16","14002","TN","Individual","No","62-0427913","14002TN0330063","Gold G06E, Network E","14002TN033",,"TNN003","TNS004","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330063-03","Limited Cost Sharing Plan Variation",,"0.800518870353699","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G06E-AI2_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","17","14002","TN","Individual","No","62-0427913","14002TN0330054","Gold G08S, Network S","14002TN033",,"TNN002","TNS010","TNF028","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330054-00","Standard Gold Off Exchange Plan",,"0.799147665500641","Yes","Yes","No","100%",,"$2,100","$0","$0","$30","$2,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/G08S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","17","14002","TN","Individual","No","62-0427913","14002TN0330054","Gold G08S, Network S","14002TN033",,"TNN002","TNS010","TNF028","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330054-01","Standard Gold On Exchange Plan",,"0.799147665500641","Yes","Yes","No","100%",,"$2,100","$0","$0","$30","$2,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/G08S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","17","14002","TN","Individual","No","62-0427913","14002TN0330054","Gold G08S, Network S","14002TN033",,"TNN002","TNS010","TNF028","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330054-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/G08S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","17","14002","TN","Individual","No","62-0427913","14002TN0330054","Gold G08S, Network S","14002TN033",,"TNN002","TNS010","TNF028","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330054-03","Limited Cost Sharing Plan Variation",,"0.799147665500641","Yes","Yes","No","100%",,"$2,100","$0","$0","$30","$2,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/G08S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","17","14002","TN","Individual","No","62-0427913","14002TN0330059","Gold G08E, Network E","14002TN033",,"TNN003","TNS009","TNF028","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330059-00","Standard Gold Off Exchange Plan",,"0.799147665500641","Yes","Yes","No","100%",,"$2,100","$0","$0","$30","$2,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/G08E_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","17","14002","TN","Individual","No","62-0427913","14002TN0330059","Gold G08E, Network E","14002TN033",,"TNN003","TNS009","TNF028","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330059-01","Standard Gold On Exchange Plan",,"0.799147665500641","Yes","Yes","No","100%",,"$2,100","$0","$0","$30","$2,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/G08E_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","13","14002","TN","Individual","No","62-0427913","14002TN0330020","Silver S16E, Network E","14002TN033",,"TNN003","TNS009","TNF028","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330020-05","87% AV Level Silver Plan",,"0.874577879905701","Yes","Yes","No","100%",,"$1,200","$0","$0","$30","$1,200","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S16E-B_SBC.pdf","www.bcbst.com/brochures","16"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","13","14002","TN","Individual","No","62-0427913","14002TN0330020","Silver S16E, Network E","14002TN033",,"TNN003","TNS009","TNF028","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330020-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S16E-C_SBC.pdf","www.bcbst.com/brochures","17"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","13","14002","TN","Individual","No","62-0427913","14002TN0330030","Silver S16E, Network E","14002TN033",,"TNN003","TNS004","TNF028","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330030-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/129800/S16E_SBC.pdf","www.bcbst.com/brochures","18"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","13","14002","TN","Individual","No","62-0427913","14002TN0330030","Silver S16E, Network E","14002TN033",,"TNN003","TNS004","TNF028","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330030-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/127600/S16E_SBC.pdf","www.bcbst.com/brochures","19"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","13","14002","TN","Individual","No","62-0427913","14002TN0330030","Silver S16E, Network E","14002TN033",,"TNN003","TNS004","TNF028","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330030-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S16E-AI1_SBC.pdf","www.bcbst.com/brochures","20"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","13","14002","TN","Individual","No","62-0427913","14002TN0330030","Silver S16E, Network E","14002TN033",,"TNN003","TNS004","TNF028","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330030-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S16E-AI2_SBC.pdf","www.bcbst.com/brochures","21"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","13","14002","TN","Individual","No","62-0427913","14002TN0330030","Silver S16E, Network E","14002TN033",,"TNN003","TNS004","TNF028","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330030-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$30","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/127600/S16E-A_SBC.pdf","www.bcbst.com/brochures","22"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","13","14002","TN","Individual","No","62-0427913","14002TN0330030","Silver S16E, Network E","14002TN033",,"TNN003","TNS004","TNF028","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330030-05","87% AV Level Silver Plan",,"0.874577879905701","Yes","Yes","No","100%",,"$1,200","$0","$0","$30","$1,200","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S16E-B_SBC.pdf","www.bcbst.com/brochures","23"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","13","14002","TN","Individual","No","62-0427913","14002TN0330030","Silver S16E, Network E","14002TN033",,"TNN003","TNS004","TNF028","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330030-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S16E-C_SBC.pdf","www.bcbst.com/brochures","24"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","14","14002","TN","Individual","No","62-0427913","14002TN0330033","Silver S19S, Network S","14002TN033",,"TNN002","TNS010","TNF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330033-00","Standard Silver Off Exchange Plan",,"0.704510569572449","Yes","Yes","No","100%",,"$3,000","$0","$400","$30","$3,000","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/129800/S19S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","14","14002","TN","Individual","No","62-0427913","14002TN0330033","Silver S19S, Network S","14002TN033",,"TNN002","TNS010","TNF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330033-01","Standard Silver On Exchange Plan",,"0.704510569572449","Yes","Yes","No","100%",,"$3,000","$0","$400","$30","$3,000","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/127600/S19S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","14","14002","TN","Individual","No","62-0427913","14002TN0330033","Silver S19S, Network S","14002TN033",,"TNN002","TNS010","TNF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330033-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S19S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","14","14002","TN","Individual","No","62-0427913","14002TN0330033","Silver S19S, Network S","14002TN033",,"TNN002","TNS010","TNF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330033-03","Limited Cost Sharing Plan Variation",,"0.704510569572449","Yes","Yes","No","100%",,"$3,000","$0","$400","$30","$3,000","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S19S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","14","14002","TN","Individual","No","62-0427913","14002TN0330033","Silver S19S, Network S","14002TN033",,"TNN002","TNS010","TNF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330033-04","73% AV Level Silver Plan",,"0.739209413528442","Yes","Yes","No","100%",,"$2,300","$0","$500","$30","$2,300","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S19S-A_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","14","14002","TN","Individual","No","62-0427913","14002TN0330033","Silver S19S, Network S","14002TN033",,"TNN002","TNS010","TNF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330033-05","87% AV Level Silver Plan",,"0.875774443149567","Yes","Yes","No","100%",,"$550","$0","$700","$30","$550","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S19S-B_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","14","14002","TN","Individual","No","62-0427913","14002TN0330033","Silver S19S, Network S","14002TN033",,"TNN002","TNS010","TNF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330033-06","94% AV Level Silver Plan",,"0.932194650173187","Yes","Yes","No","100%",,"$0","$0","$700","$30","$0","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S19S-C_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","14","14002","TN","Individual","No","62-0427913","14002TN0330031","Silver S19E, Network E","14002TN033",,"TNN003","TNS009","TNF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330031-00","Standard Silver Off Exchange Plan",,"0.704510569572449","Yes","Yes","No","100%",,"$3,000","$0","$400","$30","$3,000","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/129800/S19E_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","14","14002","TN","Individual","No","62-0427913","14002TN0330031","Silver S19E, Network E","14002TN033",,"TNN003","TNS009","TNF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330031-01","Standard Silver On Exchange Plan",,"0.704510569572449","Yes","Yes","No","100%",,"$3,000","$0","$400","$30","$3,000","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/127600/S19E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","14","14002","TN","Individual","No","62-0427913","14002TN0330031","Silver S19E, Network E","14002TN033",,"TNN003","TNS009","TNF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330031-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S19E-AI1_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","14","14002","TN","Individual","No","62-0427913","14002TN0330031","Silver S19E, Network E","14002TN033",,"TNN003","TNS009","TNF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330031-03","Limited Cost Sharing Plan Variation",,"0.704510569572449","Yes","Yes","No","100%",,"$3,000","$0","$400","$30","$3,000","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S19E-AI2_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","14","14002","TN","Individual","No","62-0427913","14002TN0330031","Silver S19E, Network E","14002TN033",,"TNN003","TNS009","TNF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330031-04","73% AV Level Silver Plan",,"0.739209413528442","Yes","Yes","No","100%",,"$2,300","$0","$500","$30","$2,300","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S19E-A_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","14","14002","TN","Individual","No","62-0427913","14002TN0330031","Silver S19E, Network E","14002TN033",,"TNN003","TNS009","TNF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330031-05","87% AV Level Silver Plan",,"0.875774443149567","Yes","Yes","No","100%",,"$550","$0","$700","$30","$550","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S19E-B_SBC.pdf","www.bcbst.com/brochures","16"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","14","14002","TN","Individual","No","62-0427913","14002TN0330031","Silver S19E, Network E","14002TN033",,"TNN003","TNS009","TNF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330031-06","94% AV Level Silver Plan",,"0.932194650173187","Yes","Yes","No","100%",,"$0","$0","$700","$30","$0","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S19E-C_SBC.pdf","www.bcbst.com/brochures","17"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","14","14002","TN","Individual","No","62-0427913","14002TN0330032","Silver S19E, Network E","14002TN033",,"TNN003","TNS004","TNF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330032-00","Standard Silver Off Exchange Plan",,"0.704510569572449","Yes","Yes","No","100%",,"$3,000","$0","$400","$30","$3,000","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/129800/S19E_SBC.pdf","www.bcbst.com/brochures","18"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","18","14002","TN","Individual","No","62-0427913","14002TN0330065","Gold G10E, Network E","14002TN033",,"TNN003","TNS004","TNF009","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330065-00","Standard Gold Off Exchange Plan","78.46%","0.747213780879974","No","Yes","No","100%",,"$3,500","$0","$0","$30","$100","$200","$2,100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/129800/G10E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","18","14002","TN","Individual","No","62-0427913","14002TN0330065","Gold G10E, Network E","14002TN033",,"TNN003","TNS004","TNF009","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330065-01","Standard Gold On Exchange Plan","78.46%","0.747213780879974","No","Yes","No","100%",,"$3,500","$0","$0","$30","$100","$200","$2,100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G10E_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","18","14002","TN","Individual","No","62-0427913","14002TN0330065","Gold G10E, Network E","14002TN033",,"TNN003","TNS004","TNF009","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330065-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G10E-AI1_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","18","14002","TN","Individual","No","62-0427913","14002TN0330065","Gold G10E, Network E","14002TN033",,"TNN003","TNS004","TNF009","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330065-03","Limited Cost Sharing Plan Variation","78.46%","0.747213780879974","No","Yes","No","100%",,"$3,500","$0","$0","$30","$100","$200","$2,100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G10E-AI2_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","19","14002","TN","Individual","No","62-0427913","14002TN0330056","Gold G11S, Network S","14002TN033",,"TNN002","TNS010","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330056-00","Standard Gold Off Exchange Plan",,"0.787487745285034","No","Yes","No","100%",,"$3,500","$30","$0","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/129800/G11S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","14","14002","TN","Individual","No","62-0427913","14002TN0330032","Silver S19E, Network E","14002TN033",,"TNN003","TNS004","TNF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330032-01","Standard Silver On Exchange Plan",,"0.704510569572449","Yes","Yes","No","100%",,"$3,000","$0","$400","$30","$3,000","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/127600/S19E_SBC.pdf","www.bcbst.com/brochures","19"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","14","14002","TN","Individual","No","62-0427913","14002TN0330032","Silver S19E, Network E","14002TN033",,"TNN003","TNS004","TNF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330032-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S19E-AI1_SBC.pdf","www.bcbst.com/brochures","20"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","14","14002","TN","Individual","No","62-0427913","14002TN0330032","Silver S19E, Network E","14002TN033",,"TNN003","TNS004","TNF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330032-03","Limited Cost Sharing Plan Variation",,"0.704510569572449","Yes","Yes","No","100%",,"$3,000","$0","$400","$30","$3,000","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S19E-AI2_SBC.pdf","www.bcbst.com/brochures","21"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","14","14002","TN","Individual","No","62-0427913","14002TN0330032","Silver S19E, Network E","14002TN033",,"TNN003","TNS004","TNF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330032-04","73% AV Level Silver Plan",,"0.739209413528442","Yes","Yes","No","100%",,"$2,300","$0","$500","$30","$2,300","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S19E-A_SBC.pdf","www.bcbst.com/brochures","22"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","14","14002","TN","Individual","No","62-0427913","14002TN0330032","Silver S19E, Network E","14002TN033",,"TNN003","TNS004","TNF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330032-05","87% AV Level Silver Plan",,"0.875774443149567","Yes","Yes","No","100%",,"$550","$0","$700","$30","$550","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S19E-B_SBC.pdf","www.bcbst.com/brochures","23"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","14","14002","TN","Individual","No","62-0427913","14002TN0330032","Silver S19E, Network E","14002TN033",,"TNN003","TNS004","TNF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330032-06","94% AV Level Silver Plan",,"0.932194650173187","Yes","Yes","No","100%",,"$0","$0","$700","$30","$0","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,950","$1950 per person","$3900 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S19E-C_SBC.pdf","www.bcbst.com/brochures","24"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","15","14002","TN","Individual","No","62-0427913","14002TN0330052","Gold G01S, Network S","14002TN033",,"TNN002","TNS010","TNF023","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330052-00","Standard Gold Off Exchange Plan",,"0.787745773792267","Yes","Yes","No","100%",,"$0","$0","$2,600","$30","$0","$0","$1,800","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/G01S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","15","14002","TN","Individual","No","62-0427913","14002TN0330052","Gold G01S, Network S","14002TN033",,"TNN002","TNS010","TNF023","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330052-01","Standard Gold On Exchange Plan",,"0.787745773792267","Yes","Yes","No","100%",,"$0","$0","$2,600","$30","$0","$0","$1,800","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/G01S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","15","14002","TN","Individual","No","62-0427913","14002TN0330052","Gold G01S, Network S","14002TN033",,"TNN002","TNS010","TNF023","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330052-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/G01S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","15","14002","TN","Individual","No","62-0427913","14002TN0330052","Gold G01S, Network S","14002TN033",,"TNN002","TNS010","TNF023","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330052-03","Limited Cost Sharing Plan Variation",,"0.787745773792267","Yes","Yes","No","100%",,"$0","$0","$2,600","$30","$0","$0","$1,800","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/G01S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","15","14002","TN","Individual","No","62-0427913","14002TN0330057","Gold G01E, Network E","14002TN033",,"TNN003","TNS009","TNF023","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330057-00","Standard Gold Off Exchange Plan",,"0.787745773792267","Yes","Yes","No","100%",,"$0","$0","$2,600","$30","$0","$0","$1,800","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/G01E_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","15","14002","TN","Individual","No","62-0427913","14002TN0330057","Gold G01E, Network E","14002TN033",,"TNN003","TNS009","TNF023","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330057-01","Standard Gold On Exchange Plan",,"0.787745773792267","Yes","Yes","No","100%",,"$0","$0","$2,600","$30","$0","$0","$1,800","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/G01E_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","15","14002","TN","Individual","No","62-0427913","14002TN0330057","Gold G01E, Network E","14002TN033",,"TNN003","TNS009","TNF023","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330057-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/G01E-AI1_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","15","14002","TN","Individual","No","62-0427913","14002TN0330057","Gold G01E, Network E","14002TN033",,"TNN003","TNS009","TNF023","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330057-03","Limited Cost Sharing Plan Variation",,"0.787745773792267","Yes","Yes","No","100%",,"$0","$0","$2,600","$30","$0","$0","$1,800","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/G01E-AI2_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","15","14002","TN","Individual","No","62-0427913","14002TN0330062","Gold G01E, Network E","14002TN033",,"TNN003","TNS004","TNF023","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330062-00","Standard Gold Off Exchange Plan",,"0.787745773792267","Yes","Yes","No","100%",,"$0","$0","$2,600","$30","$0","$0","$1,800","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/G01E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","15","14002","TN","Individual","No","62-0427913","14002TN0330062","Gold G01E, Network E","14002TN033",,"TNN003","TNS004","TNF023","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330062-01","Standard Gold On Exchange Plan",,"0.787745773792267","Yes","Yes","No","100%",,"$0","$0","$2,600","$30","$0","$0","$1,800","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/G01E_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","15","14002","TN","Individual","No","62-0427913","14002TN0330062","Gold G01E, Network E","14002TN033",,"TNN003","TNS004","TNF023","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330062-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/G01E-AI1_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","15","14002","TN","Individual","No","62-0427913","14002TN0330062","Gold G01E, Network E","14002TN033",,"TNN003","TNS004","TNF023","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330062-03","Limited Cost Sharing Plan Variation",,"0.787745773792267","Yes","Yes","No","100%",,"$0","$0","$2,600","$30","$0","$0","$1,800","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$15,750","$15750 per person","$31500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/G01E-AI2_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","16","14002","TN","Individual","No","62-0427913","14002TN0330053","Gold G06S, Network S","14002TN033",,"TNN002","TNS010","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330053-00","Standard Gold Off Exchange Plan",,"0.800518870353699","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/129800/G06S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","16","14002","TN","Individual","No","62-0427913","14002TN0330053","Gold G06S, Network S","14002TN033",,"TNN002","TNS010","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330053-01","Standard Gold On Exchange Plan",,"0.800518870353699","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G06S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","16","14002","TN","Individual","No","62-0427913","14002TN0330053","Gold G06S, Network S","14002TN033",,"TNN002","TNS010","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330053-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G06S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","16","14002","TN","Individual","No","62-0427913","14002TN0330053","Gold G06S, Network S","14002TN033",,"TNN002","TNS010","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330053-03","Limited Cost Sharing Plan Variation",,"0.800518870353699","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G06S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","16","14002","TN","Individual","No","62-0427913","14002TN0330058","Gold G06E, Network E","14002TN033",,"TNN003","TNS009","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330058-00","Standard Gold Off Exchange Plan",,"0.800518870353699","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/129800/G06E_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","16","14002","TN","Individual","No","62-0427913","14002TN0330058","Gold G06E, Network E","14002TN033",,"TNN003","TNS009","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330058-01","Standard Gold On Exchange Plan",,"0.800518870353699","No","Yes","No","100%",,"$1,500","$50","$1,000","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G06E_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","17","14002","TN","Individual","No","62-0427913","14002TN0330059","Gold G08E, Network E","14002TN033",,"TNN003","TNS009","TNF028","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330059-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/G08E-AI1_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","17","14002","TN","Individual","No","62-0427913","14002TN0330059","Gold G08E, Network E","14002TN033",,"TNN003","TNS009","TNF028","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330059-03","Limited Cost Sharing Plan Variation",,"0.799147665500641","Yes","Yes","No","100%",,"$2,100","$0","$0","$30","$2,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/G08E-AI2_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","17","14002","TN","Individual","No","62-0427913","14002TN0330064","Gold G08E, Network E","14002TN033",,"TNN003","TNS004","TNF028","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330064-00","Standard Gold Off Exchange Plan",,"0.799147665500641","Yes","Yes","No","100%",,"$2,100","$0","$0","$30","$2,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/G08E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","17","14002","TN","Individual","No","62-0427913","14002TN0330064","Gold G08E, Network E","14002TN033",,"TNN003","TNS004","TNF028","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330064-01","Standard Gold On Exchange Plan",,"0.799147665500641","Yes","Yes","No","100%",,"$2,100","$0","$0","$30","$2,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/G08E_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","17","14002","TN","Individual","No","62-0427913","14002TN0330064","Gold G08E, Network E","14002TN033",,"TNN003","TNS004","TNF028","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330064-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/G08E-AI1_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","17","14002","TN","Individual","No","62-0427913","14002TN0330064","Gold G08E, Network E","14002TN033",,"TNN003","TNS004","TNF028","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330064-03","Limited Cost Sharing Plan Variation",,"0.799147665500641","Yes","Yes","No","100%",,"$2,100","$0","$0","$30","$2,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/G08E-AI2_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","18","14002","TN","Individual","No","62-0427913","14002TN0330055","Gold G10S, Network S","14002TN033",,"TNN002","TNS010","TNF009","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330055-00","Standard Gold Off Exchange Plan","78.46%","0.747213780879974","No","Yes","No","100%",,"$3,500","$0","$0","$30","$100","$200","$2,100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/129800/G10S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","18","14002","TN","Individual","No","62-0427913","14002TN0330055","Gold G10S, Network S","14002TN033",,"TNN002","TNS010","TNF009","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330055-01","Standard Gold On Exchange Plan","78.46%","0.747213780879974","No","Yes","No","100%",,"$3,500","$0","$0","$30","$100","$200","$2,100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G10S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","18","14002","TN","Individual","No","62-0427913","14002TN0330055","Gold G10S, Network S","14002TN033",,"TNN002","TNS010","TNF009","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330055-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G10S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","18","14002","TN","Individual","No","62-0427913","14002TN0330055","Gold G10S, Network S","14002TN033",,"TNN002","TNS010","TNF009","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330055-03","Limited Cost Sharing Plan Variation","78.46%","0.747213780879974","No","Yes","No","100%",,"$3,500","$0","$0","$30","$100","$200","$2,100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G10S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","18","14002","TN","Individual","No","62-0427913","14002TN0330060","Gold G10E, Network E","14002TN033",,"TNN003","TNS009","TNF009","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330060-00","Standard Gold Off Exchange Plan","78.46%","0.747213780879974","No","Yes","No","100%",,"$3,500","$0","$0","$30","$100","$200","$2,100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/129800/G10E_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","18","14002","TN","Individual","No","62-0427913","14002TN0330060","Gold G10E, Network E","14002TN033",,"TNN003","TNS009","TNF009","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330060-01","Standard Gold On Exchange Plan","78.46%","0.747213780879974","No","Yes","No","100%",,"$3,500","$0","$0","$30","$100","$200","$2,100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G10E_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","18","14002","TN","Individual","No","62-0427913","14002TN0330060","Gold G10E, Network E","14002TN033",,"TNN003","TNS009","TNF009","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330060-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G10E-AI1_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","18","14002","TN","Individual","No","62-0427913","14002TN0330060","Gold G10E, Network E","14002TN033",,"TNN003","TNS009","TNF009","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330060-03","Limited Cost Sharing Plan Variation","78.46%","0.747213780879974","No","Yes","No","100%",,"$3,500","$0","$0","$30","$100","$200","$2,100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G10E-AI2_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","19","14002","TN","Individual","No","62-0427913","14002TN0330056","Gold G11S, Network S","14002TN033",,"TNN002","TNS010","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330056-01","Standard Gold On Exchange Plan",,"0.787487745285034","No","Yes","No","100%",,"$3,500","$30","$0","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G11S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","19","14002","TN","Individual","No","62-0427913","14002TN0330056","Gold G11S, Network S","14002TN033",,"TNN002","TNS010","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330056-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G11S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","19","14002","TN","Individual","No","62-0427913","14002TN0330056","Gold G11S, Network S","14002TN033",,"TNN002","TNS010","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330056-03","Limited Cost Sharing Plan Variation",,"0.787487745285034","No","Yes","No","100%",,"$3,500","$30","$0","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G11S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","19","14002","TN","Individual","No","62-0427913","14002TN0330061","Gold G11E, Network E","14002TN033",,"TNN003","TNS009","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330061-00","Standard Gold Off Exchange Plan",,"0.787487745285034","No","Yes","No","100%",,"$3,500","$30","$0","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/129800/G11E_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","19","14002","TN","Individual","No","62-0427913","14002TN0330061","Gold G11E, Network E","14002TN033",,"TNN003","TNS009","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330061-01","Standard Gold On Exchange Plan",,"0.787487745285034","No","Yes","No","100%",,"$3,500","$30","$0","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G11E_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","19","14002","TN","Individual","No","62-0427913","14002TN0330061","Gold G11E, Network E","14002TN033",,"TNN003","TNS009","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330061-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G11E-AI1_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","19","14002","TN","Individual","No","62-0427913","14002TN0330061","Gold G11E, Network E","14002TN033",,"TNN003","TNS009","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330061-03","Limited Cost Sharing Plan Variation",,"0.787487745285034","No","Yes","No","100%",,"$3,500","$30","$0","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G11E-AI2_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","22384","HIOS","2","2015-07-09 13:17:42","1","22384","TN","Individual","Yes","62-0812197","22384TN0010002","Delta Dental FFM Individual Product","22384TN001",,"TNN002","TNS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$33.99","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Benefits allowed as 'Non Participating","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/22384","","22384TN0010002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaltn.com/ACAMarketplace/IndividualPediatricPlan","http://www.deltadentaltn.com/ACAMarketplace/IndividualPediatricPlan","5"
"2016","TN","22384","HIOS","2","2015-07-09 13:17:42","1","22384","TN","Individual","Yes","62-0812197","22384TN0030001","Delta Dental Individual Plan","22384TN003",,"TNN002","TNS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$28.19","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Benefits allowed as 'Non Participating","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes",,"","22384TN0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","TN","22384","HIOS","2","2015-07-09 13:17:42","1","22384","TN","Individual","Yes","62-0812197","22384TN0030002","Delta Dental Individual Plan","22384TN003",,"TNN002","TNS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$33.99","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Benefits allowed as 'Non Participating","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes",,"","22384TN0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","TN","22384","HIOS","2","2015-07-09 13:17:42","2","22384","TN","Individual","Yes","62-0812197","22384TN0010003","Delta Dental FFM Individual Product","22384TN001",,"TNN002","TNS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.19","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/22384","","22384TN0010003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaltn.com/ACAMarketplace/IndividualFamilyPlan","http://www.deltadentaltn.com/ACAMarketplace/IndividualFamilyPlan","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","19","14002","TN","Individual","No","62-0427913","14002TN0330066","Gold G11E, Network E","14002TN033",,"TNN003","TNS004","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330066-00","Standard Gold Off Exchange Plan",,"0.787487745285034","No","Yes","No","100%",,"$3,500","$30","$0","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/129800/G11E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","19","14002","TN","Individual","No","62-0427913","14002TN0330066","Gold G11E, Network E","14002TN033",,"TNN003","TNS004","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330066-01","Standard Gold On Exchange Plan",,"0.787487745285034","No","Yes","No","100%",,"$3,500","$30","$0","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G11E_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","19","14002","TN","Individual","No","62-0427913","14002TN0330066","Gold G11E, Network E","14002TN033",,"TNN003","TNS004","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330066-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G11E-AI1_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","19","14002","TN","Individual","No","62-0427913","14002TN0330066","Gold G11E, Network E","14002TN033",,"TNN003","TNS004","TNF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330066-03","Limited Cost Sharing Plan Variation",,"0.787487745285034","No","Yes","No","100%",,"$3,500","$30","$0","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G11E-AI2_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","20","14002","TN","Individual","No","62-0427913","14002TN0330067","Platinum P01S, Network S","14002TN033",,"TNN002","TNS010","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330067-00","Standard Platinum Off Exchange Plan",,"0.90310537815094","No","Yes","No","100%",,"$0","$10","$1,800","$30","$0","$1,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/129800/P01S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","20","14002","TN","Individual","No","62-0427913","14002TN0330067","Platinum P01S, Network S","14002TN033",,"TNN002","TNS010","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330067-01","Standard Platinum On Exchange Plan",,"0.90310537815094","No","Yes","No","100%",,"$0","$10","$1,800","$30","$0","$1,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/P01S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","20","14002","TN","Individual","No","62-0427913","14002TN0330067","Platinum P01S, Network S","14002TN033",,"TNN002","TNS010","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330067-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/P01S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","20","14002","TN","Individual","No","62-0427913","14002TN0330067","Platinum P01S, Network S","14002TN033",,"TNN002","TNS010","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330067-03","Limited Cost Sharing Plan Variation",,"0.90310537815094","No","Yes","No","100%",,"$0","$10","$1,800","$30","$0","$1,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/P01S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","20","14002","TN","Individual","No","62-0427913","14002TN0330070","Platinum P01E, Network E","14002TN033",,"TNN003","TNS009","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330070-00","Standard Platinum Off Exchange Plan",,"0.90310537815094","No","Yes","No","100%",,"$0","$10","$1,800","$30","$0","$1,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/129800/P01E_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","20","14002","TN","Individual","No","62-0427913","14002TN0330070","Platinum P01E, Network E","14002TN033",,"TNN003","TNS009","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330070-01","Standard Platinum On Exchange Plan",,"0.90310537815094","No","Yes","No","100%",,"$0","$10","$1,800","$30","$0","$1,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/P01E_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","20","14002","TN","Individual","No","62-0427913","14002TN0330070","Platinum P01E, Network E","14002TN033",,"TNN003","TNS009","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330070-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/P01E-AI1_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","20","14002","TN","Individual","No","62-0427913","14002TN0330070","Platinum P01E, Network E","14002TN033",,"TNN003","TNS009","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330070-03","Limited Cost Sharing Plan Variation",,"0.90310537815094","No","Yes","No","100%",,"$0","$10","$1,800","$30","$0","$1,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/P01E-AI2_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","20","14002","TN","Individual","No","62-0427913","14002TN0330073","Platinum P01E, Network E","14002TN033",,"TNN003","TNS004","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330073-00","Standard Platinum Off Exchange Plan",,"0.90310537815094","No","Yes","No","100%",,"$0","$10","$1,800","$30","$0","$1,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/129800/P01E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","20","14002","TN","Individual","No","62-0427913","14002TN0330073","Platinum P01E, Network E","14002TN033",,"TNN003","TNS004","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330073-01","Standard Platinum On Exchange Plan",,"0.90310537815094","No","Yes","No","100%",,"$0","$10","$1,800","$30","$0","$1,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/P01E_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","20","14002","TN","Individual","No","62-0427913","14002TN0330073","Platinum P01E, Network E","14002TN033",,"TNN003","TNS004","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330073-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/P01E-AI1_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","20","14002","TN","Individual","No","62-0427913","14002TN0330073","Platinum P01E, Network E","14002TN033",,"TNN003","TNS004","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330073-03","Limited Cost Sharing Plan Variation",,"0.90310537815094","No","Yes","No","100%",,"$0","$10","$1,800","$30","$0","$1,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/P01E-AI2_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","21","14002","TN","Individual","No","62-0427913","14002TN0330068","Platinum P02S, Network S","14002TN033",,"TNN002","TNS010","TNF025","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330068-00","Standard Platinum Off Exchange Plan",,"0.89715188741684","Yes","Yes","No","100%",,"$0","$0","$1,500","$30","$0","$0","$1,300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/P02S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","21","14002","TN","Individual","No","62-0427913","14002TN0330068","Platinum P02S, Network S","14002TN033",,"TNN002","TNS010","TNF025","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330068-01","Standard Platinum On Exchange Plan",,"0.89715188741684","Yes","Yes","No","100%",,"$0","$0","$1,500","$30","$0","$0","$1,300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/P02S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","21","14002","TN","Individual","No","62-0427913","14002TN0330068","Platinum P02S, Network S","14002TN033",,"TNN002","TNS010","TNF025","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330068-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/P02S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","21","14002","TN","Individual","No","62-0427913","14002TN0330068","Platinum P02S, Network S","14002TN033",,"TNN002","TNS010","TNF025","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330068-03","Limited Cost Sharing Plan Variation",,"0.89715188741684","Yes","Yes","No","100%",,"$0","$0","$1,500","$30","$0","$0","$1,300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/P02S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","21","14002","TN","Individual","No","62-0427913","14002TN0330071","Platinum P02E, Network E","14002TN033",,"TNN003","TNS009","TNF025","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330071-00","Standard Platinum Off Exchange Plan",,"0.89715188741684","Yes","Yes","No","100%",,"$0","$0","$1,500","$30","$0","$0","$1,300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/P02E_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","21","14002","TN","Individual","No","62-0427913","14002TN0330071","Platinum P02E, Network E","14002TN033",,"TNN003","TNS009","TNF025","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330071-01","Standard Platinum On Exchange Plan",,"0.89715188741684","Yes","Yes","No","100%",,"$0","$0","$1,500","$30","$0","$0","$1,300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/P02E_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","21","14002","TN","Individual","No","62-0427913","14002TN0330071","Platinum P02E, Network E","14002TN033",,"TNN003","TNS009","TNF025","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330071-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/P02E-AI1_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","21","14002","TN","Individual","No","62-0427913","14002TN0330071","Platinum P02E, Network E","14002TN033",,"TNN003","TNS009","TNF025","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330071-03","Limited Cost Sharing Plan Variation",,"0.89715188741684","Yes","Yes","No","100%",,"$0","$0","$1,500","$30","$0","$0","$1,300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/P02E-AI2_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","21","14002","TN","Individual","No","62-0427913","14002TN0330074","Platinum P02E, Network E","14002TN033",,"TNN003","TNS004","TNF025","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330074-00","Standard Platinum Off Exchange Plan",,"0.89715188741684","Yes","Yes","No","100%",,"$0","$0","$1,500","$30","$0","$0","$1,300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/129800/P02E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","21","14002","TN","Individual","No","62-0427913","14002TN0330074","Platinum P02E, Network E","14002TN033",,"TNN003","TNS004","TNF025","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330074-01","Standard Platinum On Exchange Plan",,"0.89715188741684","Yes","Yes","No","100%",,"$0","$0","$1,500","$30","$0","$0","$1,300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/P02E_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","21","14002","TN","Individual","No","62-0427913","14002TN0330074","Platinum P02E, Network E","14002TN033",,"TNN003","TNS004","TNF025","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330074-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/P02E-AI1_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","21","14002","TN","Individual","No","62-0427913","14002TN0330074","Platinum P02E, Network E","14002TN033",,"TNN003","TNS004","TNF025","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330074-03","Limited Cost Sharing Plan Variation",,"0.89715188741684","Yes","Yes","No","100%",,"$0","$0","$1,500","$30","$0","$0","$1,300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/P02E-AI2_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","22","14002","TN","Individual","No","62-0427913","14002TN0330069","Platinum P03S, Network S","14002TN033",,"TNN002","TNS010","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330069-00","Standard Platinum Off Exchange Plan",,"0.902246475219727","No","Yes","No","100%",,"$0","$20","$1,700","$30","$0","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/129800/P03S_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","22","14002","TN","Individual","No","62-0427913","14002TN0330069","Platinum P03S, Network S","14002TN033",,"TNN002","TNS010","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330069-01","Standard Platinum On Exchange Plan",,"0.902246475219727","No","Yes","No","100%",,"$0","$20","$1,700","$30","$0","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/P03S_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","22","14002","TN","Individual","No","62-0427913","14002TN0330069","Platinum P03S, Network S","14002TN033",,"TNN002","TNS010","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330069-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/P03S-AI1_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","22","14002","TN","Individual","No","62-0427913","14002TN0330069","Platinum P03S, Network S","14002TN033",,"TNN002","TNS010","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330069-03","Limited Cost Sharing Plan Variation",,"0.902246475219727","No","Yes","No","100%",,"$0","$20","$1,700","$30","$0","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/P03S-AI2_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","22","14002","TN","Individual","No","62-0427913","14002TN0330072","Platinum P03E, Network E","14002TN033",,"TNN003","TNS009","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330072-00","Standard Platinum Off Exchange Plan",,"0.902246475219727","No","Yes","No","100%",,"$0","$20","$1,700","$30","$0","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/129800/P03E_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","22","14002","TN","Individual","No","62-0427913","14002TN0330072","Platinum P03E, Network E","14002TN033",,"TNN003","TNS009","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330072-01","Standard Platinum On Exchange Plan",,"0.902246475219727","No","Yes","No","100%",,"$0","$20","$1,700","$30","$0","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/P03E_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","22","14002","TN","Individual","No","62-0427913","14002TN0330072","Platinum P03E, Network E","14002TN033",,"TNN003","TNS009","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330072-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/P03E-AI1_SBC.pdf","www.bcbst.com/brochures","10"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","22","14002","TN","Individual","No","62-0427913","14002TN0330072","Platinum P03E, Network E","14002TN033",,"TNN003","TNS009","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330072-03","Limited Cost Sharing Plan Variation",,"0.902246475219727","No","Yes","No","100%",,"$0","$20","$1,700","$30","$0","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/P03E-AI2_SBC.pdf","www.bcbst.com/brochures","11"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","22","14002","TN","Individual","No","62-0427913","14002TN0330075","Platinum P03E, Network E","14002TN033",,"TNN003","TNS004","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330075-00","Standard Platinum Off Exchange Plan",,"0.902246475219727","No","Yes","No","100%",,"$0","$20","$1,700","$30","$0","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/129800/P03E_SBC.pdf","www.bcbst.com/brochures","12"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","22","14002","TN","Individual","No","62-0427913","14002TN0330075","Platinum P03E, Network E","14002TN033",,"TNN003","TNS004","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330075-01","Standard Platinum On Exchange Plan",,"0.902246475219727","No","Yes","No","100%",,"$0","$20","$1,700","$30","$0","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/P03E_SBC.pdf","www.bcbst.com/brochures","13"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","22","14002","TN","Individual","No","62-0427913","14002TN0330075","Platinum P03E, Network E","14002TN033",,"TNN003","TNS004","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330075-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/P03E-AI1_SBC.pdf","www.bcbst.com/brochures","14"
"2016","TN","14002","HIOS","5","2015-10-20 04:38:50","22","14002","TN","Individual","No","62-0427913","14002TN0330075","Platinum P03E, Network E","14002TN033",,"TNN003","TNS004","TNF008","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330075-03","Limited Cost Sharing Plan Variation",,"0.902246475219727","No","Yes","No","100%",,"$0","$20","$1,700","$30","$0","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/P03E-AI2_SBC.pdf","www.bcbst.com/brochures","15"
"2016","TN","21535","HIOS","1","2015-05-08 02:15:08","1","21535","TN","SHOP (Small Group)","Yes","13-5581829","21535TN0120001","EHB Basic Dental Plan (Low)","21535TN012",,"TNN001","TNS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$16.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","21535TN0120001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","22384","HIOS","2","2015-07-09 13:17:42","1","22384","TN","Individual","Yes","62-0812197","22384TN0010001","Delta Dental FFM Individual Product","22384TN001",,"TNN002","TNS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$28.19","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Benefits allowed as 'Non Participating","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/22384","","22384TN0010001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaltn.com/ACAMarketplace/IndividualPediatricPlan","http://www.deltadentaltn.com/ACAMarketplace/IndividualPediatricPlan","4"
"2016","TN","22384","HIOS","2","2015-07-09 13:17:42","2","22384","TN","SHOP (Small Group)","Yes","62-0812197","22384TN0040001","Delta Dental Small Group Product","22384TN004",,"TNN001","TNS001",,"Existing","POS","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$27.43","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Benefits allowed as 'Non Participating'","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/delta","","22384TN0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","60%","40%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","22384","HIOS","2","2015-07-09 13:17:42","2","22384","TN","SHOP (Small Group)","Yes","62-0812197","22384TN0040002","Delta Dental Small Group Product","22384TN004",,"TNN001","TNS001",,"Existing","POS","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$33.35","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Benefits allowed as 'Non Participating'","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/delta","","22384TN0040002-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","60%","40%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","TN","22384","HIOS","2","2015-07-09 13:17:42","2","22384","TN","Individual","Yes","62-0812197","22384TN0010004","Delta Dental FFM Individual Product","22384TN001",,"TNN002","TNS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.99","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/22384","","22384TN0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaltn.com/ACAMarketplace/IndividualFamilyPlan","http://www.deltadentaltn.com/ACAMarketplace/IndividualFamilyPlan","5"
"2016","TN","24601","HIOS","3","2015-08-27 11:14:25","1","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010007","BESTDental Premium","24601TN001",,"TNN001","TNS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.52","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2016/TN_BESTDental_Premium_Plan.pdf","4"
"2016","TN","24601","HIOS","3","2015-08-27 11:14:25","1","24601","TN","Individual","Yes","95-6042390","24601TN0020003","BESTOne Advantage Gold","24601TN002",,"TNN001","TNS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.41","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2016/TN_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","TN","24601","HIOS","3","2015-08-27 11:14:25","1","24601","TN","Individual","Yes","95-6042390","24601TN0020003","BESTOne Advantage Gold","24601TN002",,"TNN001","TNS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.41","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2016/TN_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","TN","24601","HIOS","3","2015-08-27 11:14:25","1","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010007","BESTDental Premium","24601TN001",,"TNN001","TNS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.52","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2016/TN_BESTDental_Premium_Plan.pdf","5"
"2016","TN","24601","HIOS","3","2015-08-27 11:14:25","1","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010008","BESTDental Standard - H","24601TN001",,"TNN001","TNS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.52","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2016/TN_BESTDental_Standard-H_Plan.pdf","6"
"2016","TN","24601","HIOS","3","2015-08-27 11:14:25","1","24601","TN","Individual","Yes","95-6042390","24601TN0020004","BESTOne Plus Gold","24601TN002",,"TNN001","TNS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.41","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2016/TN_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","TN","24601","HIOS","3","2015-08-27 11:14:25","1","24601","TN","Individual","Yes","95-6042390","24601TN0020004","BESTOne Plus Gold","24601TN002",,"TNN001","TNS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.41","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2016/TN_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","TN","24601","HIOS","3","2015-08-27 11:14:25","1","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010008","BESTDental Standard - H","24601TN001",,"TNN001","TNS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.52","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2016/TN_BESTDental_Standard-H_Plan.pdf","7"
"2016","TN","24601","HIOS","3","2015-08-27 11:14:25","1","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010010","BESTDental Choice - H","24601TN001",,"TNN001","TNS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.52","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2016/TN_BESTDental_Choice-H_Plan.pdf","8"
"2016","TN","24601","HIOS","3","2015-08-27 11:14:25","1","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010010","BESTDental Choice - H","24601TN001",,"TNN001","TNS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.52","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2016/TN_BESTDental_Choice-H_Plan.pdf","9"
"2016","TN","24601","HIOS","3","2015-08-27 11:14:25","2","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010009","BESTDental Standard - L","24601TN001",,"TNN001","TNS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2016/TN_BESTDental_Standard-L_Plan.pdf","4"
"2016","TN","24601","HIOS","3","2015-08-27 11:14:25","2","24601","TN","Individual","Yes","95-6042390","24601TN0020005","BESTOne Plus Silver","24601TN002",,"TNN001","TNS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.75","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2016/TN_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","TN","24601","HIOS","3","2015-08-27 11:14:25","2","24601","TN","Individual","Yes","95-6042390","24601TN0020005","BESTOne Plus Silver","24601TN002",,"TNN001","TNS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.75","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2016/TN_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","TN","24601","HIOS","3","2015-08-27 11:14:25","2","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010009","BESTDental Standard - L","24601TN001",,"TNN001","TNS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2016/TN_BESTDental_Standard-L_Plan.pdf","5"
"2016","TN","24601","HIOS","3","2015-08-27 11:14:25","2","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010011","BESTDental Choice - L","24601TN001",,"TNN001","TNS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2016/TN_BESTDental_Choice-L_Plan.pdf","6"
"2016","TN","24601","HIOS","3","2015-08-27 11:14:25","2","24601","TN","Individual","Yes","95-6042390","24601TN0020006","BESTOne Basic Silver","24601TN002",,"TNN001","TNS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.75","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2016/TN_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","TN","24601","HIOS","3","2015-08-27 11:14:25","2","24601","TN","Individual","Yes","95-6042390","24601TN0020006","BESTOne Basic Silver","24601TN002",,"TNN001","TNS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.75","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2016/TN_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","TN","24601","HIOS","3","2015-08-27 11:14:25","2","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010011","BESTDental Choice - L","24601TN001",,"TNN001","TNS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2016/TN_BESTDental_Choice-L_Plan.pdf","7"
"2016","TN","24601","HIOS","3","2015-08-27 11:14:25","2","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010012","BESTDental Value","24601TN001",,"TNN001","TNS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2016/TN_BESTDental_Value_Plan.pdf","8"
"2016","TN","24601","HIOS","3","2015-08-27 11:14:25","2","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010012","BESTDental Value","24601TN001",,"TNN001","TNS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","24601TN0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TN/2016/TN_BESTDental_Value_Plan.pdf","9"
"2016","TN","28398","HIOS","3","2015-10-20 04:38:50","1","28398","TN","SHOP (Small Group)","Yes","36-3757528","28398TN0030001","TruAssure Small Group Basic Plan","28398TN003",,"TNN001","TNS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.99","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","28398TN0030001-00","Standard High Off Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","28398","HIOS","3","2015-10-20 04:38:50","1","28398","TN","Individual","Yes","36-3757528","28398TN0010001","TruAssure Basic Adult or Child Dental Plan","28398TN001",,"TNN001","TNS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.68","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","28398TN0010001-00","Standard Low Off Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TN","https://www.truassure.com/brochure?state=TN","4"
"2016","TN","28398","HIOS","3","2015-10-20 04:38:50","1","28398","TN","Individual","Yes","36-3757528","28398TN0010001","TruAssure Basic Adult or Child Dental Plan","28398TN001",,"TNN001","TNS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.68","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","28398TN0010001-01","Standard Low On Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TN","https://www.truassure.com/brochure?state=TN","5"
"2016","TN","28398","HIOS","3","2015-10-20 04:38:50","1","28398","TN","SHOP (Small Group)","Yes","36-3757528","28398TN0040001","TruAssure Dental Small Group Preferred Plan","28398TN004",,"TNN001","TNS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.99","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","28398TN0040001-00","Standard High Off Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","TN","28398","HIOS","3","2015-10-20 04:38:50","2","28398","TN","Individual","Yes","36-3757528","28398TN0020001","TruAssure Preferred Adult or Child Dental Plan","28398TN002",,"TNN001","TNS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.18","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","28398TN0020001-00","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TN","https://www.truassure.com/brochure?state=TN","4"
"2016","TN","28398","HIOS","3","2015-10-20 04:38:50","2","28398","TN","Individual","Yes","36-3757528","28398TN0020001","TruAssure Preferred Adult or Child Dental Plan","28398TN002",,"TNN001","TNS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.18","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","28398TN0020001-01","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TN","https://www.truassure.com/brochure?state=TN","5"
"2016","TN","38886","HIOS","9","2015-10-18 12:35:12","1","38886","TN","SHOP (Small Group)","Yes","31-1185262","38886TN0080003","DentaSpan Family High Option","38886TN008","7083617077","TNN001","TNS001",,"New","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$30.35","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","38886TN0080003-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbtn.dentalcareplus.com","https://hixsgsbtn.dentalcareplus.com","4"
"2016","TN","38886","HIOS","9","2015-10-18 12:35:12","1","38886","TN","Individual","Yes","31-1185262","38886TN0070001","DentaTrust-PPO Pediatric High Option","38886TN007","7083617077","TNN001","TNS001",,"New","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Child-Only",,,,,"$35.22","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","38886TN0070001-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbtn.dentalcareplus.com","https://hixindsbtn.dentalcareplus.com","4"
"2016","TN","38886","HIOS","9","2015-10-18 12:35:12","1","38886","TN","Individual","Yes","31-1185262","38886TN0070001","DentaTrust-PPO Pediatric High Option","38886TN007","7083617077","TNN001","TNS001",,"New","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Child-Only",,,,,"$35.22","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","38886TN0070001-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbtn.dentalcareplus.com","https://hixindsbtn.dentalcareplus.com","5"
"2016","TN","38886","HIOS","9","2015-10-18 12:35:12","1","38886","TN","SHOP (Small Group)","Yes","31-1185262","38886TN0080003","DentaSpan Family High Option","38886TN008","7083617077","TNN001","TNS001",,"New","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$30.35","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","38886TN0080003-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbtn.dentalcareplus.com","https://hixsgsbtn.dentalcareplus.com","5"
"2016","TN","38886","HIOS","9","2015-10-18 12:35:12","1","38886","TN","SHOP (Small Group)","Yes","31-1185262","38886TN0080004","DentaSpan Family Low Option","38886TN008","7083617077","TNN001","TNS001",,"New","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$26.79","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","38886TN0080004-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbtn.dentalcareplus.com","https://hixsgsbtn.dentalcareplus.com","6"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070003","Silver Compass Plus 2000","69443TN007",,"TNN001","TNS001","TNF002","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070003-01","Standard Silver On Exchange Plan",,"0.714467763900757","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0007&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","9"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070003","Silver Compass Plus 2000","69443TN007",,"TNN001","TNS001","TNF002","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0012&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","10"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070003","Silver Compass Plus 2000","69443TN007",,"TNN001","TNS001","TNF002","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070003-03","Limited Cost Sharing Plan Variation",,"0.714467763900757","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0011&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","11"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070003","Silver Compass Plus 2000","69443TN007",,"TNN001","TNS001","TNF002","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070003-04","73% AV Level Silver Plan",,"0.737353503704071","No","Yes","No","100%",,"$1,800","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","25%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0008&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","12"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070003","Silver Compass Plus 2000","69443TN007",,"TNN001","TNS001","TNF002","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070003-05","87% AV Level Silver Plan",,"0.877411782741547","No","Yes","No","100%",,"$400","$0","$1,000","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","25%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0009&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","13"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070003","Silver Compass Plus 2000","69443TN007",,"TNN001","TNS001","TNF002","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070003-06","94% AV Level Silver Plan",,"0.943426787853241","No","Yes","No","100%",,"$0","$0","$500","$200","$0","$500","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0010&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","14"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070005","Silver Compass Plus 5000","69443TN007",,"TNN001","TNS001","TNF002","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070005-00","Standard Silver Off Exchange Plan",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0019&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","15"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070005","Silver Compass Plus 5000","69443TN007",,"TNN001","TNS001","TNF002","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070005-01","Standard Silver On Exchange Plan",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0019&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","16"
"2016","TN","38886","HIOS","9","2015-10-18 12:35:12","1","38886","TN","Individual","Yes","31-1185262","38886TN0070002","DentaTrust-PPO Pediatric Low Option","38886TN007","7083617077","TNN001","TNS001",,"New","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Child-Only",,,,,"$30.95","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","38886TN0070002-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbtn.dentalcareplus.com","https://hixindsbtn.dentalcareplus.com","6"
"2016","TN","38886","HIOS","9","2015-10-18 12:35:12","1","38886","TN","Individual","Yes","31-1185262","38886TN0070002","DentaTrust-PPO Pediatric Low Option","38886TN007","7083617077","TNN001","TNS001",,"New","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Child-Only",,,,,"$30.95","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","38886TN0070002-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbtn.dentalcareplus.com","https://hixindsbtn.dentalcareplus.com","7"
"2016","TN","38886","HIOS","9","2015-10-18 12:35:12","1","38886","TN","SHOP (Small Group)","Yes","31-1185262","38886TN0080004","DentaSpan Family Low Option","38886TN008","7083617077","TNN001","TNS001",,"New","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$26.79","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","38886TN0080004-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbtn.dentalcareplus.com","https://hixsgsbtn.dentalcareplus.com","7"
"2016","TN","38886","HIOS","9","2015-10-18 12:35:12","1","38886","TN","SHOP (Small Group)","Yes","31-1185262","38886TN0090003","DentaSpan Dental-Family High Option-Off Exchange","38886TN009","7083617077","TNN001","TNS001",,"New","PPO","High",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$23.03","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","38886TN0090003-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbtn.dentalcareplus.com","https://hixsgsbtn.dentalcareplus.com","8"
"2016","TN","38886","HIOS","9","2015-10-18 12:35:12","1","38886","TN","SHOP (Small Group)","Yes","31-1185262","38886TN0090004","DentaSpan Dental-Family Low Option-Off Exchange","38886TN009","7083617077","TNN001","TNS001",,"New","PPO","Low",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$19.91","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","38886TN0090004-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsbtn.dentalcareplus.com","https://hixsgsbtn.dentalcareplus.com","9"
"2016","TN","38886","HIOS","9","2015-10-18 12:35:12","2","38886","TN","SHOP (Small Group)","Yes","31-1185262","38886TN0090001","DentaSpan Pediatric High Option","38886TN009","7083617077","TNN001","TNS001",,"New","PPO","High",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$30.35","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","38886TN0090001-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","38886","HIOS","9","2015-10-18 12:35:12","2","38886","TN","Individual","Yes","31-1185262","38886TN0070003","DentaTrust-PPO Family High Option","38886TN007","7083617077","TNN001","TNS001",,"New","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$26.44","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","38886TN0070003-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbtn.dentalcareplus.com","https://hixindsbtn.dentalcareplus.com","4"
"2016","TN","38886","HIOS","9","2015-10-18 12:35:12","2","38886","TN","Individual","Yes","31-1185262","38886TN0070003","DentaTrust-PPO Family High Option","38886TN007","7083617077","TNN001","TNS001",,"New","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$26.44","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","38886TN0070003-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbtn.dentalcareplus.com","https://hixindsbtn.dentalcareplus.com","5"
"2016","TN","38886","HIOS","9","2015-10-18 12:35:12","2","38886","TN","SHOP (Small Group)","Yes","31-1185262","38886TN0090002","DentaSpan Pediatric Low Option","38886TN009","7083617077","TNN001","TNS001",,"New","PPO","Low",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$26.79","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","38886TN0090002-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","TN","38886","HIOS","9","2015-10-18 12:35:12","2","38886","TN","Individual","Yes","31-1185262","38886TN0070004","DentaTrust-PPO Family Low Option","38886TN007","7083617077","TNN001","TNS001",,"New","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$22.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","38886TN0070004-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbtn.dentalcareplus.com","https://hixindsbtn.dentalcareplus.com","6"
"2016","TN","38886","HIOS","9","2015-10-18 12:35:12","2","38886","TN","Individual","Yes","31-1185262","38886TN0070004","DentaTrust-PPO Family Low Option","38886TN007","7083617077","TNN001","TNS001",,"New","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$22.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","38886TN0070004-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsbtn.dentalcareplus.com","https://hixindsbtn.dentalcareplus.com","7"
"2016","TN","43878","HIOS","3","2015-07-22 02:19:34","1","43878","TN","Individual","Yes","20-2970185","43878TN0010001","DentaQuest EPO  Pediatric High","43878TN001",,"TNN001","TNS001",,"New","EPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$29.86","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","43878TN0010001-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/","4"
"2016","TN","43878","HIOS","3","2015-07-22 02:19:34","1","43878","TN","SHOP (Small Group)","Yes","20-2970185","43878TN0020003","DentaQuest EPO Family High","43878TN002",,"TNN001","TNS001",,"New","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.81","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","43878TN0020003-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/","4"
"2016","TN","43878","HIOS","3","2015-07-22 02:19:34","1","43878","TN","SHOP (Small Group)","Yes","20-2970185","43878TN0020003","DentaQuest EPO Family High","43878TN002",,"TNN001","TNS001",,"New","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.81","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","43878TN0020003-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/","5"
"2016","TN","43878","HIOS","3","2015-07-22 02:19:34","1","43878","TN","Individual","Yes","20-2970185","43878TN0010001","DentaQuest EPO  Pediatric High","43878TN001",,"TNN001","TNS001",,"New","EPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$29.86","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","43878TN0010001-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/","5"
"2016","TN","43878","HIOS","3","2015-07-22 02:19:34","1","43878","TN","SHOP (Small Group)","Yes","20-2970185","43878TN0020004","DentaQuest EPO Family Low","43878TN002",,"TNN001","TNS001",,"New","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$14.86","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","43878TN0020004-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/","6"
"2016","TN","43878","HIOS","3","2015-07-22 02:19:34","1","43878","TN","SHOP (Small Group)","Yes","20-2970185","43878TN0020004","DentaQuest EPO Family Low","43878TN002",,"TNN001","TNS001",,"New","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$14.86","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","43878TN0020004-01","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/","7"
"2016","TN","43878","HIOS","3","2015-07-22 02:19:34","2","43878","TN","Individual","Yes","20-2970185","43878TN0010003","DentaQuest EPO Family High","43878TN001",,"TNN001","TNS001",,"New","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.86","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","43878TN0010003-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/","4"
"2016","TN","43878","HIOS","3","2015-07-22 02:19:34","2","43878","TN","Individual","Yes","20-2970185","43878TN0010003","DentaQuest EPO Family High","43878TN001",,"TNN001","TNS001",,"New","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.86","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","43878TN0010003-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/","5"
"2016","TN","43878","HIOS","3","2015-07-22 02:19:34","2","43878","TN","Individual","Yes","20-2970185","43878TN0010004","DentaQuest EPO Family Low","43878TN001",,"TNN001","TNS001",,"New","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.35","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","43878TN0010004-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/","6"
"2016","TN","43878","HIOS","3","2015-07-22 02:19:34","2","43878","TN","Individual","Yes","20-2970185","43878TN0010004","DentaQuest EPO Family Low","43878TN001",,"TNN001","TNS001",,"New","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.35","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","43878TN0010004-01","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tn/","http://www.dentaquest.com/marketplace/tn/","7"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","1","69443","TN","Individual","No","36-2739571","69443TN0070002","Gold Compass Plus HSA 1600","69443TN007",,"TNN001","TNS001","TNF001","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070002-00","Standard Gold Off Exchange Plan",,"0.785858988761902","Yes","Yes","No","100%",,"$1,600","$0","$500","$200","$1,600","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$6850 per group",,,,"$25,000","$50000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$4800 per group","10%",,,,,"$15,000","per person not applicable","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=tn0004&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","4"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","1","69443","TN","Individual","No","36-2739571","69443TN0070002","Gold Compass Plus HSA 1600","69443TN007",,"TNN001","TNS001","TNF001","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070002-01","Standard Gold On Exchange Plan",,"0.785858988761902","Yes","Yes","No","100%",,"$1,600","$0","$500","$200","$1,600","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$6850 per group",,,,"$25,000","$50000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$4800 per group","10%",,,,,"$15,000","per person not applicable","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=tn0004&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","5"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","1","69443","TN","Individual","No","36-2739571","69443TN0070002","Gold Compass Plus HSA 1600","69443TN007",,"TNN001","TNS001","TNF001","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=tn0005&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","6"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","1","69443","TN","Individual","No","36-2739571","69443TN0070002","Gold Compass Plus HSA 1600","69443TN007",,"TNN001","TNS001","TNF001","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070002-03","Limited Cost Sharing Plan Variation",,"0.785858988761902","Yes","Yes","No","100%",,"$1,600","$0","$500","$200","$1,600","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$6850 per group",,,,"$25,000","$50000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$4800 per group","10%",,,,,"$15,000","per person not applicable","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=tn0006&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","7"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","1","69443","TN","Individual","No","36-2739571","69443TN0070004","Silver Compass Plus HSA 3600","69443TN007",,"TNN001","TNS001","TNF004","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070004-00","Standard Silver Off Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=tn0013&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","8"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","1","69443","TN","Individual","No","36-2739571","69443TN0070004","Silver Compass Plus HSA 3600","69443TN007",,"TNN001","TNS001","TNF004","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070004-01","Standard Silver On Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=tn0013&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","9"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","1","69443","TN","Individual","No","36-2739571","69443TN0070004","Silver Compass Plus HSA 3600","69443TN007",,"TNN001","TNS001","TNF004","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=tn0018&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","10"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","1","69443","TN","Individual","No","36-2739571","69443TN0070004","Silver Compass Plus HSA 3600","69443TN007",,"TNN001","TNS001","TNF004","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070004-03","Limited Cost Sharing Plan Variation",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=tn0017&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","11"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600033","Humana Silver 3800/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600033-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610192","http://apps.humana.com/marketing/documents.asp?file=2593604","29"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","1","99248","TN","Individual","No","59-1031071","99248TN0020001","Cigna Health Savings 6000","99248TN002","7730182962","TNN001","TNS001","TNF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020001-01","Standard Bronze On Exchange Plan",,"0.61153781414032","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,030","$0","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-savings-6000","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-savings-6000","5"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","1","99248","TN","Individual","Yes","59-1031071","99248TN0030001","Cigna Dental Pediatric","99248TN003","7730182962","TNN003","TNS003",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$22.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","All Services","Yes",,"","99248TN0030001-01","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/dental-pediatric","5"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","1","99248","TN","Individual","No","59-1031071","99248TN0020001","Cigna Health Savings 6000","99248TN002","7730182962","TNN001","TNS001","TNF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/lp/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/lp/naan-300b","6"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","1","99248","TN","Individual","No","59-1031071","99248TN0020001","Cigna Health Savings 6000","99248TN002","7730182962","TNN001","TNS001","TNF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020001-03","Limited Cost Sharing Plan Variation",,"0.61153781414032","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,030","$0","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-savings-6000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-savings-6000-naan-300a","7"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","1","99248","TN","Individual","No","59-1031071","99248TN0020003","Cigna Health Savings 2700","99248TN002","7730182962","TNN001","TNS001","TNF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020003-00","Standard Silver Off Exchange Plan",,"0.680516302585602","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$350","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-savings-2700","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-savings-2700","8"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","1","69443","TN","Individual","No","36-2739571","69443TN0070004","Silver Compass Plus HSA 3600","69443TN007",,"TNN001","TNS001","TNF004","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070004-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$3,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=tn0014&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","12"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","1","69443","TN","Individual","No","36-2739571","69443TN0070004","Silver Compass Plus HSA 3600","69443TN007",,"TNN001","TNS001","TNF004","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070004-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$200","$1,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tn0015&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","13"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","1","69443","TN","Individual","No","36-2739571","69443TN0070004","Silver Compass Plus HSA 3600","69443TN007",,"TNN001","TNS001","TNF004","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070004-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tn0016&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","14"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","1","69443","TN","Individual","No","36-2739571","69443TN0070006","Bronze Compass Plus HSA 5200","69443TN007",,"TNN001","TNS001","TNF001","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070006-00","Standard Bronze Off Exchange Plan",,"0.618971228599548","Yes","Yes","No","100%",,"$5,200","$0","$100","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","10%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=tn0025&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","15"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","1","69443","TN","Individual","No","36-2739571","69443TN0070006","Bronze Compass Plus HSA 5200","69443TN007",,"TNN001","TNS001","TNF001","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070006-01","Standard Bronze On Exchange Plan",,"0.618971228599548","Yes","Yes","No","100%",,"$5,200","$0","$100","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","10%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=tn0025&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","16"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","1","69443","TN","Individual","No","36-2739571","69443TN0070006","Bronze Compass Plus HSA 5200","69443TN007",,"TNN001","TNS001","TNF001","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=tn0026&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","17"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","1","69443","TN","Individual","No","36-2739571","69443TN0070006","Bronze Compass Plus HSA 5200","69443TN007",,"TNN001","TNS001","TNF001","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070006-03","Limited Cost Sharing Plan Variation",,"0.618971228599548","Yes","Yes","No","100%",,"$5,200","$0","$100","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","10%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=tn0027&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","18"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070001","Gold Compass Plus 1000","69443TN007",,"TNN001","TNS001","TNF005","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070001-00","Standard Gold Off Exchange Plan",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0001&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","4"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070001","Gold Compass Plus 1000","69443TN007",,"TNN001","TNS001","TNF005","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070001-01","Standard Gold On Exchange Plan",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0001&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","5"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070001","Gold Compass Plus 1000","69443TN007",,"TNN001","TNS001","TNF005","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0002&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","6"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070001","Gold Compass Plus 1000","69443TN007",,"TNN001","TNS001","TNF005","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070001-03","Limited Cost Sharing Plan Variation",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0003&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","7"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070003","Silver Compass Plus 2000","69443TN007",,"TNN001","TNS001","TNF002","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070003-00","Standard Silver Off Exchange Plan",,"0.714467763900757","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0007&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","8"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070005","Silver Compass Plus 5000","69443TN007",,"TNN001","TNS001","TNF002","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0023&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","17"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070005","Silver Compass Plus 5000","69443TN007",,"TNN001","TNS001","TNF002","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070005-03","Limited Cost Sharing Plan Variation",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0024&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","18"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070005","Silver Compass Plus 5000","69443TN007",,"TNN001","TNS001","TNF002","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070005-04","73% AV Level Silver Plan",,"0.728041231632233","No","Yes","No","100%",,"$3,600","$20","$500","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0020&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","19"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070005","Silver Compass Plus 5000","69443TN007",,"TNN001","TNS001","TNF002","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070005-05","87% AV Level Silver Plan",,"0.871982634067535","No","Yes","No","100%",,"$800","$0","$800","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0021&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","20"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070005","Silver Compass Plus 5000","69443TN007",,"TNN001","TNS001","TNF002","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070005-06","94% AV Level Silver Plan",,"0.949420213699341","No","Yes","No","100%",,"$0","$0","$500","$200","$0","$500","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0022&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","21"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070007","Bronze Compass Plus 6400","69443TN007",,"TNN001","TNS001","TNF002","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070007-00","Standard Bronze Off Exchange Plan",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0028&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","22"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070007","Bronze Compass Plus 6400","69443TN007",,"TNN001","TNS001","TNF002","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070007-01","Standard Bronze On Exchange Plan",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0028&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","23"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070007","Bronze Compass Plus 6400","69443TN007",,"TNN001","TNS001","TNF002","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0029&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","24"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070007","Bronze Compass Plus 6400","69443TN007",,"TNN001","TNS001","TNF002","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070007-03","Limited Cost Sharing Plan Variation",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tn0030&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","25"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070008","Bronze Compass Plus 4200","69443TN007",,"TNN001","TNS001","TNF003","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070008-00","Standard Bronze Off Exchange Plan",,"0.619571328163147","Yes","Yes","No","100%",,"$4,200","$0","$600","$200","$4,200","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tn0031&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","26"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070008","Bronze Compass Plus 4200","69443TN007",,"TNN001","TNS001","TNF003","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070008-01","Standard Bronze On Exchange Plan",,"0.619571328163147","Yes","Yes","No","100%",,"$4,200","$0","$600","$200","$4,200","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tn0031&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","27"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070008","Bronze Compass Plus 4200","69443TN007",,"TNN001","TNS001","TNF003","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=tn0033&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","28"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070008","Bronze Compass Plus 4200","69443TN007",,"TNN001","TNS001","TNF003","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070008-03","Limited Cost Sharing Plan Variation",,"0.619571328163147","Yes","Yes","No","100%",,"$4,200","$0","$600","$200","$4,200","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tn0032&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","29"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070009","Catastrophic Compass Plus 6850","69443TN007",,"TNN001","TNS001","TNF004","New","POS","Catastrophic","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070009-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tn0034&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","30"
"2016","TN","69443","HIOS","8","2015-10-21 05:00:18","2","69443","TN","Individual","No","36-2739571","69443TN0070009","Catastrophic Compass Plus 6850","69443TN007",,"TNN001","TNS001","TNF004","New","POS","Catastrophic","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tn0036&st=tn","69443TN0070009-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tn0034&st=tn","http://www.uhc.com/iex/doc?id=tn0035&st=tn","31"
"2016","TN","71781","HIOS","2","2015-07-09 13:17:42","1","71781","TN","SHOP (Small Group)","Yes","41-0808596","71781TN0010002","Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho","71781TN001",,"TNN001","TNS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are the same in and out of network","Yes",,"","71781TN0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","71781","HIOS","2","2015-07-09 13:17:42","1","71781","TN","SHOP (Small Group)","Yes","41-0808596","71781TN0010005","Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho","71781TN001",,"TNN001","TNS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are the same in and out of network","Yes",,"","71781TN0010005-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","TN","71781","HIOS","2","2015-07-09 13:17:42","1","71781","TN","SHOP (Small Group)","Yes","41-0808596","71781TN0010007","Plan 7. MAC PPO, $1500 Annual Maximum, Ortho","71781TN001",,"TNN001","TNS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$20.18","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are the same in and out of network","Yes",,"","71781TN0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","TN","75832","HIOS","2","2015-07-09 13:17:42","1","75832","TN","SHOP (Small Group)","Yes","81-0170040","75832TN0010001","Assurant Dental ACAFFO High","75832TN001",,"TNN001","TNS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$35.81","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","75832TN0010001-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","75832","HIOS","2","2015-07-09 13:17:42","1","75832","TN","SHOP (Small Group)","Yes","81-0170040","75832TN0010002","Assurant Dental ACAFFO Low","75832TN001",,"TNN001","TNS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$29.85","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","75832TN0010002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","TN","78859","HIOS","1","2015-05-16 13:12:29","1","78859","TN","SHOP (Small Group)","Yes","57-0523959","78859TN0020001","Group Dental Policy","78859TN002",,"TNN001","TNS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","78859TN0020001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","79913","HIOS","6","2015-08-26 09:56:12","1","79913","TN","Individual","Yes","75-1233841","79913TN0010007","Dentegra Dental PPO Pediatric Basic Plan","79913TN001",,"TNN001","TNS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.85","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","79913TN0010007-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tn/79913tn0010007-16","4"
"2016","TN","79913","HIOS","6","2015-08-26 09:56:12","1","79913","TN","SHOP (Small Group)","Yes","75-1233841","79913TN0020007","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","79913TN002",,"TNN001","TNS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","79913TN0020007-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tn/79913tn0020007-16","4"
"2016","TN","79913","HIOS","6","2015-08-26 09:56:12","2","79913","TN","SHOP (Small Group)","Yes","75-1233841","79913TN0020010","Dentegra Dental PPO for Small Businesses Family Preferred Plan","79913TN002",,"TNN001","TNS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.92","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","79913TN0020010-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tn/79913tn0020010-16","4"
"2016","TN","79913","HIOS","6","2015-08-26 09:56:12","2","79913","TN","Individual","Yes","75-1233841","79913TN0010010","Dentegra Dental PPO Family Preferred Plan","79913TN001",,"TNN001","TNS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","79913TN0010010-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tn/79913tn0010010-16","4"
"2016","TN","79913","HIOS","6","2015-08-26 09:56:12","3","79913","TN","Individual","Yes","75-1233841","79913TN0010009","Dentegra Dental PPO Family Basic Plan","79913TN001",,"TNN001","TNS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.85","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","79913TN0010009-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tn/79913tn0010009-16","4"
"2016","TN","79913","HIOS","6","2015-08-26 09:56:12","3","79913","TN","SHOP (Small Group)","Yes","75-1233841","79913TN0020009","Dentegra Dental PPO for Small Businesses Family Basic Plan","79913TN002",,"TNN001","TNS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","79913TN0020009-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tn/79913tn0020009-16","4"
"2016","TN","79913","HIOS","6","2015-08-26 09:56:12","3","79913","TN","SHOP (Small Group)","Yes","75-1233841","79913TN0020009","Dentegra Dental PPO for Small Businesses Family Basic Plan","79913TN002",,"TNN001","TNS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","79913TN0020009-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tn/79913tn0020009-16","5"
"2016","TN","79913","HIOS","6","2015-08-26 09:56:12","3","79913","TN","Individual","Yes","75-1233841","79913TN0010009","Dentegra Dental PPO Family Basic Plan","79913TN001",,"TNN001","TNS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.85","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","79913TN0010009-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tn/79913tn0010009-16","5"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","1","82120","TN","Individual","No","39-1263473","82120TN0600011","Humana Basic 6850/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF001","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","82120TN0600011-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2609685","http://apps.humana.com/marketing/documents.asp?file=2593448","4"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600014","Humana Gold 2250/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600014-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609854","http://apps.humana.com/marketing/documents.asp?file=2593487","14"
"2016","TN","93542","HIOS","6","2015-08-07 03:04:31","1","93542","TN","SHOP (Small Group)","Yes","86-0307623","93542TN0010001","Smile for Health - Certified Optimum Coverage","93542TN001",,"TNN001","TNS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","93542TN0010001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","93542","HIOS","6","2015-08-07 03:04:31","2","93542","TN","SHOP (Small Group)","Yes","86-0307623","93542TN0010002","Smile for Health - Certified Optimum Coverage","93542TN001",,"TNN002","TNS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","93542TN0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","4","99248","TN","Individual","No","59-1031071","99248TN0020005","Cigna Health Flex 4000","99248TN002","7730182962","TNN001","TNS001","TNF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020005-03","Limited Cost Sharing Plan Variation","68.24%","0.685991764068604","Yes","Yes","No","100%",,"$4,000","$70","$650","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-flex-4000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-flex-4000-naan-300a","7"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","4","99248","TN","Individual","No","59-1031071","99248TN0020005","Cigna Health Flex 4000","99248TN002","7730182962","TNN001","TNS001","TNF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020005-04","73% AV Level Silver Plan","72.01%","0.723933339118958","Yes","Yes","No","100%",,"$2,800","$70","$890","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-flex-4000-250","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-flex-4000-250","8"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","4","99248","TN","Individual","No","59-1031071","99248TN0020005","Cigna Health Flex 4000","99248TN002","7730182962","TNN001","TNS001","TNF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020005-05","87% AV Level Silver Plan","86.06%","0.86573338508606","Yes","Yes","No","100%",,"$300","$40","$1,040","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","15%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-flex-4000-200","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-flex-4000-200","9"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","4","99248","TN","Individual","No","59-1031071","99248TN0020005","Cigna Health Flex 4000","99248TN002","7730182962","TNN001","TNS001","TNF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020005-06","94% AV Level Silver Plan","93.05%","0.933487594127655","Yes","Yes","No","100%",,"$100","$40","$360","$30","$100","$400","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-flex-4000-150","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-flex-4000-150","10"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","1","82120","TN","Individual","Yes","39-1263473","82120TN0630001","Humana Dental Smart Choice","82120TN063",,"TNN005","TNS005",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.20","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","82120TN0630001-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","per person not applicable","per group not applicable",,,,,,"$125","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612987","4"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","1","82120","TN","Individual","Yes","39-1263473","82120TN0630001","Humana Dental Smart Choice","82120TN063",,"TNN005","TNS005",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.20","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","82120TN0630001-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","per person not applicable","per group not applicable",,,,,,"$125","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612987","5"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","1","82120","TN","Individual","No","39-1263473","82120TN0600011","Humana Basic 6850/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF001","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","82120TN0600011-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2609685","http://apps.humana.com/marketing/documents.asp?file=2593448","5"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","1","82120","TN","Individual","No","39-1263473","82120TN0600021","Humana Basic 6850/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF001","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","82120TN0600021-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2609906","http://apps.humana.com/marketing/documents.asp?file=2593513","6"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","1","82120","TN","Individual","No","39-1263473","82120TN0600021","Humana Basic 6850/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF001","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","82120TN0600021-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2609906","http://apps.humana.com/marketing/documents.asp?file=2593513","7"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","1","82120","TN","Individual","No","39-1263473","82120TN0600031","Humana Basic 6850/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF001","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","82120TN0600031-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2610114","http://apps.humana.com/marketing/documents.asp?file=2593578","8"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","1","82120","TN","Individual","No","39-1263473","82120TN0600031","Humana Basic 6850/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF001","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","82120TN0600031-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2610114","http://apps.humana.com/marketing/documents.asp?file=2593578","9"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","2","82120","TN","Individual","No","39-1263473","82120TN0600012","Humana Bronze 6450/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","82120TN0600012-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609698","http://apps.humana.com/marketing/documents.asp?file=2593461","4"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","2","82120","TN","Individual","No","39-1263473","82120TN0600012","Humana Bronze 6450/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","82120TN0600012-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609698","http://apps.humana.com/marketing/documents.asp?file=2593461","5"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","2","82120","TN","Individual","No","39-1263473","82120TN0600012","Humana Bronze 6450/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","82120TN0600012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2609711","http://apps.humana.com/marketing/documents.asp?file=2593461","6"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","2","82120","TN","Individual","No","39-1263473","82120TN0600012","Humana Bronze 6450/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","82120TN0600012-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609724","http://apps.humana.com/marketing/documents.asp?file=2593461","7"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","2","82120","TN","Individual","No","39-1263473","82120TN0600022","Humana Bronze 6450/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","82120TN0600022-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609919","http://apps.humana.com/marketing/documents.asp?file=2593526","8"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","2","82120","TN","Individual","No","39-1263473","82120TN0600022","Humana Bronze 6450/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","82120TN0600022-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609919","http://apps.humana.com/marketing/documents.asp?file=2593526","9"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","2","82120","TN","Individual","No","39-1263473","82120TN0600022","Humana Bronze 6450/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","82120TN0600022-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2609932","http://apps.humana.com/marketing/documents.asp?file=2593526","10"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","2","82120","TN","Individual","No","39-1263473","82120TN0600022","Humana Bronze 6450/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","82120TN0600022-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609945","http://apps.humana.com/marketing/documents.asp?file=2593526","11"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","2","82120","TN","Individual","No","39-1263473","82120TN0600032","Humana Bronze 6450/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","82120TN0600032-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2610127","http://apps.humana.com/marketing/documents.asp?file=2593591","12"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","2","82120","TN","Individual","No","39-1263473","82120TN0600032","Humana Bronze 6450/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","82120TN0600032-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2610127","http://apps.humana.com/marketing/documents.asp?file=2593591","13"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","2","82120","TN","Individual","No","39-1263473","82120TN0600032","Humana Bronze 6450/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","82120TN0600032-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2610140","http://apps.humana.com/marketing/documents.asp?file=2593591","14"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","2","82120","TN","Individual","No","39-1263473","82120TN0600032","Humana Bronze 6450/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF001","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","82120TN0600032-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2610153","http://apps.humana.com/marketing/documents.asp?file=2593591","15"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600013","Humana Silver 3800/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600013-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609737","http://apps.humana.com/marketing/documents.asp?file=2593474","4"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600013","Humana Silver 3800/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600013-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609737","http://apps.humana.com/marketing/documents.asp?file=2593474","5"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600013","Humana Silver 3800/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600013-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609750","http://apps.humana.com/marketing/documents.asp?file=2593474","6"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600013","Humana Silver 3800/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600013-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609763","http://apps.humana.com/marketing/documents.asp?file=2593474","7"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600013","Humana Silver 3800/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600013-04","73% AV Level Silver Plan","72.87%","0.732041835784912","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609776","http://apps.humana.com/marketing/documents.asp?file=2624206","8"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600013","Humana Silver 3800/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600013-05","87% AV Level Silver Plan","87.86%","0.88083416223526","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609789","http://apps.humana.com/marketing/documents.asp?file=2624219","9"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600013","Humana Silver 3800/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600013-06","94% AV Level Silver Plan","93.14%","0.931987762451172","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609802","http://apps.humana.com/marketing/documents.asp?file=2624232","10"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600014","Humana Gold 2250/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600014-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609815","http://apps.humana.com/marketing/documents.asp?file=2593487","11"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600014","Humana Gold 2250/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600014-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609815","http://apps.humana.com/marketing/documents.asp?file=2593487","12"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600014","Humana Gold 2250/Knoxville PPOx","82120TN060",,"TNN001","TNS001","TNF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600014-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609841","http://apps.humana.com/marketing/documents.asp?file=2593487","13"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600023","Humana Silver 3800/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600023-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609958","http://apps.humana.com/marketing/documents.asp?file=2593539","15"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600023","Humana Silver 3800/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600023-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609958","http://apps.humana.com/marketing/documents.asp?file=2593539","16"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600023","Humana Silver 3800/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600023-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609971","http://apps.humana.com/marketing/documents.asp?file=2593539","17"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600023","Humana Silver 3800/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600023-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609984","http://apps.humana.com/marketing/documents.asp?file=2593539","18"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600023","Humana Silver 3800/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600023-04","73% AV Level Silver Plan","72.87%","0.732041835784912","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609997","http://apps.humana.com/marketing/documents.asp?file=2624245","19"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600023","Humana Silver 3800/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600023-05","87% AV Level Silver Plan","87.86%","0.88083416223526","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610010","http://apps.humana.com/marketing/documents.asp?file=2624258","20"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600023","Humana Silver 3800/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600023-06","94% AV Level Silver Plan","93.14%","0.931987762451172","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610023","http://apps.humana.com/marketing/documents.asp?file=2624271","21"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600024","Humana Gold 2250/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600024-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610036","http://apps.humana.com/marketing/documents.asp?file=2593552","22"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600024","Humana Gold 2250/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600024-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610036","http://apps.humana.com/marketing/documents.asp?file=2593552","23"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600024","Humana Gold 2250/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600024-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610049","http://apps.humana.com/marketing/documents.asp?file=2593552","24"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600024","Humana Gold 2250/Memphis PPOx","82120TN060",,"TNN002","TNS002","TNF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600024-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610062","http://apps.humana.com/marketing/documents.asp?file=2593552","25"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600033","Humana Silver 3800/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600033-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610166","http://apps.humana.com/marketing/documents.asp?file=2593604","26"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600033","Humana Silver 3800/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600033-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610166","http://apps.humana.com/marketing/documents.asp?file=2593604","27"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600033","Humana Silver 3800/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600033-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610179","http://apps.humana.com/marketing/documents.asp?file=2593604","28"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600033","Humana Silver 3800/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600033-04","73% AV Level Silver Plan","72.87%","0.732041835784912","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610205","http://apps.humana.com/marketing/documents.asp?file=2624284","30"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600033","Humana Silver 3800/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600033-05","87% AV Level Silver Plan","87.86%","0.88083416223526","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610218","http://apps.humana.com/marketing/documents.asp?file=2624297","31"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600033","Humana Silver 3800/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF002","Existing","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600033-06","94% AV Level Silver Plan","93.14%","0.931987762451172","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$25,200","$25200 per person","$50400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610231","http://apps.humana.com/marketing/documents.asp?file=2624310","32"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600034","Humana Gold 2250/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600034-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610244","http://apps.humana.com/marketing/documents.asp?file=2593617","33"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600034","Humana Gold 2250/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600034-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610244","http://apps.humana.com/marketing/documents.asp?file=2593617","34"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600034","Humana Gold 2250/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600034-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610257","http://apps.humana.com/marketing/documents.asp?file=2593617","35"
"2016","TN","82120","HIOS","9","2015-08-26 09:56:12","3","82120","TN","Individual","No","39-1263473","82120TN0600034","Humana Gold 2250/Nashville PPOx","82120TN060",,"TNN003","TNS003","TNF003","Existing","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","82120TN0600034-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610270","http://apps.humana.com/marketing/documents.asp?file=2593617","36"
"2016","TN","90303","HIOS","2","2015-08-07 03:04:31","1","90303","TN","SHOP (Small Group)","Yes","47-0397286","90303TN0030001","Renaissance Group Dental PPO, EHB Certified","90303TN003",,"TNN001","TNS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.11","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","90303TN0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","90303","HIOS","2","2015-08-07 03:04:31","1","90303","TN","SHOP (Small Group)","Yes","47-0397286","90303TN0030002","Renaissance Group Dental PPO, EHB Certified","90303TN003",,"TNN001","TNS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.32","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","90303TN0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","TN","90303","HIOS","2","2015-08-07 03:04:31","1","90303","TN","Individual","Yes","47-0397286","90303TN0020001","Renaissance Individual Dental PPO, EHB Certified","90303TN002",,"TNN001","TNS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.18","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","90303TN0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","TN","90303","HIOS","2","2015-08-07 03:04:31","1","90303","TN","Individual","Yes","47-0397286","90303TN0020002","Renaissance Individual Dental PPO, EHB Certified","90303TN002",,"TNN001","TNS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.54","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","90303TN0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","TN","90402","HIOS","2","2015-05-08 02:15:08","1","90402","TN","SHOP (Small Group)","Yes","13-5123390","90402TN0010003","Guardian Pediatric Advantage","90402TN001",,"TNN001","TNS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$22.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","90402TN0010003-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","TN","90402","HIOS","2","2015-05-08 02:15:08","1","90402","TN","SHOP (Small Group)","Yes","13-5123390","90402TN0020003","Guardian Pediatric Essentials","90402TN002",,"TNN001","TNS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$17.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","90402TN0020003-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","TN","90402","HIOS","2","2015-05-08 02:15:08","2","90402","TN","SHOP (Small Group)","Yes","13-5123390","90402TN0040003","Guardian Family Advantage","90402TN004",,"TNN001","TNS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","90402TN0040003-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","TN","90402","HIOS","2","2015-05-08 02:15:08","2","90402","TN","SHOP (Small Group)","Yes","13-5123390","90402TN0040003","Guardian Family Advantage","90402TN004",,"TNN001","TNS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","90402TN0040003-01","Standard High On Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","TN","90402","HIOS","2","2015-05-08 02:15:08","2","90402","TN","SHOP (Small Group)","Yes","13-5123390","90402TN0060003","Guardian Family Essentials","90402TN006",,"TNN001","TNS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","90402TN0060003-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","TN","90402","HIOS","2","2015-05-08 02:15:08","2","90402","TN","SHOP (Small Group)","Yes","13-5123390","90402TN0060003","Guardian Family Essentials","90402TN006",,"TNN001","TNS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","90402TN0060003-01","Standard Low On Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","TN","93542","HIOS","6","2015-08-07 03:04:31","3","93542","TN","SHOP (Small Group)","Yes","86-0307623","93542TN0010003","Smile for Health - Certified Optimum Coverage","93542TN001",,"TNN003","TNS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","93542TN0010003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","93542","HIOS","6","2015-08-07 03:04:31","4","93542","TN","SHOP (Small Group)","Yes","86-0307623","93542TN0010004","Smile for Health - Certified Optimum Coverage","93542TN001",,"TNN001","TNS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","93542TN0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","93542","HIOS","6","2015-08-07 03:04:31","5","93542","TN","SHOP (Small Group)","Yes","86-0307623","93542TN0010005","Smile for Health - Certified Optimum Coverage","93542TN001",,"TNN002","TNS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","93542TN0010005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","93542","HIOS","6","2015-08-07 03:04:31","6","93542","TN","SHOP (Small Group)","Yes","86-0307623","93542TN0010006","Smile for Health - Certified Optimum Coverage","93542TN001",,"TNN003","TNS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","93542TN0010006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","93542","HIOS","6","2015-08-07 03:04:31","7","93542","TN","SHOP (Small Group)","Yes","86-0307623","93542TN0020001","Smile for Health - Certified High Option","93542TN002",,"TNN001","TNS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","93542TN0020001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","93542","HIOS","6","2015-08-07 03:04:31","8","93542","TN","SHOP (Small Group)","Yes","86-0307623","93542TN0020002","Smile for Health - Certified High Option","93542TN002",,"TNN002","TNS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","93542TN0020002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","93542","HIOS","6","2015-08-07 03:04:31","9","93542","TN","SHOP (Small Group)","Yes","86-0307623","93542TN0020003","Smile for Health - Certified High Option","93542TN002",,"TNN003","TNS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","93542TN0020003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","93542","HIOS","6","2015-08-07 03:04:31","10","93542","TN","SHOP (Small Group)","Yes","86-0307623","93542TN0020004","Smile for Health - Certified High Option Plus","93542TN002",,"TNN001","TNS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","93542TN0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","93542","HIOS","6","2015-08-07 03:04:31","11","93542","TN","SHOP (Small Group)","Yes","86-0307623","93542TN0020005","Smile for Health - Certified High Option Plus","93542TN002",,"TNN002","TNS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","93542TN0020005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","93542","HIOS","6","2015-08-07 03:04:31","12","93542","TN","SHOP (Small Group)","Yes","86-0307623","93542TN0020006","Smile for Health - Certified High Option Plus","93542TN002",,"TNN003","TNS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","93542TN0020006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","1","99248","TN","Individual","Yes","59-1031071","99248TN0030001","Cigna Dental Pediatric","99248TN003","7730182962","TNN003","TNS003",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$22.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","All Services","Yes",,"","99248TN0030001-00","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/dental-pediatric","4"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","1","99248","TN","Individual","No","59-1031071","99248TN0020001","Cigna Health Savings 6000","99248TN002","7730182962","TNN001","TNS001","TNF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020001-00","Standard Bronze Off Exchange Plan",,"0.61153781414032","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,030","$0","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-savings-6000","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-savings-6000","4"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","1","99248","TN","Individual","No","59-1031071","99248TN0020003","Cigna Health Savings 2700","99248TN002","7730182962","TNN001","TNS001","TNF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020003-01","Standard Silver On Exchange Plan",,"0.680516302585602","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$350","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-savings-2700","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-savings-2700","9"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","1","99248","TN","Individual","No","59-1031071","99248TN0020003","Cigna Health Savings 2700","99248TN002","7730182962","TNN001","TNS001","TNF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/lp/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/lp/naan-300b","10"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","1","99248","TN","Individual","No","59-1031071","99248TN0020003","Cigna Health Savings 2700","99248TN002","7730182962","TNN001","TNS001","TNF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020003-03","Limited Cost Sharing Plan Variation",,"0.680516302585602","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$350","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-savings-2700-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-savings-2700-naan-300a","11"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","1","99248","TN","Individual","No","59-1031071","99248TN0020003","Cigna Health Savings 2700","99248TN002","7730182962","TNN001","TNS001","TNF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020003-04","73% AV Level Silver Plan",,"0.720354199409485","Yes","Yes","No","100%",,"$2,100","$0","$800","$30","$2,100","$0","$440","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","15%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-savings-2700-250","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-savings-2700-250","12"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","1","99248","TN","Individual","No","59-1031071","99248TN0020003","Cigna Health Savings 2700","99248TN002","7730182962","TNN001","TNS001","TNF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020003-05","87% AV Level Silver Plan",,"0.860987782478333","Yes","Yes","No","100%",,"$500","$0","$1,040","$30","$500","$0","$680","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","15%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-savings-2700-200","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-savings-2700-200","13"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","1","99248","TN","Individual","No","59-1031071","99248TN0020003","Cigna Health Savings 2700","99248TN002","7730182962","TNN001","TNS001","TNF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020003-06","94% AV Level Silver Plan",,"0.9306760430336","Yes","Yes","No","100%",,"$100","$0","$730","$30","$100","$0","$490","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-savings-2700-150","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-savings-2700-150","14"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","2","99248","TN","Individual","No","59-1031071","99248TN0020002","Cigna Health Flex 6400","99248TN002","7730182962","TNN001","TNS001","TNF002","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020002-00","Standard Bronze Off Exchange Plan","61.60%","0.63307911157608","Yes","Yes","No","100%",,"$5,170","$90","$330","$30","$140","$880","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-flex-6400","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-flex-6400","4"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","2","99248","TN","Individual","Yes","59-1031071","99248TN0030002","Cigna Dental Family + Pediatric","99248TN003","7730182962","TNN003","TNS003",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","All Services","Yes",,"","99248TN0030002-01","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/dental-family-ped","4"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","2","99248","TN","Individual","No","59-1031071","99248TN0020002","Cigna Health Flex 6400","99248TN002","7730182962","TNN001","TNS001","TNF002","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020002-01","Standard Bronze On Exchange Plan","61.60%","0.63307911157608","Yes","Yes","No","100%",,"$5,170","$90","$330","$30","$140","$880","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-flex-6400","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-flex-6400","5"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","2","99248","TN","Individual","No","59-1031071","99248TN0020002","Cigna Health Flex 6400","99248TN002","7730182962","TNN001","TNS001","TNF002","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/lp/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/lp/naan-300b","6"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","2","99248","TN","Individual","No","59-1031071","99248TN0020002","Cigna Health Flex 6400","99248TN002","7730182962","TNN001","TNS001","TNF002","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020002-03","Limited Cost Sharing Plan Variation","61.60%","0.63307911157608","Yes","Yes","No","100%",,"$5,170","$90","$330","$30","$140","$880","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-flex-6400-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-flex-6400-naan-300a","7"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","3","99248","TN","Individual","No","59-1031071","99248TN0020004","Cigna Health Flex 2250","99248TN002","7730182962","TNN001","TNS001","TNF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020004-00","Standard Silver Off Exchange Plan","69.99%","0.704526782035828","Yes","Yes","No","100%",,"$2,250","$70","$1,500","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-flex-2250","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-flex-2250","4"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","3","99248","TN","Individual","No","59-1031071","99248TN0020004","Cigna Health Flex 2250","99248TN002","7730182962","TNN001","TNS001","TNF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020004-01","Standard Silver On Exchange Plan","69.99%","0.704526782035828","Yes","Yes","No","100%",,"$2,250","$70","$1,500","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-flex-2250","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-flex-2250","5"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","3","99248","TN","Individual","No","59-1031071","99248TN0020004","Cigna Health Flex 2250","99248TN002","7730182962","TNN001","TNS001","TNF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/lp/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/lp/naan-300b","6"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","3","99248","TN","Individual","No","59-1031071","99248TN0020004","Cigna Health Flex 2250","99248TN002","7730182962","TNN001","TNS001","TNF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020004-03","Limited Cost Sharing Plan Variation","69.99%","0.704526782035828","Yes","Yes","No","100%",,"$2,250","$70","$1,500","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-flex-2250-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-flex-2250-naan-300a","7"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","3","99248","TN","Individual","No","59-1031071","99248TN0020004","Cigna Health Flex 2250","99248TN002","7730182962","TNN001","TNS001","TNF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020004-04","73% AV Level Silver Plan","72.32%","0.727313339710236","Yes","Yes","No","100%",,"$2,100","$70","$1,540","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","30%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-flex-2250-250","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-flex-2250-250","8"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","3","99248","TN","Individual","No","59-1031071","99248TN0020004","Cigna Health Flex 2250","99248TN002","7730182962","TNN001","TNS001","TNF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020004-05","87% AV Level Silver Plan","86.10%","0.865408897399902","Yes","Yes","No","100%",,"$150","$40","$1,420","$30","$150","$440","$30","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-flex-2250-200","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-flex-2250-200","9"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","3","99248","TN","Individual","No","59-1031071","99248TN0020004","Cigna Health Flex 2250","99248TN002","7730182962","TNN001","TNS001","TNF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020004-06","94% AV Level Silver Plan","93.16%","0.935242593288422","Yes","Yes","No","100%",,"$0","$40","$360","$30","$0","$400","$10","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-flex-2250-150","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-flex-2250-150","10"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","4","99248","TN","Individual","No","59-1031071","99248TN0020005","Cigna Health Flex 4000","99248TN002","7730182962","TNN001","TNS001","TNF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020005-00","Standard Silver Off Exchange Plan","68.24%","0.685991764068604","Yes","Yes","No","100%",,"$4,000","$70","$650","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-flex-4000","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-flex-4000","4"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","4","99248","TN","Individual","No","59-1031071","99248TN0020005","Cigna Health Flex 4000","99248TN002","7730182962","TNN001","TNS001","TNF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020005-01","Standard Silver On Exchange Plan","68.24%","0.685991764068604","Yes","Yes","No","100%",,"$4,000","$70","$650","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-flex-4000","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-flex-4000","5"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","4","99248","TN","Individual","No","59-1031071","99248TN0020005","Cigna Health Flex 4000","99248TN002","7730182962","TNN001","TNS001","TNF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/lp/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/lp/naan-300b","6"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","4","99248","TN","Individual","No","59-1031071","99248TN0020007","Cigna Health Flex 1200","99248TN002","7730182962","TNN001","TNS001","TNF005","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020007-00","Standard Gold Off Exchange Plan","78.08%","0.785592615604401","Yes","Yes","No","100%",,"$1,200","$40","$1,210","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-flex-1200","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-flex-1200","11"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","4","99248","TN","Individual","No","59-1031071","99248TN0020007","Cigna Health Flex 1200","99248TN002","7730182962","TNN001","TNS001","TNF005","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020007-01","Standard Gold On Exchange Plan","78.08%","0.785592615604401","Yes","Yes","No","100%",,"$1,200","$40","$1,210","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-flex-1200","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-flex-1200","12"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","4","99248","TN","Individual","No","59-1031071","99248TN0020007","Cigna Health Flex 1200","99248TN002","7730182962","TNN001","TNS001","TNF005","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/lp/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/lp/naan-300b","13"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","4","99248","TN","Individual","No","59-1031071","99248TN0020007","Cigna Health Flex 1200","99248TN002","7730182962","TNN001","TNS001","TNF005","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Services","Yes","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0020007-03","Limited Cost Sharing Plan Variation","78.08%","0.785592615604401","Yes","Yes","No","100%",,"$1,200","$40","$1,210","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/health-flex-1200-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/health-flex-1200-naan-300a","14"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","5","99248","TN","Individual","No","59-1031071","99248TN0060001","Cigna Connect HSA Bronze 6000","99248TN006","7730182962","TNN002","TNS002","TNF001","New","EPO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060001-00","Standard Bronze Off Exchange Plan",,"0.61153781414032","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,030","$0","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/hsa-bronze-6000","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/hsa-bronze-6000","4"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","5","99248","TN","Individual","No","59-1031071","99248TN0060001","Cigna Connect HSA Bronze 6000","99248TN006","7730182962","TNN002","TNS002","TNF001","New","EPO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060001-01","Standard Bronze On Exchange Plan",,"0.61153781414032","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,030","$0","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/hsa-bronze-6000","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/hsa-bronze-6000","5"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","5","99248","TN","Individual","No","59-1031071","99248TN0060001","Cigna Connect HSA Bronze 6000","99248TN006","7730182962","TNN002","TNS002","TNF001","New","EPO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/epo/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/epo/naan-300b","6"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","5","99248","TN","Individual","No","59-1031071","99248TN0060001","Cigna Connect HSA Bronze 6000","99248TN006","7730182962","TNN002","TNS002","TNF001","New","EPO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060001-03","Limited Cost Sharing Plan Variation",,"0.61153781414032","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,030","$0","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/hsa-bronze-6000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/hsa-bronze-6000-naan-300a","7"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","5","99248","TN","Individual","No","59-1031071","99248TN0060003","Cigna Connect HSA Silver 2700","99248TN006","7730182962","TNN002","TNS002","TNF003","New","EPO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060003-00","Standard Silver Off Exchange Plan",,"0.680516302585602","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$350","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/hsa-silver-2700","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/hsa-silver-2700","8"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","5","99248","TN","Individual","No","59-1031071","99248TN0060003","Cigna Connect HSA Silver 2700","99248TN006","7730182962","TNN002","TNS002","TNF003","New","EPO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060003-01","Standard Silver On Exchange Plan",,"0.680516302585602","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$350","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/hsa-silver-2700","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/hsa-silver-2700","9"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","5","99248","TN","Individual","No","59-1031071","99248TN0060003","Cigna Connect HSA Silver 2700","99248TN006","7730182962","TNN002","TNS002","TNF003","New","EPO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/epo/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/epo/naan-300b","10"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","5","99248","TN","Individual","No","59-1031071","99248TN0060003","Cigna Connect HSA Silver 2700","99248TN006","7730182962","TNN002","TNS002","TNF003","New","EPO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060003-03","Limited Cost Sharing Plan Variation",,"0.680516302585602","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$350","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/hsa-silver-2700-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/hsa-silver-2700-naan-300a","11"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","5","99248","TN","Individual","No","59-1031071","99248TN0060003","Cigna Connect HSA Silver 2700","99248TN006","7730182962","TNN002","TNS002","TNF003","New","EPO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060003-04","73% AV Level Silver Plan",,"0.720354199409485","Yes","Yes","No","100%",,"$2,100","$0","$800","$30","$2,100","$0","$440","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/hsa-silver-2700-250","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/hsa-silver-2700-250","12"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","5","99248","TN","Individual","No","59-1031071","99248TN0060003","Cigna Connect HSA Silver 2700","99248TN006","7730182962","TNN002","TNS002","TNF003","New","EPO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060003-05","87% AV Level Silver Plan",,"0.860987782478333","Yes","Yes","No","100%",,"$500","$0","$1,040","$30","$500","$0","$680","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/hsa-silver-2700-200","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/hsa-silver-2700-200","13"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","5","99248","TN","Individual","No","59-1031071","99248TN0060003","Cigna Connect HSA Silver 2700","99248TN006","7730182962","TNN002","TNS002","TNF003","New","EPO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060003-06","94% AV Level Silver Plan",,"0.9306760430336","Yes","Yes","No","100%",,"$100","$0","$730","$30","$100","$0","$490","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/hsa-silver-2700-150","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/hsa-silver-2700-150","14"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","6","99248","TN","Individual","No","59-1031071","99248TN0060002","Cigna Connect Flex Bronze 6400","99248TN006","7730182962","TNN002","TNS002","TNF002","New","EPO","Bronze","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060002-00","Standard Bronze Off Exchange Plan","61.60%","0.63307911157608","Yes","Yes","No","100%",,"$5,170","$90","$330","$30","$140","$880","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/flex-bronze-6400","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/flex-bronze-6400","4"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","6","99248","TN","Individual","No","59-1031071","99248TN0060002","Cigna Connect Flex Bronze 6400","99248TN006","7730182962","TNN002","TNS002","TNF002","New","EPO","Bronze","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060002-01","Standard Bronze On Exchange Plan","61.60%","0.63307911157608","Yes","Yes","No","100%",,"$5,170","$90","$330","$30","$140","$880","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/flex-bronze-6400","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/flex-bronze-6400","5"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","6","99248","TN","Individual","No","59-1031071","99248TN0060002","Cigna Connect Flex Bronze 6400","99248TN006","7730182962","TNN002","TNS002","TNF002","New","EPO","Bronze","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/epo/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/epo/naan-300b","6"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","6","99248","TN","Individual","No","59-1031071","99248TN0060002","Cigna Connect Flex Bronze 6400","99248TN006","7730182962","TNN002","TNS002","TNF002","New","EPO","Bronze","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060002-03","Limited Cost Sharing Plan Variation","61.60%","0.63307911157608","Yes","Yes","No","100%",,"$5,170","$90","$330","$30","$140","$880","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/flex-bronze-6400-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/flex-bronze-6400-naan-300a","7"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","7","99248","TN","Individual","No","59-1031071","99248TN0060004","Cigna Connect Flex Silver 2250","99248TN006","7730182962","TNN002","TNS002","TNF004","New","EPO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060004-00","Standard Silver Off Exchange Plan","69.99%","0.704526782035828","Yes","Yes","No","100%",,"$2,250","$70","$1,500","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/flex-silver-2250","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/flex-silver-2250","4"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","7","99248","TN","Individual","No","59-1031071","99248TN0060004","Cigna Connect Flex Silver 2250","99248TN006","7730182962","TNN002","TNS002","TNF004","New","EPO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060004-01","Standard Silver On Exchange Plan","69.99%","0.704526782035828","Yes","Yes","No","100%",,"$2,250","$70","$1,500","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/flex-silver-2250","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/flex-silver-2250","5"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","7","99248","TN","Individual","No","59-1031071","99248TN0060004","Cigna Connect Flex Silver 2250","99248TN006","7730182962","TNN002","TNS002","TNF004","New","EPO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/epo/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/epo/naan-300b","6"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","7","99248","TN","Individual","No","59-1031071","99248TN0060004","Cigna Connect Flex Silver 2250","99248TN006","7730182962","TNN002","TNS002","TNF004","New","EPO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060004-03","Limited Cost Sharing Plan Variation","69.99%","0.704526782035828","Yes","Yes","No","100%",,"$2,250","$70","$1,500","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/flex-silver-2250-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/flex-silver-2250-naan-300a","7"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","7","99248","TN","Individual","No","59-1031071","99248TN0060004","Cigna Connect Flex Silver 2250","99248TN006","7730182962","TNN002","TNS002","TNF004","New","EPO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060004-04","73% AV Level Silver Plan","72.32%","0.727313339710236","Yes","Yes","No","100%",,"$2,100","$70","$1,540","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/flex-silver-2250-250","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/flex-silver-2250-250","8"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","7","99248","TN","Individual","No","59-1031071","99248TN0060004","Cigna Connect Flex Silver 2250","99248TN006","7730182962","TNN002","TNS002","TNF004","New","EPO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060004-05","87% AV Level Silver Plan","86.10%","0.865408897399902","Yes","Yes","No","100%",,"$150","$40","$1,420","$30","$150","$440","$30","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/flex-silver-2250-200","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/flex-silver-2250-200","9"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","7","99248","TN","Individual","No","59-1031071","99248TN0060004","Cigna Connect Flex Silver 2250","99248TN006","7730182962","TNN002","TNS002","TNF004","New","EPO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060004-06","94% AV Level Silver Plan","93.16%","0.935242593288422","Yes","Yes","No","100%",,"$0","$40","$360","$30","$0","$400","$10","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/flex-silver-2250-150","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/flex-silver-2250-150","10"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","8","99248","TN","Individual","No","59-1031071","99248TN0060005","Cigna Connect Flex Silver 4000","99248TN006","7730182962","TNN002","TNS002","TNF004","New","EPO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060005-00","Standard Silver Off Exchange Plan","68.24%","0.685991764068604","Yes","Yes","No","100%",,"$4,000","$70","$650","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/flex-silver-4000","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/flex-silver-4000","4"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","8","99248","TN","Individual","No","59-1031071","99248TN0060005","Cigna Connect Flex Silver 4000","99248TN006","7730182962","TNN002","TNS002","TNF004","New","EPO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060005-01","Standard Silver On Exchange Plan","68.24%","0.685991764068604","Yes","Yes","No","100%",,"$4,000","$70","$650","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/flex-silver-4000","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/flex-silver-4000","5"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","8","99248","TN","Individual","No","59-1031071","99248TN0060005","Cigna Connect Flex Silver 4000","99248TN006","7730182962","TNN002","TNS002","TNF004","New","EPO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/epo/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/epo/naan-300b","6"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","8","99248","TN","Individual","No","59-1031071","99248TN0060005","Cigna Connect Flex Silver 4000","99248TN006","7730182962","TNN002","TNS002","TNF004","New","EPO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060005-03","Limited Cost Sharing Plan Variation","68.24%","0.685991764068604","Yes","Yes","No","100%",,"$4,000","$70","$650","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/flex-silver-4000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/flex-silver-4000-naan-300a","7"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","8","99248","TN","Individual","No","59-1031071","99248TN0060005","Cigna Connect Flex Silver 4000","99248TN006","7730182962","TNN002","TNS002","TNF004","New","EPO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060005-04","73% AV Level Silver Plan","72.01%","0.723933339118958","Yes","Yes","No","100%",,"$2,800","$70","$890","$30","$140","$720","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/flex-silver-4000-250","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/flex-silver-4000-250","8"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","8","99248","TN","Individual","No","59-1031071","99248TN0060005","Cigna Connect Flex Silver 4000","99248TN006","7730182962","TNN002","TNS002","TNF004","New","EPO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060005-05","87% AV Level Silver Plan","86.06%","0.86573338508606","Yes","Yes","No","100%",,"$300","$40","$1,040","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/flex-silver-4000-200","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/flex-silver-4000-200","9"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","8","99248","TN","Individual","No","59-1031071","99248TN0060005","Cigna Connect Flex Silver 4000","99248TN006","7730182962","TNN002","TNS002","TNF004","New","EPO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060005-06","94% AV Level Silver Plan","93.05%","0.933487594127655","Yes","Yes","No","100%",,"$100","$40","$360","$30","$100","$400","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/flex-silver-4000-150","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/flex-silver-4000-150","10"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","8","99248","TN","Individual","No","59-1031071","99248TN0060006","Cigna Connect Flex Gold 1200","99248TN006","7730182962","TNN002","TNS002","TNF005","New","EPO","Gold","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060006-00","Standard Gold Off Exchange Plan","78.08%","0.785592615604401","Yes","Yes","No","100%",,"$1,200","$40","$1,210","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/flex-gold-1200","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/flex-gold-1200","11"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","8","99248","TN","Individual","No","59-1031071","99248TN0060006","Cigna Connect Flex Gold 1200","99248TN006","7730182962","TNN002","TNS002","TNF005","New","EPO","Gold","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060006-01","Standard Gold On Exchange Plan","78.08%","0.785592615604401","Yes","Yes","No","100%",,"$1,200","$40","$1,210","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/flex-gold-1200","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/flex-gold-1200","12"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","8","99248","TN","Individual","No","59-1031071","99248TN0060006","Cigna Connect Flex Gold 1200","99248TN006","7730182962","TNN002","TNS002","TNF005","New","EPO","Gold","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/epo/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/epo/naan-300b","13"
"2016","TN","99248","HIOS","7","2015-08-25 05:06:23","8","99248","TN","Individual","No","59-1031071","99248TN0060006","Cigna Connect Flex Gold 1200","99248TN006","7730182962","TNN002","TNS002","TNF005","New","EPO","Gold","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","99248TN0060006-03","Limited Cost Sharing Plan Variation","78.08%","0.785592615604401","Yes","Yes","No","100%",,"$1,200","$40","$1,210","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/tennessee/flex-gold-1200-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/tennessee/flex-gold-1200-naan-300a","14"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0120001","Simple Gold","20069TX012",,"TXN001","TXS001","TXF009","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0120001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF009","20069TX0120001-03","Limited Cost Sharing Plan Variation","78.90%",,"Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0120001-03","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0120001-03","14"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0140001","Simple+ Silver","20069TX014",,"TXN001","TXS001","TXF006","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0140001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF006","20069TX0140001-00","Standard Silver Off Exchange Plan","71.90%",,"Yes","Yes","No","100%",,"$5,400","$0","$0","$200","$100","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,900","$5900 per person","$11800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,900","$5900 per person","$11800 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0140001-00","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0140001-00","15"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0140001","Simple+ Silver","20069TX014",,"TXN001","TXS001","TXF006","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0140001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF006","20069TX0140001-01","Standard Silver On Exchange Plan","71.90%",,"Yes","Yes","No","100%",,"$5,400","$0","$0","$200","$100","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,900","$5900 per person","$11800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,900","$5900 per person","$11800 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0140001-01","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0140001-01","16"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0140001","Simple+ Silver","20069TX014",,"TXN001","TXS001","TXF006","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0140001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF006","20069TX0140001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0140001-02","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0140001-02","17"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0140001","Simple+ Silver","20069TX014",,"TXN001","TXS001","TXF006","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0140001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF006","20069TX0140001-03","Limited Cost Sharing Plan Variation","71.90%",,"Yes","Yes","No","100%",,"$5,400","$0","$0","$200","$100","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,900","$5900 per person","$11800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,900","$5900 per person","$11800 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0140001-03","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0140001-03","18"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0140001","Simple+ Silver","20069TX014",,"TXN001","TXS001","TXF006","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0140001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF006","20069TX0140001-04","73% AV Level Silver Plan","74.00%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$100","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,150","$5150 per person","$10300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,150","$5150 per person","$10300 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0140001-04","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0140001-04","19"
"2016","TX","12350","HIOS","2","2015-07-11 04:19:24","1","12350","TX","SHOP (Small Group)","Yes","44-0308260","12350TX0010001","KCL EHB Low PPO","12350TX001",,"TXN001","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$39.95","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","12350TX0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","12350","HIOS","2","2015-07-11 04:19:24","1","12350","TX","SHOP (Small Group)","Yes","44-0308260","12350TX0010003","KCL EHB Low MAC","12350TX001",,"TXN001","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$30.77","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","12350TX0010003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","TX","12350","HIOS","2","2015-07-11 04:19:24","1","12350","TX","SHOP (Small Group)","Yes","44-0308260","12350TX0010005","KCL Fam Low PPO","12350TX001",,"TXN001","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$39.95","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","12350TX0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","TX","12350","HIOS","2","2015-07-11 04:19:24","1","12350","TX","SHOP (Small Group)","Yes","44-0308260","12350TX0010007","KCL Fam Low MAC","12350TX001",,"TXN001","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$30.77","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","12350TX0010007-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","TX","12350","HIOS","2","2015-07-11 04:19:24","2","12350","TX","SHOP (Small Group)","Yes","44-0308260","12350TX0010002","KCL EHB High PPO","12350TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$47.30","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","12350TX0010002-00","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","12350","HIOS","2","2015-07-11 04:19:24","2","12350","TX","SHOP (Small Group)","Yes","44-0308260","12350TX0010004","KCL EHB High MAC","12350TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$37.33","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","12350TX0010004-00","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0150001","Simple+ Gold","20069TX015",,"TXN001","TXS001","TXF007","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0150001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF007","20069TX0150001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0150001-02","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0150001-02","24"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0150001","Simple+ Gold","20069TX015",,"TXN001","TXS001","TXF007","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0150001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF007","20069TX0150001-03","Limited Cost Sharing Plan Variation","81.00%",,"Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$100","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0150001-03","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0150001-03","25"
"2016","TX","22012","HIOS","2","2015-07-09 13:17:42","1","22012","TX","SHOP (Small Group)","Yes","41-0808596","22012TX0010002","Plan 2. MAC PPO, $1500 Annual Maximum, Ortho","22012TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$20.18","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","benefits the same in and out of network","Yes",,"","22012TX0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","23749","HIOS","9","2015-10-21 05:00:18","1","23749","TX","SHOP (Small Group)","Yes","75-1233841","23749TX0020001","Dentegra DPO for Small Businesses Pediatric Basic Plan","23749TX002",,"TXN001","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","23749TX0020001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tx/23749tx0020001-16","4"
"2016","TX","23749","HIOS","9","2015-10-21 05:00:18","1","23749","TX","Individual","Yes","75-1233841","23749TX0010001","Dentegra DPO Pediatric Basic Plan","23749TX001",,"TXN001","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","23749TX0010001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tx/23749tx0010001-16","4"
"2016","TX","23749","HIOS","9","2015-10-21 05:00:18","2","23749","TX","Individual","Yes","75-1233841","23749TX0010004","Dentegra DPO Family Preferred Plan","23749TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","23749TX0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tx/23749tx0010004-16","4"
"2016","TX","23749","HIOS","9","2015-10-21 05:00:18","2","23749","TX","SHOP (Small Group)","Yes","75-1233841","23749TX0020004","Dentegra DPO for Small Businesses Family Preferred Plan","23749TX002",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.35","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","23749TX0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tx/23749tx0020004-16","4"
"2016","TX","23749","HIOS","9","2015-10-21 05:00:18","2","23749","TX","SHOP (Small Group)","Yes","75-1233841","23749TX0020004","Dentegra DPO for Small Businesses Family Preferred Plan","23749TX002",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.35","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","23749TX0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tx/23749tx0020004-16","5"
"2016","TX","23749","HIOS","9","2015-10-21 05:00:18","2","23749","TX","Individual","Yes","75-1233841","23749TX0010004","Dentegra DPO Family Preferred Plan","23749TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","23749TX0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tx/23749tx0010004-16","5"
"2016","TX","23749","HIOS","9","2015-10-21 05:00:18","3","23749","TX","Individual","Yes","75-1233841","23749TX0010006","Dentegra DPO Family Basic Plan","23749TX001",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","23749TX0010006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tx/23749tx0010006-16","4"
"2016","TX","12350","HIOS","2","2015-07-11 04:19:24","2","12350","TX","SHOP (Small Group)","Yes","44-0308260","12350TX0010006","KCL Fam High PPO","12350TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$47.30","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","12350TX0010006-00","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","TX","12350","HIOS","2","2015-07-11 04:19:24","2","12350","TX","SHOP (Small Group)","Yes","44-0308260","12350TX0010008","KCL Fam High MAC","12350TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$37.33","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","12350TX0010008-00","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","TX","12846","HIOS","2","2015-07-08 02:47:08","1","12846","TX","SHOP (Small Group)","Yes","13-5123390","12846TX0200002","Guardian Pediatric Advantage","12846TX020",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$23.08","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage available outside the service area.","Yes",,"","12846TX0200002-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","TX","12846","HIOS","2","2015-07-08 02:47:08","1","12846","TX","SHOP (Small Group)","Yes","13-5123390","12846TX0210002","Guardian Pediatric Essentials","12846TX021",,"TXN001","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$17.97","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage available outside the service area.","Yes",,"","12846TX0210002-00","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","TX","12846","HIOS","2","2015-07-08 02:47:08","2","12846","TX","SHOP (Small Group)","Yes","13-5123390","12846TX0230002","Guardian Family Advantage","12846TX023",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.08","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","12846TX0230002-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","TX","12846","HIOS","2","2015-07-08 02:47:08","2","12846","TX","SHOP (Small Group)","Yes","13-5123390","12846TX0230002","Guardian Family Advantage","12846TX023",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.08","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","12846TX0230002-01","Standard High On Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","TX","12846","HIOS","2","2015-07-08 02:47:08","2","12846","TX","SHOP (Small Group)","Yes","13-5123390","12846TX0250002","Guardian Family Essentials","12846TX025",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.97","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","12846TX0250002-00","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","TX","12846","HIOS","2","2015-07-08 02:47:08","2","12846","TX","SHOP (Small Group)","Yes","13-5123390","12846TX0250002","Guardian Family Essentials","12846TX025",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.97","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","12846TX0250002-01","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","TX","19312","HIOS","3","2016-01-22 04:00:42","1","19312","TX","Individual","Yes","91-1857813","19312TX0010010","PLUS Family Plan with EHB PLUS","19312TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions.",,"No","Allows Adult and Child-Only",,,,,"$26.62","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule agreed to by participating providers.","Yes",,"","19312TX0010010-00","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.premierlife.com/exchangeplans","https://www.premierlife.com/exchangeplans","4"
"2016","TX","19312","HIOS","3","2016-01-22 04:00:42","1","19312","TX","Individual","Yes","91-1857813","19312TX0010010","PLUS Family Plan with EHB PLUS","19312TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions.",,"No","Allows Adult and Child-Only",,,,,"$26.62","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule agreed to by participating providers.","Yes",,"","19312TX0010010-01","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.premierlife.com/exchangeplans","https://www.premierlife.com/exchangeplans","5"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","1","20069","TX","Individual","No","47-3185443","20069TX0010001","Market Secure","20069TX001",,"TXN001","TXS001","TXF008","New","EPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.99741",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0010001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF008","20069TX0010001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$200","$5,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0010001-00","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0010001-00","4"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","1","20069","TX","Individual","No","47-3185443","20069TX0010001","Market Secure","20069TX001",,"TXN001","TXS001","TXF008","New","EPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.99741",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0010001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF008","20069TX0010001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$200","$5,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0010001-01","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0010001-01","5"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","1","20069","TX","Individual","No","47-3185443","20069TX0060001","Classic Bronze","20069TX006",,"TXN001","TXS001","TXF008","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9977",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0060001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF008","20069TX0060001-00","Standard Bronze Off Exchange Plan","61.60%",,"Yes","Yes","No","100%",,"$5,400","$0","$0","$200","$5,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$68500 per person","$13700 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0060001-00","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0060001-00","6"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","1","20069","TX","Individual","No","47-3185443","20069TX0060001","Classic Bronze","20069TX006",,"TXN001","TXS001","TXF008","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9977",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0060001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF008","20069TX0060001-01","Standard Bronze On Exchange Plan","61.60%",,"Yes","Yes","No","100%",,"$5,400","$0","$0","$200","$5,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$68500 per person","$13700 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0060001-01","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0060001-01","7"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","1","20069","TX","Individual","No","47-3185443","20069TX0060001","Classic Bronze","20069TX006",,"TXN001","TXS001","TXF008","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9977",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0060001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF008","20069TX0060001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0060001-02","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0060001-02","8"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","1","20069","TX","Individual","No","47-3185443","20069TX0060001","Classic Bronze","20069TX006",,"TXN001","TXS001","TXF008","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9977",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0060001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF008","20069TX0060001-03","Limited Cost Sharing Plan Variation","61.60%",,"Yes","Yes","No","100%",,"$5,400","$0","$0","$200","$5,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$68500 per person","$13700 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0060001-03","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0060001-03","9"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","2","20069","TX","Individual","No","47-3185443","20069TX0020001","Market Bronze","20069TX002",,"TXN001","TXS001","TXF004","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9977",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0020001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF004","20069TX0020001-00","Standard Bronze Off Exchange Plan","59.70%",,"Yes","Yes","No","100%",,"$5,000","$0","$200","$200","$5,000","$0","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0020001-00","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0020001-00","4"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","2","20069","TX","Individual","No","47-3185443","20069TX0020001","Market Bronze","20069TX002",,"TXN001","TXS001","TXF004","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9977",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0020001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF004","20069TX0020001-01","Standard Bronze On Exchange Plan","59.70%",,"Yes","Yes","No","100%",,"$5,000","$0","$200","$200","$5,000","$0","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0020001-01","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0020001-01","5"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","2","20069","TX","Individual","No","47-3185443","20069TX0020001","Market Bronze","20069TX002",,"TXN001","TXS001","TXF004","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9977",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0020001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF004","20069TX0020001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0020001-02","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0020001-02","6"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","2","20069","TX","Individual","No","47-3185443","20069TX0020001","Market Bronze","20069TX002",,"TXN001","TXS001","TXF004","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9977",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0020001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF004","20069TX0020001-03","Limited Cost Sharing Plan Variation","59.70%",,"Yes","Yes","No","100%",,"$5,000","$0","$200","$200","$5,000","$0","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0020001-03","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0020001-03","7"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","2","20069","TX","Individual","No","47-3185443","20069TX0030001","Market Silver","20069TX003",,"TXN001","TXS001","TXF002","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0030001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF002","20069TX0030001-00","Standard Silver Off Exchange Plan","70.90%",,"Yes","Yes","No","100%",,"$2,000","$1,600","$0","$200","$2,000","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0030001-00","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0030001-00","8"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","2","20069","TX","Individual","No","47-3185443","20069TX0030001","Market Silver","20069TX003",,"TXN001","TXS001","TXF002","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0030001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF002","20069TX0030001-01","Standard Silver On Exchange Plan","70.90%",,"Yes","Yes","No","100%",,"$2,000","$1,600","$0","$200","$2,000","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0030001-01","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0030001-01","9"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","2","20069","TX","Individual","No","47-3185443","20069TX0030001","Market Silver","20069TX003",,"TXN001","TXS001","TXF002","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0030001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF002","20069TX0030001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0030001-02","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0030001-02","10"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","2","20069","TX","Individual","No","47-3185443","20069TX0030001","Market Silver","20069TX003",,"TXN001","TXS001","TXF002","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0030001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF002","20069TX0030001-03","Limited Cost Sharing Plan Variation","70.90%",,"Yes","Yes","No","100%",,"$2,000","$1,600","$0","$200","$2,000","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0030001-03","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0030001-03","11"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","2","20069","TX","Individual","No","47-3185443","20069TX0030001","Market Silver","20069TX003",,"TXN001","TXS001","TXF002","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0030001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF002","20069TX0030001-04","73% AV Level Silver Plan","73.30%",,"Yes","Yes","No","100%",,"$1,500","$1,600","$0","$200","$1,500","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0030001-04","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0030001-04","12"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","2","20069","TX","Individual","No","47-3185443","20069TX0030001","Market Silver","20069TX003",,"TXN001","TXS001","TXF002","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0030001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF002","20069TX0030001-05","87% AV Level Silver Plan","87.60%",,"Yes","Yes","No","100%",,"$100","$1,200","$0","$200","$100","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0030001-05","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0030001-05","13"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","2","20069","TX","Individual","No","47-3185443","20069TX0030001","Market Silver","20069TX003",,"TXN001","TXS001","TXF002","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0030001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF002","20069TX0030001-06","94% AV Level Silver Plan","94.90%",,"Yes","Yes","No","100%",,"$0","$600","$0","$200","$0","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0030001-06","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0030001-06","14"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","2","20069","TX","Individual","No","47-3185443","20069TX0040001","Market Gold","20069TX004",,"TXN001","TXS001","TXF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0040001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF002","20069TX0040001-00","Standard Gold Off Exchange Plan","80.40%",,"Yes","Yes","No","100%",,"$600","$1,200","$0","$200","$600","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0040001-00","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0040001-00","15"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","2","20069","TX","Individual","No","47-3185443","20069TX0040001","Market Gold","20069TX004",,"TXN001","TXS001","TXF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0040001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF002","20069TX0040001-01","Standard Gold On Exchange Plan","80.40%",,"Yes","Yes","No","100%",,"$600","$1,200","$0","$200","$600","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0040001-01","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0040001-01","16"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","2","20069","TX","Individual","No","47-3185443","20069TX0040001","Market Gold","20069TX004",,"TXN001","TXS001","TXF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0040001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF002","20069TX0040001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0040001-02","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0040001-02","17"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","2","20069","TX","Individual","No","47-3185443","20069TX0040001","Market Gold","20069TX004",,"TXN001","TXS001","TXF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0040001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF002","20069TX0040001-03","Limited Cost Sharing Plan Variation","80.40%",,"Yes","Yes","No","100%",,"$600","$1,200","$0","$200","$600","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0040001-03","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0040001-03","18"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","3","20069","TX","Individual","No","47-3185443","20069TX0070001","Classic Silver","20069TX007",,"TXN001","TXS001","TXF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0070001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF005","20069TX0070001-00","Standard Silver Off Exchange Plan","68.40%",,"Yes","Yes","No","100%",,"$4,500","$100","$0","$200","$2,500","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0070001-00","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0070001-00","4"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","3","20069","TX","Individual","No","47-3185443","20069TX0070001","Classic Silver","20069TX007",,"TXN001","TXS001","TXF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0070001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF005","20069TX0070001-01","Standard Silver On Exchange Plan","68.40%",,"Yes","Yes","No","100%",,"$4,500","$100","$0","$200","$2,500","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0070001-01","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0070001-01","5"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","3","20069","TX","Individual","No","47-3185443","20069TX0070001","Classic Silver","20069TX007",,"TXN001","TXS001","TXF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0070001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF005","20069TX0070001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0070001-02","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0070001-02","6"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","3","20069","TX","Individual","No","47-3185443","20069TX0070001","Classic Silver","20069TX007",,"TXN001","TXS001","TXF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0070001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF005","20069TX0070001-03","Limited Cost Sharing Plan Variation","68.40%",,"Yes","Yes","No","100%",,"$4,500","$100","$0","$200","$2,500","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0070001-03","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0070001-03","7"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","3","20069","TX","Individual","No","47-3185443","20069TX0070001","Classic Silver","20069TX007",,"TXN001","TXS001","TXF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0070001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF005","20069TX0070001-04","73% AV Level Silver Plan","74.00%",,"Yes","Yes","No","100%",,"$2,500","$1,600","$0","$200","$2,500","$40","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0070001-04","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0070001-04","8"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","3","20069","TX","Individual","No","47-3185443","20069TX0070001","Classic Silver","20069TX007",,"TXN001","TXS001","TXF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0070001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF005","20069TX0070001-05","87% AV Level Silver Plan","87.60%",,"Yes","Yes","No","100%",,"$500","$1,200","$0","$200","$500","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0070001-05","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0070001-05","9"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","3","20069","TX","Individual","No","47-3185443","20069TX0070001","Classic Silver","20069TX007",,"TXN001","TXS001","TXF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0070001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF005","20069TX0070001-06","94% AV Level Silver Plan","94.70%",,"Yes","Yes","No","100%",,"$200","$700","$0","$200","$200","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0070001-06","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0070001-06","10"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","3","20069","TX","Individual","No","47-3185443","20069TX0080001","Classic Gold","20069TX008",,"TXN001","TXS001","TXF005","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0080001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF005","20069TX0080001-00","Standard Gold Off Exchange Plan","81.30%",,"Yes","Yes","No","100%",,"$1,000","$0","$0","$200","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0080001-00","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0080001-00","11"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","3","20069","TX","Individual","No","47-3185443","20069TX0080001","Classic Gold","20069TX008",,"TXN001","TXS001","TXF005","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0080001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF005","20069TX0080001-01","Standard Gold On Exchange Plan","81.30%",,"Yes","Yes","No","100%",,"$1,000","$0","$0","$200","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0080001-01","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0080001-01","12"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","3","20069","TX","Individual","No","47-3185443","20069TX0080001","Classic Gold","20069TX008",,"TXN001","TXS001","TXF005","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0080001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF005","20069TX0080001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0080001-02","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0080001-02","13"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","3","20069","TX","Individual","No","47-3185443","20069TX0080001","Classic Gold","20069TX008",,"TXN001","TXS001","TXF005","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0080001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF005","20069TX0080001-03","Limited Cost Sharing Plan Variation","81.30%",,"Yes","Yes","No","100%",,"$1,000","$0","$0","$200","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0080001-03","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0080001-03","14"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","4","20069","TX","Individual","No","47-3185443","20069TX0100001","Simple Bronze","20069TX010",,"TXN001","TXS001","TXF003","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9977",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0100001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF003","20069TX0100001-00","Standard Bronze Off Exchange Plan","62.00%",,"Yes","Yes","No","100%",,"$5,400","$0","$0","$200","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0100001-00","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0100001-00","4"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","4","20069","TX","Individual","No","47-3185443","20069TX0100001","Simple Bronze","20069TX010",,"TXN001","TXS001","TXF003","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9977",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0100001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF003","20069TX0100001-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,"$5,400","$0","$0","$200","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0100001-01","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0100001-01","5"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","4","20069","TX","Individual","No","47-3185443","20069TX0100001","Simple Bronze","20069TX010",,"TXN001","TXS001","TXF003","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9977",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0100001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF003","20069TX0100001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0100001-02","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0100001-02","6"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","4","20069","TX","Individual","No","47-3185443","20069TX0100001","Simple Bronze","20069TX010",,"TXN001","TXS001","TXF003","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9977",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0100001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF003","20069TX0100001-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,"$5,400","$0","$0","$200","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0100001-03","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0100001-03","7"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0110001","Simple Silver","20069TX011",,"TXN001","TXS001","TXF009","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0110001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF009","20069TX0110001-00","Standard Silver Off Exchange Plan","68.10%",,"Yes","Yes","No","100%",,"$5,400","$0","$0","$200","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,900","$5900 per person","$11800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,900","$5900 per person","$11800 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0110001-00","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0110001-00","4"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0110001","Simple Silver","20069TX011",,"TXN001","TXS001","TXF009","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0110001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF009","20069TX0110001-01","Standard Silver On Exchange Plan","68.10%",,"Yes","Yes","No","100%",,"$5,400","$0","$0","$200","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,900","$5900 per person","$11800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,900","$5900 per person","$11800 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0110001-01","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0110001-01","5"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0110001","Simple Silver","20069TX011",,"TXN001","TXS001","TXF009","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0110001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF009","20069TX0110001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0110001-02","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0110001-02","6"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0110001","Simple Silver","20069TX011",,"TXN001","TXS001","TXF009","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0110001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF009","20069TX0110001-03","Limited Cost Sharing Plan Variation","68.10%",,"Yes","Yes","No","100%",,"$5,400","$0","$0","$200","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,900","$5900 per person","$11800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,900","$5900 per person","$11800 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0110001-03","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0110001-03","7"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0110001","Simple Silver","20069TX011",,"TXN001","TXS001","TXF009","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0110001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF009","20069TX0110001-04","73% AV Level Silver Plan","73.70%",,"Yes","Yes","No","100%",,"$4,300","$0","$0","$200","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,300","$4300 per person","$8600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,300","$4300 per person","$8600 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0110001-04","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0110001-04","8"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0110001","Simple Silver","20069TX011",,"TXN001","TXS001","TXF009","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0110001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF009","20069TX0110001-05","87% AV Level Silver Plan","86.90%",,"Yes","Yes","No","100%",,"$1,600","$0","$0","$200","$1,600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0110001-05","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0110001-05","9"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0110001","Simple Silver","20069TX011",,"TXN001","TXS001","TXF009","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0110001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF009","20069TX0110001-06","94% AV Level Silver Plan","94.20%",,"Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0110001-06","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0110001-06","10"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0120001","Simple Gold","20069TX012",,"TXN001","TXS001","TXF009","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0120001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF009","20069TX0120001-00","Standard Gold Off Exchange Plan","78.90%",,"Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0120001-00","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0120001-00","11"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0120001","Simple Gold","20069TX012",,"TXN001","TXS001","TXF009","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0120001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF009","20069TX0120001-01","Standard Gold On Exchange Plan","78.90%",,"Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0120001-01","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0120001-01","12"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0120001","Simple Gold","20069TX012",,"TXN001","TXS001","TXF009","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0120001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF009","20069TX0120001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0120001-02","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0120001-02","13"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0140001","Simple+ Silver","20069TX014",,"TXN001","TXS001","TXF006","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0140001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF006","20069TX0140001-05","87% AV Level Silver Plan","87.90%",,"Yes","Yes","No","100%",,"$1,600","$0","$0","$200","$1,200","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0140001-05","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0140001-05","20"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0140001","Simple+ Silver","20069TX014",,"TXN001","TXS001","TXF006","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9978",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0140001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF006","20069TX0140001-06","94% AV Level Silver Plan","94.50%",,"Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$50","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0140001-06","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0140001-06","21"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0150001","Simple+ Gold","20069TX015",,"TXN001","TXS001","TXF007","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0150001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF007","20069TX0150001-00","Standard Gold Off Exchange Plan","81.00%",,"Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$100","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0150001-00","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0150001-00","22"
"2016","TX","20069","HIOS","6","2015-10-20 04:38:50","5","20069","TX","Individual","No","47-3185443","20069TX0150001","Simple+ Gold","20069TX015",,"TXN001","TXS001","TXF007","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.hioscar.com/hx/payment?state=tx&year=2016&hios=20069TX0150001","https://www.hioscar.com/hx/formulary?state=TX&year=2016&formulary=NJF007","20069TX0150001-01","Standard Gold On Exchange Plan","81.00%",,"Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$100","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"https://www.hioscar.com/hx/sbc?state=tx&year=2016&hios=20069TX0150001-01","https://www.hioscar.com/hx/brochure?state=tx&year=2016&hios=20069TX0150001-01","23"
"2016","TX","23749","HIOS","9","2015-10-21 05:00:18","3","23749","TX","SHOP (Small Group)","Yes","75-1233841","23749TX0020006","Dentegra DPO for Small Businesses Family Basic Plan","23749TX002",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","23749TX0020006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tx/23749tx0020006-16","4"
"2016","TX","23749","HIOS","9","2015-10-21 05:00:18","3","23749","TX","SHOP (Small Group)","Yes","75-1233841","23749TX0020006","Dentegra DPO for Small Businesses Family Basic Plan","23749TX002",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","23749TX0020006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tx/23749tx0020006-16","5"
"2016","TX","23749","HIOS","9","2015-10-21 05:00:18","3","23749","TX","Individual","Yes","75-1233841","23749TX0010006","Dentegra DPO Family Basic Plan","23749TX001",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","23749TX0010006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/tx/23749tx0010006-16","5"
"2016","TX","23891","HIOS","7","2015-08-26 09:56:12","1","23891","TX","SHOP (Small Group)","Yes","74-2447512","23891TX0020002","DeltaCare USA Pediatric Preferred Plan for Small Businesses","23891TX002",,"TXN001","TXS001",,"Existing","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","23891TX0020002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0010002-16","4"
"2016","TX","23891","HIOS","7","2015-08-26 09:56:12","1","23891","TX","Individual","Yes","74-2447512","23891TX0010002","DeltaCare USA Pediatric Preferred Plan","23891TX001",,"TXN001","TXS001",,"Existing","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","23891TX0010002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0010002-16","4"
"2016","TX","23891","HIOS","7","2015-08-26 09:56:12","1","23891","TX","SHOP (Small Group)","Yes","74-2447512","23891TX0020001","DeltaCare USA Pediatric Basic Plan for Small Businesses","23891TX002",,"TXN001","TXS001",,"Existing","HMO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","23891TX0020001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0010002-16","5"
"2016","TX","23891","HIOS","7","2015-08-26 09:56:12","1","23891","TX","Individual","Yes","74-2447512","23891TX0010001","DeltaCare USA Pediatric Basic Plan","23891TX001",,"TXN001","TXS001",,"Existing","HMO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","23891TX0010001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0010001-16","5"
"2016","TX","23891","HIOS","7","2015-08-26 09:56:12","2","23891","TX","SHOP (Small Group)","Yes","74-2447512","23891TX0020004","DeltaCare USA Preferred Plan for Families for Small Businesses","23891TX002",,"TXN001","TXS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","23891TX0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0010004-16","4"
"2016","TX","23891","HIOS","7","2015-08-26 09:56:12","2","23891","TX","Individual","Yes","74-2447512","23891TX0010004","DeltaCare USA Preferred Plan for Families","23891TX001",,"TXN001","TXS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","23891TX0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0010004-16","4"
"2016","TX","23891","HIOS","7","2015-08-26 09:56:12","2","23891","TX","Individual","Yes","74-2447512","23891TX0010004","DeltaCare USA Preferred Plan for Families","23891TX001",,"TXN001","TXS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","23891TX0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0010004-16","5"
"2016","TX","23891","HIOS","7","2015-08-26 09:56:12","2","23891","TX","SHOP (Small Group)","Yes","74-2447512","23891TX0020004","DeltaCare USA Preferred Plan for Families for Small Businesses","23891TX002",,"TXN001","TXS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","23891TX0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0010004-16","5"
"2016","TX","23891","HIOS","7","2015-08-26 09:56:12","3","23891","TX","SHOP (Small Group)","Yes","74-2447512","23891TX0020006","DeltaCare USA Basic Plan for Families for Small Businesses","23891TX002",,"TXN001","TXS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","23891TX0020006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0010006-16","4"
"2016","TX","23891","HIOS","7","2015-08-26 09:56:12","3","23891","TX","Individual","Yes","74-2447512","23891TX0010006","DeltaCare USA Basic Plan for Families","23891TX001",,"TXN001","TXS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","23891TX0010006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0010006-16","4"
"2016","TX","23891","HIOS","7","2015-08-26 09:56:12","3","23891","TX","Individual","Yes","74-2447512","23891TX0010006","DeltaCare USA Basic Plan for Families","23891TX001",,"TXN001","TXS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","23891TX0010006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0010006-16","5"
"2016","TX","23891","HIOS","7","2015-08-26 09:56:12","3","23891","TX","SHOP (Small Group)","Yes","74-2447512","23891TX0020006","DeltaCare USA Basic Plan for Families for Small Businesses","23891TX002",,"TXN001","TXS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No","No","No","https://www.deltadentalins.com/hx/checkout","","23891TX0020006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/23891tx0010006-16","5"
"2016","TX","24349","HIOS","7","2015-08-26 09:56:12","1","24349","TX","Individual","Yes","94-2761537","24349TX0010002","Delta Dental Individual DPO Pediatric Preferred Plan","24349TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.60","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0010002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0010002-16","4"
"2016","TX","24349","HIOS","7","2015-08-26 09:56:12","1","24349","TX","SHOP (Small Group)","Yes","94-2761537","24349TX0020002","DPO Pediatric Preferred Plan for Small Businesses","24349TX002",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.60","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0020002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0020002-16","4"
"2016","TX","24349","HIOS","7","2015-08-26 09:56:12","1","24349","TX","SHOP (Small Group)","Yes","94-2761537","24349TX0020001","DPO Pediatric Basic Plan for Small Businesses","24349TX002",,"TXN001","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0020001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0020001-16","5"
"2016","TX","24349","HIOS","7","2015-08-26 09:56:12","1","24349","TX","Individual","Yes","94-2761537","24349TX0010001","Delta Dental Individual DPO Pediatric Basic Plan","24349TX001",,"TXN001","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0010001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0010001-16","5"
"2016","TX","24349","HIOS","7","2015-08-26 09:56:12","2","24349","TX","SHOP (Small Group)","Yes","94-2761537","24349TX0020004","DPO Preferred Plan for Families for Small Businesses","24349TX002",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.60","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0020004-16","4"
"2016","TX","24349","HIOS","7","2015-08-26 09:56:12","2","24349","TX","Individual","Yes","94-2761537","24349TX0010004","Delta Dental Individual and Family DPO Preferred Plan for Families","24349TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.60","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0010004-16","4"
"2016","TX","24349","HIOS","7","2015-08-26 09:56:12","2","24349","TX","Individual","Yes","94-2761537","24349TX0010004","Delta Dental Individual and Family DPO Preferred Plan for Families","24349TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.60","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0010004-16","5"
"2016","TX","24349","HIOS","7","2015-08-26 09:56:12","2","24349","TX","SHOP (Small Group)","Yes","94-2761537","24349TX0020004","DPO Preferred Plan for Families for Small Businesses","24349TX002",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.60","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0020004-16","5"
"2016","TX","24349","HIOS","7","2015-08-26 09:56:12","3","24349","TX","SHOP (Small Group)","Yes","94-2761537","24349TX0020006","DPO Basic Plan for Families for Small Businesses","24349TX002",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0020006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0020006-16","4"
"2016","TX","24349","HIOS","7","2015-08-26 09:56:12","3","24349","TX","Individual","Yes","94-2761537","24349TX0010006","Delta Dental Individual and Family DPO Basic Plan for Families","24349TX001",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0010006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0010006-16","4"
"2016","TX","24349","HIOS","7","2015-08-26 09:56:12","3","24349","TX","Individual","Yes","94-2761537","24349TX0010006","Delta Dental Individual and Family DPO Basic Plan for Families","24349TX001",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0010006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0010006-16","5"
"2016","TX","24349","HIOS","7","2015-08-26 09:56:12","3","24349","TX","SHOP (Small Group)","Yes","94-2761537","24349TX0020006","DPO Basic Plan for Families for Small Businesses","24349TX002",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","24349TX0020006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/tx/24349tx0020006-16","5"
"2016","TX","26250","HIOS","2","2015-08-19 14:41:20","1","26250","TX","SHOP (Small Group)","Yes","75-2698702","26250TX0030003","Managed DentalGuard TX 10 Family Plan","26250TX003",,"TXN001","TXS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$8.03","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","26250TX0030003-00","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","TX","26250","HIOS","2","2015-08-19 14:41:20","1","26250","TX","Individual","Yes","75-2698702","26250TX0070001","Managed DentalGuard TX Essentials 2","26250TX007",,"TXN002","TXS001",,"New","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$11.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","26250TX0070001-00","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","4"
"2016","TX","26250","HIOS","2","2015-08-19 14:41:20","1","26250","TX","Individual","Yes","75-2698702","26250TX0070001","Managed DentalGuard TX Essentials 2","26250TX007",,"TXN002","TXS001",,"New","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$11.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","26250TX0070001-01","Standard Low On Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","5"
"2016","TX","26250","HIOS","2","2015-08-19 14:41:20","1","26250","TX","SHOP (Small Group)","Yes","75-2698702","26250TX0030003","Managed DentalGuard TX 10 Family Plan","26250TX003",,"TXN001","TXS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$8.03","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","26250TX0030003-01","Standard Low On Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","TX","26250","HIOS","2","2015-08-19 14:41:20","1","26250","TX","SHOP (Small Group)","Yes","75-2698702","26250TX0040003","Managed DentalGuard TX 30 Family Plan","26250TX004",,"TXN001","TXS001",,"Existing","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$9.69","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","26250TX0040003-00","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","TX","26250","HIOS","2","2015-08-19 14:41:20","1","26250","TX","SHOP (Small Group)","Yes","75-2698702","26250TX0050003","Managed DentalGuard TX 40 Family Plan","26250TX005",,"TXN001","TXS001",,"Existing","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$9.15","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","26250TX0050003-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","1","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130001","Gold- Coinsurance","26539TX013",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0130001-00","Standard Gold Off Exchange Plan",,"0.784211397171021","Yes","Yes","No","100%",,"$1,000","$50","$930","$150","$0","$1,080","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_GoldPlanCoinsurance_SBC_26539TX0130001.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_GoldPlanCoinsurance_SOC_26539TX0130001.pdf","4"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","1","26539","TX","Individual","No","75-2569094","26539TX0140001","Gold - Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140001-00","Standard Gold Off Exchange Plan",,"0.784211397171021","Yes","Yes","No","100%",,"$1,000","$50","$930","$150","$0","$1,080","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_GoldPlanCoinsurance_SBC_26539TX0140001.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_GoldPlanCoinsurance_SOC_26539TX0140001.pdf","4"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","5","26539","TX","Individual","No","75-2569094","26539TX0140004","Bronze - Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","3","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140004-03","Limited Cost Sharing Plan Variation",,"0.61986380815506","Yes","Yes","No","100%",,"$5,600","$20","$340","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeCoins_SBC_26539TX0140004-03.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeCoins_SOC_26539TX0140004-03.pdf","7"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","6","26539","TX","Individual","No","75-2569094","26539TX0140005","Bronze - HSA (60%)","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140005-00","Standard Bronze Off Exchange Plan",,"0.609265327453613","Yes","Yes","No","100%",,"$4,500","$0","$1,110","$150","$4,500","$0","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SBC_26539TX0140005.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SOC_26539TX0140005.pdf","4"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","2","27248","TX","Individual","No","76-0495152","27248TX0010003","Community Health Choice HMO Bronze 003","27248TX001","7932102164","TXN001","TXS001","TXF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","3","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010003-01","Standard Bronze On Exchange Plan","61.76%","0","No","Yes","No","100%",,"$4,000","$870","$0","$150","$4,000","$1,580","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$13700 per person","$13700 per group","$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$200","$200 per person","$400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010003-01_Bronze_Deductible_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/HMO_Deductible_EOC_12222015.pdf","5"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","2","27248","TX","Individual","No","76-0495152","27248TX0010003","Community Health Choice HMO Bronze 003","27248TX001","7932102164","TXN001","TXS001","TXF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","3","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010003-02_Bronze_Deductible_NAI_ZERO_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/HMO_Deductible_EOC_12222015.pdf","6"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","2","27248","TX","Individual","No","76-0495152","27248TX0010003","Community Health Choice HMO Bronze 003","27248TX001","7932102164","TXN001","TXS001","TXF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","3","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010003-03","Limited Cost Sharing Plan Variation","61.76%","0","No","Yes","No","100%",,"$4,000","$870","$0","$150","$4,000","$1,580","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$13700 per person","$13700 per group","$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$200","$200 per person","$400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010003-03_Bronze_Deductible_NAI_LIMITED_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/HMO_Deductible_EOC_12222015.pdf","7"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","1","26539","TX","Individual","No","75-2569094","26539TX0140001","Gold - Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140001-01","Standard Gold On Exchange Plan",,"0.784211397171021","Yes","Yes","No","100%",,"$1,000","$50","$930","$150","$0","$1,080","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_GoldPlanCoinsurance_SBC_26539TX0140001.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_GoldPlanCoinsurance_SOC_26539TX0140001.pdf","5"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","1","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130001","Gold- Coinsurance","26539TX013",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0130001-01","Standard Gold On Exchange Plan",,"0.784211397171021","Yes","Yes","No","100%",,"$1,000","$50","$930","$150","$0","$1,080","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_GoldPlanCoinsurance_SBC_26539TX0130001.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_GoldPlanCoinsurance_SOC_26539TX0130001.pdf","5"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","1","26539","TX","Individual","No","75-2569094","26539TX0140001","Gold - Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_GoldPlanCoinsurance_SBC_26539TX0140001-02.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_GoldPlanCoinsurance_SOC_26539TX0140002.pdf","6"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","1","26539","TX","Individual","No","75-2569094","26539TX0140001","Gold - Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140001-03","Limited Cost Sharing Plan Variation",,"0.784211397171021","Yes","Yes","No","100%",,"$1,000","$50","$930","$150","$0","$1,080","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_GoldPlanCoinsurance_SBC_26539TX0140001-03.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_GoldPlanCoinsurance_SOC_26539TX0140003.pdf","7"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","2","26539","TX","Individual","No","75-2569094","26539TX0140002","Gold - Copay","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"5","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140002-00","Standard Gold Off Exchange Plan","81.73%","0","Yes","Yes","No","100%",,"$0","$1,850","$40","$150","$0","$1,340","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_GoldPlanCopay_SBC_26539TX0140002.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_GoldPlanCopay_SOC_26539TX0140002.pdf","4"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","2","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130002","Gold- Copay","26539TX013",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"5","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0130002-00","Standard Gold Off Exchange Plan","81.73%","0","Yes","Yes","No","100%",,"$0","$1,850","$40","$150","$0","$1,340","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_GoldPlanCopay_SBC_26539TX0130002.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_GoldPlanCopay_SOC_26539TX0130002.pdf","4"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","2","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130002","Gold- Copay","26539TX013",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"5","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0130002-01","Standard Gold On Exchange Plan","81.73%","0","Yes","Yes","No","100%",,"$0","$1,850","$40","$150","$0","$1,340","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_GoldPlanCopay_SBC_26539TX0130002.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_GoldPlanCopay_SOC_26539TX0130002.pdf","5"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","2","26539","TX","Individual","No","75-2569094","26539TX0140002","Gold - Copay","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"5","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140002-01","Standard Gold On Exchange Plan","81.73%","0","Yes","Yes","No","100%",,"$0","$1,850","$40","$150","$0","$1,340","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_GoldPlanCopay_SBC_26539TX0140002.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_GoldPlanCopay_SOC_26539TX0140002.pdf","5"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","2","26539","TX","Individual","No","75-2569094","26539TX0140002","Gold - Copay","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"5","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_GoldPlanCopay_SBC_26539TX0140002-02.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_GoldPlanCopay_SOC_26539TX0140002-02.pdf","6"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","2","26539","TX","Individual","No","75-2569094","26539TX0140002","Gold - Copay","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"5","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140002-03","Limited Cost Sharing Plan Variation","81.73%","0","Yes","Yes","No","100%",,"$0","$1,850","$40","$150","$0","$1,340","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_GoldPlanCopay_SBC_26539TX0140002-03.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_GoldPlanCopay_SOC_26539TX0140002-03.pdf","7"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","6","26539","TX","Individual","No","75-2569094","26539TX0140006","Bronze - HSA (100%)","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140006-01","Standard Bronze On Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SBC_26539TX0140006.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SOC_26539TX0140006.pdf","9"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","3","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130003","Silver - Coinsurance 2500","26539TX013",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0130003-00","Standard Silver Off Exchange Plan",,"0.71755051612854","Yes","Yes","No","100%",,"$2,500","$20","$850","$150","$0","$1,550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_SilverPlan_SBC_26539TX0130003.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_SilverPlan_SOC_26539TX0130003.pdf","4"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","3","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130003","Silver - Coinsurance 2500","26539TX013",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0130003-01","Standard Silver On Exchange Plan",,"0.71755051612854","Yes","Yes","No","100%",,"$2,500","$20","$850","$150","$0","$1,550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_SilverPlan_SBC_26539TX0130003.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_SilverPlan_SOC_26539TX0130003.pdf","5"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","3","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130017","Silver - Coinsurance 4500","26539TX013",,"TXN001","TXS001","TXF001","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0130017-00","Standard Silver Off Exchange Plan",,"0.71820479631424","Yes","Yes","No","100%",,"$4,500","$20","$450","$150","$0","$1,050","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_SilverPlan_SBC_26539TX0130017.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_SilverPlan_SOC_26539TX0130017.pdf","6"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","3","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130017","Silver - Coinsurance 4500","26539TX013",,"TXN001","TXS001","TXF001","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0130017-01","Standard Silver On Exchange Plan",,"0.71820479631424","Yes","Yes","No","100%",,"$4,500","$20","$450","$150","$0","$1,050","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_SilverPlan_SBC_26539TX0130017.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_SilverPlan_SOC_26539TX0130017.pdf","7"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","4","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130006","Silver - Copay","26539TX013",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"5","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0130006-00","Standard Silver Off Exchange Plan","71.96%","0","Yes","Yes","No","100%",,"$3,000","$1,820","$0","$150","$0","$1,450","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_SilverCopay_SBC_26539TX0130006.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_SilverCopay_SOC_26539TX0130006.pdf","4"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","4","26539","TX","Individual","No","75-2569094","26539TX0140003","Silver - Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140003-00","Standard Silver Off Exchange Plan",,"0.71755051612854","Yes","Yes","No","100%",,"$2,500","$20","$850","$150","$0","$1,550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_SilverPlan_SBC_26539TX0140003.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_SilverPlan_SOC_26539TX0140003.pdf","4"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","4","26539","TX","Individual","No","75-2569094","26539TX0140003","Silver - Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140003-01","Standard Silver On Exchange Plan",,"0.71755051612854","Yes","Yes","No","100%",,"$2,500","$20","$850","$150","$0","$1,550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_SilverPlan_SBC_26539TX0140003.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_SilverPlan_SOC_26539TX0140003.pdf","5"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","4","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130006","Silver - Copay","26539TX013",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"5","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0130006-01","Standard Silver On Exchange Plan","71.96%","0","Yes","Yes","No","100%",,"$3,000","$1,820","$0","$150","$0","$1,450","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_SilverCopay_SBC_26539TX0130006.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_SilverCopay_SOC_26539TX0130006.pdf","5"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","4","26539","TX","Individual","No","75-2569094","26539TX0140003","Silver - Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_SilverPlan_SBC_26539TX0140003-02.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_SilverPlan_SOC_26539TX0140003-02.pdf","6"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","4","26539","TX","Individual","No","75-2569094","26539TX0140003","Silver - Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140003-03","Limited Cost Sharing Plan Variation",,"0.71755051612854","Yes","Yes","No","100%",,"$2,500","$20","$850","$150","$0","$1,550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_SilverPlan_SBC_26539TX0140003-03.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_SilverPlan_SOC_26539TX0140003-03.pdf","7"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","4","26539","TX","Individual","No","75-2569094","26539TX0140003","Silver - Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140003-04","73% AV Level Silver Plan",,"0.737829804420471","Yes","Yes","No","100%",,"$2,250","$20","$900","$150","$0","$1,450","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_SilverPlan_SBC_26539TX0140003-04.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_SilverPlan_SOC_26539TX0140003-04.pdf","8"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","4","26539","TX","Individual","No","75-2569094","26539TX0140003","Silver - Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140003-05","87% AV Level Silver Plan",,"0.861633777618408","Yes","Yes","No","100%",,"$500","$30","$930","$150","$0","$880","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_SilverPlan_SBC_26539TX0140003-05.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_SilverPlan_SOC_26539TX0140003-05.pdf","9"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","4","26539","TX","Individual","No","75-2569094","26539TX0140003","Silver - Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140003-06","94% AV Level Silver Plan",,"0.938822031021118","Yes","Yes","No","100%",,"$0","$20","$910","$150","$0","$810","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_SilverPlan_SBC_26539TX0140003-06.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_Marketplace_SilverPlan_SOC_26539TX0140003-06.pdf","10"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","5","26539","TX","Individual","No","75-2569094","26539TX0140004","Bronze - Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","3","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140004-00","Standard Bronze Off Exchange Plan",,"0.61986380815506","Yes","Yes","No","100%",,"$5,600","$20","$340","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeCoins_SBC_26539TX0140004.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeCoins_SOC_26539TX0140004.pdf","4"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","5","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130004","Bronze Coinsurance","26539TX013",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","3","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0130004-00","Standard Bronze Off Exchange Plan",,"0.61986380815506","Yes","Yes","No","100%",,"$5,600","$20","$340","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_BronzePlanCoinsurance_SBC_26539TX0130004.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_BronzePlanCoinsurance_SOC_26539TX0130004.pdf","4"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","5","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130004","Bronze Coinsurance","26539TX013",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","3","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0130004-01","Standard Bronze On Exchange Plan",,"0.61986380815506","Yes","Yes","No","100%",,"$5,600","$20","$340","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_BronzePlanCoinsurance_SBC_26539TX0130004.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FirstCare_SmGroup_BronzePlanCoinsurance_SOC_26539TX0130004.pdf","5"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","5","26539","TX","Individual","No","75-2569094","26539TX0140004","Bronze - Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","3","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140004-01","Standard Bronze On Exchange Plan",,"0.61986380815506","Yes","Yes","No","100%",,"$5,600","$20","$340","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeCoins_SBC_26539TX0140004.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeCoins_SOC_26539TX0140004.pdf","5"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","5","26539","TX","Individual","No","75-2569094","26539TX0140004","Bronze - Coinsurance","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","3","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeCoins_SBC_26539TX0140004-02.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeCoins_SOC_26539TX0140004-02.pdf","6"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","6","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130005","Bronze - HSA(60%)","26539TX013",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0130005-00","Standard Bronze Off Exchange Plan",,"0.609265327453613","Yes","Yes","No","100%",,"$4,500","$0","$1,110","$150","$4,500","$0","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_SmGroup_BronzeHSA_SBC_26539TX0130005.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_SmGroup_BronzeHSA_SOC_26539TX0130005.pdf","4"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","6","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130005","Bronze - HSA(60%)","26539TX013",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0130005-01","Standard Bronze On Exchange Plan",,"0.609265327453613","Yes","Yes","No","100%",,"$4,500","$0","$1,110","$150","$4,500","$0","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_SmGroup_BronzeHSA_SBC_26539TX0130005.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_SmGroup_BronzeHSA_SOC_26539TX0130005.pdf","5"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","6","26539","TX","Individual","No","75-2569094","26539TX0140005","Bronze - HSA (60%)","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140005-01","Standard Bronze On Exchange Plan",,"0.609265327453613","Yes","Yes","No","100%",,"$4,500","$0","$1,110","$150","$4,500","$0","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SBC_26539TX0140005.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SOC_26539TX0140005.pdf","5"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","6","26539","TX","Individual","No","75-2569094","26539TX0140005","Bronze - HSA (60%)","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SBC_26539TX0140005-02.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SOC_26539TX0140005-02.pdf","6"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","6","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130007","Bronze - HSA(100%)","26539TX013",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0130007-00","Standard Bronze Off Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_SmGroup_BronzeHSA_SBC_26539TX0130007.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_SmGroup_BronzeHSA_SOC_26539TX0130007.pdf","6"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","6","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130007","Bronze - HSA(100%)","26539TX013",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0130007-01","Standard Bronze On Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_SmGroup_BronzeHSA_SBC_26539TX0130007.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_SmGroup_BronzeHSA_SOC_26539TX0130007.pdf","7"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","6","26539","TX","Individual","No","75-2569094","26539TX0140005","Bronze - HSA (60%)","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140005-03","Limited Cost Sharing Plan Variation",,"0.609265327453613","Yes","Yes","No","100%",,"$4,500","$0","$1,110","$150","$4,500","$0","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SBC_26539TX0140005-03.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SOC_26539TX0140005-03.pdf","7"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","6","26539","TX","Individual","No","75-2569094","26539TX0140006","Bronze - HSA (100%)","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140006-00","Standard Bronze Off Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SBC_26539TX0140006.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SOC_26539TX0140006.pdf","8"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","6","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130016","Silver - HSA(100%)","26539TX013",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0130016-00","Standard Silver Off Exchange Plan",,"0.698973894119263","Yes","Yes","No","100%",,"$3,750","$0","$0","$150","$3,750","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_SmGroup_SilverHSA_SBC_26539TX0130016.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_SmGroup_SilverHSA_SOC_26539TX0130016.pdf","8"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","6","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130016","Silver - HSA(100%)","26539TX013",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0130016-01","Standard Silver On Exchange Plan",,"0.698973894119263","Yes","Yes","No","100%",,"$3,750","$0","$0","$150","$3,750","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_SmGroup_SilverHSA_SBC_26539TX0130016.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_SmGroup_SilverHSA_SOC_26539TX0130016.pdf","9"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","6","26539","TX","Individual","No","75-2569094","26539TX0140006","Bronze - HSA (100%)","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SBC_26539TX0140006-02.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SOC_26539TX0140006-02.pdf","10"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","6","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130018","Bronze - HSA(80%)","26539TX013",,"TXN001","TXS001","TXF001","New","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0130018-00","Standard Bronze Off Exchange Plan",,"0.613701462745667","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_SmGroup_BronzeHSA_SBC_26539TX0130018.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_SmGroup_BronzeHSA_SOC_26539TX0130018.pdf","10"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","6","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130018","Bronze - HSA(80%)","26539TX013",,"TXN001","TXS001","TXF001","New","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0130018-01","Standard Bronze On Exchange Plan",,"0.613701462745667","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_SmGroup_BronzeHSA_SBC_26539TX0130018.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_SmGroup_BronzeHSA_SOC_26539TX0130018.pdf","11"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","6","26539","TX","Individual","No","75-2569094","26539TX0140006","Bronze - HSA (100%)","26539TX014",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140006-03","Limited Cost Sharing Plan Variation",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SBC_26539TX0140006-03.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SOC_26539TX0140006-03.pdf","11"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","6","26539","TX","Individual","No","75-2569094","26539TX0140007","Bronze - HSA (80%)","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140007-00","Standard Bronze Off Exchange Plan",,"0.613701462745667","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SBC_26539TX0140007.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SOC_26539TX0140007.pdf","12"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","6","26539","TX","Individual","No","75-2569094","26539TX0140007","Bronze - HSA (80%)","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140007-01","Standard Bronze On Exchange Plan",,"0.613701462745667","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SBC_26539TX0140007.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SOC_26539TX0140007.pdf","13"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","6","26539","TX","Individual","No","75-2569094","26539TX0140007","Bronze - HSA (80%)","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SBC_26539TX0140007-02.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SOC_26539TX0140007-02.pdf","14"
"2016","TX","26539","HIOS","13","2015-10-18 12:35:12","6","26539","TX","Individual","No","75-2569094","26539TX0140007","Bronze - HSA (80%)","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/Rx_2016_MarketPlace_Firstcare_Formulary.pdf","26539TX0140007-03","Limited Cost Sharing Plan Variation",,"0.613701462745667","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SBC_26539TX0140007-03.pdf","http://www.firstcare.com/FirstCare/media/First-Care/PDFs/2016_FC_BronzeHSA_SOC_26539TX0140007-03.pdf","15"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","1","27248","TX","Individual","No","76-0495152","27248TX0010001","Community Health Choice HMO Gold 001","27248TX001","7932102164","TXN002","TXS001","TXF003","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010001-00","Standard Gold Off Exchange Plan","80.68%","0","No","Yes","No","100%",,"$0","$1,290","$0","$150","$0","$1,840","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010001-00_Gold_Copay_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2016/HMO_Copay_EOC_12222015.pdf","4"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","1","27248","TX","Individual","No","76-0495152","27248TX0010001","Community Health Choice HMO Gold 001","27248TX001","7932102164","TXN002","TXS001","TXF003","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010001-01","Standard Gold On Exchange Plan","80.68%","0","No","Yes","No","100%",,"$0","$1,290","$0","$150","$0","$1,840","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010001-01_Gold_Copay_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2016/HMO_Copay_EOC_12222015.pdf","5"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","1","27248","TX","Individual","No","76-0495152","27248TX0010001","Community Health Choice HMO Gold 001","27248TX001","7932102164","TXN002","TXS001","TXF003","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010001-02_Gold_Copay_NAI_ZERO_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2016/HMO_Copay_EOC_12222015.pdf","6"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","1","27248","TX","Individual","No","76-0495152","27248TX0010001","Community Health Choice HMO Gold 001","27248TX001","7932102164","TXN002","TXS001","TXF003","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010001-03","Limited Cost Sharing Plan Variation","80.68%","0","No","Yes","No","100%",,"$0","$1,290","$0","$150","$0","$1,840","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010001-03_Gold_Copay_NAI_LIMITED_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2016/HMO_Copay_EOC_12222015.pdf","7"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","1","27248","TX","Individual","No","76-0495152","27248TX0010002","Community Health Choice HMO Silver 002","27248TX001","7932102164","TXN002","TXS001","TXF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010002-00","Standard Silver Off Exchange Plan","71.43%","0","No","Yes","No","100%",,"$0","$1,550","$0","$150","$0","$2,620","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010002-00_Silver_Copay_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2016/HMO_Copay_EOC_12222015.pdf","8"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","1","27248","TX","Individual","No","76-0495152","27248TX0010002","Community Health Choice HMO Silver 002","27248TX001","7932102164","TXN002","TXS001","TXF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010002-01","Standard Silver On Exchange Plan","71.43%","0","No","Yes","No","100%",,"$0","$1,550","$0","$150","$0","$2,620","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010002-01_Silver_Copay_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2016/HMO_Copay_EOC_12222015.pdf","9"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","1","27248","TX","Individual","No","76-0495152","27248TX0010002","Community Health Choice HMO Silver 002","27248TX001","7932102164","TXN002","TXS001","TXF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010002-02_Silver_Copay_NAI_ZERO_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2016/HMO_Copay_EOC_12222015.pdf","10"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","1","27248","TX","Individual","No","76-0495152","27248TX0010002","Community Health Choice HMO Silver 002","27248TX001","7932102164","TXN002","TXS001","TXF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010002-03","Limited Cost Sharing Plan Variation","71.43%","0","No","Yes","No","100%",,"$0","$1,550","$0","$150","$0","$2,620","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010002-03_Silver_Copay_NAI_LIMITED_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2016/HMO_Copay_EOC_12222015.pdf","11"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","1","27248","TX","Individual","No","76-0495152","27248TX0010002","Community Health Choice HMO Silver 002","27248TX001","7932102164","TXN002","TXS001","TXF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010002-04","73% AV Level Silver Plan","73.52%","0","No","Yes","No","100%",,"$0","$1,550","$0","$150","$0","$2,620","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,200","$5200 per person","$10400 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010002-04_Silver73Copay_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2016/HMO_Copay_EOC_12222015.pdf","12"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","1","27248","TX","Individual","No","76-0495152","27248TX0010002","Community Health Choice HMO Silver 002","27248TX001","7932102164","TXN002","TXS001","TXF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010002-05","87% AV Level Silver Plan","87.42%","0","No","Yes","No","100%",,"$0","$930","$0","$150","$0","$1,350","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010002-05_Silver87Copay_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2016/HMO_Copay_EOC_12222015.pdf","13"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","1","27248","TX","Individual","No","76-0495152","27248TX0010002","Community Health Choice HMO Silver 002","27248TX001","7932102164","TXN002","TXS001","TXF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010002-06","94% AV Level Silver Plan","94.00%","0","No","Yes","No","100%",,"$0","$750","$0","$150","$0","$830","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010002-06_Silver_94_Copay_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM//PlanDocuments2016/HMO_Copay_EOC_12222015.pdf","14"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","2","27248","TX","Individual","No","76-0495152","27248TX0010003","Community Health Choice HMO Bronze 003","27248TX001","7932102164","TXN001","TXS001","TXF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","3","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010003-00","Standard Bronze Off Exchange Plan","61.76%","0","No","Yes","No","100%",,"$4,000","$870","$0","$150","$4,000","$1,580","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$13700 per person","$13700 per group","$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$200","$200 per person","$400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010003-00_Bronze_Deductible_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/HMO_Deductible_EOC_12222015.pdf","4"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","3","27248","TX","Individual","No","76-0495152","27248TX0010004","Community Health Choice HMO Silver 004","27248TX001","7932102164","TXN001","TXS001","TXF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","3","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010004-00","Standard Silver Off Exchange Plan","71.90%","0","No","Yes","No","100%",,"$1,500","$870","$0","$150","$1,500","$1,070","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010004-00_Silver_Deductible_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/HMO_Deductible_EOC_12222015.pdf","4"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","3","27248","TX","Individual","No","76-0495152","27248TX0010004","Community Health Choice HMO Silver 004","27248TX001","7932102164","TXN001","TXS001","TXF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","3","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010004-01","Standard Silver On Exchange Plan","71.90%","0","No","Yes","No","100%",,"$1,500","$870","$0","$150","$1,500","$1,070","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010004-01_Silver_Deductible_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/HMO_Deductible_EOC_12222015.pdf","5"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","3","27248","TX","Individual","No","76-0495152","27248TX0010004","Community Health Choice HMO Silver 004","27248TX001","7932102164","TXN001","TXS001","TXF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","3","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010004-02_Silver_Deductible_NAI_ZERO_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/HMO_Deductible_EOC_12222015.pdf","6"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","3","27248","TX","Individual","No","76-0495152","27248TX0010004","Community Health Choice HMO Silver 004","27248TX001","7932102164","TXN001","TXS001","TXF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","3","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010004-03","Limited Cost Sharing Plan Variation","71.90%","0","No","Yes","No","100%",,"$1,500","$870","$0","$150","$1,500","$1,070","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010004-03_Silver_Deductible_NAI_LIMITED_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/HMO_Deductible_EOC_12222015.pdf","7"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","3","27248","TX","Individual","No","76-0495152","27248TX0010004","Community Health Choice HMO Silver 004","27248TX001","7932102164","TXN001","TXS001","TXF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","3","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010004-04","73% AV Level Silver Plan","74.00%","0","No","Yes","No","100%",,"$1,250","$870","$0","$150","$1,250","$1,070","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","$1,250","$1250 per person","$2500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010004-04_Silver73Deductible_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/HMO_Deductible_EOC_12222015.pdf","8"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","3","27248","TX","Individual","No","76-0495152","27248TX0010004","Community Health Choice HMO Silver 004","27248TX001","7932102164","TXN001","TXS001","TXF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","3","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010004-05","87% AV Level Silver Plan","87.42%","0","No","Yes","No","100%",,"$0","$930","$0","$150","$0","$1,350","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010004-05_Silver87Deductible_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/HMO_Deductible_EOC_12222015.pdf","9"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","3","27248","TX","Individual","No","76-0495152","27248TX0010004","Community Health Choice HMO Silver 004","27248TX001","7932102164","TXN001","TXS001","TXF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","3","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010004-06","94% AV Level Silver Plan","94.00%","0","No","Yes","No","100%",,"$0","$750","$0","$150","$0","$830","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010004-05_Silver94Deductible_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/HMO_Deductible_EOC_12222015.pdf","10"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","3","27248","TX","Individual","No","76-0495152","27248TX0010005","Community Health Choice HMO Gold 005","27248TX001","7932102164","TXN001","TXS001","TXF005","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","3","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010005-00","Standard Gold Off Exchange Plan","81.03%","0","No","Yes","No","100%",,"$500","$730","$0","$150","$500","$1,180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010005-00_Gold_Deductible_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/HMO_Deductible_EOC_12222015.pdf","11"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","3","27248","TX","Individual","No","76-0495152","27248TX0010005","Community Health Choice HMO Gold 005","27248TX001","7932102164","TXN001","TXS001","TXF005","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","3","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010005-01","Standard Gold On Exchange Plan","81.03%","0","No","Yes","No","100%",,"$500","$730","$0","$150","$500","$1,180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010005-01_Gold_Deductible_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/HMO_Deductible_EOC_12222015.pdf","12"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","3","27248","TX","Individual","No","76-0495152","27248TX0010005","Community Health Choice HMO Gold 005","27248TX001","7932102164","TXN001","TXS001","TXF005","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","3","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010005-02_Gold_Deductible_NAI_ZERO_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/HMO_Deductible_EOC_12222015.pdf","13"
"2016","TX","27248","HIOS","6","2015-08-27 11:14:25","3","27248","TX","Individual","No","76-0495152","27248TX0010005","Community Health Choice HMO Gold 005","27248TX001","7932102164","TXN001","TXS001","TXF005","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","1",,,,"5","0","3","2016-01-01","2016-12-31","No",,"Yes","For emergency only","No","https://communitycares.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/Community-Health-Choice-Folmulary-501.pdf","27248TX0010005-03","Limited Cost Sharing Plan Variation","81.03%","0","No","Yes","No","100%",,"$500","$730","$0","$150","$500","$1,180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/27248TX0010005-03_Gold_Deductible_NAI_LIMITED_2016.pdf","https://www.communitycares.com/Portals/0/Downloads/HIM/PlanDocuments2016/HMO_Deductible_EOC_12222015.pdf","14"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140002","Ambetter Balanced Care 1 (2016)","29418TX014",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140002-05","87% AV Level Silver Plan",,"0.879890024662018","Yes","Yes","No","100%",,"$400","$10","$1,000","$200","$400","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140002-05.pdf","https://api.centene.com/Brochures/2016/29418TX0140002-05.pdf","13"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140002","Ambetter Balanced Care 1 (2016)","29418TX014",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140002-06","94% AV Level Silver Plan",,"0.948710560798645","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140002-06.pdf","https://api.centene.com/Brochures/2016/29418TX0140002-06.pdf","14"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140003","Ambetter Balanced Care 2 (2016)","29418TX014",,"TXN001","TXS001","TXF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140003-00","Standard Silver Off Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140003-00.pdf","https://api.centene.com/Brochures/2016/29418TX0140003-00.pdf","15"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140003","Ambetter Balanced Care 2 (2016)","29418TX014",,"TXN001","TXS001","TXF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140003-01","Standard Silver On Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140003-01.pdf","https://api.centene.com/Brochures/2016/29418TX0140003-01.pdf","16"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140003","Ambetter Balanced Care 2 (2016)","29418TX014",,"TXN001","TXS001","TXF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140003-02.pdf","https://api.centene.com/Brochures/2016/29418TX0140003-02.pdf","17"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140003","Ambetter Balanced Care 2 (2016)","29418TX014",,"TXN001","TXS001","TXF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140003-03","Limited Cost Sharing Plan Variation",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140003-03.pdf","https://api.centene.com/Brochures/2016/29418TX0140003-03.pdf","18"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140003","Ambetter Balanced Care 2 (2016)","29418TX014",,"TXN001","TXS001","TXF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140003-04","73% AV Level Silver Plan",,"0.739638686180115","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140003-04.pdf","https://api.centene.com/Brochures/2016/29418TX0140003-04.pdf","19"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","29418TX014",,"TXN001","TXS001","TXF001","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140001-00","Standard Gold Off Exchange Plan",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/29418TX0140001-00.pdf","https://api.centene.com/Brochures/2016/29418TX0140001-00.pdf","4"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","29418TX014",,"TXN001","TXS001","TXF001","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140001-01","Standard Gold On Exchange Plan",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/29418TX0140001-01.pdf","https://api.centene.com/Brochures/2016/29418TX0140001-01.pdf","5"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","29418TX014",,"TXN001","TXS001","TXF001","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/29418TX0140001-02.pdf","https://api.centene.com/Brochures/2016/29418TX0140001-02.pdf","6"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","29418TX014",,"TXN001","TXS001","TXF001","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140001-03","Limited Cost Sharing Plan Variation",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/29418TX0140001-03.pdf","https://api.centene.com/Brochures/2016/29418TX0140001-03.pdf","7"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140002","Ambetter Balanced Care 1 (2016)","29418TX014",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140002-00","Standard Silver Off Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140002-00.pdf","https://api.centene.com/Brochures/2016/29418TX0140002-00.pdf","8"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140002","Ambetter Balanced Care 1 (2016)","29418TX014",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140002-01","Standard Silver On Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140002-01.pdf","https://api.centene.com/Brochures/2016/29418TX0140002-01.pdf","9"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140002","Ambetter Balanced Care 1 (2016)","29418TX014",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140002-02.pdf","https://api.centene.com/Brochures/2016/29418TX0140002-02.pdf","10"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140002","Ambetter Balanced Care 1 (2016)","29418TX014",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140002-03","Limited Cost Sharing Plan Variation",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140002-03.pdf","https://api.centene.com/Brochures/2016/29418TX0140002-03.pdf","11"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140002","Ambetter Balanced Care 1 (2016)","29418TX014",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140002-04","73% AV Level Silver Plan",,"0.737546384334564","Yes","Yes","No","100%",,"$3,500","$10","$300","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140002-04.pdf","https://api.centene.com/Brochures/2016/29418TX0140002-04.pdf","12"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140003","Ambetter Balanced Care 2 (2016)","29418TX014",,"TXN001","TXS001","TXF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140003-05","87% AV Level Silver Plan",,"0.873916625976563","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,700","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140003-05.pdf","https://api.centene.com/Brochures/2016/29418TX0140003-05.pdf","20"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140003","Ambetter Balanced Care 2 (2016)","29418TX014",,"TXN001","TXS001","TXF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140003-06","94% AV Level Silver Plan",,"0.9492227435112","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140003-06.pdf","https://api.centene.com/Brochures/2016/29418TX0140003-06.pdf","21"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140005","Ambetter Balanced Care 10 (2016)","29418TX014",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140005-00","Standard Silver Off Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140005-00.pdf","https://api.centene.com/Brochures/2016/29418TX0140005-00.pdf","29"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140005","Ambetter Balanced Care 10 (2016)","29418TX014",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140005-01","Standard Silver On Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140005-01.pdf","https://api.centene.com/Brochures/2016/29418TX0140005-01.pdf","30"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140005","Ambetter Balanced Care 10 (2016)","29418TX014",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140005-02.pdf","https://api.centene.com/Brochures/2016/29418TX0140005-02.pdf","31"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140005","Ambetter Balanced Care 10 (2016)","29418TX014",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140005-03","Limited Cost Sharing Plan Variation",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140005-03.pdf","https://api.centene.com/Brochures/2016/29418TX0140005-03.pdf","32"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140005","Ambetter Balanced Care 10 (2016)","29418TX014",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140005-04","73% AV Level Silver Plan",,"0.738659501075745","Yes","Yes","No","100%",,"$4,000","$10","$200","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140005-04.pdf","https://api.centene.com/Brochures/2016/29418TX0140005-04.pdf","33"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140005","Ambetter Balanced Care 10 (2016)","29418TX014",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140005-05","87% AV Level Silver Plan",,"0.874480485916138","Yes","Yes","No","100%",,"$1,000","$0","$800","$200","$1,000","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140005-05.pdf","https://api.centene.com/Brochures/2016/29418TX0140005-05.pdf","34"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140005","Ambetter Balanced Care 10 (2016)","29418TX014",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140005-06","94% AV Level Silver Plan",,"0.946612775325775","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140005-06.pdf","https://api.centene.com/Brochures/2016/29418TX0140005-06.pdf","35"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140006","Ambetter Essential Care 1 (2016)","29418TX014",,"TXN001","TXS001","TXF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140006-00","Standard Bronze Off Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140006-00.pdf","https://api.centene.com/Brochures/2016/29418TX0140006-00.pdf","36"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140006","Ambetter Essential Care 1 (2016)","29418TX014",,"TXN001","TXS001","TXF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140006-01","Standard Bronze On Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140006-01.pdf","https://api.centene.com/Brochures/2016/29418TX0140006-01.pdf","37"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140006","Ambetter Essential Care 1 (2016)","29418TX014",,"TXN001","TXS001","TXF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140006-02.pdf","https://api.centene.com/Brochures/2016/29418TX0140006-02.pdf","38"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140006","Ambetter Essential Care 1 (2016)","29418TX014",,"TXN001","TXS001","TXF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140006-03","Limited Cost Sharing Plan Variation",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140006-03.pdf","https://api.centene.com/Brochures/2016/29418TX0140006-03.pdf","39"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140007","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","29418TX014",,"TXN001","TXS001","TXF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140007-00","Standard Bronze Off Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140007-00.pdf","https://api.centene.com/Brochures/2016/29418TX0140007-00.pdf","40"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140007","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","29418TX014",,"TXN001","TXS001","TXF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140007-01","Standard Bronze On Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140007-01.pdf","https://api.centene.com/Brochures/2016/29418TX0140007-01.pdf","41"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140007","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","29418TX014",,"TXN001","TXS001","TXF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140007-02.pdf","https://api.centene.com/Brochures/2016/29418TX0140007-02.pdf","42"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","1","29418","TX","Individual","No","06-0641618","29418TX0140007","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","29418TX014",,"TXN001","TXS001","TXF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0140007-03","Limited Cost Sharing Plan Variation",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0140007-03.pdf","https://api.centene.com/Brochures/2016/29418TX0140007-03.pdf","43"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150001","Ambetter Balanced Care 1 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9751",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150001-00","Standard Silver Off Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150001-00.pdf","https://api.centene.com/Brochures/2016/29418TX0150001-00.pdf","4"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150001","Ambetter Balanced Care 1 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9751",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150001-01","Standard Silver On Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150001-01.pdf","https://api.centene.com/Brochures/2016/29418TX0150001-01.pdf","5"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150001","Ambetter Balanced Care 1 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9751",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150001-02.pdf","https://api.centene.com/Brochures/2016/29418TX0150001-02.pdf","6"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150001","Ambetter Balanced Care 1 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9751",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150001-03","Limited Cost Sharing Plan Variation",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150001-03.pdf","https://api.centene.com/Brochures/2016/29418TX0150001-03.pdf","7"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150001","Ambetter Balanced Care 1 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9751",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150001-04","73% AV Level Silver Plan",,"0.737546384334564","Yes","Yes","No","100%",,"$3,500","$10","$300","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150001-04.pdf","https://api.centene.com/Brochures/2016/29418TX0150001-04.pdf","8"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150001","Ambetter Balanced Care 1 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9751",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150001-05","87% AV Level Silver Plan",,"0.879890024662018","Yes","Yes","No","100%",,"$400","$10","$1,000","$200","$400","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150001-05.pdf","https://api.centene.com/Brochures/2016/29418TX0150001-05.pdf","9"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150001","Ambetter Balanced Care 1 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9751",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150001-06","94% AV Level Silver Plan",,"0.948710560798645","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150001-06.pdf","https://api.centene.com/Brochures/2016/29418TX0150001-06.pdf","10"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150002","Ambetter Balanced Care 2 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9751",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150002-00","Standard Silver Off Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150002-00.pdf","https://api.centene.com/Brochures/2016/29418TX0150002-00.pdf","11"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150002","Ambetter Balanced Care 2 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9751",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150002-01","Standard Silver On Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150002-01.pdf","https://api.centene.com/Brochures/2016/29418TX0150002-01.pdf","12"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150002","Ambetter Balanced Care 2 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9751",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150002-02.pdf","https://api.centene.com/Brochures/2016/29418TX0150002-02.pdf","13"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150002","Ambetter Balanced Care 2 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9751",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150002-03","Limited Cost Sharing Plan Variation",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150002-03.pdf","https://api.centene.com/Brochures/2016/29418TX0150002-03.pdf","14"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150002","Ambetter Balanced Care 2 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9751",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150002-04","73% AV Level Silver Plan",,"0.739638686180115","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150002-04.pdf","https://api.centene.com/Brochures/2016/29418TX0150002-04.pdf","15"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150002","Ambetter Balanced Care 2 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9751",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150002-05","87% AV Level Silver Plan",,"0.873916625976563","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,700","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150002-05.pdf","https://api.centene.com/Brochures/2016/29418TX0150002-05.pdf","16"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150002","Ambetter Balanced Care 2 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9751",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150002-06","94% AV Level Silver Plan",,"0.9492227435112","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150002-06.pdf","https://api.centene.com/Brochures/2016/29418TX0150002-06.pdf","17"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150003","Ambetter Balanced Care 10 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9751",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150003-00","Standard Silver Off Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150003-00.pdf","https://api.centene.com/Brochures/2016/29418TX0150003-00.pdf","18"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150003","Ambetter Balanced Care 10 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9751",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150003-01","Standard Silver On Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150003-01.pdf","https://api.centene.com/Brochures/2016/29418TX0150003-01.pdf","19"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150003","Ambetter Balanced Care 10 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9751",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150003-02.pdf","https://api.centene.com/Brochures/2016/29418TX0150003-02.pdf","20"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150003","Ambetter Balanced Care 10 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9751",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150003-03","Limited Cost Sharing Plan Variation",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150003-03.pdf","https://api.centene.com/Brochures/2016/29418TX0150003-03.pdf","21"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150003","Ambetter Balanced Care 10 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9751",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150003-04","73% AV Level Silver Plan",,"0.738659501075745","Yes","Yes","No","100%",,"$4,000","$10","$200","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150003-04.pdf","https://api.centene.com/Brochures/2016/29418TX0150003-04.pdf","22"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150003","Ambetter Balanced Care 10 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9751",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150003-05","87% AV Level Silver Plan",,"0.874480485916138","Yes","Yes","No","100%",,"$1,000","$0","$800","$200","$1,000","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150003-05.pdf","https://api.centene.com/Brochures/2016/29418TX0150003-05.pdf","23"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150003","Ambetter Balanced Care 10 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9751",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150003-06","94% AV Level Silver Plan",,"0.946612775325775","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150003-06.pdf","https://api.centene.com/Brochures/2016/29418TX0150003-06.pdf","24"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150004","Ambetter Essential Care 1 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9731",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150004-00","Standard Bronze Off Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150004-00.pdf","https://api.centene.com/Brochures/2016/29418TX0150004-00.pdf","25"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150004","Ambetter Essential Care 1 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9731",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150004-01","Standard Bronze On Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150004-01.pdf","https://api.centene.com/Brochures/2016/29418TX0150004-01.pdf","26"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150004","Ambetter Essential Care 1 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9731",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150004-02.pdf","https://api.centene.com/Brochures/2016/29418TX0150004-02.pdf","27"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150004","Ambetter Essential Care 1 (2016) + Vision","29418TX015",,"TXN001","TXS001","TXF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9731",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150004-03","Limited Cost Sharing Plan Variation",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150004-03.pdf","https://api.centene.com/Brochures/2016/29418TX0150004-03.pdf","28"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","29418TX015",,"TXN001","TXS001","TXF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9731",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150005-00","Standard Bronze Off Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150005-00.pdf","https://api.centene.com/Brochures/2016/29418TX0150005-00.pdf","29"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","29418TX015",,"TXN001","TXS001","TXF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9731",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150005-01","Standard Bronze On Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150005-01.pdf","https://api.centene.com/Brochures/2016/29418TX0150005-01.pdf","30"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","29418TX015",,"TXN001","TXS001","TXF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9731",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150005-02.pdf","https://api.centene.com/Brochures/2016/29418TX0150005-02.pdf","31"
"2016","TX","29418","HIOS","3","2015-08-25 05:06:23","2","29418","TX","Individual","No","06-0641618","29418TX0150005","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","29418TX015",,"TXN001","TXS001","TXF006","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9731",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/formulary","29418TX0150005-03","Limited Cost Sharing Plan Variation",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/29418TX0150005-03.pdf","https://api.centene.com/Brochures/2016/29418TX0150005-03.pdf","32"
"2016","TX","29817","HIOS","2","2015-07-02 02:19:22","1","29817","TX","SHOP (Small Group)","Yes","57-0523959","29817TX0020001","Group Dental Policy","29817TX002",,"TXN001","TXS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","29817TX0020001-00","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","1","32673","TX","Individual","No","61-0994632","32673TX0640001","Humana Basic 6850/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2610322","http://apps.humana.com/marketing/documents.asp?file=2593643","4"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0630006","Humana Platinum 0/HMO Premier","32673TX063",,"TXN001","TXS004","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0630006-03","Limited Cost Sharing Plan Variation","91.71%","0.912852764129639","No","Yes","Yes","97%","3%","$0","$20","$1,030","$150","$0","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2632435","http://apps.humana.com/marketing/documents.asp?file=2593981","27"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0640030","Humana Platinum 0/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640030-00","Standard Platinum Off Exchange Plan","91.71%","0.912852764129639","No","Yes","Yes","97%","3%","$0","$20","$1,030","$150","$0","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2632591","http://apps.humana.com/marketing/documents.asp?file=2594059","28"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0630004","Humana Silver 3800/HMO Premier","32673TX063",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0630004-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610855","http://apps.humana.com/marketing/documents.asp?file=2624492","37"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0630004","Humana Silver 3800/HMO Premier","32673TX063",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0630004-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610868","http://apps.humana.com/marketing/documents.asp?file=2624505","38"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640028","Humana Silver 3800/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640028-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611011","http://apps.humana.com/marketing/documents.asp?file=2594033","39"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460143","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS091","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460143-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","1","32673","TX","Individual","No","61-0994632","32673TX0640001","Humana Basic 6850/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2610322","http://apps.humana.com/marketing/documents.asp?file=2593643","5"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","1","32673","TX","Individual","No","61-0994632","32673TX0640049","Humana Basic 6850/Corpus Christi HMOx","32673TX064",,"TXN006","TXS003","TXF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640049-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2610530","http://apps.humana.com/marketing/documents.asp?file=2593721","6"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","1","32673","TX","Individual","No","61-0994632","32673TX0640049","Humana Basic 6850/Corpus Christi HMOx","32673TX064",,"TXN006","TXS003","TXF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640049-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2610530","http://apps.humana.com/marketing/documents.asp?file=2593721","7"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","1","32673","TX","Individual","No","61-0994632","32673TX0630001","Humana Basic 6850/HMO Premier","32673TX063",,"TXN001","TXS004","TXF001","Existing","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0630001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2610712","http://apps.humana.com/marketing/documents.asp?file=2593916","12"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","1","32673","TX","Individual","No","61-0994632","32673TX0630001","Humana Basic 6850/HMO Premier","32673TX063",,"TXN001","TXS004","TXF001","Existing","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0630001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2610712","http://apps.humana.com/marketing/documents.asp?file=2593916","13"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","1","32673","TX","Individual","No","61-0994632","32673TX0640025","Humana Basic 6850/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640025-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2610920","http://apps.humana.com/marketing/documents.asp?file=2593994","14"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","1","32673","TX","Individual","No","61-0994632","32673TX0640025","Humana Basic 6850/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640025-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2610920","http://apps.humana.com/marketing/documents.asp?file=2593994","15"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","1","32673","TX","Individual","No","61-0994632","32673TX0640037","Humana Basic 6850/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640037-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2611986","http://apps.humana.com/marketing/documents.asp?file=2594397","16"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","1","32673","TX","Individual","No","61-0994632","32673TX0640037","Humana Basic 6850/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640037-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2611986","http://apps.humana.com/marketing/documents.asp?file=2594397","17"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","1","32673","TX","Individual","No","61-0994632","32673TX0640013","Humana Basic 6850/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640013-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2612194","http://apps.humana.com/marketing/documents.asp?file=2594475","18"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","1","32673","TX","Individual","No","61-0994632","32673TX0640013","Humana Basic 6850/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2612194","http://apps.humana.com/marketing/documents.asp?file=2594475","19"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0640002","Humana Bronze 6450/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640002-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2610335","http://apps.humana.com/marketing/documents.asp?file=2593656","4"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0640002","Humana Bronze 6450/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640002-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2610335","http://apps.humana.com/marketing/documents.asp?file=2593656","5"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0640002","Humana Bronze 6450/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2610348","http://apps.humana.com/marketing/documents.asp?file=2593656","6"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0640002","Humana Bronze 6450/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640002-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2610361","http://apps.humana.com/marketing/documents.asp?file=2593656","7"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0640050","Humana Bronze 6450/Corpus Christi HMOx","32673TX064",,"TXN006","TXS003","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640050-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2610543","http://apps.humana.com/marketing/documents.asp?file=2593734","8"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0640050","Humana Bronze 6450/Corpus Christi HMOx","32673TX064",,"TXN006","TXS003","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640050-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2610543","http://apps.humana.com/marketing/documents.asp?file=2593734","9"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0640050","Humana Bronze 6450/Corpus Christi HMOx","32673TX064",,"TXN006","TXS003","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640050-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2610556","http://apps.humana.com/marketing/documents.asp?file=2593734","10"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0640050","Humana Bronze 6450/Corpus Christi HMOx","32673TX064",,"TXN006","TXS003","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640050-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2610569","http://apps.humana.com/marketing/documents.asp?file=2593734","11"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0630002","Humana Bronze 6450/HMO Premier","32673TX063",,"TXN001","TXS004","TXF001","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0630002-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2610725","http://apps.humana.com/marketing/documents.asp?file=2593929","20"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0630002","Humana Bronze 6450/HMO Premier","32673TX063",,"TXN001","TXS004","TXF001","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0630002-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2610725","http://apps.humana.com/marketing/documents.asp?file=2593929","21"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0630002","Humana Bronze 6450/HMO Premier","32673TX063",,"TXN001","TXS004","TXF001","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0630002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2610738","http://apps.humana.com/marketing/documents.asp?file=2593929","22"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0630002","Humana Bronze 6450/HMO Premier","32673TX063",,"TXN001","TXS004","TXF001","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0630002-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2610751","http://apps.humana.com/marketing/documents.asp?file=2593929","23"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0640026","Humana Bronze 6450/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640026-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2610933","http://apps.humana.com/marketing/documents.asp?file=2594007","24"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0640026","Humana Bronze 6450/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640026-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2610933","http://apps.humana.com/marketing/documents.asp?file=2594007","25"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0640026","Humana Bronze 6450/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2610946","http://apps.humana.com/marketing/documents.asp?file=2594007","26"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0640026","Humana Bronze 6450/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640026-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2610959","http://apps.humana.com/marketing/documents.asp?file=2594007","27"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0640038","Humana Bronze 6450/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640038-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2611999","http://apps.humana.com/marketing/documents.asp?file=2594410","28"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0640038","Humana Bronze 6450/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640038-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2611999","http://apps.humana.com/marketing/documents.asp?file=2594410","29"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0640038","Humana Bronze 6450/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640038-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2612012","http://apps.humana.com/marketing/documents.asp?file=2594410","30"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0640038","Humana Bronze 6450/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640038-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2612025","http://apps.humana.com/marketing/documents.asp?file=2594410","31"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0640014","Humana Bronze 6450/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640014-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2612207","http://apps.humana.com/marketing/documents.asp?file=2594488","32"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0640014","Humana Bronze 6450/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640014-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2612207","http://apps.humana.com/marketing/documents.asp?file=2594488","33"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0640014","Humana Bronze 6450/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2612220","http://apps.humana.com/marketing/documents.asp?file=2594488","34"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","2","32673","TX","Individual","No","61-0994632","32673TX0640014","Humana Bronze 6450/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","32673TX0640014-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2612233","http://apps.humana.com/marketing/documents.asp?file=2594488","35"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0640042","Humana Platinum 0/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640042-00","Standard Platinum Off Exchange Plan","91.71%","0.912852764129639","No","Yes","Yes","97%","3%","$0","$20","$1,030","$150","$0","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2632331","http://apps.humana.com/marketing/documents.asp?file=2594462","4"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0640042","Humana Platinum 0/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640042-01","Standard Platinum On Exchange Plan","91.71%","0.912852764129639","No","Yes","Yes","97%","3%","$0","$20","$1,030","$150","$0","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2632331","http://apps.humana.com/marketing/documents.asp?file=2594462","5"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0640042","Humana Platinum 0/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640042-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2632344","http://apps.humana.com/marketing/documents.asp?file=2594462","6"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0640042","Humana Platinum 0/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640042-03","Limited Cost Sharing Plan Variation","91.71%","0.912852764129639","No","Yes","Yes","97%","3%","$0","$20","$1,030","$150","$0","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2632357","http://apps.humana.com/marketing/documents.asp?file=2594462","7"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0640006","Humana Platinum 0/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640006-00","Standard Platinum Off Exchange Plan","91.71%","0.912852764129639","No","Yes","Yes","97%","3%","$0","$20","$1,030","$150","$0","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2632474","http://apps.humana.com/marketing/documents.asp?file=2593708","8"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0640006","Humana Platinum 0/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640006-01","Standard Platinum On Exchange Plan","91.71%","0.912852764129639","No","Yes","Yes","97%","3%","$0","$20","$1,030","$150","$0","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2632474","http://apps.humana.com/marketing/documents.asp?file=2593708","9"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0640006","Humana Platinum 0/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2632487","http://apps.humana.com/marketing/documents.asp?file=2593708","10"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0640006","Humana Platinum 0/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640006-03","Limited Cost Sharing Plan Variation","91.71%","0.912852764129639","No","Yes","Yes","97%","3%","$0","$20","$1,030","$150","$0","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2632500","http://apps.humana.com/marketing/documents.asp?file=2593708","11"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0640053","Humana Platinum 0/Corpus Christi HMOx","32673TX064",,"TXN006","TXS003","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640053-00","Standard Platinum Off Exchange Plan","91.71%","0.912852764129639","No","Yes","Yes","97%","3%","$0","$20","$1,030","$150","$0","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2631135","http://apps.humana.com/marketing/documents.asp?file=2593773","12"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0640053","Humana Platinum 0/Corpus Christi HMOx","32673TX064",,"TXN006","TXS003","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640053-01","Standard Platinum On Exchange Plan","91.71%","0.912852764129639","No","Yes","Yes","97%","3%","$0","$20","$1,030","$150","$0","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2631135","http://apps.humana.com/marketing/documents.asp?file=2593773","13"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0640053","Humana Platinum 0/Corpus Christi HMOx","32673TX064",,"TXN006","TXS003","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640053-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2631148","http://apps.humana.com/marketing/documents.asp?file=2593773","14"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0640053","Humana Platinum 0/Corpus Christi HMOx","32673TX064",,"TXN006","TXS003","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640053-03","Limited Cost Sharing Plan Variation","91.71%","0.912852764129639","No","Yes","Yes","97%","3%","$0","$20","$1,030","$150","$0","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2631161","http://apps.humana.com/marketing/documents.asp?file=2593773","15"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640028","Humana Silver 3800/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640028-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611011","http://apps.humana.com/marketing/documents.asp?file=2594033","40"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640028","Humana Silver 3800/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640028-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611024","http://apps.humana.com/marketing/documents.asp?file=2594033","41"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640028","Humana Silver 3800/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640028-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611037","http://apps.humana.com/marketing/documents.asp?file=2594033","42"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640028","Humana Silver 3800/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640028-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611050","http://apps.humana.com/marketing/documents.asp?file=2624518","43"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640028","Humana Silver 3800/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640028-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611063","http://apps.humana.com/marketing/documents.asp?file=2624531","44"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640028","Humana Silver 3800/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640028-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611076","http://apps.humana.com/marketing/documents.asp?file=2624544","45"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640040","Humana Silver 3800/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640040-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612077","http://apps.humana.com/marketing/documents.asp?file=2594436","46"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0630006","Humana Platinum 0/HMO Premier","32673TX063",,"TXN001","TXS004","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0630006-00","Standard Platinum Off Exchange Plan","91.71%","0.912852764129639","No","Yes","Yes","97%","3%","$0","$20","$1,030","$150","$0","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2632396","http://apps.humana.com/marketing/documents.asp?file=2593981","24"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0630006","Humana Platinum 0/HMO Premier","32673TX063",,"TXN001","TXS004","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0630006-01","Standard Platinum On Exchange Plan","91.71%","0.912852764129639","No","Yes","Yes","97%","3%","$0","$20","$1,030","$150","$0","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2632396","http://apps.humana.com/marketing/documents.asp?file=2593981","25"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0630006","Humana Platinum 0/HMO Premier","32673TX063",,"TXN001","TXS004","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0630006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2632422","http://apps.humana.com/marketing/documents.asp?file=2593981","26"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0640030","Humana Platinum 0/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640030-01","Standard Platinum On Exchange Plan","91.71%","0.912852764129639","No","Yes","Yes","97%","3%","$0","$20","$1,030","$150","$0","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2632591","http://apps.humana.com/marketing/documents.asp?file=2594059","29"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0640030","Humana Platinum 0/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640030-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2632604","http://apps.humana.com/marketing/documents.asp?file=2594059","30"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0640030","Humana Platinum 0/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640030-03","Limited Cost Sharing Plan Variation","91.71%","0.912852764129639","No","Yes","Yes","97%","3%","$0","$20","$1,030","$150","$0","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2632617","http://apps.humana.com/marketing/documents.asp?file=2594059","31"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0640018","Humana Platinum 0/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640018-00","Standard Platinum Off Exchange Plan","91.71%","0.912852764129639","No","Yes","Yes","97%","3%","$0","$20","$1,030","$150","$0","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2632526","http://apps.humana.com/marketing/documents.asp?file=2594540","32"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0640018","Humana Platinum 0/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640018-01","Standard Platinum On Exchange Plan","91.71%","0.912852764129639","No","Yes","Yes","97%","3%","$0","$20","$1,030","$150","$0","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2632526","http://apps.humana.com/marketing/documents.asp?file=2594540","33"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0640018","Humana Platinum 0/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640018-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2632539","http://apps.humana.com/marketing/documents.asp?file=2594540","34"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","3","32673","TX","Individual","No","61-0994632","32673TX0640018","Humana Platinum 0/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF005","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640018-03","Limited Cost Sharing Plan Variation","91.71%","0.912852764129639","No","Yes","Yes","97%","3%","$0","$20","$1,030","$150","$0","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2632565","http://apps.humana.com/marketing/documents.asp?file=2594540","35"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640004","Humana Silver 3800/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640004-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610413","http://apps.humana.com/marketing/documents.asp?file=2593682","4"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640004","Humana Silver 3800/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640004-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610413","http://apps.humana.com/marketing/documents.asp?file=2593682","5"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640004","Humana Silver 3800/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610426","http://apps.humana.com/marketing/documents.asp?file=2593682","6"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640004","Humana Silver 3800/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640004-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610439","http://apps.humana.com/marketing/documents.asp?file=2593682","7"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640004","Humana Silver 3800/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640004-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610452","http://apps.humana.com/marketing/documents.asp?file=2624323","8"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640004","Humana Silver 3800/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640004-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610465","http://apps.humana.com/marketing/documents.asp?file=2624336","9"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640004","Humana Silver 3800/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640004-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610478","http://apps.humana.com/marketing/documents.asp?file=2624349","10"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640051","Humana Silver 3800/Corpus Christi HMOx","32673TX064",,"TXN006","TXS003","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640051-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610582","http://apps.humana.com/marketing/documents.asp?file=2593747","11"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640051","Humana Silver 3800/Corpus Christi HMOx","32673TX064",,"TXN006","TXS003","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640051-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610582","http://apps.humana.com/marketing/documents.asp?file=2593747","12"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640051","Humana Silver 3800/Corpus Christi HMOx","32673TX064",,"TXN006","TXS003","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640051-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610595","http://apps.humana.com/marketing/documents.asp?file=2593747","13"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640051","Humana Silver 3800/Corpus Christi HMOx","32673TX064",,"TXN006","TXS003","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640051-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610608","http://apps.humana.com/marketing/documents.asp?file=2593747","14"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640051","Humana Silver 3800/Corpus Christi HMOx","32673TX064",,"TXN006","TXS003","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640051-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610621","http://apps.humana.com/marketing/documents.asp?file=2624362","15"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640051","Humana Silver 3800/Corpus Christi HMOx","32673TX064",,"TXN006","TXS003","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640051-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610634","http://apps.humana.com/marketing/documents.asp?file=2624375","16"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640051","Humana Silver 3800/Corpus Christi HMOx","32673TX064",,"TXN006","TXS003","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640051-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610647","http://apps.humana.com/marketing/documents.asp?file=2624388","17"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0630004","Humana Silver 3800/HMO Premier","32673TX063",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0630004-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610803","http://apps.humana.com/marketing/documents.asp?file=2593955","32"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0630004","Humana Silver 3800/HMO Premier","32673TX063",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0630004-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610803","http://apps.humana.com/marketing/documents.asp?file=2593955","33"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0630004","Humana Silver 3800/HMO Premier","32673TX063",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0630004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610816","http://apps.humana.com/marketing/documents.asp?file=2593955","34"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0630004","Humana Silver 3800/HMO Premier","32673TX063",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0630004-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610829","http://apps.humana.com/marketing/documents.asp?file=2593955","35"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0630004","Humana Silver 3800/HMO Premier","32673TX063",,"TXN001","TXS004","TXF003","Existing","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0630004-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610842","http://apps.humana.com/marketing/documents.asp?file=2624479","36"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640040","Humana Silver 3800/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640040-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612077","http://apps.humana.com/marketing/documents.asp?file=2594436","47"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640040","Humana Silver 3800/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640040-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612090","http://apps.humana.com/marketing/documents.asp?file=2594436","48"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640040","Humana Silver 3800/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640040-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612103","http://apps.humana.com/marketing/documents.asp?file=2594436","49"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640040","Humana Silver 3800/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640040-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612116","http://apps.humana.com/marketing/documents.asp?file=2624791","50"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640040","Humana Silver 3800/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640040-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612129","http://apps.humana.com/marketing/documents.asp?file=2624804","51"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640040","Humana Silver 3800/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640040-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612142","http://apps.humana.com/marketing/documents.asp?file=2624817","52"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640016","Humana Silver 3800/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640016-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612285","http://apps.humana.com/marketing/documents.asp?file=2594514","53"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640016","Humana Silver 3800/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640016-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612285","http://apps.humana.com/marketing/documents.asp?file=2594514","54"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640016","Humana Silver 3800/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640016-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612298","http://apps.humana.com/marketing/documents.asp?file=2594514","55"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640016","Humana Silver 3800/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640016-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612311","http://apps.humana.com/marketing/documents.asp?file=2594514","56"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640016","Humana Silver 3800/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640016-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612324","http://apps.humana.com/marketing/documents.asp?file=2624830","57"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640016","Humana Silver 3800/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640016-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612337","http://apps.humana.com/marketing/documents.asp?file=2624843","58"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640016","Humana Silver 3800/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640016-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612350","http://apps.humana.com/marketing/documents.asp?file=2624856","59"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640005","Humana Gold 2250/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640005-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610491","http://apps.humana.com/marketing/documents.asp?file=2593695","60"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640005","Humana Gold 2250/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640005-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610491","http://apps.humana.com/marketing/documents.asp?file=2593695","61"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640005","Humana Gold 2250/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610504","http://apps.humana.com/marketing/documents.asp?file=2593695","62"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640005","Humana Gold 2250/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640005-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610517","http://apps.humana.com/marketing/documents.asp?file=2593695","63"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640052","Humana Gold 2250/Corpus Christi HMOx","32673TX064",,"TXN006","TXS003","TXF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640052-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610660","http://apps.humana.com/marketing/documents.asp?file=2593760","64"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640052","Humana Gold 2250/Corpus Christi HMOx","32673TX064",,"TXN006","TXS003","TXF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640052-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610660","http://apps.humana.com/marketing/documents.asp?file=2593760","65"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640052","Humana Gold 2250/Corpus Christi HMOx","32673TX064",,"TXN006","TXS003","TXF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640052-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610686","http://apps.humana.com/marketing/documents.asp?file=2593760","66"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640052","Humana Gold 2250/Corpus Christi HMOx","32673TX064",,"TXN006","TXS003","TXF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640052-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610699","http://apps.humana.com/marketing/documents.asp?file=2593760","67"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","5","32673","TX","Individual","No","61-0994632","32673TX0640027","Humana Bronze 4850/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640027-00","Standard Bronze Off Exchange Plan","61.72%","0.611959636211395","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610972","http://apps.humana.com/marketing/documents.asp?file=2594020","12"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","5","32673","TX","Individual","No","61-0994632","32673TX0640027","Humana Bronze 4850/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640027-01","Standard Bronze On Exchange Plan","61.72%","0.611959636211395","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610972","http://apps.humana.com/marketing/documents.asp?file=2594020","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460136","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS021","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460136-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430020","Blue Choice Gold PPO?  020","33602TX043",,"TXN012","TXS002","TXF010","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0430020-01","Standard Gold On Exchange Plan",,"0.803613781929016","No","Yes","Yes","60%","40%","$1,000","$20","$1,300","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","$7,800","$7800 per person","$23400 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0430020-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460143","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS091","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460143-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0630005","Humana Gold 2250/HMO Premier","32673TX063",,"TXN001","TXS004","TXF004","Existing","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0630005-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610881","http://apps.humana.com/marketing/documents.asp?file=2593968","76"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0630005","Humana Gold 2250/HMO Premier","32673TX063",,"TXN001","TXS004","TXF004","Existing","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0630005-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610881","http://apps.humana.com/marketing/documents.asp?file=2593968","77"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0630005","Humana Gold 2250/HMO Premier","32673TX063",,"TXN001","TXS004","TXF004","Existing","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0630005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610894","http://apps.humana.com/marketing/documents.asp?file=2593968","78"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","5","32673","TX","Individual","No","61-0994632","32673TX0640039","Humana Bronze 4850/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640039-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612051","http://apps.humana.com/marketing/documents.asp?file=2594423","18"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","5","32673","TX","Individual","No","61-0994632","32673TX0640039","Humana Bronze 4850/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640039-03","Limited Cost Sharing Plan Variation","61.72%","0.611959636211395","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612064","http://apps.humana.com/marketing/documents.asp?file=2594423","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","4","33602","TX","Individual","No","36-1236610","33602TX0460160","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS261","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460160-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460273","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS021","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460273-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460145","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS111","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460145-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0630005","Humana Gold 2250/HMO Premier","32673TX063",,"TXN001","TXS004","TXF004","Existing","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0630005-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610907","http://apps.humana.com/marketing/documents.asp?file=2593968","79"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640029","Humana Gold 2250/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640029-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611089","http://apps.humana.com/marketing/documents.asp?file=2594046","80"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640029","Humana Gold 2250/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640029-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611089","http://apps.humana.com/marketing/documents.asp?file=2594046","81"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640029","Humana Gold 2250/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640029-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611102","http://apps.humana.com/marketing/documents.asp?file=2594046","82"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640029","Humana Gold 2250/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640029-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611115","http://apps.humana.com/marketing/documents.asp?file=2594046","83"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640041","Humana Gold 2250/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640041-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612155","http://apps.humana.com/marketing/documents.asp?file=2594449","84"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640041","Humana Gold 2250/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640041-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612155","http://apps.humana.com/marketing/documents.asp?file=2594449","85"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640041","Humana Gold 2250/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640041-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612168","http://apps.humana.com/marketing/documents.asp?file=2594449","86"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640041","Humana Gold 2250/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640041-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612181","http://apps.humana.com/marketing/documents.asp?file=2594449","87"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640017","Humana Gold 2250/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640017-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612363","http://apps.humana.com/marketing/documents.asp?file=2594527","88"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640017","Humana Gold 2250/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640017-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612363","http://apps.humana.com/marketing/documents.asp?file=2594527","89"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640017","Humana Gold 2250/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640017-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612376","http://apps.humana.com/marketing/documents.asp?file=2594527","90"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","4","32673","TX","Individual","No","61-0994632","32673TX0640017","Humana Gold 2250/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640017-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612389","http://apps.humana.com/marketing/documents.asp?file=2594527","91"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","5","32673","TX","Individual","No","61-0994632","32673TX0640003","Humana Bronze 4850/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640003-00","Standard Bronze Off Exchange Plan","61.72%","0.611959636211395","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610374","http://apps.humana.com/marketing/documents.asp?file=2593669","4"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","5","32673","TX","Individual","No","61-0994632","32673TX0640003","Humana Bronze 4850/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640003-01","Standard Bronze On Exchange Plan","61.72%","0.611959636211395","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610374","http://apps.humana.com/marketing/documents.asp?file=2593669","5"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","5","32673","TX","Individual","No","61-0994632","32673TX0640003","Humana Bronze 4850/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610387","http://apps.humana.com/marketing/documents.asp?file=2593669","6"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","5","32673","TX","Individual","No","61-0994632","32673TX0640003","Humana Bronze 4850/Austin HMOx","32673TX064",,"TXN002","TXS001","TXF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640003-03","Limited Cost Sharing Plan Variation","61.72%","0.611959636211395","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610400","http://apps.humana.com/marketing/documents.asp?file=2593669","7"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","5","32673","TX","Individual","No","61-0994632","32673TX0630003","Humana Bronze 4850/HMO Premier","32673TX063",,"TXN001","TXS004","TXF002","Existing","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0630003-00","Standard Bronze Off Exchange Plan","61.72%","0.611959636211395","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610764","http://apps.humana.com/marketing/documents.asp?file=2593942","8"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","5","32673","TX","Individual","No","61-0994632","32673TX0630003","Humana Bronze 4850/HMO Premier","32673TX063",,"TXN001","TXS004","TXF002","Existing","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0630003-01","Standard Bronze On Exchange Plan","61.72%","0.611959636211395","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610764","http://apps.humana.com/marketing/documents.asp?file=2593942","9"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","5","32673","TX","Individual","No","61-0994632","32673TX0630003","Humana Bronze 4850/HMO Premier","32673TX063",,"TXN001","TXS004","TXF002","Existing","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0630003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610777","http://apps.humana.com/marketing/documents.asp?file=2593942","10"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","5","32673","TX","Individual","No","61-0994632","32673TX0630003","Humana Bronze 4850/HMO Premier","32673TX063",,"TXN001","TXS004","TXF002","Existing","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0630003-03","Limited Cost Sharing Plan Variation","61.72%","0.611959636211395","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610790","http://apps.humana.com/marketing/documents.asp?file=2593942","11"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","5","32673","TX","Individual","No","61-0994632","32673TX0640027","Humana Bronze 4850/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640027-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610985","http://apps.humana.com/marketing/documents.asp?file=2594020","14"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","5","32673","TX","Individual","No","61-0994632","32673TX0640027","Humana Bronze 4850/Houston HMOx","32673TX064",,"TXN003","TXS009","TXF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640027-03","Limited Cost Sharing Plan Variation","61.72%","0.611959636211395","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2610998","http://apps.humana.com/marketing/documents.asp?file=2594020","15"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","5","32673","TX","Individual","No","61-0994632","32673TX0640039","Humana Bronze 4850/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640039-00","Standard Bronze Off Exchange Plan","61.72%","0.611959636211395","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612038","http://apps.humana.com/marketing/documents.asp?file=2594423","16"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","5","32673","TX","Individual","No","61-0994632","32673TX0640039","Humana Bronze 4850/San Antonio HMOx","32673TX064",,"TXN005","TXS007","TXF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640039-01","Standard Bronze On Exchange Plan","61.72%","0.611959636211395","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612038","http://apps.humana.com/marketing/documents.asp?file=2594423","17"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","5","32673","TX","Individual","No","61-0994632","32673TX0640015","Humana Bronze 4850/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640015-00","Standard Bronze Off Exchange Plan","61.72%","0.611959636211395","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612246","http://apps.humana.com/marketing/documents.asp?file=2594501","20"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","5","32673","TX","Individual","No","61-0994632","32673TX0640015","Humana Bronze 4850/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640015-01","Standard Bronze On Exchange Plan","61.72%","0.611959636211395","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612246","http://apps.humana.com/marketing/documents.asp?file=2594501","21"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","5","32673","TX","Individual","No","61-0994632","32673TX0640015","Humana Bronze 4850/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612259","http://apps.humana.com/marketing/documents.asp?file=2594501","22"
"2016","TX","32673","HIOS","9","2015-08-26 09:56:12","5","32673","TX","Individual","No","61-0994632","32673TX0640015","Humana Bronze 4850/Waco HMOx","32673TX064",,"TXN004","TXS002","TXF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","32673TX0640015-03","Limited Cost Sharing Plan Variation","61.72%","0.611959636211395","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612272","http://apps.humana.com/marketing/documents.asp?file=2594501","23"
"2016","TX","33348","HIOS","3","2015-08-25 05:06:23","1","33348","TX","Individual","Yes","72-0977315","33348TX0090001","AlwaysCare All-Star Kids Dental Plan 2016","33348TX009",,"TXN001","TXS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$46.26","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","33348TX0090001-00","Standard High Off Exchange Plan","86.08%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","TX","33348","HIOS","3","2015-08-25 05:06:23","1","33348","TX","SHOP (Small Group)","Yes","72-0977315","33348TX0120001","AlwaysCare Small Group Dental – Child 2016","33348TX012",,"TXN001","TXS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$38.67","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","33348TX0120001-00","Standard High Off Exchange Plan","86.08%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","TX","33348","HIOS","3","2015-08-25 05:06:23","1","33348","TX","SHOP (Small Group)","Yes","72-0977315","33348TX0120002","AlwaysCare Small Group Dental – Child 2016","33348TX012",,"TXN001","TXS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$31.32","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","33348TX0120002-00","Standard Low Off Exchange Plan","70.87%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","TX","33348","HIOS","3","2015-08-25 05:06:23","2","33348","TX","SHOP (Small Group)","Yes","72-0977315","33348TX0110001","AlwaysCare Small Group Dental – Adults 2016","33348TX011",,"TXN001","TXS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$38.67","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","33348TX0110001-00","Standard High Off Exchange Plan","86.08%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","TX","33348","HIOS","3","2015-08-25 05:06:23","2","33348","TX","Individual","Yes","72-0977315","33348TX0100001","AlwaysCare All-Star Family Dental Plan 2016","33348TX010",,"TXN001","TXS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$46.26","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","33348TX0100001-00","Standard High Off Exchange Plan","86.08%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","TX","33348","HIOS","3","2015-08-25 05:06:23","2","33348","TX","SHOP (Small Group)","Yes","72-0977315","33348TX0110002","AlwaysCare Small Group Dental – Adults 2016","33348TX011",,"TXN001","TXS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$31.32","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","33348TX0110002-00","Standard Low Off Exchange Plan","70.87%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460006","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS081","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460006-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","Yes","36-1236610","33602TX0500001","BlueCare Dental? 1A","33602TX050",,"TXN003","TXS003",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500001-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbstx.com/pdf/bluecare-dental-individuals-and-families-tx.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430001","Blue Choice Gold PPO?  001","33602TX043",,"TXN012","TXS002","TXF007","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0430001-00","Standard Gold Off Exchange Plan","79.00%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0%","$3,000","$3000 per person","$9000 per group","0%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0430001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430001","Blue Choice Gold PPO?  001","33602TX043",,"TXN012","TXS002","TXF007","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0430001-01","Standard Gold On Exchange Plan","79.00%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","$3,000","$3000 per person","$9000 per group","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","0%","$3,000","$3000 per person","$9000 per group","0%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0430001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","Yes","36-1236610","33602TX0500001","BlueCare Dental? 1A","33602TX050",,"TXN003","TXS003",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500001-01","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbstx.com/pdf/bluecare-dental-individuals-and-families-tx.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460006","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS081","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460006-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460006","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS081","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430003","Blue Choice Silver PPO?  003","33602TX043",,"TXN012","TXS002","TXF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0430003-00","Standard Silver Off Exchange Plan","68.39%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","$12,000","$12000 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","$12,000","$12000 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0430003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430003","Blue Choice Silver PPO?  003","33602TX043",,"TXN012","TXS002","TXF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0430003-01","Standard Silver On Exchange Plan","68.39%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","$12,000","$12000 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","$12,000","$12000 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0430003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460006","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS081","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460006-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460136","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS021","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460136-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460136","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS021","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460136-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460136","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS021","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460136-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460137","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS031","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460137-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460137","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS031","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460137-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460137","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS031","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460137-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460137","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS031","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460137-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460138","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS041","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460138-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460138","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS041","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460138-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460138","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS041","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460138-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460138","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS041","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460138-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460139","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS051","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460139-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460139","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS051","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460139-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460139","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS051","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460139-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460139","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS051","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460139-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460140","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS061","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460140-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460140","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS061","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460140-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460140","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS061","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460140-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460140","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS061","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460140-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460141","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS071","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460141-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460141","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS071","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460141-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460141","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS071","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460141-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460141","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS071","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460141-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460142","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS011","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460142-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460142","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS011","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460142-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460142","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS011","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460142-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","1","33602","TX","Individual","No","36-1236610","33602TX0460142","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS011","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460142-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460143","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS091","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460143-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430020","Blue Choice Gold PPO?  020","33602TX043",,"TXN012","TXS002","TXF010","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0430020-00","Standard Gold Off Exchange Plan",,"0.803613781929016","No","Yes","Yes","60%","40%","$1,000","$20","$1,300","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","$7,800","$7800 per person","$23400 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0430020-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","Yes","36-1236610","33602TX0500003","BlueCare Dental 4 Kids? 1A","33602TX050",,"TXN003","TXS003",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$31.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500003-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbstx.com/pdf/bluecare-dental-individuals-and-families-tx.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","Yes","36-1236610","33602TX0500003","BlueCare Dental 4 Kids? 1A","33602TX050",,"TXN003","TXS003",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$31.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500003-01","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbstx.com/pdf/bluecare-dental-individuals-and-families-tx.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460143","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS091","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460143-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460144","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS101","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460144-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460144","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS101","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460144-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460144","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS101","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460144-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460144","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS101","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460144-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","4","33602","TX","Individual","No","36-1236610","33602TX0460160","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS261","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460160-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460145","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS111","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460145-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460145","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS111","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460145-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460145","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS111","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460145-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460146","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS121","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460146-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460146","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS121","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460146-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460146","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS121","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460146-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460151","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS171","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460151-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460152","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS181","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460152-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460146","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS121","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460146-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460147","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS131","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460147-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460147","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS131","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460147-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460147","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS131","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460147-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460147","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS131","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460147-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460148","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS141","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460148-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460148","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS141","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460148-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460148","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS141","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460148-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460148","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS141","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460148-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460149","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS151","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460149-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460149","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS151","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460149-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460149","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS151","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460149-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460149","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS151","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460149-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460150","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS161","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460150-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460150","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS161","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460150-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460150","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS161","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460150-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","2","33602","TX","Individual","No","36-1236610","33602TX0460150","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS161","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460150-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460151","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS171","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460151-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470003","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS081","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470003-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","Yes","36-1236610","33602TX0500002","BlueCare Dental? 1B","33602TX050",,"TXN003","TXS003",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500002-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbstx.com/pdf/bluecare-dental-individuals-and-families-tx.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","Yes","36-1236610","33602TX0500002","BlueCare Dental? 1B","33602TX050",,"TXN003","TXS003",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500002-01","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbstx.com/pdf/bluecare-dental-individuals-and-families-tx.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470003","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS081","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470003-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460151","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS171","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460151-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460151","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS171","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460151-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470004","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS101","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470004-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","Yes","36-1236610","33602TX0500005","BlueCare Dental? 2A","33602TX050",,"TXN003","TXS003",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500005-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbstx.com/pdf/bluecare-dental-individuals-and-families-tx.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","Yes","36-1236610","33602TX0500005","BlueCare Dental? 2A","33602TX050",,"TXN003","TXS003",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500005-01","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbstx.com/pdf/bluecare-dental-individuals-and-families-tx.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470004","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS101","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470004-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470074","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS021","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470074-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470074","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS021","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470074-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460152","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS181","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460152-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460152","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS181","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460152-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470075","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS031","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470075-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470075","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS031","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470075-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470079","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS071","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470079-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460274","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS031","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460274-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460152","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS181","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460152-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460153","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS191","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460153-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470076","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS041","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470076-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470076","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS041","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470076-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460153","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS191","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460153-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460153","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS191","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460153-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460153","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS191","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460153-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460154","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS201","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460154-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460154","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS201","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460154-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460154","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS201","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460154-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460154","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS201","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460154-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460155","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS211","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460155-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460155","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS211","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460155-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460155","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS211","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460155-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460155","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS211","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460155-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460156","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS221","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460156-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460156","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS221","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460156-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460156","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS221","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460156-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460156","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS221","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460156-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460157","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS231","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460157-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460157","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS231","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460157-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460157","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS231","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460157-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460157","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS231","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460157-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460158","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS241","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460158-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460158","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS241","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460158-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460158","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS241","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460158-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","3","33602","TX","Individual","No","36-1236610","33602TX0460158","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS241","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460158-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","4","33602","TX","Individual","No","36-1236610","33602TX0460159","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS251","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460159-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","4","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470006","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS101","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470006-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","4","33602","TX","Individual","Yes","36-1236610","33602TX0500004","BlueCare Dental 4 Kids? 1B","33602TX050",,"TXN003","TXS003",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$22.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500004-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbstx.com/pdf/bluecare-dental-individuals-and-families-tx.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","4","33602","TX","Individual","Yes","36-1236610","33602TX0500004","BlueCare Dental 4 Kids? 1B","33602TX050",,"TXN003","TXS003",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$22.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","","33602TX0500004-01","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbstx.com/pdf/bluecare-dental-individuals-and-families-tx.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","4","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470006","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS101","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470006-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","4","33602","TX","Individual","No","36-1236610","33602TX0460159","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS251","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460159-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","4","33602","TX","Individual","No","36-1236610","33602TX0460159","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS251","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460159-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","4","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470014","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS101","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470014-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","4","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470014","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS101","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470014-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","4","33602","TX","Individual","No","36-1236610","33602TX0460159","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS251","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460159-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","4","33602","TX","Individual","No","36-1236610","33602TX0460160","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS261","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460160-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","4","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470015","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS101","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470015-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","4","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470015","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS101","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470015-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","4","33602","TX","Individual","No","36-1236610","33602TX0460160","Blue Advantage Bronze HMO?  006","33602TX046",,"TXN001","TXS261","TXF001","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460160-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470077","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS051","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470077-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470077","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS051","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470077-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460273","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS021","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460273-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470091","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS191","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470091-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460280","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS091","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460280-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460280","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS091","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460280-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470092","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS201","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470092-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470092","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS201","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470092-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460273","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS021","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460273-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470078","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS061","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470078-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470078","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS061","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470078-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460273","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS021","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460273-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460274","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS031","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460274-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470079","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS071","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470079-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460274","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS031","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460274-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460278","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS071","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460278-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470087","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS151","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470087-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470087","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS151","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470087-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460278","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS071","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460278-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460278","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS071","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460278-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460281","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS101","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460281-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460281","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS101","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460281-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470080","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS011","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470080-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470080","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS011","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470080-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460274","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS031","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460274-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460275","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS041","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460275-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470081","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS091","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470081-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470081","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS091","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470081-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460275","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS041","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460275-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460275","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS041","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460275-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470082","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS101","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470082-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470082","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS101","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470082-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460275","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS041","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460275-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460276","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS051","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460276-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470083","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS111","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470083-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470083","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS111","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470083-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460276","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS051","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460276-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460276","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS051","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460276-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470084","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS121","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470084-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470084","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS121","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470084-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460276","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS051","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460276-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460277","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS061","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460277-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470085","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS131","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470085-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470085","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS131","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470085-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460277","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS061","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460277-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460277","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS061","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460277-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470086","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS141","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470086-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470086","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS141","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470086-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460277","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS061","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460277-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470088","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS161","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470088-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470088","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS161","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470088-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460278","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS071","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460278-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460279","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS081","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460279-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470089","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS171","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470089-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470089","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS171","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470089-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460279","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS081","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460279-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460279","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS081","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460279-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470090","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS181","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470090-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470090","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS181","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470090-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460279","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS081","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460279-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460280","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS091","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460280-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470091","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS191","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470091-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","Individual","No","36-1236610","33602TX0460280","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS091","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460280-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470093","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS211","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470093-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","36"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470093","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS211","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470093-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","37"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470094","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS221","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470094-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","38"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460287","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS161","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460287-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460287","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS161","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460287-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470109","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS121","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470109-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470110","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS131","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470110-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470094","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS221","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470094-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","39"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470095","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS231","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470095-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","40"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470095","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS231","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470095-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","41"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470096","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS241","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470096-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","42"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","5","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470096","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS241","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470096-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","43"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470097","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS251","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470097-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470097","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS251","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470097-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470098","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS261","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470098-00","Standard Silver Off Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470105","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS081","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470105-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460285","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS141","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460285-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460285","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS141","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460285-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470105","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS081","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470105-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470106","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS091","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470106-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470113","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS161","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470113-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","37"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460281","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS101","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460281-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460281","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS101","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460281-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470098","Blue Advantage Silver HMO?  003","33602TX047",,"TXN011","TXS261","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470098-01","Standard Silver On Exchange Plan","68.86%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$13700 per group","0%","$6,000","$6000 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470099","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS021","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470099-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460282","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS111","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460282-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460282","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS111","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460282-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470099","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS021","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470099-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470100","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS031","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470100-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460282","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS111","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460282-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460282","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS111","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460282-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470100","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS031","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470100-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470101","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS041","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470101-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460283","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS121","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460283-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460283","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS121","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460283-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470101","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS041","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470101-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470102","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS051","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470102-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460283","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS121","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460283-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460283","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS121","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460283-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470102","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS051","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470102-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470103","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS061","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470103-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460284","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS131","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460284-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460284","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS131","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460284-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470103","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS061","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470103-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470104","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS071","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470104-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460284","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS131","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460284-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460284","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS131","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460284-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470104","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS071","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470104-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460285","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS141","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460285-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460285","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS141","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460285-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470106","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS091","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470106-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470107","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS011","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470107-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460286","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS151","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460286-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460286","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS151","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460286-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470107","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS011","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470107-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470108","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS111","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470108-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460286","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS151","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460286-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460286","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS151","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460286-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470108","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS111","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470108-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470109","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS121","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470109-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460287","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS161","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460287-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460287","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS161","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460287-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470110","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS131","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470110-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470111","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS141","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470111-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460288","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS171","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460288-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470151","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS041","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470151-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460368","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS231","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460368-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460368","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS231","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460368-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460288","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS171","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460288-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470111","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS141","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470111-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470112","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS151","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470112-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460288","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS171","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460288-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","Individual","No","36-1236610","33602TX0460288","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS171","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460288-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470112","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS151","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470112-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470113","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS161","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470113-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","36"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470114","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS171","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470114-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","38"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470114","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS171","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470114-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","39"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470115","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS181","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470115-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","40"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","Individual","No","36-1236610","33602TX0460291","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS201","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460291-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","Individual","No","36-1236610","33602TX0460291","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS201","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460291-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","Individual","No","36-1236610","33602TX0460292","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS211","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460292-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","Individual","No","36-1236610","33602TX0460292","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS211","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460292-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","Individual","No","36-1236610","33602TX0460292","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS211","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460292-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470115","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS181","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470115-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","41"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470116","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS191","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470116-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","42"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470116","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS191","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470116-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","43"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470117","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS201","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470117-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","44"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470117","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS201","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470117-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","45"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470118","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS211","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470118-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","46"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","6","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470118","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS211","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470118-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","47"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470119","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS221","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470119-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","Individual","No","36-1236610","33602TX0460289","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS181","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460289-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","Individual","No","36-1236610","33602TX0460289","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS181","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460289-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470119","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS221","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470119-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470120","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS231","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470120-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","Individual","No","36-1236610","33602TX0460289","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS181","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460289-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","Individual","No","36-1236610","33602TX0460289","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS181","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460289-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470120","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS231","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470120-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470121","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS241","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470121-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","Individual","No","36-1236610","33602TX0460290","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS191","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460290-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","Individual","No","36-1236610","33602TX0460290","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS191","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460290-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470121","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS241","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470121-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470122","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS251","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470122-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","Individual","No","36-1236610","33602TX0460290","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS191","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460290-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","Individual","No","36-1236610","33602TX0460290","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS191","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460290-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470122","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS251","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470122-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470123","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS261","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470123-00","Standard Silver Off Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","Individual","No","36-1236610","33602TX0460291","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS201","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460291-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","Individual","No","36-1236610","33602TX0460291","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS201","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460291-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470123","Blue Advantage Silver HMO?  004","33602TX047",,"TXN011","TXS261","TXF014","Existing","HMO","Silver","Yes","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470123-01","Standard Silver On Exchange Plan","70.39%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470004-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","7","33602","TX","Individual","No","36-1236610","33602TX0460292","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS211","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460292-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460241","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS221","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460241-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470149","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS021","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470149-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470149","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS021","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470149-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460241","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS221","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460241-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460241","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS221","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460241-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470150","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS031","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470150-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470150","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS031","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470150-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460241","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS221","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460241-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460368","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS231","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460368-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470151","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS041","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470151-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470152","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS051","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470152-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470152","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS051","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470152-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460368","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS231","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460368-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460369","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS241","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460369-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470153","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS061","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470153-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470153","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS061","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470153-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460376","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS051","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460376-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460376","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS051","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460376-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460369","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS241","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460369-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460369","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS241","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460369-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470154","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS071","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470154-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470154","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS071","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470154-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460369","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS241","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460369-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460370","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS251","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460370-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470155","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS081","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470155-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470155","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS081","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470155-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460370","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS251","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460370-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460370","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS251","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460370-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470156","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS091","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470156-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470156","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS091","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470156-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470163","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS161","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470163-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460374","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS031","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460374-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460374","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS031","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460374-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460374","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS031","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460374-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460370","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS251","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460370-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460371","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS261","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460371-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470157","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS011","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470157-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470157","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS011","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470157-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460371","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS261","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460371-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460371","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS261","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460371-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470158","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS111","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470158-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470158","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS111","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470158-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460371","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS261","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460371-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460372","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS011","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460372-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470159","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS121","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470159-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470159","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS121","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470159-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460372","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS011","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460372-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460372","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS011","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460372-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470160","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS131","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470160-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470160","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS131","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470160-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460372","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS011","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460372-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460373","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS021","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460373-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470161","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS141","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470161-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470161","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS141","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470161-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460373","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS021","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460373-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460373","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS021","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460373-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470162","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS151","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470162-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470162","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS151","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470162-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460373","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS021","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460373-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","Individual","No","36-1236610","33602TX0460374","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS031","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460374-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470163","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS161","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470163-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460375","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS041","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460375-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470171","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS241","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470171-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470171","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS241","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470171-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460378","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS071","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460378-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460379","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS081","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460379-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460382","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS111","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460382-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470279","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS071","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470279-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470279","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS071","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470279-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470164","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS171","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470164-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470164","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS171","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470164-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460375","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS041","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460375-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460375","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS041","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460375-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470165","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS181","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470165-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470165","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS181","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470165-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460375","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS041","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460375-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460376","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS051","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460376-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470166","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS191","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470166-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470166","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS191","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470166-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470167","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS201","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470167-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470167","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS201","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470167-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460376","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS051","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460376-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460377","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS061","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460377-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470168","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS211","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470168-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470168","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS211","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470168-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460377","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS061","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460377-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470282","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS011","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470282-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","41"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460377","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS061","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460377-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470169","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS221","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470169-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470169","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS221","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470169-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460377","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS061","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460377-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460378","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS071","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460378-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470170","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS231","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470170-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470170","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS231","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470170-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460378","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS071","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460378-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460378","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS071","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460378-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470172","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS251","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470172-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470172","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS251","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470172-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460379","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS081","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460379-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460379","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS081","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460379-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470173","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS261","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470173-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470173","Blue Advantage Bronze HMO?  006","33602TX047",,"TXN011","TXS261","TXF001","New","HMO","Bronze","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0470173-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460379","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS081","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460379-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460380","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS091","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460380-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470274","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS021","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470274-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470274","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS021","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470274-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460380","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS091","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460380-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460380","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS091","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460380-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470275","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS031","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470275-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470275","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS031","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470275-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460380","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS091","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460380-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460381","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS101","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460381-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470276","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS041","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470276-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470276","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS041","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470276-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460381","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS101","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460381-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460381","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS101","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460381-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470277","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS051","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470277-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470277","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS051","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470277-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460381","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS101","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460381-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460382","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS111","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460382-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470278","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS061","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470278-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470278","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS061","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470278-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460382","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS111","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460382-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460382","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS111","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460382-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460383","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS121","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460383-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","36"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470287","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS151","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470287-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470287","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS151","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470287-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460386","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS151","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460386-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460387","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS161","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460387-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460390","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS191","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460390-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470295","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS231","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470295-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470280","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS081","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470280-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","36"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470280","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS081","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470280-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","37"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460383","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS121","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460383-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","37"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460383","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS121","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460383-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","38"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470281","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS091","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470281-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","38"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470281","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS091","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470281-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","39"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460383","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS121","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460383-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","39"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460384","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS131","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460384-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","40"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470282","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS011","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470282-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","40"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460384","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS131","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460384-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","41"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460384","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS131","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460384-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","42"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470283","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS111","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470283-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","42"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470283","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS111","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470283-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","43"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","9","33602","TX","Individual","No","36-1236610","33602TX0460384","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS131","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460384-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","43"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460385","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS141","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460385-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470284","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS121","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470284-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470284","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS121","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470284-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460385","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS141","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460385-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460385","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS141","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460385-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470285","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS131","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470285-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470285","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS131","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470285-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460385","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS141","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460385-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460386","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS151","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460386-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470286","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS141","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470286-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470286","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS141","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470286-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460386","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS151","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460386-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460386","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS151","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460386-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470288","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS161","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470288-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470288","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS161","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470288-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460387","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS161","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460387-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460387","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS161","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460387-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470289","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS171","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470289-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470289","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS171","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470289-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460387","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS161","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460387-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460388","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS171","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460388-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470290","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS181","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470290-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470290","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS181","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470290-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460388","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS171","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460388-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460388","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS171","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460388-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470291","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS191","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470291-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470291","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS191","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470291-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460388","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS171","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460388-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460389","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS181","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460389-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470292","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS201","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470292-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470292","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS201","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470292-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460389","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS181","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460389-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460389","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS181","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460389-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470293","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS211","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470293-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470293","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS211","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470293-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460389","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS181","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460389-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460390","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS191","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460390-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470294","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS221","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470294-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470294","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS221","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470294-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460390","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS191","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460390-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470295","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS231","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470295-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460390","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS191","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460390-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460391","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS201","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460391-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470305","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS081","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470305-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770003","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS221","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770003","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS221","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770003-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470305","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS081","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470305-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770057","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS261","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770057-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470296","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS241","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470296-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470296","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS241","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470296-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460391","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS201","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460391-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460391","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS201","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460391-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470297","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS251","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470297-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470297","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS251","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470297-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460391","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS201","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460391-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460392","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS211","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460392-00","Standard Bronze Off Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470298","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS261","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470298-00","Standard Gold Off Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470298","Blue Advantage Gold HMO?  014","33602TX047",,"TXN011","TXS261","TXF017","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470298-01","Standard Gold On Exchange Plan",,"0.800620555877686","No","Yes","Yes","60%","40%","$1,000","$200","$1,200","$200","$1,000","$700","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,900","$3900 per person","$11700 per group","$3,900","$3900 per person","$11700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470014-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460392","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS211","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460392-01","Standard Bronze On Exchange Plan",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460392","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS211","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460392-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470299","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS021","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470299-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470299","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS021","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470299-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","Individual","No","36-1236610","33602TX0460392","Blue Advantage Bronze HMO?  105 - Two $40 PCP Visits","33602TX046",,"TXN001","TXS211","TXF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","2","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460392-03","Limited Cost Sharing Plan Variation",,"0.604388117790222","Yes","Yes","Yes","60%","40%","$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13700 per group","30%","$6,750","$6750 per person","$13700 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460241-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470300","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS031","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470300-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","36"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470300","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS031","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470300-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","37"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470301","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS041","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470301-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","38"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470301","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS041","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470301-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","39"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470302","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS051","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470302-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","40"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470302","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS051","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470302-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","41"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470303","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS061","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470303-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","42"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470303","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS061","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470303-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","43"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470304","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS071","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470304-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770003","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS221","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770003-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770003","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS221","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770003-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470304","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS071","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470304-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470306","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS091","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470306-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770054","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS231","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770054-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770054","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS231","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770054-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470306","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS091","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470306-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470307","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS011","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470307-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770054","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS231","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770054-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770054","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS231","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770054-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470307","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS011","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470307-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470308","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS111","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470308-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770055","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS241","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770055-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770055","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS241","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770055-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770058","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS011","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770058-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470308","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS111","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470308-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470309","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS121","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470309-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770055","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS241","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770055-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770055","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS241","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770055-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470309","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS121","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470309-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470310","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS131","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470310-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770056","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS251","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770056-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770056","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS251","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770056-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470310","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS131","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470310-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470311","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS141","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470311-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770056","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS251","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770056-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770056","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS251","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770056-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470311","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS141","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470311-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470312","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS151","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470312-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770057","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS261","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770057-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470312","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS151","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470312-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470313","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS161","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470313-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770057","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS261","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770057-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770057","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS261","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770057-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470319","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS221","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470319-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770060","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS031","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770060-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770064","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS071","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770064-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770065","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS081","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770065-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470313","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS161","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470313-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470314","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS171","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470314-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770058","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS011","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770058-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770058","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS011","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770058-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470314","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS171","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470314-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470315","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS181","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470315-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770058","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS011","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770058-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470315","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS181","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470315-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430005","Blue Choice Bronze PPO?  005","33602TX043",,"TXN012","TXS002","TXF012","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0430005-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","$12,900","$12900 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group","20%","$5,000","$5000 per person","$12700 per group","20%","$10,000","$10000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0430005-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770068","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS111","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770068-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770068","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS111","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770068-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770068","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS111","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770068-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770068","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS111","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770068-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770069","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS121","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770069-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770069","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS121","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770069-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470316","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS191","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470316-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770059","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS021","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770059-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770059","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS021","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770059-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470316","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS191","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470316-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470317","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS201","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470317-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770059","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS021","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770059-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770059","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS021","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770059-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470317","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS201","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470317-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470318","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS211","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470318-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770060","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS031","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770060-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770060","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS031","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770060-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470318","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS211","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470318-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","Individual","No","36-1236610","33602TX0770060","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS031","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770060-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470319","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS221","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470319-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470320","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS231","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470320-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","36"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470320","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS231","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470320-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","37"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470321","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS241","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470321-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","38"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470321","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS241","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470321-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","39"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470322","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS251","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470322-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","40"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470322","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS251","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470322-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","41"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470323","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS261","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470323-00","Standard Gold Off Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","42"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470323","Blue Advantage Gold HMO?  015","33602TX047",,"TXN011","TXS261","TXF015","Existing","HMO","Gold","No","Both","No","Yes","All",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_3T_EX.pdf","33602TX0470323-01","Standard Gold On Exchange Plan",,"0.7850341796875","No","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","$3,125","$3125 per person","$9375 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,125","$3125 per person","$9375 per group","0%","$3,125","$3125 per person","$9375 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0470015-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","43"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430005","Blue Choice Bronze PPO?  005","33602TX043",,"TXN012","TXS002","TXF012","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0430005-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","$12,900","$12900 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group","20%","$5,000","$5000 per person","$12700 per group","20%","$10,000","$10000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0430005-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770061","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS041","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770061-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770061","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS041","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770061-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430006","Blue Choice Bronze PPO?  006","33602TX043",,"TXN012","TXS002","TXF005","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0430006-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0430006-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770061","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS041","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770061-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770061","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS041","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770061-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430006","Blue Choice Bronze PPO?  006","33602TX043",,"TXN012","TXS002","TXF005","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0430006-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbstx.com/PDF/sbc/33602TX0430006-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770062","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS051","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770062-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770062","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS051","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770062-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770062","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS051","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770062-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770062","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS051","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770062-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770063","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS061","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770063-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770063","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS061","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770063-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770063","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS061","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770063-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770063","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS061","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770063-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770064","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS071","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770064-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770064","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS071","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770064-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770064","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS071","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770064-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770065","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS081","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770065-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770065","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS081","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770065-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770065","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS081","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770065-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770066","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS091","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770066-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770079","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS221","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770079-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770079","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS221","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770079-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770080","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS231","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770080-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770080","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS231","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770080-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770066","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS091","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770066-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770066","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS091","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770066-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770066","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS091","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770066-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770067","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS101","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770067-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770067","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS101","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770067-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770067","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS101","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770067-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","12","33602","TX","Individual","No","36-1236610","33602TX0770067","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS101","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770067-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770069","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS121","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770069-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770083","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS261","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770083-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770083","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS261","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770083-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770083","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS261","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770083-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770084","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS011","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770084-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770084","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS011","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770084-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770084","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS011","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770084-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770084","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS011","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770084-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770069","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS121","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770069-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770070","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS131","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770070-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770070","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS131","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770070-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770070","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS131","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770070-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770070","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS131","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770070-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770071","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS141","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770071-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770071","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS141","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770071-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770071","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS141","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770071-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770071","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS141","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770071-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770072","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS151","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770072-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770072","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS151","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770072-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770072","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS151","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770072-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770072","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS151","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770072-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770073","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS161","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770073-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770073","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS161","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770073-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770073","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS161","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770073-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770073","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS161","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770073-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770074","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS171","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770074-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770074","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS171","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770074-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770074","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS171","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770074-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770074","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS171","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770074-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770075","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS181","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770075-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770075","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS181","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770075-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770075","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS181","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770075-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770075","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS181","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770075-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770076","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS191","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770076-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770076","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS191","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770076-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770076","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS191","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770076-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","13","33602","TX","Individual","No","36-1236610","33602TX0770076","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS191","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770076-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","14","33602","TX","Individual","No","36-1236610","33602TX0770077","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS201","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770077-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","14","33602","TX","Individual","No","36-1236610","33602TX0770077","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS201","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770077-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","14","33602","TX","Individual","No","36-1236610","33602TX0770077","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS201","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770077-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","14","33602","TX","Individual","No","36-1236610","33602TX0770077","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS201","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770077-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","14","33602","TX","Individual","No","36-1236610","33602TX0770078","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS211","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770078-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","14","33602","TX","Individual","No","36-1236610","33602TX0770078","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS211","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770078-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","14","33602","TX","Individual","No","36-1236610","33602TX0770078","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS211","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770078-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","14","33602","TX","Individual","No","36-1236610","33602TX0770078","Blue Advantage Plus Bronze? 103 - One $0 PCP Visit","33602TX077",,"TXN001","TXS211","TXF004","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770078-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770079","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS221","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770079-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770079","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS221","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770079-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770080","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS231","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770080-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770080","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS231","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770080-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770081","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS241","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770081-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770081","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS241","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770081-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770081","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS241","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770081-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770095","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS121","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770095-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770095","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS121","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770095-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770096","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS131","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770096-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770081","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS241","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770081-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770082","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS251","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770082-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770082","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS251","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770082-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770082","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS251","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770082-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770082","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS251","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770082-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770083","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS261","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770083-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770085","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS021","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770085-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770085","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS021","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770085-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770099","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS161","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770099-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770099","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS161","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770099-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770099","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS161","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770099-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770099","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS161","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770099-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770100","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS171","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770100-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770100","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS171","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770100-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770085","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS021","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770085-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770085","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS021","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770085-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770086","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS031","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770086-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770086","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS031","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770086-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770086","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS031","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770086-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","15","33602","TX","Individual","No","36-1236610","33602TX0770086","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS031","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770086-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770087","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS041","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770087-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770087","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS041","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770087-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770087","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS041","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770087-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770087","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS041","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770087-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770088","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS051","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770088-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770088","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS051","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770088-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770088","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS051","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770088-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770088","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS051","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770088-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770089","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS061","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770089-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770089","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS061","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770089-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770089","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS061","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770089-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770089","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS061","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770089-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770090","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS071","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770090-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770090","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS071","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770090-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770090","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS071","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770090-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770090","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS071","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770090-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770091","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS081","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770091-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770091","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS081","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770091-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770091","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS081","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770091-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770091","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS081","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770091-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770092","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS091","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770092-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770092","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS091","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770092-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770092","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS091","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770092-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770092","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS091","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770092-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770093","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS101","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770093-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770093","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS101","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770093-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770093","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS101","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770093-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770093","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS101","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770093-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770094","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS111","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770094-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770094","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS111","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770094-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770094","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS111","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770094-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","16","33602","TX","Individual","No","36-1236610","33602TX0770094","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS111","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770094-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770095","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS121","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770095-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770095","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS121","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770095-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770096","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS131","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770096-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770096","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS131","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770096-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770096","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS131","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770096-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770097","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS141","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770097-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770097","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS141","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770097-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770097","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS141","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770097-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770011","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS041","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770011","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS041","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770011-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770097","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS141","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770097-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770098","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS151","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770098-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770098","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS151","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770098-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770098","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS151","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770098-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770098","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS151","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770098-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770100","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS171","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770100-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770100","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS171","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770100-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770101","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS181","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770101-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770014","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS071","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770014-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770015","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS081","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770015-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770015","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS081","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770015-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770015","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS081","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770015","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS081","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770015-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770101","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS181","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770101-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770101","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS181","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770101-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770101","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS181","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770101-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770102","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS191","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770102-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770102","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS191","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770102-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770102","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS191","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770102-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","17","33602","TX","Individual","No","36-1236610","33602TX0770102","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS191","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770102-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770001","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS221","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770001-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770001","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS221","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770001-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770001","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS221","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770001","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS221","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770001-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770004","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS231","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770004-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770004","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS231","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770004-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770004","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS231","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770004","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS231","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770004-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770005","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS241","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770005-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770005","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS241","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770005-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770005","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS241","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770005","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS241","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770005-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770006","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS251","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770006-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770006","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS251","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770006-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770006","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS251","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770006","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS251","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770006-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770007","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS261","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770007-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770007","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS261","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770007-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770007","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS261","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770007","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS261","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770007-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770008","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS011","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770008-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770008","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS011","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770008-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770008","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS011","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","18","33602","TX","Individual","No","36-1236610","33602TX0770008","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS011","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770008-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770009","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS021","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770009-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770009","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS021","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770009-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770009","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS021","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770009","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS021","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770009-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770010","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS031","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770010-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770010","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS031","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770010-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770010","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS031","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770010","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS031","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770010-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770011","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS041","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770011-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770011","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS041","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770011-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770012","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS051","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770012-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770012","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS051","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770012-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770012","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS051","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770012","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS051","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770012-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770013","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS061","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770013-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770013","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS061","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770013-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770013","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS061","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","21","33602","TX","Individual","No","36-1236610","33602TX0770027","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS201","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770027-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770013","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS061","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770013-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770014","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS071","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770014-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770014","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS071","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770014-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770014","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS071","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770014-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770016","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS091","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770016-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770016","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS091","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770016-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770016","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS091","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770016-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","19","33602","TX","Individual","No","36-1236610","33602TX0770016","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS091","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770016-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770002","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS221","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770002-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770029","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS231","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770029-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770029","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS231","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770029-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770029","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS231","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770029-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770017","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS101","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770017-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770017","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS101","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770017-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770017","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS101","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770017-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770017","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS101","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770017-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770018","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS111","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770018-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770018","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS111","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770018-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770018","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS111","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770018-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770018","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS111","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770018-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770019","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS121","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770019-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770019","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS121","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770019-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770019","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS121","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770019-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770019","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS121","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770019-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770020","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS131","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770020-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770020","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS131","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770020-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770020","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS131","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770020-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770020","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS131","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770020-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770021","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS141","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770021-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770021","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS141","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770021-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770021","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS141","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770021-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770021","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS141","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770021-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770022","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS151","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770022-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770022","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS151","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770022-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770022","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS151","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770022-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770022","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS151","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770022-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770023","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS161","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770023-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770023","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS161","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770023-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770023","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS161","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770023-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770023","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS161","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770023-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770024","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS171","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770024-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770024","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS171","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770024-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770024","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS171","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770024-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","20","33602","TX","Individual","No","36-1236610","33602TX0770024","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS171","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770024-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","21","33602","TX","Individual","No","36-1236610","33602TX0770025","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS181","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770025-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","21","33602","TX","Individual","No","36-1236610","33602TX0770025","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS181","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770025-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","21","33602","TX","Individual","No","36-1236610","33602TX0770025","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS181","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770025-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","21","33602","TX","Individual","No","36-1236610","33602TX0770025","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS181","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770025-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","21","33602","TX","Individual","No","36-1236610","33602TX0770026","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS191","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770026-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","21","33602","TX","Individual","No","36-1236610","33602TX0770026","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS191","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770026-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","21","33602","TX","Individual","No","36-1236610","33602TX0770026","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS191","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770026-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","21","33602","TX","Individual","No","36-1236610","33602TX0770026","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS191","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770026-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","21","33602","TX","Individual","No","36-1236610","33602TX0770027","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS201","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770027-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","21","33602","TX","Individual","No","36-1236610","33602TX0770027","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS201","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770027-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","21","33602","TX","Individual","No","36-1236610","33602TX0770027","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS201","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770027-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","21","33602","TX","Individual","No","36-1236610","33602TX0770028","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS211","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770028-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","21","33602","TX","Individual","No","36-1236610","33602TX0770028","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS211","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770028-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","21","33602","TX","Individual","No","36-1236610","33602TX0770028","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS211","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770028-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","21","33602","TX","Individual","No","36-1236610","33602TX0770028","Blue Advantage Plus Gold? 101","33602TX077",,"TXN001","TXS211","TXF020","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770028-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$3,000","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$8250 per group","20%","$2,750","$2750 per person","$8250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770002","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS221","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770002-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770002","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS221","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770002-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770002","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS221","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770002","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS221","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770002-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770002","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS221","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770002-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770002","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS221","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770002-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770029","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS231","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770029-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770029","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS231","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770029-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770029","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS231","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770029-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770029","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS231","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770029-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770030","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS241","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770030-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770038","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS061","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770038-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770039","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS071","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770039-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770039","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS071","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770039-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770030","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS241","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770030-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770030","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS241","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770030-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770030","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS241","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770030-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770030","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS241","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770030-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770030","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS241","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770030-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770030","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS241","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770030-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770031","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS251","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770031-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770031","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS251","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770031-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770031","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS251","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770031-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770031","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS251","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770031-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770031","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS251","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770031-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770031","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS251","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770031-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770031","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS251","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770031-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770032","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS261","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770032-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770032","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS261","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770032-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770032","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS261","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770032-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770032","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS261","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770032-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770032","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS261","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770032-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","36"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770032","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS261","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770032-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","37"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770032","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS261","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770032-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","38"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770033","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS011","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770033-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","39"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770033","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS011","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770033-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","40"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770033","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS011","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770033-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","41"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770033","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS011","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770033-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","42"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770033","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS011","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770033-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","43"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770033","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS011","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770033-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","44"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770033","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS011","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770033-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","45"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770034","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS021","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770034-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","46"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770034","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS021","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770034-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","47"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770034","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS021","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770034-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","48"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770034","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS021","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770034-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","49"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770034","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS021","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770034-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","50"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770034","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS021","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770034-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","51"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","22","33602","TX","Individual","No","36-1236610","33602TX0770034","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS021","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770034-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","52"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770036","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS041","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770036-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770036","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS041","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770036-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770036","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS041","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770036-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770036","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS041","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770036-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770036","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS041","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770036-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770036","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS041","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770036-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770036","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS041","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770036-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770037","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS051","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770037-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770037","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS051","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770037-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770037","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS051","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770037-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770037","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS051","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770037-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770037","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS051","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770037-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770037","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS051","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770037-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770037","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS051","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770037-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770038","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS061","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770038-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770038","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS061","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770038-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770038","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS061","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770038-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770038","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS061","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770038-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770047","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS151","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770047-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770047","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS151","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770047-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770047","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS151","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770047-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770047","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS151","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770047-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770048","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS161","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770048-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770048","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS161","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770048-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770048","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS161","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770048-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770038","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS061","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770038-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770038","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS061","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770038-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770039","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS071","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770039-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770039","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS071","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770039-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770039","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS071","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770039-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770039","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS071","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770039-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770039","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS071","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770039-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770040","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS081","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770040-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770048","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS161","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770048-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","38"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770049","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS171","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770049-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","39"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770040","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS081","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770040-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770040","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS081","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770040-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770040","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS081","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770040-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770040","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS081","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770040-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","36"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770040","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS081","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770040-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","37"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770040","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS081","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770040-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","38"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770041","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS091","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770041-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","39"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770041","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS091","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770041-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","40"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770041","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS091","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770041-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","41"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770041","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS091","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770041-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","42"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770041","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS091","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770041-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","43"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770041","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS091","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770041-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","44"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770041","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS091","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770041-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","45"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770042","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS101","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770042-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","46"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770042","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS101","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770042-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","47"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770042","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS101","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770042-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","48"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770042","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS101","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770042-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","49"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770042","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS101","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770042-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","50"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770042","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS101","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770042-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","51"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","23","33602","TX","Individual","No","36-1236610","33602TX0770042","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS101","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770042-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","52"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770044","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS121","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770044-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770044","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS121","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770044-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770044","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS121","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770044-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770044","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS121","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770044-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770044","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS121","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770044-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770044","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS121","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770044-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770044","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS121","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770044-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770045","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS131","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770045-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770045","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS131","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770045-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770045","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS131","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770045-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770045","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS131","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770045-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770045","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS131","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770045-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770045","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS131","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770045-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770045","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS131","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770045-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770046","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS141","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770046-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770046","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS141","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770046-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770046","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS141","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770046-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770046","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS141","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770046-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770046","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS141","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770046-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770046","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS141","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770046-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770046","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS141","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770046-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770047","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS151","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770047-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770047","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS151","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770047-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770047","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS151","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770047-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770048","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS161","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770048-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770048","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS161","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770048-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","36"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460394","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS241","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460394-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460394","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS241","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460394-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460395","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS251","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460395-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460395","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS251","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460395-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460396","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS261","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460396-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460396","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS261","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460396-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770048","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS161","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770048-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","37"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770049","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS171","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770049-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","40"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770049","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS171","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770049-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","41"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770049","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS171","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770049-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","42"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770049","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS171","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770049-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","43"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770049","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS171","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770049-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","44"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770049","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS171","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770049-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","45"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770050","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS181","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770050-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","46"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460398","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS021","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460398-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770050","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS181","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770050-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","47"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770050","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS181","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770050-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","48"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770050","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS181","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770050-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","49"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770050","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS181","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770050-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","50"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770050","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS181","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770050-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","51"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","24","33602","TX","Individual","No","36-1236610","33602TX0770050","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS181","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770050-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","52"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770052","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS201","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770052-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770052","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS201","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770052-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770052","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS201","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770052-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770052","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS201","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770052-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770052","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS201","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770052-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770052","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS201","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770052-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770052","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS201","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770052-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770053","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS211","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770053-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770053","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS211","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770053-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770053","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS211","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770053-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770053","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS211","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770053-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770053","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS211","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770053-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770053","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS211","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770053-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770053","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS211","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770053-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770043","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS111","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770043-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770043","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS111","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770043-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770043","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS111","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770043-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770043","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS111","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770043-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770043","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS111","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770043-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770043","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS111","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770043-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770043","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS111","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770043-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770035","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS031","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770035-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770035","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS031","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770035-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770035","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS031","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770035-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770035","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS031","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770035-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770035","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS031","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770035-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770035","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS031","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770035-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770035","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS031","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770035-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770051","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS191","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770051-00","Standard Silver Off Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770051","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS191","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770051-01","Standard Silver On Exchange Plan","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770051","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS191","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770051-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770051","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS191","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770051-03","Limited Cost Sharing Plan Variation","69.88%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770051","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS191","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770051-04","73% AV Level Silver Plan","72.98%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","36"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770051","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS191","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770051-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","37"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","25","33602","TX","Individual","No","36-1236610","33602TX0770051","Blue Advantage Plus Silver? 102 - Three $0 PCP Visits","33602TX077",,"TXN001","TXS191","TXF020","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770051-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","38"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460242","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS221","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460242-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460242","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS221","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460242-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460393","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS231","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460393-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460393","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS231","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460393-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460397","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS011","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460397-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460397","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS011","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460397-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460398","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS021","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460398-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460294","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS241","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460294-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460294","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS241","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460294-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460294","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS241","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460294-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460294","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS241","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460294-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460294","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS241","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460294-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460399","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS031","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460399-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460399","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS031","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460399-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460400","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS041","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460400-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460400","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS041","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460400-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460401","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS051","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460401-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460401","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS051","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460401-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460402","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS061","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460402-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460402","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS061","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460402-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460403","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS071","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460403-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","26","33602","TX","Individual","No","36-1236610","33602TX0460403","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS071","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460403-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460404","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS081","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460404-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460404","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS081","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460404-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460405","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS091","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460405-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460405","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS091","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460405-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460406","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS101","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460406-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460406","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS101","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460406-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460407","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS111","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460407-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460407","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS111","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460407-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460408","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS121","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460408-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460408","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS121","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460408-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460409","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS131","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460409-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460409","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS131","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460409-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460410","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS141","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460410-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460410","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS141","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460410-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460411","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS151","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460411-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460411","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS151","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460411-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460412","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS161","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460412-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460412","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS161","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460412-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460413","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS171","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460413-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460413","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS171","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460413-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460414","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS181","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460414-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460414","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS181","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460414-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460415","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS191","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460415-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460415","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS191","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460415-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460416","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS201","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460416-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460416","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS201","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460416-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460417","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS211","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460417-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","27","33602","TX","Individual","No","36-1236610","33602TX0460417","Blue Advantage Security HMO?  100","33602TX046",,"TXN001","TXS211","TXF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460417-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460242-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460238","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS221","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460238-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460238","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS221","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460238-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460238","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS221","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460238-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460238","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS221","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460238-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460238","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS221","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460238-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460238","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS221","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460238-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460238","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS221","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460238-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460293","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS231","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460293-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460293","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS231","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460293-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460293","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS231","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460293-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460293","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS231","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460293-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460293","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS231","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460293-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460293","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS231","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460293-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460293","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS231","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460293-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460294","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS241","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460294-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460294","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS241","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460294-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460295","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS251","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460295-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460295","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS251","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460295-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460295","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS251","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460295-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460295","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS251","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460295-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460303","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS071","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460303-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460303","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS071","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460303-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460303","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS071","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460303-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460303","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS071","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460303-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460295","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS251","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460295-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460295","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS251","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460295-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460295","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS251","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460295-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460296","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS261","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460296-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460296","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS261","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460296-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460296","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS261","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460296-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460296","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS261","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460296-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460296","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS261","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460296-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","36"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460305","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS091","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460305-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","42"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460305","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS091","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460305-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","43"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460305","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS091","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460305-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","44"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460305","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS091","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460305-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","45"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460306","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS101","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460306-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","46"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460306","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS101","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460306-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","47"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460306","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS101","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460306-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","48"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460296","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS261","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460296-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","37"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460296","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS261","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460296-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","38"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460297","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS011","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460297-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","39"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460297","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS011","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460297-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","40"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460297","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS011","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460297-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","41"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460297","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS011","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460297-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","42"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460297","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS011","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460297-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","43"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460297","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS011","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460297-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","44"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460297","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS011","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460297-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","45"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460298","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS021","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460298-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","46"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460298","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS021","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460298-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","47"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460298","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS021","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460298-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","48"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460298","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS021","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460298-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","49"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460298","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS021","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460298-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","50"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460298","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS021","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460298-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","51"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","28","33602","TX","Individual","No","36-1236610","33602TX0460298","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS021","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460298-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","52"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460300","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS041","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460300-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460300","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS041","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460300-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460300","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS041","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460300-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460300","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS041","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460300-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460300","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS041","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460300-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460300","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS041","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460300-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460300","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS041","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460300-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460301","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS051","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460301-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460301","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS051","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460301-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460301","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS051","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460301-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460301","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS051","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460301-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460301","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS051","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460301-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460301","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS051","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460301-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460301","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS051","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460301-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460302","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS061","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460302-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460302","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS061","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460302-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460302","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS061","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460302-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460302","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS061","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460302-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460302","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS061","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460302-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460302","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS061","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460302-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460302","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS061","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460302-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460303","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS071","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460303-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460303","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS071","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460303-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460303","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS071","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460303-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460304","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS081","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460304-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460304","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS081","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460304-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460304","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS081","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460304-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460304","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS081","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460304-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460313","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS171","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460313-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","42"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460313","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS171","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460313-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","43"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460313","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS171","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460313-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","44"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460304","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS081","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460304-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","36"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460304","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS081","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460304-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","37"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460304","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS081","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460304-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","38"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460305","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS091","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460305-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","39"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460305","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS091","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460305-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","40"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460305","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS091","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460305-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","41"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460306","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS101","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460306-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","49"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460306","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS101","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460306-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","50"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","31","33602","TX","Individual","No","36-1236610","33602TX0460316","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS201","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460316-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","31","33602","TX","Individual","No","36-1236610","33602TX0460316","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS201","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460316-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","31","33602","TX","Individual","No","36-1236610","33602TX0460316","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS201","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460316-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","31","33602","TX","Individual","No","36-1236610","33602TX0460316","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS201","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460316-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","31","33602","TX","Individual","No","36-1236610","33602TX0460317","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS211","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460317-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","31","33602","TX","Individual","No","36-1236610","33602TX0460317","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS211","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460317-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460306","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS101","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460306-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","51"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","29","33602","TX","Individual","No","36-1236610","33602TX0460306","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS101","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460306-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","52"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460308","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS121","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460308-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460308","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS121","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460308-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460308","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS121","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460308-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460308","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS121","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460308-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460308","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS121","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460308-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460308","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS121","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460308-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460308","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS121","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460308-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460309","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS131","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460309-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460309","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS131","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460309-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460309","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS131","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460309-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460309","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS131","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460309-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460309","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS131","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460309-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460309","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS131","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460309-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460309","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS131","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460309-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460310","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS141","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460310-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460310","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS141","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460310-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460310","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS141","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460310-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460310","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS141","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460310-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460310","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS141","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460310-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460310","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS141","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460310-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460310","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS141","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460310-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460311","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS151","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460311-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460311","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS151","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460311-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460311","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS151","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460311-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460311","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS151","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460311-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460311","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS151","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460311-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460311","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS151","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460311-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460311","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS151","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460311-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460312","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS161","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460312-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460312","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS161","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460312-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460312","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS161","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460312-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460312","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS161","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460312-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460312","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS161","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460312-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","36"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460312","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS161","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460312-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","37"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460312","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS161","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460312-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","38"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460313","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS171","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460313-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","39"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460313","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS171","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460313-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","40"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460313","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS171","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460313-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","41"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460313","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS171","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460313-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","45"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460314","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS181","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460314-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","46"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460314","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS181","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460314-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","47"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460314","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS181","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460314-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","48"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460314","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS181","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460314-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","49"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460314","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS181","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460314-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","50"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460324","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS031","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460324-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460324","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS031","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460324-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460314","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS181","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460314-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","51"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","30","33602","TX","Individual","No","36-1236610","33602TX0460314","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS181","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460314-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","52"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","31","33602","TX","Individual","No","36-1236610","33602TX0460316","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS201","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460316-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","31","33602","TX","Individual","No","36-1236610","33602TX0460316","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS201","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460316-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","31","33602","TX","Individual","No","36-1236610","33602TX0460316","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS201","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460316-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","31","33602","TX","Individual","No","36-1236610","33602TX0460317","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS211","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460317-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","31","33602","TX","Individual","No","36-1236610","33602TX0460317","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS211","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460317-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","31","33602","TX","Individual","No","36-1236610","33602TX0460317","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS211","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460317-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460331","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS101","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460331-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460331","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS101","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460331-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460331","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS101","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460331-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460331","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS101","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460331-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460332","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS111","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460332-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","31","33602","TX","Individual","No","36-1236610","33602TX0460317","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS211","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460317-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","31","33602","TX","Individual","No","36-1236610","33602TX0460317","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS211","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460317-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460323","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS021","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460323-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460323","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS021","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460323-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460323","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS021","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460323-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460323","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS021","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460323-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460323","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS021","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460323-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460323","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS021","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460323-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460323","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS021","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460323-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460324","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS031","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460324-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460324","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS031","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460324-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460324","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS031","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460324-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460324","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS031","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460324-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460324","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS031","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460324-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460325","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS041","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460325-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460325","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS041","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460325-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460325","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS041","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460325-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460325","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS041","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460325-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460325","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS041","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460325-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460325","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS041","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460325-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460325","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS041","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460325-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460329","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS081","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460329-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","52"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460326","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS051","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460326-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460326","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS051","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460326-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460326","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS051","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460326-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460326","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS051","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460326-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460326","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS051","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460326-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460326","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS051","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460326-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460326","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS051","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460326-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460327","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS061","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460327-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460327","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS061","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460327-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460327","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS061","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460327-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460327","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS061","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460327-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460327","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS061","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460327-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","36"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460327","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS061","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460327-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","37"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460327","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS061","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460327-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","38"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460328","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS071","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460328-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","39"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460328","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS071","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460328-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","40"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460328","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS071","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460328-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","41"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460328","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS071","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460328-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","42"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460328","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS071","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460328-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","43"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460328","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS071","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460328-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","44"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460328","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS071","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460328-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","45"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460329","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS081","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460329-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","46"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460329","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS081","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460329-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","47"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460329","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS081","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460329-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","48"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460329","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS081","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460329-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","49"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460329","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS081","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460329-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","50"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","32","33602","TX","Individual","No","36-1236610","33602TX0460329","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS081","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460329-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","51"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460331","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS101","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460331-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460331","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS101","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460331-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460331","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS101","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460331-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460332","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS111","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460332-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460332","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS111","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460332-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460332","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS111","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460332-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460332","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS111","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460332-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460341","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS201","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460341-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460341","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS201","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460341-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460341","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS201","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460341-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460341","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS201","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460341-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460332","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS111","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460332-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460332","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS111","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460332-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460333","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS121","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460333-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460333","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS121","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460333-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460333","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS121","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460333-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460333","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS121","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460333-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460333","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS121","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460333-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460333","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS121","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460333-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460333","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS121","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460333-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460334","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS131","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460334-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460334","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS131","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460334-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460334","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS131","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460334-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460334","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS131","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460334-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460334","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS131","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460334-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460334","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS131","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460334-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460334","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS131","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460334-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460335","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS141","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460335-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460335","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS141","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460335-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460335","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS141","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460335-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460335","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS141","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460335-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460335","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS141","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460335-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","36"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460335","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS141","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460335-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","37"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460335","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS141","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460335-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","38"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460336","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS151","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460336-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","39"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460336","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS151","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460336-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","40"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460336","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS151","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460336-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","41"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460336","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS151","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460336-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","42"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460336","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS151","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460336-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","43"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460336","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS151","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460336-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","44"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460336","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS151","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460336-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","45"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460337","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS161","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460337-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","46"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460337","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS161","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460337-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","47"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460337","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS161","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460337-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","48"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460337","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS161","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460337-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","49"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460337","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS161","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460337-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","50"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460337","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS161","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460337-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","51"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","33","33602","TX","Individual","No","36-1236610","33602TX0460337","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS161","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460337-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","52"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460339","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS181","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460339-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460339","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS181","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460339-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460339","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS181","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460339-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460339","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS181","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460339-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460339","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS181","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460339-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460339","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS181","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460339-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460339","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS181","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460339-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460340","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS191","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460340-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460340","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS191","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460340-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460340","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS191","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460340-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460340","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS191","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460340-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460340","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS191","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460340-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460340","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS191","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460340-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460340","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS191","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460340-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460341","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS201","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460341-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460338","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS171","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460338-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","47"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460338","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS171","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460338-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","48"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460338","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS171","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460338-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","49"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460338","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS171","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460338-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","50"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460338","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS171","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460338-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","51"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460338","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS171","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460338-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","52"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460239","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS221","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460239-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460341","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS201","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460341-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460341","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS201","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460341-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460342","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS211","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460342-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460342","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS211","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460342-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460342","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS211","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460342-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460342","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS211","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460342-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460342","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS211","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460342-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460321","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS261","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460321-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460321","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS261","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460321-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","36"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460321","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS261","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460321-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","37"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460342","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS211","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460342-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460342","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS211","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460342-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460322","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS011","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460322-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460322","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS011","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460322-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460322","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS011","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460322-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460322","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS011","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460322-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460322","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS011","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460322-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","36"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460322","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS011","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460322-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","37"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460322","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS011","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460322-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","38"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460330","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS091","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460330-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","39"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460330","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS091","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460330-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","40"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460330","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS091","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460330-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","41"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460330","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS091","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460330-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","42"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460330","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS091","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460330-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","43"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460330","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS091","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460330-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","44"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460330","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS091","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460330-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","45"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","34","33602","TX","Individual","No","36-1236610","33602TX0460338","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS171","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460338-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","46"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460239","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS221","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460239-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460321","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS261","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460321-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","38","33602","TX","Individual","No","36-1236610","33602TX0460315","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS191","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460315-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","38","33602","TX","Individual","No","36-1236610","33602TX0460315","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS191","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460315-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","1","37392","TX","Individual","No","80-0959546","37392TX0010001","Bronze 5","37392TX001",,"TXN001","TXS001","TXF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","2","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010001-00","Standard Bronze Off Exchange Plan",,"0.595756471157074","No","Yes","No","100%",,"$6,400","$400","$0","$200","$5,100","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXB5T_1575.pdf","http://prominencehealthplan.com/wp-content/uploads/2015/10/TX16_IFP_Bronze5.pdf","4"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","1","37392","TX","Individual","No","80-0959546","37392TX0010001","Bronze 5","37392TX001",,"TXN001","TXS001","TXF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","2","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010001-01","Standard Bronze On Exchange Plan",,"0.595756471157074","No","Yes","No","100%",,"$6,400","$400","$0","$200","$5,100","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXB5T_1575.pdf","http://prominencehealthplan.com/wp-content/uploads/2015/10/TX16_IFP_Bronze5.pdf","5"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","1","37392","TX","Individual","No","80-0959546","37392TX0010001","Bronze 5","37392TX001",,"TXN001","TXS001","TXF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","2","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXAIT_000-1.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/01/6XHEXAIT.pdf","6"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","1","37392","TX","Individual","No","80-0959546","37392TX0010001","Bronze 5","37392TX001",,"TXN001","TXS001","TXF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","2","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010001-03","Limited Cost Sharing Plan Variation",,"0.595756471157074","No","Yes","No","100%",,"$6,400","$400","$0","$200","$5,100","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXB5T_1575.pdf","http://prominencehealthplan.com/wp-content/uploads/2015/10/TX16_IFP_Bronze5.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460239","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS221","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460239-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460239","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS221","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460239-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460239","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS221","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460239-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460239","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS221","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460239-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460239","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS221","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460239-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460318","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS231","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460318-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460318","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS231","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460318-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460318","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS231","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460318-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460318","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS231","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460318-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460318","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS231","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460318-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460318","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS231","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460318-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460318","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS231","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460318-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460319","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS241","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460319-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460319","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS241","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460319-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460319","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS241","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460319-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460319","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS241","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460319-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460319","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS241","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460319-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460319","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS241","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460319-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460319","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS241","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460319-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460320","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS251","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460320-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460320","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS251","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460320-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460320","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS251","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460320-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460320","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS251","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460320-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460320","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS251","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460320-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,200","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460320","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS251","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460320-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460320","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS251","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460320-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460321","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS261","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460321-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460321","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS261","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460321-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","35","33602","TX","Individual","No","36-1236610","33602TX0460321","Blue Advantage Silver HMO?  103","33602TX046",,"TXN001","TXS261","TXF001","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460321-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460239-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","38"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","36","33602","TX","Individual","No","36-1236610","33602TX0770103","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS201","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770103-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","36","33602","TX","Individual","No","36-1236610","33602TX0770103","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS201","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770103-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","36","33602","TX","Individual","No","36-1236610","33602TX0770103","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS201","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770103-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","36","33602","TX","Individual","No","36-1236610","33602TX0770103","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS201","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770103-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","36","33602","TX","Individual","No","36-1236610","33602TX0770104","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS211","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770104-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","2","37392","TX","Individual","No","80-0959546","37392TX0010002","Bronze 6","37392TX001",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","2","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010002-03","Limited Cost Sharing Plan Variation",,"0.609237790107727","No","Yes","No","100%",,"$6,400","$500","$0","$200","$5,300","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXB6T_20100.pdf","http://prominencehealthplan.com/wp-content/uploads/2015/10/TX16_IFP_Bronze6.pdf","7"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","3","37392","TX","Individual","No","80-0959546","37392TX0010003","Silver 10","37392TX001",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010003-00","Standard Silver Off Exchange Plan",,"0.692299067974091","No","Yes","No","100%",,"$0","$1,500","$0","$200","$0","$1,700","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXS10T_1555.pdf","http://prominencehealthplan.com/wp-content/uploads/2015/10/TX16_IFP_Silver10.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","36","33602","TX","Individual","No","36-1236610","33602TX0770104","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS211","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770104-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","36","33602","TX","Individual","No","36-1236610","33602TX0770104","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS211","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770104-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","36","33602","TX","Individual","No","36-1236610","33602TX0770104","Blue Advantage Plus Bronze? 104","33602TX077",,"TXN001","TXS211","TXF019","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0770104-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0770079-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460237","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS221","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460237-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460237","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS221","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460237-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460237","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS221","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460237-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460237","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS221","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460237-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460268","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS231","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460268-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460268","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS231","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460268-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460268","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS231","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460268-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460268","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS231","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460268-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460269","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS241","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460269-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460269","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS241","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460269-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460269","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS241","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460269-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460269","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS241","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460269-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460270","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS251","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460270-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460270","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS251","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460270-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460270","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS251","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460270-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460270","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS251","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460270-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460271","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS261","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460271-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460271","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS261","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460271-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460271","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS261","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460271-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460271","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS261","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460271-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460272","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS011","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460272-00","Standard Gold Off Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460272","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS011","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460272-01","Standard Gold On Exchange Plan","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460272","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS011","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460272-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","37","33602","TX","Individual","No","36-1236610","33602TX0460272","Blue Advantage Gold HMO?  101","33602TX046",,"TXN001","TXS011","TXF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460272-03","Limited Cost Sharing Plan Variation","78.51%","0","Yes","Yes","Yes","60%","40%","$800","$0","$1,900","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460237-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","38","33602","TX","Individual","No","36-1236610","33602TX0460299","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS031","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460299-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","38","33602","TX","Individual","No","36-1236610","33602TX0460299","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS031","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460299-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","38","33602","TX","Individual","No","36-1236610","33602TX0460299","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS031","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460299-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","38","33602","TX","Individual","No","36-1236610","33602TX0460299","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS031","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460299-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","38","33602","TX","Individual","No","36-1236610","33602TX0460299","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS031","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460299-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","38","33602","TX","Individual","No","36-1236610","33602TX0460299","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS031","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460299-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","38","33602","TX","Individual","No","36-1236610","33602TX0460299","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS031","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460299-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","38","33602","TX","Individual","No","36-1236610","33602TX0460307","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS111","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460307-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","38","33602","TX","Individual","No","36-1236610","33602TX0460307","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS111","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460307-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","38","33602","TX","Individual","No","36-1236610","33602TX0460307","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS111","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460307-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","38","33602","TX","Individual","No","36-1236610","33602TX0460307","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS111","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460307-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","38","33602","TX","Individual","No","36-1236610","33602TX0460307","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS111","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460307-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","38","33602","TX","Individual","No","36-1236610","33602TX0460307","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS111","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460307-05","87% AV Level Silver Plan","86.50%","0","Yes","Yes","Yes","60%","40%","$700","$0","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","38","33602","TX","Individual","No","36-1236610","33602TX0460307","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS111","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460307-06","94% AV Level Silver Plan","93.37%","0","Yes","Yes","Yes","60%","40%","$500","$0","$0","$200","$0","$60","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","38","33602","TX","Individual","No","36-1236610","33602TX0460315","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS191","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460315-00","Standard Silver Off Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-00.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","38","33602","TX","Individual","No","36-1236610","33602TX0460315","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS191","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460315-01","Standard Silver On Exchange Plan","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","38","33602","TX","Individual","No","36-1236610","33602TX0460315","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS191","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460315-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","38","33602","TX","Individual","No","36-1236610","33602TX0460315","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS191","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460315-03","Limited Cost Sharing Plan Variation","71.31%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","HIOS","9","2016-01-28 05:11:31","38","33602","TX","Individual","No","36-1236610","33602TX0460315","Blue Advantage Silver HMO?  102","33602TX046",,"TXN001","TXS191","TXF003","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0460315-04","73% AV Level Silver Plan","73.34%","0","Yes","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0460238-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","2","37392","TX","Individual","No","80-0959546","37392TX0010002","Bronze 6","37392TX001",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","2","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010002-00","Standard Bronze Off Exchange Plan",,"0.609237790107727","No","Yes","No","100%",,"$6,400","$500","$0","$200","$5,300","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXB6T_20100.pdf","http://prominencehealthplan.com/wp-content/uploads/2015/10/TX16_IFP_Bronze6.pdf","4"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","2","37392","TX","Individual","No","80-0959546","37392TX0010002","Bronze 6","37392TX001",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","2","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010002-01","Standard Bronze On Exchange Plan",,"0.609237790107727","No","Yes","No","100%",,"$6,400","$500","$0","$200","$5,300","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXB6T_20100.pdf","http://prominencehealthplan.com/wp-content/uploads/2015/10/TX16_IFP_Bronze6.pdf","5"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","2","37392","TX","Individual","No","80-0959546","37392TX0010002","Bronze 6","37392TX001",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","2","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXAIT_000-1.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/01/6XHEXAIT.pdf","6"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","3","37392","TX","Individual","No","80-0959546","37392TX0010003","Silver 10","37392TX001",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010003-01","Standard Silver On Exchange Plan",,"0.692299067974091","No","Yes","No","100%",,"$0","$1,500","$0","$200","$0","$1,700","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXS10T_1555.pdf","http://prominencehealthplan.com/wp-content/uploads/2015/10/TX16_IFP_Silver10.pdf","5"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","3","37392","TX","Individual","No","80-0959546","37392TX0010003","Silver 10","37392TX001",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXAIT_000-1.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/01/6XHEXAIT.pdf","6"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","3","37392","TX","Individual","No","80-0959546","37392TX0010003","Silver 10","37392TX001",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010003-03","Limited Cost Sharing Plan Variation",,"0.692299067974091","No","Yes","No","100%",,"$0","$1,500","$0","$200","$0","$1,700","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXS10T_1555.pdf","http://prominencehealthplan.com/wp-content/uploads/2015/10/TX16_IFP_Silver10.pdf","7"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","3","37392","TX","Individual","No","80-0959546","37392TX0010003","Silver 10","37392TX001",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010003-04","73% AV Level Silver Plan",,"0.734999418258667","No","Yes","No","100%",,"$0","$1,500","$0","$200","$0","$1,600","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXS11T_1555.pdf","http://prominencehealthplan.com/wp-content/uploads/2015/10/TX16_IFP_Silver11.pdf","8"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","3","37392","TX","Individual","No","80-0959546","37392TX0010003","Silver 10","37392TX001",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010003-05","87% AV Level Silver Plan",,"0.870700180530548","No","Yes","No","100%",,"$0","$900","$0","$200","$0","$1,200","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXS12T_1030.pdf","http://prominencehealthplan.com/wp-content/uploads/2015/10/TX16_IFP_Silver12.pdf","9"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","3","37392","TX","Individual","No","80-0959546","37392TX0010003","Silver 10","37392TX001",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010003-06","94% AV Level Silver Plan",,"0.93135529756546","No","Yes","No","100%",,"$0","$500","$0","$200","$0","$800","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","$375 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXS13T_515.pdf","http://prominencehealthplan.com/wp-content/uploads/2015/10/TX16_IFP_Silver13.pdf","10"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","4","37392","TX","Individual","No","80-0959546","37392TX0010005","Silver 50","37392TX001",,"TXN001","TXS001","TXF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010005-00","Standard Silver Off Exchange Plan",,"0.681947410106659","Yes","Yes","No","100%",,"$4,500","$300","$0","$200","$0","$1,700","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXS50T_1575.pdf","http://prominencehealthplan.com/wp-content/uploads/2015/10/TX16_IFP_Silver50.pdf","4"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","4","37392","TX","Individual","No","80-0959546","37392TX0010005","Silver 50","37392TX001",,"TXN001","TXS001","TXF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010005-01","Standard Silver On Exchange Plan",,"0.681947410106659","Yes","Yes","No","100%",,"$4,500","$300","$0","$200","$0","$1,700","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXS50T_1575.pdf","http://prominencehealthplan.com/wp-content/uploads/2015/10/TX16_IFP_Silver50.pdf","5"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","4","37392","TX","Individual","No","80-0959546","37392TX0010005","Silver 50","37392TX001",,"TXN001","TXS001","TXF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXAIT_000-1.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/01/6XHEXAIT.pdf","6"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","4","37392","TX","Individual","No","80-0959546","37392TX0010005","Silver 50","37392TX001",,"TXN001","TXS001","TXF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010005-03","Limited Cost Sharing Plan Variation",,"0.681947410106659","Yes","Yes","No","100%",,"$4,500","$300","$0","$200","$0","$1,700","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXS50T_1575.pdf","http://prominencehealthplan.com/wp-content/uploads/2015/10/TX16_IFP_Silver50.pdf","7"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","4","37392","TX","Individual","No","80-0959546","37392TX0010005","Silver 50","37392TX001",,"TXN001","TXS001","TXF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010005-04","73% AV Level Silver Plan",,"0.727858304977417","Yes","Yes","No","100%",,"$4,000","$300","$100","$200","$0","$1,600","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXS51T_1550.pdf","http://prominencehealthplan.com/wp-content/uploads/2015/10/TX16_IFP_Silver51.pdf","8"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","4","37392","TX","Individual","No","80-0959546","37392TX0010005","Silver 50","37392TX001",,"TXN001","TXS001","TXF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010005-05","87% AV Level Silver Plan",,"0.863746464252472","Yes","Yes","No","100%",,"$1,000","$300","$400","$200","$0","$1,000","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXS52T_520.pdf","http://prominencehealthplan.com/wp-content/uploads/2015/10/TX16_IFP_Silver52.pdf","9"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","4","37392","TX","Individual","No","80-0959546","37392TX0010005","Silver 50","37392TX001",,"TXN001","TXS001","TXF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010005-06","94% AV Level Silver Plan",,"0.938070297241211","Yes","Yes","No","100%",,"$400","$200","$100","$200","$0","$700","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXS53T_215.pdf","http://prominencehealthplan.com/wp-content/uploads/2015/10/TX16_IFP_Silver53.pdf","10"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","5","37392","TX","Individual","No","80-0959546","37392TX0010006","Gold 1","37392TX001",,"TXN001","TXS001","TXF006","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"2","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010006-00","Standard Gold Off Exchange Plan",,"0.802799224853516","No","Yes","No","100%",,"$0","$1,300","$0","$200","$0","$2,000","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXG1T_2550.pdf","http://prominencehealthplan.com/wp-content/uploads/2015/10/TX16_IFP_Gold1.pdf","4"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","5","37392","TX","Individual","No","80-0959546","37392TX0010006","Gold 1","37392TX001",,"TXN001","TXS001","TXF006","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"2","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010006-01","Standard Gold On Exchange Plan",,"0.802799224853516","No","Yes","No","100%",,"$0","$1,300","$0","$200","$0","$2,000","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXG1T_2550.pdf","http://prominencehealthplan.com/wp-content/uploads/2015/10/TX16_IFP_Gold1.pdf","5"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","5","37392","TX","Individual","No","80-0959546","37392TX0010006","Gold 1","37392TX001",,"TXN001","TXS001","TXF006","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"2","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXAIT_000-1.pdf","http://prominencehealthplan.com/wp-content/uploads/2016/01/6XHEXAIT.pdf","6"
"2016","TX","37392","HIOS","7","2016-03-31 08:23:43","5","37392","TX","Individual","No","80-0959546","37392TX0010006","Gold 1","37392TX001",,"TXN001","TXS001","TXF006","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"2","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","37392TX0010006-03","Limited Cost Sharing Plan Variation",,"0.802799224853516","No","Yes","No","100%",,"$0","$1,300","$0","$200","$0","$2,000","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/wp-content/uploads/2016/03/6XHEXG1T_2550.pdf","http://prominencehealthplan.com/wp-content/uploads/2015/10/TX16_IFP_Gold1.pdf","7"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","1","37755","TX","Individual","No","74-3092083","37755TX0020001","PPO 5000 HDHP","37755TX002",,"TXN001","TXS001","TXF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0020001-00","Standard Bronze Off Exchange Plan",,"0.615353941917419","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX002000100","https://swhp.org/acawelcome","4"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","1","37755","TX","Individual","No","74-3092083","37755TX0020001","PPO 5000 HDHP","37755TX002",,"TXN001","TXS001","TXF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0020001-01","Standard Bronze On Exchange Plan",,"0.615353941917419","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX002000101","https://swhp.org/acawelcome","5"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","1","37755","TX","Individual","No","74-3092083","37755TX0020001","PPO 5000 HDHP","37755TX002",,"TXN001","TXS001","TXF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0020001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX002000102","https://swhp.org/acawelcome","6"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","1","37755","TX","Individual","No","74-3092083","37755TX0020001","PPO 5000 HDHP","37755TX002",,"TXN001","TXS001","TXF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0020001-03","Limited Cost Sharing Plan Variation",,"0.615353941917419","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX002000103","https://swhp.org/acawelcome","7"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","1","37755","TX","Individual","No","74-3092083","37755TX0030002","PPO 2500","37755TX003",,"TXN001","TXS001","TXF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0030002-00","Standard Silver Off Exchange Plan",,"0.712100148200989","Yes","Yes","No","100%",,"$2,500","$0","$960","$150","$2,500","$0","$550","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX003000200","https://swhp.org/acawelcome","8"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","1","37755","TX","Individual","No","74-3092083","37755TX0030002","PPO 2500","37755TX003",,"TXN001","TXS001","TXF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0030002-01","Standard Silver On Exchange Plan",,"0.712100148200989","Yes","Yes","No","100%",,"$2,500","$0","$960","$150","$2,500","$0","$550","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX003000201","https://swhp.org/acawelcome","9"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","1","37755","TX","Individual","No","74-3092083","37755TX0030002","PPO 2500","37755TX003",,"TXN001","TXS001","TXF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0030002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX003000202","https://swhp.org/acawelcome","10"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","1","37755","TX","Individual","No","74-3092083","37755TX0030002","PPO 2500","37755TX003",,"TXN001","TXS001","TXF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0030002-03","Limited Cost Sharing Plan Variation",,"0.712100148200989","Yes","Yes","No","100%",,"$2,500","$0","$960","$150","$2,500","$0","$550","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX003000203","https://swhp.org/acawelcome","11"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","1","37755","TX","Individual","No","74-3092083","37755TX0030002","PPO 2500","37755TX003",,"TXN001","TXS001","TXF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0030002-04","73% AV Level Silver Plan",,"0.732859194278717","Yes","Yes","No","100%",,"$2,300","$20","$990","$150","$2,300","$610","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX003000204","https://swhp.org/acawelcome","12"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","1","37755","TX","Individual","No","74-3092083","37755TX0030002","PPO 2500","37755TX003",,"TXN001","TXS001","TXF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0030002-05","87% AV Level Silver Plan",,"0.861752569675446","Yes","Yes","No","100%",,"$750","$50","$700","$150","$750","$650","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX003000205","https://swhp.org/acawelcome","13"
"2016","TX","40540","HIOS","3","2015-07-11 04:19:24","2","40540","TX","Individual","Yes","47-0397286","40540TX0070002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","40540TX007",,"TXN001","TXS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$30.38","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/40540","","40540TX0070002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/TX_Ped_Low_2016","http://www.renaissancedental.com/TX_Ped_Low_2016","7"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","1","40788","TX","Individual","No","74-2052197","40788TX0160001","Scott and White Health Plan Catastrophic 6850","40788TX016",,"TXN001","TXS001","TXF001","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","3","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0160001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX016000100","https://swhp.org/acawelcome","4"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","1","40788","TX","Individual","No","74-2052197","40788TX0160001","Scott and White Health Plan Catastrophic 6850","40788TX016",,"TXN001","TXS001","TXF001","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","3","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0160001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX016000101","https://swhp.org/acawelcome","5"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","2","40788","TX","Individual","No","74-2052197","40788TX0180001","Scott and White Health Plan Silver 3000","40788TX018",,"TXN001","TXS001","TXF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180001-00","Standard Silver Off Exchange Plan",,"0.702275037765503","Yes","Yes","No","100%",,"$3,000","$10","$850","$150","$3,000","$300","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000100","https://swhp.org/acawelcome","4"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","2","40788","TX","Individual","No","74-2052197","40788TX0180001","Scott and White Health Plan Silver 3000","40788TX018",,"TXN001","TXS001","TXF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180001-01","Standard Silver On Exchange Plan",,"0.702275037765503","Yes","Yes","No","100%",,"$3,000","$10","$850","$150","$3,000","$300","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000101","https://swhp.org/acawelcome","5"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","3","45786","TX","Individual","No","20-1494502","45786TX0020001","Molina Marketplace Choice Gold Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0020001-01","Standard Gold On Exchange Plan",,"0.801033437252045","No","Yes","No","100%",,"$500","$240","$890","$150","$550","$770","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-choice-gold-2016.pdf","http://www.molinahealthcare.com/tx/en/PDF/marketplace/brochure-2016.pdf","5"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","1","37755","TX","Individual","No","74-3092083","37755TX0030002","PPO 2500","37755TX003",,"TXN001","TXS001","TXF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0030002-06","94% AV Level Silver Plan",,"0.932737410068512","Yes","Yes","No","100%",,"$100","$20","$630","$150","$100","$500","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX003000206","https://swhp.org/acawelcome","14"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","2","37755","TX","Individual","No","74-3092083","37755TX0020003","PPO 6600","37755TX002",,"TXN001","TXS001","TXF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0020003-00","Standard Bronze Off Exchange Plan","60.93%","0.663565397262573","Yes","Yes","No","100%",,"$6,600","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","0%",,,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX002000300","https://swhp.org/acawelcome","4"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","2","37755","TX","Individual","No","74-3092083","37755TX0020003","PPO 6600","37755TX002",,"TXN001","TXS001","TXF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0020003-01","Standard Bronze On Exchange Plan","60.93%","0.663565397262573","Yes","Yes","No","100%",,"$6,600","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","0%",,,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX002000301","https://swhp.org/acawelcome","5"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","2","37755","TX","Individual","No","74-3092083","37755TX0020003","PPO 6600","37755TX002",,"TXN001","TXS001","TXF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0020003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX002000302","https://swhp.org/acawelcome","6"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","2","37755","TX","Individual","No","74-3092083","37755TX0020003","PPO 6600","37755TX002",,"TXN001","TXS001","TXF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0020003-03","Limited Cost Sharing Plan Variation","60.93%","0.663565397262573","Yes","Yes","No","100%",,"$6,600","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","0%",,,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX002000303","https://swhp.org/acawelcome","7"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","3","37755","TX","Individual","No","74-3092083","37755TX0010001","PPO Premier 1000","37755TX001",,"TXN001","TXS001","TXF007","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0010001-00","Standard Gold Off Exchange Plan",,"0.812105238437653","Yes","Yes","No","100%",,"$1,000","$40","$1,010","$150","$1,000","$540","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX001000100","https://swhp.org/acawelcome","4"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","3","37755","TX","Individual","No","74-3092083","37755TX0010001","PPO Premier 1000","37755TX001",,"TXN001","TXS001","TXF007","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0010001-01","Standard Gold On Exchange Plan",,"0.812105238437653","Yes","Yes","No","100%",,"$1,000","$40","$1,010","$150","$1,000","$540","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX001000101","https://swhp.org/acawelcome","5"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","3","37755","TX","Individual","No","74-3092083","37755TX0010001","PPO Premier 1000","37755TX001",,"TXN001","TXS001","TXF007","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0010001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX001000102","https://swhp.org/acawelcome","6"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","3","37755","TX","Individual","No","74-3092083","37755TX0010001","PPO Premier 1000","37755TX001",,"TXN001","TXS001","TXF007","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0010001-03","Limited Cost Sharing Plan Variation",,"0.812105238437653","Yes","Yes","No","100%",,"$1,000","$40","$1,010","$150","$1,000","$540","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX001000103","https://swhp.org/acawelcome","7"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","3","37755","TX","Individual","No","74-3092083","37755TX0010002","PPO Premier 750","37755TX001",,"TXN001","TXS001","TXF008","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0010002-00","Standard Gold Off Exchange Plan",,"0.819886445999146","Yes","Yes","No","100%",,"$750","$40","$1,010","$150","$750","$430","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX001000200","https://swhp.org/acawelcome","8"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","3","37755","TX","Individual","No","74-3092083","37755TX0010002","PPO Premier 750","37755TX001",,"TXN001","TXS001","TXF008","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0010002-01","Standard Gold On Exchange Plan",,"0.819886445999146","Yes","Yes","No","100%",,"$750","$40","$1,010","$150","$750","$430","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX001000201","https://swhp.org/acawelcome","9"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","2","40788","TX","Individual","No","74-2052197","40788TX0180005","Scott and White Health Plan Silver 2500/OV35","40788TX018",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180005-00","Standard Silver Off Exchange Plan",,"0.706229388713837","Yes","Yes","No","100%",,"$2,500","$10","$950","$150","$2,500","$340","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000500","https://swhp.org/acawelcome","11"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","2","40788","TX","Individual","No","74-2052197","40788TX0180005","Scott and White Health Plan Silver 2500/OV35","40788TX018",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180005-01","Standard Silver On Exchange Plan",,"0.706229388713837","Yes","Yes","No","100%",,"$2,500","$10","$950","$150","$2,500","$340","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000501","https://swhp.org/acawelcome","12"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","2","40788","TX","Individual","No","74-2052197","40788TX0180005","Scott and White Health Plan Silver 2500/OV35","40788TX018",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000502","https://swhp.org/acawelcome","13"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","2","40788","TX","Individual","No","74-2052197","40788TX0180005","Scott and White Health Plan Silver 2500/OV35","40788TX018",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180005-03","Limited Cost Sharing Plan Variation",,"0.706229388713837","Yes","Yes","No","100%",,"$2,500","$10","$950","$150","$2,500","$340","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000503","https://swhp.org/acawelcome","14"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","3","37755","TX","Individual","No","74-3092083","37755TX0010002","PPO Premier 750","37755TX001",,"TXN001","TXS001","TXF008","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0010002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX001000202","https://swhp.org/acawelcome","10"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","3","37755","TX","Individual","No","74-3092083","37755TX0010002","PPO Premier 750","37755TX001",,"TXN001","TXS001","TXF008","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0010002-03","Limited Cost Sharing Plan Variation",,"0.819886445999146","Yes","Yes","No","100%",,"$750","$40","$1,010","$150","$750","$430","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX001000203","https://swhp.org/acawelcome","11"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","3","37755","TX","Individual","No","74-3092083","37755TX0010003","PPO Premier 500","37755TX001",,"TXN001","TXS001","TXF009","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0010003-00","Standard Gold Off Exchange Plan",,"0.815797388553619","Yes","Yes","No","100%",,"$500","$50","$1,010","$150","$500","$820","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX001000300","https://swhp.org/acawelcome","12"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","3","37755","TX","Individual","No","74-3092083","37755TX0010003","PPO Premier 500","37755TX001",,"TXN001","TXS001","TXF009","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0010003-01","Standard Gold On Exchange Plan",,"0.815797388553619","Yes","Yes","No","100%",,"$500","$50","$1,010","$150","$500","$820","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX001000301","https://swhp.org/acawelcome","13"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","3","37755","TX","Individual","No","74-3092083","37755TX0010003","PPO Premier 500","37755TX001",,"TXN001","TXS001","TXF009","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX001000302","https://swhp.org/acawelcome","14"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","3","37755","TX","Individual","No","74-3092083","37755TX0010003","PPO Premier 500","37755TX001",,"TXN001","TXS001","TXF009","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0010003-03","Limited Cost Sharing Plan Variation",,"0.815797388553619","Yes","Yes","No","100%",,"$500","$50","$1,010","$150","$500","$820","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX001000303","https://swhp.org/acawelcome","15"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","4","37755","TX","Individual","No","74-3092083","37755TX0030001","PPO 5000","37755TX003",,"TXN001","TXS001","TXF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0030001-00","Standard Silver Off Exchange Plan",,"0.704608738422394","Yes","Yes","No","100%",,"$5,000","$20","$450","$150","$5,000","$30","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX003000100","https://swhp.org/acawelcome","4"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","4","37755","TX","Individual","No","74-3092083","37755TX0030001","PPO 5000","37755TX003",,"TXN001","TXS001","TXF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0030001-01","Standard Silver On Exchange Plan",,"0.704608738422394","Yes","Yes","No","100%",,"$5,000","$20","$450","$150","$5,000","$30","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX003000101","https://swhp.org/acawelcome","5"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","4","37755","TX","Individual","No","74-3092083","37755TX0030001","PPO 5000","37755TX003",,"TXN001","TXS001","TXF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0030001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX003000102","https://swhp.org/acawelcome","6"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","4","37755","TX","Individual","No","74-3092083","37755TX0030001","PPO 5000","37755TX003",,"TXN001","TXS001","TXF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0030001-03","Limited Cost Sharing Plan Variation",,"0.704608738422394","Yes","Yes","No","100%",,"$5,000","$20","$450","$150","$5,000","$30","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX003000103","https://swhp.org/acawelcome","7"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","4","37755","TX","Individual","No","74-3092083","37755TX0030001","PPO 5000","37755TX003",,"TXN001","TXS001","TXF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0030001-04","73% AV Level Silver Plan",,"0.737710773944855","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$360","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX003000104","https://swhp.org/acawelcome","8"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","4","37755","TX","Individual","No","74-3092083","37755TX0030001","PPO 5000","37755TX003",,"TXN001","TXS001","TXF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0030001-05","87% AV Level Silver Plan",,"0.861414194107056","Yes","Yes","No","100%",,"$750","$40","$1,010","$150","$750","$560","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX003000105","https://swhp.org/acawelcome","9"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","4","37755","TX","Individual","No","74-3092083","37755TX0030001","PPO 5000","37755TX003",,"TXN001","TXS001","TXF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0030001-06","94% AV Level Silver Plan",,"0.93257862329483","Yes","Yes","No","100%",,"$100","$20","$630","$150","$100","$450","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20%",,,,,"$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX003000106","https://swhp.org/acawelcome","10"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","4","37755","TX","Individual","No","74-3092083","37755TX0030003","PPO Premier 2500","37755TX003",,"TXN001","TXS001","TXF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0030003-00","Standard Silver Off Exchange Plan",,"0.718896806240082","Yes","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$560","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX003000300","https://swhp.org/acawelcome","11"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","4","37755","TX","Individual","No","74-3092083","37755TX0030003","PPO Premier 2500","37755TX003",,"TXN001","TXS001","TXF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0030003-01","Standard Silver On Exchange Plan",,"0.718896806240082","Yes","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$560","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX003000301","https://swhp.org/acawelcome","12"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","4","37755","TX","Individual","No","74-3092083","37755TX0030003","PPO Premier 2500","37755TX003",,"TXN001","TXS001","TXF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0030003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX003000302","https://swhp.org/acawelcome","13"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","4","37755","TX","Individual","No","74-3092083","37755TX0030003","PPO Premier 2500","37755TX003",,"TXN001","TXS001","TXF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0030003-03","Limited Cost Sharing Plan Variation",,"0.718896806240082","Yes","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$560","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX003000303","https://swhp.org/acawelcome","14"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","4","37755","TX","Individual","No","74-3092083","37755TX0030003","PPO Premier 2500","37755TX003",,"TXN001","TXS001","TXF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0030003-04","73% AV Level Silver Plan",,"0.738994240760803","Yes","Yes","No","100%",,"$2,300","$20","$990","$150","$2,300","$610","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"$10,300","$10300 per person","$20600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20%",,,,,"$4,600","$4600 per person","$9200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX003000304","https://swhp.org/acawelcome","15"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","4","37755","TX","Individual","No","74-3092083","37755TX0030003","PPO Premier 2500","37755TX003",,"TXN001","TXS001","TXF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0030003-05","87% AV Level Silver Plan",,"0.871598422527313","Yes","Yes","No","100%",,"$750","$50","$700","$150","$750","$650","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX003000305","https://swhp.org/acawelcome","16"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","4","37755","TX","Individual","No","74-3092083","37755TX0030003","PPO Premier 2500","37755TX003",,"TXN001","TXS001","TXF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0030003-06","94% AV Level Silver Plan",,"0.930239856243134","Yes","Yes","No","100%",,"$100","$20","$630","$150","$100","$500","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX003000306","https://swhp.org/acawelcome","17"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","5","37755","TX","Individual","No","74-3092083","37755TX0010004","PPO 1500","37755TX001",,"TXN001","TXS001","TXF006","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0010004-00","Standard Gold Off Exchange Plan",,"0.792287290096283","Yes","Yes","No","100%",,"$1,500","$60","$1,010","$150","$1,500","$420","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX001000400","https://swhp.org/acawelcome","4"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","5","37755","TX","Individual","No","74-3092083","37755TX0010004","PPO 1500","37755TX001",,"TXN001","TXS001","TXF006","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0010004-01","Standard Gold On Exchange Plan",,"0.792287290096283","Yes","Yes","No","100%",,"$1,500","$60","$1,010","$150","$1,500","$420","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX001000401","https://swhp.org/acawelcome","5"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","5","37755","TX","Individual","No","74-3092083","37755TX0010004","PPO 1500","37755TX001",,"TXN001","TXS001","TXF006","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0010004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX001000402","https://swhp.org/acawelcome","6"
"2016","TX","37755","HIOS","7","2016-04-04 11:25:42","5","37755","TX","Individual","No","74-3092083","37755TX0010004","PPO 1500","37755TX001",,"TXN001","TXS001","TXF006","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent only","Yes","Emergency/Urgent same as in-network. All other services 50% after deductible.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","37755TX0010004-03","Limited Cost Sharing Plan Variation",,"0.792287290096283","Yes","Yes","No","100%",,"$1,500","$60","$1,010","$150","$1,500","$420","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/37755TX001000403","https://swhp.org/acawelcome","7"
"2016","TX","40540","HIOS","3","2015-07-11 04:19:24","1","40540","TX","Individual","Yes","47-0397286","40540TX0010001","Delta Dental Individual PPO, EHB Certified","40540TX001",,"TXN002","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.86","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","40540TX0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","40540","HIOS","3","2015-07-11 04:19:24","1","40540","TX","SHOP (Small Group)","Yes","47-0397286","40540TX0030001","Renaissance Group Dental PPO, EHB Certified","40540TX003",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.82","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","40540TX0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","40540","HIOS","3","2015-07-11 04:19:24","1","40540","TX","SHOP (Small Group)","Yes","47-0397286","40540TX0030002","Renaissance Group Dental PPO, EHB Certified","40540TX003",,"TXN001","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.44","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","40540TX0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","TX","40540","HIOS","3","2015-07-11 04:19:24","1","40540","TX","Individual","Yes","47-0397286","40540TX0010002","Delta Dental Individual PPO, EHB Certified","40540TX001",,"TXN002","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.66","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","40540TX0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","TX","40540","HIOS","3","2015-07-11 04:19:24","1","40540","TX","Individual","Yes","47-0397286","40540TX0020001","Renaissance Individual Dental PPO, EHB Certified","40540TX002",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.03","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","40540TX0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","TX","40540","HIOS","3","2015-07-11 04:19:24","1","40540","TX","SHOP (Small Group)","Yes","47-0397286","40540TX0080001","Renaissance Group Dental PPO, EHB Certified (Exchange)","40540TX008",,"TXN001","TXS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.82","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","40540TX0080001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/TX_EHB_Group_High_2016","http://www.renaissancedental.com/TX_EHB_Group_High_2016","6"
"2016","TX","40540","HIOS","3","2015-07-11 04:19:24","1","40540","TX","SHOP (Small Group)","Yes","47-0397286","40540TX0080002","Renaissance Group Dental PPO, EHB Certified (Exchange)","40540TX008",,"TXN001","TXS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.44","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","40540TX0080002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/TX_EHB_Group_Low_2016","http://www.renaissancedental.com/TX_EHB_Group_Low_2016","7"
"2016","TX","40540","HIOS","3","2015-07-11 04:19:24","1","40540","TX","Individual","Yes","47-0397286","40540TX0020002","Renaissance Individual Dental PPO, EHB Certified","40540TX002",,"TXN001","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.76","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","40540TX0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","TX","40540","HIOS","3","2015-07-11 04:19:24","1","40540","TX","Individual","Yes","47-0397286","40540TX0060001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","40540TX006",,"TXN001","TXS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.03","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/40540","","40540TX0060001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/TX_EHB_High_2016","http://www.renaissancedental.com/TX_EHB_High_2016","8"
"2016","TX","40540","HIOS","3","2015-07-11 04:19:24","1","40540","TX","SHOP (Small Group)","Yes","47-0397286","40540TX0080003","Renaissance Group Dental PPO, EHB Certified (Exchange)","40540TX008",,"TXN001","TXS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.82","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","40540TX0080003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/TX_50_50_High_2016","http://www.renaissancedental.com/TX_50_50_High_2016","8"
"2016","TX","40540","HIOS","3","2015-07-11 04:19:24","1","40540","TX","SHOP (Small Group)","Yes","47-0397286","40540TX0080004","Renaissance Group Dental PPO, EHB Certified (Exchange)","40540TX008",,"TXN001","TXS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.44","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","40540TX0080004-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/TX_50_50_Low_2016","http://www.renaissancedental.com/TX_50_50_Low_2016","9"
"2016","TX","40540","HIOS","3","2015-07-11 04:19:24","1","40540","TX","Individual","Yes","47-0397286","40540TX0060002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","40540TX006",,"TXN001","TXS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/40540","","40540TX0060002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/TX_EHB_Low_2016","http://www.renaissancedental.com/TX_EHB_Low_2016","9"
"2016","TX","40540","HIOS","3","2015-07-11 04:19:24","2","40540","TX","Individual","Yes","47-0397286","40540TX0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified","40540TX005",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$35.32","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","40540TX0050001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","40540","HIOS","3","2015-07-11 04:19:24","2","40540","TX","Individual","Yes","47-0397286","40540TX0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified","40540TX005",,"TXN001","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$30.38","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","40540TX0050002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","TX","40540","HIOS","3","2015-07-11 04:19:24","2","40540","TX","Individual","Yes","47-0397286","40540TX0070001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","40540TX007",,"TXN001","TXS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$35.32","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/40540","","40540TX0070001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/TX_Ped_High_2016","http://www.renaissancedental.com/TX_Ped_High_2016","6"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","2","40788","TX","Individual","No","74-2052197","40788TX0180001","Scott and White Health Plan Silver 3000","40788TX018",,"TXN001","TXS001","TXF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000102","https://swhp.org/acawelcome","6"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","2","40788","TX","Individual","No","74-2052197","40788TX0180001","Scott and White Health Plan Silver 3000","40788TX018",,"TXN001","TXS001","TXF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180001-03","Limited Cost Sharing Plan Variation",,"0.702275037765503","Yes","Yes","No","100%",,"$3,000","$10","$850","$150","$3,000","$300","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000103","https://swhp.org/acawelcome","7"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","2","40788","TX","Individual","No","74-2052197","40788TX0180001","Scott and White Health Plan Silver 3000","40788TX018",,"TXN001","TXS001","TXF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180001-04","73% AV Level Silver Plan",,"0.738511443138123","Yes","Yes","No","100%",,"$2,500","$10","$950","$150","$2,500","$320","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000104","https://swhp.org/acawelcome","8"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","2","40788","TX","Individual","No","74-2052197","40788TX0180001","Scott and White Health Plan Silver 3000","40788TX018",,"TXN001","TXS001","TXF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180001-05","87% AV Level Silver Plan",,"0.861601412296295","Yes","Yes","No","100%",,"$500","$60","$760","$150","$500","$690","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000105","https://swhp.org/acawelcome","9"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","2","40788","TX","Individual","No","74-2052197","40788TX0180001","Scott and White Health Plan Silver 3000","40788TX018",,"TXN001","TXS001","TXF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180001-06","94% AV Level Silver Plan",,"0.943289041519165","Yes","Yes","No","100%",,"$100","$20","$510","$150","$100","$300","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000106","https://swhp.org/acawelcome","10"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","2","40788","TX","Individual","No","74-2052197","40788TX0180005","Scott and White Health Plan Silver 2500/OV35","40788TX018",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180005-04","73% AV Level Silver Plan",,"0.738174498081207","Yes","Yes","No","100%",,"$2,000","$70","$1,010","$150","$2,000","$400","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000504","https://swhp.org/acawelcome","15"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","7","40788","TX","Individual","No","74-2052197","40788TX0180006","Scott and White Health Plan Silver 2500/30OV","40788TX018",,"TXN001","TXS001","TXF007","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180006-04","73% AV Level Silver Plan",,"0.72933042049408","No","Yes","No","100%",,"$2,000","$70","$1,010","$150","$2,000","$670","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000604","https://swhp.org/acawelcome","8"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","5","45786","TX","Individual","No","20-1494502","45786TX0020003","Molina Marketplace Choice Bronze Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0020003-03","Limited Cost Sharing Plan Variation",,"0.618895947933197","Yes","Yes","No","100%",,"$5,000","$20","$900","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-choice-bronze-2016.pdf","http://www.molinahealthcare.com/tx/en/PDF/marketplace/brochure-2016.pdf","7"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","1","46224","TX","Individual","No","74-2723334","46224TX0010001","Community First Silver Plus 1","46224TX001",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010001-00","Standard Silver Off Exchange Plan","69.94%","0.699444711208344","No","Yes","No","100%",,"$2,800","$20","$900","$200","$1,200","$1,000","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016_SBC_CF_Silver_Plus1.IndividualFamily_clean.9-21-15_.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","4"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","1","46224","TX","Individual","No","74-2723334","46224TX0010001","Community First Silver Plus 1","46224TX001",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010001-01","Standard Silver On Exchange Plan","69.94%","0.699444711208344","No","Yes","No","100%",,"$2,800","$20","$900","$200","$1,200","$1,000","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016_SBC_CF_Silver_Plus1.IndividualFamily_clean.9-21-15_.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","5"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","1","46224","TX","Individual","No","74-2723334","46224TX0010001","Community First Silver Plus 1","46224TX001",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_SilverPlus1_0CSV_IndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","6"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","1","46224","TX","Individual","No","74-2723334","46224TX0010001","Community First Silver Plus 1","46224TX001",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010001-03","Limited Cost Sharing Plan Variation","69.94%","0.699444711208344","No","Yes","No","100%",,"$2,800","$20","$900","$200","$1,200","$1,000","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016_SBC_CF_Silver_Plus1LMTD_IndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","7"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","1","46224","TX","Individual","No","74-2723334","46224TX0010001","Community First Silver Plus 1","46224TX001",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010001-04","73% AV Level Silver Plan","73.21%","0.732124626636505","No","Yes","No","100%",,"$2,800","$20","$900","$200","$1,200","$1,000","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_S73_Plus1_IndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","8"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","2","40788","TX","Individual","No","74-2052197","40788TX0180005","Scott and White Health Plan Silver 2500/OV35","40788TX018",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180005-05","87% AV Level Silver Plan",,"0.879200994968414","Yes","Yes","No","100%",,"$500","$30","$970","$150","$500","$490","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000505","https://swhp.org/acawelcome","16"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","2","40788","TX","Individual","No","74-2052197","40788TX0180005","Scott and White Health Plan Silver 2500/OV35","40788TX018",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180005-06","94% AV Level Silver Plan",,"0.943327307701111","Yes","Yes","No","100%",,"$50","$10","$640","$150","$50","$300","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000506","https://swhp.org/acawelcome","17"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","3","40788","TX","Individual","No","74-2052197","40788TX0170002","Scott and White Health Plan Bronze 5500 HDHP","40788TX017",,"TXN001","TXS001","TXF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0170002-00","Standard Bronze Off Exchange Plan",,"0.615188002586365","Yes","Yes","No","100%",,"$5,500","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX017000200","https://swhp.org/acawelcome","4"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","3","40788","TX","Individual","No","74-2052197","40788TX0170002","Scott and White Health Plan Bronze 5500 HDHP","40788TX017",,"TXN001","TXS001","TXF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0170002-01","Standard Bronze On Exchange Plan",,"0.615188002586365","Yes","Yes","No","100%",,"$5,500","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX017000201","https://swhp.org/acawelcome","5"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","3","40788","TX","Individual","No","74-2052197","40788TX0170002","Scott and White Health Plan Bronze 5500 HDHP","40788TX017",,"TXN001","TXS001","TXF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0170002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX017000202","https://swhp.org/acawelcome","6"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","3","40788","TX","Individual","No","74-2052197","40788TX0170002","Scott and White Health Plan Bronze 5500 HDHP","40788TX017",,"TXN001","TXS001","TXF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0170002-03","Limited Cost Sharing Plan Variation",,"0.615188002586365","Yes","Yes","No","100%",,"$5,500","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX017000203","https://swhp.org/acawelcome","7"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","3","40788","TX","Individual","No","74-2052197","40788TX0180003","Scott and White Health Plan Silver 2750 HDHP","40788TX018",,"TXN001","TXS001","TXF008","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180003-00","Standard Silver Off Exchange Plan",,"0.711894869804382","Yes","Yes","No","100%",,"$2,750","$0","$0","$150","$2,750","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000300","https://swhp.org/acawelcome","8"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","3","40788","TX","Individual","No","74-2052197","40788TX0180003","Scott and White Health Plan Silver 2750 HDHP","40788TX018",,"TXN001","TXS001","TXF008","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180003-01","Standard Silver On Exchange Plan",,"0.711894869804382","Yes","Yes","No","100%",,"$2,750","$0","$0","$150","$2,750","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000301","https://swhp.org/acawelcome","9"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","3","40788","TX","Individual","No","74-2052197","40788TX0180003","Scott and White Health Plan Silver 2750 HDHP","40788TX018",,"TXN001","TXS001","TXF008","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000302","https://swhp.org/acawelcome","10"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","3","40788","TX","Individual","No","74-2052197","40788TX0180003","Scott and White Health Plan Silver 2750 HDHP","40788TX018",,"TXN001","TXS001","TXF008","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180003-03","Limited Cost Sharing Plan Variation",,"0.711894869804382","Yes","Yes","No","100%",,"$2,750","$0","$0","$150","$2,750","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000303","https://swhp.org/acawelcome","11"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","3","40788","TX","Individual","No","74-2052197","40788TX0180003","Scott and White Health Plan Silver 2750 HDHP","40788TX018",,"TXN001","TXS001","TXF008","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180003-04","73% AV Level Silver Plan",,"0.732005059719086","Yes","Yes","No","100%",,"$2,500","$0","$0","$150","$2,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000304","https://swhp.org/acawelcome","12"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","3","40788","TX","Individual","No","74-2052197","40788TX0180003","Scott and White Health Plan Silver 2750 HDHP","40788TX018",,"TXN001","TXS001","TXF008","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180003-05","87% AV Level Silver Plan",,"0.868215501308441","Yes","Yes","No","100%",,"$800","$0","$0","$150","$800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000305","https://swhp.org/acawelcome","13"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","3","40788","TX","Individual","No","74-2052197","40788TX0180003","Scott and White Health Plan Silver 2750 HDHP","40788TX018",,"TXN001","TXS001","TXF008","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180003-06","94% AV Level Silver Plan",,"0.947334706783295","Yes","Yes","No","100%",,"$150","$0","$0","$150","$150","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000306","https://swhp.org/acawelcome","14"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","3","40788","TX","Individual","No","74-2052197","40788TX0190002","Scott and White Health Plan Gold 1400","40788TX019",,"TXN001","TXS001","TXF011","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0190002-00","Standard Gold Off Exchange Plan",,"0.81410139799118","Yes","Yes","No","100%",,"$1,400","$0","$0","$150","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX019000200","https://swhp.org/acawelcome","15"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","3","40788","TX","Individual","No","74-2052197","40788TX0190002","Scott and White Health Plan Gold 1400","40788TX019",,"TXN001","TXS001","TXF011","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0190002-01","Standard Gold On Exchange Plan",,"0.81410139799118","Yes","Yes","No","100%",,"$1,400","$0","$0","$150","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX019000201","https://swhp.org/acawelcome","16"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","3","40788","TX","Individual","No","74-2052197","40788TX0190002","Scott and White Health Plan Gold 1400","40788TX019",,"TXN001","TXS001","TXF011","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0190002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX019000202","https://swhp.org/acawelcome","17"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","3","40788","TX","Individual","No","74-2052197","40788TX0190002","Scott and White Health Plan Gold 1400","40788TX019",,"TXN001","TXS001","TXF011","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0190002-03","Limited Cost Sharing Plan Variation",,"0.81410139799118","Yes","Yes","No","100%",,"$1,400","$0","$0","$150","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX019000203","https://swhp.org/acawelcome","18"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","4","40788","TX","Individual","No","74-2052197","40788TX0190003","Scott and White Health Plan Gold HMO 30","40788TX019",,"TXN001","TXS001","TXF009","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0190003-00","Standard Gold Off Exchange Plan",,"0.81951779127121","Yes","Yes","No","100%",,"$0","$1,060","$40","$150","$0","$1,340","$640","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX019000300","https://swhp.org/acawelcome","4"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","4","40788","TX","Individual","No","74-2052197","40788TX0190003","Scott and White Health Plan Gold HMO 30","40788TX019",,"TXN001","TXS001","TXF009","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0190003-01","Standard Gold On Exchange Plan",,"0.81951779127121","Yes","Yes","No","100%",,"$0","$1,060","$40","$150","$0","$1,340","$640","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX019000301","https://swhp.org/acawelcome","5"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","4","40788","TX","Individual","No","74-2052197","40788TX0190003","Scott and White Health Plan Gold HMO 30","40788TX019",,"TXN001","TXS001","TXF009","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0190003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX019000302","https://swhp.org/acawelcome","6"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","4","40788","TX","Individual","No","74-2052197","40788TX0190003","Scott and White Health Plan Gold HMO 30","40788TX019",,"TXN001","TXS001","TXF009","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0190003-03","Limited Cost Sharing Plan Variation",,"0.81951779127121","Yes","Yes","No","100%",,"$0","$1,060","$40","$150","$0","$1,340","$640","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX019000303","https://swhp.org/acawelcome","7"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","5","40788","TX","Individual","No","74-2052197","40788TX0170001","Scott and White Health Plan Bronze 6000/50Ov","40788TX017",,"TXN001","TXS001","TXF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","1","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0170001-00","Standard Bronze Off Exchange Plan","61.59%","0.621009111404419","Yes","Yes","No","100%",,"$6,000","$20","$250","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX017000100","https://swhp.org/acawelcome","4"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","5","40788","TX","Individual","No","74-2052197","40788TX0170001","Scott and White Health Plan Bronze 6000/50Ov","40788TX017",,"TXN001","TXS001","TXF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","1","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0170001-01","Standard Bronze On Exchange Plan","61.59%","0.621009111404419","Yes","Yes","No","100%",,"$6,000","$20","$250","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX017000101","https://swhp.org/acawelcome","5"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","5","40788","TX","Individual","No","74-2052197","40788TX0170001","Scott and White Health Plan Bronze 6000/50Ov","40788TX017",,"TXN001","TXS001","TXF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","1","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0170001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX017000102","https://swhp.org/acawelcome","6"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","5","40788","TX","Individual","No","74-2052197","40788TX0170001","Scott and White Health Plan Bronze 6000/50Ov","40788TX017",,"TXN001","TXS001","TXF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","1","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0170001-03","Limited Cost Sharing Plan Variation","61.59%","0.621009111404419","Yes","Yes","No","100%",,"$6,000","$20","$250","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX017000103","https://swhp.org/acawelcome","7"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","6","40788","TX","Individual","No","74-2052197","40788TX0170005","Scott and White Health Plan Bronze 6600/60OV","40788TX017",,"TXN001","TXS001","TXF002","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","2","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0170005-00","Standard Bronze Off Exchange Plan","61.60%","0.624881386756897","Yes","Yes","No","100%",,"$6,600","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX017000500","https://swhp.org/acawelcome","4"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","6","40788","TX","Individual","No","74-2052197","40788TX0170005","Scott and White Health Plan Bronze 6600/60OV","40788TX017",,"TXN001","TXS001","TXF002","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","2","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0170005-01","Standard Bronze On Exchange Plan","61.60%","0.624881386756897","Yes","Yes","No","100%",,"$6,600","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX017000501","https://swhp.org/acawelcome","5"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","6","40788","TX","Individual","No","74-2052197","40788TX0170005","Scott and White Health Plan Bronze 6600/60OV","40788TX017",,"TXN001","TXS001","TXF002","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","2","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0170005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX017000502","https://swhp.org/acawelcome","6"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","6","40788","TX","Individual","No","74-2052197","40788TX0170005","Scott and White Health Plan Bronze 6600/60OV","40788TX017",,"TXN001","TXS001","TXF002","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","2","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0170005-03","Limited Cost Sharing Plan Variation","61.60%","0.624881386756897","Yes","Yes","No","100%",,"$6,600","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX017000503","https://swhp.org/acawelcome","7"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","7","40788","TX","Individual","No","74-2052197","40788TX0180006","Scott and White Health Plan Silver 2500/30OV","40788TX018",,"TXN001","TXS001","TXF007","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180006-00","Standard Silver Off Exchange Plan",,"0.684343278408051","No","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$560","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000600","https://swhp.org/acawelcome","4"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","7","40788","TX","Individual","No","74-2052197","40788TX0180006","Scott and White Health Plan Silver 2500/30OV","40788TX018",,"TXN001","TXS001","TXF007","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180006-01","Standard Silver On Exchange Plan",,"0.684343278408051","No","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$560","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000601","https://swhp.org/acawelcome","5"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","7","40788","TX","Individual","No","74-2052197","40788TX0180006","Scott and White Health Plan Silver 2500/30OV","40788TX018",,"TXN001","TXS001","TXF007","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000602","https://swhp.org/acawelcome","6"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","7","40788","TX","Individual","No","74-2052197","40788TX0180006","Scott and White Health Plan Silver 2500/30OV","40788TX018",,"TXN001","TXS001","TXF007","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180006-03","Limited Cost Sharing Plan Variation",,"0.684343278408051","No","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$560","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000603","https://swhp.org/acawelcome","7"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","7","40788","TX","Individual","No","74-2052197","40788TX0180006","Scott and White Health Plan Silver 2500/30OV","40788TX018",,"TXN001","TXS001","TXF007","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180006-05","87% AV Level Silver Plan",,"0.869422495365143","No","Yes","No","100%",,"$750","$50","$400","$150","$750","$420","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000605","https://swhp.org/acawelcome","9"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","7","40788","TX","Individual","No","74-2052197","40788TX0180006","Scott and White Health Plan Silver 2500/30OV","40788TX018",,"TXN001","TXS001","TXF007","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180006-06","94% AV Level Silver Plan",,"0.932373583316803","No","Yes","No","100%",,"$100","$50","$450","$150","$100","$420","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX018000606","https://swhp.org/acawelcome","10"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","8","40788","TX","Individual","No","74-2052197","40788TX0190001","Scott and White Health Plan Gold 1000","40788TX019",,"TXN001","TXS001","TXF010","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","2","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0190001-00","Standard Gold Off Exchange Plan",,"0.800874888896942","Yes","Yes","No","100%",,"$1,000","$50","$1,010","$150","$1,000","$390","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX019000100","https://swhp.org/acawelcome","4"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","8","40788","TX","Individual","No","74-2052197","40788TX0190001","Scott and White Health Plan Gold 1000","40788TX019",,"TXN001","TXS001","TXF010","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","2","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0190001-01","Standard Gold On Exchange Plan",,"0.800874888896942","Yes","Yes","No","100%",,"$1,000","$50","$1,010","$150","$1,000","$390","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX019000101","https://swhp.org/acawelcome","5"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","8","40788","TX","Individual","No","74-2052197","40788TX0190001","Scott and White Health Plan Gold 1000","40788TX019",,"TXN001","TXS001","TXF010","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","2","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0190001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX019000102","https://swhp.org/acawelcome","6"
"2016","TX","40788","HIOS","8","2016-07-07 07:50:21","8","40788","TX","Individual","No","74-2052197","40788TX0190001","Scott and White Health Plan Gold 1000","40788TX019",,"TXN001","TXS001","TXF010","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Weight Loss Programs","0.989",,,,"0","0","2","2016-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No",,"https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0190001-03","Limited Cost Sharing Plan Variation",,"0.800874888896942","Yes","Yes","No","100%",,"$1,000","$50","$1,010","$150","$1,000","$390","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://swhp.org/acawelcome/SBCs/2016/40788TX019000103","https://swhp.org/acawelcome","7"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","1","45786","TX","Individual","No","20-1494502","45786TX0010001","Molina Marketplace Gold Plan","45786TX001",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0010001-00","Standard Gold Off Exchange Plan",,"0.808345317840576","No","Yes","No","100%",,"$0","$380","$890","$150","$0","$1,140","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-standard-gold-off-exchange-2016.pdf","http://www.molinahealthcare.com/tx/en/PDF/marketplace/brochure-2016.pdf","4"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","1","45786","TX","Individual","No","20-1494502","45786TX0010001","Molina Marketplace Gold Plan","45786TX001",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0010001-01","Standard Gold On Exchange Plan",,"0.808345317840576","No","Yes","No","100%",,"$0","$380","$890","$150","$0","$1,140","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-standard-gold-2016.pdf","http://www.molinahealthcare.com/tx/en/PDF/marketplace/brochure-2016.pdf","5"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","1","45786","TX","Individual","No","20-1494502","45786TX0010001","Molina Marketplace Gold Plan","45786TX001",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0010001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-standard-gold-zero-cost-sharing-2016.pdf","http://www.molinahealthcare.com/tx/en/PDF/marketplace/brochure-2016.pdf","6"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","1","45786","TX","Individual","No","20-1494502","45786TX0010001","Molina Marketplace Gold Plan","45786TX001",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0010001-03","Limited Cost Sharing Plan Variation",,"0.808345317840576","No","Yes","No","100%",,"$0","$380","$890","$150","$0","$1,140","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-standard-gold-2016.pdf","http://www.molinahealthcare.com/tx/en/PDF/marketplace/brochure-2016.pdf","7"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","2","45786","TX","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0010002-00","Standard Silver Off Exchange Plan",,"0.71922492980957","No","Yes","No","100%",,"$0","$540","$1,790","$150","$0","$1,830","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-standard-silver-off-exchange-2016.pdf","http://www.molinahealthcare.com/tx/en/PDF/marketplace/brochure-2016.pdf","4"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","2","45786","TX","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0010002-01","Standard Silver On Exchange Plan",,"0.71922492980957","No","Yes","No","100%",,"$0","$540","$1,790","$150","$0","$1,830","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-standard-silver-250-2016.pdf",,"5"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","2","45786","TX","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-standard-silver-zero-cost-sharing-2016.pdf","http://www.molinahealthcare.com/tx/en/PDF/marketplace/brochure-2016.pdf","6"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","2","45786","TX","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0010002-03","Limited Cost Sharing Plan Variation",,"0.71922492980957","No","Yes","No","100%",,"$0","$540","$1,790","$150","$0","$1,830","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-standard-silver-250-2016.pdf",,"7"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","2","45786","TX","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0010002-04","73% AV Level Silver Plan",,"0.739227056503296","No","Yes","No","100%",,"$0","$540","$1,790","$150","$0","$1,780","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-standard-silver-200-2016.pdf",,"8"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","2","45786","TX","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0010002-05","87% AV Level Silver Plan",,"0.878565490245819","No","Yes","No","100%",,"$0","$450","$1,120","$150","$0","$640","$320","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$0","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-standard-silver-150-2016.pdf",,"9"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","2","45786","TX","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0010002-06","94% AV Level Silver Plan",,"0.942859530448914","No","Yes","No","100%",,"$0","$220","$450","$150","$0","$220","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$0","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-standard-silver-100-2016.pdf",,"10"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","3","45786","TX","Individual","No","20-1494502","45786TX0020001","Molina Marketplace Choice Gold Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0020001-00","Standard Gold Off Exchange Plan",,"0.801033437252045","No","Yes","No","100%",,"$500","$240","$890","$150","$550","$770","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-choice-gold-off-exchange-2016.pdf","http://www.molinahealthcare.com/tx/en/PDF/marketplace/brochure-2016.pdf","4"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","3","45786","TX","Individual","No","20-1494502","45786TX0020001","Molina Marketplace Choice Gold Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0020001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-choice-gold-zero-cost-sharing-2016.pdf","http://www.molinahealthcare.com/tx/en/PDF/marketplace/brochure-2016.pdf","6"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","3","45786","TX","Individual","No","20-1494502","45786TX0020001","Molina Marketplace Choice Gold Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0020001-03","Limited Cost Sharing Plan Variation",,"0.801033437252045","No","Yes","No","100%",,"$500","$240","$890","$150","$550","$770","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-choice-gold-2016.pdf","http://www.molinahealthcare.com/tx/en/PDF/marketplace/brochure-2016.pdf","7"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","4","45786","TX","Individual","No","20-1494502","45786TX0020002","Molina Marketplace Choice Silver Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0020002-00","Standard Silver Off Exchange Plan",,"0.714607775211334","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-choice-silver-off-exchange-2016.pdf","http://www.molinahealthcare.com/tx/en/PDF/marketplace/brochure-2016.pdf","4"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","4","45786","TX","Individual","No","20-1494502","45786TX0020002","Molina Marketplace Choice Silver Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0020002-01","Standard Silver On Exchange Plan",,"0.714607775211334","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-choice-silver-250-2016.pdf","http://www.molinahealthcare.com/tx/en/PDF/marketplace/brochure-2016.pdf","5"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","4","45786","TX","Individual","No","20-1494502","45786TX0020002","Molina Marketplace Choice Silver Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0020002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-choice-silver-zero-cost-sharing-2016.pdf","http://www.molinahealthcare.com/tx/en/PDF/marketplace/brochure-2016.pdf","6"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","4","45786","TX","Individual","No","20-1494502","45786TX0020002","Molina Marketplace Choice Silver Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0020002-03","Limited Cost Sharing Plan Variation",,"0.714607775211334","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-choice-silver-250-2016.pdf","http://www.molinahealthcare.com/tx/en/PDF/marketplace/brochure-2016.pdf","7"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","4","45786","TX","Individual","No","20-1494502","45786TX0020002","Molina Marketplace Choice Silver Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0020002-04","73% AV Level Silver Plan",,"0.739822447299957","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-choice-silver-200-2016.pdf","http://www.molinahealthcare.com/tx/en/PDF/marketplace/brochure-2016.pdf","8"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","4","45786","TX","Individual","No","20-1494502","45786TX0020002","Molina Marketplace Choice Silver Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0020002-05","87% AV Level Silver Plan",,"0.878527700901031","No","Yes","No","100%",,"$450","$180","$890","$150","$450","$320","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$450","$450 per person","$900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-choice-silver-150-2016.pdf","http://www.molinahealthcare.com/tx/en/PDF/marketplace/brochure-2016.pdf","9"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","4","45786","TX","Individual","No","20-1494502","45786TX0020002","Molina Marketplace Choice Silver Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0020002-06","94% AV Level Silver Plan",,"0.947116374969482","No","Yes","No","100%",,"$0","$210","$450","$150","$0","$180","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/tx/en-US/PDF/marketplace/summary-of-benefits-choice-silver-100-2016.pdf","http://www.molinahealthcare.com/tx/en/PDF/marketplace/brochure-2016.pdf","10"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","5","45786","TX","Individual","No","20-1494502","45786TX0020003","Molina Marketplace Choice Bronze Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0020003-00","Standard Bronze Off Exchange Plan",,"0.618895947933197","Yes","Yes","No","100%",,"$5,000","$20","$900","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.molinahealthcare.com/members/tx/en-US/tx/en/PDF/marketplace/summary-of-benefits-choice-bronze-off-exchange-2016.pdf","http://www.molinahealthcare.com/tx/en/PDF/marketplace/brochure-2016.pdf","4"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","5","45786","TX","Individual","No","20-1494502","45786TX0020003","Molina Marketplace Choice Bronze Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0020003-01","Standard Bronze On Exchange Plan",,"0.618895947933197","Yes","Yes","No","100%",,"$5,000","$20","$900","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.molinahealthcare.com/members/tx/en-US/tx/en/PDF/marketplace/summary-of-benefits-choice-bronze-2016.pdf","http://www.molinahealthcare.com/tx/en/PDF/marketplace/brochure-2016.pdf","5"
"2016","TX","45786","HIOS","7","2016-01-22 04:00:42","5","45786","TX","Individual","No","20-1494502","45786TX0020003","Molina Marketplace Choice Bronze Plan","45786TX002",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent are covered","No","Urgent and Emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/tx/en/PDF/marketplace/formulary-2016.pdf","45786TX0020003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/tx/en-US/tx/en/PDF/marketplace/summary-of-benefits-choice-bronze-zero-cost-sharing-2016.pdf","http://www.molinahealthcare.com/tx/en/PDF/marketplace/brochure-2016.pdf","6"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","1","46224","TX","Individual","No","74-2723334","46224TX0010001","Community First Silver Plus 1","46224TX001",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010001-05","87% AV Level Silver Plan","86.01%","0.860137462615967","No","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$900","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_S87_Plus1_IndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","9"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","1","46224","TX","Individual","No","74-2723334","46224TX0010001","Community First Silver Plus 1","46224TX001",,"TXN001","TXS001","TXF003","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010001-06","94% AV Level Silver Plan","93.55%","0.935503840446472","No","Yes","No","100%",,"$200","$20","$700","$200","$200","$300","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_S94_Plus1_IndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","10"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","1","46224","TX","Individual","No","74-2723334","46224TX0010002","Community First Premier Gold","46224TX001",,"TXN001","TXS001","TXF005","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010002-00","Standard Gold Off Exchange Plan","80.68%","0.806796252727509","No","Yes","No","100%",,"$1,500","$20","$900","$200","$1,200","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Premiere.Gold_IndividualFamily_clean.9-23-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","11"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","1","46224","TX","Individual","No","74-2723334","46224TX0010002","Community First Premier Gold","46224TX001",,"TXN001","TXS001","TXF005","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010002-01","Standard Gold On Exchange Plan","80.68%","0.806796252727509","No","Yes","No","100%",,"$1,500","$20","$900","$200","$1,200","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Premiere.Gold_IndividualFamily_clean.9-23-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","12"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","1","46224","TX","Individual","No","74-2723334","46224TX0010002","Community First Premier Gold","46224TX001",,"TXN001","TXS001","TXF005","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Premiere.Gold.0CSV_IndividualFamily_clean_10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","13"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","1","46224","TX","Individual","No","74-2723334","46224TX0010002","Community First Premier Gold","46224TX001",,"TXN001","TXS001","TXF005","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010002-03","Limited Cost Sharing Plan Variation","80.68%","0.806796252727509","No","Yes","No","100%",,"$1,500","$20","$900","$200","$1,200","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Premiere.GoldLMTD.IndividualFamily_.clean.9-23-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","14"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","1","46224","TX","Individual","No","74-2723334","46224TX0010004","Community First Silver Plus 2","46224TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010004-00","Standard Silver Off Exchange Plan","68.16%","0.681625247001648","No","Yes","No","100%",,"$2,800","$20","$1,300","$200","$1,200","$1,000","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016_SBC_CF_Silver_Plus2IndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","15"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","1","46224","TX","Individual","No","74-2723334","46224TX0010004","Community First Silver Plus 2","46224TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010004-01","Standard Silver On Exchange Plan","68.16%","0.681625247001648","No","Yes","No","100%",,"$2,800","$20","$1,300","$200","$1,200","$1,000","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016_SBC_CF_Silver_Plus2IndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","16"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","1","46224","TX","Individual","No","74-2723334","46224TX0010004","Community First Silver Plus 2","46224TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_SilverPlus2_0CSV_IndividualFamily_clean.9-24-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","17"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","1","46224","TX","Individual","No","74-2723334","46224TX0010004","Community First Silver Plus 2","46224TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010004-03","Limited Cost Sharing Plan Variation","68.16%","0.681625247001648","No","Yes","No","100%",,"$2,800","$20","$1,300","$200","$1,200","$1,000","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016_SBC_CF_Silver_Plus_2_LMTD_IndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","18"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","1","46224","TX","Individual","No","74-2723334","46224TX0010004","Community First Silver Plus 2","46224TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010004-04","73% AV Level Silver Plan","73.21%","0.732124626636505","No","Yes","No","100%",,"$2,800","$20","$900","$200","$1,200","$1,000","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_S73_Plus2_IndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","19"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","1","46224","TX","Individual","No","74-2723334","46224TX0010004","Community First Silver Plus 2","46224TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010004-05","87% AV Level Silver Plan","86.01%","0.860137462615967","No","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$900","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_S87_Plus2_IndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","20"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","1","46224","TX","Individual","No","74-2723334","46224TX0010004","Community First Silver Plus 2","46224TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010004-06","94% AV Level Silver Plan","93.55%","0.935503840446472","No","Yes","No","100%",,"$200","$10","$700","$200","$200","$300","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_S94_Plus2_IndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","21"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","2","46224","TX","Individual","No","74-2723334","46224TX0010003","Community First Bronze Value 1","46224TX001",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010003-00","Standard Bronze Off Exchange Plan","61.54%","0.615444004535675","No","Yes","No","100%",,"$2,800","$20","$1,800","$200","$1,200","$1,000","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF.Bronze_Value1.IF.clean_10-12-152.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","4"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","2","46224","TX","Individual","No","74-2723334","46224TX0010003","Community First Bronze Value 1","46224TX001",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010003-01","Standard Bronze On Exchange Plan","61.54%","0.615444004535675","No","Yes","No","100%",,"$2,800","$20","$1,800","$200","$1,200","$1,000","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF.Bronze_Value1.IF.clean_10-12-152.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","5"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","2","46224","TX","Individual","No","74-2723334","46224TX0010003","Community First Bronze Value 1","46224TX001",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Bronze_Value1_0CSV.IndividualFamily.clean10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","6"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","2","46224","TX","Individual","No","74-2723334","46224TX0010003","Community First Bronze Value 1","46224TX001",,"TXN001","TXS001","TXF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010003-03","Limited Cost Sharing Plan Variation","61.54%","0.615444004535675","No","Yes","No","100%",,"$2,800","$20","$1,800","$200","$1,200","$1,000","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Bronze_Value1.LMTD_IndividualFamily_clean.9-23-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","7"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","2","46224","TX","Individual","No","74-2723334","46224TX0010006","Community First Bronze Value 2","46224TX001",,"TXN001","TXS001","TXF002","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010006-00","Standard Bronze Off Exchange Plan","59.56%","0.595569908618927","No","Yes","No","100%",,"$2,800","$20","$0","$200","$1,200","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Bronze_Value2IF.clean._10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","8"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","2","46224","TX","Individual","No","74-2723334","46224TX0010006","Community First Bronze Value 2","46224TX001",,"TXN001","TXS001","TXF002","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010006-01","Standard Bronze On Exchange Plan","59.56%","0.595569908618927","No","Yes","No","100%",,"$2,800","$20","$0","$200","$1,200","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Bronze_Value2IF.clean._10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","9"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","2","46224","TX","Individual","No","74-2723334","46224TX0010006","Community First Bronze Value 2","46224TX001",,"TXN001","TXS001","TXF002","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Bronze_Value2.0CSV.IndFam.clean.9-23-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","10"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","2","46224","TX","Individual","No","74-2723334","46224TX0010006","Community First Bronze Value 2","46224TX001",,"TXN001","TXS001","TXF002","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0010006-03","Limited Cost Sharing Plan Variation","59.56%","0.595569908618927","No","Yes","No","100%",,"$2,800","$20","$0","$200","$1,200","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Bronze_Value2.LMTD.IndFam.clean.9-23-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","11"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","3","46224","TX","Individual","No","74-2723334","46224TX0030001","Community First Zero Deductible Silver","46224TX003",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0030001-00","Standard Silver Off Exchange Plan","71.13%","0","No","Yes","No","100%",,"$0","$1,300","$0","$200","$0","$3,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Silver_0Ded.IndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","4"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","3","46224","TX","Individual","No","74-2723334","46224TX0030001","Community First Zero Deductible Silver","46224TX003",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0030001-01","Standard Silver On Exchange Plan","71.13%","0","No","Yes","No","100%",,"$0","$1,300","$0","$200","$0","$3,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Silver_0Ded.IndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","5"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","3","46224","TX","Individual","No","74-2723334","46224TX0030001","Community First Zero Deductible Silver","46224TX003",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0030001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_SilverZeroDeductible_0CSV_IndividualFamily_clean.9-28-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","6"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","3","46224","TX","Individual","No","74-2723334","46224TX0030001","Community First Zero Deductible Silver","46224TX003",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0030001-03","Limited Cost Sharing Plan Variation","71.13%","0","No","Yes","No","100%",,"$0","$1,300","$0","$200","$0","$3,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Silver_0DedLMTD_IndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","7"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","3","46224","TX","Individual","No","74-2723334","46224TX0030001","Community First Zero Deductible Silver","46224TX003",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0030001-04","73% AV Level Silver Plan","73.85%","0","No","Yes","No","100%",,"$0","$1,000","$0","$200","$0","$3,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Silver_0Ded.73.IndividualFamily_clean.9-28-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","8"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","3","46224","TX","Individual","No","74-2723334","46224TX0030001","Community First Zero Deductible Silver","46224TX003",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0030001-05","87% AV Level Silver Plan","87.82%","0","No","Yes","No","100%",,"$0","$600","$0","$200","$0","$1,900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Silver_0Ded.87.IndividualFamily_clean_9-28-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","9"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","3","46224","TX","Individual","No","74-2723334","46224TX0030001","Community First Zero Deductible Silver","46224TX003",,"TXN001","TXS001","TXF006","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0030001-06","94% AV Level Silver Plan","94.38%","0","No","Yes","No","100%",,"$0","$400","$0","$200","$0","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Silver_0Ded.94.IndividualFamily.clean_9-28-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","10"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","3","46224","TX","Individual","No","74-2723334","46224TX0030002","Community First Zero Deductible Gold","46224TX003",,"TXN001","TXS001","TXF007","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0030002-00","Standard Gold Off Exchange Plan","80.35%","0","No","Yes","No","100%",,"$0","$1,000","$0","$200","$0","$2,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Gold.Zero.Ded%2BVision-IndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","11"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","3","46224","TX","Individual","No","74-2723334","46224TX0030002","Community First Zero Deductible Gold","46224TX003",,"TXN001","TXS001","TXF007","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0030002-01","Standard Gold On Exchange Plan","80.35%","0","No","Yes","No","100%",,"$0","$1,000","$0","$200","$0","$2,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Gold.Zero.Ded%2BVision-IndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","12"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","3","46224","TX","Individual","No","74-2723334","46224TX0030002","Community First Zero Deductible Gold","46224TX003",,"TXN001","TXS001","TXF007","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0030002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Gold.Zero.Ded_0CSV%2BVision.IndFam.clean_9-23-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","13"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","3","46224","TX","Individual","No","74-2723334","46224TX0030002","Community First Zero Deductible Gold","46224TX003",,"TXN001","TXS001","TXF007","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0030002-03","Limited Cost Sharing Plan Variation","80.35%","0","No","Yes","No","100%",,"$0","$1,000","$0","$200","$0","$2,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Gold.Zero.Ded.LMTD%2BVision-IndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","14"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","4","46224","TX","Individual","No","74-2723334","46224TX0050001","Community First Silver 1 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9848",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050001-00","Standard Silver Off Exchange Plan","69.94%","0.699444711208344","No","Yes","No","100%",,"$2,800","$20","$900","$200","$1,200","$1,000","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Silver_Plus1%2BVisionIndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","4"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","4","46224","TX","Individual","No","74-2723334","46224TX0050001","Community First Silver 1 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9848",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050001-01","Standard Silver On Exchange Plan","69.94%","0.699444711208344","No","Yes","No","100%",,"$2,800","$20","$900","$200","$1,200","$1,000","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Silver_Plus1%2BVisionIndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","5"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","4","46224","TX","Individual","No","74-2723334","46224TX0050001","Community First Silver 1 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9848",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_SilverPlus1_0CSV%2BVision_IndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","6"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","4","46224","TX","Individual","No","74-2723334","46224TX0050001","Community First Silver 1 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9848",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050001-03","Limited Cost Sharing Plan Variation","69.94%","0.699444711208344","No","Yes","No","100%",,"$2,800","$20","$900","$200","$1,200","$1,000","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016_SBC_CF_Silver_Plus1LMTD%2BVisionIndividualFamily_clean_10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","7"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","4","46224","TX","Individual","No","74-2723334","46224TX0050001","Community First Silver 1 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9848",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050001-04","73% AV Level Silver Plan","73.21%","0.732124626636505","No","Yes","No","100%",,"$2,800","$20","$900","$200","$1,200","$1,000","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_S73_Plus1%2BVision.IndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","8"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","4","46224","TX","Individual","No","74-2723334","46224TX0050001","Community First Silver 1 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9848",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050001-05","87% AV Level Silver Plan","86.01%","0.860137462615967","No","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$900","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_S87_Plus1%2BVisionIndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","9"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","4","46224","TX","Individual","No","74-2723334","46224TX0050001","Community First Silver 1 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9848",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050001-06","94% AV Level Silver Plan","93.55%","0.935503840446472","No","Yes","No","100%",,"$200","$10","$700","$200","$200","$300","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_S94_Plus1%2BVisionIndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","10"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","4","46224","TX","Individual","No","74-2723334","46224TX0050002","Community First Gold Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF005","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9866",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050002-00","Standard Gold Off Exchange Plan","80.68%","0.806796252727509","No","Yes","No","100%",,"$1,500","$20","$900","$200","$1,200","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Premiere.Gold%2BVision_IndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","11"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","4","46224","TX","Individual","No","74-2723334","46224TX0050002","Community First Gold Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF005","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9866",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050002-01","Standard Gold On Exchange Plan","80.68%","0.806796252727509","No","Yes","No","100%",,"$1,500","$20","$900","$200","$1,200","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Premiere.Gold%2BVision_IndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","12"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","4","46224","TX","Individual","No","74-2723334","46224TX0050002","Community First Gold Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF005","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9866",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Premiere.Gold.0CSV%2BVisionIndividualFamily_clean_10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","13"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","4","46224","TX","Individual","No","74-2723334","46224TX0050002","Community First Gold Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF005","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9866",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050002-03","Limited Cost Sharing Plan Variation","80.68%","0.806796252727509","No","Yes","No","100%",,"$1,500","$20","$900","$200","$1,200","$800","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Premiere.GoldLMTD%2BVisionIndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","14"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","4","46224","TX","Individual","No","74-2723334","46224TX0050004","Community First Silver 2 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.984",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050004-00","Standard Silver Off Exchange Plan","68.16%","0.681625247001648","No","Yes","No","100%",,"$2,800","$20","$1,300","$200","$1,200","$1,000","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Silver_Plus2%2BVisionIndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","15"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","4","46224","TX","Individual","No","74-2723334","46224TX0050004","Community First Silver 2 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.984",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050004-01","Standard Silver On Exchange Plan","68.16%","0.681625247001648","No","Yes","No","100%",,"$2,800","$20","$1,300","$200","$1,200","$1,000","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Silver_Plus2%2BVisionIndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","16"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","4","46224","TX","Individual","No","74-2723334","46224TX0050004","Community First Silver 2 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.984",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_SilverPlus2_0CSV%2BVision_IndividualFamily_clean.9-24-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","17"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","4","46224","TX","Individual","No","74-2723334","46224TX0050004","Community First Silver 2 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.984",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050004-03","Limited Cost Sharing Plan Variation","68.16%","0.681625247001648","No","Yes","No","100%",,"$2,800","$20","$1,300","$200","$1,200","$1,000","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016_SBC_CF_Silver_Plus2_LMTD%2BVisionIndividualFamily_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","18"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","4","46224","TX","Individual","No","74-2723334","46224TX0050004","Community First Silver 2 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.984",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050004-04","73% AV Level Silver Plan","73.21%","0.732124626636505","No","Yes","No","100%",,"$2,800","$20","$900","$200","$1,200","$1,000","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_S73_Plus2%2BVisionIndividualFamily_Individual.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","19"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","4","46224","TX","Individual","No","74-2723334","46224TX0050004","Community First Silver 2 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.984",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050004-05","87% AV Level Silver Plan","86.01%","0.860137462615967","No","Yes","No","100%",,"$700","$20","$1,000","$200","$700","$900","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_S87_Plus2%2BVisionIndFam_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","20"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","4","46224","TX","Individual","No","74-2723334","46224TX0050004","Community First Silver 2 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.984",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050004-06","94% AV Level Silver Plan","93.55%","0.935503840446472","No","Yes","No","100%",,"$200","$10","$700","$200","$200","$300","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_S94_Plus2%2BVisionIndFam_clean.10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","21"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","5","46224","TX","Individual","No","74-2723334","46224TX0050003","Community First Bronze 1 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9836",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050003-00","Standard Bronze Off Exchange Plan","61.54%","0.615444004535675","No","Yes","No","100%",,"$2,800","$20","$1,800","$200","$1,200","$1,000","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF.Bronze_Value1.IF.Vis_clean_10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","4"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","5","46224","TX","Individual","No","74-2723334","46224TX0050003","Community First Bronze 1 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9836",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050003-01","Standard Bronze On Exchange Plan","61.54%","0.615444004535675","No","Yes","No","100%",,"$2,800","$20","$1,800","$200","$1,200","$1,000","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF.Bronze_Value1.IF.Vis_clean_10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","5"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","5","46224","TX","Individual","No","74-2723334","46224TX0050003","Community First Bronze 1 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9836",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Bronze_Value1_0CSV%2BVis.IndFam_clean_10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","6"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","5","46224","TX","Individual","No","74-2723334","46224TX0050003","Community First Bronze 1 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9836",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050003-03","Limited Cost Sharing Plan Variation","61.54%","0.615444004535675","No","Yes","No","100%",,"$2,800","$20","$1,800","$200","$1,200","$1,000","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Bronze_Value1.LMTD%2BVision_IndFam_clean_10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","7"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","5","46224","TX","Individual","No","74-2723334","46224TX0050006","Community First Bronze 2 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF002","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.983",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050006-00","Standard Bronze Off Exchange Plan","59.56%","0.595569908618927","No","Yes","No","100%",,"$2,800","$20","$0","$200","$1,200","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Bronze_Value2%2BVis.IF_clean_10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","8"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","5","46224","TX","Individual","No","74-2723334","46224TX0050006","Community First Bronze 2 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF002","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.983",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050006-01","Standard Bronze On Exchange Plan","59.56%","0.595569908618927","No","Yes","No","100%",,"$2,800","$20","$0","$200","$1,200","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Bronze_Value2%2BVis.IF_clean_10-12-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","9"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","5","46224","TX","Individual","No","74-2723334","46224TX0050006","Community First Bronze 2 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF002","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.983",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Bronze_Value2.0CSV%2BVision.IndFam.clean.9-21-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","10"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","5","46224","TX","Individual","No","74-2723334","46224TX0050006","Community First Bronze 2 Coinsur + Vision","46224TX005",,"TXN001","TXS001","TXF002","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.983",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0050006-03","Limited Cost Sharing Plan Variation","59.56%","0.595569908618927","No","Yes","No","100%",,"$2,800","$20","$0","$200","$1,200","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Bronze_Value2IndFam.LMTD%2BVision.clean.9-23-15.pdf","http://www.cfhp.com/Members/Documents/HIE-Plan-Brochure_Web.pdf","11"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","6","46224","TX","Individual","No","74-2723334","46224TX0060001","Community First Silver Copay + Vision","46224TX006",,"TXN001","TXS001","TXF006","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9858",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0060001-00","Standard Silver Off Exchange Plan","71.13%","0","No","Yes","No","100%",,"$0","$1,300","$0","$200","$0","$3,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Silver_0Ded.IndividualFamily%2BVision_clean.10-12-15.pdf",,"4"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","6","46224","TX","Individual","No","74-2723334","46224TX0060001","Community First Silver Copay + Vision","46224TX006",,"TXN001","TXS001","TXF006","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9858",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0060001-01","Standard Silver On Exchange Plan","71.13%","0","No","Yes","No","100%",,"$0","$1,300","$0","$200","$0","$3,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Silver_0Ded.IndividualFamily%2BVision_clean.10-12-15.pdf",,"5"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","6","46224","TX","Individual","No","74-2723334","46224TX0060001","Community First Silver Copay + Vision","46224TX006",,"TXN001","TXS001","TXF006","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9858",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0060001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_SilverZeroDeductible_0CSV%2BVision_IndividualFamily_clean.9-28-15.pdf",,"6"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","6","46224","TX","Individual","No","74-2723334","46224TX0060001","Community First Silver Copay + Vision","46224TX006",,"TXN001","TXS001","TXF006","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9858",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0060001-03","Limited Cost Sharing Plan Variation","71.13%","0","No","Yes","No","100%",,"$0","$1,300","$0","$200","$0","$3,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Silver_0DedLMTD%2BVision_IndividualFamily_clean.10-12-15.pdf",,"7"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","6","46224","TX","Individual","No","74-2723334","46224TX0060001","Community First Silver Copay + Vision","46224TX006",,"TXN001","TXS001","TXF006","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9858",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0060001-04","73% AV Level Silver Plan","73.85%","0","No","Yes","No","100%",,"$0","$1,000","$0","$200","$0","$3,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Silver_0Ded.73.IndividualFamily%2BVision_clean.9-28-15.pdf",,"8"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","6","46224","TX","Individual","No","74-2723334","46224TX0060001","Community First Silver Copay + Vision","46224TX006",,"TXN001","TXS001","TXF006","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9858",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0060001-05","87% AV Level Silver Plan","87.82%","0","No","Yes","No","100%",,"$0","$600","$0","$200","$0","$1,900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Silver_0Ded.87.IndividualFamily%2BVision_clean_9-28-15.pdf",,"9"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","6","46224","TX","Individual","No","74-2723334","46224TX0060001","Community First Silver Copay + Vision","46224TX006",,"TXN001","TXS001","TXF006","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9858",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0060001-06","94% AV Level Silver Plan","94.38%","0","No","Yes","No","100%",,"$0","$400","$0","$200","$0","$900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Silver_0Ded.94.Indivfamily%2BVision.clean_9-28-15.pdf",,"10"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","6","46224","TX","Individual","No","74-2723334","46224TX0060002","Community First Gold Copay + Vision","46224TX006",,"TXN001","TXS001","TXF007","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9868",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0060002-00","Standard Gold Off Exchange Plan","80.35%","0","No","Yes","No","100%",,"$0","$900","$0","$200","$0","$2,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Gold.Zero.Ded%2BVision-IndividualFamily_clean.10-12-15.pdf",,"11"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","6","46224","TX","Individual","No","74-2723334","46224TX0060002","Community First Gold Copay + Vision","46224TX006",,"TXN001","TXS001","TXF007","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9868",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0060002-01","Standard Gold On Exchange Plan","80.35%","0","No","Yes","No","100%",,"$0","$900","$0","$200","$0","$2,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Gold.Zero.Ded%2BVision-IndividualFamily_clean.10-12-15.pdf",,"12"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","6","46224","TX","Individual","No","74-2723334","46224TX0060002","Community First Gold Copay + Vision","46224TX006",,"TXN001","TXS001","TXF007","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9868",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0060002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Gold.Zero.Ded_0CSV%2BVision.IndFam.clean_9-23-15.pdf",,"13"
"2016","TX","46224","HIOS","7","2016-07-12 17:05:10","6","46224","TX","Individual","No","74-2723334","46224TX0060002","Community First Gold Copay + Vision","46224TX006",,"TXN001","TXS001","TXF007","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9868",,,,"5","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://cfhp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.cfhp.com/images/uploads/CFHPExchangeform2016.pdf","46224TX0060002-03","Limited Cost Sharing Plan Variation","80.35%","0","No","Yes","No","100%",,"$0","$900","$0","$200","$0","$2,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.cfhp.com/images/uploads/2016SBC_CF_Gold.Zero.Ded.LMTD%2BVision-IndividualFamily_clean.10-12-15.pdf",,"14"
"2016","TX","47665","HIOS","3","2015-08-27 11:14:25","1","47665","TX","Individual","Yes","95-6042390","47665TX0020003","BESTOne Advantage Gold","47665TX002",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.27","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TX/2016/TX_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","TX","47665","HIOS","3","2015-08-27 11:14:25","1","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010007","BESTDental Premium","47665TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.42","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TX/2016/TX_BESTDental_Premium_Plan.pdf","4"
"2016","TX","47665","HIOS","3","2015-08-27 11:14:25","1","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010007","BESTDental Premium","47665TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.42","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TX/2016/TX_BESTDental_Premium_Plan.pdf","5"
"2016","TX","47665","HIOS","3","2015-08-27 11:14:25","1","47665","TX","Individual","Yes","95-6042390","47665TX0020003","BESTOne Advantage Gold","47665TX002",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.27","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TX/2016/TX_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","TX","47665","HIOS","3","2015-08-27 11:14:25","1","47665","TX","Individual","Yes","95-6042390","47665TX0020004","BESTOne Plus Gold","47665TX002",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.27","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TX/2016/TX_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","TX","47665","HIOS","3","2015-08-27 11:14:25","1","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010008","BESTDental Standard - H","47665TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.42","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TX/2016/TX_BESTDental_Standard-H_Plan.pdf","6"
"2016","TX","47665","HIOS","3","2015-08-27 11:14:25","1","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010008","BESTDental Standard - H","47665TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.42","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TX/2016/TX_BESTDental_Standard-H_Plan.pdf","7"
"2016","TX","47665","HIOS","3","2015-08-27 11:14:25","1","47665","TX","Individual","Yes","95-6042390","47665TX0020004","BESTOne Plus Gold","47665TX002",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.27","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TX/2016/TX_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","TX","47665","HIOS","3","2015-08-27 11:14:25","1","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010010","BESTDental Choice - H","47665TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.42","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TX/2016/TX_BESTDental_Choice-H_Plan.pdf","8"
"2016","TX","47665","HIOS","3","2015-08-27 11:14:25","1","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010010","BESTDental Choice - H","47665TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.42","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TX/2016/TX_BESTDental_Choice-H_Plan.pdf","9"
"2016","TX","47665","HIOS","3","2015-08-27 11:14:25","2","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010009","BESTDental Standard - L","47665TX001",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.04","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TX/2016/TX_BESTDental_Standard-L_Plan.pdf","4"
"2016","TX","47665","HIOS","3","2015-08-27 11:14:25","2","47665","TX","Individual","Yes","95-6042390","47665TX0020005","BESTOne Plus Silver","47665TX002",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.82","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TX/2016/TX_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","TX","47665","HIOS","3","2015-08-27 11:14:25","2","47665","TX","Individual","Yes","95-6042390","47665TX0020005","BESTOne Plus Silver","47665TX002",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.82","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TX/2016/TX_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","TX","47665","HIOS","3","2015-08-27 11:14:25","2","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010009","BESTDental Standard - L","47665TX001",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.04","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TX/2016/TX_BESTDental_Standard-L_Plan.pdf","5"
"2016","TX","47665","HIOS","3","2015-08-27 11:14:25","2","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010011","BESTDental Choice - L","47665TX001",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.04","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TX/2016/TX_BESTDental_Choice-L_Plan.pdf","6"
"2016","TX","47665","HIOS","3","2015-08-27 11:14:25","2","47665","TX","Individual","Yes","95-6042390","47665TX0020006","BESTOne Basic Silver","47665TX002",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.82","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TX/2016/TX_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","TX","47665","HIOS","3","2015-08-27 11:14:25","2","47665","TX","Individual","Yes","95-6042390","47665TX0020006","BESTOne Basic Silver","47665TX002",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.82","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TX/2016/TX_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","TX","47665","HIOS","3","2015-08-27 11:14:25","2","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010011","BESTDental Choice - L","47665TX001",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.04","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TX/2016/TX_BESTDental_Choice-L_Plan.pdf","7"
"2016","TX","47665","HIOS","3","2015-08-27 11:14:25","2","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010012","BESTDental Value","47665TX001",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.04","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TX/2016/TX_BESTDental_Value_Plan.pdf","8"
"2016","TX","47665","HIOS","3","2015-08-27 11:14:25","2","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010012","BESTDental Value","47665TX001",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.04","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47665TX0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/TX/2016/TX_BESTDental_Value_Plan.pdf","9"
"2016","TX","48364","HIOS","2","2015-08-21 03:45:06","1","48364","TX","SHOP (Small Group)","Yes","75-2046497","48364TX0030001","Family Basic Dental Plan (Low)","48364TX003",,"TXN001","TXS001",,"Existing","HMO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$10.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","48364TX0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48057","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48056","4"
"2016","TX","48364","HIOS","2","2015-08-21 03:45:06","1","48364","TX","SHOP (Small Group)","Yes","75-2046497","48364TX0030001","Family Basic Dental Plan (Low)","48364TX003",,"TXN001","TXS001",,"Existing","HMO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$10.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","48364TX0030001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48057","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48056","5"
"2016","TX","48364","HIOS","2","2015-08-21 03:45:06","2","48364","TX","SHOP (Small Group)","Yes","75-2046497","48364TX0040001","Family Enhanced Dental Plan (High)","48364TX004",,"TXN001","TXS001",,"Existing","HMO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$12.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","48364TX0040001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49128","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49127","4"
"2016","TX","48364","HIOS","2","2015-08-21 03:45:06","2","48364","TX","SHOP (Small Group)","Yes","75-2046497","48364TX0040001","Family Enhanced Dental Plan (High)","48364TX004",,"TXN001","TXS001",,"Existing","HMO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$12.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No",,"","48364TX0040001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49128","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49127","5"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","1","55409","TX","Individual","Yes","59-1031071","55409TX0030001","Cigna Dental Pediatric","55409TX003","7730182962","TXN003","TXS004",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$16.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","All Services","Yes",,"","55409TX0030001-00","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/individuals-families/2016-plans/sob/texas/dental-pediatric","4"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","1","55409","TX","Individual","Yes","59-1031071","55409TX0030001","Cigna Dental Pediatric","55409TX003","7730182962","TXN003","TXS004",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$16.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","All Services","Yes",,"","55409TX0030001-01","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/individuals-families/2016-plans/sob/texas/dental-pediatric","5"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","2","55409","TX","Individual","Yes","59-1031071","55409TX0030002","Cigna Dental Family + Pediatric","55409TX003","7730182962","TXN003","TXS004",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","All Services","Yes",,"","55409TX0030002-01","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.cigna.com/individuals-families/2016-plans/sob/texas/dental-family-ped","4"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","3","55409","TX","Individual","No","59-1031071","55409TX0060001","Cigna FocusIn HSA Bronze 6000","55409TX006","7730182962","TXN002","TXS003","TXF008","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060001-00","Standard Bronze Off Exchange Plan",,"0.61153781414032","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,030","$0","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/hsa-bronze-6000","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/hsa-bronze-6000","4"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","3","55409","TX","Individual","No","59-1031071","55409TX0060001","Cigna FocusIn HSA Bronze 6000","55409TX006","7730182962","TXN002","TXS003","TXF008","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060001-01","Standard Bronze On Exchange Plan",,"0.61153781414032","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,030","$0","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/hsa-bronze-6000","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/hsa-bronze-6000","5"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","3","55409","TX","Individual","No","59-1031071","55409TX0060001","Cigna FocusIn HSA Bronze 6000","55409TX006","7730182962","TXN002","TXS003","TXF008","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas/epo/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas/epo/naan-300b","6"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","3","55409","TX","Individual","No","59-1031071","55409TX0060001","Cigna FocusIn HSA Bronze 6000","55409TX006","7730182962","TXN002","TXS003","TXF008","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060001-03","Limited Cost Sharing Plan Variation",,"0.61153781414032","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,030","$0","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/hsa-bronze-6000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/hsa-bronze-6000-naan-300a","7"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","3","55409","TX","Individual","No","59-1031071","55409TX0060003","Cigna FocusIn HSA Silver 2700","55409TX006","7730182962","TXN002","TXS003","TXF010","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060003-00","Standard Silver Off Exchange Plan",,"0.680516302585602","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$350","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/hsa-silver-2700","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/hsa-silver-2700","8"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","3","55409","TX","Individual","No","59-1031071","55409TX0060003","Cigna FocusIn HSA Silver 2700","55409TX006","7730182962","TXN002","TXS003","TXF010","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060003-01","Standard Silver On Exchange Plan",,"0.680516302585602","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$350","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/hsa-silver-2700","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/hsa-silver-2700","9"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","3","55409","TX","Individual","No","59-1031071","55409TX0060003","Cigna FocusIn HSA Silver 2700","55409TX006","7730182962","TXN002","TXS003","TXF010","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas/epo/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas/epo/naan-300b","10"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","3","55409","TX","Individual","No","59-1031071","55409TX0060003","Cigna FocusIn HSA Silver 2700","55409TX006","7730182962","TXN002","TXS003","TXF010","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060003-03","Limited Cost Sharing Plan Variation",,"0.680516302585602","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$350","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/hsa-silver-2700-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/hsa-silver-2700-naan-300a","11"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","3","55409","TX","Individual","No","59-1031071","55409TX0060003","Cigna FocusIn HSA Silver 2700","55409TX006","7730182962","TXN002","TXS003","TXF010","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060003-04","73% AV Level Silver Plan",,"0.720354199409485","Yes","Yes","No","100%",,"$2,100","$0","$800","$30","$2,100","$0","$440","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/hsa-silver-2700-250","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/hsa-silver-2700-250","12"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","3","55409","TX","Individual","No","59-1031071","55409TX0060003","Cigna FocusIn HSA Silver 2700","55409TX006","7730182962","TXN002","TXS003","TXF010","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060003-05","87% AV Level Silver Plan",,"0.860987782478333","Yes","Yes","No","100%",,"$500","$0","$1,040","$30","$500","$0","$680","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/hsa-silver-2700-200","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/hsa-silver-2700-200","13"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","3","55409","TX","Individual","No","59-1031071","55409TX0060003","Cigna FocusIn HSA Silver 2700","55409TX006","7730182962","TXN002","TXS003","TXF010","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060003-06","94% AV Level Silver Plan",,"0.9306760430336","Yes","Yes","No","100%",,"$100","$0","$730","$30","$100","$0","$490","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/hsa-silver-2700-150","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/hsa-silver-2700-150","14"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","4","55409","TX","Individual","No","59-1031071","55409TX0060002","Cigna FocusIn Flex Bronze 6400","55409TX006","7730182962","TXN002","TXS003","TXF009","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060002-00","Standard Bronze Off Exchange Plan","61.71%","0.634117603302002","Yes","Yes","No","100%",,"$5,170","$80","$330","$30","$140","$840","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-bronze-6400","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-bronze-6400","4"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","4","55409","TX","Individual","No","59-1031071","55409TX0060002","Cigna FocusIn Flex Bronze 6400","55409TX006","7730182962","TXN002","TXS003","TXF009","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060002-01","Standard Bronze On Exchange Plan","61.71%","0.634117603302002","Yes","Yes","No","100%",,"$5,170","$80","$330","$30","$140","$840","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-bronze-6400","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-bronze-6400","5"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","4","55409","TX","Individual","No","59-1031071","55409TX0060002","Cigna FocusIn Flex Bronze 6400","55409TX006","7730182962","TXN002","TXS003","TXF009","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas/epo/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas/epo/naan-300b","6"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","4","55409","TX","Individual","No","59-1031071","55409TX0060002","Cigna FocusIn Flex Bronze 6400","55409TX006","7730182962","TXN002","TXS003","TXF009","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060002-03","Limited Cost Sharing Plan Variation","61.71%","0.634117603302002","Yes","Yes","No","100%",,"$5,170","$80","$330","$30","$140","$840","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-bronze-6400-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-bronze-6400-naan-300a","7"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","4","55409","TX","Individual","No","59-1031071","55409TX0060006","Cigna FocusIn Flex Silver 2000","55409TX006","7730182962","TXN002","TXS003","TXF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060006-00","Standard Silver Off Exchange Plan","71.30%","0.71729987859726","Yes","Yes","No","100%",,"$2,000","$40","$1,570","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-silver-2000","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-silver-2000","8"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","4","55409","TX","Individual","No","59-1031071","55409TX0060006","Cigna FocusIn Flex Silver 2000","55409TX006","7730182962","TXN002","TXS003","TXF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060006-01","Standard Silver On Exchange Plan","71.30%","0.71729987859726","Yes","Yes","No","100%",,"$2,000","$40","$1,570","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-silver-2000","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-silver-2000","9"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","4","55409","TX","Individual","No","59-1031071","55409TX0060006","Cigna FocusIn Flex Silver 2000","55409TX006","7730182962","TXN002","TXS003","TXF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas/epo/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas/epo/naan-300b","10"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","4","55409","TX","Individual","No","59-1031071","55409TX0060006","Cigna FocusIn Flex Silver 2000","55409TX006","7730182962","TXN002","TXS003","TXF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060006-03","Limited Cost Sharing Plan Variation","71.30%","0.71729987859726","Yes","Yes","No","100%",,"$2,000","$40","$1,570","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-silver-2000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-silver-2000-naan-300a","11"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","4","55409","TX","Individual","No","59-1031071","55409TX0060006","Cigna FocusIn Flex Silver 2000","55409TX006","7730182962","TXN002","TXS003","TXF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060006-04","73% AV Level Silver Plan","73.34%","0.737254202365875","Yes","Yes","No","100%",,"$1,900","$40","$1,600","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-silver-2000-250","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-silver-2000-250","12"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","4","55409","TX","Individual","No","59-1031071","55409TX0060006","Cigna FocusIn Flex Silver 2000","55409TX006","7730182962","TXN002","TXS003","TXF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060006-05","87% AV Level Silver Plan","86.32%","0.868290364742279","Yes","Yes","No","100%",,"$150","$40","$1,420","$30","$150","$440","$30","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-silver-2000-200","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-silver-2000-200","13"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","4","55409","TX","Individual","No","59-1031071","55409TX0060006","Cigna FocusIn Flex Silver 2000","55409TX006","7730182962","TXN002","TXS003","TXF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060006-06","94% AV Level Silver Plan","93.28%","0.936175405979156","Yes","Yes","No","100%",,"$0","$30","$360","$30","$0","$360","$10","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-silver-2000-150","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-silver-2000-150","14"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","4","55409","TX","Individual","No","59-1031071","55409TX0060004","Cigna FocusIn Flex Silver 4000","55409TX006","7730182962","TXN002","TXS003","TXF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060004-00","Standard Silver Off Exchange Plan","68.48%","0.687563359737396","Yes","Yes","No","100%",,"$4,000","$40","$970","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-silver-4000","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-silver-4000","15"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","4","55409","TX","Individual","No","59-1031071","55409TX0060004","Cigna FocusIn Flex Silver 4000","55409TX006","7730182962","TXN002","TXS003","TXF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060004-01","Standard Silver On Exchange Plan","68.48%","0.687563359737396","Yes","Yes","No","100%",,"$4,000","$40","$970","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-silver-4000","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-silver-4000","16"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","4","55409","TX","Individual","No","59-1031071","55409TX0060004","Cigna FocusIn Flex Silver 4000","55409TX006","7730182962","TXN002","TXS003","TXF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas/epo/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas/epo/naan-300b","17"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","4","55409","TX","Individual","No","59-1031071","55409TX0060004","Cigna FocusIn Flex Silver 4000","55409TX006","7730182962","TXN002","TXS003","TXF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060004-03","Limited Cost Sharing Plan Variation","68.48%","0.687563359737396","Yes","Yes","No","100%",,"$4,000","$40","$970","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-silver-4000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-silver-4000-naan-300a","18"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","4","55409","TX","Individual","No","59-1031071","55409TX0060004","Cigna FocusIn Flex Silver 4000","55409TX006","7730182962","TXN002","TXS003","TXF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060004-04","73% AV Level Silver Plan","72.01%","0.723574161529541","Yes","Yes","No","100%",,"$2,800","$40","$1,330","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-silver-4000-250","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-silver-4000-250","19"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","4","55409","TX","Individual","No","59-1031071","55409TX0060004","Cigna FocusIn Flex Silver 4000","55409TX006","7730182962","TXN002","TXS003","TXF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060004-05","87% AV Level Silver Plan","86.05%","0.865179359912872","Yes","Yes","No","100%",,"$200","$40","$1,410","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-silver-4000-200","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-silver-4000-200","20"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","4","55409","TX","Individual","No","59-1031071","55409TX0060004","Cigna FocusIn Flex Silver 4000","55409TX006","7730182962","TXN002","TXS003","TXF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060004-06","94% AV Level Silver Plan","93.10%","0.933904051780701","Yes","Yes","No","100%",,"$100","$30","$360","$30","$100","$360","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-silver-4000-150","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-silver-4000-150","21"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","5","55409","TX","Individual","No","59-1031071","55409TX0060005","Cigna FocusIn Flex Silver 5000","55409TX006","7730182962","TXN002","TXS003","TXF014","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060005-00","Standard Silver Off Exchange Plan","68.59%","0.688715994358063","Yes","Yes","No","100%",,"$5,000","$40","$450","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-silver-5000","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-silver-5000","4"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","5","55409","TX","Individual","No","59-1031071","55409TX0060005","Cigna FocusIn Flex Silver 5000","55409TX006","7730182962","TXN002","TXS003","TXF014","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060005-01","Standard Silver On Exchange Plan","68.59%","0.688715994358063","Yes","Yes","No","100%",,"$5,000","$40","$450","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-silver-5000","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-silver-5000","5"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","5","55409","TX","Individual","No","59-1031071","55409TX0060005","Cigna FocusIn Flex Silver 5000","55409TX006","7730182962","TXN002","TXS003","TXF014","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas/epo/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas/epo/naan-300b","6"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","5","55409","TX","Individual","No","59-1031071","55409TX0060005","Cigna FocusIn Flex Silver 5000","55409TX006","7730182962","TXN002","TXS003","TXF014","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060005-03","Limited Cost Sharing Plan Variation","68.59%","0.688715994358063","Yes","Yes","No","100%",,"$5,000","$40","$450","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-silver-5000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-silver-5000-naan-300a","7"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","5","55409","TX","Individual","No","59-1031071","55409TX0060005","Cigna FocusIn Flex Silver 5000","55409TX006","7730182962","TXN002","TXS003","TXF014","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060005-04","73% AV Level Silver Plan","72.79%","0.731734693050385","Yes","Yes","No","100%",,"$3,100","$40","$830","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-silver-5000-250","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-silver-5000-250","8"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","5","55409","TX","Individual","No","59-1031071","55409TX0060005","Cigna FocusIn Flex Silver 5000","55409TX006","7730182962","TXN002","TXS003","TXF014","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060005-05","87% AV Level Silver Plan","86.92%","0.874993681907654","Yes","Yes","No","100%",,"$350","$40","$1,030","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-silver-5000-200","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-silver-5000-200","9"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","5","55409","TX","Individual","No","59-1031071","55409TX0060005","Cigna FocusIn Flex Silver 5000","55409TX006","7730182962","TXN002","TXS003","TXF014","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060005-06","94% AV Level Silver Plan","93.23%","0.935186922550201","Yes","Yes","No","100%",,"$150","$30","$350","$30","$150","$360","$10","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-silver-5000-150","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-silver-5000-150","10"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","5","55409","TX","Individual","No","59-1031071","55409TX0060007","Cigna FocusIn Flex Gold 1000","55409TX006","7730182962","TXN002","TXS003","TXF012","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060007-00","Standard Gold Off Exchange Plan","78.15%","0.784567058086395","Yes","Yes","No","100%",,"$1,000","$50","$1,250","$30","$140","$480","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-gold-1000","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-gold-1000","11"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","5","55409","TX","Individual","No","59-1031071","55409TX0060007","Cigna FocusIn Flex Gold 1000","55409TX006","7730182962","TXN002","TXS003","TXF012","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060007-01","Standard Gold On Exchange Plan","78.15%","0.784567058086395","Yes","Yes","No","100%",,"$1,000","$50","$1,250","$30","$140","$480","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-gold-1000","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-gold-1000","12"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","5","55409","TX","Individual","No","59-1031071","55409TX0060007","Cigna FocusIn Flex Gold 1000","55409TX006","7730182962","TXN002","TXS003","TXF012","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas/epo/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas/epo/naan-300b","13"
"2016","TX","55409","HIOS","6","2015-08-26 09:56:12","5","55409","TX","Individual","No","59-1031071","55409TX0060007","Cigna FocusIn Flex Gold 1000","55409TX006","7730182962","TXN002","TXS003","TXF012","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","55409TX0060007-03","Limited Cost Sharing Plan Variation","78.15%","0.784567058086395","Yes","Yes","No","100%",,"$1,000","$50","$1,250","$30","$140","$480","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-dallas-epo/flex-gold-1000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/texas-dallas-epo/flex-gold-1000-naan-300a","14"
"2016","TX","58609","HIOS","6","2015-08-25 05:06:23","1","58609","TX","Individual","Yes","20-2970185","58609TX0010001","DentaQuest PPO  Pediatric High","58609TX001","7083617218","TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$32.99","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","58609TX0010001-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/","4"
"2016","TX","58609","HIOS","6","2015-08-25 05:06:23","1","58609","TX","SHOP (Small Group)","Yes","20-2970185","58609TX0020003","DentaQuest PPO Family High","58609TX002","7083617218","TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","58609TX0020003-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/","4"
"2016","TX","58609","HIOS","6","2015-08-25 05:06:23","1","58609","TX","SHOP (Small Group)","Yes","20-2970185","58609TX0020003","DentaQuest PPO Family High","58609TX002","7083617218","TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","58609TX0020003-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/","5"
"2016","TX","58609","HIOS","6","2015-08-25 05:06:23","1","58609","TX","Individual","Yes","20-2970185","58609TX0010001","DentaQuest PPO  Pediatric High","58609TX001","7083617218","TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$32.99","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","58609TX0010001-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/","5"
"2016","TX","58609","HIOS","6","2015-08-25 05:06:23","1","58609","TX","SHOP (Small Group)","Yes","20-2970185","58609TX0020004","DentaQuest PPO Family Low","58609TX002","7083617218","TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","58609TX0020004-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/","6"
"2016","TX","58609","HIOS","6","2015-08-25 05:06:23","1","58609","TX","SHOP (Small Group)","Yes","20-2970185","58609TX0020004","DentaQuest PPO Family Low","58609TX002","7083617218","TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","58609TX0020004-01","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/","7"
"2016","TX","58609","HIOS","6","2015-08-25 05:06:23","2","58609","TX","Individual","Yes","20-2970185","58609TX0010003","DentaQuest PPO Family High","58609TX001","7083617218","TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.99","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","58609TX0010003-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/","4"
"2016","TX","58609","HIOS","6","2015-08-25 05:06:23","2","58609","TX","Individual","Yes","20-2970185","58609TX0010003","DentaQuest PPO Family High","58609TX001","7083617218","TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.99","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","58609TX0010003-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/","5"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740004","Humana Silver 3800/Rio Grande EPOx","63141TX074",,"TXN001","TXS003","TXF003","Existing","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740004-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611856","http://apps.humana.com/marketing/documents.asp?file=2594358","7"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740004","Humana Silver 3800/Rio Grande EPOx","63141TX074",,"TXN001","TXS003","TXF003","Existing","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740004-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611869","http://apps.humana.com/marketing/documents.asp?file=2624752","8"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740004","Humana Silver 3800/Rio Grande EPOx","63141TX074",,"TXN001","TXS003","TXF003","Existing","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740004-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$460","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611882","http://apps.humana.com/marketing/documents.asp?file=2624765","9"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740004","Humana Silver 3800/Rio Grande EPOx","63141TX074",,"TXN001","TXS003","TXF003","Existing","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740004-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611895","http://apps.humana.com/marketing/documents.asp?file=2624778","10"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740032","Humana Silver 3800/Rio Grande EPOx","63141TX074",,"TXN001","TXS004","TXF003","Existing","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740032-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611830","http://apps.humana.com/marketing/documents.asp?file=2594358","11"
"2016","TX","58609","HIOS","6","2015-08-25 05:06:23","2","58609","TX","Individual","Yes","20-2970185","58609TX0010004","DentaQuest PPO Family Low","58609TX001","7083617218","TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","58609TX0010004-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/","6"
"2016","TX","58609","HIOS","6","2015-08-25 05:06:23","2","58609","TX","Individual","Yes","20-2970185","58609TX0010004","DentaQuest PPO Family Low","58609TX001","7083617218","TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","58609TX0010004-01","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/tx/","http://www.dentaquest.com/marketplace/tx/","7"
"2016","TX","59246","HIOS","3","2015-08-27 11:14:25","1","59246","TX","Individual","Yes","95-2371728","59246TX0010001","PPO MAC","59246TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$34.57","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Any service received outside of the state of Texas","Yes",,"","59246TX0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","59246","HIOS","3","2015-08-27 11:14:25","1","59246","TX","SHOP (Small Group)","Yes","95-2371728","59246TX0020001","PPO MAC","59246TX002",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$28.39","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Any service received outside of the state of Texas","Yes",,"","59246TX0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","59246","HIOS","3","2015-08-27 11:14:25","1","59246","TX","SHOP (Small Group)","Yes","95-2371728","59246TX0020002","PPO MAC","59246TX002",,"TXN001","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$21.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Any service received outside of the state of Texas","Yes",,"","59246TX0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","TX","59246","HIOS","3","2015-08-27 11:14:25","1","59246","TX","Individual","Yes","95-2371728","59246TX0010002","PPO MAC","59246TX001",,"TXN001","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$28.22","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Any service received outside of the state of Texas","Yes",,"","59246TX0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","TX","59246","HIOS","3","2015-08-27 11:14:25","2","59246","TX","Individual","Yes","95-2371728","59246TX0010003","PPO MAC","59246TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$35.64","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Any service received outside of the state of Texas","Yes",,"","59246TX0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","59246","HIOS","3","2015-08-27 11:14:25","2","59246","TX","SHOP (Small Group)","Yes","95-2371728","59246TX0020003","PPO MAC","59246TX002",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$29.27","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Any service received outside of the state of Texas","Yes",,"","59246TX0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","61315","HIOS","5","2015-10-20 04:38:50","1","61315","TX","Individual","Yes","36-3757528","61315TX0010001","TruAssure Basic Adult or Child Dental Plan","61315TX001",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.10","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","61315TX0010001-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TX","https://www.truassure.com/brochure?state=TX","4"
"2016","TX","61315","HIOS","5","2015-10-20 04:38:50","1","61315","TX","SHOP (Small Group)","Yes","36-3757528","61315TX0030001","TruAssure Dental Small Group Basic Plan","61315TX003",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.80","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","61315TX0030001-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","61315","HIOS","5","2015-10-20 04:38:50","1","61315","TX","SHOP (Small Group)","Yes","36-3757528","61315TX0040001","TruAssure Dental Small Group Preferred Plan","61315TX004",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.80","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","61315TX0040001-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","TX","61315","HIOS","5","2015-10-20 04:38:50","1","61315","TX","Individual","Yes","36-3757528","61315TX0010001","TruAssure Basic Adult or Child Dental Plan","61315TX001",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.10","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","61315TX0010001-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TX","https://www.truassure.com/brochure?state=TX","5"
"2016","TX","61315","HIOS","5","2015-10-20 04:38:50","2","61315","TX","Individual","Yes","36-3757528","61315TX0020001","TruAssure Preferred Adult or Child Dental Plan","61315TX002",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.65","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","61315TX0020001-00","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TX","https://www.truassure.com/brochure?state=TX","4"
"2016","TX","61315","HIOS","5","2015-10-20 04:38:50","2","61315","TX","Individual","Yes","36-3757528","61315TX0020001","TruAssure Preferred Adult or Child Dental Plan","61315TX002",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.65","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","61315TX0020001-01","Standard High On Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=TX","https://www.truassure.com/brochure?state=TX","5"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","1","63141","TX","Individual","Yes","39-1263473","63141TX0760001","Humana Dental Smart Choice","63141TX076",,"TXN002","TXS002",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.65","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","63141TX0760001-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","per group not applicable",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2613000","4"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","1","63141","TX","Individual","No","39-1263473","63141TX0740001","Humana Basic 6850/Rio Grande EPOx","63141TX074",,"TXN001","TXS003","TXF001","Existing","EPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","63141TX0740001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2611739","http://apps.humana.com/marketing/documents.asp?file=2594319","4"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","1","63141","TX","Individual","No","39-1263473","63141TX0740001","Humana Basic 6850/Rio Grande EPOx","63141TX074",,"TXN001","TXS003","TXF001","Existing","EPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","63141TX0740001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2611739","http://apps.humana.com/marketing/documents.asp?file=2594319","5"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","4","63141","TX","Individual","No","39-1263473","63141TX0740031","Humana Bronze 4850/Rio Grande EPOx","63141TX074",,"TXN001","TXS004","TXF002","Existing","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740031-03","Limited Cost Sharing Plan Variation","61.72%","0.588930368423462","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611817","http://apps.humana.com/marketing/documents.asp?file=2594345","11"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","1","63509","TX","Individual","No","20-3870730","63509TX0150001","Allegian Choice Gold HMO","63509TX015",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0150001-00","Standard Gold Off Exchange Plan",,"0.787872970104218","No","Yes","No","100%",,"$1,500","$300","$800","$200","$1,500","$700","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/HMOGold2016","http://www.allegianchoice.com/brochures","4"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","1","63509","TX","Individual","No","20-3870730","63509TX0150001","Allegian Choice Gold HMO","63509TX015",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0150001-01","Standard Gold On Exchange Plan",,"0.787872970104218","No","Yes","No","100%",,"$1,500","$300","$800","$200","$1,500","$700","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/HMOGold2016","http://www.allegianchoice.com/brochures","5"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","1","63509","TX","Individual","No","20-3870730","63509TX0150001","Allegian Choice Gold HMO","63509TX015",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0150001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/HMOGoldZCS2016","http://www.allegianchoice.com/brochures","6"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","1","63509","TX","Individual","No","20-3870730","63509TX0150001","Allegian Choice Gold HMO","63509TX015",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.999",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0150001-03","Limited Cost Sharing Plan Variation",,"0.787872970104218","No","Yes","No","100%",,"$1,500","$300","$800","$200","$1,500","$700","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/HMOGoldLCS2016","http://www.allegianchoice.com/brochures","7"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","1","63509","TX","Individual","No","20-3870730","63509TX0150002","Allegian Choice Silver HMO","63509TX015",,"TXN001","TXS001","TXF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9988",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0150002-00","Standard Silver Off Exchange Plan",,"0.681194186210632","No","Yes","No","100%",,"$5,500","$20","$300","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/HMOSilver2016","http://www.allegianchoice.com/brochures","8"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","1","63509","TX","Individual","No","20-3870730","63509TX0150002","Allegian Choice Silver HMO","63509TX015",,"TXN001","TXS001","TXF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9988",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0150002-01","Standard Silver On Exchange Plan",,"0.681194186210632","No","Yes","No","100%",,"$5,500","$20","$300","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/HMOSilver2016","http://www.allegianchoice.com/brochures","9"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","1","63141","TX","Individual","Yes","39-1263473","63141TX0760001","Humana Dental Smart Choice","63141TX076",,"TXN002","TXS002",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.65","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","63141TX0760001-01","Standard Low On Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","per group not applicable",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2613000","5"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","1","63141","TX","Individual","No","39-1263473","63141TX0740029","Humana Basic 6850/Rio Grande EPOx","63141TX074",,"TXN001","TXS004","TXF001","Existing","EPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","63141TX0740029-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2611739","http://apps.humana.com/marketing/documents.asp?file=2594319","6"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","1","63141","TX","Individual","No","39-1263473","63141TX0740029","Humana Basic 6850/Rio Grande EPOx","63141TX074",,"TXN001","TXS004","TXF001","Existing","EPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","63141TX0740029-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2611739","http://apps.humana.com/marketing/documents.asp?file=2594319","7"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","2","63141","TX","Individual","No","39-1263473","63141TX0740002","Humana Bronze 6450/Rio Grande EPOx","63141TX074",,"TXN001","TXS003","TXF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","63141TX0740002-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2611752","http://apps.humana.com/marketing/documents.asp?file=2594332","4"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","2","63141","TX","Individual","No","39-1263473","63141TX0740002","Humana Bronze 6450/Rio Grande EPOx","63141TX074",,"TXN001","TXS003","TXF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","63141TX0740002-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2611752","http://apps.humana.com/marketing/documents.asp?file=2594332","5"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","2","63141","TX","Individual","No","39-1263473","63141TX0740002","Humana Bronze 6450/Rio Grande EPOx","63141TX074",,"TXN001","TXS003","TXF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","63141TX0740002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2611765","http://apps.humana.com/marketing/documents.asp?file=2594332","6"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","2","63141","TX","Individual","No","39-1263473","63141TX0740002","Humana Bronze 6450/Rio Grande EPOx","63141TX074",,"TXN001","TXS003","TXF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","63141TX0740002-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2611778","http://apps.humana.com/marketing/documents.asp?file=2594332","7"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","2","63141","TX","Individual","No","39-1263473","63141TX0740030","Humana Bronze 6450/Rio Grande EPOx","63141TX074",,"TXN001","TXS004","TXF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","63141TX0740030-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2611752","http://apps.humana.com/marketing/documents.asp?file=2594332","8"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","2","63141","TX","Individual","No","39-1263473","63141TX0740030","Humana Bronze 6450/Rio Grande EPOx","63141TX074",,"TXN001","TXS004","TXF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","63141TX0740030-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2611752","http://apps.humana.com/marketing/documents.asp?file=2594332","9"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","2","63141","TX","Individual","No","39-1263473","63141TX0740030","Humana Bronze 6450/Rio Grande EPOx","63141TX074",,"TXN001","TXS004","TXF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","63141TX0740030-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2611765","http://apps.humana.com/marketing/documents.asp?file=2594332","10"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","2","63141","TX","Individual","No","39-1263473","63141TX0740030","Humana Bronze 6450/Rio Grande EPOx","63141TX074",,"TXN001","TXS004","TXF001","Existing","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Complete","63141TX0740030-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2611778","http://apps.humana.com/marketing/documents.asp?file=2594332","11"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740004","Humana Silver 3800/Rio Grande EPOx","63141TX074",,"TXN001","TXS003","TXF003","Existing","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740004-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611830","http://apps.humana.com/marketing/documents.asp?file=2594358","4"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740004","Humana Silver 3800/Rio Grande EPOx","63141TX074",,"TXN001","TXS003","TXF003","Existing","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740004-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611830","http://apps.humana.com/marketing/documents.asp?file=2594358","5"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740004","Humana Silver 3800/Rio Grande EPOx","63141TX074",,"TXN001","TXS003","TXF003","Existing","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611843","http://apps.humana.com/marketing/documents.asp?file=2594358","6"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740032","Humana Silver 3800/Rio Grande EPOx","63141TX074",,"TXN001","TXS004","TXF003","Existing","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740032-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611830","http://apps.humana.com/marketing/documents.asp?file=2594358","12"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740032","Humana Silver 3800/Rio Grande EPOx","63141TX074",,"TXN001","TXS004","TXF003","Existing","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740032-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611843","http://apps.humana.com/marketing/documents.asp?file=2594358","13"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740032","Humana Silver 3800/Rio Grande EPOx","63141TX074",,"TXN001","TXS004","TXF003","Existing","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740032-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611856","http://apps.humana.com/marketing/documents.asp?file=2594358","14"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740032","Humana Silver 3800/Rio Grande EPOx","63141TX074",,"TXN001","TXS004","TXF003","Existing","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740032-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611869","http://apps.humana.com/marketing/documents.asp?file=2624752","15"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","3","63509","TX","Individual","No","20-3870730","63509TX0160002","Allegian Choice Silver PPO 3500","63509TX016",,"TXN002","TXS002","TXF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9989",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160002-00","Standard Silver Off Exchange Plan",,"0.684366762638092","No","Yes","No","100%",,"$3,500","$20","$800","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/PPO3500Silver2016","http://www.allegianchoice.com/brochures","8"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","3","63509","TX","Individual","No","20-3870730","63509TX0160002","Allegian Choice Silver PPO 3500","63509TX016",,"TXN002","TXS002","TXF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9989",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160002-01","Standard Silver On Exchange Plan",,"0.684366762638092","No","Yes","No","100%",,"$3,500","$20","$800","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/PPO3500Silver2016","http://www.allegianchoice.com/brochures","9"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","3","63509","TX","Individual","No","20-3870730","63509TX0160002","Allegian Choice Silver PPO 3500","63509TX016",,"TXN002","TXS002","TXF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9989",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/PPO3500SilverZCS2016","http://www.allegianchoice.com/brochures","10"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","3","63509","TX","Individual","No","20-3870730","63509TX0160002","Allegian Choice Silver PPO 3500","63509TX016",,"TXN002","TXS002","TXF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9989",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160002-03","Limited Cost Sharing Plan Variation",,"0.684366762638092","No","Yes","No","100%",,"$3,500","$20","$800","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/PPO3500SilverLCS2016","http://www.allegianchoice.com/brochures","11"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740032","Humana Silver 3800/Rio Grande EPOx","63141TX074",,"TXN001","TXS004","TXF003","Existing","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740032-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$460","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611882","http://apps.humana.com/marketing/documents.asp?file=2624765","16"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740032","Humana Silver 3800/Rio Grande EPOx","63141TX074",,"TXN001","TXS004","TXF003","Existing","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740032-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611895","http://apps.humana.com/marketing/documents.asp?file=2624778","17"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740005","Humana Gold 2250/Rio Grande EPOx","63141TX074",,"TXN001","TXS003","TXF004","Existing","EPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740005-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611908","http://apps.humana.com/marketing/documents.asp?file=2594371","18"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740005","Humana Gold 2250/Rio Grande EPOx","63141TX074",,"TXN001","TXS003","TXF004","Existing","EPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740005-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611908","http://apps.humana.com/marketing/documents.asp?file=2594371","19"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740005","Humana Gold 2250/Rio Grande EPOx","63141TX074",,"TXN001","TXS003","TXF004","Existing","EPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611921","http://apps.humana.com/marketing/documents.asp?file=2594371","20"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740005","Humana Gold 2250/Rio Grande EPOx","63141TX074",,"TXN001","TXS003","TXF004","Existing","EPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740005-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611934","http://apps.humana.com/marketing/documents.asp?file=2594371","21"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740033","Humana Gold 2250/Rio Grande EPOx","63141TX074",,"TXN001","TXS004","TXF004","Existing","EPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740033-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$1,060","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611908","http://apps.humana.com/marketing/documents.asp?file=2594371","22"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740033","Humana Gold 2250/Rio Grande EPOx","63141TX074",,"TXN001","TXS004","TXF004","Existing","EPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740033-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$1,060","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611908","http://apps.humana.com/marketing/documents.asp?file=2594371","23"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740033","Humana Gold 2250/Rio Grande EPOx","63141TX074",,"TXN001","TXS004","TXF004","Existing","EPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740033-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611921","http://apps.humana.com/marketing/documents.asp?file=2594371","24"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","3","63141","TX","Individual","No","39-1263473","63141TX0740033","Humana Gold 2250/Rio Grande EPOx","63141TX074",,"TXN001","TXS004","TXF004","Existing","EPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740033-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$1,060","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611934","http://apps.humana.com/marketing/documents.asp?file=2594371","25"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","4","63141","TX","Individual","No","39-1263473","63141TX0740003","Humana Bronze 4850/Rio Grande EPOx","63141TX074",,"TXN001","TXS003","TXF002","Existing","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740003-00","Standard Bronze Off Exchange Plan","61.72%","0.588930368423462","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611791","http://apps.humana.com/marketing/documents.asp?file=2594345","4"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","4","63141","TX","Individual","No","39-1263473","63141TX0740003","Humana Bronze 4850/Rio Grande EPOx","63141TX074",,"TXN001","TXS003","TXF002","Existing","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740003-01","Standard Bronze On Exchange Plan","61.72%","0.588930368423462","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611791","http://apps.humana.com/marketing/documents.asp?file=2594345","5"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","4","63141","TX","Individual","No","39-1263473","63141TX0740003","Humana Bronze 4850/Rio Grande EPOx","63141TX074",,"TXN001","TXS003","TXF002","Existing","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611804","http://apps.humana.com/marketing/documents.asp?file=2594345","6"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","4","63141","TX","Individual","No","39-1263473","63141TX0740003","Humana Bronze 4850/Rio Grande EPOx","63141TX074",,"TXN001","TXS003","TXF002","Existing","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740003-03","Limited Cost Sharing Plan Variation","61.72%","0.588930368423462","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611817","http://apps.humana.com/marketing/documents.asp?file=2594345","7"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","4","63141","TX","Individual","No","39-1263473","63141TX0740031","Humana Bronze 4850/Rio Grande EPOx","63141TX074",,"TXN001","TXS004","TXF002","Existing","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740031-00","Standard Bronze Off Exchange Plan","61.72%","0.588930368423462","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611791","http://apps.humana.com/marketing/documents.asp?file=2594345","8"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","4","63141","TX","Individual","No","39-1263473","63141TX0740031","Humana Bronze 4850/Rio Grande EPOx","63141TX074",,"TXN001","TXS004","TXF002","Existing","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740031-01","Standard Bronze On Exchange Plan","61.72%","0.588930368423462","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611791","http://apps.humana.com/marketing/documents.asp?file=2594345","9"
"2016","TX","63141","HIOS","9","2016-01-22 04:00:42","4","63141","TX","Individual","No","39-1263473","63141TX0740031","Humana Bronze 4850/Rio Grande EPOx","63141TX074",,"TXN001","TXS004","TXF002","Existing","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Complete","63141TX0740031-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2611804","http://apps.humana.com/marketing/documents.asp?file=2594345","10"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","1","63509","TX","Individual","No","20-3870730","63509TX0150002","Allegian Choice Silver HMO","63509TX015",,"TXN001","TXS001","TXF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9988",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0150002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/HMOSilverZCS2016","http://www.allegianchoice.com/brochures","10"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","1","63509","TX","Individual","No","20-3870730","63509TX0150002","Allegian Choice Silver HMO","63509TX015",,"TXN001","TXS001","TXF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9988",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0150002-03","Limited Cost Sharing Plan Variation",,"0.681194186210632","No","Yes","No","100%",,"$5,500","$20","$300","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/HMOSilverLCS2016","http://www.allegianchoice.com/brochures","11"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","1","63509","TX","Individual","No","20-3870730","63509TX0150002","Allegian Choice Silver HMO","63509TX015",,"TXN001","TXS001","TXF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9988",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0150002-04","73% AV Level Silver Plan",,"0.739383101463318","No","Yes","No","100%",,"$2,750","$50","$700","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,750","$2750 per person","$5500 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/HMOSilver73CSR2016","http://www.allegianchoice.com/brochures","12"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","1","63509","TX","Individual","No","20-3870730","63509TX0150002","Allegian Choice Silver HMO","63509TX015",,"TXN001","TXS001","TXF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9988",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0150002-05","87% AV Level Silver Plan",,"0.875492870807648","No","Yes","No","100%",,"$750","$300","$500","$200","$750","$600","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/HMOSilver87CSR2016","http://www.allegianchoice.com/brochures","13"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","1","63509","TX","Individual","No","20-3870730","63509TX0150002","Allegian Choice Silver HMO","63509TX015",,"TXN001","TXS001","TXF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9988",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0150002-06","94% AV Level Silver Plan",,"0.947173714637756","No","Yes","No","100%",,"$200","$80","$200","$200","$200","$300","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/HMOSilver94CSR2016","http://www.allegianchoice.com/brochures","14"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","2","63509","TX","Individual","No","20-3870730","63509TX0150003","Allegian Choice Bronze HMO","63509TX015",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9983",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0150003-00","Standard Bronze Off Exchange Plan",,"0.595816850662231","Yes","Yes","No","100%",,"$6,000","$0","$200","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.allegianchoice.com/HMOBronze2016","http://www.allegianchoice.com/brochures","4"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","2","63509","TX","Individual","No","20-3870730","63509TX0150003","Allegian Choice Bronze HMO","63509TX015",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9983",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0150003-01","Standard Bronze On Exchange Plan",,"0.595816850662231","Yes","Yes","No","100%",,"$6,000","$0","$200","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.allegianchoice.com/HMOBronze2016","http://www.allegianchoice.com/brochures","5"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","2","63509","TX","Individual","No","20-3870730","63509TX0150003","Allegian Choice Bronze HMO","63509TX015",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9983",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0150003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.allegianchoice.com/HMOBronzeZCS2016","http://www.allegianchoice.com/brochures","6"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","2","63509","TX","Individual","No","20-3870730","63509TX0150003","Allegian Choice Bronze HMO","63509TX015",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9983",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0150003-03","Limited Cost Sharing Plan Variation",,"0.595816850662231","Yes","Yes","No","100%",,"$6,000","$0","$200","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.allegianchoice.com/HMOBronseLCS2016","http://www.allegianchoice.com/brochures","7"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","3","63509","TX","Individual","No","20-3870730","63509TX0160001","Allegian Choice Gold PPO","63509TX016",,"TXN002","TXS002","TXF003","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9991",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160001-00","Standard Gold Off Exchange Plan",,"0.780925273895264","No","Yes","No","100%",,"$1,500","$200","$1,600","$200","$1,500","$600","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/PPOGold2016","http://www.allegianchoice.com/brochures","4"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","3","63509","TX","Individual","No","20-3870730","63509TX0160001","Allegian Choice Gold PPO","63509TX016",,"TXN002","TXS002","TXF003","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9991",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160001-01","Standard Gold On Exchange Plan",,"0.780925273895264","No","Yes","No","100%",,"$1,500","$200","$1,600","$200","$1,500","$600","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/PPOGold2016","http://www.allegianchoice.com/brochures","5"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","3","63509","TX","Individual","No","20-3870730","63509TX0160001","Allegian Choice Gold PPO","63509TX016",,"TXN002","TXS002","TXF003","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9991",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/PPOGoldZCS2016","http://www.allegianchoice.com/brochures","6"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","3","63509","TX","Individual","No","20-3870730","63509TX0160001","Allegian Choice Gold PPO","63509TX016",,"TXN002","TXS002","TXF003","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9991",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160001-03","Limited Cost Sharing Plan Variation",,"0.780925273895264","No","Yes","No","100%",,"$1,500","$200","$1,600","$200","$1,500","$600","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/PPOGoldLCS2016","http://www.allegianchoice.com/brochures","7"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","3","63509","TX","Individual","No","20-3870730","63509TX0160002","Allegian Choice Silver PPO 3500","63509TX016",,"TXN002","TXS002","TXF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9989",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160002-04","73% AV Level Silver Plan",,"0.732470810413361","No","Yes","No","100%",,"$2,100","$300","$900","$200","$2,100","$600","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","20%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/PPO3500Silver73CSR2016","http://www.allegianchoice.com/brochures","12"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","3","63509","TX","Individual","No","20-3870730","63509TX0160002","Allegian Choice Silver PPO 3500","63509TX016",,"TXN002","TXS002","TXF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9989",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160002-05","87% AV Level Silver Plan",,"0.866345167160034","No","Yes","No","100%",,"$600","$80","$300","$200","$600","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","20%",,,,,"$1,200","$1200 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/PPO3500Silver87CSR2016","http://www.allegianchoice.com/brochures","13"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","3","63509","TX","Individual","No","20-3870730","63509TX0160002","Allegian Choice Silver PPO 3500","63509TX016",,"TXN002","TXS002","TXF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9989",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160002-06","94% AV Level Silver Plan",,"0.940656423568726","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$400","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20%",,,,,"$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","50%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/PPO3500Silver94CSR2016","http://www.allegianchoice.com/brochures","14"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","3","63509","TX","Individual","No","20-3870730","63509TX0160003","Allegian Choice Silver PPO 5500","63509TX016",,"TXN002","TXS002","TXF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9989",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160003-00","Standard Silver Off Exchange Plan",,"0.682465493679047","No","Yes","No","100%",,"$5,500","$20","$500","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","30%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/PPO5500Silver2016","http://www.allegianchoice.com/brochures","15"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","3","63509","TX","Individual","No","20-3870730","63509TX0160003","Allegian Choice Silver PPO 5500","63509TX016",,"TXN002","TXS002","TXF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9989",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160003-01","Standard Silver On Exchange Plan",,"0.682465493679047","No","Yes","No","100%",,"$5,500","$20","$500","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","30%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/PPO5500Silver2016","http://www.allegianchoice.com/brochures","16"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","3","63509","TX","Individual","No","20-3870730","63509TX0160003","Allegian Choice Silver PPO 5500","63509TX016",,"TXN002","TXS002","TXF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9989",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/PPO5500SilverZCS2016","http://www.allegianchoice.com/brochures","17"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","3","63509","TX","Individual","No","20-3870730","63509TX0160003","Allegian Choice Silver PPO 5500","63509TX016",,"TXN002","TXS002","TXF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9989",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160003-03","Limited Cost Sharing Plan Variation",,"0.682465493679047","No","Yes","No","100%",,"$5,500","$20","$500","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","30%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/PPO5500SilverLCS2016","http://www.allegianchoice.com/brochures","18"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","3","63509","TX","Individual","No","20-3870730","63509TX0160003","Allegian Choice Silver PPO 5500","63509TX016",,"TXN002","TXS002","TXF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9989",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160003-04","73% AV Level Silver Plan",,"0.731362342834473","No","Yes","No","100%",,"$3,000","$20","$1,300","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/PPO5500Silver73CSR2016","http://www.allegianchoice.com/brochures","19"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","3","63509","TX","Individual","No","20-3870730","63509TX0160003","Allegian Choice Silver PPO 5500","63509TX016",,"TXN002","TXS002","TXF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9989",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160003-05","87% AV Level Silver Plan",,"0.861612856388092","No","Yes","No","100%",,"$400","$200","$1,300","$200","$400","$800","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"$3,800","$3800 per person","$7600 per group","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","30%",,,,,"$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","50%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/PPO5500Silver87CSR2016","http://www.allegianchoice.com/brochures","20"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","3","63509","TX","Individual","No","20-3870730","63509TX0160003","Allegian Choice Silver PPO 5500","63509TX016",,"TXN002","TXS002","TXF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9989",,,"$500","0","0","0","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160003-06","94% AV Level Silver Plan",,"0.944051384925842","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$300","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","30%",,,,,"$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","50%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.allegianchoice.com/PPO5500Silver94CSR2016","http://www.allegianchoice.com/brochures","21"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","4","63509","TX","Individual","No","20-3870730","63509TX0160004","Allegian Choice Bronze PPO","63509TX016",,"TXN002","TXS002","TXF004","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9986",,,"$500","0","0","3","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160004-00","Standard Bronze Off Exchange Plan",,"0.612626135349274","Yes","Yes","No","100%",,"$6,850","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.allegianchoice.com/PPOBronze2016","http://www.allegianchoice.com/brochures","4"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","4","63509","TX","Individual","No","20-3870730","63509TX0160004","Allegian Choice Bronze PPO","63509TX016",,"TXN002","TXS002","TXF004","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9986",,,"$500","0","0","3","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160004-01","Standard Bronze On Exchange Plan",,"0.612626135349274","Yes","Yes","No","100%",,"$6,850","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.allegianchoice.com/PPOBronze2016","http://www.allegianchoice.com/brochures","5"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","4","63509","TX","Individual","No","20-3870730","63509TX0160004","Allegian Choice Bronze PPO","63509TX016",,"TXN002","TXS002","TXF004","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9986",,,"$500","0","0","3","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.allegianchoice.com/PPOBronzeZCS2016","http://www.allegianchoice.com/brochures","6"
"2016","TX","63509","HIOS","10","2015-08-27 11:14:25","4","63509","TX","Individual","No","20-3870730","63509TX0160004","Allegian Choice Bronze PPO","63509TX016",,"TXN002","TXS002","TXF004","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9986",,,"$500","0","0","3","2016-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state-TX","http://www.allegianchoice.com/Formulary","63509TX0160004-03","Limited Cost Sharing Plan Variation",,"0.612626135349274","Yes","Yes","No","100%",,"$6,850","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.allegianchoice.com/PPOBronzeLCS2016","http://www.allegianchoice.com/brochures","7"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0010001","CHP TX Catastrophic","66252TX001",,"TXN001","TXS001","TXF001","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0010001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$0","$0","$0","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCCatastrophic.pdf","http://www.christushealthplan.org/planinformationtexas","4"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0010001","CHP TX Catastrophic","66252TX001",,"TXN001","TXS001","TXF001","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0010001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$0","$0","$0","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCCatastrophic.pdf","http://www.christushealthplan.org/planinformationtexas","5"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0010002","CHP TX Catastrophic","66252TX001",,"TXN002","TXS002","TXF001","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0010002-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$0","$0","$0","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCCatastrophic.pdf","http://www.christushealthplan.org/planinformationtexas","6"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0010002","CHP TX Catastrophic","66252TX001",,"TXN002","TXS002","TXF001","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0010002-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$0","$0","$0","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCCatastrophic.pdf","http://www.christushealthplan.org/planinformationtexas","7"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0010003","CHP TX Catastrophic","66252TX001",,"TXN003","TXS003","TXF001","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0010003-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$0","$0","$0","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCCatastrophic.pdf","http://www.christushealthplan.org/planinformationtexas","8"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0010003","CHP TX Catastrophic","66252TX001",,"TXN003","TXS003","TXF001","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0010003-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$0","$0","$0","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCCatastrophic.pdf","http://www.christushealthplan.org/planinformationtexas","9"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0010004","CHP TX Catastrophic","66252TX001",,"TXN004","TXS004","TXF001","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0010004-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$0","$0","$0","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCCatastrophic.pdf","http://www.christushealthplan.org/planinformationtexas","10"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0010004","CHP TX Catastrophic","66252TX001",,"TXN004","TXS004","TXF001","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0010004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$0","$0","$0","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCCatastrophic.pdf","http://www.christushealthplan.org/planinformationtexas","11"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0010005","CHP TX Catastrophic","66252TX001",,"TXN003","TXS005","TXF001","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0010005-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$0","$0","$0","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCCatastrophic.pdf","http://www.christushealthplan.org/planinformationtexas","12"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0010005","CHP TX Catastrophic","66252TX001",,"TXN003","TXS005","TXF001","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0010005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,800","$0","$0","$0","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCCatastrophic.pdf","http://www.christushealthplan.org/planinformationtexas","13"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0020001","CHP TX Bronze HD","66252TX002",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0020001-00","Standard Bronze Off Exchange Plan",,"0.606248557567596","Yes","Yes","No","100%",,"$5,800","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeHD.pdf","http://www.christushealthplan.org/planinformationtexas","14"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0020001","CHP TX Bronze HD","66252TX002",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0020001-01","Standard Bronze On Exchange Plan",,"0.606248557567596","Yes","Yes","No","100%",,"$5,800","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeHD.pdf","http://www.christushealthplan.org/planinformationtexas","15"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0020001","CHP TX Bronze HD","66252TX002",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0020001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeHD.pdf","http://www.christushealthplan.org/planinformationtexas","16"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0020001","CHP TX Bronze HD","66252TX002",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0020001-03","Limited Cost Sharing Plan Variation",,"0.606248557567596","Yes","Yes","No","100%",,"$5,800","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeHD.pdf","http://www.christushealthplan.org/planinformationtexas","17"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0020002","CHP TX Bronze HD","66252TX002",,"TXN002","TXS002","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0020002-00","Standard Bronze Off Exchange Plan",,"0.606248557567596","Yes","Yes","No","100%",,"$5,800","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeHD.pdf","http://www.christushealthplan.org/planinformationtexas","18"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0020002","CHP TX Bronze HD","66252TX002",,"TXN002","TXS002","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0020002-01","Standard Bronze On Exchange Plan",,"0.606248557567596","Yes","Yes","No","100%",,"$5,800","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeHD.pdf","http://www.christushealthplan.org/planinformationtexas","19"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0020002","CHP TX Bronze HD","66252TX002",,"TXN002","TXS002","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0020002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeHD.pdf","http://www.christushealthplan.org/planinformationtexas","20"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0020002","CHP TX Bronze HD","66252TX002",,"TXN002","TXS002","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0020002-03","Limited Cost Sharing Plan Variation",,"0.606248557567596","Yes","Yes","No","100%",,"$5,800","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeHD.pdf","http://www.christushealthplan.org/planinformationtexas","21"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0020003","CHP TX Bronze HD","66252TX002",,"TXN003","TXS003","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0020003-00","Standard Bronze Off Exchange Plan",,"0.606248557567596","Yes","Yes","No","100%",,"$5,800","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeHD.pdf","http://www.christushealthplan.org/planinformationtexas","22"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0020003","CHP TX Bronze HD","66252TX002",,"TXN003","TXS003","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0020003-01","Standard Bronze On Exchange Plan",,"0.606248557567596","Yes","Yes","No","100%",,"$5,800","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeHD.pdf","http://www.christushealthplan.org/planinformationtexas","23"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0020003","CHP TX Bronze HD","66252TX002",,"TXN003","TXS003","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0020003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeHD.pdf","http://www.christushealthplan.org/planinformationtexas","24"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0020003","CHP TX Bronze HD","66252TX002",,"TXN003","TXS003","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0020003-03","Limited Cost Sharing Plan Variation",,"0.606248557567596","Yes","Yes","No","100%",,"$5,800","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeHD.pdf","http://www.christushealthplan.org/planinformationtexas","25"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0020004","CHP TX Bronze HD","66252TX002",,"TXN004","TXS004","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0020004-00","Standard Bronze Off Exchange Plan",,"0.606248557567596","Yes","Yes","No","100%",,"$5,800","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeHD.pdf","http://www.christushealthplan.org/planinformationtexas","26"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0020004","CHP TX Bronze HD","66252TX002",,"TXN004","TXS004","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0020004-01","Standard Bronze On Exchange Plan",,"0.606248557567596","Yes","Yes","No","100%",,"$5,800","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeHD.pdf","http://www.christushealthplan.org/planinformationtexas","27"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0020004","CHP TX Bronze HD","66252TX002",,"TXN004","TXS004","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0020004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeHD.pdf","http://www.christushealthplan.org/planinformationtexas","28"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0020004","CHP TX Bronze HD","66252TX002",,"TXN004","TXS004","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0020004-03","Limited Cost Sharing Plan Variation",,"0.606248557567596","Yes","Yes","No","100%",,"$5,800","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeHD.pdf","http://www.christushealthplan.org/planinformationtexas","29"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0020005","CHP TX Bronze HD","66252TX002",,"TXN003","TXS005","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0020005-00","Standard Bronze Off Exchange Plan",,"0.606248557567596","Yes","Yes","No","100%",,"$5,800","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeHD.pdf","http://www.christushealthplan.org/planinformationtexas","30"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0020005","CHP TX Bronze HD","66252TX002",,"TXN003","TXS005","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0020005-01","Standard Bronze On Exchange Plan",,"0.606248557567596","Yes","Yes","No","100%",,"$5,800","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeHD.pdf","http://www.christushealthplan.org/planinformationtexas","31"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0020005","CHP TX Bronze HD","66252TX002",,"TXN003","TXS005","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0020005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeHD.pdf","http://www.christushealthplan.org/planinformationtexas","32"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0020005","CHP TX Bronze HD","66252TX002",,"TXN003","TXS005","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0020005-03","Limited Cost Sharing Plan Variation",,"0.606248557567596","Yes","Yes","No","100%",,"$5,800","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeHD.pdf","http://www.christushealthplan.org/planinformationtexas","33"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0030001","CHP TX Bronze LD","66252TX003",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0030001-00","Standard Bronze Off Exchange Plan",,"0.615943133831024","Yes","Yes","No","100%",,"$5,600","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeLD.pdf","http://www.christushealthplan.org/planinformationtexas","34"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0030001","CHP TX Bronze LD","66252TX003",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0030001-01","Standard Bronze On Exchange Plan",,"0.615943133831024","Yes","Yes","No","100%",,"$5,600","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeLD.pdf","http://www.christushealthplan.org/planinformationtexas","35"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0030001","CHP TX Bronze LD","66252TX003",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0030001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeLD.pdf","http://www.christushealthplan.org/planinformationtexas","36"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0030001","CHP TX Bronze LD","66252TX003",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0030001-03","Limited Cost Sharing Plan Variation",,"0.615943133831024","Yes","Yes","No","100%",,"$5,600","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeLD.pdf","http://www.christushealthplan.org/planinformationtexas","37"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0030002","CHP TX Bronze LD","66252TX003",,"TXN002","TXS002","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0030002-00","Standard Bronze Off Exchange Plan",,"0.615943133831024","Yes","Yes","No","100%",,"$5,600","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeLD.pdf","http://www.christushealthplan.org/planinformationtexas","38"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0030002","CHP TX Bronze LD","66252TX003",,"TXN002","TXS002","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0030002-01","Standard Bronze On Exchange Plan",,"0.615943133831024","Yes","Yes","No","100%",,"$5,600","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeLD.pdf","http://www.christushealthplan.org/planinformationtexas","39"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0030002","CHP TX Bronze LD","66252TX003",,"TXN002","TXS002","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0030002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeLD.pdf","http://www.christushealthplan.org/planinformationtexas","40"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0030002","CHP TX Bronze LD","66252TX003",,"TXN002","TXS002","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9982",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0030002-03","Limited Cost Sharing Plan Variation",,"0.615943133831024","Yes","Yes","No","100%",,"$5,600","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeLD.pdf","http://www.christushealthplan.org/planinformationtexas","41"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0030003","CHP TX Bronze LD","66252TX003",,"TXN003","TXS003","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0030003-00","Standard Bronze Off Exchange Plan",,"0.615943133831024","Yes","Yes","No","100%",,"$5,600","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeLD.pdf","http://www.christushealthplan.org/planinformationtexas","42"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0030003","CHP TX Bronze LD","66252TX003",,"TXN003","TXS003","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0030003-01","Standard Bronze On Exchange Plan",,"0.615943133831024","Yes","Yes","No","100%",,"$5,600","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeLD.pdf","http://www.christushealthplan.org/planinformationtexas","43"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0030003","CHP TX Bronze LD","66252TX003",,"TXN003","TXS003","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0030003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeLD.pdf","http://www.christushealthplan.org/planinformationtexas","44"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0030003","CHP TX Bronze LD","66252TX003",,"TXN003","TXS003","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9984",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0030003-03","Limited Cost Sharing Plan Variation",,"0.615943133831024","Yes","Yes","No","100%",,"$5,600","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeLD.pdf","http://www.christushealthplan.org/planinformationtexas","45"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0030004","CHP TX Bronze LD","66252TX003",,"TXN004","TXS004","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0030004-00","Standard Bronze Off Exchange Plan",,"0.615943133831024","Yes","Yes","No","100%",,"$5,600","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeLD.pdf","http://www.christushealthplan.org/planinformationtexas","46"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0030004","CHP TX Bronze LD","66252TX003",,"TXN004","TXS004","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0030004-01","Standard Bronze On Exchange Plan",,"0.615943133831024","Yes","Yes","No","100%",,"$5,600","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeLD.pdf","http://www.christushealthplan.org/planinformationtexas","47"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0030004","CHP TX Bronze LD","66252TX003",,"TXN004","TXS004","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0030004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeLD.pdf","http://www.christushealthplan.org/planinformationtexas","48"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0030004","CHP TX Bronze LD","66252TX003",,"TXN004","TXS004","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0030004-03","Limited Cost Sharing Plan Variation",,"0.615943133831024","Yes","Yes","No","100%",,"$5,600","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeLD.pdf","http://www.christushealthplan.org/planinformationtexas","49"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0030005","CHP TX Bronze LD","66252TX003",,"TXN003","TXS005","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0030005-00","Standard Bronze Off Exchange Plan",,"0.615943133831024","Yes","Yes","No","100%",,"$5,600","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeLD.pdf","http://www.christushealthplan.org/planinformationtexas","50"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0030005","CHP TX Bronze LD","66252TX003",,"TXN003","TXS005","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0030005-01","Standard Bronze On Exchange Plan",,"0.615943133831024","Yes","Yes","No","100%",,"$5,600","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeLD.pdf","http://www.christushealthplan.org/planinformationtexas","51"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0030005","CHP TX Bronze LD","66252TX003",,"TXN003","TXS005","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0030005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeLD.pdf","http://www.christushealthplan.org/planinformationtexas","52"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0030005","CHP TX Bronze LD","66252TX003",,"TXN003","TXS005","TXF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0030005-03","Limited Cost Sharing Plan Variation",,"0.615943133831024","Yes","Yes","No","100%",,"$5,600","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCBronzeLD.pdf","http://www.christushealthplan.org/planinformationtexas","53"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040001","CHP TX Silver HD","66252TX004",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040001-00","Standard Silver Off Exchange Plan",,"0.68300187587738","Yes","Yes","No","100%",,"$5,000","$400","$0","$0","$1,200","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD.pdf","http://www.christushealthplan.org/planinformationtexas","54"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040001","CHP TX Silver HD","66252TX004",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040001-01","Standard Silver On Exchange Plan",,"0.68300187587738","Yes","Yes","No","100%",,"$5,000","$400","$0","$0","$1,200","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD.pdf","http://www.christushealthplan.org/planinformationtexas","55"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040001","CHP TX Silver HD","66252TX004",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD.pdf","http://www.christushealthplan.org/planinformationtexas","56"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040001","CHP TX Silver HD","66252TX004",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040001-03","Limited Cost Sharing Plan Variation",,"0.68300187587738","Yes","Yes","No","100%",,"$5,000","$400","$0","$0","$1,200","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD.pdf","http://www.christushealthplan.org/planinformationtexas","57"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040001","CHP TX Silver HD","66252TX004",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040001-04","73% AV Level Silver Plan",,"0.730326414108276","Yes","Yes","No","100%",,"$3,000","$300","$0","$0","$1,200","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD73.pdf","http://www.christushealthplan.org/planinformationtexas","58"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040001","CHP TX Silver HD","66252TX004",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040001-05","87% AV Level Silver Plan",,"0.878548920154572","Yes","Yes","No","100%",,"$500","$200","$0","$0","$500","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD87.pdf","http://www.christushealthplan.org/planinformationtexas","59"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040001","CHP TX Silver HD","66252TX004",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040001-06","94% AV Level Silver Plan",,"0.948130488395691","Yes","Yes","No","100%",,"$0","$200","$0","$0","$0","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD94.pdf","http://www.christushealthplan.org/planinformationtexas","60"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040002","CHP TX Silver HD","66252TX004",,"TXN002","TXS002","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040002-00","Standard Silver Off Exchange Plan",,"0.68300187587738","Yes","Yes","No","100%",,"$5,000","$400","$0","$0","$1,200","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD.pdf","http://www.christushealthplan.org/planinformationtexas","61"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040002","CHP TX Silver HD","66252TX004",,"TXN002","TXS002","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040002-01","Standard Silver On Exchange Plan",,"0.68300187587738","Yes","Yes","No","100%",,"$5,000","$400","$0","$0","$1,200","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD.pdf","http://www.christushealthplan.org/planinformationtexas","62"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040002","CHP TX Silver HD","66252TX004",,"TXN002","TXS002","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD.pdf","http://www.christushealthplan.org/planinformationtexas","63"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040002","CHP TX Silver HD","66252TX004",,"TXN002","TXS002","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040002-03","Limited Cost Sharing Plan Variation",,"0.68300187587738","Yes","Yes","No","100%",,"$5,000","$400","$0","$0","$1,200","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD.pdf","http://www.christushealthplan.org/planinformationtexas","64"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040002","CHP TX Silver HD","66252TX004",,"TXN002","TXS002","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040002-04","73% AV Level Silver Plan",,"0.730326414108276","Yes","Yes","No","100%",,"$3,000","$300","$0","$0","$1,200","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD73.pdf","http://www.christushealthplan.org/planinformationtexas","65"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040002","CHP TX Silver HD","66252TX004",,"TXN002","TXS002","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040002-05","87% AV Level Silver Plan",,"0.878548920154572","Yes","Yes","No","100%",,"$500","$200","$0","$0","$500","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD87.pdf","http://www.christushealthplan.org/planinformationtexas","66"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040002","CHP TX Silver HD","66252TX004",,"TXN002","TXS002","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040002-06","94% AV Level Silver Plan",,"0.948130488395691","Yes","Yes","No","100%",,"$0","$200","$0","$0","$0","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD94.pdf","http://www.christushealthplan.org/planinformationtexas","67"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040003","CHP TX Silver HD","66252TX004",,"TXN003","TXS003","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040003-00","Standard Silver Off Exchange Plan",,"0.68300187587738","Yes","Yes","No","100%",,"$5,000","$400","$0","$0","$1,200","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD.pdf","http://www.christushealthplan.org/planinformationtexas","68"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040003","CHP TX Silver HD","66252TX004",,"TXN003","TXS003","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040003-01","Standard Silver On Exchange Plan",,"0.68300187587738","Yes","Yes","No","100%",,"$5,000","$400","$0","$0","$1,200","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD.pdf","http://www.christushealthplan.org/planinformationtexas","69"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040003","CHP TX Silver HD","66252TX004",,"TXN003","TXS003","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD.pdf","http://www.christushealthplan.org/planinformationtexas","70"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040003","CHP TX Silver HD","66252TX004",,"TXN003","TXS003","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040003-03","Limited Cost Sharing Plan Variation",,"0.68300187587738","Yes","Yes","No","100%",,"$5,000","$400","$0","$0","$1,200","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD.pdf","http://www.christushealthplan.org/planinformationtexas","71"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040003","CHP TX Silver HD","66252TX004",,"TXN003","TXS003","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040003-04","73% AV Level Silver Plan",,"0.730326414108276","Yes","Yes","No","100%",,"$3,000","$300","$0","$0","$1,200","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD73.pdf","http://www.christushealthplan.org/planinformationtexas","72"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040003","CHP TX Silver HD","66252TX004",,"TXN003","TXS003","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040003-05","87% AV Level Silver Plan",,"0.878548920154572","Yes","Yes","No","100%",,"$500","$200","$0","$0","$500","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD87.pdf","http://www.christushealthplan.org/planinformationtexas","73"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040003","CHP TX Silver HD","66252TX004",,"TXN003","TXS003","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040003-06","94% AV Level Silver Plan",,"0.948130488395691","Yes","Yes","No","100%",,"$0","$200","$0","$0","$0","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD94.pdf","http://www.christushealthplan.org/planinformationtexas","74"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040004","CHP TX Silver HD","66252TX004",,"TXN004","TXS004","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040004-00","Standard Silver Off Exchange Plan",,"0.68300187587738","Yes","Yes","No","100%",,"$5,000","$400","$0","$0","$1,200","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD.pdf","http://www.christushealthplan.org/planinformationtexas","75"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040004","CHP TX Silver HD","66252TX004",,"TXN004","TXS004","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040004-01","Standard Silver On Exchange Plan",,"0.68300187587738","Yes","Yes","No","100%",,"$5,000","$400","$0","$0","$1,200","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD.pdf","http://www.christushealthplan.org/planinformationtexas","76"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040004","CHP TX Silver HD","66252TX004",,"TXN004","TXS004","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD.pdf","http://www.christushealthplan.org/planinformationtexas","77"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040004","CHP TX Silver HD","66252TX004",,"TXN004","TXS004","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040004-03","Limited Cost Sharing Plan Variation",,"0.68300187587738","Yes","Yes","No","100%",,"$5,000","$400","$0","$0","$1,200","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD.pdf","http://www.christushealthplan.org/planinformationtexas","78"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040004","CHP TX Silver HD","66252TX004",,"TXN004","TXS004","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040004-04","73% AV Level Silver Plan",,"0.730326414108276","Yes","Yes","No","100%",,"$3,000","$300","$0","$0","$1,200","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD73.pdf","http://www.christushealthplan.org/planinformationtexas","79"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040004","CHP TX Silver HD","66252TX004",,"TXN004","TXS004","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040004-05","87% AV Level Silver Plan",,"0.878548920154572","Yes","Yes","No","100%",,"$500","$200","$0","$0","$500","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD87.pdf","http://www.christushealthplan.org/planinformationtexas","80"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040004","CHP TX Silver HD","66252TX004",,"TXN004","TXS004","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040004-06","94% AV Level Silver Plan",,"0.948130488395691","Yes","Yes","No","100%",,"$0","$200","$0","$0","$0","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD94.pdf","http://www.christushealthplan.org/planinformationtexas","81"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040005","CHP TX Silver HD","66252TX004",,"TXN003","TXS005","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040005-00","Standard Silver Off Exchange Plan",,"0.68300187587738","Yes","Yes","No","100%",,"$5,000","$400","$0","$0","$1,200","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD.pdf","http://www.christushealthplan.org/planinformationtexas","82"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040005","CHP TX Silver HD","66252TX004",,"TXN003","TXS005","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040005-01","Standard Silver On Exchange Plan",,"0.68300187587738","Yes","Yes","No","100%",,"$5,000","$400","$0","$0","$1,200","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD.pdf","http://www.christushealthplan.org/planinformationtexas","83"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040005","CHP TX Silver HD","66252TX004",,"TXN003","TXS005","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD.pdf","http://www.christushealthplan.org/planinformationtexas","84"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040005","CHP TX Silver HD","66252TX004",,"TXN003","TXS005","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040005-03","Limited Cost Sharing Plan Variation",,"0.68300187587738","Yes","Yes","No","100%",,"$5,000","$400","$0","$0","$1,200","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD.pdf","http://www.christushealthplan.org/planinformationtexas","85"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040005","CHP TX Silver HD","66252TX004",,"TXN003","TXS005","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040005-04","73% AV Level Silver Plan",,"0.730326414108276","Yes","Yes","No","100%",,"$3,000","$300","$0","$0","$1,200","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD73.pdf","http://www.christushealthplan.org/planinformationtexas","86"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040005","CHP TX Silver HD","66252TX004",,"TXN003","TXS005","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040005-05","87% AV Level Silver Plan",,"0.878548920154572","Yes","Yes","No","100%",,"$500","$200","$0","$0","$500","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD87.pdf","http://www.christushealthplan.org/planinformationtexas","87"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0040005","CHP TX Silver HD","66252TX004",,"TXN003","TXS005","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0040005-06","94% AV Level Silver Plan",,"0.948130488395691","Yes","Yes","No","100%",,"$0","$200","$0","$0","$0","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverHD94.pdf","http://www.christushealthplan.org/planinformationtexas","88"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050001","CHP TX Silver LD","66252TX005",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050001-00","Standard Silver Off Exchange Plan",,"0.710015058517456","Yes","Yes","No","100%",,"$3,000","$400","$0","$0","$1,000","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD.pdf","http://www.christushealthplan.org/planinformationtexas","89"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050001","CHP TX Silver LD","66252TX005",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050001-01","Standard Silver On Exchange Plan",,"0.710015058517456","Yes","Yes","No","100%",,"$3,000","$400","$0","$0","$1,000","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD.pdf","http://www.christushealthplan.org/planinformationtexas","90"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050001","CHP TX Silver LD","66252TX005",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD.pdf","http://www.christushealthplan.org/planinformationtexas","91"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050001","CHP TX Silver LD","66252TX005",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050001-03","Limited Cost Sharing Plan Variation",,"0.710015058517456","Yes","Yes","No","100%",,"$3,000","$400","$0","$0","$1,000","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD.pdf","http://www.christushealthplan.org/planinformationtexas","92"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050001","CHP TX Silver LD","66252TX005",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050001-04","73% AV Level Silver Plan",,"0.738848507404327","Yes","Yes","No","100%",,"$3,000","$300","$0","$0","$1,000","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD73.pdf","http://www.christushealthplan.org/planinformationtexas","93"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050001","CHP TX Silver LD","66252TX005",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050001-05","87% AV Level Silver Plan",,"0.878548920154572","Yes","Yes","No","100%",,"$500","$200","$0","$0","$500","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD87.pdf","http://www.christushealthplan.org/planinformationtexas","94"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050001","CHP TX Silver LD","66252TX005",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050001-06","94% AV Level Silver Plan",,"0.948130488395691","Yes","Yes","No","100%",,"$0","$200","$0","$0","$0","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD94.pdf","http://www.christushealthplan.org/planinformationtexas","95"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050002","CHP TX Silver LD","66252TX005",,"TXN002","TXS002","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050002-00","Standard Silver Off Exchange Plan",,"0.710015058517456","Yes","Yes","No","100%",,"$3,000","$400","$0","$0","$1,000","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD.pdf","http://www.christushealthplan.org/planinformationtexas","96"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050002","CHP TX Silver LD","66252TX005",,"TXN002","TXS002","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050002-01","Standard Silver On Exchange Plan",,"0.710015058517456","Yes","Yes","No","100%",,"$3,000","$400","$0","$0","$1,000","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD.pdf","http://www.christushealthplan.org/planinformationtexas","97"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050002","CHP TX Silver LD","66252TX005",,"TXN002","TXS002","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD.pdf","http://www.christushealthplan.org/planinformationtexas","98"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050002","CHP TX Silver LD","66252TX005",,"TXN002","TXS002","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050002-03","Limited Cost Sharing Plan Variation",,"0.710015058517456","Yes","Yes","No","100%",,"$3,000","$400","$0","$0","$1,000","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD.pdf","http://www.christushealthplan.org/planinformationtexas","99"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050002","CHP TX Silver LD","66252TX005",,"TXN002","TXS002","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050002-04","73% AV Level Silver Plan",,"0.738848507404327","Yes","Yes","No","100%",,"$3,000","$300","$0","$0","$1,000","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD73.pdf","http://www.christushealthplan.org/planinformationtexas","100"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050002","CHP TX Silver LD","66252TX005",,"TXN002","TXS002","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050002-05","87% AV Level Silver Plan",,"0.878548920154572","Yes","Yes","No","100%",,"$500","$200","$0","$0","$500","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD87.pdf","http://www.christushealthplan.org/planinformationtexas","101"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050002","CHP TX Silver LD","66252TX005",,"TXN002","TXS002","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050002-06","94% AV Level Silver Plan",,"0.948130488395691","Yes","Yes","No","100%",,"$0","$200","$0","$0","$0","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD94.pdf","http://www.christushealthplan.org/planinformationtexas","102"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050003","CHP TX Silver LD","66252TX005",,"TXN003","TXS003","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050003-00","Standard Silver Off Exchange Plan",,"0.710015058517456","Yes","Yes","No","100%",,"$3,000","$400","$0","$0","$1,000","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD.pdf","http://www.christushealthplan.org/planinformationtexas","103"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050003","CHP TX Silver LD","66252TX005",,"TXN003","TXS003","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050003-01","Standard Silver On Exchange Plan",,"0.710015058517456","Yes","Yes","No","100%",,"$3,000","$400","$0","$0","$1,000","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD.pdf","http://www.christushealthplan.org/planinformationtexas","104"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050003","CHP TX Silver LD","66252TX005",,"TXN003","TXS003","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD.pdf","http://www.christushealthplan.org/planinformationtexas","105"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050003","CHP TX Silver LD","66252TX005",,"TXN003","TXS003","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050003-03","Limited Cost Sharing Plan Variation",,"0.710015058517456","Yes","Yes","No","100%",,"$3,000","$400","$0","$0","$1,000","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD.pdf","http://www.christushealthplan.org/planinformationtexas","106"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050003","CHP TX Silver LD","66252TX005",,"TXN003","TXS003","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050003-04","73% AV Level Silver Plan",,"0.738848507404327","Yes","Yes","No","100%",,"$3,000","$300","$0","$0","$1,000","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD73.pdf","http://www.christushealthplan.org/planinformationtexas","107"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050003","CHP TX Silver LD","66252TX005",,"TXN003","TXS003","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050003-05","87% AV Level Silver Plan",,"0.878548920154572","Yes","Yes","No","100%",,"$500","$200","$0","$0","$500","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD87.pdf","http://www.christushealthplan.org/planinformationtexas","108"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050003","CHP TX Silver LD","66252TX005",,"TXN003","TXS003","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050003-06","94% AV Level Silver Plan",,"0.948130488395691","Yes","Yes","No","100%",,"$0","$200","$0","$0","$0","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD94.pdf","http://www.christushealthplan.org/planinformationtexas","109"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050004","CHP TX Silver LD","66252TX005",,"TXN004","TXS004","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050004-00","Standard Silver Off Exchange Plan",,"0.710015058517456","Yes","Yes","No","100%",,"$3,000","$400","$0","$0","$1,000","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD.pdf","http://www.christushealthplan.org/planinformationtexas","110"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050004","CHP TX Silver LD","66252TX005",,"TXN004","TXS004","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050004-01","Standard Silver On Exchange Plan",,"0.710015058517456","Yes","Yes","No","100%",,"$3,000","$400","$0","$0","$1,000","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD.pdf","http://www.christushealthplan.org/planinformationtexas","111"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050004","CHP TX Silver LD","66252TX005",,"TXN004","TXS004","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD.pdf","http://www.christushealthplan.org/planinformationtexas","112"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050004","CHP TX Silver LD","66252TX005",,"TXN004","TXS004","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050004-03","Limited Cost Sharing Plan Variation",,"0.710015058517456","Yes","Yes","No","100%",,"$3,000","$400","$0","$0","$1,000","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD.pdf","http://www.christushealthplan.org/planinformationtexas","113"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050004","CHP TX Silver LD","66252TX005",,"TXN004","TXS004","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050004-04","73% AV Level Silver Plan",,"0.738848507404327","Yes","Yes","No","100%",,"$3,000","$300","$0","$0","$1,000","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD73.pdf","http://www.christushealthplan.org/planinformationtexas","114"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050004","CHP TX Silver LD","66252TX005",,"TXN004","TXS004","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050004-05","87% AV Level Silver Plan",,"0.878548920154572","Yes","Yes","No","100%",,"$500","$200","$0","$0","$500","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD87.pdf","http://www.christushealthplan.org/planinformationtexas","115"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050004","CHP TX Silver LD","66252TX005",,"TXN004","TXS004","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050004-06","94% AV Level Silver Plan",,"0.948130488395691","Yes","Yes","No","100%",,"$0","$200","$0","$0","$0","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD94.pdf","http://www.christushealthplan.org/planinformationtexas","116"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050005","CHP TX Silver LD","66252TX005",,"TXN003","TXS005","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050005-00","Standard Silver Off Exchange Plan",,"0.710015058517456","Yes","Yes","No","100%",,"$3,000","$400","$0","$0","$1,000","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD.pdf","http://www.christushealthplan.org/planinformationtexas","117"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050005","CHP TX Silver LD","66252TX005",,"TXN003","TXS005","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050005-01","Standard Silver On Exchange Plan",,"0.710015058517456","Yes","Yes","No","100%",,"$3,000","$400","$0","$0","$1,000","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD.pdf","http://www.christushealthplan.org/planinformationtexas","118"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050005","CHP TX Silver LD","66252TX005",,"TXN003","TXS005","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD.pdf","http://www.christushealthplan.org/planinformationtexas","119"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050005","CHP TX Silver LD","66252TX005",,"TXN003","TXS005","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050005-03","Limited Cost Sharing Plan Variation",,"0.710015058517456","Yes","Yes","No","100%",,"$3,000","$400","$0","$0","$1,000","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD.pdf","http://www.christushealthplan.org/planinformationtexas","120"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050005","CHP TX Silver LD","66252TX005",,"TXN003","TXS005","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050005-04","73% AV Level Silver Plan",,"0.738848507404327","Yes","Yes","No","100%",,"$3,000","$300","$0","$0","$1,000","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD73.pdf","http://www.christushealthplan.org/planinformationtexas","121"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050005","CHP TX Silver LD","66252TX005",,"TXN003","TXS005","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050005-05","87% AV Level Silver Plan",,"0.878548920154572","Yes","Yes","No","100%",,"$500","$200","$0","$0","$500","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD87.pdf","http://www.christushealthplan.org/planinformationtexas","122"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0050005","CHP TX Silver LD","66252TX005",,"TXN003","TXS005","TXF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9985",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0050005-06","94% AV Level Silver Plan",,"0.948130488395691","Yes","Yes","No","100%",,"$0","$200","$0","$0","$0","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCSilverLD94.pdf","http://www.christushealthplan.org/planinformationtexas","123"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0060001","CHP TX Gold HD","66252TX006",,"TXN001","TXS001","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9987",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0060001-00","Standard Gold Off Exchange Plan",,"0.799455106258392","Yes","Yes","No","100%",,"$2,500","$300","$0","$0","$1,200","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldHD.pdf","http://www.christushealthplan.org/planinformationtexas","124"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0060001","CHP TX Gold HD","66252TX006",,"TXN001","TXS001","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9987",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0060001-01","Standard Gold On Exchange Plan",,"0.799455106258392","Yes","Yes","No","100%",,"$2,500","$300","$0","$0","$1,200","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldHD.pdf","http://www.christushealthplan.org/planinformationtexas","125"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0060001","CHP TX Gold HD","66252TX006",,"TXN001","TXS001","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9987",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0060001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldHD.pdf","http://www.christushealthplan.org/planinformationtexas","126"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0060001","CHP TX Gold HD","66252TX006",,"TXN001","TXS001","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9987",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0060001-03","Limited Cost Sharing Plan Variation",,"0.799455106258392","Yes","Yes","No","100%",,"$2,500","$300","$0","$0","$1,200","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldHD.pdf","http://www.christushealthplan.org/planinformationtexas","127"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0060002","CHP TX Gold HD","66252TX006",,"TXN002","TXS002","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9987",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0060002-00","Standard Gold Off Exchange Plan",,"0.799455106258392","Yes","Yes","No","100%",,"$2,500","$300","$0","$0","$1,200","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldHD.pdf","http://www.christushealthplan.org/planinformationtexas","128"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0060002","CHP TX Gold HD","66252TX006",,"TXN002","TXS002","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9987",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0060002-01","Standard Gold On Exchange Plan",,"0.799455106258392","Yes","Yes","No","100%",,"$2,500","$300","$0","$0","$1,200","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldHD.pdf","http://www.christushealthplan.org/planinformationtexas","129"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0060002","CHP TX Gold HD","66252TX006",,"TXN002","TXS002","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9987",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0060002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldHD.pdf","http://www.christushealthplan.org/planinformationtexas","130"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0060002","CHP TX Gold HD","66252TX006",,"TXN002","TXS002","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9987",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0060002-03","Limited Cost Sharing Plan Variation",,"0.799455106258392","Yes","Yes","No","100%",,"$2,500","$300","$0","$0","$1,200","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldHD.pdf","http://www.christushealthplan.org/planinformationtexas","131"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0060003","CHP TX Gold HD","66252TX006",,"TXN003","TXS003","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0060003-00","Standard Gold Off Exchange Plan",,"0.799455106258392","Yes","Yes","No","100%",,"$2,500","$300","$0","$0","$1,200","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldHD.pdf","http://www.christushealthplan.org/planinformationtexas","132"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0060003","CHP TX Gold HD","66252TX006",,"TXN003","TXS003","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0060003-01","Standard Gold On Exchange Plan",,"0.799455106258392","Yes","Yes","No","100%",,"$2,500","$300","$0","$0","$1,200","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldHD.pdf","http://www.christushealthplan.org/planinformationtexas","133"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0060003","CHP TX Gold HD","66252TX006",,"TXN003","TXS003","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0060003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldHD.pdf","http://www.christushealthplan.org/planinformationtexas","134"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0060003","CHP TX Gold HD","66252TX006",,"TXN003","TXS003","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0060003-03","Limited Cost Sharing Plan Variation",,"0.799455106258392","Yes","Yes","No","100%",,"$2,500","$300","$0","$0","$1,200","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldHD.pdf","http://www.christushealthplan.org/planinformationtexas","135"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0060004","CHP TX Gold HD","66252TX006",,"TXN004","TXS004","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0060004-00","Standard Gold Off Exchange Plan",,"0.799455106258392","Yes","Yes","No","100%",,"$2,500","$300","$0","$0","$1,200","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldHD.pdf","http://www.christushealthplan.org/planinformationtexas","136"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0060004","CHP TX Gold HD","66252TX006",,"TXN004","TXS004","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0060004-01","Standard Gold On Exchange Plan",,"0.799455106258392","Yes","Yes","No","100%",,"$2,500","$300","$0","$0","$1,200","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldHD.pdf","http://www.christushealthplan.org/planinformationtexas","137"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0060004","CHP TX Gold HD","66252TX006",,"TXN004","TXS004","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0060004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldHD.pdf","http://www.christushealthplan.org/planinformationtexas","138"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0060004","CHP TX Gold HD","66252TX006",,"TXN004","TXS004","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0060004-03","Limited Cost Sharing Plan Variation",,"0.799455106258392","Yes","Yes","No","100%",,"$2,500","$300","$0","$0","$1,200","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldHD.pdf","http://www.christushealthplan.org/planinformationtexas","139"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0060005","CHP TX Gold HD","66252TX006",,"TXN003","TXS005","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0060005-00","Standard Gold Off Exchange Plan",,"0.799455106258392","Yes","Yes","No","100%",,"$2,500","$300","$0","$0","$1,200","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldHD.pdf","http://www.christushealthplan.org/planinformationtexas","140"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0060005","CHP TX Gold HD","66252TX006",,"TXN003","TXS005","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0060005-01","Standard Gold On Exchange Plan",,"0.799455106258392","Yes","Yes","No","100%",,"$2,500","$300","$0","$0","$1,200","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldHD.pdf","http://www.christushealthplan.org/planinformationtexas","141"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0060005","CHP TX Gold HD","66252TX006",,"TXN003","TXS005","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0060005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldHD.pdf","http://www.christushealthplan.org/planinformationtexas","142"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0060005","CHP TX Gold HD","66252TX006",,"TXN003","TXS005","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0060005-03","Limited Cost Sharing Plan Variation",,"0.799455106258392","Yes","Yes","No","100%",,"$2,500","$300","$0","$0","$1,200","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldHD.pdf","http://www.christushealthplan.org/planinformationtexas","143"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0070001","CHP TX Gold LD","66252TX007",,"TXN001","TXS001","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9987",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0070001-00","Standard Gold Off Exchange Plan",,"0.803979277610779","Yes","Yes","No","100%",,"$1,500","$300","$0","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldLD.pdf","http://www.christushealthplan.org/planinformationtexas","144"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0070001","CHP TX Gold LD","66252TX007",,"TXN001","TXS001","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9987",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0070001-01","Standard Gold On Exchange Plan",,"0.803979277610779","Yes","Yes","No","100%",,"$1,500","$300","$0","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldLD.pdf","http://www.christushealthplan.org/planinformationtexas","145"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0070001","CHP TX Gold LD","66252TX007",,"TXN001","TXS001","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9987",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0070001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldLD.pdf","http://www.christushealthplan.org/planinformationtexas","146"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0070001","CHP TX Gold LD","66252TX007",,"TXN001","TXS001","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9987",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0070001-03","Limited Cost Sharing Plan Variation",,"0.803979277610779","Yes","Yes","No","100%",,"$1,500","$300","$0","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldLD.pdf","http://www.christushealthplan.org/planinformationtexas","147"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0070002","CHP TX Gold LD","66252TX007",,"TXN002","TXS002","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9987",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0070002-00","Standard Gold Off Exchange Plan",,"0.803979277610779","Yes","Yes","No","100%",,"$1,500","$300","$0","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldLD.pdf","http://www.christushealthplan.org/planinformationtexas","148"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0070002","CHP TX Gold LD","66252TX007",,"TXN002","TXS002","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9987",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0070002-01","Standard Gold On Exchange Plan",,"0.803979277610779","Yes","Yes","No","100%",,"$1,500","$300","$0","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldLD.pdf","http://www.christushealthplan.org/planinformationtexas","149"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0070002","CHP TX Gold LD","66252TX007",,"TXN002","TXS002","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9987",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0070002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldLD.pdf","http://www.christushealthplan.org/planinformationtexas","150"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0070002","CHP TX Gold LD","66252TX007",,"TXN002","TXS002","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9987",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0070002-03","Limited Cost Sharing Plan Variation",,"0.803979277610779","Yes","Yes","No","100%",,"$1,500","$300","$0","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldLD.pdf","http://www.christushealthplan.org/planinformationtexas","151"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0070003","CHP TX Gold LD","66252TX007",,"TXN003","TXS003","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0070003-00","Standard Gold Off Exchange Plan",,"0.803979277610779","Yes","Yes","No","100%",,"$1,500","$300","$0","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldLD.pdf","http://www.christushealthplan.org/planinformationtexas","152"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0070003","CHP TX Gold LD","66252TX007",,"TXN003","TXS003","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0070003-01","Standard Gold On Exchange Plan",,"0.803979277610779","Yes","Yes","No","100%",,"$1,500","$300","$0","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldLD.pdf","http://www.christushealthplan.org/planinformationtexas","153"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0070003","CHP TX Gold LD","66252TX007",,"TXN003","TXS003","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0070003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldLD.pdf","http://www.christushealthplan.org/planinformationtexas","154"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0070003","CHP TX Gold LD","66252TX007",,"TXN003","TXS003","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0070003-03","Limited Cost Sharing Plan Variation",,"0.803979277610779","Yes","Yes","No","100%",,"$1,500","$300","$0","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldLD.pdf","http://www.christushealthplan.org/planinformationtexas","155"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0070004","CHP TX Gold LD","66252TX007",,"TXN004","TXS004","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0070004-00","Standard Gold Off Exchange Plan",,"0.803979277610779","Yes","Yes","No","100%",,"$1,500","$300","$0","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldLD.pdf","http://www.christushealthplan.org/planinformationtexas","156"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0070004","CHP TX Gold LD","66252TX007",,"TXN004","TXS004","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0070004-01","Standard Gold On Exchange Plan",,"0.803979277610779","Yes","Yes","No","100%",,"$1,500","$300","$0","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldLD.pdf","http://www.christushealthplan.org/planinformationtexas","157"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0070004","CHP TX Gold LD","66252TX007",,"TXN004","TXS004","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0070004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldLD.pdf","http://www.christushealthplan.org/planinformationtexas","158"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0070004","CHP TX Gold LD","66252TX007",,"TXN004","TXS004","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0070004-03","Limited Cost Sharing Plan Variation",,"0.803979277610779","Yes","Yes","No","100%",,"$1,500","$300","$0","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldLD.pdf","http://www.christushealthplan.org/planinformationtexas","159"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0070005","CHP TX Gold LD","66252TX007",,"TXN003","TXS005","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0070005-00","Standard Gold Off Exchange Plan",,"0.803979277610779","Yes","Yes","No","100%",,"$1,500","$300","$0","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldLD.pdf","http://www.christushealthplan.org/planinformationtexas","160"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0070005","CHP TX Gold LD","66252TX007",,"TXN003","TXS005","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0070005-01","Standard Gold On Exchange Plan",,"0.803979277610779","Yes","Yes","No","100%",,"$1,500","$300","$0","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldLD.pdf","http://www.christushealthplan.org/planinformationtexas","161"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0070005","CHP TX Gold LD","66252TX007",,"TXN003","TXS005","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0070005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldLD.pdf","http://www.christushealthplan.org/planinformationtexas","162"
"2016","TX","66252","HIOS","8","2016-04-04 11:25:42","1","66252","TX","Individual","No","45-2106295","66252TX0070005","CHP TX Gold LD","66252TX007",,"TXN003","TXS005","TXF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes","0.9986",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","http://www.christushealthplan.org/tx2016healthexchangeformulary","66252TX0070005-03","Limited Cost Sharing Plan Variation",,"0.803979277610779","Yes","Yes","No","100%",,"$1,500","$300","$0","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/workfiles/HIX%2FTexasSummaryofBenefits/TXHIX2016SBCGoldLD.pdf","http://www.christushealthplan.org/planinformationtexas","163"
"2016","TX","69758","HIOS","3","2015-08-27 11:14:25","1","69758","TX","SHOP (Small Group)","Yes","36-0883760","69758TX0030002","EHB High Passive","69758TX003",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.02","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","69758TX0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","TX","69758","HIOS","3","2015-08-27 11:14:25","1","69758","TX","SHOP (Small Group)","Yes","36-0883760","69758TX0030001","EHB Low Passive","69758TX003",,"TXN001","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.76","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","69758TX0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","1","76589","TX","Individual","No","74-2767437","76589TX0010003","Cigna Connect HSA Silver 2700","76589TX001",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010003-04","73% AV Level Silver Plan",,"0.720354199409485","Yes","Yes","No","100%",,"$2,100","$0","$800","$30","$2,100","$0","$440","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/hsa-silver-2700-250","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/hsa-silver-2700-250","12"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","1","76589","TX","Individual","No","74-2767437","76589TX0010003","Cigna Connect HSA Silver 2700","76589TX001",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010003-05","87% AV Level Silver Plan",,"0.860987782478333","Yes","Yes","No","100%",,"$500","$0","$1,040","$30","$500","$0","$680","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/hsa-silver-2700-200","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/hsa-silver-2700-200","13"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","1","76589","TX","Individual","No","74-2767437","76589TX0010003","Cigna Connect HSA Silver 2700","76589TX001",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010003-03","Limited Cost Sharing Plan Variation",,"0.680516302585602","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$350","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/hsa-silver-2700-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/hsa-silver-2700-naan-300a","11"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","1","76589","TX","Individual","No","74-2767437","76589TX0010003","Cigna Connect HSA Silver 2700","76589TX001",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010003-06","94% AV Level Silver Plan",,"0.9306760430336","Yes","Yes","No","100%",,"$100","$0","$730","$30","$100","$0","$490","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/hsa-silver-2700-150","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/hsa-silver-2700-150","14"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","2","76589","TX","Individual","No","74-2767437","76589TX0010002","Cigna Connect Flex Bronze 6400","76589TX001",,"TXN001","TXS001","TXF002","New","HMO","Bronze","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010002-00","Standard Bronze Off Exchange Plan","61.83%","0.635156750679016","Yes","Yes","No","100%",,"$5,170","$80","$330","$30","$140","$800","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-bronze-6400","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-bronze-6400","4"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","2","76589","TX","Individual","No","74-2767437","76589TX0010002","Cigna Connect Flex Bronze 6400","76589TX001",,"TXN001","TXS001","TXF002","New","HMO","Bronze","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010002-01","Standard Bronze On Exchange Plan","61.83%","0.635156750679016","Yes","Yes","No","100%",,"$5,170","$80","$330","$30","$140","$800","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-bronze-6400","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-bronze-6400","5"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","2","76589","TX","Individual","No","74-2767437","76589TX0010002","Cigna Connect Flex Bronze 6400","76589TX001",,"TXN001","TXS001","TXF002","New","HMO","Bronze","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston/hmo/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston/hmo/naan-300b","6"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","2","76589","TX","Individual","No","74-2767437","76589TX0010002","Cigna Connect Flex Bronze 6400","76589TX001",,"TXN001","TXS001","TXF002","New","HMO","Bronze","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010002-03","Limited Cost Sharing Plan Variation","61.83%","0.635156750679016","Yes","Yes","No","100%",,"$5,170","$80","$330","$30","$140","$800","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-bronze-6400-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-bronze-6400-naan-300a","7"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010004","Cigna Connect Flex Silver 5000","76589TX001",,"TXN001","TXS001","TXF007","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010004-00","Standard Silver Off Exchange Plan","68.48%","0.685960710048676","Yes","Yes","No","100%",,"$5,000","$50","$450","$30","$140","$480","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-silver-5000","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-silver-5000","4"
"2016","TX","71837","HIOS","5","2015-09-27 18:35:28","1","71837","TX","Individual","No","27-5219887","71837TX0010001","IdealCare Complete","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.999107688590517",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.senderohealth.com/idealcareeng/payments.html","http://www.senderohealth.com/idealcareeng/formulary.html","71837TX0010001-00","Standard Silver Off Exchange Plan",,"0.694234549999237","Yes","Yes","No","100%",,"$2,790","$260","$0","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,100","$6100 per person","$12200 per group","No",,,"http://www.senderohealth.com/idealcareeng/benefits.html","http://www.senderohealth.com/idealcareeng/planbrochure.html","4"
"2016","TX","71837","HIOS","5","2015-09-27 18:35:28","1","71837","TX","Individual","No","27-5219887","71837TX0010001","IdealCare Complete","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.999107688590517",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.senderohealth.com/idealcareeng/payments.html","http://www.senderohealth.com/idealcareeng/formulary.html","71837TX0010001-01","Standard Silver On Exchange Plan",,"0.694234549999237","Yes","Yes","No","100%",,"$2,790","$260","$0","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,100","$6100 per person","$12200 per group","No",,,"http://www.senderohealth.com/idealcareeng/benefits.html","http://www.senderohealth.com/idealcareeng/planbrochure.html","5"
"2016","TX","71837","HIOS","5","2015-09-27 18:35:28","1","71837","TX","Individual","No","27-5219887","71837TX0010001","IdealCare Complete","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.999107688590517",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.senderohealth.com/idealcareeng/payments.html","http://www.senderohealth.com/idealcareeng/formulary.html","71837TX0010001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.senderohealth.com/idealcareeng/benefits.html","http://www.senderohealth.com/idealcareeng/planbrochure.html","6"
"2016","TX","71837","HIOS","5","2015-09-27 18:35:28","1","71837","TX","Individual","No","27-5219887","71837TX0010001","IdealCare Complete","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.999107688590517",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.senderohealth.com/idealcareeng/payments.html","http://www.senderohealth.com/idealcareeng/formulary.html","71837TX0010001-03","Limited Cost Sharing Plan Variation",,"0.694234549999237","Yes","Yes","No","100%",,"$2,790","$260","$0","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,100","$6100 per person","$12200 per group","No",,,"http://www.senderohealth.com/idealcareeng/benefits.html","http://www.senderohealth.com/idealcareeng/planbrochure.html","7"
"2016","TX","71837","HIOS","5","2015-09-27 18:35:28","1","71837","TX","Individual","No","27-5219887","71837TX0010001","IdealCare Complete","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.999107688590517",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.senderohealth.com/idealcareeng/payments.html","http://www.senderohealth.com/idealcareeng/formulary.html","71837TX0010001-04","73% AV Level Silver Plan",,"0.732943773269653","Yes","Yes","No","100%",,"$2,790","$260","$0","$150","$1,150","$200","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,200","$5200 per person","$10400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,900","$4900 per person","$9800 per group","No",,,"http://www.senderohealth.com/idealcareeng/benefits.html","http://www.senderohealth.com/idealcareeng/planbrochure.html","8"
"2016","TX","71837","HIOS","5","2015-09-27 18:35:28","1","71837","TX","Individual","No","27-5219887","71837TX0010001","IdealCare Complete","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.999107688590517",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.senderohealth.com/idealcareeng/payments.html","http://www.senderohealth.com/idealcareeng/formulary.html","71837TX0010001-05","87% AV Level Silver Plan",,"0.879772484302521","Yes","Yes","No","100%",,"$400","$270","$60","$150","$400","$300","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","No",,,"http://www.senderohealth.com/idealcareeng/benefits.html","http://www.senderohealth.com/idealcareeng/planbrochure.html","9"
"2016","TX","71837","HIOS","5","2015-09-27 18:35:28","1","71837","TX","Individual","No","27-5219887","71837TX0010001","IdealCare Complete","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Silver","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.999107688590517",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.senderohealth.com/idealcareeng/payments.html","http://www.senderohealth.com/idealcareeng/formulary.html","71837TX0010001-06","94% AV Level Silver Plan",,"0.946362793445587","Yes","Yes","No","100%",,"$0","$120","$40","$150","$0","$250","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.senderohealth.com/idealcareeng/benefits.html","http://www.senderohealth.com/idealcareeng/planbrochure.html","10"
"2016","TX","71837","HIOS","5","2015-09-27 18:35:28","1","71837","TX","Individual","No","27-5219887","71837TX0010003","IdealCare Essential","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.999635254211349",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.senderohealth.com/idealcareeng/payments.html","http://www.senderohealth.com/idealcareeng/formulary.html","71837TX0010003-00","Standard Bronze Off Exchange Plan",,"0.597502410411835","Yes","Yes","No","100%",,"$6,500","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,450","$6450 per person","$12900 per group","No",,,"http://www.senderohealth.com/idealcareeng/benefits.html","http://www.senderohealth.com/idealcareeng/planbrochure.html","11"
"2016","TX","71837","HIOS","5","2015-09-27 18:35:28","1","71837","TX","Individual","No","27-5219887","71837TX0010003","IdealCare Essential","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.999635254211349",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.senderohealth.com/idealcareeng/payments.html","http://www.senderohealth.com/idealcareeng/formulary.html","71837TX0010003-01","Standard Bronze On Exchange Plan",,"0.597502410411835","Yes","Yes","No","100%",,"$6,500","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,450","$6450 per person","$12900 per group","No",,,"http://www.senderohealth.com/idealcareeng/benefits.html","http://www.senderohealth.com/idealcareeng/planbrochure.html","12"
"2016","TX","71837","HIOS","5","2015-09-27 18:35:28","1","71837","TX","Individual","No","27-5219887","71837TX0010003","IdealCare Essential","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.999635254211349",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.senderohealth.com/idealcareeng/payments.html","http://www.senderohealth.com/idealcareeng/formulary.html","71837TX0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.senderohealth.com/idealcareeng/benefits.html","http://www.senderohealth.com/idealcareeng/planbrochure.html","13"
"2016","TX","71837","HIOS","5","2015-09-27 18:35:28","1","71837","TX","Individual","No","27-5219887","71837TX0010003","IdealCare Essential","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Bronze","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.999635254211349",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.senderohealth.com/idealcareeng/payments.html","http://www.senderohealth.com/idealcareeng/formulary.html","71837TX0010003-03","Limited Cost Sharing Plan Variation",,"0.597502410411835","Yes","Yes","No","100%",,"$6,500","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,450","$6450 per person","$12900 per group","No",,,"http://www.senderohealth.com/idealcareeng/benefits.html","http://www.senderohealth.com/idealcareeng/planbrochure.html","14"
"2016","TX","71837","HIOS","5","2015-09-27 18:35:28","2","71837","TX","Individual","No","27-5219887","71837TX0010002","IdealCare Total","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Gold","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.993781513549149",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.senderohealth.com/idealcareeng/payments.html","http://www.senderohealth.com/idealcareeng/formulary.html","71837TX0010002-00","Standard Gold Off Exchange Plan",,"0.786648750305176","Yes","Yes","No","100%",,"$0","$270","$350","$150","$0","$400","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.senderohealth.com/idealcareeng/benefits.html","http://www.senderohealth.com/idealcareeng/planbrochure.html","4"
"2016","TX","71837","HIOS","5","2015-09-27 18:35:28","2","71837","TX","Individual","No","27-5219887","71837TX0010002","IdealCare Total","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Gold","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.993781513549149",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.senderohealth.com/idealcareeng/payments.html","http://www.senderohealth.com/idealcareeng/formulary.html","71837TX0010002-01","Standard Gold On Exchange Plan",,"0.786648750305176","Yes","Yes","No","100%",,"$0","$270","$350","$150","$0","$400","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.senderohealth.com/idealcareeng/benefits.html","http://www.senderohealth.com/idealcareeng/planbrochure.html","5"
"2016","TX","71837","HIOS","5","2015-09-27 18:35:28","2","71837","TX","Individual","No","27-5219887","71837TX0010002","IdealCare Total","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Gold","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.993781513549149",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.senderohealth.com/idealcareeng/payments.html","http://www.senderohealth.com/idealcareeng/formulary.html","71837TX0010002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.senderohealth.com/idealcareeng/benefits.html","http://www.senderohealth.com/idealcareeng/planbrochure.html","6"
"2016","TX","71837","HIOS","5","2015-09-27 18:35:28","2","71837","TX","Individual","No","27-5219887","71837TX0010002","IdealCare Total","71837TX001","7386647516","TXN001","TXS001","TXF001","Existing","HMO","Gold","No","Both","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ŢAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ŢNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ŢFamily Practice (General Family Medical Care), ŢEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes","0.993781513549149",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.senderohealth.com/idealcareeng/payments.html","http://www.senderohealth.com/idealcareeng/formulary.html","71837TX0010002-03","Limited Cost Sharing Plan Variation",,"0.786648750305176","Yes","Yes","No","100%",,"$0","$270","$350","$150","$0","$400","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.senderohealth.com/idealcareeng/benefits.html","http://www.senderohealth.com/idealcareeng/planbrochure.html","7"
"2016","TX","72166","HIOS","2","2015-07-10 02:19:03","1","72166","TX","SHOP (Small Group)","Yes","35-0472300","72166TX0010001","Lincoln DentalConnect®","72166TX001","7063415294","TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.79","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","72166TX0010001-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","72166","HIOS","2","2015-07-10 02:19:03","1","72166","TX","SHOP (Small Group)","Yes","35-0472300","72166TX0010002","Lincoln DentalConnect®","72166TX001","7063415294","TXN001","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.79","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","72166TX0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","TX","72166","HIOS","2","2015-07-10 02:19:03","1","72166","TX","SHOP (Small Group)","Yes","35-0472300","72166TX0010003","Lincoln DentalConnect®","72166TX001","7063415294","TXN001","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.12","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","72166TX0010003-00","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","TX","72166","HIOS","2","2015-07-10 02:19:03","1","72166","TX","SHOP (Small Group)","Yes","35-0472300","72166TX0010004","Lincoln DentalConnect®","72166TX001","7063415294","TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.27","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","72166TX0010004-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","1","76589","TX","Individual","No","74-2767437","76589TX0010001","Cigna Connect HSA Bronze 6000","76589TX001",,"TXN001","TXS001","TXF001","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010001-00","Standard Bronze Off Exchange Plan",,"0.61153781414032","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,030","$0","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/hsa-bronze-6000","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/hsa-bronze-6000","4"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","1","76589","TX","Individual","No","74-2767437","76589TX0010001","Cigna Connect HSA Bronze 6000","76589TX001",,"TXN001","TXS001","TXF001","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010001-01","Standard Bronze On Exchange Plan",,"0.61153781414032","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,030","$0","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/hsa-bronze-6000","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/hsa-bronze-6000","5"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","1","76589","TX","Individual","No","74-2767437","76589TX0010001","Cigna Connect HSA Bronze 6000","76589TX001",,"TXN001","TXS001","TXF001","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston/hmo/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston/hmo/naan-300b","6"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","1","76589","TX","Individual","No","74-2767437","76589TX0010001","Cigna Connect HSA Bronze 6000","76589TX001",,"TXN001","TXS001","TXF001","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010001-03","Limited Cost Sharing Plan Variation",,"0.61153781414032","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,030","$0","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/hsa-bronze-6000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/hsa-bronze-6000-naan-300a","7"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","1","76589","TX","Individual","No","74-2767437","76589TX0010003","Cigna Connect HSA Silver 2700","76589TX001",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010003-00","Standard Silver Off Exchange Plan",,"0.680516302585602","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$350","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/hsa-silver-2700","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/hsa-silver-2700","8"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","1","76589","TX","Individual","No","74-2767437","76589TX0010003","Cigna Connect HSA Silver 2700","76589TX001",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010003-01","Standard Silver On Exchange Plan",,"0.680516302585602","Yes","Yes","No","100%",,"$2,700","$0","$710","$30","$2,700","$0","$350","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/hsa-silver-2700","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/hsa-silver-2700","9"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","1","76589","TX","Individual","No","74-2767437","76589TX0010003","Cigna Connect HSA Silver 2700","76589TX001",,"TXN001","TXS001","TXF003","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston/hmo/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston/hmo/naan-300b","10"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010004","Cigna Connect Flex Silver 5000","76589TX001",,"TXN001","TXS001","TXF007","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010004-01","Standard Silver On Exchange Plan","68.48%","0.685960710048676","Yes","Yes","No","100%",,"$5,000","$50","$450","$30","$140","$480","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-silver-5000","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-silver-5000","5"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010004","Cigna Connect Flex Silver 5000","76589TX001",,"TXN001","TXS001","TXF007","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston/hmo/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston/hmo/naan-300b","6"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010004","Cigna Connect Flex Silver 5000","76589TX001",,"TXN001","TXS001","TXF007","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010004-03","Limited Cost Sharing Plan Variation","68.48%","0.685960710048676","Yes","Yes","No","100%",,"$5,000","$50","$450","$30","$140","$480","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-silver-5000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-silver-5000-naan-300a","7"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010004","Cigna Connect Flex Silver 5000","76589TX001",,"TXN001","TXS001","TXF007","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010004-04","73% AV Level Silver Plan","72.58%","0.727951765060425","Yes","Yes","No","100%",,"$3,200","$50","$810","$30","$140","$480","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-silver-5000-250","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-silver-5000-250","8"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010004","Cigna Connect Flex Silver 5000","76589TX001",,"TXN001","TXS001","TXF007","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010004-05","87% AV Level Silver Plan","86.98%","0.874024271965027","Yes","Yes","No","100%",,"$350","$40","$1,030","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-silver-5000-200","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-silver-5000-200","9"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010004","Cigna Connect Flex Silver 5000","76589TX001",,"TXN001","TXS001","TXF007","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010004-06","94% AV Level Silver Plan","93.17%","0.934490203857422","Yes","Yes","No","100%",,"$140","$30","$360","$30","$140","$360","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$140","$140 per person","$280 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-silver-5000-150","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-silver-5000-150","10"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010005","Cigna Connect Flex Silver 4000","76589TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010005-00","Standard Silver Off Exchange Plan","68.61%","0.686600685119629","Yes","Yes","No","100%",,"$4,000","$50","$970","$30","$140","$480","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-silver-4000","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-silver-4000","11"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010005","Cigna Connect Flex Silver 4000","76589TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010005-01","Standard Silver On Exchange Plan","68.61%","0.686600685119629","Yes","Yes","No","100%",,"$4,000","$50","$970","$30","$140","$480","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-silver-4000","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-silver-4000","12"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010005","Cigna Connect Flex Silver 4000","76589TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston/hmo/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston/hmo/naan-300b","13"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010005","Cigna Connect Flex Silver 4000","76589TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010005-03","Limited Cost Sharing Plan Variation","68.61%","0.686600685119629","Yes","Yes","No","100%",,"$4,000","$50","$970","$30","$140","$480","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-silver-4000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-silver-4000-naan-300a","14"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010005","Cigna Connect Flex Silver 4000","76589TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010005-04","73% AV Level Silver Plan","72.02%","0.721385657787323","Yes","Yes","No","100%",,"$2,900","$50","$1,300","$30","$140","$480","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-silver-4000-250","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-silver-4000-250","15"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010005","Cigna Connect Flex Silver 4000","76589TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010005-05","87% AV Level Silver Plan","86.14%","0.864277005195618","Yes","Yes","No","100%",,"$200","$50","$1,410","$30","$140","$480","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-silver-4000-200","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-silver-4000-200","16"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010005","Cigna Connect Flex Silver 4000","76589TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010005-06","94% AV Level Silver Plan","93.11%","0.934319972991943","Yes","Yes","No","100%",,"$100","$40","$360","$30","$100","$400","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-silver-4000-150","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-silver-4000-150","17"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010006","Cigna Connect Flex Silver 3000","76589TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010006-00","Standard Silver Off Exchange Plan","70.71%","0.708756864070892","Yes","Yes","No","100%",,"$3,000","$50","$850","$30","$140","$480","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-silver-3000","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-silver-3000","18"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010006","Cigna Connect Flex Silver 3000","76589TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010006-01","Standard Silver On Exchange Plan","70.71%","0.708756864070892","Yes","Yes","No","100%",,"$3,000","$50","$850","$30","$140","$480","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-silver-3000","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-silver-3000","19"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010006","Cigna Connect Flex Silver 3000","76589TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston/hmo/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston/hmo/naan-300b","20"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010006","Cigna Connect Flex Silver 3000","76589TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010006-03","Limited Cost Sharing Plan Variation","70.71%","0.708756864070892","Yes","Yes","No","100%",,"$3,000","$50","$850","$30","$140","$480","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-silver-3000-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-silver-3000-naan-300a","21"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010006","Cigna Connect Flex Silver 3000","76589TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010006-04","73% AV Level Silver Plan","72.80%","0.729323387145996","Yes","Yes","No","100%",,"$2,800","$50","$890","$30","$140","$480","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-silver-3000-250","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-silver-3000-250","22"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010006","Cigna Connect Flex Silver 3000","76589TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010006-05","87% AV Level Silver Plan","86.28%","0.865824282169342","Yes","Yes","No","100%",,"$180","$50","$1,410","$30","$140","$480","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-silver-3000-200","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-silver-3000-200","23"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010006","Cigna Connect Flex Silver 3000","76589TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010006-06","94% AV Level Silver Plan","93.21%","0.936099946498871","Yes","Yes","No","100%",,"$0","$40","$360","$30","$0","$400","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-silver-3000-150","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-silver-3000-150","24"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010007","Cigna Connect Flex Gold 1500","76589TX001",,"TXN001","TXS001","TXF005","New","HMO","Gold","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010007-00","Standard Gold Off Exchange Plan","78.37%","0.785438477993011","Yes","Yes","No","100%",,"$1,500","$40","$1,150","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-gold-1500","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-gold-1500","25"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010007","Cigna Connect Flex Gold 1500","76589TX001",,"TXN001","TXS001","TXF005","New","HMO","Gold","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010007-01","Standard Gold On Exchange Plan","78.37%","0.785438477993011","Yes","Yes","No","100%",,"$1,500","$40","$1,150","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-gold-1500","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-gold-1500","26"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010007","Cigna Connect Flex Gold 1500","76589TX001",,"TXN001","TXS001","TXF005","New","HMO","Gold","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston/hmo/naan-300b","http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston/hmo/naan-300b","27"
"2016","TX","76589","HIOS","7","2015-08-26 09:56:12","3","76589","TX","Individual","No","74-2767437","76589TX0010007","Cigna Connect Flex Gold 1500","76589TX001",,"TXN001","TXS001","TXF005","New","HMO","Gold","Yes","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/ifp-drug-list","76589TX0010007-03","Limited Cost Sharing Plan Variation","78.37%","0.785438477993011","Yes","Yes","No","100%",,"$1,500","$40","$1,150","$30","$140","$440","$0","$280",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.cigna.com/individuals-families/2016-plans/sob/texas-houston-hmo/flex-gold-1500-naan-300a","http://www.cigna.com/individuals-families/2016-plans/sbc/texas-houston-hmo/flex-gold-1500-naan-300a","28"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","1","85947","TX","Individual","No","35-1665915","85947TX0010004","Silver Compass Balanced HSA 3000","85947TX001",,"TXN001","TXS001","TXF010","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010004-00","Standard Silver Off Exchange Plan","68.9%",,"Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=tx0013&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","4"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","1","85947","TX","Individual","No","35-1665915","85947TX0010004","Silver Compass Balanced HSA 3000","85947TX001",,"TXN001","TXS001","TXF010","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010004-01","Standard Silver On Exchange Plan","68.9%",,"Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=tx0013&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","5"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","1","85947","TX","Individual","No","35-1665915","85947TX0010004","Silver Compass Balanced HSA 3000","85947TX001",,"TXN001","TXS001","TXF010","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010004-02","Zero Cost Sharing Plan Variation","100.0%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tx0014&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","6"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","1","85947","TX","Individual","No","35-1665915","85947TX0010004","Silver Compass Balanced HSA 3000","85947TX001",,"TXN001","TXS001","TXF010","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010004-03","Limited Cost Sharing Plan Variation","68.9%",,"Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=tx0015&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","7"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","1","85947","TX","Individual","No","35-1665915","85947TX0010004","Silver Compass Balanced HSA 3000","85947TX001",,"TXN001","TXS001","TXF010","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010004-04","73% AV Level Silver Plan","72.0%",,"Yes","Yes","No","100%",,"$2,500","$10","$0","$200","$2,500","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=tx0016&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","8"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","1","85947","TX","Individual","No","35-1665915","85947TX0010004","Silver Compass Balanced HSA 3000","85947TX001",,"TXN001","TXS001","TXF010","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010004-05","87% AV Level Silver Plan","86.2%",,"Yes","Yes","No","100%",,"$800","$10","$0","$200","$800","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tx0017&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","9"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","1","85947","TX","Individual","No","35-1665915","85947TX0010004","Silver Compass Balanced HSA 3000","85947TX001",,"TXN001","TXS001","TXF010","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010004-06","94% AV Level Silver Plan","93.2%",,"Yes","Yes","No","100%",,"$300","$10","$0","$200","$300","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tx0018&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","10"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","1","85947","TX","Individual","No","35-1665915","85947TX0010009","Bronze Compass Balanced HSA 5500","85947TX001",,"TXN001","TXS001","TXF001","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010009-00","Standard Bronze Off Exchange Plan","61.3%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=tx0043&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","11"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","1","85947","TX","Individual","No","35-1665915","85947TX0010009","Bronze Compass Balanced HSA 5500","85947TX001",,"TXN001","TXS001","TXF001","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010009-01","Standard Bronze On Exchange Plan","61.3%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=tx0043&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","12"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","1","85947","TX","Individual","No","35-1665915","85947TX0010009","Bronze Compass Balanced HSA 5500","85947TX001",,"TXN001","TXS001","TXF001","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010009-02","Zero Cost Sharing Plan Variation","100.0%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tx0044&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","13"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","1","85947","TX","Individual","No","35-1665915","85947TX0010009","Bronze Compass Balanced HSA 5500","85947TX001",,"TXN001","TXS001","TXF001","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010009-03","Limited Cost Sharing Plan Variation","61.3%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=tx0045&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","14"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010002","Gold Compass Balanced 1000","85947TX001",,"TXN001","TXS001","TXF002","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010002-00","Standard Gold Off Exchange Plan","78.8%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0004&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","8"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010002","Gold Compass Balanced 1000","85947TX001",,"TXN001","TXS001","TXF002","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010002-01","Standard Gold On Exchange Plan","78.8%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0004&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","9"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010002","Gold Compass Balanced 1000","85947TX001",,"TXN001","TXS001","TXF002","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010002-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0005&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","10"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010002","Gold Compass Balanced 1000","85947TX001",,"TXN001","TXS001","TXF002","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010002-03","Limited Cost Sharing Plan Variation","78.8%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0006&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","11"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010003","Gold Compass Balanced 500","85947TX001",,"TXN001","TXS001","TXF003","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010003-00","Standard Gold Off Exchange Plan","78.6%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0007&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","12"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010003","Gold Compass Balanced 500","85947TX001",,"TXN001","TXS001","TXF003","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010003-01","Standard Gold On Exchange Plan","78.6%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0007&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","13"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010003","Gold Compass Balanced 500","85947TX001",,"TXN001","TXS001","TXF003","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010003-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0008&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","14"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010003","Gold Compass Balanced 500","85947TX001",,"TXN001","TXS001","TXF003","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010003-03","Limited Cost Sharing Plan Variation","78.6%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0009&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","15"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010006","Silver Compass Balanced  2000","85947TX001",,"TXN001","TXS001","TXF009","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010006-00","Standard Silver Off Exchange Plan","69.2%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0025&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","16"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010006","Silver Compass Balanced  2000","85947TX001",,"TXN001","TXS001","TXF009","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010006-01","Standard Silver On Exchange Plan","69.2%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0025&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","17"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010006","Silver Compass Balanced  2000","85947TX001",,"TXN001","TXS001","TXF009","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010006-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0026&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","18"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010006","Silver Compass Balanced  2000","85947TX001",,"TXN001","TXS001","TXF009","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010006-03","Limited Cost Sharing Plan Variation","69.2%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0027&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","19"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010006","Silver Compass Balanced  2000","85947TX001",,"TXN001","TXS001","TXF009","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010006-04","73% AV Level Silver Plan","73.3%",,"No","Yes","No","100%",,"$1,200","$20","$1,500","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0028&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","20"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010006","Silver Compass Balanced  2000","85947TX001",,"TXN001","TXS001","TXF009","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010006-05","87% AV Level Silver Plan","87.4%",,"No","Yes","No","100%",,"$300","$10","$600","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0029&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","21"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010006","Silver Compass Balanced  2000","85947TX001",,"TXN001","TXS001","TXF009","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010006-06","94% AV Level Silver Plan","93.9%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0030&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","22"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010007","Silver Compass Balanced 3500","85947TX001",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010007-00","Standard Silver Off Exchange Plan","68.1%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0031&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","23"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010007","Silver Compass Balanced 3500","85947TX001",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010007-01","Standard Silver On Exchange Plan","68.1%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0031&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","24"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010007","Silver Compass Balanced 3500","85947TX001",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010007-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0032&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","25"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010007","Silver Compass Balanced 3500","85947TX001",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010007-03","Limited Cost Sharing Plan Variation","68.1%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0033&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","26"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010007","Silver Compass Balanced 3500","85947TX001",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010007-04","73% AV Level Silver Plan","72.6%",,"No","Yes","No","100%",,"$2,500","$10","$800","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0034&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","27"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010007","Silver Compass Balanced 3500","85947TX001",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010007-05","87% AV Level Silver Plan","87.6%",,"No","Yes","No","100%",,"$300","$10","$600","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0035&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","28"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010007","Silver Compass Balanced 3500","85947TX001",,"TXN001","TXS001","TXF006","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010007-06","94% AV Level Silver Plan","93.9%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0036&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","29"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010008","Silver Compass Balanced 4500","85947TX001",,"TXN001","TXS001","TXF005","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010008-00","Standard Silver Off Exchange Plan","69.1%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0037&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","30"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010008","Silver Compass Balanced 4500","85947TX001",,"TXN001","TXS001","TXF005","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010008-01","Standard Silver On Exchange Plan","69.1%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0037&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","31"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010008","Silver Compass Balanced 4500","85947TX001",,"TXN001","TXS001","TXF005","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010008-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0038&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","32"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010008","Silver Compass Balanced 4500","85947TX001",,"TXN001","TXS001","TXF005","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010008-03","Limited Cost Sharing Plan Variation","69.1%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0039&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","33"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010008","Silver Compass Balanced 4500","85947TX001",,"TXN001","TXS001","TXF005","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010008-04","73% AV Level Silver Plan","73.3%",,"No","Yes","No","100%",,"$3,300","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0040&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","34"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010008","Silver Compass Balanced 4500","85947TX001",,"TXN001","TXS001","TXF005","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010008-05","87% AV Level Silver Plan","86.6%",,"No","Yes","No","100%",,"$600","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0041&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","35"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010008","Silver Compass Balanced 4500","85947TX001",,"TXN001","TXS001","TXF005","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010008-06","94% AV Level Silver Plan","93.3%",,"No","Yes","No","100%",,"$100","$10","$0","$200","$100","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0042&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","36"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010011","Gold Compass Balanced  0","85947TX001",,"TXN001","TXS001","TXF008","New","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010011-00","Standard Gold Off Exchange Plan","79.4%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0010&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","37"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010011","Gold Compass Balanced  0","85947TX001",,"TXN001","TXS001","TXF008","New","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010011-01","Standard Gold On Exchange Plan","79.4%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0010&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","38"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010011","Gold Compass Balanced  0","85947TX001",,"TXN001","TXS001","TXF008","New","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010011-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0011&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","39"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010011","Gold Compass Balanced  0","85947TX001",,"TXN001","TXS001","TXF008","New","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010011-03","Limited Cost Sharing Plan Variation","79.4%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=tx0012&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","40"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010010","Bronze Compass Balanced  6500","85947TX001",,"TXN001","TXS001","TXF001","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010010-00","Standard Bronze Off Exchange Plan","61.9%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tx0046&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","41"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010010","Bronze Compass Balanced  6500","85947TX001",,"TXN001","TXS001","TXF001","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010010-01","Standard Bronze On Exchange Plan","61.9%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tx0046&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","42"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010010","Bronze Compass Balanced  6500","85947TX001",,"TXN001","TXS001","TXF001","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010010-02","Zero Cost Sharing Plan Variation","100.0%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tx0047&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","43"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","2","85947","TX","Individual","No","35-1665915","85947TX0010010","Bronze Compass Balanced  6500","85947TX001",,"TXN001","TXS001","TXF001","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010010-03","Limited Cost Sharing Plan Variation","61.9%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tx0048&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","44"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","3","85947","TX","Individual","No","35-1665915","85947TX0010005","Silver Compass Balanced 2000  1","85947TX001",,"TXN001","TXS001","TXF007","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010005-00","Standard Silver Off Exchange Plan","71.0%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tx0019&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","4"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","3","85947","TX","Individual","No","35-1665915","85947TX0010005","Silver Compass Balanced 2000  1","85947TX001",,"TXN001","TXS001","TXF007","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010005-01","Standard Silver On Exchange Plan","71.0%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tx0019&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","5"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","3","85947","TX","Individual","No","35-1665915","85947TX0010005","Silver Compass Balanced 2000  1","85947TX001",,"TXN001","TXS001","TXF007","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010005-02","Zero Cost Sharing Plan Variation","100.0%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tx0020&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","6"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","3","85947","TX","Individual","No","35-1665915","85947TX0010005","Silver Compass Balanced 2000  1","85947TX001",,"TXN001","TXS001","TXF007","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010005-03","Limited Cost Sharing Plan Variation","71.0%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tx0021&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","7"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","3","85947","TX","Individual","No","35-1665915","85947TX0010005","Silver Compass Balanced 2000  1","85947TX001",,"TXN001","TXS001","TXF007","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010005-04","73% AV Level Silver Plan","73.0%",,"Yes","Yes","No","100%",,"$1,800","$1,500","$0","$200","$1,800","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tx0022&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","8"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","3","85947","TX","Individual","No","35-1665915","85947TX0010005","Silver Compass Balanced 2000  1","85947TX001",,"TXN001","TXS001","TXF007","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010005-05","87% AV Level Silver Plan","86.2%",,"Yes","Yes","No","100%",,"$600","$800","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tx0023&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","9"
"2016","TX","85947","HIOS","10","2015-10-18 12:35:12","3","85947","TX","Individual","No","35-1665915","85947TX0010005","Silver Compass Balanced 2000  1","85947TX001",,"TXN001","TXS001","TXF007","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=tx0097&st=tx","85947TX0010005-06","94% AV Level Silver Plan","93.1%",,"Yes","Yes","No","100%",,"$200","$500","$0","$200","$200","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=tx0024&st=tx","http://www.uhc.com/iex/doc?id=tx0095&st=tx","10"
"2016","TX","86889","HIOS","3","2015-07-11 04:19:24","1","86889","TX","SHOP (Small Group)","Yes","47-0322111","86889TX0010001","Certified Dental Plan 1","86889TX001",,"TXN001","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.73","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","86889TX0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","86889","HIOS","3","2015-07-11 04:19:24","1","86889","TX","SHOP (Small Group)","Yes","47-0322111","86889TX0010002","Certified Dental Plan 2","86889TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.11","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","86889TX0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","TX","86889","HIOS","3","2015-07-11 04:19:24","1","86889","TX","SHOP (Small Group)","Yes","47-0322111","86889TX0010003","Certified Dental Plan 3","86889TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.06","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","86889TX0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","TX","86889","HIOS","3","2015-07-11 04:19:24","1","86889","TX","SHOP (Small Group)","Yes","47-0322111","86889TX0010004","Certified Dental Plan 4","86889TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.38","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","86889TX0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","TX","90453","HIOS","2","2015-07-10 02:19:03","1","90453","TX","SHOP (Small Group)","Yes","42-0127290","90453TX0050001","Principal Plan Dental 70","90453TX005",,"TXN001","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$27.08","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","90453TX0050001-00","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","90453","HIOS","2","2015-07-10 02:19:03","1","90453","TX","SHOP (Small Group)","Yes","42-0127290","90453TX0050002","Principal Plan Dental 85","90453TX005",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$28.24","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","90453TX0050002-00","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","1","91716","TX","Individual","No","06-6033492","91716TX0200007","Aetna Bronze $15 Copay","91716TX020",,"TXN001","TXS001","TXF019","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200007-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711133.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","4"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","1","91716","TX","Individual","No","06-6033492","91716TX0200007","Aetna Bronze $15 Copay","91716TX020",,"TXN001","TXS001","TXF019","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200007-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711133.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","5"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","1","91716","TX","Individual","No","06-6033492","91716TX0200007","Aetna Bronze $15 Copay","91716TX020",,"TXN001","TXS001","TXF019","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200007-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711125.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","6"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","1","91716","TX","Individual","No","06-6033492","91716TX0200007","Aetna Bronze $15 Copay","91716TX020",,"TXN001","TXS001","TXF019","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200007-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711136.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","7"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","2","91716","TX","Individual","No","06-6033492","91716TX0200009","Aetna Bronze $15 Copay Memorial Hermann","91716TX020",,"TXN003","TXS003","TXF021","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200009-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711141.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","4"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","2","91716","TX","Individual","No","06-6033492","91716TX0200009","Aetna Bronze $15 Copay Memorial Hermann","91716TX020",,"TXN003","TXS003","TXF021","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200009-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711141.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","5"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","2","91716","TX","Individual","No","06-6033492","91716TX0200009","Aetna Bronze $15 Copay Memorial Hermann","91716TX020",,"TXN003","TXS003","TXF021","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200009-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711127.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","6"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","2","91716","TX","Individual","No","06-6033492","91716TX0200009","Aetna Bronze $15 Copay Memorial Hermann","91716TX020",,"TXN003","TXS003","TXF021","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200009-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711144.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","7"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","5","91716","TX","Individual","No","06-6033492","91716TX0200011","Aetna Bronze $15 Copay San Antonio Community Plan","91716TX020",,"TXN002","TXS002","TXF023","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200011-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711157.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","4"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","5","91716","TX","Individual","No","06-6033492","91716TX0200011","Aetna Bronze $15 Copay San Antonio Community Plan","91716TX020",,"TXN002","TXS002","TXF023","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200011-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711157.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","5"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","5","91716","TX","Individual","No","06-6033492","91716TX0200011","Aetna Bronze $15 Copay San Antonio Community Plan","91716TX020",,"TXN002","TXS002","TXF023","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200011-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711131.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","6"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","5","91716","TX","Individual","No","06-6033492","91716TX0200011","Aetna Bronze $15 Copay San Antonio Community Plan","91716TX020",,"TXN002","TXS002","TXF023","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200011-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711160.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","7"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","7","91716","TX","Individual","No","06-6033492","91716TX0200008","Aetna Bronze HSA Eligible","91716TX020",,"TXN001","TXS001","TXF020","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200008-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711137.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","4"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","7","91716","TX","Individual","No","06-6033492","91716TX0200008","Aetna Bronze HSA Eligible","91716TX020",,"TXN001","TXS001","TXF020","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200008-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711137.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","5"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","7","91716","TX","Individual","No","06-6033492","91716TX0200008","Aetna Bronze HSA Eligible","91716TX020",,"TXN001","TXS001","TXF020","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200008-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711126.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","6"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","7","91716","TX","Individual","No","06-6033492","91716TX0200008","Aetna Bronze HSA Eligible","91716TX020",,"TXN001","TXS001","TXF020","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200008-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711140.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","7"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","10","91716","TX","Individual","No","06-6033492","91716TX0200012","Aetna Bronze HSA Eligible San Antonio Community Plan","91716TX020",,"TXN002","TXS002","TXF024","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200012-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711161.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","4"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","10","91716","TX","Individual","No","06-6033492","91716TX0200012","Aetna Bronze HSA Eligible San Antonio Community Plan","91716TX020",,"TXN002","TXS002","TXF024","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200012-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711161.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","5"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","10","91716","TX","Individual","No","06-6033492","91716TX0200012","Aetna Bronze HSA Eligible San Antonio Community Plan","91716TX020",,"TXN002","TXS002","TXF024","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200012-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711132.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","6"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","10","91716","TX","Individual","No","06-6033492","91716TX0200012","Aetna Bronze HSA Eligible San Antonio Community Plan","91716TX020",,"TXN002","TXS002","TXF024","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200012-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711164.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","7"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","12","91716","TX","Individual","No","06-6033492","91716TX0200010","Aetna Memorial Hermann Bronze HSA Eligible","91716TX020",,"TXN003","TXS003","TXF022","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200010-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711145.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","4"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","12","91716","TX","Individual","No","06-6033492","91716TX0200010","Aetna Memorial Hermann Bronze HSA Eligible","91716TX020",,"TXN003","TXS003","TXF022","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200010-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711145.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","5"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","12","91716","TX","Individual","No","06-6033492","91716TX0200010","Aetna Memorial Hermann Bronze HSA Eligible","91716TX020",,"TXN003","TXS003","TXF022","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200010-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711128.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","6"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","12","91716","TX","Individual","No","06-6033492","91716TX0200010","Aetna Memorial Hermann Bronze HSA Eligible","91716TX020",,"TXN003","TXS003","TXF022","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5198608797","91716TX0200010-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711148.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","7"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","14","91716","TX","Individual","No","06-6033492","91716TX0200004","Aetna Silver $10 Copay","91716TX020",,"TXN001","TXS001","TXF016","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200004-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711093.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","4"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","14","91716","TX","Individual","No","06-6033492","91716TX0200004","Aetna Silver $10 Copay","91716TX020",,"TXN001","TXS001","TXF016","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200004-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711093.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","5"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","14","91716","TX","Individual","No","06-6033492","91716TX0200004","Aetna Silver $10 Copay","91716TX020",,"TXN001","TXS001","TXF016","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711118.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","6"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","14","91716","TX","Individual","No","06-6033492","91716TX0200004","Aetna Silver $10 Copay","91716TX020",,"TXN001","TXS001","TXF016","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200004-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711096.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","7"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","14","91716","TX","Individual","No","06-6033492","91716TX0200004","Aetna Silver $10 Copay","91716TX020",,"TXN001","TXS001","TXF016","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200004-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711109.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","8"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","14","91716","TX","Individual","No","06-6033492","91716TX0200004","Aetna Silver $10 Copay","91716TX020",,"TXN001","TXS001","TXF016","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200004-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711113.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","9"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","14","91716","TX","Individual","No","06-6033492","91716TX0200004","Aetna Silver $10 Copay","91716TX020",,"TXN001","TXS001","TXF016","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200004-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711073.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","10"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","15","91716","TX","Individual","No","06-6033492","91716TX0200005","Aetna Silver $10 Copay Memorial Hermann","91716TX020",,"TXN003","TXS003","TXF017","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200005-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711097.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","4"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","15","91716","TX","Individual","No","06-6033492","91716TX0200005","Aetna Silver $10 Copay Memorial Hermann","91716TX020",,"TXN003","TXS003","TXF017","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200005-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711097.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","5"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","15","91716","TX","Individual","No","06-6033492","91716TX0200005","Aetna Silver $10 Copay Memorial Hermann","91716TX020",,"TXN003","TXS003","TXF017","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200005-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711120.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","6"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","15","91716","TX","Individual","No","06-6033492","91716TX0200005","Aetna Silver $10 Copay Memorial Hermann","91716TX020",,"TXN003","TXS003","TXF017","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200005-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711100.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","7"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","15","91716","TX","Individual","No","06-6033492","91716TX0200005","Aetna Silver $10 Copay Memorial Hermann","91716TX020",,"TXN003","TXS003","TXF017","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200005-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711110.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","8"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","15","91716","TX","Individual","No","06-6033492","91716TX0200005","Aetna Silver $10 Copay Memorial Hermann","91716TX020",,"TXN003","TXS003","TXF017","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200005-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711114.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","9"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","15","91716","TX","Individual","No","06-6033492","91716TX0200005","Aetna Silver $10 Copay Memorial Hermann","91716TX020",,"TXN003","TXS003","TXF017","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200005-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711074.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","10"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","19","91716","TX","Individual","No","06-6033492","91716TX0200006","Aetna Silver $10 Copay San Antonio Community Plan","91716TX020",,"TXN002","TXS002","TXF018","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200006-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711105.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","4"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","19","91716","TX","Individual","No","06-6033492","91716TX0200006","Aetna Silver $10 Copay San Antonio Community Plan","91716TX020",,"TXN002","TXS002","TXF018","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200006-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711105.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","5"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","19","91716","TX","Individual","No","06-6033492","91716TX0200006","Aetna Silver $10 Copay San Antonio Community Plan","91716TX020",,"TXN002","TXS002","TXF018","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200006-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711124.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","6"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","19","91716","TX","Individual","No","06-6033492","91716TX0200006","Aetna Silver $10 Copay San Antonio Community Plan","91716TX020",,"TXN002","TXS002","TXF018","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200006-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711108.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","7"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","19","91716","TX","Individual","No","06-6033492","91716TX0200006","Aetna Silver $10 Copay San Antonio Community Plan","91716TX020",,"TXN002","TXS002","TXF018","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200006-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711112.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","8"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","19","91716","TX","Individual","No","06-6033492","91716TX0200006","Aetna Silver $10 Copay San Antonio Community Plan","91716TX020",,"TXN002","TXS002","TXF018","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200006-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711116.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","9"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","19","91716","TX","Individual","No","06-6033492","91716TX0200006","Aetna Silver $10 Copay San Antonio Community Plan","91716TX020",,"TXN002","TXS002","TXF018","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200006-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711076.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","10"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","21","91716","TX","Individual","No","06-6033492","91716TX0200001","Aetna Gold $10 Copay","91716TX020",,"TXN001","TXS001","TXF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200001-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711077.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","4"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","21","91716","TX","Individual","No","06-6033492","91716TX0200001","Aetna Gold $10 Copay","91716TX020",,"TXN001","TXS001","TXF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200001-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711077.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","5"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","21","91716","TX","Individual","No","06-6033492","91716TX0200001","Aetna Gold $10 Copay","91716TX020",,"TXN001","TXS001","TXF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711117.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","6"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","21","91716","TX","Individual","No","06-6033492","91716TX0200001","Aetna Gold $10 Copay","91716TX020",,"TXN001","TXS001","TXF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200001-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711080.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","7"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","22","91716","TX","Individual","No","06-6033492","91716TX0200002","Aetna Gold $10 Copay Memorial Hermann","91716TX020",,"TXN003","TXS003","TXF014","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200002-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711081.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","4"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","22","91716","TX","Individual","No","06-6033492","91716TX0200002","Aetna Gold $10 Copay Memorial Hermann","91716TX020",,"TXN003","TXS003","TXF014","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200002-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711081.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","5"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","22","91716","TX","Individual","No","06-6033492","91716TX0200002","Aetna Gold $10 Copay Memorial Hermann","91716TX020",,"TXN003","TXS003","TXF014","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711119.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","6"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","22","91716","TX","Individual","No","06-6033492","91716TX0200002","Aetna Gold $10 Copay Memorial Hermann","91716TX020",,"TXN003","TXS003","TXF014","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200002-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711084.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","7"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","25","91716","TX","Individual","No","06-6033492","91716TX0200003","Aetna Gold $10 Copay San Antonio Community Plan","91716TX020",,"TXN002","TXS002","TXF015","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200003-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711089.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","4"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","25","91716","TX","Individual","No","06-6033492","91716TX0200003","Aetna Gold $10 Copay San Antonio Community Plan","91716TX020",,"TXN002","TXS002","TXF015","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200003-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711089.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","5"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","25","91716","TX","Individual","No","06-6033492","91716TX0200003","Aetna Gold $10 Copay San Antonio Community Plan","91716TX020",,"TXN002","TXS002","TXF015","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711123.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","6"
"2016","TX","91716","HIOS","5","2016-01-26 05:20:14","25","91716","TX","Individual","No","06-6033492","91716TX0200003","Aetna Gold $10 Copay San Antonio Community Plan","91716TX020",,"TXN002","TXS002","TXF015","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5196000181","91716TX0200003-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/TX/TX_SBC_711092.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/tx-on-booklet01-16.pdf","7"
"2016","TX","92388","HIOS","3","2015-08-21 03:45:06","1","92388","TX","SHOP (Small Group)","Yes","13-5581829","92388TX0190001","Family Basic Dental Plan (Low)","92388TX019",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$15.65","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","92388TX0190001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48059","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48058","4"
"2016","TX","92388","HIOS","3","2015-08-21 03:45:06","1","92388","TX","SHOP (Small Group)","Yes","13-5581829","92388TX0190001","Family Basic Dental Plan (Low)","92388TX019",,"TXN001","TXS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$15.65","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","92388TX0190001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48059","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48058","5"
"2016","WI","31248","HIOS","6","2015-10-20 04:38:50","2","31248","WI","Individual","Yes","36-3757528","31248WI0020001","TruAssure Preferred Adult or Child Dental Plan","31248WI002",,"WIN001","WIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","31248WI0020001-00","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WI","https://www.truassure.com/brochure?state=WI","4"
"2016","WI","31248","HIOS","6","2015-10-20 04:38:50","2","31248","WI","Individual","Yes","36-3757528","31248WI0020001","TruAssure Preferred Adult or Child Dental Plan","31248WI002",,"WIN001","WIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","31248WI0020001-01","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WI","https://www.truassure.com/brochure?state=WI","5"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010002","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","32754WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010002-00","Standard Gold Off Exchange Plan",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/32754WI0010002-00.pdf","https://api.centene.com/Brochures/2016/32754WI0010002-00.pdf","4"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010002","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","32754WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010002-01","Standard Gold On Exchange Plan",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/32754WI0010002-01.pdf","https://api.centene.com/Brochures/2016/32754WI0010002-01.pdf","5"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010002","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","32754WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/32754WI0010002-02.pdf","https://api.centene.com/Brochures/2016/32754WI0010002-02.pdf","6"
"2016","TX","92388","HIOS","3","2015-08-21 03:45:06","2","92388","TX","SHOP (Small Group)","Yes","13-5581829","92388TX0200001","Family Enhanced Dental Plan (High)","92388TX020",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$20.46","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","92388TX0200001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49126","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49125","4"
"2016","TX","92388","HIOS","3","2015-08-21 03:45:06","2","92388","TX","SHOP (Small Group)","Yes","13-5581829","92388TX0200001","Family Enhanced Dental Plan (High)","92388TX020",,"TXN001","TXS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$20.46","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","92388TX0200001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49126","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49125","5"
"2016","TX","95819","HIOS","2","2015-07-09 13:17:42","1","95819","TX","SHOP (Small Group)","Yes","81-0170040","95819TX0010001","Assurant Dental ACAFFO High","95819TX001",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$34.48","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","95819TX0010001-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","95819","HIOS","2","2015-07-09 13:17:42","1","95819","TX","SHOP (Small Group)","Yes","81-0170040","95819TX0010002","Assurant Dental ACAFFO Low","95819TX001",,"TXN001","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$28.88","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","95819TX0010002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","TX","97937","HIOS","6","2015-08-25 05:06:23","1","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0270001","Smile for Health - Certified Optimum Coverage","97937TX027",,"TXN001","TXS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97937TX0270001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","97937","HIOS","6","2015-08-25 05:06:23","2","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0270002","Smile for Health - Certified Optimum Coverage","97937TX027",,"TXN002","TXS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97937TX0270002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","97937","HIOS","6","2015-08-25 05:06:23","3","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0270003","Smile for Health - Certified Optimum Coverage","97937TX027",,"TXN003","TXS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97937TX0270003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","97937","HIOS","6","2015-08-25 05:06:23","4","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0270004","Smile for Health - Certified Optimum Coverage","97937TX027",,"TXN001","TXS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97937TX0270004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","97937","HIOS","6","2015-08-25 05:06:23","5","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0270005","Smile for Health - Certified Optimum Coverage","97937TX027",,"TXN002","TXS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97937TX0270005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","97937","HIOS","6","2015-08-25 05:06:23","6","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0270006","Smile for Health - Certified Optimum Coverage","97937TX027",,"TXN003","TXS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97937TX0270006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","97937","HIOS","6","2015-08-25 05:06:23","7","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0280001","Smile for Health - Certified High Option","97937TX028",,"TXN001","TXS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97937TX0280001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","97937","HIOS","6","2015-08-25 05:06:23","8","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0280002","Smile for Health - Certified High Option","97937TX028",,"TXN002","TXS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97937TX0280002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","97937","HIOS","6","2015-08-25 05:06:23","9","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0280003","Smile for Health - Certified High Option","97937TX028",,"TXN003","TXS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97937TX0280003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","97937","HIOS","6","2015-08-25 05:06:23","10","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0280004","Smile for Health - Certified High Option Plus","97937TX028",,"TXN001","TXS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97937TX0280004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","97937","HIOS","6","2015-08-25 05:06:23","11","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0280005","Smile for Health - Certified High Option Plus","97937TX028",,"TXN002","TXS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97937TX0280005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","97937","HIOS","6","2015-08-25 05:06:23","12","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0280006","Smile for Health - Certified High Option Plus","97937TX028",,"TXN003","TXS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","97937TX0280006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","TX","98809","HIOS","10","2016-02-03 05:57:02","13","98809","TX","SHOP (Small Group)","No","36-2739571","98809TX0100183","Gold Choice HSA 2000 - 2","98809TX010",,"TXN002","TXS002","TXF019","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=tx0007&st=tx","98809TX0100183-00","Standard Gold Off Exchange Plan","81.49%",,"Yes","Yes","No","100%",,"$2,000","$20","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$600.00","http://www.uhc.com/shop/doc?id=tx0001&st=tx",,"4"
"2016","TX","98809","HIOS","10","2016-02-03 05:57:02","13","98809","TX","SHOP (Small Group)","No","36-2739571","98809TX0100183","Gold Choice HSA 2000 - 2","98809TX010",,"TXN002","TXS002","TXF019","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=tx0007&st=tx","98809TX0100183-01","Standard Gold On Exchange Plan","81.49%",,"Yes","Yes","No","100%",,"$2,000","$20","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$600.00","http://www.uhc.com/shop/doc?id=tx0001&st=tx",,"5"
"2016","TX","98809","HIOS","10","2016-02-03 05:57:02","13","98809","TX","SHOP (Small Group)","No","36-2739571","98809TX0100040","Silver Choice HSA 3000 - 4","98809TX010",,"TXN002","TXS002","TXF010","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=tx0007&st=tx","98809TX0100040-00","Standard Silver Off Exchange Plan","71.65%",,"Yes","Yes","No","100%",,"$3,000","$20","$0","$200","$3,000","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$50.00","http://www.uhc.com/shop/doc?id=tx0002&st=tx",,"6"
"2016","TX","98809","HIOS","10","2016-02-03 05:57:02","13","98809","TX","SHOP (Small Group)","No","36-2739571","98809TX0100040","Silver Choice HSA 3000 - 4","98809TX010",,"TXN002","TXS002","TXF010","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=tx0007&st=tx","98809TX0100040-01","Standard Silver On Exchange Plan","71.65%",,"Yes","Yes","No","100%",,"$3,000","$20","$0","$200","$3,000","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$50.00","http://www.uhc.com/shop/doc?id=tx0002&st=tx",,"7"
"2016","TX","98809","HIOS","10","2016-02-03 05:57:02","13","98809","TX","SHOP (Small Group)","No","36-2739571","98809TX0100042","Bronze Choice HSA 6300 - 2","98809TX010",,"TXN002","TXS002","TXF004","New","EPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=tx0007&st=tx","98809TX0100042-00","Standard Bronze Off Exchange Plan","61.84%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$75.00","http://www.uhc.com/shop/doc?id=tx0003&st=tx",,"8"
"2016","TX","98809","HIOS","10","2016-02-03 05:57:02","13","98809","TX","SHOP (Small Group)","No","36-2739571","98809TX0100042","Bronze Choice HSA 6300 - 2","98809TX010",,"TXN002","TXS002","TXF004","New","EPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=tx0007&st=tx","98809TX0100042-01","Standard Bronze On Exchange Plan","61.84%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$75.00","http://www.uhc.com/shop/doc?id=tx0003&st=tx",,"9"
"2016","TX","98809","HIOS","10","2016-02-03 05:57:02","14","98809","TX","SHOP (Small Group)","No","36-2739571","98809TX0100186","Gold Choice HSA 2000 - 2 with IVF","98809TX010",,"TXN002","TXS002","TXF019","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=tx0007&st=tx","98809TX0100186-00","Standard Gold Off Exchange Plan","81.49%",,"Yes","Yes","No","100%",,"$2,000","$20","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$600.00","http://www.uhc.com/shop/doc?id=tx0004&st=tx",,"4"
"2016","TX","98809","HIOS","10","2016-02-03 05:57:02","14","98809","TX","SHOP (Small Group)","No","36-2739571","98809TX0100186","Gold Choice HSA 2000 - 2 with IVF","98809TX010",,"TXN002","TXS002","TXF019","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=tx0007&st=tx","98809TX0100186-01","Standard Gold On Exchange Plan","81.49%",,"Yes","Yes","No","100%",,"$2,000","$20","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$600.00","http://www.uhc.com/shop/doc?id=tx0004&st=tx",,"5"
"2016","TX","98809","HIOS","10","2016-02-03 05:57:02","14","98809","TX","SHOP (Small Group)","No","36-2739571","98809TX0100092","Silver Choice HSA 3000 - 4 with IVF","98809TX010",,"TXN002","TXS002","TXF010","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=tx0007&st=tx","98809TX0100092-00","Standard Silver Off Exchange Plan","71.65%",,"Yes","Yes","No","100%",,"$3,000","$20","$0","$200","$3,000","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$50.00","http://www.uhc.com/shop/doc?id=tx0005&st=tx",,"6"
"2016","TX","98809","HIOS","10","2016-02-03 05:57:02","14","98809","TX","SHOP (Small Group)","No","36-2739571","98809TX0100092","Silver Choice HSA 3000 - 4 with IVF","98809TX010",,"TXN002","TXS002","TXF010","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=tx0007&st=tx","98809TX0100092-01","Standard Silver On Exchange Plan","71.65%",,"Yes","Yes","No","100%",,"$3,000","$20","$0","$200","$3,000","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$50.00","http://www.uhc.com/shop/doc?id=tx0005&st=tx",,"7"
"2016","TX","98809","HIOS","10","2016-02-03 05:57:02","14","98809","TX","SHOP (Small Group)","No","36-2739571","98809TX0100094","Bronze Choice HSA 6300 - 2 with IVF","98809TX010",,"TXN002","TXS002","TXF004","New","EPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=tx0007&st=tx","98809TX0100094-00","Standard Bronze Off Exchange Plan","61.84%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$75.00","http://www.uhc.com/shop/doc?id=tx0006&st=tx",,"8"
"2016","TX","98809","HIOS","10","2016-02-03 05:57:02","14","98809","TX","SHOP (Small Group)","No","36-2739571","98809TX0100094","Bronze Choice HSA 6300 - 2 with IVF","98809TX010",,"TXN002","TXS002","TXF004","New","EPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=tx0007&st=tx","98809TX0100094-01","Standard Bronze On Exchange Plan","61.84%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$75.00","http://www.uhc.com/shop/doc?id=tx0006&st=tx",,"9"
"2016","TX","98899","HIOS","3","2015-08-27 11:14:25","1","98899","TX","SHOP (Small Group)","Yes","93-0242990","98899TX0030002","EHB High Passive","98899TX003",,"TXN001","TXS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.15","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","98899TX0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","TX","98899","HIOS","3","2015-08-27 11:14:25","1","98899","TX","SHOP (Small Group)","Yes","93-0242990","98899TX0030001","EHB Low Passive","98899TX003",,"TXN001","TXS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.83","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","98899TX0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","WI","16837","HIOS","7","2015-10-22 04:38:36","1","16837","WI","SHOP (Small Group)","Yes","75-1233841","16837WI0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","16837WI002",,"WIN001","WIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","16837WI0020001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"dentegra.com/hcx/wi/16837wi0020001-16","4"
"2016","WI","16837","HIOS","7","2015-10-22 04:38:36","1","16837","WI","Individual","Yes","75-1233841","16837WI0010001","Dentegra Dental PPO Pediatric Basic Plan","16837WI001",,"WIN001","WIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","16837WI0010001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wi/16837wi0010001-16","4"
"2016","WI","16837","HIOS","7","2015-10-22 04:38:36","2","16837","WI","Individual","Yes","75-1233841","16837WI0010004","Dentegra Dental PPO Family Preferred Plan","16837WI001",,"WIN001","WIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","16837WI0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wi/16837wi0010004-16","4"
"2016","WI","16837","HIOS","7","2015-10-22 04:38:36","2","16837","WI","SHOP (Small Group)","Yes","75-1233841","16837WI0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","16837WI002",,"WIN001","WIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.52","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","16837WI0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"dentegra.com/hcx/wi/16837wi0020004-16","4"
"2016","WI","16837","HIOS","7","2015-10-22 04:38:36","2","16837","WI","SHOP (Small Group)","Yes","75-1233841","16837WI0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","16837WI002",,"WIN001","WIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.52","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","16837WI0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"dentegra.com/hcx/wi/16837wi0020004-16","5"
"2016","WI","16837","HIOS","7","2015-10-22 04:38:36","2","16837","WI","Individual","Yes","75-1233841","16837WI0010004","Dentegra Dental PPO Family Preferred Plan","16837WI001",,"WIN001","WIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","16837WI0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wi/16837wi0010004-16","5"
"2016","WI","16837","HIOS","7","2015-10-22 04:38:36","3","16837","WI","Individual","Yes","75-1233841","16837WI0010006","Dentegra Dental PPO Family Basic Plan","16837WI001",,"WIN001","WIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","16837WI0010006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wi/16837wi0010006-16","4"
"2016","WI","16837","HIOS","7","2015-10-22 04:38:36","3","16837","WI","SHOP (Small Group)","Yes","75-1233841","16837WI0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","16837WI002",,"WIN001","WIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","16837WI0020006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wi/16837wi0020006-16","4"
"2016","WI","16837","HIOS","7","2015-10-22 04:38:36","3","16837","WI","SHOP (Small Group)","Yes","75-1233841","16837WI0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","16837WI002",,"WIN001","WIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","16837WI0020006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wi/16837wi0020006-16","5"
"2016","WI","16837","HIOS","7","2015-10-22 04:38:36","3","16837","WI","Individual","Yes","75-1233841","16837WI0010006","Dentegra Dental PPO Family Basic Plan","16837WI001",,"WIN001","WIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","16837WI0010006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wi/16837wi0010006-16","5"
"2016","WI","31248","HIOS","6","2015-10-20 04:38:50","1","31248","WI","SHOP (Small Group)","Yes","36-3757528","31248WI0030001","TruAssure Dental Small Group Basic Plan","31248WI003",,"WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.46","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","31248WI0030001-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$80","$80 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","31248","HIOS","6","2015-10-20 04:38:50","1","31248","WI","Individual","Yes","36-3757528","31248WI0010001","TruAssure Basic Adult or Child Dental Plan","31248WI001",,"WIN001","WIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.75","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","31248WI0010001-00","Standard Low Off Exchange Plan","68.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$145","$145 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WI","https://www.truassure.com/brochure?state=WI","4"
"2016","WI","31248","HIOS","6","2015-10-20 04:38:50","1","31248","WI","Individual","Yes","36-3757528","31248WI0010001","TruAssure Basic Adult or Child Dental Plan","31248WI001",,"WIN001","WIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.75","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","31248WI0010001-01","Standard Low On Exchange Plan","68.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$145","$145 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WI","https://www.truassure.com/brochure?state=WI","5"
"2016","WI","31248","HIOS","6","2015-10-20 04:38:50","1","31248","WI","SHOP (Small Group)","Yes","36-3757528","31248WI0040001","TruAssure Dental Small Group Preferred Plan","31248WI004",,"WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.46","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","31248WI0040001-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$80","$80 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010002","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","32754WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010002-03","Limited Cost Sharing Plan Variation",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/32754WI0010002-03.pdf","https://api.centene.com/Brochures/2016/32754WI0010002-03.pdf","7"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010012","Ambetter Balanced Care 2 (2016)","32754WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010012-00","Standard Silver Off Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/32754WI0010012-00.pdf","https://api.centene.com/Brochures/2016/32754WI0010012-00.pdf","8"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010012","Ambetter Balanced Care 2 (2016)","32754WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010012-01","Standard Silver On Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/32754WI0010012-01.pdf","https://api.centene.com/Brochures/2016/32754WI0010012-01.pdf","9"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010012","Ambetter Balanced Care 2 (2016)","32754WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/32754WI0010012-02.pdf","https://api.centene.com/Brochures/2016/32754WI0010012-02.pdf","10"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010012","Ambetter Balanced Care 2 (2016)","32754WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010012-03","Limited Cost Sharing Plan Variation",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/32754WI0010012-03.pdf","https://api.centene.com/Brochures/2016/32754WI0010012-03.pdf","11"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010012","Ambetter Balanced Care 2 (2016)","32754WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010012-04","73% AV Level Silver Plan",,"0.739638686180115","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/32754WI0010012-04.pdf","https://api.centene.com/Brochures/2016/32754WI0010012-04.pdf","12"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010012","Ambetter Balanced Care 2 (2016)","32754WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010012-05","87% AV Level Silver Plan",,"0.873916625976563","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,700","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/32754WI0010012-05.pdf","https://api.centene.com/Brochures/2016/32754WI0010012-05.pdf","13"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010012","Ambetter Balanced Care 2 (2016)","32754WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010012-06","94% AV Level Silver Plan",,"0.9492227435112","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/32754WI0010012-06.pdf","https://api.centene.com/Brochures/2016/32754WI0010012-06.pdf","14"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010014","Ambetter Balanced Care 10 (2016)","32754WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010014-00","Standard Silver Off Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/32754WI0010014-00.pdf","https://api.centene.com/Brochures/2016/32754WI0010014-00.pdf","22"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010014","Ambetter Balanced Care 10 (2016)","32754WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010014-01","Standard Silver On Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/32754WI0010014-01.pdf","https://api.centene.com/Brochures/2016/32754WI0010014-01.pdf","23"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010014","Ambetter Balanced Care 10 (2016)","32754WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/32754WI0010014-02.pdf","https://api.centene.com/Brochures/2016/32754WI0010014-02.pdf","24"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010014","Ambetter Balanced Care 10 (2016)","32754WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010014-03","Limited Cost Sharing Plan Variation",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/32754WI0010014-03.pdf","https://api.centene.com/Brochures/2016/32754WI0010014-03.pdf","25"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010014","Ambetter Balanced Care 10 (2016)","32754WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010014-04","73% AV Level Silver Plan",,"0.738659501075745","Yes","Yes","No","100%",,"$4,000","$10","$200","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/32754WI0010014-04.pdf","https://api.centene.com/Brochures/2016/32754WI0010014-04.pdf","26"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010014","Ambetter Balanced Care 10 (2016)","32754WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010014-05","87% AV Level Silver Plan",,"0.874480485916138","Yes","Yes","No","100%",,"$1,000","$0","$800","$200","$1,000","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/32754WI0010014-05.pdf","https://api.centene.com/Brochures/2016/32754WI0010014-05.pdf","27"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010014","Ambetter Balanced Care 10 (2016)","32754WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010014-06","94% AV Level Silver Plan",,"0.946612775325775","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/32754WI0010014-06.pdf","https://api.centene.com/Brochures/2016/32754WI0010014-06.pdf","28"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010011","Ambetter Essential Care 1 (2016)","32754WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010011-00","Standard Bronze Off Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/32754WI0010011-00.pdf","https://api.centene.com/Brochures/2016/32754WI0010011-00.pdf","29"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010011","Ambetter Essential Care 1 (2016)","32754WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010011-01","Standard Bronze On Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/32754WI0010011-01.pdf","https://api.centene.com/Brochures/2016/32754WI0010011-01.pdf","30"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010011","Ambetter Essential Care 1 (2016)","32754WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/32754WI0010011-02.pdf","https://api.centene.com/Brochures/2016/32754WI0010011-02.pdf","31"
"2016","WI","32754","HIOS","4","2015-08-26 09:56:12","1","32754","WI","Individual","No","39-1678579","32754WI0010011","Ambetter Essential Care 1 (2016)","32754WI001",,"WIN001","WIS001","WIF005","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.mhswi.com/payments","http://ambetter.mhswi.com/formulary","32754WI0010011-03","Limited Cost Sharing Plan Variation",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/32754WI0010011-03.pdf","https://api.centene.com/Brochures/2016/32754WI0010011-03.pdf","32"
"2016","WI","34210","HIOS","1","2015-05-05 11:48:23","1","34210","WI","Individual","Yes","47-0397286","34210WI0010001","Delta Dental Individual PPO, EHB Certified","34210WI001",,"WIN002","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.10","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","34210WI0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","34210","HIOS","1","2015-05-05 11:48:23","1","34210","WI","SHOP (Small Group)","Yes","47-0397286","34210WI0030001","Renaissance Group Dental PPO, EHB Certified","34210WI003",,"WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.48","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","34210WI0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","34210","HIOS","1","2015-05-05 11:48:23","1","34210","WI","SHOP (Small Group)","Yes","47-0397286","34210WI0030002","Renaissance Group Dental PPO, EHB Certified","34210WI003",,"WIN001","WIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.11","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","34210WI0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","WI","34210","HIOS","1","2015-05-05 11:48:23","1","34210","WI","Individual","Yes","47-0397286","34210WI0010002","Delta Dental Individual PPO, EHB Certified","34210WI001",,"WIN002","WIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.99","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","34210WI0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","WI","34210","HIOS","1","2015-05-05 11:48:23","1","34210","WI","Individual","Yes","47-0397286","34210WI0020001","Renaissance Individual Dental PPO, EHB Certified","34210WI002",,"WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.77","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","34210WI0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","WI","34210","HIOS","1","2015-05-05 11:48:23","1","34210","WI","Individual","Yes","47-0397286","34210WI0020002","Renaissance Individual Dental PPO, EHB Certified","34210WI002",,"WIN001","WIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.85","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","34210WI0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","WI","35334","HIOS","5","2015-08-26 09:56:12","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010101","MercyCare PPO CO 90-70 $0 Deductible; $10/$25/$50 Rx","35334WI001",,"WIN001","WIS001","WIF001","New","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","Yes","Providers in Multiplan or PHCS PPO networks","Yes","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","35334WI0010101-00","Standard Platinum Off Exchange Plan","90.75%","0.907508313655853","No","Yes","No","100%",,"$250","$20","$700","$150","$0","$700","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/PPO-CO-90-70-35334WI0010101.pdf",,"4"
"2016","WI","35334","HIOS","5","2015-08-26 09:56:12","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010101","MercyCare PPO CO 90-70 $0 Deductible; $10/$25/$50 Rx","35334WI001",,"WIN001","WIS001","WIF001","New","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","Yes","Providers in Multiplan or PHCS PPO networks","Yes","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","35334WI0010101-01","Standard Platinum On Exchange Plan","90.75%","0.907508313655853","No","Yes","No","100%",,"$250","$20","$700","$150","$0","$700","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/PPO-CO-90-70-35334WI0010101.pdf",,"5"
"2016","WI","35334","HIOS","5","2015-08-26 09:56:12","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010102","MercyCare PPO CO 80-60 $500 Deductible; $10/$25/$50 Rx","35334WI001",,"WIN001","WIS001","WIF001","New","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","Yes","Providers in Multiplan or PHCS PPO networks","Yes","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","35334WI0010102-00","Standard Platinum Off Exchange Plan","88.08%","0.880777060985565","No","Yes","No","100%",,"$750","$0","$750","$150","$500","$680","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/PPO-CO-80-60-500-Ded.-35334WI0010102.pdf",,"6"
"2016","WI","35334","HIOS","5","2015-08-26 09:56:12","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010102","MercyCare PPO CO 80-60 $500 Deductible; $10/$25/$50 Rx","35334WI001",,"WIN001","WIS001","WIF001","New","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","Yes","Providers in Multiplan or PHCS PPO networks","Yes","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","35334WI0010102-01","Standard Platinum On Exchange Plan","88.08%","0.880777060985565","No","Yes","No","100%",,"$750","$0","$750","$150","$500","$680","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/PPO-CO-80-60-500-Ded.-35334WI0010102.pdf",,"7"
"2016","WI","35334","HIOS","5","2015-08-26 09:56:12","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010103","MercyCare PPO CO 80-60 $1250 Deductible; $20/$40/$60 Rx","35334WI001",,"WIN001","WIS001","WIF002","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","Yes","Providers in Multiplan or PHCS PPO networks","Yes","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","35334WI0010103-00","Standard Gold Off Exchange Plan","80.85%","0.808492004871368","No","Yes","No","100%",,"$1,500","$20","$1,150","$150","$1,250","$870","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/PPO-CO-80-60-1250-Ded.-35334WI0010103.pdf",,"8"
"2016","WI","35334","HIOS","5","2015-08-26 09:56:12","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010103","MercyCare PPO CO 80-60 $1250 Deductible; $20/$40/$60 Rx","35334WI001",,"WIN001","WIS001","WIF002","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","Yes","Providers in Multiplan or PHCS PPO networks","Yes","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","35334WI0010103-01","Standard Gold On Exchange Plan","80.85%","0.808492004871368","No","Yes","No","100%",,"$1,500","$20","$1,150","$150","$1,250","$870","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/PPO-CO-80-60-1250-Ded.-35334WI0010103.pdf",,"9"
"2016","WI","35334","HIOS","5","2015-08-26 09:56:12","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010104","MercyCare PPO CO 80-60 $2000 Deductible; $20/$40/$60 Rx","35334WI001",,"WIN001","WIS001","WIF002","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","Yes","Providers in Multiplan or PHCS PPO networks","Yes","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","35334WI0010104-00","Standard Gold Off Exchange Plan","78.13%","0.781248807907104","No","Yes","No","100%",,"$2,250","$20","$1,000","$150","$2,000","$730","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$8,750","$8750 per person","$17500 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/PPO-CO-80-60-2000-Ded.-35334WI0010104.pdf",,"10"
"2016","WI","35334","HIOS","5","2015-08-26 09:56:12","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010104","MercyCare PPO CO 80-60 $2000 Deductible; $20/$40/$60 Rx","35334WI001",,"WIN001","WIS001","WIF002","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","Yes","Providers in Multiplan or PHCS PPO networks","Yes","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","35334WI0010104-01","Standard Gold On Exchange Plan","78.13%","0.781248807907104","No","Yes","No","100%",,"$2,250","$20","$1,000","$150","$2,000","$730","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$8,750","$8750 per person","$17500 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/PPO-CO-80-60-2000-Ded.-35334WI0010104.pdf",,"11"
"2016","WI","35334","HIOS","5","2015-08-26 09:56:12","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010105","MercyCare PPO CO 70-50 $2500 Deductible; $20/$40/$60 Rx","35334WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","Yes","Providers in Multiplan or PHCS PPO networks","Yes","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","35334WI0010105-00","Standard Silver Off Exchange Plan","71.50%","0.714952886104584","No","Yes","No","100%",,"$2,750","$20","$1,350","$150","$2,500","$620","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/PPO-CO-70-50-2500-Ded.-35334WI0010105.pdf",,"12"
"2016","WI","35334","HIOS","5","2015-08-26 09:56:12","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010105","MercyCare PPO CO 70-50 $2500 Deductible; $20/$40/$60 Rx","35334WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","Yes","Providers in Multiplan or PHCS PPO networks","Yes","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","35334WI0010105-01","Standard Silver On Exchange Plan","71.50%","0.714952886104584","No","Yes","No","100%",,"$2,750","$20","$1,350","$150","$2,500","$620","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/PPO-CO-70-50-2500-Ded.-35334WI0010105.pdf",,"13"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510001","Unity Prime Platinum 30/60","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510001-00","Standard Platinum Off Exchange Plan",,"0.880473077297211","No","Yes","No","100%",,"$500","$100","$900","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP1","https://unityhealth.com/HIM2016-Prime/INDPP1","4"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510014","Unity Elite Gold 20/40","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510014-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEG2I2","https://unityhealth.com/HIM2016-Elite/INDEG2","53"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510014","Unity Elite Gold 20/40","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510014-03","Limited Cost Sharing Plan Variation",,"0.816758096218109","No","Yes","No","100%",,"$1,000","$400","$800","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEG2I1","https://unityhealth.com/HIM2016-Elite/INDEG2","54"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510021","Unity Beloit One Platinum 30/60","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510021-00","Standard Platinum Off Exchange Plan",,"0.880473077297211","No","Yes","No","100%",,"$500","$100","$900","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP1","https://unityhealth.com/HIM2016-BeloitOne/INDBP1","82"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510021","Unity Beloit One Platinum 30/60","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510021-01","Standard Platinum On Exchange Plan",,"0.880473077297211","No","Yes","No","100%",,"$500","$100","$900","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP1","https://unityhealth.com/HIM2016-BeloitOne/INDBP1","83"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510021","Unity Beloit One Platinum 30/60","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510021-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP1I2","https://unityhealth.com/HIM2016-BeloitOne/INDBP1","84"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510021","Unity Beloit One Platinum 30/60","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510021-03","Limited Cost Sharing Plan Variation",,"0.880473077297211","No","Yes","No","100%",,"$500","$100","$900","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP1I1","https://unityhealth.com/HIM2016-BeloitOne/INDBP1","85"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510040","Unity Beloit One Platinum 25/50","37833WI051","7114920342","WIN003","WIS003","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510040-00","Standard Platinum Off Exchange Plan",,"0.913492679595947","No","Yes","No","100%",,"$0","$400","$0","$30","$0","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP3","https://unityhealth.com/HIM2016-BeloitOne/INDBP3","86"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510001","Unity Prime Platinum 30/60","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510001-01","Standard Platinum On Exchange Plan",,"0.880473077297211","No","Yes","No","100%",,"$500","$100","$900","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP1","https://unityhealth.com/HIM2016-Prime/INDPP1","5"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510001","Unity Prime Platinum 30/60","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP1I2","https://unityhealth.com/HIM2016-Prime/INDPP1","6"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510001","Unity Prime Platinum 30/60","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510001-03","Limited Cost Sharing Plan Variation",,"0.880473077297211","No","Yes","No","100%",,"$500","$100","$900","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP1I1","https://unityhealth.com/HIM2016-Prime/INDPP1","7"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510002","Unity Prime Platinum 25/50","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510002-00","Standard Platinum Off Exchange Plan",,"0.913492679595947","No","Yes","No","100%",,"$0","$400","$0","$30","$0","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP3","https://unityhealth.com/HIM2016-Prime/INDPP3","8"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510002","Unity Prime Platinum 25/50","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510002-01","Standard Platinum On Exchange Plan",,"0.913492679595947","No","Yes","No","100%",,"$0","$400","$0","$30","$0","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP3","https://unityhealth.com/HIM2016-Prime/INDPP3","9"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510002","Unity Prime Platinum 25/50","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP3I2","https://unityhealth.com/HIM2016-Prime/INDPP3","10"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510002","Unity Prime Platinum 25/50","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510002-03","Limited Cost Sharing Plan Variation",,"0.913492679595947","No","Yes","No","100%",,"$0","$400","$0","$30","$0","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP3I1","https://unityhealth.com/HIM2016-Prime/INDPP3","11"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510004","Unity Prime Gold 20/40","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510004-00","Standard Gold Off Exchange Plan",,"0.816758096218109","No","Yes","No","100%",,"$1,000","$400","$800","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPG2","https://unityhealth.com/HIM2016-Prime/INDPG2","12"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510004","Unity Prime Gold 20/40","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510004-01","Standard Gold On Exchange Plan",,"0.816758096218109","No","Yes","No","100%",,"$1,000","$400","$800","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPG2","https://unityhealth.com/HIM2016-Prime/INDPG2","13"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510004","Unity Prime Gold 20/40","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPG2I2","https://unityhealth.com/HIM2016-Prime/INDPG2","14"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510004","Unity Prime Gold 20/40","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510004-03","Limited Cost Sharing Plan Variation",,"0.816758096218109","No","Yes","No","100%",,"$1,000","$400","$800","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPG2I1","https://unityhealth.com/HIM2016-Prime/INDPG2","15"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510030","Unity Prime Silver Maintenance","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510030-00","Standard Silver Off Exchange Plan",,"0.70446103811264","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS3","https://unityhealth.com/HIM2016-Prime/INDPS3","16"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510030","Unity Prime Silver Maintenance","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510030-01","Standard Silver On Exchange Plan",,"0.70446103811264","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS3","https://unityhealth.com/HIM2016-Prime/INDPS3","17"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510030","Unity Prime Silver Maintenance","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510030-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS3I2","https://unityhealth.com/HIM2016-Prime/INDPS3","18"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510030","Unity Prime Silver Maintenance","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510030-03","Limited Cost Sharing Plan Variation",,"0.70446103811264","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS3I1","https://unityhealth.com/HIM2016-Prime/INDPS3","19"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510030","Unity Prime Silver Maintenance","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510030-04","73% AV Level Silver Plan",,"0.739607036113739","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS3C3","https://unityhealth.com/HIM2016-Prime/INDPS3","20"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510030","Unity Prime Silver Maintenance","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510030-05","87% AV Level Silver Plan",,"0.879408359527588","No","Yes","No","100%",,"$250","$1,400","$0","$30","$100","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS3C2","https://unityhealth.com/HIM2016-Prime/INDPS3","21"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510030","Unity Prime Silver Maintenance","37833WI051","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510030-06","94% AV Level Silver Plan",,"0.945597589015961","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS3C1","https://unityhealth.com/HIM2016-Prime/INDPS3","22"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510008","Unity Prime Silver Choice Value","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510008-00","Standard Silver Off Exchange Plan",,"0.714424312114716","No","Yes","No","100%",,"$3,000","$400","$400","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$6000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS4","https://unityhealth.com/HIM2016-Prime/INDPS4","23"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510008","Unity Prime Silver Choice Value","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510008-01","Standard Silver On Exchange Plan",,"0.714424312114716","No","Yes","No","100%",,"$3,000","$400","$400","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$6000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS4","https://unityhealth.com/HIM2016-Prime/INDPS4","24"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510008","Unity Prime Silver Choice Value","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS4I2","https://unityhealth.com/HIM2016-Prime/INDPS4","25"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510008","Unity Prime Silver Choice Value","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510008-03","Limited Cost Sharing Plan Variation",,"0.714424312114716","No","Yes","No","100%",,"$3,000","$400","$400","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$6000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS4I1","https://unityhealth.com/HIM2016-Prime/INDPS4","26"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510008","Unity Prime Silver Choice Value","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510008-04","73% AV Level Silver Plan",,"0.739143431186676","No","Yes","No","100%",,"$2,600","$400","$500","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$5200 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS4C3","https://unityhealth.com/HIM2016-Prime/INDPS4","27"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510008","Unity Prime Silver Choice Value","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510008-05","87% AV Level Silver Plan",,"0.877998948097229","No","Yes","No","100%",,"$650","$200","$900","$30","$100","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$1300 per person","$1300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS4C2","https://unityhealth.com/HIM2016-Prime/INDPS4","28"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510008","Unity Prime Silver Choice Value","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510008-06","94% AV Level Silver Plan",,"0.94908195734024","No","Yes","No","100%",,"$100","$100","$500","$30","$100","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS4C1","https://unityhealth.com/HIM2016-Prime/INDPS4","29"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510009","Unity Prime Silver Exclusive Value","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510009-00","Standard Silver Off Exchange Plan",,"0.68013334274292","No","Yes","No","100%",,"$4,000","$700","$500","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$6850 per person","$8000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS5","https://unityhealth.com/HIM2016-Prime/INDPS5","30"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510009","Unity Prime Silver Exclusive Value","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510009-01","Standard Silver On Exchange Plan",,"0.68013334274292","No","Yes","No","100%",,"$4,000","$700","$500","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$6850 per person","$8000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS5","https://unityhealth.com/HIM2016-Prime/INDPS5","31"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510009","Unity Prime Silver Exclusive Value","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS5I2","https://unityhealth.com/HIM2016-Prime/INDPS5","32"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510009","Unity Prime Silver Exclusive Value","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510009-03","Limited Cost Sharing Plan Variation",,"0.68013334274292","No","Yes","No","100%",,"$4,000","$700","$500","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$6850 per person","$8000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS5I1","https://unityhealth.com/HIM2016-Prime/INDPS5","33"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510040","Unity Beloit One Platinum 25/50","37833WI051","7114920342","WIN003","WIS003","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510040-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP3I2","https://unityhealth.com/HIM2016-BeloitOne/INDBP3","88"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510040","Unity Beloit One Platinum 25/50","37833WI051","7114920342","WIN003","WIS003","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510040-03","Limited Cost Sharing Plan Variation",,"0.913492679595947","No","Yes","No","100%",,"$0","$400","$0","$30","$0","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP3I1","https://unityhealth.com/HIM2016-BeloitOne/INDBP3","89"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510041","Unity Beloit One Gold 20/40","37833WI051","7114920342","WIN003","WIS003","WIF002","New","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510041-00","Standard Gold Off Exchange Plan",,"0.816758096218109","No","Yes","No","100%",,"$1,000","$400","$800","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBG2","https://unityhealth.com/HIM2016-BeloitOne/INDBG2","90"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510041","Unity Beloit One Gold 20/40","37833WI051","7114920342","WIN003","WIS003","WIF002","New","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510041-01","Standard Gold On Exchange Plan",,"0.816758096218109","No","Yes","No","100%",,"$1,000","$400","$800","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBG2","https://unityhealth.com/HIM2016-BeloitOne/INDBG2","91"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510041","Unity Beloit One Gold 20/40","37833WI051","7114920342","WIN003","WIS003","WIF002","New","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510041-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBG2I2","https://unityhealth.com/HIM2016-BeloitOne/INDBG2","92"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0540011","Unity Beloit One Catastrophic","37833WI054","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Catastrophic","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540011-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$30","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/HIM2016-4/SBC/INDBC1","https://unityhealth.com/HIM2016-BeloitOne/INDBC1","120"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510009","Unity Prime Silver Exclusive Value","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510009-04","73% AV Level Silver Plan",,"0.739812910556793","No","Yes","No","100%",,"$2,500","$500","$200","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$5450 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$5000 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS5C3","https://unityhealth.com/HIM2016-Prime/INDPS5","34"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510009","Unity Prime Silver Exclusive Value","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510009-05","87% AV Level Silver Plan",,"0.876107454299927","No","Yes","No","100%",,"$65","$500","$0","$30","$65","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$65","$130 per person","$130 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS5C2","https://unityhealth.com/HIM2016-Prime/INDPS5","35"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510009","Unity Prime Silver Exclusive Value","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510009-06","94% AV Level Silver Plan",,"0.943773090839386","No","Yes","No","100%",,"$0","$300","$0","$30","$0","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2250 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS5C1","https://unityhealth.com/HIM2016-Prime/INDPS5","36"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510035","Unity Prime Bronze 45/125 Value","37833WI051","7114920342","WIN001","WIS001","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510035-00","Standard Bronze Off Exchange Plan",,"0.611985385417938","No","Yes","No","100%",,"$5,000","$800","$0","$30","$100","$2,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,600","$6850 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPB3","https://unityhealth.com/HIM2016-Prime/INDPB3","37"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510035","Unity Prime Bronze 45/125 Value","37833WI051","7114920342","WIN001","WIS001","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510035-01","Standard Bronze On Exchange Plan",,"0.611985385417938","No","Yes","No","100%",,"$5,000","$800","$0","$30","$100","$2,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,600","$6850 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPB3","https://unityhealth.com/HIM2016-Prime/INDPB3","38"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510035","Unity Prime Bronze 45/125 Value","37833WI051","7114920342","WIN001","WIS001","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510035-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPB3I2","https://unityhealth.com/HIM2016-Prime/INDPB3","39"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510035","Unity Prime Bronze 45/125 Value","37833WI051","7114920342","WIN001","WIS001","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510035-03","Limited Cost Sharing Plan Variation",,"0.611985385417938","No","Yes","No","100%",,"$5,000","$800","$0","$30","$100","$2,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,600","$6850 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPB3I1","https://unityhealth.com/HIM2016-Prime/INDPB3","40"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0540004","Unity Prime Catastrophic","37833WI054","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Catastrophic","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540004-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$30","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPC1","https://unityhealth.com/HIM2016-Prime/INDPC1","41"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0540004","Unity Prime Catastrophic","37833WI054","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Catastrophic","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$30","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPC1","https://unityhealth.com/HIM2016-Prime/INDPC1","42"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510011","Unity Elite Platinum 30/60","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510011-00","Standard Platinum Off Exchange Plan",,"0.880473077297211","No","Yes","No","100%",,"$500","$100","$900","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP1","https://unityhealth.com/HIM2016-Elite/INDEP1","43"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510011","Unity Elite Platinum 30/60","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510011-01","Standard Platinum On Exchange Plan",,"0.880473077297211","No","Yes","No","100%",,"$500","$100","$900","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP1","https://unityhealth.com/HIM2016-Elite/INDEP1","44"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510011","Unity Elite Platinum 30/60","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510011-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP1I2","https://unityhealth.com/HIM2016-Elite/INDEP1","45"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510011","Unity Elite Platinum 30/60","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510011-03","Limited Cost Sharing Plan Variation",,"0.880473077297211","No","Yes","No","100%",,"$500","$100","$900","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP1I1","https://unityhealth.com/HIM2016-Elite/INDEP1","46"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510012","Unity Elite Platinum 25/50","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510012-00","Standard Platinum Off Exchange Plan",,"0.913492679595947","No","Yes","No","100%",,"$0","$400","$0","$30","$0","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP3","https://unityhealth.com/HIM2016-Elite/INDEP3","47"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510012","Unity Elite Platinum 25/50","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510012-01","Standard Platinum On Exchange Plan",,"0.913492679595947","No","Yes","No","100%",,"$0","$400","$0","$30","$0","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP3","https://unityhealth.com/HIM2016-Elite/INDEP3","48"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510012","Unity Elite Platinum 25/50","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510012-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP3I2","https://unityhealth.com/HIM2016-Elite/INDEP3","49"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510012","Unity Elite Platinum 25/50","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510012-03","Limited Cost Sharing Plan Variation",,"0.913492679595947","No","Yes","No","100%",,"$0","$400","$0","$30","$0","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP3I1","https://unityhealth.com/HIM2016-Elite/INDEP3","50"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510014","Unity Elite Gold 20/40","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510014-00","Standard Gold Off Exchange Plan",,"0.816758096218109","No","Yes","No","100%",,"$1,000","$400","$800","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEG2","https://unityhealth.com/HIM2016-Elite/INDEG2","51"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510014","Unity Elite Gold 20/40","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510014-01","Standard Gold On Exchange Plan",,"0.816758096218109","No","Yes","No","100%",,"$1,000","$400","$800","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEG2","https://unityhealth.com/HIM2016-Elite/INDEG2","52"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510032","Unity Elite Silver Maintenance","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510032-00","Standard Silver Off Exchange Plan",,"0.70446103811264","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES3","https://unityhealth.com/HIM2016-Elite/INDES3","55"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510032","Unity Elite Silver Maintenance","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510032-01","Standard Silver On Exchange Plan",,"0.70446103811264","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES3","https://unityhealth.com/HIM2016-Elite/INDES3","56"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510032","Unity Elite Silver Maintenance","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510032-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES3I2","https://unityhealth.com/HIM2016-Elite/INDES3","57"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510032","Unity Elite Silver Maintenance","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510032-03","Limited Cost Sharing Plan Variation",,"0.70446103811264","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES3I1","https://unityhealth.com/HIM2016-Elite/INDES3","58"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510032","Unity Elite Silver Maintenance","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510032-04","73% AV Level Silver Plan",,"0.739607036113739","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES3C3","https://unityhealth.com/HIM2016-Elite/INDES3","59"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510032","Unity Elite Silver Maintenance","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510032-05","87% AV Level Silver Plan",,"0.879408359527588","No","Yes","No","100%",,"$250","$1,400","$0","$30","$100","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES3C2","https://unityhealth.com/HIM2016-Elite/INDES3","60"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510032","Unity Elite Silver Maintenance","37833WI051","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510032-06","94% AV Level Silver Plan",,"0.945597589015961","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES3C1","https://unityhealth.com/HIM2016-Elite/INDES3","61"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510018","Unity Elite Silver Choice Value","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510018-00","Standard Silver Off Exchange Plan",,"0.714424312114716","No","Yes","No","100%",,"$3,000","$400","$400","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$6000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES4","https://unityhealth.com/HIM2016-Elite/INDES4","62"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510018","Unity Elite Silver Choice Value","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510018-01","Standard Silver On Exchange Plan",,"0.714424312114716","No","Yes","No","100%",,"$3,000","$400","$400","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$6000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES4","https://unityhealth.com/HIM2016-Elite/INDES4","63"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510018","Unity Elite Silver Choice Value","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510018-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES4I2","https://unityhealth.com/HIM2016-Elite/INDES4","64"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510018","Unity Elite Silver Choice Value","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510018-03","Limited Cost Sharing Plan Variation",,"0.714424312114716","No","Yes","No","100%",,"$3,000","$400","$400","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$6000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES4I1","https://unityhealth.com/HIM2016-Elite/INDES4","65"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510018","Unity Elite Silver Choice Value","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510018-04","73% AV Level Silver Plan",,"0.739143431186676","No","Yes","No","100%",,"$2,600","$400","$500","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$5200 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES4C3","https://unityhealth.com/HIM2016-Elite/INDES4","66"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510018","Unity Elite Silver Choice Value","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510018-05","87% AV Level Silver Plan",,"0.877998948097229","No","Yes","No","100%",,"$650","$200","$900","$30","$100","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$1300 per person","$1300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES4C2","https://unityhealth.com/HIM2016-Elite/INDES4","67"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510018","Unity Elite Silver Choice Value","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510018-06","94% AV Level Silver Plan",,"0.94908195734024","No","Yes","No","100%",,"$100","$100","$500","$30","$100","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES4C1","https://unityhealth.com/HIM2016-Elite/INDES4","68"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510019","Unity Elite Silver Exclusive Value","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510019-00","Standard Silver Off Exchange Plan",,"0.68013334274292","No","Yes","No","100%",,"$4,000","$700","$500","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$6850 per person","$8000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES5","https://unityhealth.com/HIM2016-Elite/INDES5","69"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510019","Unity Elite Silver Exclusive Value","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510019-01","Standard Silver On Exchange Plan",,"0.68013334274292","No","Yes","No","100%",,"$4,000","$700","$500","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$6850 per person","$8000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES5","https://unityhealth.com/HIM2016-Elite/INDES5","70"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510019","Unity Elite Silver Exclusive Value","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510019-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES5I2","https://unityhealth.com/HIM2016-Elite/INDES5","71"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510019","Unity Elite Silver Exclusive Value","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510019-03","Limited Cost Sharing Plan Variation",,"0.68013334274292","No","Yes","No","100%",,"$4,000","$700","$500","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$6850 per person","$8000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES5I1","https://unityhealth.com/HIM2016-Elite/INDES5","72"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510019","Unity Elite Silver Exclusive Value","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510019-04","73% AV Level Silver Plan",,"0.739812910556793","No","Yes","No","100%",,"$2,500","$500","$200","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$5450 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$5000 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES5C3","https://unityhealth.com/HIM2016-Elite/INDES5","73"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510019","Unity Elite Silver Exclusive Value","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510019-05","87% AV Level Silver Plan",,"0.876107454299927","No","Yes","No","100%",,"$65","$500","$0","$30","$65","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$65","$130 per person","$130 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES5C2","https://unityhealth.com/HIM2016-Elite/INDES5","74"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510019","Unity Elite Silver Exclusive Value","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510019-06","94% AV Level Silver Plan",,"0.943773090839386","No","Yes","No","100%",,"$0","$300","$0","$30","$0","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2250 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES5C1","https://unityhealth.com/HIM2016-Elite/INDES5","75"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510037","Unity Elite Bronze 45/125 Value","37833WI051","7114920342","WIN002","WIS002","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510037-00","Standard Bronze Off Exchange Plan",,"0.611985385417938","No","Yes","No","100%",,"$5,000","$800","$0","$30","$100","$2,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,600","$6850 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEB3","https://unityhealth.com/HIM2016-Elite/INDEB3","76"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510037","Unity Elite Bronze 45/125 Value","37833WI051","7114920342","WIN002","WIS002","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510037-01","Standard Bronze On Exchange Plan",,"0.611985385417938","No","Yes","No","100%",,"$5,000","$800","$0","$30","$100","$2,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,600","$6850 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEB3","https://unityhealth.com/HIM2016-Elite/INDEB3","77"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510037","Unity Elite Bronze 45/125 Value","37833WI051","7114920342","WIN002","WIS002","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510037-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEB3I2","https://unityhealth.com/HIM2016-Elite/INDEB3","78"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510037","Unity Elite Bronze 45/125 Value","37833WI051","7114920342","WIN002","WIS002","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510037-03","Limited Cost Sharing Plan Variation",,"0.611985385417938","No","Yes","No","100%",,"$5,000","$800","$0","$30","$100","$2,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,600","$6850 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEB3I1","https://unityhealth.com/HIM2016-Elite/INDEB3","79"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0540008","Unity Elite Catastrophic","37833WI054","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Catastrophic","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540008-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$30","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/HIM2016-1/SBC/INDEC1","https://unityhealth.com/HIM2016-Elite/INDEC1","80"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0540008","Unity Elite Catastrophic","37833WI054","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Catastrophic","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540008-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$30","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/HIM2016-1/SBC/INDEC1","https://unityhealth.com/HIM2016-Elite/INDEC1","81"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510040","Unity Beloit One Platinum 25/50","37833WI051","7114920342","WIN003","WIS003","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510040-01","Standard Platinum On Exchange Plan",,"0.913492679595947","No","Yes","No","100%",,"$0","$400","$0","$30","$0","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP3","https://unityhealth.com/HIM2016-BeloitOne/INDBP3","87"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510041","Unity Beloit One Gold 20/40","37833WI051","7114920342","WIN003","WIS003","WIF002","New","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510041-03","Limited Cost Sharing Plan Variation",,"0.816758096218109","No","Yes","No","100%",,"$1,000","$400","$800","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBG2I1","https://unityhealth.com/HIM2016-BeloitOne/INDBG2","93"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510043","Unity Beloit One Silver Maintenance","37833WI051","7114920342","WIN003","WIS003","WIF001","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510043-00","Standard Silver Off Exchange Plan",,"0.70446103811264","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS3","https://unityhealth.com/HIM2016-BeloitOne/INDBS3","94"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510043","Unity Beloit One Silver Maintenance","37833WI051","7114920342","WIN003","WIS003","WIF001","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510043-01","Standard Silver On Exchange Plan",,"0.70446103811264","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS3","https://unityhealth.com/HIM2016-BeloitOne/INDBS3","95"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510043","Unity Beloit One Silver Maintenance","37833WI051","7114920342","WIN003","WIS003","WIF001","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510043-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS3I2","https://unityhealth.com/HIM2016-BeloitOne/INDBS3","96"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510043","Unity Beloit One Silver Maintenance","37833WI051","7114920342","WIN003","WIS003","WIF001","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510043-03","Limited Cost Sharing Plan Variation",,"0.70446103811264","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS3I1","https://unityhealth.com/HIM2016-BeloitOne/INDBS3","97"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510043","Unity Beloit One Silver Maintenance","37833WI051","7114920342","WIN003","WIS003","WIF001","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510043-04","73% AV Level Silver Plan",,"0.739607036113739","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS3C3","https://unityhealth.com/HIM2016-BeloitOne/INDBS3","98"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510043","Unity Beloit One Silver Maintenance","37833WI051","7114920342","WIN003","WIS003","WIF001","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510043-05","87% AV Level Silver Plan",,"0.879408359527588","No","Yes","No","100%",,"$250","$1,400","$0","$30","$100","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS3C2","https://unityhealth.com/HIM2016-BeloitOne/INDBS3","99"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510043","Unity Beloit One Silver Maintenance","37833WI051","7114920342","WIN003","WIS003","WIF001","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510043-06","94% AV Level Silver Plan",,"0.945597589015961","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS3C1","https://unityhealth.com/HIM2016-BeloitOne/INDBS3","100"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510044","Unity Beloit One Silver Choice Value","37833WI051","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510044-00","Standard Silver Off Exchange Plan",,"0.714424312114716","No","Yes","No","100%",,"$3,000","$400","$400","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$6000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS4","https://unityhealth.com/HIM2016-BeloitOne/INDBS4","101"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510044","Unity Beloit One Silver Choice Value","37833WI051","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510044-01","Standard Silver On Exchange Plan",,"0.714424312114716","No","Yes","No","100%",,"$3,000","$400","$400","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$6000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS4","https://unityhealth.com/HIM2016-BeloitOne/INDBS4","102"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510044","Unity Beloit One Silver Choice Value","37833WI051","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510044-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS4I2","https://unityhealth.com/HIM2016-BeloitOne/INDBS4","103"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510044","Unity Beloit One Silver Choice Value","37833WI051","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510044-03","Limited Cost Sharing Plan Variation",,"0.714424312114716","No","Yes","No","100%",,"$3,000","$400","$400","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$6000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS4I1","https://unityhealth.com/HIM2016-BeloitOne/INDBS4","104"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510044","Unity Beloit One Silver Choice Value","37833WI051","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510044-04","73% AV Level Silver Plan",,"0.739143431186676","No","Yes","No","100%",,"$2,600","$400","$500","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$5200 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS4C3","https://unityhealth.com/HIM2016-BeloitOne/INDBS4","105"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510044","Unity Beloit One Silver Choice Value","37833WI051","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510044-05","87% AV Level Silver Plan",,"0.877998948097229","No","Yes","No","100%",,"$650","$200","$900","$30","$100","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$1300 per person","$1300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS4C2","https://unityhealth.com/HIM2016-BeloitOne/INDBS4","106"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510044","Unity Beloit One Silver Choice Value","37833WI051","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510044-06","94% AV Level Silver Plan",,"0.94908195734024","No","Yes","No","100%",,"$100","$100","$500","$30","$100","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS4C1","https://unityhealth.com/HIM2016-BeloitOne/INDBS4","107"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510024","Unity Beloit One Silver Exclusive Value","37833WI051","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510024-00","Standard Silver Off Exchange Plan",,"0.68013334274292","No","Yes","No","100%",,"$4,000","$700","$500","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$6850 per person","$8000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS5","https://unityhealth.com/HIM2016-BeloitOne/INDBS5","108"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510024","Unity Beloit One Silver Exclusive Value","37833WI051","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510024-01","Standard Silver On Exchange Plan",,"0.68013334274292","No","Yes","No","100%",,"$4,000","$700","$500","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$6850 per person","$8000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS5","https://unityhealth.com/HIM2016-BeloitOne/INDBS5","109"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510024","Unity Beloit One Silver Exclusive Value","37833WI051","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510024-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS5I2","https://unityhealth.com/HIM2016-BeloitOne/INDBS5","110"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510024","Unity Beloit One Silver Exclusive Value","37833WI051","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510024-03","Limited Cost Sharing Plan Variation",,"0.68013334274292","No","Yes","No","100%",,"$4,000","$700","$500","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$6850 per person","$8000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS5I1","https://unityhealth.com/HIM2016-BeloitOne/INDBS5","111"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510024","Unity Beloit One Silver Exclusive Value","37833WI051","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510024-04","73% AV Level Silver Plan",,"0.739812910556793","No","Yes","No","100%",,"$2,500","$500","$200","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$5450 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$5000 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS5C3","https://unityhealth.com/HIM2016-BeloitOne/INDBS5","112"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510024","Unity Beloit One Silver Exclusive Value","37833WI051","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510024-05","87% AV Level Silver Plan",,"0.876107454299927","No","Yes","No","100%",,"$65","$500","$0","$30","$65","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$65","$130 per person","$130 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS5C2","https://unityhealth.com/HIM2016-BeloitOne/INDBS5","113"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510024","Unity Beloit One Silver Exclusive Value","37833WI051","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510024-06","94% AV Level Silver Plan",,"0.943773090839386","No","Yes","No","100%",,"$0","$300","$0","$30","$0","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2250 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS5C1","https://unityhealth.com/HIM2016-BeloitOne/INDBS5","114"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510039","Unity Beloit One Bronze 45/125 Value","37833WI051","7114920342","WIN003","WIS003","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510039-00","Standard Bronze Off Exchange Plan",,"0.611985385417938","No","Yes","No","100%",,"$5,000","$800","$0","$30","$100","$2,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,600","$6850 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-4/SBC/INDBB3","https://unityhealth.com/HIM2016-BeloitOne/INDBB3","115"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510039","Unity Beloit One Bronze 45/125 Value","37833WI051","7114920342","WIN003","WIS003","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510039-01","Standard Bronze On Exchange Plan",,"0.611985385417938","No","Yes","No","100%",,"$5,000","$800","$0","$30","$100","$2,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,600","$6850 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-4/SBC/INDBB3","https://unityhealth.com/HIM2016-BeloitOne/INDBB3","116"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510039","Unity Beloit One Bronze 45/125 Value","37833WI051","7114920342","WIN003","WIS003","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510039-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-4/SBC/INDBB3I2","https://unityhealth.com/HIM2016-BeloitOne/INDBB3","117"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0510039","Unity Beloit One Bronze 45/125 Value","37833WI051","7114920342","WIN003","WIS003","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510039-03","Limited Cost Sharing Plan Variation",,"0.611985385417938","No","Yes","No","100%",,"$5,000","$800","$0","$30","$100","$2,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,600","$6850 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-4/SBC/INDBB3I1","https://unityhealth.com/HIM2016-BeloitOne/INDBB3","118"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","1","37833","WI","Individual","No","39-1450766","37833WI0540011","Unity Beloit One Catastrophic","37833WI054","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Catastrophic","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540011-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$30","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/HIM2016-4/SBC/INDBC1","https://unityhealth.com/HIM2016-BeloitOne/INDBC1","119"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380005","Unity Prime Platinum 30/60 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380005-00","Standard Platinum Off Exchange Plan",,"0.880473077297211","No","Yes","No","100%",,"$500","$100","$900","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP1D","https://unityhealth.com/HIM2016-Prime/INDPP1D","4"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380044","Unity Elite Silver Maintenance with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380044-06","94% AV Level Silver Plan",,"0.945597589015961","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES3DC1","https://unityhealth.com/HIM2016-Elite/INDES3D","59"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380028","Unity Elite Silver Choice Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380028-00","Standard Silver Off Exchange Plan",,"0.714424312114716","No","Yes","No","100%",,"$3,000","$400","$400","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$6000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES4D","https://unityhealth.com/HIM2016-Elite/INDES4D","60"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380028","Unity Elite Silver Choice Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380028-01","Standard Silver On Exchange Plan",,"0.714424312114716","No","Yes","No","100%",,"$3,000","$400","$400","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$6000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES4D","https://unityhealth.com/HIM2016-Elite/INDES4D","61"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380028","Unity Elite Silver Choice Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380028-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES4DI2","https://unityhealth.com/HIM2016-Elite/INDES4D","62"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380028","Unity Elite Silver Choice Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380028-03","Limited Cost Sharing Plan Variation",,"0.714424312114716","No","Yes","No","100%",,"$3,000","$400","$400","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$6000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES4DI1","https://unityhealth.com/HIM2016-Elite/INDES4D","63"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380060","Unity Beloit One Silver Maintenance with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380060-01","Standard Silver On Exchange Plan",,"0.70446103811264","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS3D","https://unityhealth.com/HIM2016-BeloitOne/INDBS3D","91"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380060","Unity Beloit One Silver Maintenance with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380060-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS3DI2","https://unityhealth.com/HIM2016-BeloitOne/INDBS3D","92"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380005","Unity Prime Platinum 30/60 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380005-01","Standard Platinum On Exchange Plan",,"0.880473077297211","No","Yes","No","100%",,"$500","$100","$900","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP1D","https://unityhealth.com/HIM2016-Prime/INDPP1D","5"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380005","Unity Prime Platinum 30/60 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP1DI2","https://unityhealth.com/HIM2016-Prime/INDPP1D","6"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380005","Unity Prime Platinum 30/60 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380005-03","Limited Cost Sharing Plan Variation",,"0.880473077297211","No","Yes","No","100%",,"$500","$100","$900","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP1DI1","https://unityhealth.com/HIM2016-Prime/INDPP1D","7"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380006","Unity Prime Platinum 25/50 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380006-00","Standard Platinum Off Exchange Plan",,"0.913492679595947","No","Yes","No","100%",,"$0","$400","$0","$30","$0","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP3D","https://unityhealth.com/HIM2016-Prime/INDPP3D","8"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380006","Unity Prime Platinum 25/50 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380006-01","Standard Platinum On Exchange Plan",,"0.913492679595947","No","Yes","No","100%",,"$0","$400","$0","$30","$0","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP3D","https://unityhealth.com/HIM2016-Prime/INDPP3D","9"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380006","Unity Prime Platinum 25/50 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP3DI2","https://unityhealth.com/HIM2016-Prime/INDPP3D","10"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380006","Unity Prime Platinum 25/50 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380006-03","Limited Cost Sharing Plan Variation",,"0.913492679595947","No","Yes","No","100%",,"$0","$400","$0","$30","$0","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP3DI1","https://unityhealth.com/HIM2016-Prime/INDPP3D","11"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380010","Unity Prime Gold 20/40 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380010-00","Standard Gold Off Exchange Plan",,"0.816758096218109","No","Yes","No","100%",,"$1,000","$400","$800","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPG2D","https://unityhealth.com/HIM2016-Prime/INDPG2D","12"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380010","Unity Prime Gold 20/40 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380010-01","Standard Gold On Exchange Plan",,"0.816758096218109","No","Yes","No","100%",,"$1,000","$400","$800","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPG2D","https://unityhealth.com/HIM2016-Prime/INDPG2D","13"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380010","Unity Prime Gold 20/40 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPG2DI2","https://unityhealth.com/HIM2016-Prime/INDPG2D","14"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380010","Unity Prime Gold 20/40 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380010-03","Limited Cost Sharing Plan Variation",,"0.816758096218109","No","Yes","No","100%",,"$1,000","$400","$800","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPG2DI1","https://unityhealth.com/HIM2016-Prime/INDPG2D","15"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380042","Unity Prime Silver Maintenance with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380042-00","Standard Silver Off Exchange Plan",,"0.70446103811264","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS3D","https://unityhealth.com/HIM2016-Prime/INDPS3D","16"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380042","Unity Prime Silver Maintenance with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380042-01","Standard Silver On Exchange Plan",,"0.70446103811264","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS3D","https://unityhealth.com/HIM2016-Prime/INDPS3D","17"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380042","Unity Prime Silver Maintenance with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380042-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS3DI2","https://unityhealth.com/HIM2016-Prime/INDPS3D","18"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380042","Unity Prime Silver Maintenance with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380042-03","Limited Cost Sharing Plan Variation",,"0.70446103811264","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS3DI1","https://unityhealth.com/HIM2016-Prime/INDPS3D","19"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380042","Unity Prime Silver Maintenance with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380042-04","73% AV Level Silver Plan",,"0.739607036113739","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS3DC3","https://unityhealth.com/HIM2016-Prime/INDPS3D","20"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380042","Unity Prime Silver Maintenance with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380042-05","87% AV Level Silver Plan",,"0.879408359527588","No","Yes","No","100%",,"$250","$1,400","$0","$30","$100","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS3DC2","https://unityhealth.com/HIM2016-Prime/INDPS3D","21"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380042","Unity Prime Silver Maintenance with Dental","37833WI038","7114920342","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380042-06","94% AV Level Silver Plan",,"0.945597589015961","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS3DC1","https://unityhealth.com/HIM2016-Prime/INDPS3D","22"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380018","Unity Prime Silver Choice Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380018-00","Standard Silver Off Exchange Plan",,"0.714424312114716","No","Yes","No","100%",,"$3,000","$400","$400","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$6000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS4D","https://unityhealth.com/HIM2016-Prime/INDPS4D","23"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380018","Unity Prime Silver Choice Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380018-01","Standard Silver On Exchange Plan",,"0.714424312114716","No","Yes","No","100%",,"$3,000","$400","$400","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$6000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS4D","https://unityhealth.com/HIM2016-Prime/INDPS4D","24"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380024","Unity Elite Gold 20/40 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380024-03","Limited Cost Sharing Plan Variation",,"0.816758096218109","No","Yes","No","100%",,"$1,000","$400","$800","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEG2DI1","https://unityhealth.com/HIM2016-Elite/INDEG2D","52"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380044","Unity Elite Silver Maintenance with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380044-00","Standard Silver Off Exchange Plan",,"0.70446103811264","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES3D","https://unityhealth.com/HIM2016-Elite/INDES3D","53"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380044","Unity Elite Silver Maintenance with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380044-01","Standard Silver On Exchange Plan",,"0.70446103811264","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES3D","https://unityhealth.com/HIM2016-Elite/INDES3D","54"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380044","Unity Elite Silver Maintenance with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380044-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES3DI2","https://unityhealth.com/HIM2016-Elite/INDES3D","55"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380044","Unity Elite Silver Maintenance with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380044-03","Limited Cost Sharing Plan Variation",,"0.70446103811264","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES3DI1","https://unityhealth.com/HIM2016-Elite/INDES3D","56"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510034","Unity Prime Platinum 20/40","37833WI051","7114920342","WIN001","WIS001","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510034-03","Limited Cost Sharing Plan Variation",,"0.902003943920136","No","Yes","No","100%",,"$200","$400","$500","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP2I1","https://unityhealth.com/HIM2016-Prime/INDPP2","7"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380018","Unity Prime Silver Choice Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380018-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS4DI2","https://unityhealth.com/HIM2016-Prime/INDPS4D","25"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380018","Unity Prime Silver Choice Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380018-03","Limited Cost Sharing Plan Variation",,"0.714424312114716","No","Yes","No","100%",,"$3,000","$400","$400","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$6000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS4DI1","https://unityhealth.com/HIM2016-Prime/INDPS4D","26"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380018","Unity Prime Silver Choice Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380018-04","73% AV Level Silver Plan",,"0.739143431186676","No","Yes","No","100%",,"$2,600","$400","$500","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$5200 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS4DC3","https://unityhealth.com/HIM2016-Prime/INDPS4D","27"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380018","Unity Prime Silver Choice Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380018-05","87% AV Level Silver Plan",,"0.877998948097229","No","Yes","No","100%",,"$650","$200","$900","$30","$100","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$1300 per person","$1300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS4DC2","https://unityhealth.com/HIM2016-Prime/INDPS4D","28"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380018","Unity Prime Silver Choice Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380018-06","94% AV Level Silver Plan",,"0.94908195734024","No","Yes","No","100%",,"$100","$100","$500","$30","$100","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS4DC1","https://unityhealth.com/HIM2016-Prime/INDPS4D","29"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380019","Unity Prime Silver Exclusive Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380019-00","Standard Silver Off Exchange Plan",,"0.68013334274292","No","Yes","No","100%",,"$4,000","$700","$500","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$6850 per person","$8000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS5D","https://unityhealth.com/HIM2016-Prime/INDPS5D","30"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380019","Unity Prime Silver Exclusive Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380019-01","Standard Silver On Exchange Plan",,"0.68013334274292","No","Yes","No","100%",,"$4,000","$700","$500","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$6850 per person","$8000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS5D","https://unityhealth.com/HIM2016-Prime/INDPS5D","31"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380019","Unity Prime Silver Exclusive Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380019-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS5DI2","https://unityhealth.com/HIM2016-Prime/INDPS5D","32"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380019","Unity Prime Silver Exclusive Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380019-03","Limited Cost Sharing Plan Variation",,"0.68013334274292","No","Yes","No","100%",,"$4,000","$700","$500","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$6850 per person","$8000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS5DI1","https://unityhealth.com/HIM2016-Prime/INDPS5D","33"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380019","Unity Prime Silver Exclusive Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380019-04","73% AV Level Silver Plan",,"0.739812910556793","No","Yes","No","100%",,"$2,500","$500","$200","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$5450 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$5000 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS5DC3","https://unityhealth.com/HIM2016-Prime/INDPS5D","34"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380019","Unity Prime Silver Exclusive Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380019-05","87% AV Level Silver Plan",,"0.876107454299927","No","Yes","No","100%",,"$65","$500","$0","$30","$65","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$65","$130 per person","$130 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS5DC2","https://unityhealth.com/HIM2016-Prime/INDPS5D","35"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380019","Unity Prime Silver Exclusive Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380019-06","94% AV Level Silver Plan",,"0.943773090839386","No","Yes","No","100%",,"$0","$300","$0","$30","$0","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2250 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS5DC1","https://unityhealth.com/HIM2016-Prime/INDPS5D","36"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380052","Unity Prime Bronze 45/125 Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380052-00","Standard Bronze Off Exchange Plan",,"0.611985385417938","No","Yes","No","100%",,"$5,000","$800","$0","$30","$100","$2,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,600","$6850 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPB3D","https://unityhealth.com/HIM2016-Prime/INDPB3D","37"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380052","Unity Prime Bronze 45/125 Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380052-01","Standard Bronze On Exchange Plan",,"0.611985385417938","No","Yes","No","100%",,"$5,000","$800","$0","$30","$100","$2,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,600","$6850 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPB3D","https://unityhealth.com/HIM2016-Prime/INDPB3D","38"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380052","Unity Prime Bronze 45/125 Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380052-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPB3DI2","https://unityhealth.com/HIM2016-Prime/INDPB3D","39"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380052","Unity Prime Bronze 45/125 Value with Dental","37833WI038","7114920342","WIN001","WIS001","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380052-03","Limited Cost Sharing Plan Variation",,"0.611985385417938","No","Yes","No","100%",,"$5,000","$800","$0","$30","$100","$2,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,600","$6850 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPB3DI1","https://unityhealth.com/HIM2016-Prime/INDPB3D","40"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380021","Unity Elite Platinum 30/60 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380021-00","Standard Platinum Off Exchange Plan",,"0.880473077297211","No","Yes","No","100%",,"$500","$100","$900","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP1D","https://unityhealth.com/HIM2016-Elite/INDEP1D","41"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380021","Unity Elite Platinum 30/60 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380021-01","Standard Platinum On Exchange Plan",,"0.880473077297211","No","Yes","No","100%",,"$500","$100","$900","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP1D","https://unityhealth.com/HIM2016-Elite/INDEP1D","42"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380021","Unity Elite Platinum 30/60 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380021-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP1DI2","https://unityhealth.com/HIM2016-Elite/INDEP1D","43"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380021","Unity Elite Platinum 30/60 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380021-03","Limited Cost Sharing Plan Variation",,"0.880473077297211","No","Yes","No","100%",,"$500","$100","$900","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP1DI1","https://unityhealth.com/HIM2016-Elite/INDEP1D","44"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380022","Unity Elite Platinum 25/50 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380022-00","Standard Platinum Off Exchange Plan",,"0.913492679595947","No","Yes","No","100%",,"$0","$400","$0","$30","$0","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP3D","https://unityhealth.com/HIM2016-Elite/INDEP3D","45"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380022","Unity Elite Platinum 25/50 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380022-01","Standard Platinum On Exchange Plan",,"0.913492679595947","No","Yes","No","100%",,"$0","$400","$0","$30","$0","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP3D","https://unityhealth.com/HIM2016-Elite/INDEP3D","46"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380022","Unity Elite Platinum 25/50 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380022-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP3DI2","https://unityhealth.com/HIM2016-Elite/INDEP3D","47"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380022","Unity Elite Platinum 25/50 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380022-03","Limited Cost Sharing Plan Variation",,"0.913492679595947","No","Yes","No","100%",,"$0","$400","$0","$30","$0","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP3DI1","https://unityhealth.com/HIM2016-Elite/INDEP3D","48"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380024","Unity Elite Gold 20/40 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380024-00","Standard Gold Off Exchange Plan",,"0.816758096218109","No","Yes","No","100%",,"$1,000","$400","$800","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEG2D","https://unityhealth.com/HIM2016-Elite/INDEG2D","49"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380024","Unity Elite Gold 20/40 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380024-01","Standard Gold On Exchange Plan",,"0.816758096218109","No","Yes","No","100%",,"$1,000","$400","$800","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEG2D","https://unityhealth.com/HIM2016-Elite/INDEG2D","50"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380024","Unity Elite Gold 20/40 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380024-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEG2DI2","https://unityhealth.com/HIM2016-Elite/INDEG2D","51"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380044","Unity Elite Silver Maintenance with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380044-04","73% AV Level Silver Plan",,"0.739607036113739","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES3DC3","https://unityhealth.com/HIM2016-Elite/INDES3D","57"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380044","Unity Elite Silver Maintenance with Dental","37833WI038","7114920342","WIN002","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380044-05","87% AV Level Silver Plan",,"0.879408359527588","No","Yes","No","100%",,"$250","$1,400","$0","$30","$100","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES3DC2","https://unityhealth.com/HIM2016-Elite/INDES3D","58"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380028","Unity Elite Silver Choice Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380028-04","73% AV Level Silver Plan",,"0.739143431186676","No","Yes","No","100%",,"$2,600","$400","$500","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$5200 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES4DC3","https://unityhealth.com/HIM2016-Elite/INDES4D","64"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380028","Unity Elite Silver Choice Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380028-05","87% AV Level Silver Plan",,"0.877998948097229","No","Yes","No","100%",,"$650","$200","$900","$30","$100","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$1300 per person","$1300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES4DC2","https://unityhealth.com/HIM2016-Elite/INDES4D","65"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380028","Unity Elite Silver Choice Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380028-06","94% AV Level Silver Plan",,"0.94908195734024","No","Yes","No","100%",,"$100","$100","$500","$30","$100","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES4DC1","https://unityhealth.com/HIM2016-Elite/INDES4D","66"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380029","Unity Elite Silver Exclusive Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380029-00","Standard Silver Off Exchange Plan",,"0.68013334274292","No","Yes","No","100%",,"$4,000","$700","$500","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$6850 per person","$8000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES5D","https://unityhealth.com/HIM2016-Elite/INDES5D","67"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380029","Unity Elite Silver Exclusive Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380029-01","Standard Silver On Exchange Plan",,"0.68013334274292","No","Yes","No","100%",,"$4,000","$700","$500","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$6850 per person","$8000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES5D","https://unityhealth.com/HIM2016-Elite/INDES5D","68"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380029","Unity Elite Silver Exclusive Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380029-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES5DI2","https://unityhealth.com/HIM2016-Elite/INDES5D","69"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380029","Unity Elite Silver Exclusive Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380029-03","Limited Cost Sharing Plan Variation",,"0.68013334274292","No","Yes","No","100%",,"$4,000","$700","$500","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$6850 per person","$8000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES5DI1","https://unityhealth.com/HIM2016-Elite/INDES5D","70"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380029","Unity Elite Silver Exclusive Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380029-04","73% AV Level Silver Plan",,"0.739812910556793","No","Yes","No","100%",,"$2,500","$500","$200","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$5450 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$5000 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES5DC3","https://unityhealth.com/HIM2016-Elite/INDES5D","71"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380029","Unity Elite Silver Exclusive Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380029-05","87% AV Level Silver Plan",,"0.876107454299927","No","Yes","No","100%",,"$65","$500","$0","$30","$65","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$65","$130 per person","$130 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES5DC2","https://unityhealth.com/HIM2016-Elite/INDES5D","72"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380029","Unity Elite Silver Exclusive Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380029-06","94% AV Level Silver Plan",,"0.943773090839386","No","Yes","No","100%",,"$0","$300","$0","$30","$0","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2250 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES5DC1","https://unityhealth.com/HIM2016-Elite/INDES5D","73"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380054","Unity Elite Bronze 45/125 Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380054-00","Standard Bronze Off Exchange Plan",,"0.611985385417938","No","Yes","No","100%",,"$5,000","$800","$0","$30","$100","$2,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,600","$6850 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEB3D","https://unityhealth.com/HIM2016-Elite/INDEB3D","74"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380054","Unity Elite Bronze 45/125 Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380054-01","Standard Bronze On Exchange Plan",,"0.611985385417938","No","Yes","No","100%",,"$5,000","$800","$0","$30","$100","$2,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,600","$6850 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEB3D","https://unityhealth.com/HIM2016-Elite/INDEB3D","75"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380054","Unity Elite Bronze 45/125 Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380054-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDEB3DI2","https://unityhealth.com/HIM2016-Elite/INDEB3D","76"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380054","Unity Elite Bronze 45/125 Value with Dental","37833WI038","7114920342","WIN002","WIS002","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380054-03","Limited Cost Sharing Plan Variation",,"0.611985385417938","No","Yes","No","100%",,"$5,000","$800","$0","$30","$100","$2,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,600","$6850 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEB3DI1","https://unityhealth.com/HIM2016-Elite/INDEB3D","77"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380031","Unity Beloit One Platinum 30/60 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380031-00","Standard Platinum Off Exchange Plan",,"0.880473077297211","No","Yes","No","100%",,"$500","$100","$900","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP1D","https://unityhealth.com/HIM2016-BeloitOne/INDBP1D","78"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380031","Unity Beloit One Platinum 30/60 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380031-01","Standard Platinum On Exchange Plan",,"0.880473077297211","No","Yes","No","100%",,"$500","$100","$900","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP1D","https://unityhealth.com/HIM2016-BeloitOne/INDBP1D","79"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380031","Unity Beloit One Platinum 30/60 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380031-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP1DI2","https://unityhealth.com/HIM2016-BeloitOne/INDBP1D","80"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380031","Unity Beloit One Platinum 30/60 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380031-03","Limited Cost Sharing Plan Variation",,"0.880473077297211","No","Yes","No","100%",,"$500","$100","$900","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP1DI1","https://unityhealth.com/HIM2016-BeloitOne/INDBP1D","81"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380057","Unity Beloit One Platinum 25/50 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380057-00","Standard Platinum Off Exchange Plan",,"0.913492679595947","No","Yes","No","100%",,"$0","$400","$0","$30","$0","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP3D","https://unityhealth.com/HIM2016-BeloitOne/INDBP3D","82"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380057","Unity Beloit One Platinum 25/50 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380057-01","Standard Platinum On Exchange Plan",,"0.913492679595947","No","Yes","No","100%",,"$0","$400","$0","$30","$0","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP3D","https://unityhealth.com/HIM2016-BeloitOne/INDBP3D","83"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380057","Unity Beloit One Platinum 25/50 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380057-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP3DI2","https://unityhealth.com/HIM2016-BeloitOne/INDBP3D","84"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380057","Unity Beloit One Platinum 25/50 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380057-03","Limited Cost Sharing Plan Variation",,"0.913492679595947","No","Yes","No","100%",,"$0","$400","$0","$30","$0","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP3DI1","https://unityhealth.com/HIM2016-BeloitOne/INDBP3D","85"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380058","Unity Beloit One Gold 20/40 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","New","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380058-00","Standard Gold Off Exchange Plan",,"0.816758096218109","No","Yes","No","100%",,"$1,000","$400","$800","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBG2D","https://unityhealth.com/HIM2016-BeloitOne/INDBG2D","86"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380058","Unity Beloit One Gold 20/40 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","New","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380058-01","Standard Gold On Exchange Plan",,"0.816758096218109","No","Yes","No","100%",,"$1,000","$400","$800","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBG2D","https://unityhealth.com/HIM2016-BeloitOne/INDBG2D","87"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380058","Unity Beloit One Gold 20/40 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","New","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380058-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBG2DI2","https://unityhealth.com/HIM2016-BeloitOne/INDBG2D","88"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380058","Unity Beloit One Gold 20/40 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","New","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380058-03","Limited Cost Sharing Plan Variation",,"0.816758096218109","No","Yes","No","100%",,"$1,000","$400","$800","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBG2DI1","https://unityhealth.com/HIM2016-BeloitOne/INDBG2D","89"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380060","Unity Beloit One Silver Maintenance with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380060-00","Standard Silver Off Exchange Plan",,"0.70446103811264","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS3D","https://unityhealth.com/HIM2016-BeloitOne/INDBS3D","90"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380060","Unity Beloit One Silver Maintenance with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380060-03","Limited Cost Sharing Plan Variation",,"0.70446103811264","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS3DI1","https://unityhealth.com/HIM2016-BeloitOne/INDBS3D","93"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380060","Unity Beloit One Silver Maintenance with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380060-04","73% AV Level Silver Plan",,"0.739607036113739","No","Yes","No","100%",,"$500","$2,800","$0","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS3DC3","https://unityhealth.com/HIM2016-BeloitOne/INDBS3D","94"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380060","Unity Beloit One Silver Maintenance with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380060-05","87% AV Level Silver Plan",,"0.879408359527588","No","Yes","No","100%",,"$250","$1,400","$0","$30","$100","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS3DC2","https://unityhealth.com/HIM2016-BeloitOne/INDBS3D","95"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380060","Unity Beloit One Silver Maintenance with Dental","37833WI038","7114920342","WIN003","WIS003","WIF001","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380060-06","94% AV Level Silver Plan",,"0.945597589015961","No","Yes","No","100%",,"$0","$600","$0","$30","$0","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS3DC1","https://unityhealth.com/HIM2016-BeloitOne/INDBS3D","96"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380061","Unity Beloit One Silver Choice Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380061-00","Standard Silver Off Exchange Plan",,"0.714424312114716","No","Yes","No","100%",,"$3,000","$400","$400","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$6000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS4D","https://unityhealth.com/HIM2016-BeloitOne/INDBS4D","97"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380061","Unity Beloit One Silver Choice Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380061-01","Standard Silver On Exchange Plan",,"0.714424312114716","No","Yes","No","100%",,"$3,000","$400","$400","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$6000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS4D","https://unityhealth.com/HIM2016-BeloitOne/INDBS4D","98"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380061","Unity Beloit One Silver Choice Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380061-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS4DI2","https://unityhealth.com/HIM2016-BeloitOne/INDBS4D","99"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380061","Unity Beloit One Silver Choice Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380061-03","Limited Cost Sharing Plan Variation",,"0.714424312114716","No","Yes","No","100%",,"$3,000","$400","$400","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$6000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS4DI1","https://unityhealth.com/HIM2016-BeloitOne/INDBS4D","100"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380061","Unity Beloit One Silver Choice Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380061-04","73% AV Level Silver Plan",,"0.739143431186676","No","Yes","No","100%",,"$2,600","$400","$500","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$5200 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS4DC3","https://unityhealth.com/HIM2016-BeloitOne/INDBS4D","101"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380061","Unity Beloit One Silver Choice Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380061-05","87% AV Level Silver Plan",,"0.877998948097229","No","Yes","No","100%",,"$650","$200","$900","$30","$100","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$1300 per person","$1300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS4DC2","https://unityhealth.com/HIM2016-BeloitOne/INDBS4D","102"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380061","Unity Beloit One Silver Choice Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380061-06","94% AV Level Silver Plan",,"0.94908195734024","No","Yes","No","100%",,"$100","$100","$500","$30","$100","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS4DC1","https://unityhealth.com/HIM2016-BeloitOne/INDBS4D","103"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380035","Unity Beloit One Silver Exclusive Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380035-00","Standard Silver Off Exchange Plan",,"0.68013334274292","No","Yes","No","100%",,"$4,000","$700","$500","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$6850 per person","$8000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS5D","https://unityhealth.com/HIM2016-BeloitOne/INDBS5D","104"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380035","Unity Beloit One Silver Exclusive Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380035-01","Standard Silver On Exchange Plan",,"0.68013334274292","No","Yes","No","100%",,"$4,000","$700","$500","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$6850 per person","$8000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS5D","https://unityhealth.com/HIM2016-BeloitOne/INDBS5D","105"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380035","Unity Beloit One Silver Exclusive Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380035-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS5DI2","https://unityhealth.com/HIM2016-BeloitOne/INDBS5D","106"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380035","Unity Beloit One Silver Exclusive Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380035-03","Limited Cost Sharing Plan Variation",,"0.68013334274292","No","Yes","No","100%",,"$4,000","$700","$500","$30","$100","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$6850 per person","$8000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS5DI1","https://unityhealth.com/HIM2016-BeloitOne/INDBS5D","107"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380035","Unity Beloit One Silver Exclusive Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380035-04","73% AV Level Silver Plan",,"0.739812910556793","No","Yes","No","100%",,"$2,500","$500","$200","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$5450 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$5000 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS5DC3","https://unityhealth.com/HIM2016-BeloitOne/INDBS5D","108"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380035","Unity Beloit One Silver Exclusive Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380035-05","87% AV Level Silver Plan",,"0.876107454299927","No","Yes","No","100%",,"$65","$500","$0","$30","$65","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$65","$130 per person","$130 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS5DC2","https://unityhealth.com/HIM2016-BeloitOne/INDBS5D","109"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380035","Unity Beloit One Silver Exclusive Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380035-06","94% AV Level Silver Plan",,"0.943773090839386","No","Yes","No","100%",,"$0","$300","$0","$30","$0","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2250 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS5DC1","https://unityhealth.com/HIM2016-BeloitOne/INDBS5D","110"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380056","Unity Beloit One Bronze 45/125 Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380056-00","Standard Bronze Off Exchange Plan",,"0.611985385417938","No","Yes","No","100%",,"$5,000","$800","$0","$30","$100","$2,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,600","$6850 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-4/SBC/INDBB3D","https://unityhealth.com/HIM2016-BeloitOne/INDBB3D","111"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380056","Unity Beloit One Bronze 45/125 Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380056-01","Standard Bronze On Exchange Plan",,"0.611985385417938","No","Yes","No","100%",,"$5,000","$800","$0","$30","$100","$2,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,600","$6850 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-4/SBC/INDBB3D","https://unityhealth.com/HIM2016-BeloitOne/INDBB3D","112"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380056","Unity Beloit One Bronze 45/125 Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380056-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-4/SBC/INDBB3DI2","https://unityhealth.com/HIM2016-BeloitOne/INDBB3D","113"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","2","37833","WI","Individual","No","39-1450766","37833WI0380056","Unity Beloit One Bronze 45/125 Value with Dental","37833WI038","7114920342","WIN003","WIS003","WIF004","New","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380056-03","Limited Cost Sharing Plan Variation",,"0.611985385417938","No","Yes","No","100%",,"$5,000","$800","$0","$30","$100","$2,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,600","$6850 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-4/SBC/INDBB3DI1","https://unityhealth.com/HIM2016-BeloitOne/INDBB3D","114"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510034","Unity Prime Platinum 20/40","37833WI051","7114920342","WIN001","WIS001","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510034-00","Standard Platinum Off Exchange Plan",,"0.902003943920136","No","Yes","No","100%",,"$200","$400","$500","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP2","https://unityhealth.com/HIM2016-Prime/INDPP2","4"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510034","Unity Prime Platinum 20/40","37833WI051","7114920342","WIN001","WIS001","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510034-01","Standard Platinum On Exchange Plan",,"0.902003943920136","No","Yes","No","100%",,"$200","$400","$500","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP2","https://unityhealth.com/HIM2016-Prime/INDPP2","5"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510034","Unity Prime Platinum 20/40","37833WI051","7114920342","WIN001","WIS001","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510034-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP2I2","https://unityhealth.com/HIM2016-Prime/INDPP2","6"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510003","Unity Prime Gold 30/60","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510003-00","Standard Gold Off Exchange Plan",,"0.780173242092133","No","Yes","No","100%",,"$1,350","$500","$700","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPG3","https://unityhealth.com/HIM2016-Prime/INDPG3","8"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510017","Unity Elite Silver Plus","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510017-05","87% AV Level Silver Plan",,"0.875345945358276","No","Yes","No","100%",,"$600","$300","$400","$30","$100","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES1C2","https://unityhealth.com/HIM2016-Elite/INDES1","36"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510017","Unity Elite Silver Plus","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510017-06","94% AV Level Silver Plan",,"0.939794957637787","No","Yes","No","100%",,"$0","$200","$500","$30","$0","$700","$10","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES1C1","https://unityhealth.com/HIM2016-Elite/INDES1","37"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510020","Unity Elite Bronze 55/150","37833WI051","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510020-00","Standard Bronze Off Exchange Plan",,"0.609490394592285","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEB2","https://unityhealth.com/HIM2016-Elite/INDEB2","38"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510020","Unity Elite Bronze 55/150","37833WI051","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510020-01","Standard Bronze On Exchange Plan",,"0.609490394592285","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEB2","https://unityhealth.com/HIM2016-Elite/INDEB2","39"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510020","Unity Elite Bronze 55/150","37833WI051","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510020-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEB2I2","https://unityhealth.com/HIM2016-Elite/INDEB2","40"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380027","Unity Elite Silver Plus with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380027-06","94% AV Level Silver Plan",,"0.939794957637787","No","Yes","No","100%",,"$0","$200","$500","$30","$0","$700","$10","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES1DC1","https://unityhealth.com/HIM2016-Elite/INDES1D","37"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380030","Unity Elite Bronze 55/150 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380030-00","Standard Bronze Off Exchange Plan",,"0.609490394592285","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEB2D","https://unityhealth.com/HIM2016-Elite/INDEB2D","38"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510003","Unity Prime Gold 30/60","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510003-01","Standard Gold On Exchange Plan",,"0.780173242092133","No","Yes","No","100%",,"$1,350","$500","$700","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPG3","https://unityhealth.com/HIM2016-Prime/INDPG3","9"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510003","Unity Prime Gold 30/60","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPG3I2","https://unityhealth.com/HIM2016-Prime/INDPG3","10"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510003","Unity Prime Gold 30/60","37833WI051","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510003-03","Limited Cost Sharing Plan Variation",,"0.780173242092133","No","Yes","No","100%",,"$1,350","$500","$700","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPG3I1","https://unityhealth.com/HIM2016-Prime/INDPG3","11"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510007","Unity Prime Silver Plus","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510007-00","Standard Silver Off Exchange Plan",,"0.68022757768631","No","Yes","No","100%",,"$4,550","$500","$90","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,550","$4550 per person","$9100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS1","https://unityhealth.com/HIM2016-Prime/INDPS1","12"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510007","Unity Prime Silver Plus","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510007-01","Standard Silver On Exchange Plan",,"0.68022757768631","No","Yes","No","100%",,"$4,550","$500","$90","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,550","$4550 per person","$9100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS1","https://unityhealth.com/HIM2016-Prime/INDPS1","13"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510007","Unity Prime Silver Plus","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS1I2","https://unityhealth.com/HIM2016-Prime/INDPS1","14"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510007","Unity Prime Silver Plus","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510007-03","Limited Cost Sharing Plan Variation",,"0.68022757768631","No","Yes","No","100%",,"$4,550","$500","$90","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,550","$4550 per person","$9100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS1I1","https://unityhealth.com/HIM2016-Prime/INDPS1","15"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510007","Unity Prime Silver Plus","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510007-04","73% AV Level Silver Plan",,"0.736011147499084","No","Yes","No","100%",,"$2,400","$500","$500","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS1C3","https://unityhealth.com/HIM2016-Prime/INDPS1","16"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510007","Unity Prime Silver Plus","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510007-05","87% AV Level Silver Plan",,"0.875345945358276","No","Yes","No","100%",,"$600","$300","$400","$30","$100","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS1C2","https://unityhealth.com/HIM2016-Prime/INDPS1","17"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510007","Unity Prime Silver Plus","37833WI051","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510007-06","94% AV Level Silver Plan",,"0.939794957637787","No","Yes","No","100%",,"$0","$200","$500","$30","$0","$700","$10","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS1C1","https://unityhealth.com/HIM2016-Prime/INDPS1","18"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510010","Unity Prime Bronze 55/150","37833WI051","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510010-00","Standard Bronze Off Exchange Plan",,"0.609490394592285","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPB2","https://unityhealth.com/HIM2016-Prime/INDPB2","19"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510010","Unity Prime Bronze 55/150","37833WI051","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510010-01","Standard Bronze On Exchange Plan",,"0.609490394592285","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPB2","https://unityhealth.com/HIM2016-Prime/INDPB2","20"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510010","Unity Prime Bronze 55/150","37833WI051","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPB2I2","https://unityhealth.com/HIM2016-Prime/INDPB2","21"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510010","Unity Prime Bronze 55/150","37833WI051","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510010-03","Limited Cost Sharing Plan Variation",,"0.609490394592285","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPB2I1","https://unityhealth.com/HIM2016-Prime/INDPB2","22"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510036","Unity Elite Platinum 20/40","37833WI051","7114920342","WIN002","WIS002","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510036-00","Standard Platinum Off Exchange Plan",,"0.902003943920136","No","Yes","No","100%",,"$200","$400","$500","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP2","https://unityhealth.com/HIM2016-Elite/INDEP2","23"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510036","Unity Elite Platinum 20/40","37833WI051","7114920342","WIN002","WIS002","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510036-01","Standard Platinum On Exchange Plan",,"0.902003943920136","No","Yes","No","100%",,"$200","$400","$500","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP2","https://unityhealth.com/HIM2016-Elite/INDEP2","24"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510036","Unity Elite Platinum 20/40","37833WI051","7114920342","WIN002","WIS002","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510036-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP2I2","https://unityhealth.com/HIM2016-Elite/INDEP2","25"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510036","Unity Elite Platinum 20/40","37833WI051","7114920342","WIN002","WIS002","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510036-03","Limited Cost Sharing Plan Variation",,"0.902003943920136","No","Yes","No","100%",,"$200","$400","$500","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP2I1","https://unityhealth.com/HIM2016-Elite/INDEP2","26"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510013","Unity Elite Gold 30/60","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510013-00","Standard Gold Off Exchange Plan",,"0.780173242092133","No","Yes","No","100%",,"$1,350","$500","$700","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEG3","https://unityhealth.com/HIM2016-Elite/INDEG3","27"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510013","Unity Elite Gold 30/60","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510013-01","Standard Gold On Exchange Plan",,"0.780173242092133","No","Yes","No","100%",,"$1,350","$500","$700","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEG3","https://unityhealth.com/HIM2016-Elite/INDEG3","28"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510013","Unity Elite Gold 30/60","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510013-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEG3I2","https://unityhealth.com/HIM2016-Elite/INDEG3","29"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510013","Unity Elite Gold 30/60","37833WI051","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510013-03","Limited Cost Sharing Plan Variation",,"0.780173242092133","No","Yes","No","100%",,"$1,350","$500","$700","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEG3I1","https://unityhealth.com/HIM2016-Elite/INDEG3","30"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510017","Unity Elite Silver Plus","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510017-00","Standard Silver Off Exchange Plan",,"0.68022757768631","No","Yes","No","100%",,"$4,550","$500","$90","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,550","$4550 per person","$9100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES1","https://unityhealth.com/HIM2016-Elite/INDES1","31"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510017","Unity Elite Silver Plus","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510017-01","Standard Silver On Exchange Plan",,"0.68022757768631","No","Yes","No","100%",,"$4,550","$500","$90","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,550","$4550 per person","$9100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES1","https://unityhealth.com/HIM2016-Elite/INDES1","32"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510017","Unity Elite Silver Plus","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510017-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES1I2","https://unityhealth.com/HIM2016-Elite/INDES1","33"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510017","Unity Elite Silver Plus","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510017-03","Limited Cost Sharing Plan Variation",,"0.68022757768631","No","Yes","No","100%",,"$4,550","$500","$90","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,550","$4550 per person","$9100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES1I1","https://unityhealth.com/HIM2016-Elite/INDES1","34"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510017","Unity Elite Silver Plus","37833WI051","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510017-04","73% AV Level Silver Plan",,"0.736011147499084","No","Yes","No","100%",,"$2,400","$500","$500","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES1C3","https://unityhealth.com/HIM2016-Elite/INDES1","35"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380009","Unity Prime Gold 30/60 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380009-03","Limited Cost Sharing Plan Variation",,"0.780173242092133","No","Yes","No","100%",,"$1,350","$500","$700","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPG3DI1","https://unityhealth.com/HIM2016-Prime/INDPG3D","11"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380017","Unity Prime Silver Plus with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380017-00","Standard Silver Off Exchange Plan",,"0.68022757768631","No","Yes","No","100%",,"$4,550","$500","$90","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,550","$4550 per person","$9100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS1D","https://unityhealth.com/HIM2016-Prime/INDPS1D","12"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540002","Unity Prime Silver Deductible","37833WI054","7114920342","WIN001","WIS001","WIF007","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS2I2","https://unityhealth.com/HIM2016-Prime/INDPS2","10"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510020","Unity Elite Bronze 55/150","37833WI051","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510020-03","Limited Cost Sharing Plan Variation",,"0.609490394592285","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEB2I1","https://unityhealth.com/HIM2016-Elite/INDEB2","41"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510038","Unity Beloit One Platinum 20/40","37833WI051","7114920342","WIN003","WIS003","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510038-00","Standard Platinum Off Exchange Plan",,"0.902003943920136","No","Yes","No","100%",,"$200","$400","$500","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP2","https://unityhealth.com/HIM2016-BeloitOne/INDBP2","42"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510038","Unity Beloit One Platinum 20/40","37833WI051","7114920342","WIN003","WIS003","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510038-01","Standard Platinum On Exchange Plan",,"0.902003943920136","No","Yes","No","100%",,"$200","$400","$500","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP2","https://unityhealth.com/HIM2016-BeloitOne/INDBP2","43"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510038","Unity Beloit One Platinum 20/40","37833WI051","7114920342","WIN003","WIS003","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510038-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP2I2","https://unityhealth.com/HIM2016-BeloitOne/INDBP2","44"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510038","Unity Beloit One Platinum 20/40","37833WI051","7114920342","WIN003","WIS003","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510038-03","Limited Cost Sharing Plan Variation",,"0.902003943920136","No","Yes","No","100%",,"$200","$400","$500","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP2I1","https://unityhealth.com/HIM2016-BeloitOne/INDBP2","45"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510022","Unity Beloit One Gold 30/60","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510022-00","Standard Gold Off Exchange Plan",,"0.780173242092133","No","Yes","No","100%",,"$1,350","$500","$700","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBG3","https://unityhealth.com/HIM2016-BeloitOne/INDBG3","46"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510022","Unity Beloit One Gold 30/60","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510022-01","Standard Gold On Exchange Plan",,"0.780173242092133","No","Yes","No","100%",,"$1,350","$500","$700","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBG3","https://unityhealth.com/HIM2016-BeloitOne/INDBG3","47"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510022","Unity Beloit One Gold 30/60","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510022-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBG3I2","https://unityhealth.com/HIM2016-BeloitOne/INDBG3","48"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510022","Unity Beloit One Gold 30/60","37833WI051","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510022-03","Limited Cost Sharing Plan Variation",,"0.780173242092133","No","Yes","No","100%",,"$1,350","$500","$700","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBG3I1","https://unityhealth.com/HIM2016-BeloitOne/INDBG3","49"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510042","Unity Beloit One Silver Plus","37833WI051","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510042-00","Standard Silver Off Exchange Plan",,"0.68022757768631","No","Yes","No","100%",,"$4,550","$500","$90","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,550","$4550 per person","$9100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS1","https://unityhealth.com/HIM2016-BeloitOne/INDBS1","50"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510042","Unity Beloit One Silver Plus","37833WI051","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510042-01","Standard Silver On Exchange Plan",,"0.68022757768631","No","Yes","No","100%",,"$4,550","$500","$90","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,550","$4550 per person","$9100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS1","https://unityhealth.com/HIM2016-BeloitOne/INDBS1","51"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510042","Unity Beloit One Silver Plus","37833WI051","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510042-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS1I2","https://unityhealth.com/HIM2016-BeloitOne/INDBS1","52"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510042","Unity Beloit One Silver Plus","37833WI051","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510042-03","Limited Cost Sharing Plan Variation",,"0.68022757768631","No","Yes","No","100%",,"$4,550","$500","$90","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,550","$4550 per person","$9100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS1I1","https://unityhealth.com/HIM2016-BeloitOne/INDBS1","53"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510042","Unity Beloit One Silver Plus","37833WI051","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510042-04","73% AV Level Silver Plan",,"0.736011147499084","No","Yes","No","100%",,"$2,400","$500","$500","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS1C3","https://unityhealth.com/HIM2016-BeloitOne/INDBS1","54"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510042","Unity Beloit One Silver Plus","37833WI051","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510042-05","87% AV Level Silver Plan",,"0.875345945358276","No","Yes","No","100%",,"$600","$300","$400","$30","$100","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS1C2","https://unityhealth.com/HIM2016-BeloitOne/INDBS1","55"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510042","Unity Beloit One Silver Plus","37833WI051","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510042-06","94% AV Level Silver Plan",,"0.939794957637787","No","Yes","No","100%",,"$0","$200","$500","$30","$0","$700","$10","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS1C1","https://unityhealth.com/HIM2016-BeloitOne/INDBS1","56"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510025","Unity Beloit One Bronze 55/150","37833WI051","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510025-00","Standard Bronze Off Exchange Plan",,"0.609490394592285","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-4/SBC/INDBB2","https://unityhealth.com/HIM2016-BeloitOne/INDBB2","57"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510025","Unity Beloit One Bronze 55/150","37833WI051","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510025-01","Standard Bronze On Exchange Plan",,"0.609490394592285","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-4/SBC/INDBB2","https://unityhealth.com/HIM2016-BeloitOne/INDBB2","58"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510025","Unity Beloit One Bronze 55/150","37833WI051","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510025-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-4/SBC/INDBB2I2","https://unityhealth.com/HIM2016-BeloitOne/INDBB2","59"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","3","37833","WI","Individual","No","39-1450766","37833WI0510025","Unity Beloit One Bronze 55/150","37833WI051","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0510025-03","Limited Cost Sharing Plan Variation",,"0.609490394592285","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-4/SBC/INDBB2I1","https://unityhealth.com/HIM2016-BeloitOne/INDBB2","60"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380051","Unity Prime Platinum 20/40 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380051-00","Standard Platinum Off Exchange Plan",,"0.902003943920136","No","Yes","No","100%",,"$200","$400","$500","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP2D","https://unityhealth.com/HIM2016-Prime/INDPP2D","4"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380051","Unity Prime Platinum 20/40 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380051-01","Standard Platinum On Exchange Plan",,"0.902003943920136","No","Yes","No","100%",,"$200","$400","$500","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP2D","https://unityhealth.com/HIM2016-Prime/INDPP2D","5"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380051","Unity Prime Platinum 20/40 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380051-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP2DI2","https://unityhealth.com/HIM2016-Prime/INDPP2D","6"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380051","Unity Prime Platinum 20/40 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380051-03","Limited Cost Sharing Plan Variation",,"0.902003943920136","No","Yes","No","100%",,"$200","$400","$500","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPP2DI1","https://unityhealth.com/HIM2016-Prime/INDPP2D","7"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380009","Unity Prime Gold 30/60 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380009-00","Standard Gold Off Exchange Plan",,"0.780173242092133","No","Yes","No","100%",,"$1,350","$500","$700","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPG3D","https://unityhealth.com/HIM2016-Prime/INDPG3D","8"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380009","Unity Prime Gold 30/60 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380009-01","Standard Gold On Exchange Plan",,"0.780173242092133","No","Yes","No","100%",,"$1,350","$500","$700","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPG3D","https://unityhealth.com/HIM2016-Prime/INDPG3D","9"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380009","Unity Prime Gold 30/60 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPG3DI2","https://unityhealth.com/HIM2016-Prime/INDPG3D","10"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380017","Unity Prime Silver Plus with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380017-01","Standard Silver On Exchange Plan",,"0.68022757768631","No","Yes","No","100%",,"$4,550","$500","$90","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,550","$4550 per person","$9100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS1D","https://unityhealth.com/HIM2016-Prime/INDPS1D","13"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380017","Unity Prime Silver Plus with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380017-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS1DI2","https://unityhealth.com/HIM2016-Prime/INDPS1D","14"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380017","Unity Prime Silver Plus with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380017-03","Limited Cost Sharing Plan Variation",,"0.68022757768631","No","Yes","No","100%",,"$4,550","$500","$90","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,550","$4550 per person","$9100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS1DI1","https://unityhealth.com/HIM2016-Prime/INDPS1D","15"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380017","Unity Prime Silver Plus with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380017-04","73% AV Level Silver Plan",,"0.736011147499084","No","Yes","No","100%",,"$2,400","$500","$500","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS1DC3","https://unityhealth.com/HIM2016-Prime/INDPS1D","16"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380017","Unity Prime Silver Plus with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380017-05","87% AV Level Silver Plan",,"0.875345945358276","No","Yes","No","100%",,"$600","$300","$400","$30","$100","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS1DC2","https://unityhealth.com/HIM2016-Prime/INDPS1D","17"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380017","Unity Prime Silver Plus with Dental","37833WI038","7114920342","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380017-06","94% AV Level Silver Plan",,"0.939794957637787","No","Yes","No","100%",,"$0","$200","$500","$30","$0","$700","$10","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS1DC1","https://unityhealth.com/HIM2016-Prime/INDPS1D","18"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380020","Unity Prime Bronze 55/150 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380020-00","Standard Bronze Off Exchange Plan",,"0.609490394592285","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPB2D","https://unityhealth.com/HIM2016-Prime/INDPB2D","19"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380020","Unity Prime Bronze 55/150 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380020-01","Standard Bronze On Exchange Plan",,"0.609490394592285","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPB2D","https://unityhealth.com/HIM2016-Prime/INDPB2D","20"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380020","Unity Prime Bronze 55/150 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380020-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPB2DI2","https://unityhealth.com/HIM2016-Prime/INDPB2D","21"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380020","Unity Prime Bronze 55/150 with Dental","37833WI038","7114920342","WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380020-03","Limited Cost Sharing Plan Variation",,"0.609490394592285","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPB2DI1","https://unityhealth.com/HIM2016-Prime/INDPB2D","22"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380053","Unity Elite Platinum 20/40 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380053-00","Standard Platinum Off Exchange Plan",,"0.902003943920136","No","Yes","No","100%",,"$200","$400","$500","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP2D","https://unityhealth.com/HIM2016-Elite/INDEP2D","23"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380053","Unity Elite Platinum 20/40 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380053-01","Standard Platinum On Exchange Plan",,"0.902003943920136","No","Yes","No","100%",,"$200","$400","$500","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP2D","https://unityhealth.com/HIM2016-Elite/INDEP2D","24"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380053","Unity Elite Platinum 20/40 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380053-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP2DI2","https://unityhealth.com/HIM2016-Elite/INDEP2D","25"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380053","Unity Elite Platinum 20/40 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380053-03","Limited Cost Sharing Plan Variation",,"0.902003943920136","No","Yes","No","100%",,"$200","$400","$500","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEP2DI1","https://unityhealth.com/HIM2016-Elite/INDEP2D","26"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380023","Unity Elite Gold 30/60 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380023-00","Standard Gold Off Exchange Plan",,"0.780173242092133","No","Yes","No","100%",,"$1,350","$500","$700","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEG3D","https://unityhealth.com/HIM2016-Elite/INDEG3D","27"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380023","Unity Elite Gold 30/60 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380023-01","Standard Gold On Exchange Plan",,"0.780173242092133","No","Yes","No","100%",,"$1,350","$500","$700","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEG3D","https://unityhealth.com/HIM2016-Elite/INDEG3D","28"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380023","Unity Elite Gold 30/60 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380023-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEG3DI2","https://unityhealth.com/HIM2016-Elite/INDEG3D","29"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380023","Unity Elite Gold 30/60 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380023-03","Limited Cost Sharing Plan Variation",,"0.780173242092133","No","Yes","No","100%",,"$1,350","$500","$700","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEG3DI1","https://unityhealth.com/HIM2016-Elite/INDEG3D","30"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380027","Unity Elite Silver Plus with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380027-00","Standard Silver Off Exchange Plan",,"0.68022757768631","No","Yes","No","100%",,"$4,550","$500","$90","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,550","$4550 per person","$9100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES1D","https://unityhealth.com/HIM2016-Elite/INDES1D","31"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380027","Unity Elite Silver Plus with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380027-01","Standard Silver On Exchange Plan",,"0.68022757768631","No","Yes","No","100%",,"$4,550","$500","$90","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,550","$4550 per person","$9100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES1D","https://unityhealth.com/HIM2016-Elite/INDES1D","32"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380027","Unity Elite Silver Plus with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380027-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES1DI2","https://unityhealth.com/HIM2016-Elite/INDES1D","33"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380027","Unity Elite Silver Plus with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380027-03","Limited Cost Sharing Plan Variation",,"0.68022757768631","No","Yes","No","100%",,"$4,550","$500","$90","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,550","$4550 per person","$9100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES1DI1","https://unityhealth.com/HIM2016-Elite/INDES1D","34"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380027","Unity Elite Silver Plus with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380027-04","73% AV Level Silver Plan",,"0.736011147499084","No","Yes","No","100%",,"$2,400","$500","$500","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES1DC3","https://unityhealth.com/HIM2016-Elite/INDES1D","35"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380027","Unity Elite Silver Plus with Dental","37833WI038","7114920342","WIN002","WIS002","WIF003","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380027-05","87% AV Level Silver Plan",,"0.875345945358276","No","Yes","No","100%",,"$600","$300","$400","$30","$100","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDES1DC2","https://unityhealth.com/HIM2016-Elite/INDES1D","36"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380030","Unity Elite Bronze 55/150 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380030-01","Standard Bronze On Exchange Plan",,"0.609490394592285","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEB2D","https://unityhealth.com/HIM2016-Elite/INDEB2D","39"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380030","Unity Elite Bronze 55/150 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380030-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-1/SBC/INDEB2DI2","https://unityhealth.com/HIM2016-Elite/INDEB2D","40"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380030","Unity Elite Bronze 55/150 with Dental","37833WI038","7114920342","WIN002","WIS002","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380030-03","Limited Cost Sharing Plan Variation",,"0.609490394592285","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016/SBC/INDEB2DI1","https://unityhealth.com/HIM2016-Elite/INDEB2D","41"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380055","Unity Beloit One Platinum 20/40 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380055-00","Standard Platinum Off Exchange Plan",,"0.902003943920136","No","Yes","No","100%",,"$200","$400","$500","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP2D","https://unityhealth.com/HIM2016-BeloitOne/INDBP2D","42"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380055","Unity Beloit One Platinum 20/40 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380055-01","Standard Platinum On Exchange Plan",,"0.902003943920136","No","Yes","No","100%",,"$200","$400","$500","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP2D","https://unityhealth.com/HIM2016-BeloitOne/INDBP2D","43"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380055","Unity Beloit One Platinum 20/40 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380055-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP2DI2","https://unityhealth.com/HIM2016-BeloitOne/INDBP2D","44"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380055","Unity Beloit One Platinum 20/40 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","New","HMO","Platinum","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380055-03","Limited Cost Sharing Plan Variation",,"0.902003943920136","No","Yes","No","100%",,"$200","$400","$500","$30","$100","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBP2DI1","https://unityhealth.com/HIM2016-BeloitOne/INDBP2D","45"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380032","Unity Beloit One Gold 30/60 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380032-00","Standard Gold Off Exchange Plan",,"0.780173242092133","No","Yes","No","100%",,"$1,350","$500","$700","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBG3D","https://unityhealth.com/HIM2016-BeloitOne/INDBG3D","46"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380032","Unity Beloit One Gold 30/60 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380032-01","Standard Gold On Exchange Plan",,"0.780173242092133","No","Yes","No","100%",,"$1,350","$500","$700","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBG3D","https://unityhealth.com/HIM2016-BeloitOne/INDBG3D","47"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380032","Unity Beloit One Gold 30/60 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380032-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBG3DI2","https://unityhealth.com/HIM2016-BeloitOne/INDBG3D","48"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380032","Unity Beloit One Gold 30/60 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF002","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380032-03","Limited Cost Sharing Plan Variation",,"0.780173242092133","No","Yes","No","100%",,"$1,350","$500","$700","$30","$100","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBG3DI1","https://unityhealth.com/HIM2016-BeloitOne/INDBG3D","49"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380059","Unity Beloit One Silver Plus with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380059-00","Standard Silver Off Exchange Plan",,"0.68022757768631","No","Yes","No","100%",,"$4,550","$500","$90","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,550","$4550 per person","$9100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS1D","https://unityhealth.com/HIM2016-BeloitOne/INDBS1D","50"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380059","Unity Beloit One Silver Plus with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380059-01","Standard Silver On Exchange Plan",,"0.68022757768631","No","Yes","No","100%",,"$4,550","$500","$90","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,550","$4550 per person","$9100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS1D","https://unityhealth.com/HIM2016-BeloitOne/INDBS1D","51"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380059","Unity Beloit One Silver Plus with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380059-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS1DI2","https://unityhealth.com/HIM2016-BeloitOne/INDBS1D","52"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380059","Unity Beloit One Silver Plus with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380059-03","Limited Cost Sharing Plan Variation",,"0.68022757768631","No","Yes","No","100%",,"$4,550","$500","$90","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,550","$4550 per person","$9100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS1DI1","https://unityhealth.com/HIM2016-BeloitOne/INDBS1D","53"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380059","Unity Beloit One Silver Plus with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380059-04","73% AV Level Silver Plan",,"0.736011147499084","No","Yes","No","100%",,"$2,400","$500","$500","$30","$100","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS1DC3","https://unityhealth.com/HIM2016-BeloitOne/INDBS1D","54"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380059","Unity Beloit One Silver Plus with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380059-05","87% AV Level Silver Plan",,"0.875345945358276","No","Yes","No","100%",,"$600","$300","$400","$30","$100","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS1DC2","https://unityhealth.com/HIM2016-BeloitOne/INDBS1D","55"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380059","Unity Beloit One Silver Plus with Dental","37833WI038","7114920342","WIN003","WIS003","WIF003","New","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380059-06","94% AV Level Silver Plan",,"0.939794957637787","No","Yes","No","100%",,"$0","$200","$500","$30","$0","$700","$10","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS1DC1","https://unityhealth.com/HIM2016-BeloitOne/INDBS1D","56"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380036","Unity Beloit One Bronze 55/150 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380036-00","Standard Bronze Off Exchange Plan",,"0.609490394592285","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-4/SBC/INDBB2D","https://unityhealth.com/HIM2016-BeloitOne/INDBB2D","57"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380036","Unity Beloit One Bronze 55/150 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380036-01","Standard Bronze On Exchange Plan",,"0.609490394592285","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-4/SBC/INDBB2D","https://unityhealth.com/HIM2016-BeloitOne/INDBB2D","58"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380036","Unity Beloit One Bronze 55/150 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380036-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-4/SBC/INDBB2DI2","https://unityhealth.com/HIM2016-BeloitOne/INDBB2D","59"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","4","37833","WI","Individual","No","39-1450766","37833WI0380036","Unity Beloit One Bronze 55/150 with Dental","37833WI038","7114920342","WIN003","WIS003","WIF004","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.942856",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HIMformulary","37833WI0380036-03","Limited Cost Sharing Plan Variation",,"0.609490394592285","No","Yes","No","100%",,"$5,000","$900","$0","$30","$100","$2,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://unityhealth.com/HIM2016-4/SBC/INDBB2DI1","https://unityhealth.com/HIM2016-BeloitOne/INDBB2D","60"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540001","Unity Prime Gold Deductible","37833WI054","7114920342","WIN001","WIS001","WIF008","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540001-00","Standard Gold Off Exchange Plan",,"0.804076492786407","Yes","Yes","No","100%",,"$1,400","$0","$600","$30","$1,400","$0","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016-1/SBC/INDPG1","https://unityhealth.com/HIM2016-Prime/INDPG1","4"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540001","Unity Prime Gold Deductible","37833WI054","7114920342","WIN001","WIS001","WIF008","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540001-01","Standard Gold On Exchange Plan",,"0.804076492786407","Yes","Yes","No","100%",,"$1,400","$0","$600","$30","$1,400","$0","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016-1/SBC/INDPG1","https://unityhealth.com/HIM2016-Prime/INDPG1","5"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540001","Unity Prime Gold Deductible","37833WI054","7114920342","WIN001","WIS001","WIF008","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/HIM2016-1/SBC/INDPG1I2","https://unityhealth.com/HIM2016-Prime/INDPG1","6"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540001","Unity Prime Gold Deductible","37833WI054","7114920342","WIN001","WIS001","WIF008","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540001-03","Limited Cost Sharing Plan Variation",,"0.804076492786407","Yes","Yes","No","100%",,"$1,400","$0","$600","$30","$1,400","$0","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016-1/SBC/INDPG1I1","https://unityhealth.com/HIM2016-Prime/INDPG1","7"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540002","Unity Prime Silver Deductible","37833WI054","7114920342","WIN001","WIS001","WIF007","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540002-00","Standard Silver Off Exchange Plan",,"0.680779337882996","Yes","Yes","No","100%",,"$2,500","$0","$1,500","$30","$2,500","$0","$900","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6850 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS2","https://unityhealth.com/HIM2016-Prime/INDPS2","8"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540002","Unity Prime Silver Deductible","37833WI054","7114920342","WIN001","WIS001","WIF007","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540002-01","Standard Silver On Exchange Plan",,"0.680779337882996","Yes","Yes","No","100%",,"$2,500","$0","$1,500","$30","$2,500","$0","$900","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6850 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS2","https://unityhealth.com/HIM2016-Prime/INDPS2","9"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540002","Unity Prime Silver Deductible","37833WI054","7114920342","WIN001","WIS001","WIF007","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540002-03","Limited Cost Sharing Plan Variation",,"0.680779337882996","Yes","Yes","No","100%",,"$2,500","$0","$1,500","$30","$2,500","$0","$900","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6850 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016-1/SBC/INDPS2I1","https://unityhealth.com/HIM2016-Prime/INDPS2","11"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540002","Unity Prime Silver Deductible","37833WI054","7114920342","WIN001","WIS001","WIF007","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540002-04","73% AV Level Silver Plan",,"0.738503038883209","Yes","Yes","No","100%",,"$1,800","$0","$1,700","$30","$1,800","$0","$1,100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$5450 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS2C3","https://unityhealth.com/HIM2016-Prime/INDPS2","12"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540002","Unity Prime Silver Deductible","37833WI054","7114920342","WIN001","WIS001","WIF007","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540002-05","87% AV Level Silver Plan",,"0.878993332386017","Yes","Yes","No","100%",,"$625","$0","$625","$30","$625","$0","$625","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$625","$1250 per person","$1250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS2C2","https://unityhealth.com/HIM2016-Prime/INDPS2","13"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540002","Unity Prime Silver Deductible","37833WI054","7114920342","WIN001","WIS001","WIF007","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540002-06","94% AV Level Silver Plan",,"0.949582517147064","Yes","Yes","No","100%",,"$250","$0","$200","$30","$250","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$900 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$500 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPS2C1","https://unityhealth.com/HIM2016-Prime/INDPS2","14"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540009","Unity Beloit One Silver Deductible","37833WI054","7114920342","WIN003","WIS003","WIF007","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540009-01","Standard Silver On Exchange Plan",,"0.680779337882996","Yes","Yes","No","100%",,"$2,500","$0","$1,500","$30","$2,500","$0","$900","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6850 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS2","https://unityhealth.com/HIM2016-BeloitOne/INDBS2","39"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140016","Tradition $3,500 - Copay","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140016-00","Standard Silver Off Exchange Plan",,"0.717372715473175","No","Yes","No","100%",,"$3,500","$0","$0","$0","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%203500%20copay.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","18"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140016","Tradition $3,500 - Copay","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140016-01","Standard Silver On Exchange Plan",,"0.717372715473175","No","Yes","No","100%",,"$3,500","$0","$0","$0","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%203500%20copay.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","19"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540009","Unity Beloit One Silver Deductible","37833WI054","7114920342","WIN003","WIS003","WIF007","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540009-04","73% AV Level Silver Plan",,"0.738503038883209","Yes","Yes","No","100%",,"$1,800","$0","$1,700","$30","$1,800","$0","$1,100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$5450 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS2C3","https://unityhealth.com/HIM2016-BeloitOne/INDBS2","42"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540009","Unity Beloit One Silver Deductible","37833WI054","7114920342","WIN003","WIS003","WIF007","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540009-05","87% AV Level Silver Plan",,"0.878993332386017","Yes","Yes","No","100%",,"$625","$0","$625","$30","$625","$0","$625","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$625","$1250 per person","$1250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS2C2","https://unityhealth.com/HIM2016-BeloitOne/INDBS2","43"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140006","Tradition $2,000 - 20%","38166WI014",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140006-00","Standard Silver Off Exchange Plan",,"0.715144395828247","No","Yes","No","100%",,"$2,000","$0","$1,060","$0","$2,000","$0","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%202000-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","14"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540003","Unity Prime Bronze HSA","37833WI054","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540003-00","Standard Bronze Off Exchange Plan",,"0.599393308162689","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016-2/SBC/INDPB1","https://unityhealth.com/HIM2016-Prime/INDPB1","15"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540003","Unity Prime Bronze HSA","37833WI054","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540003-01","Standard Bronze On Exchange Plan",,"0.599393308162689","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016-2/SBC/INDPB1","https://unityhealth.com/HIM2016-Prime/INDPB1","16"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540003","Unity Prime Bronze HSA","37833WI054","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/HIM2016-2/SBC/INDPB1I2","https://unityhealth.com/HIM2016-Prime/INDPB1","17"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540003","Unity Prime Bronze HSA","37833WI054","7114920342","WIN001","WIS001","WIF005","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540003-03","Limited Cost Sharing Plan Variation",,"0.599393308162689","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016-2/SBC/INDPB1I1","https://unityhealth.com/HIM2016-Prime/INDPB1","18"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540005","Unity Elite Gold Deductible","37833WI054","7114920342","WIN002","WIS002","WIF008","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540005-00","Standard Gold Off Exchange Plan",,"0.804076492786407","Yes","Yes","No","100%",,"$1,400","$0","$600","$30","$1,400","$0","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016/SBC/INDEG1","https://unityhealth.com/HIM2016-Elite/INDEG1","19"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540005","Unity Elite Gold Deductible","37833WI054","7114920342","WIN002","WIS002","WIF008","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540005-01","Standard Gold On Exchange Plan",,"0.804076492786407","Yes","Yes","No","100%",,"$1,400","$0","$600","$30","$1,400","$0","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016/SBC/INDEG1","https://unityhealth.com/HIM2016-Elite/INDEG1","20"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540005","Unity Elite Gold Deductible","37833WI054","7114920342","WIN002","WIS002","WIF008","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/HIM2016/SBC/INDEG1I2","https://unityhealth.com/HIM2016-Elite/INDEG1","21"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540005","Unity Elite Gold Deductible","37833WI054","7114920342","WIN002","WIS002","WIF008","Existing","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540005-03","Limited Cost Sharing Plan Variation",,"0.804076492786407","Yes","Yes","No","100%",,"$1,400","$0","$600","$30","$1,400","$0","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016/SBC/INDEG1I1","https://unityhealth.com/HIM2016-Elite/INDEG1","22"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540006","Unity Elite Silver Deductible","37833WI054","7114920342","WIN002","WIS002","WIF007","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540006-00","Standard Silver Off Exchange Plan",,"0.680779337882996","Yes","Yes","No","100%",,"$2,500","$0","$1,500","$30","$2,500","$0","$900","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6850 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016/SBC/INDES2","https://unityhealth.com/HIM2016-Elite/INDES2","23"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540006","Unity Elite Silver Deductible","37833WI054","7114920342","WIN002","WIS002","WIF007","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540006-01","Standard Silver On Exchange Plan",,"0.680779337882996","Yes","Yes","No","100%",,"$2,500","$0","$1,500","$30","$2,500","$0","$900","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6850 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016/SBC/INDES2","https://unityhealth.com/HIM2016-Elite/INDES2","24"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540006","Unity Elite Silver Deductible","37833WI054","7114920342","WIN002","WIS002","WIF007","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/HIM2016/SBC/INDES2I2","https://unityhealth.com/HIM2016-Elite/INDES2","25"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540006","Unity Elite Silver Deductible","37833WI054","7114920342","WIN002","WIS002","WIF007","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540006-03","Limited Cost Sharing Plan Variation",,"0.680779337882996","Yes","Yes","No","100%",,"$2,500","$0","$1,500","$30","$2,500","$0","$900","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6850 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016/SBC/INDES2I1","https://unityhealth.com/HIM2016-Elite/INDES2","26"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540006","Unity Elite Silver Deductible","37833WI054","7114920342","WIN002","WIS002","WIF007","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540006-04","73% AV Level Silver Plan",,"0.738503038883209","Yes","Yes","No","100%",,"$1,800","$0","$1,700","$30","$1,800","$0","$1,100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$5450 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016/SBC/INDES2C3","https://unityhealth.com/HIM2016-Elite/INDES2","27"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540006","Unity Elite Silver Deductible","37833WI054","7114920342","WIN002","WIS002","WIF007","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540006-05","87% AV Level Silver Plan",,"0.878993332386017","Yes","Yes","No","100%",,"$625","$0","$625","$30","$625","$0","$625","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$625","$1250 per person","$1250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/HIM2016/SBC/INDES2C2","https://unityhealth.com/HIM2016-Elite/INDES2","28"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540006","Unity Elite Silver Deductible","37833WI054","7114920342","WIN002","WIS002","WIF007","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540006-06","94% AV Level Silver Plan",,"0.949582517147064","Yes","Yes","No","100%",,"$250","$0","$200","$30","$250","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$900 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$500 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/HIM2016/SBC/INDES2C1","https://unityhealth.com/HIM2016-Elite/INDES2","29"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540007","Unity Elite Bronze HSA","37833WI054","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540007-00","Standard Bronze Off Exchange Plan",,"0.599393308162689","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016/SBC/INDEB1","https://unityhealth.com/HIM2016-Elite/INDEB1","30"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540007","Unity Elite Bronze HSA","37833WI054","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540007-01","Standard Bronze On Exchange Plan",,"0.599393308162689","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016/SBC/INDEB1","https://unityhealth.com/HIM2016-Elite/INDEB1","31"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540007","Unity Elite Bronze HSA","37833WI054","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/HIM2016/SBC/INDEB1I2","https://unityhealth.com/HIM2016-Elite/INDEB1","32"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540007","Unity Elite Bronze HSA","37833WI054","7114920342","WIN002","WIS002","WIF005","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540007-03","Limited Cost Sharing Plan Variation",,"0.599393308162689","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016/SBC/INDEB1I1","https://unityhealth.com/HIM2016-Elite/INDEB1","33"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540014","Unity Beloit One Gold Deductible","37833WI054","7114920342","WIN003","WIS003","WIF008","New","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540014-00","Standard Gold Off Exchange Plan",,"0.804076492786407","Yes","Yes","No","100%",,"$1,400","$0","$600","$30","$1,400","$0","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016-3/SBC/INDBG1","https://unityhealth.com/HIM2016-BeloitOne/INDBG1","34"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540014","Unity Beloit One Gold Deductible","37833WI054","7114920342","WIN003","WIS003","WIF008","New","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540014-01","Standard Gold On Exchange Plan",,"0.804076492786407","Yes","Yes","No","100%",,"$1,400","$0","$600","$30","$1,400","$0","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016-3/SBC/INDBG1","https://unityhealth.com/HIM2016-BeloitOne/INDBG1","35"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540014","Unity Beloit One Gold Deductible","37833WI054","7114920342","WIN003","WIS003","WIF008","New","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBG1I2","https://unityhealth.com/HIM2016-BeloitOne/INDBG1","36"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540014","Unity Beloit One Gold Deductible","37833WI054","7114920342","WIN003","WIS003","WIF008","New","HMO","Gold","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540014-03","Limited Cost Sharing Plan Variation",,"0.804076492786407","Yes","Yes","No","100%",,"$1,400","$0","$600","$30","$1,400","$0","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016-3/SBC/INDBG1I1","https://unityhealth.com/HIM2016-BeloitOne/INDBG1","37"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540009","Unity Beloit One Silver Deductible","37833WI054","7114920342","WIN003","WIS003","WIF007","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540009-00","Standard Silver Off Exchange Plan",,"0.680779337882996","Yes","Yes","No","100%",,"$2,500","$0","$1,500","$30","$2,500","$0","$900","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6850 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS2","https://unityhealth.com/HIM2016-BeloitOne/INDBS2","38"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540009","Unity Beloit One Silver Deductible","37833WI054","7114920342","WIN003","WIS003","WIF007","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS2I2","https://unityhealth.com/HIM2016-BeloitOne/INDBS2","40"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540009","Unity Beloit One Silver Deductible","37833WI054","7114920342","WIN003","WIS003","WIF007","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540009-03","Limited Cost Sharing Plan Variation",,"0.680779337882996","Yes","Yes","No","100%",,"$2,500","$0","$1,500","$30","$2,500","$0","$900","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6850 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS2I1","https://unityhealth.com/HIM2016-BeloitOne/INDBS2","41"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540009","Unity Beloit One Silver Deductible","37833WI054","7114920342","WIN003","WIS003","WIF007","Existing","HMO","Silver","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540009-06","94% AV Level Silver Plan",,"0.949582517147064","Yes","Yes","No","100%",,"$250","$0","$200","$30","$250","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$900 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$500 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/HIM2016-3/SBC/INDBS2C1","https://unityhealth.com/HIM2016-BeloitOne/INDBS2","44"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540010","Unity Beloit One Bronze HSA","37833WI054","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540010-00","Standard Bronze Off Exchange Plan",,"0.599393308162689","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016-4/SBC/INDBB1","https://unityhealth.com/HIM2016-BeloitOne/INDBB1","45"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540010","Unity Beloit One Bronze HSA","37833WI054","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540010-01","Standard Bronze On Exchange Plan",,"0.599393308162689","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016-4/SBC/INDBB1","https://unityhealth.com/HIM2016-BeloitOne/INDBB1","46"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540010","Unity Beloit One Bronze HSA","37833WI054","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://unityhealth.com/HIM2016-4/SBC/INDBB1I2","https://unityhealth.com/HIM2016-BeloitOne/INDBB1","47"
"2016","WI","37833","HIOS","3","2015-08-26 09:56:12","5","37833","WI","Individual","No","39-1450766","37833WI0540010","Unity Beloit One Bronze HSA","37833WI054","7114920342","WIN003","WIS003","WIF005","Existing","HMO","Bronze","No","Both","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","https://hixenroll.unityhealth.com","https://unityhealth.com/HSAformulary","37833WI0540010-03","Limited Cost Sharing Plan Variation",,"0.599393308162689","Yes","Yes","No","100%",,"$6,550","$0","$0","$30","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://unityhealth.com/HIM2016-4/SBC/INDBB1I1","https://unityhealth.com/HIM2016-BeloitOne/INDBB1","48"
"2016","WI","38152","HIOS","2","2015-07-10 02:19:03","1","38152","WI","SHOP (Small Group)","Yes","35-0472300","38152WI0010001","Lincoln DentalConnect®","38152WI001","7063415294","WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.40","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","38152WI0010001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","38152","HIOS","2","2015-07-10 02:19:03","1","38152","WI","SHOP (Small Group)","Yes","35-0472300","38152WI0010002","Lincoln DentalConnect®","38152WI001","7063415294","WIN001","WIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.05","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","38152WI0010002-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","WI","38152","HIOS","2","2015-07-10 02:19:03","1","38152","WI","SHOP (Small Group)","Yes","35-0472300","38152WI0010003","Lincoln DentalConnect®","38152WI001","7063415294","WIN001","WIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.02","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","38152WI0010003-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","WI","38152","HIOS","2","2015-07-10 02:19:03","1","38152","WI","SHOP (Small Group)","Yes","35-0472300","38152WI0010004","Lincoln DentalConnect®","38152WI001","7063415294","WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.66","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","38152WI0010004-00","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","WI","38152","HIOS","2","2015-07-10 02:19:03","1","38152","WI","SHOP (Small Group)","Yes","35-0472300","38152WI0010005","Lincoln DentalConnect®","38152WI001","7063415294","WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.14","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","38152WI0010005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","WI","38152","HIOS","2","2015-07-10 02:19:03","1","38152","WI","SHOP (Small Group)","Yes","35-0472300","38152WI0010006","Lincoln DentalConnect®","38152WI001","7063415294","WIN001","WIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.38","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","38152WI0010006-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","WI","38152","HIOS","2","2015-07-10 02:19:03","1","38152","WI","SHOP (Small Group)","Yes","35-0472300","38152WI0010007","Lincoln DentalConnect®","38152WI001","7063415294","WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.79","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","38152WI0010007-00","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140001","Tradition $500 - 10%","38166WI014",,"WIN001","WIS001","WIF007","Existing","HMO","Platinum","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140001-00","Standard Platinum Off Exchange Plan",,"0.901655852794647","No","Yes","No","100%",,"$500","$0","$500","$0","$500","$0","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%20500-10.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","4"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140001","Tradition $500 - 10%","38166WI014",,"WIN001","WIS001","WIF007","Existing","HMO","Platinum","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140001-01","Standard Platinum On Exchange Plan",,"0.901655852794647","No","Yes","No","100%",,"$500","$0","$500","$0","$500","$0","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%20500-10.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","5"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140014","Tradition $1,000","38166WI014",,"WIN001","WIS001","WIF004","New","HMO","Platinum","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140014-00","Standard Platinum Off Exchange Plan",,"0.882003605365753","No","Yes","No","100%",,"$1,000","$0","$0","$0","$1,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%201000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","6"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140014","Tradition $1,000","38166WI014",,"WIN001","WIS001","WIF004","New","HMO","Platinum","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140014-01","Standard Platinum On Exchange Plan",,"0.882003605365753","No","Yes","No","100%",,"$1,000","$0","$0","$0","$1,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%201000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","7"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140015","Tradition $1,000 - Copay","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140015-00","Standard Gold Off Exchange Plan",,"0.813456177711487","No","Yes","No","100%",,"$1,000","$0","$0","$0","$1,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%201000%20copay.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","8"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140015","Tradition $1,000 - Copay","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140015-01","Standard Gold On Exchange Plan",,"0.813456177711487","No","Yes","No","100%",,"$1,000","$0","$0","$0","$1,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%201000%20copay.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","9"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140004","Tradition $1,000 - 20%","38166WI014",,"WIN001","WIS001","WIF005","Existing","HMO","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140004-00","Standard Gold Off Exchange Plan",,"0.796598374843597","No","Yes","No","100%",,"$1,000","$0","$1,260","$0","$1,000","$0","$90","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%201000-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","10"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140004","Tradition $1,000 - 20%","38166WI014",,"WIN001","WIS001","WIF005","Existing","HMO","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140004-01","Standard Gold On Exchange Plan",,"0.796598374843597","No","Yes","No","100%",,"$1,000","$0","$1,260","$0","$1,000","$0","$90","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%201000-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","11"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140007","Tradition $1,500 - 30%","38166WI014",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140007-00","Standard Silver Off Exchange Plan",,"0.718453407287598","No","Yes","No","100%",,"$1,500","$0","$1,740","$0","$1,500","$0","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%201500-30.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","12"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140007","Tradition $1,500 - 30%","38166WI014",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140007-01","Standard Silver On Exchange Plan",,"0.718453407287598","No","Yes","No","100%",,"$1,500","$0","$1,740","$0","$1,500","$0","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%201500-30.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","13"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140006","Tradition $2,000 - 20%","38166WI014",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140006-01","Standard Silver On Exchange Plan",,"0.715144395828247","No","Yes","No","100%",,"$2,000","$0","$1,060","$0","$2,000","$0","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%202000-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","15"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160018","Reliance $4,000","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160018-00","Standard Silver Off Exchange Plan",,"0.692709982395172","No","Yes","No","100%",,"$4,000","$0","$0","$0","$4,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%204000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","42"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160018","Reliance $4,000","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160018-01","Standard Silver On Exchange Plan",,"0.692709982395172","No","Yes","No","100%",,"$4,000","$0","$0","$0","$4,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%204000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","43"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140002","Tradition $2,000","38166WI014",,"WIN001","WIS001","WIF006","Existing","HMO","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140002-00","Standard Gold Off Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$0","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%202000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","44"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140002","Tradition $2,000","38166WI014",,"WIN001","WIS001","WIF006","Existing","HMO","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140002-01","Standard Gold On Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$0","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%202000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","45"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160005","Reliance $2,000","38166WI016",,"WIN002","WIS002","WIF006","Existing","EPO","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urd","No",,"http://securityhealth.org/formulary","38166WI0160005-00","Standard Gold Off Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$0","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%202000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","46"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140011","Tradition $2,500 - 20%","38166WI014",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140011-00","Standard Silver Off Exchange Plan",,"0.685283362865448","No","Yes","No","100%",,"$2,500","$0","$960","$0","$2,500","$0","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%202500-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","16"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140011","Tradition $2,500 - 20%","38166WI014",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140011-01","Standard Silver On Exchange Plan",,"0.685283362865448","No","Yes","No","100%",,"$2,500","$0","$960","$0","$2,500","$0","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%202500-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","17"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140017","Tradition $3,000 - 10%","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140017-00","Standard Silver Off Exchange Plan",,"0.686242580413818","No","Yes","No","100%",,"$3,000","$40","$430","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%203000-10.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","20"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140017","Tradition $3,000 - 10%","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140017-01","Standard Silver On Exchange Plan",,"0.686242580413818","No","Yes","No","100%",,"$3,000","$40","$430","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%203000-10.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","21"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140018","Tradition $4,000","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140018-00","Standard Silver Off Exchange Plan",,"0.692709982395172","No","Yes","No","100%",,"$4,000","$0","$0","$0","$4,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%204000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","22"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140018","Tradition $4,000","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140018-01","Standard Silver On Exchange Plan",,"0.692709982395172","No","Yes","No","100%",,"$4,000","$0","$0","$0","$4,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%204000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","23"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140012","Tradition $3,000 HDHP","38166WI014",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140012-01","Standard Silver On Exchange Plan",,"0.713499546051025","Yes","Yes","No","100%",,"$3,000","$40","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%203000%20copay%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","5"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140021","Tradition $3,000 - Copay HDHP","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Silver","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140021-00","Standard Silver Off Exchange Plan",,"0.694658041000366","Yes","Yes","No","100%",,"$3,000","$0","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%203000%20copay%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","6"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170001","Classic $1,000 - 20%","38166WI017",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993492367",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Native%20American%20Plans/NA%20-%20Classic%201000-20.ashx","https://www.securityhealth.org/myplans","6"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170001","Classic $1,000 - 20%","38166WI017",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993492367",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170001-03","Limited Cost Sharing Plan Variation","81.13%","0.806208372116089","No","Yes","No","100%",,"$1,000","$40","$1,000","$0","$850","$850","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%201000-20.ashx","https://www.securityhealth.org/myplans","7"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160001","Reliance $500 - 10%","38166WI016",,"WIN002","WIS002","WIF007","Existing","EPO","Platinum","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160001-00","Standard Platinum Off Exchange Plan",,"0.901655852794647","No","Yes","No","100%",,"$500","$0","$500","$0","$500","$0","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%20500-10.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","24"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160001","Reliance $500 - 10%","38166WI016",,"WIN002","WIS002","WIF007","Existing","EPO","Platinum","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160001-01","Standard Platinum On Exchange Plan",,"0.901655852794647","No","Yes","No","100%",,"$500","$0","$500","$0","$500","$0","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%20500-10.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","25"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160014","Reliance $1,000","38166WI016",,"WIN002","WIS002","WIF004","New","EPO","Platinum","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160014-00","Standard Platinum Off Exchange Plan",,"0.882003605365753","No","Yes","No","100%",,"$1,000","$0","$0","$0","$1,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%201000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","26"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160014","Reliance $1,000","38166WI016",,"WIN002","WIS002","WIF004","New","EPO","Platinum","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160014-01","Standard Platinum On Exchange Plan",,"0.882003605365753","No","Yes","No","100%",,"$1,000","$0","$0","$0","$1,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%201000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","27"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160015","Reliance $1,000 - Copay","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160015-00","Standard Gold Off Exchange Plan",,"0.813456177711487","No","Yes","No","100%",,"$1,000","$0","$0","$0","$1,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%201000%20copay.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","28"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160015","Reliance $1,000 - Copay","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160015-01","Standard Gold On Exchange Plan",,"0.813456177711487","No","Yes","No","100%",,"$1,000","$0","$0","$0","$1,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%201000%20copay.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","29"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160002","Reliance $1,000 - 20%","38166WI016",,"WIN002","WIS002","WIF005","Existing","EPO","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160002-00","Standard Gold Off Exchange Plan",,"0.796598374843597","No","Yes","No","100%",,"$1,000","$0","$1,260","$0","$1,000","$0","$90","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%201000-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","30"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160002","Reliance $1,000 - 20%","38166WI016",,"WIN002","WIS002","WIF005","Existing","EPO","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160002-01","Standard Gold On Exchange Plan",,"0.796598374843597","No","Yes","No","100%",,"$1,000","$0","$1,260","$0","$1,000","$0","$90","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%201000-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","31"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160004","Reliance $1,500 - 30%","38166WI016",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160004-00","Standard Silver Off Exchange Plan",,"0.718453407287598","No","Yes","No","100%",,"$1,500","$0","$1,740","$0","$1,500","$0","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%201500-30.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","32"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160004","Reliance $1,500 - 30%","38166WI016",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160004-01","Standard Silver On Exchange Plan",,"0.718453407287598","No","Yes","No","100%",,"$1,500","$0","$1,740","$0","$1,500","$0","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%201500-30.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","33"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160003","Reliance $2,000 - 20%","38166WI016",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160003-00","Standard Silver Off Exchange Plan",,"0.715144395828247","No","Yes","No","100%",,"$2,000","$0","$1,060","$0","$2,000","$0","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%202000-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","34"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160003","Reliance $2,000 - 20%","38166WI016",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160003-01","Standard Silver On Exchange Plan",,"0.715144395828247","No","Yes","No","100%",,"$2,000","$0","$1,060","$0","$2,000","$0","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%202000-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","35"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160011","Reliance $2,500 - 20%","38166WI016",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160011-00","Standard Silver Off Exchange Plan",,"0.685283362865448","No","Yes","No","100%",,"$2,500","$0","$960","$0","$2,500","$0","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%202500-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","36"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160011","Reliance $2,500 - 20%","38166WI016",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160011-01","Standard Silver On Exchange Plan",,"0.685283362865448","No","Yes","No","100%",,"$2,500","$0","$960","$0","$2,500","$0","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%202500-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","37"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160016","Reliance $3,500 - Copay","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160016-00","Standard Silver Off Exchange Plan",,"0.717372715473175","No","Yes","No","100%",,"$3,500","$0","$0","$0","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%203500%20copay.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","38"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160016","Reliance $3,500 - Copay","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160016-01","Standard Silver On Exchange Plan",,"0.717372715473175","No","Yes","No","100%",,"$3,500","$0","$0","$0","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%203500%20copay.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","39"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160017","Reliance $3,000 - 10%","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160017-00","Standard Silver Off Exchange Plan",,"0.686242580413818","No","Yes","No","100%",,"$3,000","$0","$430","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%203000-10.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","40"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160017","Reliance $3,000 - 10%","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160017-01","Standard Silver On Exchange Plan",,"0.686242580413818","No","Yes","No","100%",,"$3,000","$0","$430","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%203000-10.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","41"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160005","Reliance $2,000","38166WI016",,"WIN002","WIS002","WIF006","Existing","EPO","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urd","No",,"http://securityhealth.org/formulary","38166WI0160005-01","Standard Gold On Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$0","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%202000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","47"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140012","Tradition $3,000 HDHP","38166WI014",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140012-00","Standard Silver Off Exchange Plan",,"0.713499546051025","Yes","Yes","No","100%",,"$3,000","$40","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%203000%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","4"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150015","Independence $1,000 - Copay","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150015-01","Standard Gold On Exchange Plan",,"0.813456177711487","No","Yes","No","100%",,"$1,000","$0","$0","$0","$1,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","$16,850","$16850 per person","$33700 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"$1,500","$1500 per person","$3000 per group","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%201000%20copay.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","9"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180002","Select $3,500 HDHP","38166WI018",,"WIN002","WIS002","WIF006","Existing","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993725369",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180002-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$0","$3,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%203500%20HDHP.ashx","https://www.securityhealth.org/myplans","9"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180002","Select $3,500 HDHP","38166WI018",,"WIN002","WIS002","WIF006","Existing","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993725369",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Native%20American%20Plans/NA%20-%20Select%203500%20HDHP.ashx","https://www.securityhealth.org/myplans","10"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150002","Independence $1,000 - 20%","38166WI015",,"WIN001","WIS001","WIF005","Existing","POS","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150002-00","Standard Gold Off Exchange Plan",,"0.796598374843597","No","Yes","No","100%",,"$1,000","$0","$1,260","$0","$1,000","$0","$90","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$9,000","$9000 per person","$18000 per group","$14,000","$14000 per person","$28000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%201000-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","10"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150002","Independence $1,000 - 20%","38166WI015",,"WIN001","WIS001","WIF005","Existing","POS","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150002-01","Standard Gold On Exchange Plan",,"0.796598374843597","No","Yes","No","100%",,"$1,000","$0","$1,260","$0","$1,000","$0","$90","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$9,000","$9000 per person","$18000 per group","$14,000","$14000 per person","$28000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%201000-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","11"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180002","Select $3,500 HDHP","38166WI018",,"WIN002","WIS002","WIF006","Existing","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993725369",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180002-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$0","$3,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%203500%20HDHP.ashx","https://www.securityhealth.org/myplans","11"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170001","Classic $1,000 - 20%","38166WI017",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993492367",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170001-00","Standard Gold Off Exchange Plan","81.13%","0.806208372116089","No","Yes","No","100%",,"$1,000","$40","$1,000","$0","$850","$850","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%201000-20.ashx","https://www.securityhealth.org/myplans","4"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170001","Classic $1,000 - 20%","38166WI017",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993492367",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170001-01","Standard Gold On Exchange Plan","81.13%","0.806208372116089","No","Yes","No","100%",,"$1,000","$40","$1,000","$0","$850","$850","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%201000-20.ashx","https://www.securityhealth.org/myplans","5"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140021","Tradition $3,000 - Copay HDHP","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Silver","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140021-01","Standard Silver On Exchange Plan",,"0.694658041000366","Yes","Yes","No","100%",,"$3,000","$0","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%203000%20copay%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","7"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140005","Tradition $3,000 - 10% HDHP","38166WI014",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140005-00","Standard Silver Off Exchange Plan",,"0.687992513179779","Yes","Yes","No","100%",,"$3,000","$40","$430","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%203000-10%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","8"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170002","Classic $3,500 HDHP","38166WI017",,"WIN001","WIS001","WIF006","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993780819",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170002-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$0","$3,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%203500%20HDHP.ashx","https://www.securityhealth.org/myplans","8"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170002","Classic $3,500 HDHP","38166WI017",,"WIN001","WIS001","WIF006","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993780819",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170002-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$0","$3,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%203500%20HDHP.ashx","https://www.securityhealth.org/myplans","9"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170009","Classic $4,500 - 30%","38166WI017",,"WIN001","WIS001","WIF008","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994227715",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170009-03","Limited Cost Sharing Plan Variation",,"0.685830593109131","No","Yes","No","100%",,"$4,500","$0","$0","$0","$640","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%204500-30.ashx","https://www.securityhealth.org/myplans","42"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170009","Classic $4,500 - 30%","38166WI017",,"WIN001","WIS001","WIF008","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994227715",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170009-04","73% AV Level Silver Plan",,"0.738188922405243","No","Yes","No","100%",,"$3,000","$2,000","$0","$0","$640","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic-CSR/Classic%204500-73.ashx","https://www.securityhealth.org/myplans","43"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170009","Classic $4,500 - 30%","38166WI017",,"WIN001","WIS001","WIF008","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994227715",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170009-05","87% AV Level Silver Plan",,"0.875900149345398","No","Yes","No","100%",,"$1,500","$540","$960","$0","$1,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic-CSR/Classic%204500-84.ashx","https://www.securityhealth.org/myplans","44"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170009","Classic $4,500 - 30%","38166WI017",,"WIN001","WIS001","WIF008","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994227715",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170009-06","94% AV Level Silver Plan",,"0.948937118053436","No","Yes","No","100%",,"$480","$20","$0","$0","$210","$290","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic-CSR/Classic%204500-94.ashx","https://www.securityhealth.org/myplans","45"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140005","Tradition $3,000 - 10% HDHP","38166WI014",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140005-01","Standard Silver On Exchange Plan",,"0.687992513179779","Yes","Yes","No","100%",,"$3,000","$40","$430","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%203000-10%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","9"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140022","Tradition $3,500 HDHP","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Silver","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140022-00","Standard Silver Off Exchange Plan",,"0.688498795032501","Yes","Yes","No","100%",,"$3,500","$40","$0","$0","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%203500%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","10"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170002","Classic $3,500 HDHP","38166WI017",,"WIN001","WIS001","WIF006","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993780819",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Native%20American%20Plans/NA%20-%20Classic%203500%20HDHP.ashx","https://www.securityhealth.org/myplans","10"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170002","Classic $3,500 HDHP","38166WI017",,"WIN001","WIS001","WIF006","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993780819",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170002-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$0","$3,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%203500%20HDHP.ashx","https://www.securityhealth.org/myplans","11"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140022","Tradition $3,500 HDHP","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Silver","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140022-01","Standard Silver On Exchange Plan",,"0.688498795032501","Yes","Yes","No","100%",,"$3,500","$40","$0","$0","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%203500%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","11"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140023","Tradition $4,000 HDHP","38166WI014",,"WIN001","WIS001","WIF006","New","HMO","Silver","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140023-00","Standard Silver Off Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$0","$4,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%204000%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","12"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170002","Classic $3,500 HDHP","38166WI017",,"WIN001","WIS001","WIF006","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993780819",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170002-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic-CSR/Classic%203500-73.ashx","https://www.securityhealth.org/myplans","12"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170002","Classic $3,500 HDHP","38166WI017",,"WIN001","WIS001","WIF006","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993780819",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170002-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$0","$1,250","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic-CSR/Classic%203500-87.ashx","https://www.securityhealth.org/myplans","13"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140023","Tradition $4,000 HDHP","38166WI014",,"WIN001","WIS001","WIF006","New","HMO","Silver","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140023-01","Standard Silver On Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$0","$4,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%204000%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","13"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140010","Tradition $4,500 - 30% HDHP","38166WI014",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140010-00","Standard Bronze Off Exchange Plan",,"0.619847416877747","Yes","Yes","No","100%",,"$4,400","$40","$870","$0","$4,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%204500-30%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","14"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170002","Classic $3,500 HDHP","38166WI017",,"WIN001","WIS001","WIF006","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993780819",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170002-06","94% AV Level Silver Plan",,"0.945099532604218","Yes","Yes","No","100%",,"$450","$0","$0","$0","$450","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic-CSR/Classic%203500-94.ashx","https://www.securityhealth.org/myplans","14"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170003","Classic $2,500 - 20%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170003-00","Standard Silver Off Exchange Plan","68.19%","0.688730239868164","No","Yes","No","100%",,"$2,500","$70","$770","$0","$850","$980","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%202500-20.ashx","https://www.securityhealth.org/myplans","15"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140010","Tradition $4,500 - 30% HDHP","38166WI014",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140010-01","Standard Bronze On Exchange Plan",,"0.619847416877747","Yes","Yes","No","100%",,"$4,400","$40","$870","$0","$4,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%204500-30%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","15"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140013","Tradition $5,000 - 10% HDHP","38166WI014",,"WIN001","WIS001","WIF008","Existing","HMO","Bronze","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140013-00","Standard Bronze Off Exchange Plan",,"0.619730949401855","Yes","Yes","No","100%",,"$5,000","$40","$230","$0","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%205000-10%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","16"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170003","Classic $2,500 - 20%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170003-01","Standard Silver On Exchange Plan","68.19%","0.688730239868164","No","Yes","No","100%",,"$2,500","$70","$770","$0","$850","$980","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%202500-20.ashx","https://www.securityhealth.org/myplans","16"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170003","Classic $2,500 - 20%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Native%20American%20Plans/NA%20-%20Classic%202500-20.ashx","https://www.securityhealth.org/myplans","17"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140013","Tradition $5,000 - 10% HDHP","38166WI014",,"WIN001","WIS001","WIF008","Existing","HMO","Bronze","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0140013-01","Standard Bronze On Exchange Plan",,"0.619730949401855","Yes","Yes","No","100%",,"$5,000","$40","$230","$0","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Tradition/Tradition%205000-10%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","17"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160012","Reliance $3,000 HDHP","38166WI016",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160012-00","Standard Silver Off Exchange Plan",,"0.713499546051025","Yes","Yes","No","100%",,"$3,000","$40","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%203000%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","18"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170003","Classic $2,500 - 20%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170003-03","Limited Cost Sharing Plan Variation","68.19%","0.688730239868164","No","Yes","No","100%",,"$2,500","$70","$770","$0","$850","$980","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%202500-20.ashx","https://www.securityhealth.org/myplans","18"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170003","Classic $2,500 - 20%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170003-04","73% AV Level Silver Plan","73.72%","0.737187206745148","No","Yes","No","100%",,"$1,750","$40","$920","$0","$850","$850","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic-CSR/Classic%202500-73.ashx","https://www.securityhealth.org/myplans","19"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160012","Reliance $3,000 HDHP","38166WI016",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160012-01","Standard Silver On Exchange Plan",,"0.713499546051025","Yes","Yes","No","100%",,"$3,000","$40","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%203000%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","19"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160021","Reliance $3,000 - Copay HDHP","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Silver","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160021-00","Standard Silver Off Exchange Plan",,"0.694658041000366","Yes","Yes","No","100%",,"$3,000","$40","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%203000%20copay%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","20"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170003","Classic $2,500 - 20%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170003-05","87% AV Level Silver Plan","87.87%","0.87866336107254","No","Yes","No","100%",,"$500","$40","$780","$0","$500","$700","$40","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic-CSR/Classic%202500-87.ashx","https://www.securityhealth.org/myplans","20"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170003","Classic $2,500 - 20%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170003-06","94% AV Level Silver Plan","93.88%","0.938797354698181","No","Yes","No","100%",,"$250","$20","$230","$0","$250","$230","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic-CSR/Classic%202500-94.ashx","https://www.securityhealth.org/myplans","21"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160021","Reliance $3,000 - Copay HDHP","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Silver","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160021-01","Standard Silver On Exchange Plan",,"0.694658041000366","Yes","Yes","No","100%",,"$3,000","$40","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%203000%20copay%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","21"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160007","Reliance $3,000 - 10% HDHP","38166WI016",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160007-00","Standard Silver Off Exchange Plan",,"0.687992513179779","Yes","Yes","No","100%",,"$3,000","$40","$430","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%203000-10%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","22"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170004","Classic $2,000 - 30%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993770771",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170004-00","Standard Silver Off Exchange Plan","69.66%","0.700760245323181","No","Yes","No","100%",,"$2,000","$70","$1,300","$0","$850","$980","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%202000-30.ashx","https://www.securityhealth.org/myplans","22"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170004","Classic $2,000 - 30%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993770771",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170004-01","Standard Silver On Exchange Plan","69.66%","0.700760245323181","No","Yes","No","100%",,"$2,000","$70","$1,300","$0","$850","$980","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%202000-30.ashx","https://www.securityhealth.org/myplans","23"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160007","Reliance $3,000 - 10% HDHP","38166WI016",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160007-01","Standard Silver On Exchange Plan",,"0.687992513179779","Yes","Yes","No","100%",,"$3,000","$40","$430","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%203000-10%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","23"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160022","Reliance $3,500 HDHP","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Silver","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160022-00","Standard Silver Off Exchange Plan",,"0.688498795032501","Yes","Yes","No","100%",,"$3,500","$40","$0","$0","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%203500%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","24"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170004","Classic $2,000 - 30%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993770771",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Native%20American%20Plans/NA%20-%20Classic%202000-30.ashx","https://www.securityhealth.org/myplans","24"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170004","Classic $2,000 - 30%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993770771",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170004-03","Limited Cost Sharing Plan Variation","69.66%","0.700760245323181","No","Yes","No","100%",,"$2,000","$70","$1,300","$0","$850","$980","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%202000-30.ashx","https://www.securityhealth.org/myplans","25"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160022","Reliance $3,500 HDHP","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Silver","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160022-01","Standard Silver On Exchange Plan",,"0.688498795032501","Yes","Yes","No","100%",,"$3,500","$40","$0","$0","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%203500%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","25"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160023","Reliance $4,000 HDHP","38166WI016",,"WIN002","WIS002","WIF006","New","EPO","Silver","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160023-00","Standard Silver Off Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$0","$4,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%204000%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","26"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170004","Classic $2,000 - 30%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993770771",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170004-04","73% AV Level Silver Plan","73.15%","0.731538116931915","No","Yes","No","100%",,"$1,750","$1,620","$1,380","$0","$850","$980","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","$1,750","$1750 per person","$3500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic-CSR/Classic%202000-73.ashx","https://www.securityhealth.org/myplans","26"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170004","Classic $2,000 - 30%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993770771",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170004-05","87% AV Level Silver Plan","87.47%","0.874695718288422","No","Yes","No","100%",,"$250","$40","$1,220","$0","$250","$700","$120","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic-CSR/Classic%202000-87.ashx","https://www.securityhealth.org/myplans","27"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160023","Reliance $4,000 HDHP","38166WI016",,"WIN002","WIS002","WIF006","New","EPO","Silver","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160023-01","Standard Silver On Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$0","$4,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%204000%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","27"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160010","Reliance $4,500 - 30% HDHP","38166WI016",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160010-00","Standard Bronze Off Exchange Plan",,"0.619847416877747","Yes","Yes","No","100%",,"$4,500","$40","$870","$0","$4,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%204500-30%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","28"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170004","Classic $2,000 - 30%","38166WI017",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993770771",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170004-06","94% AV Level Silver Plan","93.88%","0.938797354698181","No","Yes","No","100%",,"$250","$20","$230","$0","$250","$230","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic-CSR/Classic%202000-94.ashx","https://www.securityhealth.org/myplans","28"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170006","Classic $6,000 HDHP","38166WI017",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994160292",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170006-00","Standard Bronze Off Exchange Plan",,"0.613106071949005","Yes","Yes","No","100%",,"$6,000","$40","$0","$0","$2,790","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%206000%20HDHP.ashx","https://www.securityhealth.org/myplans","29"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160010","Reliance $4,500 - 30% HDHP","38166WI016",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160010-01","Standard Bronze On Exchange Plan",,"0.619847416877747","Yes","Yes","No","100%",,"$4,500","$40","$870","$0","$4,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%204500-30%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","29"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160013","Reliance $5,000 - 10% HDHP","38166WI016",,"WIN002","WIS002","WIF008","Existing","EPO","Bronze","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160013-00","Standard Bronze Off Exchange Plan",,"0.619730949401855","Yes","Yes","No","100%",,"$5,000","$40","$230","$0","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%205000-10%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","30"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170006","Classic $6,000 HDHP","38166WI017",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994160292",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170006-01","Standard Bronze On Exchange Plan",,"0.613106071949005","Yes","Yes","No","100%",,"$6,000","$40","$0","$0","$2,790","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%206000%20HDHP.ashx","https://www.securityhealth.org/myplans","30"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170006","Classic $6,000 HDHP","38166WI017",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994160292",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Native%20American%20Plans/NA%20-%20Classic%206000%20HDHP.ashx","https://www.securityhealth.org/myplans","31"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160013","Reliance $5,000 - 10% HDHP","38166WI016",,"WIN002","WIS002","WIF008","Existing","EPO","Bronze","no","Both","yes","yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0160013-01","Standard Bronze On Exchange Plan",,"0.619730949401855","Yes","Yes","No","100%",,"$5,000","$40","$230","$0","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Reliance/Reliance%205000-10%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","31"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170006","Classic $6,000 HDHP","38166WI017",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994160292",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170006-03","Limited Cost Sharing Plan Variation",,"0.613106071949005","Yes","Yes","No","100%",,"$6,000","$40","$0","$0","$2,790","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%206000%20HDHP.ashx","https://www.securityhealth.org/myplans","32"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170007","Classic $5,500 HDHP","38166WI017",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994017682",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170007-00","Standard Bronze Off Exchange Plan",,"0.618882298469543","Yes","Yes","No","100%",,"$5,500","$40","$0","$0","$2,790","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%205500%20HDHP.ashx","https://www.securityhealth.org/myplans","33"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170007","Classic $5,500 HDHP","38166WI017",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994017682",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170007-01","Standard Bronze On Exchange Plan",,"0.618882298469543","Yes","Yes","No","100%",,"$5,500","$40","$0","$0","$2,790","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%205500%20HDHP.ashx","https://www.securityhealth.org/myplans","34"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170007","Classic $5,500 HDHP","38166WI017",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994017682",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Native%20American%20Plans/NA%20-%20Classic%205500%20HDHP.ashx","https://www.securityhealth.org/myplans","35"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170007","Classic $5,500 HDHP","38166WI017",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994017682",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170007-03","Limited Cost Sharing Plan Variation",,"0.618882298469543","Yes","Yes","No","100%",,"$5,500","$40","$0","$0","$2,790","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%205500%20HDHP.ashx","https://www.securityhealth.org/myplans","36"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170008","Classic $6,850","38166WI017",,"WIN001","WIS001","WIF006","Existing","HMO","Catastrophic","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170008-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,510","$0","$0","$0","$2,800","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%206850.ashx","https://www.securityhealth.org/myplans","37"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170008","Classic $6,850","38166WI017",,"WIN001","WIS001","WIF006","Existing","HMO","Catastrophic","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170008-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,510","$0","$0","$0","$2,800","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%206850.ashx","https://www.securityhealth.org/myplans","38"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170009","Classic $4,500 - 30%","38166WI017",,"WIN001","WIS001","WIF008","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994227715",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170009-00","Standard Silver Off Exchange Plan",,"0.685830593109131","No","Yes","No","100%",,"$4,500","$0","$0","$0","$640","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%204500-30.ashx","https://www.securityhealth.org/myplans","39"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170009","Classic $4,500 - 30%","38166WI017",,"WIN001","WIS001","WIF008","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994227715",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170009-01","Standard Silver On Exchange Plan",,"0.685830593109131","No","Yes","No","100%",,"$4,500","$0","$0","$0","$640","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%204500-30.ashx","https://www.securityhealth.org/myplans","40"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170009","Classic $4,500 - 30%","38166WI017",,"WIN001","WIS001","WIF008","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994227715",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Native%20American%20Plans/NA%20-%20Classic%204500-30.ashx","https://www.securityhealth.org/myplans","41"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170010","Classic $6,500 HDHP","38166WI017",,"WIN001","WIS001","WIF003","New","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994258923",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170010-00","Standard Bronze Off Exchange Plan",,"0.597133219242096","Yes","Yes","No","100%",,"$6,500","$10","$0","$0","$2,790","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%206500%20HDHP.ashx","https://www.securityhealth.org/myplans","46"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170010","Classic $6,500 HDHP","38166WI017",,"WIN001","WIS001","WIF003","New","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994258923",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170010-01","Standard Bronze On Exchange Plan",,"0.597133219242096","Yes","Yes","No","100%",,"$6,500","$10","$0","$0","$2,790","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%206500%20HDHP.ashx","https://www.securityhealth.org/myplans","47"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170010","Classic $6,500 HDHP","38166WI017",,"WIN001","WIS001","WIF003","New","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994258923",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Native%20American%20Plans/NA%20-%20Classic%206500%20HDHP.ashx","https://www.securityhealth.org/myplans","48"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","2","38166","WI","Individual","No","39-1572880","38166WI0170010","Classic $6,500 HDHP","38166WI017",,"WIN001","WIS001","WIF003","New","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994258923",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0170010-03","Limited Cost Sharing Plan Variation",,"0.597133219242096","Yes","Yes","No","100%",,"$6,500","$10","$0","$0","$2,790","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Classic/Classic%206500%20HDHP.ashx","https://www.securityhealth.org/myplans","49"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180003","Select $2,500 - 20%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Native%20American%20Plans/NA%20-%20Select%202500-20.ashx","https://www.securityhealth.org/myplans","17"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180003","Select $2,500 - 20%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180003-03","Limited Cost Sharing Plan Variation","68.19%","0.688730239868164","No","Yes","No","100%",,"$2,500","$70","$770","$0","$850","$980","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%202500-20.ashx","https://www.securityhealth.org/myplans","18"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150011","Independence $2,500 - 20%","38166WI015",,"WIN001","WIS001","WIF003","Existing","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150011-00","Standard Silver Off Exchange Plan",,"0.685283362865448","No","Yes","No","100%",,"$2,500","$0","$960","$0","$2,500","$0","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$9,750","$9750 per person","$19500 per group","$16,600","$16600 per person","$33200 per group","$2,500","$2500 per person","$5000 per group","20%",,,,,"$3,750","$3750 per person","$7500 per group","$6,250","$6250 per person","$12500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%202500-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","18"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150011","Independence $2,500 - 20%","38166WI015",,"WIN001","WIS001","WIF003","Existing","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150011-01","Standard Silver On Exchange Plan",,"0.685283362865448","No","Yes","No","100%",,"$2,500","$0","$960","$0","$2,500","$0","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$9,750","$9750 per person","$19500 per group","$16,600","$16600 per person","$33200 per group","$2,500","$2500 per person","$5000 per group","20%",,,,,"$3,750","$3750 per person","$7500 per group","$6,250","$6250 per person","$12500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%202500-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","19"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180001","Select $1,000 - 20%","38166WI018",,"WIN002","WIS002","WIF001","Existing","EPO","Gold","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993434215",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180001-00","Standard Gold Off Exchange Plan","81.13%","0.806208372116089","No","Yes","No","100%",,"$1,000","$40","$1,000","$0","$850","$850","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%201000-20.ashx","https://www.securityhealth.org/myplans","4"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150001","Independence $500 - 10%","38166WI015",,"WIN001","WIS001","WIF007","Existing","POS","Platinum","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150001-00","Standard Platinum Off Exchange Plan",,"0.901655852794647","No","Yes","No","100%",,"$500","$0","$500","$0","$500","$0","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$1,750","$1750 per person","$3500 per group","$2,750","$2750 per person","$5500 per group","$500","$500 per person","$1000 per group","10%",,,,,"$750","$750 per person","$1500 per group","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%20500-10.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","4"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150001","Independence $500 - 10%","38166WI015",,"WIN001","WIS001","WIF007","Existing","POS","Platinum","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150001-01","Standard Platinum On Exchange Plan",,"0.901655852794647","No","Yes","No","100%",,"$500","$0","$500","$0","$500","$0","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$1,750","$1750 per person","$3500 per group","$2,750","$2750 per person","$5500 per group","$500","$500 per person","$1000 per group","10%",,,,,"$750","$750 per person","$1500 per group","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%20500-10.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","5"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180001","Select $1,000 - 20%","38166WI018",,"WIN002","WIS002","WIF001","Existing","EPO","Gold","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993434215",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180001-01","Standard Gold On Exchange Plan","81.13%","0.806208372116089","No","Yes","No","100%",,"$1,000","$40","$1,000","$0","$850","$850","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%201000-20.ashx","https://www.securityhealth.org/myplans","5"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180001","Select $1,000 - 20%","38166WI018",,"WIN002","WIS002","WIF001","Existing","EPO","Gold","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993434215",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Native%20American%20Plans/NA%20-%20Select%201000-20.ashx","https://www.securityhealth.org/myplans","6"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150014","Independence $1,000","38166WI015",,"WIN001","WIS001","WIF004","New","POS","Platinum","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150014-00","Standard Platinum Off Exchange Plan",,"0.882003605365753","No","Yes","No","100%",,"$1,000","$0","$0","$0","$1,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$5,500","$5500 per person","$11000 per group","$7,500","$7500 per person","$15000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"$1,500","$1500 per person","$3000 per group","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%201000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","6"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150014","Independence $1,000","38166WI015",,"WIN001","WIS001","WIF004","New","POS","Platinum","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150014-01","Standard Platinum On Exchange Plan",,"0.882003605365753","No","Yes","No","100%",,"$1,000","$0","$0","$0","$1,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$5,500","$5500 per person","$11000 per group","$7,500","$7500 per person","$15000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"$1,500","$1500 per person","$3000 per group","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%201000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","7"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180001","Select $1,000 - 20%","38166WI018",,"WIN002","WIS002","WIF001","Existing","EPO","Gold","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993434215",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180001-03","Limited Cost Sharing Plan Variation","81.13%","0.806208372116089","No","Yes","No","100%",,"$1,000","$40","$1,000","$0","$850","$850","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%201000-20.ashx","https://www.securityhealth.org/myplans","7"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180002","Select $3,500 HDHP","38166WI018",,"WIN002","WIS002","WIF006","Existing","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993725369",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180002-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$0","$3,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%203500%20HDHP.ashx","https://www.securityhealth.org/myplans","8"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150015","Independence $1,000 - Copay","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150015-00","Standard Gold Off Exchange Plan",,"0.813456177711487","No","Yes","No","100%",,"$1,000","$0","$0","$0","$1,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","$16,850","$16850 per person","$33700 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"$1,500","$1500 per person","$3000 per group","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%201000%20copay.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","8"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180002","Select $3,500 HDHP","38166WI018",,"WIN002","WIS002","WIF006","Existing","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993725369",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180002-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select-CSR/Select%203500-73.ashx","https://www.securityhealth.org/myplans","12"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150004","Independence $1,500 - 30%","38166WI015",,"WIN001","WIS001","WIF003","Existing","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150004-00","Standard Silver Off Exchange Plan",,"0.718453407287598","No","Yes","No","100%",,"$1,500","$0","$1,740","$0","$1,500","$0","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$9,000","$9000 per person","$18000 per group","$15,000","$15000 per person","$30000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$2,250","$2250 per person","$4500 per group","$3,750","$3750 per person","$7500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%201500-30.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","12"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180009","Select $4,500 - 30%","38166WI018",,"WIN002","WIS002","WIF008","Existing","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9941176277",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Native%20American%20Plans/NA%20-%20Select%204500-30.ashx","https://www.securityhealth.org/myplans","41"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180009","Select $4,500 - 30%","38166WI018",,"WIN002","WIS002","WIF008","Existing","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9941176277",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180009-03","Limited Cost Sharing Plan Variation",,"0.685830593109131","No","Yes","No","100%",,"$4,500","$0","$0","$0","$640","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%204500-30.ashx","https://www.securityhealth.org/myplans","42"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180009","Select $4,500 - 30%","38166WI018",,"WIN002","WIS002","WIF008","Existing","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9941176277",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180009-04","73% AV Level Silver Plan",,"0.738188922405243","No","Yes","No","100%",,"$3,000","$2,000","$0","$0","$640","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select-CSR/Select%204500-73.ashx","https://www.securityhealth.org/myplans","43"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180009","Select $4,500 - 30%","38166WI018",,"WIN002","WIS002","WIF008","Existing","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9941176277",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180009-05","87% AV Level Silver Plan",,"0.875900149345398","No","Yes","No","100%",,"$1,500","$540","$960","$0","$1,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select-CSR/Select%204500-84.ashx","https://www.securityhealth.org/myplans","44"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180009","Select $4,500 - 30%","38166WI018",,"WIN002","WIS002","WIF008","Existing","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9941176277",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180009-06","94% AV Level Silver Plan",,"0.948937118053436","No","Yes","No","100%",,"$480","$20","$0","$0","$210","$290","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select-CSR/Select%204500-94.ashx","https://www.securityhealth.org/myplans","45"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180010","Select $6,500 HDHP","38166WI018",,"WIN002","WIS002","WIF003","New","EPO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994207848",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180010-00","Standard Bronze Off Exchange Plan",,"0.597133219242096","Yes","Yes","No","100%",,"$6,500","$10","$0","$0","$2,790","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%206500%20HDHP.ashx","https://www.securityhealth.org/myplans","46"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150004","Independence $1,500 - 30%","38166WI015",,"WIN001","WIS001","WIF003","Existing","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150004-01","Standard Silver On Exchange Plan",,"0.718453407287598","No","Yes","No","100%",,"$1,500","$0","$1,740","$0","$1,500","$0","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$9,000","$9000 per person","$18000 per group","$15,000","$15000 per person","$30000 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$2,250","$2250 per person","$4500 per group","$3,750","$3750 per person","$7500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%201500-30.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","13"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180002","Select $3,500 HDHP","38166WI018",,"WIN002","WIS002","WIF006","Existing","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993725369",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180002-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$0","$1,250","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select-CSR/Select%203500-87.ashx","https://www.securityhealth.org/myplans","13"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180002","Select $3,500 HDHP","38166WI018",,"WIN002","WIS002","WIF006","Existing","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993725369",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180002-06","94% AV Level Silver Plan",,"0.945099532604218","Yes","Yes","No","100%",,"$450","$0","$0","$0","$450","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select-CSR/Select%203500-94.ashx","https://www.securityhealth.org/myplans","14"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150005","Independence $2,000","38166WI015",,"WIN001","WIS001","WIF006","Existing","POS","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150005-00","Standard Gold Off Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$0","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,000","$7000 per person","$14000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"$3,000","$3000 per person","$6000 per group","$5,000","$5000 per person","$10000 per group","No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%202000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","14"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150005","Independence $2,000","38166WI015",,"WIN001","WIS001","WIF006","Existing","POS","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150005-01","Standard Gold On Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$0","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,000","$7000 per person","$14000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"$3,000","$3000 per person","$6000 per group","$5,000","$5000 per person","$10000 per group","No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%202000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","15"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180003","Select $2,500 - 20%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180003-00","Standard Silver Off Exchange Plan","68.19%","0.688730239868164","No","Yes","No","100%",,"$2,500","$70","$770","$0","$850","$980","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%202500-20.ashx","https://www.securityhealth.org/myplans","15"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180003","Select $2,500 - 20%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180003-01","Standard Silver On Exchange Plan","68.19%","0.688730239868164","No","Yes","No","100%",,"$2,500","$70","$770","$0","$850","$980","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%202500-20.ashx","https://www.securityhealth.org/myplans","16"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150003","Independence $2,000 - 20%","38166WI015",,"WIN001","WIS001","WIF003","Existing","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150003-00","Standard Silver Off Exchange Plan",,"0.715144395828247","No","Yes","No","100%",,"$2,000","$0","$1,060","$0","$2,000","$0","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,500","$15500 per person","$31000 per group","$2,000","$2000 per person","$4000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%202000-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","16"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150003","Independence $2,000 - 20%","38166WI015",,"WIN001","WIS001","WIF003","Existing","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150003-01","Standard Silver On Exchange Plan",,"0.715144395828247","No","Yes","No","100%",,"$2,000","$0","$1,060","$0","$2,000","$0","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,500","$15500 per person","$31000 per group","$2,000","$2000 per person","$4000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$5,000","$5000 per person","$10000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%202000-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","17"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180003","Select $2,500 - 20%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180003-04","73% AV Level Silver Plan","73.72%","0.737187206745148","No","Yes","No","100%",,"$1,750","$40","$920","$0","$850","$850","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select-CSR/Select%202500-73.ashx","https://www.securityhealth.org/myplans","19"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180003","Select $2,500 - 20%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180003-05","87% AV Level Silver Plan","87.87%","0.87866336107254","No","Yes","No","100%",,"$500","$40","$780","$0","$500","$700","$40","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select-CSR/Select%202500-87.ashx","https://www.securityhealth.org/myplans","20"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150016","Independence $3,500 - Copay","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150016-00","Standard Silver Off Exchange Plan",,"0.717372715473175","No","Yes","No","100%",,"$3,500","$0","$0","$0","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$6,850","$6850 per person","$13700 per group","$3,500","$3500 per person","$7000 per group","0%",,,,,"$4,500","$4500 per person","$9000 per group","$8,000","$8000 per person","$16000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%203500%20copay.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","20"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150016","Independence $3,500 - Copay","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150016-01","Standard Silver On Exchange Plan",,"0.717372715473175","No","Yes","No","100%",,"$3,500","$0","$0","$0","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","$6,850","$6850 per person","$13700 per group","$3,500","$3500 per person","$7000 per group","0%",,,,,"$4,500","$4500 per person","$9000 per group","$8,000","$8000 per person","$16000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%203500%20copay.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","21"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010124","Dean Gold Copay Plus 1000X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010124-00","Standard Gold Off Exchange Plan",,"0.813390076160431","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldCopayPlus1000X00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","8"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010124","Dean Gold Copay Plus 1000X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010124-01","Standard Gold On Exchange Plan",,"0.813390076160431","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldCopayPlus1000X01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","9"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010124","Dean Gold Copay Plus 1000X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010124-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldCopayPlus1000X02_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","10"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010124","Dean Gold Copay Plus 1000X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010124-03","Limited Cost Sharing Plan Variation",,"0.813390076160431","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldCopayPlus1000X03_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","11"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180003","Select $2,500 - 20%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180003-06","94% AV Level Silver Plan","93.88%","0.938797354698181","No","Yes","No","100%",,"$250","$20","$230","$0","$250","$230","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select-CSR/Select%202500-94.ashx","https://www.securityhealth.org/myplans","21"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180004","Select $2,000 - 30%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993715267",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180004-00","Standard Silver Off Exchange Plan","69.66%","0.700760245323181","No","Yes","No","100%",,"$2,000","$70","$1,300","$0","$850","$980","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%202000-30.ashx","https://www.securityhealth.org/myplans","22"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150017","Independence $3,000 - 10%","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150017-00","Standard Silver Off Exchange Plan",,"0.686242580413818","No","Yes","No","100%",,"$3,000","$0","$430","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$3,000","$3000 per person","$6000 per group","10%",,,,,"$4,500","$4500 per person","$9000 per group","$7,500","$7500 per person","$15000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%203000-10.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","22"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150017","Independence $3,000 - 10%","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150017-01","Standard Silver On Exchange Plan",,"0.686242580413818","No","Yes","No","100%",,"$3,000","$0","$430","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$3,000","$3000 per person","$6000 per group","10%",,,,,"$4,500","$4500 per person","$9000 per group","$7,500","$7500 per person","$15000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%203000-10.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","23"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180004","Select $2,000 - 30%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993715267",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180004-01","Standard Silver On Exchange Plan","69.66%","0.700760245323181","No","Yes","No","100%",,"$2,000","$70","$1,300","$0","$850","$980","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%202000-30.ashx","https://www.securityhealth.org/myplans","23"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180004","Select $2,000 - 30%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993715267",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Native%20American%20Plans/NA%20-%20Classic%202000-30.ashx","https://www.securityhealth.org/myplans","24"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150018","Independence $4,000","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150018-00","Standard Silver Off Exchange Plan",,"0.692709982395172","No","Yes","No","100%",,"$4,000","$0","$0","$0","$4,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$10,000","$10000 per person","$20000 per group","$16,600","$16600 per person","$33200 per group","$4,000","$4000 per person","$8000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$10,000","$10000 per person","$20000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%204000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","24"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150018","Independence $4,000","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150018-01","Standard Silver On Exchange Plan",,"0.692709982395172","No","Yes","No","100%",,"$4,000","$0","$0","$0","$4,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$10,000","$10000 per person","$20000 per group","$16,600","$16600 per person","$33200 per group","$4,000","$4000 per person","$8000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$10,000","$10000 per person","$20000 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%204000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","25"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180004","Select $2,000 - 30%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993715267",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180004-03","Limited Cost Sharing Plan Variation","69.66%","0.700760245323181","No","Yes","No","100%",,"$2,000","$70","$1,300","$0","$850","$980","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%202000-30.ashx","https://www.securityhealth.org/myplans","25"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180004","Select $2,000 - 30%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993715267",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180004-04","73% AV Level Silver Plan","73.15%","0.731538116931915","No","Yes","No","100%",,"$1,750","$1,620","$1,380","$0","$850","$980","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","$1,750","$1750 per person","$3500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select-CSR/Select%202000-73.ashx","https://www.securityhealth.org/myplans","26"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150012","Independence $3,000 HDHP","38166WI015",,"WIN001","WIS001","WIF003","Existing","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150012-00","Standard Silver Off Exchange Plan",,"0.713499546051025","Yes","Yes","No","100%",,"$3,000","$40","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,000","$13000 per person","$26000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$4,500","$4500 per person","$9000 per group","$7,500","$7500 per person","$15000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%203000%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","26"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150012","Independence $3,000 HDHP","38166WI015",,"WIN001","WIS001","WIF003","Existing","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150012-01","Standard Silver On Exchange Plan",,"0.713499546051025","Yes","Yes","No","100%",,"$3,000","$40","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,000","$13000 per person","$26000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$4,500","$4500 per person","$9000 per group","$7,500","$7500 per person","$15000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%203000%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","27"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180004","Select $2,000 - 30%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993715267",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180004-05","87% AV Level Silver Plan","87.47%","0.874695718288422","No","Yes","No","100%",,"$250","$40","$1,220","$0","$250","$700","$120","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select-CSR/Select%202000-87.ashx","https://www.securityhealth.org/myplans","27"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180004","Select $2,000 - 30%","38166WI018",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Yes","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel","Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993715267",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180004-06","94% AV Level Silver Plan","93.88%","0.938797354698181","No","Yes","No","100%",,"$250","$20","$230","$0","$250","$230","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select-CSR/Select%202000-94.ashx","https://www.securityhealth.org/myplans","28"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150021","Independence $3,000 - Copay HDHP","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150021-00","Standard Silver Off Exchange Plan",,"0.694658041000366","Yes","Yes","No","100%",,"$3,000","$0","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$4,500","$4500 per person","$9000 per group","$7,500","$7500 per person","$15000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%203000%20copay%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","28"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150021","Independence $3,000 - Copay HDHP","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150021-01","Standard Silver On Exchange Plan",,"0.694658041000366","Yes","Yes","No","100%",,"$3,000","$0","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$4,500","$4500 per person","$9000 per group","$7,500","$7500 per person","$15000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%203000%20copay%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","29"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180006","Select $6,000 HDHP","38166WI018",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994108371",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180006-00","Standard Bronze Off Exchange Plan",,"0.613106071949005","Yes","Yes","No","100%",,"$6,000","$40","$0","$0","$2,790","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%206000%20HDHP.ashx","https://www.securityhealth.org/myplans","29"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180006","Select $6,000 HDHP","38166WI018",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994108371",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180006-01","Standard Bronze On Exchange Plan",,"0.613106071949005","Yes","Yes","No","100%",,"$6,000","$40","$0","$0","$2,790","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%206000%20HDHP.ashx","https://www.securityhealth.org/myplans","30"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150007","Independence $3,000 - 10% HDHP","38166WI015",,"WIN001","WIS001","WIF003","Existing","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150007-00","Standard Silver Off Exchange Plan",,"0.687992513179779","Yes","Yes","No","100%",,"$3,000","$40","$430","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$4,500","$4500 per person","$9000 per group","$7,500","$7500 per person","$15000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%203000-10%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","30"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150007","Independence $3,000 - 10% HDHP","38166WI015",,"WIN001","WIS001","WIF003","Existing","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150007-01","Standard Silver On Exchange Plan",,"0.687992513179779","Yes","Yes","No","100%",,"$3,000","$40","$430","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$4,500","$4500 per person","$9000 per group","$7,500","$7500 per person","$15000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%203000-10%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","31"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180006","Select $6,000 HDHP","38166WI018",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994108371",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Native%20American%20Plans/NA%20-%20Select%206000%20HDHP.ashx","https://www.securityhealth.org/myplans","31"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180006","Select $6,000 HDHP","38166WI018",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994108371",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180006-03","Limited Cost Sharing Plan Variation",,"0.613106071949005","Yes","Yes","No","100%",,"$6,000","$40","$0","$0","$2,790","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%206000%20HDHP.ashx","https://www.securityhealth.org/myplans","32"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150022","Independence $3,500 HDHP","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150022-00","Standard Silver Off Exchange Plan",,"0.688498795032501","Yes","Yes","No","100%",,"$3,500","$40","$0","$0","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,250","$9250 per person","$18500 per group","$13,750","$13750 per person","$27500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$5,250","$5250 per person","$10500 per group","$8,750","$8750 per person","$17500 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%203500%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","32"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150022","Independence $3,500 HDHP","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150022-01","Standard Silver On Exchange Plan",,"0.688498795032501","Yes","Yes","No","100%",,"$3,500","$40","$0","$0","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,250","$9250 per person","$18500 per group","$13,750","$13750 per person","$27500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$5,250","$5250 per person","$10500 per group","$8,750","$8750 per person","$17500 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%203500%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","33"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180007","Select $5,500 HDHP","38166WI018",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993964368",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180007-00","Standard Bronze Off Exchange Plan",,"0.618882298469543","Yes","Yes","No","100%",,"$5,500","$40","$0","$0","$2,790","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%205500%20HDHP.ashx","https://www.securityhealth.org/myplans","33"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180007","Select $5,500 HDHP","38166WI018",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993964368",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180007-01","Standard Bronze On Exchange Plan",,"0.618882298469543","Yes","Yes","No","100%",,"$5,500","$40","$0","$0","$2,790","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%205500%20HDHP.ashx","https://www.securityhealth.org/myplans","34"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150023","Independence $4,000 HDHP","38166WI015",,"WIN001","WIS001","WIF006","New","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150023-00","Standard Silver Off Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$0","$4,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","$14,000","$14000 per person","$28000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$10,000","$10000 per person","$20000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%204000%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","34"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150023","Independence $4,000 HDHP","38166WI015",,"WIN001","WIS001","WIF006","New","POS","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150023-01","Standard Silver On Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$0","$4,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","$14,000","$14000 per person","$28000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$10,000","$10000 per person","$20000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%204000%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","35"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180007","Select $5,500 HDHP","38166WI018",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993964368",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Native%20American%20Plans/NA%20-%20Select%205500%20HDHP.ashx","https://www.securityhealth.org/myplans","35"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180007","Select $5,500 HDHP","38166WI018",,"WIN002","WIS002","WIF003","Existing","EPO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993964368",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180007-03","Limited Cost Sharing Plan Variation",,"0.618882298469543","Yes","Yes","No","100%",,"$5,500","$40","$0","$0","$2,790","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","Yes",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%205500%20HDHP.ashx","https://www.securityhealth.org/myplans","36"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150010","Independence $4,500 - 30% HDHP","38166WI015",,"WIN001","WIS001","WIF003","Existing","POS","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150010-00","Standard Bronze Off Exchange Plan",,"0.619847416877747","Yes","Yes","No","100%",,"$4,500","$40","$870","$0","$4,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$14,000","$14000 per person","$28000 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$6,600","$6600 per person","$13200 per group","$11,100","$11100 per person","$22200 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%204500-30%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","36"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150010","Independence $4,500 - 30% HDHP","38166WI015",,"WIN001","WIS001","WIF003","Existing","POS","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150010-01","Standard Bronze On Exchange Plan",,"0.619847416877747","Yes","Yes","No","100%",,"$4,500","$40","$870","$0","$4,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$14,000","$14000 per person","$28000 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$6,600","$6600 per person","$13200 per group","$11,100","$11100 per person","$22200 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%204500-30%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","37"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180008","Select $6,850","38166WI018",,"WIN002","WIS002","WIF006","Existing","EPO","Catastrophic","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180008-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,510","$0","$0","$0","$2,800","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%206850.ashx","https://www.securityhealth.org/myplans","37"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180008","Select $6,850","38166WI018",,"WIN002","WIS002","WIF006","Existing","EPO","Catastrophic","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180008-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,510","$0","$0","$0","$2,800","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%206850.ashx","https://www.securityhealth.org/myplans","38"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150013","Independence $5,000 - 10% HDHP","38166WI015",,"WIN001","WIS001","WIF008","Existing","POS","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150013-00","Standard Bronze Off Exchange Plan",,"0.619730949401855","Yes","Yes","No","100%",,"$5,000","$40","$230","$0","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$11,200","$11200 per person","$22400 per group","$17,750","$17750 per person","$35500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","$12,500","$12500 per person","$25000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%205000-10%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","38"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150013","Independence $5,000 - 10% HDHP","38166WI015",,"WIN001","WIS001","WIF008","Existing","POS","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No",,"http://securityhealth.org/formulary","38166WI0150013-01","Standard Bronze On Exchange Plan",,"0.619730949401855","Yes","Yes","No","100%",,"$5,000","$40","$230","$0","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$11,200","$11200 per person","$22400 per group","$17,750","$17750 per person","$35500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","$12,500","$12500 per person","$25000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Independence/Independence%205000-10%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","39"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180009","Select $4,500 - 30%","38166WI018",,"WIN002","WIS002","WIF008","Existing","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9941176277",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180009-00","Standard Silver Off Exchange Plan",,"0.685830593109131","No","Yes","No","100%",,"$4,500","$0","$0","$0","$640","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%204500-30.ashx","https://www.securityhealth.org/myplans","39"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180009","Select $4,500 - 30%","38166WI018",,"WIN002","WIS002","WIF008","Existing","EPO","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9941176277",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180009-01","Standard Silver On Exchange Plan",,"0.685830593109131","No","Yes","No","100%",,"$4,500","$0","$0","$0","$640","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%204500-30.ashx","https://www.securityhealth.org/myplans","40"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180010","Select $6,500 HDHP","38166WI018",,"WIN002","WIS002","WIF003","New","EPO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994207848",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180010-01","Standard Bronze On Exchange Plan",,"0.597133219242096","Yes","Yes","No","100%",,"$6,500","$10","$0","$0","$2,790","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%206500%20HDHP.ashx","https://www.securityhealth.org/myplans","47"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180010","Select $6,500 HDHP","38166WI018",,"WIN002","WIS002","WIF003","New","EPO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994207848",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Native%20American%20Plans/NA%20-%20Select%206500%20HDHP.ashx","https://www.securityhealth.org/myplans","48"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010123","Dean Platinum Copay Plus 500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Platinum","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010123-00","Standard Platinum Off Exchange Plan",,"0.901728987693787","No","Yes","No","100%",,"$500","$0","$500","$200","$300","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_PlatinumCopayPlus500X00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","4"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010123","Dean Platinum Copay Plus 500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Platinum","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010123-01","Standard Platinum On Exchange Plan",,"0.901728987693787","No","Yes","No","100%",,"$500","$0","$500","$200","$300","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_PlatinumCopayPlus500X01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","5"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010123","Dean Platinum Copay Plus 500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Platinum","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010123-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_PlatinumCopayPlus500X02_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","6"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","3","38166","WI","Individual","No","39-1572880","38166WI0180010","Select $6,500 HDHP","38166WI018",,"WIN002","WIS002","WIF003","New","EPO","Bronze","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994207848",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","https://ww3.securityhealth.org/onlinepayment","http://securityhealth.org/formulary","38166WI0180010-03","Limited Cost Sharing Plan Variation",,"0.597133219242096","Yes","Yes","No","100%",,"$6,500","$10","$0","$0","$2,790","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","No",,,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Individual/Select/Select%206500%20HDHP.ashx","https://www.securityhealth.org/myplans","49"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","4","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0190001","Freedom $500 - 10%","38166WI019",,"WIN004","WIS001","WIF007","New","Indemnity","Platinum","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","Yes",,"http://securityhealth.org/formulary","38166WI0190001-00","Standard Platinum Off Exchange Plan",,"0.901655673980713","No","Yes","No","100%",,"$500","$0","$500","$0","$500","$0","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$500","$500 per person","$1000 per group","10%",,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Freedom/Freedom%20500-10.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","4"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","4","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0190001","Freedom $500 - 10%","38166WI019",,"WIN004","WIS001","WIF007","New","Indemnity","Platinum","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","Yes",,"http://securityhealth.org/formulary","38166WI0190001-01","Standard Platinum On Exchange Plan",,"0.901655673980713","No","Yes","No","100%",,"$500","$0","$500","$0","$500","$0","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$500","$500 per person","$1000 per group","10%",,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Freedom/Freedom%20500-10.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","5"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","4","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0190002","Freedom $1,000","38166WI019",,"WIN004","WIS001","WIF004","New","Indemnity","Platinum","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","Yes",,"http://securityhealth.org/formulary","38166WI0190002-00","Standard Platinum Off Exchange Plan",,"0.882003605365753","No","Yes","No","100%",,"$1,000","$0","$0","$0","$1,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Freedom/Freedom%201000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","6"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","4","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0190002","Freedom $1,000","38166WI019",,"WIN004","WIS001","WIF004","New","Indemnity","Platinum","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","Yes",,"http://securityhealth.org/formulary","38166WI0190002-01","Standard Platinum On Exchange Plan",,"0.882003605365753","No","Yes","No","100%",,"$1,000","$0","$0","$0","$1,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Freedom/Freedom%201000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","7"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","4","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0190003","Freedom $1,000 - 20%","38166WI019",,"WIN004","WIS001","WIF005","New","Indemnity","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","Yes",,"http://securityhealth.org/formulary","38166WI0190003-00","Standard Gold Off Exchange Plan",,"0.796598374843597","No","Yes","No","100%",,"$1,000","$0","$1,260","$0","$1,000","$0","$90","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Freedom/Freedom%201000-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","8"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","4","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0190003","Freedom $1,000 - 20%","38166WI019",,"WIN004","WIS001","WIF005","New","Indemnity","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","Yes",,"http://securityhealth.org/formulary","38166WI0190003-01","Standard Gold On Exchange Plan",,"0.796598374843597","No","Yes","No","100%",,"$1,000","$0","$1,260","$0","$1,000","$0","$90","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","33%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Freedom/Freedom%201000-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","9"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","4","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0190006","Freedom $2,000","38166WI019",,"WIN004","WIS001","WIF006","New","Indemnity","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","Yes",,"http://securityhealth.org/formulary","38166WI0190006-00","Standard Gold Off Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$0","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Freedom/Freedom%202000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","10"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","4","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0190006","Freedom $2,000","38166WI019",,"WIN004","WIS001","WIF006","New","Indemnity","Gold","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","Yes",,"http://securityhealth.org/formulary","38166WI0190006-01","Standard Gold On Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$0","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Freedom/Freedom%202000.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","11"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","4","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0190004","Freedom $2,000 - 20%","38166WI019",,"WIN004","WIS001","WIF003","New","Indemnity","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","Yes",,"http://securityhealth.org/formulary","38166WI0190004-00","Standard Silver Off Exchange Plan",,"0.715144395828247","No","Yes","No","100%",,"$2,000","$0","$1,060","$0","$2,000","$0","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$2,000","$2000 per person","$4000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Freedom/Freedom%202000-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","12"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","4","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0190004","Freedom $2,000 - 20%","38166WI019",,"WIN004","WIS001","WIF003","New","Indemnity","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","1","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","Yes",,"http://securityhealth.org/formulary","38166WI0190004-01","Standard Silver On Exchange Plan",,"0.715144395828247","No","Yes","No","100%",,"$2,000","$0","$1,060","$0","$2,000","$0","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","$2,000","$2000 per person","$4000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","33%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Freedom/Freedom%202000-20.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","13"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","4","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0190007","Freedom $3,000 - Copay HDHP","38166WI019",,"WIN004","WIS001","WIF003","New","Indemnity","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","Yes",,"http://securityhealth.org/formulary","38166WI0190007-00","Standard Silver Off Exchange Plan",,"0.694658041000366","Yes","Yes","No","100%",,"$3,000","$0","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Freedom/Freedom%203000%20Copay%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","14"
"2016","WI","38166","HIOS","15","2016-03-02 04:41:46","4","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0190007","Freedom $3,000 - Copay HDHP","38166WI019",,"WIN004","WIS001","WIF003","New","Indemnity","Silver","No","Both","Yes","Yes","Referrals are required for:  Orthopedist for knee and hip replacement, knee arthroscopies, back pain/surgery and carpal tunnel surgery   Neurosurgery for back pain/surgery  Referral to hand specialist for carpal tunnel",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","Yes",,"http://securityhealth.org/formulary","38166WI0190007-01","Standard Silver On Exchange Plan",,"0.694658041000366","Yes","Yes","No","100%",,"$3,000","$0","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","Yes","No",,"https://www.securityhealth.org/~/media/Member/2016%20SBC/Small%20Group/Freedom/Freedom%203000%20Copay%20HDHP.ashx","https://www.securityhealth.org/find-your-plan/employer-groups/2016-small-group/shop","15"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010123","Dean Platinum Copay Plus 500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Platinum","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010123-03","Limited Cost Sharing Plan Variation",,"0.901728987693787","No","Yes","No","100%",,"$500","$0","$500","$200","$300","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_PlatinumCopayPlus500X03_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","7"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010095","Dean Silver Copay Plus 2000X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010095-00","Standard Silver Off Exchange Plan",,"0.719679236412048","No","Yes","No","100%",,"$2,000","$20","$1,600","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus2000X00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","12"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010095","Dean Silver Copay Plus 2000X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010095-01","Standard Silver On Exchange Plan",,"0.719679236412048","No","Yes","No","100%",,"$2,000","$20","$1,600","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus2000X01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","13"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010095","Dean Silver Copay Plus 2000X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010095-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus2000X02_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","14"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010095","Dean Silver Copay Plus 2000X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010095-03","Limited Cost Sharing Plan Variation",,"0.719679236412048","No","Yes","No","100%",,"$2,000","$20","$1,600","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus2000X03_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","15"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010095","Dean Silver Copay Plus 2000X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010095-04","73% AV Level Silver Plan",,"0.739713788032532","No","Yes","No","100%",,"$2,000","$20","$1,600","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,320","$5320 per person","$10640 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus2000X04_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","16"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010095","Dean Silver Copay Plus 2000X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010095-05","87% AV Level Silver Plan",,"0.879033267498016","No","Yes","No","100%",,"$100","$20","$700","$200","$100","$900","$20","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus2000X05_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","17"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010095","Dean Silver Copay Plus 2000X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010095-06","94% AV Level Silver Plan",,"0.947618544101715","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$300","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus2000X06_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","18"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010125","Dean Silver Copay Plus 3500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010125-00","Standard Silver Off Exchange Plan",,"0.690329968929291","No","Yes","No","100%",,"$3,500","$20","$400","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus3500X00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","19"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010125","Dean Silver Copay Plus 3500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010125-01","Standard Silver On Exchange Plan",,"0.690329968929291","No","Yes","No","100%",,"$3,500","$20","$400","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus3500X01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","20"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010125","Dean Silver Copay Plus 3500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010125-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus3500X02_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","21"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010125","Dean Silver Copay Plus 3500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010125-03","Limited Cost Sharing Plan Variation",,"0.690329968929291","No","Yes","No","100%",,"$3,500","$20","$400","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus3500X03_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","22"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010125","Dean Silver Copay Plus 3500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010125-04","73% AV Level Silver Plan",,"0.739732623100281","No","Yes","No","100%",,"$2,300","$20","$500","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus3500X04_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","23"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010125","Dean Silver Copay Plus 3500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010125-05","87% AV Level Silver Plan",,"0.879033267498016","No","Yes","No","100%",,"$100","$20","$700","$200","$100","$900","$20","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus3500X05_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","24"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0010125","Dean Silver Copay Plus 3500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010125-06","94% AV Level Silver Plan",,"0.947618544101715","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$300","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverCopayPlus3500X06_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","25"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060073","Prevea360 Platinum Copay Plus 500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Platinum","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060073-00","Standard Platinum Off Exchange Plan",,"0.901728987693787","No","Yes","No","100%",,"$500","$0","$500","$200","$300","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_PlatinumCopayPlus500X00_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","26"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060073","Prevea360 Platinum Copay Plus 500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Platinum","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060073-01","Standard Platinum On Exchange Plan",,"0.901728987693787","No","Yes","No","100%",,"$500","$0","$500","$200","$300","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_PlatinumCopayPlus500X01_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","27"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060073","Prevea360 Platinum Copay Plus 500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Platinum","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060073-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_PlatinumCopayPlus500X02_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","28"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060073","Prevea360 Platinum Copay Plus 500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Platinum","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060073-03","Limited Cost Sharing Plan Variation",,"0.901728987693787","No","Yes","No","100%",,"$500","$0","$500","$200","$300","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_PlatinumCopayPlus500X03_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","29"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060074","Prevea360 Gold Copay Plus 1000X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060074-00","Standard Gold Off Exchange Plan",,"0.813390076160431","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_GoldCopayPlus1000X00_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","30"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060074","Prevea360 Gold Copay Plus 1000X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060074-01","Standard Gold On Exchange Plan",,"0.813390076160431","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_GoldCopayPlus1000X01_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","31"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060074","Prevea360 Gold Copay Plus 1000X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060074-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_GoldCopayPlus1000X02_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","32"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060074","Prevea360 Gold Copay Plus 1000X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060074-03","Limited Cost Sharing Plan Variation",,"0.813390076160431","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_GoldCopayPlus1000X03_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","33"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060045","Prevea360 Silver Copay Plus 2000X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060045-00","Standard Silver Off Exchange Plan",,"0.719679236412048","No","Yes","No","100%",,"$2,000","$20","$1,600","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverCopayPlus2000X00_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","34"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060045","Prevea360 Silver Copay Plus 2000X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060045-01","Standard Silver On Exchange Plan",,"0.719679236412048","No","Yes","No","100%",,"$2,000","$20","$1,600","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverCopayPlus2000X01_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","35"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060045","Prevea360 Silver Copay Plus 2000X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060045-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverCopayPlus2000X02_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","36"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060045","Prevea360 Silver Copay Plus 2000X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060045-03","Limited Cost Sharing Plan Variation",,"0.719679236412048","No","Yes","No","100%",,"$2,000","$20","$1,600","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverCopayPlus2000X03_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","37"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060045","Prevea360 Silver Copay Plus 2000X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060045-04","73% AV Level Silver Plan",,"0.739713788032532","No","Yes","No","100%",,"$2,000","$20","$1,600","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,320","$5320 per person","$10640 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverCopayPlus2000X04_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","38"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060045","Prevea360 Silver Copay Plus 2000X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060045-05","87% AV Level Silver Plan",,"0.879033267498016","No","Yes","No","100%",,"$100","$20","$700","$200","$100","$900","$20","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverCopayPlus2000X05_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","39"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060045","Prevea360 Silver Copay Plus 2000X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060045-06","94% AV Level Silver Plan",,"0.947618544101715","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$300","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverCopayPlus2000X06_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","40"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060075","Prevea360 Silver Copay Plus 3500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060075-00","Standard Silver Off Exchange Plan",,"0.690329968929291","No","Yes","No","100%",,"$3,500","$20","$400","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverCopayPlus3500X00_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","41"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060075","Prevea360 Silver Copay Plus 3500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060075-01","Standard Silver On Exchange Plan",,"0.690329968929291","No","Yes","No","100%",,"$3,500","$20","$400","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverCopayPlus3500X01_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","42"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060075","Prevea360 Silver Copay Plus 3500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060075-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverCopayPlus3500X02_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","43"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060075","Prevea360 Silver Copay Plus 3500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060075-03","Limited Cost Sharing Plan Variation",,"0.690329968929291","No","Yes","No","100%",,"$3,500","$20","$400","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverCopayPlus3500X03_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","44"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060075","Prevea360 Silver Copay Plus 3500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060075-04","73% AV Level Silver Plan",,"0.739732623100281","No","Yes","No","100%",,"$2,300","$20","$500","$200","$300","$900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverCopayPlus3500X04_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","45"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060075","Prevea360 Silver Copay Plus 3500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060075-05","87% AV Level Silver Plan",,"0.879033267498016","No","Yes","No","100%",,"$100","$20","$700","$200","$100","$900","$20","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverCopayPlus3500X05_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","46"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","1","38345","WI","Individual","No","39-1535024","38345WI0060075","Prevea360 Silver Copay Plus 3500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060075-06","94% AV Level Silver Plan",,"0.947618544101715","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$300","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverCopayPlus3500X06_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","47"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0010106","Dean Gold Classic 1500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010106-00","Standard Gold Off Exchange Plan",,"0.79427045583725","No","Yes","No","100%",,"$1,500","$20","$600","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldClassic1500X00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","4"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0010106","Dean Gold Classic 1500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010106-01","Standard Gold On Exchange Plan",,"0.79427045583725","No","Yes","No","100%",,"$1,500","$20","$600","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldClassic1500X01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","5"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0010106","Dean Gold Classic 1500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010106-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldClassic1500X02_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","6"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0010106","Dean Gold Classic 1500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010106-03","Limited Cost Sharing Plan Variation",,"0.79427045583725","No","Yes","No","100%",,"$1,500","$20","$600","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldClassic1500X03_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","7"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0010097","Dean Silver Classic 2500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010097-00","Standard Silver Off Exchange Plan",,"0.693912327289581","No","Yes","No","100%",,"$2,500","$20","$500","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic2500X00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","8"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0010097","Dean Silver Classic 2500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010097-01","Standard Silver On Exchange Plan",,"0.693912327289581","No","Yes","No","100%",,"$2,500","$20","$500","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic2500X01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","9"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0010097","Dean Silver Classic 2500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010097-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic2500X02_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","10"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0010097","Dean Silver Classic 2500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010097-03","Limited Cost Sharing Plan Variation",,"0.693912327289581","No","Yes","No","100%",,"$2,500","$20","$500","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic2500X03_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","11"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0010097","Dean Silver Classic 2500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010097-04","73% AV Level Silver Plan",,"0.738120079040527","No","Yes","No","100%",,"$1,800","$20","$600","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic2500X04_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","12"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0010097","Dean Silver Classic 2500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010097-05","87% AV Level Silver Plan",,"0.878522515296936","No","Yes","No","100%",,"$200","$20","$700","$200","$200","$700","$80","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic2500X05_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","13"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0010097","Dean Silver Classic 2500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010097-06","94% AV Level Silver Plan",,"0.948681235313416","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$300","$30","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic2500X06_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","14"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0010098","Dean Silver Classic 4500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010098-00","Standard Silver Off Exchange Plan",,"0.686329960823059","No","Yes","No","100%",,"$4,500","$0","$0","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic4500X00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","15"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0010098","Dean Silver Classic 4500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010098-01","Standard Silver On Exchange Plan",,"0.686329960823059","No","Yes","No","100%",,"$4,500","$0","$0","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic4500X01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","16"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0010098","Dean Silver Classic 4500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010098-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic4500X02_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","17"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0010098","Dean Silver Classic 4500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010098-03","Limited Cost Sharing Plan Variation",,"0.686329960823059","No","Yes","No","100%",,"$4,500","$0","$0","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic4500X03_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","18"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0010098","Dean Silver Classic 4500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010098-04","73% AV Level Silver Plan",,"0.730183184146881","No","Yes","No","100%",,"$3,500","$0","$0","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic4500X04_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","19"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0010098","Dean Silver Classic 4500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010098-05","87% AV Level Silver Plan",,"0.873653531074524","No","Yes","No","100%",,"$1,200","$0","$0","$200","$800","$400","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic4500X05_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","20"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0010098","Dean Silver Classic 4500X","38345WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010098-06","94% AV Level Silver Plan",,"0.944884538650513","No","Yes","No","100%",,"$500","$0","$0","$200","$400","$90","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverClassic4500X06_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","21"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0060056","Prevea360 Gold Classic 1500X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060056-00","Standard Gold Off Exchange Plan",,"0.79427045583725","No","Yes","No","100%",,"$1,500","$20","$600","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_GoldClassic1500X00_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","22"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0060056","Prevea360 Gold Classic 1500X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060056-01","Standard Gold On Exchange Plan",,"0.79427045583725","No","Yes","No","100%",,"$1,500","$20","$600","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_GoldClassic1500X01_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","23"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0060056","Prevea360 Gold Classic 1500X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060056-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_GoldClassic1500X02_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","24"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0060056","Prevea360 Gold Classic 1500X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060056-03","Limited Cost Sharing Plan Variation",,"0.79427045583725","No","Yes","No","100%",,"$1,500","$20","$600","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_GoldClassic1500X03_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","25"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0060047","Prevea360 Silver Classic 2500X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060047-00","Standard Silver Off Exchange Plan",,"0.693912327289581","No","Yes","No","100%",,"$2,500","$20","$500","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverClassic2500X00_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","26"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0060047","Prevea360 Silver Classic 2500X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060047-01","Standard Silver On Exchange Plan",,"0.693912327289581","No","Yes","No","100%",,"$2,500","$20","$500","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverClassic2500X01_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","27"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0060047","Prevea360 Silver Classic 2500X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060047-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverClassic2500X02_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","28"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0060047","Prevea360 Silver Classic 2500X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060047-03","Limited Cost Sharing Plan Variation",,"0.693912327289581","No","Yes","No","100%",,"$2,500","$20","$500","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverClassic2500X03_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","29"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0060047","Prevea360 Silver Classic 2500X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060047-04","73% AV Level Silver Plan",,"0.738120079040527","No","Yes","No","100%",,"$1,800","$20","$600","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverClassic2500X04_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","30"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0060047","Prevea360 Silver Classic 2500X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060047-05","87% AV Level Silver Plan",,"0.878522515296936","No","Yes","No","100%",,"$200","$20","$700","$200","$200","$700","$80","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverClassic2500X05_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","31"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0060047","Prevea360 Silver Classic 2500X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060047-06","94% AV Level Silver Plan",,"0.948681235313416","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$300","$30","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverClassic2500X06_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","32"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0060048","Prevea360 Silver Classic 4500X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060048-00","Standard Silver Off Exchange Plan",,"0.686329960823059","No","Yes","No","100%",,"$4,500","$0","$0","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverClassic4500X00_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","33"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0060048","Prevea360 Silver Classic 4500X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060048-01","Standard Silver On Exchange Plan",,"0.686329960823059","No","Yes","No","100%",,"$4,500","$0","$0","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverClassic4500X01_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","34"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0060048","Prevea360 Silver Classic 4500X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060048-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverClassic4500X02_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","35"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0060048","Prevea360 Silver Classic 4500X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060048-03","Limited Cost Sharing Plan Variation",,"0.686329960823059","No","Yes","No","100%",,"$4,500","$0","$0","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverClassic4500X03_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","36"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0060048","Prevea360 Silver Classic 4500X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060048-04","73% AV Level Silver Plan",,"0.730183184146881","No","Yes","No","100%",,"$3,500","$0","$0","$200","$1,000","$700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverClassic4500X04_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","37"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0060048","Prevea360 Silver Classic 4500X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060048-05","87% AV Level Silver Plan",,"0.873653531074524","No","Yes","No","100%",,"$1,200","$0","$0","$200","$800","$400","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverClassic4500X05_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","38"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","2","38345","WI","Individual","No","39-1535024","38345WI0060048","Prevea360 Silver Classic 4500X","38345WI006",,"WIN003","WIS003","WIF005","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060048-06","94% AV Level Silver Plan",,"0.944884538650513","No","Yes","No","100%",,"$500","$0","$0","$200","$400","$90","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverClassic4500X06_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","39"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0010108","Dean Gold Value Copay 2250X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010108-00","Standard Gold Off Exchange Plan",,"0.815156638622284","No","Yes","No","100%",,"$2,300","$0","$0","$200","$300","$800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldValueCopay2250X00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","4"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0010108","Dean Gold Value Copay 2250X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010108-01","Standard Gold On Exchange Plan",,"0.815156638622284","No","Yes","No","100%",,"$2,300","$0","$0","$200","$300","$800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldValueCopay2250X01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","5"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0010108","Dean Gold Value Copay 2250X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010108-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldValueCopay2250X02_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","6"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0010108","Dean Gold Value Copay 2250X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010108-03","Limited Cost Sharing Plan Variation",,"0.815156638622284","No","Yes","No","100%",,"$2,300","$0","$0","$200","$300","$800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldValueCopay2250X03_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","7"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0010099","Dean Silver Value Copay 5150X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010099-00","Standard Silver Off Exchange Plan",,"0.681553244590759","No","Yes","No","100%",,"$5,200","$0","$0","$200","$300","$800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,150","$5150 per person","$10300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverValueCopay5150X00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","8"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0010099","Dean Silver Value Copay 5150X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010099-01","Standard Silver On Exchange Plan",,"0.681553244590759","No","Yes","No","100%",,"$5,200","$0","$0","$200","$300","$800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,150","$5150 per person","$10300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverValueCopay5150X01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","9"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0010099","Dean Silver Value Copay 5150X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010099-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverValueCopay5150X02_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","10"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0010099","Dean Silver Value Copay 5150X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010099-03","Limited Cost Sharing Plan Variation",,"0.681553244590759","No","Yes","No","100%",,"$5,200","$0","$0","$200","$300","$800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,150","$5150 per person","$10300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverValueCopay5150X03_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","11"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0010099","Dean Silver Value Copay 5150X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010099-04","73% AV Level Silver Plan",,"0.738711357116699","No","Yes","No","100%",,"$3,800","$0","$0","$200","$300","$800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverValueCopay5150X04_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","12"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0010099","Dean Silver Value Copay 5150X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010099-05","87% AV Level Silver Plan",,"0.879224598407745","No","Yes","No","100%",,"$1,400","$0","$0","$200","$300","$800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverValueCopay5150X05_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","13"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0010099","Dean Silver Value Copay 5150X","38345WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010099-06","94% AV Level Silver Plan",,"0.948742210865021","No","Yes","No","100%",,"$500","$0","$0","$200","$200","$300","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverValueCopay5150X06_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","14"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0010100","Dean Bronze Value Copay 5500X","38345WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010100-00","Standard Bronze Off Exchange Plan",,"0.618847012519836","No","Yes","No","100%",,"$5,500","$20","$400","$200","$300","$1,900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeValueCopay5500X00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","15"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0010100","Dean Bronze Value Copay 5500X","38345WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010100-01","Standard Bronze On Exchange Plan",,"0.618847012519836","No","Yes","No","100%",,"$5,500","$20","$400","$200","$300","$1,900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeValueCopay5500X01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","16"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0010100","Dean Bronze Value Copay 5500X","38345WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010100-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeValueCopay5500X02_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","17"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0010100","Dean Bronze Value Copay 5500X","38345WI001",,"WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010100-03","Limited Cost Sharing Plan Variation",,"0.618847012519836","No","Yes","No","100%",,"$5,500","$20","$400","$200","$300","$1,900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeValueCopay5500X03_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","18"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0080018","Dean Focus Network Silver Value Copay 5150X","38345WI008",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080018-00","Standard Silver Off Exchange Plan",,"0.681553244590759","No","Yes","No","100%",,"$5,200","$0","$0","$200","$300","$800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,150","$5150 per person","$10300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverValueCopay5150X00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","19"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0080018","Dean Focus Network Silver Value Copay 5150X","38345WI008",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080018-01","Standard Silver On Exchange Plan",,"0.681553244590759","No","Yes","No","100%",,"$5,200","$0","$0","$200","$300","$800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,150","$5150 per person","$10300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverValueCopay5150X01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","20"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0080018","Dean Focus Network Silver Value Copay 5150X","38345WI008",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080018-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverValueCopay5150X02_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","21"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0080018","Dean Focus Network Silver Value Copay 5150X","38345WI008",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080018-03","Limited Cost Sharing Plan Variation",,"0.681553244590759","No","Yes","No","100%",,"$5,200","$0","$0","$200","$300","$800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,150","$5150 per person","$10300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverValueCopay5150X03_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","22"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0080018","Dean Focus Network Silver Value Copay 5150X","38345WI008",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080018-04","73% AV Level Silver Plan",,"0.738711357116699","No","Yes","No","100%",,"$3,800","$0","$0","$200","$300","$800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverValueCopay5150X04_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","23"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0080018","Dean Focus Network Silver Value Copay 5150X","38345WI008",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080018-05","87% AV Level Silver Plan",,"0.879224598407745","No","Yes","No","100%",,"$1,400","$0","$0","$200","$300","$800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverValueCopay5150X05_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","24"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0080018","Dean Focus Network Silver Value Copay 5150X","38345WI008",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080018-06","94% AV Level Silver Plan",,"0.948742210865021","No","Yes","No","100%",,"$500","$0","$0","$200","$200","$300","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverValueCopay5150X06_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","25"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0080019","Dean Focus Network Bronze Value Copay 5500X","38345WI008",,"WIN002","WIS002","WIF004","Existing","EPO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080019-00","Standard Bronze Off Exchange Plan",,"0.618847012519836","No","Yes","No","100%",,"$5,500","$20","$400","$200","$300","$1,900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeValueCopay5500X00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","26"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0080019","Dean Focus Network Bronze Value Copay 5500X","38345WI008",,"WIN002","WIS002","WIF004","Existing","EPO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080019-01","Standard Bronze On Exchange Plan",,"0.618847012519836","No","Yes","No","100%",,"$5,500","$20","$400","$200","$300","$1,900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeValueCopay5500X01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","27"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0080019","Dean Focus Network Bronze Value Copay 5500X","38345WI008",,"WIN002","WIS002","WIF004","Existing","EPO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080019-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeValueCopay5500X02_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","28"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0080019","Dean Focus Network Bronze Value Copay 5500X","38345WI008",,"WIN002","WIS002","WIF004","Existing","EPO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080019-03","Limited Cost Sharing Plan Variation",,"0.618847012519836","No","Yes","No","100%",,"$5,500","$20","$400","$200","$300","$1,900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeValueCopay5500X03_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","29"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0060058","Prevea360 Gold Value Copay 2250X","38345WI006",,"WIN003","WIS003","WIF007","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060058-00","Standard Gold Off Exchange Plan",,"0.815156638622284","No","Yes","No","100%",,"$2,300","$0","$0","$200","$300","$800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_GoldValueCopay2250X00_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","30"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0060058","Prevea360 Gold Value Copay 2250X","38345WI006",,"WIN003","WIS003","WIF007","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060058-01","Standard Gold On Exchange Plan",,"0.815156638622284","No","Yes","No","100%",,"$2,300","$0","$0","$200","$300","$800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_GoldValueCopay2250X01_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","31"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0060058","Prevea360 Gold Value Copay 2250X","38345WI006",,"WIN003","WIS003","WIF007","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060058-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_GoldValueCopay2250X02_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","32"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0060058","Prevea360 Gold Value Copay 2250X","38345WI006",,"WIN003","WIS003","WIF007","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060058-03","Limited Cost Sharing Plan Variation",,"0.815156638622284","No","Yes","No","100%",,"$2,300","$0","$0","$200","$300","$800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_GoldValueCopay2250X03_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","33"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0060049","Prevea360 Silver Value Copay 5150X","38345WI006",,"WIN003","WIS003","WIF007","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060049-00","Standard Silver Off Exchange Plan",,"0.681553244590759","No","Yes","No","100%",,"$5,200","$0","$0","$200","$300","$800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,150","$5150 per person","$10300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverValueCopay5150X00_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","34"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0060049","Prevea360 Silver Value Copay 5150X","38345WI006",,"WIN003","WIS003","WIF007","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060049-01","Standard Silver On Exchange Plan",,"0.681553244590759","No","Yes","No","100%",,"$5,200","$0","$0","$200","$300","$800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,150","$5150 per person","$10300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverValueCopay5150X01_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","35"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0060049","Prevea360 Silver Value Copay 5150X","38345WI006",,"WIN003","WIS003","WIF007","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060049-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverValueCopay5150X02_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","36"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0060049","Prevea360 Silver Value Copay 5150X","38345WI006",,"WIN003","WIS003","WIF007","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060049-03","Limited Cost Sharing Plan Variation",,"0.681553244590759","No","Yes","No","100%",,"$5,200","$0","$0","$200","$300","$800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,150","$5150 per person","$10300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverValueCopay5150X03_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","37"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0060049","Prevea360 Silver Value Copay 5150X","38345WI006",,"WIN003","WIS003","WIF007","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060049-04","73% AV Level Silver Plan",,"0.738711357116699","No","Yes","No","100%",,"$3,800","$0","$0","$200","$300","$800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverValueCopay5150X04_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","38"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0060049","Prevea360 Silver Value Copay 5150X","38345WI006",,"WIN003","WIS003","WIF007","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060049-05","87% AV Level Silver Plan",,"0.879224598407745","No","Yes","No","100%",,"$1,400","$0","$0","$200","$300","$800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverValueCopay5150X05_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","39"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0060049","Prevea360 Silver Value Copay 5150X","38345WI006",,"WIN003","WIS003","WIF007","Existing","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060049-06","94% AV Level Silver Plan",,"0.948742210865021","No","Yes","No","100%",,"$500","$0","$0","$200","$200","$300","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverValueCopay5150X06_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","40"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0060050","Prevea360 Bronze Value Copay 5500X","38345WI006",,"WIN003","WIS003","WIF008","Existing","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060050-00","Standard Bronze Off Exchange Plan",,"0.618847012519836","No","Yes","No","100%",,"$5,500","$20","$400","$200","$300","$1,900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_BronzeValueCopay5500X00_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","41"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0060050","Prevea360 Bronze Value Copay 5500X","38345WI006",,"WIN003","WIS003","WIF008","Existing","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060050-01","Standard Bronze On Exchange Plan",,"0.618847012519836","No","Yes","No","100%",,"$5,500","$20","$400","$200","$300","$1,900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_BronzeValueCopay5500X01_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","42"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0060050","Prevea360 Bronze Value Copay 5500X","38345WI006",,"WIN003","WIS003","WIF008","Existing","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060050-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_BronzeValueCopay5500X02_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","43"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","3","38345","WI","Individual","No","39-1535024","38345WI0060050","Prevea360 Bronze Value Copay 5500X","38345WI006",,"WIN003","WIS003","WIF008","Existing","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060050-03","Limited Cost Sharing Plan Variation",,"0.618847012519836","No","Yes","No","100%",,"$5,500","$20","$400","$200","$300","$1,900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://app.prevea360.com/sbc/Individual/Prevea_BronzeValueCopay5500X03_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","44"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010119","Dean Bronze Value Copay 6750X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010119-00","Standard Bronze Off Exchange Plan",,"0.614275217056274","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$300","$200","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeValueCopay6750X00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","4"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010119","Dean Bronze Value Copay 6750X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010119-01","Standard Bronze On Exchange Plan",,"0.614275217056274","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$300","$200","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeValueCopay6750X01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","5"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010119","Dean Bronze Value Copay 6750X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010119-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeValueCopay6750X02_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","6"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010119","Dean Bronze Value Copay 6750X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010119-03","Limited Cost Sharing Plan Variation",,"0.614275217056274","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$300","$200","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeValueCopay6750X03_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","7"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010109","Dean Gold HSA 2000X","38345WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010109-00","Standard Gold Off Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_GoldHSA2000X00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","8"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010109","Dean Gold HSA 2000X","38345WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010109-01","Standard Gold On Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_GoldHSA2000X01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","9"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010109","Dean Gold HSA 2000X","38345WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010109-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_GoldHSA2000X02_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","10"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010109","Dean Gold HSA 2000X","38345WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010109-03","Limited Cost Sharing Plan Variation",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_GoldHSA2000X03_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","11"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010122","Dean Silver HSA-E 3400X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010122-00","Standard Silver Off Exchange Plan",,"0.716870069503784","Yes","Yes","No","100%",,"$3,400","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_SilverHSA-E3400X00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","12"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010122","Dean Silver HSA-E 3400X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010122-01","Standard Silver On Exchange Plan",,"0.716870069503784","Yes","Yes","No","100%",,"$3,400","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_SilverHSA-E3400X01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","13"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010122","Dean Silver HSA-E 3400X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010122-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverHSA-E3400X02_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","14"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010122","Dean Silver HSA-E 3400X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010122-03","Limited Cost Sharing Plan Variation",,"0.716870069503784","Yes","Yes","No","100%",,"$3,400","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_SilverHSA-E3400X03_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","15"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010122","Dean Silver HSA-E 3400X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010122-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_SilverHSA-E3400X04_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","16"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010122","Dean Silver HSA-E 3400X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010122-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverHSA-E3400X05_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","17"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010122","Dean Silver HSA-E 3400X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010122-06","94% AV Level Silver Plan",,"0.945099532604218","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_SilverHSA-E3400X06_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","18"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010120","Dean Bronze HSA-E 6000X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010120-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeHSA-E6000X00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","19"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010120","Dean Bronze HSA-E 6000X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010120-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeHSA-E6000X01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","20"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010120","Dean Bronze HSA-E 6000X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010120-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeHSA-E6000X02_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","21"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010120","Dean Bronze HSA-E 6000X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010120-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeHSA-E6000X03_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","22"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010121","Dean Bronze HSA-E 6450X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010121-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeHSA-E6450X00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","23"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010121","Dean Bronze HSA-E 6450X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010121-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeHSA-E6450X01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","24"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010121","Dean Bronze HSA-E 6450X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010121-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeHSA-E6450X02_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","25"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0010121","Dean Bronze HSA-E 6450X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010121-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_BronzeHSA-E6450X03_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","26"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0080029","Dean Focus Network Bronze Value Copay 6750X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080029-00","Standard Bronze Off Exchange Plan",,"0.614275217056274","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$300","$200","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeValueCopay6750X00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","27"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0080029","Dean Focus Network Bronze Value Copay 6750X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080029-01","Standard Bronze On Exchange Plan",,"0.614275217056274","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$300","$200","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeValueCopay6750X01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","28"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","SHOP (Small Group)","No","35-1665915","39924WI0040001","Gold Navigate 1000-2","39924WI004",,"WIN002","WIS002","WIF001","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=wi0005&st=wi","39924WI0040001-00","Standard Gold Off Exchange Plan","80.0%",,"No","Yes","No","100%",,"$1,000","$20","$900","$200","$200","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=wi0001&st=wi",,"4"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","SHOP (Small Group)","No","35-1665915","39924WI0040001","Gold Navigate 1000-2","39924WI004",,"WIN002","WIS002","WIF001","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=wi0005&st=wi","39924WI0040001-01","Standard Gold On Exchange Plan","80.0%",,"No","Yes","No","100%",,"$1,000","$20","$900","$200","$200","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=wi0001&st=wi",,"5"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","SHOP (Small Group)","No","35-1665915","39924WI0040002","Silver Navigate 2000","39924WI004",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=wi0005&st=wi","39924WI0040002-00","Standard Silver Off Exchange Plan","71.9%",,"No","Yes","No","100%",,"$2,000","$20","$900","$200","$300","$1,900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=wi0002&st=wi",,"6"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","SHOP (Small Group)","No","35-1665915","39924WI0040002","Silver Navigate 2000","39924WI004",,"WIN002","WIS002","WIF003","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=wi0005&st=wi","39924WI0040002-01","Standard Silver On Exchange Plan","71.9%",,"No","Yes","No","100%",,"$2,000","$20","$900","$200","$300","$1,900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=wi0002&st=wi",,"7"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030002","Gold Compass 1000","39924WI003",,"WIN001","WIS001","WIF005","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030002-00","Standard Gold Off Exchange Plan","78.2%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0004&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","8"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030002","Gold Compass 1000","39924WI003",,"WIN001","WIS001","WIF005","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030002-01","Standard Gold On Exchange Plan","78.2%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0004&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","9"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0080029","Dean Focus Network Bronze Value Copay 6750X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080029-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeValueCopay6750X02_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","29"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0080029","Dean Focus Network Bronze Value Copay 6750X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080029-03","Limited Cost Sharing Plan Variation",,"0.614275217056274","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$300","$200","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeValueCopay6750X03_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","30"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0080032","Dean Focus Network Silver HSA-E 3400X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080032-00","Standard Silver Off Exchange Plan",,"0.716870069503784","Yes","Yes","No","100%",,"$3,400","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverHSA-E3400X00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","31"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0080032","Dean Focus Network Silver HSA-E 3400X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080032-01","Standard Silver On Exchange Plan",,"0.716870069503784","Yes","Yes","No","100%",,"$3,400","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverHSA-E3400X01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","32"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0080032","Dean Focus Network Silver HSA-E 3400X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080032-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverHSA-E3400X02_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","33"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0080032","Dean Focus Network Silver HSA-E 3400X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080032-03","Limited Cost Sharing Plan Variation",,"0.716870069503784","Yes","Yes","No","100%",,"$3,400","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverHSA-E3400X03_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","34"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0080032","Dean Focus Network Silver HSA-E 3400X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080032-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverHSA-E3400X04_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","35"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0080032","Dean Focus Network Silver HSA-E 3400X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080032-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverHSA-E3400X05_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","36"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0080032","Dean Focus Network Silver HSA-E 3400X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080032-06","94% AV Level Silver Plan",,"0.945099532604218","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkSilverHSA-E3400X06_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","37"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0080030","Dean Focus Network Bronze HSA-E 6000X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080030-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeHSA-E6000X00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","38"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0080030","Dean Focus Network Bronze HSA-E 6000X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080030-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeHSA-E6000X01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","39"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0080030","Dean Focus Network Bronze HSA-E 6000X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080030-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeHSA-E6000X02_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","40"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0080030","Dean Focus Network Bronze HSA-E 6000X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080030-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeHSA-E6000X03_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","41"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0080031","Dean Focus Network Bronze HSA-E 6450X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080031-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeHSA-E6450X00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","42"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0080031","Dean Focus Network Bronze HSA-E 6450X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080031-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeHSA-E6450X01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","43"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0080031","Dean Focus Network Bronze HSA-E 6450X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080031-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeHSA-E6450X02_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","44"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0080031","Dean Focus Network Bronze HSA-E 6450X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080031-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.deancare.com/sbc/Individual/Dean_FocusNetworkBronzeHSA-E6450X03_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","45"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060069","Prevea360 Bronze Value Copay 6750X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060069-00","Standard Bronze Off Exchange Plan",,"0.614275217056274","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$300","$200","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.prevea360.com/sbc/Individual/Prevea_BronzeValueCopay6750X00_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","46"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060069","Prevea360 Bronze Value Copay 6750X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060069-01","Standard Bronze On Exchange Plan",,"0.614275217056274","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$300","$200","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.prevea360.com/sbc/Individual/Prevea_BronzeValueCopay6750X01_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","47"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060069","Prevea360 Bronze Value Copay 6750X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060069-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.prevea360.com/sbc/Individual/Prevea_BronzeValueCopay6750X02_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","48"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060069","Prevea360 Bronze Value Copay 6750X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060069-03","Limited Cost Sharing Plan Variation",,"0.614275217056274","Yes","Yes","No","100%",,"$6,800","$0","$0","$200","$300","$200","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.prevea360.com/sbc/Individual/Prevea_BronzeValueCopay6750X03_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","49"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060059","Prevea360 Gold HSA 2000X","38345WI006",,"WIN003","WIS003","WIF006","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060059-00","Standard Gold Off Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.prevea360.com/sbc/Individual/Prevea_GoldHSA2000X00_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","50"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060059","Prevea360 Gold HSA 2000X","38345WI006",,"WIN003","WIS003","WIF006","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060059-01","Standard Gold On Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.prevea360.com/sbc/Individual/Prevea_GoldHSA2000X01_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","51"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060059","Prevea360 Gold HSA 2000X","38345WI006",,"WIN003","WIS003","WIF006","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060059-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.prevea360.com/sbc/Individual/Prevea_GoldHSA2000X02_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","52"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060059","Prevea360 Gold HSA 2000X","38345WI006",,"WIN003","WIS003","WIF006","Existing","HMO","Gold","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060059-03","Limited Cost Sharing Plan Variation",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.prevea360.com/sbc/Individual/Prevea_GoldHSA2000X03_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","53"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060072","Prevea360 Silver HSA-E 3400X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060072-00","Standard Silver Off Exchange Plan",,"0.716870069503784","Yes","Yes","No","100%",,"$3,400","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverHSA-E3400X00_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","54"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060072","Prevea360 Silver HSA-E 3400X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060072-01","Standard Silver On Exchange Plan",,"0.716870069503784","Yes","Yes","No","100%",,"$3,400","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverHSA-E3400X01_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","55"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060072","Prevea360 Silver HSA-E 3400X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060072-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverHSA-E3400X02_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","56"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060072","Prevea360 Silver HSA-E 3400X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060072-03","Limited Cost Sharing Plan Variation",,"0.716870069503784","Yes","Yes","No","100%",,"$3,400","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverHSA-E3400X03_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","57"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060072","Prevea360 Silver HSA-E 3400X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060072-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverHSA-E3400X04_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","58"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060072","Prevea360 Silver HSA-E 3400X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060072-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverHSA-E3400X05_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","59"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060072","Prevea360 Silver HSA-E 3400X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Silver","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060072-06","94% AV Level Silver Plan",,"0.945099532604218","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.prevea360.com/sbc/Individual/Prevea_SilverHSA-E3400X06_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","60"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060070","Prevea360 Bronze HSA-E 6000X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060070-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.prevea360.com/sbc/Individual/Prevea_BronzeHSA-E6000X00_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","61"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060070","Prevea360 Bronze HSA-E 6000X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060070-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.prevea360.com/sbc/Individual/Prevea_BronzeHSA-E6000X01_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","62"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060070","Prevea360 Bronze HSA-E 6000X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060070-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.prevea360.com/sbc/Individual/Prevea_BronzeHSA-E6000X02_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","63"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030002","Gold Compass 1000","39924WI003",,"WIN001","WIS001","WIF005","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030002-03","Limited Cost Sharing Plan Variation","78.2%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0006&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","11"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030003","Gold Compass 500","39924WI003",,"WIN001","WIS001","WIF006","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030003-00","Standard Gold Off Exchange Plan","78.4%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0007&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","12"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030003","Gold Compass 500","39924WI003",,"WIN001","WIS001","WIF006","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030003-01","Standard Gold On Exchange Plan","78.4%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0007&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","13"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030003","Gold Compass 500","39924WI003",,"WIN001","WIS001","WIF006","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030003-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0008&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","14"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030003","Gold Compass 500","39924WI003",,"WIN001","WIS001","WIF006","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030003-03","Limited Cost Sharing Plan Variation","78.4%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0009&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","15"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030006","Silver Compass 2000","39924WI003",,"WIN001","WIS001","WIF011","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030006-00","Standard Silver Off Exchange Plan","69.3%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0025&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","16"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060070","Prevea360 Bronze HSA-E 6000X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060070-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.prevea360.com/sbc/Individual/Prevea_BronzeHSA-E6000X03_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","64"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060071","Prevea360 Bronze HSA-E 6450X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060071-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.prevea360.com/sbc/Individual/Prevea_BronzeHSA-E6450X00_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","65"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060071","Prevea360 Bronze HSA-E 6450X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060071-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.prevea360.com/sbc/Individual/Prevea_BronzeHSA-E6450X01_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","66"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060071","Prevea360 Bronze HSA-E 6450X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060071-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.prevea360.com/sbc/Individual/Prevea_BronzeHSA-E6450X02_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","67"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","4","38345","WI","Individual","No","39-1535024","38345WI0060071","Prevea360 Bronze HSA-E 6450X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Bronze","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060071-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,500","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://app.prevea360.com/sbc/Individual/Prevea_BronzeHSA-E6450X03_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","68"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","5","38345","WI","Individual","No","39-1535024","38345WI0010063","Dean Catastrophic Safety Net","38345WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Catastrophic","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010063-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_CatastrophicSafetyNet00_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","4"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","5","38345","WI","Individual","No","39-1535024","38345WI0010063","Dean Catastrophic Safety Net","38345WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Catastrophic","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010063-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.deancare.com/sbc/Individual/Dean_CatastrophicSafetyNet01_0116.PDF","http://www.deancare.com/health-insurance/sign-me-up/learn/","5"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","5","38345","WI","Individual","No","39-1535024","38345WI0060013","Prevea360 Catastrophic Safety Net","38345WI006",,"WIN003","WIS003","WIF006","Existing","HMO","Catastrophic","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060013-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.prevea360.com/sbc/Individual/Prevea_CatastrophicSafetyNet00_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","6"
"2016","WI","38345","HIOS","4","2015-08-25 05:06:23","5","38345","WI","Individual","No","39-1535024","38345WI0060013","Prevea360 Catastrophic Safety Net","38345WI006",,"WIN003","WIS003","WIF006","Existing","HMO","Catastrophic","No","Both","No","No",,"See policy or plan document for additional excluded services.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://payment.prevea360.com/payment.php","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$1,000","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://app.prevea360.com/sbc/Individual/Prevea_CatastrophicSafetyNet01_0116.PDF","http://www.prevea360.com/quote-buy-insurance/sign-me-up/learn.aspx","7"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","1","39924","WI","SHOP (Small Group)","No","35-1665915","39924WI0040003","Silver Navigate HSA 2850-2","39924WI004",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=wi0005&st=wi","39924WI0040003-00","Standard Silver Off Exchange Plan","71.7%",,"Yes","Yes","No","100%",,"$2,900","$20","$700","$200","$2,900","$600","$70","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$400.00","http://www.uhc.com/shop/doc?id=wi0003&st=wi",,"4"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","1","39924","WI","Individual","No","35-1665915","39924WI0030004","Silver Compass HSA 3000","39924WI003",,"WIN001","WIS001","WIF012","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030004-00","Standard Silver Off Exchange Plan","69.2%",,"Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=wi0013&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","4"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","1","39924","WI","Individual","No","35-1665915","39924WI0030004","Silver Compass HSA 3000","39924WI003",,"WIN001","WIS001","WIF012","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030004-01","Standard Silver On Exchange Plan","69.2%",,"Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=wi0013&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","5"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","1","39924","WI","SHOP (Small Group)","No","35-1665915","39924WI0040003","Silver Navigate HSA 2850-2","39924WI004",,"WIN002","WIS002","WIF002","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=wi0005&st=wi","39924WI0040003-01","Standard Silver On Exchange Plan","71.7%",,"Yes","Yes","No","100%",,"$2,900","$20","$700","$200","$2,900","$600","$70","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$400.00","http://www.uhc.com/shop/doc?id=wi0003&st=wi",,"5"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","1","39924","WI","SHOP (Small Group)","No","35-1665915","39924WI0040004","Bronze Navigate HSA 5500-2","39924WI004",,"WIN002","WIS002","WIF002","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=wi0005&st=wi","39924WI0040004-00","Standard Bronze Off Exchange Plan","62.0%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.uhc.com/shop/doc?id=wi0004&st=wi",,"6"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","1","39924","WI","Individual","No","35-1665915","39924WI0030004","Silver Compass HSA 3000","39924WI003",,"WIN001","WIS001","WIF012","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030004-02","Zero Cost Sharing Plan Variation","100.0%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=wi0014&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","6"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","1","39924","WI","Individual","No","35-1665915","39924WI0030004","Silver Compass HSA 3000","39924WI003",,"WIN001","WIS001","WIF012","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030004-03","Limited Cost Sharing Plan Variation","69.2%",,"Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=wi0015&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","7"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","1","39924","WI","SHOP (Small Group)","No","35-1665915","39924WI0040004","Bronze Navigate HSA 5500-2","39924WI004",,"WIN002","WIS002","WIF002","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=wi0005&st=wi","39924WI0040004-01","Standard Bronze On Exchange Plan","62.0%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.uhc.com/shop/doc?id=wi0005&st=wi",,"7"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","1","39924","WI","Individual","No","35-1665915","39924WI0030004","Silver Compass HSA 3000","39924WI003",,"WIN001","WIS001","WIF012","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030004-04","73% AV Level Silver Plan","72.1%",,"Yes","Yes","No","100%",,"$2,500","$10","$0","$200","$2,500","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=wi0016&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","8"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","1","39924","WI","Individual","No","35-1665915","39924WI0030004","Silver Compass HSA 3000","39924WI003",,"WIN001","WIS001","WIF012","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030004-05","87% AV Level Silver Plan","86.3%",,"Yes","Yes","No","100%",,"$800","$10","$0","$200","$800","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=wi0017&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","9"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","1","39924","WI","Individual","No","35-1665915","39924WI0030004","Silver Compass HSA 3000","39924WI003",,"WIN001","WIS001","WIF012","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030004-06","94% AV Level Silver Plan","93.2%",,"Yes","Yes","No","100%",,"$300","$10","$0","$200","$300","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=wi0018&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","10"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","1","39924","WI","Individual","No","35-1665915","39924WI0030009","Bronze Compass HSA 5500","39924WI003",,"WIN001","WIS001","WIF004","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030009-00","Standard Bronze Off Exchange Plan","61.3%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=wi0043&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","11"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","1","39924","WI","Individual","No","35-1665915","39924WI0030009","Bronze Compass HSA 5500","39924WI003",,"WIN001","WIS001","WIF004","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030009-01","Standard Bronze On Exchange Plan","61.3%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=wi0043&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","12"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","1","39924","WI","Individual","No","35-1665915","39924WI0030009","Bronze Compass HSA 5500","39924WI003",,"WIN001","WIS001","WIF004","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030009-02","Zero Cost Sharing Plan Variation","100.0%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=wi0044&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","13"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","1","39924","WI","Individual","No","35-1665915","39924WI0030009","Bronze Compass HSA 5500","39924WI003",,"WIN001","WIS001","WIF004","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030009-03","Limited Cost Sharing Plan Variation","61.3%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=wi0045&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","14"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030002","Gold Compass 1000","39924WI003",,"WIN001","WIS001","WIF005","Existing","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030002-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0005&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","10"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030006","Silver Compass 2000","39924WI003",,"WIN001","WIS001","WIF011","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030006-01","Standard Silver On Exchange Plan","69.3%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0025&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","17"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030006","Silver Compass 2000","39924WI003",,"WIN001","WIS001","WIF011","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030006-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0026&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","18"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030006","Silver Compass 2000","39924WI003",,"WIN001","WIS001","WIF011","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030006-03","Limited Cost Sharing Plan Variation","69.3%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0027&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","19"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030006","Silver Compass 2000","39924WI003",,"WIN001","WIS001","WIF011","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030006-04","73% AV Level Silver Plan","73.5%",,"No","Yes","No","100%",,"$1,200","$20","$1,500","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0028&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","20"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030006","Silver Compass 2000","39924WI003",,"WIN001","WIS001","WIF011","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030006-05","87% AV Level Silver Plan","87.9%",,"No","Yes","No","100%",,"$300","$10","$600","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0029&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","21"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030006","Silver Compass 2000","39924WI003",,"WIN001","WIS001","WIF011","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030006-06","94% AV Level Silver Plan","93.9%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0030&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","22"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030007","Silver Compass 3500","39924WI003",,"WIN001","WIS001","WIF008","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030007-00","Standard Silver Off Exchange Plan","68.1%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0031&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","23"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030007","Silver Compass 3500","39924WI003",,"WIN001","WIS001","WIF008","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030007-01","Standard Silver On Exchange Plan","68.1%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0031&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","24"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030007","Silver Compass 3500","39924WI003",,"WIN001","WIS001","WIF008","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030007-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0032&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","25"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030007","Silver Compass 3500","39924WI003",,"WIN001","WIS001","WIF008","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030007-03","Limited Cost Sharing Plan Variation","68.1%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0033&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","26"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030007","Silver Compass 3500","39924WI003",,"WIN001","WIS001","WIF008","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030007-04","73% AV Level Silver Plan","72.5%",,"No","Yes","No","100%",,"$2,500","$10","$800","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0034&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","27"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030007","Silver Compass 3500","39924WI003",,"WIN001","WIS001","WIF008","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030007-05","87% AV Level Silver Plan","87.9%",,"No","Yes","No","100%",,"$300","$10","$600","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0035&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","28"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030007","Silver Compass 3500","39924WI003",,"WIN001","WIS001","WIF008","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030007-06","94% AV Level Silver Plan","93.9%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0036&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","29"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030008","Silver Compass 4500","39924WI003",,"WIN001","WIS001","WIF008","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030008-00","Standard Silver Off Exchange Plan","68.4%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0037&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","30"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030008","Silver Compass 4500","39924WI003",,"WIN001","WIS001","WIF008","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030008-01","Standard Silver On Exchange Plan","68.4%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0037&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","31"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030008","Silver Compass 4500","39924WI003",,"WIN001","WIS001","WIF008","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030008-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0038&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","32"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030008","Silver Compass 4500","39924WI003",,"WIN001","WIS001","WIF008","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030008-03","Limited Cost Sharing Plan Variation","68.4%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0039&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","33"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030008","Silver Compass 4500","39924WI003",,"WIN001","WIS001","WIF008","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030008-04","73% AV Level Silver Plan","72.5%",,"No","Yes","No","100%",,"$3,300","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0040&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","34"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030008","Silver Compass 4500","39924WI003",,"WIN001","WIS001","WIF008","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030008-05","87% AV Level Silver Plan","86.1%",,"No","Yes","No","100%",,"$600","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0041&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","35"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030008","Silver Compass 4500","39924WI003",,"WIN001","WIS001","WIF008","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030008-06","94% AV Level Silver Plan","93.3%",,"No","Yes","No","100%",,"$100","$10","$0","$200","$100","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0042&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","36"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030010","Bronze Compass 6500","39924WI003",,"WIN001","WIS001","WIF004","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030010-00","Standard Bronze Off Exchange Plan","61.9%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=wi0046&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","37"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030010","Bronze Compass 6500","39924WI003",,"WIN001","WIS001","WIF004","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030010-01","Standard Bronze On Exchange Plan","61.9%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=wi0046&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","38"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030010","Bronze Compass 6500","39924WI003",,"WIN001","WIS001","WIF004","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030010-02","Zero Cost Sharing Plan Variation","100.0%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=wi0047&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","39"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030010","Bronze Compass 6500","39924WI003",,"WIN001","WIS001","WIF004","Existing","EPO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030010-03","Limited Cost Sharing Plan Variation","61.9%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=wi0048&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","40"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030011","Gold Compass 0","39924WI003",,"WIN001","WIS001","WIF010","New","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030011-00","Standard Gold Off Exchange Plan","79.4%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0010&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","41"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030011","Gold Compass 0","39924WI003",,"WIN001","WIS001","WIF010","New","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030011-01","Standard Gold On Exchange Plan","79.4%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0010&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","42"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030011","Gold Compass 0","39924WI003",,"WIN001","WIS001","WIF010","New","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030011-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0011&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","43"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","2","39924","WI","Individual","No","35-1665915","39924WI0030011","Gold Compass 0","39924WI003",,"WIN001","WIS001","WIF010","New","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030011-03","Limited Cost Sharing Plan Variation","79.4%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=wi0012&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","44"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","3","39924","WI","Individual","No","35-1665915","39924WI0030005","Silver Compass 2000 1","39924WI003",,"WIN001","WIS001","WIF009","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030005-00","Standard Silver Off Exchange Plan","71.0%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=wi0019&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","4"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","3","39924","WI","Individual","No","35-1665915","39924WI0030005","Silver Compass 2000 1","39924WI003",,"WIN001","WIS001","WIF009","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030005-01","Standard Silver On Exchange Plan","71.0%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=wi0019&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","5"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","3","39924","WI","Individual","No","35-1665915","39924WI0030005","Silver Compass 2000 1","39924WI003",,"WIN001","WIS001","WIF009","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030005-02","Zero Cost Sharing Plan Variation","100.0%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=wi0020&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","6"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","3","39924","WI","Individual","No","35-1665915","39924WI0030005","Silver Compass 2000 1","39924WI003",,"WIN001","WIS001","WIF009","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030005-03","Limited Cost Sharing Plan Variation","71.0%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=wi0021&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","7"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","3","39924","WI","Individual","No","35-1665915","39924WI0030005","Silver Compass 2000 1","39924WI003",,"WIN001","WIS001","WIF009","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030005-04","73% AV Level Silver Plan","73.0%",,"Yes","Yes","No","100%",,"$1,800","$1,500","$0","$200","$1,800","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=wi0022&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","8"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","3","39924","WI","Individual","No","35-1665915","39924WI0030005","Silver Compass 2000 1","39924WI003",,"WIN001","WIS001","WIF009","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030005-05","87% AV Level Silver Plan","86.2%",,"Yes","Yes","No","100%",,"$600","$800","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=wi0023&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","9"
"2016","WI","39924","HIOS","5","2015-08-27 11:14:25","3","39924","WI","Individual","No","35-1665915","39924WI0030005","Silver Compass 2000 1","39924WI003",,"WIN001","WIS001","WIF009","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=wi0050&st=wi","39924WI0030005-06","94% AV Level Silver Plan","93.1%",,"Yes","Yes","No","100%",,"$200","$500","$0","$200","$200","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=wi0024&st=wi","http://www.uhc.com/iex/doc?id=wi0049&st=wi","10"
"2016","WI","41436","HIOS","2","2015-07-09 13:17:42","1","41436","WI","SHOP (Small Group)","Yes","41-0808596","41436WI0010002","Plan 2.  Passive PPO, $1000 Annual Maximum, Ortho","41436WI001",,"WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are the same in and out of network","Yes",,"","41436WI0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","41436","HIOS","2","2015-07-09 13:17:42","1","41436","WI","SHOP (Small Group)","Yes","41-0808596","41436WI0010005","Plan 5.  Passive PPO, $2000 Annual Maximum, Ortho","41436WI001",,"WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are the same in and out of network","Yes",,"","41436WI0010005-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","WI","41436","HIOS","2","2015-07-09 13:17:42","1","41436","WI","SHOP (Small Group)","Yes","41-0808596","41436WI0010006","Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho","41436WI001",,"WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are the same in and out of network","Yes",,"","41436WI0010006-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","WI","41436","HIOS","2","2015-07-09 13:17:42","1","41436","WI","SHOP (Small Group)","Yes","41-0808596","41436WI0010009","Plan 9. MAC PPO, $1500 Annual Maximum, Ortho","41436WI001",,"WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$20.18","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are the same in and out of network","Yes",,"","41436WI0010009-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050005","Gold 2000/80  w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050005-00","Standard Gold Off Exchange Plan",,"0.792689323425293","No","Yes","No","100%",,"$2,900","$80","$880","$0","$1,700","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Gold-2000-80-copay2.pdf","https://www.healthtradition.com/brochures-for-individuals","4"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060001","Platinum 1000","47342WI006","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060001-00","Standard Platinum Off Exchange Plan",,"0.909877419471741","No","Yes","No","100%",,"$1,900","$0","$0","$0","$1,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","4"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060001","Platinum 1000","47342WI006","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060001-01","Standard Platinum On Exchange Plan",,"0.909877419471741","No","Yes","No","100%",,"$1,900","$0","$0","$0","$1,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","5"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050005","Gold 2000/80  w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050005-01","Standard Gold On Exchange Plan",,"0.792689323425293","No","Yes","No","100%",,"$2,900","$80","$880","$0","$1,700","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Gold-2000-80-copay2.pdf","https://www.healthtradition.com/brochures-for-individuals","5"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050005","Gold 2000/80  w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Gold-2000-80-copay-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","6"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060002","Platinum 1000","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060002-00","Standard Platinum Off Exchange Plan",,"0.909877419471741","No","Yes","No","100%",,"$1,900","$0","$0","$0","$1,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","6"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060002","Platinum 1000","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060002-01","Standard Platinum On Exchange Plan",,"0.909877419471741","No","Yes","No","100%",,"$1,900","$0","$0","$0","$1,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","7"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050005","Gold 2000/80  w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050005-03","Limited Cost Sharing Plan Variation",,"0.792689323425293","No","Yes","No","100%",,"$2,900","$80","$880","$0","$1,700","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Gold-2000-80-copay-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","7"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050006","Gold 2000/80  w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050006-00","Standard Gold Off Exchange Plan",,"0.792689323425293","No","Yes","No","100%",,"$2,900","$80","$880","$0","$1,700","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Gold-2000-80-copay2.pdf","https://www.healthtradition.com/brochures-for-individuals","8"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060003","Gold 1000/80 w/copay","47342WI006","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060003-00","Standard Gold Off Exchange Plan",,"0.817508578300476","No","Yes","No","100%",,"$1,900","$70","$1,080","$0","$1,000","$560","$140","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","8"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060003","Gold 1000/80 w/copay","47342WI006","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060003-01","Standard Gold On Exchange Plan",,"0.817508578300476","No","Yes","No","100%",,"$1,900","$70","$1,080","$0","$1,000","$560","$140","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","9"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050006","Gold 2000/80  w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050006-01","Standard Gold On Exchange Plan",,"0.792689323425293","No","Yes","No","100%",,"$2,900","$80","$880","$0","$1,700","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Gold-2000-80-copay2.pdf","https://www.healthtradition.com/brochures-for-individuals","9"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050006","Gold 2000/80  w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Gold-2000-80-copay-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","10"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060004","Gold 1000/80 w/copay","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060004-00","Standard Gold Off Exchange Plan",,"0.817508578300476","No","Yes","No","100%",,"$1,900","$70","$1,080","$0","$1,000","$560","$140","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","10"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060004","Gold 1000/80 w/copay","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060004-01","Standard Gold On Exchange Plan",,"0.817508578300476","No","Yes","No","100%",,"$1,900","$70","$1,080","$0","$1,000","$560","$140","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","11"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050006","Gold 2000/80  w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050006-03","Limited Cost Sharing Plan Variation",,"0.792689323425293","No","Yes","No","100%",,"$2,900","$80","$880","$0","$1,700","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Gold-2000-80-copay-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","11"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050034","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050034-00","Standard Silver Off Exchange Plan",,"0.686924338340759","No","Yes","No","100%",,"$4,900","$100","$480","$0","$1,700","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-4000-80-copay2.pdf","https://www.healthtradition.com/brochures-for-individuals","12"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060013","Silver 2500/80 w/copay","47342WI006","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060013-00","Standard Silver Off Exchange Plan",,"0.718373954296112","No","Yes","No","100%",,"$3,400","$70","$1,170","$0","$1,700","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","12"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060013","Silver 2500/80 w/copay","47342WI006","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060013-01","Standard Silver On Exchange Plan",,"0.718373954296112","No","Yes","No","100%",,"$3,400","$70","$1,170","$0","$1,700","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","13"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050034","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050034-01","Standard Silver On Exchange Plan",,"0.686924338340759","No","Yes","No","100%",,"$4,900","$100","$480","$0","$1,700","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-4000-80-copay2.pdf","https://www.healthtradition.com/brochures-for-individuals","13"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050034","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050034-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-4000-80-copay-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","14"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060014","Silver 2500/80 w/copay","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060014-00","Standard Silver Off Exchange Plan",,"0.718373954296112","No","Yes","No","100%",,"$3,400","$70","$1,170","$0","$1,700","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","14"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060014","Silver 2500/80 w/copay","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060014-01","Standard Silver On Exchange Plan",,"0.718373954296112","No","Yes","No","100%",,"$3,400","$70","$1,170","$0","$1,700","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","15"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050034","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050034-03","Limited Cost Sharing Plan Variation",,"0.686924338340759","No","Yes","No","100%",,"$4,900","$100","$480","$0","$1,700","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-4000-80-copay-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","15"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050034","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050034-04","73% AV Level Silver Plan",,"0.729770600795746","No","Yes","No","100%",,"$4,150","$100","$630","$0","$1,700","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-4000-80-Copay-73.pdf","https://www.healthtradition.com/brochures-for-individuals","16"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060034","Silver 1500/70 w/copay","47342WI006","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060034-00","Standard Silver Off Exchange Plan",,"0.708445489406586","No","Yes","No","100%",,"$2,400","$140","$1,470","$0","$1,500","$860","$60","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","16"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060034","Silver 1500/70 w/copay","47342WI006","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060034-01","Standard Silver On Exchange Plan",,"0.708445489406586","No","Yes","No","100%",,"$2,400","$140","$1,470","$0","$1,500","$860","$60","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","17"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050034","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050034-05","87% AV Level Silver Plan",,"0.877675116062164","No","Yes","No","100%",,"$1,900","$70","$430","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-4000-80-Copay-87.pdf","https://www.healthtradition.com/brochures-for-individuals","17"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050034","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050034-06","94% AV Level Silver Plan",,"0.937322735786438","No","Yes","No","100%",,"$600","$40","$480","$0","$300","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-4000-80-Copay94.pdf","https://www.healthtradition.com/brochures-for-individuals","18"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060035","Silver 1500/70 w/copay","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060035-00","Standard Silver Off Exchange Plan",,"0.708445489406586","No","Yes","No","100%",,"$2,400","$140","$1,470","$0","$1,500","$860","$60","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","18"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060035","Silver 1500/70 w/copay","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060035-01","Standard Silver On Exchange Plan",,"0.708445489406586","No","Yes","No","100%",,"$2,400","$140","$1,470","$0","$1,500","$860","$60","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","19"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050035","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050035-00","Standard Silver Off Exchange Plan",,"0.686924338340759","No","Yes","No","100%",,"$4,900","$100","$480","$0","$1,700","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-4000-80-copay2.pdf","https://www.healthtradition.com/brochures-for-individuals","19"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050035","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050035-01","Standard Silver On Exchange Plan",,"0.686924338340759","No","Yes","No","100%",,"$4,900","$100","$480","$0","$1,700","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-4000-80-copay2.pdf","https://www.healthtradition.com/brochures-for-individuals","20"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050035","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050035-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-4000-80-copay-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","21"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050035","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050035-03","Limited Cost Sharing Plan Variation",,"0.686924338340759","No","Yes","No","100%",,"$4,900","$100","$480","$0","$1,700","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-4000-80-copay-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","22"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050035","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050035-04","73% AV Level Silver Plan",,"0.729770600795746","No","Yes","No","100%",,"$4,150","$100","$630","$0","$1,700","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-4000-80-Copay-73.pdf","https://www.healthtradition.com/brochures-for-individuals","23"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050035","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050035-05","87% AV Level Silver Plan",,"0.877675116062164","No","Yes","No","100%",,"$1,900","$70","$430","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-4000-80-Copay-87.pdf","https://www.healthtradition.com/brochures-for-individuals","24"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050035","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050035-06","94% AV Level Silver Plan",,"0.937322735786438","No","Yes","No","100%",,"$600","$40","$480","$0","$300","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-4000-80-Copay94.pdf","https://www.healthtradition.com/brochures-for-individuals","25"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050051","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","2","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050051-00","Standard Silver Off Exchange Plan",,"0.695462703704834","No","Yes","No","100%",,"$3,900","$100","$1,020","$0","$1,700","$765","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-3000-70-copay-2-free1.pdf","https://www.healthtradition.com/brochures-for-individuals","26"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050051","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","2","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050051-01","Standard Silver On Exchange Plan",,"0.695462703704834","No","Yes","No","100%",,"$3,900","$100","$1,020","$0","$1,700","$765","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-3000-70-copay-2-free1.pdf","https://www.healthtradition.com/brochures-for-individuals","27"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050051","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","2","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050051-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-3000-70-copay-2-free-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","28"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050051","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","2","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050051-03","Limited Cost Sharing Plan Variation",,"0.695462703704834","No","Yes","No","100%",,"$3,900","$100","$1,020","$0","$1,700","$765","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-3000-70-copay-2-free-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","29"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050051","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","2","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050051-04","73% AV Level Silver Plan",,"0.722660481929779","No","Yes","No","100%",,"$2,900","$100","$1,320","$0","$1,700","$765","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-3000-70-Copay-73.pdf","https://www.healthtradition.com/brochures-for-individuals","30"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050051","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","2","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050051-05","87% AV Level Silver Plan",,"0.865416586399078","No","Yes","No","100%",,"$1,600","$80","$640","$0","$800","$520","$180","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-3000-70-Copay-87.pdf","https://www.healthtradition.com/brochures-for-individuals","31"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050051","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","2","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050051-06","94% AV Level Silver Plan",,"0.947306454181671","No","Yes","No","100%",,"$700","$70","$290","$0","$350","$0","$250","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-3000-70-Copay94.pdf","https://www.healthtradition.com/brochures-for-individuals","32"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050050","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","2","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050050-00","Standard Silver Off Exchange Plan",,"0.695462703704834","No","Yes","No","100%",,"$3,900","$100","$1,020","$0","$1,700","$765","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-3000-70-copay-2-free1.pdf","https://www.healthtradition.com/brochures-for-individuals","33"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050050","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","2","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050050-01","Standard Silver On Exchange Plan",,"0.695462703704834","No","Yes","No","100%",,"$3,900","$100","$1,020","$0","$1,700","$765","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-3000-70-copay-2-free1.pdf","https://www.healthtradition.com/brochures-for-individuals","34"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050050","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","2","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050050-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-3000-70-copay-2-free-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","35"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050050","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","2","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050050-03","Limited Cost Sharing Plan Variation",,"0.695462703704834","No","Yes","No","100%",,"$3,900","$100","$1,020","$0","$1,700","$765","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-3000-70-copay-2-free-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","36"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050050","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","2","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050050-04","73% AV Level Silver Plan",,"0.722660481929779","No","Yes","No","100%",,"$2,900","$100","$1,320","$0","$1,700","$765","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-3000-70-Copay-73.pdf","https://www.healthtradition.com/brochures-for-individuals","37"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050050","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","2","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050050-05","87% AV Level Silver Plan",,"0.865416586399078","No","Yes","No","100%",,"$1,600","$80","$640","$0","$800","$520","$180","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-3000-70-Copay-87.pdf","https://www.healthtradition.com/brochures-for-individuals","38"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050050","Silver 3000/70 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","2","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050050-06","94% AV Level Silver Plan",,"0.947306454181671","No","Yes","No","100%",,"$700","$70","$290","$0","$350","$0","$250","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-3000-70-Copay94.pdf","https://www.healthtradition.com/brochures-for-individuals","39"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050055","Silver 3500","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050055-00","Standard Silver Off Exchange Plan",,"0.699543535709381","No","Yes","No","100%",,"$4,600","$0","$0","$0","$1,900","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-3500.pdf","https://www.healthtradition.com/brochures-for-individuals","40"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050055","Silver 3500","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050055-01","Standard Silver On Exchange Plan",,"0.699543535709381","No","Yes","No","100%",,"$4,600","$0","$0","$0","$1,900","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-3500.pdf","https://www.healthtradition.com/brochures-for-individuals","41"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050055","Silver 3500","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050055-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-3500-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","42"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050055","Silver 3500","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050055-03","Limited Cost Sharing Plan Variation",,"0.699543535709381","No","Yes","No","100%",,"$4,600","$0","$0","$0","$1,900","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-3500-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","43"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050055","Silver 3500","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050055-04","73% AV Level Silver Plan",,"0.730722427368164","No","Yes","No","100%",,"$4,100","$0","$0","$0","$1,900","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-3500-73.pdf","https://www.healthtradition.com/brochures-for-individuals","44"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050055","Silver 3500","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050055-05","87% AV Level Silver Plan",,"0.865882933139801","No","Yes","No","100%",,"$1,975","$0","$0","$0","$1,075","$425","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-3500-87.pdf","https://www.healthtradition.com/brochures-for-individuals","45"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050055","Silver 3500","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050055-06","94% AV Level Silver Plan",,"0.942316114902496","No","Yes","No","100%",,"$800","$20","$0","$0","$400","$150","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-3500-94.pdf","https://www.healthtradition.com/brochures-for-individuals","46"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050054","Silver 3500","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050054-00","Standard Silver Off Exchange Plan",,"0.699543535709381","No","Yes","No","100%",,"$4,600","$0","$0","$0","$1,900","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-3500.pdf","https://www.healthtradition.com/brochures-for-individuals","47"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050054","Silver 3500","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050054-01","Standard Silver On Exchange Plan",,"0.699543535709381","No","Yes","No","100%",,"$4,600","$0","$0","$0","$1,900","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-3500.pdf","https://www.healthtradition.com/brochures-for-individuals","48"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050054","Silver 3500","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050054-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-3500-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","49"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050054","Silver 3500","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050054-03","Limited Cost Sharing Plan Variation",,"0.699543535709381","No","Yes","No","100%",,"$4,600","$0","$0","$0","$1,900","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-3500-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","50"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050054","Silver 3500","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050054-04","73% AV Level Silver Plan",,"0.730722427368164","No","Yes","No","100%",,"$4,100","$0","$0","$0","$1,900","$560","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-3500-73.pdf","https://www.healthtradition.com/brochures-for-individuals","51"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050054","Silver 3500","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050054-05","87% AV Level Silver Plan",,"0.865882933139801","No","Yes","No","100%",,"$1,975","$0","$0","$0","$1,075","$425","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$150 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-3500-87.pdf","https://www.healthtradition.com/brochures-for-individuals","52"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","1","47342","WI","Individual","No","39-1545987","47342WI0050054","Silver 3500","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050054-06","94% AV Level Silver Plan",,"0.942316114902496","No","Yes","No","100%",,"$800","$20","$0","$0","$400","$150","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-3500-94.pdf","https://www.healthtradition.com/brochures-for-individuals","53"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050003","Gold 1000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050003-00","Standard Gold Off Exchange Plan",,"0.781743824481964","No","Yes","No","100%",,"$1,900","$80","$1,080","$0","$1,000","$485","$140","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Gold-1000-802.pdf","https://www.healthtradition.com/brochures-for-individuals","4"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060017","Silver HDHP 90","47342WI006","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060017-00","Standard Silver Off Exchange Plan",,"0.702123284339905","Yes","Yes","No","100%",,"$3,900","$20","$360","$0","$3,000","$0","$230","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","4"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060017","Silver HDHP 90","47342WI006","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060017-01","Standard Silver On Exchange Plan",,"0.702123284339905","Yes","Yes","No","100%",,"$3,900","$20","$360","$0","$3,000","$0","$230","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","5"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050003","Gold 1000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050003-01","Standard Gold On Exchange Plan",,"0.781743824481964","No","Yes","No","100%",,"$1,900","$80","$1,080","$0","$1,000","$485","$140","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Gold-1000-802.pdf","https://www.healthtradition.com/brochures-for-individuals","5"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050003","Gold 1000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Gold-1000-80-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","6"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060018","Silver HDHP 90","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060018-00","Standard Silver Off Exchange Plan",,"0.702123284339905","Yes","Yes","No","100%",,"$3,900","$20","$360","$0","$3,000","$0","$230","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","6"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060018","Silver HDHP 90","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060018-01","Standard Silver On Exchange Plan",,"0.702123284339905","Yes","Yes","No","100%",,"$3,900","$20","$360","$0","$3,000","$0","$230","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","7"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050003","Gold 1000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050003-03","Limited Cost Sharing Plan Variation",,"0.781743824481964","No","Yes","No","100%",,"$1,900","$80","$1,080","$0","$1,000","$485","$140","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Gold-1000-80-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","7"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050004","Gold 1000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050004-00","Standard Gold Off Exchange Plan",,"0.781743824481964","No","Yes","No","100%",,"$1,900","$80","$1,080","$0","$1,000","$485","$140","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Gold-1000-802.pdf","https://www.healthtradition.com/brochures-for-individuals","8"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060046","Silver HDHP 100","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060046-00","Standard Silver Off Exchange Plan",,"0.680907964706421","Yes","Yes","No","100%",,"$5,025","$0","$0","$0","$4,125","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","8"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060046","Silver HDHP 100","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060046-01","Standard Silver On Exchange Plan",,"0.680907964706421","Yes","Yes","No","100%",,"$5,025","$0","$0","$0","$4,125","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","9"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050004","Gold 1000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050004-01","Standard Gold On Exchange Plan",,"0.781743824481964","No","Yes","No","100%",,"$1,900","$80","$1,080","$0","$1,000","$485","$140","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Gold-1000-802.pdf","https://www.healthtradition.com/brochures-for-individuals","9"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050004","Gold 1000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Gold-1000-80-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","10"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060049","Bronze HDHP 80","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060049-00","Standard Bronze Off Exchange Plan",,"0.614920496940613","Yes","Yes","No","100%",,"$5,900","$40","$280","$0","$5,000","$0","$60","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","10"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060049","Bronze HDHP 80","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060049-01","Standard Bronze On Exchange Plan",,"0.614920496940613","Yes","Yes","No","100%",,"$5,900","$40","$280","$0","$5,000","$0","$60","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","11"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050004","Gold 1000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050004-03","Limited Cost Sharing Plan Variation",,"0.781743824481964","No","Yes","No","100%",,"$1,900","$80","$1,080","$0","$1,000","$485","$140","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Gold-1000-80-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","11"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060048","Bronze HDHP 80","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060048-00","Standard Bronze Off Exchange Plan",,"0.614920496940613","Yes","Yes","No","100%",,"$5,900","$40","$280","$0","$5,000","$0","$60","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","12"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050049","Gold 2375/100","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050049-00","Standard Gold Off Exchange Plan",,"0.780349254608154","Yes","Yes","No","100%",,"$3,275","$0","$0","$0","$2,375","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,375","$2375 per person","$4750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,375","$2375 per person","$4750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Gold-2375-100.pdf","https://www.healthtradition.com/brochures-for-individuals","12"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050049","Gold 2375/100","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050049-01","Standard Gold On Exchange Plan",,"0.780349254608154","Yes","Yes","No","100%",,"$3,275","$0","$0","$0","$2,375","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,375","$2375 per person","$4750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,375","$2375 per person","$4750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Gold-2375-100.pdf","https://www.healthtradition.com/brochures-for-individuals","13"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060048","Bronze HDHP 80","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060048-01","Standard Bronze On Exchange Plan",,"0.614920496940613","Yes","Yes","No","100%",,"$5,900","$40","$280","$0","$5,000","$0","$60","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","13"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060011","Bronze HDHP 60","47342WI006","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060011-00","Standard Bronze Off Exchange Plan",,"0.616620361804962","Yes","Yes","No","100%",,"$4,900","$80","$960","$0","$4,000","$0","$520","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","14"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050049","Gold 2375/100","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050049-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Gold-2375-100-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","14"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050049","Gold 2375/100","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050049-03","Limited Cost Sharing Plan Variation",,"0.780349254608154","Yes","Yes","No","100%",,"$3,275","$0","$0","$0","$2,375","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,375","$2375 per person","$4750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,375","$2375 per person","$4750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Gold-2375-100-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","15"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060011","Bronze HDHP 60","47342WI006","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060011-01","Standard Bronze On Exchange Plan",,"0.616620361804962","Yes","Yes","No","100%",,"$4,900","$80","$960","$0","$4,000","$0","$520","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","15"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060012","Bronze HDHP 60","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060012-00","Standard Bronze Off Exchange Plan",,"0.616620361804962","Yes","Yes","No","100%",,"$4,900","$80","$960","$0","$4,000","$0","$520","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","16"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050048","Gold 2375/100","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050048-00","Standard Gold Off Exchange Plan",,"0.780349254608154","Yes","Yes","No","100%",,"$3,275","$0","$0","$0","$2,375","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,375","$2375 per person","$4750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,375","$2375 per person","$4750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Gold-2375-100.pdf","https://www.healthtradition.com/brochures-for-individuals","16"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050048","Gold 2375/100","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050048-01","Standard Gold On Exchange Plan",,"0.780349254608154","Yes","Yes","No","100%",,"$3,275","$0","$0","$0","$2,375","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,375","$2375 per person","$4750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,375","$2375 per person","$4750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Gold-2375-100.pdf","https://www.healthtradition.com/brochures-for-individuals","17"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060012","Bronze HDHP 60","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060012-01","Standard Bronze On Exchange Plan",,"0.616620361804962","Yes","Yes","No","100%",,"$4,900","$80","$960","$0","$4,000","$0","$520","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","17"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060051","Bronze HDHP 50","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060051-00","Standard Bronze Off Exchange Plan",,"0.618300259113312","Yes","Yes","No","100%",,"$4,400","$100","$1,450","$0","$3,500","$0","$900","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","18"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050048","Gold 2375/100","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050048-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Gold-2375-100-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","18"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050048","Gold 2375/100","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050048-03","Limited Cost Sharing Plan Variation",,"0.780349254608154","Yes","Yes","No","100%",,"$3,275","$0","$0","$0","$2,375","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,375","$2375 per person","$4750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,375","$2375 per person","$4750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Gold-2375-100-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","19"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060051","Bronze HDHP 50","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060051-01","Standard Bronze On Exchange Plan",,"0.618300259113312","Yes","Yes","No","100%",,"$4,400","$100","$1,450","$0","$3,500","$0","$900","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","19"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060050","Bronze HDHP 50","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060050-00","Standard Bronze Off Exchange Plan",,"0.618300259113312","Yes","Yes","No","100%",,"$4,400","$100","$1,450","$0","$3,500","$0","$900","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","20"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050031","Silver 2000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050031-00","Standard Silver Off Exchange Plan",,"0.700861513614655","No","Yes","No","100%",,"$2,900","$140","$880","$0","$2,000","$500","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-2000-802.pdf","https://www.healthtradition.com/brochures-for-individuals","20"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050031","Silver 2000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050031-01","Standard Silver On Exchange Plan",,"0.700861513614655","No","Yes","No","100%",,"$2,900","$140","$880","$0","$2,000","$500","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-2000-802.pdf","https://www.healthtradition.com/brochures-for-individuals","21"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060050","Bronze HDHP 50","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060050-01","Standard Bronze On Exchange Plan",,"0.618300259113312","Yes","Yes","No","100%",,"$4,400","$100","$1,450","$0","$3,500","$0","$900","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","21"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060047","Silver HDHP 100","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060047-00","Standard Silver Off Exchange Plan",,"0.680907964706421","Yes","Yes","No","100%",,"$5,025","$0","$0","$0","$4,125","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","22"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050031","Silver 2000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050031-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-2000-80-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","22"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050031","Silver 2000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050031-03","Limited Cost Sharing Plan Variation",,"0.700861513614655","No","Yes","No","100%",,"$2,900","$140","$880","$0","$2,000","$500","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-2000-80-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","23"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060047","Silver HDHP 100","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060047-01","Standard Silver On Exchange Plan",,"0.680907964706421","Yes","Yes","No","100%",,"$5,025","$0","$0","$0","$4,125","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","23"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050031","Silver 2000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050031-04","73% AV Level Silver Plan",,"0.720963180065155","No","Yes","No","100%",,"$2,900","$140","$860","$0","$2,000","$500","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-2000-80-73.pdf","https://www.healthtradition.com/brochures-for-individuals","24"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050031","Silver 2000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050031-05","87% AV Level Silver Plan",,"0.873857855796814","No","Yes","No","100%",,"$1,600","$100","$320","$0","$800","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-2000-80-87.pdf","https://www.healthtradition.com/brochures-for-individuals","25"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050031","Silver 2000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050031-06","94% AV Level Silver Plan",,"0.938887000083923","No","Yes","No","100%",,"$500","$70","$360","$0","$250","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-2000-80-94.pdf","https://www.healthtradition.com/brochures-for-individuals","26"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050032","Silver 2000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050032-00","Standard Silver Off Exchange Plan",,"0.700861513614655","No","Yes","No","100%",,"$2,900","$140","$880","$0","$2,000","$500","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-2000-802.pdf","https://www.healthtradition.com/brochures-for-individuals","27"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050032","Silver 2000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050032-01","Standard Silver On Exchange Plan",,"0.700861513614655","No","Yes","No","100%",,"$2,900","$140","$880","$0","$2,000","$500","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-2000-802.pdf","https://www.healthtradition.com/brochures-for-individuals","28"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050032","Silver 2000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050032-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-2000-80-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","29"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050032","Silver 2000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050032-03","Limited Cost Sharing Plan Variation",,"0.700861513614655","No","Yes","No","100%",,"$2,900","$140","$880","$0","$2,000","$500","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-2000-80-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","30"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050032","Silver 2000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050032-04","73% AV Level Silver Plan",,"0.720963180065155","No","Yes","No","100%",,"$2,900","$140","$860","$0","$2,000","$500","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-2000-80-73.pdf","https://www.healthtradition.com/brochures-for-individuals","31"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050032","Silver 2000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050032-05","87% AV Level Silver Plan",,"0.873857855796814","No","Yes","No","100%",,"$1,600","$100","$320","$0","$800","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-2000-80-87.pdf","https://www.healthtradition.com/brochures-for-individuals","32"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050032","Silver 2000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050032-06","94% AV Level Silver Plan",,"0.938887000083923","No","Yes","No","100%",,"$500","$70","$360","$0","$250","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-2000-80-94.pdf","https://www.healthtradition.com/brochures-for-individuals","33"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050015","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050015-00","Standard Bronze Off Exchange Plan",,"0.594148576259613","No","Yes","No","100%",,"$6,900","$200","$80","$0","$2,400","$580","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Bronze-6000-802.pdf","https://www.healthtradition.com/brochures-for-individuals","34"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050015","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050015-01","Standard Bronze On Exchange Plan",,"0.594148576259613","No","Yes","No","100%",,"$6,900","$200","$80","$0","$2,400","$580","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Bronze-6000-802.pdf","https://www.healthtradition.com/brochures-for-individuals","35"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050015","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050015-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-6000-80-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","36"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050015","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050015-03","Limited Cost Sharing Plan Variation",,"0.594148576259613","No","Yes","No","100%",,"$6,900","$200","$80","$0","$2,400","$580","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-6000-80-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","37"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050016","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050016-00","Standard Bronze Off Exchange Plan",,"0.594148576259613","No","Yes","No","100%",,"$6,900","$200","$80","$0","$2,400","$580","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Bronze-6000-802.pdf","https://www.healthtradition.com/brochures-for-individuals","38"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050016","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050016-01","Standard Bronze On Exchange Plan",,"0.594148576259613","No","Yes","No","100%",,"$6,900","$200","$80","$0","$2,400","$580","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Bronze-6000-802.pdf","https://www.healthtradition.com/brochures-for-individuals","39"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050016","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050016-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-6000-80-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","40"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050016","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050016-03","Limited Cost Sharing Plan Variation",,"0.594148576259613","No","Yes","No","100%",,"$6,900","$200","$80","$0","$2,400","$580","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-6000-80-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","41"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050061","Bronze 6850/100 Rx","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050061-00","Standard Bronze Off Exchange Plan",,"0.593360364437103","No","Yes","No","100%",,"$7,300","$200","$0","$0","$2,400","$580","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/2016-Individual-Bronze-6850-100-RX-DEC.pdf","https://www.healthtradition.com/brochures-for-individuals","42"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050061","Bronze 6850/100 Rx","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050061-01","Standard Bronze On Exchange Plan",,"0.593360364437103","No","Yes","No","100%",,"$7,300","$200","$0","$0","$2,400","$580","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/2016-Individual-Bronze-6850-100-RX-DEC.pdf","https://www.healthtradition.com/brochures-for-individuals","43"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050061","Bronze 6850/100 Rx","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050061-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-6850-100-RX-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","44"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050061","Bronze 6850/100 Rx","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050061-03","Limited Cost Sharing Plan Variation",,"0.593360364437103","No","Yes","No","100%",,"$7,300","$200","$0","$0","$2,400","$580","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-6850-100-RX-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","45"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050060","Bronze 6850/100 Rx","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050060-00","Standard Bronze Off Exchange Plan",,"0.593360364437103","No","Yes","No","100%",,"$7,300","$200","$0","$0","$2,400","$580","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/2016-Individual-Bronze-6850-100-RX-DEC.pdf","https://www.healthtradition.com/brochures-for-individuals","46"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050060","Bronze 6850/100 Rx","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050060-01","Standard Bronze On Exchange Plan",,"0.593360364437103","No","Yes","No","100%",,"$7,300","$200","$0","$0","$2,400","$580","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/2016-Individual-Bronze-6850-100-RX-DEC.pdf","https://www.healthtradition.com/brochures-for-individuals","47"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050060","Bronze 6850/100 Rx","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050060-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-6850-100-RX-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","48"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050060","Bronze 6850/100 Rx","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050060-03","Limited Cost Sharing Plan Variation",,"0.593360364437103","No","Yes","No","100%",,"$7,300","$200","$0","$0","$2,400","$580","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-6850-100-RX-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","49"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050063","Bronze 6850/100","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050063-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Bronze-6850-100.pdf","https://www.healthtradition.com/brochures-for-individuals","50"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050063","Bronze 6850/100","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050063-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Bronze-6850-100.pdf","https://www.healthtradition.com/brochures-for-individuals","51"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050063","Bronze 6850/100","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050063-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-6850-100-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","52"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050063","Bronze 6850/100","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050063-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-6850-100-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","53"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050062","Bronze 6850/100","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050062-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Bronze-6850-100.pdf","https://www.healthtradition.com/brochures-for-individuals","54"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050062","Bronze 6850/100","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050062-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Bronze-6850-100.pdf","https://www.healthtradition.com/brochures-for-individuals","55"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050062","Bronze 6850/100","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050062-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-6850-100-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","56"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","2","47342","WI","Individual","No","39-1545987","47342WI0050062","Bronze 6850/100","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050062-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-6850-100-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","57"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050053","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050053-00","Standard Silver Off Exchange Plan",,"0.680907964706421","Yes","Yes","No","100%",,"$5,025","$0","$0","$0","$4,125","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-HDHP-100.pdf","https://www.healthtradition.com/brochures-for-individuals","4"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060005","Gold 1000/80","47342WI006","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060005-00","Standard Gold Off Exchange Plan",,"0.814939737319946","No","Yes","No","100%",,"$1,900","$70","$1,080","$0","$1,000","$435","$280","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","4"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060005","Gold 1000/80","47342WI006","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060005-01","Standard Gold On Exchange Plan",,"0.814939737319946","No","Yes","No","100%",,"$1,900","$70","$1,080","$0","$1,000","$435","$280","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","5"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050053","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050053-01","Standard Silver On Exchange Plan",,"0.680907964706421","Yes","Yes","No","100%",,"$5,025","$0","$0","$0","$4,125","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-HDHP-100.pdf","https://www.healthtradition.com/brochures-for-individuals","5"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050053","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050053-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-HDHP-100-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","6"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060006","Gold 1000/80","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060006-00","Standard Gold Off Exchange Plan",,"0.814939737319946","No","Yes","No","100%",,"$1,900","$70","$1,080","$0","$1,000","$435","$280","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","6"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060006","Gold 1000/80","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060006-01","Standard Gold On Exchange Plan",,"0.814939737319946","No","Yes","No","100%",,"$1,900","$70","$1,080","$0","$1,000","$435","$280","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","7"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050053","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050053-03","Limited Cost Sharing Plan Variation",,"0.680907964706421","Yes","Yes","No","100%",,"$5,025","$0","$0","$0","$4,125","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-HDHP-100-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","7"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050053","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050053-04","73% AV Level Silver Plan",,"0.724917531013489","Yes","Yes","No","100%",,"$4,150","$0","$0","$0","$3,250","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-HDHP-100-73.pdf","https://www.healthtradition.com/brochures-for-individuals","8"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060009","Silver 2000/70","47342WI006","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060009-00","Standard Silver Off Exchange Plan",,"0.703603863716125","No","Yes","No","100%",,"$2,900","$70","$1,320","$0","$2,000","$435","$120","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","8"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060009","Silver 2000/70","47342WI006","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060009-01","Standard Silver On Exchange Plan",,"0.703603863716125","No","Yes","No","100%",,"$2,900","$70","$1,320","$0","$2,000","$435","$120","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","9"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050053","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050053-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$2,150","$0","$0","$0","$1,250","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-HDHP-100-87.pdf","https://www.healthtradition.com/brochures-for-individuals","9"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050053","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050053-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$1,000","$0","$0","$0","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-HDHP-100-94.pdf","https://www.healthtradition.com/brochures-for-individuals","10"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060010","Silver 2000/70","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060010-00","Standard Silver Off Exchange Plan",,"0.703603863716125","No","Yes","No","100%",,"$2,900","$70","$1,320","$0","$2,000","$435","$120","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","10"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060010","Silver 2000/70","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060010-01","Standard Silver On Exchange Plan",,"0.703603863716125","No","Yes","No","100%",,"$2,900","$70","$1,320","$0","$2,000","$435","$120","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","11"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050052","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050052-00","Standard Silver Off Exchange Plan",,"0.680907964706421","Yes","Yes","No","100%",,"$5,025","$0","$0","$0","$4,125","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-HDHP-100.pdf","https://www.healthtradition.com/brochures-for-individuals","11"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050052","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050052-01","Standard Silver On Exchange Plan",,"0.680907964706421","Yes","Yes","No","100%",,"$5,025","$0","$0","$0","$4,125","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-HDHP-100.pdf","https://www.healthtradition.com/brochures-for-individuals","12"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060053","Bronze 6000/80","47342WI006","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060053-00","Standard Bronze Off Exchange Plan",,"0.601341962814331","No","Yes","No","100%",,"$6,900","$120","$80","$0","$2,400","$435","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","12"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060053","Bronze 6000/80","47342WI006","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060053-01","Standard Bronze On Exchange Plan",,"0.601341962814331","No","Yes","No","100%",,"$6,900","$120","$80","$0","$2,400","$435","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","13"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050052","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050052-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-HDHP-100-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","13"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050052","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050052-03","Limited Cost Sharing Plan Variation",,"0.680907964706421","Yes","Yes","No","100%",,"$5,025","$0","$0","$0","$4,125","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,125","$4125 per person","$8250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-HDHP-100-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","14"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060052","Bronze 6000/80","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060052-00","Standard Bronze Off Exchange Plan",,"0.601341962814331","No","Yes","No","100%",,"$6,900","$120","$80","$0","$2,400","$435","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","14"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060052","Bronze 6000/80","47342WI006","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060052-01","Standard Bronze On Exchange Plan",,"0.601341962814331","No","Yes","No","100%",,"$6,900","$120","$80","$0","$2,400","$435","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","15"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050052","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050052-04","73% AV Level Silver Plan",,"0.724917531013489","Yes","Yes","No","100%",,"$4,150","$0","$0","$0","$3,250","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-HDHP-100-73.pdf","https://www.healthtradition.com/brochures-for-individuals","15"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050052","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050052-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$2,150","$0","$0","$0","$1,250","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-HDHP-100-87.pdf","https://www.healthtradition.com/brochures-for-individuals","16"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060041","Gold 2000/100","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060041-00","Standard Gold Off Exchange Plan",,"0.81625884771347","No","Yes","No","100%",,"$2,900","$0","$0","$0","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","16"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060041","Gold 2000/100","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060041-01","Standard Gold On Exchange Plan",,"0.81625884771347","No","Yes","No","100%",,"$2,900","$0","$0","$0","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","17"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050052","Silver HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050052-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$1,000","$0","$0","$0","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-HDHP-100-94.pdf","https://www.healthtradition.com/brochures-for-individuals","17"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060040","Gold 2000/100","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060040-00","Standard Gold Off Exchange Plan",,"0.81625884771347","No","Yes","No","100%",,"$2,900","$0","$0","$0","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","18"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050037","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050037-00","Standard Silver Off Exchange Plan",,"0.703783571720123","Yes","Yes","No","100%",,"$3,900","$20","$510","$0","$3,000","$0","$345","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-HDHP-852.pdf","https://www.healthtradition.com/brochures-for-individuals","18"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050037","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050037-01","Standard Silver On Exchange Plan",,"0.703783571720123","Yes","Yes","No","100%",,"$3,900","$20","$510","$0","$3,000","$0","$345","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-HDHP-852.pdf","https://www.healthtradition.com/brochures-for-individuals","19"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060040","Gold 2000/100","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060040-01","Standard Gold On Exchange Plan",,"0.81625884771347","No","Yes","No","100%",,"$2,900","$0","$0","$0","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","19"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060045","Silver 2000/80","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060045-00","Standard Silver Off Exchange Plan",,"0.713169574737549","No","Yes","No","100%",,"$2,900","$0","$920","$0","$2,000","$0","$660","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","20"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050037","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050037-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-HDHP-100-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","20"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050037","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050037-03","Limited Cost Sharing Plan Variation",,"0.703783571720123","Yes","Yes","No","100%",,"$3,900","$20","$510","$0","$3,000","$0","$345","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-HDHP-100-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","21"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060045","Silver 2000/80","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060045-01","Standard Silver On Exchange Plan",,"0.713169574737549","No","Yes","No","100%",,"$2,900","$0","$920","$0","$2,000","$0","$660","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","21"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060044","Silver 2000/80","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060044-00","Standard Silver Off Exchange Plan",,"0.713169574737549","No","Yes","No","100%",,"$2,900","$0","$920","$0","$2,000","$0","$660","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","22"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050037","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050037-04","73% AV Level Silver Plan",,"0.731655180454254","Yes","Yes","No","100%",,"$3,150","$20","$620","$0","$2,250","$0","$455","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-HDHP-85-73.pdf","https://www.healthtradition.com/brochures-for-individuals","22"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050037","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050037-05","87% AV Level Silver Plan",,"0.872887551784515","Yes","Yes","No","100%",,"$1,800","$20","$330","$0","$900","$0","$350","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-HDHP-85-87.pdf","https://www.healthtradition.com/brochures-for-individuals","23"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060044","Silver 2000/80","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060044-01","Standard Silver On Exchange Plan",,"0.713169574737549","No","Yes","No","100%",,"$2,900","$0","$920","$0","$2,000","$0","$660","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","23"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060042","Gold 2000/90","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060042-00","Standard Gold Off Exchange Plan",,"0.780028462409973","No","Yes","No","100%",,"$2,900","$120","$230","$0","$2,000","$350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","24"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050037","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050037-06","94% AV Level Silver Plan",,"0.938754558563232","Yes","Yes","No","100%",,"$500","$20","$425","$0","$250","$0","$350","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-HDHP-85-94.pdf","https://www.healthtradition.com/brochures-for-individuals","24"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050038","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050038-00","Standard Silver Off Exchange Plan",,"0.703783571720123","Yes","Yes","No","100%",,"$3,900","$20","$510","$0","$3,000","$0","$345","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-HDHP-852.pdf","https://www.healthtradition.com/brochures-for-individuals","25"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060042","Gold 2000/90","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060042-01","Standard Gold On Exchange Plan",,"0.780028462409973","No","Yes","No","100%",,"$2,900","$120","$230","$0","$2,000","$350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","25"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060043","Gold 2000/90","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060043-00","Standard Gold Off Exchange Plan",,"0.780028462409973","No","Yes","No","100%",,"$2,900","$120","$230","$0","$2,000","$350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","26"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050038","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050038-01","Standard Silver On Exchange Plan",,"0.703783571720123","Yes","Yes","No","100%",,"$3,900","$20","$510","$0","$3,000","$0","$345","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Silver-HDHP-852.pdf","https://www.healthtradition.com/brochures-for-individuals","26"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050038","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050038-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-HDHP-100-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","27"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060043","Gold 2000/90","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060043-01","Standard Gold On Exchange Plan",,"0.780028462409973","No","Yes","No","100%",,"$2,900","$120","$230","$0","$2,000","$350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","27"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050038","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050038-03","Limited Cost Sharing Plan Variation",,"0.703783571720123","Yes","Yes","No","100%",,"$3,900","$20","$510","$0","$3,000","$0","$345","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-HDHP-100-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","28"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060054","Bronze 6850/100","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060054-00","Standard Bronze Off Exchange Plan",,"0.618613183498383","No","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","28"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060054","Bronze 6850/100","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060054-01","Standard Bronze On Exchange Plan",,"0.618613183498383","No","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","29"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050038","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050038-04","73% AV Level Silver Plan",,"0.731655180454254","Yes","Yes","No","100%",,"$3,150","$20","$620","$0","$2,250","$0","$455","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-HDHP-85-73.pdf","https://www.healthtradition.com/brochures-for-individuals","29"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050038","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050038-05","87% AV Level Silver Plan",,"0.872887551784515","Yes","Yes","No","100%",,"$1,800","$20","$330","$0","$900","$0","$350","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-HDHP-85-87.pdf","https://www.healthtradition.com/brochures-for-individuals","30"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060055","Bronze 6850/100","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060055-00","Standard Bronze Off Exchange Plan",,"0.618613183498383","No","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","30"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060055","Bronze 6850/100","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No",,"https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0060055-01","Standard Bronze On Exchange Plan",,"0.618613183498383","No","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.healthtradition.com/coverage-summary-for-groups","http://www.healthtradition.com/brochures-for-groups","31"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050038","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050038-06","94% AV Level Silver Plan",,"0.938754558563232","Yes","Yes","No","100%",,"$500","$20","$425","$0","$250","$0","$350","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Silver-HDHP-85-94.pdf","https://www.healthtradition.com/brochures-for-individuals","31"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050013","Bronze HDHP 100 Low","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050013-00","Standard Bronze Off Exchange Plan",,"0.609101891517639","Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/2016-Individual-Bronze-HDHP-100-Low.pdf","https://www.healthtradition.com/brochures-for-individuals","32"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050013","Bronze HDHP 100 Low","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050013-01","Standard Bronze On Exchange Plan",,"0.609101891517639","Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/2016-Individual-Bronze-HDHP-100-Low.pdf","https://www.healthtradition.com/brochures-for-individuals","33"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050013","Bronze HDHP 100 Low","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-HDHP-100-Low-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","34"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050013","Bronze HDHP 100 Low","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050013-03","Limited Cost Sharing Plan Variation",,"0.609101891517639","Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-HDHP-100-Low-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","35"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050014","Bronze HDHP 100 Low","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050014-00","Standard Bronze Off Exchange Plan",,"0.609101891517639","Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/2016-Individual-Bronze-HDHP-100-Low.pdf","https://www.healthtradition.com/brochures-for-individuals","36"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050014","Bronze HDHP 100 Low","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050014-01","Standard Bronze On Exchange Plan",,"0.609101891517639","Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/2016-Individual-Bronze-HDHP-100-Low.pdf","https://www.healthtradition.com/brochures-for-individuals","37"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050014","Bronze HDHP 100 Low","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-HDHP-100-Low-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","38"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050014","Bronze HDHP 100 Low","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050014-03","Limited Cost Sharing Plan Variation",,"0.609101891517639","Yes","Yes","No","100%",,"$7,150","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-HDHP-100-Low-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","39"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050017","Bronze HDHP 100 High","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050017-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/2016-Individual-Bronze-HDHP-100-High.pdf","https://www.healthtradition.com/brochures-for-individuals","40"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050017","Bronze HDHP 100 High","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050017-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/2016-Individual-Bronze-HDHP-100-High.pdf","https://www.healthtradition.com/brochures-for-individuals","41"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050017","Bronze HDHP 100 High","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-HDHP-100-High-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","42"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050017","Bronze HDHP 100 High","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050017-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-HDHP-100-High-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","43"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050018","Bronze HDHP 100 High","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050018-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/2016-Individual-Bronze-HDHP-100-High.pdf","https://www.healthtradition.com/brochures-for-individuals","44"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050018","Bronze HDHP 100 High","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050018-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/2016-Individual-Bronze-HDHP-100-High.pdf","https://www.healthtradition.com/brochures-for-individuals","45"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050018","Bronze HDHP 100 High","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-HDHP-100-High-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","46"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050018","Bronze HDHP 100 High","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050018-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$7,350","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-HDHP-100-High-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","47"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050057","Bronze HDHP 80","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050057-00","Standard Bronze Off Exchange Plan",,"0.6140016913414","Yes","Yes","No","100%",,"$5,900","$40","$280","$0","$5,000","$0","$60","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Bronze-HDHP-80.pdf","https://www.healthtradition.com/brochures-for-individuals","48"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050057","Bronze HDHP 80","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050057-01","Standard Bronze On Exchange Plan",,"0.6140016913414","Yes","Yes","No","100%",,"$5,900","$40","$280","$0","$5,000","$0","$60","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Bronze-HDHP-80.pdf","https://www.healthtradition.com/brochures-for-individuals","49"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050057","Bronze HDHP 80","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050057-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-HDHP-80-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","50"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","3","47342","WI","Individual","No","39-1545987","47342WI0050057","Bronze HDHP 80","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050057-03","Limited Cost Sharing Plan Variation",,"0.6140016913414","Yes","Yes","No","100%",,"$5,900","$40","$280","$0","$5,000","$0","$60","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-HDHP-80-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","51"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","4","47342","WI","Individual","No","39-1545987","47342WI0050056","Bronze HDHP 80","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050056-00","Standard Bronze Off Exchange Plan",,"0.6140016913414","Yes","Yes","No","100%",,"$5,900","$40","$280","$0","$5,000","$0","$60","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Bronze-HDHP-80.pdf","https://www.healthtradition.com/brochures-for-individuals","4"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","4","47342","WI","Individual","No","39-1545987","47342WI0050056","Bronze HDHP 80","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050056-01","Standard Bronze On Exchange Plan",,"0.6140016913414","Yes","Yes","No","100%",,"$5,900","$40","$280","$0","$5,000","$0","$60","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Bronze-HDHP-80.pdf","https://www.healthtradition.com/brochures-for-individuals","5"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","4","47342","WI","Individual","No","39-1545987","47342WI0050056","Bronze HDHP 80","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050056-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-HDHP-80-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","6"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","4","47342","WI","Individual","No","39-1545987","47342WI0050056","Bronze HDHP 80","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050056-03","Limited Cost Sharing Plan Variation",,"0.6140016913414","Yes","Yes","No","100%",,"$5,900","$40","$280","$0","$5,000","$0","$60","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-HDHP-80-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","7"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","4","47342","WI","Individual","No","39-1545987","47342WI0050059","Bronze HDHP 50","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050059-00","Standard Bronze Off Exchange Plan",,"0.618300259113312","Yes","Yes","No","100%",,"$4,400","$100","$1,450","$0","$3,500","$0","$360","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Bronze-HDHP-50.pdf","https://www.healthtradition.com/brochures-for-individuals","8"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","4","47342","WI","Individual","No","39-1545987","47342WI0050059","Bronze HDHP 50","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050059-01","Standard Bronze On Exchange Plan",,"0.618300259113312","Yes","Yes","No","100%",,"$4,400","$100","$1,450","$0","$3,500","$0","$360","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Bronze-HDHP-50.pdf","https://www.healthtradition.com/brochures-for-individuals","9"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","4","47342","WI","Individual","No","39-1545987","47342WI0050059","Bronze HDHP 50","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050059-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-HDHP-50-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","10"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","4","47342","WI","Individual","No","39-1545987","47342WI0050059","Bronze HDHP 50","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050059-03","Limited Cost Sharing Plan Variation",,"0.618300259113312","Yes","Yes","No","100%",,"$4,400","$100","$1,450","$0","$3,500","$0","$360","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-HDHP-50-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","11"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","4","47342","WI","Individual","No","39-1545987","47342WI0050058","Bronze HDHP 50","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050058-00","Standard Bronze Off Exchange Plan",,"0.618300259113312","Yes","Yes","No","100%",,"$4,400","$100","$1,450","$0","$3,500","$0","$360","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Bronze-HDHP-50.pdf","https://www.healthtradition.com/brochures-for-individuals","12"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","4","47342","WI","Individual","No","39-1545987","47342WI0050058","Bronze HDHP 50","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050058-01","Standard Bronze On Exchange Plan",,"0.618300259113312","Yes","Yes","No","100%",,"$4,400","$100","$1,450","$0","$3,500","$0","$360","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.healthtradition.com/wp-content/uploads/2013/10/Individual-Bronze-HDHP-50.pdf","https://www.healthtradition.com/brochures-for-individuals","13"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","4","47342","WI","Individual","No","39-1545987","47342WI0050058","Bronze HDHP 50","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050058-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-HDHP-50-Zero.pdf","https://www.healthtradition.com/brochures-for-individuals","14"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","4","47342","WI","Individual","No","39-1545987","47342WI0050058","Bronze HDHP 50","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050058-03","Limited Cost Sharing Plan Variation",,"0.618300259113312","Yes","Yes","No","100%",,"$4,400","$100","$1,450","$0","$3,500","$0","$360","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/Individual-Bronze-HDHP-50-Limited.pdf","https://www.healthtradition.com/brochures-for-individuals","15"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","4","47342","WI","Individual","No","39-1545987","47342WI0050019","Essential HDHP","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050019-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/2016-Individual-Essential.pdf","https://www.healthtradition.com/brochures-for-individuals","16"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","4","47342","WI","Individual","No","39-1545987","47342WI0050019","Essential HDHP","47342WI005","7720081950","WIN001","WIS001","WIF001","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050019-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/2016-Individual-Essential.pdf","https://www.healthtradition.com/brochures-for-individuals","17"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","4","47342","WI","Individual","No","39-1545987","47342WI0050020","Essential HDHP","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050020-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/2016-Individual-Essential.pdf","https://www.healthtradition.com/brochures-for-individuals","18"
"2016","WI","47342","HIOS","11","2016-01-26 05:20:14","4","47342","WI","Individual","No","39-1545987","47342WI0050020","Essential HDHP","47342WI005","7720081950","WIN001","WIS002","WIF001","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain","0.998110682515941",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Urgent Care and Emergency Only","Yes","Urgent Care and Emergency Only","No","https://www.HealthTradition.com/go/paynow","https://www.healthtradition.com/members/health-plan/employer-group-members/prescription-drug-benefit/","47342WI0050020-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,500","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthtradition.com/wp-content/uploads/2012/02/2016-Individual-Essential.pdf","https://www.healthtradition.com/brochures-for-individuals","19"
"2016","WI","52697","HIOS","9","2015-11-18 07:25:09","1","52697","WI","Individual","No","20-0813104","52697WI0010001","Molina Marketplace  Gold Plan","52697WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/wi/en/PDF/marketplace/formulary-2016.pdf","52697WI0010001-00","Standard Gold Off Exchange Plan",,"0.801033437252045","No","Yes","No","100%",,"$500","$240","$890","$150","$500","$770","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/summary-of-benefits-gold-2016.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/brochure-2016.pdf","4"
"2016","WI","52697","HIOS","9","2015-11-18 07:25:09","1","52697","WI","Individual","No","20-0813104","52697WI0010001","Molina Marketplace  Gold Plan","52697WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/wi/en/PDF/marketplace/formulary-2016.pdf","52697WI0010001-01","Standard Gold On Exchange Plan",,"0.801033437252045","No","Yes","No","100%",,"$500","$240","$890","$150","$500","$770","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/summary-of-benefits-gold-2016.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/brochure-2016.pdf","5"
"2016","WI","52697","HIOS","9","2015-11-18 07:25:09","1","52697","WI","Individual","No","20-0813104","52697WI0010001","Molina Marketplace  Gold Plan","52697WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/wi/en/PDF/marketplace/formulary-2016.pdf","52697WI0010001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/summary-of-benefits-gold-aian-2016.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/brochure-2016.pdf","6"
"2016","WI","52697","HIOS","9","2015-11-18 07:25:09","1","52697","WI","Individual","No","20-0813104","52697WI0010001","Molina Marketplace  Gold Plan","52697WI001",,"WIN001","WIS001","WIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/wi/en/PDF/marketplace/formulary-2016.pdf","52697WI0010001-03","Limited Cost Sharing Plan Variation",,"0.801033437252045","No","Yes","No","100%",,"$500","$240","$890","$150","$500","$770","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/summary-of-benefits-gold-2016.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/brochure-2016.pdf","7"
"2016","WI","52697","HIOS","9","2015-11-18 07:25:09","2","52697","WI","Individual","No","20-0813104","52697WI0010002","Molina Marketplace  Silver Plan","52697WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/wi/en/PDF/marketplace/formulary-2016.pdf","52697WI0010002-00","Standard Silver Off Exchange Plan",,"0.714607775211334","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/summary-of-benefits-silver-250-2016.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/brochure-2016.pdf","4"
"2016","WI","52697","HIOS","9","2015-11-18 07:25:09","2","52697","WI","Individual","No","20-0813104","52697WI0010002","Molina Marketplace  Silver Plan","52697WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/wi/en/PDF/marketplace/formulary-2016.pdf","52697WI0010002-01","Standard Silver On Exchange Plan",,"0.714607775211334","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/summary-of-benefits-silver-250-2016.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/brochure-2016.pdf","5"
"2016","WI","52697","HIOS","9","2015-11-18 07:25:09","2","52697","WI","Individual","No","20-0813104","52697WI0010002","Molina Marketplace  Silver Plan","52697WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/wi/en/PDF/marketplace/formulary-2016.pdf","52697WI0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/summary-of-benefits-silver-aian-2016.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/brochure-2016.pdf","6"
"2016","WI","52697","HIOS","9","2015-11-18 07:25:09","2","52697","WI","Individual","No","20-0813104","52697WI0010002","Molina Marketplace  Silver Plan","52697WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/wi/en/PDF/marketplace/formulary-2016.pdf","52697WI0010002-03","Limited Cost Sharing Plan Variation",,"0.714607775211334","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/summary-of-benefits-silver-250-2016.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/brochure-2016.pdf","7"
"2016","WI","52697","HIOS","9","2015-11-18 07:25:09","2","52697","WI","Individual","No","20-0813104","52697WI0010002","Molina Marketplace  Silver Plan","52697WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/wi/en/PDF/marketplace/formulary-2016.pdf","52697WI0010002-04","73% AV Level Silver Plan",,"0.739822447299957","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/summary-of-benefits-silver-200-2016.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/brochure-2016.pdf","8"
"2016","WI","52697","HIOS","9","2015-11-18 07:25:09","2","52697","WI","Individual","No","20-0813104","52697WI0010002","Molina Marketplace  Silver Plan","52697WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/wi/en/PDF/marketplace/formulary-2016.pdf","52697WI0010002-05","87% AV Level Silver Plan",,"0.878527700901031","No","Yes","No","100%",,"$450","$180","$890","$150","$450","$320","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$450","$450 per person","$900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/summary-of-benefits-silver-150-2016.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/brochure-2016.pdf","9"
"2016","WI","52697","HIOS","9","2015-11-18 07:25:09","2","52697","WI","Individual","No","20-0813104","52697WI0010002","Molina Marketplace  Silver Plan","52697WI001",,"WIN001","WIS001","WIF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/wi/en/PDF/marketplace/formulary-2016.pdf","52697WI0010002-06","94% AV Level Silver Plan",,"0.947116374969482","No","Yes","No","100%",,"$0","$210","$450","$150","$0","$180","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/summary-of-benefits-silver-100-2016.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/brochure-2016.pdf","10"
"2016","WI","52697","HIOS","9","2015-11-18 07:25:09","3","52697","WI","Individual","No","20-0813104","52697WI0010003","Molina Marketplace  Bronze Plan","52697WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/wi/en/PDF/marketplace/formulary-2016.pdf","52697WI0010003-00","Standard Bronze Off Exchange Plan",,"0.618895947933197","Yes","Yes","No","100%",,"$5,000","$20","$900","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/summary-of-benefits-bronze-2016.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/brochure-2016.pdf","4"
"2016","WI","52697","HIOS","9","2015-11-18 07:25:09","3","52697","WI","Individual","No","20-0813104","52697WI0010003","Molina Marketplace  Bronze Plan","52697WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/wi/en/PDF/marketplace/formulary-2016.pdf","52697WI0010003-01","Standard Bronze On Exchange Plan",,"0.618895947933197","Yes","Yes","No","100%",,"$5,000","$20","$900","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/summary-of-benefits-bronze-2016.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/brochure-2016.pdf","5"
"2016","WI","52697","HIOS","9","2015-11-18 07:25:09","3","52697","WI","Individual","No","20-0813104","52697WI0010003","Molina Marketplace  Bronze Plan","52697WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/wi/en/PDF/marketplace/formulary-2016.pdf","52697WI0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/summary-of-benefits-bronze-aian-2016.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/brochure-2016.pdf","6"
"2016","WI","52697","HIOS","9","2015-11-18 07:25:09","3","52697","WI","Individual","No","20-0813104","52697WI0010003","Molina Marketplace  Bronze Plan","52697WI001",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/wi/en/PDF/marketplace/formulary-2016.pdf","52697WI0010003-03","Limited Cost Sharing Plan Variation",,"0.618895947933197","Yes","Yes","No","100%",,"$5,000","$20","$900","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/summary-of-benefits-bronze-2016.pdf","http://www.molinahealthcare.com/members/wi/en-US/PDF/marketplace/brochure-2016.pdf","7"
"2016","WI","57369","HIOS","2","2015-07-10 02:19:03","1","57369","WI","SHOP (Small Group)","Yes","42-0127290","57369WI0040001","Principal Plan Dental 70","57369WI004",,"WIN001","WIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$32.09","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","57369WI0040001-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","57369","HIOS","2","2015-07-10 02:19:03","1","57369","WI","SHOP (Small Group)","Yes","42-0127290","57369WI0040002","Principal Plan Dental 85","57369WI004",,"WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$33.92","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","57369WI0040002-00","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","1","57845","WI","Individual","No","41-1843804","57845WI0020001","Medica Individual Choice Gold Copay","57845WI002",,"WIN002","WIS002","WIF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020001-00","Standard Gold Off Exchange Plan",,"0.795177459716797","Yes","Yes","No","100%",,"$300","$20","$1,500","$1,000","$300","$600","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICGCWI&uid=FFM",,"4"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","1","57845","WI","Individual","No","41-1843804","57845WI0020001","Medica Individual Choice Gold Copay","57845WI002",,"WIN002","WIS002","WIF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020001-01","Standard Gold On Exchange Plan",,"0.795177459716797","Yes","Yes","No","100%",,"$300","$20","$1,500","$1,000","$300","$600","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICGCWI&uid=FFM",,"5"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","1","57845","WI","Individual","No","41-1843804","57845WI0020001","Medica Individual Choice Gold Copay","57845WI002",,"WIN002","WIS002","WIF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICGCWIZ&uid=FFM",,"6"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","1","57845","WI","Individual","No","41-1843804","57845WI0020001","Medica Individual Choice Gold Copay","57845WI002",,"WIN002","WIS002","WIF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020001-03","Limited Cost Sharing Plan Variation",,"0.795177459716797","Yes","Yes","No","100%",,"$300","$20","$1,500","$1,000","$300","$600","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICGCWIL&uid=FFM",,"7"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","1","57845","WI","Individual","No","41-1843804","57845WI0020017","Medica Individual Choice Gold Copay 100","57845WI002",,"WIN002","WIS002","WIF002","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020017-00","Standard Gold Off Exchange Plan",,"0.818332970142365","Yes","Yes","No","100%",,"$2,400","$0","$0","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICG100CWI&uid=FFM",,"8"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","1","57845","WI","Individual","No","41-1843804","57845WI0020017","Medica Individual Choice Gold Copay 100","57845WI002",,"WIN002","WIS002","WIF002","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020017-01","Standard Gold On Exchange Plan",,"0.818332970142365","Yes","Yes","No","100%",,"$2,400","$0","$0","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICG100CWI&uid=FFM",,"9"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","1","57845","WI","Individual","No","41-1843804","57845WI0020017","Medica Individual Choice Gold Copay 100","57845WI002",,"WIN002","WIS002","WIF002","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICG100CWIZ&uid=FFM",,"10"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","1","57845","WI","Individual","No","41-1843804","57845WI0020017","Medica Individual Choice Gold Copay 100","57845WI002",,"WIN002","WIS002","WIF002","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020017-03","Limited Cost Sharing Plan Variation",,"0.818332970142365","Yes","Yes","No","100%",,"$2,400","$0","$0","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICG100CWIL&uid=FFM",,"11"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","1","57845","WI","Individual","No","41-1843804","57845WI0020019","Medica Individual Choice Gold Copay Plus","57845WI002",,"WIN002","WIS002","WIF003","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020019-00","Standard Gold Off Exchange Plan",,"0.786018192768097","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICGPCWI&uid=FFM",,"12"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","1","57845","WI","Individual","No","41-1843804","57845WI0020019","Medica Individual Choice Gold Copay Plus","57845WI002",,"WIN002","WIS002","WIF003","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020019-01","Standard Gold On Exchange Plan",,"0.786018192768097","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICGPCWI&uid=FFM",,"13"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","1","57845","WI","Individual","No","41-1843804","57845WI0020019","Medica Individual Choice Gold Copay Plus","57845WI002",,"WIN002","WIS002","WIF003","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICGPCWIZ&uid=FFM",,"14"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","1","57845","WI","Individual","No","41-1843804","57845WI0020019","Medica Individual Choice Gold Copay Plus","57845WI002",,"WIN002","WIS002","WIF003","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020019-03","Limited Cost Sharing Plan Variation",,"0.786018192768097","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICGPCWIL&uid=FFM",,"15"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","1","57845","WI","Individual","No","41-1843804","57845WI0020007","Medica Individual Choice Gold H S A","57845WI002",,"WIN002","WIS002","WIF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020007-00","Standard Gold Off Exchange Plan",,"0.788612484931946","Yes","Yes","No","100%",,"$1,300","$0","$1,200","$1,000","$1,300","$0","$1,200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7050 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICGHWI&uid=FFM",,"16"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","1","57845","WI","Individual","No","41-1843804","57845WI0020007","Medica Individual Choice Gold H S A","57845WI002",,"WIN002","WIS002","WIF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020007-01","Standard Gold On Exchange Plan",,"0.788612484931946","Yes","Yes","No","100%",,"$1,300","$0","$1,200","$1,000","$1,300","$0","$1,200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7050 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICGHWI&uid=FFM",,"17"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","1","57845","WI","Individual","No","41-1843804","57845WI0020007","Medica Individual Choice Gold H S A","57845WI002",,"WIN002","WIS002","WIF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICGHWIZ&uid=FFM",,"18"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","1","57845","WI","Individual","No","41-1843804","57845WI0020007","Medica Individual Choice Gold H S A","57845WI002",,"WIN002","WIS002","WIF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020007-03","Limited Cost Sharing Plan Variation",,"0.788612484931946","Yes","Yes","No","100%",,"$1,300","$0","$1,200","$1,000","$1,300","$0","$1,200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7050 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICGHWIL&uid=FFM",,"19"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","2","57845","WI","Individual","No","41-1843804","57845WI0020003","Medica Individual Choice Silver Copay","57845WI002",,"WIN002","WIS002","WIF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020003-00","Standard Silver Off Exchange Plan",,"0.69723379611969","Yes","Yes","No","100%",,"$2,600","$20","$1,100","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICSCWI&uid=FFM",,"4"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","2","57845","WI","Individual","No","41-1843804","57845WI0020003","Medica Individual Choice Silver Copay","57845WI002",,"WIN002","WIS002","WIF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020003-01","Standard Silver On Exchange Plan",,"0.69723379611969","Yes","Yes","No","100%",,"$2,600","$20","$1,100","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICSCWI&uid=FFM",,"5"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","2","57845","WI","Individual","No","41-1843804","57845WI0020003","Medica Individual Choice Silver Copay","57845WI002",,"WIN002","WIS002","WIF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICSCWIZ&uid=FFM",,"6"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","2","57845","WI","Individual","No","41-1843804","57845WI0020003","Medica Individual Choice Silver Copay","57845WI002",,"WIN002","WIS002","WIF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020003-03","Limited Cost Sharing Plan Variation",,"0.69723379611969","Yes","Yes","No","100%",,"$2,600","$20","$1,100","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICSCWIL&uid=FFM",,"7"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","2","57845","WI","Individual","No","41-1843804","57845WI0020003","Medica Individual Choice Silver Copay","57845WI002",,"WIN002","WIS002","WIF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020003-04","73% AV Level Silver Plan",,"0.730964839458466","Yes","Yes","No","100%",,"$2,400","$20","$900","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICSCWI73&uid=FFM",,"8"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","2","57845","WI","Individual","No","41-1843804","57845WI0020003","Medica Individual Choice Silver Copay","57845WI002",,"WIN002","WIS002","WIF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020003-05","87% AV Level Silver Plan",,"0.873378396034241","Yes","Yes","No","100%",,"$400","$20","$1,000","$1,000","$400","$600","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","per person not applicable","$1200 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICSCWI87&uid=FFM",,"9"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","2","57845","WI","Individual","No","41-1843804","57845WI0020003","Medica Individual Choice Silver Copay","57845WI002",,"WIN002","WIS002","WIF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020003-06","94% AV Level Silver Plan",,"0.946734488010406","Yes","Yes","No","100%",,"$50","$20","$300","$1,000","$50","$600","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","$150 per group","5%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICSCWI94&uid=FFM",,"10"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","2","57845","WI","Individual","No","41-1843804","57845WI0020021","Medica Individual Choice Silver Copay Plus","57845WI002",,"WIN002","WIS002","WIF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020021-00","Standard Silver Off Exchange Plan",,"0.686831414699554","Yes","Yes","No","100%",,"$2,500","$800","$50","$1,000","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","35%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICSPCWI&uid=FFM",,"11"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","2","57845","WI","Individual","No","41-1843804","57845WI0020021","Medica Individual Choice Silver Copay Plus","57845WI002",,"WIN002","WIS002","WIF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020021-01","Standard Silver On Exchange Plan",,"0.686831414699554","Yes","Yes","No","100%",,"$2,500","$800","$50","$1,000","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","35%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICSPCWI&uid=FFM",,"12"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","2","57845","WI","Individual","No","41-1843804","57845WI0020021","Medica Individual Choice Silver Copay Plus","57845WI002",,"WIN002","WIS002","WIF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICSPCWIZ&uid=FFM",,"13"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","2","57845","WI","Individual","No","41-1843804","57845WI0020021","Medica Individual Choice Silver Copay Plus","57845WI002",,"WIN002","WIS002","WIF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020021-03","Limited Cost Sharing Plan Variation",,"0.686831414699554","Yes","Yes","No","100%",,"$2,500","$800","$50","$1,000","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","35%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICSPCWIL&uid=FFM",,"14"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","2","57845","WI","Individual","No","41-1843804","57845WI0020021","Medica Individual Choice Silver Copay Plus","57845WI002",,"WIN002","WIS002","WIF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020021-04","73% AV Level Silver Plan",,"0.722007930278778","Yes","Yes","No","100%",,"$1,500","$800","$400","$1,000","$1,500","$900","$30","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$4500 per group","35%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICSPCWI73&uid=FFM",,"15"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","2","57845","WI","Individual","No","41-1843804","57845WI0020021","Medica Individual Choice Silver Copay Plus","57845WI002",,"WIN002","WIS002","WIF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020021-05","87% AV Level Silver Plan",,"0.867308914661407","Yes","Yes","No","100%",,"$100","$700","$200","$1,000","$100","$700","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$300 per group","15%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICSPCWI87&uid=FFM",,"16"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","2","57845","WI","Individual","No","41-1843804","57845WI0020021","Medica Individual Choice Silver Copay Plus","57845WI002",,"WIN002","WIS002","WIF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020021-06","94% AV Level Silver Plan",,"0.932673752307892","Yes","Yes","No","100%",,"$0","$700","$50","$1,000","$0","$700","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","5%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICSPCWI94&uid=FFM",,"17"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","2","57845","WI","Individual","No","41-1843804","57845WI0020009","Medica Individual Choice Silver H S A","57845WI002",,"WIN002","WIS002","WIF007","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020009-00","Standard Silver Off Exchange Plan",,"0.697753369808197","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICSHWI&uid=FFM",,"18"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","2","57845","WI","Individual","No","41-1843804","57845WI0020009","Medica Individual Choice Silver H S A","57845WI002",,"WIN002","WIS002","WIF007","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020009-01","Standard Silver On Exchange Plan",,"0.697753369808197","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICSHWI&uid=FFM",,"19"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","2","57845","WI","Individual","No","41-1843804","57845WI0020009","Medica Individual Choice Silver H S A","57845WI002",,"WIN002","WIS002","WIF007","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICSHWIZ&uid=FFM",,"20"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","2","57845","WI","Individual","No","41-1843804","57845WI0020009","Medica Individual Choice Silver H S A","57845WI002",,"WIN002","WIS002","WIF007","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020009-03","Limited Cost Sharing Plan Variation",,"0.697753369808197","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICSHWIL&uid=FFM",,"21"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","2","57845","WI","Individual","No","41-1843804","57845WI0020009","Medica Individual Choice Silver H S A","57845WI002",,"WIN002","WIS002","WIF007","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020009-04","73% AV Level Silver Plan",,"0.736685276031494","Yes","Yes","No","100%",,"$1,050","$0","$1,300","$1,000","$1,050","$0","$1,300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","per person not applicable","$3150 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICSHWI73&uid=FFM",,"22"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","2","57845","WI","Individual","No","41-1843804","57845WI0020009","Medica Individual Choice Silver H S A","57845WI002",,"WIN002","WIS002","WIF007","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020009-05","87% AV Level Silver Plan",,"0.870106041431427","Yes","Yes","No","100%",,"$250","$0","$1,000","$1,000","$250","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","per person not applicable","$750 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICSHWI87&uid=FFM",,"23"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","2","57845","WI","Individual","No","41-1843804","57845WI0020009","Medica Individual Choice Silver H S A","57845WI002",,"WIN002","WIS002","WIF007","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only","Yes","Out-of-network coverage","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020009-06","94% AV Level Silver Plan",,"0.939850509166718","Yes","Yes","No","100%",,"$150","$0","$300","$1,000","$150","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","per person not applicable","$450 per group","5%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICSHWI94&uid=FFM",,"24"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","3","57845","WI","Individual","No","41-1843804","57845WI0020005","Medica Individual Choice Bronze Copay","57845WI002",,"WIN002","WIS002","WIF008","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020005-00","Standard Bronze Off Exchange Plan",,"0.617384314537048","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICBCWI&uid=FFM",,"4"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","3","57845","WI","Individual","No","41-1843804","57845WI0020005","Medica Individual Choice Bronze Copay","57845WI002",,"WIN002","WIS002","WIF008","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020005-01","Standard Bronze On Exchange Plan",,"0.617384314537048","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICBCWI&uid=FFM",,"5"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","3","57845","WI","Individual","No","41-1843804","57845WI0020005","Medica Individual Choice Bronze Copay","57845WI002",,"WIN002","WIS002","WIF008","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICBCWIZ&uid=FFM",,"6"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","3","57845","WI","Individual","No","41-1843804","57845WI0020005","Medica Individual Choice Bronze Copay","57845WI002",,"WIN002","WIS002","WIF008","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020005-03","Limited Cost Sharing Plan Variation",,"0.617384314537048","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICBCWIL&uid=FFM",,"7"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","3","57845","WI","Individual","No","41-1843804","57845WI0020011","Medica Individual Choice Bronze H S A","57845WI002",,"WIN002","WIS002","WIF009","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020011-00","Standard Bronze Off Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","per person not applicable","$12700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICBHWI&uid=FFM",,"8"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","3","57845","WI","Individual","No","41-1843804","57845WI0020011","Medica Individual Choice Bronze H S A","57845WI002",,"WIN002","WIS002","WIF009","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020011-01","Standard Bronze On Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","per person not applicable","$12700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICBHWI&uid=FFM",,"9"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","3","57845","WI","Individual","No","41-1843804","57845WI0020011","Medica Individual Choice Bronze H S A","57845WI002",,"WIN002","WIS002","WIF009","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICBHWIZ&uid=FFM",,"10"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","3","57845","WI","Individual","No","41-1843804","57845WI0020011","Medica Individual Choice Bronze H S A","57845WI002",,"WIN002","WIS002","WIF009","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020011-03","Limited Cost Sharing Plan Variation",,"0.607437193393707","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","per person not applicable","$12700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICBHWIL&uid=FFM",,"11"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","4","57845","WI","Individual","No","41-1843804","57845WI0020013","Medica Individual Choice Catastrophic","57845WI002",,"WIN002","WIS002","WIF010","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020013-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICCWI&uid=FFM",,"4"
"2016","WI","57845","HIOS","11","2016-03-04 04:36:30","4","57845","WI","Individual","No","41-1843804","57845WI0020013","Medica Individual Choice Catastrophic","57845WI002",,"WIN002","WIS002","WIF010","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","57845WI0020013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICCWI&uid=FFM",,"5"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090001","MercyCare HMO Gold Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090001-00","Standard Gold Off Exchange Plan","78.36%","0.783564209938049","No","Yes","No","100%",,"$2,000","$20","$1,050","$150","$2,000","$710","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Gold-Opt-A-58326WI0090001.pdf",,"4"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060101","MercyCare HMO Full Pay $0 Deductible; $10/$25/$50 Rx","58326WI006",,"WIN001","WIS001","WIF007","New","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0060101-00","Standard Platinum Off Exchange Plan","91.64%","0.916385114192963","No","Yes","No","100%",,"$0","$20","$0","$150","$0","$700","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Full-Pay-58326WI0060101.pdf",,"4"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060101","MercyCare HMO Full Pay $0 Deductible; $10/$25/$50 Rx","58326WI006",,"WIN001","WIS001","WIF007","New","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0060101-01","Standard Platinum On Exchange Plan","91.64%","0.916385114192963","No","Yes","No","100%",,"$0","$20","$0","$150","$0","$700","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Full-Pay-58326WI0060101.pdf",,"5"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090001","MercyCare HMO Gold Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090001-01","Standard Gold On Exchange Plan","78.36%","0.783564209938049","No","Yes","No","100%",,"$2,000","$20","$1,050","$150","$2,000","$710","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Gold-Opt-A-58326WI0090001.pdf",,"5"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090001","MercyCare HMO Gold Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/05/HMO-Gold-Opt-A-Zero-Cost-Share-58326WI0090001-02.pdf",,"6"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060102","MercyCare HMO CO-90 $0 Deductible; $10/$25/$50 Rx","58326WI006",,"WIN001","WIS001","WIF007","New","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0060102-00","Standard Platinum Off Exchange Plan","90.75%","0.907508313655853","No","Yes","No","100%",,"$0","$20","$730","$150","$0","$700","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-CO-90-58326WI0060102.pdf",,"6"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060102","MercyCare HMO CO-90 $0 Deductible; $10/$25/$50 Rx","58326WI006",,"WIN001","WIS001","WIF007","New","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0060102-01","Standard Platinum On Exchange Plan","90.75%","0.907508313655853","No","Yes","No","100%",,"$0","$20","$730","$150","$0","$700","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-CO-90-58326WI0060102.pdf",,"7"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090001","MercyCare HMO Gold Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090001-03","Limited Cost Sharing Plan Variation","78.36%","0.783564209938049","No","Yes","No","100%",,"$2,000","$20","$1,050","$150","$2,000","$710","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Gold-Opt-A-58326WI0090001.pdf",,"7"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090012","MercyCare HMO Gold Option B","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090012-00","Standard Gold Off Exchange Plan","80.28%","0.802785575389862","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$930","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Gold-Opt-B-58326WI0090012.pdf",,"8"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060103","MercyCare HMO CO-80 $500 Deductible; $10/$25/$50 Rx","58326WI006",,"WIN001","WIS001","WIF007","New","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0060103-00","Standard Platinum Off Exchange Plan","88.08%","0.88077712059021","No","Yes","No","100%",,"$500","$0","$1,000","$150","$500","$680","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-CO-80-500-Ded-58326WI0060103.pdf",,"8"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060103","MercyCare HMO CO-80 $500 Deductible; $10/$25/$50 Rx","58326WI006",,"WIN001","WIS001","WIF007","New","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0060103-01","Standard Platinum On Exchange Plan","88.08%","0.88077712059021","No","Yes","No","100%",,"$500","$0","$1,000","$150","$500","$680","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-CO-80-500-Ded-58326WI0060103.pdf",,"9"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090012","MercyCare HMO Gold Option B","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090012-01","Standard Gold On Exchange Plan","80.28%","0.802785575389862","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$930","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Gold-Opt-B-58326WI0090012.pdf",,"9"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090012","MercyCare HMO Gold Option B","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090012-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/05/HMO-Gold-Opt-B-Zero-Cost-Share-58326WI0090012-02.pdf",,"10"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060104","MercyCare HMO CO-80 $1,250 Deductible; $20/$40/$60 Rx","58326WI006",,"WIN001","WIS001","WIF008","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0060104-00","Standard Gold Off Exchange Plan","80.85%","0.808492958545685","No","Yes","No","100%",,"$1,250","$20","$1,200","$150","$1,250","$870","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-CO-80-1250-Ded-58326WI0060104.pdf",,"10"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070101","MercyCare EPO Full Pay $0 Deductible; $10/$25/$50 Rx","58326WI007",,"WIN002","WIS001","WIF007","New","EPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0070101-01","Standard Platinum On Exchange Plan","91.64%","0.916385114192963","No","Yes","No","100%",,"$0","$20","$0","$150","$0","$700","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/EPO-Full-Pay-58326WI0070101.pdf",,"25"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090015","MercyCare HMO Silver Option B","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/05/HMO-Silver-Opt-B-Zero-Cost-Share-58326WI0090015-02.pdf",,"25"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090015","MercyCare HMO Silver Option B","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090015-03","Limited Cost Sharing Plan Variation","71.72%","0.717205703258514","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$600","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Silver-Opt-B-58326WI0090015.pdf",,"26"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070102","MercyCare EPO CO-90 $0 Deductible; $10/$25/$50 Rx","58326WI007",,"WIN002","WIS001","WIF007","New","EPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0070102-00","Standard Platinum Off Exchange Plan","90.75%","0.907508313655853","No","Yes","No","100%",,"$0","$20","$730","$150","$0","$700","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/EPO-CO-90-58326WI0070102.pdf",,"26"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070102","MercyCare EPO CO-90 $0 Deductible; $10/$25/$50 Rx","58326WI007",,"WIN002","WIS001","WIF007","New","EPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0070102-01","Standard Platinum On Exchange Plan","90.75%","0.907508313655853","No","Yes","No","100%",,"$0","$20","$730","$150","$0","$700","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/EPO-CO-90-58326WI0070102.pdf",,"27"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090015","MercyCare HMO Silver Option B","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090015-04","73% AV Level Silver Plan","73.79%","0.737940490245819","No","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$600","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Silver-Opt-B-73-CSR-58326WI0090015-04.pdf",,"27"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090015","MercyCare HMO Silver Option B","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090015-05","87% AV Level Silver Plan","87.51%","0.875101208686829","No","Yes","No","100%",,"$250","$20","$700","$150","$250","$1,100","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Silver-Opt-B-87-CSR-58326WI0090015-05.pdf",,"28"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060104","MercyCare HMO CO-80 $1,250 Deductible; $20/$40/$60 Rx","58326WI006",,"WIN001","WIS001","WIF008","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0060104-01","Standard Gold On Exchange Plan","80.85%","0.808492958545685","No","Yes","No","100%",,"$1,250","$20","$1,200","$150","$1,250","$870","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-CO-80-1250-Ded-58326WI0060104.pdf",,"11"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090012","MercyCare HMO Gold Option B","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090012-03","Limited Cost Sharing Plan Variation","80.28%","0.802785575389862","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$930","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Gold-Opt-B-58326WI0090012.pdf",,"11"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090013","MercyCare HMO Gold Option C","58326WI009",,"WIN001","WIS002","WIF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090013-00","Standard Gold Off Exchange Plan","81.74%","0.817416191101074","No","Yes","No","100%",,"$500","$20","$1,350","$150","$500","$680","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Gold-Opt-C-58326WI0090013.pdf",,"12"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060105","MercyCare HMO CO-80 $2,000 Deductible; $20/$40/$60 Rx","58326WI006",,"WIN001","WIS001","WIF008","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0060105-00","Standard Gold Off Exchange Plan","78.13%","0.781251490116119","No","Yes","No","100%",,"$2,000","$20","$1,050","$150","$2,000","$730","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-CO-80-2000-Ded-58326WI0060105.pdf",,"12"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060105","MercyCare HMO CO-80 $2,000 Deductible; $20/$40/$60 Rx","58326WI006",,"WIN001","WIS001","WIF008","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0060105-01","Standard Gold On Exchange Plan","78.13%","0.781251490116119","No","Yes","No","100%",,"$2,000","$20","$1,050","$150","$2,000","$730","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-CO-80-2000-Ded-58326WI0060105.pdf",,"13"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070103","MercyCare EPO CO-80 $500 Deductible; $10/$25/$50 Rx","58326WI007",,"WIN002","WIS001","WIF007","New","EPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0070103-01","Standard Platinum On Exchange Plan","88.08%","0.88077712059021","No","Yes","No","100%",,"$500","$0","$1,000","$150","$500","$680","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/EPO-CO-80-500-Ded-58326WI0070103.pdf",,"29"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090015","MercyCare HMO Silver Option B","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090015-06","94% AV Level Silver Plan","94.25%","0.942470192909241","No","Yes","No","100%",,"$50","$20","$0","$150","$50","$550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Silver-Opt-B-94-CSR-58326WI0090015-06.pdf",,"29"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090016","MercyCare HMO Silver Option C","58326WI009",,"WIN001","WIS002","WIF001","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090016-00","Standard Silver Off Exchange Plan","68.19%","0.681926786899567","No","Yes","No","100%",,"$3,000","$20","$1,280","$150","$3,000","$200","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Silver-Opt-C-58326WI0090016.pdf",,"30"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090013","MercyCare HMO Gold Option C","58326WI009",,"WIN001","WIS002","WIF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090013-01","Standard Gold On Exchange Plan","81.74%","0.817416191101074","No","Yes","No","100%",,"$500","$20","$1,350","$150","$500","$680","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Gold-Opt-C-58326WI0090013.pdf",,"13"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090013","MercyCare HMO Gold Option C","58326WI009",,"WIN001","WIS002","WIF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090013-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/05/HMO-Gold-Opt-C-Zero-Cost-Share-58326WI0090013-02.pdf",,"14"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060106","MercyCare HMO CO-70 $2,500 Deductible; $20/$40/$60 Rx","58326WI006",,"WIN001","WIS001","WIF008","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0060106-00","Standard Silver Off Exchange Plan","71.50%","0.714959919452667","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$620","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-CO-70-2500-Ded-58326WI0060106.pdf",,"14"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060106","MercyCare HMO CO-70 $2,500 Deductible; $20/$40/$60 Rx","58326WI006",,"WIN001","WIS001","WIF008","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0060106-01","Standard Silver On Exchange Plan","71.50%","0.714959919452667","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$620","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-CO-70-2500-Ded-58326WI0060106.pdf",,"15"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090013","MercyCare HMO Gold Option C","58326WI009",,"WIN001","WIS002","WIF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090013-03","Limited Cost Sharing Plan Variation","81.74%","0.817416191101074","No","Yes","No","100%",,"$500","$20","$1,350","$150","$500","$680","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Gold-Opt-C-58326WI0090013.pdf",,"15"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090002","MercyCare HMO Silver Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090002-00","Standard Silver Off Exchange Plan","69.22%","0.692167401313782","No","Yes","No","100%",,"$5,000","$20","$680","$150","$5,000","$60","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Silver-Opt-A-58326WI0090002.pdf",,"16"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060107","MercyCare HMO CO-70 $5,000 Deductible; $20/$40/$60 Rx","58326WI006",,"WIN001","WIS001","WIF008","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0060107-00","Standard Silver Off Exchange Plan","68.27%","0.682697296142578","No","Yes","No","100%",,"$5,000","$20","$680","$150","$5,000","$60","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-CO-70-5000-Ded-58326WI0060107.pdf",,"16"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060107","MercyCare HMO CO-70 $5,000 Deductible; $20/$40/$60 Rx","58326WI006",,"WIN001","WIS001","WIF008","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0060107-01","Standard Silver On Exchange Plan","68.27%","0.682697296142578","No","Yes","No","100%",,"$5,000","$20","$680","$150","$5,000","$60","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-CO-70-5000-Ded-58326WI0060107.pdf",,"17"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090002","MercyCare HMO Silver Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090002-01","Standard Silver On Exchange Plan","69.22%","0.692167401313782","No","Yes","No","100%",,"$5,000","$20","$680","$150","$5,000","$60","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Silver-Opt-A-58326WI0090002.pdf",,"17"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090002","MercyCare HMO Silver Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/05/HMO-Silver-Opt-A-Zero-Cost-Share-58326WI0090002-02.pdf",,"18"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060108","MercyCare HMO H.S.A. $2,000 Deductible","58326WI006",,"WIN001","WIS001","WIF009","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0060108-00","Standard Gold Off Exchange Plan","80.63%","0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-HSA-2000-Ded-58326WI0060108.pdf",,"18"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060108","MercyCare HMO H.S.A. $2,000 Deductible","58326WI006",,"WIN001","WIS001","WIF009","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0060108-01","Standard Gold On Exchange Plan","80.63%","0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-HSA-2000-Ded-58326WI0060108.pdf",,"19"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090002","MercyCare HMO Silver Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090002-03","Limited Cost Sharing Plan Variation","69.22%","0.692167401313782","No","Yes","No","100%",,"$5,000","$20","$680","$150","$5,000","$60","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Silver-Opt-A-58326WI0090002.pdf",,"19"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090002","MercyCare HMO Silver Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090002-04","73% AV Level Silver Plan","73.80%","0.738010704517365","No","Yes","No","100%",,"$3,000","$20","$1,280","$150","$3,000","$520","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Silver-Opt-A-73-CSR-58326WI0090002-04.pdf",,"20"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060109","MercyCare HMO H.S.A. $4,000 Deductible","58326WI006",,"WIN001","WIS001","WIF009","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0060109-00","Standard Silver Off Exchange Plan","68.68%","0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$4,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-HSA-4000-Ded-58326WI0060109.pdf",,"20"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060109","MercyCare HMO H.S.A. $4,000 Deductible","58326WI006",,"WIN001","WIS001","WIF009","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0060109-01","Standard Silver On Exchange Plan","68.68%","0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$4,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-HSA-4000-Ded-58326WI0060109.pdf",,"21"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090002","MercyCare HMO Silver Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090002-05","87% AV Level Silver Plan","87.75%","0.87745076417923","No","Yes","No","100%",,"$750","$0","$750","$150","$750","$620","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Silver-Opt-A-87-CSR-58326WI0090002-05.pdf",,"21"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090002","MercyCare HMO Silver Option A","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090002-06","94% AV Level Silver Plan","94.27%","0.942659974098206","No","Yes","No","100%",,"$0","$20","$0","$150","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Silver-Opt-A-94-CSR-58326WI0090002-06.pdf",,"22"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060110","MercyCare HMO H.S.A. $6,000 Deductible","58326WI006",,"WIN001","WIS001","WIF009","New","HMO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0060110-00","Standard Bronze Off Exchange Plan","61.75%","0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-HSA-6000-Ded-58326WI0060110.pdf",,"22"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060110","MercyCare HMO H.S.A. $6,000 Deductible","58326WI006",,"WIN001","WIS001","WIF009","New","HMO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0060110-01","Standard Bronze On Exchange Plan","61.75%","0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-HSA-6000-Ded-58326WI0060110.pdf",,"23"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090015","MercyCare HMO Silver Option B","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090015-00","Standard Silver Off Exchange Plan","71.72%","0.717205703258514","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$600","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Silver-Opt-B-58326WI0090015.pdf",,"23"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090015","MercyCare HMO Silver Option B","58326WI009",,"WIN001","WIS002","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090015-01","Standard Silver On Exchange Plan","71.72%","0.717205703258514","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$600","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Silver-Opt-B-58326WI0090015.pdf",,"24"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070101","MercyCare EPO Full Pay $0 Deductible; $10/$25/$50 Rx","58326WI007",,"WIN002","WIS001","WIF007","New","EPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0070101-00","Standard Platinum Off Exchange Plan","91.64%","0.916385114192963","No","Yes","No","100%",,"$0","$20","$0","$150","$0","$700","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/EPO-Full-Pay-58326WI0070101.pdf",,"24"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070103","MercyCare EPO CO-80 $500 Deductible; $10/$25/$50 Rx","58326WI007",,"WIN002","WIS001","WIF007","New","EPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0070103-00","Standard Platinum Off Exchange Plan","88.08%","0.88077712059021","No","Yes","No","100%",,"$500","$0","$1,000","$150","$500","$680","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/EPO-CO-80-500-Ded-58326WI0070103.pdf",,"28"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070104","MercyCare EPO CO-80 $1,250 Deductible; $20/$40/$60 Rx","58326WI007",,"WIN002","WIS001","WIF008","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0070104-00","Standard Gold Off Exchange Plan","80.85%","0.808492958545685","No","Yes","No","100%",,"$1,250","$20","$1,200","$150","$1,250","$870","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/EPO-CO-80-1250-Ded-58326WI0070104.pdf",,"30"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070104","MercyCare EPO CO-80 $1,250 Deductible; $20/$40/$60 Rx","58326WI007",,"WIN002","WIS001","WIF008","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0070104-01","Standard Gold On Exchange Plan","80.85%","0.808492958545685","No","Yes","No","100%",,"$1,250","$20","$1,200","$150","$1,250","$870","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/EPO-CO-80-1250-Ded-58326WI0070104.pdf",,"31"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090016","MercyCare HMO Silver Option C","58326WI009",,"WIN001","WIS002","WIF001","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090016-01","Standard Silver On Exchange Plan","68.19%","0.681926786899567","No","Yes","No","100%",,"$3,000","$20","$1,280","$150","$3,000","$200","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Silver-Opt-C-58326WI0090016.pdf",,"31"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090016","MercyCare HMO Silver Option C","58326WI009",,"WIN001","WIS002","WIF001","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090016-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/05/HMO-Silver-Opt-C-Zero-Cost-Share-58326WI0090016-02.pdf",,"32"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070105","MercyCare EPO CO-80 $2,000 Deductible; $20/$40/$60 Rx","58326WI007",,"WIN002","WIS001","WIF008","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0070105-00","Standard Gold Off Exchange Plan","78.13%","0.781251490116119","No","Yes","No","100%",,"$2,000","$20","$1,050","$150","$2,000","$730","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/EPO-CO-80-2000-Ded-58326WI0070105.pdf",,"32"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070105","MercyCare EPO CO-80 $2,000 Deductible; $20/$40/$60 Rx","58326WI007",,"WIN002","WIS001","WIF008","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0070105-01","Standard Gold On Exchange Plan","78.13%","0.781251490116119","No","Yes","No","100%",,"$2,000","$20","$1,050","$150","$2,000","$730","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/EPO-CO-80-2000-Ded-58326WI0070105.pdf",,"33"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090016","MercyCare HMO Silver Option C","58326WI009",,"WIN001","WIS002","WIF001","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090016-03","Limited Cost Sharing Plan Variation","68.19%","0.681926786899567","No","Yes","No","100%",,"$3,000","$20","$1,280","$150","$3,000","$200","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Silver-Opt-C-58326WI0090016.pdf",,"33"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090016","MercyCare HMO Silver Option C","58326WI009",,"WIN001","WIS002","WIF001","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090016-04","73% AV Level Silver Plan","73.58%","0.735833048820496","No","Yes","No","100%",,"$2,000","$20","$1,050","$150","$2,000","$290","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Silver-Opt-C-73-CSR-58326WI0090016-04.pdf",,"34"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070106","MercyCare EPO CO-70 $2,500 Deductible; $20/$40/$60 Rx","58326WI007",,"WIN002","WIS001","WIF008","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0070106-00","Standard Silver Off Exchange Plan","71.50%","0.714959919452667","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$620","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/EPO-CO-70-2500-Ded-58326WI0070106.pdf",,"34"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070106","MercyCare EPO CO-70 $2,500 Deductible; $20/$40/$60 Rx","58326WI007",,"WIN002","WIS001","WIF008","New","EPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0070106-01","Standard Silver On Exchange Plan","71.50%","0.714959919452667","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$620","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/EPO-CO-70-2500-Ded-58326WI0070106.pdf",,"35"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090016","MercyCare HMO Silver Option C","58326WI009",,"WIN001","WIS002","WIF001","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090016-05","87% AV Level Silver Plan","87.60%","0.875950932502747","No","Yes","No","100%",,"$500","$0","$1,000","$150","$500","$380","$440","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Silver-Opt-C-87-CSR-58326WI0090016-05-1.pdf",,"35"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090016","MercyCare HMO Silver Option C","58326WI009",,"WIN001","WIS002","WIF001","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090016-06","94% AV Level Silver Plan","93.82%","0.938189566135406","No","Yes","No","100%",,"$0","$20","$730","$150","$0","$400","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Silver-Opt-C-94-CSR-58326WI0090016-06.pdf",,"36"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090006","MercyCare HMO Bronze Option A","58326WI009",,"WIN001","WIS002","WIF005","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090006-00","Standard Bronze Off Exchange Plan","60.75%","0.607517838478088","Yes","Yes","No","100%",,"$5,020","$0","$680","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Bronze-Opt-A-58326WI0090006.pdf",,"37"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090006","MercyCare HMO Bronze Option A","58326WI009",,"WIN001","WIS002","WIF005","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090006-01","Standard Bronze On Exchange Plan","60.75%","0.607517838478088","Yes","Yes","No","100%",,"$5,020","$0","$680","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Bronze-Opt-A-58326WI0090006.pdf",,"38"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090006","MercyCare HMO Bronze Option A","58326WI009",,"WIN001","WIS002","WIF005","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/05/HMO-Bronze-Opt-A-Zero-Cost-Share-58326WI0090006-02.pdf",,"39"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090006","MercyCare HMO Bronze Option A","58326WI009",,"WIN001","WIS002","WIF005","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090006-03","Limited Cost Sharing Plan Variation","60.75%","0.607517838478088","Yes","Yes","No","100%",,"$5,020","$0","$680","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Bronze-Opt-A-58326WI0090006.pdf",,"40"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090018","MercyCare HMO Bronze Option B","58326WI009",,"WIN001","WIS002","WIF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090018-00","Standard Bronze Off Exchange Plan","61.93%","0.619310796260834","Yes","Yes","No","100%",,"$3,800","$0","$1,390","$150","$3,800","$0","$590","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Bronze-Opt-B-58326WI0090018.pdf",,"41"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090018","MercyCare HMO Bronze Option B","58326WI009",,"WIN001","WIS002","WIF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090018-01","Standard Bronze On Exchange Plan","61.93%","0.619310796260834","Yes","Yes","No","100%",,"$3,800","$0","$1,390","$150","$3,800","$0","$590","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Bronze-Opt-B-58326WI0090018.pdf",,"42"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090018","MercyCare HMO Bronze Option B","58326WI009",,"WIN001","WIS002","WIF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090018-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/05/HMO-Bronze-Opt-B-Zero-Cost-Share-58326WI0090018-02.pdf",,"43"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090018","MercyCare HMO Bronze Option B","58326WI009",,"WIN001","WIS002","WIF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090018-03","Limited Cost Sharing Plan Variation","61.93%","0.619310796260834","Yes","Yes","No","100%",,"$3,800","$0","$1,390","$150","$3,800","$0","$590","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Bronze-Opt-B-58326WI0090018.pdf",,"44"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090019","MercyCare HMO Bronze Option C","58326WI009",,"WIN001","WIS002","WIF006","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090019-00","Standard Bronze Off Exchange Plan","59.94%","0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Bronze-Opt-C-58326WI0090019.pdf",,"45"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090019","MercyCare HMO Bronze Option C","58326WI009",,"WIN001","WIS002","WIF006","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090019-01","Standard Bronze On Exchange Plan","59.94%","0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Bronze-Opt-C-58326WI0090019.pdf",,"46"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260023","3000D 20 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260023-06","94% AV Level Silver Plan","94.16%","0.946677923202515","No","Yes","No","100%",,"$100","$10","$120","$150","$100","$160","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-100d-ov-10-94av.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-100d-ov-10-94av.pdf","27"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","2","58564","WI","Individual","No","39-1565691","58564WI0260021","4000D","58564WI026","7477556600","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260021-00","Standard Silver Off Exchange Plan","68.68%","0.686785042285919","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-4000d-hsa.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-4000d.pdf","16"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","2","58564","WI","Individual","No","39-1565691","58564WI0260021","4000D","58564WI026","7477556600","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260021-01","Standard Silver On Exchange Plan","68.68%","0.686785042285919","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-4000d-hsa.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-4000d.pdf","17"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","2","58564","WI","Individual","No","39-1565691","58564WI0260021","4000D","58564WI026","7477556600","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260021-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-zero-cost-sharing.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-zero-cost-sharing.pdf","18"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","2","58564","WI","Individual","No","39-1565691","58564WI0260021","4000D","58564WI026","7477556600","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260021-03","Limited Cost Sharing Plan Variation","68.68%","0.686785042285919","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","Yes",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-4000d-hsa.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-4000d.pdf","19"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","4","58564","WI","Individual","No","39-1565691","58564WI0260032","5500D OV 25","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260032-05","87% AV Level Silver Plan","86.47%","0.866815209388733","No","Yes","No","100%",,"$710","$10","$0","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-1750d-ov-20-87av.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-1750d-ov20-87av.pdf","16"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090019","MercyCare HMO Bronze Option C","58326WI009",,"WIN001","WIS002","WIF006","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090019-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/05/HMO-Bronze-Opt-C-Zero-Cost-Share-58326WI0090019-02.pdf",,"47"
"2016","WI","58326","HIOS","6","2016-07-08 07:33:42","1","58326","WI","Individual","No","20-1482553","58326WI0090019","MercyCare HMO Bronze Option C","58326WI009",,"WIN001","WIS002","WIF006","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9948",,,,"0","0","0","2016-01-01","2016-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://mercycarehealthplans.com/line-premium-payment/","http://mercycarehealthplans.com/pharmacy-programs/","58326WI0090019-03","Limited Cost Sharing Plan Variation","59.94%","0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://72.52.162.26/~mercycare/wp-content/uploads/2015/04/HMO-Bronze-Opt-C-58326WI0090019.pdf",,"48"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260027","1500D 20 COINS OV 35","58564WI026","7477556600","WIN001","WIS001","WIF004","New","HMO","Gold","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260027-00","Standard Gold Off Exchange Plan","78.88%","0.788730323314667","No","Yes","No","100%",,"$710","$10","$890","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-1500d-20-coins-ov-35.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-1500d-20coins-ov35.pdf","6"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260027","1500D 20 COINS OV 35","58564WI026","7477556600","WIN001","WIS001","WIF004","New","HMO","Gold","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260027-01","Standard Gold On Exchange Plan","78.88%","0.788730323314667","No","Yes","No","100%",,"$710","$10","$890","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-1500d-20-coins-ov-35.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-1500d-20coins-ov35.pdf","7"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260027","1500D 20 COINS OV 35","58564WI026","7477556600","WIN001","WIS001","WIF004","New","HMO","Gold","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260027-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-zero-cost-sharing.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-zero-cost-sharing.pdf","8"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260027","1500D 20 COINS OV 35","58564WI026","7477556600","WIN001","WIS001","WIF004","New","HMO","Gold","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260027-03","Limited Cost Sharing Plan Variation","78.88%","0.788730323314667","No","Yes","No","100%",,"$710","$10","$890","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-1500d-20-coins-ov-35.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-1500d-20coins-ov35.pdf","9"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260029","2000D 20 COINS OV 35","58564WI026","7477556600","WIN001","WIS001","WIF004","New","HMO","Gold","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260029-00","Standard Gold Off Exchange Plan","78.38%","0.783725678920746","No","Yes","No","100%",,"$710","$10","$890","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-2000d-20-coins-ov-35.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-2000d-20coins-ov35.pdf","10"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260029","2000D 20 COINS OV 35","58564WI026","7477556600","WIN001","WIS001","WIF004","New","HMO","Gold","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260029-01","Standard Gold On Exchange Plan","78.38%","0.783725678920746","No","Yes","No","100%",,"$710","$10","$890","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-2000d-20-coins-ov-35.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-2000d-20coins-ov35.pdf","11"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260029","2000D 20 COINS OV 35","58564WI026","7477556600","WIN001","WIS001","WIF004","New","HMO","Gold","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260029-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-zero-cost-sharing.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-zero-cost-sharing.pdf","12"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260029","2000D 20 COINS OV 35","58564WI026","7477556600","WIN001","WIS001","WIF004","New","HMO","Gold","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260029-03","Limited Cost Sharing Plan Variation","78.38%","0.783725678920746","No","Yes","No","100%",,"$710","$10","$890","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-2000d-20-coins-ov-35.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-2000d-20coins-ov35.pdf","13"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260022","3000D 30 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260022-00","Standard Silver Off Exchange Plan","68.47%","0.684689342975616","No","Yes","No","100%",,"$2,790","$10","$1,340","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-3000d-30-coins-ov-40.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-3000d-30coins-ov40.pdf","14"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260022","3000D 30 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260022-01","Standard Silver On Exchange Plan","68.47%","0.684689342975616","No","Yes","No","100%",,"$2,790","$10","$1,340","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-3000d-30-coins-ov-40.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-3000d-30coins-ov40.pdf","15"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260022","3000D 30 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260022-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-zero-cost-sharing.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-zero-cost-sharing.pdf","16"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260022","3000D 30 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260022-03","Limited Cost Sharing Plan Variation","68.47%","0.684689342975616","No","Yes","No","100%",,"$2,790","$10","$1,340","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-3000d-30-coins-ov-40.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-3000d-30coins-ov40.pdf","17"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260022","3000D 30 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260022-04","73% AV Level Silver Plan","72.67%","0.726753771305084","No","Yes","No","100%",,"$2,200","$10","$0","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","$2,200","$2200 per person","$4400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-2200d-ov-40-73av.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-2200d-ov40-73av.pdf","18"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260022","3000D 30 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260022-05","87% AV Level Silver Plan","86.58%","0.871368169784546","No","Yes","No","100%",,"$710","$10","$0","$150","$750","$110","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$750","$750 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-750d-ov-20-87av.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-750d-ov-20-87av.pdf","19"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260022","3000D 30 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260022-06","94% AV Level Silver Plan","94.16%","0.946677923202515","No","Yes","No","100%",,"$100","$10","$120","$150","$100","$160","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-100d-ov-10-94av.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-100d-ov-10-94av.pdf","20"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260023","3000D 20 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260023-00","Standard Silver Off Exchange Plan","68.29%","0.682881534099579","No","Yes","No","100%",,"$2,790","$10","$1,340","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-3000d-20-coins-ov-40.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-3000d-20coins-ov40.pdf","21"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","2","58564","WI","Individual","No","39-1565691","58564WI0260020","6600D 50 COINS","58564WI026","7477556600","WIN001","WIS001","WIF002","New","HMO","Bronze","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260020-01","Standard Bronze On Exchange Plan","58.51%","0.585051894187927","Yes","Yes","No","100%",,"$2,790","$0","$2,240","$150","$1,150","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-6600d-50-coins.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-6600d-50coins.pdf","9"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","2","58564","WI","Individual","No","39-1565691","58564WI0260020","6600D 50 COINS","58564WI026","7477556600","WIN001","WIS001","WIF002","New","HMO","Bronze","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260020-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-zero-cost-sharing.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-zero-cost-sharing.pdf","10"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","2","58564","WI","Individual","No","39-1565691","58564WI0260020","6600D 50 COINS","58564WI026","7477556600","WIN001","WIS001","WIF002","New","HMO","Bronze","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260020-03","Limited Cost Sharing Plan Variation","58.51%","0.585051894187927","Yes","Yes","No","100%",,"$2,790","$0","$2,240","$150","$1,150","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-6600d-50-coins.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-6600d-50coins.pdf","11"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","4","58564","WI","Individual","No","39-1565691","58564WI0260032","5500D OV 25","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260032-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-zero-cost-sharing.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-zero-cost-sharing.pdf","13"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","4","58564","WI","Individual","No","39-1565691","58564WI0260032","5500D OV 25","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260032-03","Limited Cost Sharing Plan Variation","68.00%","0.680032432079315","No","Yes","No","100%",,"$2,790","$20","$0","$150","$1,150","$400","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-5500d-ov-25.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-5500d-ov25.pdf","14"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","4","58564","WI","Individual","No","39-1565691","58564WI0260032","5500D OV 25","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260032-04","73% AV Level Silver Plan","72.90%","0.736495077610016","No","Yes","No","100%",,"$2,790","$20","$0","$150","$1,150","$400","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-4500d-ov-25-er-200-73av.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-4500d-ov25-er200-73av.pdf","15"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","1","79475","WI","Individual","No","39-1462554","79475WI0340021","Anthem Silver Blue Priority X WI 2500/10%","79475WI034",,"WIN001","WIS001","WIF013","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340021-03","Limited Cost Sharing Plan Variation","70.09%","0.733864367008209","Yes","Yes","No","100%",,"$2,500","$750","$336","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GN7","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","9"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","1","79475","WI","Individual","No","39-1462554","79475WI0340021","Anthem Silver Blue Priority X WI 2500/10%","79475WI034",,"WIN001","WIS001","WIF013","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340021-04","73% AV Level Silver Plan","72.45%","0.752365529537201","Yes","Yes","No","100%",,"$2,450","$750","$341","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GN9","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","10"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260023","3000D 20 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260023-01","Standard Silver On Exchange Plan","68.29%","0.682881534099579","No","Yes","No","100%",,"$2,790","$10","$1,340","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-3000d-20-coins-ov-40.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-3000d-20coins-ov40.pdf","22"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260023","3000D 20 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260023-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-zero-cost-sharing.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-zero-cost-sharing.pdf","23"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260023","3000D 20 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260023-03","Limited Cost Sharing Plan Variation","68.29%","0.682881534099579","No","Yes","No","100%",,"$2,790","$10","$1,340","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-3000d-20-coins-ov-40.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-3000d-20coins-ov40.pdf","24"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260023","3000D 20 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260023-04","73% AV Level Silver Plan","72.67%","0.726753771305084","No","Yes","No","100%",,"$2,200","$10","$0","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","$2,200","$2200 per person","$4400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-2200d-ov-40-73av.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-2200d-ov40-73av.pdf","25"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260023","3000D 20 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260023-05","87% AV Level Silver Plan","86.58%","0.871368169784546","No","Yes","No","100%",,"$710","$10","$0","$150","$750","$110","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$750","$750 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-750d-ov-20-87av.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-750d-ov-20-87av.pdf","26"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260024","2500D 30 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260024-00","Standard Silver Off Exchange Plan","69.26%","0.692610859870911","No","Yes","No","100%",,"$2,500","$10","$1,430","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-2500d-30c-ov40.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-2500d-30coins-ov40.pdf","28"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260024","2500D 30 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260024-01","Standard Silver On Exchange Plan","69.26%","0.692610859870911","No","Yes","No","100%",,"$2,500","$10","$1,430","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-2500d-30c-ov40.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-2500d-30coins-ov40.pdf","29"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260024","2500D 30 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260024-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-zero-cost-sharing.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-zero-cost-sharing.pdf","30"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260024","2500D 30 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260024-03","Limited Cost Sharing Plan Variation","69.26%","0.692610859870911","No","Yes","No","100%",,"$2,500","$10","$1,430","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-2500d-30c-ov40.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-2500d-30coins-ov40.pdf","31"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260024","2500D 30 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260024-04","73% AV Level Silver Plan","72.67%","0.726753771305084","No","Yes","No","100%",,"$2,200","$10","$0","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","$2,200","$2200 per person","$4400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-2200d-ov-40-73av.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-2200d-ov40-73av.pdf","32"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260024","2500D 30 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260024-05","87% AV Level Silver Plan","86.58%","0.871368169784546","No","Yes","No","100%",,"$710","$10","$0","$150","$750","$110","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$750","$750 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-750d-ov-20-87av.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-750d-ov-20-87av.pdf","33"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260024","2500D 30 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260024-06","94% AV Level Silver Plan","94.16%","0.946677923202515","No","Yes","No","100%",,"$100","$10","$120","$150","$100","$160","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-100d-ov-10-94av.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-100d-ov-10-94av.pdf","34"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260025","2500D 20 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260025-00","Standard Silver Off Exchange Plan","69.32%","0.693267643451691","No","Yes","No","100%",,"$2,500","$10","$1,430","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-2500d-20-coins-ov-40.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-2500d-20-coins-ov40.pdf","35"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260025","2500D 20 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260025-01","Standard Silver On Exchange Plan","69.32%","0.693267643451691","No","Yes","No","100%",,"$2,500","$10","$1,430","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-2500d-20-coins-ov-40.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-2500d-20-coins-ov40.pdf","36"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260025","2500D 20 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260025-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-zero-cost-sharing.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-zero-cost-sharing.pdf","37"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260025","2500D 20 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260025-03","Limited Cost Sharing Plan Variation","69.32%","0.693267643451691","No","Yes","No","100%",,"$2,500","$10","$1,430","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-2500d-20-coins-ov-40.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-2500d-20-coins-ov40.pdf","38"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260025","2500D 20 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260025-04","73% AV Level Silver Plan","72.67%","0.726753771305084","No","Yes","No","100%",,"$2,200","$10","$0","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,400","$4400 per person","$8800 per group","$2,200","$2200 per person","$4400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-2200d-ov-40-73av.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-2200d-ov40-73av.pdf","39"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260025","2500D 20 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260025-05","87% AV Level Silver Plan","86.58%","0.871368169784546","No","Yes","No","100%",,"$710","$10","$0","$150","$750","$110","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$750","$750 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-750d-ov-20-87av.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-750d-ov-20-87av.pdf","40"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","1","58564","WI","Individual","No","39-1565691","58564WI0260025","2500D 20 COINS OV 40","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260025-06","94% AV Level Silver Plan","94.16%","0.946677923202515","No","Yes","No","100%",,"$100","$10","$120","$150","$100","$160","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-100d-ov-10-94av.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-100d-ov-10-94av.pdf","41"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","2","58564","WI","Individual","No","39-1565691","58564WI0260018","6550D","58564WI026","7477556600","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260018-00","Standard Bronze Off Exchange Plan","59.94%","0.5993931889534","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group","Yes",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-6550d-hsa.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-6550d.pdf","4"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","2","58564","WI","Individual","No","39-1565691","58564WI0260018","6550D","58564WI026","7477556600","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260018-01","Standard Bronze On Exchange Plan","59.94%","0.5993931889534","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group","Yes",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-6550d-hsa.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-6550d.pdf","5"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","2","58564","WI","Individual","No","39-1565691","58564WI0260018","6550D","58564WI026","7477556600","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260018-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-zero-cost-sharing.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-zero-cost-sharing.pdf","6"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","2","58564","WI","Individual","No","39-1565691","58564WI0260018","6550D","58564WI026","7477556600","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260018-03","Limited Cost Sharing Plan Variation","59.94%","0.5993931889534","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group","Yes",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-6550d-hsa.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-6550d.pdf","7"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","2","58564","WI","Individual","No","39-1565691","58564WI0260020","6600D 50 COINS","58564WI026","7477556600","WIN001","WIS001","WIF002","New","HMO","Bronze","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260020-00","Standard Bronze Off Exchange Plan","58.51%","0.585051894187927","Yes","Yes","No","100%",,"$2,790","$0","$2,240","$150","$1,150","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-6600d-50-coins.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-6600d-50coins.pdf","8"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","2","58564","WI","Individual","No","39-1565691","58564WI0260028","2250D","58564WI026","7477556600","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260028-00","Standard Gold Off Exchange Plan","78.88%","0.788755416870117","Yes","Yes","No","100%",,"$2,250","$0","$0","$150","$1,150","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","Yes",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-2250d-hsa.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-2250d.pdf","12"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","2","58564","WI","Individual","No","39-1565691","58564WI0260028","2250D","58564WI026","7477556600","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260028-01","Standard Gold On Exchange Plan","78.88%","0.788755416870117","Yes","Yes","No","100%",,"$2,250","$0","$0","$150","$1,150","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","Yes",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-2250d-hsa.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-2250d.pdf","13"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","2","58564","WI","Individual","No","39-1565691","58564WI0260028","2250D","58564WI026","7477556600","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260028-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-zero-cost-sharing.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-zero-cost-sharing.pdf","14"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","2","58564","WI","Individual","No","39-1565691","58564WI0260028","2250D","58564WI026","7477556600","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260028-03","Limited Cost Sharing Plan Variation","78.88%","0.788755416870117","Yes","Yes","No","100%",,"$2,250","$0","$0","$150","$1,150","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","Yes",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-2250d-hsa.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-2250d.pdf","15"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","2","58564","WI","Individual","No","39-1565691","58564WI0260021","4000D","58564WI026","7477556600","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260021-04","73% AV Level Silver Plan","73.90%","0.738955080509186","Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-3000d-hsa-73av.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-3000d-73av.pdf","20"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","2","58564","WI","Individual","No","39-1565691","58564WI0260021","4000D","58564WI026","7477556600","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260021-05","87% AV Level Silver Plan","87.13%","0.874577879905701","Yes","Yes","No","100%",,"$710","$0","$0","$150","$1,010","$0","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group","No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-1150d-hsa-87av.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-1150d-87av.pdf","21"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","2","58564","WI","Individual","No","39-1565691","58564WI0260021","4000D","58564WI026","7477556600","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260021-06","94% AV Level Silver Plan","93.60%","0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$150","$500","$450","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-500d-hsa-94av.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-500d-94av.pdf","22"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","3","58564","WI","Individual","No","39-1565691","58564WI0260016","6850D","58564WI026","7477556600","WIN001","WIS001","WIF001","New","HMO","Catastrophic","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","3","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260016-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-6850d.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-6850d.pdf","4"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","3","58564","WI","Individual","No","39-1565691","58564WI0260016","6850D","58564WI026","7477556600","WIN001","WIS001","WIF001","New","HMO","Catastrophic","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","3","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260016-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-6850d.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-6850d.pdf","5"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","3","58564","WI","Individual","No","39-1565691","58564WI0260017","6600D OV 75 LTD","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","3","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260017-00","Standard Bronze Off Exchange Plan","59.62%","0.602400124073029","No","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$6,600","$6600 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-6600d-ov-75-ltd.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-6600d-ov75-ltd.pdf","6"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","3","58564","WI","Individual","No","39-1565691","58564WI0260017","6600D OV 75 LTD","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","3","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260017-01","Standard Bronze On Exchange Plan","59.62%","0.602400124073029","No","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$6,600","$6600 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-6600d-ov-75-ltd.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-6600d-ov75-ltd.pdf","7"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","3","58564","WI","Individual","No","39-1565691","58564WI0260017","6600D OV 75 LTD","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","3","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260017-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-zero-cost-sharing.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-zero-cost-sharing.pdf","8"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","3","58564","WI","Individual","No","39-1565691","58564WI0260017","6600D OV 75 LTD","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","3","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260017-03","Limited Cost Sharing Plan Variation","59.62%","0.602400124073029","No","Yes","No","100%",,"$2,790","$0","$0","$150","$1,150","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$6,600","$6600 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-6600d-ov-75-ltd.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-6600d-ov75-ltd.pdf","9"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","3","58564","WI","Individual","No","39-1565691","58564WI0260019","6600D 50 COINS OV 75 LTD","58564WI026","7477556600","WIN001","WIS001","WIF002","New","HMO","Bronze","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","3","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260019-00","Standard Bronze Off Exchange Plan","59.59%","0.59741598367691","Yes","Yes","No","100%",,"$2,790","$0","$2,240","$150","$1,150","$75","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-6600d-50-coins-ov-75-ltd.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-6600d-50coins-ov75-ltd.pdf","10"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","3","58564","WI","Individual","No","39-1565691","58564WI0260019","6600D 50 COINS OV 75 LTD","58564WI026","7477556600","WIN001","WIS001","WIF002","New","HMO","Bronze","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","3","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260019-01","Standard Bronze On Exchange Plan","59.59%","0.59741598367691","Yes","Yes","No","100%",,"$2,790","$0","$2,240","$150","$1,150","$75","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-6600d-50-coins-ov-75-ltd.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-6600d-50coins-ov75-ltd.pdf","11"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","3","58564","WI","Individual","No","39-1565691","58564WI0260019","6600D 50 COINS OV 75 LTD","58564WI026","7477556600","WIN001","WIS001","WIF002","New","HMO","Bronze","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","3","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260019-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-zero-cost-sharing.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-zero-cost-sharing.pdf","12"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","3","58564","WI","Individual","No","39-1565691","58564WI0260019","6600D 50 COINS OV 75 LTD","58564WI026","7477556600","WIN001","WIS001","WIF002","New","HMO","Bronze","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","3","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260019-03","Limited Cost Sharing Plan Variation","59.59%","0.59741598367691","Yes","Yes","No","100%",,"$2,790","$0","$2,240","$150","$1,150","$75","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-6600d-50-coins-ov-75-ltd.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-6600d-50coins-ov75-ltd.pdf","13"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","4","58564","WI","Individual","No","39-1565691","58564WI0260031","5250D OV 25","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260031-00","Standard Silver Off Exchange Plan","68.84%","0.688418447971344","No","Yes","No","100%",,"$2,790","$20","$0","$150","$1,150","$400","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-5250d-ov-25.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-5250d-ov25.pdf","4"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","4","58564","WI","Individual","No","39-1565691","58564WI0260031","5250D OV 25","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260031-01","Standard Silver On Exchange Plan","68.84%","0.688418447971344","No","Yes","No","100%",,"$2,790","$20","$0","$150","$1,150","$400","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-5250d-ov-25.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-5250d-ov25.pdf","5"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","4","58564","WI","Individual","No","39-1565691","58564WI0260031","5250D OV 25","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260031-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-zero-cost-sharing.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-zero-cost-sharing.pdf","6"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","4","58564","WI","Individual","No","39-1565691","58564WI0260031","5250D OV 25","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260031-03","Limited Cost Sharing Plan Variation","68.84%","0.688418447971344","No","Yes","No","100%",,"$2,790","$20","$0","$150","$1,150","$400","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-5250d-ov-25.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-5250d-ov25.pdf","7"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","4","58564","WI","Individual","No","39-1565691","58564WI0260031","5250D OV 25","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260031-04","73% AV Level Silver Plan","72.88%","0.736495077610016","No","Yes","No","100%",,"$2,790","$20","$0","$150","$1,150","$400","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-4500d-ov-25-73av.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-4500d-ov25-73av.pdf","8"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","4","58564","WI","Individual","No","39-1565691","58564WI0260031","5250D OV 25","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260031-05","87% AV Level Silver Plan","86.47%","0.866815209388733","No","Yes","No","100%",,"$710","$10","$0","$150","$1,150","$200","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-1750d-ov-20-87av.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-1750d-ov20-87av.pdf","9"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","4","58564","WI","Individual","No","39-1565691","58564WI0260031","5250D OV 25","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260031-06","94% AV Level Silver Plan","93.72%","0.940276086330414","No","Yes","No","100%",,"$650","$0","$0","$150","$580","$20","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$650","$650 per person","$1300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-650d-ov-20-94av.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-650d-ov20-94av.pdf","10"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","4","58564","WI","Individual","No","39-1565691","58564WI0260032","5500D OV 25","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260032-00","Standard Silver Off Exchange Plan","68.00%","0.680032432079315","No","Yes","No","100%",,"$2,790","$20","$0","$150","$1,150","$400","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-5500d-ov-25.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-5500d-ov25.pdf","11"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","4","58564","WI","Individual","No","39-1565691","58564WI0260032","5500D OV 25","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260032-01","Standard Silver On Exchange Plan","68.00%","0.680032432079315","No","Yes","No","100%",,"$2,790","$20","$0","$150","$1,150","$400","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-5500d-ov-25.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-5500d-ov25.pdf","12"
"2016","WI","58564","HIOS","7","2015-10-20 04:38:50","4","58564","WI","Individual","No","39-1565691","58564WI0260032","5500D OV 25","58564WI026","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All Specialty Care with the exception of OB/GYN requires prior authorization","Any services performed by a Non-participating: Physician, Hospital, Facility or other Provider.  Any services for which Prior Authorization was required but was not obtained. Services or supplies that are not Medically Indicated and/or not appropriate or the standard of care to treat the illness or injury, as deteremined by Physicians Plus","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan. Emergency care until the patient is stabilized for transport to a facility in the Service Area.","No",,"http://www.pplusic.com/documents/upload/2016premierformulary.pdf","58564WI0260032-06","94% AV Level Silver Plan","93.72%","0.940276086330414","No","Yes","No","100%",,"$650","$0","$0","$150","$580","$20","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$650","$650 per person","$1300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pplusic.com/documents/upload/2016-ind-aca-650d-ov-20-94av.pdf","http://www.pplusic.com/documents/upload/2016-ind-aca-sob-650d-ov20-94av.pdf","17"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","1","79475","WI","Individual","No","39-1462554","79475WI0340023","Anthem Silver Blue Priority X WI 1850/20%","79475WI034",,"WIN001","WIS001","WIF015","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340023-05","87% AV Level Silver Plan","87.07%","0.873311877250671","Yes","Yes","No","100%",,"$750","$500","$250","$0","$750","$30","$74","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GNN","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","18"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","1","79475","WI","Individual","No","39-1462554","79475WI0340023","Anthem Silver Blue Priority X WI 1850/20%","79475WI034",,"WIN001","WIS001","WIF015","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340023-06","94% AV Level Silver Plan","93.84%","0.934682071208954","Yes","Yes","No","100%",,"$175","$250","$225","$0","$175","$20","$191","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GNP","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","19"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","2","79475","WI","Individual","No","39-1462554","79475WI0340015","Anthem Bronze Blue Priority X WI 5850 20","79475WI034",,"WIN001","WIS001","WIF016","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340015-00","Standard Bronze Off Exchange Plan","62.00%","0.636431634426117","Yes","Yes","No","100%",,"$5,850","$0","$152","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMM","http://editiondigital.net/view/IU65/2016/OFF_HIX_WI_KIT_2016","4"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","2","79475","WI","Individual","No","39-1462554","79475WI0340015","Anthem Bronze Blue Priority X WI 5850 20","79475WI034",,"WIN001","WIS001","WIF016","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340015-01","Standard Bronze On Exchange Plan","62.00%","0.636431634426117","Yes","Yes","No","100%",,"$5,850","$0","$152","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMK","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","5"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","2","79475","WI","Individual","No","39-1462554","79475WI0340015","Anthem Bronze Blue Priority X WI 5850 20","79475WI034",,"WIN001","WIS001","WIF016","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GML","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","6"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","2","79475","WI","Individual","No","39-1462554","79475WI0340015","Anthem Bronze Blue Priority X WI 5850 20","79475WI034",,"WIN001","WIS001","WIF016","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340015-03","Limited Cost Sharing Plan Variation","62.00%","0.636431634426117","Yes","Yes","No","100%",,"$5,850","$0","$152","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMK","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","7"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340016","Anthem Bronze Blue Priority X WI 6050 25","79475WI034",,"WIN001","WIS001","WIF017","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340016-00","Standard Bronze Off Exchange Plan","61.63%","0.622079193592072","Yes","Yes","No","100%",,"$6,050","$0","$280","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMQ","http://editiondigital.net/view/IU65/2016/OFF_HIX_WI_KIT_2016","4"
"2016","WI","62011","HIOS","1","2015-05-01 02:23:41","1","62011","WI","SHOP (Small Group)","Yes","93-0242990","62011WI0040002","EHB High PPO","62011WI004",,"WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$50.43","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","62011WI0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","WI","62011","HIOS","1","2015-05-01 02:23:41","1","62011","WI","SHOP (Small Group)","Yes","93-0242990","62011WI0040001","EHB Low PPO","62011WI004",,"WIN001","WIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.97","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","62011WI0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","WI","62011","HIOS","1","2015-05-01 02:23:41","1","62011","WI","SHOP (Small Group)","Yes","93-0242990","62011WI0030002","EHB High Passive","62011WI003",,"WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$52.74","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","62011WI0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","WI","62011","HIOS","1","2015-05-01 02:23:41","1","62011","WI","SHOP (Small Group)","Yes","93-0242990","62011WI0030001","EHB Low Passive","62011WI003",,"WIN001","WIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.48","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","62011WI0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","WI","66115","HIOS","1","2015-05-01 02:23:41","1","66115","WI","SHOP (Small Group)","Yes","47-0098400","66115WI0040002","EHB High PPO","66115WI004",,"WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$49.59","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","66115WI0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","WI","66115","HIOS","1","2015-05-01 02:23:41","1","66115","WI","SHOP (Small Group)","Yes","47-0098400","66115WI0040001","EHB Low PPO","66115WI004",,"WIN001","WIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.52","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","66115WI0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","WI","66115","HIOS","1","2015-05-01 02:23:41","1","66115","WI","SHOP (Small Group)","Yes","47-0098400","66115WI0030002","EHB High Passive","66115WI003",,"WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$51.86","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","66115WI0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","WI","66115","HIOS","1","2015-05-01 02:23:41","1","66115","WI","SHOP (Small Group)","Yes","47-0098400","66115WI0030001","EHB Low Passive","66115WI003",,"WIN001","WIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.96","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","66115WI0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","WI","69380","HIOS","1","2015-05-16 13:12:29","1","69380","WI","SHOP (Small Group)","Yes","57-0523959","69380WI0030001","Group Dental Policy","69380WI003",,"WIN001","WIS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.31","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","69380WI0030001-00","Standard High Off Exchange Plan","85.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","69589","HIOS","1","2015-04-29 10:59:03","1","69589","WI","SHOP (Small Group)","Yes","13-5123390","69589WI0010003","Guardian Pediatric Advantage","69589WI001",,"WIN001","WIS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$28.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","69589WI0010003-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","WI","69589","HIOS","1","2015-04-29 10:59:03","1","69589","WI","SHOP (Small Group)","Yes","13-5123390","69589WI0020003","Guardian Pediatric Essentials","69589WI002",,"WIN001","WIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$20.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","69589WI0020003-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","WI","69589","HIOS","1","2015-04-29 10:59:03","2","69589","WI","SHOP (Small Group)","Yes","13-5123390","69589WI0040003","Guardian Family Advantage","69589WI004",,"WIN001","WIS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","69589WI0040003-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","WI","69589","HIOS","1","2015-04-29 10:59:03","2","69589","WI","SHOP (Small Group)","Yes","13-5123390","69589WI0040003","Guardian Family Advantage","69589WI004",,"WIN001","WIS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","69589WI0040003-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","WI","69589","HIOS","1","2015-04-29 10:59:03","2","69589","WI","SHOP (Small Group)","Yes","13-5123390","69589WI0060003","Guardian Family Essentials","69589WI006",,"WIN001","WIS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","69589WI0060003-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","WI","69589","HIOS","1","2015-04-29 10:59:03","2","69589","WI","SHOP (Small Group)","Yes","13-5123390","69589WI0060003","Guardian Family Essentials","69589WI006",,"WIN001","WIS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","69589WI0060003-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","WI","69883","HIOS","2","2015-07-09 13:17:42","1","69883","WI","SHOP (Small Group)","Yes","81-0170040","69883WI0010001","Assurant Dental ACAFFO High","69883WI001",,"WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$45.79","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","69883WI0010001-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","69883","HIOS","2","2015-07-09 13:17:42","1","69883","WI","SHOP (Small Group)","Yes","81-0170040","69883WI0010002","Assurant Dental ACAFFO Low","69883WI001",,"WIN001","WIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$38.09","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","69883WI0010002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","WI","77525","HIOS","1","2015-05-06 02:44:46","1","77525","WI","Individual","Yes","72-0977315","77525WI0050001","AlwaysCare All-Star Kids Dental Plan 2016","77525WI005",,"WIN001","WIS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$21.93","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","77525WI0050001-00","Standard High Off Exchange Plan","86.15%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","WI","77525","HIOS","1","2015-05-06 02:44:46","1","77525","WI","SHOP (Small Group)","Yes","72-0977315","77525WI0080001","AlwaysCare Small Group Dental – Child 2016","77525WI008",,"WIN001","WIS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$28.43","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","77525WI0080001-00","Standard High Off Exchange Plan","86.15%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","WI","77525","HIOS","1","2015-05-06 02:44:46","1","77525","WI","SHOP (Small Group)","Yes","72-0977315","77525WI0080002","AlwaysCare Small Group Dental – Child 2016","77525WI008",,"WIN001","WIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$23.37","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","77525WI0080002-00","Standard Low Off Exchange Plan","70.82%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","WI","77525","HIOS","1","2015-05-06 02:44:46","1","77525","WI","Individual","Yes","72-0977315","77525WI0050002","AlwaysCare All-Star Kids Dental Plan 2016","77525WI005",,"WIN001","WIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$17.81","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","77525WI0050002-00","Standard Low Off Exchange Plan","70.82%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","WI","77525","HIOS","1","2015-05-06 02:44:46","2","77525","WI","Individual","Yes","72-0977315","77525WI0060001","AlwaysCare All-Star Family Dental Plan 2016","77525WI006",,"WIN001","WIS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$21.93","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","77525WI0060001-00","Standard High Off Exchange Plan","86.15%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","WI","77525","HIOS","1","2015-05-06 02:44:46","2","77525","WI","SHOP (Small Group)","Yes","72-0977315","77525WI0070001","AlwaysCare Small Group Dental – Adults 2016","77525WI007",,"WIN001","WIS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$28.43","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","77525WI0070001-00","Standard High Off Exchange Plan","86.15%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","WI","77525","HIOS","1","2015-05-06 02:44:46","2","77525","WI","SHOP (Small Group)","Yes","72-0977315","77525WI0070002","AlwaysCare Small Group Dental – Adults 2016","77525WI007",,"WIN001","WIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$23.37","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","77525WI0070002-00","Standard Low Off Exchange Plan","70.82%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","WI","77525","HIOS","1","2015-05-06 02:44:46","3","77525","WI","Individual","Yes","72-0977315","77525WI0060002","AlwaysCare All-Star Family Dental Plan 2016","77525WI006",,"WIN001","WIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$17.81","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","77525WI0060002-00","Standard Low Off Exchange Plan","70.82%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","1","79475","WI","Individual","No","39-1462554","79475WI0340014","Anthem Catastrophic Blue Priority X WI 6850/0%","79475WI034",,"WIN001","WIS001","WIF001","Existing","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340014-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,554","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMJ","http://editiondigital.net/view/IU65/2016/OFF_HIX_WI_KIT_2016","4"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","1","79475","WI","Individual","No","39-1462554","79475WI0340014","Anthem Catastrophic Blue Priority X WI 6850/0%","79475WI034",,"WIN001","WIS001","WIF001","Existing","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340014-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,554","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMH","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","5"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","1","79475","WI","Individual","No","39-1462554","79475WI0340021","Anthem Silver Blue Priority X WI 2500/10%","79475WI034",,"WIN001","WIS001","WIF013","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340021-00","Standard Silver Off Exchange Plan","70.09%","0.733864367008209","Yes","Yes","No","100%",,"$2,500","$750","$336","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GNC","http://editiondigital.net/view/IU65/2016/OFF_HIX_WI_KIT_2016","6"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","1","79475","WI","Individual","No","39-1462554","79475WI0340021","Anthem Silver Blue Priority X WI 2500/10%","79475WI034",,"WIN001","WIS001","WIF013","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340021-01","Standard Silver On Exchange Plan","70.09%","0.733864367008209","Yes","Yes","No","100%",,"$2,500","$750","$336","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GN7","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","7"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","1","79475","WI","Individual","No","39-1462554","79475WI0340021","Anthem Silver Blue Priority X WI 2500/10%","79475WI034",,"WIN001","WIS001","WIF013","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340021-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GN8","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","8"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","1","79475","WI","Individual","No","39-1462554","79475WI0340021","Anthem Silver Blue Priority X WI 2500/10%","79475WI034",,"WIN001","WIS001","WIF013","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340021-05","87% AV Level Silver Plan","87.62%","0.878777503967285","Yes","Yes","No","100%",,"$750","$500","$250","$0","$750","$50","$35","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GNA","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","11"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","1","79475","WI","Individual","No","39-1462554","79475WI0340021","Anthem Silver Blue Priority X WI 2500/10%","79475WI034",,"WIN001","WIS001","WIF013","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340021-06","94% AV Level Silver Plan","94.49%","0.940643012523651","Yes","Yes","No","100%",,"$200","$250","$150","$0","$200","$20","$93","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GNB","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","12"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","1","79475","WI","Individual","No","39-1462554","79475WI0340023","Anthem Silver Blue Priority X WI 1850/20%","79475WI034",,"WIN001","WIS001","WIF015","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340023-00","Standard Silver Off Exchange Plan","69.94%","0.726495444774628","Yes","Yes","No","100%",,"$1,850","$750","$802","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GNQ","http://editiondigital.net/view/IU65/2016/OFF_HIX_WI_KIT_2016","13"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","1","79475","WI","Individual","No","39-1462554","79475WI0340023","Anthem Silver Blue Priority X WI 1850/20%","79475WI034",,"WIN001","WIS001","WIF015","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340023-01","Standard Silver On Exchange Plan","69.94%","0.726495444774628","Yes","Yes","No","100%",,"$1,850","$750","$802","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GNK","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","14"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","1","79475","WI","Individual","No","39-1462554","79475WI0340023","Anthem Silver Blue Priority X WI 1850/20%","79475WI034",,"WIN001","WIS001","WIF015","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340023-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GNL","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","15"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","1","79475","WI","Individual","No","39-1462554","79475WI0340023","Anthem Silver Blue Priority X WI 1850/20%","79475WI034",,"WIN001","WIS001","WIF015","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340023-03","Limited Cost Sharing Plan Variation","69.94%","0.726495444774628","Yes","Yes","No","100%",,"$1,850","$750","$802","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GNK","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","16"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","1","79475","WI","Individual","No","39-1462554","79475WI0340023","Anthem Silver Blue Priority X WI 1850/20%","79475WI034",,"WIN001","WIS001","WIF015","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340023-04","73% AV Level Silver Plan","73.37%","0.75480192899704","Yes","Yes","No","100%",,"$1,700","$750","$832","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GNM","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","17"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340016","Anthem Bronze Blue Priority X WI 6050 25","79475WI034",,"WIN001","WIS001","WIF017","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340016-01","Standard Bronze On Exchange Plan","61.63%","0.622079193592072","Yes","Yes","No","100%",,"$6,050","$0","$140","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMN","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","5"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340016","Anthem Bronze Blue Priority X WI 6050 25","79475WI034",,"WIN001","WIS001","WIF017","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340016-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMP","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","6"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340016","Anthem Bronze Blue Priority X WI 6050 25","79475WI034",,"WIN001","WIS001","WIF017","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340016-03","Limited Cost Sharing Plan Variation","61.63%","0.622079193592072","Yes","Yes","No","100%",,"$6,050","$0","$140","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,050","$6050 per person","$12100 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMN","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","7"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340017","Anthem Bronze Blue Priority X WI 0 for HSA","79475WI034",,"WIN001","WIS001","WIF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340017-00","Standard Bronze Off Exchange Plan","59.94%","0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMU","http://editiondigital.net/view/IU65/2016/OFF_HIX_WI_KIT_2016","8"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340017","Anthem Bronze Blue Priority X WI 0 for HSA","79475WI034",,"WIN001","WIS001","WIF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340017-01","Standard Bronze On Exchange Plan","59.94%","0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMR","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","9"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340017","Anthem Bronze Blue Priority X WI 0 for HSA","79475WI034",,"WIN001","WIS001","WIF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340017-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMT","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","10"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340017","Anthem Bronze Blue Priority X WI 0 for HSA","79475WI034",,"WIN001","WIS001","WIF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340017-03","Limited Cost Sharing Plan Variation","59.94%","0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMR","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","11"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340018","Anthem Bronze Blue Priority X WI 30 for HSA","79475WI034",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340018-00","Standard Bronze Off Exchange Plan","61.26%","0.61313408613205","Yes","Yes","No","100%",,"$4,650","$223","$688","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMX","http://editiondigital.net/view/IU65/2016/OFF_HIX_WI_KIT_2016","12"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340018","Anthem Bronze Blue Priority X WI 30 for HSA","79475WI034",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340018-01","Standard Bronze On Exchange Plan","61.26%","0.61313408613205","Yes","Yes","No","100%",,"$4,650","$0","$588","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMV","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","13"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340018","Anthem Bronze Blue Priority X WI 30 for HSA","79475WI034",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340018-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMW","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","14"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340018","Anthem Bronze Blue Priority X WI 30 for HSA","79475WI034",,"WIN001","WIS001","WIF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340018-03","Limited Cost Sharing Plan Variation","61.26%","0.61313408613205","Yes","Yes","No","100%",,"$4,650","$0","$588","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMV","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","15"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340020","Anthem Silver Blue Priority X WI 3750 10","79475WI034",,"WIN001","WIS001","WIF013","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340020-00","Standard Silver Off Exchange Plan","70.38%","0.708719551563263","Yes","Yes","No","100%",,"$3,750","$750","$267","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GN6","http://editiondigital.net/view/IU65/2016/OFF_HIX_WI_KIT_2016","16"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340020","Anthem Silver Blue Priority X WI 3750 10","79475WI034",,"WIN001","WIS001","WIF013","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340020-01","Standard Silver On Exchange Plan","70.38%","0.708719551563263","Yes","Yes","No","100%",,"$3,750","$565","$230","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GN1","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","17"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340020","Anthem Silver Blue Priority X WI 3750 10","79475WI034",,"WIN001","WIS001","WIF013","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340020-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GN2","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","18"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340020","Anthem Silver Blue Priority X WI 3750 10","79475WI034",,"WIN001","WIS001","WIF013","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340020-03","Limited Cost Sharing Plan Variation","70.38%","0.708719551563263","Yes","Yes","No","100%",,"$3,750","$565","$230","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GN1","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","19"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340020","Anthem Silver Blue Priority X WI 3750 10","79475WI034",,"WIN001","WIS001","WIF013","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340020-04","73% AV Level Silver Plan","72.82%","0.735063374042511","Yes","Yes","No","100%",,"$3,100","$750","$276","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GN3","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","20"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340020","Anthem Silver Blue Priority X WI 3750 10","79475WI034",,"WIN001","WIS001","WIF013","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340020-05","87% AV Level Silver Plan","86.78%","0.867301821708679","Yes","Yes","No","100%",,"$800","$500","$531","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GN4","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","21"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340020","Anthem Silver Blue Priority X WI 3750 10","79475WI034",,"WIN001","WIS001","WIF013","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340020-06","94% AV Level Silver Plan","94.37%","0.939776122570038","Yes","Yes","No","100%",,"$200","$250","$200","$0","$200","$20","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GN5","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","22"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340022","Anthem Silver Blue Priority X WI 10 for HSA","79475WI034",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340022-00","Standard Silver Off Exchange Plan","68.62%","0.69658088684082","Yes","Yes","No","100%",,"$3,000","$750","$342","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GNJ","http://editiondigital.net/view/IU65/2016/OFF_HIX_WI_KIT_2016","23"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340022","Anthem Silver Blue Priority X WI 10 for HSA","79475WI034",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340022-01","Standard Silver On Exchange Plan","68.62%","0.69658088684082","Yes","Yes","No","100%",,"$3,000","$750","$286","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GND","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","24"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340022","Anthem Silver Blue Priority X WI 10 for HSA","79475WI034",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340022-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GNE","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","25"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340022","Anthem Silver Blue Priority X WI 10 for HSA","79475WI034",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340022-03","Limited Cost Sharing Plan Variation","68.62%","0.69658088684082","Yes","Yes","No","100%",,"$3,000","$750","$286","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GND","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","26"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340022","Anthem Silver Blue Priority X WI 10 for HSA","79475WI034",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340022-04","73% AV Level Silver Plan","72.80%","0.730841338634491","Yes","Yes","No","100%",,"$2,600","$750","$250","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GNF","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","27"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340022","Anthem Silver Blue Priority X WI 10 for HSA","79475WI034",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340022-05","87% AV Level Silver Plan","87.46%","0.874577879905701","Yes","Yes","No","100%",,"$1,150","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GNG","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","28"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340022","Anthem Silver Blue Priority X WI 10 for HSA","79475WI034",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340022-06","94% AV Level Silver Plan","93.96%","0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$0","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GNH","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","29"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340025","Anthem Bronze Blue Priority X WI 40 for HSA","79475WI034",,"WIN001","WIS001","WIF004","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340025-00","Standard Bronze Off Exchange Plan","60.40%","0.601964175701141","Yes","Yes","No","100%",,"$5,500","$0","$444","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X0P","http://editiondigital.net/view/IU65/2016/OFF_HIX_WI_KIT_2016","30"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340025","Anthem Bronze Blue Priority X WI 40 for HSA","79475WI034",,"WIN001","WIS001","WIF004","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340025-01","Standard Bronze On Exchange Plan","60.40%","0.601964175701141","Yes","Yes","No","100%",,"$5,500","$0","$444","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X0Q","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","31"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340025","Anthem Bronze Blue Priority X WI 40 for HSA","79475WI034",,"WIN001","WIS001","WIF004","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340025-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X0R","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","32"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340025","Anthem Bronze Blue Priority X WI 40 for HSA","79475WI034",,"WIN001","WIS001","WIF004","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340025-03","Limited Cost Sharing Plan Variation","60.40%","0.601964175701141","Yes","Yes","No","100%",,"$5,500","$0","$444","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X0Q","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","33"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340026","Anthem Bronze Blue Priority X WI 5450 30","79475WI034",,"WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340026-00","Standard Bronze Off Exchange Plan","58.85%","0.591137230396271","Yes","Yes","No","100%",,"$5,450","$0","$348","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X0S","http://editiondigital.net/view/IU65/2016/OFF_HIX_WI_KIT_2016","34"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340026","Anthem Bronze Blue Priority X WI 5450 30","79475WI034",,"WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340026-01","Standard Bronze On Exchange Plan","58.85%","0.591137230396271","Yes","Yes","No","100%",,"$5,450","$0","$348","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X0T","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","35"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340026","Anthem Bronze Blue Priority X WI 5450 30","79475WI034",,"WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340026-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X0U","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","36"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","3","79475","WI","Individual","No","39-1462554","79475WI0340026","Anthem Bronze Blue Priority X WI 5450 30","79475WI034",,"WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340026-03","Limited Cost Sharing Plan Variation","58.85%","0.591137230396271","Yes","Yes","No","100%",,"$5,450","$0","$348","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X0T","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","37"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","4","79475","WI","Individual","No","39-1462554","79475WI0340027","Anthem Silver Blue Priority X WI 4000 25","79475WI034",,"WIN001","WIS001","WIF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340027-00","Standard Silver Off Exchange Plan","68.20%","0.684162259101868","No","Yes","No","100%",,"$4,000","$315","$574","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X0V","http://editiondigital.net/view/IU65/2016/OFF_HIX_WI_KIT_2016","4"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","4","79475","WI","Individual","No","39-1462554","79475WI0340027","Anthem Silver Blue Priority X WI 4000 25","79475WI034",,"WIN001","WIS001","WIF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340027-01","Standard Silver On Exchange Plan","68.20%","0.684162259101868","No","Yes","No","100%",,"$4,000","$315","$574","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X0W","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","5"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","4","79475","WI","Individual","No","39-1462554","79475WI0340027","Anthem Silver Blue Priority X WI 4000 25","79475WI034",,"WIN001","WIS001","WIF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340027-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd28ZS","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","6"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","4","79475","WI","Individual","No","39-1462554","79475WI0340027","Anthem Silver Blue Priority X WI 4000 25","79475WI034",,"WIN001","WIS001","WIF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340027-03","Limited Cost Sharing Plan Variation","68.20%","0.684162259101868","No","Yes","No","100%",,"$4,000","$315","$574","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X0W","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","7"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","4","79475","WI","Individual","No","39-1462554","79475WI0340027","Anthem Silver Blue Priority X WI 4000 25","79475WI034",,"WIN001","WIS001","WIF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340027-04","73% AV Level Silver Plan","72.19%","0.729619562625885","No","Yes","No","100%",,"$2,250","$750","$903","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X0Y","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","8"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","4","79475","WI","Individual","No","39-1462554","79475WI0340027","Anthem Silver Blue Priority X WI 4000 25","79475WI034",,"WIN001","WIS001","WIF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340027-05","87% AV Level Silver Plan","87.30%","0.850091457366943","No","Yes","No","100%",,"$750","$500","$250","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X0Z","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","9"
"2016","WI","79475","HIOS","11","2015-10-18 12:35:12","4","79475","WI","Individual","No","39-1462554","79475WI0340027","Anthem Silver Blue Priority X WI 4000 25","79475WI034",,"WIN001","WIS001","WIF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","https://www.anthem.com/WISelectdrugtier4","79475WI0340027-06","94% AV Level Silver Plan","94.01%","0.924169778823853","No","Yes","No","100%",,"$250","$225","$125","$0","$250","$40","$44","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X10","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","10"
"2016","WI","79597","HIOS","3","2015-08-07 03:04:31","1","79597","WI","Individual","Yes","39-6094742","79597WI0030001","Delta Dental Individual and Family High Plan","79597WI003",,"WIN001","WIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.24","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","79597WI0030001-00","Standard High Off Exchange Plan","85.10%",,,,"Yes","55%","45%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,"$25","$25 per person","$75 per group",,"$25","$25 per person","$75 per group","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_High_Plan.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_High_Plan.pdf","4"
"2016","WI","79597","HIOS","3","2015-08-07 03:04:31","1","79597","WI","SHOP (Small Group)","Yes","39-6094742","79597WI0040001","Delta Dental PPO Plus Premier Family Plan High Option","79597WI004",,"WIN002","WIS001",,"Existing","PPO","High",,"Both",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$32.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes",,"","79597WI0040001-00","Standard High Off Exchange Plan","85.10%",,,,"Yes","55%","45%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,"$25","$25 per person","$75 per group",,"$25","$25 per person","$75 per group","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2015/SG_FamilyHighPlan.pdf","http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2015/SG_FamilyHighPlan.pdf","4"
"2016","WI","79597","HIOS","3","2015-08-07 03:04:31","1","79597","WI","SHOP (Small Group)","Yes","39-6094742","79597WI0040001","Delta Dental PPO Plus Premier Family Plan High Option","79597WI004",,"WIN002","WIS001",,"Existing","PPO","High",,"Both",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$32.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes",,"","79597WI0040001-01","Standard High On Exchange Plan","85.10%",,,,"Yes","55%","45%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,"$25","$25 per person","$75 per group",,"$25","$25 per person","$75 per group","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2015/SG_FamilyHighPlan.pdf","http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2015/SG_FamilyHighPlan.pdf","5"
"2016","WI","79597","HIOS","3","2015-08-07 03:04:31","1","79597","WI","Individual","Yes","39-6094742","79597WI0030001","Delta Dental Individual and Family High Plan","79597WI003",,"WIN001","WIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.24","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","79597WI0030001-01","Standard High On Exchange Plan","85.10%",,,,"Yes","55%","45%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,"$25","$25 per person","$75 per group",,"$25","$25 per person","$75 per group","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_High_Plan.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_High_Plan.pdf","5"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","2","81413","WI","Individual","No","39-1442058","81413WI0470002","Prestige Silver 20","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470002-04","73% AV Level Silver Plan",,"0.737114131450653","Yes","Yes","No","100%",,"$3,100","$70","$990","$150","$140","$1,730","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/silver2073av.pdf","http://www.networkhealth.com/plans/individualbrochuresewi.pdf","15"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","2","81413","WI","Individual","No","39-1442058","81413WI0470002","Prestige Silver 20","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470002-05","87% AV Level Silver Plan",,"0.87376457452774","Yes","Yes","No","100%",,"$1,500","$50","$700","$150","$140","$1,360","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/silver2087av.pdf","http://www.networkhealth.com/plans/individualbrochuresewi.pdf","16"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","2","81413","WI","Individual","No","39-1442058","81413WI0470002","Prestige Silver 20","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470002-06","94% AV Level Silver Plan",,"0.94186407327652","Yes","Yes","No","100%",,"$500","$50","$260","$150","$100","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/silver2094av.pdf","http://www.networkhealth.com/plans/individualbrochuresewi.pdf","17"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","3","81413","WI","Individual","No","39-1442058","81413WI0460003","Prestige Silver 0","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460003-00","Standard Silver Off Exchange Plan",,"0.707096219062805","Yes","Yes","No","100%",,"$4,350","$20","$0","$150","$1,150","$1,230","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,,,"4"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","3","81413","WI","Individual","No","39-1442058","81413WI0460003","Prestige Silver 0","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460003-01","Standard Silver On Exchange Plan",,"0.707096219062805","Yes","Yes","No","100%",,"$4,350","$20","$0","$150","$1,150","$1,230","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/silver0.pdf","http://www.networkhealth.com/plans/individualbrochurenewi.pdf","5"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250048","Aspirus Arise HMO 4000","84670WI125","7467455680","WIN001","WIS001","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250048-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125004804","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125004804.pdf","12"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250048","Aspirus Arise HMO 4000","84670WI125","7467455680","WIN001","WIS001","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250048-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125004805","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125004805.pdf","13"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330119","Arise AboutHealth HMO 3000 HDHP","84670WI133","7467455680","WIN001","WIS007","WIF005","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330119-01","Standard Silver On Exchange Plan",,"0.688159942626953","Yes","Yes","No","100%",,"$3,000","$0","$360","$30","$3,000","$0","$190","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133011901","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133011901.pdf","13"
"2016","WI","79597","HIOS","3","2015-08-07 03:04:31","2","79597","WI","Individual","Yes","39-6094742","79597WI0030002","Delta Dental Individual and Family Low Plan Major","79597WI003",,"WIN001","WIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","79597WI0030002-00","Standard Low Off Exchange Plan","72.00%",,,,"Yes","55%","45%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,"$75","$75 per person","$225 per group",,"$75","$75 per person","$225 per group","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_Low_Plan_Major.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_Low_Plan_Major.pdf","4"
"2016","WI","79597","HIOS","3","2015-08-07 03:04:31","2","79597","WI","SHOP (Small Group)","Yes","39-6094742","79597WI0040002","Delta Dental PPO Plus Premier Family Plan Low Option","79597WI004",,"WIN002","WIS001",,"Existing","PPO","Low",,"Both",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.12","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes",,"","79597WI0040002-00","Standard Low Off Exchange Plan","72.00%",,,,"Yes","55%","45%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,"$75","$75 per person","$225 per group",,"$75","$75 per person","$225 per group","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2015/SG_FamilyLowPlan.pdf","http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2015/SG_FamilyLowPlan.pdf","4"
"2016","WI","79597","HIOS","3","2015-08-07 03:04:31","2","79597","WI","SHOP (Small Group)","Yes","39-6094742","79597WI0040002","Delta Dental PPO Plus Premier Family Plan Low Option","79597WI004",,"WIN002","WIS001",,"Existing","PPO","Low",,"Both",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.12","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes",,"","79597WI0040002-01","Standard Low On Exchange Plan","72.00%",,,,"Yes","55%","45%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,"$75","$75 per person","$225 per group",,"$75","$75 per person","$225 per group","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2015/SG_FamilyLowPlan.pdf","http://www.deltadentalwi.com/assets/docs/ACA_Exchange/2015/SG_FamilyLowPlan.pdf","5"
"2016","WI","79597","HIOS","3","2015-08-07 03:04:31","2","79597","WI","Individual","Yes","39-6094742","79597WI0030002","Delta Dental Individual and Family Low Plan Major","79597WI003",,"WIN001","WIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","79597WI0030002-01","Standard Low On Exchange Plan","72.00%",,,,"Yes","55%","45%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,"$75","$75 per person","$225 per group",,"$75","$75 per person","$225 per group","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_Low_Plan_Major.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_Low_Plan_Major.pdf","5"
"2016","WI","79597","HIOS","3","2015-08-07 03:04:31","3","79597","WI","Individual","Yes","39-6094742","79597WI0030003","Delta Dental Individual and Family Low Plan","79597WI003",,"WIN001","WIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","79597WI0030003-00","Standard Low Off Exchange Plan","72.00%",,,,"Yes","55%","45%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,"$75","$75 per person","$225 per group",,"$75","$75 per person","$225 per group","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_Low_Plan.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_Low_Plan.pdf","4"
"2016","WI","79597","HIOS","3","2015-08-07 03:04:31","3","79597","WI","SHOP (Small Group)","Yes","39-6094742","79597WI0040003","Delta Dental PPO Plus Premier Family Plan High Option Orthodontics","79597WI004",,"WIN002","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.71","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes",,"","79597WI0040003-00","Standard High Off Exchange Plan","85.10%",,,,"Yes","55%","45%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,"$25","$25 per person","$75 per group",,"$25","$25 per person","$75 per group","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","79597","HIOS","3","2015-08-07 03:04:31","3","79597","WI","Individual","Yes","39-6094742","79597WI0030003","Delta Dental Individual and Family Low Plan","79597WI003",,"WIN001","WIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network.  Through the Delta Dental Plan Association there is a nationwide network presence.","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","79597WI0030003-01","Standard Low On Exchange Plan","72.00%",,,,"Yes","55%","45%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,"$75","$75 per person","$225 per group",,"$75","$75 per person","$225 per group","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_Low_Plan.pdf","https://www.deltadentalcoversme.com/enrollment/pdfs/DDWI_Individual_Low_Plan.pdf","5"
"2016","WI","80550","HIOS","4","2015-08-26 09:56:12","1","80550","WI","SHOP (Small Group)","Yes","86-0307623","80550WI0010001","Smile for Health - Certified Optimum Coverage","80550WI001",,"WIN001","WIS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","80550WI0010001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","80550","HIOS","4","2015-08-26 09:56:12","2","80550","WI","SHOP (Small Group)","Yes","86-0307623","80550WI0010002","Smile for Health - Certified Optimum Coverage","80550WI001",,"WIN002","WIS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","80550WI0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","80550","HIOS","4","2015-08-26 09:56:12","3","80550","WI","SHOP (Small Group)","Yes","86-0307623","80550WI0010003","Smile for Health - Certified Optimum Coverage","80550WI001",,"WIN003","WIS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","80550WI0010003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","80550","HIOS","4","2015-08-26 09:56:12","4","80550","WI","SHOP (Small Group)","Yes","86-0307623","80550WI0010004","Smile for Health - Certified Optimum Coverage","80550WI001",,"WIN001","WIS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","80550WI0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","80550","HIOS","4","2015-08-26 09:56:12","5","80550","WI","SHOP (Small Group)","Yes","86-0307623","80550WI0010005","Smile for Health - Certified Optimum Coverage","80550WI001",,"WIN002","WIS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","80550WI0010005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","80550","HIOS","4","2015-08-26 09:56:12","6","80550","WI","SHOP (Small Group)","Yes","86-0307623","80550WI0010006","Smile for Health - Certified Optimum Coverage","80550WI001",,"WIN003","WIS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","80550WI0010006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","80550","HIOS","4","2015-08-26 09:56:12","7","80550","WI","SHOP (Small Group)","Yes","86-0307623","80550WI0020001","Smile for Health - Certified High Option","80550WI002",,"WIN001","WIS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","80550WI0020001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","80550","HIOS","4","2015-08-26 09:56:12","8","80550","WI","SHOP (Small Group)","Yes","86-0307623","80550WI0020002","Smile for Health - Certified High Option","80550WI002",,"WIN002","WIS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","80550WI0020002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","80550","HIOS","4","2015-08-26 09:56:12","9","80550","WI","SHOP (Small Group)","Yes","86-0307623","80550WI0020003","Smile for Health - Certified High Option","80550WI002",,"WIN003","WIS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","80550WI0020003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","80550","HIOS","4","2015-08-26 09:56:12","10","80550","WI","SHOP (Small Group)","Yes","86-0307623","80550WI0020004","Smile for Health - Certified High Option Plus","80550WI002",,"WIN001","WIS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","80550WI0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","80550","HIOS","4","2015-08-26 09:56:12","11","80550","WI","SHOP (Small Group)","Yes","86-0307623","80550WI0020005","Smile for Health - Certified High Option Plus","80550WI002",,"WIN002","WIS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","80550WI0020005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","80550","HIOS","4","2015-08-26 09:56:12","12","80550","WI","SHOP (Small Group)","Yes","86-0307623","80550WI0020006","Smile for Health - Certified High Option Plus","80550WI002",,"WIN003","WIS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","80550WI0020006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","81335","HIOS","2","2015-08-21 03:45:06","1","81335","WI","SHOP (Small Group)","Yes","13-5581829","81335WI0120001","EHB Basic Dental Plan (Low)","81335WI012",,"WIN001","WIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$18.82","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","81335WI0120001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WI","81335","HIOS","2","2015-08-21 03:45:06","2","81335","WI","SHOP (Small Group)","Yes","13-5581829","81335WI0140001","Family Basic Dental Plan (Low)","81335WI014",,"WIN001","WIS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$18.82","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","81335WI0140001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49139","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49138","4"
"2016","WI","81335","HIOS","2","2015-08-21 03:45:06","2","81335","WI","SHOP (Small Group)","Yes","13-5581829","81335WI0140001","Family Basic Dental Plan (Low)","81335WI014",,"WIN001","WIS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$18.82","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","81335WI0140001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49139","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49138","5"
"2016","WI","81335","HIOS","2","2015-08-21 03:45:06","3","81335","WI","SHOP (Small Group)","Yes","13-5581829","81335WI0150001","Family Enhanced Dental Plan (High)","81335WI015",,"WIN001","WIS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$23.23","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","81335WI0150001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49141","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49140","4"
"2016","WI","81335","HIOS","2","2015-08-21 03:45:06","3","81335","WI","SHOP (Small Group)","Yes","13-5581829","81335WI0150001","Family Enhanced Dental Plan (High)","81335WI015",,"WIN001","WIS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$23.23","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","81335WI0150001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49141","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49140","5"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","1","81413","WI","Individual","No","39-1442058","81413WI0460001","Prestige Bronze 20","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460001-00","Standard Bronze Off Exchange Plan",,"0.618134140968323","Yes","Yes","No","100%",,"$5,350","$0","$560","$150","$4,160","$50","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,,,"4"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","1","81413","WI","Individual","No","39-1442058","81413WI0460001","Prestige Bronze 20","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460001-01","Standard Bronze On Exchange Plan",,"0.618134140968323","Yes","Yes","No","100%",,"$5,350","$0","$560","$150","$4,160","$50","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/bronze20.pdf","http://www.networkhealth.com/plans/individualbrochurenewi.pdf","5"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","1","81413","WI","Individual","No","39-1442058","81413WI0460001","Prestige Bronze 20","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://networkhealth.com/benefits/sbc/bronze20na0.pdf","http://www.networkhealth.com/plans/individualbrochurenewi.pdf","6"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","1","81413","WI","Individual","No","39-1442058","81413WI0460001","Prestige Bronze 20","81413WI046","7114920748","WIN001","WIS001","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460001-03","Limited Cost Sharing Plan Variation",,"0.618134140968323","Yes","Yes","No","100%",,"$5,350","$0","$560","$150","$4,160","$50","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/bronze20nalim.pdf","http://www.networkhealth.com/plans/individualbrochurenewi.pdf","7"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","1","81413","WI","Individual","No","39-1442058","81413WI0470001","Prestige Bronze 20","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470001-00","Standard Bronze Off Exchange Plan",,"0.618134140968323","Yes","Yes","No","100%",,"$5,350","$0","$560","$150","$4,160","$50","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,,,"8"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","1","81413","WI","Individual","No","39-1442058","81413WI0470001","Prestige Bronze 20","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470001-01","Standard Bronze On Exchange Plan",,"0.618134140968323","Yes","Yes","No","100%",,"$5,350","$0","$560","$150","$4,160","$50","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/bronze20.pdf","http://www.networkhealth.com/plans/individualbrochuresewi.pdf","9"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","1","81413","WI","Individual","No","39-1442058","81413WI0470001","Prestige Bronze 20","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://networkhealth.com/benefits/sbc/bronze20na0.pdf","http://www.networkhealth.com/plans/individualbrochuresewi.pdf","10"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","1","81413","WI","Individual","No","39-1442058","81413WI0470001","Prestige Bronze 20","81413WI047","7114920748","WIN002","WIS002","WIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470001-03","Limited Cost Sharing Plan Variation",,"0.618134140968323","Yes","Yes","No","100%",,"$5,350","$0","$560","$150","$4,160","$50","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/bronze20nalim.pdf","http://www.networkhealth.com/plans/individualbrochuresewi.pdf","11"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","2","81413","WI","Individual","No","39-1442058","81413WI0460002","Prestige Silver 20","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460002-00","Standard Silver Off Exchange Plan",,"0.716621577739716","Yes","Yes","No","100%",,"$3,600","$70","$890","$150","$140","$1,730","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,,,"4"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","2","81413","WI","Individual","No","39-1442058","81413WI0460002","Prestige Silver 20","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460002-01","Standard Silver On Exchange Plan",,"0.716621577739716","Yes","Yes","No","100%",,"$3,600","$70","$890","$150","$140","$1,730","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/silver20.pdf","http://www.networkhealth.com/plans/individualbrochurenewi.pdf","5"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","2","81413","WI","Individual","No","39-1442058","81413WI0460002","Prestige Silver 20","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://networkhealth.com/benefits/sbc/silver20na0.pdf","http://www.networkhealth.com/plans/individualbrochurenewi.pdf","6"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","2","81413","WI","Individual","No","39-1442058","81413WI0460002","Prestige Silver 20","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460002-03","Limited Cost Sharing Plan Variation",,"0.716621577739716","Yes","Yes","No","100%",,"$3,600","$70","$890","$150","$140","$1,730","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/silver20nalim.pdf","http://www.networkhealth.com/plans/individualbrochurenewi.pdf","7"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","2","81413","WI","Individual","No","39-1442058","81413WI0460002","Prestige Silver 20","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460002-04","73% AV Level Silver Plan",,"0.737114131450653","Yes","Yes","No","100%",,"$3,100","$70","$990","$150","$140","$1,730","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/silver2073av.pdf","http://www.networkhealth.com/plans/individualbrochurenewi.pdf","8"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","2","81413","WI","Individual","No","39-1442058","81413WI0460002","Prestige Silver 20","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460002-05","87% AV Level Silver Plan",,"0.87376457452774","Yes","Yes","No","100%",,"$1,500","$50","$700","$150","$140","$1,360","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/silver2087av.pdf","http://www.networkhealth.com/plans/individualbrochurenewi.pdf","9"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","2","81413","WI","Individual","No","39-1442058","81413WI0460002","Prestige Silver 20","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460002-06","94% AV Level Silver Plan",,"0.94186407327652","Yes","Yes","No","100%",,"$500","$50","$260","$150","$100","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/silver2094av.pdf","http://www.networkhealth.com/plans/individualbrochurenewi.pdf","10"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","2","81413","WI","Individual","No","39-1442058","81413WI0470002","Prestige Silver 20","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470002-00","Standard Silver Off Exchange Plan",,"0.716621577739716","Yes","Yes","No","100%",,"$3,600","$70","$890","$150","$140","$1,730","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,,,"11"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","2","81413","WI","Individual","No","39-1442058","81413WI0470002","Prestige Silver 20","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470002-01","Standard Silver On Exchange Plan",,"0.716621577739716","Yes","Yes","No","100%",,"$3,600","$70","$890","$150","$140","$1,730","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/silver20.pdf","http://www.networkhealth.com/plans/individualbrochuresewi.pdf","12"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","2","81413","WI","Individual","No","39-1442058","81413WI0470002","Prestige Silver 20","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://networkhealth.com/benefits/sbc/silver20na0.pdf","http://www.networkhealth.com/plans/individualbrochuresewi.pdf","13"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","2","81413","WI","Individual","No","39-1442058","81413WI0470002","Prestige Silver 20","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470002-03","Limited Cost Sharing Plan Variation",,"0.716621577739716","Yes","Yes","No","100%",,"$3,600","$70","$890","$150","$140","$1,730","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/silver20nalim.pdf","http://www.networkhealth.com/plans/individualbrochuresewi.pdf","14"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","3","81413","WI","Individual","No","39-1442058","81413WI0460003","Prestige Silver 0","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://networkhealth.com/benefits/sbc/silver0na0.pdf","http://www.networkhealth.com/plans/individualbrochurenewi.pdf","6"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","3","81413","WI","Individual","No","39-1442058","81413WI0460003","Prestige Silver 0","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460003-03","Limited Cost Sharing Plan Variation",,"0.707096219062805","Yes","Yes","No","100%",,"$4,350","$20","$0","$150","$1,150","$1,230","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/silver0nalim.pdf","http://www.networkhealth.com/plans/individualbrochurenewi.pdf","7"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","3","81413","WI","Individual","No","39-1442058","81413WI0460003","Prestige Silver 0","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460003-04","73% AV Level Silver Plan",,"0.729377210140228","Yes","Yes","No","100%",,"$3,850","$20","$0","$150","$1,150","$1,230","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/silver073av.pdf","http://www.networkhealth.com/plans/individualbrochurenewi.pdf","8"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","3","81413","WI","Individual","No","39-1442058","81413WI0460003","Prestige Silver 0","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460003-05","87% AV Level Silver Plan",,"0.865849614143372","Yes","Yes","No","100%",,"$1,850","$20","$0","$150","$680","$820","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/silver087av.pdf","http://www.networkhealth.com/plans/individualbrochurenewi.pdf","9"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","3","81413","WI","Individual","No","39-1442058","81413WI0460003","Prestige Silver 0","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460003-06","94% AV Level Silver Plan",,"0.939286172389984","Yes","Yes","No","100%",,"$500","$20","$0","$150","$250","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/silver094av.pdf","http://www.networkhealth.com/plans/individualbrochurenewi.pdf","10"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","3","81413","WI","Individual","No","39-1442058","81413WI0470003","Prestige Silver 0","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470003-00","Standard Silver Off Exchange Plan",,"0.707096219062805","Yes","Yes","No","100%",,"$4,350","$20","$0","$150","$1,150","$1,230","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,,,"11"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","3","81413","WI","Individual","No","39-1442058","81413WI0470003","Prestige Silver 0","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470003-01","Standard Silver On Exchange Plan",,"0.707096219062805","Yes","Yes","No","100%",,"$4,350","$20","$0","$150","$1,150","$1,230","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/silver0.pdf","http://www.networkhealth.com/plans/individualbrochuresewi.pdf","12"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","3","81413","WI","Individual","No","39-1442058","81413WI0470003","Prestige Silver 0","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://networkhealth.com/benefits/sbc/silver0na0.pdf","http://www.networkhealth.com/plans/individualbrochuresewi.pdf","13"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","3","81413","WI","Individual","No","39-1442058","81413WI0470003","Prestige Silver 0","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470003-03","Limited Cost Sharing Plan Variation",,"0.707096219062805","Yes","Yes","No","100%",,"$4,350","$20","$0","$150","$1,150","$1,230","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/silver0nalim.pdf","http://www.networkhealth.com/plans/individualbrochuresewi.pdf","14"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","3","81413","WI","Individual","No","39-1442058","81413WI0470003","Prestige Silver 0","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470003-04","73% AV Level Silver Plan",,"0.729377210140228","Yes","Yes","No","100%",,"$3,850","$20","$0","$150","$1,150","$1,230","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/silver073av.pdf","http://www.networkhealth.com/plans/individualbrochuresewi.pdf","15"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","3","81413","WI","Individual","No","39-1442058","81413WI0470003","Prestige Silver 0","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470003-05","87% AV Level Silver Plan",,"0.865849614143372","Yes","Yes","No","100%",,"$1,850","$20","$0","$150","$680","$820","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/silver087av.pdf","http://www.networkhealth.com/plans/individualbrochuresewi.pdf","16"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","3","81413","WI","Individual","No","39-1442058","81413WI0470003","Prestige Silver 0","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470003-06","94% AV Level Silver Plan",,"0.939286172389984","Yes","Yes","No","100%",,"$500","$20","$0","$150","$250","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/silver094av.pdf","http://www.networkhealth.com/plans/individualbrochuresewi.pdf","17"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","4","81413","WI","Individual","No","39-1442058","81413WI0460004","Prestige Gold 10","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","6","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460004-00","Standard Gold Off Exchange Plan",,"0.810356140136719","Yes","Yes","No","100%",,"$1,850","$20","$630","$150","$1,000","$1,230","$15","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,,,"4"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","4","81413","WI","Individual","No","39-1442058","81413WI0460004","Prestige Gold 10","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","6","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460004-01","Standard Gold On Exchange Plan",,"0.810356140136719","Yes","Yes","No","100%",,"$1,850","$20","$630","$150","$1,000","$1,230","$15","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/gold10.pdf","http://www.networkhealth.com/plans/individualbrochurenewi.pdf","5"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","4","81413","WI","Individual","No","39-1442058","81413WI0460004","Prestige Gold 10","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","6","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://networkhealth.com/benefits/sbc/gold10na0.pdf","http://www.networkhealth.com/plans/individualbrochurenewi.pdf","6"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","4","81413","WI","Individual","No","39-1442058","81413WI0460004","Prestige Gold 10","81413WI046","7114920748","WIN001","WIS001","WIF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","6","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care required from tertiary entities","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0460004-03","Limited Cost Sharing Plan Variation",,"0.810356140136719","Yes","Yes","No","100%",,"$1,850","$20","$630","$150","$1,000","$1,230","$15","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/gold10nalim.pdf","http://www.networkhealth.com/plans/individualbrochurenewi.pdf","7"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","4","81413","WI","Individual","No","39-1442058","81413WI0470004","Prestige Gold 10","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","6","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470004-00","Standard Gold Off Exchange Plan",,"0.810356140136719","Yes","Yes","No","100%",,"$1,850","$20","$630","$150","$1,000","$1,230","$15","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,,,"8"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","4","81413","WI","Individual","No","39-1442058","81413WI0470004","Prestige Gold 10","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","6","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470004-01","Standard Gold On Exchange Plan",,"0.810356140136719","Yes","Yes","No","100%",,"$1,850","$20","$630","$150","$1,000","$1,230","$15","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/gold10.pdf","http://www.networkhealth.com/plans/individualbrochuresewi.pdf","9"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","4","81413","WI","Individual","No","39-1442058","81413WI0470004","Prestige Gold 10","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","6","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://networkhealth.com/benefits/sbc/gold10na0.pdf","http://www.networkhealth.com/plans/individualbrochuresewi.pdf","10"
"2016","WI","81413","HIOS","9","2015-08-20 09:36:54","4","81413","WI","Individual","No","39-1442058","81413WI0470004","Prestige Gold 10","81413WI047","7114920748","WIN002","WIS002","WIF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","6","0","2016-01-01","2016-12-31","No",,"Yes","Out of service area coverage limited to care from in-network providers at locations outside of the Southeast Wisconsin service area.","No","https://nhp.jet-insure.com/JI/consumerpayment.aspx","http://www.networkhealth.com/benefits/individualdruglist.php","81413WI0470004-03","Limited Cost Sharing Plan Variation",,"0.810356140136719","Yes","Yes","No","100%",,"$1,850","$20","$630","$150","$1,000","$1,230","$15","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://networkhealth.com/benefits/sbc/gold10nalim.pdf","http://www.networkhealth.com/plans/individualbrochuresewi.pdf","11"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330114","Arise AboutHealth HMO 2000 HDHP","84670WI133","7467455680","WIN001","WIS007","WIF006","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330114-00","Standard Gold Off Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$30","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133011400","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133011400.pdf","4"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250045","Aspirus Arise HMO 1500","84670WI125","7467455680","WIN001","WIS001","WIF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250045-00","Standard Gold Off Exchange Plan","81.85%","0.821058511734009","No","Yes","No","100%",,"$1,500","$110","$930","$30","$140","$1,830","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125004500","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125004500.pdf","4"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250045","Aspirus Arise HMO 1500","84670WI125","7467455680","WIN001","WIS001","WIF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250045-01","Standard Gold On Exchange Plan","81.85%","0.821058511734009","No","Yes","No","100%",,"$1,500","$110","$930","$30","$140","$1,830","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125004501","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125004501.pdf","5"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330114","Arise AboutHealth HMO 2000 HDHP","84670WI133","7467455680","WIN001","WIS007","WIF006","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330114-01","Standard Gold On Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$30","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133011401","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133011401.pdf","5"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330115","Arise AboutHealth HMO 1500 HDHP","84670WI133","7467455680","WIN001","WIS007","WIF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330115-00","Standard Silver Off Exchange Plan",,"0.697972118854523","Yes","Yes","No","100%",,"$1,500","$0","$1,530","$30","$1,500","$0","$1,020","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133011500","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133011500.pdf","6"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250045","Aspirus Arise HMO 1500","84670WI125","7467455680","WIN001","WIS001","WIF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250045-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125004502","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125004502.pdf","6"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250045","Aspirus Arise HMO 1500","84670WI125","7467455680","WIN001","WIS001","WIF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250045-03","Limited Cost Sharing Plan Variation","81.85%","0.821058511734009","No","Yes","No","100%",,"$1,500","$110","$930","$30","$140","$1,830","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125004503","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125004503.pdf","7"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330115","Arise AboutHealth HMO 1500 HDHP","84670WI133","7467455680","WIN001","WIS007","WIF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330115-01","Standard Silver On Exchange Plan",,"0.697972118854523","Yes","Yes","No","100%",,"$1,500","$0","$1,530","$30","$1,500","$0","$1,020","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133011501","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133011501.pdf","7"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330116","Arise AboutHealth HMO 2000-80 HDHP","84670WI133","7467455680","WIN001","WIS007","WIF004","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330116-00","Standard Silver Off Exchange Plan",,"0.717611312866211","Yes","Yes","No","100%",,"$2,000","$0","$920","$30","$2,000","$0","$580","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133011600","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133011600.pdf","8"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250048","Aspirus Arise HMO 4000","84670WI125","7467455680","WIN001","WIS001","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250048-00","Standard Silver Off Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125004800","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125004800.pdf","8"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250048","Aspirus Arise HMO 4000","84670WI125","7467455680","WIN001","WIS001","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250048-01","Standard Silver On Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125004801","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125004801.pdf","9"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330116","Arise AboutHealth HMO 2000-80 HDHP","84670WI133","7467455680","WIN001","WIS007","WIF004","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330116-01","Standard Silver On Exchange Plan",,"0.717611312866211","Yes","Yes","No","100%",,"$2,000","$0","$920","$30","$2,000","$0","$580","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133011601","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133011601.pdf","9"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330117","Arise AboutHealth HMO 2500 HDHP","84670WI133","7467455680","WIN001","WIS007","WIF004","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330117-00","Standard Silver Off Exchange Plan",,"0.683657169342041","Yes","Yes","No","100%",,"$2,500","$0","$820","$30","$2,500","$0","$480","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133011700","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133011700.pdf","10"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250048","Aspirus Arise HMO 4000","84670WI125","7467455680","WIN001","WIS001","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250048-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125004802","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125004802.pdf","10"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250048","Aspirus Arise HMO 4000","84670WI125","7467455680","WIN001","WIS001","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250048-03","Limited Cost Sharing Plan Variation","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125004803","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125004803.pdf","11"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330117","Arise AboutHealth HMO 2500 HDHP","84670WI133","7467455680","WIN001","WIS007","WIF004","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330117-01","Standard Silver On Exchange Plan",,"0.683657169342041","Yes","Yes","No","100%",,"$2,500","$0","$820","$30","$2,500","$0","$480","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133011701","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133011701.pdf","11"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330119","Arise AboutHealth HMO 3000 HDHP","84670WI133","7467455680","WIN001","WIS007","WIF005","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330119-00","Standard Silver Off Exchange Plan",,"0.688159942626953","Yes","Yes","No","100%",,"$3,000","$0","$360","$30","$3,000","$0","$190","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133011900","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133011900.pdf","12"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330120","Arise AboutHealth HMO 3500 HDHP","84670WI133","7467455680","WIN001","WIS007","WIF006","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330120-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133012000","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133012000.pdf","14"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250048","Aspirus Arise HMO 4000","84670WI125","7467455680","WIN001","WIS001","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250048-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125004806","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125004806.pdf","14"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250104","Aspirus Arise HMO 6000","84670WI125","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250104-00","Standard Silver Off Exchange Plan","70.34%","0.701759696006775","No","Yes","No","100%",,"$6,000","$110","$20","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010400","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010400.pdf","15"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330120","Arise AboutHealth HMO 3500 HDHP","84670WI133","7467455680","WIN001","WIS007","WIF006","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330120-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133012001","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133012001.pdf","15"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330122","Arise AboutHealth HMO 5000 HDHP","84670WI133","7467455680","WIN001","WIS007","WIF004","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330122-00","Standard Bronze Off Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$320","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133012200","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133012200.pdf","16"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250104","Aspirus Arise HMO 6000","84670WI125","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250104-01","Standard Silver On Exchange Plan","70.34%","0.701759696006775","No","Yes","No","100%",,"$6,000","$110","$20","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010401","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010401.pdf","16"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250104","Aspirus Arise HMO 6000","84670WI125","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250104-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010402","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010402.pdf","17"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330122","Arise AboutHealth HMO 5000 HDHP","84670WI133","7467455680","WIN001","WIS007","WIF004","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330122-01","Standard Bronze On Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$320","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133012201","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133012201.pdf","17"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330123","Arise AboutHealth HMO 6450 HDHP","84670WI133","7467455680","WIN001","WIS007","WIF006","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330123-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133012300","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133012300.pdf","18"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250104","Aspirus Arise HMO 6000","84670WI125","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250104-03","Limited Cost Sharing Plan Variation","70.34%","0.701759696006775","No","Yes","No","100%",,"$6,000","$110","$20","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010403","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010403.pdf","18"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250104","Aspirus Arise HMO 6000","84670WI125","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250104-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010404","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010404.pdf","19"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330123","Arise AboutHealth HMO 6450 HDHP","84670WI133","7467455680","WIN001","WIS007","WIF006","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330123-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133012301","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133012301.pdf","19"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330073","Aspirus Arise HMO 2000 HDHP","84670WI133","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330073-00","Standard Gold Off Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$30","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133007300","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133007300.pdf","20"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250104","Aspirus Arise HMO 6000","84670WI125","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250104-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010405","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010405.pdf","20"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250104","Aspirus Arise HMO 6000","84670WI125","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250104-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010406","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010406.pdf","21"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330073","Aspirus Arise HMO 2000 HDHP","84670WI133","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330073-01","Standard Gold On Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$30","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133007301","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133007301.pdf","21"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330078","Aspirus Arise HMO 1500 HDHP","84670WI133","7467455680","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330078-00","Standard Silver Off Exchange Plan",,"0.697972118854523","Yes","Yes","No","100%",,"$1,500","$0","$1,530","$30","$1,500","$0","$1,020","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133007800","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133007800.pdf","22"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250105","Aspirus Arise HMO 6850","84670WI125","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250105-00","Standard Silver Off Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010500","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010500.pdf","22"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250105","Aspirus Arise HMO 6850","84670WI125","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250105-01","Standard Silver On Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010501","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010501.pdf","23"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330078","Aspirus Arise HMO 1500 HDHP","84670WI133","7467455680","WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330078-01","Standard Silver On Exchange Plan",,"0.697972118854523","Yes","Yes","No","100%",,"$1,500","$0","$1,530","$30","$1,500","$0","$1,020","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133007801","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133007801.pdf","23"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330079","Aspirus Arise HMO 2000-80 HDHP","84670WI133","7467455680","WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330079-00","Standard Silver Off Exchange Plan",,"0.717611312866211","Yes","Yes","No","100%",,"$2,000","$0","$920","$30","$2,000","$0","$580","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133007900","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133007900.pdf","24"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250105","Aspirus Arise HMO 6850","84670WI125","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250105-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010502","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010502.pdf","24"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250105","Aspirus Arise HMO 6850","84670WI125","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250105-03","Limited Cost Sharing Plan Variation","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010503","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010503.pdf","25"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330079","Aspirus Arise HMO 2000-80 HDHP","84670WI133","7467455680","WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330079-01","Standard Silver On Exchange Plan",,"0.717611312866211","Yes","Yes","No","100%",,"$2,000","$0","$920","$30","$2,000","$0","$580","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133007901","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133007901.pdf","25"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330077","Aspirus Arise HMO 2500 HDHP","84670WI133","7467455680","WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330077-00","Standard Silver Off Exchange Plan",,"0.683657169342041","Yes","Yes","No","100%",,"$2,500","$0","$820","$30","$2,500","$0","$480","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133007700","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133007700.pdf","26"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250105","Aspirus Arise HMO 6850","84670WI125","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250105-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010504","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010504.pdf","26"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250105","Aspirus Arise HMO 6850","84670WI125","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250105-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010505","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010505.pdf","27"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330077","Aspirus Arise HMO 2500 HDHP","84670WI133","7467455680","WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330077-01","Standard Silver On Exchange Plan",,"0.683657169342041","Yes","Yes","No","100%",,"$2,500","$0","$820","$30","$2,500","$0","$480","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133007701","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133007701.pdf","27"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330076","Aspirus Arise HMO 3000 HDHP","84670WI133","7467455680","WIN001","WIS001","WIF005","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330076-00","Standard Silver Off Exchange Plan",,"0.688159942626953","Yes","Yes","No","100%",,"$3,000","$0","$360","$30","$3,000","$0","$190","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133007600","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133007600.pdf","28"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250105","Aspirus Arise HMO 6850","84670WI125","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250105-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010506","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010506.pdf","28"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250051","Aurora HMO 1500 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250051-00","Standard Gold Off Exchange Plan","81.85%","0.821058511734009","No","Yes","No","100%",,"$1,500","$110","$930","$30","$140","$1,830","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125005100","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125005100.pdf","29"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330076","Aspirus Arise HMO 3000 HDHP","84670WI133","7467455680","WIN001","WIS001","WIF005","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330076-01","Standard Silver On Exchange Plan",,"0.688159942626953","Yes","Yes","No","100%",,"$3,000","$0","$360","$30","$3,000","$0","$190","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133007601","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133007601.pdf","29"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330074","Aspirus Arise HMO 3500 HDHP","84670WI133","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330074-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133007400","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133007400.pdf","30"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250051","Aurora HMO 1500 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250051-01","Standard Gold On Exchange Plan","81.85%","0.821058511734009","No","Yes","No","100%",,"$1,500","$110","$930","$30","$140","$1,830","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125005101","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125005101.pdf","30"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250051","Aurora HMO 1500 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250051-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125005102","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125005102.pdf","31"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330074","Aspirus Arise HMO 3500 HDHP","84670WI133","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330074-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133007401","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133007401.pdf","31"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330081","Aspirus Arise HMO 5000 HDHP","84670WI133","7467455680","WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330081-00","Standard Bronze Off Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$320","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133008100","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133008100.pdf","32"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250051","Aurora HMO 1500 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250051-03","Limited Cost Sharing Plan Variation","81.85%","0.821058511734009","No","Yes","No","100%",,"$1,500","$110","$930","$30","$140","$1,830","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125005103","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125005103.pdf","32"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250054","Aurora HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250054-00","Standard Silver Off Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125005400","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125005400.pdf","33"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330081","Aspirus Arise HMO 5000 HDHP","84670WI133","7467455680","WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330081-01","Standard Bronze On Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$320","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133008101","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133008101.pdf","33"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330080","Aspirus Arise HMO 6450 HDHP","84670WI133","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330080-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133008000","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133008000.pdf","34"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250054","Aurora HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250054-01","Standard Silver On Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125005401","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125005401.pdf","34"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250054","Aurora HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250054-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125005402","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125005402.pdf","35"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330080","Aspirus Arise HMO 6450 HDHP","84670WI133","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330080-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133008001","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133008001.pdf","35"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250054","Aurora HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250054-03","Limited Cost Sharing Plan Variation","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125005403","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125005403.pdf","36"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250054","Aurora HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250054-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125005404","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125005404.pdf","37"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250054","Aurora HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250054-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125005405","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125005405.pdf","38"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250054","Aurora HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250054-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125005406","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125005406.pdf","39"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250106","Aurora HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250106-00","Standard Silver Off Exchange Plan","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010600","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010600.pdf","40"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250106","Aurora HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250106-01","Standard Silver On Exchange Plan","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010601","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010601.pdf","41"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250106","Aurora HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250106-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010602","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010602.pdf","42"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250106","Aurora HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250106-03","Limited Cost Sharing Plan Variation","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010603","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010603.pdf","43"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250106","Aurora HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250106-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010604","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010604.pdf","44"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250106","Aurora HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250106-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010605","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010605.pdf","45"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250106","Aurora HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250106-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010606","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010606.pdf","46"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250107","Aurora HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250107-00","Standard Silver Off Exchange Plan","70.34%","0.701759696006775","No","Yes","No","100%",,"$6,000","$110","$20","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010700","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010700.pdf","47"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250107","Aurora HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250107-01","Standard Silver On Exchange Plan","70.34%","0.701759696006775","No","Yes","No","100%",,"$6,000","$110","$20","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010701","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010701.pdf","48"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250107","Aurora HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250107-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010702","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010702.pdf","49"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250107","Aurora HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250107-03","Limited Cost Sharing Plan Variation","70.34%","0.701759696006775","No","Yes","No","100%",,"$6,000","$110","$20","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010703","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010703.pdf","50"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250107","Aurora HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250107-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010704","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010704.pdf","51"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250107","Aurora HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250107-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010705","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010705.pdf","52"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250107","Aurora HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250107-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010706","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010706.pdf","53"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250108","Aurora HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250108-00","Standard Silver Off Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010800","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010800.pdf","54"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250108","Aurora HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250108-01","Standard Silver On Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010801","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010801.pdf","55"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250108","Aurora HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250108-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010802","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010802.pdf","56"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250108","Aurora HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250108-03","Limited Cost Sharing Plan Variation","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010803","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010803.pdf","57"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250108","Aurora HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250108-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010804","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010804.pdf","58"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250108","Aurora HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250108-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010805","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010805.pdf","59"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250108","Aurora HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250108-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010806","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010806.pdf","60"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250120","Aurora and Bellin HMO 1500 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250120-00","Standard Gold Off Exchange Plan","81.85%","0.821058511734009","No","Yes","No","100%",,"$1,500","$110","$930","$30","$140","$1,830","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012000","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012000.pdf","61"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250120","Aurora and Bellin HMO 1500 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250120-01","Standard Gold On Exchange Plan","81.85%","0.821058511734009","No","Yes","No","100%",,"$1,500","$110","$930","$30","$140","$1,830","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012001","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012001.pdf","62"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250120","Aurora and Bellin HMO 1500 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250120-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012002","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012002.pdf","63"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250120","Aurora and Bellin HMO 1500 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250120-03","Limited Cost Sharing Plan Variation","81.85%","0.821058511734009","No","Yes","No","100%",,"$1,500","$110","$930","$30","$140","$1,830","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012003","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012003.pdf","64"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250119","Aurora and Bellin HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250119-00","Standard Silver Off Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011900","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011900.pdf","65"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250119","Aurora and Bellin HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250119-01","Standard Silver On Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011901","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011901.pdf","66"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250119","Aurora and Bellin HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250119-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011902","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011902.pdf","67"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250119","Aurora and Bellin HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250119-03","Limited Cost Sharing Plan Variation","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011903","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011903.pdf","68"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250119","Aurora and Bellin HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250119-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011904","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011904.pdf","69"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250119","Aurora and Bellin HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250119-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011905","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011905.pdf","70"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250119","Aurora and Bellin HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250119-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011906","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011906.pdf","71"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250126","Aurora and Bellin HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250126-00","Standard Silver Off Exchange Plan","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012600","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012600.pdf","72"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250126","Aurora and Bellin HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250126-01","Standard Silver On Exchange Plan","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012601","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012601.pdf","73"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250126","Aurora and Bellin HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250126-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012602","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012602.pdf","74"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250126","Aurora and Bellin HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250126-03","Limited Cost Sharing Plan Variation","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012603","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012603.pdf","75"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250126","Aurora and Bellin HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250126-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012604","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012604.pdf","76"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250126","Aurora and Bellin HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250126-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012605","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012605.pdf","77"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250126","Aurora and Bellin HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250126-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012606","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012606.pdf","78"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250127","Aurora and Bellin HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250127-00","Standard Silver Off Exchange Plan","70.34%","0.701759696006775","No","Yes","No","100%",,"$6,000","$110","$20","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012700","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012700.pdf","79"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250127","Aurora and Bellin HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250127-01","Standard Silver On Exchange Plan","70.34%","0.701759696006775","No","Yes","No","100%",,"$6,000","$110","$20","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012701","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012701.pdf","80"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250127","Aurora and Bellin HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250127-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012702","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012702.pdf","81"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250127","Aurora and Bellin HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250127-03","Limited Cost Sharing Plan Variation","70.34%","0.701759696006775","No","Yes","No","100%",,"$6,000","$110","$20","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012703","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012703.pdf","82"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250127","Aurora and Bellin HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250127-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012704","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012704.pdf","83"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250127","Aurora and Bellin HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250127-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012705","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012705.pdf","84"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250127","Aurora and Bellin HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250127-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012706","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012706.pdf","85"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250128","Aurora and Bellin HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250128-00","Standard Silver Off Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012800","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012800.pdf","86"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250128","Aurora and Bellin HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250128-01","Standard Silver On Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012801","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012801.pdf","87"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250128","Aurora and Bellin HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250128-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012802","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012802.pdf","88"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250128","Aurora and Bellin HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250128-03","Limited Cost Sharing Plan Variation","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012803","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012803.pdf","89"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250128","Aurora and Bellin HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250128-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012804","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012804.pdf","90"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250128","Aurora and Bellin HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250128-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012805","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012805.pdf","91"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250128","Aurora and Bellin HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250128-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012806","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012806.pdf","92"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250110","Aurora and ThedaCare HMO 1500 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250110-00","Standard Gold Off Exchange Plan","81.85%","0.821058511734009","No","Yes","No","100%",,"$1,500","$110","$930","$30","$140","$1,830","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011000","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011000.pdf","93"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250110","Aurora and ThedaCare HMO 1500 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250110-01","Standard Gold On Exchange Plan","81.85%","0.821058511734009","No","Yes","No","100%",,"$1,500","$110","$930","$30","$140","$1,830","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011001","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011001.pdf","94"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250110","Aurora and ThedaCare HMO 1500 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250110-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011002","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011002.pdf","95"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250110","Aurora and ThedaCare HMO 1500 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250110-03","Limited Cost Sharing Plan Variation","81.85%","0.821058511734009","No","Yes","No","100%",,"$1,500","$110","$930","$30","$140","$1,830","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011003","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011003.pdf","96"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250109","Aurora and ThedaCare HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250109-00","Standard Silver Off Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010900","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010900.pdf","97"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250109","Aurora and ThedaCare HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250109-01","Standard Silver On Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010901","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010901.pdf","98"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250109","Aurora and ThedaCare HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250109-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010902","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010902.pdf","99"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250109","Aurora and ThedaCare HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250109-03","Limited Cost Sharing Plan Variation","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010903","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010903.pdf","100"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250109","Aurora and ThedaCare HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250109-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010904","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010904.pdf","101"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250109","Aurora and ThedaCare HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250109-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010905","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010905.pdf","102"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250109","Aurora and ThedaCare HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250109-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010906","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010906.pdf","103"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250116","Aurora and ThedaCare HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250116-00","Standard Silver Off Exchange Plan","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011600","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011600.pdf","104"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250116","Aurora and ThedaCare HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250116-01","Standard Silver On Exchange Plan","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011601","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011601.pdf","105"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250116","Aurora and ThedaCare HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250116-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011602","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011602.pdf","106"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250116","Aurora and ThedaCare HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250116-03","Limited Cost Sharing Plan Variation","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011603","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011603.pdf","107"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250116","Aurora and ThedaCare HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250116-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011604","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011604.pdf","108"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250116","Aurora and ThedaCare HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250116-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011605","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011605.pdf","109"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250116","Aurora and ThedaCare HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250116-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011606","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011606.pdf","110"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250117","Aurora and ThedaCare HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250117-00","Standard Silver Off Exchange Plan","70.34%","0.701759696006775","No","Yes","No","100%",,"$6,000","$110","$20","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011700","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011700.pdf","111"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250117","Aurora and ThedaCare HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250117-01","Standard Silver On Exchange Plan","70.34%","0.701759696006775","No","Yes","No","100%",,"$6,000","$110","$20","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011701","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011701.pdf","112"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250117","Aurora and ThedaCare HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250117-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011702","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011702.pdf","113"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250117","Aurora and ThedaCare HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250117-03","Limited Cost Sharing Plan Variation","70.34%","0.701759696006775","No","Yes","No","100%",,"$6,000","$110","$20","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011703","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011703.pdf","114"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250117","Aurora and ThedaCare HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250117-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011704","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011704.pdf","115"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250117","Aurora and ThedaCare HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250117-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011705","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011705.pdf","116"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250117","Aurora and ThedaCare HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250117-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011706","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011706.pdf","117"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250118","Aurora and ThedaCare HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250118-00","Standard Silver Off Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011800","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011800.pdf","118"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250118","Aurora and ThedaCare HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250118-01","Standard Silver On Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011801","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011801.pdf","119"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250118","Aurora and ThedaCare HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250118-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011802","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011802.pdf","120"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250118","Aurora and ThedaCare HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250118-03","Limited Cost Sharing Plan Variation","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011803","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011803.pdf","121"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250118","Aurora and ThedaCare HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250118-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011804","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011804.pdf","122"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250118","Aurora and ThedaCare HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250118-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011805","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011805.pdf","123"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250118","Aurora and ThedaCare HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250118-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011806","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011806.pdf","124"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250130","ProHealth and Aurora HMO 1500 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250130-00","Standard Gold Off Exchange Plan","81.85%","0.821058511734009","No","Yes","No","100%",,"$1,500","$110","$930","$30","$140","$1,830","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013000","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013000.pdf","125"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250130","ProHealth and Aurora HMO 1500 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250130-01","Standard Gold On Exchange Plan","81.85%","0.821058511734009","No","Yes","No","100%",,"$1,500","$110","$930","$30","$140","$1,830","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013001","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013001.pdf","126"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250130","ProHealth and Aurora HMO 1500 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250130-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013002","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013002.pdf","127"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250130","ProHealth and Aurora HMO 1500 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250130-03","Limited Cost Sharing Plan Variation","81.85%","0.821058511734009","No","Yes","No","100%",,"$1,500","$110","$930","$30","$140","$1,830","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013003","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013003.pdf","128"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250129","ProHealth and Aurora HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250129-00","Standard Silver Off Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012900","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012900.pdf","129"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250129","ProHealth and Aurora HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250129-01","Standard Silver On Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012901","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012901.pdf","130"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250129","ProHealth and Aurora HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250129-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012902","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012902.pdf","131"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250129","ProHealth and Aurora HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250129-03","Limited Cost Sharing Plan Variation","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012903","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012903.pdf","132"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250129","ProHealth and Aurora HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250129-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012904","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012904.pdf","133"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250129","ProHealth and Aurora HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250129-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012905","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012905.pdf","134"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250129","ProHealth and Aurora HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250129-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012906","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012906.pdf","135"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250136","ProHealth and Aurora HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250136-00","Standard Silver Off Exchange Plan","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013600","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013600.pdf","136"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250136","ProHealth and Aurora HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250136-01","Standard Silver On Exchange Plan","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013601","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013601.pdf","137"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250136","ProHealth and Aurora HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250136-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013602","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013602.pdf","138"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250136","ProHealth and Aurora HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250136-03","Limited Cost Sharing Plan Variation","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013603","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013603.pdf","139"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250136","ProHealth and Aurora HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250136-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013604","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013604.pdf","140"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250136","ProHealth and Aurora HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250136-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013605","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013605.pdf","141"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250136","ProHealth and Aurora HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250136-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013606","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013606.pdf","142"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250137","ProHealth and Aurora HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250137-00","Standard Silver Off Exchange Plan","70.34%","0.701759696006775","No","Yes","No","100%",,"$6,000","$110","$20","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013700","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013700.pdf","143"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250137","ProHealth and Aurora HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250137-01","Standard Silver On Exchange Plan","70.34%","0.701759696006775","No","Yes","No","100%",,"$6,000","$110","$20","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013701","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013701.pdf","144"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250137","ProHealth and Aurora HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250137-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013702","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013702.pdf","145"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250137","ProHealth and Aurora HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250137-03","Limited Cost Sharing Plan Variation","70.34%","0.701759696006775","No","Yes","No","100%",,"$6,000","$110","$20","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013703","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013703.pdf","146"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250137","ProHealth and Aurora HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250137-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013704","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013704.pdf","147"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250137","ProHealth and Aurora HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250137-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013705","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013705.pdf","148"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250137","ProHealth and Aurora HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250137-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013706","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013706.pdf","149"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250138","ProHealth and Aurora HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250138-00","Standard Silver Off Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013800","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013800.pdf","150"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250138","ProHealth and Aurora HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250138-01","Standard Silver On Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013801","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013801.pdf","151"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250138","ProHealth and Aurora HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250138-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013802","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013802.pdf","152"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250138","ProHealth and Aurora HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250138-03","Limited Cost Sharing Plan Variation","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013803","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013803.pdf","153"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250138","ProHealth and Aurora HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250138-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013804","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013804.pdf","154"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250138","ProHealth and Aurora HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250138-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013805","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013805.pdf","155"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250138","ProHealth and Aurora HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250138-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013806","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013806.pdf","156"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250007","ThedaCare HMO 1500 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250007-00","Standard Gold Off Exchange Plan","81.85%","0.821058511734009","No","Yes","No","100%",,"$1,500","$110","$930","$30","$140","$1,830","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125000700","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125000700.pdf","157"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250007","ThedaCare HMO 1500 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250007-01","Standard Gold On Exchange Plan","81.85%","0.821058511734009","No","Yes","No","100%",,"$1,500","$110","$930","$30","$140","$1,830","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125000701","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125000701.pdf","158"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250007","ThedaCare HMO 1500 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125000702","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125000702.pdf","159"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250007","ThedaCare HMO 1500 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250007-03","Limited Cost Sharing Plan Variation","81.85%","0.821058511734009","No","Yes","No","100%",,"$1,500","$110","$930","$30","$140","$1,830","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125000703","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125000703.pdf","160"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250015","ThedaCare HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250015-00","Standard Silver Off Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125001500","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125001500.pdf","161"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250015","ThedaCare HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250015-01","Standard Silver On Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125001501","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125001501.pdf","162"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250015","ThedaCare HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125001502","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125001502.pdf","163"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250015","ThedaCare HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250015-03","Limited Cost Sharing Plan Variation","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125001503","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125001503.pdf","164"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250015","ThedaCare HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250015-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125001504","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125001504.pdf","165"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250015","ThedaCare HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250015-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125001505","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125001505.pdf","166"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250015","ThedaCare HMO 4000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250015-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125001506","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125001506.pdf","167"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250100","ThedaCare HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250100-00","Standard Silver Off Exchange Plan","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010000","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010000.pdf","168"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250100","ThedaCare HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250100-01","Standard Silver On Exchange Plan","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010001","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010001.pdf","169"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250100","ThedaCare HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250100-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010002","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010002.pdf","170"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250100","ThedaCare HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250100-03","Limited Cost Sharing Plan Variation","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010003","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010003.pdf","171"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250100","ThedaCare HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250100-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010004","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010004.pdf","172"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250100","ThedaCare HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250100-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010005","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010005.pdf","173"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250100","ThedaCare HMO 5000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250100-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010006","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010006.pdf","174"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250101","ThedaCare HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250101-00","Standard Silver Off Exchange Plan","70.34%","0.701759696006775","No","Yes","No","100%",,"$6,000","$110","$20","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010100","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010100.pdf","175"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250101","ThedaCare HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250101-01","Standard Silver On Exchange Plan","70.34%","0.701759696006775","No","Yes","No","100%",,"$6,000","$110","$20","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010101","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010101.pdf","176"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250101","ThedaCare HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250101-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010102","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010102.pdf","177"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250101","ThedaCare HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250101-03","Limited Cost Sharing Plan Variation","70.34%","0.701759696006775","No","Yes","No","100%",,"$6,000","$110","$20","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010103","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010103.pdf","178"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250101","ThedaCare HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250101-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010104","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010104.pdf","179"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250101","ThedaCare HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250101-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010105","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010105.pdf","180"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250101","ThedaCare HMO 6000 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250101-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010106","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010106.pdf","181"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250102","ThedaCare HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250102-00","Standard Silver Off Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010200","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010200.pdf","182"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250102","ThedaCare HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250102-01","Standard Silver On Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010201","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010201.pdf","183"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250102","ThedaCare HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250102-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010202","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010202.pdf","184"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250102","ThedaCare HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250102-03","Limited Cost Sharing Plan Variation","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010203","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010203.pdf","185"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250102","ThedaCare HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250102-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010204","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010204.pdf","186"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250102","ThedaCare HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250102-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010205","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010205.pdf","187"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250102","ThedaCare HMO 6850 Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250102-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010206","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010206.pdf","188"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250103","Aspirus Arise HMO 5000","84670WI125","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250103-00","Standard Silver Off Exchange Plan","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010300","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010300.pdf","189"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250103","Aspirus Arise HMO 5000","84670WI125","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250103-01","Standard Silver On Exchange Plan","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010301","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010301.pdf","190"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250103","Aspirus Arise HMO 5000","84670WI125","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250103-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010302","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010302.pdf","191"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250103","Aspirus Arise HMO 5000","84670WI125","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250103-03","Limited Cost Sharing Plan Variation","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010303","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010303.pdf","192"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250103","Aspirus Arise HMO 5000","84670WI125","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250103-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010304","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010304.pdf","193"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250103","Aspirus Arise HMO 5000","84670WI125","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250103-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010305","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010305.pdf","194"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","1","84670","WI","Individual","No","20-2660193","84670WI1250103","Aspirus Arise HMO 5000","84670WI125","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250103-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125010306","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125010306.pdf","195"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250077","Aspirus Arise HMO 2600 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250077-00","Standard Silver Off Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125007700","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125007700.pdf","4"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350114","Arise AboutHealth 2000 HDHP","84670WI135","7467455680","WIN001","WIS007","WIF006","Existing","POS","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350114-00","Standard Gold Off Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$30","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135011400","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135011400.pdf","4"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350114","Arise AboutHealth 2000 HDHP","84670WI135","7467455680","WIN001","WIS007","WIF006","Existing","POS","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350114-01","Standard Gold On Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$30","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135011401","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135011401.pdf","5"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250077","Aspirus Arise HMO 2600 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250077-01","Standard Silver On Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125007701","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125007701.pdf","5"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250077","Aspirus Arise HMO 2600 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250077-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125007702","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125007702.pdf","6"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350115","Arise AboutHealth 1500 HDHP","84670WI135","7467455680","WIN001","WIS007","WIF003","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350115-00","Standard Silver Off Exchange Plan",,"0.697972118854523","Yes","Yes","No","100%",,"$1,500","$0","$1,530","$30","$1,500","$0","$1,020","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135011500","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135011500.pdf","6"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350115","Arise AboutHealth 1500 HDHP","84670WI135","7467455680","WIN001","WIS007","WIF003","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350115-01","Standard Silver On Exchange Plan",,"0.697972118854523","Yes","Yes","No","100%",,"$1,500","$0","$1,530","$30","$1,500","$0","$1,020","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135011501","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135011501.pdf","7"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250077","Aspirus Arise HMO 2600 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250077-03","Limited Cost Sharing Plan Variation",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125007703","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125007703.pdf","7"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250077","Aspirus Arise HMO 2600 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250077-04","73% AV Level Silver Plan",,"0.739875257015228","Yes","Yes","No","100%",,"$2,000","$0","$920","$30","$2,000","$0","$580","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,625","$3625 per person","$7250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125007704","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125007704.pdf","8"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350116","Arise AboutHealth 2000-80 HDHP","84670WI135","7467455680","WIN001","WIS007","WIF004","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350116-00","Standard Silver Off Exchange Plan",,"0.717611312866211","Yes","Yes","No","100%",,"$2,000","$0","$920","$30","$2,000","$0","$580","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135011600","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135011600.pdf","8"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350116","Arise AboutHealth 2000-80 HDHP","84670WI135","7467455680","WIN001","WIS007","WIF004","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350116-01","Standard Silver On Exchange Plan",,"0.717611312866211","Yes","Yes","No","100%",,"$2,000","$0","$920","$30","$2,000","$0","$580","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135011601","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135011601.pdf","9"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250077","Aspirus Arise HMO 2600 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250077-05","87% AV Level Silver Plan",,"0.861428439617157","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125007705","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125007705.pdf","9"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250077","Aspirus Arise HMO 2600 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250077-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125007706","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125007706.pdf","10"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350117","Arise Abouthealth 2500 HDHP","84670WI135","7467455680","WIN001","WIS007","WIF004","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350117-00","Standard Silver Off Exchange Plan",,"0.683657169342041","Yes","Yes","No","100%",,"$2,500","$0","$820","$30","$2,500","$0","$480","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135011700","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135011700.pdf","10"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350117","Arise Abouthealth 2500 HDHP","84670WI135","7467455680","WIN001","WIS007","WIF004","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350117-01","Standard Silver On Exchange Plan",,"0.683657169342041","Yes","Yes","No","100%",,"$2,500","$0","$820","$30","$2,500","$0","$480","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135011701","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135011701.pdf","11"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250074","Aspirus Arise HMO 3500 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250074-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125007400","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125007400.pdf","11"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250074","Aspirus Arise HMO 3500 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250074-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125007401","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125007401.pdf","12"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350119","Arise AboutHealth 3000 HDHP","84670WI135","7467455680","WIN001","WIS007","WIF005","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350119-00","Standard Silver Off Exchange Plan",,"0.688159942626953","Yes","Yes","No","100%",,"$3,000","$0","$360","$30","$3,000","$0","$190","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135011900","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135011900.pdf","12"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350119","Arise AboutHealth 3000 HDHP","84670WI135","7467455680","WIN001","WIS007","WIF005","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350119-01","Standard Silver On Exchange Plan",,"0.688159942626953","Yes","Yes","No","100%",,"$3,000","$0","$360","$30","$3,000","$0","$190","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135011901","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135011901.pdf","13"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250074","Aspirus Arise HMO 3500 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250074-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125007402","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125007402.pdf","13"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250074","Aspirus Arise HMO 3500 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250074-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125007403","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125007403.pdf","14"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350120","Arise AboutHealth 3500 HDHP","84670WI135","7467455680","WIN001","WIS007","WIF006","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350120-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135012000","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135012000.pdf","14"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350120","Arise AboutHealth 3500 HDHP","84670WI135","7467455680","WIN001","WIS007","WIF006","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350120-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135012001","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135012001.pdf","15"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250074","Aspirus Arise HMO 3500 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250074-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$30","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125007404","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125007404.pdf","15"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250074","Aspirus Arise HMO 3500 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250074-05","87% AV Level Silver Plan",,"0.861428439617157","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125007405","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125007405.pdf","16"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350122","Arise AboutHealth 5000 HDHP","84670WI135","7467455680","WIN001","WIS007","WIF004","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350122-00","Standard Bronze Off Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$320","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135012200","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135012200.pdf","16"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350122","Arise AboutHealth 5000 HDHP","84670WI135","7467455680","WIN001","WIS007","WIF004","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350122-01","Standard Bronze On Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$320","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135012201","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135012201.pdf","17"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250074","Aspirus Arise HMO 3500 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250074-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125007406","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125007406.pdf","17"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250081","Aspirus Arise HMO 5500 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250081-00","Standard Bronze Off Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008100","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008100.pdf","18"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350123","Arise AboutHealth 6450 HDHP","84670WI135","7467455680","WIN001","WIS007","WIF006","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350123-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$18,900","$18900 per person","$37800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135012300","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135012300.pdf","18"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350123","Arise AboutHealth 6450 HDHP","84670WI135","7467455680","WIN001","WIS007","WIF006","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350123-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$18,900","$18900 per person","$37800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135012301","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135012301.pdf","19"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250081","Aspirus Arise HMO 5500 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250081-01","Standard Bronze On Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008101","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008101.pdf","19"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250081","Aspirus Arise HMO 5500 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250081-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008102","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008102.pdf","20"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350073","Aspirus Arise 2000 HDHP","84670WI135","7467455680","WIN001","WIS001","WIF006","Existing","POS","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350073-00","Standard Gold Off Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$30","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135007300","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135007300.pdf","20"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350073","Aspirus Arise 2000 HDHP","84670WI135","7467455680","WIN001","WIS001","WIF006","Existing","POS","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350073-01","Standard Gold On Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$30","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135007301","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135007301.pdf","21"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250081","Aspirus Arise HMO 5500 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250081-03","Limited Cost Sharing Plan Variation",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008103","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008103.pdf","21"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250080","Aspirus Arise HMO 6450 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250080-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008000","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008000.pdf","22"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350078","Aspirus Arise 1500 HDHP","84670WI135","7467455680","WIN001","WIS001","WIF003","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350078-00","Standard Silver Off Exchange Plan",,"0.697972118854523","Yes","Yes","No","100%",,"$1,500","$0","$1,530","$30","$1,500","$0","$1,020","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135007800","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135007800.pdf","22"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350078","Aspirus Arise 1500 HDHP","84670WI135","7467455680","WIN001","WIS001","WIF003","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350078-01","Standard Silver On Exchange Plan",,"0.697972118854523","Yes","Yes","No","100%",,"$1,500","$0","$1,530","$30","$1,500","$0","$1,020","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135007801","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135007801.pdf","23"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250080","Aspirus Arise HMO 6450 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250080-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008001","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008001.pdf","23"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250080","Aspirus Arise HMO 6450 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250080-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008002","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008002.pdf","24"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350079","Aspirus Arise 2000-80 HDHP","84670WI135","7467455680","WIN001","WIS001","WIF004","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350079-00","Standard Silver Off Exchange Plan",,"0.717611312866211","Yes","Yes","No","100%",,"$2,000","$0","$920","$30","$2,000","$0","$580","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135007900","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135007900.pdf","24"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350079","Aspirus Arise 2000-80 HDHP","84670WI135","7467455680","WIN001","WIS001","WIF004","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350079-01","Standard Silver On Exchange Plan",,"0.717611312866211","Yes","Yes","No","100%",,"$2,000","$0","$920","$30","$2,000","$0","$580","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135007901","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135007901.pdf","25"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250080","Aspirus Arise HMO 6450 HDHP","84670WI125","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250080-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008003","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008003.pdf","25"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250087","Aurora HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250087-00","Standard Silver Off Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008700","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008700.pdf","26"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350077","Aspirus Arise 2500 HDHP","84670WI135","7467455680","WIN001","WIS001","WIF004","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350077-00","Standard Silver Off Exchange Plan",,"0.683657169342041","Yes","Yes","No","100%",,"$2,500","$0","$820","$30","$2,500","$0","$480","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135007700","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135007700.pdf","26"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350077","Aspirus Arise 2500 HDHP","84670WI135","7467455680","WIN001","WIS001","WIF004","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350077-01","Standard Silver On Exchange Plan",,"0.683657169342041","Yes","Yes","No","100%",,"$2,500","$0","$820","$30","$2,500","$0","$480","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","20%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135007701","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135007701.pdf","27"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250087","Aurora HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250087-01","Standard Silver On Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008701","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008701.pdf","27"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250087","Aurora HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250087-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008702","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008702.pdf","28"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350076","Aspirus Arise 3000 HDHP","84670WI135","7467455680","WIN001","WIS001","WIF005","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350076-00","Standard Silver Off Exchange Plan",,"0.688159942626953","Yes","Yes","No","100%",,"$3,000","$0","$360","$30","$3,000","$0","$190","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135007600","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135007600.pdf","28"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350076","Aspirus Arise 3000 HDHP","84670WI135","7467455680","WIN001","WIS001","WIF005","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350076-01","Standard Silver On Exchange Plan",,"0.688159942626953","Yes","Yes","No","100%",,"$3,000","$0","$360","$30","$3,000","$0","$190","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135007601","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135007601.pdf","29"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250087","Aurora HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250087-03","Limited Cost Sharing Plan Variation",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008703","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008703.pdf","29"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250087","Aurora HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250087-04","73% AV Level Silver Plan",,"0.739875257015228","Yes","Yes","No","100%",,"$2,000","$0","$920","$30","$2,000","$0","$580","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,625","$3625 per person","$7250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008704","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008704.pdf","30"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350074","Aspirus Arise 3500 HDHP","84670WI135","7467455680","WIN001","WIS001","WIF006","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350074-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135007400","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135007400.pdf","30"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350074","Aspirus Arise 3500 HDHP","84670WI135","7467455680","WIN001","WIS001","WIF006","Existing","POS","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350074-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135007401","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135007401.pdf","31"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250087","Aurora HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250087-05","87% AV Level Silver Plan",,"0.861428439617157","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008705","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008705.pdf","31"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250087","Aurora HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250087-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008706","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008706.pdf","32"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350081","Aspirus Arise 5000 HDHP","84670WI135","7467455680","WIN001","WIS001","WIF004","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350081-00","Standard Bronze Off Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$320","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135008100","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135008100.pdf","32"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350081","Aspirus Arise 5000 HDHP","84670WI135","7467455680","WIN001","WIS001","WIF004","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350081-01","Standard Bronze On Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$320","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135008101","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135008101.pdf","33"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250084","Aurora HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250084-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008400","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008400.pdf","33"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250084","Aurora HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250084-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008401","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008401.pdf","34"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350103","Arise AboutHealth 2000","84670WI135","7467455680","WIN001","WIS007","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350103-00","Standard Gold Off Exchange Plan","81.96%","0.832643330097198","No","Yes","No","100%",,"$2,000","$80","$0","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135010300","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135010300.pdf","12"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350103","Arise AboutHealth 2000","84670WI135","7467455680","WIN001","WIS007","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350103-01","Standard Gold On Exchange Plan","81.96%","0.832643330097198","No","Yes","No","100%",,"$2,000","$80","$0","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135010301","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135010301.pdf","13"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270105","Aspirus Arise 6850","84670WI127","7467455680","WIN001","WIS001","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270105-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010502","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010502.pdf","13"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270105","Aspirus Arise 6850","84670WI127","7467455680","WIN001","WIS001","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270105-00","Standard Silver Off Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010500","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010500.pdf","11"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270105","Aspirus Arise 6850","84670WI127","7467455680","WIN001","WIS001","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270105-01","Standard Silver On Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010501","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010501.pdf","12"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350125","Arise AboutHealth 2000-80","84670WI135","7467455680","WIN001","WIS007","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350125-01","Standard Gold On Exchange Plan","78.09%","0.783013999462128","No","Yes","No","100%",,"$2,000","$80","$830","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135012501","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135012501.pdf","15"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270105","Aspirus Arise 6850","84670WI127","7467455680","WIN001","WIS001","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270105-03","Limited Cost Sharing Plan Variation","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010503","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010503.pdf","14"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350125","Arise AboutHealth 2000-80","84670WI135","7467455680","WIN001","WIS007","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350125-00","Standard Gold Off Exchange Plan","78.09%","0.783013999462128","No","Yes","No","100%",,"$2,000","$80","$830","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135012500","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135012500.pdf","14"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350080","Aspirus Arise 6450 HDHP","84670WI135","7467455680","WIN001","WIS001","WIF006","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350080-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$18,900","$18900 per person","$37800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135008000","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135008000.pdf","34"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350080","Aspirus Arise 6450 HDHP","84670WI135","7467455680","WIN001","WIS001","WIF006","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350080-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$18,900","$18900 per person","$37800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135008001","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135008001.pdf","35"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250084","Aurora HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250084-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008402","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008402.pdf","35"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250084","Aurora HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250084-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008403","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008403.pdf","36"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250084","Aurora HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250084-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$30","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008404","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008404.pdf","37"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250084","Aurora HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250084-05","87% AV Level Silver Plan",,"0.861428439617157","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008405","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008405.pdf","38"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250084","Aurora HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250084-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125008406","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125008406.pdf","39"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250091","Aurora HMO 5500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250091-00","Standard Bronze Off Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125009100","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125009100.pdf","40"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250091","Aurora HMO 5500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250091-01","Standard Bronze On Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125009101","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125009101.pdf","41"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250091","Aurora HMO 5500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250091-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125009102","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125009102.pdf","42"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250091","Aurora HMO 5500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250091-03","Limited Cost Sharing Plan Variation",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125009103","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125009103.pdf","43"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250090","Aurora HMO 6450 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF006","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250090-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125009000","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125009000.pdf","44"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250090","Aurora HMO 6450 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF006","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250090-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125009001","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125009001.pdf","45"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250090","Aurora HMO 6450 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF006","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250090-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125009002","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125009002.pdf","46"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","2","84670","WI","Individual","No","20-2660193","84670WI1250090","Aurora HMO 6450 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF006","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250090-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125009003","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125009003.pdf","47"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270048","Aspirus Arise 4000","84670WI127","7467455680","WIN001","WIS001","WIF002","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270048-00","Standard Silver Off Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127004800","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127004800.pdf","4"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350101","Arise AboutHealth 500","84670WI135","7467455680","WIN001","WIS007","WIF001","New","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350101-00","Standard Platinum Off Exchange Plan","88.35%","0.886274874210358","No","Yes","No","100%",,"$500","$80","$1,130","$30","$140","$1,510","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135010100","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135010100.pdf","4"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350101","Arise AboutHealth 500","84670WI135","7467455680","WIN001","WIS007","WIF001","New","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350101-01","Standard Platinum On Exchange Plan","88.35%","0.886274874210358","No","Yes","No","100%",,"$500","$80","$1,130","$30","$140","$1,510","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135010101","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135010101.pdf","5"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270048","Aspirus Arise 4000","84670WI127","7467455680","WIN001","WIS001","WIF002","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270048-01","Standard Silver On Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127004801","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127004801.pdf","5"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270048","Aspirus Arise 4000","84670WI127","7467455680","WIN001","WIS001","WIF002","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270048-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127004802","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127004802.pdf","6"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350124","Arise AboutHealth 1000","84670WI135","7467455680","WIN001","WIS007","WIF001","New","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350124-00","Standard Platinum Off Exchange Plan","88.01%","0.89091819524765","No","Yes","No","100%",,"$1,000","$80","$0","$30","$140","$1,510","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135012400","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135012400.pdf","6"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350124","Arise AboutHealth 1000","84670WI135","7467455680","WIN001","WIS007","WIF001","New","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350124-01","Standard Platinum On Exchange Plan","88.01%","0.89091819524765","No","Yes","No","100%",,"$1,000","$80","$0","$30","$140","$1,510","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135012401","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135012401.pdf","7"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270048","Aspirus Arise 4000","84670WI127","7467455680","WIN001","WIS001","WIF002","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270048-03","Limited Cost Sharing Plan Variation","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127004803","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127004803.pdf","7"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270048","Aspirus Arise 4000","84670WI127","7467455680","WIN001","WIS001","WIF002","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270048-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127004804","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127004804.pdf","8"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350102","Arise AboutHealth 1000-80","84670WI135","7467455680","WIN001","WIS007","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350102-00","Standard Gold Off Exchange Plan","81.55%","0.820885002613068","No","Yes","No","100%",,"$1,000","$80","$1,030","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135010200","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135010200.pdf","8"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350102","Arise AboutHealth 1000-80","84670WI135","7467455680","WIN001","WIS007","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350102-01","Standard Gold On Exchange Plan","81.55%","0.820885002613068","No","Yes","No","100%",,"$1,000","$80","$1,030","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135010201","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135010201.pdf","9"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270048","Aspirus Arise 4000","84670WI127","7467455680","WIN001","WIS001","WIF002","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270048-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127004805","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127004805.pdf","9"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270048","Aspirus Arise 4000","84670WI127","7467455680","WIN001","WIS001","WIF002","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270048-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127004806","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127004806.pdf","10"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350104","Arise AboutHealth 1500","84670WI135","7467455680","WIN001","WIS007","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350104-00","Standard Gold Off Exchange Plan","78.33%","0.788239300251007","No","Yes","No","100%",,"$1,500","$80","$930","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135010400","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135010400.pdf","10"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350104","Arise AboutHealth 1500","84670WI135","7467455680","WIN001","WIS007","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350104-01","Standard Gold On Exchange Plan","78.33%","0.788239300251007","No","Yes","No","100%",,"$1,500","$80","$930","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135010401","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135010401.pdf","11"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270105","Aspirus Arise 6850","84670WI127","7467455680","WIN001","WIS001","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270105-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010504","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010504.pdf","15"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270105","Aspirus Arise 6850","84670WI127","7467455680","WIN001","WIS001","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270105-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010505","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010505.pdf","16"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350126","Arise AboutHealth 2500","84670WI135","7467455680","WIN001","WIS007","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350126-00","Standard Gold Off Exchange Plan","79.01%","0.78987044095993","No","Yes","No","100%",,"$2,500","$80","$370","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135012600","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135012600.pdf","16"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350126","Arise AboutHealth 2500","84670WI135","7467455680","WIN001","WIS007","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350126-01","Standard Gold On Exchange Plan","79.01%","0.78987044095993","No","Yes","No","100%",,"$2,500","$80","$370","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135012601","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135012601.pdf","17"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270105","Aspirus Arise 6850","84670WI127","7467455680","WIN001","WIS001","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270105-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010506","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010506.pdf","17"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270054","Aurora 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF002","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270054-00","Standard Silver Off Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127005400","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127005400.pdf","18"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350127","Arise AboutHealth 3000","84670WI135","7467455680","WIN001","WIS007","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350127-00","Standard Gold Off Exchange Plan","78.23%","0.793198883533478","No","Yes","No","100%",,"$3,000","$80","$0","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135012700","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135012700.pdf","18"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350127","Arise AboutHealth 3000","84670WI135","7467455680","WIN001","WIS007","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350127-01","Standard Gold On Exchange Plan","78.23%","0.793198883533478","No","Yes","No","100%",,"$3,000","$80","$0","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135012701","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135012701.pdf","19"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270054","Aurora 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF002","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270054-01","Standard Silver On Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127005401","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127005401.pdf","19"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270054","Aurora 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF002","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270054-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127005402","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127005402.pdf","20"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270119","Aurora and Bellin 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270119-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011904","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011904.pdf","36"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350130","Aspirus Arise 2000-80","84670WI135","7467455680","WIN001","WIS001","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350130-00","Standard Gold Off Exchange Plan","78.09%","0.783013999462128","No","Yes","No","100%",,"$2,000","$80","$830","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135013000","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135013000.pdf","36"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350130","Aspirus Arise 2000-80","84670WI135","7467455680","WIN001","WIS001","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350130-01","Standard Gold On Exchange Plan","78.09%","0.783013999462128","No","Yes","No","100%",,"$2,000","$80","$830","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$14,000","$14000 per person","$28000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135013001","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135013001.pdf","37"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350044","Aspirus Arise 2000","84670WI135","7467455680","WIN001","WIS001","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350044-01","Standard Gold On Exchange Plan","81.96%","0.832643330097198","No","Yes","No","100%",,"$2,000","$80","$0","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135004401","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135004401.pdf","35"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270119","Aurora and Bellin 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270119-03","Limited Cost Sharing Plan Variation","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011903","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011903.pdf","35"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270119","Aurora and Bellin 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270119-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011906","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011906.pdf","38"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270119","Aurora and Bellin 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270119-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011905","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011905.pdf","37"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270118","Aurora and ThedaCare 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270118-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011806","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011806.pdf","59"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350106","Arise AboutHealth 3750","84670WI135","7467455680","WIN001","WIS007","WIF002","New","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350106-00","Standard Silver Off Exchange Plan","71.96%","0.721038579940796","No","Yes","No","100%",,"$3,750","$110","$480","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","20%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135010600","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135010600.pdf","20"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350106","Arise AboutHealth 3750","84670WI135","7467455680","WIN001","WIS007","WIF002","New","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350106-01","Standard Silver On Exchange Plan","71.96%","0.721038579940796","No","Yes","No","100%",,"$3,750","$110","$480","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","20%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135010601","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135010601.pdf","21"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270054","Aurora 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF002","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270054-03","Limited Cost Sharing Plan Variation","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127005403","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127005403.pdf","21"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270054","Aurora 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF002","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270054-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127005404","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127005404.pdf","22"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350107","Arise AboutHealth 4000","84670WI135","7467455680","WIN001","WIS007","WIF002","New","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350107-00","Standard Silver Off Exchange Plan","71.61%","0.717644512653351","No","Yes","No","100%",,"$4,000","$110","$220","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135010700","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135010700.pdf","22"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350107","Arise AboutHealth 4000","84670WI135","7467455680","WIN001","WIS007","WIF002","New","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350107-01","Standard Silver On Exchange Plan","71.61%","0.717644512653351","No","Yes","No","100%",,"$4,000","$110","$220","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135010701","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135010701.pdf","23"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270054","Aurora 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF002","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270054-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127005405","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127005405.pdf","23"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270054","Aurora 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF002","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270054-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127005406","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127005406.pdf","24"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350128","Arise AboutHealth 5000","84670WI135","7467455680","WIN001","WIS007","WIF002","New","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350128-00","Standard Silver Off Exchange Plan","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135012800","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135012800.pdf","24"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350128","Arise AboutHealth 5000","84670WI135","7467455680","WIN001","WIS007","WIF002","New","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350128-01","Standard Silver On Exchange Plan","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135012801","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135012801.pdf","25"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270108","Aurora 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270108-00","Standard Silver Off Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010800","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010800.pdf","25"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270108","Aurora 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270108-01","Standard Silver On Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010801","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010801.pdf","26"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350055","Aspirus Arise 500","84670WI135","7467455680","WIN001","WIS001","WIF001","New","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350055-00","Standard Platinum Off Exchange Plan","88.35%","0.886274874210358","No","Yes","No","100%",,"$500","$80","$1,130","$30","$140","$1,510","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135005500","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135005500.pdf","26"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350055","Aspirus Arise 500","84670WI135","7467455680","WIN001","WIS001","WIF001","New","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350055-01","Standard Platinum On Exchange Plan","88.35%","0.886274874210358","No","Yes","No","100%",,"$500","$80","$1,130","$30","$140","$1,510","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135005501","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135005501.pdf","27"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270108","Aurora 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270108-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010802","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010802.pdf","27"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270108","Aurora 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270108-03","Limited Cost Sharing Plan Variation","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010803","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010803.pdf","28"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350129","Aspirus Arise 1000","84670WI135","7467455680","WIN001","WIS001","WIF001","New","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350129-00","Standard Platinum Off Exchange Plan","88.01%","0.89091819524765","No","Yes","No","100%",,"$1,000","$80","$0","$30","$140","$1,510","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135012900","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135012900.pdf","28"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350129","Aspirus Arise 1000","84670WI135","7467455680","WIN001","WIS001","WIF001","New","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350129-01","Standard Platinum On Exchange Plan","88.01%","0.89091819524765","No","Yes","No","100%",,"$1,000","$80","$0","$30","$140","$1,510","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135012901","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135012901.pdf","29"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270108","Aurora 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270108-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010804","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010804.pdf","29"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270108","Aurora 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270108-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010805","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010805.pdf","30"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350045","Aspirus Arise 1000-80","84670WI135","7467455680","WIN001","WIS001","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350045-00","Standard Gold Off Exchange Plan","81.55%","0.820885002613068","No","Yes","No","100%",,"$1,000","$80","$1,030","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135004500","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135004500.pdf","30"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350045","Aspirus Arise 1000-80","84670WI135","7467455680","WIN001","WIS001","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350045-01","Standard Gold On Exchange Plan","81.55%","0.820885002613068","No","Yes","No","100%",,"$1,000","$80","$1,030","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135004501","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135004501.pdf","31"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270108","Aurora 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270108-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010806","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010806.pdf","31"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270119","Aurora and Bellin 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270119-00","Standard Silver Off Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011900","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011900.pdf","32"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350057","Aspirus Arise 1500","84670WI135","7467455680","WIN001","WIS001","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350057-00","Standard Gold Off Exchange Plan","78.33%","0.788239300251007","No","Yes","No","100%",,"$1,500","$80","$930","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135005700","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135005700.pdf","32"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350057","Aspirus Arise 1500","84670WI135","7467455680","WIN001","WIS001","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350057-01","Standard Gold On Exchange Plan","78.33%","0.788239300251007","No","Yes","No","100%",,"$1,500","$80","$930","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135005701","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135005701.pdf","33"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270119","Aurora and Bellin 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270119-01","Standard Silver On Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011901","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011901.pdf","33"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270119","Aurora and Bellin 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270119-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011902","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011902.pdf","34"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350044","Aspirus Arise 2000","84670WI135","7467455680","WIN001","WIS001","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350044-00","Standard Gold Off Exchange Plan","81.96%","0.832643330097198","No","Yes","No","100%",,"$2,000","$80","$0","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135004400","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135004400.pdf","34"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350131","Aspirus Arise 2500","84670WI135","7467455680","WIN001","WIS001","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350131-00","Standard Gold Off Exchange Plan","79.01%","0.78987044095993","No","Yes","No","100%",,"$2,500","$80","$370","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135013100","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135013100.pdf","38"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270129","ProHealth and Aurora 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270129-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012902","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012902.pdf","62"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330124","Arise AboutHealth HMO 1000","84670WI133","7467455680","WIN001","WIS007","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330124-01","Standard Platinum On Exchange Plan","88.01%","0.89091819524765","No","Yes","No","100%",,"$1,000","$80","$0","$30","$140","$1,510","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133012401","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133012401.pdf","7"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270077","Aspirus Arise 2600 HDHP","84670WI127","7467455680","WIN001","WIS001","WIF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270077-03","Limited Cost Sharing Plan Variation",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127007703","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127007703.pdf","7"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270077","Aspirus Arise 2600 HDHP","84670WI127","7467455680","WIN001","WIS001","WIF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270077-04","73% AV Level Silver Plan",,"0.739875257015228","Yes","Yes","No","100%",,"$2,000","$0","$920","$30","$2,000","$0","$580","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,625","$3625 per person","$7250 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127007704","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127007704.pdf","8"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330102","Arise AboutHealth HMO 1000-80","84670WI133","7467455680","WIN001","WIS007","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330102-00","Standard Gold Off Exchange Plan","81.55%","0.820885002613068","No","Yes","No","100%",,"$1,000","$80","$1,030","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133010200","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133010200.pdf","8"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330102","Arise AboutHealth HMO 1000-80","84670WI133","7467455680","WIN001","WIS007","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330102-01","Standard Gold On Exchange Plan","81.55%","0.820885002613068","No","Yes","No","100%",,"$1,000","$80","$1,030","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133010201","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133010201.pdf","9"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270129","ProHealth and Aurora 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270129-03","Limited Cost Sharing Plan Variation","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012903","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012903.pdf","63"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350131","Aspirus Arise 2500","84670WI135","7467455680","WIN001","WIS001","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350131-01","Standard Gold On Exchange Plan","79.01%","0.78987044095993","No","Yes","No","100%",,"$2,500","$80","$370","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135013101","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135013101.pdf","39"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270128","Aurora and Bellin 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270128-00","Standard Silver Off Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012800","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012800.pdf","39"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270128","Aurora and Bellin 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270128-01","Standard Silver On Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012801","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012801.pdf","40"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350132","Aspirus Arise 3000","84670WI135","7467455680","WIN001","WIS001","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350132-00","Standard Gold Off Exchange Plan","78.23%","0.793198883533478","No","Yes","No","100%",,"$3,000","$80","$0","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135013200","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135013200.pdf","40"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350132","Aspirus Arise 3000","84670WI135","7467455680","WIN001","WIS001","WIF001","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350132-01","Standard Gold On Exchange Plan","78.23%","0.793198883533478","No","Yes","No","100%",,"$3,000","$80","$0","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135013201","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135013201.pdf","41"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270128","Aurora and Bellin 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270128-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012802","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012802.pdf","41"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270128","Aurora and Bellin 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270128-03","Limited Cost Sharing Plan Variation","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012803","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012803.pdf","42"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350046","Aspirus Arise 3750","84670WI135","7467455680","WIN001","WIS001","WIF002","New","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350046-00","Standard Silver Off Exchange Plan","71.96%","0.721038579940796","No","Yes","No","100%",,"$3,750","$110","$480","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","20%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135004600","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135004600.pdf","42"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350046","Aspirus Arise 3750","84670WI135","7467455680","WIN001","WIS001","WIF002","New","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350046-01","Standard Silver On Exchange Plan","71.96%","0.721038579940796","No","Yes","No","100%",,"$3,750","$110","$480","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","20%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135004601","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135004601.pdf","43"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270128","Aurora and Bellin 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270128-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012804","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012804.pdf","43"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270128","Aurora and Bellin 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270128-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012805","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012805.pdf","44"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350048","Aspirus Arise 4000","84670WI135","7467455680","WIN001","WIS001","WIF002","New","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350048-00","Standard Silver Off Exchange Plan","71.61%","0.717644512653351","No","Yes","No","100%",,"$4,000","$110","$220","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135004800","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135004800.pdf","44"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350048","Aspirus Arise 4000","84670WI135","7467455680","WIN001","WIS001","WIF002","New","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350048-01","Standard Silver On Exchange Plan","71.61%","0.717644512653351","No","Yes","No","100%",,"$4,000","$110","$220","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,000","$16000 per person","$32000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135004801","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135004801.pdf","45"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270128","Aurora and Bellin 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270128-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012806","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012806.pdf","45"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270109","Aurora and ThedaCare 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270109-00","Standard Silver Off Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010900","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010900.pdf","46"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350133","Aspirus Arise 5000","84670WI135","7467455680","WIN001","WIS001","WIF002","New","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350133-00","Standard Silver Off Exchange Plan","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135013300","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135013300.pdf","46"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350133","Aspirus Arise 5000","84670WI135","7467455680","WIN001","WIS001","WIF002","New","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1350133-01","Standard Silver On Exchange Plan","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/135013301","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI135013301.pdf","47"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270109","Aurora and ThedaCare 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270109-01","Standard Silver On Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010901","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010901.pdf","47"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270109","Aurora and ThedaCare 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270109-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010902","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010902.pdf","48"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270109","Aurora and ThedaCare 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270109-03","Limited Cost Sharing Plan Variation","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010903","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010903.pdf","49"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270109","Aurora and ThedaCare 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270109-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010904","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010904.pdf","50"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270109","Aurora and ThedaCare 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270109-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010905","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010905.pdf","51"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270109","Aurora and ThedaCare 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270109-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010906","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010906.pdf","52"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270118","Aurora and ThedaCare 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270118-00","Standard Silver Off Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011800","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011800.pdf","53"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270118","Aurora and ThedaCare 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270118-01","Standard Silver On Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011801","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011801.pdf","54"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270118","Aurora and ThedaCare 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270118-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011802","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011802.pdf","55"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270118","Aurora and ThedaCare 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270118-03","Limited Cost Sharing Plan Variation","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011803","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011803.pdf","56"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270118","Aurora and ThedaCare 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270118-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011804","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011804.pdf","57"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270118","Aurora and ThedaCare 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270118-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011805","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011805.pdf","58"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270129","ProHealth and Aurora 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270129-00","Standard Silver Off Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012900","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012900.pdf","60"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270129","ProHealth and Aurora 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270129-01","Standard Silver On Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012901","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012901.pdf","61"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270129","ProHealth and Aurora 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270129-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012904","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012904.pdf","64"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270129","ProHealth and Aurora 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270129-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012905","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012905.pdf","65"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270129","ProHealth and Aurora 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270129-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012906","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012906.pdf","66"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270138","ProHealth and Aurora 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270138-00","Standard Silver Off Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127013800","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127013800.pdf","67"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270138","ProHealth and Aurora 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270138-01","Standard Silver On Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127013801","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127013801.pdf","68"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270138","ProHealth and Aurora 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270138-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127013802","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127013802.pdf","69"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270138","ProHealth and Aurora 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270138-03","Limited Cost Sharing Plan Variation","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127013803","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127013803.pdf","70"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270138","ProHealth and Aurora 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270138-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127013804","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127013804.pdf","71"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270138","ProHealth and Aurora 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270138-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127013805","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127013805.pdf","72"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270138","ProHealth and Aurora 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270138-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127013806","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127013806.pdf","73"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270015","ThedaCare 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF002","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270015-00","Standard Silver Off Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127001500","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127001500.pdf","74"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270015","ThedaCare 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF002","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270015-01","Standard Silver On Exchange Plan","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127001501","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127001501.pdf","75"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270015","ThedaCare 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF002","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127001502","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127001502.pdf","76"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270015","ThedaCare 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF002","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270015-03","Limited Cost Sharing Plan Variation","71.72%","0.717848122119904","No","Yes","No","100%",,"$4,000","$110","$650","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127001503","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127001503.pdf","77"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270015","ThedaCare 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF002","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270015-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127001504","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127001504.pdf","78"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270015","ThedaCare 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF002","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270015-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127001505","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127001505.pdf","79"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270015","ThedaCare 4000 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF002","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270015-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127001506","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127001506.pdf","80"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270102","ThedaCare 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270102-00","Standard Silver Off Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010200","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010200.pdf","81"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270102","ThedaCare 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270102-01","Standard Silver On Exchange Plan","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010201","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010201.pdf","82"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270102","ThedaCare 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270102-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010202","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010202.pdf","83"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270102","ThedaCare 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270102-03","Limited Cost Sharing Plan Variation","70.50%","0.701512157917023","No","Yes","No","100%",,"$6,160","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010203","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010203.pdf","84"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270102","ThedaCare 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270102-04","73% AV Level Silver Plan","73.93%","0.74109935760498","No","Yes","No","100%",,"$3,600","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010204","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010204.pdf","85"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270102","ThedaCare 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270102-05","87% AV Level Silver Plan","87.95%","0.887953758239746","No","Yes","No","100%",,"$350","$110","$0","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010205","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010205.pdf","86"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","3","84670","WI","Individual","No","20-2660193","84670WI1270102","ThedaCare 6850 Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF002","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270102-06","94% AV Level Silver Plan","95.00%","0.954653441905975","No","Yes","No","100%",,"$0","$110","$0","$30","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$19,700","$19700 per person","$39400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127010206","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127010206.pdf","87"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270077","Aspirus Arise 2600 HDHP","84670WI127","7467455680","WIN001","WIS001","WIF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270077-00","Standard Silver Off Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127007700","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127007700.pdf","4"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330101","Arise AboutHealth HMO 500","84670WI133","7467455680","WIN001","WIS007","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330101-00","Standard Platinum Off Exchange Plan","88.35%","0.886274874210358","No","Yes","No","100%",,"$500","$80","$1,130","$30","$140","$1,510","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133010100","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133010100.pdf","4"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330101","Arise AboutHealth HMO 500","84670WI133","7467455680","WIN001","WIS007","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330101-01","Standard Platinum On Exchange Plan","88.35%","0.886274874210358","No","Yes","No","100%",,"$500","$80","$1,130","$30","$140","$1,510","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133010101","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133010101.pdf","5"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270077","Aspirus Arise 2600 HDHP","84670WI127","7467455680","WIN001","WIS001","WIF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270077-01","Standard Silver On Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127007701","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127007701.pdf","5"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270077","Aspirus Arise 2600 HDHP","84670WI127","7467455680","WIN001","WIS001","WIF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270077-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127007702","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127007702.pdf","6"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330124","Arise AboutHealth HMO 1000","84670WI133","7467455680","WIN001","WIS007","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330124-00","Standard Platinum Off Exchange Plan","88.01%","0.89091819524765","No","Yes","No","100%",,"$1,000","$80","$0","$30","$140","$1,510","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133012400","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133012400.pdf","6"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270077","Aspirus Arise 2600 HDHP","84670WI127","7467455680","WIN001","WIS001","WIF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270077-05","87% AV Level Silver Plan",,"0.861428439617157","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127007705","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127007705.pdf","9"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270077","Aspirus Arise 2600 HDHP","84670WI127","7467455680","WIN001","WIS001","WIF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270077-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127007706","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127007706.pdf","10"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330104","Arise AboutHealth HMO 1500","84670WI133","7467455680","WIN001","WIS007","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330104-00","Standard Gold Off Exchange Plan","78.33%","0.788239300251007","No","Yes","No","100%",,"$1,500","$80","$930","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133010400","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133010400.pdf","10"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330104","Arise AboutHealth HMO 1500","84670WI133","7467455680","WIN001","WIS007","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330104-01","Standard Gold On Exchange Plan","78.33%","0.788239300251007","No","Yes","No","100%",,"$1,500","$80","$930","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133010401","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133010401.pdf","11"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270081","Aspirus Arise 5500 HDHP","84670WI127","7467455680","WIN001","WIS001","WIF004","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270081-00","Standard Bronze Off Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127008100","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127008100.pdf","11"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270081","Aspirus Arise 5500 HDHP","84670WI127","7467455680","WIN001","WIS001","WIF004","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270081-01","Standard Bronze On Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127008101","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127008101.pdf","12"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330103","Arise AboutHealth HMO 2000","84670WI133","7467455680","WIN001","WIS007","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330103-00","Standard Gold Off Exchange Plan","81.96%","0.832643330097198","No","Yes","No","100%",,"$2,000","$80","$0","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133010300","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133010300.pdf","12"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330103","Arise AboutHealth HMO 2000","84670WI133","7467455680","WIN001","WIS007","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330103-01","Standard Gold On Exchange Plan","81.96%","0.832643330097198","No","Yes","No","100%",,"$2,000","$80","$0","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133010301","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133010301.pdf","13"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270081","Aspirus Arise 5500 HDHP","84670WI127","7467455680","WIN001","WIS001","WIF004","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270081-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127008102","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127008102.pdf","13"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270081","Aspirus Arise 5500 HDHP","84670WI127","7467455680","WIN001","WIS001","WIF004","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270081-03","Limited Cost Sharing Plan Variation",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127008103","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127008103.pdf","14"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330045","Aspirus Arise HMO 1000-80","84670WI133","7467455680","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330045-00","Standard Gold Off Exchange Plan","81.55%","0.820885002613068","No","Yes","No","100%",,"$1,000","$80","$1,030","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133004500","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133004500.pdf","30"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270125","Aurora and Bellin 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270125-04","73% AV Level Silver Plan",,"0.739875257015228","Yes","Yes","No","100%",,"$2,000","$0","$920","$30","$2,000","$0","$580","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,625","$3625 per person","$7250 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012504","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012504.pdf","30"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270125","Aurora and Bellin 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270125-05","87% AV Level Silver Plan",,"0.861428439617157","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012505","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012505.pdf","31"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330045","Aspirus Arise HMO 1000-80","84670WI133","7467455680","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330045-01","Standard Gold On Exchange Plan","81.55%","0.820885002613068","No","Yes","No","100%",,"$1,000","$80","$1,030","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133004501","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133004501.pdf","31"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330057","Aspirus Arise HMO 1500","84670WI133","7467455680","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330057-00","Standard Gold Off Exchange Plan","78.33%","0.788239300251007","No","Yes","No","100%",,"$1,500","$80","$930","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133005700","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133005700.pdf","32"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270125","Aurora and Bellin 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270125-03","Limited Cost Sharing Plan Variation",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012503","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012503.pdf","29"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330129","Aspirus Arise HMO 1000","84670WI133","7467455680","WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330129-01","Standard Platinum On Exchange Plan","88.01%","0.89091819524765","No","Yes","No","100%",,"$1,000","$80","$0","$30","$140","$1,510","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133012901","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133012901.pdf","29"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330057","Aspirus Arise HMO 1500","84670WI133","7467455680","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330057-01","Standard Gold On Exchange Plan","78.33%","0.788239300251007","No","Yes","No","100%",,"$1,500","$80","$930","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133005701","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133005701.pdf","33"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270125","Aurora and Bellin 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270125-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012506","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012506.pdf","32"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270122","Aurora and Bellin 5500 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270122-00","Standard Bronze Off Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012200","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012200.pdf","33"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330125","Arise AboutHealth HMO 2000-80","84670WI133","7467455680","WIN001","WIS007","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330125-00","Standard Gold Off Exchange Plan","78.09%","0.783013999462128","No","Yes","No","100%",,"$2,000","$80","$830","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133012500","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133012500.pdf","14"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330125","Arise AboutHealth HMO 2000-80","84670WI133","7467455680","WIN001","WIS007","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330125-01","Standard Gold On Exchange Plan","78.09%","0.783013999462128","No","Yes","No","100%",,"$2,000","$80","$830","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133012501","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133012501.pdf","15"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270087","Aurora 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270087-00","Standard Silver Off Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127008700","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127008700.pdf","15"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270087","Aurora 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270087-01","Standard Silver On Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127008701","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127008701.pdf","16"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330126","Arise AboutHealth HMO 2500","84670WI133","7467455680","WIN001","WIS007","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330126-00","Standard Gold Off Exchange Plan","79.01%","0.78987044095993","No","Yes","No","100%",,"$2,500","$80","$370","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133012600","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133012600.pdf","16"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330126","Arise AboutHealth HMO 2500","84670WI133","7467455680","WIN001","WIS007","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330126-01","Standard Gold On Exchange Plan","79.01%","0.78987044095993","No","Yes","No","100%",,"$2,500","$80","$370","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133012601","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133012601.pdf","17"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270087","Aurora 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270087-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127008702","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127008702.pdf","17"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270087","Aurora 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270087-03","Limited Cost Sharing Plan Variation",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127008703","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127008703.pdf","18"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330127","Arise AboutHealth HMO 3000","84670WI133","7467455680","WIN001","WIS007","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330127-00","Standard Gold Off Exchange Plan","78.23%","0.793198883533478","No","Yes","No","100%",,"$3,000","$80","$0","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133012700","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133012700.pdf","18"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330127","Arise AboutHealth HMO 3000","84670WI133","7467455680","WIN001","WIS007","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330127-01","Standard Gold On Exchange Plan","78.23%","0.793198883533478","No","Yes","No","100%",,"$3,000","$80","$0","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133012701","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133012701.pdf","19"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270087","Aurora 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270087-04","73% AV Level Silver Plan",,"0.739875257015228","Yes","Yes","No","100%",,"$2,000","$0","$920","$30","$2,000","$0","$580","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,625","$3625 per person","$7250 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127008704","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127008704.pdf","19"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270087","Aurora 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270087-05","87% AV Level Silver Plan",,"0.861428439617157","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127008705","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127008705.pdf","20"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330106","Arise AboutHealth HMO 3750","84670WI133","7467455680","WIN001","WIS007","WIF002","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330106-00","Standard Silver Off Exchange Plan","71.96%","0.721038579940796","No","Yes","No","100%",,"$3,750","$110","$480","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133010600","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133010600.pdf","20"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330106","Arise AboutHealth HMO 3750","84670WI133","7467455680","WIN001","WIS007","WIF002","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330106-01","Standard Silver On Exchange Plan","71.96%","0.721038579940796","No","Yes","No","100%",,"$3,750","$110","$480","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133010601","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133010601.pdf","21"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270087","Aurora 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270087-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127008706","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127008706.pdf","21"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270091","Aurora 5500 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF004","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270091-00","Standard Bronze Off Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127009100","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127009100.pdf","22"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330107","Arise AboutHealth HMO 4000","84670WI133","7467455680","WIN001","WIS007","WIF002","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330107-00","Standard Silver Off Exchange Plan","71.61%","0.717644512653351","No","Yes","No","100%",,"$4,000","$110","$220","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133010700","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133010700.pdf","22"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330107","Arise AboutHealth HMO 4000","84670WI133","7467455680","WIN001","WIS007","WIF002","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330107-01","Standard Silver On Exchange Plan","71.61%","0.717644512653351","No","Yes","No","100%",,"$4,000","$110","$220","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133010701","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133010701.pdf","23"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270091","Aurora 5500 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF004","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270091-01","Standard Bronze On Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127009101","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127009101.pdf","23"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270091","Aurora 5500 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF004","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270091-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127009102","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127009102.pdf","24"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330128","Arise AboutHealth HMO 5000","84670WI133","7467455680","WIN001","WIS007","WIF002","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330128-00","Standard Silver Off Exchange Plan","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133012800","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133012800.pdf","24"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330128","Arise AboutHealth HMO 5000","84670WI133","7467455680","WIN001","WIS007","WIF002","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330128-01","Standard Silver On Exchange Plan","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133012801","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133012801.pdf","25"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270091","Aurora 5500 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS002","WIF004","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270091-03","Limited Cost Sharing Plan Variation",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127009103","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127009103.pdf","25"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330055","Aspirus Arise HMO 500","84670WI133","7467455680","WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330055-00","Standard Platinum Off Exchange Plan","88.35%","0.886274874210358","No","Yes","No","100%",,"$500","$80","$1,130","$30","$140","$1,510","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133005500","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133005500.pdf","26"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270125","Aurora and Bellin 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270125-00","Standard Silver Off Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012500","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012500.pdf","26"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270125","Aurora and Bellin 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270125-01","Standard Silver On Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012501","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012501.pdf","27"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330055","Aspirus Arise HMO 500","84670WI133","7467455680","WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330055-01","Standard Platinum On Exchange Plan","88.35%","0.886274874210358","No","Yes","No","100%",,"$500","$80","$1,130","$30","$140","$1,510","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133005501","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133005501.pdf","27"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330129","Aspirus Arise HMO 1000","84670WI133","7467455680","WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330129-00","Standard Platinum Off Exchange Plan","88.01%","0.89091819524765","No","Yes","No","100%",,"$1,000","$80","$0","$30","$140","$1,510","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133012900","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133012900.pdf","28"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270125","Aurora and Bellin 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270125-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012502","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012502.pdf","28"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330044","Aspirus Arise HMO 2000","84670WI133","7467455680","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330044-00","Standard Gold Off Exchange Plan","81.96%","0.832643330097198","No","Yes","No","100%",,"$2,000","$80","$0","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133004400","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133004400.pdf","34"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270122","Aurora and Bellin 5500 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270122-01","Standard Bronze On Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012201","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012201.pdf","34"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270122","Aurora and Bellin 5500 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270122-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012202","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012202.pdf","35"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330044","Aspirus Arise HMO 2000","84670WI133","7467455680","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330044-01","Standard Gold On Exchange Plan","81.96%","0.832643330097198","No","Yes","No","100%",,"$2,000","$80","$0","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133004401","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133004401.pdf","35"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330130","Aspirus Arise HMO 2000-80","84670WI133","7467455680","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330130-00","Standard Gold Off Exchange Plan","78.09%","0.783013999462128","No","Yes","No","100%",,"$2,000","$80","$830","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133013000","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133013000.pdf","36"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270122","Aurora and Bellin 5500 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS003","WIF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270122-03","Limited Cost Sharing Plan Variation",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127012203","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127012203.pdf","36"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270115","Aurora and ThedaCare 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270115-00","Standard Silver Off Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011500","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011500.pdf","37"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330130","Aspirus Arise HMO 2000-80","84670WI133","7467455680","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330130-01","Standard Gold On Exchange Plan","78.09%","0.783013999462128","No","Yes","No","100%",,"$2,000","$80","$830","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133013001","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133013001.pdf","37"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330131","Aspirus Arise HMO 2500","84670WI133","7467455680","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330131-00","Standard Gold Off Exchange Plan","79.01%","0.78987044095993","No","Yes","No","100%",,"$2,500","$80","$370","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133013100","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133013100.pdf","38"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270115","Aurora and ThedaCare 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270115-01","Standard Silver On Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011501","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011501.pdf","38"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270115","Aurora and ThedaCare 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270115-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011502","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011502.pdf","39"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330131","Aspirus Arise HMO 2500","84670WI133","7467455680","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330131-01","Standard Gold On Exchange Plan","79.01%","0.78987044095993","No","Yes","No","100%",,"$2,500","$80","$370","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133013101","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133013101.pdf","39"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330132","Aspirus Arise HMO 3000","84670WI133","7467455680","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330132-00","Standard Gold Off Exchange Plan","78.23%","0.793198883533478","No","Yes","No","100%",,"$3,000","$80","$0","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133013200","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133013200.pdf","40"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270115","Aurora and ThedaCare 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270115-03","Limited Cost Sharing Plan Variation",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011503","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011503.pdf","40"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270115","Aurora and ThedaCare 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270115-04","73% AV Level Silver Plan",,"0.739875257015228","Yes","Yes","No","100%",,"$2,000","$0","$920","$30","$2,000","$0","$580","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,625","$3625 per person","$7250 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011504","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011504.pdf","41"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330132","Aspirus Arise HMO 3000","84670WI133","7467455680","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330132-01","Standard Gold On Exchange Plan","78.23%","0.793198883533478","No","Yes","No","100%",,"$3,000","$80","$0","$30","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133013201","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133013201.pdf","41"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330046","Aspirus Arise HMO 3750","84670WI133","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330046-00","Standard Silver Off Exchange Plan","71.96%","0.721038579940796","No","Yes","No","100%",,"$3,750","$110","$480","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133004600","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133004600.pdf","42"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270115","Aurora and ThedaCare 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270115-05","87% AV Level Silver Plan",,"0.861428439617157","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011505","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011505.pdf","42"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270115","Aurora and ThedaCare 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270115-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011506","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011506.pdf","43"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330046","Aspirus Arise HMO 3750","84670WI133","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330046-01","Standard Silver On Exchange Plan","71.96%","0.721038579940796","No","Yes","No","100%",,"$3,750","$110","$480","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133004601","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133004601.pdf","43"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330048","Aspirus Arise HMO 4000","84670WI133","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330048-00","Standard Silver Off Exchange Plan","71.61%","0.717644512653351","No","Yes","No","100%",,"$4,000","$110","$220","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133004800","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133004800.pdf","44"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270112","Aurora and ThedaCare 5500 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270112-00","Standard Bronze Off Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011200","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011200.pdf","44"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270112","Aurora and ThedaCare 5500 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270112-01","Standard Bronze On Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011201","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011201.pdf","45"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330048","Aspirus Arise HMO 4000","84670WI133","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330048-01","Standard Silver On Exchange Plan","71.61%","0.717644512653351","No","Yes","No","100%",,"$4,000","$110","$220","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133004801","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133004801.pdf","45"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330133","Aspirus Arise HMO 5000","84670WI133","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330133-00","Standard Silver Off Exchange Plan","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133013300","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133013300.pdf","46"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270112","Aurora and ThedaCare 5500 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270112-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011202","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011202.pdf","46"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","Individual","No","20-2660193","84670WI1270112","Aurora and ThedaCare 5500 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS004","WIF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270112-03","Limited Cost Sharing Plan Variation",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127011203","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127011203.pdf","47"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","4","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330133","Aspirus Arise HMO 5000","84670WI133","7467455680","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,"$500","0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No",,"http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1330133-01","Standard Silver On Exchange Plan","70.88%","0.708280086517334","No","Yes","No","100%",,"$5,000","$110","$230","$30","$140","$1,860","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://secure.wecareforwisconsin.com/visitors/find_sbc/133013301","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI133013301.pdf","47"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","5","84670","WI","Individual","No","20-2660193","84670WI1250093","Aspirus Arise HMO 6850 Catastrophic","84670WI125","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250093-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$4,560","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125009300","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125009300.pdf","4"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","5","84670","WI","Individual","No","20-2660193","84670WI1250093","Aspirus Arise HMO 6850 Catastrophic","84670WI125","7467455680","WIN001","WIS001","WIF006","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250093-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$4,560","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125009301","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125009301.pdf","5"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","5","84670","WI","Individual","No","20-2660193","84670WI1250094","Aurora HMO 6850 Catastrophic Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF006","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250094-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$4,560","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125009400","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125009400.pdf","6"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","5","84670","WI","Individual","No","20-2660193","84670WI1250094","Aurora HMO 6850 Catastrophic Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS002","WIF006","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250094-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$4,560","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125009401","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125009401.pdf","7"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","5","84670","WI","Individual","No","20-2660193","84670WI1250121","Aurora and Bellin HMO 6850 Catastrophic Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF006","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250121-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$4,560","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012100","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012100.pdf","8"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","5","84670","WI","Individual","No","20-2660193","84670WI1250121","Aurora and Bellin HMO 6850 Catastrophic Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF006","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250121-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$4,560","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012101","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012101.pdf","9"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","5","84670","WI","Individual","No","20-2660193","84670WI1250111","Aurora and ThedaCare HMO 6850 Catastrophic Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF006","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250111-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$4,560","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011100","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011100.pdf","10"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","5","84670","WI","Individual","No","20-2660193","84670WI1250111","Aurora and ThedaCare HMO 6850 Catastrophic Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF006","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250111-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$4,560","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011101","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011101.pdf","11"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","5","84670","WI","Individual","No","20-2660193","84670WI1250131","ProHealth and Aurora HMO 6850 Catastrophic Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF006","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250131-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$4,560","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013100","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013100.pdf","12"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","5","84670","WI","Individual","No","20-2660193","84670WI1250131","ProHealth and Aurora HMO 6850 Catastrophic Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF006","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250131-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$4,560","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013101","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013101.pdf","13"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","5","84670","WI","Individual","No","20-2660193","84670WI1250039","ThedaCare HMO 6850 Catastrophic Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF006","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250039-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$4,560","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125003900","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125003900.pdf","14"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","5","84670","WI","Individual","No","20-2660193","84670WI1250039","ThedaCare HMO 6850 Catastrophic Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF006","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250039-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$4,560","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125003901","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125003901.pdf","15"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250125","Aurora and Bellin HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250125-00","Standard Silver Off Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012500","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012500.pdf","4"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250125","Aurora and Bellin HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250125-01","Standard Silver On Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012501","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012501.pdf","5"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250125","Aurora and Bellin HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250125-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012502","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/zero-cost-share.pdf","6"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250125","Aurora and Bellin HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250125-03","Limited Cost Sharing Plan Variation",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012503","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012503.pdf","7"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250125","Aurora and Bellin HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250125-04","73% AV Level Silver Plan",,"0.739875257015228","Yes","Yes","No","100%",,"$2,000","$0","$920","$30","$2,000","$0","$580","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,625","$3625 per person","$7250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012504","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012504.pdf","8"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250125","Aurora and Bellin HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250125-05","87% AV Level Silver Plan",,"0.861428439617157","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012505","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012505.pdf","9"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250125","Aurora and Bellin HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250125-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012506","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012506.pdf","10"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250124","Aurora and Bellin HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250124-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012400","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012400.pdf","11"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250124","Aurora and Bellin HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250124-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012401","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012401.pdf","12"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250124","Aurora and Bellin HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250124-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012402","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/zero-cost-share.pdf","13"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250124","Aurora and Bellin HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250124-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012403","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012403.pdf","14"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250124","Aurora and Bellin HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250124-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$30","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012404","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012404.pdf","15"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250124","Aurora and Bellin HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250124-05","87% AV Level Silver Plan",,"0.861428439617157","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012405","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012405.pdf","16"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250124","Aurora and Bellin HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250124-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012406","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012406.pdf","17"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250122","Aurora and Bellin HMO 5500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250122-00","Standard Bronze Off Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012200","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012200.pdf","18"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250122","Aurora and Bellin HMO 5500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250122-01","Standard Bronze On Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012201","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012201.pdf","19"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250122","Aurora and Bellin HMO 5500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250122-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012202","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012202.pdf","20"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250122","Aurora and Bellin HMO 5500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250122-03","Limited Cost Sharing Plan Variation",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012203","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012203.pdf","21"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250123","Aurora and Bellin HMO 6450 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF006","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250123-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012300","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012300.pdf","22"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250123","Aurora and Bellin HMO 6450 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF006","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250123-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012301","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012301.pdf","23"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250123","Aurora and Bellin HMO 6450 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF006","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250123-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012302","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012302.pdf","24"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250123","Aurora and Bellin HMO 6450 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS003","WIF006","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250123-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125012303","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125012303.pdf","25"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250115","Aurora and ThedaCare HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250115-00","Standard Silver Off Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011500","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011500.pdf","26"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250115","Aurora and ThedaCare HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250115-01","Standard Silver On Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011501","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011501.pdf","27"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250115","Aurora and ThedaCare HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250115-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011502","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011502.pdf","28"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250115","Aurora and ThedaCare HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250115-03","Limited Cost Sharing Plan Variation",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011503","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011503.pdf","29"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250115","Aurora and ThedaCare HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250115-04","73% AV Level Silver Plan",,"0.739875257015228","Yes","Yes","No","100%",,"$2,000","$0","$920","$30","$2,000","$0","$580","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,625","$3625 per person","$7250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011504","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011504.pdf","30"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250115","Aurora and ThedaCare HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250115-05","87% AV Level Silver Plan",,"0.861428439617157","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011505","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011505.pdf","31"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250115","Aurora and ThedaCare HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250115-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011506","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011506.pdf","32"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250114","Aurora and ThedaCare HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250114-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011400","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011400.pdf","33"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250114","Aurora and ThedaCare HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250114-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011401","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011401.pdf","34"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250114","Aurora and ThedaCare HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250114-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011402","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011402.pdf","35"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250114","Aurora and ThedaCare HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250114-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011403","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011403.pdf","36"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250114","Aurora and ThedaCare HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250114-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$30","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011404","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011404.pdf","37"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250114","Aurora and ThedaCare HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250114-05","87% AV Level Silver Plan",,"0.861428439617157","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011405","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011405.pdf","38"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250114","Aurora and ThedaCare HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250114-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011406","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011406.pdf","39"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250112","Aurora and ThedaCare HMO 5500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250112-00","Standard Bronze Off Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011200","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011200.pdf","40"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250112","Aurora and ThedaCare HMO 5500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250112-01","Standard Bronze On Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011201","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011201.pdf","41"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250112","Aurora and ThedaCare HMO 5500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250112-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011202","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011202.pdf","42"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250112","Aurora and ThedaCare HMO 5500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250112-03","Limited Cost Sharing Plan Variation",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011203","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011203.pdf","43"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250113","Aurora and ThedaCare HMO 6450 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF006","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250113-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011300","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011300.pdf","44"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250113","Aurora and ThedaCare HMO 6450 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF006","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250113-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011301","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011301.pdf","45"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250113","Aurora and ThedaCare HMO 6450 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF006","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250113-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011302","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011302.pdf","46"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","6","84670","WI","Individual","No","20-2660193","84670WI1250113","Aurora and ThedaCare HMO 6450 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS004","WIF006","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250113-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125011303","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125011303.pdf","47"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250135","ProHealth and Aurora HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250135-00","Standard Silver Off Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013500","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013500.pdf","4"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250135","ProHealth and Aurora HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250135-01","Standard Silver On Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013501","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013501.pdf","5"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250135","ProHealth and Aurora HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250135-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013502","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013502.pdf","6"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250135","ProHealth and Aurora HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250135-03","Limited Cost Sharing Plan Variation",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013503","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013503.pdf","7"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250135","ProHealth and Aurora HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250135-04","73% AV Level Silver Plan",,"0.739875257015228","Yes","Yes","No","100%",,"$2,000","$0","$920","$30","$2,000","$0","$580","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,625","$3625 per person","$7250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013504","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013504.pdf","8"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250135","ProHealth and Aurora HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250135-05","87% AV Level Silver Plan",,"0.861428439617157","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013505","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013505.pdf","9"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250135","ProHealth and Aurora HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250135-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013506","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013506.pdf","10"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250134","ProHealth and Aurora HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250134-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013400","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013400.pdf","11"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250134","ProHealth and Aurora HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250134-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013401","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013401.pdf","12"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250134","ProHealth and Aurora HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250134-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013402","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013402.pdf","13"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250134","ProHealth and Aurora HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250134-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013403","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013403.pdf","14"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250134","ProHealth and Aurora HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250134-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$30","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013404","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013404.pdf","15"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250134","ProHealth and Aurora HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250134-05","87% AV Level Silver Plan",,"0.861428439617157","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013405","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013405.pdf","16"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250134","ProHealth and Aurora HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250134-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013406","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013406.pdf","17"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250132","ProHealth and Aurora HMO 5500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250132-00","Standard Bronze Off Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013200","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013200.pdf","18"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250132","ProHealth and Aurora HMO 5500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250132-01","Standard Bronze On Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013201","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013201.pdf","19"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250132","ProHealth and Aurora HMO 5500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250132-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013202","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013202.pdf","20"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250132","ProHealth and Aurora HMO 5500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250132-03","Limited Cost Sharing Plan Variation",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013203","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013203.pdf","21"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250133","ProHealth and Aurora HMO 6450 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF006","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250133-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013300","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013300.pdf","22"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250133","ProHealth and Aurora HMO 6450 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF006","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250133-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013301","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013301.pdf","23"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250133","ProHealth and Aurora HMO 6450 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF006","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250133-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013302","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013302.pdf","24"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250133","ProHealth and Aurora HMO 6450 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS005","WIF006","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250133-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125013303","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125013303.pdf","25"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250032","ThedaCare HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250032-00","Standard Silver Off Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125003200","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125003200.pdf","26"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250032","ThedaCare HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250032-01","Standard Silver On Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125003201","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125003201.pdf","27"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250032","ThedaCare HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250032-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125003202","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125003202.pdf","28"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250032","ThedaCare HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250032-03","Limited Cost Sharing Plan Variation",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125003203","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125003203.pdf","29"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250032","ThedaCare HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250032-04","73% AV Level Silver Plan",,"0.739875257015228","Yes","Yes","No","100%",,"$2,000","$0","$920","$30","$2,000","$0","$580","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,625","$3625 per person","$7250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125003204","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125003204.pdf","30"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250032","ThedaCare HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250032-05","87% AV Level Silver Plan",,"0.861428439617157","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125003205","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125003205.pdf","31"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250032","ThedaCare HMO 2600 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250032-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125003206","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125003206.pdf","32"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250029","ThedaCare HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250029-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125002900","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125002900.pdf","33"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250029","ThedaCare HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250029-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125002901","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125002901.pdf","34"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250029","ThedaCare HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250029-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125002902","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125002902.pdf","35"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250029","ThedaCare HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250029-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125002903","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125002903.pdf","36"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250029","ThedaCare HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250029-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$30","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125002904","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125002904.pdf","37"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250029","ThedaCare HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250029-05","87% AV Level Silver Plan",,"0.861428439617157","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125002905","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125002905.pdf","38"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250029","ThedaCare HMO 3500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250029-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125002906","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125002906.pdf","39"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250036","ThedaCare HMO 5500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250036-00","Standard Bronze Off Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125003600","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125003600.pdf","40"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250036","ThedaCare HMO 5500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250036-01","Standard Bronze On Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125003601","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125003601.pdf","41"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250036","ThedaCare HMO 5500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250036-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125003602","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125003602.pdf","42"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250036","ThedaCare HMO 5500 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250036-03","Limited Cost Sharing Plan Variation",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125003603","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125003603.pdf","43"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250034","ThedaCare HMO 6450 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF006","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250034-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125003400","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125003400.pdf","44"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250034","ThedaCare HMO 6450 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF006","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250034-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125003401","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125003401.pdf","45"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250034","ThedaCare HMO 6450 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF006","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250034-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125003402","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125003402.pdf","46"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","7","84670","WI","Individual","No","20-2660193","84670WI1250034","ThedaCare HMO 6450 HDHP Featuring the AboutHealth Network","84670WI125","7467455680","WIN001","WIS006","WIF006","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Limited to emergency care only","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1250034-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/125003403","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI125003403.pdf","47"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270132","ProHealth and Aurora 5500 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270132-00","Standard Bronze Off Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127013200","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127013200.pdf","4"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010019","Envision Aurora Bellin PPO - Gold 600/80","87416WI001",,"WIN002","WIS001","WIF003","Existing","PPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010019-00","Standard Gold Off Exchange Plan",,"0.791004300117493","Yes","Yes","No","100%",,"$600","$20","$1,330","$150","$600","$710","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20%",,,,,"$1,200","$1200 per person","$2400 per group","$1,800","$1800 per person","$3600 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Gold600-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Gold600-80.pdf","4"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010019","Envision Aurora Bellin PPO - Gold 600/80","87416WI001",,"WIN002","WIS001","WIF003","Existing","PPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010019-01","Standard Gold On Exchange Plan",,"0.791004300117493","Yes","Yes","No","100%",,"$600","$20","$1,330","$150","$600","$710","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20%",,,,,"$1,200","$1200 per person","$2400 per group","$1,800","$1800 per person","$3600 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Gold600-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Gold600-80.pdf","5"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020015","Envision Aurora Bellin PPO - Gold 600/80","87416WI002",,"WIN002","WIS001","WIF003","Existing","PPO","Gold","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020015-01","Standard Gold On Exchange Plan",,"0.791004300117493","Yes","Yes","No","100%",,"$600","$20","$1,330","$150","$600","$710","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20%",,,,,"$1,200","$1200 per person","$2400 per group","$1,800","$1800 per person","$3600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Gold600-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Gold600-80.pdf","5"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020016","Envision Aurora Bellin PPO - Gold 1000/90","87416WI002",,"WIN002","WIS001","WIF004","Existing","PPO","Gold","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020016-00","Standard Gold Off Exchange Plan",,"0.802700340747833","Yes","Yes","No","100%",,"$1,000","$20","$630","$150","$1,000","$610","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Gold1000-90.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Gold1000-90.pdf","6"
"2016","WI","86572","HIOS","1","2015-05-01 02:23:41","1","86572","WI","SHOP (Small Group)","Yes","36-0883760","86572WI0030002","EHB High Passive","86572WI003",,"WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$52.59","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","86572WI0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","WI","86572","HIOS","1","2015-05-01 02:23:41","1","86572","WI","SHOP (Small Group)","Yes","36-0883760","86572WI0030001","EHB Low Passive","86572WI003",,"WIN001","WIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.39","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","86572WI0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020015","Envision Aurora Bellin PPO - Gold 600/80","87416WI002",,"WIN002","WIS001","WIF003","Existing","PPO","Gold","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020015-00","Standard Gold Off Exchange Plan",,"0.791004300117493","Yes","Yes","No","100%",,"$600","$20","$1,330","$150","$600","$710","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20%",,,,,"$1,200","$1200 per person","$2400 per group","$1,800","$1800 per person","$3600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Gold600-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Gold600-80.pdf","4"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020016","Envision Aurora Bellin PPO - Gold 1000/90","87416WI002",,"WIN002","WIS001","WIF004","Existing","PPO","Gold","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020016-01","Standard Gold On Exchange Plan",,"0.802700340747833","Yes","Yes","No","100%",,"$1,000","$20","$630","$150","$1,000","$610","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Gold1000-90.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Gold1000-90.pdf","7"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010019","Envision Aurora Bellin PPO - Gold 600/80","87416WI001",,"WIN002","WIS001","WIF003","Existing","PPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Gold600-80NCS.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Gold600-80NCS.pdf","6"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010019","Envision Aurora Bellin PPO - Gold 600/80","87416WI001",,"WIN002","WIS001","WIF003","Existing","PPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010019-03","Limited Cost Sharing Plan Variation",,"0.791004300117493","Yes","Yes","No","100%",,"$600","$20","$1,330","$150","$600","$710","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20%",,,,,"$1,200","$1200 per person","$2400 per group","$1,800","$1800 per person","$3600 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Gold600-80LCS.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Gold600-80LCS.pdf","7"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270132","ProHealth and Aurora 5500 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270132-01","Standard Bronze On Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127013201","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127013201.pdf","5"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270132","ProHealth and Aurora 5500 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270132-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127013202","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127013202.pdf","6"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270132","ProHealth and Aurora 5500 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270132-03","Limited Cost Sharing Plan Variation",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127013203","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127013203.pdf","7"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270032","ThedaCare 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270032-00","Standard Silver Off Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127003200","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127003200.pdf","8"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270032","ThedaCare 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270032-01","Standard Silver On Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127003201","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127003201.pdf","9"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270032","ThedaCare 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270032-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127003202","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127003202.pdf","10"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270032","ThedaCare 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270032-03","Limited Cost Sharing Plan Variation",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127003203","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127003203.pdf","11"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270032","ThedaCare 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270032-04","73% AV Level Silver Plan",,"0.739875257015228","Yes","Yes","No","100%",,"$2,000","$0","$920","$30","$2,000","$0","$580","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,625","$3625 per person","$7250 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127003204","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127003204.pdf","12"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270032","ThedaCare 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270032-05","87% AV Level Silver Plan",,"0.861428439617157","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127003205","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127003205.pdf","13"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270032","ThedaCare 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270032-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127003206","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127003206.pdf","14"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270036","ThedaCare 5500 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF004","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270036-00","Standard Bronze Off Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127003600","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127003600.pdf","15"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270036","ThedaCare 5500 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF004","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270036-01","Standard Bronze On Exchange Plan",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127003601","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127003601.pdf","16"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270036","ThedaCare 5500 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF004","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270036-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127003602","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127003602.pdf","17"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270036","ThedaCare 5500 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS006","WIF004","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270036-03","Limited Cost Sharing Plan Variation",,"0.608003854751587","Yes","Yes","No","100%",,"$5,500","$0","$220","$30","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127003603","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127003603.pdf","18"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270135","ProHealth and Aurora 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270135-00","Standard Silver Off Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127013500","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127013500.pdf","19"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270135","ProHealth and Aurora 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270135-01","Standard Silver On Exchange Plan",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127013501","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127013501.pdf","20"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270135","ProHealth and Aurora 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270135-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127013502","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127013502.pdf","21"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270135","ProHealth and Aurora 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270135-03","Limited Cost Sharing Plan Variation",,"0.710013210773468","Yes","Yes","No","100%",,"$2,600","$0","$800","$30","$2,600","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127013503","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127013503.pdf","22"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270135","ProHealth and Aurora 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270135-04","73% AV Level Silver Plan",,"0.739875257015228","Yes","Yes","No","100%",,"$2,000","$0","$920","$30","$2,000","$0","$580","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,625","$3625 per person","$7250 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127013504","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127013504.pdf","23"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270135","ProHealth and Aurora 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270135-05","87% AV Level Silver Plan",,"0.861428439617157","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127013505","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127013505.pdf","24"
"2016","WI","84670","HIOS","8","2016-06-06 12:06:06","8","84670","WI","Individual","No","20-2660193","84670WI1270135","ProHealth and Aurora 2600 HDHP Featuring the AboutHealth Network","84670WI127","7467455680","WIN001","WIS005","WIF004","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Low Back Pain","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Limited to emergency care only","Yes","Services paid at the non-participating provider level.","No","http://www.wecareforwisconsin.com/payment","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary","84670WI1270135-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$15,200","$15200 per person","$30400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.wecareforwisconsin.com/visitors/find_sbc/127013506","http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/2016/84670WI127013506.pdf","25"
"2016","WI","85005","HIOS","4","2015-09-25 04:20:25","1","85005","WI","SHOP (Small Group)","Yes","27-2407349","85005WI0070001","Group Dental Only High","85005WI007",,"WIN001","WIS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.86","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Covered if seeing an in-network provider","Yes","http://www.momentumplans.com/find/ShoppingCart/Payment","","85005WI0070001-00","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.momentumplans.com/Content/files/MomentumInsurancePlansGroupDental_High_Low_Plans.pdf",,"4"
"2016","WI","85005","HIOS","4","2015-09-25 04:20:25","1","85005","WI","Individual","Yes","27-2407349","85005WI0010001","Individual Pediatric Dental Only High","85005WI001",,"WIN001","WIS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$43.86","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Covered if seeing an in-network provider","Yes",,"","85005WI0010001-00","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.momentumplans.com/Content/files/MomentumInsurancePlansIndividualPediatricDental_High_Low_.pdf",,"4"
"2016","WI","85005","HIOS","4","2015-09-25 04:20:25","1","85005","WI","Individual","Yes","27-2407349","85005WI0010001","Individual Pediatric Dental Only High","85005WI001",,"WIN001","WIS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$43.86","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Covered if seeing an in-network provider","Yes",,"","85005WI0010001-01","Standard High On Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.momentumplans.com/Content/files/MomentumInsurancePlansIndividualPediatricDental_High_Low_.pdf",,"5"
"2016","WI","85005","HIOS","4","2015-09-25 04:20:25","1","85005","WI","SHOP (Small Group)","Yes","27-2407349","85005WI0070001","Group Dental Only High","85005WI007",,"WIN001","WIS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.86","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Covered if seeing an in-network provider","Yes","http://www.momentumplans.com/find/ShoppingCart/Payment","","85005WI0070001-01","Standard High On Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.momentumplans.com/Content/files/MomentumInsurancePlansGroupDental_High_Low_Plans.pdf",,"5"
"2016","WI","85005","HIOS","4","2015-09-25 04:20:25","1","85005","WI","SHOP (Small Group)","Yes","27-2407349","85005WI0080001","Group Dental Only Low","85005WI008",,"WIN001","WIS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.21","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Covered if seeing an in-network provider","Yes","http://www.momentumplans.com/find/ShoppingCart/Payment","","85005WI0080001-00","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","$90 per person","$270 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.momentumplans.com/Content/files/MomentumInsurancePlansGroupDental_High_Low_Plans.pdf",,"6"
"2016","WI","85005","HIOS","4","2015-09-25 04:20:25","1","85005","WI","Individual","Yes","27-2407349","85005WI0020001","Individual Pediatric Dental Only Low","85005WI002",,"WIN001","WIS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$33.21","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Covered if seeing an in-network provider","Yes",,"","85005WI0020001-00","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","$90 per person","$270 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.momentumplans.com/Content/files/MomentumInsurancePlansIndividualPediatricDental_High_Low_.pdf",,"6"
"2016","WI","85005","HIOS","4","2015-09-25 04:20:25","1","85005","WI","Individual","Yes","27-2407349","85005WI0020001","Individual Pediatric Dental Only Low","85005WI002",,"WIN001","WIS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$33.21","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Covered if seeing an in-network provider","Yes",,"","85005WI0020001-01","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","$90 per person","$270 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.momentumplans.com/Content/files/MomentumInsurancePlansIndividualPediatricDental_High_Low_.pdf",,"7"
"2016","WI","85005","HIOS","4","2015-09-25 04:20:25","1","85005","WI","SHOP (Small Group)","Yes","27-2407349","85005WI0080001","Group Dental Only Low","85005WI008",,"WIN001","WIS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.21","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Covered if seeing an in-network provider","Yes","http://www.momentumplans.com/find/ShoppingCart/Payment","","85005WI0080001-01","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","$90 per person","$270 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.momentumplans.com/Content/files/MomentumInsurancePlansGroupDental_High_Low_Plans.pdf",,"7"
"2016","WI","85005","HIOS","4","2015-09-25 04:20:25","1","85005","WI","Individual","Yes","27-2407349","85005WI0030001","Individual Dental Only High","85005WI003",,"WIN001","WIS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.86","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Covered if seeing an in-network provider","Yes",,"","85005WI0030001-00","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.momentumplans.com/Content/files/MomentumInsurancePlansIndividualDental_High_Low.pdf",,"8"
"2016","WI","85005","HIOS","4","2015-09-25 04:20:25","1","85005","WI","Individual","Yes","27-2407349","85005WI0030001","Individual Dental Only High","85005WI003",,"WIN001","WIS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.86","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Covered if seeing an in-network provider","Yes",,"","85005WI0030001-01","Standard High On Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","$105 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.momentumplans.com/Content/files/MomentumInsurancePlansIndividualDental_High_Low.pdf",,"9"
"2016","WI","85005","HIOS","4","2015-09-25 04:20:25","1","85005","WI","Individual","Yes","27-2407349","85005WI0040001","Individual Dental Only Low","85005WI004",,"WIN001","WIS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.21","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Covered if seeing an in-network provider","Yes",,"","85005WI0040001-00","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","$90 per person","$270 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.momentumplans.com/Content/files/MomentumInsurancePlansIndividualDental_High_Low.pdf",,"10"
"2016","WI","85005","HIOS","4","2015-09-25 04:20:25","1","85005","WI","Individual","Yes","27-2407349","85005WI0040001","Individual Dental Only Low","85005WI004",,"WIN001","WIS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.21","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Covered if seeing an in-network provider","Yes",,"","85005WI0040001-01","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","$90 per person","$270 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.momentumplans.com/Content/files/MomentumInsurancePlansIndividualDental_High_Low.pdf",,"11"
"2016","WI","86572","HIOS","1","2015-05-01 02:23:41","1","86572","WI","SHOP (Small Group)","Yes","36-0883760","86572WI0040002","EHB High PPO","86572WI004",,"WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$50.28","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","86572WI0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","WI","86572","HIOS","1","2015-05-01 02:23:41","1","86572","WI","SHOP (Small Group)","Yes","36-0883760","86572WI0040001","EHB Low PPO","86572WI004",,"WIN001","WIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.89","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","86572WI0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020053","Envision Aurora Bellin PPO - Silver 3600/80","87416WI002",,"WIN002","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020053-00","Standard Silver Off Exchange Plan",,"0.696933448314667","Yes","Yes","No","100%",,"$3,600","$20","$730","$150","$3,600","$460","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","20%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver3600-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver3600-80.pdf","8"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010020","Envision Aurora Bellin PPO - Gold 1000/90","87416WI001",,"WIN002","WIS001","WIF004","Existing","PPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010020-00","Standard Gold Off Exchange Plan",,"0.802700340747833","Yes","Yes","No","100%",,"$1,000","$20","$630","$150","$1,000","$610","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Gold1000-90.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Gold1000-90.pdf","8"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010020","Envision Aurora Bellin PPO - Gold 1000/90","87416WI001",,"WIN002","WIS001","WIF004","Existing","PPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010020-01","Standard Gold On Exchange Plan",,"0.802700340747833","Yes","Yes","No","100%",,"$1,000","$20","$630","$150","$1,000","$610","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Gold1000-90.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Gold1000-90.pdf","9"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020053","Envision Aurora Bellin PPO - Silver 3600/80","87416WI002",,"WIN002","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020053-01","Standard Silver On Exchange Plan",,"0.696933448314667","Yes","Yes","No","100%",,"$3,600","$20","$730","$150","$3,600","$460","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","20%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver3600-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver3600-80.pdf","9"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020017","Envision Aurora Bellin PPO - Silver 2400/80/Copay35","87416WI002",,"WIN002","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020017-00","Standard Silver Off Exchange Plan",,"0.716324090957642","Yes","Yes","No","100%",,"$2,400","$20","$970","$150","$2,400","$790","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$4,800","$4800 per person","$9600 per group","$7,200","$7200 per person","$14400 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver2400-80-Copay35.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver2400-80-Copay35.pdf","10"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010020","Envision Aurora Bellin PPO - Gold 1000/90","87416WI001",,"WIN002","WIS001","WIF004","Existing","PPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010020-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Gold1000-90NCS.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Gold1000-90NCS.pdf","10"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010023","Envision Aurora Bellin PPO - Silver 2400/80","87416WI001",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.992892893",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010023-03","Limited Cost Sharing Plan Variation",,"0.68081796169281","Yes","Yes","No","100%",,"$2,400","$0","$980","$150","$2,400","$0","$570","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$4,800","$4800 per person","$9600 per group","$7,200","$7200 per person","$14400 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver2400-80LCS.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver2400-80LCS.pdf","7"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010020","Envision Aurora Bellin PPO - Gold 1000/90","87416WI001",,"WIN002","WIS001","WIF004","Existing","PPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010020-03","Limited Cost Sharing Plan Variation",,"0.802700340747833","Yes","Yes","No","100%",,"$1,000","$20","$630","$150","$1,000","$610","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Gold1000-90LCS.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Gold1000-90LCS.pdf","11"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020017","Envision Aurora Bellin PPO - Silver 2400/80/Copay35","87416WI002",,"WIN002","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020017-01","Standard Silver On Exchange Plan",,"0.716324090957642","Yes","Yes","No","100%",,"$2,400","$20","$970","$150","$2,400","$790","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$4,800","$4800 per person","$9600 per group","$7,200","$7200 per person","$14400 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver2400-80-Copay35.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver2400-80-Copay35.pdf","11"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020008","Empower Open Network - Gold 600/80","87416WI002",,"WIN001","WIS001","WIF003","Existing","PPO","Gold","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020008-00","Standard Gold Off Exchange Plan",,"0.791004300117493","Yes","Yes","No","100%",,"$600","$20","$1,330","$150","$600","$710","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20%",,,,,"$1,200","$1200 per person","$2400 per group","$1,800","$1800 per person","$3600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Gold600-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Gold600-80.pdf","12"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010023","Envision Aurora Bellin PPO - Silver 2400/80","87416WI001",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.992892893",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010023-05","87% AV Level Silver Plan",,"0.873863995075226","Yes","Yes","No","100%",,"$200","$0","$1,420","$150","$200","$0","$1,010","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,250","$7250 per person","$14500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,700","$2700 per person","$5400 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/200-80CSR.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/200-80CSR.pdf","9"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010023","Envision Aurora Bellin PPO - Silver 2400/80","87416WI001",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.992892893",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010023-06","94% AV Level Silver Plan",,"0.93374639749527","Yes","Yes","No","100%",,"$0","$0","$830","$150","$0","$0","$830","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$830","$830 per person","$1660 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,830","$5830 per person","$11660 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/0Ded-Max830CSR.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/0Ded-Max830CSR.pdf","10"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020052","Envision Aurora Bellin PPO - HSA Bronze 5650/90","87416WI002",,"WIN002","WIS001","WIF006","Existing","PPO","Bronze","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020052-00","Standard Bronze Off Exchange Plan",,"0.60942155122757","Yes","Yes","No","100%",,"$5,650","$0","$160","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","10%",,,,,"$11,300","$11300 per person","$22600 per group","$16,950","$16950 per person","$33900 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/HSABronze5650-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/HSABronze5650-80.pdf","10"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020052","Envision Aurora Bellin PPO - HSA Bronze 5650/90","87416WI002",,"WIN002","WIS001","WIF006","Existing","PPO","Bronze","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020052-01","Standard Bronze On Exchange Plan",,"0.60942155122757","Yes","Yes","No","100%",,"$5,650","$0","$160","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","10%",,,,,"$11,300","$11300 per person","$22600 per group","$16,950","$16950 per person","$33900 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/HSABronze5650-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/HSABronze5650-80.pdf","11"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010024","Envision Aurora Bellin PPO - Silver 1800/80","87416WI001",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.993117221",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010024-00","Standard Silver Off Exchange Plan",,"0.711280226707459","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$150","$1,800","$0","$690","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20%",,,,,"$3,600","$3600 per person","$7200 per group","$5,400","$5400 per person","$10800 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver1800-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver1800-80.pdf","11"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010024","Envision Aurora Bellin PPO - Silver 1800/80","87416WI001",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.993117221",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010024-01","Standard Silver On Exchange Plan",,"0.711280226707459","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$150","$1,800","$0","$690","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20%",,,,,"$3,600","$3600 per person","$7200 per group","$5,400","$5400 per person","$10800 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver1800-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver1800-80.pdf","12"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010021","Envision Aurora Bellin PPO - Silver 3600/80","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.992834797",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010021-00","Standard Silver Off Exchange Plan",,"0.696933448314667","Yes","Yes","No","100%",,"$3,600","$20","$730","$150","$3,600","$460","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","20%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver3600-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver3600-80.pdf","12"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010021","Envision Aurora Bellin PPO - Silver 3600/80","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.992834797",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010021-01","Standard Silver On Exchange Plan",,"0.696933448314667","Yes","Yes","No","100%",,"$3,600","$20","$730","$150","$3,600","$460","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","20%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver3600-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver3600-80.pdf","13"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020008","Empower Open Network - Gold 600/80","87416WI002",,"WIN001","WIS001","WIF003","Existing","PPO","Gold","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020008-01","Standard Gold On Exchange Plan",,"0.791004300117493","Yes","Yes","No","100%",,"$600","$20","$1,330","$150","$600","$710","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","20%",,,,,"$1,200","$1200 per person","$2400 per group","$1,800","$1800 per person","$3600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Gold600-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Gold600-80.pdf","13"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020009","Empower Open Network - Gold 1000/90","87416WI002",,"WIN001","WIS001","WIF004","Existing","PPO","Gold","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020009-00","Standard Gold Off Exchange Plan",,"0.802700340747833","Yes","Yes","No","100%",,"$1,000","$20","$630","$150","$1,000","$610","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Gold1000-90.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Gold1000-90.pdf","14"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010021","Envision Aurora Bellin PPO - Silver 3600/80","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.992834797",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver3600-80NCS.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver3600-80NCS.pdf","14"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010021","Envision Aurora Bellin PPO - Silver 3600/80","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.992834797",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010021-03","Limited Cost Sharing Plan Variation",,"0.696933448314667","Yes","Yes","No","100%",,"$3,600","$20","$730","$150","$3,600","$460","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","20%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver3600-80LCS.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver3600-80LCS.pdf","15"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020009","Empower Open Network - Gold 1000/90","87416WI002",,"WIN001","WIS001","WIF004","Existing","PPO","Gold","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020009-01","Standard Gold On Exchange Plan",,"0.802700340747833","Yes","Yes","No","100%",,"$1,000","$20","$630","$150","$1,000","$610","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Gold1000-90.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Gold1000-90.pdf","15"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020033","Empower Open Network - Silver 3600/80","87416WI002",,"WIN001","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020033-00","Standard Silver Off Exchange Plan",,"0.696933448314667","Yes","Yes","No","100%",,"$3,600","$20","$730","$150","$3,600","$460","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","20%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver3600-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver3600-80.pdf","16"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010021","Envision Aurora Bellin PPO - Silver 3600/80","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.992834797",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010021-04","73% AV Level Silver Plan",,"0.736680269241333","Yes","Yes","No","100%",,"$2,400","$20","$970","$150","$2,400","$660","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$4,800","$4800 per person","$9600 per group","$7,200","$7200 per person","$14400 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/2400-Copay35CSR.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/2400-Copay35CSR.pdf","16"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010021","Envision Aurora Bellin PPO - Silver 3600/80","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.992834797",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010021-05","87% AV Level Silver Plan",,"0.877924740314484","Yes","Yes","No","100%",,"$0","$20","$1,450","$150","$0","$700","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,250","$7250 per person","$14500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/0Ded-Copay30CSR.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/0Ded-Copay30CSR.pdf","17"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020033","Empower Open Network - Silver 3600/80","87416WI002",,"WIN001","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020033-01","Standard Silver On Exchange Plan",,"0.696933448314667","Yes","Yes","No","100%",,"$3,600","$20","$730","$150","$3,600","$460","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","20%",,,,,"$7,200","$7200 per person","$14400 per group","$10,800","$10800 per person","$21600 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver3600-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver3600-80.pdf","17"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020010","Empower Open Network - Silver 2400/80/Copay35","87416WI002",,"WIN001","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020010-00","Standard Silver Off Exchange Plan",,"0.716324090957642","Yes","Yes","No","100%",,"$2,400","$20","$970","$150","$2,400","$790","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$4,800","$4800 per person","$9600 per group","$7,200","$7200 per person","$14400 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver2400-80-Copay35.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver2400-80-Copay35.pdf","18"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010021","Envision Aurora Bellin PPO - Silver 3600/80","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.992834797",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010021-06","94% AV Level Silver Plan",,"0.930436730384827","Yes","Yes","No","100%",,"$0","$0","$1,000","$150","$0","$450","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$5,000","$5000 per person","$10000 per group","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/0Ded-Copay5-Max1000CSR.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/0Ded-Copay5-Max1000CSR.pdf","18"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010022","Envision Aurora Bellin PPO - Silver 2400/80/Copay35","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.993267079",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010022-00","Standard Silver Off Exchange Plan",,"0.716324090957642","Yes","Yes","No","100%",,"$2,400","$20","$970","$150","$2,400","$790","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$4,800","$4800 per person","$9600 per group","$7,200","$7200 per person","$14400 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver2400-80-Copay35.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver2400-80-Copay35.pdf","19"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020010","Empower Open Network - Silver 2400/80/Copay35","87416WI002",,"WIN001","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020010-01","Standard Silver On Exchange Plan",,"0.716324090957642","Yes","Yes","No","100%",,"$2,400","$20","$970","$150","$2,400","$790","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$4,800","$4800 per person","$9600 per group","$7,200","$7200 per person","$14400 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver2400-80-Copay35.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver2400-80-Copay35.pdf","19"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010022","Envision Aurora Bellin PPO - Silver 2400/80/Copay35","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.993267079",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010022-01","Standard Silver On Exchange Plan",,"0.716324090957642","Yes","Yes","No","100%",,"$2,400","$20","$970","$150","$2,400","$790","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$4,800","$4800 per person","$9600 per group","$7,200","$7200 per person","$14400 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver2400-80-Copay35.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver2400-80-Copay35.pdf","20"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010022","Envision Aurora Bellin PPO - Silver 2400/80/Copay35","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.993267079",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010022-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver2400-80-Copay35NCS.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver2400-80-Copay35NCS.pdf","21"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010022","Envision Aurora Bellin PPO - Silver 2400/80/Copay35","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.993267079",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010022-03","Limited Cost Sharing Plan Variation",,"0.716324090957642","Yes","Yes","No","100%",,"$2,400","$20","$970","$150","$2,400","$790","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$4,800","$4800 per person","$9600 per group","$7,200","$7200 per person","$14400 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver2400-80-Copay35LCS.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver2400-80-Copay35LCS.pdf","22"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010022","Envision Aurora Bellin PPO - Silver 2400/80/Copay35","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.993267079",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010022-04","73% AV Level Silver Plan",,"0.738015115261078","Yes","Yes","No","100%",,"$2,400","$20","$970","$150","$2,400","$640","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$4,800","$4800 per person","$9600 per group","$7,200","$7200 per person","$14400 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/2400-Copay30CSR.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/2400-Copay30CSR.pdf","23"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010022","Envision Aurora Bellin PPO - Silver 2400/80/Copay35","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.993267079",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010022-05","87% AV Level Silver Plan",,"0.879009664058685","Yes","Yes","No","100%",,"$0","$20","$1,450","$150","$0","$650","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,250","$7250 per person","$14500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/0Ded-Copay25CSR.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/0Ded-Copay25CSR.pdf","24"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","1","87416","WI","Individual","No","45-3309488","87416WI0010022","Envision Aurora Bellin PPO - Silver 2400/80/Copay35","87416WI001",,"WIN002","WIS001","WIF001","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.993267079",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010022-06","94% AV Level Silver Plan",,"0.949070751667023","Yes","Yes","No","100%",,"$0","$0","$600","$150","$0","$250","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,600","$5600 per person","$11200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/0Ded-Copay5-Max600CSR.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/0Ded-Copay5-Max600CSR.pdf","25"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010023","Envision Aurora Bellin PPO - Silver 2400/80","87416WI001",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.992892893",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010023-00","Standard Silver Off Exchange Plan",,"0.68081796169281","Yes","Yes","No","100%",,"$2,400","$0","$980","$150","$2,400","$0","$570","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$4,800","$4800 per person","$9600 per group","$7,200","$7200 per person","$14400 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver2400-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver2400-80.pdf","4"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020018","Envision Aurora Bellin PPO - Silver 2400/80","87416WI002",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020018-00","Standard Silver Off Exchange Plan",,"0.68081796169281","Yes","Yes","No","100%",,"$2,400","$0","$980","$150","$2,400","$0","$570","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$4,800","$4800 per person","$9600 per group","$7,200","$7200 per person","$14400 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver2400-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver2400-80.pdf","4"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020018","Envision Aurora Bellin PPO - Silver 2400/80","87416WI002",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020018-01","Standard Silver On Exchange Plan",,"0.68081796169281","Yes","Yes","No","100%",,"$2,400","$0","$980","$150","$2,400","$0","$570","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$4,800","$4800 per person","$9600 per group","$7,200","$7200 per person","$14400 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver2400-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver2400-80.pdf","5"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010023","Envision Aurora Bellin PPO - Silver 2400/80","87416WI001",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.992892893",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010023-01","Standard Silver On Exchange Plan",,"0.68081796169281","Yes","Yes","No","100%",,"$2,400","$0","$980","$150","$2,400","$0","$570","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$4,800","$4800 per person","$9600 per group","$7,200","$7200 per person","$14400 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver2400-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver2400-80.pdf","5"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010023","Envision Aurora Bellin PPO - Silver 2400/80","87416WI001",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.992892893",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010023-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver2400-80NCS.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver2400-80NCS.pdf","6"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020019","Envision Aurora Bellin PPO - Silver 1800/80","87416WI002",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020019-00","Standard Silver Off Exchange Plan",,"0.711280226707459","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$150","$1,800","$0","$690","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20%",,,,,"$3,600","$3600 per person","$7200 per group","$5,400","$5400 per person","$10800 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver1800-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver1800-80.pdf","6"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020019","Envision Aurora Bellin PPO - Silver 1800/80","87416WI002",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020019-01","Standard Silver On Exchange Plan",,"0.711280226707459","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$150","$1,800","$0","$690","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20%",,,,,"$3,600","$3600 per person","$7200 per group","$5,400","$5400 per person","$10800 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver1800-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver1800-80.pdf","7"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010023","Envision Aurora Bellin PPO - Silver 2400/80","87416WI001",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.992892893",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010023-04","73% AV Level Silver Plan",,"0.733386754989624","Yes","Yes","No","100%",,"$1,600","$0","$1,140","$150","$1,600","$0","$730","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","20%",,,,,"$3,200","$3200 per person","$6400 per group","$4,800","$4800 per person","$9600 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/1600-80CSR.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/1600-80CSR.pdf","8"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020051","Envision Aurora Bellin PPO - HSA Silver 3000/80","87416WI002",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020051-00","Standard Silver Off Exchange Plan",,"0.687331318855286","Yes","Yes","No","100%",,"$3,000","$0","$860","$150","$3,000","$0","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/HSASilver3000-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/HSASilver3000-80.pdf","8"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020051","Envision Aurora Bellin PPO - HSA Silver 3000/80","87416WI002",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020051-01","Standard Silver On Exchange Plan",,"0.687331318855286","Yes","Yes","No","100%",,"$3,000","$0","$860","$150","$3,000","$0","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/HSASilver3000-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/HSASilver3000-80.pdf","9"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020011","Empower Open Network - Silver 2400/80","87416WI002",,"WIN001","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020011-00","Standard Silver Off Exchange Plan",,"0.68081796169281","Yes","Yes","No","100%",,"$2,400","$0","$980","$150","$2,400","$0","$570","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$4,800","$4800 per person","$9600 per group","$7,200","$7200 per person","$14400 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver2400-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver2400-80.pdf","12"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020011","Empower Open Network - Silver 2400/80","87416WI002",,"WIN001","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020011-01","Standard Silver On Exchange Plan",,"0.68081796169281","Yes","Yes","No","100%",,"$2,400","$0","$980","$150","$2,400","$0","$570","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$4,800","$4800 per person","$9600 per group","$7,200","$7200 per person","$14400 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver2400-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver2400-80.pdf","13"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010024","Envision Aurora Bellin PPO - Silver 1800/80","87416WI001",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.993117221",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010024-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver1800-80NCS.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver1800-80NCS.pdf","13"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010024","Envision Aurora Bellin PPO - Silver 1800/80","87416WI001",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.993117221",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010024-03","Limited Cost Sharing Plan Variation",,"0.711280226707459","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$150","$1,800","$0","$690","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20%",,,,,"$3,600","$3600 per person","$7200 per group","$5,400","$5400 per person","$10800 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver1800-80LCS.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver1800-80LCS.pdf+G13","14"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020012","Empower Open Network - Silver 1800/80","87416WI002",,"WIN001","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020012-00","Standard Silver Off Exchange Plan",,"0.711280226707459","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$150","$1,800","$0","$690","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20%",,,,,"$3,600","$3600 per person","$7200 per group","$5,400","$5400 per person","$10800 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver1800-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver1800-80.pdf","14"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020012","Empower Open Network - Silver 1800/80","87416WI002",,"WIN001","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020012-01","Standard Silver On Exchange Plan",,"0.711280226707459","Yes","Yes","No","100%",,"$1,800","$0","$1,100","$150","$1,800","$0","$690","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20%",,,,,"$3,600","$3600 per person","$7200 per group","$5,400","$5400 per person","$10800 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Silver1800-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Silver1800-80.pdf","15"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","3","87416","WI","Individual","No","45-3309488","87416WI0010026","Envision Aurora Bellin PPO - Catastrophic 6850/100","87416WI001",,"WIN002","WIS001","WIF005","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010026-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","$34,250","$34250 per person","$68500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Catastrophic6850.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Catastrophic6850.pdf","9"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010024","Envision Aurora Bellin PPO - Silver 1800/80","87416WI001",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.993117221",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010024-04","73% AV Level Silver Plan",,"0.739117741584778","Yes","Yes","No","100%",,"$1,500","$0","$1,160","$150","$1,500","$0","$750","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/1500-80CSR.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/1500-80CSR.pdf","15"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010024","Envision Aurora Bellin PPO - Silver 1800/80","87416WI001",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.993117221",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010024-05","87% AV Level Silver Plan",,"0.878275394439697","Yes","Yes","No","100%",,"$150","$0","$1,430","$150","$150","$0","$1,020","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,250","$7250 per person","$14500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,650","$2650 per person","$5300 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/150-80CSR.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/150-80CSR.pdf","16"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020031","Empower Open Network - HSA Silver 3000/80","87416WI002",,"WIN001","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020031-00","Standard Silver Off Exchange Plan",,"0.687331318855286","Yes","Yes","No","100%",,"$3,000","$0","$860","$150","$3,000","$0","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/HSASilver3000-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/HSASilver3000-80.pdf","16"
"2016","WI","90028","HIOS","1","2015-05-08 02:15:08","3","90028","WI","Individual","Yes","39-0138065","90028WI0420004","Anthem Dental Family Enhanced","90028WI042",,"WIN001","WIS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.30","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","90028WI0420004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/wi/f0/s0/t0/pw_e214662.pdf",,"4"
"2016","WI","90028","HIOS","1","2015-05-08 02:15:08","3","90028","WI","SHOP (Small Group)","Yes","39-0138065","90028WI0450004","Anthem Dental Family Enhanced","90028WI045",,"WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.30","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","90028WI0450004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/wi/f0/s0/t0/pw_e214662.pdf",,"4"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070008","Silver $3000 - 0%","91058WI007",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.992508228695986",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070008-01","Standard Silver On Exchange Plan",,"0.716023087501526","No","Yes","No","100%",,"$5,080","$20","$0","$150","$3,000","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8H&eff_date=01/01/2016&state=WI",,"19"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070009","Bronze $3500 - 30%","91058WI007",,"WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.990289529003403",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070009-00","Standard Bronze Off Exchange Plan",,"0.619468808174133","No","Yes","No","100%",,"$5,580","$20","$500","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8I&eff_date=01/01/2016&state=WI",,"20"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050004","Gold $3500 - 0%","91058WI005",,"WIN002","WIS001","WIF006","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995350137582954",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZG&eff_date=01/01/2016&state=WI",,"18"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050004","Gold $3500 - 0%","91058WI005",,"WIN002","WIS001","WIF006","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995350137582954",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050004-03","Limited Cost Sharing Plan Variation",,"0.783213078975677","No","Yes","No","100%",,"$3,500","$0","$0","$150","$3,136","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZH&eff_date=01/01/2016&state=WI",,"19"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070009","Bronze $3500 - 30%","91058WI007",,"WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.990289529003403",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070009-01","Standard Bronze On Exchange Plan",,"0.619468808174133","No","Yes","No","100%",,"$5,580","$20","$500","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8I&eff_date=01/01/2016&state=WI",,"21"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020031","Empower Open Network - HSA Silver 3000/80","87416WI002",,"WIN001","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020031-01","Standard Silver On Exchange Plan",,"0.687331318855286","Yes","Yes","No","100%",,"$3,000","$0","$860","$150","$3,000","$0","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/HSASilver3000-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/HSASilver3000-80.pdf","17"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010024","Envision Aurora Bellin PPO - Silver 1800/80","87416WI001",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.993117221",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010024-06","94% AV Level Silver Plan",,"0.949597895145416","Yes","Yes","No","100%",,"$0","$0","$550","$150","$0","$0","$550","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,550","$5550 per person","$11100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,500","$2500 per person","$5000 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/0Ded-Max550CSR.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/0Ded-Max550CSR.pdf","17"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010050","Envision Aurora Bellin PPO - HSA Silver 3000/80","87416WI001",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.992791878",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010050-00","Standard Silver Off Exchange Plan",,"0.687331318855286","Yes","Yes","No","100%",,"$3,000","$0","$860","$150","$3,000","$0","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","Yes",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/HSASilver3000-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/HSASilver3000-80.pdf","18"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020032","Empower Open Network - HSA Bronze 5650/90","87416WI002",,"WIN001","WIS001","WIF006","Existing","PPO","Bronze","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020032-00","Standard Bronze Off Exchange Plan",,"0.60942155122757","Yes","Yes","No","100%",,"$5,650","$0","$160","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","10%",,,,,"$11,300","$11300 per person","$22600 per group","$16,950","$16950 per person","$33900 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/HSABronze5650-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/HSABronze5650-80.pdf","18"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020032","Empower Open Network - HSA Bronze 5650/90","87416WI002",,"WIN001","WIS001","WIF006","Existing","PPO","Bronze","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020032-01","Standard Bronze On Exchange Plan",,"0.60942155122757","Yes","Yes","No","100%",,"$5,650","$0","$160","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","10%",,,,,"$11,300","$11300 per person","$22600 per group","$16,950","$16950 per person","$33900 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/HSABronze5650-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/HSABronze5650-80.pdf","19"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010050","Envision Aurora Bellin PPO - HSA Silver 3000/80","87416WI001",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.992791878",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010050-01","Standard Silver On Exchange Plan",,"0.687331318855286","Yes","Yes","No","100%",,"$3,000","$0","$860","$150","$3,000","$0","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","Yes",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/HSASilver3000-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/HSASilver3000-80.pdf","19"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010050","Envision Aurora Bellin PPO - HSA Silver 3000/80","87416WI001",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.992791878",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010050-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/HSASilver3000-80NCS.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/HSASilver3000-80NCS.pdf","20"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020050","Envision Aurora Bellin PPO - HSA Gold 2300/100","87416WI002",,"WIN002","WIS001","WIF002","Existing","PPO","Gold","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020050-00","Standard Gold Off Exchange Plan",,"0.785342574119568","Yes","Yes","No","100%",,"$2,300","$0","$0","$150","$2,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group",,,,"$9,200","$18400 per person","$18400 per group","$11,500","$23000 per person","$23000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group","0%",,,,,"$4,600","$9200 per person","$9200 per group","$6,900","$13800 per person","$13800 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/GoldHSA.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/GoldHSA.pdf","20"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020050","Envision Aurora Bellin PPO - HSA Gold 2300/100","87416WI002",,"WIN002","WIS001","WIF002","Existing","PPO","Gold","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020050-01","Standard Gold On Exchange Plan",,"0.785342574119568","Yes","Yes","No","100%",,"$2,300","$0","$0","$150","$2,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group",,,,"$9,200","$18400 per person","$18400 per group","$11,500","$23000 per person","$23000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group","0%",,,,,"$4,600","$9200 per person","$9200 per group","$6,900","$13800 per person","$13800 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/GoldHSA.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/GoldHSA.pdf","21"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010050","Envision Aurora Bellin PPO - HSA Silver 3000/80","87416WI001",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.992791878",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010050-03","Limited Cost Sharing Plan Variation",,"0.687331318855286","Yes","Yes","No","100%",,"$3,000","$0","$860","$150","$3,000","$0","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","Yes",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/HSASilver3000-80LCS.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/HSASilver3000-80LCS.pdf","21"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010050","Envision Aurora Bellin PPO - HSA Silver 3000/80","87416WI001",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.992791878",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010050-04","73% AV Level Silver Plan",,"0.728554546833038","Yes","Yes","No","100%",,"$1,900","$0","$1,080","$150","$1,900","$0","$670","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","20%",,,,,"$3,800","$3800 per person","$7600 per group","$5,700","$5700 per person","$11400 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/1900-80HSACSR.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/1900-80HSACSR.pdf","22"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020030","Empower Open Network - HSA Gold 2300/100","87416WI002",,"WIN001","WIS001","WIF006","Existing","PPO","Gold","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020030-00","Standard Gold Off Exchange Plan",,"0.785342574119568","Yes","Yes","No","100%",,"$2,300","$0","$0","$150","$2,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group",,,,"$9,200","$18400 per person","$18400 per group","$11,500","$23000 per person","$23000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group","0%",,,,,"$4,600","$9200 per person","$9200 per group","$6,900","$13800 per person","$13800 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/GoldHSA.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/GoldHSA.pdf","22"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020030","Empower Open Network - HSA Gold 2300/100","87416WI002",,"WIN001","WIS001","WIF006","Existing","PPO","Gold","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020030-01","Standard Gold On Exchange Plan",,"0.785342574119568","Yes","Yes","No","100%",,"$2,300","$0","$0","$150","$2,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group",,,,"$9,200","$18400 per person","$18400 per group","$11,500","$23000 per person","$23000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$4600 per person","$4600 per group","0%",,,,,"$4,600","$9200 per person","$9200 per group","$6,900","$13800 per person","$13800 per group","Yes","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/GoldHSA.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/GoldHSA.pdf","23"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010050","Envision Aurora Bellin PPO - HSA Silver 3000/80","87416WI001",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.992791878",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010050-05","87% AV Level Silver Plan",,"0.869724869728088","Yes","Yes","No","100%",,"$250","$0","$1,410","$150","$250","$0","$1,000","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$5,000","$5000 per person","$10000 per group","$7,250","$7250 per person","$14500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,750","$2750 per person","$5500 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/250-80CSR.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/250-80CSR.pdf","23"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010050","Envision Aurora Bellin PPO - HSA Silver 3000/80","87416WI001",,"WIN002","WIS001","WIF002","Existing","PPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.992791878",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010050-06","94% AV Level Silver Plan",,"0.934199154376984","Yes","Yes","No","100%",,"$50","$0","$710","$150","$50","$0","$710","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$760","$760 per person","$1520 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,760","$5760 per person","$11520 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","$2,550","$2550 per person","$5100 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/50Ded-Max760CSR.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/50Ded-Max760CSR.pdf","24"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010051","Envision Aurora Bellin PPO - HSA Bronze 5650/90","87416WI001",,"WIN002","WIS001","WIF006","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.991150884",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010051-00","Standard Bronze Off Exchange Plan",,"0.60942155122757","Yes","Yes","No","100%",,"$5,650","$0","$160","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","10%",,,,,"$11,300","$11300 per person","$22600 per group","$16,950","$16950 per person","$33900 per group","Yes",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/HSABronze5650-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/HSABronze5650-80.pdf","25"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010051","Envision Aurora Bellin PPO - HSA Bronze 5650/90","87416WI001",,"WIN002","WIS001","WIF006","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.991150884",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010051-01","Standard Bronze On Exchange Plan",,"0.60942155122757","Yes","Yes","No","100%",,"$5,650","$0","$160","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","10%",,,,,"$11,300","$11300 per person","$22600 per group","$16,950","$16950 per person","$33900 per group","Yes",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/HSABronze5650-80.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/HSABronze5650-80.pdf","26"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010051","Envision Aurora Bellin PPO - HSA Bronze 5650/90","87416WI001",,"WIN002","WIS001","WIF006","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.991150884",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010051-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/HSABronze5650-80NCS.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/HSABronze5650-80NCS.pdf","27"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","2","87416","WI","Individual","No","45-3309488","87416WI0010051","Envision Aurora Bellin PPO - HSA Bronze 5650/90","87416WI001",,"WIN002","WIS001","WIF006","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.991150884",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010051-03","Limited Cost Sharing Plan Variation",,"0.60942155122757","Yes","Yes","No","100%",,"$5,650","$0","$160","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,650","$5650 per person","$11300 per group","10%",,,,,"$11,300","$11300 per person","$22600 per group","$16,950","$16950 per person","$33900 per group","Yes",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/HSABronze5650-80LCS.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/HSABronze5650-80LCS.pdf","28"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","3","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020014","Empower Open Network - Bronze 6850/100","87416WI002",,"WIN002","WIS001","WIF005","Existing","PPO","Bronze","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020014-00","Standard Bronze Off Exchange Plan",,"0.61087042093277","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","$34,250","$34250 per person","$68500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Bronze6850-100.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Bronze6850-100.pdf","4"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","3","87416","WI","Individual","No","45-3309488","87416WI0010027","Envision Aurora Bellin PPO - Bronze 6850/100","87416WI001",,"WIN002","WIS001","WIF005","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.990804776",,,,"0","0","3","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010027-00","Standard Bronze Off Exchange Plan",,"0.61087042093277","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","$34,250","$34250 per person","$68500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Bronze6850-100.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Bronze6850-100.pdf","4"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","3","87416","WI","Individual","No","45-3309488","87416WI0010027","Envision Aurora Bellin PPO - Bronze 6850/100","87416WI001",,"WIN002","WIS001","WIF005","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.990804776",,,,"0","0","3","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010027-01","Standard Bronze On Exchange Plan",,"0.61087042093277","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","$34,250","$34250 per person","$68500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Bronze6850-100.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Bronze6850-100.pdf","5"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","3","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020014","Empower Open Network - Bronze 6850/100","87416WI002",,"WIN002","WIS001","WIF005","Existing","PPO","Bronze","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020014-01","Standard Bronze On Exchange Plan",,"0.61087042093277","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","$34,250","$34250 per person","$68500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Bronze6850-100.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Bronze6850-100.pdf","5"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","3","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020021","Envision Aurora Bellin PPO - Bronze 6850/100","87416WI002",,"WIN001","WIS001","WIF005","Existing","PPO","Bronze","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020021-00","Standard Bronze Off Exchange Plan",,"0.61087042093277","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","$34,250","$34250 per person","$68500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Bronze6850-100.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Bronze6850-100.pdf","6"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","3","87416","WI","Individual","No","45-3309488","87416WI0010027","Envision Aurora Bellin PPO - Bronze 6850/100","87416WI001",,"WIN002","WIS001","WIF005","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.990804776",,,,"0","0","3","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010027-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Bronze6850-100NCS.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Bronze6850-100NCS.pdf","6"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","3","87416","WI","Individual","No","45-3309488","87416WI0010027","Envision Aurora Bellin PPO - Bronze 6850/100","87416WI001",,"WIN002","WIS001","WIF005","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.990804776",,,,"0","0","3","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010027-03","Limited Cost Sharing Plan Variation",,"0.61087042093277","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","$34,250","$34250 per person","$68500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Bronze6850-100LCS.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Bronze6850-100LCS.pdf","7"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","3","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020021","Envision Aurora Bellin PPO - Bronze 6850/100","87416WI002",,"WIN001","WIS001","WIF005","Existing","PPO","Bronze","No","Both","Yes","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0020021-01","Standard Bronze On Exchange Plan",,"0.61087042093277","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","$34,250","$34250 per person","$68500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No","No",,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Bronze6850-100.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Bronze6850-100.pdf","7"
"2016","WI","87416","HIOS","9","2016-01-22 04:00:42","3","87416","WI","Individual","No","45-3309488","87416WI0010026","Envision Aurora Bellin PPO - Catastrophic 6850/100","87416WI001",,"WIN002","WIS001","WIF005","Existing","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/Formulary.pdf","87416WI0010026-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","$34,250","$34250 per person","$68500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/SBC/Catastrophic6850.pdf","http://www.commongroundhealthcare.org/assets/pdf/Plans-and-Benefits/2016/BRO/Catastrophic6850.pdf","8"
"2016","WI","90028","HIOS","1","2015-05-08 02:15:08","1","90028","WI","Individual","Yes","39-0138065","90028WI0400003","Anthem Dental Pediatric","90028WI040",,"WIN001","WIS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$24.75","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","90028WI0400003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/wi/f0/s0/t0/pw_e214663.pdf",,"4"
"2016","WI","90028","HIOS","1","2015-05-08 02:15:08","1","90028","WI","SHOP (Small Group)","Yes","39-0138065","90028WI0430003","Anthem Dental Pediatric","90028WI043",,"WIN001","WIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$24.75","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","90028WI0430003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/wi/f0/s0/t0/pw_e214663.pdf",,"4"
"2016","WI","90028","HIOS","1","2015-05-08 02:15:08","1","90028","WI","Individual","Yes","39-0138065","90028WI0460003","Anthem Dental Pediatric","90028WI046",,"WIN001","WIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$24.75","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","90028WI0460003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/wi/f0/s0/t0/pw_e214663.pdf",,"5"
"2016","WI","90028","HIOS","1","2015-05-08 02:15:08","2","90028","WI","Individual","Yes","39-0138065","90028WI0420003","Anthem Dental Family","90028WI042",,"WIN001","WIS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.20","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","90028WI0420003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/wi/f0/s0/t0/pw_e214661.pdf",,"4"
"2016","WI","90028","HIOS","1","2015-05-08 02:15:08","2","90028","WI","SHOP (Small Group)","Yes","39-0138065","90028WI0450003","Anthem Dental Family","90028WI045",,"WIN001","WIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.20","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","90028WI0450003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/wi/f0/s0/t0/pw_e214661.pdf",,"4"
"2016","WI","90028","HIOS","1","2015-05-08 02:15:08","2","90028","WI","Individual","Yes","39-0138065","90028WI0480003","Anthem Dental Family","90028WI048",,"WIN001","WIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.20","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","90028WI0480003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/wi/f0/s0/t0/pw_e214661.pdf",,"5"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050005","Silver $3500 - 20%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995036285382175",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050005-00","Standard Silver Off Exchange Plan",,"0.710161626338959","No","Yes","No","100%",,"$5,000","$0","$0","$150","$3,500","$220","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2016&state=WI",,"20"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050005","Silver $3500 - 20%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995036285382175",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050005-01","Standard Silver On Exchange Plan",,"0.710161626338959","No","Yes","No","100%",,"$5,000","$0","$0","$150","$3,500","$220","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2016&state=WI",,"21"
"2016","WI","90028","HIOS","1","2015-05-08 02:15:08","3","90028","WI","Individual","Yes","39-0138065","90028WI0480004","Anthem Dental Family Enhanced","90028WI048",,"WIN001","WIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.30","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","90028WI0480004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/wi/f0/s0/t0/pw_e214662.pdf",,"5"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070001","Platinum $1000 - 0% $30 OV","91058WI007",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993934020722511",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070001-00","Standard Platinum Off Exchange Plan",,"0.913640677928925","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8A&eff_date=01/01/2016&state=WI",,"4"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050001","Platinum $1000 - 0%","91058WI005",,"WIN002","WIS001","WIF005","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.99608450529707",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050001-00","Standard Platinum Off Exchange Plan",,"0.909501492977142","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2016&state=WI",,"4"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050001","Platinum $1000 - 0%","91058WI005",,"WIN002","WIS001","WIF005","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.99608450529707",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050001-01","Standard Platinum On Exchange Plan",,"0.909501492977142","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2016&state=WI",,"5"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070001","Platinum $1000 - 0% $30 OV","91058WI007",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993934020722511",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070001-01","Standard Platinum On Exchange Plan",,"0.913640677928925","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8A&eff_date=01/01/2016&state=WI",,"5"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070002","Platinum $500 - 20% $15 OV","91058WI007",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993735334289589",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070002-00","Standard Platinum Off Exchange Plan",,"0.892076551914215","No","Yes","No","100%",,"$1,000","$0","$500","$150","$500","$340","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8B&eff_date=01/01/2016&state=WI",,"6"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050001","Platinum $1000 - 0%","91058WI005",,"WIN002","WIS001","WIF005","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.99608450529707",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZC&eff_date=01/01/2016&state=WI",,"6"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050001","Platinum $1000 - 0%","91058WI005",,"WIN002","WIS001","WIF005","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.99608450529707",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050001-03","Limited Cost Sharing Plan Variation",,"0.909501492977142","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZD&eff_date=01/01/2016&state=WI",,"7"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070002","Platinum $500 - 20% $15 OV","91058WI007",,"WIN001","WIS001","WIF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993735334289589",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070002-01","Standard Platinum On Exchange Plan",,"0.892076551914215","No","Yes","No","100%",,"$1,000","$0","$500","$150","$500","$340","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8B&eff_date=01/01/2016&state=WI",,"7"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070003","Gold $2000 - 0%","91058WI007",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993101301974353",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070003-00","Standard Gold Off Exchange Plan",,"0.819067180156708","No","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8C&eff_date=01/01/2016&state=WI",,"8"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050002","Platinum $500 - 20%","91058WI005",,"WIN002","WIS001","WIF005","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.996062795913282",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050002-00","Standard Platinum Off Exchange Plan",,"0.911845445632935","No","Yes","No","100%",,"$1,000","$0","$0","$150","$500","$350","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2016&state=WI",,"8"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050002","Platinum $500 - 20%","91058WI005",,"WIN002","WIS001","WIF005","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.996062795913282",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050002-01","Standard Platinum On Exchange Plan",,"0.911845445632935","No","Yes","No","100%",,"$1,000","$0","$0","$150","$500","$350","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2016&state=WI",,"9"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070003","Gold $2000 - 0%","91058WI007",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993101301974353",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070003-01","Standard Gold On Exchange Plan",,"0.819067180156708","No","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8C&eff_date=01/01/2016&state=WI",,"9"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070004","Gold $1000 - 20% $40 OV","91058WI007",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993284140437885",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070004-00","Standard Gold Off Exchange Plan",,"0.81262469291687","No","Yes","No","100%",,"$2,000","$10","$830","$150","$1,000","$460","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8D&eff_date=01/01/2016&state=WI",,"10"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050002","Platinum $500 - 20%","91058WI005",,"WIN002","WIS001","WIF005","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.996062795913282",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZA&eff_date=01/01/2016&state=WI",,"10"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050002","Platinum $500 - 20%","91058WI005",,"WIN002","WIS001","WIF005","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.996062795913282",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050002-03","Limited Cost Sharing Plan Variation",,"0.911845445632935","No","Yes","No","100%",,"$1,000","$0","$0","$150","$500","$350","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZB&eff_date=01/01/2016&state=WI",,"11"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070004","Gold $1000 - 20% $40 OV","91058WI007",,"WIN001","WIS001","WIF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993284140437885",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070004-01","Standard Gold On Exchange Plan",,"0.81262469291687","No","Yes","No","100%",,"$2,000","$10","$830","$150","$1,000","$460","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8D&eff_date=01/01/2016&state=WI",,"11"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070005","Silver $2500 - 20%","91058WI007",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.992131989242598",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070005-00","Standard Silver Off Exchange Plan",,"0.713750898838043","No","Yes","No","100%",,"$4,500","$0","$0","$150","$2,500","$240","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8E&eff_date=01/01/2016&state=WI",,"12"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050003","Gold $1500 - 30%","91058WI005",,"WIN002","WIS001","WIF006","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.99554678692221",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050003-00","Standard Gold Off Exchange Plan",,"0.816327631473541","No","Yes","No","100%",,"$3,000","$0","$0","$150","$1,500","$290","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2016&state=WI",,"12"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050003","Gold $1500 - 30%","91058WI005",,"WIN002","WIS001","WIF006","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.99554678692221",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050003-01","Standard Gold On Exchange Plan",,"0.816327631473541","No","Yes","No","100%",,"$3,000","$0","$0","$150","$1,500","$290","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2016&state=WI",,"13"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070005","Silver $2500 - 20%","91058WI007",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.992131989242598",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070005-01","Standard Silver On Exchange Plan",,"0.713750898838043","No","Yes","No","100%",,"$4,500","$0","$0","$150","$2,500","$240","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8E&eff_date=01/01/2016&state=WI",,"13"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070006","Silver $2000 - 30% $40 OV","91058WI007",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.992392955615806",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070006-00","Standard Silver Off Exchange Plan",,"0.718843877315521","No","Yes","No","100%",,"$4,000","$20","$950","$150","$2,000","$480","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8F&eff_date=01/01/2016&state=WI",,"14"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050003","Gold $1500 - 30%","91058WI005",,"WIN002","WIS001","WIF006","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.99554678692221",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZE&eff_date=01/01/2016&state=WI",,"14"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050003","Gold $1500 - 30%","91058WI005",,"WIN002","WIS001","WIF006","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.99554678692221",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050003-03","Limited Cost Sharing Plan Variation",,"0.816327631473541","No","Yes","No","100%",,"$3,000","$0","$0","$150","$1,500","$290","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZF&eff_date=01/01/2016&state=WI",,"15"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070006","Silver $2000 - 30% $40 OV","91058WI007",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.992392955615806",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070006-01","Standard Silver On Exchange Plan",,"0.718843877315521","No","Yes","No","100%",,"$4,000","$20","$950","$150","$2,000","$480","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8F&eff_date=01/01/2016&state=WI",,"15"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070007","Silver $500 - 50%","91058WI007",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.992061373217365",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070007-00","Standard Silver Off Exchange Plan",,"0.716008126735687","No","Yes","No","100%",,"$1,000","$20","$2,110","$150","$500","$380","$1,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8G&eff_date=01/01/2016&state=WI",,"16"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050004","Gold $3500 - 0%","91058WI005",,"WIN002","WIS001","WIF006","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995350137582954",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050004-00","Standard Gold Off Exchange Plan",,"0.783213078975677","No","Yes","No","100%",,"$3,500","$0","$0","$150","$3,136","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2016&state=WI",,"16"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050004","Gold $3500 - 0%","91058WI005",,"WIN002","WIS001","WIF006","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995350137582954",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050004-01","Standard Gold On Exchange Plan",,"0.783213078975677","No","Yes","No","100%",,"$3,500","$0","$0","$150","$3,136","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2016&state=WI",,"17"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070007","Silver $500 - 50%","91058WI007",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.992061373217365",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070007-01","Standard Silver On Exchange Plan",,"0.716008126735687","No","Yes","No","100%",,"$1,000","$20","$2,110","$150","$500","$380","$1,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8G&eff_date=01/01/2016&state=WI",,"17"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070008","Silver $3000 - 0%","91058WI007",,"WIN001","WIS001","WIF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.992508228695986",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070008-00","Standard Silver Off Exchange Plan",,"0.716023087501526","No","Yes","No","100%",,"$5,080","$20","$0","$150","$3,000","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8H&eff_date=01/01/2016&state=WI",,"18"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070010","Bronze $6350 - 0%","91058WI007",,"WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.990111257924459",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070010-00","Standard Bronze Off Exchange Plan",,"0.606652140617371","No","Yes","No","100%",,"$6,350","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8J&eff_date=01/01/2016&state=WI",,"22"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050005","Silver $3500 - 20%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995036285382175",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZM&eff_date=01/01/2016&state=WI",,"22"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050005","Silver $3500 - 20%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995036285382175",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050005-03","Limited Cost Sharing Plan Variation",,"0.710161626338959","No","Yes","No","100%",,"$5,000","$0","$0","$150","$3,500","$220","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZN&eff_date=01/01/2016&state=WI",,"23"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070010","Bronze $6350 - 0%","91058WI007",,"WIN001","WIS001","WIF004","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.990111257924459",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0070010-01","Standard Bronze On Exchange Plan",,"0.606652140617371","No","Yes","No","100%",,"$6,350","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8J&eff_date=01/01/2016&state=WI",,"23"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080001","Silver HSA $2500 - 20%","91058WI008",,"WIN001","WIS001","WIF009","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.991858298128914",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0080001-00","Standard Silver Off Exchange Plan",,"0.713323950767517","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,500","$0","$550","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6550 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=A8&eff_date=01/01/2016&state=WI",,"24"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050005","Silver $3500 - 20%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995036285382175",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050005-04","73% AV Level Silver Plan",,"0.734561443328857","No","Yes","No","100%",,"$5,000","$0","$0","$150","$3,000","$300","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=9S&eff_date=01/01/2016&state=WI",,"24"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050005","Silver $3500 - 20%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995036285382175",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050005-05","87% AV Level Silver Plan",,"0.870575726032257","No","Yes","No","100%",,"$1,750","$0","$0","$150","$1,250","$260","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8S&eff_date=01/01/2016&state=WI",,"25"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080001","Silver HSA $2500 - 20%","91058WI008",,"WIN001","WIS001","WIF009","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.991858298128914",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0080001-01","Standard Silver On Exchange Plan",,"0.713323950767517","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,500","$0","$550","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6550 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=A8&eff_date=01/01/2016&state=WI",,"25"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080002","Bronze HSA $3250 - 50%","91058WI008",,"WIN001","WIS001","WIF010","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.990139911500677",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0080002-00","Standard Bronze Off Exchange Plan",,"0.618900716304779","Yes","Yes","No","100%",,"$5,330","$0","$970","$150","$3,250","$0","$1,010","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=B8&eff_date=01/01/2016&state=WI",,"26"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050005","Silver $3500 - 20%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995036285382175",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050005-06","94% AV Level Silver Plan",,"0.941182613372803","No","Yes","No","100%",,"$500","$0","$250","$150","$250","$200","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=7S&eff_date=01/01/2016&state=WI",,"26"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050006","Silver $2500 - 50%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995039947260199",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050006-00","Standard Silver Off Exchange Plan",,"0.704307496547699","No","Yes","No","100%",,"$4,580","$20","$1,200","$150","$2,500","$440","$390","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2016&state=WI",,"27"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080002","Bronze HSA $3250 - 50%","91058WI008",,"WIN001","WIS001","WIF010","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.990139911500677",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0080002-01","Standard Bronze On Exchange Plan",,"0.618900716304779","Yes","Yes","No","100%",,"$5,330","$0","$970","$150","$3,250","$0","$1,010","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=B8&eff_date=01/01/2016&state=WI",,"27"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080003","Bronze HSA $5000 - 30%","91058WI008",,"WIN001","WIS001","WIF011","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.989122016454023",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0080003-00","Standard Bronze Off Exchange Plan",,"0.612498223781586","Yes","Yes","No","100%",,"$6,350","$0","$0","$150","$5,000","$0","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6550 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=D8&eff_date=01/01/2016&state=WI",,"28"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050006","Silver $2500 - 50%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995039947260199",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050006-01","Standard Silver On Exchange Plan",,"0.704307496547699","No","Yes","No","100%",,"$4,580","$20","$1,200","$150","$2,500","$440","$390","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2016&state=WI",,"28"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050006","Silver $2500 - 50%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995039947260199",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZK&eff_date=01/01/2016&state=WI",,"29"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080003","Bronze HSA $5000 - 30%","91058WI008",,"WIN001","WIS001","WIF011","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.989122016454023",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0080003-01","Standard Bronze On Exchange Plan",,"0.612498223781586","Yes","Yes","No","100%",,"$6,350","$0","$0","$150","$5,000","$0","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6550 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=D8&eff_date=01/01/2016&state=WI",,"29"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080004","Bronze HSA $6300 - 0%","91058WI008",,"WIN001","WIS001","WIF012","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.989369080292144",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0080004-00","Standard Bronze Off Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$6,300","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6550 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6550 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=E8&eff_date=01/01/2016&state=WI",,"30"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060002","Silver HSA $2000 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994557635671598",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060002-05","87% AV Level Silver Plan",,"0.873969435691834","Yes","Yes","No","100%",,"$1,000","$0","$500","$150","$500","$0","$950","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$2250 per person","$3000 per group",,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group","20%",,,,,"$5,000","$10000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S5&eff_date=01/01/2016&state=WI",,"16"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060002","Silver HSA $2000 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994557635671598",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060002-06","94% AV Level Silver Plan",,"0.94617486000061","Yes","Yes","No","100%",,"$500","$0","$0","$150","$250","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group",,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$500 per person","$500 per group","10%",,,,,"$2,500","$5000 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S4&eff_date=01/01/2016&state=WI",,"17"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060003","Bronze HSA $3250 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.99386336272187",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060003-00","Standard Bronze Off Exchange Plan",,"0.618900716304779","Yes","Yes","No","100%",,"$5,330","$0","$970","$150","$3,250","$0","$1,010","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group","50%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2016&state=WI",,"18"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060003","Bronze HSA $3250 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.99386336272187",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060003-01","Standard Bronze On Exchange Plan",,"0.618900716304779","Yes","Yes","No","100%",,"$5,330","$0","$970","$150","$3,250","$0","$1,010","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group","50%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2016&state=WI",,"19"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050006","Silver $2500 - 50%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995039947260199",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050006-03","Limited Cost Sharing Plan Variation",,"0.704307496547699","No","Yes","No","100%",,"$4,580","$20","$1,200","$150","$2,500","$440","$390","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZL&eff_date=01/01/2016&state=WI",,"30"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050006","Silver $2500 - 50%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995039947260199",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050006-04","73% AV Level Silver Plan",,"0.734937191009521","No","Yes","No","100%",,"$4,580","$0","$870","$150","$2,500","$340","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","40%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=6S&eff_date=01/01/2016&state=WI",,"31"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080004","Bronze HSA $6300 - 0%","91058WI008",,"WIN001","WIS001","WIF012","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.989369080292144",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","91058WI0080004-01","Standard Bronze On Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$6,300","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6550 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6550 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=E8&eff_date=01/01/2016&state=WI",,"31"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050006","Silver $2500 - 50%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995039947260199",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050006-05","87% AV Level Silver Plan",,"0.863643050193787","No","Yes","No","100%",,"$2,000","$0","$0","$150","$1,000","$290","$320","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=5S&eff_date=01/01/2016&state=WI",,"32"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050006","Silver $2500 - 50%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995039947260199",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050006-06","94% AV Level Silver Plan",,"0.941182613372803","No","Yes","No","100%",,"$500","$0","$250","$150","$250","$200","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=4S&eff_date=01/01/2016&state=WI",,"33"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050007","Silver $2500 - 20%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995190112332187",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050007-00","Standard Silver Off Exchange Plan",,"0.700737416744232","No","Yes","No","100%",,"$4,580","$220","$0","$150","$2,500","$240","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2016&state=WI",,"34"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050007","Silver $2500 - 20%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995190112332187",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050007-01","Standard Silver On Exchange Plan",,"0.700737416744232","No","Yes","No","100%",,"$4,580","$220","$0","$150","$2,500","$240","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2016&state=WI",,"35"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050007","Silver $2500 - 20%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995190112332187",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZI&eff_date=01/01/2016&state=WI",,"36"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050007","Silver $2500 - 20%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995190112332187",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050007-03","Limited Cost Sharing Plan Variation",,"0.700737416744232","No","Yes","No","100%",,"$4,580","$220","$0","$150","$2,500","$240","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZJ&eff_date=01/01/2016&state=WI",,"37"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050007","Silver $2500 - 20%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995190112332187",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050007-04","73% AV Level Silver Plan",,"0.731458604335785","No","Yes","No","100%",,"$4,000","$0","$0","$150","$2,000","$290","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=3S&eff_date=01/01/2016&state=WI",,"38"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050007","Silver $2500 - 20%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995190112332187",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050007-05","87% AV Level Silver Plan",,"0.871182441711426","No","Yes","No","100%",,"$1,250","$0","$0","$150","$1,000","$80","$170","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=2S&eff_date=01/01/2016&state=WI",,"39"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050007","Silver $2500 - 20%","91058WI005",,"WIN002","WIS001","WIF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995190112332187",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050007-06","94% AV Level Silver Plan",,"0.943733274936676","No","Yes","No","100%",,"$500","$0","$0","$150","$250","$100","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=1S&eff_date=01/01/2016&state=WI",,"40"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050008","Bronze $3000 - 50%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993958974555048",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050008-00","Standard Bronze Off Exchange Plan",,"0.618284046649933","No","Yes","No","100%",,"$5,080","$20","$1,090","$150","$3,000","$300","$470","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2016&state=WI",,"41"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050008","Bronze $3000 - 50%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993958974555048",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050008-01","Standard Bronze On Exchange Plan",,"0.618284046649933","No","Yes","No","100%",,"$5,080","$20","$1,090","$150","$3,000","$300","$470","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2016&state=WI",,"42"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050008","Bronze $3000 - 50%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993958974555048",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZQ&eff_date=01/01/2016&state=WI",,"43"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050008","Bronze $3000 - 50%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993958974555048",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050008-03","Limited Cost Sharing Plan Variation",,"0.618284046649933","No","Yes","No","100%",,"$5,080","$20","$1,090","$150","$3,000","$300","$470","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZR&eff_date=01/01/2016&state=WI",,"44"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050009","Bronze $4000 - 30%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994082286185135",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050009-00","Standard Bronze Off Exchange Plan",,"0.610205709934235","No","Yes","No","100%",,"$6,080","$20","$350","$150","$4,000","$200","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2016&state=WI",,"45"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050009","Bronze $4000 - 30%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994082286185135",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050009-01","Standard Bronze On Exchange Plan",,"0.610205709934235","No","Yes","No","100%",,"$6,080","$20","$350","$150","$4,000","$200","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2016&state=WI",,"46"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050009","Bronze $4000 - 30%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994082286185135",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZO&eff_date=01/01/2016&state=WI",,"47"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050009","Bronze $4000 - 30%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994082286185135",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050009-03","Limited Cost Sharing Plan Variation",,"0.610205709934235","No","Yes","No","100%",,"$6,080","$20","$350","$150","$4,000","$200","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZP&eff_date=01/01/2016&state=WI",,"48"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050010","Bronze $6250 - 30%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994374621711112",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050010-00","Standard Bronze Off Exchange Plan",,"0.618025720119476","No","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","30%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2016&state=WI",,"49"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050010","Bronze $6250 - 30%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994374621711112",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050010-01","Standard Bronze On Exchange Plan",,"0.618025720119476","No","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","30%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2016&state=WI",,"50"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050010","Bronze $6250 - 30%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994374621711112",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZS&eff_date=01/01/2016&state=WI",,"51"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","1","91058","WI","Individual","No","39-1807071","91058WI0050010","Bronze $6250 - 30%","91058WI005",,"WIN002","WIS001","WIF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994374621711112",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050010-03","Limited Cost Sharing Plan Variation",,"0.618025720119476","No","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","30%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZT&eff_date=01/01/2016&state=WI",,"52"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060001","Silver HSA $3500 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994733333333333",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060001-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6550 per person","$7000 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6550 per person","$7000 per group","0%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2016&state=WI",,"4"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060001","Silver HSA $3500 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994733333333333",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060001-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6550 per person","$7000 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6550 per person","$7000 per group","0%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2016&state=WI",,"5"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060001","Silver HSA $3500 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994733333333333",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZU&eff_date=01/01/2016&state=WI",,"6"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060001","Silver HSA $3500 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994733333333333",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060001-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6550 per person","$7000 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6550 per person","$7000 per group","0%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZV&eff_date=01/01/2016&state=WI",,"7"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060001","Silver HSA $3500 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994733333333333",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060001-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$150","$3,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$5450 per person","$6000 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","0%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S3&eff_date=01/01/2016&state=WI",,"8"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060001","Silver HSA $3500 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994733333333333",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060001-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$150","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2250 per person","$2500 per group",,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2500 per person","$2500 per group","0%",,,,,"$5,000","$10000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S2&eff_date=01/01/2016&state=WI",,"9"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060001","Silver HSA $3500 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994733333333333",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060001-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$150","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group",,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group","0%",,,,,"$2,500","$5000 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S1&eff_date=01/01/2016&state=WI",,"10"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060002","Silver HSA $2000 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994557635671598",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060002-00","Standard Silver Off Exchange Plan",,"0.700391530990601","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,000","$0","$1,640","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6550 per person","$8000 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","50%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2016&state=WI",,"11"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060002","Silver HSA $2000 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994557635671598",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060002-01","Standard Silver On Exchange Plan",,"0.700391530990601","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,000","$0","$1,640","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6550 per person","$8000 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","50%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2016&state=WI",,"12"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060002","Silver HSA $2000 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994557635671598",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZY&eff_date=01/01/2016&state=WI",,"13"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060002","Silver HSA $2000 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994557635671598",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060002-03","Limited Cost Sharing Plan Variation",,"0.700391530990601","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,000","$0","$1,640","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6550 per person","$8000 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","50%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=Z1&eff_date=01/01/2016&state=WI",,"14"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060002","Silver HSA $2000 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994557635671598",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060002-04","73% AV Level Silver Plan",,"0.730460643768311","Yes","Yes","No","100%",,"$3,250","$0","$0","$150","$2,000","$0","$1,250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$5450 per person","$6500 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","50%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S6&eff_date=01/01/2016&state=WI",,"15"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060003","Bronze HSA $3250 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.99386336272187",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YE&eff_date=01/01/2016&state=WI",,"20"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060003","Bronze HSA $3250 - 50%","91058WI006",,"WIN002","WIS001","WIF010","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.99386336272187",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060003-03","Limited Cost Sharing Plan Variation",,"0.618900716304779","Yes","Yes","No","100%",,"$5,330","$0","$970","$150","$3,250","$0","$1,010","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group","50%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YF&eff_date=01/01/2016&state=WI",,"21"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060004","Bronze HSA $6000 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993617837739583",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060004-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6550 per person","$12000 per group",,,,"$20,000","$40000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6550 per person","$12000 per group","0%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2016&state=WI",,"22"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060004","Bronze HSA $6000 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993617837739583",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060004-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6550 per person","$12000 per group",,,,"$20,000","$40000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6550 per person","$12000 per group","0%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2016&state=WI",,"23"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060004","Bronze HSA $6000 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993617837739583",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YA&eff_date=01/01/2016&state=WI",,"24"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060004","Bronze HSA $6000 - 0%","91058WI006",,"WIN002","WIS001","WIF012","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993617837739583",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060004-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6550 per person","$12000 per group",,,,"$20,000","$40000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6550 per person","$12000 per group","0%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YB&eff_date=01/01/2016&state=WI",,"25"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060005","Bronze HSA $5000 - 20%","91058WI006",,"WIN002","WIS001","WIF009","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993408702181803",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060005-00","Standard Bronze Off Exchange Plan",,"0.613701462745667","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2016&state=WI",,"26"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060005","Bronze HSA $5000 - 20%","91058WI006",,"WIN002","WIS001","WIF009","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993408702181803",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060005-01","Standard Bronze On Exchange Plan",,"0.613701462745667","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2016&state=WI",,"27"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060005","Bronze HSA $5000 - 20%","91058WI006",,"WIN002","WIS001","WIF009","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993408702181803",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YC&eff_date=01/01/2016&state=WI",,"28"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0060005","Bronze HSA $5000 - 20%","91058WI006",,"WIN002","WIS001","WIF009","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993408702181803",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0060005-03","Limited Cost Sharing Plan Variation",,"0.613701462745667","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YD&eff_date=01/01/2016&state=WI",,"29"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0050014","Catastrophic $6,850 - 0%","91058WI005",,"WIN002","WIS001","WIF012","Existing","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9920543122957",,,,"0","0","3","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050014-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=CT&eff_date=01/01/2016&state=WI",,"30"
"2016","WI","91058","HIOS","3","2015-08-26 09:56:12","2","91058","WI","Individual","No","39-1807071","91058WI0050014","Catastrophic $6,850 - 0%","91058WI005",,"WIN002","WIS001","WIF012","Existing","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.9920543122957",,,,"0","0","3","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","91058WI0050014-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=CT&eff_date=01/01/2016&state=WI",,"31"
"2016","WI","91604","HIOS","7","2015-08-20 09:36:54","1","91604","WI","Individual","Yes","39-1263473","91604WI0490001","Humana Dental Smart Choice","91604WI049",,"WIN001","WIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.67","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","91604WI0490001-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2613026","4"
"2016","WI","91604","HIOS","7","2015-08-20 09:36:54","1","91604","WI","Individual","Yes","39-1263473","91604WI0490001","Humana Dental Smart Choice","91604WI049",,"WIN001","WIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.67","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","91604WI0490001-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2613026","5"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210022","Silver 30 Copay","94529WI021","7558364783","WIN001","WIS001","WIF005","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210022-03","Limited Cost Sharing Plan Variation",,"0.719304203987122","No","Yes","No","100%",,"$4,000","$20","$350","$150","$4,000","$470","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7017","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7017&year=2016","15"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210017","Platinum 500 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF001","Existing","HMO","Platinum","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210017-00","Standard Platinum Off Exchange Plan",,"0.913063883781433","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7100","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7000&year=2016","4"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220017","Platinum 1000 Deductible Benefit Arch","94529WI022","7558364783","WIN001","WIS003","WIF001","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220017-00","Standard Platinum Off Exchange Plan","88.23%",,"No","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7303","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7203&year=2016","4"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220017","Platinum 1000 Deductible Benefit Arch","94529WI022","7558364783","WIN001","WIS003","WIF001","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220017-01","Standard Platinum On Exchange Plan","88.23%",,"No","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7203","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7203&year=2016","5"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210017","Platinum 500 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF001","Existing","HMO","Platinum","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210017-01","Standard Platinum On Exchange Plan",,"0.913063883781433","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7000","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7000&year=2016","5"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210017","Platinum 500 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF001","Existing","HMO","Platinum","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210017-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7001","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7001&year=2016","6"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220019","Gold 2000 Deductible Benefit Arch","94529WI022","7558364783","WIN001","WIS003","WIF002","Existing","HMO","Gold","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220019-00","Standard Gold Off Exchange Plan","80.68%",,"No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$580","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7309","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7209&year=2016","6"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220019","Gold 2000 Deductible Benefit Arch","94529WI022","7558364783","WIN001","WIS003","WIF002","Existing","HMO","Gold","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220019-01","Standard Gold On Exchange Plan","80.68%",,"No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$580","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7209","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7209&year=2016","7"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210017","Platinum 500 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF001","Existing","HMO","Platinum","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210017-03","Limited Cost Sharing Plan Variation",,"0.913063883781433","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7002","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7002&year=2016","7"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210019","Gold 1000 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF003","Existing","HMO","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210019-00","Standard Gold Off Exchange Plan",,"0.816434919834137","No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$830","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7106","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7006&year=2016","8"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220027","Select Platinum 1000 Deductible Benefit Arch","94529WI022","7558364783","WIN002","WIS004","WIF001","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220027-00","Standard Platinum Off Exchange Plan","88.23%",,"No","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7343","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7243&year=2016","8"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220027","Select Platinum 1000 Deductible Benefit Arch","94529WI022","7558364783","WIN002","WIS004","WIF001","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220027-01","Standard Platinum On Exchange Plan","88.23%",,"No","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7243","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7243&year=2016","9"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210019","Gold 1000 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF003","Existing","HMO","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210019-01","Standard Gold On Exchange Plan",,"0.816434919834137","No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$830","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7006","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7006&year=2016","9"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210019","Gold 1000 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF003","Existing","HMO","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210019-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7007","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7007&year=2016","10"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220029","Select Gold 2000 Deductible Benefit Arch","94529WI022","7558364783","WIN002","WIS004","WIF002","Existing","HMO","Gold","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220029-00","Standard Gold Off Exchange Plan","80.68%",,"No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$580","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7349","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7249&year=2016","10"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220029","Select Gold 2000 Deductible Benefit Arch","94529WI022","7558364783","WIN002","WIS004","WIF002","Existing","HMO","Gold","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220029-01","Standard Gold On Exchange Plan","80.68%",,"No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$580","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7249","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7249&year=2016","11"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210019","Gold 1000 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF003","Existing","HMO","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210019-03","Limited Cost Sharing Plan Variation",,"0.816434919834137","No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$830","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7008","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7008&year=2016","11"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210022","Silver 30 Copay","94529WI021","7558364783","WIN001","WIS001","WIF005","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210022-00","Standard Silver Off Exchange Plan",,"0.719304203987122","No","Yes","No","100%",,"$4,000","$20","$350","$150","$4,000","$470","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7115","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7015&year=2016","12"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210022","Silver 30 Copay","94529WI021","7558364783","WIN001","WIS001","WIF005","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210022-01","Standard Silver On Exchange Plan",,"0.719304203987122","No","Yes","No","100%",,"$4,000","$20","$350","$150","$4,000","$470","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7015","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7015&year=2016","13"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210022","Silver 30 Copay","94529WI021","7558364783","WIN001","WIS001","WIF005","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210022-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7016","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7016&year=2016","14"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210022","Silver 30 Copay","94529WI021","7558364783","WIN001","WIS001","WIF005","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210022-04","73% AV Level Silver Plan",,"0.739963412284851","No","Yes","No","100%",,"$3,500","$20","$330","$150","$3,500","$620","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7018","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7018&year=2016","16"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210022","Silver 30 Copay","94529WI021","7558364783","WIN001","WIS001","WIF005","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210022-05","87% AV Level Silver Plan",,"0.877399921417236","No","Yes","No","100%",,"$0","$20","$1,030","$150","$0","$1,390","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7019","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7019&year=2016","17"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210022","Silver 30 Copay","94529WI021","7558364783","WIN001","WIS001","WIF005","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210022-06","94% AV Level Silver Plan",,"0.940293371677399","No","Yes","No","100%",,"$0","$20","$520","$150","$0","$400","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7020","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7020&year=2016","18"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210025","Bronze 4000 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF006","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210025-00","Standard Bronze Off Exchange Plan",,"0.614323556423187","No","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7133","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7033&year=2016","19"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210025","Bronze 4000 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF006","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210025-01","Standard Bronze On Exchange Plan",,"0.614323556423187","No","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7033","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7033&year=2016","20"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210025","Bronze 4000 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF006","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210025-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7034","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7034&year=2016","21"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210025","Bronze 4000 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF006","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210025-03","Limited Cost Sharing Plan Variation",,"0.614323556423187","No","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7035","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7035&year=2016","22"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210039","Silver 3500 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF004","New","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210039-00","Standard Silver Off Exchange Plan",,"0.689991056919098","No","Yes","No","100%",,"$3,500","$20","$670","$150","$3,500","$540","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7139","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7039&year=2016","23"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210039","Silver 3500 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF004","New","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210039-01","Standard Silver On Exchange Plan",,"0.689991056919098","No","Yes","No","100%",,"$3,500","$20","$670","$150","$3,500","$540","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7039","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7039&year=2016","24"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210039","Silver 3500 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF004","New","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210039-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7040","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7040&year=2016","25"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210039","Silver 3500 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF004","New","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210039-03","Limited Cost Sharing Plan Variation",,"0.689991056919098","No","Yes","No","100%",,"$3,500","$20","$670","$150","$3,500","$540","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7041","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7041&year=2016","26"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210039","Silver 3500 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF004","New","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210039-04","73% AV Level Silver Plan",,"0.723865747451782","No","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7042","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7042&year=2016","27"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210039","Silver 3500 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF004","New","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210039-05","87% AV Level Silver Plan",,"0.871516048908234","No","Yes","No","100%",,"$0","$20","$1,030","$150","$0","$1,200","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7043","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7043&year=2016","28"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210039","Silver 3500 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF004","New","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210039-06","94% AV Level Silver Plan",,"0.941025674343109","No","Yes","No","100%",,"$0","$0","$500","$150","$0","$390","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7044","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7044&year=2016","29"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210028","Select Platinum 500 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF001","Existing","HMO","Platinum","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210028-00","Standard Platinum Off Exchange Plan",,"0.913063883781433","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7150","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7050&year=2016","30"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210028","Select Platinum 500 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF001","Existing","HMO","Platinum","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210028-01","Standard Platinum On Exchange Plan",,"0.913063883781433","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7050","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7050&year=2016","31"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210028","Select Platinum 500 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF001","Existing","HMO","Platinum","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210028-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7051","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7051&year=2016","32"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210028","Select Platinum 500 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF001","Existing","HMO","Platinum","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210028-03","Limited Cost Sharing Plan Variation",,"0.913063883781433","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7052","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7052&year=2016","33"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210030","Select Gold 1000 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF003","Existing","HMO","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210030-00","Standard Gold Off Exchange Plan",,"0.816434919834137","No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$830","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7156","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7056&year=2016","34"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210030","Select Gold 1000 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF003","Existing","HMO","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210030-01","Standard Gold On Exchange Plan",,"0.816434919834137","No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$830","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7056","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7056&year=2016","35"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210030","Select Gold 1000 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF003","Existing","HMO","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210030-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7057","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7057&year=2016","36"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210030","Select Gold 1000 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF003","Existing","HMO","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210030-03","Limited Cost Sharing Plan Variation",,"0.816434919834137","No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$830","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7058","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7058&year=2016","37"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","2","94529","WI","Individual","No","39-1199466","94529WI0210018","Platinum 1000 Deductible Benefit Arch","94529WI021","7558364783","WIN001","WIS001","WIF001","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210018-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7004","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7004&year=2016","6"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210041","Select Silver 3500 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF004","New","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210041-04","73% AV Level Silver Plan",,"0.723865747451782","No","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7092","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7092&year=2016","53"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","4","94529","WI","Individual","No","39-1199466","94529WI0210023","Silver 2000 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210023-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7022","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7022&year=2016","6"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","6","94529","WI","Individual","No","39-1199466","94529WI0210040","Catastrophic 6850 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF007","New","HMO","Catastrophic","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210040-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7045","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7045&year=2016","5"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220034","Select Bronze 4000 Deductible","94529WI022","7558364783","WIN002","WIS004","WIF006","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220034-01","Standard Bronze On Exchange Plan",,"0.614323556423187","No","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7273","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7273&year=2016","21"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","6","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080017","BlueSelect Gold HealthPlus with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080017-00","Standard Gold Off Exchange Plan","79.54%","0.791854798793793","Yes","Yes","No","100%",,"$1,000","$10","$1,300","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$8,250","$8250 per person","$16700 per group","$14,500","$14500 per person","$29200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlusGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Gold_Plans.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","6","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080017","BlueSelect Gold HealthPlus with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080017-01","Standard Gold On Exchange Plan","79.54%","0.791854798793793","Yes","Yes","No","100%",,"$1,000","$10","$1,300","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$8,250","$8250 per person","$16700 per group","$14,500","$14500 per person","$29200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlusGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Gold_Plans.pdf","5"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","6","94529","WI","Individual","No","39-1199466","94529WI0210042","Select Catastrophic 6850 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF007","New","HMO","Catastrophic","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210042-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7095","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7095&year=2016","6"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220018","Gold 1000 Deductible","94529WI022","7558364783","WIN001","WIS003","WIF003","Existing","HMO","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220018-01","Standard Gold On Exchange Plan",,"0.816434919834137","No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$830","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7206","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7206&year=2016","7"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220021","Silver 30 Copay","94529WI022","7558364783","WIN001","WIS003","WIF005","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220021-00","Standard Silver Off Exchange Plan",,"0.719304203987122","No","Yes","No","100%",,"$4,000","$20","$350","$150","$4,000","$470","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7315","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7215&year=2016","8"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","11","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220030","Select Gold 2000 Deductible HSA","94529WI022","7558364783","WIN002","WIS004","WIF007","Existing","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220030-00","Standard Gold Off Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7352","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7252&year=2016","8"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","11","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220030","Select Gold 2000 Deductible HSA","94529WI022","7558364783","WIN002","WIS004","WIF007","Existing","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220030-01","Standard Gold On Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7252","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7252&year=2016","9"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210033","Select Silver 30 Copay","94529WI021","7558364783","WIN002","WIS002","WIF005","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210033-00","Standard Silver Off Exchange Plan",,"0.719304203987122","No","Yes","No","100%",,"$4,000","$20","$350","$150","$4,000","$470","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7165","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7065&year=2016","38"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210033","Select Silver 30 Copay","94529WI021","7558364783","WIN002","WIS002","WIF005","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210033-01","Standard Silver On Exchange Plan",,"0.719304203987122","No","Yes","No","100%",,"$4,000","$20","$350","$150","$4,000","$470","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7065","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7065&year=2016","39"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210033","Select Silver 30 Copay","94529WI021","7558364783","WIN002","WIS002","WIF005","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210033-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7066","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7066&year=2016","40"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210033","Select Silver 30 Copay","94529WI021","7558364783","WIN002","WIS002","WIF005","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210033-03","Limited Cost Sharing Plan Variation",,"0.719304203987122","No","Yes","No","100%",,"$4,000","$20","$350","$150","$4,000","$470","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7067","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7067&year=2016","41"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210033","Select Silver 30 Copay","94529WI021","7558364783","WIN002","WIS002","WIF005","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210033-04","73% AV Level Silver Plan",,"0.739963412284851","No","Yes","No","100%",,"$3,500","$20","$330","$150","$350","$620","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7068","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7068&year=2016","42"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210033","Select Silver 30 Copay","94529WI021","7558364783","WIN002","WIS002","WIF005","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210033-05","87% AV Level Silver Plan",,"0.877399921417236","No","Yes","No","100%",,"$0","$20","$1,030","$150","$0","$1,390","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7069","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7069&year=2016","43"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210033","Select Silver 30 Copay","94529WI021","7558364783","WIN002","WIS002","WIF005","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210033-06","94% AV Level Silver Plan",,"0.940293371677399","No","Yes","No","100%",,"$0","$20","$520","$150","$0","$400","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7070","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7070&year=2016","44"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210036","Select Bronze 4000 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF006","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210036-00","Standard Bronze Off Exchange Plan",,"0.614323556423187","No","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7183","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7083&year=2016","45"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210036","Select Bronze 4000 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF006","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210036-01","Standard Bronze On Exchange Plan",,"0.614323556423187","No","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7083","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7083&year=2016","46"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210036","Select Bronze 4000 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF006","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210036-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7084","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7084&year=2016","47"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210036","Select Bronze 4000 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF006","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210036-03","Limited Cost Sharing Plan Variation",,"0.614323556423187","No","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7085","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7085&year=2016","48"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210041","Select Silver 3500 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF004","New","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210041-00","Standard Silver Off Exchange Plan",,"0.689991056919098","No","Yes","No","100%",,"$3,500","$20","$670","$150","$3,500","$540","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7189","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7089&year=2016","49"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210041","Select Silver 3500 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF004","New","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210041-01","Standard Silver On Exchange Plan",,"0.689991056919098","No","Yes","No","100%",,"$3,500","$20","$670","$150","$3,500","$540","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7089","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7089&year=2016","50"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210041","Select Silver 3500 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF004","New","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210041-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7090","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7090&year=2016","51"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210041","Select Silver 3500 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF004","New","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210041-03","Limited Cost Sharing Plan Variation",,"0.689991056919098","No","Yes","No","100%",,"$3,500","$20","$670","$150","$3,500","$540","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7091","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7091&year=2016","52"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210041","Select Silver 3500 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF004","New","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210041-05","87% AV Level Silver Plan",,"0.871516048908234","No","Yes","No","100%",,"$0","$20","$1,030","$150","$0","$1,200","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7093","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7093&year=2016","54"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","1","94529","WI","Individual","No","39-1199466","94529WI0210041","Select Silver 3500 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF004","New","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210041-06","94% AV Level Silver Plan",,"0.941025674343109","No","Yes","No","100%",,"$0","$0","$500","$150","$0","$390","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7094","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7094&year=2016","55"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","2","94529","WI","Individual","No","39-1199466","94529WI0210018","Platinum 1000 Deductible Benefit Arch","94529WI021","7558364783","WIN001","WIS001","WIF001","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210018-00","Standard Platinum Off Exchange Plan","88.23%","0.837167799472809","No","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7103","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7003&year=2016","4"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","2","94529","WI","Individual","No","39-1199466","94529WI0210018","Platinum 1000 Deductible Benefit Arch","94529WI021","7558364783","WIN001","WIS001","WIF001","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210018-01","Standard Platinum On Exchange Plan","88.23%","0.837167799472809","No","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7003","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7003&year=2016","5"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","2","94529","WI","Individual","No","39-1199466","94529WI0210018","Platinum 1000 Deductible Benefit Arch","94529WI021","7558364783","WIN001","WIS001","WIF001","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210018-03","Limited Cost Sharing Plan Variation","88.23%","0.837167799472809","No","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7005","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7005&year=2016","7"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","2","94529","WI","Individual","No","39-1199466","94529WI0210020","Gold 2000 Deductible Benefit Arch","94529WI021","7558364783","WIN001","WIS001","WIF002","Existing","HMO","Gold","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210020-00","Standard Gold Off Exchange Plan","80.68%","0.745214641094208","No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$580","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7109","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7009&year=2016","8"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","2","94529","WI","Individual","No","39-1199466","94529WI0210020","Gold 2000 Deductible Benefit Arch","94529WI021","7558364783","WIN001","WIS001","WIF002","Existing","HMO","Gold","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210020-01","Standard Gold On Exchange Plan","80.68%","0.745214641094208","No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$580","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7009","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7009&year=2016","9"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","2","94529","WI","Individual","No","39-1199466","94529WI0210020","Gold 2000 Deductible Benefit Arch","94529WI021","7558364783","WIN001","WIS001","WIF002","Existing","HMO","Gold","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210020-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7010","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7010&year=2016","10"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","2","94529","WI","Individual","No","39-1199466","94529WI0210020","Gold 2000 Deductible Benefit Arch","94529WI021","7558364783","WIN001","WIS001","WIF002","Existing","HMO","Gold","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210020-03","Limited Cost Sharing Plan Variation","80.68%","0.745214641094208","No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$580","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7011","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7011&year=2016","11"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","2","94529","WI","Individual","No","39-1199466","94529WI0210029","Select Platinum 1000 Deductible Benefit Arch","94529WI021","7558364783","WIN002","WIS002","WIF001","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210029-00","Standard Platinum Off Exchange Plan","88.23%","0.837167799472809","No","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7153","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7053&year=2016","12"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","2","94529","WI","Individual","No","39-1199466","94529WI0210029","Select Platinum 1000 Deductible Benefit Arch","94529WI021","7558364783","WIN002","WIS002","WIF001","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210029-01","Standard Platinum On Exchange Plan","88.23%","0.837167799472809","No","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7053","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7053&year=2016","13"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","2","94529","WI","Individual","No","39-1199466","94529WI0210029","Select Platinum 1000 Deductible Benefit Arch","94529WI021","7558364783","WIN002","WIS002","WIF001","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210029-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7054","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7054&year=2016","14"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","2","94529","WI","Individual","No","39-1199466","94529WI0210029","Select Platinum 1000 Deductible Benefit Arch","94529WI021","7558364783","WIN002","WIS002","WIF001","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210029-03","Limited Cost Sharing Plan Variation","88.23%","0.837167799472809","No","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7055","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7055&year=2016","15"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","2","94529","WI","Individual","No","39-1199466","94529WI0210031","Select Gold 2000 Deductible Benefit Arch","94529WI021","7558364783","WIN002","WIS002","WIF002","Existing","HMO","Gold","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210031-00","Standard Gold Off Exchange Plan","80.68%","0.745214641094208","No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$580","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7159","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7059&year=2016","16"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","2","94529","WI","Individual","No","39-1199466","94529WI0210031","Select Gold 2000 Deductible Benefit Arch","94529WI021","7558364783","WIN002","WIS002","WIF002","Existing","HMO","Gold","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210031-01","Standard Gold On Exchange Plan","80.68%","0.745214641094208","No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$580","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7059","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7059&year=2016","17"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","2","94529","WI","Individual","No","39-1199466","94529WI0210031","Select Gold 2000 Deductible Benefit Arch","94529WI021","7558364783","WIN002","WIS002","WIF002","Existing","HMO","Gold","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210031-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7060","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7060&year=2016","18"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","2","94529","WI","Individual","No","39-1199466","94529WI0210031","Select Gold 2000 Deductible Benefit Arch","94529WI021","7558364783","WIN002","WIS002","WIF002","Existing","HMO","Gold","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210031-03","Limited Cost Sharing Plan Variation","80.68%","0.745214641094208","No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$580","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7061","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7061&year=2016","19"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210021","Gold 2000 Deductible HSA","94529WI021","7558364783","WIN001","WIS001","WIF007","Existing","HMO","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210021-00","Standard Gold Off Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7112","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7012&year=2016","4"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210021","Gold 2000 Deductible HSA","94529WI021","7558364783","WIN001","WIS001","WIF007","Existing","HMO","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210021-01","Standard Gold On Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7012","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7012&year=2016","5"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210021","Gold 2000 Deductible HSA","94529WI021","7558364783","WIN001","WIS001","WIF007","Existing","HMO","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7013","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7013&year=2016","6"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210021","Gold 2000 Deductible HSA","94529WI021","7558364783","WIN001","WIS001","WIF007","Existing","HMO","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210021-03","Limited Cost Sharing Plan Variation",,"0.806294620037079","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7014","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7014&year=2016","7"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210024","Silver 3500 Deductible HSA","94529WI021","7558364783","WIN001","WIS001","WIF007","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210024-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7127","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7027&year=2016","8"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210024","Silver 3500 Deductible HSA","94529WI021","7558364783","WIN001","WIS001","WIF007","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210024-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7027","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7027&year=2016","9"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210024","Silver 3500 Deductible HSA","94529WI021","7558364783","WIN001","WIS001","WIF007","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210024-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7028","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7028&year=2016","10"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210024","Silver 3500 Deductible HSA","94529WI021","7558364783","WIN001","WIS001","WIF007","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210024-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7029","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7029&year=2016","11"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210024","Silver 3500 Deductible HSA","94529WI021","7558364783","WIN001","WIS001","WIF007","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210024-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7030","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7030&year=2016","12"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210024","Silver 3500 Deductible HSA","94529WI021","7558364783","WIN001","WIS001","WIF007","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210024-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7031","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7031&year=2016","13"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210024","Silver 3500 Deductible HSA","94529WI021","7558364783","WIN001","WIS001","WIF007","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210024-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7032","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7032&year=2016","14"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210032","Select Gold 2000 Deductible HSA","94529WI021","7558364783","WIN002","WIS002","WIF007","Existing","HMO","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210032-00","Standard Gold Off Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7162","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7062&year=2016","15"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210032","Select Gold 2000 Deductible HSA","94529WI021","7558364783","WIN002","WIS002","WIF007","Existing","HMO","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210032-01","Standard Gold On Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7062","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7062&year=2016","16"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210032","Select Gold 2000 Deductible HSA","94529WI021","7558364783","WIN002","WIS002","WIF007","Existing","HMO","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210032-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7063","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7063&year=2016","17"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210032","Select Gold 2000 Deductible HSA","94529WI021","7558364783","WIN002","WIS002","WIF007","Existing","HMO","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210032-03","Limited Cost Sharing Plan Variation",,"0.806294620037079","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7064","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7064&year=2016","18"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210035","Select Silver 3500 Deductible HSA","94529WI021","7558364783","WIN002","WIS002","WIF007","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210035-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7177","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7077&year=2016","19"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210035","Select Silver 3500 Deductible HSA","94529WI021","7558364783","WIN002","WIS002","WIF007","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210035-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7077","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7077&year=2016","20"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210035","Select Silver 3500 Deductible HSA","94529WI021","7558364783","WIN002","WIS002","WIF007","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210035-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7078","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7078&year=2016","21"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210035","Select Silver 3500 Deductible HSA","94529WI021","7558364783","WIN002","WIS002","WIF007","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210035-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7079","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7079&year=2016","22"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210035","Select Silver 3500 Deductible HSA","94529WI021","7558364783","WIN002","WIS002","WIF007","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210035-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7080","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7080&year=2016","23"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210035","Select Silver 3500 Deductible HSA","94529WI021","7558364783","WIN002","WIS002","WIF007","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210035-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7081","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7081&year=2016","24"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","3","94529","WI","Individual","No","39-1199466","94529WI0210035","Select Silver 3500 Deductible HSA","94529WI021","7558364783","WIN002","WIS002","WIF007","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210035-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7082","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7082&year=2016","25"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","4","94529","WI","Individual","No","39-1199466","94529WI0210023","Silver 2000 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210023-00","Standard Silver Off Exchange Plan",,"0.686693131923676","No","Yes","No","100%",,"$4,000","$20","$230","$150","$4,000","$380","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7121","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7021&year=2016","4"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","4","94529","WI","Individual","No","39-1199466","94529WI0210023","Silver 2000 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210023-01","Standard Silver On Exchange Plan",,"0.686693131923676","No","Yes","No","100%",,"$4,000","$20","$230","$150","$4,000","$380","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7021","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7021&year=2016","5"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","4","94529","WI","Individual","No","39-1199466","94529WI0210023","Silver 2000 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210023-03","Limited Cost Sharing Plan Variation",,"0.686693131923676","No","Yes","No","100%",,"$4,000","$20","$230","$150","$4,000","$380","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7023","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7023&year=2016","7"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","4","94529","WI","Individual","No","39-1199466","94529WI0210023","Silver 2000 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210023-04","73% AV Level Silver Plan",,"0.737427830696106","No","Yes","No","100%",,"$3,000","$20","$430","$150","$3,000","$600","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7024","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7024&year=2016","8"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","4","94529","WI","Individual","No","39-1199466","94529WI0210023","Silver 2000 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210023-05","87% AV Level Silver Plan",,"0.871497094631195","No","Yes","No","100%",,"$0","$20","$1,030","$150","$0","$1,200","$480","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7025","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7025&year=2016","9"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","4","94529","WI","Individual","No","39-1199466","94529WI0210023","Silver 2000 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF004","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210023-06","94% AV Level Silver Plan",,"0.930353343486786","No","Yes","No","100%",,"$0","$20","$520","$150","$0","$400","$370","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7026","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7026&year=2016","10"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","4","94529","WI","Individual","No","39-1199466","94529WI0210034","Select Silver 2000 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF004","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210034-00","Standard Silver Off Exchange Plan",,"0.686693131923676","No","Yes","No","100%",,"$4,000","$20","$230","$150","$4,000","$380","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7171","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7071&year=2016","11"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","4","94529","WI","Individual","No","39-1199466","94529WI0210034","Select Silver 2000 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF004","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210034-01","Standard Silver On Exchange Plan",,"0.686693131923676","No","Yes","No","100%",,"$4,000","$20","$230","$150","$4,000","$380","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7071","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7071&year=2016","12"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","4","94529","WI","Individual","No","39-1199466","94529WI0210034","Select Silver 2000 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF004","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210034-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7072","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7072&year=2016","13"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","4","94529","WI","Individual","No","39-1199466","94529WI0210034","Select Silver 2000 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF004","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210034-03","Limited Cost Sharing Plan Variation",,"0.686693131923676","No","Yes","No","100%",,"$4,000","$20","$230","$150","$4,000","$380","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7073","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7073&year=2016","14"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","4","94529","WI","Individual","No","39-1199466","94529WI0210034","Select Silver 2000 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF004","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210034-04","73% AV Level Silver Plan",,"0.737427830696106","No","Yes","No","100%",,"$3,000","$20","$430","$150","$3,000","$600","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7074","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7074&year=2016","15"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","4","94529","WI","Individual","No","39-1199466","94529WI0210034","Select Silver 2000 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF004","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210034-05","87% AV Level Silver Plan",,"0.871497094631195","No","Yes","No","100%",,"$0","$20","$1,030","$150","$0","$1,200","$480","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7075","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7075&year=2016","16"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","4","94529","WI","Individual","No","39-1199466","94529WI0210034","Select Silver 2000 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF004","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210034-06","94% AV Level Silver Plan",,"0.930353343486786","No","Yes","No","100%",,"$0","$20","$520","$150","$0","$400","$370","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7076","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7076&year=2016","17"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","5","94529","WI","Individual","No","39-1199466","94529WI0210026","Bronze 5000 Deductible HSA","94529WI021","7558364783","WIN001","WIS001","WIF008","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210026-00","Standard Bronze Off Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7136","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7036&year=2016","4"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","5","94529","WI","Individual","No","39-1199466","94529WI0210026","Bronze 5000 Deductible HSA","94529WI021","7558364783","WIN001","WIS001","WIF008","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210026-01","Standard Bronze On Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7036","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7036&year=2016","5"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","5","94529","WI","Individual","No","39-1199466","94529WI0210026","Bronze 5000 Deductible HSA","94529WI021","7558364783","WIN001","WIS001","WIF008","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7037","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7037&year=2016","6"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","5","94529","WI","Individual","No","39-1199466","94529WI0210026","Bronze 5000 Deductible HSA","94529WI021","7558364783","WIN001","WIS001","WIF008","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210026-03","Limited Cost Sharing Plan Variation",,"0.615576088428497","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7038","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7038&year=2016","7"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","5","94529","WI","Individual","No","39-1199466","94529WI0210037","Select Bronze 5000 Deductible HSA","94529WI021","7558364783","WIN002","WIS002","WIF008","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210037-00","Standard Bronze Off Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7186","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7086&year=2016","8"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","5","94529","WI","Individual","No","39-1199466","94529WI0210037","Select Bronze 5000 Deductible HSA","94529WI021","7558364783","WIN002","WIS002","WIF008","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210037-01","Standard Bronze On Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7086","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7086&year=2016","9"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","5","94529","WI","Individual","No","39-1199466","94529WI0210037","Select Bronze 5000 Deductible HSA","94529WI021","7558364783","WIN002","WIS002","WIF008","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210037-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7087","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7087&year=2016","10"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","5","94529","WI","Individual","No","39-1199466","94529WI0210037","Select Bronze 5000 Deductible HSA","94529WI021","7558364783","WIN002","WIS002","WIF008","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210037-03","Limited Cost Sharing Plan Variation",,"0.615576088428497","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7088","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7088&year=2016","11"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","6","94529","WI","Individual","No","39-1199466","94529WI0210040","Catastrophic 6850 Deductible","94529WI021","7558364783","WIN001","WIS001","WIF007","New","HMO","Catastrophic","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210040-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7045","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7045&year=2016","4"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","6","94529","WI","Individual","No","39-1199466","94529WI0210042","Select Catastrophic 6850 Deductible","94529WI021","7558364783","WIN002","WIS002","WIF007","New","HMO","Catastrophic","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210042-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7095","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7095&year=2016","7"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","9","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0230001","Gold 1000 Deductible POS","94529WI023","7558364783","WIN001","WIS006","WIF003","New","POS","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","Yes","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0230001-00","Standard Gold Off Exchange Plan",,"0.816434919834137","No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$830","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7390","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7290&year=2016","4"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","9","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0230001","Gold 1000 Deductible POS","94529WI023","7558364783","WIN001","WIS006","WIF003","New","POS","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","Yes","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0230001-01","Standard Gold On Exchange Plan",,"0.816434919834137","No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$830","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7290","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7290&year=2016","5"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","9","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0230002","Silver 2000 Deductible POS","94529WI023","7558364783","WIN001","WIS006","WIF005","New","POS","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","Yes","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0230002-00","Standard Silver Off Exchange Plan",,"0.719242751598358","No","Yes","No","100%",,"$4,000","$20","$350","$150","$4,000","$470","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7391","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7291&year=2016","6"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","9","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0230002","Silver 2000 Deductible POS","94529WI023","7558364783","WIN001","WIS006","WIF005","New","POS","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","Yes","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0230002-01","Standard Silver On Exchange Plan",,"0.719242751598358","No","Yes","No","100%",,"$4,000","$20","$350","$150","$4,000","$470","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7291","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7291&year=2016","7"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220016","Platinum 500 Deductible","94529WI022","7558364783","WIN001","WIS003","WIF001","Existing","HMO","Platinum","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220016-00","Standard Platinum Off Exchange Plan",,"0.913063883781433","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7300","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7200&year=2016","4"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220016","Platinum 500 Deductible","94529WI022","7558364783","WIN001","WIS003","WIF001","Existing","HMO","Platinum","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220016-01","Standard Platinum On Exchange Plan",,"0.913063883781433","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7200","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7200&year=2016","5"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220018","Gold 1000 Deductible","94529WI022","7558364783","WIN001","WIS003","WIF003","Existing","HMO","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220018-00","Standard Gold Off Exchange Plan",,"0.816434919834137","No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$830","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7306","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7206&year=2016","6"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220021","Silver 30 Copay","94529WI022","7558364783","WIN001","WIS003","WIF005","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220021-01","Standard Silver On Exchange Plan",,"0.719304203987122","No","Yes","No","100%",,"$4,000","$20","$350","$150","$4,000","$470","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7215","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7215&year=2016","9"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220024","Bronze 4000 Deductible","94529WI022","7558364783","WIN001","WIS003","WIF006","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220024-00","Standard Bronze Off Exchange Plan",,"0.614323556423187","No","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7333","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7233&year=2016","10"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220024","Bronze 4000 Deductible","94529WI022","7558364783","WIN001","WIS003","WIF006","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220024-01","Standard Bronze On Exchange Plan",,"0.614323556423187","No","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7233","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7233&year=2016","11"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220036","Silver 3500 Deductible","94529WI022","7558364783","WIN001","WIS003","WIF004","New","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220036-00","Standard Silver Off Exchange Plan",,"0.689991056919098","No","Yes","No","100%",,"$3,500","$20","$630","$150","$3,500","$540","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7339","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7239&year=2016","12"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220036","Silver 3500 Deductible","94529WI022","7558364783","WIN001","WIS003","WIF004","New","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220036-01","Standard Silver On Exchange Plan",,"0.689991056919098","No","Yes","No","100%",,"$3,500","$20","$630","$150","$3,500","$540","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7239","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7239&year=2016","13"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220026","Select Platinum 500 Deductible","94529WI022","7558364783","WIN002","WIS004","WIF001","Existing","HMO","Platinum","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220026-00","Standard Platinum Off Exchange Plan",,"0.913063883781433","No","Yes","No","100%",,"$100","$0","$0","$150","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7340","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7240&year=2016","14"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220026","Select Platinum 500 Deductible","94529WI022","7558364783","WIN002","WIS004","WIF001","Existing","HMO","Platinum","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220026-01","Standard Platinum On Exchange Plan",,"0.913063883781433","No","Yes","No","100%",,"$100","$0","$0","$150","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7240","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7240&year=2016","15"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220028","Select Gold 1000 Deductible","94529WI022","7558364783","WIN002","WIS004","WIF003","Existing","HMO","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220028-00","Standard Gold Off Exchange Plan",,"0.816434919834137","No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$830","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7346","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7246&year=2016","16"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220028","Select Gold 1000 Deductible","94529WI022","7558364783","WIN002","WIS004","WIF003","Existing","HMO","Gold","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220028-01","Standard Gold On Exchange Plan",,"0.816434919834137","No","Yes","No","100%",,"$2,000","$20","$630","$150","$2,000","$830","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7246","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7246&year=2016","17"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220031","Select Silver 30 Copay","94529WI022","7558364783","WIN002","WIS004","WIF005","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220031-00","Standard Silver Off Exchange Plan",,"0.719304203987122","No","Yes","No","100%",,"$4,000","$20","$350","$150","$4,000","$470","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7355","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7255&year=2016","18"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220031","Select Silver 30 Copay","94529WI022","7558364783","WIN002","WIS004","WIF005","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220031-01","Standard Silver On Exchange Plan",,"0.719304203987122","No","Yes","No","100%",,"$4,000","$20","$350","$150","$4,000","$470","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7255","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7255&year=2016","19"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220034","Select Bronze 4000 Deductible","94529WI022","7558364783","WIN002","WIS004","WIF006","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220034-00","Standard Bronze Off Exchange Plan",,"0.614323556423187","No","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7373","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7273&year=2016","20"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220037","Select Silver 3500 Deductible","94529WI022","7558364783","WIN002","WIS004","WIF004","New","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220037-00","Standard Silver Off Exchange Plan",,"0.689991056919098","No","Yes","No","100%",,"$3,500","$20","$670","$150","$3,500","$540","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7379","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7279&year=2016","22"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220037","Select Silver 3500 Deductible","94529WI022","7558364783","WIN002","WIS004","WIF004","New","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220037-01","Standard Silver On Exchange Plan",,"0.689991056919098","No","Yes","No","100%",,"$3,500","$20","$670","$150","$3,500","$540","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7279","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7279&year=2016","23"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","11","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220020","Gold 2000 Deductible HSA","94529WI022","7558364783","WIN001","WIS003","WIF007","Existing","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220020-00","Standard Gold Off Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7312","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7212&year=2016","4"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","11","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220020","Gold 2000 Deductible HSA","94529WI022","7558364783","WIN001","WIS003","WIF007","Existing","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220020-01","Standard Gold On Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7212","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7212&year=2016","5"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","11","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220023","Silver 3500 Deductible HSA","94529WI022","7558364783","WIN001","WIS003","WIF007","Existing","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220023-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7327","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7227&year=2016","6"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","11","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220023","Silver 3500 Deductible HSA","94529WI022","7558364783","WIN001","WIS003","WIF007","Existing","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220023-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7227","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7227&year=2016","7"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","11","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220033","Select Silver 3500 Deductible HSA","94529WI022","7558364783","WIN002","WIS004","WIF007","Existing","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220033-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7367","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7267&year=2016","10"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","11","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220033","Select Silver 3500 Deductible HSA","94529WI022","7558364783","WIN002","WIS004","WIF007","Existing","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220033-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7267","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7267&year=2016","11"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","12","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220022","Silver 2000 Deductible","94529WI022","7558364783","WIN001","WIS003","WIF004","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220022-00","Standard Silver Off Exchange Plan",,"0.686693131923676","No","Yes","No","100%",,"$4,000","$20","$230","$150","$4,000","$380","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7321","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7221&year=2016","4"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","12","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220022","Silver 2000 Deductible","94529WI022","7558364783","WIN001","WIS003","WIF004","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220022-01","Standard Silver On Exchange Plan",,"0.686693131923676","No","Yes","No","100%",,"$4,000","$20","$230","$150","$4,000","$380","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7221","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7221&year=2016","5"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","12","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220032","Select Silver 2000 Deductible","94529WI022","7558364783","WIN002","WIS004","WIF004","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220032-00","Standard Silver Off Exchange Plan",,"0.686693131923676","No","Yes","No","100%",,"$4,000","$20","$230","$150","$400","$380","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7361","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7261&year=2016","6"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","12","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220032","Select Silver 2000 Deductible","94529WI022","7558364783","WIN002","WIS004","WIF004","Existing","HMO","Silver","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220032-01","Standard Silver On Exchange Plan",,"0.686693131923676","No","Yes","No","100%",,"$4,000","$20","$230","$150","$400","$380","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7261","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7261&year=2016","7"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","13","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220025","Bronze 5000 Deductible HSA","94529WI022","7558364783","WIN001","WIS003","WIF008","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220025-00","Standard Bronze Off Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7336","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7236&year=2016","4"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","13","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220025","Bronze 5000 Deductible HSA","94529WI022","7558364783","WIN001","WIS003","WIF008","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220025-01","Standard Bronze On Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7236","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7236&year=2016","5"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","13","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220035","Select Bronze 5000 Deductible HSA","94529WI022","7558364783","WIN002","WIS004","WIF008","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220035-00","Standard Bronze Off Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7376","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7276&year=2016","6"
"2016","WI","94529","HIOS","6","2015-11-14 04:47:21","13","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220035","Select Bronze 5000 Deductible HSA","94529WI022","7558364783","WIN002","WIS004","WIF008","Existing","HMO","Bronze","No","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Only Urgent and/or Emergency Care","No","Only Urgent and/or Emergency Care","No","https://ghcscw.com/welcome","https://www.ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220035-01","Standard Bronze On Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://benefitsummary.ghcscw.com/Plans/PreviewPdf/7276","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=7276&year=2016","7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","1","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080001","BlueSelect Gold Basic with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF001","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080001-00","Standard Gold Off Exchange Plan","79.13%","0.791336119174957","Yes","Yes","No","100%",,"$1,000","$10","$1,300","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBasicGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Gold_Plans.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","1","11269","WY","Individual","No","83-0231011","11269WY0070001","BlueSelect Gold Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/shopping","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070001-00","Standard Gold Off Exchange Plan","79.13%","0.791336119174957","Yes","Yes","No","100%",,"$1,000","$10","$1,300","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBasicIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","1","11269","WY","Individual","No","83-0231011","11269WY0070001","BlueSelect Gold Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/shopping","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070001-01","Standard Gold On Exchange Plan","79.13%","0.791336119174957","Yes","Yes","No","100%",,"$1,000","$10","$1,300","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBasicIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","1","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080001","BlueSelect Gold Basic with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF001","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080001-01","Standard Gold On Exchange Plan","79.13%","0.791336119174957","Yes","Yes","No","100%",,"$1,000","$10","$1,300","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBasicGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Gold_Plans.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","1","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080002","BlueSelect Silver Basic with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF002","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080002-00","Standard Silver Off Exchange Plan","71.97%","0.719709157943726","Yes","Yes","No","100%",,"$2,000","$10","$1,300","$200","$900","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25%",,,,,"$4,500","$4500 per person","$9000 per group","$6,500","$6500 per person","$13000 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasicGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Silver_Plans.pdf","6"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","1","11269","WY","Individual","No","83-0231011","11269WY0070001","BlueSelect Gold Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/shopping","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBasic100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","6"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","1","11269","WY","Individual","No","83-0231011","11269WY0070001","BlueSelect Gold Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/shopping","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070001-03","Limited Cost Sharing Plan Variation","79.13%","0.791336119174957","Yes","Yes","No","100%",,"$1,000","$10","$1,300","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBasic300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","1","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080002","BlueSelect Silver Basic with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF002","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080002-01","Standard Silver On Exchange Plan","71.97%","0.719709157943726","Yes","Yes","No","100%",,"$2,000","$10","$1,300","$200","$900","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25%",,,,,"$4,500","$4500 per person","$9000 per group","$6,500","$6500 per person","$13000 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasicGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Silver_Plans.pdf","7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","1","11269","WY","Individual","No","83-0231011","11269WY0070002","BlueSelect Silver Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/shopping","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070002-00","Standard Silver Off Exchange Plan","70.84%","0.708388090133667","Yes","Yes","No","100%",,"$2,500","$10","$1,200","$200","$900","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasicIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","8"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","1","11269","WY","Individual","No","83-0231011","11269WY0070002","BlueSelect Silver Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/shopping","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070002-01","Standard Silver On Exchange Plan","70.84%","0.708388090133667","Yes","Yes","No","100%",,"$2,500","$10","$1,200","$200","$900","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasicIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","9"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","1","11269","WY","Individual","No","83-0231011","11269WY0070002","BlueSelect Silver Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/shopping","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasic100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","10"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","1","11269","WY","Individual","No","83-0231011","11269WY0070002","BlueSelect Silver Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/shopping","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070002-03","Limited Cost Sharing Plan Variation","70.84%","0.708388090133667","Yes","Yes","No","100%",,"$2,500","$10","$1,200","$200","$900","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasic300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","11"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","1","11269","WY","Individual","No","83-0231011","11269WY0070002","BlueSelect Silver Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/shopping","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070002-04","73% AV Level Silver Plan","73.73%","0.737348973751068","Yes","Yes","No","100%",,"$2,100","$10","$1,300","$200","$1,000","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$12,700","$12700 per person","$25400 per group","$18,150","$18150 per person","$36300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,100","$7100 per person","$14200 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasic73DentalforIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver73.pdf","12"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","1","11269","WY","Individual","No","83-0231011","11269WY0070002","BlueSelect Silver Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/shopping","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070002-05","87% AV Level Silver Plan","86.58%","0.865765273571014","Yes","Yes","No","100%",,"$400","$10","$1,700","$200","$400","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,700","$12700 per person","$25400 per group","$14,950","$14950 per person","$29900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$5,400","$5400 per person","$10800 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasic87DentalforIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver87.pdf","13"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","1","11269","WY","Individual","No","83-0231011","11269WY0070002","BlueSelect Silver Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/shopping","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070002-06","94% AV Level Silver Plan","93.17%","0.93170291185379","Yes","Yes","No","100%",,"$100","$0","$700","$200","$100","$100","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$12,700","$12700 per person","$25400 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$5,100","$5100 per person","$10200 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasic94DentalforIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver94.pdf","14"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","1","11269","WY","Individual","No","83-0231011","11269WY0070003","BlueSelect Bronze Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/shopping","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070003-00","Standard Bronze Off Exchange Plan","61.99%","0.619873344898224","Yes","Yes","No","100%",,"$5,500","$20","$900","$200","$700","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50%",,,,,"$8,000","$8000 per person","$15000 per group","$13,500","$13500 per person","$26000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBasicIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","15"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","1","11269","WY","Individual","No","83-0231011","11269WY0070003","BlueSelect Bronze Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/shopping","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070003-01","Standard Bronze On Exchange Plan","61.99%","0.619873344898224","Yes","Yes","No","100%",,"$5,500","$20","$900","$200","$700","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50%",,,,,"$8,000","$8000 per person","$15000 per group","$13,500","$13500 per person","$26000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBasicIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","16"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","1","11269","WY","Individual","No","83-0231011","11269WY0070003","BlueSelect Bronze Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/shopping","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBasic100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","17"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","1","11269","WY","Individual","No","83-0231011","11269WY0070003","BlueSelect Bronze Basic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/shopping","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070003-03","Limited Cost Sharing Plan Variation","61.99%","0.619873344898224","Yes","Yes","No","100%",,"$5,500","$20","$900","$200","$700","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50%",,,,,"$8,000","$8000 per person","$15000 per group","$13,500","$13500 per person","$26000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBasic300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","18"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","Individual","No","83-0231011","11269WY0070004","BlueSelect Bronze Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070004-00","Standard Bronze Off Exchange Plan","61.83%","0.618300259113312","Yes","Yes","No","100%",,"$3,500","$0","$1,900","$200","$3,500","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,800","$12800 per person","$25600 per group","$19,250","$19250 per person","$38500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$6000 per group","50%",,,,,"$6,000","per person not applicable","$12000 per group","$9,500","per person not applicable","$18000 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSAIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080004","BlueSelect Bronze CoreOne with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF004","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080004-00","Standard Bronze Off Exchange Plan","61.83%","0.618300259113312","Yes","Yes","No","100%",,"$3,500","$0","$1,900","$200","$3,500","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","$19,350","$19350 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$6000 per group","50%",,,,,"$6,000","per person not applicable","$12000 per group","$9,500","per person not applicable","$18000 per group","Yes","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSAOneGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Bronze_Plans.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080004","BlueSelect Bronze CoreOne with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF004","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080004-01","Standard Bronze On Exchange Plan","61.83%","0.618300259113312","Yes","Yes","No","100%",,"$3,500","$0","$1,900","$200","$3,500","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","$19,350","$19350 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$6000 per group","50%",,,,,"$6,000","per person not applicable","$12000 per group","$9,500","per person not applicable","$18000 per group","Yes","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSAOneGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Bronze_Plans.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","Individual","No","83-0231011","11269WY0070004","BlueSelect Bronze Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070004-01","Standard Bronze On Exchange Plan","61.83%","0.618300259113312","Yes","Yes","No","100%",,"$3,500","$0","$1,900","$200","$3,500","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,800","$12800 per person","$25600 per group","$19,250","$19250 per person","$38500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$6000 per group","50%",,,,,"$6,000","per person not applicable","$12000 per group","$9,500","per person not applicable","$18000 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSAIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","Individual","No","83-0231011","11269WY0070004","BlueSelect Bronze Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSA100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","6"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080013","BlueSelect Gold Core with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF007","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080013-00","Standard Gold Off Exchange Plan","80.80%","0.807998836040497","Yes","Yes","No","100%",,"$1,500","$0","$300","$200","$1,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$8,550","$8550 per person","$17100 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","5%",,,,,"$4,000","per person not applicable","$5500 per group","$5,500","per person not applicable","$8500 per group","Yes","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSAGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Gold_Plans.pdf","6"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080013","BlueSelect Gold Core with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF007","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080013-01","Standard Gold On Exchange Plan","80.80%","0.807998836040497","Yes","Yes","No","100%",,"$1,500","$0","$300","$200","$1,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$8,550","$8550 per person","$17100 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","5%",,,,,"$4,000","per person not applicable","$5500 per group","$5,500","per person not applicable","$8500 per group","Yes","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSAGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Gold_Plans.pdf","7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","Individual","No","83-0231011","11269WY0070004","BlueSelect Bronze Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070004-03","Limited Cost Sharing Plan Variation","61.83%","0.618300259113312","Yes","Yes","No","100%",,"$3,500","$0","$1,900","$200","$3,500","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,800","$12800 per person","$25600 per group","$19,250","$19250 per person","$38500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$6000 per group","50%",,,,,"$6,000","per person not applicable","$12000 per group","$9,500","per person not applicable","$18000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSA300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","Individual","No","83-0231011","11269WY0070012","BlueSelect Gold Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF007","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070012-00","Standard Gold Off Exchange Plan","80.42%","0.804197251796722","Yes","Yes","No","100%",,"$1,550","$0","$300","$200","$1,550","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$8,550","$8550 per person","$17100 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","per person not applicable","$3100 per group","5%",,,,,"$4,050","per person not applicable","$8100 per group","$5,600","per person not applicable","$11200 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSAIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","8"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080014","BlueSelect Silver Core with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF018","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080014-00","Standard Silver Off Exchange Plan","71.34%","0.713446140289307","Yes","Yes","No","100%",,"$1,500","$0","$1,400","$200","$1,500","$0","$1,000","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$9,700","$9700 per person","$19400 per group","$16,150","$16150 per person","$32300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","25%",,,,,"$4,000","per person not applicable","$5500 per group","$5,500","per person not applicable","$8500 per group","Yes","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSAGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Silver_Plans.pdf","8"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080014","BlueSelect Silver Core with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF018","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080014-01","Standard Silver On Exchange Plan","71.34%","0.713446140289307","Yes","Yes","No","100%",,"$1,500","$0","$1,400","$200","$1,500","$0","$1,000","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$9,700","$9700 per person","$19400 per group","$16,150","$16150 per person","$32300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","25%",,,,,"$4,000","per person not applicable","$5500 per group","$5,500","per person not applicable","$8500 per group","Yes","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSAGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Silver_Plans.pdf","9"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","Individual","No","83-0231011","11269WY0070012","BlueSelect Gold Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF007","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070012-01","Standard Gold On Exchange Plan","80.42%","0.804197251796722","Yes","Yes","No","100%",,"$1,550","$0","$300","$200","$1,550","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$8,550","$8550 per person","$17100 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","per person not applicable","$3100 per group","5%",,,,,"$4,050","per person not applicable","$8100 per group","$5,600","per person not applicable","$11200 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSAIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","9"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","Individual","No","83-0231011","11269WY0070012","BlueSelect Gold Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF007","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSA100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","10"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080015","BlueSelect Bronze CoreTwo with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF015","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080015-00","Standard Bronze Off Exchange Plan","61.75%","0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,500","$10500 per person","$21000 per group","$16,500","$16500 per person","$33000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"$8,500","per person not applicable","$14500 per group","$14,500","per person not applicable","$26500 per group","Yes","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSATwoGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Bronze_Plans.pdf","10"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080015","BlueSelect Bronze CoreTwo with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF015","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080015-01","Standard Bronze On Exchange Plan","61.75%","0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,500","$10500 per person","$21000 per group","$16,500","$16500 per person","$33000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"$8,500","per person not applicable","$14500 per group","$14,500","per person not applicable","$26500 per group","Yes","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSATwoGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Bronze_Plans.pdf","11"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","Individual","No","83-0231011","11269WY0070012","BlueSelect Gold Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF007","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070012-03","Limited Cost Sharing Plan Variation","80.42%","0.804197251796722","Yes","Yes","No","100%",,"$1,550","$0","$300","$200","$1,550","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$8,550","$8550 per person","$17100 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","per person not applicable","$3100 per group","5%",,,,,"$4,050","per person not applicable","$8100 per group","$5,600","per person not applicable","$11200 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSA300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","11"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","Individual","No","83-0231011","11269WY0070015","BlueSelect Silver Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070015-00","Standard Silver Off Exchange Plan","70.32%","0.70324981212616","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$200","$2,000","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$9,700","$9700 per person","$19400 per group","$16,150","$16150 per person","$32300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$6,500","per person not applicable","$10500 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSAIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","12"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","Individual","No","83-0231011","11269WY0070015","BlueSelect Silver Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070015-01","Standard Silver On Exchange Plan","70.32%","0.70324981212616","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$200","$2,000","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$9,700","$9700 per person","$19400 per group","$16,150","$16150 per person","$32300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$6,500","per person not applicable","$10500 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSAIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","13"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","Individual","No","83-0231011","11269WY0070015","BlueSelect Silver Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSA100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","14"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","Individual","No","83-0231011","11269WY0070015","BlueSelect Silver Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070015-03","Limited Cost Sharing Plan Variation","70.32%","0.70324981212616","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$200","$2,000","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$9,700","$9700 per person","$19400 per group","$16,150","$16150 per person","$32300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$6,500","per person not applicable","$10500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSA300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","15"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","Individual","No","83-0231011","11269WY0070015","BlueSelect Silver Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070015-04","73% AV Level Silver Plan","73.91%","0.739117741584778","Yes","Yes","No","100%",,"$1,500","$0","$1,200","$200","$1,500","$0","$800","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$9,700","$9700 per person","$19400 per group","$15,150","$15150 per person","$30300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$6,000","per person not applicable","$9500 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSA73DentalforIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver73.pdf","16"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","Individual","No","83-0231011","11269WY0070015","BlueSelect Silver Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070015-05","87% AV Level Silver Plan","87.39%","0.873863995075226","Yes","Yes","No","100%",,"$200","$0","$1,400","$200","$200","$0","$1,000","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$9,700","$9700 per person","$19400 per group","$11,950","$11950 per person","$23900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","per person not applicable","$400 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$4,700","per person not applicable","$6900 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSA87DentalforIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver87.pdf","17"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","Individual","No","83-0231011","11269WY0070015","BlueSelect Silver Core with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070015-06","94% AV Level Silver Plan","94.10%","0.940959990024567","Yes","Yes","No","100%",,"$100","$0","$500","$200","$100","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$9,700","$9700 per person","$19400 per group","$10,300","$10300 per person","$20600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$4,600","per person not applicable","$6700 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSA94DentalforIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver94.pdf","18"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","Individual","No","83-0231011","11269WY0070020","BlueSelect Bronze Classic with Kid'sDental","11269WY007","7154324389","WYN001","WYS001","WYF015","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070020-00","Standard Bronze Off Exchange Plan","61.75%","0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,050","$10050 per person","$20100 per group","$16,050","$16050 per person","$32100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$8,500","$8500 per person","$17000 per group","$14,500","$14500 per person","$29000 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeClassicIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","19"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","Individual","No","83-0231011","11269WY0070020","BlueSelect Bronze Classic with Kid'sDental","11269WY007","7154324389","WYN001","WYS001","WYF015","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070020-01","Standard Bronze On Exchange Plan","61.75%","0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,050","$10050 per person","$20100 per group","$16,050","$16050 per person","$32100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$8,500","$8500 per person","$17000 per group","$14,500","$14500 per person","$29000 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeClassicIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","20"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","Individual","No","83-0231011","11269WY0070020","BlueSelect Bronze Classic with Kid'sDental","11269WY007","7154324389","WYN001","WYS001","WYF015","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070020-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeClassic100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","21"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","2","11269","WY","Individual","No","83-0231011","11269WY0070020","BlueSelect Bronze Classic with Kid'sDental","11269WY007","7154324389","WYN001","WYS001","WYF015","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070020-03","Limited Cost Sharing Plan Variation","61.75%","0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,050","$10050 per person","$20100 per group","$16,050","$16050 per person","$32100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$8,500","$8500 per person","$17000 per group","$14,500","$14500 per person","$29000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeClassic300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","22"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","3","11269","WY","Individual","No","83-0231011","11269WY0070005","BlueSelect Catastrophic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF005","Existing","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070005-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$200","$5,100","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,200","$13200 per person","$26400 per group","$20,050","$20050 per person","$40100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$9,350","$9350 per person","$18700 per group","$16,200","$16200 per person","$32400 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectCatastrophicIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","3","11269","WY","Individual","No","83-0231011","11269WY0070005","BlueSelect Catastrophic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF005","Existing","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$200","$5,100","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,200","$13200 per person","$26400 per group","$20,050","$20050 per person","$40100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$9,350","$9350 per person","$18700 per group","$16,200","$16200 per person","$32400 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectCatastrophicIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","5","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080016","BlueSelect Gold Classic with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF016","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080016-00","Standard Gold Off Exchange Plan","79.77%","0.797657012939453","Yes","Yes","No","100%",,"$500","$10","$1,700","$200","$500","$500","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","25%",,,,,"$3,000","$3000 per person","$3500 per group","$3,500","$3500 per person","$4500 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassicGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Gold_Plans.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","5","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080016","BlueSelect Gold Classic with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF016","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080016-01","Standard Gold On Exchange Plan","79.77%","0.797657012939453","Yes","Yes","No","100%",,"$500","$10","$1,700","$200","$500","$500","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","25%",,,,,"$3,000","$3000 per person","$3500 per group","$3,500","$3500 per person","$4500 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassicGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Gold_Plans.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","6","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080010","BlueSelect Silver HealthPlus with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF011","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080010-00","Standard Silver Off Exchange Plan","71.88%","0.711951196193695","Yes","Yes","No","100%",,"$2,250","$10","$1,300","$200","$900","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$9,900","$9900 per person","$19800 per group","$16,500","$16500 per person","$33000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","25%",,,,,"$4,500","$4500 per person","$9000 per group","$6,750","$6750 per person","$13500 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlusGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Silver_Plans.pdf","6"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","12","11269","WY","Individual","No","83-0231011","11269WY0170002","BlueSelect Silver Classic","11269WY017","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170002-05","87% AV Level Silver Plan","86.06%","0.860582411289215","Yes","Yes","No","100%",,"$100","$10","$2,100","$200","$100","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$8,750","$8750 per person","$17500 per group","$11,000","$11000 per person","$22000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$4,600","$4600 per person","$6700 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic87forIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver87.pdf","13"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","12","11269","WY","Individual","No","83-0231011","11269WY0170002","BlueSelect Silver Classic","11269WY017","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170002-06","94% AV Level Silver Plan","93.06%","0.930634260177612","Yes","Yes","No","100%",,"$50","$0","$600","$200","$50","$90","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$8,750","$8750 per person","$17500 per group","$9,450","$9450 per person","$18900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$4,550","$4550 per person","$6600 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic94forIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver94.pdf","14"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","15","11269","WY","Individual","No","83-0231011","11269WY0170015","BlueSelect Silver ValueOne","11269WY017","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170015-03","Limited Cost Sharing Plan Variation","68.11%","0.681100010871887","No","Yes","No","100%",,"$3,250","$20","$1,800","$200","$1,000","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$3,250","$3250 per person","$6500 per group","50%",,,,,"$6,500","$6500 per person","$13000 per group","$9,750","$9750 per person","$19500 per group","$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOne300forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","15","11269","WY","Individual","No","83-0231011","11269WY0170015","BlueSelect Silver ValueOne","11269WY017","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170015-04","73% AV Level Silver Plan","72.51%","0.725097060203552","No","Yes","No","100%",,"$2,750","$20","$700","$200","$1,000","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","$13,500","$13500 per person","$27000 per group","$2,750","$2750 per person","$5500 per group","50%",,,,,"$6,500","$6500 per person","$13000 per group","$9,250","$9250 per person","$18500 per group","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOne73forIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver73.pdf","8"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","15","11269","WY","Individual","No","83-0231011","11269WY0170015","BlueSelect Silver ValueOne","11269WY017","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170015-05","87% AV Level Silver Plan","87.82%","0.878226518630981","No","Yes","No","100%",,"$750","$10","$200","$200","$750","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","$11,000","$11000 per person","$22000 per group","$750","$750 per person","$1500 per group","20%",,,,,"$6,500","$6500 per person","$13000 per group","$7,250","$7250 per person","$14500 per group","$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOne87forIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver87.pdf","9"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","30","11269","WY","Individual","No","83-0231011","11269WY0170013","BlueSelect Bronze Basic","11269WY017","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170013-03","Limited Cost Sharing Plan Variation","61.99%","0.619873344898224","Yes","Yes","No","100%",,"$5,500","$20","$900","$200","$700","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50%",,,,,"$8,000","$8000 per person","$15000 per group","$13,500","$13500 per person","$26000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBasic300forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","18"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","31","11269","WY","Individual","No","83-0231011","11269WY0170014","BlueSelect Catastrophic","11269WY017","7154324389","WYN001","WYS001","WYF005","Existing","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170014-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$200","$5,100","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,200","$13200 per person","$26400 per group","$20,050","$20050 per person","$40100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$9,350","$9350 per person","$18700 per group","$16,200","$16200 per person","$32400 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectCatastrophicIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","6","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080010","BlueSelect Silver HealthPlus with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF011","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080010-01","Standard Silver On Exchange Plan","71.88%","0.711951196193695","Yes","Yes","No","100%",,"$2,250","$10","$1,300","$200","$900","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$9,900","$9900 per person","$19800 per group","$16,500","$16500 per person","$33000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","25%",,,,,"$4,500","$4500 per person","$9000 per group","$6,750","$6750 per person","$13500 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlusGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Silver_Plans.pdf","7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","7","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080011","BlueSelect Silver Classic with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF017","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080011-00","Standard Silver Off Exchange Plan","71.62%","0.716211915016174","Yes","Yes","No","100%",,"$1,400","$10","$1,800","$200","$1,200","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$9,900","$9900 per person","$19800 per group","$16,500","$16500 per person","$33000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","30%",,,,,"$3,900","$3900 per person","$5300 per group","$5,300","$5300 per person","$8100 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassicGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Silver_Plans.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","7","11269","WY","Individual","No","83-0231011","11269WY0070011","BlueSelect Gold Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF006","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070011-00","Standard Gold Off Exchange Plan","80.13%","0.801341772079468","Yes","Yes","No","100%",,"$750","$10","$1,300","$200","$750","$500","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$3,250","$3250 per person","$4000 per group","$4,000","$4000 per person","$5500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassicIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","7","11269","WY","Individual","No","83-0231011","11269WY0070011","BlueSelect Gold Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF006","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070011-01","Standard Gold On Exchange Plan","80.13%","0.801341772079468","Yes","Yes","No","100%",,"$750","$10","$1,300","$200","$750","$500","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$3,250","$3250 per person","$4000 per group","$4,000","$4000 per person","$5500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassicIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","7","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080011","BlueSelect Silver Classic with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF017","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080011-01","Standard Silver On Exchange Plan","71.62%","0.716211915016174","Yes","Yes","No","100%",,"$1,400","$10","$1,800","$200","$1,200","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$9,900","$9900 per person","$19800 per group","$16,500","$16500 per person","$33000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","30%",,,,,"$3,900","$3900 per person","$5300 per group","$5,300","$5300 per person","$8100 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassicGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Silver_Plans.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","7","11269","WY","Individual","No","83-0231011","11269WY0070011","BlueSelect Gold Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF006","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassic100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","6"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","7","11269","WY","Individual","No","83-0231011","11269WY0070011","BlueSelect Gold Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF006","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070011-03","Limited Cost Sharing Plan Variation","80.13%","0.801341772079468","Yes","Yes","No","100%",,"$750","$10","$1,300","$200","$750","$500","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$3,250","$3250 per person","$4000 per group","$4,000","$4000 per person","$5500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassic300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","7","11269","WY","Individual","No","83-0231011","11269WY0070014","BlueSelect Silver Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070014-00","Standard Silver Off Exchange Plan","70.58%","0.705815017223358","Yes","Yes","No","100%",,"$2,000","$10","$1,800","$200","$1,100","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$8,750","$8750 per person","$17500 per group","$14,750","$14750 per person","$29500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$6,500","$6500 per person","$10500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassicIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","8"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","7","11269","WY","Individual","No","83-0231011","11269WY0070014","BlueSelect Silver Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070014-01","Standard Silver On Exchange Plan","70.58%","0.705815017223358","Yes","Yes","No","100%",,"$2,000","$10","$1,800","$200","$1,100","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$8,750","$8750 per person","$17500 per group","$14,750","$14750 per person","$29500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$6,500","$6500 per person","$10500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassicIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","9"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","7","11269","WY","Individual","No","83-0231011","11269WY0070014","BlueSelect Silver Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070014-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","10"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","7","11269","WY","Individual","No","83-0231011","11269WY0070014","BlueSelect Silver Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070014-03","Limited Cost Sharing Plan Variation","70.58%","0.705815017223358","Yes","Yes","No","100%",,"$2,000","$10","$1,800","$200","$1,100","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$8,750","$8750 per person","$17500 per group","$14,750","$14750 per person","$29500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$6,500","$6500 per person","$10500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","11"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","7","11269","WY","Individual","No","83-0231011","11269WY0070014","BlueSelect Silver Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070014-04","73% AV Level Silver Plan","73.51%","0.735129833221436","Yes","Yes","No","100%",,"$1,600","$10","$2,000","$200","$1,100","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$8,750","$8750 per person","$17500 per group","$13,950","$13950 per person","$27900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$6,100","$6100 per person","$9700 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic73DentalforIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver73.pdf","12"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","7","11269","WY","Individual","No","83-0231011","11269WY0070014","BlueSelect Silver Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070014-05","87% AV Level Silver Plan","86.06%","0.860582411289215","Yes","Yes","No","100%",,"$100","$10","$2,100","$200","$100","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$8,750","$8750 per person","$17500 per group","$11,000","$11000 per person","$22000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$4,600","$4600 per person","$6700 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic87DentalforIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver87.pdf","13"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","7","11269","WY","Individual","No","83-0231011","11269WY0070014","BlueSelect Silver Classic with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070014-06","94% AV Level Silver Plan","93.06%","0.930634260177612","Yes","Yes","No","100%",,"$50","$0","$600","$200","$50","$90","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$8,750","$8750 per person","$17500 per group","$9,450","$9450 per person","$18900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$4,550","$4550 per person","$6600 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic94DentalforIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver94.pdf","14"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","8","11269","WY","Individual","No","83-0231011","11269WY0070013","BlueSelect Gold HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF008","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070013-00","Standard Gold Off Exchange Plan","81.27%","0.808982491493225","Yes","Yes","No","100%",,"$1,000","$10","$900","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlusIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","8","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080012","BlueSelect Bronze Value with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF019","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080012-00","Standard Bronze Off Exchange Plan","58.54%","0.58540552854538","No","Yes","No","100%",,"$5,000","$0","$1,100","$200","$1,200","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group","$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValueGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Bronze_Plans.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","8","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080012","BlueSelect Bronze Value with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF019","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080012-01","Standard Bronze On Exchange Plan","58.54%","0.58540552854538","No","Yes","No","100%",,"$5,000","$0","$1,100","$200","$1,200","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group","$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValueGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Bronze_Plans.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","8","11269","WY","Individual","No","83-0231011","11269WY0070013","BlueSelect Gold HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF008","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070013-01","Standard Gold On Exchange Plan","81.27%","0.808982491493225","Yes","Yes","No","100%",,"$1,000","$10","$900","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlusIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","8","11269","WY","Individual","No","83-0231011","11269WY0070013","BlueSelect Gold HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF008","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlus100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","6"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","8","11269","WY","Individual","No","83-0231011","11269WY0070013","BlueSelect Gold HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF008","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070013-03","Limited Cost Sharing Plan Variation","81.27%","0.808982491493225","Yes","Yes","No","100%",,"$1,000","$10","$900","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlus300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","8","11269","WY","Individual","No","83-0231011","11269WY0070016","BlueSelect Silver HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070016-00","Standard Silver Off Exchange Plan","71.17%","0.705352425575256","Yes","Yes","No","100%",,"$2,500","$10","$1,200","$200","$900","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$9,900","$9900 per person","$19800 per group","$16,500","$16500 per person","$33000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlusIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","8"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","8","11269","WY","Individual","No","83-0231011","11269WY0070016","BlueSelect Silver HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070016-01","Standard Silver On Exchange Plan","71.17%","0.705352425575256","Yes","Yes","No","100%",,"$2,500","$10","$1,200","$200","$900","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$9,900","$9900 per person","$19800 per group","$16,500","$16500 per person","$33000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlusIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","9"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","8","11269","WY","Individual","No","83-0231011","11269WY0070016","BlueSelect Silver HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070016-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","10"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","8","11269","WY","Individual","No","83-0231011","11269WY0070016","BlueSelect Silver HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070016-03","Limited Cost Sharing Plan Variation","71.17%","0.705352425575256","Yes","Yes","No","100%",,"$2,500","$10","$1,200","$200","$900","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$9,900","$9900 per person","$19800 per group","$16,500","$16500 per person","$33000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","11"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","8","11269","WY","Individual","No","83-0231011","11269WY0070016","BlueSelect Silver HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070016-04","73% AV Level Silver Plan","73.91%","0.732912957668304","Yes","Yes","No","100%",,"$2,100","$10","$1,300","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$9,900","$9900 per person","$19800 per group","$15,300","$15300 per person","$30600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,100","$7100 per person","$14200 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus73DentalforIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver73.pdf","12"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","8","11269","WY","Individual","No","83-0231011","11269WY0070016","BlueSelect Silver HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070016-05","87% AV Level Silver Plan","86.97%","0.86704695224762","Yes","Yes","No","100%",,"$400","$0","$1,600","$200","$400","$300","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$9,900","$9900 per person","$19800 per group","$11,900","$11900 per person","$23800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$5,400","$5400 per person","$10800 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus87DentalforIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver87.pdf","13"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","8","11269","WY","Individual","No","83-0231011","11269WY0070016","BlueSelect Silver HealthPlus with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070016-06","94% AV Level Silver Plan","93.37%","0.933198094367981","Yes","Yes","No","100%",,"$100","$10","$600","$200","$100","$100","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$9,900","$9900 per person","$19800 per group","$10,650","$10650 per person","$21300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$5,100","$5100 per person","$10200 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus94DentalforIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver94.pdf","14"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","9","11269","WY","Individual","No","83-0231011","11269WY0070021","BlueSelect Silver ValueOne with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070021-00","Standard Silver Off Exchange Plan","68.11%","0.681100010871887","No","Yes","No","100%",,"$3,250","$20","$1,800","$200","$1,000","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$3,250","$3250 per person","$6500 per group","50%",,,,,"$6,500","$6500 per person","$13000 per group","$9,750","$9750 per person","$19500 per group","$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOneIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","9","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190001","BlueSelect Gold Classic","11269WY019",,"WYN001","WYS001","WYF016","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190001-00","Standard Gold Off Exchange Plan","79.77%","0.797657012939453","Yes","Yes","No","100%",,"$500","$10","$1,700","$200","$500","$500","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","25%",,,,,"$3,000","$3000 per person","$3500 per group","$3,500","$3500 per person","$4500 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassicGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Gold_Plans.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","9","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190001","BlueSelect Gold Classic","11269WY019",,"WYN001","WYS001","WYF016","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190001-01","Standard Gold On Exchange Plan","79.77%","0.797657012939453","Yes","Yes","No","100%",,"$500","$10","$1,700","$200","$500","$500","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","25%",,,,,"$3,000","$3000 per person","$3500 per group","$3,500","$3500 per person","$4500 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassicGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Gold_Plans.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","9","11269","WY","Individual","No","83-0231011","11269WY0070021","BlueSelect Silver ValueOne with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070021-01","Standard Silver On Exchange Plan","68.11%","0.681100010871887","No","Yes","No","100%",,"$3,250","$20","$1,800","$200","$1,000","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$3,250","$3250 per person","$6500 per group","50%",,,,,"$6,500","$6500 per person","$13000 per group","$9,750","$9750 per person","$19500 per group","$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOneIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","9","11269","WY","Individual","No","83-0231011","11269WY0070021","BlueSelect Silver ValueOne with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070021-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOne100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","6"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","9","11269","WY","Individual","No","83-0231011","11269WY0070021","BlueSelect Silver ValueOne with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070021-03","Limited Cost Sharing Plan Variation","68.11%","0.681100010871887","No","Yes","No","100%",,"$3,250","$20","$1,800","$200","$1,000","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$3,250","$3250 per person","$6500 per group","50%",,,,,"$6,500","$6500 per person","$13000 per group","$9,750","$9750 per person","$19500 per group","$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOne300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","9","11269","WY","Individual","No","83-0231011","11269WY0070021","BlueSelect Silver ValueOne with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070021-04","73% AV Level Silver Plan","72.51%","0.725097060203552","No","Yes","No","100%",,"$2,750","$20","$700","$200","$1,000","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","$13,500","$13500 per person","$27000 per group","$2,750","$2750 per person","$5500 per group","50%",,,,,"$6,500","$6500 per person","$13000 per group","$9,250","$9250 per person","$18500 per group","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOne73DentalforIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver73.pdf","8"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","9","11269","WY","Individual","No","83-0231011","11269WY0070021","BlueSelect Silver ValueOne with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070021-05","87% AV Level Silver Plan","87.82%","0.878226518630981","No","Yes","No","100%",,"$750","$10","$200","$200","$750","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","$11,000","$11000 per person","$22000 per group","$750","$750 per person","$1500 per group","20%",,,,,"$6,500","$6500 per person","$13000 per group","$7,250","$7250 per person","$14500 per group","$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOne87DentalforIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver87.pdf","9"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","9","11269","WY","Individual","No","83-0231011","11269WY0070021","BlueSelect Silver ValueOne with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070021-06","94% AV Level Silver Plan","93.43%","0.934345066547394","No","Yes","No","100%",,"$250","$10","$200","$200","$250","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$10,000","$10000 per person","$20000 per group","$10,500","$10500 per person","$21000 per group","$250","$250 per person","$500 per group","20%",,,,,"$6,500","$6500 per person","$13000 per group","$6,750","$6750 per person","$13500 per group","$50","$50 per person","$100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOne94DentalforIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver94.pdf","10"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","10","11269","WY","Individual","No","83-0231011","11269WY0070018","BlueSelect Silver ValueTwo with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070018-00","Standard Silver Off Exchange Plan","68.73%","0.687343895435333","No","Yes","No","100%",,"$3,000","$10","$900","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwoIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","10","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190002","BlueSelect Gold Core","11269WY019",,"WYN001","WYS001","WYF007","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190002-00","Standard Gold Off Exchange Plan","80.80%","0.807998836040497","Yes","Yes","No","100%",,"$1,500","$0","$300","$200","$1,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$8,550","$8550 per person","$17100 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","5%",,,,,"$4,000","per person not applicable","$5500 per group","$5,500","per person not applicable","$8500 per group","Yes","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSAGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Gold_Plans.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","10","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190002","BlueSelect Gold Core","11269WY019",,"WYN001","WYS001","WYF007","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190002-01","Standard Gold On Exchange Plan","80.80%","0.807998836040497","Yes","Yes","No","100%",,"$1,500","$0","$300","$200","$1,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$8,550","$8550 per person","$17100 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","5%",,,,,"$4,000","per person not applicable","$5500 per group","$5,500","per person not applicable","$8500 per group","Yes","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSAGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Gold_Plans.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","10","11269","WY","Individual","No","83-0231011","11269WY0070018","BlueSelect Silver ValueTwo with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070018-01","Standard Silver On Exchange Plan","68.73%","0.687343895435333","No","Yes","No","100%",,"$3,000","$10","$900","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwoIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","10","11269","WY","Individual","No","83-0231011","11269WY0070018","BlueSelect Silver ValueTwo with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070018-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwo100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","6"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","10","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190003","BlueSelect Silver Core","11269WY019",,"WYN001","WYS001","WYF018","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190003-00","Standard Silver Off Exchange Plan","71.34%","0.713446140289307","Yes","Yes","No","100%",,"$1,500","$0","$1,400","$200","$1,500","$0","$1,000","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$9,700","$9700 per person","$19400 per group","$16,150","$16150 per person","$32300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","25%",,,,,"$4,000","per person not applicable","$5500 per group","$5,500","per person not applicable","$8500 per group","Yes","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSAGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Silver_Plans.pdf","6"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","10","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190003","BlueSelect Silver Core","11269WY019",,"WYN001","WYS001","WYF018","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190003-01","Standard Silver On Exchange Plan","71.34%","0.713446140289307","Yes","Yes","No","100%",,"$1,500","$0","$1,400","$200","$1,500","$0","$1,000","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$9,700","$9700 per person","$19400 per group","$16,150","$16150 per person","$32300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","25%",,,,,"$4,000","per person not applicable","$5500 per group","$5,500","per person not applicable","$8500 per group","Yes","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSAGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Silver_Plans.pdf","7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","10","11269","WY","Individual","No","83-0231011","11269WY0070018","BlueSelect Silver ValueTwo with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070018-03","Limited Cost Sharing Plan Variation","68.73%","0.687343895435333","No","Yes","No","100%",,"$3,000","$10","$900","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwo300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","10","11269","WY","Individual","No","83-0231011","11269WY0070018","BlueSelect Silver ValueTwo with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070018-04","73% AV Level Silver Plan","72.97%","0.72965943813324","No","Yes","No","100%",,"$3,000","$10","$0","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"$13,200","$13200 per person","$26400 per group","$16,950","$16950 per person","$33900 per group","$3,000","$3000 per person","$6000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwo73DentalforIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver73.pdf","8"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","10","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190004","BlueSelect Bronze CoreTwo","11269WY019",,"WYN001","WYS001","WYF015","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190004-00","Standard Bronze Off Exchange Plan","61.75%","0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,500","$10500 per person","$21000 per group","$16,500","$16500 per person","$33000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"$8,500","per person not applicable","$14500 per group","$14,500","per person not applicable","$26500 per group","Yes","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSATwoGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Bronze_Plans.pdf","8"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","10","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190004","BlueSelect Bronze CoreTwo","11269WY019",,"WYN001","WYS001","WYF015","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190004-01","Standard Bronze On Exchange Plan","61.75%","0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,500","$10500 per person","$21000 per group","$16,500","$16500 per person","$33000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","per person not applicable","$12000 per group","0%",,,,,"$8,500","per person not applicable","$14500 per group","$14,500","per person not applicable","$26500 per group","Yes","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSATwoGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Bronze_Plans.pdf","9"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","10","11269","WY","Individual","No","83-0231011","11269WY0070018","BlueSelect Silver ValueTwo with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070018-05","87% AV Level Silver Plan","86.33%","0.86327451467514","No","Yes","No","100%",,"$1,250","$10","$0","$200","$1,100","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$13,200","$13200 per person","$26400 per group","$14,700","$14700 per person","$29400 per group","$1,250","$1250 per person","$2500 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$7,250","$7250 per person","$14500 per group","$150","$150 per person","$300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwo87DentalforIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver87.pdf","9"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","10","11269","WY","Individual","No","83-0231011","11269WY0070018","BlueSelect Silver ValueTwo with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070018-06","94% AV Level Silver Plan","94.95%","0.949480056762695","No","Yes","No","100%",,"$150","$10","$0","$200","$150","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$13,200","$13200 per person","$26400 per group","$13,900","$13900 per person","$27800 per group","$150","$150 per person","$300 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$6,150","$6150 per person","$12300 per group","$50","$50 per person","$100 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwo94DentalforIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver94.pdf","10"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","10","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190005","BlueSelect Bronze CoreOne","11269WY019",,"WYN001","WYS001","WYF004","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190005-00","Standard Bronze Off Exchange Plan","61.83%","0.618300259113312","Yes","Yes","No","100%",,"$3,500","$0","$1,900","$200","$3,500","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","$19,350","$19350 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$6000 per group","50%",,,,,"$6,000","per person not applicable","$12000 per group","$9,500","per person not applicable","$18000 per group","Yes","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSAOneGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Bronze_Plans.pdf","10"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","10","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190005","BlueSelect Bronze CoreOne","11269WY019",,"WYN001","WYS001","WYF004","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190005-01","Standard Bronze On Exchange Plan","61.83%","0.618300259113312","Yes","Yes","No","100%",,"$3,500","$0","$1,900","$200","$3,500","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","$19,350","$19350 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$6000 per group","50%",,,,,"$6,000","per person not applicable","$12000 per group","$9,500","per person not applicable","$18000 per group","Yes","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSAOneGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Bronze_Plans.pdf","11"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","11","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190006","BlueSelect Gold HealthPlus","11269WY019",,"WYN001","WYS001","WYF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190006-00","Standard Gold Off Exchange Plan","79.54%","0.791854798793793","Yes","Yes","No","100%",,"$1,000","$10","$1,300","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$8,250","$8250 per person","$16700 per group","$14,500","$14500 per person","$29200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlusGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Gold_Plans.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","11","11269","WY","Individual","No","83-0231011","11269WY0070019","BlueSelect Bronze Value with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF014","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070019-00","Standard Bronze Off Exchange Plan","58.33%","0.583344697952271","No","Yes","No","100%",,"$5,500","$0","$0","$200","$1,200","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group","$5,500","$5500 per person","$11000 per group","0%",,,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValueIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","11","11269","WY","Individual","No","83-0231011","11269WY0070019","BlueSelect Bronze Value with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF014","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070019-01","Standard Bronze On Exchange Plan","58.33%","0.583344697952271","No","Yes","No","100%",,"$5,500","$0","$0","$200","$1,200","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group","$5,500","$5500 per person","$11000 per group","0%",,,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValueIXD","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","11","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190006","BlueSelect Gold HealthPlus","11269WY019",,"WYN001","WYS001","WYF006","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190006-01","Standard Gold On Exchange Plan","79.54%","0.791854798793793","Yes","Yes","No","100%",,"$1,000","$10","$1,300","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$8,250","$8250 per person","$16700 per group","$14,500","$14500 per person","$29200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlusGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Gold_Plans.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","11","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190007","BlueSelect Silver HealthPlus","11269WY019",,"WYN001","WYS001","WYF011","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190007-00","Standard Silver Off Exchange Plan","71.88%","0.711951196193695","Yes","Yes","No","100%",,"$2,250","$10","$1,300","$200","$900","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$9,900","$9900 per person","$19800 per group","$16,500","$16500 per person","$33000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","25%",,,,,"$4,500","$4500 per person","$9000 per group","$6,750","$6750 per person","$13500 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlusGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Silver_Plans.pdf","6"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","11","11269","WY","Individual","No","83-0231011","11269WY0070019","BlueSelect Bronze Value with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF014","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070019-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValue100forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","6"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","11","11269","WY","Individual","No","83-0231011","11269WY0070019","BlueSelect Bronze Value with Kid's Dental","11269WY007","7154324389","WYN001","WYS001","WYF014","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0070019-03","Limited Cost Sharing Plan Variation","58.33%","0.583344697952271","No","Yes","No","100%",,"$5,500","$0","$0","$200","$1,200","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group","$5,500","$5500 per person","$11000 per group","0%",,,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValue300forTribalMembersDental","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","11","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190007","BlueSelect Silver HealthPlus","11269WY019",,"WYN001","WYS001","WYF011","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190007-01","Standard Silver On Exchange Plan","71.88%","0.711951196193695","Yes","Yes","No","100%",,"$2,250","$10","$1,300","$200","$900","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$9,900","$9900 per person","$19800 per group","$16,500","$16500 per person","$33000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","25%",,,,,"$4,500","$4500 per person","$9000 per group","$6,750","$6750 per person","$13500 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlusGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Silver_Plans.pdf","7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","12","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190008","BlueSelect Silver Classic","11269WY019",,"WYN001","WYS001","WYF017","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190008-00","Standard Silver Off Exchange Plan","71.62%","0.716211915016174","Yes","Yes","No","100%",,"$1,400","$10","$1,800","$200","$1,200","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$9,900","$9900 per person","$19800 per group","$16,500","$16500 per person","$33000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","30%",,,,,"$3,900","$3900 per person","$5300 per group","$5,300","$5300 per person","$8100 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassicGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Silver_Plans.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","12","11269","WY","Individual","No","83-0231011","11269WY0170001","BlueSelect Gold Classic","11269WY017","7154324389","WYN001","WYS001","WYF006","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170001-00","Standard Gold Off Exchange Plan","80.13%","0.801341772079468","Yes","Yes","No","100%",,"$750","$10","$1,300","$200","$750","$500","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$3,250","$3250 per person","$4000 per group","$4,000","$4000 per person","$5500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassicIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","12","11269","WY","Individual","No","83-0231011","11269WY0170001","BlueSelect Gold Classic","11269WY017","7154324389","WYN001","WYS001","WYF006","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170001-01","Standard Gold On Exchange Plan","80.13%","0.801341772079468","Yes","Yes","No","100%",,"$750","$10","$1,300","$200","$750","$500","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$3,250","$3250 per person","$4000 per group","$4,000","$4000 per person","$5500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassicIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","12","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190008","BlueSelect Silver Classic","11269WY019",,"WYN001","WYS001","WYF017","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190008-01","Standard Silver On Exchange Plan","71.62%","0.716211915016174","Yes","Yes","No","100%",,"$1,400","$10","$1,800","$200","$1,200","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$9,900","$9900 per person","$19800 per group","$16,500","$16500 per person","$33000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","30%",,,,,"$3,900","$3900 per person","$5300 per group","$5,300","$5300 per person","$8100 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassicGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Silver_Plans.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","12","11269","WY","Individual","No","83-0231011","11269WY0170001","BlueSelect Gold Classic","11269WY017","7154324389","WYN001","WYS001","WYF006","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassic100forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","6"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","15","11269","WY","Individual","No","83-0231011","11269WY0170015","BlueSelect Silver ValueOne","11269WY017","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170015-01","Standard Silver On Exchange Plan","68.11%","0.681100010871887","No","Yes","No","100%",,"$3,250","$20","$1,800","$200","$1,000","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$3,250","$3250 per person","$6500 per group","50%",,,,,"$6,500","$6500 per person","$13000 per group","$9,750","$9750 per person","$19500 per group","$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOneIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","15","11269","WY","Individual","No","83-0231011","11269WY0170015","BlueSelect Silver ValueOne","11269WY017","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOne100forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","6"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","15","11269","WY","Individual","No","83-0231011","11269WY0170015","BlueSelect Silver ValueOne","11269WY017","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170015-06","94% AV Level Silver Plan","93.43%","0.934345066547394","No","Yes","No","100%",,"$250","$10","$200","$200","$250","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$10,000","$10000 per person","$20000 per group","$10,500","$10500 per person","$21000 per group","$250","$250 per person","$500 per group","20%",,,,,"$6,500","$6500 per person","$13000 per group","$6,750","$6750 per person","$13500 per group","$50","$50 per person","$100 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOne94forIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver94.pdf","10"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","31","11269","WY","Individual","No","83-0231011","11269WY0170014","BlueSelect Catastrophic","11269WY017","7154324389","WYN001","WYS001","WYF005","Existing","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170014-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$200","$5,100","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,200","$13200 per person","$26400 per group","$20,050","$20050 per person","$40100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$9,350","$9350 per person","$18700 per group","$16,200","$16200 per person","$32400 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectCatastrophicIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","5"
"2016","WY","14609","HIOS","2","2015-07-09 13:17:42","1","14609","WY","SHOP (Small Group)","Yes","57-0523959","14609WY0020001","Group Dental Policy","14609WY002",,"WYN001","WYS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.06","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","14609WY0020001-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WY","37378","HIOS","2","2015-07-10 02:19:03","1","37378","WY","SHOP (Small Group)","Yes","35-0472300","37378WY0010001","Lincoln DentalConnect®","37378WY001","7063415294","WYN001","WYS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.09","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","37378WY0010001-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WY","37378","HIOS","2","2015-07-10 02:19:03","1","37378","WY","SHOP (Small Group)","Yes","35-0472300","37378WY0010002","Lincoln DentalConnect®","37378WY001","7063415294","WYN001","WYS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.27","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","37378WY0010002-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","WY","37378","HIOS","2","2015-07-10 02:19:03","1","37378","WY","SHOP (Small Group)","Yes","35-0472300","37378WY0010003","Lincoln DentalConnect®","37378WY001","7063415294","WYN001","WYS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.98","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","37378WY0010003-00","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","WY","37378","HIOS","2","2015-07-10 02:19:03","1","37378","WY","SHOP (Small Group)","Yes","35-0472300","37378WY0010004","Lincoln DentalConnect®","37378WY001","7063415294","WYN001","WYS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.35","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","37378WY0010004-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","12","11269","WY","Individual","No","83-0231011","11269WY0170001","BlueSelect Gold Classic","11269WY017","7154324389","WYN001","WYS001","WYF006","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170001-03","Limited Cost Sharing Plan Variation","80.13%","0.801341772079468","Yes","Yes","No","100%",,"$750","$10","$1,300","$200","$750","$500","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$3,250","$3250 per person","$4000 per group","$4,000","$4000 per person","$5500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldClassic300forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","12","11269","WY","Individual","No","83-0231011","11269WY0170002","BlueSelect Silver Classic","11269WY017","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170002-00","Standard Silver Off Exchange Plan","70.58%","0.705815017223358","Yes","Yes","No","100%",,"$2,000","$10","$1,800","$200","$1,100","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$8,750","$8750 per person","$17500 per group","$14,750","$14750 per person","$29500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$6,500","$6500 per person","$10500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassicIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","8"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","12","11269","WY","Individual","No","83-0231011","11269WY0170002","BlueSelect Silver Classic","11269WY017","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170002-01","Standard Silver On Exchange Plan","70.58%","0.705815017223358","Yes","Yes","No","100%",,"$2,000","$10","$1,800","$200","$1,100","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$8,750","$8750 per person","$17500 per group","$14,750","$14750 per person","$29500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$6,500","$6500 per person","$10500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassicIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","9"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","12","11269","WY","Individual","No","83-0231011","11269WY0170002","BlueSelect Silver Classic","11269WY017","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic100forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","10"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","12","11269","WY","Individual","No","83-0231011","11269WY0170002","BlueSelect Silver Classic","11269WY017","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170002-03","Limited Cost Sharing Plan Variation","70.58%","0.705815017223358","Yes","Yes","No","100%",,"$2,000","$10","$1,800","$200","$1,100","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$8,750","$8750 per person","$17500 per group","$14,750","$14750 per person","$29500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$6,500","$6500 per person","$10500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic300forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","11"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","12","11269","WY","Individual","No","83-0231011","11269WY0170002","BlueSelect Silver Classic","11269WY017","7154324389","WYN001","WYS001","WYF009","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","2","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170002-04","73% AV Level Silver Plan","73.51%","0.735129833221436","Yes","Yes","No","100%",,"$1,600","$10","$2,000","$200","$1,100","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$8,750","$8750 per person","$17500 per group","$13,950","$13950 per person","$27900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","35%",,,,,"$4,500","$4500 per person","$6500 per group","$6,100","$6100 per person","$9700 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverClassic73forIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver73.pdf","12"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","13","11269","WY","Individual","No","83-0231011","11269WY0170003","BlueSelect Gold Core","11269WY017","7154324389","WYN001","WYS001","WYF007","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170003-00","Standard Gold Off Exchange Plan","80.42%","0.804197251796722","Yes","Yes","No","100%",,"$1,550","$0","$300","$200","$1,550","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$8,550","$8550 per person","$17100 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","per person not applicable","$3100 per group","5%",,,,,"$4,050","per person not applicable","$8100 per group","$5,600","per person not applicable","$11200 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSAIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","13","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190009","BlueSelect Bronze Value","11269WY019",,"WYN001","WYS001","WYF019","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190009-00","Standard Bronze Off Exchange Plan","58.54%","0.58540552854538","No","Yes","No","100%",,"$5,000","$0","$1,100","$200","$1,200","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group","$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValueGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Bronze_Plans.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","13","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190009","BlueSelect Bronze Value","11269WY019",,"WYN001","WYS001","WYF019","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190009-01","Standard Bronze On Exchange Plan","58.54%","0.58540552854538","No","Yes","No","100%",,"$5,000","$0","$1,100","$200","$1,200","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group","$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValueGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Bronze_Plans.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","13","11269","WY","Individual","No","83-0231011","11269WY0170003","BlueSelect Gold Core","11269WY017","7154324389","WYN001","WYS001","WYF007","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170003-01","Standard Gold On Exchange Plan","80.42%","0.804197251796722","Yes","Yes","No","100%",,"$1,550","$0","$300","$200","$1,550","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$8,550","$8550 per person","$17100 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","per person not applicable","$3100 per group","5%",,,,,"$4,050","per person not applicable","$8100 per group","$5,600","per person not applicable","$11200 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSAIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","13","11269","WY","Individual","No","83-0231011","11269WY0170003","BlueSelect Gold Core","11269WY017","7154324389","WYN001","WYS001","WYF007","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSA100forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","6"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","13","11269","WY","Individual","No","83-0231011","11269WY0170003","BlueSelect Gold Core","11269WY017","7154324389","WYN001","WYS001","WYF007","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170003-03","Limited Cost Sharing Plan Variation","80.42%","0.804197251796722","Yes","Yes","No","100%",,"$1,550","$0","$300","$200","$1,550","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$8,550","$8550 per person","$17100 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","per person not applicable","$3100 per group","5%",,,,,"$4,050","per person not applicable","$8100 per group","$5,600","per person not applicable","$11200 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHSA300forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","13","11269","WY","Individual","No","83-0231011","11269WY0170004","BlueSelect Silver Core","11269WY017","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170004-00","Standard Silver Off Exchange Plan","70.32%","0.70324981212616","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$200","$2,000","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$9,700","$9700 per person","$19400 per group","$16,150","$16150 per person","$32300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$6,500","per person not applicable","$10500 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSAIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","8"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","13","11269","WY","Individual","No","83-0231011","11269WY0170004","BlueSelect Silver Core","11269WY017","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170004-01","Standard Silver On Exchange Plan","70.32%","0.70324981212616","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$200","$2,000","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$9,700","$9700 per person","$19400 per group","$16,150","$16150 per person","$32300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$6,500","per person not applicable","$10500 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSAIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","9"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","13","11269","WY","Individual","No","83-0231011","11269WY0170004","BlueSelect Silver Core","11269WY017","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSA100forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","10"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","13","11269","WY","Individual","No","83-0231011","11269WY0170004","BlueSelect Silver Core","11269WY017","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170004-03","Limited Cost Sharing Plan Variation","70.32%","0.70324981212616","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$200","$2,000","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$9,700","$9700 per person","$19400 per group","$16,150","$16150 per person","$32300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$6,500","per person not applicable","$10500 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSA300forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","11"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","13","11269","WY","Individual","No","83-0231011","11269WY0170004","BlueSelect Silver Core","11269WY017","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170004-04","73% AV Level Silver Plan","73.91%","0.739117741584778","Yes","Yes","No","100%",,"$1,500","$0","$1,200","$200","$1,500","$0","$800","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$9,700","$9700 per person","$19400 per group","$15,150","$15150 per person","$30300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$6,000","per person not applicable","$9500 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSA73forIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver73.pdf","12"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","13","11269","WY","Individual","No","83-0231011","11269WY0170004","BlueSelect Silver Core","11269WY017","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170004-05","87% AV Level Silver Plan","87.39%","0.873863995075226","Yes","Yes","No","100%",,"$200","$0","$1,400","$200","$200","$0","$1,000","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$9,700","$9700 per person","$19400 per group","$11,950","$11950 per person","$23900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","per person not applicable","$400 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$4,700","per person not applicable","$6900 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSA87forIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver87.pdf","13"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","13","11269","WY","Individual","No","83-0231011","11269WY0170004","BlueSelect Silver Core","11269WY017","7154324389","WYN001","WYS001","WYF010","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170004-06","94% AV Level Silver Plan","94.10%","0.940959990024567","Yes","Yes","No","100%",,"$100","$0","$500","$200","$100","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$9,700","$9700 per person","$19400 per group","$10,300","$10300 per person","$20600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group","20%",,,,,"$4,500","per person not applicable","$6500 per group","$4,600","per person not applicable","$6700 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHSA94forIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver94.pdf","14"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","13","11269","WY","Individual","No","83-0231011","11269WY0170005","BlueSelect Bronze Classic","11269WY017","7154324389","WYN001","WYS001","WYF015","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170005-00","Standard Bronze Off Exchange Plan","61.75%","0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,050","$10050 per person","$20100 per group","$16,050","$16050 per person","$32100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$8,500","$8500 per person","$17000 per group","$14,500","$14500 per person","$29000 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeClassicIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","15"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","13","11269","WY","Individual","No","83-0231011","11269WY0170005","BlueSelect Bronze Classic","11269WY017","7154324389","WYN001","WYS001","WYF015","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170005-01","Standard Bronze On Exchange Plan","61.75%","0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,050","$10050 per person","$20100 per group","$16,050","$16050 per person","$32100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$8,500","$8500 per person","$17000 per group","$14,500","$14500 per person","$29000 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeClassicIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","16"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","13","11269","WY","Individual","No","83-0231011","11269WY0170005","BlueSelect Bronze Classic","11269WY017","7154324389","WYN001","WYS001","WYF015","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeClassic100forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","17"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","13","11269","WY","Individual","No","83-0231011","11269WY0170005","BlueSelect Bronze Classic","11269WY017","7154324389","WYN001","WYS001","WYF015","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170005-03","Limited Cost Sharing Plan Variation","61.75%","0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,050","$10050 per person","$20100 per group","$16,050","$16050 per person","$32100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$8,500","$8500 per person","$17000 per group","$14,500","$14500 per person","$29000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeClassic300forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","18"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","13","11269","WY","Individual","No","83-0231011","11269WY0170006","BlueSelect Bronze Core","11269WY017","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170006-00","Standard Bronze Off Exchange Plan","61.83%","0.618300259113312","Yes","Yes","No","100%",,"$3,500","$0","$1,900","$200","$3,500","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,800","$12800 per person","$25600 per group","$19,250","$19250 per person","$38500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$6000 per group","50%",,,,,"$6,000","per person not applicable","$12000 per group","$9,500","per person not applicable","$18000 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSAIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","19"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","13","11269","WY","Individual","No","83-0231011","11269WY0170006","BlueSelect Bronze Core","11269WY017","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170006-01","Standard Bronze On Exchange Plan","61.83%","0.618300259113312","Yes","Yes","No","100%",,"$3,500","$0","$1,900","$200","$3,500","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,800","$12800 per person","$25600 per group","$19,250","$19250 per person","$38500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$6000 per group","50%",,,,,"$6,000","per person not applicable","$12000 per group","$9,500","per person not applicable","$18000 per group","Yes",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSAIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","20"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","13","11269","WY","Individual","No","83-0231011","11269WY0170006","BlueSelect Bronze Core","11269WY017","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSA100forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","21"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","13","11269","WY","Individual","No","83-0231011","11269WY0170006","BlueSelect Bronze Core","11269WY017","7154324389","WYN001","WYS001","WYF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170006-03","Limited Cost Sharing Plan Variation","61.83%","0.618300259113312","Yes","Yes","No","100%",,"$3,500","$0","$1,900","$200","$3,500","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,800","$12800 per person","$25600 per group","$19,250","$19250 per person","$38500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$6000 per group","50%",,,,,"$6,000","per person not applicable","$12000 per group","$9,500","per person not applicable","$18000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeHSA300forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","22"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","14","11269","WY","Individual","No","83-0231011","11269WY0170007","BlueSelect Gold HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF008","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170007-00","Standard Gold Off Exchange Plan","81.27%","0.808982491493225","Yes","Yes","No","100%",,"$1,000","$10","$900","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlusIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","14","11269","WY","Individual","No","83-0231011","11269WY0170007","BlueSelect Gold HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF008","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170007-01","Standard Gold On Exchange Plan","81.27%","0.808982491493225","Yes","Yes","No","100%",,"$1,000","$10","$900","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlusIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","14","11269","WY","Individual","No","83-0231011","11269WY0170007","BlueSelect Gold HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF008","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlus100forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","6"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","14","11269","WY","Individual","No","83-0231011","11269WY0170007","BlueSelect Gold HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF008","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170007-03","Limited Cost Sharing Plan Variation","81.27%","0.808982491493225","Yes","Yes","No","100%",,"$1,000","$10","$900","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$8,800","$8800 per person","$17600 per group","$15,400","$15400 per person","$30800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldHealthPlus300forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","14","11269","WY","Individual","No","83-0231011","11269WY0170008","BlueSelect Silver HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170008-00","Standard Silver Off Exchange Plan","71.17%","0.705352425575256","Yes","Yes","No","100%",,"$2,500","$10","$1,200","$200","$900","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$9,900","$9900 per person","$19800 per group","$16,500","$16500 per person","$33000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlusIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","8"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","14","11269","WY","Individual","No","83-0231011","11269WY0170008","BlueSelect Silver HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170008-01","Standard Silver On Exchange Plan","71.17%","0.705352425575256","Yes","Yes","No","100%",,"$2,500","$10","$1,200","$200","$900","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$9,900","$9900 per person","$19800 per group","$16,500","$16500 per person","$33000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlusIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","9"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","14","11269","WY","Individual","No","83-0231011","11269WY0170008","BlueSelect Silver HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus100forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","10"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","14","11269","WY","Individual","No","83-0231011","11269WY0170008","BlueSelect Silver HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170008-03","Limited Cost Sharing Plan Variation","71.17%","0.705352425575256","Yes","Yes","No","100%",,"$2,500","$10","$1,200","$200","$900","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$9,900","$9900 per person","$19800 per group","$16,500","$16500 per person","$33000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus300forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","11"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","14","11269","WY","Individual","No","83-0231011","11269WY0170008","BlueSelect Silver HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170008-04","73% AV Level Silver Plan","73.91%","0.732912957668304","Yes","Yes","No","100%",,"$2,100","$10","$1,300","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$9,900","$9900 per person","$19800 per group","$15,300","$15300 per person","$30600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,100","$7100 per person","$14200 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus73forIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver73.pdf","12"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","14","11269","WY","Individual","No","83-0231011","11269WY0170008","BlueSelect Silver HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170008-05","87% AV Level Silver Plan","86.97%","0.86704695224762","Yes","Yes","No","100%",,"$400","$0","$1,600","$200","$400","$300","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$9,900","$9900 per person","$19800 per group","$11,900","$11900 per person","$23800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$5,400","$5400 per person","$10800 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus87forIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver87.pdf","13"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","14","11269","WY","Individual","No","83-0231011","11269WY0170008","BlueSelect Silver HealthPlus","11269WY017","7154324389","WYN001","WYS001","WYF011","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170008-06","94% AV Level Silver Plan","93.37%","0.933198094367981","Yes","Yes","No","100%",,"$100","$10","$600","$200","$100","$100","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$9,900","$9900 per person","$19800 per group","$10,650","$10650 per person","$21300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$5,100","$5100 per person","$10200 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverHealthPlus94forIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver94.pdf","14"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","15","11269","WY","Individual","No","83-0231011","11269WY0170015","BlueSelect Silver ValueOne","11269WY017","7154324389","WYN001","WYS001","WYF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170015-00","Standard Silver Off Exchange Plan","68.11%","0.681100010871887","No","Yes","No","100%",,"$3,250","$20","$1,800","$200","$1,000","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$3,250","$3250 per person","$6500 per group","50%",,,,,"$6,500","$6500 per person","$13000 per group","$9,750","$9750 per person","$19500 per group","$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueOneIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","16","11269","WY","Individual","No","83-0231011","11269WY0170009","BlueSelect Silver ValueTwo","11269WY017","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170009-00","Standard Silver Off Exchange Plan","68.73%","0.687343895435333","No","Yes","No","100%",,"$3,000","$10","$900","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwoIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","16","11269","WY","Individual","No","83-0231011","11269WY0170009","BlueSelect Silver ValueTwo","11269WY017","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170009-01","Standard Silver On Exchange Plan","68.73%","0.687343895435333","No","Yes","No","100%",,"$3,000","$10","$900","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwoIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","16","11269","WY","Individual","No","83-0231011","11269WY0170009","BlueSelect Silver ValueTwo","11269WY017","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwo100forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","6"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","16","11269","WY","Individual","No","83-0231011","11269WY0170009","BlueSelect Silver ValueTwo","11269WY017","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170009-03","Limited Cost Sharing Plan Variation","68.73%","0.687343895435333","No","Yes","No","100%",,"$3,000","$10","$900","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwo300forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","16","11269","WY","Individual","No","83-0231011","11269WY0170009","BlueSelect Silver ValueTwo","11269WY017","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170009-04","73% AV Level Silver Plan","72.97%","0.72965943813324","No","Yes","No","100%",,"$3,000","$10","$0","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"$13,200","$13200 per person","$26400 per group","$16,950","$16950 per person","$33900 per group","$3,000","$3000 per person","$6000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwo73forIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver73.pdf","8"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","16","11269","WY","Individual","No","83-0231011","11269WY0170009","BlueSelect Silver ValueTwo","11269WY017","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170009-05","87% AV Level Silver Plan","86.33%","0.86327451467514","No","Yes","No","100%",,"$1,250","$10","$0","$200","$1,100","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$13,200","$13200 per person","$26400 per group","$14,700","$14700 per person","$29400 per group","$1,250","$1250 per person","$2500 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$7,250","$7250 per person","$14500 per group","$150","$150 per person","$300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwo87forIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver87.pdf","9"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","16","11269","WY","Individual","No","83-0231011","11269WY0170009","BlueSelect Silver ValueTwo","11269WY017","7154324389","WYN001","WYS001","WYF013","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170009-06","94% AV Level Silver Plan","94.95%","0.949480056762695","No","Yes","No","100%",,"$150","$10","$0","$200","$150","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$13,200","$13200 per person","$26400 per group","$13,900","$13900 per person","$27800 per group","$150","$150 per person","$300 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$6,150","$6150 per person","$12300 per group","$50","$50 per person","$100 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverValueTwo94forIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver94.pdf","10"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","17","11269","WY","Individual","No","83-0231011","11269WY0170010","BlueSelect Bronze Value","11269WY017","7154324389","WYN001","WYS001","WYF014","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170010-00","Standard Bronze Off Exchange Plan","58.33%","0.583344697952271","No","Yes","No","100%",,"$5,500","$0","$0","$200","$1,200","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group","$5,500","$5500 per person","$11000 per group","0%",,,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValueIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","17","11269","WY","Individual","No","83-0231011","11269WY0170010","BlueSelect Bronze Value","11269WY017","7154324389","WYN001","WYS001","WYF014","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170010-01","Standard Bronze On Exchange Plan","58.33%","0.583344697952271","No","Yes","No","100%",,"$5,500","$0","$0","$200","$1,200","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group","$5,500","$5500 per person","$11000 per group","0%",,,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValueIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","17","11269","WY","Individual","No","83-0231011","11269WY0170010","BlueSelect Bronze Value","11269WY017","7154324389","WYN001","WYS001","WYF014","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValue100forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","6"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","17","11269","WY","Individual","No","83-0231011","11269WY0170010","BlueSelect Bronze Value","11269WY017","7154324389","WYN001","WYS001","WYF014","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170010-03","Limited Cost Sharing Plan Variation","58.33%","0.583344697952271","No","Yes","No","100%",,"$5,500","$0","$0","$200","$1,200","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$19500 per person","$39000 per group","$5,500","$5500 per person","$11000 per group","0%",,,,,"$11,000","$11000 per person","$22000 per group","$16,500","$16500 per person","$33000 per group","$1,000","$1000 per person","$2000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeValue300forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","23","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190010","BlueSelect Gold Basic","11269WY019",,"WYN001","WYS001","WYF001","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190010-00","Standard Gold Off Exchange Plan","79.13%","0.791336119174957","Yes","Yes","No","100%",,"$1,000","$10","$1,300","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBasicGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Gold_Plans.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","23","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190010","BlueSelect Gold Basic","11269WY019",,"WYN001","WYS001","WYF001","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190010-01","Standard Gold On Exchange Plan","79.13%","0.791336119174957","Yes","Yes","No","100%",,"$1,000","$10","$1,300","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBasicGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Gold_Plans.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","23","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190011","BlueSelect Silver Basic","11269WY019",,"WYN001","WYS001","WYF002","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190011-00","Standard Silver Off Exchange Plan","71.97%","0.719709157943726","Yes","Yes","No","100%",,"$2,000","$10","$1,300","$200","$900","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25%",,,,,"$4,500","$4500 per person","$9000 per group","$6,500","$6500 per person","$13000 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasicGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Silver_Plans.pdf","6"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","23","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190011","BlueSelect Silver Basic","11269WY019",,"WYN001","WYS001","WYF002","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190011-01","Standard Silver On Exchange Plan","71.97%","0.719709157943726","Yes","Yes","No","100%",,"$2,000","$10","$1,300","$200","$900","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,800","$19800 per person","$39600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","25%",,,,,"$4,500","$4500 per person","$9000 per group","$6,500","$6500 per person","$13000 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasicGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Silver_Plans.pdf","7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","25","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080003","BlueSelect Bronze Basic with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF020","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080003-00","Standard Bronze Off Exchange Plan","61.96%","0.619552910327911","Yes","Yes","No","100%",,"$4,000","$20","$1,600","$200","$900","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50%",,,,,"$6,500","$6500 per person","$13000 per group","$10,500","$10500 per person","$21000 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBasicGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Bronze_Plans.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","25","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080003","BlueSelect Bronze Basic with Kid's Dental","11269WY008",,"WYN001","WYS001","WYF020","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0080003-01","Standard Bronze On Exchange Plan","61.96%","0.619552910327911","Yes","Yes","No","100%",,"$4,000","$20","$1,600","$200","$900","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50%",,,,,"$6,500","$6500 per person","$13000 per group","$10,500","$10500 per person","$21000 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBasicGXD","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Bronze_Plans.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","26","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190012","BlueSelect Bronze Basic","11269WY019",,"WYN001","WYS001","WYF020","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190012-00","Standard Bronze Off Exchange Plan","61.96%","0.619552910327911","Yes","Yes","No","100%",,"$4,000","$20","$1,600","$200","$900","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50%",,,,,"$6,500","$6500 per person","$13000 per group","$10,500","$10500 per person","$21000 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBasicGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Bronze_Plans.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","26","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0190012","BlueSelect Bronze Basic","11269WY019",,"WYN001","WYS001","WYF020","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","3","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0190012-01","Standard Bronze On Exchange Plan","61.96%","0.619552910327911","Yes","Yes","No","100%",,"$4,000","$20","$1,600","$200","$900","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50%",,,,,"$6,500","$6500 per person","$13000 per group","$10,500","$10500 per person","$21000 per group","No","No",,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBasicGX","https://www.bcbswy.com/docs/employers/BlueSelect_Small_Group_Bronze_Plans.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","30","11269","WY","Individual","No","83-0231011","11269WY0170011","BlueSelect Gold Basic","11269WY017","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170011-00","Standard Gold Off Exchange Plan","79.13%","0.791336119174957","Yes","Yes","No","100%",,"$1,000","$10","$1,300","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBasicIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","4"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","30","11269","WY","Individual","No","83-0231011","11269WY0170011","BlueSelect Gold Basic","11269WY017","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170011-01","Standard Gold On Exchange Plan","79.13%","0.791336119174957","Yes","Yes","No","100%",,"$1,000","$10","$1,300","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBasicIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","5"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","30","11269","WY","Individual","No","83-0231011","11269WY0170011","BlueSelect Gold Basic","11269WY017","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBasic100forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","6"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","30","11269","WY","Individual","No","83-0231011","11269WY0170011","BlueSelect Gold Basic","11269WY017","7154324389","WYN001","WYS001","WYF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170011-03","Limited Cost Sharing Plan Variation","79.13%","0.791336119174957","Yes","Yes","No","100%",,"$1,000","$10","$1,300","$200","$1,000","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","$4,500","$4500 per person","$9000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectGoldBasic300forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","7"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","30","11269","WY","Individual","No","83-0231011","11269WY0170012","BlueSelect Silver Basic","11269WY017","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170012-00","Standard Silver Off Exchange Plan","70.84%","0.708388090133667","Yes","Yes","No","100%",,"$2,500","$10","$1,200","$200","$900","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasicIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","8"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","30","11269","WY","Individual","No","83-0231011","11269WY0170012","BlueSelect Silver Basic","11269WY017","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170012-01","Standard Silver On Exchange Plan","70.84%","0.708388090133667","Yes","Yes","No","100%",,"$2,500","$10","$1,200","$200","$900","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasicIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","9"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","30","11269","WY","Individual","No","83-0231011","11269WY0170012","BlueSelect Silver Basic","11269WY017","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasic100forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","10"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","30","11269","WY","Individual","No","83-0231011","11269WY0170012","BlueSelect Silver Basic","11269WY017","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170012-03","Limited Cost Sharing Plan Variation","70.84%","0.708388090133667","Yes","Yes","No","100%",,"$2,500","$10","$1,200","$200","$900","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasic300forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","11"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","30","11269","WY","Individual","No","83-0231011","11269WY0170012","BlueSelect Silver Basic","11269WY017","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170012-04","73% AV Level Silver Plan","73.73%","0.737348973751068","Yes","Yes","No","100%",,"$2,100","$10","$1,300","$200","$1,000","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$12,700","$12700 per person","$25400 per group","$18,150","$18150 per person","$36300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$7,100","$7100 per person","$14200 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasic73forIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver73.pdf","12"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","30","11269","WY","Individual","No","83-0231011","11269WY0170012","BlueSelect Silver Basic","11269WY017","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170012-05","87% AV Level Silver Plan","86.58%","0.865765273571014","Yes","Yes","No","100%",,"$400","$10","$1,700","$200","$400","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,700","$12700 per person","$25400 per group","$14,950","$14950 per person","$29900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$5,400","$5400 per person","$10800 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasic87forIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver87.pdf","13"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","30","11269","WY","Individual","No","83-0231011","11269WY0170012","BlueSelect Silver Basic","11269WY017","7154324389","WYN001","WYS001","WYF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170012-06","94% AV Level Silver Plan","93.17%","0.93170291185379","Yes","Yes","No","100%",,"$100","$0","$700","$200","$100","$100","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$12,700","$12700 per person","$25400 per group","$13,500","$13500 per person","$27000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","$5,100","$5100 per person","$10200 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectSilverBasic94forIndividuals","https://www.bcbswy.com/docs/coverage/Subsidy_Silver94.pdf","14"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","30","11269","WY","Individual","No","83-0231011","11269WY0170013","BlueSelect Bronze Basic","11269WY017","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170013-00","Standard Bronze Off Exchange Plan","61.99%","0.619873344898224","Yes","Yes","No","100%",,"$5,500","$20","$900","$200","$700","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50%",,,,,"$8,000","$8000 per person","$15000 per group","$13,500","$13500 per person","$26000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBasicIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","15"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","30","11269","WY","Individual","No","83-0231011","11269WY0170013","BlueSelect Bronze Basic","11269WY017","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170013-01","Standard Bronze On Exchange Plan","61.99%","0.619873344898224","Yes","Yes","No","100%",,"$5,500","$20","$900","$200","$700","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50%",,,,,"$8,000","$8000 per person","$15000 per group","$13,500","$13500 per person","$26000 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBasicIX","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","16"
"2016","WY","11269","HIOS","6","2016-01-23 05:53:30","30","11269","WY","Individual","No","83-0231011","11269WY0170013","BlueSelect Bronze Basic","11269WY017","7154324389","WYN001","WYS001","WYF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","6","2016-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","https://shop.bcbswy.com/pay","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_WY_3T_HealthInsuranceMarketplaceBlueSelect.pdf","11269WY0170013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://wyomingbluesbc.com/marketplace/BlueSelectBronzeBasic100forTribalMembers","https://www.bcbswy.com/docs/coverage/BCBSWY_BlueSelect_IndFam_BRO.pdf","17"
"2016","WY","37378","HIOS","2","2015-07-10 02:19:03","1","37378","WY","SHOP (Small Group)","Yes","35-0472300","37378WY0010005","Lincoln DentalConnect®","37378WY001","7063415294","WYN001","WYS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.00","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","37378WY0010005-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","WY","37378","HIOS","2","2015-07-10 02:19:03","1","37378","WY","SHOP (Small Group)","Yes","35-0472300","37378WY0010006","Lincoln DentalConnect®","37378WY001","7063415294","WYN001","WYS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.96","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","37378WY0010006-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","WY","37378","HIOS","2","2015-07-10 02:19:03","1","37378","WY","SHOP (Small Group)","Yes","35-0472300","37378WY0010007","Lincoln DentalConnect®","37378WY001","7063415294","WYN001","WYS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.21","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","37378WY0010007-00","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2016","WY","37378","HIOS","2","2015-07-10 02:19:03","1","37378","WY","SHOP (Small Group)","Yes","35-0472300","37378WY0010008","Lincoln DentalConnect®","37378WY001","7063415294","WYN001","WYS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.35","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","37378WY0010008-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2016","WY","44450","HIOS","6","2015-08-26 09:56:12","1","44450","WY","SHOP (Small Group)","Yes","75-1233841","44450WY0020007","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","44450WY002",,"WYN001","WYS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","44450WY0020007-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wy/44450wy0020007-16","4"
"2016","WY","44450","HIOS","6","2015-08-26 09:56:12","1","44450","WY","Individual","Yes","75-1233841","44450WY0010007","Dentegra Dental PPO Pediatric Basic Plan","44450WY001",,"WYN001","WYS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.22","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","44450WY0010007-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wy/44450wy0010007-16","4"
"2016","WY","44450","HIOS","6","2015-08-26 09:56:12","2","44450","WY","Individual","Yes","75-1233841","44450WY0010010","Dentegra Dental PPO Family Preferred Plan","44450WY001",,"WYN001","WYS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.01","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","44450WY0010010-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wy/44450wy0010010-16","4"
"2016","WY","44450","HIOS","6","2015-08-26 09:56:12","2","44450","WY","SHOP (Small Group)","Yes","75-1233841","44450WY0020010","Dentegra Dental PPO for Small Businesses Family Preferred Plan","44450WY002",,"WYN001","WYS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.24","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","44450WY0020010-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wy/44450wy0020010-16","4"
"2016","WY","44450","HIOS","6","2015-08-26 09:56:12","3","44450","WY","SHOP (Small Group)","Yes","75-1233841","44450WY0020009","Dentegra Dental PPO for Small Businesses Family Basic Plan","44450WY002",,"WYN001","WYS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","44450WY0020009-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wy/44450wy0020009-16","4"
"2016","WY","44450","HIOS","6","2015-08-26 09:56:12","3","44450","WY","Individual","Yes","75-1233841","44450WY0010009","Dentegra Dental PPO Family Basic Plan","44450WY001",,"WYN001","WYS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.22","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","44450WY0010009-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wy/44450wy0010009-16","4"
"2016","WY","44450","HIOS","6","2015-08-26 09:56:12","3","44450","WY","Individual","Yes","75-1233841","44450WY0010009","Dentegra Dental PPO Family Basic Plan","44450WY001",,"WYN001","WYS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.22","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","44450WY0010009-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wy/44450wy0010009-16","5"
"2016","WY","44450","HIOS","6","2015-08-26 09:56:12","3","44450","WY","SHOP (Small Group)","Yes","75-1233841","44450WY0020009","Dentegra Dental PPO for Small Businesses Family Basic Plan","44450WY002",,"WYN001","WYS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","44450WY0020009-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wy/44450wy0020009-16","5"
"2016","WY","47731","HIOS","3","2015-08-27 11:14:25","1","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0010007","BESTDental Premium","47731WY001",,"WYN001","WYS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/WY/2016/WY_BESTDental_Premium_Plan.pdf","4"
"2016","WY","47731","HIOS","3","2015-08-27 11:14:25","1","47731","WY","Individual","Yes","95-6042390","47731WY0020003","BESTOne Advantage Gold","47731WY002",,"WYN001","WYS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.10","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/WY/2016/WY_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","WY","47731","HIOS","3","2015-08-27 11:14:25","1","47731","WY","Individual","Yes","95-6042390","47731WY0020003","BESTOne Advantage Gold","47731WY002",,"WYN001","WYS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.10","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/WY/2016/WY_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","WY","47731","HIOS","3","2015-08-27 11:14:25","1","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0010007","BESTDental Premium","47731WY001",,"WYN001","WYS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/WY/2016/WY_BESTDental_Premium_Plan.pdf","5"
"2016","WY","47731","HIOS","3","2015-08-27 11:14:25","1","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0010008","BESTDental Standard - H","47731WY001",,"WYN001","WYS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/WY/2016/WY_BESTDental_Standard-H_Plan.pdf","6"
"2016","WY","47731","HIOS","3","2015-08-27 11:14:25","1","47731","WY","Individual","Yes","95-6042390","47731WY0020004","BESTOne Plus Gold","47731WY002",,"WYN001","WYS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.10","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/WY/2016/WY_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","WY","47731","HIOS","3","2015-08-27 11:14:25","1","47731","WY","Individual","Yes","95-6042390","47731WY0020004","BESTOne Plus Gold","47731WY002",,"WYN001","WYS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.10","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/WY/2016/WY_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","WY","47731","HIOS","3","2015-08-27 11:14:25","1","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0010008","BESTDental Standard - H","47731WY001",,"WYN001","WYS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/WY/2016/WY_BESTDental_Standard-H_Plan.pdf","7"
"2016","WY","47731","HIOS","3","2015-08-27 11:14:25","1","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0010010","BESTDental Choice - H","47731WY001",,"WYN001","WYS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/WY/2016/WY_BESTDental_Choice-H_Plan.pdf","8"
"2016","WY","47731","HIOS","3","2015-08-27 11:14:25","1","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0010010","BESTDental Choice - H","47731WY001",,"WYN001","WYS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/WY/2016/WY_BESTDental_Choice-H_Plan.pdf","9"
"2016","WY","47731","HIOS","3","2015-08-27 11:14:25","2","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0010009","BESTDental Standard - L","47731WY001",,"WYN001","WYS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.08","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/WY/2016/WY_BESTDental_Standard-L_Plan.pdf","4"
"2016","WY","47731","HIOS","3","2015-08-27 11:14:25","2","47731","WY","Individual","Yes","95-6042390","47731WY0020005","BESTOne Plus Silver","47731WY002",,"WYN001","WYS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.58","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/WY/2016/WY_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","WY","47731","HIOS","3","2015-08-27 11:14:25","2","47731","WY","Individual","Yes","95-6042390","47731WY0020005","BESTOne Plus Silver","47731WY002",,"WYN001","WYS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.58","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/WY/2016/WY_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","WY","47731","HIOS","3","2015-08-27 11:14:25","2","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0010009","BESTDental Standard - L","47731WY001",,"WYN001","WYS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.08","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/WY/2016/WY_BESTDental_Standard-L_Plan.pdf","5"
"2016","WY","47731","HIOS","3","2015-08-27 11:14:25","2","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0010011","BESTDental Choice - L","47731WY001",,"WYN001","WYS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.08","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/WY/2016/WY_BESTDental_Choice-L_Plan.pdf","6"
"2016","WY","47731","HIOS","3","2015-08-27 11:14:25","2","47731","WY","Individual","Yes","95-6042390","47731WY0020006","BESTOne Basic Silver","47731WY002",,"WYN001","WYS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.58","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/WY/2016/WY_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","WY","47731","HIOS","3","2015-08-27 11:14:25","2","47731","WY","Individual","Yes","95-6042390","47731WY0020006","BESTOne Basic Silver","47731WY002",,"WYN001","WYS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.58","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/WY/2016/WY_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","WY","47731","HIOS","3","2015-08-27 11:14:25","2","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0010011","BESTDental Choice - L","47731WY001",,"WYN001","WYS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.08","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/WY/2016/WY_BESTDental_Choice-L_Plan.pdf","7"
"2016","WY","47731","HIOS","3","2015-08-27 11:14:25","2","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0010012","BESTDental Value","47731WY001",,"WYN001","WYS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.08","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/WY/2016/WY_BESTDental_Value_Plan.pdf","8"
"2016","WY","47731","HIOS","3","2015-08-27 11:14:25","2","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0010012","BESTDental Value","47731WY001",,"WYN001","WYS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.08","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47731WY0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/WY/2016/WY_BESTDental_Value_Plan.pdf","9"
"2016","WY","80132","HIOS","2","2015-07-11 04:19:24","1","80132","WY","Individual","Yes","47-0397286","80132WY0040001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","80132WY004",,"WYN001","WYS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.62","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/80132","","80132WY0040001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/WY_EHB_High_2016","http://www.renaissancedental.com/WY_EHB_High_2016","8"
"2016","WY","80132","HIOS","2","2015-07-11 04:19:24","1","80132","WY","Individual","Yes","47-0397286","80132WY0040002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","80132WY004",,"WYN001","WYS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.91","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/80132","","80132WY0040002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/WY_EHB_Low_2016","http://www.renaissancedental.com/WY_EHB_Low_2016","9"
"2016","WY","54763","HIOS","3","2015-08-27 11:14:25","1","54763","WY","SHOP (Small Group)","Yes","47-0098400","54763WY0040002","EHB High PPO","54763WY004",,"WYN001","WYS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.05","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","54763WY0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","WY","54763","HIOS","3","2015-08-27 11:14:25","1","54763","WY","SHOP (Small Group)","Yes","47-0098400","54763WY0040001","EHB Low PPO","54763WY004",,"WYN001","WYS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.92","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","54763WY0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970028","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS026","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970028-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970029","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS036","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970029-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$500","$310","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970029","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS036","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970029-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970029","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS036","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970029-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970018","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS046","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970018-03","Limited Cost Sharing Plan Variation","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$0","$200","$3,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970018","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS046","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970018-04","73% AV Level Silver Plan","73.02%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","WY","54763","HIOS","3","2015-08-27 11:14:25","1","54763","WY","SHOP (Small Group)","Yes","47-0098400","54763WY0030002","EHB High Passive","54763WY003",,"WYN001","WYS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$47.50","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","54763WY0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","WY","54763","HIOS","3","2015-08-27 11:14:25","1","54763","WY","SHOP (Small Group)","Yes","47-0098400","54763WY0030001","EHB Low Passive","54763WY003",,"WYN001","WYS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.72","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","54763WY0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","WY","62081","HIOS","5","2015-10-20 04:38:50","1","62081","WY","Individual","Yes","36-3757528","62081WY0010001","TruAssure Basic Adult or Child Dental Plan","62081WY001",,"WYN001","WYS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","62081WY0010001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$140","$140 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WY","https://www.truassure.com/brochure?state=WY","4"
"2016","WY","62081","HIOS","5","2015-10-20 04:38:50","1","62081","WY","SHOP (Small Group)","Yes","36-3757528","62081WY0030001","TruAssure Dental Small Group Basic Plan","62081WY003",,"WYN001","WYS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$50.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","62081WY0030001-00","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WY","62081","HIOS","5","2015-10-20 04:38:50","1","62081","WY","SHOP (Small Group)","Yes","36-3757528","62081WY0040001","TruAssure Dental Small Group Preferred Plan","62081WY004",,"WYN001","WYS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$50.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","62081WY0040001-00","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","WY","62081","HIOS","5","2015-10-20 04:38:50","1","62081","WY","Individual","Yes","36-3757528","62081WY0010001","TruAssure Basic Adult or Child Dental Plan","62081WY001",,"WYN001","WYS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","62081WY0010001-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$140","$140 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WY","https://www.truassure.com/brochure?state=WY","5"
"2016","WY","62081","HIOS","5","2015-10-20 04:38:50","2","62081","WY","Individual","Yes","36-3757528","62081WY0020001","TruAssure Preferred Adult or Child Dental Plan","62081WY002",,"WYN001","WYS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.73","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","62081WY0020001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","$45 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WY","https://www.truassure.com/brochure?state=WY","4"
"2016","WY","62081","HIOS","5","2015-10-20 04:38:50","2","62081","WY","Individual","Yes","36-3757528","62081WY0020001","TruAssure Preferred Adult or Child Dental Plan","62081WY002",,"WYN001","WYS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.73","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","62081WY0020001-01","Standard High On Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","$45 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WY","https://www.truassure.com/brochure?state=WY","5"
"2016","WY","76197","HIOS","3","2015-08-27 11:14:25","1","76197","WY","SHOP (Small Group)","Yes","36-0883760","76197WY0040002","EHB High PPO","76197WY004",,"WYN001","WYS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.67","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","76197WY0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","WY","76197","HIOS","3","2015-08-27 11:14:25","1","76197","WY","SHOP (Small Group)","Yes","36-0883760","76197WY0040001","EHB Low PPO","76197WY004",,"WYN001","WYS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.23","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","76197WY0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","WY","76197","HIOS","3","2015-08-27 11:14:25","1","76197","WY","SHOP (Small Group)","Yes","36-0883760","76197WY0030002","EHB High Passive","76197WY003",,"WYN001","WYS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$48.16","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","76197WY0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","WY","76197","HIOS","3","2015-08-27 11:14:25","1","76197","WY","SHOP (Small Group)","Yes","36-0883760","76197WY0030001","EHB Low Passive","76197WY003",,"WYN001","WYS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.10","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","76197WY0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","WY","80132","HIOS","2","2015-07-11 04:19:24","1","80132","WY","Individual","Yes","47-0397286","80132WY0010001","Delta Dental Individual PPO, EHB Certified","80132WY001",,"WYN002","WYS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.86","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","80132WY0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WY","80132","HIOS","2","2015-07-11 04:19:24","1","80132","WY","SHOP (Small Group)","Yes","47-0397286","80132WY0030001","Renaissance Group Dental PPO, EHB Certified","80132WY003",,"WYN001","WYS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.53","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","80132WY0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WY","80132","HIOS","2","2015-07-11 04:19:24","1","80132","WY","SHOP (Small Group)","Yes","47-0397286","80132WY0030002","Renaissance Group Dental PPO, EHB Certified","80132WY003",,"WYN001","WYS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.53","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","80132WY0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","WY","80132","HIOS","2","2015-07-11 04:19:24","1","80132","WY","Individual","Yes","47-0397286","80132WY0010002","Delta Dental Individual PPO, EHB Certified","80132WY001",,"WYN002","WYS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.95","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","80132WY0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","WY","80132","HIOS","2","2015-07-11 04:19:24","1","80132","WY","Individual","Yes","47-0397286","80132WY0020001","Renaissance Individual Dental PPO, EHB Certified","80132WY002",,"WYN001","WYS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.62","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","80132WY0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","WY","80132","HIOS","2","2015-07-11 04:19:24","1","80132","WY","Individual","Yes","47-0397286","80132WY0020002","Renaissance Individual Dental PPO, EHB Certified","80132WY002",,"WYN001","WYS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.91","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","80132WY0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","WY","80132","HIOS","2","2015-07-11 04:19:24","2","80132","WY","Individual","Yes","47-0397286","80132WY0050001","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)","80132WY005",,"WYN001","WYS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$37.84","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/80132","","80132WY0050001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/WY_Ped_High_2016","http://www.renaissancedental.com/WY_Ped_High_2016","4"
"2016","WY","80132","HIOS","2","2015-07-11 04:19:24","2","80132","WY","Individual","Yes","47-0397286","80132WY0050002","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified (Exchange)","80132WY005",,"WYN001","WYS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$29.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/80132","","80132WY0050002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.renaissancedental.com/WY_Ped_Low_2016","http://www.renaissancedental.com/WY_Ped_Low_2016","5"
"2016","WY","80132","HIOS","2","2015-07-11 04:19:24","2","80132","WY","Individual","Yes","47-0397286","80132WY0060001","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified","80132WY006",,"WYN001","WYS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$37.84","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","80132WY0060001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","WY","80132","HIOS","2","2015-07-11 04:19:24","2","80132","WY","Individual","Yes","47-0397286","80132WY0060002","Renaissance Individual Pediatric-Only Dental PPO, EHB Certified","80132WY006",,"WYN001","WYS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$29.73","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","80132WY0060002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","WY","83964","HIOS","2","2015-07-10 02:19:03","1","83964","WY","Individual","Yes","83-0209667","83964WY0010003","Delta Dental Individual & Family Low Plan","83964WY001",,"WYN001","WYS001",,"Existing","Indemnity","Low",,"Both",,,,"EHB Pediatric Coverage is not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"$34.65","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.   Through the Delta Dental Plan Association there is a nationwide Premier network presence","Yes","https://secure.deltadentalwy.org/wyffm/default.aspx","","83964WY0010003-00","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","$125","$125 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwy.org/Subscribers/SubscribersDocuments/d126603.aspx",,"4"
"2016","WY","83964","HIOS","2","2015-07-10 02:19:03","1","83964","WY","SHOP (Small Group)","Yes","83-0209667","83964WY0020003","Delta Dental Small Group Low Plan","83964WY002",,"WYN001","WYS001",,"Existing","Indemnity","Low",,"Off the Exchange",,,,"EHB Pediatric Coverage is not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"$26.52","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.   Through the Delta Dental Plan Association there is a nationwide Premier network presence","Yes","https://secure.deltadentalwy.org/wyffm/default.aspx","","83964WY0020003-00","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","$125","$125 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwy.org/Subscribers/SubscribersDocuments/d126605.aspx",,"4"
"2016","WY","83964","HIOS","2","2015-07-10 02:19:03","1","83964","WY","Individual","Yes","83-0209667","83964WY0010003","Delta Dental Individual & Family Low Plan","83964WY001",,"WYN001","WYS001",,"Existing","Indemnity","Low",,"Both",,,,"EHB Pediatric Coverage is not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"$34.65","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.   Through the Delta Dental Plan Association there is a nationwide Premier network presence","Yes","https://secure.deltadentalwy.org/wyffm/default.aspx","","83964WY0010003-01","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","$125","$125 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","WY","83964","HIOS","2","2015-07-10 02:19:03","2","83964","WY","Individual","Yes","83-0209667","83964WY0010004","Delta Dental Individual & Family High Plan","83964WY001",,"WYN001","WYS001",,"Existing","Indemnity","High",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18.",,"No","Allows Adult and Child-Only",,,,,"$40.96","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","https://secure.deltadentalwy.org/wyffm/default.aspx","","83964WY0010004-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$25","$25 per person","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwy.org/Subscribers/SubscribersDocuments/d126602.aspx",,"4"
"2016","WY","83964","HIOS","2","2015-07-10 02:19:03","2","83964","WY","SHOP (Small Group)","Yes","83-0209667","83964WY0020004","Delta Dental Small Group High Plan","83964WY002",,"WYN001","WYS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,"EHB Pediatric coverage not available for anyone over the age of 18.",,"No","Allows Adult and Child-Only",,,,,"$31.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","https://secure.deltadentalwy.org/wyffm/default.aspx","","83964WY0020004-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$25","$25 per person","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalwy.org/Subscribers/SubscribersDocuments/d126604.aspx",,"4"
"2016","WY","83964","HIOS","2","2015-07-10 02:19:03","2","83964","WY","Individual","Yes","83-0209667","83964WY0010004","Delta Dental Individual & Family High Plan","83964WY001",,"WYN001","WYS001",,"Existing","Indemnity","High",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18.",,"No","Allows Adult and Child-Only",,,,,"$40.96","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","https://secure.deltadentalwy.org/wyffm/default.aspx","","83964WY0010004-01","Standard High On Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$25","$25 per person","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","WY","90776","HIOS","3","2015-08-27 11:14:25","1","90776","WY","SHOP (Small Group)","Yes","93-0242990","90776WY0040002","EHB High PPO","90776WY004",,"WYN001","WYS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.79","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","90776WY0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","WY","90776","HIOS","3","2015-08-27 11:14:25","1","90776","WY","SHOP (Small Group)","Yes","93-0242990","90776WY0040001","EHB Low PPO","90776WY004",,"WYN001","WYS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.29","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","90776WY0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","AL","46944","OPM","5","2015-10-23 10:28:16","2","46944","AL","Individual","No","63-0103830","46944AL0630001","Blue Cross Select Silver, a Multi-State Plan","46944AL063","7346243505","ALN201","ALS201","ALF202","New","PPO","Silver","Yes","On the Exchange","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0630001-06","94% AV Level Silver Plan","93.35%",,"No","Yes","Yes","95%","5%","$100","$200","$0","$200","$20","$500","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%","$100","$100 per person","$200 per group","10%","$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016sms-94.pdf","https://www.ibcbsal.com/bb/2016sms-94.pdf","9"
"2016","AR","75293","OPM","2","2016-01-29 07:27:50","1","75293","AR","Individual","No","71-0226428","75293AR0330001","Blue Cross and Blue Shield Gold 500, a Multi-State Plan","75293AR033","7427051652","ARN201","ARS201","ARF205","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0330001-01","Standard Gold On Exchange Plan",,"0.819735884666443","Yes","Yes","No","100%",,"$500","$60","$1,300","$40","$500","$900","$300","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=28002&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","4"
"2016","WY","90776","HIOS","3","2015-08-27 11:14:25","1","90776","WY","SHOP (Small Group)","Yes","93-0242990","90776WY0030002","EHB High Passive","90776WY003",,"WYN001","WYS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$48.30","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","90776WY0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","WY","90776","HIOS","3","2015-08-27 11:14:25","1","90776","WY","SHOP (Small Group)","Yes","93-0242990","90776WY0030001","EHB Low Passive","90776WY003",,"WYN001","WYS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.19","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","90776WY0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","1","38344","AK","SHOP (Small Group)","No","91-0499247","38344AK0980003","Blue Cross Blue Shield Plus 1000, a Multi-State Plan","38344AK098",,"AKN201","AKS201","AKF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9833",,,,"0","2","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you’re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0980003-01","Standard Gold On Exchange Plan",,"0.786352336406708","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","20%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.premera.com/documents/028492_2016.pdf","https://www.premera.com/documents/031125_2016.pdf","4"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","1","38344","AK","Individual","No","91-0499247","38344AK0620003","Blue Cross Blue Shield Plus 1500, a Multi-State Plan","38344AK062",,"AKN201","AKS201","AKF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","2","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620003-01","Standard Gold On Exchange Plan",,"0.785596191883087","Yes","Yes","No","100%",,"$1,500","$20","$1,200","$200","$1,500","$400","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/028230_2016.pdf","https://www.premera.com/documents/031112_2016.pdf","4"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","1","38344","AK","Individual","No","91-0499247","38344AK0620003","Blue Cross Blue Shield Plus 1500, a Multi-State Plan","38344AK062",,"AKN201","AKS201","AKF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","2","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.premera.com/documents/033199_2016.pdf","https://www.premera.com/documents/031040_2016.pdf","5"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","1","38344","AK","SHOP (Small Group)","No","91-0499247","38344AK0980006","Blue Cross Blue Shield Plus 2000, a Multi-State Plan","38344AK098",,"AKN201","AKS201","AKF202","Existing","PPO","Silver","No","On the Exchange","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9809",,,,"0","2","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you’re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0980006-01","Standard Silver On Exchange Plan",,"0.712011933326721","Yes","Yes","No","100%",,"$2,000","$20","$1,600","$200","$2,000","$600","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.premera.com/documents/028495_2016.pdf","https://www.premera.com/documents/031125_2016.pdf","5"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","1","38344","AK","Individual","No","91-0499247","38344AK0620003","Blue Cross Blue Shield Plus 1500, a Multi-State Plan","38344AK062",,"AKN201","AKS201","AKF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","2","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620003-03","Limited Cost Sharing Plan Variation",,"0.785596191883087","Yes","Yes","No","100%",,"$1,500","$20","$1,200","$200","$1,500","$400","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/033200_2016.pdf","https://www.premera.com/documents/031040_2016.pdf","6"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","1","38344","AK","Individual","No","91-0499247","38344AK0620004","Blue Cross Blue Shield Plus 2000, a Multi-State Plan","38344AK062",,"AKN201","AKS201","AKF202","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","2","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620004-01","Standard Silver On Exchange Plan",,"0.714891314506531","Yes","Yes","No","100%",,"$2,000","$200","$1,600","$200","$2,000","$800","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/028235_2016.pdf","https://www.premera.com/documents/031112_2016.pdf","7"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","1","38344","AK","Individual","No","91-0499247","38344AK0620004","Blue Cross Blue Shield Plus 2000, a Multi-State Plan","38344AK062",,"AKN201","AKS201","AKF202","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","2","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.premera.com/documents/033201_2016.pdf","https://www.premera.com/documents/031040_2016.pdf","8"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","1","38344","AK","Individual","No","91-0499247","38344AK0620004","Blue Cross Blue Shield Plus 2000, a Multi-State Plan","38344AK062",,"AKN201","AKS201","AKF202","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","2","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620004-03","Limited Cost Sharing Plan Variation",,"0.714891314506531","Yes","Yes","No","100%",,"$2,000","$200","$1,600","$200","$2,000","$800","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/033202_2016.pdf","https://www.premera.com/documents/031040_2016.pdf","9"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","1","38344","AK","Individual","No","91-0499247","38344AK0620004","Blue Cross Blue Shield Plus 2000, a Multi-State Plan","38344AK062",,"AKN201","AKS201","AKF202","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","2","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620004-04","73% AV Level Silver Plan",,"0.737512528896332","Yes","Yes","No","100%",,"$2,000","$20","$1,600","$200","$2,000","$800","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/033203_2016.pdf","https://www.premera.com/documents/031112_2016.pdf","10"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","1","38344","AK","Individual","No","91-0499247","38344AK0620004","Blue Cross Blue Shield Plus 2000, a Multi-State Plan","38344AK062",,"AKN201","AKS201","AKF202","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","2","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620004-05","87% AV Level Silver Plan",,"0.874871134757996","Yes","Yes","No","100%",,"$500","$0","$1,100","$200","$500","$700","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/033204_2016.pdf","https://www.premera.com/documents/031112_2016.pdf","11"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","1","38344","AK","Individual","No","91-0499247","38344AK0620004","Blue Cross Blue Shield Plus 2000, a Multi-State Plan","38344AK062",,"AKN201","AKS201","AKF202","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","2","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620004-06","94% AV Level Silver Plan",,"0.949145078659058","Yes","Yes","No","100%",,"$200","$0","$300","$200","$200","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30%",,,,,"$400","$400 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/033205_2016.pdf","https://www.premera.com/documents/031112_2016.pdf","12"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","1","38344","AK","Individual","No","91-0499247","38344AK0620006","Blue Cross Blue Shield Plus 3000, a Multi-State Plan","38344AK062",,"AKN201","AKS201","AKF203","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","2","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620006-01","Standard Silver On Exchange Plan",,"0.714078724384308","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$500","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/028245_2016.pdf","https://www.premera.com/documents/031112_2016.pdf","13"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","1","38344","AK","Individual","No","91-0499247","38344AK0620006","Blue Cross Blue Shield Plus 3000, a Multi-State Plan","38344AK062",,"AKN201","AKS201","AKF203","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","2","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.premera.com/documents/033206_2016.pdf","https://www.premera.com/documents/031040_2016.pdf","14"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","1","38344","AK","Individual","No","91-0499247","38344AK0620006","Blue Cross Blue Shield Plus 3000, a Multi-State Plan","38344AK062",,"AKN201","AKS201","AKF203","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","2","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620006-03","Limited Cost Sharing Plan Variation",,"0.714078724384308","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$500","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/033207_2016.pdf","https://www.premera.com/documents/031040_2016.pdf","15"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","1","38344","AK","Individual","No","91-0499247","38344AK0620006","Blue Cross Blue Shield Plus 3000, a Multi-State Plan","38344AK062",,"AKN201","AKS201","AKF203","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","2","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620006-04","73% AV Level Silver Plan",,"0.736066520214081","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$500","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/033208_2016.pdf","https://www.premera.com/documents/031112_2016.pdf","16"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","1","38344","AK","Individual","No","91-0499247","38344AK0620006","Blue Cross Blue Shield Plus 3000, a Multi-State Plan","38344AK062",,"AKN201","AKS201","AKF203","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","2","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620006-05","87% AV Level Silver Plan",,"0.873358726501465","Yes","Yes","No","100%",,"$1,000","$0","$500","$200","$1,000","$400","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/033209_2016.pdf","https://www.premera.com/documents/031112_2016.pdf","17"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","1","38344","AK","Individual","No","91-0499247","38344AK0620006","Blue Cross Blue Shield Plus 3000, a Multi-State Plan","38344AK062",,"AKN201","AKS201","AKF203","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","2","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620006-06","94% AV Level Silver Plan",,"0.94392853975296","Yes","Yes","No","100%",,"$300","$0","$200","$200","$300","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","20%",,,,,"$600","$600 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/033210_2016.pdf","https://www.premera.com/documents/031112_2016.pdf","18"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","2","38344","AK","SHOP (Small Group)","No","91-0499247","38344AK0980012","Blue Cross Blue Shield Plus 6350, a Multi-State Plan","38344AK098",,"AKN201","AKS201","AKF203","Existing","PPO","Bronze","No","On the Exchange","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9767",,,,"0","0","6","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you’re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0980012-01","Standard Bronze On Exchange Plan",,"0.615849912166595","Yes","Yes","No","100%",,"$6,400","$20","$300","$200","$5,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","30%",,,,,"$12,700","$12700 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.premera.com/documents/028491_2016.pdf","https://www.premera.com/documents/031125_2016.pdf","4"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","2","38344","AK","Individual","No","91-0499247","38344AK0570001","Blue Cross Blue Shield Plus 5250 HSA HIGH, a Multi-State Plan","38344AK057",,"AKN201","AKS201","AKF204","Existing","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9982",,,,"0","0","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7425239228","38344AK0570001-01","Standard Bronze On Exchange Plan",,"0.618741571903229","Yes","Yes","No","100%",,"$5,300","$0","$400","$200","$5,300","$0","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","20%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.premera.com/documents/028246_2016.pdf","https://www.premera.com/documents/031112_2016.pdf","4"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","2","38344","AK","Individual","No","91-0499247","38344AK0570001","Blue Cross Blue Shield Plus 5250 HSA HIGH, a Multi-State Plan","38344AK057",,"AKN201","AKS201","AKF204","Existing","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9982",,,,"0","0","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7425239228","38344AK0570001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/033192_2016.pdf","https://www.premera.com/documents/031040_2016.pdf","5"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","2","38344","AK","Individual","No","91-0499247","38344AK0570001","Blue Cross Blue Shield Plus 5250 HSA HIGH, a Multi-State Plan","38344AK057",,"AKN201","AKS201","AKF204","Existing","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9982",,,,"0","0","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7425239228","38344AK0570001-03","Limited Cost Sharing Plan Variation",,"0.618741571903229","Yes","Yes","No","100%",,"$5,300","$0","$400","$200","$5,300","$0","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","20%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.premera.com/documents/033193_2016.pdf","https://www.premera.com/documents/031040_2016.pdf","6"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","2","38344","AK","Individual","No","91-0499247","38344AK0570002","Blue Cross Blue Shield Plus 3000 HSA HIGH, a Multi-State Plan","38344AK057",,"AKN201","AKS201","AKF204","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7425239228","38344AK0570002-01","Standard Silver On Exchange Plan",,"0.696658730506897","Yes","Yes","No","100%",,"$3,000","$0","$900","$200","$3,000","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.premera.com/documents/028239_2016.pdf","https://www.premera.com/documents/031112_2016.pdf","7"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","2","38344","AK","Individual","No","91-0499247","38344AK0570002","Blue Cross Blue Shield Plus 3000 HSA HIGH, a Multi-State Plan","38344AK057",,"AKN201","AKS201","AKF204","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7425239228","38344AK0570002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/033194_2016.pdf","https://www.premera.com/documents/031040_2016.pdf","8"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","2","38344","AK","Individual","No","91-0499247","38344AK0570002","Blue Cross Blue Shield Plus 3000 HSA HIGH, a Multi-State Plan","38344AK057",,"AKN201","AKS201","AKF204","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7425239228","38344AK0570002-03","Limited Cost Sharing Plan Variation",,"0.696658730506897","Yes","Yes","No","100%",,"$3,000","$0","$900","$200","$3,000","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.premera.com/documents/033195_2016.pdf","https://www.premera.com/documents/031040_2016.pdf","9"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","2","38344","AK","Individual","No","91-0499247","38344AK0570002","Blue Cross Blue Shield Plus 3000 HSA HIGH, a Multi-State Plan","38344AK057",,"AKN201","AKS201","AKF204","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7425239228","38344AK0570002-04","73% AV Level Silver Plan",,"0.720484733581543","Yes","Yes","No","100%",,"$2,600","$0","$900","$200","$2,600","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.premera.com/documents/033196_2016.pdf","https://www.premera.com/documents/031112_2016.pdf","10"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","2","38344","AK","Individual","No","91-0499247","38344AK0570002","Blue Cross Blue Shield Plus 3000 HSA HIGH, a Multi-State Plan","38344AK057",,"AKN201","AKS201","AKF204","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7425239228","38344AK0570002-05","87% AV Level Silver Plan",,"0.861618638038635","Yes","Yes","No","100%",,"$800","$0","$800","$200","$800","$0","$800","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/033197_2016.pdf","https://www.premera.com/documents/031112_2016.pdf","11"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","2","38344","AK","Individual","No","91-0499247","38344AK0570002","Blue Cross Blue Shield Plus 3000 HSA HIGH, a Multi-State Plan","38344AK057",,"AKN201","AKS201","AKF204","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7425239228","38344AK0570002-06","94% AV Level Silver Plan",,"0.94278472661972","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/033198_2016.pdf","https://www.premera.com/documents/031112_2016.pdf","12"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","3","38344","AK","Individual","No","91-0499247","38344AK0620008","Blue Cross Blue Shield Plus 6350, a Multi-State Plan","38344AK062",,"AKN201","AKS201","AKF204","Existing","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7425239228","38344AK0620008-01","Standard Bronze On Exchange Plan",,"0.619036376476288","Yes","Yes","No","100%",,"$6,400","$0","$200","$200","$5,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","20%",,,,,"$12,700","$12700 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/028252_2016.pdf","https://www.premera.com/documents/031112_2016.pdf","4"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","3","38344","AK","Individual","No","91-0499247","38344AK0620008","Blue Cross Blue Shield Plus 6350, a Multi-State Plan","38344AK062",,"AKN201","AKS201","AKF204","Existing","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7425239228","38344AK0620008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.premera.com/documents/033211_2016.pdf","https://www.premera.com/documents/031040_2016.pdf","5"
"2016","AK","38344","OPM","10","2016-03-05 07:51:04","3","38344","AK","Individual","No","91-0499247","38344AK0620008","Blue Cross Blue Shield Plus 6350, a Multi-State Plan","38344AK062",,"AKN201","AKS201","AKF204","Existing","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7425239228","38344AK0620008-03","Limited Cost Sharing Plan Variation",,"0.619036376476288","Yes","Yes","No","100%",,"$6,400","$0","$200","$200","$5,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","20%",,,,,"$12,700","$12700 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.premera.com/documents/033212_2016.pdf","https://www.premera.com/documents/031040_2016.pdf","6"
"2016","AL","46944","OPM","5","2015-10-23 10:28:16","1","46944","AL","Individual","No","63-0103830","46944AL0620001","Blue Cross Select Gold, a Multi-State Plan","46944AL062","7346243505","ALN201","ALS201","ALF201","New","PPO","Gold","Yes","On the Exchange","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0620001-01","Standard Gold On Exchange Plan","78.08%",,"No","Yes","Yes","95%","5%","$850","$400","$0","$200","$20","$1,300","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","20%","$850","$850 per person","$1700 per group","20%","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016gms.pdf","https://www.ibcbsal.com/bb/2016gms.pdf","4"
"2016","AL","46944","OPM","5","2015-10-23 10:28:16","1","46944","AL","Individual","No","63-0103830","46944AL0620001","Blue Cross Select Gold, a Multi-State Plan","46944AL062","7346243505","ALN201","ALS201","ALF201","New","PPO","Gold","Yes","On the Exchange","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0620001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","95%","5%","$0","$0","$0","$200","$0","$0","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016gms-nocost.pdf","https://www.ibcbsal.com/bb/2016gms-nocost.pdf","5"
"2016","AL","46944","OPM","5","2015-10-23 10:28:16","1","46944","AL","Individual","No","63-0103830","46944AL0620001","Blue Cross Select Gold, a Multi-State Plan","46944AL062","7346243505","ALN201","ALS201","ALF201","New","PPO","Gold","Yes","On the Exchange","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0620001-03","Limited Cost Sharing Plan Variation","78.08%",,"No","Yes","Yes","95%","5%","$850","$400","$0","$200","$20","$1,300","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","20%","$850","$850 per person","$1700 per group","20%","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016gms-limited.pdf","https://www.ibcbsal.com/bb/2016gms-limited.pdf","6"
"2016","AL","46944","OPM","5","2015-10-23 10:28:16","2","46944","AL","Individual","No","63-0103830","46944AL0630001","Blue Cross Select Silver, a Multi-State Plan","46944AL063","7346243505","ALN201","ALS201","ALF202","New","PPO","Silver","Yes","On the Exchange","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0630001-01","Standard Silver On Exchange Plan","68.07%",,"No","Yes","Yes","95%","5%","$2,800","$700","$0","$200","$20","$1,700","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","20%","$2,800","$2800 per person","$5600 per group","20%","$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016sms.pdf","https://www.ibcbsal.com/bb/2016sms.pdf","4"
"2016","AL","46944","OPM","5","2015-10-23 10:28:16","2","46944","AL","Individual","No","63-0103830","46944AL0630001","Blue Cross Select Silver, a Multi-State Plan","46944AL063","7346243505","ALN201","ALS201","ALF202","New","PPO","Silver","Yes","On the Exchange","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0630001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","95%","5%","$0","$0","$0","$200","$0","$0","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016sms-nocost.pdf","https://www.ibcbsal.com/bb/2016sms-nocost.pdf","5"
"2016","AL","46944","OPM","5","2015-10-23 10:28:16","2","46944","AL","Individual","No","63-0103830","46944AL0630001","Blue Cross Select Silver, a Multi-State Plan","46944AL063","7346243505","ALN201","ALS201","ALF202","New","PPO","Silver","Yes","On the Exchange","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0630001-03","Limited Cost Sharing Plan Variation","68.07%",,"No","Yes","Yes","95%","5%","$2,800","$700","$0","$200","$20","$1,700","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","20%","$2,800","$2800 per person","$5600 per group","20%","$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016sms-limited.pdf","https://www.ibcbsal.com/bb/2016sms-limited.pdf","6"
"2016","AL","46944","OPM","5","2015-10-23 10:28:16","2","46944","AL","Individual","No","63-0103830","46944AL0630001","Blue Cross Select Silver, a Multi-State Plan","46944AL063","7346243505","ALN201","ALS201","ALF202","New","PPO","Silver","Yes","On the Exchange","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0630001-04","73% AV Level Silver Plan","72.95%",,"No","Yes","Yes","95%","5%","$2,000","$600","$0","$200","$20","$1,100","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016sms-73.pdf","https://www.ibcbsal.com/bb/2016sms-73.pdf","7"
"2016","AL","46944","OPM","5","2015-10-23 10:28:16","2","46944","AL","Individual","No","63-0103830","46944AL0630001","Blue Cross Select Silver, a Multi-State Plan","46944AL063","7346243505","ALN201","ALS201","ALF202","New","PPO","Silver","Yes","On the Exchange","No","Yes","All specialists seen in an office setting, excluding OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"5","0","0","2016-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://sso.bcbsal.org/sp/ACS.saml2","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_AL_4T_Essential.pdf","46944AL0630001-05","87% AV Level Silver Plan","86.99%",,"No","Yes","Yes","95%","5%","$450","$600","$0","$200","$20","$700","$0","$400",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","20%","$450","$450 per person","$900 per group","20%","$450","$450 per person","$900 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibcbsal.com/sbc/2016sms-87.pdf","https://www.ibcbsal.com/bb/2016sms-87.pdf","8"
"2016","AR","75293","OPM","2","2016-01-29 07:27:50","1","75293","AR","Individual","No","71-0226428","75293AR0330001","Blue Cross and Blue Shield Gold 500, a Multi-State Plan","75293AR033","7427051652","ARN201","ARS201","ARF205","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0330001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34007&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","5"
"2016","AR","75293","OPM","2","2016-01-29 07:27:50","1","75293","AR","Individual","No","71-0226428","75293AR0330001","Blue Cross and Blue Shield Gold 500, a Multi-State Plan","75293AR033","7427051652","ARN201","ARS201","ARF205","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0330001-03","Limited Cost Sharing Plan Variation",,"0.819735884666443","Yes","Yes","No","100%",,"$500","$60","$1,300","$40","$500","$900","$300","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=29002&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","6"
"2016","AR","75293","OPM","2","2016-01-29 07:27:50","2","75293","AR","Individual","No","71-0226428","75293AR0350001","Blue Cross and Blue Shield Silver 2600, a Multi-State Plan","75293AR035","7427051652","ARN201","ARS201","ARF221","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0350001-01","Standard Silver On Exchange Plan","71.54%",,"No","Yes","No","100%",,"$2,600","$30","$0","$40","$1,600","$1,500","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","30%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32027&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","4"
"2016","AR","75293","OPM","2","2016-01-29 07:27:50","2","75293","AR","Individual","No","71-0226428","75293AR0350001","Blue Cross and Blue Shield Silver 2600, a Multi-State Plan","75293AR035","7427051652","ARN201","ARS201","ARF221","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0350001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34015&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","5"
"2016","AR","75293","OPM","2","2016-01-29 07:27:50","2","75293","AR","Individual","No","71-0226428","75293AR0350001","Blue Cross and Blue Shield Silver 2600, a Multi-State Plan","75293AR035","7427051652","ARN201","ARS201","ARF221","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0350001-03","Limited Cost Sharing Plan Variation","71.54%",,"No","Yes","No","100%",,"$2,600","$30","$0","$40","$1,600","$1,500","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","30%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=33005&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","6"
"2016","AR","75293","OPM","2","2016-01-29 07:27:50","2","75293","AR","Individual","No","71-0226428","75293AR0350001","Blue Cross and Blue Shield Silver 2600, a Multi-State Plan","75293AR035","7427051652","ARN201","ARS201","ARF221","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0350001-04","73% AV Level Silver Plan","73.92%",,"No","Yes","No","100%",,"$2,300","$30","$0","$40","$1,600","$1,500","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,300","$2300 per person","$4600 per group","30%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32028&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","7"
"2016","AR","75293","OPM","2","2016-01-29 07:27:50","2","75293","AR","Individual","No","71-0226428","75293AR0350001","Blue Cross and Blue Shield Silver 2600, a Multi-State Plan","75293AR035","7427051652","ARN201","ARS201","ARF221","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0350001-05","87% AV Level Silver Plan","87.68%",,"No","Yes","No","100%",,"$500","$20","$200","$40","$500","$1,000","$80","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32029&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","8"
"2016","AR","75293","OPM","2","2016-01-29 07:27:50","2","75293","AR","Individual","No","71-0226428","75293AR0350001","Blue Cross and Blue Shield Silver 2600, a Multi-State Plan","75293AR035","7427051652","ARN201","ARS201","ARF221","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0350001-06","94% AV Level Silver Plan","94.93%",,"No","Yes","No","100%",,"$200","$10","$0","$40","$200","$200","$50","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$829","$829 per person","$1658 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$225","$225 per person","$450 per group","0%",,,,,"$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32030&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","9"
"2016","AR","75293","OPM","2","2016-01-29 07:27:50","3","75293","AR","Individual","No","71-0226428","75293AR0290001","Blue Cross and Blue Shield Bronze 6200, a Multi-State Plan","75293AR029","7427051652","ARN201","ARS201","ARF248","Existing","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0290001-01","Standard Bronze On Exchange Plan",,"0.619738042354584","Yes","Yes","No","100%",,"$6,200","$30","$300","$40","$1,600","$800","$900","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","50%",,,,,"$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23004&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","4"
"2016","AR","75293","OPM","2","2016-01-29 07:27:50","3","75293","AR","Individual","No","71-0226428","75293AR0290001","Blue Cross and Blue Shield Bronze 6200, a Multi-State Plan","75293AR029","7427051652","ARN201","ARS201","ARF248","Existing","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0290001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34013&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","5"
"2016","AR","75293","OPM","2","2016-01-29 07:27:50","3","75293","AR","Individual","No","71-0226428","75293AR0290001","Blue Cross and Blue Shield Bronze 6200, a Multi-State Plan","75293AR029","7427051652","ARN201","ARS201","ARF248","Existing","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0290001-03","Limited Cost Sharing Plan Variation",,"0.619738042354584","Yes","Yes","No","100%",,"$6,200","$30","$300","$40","$1,600","$800","$900","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","50%",,,,,"$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=24004&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","6"
"2016","DE","76168","OPM","5","2016-01-26 09:59:26","1","76168","DE","Individual","No","51-0020405","76168DE0390002","Blue Cross Blue Shield Health Savings 2100, a Multi-State Plan","76168DE039",,"DEN201","DES201","DEF201","Existing","EPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0390002-01","Standard Gold On Exchange Plan",,"0.799147665500641","Yes","Yes","No","100%",,"$2,100","$0","$0","$0","$2,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbsde.com/sbc/bcbsde.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/delaware","4"
"2016","DE","76168","OPM","5","2016-01-26 09:59:26","1","76168","DE","Individual","No","51-0020405","76168DE0390002","Blue Cross Blue Shield Health Savings 2100, a Multi-State Plan","76168DE039",,"DEN201","DES201","DEF201","Existing","EPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0390002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.highmarkbcbsde.com/sbc/bcbsde.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/delaware","5"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970030","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS046","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970030-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$500","$310","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970030","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS046","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970030-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970030","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS046","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970030-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","DE","76168","OPM","5","2016-01-26 09:59:26","1","76168","DE","Individual","No","51-0020405","76168DE0390002","Blue Cross Blue Shield Health Savings 2100, a Multi-State Plan","76168DE039",,"DEN201","DES201","DEF201","Existing","EPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0390002-03","Limited Cost Sharing Plan Variation",,"0.799147665500641","Yes","Yes","No","100%",,"$2,100","$0","$0","$0","$2,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbsde.com/sbc/bcbsde.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/delaware","6"
"2016","DE","76168","OPM","5","2016-01-26 09:59:26","2","76168","DE","Individual","No","51-0020405","76168DE0390001","Blue Cross Blue Shield Shared Cost Blue 3100, a Multi-State Plan","76168DE039",,"DEN201","DES201","DEF202","Existing","EPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0390001-01","Standard Silver On Exchange Plan",,"0.713368356227875","No","Yes","No","100%",,"$3,100","$200","$900","$0","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/bcbsde.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/delaware","4"
"2016","DE","76168","OPM","5","2016-01-26 09:59:26","2","76168","DE","Individual","No","51-0020405","76168DE0390001","Blue Cross Blue Shield Shared Cost Blue 3100, a Multi-State Plan","76168DE039",,"DEN201","DES201","DEF202","Existing","EPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0390001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/bcbsde.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/delaware","5"
"2016","DE","76168","OPM","5","2016-01-26 09:59:26","2","76168","DE","Individual","No","51-0020405","76168DE0390001","Blue Cross Blue Shield Shared Cost Blue 3100, a Multi-State Plan","76168DE039",,"DEN201","DES201","DEF202","Existing","EPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0390001-03","Limited Cost Sharing Plan Variation",,"0.713368356227875","No","Yes","No","100%",,"$3,100","$200","$900","$0","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/bcbsde.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/delaware","6"
"2016","DE","76168","OPM","5","2016-01-26 09:59:26","2","76168","DE","Individual","No","51-0020405","76168DE0390001","Blue Cross Blue Shield Shared Cost Blue 3100, a Multi-State Plan","76168DE039",,"DEN201","DES201","DEF202","Existing","EPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0390001-04","73% AV Level Silver Plan",,"0.739495098590851","No","Yes","No","100%",,"$2,500","$200","$800","$0","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/bcbsde.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/delaware","7"
"2016","DE","76168","OPM","5","2016-01-26 09:59:26","2","76168","DE","Individual","No","51-0020405","76168DE0390001","Blue Cross Blue Shield Shared Cost Blue 3100, a Multi-State Plan","76168DE039",,"DEN201","DES201","DEF202","Existing","EPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0390001-05","87% AV Level Silver Plan",,"0.868446886539459","No","Yes","No","100%",,"$750","$90","$600","$0","$750","$700","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/bcbsde.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/delaware","8"
"2016","DE","76168","OPM","5","2016-01-26 09:59:26","2","76168","DE","Individual","No","51-0020405","76168DE0390001","Blue Cross Blue Shield Shared Cost Blue 3100, a Multi-State Plan","76168DE039",,"DEN201","DES201","DEF202","Existing","EPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0390001-06","94% AV Level Silver Plan",,"0.930503368377686","No","Yes","No","100%",,"$200","$50","$500","$0","$200","$450","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/bcbsde.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/delaware","9"
"2016","GA","49046","OPM","3","2016-01-26 09:59:26","1","49046","GA","Individual","No","58-1638390","49046GA0610003","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess a Multi State Plan","49046GA061",,"GAN201","GAS201","GAF205","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","www.bcbsga.com/GASelectdrugtier4","49046GA0610003-01","Standard Silver On Exchange Plan","70.53%","0.728377044200897","Yes","Yes","No","100%",,"$2,000","$900","$900","$0","$500","$1,700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1G64","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","4"
"2016","GA","49046","OPM","3","2016-01-26 09:59:26","1","49046","GA","Individual","No","58-1638390","49046GA0610003","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess a Multi State Plan","49046GA061",,"GAN201","GAS201","GAF205","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","www.bcbsga.com/GASelectdrugtier4","49046GA0610003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1G68","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","5"
"2016","GA","49046","OPM","3","2016-01-26 09:59:26","1","49046","GA","Individual","No","58-1638390","49046GA0610003","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess a Multi State Plan","49046GA061",,"GAN201","GAS201","GAF205","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","www.bcbsga.com/GASelectdrugtier4","49046GA0610003-03","Limited Cost Sharing Plan Variation","70.53%","0.728377044200897","Yes","Yes","No","100%",,"$2,000","$900","$900","$0","$500","$1,700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1G64","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","6"
"2016","GA","49046","OPM","3","2016-01-26 09:59:26","1","49046","GA","Individual","No","58-1638390","49046GA0610003","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess a Multi State Plan","49046GA061",,"GAN201","GAS201","GAF205","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","www.bcbsga.com/GASelectdrugtier4","49046GA0610003-04","73% AV Level Silver Plan","73.13%","0.748122990131378","Yes","Yes","No","100%",,"$2,000","$900","$900","$0","$500","$1,700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1G65","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","7"
"2016","GA","49046","OPM","3","2016-01-26 09:59:26","1","49046","GA","Individual","No","58-1638390","49046GA0610003","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess a Multi State Plan","49046GA061",,"GAN201","GAS201","GAF205","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","www.bcbsga.com/GASelectdrugtier4","49046GA0610003-05","87% AV Level Silver Plan","86.14%","0.867201924324036","Yes","Yes","No","100%",,"$700","$500","$500","$0","$500","$1,200","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1G66","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","8"
"2016","GA","49046","OPM","3","2016-01-26 09:59:26","1","49046","GA","Individual","No","58-1638390","49046GA0610003","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess a Multi State Plan","49046GA061",,"GAN201","GAS201","GAF205","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","www.bcbsga.com/GASelectdrugtier4","49046GA0610003-06","94% AV Level Silver Plan","93.30%","0.931320071220398","Yes","Yes","No","100%",,"$200","$200","$300","$0","$200","$400","$10","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1G67","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","9"
"2016","GA","49046","OPM","3","2016-01-26 09:59:26","2","49046","GA","Individual","No","58-1638390","49046GA0610004","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold DirectAccess a Multi State Plan","49046GA061",,"GAN201","GAS201","GAF204","Existing","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","www.bcbsga.com/GASelectdrugtier4","49046GA0610004-01","Standard Gold On Exchange Plan","79.75%","0.805611431598663","Yes","Yes","No","100%",,"$1,200","$1,100","$500","$0","$500","$1,700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1G6A","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","4"
"2016","GA","49046","OPM","3","2016-01-26 09:59:26","2","49046","GA","Individual","No","58-1638390","49046GA0610004","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold DirectAccess a Multi State Plan","49046GA061",,"GAN201","GAS201","GAF204","Existing","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","www.bcbsga.com/GASelectdrugtier4","49046GA0610004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"www.sbc.anthem.com/dps/ccd1G6B","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","5"
"2016","GA","49046","OPM","3","2016-01-26 09:59:26","2","49046","GA","Individual","No","58-1638390","49046GA0610004","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold DirectAccess a Multi State Plan","49046GA061",,"GAN201","GAS201","GAF204","Existing","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=GA","www.bcbsga.com/GASelectdrugtier4","49046GA0610004-03","Limited Cost Sharing Plan Variation","79.75%","0.805611431598663","Yes","Yes","No","100%",,"$1,200","$1,100","$500","$0","$500","$1,700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1G6A","http://editiondigital.net/view/IU65/2016/ON_HIX_GA_KIT_2016","6"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970003","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS016","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970003-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$500","$310","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970003","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS016","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970003","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS016","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970003-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970028","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS026","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970028-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$500","$310","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970028","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS026","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970028-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970031","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS056","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970031-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$500","$310","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970031","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS056","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970031-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970031","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS056","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970031-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS016","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970002-01","Standard Silver On Exchange Plan","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$300","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS016","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS016","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970002-03","Limited Cost Sharing Plan Variation","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$0","$200","$3,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970019","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS056","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970019-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$300","$800","$200","$800","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","32"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970019","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS056","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970019-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","33"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970032","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS066","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970032-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$500","$310","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970032","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS066","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970032-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970032","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS066","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970032-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970033","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS076","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970033-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$500","$310","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970033","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS076","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970033-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970033","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS076","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970033-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970034","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS086","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970034-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$500","$310","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970034","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS086","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970034-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0970034","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS086","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970034-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0970035","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS096","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970035-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$500","$310","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0970035","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS096","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970035-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0970035","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS096","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970035-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0970036","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS106","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970036-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$500","$310","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0970036","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS106","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970036-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0970036","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS106","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970036-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0970037","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS116","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970037-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$500","$310","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0970037","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS116","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970037-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0970037","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS116","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970037-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0970038","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS126","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970038-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$500","$310","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0970038","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS126","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970038-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0970038","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS126","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970038-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0970039","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS136","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970039-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$500","$310","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0970039","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS136","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970039-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0970039","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","36096IL097",,"ILN006","ILS136","ILF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970039-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS016","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970002-04","73% AV Level Silver Plan","73.02%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS016","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970002-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$300","$800","$200","$800","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS016","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970002-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970016","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS026","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970016-01","Standard Silver On Exchange Plan","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$300","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970016","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS026","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970016-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970016","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS026","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970016-03","Limited Cost Sharing Plan Variation","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$0","$200","$3,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970016","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS026","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970016-04","73% AV Level Silver Plan","73.02%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970016","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS026","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970016-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$300","$800","$200","$800","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970016","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS026","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970016-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970017","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS036","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970017-01","Standard Silver On Exchange Plan","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$300","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970017","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS036","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970017-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970017","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS036","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970017-03","Limited Cost Sharing Plan Variation","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$0","$200","$3,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970017","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS036","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970017-04","73% AV Level Silver Plan","73.02%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970017","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS036","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970017-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$300","$800","$200","$800","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970017","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS036","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970017-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970018","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS046","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970018-01","Standard Silver On Exchange Plan","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$300","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970018","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS046","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970018-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970018","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS046","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970018-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$300","$800","$200","$800","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970018","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS046","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970018-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970019","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS056","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970019-01","Standard Silver On Exchange Plan","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$300","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970026","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS126","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970026-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970027","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS136","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970027-01","Standard Silver On Exchange Plan","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$300","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970027","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS136","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970027-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970027","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS136","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970027-03","Limited Cost Sharing Plan Variation","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$0","$200","$3,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","30"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970027","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS136","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970027-04","73% AV Level Silver Plan","73.02%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","31"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970019","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS056","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970019-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970019","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS056","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970019-03","Limited Cost Sharing Plan Variation","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$0","$200","$3,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","30"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970019","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS056","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970019-04","73% AV Level Silver Plan","73.02%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","31"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970020","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS066","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970020-01","Standard Silver On Exchange Plan","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$300","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","34"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970020","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS066","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970020-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","35"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970020","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS066","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970020-03","Limited Cost Sharing Plan Variation","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$0","$200","$3,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","36"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970020","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS066","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970020-04","73% AV Level Silver Plan","73.02%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","37"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970020","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS066","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970020-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$300","$800","$200","$800","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","38"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970020","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS066","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970020-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","39"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970021","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS076","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970021-01","Standard Silver On Exchange Plan","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$300","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","40"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970021","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS076","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970021-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","41"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970021","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS076","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970021-03","Limited Cost Sharing Plan Variation","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$0","$200","$3,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","42"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970021","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS076","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970021-04","73% AV Level Silver Plan","73.02%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","43"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970021","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS076","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970021-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$300","$800","$200","$800","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","44"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970021","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS076","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970021-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","45"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970022","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS086","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970022-01","Standard Silver On Exchange Plan","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$300","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","46"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970022","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS086","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970022-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","47"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970022","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS086","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970022-03","Limited Cost Sharing Plan Variation","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$0","$200","$3,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","48"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970022","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS086","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970022-04","73% AV Level Silver Plan","73.02%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","49"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970022","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS086","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970022-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$300","$800","$200","$800","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","50"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0970022","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS086","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970022-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","51"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970023","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS096","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970023-01","Standard Silver On Exchange Plan","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$300","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970023","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS096","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970023-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970023","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS096","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970023-03","Limited Cost Sharing Plan Variation","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$0","$200","$3,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970023","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS096","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970023-04","73% AV Level Silver Plan","73.02%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970023","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS096","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970023-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$300","$800","$200","$800","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970023","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS096","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970023-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970024","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS106","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970024-01","Standard Silver On Exchange Plan","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$300","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970024","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS106","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970024-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970024","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS106","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970024-03","Limited Cost Sharing Plan Variation","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$0","$200","$3,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970004","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS026","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970004","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS026","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970004-03","Limited Cost Sharing Plan Variation","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$0","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0970013","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS116","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970013-01","Standard Gold On Exchange Plan","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0970013","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS116","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0970013","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS116","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970013-03","Limited Cost Sharing Plan Variation","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$0","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970024","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS106","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970024-04","73% AV Level Silver Plan","73.02%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970024","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS106","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970024-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$300","$800","$200","$800","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970024","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS106","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970024-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970025","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS116","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970025-01","Standard Silver On Exchange Plan","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$300","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970025","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS116","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970025-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970025","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS116","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970025-03","Limited Cost Sharing Plan Variation","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$0","$200","$3,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970025","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS116","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970025-04","73% AV Level Silver Plan","73.02%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970025","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS116","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970025-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$300","$800","$200","$800","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970025","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS116","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970025-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970026","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS126","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970026-01","Standard Silver On Exchange Plan","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$300","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970026","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS126","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970026-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970026","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS126","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970026-03","Limited Cost Sharing Plan Variation","68.92%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$0","$200","$3,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970026","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS126","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970026-04","73% AV Level Silver Plan","73.02%","0","Yes","Yes","Yes","60%","40%","$3,400","$400","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970026","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS126","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970026-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$300","$800","$200","$800","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970027","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS136","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970027-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$300","$800","$200","$800","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","32"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0970027","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","36096IL097",,"ILN006","ILS136","ILF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970027-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","33"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970001","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS016","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970001-01","Standard Gold On Exchange Plan","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970001","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS016","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970001","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS016","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970001-03","Limited Cost Sharing Plan Variation","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$0","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970004","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS026","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970004-01","Standard Gold On Exchange Plan","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970005","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS036","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970005-01","Standard Gold On Exchange Plan","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970005","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS036","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970005","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS036","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970005-03","Limited Cost Sharing Plan Variation","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$0","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS046","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970006-01","Standard Gold On Exchange Plan","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS046","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS046","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970006-03","Limited Cost Sharing Plan Variation","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$0","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970007","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS056","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970007-01","Standard Gold On Exchange Plan","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970007","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS056","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970007","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS056","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970007-03","Limited Cost Sharing Plan Variation","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$0","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970008","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS066","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970008-01","Standard Gold On Exchange Plan","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970008","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS066","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970008","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS066","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970008-03","Limited Cost Sharing Plan Variation","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$0","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970009","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS076","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970009-01","Standard Gold On Exchange Plan","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970009","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS076","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970009","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS076","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970009-03","Limited Cost Sharing Plan Variation","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$0","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970010","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS086","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970010-01","Standard Gold On Exchange Plan","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970010","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS086","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0970010","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS086","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970010-03","Limited Cost Sharing Plan Variation","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$0","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0970011","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS096","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970011-01","Standard Gold On Exchange Plan","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0970011","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS096","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0970011","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS096","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970011-03","Limited Cost Sharing Plan Variation","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$0","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0970012","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS106","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970012-01","Standard Gold On Exchange Plan","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0970012","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS106","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0970012","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS106","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970012-03","Limited Cost Sharing Plan Variation","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$0","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0970014","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS126","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970014-01","Standard Gold On Exchange Plan","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0970014","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS126","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970014-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0970014","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS126","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970014-03","Limited Cost Sharing Plan Variation","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$0","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0970015","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS136","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970015-01","Standard Gold On Exchange Plan","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$300","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0970015","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS136","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","OPM","6","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0970015","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","36096IL097",,"ILN006","ILS136","ILF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0970015-03","Limited Cost Sharing Plan Variation","78.82%","0","Yes","Yes","Yes","60%","40%","$1,800","$0","$0","$200","$1,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0970001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IN","17575","OPM","8","2016-01-27 11:15:49","1","17575","IN","Individual","No","35-0781558","17575IN0930005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","17575IN093",,"INN201","INS201","INF206","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","www.anthem.com/INSelectdrugtier4","17575IN0930005-01","Standard Silver On Exchange Plan","70.67%","0.716616690158844","Yes","Yes","No","100%",,"$2,000","$1,000","$900","$0","$500","$2,000","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GFA","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","4"
"2016","IN","17575","OPM","8","2016-01-27 11:15:49","1","17575","IN","Individual","No","35-0781558","17575IN0930005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","17575IN093",,"INN201","INS201","INF206","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","www.anthem.com/INSelectdrugtier4","17575IN0930005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GG0","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","5"
"2016","IN","17575","OPM","8","2016-01-27 11:15:49","1","17575","IN","Individual","No","35-0781558","17575IN0930005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","17575IN093",,"INN201","INS201","INF206","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","www.anthem.com/INSelectdrugtier4","17575IN0930005-03","Limited Cost Sharing Plan Variation","70.67%","0.716616690158844","Yes","Yes","No","100%",,"$2,000","$1,000","$900","$0","$500","$2,000","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GFA","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","6"
"2016","IN","17575","OPM","8","2016-01-27 11:15:49","1","17575","IN","Individual","No","35-0781558","17575IN0930005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","17575IN093",,"INN201","INS201","INF206","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","www.anthem.com/INSelectdrugtier4","17575IN0930005-04","73% AV Level Silver Plan","73.71%","0.743468225002289","Yes","Yes","No","100%",,"$2,000","$900","$900","$0","$500","$1,700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GFB","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","7"
"2016","IN","17575","OPM","8","2016-01-27 11:15:49","1","17575","IN","Individual","No","35-0781558","17575IN0930005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","17575IN093",,"INN201","INS201","INF206","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","www.anthem.com/INSelectdrugtier4","17575IN0930005-05","87% AV Level Silver Plan","87.65%","0.873311877250671","Yes","Yes","No","100%",,"$800","$500","$300","$0","$500","$1,000","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GFC","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","8"
"2016","IN","17575","OPM","8","2016-01-27 11:15:49","1","17575","IN","Individual","No","35-0781558","17575IN0930005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","17575IN093",,"INN201","INS201","INF206","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=IN","www.anthem.com/INSelectdrugtier4","17575IN0930005-06","94% AV Level Silver Plan","94.07%","0.93763667345047","Yes","Yes","No","100%",,"$200","$100","$300","$0","$200","$400","$10","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GFD","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","9"
"2016","IN","17575","OPM","8","2016-01-27 11:15:49","2","17575","IN","Individual","No","35-0781558","17575IN0930006","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","17575IN093",,"INN201","INS201","INF204","Existing","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No",,"www.anthem.com/INSelectdrugtier4","17575IN0930006-01","Standard Gold On Exchange Plan","80.29%","0.813572406768799","Yes","Yes","No","100%",,"$1,000","$1,100","$500","$0","$500","$1,700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GFE","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","4"
"2016","IN","17575","OPM","8","2016-01-27 11:15:49","2","17575","IN","Individual","No","35-0781558","17575IN0930006","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","17575IN093",,"INN201","INS201","INF204","Existing","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No",,"www.anthem.com/INSelectdrugtier4","17575IN0930006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GG1","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","5"
"2016","IN","17575","OPM","8","2016-01-27 11:15:49","2","17575","IN","Individual","No","35-0781558","17575IN0930006","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","17575IN093",,"INN201","INS201","INF204","Existing","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No",,"www.anthem.com/INSelectdrugtier4","17575IN0930006-03","Limited Cost Sharing Plan Variation","80.29%","0.813572406768799","Yes","Yes","No","100%",,"$1,000","$1,100","$500","$0","$500","$1,700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GFE","http://editiondigital.net/view/IU65/2016/ON_HIX_IN_KIT_2016","6"
"2016","KS","18558","OPM","3","2015-11-18 10:26:26","1","18558","KS","Individual","No","48-0952857","18558KS0380001","Blue Cross and Blue Shield FreedomPlus, a Multi-State Plan","18558KS038",,"KSN201","KSS201","KSF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0380001-01","Standard Gold On Exchange Plan",,"0.78017795085907","No","Yes","No","100%",,"$1,000","$0","$1,200","$200","$300","$400","$1,500","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","50%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0380001-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0380001-01","4"
"2016","KS","18558","OPM","3","2015-11-18 10:26:26","1","18558","KS","Individual","No","48-0952857","18558KS0380001","Blue Cross and Blue Shield FreedomPlus, a Multi-State Plan","18558KS038",,"KSN201","KSS201","KSF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0380001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0380001-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0380001-02","5"
"2016","KS","18558","OPM","3","2015-11-18 10:26:26","1","18558","KS","Individual","No","48-0952857","18558KS0380001","Blue Cross and Blue Shield FreedomPlus, a Multi-State Plan","18558KS038",,"KSN201","KSS201","KSF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0380001-03","Limited Cost Sharing Plan Variation",,"0.78017795085907","No","Yes","No","100%",,"$1,000","$0","$1,200","$200","$300","$400","$1,500","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","50%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0380001-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0380001-03","6"
"2016","KS","18558","OPM","3","2015-11-18 10:26:26","1","18558","KS","Individual","No","48-0952857","18558KS0380002","Blue Cross and Blue Shield Freedom, a Multi-State Plan","18558KS038",,"KSN201","KSS201","KSF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0380002-01","Standard Silver On Exchange Plan",,"0.687159419059753","No","Yes","No","100%",,"$2,200","$0","$1,000","$200","$400","$400","$2,000","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","50%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0380002-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0380002-01","7"
"2016","KS","18558","OPM","3","2015-11-18 10:26:26","1","18558","KS","Individual","No","48-0952857","18558KS0380002","Blue Cross and Blue Shield Freedom, a Multi-State Plan","18558KS038",,"KSN201","KSS201","KSF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0380002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0380002-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0380002-02","8"
"2016","KS","18558","OPM","3","2015-11-18 10:26:26","1","18558","KS","Individual","No","48-0952857","18558KS0380002","Blue Cross and Blue Shield Freedom, a Multi-State Plan","18558KS038",,"KSN201","KSS201","KSF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0380002-03","Limited Cost Sharing Plan Variation",,"0.687159419059753","No","Yes","No","100%",,"$2,200","$0","$1,000","$200","$400","$400","$2,000","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","50%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0380002-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0380002-03","9"
"2016","KS","18558","OPM","3","2015-11-18 10:26:26","1","18558","KS","Individual","No","48-0952857","18558KS0380002","Blue Cross and Blue Shield Freedom, a Multi-State Plan","18558KS038",,"KSN201","KSS201","KSF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0380002-04","73% AV Level Silver Plan",,"0.720406591892242","No","Yes","No","100%",,"$2,000","$0","$1,000","$200","$400","$400","$2,000","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","50%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0380002-04","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0380002-04","10"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","3","48396","ME","Individual","No","31-1705652","48396ME0940005","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES203","MEF210","Existing","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://shop.anthem.com/sales/eox/payment/landing/co","www.anthem.com/MESelectdrugtier4","48396ME0940005-04","73% AV Level Silver Plan","73.89%","0.73619931936264","Yes","Yes","No","100%",,"$2,300","$80","$1,000","$0","$500","$1,700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J3R","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","16"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","3","48396","ME","Individual","No","31-1705652","48396ME0940005","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES203","MEF210","Existing","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://shop.anthem.com/sales/eox/payment/landing/co","www.anthem.com/MESelectdrugtier4","48396ME0940005-05","87% AV Level Silver Plan","87.37%","0.872969746589661","Yes","Yes","No","100%",,"$800","$40","$700","$0","$500","$1,000","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J3S","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","17"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","3","48396","ME","Individual","No","31-1705652","48396ME0940005","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES203","MEF210","Existing","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://shop.anthem.com/sales/eox/payment/landing/co","www.anthem.com/MESelectdrugtier4","48396ME0940005-06","94% AV Level Silver Plan","93.87%","0.93978750705719","Yes","Yes","No","100%",,"$200","$40","$400","$0","$200","$400","$10","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J3T","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","18"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","3","48396","ME","Individual","No","31-1705652","48396ME0940006","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES203","MEF208","Existing","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://shop.anthem.com/sales/eox/payment/landing/co","www.anthem.com/MESelectdrugtier4","48396ME0940006-01","Standard Gold On Exchange Plan","78.25%","0.77190887928009","Yes","Yes","No","100%",,"$1,400","$80","$600","$0","$500","$1,800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J3Z","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","19"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","3","48396","ME","Individual","No","31-1705652","48396ME0940006","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES203","MEF208","Existing","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://shop.anthem.com/sales/eox/payment/landing/co","www.anthem.com/MESelectdrugtier4","48396ME0940006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J40","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","20"
"2016","KS","18558","OPM","3","2015-11-18 10:26:26","1","18558","KS","Individual","No","48-0952857","18558KS0380002","Blue Cross and Blue Shield Freedom, a Multi-State Plan","18558KS038",,"KSN201","KSS201","KSF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0380002-05","87% AV Level Silver Plan",,"0.863598048686981","No","Yes","No","100%",,"$600","$0","$600","$200","$300","$300","$600","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","50%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0380002-05","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0380002-05","11"
"2016","KS","18558","OPM","3","2015-11-18 10:26:26","1","18558","KS","Individual","No","48-0952857","18558KS0380002","Blue Cross and Blue Shield Freedom, a Multi-State Plan","18558KS038",,"KSN201","KSS201","KSF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0380002-06","94% AV Level Silver Plan",,"0.945690453052521","No","Yes","No","100%",,"$300","$0","$300","$200","$200","$200","$200","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group","50%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0380002-06","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0380002-06","12"
"2016","LA","97176","OPM","3","2015-08-25 12:56:34","1","97176","LA","Individual","No","23-7384555","97176LA0330003","Blue Cross and Blue Shield of Louisiana $1900, a Multi-State Plan","97176LA033",,"LAN201","LAS201","LAF203","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0330003-01","Standard Gold On Exchange Plan",,"0.784699201583862","Yes","Yes","No","100%",,"$1,900","$0","$0","$150","$1,900","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$5700 per group","0%",,,,,"$3,800","$3800 per person","$11400 per group","$5,700","$5700 per person","$17100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0330003-01&Year=2016","http://www.bcbsla.com/individual-mspp-brochure2016","4"
"2016","LA","97176","OPM","3","2015-08-25 12:56:34","1","97176","LA","Individual","No","23-7384555","97176LA0330003","Blue Cross and Blue Shield of Louisiana $1900, a Multi-State Plan","97176LA033",,"LAN201","LAS201","LAF203","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0330003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0330003-02&Year=2016","http://www.bcbsla.com/individual-mspp-brochure2016","5"
"2016","LA","97176","OPM","3","2015-08-25 12:56:34","1","97176","LA","Individual","No","23-7384555","97176LA0330003","Blue Cross and Blue Shield of Louisiana $1900, a Multi-State Plan","97176LA033",,"LAN201","LAS201","LAF203","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/pharmacy-2tier-formulary2016","97176LA0330003-03","Limited Cost Sharing Plan Variation",,"0.784699201583862","Yes","Yes","No","100%",,"$1,900","$0","$0","$150","$1,900","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$5700 per group","0%",,,,,"$3,800","$3800 per person","$11400 per group","$5,700","$5700 per person","$17100 per group","No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0330003-03&Year=2016","http://www.bcbsla.com/individual-mspp-brochure2016","6"
"2016","LA","97176","OPM","3","2015-08-25 12:56:34","2","97176","LA","Individual","No","23-7384555","97176LA0330002","Blue Cross and Blue Shield of Louisiana $2250, a Multi-State Plan","97176LA033",,"LAN201","LAS201","LAF201","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0330002-01","Standard Silver On Exchange Plan","71.56%","0.706059694290161","No","Yes","No","100%",,"$2,250","$900","$889","$150","$1,272","$1,000","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,250","$2250 per person","$6750 per group","40%",,,,,"$4,500","$4500 per person","$13500 per group","$6,750","$6750 per person","$20250 per group","$0","$0 per person","per group not applicable","10%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0330002-01&Year=2016","http://www.bcbsla.com/individual-mspp-brochure2016","4"
"2016","LA","97176","OPM","3","2015-08-25 12:56:34","2","97176","LA","Individual","No","23-7384555","97176LA0330002","Blue Cross and Blue Shield of Louisiana $2250, a Multi-State Plan","97176LA033",,"LAN201","LAS201","LAF201","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0330002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0330002-02&Year=2016","http://www.bcbsla.com/individual-mspp-brochure2016","5"
"2016","LA","97176","OPM","3","2015-08-25 12:56:34","2","97176","LA","Individual","No","23-7384555","97176LA0330002","Blue Cross and Blue Shield of Louisiana $2250, a Multi-State Plan","97176LA033",,"LAN201","LAS201","LAF201","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0330002-03","Limited Cost Sharing Plan Variation","71.56%","0.706059694290161","No","Yes","No","100%",,"$2,250","$900","$889","$150","$1,272","$1,000","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$2,250","$2250 per person","$6750 per group","40%",,,,,"$4,500","$4500 per person","$13500 per group","$6,750","$6750 per person","$20250 per group","$0","$0 per person","per group not applicable","10%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0330002-03&Year=2016","http://www.bcbsla.com/individual-mspp-brochure2016","6"
"2016","LA","97176","OPM","3","2015-08-25 12:56:34","2","97176","LA","Individual","No","23-7384555","97176LA0330002","Blue Cross and Blue Shield of Louisiana $2250, a Multi-State Plan","97176LA033",,"LAN201","LAS201","LAF201","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0330002-04","73% AV Level Silver Plan","73.63%","0.727965116500854","No","Yes","No","100%",,"$2,250","$900","$889","$150","$1,272","$1,000","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$13,700","$13700 per person","$27400 per group","$19,100","$19100 per person","$38200 per group","$2,250","$2250 per person","$6750 per group","40%",,,,,"$4,500","$4500 per person","$13500 per group","$6,750","$6750 per person","$20250 per group","$0","$0 per person","per group not applicable","10%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0330002-04&Year=2016","http://www.bcbsla.com/individual-mspp-brochure2016","7"
"2016","LA","97176","OPM","3","2015-08-25 12:56:34","2","97176","LA","Individual","No","23-7384555","97176LA0330002","Blue Cross and Blue Shield of Louisiana $2250, a Multi-State Plan","97176LA033",,"LAN201","LAS201","LAF201","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0330002-05","87% AV Level Silver Plan","87.00%","0.865297913551331","No","Yes","No","100%",,"$400","$572","$1,221","$150","$400","$480","$262","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$13,700","$13700 per person","$27400 per group","$15,950","$15950 per person","$31900 per group","$400","$400 per person","$1200 per group","30%",,,,,"$4,500","$4500 per person","$13500 per group","$4,900","$4900 per person","$14700 per group","$0","$0 per person","per group not applicable","10%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0330002-05&Year=2016","http://www.bcbsla.com/individual-mspp-brochure2016","8"
"2016","LA","97176","OPM","3","2015-08-25 12:56:34","2","97176","LA","Individual","No","23-7384555","97176LA0330002","Blue Cross and Blue Shield of Louisiana $2250, a Multi-State Plan","97176LA033",,"LAN201","LAS201","LAF201","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,"$150","0","0","0","2016-01-01","2016-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/pharmacy-4tier-formulary2016","97176LA0330002-06","94% AV Level Silver Plan","93.50%","0.928754091262817","No","Yes","No","100%",,"$50","$412","$0","$150","$50","$380","$0","$79",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$13,700","$13700 per person","$27400 per group","$15,950","$15950 per person","$31900 per group","$50","$50 per person","$150 per group","0%",,,,,"$4,500","$4500 per person","$13500 per group","$4,550","$4550 per person","$13650 per group","$0","$0 per person","per group not applicable","10%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0330002-06&Year=2016","http://www.bcbsla.com/individual-mspp-brochure2016","9"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","1","48396","ME","Individual","No","31-1705652","48396ME0930003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME093",,"MEN201","MES201","MEF209","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","www.anthem.com/MESelectdrugtier4","48396ME0930003-01","Standard Silver On Exchange Plan","69.58%","0.69126296043396","Yes","Yes","No","100%",,"$3,000","$80","$600","$0","$500","$1,900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J4K","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","4"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","1","48396","ME","Individual","No","31-1705652","48396ME0930003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME093",,"MEN201","MES201","MEF209","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","www.anthem.com/MESelectdrugtier4","48396ME0930003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J4L","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","5"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","1","48396","ME","Individual","No","31-1705652","48396ME0930003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME093",,"MEN201","MES201","MEF209","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","www.anthem.com/MESelectdrugtier4","48396ME0930003-03","Limited Cost Sharing Plan Variation","69.58%","0.69126296043396","Yes","Yes","No","100%",,"$3,000","$80","$600","$0","$500","$1,900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J4K","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","6"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","1","48396","ME","Individual","No","31-1705652","48396ME0930003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME093",,"MEN201","MES201","MEF209","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","www.anthem.com/MESelectdrugtier4","48396ME0930003-04","73% AV Level Silver Plan","73.71%","0.733312606811523","Yes","Yes","No","100%",,"$2,400","$80","$700","$0","$500","$1,800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J4M","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","7"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","1","48396","ME","Individual","No","31-1705652","48396ME0930003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME093",,"MEN201","MES201","MEF209","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","www.anthem.com/MESelectdrugtier4","48396ME0930003-05","87% AV Level Silver Plan","87.46%","0.873105764389038","Yes","Yes","No","100%",,"$700","$40","$800","$0","$500","$1,000","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J4N","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","8"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","1","48396","ME","Individual","No","31-1705652","48396ME0930003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME093",,"MEN201","MES201","MEF209","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","www.anthem.com/MESelectdrugtier4","48396ME0930003-06","94% AV Level Silver Plan","93.68%","0.937355279922485","Yes","Yes","No","100%",,"$200","$40","$500","$0","$200","$500","$20","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J4P","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","9"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","2","48396","ME","Individual","No","31-1705652","48396ME0930004","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME093",,"MEN201","MES201","MEF209","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","www.anthem.com/MESelectdrugtier4","48396ME0930004-01","Standard Gold On Exchange Plan","78.32%","0.773384213447571","Yes","Yes","No","100%",,"$1,000","$80","$900","$0","$500","$1,800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J57","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","4"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","2","48396","ME","Individual","No","31-1705652","48396ME0930004","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME093",,"MEN201","MES201","MEF209","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","www.anthem.com/MESelectdrugtier4","48396ME0930004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J58","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","5"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","2","48396","ME","Individual","No","31-1705652","48396ME0930004","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME093",,"MEN201","MES201","MEF209","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","www.anthem.com/MESelectdrugtier4","48396ME0930004-03","Limited Cost Sharing Plan Variation","78.32%","0.773384213447571","Yes","Yes","No","100%",,"$1,000","$80","$900","$0","$500","$1,800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J57","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","6"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","3","48396","ME","Individual","No","31-1705652","48396ME0940003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES202","MEF210","Existing","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://shop.anthem.com/sales/eox/payment/landing/co","www.anthem.com/MESelectdrugtier4","48396ME0940003-01","Standard Silver On Exchange Plan","70.68%","0.702356398105621","Yes","Yes","No","100%",,"$2,500","$80","$900","$0","$500","$1,900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J3P","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","4"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","3","48396","ME","Individual","No","31-1705652","48396ME0940003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES202","MEF210","Existing","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://shop.anthem.com/sales/eox/payment/landing/co","www.anthem.com/MESelectdrugtier4","48396ME0940003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J3Q","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","5"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","3","48396","ME","Individual","No","31-1705652","48396ME0940003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES202","MEF210","Existing","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://shop.anthem.com/sales/eox/payment/landing/co","www.anthem.com/MESelectdrugtier4","48396ME0940003-03","Limited Cost Sharing Plan Variation","70.68%","0.702356398105621","Yes","Yes","No","100%",,"$2,500","$80","$900","$0","$500","$1,900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J3P","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","6"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","3","48396","ME","Individual","No","31-1705652","48396ME0940003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES202","MEF210","Existing","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://shop.anthem.com/sales/eox/payment/landing/co","www.anthem.com/MESelectdrugtier4","48396ME0940003-04","73% AV Level Silver Plan","73.89%","0.73619931936264","Yes","Yes","No","100%",,"$2,300","$80","$1,000","$0","$500","$1,700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J3R","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","7"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","3","48396","ME","Individual","No","31-1705652","48396ME0940003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES202","MEF210","Existing","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://shop.anthem.com/sales/eox/payment/landing/co","www.anthem.com/MESelectdrugtier4","48396ME0940003-05","87% AV Level Silver Plan","87.37%","0.872969746589661","Yes","Yes","No","100%",,"$800","$40","$700","$0","$500","$1,000","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J3S","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","8"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","3","48396","ME","Individual","No","31-1705652","48396ME0940003","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES202","MEF210","Existing","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://shop.anthem.com/sales/eox/payment/landing/co","www.anthem.com/MESelectdrugtier4","48396ME0940003-06","94% AV Level Silver Plan","93.87%","0.93978750705719","Yes","Yes","No","100%",,"$200","$40","$400","$0","$200","$400","$10","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J3T","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","9"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","3","48396","ME","Individual","No","31-1705652","48396ME0940004","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES202","MEF208","Existing","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://shop.anthem.com/sales/eox/payment/landing/co","www.anthem.com/MESelectdrugtier4","48396ME0940004-01","Standard Gold On Exchange Plan","78.25%","0.77190887928009","Yes","Yes","No","100%",,"$1,400","$80","$600","$0","$500","$1,800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J3Z","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","10"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","3","48396","ME","Individual","No","31-1705652","48396ME0940004","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES202","MEF208","Existing","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://shop.anthem.com/sales/eox/payment/landing/co","www.anthem.com/MESelectdrugtier4","48396ME0940004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J40","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","11"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","3","48396","ME","Individual","No","31-1705652","48396ME0940004","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES202","MEF208","Existing","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://shop.anthem.com/sales/eox/payment/landing/co","www.anthem.com/MESelectdrugtier4","48396ME0940004-03","Limited Cost Sharing Plan Variation","78.25%","0.77190887928009","Yes","Yes","No","100%",,"$1,400","$80","$600","$0","$500","$1,800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J3Z","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","12"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","3","48396","ME","Individual","No","31-1705652","48396ME0940005","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES203","MEF210","Existing","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://shop.anthem.com/sales/eox/payment/landing/co","www.anthem.com/MESelectdrugtier4","48396ME0940005-01","Standard Silver On Exchange Plan","70.68%","0.702356398105621","Yes","Yes","No","100%",,"$2,500","$80","$900","$0","$500","$1,900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J3P","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","13"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","3","48396","ME","Individual","No","31-1705652","48396ME0940005","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES203","MEF210","Existing","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://shop.anthem.com/sales/eox/payment/landing/co","www.anthem.com/MESelectdrugtier4","48396ME0940005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J3Q","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","14"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","3","48396","ME","Individual","No","31-1705652","48396ME0940005","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES203","MEF210","Existing","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://shop.anthem.com/sales/eox/payment/landing/co","www.anthem.com/MESelectdrugtier4","48396ME0940005-03","Limited Cost Sharing Plan Variation","70.68%","0.702356398105621","Yes","Yes","No","100%",,"$2,500","$80","$900","$0","$500","$1,900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J3P","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","15"
"2016","ME","48396","OPM","5","2016-01-26 09:59:26","3","48396","ME","Individual","No","31-1705652","48396ME0940006","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME094",,"MEN202","MES203","MEF208","Existing","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://shop.anthem.com/sales/eox/payment/landing/co","www.anthem.com/MESelectdrugtier4","48396ME0940006-03","Limited Cost Sharing Plan Variation","78.25%","0.77190887928009","Yes","Yes","No","100%",,"$1,400","$80","$600","$0","$500","$1,800","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1J3Z","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","21"
"2016","MI","15560","OPM","5","2016-01-26 09:59:26","1","15560","MI","Individual","No","38-2069753","15560MI0410001","Blue Cross® Silver with Dental and Vision, a Multi-State Plan","15560MI041","7538162760","MIN201","MIS201","MIF202","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9404",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","www.bcbsm.com/customselectdruglist","15560MI0410001-01","Standard Silver On Exchange Plan","71.80%","0.728568077087402","Yes","Yes","No","100%",,"$1,400","$500","$850","$150","$1,400","$90","$725","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","20%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/silver-dental-vision-multi-state-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/multi-state-ppo.html","4"
"2016","MI","15560","OPM","5","2016-01-26 09:59:26","1","15560","MI","Individual","No","38-2069753","15560MI0410001","Blue Cross® Silver with Dental and Vision, a Multi-State Plan","15560MI041","7538162760","MIN201","MIS201","MIF202","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9404",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","www.bcbsm.com/customselectdruglist","15560MI0410001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/silver-dental-vision-multi-state-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/silver-dental-vision-multi-state-na-less-than-300-sbc.pdf","5"
"2016","MI","15560","OPM","5","2016-01-26 09:59:26","1","15560","MI","Individual","No","38-2069753","15560MI0410001","Blue Cross® Silver with Dental and Vision, a Multi-State Plan","15560MI041","7538162760","MIN201","MIS201","MIF202","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9404",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","www.bcbsm.com/customselectdruglist","15560MI0410001-03","Limited Cost Sharing Plan Variation","71.80%","0.728568077087402","Yes","Yes","No","100%",,"$1,400","$500","$850","$150","$1,400","$90","$725","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","20%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/silver-dental-vision-multi-state-plan-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/silver-dental-vision-multi-state-plan-na-more-than-300-sbc.pdf","6"
"2016","MI","15560","OPM","5","2016-01-26 09:59:26","1","15560","MI","Individual","No","38-2069753","15560MI0410001","Blue Cross® Silver with Dental and Vision, a Multi-State Plan","15560MI041","7538162760","MIN201","MIS201","MIF202","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9404",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","www.bcbsm.com/customselectdruglist","15560MI0410001-04","73% AV Level Silver Plan","73.80%","0.748178541660309","Yes","Yes","No","100%",,"$1,150","$500","$870","$150","$1,150","$150","$780","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","20%",,,,,"$2,300","$2300 per person","$4600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/silver-dental-vision-multi-state-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/multi-state-ppo.html?costshare=73","7"
"2016","MI","15560","OPM","5","2016-01-26 09:59:26","1","15560","MI","Individual","No","38-2069753","15560MI0410001","Blue Cross® Silver with Dental and Vision, a Multi-State Plan","15560MI041","7538162760","MIN201","MIS201","MIF202","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9404",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","www.bcbsm.com/customselectdruglist","15560MI0410001-05","87% AV Level Silver Plan","86.32%","0.869654595851898","Yes","Yes","No","100%",,"$500","$500","$500","$150","$500","$180","$450","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$3,400","$3400 per person","$6800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/silver-dental-vision-multi-state-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/multi-state-ppo.html?costshare=87","8"
"2016","MI","15560","OPM","5","2016-01-26 09:59:26","1","15560","MI","Individual","No","38-2069753","15560MI0410001","Blue Cross® Silver with Dental and Vision, a Multi-State Plan","15560MI041","7538162760","MIN201","MIS201","MIF202","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9404",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","www.bcbsm.com/customselectdruglist","15560MI0410001-06","94% AV Level Silver Plan","94.52%","0.947920799255371","Yes","Yes","No","100%",,"$175","$0","$325","$150","$175","$180","$145","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","10%",,,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/silver-dental-vision-multi-state-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/multi-state-ppo.html?costshare=94","9"
"2016","MI","15560","OPM","5","2016-01-26 09:59:26","1","15560","MI","Individual","No","38-2069753","15560MI0410002","Blue Cross® Gold with Dental and Vision, a Multi-State Plan","15560MI041","7538162760","MIN201","MIS201","MIF202","Existing","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9433",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","www.bcbsm.com/customselectdruglist","15560MI0410002-01","Standard Gold On Exchange Plan","80.95%","0.824733197689056","Yes","Yes","No","100%",,"$150","$500","$1,100","$150","$150","$180","$890","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","20%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/gold-dental-vision-multi-state-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/multi-state-ppo.html","10"
"2016","MI","15560","OPM","5","2016-01-26 09:59:26","1","15560","MI","Individual","No","38-2069753","15560MI0410002","Blue Cross® Gold with Dental and Vision, a Multi-State Plan","15560MI041","7538162760","MIN201","MIS201","MIF202","Existing","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9433",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","www.bcbsm.com/customselectdruglist","15560MI0410002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/gold-dental-vision-multi-state-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/gold-dental-vision-multi-state-na-less-than-300-sbc.pdf","11"
"2016","MI","15560","OPM","5","2016-01-26 09:59:26","1","15560","MI","Individual","No","38-2069753","15560MI0410002","Blue Cross® Gold with Dental and Vision, a Multi-State Plan","15560MI041","7538162760","MIN201","MIS201","MIF202","Existing","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9433",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","www.bcbsm.com/customselectdruglist","15560MI0410002-03","Limited Cost Sharing Plan Variation","80.95%","0.824733197689056","Yes","Yes","No","100%",,"$150","$500","$1,100","$150","$150","$180","$890","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","20%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/gold-dental-vision-multi-state-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/gold-dental-vision-multi-state-na-more-than-300-sbc.pdf","12"
"2016","MI","15560","OPM","5","2016-01-26 09:59:26","2","15560","MI","Individual","No","38-2069753","15560MI0880001","Blue Cross® Silver Extra with Dental and Vision, a Multi-State Plan","15560MI088","7538162760","MIN201","MIS201","MIF203","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9396",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","www.bcbsm.com/customselectdruglist","15560MI0880001-01","Standard Silver On Exchange Plan","71.96%",,"Yes","Yes","No","100%",,"$2,300","$0","$740","$150","$2,300","$300","$520","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"$11,600","$11600 per person","$23200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20%",,,,,"$4,600","$4600 per person","$9200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/silver-extra-dental-vision-multi-state-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/multi-state-ppo-extra.html","4"
"2016","MI","15560","OPM","5","2016-01-26 09:59:26","2","15560","MI","Individual","No","38-2069753","15560MI0880001","Blue Cross® Silver Extra with Dental and Vision, a Multi-State Plan","15560MI088","7538162760","MIN201","MIS201","MIF203","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9396",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","www.bcbsm.com/customselectdruglist","15560MI0880001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/silver-extra-dental-vision-multi-state-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/silver-extra-dental-vision-multi-state-na-less-than-300-sbc.pdf","5"
"2016","MI","15560","OPM","5","2016-01-26 09:59:26","2","15560","MI","Individual","No","38-2069753","15560MI0880001","Blue Cross® Silver Extra with Dental and Vision, a Multi-State Plan","15560MI088","7538162760","MIN201","MIS201","MIF203","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9396",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","www.bcbsm.com/customselectdruglist","15560MI0880001-03","Limited Cost Sharing Plan Variation","71.96%",,"Yes","Yes","No","100%",,"$2,300","$0","$740","$150","$2,300","$300","$520","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"$11,600","$11600 per person","$23200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20%",,,,,"$4,600","$4600 per person","$9200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/silver-extra-dental-vision-multi-state-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/silver-extra-dental-vision-multi-state-na-more-than-300-sbc.pdf","6"
"2016","MI","15560","OPM","5","2016-01-26 09:59:26","2","15560","MI","Individual","No","38-2069753","15560MI0880001","Blue Cross® Silver Extra with Dental and Vision, a Multi-State Plan","15560MI088","7538162760","MIN201","MIS201","MIF203","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9396",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","www.bcbsm.com/customselectdruglist","15560MI0880001-04","73% AV Level Silver Plan","73.99%",,"Yes","Yes","No","100%",,"$1,850","$0","$830","$150","$1,850","$300","$610","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20%",,,,,"$3,700","$3700 per person","$7400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/silver-extra-dental-vision-multi-state-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/multi-state-ppo-extra.html?costshare=73","7"
"2016","MI","15560","OPM","5","2016-01-26 09:59:26","2","15560","MI","Individual","No","38-2069753","15560MI0880001","Blue Cross® Silver Extra with Dental and Vision, a Multi-State Plan","15560MI088","7538162760","MIN201","MIS201","MIF203","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9396",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","www.bcbsm.com/customselectdruglist","15560MI0880001-05","87% AV Level Silver Plan","87.27%",,"Yes","Yes","No","100%",,"$500","$0","$550","$150","$500","$300","$440","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$3,400","$3400 per person","$6800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/silver-extra-dental-vision-multi-state-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/multi-state-ppo-extra.html?costshare=87","8"
"2016","MI","15560","OPM","5","2016-01-26 09:59:26","2","15560","MI","Individual","No","38-2069753","15560MI0880001","Blue Cross® Silver Extra with Dental and Vision, a Multi-State Plan","15560MI088","7538162760","MIN201","MIS201","MIF203","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9396",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","www.bcbsm.com/customselectdruglist","15560MI0880001-06","94% AV Level Silver Plan","94.78%",,"Yes","Yes","No","100%",,"$150","$0","$590","$150","$150","$300","$50","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","10%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/silver-extra-dental-vision-multi-state-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/multi-state-ppo-extra.html?costshare=94","9"
"2016","MI","15560","OPM","5","2016-01-26 09:59:26","2","15560","MI","Individual","No","38-2069753","15560MI0880002","Blue Cross® Gold Extra with Dental and Vision, a Multi-State Plan","15560MI088","7538162760","MIN201","MIS201","MIF203","Existing","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9433",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","www.bcbsm.com/customselectdruglist","15560MI0880002-01","Standard Gold On Exchange Plan","81.75%",,"Yes","Yes","No","100%",,"$750","$0","$1,050","$150","$750","$300","$830","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/gold-extra-dental-vision-multi-state-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/multi-state-ppo-extra.html","10"
"2016","MI","15560","OPM","5","2016-01-26 09:59:26","2","15560","MI","Individual","No","38-2069753","15560MI0880002","Blue Cross® Gold Extra with Dental and Vision, a Multi-State Plan","15560MI088","7538162760","MIN201","MIS201","MIF203","Existing","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9433",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","www.bcbsm.com/customselectdruglist","15560MI0880002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/gold-extra-dental-vision-multi-state-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/gold-extra-dental-vision-multi-state-na-less-than-300-sbc.pdf","11"
"2016","MI","15560","OPM","5","2016-01-26 09:59:26","2","15560","MI","Individual","No","38-2069753","15560MI0880002","Blue Cross® Gold Extra with Dental and Vision, a Multi-State Plan","15560MI088","7538162760","MIN201","MIS201","MIF203","Existing","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9433",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","www.bcbsm.com/customselectdruglist","15560MI0880002-03","Limited Cost Sharing Plan Variation","81.75%",,"Yes","Yes","No","100%",,"$750","$0","$1,050","$150","$750","$300","$830","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/gold-extra-dental-vision-multi-state-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/gold-extra-dental-vision-multi-state-na-more-than-300-sbc.pdf","12"
"2016","NC","11512","OPM","2","2015-08-27 15:13:29","1","11512","NC","Individual","No","56-0894904","11512NC0150001","Blue Cross Blue Shield 100, a Multi-State Plan","11512NC015",,"NCN201","NCS201","NCF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","BlueCard","Yes","BlueCard","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0150001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_MSP_100.pdf","www.bcbsnc.com/baplanbrochure","5"
"2016","NC","11512","OPM","2","2015-08-27 15:13:29","1","11512","NC","Individual","No","56-0894904","11512NC0150001","Blue Cross Blue Shield 100, a Multi-State Plan","11512NC015",,"NCN201","NCS201","NCF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","BlueCard","Yes","BlueCard","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0150001-03","Limited Cost Sharing Plan Variation",,"0.803065896034241","Yes","Yes","No","100%",,"$100","$0","$2,000","$200","$100","$0","$1,400","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","30%",,,,,"$200","$200 per person","$400 per group","$300","$300 per person","$600 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_MSP_Gold_100.pdf","www.bcbsnc.com/baplanbrochure","6"
"2016","MO","32753","OPM","6","2016-01-26 09:59:26","1","32753","MO","Individual","No","86-0257201","32753MO0930004","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","32753MO093",,"MON201","MOS201","MOF205","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","www.anthem.com/MOSelectdrugtier4","32753MO0930004-01","Standard Silver On Exchange Plan","70.53%","0.731965124607086","Yes","Yes","No","100%",,"$1,800","$1,100","$900","$0","$500","$1,900","$0","$300",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GK2","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","4"
"2016","MO","32753","OPM","6","2016-01-26 09:59:26","1","32753","MO","Individual","No","86-0257201","32753MO0930004","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","32753MO093",,"MON201","MOS201","MOF205","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","www.anthem.com/MOSelectdrugtier4","32753MO0930004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"www.sbc.anthem.com/dps/ccd1GK3","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","5"
"2016","MO","32753","OPM","6","2016-01-26 09:59:26","1","32753","MO","Individual","No","86-0257201","32753MO0930004","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","32753MO093",,"MON201","MOS201","MOF205","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","www.anthem.com/MOSelectdrugtier4","32753MO0930004-03","Limited Cost Sharing Plan Variation","70.53%","0.731965124607086","Yes","Yes","No","100%",,"$1,800","$1,100","$900","$0","$500","$1,900","$0","$300",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GK2","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","6"
"2016","MO","32753","OPM","6","2016-01-26 09:59:26","1","32753","MO","Individual","No","86-0257201","32753MO0930004","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","32753MO093",,"MON201","MOS201","MOF205","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","www.anthem.com/MOSelectdrugtier4","32753MO0930004-04","73% AV Level Silver Plan","73.10%","0.751755237579346","Yes","Yes","No","100%",,"$1,700","$1,100","$900","$0","$500","$1,900","$0","$300",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GK5","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","7"
"2016","MO","32753","OPM","6","2016-01-26 09:59:26","1","32753","MO","Individual","No","86-0257201","32753MO0930004","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","32753MO093",,"MON201","MOS201","MOF205","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","www.anthem.com/MOSelectdrugtier4","32753MO0930004-05","87% AV Level Silver Plan","86.79%","0.873311877250671","Yes","Yes","No","100%",,"$800","$500","$300","$0","$500","$1,000","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GK6","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","8"
"2016","MO","32753","OPM","6","2016-01-26 09:59:26","1","32753","MO","Individual","No","86-0257201","32753MO0930004","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","32753MO093",,"MON201","MOS201","MOF205","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","www.anthem.com/MOSelectdrugtier4","32753MO0930004-06","94% AV Level Silver Plan","93.69%","0.934682071208954","Yes","Yes","No","100%",,"$200","$200","$300","$0","$200","$500","$20","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","20%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GK7","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","9"
"2016","NH","96751","OPM","5","2016-01-29 07:27:50","2","96751","NH","Individual","No","02-0494919","96751NH0330005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","96751NH033",,"NHN201","NHS201","NHF202","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","www.anthem.com/NHSelectdrugtier4","96751NH0330005-04","73% AV Level Silver Plan","72.84%","0.738465964794159","Yes","Yes","No","100%",,"$1,500","$1,100","$1,400","$0","$500","$1,500","$0","$700",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GPR","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","7"
"2016","NH","96751","OPM","5","2016-01-29 07:27:50","2","96751","NH","Individual","No","02-0494919","96751NH0330005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","96751NH033",,"NHN201","NHS201","NHF202","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","www.anthem.com/NHSelectdrugtier4","96751NH0330005-05","87% AV Level Silver Plan","86.62%","0.868797719478607","Yes","Yes","No","100%",,"$800","$300","$400","$0","$500","$900","$0","$700",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GPS","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","8"
"2016","MO","32753","OPM","6","2016-01-26 09:59:26","2","32753","MO","Individual","No","86-0257201","32753MO0930006","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","32753MO093",,"MON201","MOS201","MOF204","Existing","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","www.anthem.com/MOSelectdrugtier4","32753MO0930006-01","Standard Gold On Exchange Plan","78.70%","0.8111692070961","Yes","Yes","No","100%",,"$1,000","$1,100","$500","$0","$500","$1,700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GK8","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","4"
"2016","MO","32753","OPM","6","2016-01-26 09:59:26","2","32753","MO","Individual","No","86-0257201","32753MO0930006","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","32753MO093",,"MON201","MOS201","MOF204","Existing","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","www.anthem.com/MOSelectdrugtier4","32753MO0930006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"www.sbc.anthem.com/dps/ccd1GK9","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","5"
"2016","MO","32753","OPM","6","2016-01-26 09:59:26","2","32753","MO","Individual","No","86-0257201","32753MO0930006","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","32753MO093",,"MON201","MOS201","MOF204","Existing","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Network benefits apply for Blue Card providers in the Kansas City area.  Out of Network benefits apply for non-network providers in the state of MO.  Emergency Care and Urgent Care are covered at the network level of benefits outside of MO.","No","https://payment.anthem.com/sales/payment/exchange?state=MO","www.anthem.com/MOSelectdrugtier4","32753MO0930006-03","Limited Cost Sharing Plan Variation","78.70%","0.8111692070961","Yes","Yes","No","100%",,"$1,000","$1,100","$500","$0","$500","$1,700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GK8","http://editiondigital.net/view/IU65/2016/ON_HIX_MO_KIT_2016","6"
"2016","MT","30751","OPM","6","2016-01-29 07:27:50","1","30751","MT","Individual","No","36-1236610","30751MT0570006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","30751MT057",,"MTN201","MTS201","MTF203","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0570006-01","Standard Gold On Exchange Plan","78.41%","0","No","Yes","Yes","60%","40%","$2,100","$0","$1,000","$200","$1,800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%","$1,500","$1500 per person","$3000 per group","20%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0570006-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","4"
"2016","MT","30751","OPM","6","2016-01-29 07:27:50","1","30751","MT","Individual","No","36-1236610","30751MT0570006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","30751MT057",,"MTN201","MTS201","MTF203","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0570006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0570006-02.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","5"
"2016","MT","30751","OPM","6","2016-01-29 07:27:50","1","30751","MT","Individual","No","36-1236610","30751MT0570006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","30751MT057",,"MTN201","MTS201","MTF203","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0570006-03","Limited Cost Sharing Plan Variation","78.41%","0","No","Yes","Yes","60%","40%","$2,100","$0","$1,000","$200","$1,800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%","$1,500","$1500 per person","$3000 per group","20%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0570006-03.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","6"
"2016","MT","30751","OPM","6","2016-01-29 07:27:50","2","30751","MT","Individual","No","36-1236610","30751MT0570007","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN201","MTS201","MTF203","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0570007-01","Standard Silver On Exchange Plan","68.51%","0","No","Yes","Yes","60%","40%","$4,200","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","$22,400","$22400 per person","$44800 per group","Not Applicable","per person not applicable","per group not applicable","$3,350","$3350 per person","$6700 per group","20%","$3,350","$3350 per person","$6700 per group","20%","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0570007-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","4"
"2016","MT","30751","OPM","6","2016-01-29 07:27:50","2","30751","MT","Individual","No","36-1236610","30751MT0570007","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN201","MTS201","MTF203","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0570007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0570007-02.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","5"
"2016","MT","30751","OPM","6","2016-01-29 07:27:50","2","30751","MT","Individual","No","36-1236610","30751MT0570007","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN201","MTS201","MTF203","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0570007-03","Limited Cost Sharing Plan Variation","68.51%","0","No","Yes","Yes","60%","40%","$4,200","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group","$5,600","$5600 per person","$11200 per group","$22,400","$22400 per person","$44800 per group","Not Applicable","per person not applicable","per group not applicable","$3,350","$3350 per person","$6700 per group","20%","$3,350","$3350 per person","$6700 per group","20%","$13,400","$13400 per person","$26800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0570007-03.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","6"
"2016","MT","30751","OPM","6","2016-01-29 07:27:50","2","30751","MT","Individual","No","36-1236610","30751MT0570007","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN201","MTS201","MTF203","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0570007-04","73% AV Level Silver Plan","72.45%","0","No","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%","$2,500","$2500 per person","$5000 per group","20%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0570007-04.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","7"
"2016","MT","30751","OPM","6","2016-01-29 07:27:50","2","30751","MT","Individual","No","36-1236610","30751MT0570007","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN201","MTS201","MTF203","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0570007-05","87% AV Level Silver Plan","87.10%","0","No","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%","$750","$750 per person","$1500 per group","20%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0570007-05.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","8"
"2016","MT","30751","OPM","6","2016-01-29 07:27:50","2","30751","MT","Individual","No","36-1236610","30751MT0570007","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","30751MT057",,"MTN201","MTS201","MTF203","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0570007-06","94% AV Level Silver Plan","94.43%","0","No","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20%","$100","$100 per person","$200 per group","20%","$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0570007-06.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","9"
"2016","MT","30751","OPM","6","2016-01-29 07:27:50","3","30751","MT","Individual","No","36-1236610","30751MT0570008","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","30751MT057",,"MTN201","MTS201","MTF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0570008-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$0","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","30%","$6,250","$6250 per person","$12500 per group","30%","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0570008-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","4"
"2016","MT","30751","OPM","6","2016-01-29 07:27:50","3","30751","MT","Individual","No","36-1236610","30751MT0570008","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","30751MT057",,"MTN201","MTS201","MTF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0570008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0570008-02.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","5"
"2016","MT","30751","OPM","6","2016-01-29 07:27:50","3","30751","MT","Individual","No","36-1236610","30751MT0570008","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","30751MT057",,"MTN201","MTS201","MTF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0570008-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$0","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","30%","$6,250","$6250 per person","$12500 per group","30%","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0570008-03.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","6"
"2016","NC","11512","OPM","2","2015-08-27 15:13:29","1","11512","NC","Individual","No","56-0894904","11512NC0150001","Blue Cross Blue Shield 100, a Multi-State Plan","11512NC015",,"NCN201","NCS201","NCF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","BlueCard","Yes","BlueCard","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0150001-01","Standard Gold On Exchange Plan",,"0.803065896034241","Yes","Yes","No","100%",,"$100","$0","$2,000","$200","$100","$0","$1,400","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","30%",,,,,"$200","$200 per person","$400 per group","$300","$300 per person","$600 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_MSP_Gold_100.pdf","www.bcbsnc.com/baplanbrochure","4"
"2016","NC","11512","OPM","2","2015-08-27 15:13:29","1","11512","NC","Individual","No","56-0894904","11512NC0150002","Blue Cross Blue Shield 200, a Multi-State Plan","11512NC015",,"NCN201","NCS201","NCF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","BlueCard","Yes","BlueCard","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0150002-01","Standard Silver On Exchange Plan",,"0.698150455951691","Yes","Yes","No","100%",,"$200","$0","$3,300","$200","$200","$0","$2,300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","50%",,,,,"$400","$400 per person","$800 per group","$600","$600 per person","$1200 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_MSP_Silver_200.pdf","www.bcbsnc.com/baplanbrochure","7"
"2016","NC","11512","OPM","2","2015-08-27 15:13:29","1","11512","NC","Individual","No","56-0894904","11512NC0150002","Blue Cross Blue Shield 200, a Multi-State Plan","11512NC015",,"NCN201","NCS201","NCF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","BlueCard","Yes","BlueCard","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0150002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_MSP_100.pdf","www.bcbsnc.com/baplanbrochure","8"
"2016","NC","11512","OPM","2","2015-08-27 15:13:29","1","11512","NC","Individual","No","56-0894904","11512NC0150002","Blue Cross Blue Shield 200, a Multi-State Plan","11512NC015",,"NCN201","NCS201","NCF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","BlueCard","Yes","BlueCard","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0150002-03","Limited Cost Sharing Plan Variation",,"0.698150455951691","Yes","Yes","No","100%",,"$200","$0","$3,300","$200","$200","$0","$2,300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","50%",,,,,"$400","$400 per person","$800 per group","$600","$600 per person","$1200 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_MSP_Silver_200.pdf","www.bcbsnc.com/baplanbrochure","9"
"2016","NC","11512","OPM","2","2015-08-27 15:13:29","1","11512","NC","Individual","No","56-0894904","11512NC0150002","Blue Cross Blue Shield 200, a Multi-State Plan","11512NC015",,"NCN201","NCS201","NCF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","BlueCard","Yes","BlueCard","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0150002-04","73% AV Level Silver Plan",,"0.729618012905121","Yes","Yes","No","100%",,"$200","$0","$3,400","$200","$200","$0","$2,300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","$16,350","$16350 per person","$32700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","50%",,,,,"$200","$200 per person","$400 per group","$300","$300 per person","$600 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_MSP_Silver_Enhanced_100-1.pdf","www.bcbsnc.com/baplanbrochure","10"
"2016","NC","11512","OPM","2","2015-08-27 15:13:29","1","11512","NC","Individual","No","56-0894904","11512NC0150002","Blue Cross Blue Shield 200, a Multi-State Plan","11512NC015",,"NCN201","NCS201","NCF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","BlueCard","Yes","BlueCard","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0150002-05","87% AV Level Silver Plan",,"0.87001234292984","Yes","Yes","No","100%",,"$100","$0","$3,400","$200","$100","$0","$2,300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$2,800","$2800 per person","$5600 per group","$4,200","$4200 per person","$8400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","50%",,,,,"$200","$200 per person","$400 per group","$300","$300 per person","$600 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_MSP_Silver_Enhanced_100-2.pdf","www.bcbsnc.com/baplanbrochure","11"
"2016","NC","11512","OPM","2","2015-08-27 15:13:29","1","11512","NC","Individual","No","56-0894904","11512NC0150002","Blue Cross Blue Shield 200, a Multi-State Plan","11512NC015",,"NCN201","NCS201","NCF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","BlueCard","Yes","BlueCard","Yes","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NC_5T_HealthInsuranceMarketplaceBasic.pdf","11512NC0150002-06","94% AV Level Silver Plan",,"0.94140613079071","Yes","Yes","No","100%",,"$100","$0","$1,300","$200","$100","$0","$1,300","$50",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","50%",,,,,"$200","$200 per person","$400 per group","$300","$300 per person","$600 per group","No",,,"http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_MSP_Silver_Enhanced_100-3.pdf","www.bcbsnc.com/baplanbrochure","12"
"2016","NH","96751","OPM","5","2016-01-29 07:27:50","1","96751","NH","Individual","No","02-0494919","96751NH0330006","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","96751NH033",,"NHN202","NHS201","NHF201","Existing","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","www.anthem.com/NHSelectdrugtier4","96751NH0330006-01","Standard Gold On Exchange Plan","81.34%","0.816314697265625","Yes","Yes","No","100%",,"$1,000","$1,100","$500","$0","$500","$1,700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$4,050","$4050 per person","$8100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GP4","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","4"
"2016","NH","96751","OPM","5","2016-01-29 07:27:50","1","96751","NH","Individual","No","02-0494919","96751NH0330006","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","96751NH033",,"NHN202","NHS201","NHF201","Existing","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","www.anthem.com/NHSelectdrugtier4","96751NH0330006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$300",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"www.sbc.anthem.com/dps/ccd1GPF","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","5"
"2016","NH","96751","OPM","5","2016-01-29 07:27:50","1","96751","NH","Individual","No","02-0494919","96751NH0330006","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","96751NH033",,"NHN202","NHS201","NHF201","Existing","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","www.anthem.com/NHSelectdrugtier4","96751NH0330006-03","Limited Cost Sharing Plan Variation","81.34%","0.816314697265625","Yes","Yes","No","100%",,"$1,000","$1,100","$500","$0","$500","$1,700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$4,050","$4050 per person","$8100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GP4","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","6"
"2016","NH","96751","OPM","5","2016-01-29 07:27:50","2","96751","NH","Individual","No","02-0494919","96751NH0330005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","96751NH033",,"NHN201","NHS201","NHF202","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","www.anthem.com/NHSelectdrugtier4","96751NH0330005-01","Standard Silver On Exchange Plan","68.79%","0.700624108314514","Yes","Yes","No","100%",,"$2,000","$900","$1,300","$0","$500","$1,500","$0","$700",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GPQ","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","4"
"2016","NH","96751","OPM","5","2016-01-29 07:27:50","2","96751","NH","Individual","No","02-0494919","96751NH0330005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","96751NH033",,"NHN201","NHS201","NHF202","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","www.anthem.com/NHSelectdrugtier4","96751NH0330005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$300",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"www.sbc.anthem.com/dps/ccd1GQ5","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","5"
"2016","NH","96751","OPM","5","2016-01-29 07:27:50","2","96751","NH","Individual","No","02-0494919","96751NH0330005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","96751NH033",,"NHN201","NHS201","NHF202","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","www.anthem.com/NHSelectdrugtier4","96751NH0330005-03","Limited Cost Sharing Plan Variation","68.79%","0.700624108314514","Yes","Yes","No","100%",,"$2,000","$900","$1,300","$0","$500","$1,500","$0","$700",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GPQ","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","6"
"2016","NH","96751","OPM","5","2016-01-29 07:27:50","2","96751","NH","Individual","No","02-0494919","96751NH0330005","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","96751NH033",,"NHN201","NHS201","NHF202","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","www.anthem.com/NHSelectdrugtier4","96751NH0330005-06","94% AV Level Silver Plan","93.68%","0.934611320495605","Yes","Yes","No","100%",,"$200","$40","$400","$0","$200","$400","$30","$700",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GPT","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","9"
"2016","NV","60156","OPM","5","2016-01-26 09:59:26","1","60156","NV","Individual","No","84-1017384","60156NV0390004","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","60156NV039",,"NVN201","NVS201","NVF204","Existing","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","www.anthem.com/NVSelectdrugtier4","60156NV0390004-01","Standard Gold On Exchange Plan","80.38%","0.80801522731781","Yes","Yes","No","100%",,"$1,100","$1,100","$500","$0","$500","$1,600","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1G3B","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","4"
"2016","NV","60156","OPM","5","2016-01-26 09:59:26","1","60156","NV","Individual","No","84-1017384","60156NV0390004","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","60156NV039",,"NVN201","NVS201","NVF204","Existing","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","www.anthem.com/NVSelectdrugtier4","60156NV0390004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1G2U","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","5"
"2016","NV","60156","OPM","5","2016-01-26 09:59:26","1","60156","NV","Individual","No","84-1017384","60156NV0390004","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","60156NV039",,"NVN201","NVS201","NVF204","Existing","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","www.anthem.com/NVSelectdrugtier4","60156NV0390004-03","Limited Cost Sharing Plan Variation","80.38%","0.80801522731781","Yes","Yes","No","100%",,"$1,100","$1,100","$500","$0","$500","$1,600","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1G3B","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","6"
"2016","NV","60156","OPM","5","2016-01-26 09:59:26","2","60156","NV","Individual","No","84-1017384","60156NV0390003","Anthem Blue Cross and Blue Shield  Silver DirectAccess, a Multi-State Plan","60156NV039",,"NVN201","NVS201","NVF205","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","www.anthem.com/NVSelectdrugtier4","60156NV0390003-01","Standard Silver On Exchange Plan","71.75%","0.723783075809479","Yes","Yes","No","100%",,"$1,800","$100","$1,100","$0","$500","$2,000","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1G2H","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","4"
"2016","NV","60156","OPM","5","2016-01-26 09:59:26","2","60156","NV","Individual","No","84-1017384","60156NV0390003","Anthem Blue Cross and Blue Shield  Silver DirectAccess, a Multi-State Plan","60156NV039",,"NVN201","NVS201","NVF205","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","www.anthem.com/NVSelectdrugtier4","60156NV0390003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1G2U","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","5"
"2016","NV","60156","OPM","5","2016-01-26 09:59:26","2","60156","NV","Individual","No","84-1017384","60156NV0390003","Anthem Blue Cross and Blue Shield  Silver DirectAccess, a Multi-State Plan","60156NV039",,"NVN201","NVS201","NVF205","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","www.anthem.com/NVSelectdrugtier4","60156NV0390003-03","Limited Cost Sharing Plan Variation","71.75%","0.723783075809479","Yes","Yes","No","100%",,"$1,800","$100","$1,100","$0","$500","$2,000","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1G2H","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","6"
"2016","NV","60156","OPM","5","2016-01-26 09:59:26","2","60156","NV","Individual","No","84-1017384","60156NV0390003","Anthem Blue Cross and Blue Shield  Silver DirectAccess, a Multi-State Plan","60156NV039",,"NVN201","NVS201","NVF205","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","www.anthem.com/NVSelectdrugtier4","60156NV0390003-04","73% AV Level Silver Plan","73.76%","0.739634096622467","Yes","Yes","No","100%",,"$1,800","$100","$1,100","$0","$500","$2,000","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1G56","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","7"
"2016","NV","60156","OPM","5","2016-01-26 09:59:26","2","60156","NV","Individual","No","84-1017384","60156NV0390003","Anthem Blue Cross and Blue Shield  Silver DirectAccess, a Multi-State Plan","60156NV039",,"NVN201","NVS201","NVF205","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","www.anthem.com/NVSelectdrugtier4","60156NV0390003-05","87% AV Level Silver Plan","87.23%","0.872775912284851","Yes","Yes","No","100%",,"$700","$40","$800","$0","$500","$1,000","$82","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1G57","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","8"
"2016","NV","60156","OPM","5","2016-01-26 09:59:26","2","60156","NV","Individual","No","84-1017384","60156NV0390003","Anthem Blue Cross and Blue Shield  Silver DirectAccess, a Multi-State Plan","60156NV039",,"NVN201","NVS201","NVF205","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","www.anthem.com/NVSelectdrugtier4","60156NV0390003-06","94% AV Level Silver Plan","93.34%","0.93325263261795","Yes","Yes","No","100%",,"$200","$40","$400","$0","$200","$400","$10","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1G58","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","9"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","1","87571","OK","Individual","No","36-1236610","87571OK0460004","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN005","OKS025","OKF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460004-01","Standard Gold On Exchange Plan","78.82%","0","Yes","Yes","Yes","60%","40%","$2,100","$0","$1,000","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$5,250","$5250 per person","$15750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460001-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","4"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","1","87571","OK","Individual","No","36-1236610","87571OK0460004","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN005","OKS025","OKF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460001-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","5"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460009","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS035","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460009-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$300","$300 per person","$900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-06.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","15"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","1","87571","OK","Individual","No","36-1236610","87571OK0460004","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN005","OKS025","OKF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460004-03","Limited Cost Sharing Plan Variation","78.82%","0","Yes","Yes","Yes","60%","40%","$2,100","$0","$1,000","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$5,250","$5250 per person","$15750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460001-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","6"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460010","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS045","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","17"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","3","87571","OK","Individual","No","36-1236610","87571OK0460015","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN005","OKS055","OKF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460015-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$18,750","$18750 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460003-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","13"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","1","87571","OK","Individual","No","36-1236610","87571OK0460005","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN005","OKS035","OKF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460005-01","Standard Gold On Exchange Plan","78.82%","0","Yes","Yes","Yes","60%","40%","$2,100","$0","$1,000","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$5,250","$5250 per person","$15750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460001-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","7"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","1","87571","OK","Individual","No","36-1236610","87571OK0460005","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN005","OKS035","OKF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460001-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","8"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","1","87571","OK","Individual","No","36-1236610","87571OK0460005","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN005","OKS035","OKF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460005-03","Limited Cost Sharing Plan Variation","78.82%","0","Yes","Yes","Yes","60%","40%","$2,100","$0","$1,000","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$5,250","$5250 per person","$15750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460001-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","9"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","1","87571","OK","Individual","No","36-1236610","87571OK0460006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN005","OKS045","OKF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460006-01","Standard Gold On Exchange Plan","78.82%","0","Yes","Yes","Yes","60%","40%","$2,100","$0","$1,000","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$5,250","$5250 per person","$15750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460001-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","10"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","1","87571","OK","Individual","No","36-1236610","87571OK0460006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN005","OKS045","OKF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460001-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","11"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","1","87571","OK","Individual","No","36-1236610","87571OK0460006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN005","OKS045","OKF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460006-03","Limited Cost Sharing Plan Variation","78.82%","0","Yes","Yes","Yes","60%","40%","$2,100","$0","$1,000","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$5,250","$5250 per person","$15750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460001-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","12"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","1","87571","OK","Individual","No","36-1236610","87571OK0460007","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN005","OKS055","OKF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460007-01","Standard Gold On Exchange Plan","78.82%","0","Yes","Yes","Yes","60%","40%","$2,100","$0","$1,000","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$5,250","$5250 per person","$15750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460001-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","13"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","1","87571","OK","Individual","No","36-1236610","87571OK0460007","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN005","OKS055","OKF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460001-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","14"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","1","87571","OK","Individual","No","36-1236610","87571OK0460007","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN005","OKS055","OKF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460007-03","Limited Cost Sharing Plan Variation","78.82%","0","Yes","Yes","Yes","60%","40%","$2,100","$0","$1,000","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$5,250","$5250 per person","$15750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460001-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","15"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","1","87571","OK","Individual","No","36-1236610","87571OK0460001","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN005","OKS015","OKF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460001-01","Standard Gold On Exchange Plan","78.82%","0","Yes","Yes","Yes","60%","40%","$2,100","$0","$1,000","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$5,250","$5250 per person","$15750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460001-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","16"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","1","87571","OK","Individual","No","36-1236610","87571OK0460001","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN005","OKS015","OKF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460001-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","17"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","1","87571","OK","Individual","No","36-1236610","87571OK0460001","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","87571OK046",,"OKN005","OKS015","OKF202","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460001-03","Limited Cost Sharing Plan Variation","78.82%","0","Yes","Yes","Yes","60%","40%","$2,100","$0","$1,000","$200","$1,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$9900 per group","$3,300","$3300 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%","$1,750","$1750 per person","$5250 per group","20%","$5,250","$5250 per person","$15750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460001-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","18"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460008","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS025","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460008-01","Standard Silver On Exchange Plan","68.90%","0","Yes","Yes","Yes","60%","40%","$4,200","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$11,250","$11250 per person","$33750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","4"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460008","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS025","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","5"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460008","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS025","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460008-03","Limited Cost Sharing Plan Variation","68.90%","0","Yes","Yes","Yes","60%","40%","$4,200","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$11,250","$11250 per person","$33750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","6"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460008","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS025","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460008-04","73% AV Level Silver Plan","73.00%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$10,200","$10200 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-04.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","7"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460008","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS025","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460008-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$2,250","$2250 per person","$6750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-05.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","8"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460008","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS025","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460008-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$300","$300 per person","$900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-06.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","9"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460009","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS035","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460009-01","Standard Silver On Exchange Plan","68.90%","0","Yes","Yes","Yes","60%","40%","$4,200","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$11,250","$11250 per person","$33750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","10"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460009","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS035","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","11"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460009","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS035","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460009-03","Limited Cost Sharing Plan Variation","68.90%","0","Yes","Yes","Yes","60%","40%","$4,200","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$11,250","$11250 per person","$33750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","12"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460009","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS035","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460009-04","73% AV Level Silver Plan","73.00%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$10,200","$10200 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-04.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","13"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460009","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS035","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460009-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$2,250","$2250 per person","$6750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-05.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","14"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460010","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS045","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460010-01","Standard Silver On Exchange Plan","68.90%","0","Yes","Yes","Yes","60%","40%","$4,200","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$11,250","$11250 per person","$33750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","16"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","3","87571","OK","Individual","No","36-1236610","87571OK0460015","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN005","OKS055","OKF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460003-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","14"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0040002","BlueCross Value 0.50, a Multi-State Plan","53789PA004","7205839443","PAN201","PAS203","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0040002-05","87% AV Level Silver Plan",,"0.860983967781067","Yes","Yes","Yes","40%","60%","$0","$0","$2,000","$200","$0","$100","$1,300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA004000205_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","20"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0040002","BlueCross Value 0.50, a Multi-State Plan","53789PA004","7205839443","PAN201","PAS203","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0040002-06","94% AV Level Silver Plan",,"0.932727932929993","Yes","Yes","Yes","40%","60%","$0","$0","$500","$200","$0","$40","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA004000206_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","21"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0040003","BlueCross Value 0.50, a Multi-State Plan","53789PA004","7205839443","PAN201","PAS200","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0040003-01","Standard Silver On Exchange Plan",,"0.709830403327942","Yes","Yes","Yes","40%","60%","$0","$0","$3,400","$200","$0","$200","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA004000301_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","22"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0040003","BlueCross Value 0.50, a Multi-State Plan","53789PA004","7205839443","PAN201","PAS200","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0040003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA004000302_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","23"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460010","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS045","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460010-03","Limited Cost Sharing Plan Variation","68.90%","0","Yes","Yes","Yes","60%","40%","$4,200","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$11,250","$11250 per person","$33750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","18"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460010","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS045","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460010-04","73% AV Level Silver Plan","73.00%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$10,200","$10200 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-04.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","19"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460010","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS045","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460010-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$2,250","$2250 per person","$6750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-05.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","20"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460010","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS045","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460010-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$300","$300 per person","$900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-06.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","21"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460011","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS055","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460011-01","Standard Silver On Exchange Plan","68.90%","0","Yes","Yes","Yes","60%","40%","$4,200","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$11,250","$11250 per person","$33750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","22"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460011","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS055","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","23"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460011","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS055","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460011-03","Limited Cost Sharing Plan Variation","68.90%","0","Yes","Yes","Yes","60%","40%","$4,200","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$11,250","$11250 per person","$33750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","24"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460011","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS055","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460011-04","73% AV Level Silver Plan","73.00%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$10,200","$10200 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-04.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","25"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460011","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS055","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460011-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$2,250","$2250 per person","$6750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-05.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","26"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460011","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS055","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460011-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$300","$300 per person","$900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-06.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","27"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS015","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460002-01","Standard Silver On Exchange Plan","68.90%","0","Yes","Yes","Yes","60%","40%","$4,200","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$11,250","$11250 per person","$33750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","28"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS015","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","29"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS015","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460002-03","Limited Cost Sharing Plan Variation","68.90%","0","Yes","Yes","Yes","60%","40%","$4,200","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$11,250","$11250 per person","$33750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","30"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS015","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460002-04","73% AV Level Silver Plan","73.00%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$10,200","$10200 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-04.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","31"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS015","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460002-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$2,250","$2250 per person","$6750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-05.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","32"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","2","87571","OK","Individual","No","36-1236610","87571OK0460002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","87571OK046",,"OKN005","OKS015","OKF202","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460002-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$300","$300 per person","$900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460002-06.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","33"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","3","87571","OK","Individual","No","36-1236610","87571OK0460012","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN005","OKS025","OKF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460012-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$18,750","$18750 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460003-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","4"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","3","87571","OK","Individual","No","36-1236610","87571OK0460012","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN005","OKS025","OKF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460003-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","5"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","3","87571","OK","Individual","No","36-1236610","87571OK0460012","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN005","OKS025","OKF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460012-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$18,750","$18750 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460003-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","6"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","3","87571","OK","Individual","No","36-1236610","87571OK0460013","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN005","OKS035","OKF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460013-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$18,750","$18750 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460003-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","7"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","3","87571","OK","Individual","No","36-1236610","87571OK0460013","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN005","OKS035","OKF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460003-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","8"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","3","87571","OK","Individual","No","36-1236610","87571OK0460013","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN005","OKS035","OKF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460013-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$18,750","$18750 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460003-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","9"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","3","87571","OK","Individual","No","36-1236610","87571OK0460014","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN005","OKS045","OKF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460014-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$18,750","$18750 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460003-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","10"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","3","87571","OK","Individual","No","36-1236610","87571OK0460014","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN005","OKS045","OKF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460014-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460003-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","11"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","3","87571","OK","Individual","No","36-1236610","87571OK0460014","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN005","OKS045","OKF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460014-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$18,750","$18750 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460003-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","12"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","3","87571","OK","Individual","No","36-1236610","87571OK0460015","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN005","OKS055","OKF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460015-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$18,750","$18750 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460003-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","15"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","3","87571","OK","Individual","No","36-1236610","87571OK0460003","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN005","OKS015","OKF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460003-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$18,750","$18750 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460003-01.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","16"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","3","87571","OK","Individual","No","36-1236610","87571OK0460003","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN005","OKS015","OKF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460003-02.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","17"
"2016","OK","87571","OPM","7","2016-01-26 09:59:26","3","87571","OK","Individual","No","36-1236610","87571OK0460003","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","87571OK046",,"OKN005","OKS015","OKF201","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/OK/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_OK_5T_EX.pdf","87571OK0460003-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$18,750","$18750 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsok.com/PDF/sbc/87571OK0460003-03.PDF","http://www.bcbsok.com/pdf/sbc/2016-oklahoma-plan-overview.pdf","18"
"2016","PA","31609","OPM","3","2015-11-18 10:26:26","1","31609","PA","Individual","No","23-2184623","31609PA0140001","Blue Cross Gold, a Multi-State Plan","31609PA014",,"PAN201","PAS201","PAF201","Existing","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing,  Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9984",,,"$700","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0140001-01","Standard Gold On Exchange Plan","81.46%",,"No","Yes","No","100%",,"$0","$140","$450","$150","$0","$290","$830","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/ppogoldmsp2016","https://www.ibx4you.com/ffm/brochure","4"
"2016","PA","31609","OPM","3","2015-11-18 10:26:26","1","31609","PA","Individual","No","23-2184623","31609PA0140001","Blue Cross Gold, a Multi-State Plan","31609PA014",,"PAN201","PAS201","PAF201","Existing","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing,  Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9984",,,"$700","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0140001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/ppogoldmspZeroCost2016","https://www.ibx4you.com/ffm/brochure","5"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0030002","BlueCross Value 750.0, a Multi-State Plan","53789PA003","7205839443","PAN201","PAS201","PAF202","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0030002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA003000202_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","32"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0030002","BlueCross Value 750.0, a Multi-State Plan","53789PA003","7205839443","PAN201","PAS201","PAF202","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0030002-03","Limited Cost Sharing Plan Variation",,"0.805252492427826","No","Yes","Yes","40%","60%","$800","$0","$0","$200","$400","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%","$750","$750 per person","$1500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%","$50","$50 per person","$100 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA003000203_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","33"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0030003","BlueCross Value 750.0, a Multi-State Plan","53789PA003","7205839443","PAN201","PAS203","PAF202","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0030003-01","Standard Gold On Exchange Plan",,"0.805252492427826","No","Yes","Yes","40%","60%","$800","$0","$0","$200","$400","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%","$750","$750 per person","$1500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%","$50","$50 per person","$100 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA003000301_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","34"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0030003","BlueCross Value 750.0, a Multi-State Plan","53789PA003","7205839443","PAN201","PAS203","PAF202","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0030003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA003000302_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","35"
"2016","PA","31609","OPM","3","2015-11-18 10:26:26","1","31609","PA","Individual","No","23-2184623","31609PA0140001","Blue Cross Gold, a Multi-State Plan","31609PA014",,"PAN201","PAS201","PAF201","Existing","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing,  Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9984",,,"$700","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0140001-03","Limited Cost Sharing Plan Variation","81.46%",,"No","Yes","No","100%",,"$0","$140","$450","$150","$0","$290","$830","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/ppogoldmspLimitedCost2016","https://www.ibx4you.com/ffm/brochure","6"
"2016","PA","31609","OPM","3","2015-11-18 10:26:26","2","31609","PA","Individual","No","23-2184623","31609PA0140002","Blue Cross Silver, a Multi-State Plan","31609PA014",,"PAN201","PAS201","PAF203","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9887",,,"$700","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0140002-01","Standard Silver On Exchange Plan","71.53%",,"No","Yes","No","100%",,"$2,000","$90","$810","$150","$160","$420","$1,010","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/pposilvermsp2016","https://www.ibx4you.com/ffm/brochure","4"
"2016","PA","31609","OPM","3","2015-11-18 10:26:26","2","31609","PA","Individual","No","23-2184623","31609PA0140002","Blue Cross Silver, a Multi-State Plan","31609PA014",,"PAN201","PAS201","PAF203","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9887",,,"$700","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0140002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/pposilvermspZeroCost2016","https://www.ibx4you.com/ffm/brochure","5"
"2016","PA","31609","OPM","3","2015-11-18 10:26:26","2","31609","PA","Individual","No","23-2184623","31609PA0140002","Blue Cross Silver, a Multi-State Plan","31609PA014",,"PAN201","PAS201","PAF203","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9887",,,"$700","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0140002-03","Limited Cost Sharing Plan Variation","71.53%",,"No","Yes","No","100%",,"$2,000","$90","$810","$150","$160","$420","$1,010","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/pposilvemspLimitedCost2016","https://www.ibx4you.com/ffm/brochure","6"
"2016","PA","31609","OPM","3","2015-11-18 10:26:26","2","31609","PA","Individual","No","23-2184623","31609PA0140002","Blue Cross Silver, a Multi-State Plan","31609PA014",,"PAN201","PAS201","PAF203","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9887",,,"$700","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0140002-04","73% AV Level Silver Plan","73.85%",,"No","Yes","No","100%",,"$2,000","$90","$540","$150","$480","$210","$610","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/pposilvermsp73CSR2016","https://www.ibx4you.com/ffm/brochure","7"
"2016","PA","31609","OPM","3","2015-11-18 10:26:26","2","31609","PA","Individual","No","23-2184623","31609PA0140002","Blue Cross Silver, a Multi-State Plan","31609PA014",,"PAN201","PAS201","PAF203","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9887",,,"$700","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0140002-05","87% AV Level Silver Plan","86.64%",,"No","Yes","No","100%",,"$180","$40","$450","$150","$0","$150","$620","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/pposilvermsp87CSR2016","https://www.ibx4you.com/ffm/brochure","8"
"2016","PA","31609","OPM","3","2015-11-18 10:26:26","2","31609","PA","Individual","No","23-2184623","31609PA0140002","Blue Cross Silver, a Multi-State Plan","31609PA014",,"PAN201","PAS201","PAF203","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9887",,,"$700","0","0","0","2016-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","https://apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","http://www.ibx.com/ffm/formulary5s","31609PA0140002-06","94% AV Level Silver Plan","93.68%",,"No","Yes","No","100%",,"$0","$20","$460","$150","$0","$100","$420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.ibx4you.com/ffm/pposilvermsp94CSR2016","https://www.ibx4you.com/ffm/brochure","9"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0060001","BlueCross 0.50, a Multi-State Plan","53789PA006","7205839443","PAN202","PAS202","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0060001-01","Standard Silver On Exchange Plan",,"0.709830403327942","Yes","Yes","Yes","40%","60%","$0","$0","$3,400","$200","$0","$200","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA006000101_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","4"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0060001","BlueCross 0.50, a Multi-State Plan","53789PA006","7205839443","PAN202","PAS202","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0060001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA006000102_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","5"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0060001","BlueCross 0.50, a Multi-State Plan","53789PA006","7205839443","PAN202","PAS202","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0060001-03","Limited Cost Sharing Plan Variation",,"0.709830403327942","Yes","Yes","Yes","40%","60%","$0","$0","$3,400","$200","$0","$200","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA006000103_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","6"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0060001","BlueCross 0.50, a Multi-State Plan","53789PA006","7205839443","PAN202","PAS202","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0060001-04","73% AV Level Silver Plan",,"0.736265063285828","Yes","Yes","Yes","40%","60%","$0","$0","$3,400","$200","$0","$200","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA006000104_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","7"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0060001","BlueCross 0.50, a Multi-State Plan","53789PA006","7205839443","PAN202","PAS202","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0060001-05","87% AV Level Silver Plan",,"0.860983967781067","Yes","Yes","Yes","40%","60%","$0","$0","$2,000","$200","$0","$100","$1,300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA006000105_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","8"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0060001","BlueCross 0.50, a Multi-State Plan","53789PA006","7205839443","PAN202","PAS202","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0060001-06","94% AV Level Silver Plan",,"0.936088621616364","Yes","Yes","Yes","40%","60%","$0","$0","$500","$200","$0","$40","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","8%","$0","$0 per person","$0 per group","8%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA006000106_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","9"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0040001","BlueCross Value 0.50, a Multi-State Plan","53789PA004","7205839443","PAN201","PAS201","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0040001-01","Standard Silver On Exchange Plan",,"0.709830403327942","Yes","Yes","Yes","40%","60%","$0","$0","$3,400","$200","$0","$200","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA004000101_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","10"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0040001","BlueCross Value 0.50, a Multi-State Plan","53789PA004","7205839443","PAN201","PAS201","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0040001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA004000102_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","11"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0040001","BlueCross Value 0.50, a Multi-State Plan","53789PA004","7205839443","PAN201","PAS201","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0040001-03","Limited Cost Sharing Plan Variation",,"0.709830403327942","Yes","Yes","Yes","40%","60%","$0","$0","$3,400","$200","$0","$200","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA004000103_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","12"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0040001","BlueCross Value 0.50, a Multi-State Plan","53789PA004","7205839443","PAN201","PAS201","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0040001-04","73% AV Level Silver Plan",,"0.736265063285828","Yes","Yes","Yes","40%","60%","$0","$0","$3,400","$200","$0","$200","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA004000104_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","13"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0040001","BlueCross Value 0.50, a Multi-State Plan","53789PA004","7205839443","PAN201","PAS201","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0040001-05","87% AV Level Silver Plan",,"0.860983967781067","Yes","Yes","Yes","40%","60%","$0","$0","$2,000","$200","$0","$100","$1,300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA004000105_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","14"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0040001","BlueCross Value 0.50, a Multi-State Plan","53789PA004","7205839443","PAN201","PAS201","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0040001-06","94% AV Level Silver Plan",,"0.932727932929993","Yes","Yes","Yes","40%","60%","$0","$0","$500","$200","$0","$40","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA004000106_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","15"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0040002","BlueCross Value 0.50, a Multi-State Plan","53789PA004","7205839443","PAN201","PAS203","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0040002-01","Standard Silver On Exchange Plan",,"0.709830403327942","Yes","Yes","Yes","40%","60%","$0","$0","$3,400","$200","$0","$200","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA004000201_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","16"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0040002","BlueCross Value 0.50, a Multi-State Plan","53789PA004","7205839443","PAN201","PAS203","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0040002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA004000202_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","17"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0040002","BlueCross Value 0.50, a Multi-State Plan","53789PA004","7205839443","PAN201","PAS203","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0040002-03","Limited Cost Sharing Plan Variation",,"0.709830403327942","Yes","Yes","Yes","40%","60%","$0","$0","$3,400","$200","$0","$200","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA004000203_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","18"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0040002","BlueCross Value 0.50, a Multi-State Plan","53789PA004","7205839443","PAN201","PAS203","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0040002-04","73% AV Level Silver Plan",,"0.736265063285828","Yes","Yes","Yes","40%","60%","$0","$0","$3,400","$200","$0","$200","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA004000204_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","19"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0040003","BlueCross Value 0.50, a Multi-State Plan","53789PA004","7205839443","PAN201","PAS200","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0040003-03","Limited Cost Sharing Plan Variation",,"0.709830403327942","Yes","Yes","Yes","40%","60%","$0","$0","$3,400","$200","$0","$200","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA004000303_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","24"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0040003","BlueCross Value 0.50, a Multi-State Plan","53789PA004","7205839443","PAN201","PAS200","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0040003-04","73% AV Level Silver Plan",,"0.736265063285828","Yes","Yes","Yes","40%","60%","$0","$0","$3,400","$200","$0","$200","$2,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA004000304_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","25"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0040003","BlueCross Value 0.50, a Multi-State Plan","53789PA004","7205839443","PAN201","PAS200","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0040003-05","87% AV Level Silver Plan",,"0.860983967781067","Yes","Yes","Yes","40%","60%","$0","$0","$2,000","$200","$0","$100","$1,300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA004000305_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","26"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0040003","BlueCross Value 0.50, a Multi-State Plan","53789PA004","7205839443","PAN201","PAS200","PAF201","Existing","HMO","Silver","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0040003-06","94% AV Level Silver Plan",,"0.932727932929993","Yes","Yes","Yes","40%","60%","$0","$0","$500","$200","$0","$40","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA004000306_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","27"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0050002","BlueCross 750.0, a Multi-State Plan","53789PA005","7205839443","PAN202","PAS202","PAF202","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0050002-01","Standard Gold On Exchange Plan",,"0.805252492427826","No","Yes","Yes","40%","60%","$800","$0","$0","$200","$400","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%","$750","$750 per person","$1500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%","$50","$50 per person","$100 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA005000201_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","28"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0050002","BlueCross 750.0, a Multi-State Plan","53789PA005","7205839443","PAN202","PAS202","PAF202","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0050002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA005000202_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","29"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0050002","BlueCross 750.0, a Multi-State Plan","53789PA005","7205839443","PAN202","PAS202","PAF202","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0050002-03","Limited Cost Sharing Plan Variation",,"0.805252492427826","No","Yes","Yes","40%","60%","$800","$0","$0","$200","$400","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%","$750","$750 per person","$1500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%","$50","$50 per person","$100 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA005000203_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","30"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0030002","BlueCross Value 750.0, a Multi-State Plan","53789PA003","7205839443","PAN201","PAS201","PAF202","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0030002-01","Standard Gold On Exchange Plan",,"0.805252492427826","No","Yes","Yes","40%","60%","$800","$0","$0","$200","$400","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%","$750","$750 per person","$1500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%","$50","$50 per person","$100 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA003000201_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","31"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0030003","BlueCross Value 750.0, a Multi-State Plan","53789PA003","7205839443","PAN201","PAS203","PAF202","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0030003-03","Limited Cost Sharing Plan Variation",,"0.805252492427826","No","Yes","Yes","40%","60%","$800","$0","$0","$200","$400","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%","$750","$750 per person","$1500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%","$50","$50 per person","$100 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA003000303_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","36"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0030004","BlueCross Value 750.0, a Multi-State Plan","53789PA003","7205839443","PAN201","PAS200","PAF202","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0030004-01","Standard Gold On Exchange Plan",,"0.805252492427826","No","Yes","Yes","40%","60%","$800","$0","$0","$200","$400","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%","$750","$750 per person","$1500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%","$50","$50 per person","$100 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA003000401_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","37"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0030004","BlueCross Value 750.0, a Multi-State Plan","53789PA003","7205839443","PAN201","PAS200","PAF202","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0030004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","40%","60%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA003000402_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","38"
"2016","PA","53789","OPM","6","2016-01-28 08:29:40","1","53789","PA","Individual","No","23-2399845","53789PA0030004","BlueCross Value 750.0, a Multi-State Plan","53789PA003","7205839443","PAN201","PAS200","PAF202","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All except OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergent and Urgent","Yes","Emergent and Urgent","Yes","https://w2.capbluecross.com/sp/ACS.saml2","https://www.capbluecross.com/wps/wcm/connect/cbc-public/pdf/myCapLinks/RxInfo/Formulary-SelectivelyClosed","53789PA0030004-03","Limited Cost Sharing Plan Variation",,"0.805252492427826","No","Yes","Yes","40%","60%","$800","$0","$0","$200","$400","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%","$750","$750 per person","$1500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%","$50","$50 per person","$100 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.capbluecross.com/pdf/benefits_summary/ia/2016/53789PA003000403_2016.pdf","https://www.choosecapitalblue.com/wps/wcm/connect/fafcebb4-61dc-43cc-acda-e481b2912445/C-438.pdf?MOD=AJPERES","39"
"2016","PA","70194","OPM","4","2015-08-27 03:52:03","1","70194","PA","Individual","No","54-1637426","70194PA0130001","Blue Cross Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN201","PAS201","PAF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0130001-01","Standard Silver On Exchange Plan",,"0.687843024730682","No","Yes","No","100%",,"$3,200","$200","$700","$0","$1,600","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","20%",,,,,"$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/bcbs.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/westernpa","4"
"2016","PA","70194","OPM","4","2015-08-27 03:52:03","1","70194","PA","Individual","No","54-1637426","70194PA0130001","Blue Cross Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN201","PAS201","PAF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0130001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/bcbs.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/westernpa","5"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","2","14002","TN","Individual","No","62-0427913","14002TN0330035","Silver S09P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF202","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330035-04","73% AV Level Silver Plan",,"0.7394158244133","Yes","Yes","No","100%",,"$2,000","$0","$1,100","$30","$2,000","$0","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,650","$3650 per person","$7300 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S09P-A_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","2","14002","TN","Individual","No","62-0427913","14002TN0330035","Silver S09P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF202","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330035-05","87% AV Level Silver Plan",,"0.871699452400208","Yes","Yes","No","100%",,"$300","$0","$1,400","$30","$300","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S09P-B_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","2","14002","TN","Individual","No","62-0427913","14002TN0330035","Silver S09P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF202","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330035-06","94% AV Level Silver Plan",,"0.93526965379715","Yes","Yes","No","100%",,"$0","$0","$800","$30","$0","$0","$800","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S09P-C_SBC.pdf","www.bcbst.com/brochures","9"
"2016","PA","70194","OPM","4","2015-08-27 03:52:03","1","70194","PA","Individual","No","54-1637426","70194PA0130001","Blue Cross Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN201","PAS201","PAF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0130001-03","Limited Cost Sharing Plan Variation",,"0.687843024730682","No","Yes","No","100%",,"$3,200","$200","$700","$0","$1,600","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","20%",,,,,"$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/bcbs.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/westernpa","6"
"2016","PA","70194","OPM","4","2015-08-27 03:52:03","1","70194","PA","Individual","No","54-1637426","70194PA0130001","Blue Cross Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN201","PAS201","PAF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0130001-04","73% AV Level Silver Plan",,"0.728488087654114","No","Yes","No","100%",,"$3,200","$200","$700","$0","$1,600","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","20%",,,,,"$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/bcbs.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/westernpa","7"
"2016","PA","70194","OPM","4","2015-08-27 03:52:03","1","70194","PA","Individual","No","54-1637426","70194PA0130001","Blue Cross Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN201","PAS201","PAF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0130001-05","87% AV Level Silver Plan",,"0.868146419525146","No","Yes","No","100%",,"$750","$200","$600","$0","$750","$300","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/bcbs.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/westernpa","8"
"2016","PA","70194","OPM","4","2015-08-27 03:52:03","1","70194","PA","Individual","No","54-1637426","70194PA0130001","Blue Cross Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN201","PAS201","PAF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0130001-06","94% AV Level Silver Plan",,"0.933157920837402","No","Yes","No","100%",,"$250","$100","$150","$0","$250","$200","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/bcbs.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/westernpa","9"
"2016","PA","70194","OPM","4","2015-08-27 03:52:03","1","70194","PA","Individual","No","54-1637426","70194PA0130003","Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN202","PAS202","PAF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0130003-01","Standard Silver On Exchange Plan",,"0.687843024730682","No","Yes","No","100%",,"$3,200","$200","$700","$0","$1,600","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","20%",,,,,"$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/sbc/bs.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/centralpa","10"
"2016","PA","70194","OPM","4","2015-08-27 03:52:03","1","70194","PA","Individual","No","54-1637426","70194PA0130003","Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN202","PAS202","PAF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0130003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/sbc/bs.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/centralpa","11"
"2016","PA","70194","OPM","4","2015-08-27 03:52:03","1","70194","PA","Individual","No","54-1637426","70194PA0130003","Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN202","PAS202","PAF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0130003-03","Limited Cost Sharing Plan Variation",,"0.687843024730682","No","Yes","No","100%",,"$3,200","$200","$700","$0","$1,600","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","20%",,,,,"$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/sbc/bs.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/centralpa","12"
"2016","PA","70194","OPM","4","2015-08-27 03:52:03","1","70194","PA","Individual","No","54-1637426","70194PA0130003","Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN202","PAS202","PAF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0130003-04","73% AV Level Silver Plan",,"0.720950961112976","No","Yes","No","100%",,"$3,200","$200","$700","$0","$1,600","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","20%",,,,,"$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/sbc/bs.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/centralpa","13"
"2016","PA","70194","OPM","4","2015-08-27 03:52:03","1","70194","PA","Individual","No","54-1637426","70194PA0130003","Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN202","PAS202","PAF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0130003-05","87% AV Level Silver Plan",,"0.867356598377228","No","Yes","No","100%",,"$650","$60","$600","$0","$650","$300","$90","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","10%",,,,,"$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/sbc/bs.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/centralpa","14"
"2016","PA","70194","OPM","4","2015-08-27 03:52:03","1","70194","PA","Individual","No","54-1637426","70194PA0130003","Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN202","PAS202","PAF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0130003-06","94% AV Level Silver Plan",,"0.933232009410858","No","Yes","No","100%",,"$100","$30","$600","$0","$100","$200","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/sbc/bs.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/centralpa","15"
"2016","PA","70194","OPM","4","2015-08-27 03:52:03","1","70194","PA","Individual","No","54-1637426","70194PA0130004","Blue Shield Shared Cost 1500, a Multi-State Plan","70194PA013",,"PAN202","PAS202","PAF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0130004-01","Standard Gold On Exchange Plan",,"0.786101043224335","No","Yes","No","100%",,"$1,500","$100","$500","$0","$1,500","$300","$10","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/sbc/bs.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/centralpa","16"
"2016","PA","70194","OPM","4","2015-08-27 03:52:03","1","70194","PA","Individual","No","54-1637426","70194PA0130004","Blue Shield Shared Cost 1500, a Multi-State Plan","70194PA013",,"PAN202","PAS202","PAF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0130004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/sbc/bs.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/centralpa","17"
"2016","PA","70194","OPM","4","2015-08-27 03:52:03","1","70194","PA","Individual","No","54-1637426","70194PA0130004","Blue Shield Shared Cost 1500, a Multi-State Plan","70194PA013",,"PAN202","PAS202","PAF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0130004-03","Limited Cost Sharing Plan Variation",,"0.786101043224335","No","Yes","No","100%",,"$1,500","$100","$500","$0","$1,500","$300","$10","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkblueshield.com/sbc/bs.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/centralpa","18"
"2016","PA","70194","OPM","4","2015-08-27 03:52:03","1","70194","PA","Individual","No","54-1637426","70194PA0130002","Blue Cross Blue Shield Shared Cost 1500, a Multi-State Plan","70194PA013",,"PAN201","PAS201","PAF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0130002-01","Standard Gold On Exchange Plan",,"0.786101043224335","No","Yes","No","100%",,"$1,500","$100","$500","$0","$1,500","$300","$10","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/bcbs.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/westernpa","19"
"2016","PA","70194","OPM","4","2015-08-27 03:52:03","1","70194","PA","Individual","No","54-1637426","70194PA0130002","Blue Cross Blue Shield Shared Cost 1500, a Multi-State Plan","70194PA013",,"PAN201","PAS201","PAF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0130002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/bcbs.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/westernpa","20"
"2016","PA","70194","OPM","4","2015-08-27 03:52:03","1","70194","PA","Individual","No","54-1637426","70194PA0130002","Blue Cross Blue Shield Shared Cost 1500, a Multi-State Plan","70194PA013",,"PAN201","PAS201","PAF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$600","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1791332925","70194PA0130002-03","Limited Cost Sharing Plan Variation",,"0.786101043224335","No","Yes","No","100%",,"$1,500","$100","$500","$0","$1,500","$300","$10","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbs.com/sbc/bcbs.html","http://www.discoverhighmark.com/individuals-families/insurance/product-information/westernpa","21"
"2016","SC","26065","OPM","5","2016-01-26 09:59:26","1","26065","SC","Individual","No","57-0287419","26065SC0400001","Blue Cross Blue Shield Gold 1, a Multi-State Plan","26065SC040",,"SCN201","SCS201","SCF204","Existing","EPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9966",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0400001-01","Standard Gold On Exchange Plan",,"0.80035811662674","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$570","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/MSPP/Gold1","https://www.SouthCarolinaBlues.com/links/metallic/2016/MSPP/Gold1","4"
"2016","SC","26065","OPM","5","2016-01-26 09:59:26","1","26065","SC","Individual","No","57-0287419","26065SC0400001","Blue Cross Blue Shield Gold 1, a Multi-State Plan","26065SC040",,"SCN201","SCS201","SCF204","Existing","EPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9966",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0400001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/MSPP/Gold1_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/MSPP/Gold1_L300","5"
"2016","SC","26065","OPM","5","2016-01-26 09:59:26","1","26065","SC","Individual","No","57-0287419","26065SC0400001","Blue Cross Blue Shield Gold 1, a Multi-State Plan","26065SC040",,"SCN201","SCS201","SCF204","Existing","EPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9966",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0400001-03","Limited Cost Sharing Plan Variation",,"0.80035811662674","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$570","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/MSPP/Gold1_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/MSPP/Gold1_G300","6"
"2016","SC","26065","OPM","5","2016-01-26 09:59:26","1","26065","SC","Individual","No","57-0287419","26065SC0400002","Blue Cross Blue Shield Silver 1, a Multi-State Plan","26065SC040",,"SCN201","SCS201","SCF201","Existing","EPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0400002-01","Standard Silver On Exchange Plan",,"0.71593302488327","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$340","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/MSPP/Silver1","https://www.SouthCarolinaBlues.com/links/metallic/2016/MSPP/Silver1","7"
"2016","SC","26065","OPM","5","2016-01-26 09:59:26","1","26065","SC","Individual","No","57-0287419","26065SC0400002","Blue Cross Blue Shield Silver 1, a Multi-State Plan","26065SC040",,"SCN201","SCS201","SCF201","Existing","EPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0400002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/MSPP/Silver1_L300","https://www.SouthCarolinaBlues.com/links/metallic/2016/MSPP/Silver1_L300","8"
"2016","SC","26065","OPM","5","2016-01-26 09:59:26","1","26065","SC","Individual","No","57-0287419","26065SC0400002","Blue Cross Blue Shield Silver 1, a Multi-State Plan","26065SC040",,"SCN201","SCS201","SCF201","Existing","EPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0400002-03","Limited Cost Sharing Plan Variation",,"0.71593302488327","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$340","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/MSPP/Silver1_G300","https://www.SouthCarolinaBlues.com/links/metallic/2016/MSPP/Silver1_G300","9"
"2016","SC","26065","OPM","5","2016-01-26 09:59:26","1","26065","SC","Individual","No","57-0287419","26065SC0400002","Blue Cross Blue Shield Silver 1, a Multi-State Plan","26065SC040",,"SCN201","SCS201","SCF201","Existing","EPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0400002-04","73% AV Level Silver Plan",,"0.736713349819183","No","Yes","No","100%",,"$2,200","$20","$1,520","$150","$2,200","$350","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/MSPP/Silver1_201-250","https://www.SouthCarolinaBlues.com/links/metallic/2016/MSPP/Silver1_201-250","10"
"2016","SC","26065","OPM","5","2016-01-26 09:59:26","1","26065","SC","Individual","No","57-0287419","26065SC0400002","Blue Cross Blue Shield Silver 1, a Multi-State Plan","26065SC040",,"SCN201","SCS201","SCF201","Existing","EPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0400002-05","87% AV Level Silver Plan",,"0.877707779407501","No","Yes","No","100%",,"$100","$20","$1,430","$150","$100","$600","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/MSPP/Silver1_151-200","https://www.SouthCarolinaBlues.com/links/metallic/2016/MSPP/Silver1_151-200","11"
"2016","SC","26065","OPM","5","2016-01-26 09:59:26","1","26065","SC","Individual","No","57-0287419","26065SC0400002","Blue Cross Blue Shield Silver 1, a Multi-State Plan","26065SC040",,"SCN201","SCS201","SCF201","Existing","EPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9957",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/pay","https://www.southcarolinablues.com/links/metallic/pharmacy/BlueEssentials","26065SC0400002-06","94% AV Level Silver Plan",,"0.932157814502716","No","Yes","No","100%",,"$0","$0","$360","$150","$0","$0","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.SouthCarolinaBlues.com/links/metallic/2016/MSPP/Silver1_100-150","https://www.SouthCarolinaBlues.com/links/metallic/2016/MSPP/Silver1_100-150","12"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","1","14002","TN","Individual","No","62-0427913","14002TN0330034","Bronze B04P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF201","Existing","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330034-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbst.com/sbc/2016/127600/B04P_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","1","14002","TN","Individual","No","62-0427913","14002TN0330034","Bronze B04P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF201","Existing","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330034-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/B04P-AI1_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","1","14002","TN","Individual","No","62-0427913","14002TN0330034","Bronze B04P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF201","Existing","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330034-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$30","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/B04P-AI2_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","2","14002","TN","Individual","No","62-0427913","14002TN0330035","Silver S09P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF202","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330035-01","Standard Silver On Exchange Plan",,"0.704136252403259","Yes","Yes","No","100%",,"$2,500","$0","$1,000","$30","$2,500","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S09P_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","2","14002","TN","Individual","No","62-0427913","14002TN0330035","Silver S09P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF202","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330035-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S09P-AI1_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","2","14002","TN","Individual","No","62-0427913","14002TN0330035","Silver S09P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF202","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330035-03","Limited Cost Sharing Plan Variation",,"0.704136252403259","Yes","Yes","No","100%",,"$2,500","$0","$1,000","$30","$2,500","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S09P-AI2_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","3","14002","TN","Individual","No","62-0427913","14002TN0330036","Silver S11P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF203","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330036-01","Standard Silver On Exchange Plan",,"0.706067264080048","No","Yes","No","100%",,"$2,500","$50","$900","$30","$800","$1,300","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11P_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","3","14002","TN","Individual","No","62-0427913","14002TN0330036","Silver S11P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF203","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330036-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11P-AI1_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","3","14002","TN","Individual","No","62-0427913","14002TN0330036","Silver S11P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF203","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330036-03","Limited Cost Sharing Plan Variation",,"0.706067264080048","No","Yes","No","100%",,"$2,500","$50","$900","$30","$800","$1,300","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11P-AI2_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","3","14002","TN","Individual","No","62-0427913","14002TN0330036","Silver S11P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF203","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330036-04","73% AV Level Silver Plan",,"0.726508617401123","No","Yes","No","100%",,"$2,500","$50","$900","$30","$800","$1,300","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11P-A_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","3","14002","TN","Individual","No","62-0427913","14002TN0330036","Silver S11P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF203","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330036-05","87% AV Level Silver Plan",,"0.874034881591797","No","Yes","No","100%",,"$500","$30","$1,000","$30","$500","$900","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11P-B_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","3","14002","TN","Individual","No","62-0427913","14002TN0330036","Silver S11P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF203","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330036-06","94% AV Level Silver Plan",,"0.93783438205719","No","Yes","No","100%",,"$0","$30","$700","$30","$0","$600","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/S11P-C_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","4","14002","TN","Individual","No","62-0427913","14002TN0330037","Silver S12P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF202","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330037-01","Standard Silver On Exchange Plan",,"0.707108318805695","Yes","Yes","No","100%",,"$4,000","$0","$600","$30","$4,000","$60","$40","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S12P_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","4","14002","TN","Individual","No","62-0427913","14002TN0330037","Silver S12P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF202","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330037-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/S12P-AI1_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","4","14002","TN","Individual","No","62-0427913","14002TN0330037","Silver S12P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF202","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330037-03","Limited Cost Sharing Plan Variation",,"0.707108318805695","Yes","Yes","No","100%",,"$4,000","$0","$600","$30","$4,000","$60","$40","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S12P-AI2_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","4","14002","TN","Individual","No","62-0427913","14002TN0330037","Silver S12P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF202","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330037-04","73% AV Level Silver Plan",,"0.735155284404755","Yes","Yes","No","100%",,"$3,000","$0","$800","$30","$3,000","$60","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S12P-A_SBC.pdf","www.bcbst.com/brochures","7"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","4","14002","TN","Individual","No","62-0427913","14002TN0330037","Silver S12P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF202","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330037-05","87% AV Level Silver Plan",,"0.866357207298279","Yes","Yes","No","100%",,"$800","$0","$1,200","$30","$800","$60","$700","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S12P-B_SBC.pdf","www.bcbst.com/brochures","8"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","4","14002","TN","Individual","No","62-0427913","14002TN0330037","Silver S12P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF202","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330037-06","94% AV Level Silver Plan",,"0.93218195438385","Yes","Yes","No","100%",,"$0","$0","$1,100","$30","$0","$60","$800","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/S12P-C_SBC.pdf","www.bcbst.com/brochures","9"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","5","14002","TN","Individual","No","62-0427913","14002TN0330038","Gold G08P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330038-01","Standard Gold On Exchange Plan",,"0.799147665500641","Yes","Yes","No","100%",,"$2,100","$0","$0","$30","$2,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/G08P_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","5","14002","TN","Individual","No","62-0427913","14002TN0330038","Gold G08P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330038-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbst.com/sbc/2016/127600/G08P-AI1_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","5","14002","TN","Individual","No","62-0427913","14002TN0330038","Gold G08P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330038-03","Limited Cost Sharing Plan Variation",,"0.799147665500641","Yes","Yes","No","100%",,"$2,100","$0","$0","$30","$2,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbst.com/sbc/2016/127600/G08P-AI2_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","6","14002","TN","Individual","No","62-0427913","14002TN0330039","Gold G11P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF203","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330039-01","Standard Gold On Exchange Plan",,"0.787487745285034","No","Yes","No","100%",,"$3,500","$30","$0","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G11P_SBC.pdf","www.bcbst.com/brochures","4"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","6","14002","TN","Individual","No","62-0427913","14002TN0330039","Gold G11P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF203","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330039-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G11P-AI1_SBC.pdf","www.bcbst.com/brochures","5"
"2016","TN","14002","OPM","2","2015-10-23 10:28:16","6","14002","TN","Individual","No","62-0427913","14002TN0330039","Gold G11P, Network P, a Multi-State Plan","14002TN033",,"TNN201","TNS201","TNF203","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","1",,,,"0","0","0","2016-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","http://www.bcbst.com/manage-my-plan/pharmacies-and-prescriptions/essential-formulary-2016/index.page?","14002TN0330039-03","Limited Cost Sharing Plan Variation",,"0.787487745285034","No","Yes","No","100%",,"$3,500","$30","$0","$30","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbst.com/sbc/2016/127600/G11P-AI2_SBC.pdf","www.bcbst.com/brochures","6"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780001","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS224","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780001-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780001","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS224","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780001","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS224","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780001-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780004","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS234","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780004-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780013","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS064","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780013-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780013","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS064","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780013","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS064","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780013-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780023","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS164","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780023-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780023","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS164","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780023-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780024","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS174","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780024-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780004","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS234","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780004","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS234","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780004-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780014","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS074","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780014-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780005","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS244","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780005-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780005","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS244","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780005","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS244","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780005-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS254","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780006-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS254","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780006","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS254","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780006-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780007","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS264","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780007-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780007","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS264","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780007","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS264","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780007-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780008","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS014","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780008-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780008","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS014","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780008","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS014","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780008-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780009","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS024","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780009-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780009","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS024","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780009","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS024","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780009-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780010","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS034","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780010-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780010","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS034","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","1","33602","TX","Individual","No","36-1236610","33602TX0780010","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS034","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780010-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780011","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS044","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780011-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780011","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS044","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780011","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS044","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780011-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780012","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS054","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780012-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780012","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS054","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780012","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS054","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780012-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780014","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS074","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780014","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS074","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780014-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780015","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS084","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780015-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780015","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS084","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780015","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS084","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780015-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780016","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS094","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780016-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780016","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS094","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780016","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS094","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780016-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780017","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS104","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780017-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780017","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS104","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780017","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS104","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780017-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780018","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS114","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780018-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780018","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS114","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","2","33602","TX","Individual","No","36-1236610","33602TX0780018","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS114","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780018-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780019","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS124","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780019-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780019","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS124","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780019","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS124","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780019-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780020","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS134","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780020-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780020","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS134","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780020-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780020","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS134","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780020-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780021","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS144","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780021-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780021","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS144","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780021","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS144","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780021-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780022","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS154","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780022-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780022","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS154","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780022-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780022","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS154","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780022-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780023","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS164","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780023-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780024","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS174","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780024-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780024","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS174","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780024-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780025","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS184","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780025-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780030","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS244","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780030-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780030","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS244","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780030-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780031","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS254","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780031-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780034","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS024","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780034-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","43"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780034","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS024","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780034-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","44"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780025","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS184","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780025-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780025","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS184","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780025-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780026","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS194","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780026-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780026","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS194","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","3","33602","TX","Individual","No","36-1236610","33602TX0780026","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS194","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780026-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","4","33602","TX","Individual","No","36-1236610","33602TX0780027","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS204","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780027-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","4","33602","TX","Individual","No","36-1236610","33602TX0780027","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS204","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780027-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","4","33602","TX","Individual","No","36-1236610","33602TX0780027","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS204","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780027-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","4","33602","TX","Individual","No","36-1236610","33602TX0780028","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS214","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780028-01","Standard Gold On Exchange Plan",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","4","33602","TX","Individual","No","36-1236610","33602TX0780028","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS214","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780028-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","4","33602","TX","Individual","No","36-1236610","33602TX0780028","Blue Cross Blue Shield Premier? 101, a Multi-State Plan","33602TX078",,"TXN004","TXS214","TXF202","New","HMO","Gold","No","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780028-03","Limited Cost Sharing Plan Variation",,"0.788054406642914","Yes","Yes","Yes","60%","40%","$1,000","$0","$1,300","$200","$1,000","$80","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","$6,000","$6000 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$3000 per group","20%","$1,000","$1000 per person","$3000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780001-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS224","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780002-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS224","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS224","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780002-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS224","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780002-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS224","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780002-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780002","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS224","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780002-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780029","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS234","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780029-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780029","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS234","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780029-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780029","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS234","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780029-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780029","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS234","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780029-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780029","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS234","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780029-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780029","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS234","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780029-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780030","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS244","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780030-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780030","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS244","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780030-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780030","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS244","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780030-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780030","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS244","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780030-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780035","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS034","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780035-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","50"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780035","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS034","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780035-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","51"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780036","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS044","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780036-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780036","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS044","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780036-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780036","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS044","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780036-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780036","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS044","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780036-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780036","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS044","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780036-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780031","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS254","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780031-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780031","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS254","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780031-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780031","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS254","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780031-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780031","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS254","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780031-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780031","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS254","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780031-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780032","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS264","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780032-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780032","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS264","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780032-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780032","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS264","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780032-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780032","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS264","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780032-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780032","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS264","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780032-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780032","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS264","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780032-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780033","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS014","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780033-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780033","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS014","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780033-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780033","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS014","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780033-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","36"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780033","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS014","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780033-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","37"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780033","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS014","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780033-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","38"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780033","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS014","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780033-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","39"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780034","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS024","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780034-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","40"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780034","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS024","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780034-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","41"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780034","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS024","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780034-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","42"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780034","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS024","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780034-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","45"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780035","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS034","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780035-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","46"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780035","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS034","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780035-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","47"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780035","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS034","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780035-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","48"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780040","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS084","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780040-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780040","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS084","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780040-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780040","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS084","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780040-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780045","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS134","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780045-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","5","33602","TX","Individual","No","36-1236610","33602TX0780035","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS034","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780035-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","49"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780036","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS044","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780036-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780041","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS094","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780041-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","37"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780046","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS144","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780046-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780046","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS144","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780046-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780046","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS144","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780046-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780046","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS144","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780046-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780046","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS144","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780046-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780047","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS154","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780047-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780037","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS054","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780037-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780037","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS054","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780037-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780037","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS054","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780037-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780037","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS054","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780037-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780037","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS054","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780037-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780037","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS054","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780037-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780038","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS064","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780038-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780038","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS064","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780038-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780038","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS064","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780038-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780038","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS064","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780038-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780038","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS064","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780038-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780038","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS064","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780038-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780039","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS074","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780039-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780039","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS074","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780039-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780039","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS074","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780039-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780039","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS074","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780039-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780039","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS074","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780039-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780039","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS074","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780039-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780040","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS084","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780040-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780040","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS084","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780040-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780040","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS084","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780040-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780041","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS094","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780041-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780041","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS094","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780041-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780041","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS094","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780041-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","36"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780041","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS094","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780041-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","38"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780041","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS094","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780041-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","39"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780042","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS104","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780042-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","40"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780042","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS104","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780042-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","41"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780042","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS104","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780042-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","42"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780042","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS104","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780042-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","43"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780042","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS104","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780042-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","44"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780042","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS104","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780042-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","45"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780043","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS114","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780043-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","46"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780043","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS114","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780043-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","47"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780043","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS114","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780043-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","48"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780043","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS114","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780043-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","49"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780043","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS114","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780043-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","50"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","6","33602","TX","Individual","No","36-1236610","33602TX0780043","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS114","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780043-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","51"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780044","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS124","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780044-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780044","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS124","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780044-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780044","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS124","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780044-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780044","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS124","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780044-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780044","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS124","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780044-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780044","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS124","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780044-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780045","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS134","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780045-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780045","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS134","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780045-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780045","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS134","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780045-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780045","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS134","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780045-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780045","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS134","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780045-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780046","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS144","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780046-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780050","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS184","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780050-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","44"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780050","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS184","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780050-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","45"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780051","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS194","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780051-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","46"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780047","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS154","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780047-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780047","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS154","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780047-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","8","33602","TX","Individual","No","36-1236610","33602TX0780052","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS204","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780052-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780058","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS014","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780058-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780058","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS014","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780058-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780059","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS024","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780059-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780059","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS024","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780059-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780059","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS024","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780059-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780047","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS154","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780047-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780047","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS154","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780047-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780047","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS154","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780047-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780048","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS164","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780048-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","28"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780048","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS164","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780048-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","29"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780048","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS164","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780048-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","30"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780048","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS164","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780048-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","31"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780048","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS164","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780048-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","32"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780048","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS164","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780048-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","33"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780049","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS174","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780049-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","34"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780049","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS174","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780049-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","35"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780049","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS174","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780049-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","36"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780049","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS174","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780049-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","37"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780049","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS174","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780049-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","38"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780049","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS174","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780049-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","39"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780050","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS184","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780050-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","40"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780050","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS184","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780050-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","41"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780050","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS184","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780050-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","42"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780050","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS184","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780050-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","43"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780051","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS194","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780051-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","47"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780051","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS194","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780051-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","48"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780051","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS194","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780051-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","49"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780051","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS194","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780051-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","50"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","7","33602","TX","Individual","No","36-1236610","33602TX0780051","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS194","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780051-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","51"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","8","33602","TX","Individual","No","36-1236610","33602TX0780052","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS204","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780052-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","8","33602","TX","Individual","No","36-1236610","33602TX0780052","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS204","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780052-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","8","33602","TX","Individual","No","36-1236610","33602TX0780052","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS204","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780052-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","8","33602","TX","Individual","No","36-1236610","33602TX0780052","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS204","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780052-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","8","33602","TX","Individual","No","36-1236610","33602TX0780052","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS204","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780052-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","8","33602","TX","Individual","No","36-1236610","33602TX0780053","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS214","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780053-01","Standard Silver On Exchange Plan","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","8","33602","TX","Individual","No","36-1236610","33602TX0780053","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS214","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780053-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","8","33602","TX","Individual","No","36-1236610","33602TX0780053","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS214","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780053-03","Limited Cost Sharing Plan Variation","68.93%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13700 per group","$6,500","$6500 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$11250 per group","20%","$3,750","$3750 per person","$11250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","8","33602","TX","Individual","No","36-1236610","33602TX0780053","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS214","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780053-04","73% AV Level Silver Plan","73.03%","0","Yes","Yes","Yes","60%","40%","$3,800","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$10900 per group","$4,600","$4600 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$10200 per group","20%","$3,400","$3400 per person","$10200 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-04.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","8","33602","TX","Individual","No","36-1236610","33602TX0780053","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS214","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780053-05","87% AV Level Silver Plan","87.61%","0","Yes","Yes","Yes","60%","40%","$800","$0","$800","$200","$800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$4500 per group","$1,500","$1500 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","20%","$750","$750 per person","$2250 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-05.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","8","33602","TX","Individual","No","36-1236610","33602TX0780053","Blue Cross Blue Shield Solution? 102, a Multi-State Plan","33602TX078",,"TXN004","TXS214","TXF202","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","2","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780053-06","94% AV Level Silver Plan","94.31%","0","Yes","Yes","Yes","60%","40%","$100","$0","$500","$200","$100","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1800 per group","$600","$600 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group","20%","$100","$100 per person","$300 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780002-06.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780003","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS224","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780003-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780003","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS224","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780003","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS224","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780003-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780054","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS234","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780054-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780054","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS234","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780054-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780054","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS234","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780054-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780055","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS244","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780055-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780055","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS244","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780055-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780055","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS244","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780055-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780056","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS254","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780056-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780056","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS254","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780056-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780056","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS254","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780056-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780057","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS264","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780057-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780057","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS264","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780057-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780057","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS264","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780057-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780058","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS014","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780058-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780060","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS034","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780060-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780069","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS124","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780069-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780069","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS124","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780069-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780060","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS034","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780060-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","9","33602","TX","Individual","No","36-1236610","33602TX0780060","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS034","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780060-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780070","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS134","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780070-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780061","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS044","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780061-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780061","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS044","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780061-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780061","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS044","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780061-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780062","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS054","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780062-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780062","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS054","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780062-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780062","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS054","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780062-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780063","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS064","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780063-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780063","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS064","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780063-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780063","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS064","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780063-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780064","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS074","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780064-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780064","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS074","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780064-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780064","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS074","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780064-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780065","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS084","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780065-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780065","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS084","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780065-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780065","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS084","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780065-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780066","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS094","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780066-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780066","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS094","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780066-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780066","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS094","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780066-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780067","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS104","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780067-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780067","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS104","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780067-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780067","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS104","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780067-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780068","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS114","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780068-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780068","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS114","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780068-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","10","33602","TX","Individual","No","36-1236610","33602TX0780068","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS114","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780068-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780069","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS124","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780069-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","VA","40308","OPM","7","2016-03-08 06:56:35","1","40308","VA","SHOP (Small Group)","No","53-0078070","40308VA0230002","BlueCross BlueShield Preferred 2000, a Multi-State Plan","40308VA023",,"VAN200","VAS001","VAF200","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9974",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services","Yes","All covered services","Yes",,"www.carefirst.com/acarx","40308VA0230002-01","Standard Silver On Exchange Plan","71.99%",,"Yes","Yes","No","100%",,"$2,000","$15","$645","$30","$2,000","$290","$246","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","20%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://content.carefirst.com/sbc/APHVB66DRXCVBB6GN012016.pdf",,"4"
"2016","VA","40308","OPM","7","2016-03-08 06:56:35","1","40308","VA","SHOP (Small Group)","No","53-0078070","40308VA0230001","BlueCross BlueShield Preferred 1000, a Multi-State Plan","40308VA023",,"VAN200","VAS001","VAF200","Existing","PPO","Gold","Yes","On the Exchange","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9974",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services","Yes","All covered services","Yes",,"www.carefirst.com/acarx","40308VA0230001-01","Standard Gold On Exchange Plan","81.60%",,"Yes","Yes","No","100%",,"$1,000","$15","$423","$30","$1,000","$360","$169","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://content.carefirst.com/sbc/APHVB67BRXMVBB7CN012016.pdf",,"5"
"2016","VA","40308","OPM","7","2016-03-08 06:56:35","1","40308","VA","Individual","No","53-0078070","40308VA0220001","BlueCross BlueShield Preferred 500, a Multi-State Plan","40308VA022",,"VAN200","VAS001","VAF202","Existing","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996953039444789",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"www.carefirst.com/acarx","40308VA0220001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/APPVBN7ARXNVBN70N012016.pdf",,"5"
"2016","VA","40308","OPM","7","2016-03-08 06:56:35","1","40308","VA","Individual","No","53-0078070","40308VA0220001","BlueCross BlueShield Preferred 500, a Multi-State Plan","40308VA022",,"VAN200","VAS001","VAF202","Existing","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996953039444789",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"www.carefirst.com/acarx","40308VA0220001-03","Limited Cost Sharing Plan Variation","80.37%",,"No","Yes","No","100%",,"$500","$545","$0","$30","$500","$15","$162","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/APPVBN7BRXNVBN7LN012016.pdf",,"6"
"2016","VA","40308","OPM","7","2016-03-08 06:56:35","1","40308","VA","Individual","No","53-0078070","40308VA0220002","BlueCross BlueShield Preferred 1600, a Multi-State Plan","40308VA022",,"VAN200","VAS001","VAF201","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996949637045141",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"www.carefirst.com/acarx","40308VA0220002-01","Standard Silver On Exchange Plan","69.34%",,"Yes","Yes","No","100%",,"$1,600","$15","$1,088","$30","$1,600","$475","$255","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","30%",,,,,"$3,200","$3200 per person","$6400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://content.carefirst.com/sbc/APHVBN6CRXMVBN6LN012016.pdf",,"7"
"2016","VA","40308","OPM","7","2016-03-08 06:56:35","1","40308","VA","Individual","No","53-0078070","40308VA0220002","BlueCross BlueShield Preferred 1600, a Multi-State Plan","40308VA022",,"VAN200","VAS001","VAF201","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996949637045141",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"www.carefirst.com/acarx","40308VA0220002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://content.carefirst.com/sbc/APPVBN6ARXNVBN65N012016.pdf",,"8"
"2016","VA","40308","OPM","7","2016-03-08 06:56:35","1","40308","VA","Individual","No","53-0078070","40308VA0220002","BlueCross BlueShield Preferred 1600, a Multi-State Plan","40308VA022",,"VAN200","VAS001","VAF201","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996949637045141",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"www.carefirst.com/acarx","40308VA0220002-03","Limited Cost Sharing Plan Variation","69.34%",,"Yes","Yes","No","100%",,"$1,600","$15","$1,088","$30","$1,600","$475","$255","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","30%",,,,,"$3,200","$3200 per person","$6400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://content.carefirst.com/sbc/APHVBN6BRXMVBN6LN012016.pdf",,"9"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780070","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS134","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780070-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780070","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS134","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780070-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780071","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS144","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780071-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","10"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780071","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS144","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780071-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","11"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780071","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS144","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780071-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","12"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780072","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS154","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780072-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","13"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780072","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS154","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780072-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","14"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780072","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS154","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780072-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","15"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780073","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS164","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780073-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","16"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780073","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS164","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780073-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","17"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780073","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS164","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780073-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","18"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780074","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS174","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780074-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","19"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780074","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS174","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780074-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","20"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780074","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS174","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780074-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","21"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780075","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS184","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780075-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","22"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780075","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS184","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780075-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","23"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780075","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS184","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780075-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","24"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780076","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS194","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780076-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","25"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780076","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS194","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780076-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","26"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","11","33602","TX","Individual","No","36-1236610","33602TX0780076","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS194","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780076-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","27"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","12","33602","TX","Individual","No","36-1236610","33602TX0780077","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS204","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780077-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","4"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","12","33602","TX","Individual","No","36-1236610","33602TX0780077","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS204","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780077-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","5"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","12","33602","TX","Individual","No","36-1236610","33602TX0780077","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS204","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780077-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","6"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","12","33602","TX","Individual","No","36-1236610","33602TX0780078","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS214","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780078-01","Standard Bronze On Exchange Plan","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-01.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","7"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","12","33602","TX","Individual","No","36-1236610","33602TX0780078","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS214","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780078-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-02.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","8"
"2016","TX","33602","OPM","7","2016-01-26 09:59:26","12","33602","TX","Individual","No","36-1236610","33602TX0780078","Blue Cross Blue Shield Basic? 103, a Multi-State Plan","33602TX078",,"TXN004","TXS214","TXF201","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/TX/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_TX_5T_EX.pdf","33602TX0780078-03","Limited Cost Sharing Plan Variation","60.91%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$13700 per group","30%","$6,250","$6250 per person","$13700 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbstx.com/PDF/sbc/33602TX0780003-03.PDF","http://www.bcbstx.com/pdf/sbc/2016-texas-plan-overview.pdf","9"
"2016","VA","40308","OPM","7","2016-03-08 06:56:35","1","40308","VA","Individual","No","53-0078070","40308VA0220001","BlueCross BlueShield Preferred 500, a Multi-State Plan","40308VA022",,"VAN200","VAS001","VAF202","Existing","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996953039444789",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"www.carefirst.com/acarx","40308VA0220001-01","Standard Gold On Exchange Plan","80.37%",,"No","Yes","No","100%",,"$500","$545","$0","$30","$500","$15","$162","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/APPVBN7CRXNVBN7LN012016.pdf",,"4"
"2016","VA","40308","OPM","7","2016-03-08 06:56:35","1","40308","VA","Individual","No","53-0078070","40308VA0220002","BlueCross BlueShield Preferred 1600, a Multi-State Plan","40308VA022",,"VAN200","VAS001","VAF201","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996949637045141",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"www.carefirst.com/acarx","40308VA0220002-04","73% AV Level Silver Plan","72.30%",,"Yes","Yes","No","100%",,"$1,250","$15","$1,193","$30","$1,250","$505","$297","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","30%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://content.carefirst.com/sbc/APHVBN6DRXMVBN6NN012016.pdf",,"10"
"2016","VA","40308","OPM","7","2016-03-08 06:56:35","1","40308","VA","Individual","No","53-0078070","40308VA0220002","BlueCross BlueShield Preferred 1600, a Multi-State Plan","40308VA022",,"VAN200","VAS001","VAF201","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996949637045141",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"www.carefirst.com/acarx","40308VA0220002-05","87% AV Level Silver Plan","86.83%",,"Yes","Yes","No","100%",,"$0","$170","$1,350","$30","$0","$690","$366","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://content.carefirst.com/sbc/APPVBN6CRXNVBN6MN012016.pdf",,"11"
"2016","VA","40308","OPM","7","2016-03-08 06:56:35","1","40308","VA","Individual","No","53-0078070","40308VA0220002","BlueCross BlueShield Preferred 1600, a Multi-State Plan","40308VA022",,"VAN200","VAS001","VAF201","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996949637045141",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"www.carefirst.com/acarx","40308VA0220002-06","94% AV Level Silver Plan","94.42%",,"Yes","Yes","No","100%",,"$0","$0","$450","$30","$0","$0","$366","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://content.carefirst.com/sbc/APPVBN6BRXNVBN6LN012016.pdf",,"12"
"2016","VA","88380","OPM","5","2016-01-26 09:59:26","1","88380","VA","Individual","No","54-1356687","88380VA0880005","Anthem HealthKeepers Silver, a Blue Cross and Blue Shield Multi-State Plan","88380VA088",,"VAN201","VAS201","VAF206","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","www.anthem.com/VASelectdrugtier4","88380VA0880005-01","Standard Silver On Exchange Plan","70.64%","0.706852495670319","Yes","Yes","Yes","70%","30%","$1,600","$80","$2,400","$0","$500","$1,900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group","30%","$1,550","$1550 per person","$3100 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GAV","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","4"
"2016","VA","88380","OPM","5","2016-01-26 09:59:26","1","88380","VA","Individual","No","54-1356687","88380VA0880005","Anthem HealthKeepers Silver, a Blue Cross and Blue Shield Multi-State Plan","88380VA088",,"VAN201","VAS201","VAF206","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","www.anthem.com/VASelectdrugtier4","88380VA0880005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GAW","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","5"
"2016","VA","88380","OPM","5","2016-01-26 09:59:26","1","88380","VA","Individual","No","54-1356687","88380VA0880005","Anthem HealthKeepers Silver, a Blue Cross and Blue Shield Multi-State Plan","88380VA088",,"VAN201","VAS201","VAF206","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","www.anthem.com/VASelectdrugtier4","88380VA0880005-03","Limited Cost Sharing Plan Variation","70.64%","0.706852495670319","Yes","Yes","Yes","70%","30%","$1,600","$80","$2,400","$0","$500","$1,900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group","30%","$1,550","$1550 per person","$3100 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GAV","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","6"
"2016","VA","88380","OPM","5","2016-01-26 09:59:26","1","88380","VA","Individual","No","54-1356687","88380VA0880005","Anthem HealthKeepers Silver, a Blue Cross and Blue Shield Multi-State Plan","88380VA088",,"VAN201","VAS201","VAF206","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","www.anthem.com/VASelectdrugtier4","88380VA0880005-04","73% AV Level Silver Plan","73.83%","0.739428520202637","Yes","Yes","Yes","70%","30%","$1,500","$80","$2,400","$0","$500","$1,700","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%","$1,500","$1500 per person","$3000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GAX","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","7"
"2016","VA","88380","OPM","5","2016-01-26 09:59:26","1","88380","VA","Individual","No","54-1356687","88380VA0880005","Anthem HealthKeepers Silver, a Blue Cross and Blue Shield Multi-State Plan","88380VA088",,"VAN201","VAS201","VAF206","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","www.anthem.com/VASelectdrugtier4","88380VA0880005-05","87% AV Level Silver Plan","87.23%","0.874234914779663","Yes","Yes","Yes","70%","30%","$700","$40","$700","$0","$500","$1,000","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group","$1,450","$1450 per person","$2900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$725","$725 per person","$1450 per group","30%","$725","$725 per person","$1450 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GAY","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","8"
"2016","VA","88380","OPM","5","2016-01-26 09:59:26","1","88380","VA","Individual","No","54-1356687","88380VA0880005","Anthem HealthKeepers Silver, a Blue Cross and Blue Shield Multi-State Plan","88380VA088",,"VAN201","VAS201","VAF206","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","www.anthem.com/VASelectdrugtier4","88380VA0880005-06","94% AV Level Silver Plan","93.67%","0.938924610614777","Yes","Yes","Yes","70%","30%","$200","$40","$400","$0","$200","$400","$30","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","30%","$175","$175 per person","$350 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GAZ","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","9"
"2016","VA","88380","OPM","5","2016-01-26 09:59:26","2","88380","VA","Individual","No","54-1356687","88380VA0880006","Anthem HealthKeepers Gold, a Blue Cross and Blue Shield Multi-State Plan","88380VA088",,"VAN201","VAS201","VAF205","Existing","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","www.anthem.com/VASelectdrugtier4","88380VA0880006-01","Standard Gold On Exchange Plan","78.09%","0.783238470554352","Yes","Yes","Yes","70%","30%","$800","$80","$2,400","$0","$500","$1,900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%","$750","$750 per person","$1500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GB4","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","4"
"2016","VA","88380","OPM","5","2016-01-26 09:59:26","2","88380","VA","Individual","No","54-1356687","88380VA0880006","Anthem HealthKeepers Gold, a Blue Cross and Blue Shield Multi-State Plan","88380VA088",,"VAN201","VAS201","VAF205","Existing","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","www.anthem.com/VASelectdrugtier4","88380VA0880006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GB5","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","5"
"2016","VA","88380","OPM","5","2016-01-26 09:59:26","2","88380","VA","Individual","No","54-1356687","88380VA0880006","Anthem HealthKeepers Gold, a Blue Cross and Blue Shield Multi-State Plan","88380VA088",,"VAN201","VAS201","VAF205","Existing","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","www.anthem.com/VASelectdrugtier4","88380VA0880006-03","Limited Cost Sharing Plan Variation","78.09%","0.783238470554352","Yes","Yes","Yes","70%","30%","$800","$80","$2,400","$0","$500","$1,900","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%","$750","$750 per person","$1500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GB4","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","6"
"2016","WI","79475","OPM","6","2016-01-26 09:59:26","1","79475","WI","Individual","No","39-1462554","79475WI0500003","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","79475WI050",,"WIN201","WIS201","WIF205","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","www.anthem.com/WISelectdrugtier4","79475WI0500003-01","Standard Silver On Exchange Plan","70.55%","0.731965124607086","Yes","Yes","No","100%",,"$1,800","$1,400","$800","$0","$500","$1,900","$0","$300",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GNR","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","4"
"2016","WI","79475","OPM","6","2016-01-26 09:59:26","1","79475","WI","Individual","No","39-1462554","79475WI0500003","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","79475WI050",,"WIN201","WIS201","WIF205","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","www.anthem.com/WISelectdrugtier4","79475WI0500003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"www.sbc.anthem.com/dps/ccd1GNS","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","5"
"2016","WI","79475","OPM","6","2016-01-26 09:59:26","1","79475","WI","Individual","No","39-1462554","79475WI0500003","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","79475WI050",,"WIN201","WIS201","WIF205","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","www.anthem.com/WISelectdrugtier4","79475WI0500003-03","Limited Cost Sharing Plan Variation","70.55%","0.731965124607086","Yes","Yes","No","100%",,"$1,800","$1,400","$800","$0","$500","$1,900","$0","$300",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GNR","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","6"
"2016","WI","79475","OPM","6","2016-01-26 09:59:26","1","79475","WI","Individual","No","39-1462554","79475WI0500003","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","79475WI050",,"WIN201","WIS201","WIF205","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","www.anthem.com/WISelectdrugtier4","79475WI0500003-04","73% AV Level Silver Plan","73.56%","0.75600653886795","Yes","Yes","No","100%",,"$1,700","$1,500","$800","$0","$500","$1,700","$0","$300",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GNT","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","7"
"2016","WI","79475","OPM","6","2016-01-26 09:59:26","1","79475","WI","Individual","No","39-1462554","79475WI0500003","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","79475WI050",,"WIN201","WIS201","WIF205","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","www.anthem.com/WISelectdrugtier4","79475WI0500003-05","87% AV Level Silver Plan","87.07%","0.873311877250671","Yes","Yes","No","100%",,"$800","$500","$200","$0","$500","$1,000","$0","$300",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GNU","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","8"
"2016","WI","79475","OPM","6","2016-01-26 09:59:26","1","79475","WI","Individual","No","39-1462554","79475WI0500003","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","79475WI050",,"WIN201","WIS201","WIF205","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","www.anthem.com/WISelectdrugtier4","79475WI0500003-06","94% AV Level Silver Plan","93.84%","0.934682071208954","Yes","Yes","No","100%",,"$200","$200","$300","$0","$200","$500","$20","$300",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GNV","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","9"
"2016","WI","79475","OPM","6","2016-01-26 09:59:26","2","79475","WI","Individual","No","39-1462554","79475WI0500004","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","79475WI050",,"WIN201","WIS201","WIF203","Existing","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","www.anthem.com/WISelectdrugtier4","79475WI0500004-01","Standard Gold On Exchange Plan","78.70%","0.8111692070961","Yes","Yes","No","100%",,"$1,000","$1,100","$500","$0","$500","$1,600","$0","$300",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GNX","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","4"
"2016","WI","79475","OPM","6","2016-01-26 09:59:26","2","79475","WI","Individual","No","39-1462554","79475WI0500004","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","79475WI050",,"WIN201","WIS201","WIF203","Existing","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","www.anthem.com/WISelectdrugtier4","79475WI0500004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$200",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"www.sbc.anthem.com/dps/ccd1GNY","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","5"
"2016","WI","79475","OPM","6","2016-01-26 09:59:26","2","79475","WI","Individual","No","39-1462554","79475WI0500004","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","79475WI050",,"WIN201","WIS201","WIF203","Existing","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=WI","www.anthem.com/WISelectdrugtier4","79475WI0500004-03","Limited Cost Sharing Plan Variation","78.70%","0.8111692070961","Yes","Yes","No","100%",,"$1,000","$1,100","$500","$0","$500","$1,600","$0","$300",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"www.sbc.anthem.com/dps/ccd1GNX","http://editiondigital.net/view/IU65/2016/ON_HIX_WI_KIT_2016","6"
"2016","AR","28348","SERFF","2","2015-08-27 03:52:03","2","28348","AR","Individual","Yes","71-0561140","28348AR0090002","Delta Dental Pediatric Gold Plan","28348AR009",,"ARN001","ARS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$21.15","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348","","28348AR0090002-01","Standard High On Exchange Plan","85.00%",,,,"Yes","30%","70%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalar.com/ACA-Marketplace/2016-pediatric-gold-ehb-plan","http://www.deltadentalar.com/ACA-Marketplace/2016-pediatric-gold-ehb-plan","4"
"2016","AR","28348","SERFF","2","2015-08-27 03:52:03","2","28348","AR","Individual","Yes","71-0561140","28348AR0110002","Delta Dental Pediatric Gold Plan","28348AR011",,"ARN001","ARS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$25.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348","","28348AR0110002-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","30%","70%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalar.com/ACA-Marketplace/2016-pediatric-gold-ehb-plan","http://www.deltadentalar.com/ACA-Marketplace/2016-pediatric-gold-ehb-plan","5"
"2016","WV","31274","OPM","5","2016-01-26 09:59:26","1","31274","WV","Individual","No","55-0624615","31274WV0310002","Blue Cross Blue Shield Shared Cost Blue 4750, a Multi-State Plan","31274WV031",,"WVN201","WVS201","WVF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310002-01","Standard Silver On Exchange Plan",,"0.690946340560913","No","Yes","No","100%",,"$4,750","$10","$500","$0","$1,700","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$4,750","per person not applicable","$9500 per group","20%",,,,,"$9,500","per person not applicable","$19000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmark.com/sbc/bcbswv","http://www.discoverhighmark.com/individuals-families/insurance/product-information/westvirginia","4"
"2016","WV","31274","OPM","5","2016-01-26 09:59:26","1","31274","WV","Individual","No","55-0624615","31274WV0310002","Blue Cross Blue Shield Shared Cost Blue 4750, a Multi-State Plan","31274WV031",,"WVN201","WVS201","WVF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmark.com/sbc/bcbswv","http://www.discoverhighmark.com/individuals-families/insurance/product-information/westvirginia","5"
"2016","WV","31274","OPM","5","2016-01-26 09:59:26","1","31274","WV","Individual","No","55-0624615","31274WV0310002","Blue Cross Blue Shield Shared Cost Blue 4750, a Multi-State Plan","31274WV031",,"WVN201","WVS201","WVF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310002-03","Limited Cost Sharing Plan Variation",,"0.690946340560913","No","Yes","No","100%",,"$4,750","$10","$500","$0","$1,700","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$4,750","per person not applicable","$9500 per group","20%",,,,,"$9,500","per person not applicable","$19000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmark.com/sbc/bcbswv","http://www.discoverhighmark.com/individuals-families/insurance/product-information/westvirginia","6"
"2016","AR","37903","SERFF","2","2015-08-27 03:52:03","1","37903","AR","Individual","No","71-0386640","37903AR0070008","Gold 2000","37903AR007",,"ARN001","ARS001","ARF002","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","37903AR0070008-01","Standard Gold On Exchange Plan",,"0.785819947719574","No","Yes","No","100%",,"$2,000","$0","$1,500","$200","$1,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Gold_2000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-PPO.pdf","12"
"2016","AR","37903","SERFF","2","2015-08-27 03:52:03","1","37903","AR","Individual","No","71-0386640","37903AR0070008","Gold 2000","37903AR007",,"ARN001","ARS001","ARF002","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","37903AR0070008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Gold_2000_Zero.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-PPO.pdf","13"
"2016","AR","37903","SERFF","2","2015-08-27 03:52:03","1","37903","AR","Individual","No","71-0386640","37903AR0070008","Gold 2000","37903AR007",,"ARN001","ARS001","ARF002","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","37903AR0070008-03","Limited Cost Sharing Plan Variation",,"0.785819947719574","No","Yes","No","100%",,"$2,000","$0","$1,500","$200","$1,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Gold_2000_Limited.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-PPO.pdf","14"
"2016","AR","60559","SERFF","2","2015-08-27 03:52:03","1","60559","AR","Individual","Yes","75-1233841","60559AR0010007","Dentegra Dental PPO Pediatric Basic Plan","60559AR001",,"ARN001","ARS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.48","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","60559AR0010007-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","per person not applicable","per group not applicable",,,,,,"$90","per person not applicable","per group not applicable","$90","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ar/60559ar0010007-16","4"
"2016","AR","60559","SERFF","2","2015-08-27 03:52:03","2","60559","AR","Individual","Yes","75-1233841","60559AR0010010","Dentegra Dental PPO Family Preferred Plan","60559AR001",,"ARN001","ARS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.01","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","60559AR0010010-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ar/60559ar0010010-16","4"
"2016","AR","60559","SERFF","2","2015-08-27 03:52:03","3","60559","AR","Individual","Yes","75-1233841","60559AR0010009","Dentegra Dental PPO Family Basic Plan","60559AR001",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.48","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","60559AR0010009-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","per person not applicable","per group not applicable",,,,,,"$90","per person not applicable","per group not applicable","$90","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ar/60559ar0010009-16","4"
"2016","AR","60559","SERFF","2","2015-08-27 03:52:03","3","60559","AR","Individual","Yes","75-1233841","60559AR0010009","Dentegra Dental PPO Family Basic Plan","60559AR001",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.48","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","60559AR0010009-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$90","per person not applicable","per group not applicable",,,,,,"$90","per person not applicable","per group not applicable","$90","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ar/60559ar0010009-16","5"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","1","62141","AR","Individual","No","06-0641618","62141AR0080002","Ambetter Secure Care 2 (2016) with 3 Free PCP Visits","62141AR008",,"ARN001","ARS001","ARF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999859694867078",,,"$350","0","3","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080002-00","Standard Gold Off Exchange Plan",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,850","$18850 per person","$37700 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0080002-00.pdf","https://api.centene.com/Brochures/2016/62141AR0080002-00.pdf","4"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","1","62141","AR","Individual","No","06-0641618","62141AR0080002","Ambetter Secure Care 2 (2016) with 3 Free PCP Visits","62141AR008",,"ARN001","ARS001","ARF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999859694867078",,,"$350","0","3","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080002-01","Standard Gold On Exchange Plan",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,850","$18850 per person","$37700 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0080002-01.pdf","https://api.centene.com/Brochures/2016/62141AR0080002-01.pdf","5"
"2016","WV","31274","OPM","5","2016-01-26 09:59:26","1","31274","WV","Individual","No","55-0624615","31274WV0310002","Blue Cross Blue Shield Shared Cost Blue 4750, a Multi-State Plan","31274WV031",,"WVN201","WVS201","WVF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310002-04","73% AV Level Silver Plan",,"0.720811367034912","No","Yes","No","100%",,"$4,000","$0","$700","$0","$1,700","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","per person not applicable","$8000 per group","20%",,,,,"$9,500","per person not applicable","$19000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmark.com/sbc/bcbswv","http://www.discoverhighmark.com/individuals-families/insurance/product-information/westvirginia","7"
"2016","WV","31274","OPM","5","2016-01-26 09:59:26","1","31274","WV","Individual","No","55-0624615","31274WV0310002","Blue Cross Blue Shield Shared Cost Blue 4750, a Multi-State Plan","31274WV031",,"WVN201","WVS201","WVF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310002-05","87% AV Level Silver Plan",,"0.870044052600861","No","Yes","No","100%",,"$500","$10","$700","$0","$500","$300","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$500","per person not applicable","$1000 per group","10%",,,,,"$9,500","per person not applicable","$19000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmark.com/sbc/bcbswv","http://www.discoverhighmark.com/individuals-families/insurance/product-information/westvirginia","8"
"2016","WV","31274","OPM","5","2016-01-26 09:59:26","1","31274","WV","Individual","No","55-0624615","31274WV0310002","Blue Cross Blue Shield Shared Cost Blue 4750, a Multi-State Plan","31274WV031",,"WVN201","WVS201","WVF201","Existing","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310002-06","94% AV Level Silver Plan",,"0.949489951133728","No","Yes","No","100%",,"$100","$10","$500","$0","$100","$200","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$100","per person not applicable","$200 per group","10%",,,,,"$9,500","per person not applicable","$19000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmark.com/sbc/bcbswv","http://www.discoverhighmark.com/individuals-families/insurance/product-information/westvirginia","9"
"2016","WV","31274","OPM","5","2016-01-26 09:59:26","1","31274","WV","Individual","No","55-0624615","31274WV0310001","Blue Cross Blue Shield Shared Cost Blue 1500, a Multi-State Plan","31274WV031",,"WVN201","WVS201","WVF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310001-01","Standard Gold On Exchange Plan",,"0.794185221195221","No","Yes","No","100%",,"$1,500","$10","$1,200","$0","$1,500","$400","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","per person not applicable","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","per person not applicable","$3000 per group","20%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmark.com/sbc/bcbswv","http://www.discoverhighmark.com/individuals-families/insurance/product-information/westvirginia","10"
"2016","WV","31274","OPM","5","2016-01-26 09:59:26","1","31274","WV","Individual","No","55-0624615","31274WV0310001","Blue Cross Blue Shield Shared Cost Blue 1500, a Multi-State Plan","31274WV031",,"WVN201","WVS201","WVF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmark.com/sbc/bcbswv","http://www.discoverhighmark.com/individuals-families/insurance/product-information/westvirginia","11"
"2016","WV","31274","OPM","5","2016-01-26 09:59:26","1","31274","WV","Individual","No","55-0624615","31274WV0310001","Blue Cross Blue Shield Shared Cost Blue 1500, a Multi-State Plan","31274WV031",,"WVN201","WVS201","WVF201","Existing","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310001-03","Limited Cost Sharing Plan Variation",,"0.794185221195221","No","Yes","No","100%",,"$1,500","$10","$1,200","$0","$1,500","$400","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","per person not applicable","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","per person not applicable","$3000 per group","20%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmark.com/sbc/bcbswv","http://www.discoverhighmark.com/individuals-families/insurance/product-information/westvirginia","12"
"2016","AR","15995","SERFF","2","2015-08-27 03:52:03","1","15995","AR","Individual","Yes","47-0397286","15995AR0040001","Delta Dental Individual, EHB Certified","15995AR004",,"ARN001","ARS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.31","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","15995AR0040001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","AR","15995","SERFF","2","2015-08-27 03:52:03","1","15995","AR","Individual","Yes","47-0397286","15995AR0040002","Delta Dental Individual, EHB Certified","15995AR004",,"ARN001","ARS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.55","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","15995AR0040002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","AR","26904","SERFF","2","2015-08-27 03:52:03","1","26904","AR","Individual","Yes","95-6042390","26904AR0020003","BESTOne Advantage Gold","26904AR002",,"ARN001","ARS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.82","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/2015/AR_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","AR","26904","SERFF","2","2015-08-27 03:52:03","1","26904","AR","Individual","Yes","95-6042390","26904AR0020003","BESTOne Advantage Gold","26904AR002",,"ARN001","ARS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.82","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/2015/AR_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","AR","26904","SERFF","2","2015-08-27 03:52:03","1","26904","AR","Individual","Yes","95-6042390","26904AR0020004","BESTOne Plus Gold","26904AR002",,"ARN001","ARS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.82","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/2015/AR_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","AR","26904","SERFF","2","2015-08-27 03:52:03","1","26904","AR","Individual","Yes","95-6042390","26904AR0020004","BESTOne Plus Gold","26904AR002",,"ARN001","ARS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.82","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/2015/AR_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","AR","26904","SERFF","2","2015-08-27 03:52:03","2","26904","AR","Individual","Yes","95-6042390","26904AR0020005","BESTOne Plus Silver","26904AR002",,"ARN001","ARS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.78","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/2015/AR_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","AR","26904","SERFF","2","2015-08-27 03:52:03","2","26904","AR","Individual","Yes","95-6042390","26904AR0020005","BESTOne Plus Silver","26904AR002",,"ARN001","ARS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.78","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/2015/AR_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","AR","26904","SERFF","2","2015-08-27 03:52:03","2","26904","AR","Individual","Yes","95-6042390","26904AR0020006","BESTOne Basic Silver","26904AR002",,"ARN001","ARS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.78","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/2015/AR_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","AR","26904","SERFF","2","2015-08-27 03:52:03","2","26904","AR","Individual","Yes","95-6042390","26904AR0020006","BESTOne Basic Silver","26904AR002",,"ARN001","ARS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.78","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","26904AR0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/AR/2015/AR_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","AR","28348","SERFF","2","2015-08-27 03:52:03","1","28348","AR","Individual","Yes","71-0561140","28348AR0090001","Delta Dental Pediatric Silver Plan","28348AR009",,"ARN001","ARS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$18.08","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348","","28348AR0090001-01","Standard Low On Exchange Plan","70.00%",,,,"Yes","30%","70%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalar.com/ACA-Marketplace/2016-pediatric-silver-ehb-plan","http://www.deltadentalar.com/ACA-Marketplace/2016-pediatric-silver-ehb-plan","4"
"2016","AR","28348","SERFF","2","2015-08-27 03:52:03","1","28348","AR","Individual","Yes","71-0561140","28348AR0110001","Delta Dental Pediatric Silver Plan","28348AR011",,"ARN001","ARS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$21.21","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348","","28348AR0110001-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","30%","70%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalar.com/ACA-Marketplace/2016-pediatric-silver-ehb-plan","http://www.deltadentalar.com/ACA-Marketplace/2016-pediatric-silver-ehb-plan","5"
"2016","AR","28348","SERFF","2","2015-08-27 03:52:03","3","28348","AR","Individual","Yes","71-0561140","28348AR0100001","Delta Dental Family Silver Plan","28348AR010",,"ARN001","ARS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.08","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348","","28348AR0100001-01","Standard Low On Exchange Plan","70.00%",,,,"Yes","30%","70%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalar.com/ACA-Marketplace/2016-family-silver-plan-ehb-covered-benefits","http://www.deltadentalar.com/ACA-Marketplace/2016-family-silver-plan-ehb-covered-benefits","4"
"2016","AR","28348","SERFF","2","2015-08-27 03:52:03","3","28348","AR","Individual","Yes","71-0561140","28348AR0120001","Delta Dental Family Silver Plan","28348AR012",,"ARN001","ARS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.21","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348","","28348AR0120001-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","30%","70%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalar.com/ACA-Marketplace/2016-family-silver-plan-ehb-covered-benefits","http://www.deltadentalar.com/ACA-Marketplace/2016-family-silver-plan-ehb-covered-benefits","5"
"2016","AR","28348","SERFF","2","2015-08-27 03:52:03","4","28348","AR","Individual","Yes","71-0561140","28348AR0100002","Delta Dental Family Gold Plan","28348AR010",,"ARN001","ARS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.15","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348","","28348AR0100002-01","Standard High On Exchange Plan","85.00%",,,,"Yes","30%","70%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalar.com/ACA-Marketplace/2016-family-gold-plan-ehb-covered-benefits","http://www.deltadentalar.com/ACA-Marketplace/2016-family-gold-plan-ehb-covered-benefits","4"
"2016","AR","28348","SERFF","2","2015-08-27 03:52:03","4","28348","AR","Individual","Yes","71-0561140","28348AR0120002","Delta Dental Family Gold Plan","28348AR012",,"ARN001","ARS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348","","28348AR0120002-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","30%","70%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalar.com/ACA-Marketplace/2016-family-gold-plan-ehb-covered-benefits","http://www.deltadentalar.com/ACA-Marketplace/2016-family-gold-plan-ehb-covered-benefits","5"
"2016","AR","37903","SERFF","2","2015-08-27 03:52:03","1","37903","AR","Individual","No","71-0386640","37903AR0070001","Silver 2500","37903AR007",,"ARN001","ARS001","ARF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","37903AR0070001-00","Standard Silver Off Exchange Plan",,"0.719040095806122","No","Yes","No","100%",,"$2,500","$600","$1,200","$200","$1,400","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Silver_2500.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/IQC-PPO.pdf","4"
"2016","AR","37903","SERFF","2","2015-08-27 03:52:03","1","37903","AR","Individual","No","71-0386640","37903AR0070001","Silver 2500","37903AR007",,"ARN001","ARS001","ARF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","37903AR0070001-01","Standard Silver On Exchange Plan",,"0.719040095806122","No","Yes","No","100%",,"$2,500","$600","$1,200","$200","$1,400","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Silver_2500.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-PPO.pdf","5"
"2016","AR","37903","SERFF","2","2015-08-27 03:52:03","1","37903","AR","Individual","No","71-0386640","37903AR0070001","Silver 2500","37903AR007",,"ARN001","ARS001","ARF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","37903AR0070001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Silver_2500_Zero.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-PPO.pdf","6"
"2016","AR","37903","SERFF","2","2015-08-27 03:52:03","1","37903","AR","Individual","No","71-0386640","37903AR0070001","Silver 2500","37903AR007",,"ARN001","ARS001","ARF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","37903AR0070001-03","Limited Cost Sharing Plan Variation",,"0.719040095806122","No","Yes","No","100%",,"$2,500","$600","$1,200","$200","$1,400","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Silver_2500_Limited.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-PPO.pdf","7"
"2016","AR","37903","SERFF","2","2015-08-27 03:52:03","1","37903","AR","Individual","No","71-0386640","37903AR0070001","Silver 2500","37903AR007",,"ARN001","ARS001","ARF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","37903AR0070001-04","73% AV Level Silver Plan",,"0.739283859729767","No","Yes","No","100%",,"$2,300","$20","$1,300","$200","$1,400","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Silver_2500_73.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-PPO.pdf","8"
"2016","AR","37903","SERFF","2","2015-08-27 03:52:03","1","37903","AR","Individual","No","71-0386640","37903AR0070001","Silver 2500","37903AR007",,"ARN001","ARS001","ARF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","37903AR0070001-05","87% AV Level Silver Plan",,"0.873290657997131","No","Yes","No","100%",,"$500","$600","$400","$200","$500","$900","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Silver_2500_87.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-PPO.pdf","9"
"2016","AR","37903","SERFF","2","2015-08-27 03:52:03","1","37903","AR","Individual","No","71-0386640","37903AR0070001","Silver 2500","37903AR007",,"ARN001","ARS001","ARF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","37903AR0070001-06","94% AV Level Silver Plan",,"0.949190735816956","No","Yes","No","100%",,"$200","$300","$300","$200","$200","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$829","$829 per person","$1658 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$225","$225 per person","$450 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Silver_2500_94.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-PPO.pdf","10"
"2016","AR","37903","SERFF","2","2015-08-27 03:52:03","1","37903","AR","Individual","No","71-0386640","37903AR0070008","Gold 2000","37903AR007",,"ARN001","ARS001","ARF002","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","37903AR0070008-00","Standard Gold Off Exchange Plan",,"0.785819947719574","No","Yes","No","100%",,"$2,000","$0","$1,500","$200","$1,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Gold_2000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/IQC-PPO.pdf","11"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","2","62141","AR","Individual","No","06-0641618","62141AR0100007","Ambetter Balanced Care 7 (2016) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9049",,,,"0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100007-00","Standard Silver Off Exchange Plan",,"0.680503606796265","No","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0100007-00.pdf","https://api.centene.com/Brochures/2016/62141AR0100007-00.pdf","8"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","2","62141","AR","Individual","No","06-0641618","62141AR0100007","Ambetter Balanced Care 7 (2016) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9049",,,,"0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100007-01","Standard Silver On Exchange Plan",,"0.680503606796265","No","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0100007-01.pdf","https://api.centene.com/Brochures/2016/62141AR0100007-01.pdf","9"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","2","62141","AR","Individual","No","06-0641618","62141AR0100007","Ambetter Balanced Care 7 (2016) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9049",,,,"0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0100007-02.pdf","https://api.centene.com/Brochures/2016/62141AR0100007-02.pdf","10"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","2","62141","AR","Individual","No","06-0641618","62141AR0100007","Ambetter Balanced Care 7 (2016) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9049",,,,"0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100007-03","Limited Cost Sharing Plan Variation",,"0.680503606796265","No","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0100007-03.pdf","https://api.centene.com/Brochures/2016/62141AR0100007-03.pdf","11"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","2","62141","AR","Individual","No","06-0641618","62141AR0100007","Ambetter Balanced Care 7 (2016) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9049",,,,"0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100007-04","73% AV Level Silver Plan",,"0.737817168235779","No","Yes","No","100%",,"$2,800","$1,000","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,000","$12000 per person","$24000 per group","$17,200","$17200 per person","$34400 per group","$2,750","$2750 per person","$5500 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","$8,750","$8750 per person","$17500 per group","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0100007-04.pdf","https://api.centene.com/Brochures/2016/62141AR0100007-04.pdf","12"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","1","62141","AR","Individual","No","06-0641618","62141AR0080002","Ambetter Secure Care 2 (2016) with 3 Free PCP Visits","62141AR008",,"ARN001","ARS001","ARF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999859694867078",,,"$350","0","3","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0080002-02.pdf","https://api.centene.com/Brochures/2016/62141AR0080002-02.pdf","6"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","1","62141","AR","Individual","No","06-0641618","62141AR0080002","Ambetter Secure Care 2 (2016) with 3 Free PCP Visits","62141AR008",,"ARN001","ARS001","ARF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.999859694867078",,,"$350","0","3","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080002-03","Limited Cost Sharing Plan Variation",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,850","$18850 per person","$37700 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$3,000","$3000 per person","$6000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0080002-03.pdf","https://api.centene.com/Brochures/2016/62141AR0080002-03.pdf","7"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","1","62141","AR","Individual","No","06-0641618","62141AR0080005","Ambetter Essential Care 6 (2016)","62141AR008",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"$350","0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080005-00","Standard Bronze Off Exchange Plan",,"0.609050095081329","No","Yes","No","100%",,"$5,000","$20","$70","$200","$2,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,850","$18850 per person","$37700 per group","$5,000","$5000 per person","$10000 per group","40%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0080005-00.pdf","https://api.centene.com/Brochures/2016/62141AR0080005-00.pdf","8"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","1","62141","AR","Individual","No","06-0641618","62141AR0080005","Ambetter Essential Care 6 (2016)","62141AR008",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"$350","0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080005-01","Standard Bronze On Exchange Plan",,"0.609050095081329","No","Yes","No","100%",,"$5,000","$20","$70","$200","$2,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,850","$18850 per person","$37700 per group","$5,000","$5000 per person","$10000 per group","40%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0080005-01.pdf","https://api.centene.com/Brochures/2016/62141AR0080005-01.pdf","9"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","1","62141","AR","Individual","No","06-0641618","62141AR0080005","Ambetter Essential Care 6 (2016)","62141AR008",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"$350","0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0080005-02.pdf","https://api.centene.com/Brochures/2016/62141AR0080005-02.pdf","10"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","1","62141","AR","Individual","No","06-0641618","62141AR0080005","Ambetter Essential Care 6 (2016)","62141AR008",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,"$350","0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080005-03","Limited Cost Sharing Plan Variation",,"0.609050095081329","No","Yes","No","100%",,"$5,000","$20","$70","$200","$2,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,850","$18850 per person","$37700 per group","$5,000","$5000 per person","$10000 per group","40%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0080005-03.pdf","https://api.centene.com/Brochures/2016/62141AR0080005-03.pdf","11"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","1","62141","AR","Individual","No","06-0641618","62141AR0080007","Ambetter Balanced Care 7 (2016)","62141AR008",,"ARN001","ARS001","ARF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,,"0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080007-00","Standard Silver Off Exchange Plan",,"0.680503606796265","No","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0080007-00.pdf","https://api.centene.com/Brochures/2016/62141AR0080007-00.pdf","12"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","1","62141","AR","Individual","No","06-0641618","62141AR0080007","Ambetter Balanced Care 7 (2016)","62141AR008",,"ARN001","ARS001","ARF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,,"0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080007-01","Standard Silver On Exchange Plan",,"0.680503606796265","No","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0080007-01.pdf","https://api.centene.com/Brochures/2016/62141AR0080007-01.pdf","13"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","1","62141","AR","Individual","No","06-0641618","62141AR0080007","Ambetter Balanced Care 7 (2016)","62141AR008",,"ARN001","ARS001","ARF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,,"0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0080007-02.pdf","https://api.centene.com/Brochures/2016/62141AR0080007-02.pdf","14"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","1","62141","AR","Individual","No","06-0641618","62141AR0080007","Ambetter Balanced Care 7 (2016)","62141AR008",,"ARN001","ARS001","ARF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,,"0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080007-03","Limited Cost Sharing Plan Variation",,"0.680503606796265","No","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0080007-03.pdf","https://api.centene.com/Brochures/2016/62141AR0080007-03.pdf","15"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030003","Silver Compass Plus 5000","65817AR003",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030003-00","Standard Silver Off Exchange Plan",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0007&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","8"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030003","Silver Compass Plus 5000","65817AR003",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030003-01","Standard Silver On Exchange Plan",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0007&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","9"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030003","Silver Compass Plus 5000","65817AR003",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0012&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","10"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030003","Silver Compass Plus 5000","65817AR003",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030003-03","Limited Cost Sharing Plan Variation",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0011&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","11"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030003","Silver Compass Plus 5000","65817AR003",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030003-04","73% AV Level Silver Plan",,"0.728041231632233","No","Yes","No","100%",,"$3,600","$20","$500","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0008&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","12"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030003","Silver Compass Plus 5000","65817AR003",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030003-05","87% AV Level Silver Plan",,"0.871982634067535","No","Yes","No","100%",,"$800","$0","$800","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0009&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","13"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","1","62141","AR","Individual","No","06-0641618","62141AR0080007","Ambetter Balanced Care 7 (2016)","62141AR008",,"ARN001","ARS001","ARF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,,"0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080007-04","73% AV Level Silver Plan",,"0.737817168235779","No","Yes","No","100%",,"$2,800","$1,000","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,000","$12000 per person","$24000 per group","$17,200","$17200 per person","$34400 per group","$2,750","$2750 per person","$5500 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","$8,750","$8750 per person","$17500 per group","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0080007-04.pdf","https://api.centene.com/Brochures/2016/62141AR0080007-04.pdf","16"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","1","62141","AR","Individual","No","06-0641618","62141AR0080007","Ambetter Balanced Care 7 (2016)","62141AR008",,"ARN001","ARS001","ARF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,,"0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080007-05","87% AV Level Silver Plan",,"0.868424773216248","No","Yes","No","100%",,"$800","$300","$0","$200","$800","$500","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,000","$12000 per person","$24000 per group","$14,250","$14250 per person","$28500 per group","$750","$750 per person","$1500 per group","5%",,,,,"$6,000","$6000 per person","$12000 per group","$6,750","$6750 per person","$13500 per group","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0080007-05.pdf","https://api.centene.com/Brochures/2016/62141AR0080007-05.pdf","17"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","1","62141","AR","Individual","No","06-0641618","62141AR0080007","Ambetter Balanced Care 7 (2016)","62141AR008",,"ARN001","ARS001","ARF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9999",,,,"0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0080007-06","94% AV Level Silver Plan",,"0.9491907954216","No","Yes","No","100%",,"$200","$200","$0","$200","$200","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$829","$829 per person","$1658 per group",,,,"$12,000","$12000 per person","$24000 per group","$12,829","$12829 per person","$25658 per group","$225","$225 per person","$450 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$6,225","$6225 per person","$12450 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0080007-06.pdf","https://api.centene.com/Brochures/2016/62141AR0080007-06.pdf","18"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","2","62141","AR","Individual","No","06-0641618","62141AR0100005","Ambetter Essential Care 6 (2016) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.915",,,"$350","0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100005-00","Standard Bronze Off Exchange Plan",,"0.609050095081329","No","Yes","No","100%",,"$5,000","$20","$70","$200","$2,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,850","$18850 per person","$37700 per group","$5,000","$5000 per person","$10000 per group","40%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0100005-00.pdf","https://api.centene.com/Brochures/2016/62141AR0100005-00.pdf","4"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","2","62141","AR","Individual","No","06-0641618","62141AR0100005","Ambetter Essential Care 6 (2016) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.915",,,"$350","0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100005-01","Standard Bronze On Exchange Plan",,"0.609050095081329","No","Yes","No","100%",,"$5,000","$20","$70","$200","$2,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,850","$18850 per person","$37700 per group","$5,000","$5000 per person","$10000 per group","40%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0100005-01.pdf","https://api.centene.com/Brochures/2016/62141AR0100005-01.pdf","5"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","2","62141","AR","Individual","No","06-0641618","62141AR0100005","Ambetter Essential Care 6 (2016) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.915",,,"$350","0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0100005-02.pdf","https://api.centene.com/Brochures/2016/62141AR0100005-02.pdf","6"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","2","62141","AR","Individual","No","06-0641618","62141AR0100005","Ambetter Essential Care 6 (2016) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.915",,,"$350","0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100005-03","Limited Cost Sharing Plan Variation",,"0.609050095081329","No","Yes","No","100%",,"$5,000","$20","$70","$200","$2,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,500","$12500 per person","$25000 per group","$18,850","$18850 per person","$37700 per group","$5,000","$5000 per person","$10000 per group","40%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0100005-03.pdf","https://api.centene.com/Brochures/2016/62141AR0100005-03.pdf","7"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","2","62141","AR","Individual","No","06-0641618","62141AR0100007","Ambetter Balanced Care 7 (2016) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9049",,,,"0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100007-05","87% AV Level Silver Plan",,"0.868424773216248","No","Yes","No","100%",,"$800","$300","$0","$200","$800","$500","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,000","$12000 per person","$24000 per group","$14,250","$14250 per person","$28500 per group","$750","$750 per person","$1500 per group","5%",,,,,"$6,000","$6000 per person","$12000 per group","$6,750","$6750 per person","$13500 per group","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0100007-05.pdf","https://api.centene.com/Brochures/2016/62141AR0100007-05.pdf","13"
"2016","AR","62141","SERFF","3","2016-01-29 07:27:50","2","62141","AR","Individual","No","06-0641618","62141AR0100007","Ambetter Balanced Care 7 (2016) + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9049",,,,"0","0","0","2016-01-01",,"No",,"Yes","PPO Plan - out of network limitations apply","No","http://ambetterofarkansas.com/payments","http://ambetterofarkansas.com/formulary","62141AR0100007-06","94% AV Level Silver Plan",,"0.9491907954216","No","Yes","No","100%",,"$200","$200","$0","$200","$200","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$829","$829 per person","$1658 per group",,,,"$12,000","$12000 per person","$24000 per group","$12,829","$12829 per person","$25658 per group","$225","$225 per person","$450 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","$6,225","$6225 per person","$12450 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/62141AR0100007-06.pdf","https://api.centene.com/Brochures/2016/62141AR0100007-06.pdf","14"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","1","65817","AR","Individual","No","63-1036819","65817AR0030002","Gold Compass Plus HSA 1600","65817AR003",,"ARN001","ARS001","ARF002","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030002-00","Standard Gold Off Exchange Plan",,"0.785858988761902","Yes","Yes","No","100%",,"$1,600","$0","$500","$200","$1,600","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$6850 per group",,,,"$25,000","per person not applicable","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$4800 per group","10%",,,,,"$15,000","per person not applicable","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=AR0004&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","4"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","1","65817","AR","Individual","No","63-1036819","65817AR0030002","Gold Compass Plus HSA 1600","65817AR003",,"ARN001","ARS001","ARF002","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030002-01","Standard Gold On Exchange Plan",,"0.785858988761902","Yes","Yes","No","100%",,"$1,600","$0","$500","$200","$1,600","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$6850 per group",,,,"$25,000","per person not applicable","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$4800 per group","10%",,,,,"$15,000","per person not applicable","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=AR0004&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","5"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","1","65817","AR","Individual","No","63-1036819","65817AR0030002","Gold Compass Plus HSA 1600","65817AR003",,"ARN001","ARS001","ARF002","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=AR0006&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","6"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","1","65817","AR","Individual","No","63-1036819","65817AR0030002","Gold Compass Plus HSA 1600","65817AR003",,"ARN001","ARS001","ARF002","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030002-03","Limited Cost Sharing Plan Variation",,"0.785858988761902","Yes","Yes","No","100%",,"$1,600","$0","$500","$200","$1,600","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$6850 per group",,,,"$25,000","per person not applicable","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$4800 per group","10%",,,,,"$15,000","per person not applicable","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=AR0005&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","7"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","1","65817","AR","Individual","No","63-1036819","65817AR0030005","Silver Compass Plus HSA 3600","65817AR003",,"ARN001","ARS001","ARF004","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030005-00","Standard Silver Off Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=AR0019&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","8"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","1","65817","AR","Individual","No","63-1036819","65817AR0030005","Silver Compass Plus HSA 3600","65817AR003",,"ARN001","ARS001","ARF004","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030005-01","Standard Silver On Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=AR0019&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","9"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","1","65817","AR","Individual","No","63-1036819","65817AR0030005","Silver Compass Plus HSA 3600","65817AR003",,"ARN001","ARS001","ARF004","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=AR0024&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","10"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","1","65817","AR","Individual","No","63-1036819","65817AR0030005","Silver Compass Plus HSA 3600","65817AR003",,"ARN001","ARS001","ARF004","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030005-03","Limited Cost Sharing Plan Variation",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=AR0023&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","11"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","1","65817","AR","Individual","No","63-1036819","65817AR0030005","Silver Compass Plus HSA 3600","65817AR003",,"ARN001","ARS001","ARF004","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030005-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$3,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=AR0020&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","12"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","1","65817","AR","Individual","No","63-1036819","65817AR0030005","Silver Compass Plus HSA 3600","65817AR003",,"ARN001","ARS001","ARF004","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030005-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$200","$1,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=AR0021&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","13"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","1","65817","AR","Individual","No","63-1036819","65817AR0030005","Silver Compass Plus HSA 3600","65817AR003",,"ARN001","ARS001","ARF004","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030005-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=AR0022&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","14"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","1","65817","AR","Individual","No","63-1036819","65817AR0030006","Bronze Compass Plus HSA 5200","65817AR003",,"ARN001","ARS001","ARF002","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030006-00","Standard Bronze Off Exchange Plan",,"0.618971228599548","Yes","Yes","No","100%",,"$5,200","$0","$100","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","10%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=AR0025&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","15"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","1","65817","AR","Individual","No","63-1036819","65817AR0030006","Bronze Compass Plus HSA 5200","65817AR003",,"ARN001","ARS001","ARF002","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030006-01","Standard Bronze On Exchange Plan",,"0.618971228599548","Yes","Yes","No","100%",,"$5,200","$0","$100","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","10%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=AR0025&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","16"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","1","65817","AR","Individual","No","63-1036819","65817AR0030006","Bronze Compass Plus HSA 5200","65817AR003",,"ARN001","ARS001","ARF002","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=AR0027&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","17"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","1","65817","AR","Individual","No","63-1036819","65817AR0030006","Bronze Compass Plus HSA 5200","65817AR003",,"ARN001","ARS001","ARF002","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030006-03","Limited Cost Sharing Plan Variation",,"0.618971228599548","Yes","Yes","No","100%",,"$5,200","$0","$100","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","10%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=AR0026&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","18"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","2","65817","AR","Individual","No","63-1036819","65817AR0040003","Gold Compass Plus HSA 1600-1","65817AR004",,"ARN001","ARS001","ARF002","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040003-00","Standard Gold Off Exchange Plan",,"0.785858988761902","Yes","Yes","No","100%",,"$1,600","$0","$500","$200","$1,600","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$6850 per group",,,,"$25,000","per person not applicable","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$4800 per group","10%",,,,,"$15,000","per person not applicable","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=AR0044&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","4"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","2","65817","AR","Individual","No","63-1036819","65817AR0040003","Gold Compass Plus HSA 1600-1","65817AR004",,"ARN001","ARS001","ARF002","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040003-01","Standard Gold On Exchange Plan",,"0.785858988761902","Yes","Yes","No","100%",,"$1,600","$0","$500","$200","$1,600","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$6850 per group",,,,"$25,000","per person not applicable","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$4800 per group","10%",,,,,"$15,000","per person not applicable","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=AR0044&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","5"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","2","65817","AR","Individual","No","63-1036819","65817AR0040003","Gold Compass Plus HSA 1600-1","65817AR004",,"ARN001","ARS001","ARF002","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=AR0046&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","6"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","2","65817","AR","Individual","No","63-1036819","65817AR0040003","Gold Compass Plus HSA 1600-1","65817AR004",,"ARN001","ARS001","ARF002","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040003-03","Limited Cost Sharing Plan Variation",,"0.785858988761902","Yes","Yes","No","100%",,"$1,600","$0","$500","$200","$1,600","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$6850 per group",,,,"$25,000","per person not applicable","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","per person not applicable","$4800 per group","10%",,,,,"$15,000","per person not applicable","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=AR0045&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","7"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","2","65817","AR","Individual","No","63-1036819","65817AR0040006","Silver Compass Plus HSA 3600-1","65817AR004",,"ARN001","ARS001","ARF004","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040006-00","Standard Silver Off Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=AR0059&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","8"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","2","65817","AR","Individual","No","63-1036819","65817AR0040006","Silver Compass Plus HSA 3600-1","65817AR004",,"ARN001","ARS001","ARF004","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040006-01","Standard Silver On Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=AR0059&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","9"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","2","65817","AR","Individual","No","63-1036819","65817AR0040006","Silver Compass Plus HSA 3600-1","65817AR004",,"ARN001","ARS001","ARF004","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=AR0064&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","10"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","2","65817","AR","Individual","No","63-1036819","65817AR0040006","Silver Compass Plus HSA 3600-1","65817AR004",,"ARN001","ARS001","ARF004","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040006-03","Limited Cost Sharing Plan Variation",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$3,600","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=AR0063&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","11"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","2","65817","AR","Individual","No","63-1036819","65817AR0040006","Silver Compass Plus HSA 3600-1","65817AR004",,"ARN001","ARS001","ARF004","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040006-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$3,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=AR0060&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","12"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","2","65817","AR","Individual","No","63-1036819","65817AR0040006","Silver Compass Plus HSA 3600-1","65817AR004",,"ARN001","ARS001","ARF004","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040006-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$200","$1,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=AR0061&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","13"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","2","65817","AR","Individual","No","63-1036819","65817AR0040006","Silver Compass Plus HSA 3600-1","65817AR004",,"ARN001","ARS001","ARF004","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040006-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=AR0062&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","14"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","2","65817","AR","Individual","No","63-1036819","65817AR0040007","Bronze Compass Plus HSA 5200-1","65817AR004",,"ARN001","ARS001","ARF002","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040007-00","Standard Bronze Off Exchange Plan",,"0.618971228599548","Yes","Yes","No","100%",,"$5,200","$0","$100","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","10%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=AR0065&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","15"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","2","65817","AR","Individual","No","63-1036819","65817AR0040007","Bronze Compass Plus HSA 5200-1","65817AR004",,"ARN001","ARS001","ARF002","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040007-01","Standard Bronze On Exchange Plan",,"0.618971228599548","Yes","Yes","No","100%",,"$5,200","$0","$100","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","10%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=AR0065&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","16"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","2","65817","AR","Individual","No","63-1036819","65817AR0040007","Bronze Compass Plus HSA 5200-1","65817AR004",,"ARN001","ARS001","ARF002","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=AR0067&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","17"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","2","65817","AR","Individual","No","63-1036819","65817AR0040007","Bronze Compass Plus HSA 5200-1","65817AR004",,"ARN001","ARS001","ARF002","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040007-03","Limited Cost Sharing Plan Variation",,"0.618971228599548","Yes","Yes","No","100%",,"$5,200","$0","$100","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","10%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=AR0066&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","18"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030001","Gold Compass Plus 1000","65817AR003",,"ARN001","ARS001","ARF002","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030001-00","Standard Gold Off Exchange Plan",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0001&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","4"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030001","Gold Compass Plus 1000","65817AR003",,"ARN001","ARS001","ARF002","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030001-01","Standard Gold On Exchange Plan",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0001&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","5"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030001","Gold Compass Plus 1000","65817AR003",,"ARN001","ARS001","ARF002","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0003&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","6"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030001","Gold Compass Plus 1000","65817AR003",,"ARN001","ARS001","ARF002","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030001-03","Limited Cost Sharing Plan Variation",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0002&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","7"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040004","Silver Compass Plus 5000-1","65817AR004",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040004-01","Standard Silver On Exchange Plan",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0047&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","16"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040004","Silver Compass Plus 5000-1","65817AR004",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0052&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","17"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040004","Silver Compass Plus 5000-1","65817AR004",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040004-03","Limited Cost Sharing Plan Variation",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0051&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","18"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030003","Silver Compass Plus 5000","65817AR003",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030003-06","94% AV Level Silver Plan",,"0.949420213699341","No","Yes","No","100%",,"$0","$0","$500","$200","$0","$500","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0010&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","14"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040005","Silver Compass Plus 2000-1","65817AR004",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040005-04","73% AV Level Silver Plan",,"0.737353503704071","No","Yes","No","100%",,"$1,800","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","25%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0053&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","26"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040005","Silver Compass Plus 2000-1","65817AR004",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040005-05","87% AV Level Silver Plan",,"0.877411782741547","No","Yes","No","100%",,"$400","$0","$1,000","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","25%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0054&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","27"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040005","Silver Compass Plus 2000-1","65817AR004",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040005-06","94% AV Level Silver Plan",,"0.943426787853241","No","Yes","No","100%",,"$0","$0","$500","$200","$0","$500","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0055&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","28"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040008","Bronze Compass Plus 6400-1","65817AR004",,"ARN001","ARS001","ARF003","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040008-00","Standard Bronze Off Exchange Plan",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0068&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","29"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040008","Bronze Compass Plus 6400-1","65817AR004",,"ARN001","ARS001","ARF003","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040008-01","Standard Bronze On Exchange Plan",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0068&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","30"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040008","Bronze Compass Plus 6400-1","65817AR004",,"ARN001","ARS001","ARF003","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0070&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","31"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040008","Bronze Compass Plus 6400-1","65817AR004",,"ARN001","ARS001","ARF003","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040008-03","Limited Cost Sharing Plan Variation",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0069&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","32"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030004","Silver Compass Plus 2000","65817AR003",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030004-00","Standard Silver Off Exchange Plan",,"0.714467763900757","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0016&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","15"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030004","Silver Compass Plus 2000","65817AR003",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030004-01","Standard Silver On Exchange Plan",,"0.714467763900757","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0016&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","16"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030004","Silver Compass Plus 2000","65817AR003",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0018&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","17"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030004","Silver Compass Plus 2000","65817AR003",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030004-03","Limited Cost Sharing Plan Variation",,"0.714467763900757","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0017&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","18"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030004","Silver Compass Plus 2000","65817AR003",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030004-04","73% AV Level Silver Plan",,"0.737353503704071","No","Yes","No","100%",,"$1,800","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","25%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0013&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","19"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030004","Silver Compass Plus 2000","65817AR003",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030004-05","87% AV Level Silver Plan",,"0.877411782741547","No","Yes","No","100%",,"$400","$0","$1,000","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","25%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0014&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","20"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030004","Silver Compass Plus 2000","65817AR003",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030004-06","94% AV Level Silver Plan",,"0.943426787853241","No","Yes","No","100%",,"$0","$0","$500","$200","$0","$500","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0015&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","21"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030007","Bronze Compass Plus 6400","65817AR003",,"ARN001","ARS001","ARF003","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030007-00","Standard Bronze Off Exchange Plan",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0028&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","22"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030007","Bronze Compass Plus 6400","65817AR003",,"ARN001","ARS001","ARF003","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030007-01","Standard Bronze On Exchange Plan",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0028&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","23"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030007","Bronze Compass Plus 6400","65817AR003",,"ARN001","ARS001","ARF003","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0030&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","24"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030007","Bronze Compass Plus 6400","65817AR003",,"ARN001","ARS001","ARF003","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030007-03","Limited Cost Sharing Plan Variation",,"0.619268357753754","No","Yes","No","100%",,"$6,300","$20","$0","$200","$1,000","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0029&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","25"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030008","Bronze Compass Plus 4200","65817AR003",,"ARN001","ARS001","ARF005","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030008-00","Standard Bronze Off Exchange Plan",,"0.619571328163147","Yes","Yes","No","100%",,"$4,200","$0","$600","$200","$4,200","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=AR0031&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","26"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030008","Bronze Compass Plus 4200","65817AR003",,"ARN001","ARS001","ARF005","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030008-01","Standard Bronze On Exchange Plan",,"0.619571328163147","Yes","Yes","No","100%",,"$4,200","$0","$600","$200","$4,200","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=AR0031&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","27"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030008","Bronze Compass Plus 4200","65817AR003",,"ARN001","ARS001","ARF005","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=AR0033&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","28"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030008","Bronze Compass Plus 4200","65817AR003",,"ARN001","ARS001","ARF005","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030008-03","Limited Cost Sharing Plan Variation",,"0.619571328163147","Yes","Yes","No","100%",,"$4,200","$0","$600","$200","$4,200","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=AR0032&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","29"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030009","Catastrophic Compass Plus 6850","65817AR003",,"ARN001","ARS001","ARF004","New","POS","Catastrophic","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030009-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,700","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=AR0034&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","30"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","3","65817","AR","Individual","No","63-1036819","65817AR0030009","Catastrophic Compass Plus 6850","65817AR003",,"ARN001","ARS001","ARF004","New","POS","Catastrophic","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0030009-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,700","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=AR0034&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","31"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040001","Silver Compass Plus 4500-1","65817AR004",,"ARN001","ARS001","ARF006","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0077&st=ar","65817AR0040001-00","Standard Silver Off Exchange Plan",,"0.715490102767944","No","Yes","No","100%",,"$4,500","$400","$0","$200","$200","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0035&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","4"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040001","Silver Compass Plus 4500-1","65817AR004",,"ARN001","ARS001","ARF006","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0077&st=ar","65817AR0040001-01","Standard Silver On Exchange Plan",,"0.715490102767944","No","Yes","No","100%",,"$4,500","$400","$0","$200","$200","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0035&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","5"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040001","Silver Compass Plus 4500-1","65817AR004",,"ARN001","ARS001","ARF006","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0077&st=ar","65817AR0040001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0040&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","6"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040001","Silver Compass Plus 4500-1","65817AR004",,"ARN001","ARS001","ARF006","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0077&st=ar","65817AR0040001-03","Limited Cost Sharing Plan Variation",,"0.715490102767944","No","Yes","No","100%",,"$4,500","$400","$0","$200","$200","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0039&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","7"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040001","Silver Compass Plus 4500-1","65817AR004",,"ARN001","ARS001","ARF006","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0077&st=ar","65817AR0040001-04","73% AV Level Silver Plan",,"0.736826837062836","No","Yes","No","100%",,"$3,800","$400","$0","$200","$200","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0036&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","8"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040001","Silver Compass Plus 4500-1","65817AR004",,"ARN001","ARS001","ARF006","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0077&st=ar","65817AR0040001-05","87% AV Level Silver Plan",,"0.876020908355713","No","Yes","No","100%",,"$1,300","$300","$0","$200","$200","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0037&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","9"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040001","Silver Compass Plus 4500-1","65817AR004",,"ARN001","ARS001","ARF006","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0077&st=ar","65817AR0040001-06","94% AV Level Silver Plan",,"0.9491907954216","No","Yes","No","100%",,"$200","$300","$0","$200","$200","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$829","$829 per person","$1658 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$225","$225 per person","$450 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0038&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","10"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040002","Gold Compass Plus 1000-1","65817AR004",,"ARN001","ARS001","ARF001","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040002-00","Standard Gold Off Exchange Plan",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0041&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","11"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040002","Gold Compass Plus 1000-1","65817AR004",,"ARN001","ARS001","ARF001","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040002-01","Standard Gold On Exchange Plan",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0041&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","12"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040002","Gold Compass Plus 1000-1","65817AR004",,"ARN001","ARS001","ARF001","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0043&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","13"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040002","Gold Compass Plus 1000-1","65817AR004",,"ARN001","ARS001","ARF001","New","POS","Gold","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040002-03","Limited Cost Sharing Plan Variation",,"0.795113682746887","No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0042&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","14"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040004","Silver Compass Plus 5000-1","65817AR004",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040004-00","Standard Silver Off Exchange Plan",,"0.681269645690918","No","Yes","No","100%",,"$5,000","$20","$300","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0047&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","15"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040004","Silver Compass Plus 5000-1","65817AR004",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040004-04","73% AV Level Silver Plan",,"0.728041231632233","No","Yes","No","100%",,"$3,600","$20","$500","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0048&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","19"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040004","Silver Compass Plus 5000-1","65817AR004",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040004-05","87% AV Level Silver Plan",,"0.871982634067535","No","Yes","No","100%",,"$800","$0","$800","$200","$300","$1,300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0049&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","20"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040004","Silver Compass Plus 5000-1","65817AR004",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040004-06","94% AV Level Silver Plan",,"0.949420213699341","No","Yes","No","100%",,"$0","$0","$500","$200","$0","$500","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0050&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","21"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040005","Silver Compass Plus 2000-1","65817AR004",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040005-00","Standard Silver Off Exchange Plan",,"0.714467763900757","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0056&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","22"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040005","Silver Compass Plus 2000-1","65817AR004",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040005-01","Standard Silver On Exchange Plan",,"0.714467763900757","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0056&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","23"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040005","Silver Compass Plus 2000-1","65817AR004",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0058&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","24"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040005","Silver Compass Plus 2000-1","65817AR004",,"ARN001","ARS001","ARF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040005-03","Limited Cost Sharing Plan Variation",,"0.714467763900757","No","Yes","No","100%",,"$2,000","$20","$1,100","$200","$300","$1,400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=AR0057&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","25"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040009","Bronze Compass Plus 4200-1","65817AR004",,"ARN001","ARS001","ARF005","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040009-00","Standard Bronze Off Exchange Plan",,"0.619571328163147","Yes","Yes","No","100%",,"$4,200","$0","$600","$200","$4,200","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=AR0071&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","33"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040009","Bronze Compass Plus 4200-1","65817AR004",,"ARN001","ARS001","ARF005","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040009-01","Standard Bronze On Exchange Plan",,"0.619571328163147","Yes","Yes","No","100%",,"$4,200","$0","$600","$200","$4,200","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=AR0071&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","34"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","1","75293","AR","Individual","No","71-0226428","75293AR0260001","Gold 1000 with PCP/Specialist/Rx Copays","75293AR026","7427051652","ARN001","ARS001","ARF002","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0260001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34006&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","6"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040009","Bronze Compass Plus 4200-1","65817AR004",,"ARN001","ARS001","ARF005","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=AR0073&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","35"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040009","Bronze Compass Plus 4200-1","65817AR004",,"ARN001","ARS001","ARF005","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040009-03","Limited Cost Sharing Plan Variation",,"0.619571328163147","Yes","Yes","No","100%",,"$4,200","$0","$600","$200","$4,200","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=AR0072&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","36"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040010","Catastrophic Compass Plus 6850-1","65817AR004",,"ARN001","ARS001","ARF004","New","POS","Catastrophic","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040010-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,700","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=AR0074&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","37"
"2016","AR","65817","SERFF","4","2015-08-27 03:52:03","4","65817","AR","Individual","No","63-1036819","65817AR0040010","Catastrophic Compass Plus 6850-1","65817AR004",,"ARN001","ARS001","ARF004","New","POS","Catastrophic","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=AR0076&st=ar","65817AR0040010-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,700","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=AR0074&st=ar","http://www.uhc.com/iex/doc?id=AR0075&st=ar","38"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","1","70525","AR","Individual","No","71-0794605","70525AR0070006","Catastrophic","70525AR007",,"ARN001","ARS001","ARF001","Existing","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult-Only",,"No","Diabetes, Pregnancy",,,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070006-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Catastrophic.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/IQC-POS-HMO.pdf","4"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","1","70525","AR","Individual","No","71-0794605","70525AR0070006","Catastrophic","70525AR007",,"ARN001","ARS001","ARF001","Existing","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult-Only",,"No","Diabetes, Pregnancy",,,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070006-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$4,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Catastrophic.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","5"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070001","Bronze Classic Saver 5000","70525AR007",,"ARN001","ARS001","ARF002","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070001-00","Standard Bronze Off Exchange Plan",,"0.60584557056427","Yes","Yes","No","100%",,"$5,000","$0","$1,100","$200","$5,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group",,,,"$12,900","per person not applicable","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6850 per person","$10000 per group","50%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Bronze_Classic_Saver_5000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/IQC-POS-HMO.pdf","4"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070001","Bronze Classic Saver 5000","70525AR007",,"ARN001","ARS001","ARF002","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070001-01","Standard Bronze On Exchange Plan",,"0.60584557056427","Yes","Yes","No","100%",,"$5,000","$0","$1,100","$200","$5,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group",,,,"$12,900","per person not applicable","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6850 per person","$10000 per group","50%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Bronze_Classic_Saver_5000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","5"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","3","75293","AR","Individual","No","71-0226428","75293AR1180001","Silver 1500 with PCP/Rx Copays","75293AR118","7427051652","ARN001","ARS001","ARF016","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR1180001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34011&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","6"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","3","75293","AR","Individual","No","71-0226428","75293AR1180001","Silver 1500 with PCP/Rx Copays","75293AR118","7427051652","ARN001","ARS001","ARF016","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR1180001-03","Limited Cost Sharing Plan Variation",,"0.719191789627075","Yes","Yes","No","100%",,"$1,500","$30","$1,600","$40","$1,500","$1,200","$30","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=33004&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","7"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070001","Bronze Classic Saver 5000","70525AR007",,"ARN001","ARS001","ARF002","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Bronze_Classic_Saver_5000_Zero.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","6"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070001","Bronze Classic Saver 5000","70525AR007",,"ARN001","ARS001","ARF002","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070001-03","Limited Cost Sharing Plan Variation",,"0.60584557056427","Yes","Yes","No","100%",,"$5,000","$0","$1,100","$200","$5,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group",,,,"$12,900","per person not applicable","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6850 per person","$10000 per group","50%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Bronze_Classic_Saver_5000_Limited.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","7"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070002","Bronze Classic Saver 3500","70525AR007",,"ARN001","ARS001","ARF002","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070002-00","Standard Bronze Off Exchange Plan",,"0.618300259113312","Yes","Yes","No","100%",,"$3,500","$0","$1,900","$200","$3,500","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group",,,,"$12,900","per person not applicable","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$7000 per group","50%",,,,,"$7,000","per person not applicable","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Bronze_Classic_Saver_3500.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/IQC-POS-HMO.pdf","8"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070002","Bronze Classic Saver 3500","70525AR007",,"ARN001","ARS001","ARF002","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070002-01","Standard Bronze On Exchange Plan",,"0.618300259113312","Yes","Yes","No","100%",,"$3,500","$0","$1,900","$200","$3,500","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group",,,,"$12,900","per person not applicable","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$7000 per group","50%",,,,,"$7,000","per person not applicable","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Bronze_Classic_Saver_3500.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","9"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070002","Bronze Classic Saver 3500","70525AR007",,"ARN001","ARS001","ARF002","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Bronze_Classic_Saver_3500_Zero.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","10"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070002","Bronze Classic Saver 3500","70525AR007",,"ARN001","ARS001","ARF002","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070002-03","Limited Cost Sharing Plan Variation",,"0.618300259113312","Yes","Yes","No","100%",,"$3,500","$0","$1,900","$200","$3,500","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group",,,,"$12,900","per person not applicable","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6850 per person","$7000 per group","50%",,,,,"$7,000","per person not applicable","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Bronze_Classic_Saver_3500_Limited.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","11"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070003","Silver Classic 2500","70525AR007",,"ARN001","ARS001","ARF003","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070003-00","Standard Silver Off Exchange Plan",,"0.719040095806122","No","Yes","No","100%",,"$2,500","$600","$1,200","$200","$1,400","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Silver_Classic_2500.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/IQC-POS-HMO.pdf","12"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070003","Silver Classic 2500","70525AR007",,"ARN001","ARS001","ARF003","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070003-01","Standard Silver On Exchange Plan",,"0.719040095806122","No","Yes","No","100%",,"$2,500","$600","$1,200","$200","$1,400","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Silver_Classic_2500.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","13"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070003","Silver Classic 2500","70525AR007",,"ARN001","ARS001","ARF003","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Silver_Classic_2500_Zero.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","14"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070003","Silver Classic 2500","70525AR007",,"ARN001","ARS001","ARF003","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070003-03","Limited Cost Sharing Plan Variation",,"0.719040095806122","No","Yes","No","100%",,"$2,500","$600","$1,200","$200","$1,400","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Silver_Classic_2500_Limited.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","15"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070003","Silver Classic 2500","70525AR007",,"ARN001","ARS001","ARF003","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070003-04","73% AV Level Silver Plan",,"0.739283859729767","No","Yes","No","100%",,"$2,300","$20","$1,300","$200","$1,400","$1,300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Silver_Classic_2500_73.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","16"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070003","Silver Classic 2500","70525AR007",,"ARN001","ARS001","ARF003","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070003-05","87% AV Level Silver Plan",,"0.873290657997131","No","Yes","No","100%",,"$500","$600","$400","$200","$500","$900","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Silver_Classic_2500_87.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","17"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070003","Silver Classic 2500","70525AR007",,"ARN001","ARS001","ARF003","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070003-06","94% AV Level Silver Plan",,"0.949190735816956","No","Yes","No","100%",,"$200","$300","$300","$200","$200","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$829","$829 per person","$1658 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$225","$225 per person","$450 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Silver_Classic_2500_94.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","18"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070151","Silver Classic Saver 3000","70525AR007",,"ARN001","ARS001","ARF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070151-00","Standard Silver Off Exchange Plan",,"0.708549320697784","Yes","Yes","No","100%",,"$3,000","$0","$400","$200","$3,000","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6850 per person","$8000 per group",,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","10%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Silver_Classic_Saver_3000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/IQC-POS-HMO.pdf","19"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070151","Silver Classic Saver 3000","70525AR007",,"ARN001","ARS001","ARF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070151-01","Standard Silver On Exchange Plan",,"0.708549320697784","Yes","Yes","No","100%",,"$3,000","$0","$400","$200","$3,000","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6850 per person","$8000 per group",,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","10%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Silver_Classic_Saver_3000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","20"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070151","Silver Classic Saver 3000","70525AR007",,"ARN001","ARS001","ARF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070151-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Silver_Classic_Saver_3000_Zero.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","21"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070151","Silver Classic Saver 3000","70525AR007",,"ARN001","ARS001","ARF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070151-03","Limited Cost Sharing Plan Variation",,"0.708549320697784","Yes","Yes","No","100%",,"$3,000","$0","$400","$200","$3,000","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6850 per person","$8000 per group",,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","10%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Silver_Classic_Saver_3000_Limited.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","22"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070151","Silver Classic Saver 3000","70525AR007",,"ARN001","ARS001","ARF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070151-04","73% AV Level Silver Plan",,"0.729292571544647","Yes","Yes","No","100%",,"$2,500","$0","$500","$200","$2,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$5450 per person","$8000 per group",,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","10%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Silver_Classic_Saver_3000_73.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","23"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070151","Silver Classic Saver 3000","70525AR007",,"ARN001","ARS001","ARF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070151-05","87% AV Level Silver Plan",,"0.860010147094727","Yes","Yes","No","100%",,"$1,000","$0","$300","$200","$1,000","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2250 per person","$4000 per group",,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$2000 per person","$2000 per group","5%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Silver_Classic_Saver_3000_87.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","24"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070151","Silver Classic Saver 3000","70525AR007",,"ARN001","ARS001","ARF004","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070151-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group",,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group","0%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Silver_Classic_Saver_3000_94.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","25"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070050","Gold Classic 2000","70525AR007",,"ARN001","ARS001","ARF005","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070050-00","Standard Gold Off Exchange Plan",,"0.785819947719574","No","Yes","No","100%",,"$2,000","$0","$1,500","$200","$1,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Gold_Classic_2000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/IQC-POS-HMO.pdf","26"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070050","Gold Classic 2000","70525AR007",,"ARN001","ARS001","ARF005","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070050-01","Standard Gold On Exchange Plan",,"0.785819947719574","No","Yes","No","100%",,"$2,000","$0","$1,500","$200","$1,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Gold_Classic_2000.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","27"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070050","Gold Classic 2000","70525AR007",,"ARN001","ARS001","ARF005","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070050-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Gold_Classic_2000_Zero.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","28"
"2016","AR","70525","SERFF","2","2015-08-27 03:52:03","2","70525","AR","Individual","No","71-0794605","70525AR0070050","Gold Classic 2000","70525AR007",,"ARN001","ARS001","ARF005","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency care only","Yes","Medical benefits are subject to out-of-network cost sharing","No",,"https://www.qualchoice.com/!userfiles/pdfs/Pharmacy/2016-Formulary-Essential.pdf","70525AR0070050-03","Limited Cost Sharing Plan Variation",,"0.785819947719574","No","Yes","No","100%",,"$2,000","$0","$1,500","$200","$1,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Gold_Classic_2000_Limited.pdf","https://www.qualchoice.com/!userfiles/pdfs/IND-2016/Mktpl-POS-HMO.pdf","29"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","1","75293","AR","Individual","No","71-0226428","75293AR0260001","Gold 1000 with PCP/Specialist/Rx Copays","75293AR026","7427051652","ARN001","ARS001","ARF002","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0260001-00","Standard Gold Off Exchange Plan",,"0.801007151603699","Yes","Yes","No","100%",,"$1,000","$60","$1,200","$40","$1,000","$1,000","$200","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=30001&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","4"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","1","75293","AR","Individual","Yes","71-0226428","75293AR0400001","Pediatric Dental","75293AR040","7427051652","ARN002","ARS002",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$28.07","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefit reduction for dental care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","","75293AR0400001-00","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$20","$20 per person","$40 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D","4"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","1","75293","AR","Individual","Yes","71-0226428","75293AR0400001","Pediatric Dental","75293AR040","7427051652","ARN002","ARS002",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$28.07","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefit reduction for dental care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","","75293AR0400001-01","Standard High On Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$20","$20 per person","$40 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D","5"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","1","75293","AR","Individual","No","71-0226428","75293AR0260001","Gold 1000 with PCP/Specialist/Rx Copays","75293AR026","7427051652","ARN001","ARS001","ARF002","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0260001-01","Standard Gold On Exchange Plan",,"0.801007151603699","Yes","Yes","No","100%",,"$1,000","$60","$1,200","$40","$1,000","$1,000","$200","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=30001&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","5"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","1","75293","AR","Individual","No","71-0226428","75293AR0260001","Gold 1000 with PCP/Specialist/Rx Copays","75293AR026","7427051652","ARN001","ARS001","ARF002","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0260001-03","Limited Cost Sharing Plan Variation",,"0.801007151603699","Yes","Yes","No","100%",,"$1,000","$60","$1,200","$40","$1,000","$1,000","$200","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=31001&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","7"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","2","75293","AR","Individual","No","71-0226428","75293AR0250001","Gold 500 with PCP/Rx Copays","75293AR025","7427051652","ARN001","ARS001","ARF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0250001-00","Standard Gold Off Exchange Plan",,"0.819096446037292","Yes","Yes","No","100%",,"$500","$60","$1,300","$40","$500","$900","$300","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=28001&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","4"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","2","75293","AR","Individual","Yes","71-0226428","75293AR0410001","Dental Gold","75293AR041","7427051652","ARN002","ARS002",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.07","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefit reduction for dental care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","","75293AR0410001-00","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$20","$20 per person","$40 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D","4"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","2","75293","AR","Individual","Yes","71-0226428","75293AR0410001","Dental Gold","75293AR041","7427051652","ARN002","ARS002",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.07","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefit reduction for dental care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","","75293AR0410001-01","Standard High On Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$20","$20 per person","$40 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D","5"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","2","75293","AR","Individual","No","71-0226428","75293AR0250001","Gold 500 with PCP/Rx Copays","75293AR025","7427051652","ARN001","ARS001","ARF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0250001-01","Standard Gold On Exchange Plan",,"0.819096446037292","Yes","Yes","No","100%",,"$500","$60","$1,300","$40","$500","$900","$300","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=28001&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","5"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","2","75293","AR","Individual","No","71-0226428","75293AR0250001","Gold 500 with PCP/Rx Copays","75293AR025","7427051652","ARN001","ARS001","ARF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0250001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34005&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","6"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","2","75293","AR","Individual","Yes","71-0226428","75293AR0420001","Dental Gold Plus Vision","75293AR042","7427051652","ARN002","ARS002",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.07","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefit reduction for dental care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","","75293AR0420001-00","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$20","$20 per person","$40 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D","6"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","2","75293","AR","Individual","Yes","71-0226428","75293AR0420001","Dental Gold Plus Vision","75293AR042","7427051652","ARN002","ARS002",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.07","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefit reduction for dental care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","","75293AR0420001-01","Standard High On Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$20","$20 per person","$40 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D","7"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","2","75293","AR","Individual","No","71-0226428","75293AR0250001","Gold 500 with PCP/Rx Copays","75293AR025","7427051652","ARN001","ARS001","ARF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0250001-03","Limited Cost Sharing Plan Variation",,"0.819096446037292","Yes","Yes","No","100%",,"$500","$60","$1,300","$40","$500","$900","$300","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=29001&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","7"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","3","75293","AR","Individual","No","71-0226428","75293AR1180001","Silver 1500 with PCP/Rx Copays","75293AR118","7427051652","ARN001","ARS001","ARF016","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR1180001-00","Standard Silver Off Exchange Plan",,"0.719191789627075","Yes","Yes","No","100%",,"$1,500","$80","$1,400","$40","$1,500","$1,200","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32019&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","4"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","3","75293","AR","Individual","Yes","71-0226428","75293AR0430001","Dental Silver","75293AR043","7427051652","ARN002","ARS002",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.23","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefit reduction for dental care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","","75293AR0430001-00","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D","4"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","3","75293","AR","Individual","Yes","71-0226428","75293AR0430001","Dental Silver","75293AR043","7427051652","ARN002","ARS002",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.23","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefit reduction for dental care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","","75293AR0430001-01","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D","5"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","3","75293","AR","Individual","No","71-0226428","75293AR1180001","Silver 1500 with PCP/Rx Copays","75293AR118","7427051652","ARN001","ARS001","ARF016","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR1180001-01","Standard Silver On Exchange Plan",,"0.719191789627075","Yes","Yes","No","100%",,"$1,500","$80","$1,400","$40","$1,500","$1,200","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32019&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","5"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","3","75293","AR","Individual","No","71-0226428","75293AR1180001","Silver 1500 with PCP/Rx Copays","75293AR118","7427051652","ARN001","ARS001","ARF016","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR1180001-04","73% AV Level Silver Plan",,"0.739506602287292","Yes","Yes","No","100%",,"$1,500","$30","$1,600","$40","$1,500","$1,100","$30","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32020&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","8"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","3","75293","AR","Individual","No","71-0226428","75293AR1180001","Silver 1500 with PCP/Rx Copays","75293AR118","7427051652","ARN001","ARS001","ARF016","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR1180001-05","87% AV Level Silver Plan",,"0.875911831855774","Yes","Yes","No","100%",,"$800","$20","$200","$40","$700","$900","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32021&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","9"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","3","75293","AR","Individual","No","71-0226428","75293AR1180001","Silver 1500 with PCP/Rx Copays","75293AR118","7427051652","ARN001","ARS001","ARF016","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR1180001-06","94% AV Level Silver Plan",,"0.943623542785645","Yes","Yes","No","100%",,"$300","$20","$200","$40","$0","$500","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32022&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","10"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","4","75293","AR","Individual","No","71-0226428","75293AR0270001","Silver 2500 with PCP/Rx Copays","75293AR027","7427051652","ARN001","ARS001","ARF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0270001-00","Standard Silver Off Exchange Plan",,"0.718513190746307","Yes","Yes","No","100%",,"$2,500","$20","$800","$40","$1,600","$1,100","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32001&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","4"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","4","75293","AR","Individual","No","71-0226428","75293AR0270001","Silver 2500 with PCP/Rx Copays","75293AR027","7427051652","ARN001","ARS001","ARF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0270001-01","Standard Silver On Exchange Plan",,"0.718513190746307","Yes","Yes","No","100%",,"$2,500","$20","$800","$40","$1,600","$1,100","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32001&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","5"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","4","75293","AR","Individual","No","71-0226428","75293AR0270001","Silver 2500 with PCP/Rx Copays","75293AR027","7427051652","ARN001","ARS001","ARF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0270001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34008&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","6"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","4","75293","AR","Individual","No","71-0226428","75293AR0270001","Silver 2500 with PCP/Rx Copays","75293AR027","7427051652","ARN001","ARS001","ARF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0270001-03","Limited Cost Sharing Plan Variation",,"0.718513190746307","Yes","Yes","No","100%",,"$2,500","$20","$800","$40","$1,600","$1,100","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=33001&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","7"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","4","75293","AR","Individual","No","71-0226428","75293AR0270001","Silver 2500 with PCP/Rx Copays","75293AR027","7427051652","ARN001","ARS001","ARF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0270001-04","73% AV Level Silver Plan",,"0.739867866039276","Yes","Yes","No","100%",,"$2,400","$20","$900","$40","$1,600","$1,100","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32002&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","8"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","4","75293","AR","Individual","No","71-0226428","75293AR0270001","Silver 2500 with PCP/Rx Copays","75293AR027","7427051652","ARN001","ARS001","ARF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0270001-05","87% AV Level Silver Plan",,"0.877125263214111","Yes","Yes","No","100%",,"$500","$20","$900","$40","$500","$900","$200","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","15%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32003&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","9"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","4","75293","AR","Individual","No","71-0226428","75293AR0270001","Silver 2500 with PCP/Rx Copays","75293AR027","7427051652","ARN001","ARS001","ARF027","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0270001-06","94% AV Level Silver Plan",,"0.947440624237061","Yes","Yes","No","100%",,"$200","$20","$300","$40","$0","$500","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32004&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","10"
"2016","DE","26018","SERFF","5","2015-08-22 23:36:24","2","26018","DE","Individual","Yes","94-2761537","26018DE0010004","Delta Dental PPO Preferred Plan for Families","26018DE001",,"DEN001","DES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.57","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0010004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0010004-16","5"
"2016","DE","26018","SERFF","5","2015-08-22 23:36:24","2","26018","DE","SHOP (Small Group)","Yes","94-2761537","26018DE0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","26018DE002",,"DEN001","DES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.80","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0020004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0020004-16","5"
"2016","DE","26018","SERFF","5","2015-08-22 23:36:24","3","26018","DE","SHOP (Small Group)","Yes","94-2761537","26018DE0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","26018DE002",,"DEN001","DES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0020006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0020006-16","4"
"2016","DE","26018","SERFF","5","2015-08-22 23:36:24","3","26018","DE","Individual","Yes","94-2761537","26018DE0010006","Delta Dental PPO Basic Plan for Families","26018DE001",,"DEN001","DES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0010006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0010006-16","4"
"2016","DE","26018","SERFF","5","2015-08-22 23:36:24","3","26018","DE","Individual","Yes","94-2761537","26018DE0010006","Delta Dental PPO Basic Plan for Families","26018DE001",,"DEN001","DES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0010006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0010006-16","5"
"2016","DE","26018","SERFF","5","2015-08-22 23:36:24","3","26018","DE","SHOP (Small Group)","Yes","94-2761537","26018DE0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","26018DE002",,"DEN001","DES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0020006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0020006-16","5"
"2016","DE","29497","SERFF","6","2015-08-25 12:56:34","1","29497","DE","Individual","No","06-6033492","29497DE0090001","Aetna Bronze $15 Copay PPO","29497DE009",,"DEN001","DES001","DEF005","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8432547284","29497DE0090001-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709290.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","4"
"2016","DE","29497","SERFF","6","2015-08-25 12:56:34","1","29497","DE","Individual","No","06-6033492","29497DE0090001","Aetna Bronze $15 Copay PPO","29497DE009",,"DEN001","DES001","DEF005","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8432547284","29497DE0090001-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709290.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","5"
"2016","DE","29497","SERFF","6","2015-08-25 12:56:34","1","29497","DE","Individual","No","06-6033492","29497DE0090001","Aetna Bronze $15 Copay PPO","29497DE009",,"DEN001","DES001","DEF005","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8432547284","29497DE0090001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709294.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","6"
"2016","DE","29497","SERFF","6","2015-08-25 12:56:34","1","29497","DE","Individual","No","06-6033492","29497DE0090001","Aetna Bronze $15 Copay PPO","29497DE009",,"DEN001","DES001","DEF005","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8432547284","29497DE0090001-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709293.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","7"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","5","75293","AR","Individual","No","71-0226428","75293AR1190001","Silver 3350","75293AR119","7427051652","ARN001","ARS001","ARF034","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR1190001-00","Standard Silver Off Exchange Plan",,"0.719523191452026","Yes","Yes","No","100%",,"$3,400","$0","$0","$40","$1,600","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group",,,,"$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","0%",,,,,"$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32023&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","4"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","5","75293","AR","Individual","No","71-0226428","75293AR1190001","Silver 3350","75293AR119","7427051652","ARN001","ARS001","ARF034","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR1190001-01","Standard Silver On Exchange Plan",,"0.719523191452026","Yes","Yes","No","100%",,"$3,400","$0","$0","$40","$1,600","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group",,,,"$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","0%",,,,,"$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32023&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","5"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","5","75293","AR","Individual","No","71-0226428","75293AR1190001","Silver 3350","75293AR119","7427051652","ARN001","ARS001","ARF034","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR1190001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34012&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","6"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","5","75293","AR","Individual","No","71-0226428","75293AR1190001","Silver 3350","75293AR119","7427051652","ARN001","ARS001","ARF034","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR1190001-03","Limited Cost Sharing Plan Variation",,"0.719523191452026","Yes","Yes","No","100%",,"$3,400","$0","$0","$40","$1,600","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group",,,,"$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","0%",,,,,"$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=33006&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","7"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","5","75293","AR","Individual","No","71-0226428","75293AR1190001","Silver 3350","75293AR119","7427051652","ARN001","ARS001","ARF034","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR1190001-04","73% AV Level Silver Plan",,"0.739534437656403","Yes","Yes","No","100%",,"$2,900","$0","$0","$40","$2,900","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$2,990","$2990 per person","$5980 per group",,,,"$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,990","$2990 per person","$5980 per group","0%",,,,,"$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32024&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","8"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","5","75293","AR","Individual","No","71-0226428","75293AR1190001","Silver 3350","75293AR119","7427051652","ARN001","ARS001","ARF034","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR1190001-05","87% AV Level Silver Plan",,"0.870122313499451","Yes","Yes","No","100%",,"$1,200","$0","$0","$40","$1,200","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","0%",,,,,"$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32025&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","9"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","5","75293","AR","Individual","No","71-0226428","75293AR1190001","Silver 3350","75293AR119","7427051652","ARN001","ARS001","ARF034","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit Reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR1190001-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$40","$500","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$6,700","$6700 per person","$13400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32026&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","10"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","6","75293","AR","Individual","No","71-0226428","75293AR0280001","Silver 3500 with PCP/Specialist/Rx Copays","75293AR028","7427051652","ARN001","ARS001","ARF044","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0280001-00","Standard Silver Off Exchange Plan","71.17%",,"No","Yes","No","100%",,"$3,500","$100","$700","$40","$0","$2,100","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32007&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","4"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","6","75293","AR","Individual","No","71-0226428","75293AR0280001","Silver 3500 with PCP/Specialist/Rx Copays","75293AR028","7427051652","ARN001","ARS001","ARF044","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0280001-01","Standard Silver On Exchange Plan","71.17%",,"No","Yes","No","100%",,"$3,500","$100","$700","$40","$0","$2,100","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32007&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","5"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","6","75293","AR","Individual","No","71-0226428","75293AR0280001","Silver 3500 with PCP/Specialist/Rx Copays","75293AR028","7427051652","ARN001","ARS001","ARF044","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0280001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34009&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","6"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","6","75293","AR","Individual","No","71-0226428","75293AR0280001","Silver 3500 with PCP/Specialist/Rx Copays","75293AR028","7427051652","ARN001","ARS001","ARF044","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0280001-03","Limited Cost Sharing Plan Variation","71.17%",,"No","Yes","No","100%",,"$3,500","$100","$700","$40","$0","$2,100","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=33002&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","7"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","6","75293","AR","Individual","No","71-0226428","75293AR0280001","Silver 3500 with PCP/Specialist/Rx Copays","75293AR028","7427051652","ARN001","ARS001","ARF044","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0280001-04","73% AV Level Silver Plan","73.90%",,"No","Yes","No","100%",,"$3,500","$30","$0","$40","$1,600","$1,400","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32008&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","8"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","6","75293","AR","Individual","No","71-0226428","75293AR0280001","Silver 3500 with PCP/Specialist/Rx Copays","75293AR028","7427051652","ARN001","ARS001","ARF044","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0280001-05","87% AV Level Silver Plan","87.68%",,"No","Yes","No","100%",,"$500","$60","$700","$40","$0","$1,200","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32009&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","9"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","6","75293","AR","Individual","No","71-0226428","75293AR0280001","Silver 3500 with PCP/Specialist/Rx Copays","75293AR028","7427051652","ARN001","ARS001","ARF044","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9983",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0280001-06","94% AV Level Silver Plan","94.93%",,"No","Yes","No","100%",,"$200","$10","$0","$40","$200","$300","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$829","$829 per person","$1658 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$225","$225 per person","$450 per group","0%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32010&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","10"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","7","75293","AR","Individual","No","71-0226428","75293AR0370001","Bronze 6350 with PCP/RX Copays","75293AR037","7427051652","ARN001","ARS001","ARF048","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0370001-00","Standard Bronze Off Exchange Plan",,"0.619592607021332","Yes","Yes","No","100%",,"$6,400","$30","$200","$40","$1,600","$800","$900","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","50%",,,,,"$12,700","$12700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23005&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","4"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","7","75293","AR","Individual","No","71-0226428","75293AR0370001","Bronze 6350 with PCP/RX Copays","75293AR037","7427051652","ARN001","ARS001","ARF048","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0370001-01","Standard Bronze On Exchange Plan",,"0.619592607021332","Yes","Yes","No","100%",,"$6,400","$30","$200","$40","$1,600","$800","$900","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","50%",,,,,"$12,700","$12700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23005&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","5"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","7","75293","AR","Individual","No","71-0226428","75293AR0370001","Bronze 6350 with PCP/RX Copays","75293AR037","7427051652","ARN001","ARS001","ARF048","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0370001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34014&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","6"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","7","75293","AR","Individual","No","71-0226428","75293AR0370001","Bronze 6350 with PCP/RX Copays","75293AR037","7427051652","ARN001","ARS001","ARF048","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0370001-03","Limited Cost Sharing Plan Variation",,"0.619592607021332","Yes","Yes","No","100%",,"$6,400","$30","$200","$40","$1,600","$800","$900","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","50%",,,,,"$12,700","$12700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=24005&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","7"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","8","75293","AR","Individual","No","71-0226428","75293AR0310001","Bronze 6300 HSA","75293AR031","7427051652","ARN001","ARS001","ARF040","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0310001-00","Standard Bronze Off Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$6,300","$0","$0","$40","$5,300","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"$12,600","$12600 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"$12,600","$12600 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=25001&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","4"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","8","75293","AR","Individual","No","71-0226428","75293AR0310001","Bronze 6300 HSA","75293AR031","7427051652","ARN001","ARS001","ARF040","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0310001-01","Standard Bronze On Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$6,300","$0","$0","$40","$5,300","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"$12,600","$12600 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"$12,600","$12600 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=25001&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","5"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","8","75293","AR","Individual","No","71-0226428","75293AR0310001","Bronze 6300 HSA","75293AR031","7427051652","ARN001","ARS001","ARF040","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0310001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$40","$0","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=34003&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","6"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","8","75293","AR","Individual","No","71-0226428","75293AR0310001","Bronze 6300 HSA","75293AR031","7427051652","ARN001","ARS001","ARF040","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0310001-03","Limited Cost Sharing Plan Variation",,"0.607437193393707","Yes","Yes","No","100%",,"$6,300","$0","$0","$40","$5,300","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"$12,600","$12600 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"$12,600","$12600 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=26001&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","7"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","9","75293","AR","Individual","No","71-0226428","75293AR0320001","Catastrophic","75293AR032","7427051652","ARN001","ARS001","ARF040","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0320001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$40","$5,000","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=27001&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","4"
"2016","AR","75293","SERFF","6","2016-01-29 07:27:50","9","75293","AR","Individual","No","71-0226428","75293AR0320001","Catastrophic","75293AR032","7427051652","ARN001","ARS001","ARF040","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Weight Loss Programs","0.9961",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/pd_list/exchange/2016/metallicdruglist.aspx","75293AR0320001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$40","$5,000","$0","$0","$100",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=27001&year=2016","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","5"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","1","67190","DE","Individual","No","23-2169745","67190DE0080001","Aetna Bronze $15 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8432547284","67190DE0080001-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709313.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","5"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","1","67190","DE","SHOP (Small Group)","No","23-2169745","67190DE0060001","Aetna Bronze HNOption 5000 80/50 HSA","67190DE006",,"DEN001","DES001","DEF030","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=2827506342","67190DE0060001-01","Standard Bronze On Exchange Plan","61.56%",,"Yes","Yes","No","100%",,"$5,000","$10","$30","$200","$5,000","$10","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aetna.com/employer-plans/document-library/small-group/SBC/2016/DE/DE_SBC_711748.pdf",,"5"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","1","67190","DE","Individual","No","23-2169745","67190DE0080001","Aetna Bronze $15 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8432547284","67190DE0080001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709317.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","6"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","1","67190","DE","Individual","No","23-2169745","67190DE0080001","Aetna Bronze $15 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8432547284","67190DE0080001-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709316.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","7"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","3","67190","DE","Individual","No","23-2169745","67190DE0080002","Aetna Bronze Deductible Only HSA Eligible HNOnly","67190DE008",,"DEN001","DES001","DEF010","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8432547284","67190DE0080002-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709318.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","4"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","3","67190","DE","Individual","No","23-2169745","67190DE0080002","Aetna Bronze Deductible Only HSA Eligible HNOnly","67190DE008",,"DEN001","DES001","DEF010","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8432547284","67190DE0080002-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709318.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","5"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","3","67190","DE","Individual","No","23-2169745","67190DE0080002","Aetna Bronze Deductible Only HSA Eligible HNOnly","67190DE008",,"DEN001","DES001","DEF010","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8432547284","67190DE0080002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709322.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","6"
"2016","DE","19005","SERFF","5","2015-08-22 23:36:24","1","19005","DE","SHOP (Small Group)","Yes","93-0242990","19005DE0040002","EHB High PPO","19005DE004",,"DEN001","DES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$51.84","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","19005DE0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","DE","19005","SERFF","5","2015-08-22 23:36:24","1","19005","DE","SHOP (Small Group)","Yes","93-0242990","19005DE0040001","EHB Low PPO","19005DE004",,"DEN001","DES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.51","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","19005DE0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","DE","19005","SERFF","5","2015-08-22 23:36:24","1","19005","DE","SHOP (Small Group)","Yes","93-0242990","19005DE0030002","EHB High Passive","19005DE003",,"DEN001","DES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$53.99","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","19005DE0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","DE","19005","SERFF","5","2015-08-22 23:36:24","1","19005","DE","SHOP (Small Group)","Yes","93-0242990","19005DE0030001","EHB Low Passive","19005DE003",,"DEN001","DES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.18","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","19005DE0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","DE","26018","SERFF","5","2015-08-22 23:36:24","1","26018","DE","Individual","Yes","94-2761537","26018DE0010002","Delta Dental PPO Pediatric Preferred Plan","26018DE001",,"DEN001","DES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.57","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0010002-16","4"
"2016","DE","26018","SERFF","5","2015-08-22 23:36:24","1","26018","DE","SHOP (Small Group)","Yes","94-2761537","26018DE0020002","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","26018DE002",,"DEN001","DES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.80","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0020002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0020002-16","4"
"2016","DE","26018","SERFF","5","2015-08-22 23:36:24","1","26018","DE","Individual","Yes","94-2761537","26018DE0010001","Delta Dental PPO Pediatric Basic Plan","26018DE001",,"DEN001","DES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0010001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0010001-16","5"
"2016","DE","26018","SERFF","5","2015-08-22 23:36:24","1","26018","DE","SHOP (Small Group)","Yes","94-2761537","26018DE0020001","Delta Dental PPO Pediatric Basic Plan for Small Businesses","26018DE002",,"DEN001","DES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0020001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0020001-16","5"
"2016","DE","26018","SERFF","5","2015-08-22 23:36:24","2","26018","DE","SHOP (Small Group)","Yes","94-2761537","26018DE0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","26018DE002",,"DEN001","DES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.80","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0020004-16","4"
"2016","DE","26018","SERFF","5","2015-08-22 23:36:24","2","26018","DE","Individual","Yes","94-2761537","26018DE0010004","Delta Dental PPO Preferred Plan for Families","26018DE001",,"DEN001","DES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.57","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","26018DE0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/de/26018de0010004-16","4"
"2016","DE","29497","SERFF","6","2015-08-25 12:56:34","3","29497","DE","Individual","No","06-6033492","29497DE0090002","Aetna Bronze Deductible Only HSA Eligible PPO","29497DE009",,"DEN001","DES001","DEF009","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8432547284","29497DE0090002-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709295.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","4"
"2016","DE","29497","SERFF","6","2015-08-25 12:56:34","3","29497","DE","Individual","No","06-6033492","29497DE0090002","Aetna Bronze Deductible Only HSA Eligible PPO","29497DE009",,"DEN001","DES001","DEF009","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8432547284","29497DE0090002-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709295.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","5"
"2016","DE","29497","SERFF","6","2015-08-25 12:56:34","3","29497","DE","Individual","No","06-6033492","29497DE0090002","Aetna Bronze Deductible Only HSA Eligible PPO","29497DE009",,"DEN001","DES001","DEF009","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8432547284","29497DE0090002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709299.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","6"
"2016","DE","29497","SERFF","6","2015-08-25 12:56:34","3","29497","DE","Individual","No","06-6033492","29497DE0090002","Aetna Bronze Deductible Only HSA Eligible PPO","29497DE009",,"DEN001","DES001","DEF009","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8432547284","29497DE0090002-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709298.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","7"
"2016","DE","29497","SERFF","6","2015-08-25 12:56:34","5","29497","DE","Individual","No","06-6033492","29497DE0090004","Aetna Silver $10 Copay PPO","29497DE009",,"DEN001","DES001","DEF008","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","29497DE0090004-00","Standard Silver Off Exchange Plan","68.25%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709282.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","4"
"2016","DE","29497","SERFF","6","2015-08-25 12:56:34","5","29497","DE","Individual","No","06-6033492","29497DE0090004","Aetna Silver $10 Copay PPO","29497DE009",,"DEN001","DES001","DEF008","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","29497DE0090004-01","Standard Silver On Exchange Plan","68.25%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709282.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","5"
"2016","DE","29497","SERFF","6","2015-08-25 12:56:34","5","29497","DE","Individual","No","06-6033492","29497DE0090004","Aetna Silver $10 Copay PPO","29497DE009",,"DEN001","DES001","DEF008","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","29497DE0090004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709286.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","6"
"2016","DE","29497","SERFF","6","2015-08-25 12:56:34","5","29497","DE","Individual","No","06-6033492","29497DE0090004","Aetna Silver $10 Copay PPO","29497DE009",,"DEN001","DES001","DEF008","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","29497DE0090004-03","Limited Cost Sharing Plan Variation","68.25%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709285.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","7"
"2016","DE","29497","SERFF","6","2015-08-25 12:56:34","5","29497","DE","Individual","No","06-6033492","29497DE0090004","Aetna Silver $10 Copay PPO","29497DE009",,"DEN001","DES001","DEF008","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","29497DE0090004-04","73% AV Level Silver Plan","72.19%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709289.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","8"
"2016","DE","29497","SERFF","6","2015-08-25 12:56:34","5","29497","DE","Individual","No","06-6033492","29497DE0090004","Aetna Silver $10 Copay PPO","29497DE009",,"DEN001","DES001","DEF008","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","29497DE0090004-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709288.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","9"
"2016","DE","29497","SERFF","6","2015-08-25 12:56:34","5","29497","DE","Individual","No","06-6033492","29497DE0090004","Aetna Silver $10 Copay PPO","29497DE009",,"DEN001","DES001","DEF008","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","29497DE0090004-06","94% AV Level Silver Plan","93.14%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709287.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","10"
"2016","DE","29497","SERFF","6","2015-08-25 12:56:34","7","29497","DE","Individual","No","06-6033492","29497DE0090003","Aetna Gold $10 Copay PPO","29497DE009",,"DEN001","DES001","DEF007","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","29497DE0090003-00","Standard Gold Off Exchange Plan","78.07%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709277.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","4"
"2016","DE","29497","SERFF","6","2015-08-25 12:56:34","7","29497","DE","Individual","No","06-6033492","29497DE0090003","Aetna Gold $10 Copay PPO","29497DE009",,"DEN001","DES001","DEF007","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","29497DE0090003-01","Standard Gold On Exchange Plan","78.07%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709277.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","5"
"2016","DE","29497","SERFF","6","2015-08-25 12:56:34","7","29497","DE","Individual","No","06-6033492","29497DE0090003","Aetna Gold $10 Copay PPO","29497DE009",,"DEN001","DES001","DEF007","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","29497DE0090003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709281.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","6"
"2016","DE","29497","SERFF","6","2015-08-25 12:56:34","7","29497","DE","Individual","No","06-6033492","29497DE0090003","Aetna Gold $10 Copay PPO","29497DE009",,"DEN001","DES001","DEF007","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","29497DE0090003-03","Limited Cost Sharing Plan Variation","78.07%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709280.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","7"
"2016","DE","48664","SERFF","5","2015-08-22 23:36:24","1","48664","DE","Individual","Yes","75-1233841","48664DE0010001","Dentegra Dental PPO Pediatric Basic Plan","48664DE001",,"DEN001","DES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","48664DE0010001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","$80","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/de/48664de0010001-16","4"
"2016","DE","48664","SERFF","5","2015-08-22 23:36:24","1","48664","DE","SHOP (Small Group)","Yes","75-1233841","48664DE0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","48664DE002",,"DEN001","DES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.63","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","48664DE0020001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","$80","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/de/48664de0020001-16","4"
"2016","DE","48664","SERFF","5","2015-08-22 23:36:24","2","48664","DE","SHOP (Small Group)","Yes","75-1233841","48664DE0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","48664DE002",,"DEN001","DES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","48664DE0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","$80","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/de/48664de0020004-16","4"
"2016","DE","48664","SERFF","5","2015-08-22 23:36:24","2","48664","DE","Individual","Yes","75-1233841","48664DE0010004","Dentegra Dental PPO Family Preferred Plan","48664DE001",,"DEN001","DES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.63","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","48664DE0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","$80","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/de/48664de0010004-16","4"
"2016","DE","48664","SERFF","5","2015-08-22 23:36:24","2","48664","DE","Individual","Yes","75-1233841","48664DE0010004","Dentegra Dental PPO Family Preferred Plan","48664DE001",,"DEN001","DES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.63","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","48664DE0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","$80","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/de/48664de0010004-16","5"
"2016","DE","48664","SERFF","5","2015-08-22 23:36:24","2","48664","DE","SHOP (Small Group)","Yes","75-1233841","48664DE0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","48664DE002",,"DEN001","DES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","48664DE0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","$80","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/de/48664de0020004-16","5"
"2016","DE","48664","SERFF","5","2015-08-22 23:36:24","3","48664","DE","SHOP (Small Group)","Yes","75-1233841","48664DE0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","48664DE002",,"DEN001","DES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.63","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","48664DE0020006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","$80","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/de/48664de0020006-16","4"
"2016","DE","48664","SERFF","5","2015-08-22 23:36:24","3","48664","DE","Individual","Yes","75-1233841","48664DE0010006","Dentegra Dental PPO Family Basic Plan","48664DE001",,"DEN001","DES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","48664DE0010006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","$80","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/de/48664de0010006-16","4"
"2016","DE","48664","SERFF","5","2015-08-22 23:36:24","3","48664","DE","Individual","Yes","75-1233841","48664DE0010006","Dentegra Dental PPO Family Basic Plan","48664DE001",,"DEN001","DES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","48664DE0010006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","$80","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/de/48664de0010006-16","5"
"2016","DE","48664","SERFF","5","2015-08-22 23:36:24","3","48664","DE","SHOP (Small Group)","Yes","75-1233841","48664DE0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","48664DE002",,"DEN001","DES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.63","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","48664DE0020006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","$80","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/de/48664de0020006-16","5"
"2016","DE","60359","SERFF","3","2015-08-22 23:36:24","1","60359","DE","SHOP (Small Group)","Yes","13-5581829","60359DE0090001","EHB Basic Dental Plan (Low)","60359DE009",,"DEN001","DES001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$22.24","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","60359DE0090001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.metlife.com/reform","www.metlife.com/reform","4"
"2016","DE","61298","SERFF","4","2015-08-22 23:36:24","1","61298","DE","SHOP (Small Group)","Yes","47-0098400","61298DE0040002","EHB High PPO","61298DE004",,"DEN001","DES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$50.97","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","61298DE0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","DE","61298","SERFF","4","2015-08-22 23:36:24","1","61298","DE","SHOP (Small Group)","Yes","47-0098400","61298DE0040001","EHB Low PPO","61298DE004",,"DEN001","DES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.01","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","61298DE0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","DE","61298","SERFF","4","2015-08-22 23:36:24","1","61298","DE","SHOP (Small Group)","Yes","47-0098400","61298DE0030002","EHB High Passive","61298DE003",,"DEN001","DES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$53.09","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","61298DE0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","DE","61298","SERFF","4","2015-08-22 23:36:24","1","61298","DE","SHOP (Small Group)","Yes","47-0098400","61298DE0030001","EHB Low Passive","61298DE003",,"DEN001","DES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.59","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","61298DE0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","1","67190","DE","SHOP (Small Group)","No","23-2169745","67190DE0060001","Aetna Bronze HNOption 5000 80/50 HSA","67190DE006",,"DEN001","DES001","DEF030","Existing","POS","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=2827506342","67190DE0060001-00","Standard Bronze Off Exchange Plan","61.56%",,"Yes","Yes","No","100%",,"$5,000","$10","$30","$200","$5,000","$10","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aetna.com/employer-plans/document-library/small-group/SBC/2016/DE/DE_SBC_711748.pdf",,"4"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","1","67190","DE","Individual","No","23-2169745","67190DE0080001","Aetna Bronze $15 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8432547284","67190DE0080001-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709313.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","4"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","3","67190","DE","Individual","No","23-2169745","67190DE0080002","Aetna Bronze Deductible Only HSA Eligible HNOnly","67190DE008",,"DEN001","DES001","DEF010","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8432547284","67190DE0080002-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709321.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","7"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","5","67190","DE","Individual","No","23-2169745","67190DE0080004","Aetna Silver $10 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","67190DE0080004-00","Standard Silver Off Exchange Plan","68.25%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709305.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","4"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","5","67190","DE","Individual","No","23-2169745","67190DE0080004","Aetna Silver $10 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","67190DE0080004-01","Standard Silver On Exchange Plan","68.25%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709305.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","5"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","5","67190","DE","Individual","No","23-2169745","67190DE0080004","Aetna Silver $10 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","67190DE0080004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709309.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","6"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","5","67190","DE","Individual","No","23-2169745","67190DE0080004","Aetna Silver $10 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","67190DE0080004-03","Limited Cost Sharing Plan Variation","68.25%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709308.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","7"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","5","67190","DE","Individual","No","23-2169745","67190DE0080004","Aetna Silver $10 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","67190DE0080004-04","73% AV Level Silver Plan","72.19%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709312.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","8"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","5","67190","DE","Individual","No","23-2169745","67190DE0080004","Aetna Silver $10 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","67190DE0080004-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709311.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","9"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","5","67190","DE","Individual","No","23-2169745","67190DE0080004","Aetna Silver $10 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","67190DE0080004-06","94% AV Level Silver Plan","93.14%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709310.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","10"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","7","67190","DE","Individual","No","23-2169745","67190DE0080003","Aetna Gold $10 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF003","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","67190DE0080003-00","Standard Gold Off Exchange Plan","78.07%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709300.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","4"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","7","67190","DE","Individual","No","23-2169745","67190DE0080003","Aetna Gold $10 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF003","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","67190DE0080003-01","Standard Gold On Exchange Plan","78.07%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709300.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","5"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","7","67190","DE","Individual","No","23-2169745","67190DE0080003","Aetna Gold $10 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF003","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","67190DE0080003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709304.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","6"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","7","67190","DE","Individual","No","23-2169745","67190DE0080003","Aetna Gold $10 Copay HNOnly","67190DE008",,"DEN001","DES001","DEF003","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8430124997","67190DE0080003-03","Limited Cost Sharing Plan Variation","78.07%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/DE/DE_SBC_709303.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/de-on-booklet01-16.pdf","7"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","10","67190","DE","SHOP (Small Group)","No","23-2169745","67190DE0060003","Aetna Silver HNOption 3000 90/50 HSA","67190DE006",,"DEN001","DES001","DEF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=2827506342","67190DE0060003-00","Standard Silver Off Exchange Plan","68.40%",,"Yes","Yes","No","100%",,"$3,000","$10","$200","$200","$3,000","$60","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aetna.com/employer-plans/document-library/small-group/SBC/2016/DE/DE_SBC_711747.pdf",,"4"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","10","67190","DE","SHOP (Small Group)","No","23-2169745","67190DE0060003","Aetna Silver HNOption 3000 90/50 HSA","67190DE006",,"DEN001","DES001","DEF032","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=2827506342","67190DE0060003-01","Standard Silver On Exchange Plan","68.40%",,"Yes","Yes","No","100%",,"$3,000","$10","$200","$200","$3,000","$60","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aetna.com/employer-plans/document-library/small-group/SBC/2016/DE/DE_SBC_711747.pdf",,"5"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","21","67190","DE","SHOP (Small Group)","No","23-2169745","67190DE0060002","Aetna Gold HNOption 1500 80/50","67190DE006",,"DEN001","DES001","DEF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=2827506342","67190DE0060002-00","Standard Gold Off Exchange Plan","81.73%",,"No","Yes","No","100%",,"$1,500","$10","$700","$200","$1,500","$100","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aetna.com/employer-plans/document-library/small-group/SBC/2016/DE/DE_SBC_711746.pdf",,"4"
"2016","DE","67190","SERFF","7","2015-08-23 14:39:40","21","67190","DE","SHOP (Small Group)","No","23-2169745","67190DE0060002","Aetna Gold HNOption 1500 80/50","67190DE006",,"DEN001","DES001","DEF031","Existing","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=2827506342","67190DE0060002-01","Standard Gold On Exchange Plan","81.73%",,"No","Yes","No","100%",,"$1,500","$10","$700","$200","$1,500","$100","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aetna.com/employer-plans/document-library/small-group/SBC/2016/DE/DE_SBC_711746.pdf",,"5"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","1","67775","DE","SHOP (Small Group)","Yes","54-1808292","67775DE0040004","Access PPO Basic","67775DE004",,"DEN002","DES002",,"New","PPO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$25.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","67775DE0040004-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBLSMGFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBLSMGFAMEHB.PDF","4"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","1","67775","DE","Individual","Yes","54-1808292","67775DE0020005","PPO Elite Basic Kids","67775DE002",,"DEN003","DES003",,"New","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$19.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020005-00","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBLINDPEDEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBLINDPEDEHB.PDF","4"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","1","67775","DE","Individual","Yes","54-1808292","67775DE0020005","PPO Elite Basic Kids","67775DE002",,"DEN003","DES003",,"New","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$19.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020005-01","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBLINDPEDEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBLINDPEDEHB.PDF","5"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","1","67775","DE","SHOP (Small Group)","Yes","54-1808292","67775DE0040004","Access PPO Basic","67775DE004",,"DEN002","DES002",,"New","PPO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$25.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","67775DE0040004-01","Standard High On Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBLSMGFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBLSMGFAMEHB.PDF","5"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","1","67775","DE","SHOP (Small Group)","Yes","54-1808292","67775DE0040005","Access PPO Premium","67775DE004",,"DEN002","DES002",,"New","PPO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$25.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","67775DE0040005-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBHSMGFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBHSMGFAMEHB.PDF","6"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","1","67775","DE","Individual","Yes","54-1808292","67775DE0020003","PPO Elite Premium Kids","67775DE002",,"DEN003","DES003",,"New","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$25.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020003-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBHINDPEDEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBHINDPEDEHB.PDF","6"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","1","67775","DE","Individual","Yes","54-1808292","67775DE0020003","PPO Elite Premium Kids","67775DE002",,"DEN003","DES003",,"New","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$25.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020003-01","Standard High On Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBHINDPEDEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBHINDPEDEHB.PDF","7"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","1","67775","DE","SHOP (Small Group)","Yes","54-1808292","67775DE0040005","Access PPO Premium","67775DE004",,"DEN002","DES002",,"New","PPO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$25.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard PPO Out-of-Network Coverage","Yes","Standard PPO Out-of-Network Coverage","Yes",,"","67775DE0040005-01","Standard High On Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBHSMGFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBHSMGFAMEHB.PDF","7"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","1","67775","DE","Individual","Yes","54-1808292","67775DE0010003","Select Plan Basic Kids","67775DE001",,"DEN001","DES001",,"Existing","HMO","Low",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"$13.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010003-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16DBLINDPEDEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16DBLINDPEDEHB.PDF","8"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","1","67775","DE","Individual","Yes","54-1808292","67775DE0010003","Select Plan Basic Kids","67775DE001",,"DEN001","DES001",,"Existing","HMO","Low",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"$13.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010003-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16DBLINDPEDEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16DBLINDPEDEHB.PDF","9"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","1","67775","DE","Individual","Yes","54-1808292","67775DE0010005","Select Plan Premium Kids","67775DE001",,"DEN001","DES001",,"New","HMO","High",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"$23.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010005-00","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16DBHINDPEDEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16DBHINDPEDEHB.PDF","10"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","1","67775","DE","Individual","Yes","54-1808292","67775DE0010005","Select Plan Premium Kids","67775DE001",,"DEN001","DES001",,"New","HMO","High",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"$23.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010005-01","Standard High On Exchange Plan","85.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16DBHINDPEDEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16DBHINDPEDEHB.PDF","11"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","2","67775","DE","Individual","Yes","54-1808292","67775DE0020004","PPO Elite Basic","67775DE002",,"DEN003","DES003",,"New","PPO","Low",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$19.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020004-00","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBLINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBLINDFAMEHB.PDF","4"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","2","67775","DE","SHOP (Small Group)","Yes","54-1808292","67775DE0030004","Select Plan Premium","67775DE003",,"DEN001","DES001",,"New","HMO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"$23.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0030004-00","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16DBHSMGFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16DBHSMGFAMEHB.PDF","4"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410013","Shared Cost Blue EPO 4000","76168DE041",,"DEN001","DES001","DEF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410013-06","94% AV Level Silver Plan",,"0.935195624828339","No","Yes","No","100%",,"$250","$0","$250","$0","$250","$200","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096405046_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","10"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410004","Shared Cost Blue EPO 300","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410004-00","Standard Platinum Off Exchange Plan",,"0.898778080940247","No","Yes","No","100%",,"$300","$40","$700","$0","$300","$700","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096022491_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","11"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410012","Shared Cost Blue EPO 750","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410012-03","Limited Cost Sharing Plan Variation",,"0.814157962799072","No","Yes","No","100%",,"$750","$40","$1,300","$0","$750","$800","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095645952_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","18"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410002","Shared Cost Blue EPO 0","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"5","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410002-03","Limited Cost Sharing Plan Variation",,"0.809076249599457","No","Yes","No","100%",,"$0","$700","$0","$0","$0","$1,000","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095632921_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","41"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640004","PCMH Blue EPO 2800","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640004-00","Standard Silver Off Exchange Plan",,"0.691358208656311","No","Yes","Yes","98%","2%","$2,800","$300","$900","$0","$1,600","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","25%","$2,800","$2800 per person","$5600 per group","25%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096591640_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","4"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0580001","PCMH Blue EPO $750-100","76168DE058",,"DEN001","DES001","DEF006","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9978",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0580001-00","Standard Gold Off Exchange Plan","80.97%","0.827150046825409","No","Yes","Yes","98%","2%","$750","$200","$0","$0","$750","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%","$750","$750 per person","$1500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","4"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640003","PCMH Blue EPO 2300","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640003-05","87% AV Level Silver Plan","87.57%","0.875673592090607","No","Yes","Yes","98%","2%","$750","$100","$600","$0","$750","$300","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%","$750","$750 per person","$1500 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096533301_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","20"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640003","PCMH Blue EPO 2300","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640003-06","94% AV Level Silver Plan","94.39%","0.943923830986023","No","Yes","Yes","98%","2%","$100","$100","$300","$0","$100","$200","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%","$100","$100 per person","$200 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096536763_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","21"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640001","PCMH Blue EPO 900","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640001-00","Standard Gold Off Exchange Plan",,"0.815888941287994","No","Yes","Yes","98%","2%","$900","$200","$600","$0","$900","$400","$70","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","10%","$900","$900 per person","$1800 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096303020_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","22"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","2","67775","DE","SHOP (Small Group)","Yes","54-1808292","67775DE0030004","Select Plan Premium","67775DE003",,"DEN001","DES001",,"New","HMO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"$23.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0030004-01","Standard High On Exchange Plan","85.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","2","67775","DE","Individual","Yes","54-1808292","67775DE0020004","PPO Elite Basic","67775DE002",,"DEN003","DES003",,"New","PPO","Low",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$19.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020004-01","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBLINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBLINDFAMEHB.PDF","5"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","2","67775","DE","Individual","Yes","54-1808292","67775DE0020006","PPO Elite Premium","67775DE002",,"DEN003","DES003",,"New","PPO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$25.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020006-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBHINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBHINDFAMEHB.PDF","6"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","2","67775","DE","Individual","Yes","54-1808292","67775DE0020006","PPO Elite Premium","67775DE002",,"DEN003","DES003",,"New","PPO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$25.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020006-01","Standard High On Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBHINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16SBHINDFAMEHB.PDF","7"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","3","67775","DE","Individual","Yes","54-1808292","67775DE0020007","PPO Elite Plus","67775DE002",,"DEN003","DES003",,"New","PPO","Low",,"Off the Exchange",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$19.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","67775DE0020007-00","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","4","67775","DE","Individual","Yes","54-1808292","67775DE0010004","Select Plan Basic","67775DE001",,"DEN001","DES001",,"Existing","HMO","Low",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"$13.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010004-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16DBLINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16DBLINDFAMEHB.PDF","4"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","4","67775","DE","Individual","Yes","54-1808292","67775DE0010004","Select Plan Basic","67775DE001",,"DEN001","DES001",,"Existing","HMO","Low",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"$13.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010004-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16DBLINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16DBLINDFAMEHB.PDF","5"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","4","67775","DE","Individual","Yes","54-1808292","67775DE0010006","Select Plan Premium","67775DE001",,"DEN001","DES001",,"New","HMO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"$23.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010006-00","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16DBHINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16DBHINDFAMEHB.PDF","6"
"2016","DE","67775","SERFF","5","2015-08-22 23:36:24","4","67775","DE","Individual","Yes","54-1808292","67775DE0010006","Select Plan Premium","67775DE001",,"DEN001","DES001",,"New","HMO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"$23.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","67775DE0010006-01","Standard High On Exchange Plan","85.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16DBHINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSDE16DBHINDFAMEHB.PDF","7"
"2016","DE","68245","SERFF","3","2015-08-22 23:36:24","1","68245","DE","SHOP (Small Group)","Yes","36-0883760","68245DE0040002","EHB High PPO","68245DE004",,"DEN001","DES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$51.69","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","68245DE0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","DE","68245","SERFF","3","2015-08-22 23:36:24","1","68245","DE","SHOP (Small Group)","Yes","36-0883760","68245DE0040001","EHB Low PPO","68245DE004",,"DEN001","DES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.41","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","68245DE0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","DE","68245","SERFF","3","2015-08-22 23:36:24","1","68245","DE","SHOP (Small Group)","Yes","36-0883760","68245DE0030002","EHB High Passive","68245DE003",,"DEN001","DES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$53.83","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","68245DE0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","DE","68245","SERFF","3","2015-08-22 23:36:24","1","68245","DE","SHOP (Small Group)","Yes","36-0883760","68245DE0030001","EHB Low Passive","68245DE003",,"DEN001","DES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.08","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","68245DE0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410013","Shared Cost Blue EPO 4000","76168DE041",,"DEN001","DES001","DEF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410013-00","Standard Silver Off Exchange Plan",,"0.687461316585541","No","Yes","No","100%",,"$4,000","$40","$700","$0","$2,100","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096325900_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","4"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0510011","Health Savings EPO HSA $1850-100","76168DE051",,"DEN001","DES001","DEF001","New","EPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9977",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0510011-00","Standard Gold Off Exchange Plan",,"0.817367315292358","Yes","Yes","No","100%",,"$1,850","$0","$0","$0","$1,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","4"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0510011","Health Savings EPO HSA $1850-100","76168DE051",,"DEN001","DES001","DEF001","New","EPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9977",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0510011-01","Standard Gold On Exchange Plan",,"0.817367315292358","Yes","Yes","No","100%",,"$1,850","$0","$0","$0","$1,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","5"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410013","Shared Cost Blue EPO 4000","76168DE041",,"DEN001","DES001","DEF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410013-01","Standard Silver On Exchange Plan",,"0.687461316585541","No","Yes","No","100%",,"$4,000","$40","$700","$0","$2,100","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096325900_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","5"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410013","Shared Cost Blue EPO 4000","76168DE041",,"DEN001","DES001","DEF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410013-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096473123_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","6"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410013","Shared Cost Blue EPO 4000","76168DE041",,"DEN001","DES001","DEF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410013-03","Limited Cost Sharing Plan Variation",,"0.687461316585541","No","Yes","No","100%",,"$4,000","$40","$700","$0","$2,100","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096396406_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","7"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410013","Shared Cost Blue EPO 4000","76168DE041",,"DEN001","DES001","DEF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410013-04","73% AV Level Silver Plan",,"0.736877918243408","No","Yes","No","100%",,"$4,000","$0","$500","$0","$2,100","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096398561_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","8"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410013","Shared Cost Blue EPO 4000","76168DE041",,"DEN001","DES001","DEF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410013-05","87% AV Level Silver Plan",,"0.873903214931488","No","Yes","No","100%",,"$750","$40","$700","$0","$750","$600","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096400792_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","9"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410004","Shared Cost Blue EPO 300","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410004-01","Standard Platinum On Exchange Plan",,"0.898778080940247","No","Yes","No","100%",,"$300","$40","$700","$0","$300","$700","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096022491_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","12"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410006","Shared Cost Blue EPO 1000","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095453107_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","36"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410006","Shared Cost Blue EPO 1000","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410006-03","Limited Cost Sharing Plan Variation",,"0.812957167625427","No","Yes","No","100%",,"$1,000","$200","$1,100","$0","$1,000","$900","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095451634_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","37"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410002","Shared Cost Blue EPO 0","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"5","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410002-00","Standard Gold Off Exchange Plan",,"0.809076249599457","No","Yes","No","100%",,"$0","$700","$0","$0","$0","$1,000","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095599891_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","38"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640003","PCMH Blue EPO 2300","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640003-03","Limited Cost Sharing Plan Variation","71.52%","0.715213179588318","No","Yes","Yes","98%","2%","$2,300","$300","$1,100","$0","$1,600","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,300","$2300 per person","$4600 per group","25%","$2,300","$2300 per person","$4600 per group","25%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096531308_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","18"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640003","PCMH Blue EPO 2300","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640003-04","73% AV Level Silver Plan","73.63%","0.732999324798584","No","Yes","Yes","98%","2%","$2,300","$300","$1,100","$0","$1,600","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,300","$2300 per person","$4600 per group","25%","$2,300","$2300 per person","$4600 per group","25%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096532285_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","19"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640001","PCMH Blue EPO 900","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640001-01","Standard Gold On Exchange Plan",,"0.815888941287994","No","Yes","Yes","98%","2%","$900","$200","$600","$0","$900","$400","$70","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","10%","$900","$900 per person","$1800 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096303020_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","23"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","5","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0430001","Shared Cost EPO Basic $1000-75","76168DE043",,"DEN001","DES001","DEF006","Existing","EPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9977",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0430001-01","Standard Gold On Exchange Plan",,"0.805879890918732","No","Yes","No","100%",,"$1,000","$40","$1,600","$0","$1,000","$700","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","7"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410004","Shared Cost Blue EPO 300","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096026817_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","13"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410004","Shared Cost Blue EPO 300","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410004-03","Limited Cost Sharing Plan Variation",,"0.898778080940247","No","Yes","No","100%",,"$300","$40","$700","$0","$300","$700","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096046803_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","14"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410012","Shared Cost Blue EPO 750","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410012-00","Standard Gold Off Exchange Plan",,"0.814157962799072","No","Yes","No","100%",,"$750","$40","$1,300","$0","$750","$800","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095644286_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","15"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410012","Shared Cost Blue EPO 750","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410012-01","Standard Gold On Exchange Plan",,"0.814157962799072","No","Yes","No","100%",,"$750","$40","$1,300","$0","$750","$800","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095644286_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","16"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410012","Shared Cost Blue EPO 750","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410012-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095646659_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","17"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410011","Shared Cost Blue EPO 1550","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410011-00","Standard Gold Off Exchange Plan",,"0.816235065460205","No","Yes","No","100%",,"$1,550","$40","$0","$0","$1,550","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,550","$1550 per person","$3100 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,,"http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","19"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410011","Shared Cost Blue EPO 1550","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410011-01","Standard Gold On Exchange Plan",,"0.816235065460205","No","Yes","No","100%",,"$1,550","$40","$0","$0","$1,550","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,550","$1550 per person","$3100 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096035077_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","20"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410011","Shared Cost Blue EPO 1550","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410011-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096043939_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","21"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410011","Shared Cost Blue EPO 1550","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410011-03","Limited Cost Sharing Plan Variation",,"0.816235065460205","No","Yes","No","100%",,"$1,550","$40","$0","$0","$1,550","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,550","$1550 per person","$3100 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096043885_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","22"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410008","Shared Cost Blue EPO 3000","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410008-00","Standard Silver Off Exchange Plan",,"0.714801430702209","No","Yes","No","100%",,"$3,000","$200","$500","$0","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096178607_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","23"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410008","Shared Cost Blue EPO 3000","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410008-01","Standard Silver On Exchange Plan",,"0.714801430702209","No","Yes","No","100%",,"$3,000","$200","$500","$0","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096178607_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","24"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410008","Shared Cost Blue EPO 3000","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096302637_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","25"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410008","Shared Cost Blue EPO 3000","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410008-03","Limited Cost Sharing Plan Variation",,"0.714801430702209","No","Yes","No","100%",,"$3,000","$200","$500","$0","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096241442_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","26"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410008","Shared Cost Blue EPO 3000","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410008-04","73% AV Level Silver Plan",,"0.739495098590851","No","Yes","No","100%",,"$2,500","$200","$800","$0","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096303876_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","27"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410008","Shared Cost Blue EPO 3000","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410008-05","87% AV Level Silver Plan",,"0.868446886539459","No","Yes","No","100%",,"$750","$90","$600","$0","$750","$700","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096313196_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","28"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410008","Shared Cost Blue EPO 3000","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410008-06","94% AV Level Silver Plan",,"0.930701851844788","No","Yes","No","100%",,"$200","$50","$500","$0","$200","$470","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096322885_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","29"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410010","Shared Cost Blue EPO 6000","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410010-00","Standard Bronze Off Exchange Plan",,"0.619295239448547","Yes","Yes","No","100%",,"$6,000","$0","$200","$0","$4,900","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095436166_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","30"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410010","Shared Cost Blue EPO 6000","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410010-01","Standard Bronze On Exchange Plan",,"0.619295239448547","Yes","Yes","No","100%",,"$6,000","$0","$200","$0","$4,900","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095436166_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","31"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410010","Shared Cost Blue EPO 6000","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095449473_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","32"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410010","Shared Cost Blue EPO 6000","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410010-03","Limited Cost Sharing Plan Variation",,"0.619295239448547","Yes","Yes","No","100%",,"$6,000","$0","$200","$0","$4,900","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095452496_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","33"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410006","Shared Cost Blue EPO 1000","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410006-00","Standard Gold Off Exchange Plan",,"0.812957167625427","No","Yes","No","100%",,"$1,000","$200","$1,100","$0","$1,000","$900","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095445669_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","34"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410006","Shared Cost Blue EPO 1000","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410006-01","Standard Gold On Exchange Plan",,"0.812957167625427","No","Yes","No","100%",,"$1,000","$200","$1,100","$0","$1,000","$900","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095445669_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","35"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410002","Shared Cost Blue EPO 0","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"5","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410002-01","Standard Gold On Exchange Plan",,"0.809076249599457","No","Yes","No","100%",,"$0","$700","$0","$0","$0","$1,000","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095599891_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","39"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","1","76168","DE","Individual","No","51-0020405","76168DE0410002","Shared Cost Blue EPO 0","76168DE041",,"DEN001","DES001","DEF003","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"5","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095633945_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","40"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0580001","PCMH Blue EPO $750-100","76168DE058",,"DEN001","DES001","DEF006","New","EPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9978",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0580001-01","Standard Gold On Exchange Plan","80.97%","0.827150046825409","No","Yes","Yes","98%","2%","$750","$200","$0","$0","$750","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%","$750","$750 per person","$1500 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","5"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640004","PCMH Blue EPO 2800","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640004-01","Standard Silver On Exchange Plan",,"0.691358208656311","No","Yes","Yes","98%","2%","$2,800","$300","$900","$0","$1,600","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","25%","$2,800","$2800 per person","$5600 per group","25%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096591640_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","5"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640004","PCMH Blue EPO 2800","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","98%","2%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096680487_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","6"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0580002","PCMH Blue EPO $1500-100","76168DE058",,"DEN001","DES001","DEF006","New","EPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9977",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0580002-00","Standard Gold Off Exchange Plan",,"0.802747845649719","No","Yes","Yes","98%","2%","$1,500","$200","$0","$0","$1,500","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%","$1,500","$1500 per person","$3000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","6"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0580002","PCMH Blue EPO $1500-100","76168DE058",,"DEN001","DES001","DEF006","New","EPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9977",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0580002-01","Standard Gold On Exchange Plan",,"0.802747845649719","No","Yes","Yes","98%","2%","$1,500","$200","$0","$0","$1,500","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%","$1,500","$1500 per person","$3000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","7"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640004","PCMH Blue EPO 2800","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640004-03","Limited Cost Sharing Plan Variation",,"0.691358208656311","No","Yes","Yes","98%","2%","$2,800","$300","$900","$0","$1,600","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","25%","$2,800","$2800 per person","$5600 per group","25%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096654834_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","7"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640004","PCMH Blue EPO 2800","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640004-04","73% AV Level Silver Plan",,"0.735679924488068","No","Yes","Yes","98%","2%","$2,200","$300","$900","$0","$1,600","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","20%","$2,200","$2200 per person","$4400 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096656477_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","8"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0590001","PCMH Blue PPO $2500-100","76168DE059",,"DEN001","DES001","DEF007","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9974",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0590001-00","Standard Silver Off Exchange Plan","71.53%","0.737486898899078","No","Yes","Yes","98%","2%","$2,500","$200","$0","$0","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%","$2,500","$2500 per person","$5000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","8"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0590001","PCMH Blue PPO $2500-100","76168DE059",,"DEN001","DES001","DEF007","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9974",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0590001-01","Standard Silver On Exchange Plan","71.53%","0.737486898899078","No","Yes","Yes","98%","2%","$2,500","$200","$0","$0","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%","$2,500","$2500 per person","$5000 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","9"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640004","PCMH Blue EPO 2800","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640004-05","87% AV Level Silver Plan",,"0.867785513401031","No","Yes","Yes","98%","2%","$500","$200","$600","$0","$500","$400","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%","$500","$500 per person","$1000 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096661333_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","9"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640004","PCMH Blue EPO 2800","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640004-06","94% AV Level Silver Plan",,"0.937321960926056","No","Yes","Yes","98%","2%","$100","$100","$300","$0","$100","$300","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%","$100","$100 per person","$200 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096675561_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","10"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0590003","PCMH Blue PPO $3,000-90","76168DE059",,"DEN001","DES001","DEF005","New","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9973",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0590003-00","Standard Silver Off Exchange Plan",,"0.68872481584549","No","Yes","Yes","98%","2%","$3,000","$300","$400","$0","$1,600","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","10%","$3,000","$3000 per person","$6000 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","10"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0590003","PCMH Blue PPO $3,000-90","76168DE059",,"DEN001","DES001","DEF005","New","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9973",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0590003-01","Standard Silver On Exchange Plan",,"0.68872481584549","No","Yes","Yes","98%","2%","$3,000","$300","$400","$0","$1,600","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","10%","$3,000","$3000 per person","$6000 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","11"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640002","PCMH Blue EPO 1200","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640002-00","Standard Gold Off Exchange Plan",,"0.782603442668915","No","Yes","Yes","98%","2%","$1,200","$200","$1,100","$0","$1,200","$500","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","$3,750","$3750 per person","$7500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20%","$1,200","$1200 per person","$2400 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096401226_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","11"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640002","PCMH Blue EPO 1200","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640002-01","Standard Gold On Exchange Plan",,"0.782603442668915","No","Yes","Yes","98%","2%","$1,200","$200","$1,100","$0","$1,200","$500","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","$3,750","$3750 per person","$7500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20%","$1,200","$1200 per person","$2400 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096401226_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","12"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640002","PCMH Blue EPO 1200","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","98%","2%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096407216_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","13"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640002","PCMH Blue EPO 1200","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640002-03","Limited Cost Sharing Plan Variation",,"0.782603442668915","No","Yes","Yes","98%","2%","$1,200","$200","$1,100","$0","$1,200","$500","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","$3,750","$3750 per person","$7500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","20%","$1,200","$1200 per person","$2400 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096406072_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","14"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640003","PCMH Blue EPO 2300","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640003-00","Standard Silver Off Exchange Plan","71.52%","0.715213179588318","No","Yes","Yes","98%","2%","$2,300","$300","$1,100","$0","$1,600","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,300","$2300 per person","$4600 per group","25%","$2,300","$2300 per person","$4600 per group","25%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096481080_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","15"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640003","PCMH Blue EPO 2300","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640003-01","Standard Silver On Exchange Plan","71.52%","0.715213179588318","No","Yes","Yes","98%","2%","$2,300","$300","$1,100","$0","$1,600","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,300","$2300 per person","$4600 per group","25%","$2,300","$2300 per person","$4600 per group","25%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096481080_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","16"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640003","PCMH Blue EPO 2300","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","98%","2%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096584671_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","17"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640001","PCMH Blue EPO 900","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","98%","2%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096396465_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","24"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","2","76168","DE","Individual","No","51-0020405","76168DE0640001","PCMH Blue EPO 900","76168DE064",,"DEN001","DES001","DEF004","New","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0640001-03","Limited Cost Sharing Plan Variation",,"0.815888941287994","No","Yes","Yes","98%","2%","$900","$200","$600","$0","$900","$400","$70","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","10%","$900","$900 per person","$1800 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096396078_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","25"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","3","76168","DE","Individual","No","51-0020405","76168DE0630001","HDHP Blue EPO 6850","76168DE063",,"DEN001","DES001","DEF001","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0630001-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095461151_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","4"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","3","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0620001","HDHP Blue EPO $6850","76168DE062",,"DEN001","DES001","DEF001","New","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9966",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0620001-00","Standard Bronze Off Exchange Plan",,"0.618613183498383","No","Yes","No","100%",,"$6,850","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","4"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","3","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0620001","HDHP Blue EPO $6850","76168DE062",,"DEN001","DES001","DEF001","New","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9966",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0620001-01","Standard Bronze On Exchange Plan",,"0.618613183498383","No","Yes","No","100%",,"$6,850","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","5"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","3","76168","DE","Individual","No","51-0020405","76168DE0630001","HDHP Blue EPO 6850","76168DE063",,"DEN001","DES001","DEF001","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0630001-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095461151_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","5"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","3","76168","DE","Individual","No","51-0020405","76168DE0630001","HDHP Blue EPO 6850","76168DE063",,"DEN001","DES001","DEF001","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0630001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095478152_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","6"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","3","76168","DE","Individual","No","51-0020405","76168DE0630001","HDHP Blue EPO 6850","76168DE063",,"DEN001","DES001","DEF001","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0630001-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095481016_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","7"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","4","76168","DE","Individual","No","51-0020405","76168DE0400001","Major Events Blue EPO 6850","76168DE040",,"DEN001","DES001","DEF001","Existing","EPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0400001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$2,500","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095665904_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","4"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","4","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0610001","Health Savings Embedded EPO HSA Copay $2750","76168DE061",,"DEN001","DES001","DEF008","New","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9972",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0610001-00","Standard Silver Off Exchange Plan",,"0.689427256584167","Yes","Yes","No","100%",,"$2,750","$30","$0","$0","$2,500","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","4"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","4","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0610001","Health Savings Embedded EPO HSA Copay $2750","76168DE061",,"DEN001","DES001","DEF008","New","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9972",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0610001-01","Standard Silver On Exchange Plan",,"0.689427256584167","Yes","Yes","No","100%",,"$2,750","$30","$0","$0","$2,500","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","5"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","4","76168","DE","Individual","No","51-0020405","76168DE0400001","Major Events Blue EPO 6850","76168DE040",,"DEN001","DES001","DEF001","Existing","EPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0400001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$2,500","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095665904_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","5"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","4","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0610002","Health Savings Embedded EPO HSA $4750-90","76168DE061",,"DEN001","DES001","DEF002","New","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0610002-00","Standard Bronze Off Exchange Plan",,"0.618589639663696","Yes","Yes","No","100%",,"$4,750","$0","$300","$0","$4,750","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","6"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","4","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0610002","Health Savings Embedded EPO HSA $4750-90","76168DE061",,"DEN001","DES001","DEF002","New","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0610002-01","Standard Bronze On Exchange Plan",,"0.618589639663696","Yes","Yes","No","100%",,"$4,750","$0","$300","$0","$4,750","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","7"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","4","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0610003","Health Savings Embedded EPO HSA $6000-100","76168DE061",,"DEN001","DES001","DEF001","New","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0610003-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","8"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","4","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0610003","Health Savings Embedded EPO HSA $6000-100","76168DE061",,"DEN001","DES001","DEF001","New","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0610003-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","9"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","5","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0500004","Shared Cost EPO Basic $6000-90","76168DE050",,"DEN001","DES001","DEF002","New","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0500004-00","Standard Bronze Off Exchange Plan",,"0.619295239448547","Yes","Yes","No","100%",,"$6,000","$0","$200","$0","$4,900","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","4"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","5","76168","DE","Individual","No","51-0020405","76168DE0420002","Health Savings Blue EPO 2000","76168DE042",,"DEN001","DES001","DEF001","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420002-00","Standard Gold Off Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$0","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096049833_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","4"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","5","76168","DE","Individual","No","51-0020405","76168DE0420002","Health Savings Blue EPO 2000","76168DE042",,"DEN001","DES001","DEF001","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420002-01","Standard Gold On Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$0","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096049833_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","5"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","5","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0500004","Shared Cost EPO Basic $6000-90","76168DE050",,"DEN001","DES001","DEF002","New","EPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0500004-01","Standard Bronze On Exchange Plan",,"0.619295239448547","Yes","Yes","No","100%",,"$6,000","$0","$200","$0","$4,900","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","5"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","5","76168","DE","Individual","No","51-0020405","76168DE0420002","Health Savings Blue EPO 2000","76168DE042",,"DEN001","DES001","DEF001","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096056068_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","6"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","5","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0430001","Shared Cost EPO Basic $1000-75","76168DE043",,"DEN001","DES001","DEF006","Existing","EPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9977",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0430001-00","Standard Gold Off Exchange Plan",,"0.805879890918732","No","Yes","No","100%",,"$1,000","$40","$1,600","$0","$1,000","$700","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","6"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","5","76168","DE","Individual","No","51-0020405","76168DE0420002","Health Savings Blue EPO 2000","76168DE042",,"DEN001","DES001","DEF001","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420002-03","Limited Cost Sharing Plan Variation",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$0","$2,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096055425_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","7"
"2016","DE","90955","SERFF","3","2015-08-22 23:36:24","2","90955","DE","SHOP (Small Group)","Yes","13-5123390","90955DE0080002","Guardian Family Essentials","90955DE008",,"DEN001","DES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","90955DE0080002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","DE","90955","SERFF","3","2015-08-22 23:36:24","2","90955","DE","SHOP (Small Group)","Yes","13-5123390","90955DE0080002","Guardian Family Essentials","90955DE008",,"DEN001","DES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","90955DE0080002-01","Standard Low On Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","DE","96320","SERFF","3","2015-08-22 23:36:24","1","96320","DE","SHOP (Small Group)","Yes","57-0523959","96320DE0020001","Group Dental Policy","96320DE002",,"DEN001","DES001",,"New","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$61.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","96320DE0020001-00","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","HI","10046","SERFF","9","2015-10-29 11:27:21","1","10046","HI","Individual","Yes","95-6042390","10046HI0020003","BESTOne Advantage Gold","10046HI002",,"HIN001","HIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$56.12","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","HI","10046","SERFF","9","2015-10-29 11:27:21","1","10046","HI","Individual","Yes","95-6042390","10046HI0020003","BESTOne Advantage Gold","10046HI002",,"HIN001","HIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$56.12","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","HI","10046","SERFF","9","2015-10-29 11:27:21","1","10046","HI","Individual","Yes","95-6042390","10046HI0020004","BESTOne Plus Gold","10046HI002",,"HIN001","HIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$56.12","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","HI","10046","SERFF","9","2015-10-29 11:27:21","1","10046","HI","Individual","Yes","95-6042390","10046HI0020004","BESTOne Plus Gold","10046HI002",,"HIN001","HIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$56.12","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","HI","10046","SERFF","9","2015-10-29 11:27:21","2","10046","HI","Individual","Yes","95-6042390","10046HI0020005","BESTOne Plus Silver","10046HI002",,"HIN001","HIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$46.59","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","HI","10046","SERFF","9","2015-10-29 11:27:21","2","10046","HI","Individual","Yes","95-6042390","10046HI0020005","BESTOne Plus Silver","10046HI002",,"HIN001","HIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$46.59","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","HI","10046","SERFF","9","2015-10-29 11:27:21","2","10046","HI","Individual","Yes","95-6042390","10046HI0020006","BESTOne Basic Silver","10046HI002",,"HIN001","HIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$46.59","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","5","76168","DE","Individual","No","51-0020405","76168DE0420004","Health Savings Embedded Blue EPO 3400","76168DE042",,"DEN001","DES001","DEF001","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420004-00","Standard Silver Off Exchange Plan",,"0.716870069503784","Yes","Yes","No","100%",,"$3,400","$0","$0","$0","$3,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2099156984_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","8"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","1","18350","HI","Individual","No","99-0040115","18350HI0880001","HMSA Platinum PPO","18350HI088",,"HIN003","HIS001","HIF001","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9743",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/platinum-ppo-ai-an-zero-cs.pdf",,"6"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","1","18350","HI","Individual","No","99-0040115","18350HI0880001","HMSA Platinum PPO","18350HI088",,"HIN003","HIS001","HIF001","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9743",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880001-03","Limited Cost Sharing Plan Variation",,"0.882637023925781","Yes","Yes","No","100%",,"$0","$10","$730","$150","$0","$48","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/platinum-ppo-ai-an-limited-cs.pdf",,"7"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","5","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0430002","Shared Cost EPO Basic $2000-75","76168DE043",,"DEN001","DES001","DEF009","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9972",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0430002-00","Standard Silver Off Exchange Plan",,"0.719072639942169","No","Yes","No","100%",,"$2,000","$40","$1,300","$0","$1,600","$700","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","8"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","5","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0430002","Shared Cost EPO Basic $2000-75","76168DE043",,"DEN001","DES001","DEF009","Existing","EPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9972",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0430002-01","Standard Silver On Exchange Plan",,"0.719072639942169","No","Yes","No","100%",,"$2,000","$40","$1,300","$0","$1,600","$700","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=delaware","9"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","5","76168","DE","Individual","No","51-0020405","76168DE0420004","Health Savings Embedded Blue EPO 3400","76168DE042",,"DEN001","DES001","DEF001","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420004-01","Standard Silver On Exchange Plan",,"0.716870069503784","Yes","Yes","No","100%",,"$3,400","$0","$0","$0","$3,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2099156984_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","9"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","5","76168","DE","Individual","No","51-0020405","76168DE0420004","Health Savings Embedded Blue EPO 3400","76168DE042",,"DEN001","DES001","DEF001","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2099157797_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","10"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","5","76168","DE","Individual","No","51-0020405","76168DE0420004","Health Savings Embedded Blue EPO 3400","76168DE042",,"DEN001","DES001","DEF001","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420004-03","Limited Cost Sharing Plan Variation",,"0.716870069503784","Yes","Yes","No","100%",,"$3,400","$0","$0","$0","$3,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2099157397_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","11"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","5","76168","DE","Individual","No","51-0020405","76168DE0420004","Health Savings Embedded Blue EPO 3400","76168DE042",,"DEN001","DES001","DEF001","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420004-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2099158226_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","12"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","5","76168","DE","Individual","No","51-0020405","76168DE0420004","Health Savings Embedded Blue EPO 3400","76168DE042",,"DEN001","DES001","DEF001","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420004-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$0","$1,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2099158838_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","13"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","5","76168","DE","Individual","No","51-0020405","76168DE0420004","Health Savings Embedded Blue EPO 3400","76168DE042",,"DEN001","DES001","DEF001","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420004-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$0","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2099160972_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","14"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","5","76168","DE","Individual","No","51-0020405","76168DE0420001","Health Savings Embedded Blue EPO 6300 Rewards","76168DE042",,"DEN001","DES001","DEF001","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420001-00","Standard Bronze Off Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$6,300","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095530407_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","15"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","5","76168","DE","Individual","No","51-0020405","76168DE0420001","Health Savings Embedded Blue EPO 6300 Rewards","76168DE042",,"DEN001","DES001","DEF001","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420001-01","Standard Bronze On Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$6,300","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095530407_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","16"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","5","76168","DE","Individual","No","51-0020405","76168DE0420001","Health Savings Embedded Blue EPO 6300 Rewards","76168DE042",,"DEN001","DES001","DEF001","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095528958_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","17"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","5","76168","DE","Individual","No","51-0020405","76168DE0420001","Health Savings Embedded Blue EPO 6300 Rewards","76168DE042",,"DEN001","DES001","DEF001","Existing","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420001-03","Limited Cost Sharing Plan Variation",,"0.607437193393707","Yes","Yes","No","100%",,"$6,300","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2095531747_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","18"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","6","76168","DE","Individual","No","51-0020405","76168DE0560002","Shared Cost Blue PPO 1800 Rewards","76168DE056",,"DEN001","DES001","DEF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0560002-00","Standard Gold Off Exchange Plan",,"0.793740689754486","No","Yes","No","100%",,"$1,800","$200","$0","$0","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","0%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096126687_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","4"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","6","76168","DE","Individual","No","51-0020405","76168DE0560002","Shared Cost Blue PPO 1800 Rewards","76168DE056",,"DEN001","DES001","DEF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0560002-01","Standard Gold On Exchange Plan",,"0.793740689754486","No","Yes","No","100%",,"$1,800","$200","$0","$0","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","0%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096126687_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","5"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","6","76168","DE","Individual","No","51-0020405","76168DE0560002","Shared Cost Blue PPO 1800 Rewards","76168DE056",,"DEN001","DES001","DEF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0560002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096200961_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","6"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","6","76168","DE","Individual","No","51-0020405","76168DE0560002","Shared Cost Blue PPO 1800 Rewards","76168DE056",,"DEN001","DES001","DEF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0560002-03","Limited Cost Sharing Plan Variation",,"0.793740689754486","No","Yes","No","100%",,"$1,800","$200","$0","$0","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group","0%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096193579_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","7"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","6","76168","DE","Individual","No","51-0020405","76168DE0560001","Shared Cost Blue PPO 1500","76168DE056",,"DEN001","DES001","DEF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0560001-00","Standard Gold Off Exchange Plan",,"0.815317034721375","No","Yes","No","100%",,"$1,500","$40","$0","$0","$1,500","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096204034_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","8"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","6","76168","DE","Individual","No","51-0020405","76168DE0560001","Shared Cost Blue PPO 1500","76168DE056",,"DEN001","DES001","DEF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0560001-01","Standard Gold On Exchange Plan",,"0.815317034721375","No","Yes","No","100%",,"$1,500","$40","$0","$0","$1,500","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096204034_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","9"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","6","76168","DE","Individual","No","51-0020405","76168DE0560001","Shared Cost Blue PPO 1500","76168DE056",,"DEN001","DES001","DEF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0560001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096207121_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","10"
"2016","DE","76168","SERFF","6","2016-01-28 08:29:40","6","76168","DE","Individual","No","51-0020405","76168DE0560001","Shared Cost Blue PPO 1500","76168DE056",,"DEN001","DES001","DEF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0560001-03","Limited Cost Sharing Plan Variation",,"0.815317034721375","No","Yes","No","100%",,"$1,500","$40","$0","$0","$1,500","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","0%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbsde.com/sbc/pdf/bcbsde/I_2096205677_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/DEL%20Product%20Brochure_SP_Revised%201-7_508.PDF","11"
"2016","DE","90955","SERFF","3","2015-08-22 23:36:24","1","90955","DE","SHOP (Small Group)","Yes","13-5123390","90955DE0090002","Guardian Pediatric Advantage","90955DE009",,"DEN001","DES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$34.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","90955DE0090002-00","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","DE","90955","SERFF","3","2015-08-22 23:36:24","1","90955","DE","SHOP (Small Group)","Yes","13-5123390","90955DE0100002","Guardian Pediatric Essentials","90955DE010",,"DEN001","DES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$26.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","90955DE0100002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","DE","90955","SERFF","3","2015-08-22 23:36:24","2","90955","DE","SHOP (Small Group)","Yes","13-5123390","90955DE0060002","Guardian Family Advantage","90955DE006",,"DEN001","DES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","90955DE0060002-00","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","DE","90955","SERFF","3","2015-08-22 23:36:24","2","90955","DE","SHOP (Small Group)","Yes","13-5123390","90955DE0060002","Guardian Family Advantage","90955DE006",,"DEN001","DES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","90955DE0060002-01","Standard High On Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","HI","10046","SERFF","9","2015-10-29 11:27:21","2","10046","HI","Individual","Yes","95-6042390","10046HI0020006","BESTOne Basic Silver","10046HI002",,"HIN001","HIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$46.59","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","10046HI0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","1","18350","HI","Individual","No","99-0040115","18350HI0880001","HMSA Platinum PPO","18350HI088",,"HIN003","HIS001","HIF001","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9743",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880001-00","Standard Platinum Off Exchange Plan",,"0.882637023925781","Yes","Yes","No","100%",,"$0","$10","$730","$150","$0","$48","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/platinum-ppo.pdf",,"4"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","1","18350","HI","Individual","Yes","99-0040115","18350HI0920001","HMSA Individual Dental PPP High","18350HI092",,"HIN006","HIS002",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.13","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","covered","Yes","covered","Yes",,"","18350HI0920001-01","Standard High On Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","1","18350","HI","Individual","No","99-0040115","18350HI0880001","HMSA Platinum PPO","18350HI088",,"HIN003","HIS001","HIF001","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9743",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880001-01","Standard Platinum On Exchange Plan",,"0.882637023925781","Yes","Yes","No","100%",,"$0","$10","$730","$150","$0","$48","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/platinum-ppo.pdf",,"5"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","2","18350","HI","Individual","No","99-0040115","18350HI0880007","HMSA Gold PPO","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880007-00","Standard Gold Off Exchange Plan",,"0.811923623085022","Yes","Yes","No","100%",,"$0","$10","$2,180","$150","$0","$580","$420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/gold-ppo.pdf",,"4"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","2","18350","HI","Individual","Yes","99-0040115","18350HI0920002","HMSA Individual Dental PPP Basic","18350HI092",,"HIN006","HIS002",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.85","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","covered","Yes","covered","Yes",,"","18350HI0920002-01","Standard Low On Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","2","18350","HI","Individual","No","99-0040115","18350HI0880007","HMSA Gold PPO","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880007-01","Standard Gold On Exchange Plan",,"0.811923623085022","Yes","Yes","No","100%",,"$0","$10","$2,180","$150","$0","$580","$420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/gold-ppo.pdf",,"5"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","2","18350","HI","Individual","No","99-0040115","18350HI0880007","HMSA Gold PPO","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/gold-ppo-ai-an-zero-cs.pdf",,"6"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","2","18350","HI","Individual","No","99-0040115","18350HI0880007","HMSA Gold PPO","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880007-03","Limited Cost Sharing Plan Variation",,"0.811923623085022","Yes","Yes","No","100%",,"$0","$10","$2,180","$150","$0","$580","$420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/gold-ppo-ai-an-limited-cs.pdf",,"7"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","3","18350","HI","Individual","No","99-0040115","18350HI0880013","HMSA Gold PPO 1000","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880013-00","Standard Gold Off Exchange Plan",,"0.791639447212219","Yes","Yes","No","100%",,"$1,000","$10","$1,250","$150","$1,000","$390","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"http://www.hmsa.com/sbc/2016/gold-ppo-1000.pdf",,"4"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","3","18350","HI","Individual","Yes","99-0040115","18350HI0930001","HMSA Individual Dental HMO Basic","18350HI093",,"HIN007","HIS002",,"Existing","HMO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.39","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency only","No",,"","18350HI0930001-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","3","18350","HI","Individual","No","99-0040115","18350HI0880013","HMSA Gold PPO 1000","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880013-01","Standard Gold On Exchange Plan",,"0.791639447212219","Yes","Yes","No","100%",,"$1,000","$10","$1,250","$150","$1,000","$390","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"http://www.hmsa.com/sbc/2016/gold-ppo-1000.pdf",,"5"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","3","18350","HI","Individual","No","99-0040115","18350HI0880013","HMSA Gold PPO 1000","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/gold-ppo-1000-ai-an-zero-cs.pdf",,"6"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","3","18350","HI","Individual","No","99-0040115","18350HI0880013","HMSA Gold PPO 1000","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880013-03","Limited Cost Sharing Plan Variation",,"0.791639447212219","Yes","Yes","No","100%",,"$1,000","$10","$1,250","$150","$1,000","$390","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"http://www.hmsa.com/sbc/2016/gold-ppo-1000-ai-an-limited-cs.pdf",,"7"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","4","18350","HI","Individual","No","99-0040115","18350HI0880017","HMSA Silver PPO 1500","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880017-00","Standard Silver Off Exchange Plan",,"0.713487803936005","Yes","Yes","No","100%",,"$1,500","$20","$1,830","$150","$1,500","$530","$420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"http://www.hmsa.com/sbc/2016/silver-ppo-1500.pdf",,"4"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","4","18350","HI","Individual","Yes","99-0040115","18350HI0920005","HMSA Individual Dental PPP Pediatric Essential","18350HI092",,"HIN006","HIS002",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$39.37","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","covered","Yes","covered","Yes",,"","18350HI0920005-01","Standard High On Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","4","18350","HI","Individual","No","99-0040115","18350HI0880017","HMSA Silver PPO 1500","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880017-01","Standard Silver On Exchange Plan",,"0.713487803936005","Yes","Yes","No","100%",,"$1,500","$20","$1,830","$150","$1,500","$530","$420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"http://www.hmsa.com/sbc/2016/silver-ppo-1500.pdf",,"5"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","4","18350","HI","Individual","No","99-0040115","18350HI0880017","HMSA Silver PPO 1500","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/silver-ppo-1500-ai-an-zero-cs.pdf",,"6"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","4","18350","HI","Individual","No","99-0040115","18350HI0880017","HMSA Silver PPO 1500","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880017-03","Limited Cost Sharing Plan Variation",,"0.713487803936005","Yes","Yes","No","100%",,"$1,500","$20","$1,830","$150","$1,500","$530","$420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"http://www.hmsa.com/sbc/2016/silver-ppo-1500-ai-an-limited-cs.pdf",,"7"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","4","18350","HI","Individual","No","99-0040115","18350HI0880017","HMSA Silver PPO 1500","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880017-04","73% AV Level Silver Plan",,"0.734987020492554","Yes","Yes","No","100%",,"$1,500","$20","$1,830","$150","$1,500","$530","$420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$5,200","$5200 per person","$10400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"http://www.hmsa.com/sbc/2016/silver-ppo-1500-csr-73.pdf",,"8"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","4","18350","HI","Individual","No","99-0040115","18350HI0880017","HMSA Silver PPO 1500","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880017-05","87% AV Level Silver Plan",,"0.868705809116364","Yes","Yes","No","100%",,"$500","$10","$1,350","$150","$500","$370","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","No",,,"http://www.hmsa.com/sbc/2016/silver-ppo-1500-csr-87.pdf",,"9"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","4","18350","HI","Individual","No","99-0040115","18350HI0880017","HMSA Silver PPO 1500","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880017-06","94% AV Level Silver Plan",,"0.940094113349915","Yes","Yes","No","100%",,"$0","$10","$730","$150","$0","$380","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/silver-ppo-1500-csr-94.pdf",,"10"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","5","18350","HI","Individual","No","99-0040115","18350HI0880029","HMSA Silver PPO 2500","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880029-00","Standard Silver Off Exchange Plan",,"0.719303786754608","Yes","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$360","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hmsa.com/sbc/2016/silver-ppo-2500.pdf",,"4"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","5","18350","HI","Individual","No","99-0040115","18350HI0880029","HMSA Silver PPO 2500","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880029-01","Standard Silver On Exchange Plan",,"0.719303786754608","Yes","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$360","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hmsa.com/sbc/2016/silver-ppo-2500.pdf",,"5"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","5","18350","HI","Individual","No","99-0040115","18350HI0880029","HMSA Silver PPO 2500","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880029-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/silver-ppo-2500-ai-an-zero-cs.pdf",,"6"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","5","18350","HI","Individual","No","99-0040115","18350HI0880029","HMSA Silver PPO 2500","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880029-03","Limited Cost Sharing Plan Variation",,"0.719303786754608","Yes","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$360","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hmsa.com/sbc/2016/silver-ppo-2500-ai-an-limited-cs.pdf",,"7"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","5","18350","HI","Individual","No","99-0040115","18350HI0880029","HMSA Silver PPO 2500","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880029-04","73% AV Level Silver Plan",,"0.739374697208405","Yes","Yes","No","100%",,"$2,400","$20","$970","$150","$2,400","$380","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$5,200","$5200 per person","$10400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,395","$2395 per person","$4790 per group","No",,,"http://www.hmsa.com/sbc/2016/silver-ppo-2500-csr-73.pdf",,"8"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","5","18350","HI","Individual","No","99-0040115","18350HI0880029","HMSA Silver PPO 2500","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880029-05","87% AV Level Silver Plan",,"0.868705809116364","Yes","Yes","No","100%",,"$500","$10","$1,350","$150","$500","$370","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","No",,,"http://www.hmsa.com/sbc/2016/silver-ppo-2500-csr-87.pdf",,"9"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","5","18350","HI","Individual","No","99-0040115","18350HI0880029","HMSA Silver PPO 2500","18350HI088",,"HIN001","HIS001","HIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880029-06","94% AV Level Silver Plan",,"0.940094113349915","Yes","Yes","No","100%",,"$0","$10","$730","$150","$0","$380","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/silver-ppo-2500-csr-94.pdf",,"10"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","6","18350","HI","Individual","No","99-0040115","18350HI0880033","HMSA Bronze PPO 6850","18350HI088",,"HIN005","HIS001","HIF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880033-00","Standard Bronze Off Exchange Plan",,"0.608081758022308","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.hmsa.com/sbc/2016/bronze-ppo-6850.pdf",,"4"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","6","18350","HI","Individual","No","99-0040115","18350HI0880033","HMSA Bronze PPO 6850","18350HI088",,"HIN005","HIS001","HIF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880033-01","Standard Bronze On Exchange Plan",,"0.608081758022308","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.hmsa.com/sbc/2016/bronze-ppo-6850.pdf",,"5"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","6","18350","HI","Individual","No","99-0040115","18350HI0880033","HMSA Bronze PPO 6850","18350HI088",,"HIN005","HIS001","HIF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880033-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/bronze-ppo-6850-ai-an-zero-cs.pdf",,"6"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","6","18350","HI","Individual","No","99-0040115","18350HI0880033","HMSA Bronze PPO 6850","18350HI088",,"HIN005","HIS001","HIF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880033-03","Limited Cost Sharing Plan Variation",,"0.608081758022308","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.hmsa.com/sbc/2016/bronze-ppo-6850-ai-an-limited-cs.pdf",,"7"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","7","18350","HI","Individual","No","99-0040115","18350HI0890003","HMSA Platinum HMO","18350HI089",,"HIN004","HIS001","HIF001","Existing","HMO","Platinum","No","Both","No","Yes","Refer to plan for details.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9743",,,,"0","0","0","2016-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com","18350HI0890003-00","Standard Platinum Off Exchange Plan",,"0.892013013362885","Yes","Yes","No","100%",,"$0","$600","$210","$150","$0","$480","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/platinum-hmo.pdf",,"4"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","7","18350","HI","Individual","No","99-0040115","18350HI0890003","HMSA Platinum HMO","18350HI089",,"HIN004","HIS001","HIF001","Existing","HMO","Platinum","No","Both","No","Yes","Refer to plan for details.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9743",,,,"0","0","0","2016-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com","18350HI0890003-01","Standard Platinum On Exchange Plan",,"0.892013013362885","Yes","Yes","No","100%",,"$0","$600","$210","$150","$0","$480","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/platinum-hmo.pdf",,"5"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","7","18350","HI","Individual","No","99-0040115","18350HI0890003","HMSA Platinum HMO","18350HI089",,"HIN004","HIS001","HIF001","Existing","HMO","Platinum","No","Both","No","Yes","Refer to plan for details.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9743",,,,"0","0","0","2016-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com","18350HI0890003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/platinum-hmo-ai-an-zero-cs.pdf",,"6"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","7","18350","HI","Individual","No","99-0040115","18350HI0890003","HMSA Platinum HMO","18350HI089",,"HIN004","HIS001","HIF001","Existing","HMO","Platinum","No","Both","No","Yes","Refer to plan for details.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9743",,,,"0","0","0","2016-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com","18350HI0890003-03","Limited Cost Sharing Plan Variation",,"0.892013013362885","Yes","Yes","No","100%",,"$0","$600","$210","$150","$0","$480","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/platinum-hmo-ai-an-limited-cs.pdf",,"7"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","8","18350","HI","Individual","No","99-0040115","18350HI0890004","HMSA Gold HMO","18350HI089",,"HIN002","HIS001","HIF001","Existing","HMO","Gold","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com","18350HI0890004-00","Standard Gold Off Exchange Plan",,"0.798655867576599","Yes","Yes","No","100%",,"$1,000","$680","$240","$150","$1,000","$400","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"http://www.hmsa.com/sbc/2016/gold-hmo.pdf",,"4"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","8","18350","HI","Individual","No","99-0040115","18350HI0890004","HMSA Gold HMO","18350HI089",,"HIN002","HIS001","HIF001","Existing","HMO","Gold","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com","18350HI0890004-01","Standard Gold On Exchange Plan",,"0.798655867576599","Yes","Yes","No","100%",,"$1,000","$680","$240","$150","$1,000","$400","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"http://www.hmsa.com/sbc/2016/gold-hmo.pdf",,"5"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","8","18350","HI","Individual","No","99-0040115","18350HI0890004","HMSA Gold HMO","18350HI089",,"HIN002","HIS001","HIF001","Existing","HMO","Gold","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com","18350HI0890004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/gold-hmo-ai-an-zero-cs.pdf",,"6"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","8","18350","HI","Individual","No","99-0040115","18350HI0890004","HMSA Gold HMO","18350HI089",,"HIN002","HIS001","HIF001","Existing","HMO","Gold","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com","18350HI0890004-03","Limited Cost Sharing Plan Variation",,"0.798655867576599","Yes","Yes","No","100%",,"$1,000","$680","$240","$150","$1,000","$400","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"http://www.hmsa.com/sbc/2016/gold-hmo-ai-an-limited-cs.pdf",,"7"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","9","18350","HI","Individual","No","99-0040115","18350HI0890005","HMSA Silver HMO","18350HI089",,"HIN002","HIS001","HIF001","Existing","HMO","Silver","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com","18350HI0890005-00","Standard Silver Off Exchange Plan",,"0.707984149456024","Yes","Yes","No","100%",,"$2,500","$580","$0","$150","$2,500","$360","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hmsa.com/sbc/2016/silver-hmo.pdf",,"4"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","9","18350","HI","Individual","No","99-0040115","18350HI0890005","HMSA Silver HMO","18350HI089",,"HIN002","HIS001","HIF001","Existing","HMO","Silver","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com","18350HI0890005-01","Standard Silver On Exchange Plan",,"0.707984149456024","Yes","Yes","No","100%",,"$2,500","$580","$0","$150","$2,500","$360","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hmsa.com/sbc/2016/silver-hmo.pdf",,"5"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","9","18350","HI","Individual","No","99-0040115","18350HI0890005","HMSA Silver HMO","18350HI089",,"HIN002","HIS001","HIF001","Existing","HMO","Silver","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com","18350HI0890005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/silver-hmo-ai-an-zero-cs.pdf",,"6"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","9","18350","HI","Individual","No","99-0040115","18350HI0890005","HMSA Silver HMO","18350HI089",,"HIN002","HIS001","HIF001","Existing","HMO","Silver","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com","18350HI0890005-03","Limited Cost Sharing Plan Variation",,"0.707984149456024","Yes","Yes","No","100%",,"$2,500","$580","$0","$150","$2,500","$360","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hmsa.com/sbc/2016/silver-hmo-ai-an-limited-cs.pdf",,"7"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","9","18350","HI","Individual","No","99-0040115","18350HI0890005","HMSA Silver HMO","18350HI089",,"HIN002","HIS001","HIF001","Existing","HMO","Silver","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com","18350HI0890005-04","73% AV Level Silver Plan",,"0.735099673271179","Yes","Yes","No","100%",,"$2,000","$720","$60","$150","$2,000","$430","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$5,200","$5200 per person","$10400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","No",,,"http://www.hmsa.com/sbc/2016/silver-hmo-csr-73.pdf",,"8"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","9","18350","HI","Individual","No","99-0040115","18350HI0890005","HMSA Silver HMO","18350HI089",,"HIN002","HIS001","HIF001","Existing","HMO","Silver","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com","18350HI0890005-05","87% AV Level Silver Plan",,"0.873572289943695","Yes","Yes","No","100%",,"$500","$530","$170","$150","$500","$470","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$2,225","$2225 per person","$4450 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","No",,,"http://www.hmsa.com/sbc/2016/silver-hmo-csr-87.pdf",,"9"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","9","18350","HI","Individual","No","99-0040115","18350HI0890005","HMSA Silver HMO","18350HI089",,"HIN002","HIS001","HIF001","Existing","HMO","Silver","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com","18350HI0890005-06","94% AV Level Silver Plan",,"0.938800573348999","Yes","Yes","No","100%",,"$0","$400","$210","$150","$0","$480","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$745","$745 per person","$1490 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/silver-hmo-csr-94.pdf",,"10"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","10","18350","HI","Individual","No","99-0040115","18350HI0890006","HMSA Bronze HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Bronze","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com","18350HI0890006-00","Standard Bronze Off Exchange Plan",,"0.615094125270844","Yes","Yes","No","100%",,"$5,000","$420","$0","$150","$5,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.hmsa.com/sbc/2016/bronze-hmo.pdf",,"4"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","10","18350","HI","Individual","No","99-0040115","18350HI0890006","HMSA Bronze HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Bronze","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com","18350HI0890006-01","Standard Bronze On Exchange Plan",,"0.615094125270844","Yes","Yes","No","100%",,"$5,000","$420","$0","$150","$5,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.hmsa.com/sbc/2016/bronze-hmo.pdf",,"5"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","10","18350","HI","Individual","No","99-0040115","18350HI0890006","HMSA Bronze HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Bronze","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com","18350HI0890006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hmsa.com/sbc/2016/bronze-hmo-ai-an-zero-cs.pdf",,"6"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","10","18350","HI","Individual","No","99-0040115","18350HI0890006","HMSA Bronze HMO","18350HI089",,"HIN005","HIS001","HIF001","Existing","HMO","Bronze","No","Both","No","Yes","Refer to plan for details",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9879",,,,"0","0","0","2016-01-01",,"Yes","Covered for certain services","Yes","Covered for certain services","Yes",,"https://hmsa.com","18350HI0890006-03","Limited Cost Sharing Plan Variation",,"0.615094125270844","Yes","Yes","No","100%",,"$5,000","$420","$0","$150","$5,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.hmsa.com/sbc/2016/bronze-hmo-ai-an-limited-cs.pdf",,"7"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","11","18350","HI","Individual","No","99-0040115","18350HI0880003","HMSA Catastrophic Plan","18350HI088",,"HIN005","HIS001","HIF001","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9934",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880003-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.hmsa.com/sbc/2016/catastrophic-plan.pdf",,"4"
"2016","HI","18350","SERFF","12","2015-10-29 11:27:21","11","18350","HI","Individual","No","99-0040115","18350HI0880003","HMSA Catastrophic Plan","18350HI088",,"HIN005","HIS001","HIF001","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9934",,,,"0","0","0","2016-01-01",,"Yes","Covered","Yes","Covered","Yes",,"https://hmsa.com","18350HI0880003-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0.00","$150","$5,270","$0","$0.00","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.hmsa.com/sbc/2016/catastrophic-plan.pdf",,"5"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","11","60612","HI","Individual","No","94-1340523","60612HI0110004","KP Silver II $30 - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.949632139103913",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-AI-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","5"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","11","60612","HI","Individual","No","94-1340523","60612HI0110004","KP Silver II $30 - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.949632139103913",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110004-03","Limited Cost Sharing Plan Variation",,"0.698754251003265","No","Yes","No","100%",,"$2,400","$20","$800","$200","$0","$600","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-AI-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","6"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","11","60612","HI","Individual","No","94-1340523","60612HI0110004","KP Silver II $30 - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.949632139103913",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110004-04","73% AV Level Silver Plan",,"0.729569971561432","No","Yes","No","100%",,"$2,400","$20","$800","$200","$0","$500","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-1000404-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","7"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","11","60612","HI","Individual","No","94-1340523","60612HI0110004","KP Silver II $30 - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.949632139103913",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110004-05","87% AV Level Silver Plan",,"0.875067532062531","No","Yes","No","100%",,"$0","$20","$700","$200","$0","$400","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-1000405-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","8"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","11","60612","HI","Individual","No","94-1340523","60612HI0110004","KP Silver II $30 - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.949632139103913",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110004-06","94% AV Level Silver Plan",,"0.937346279621124","No","Yes","No","100%",,"$0","$20","$400","$200","$0","$300","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-1000406-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","9"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","12","60612","HI","Individual","No","94-1340523","60612HI0110013","KP Silver III $30 - Fit","60612HI011",,"HIN001","HIS001","HIF005","Existing","HMO","Silver","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.948502370249805",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110013-01","Standard Silver On Exchange Plan",,"0.683236122131348","No","Yes","No","100%",,"$3,400","$30","$600","$200","$0","$1,000","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-10013-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","4"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","12","60612","HI","Individual","No","94-1340523","60612HI0110013","KP Silver III $30 - Fit","60612HI011",,"HIN001","HIS001","HIF005","Existing","HMO","Silver","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.948502370249805",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110013-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-AI-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","5"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","14","60612","HI","Individual","No","94-1340523","60612HI0110009","KP Silver II $30 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.937127150859816",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110009-01","Standard Silver On Exchange Plan",,"0.698754251003265","No","Yes","No","100%",,"$2,400","$20","$800","$200","$0","$600","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-10009-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","4"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","14","60612","HI","Individual","No","94-1340523","60612HI0110009","KP Silver II $30 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.937127150859816",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-AI1-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","5"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","14","60612","HI","Individual","No","94-1340523","60612HI0110009","KP Silver II $30 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.937127150859816",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110009-03","Limited Cost Sharing Plan Variation",,"0.698754251003265","No","Yes","No","100%",,"$2,400","$20","$800","$200","$0","$600","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-AI1-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","6"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","14","60612","HI","Individual","No","94-1340523","60612HI0110009","KP Silver II $30 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.937127150859816",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110009-04","73% AV Level Silver Plan",,"0.729569971561432","No","Yes","No","100%",,"$2,400","$20","$800","$200","$0","$500","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-1000904-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","7"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","14","60612","HI","Individual","No","94-1340523","60612HI0110009","KP Silver II $30 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.937127150859816",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110009-05","87% AV Level Silver Plan",,"0.875067532062531","No","Yes","No","100%",,"$0","$20","$700","$200","$0","$400","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-1000905-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","8"
"2016","HI","46082","SERFF","10","2015-10-29 11:27:21","1","46082","HI","Individual","Yes","99-0107971","46082HI0020001","HDS Individual Dental Plan for Children","46082HI002",,"HIN001","HIS001",,"Existing","PPO","Low",,"Both",,,,"Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply.",,"No","Allows Child-Only",,,,,"$31.20","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","For services received outside of the country, member will pay the claim in full at the time of service.  Member is responsible to submit the claim to HDS translated into English and U.S. Dollars.  HDS will reimburse the member based on a non participating dentist fee schedule.","Yes","Service area includes:  Hawaii, Guam and Saipan.  For services received on the Mainland (Continental U.S), HDS recommends visiting a Delta Dental participating dentist to receive the maximum benefit from the plan.   The Delta Dentist will submit claim directly to HDS.  Member out-of-pocket share will be in accordance to the plan benefits.","Yes","www.hawaiidentalservice.com/ddpahi/ffm_initial_payment.html","","46082HI0020001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.hawaiidentalservice.com/ddpahi/Form_HDS_Individual_Dental_Plan_for_Children_0715.pdf",,"4"
"2016","HI","46082","SERFF","10","2015-10-29 11:27:21","1","46082","HI","Individual","Yes","99-0107971","46082HI0020001","HDS Individual Dental Plan for Children","46082HI002",,"HIN001","HIS001",,"Existing","PPO","Low",,"Both",,,,"Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply.",,"No","Allows Child-Only",,,,,"$31.20","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","For services received outside of the country, member will pay the claim in full at the time of service.  Member is responsible to submit the claim to HDS translated into English and U.S. Dollars.  HDS will reimburse the member based on a non participating dentist fee schedule.","Yes","Service area includes:  Hawaii, Guam and Saipan.  For services received on the Mainland (Continental U.S), HDS recommends visiting a Delta Dental participating dentist to receive the maximum benefit from the plan.   The Delta Dentist will submit claim directly to HDS.  Member out-of-pocket share will be in accordance to the plan benefits.","Yes","www.hawaiidentalservice.com/ddpahi/ffm_initial_payment.html","","46082HI0020001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.hawaiidentalservice.com/ddpahi/Form_HDS_Individual_Dental_Plan_for_Children_0715.pdf",,"5"
"2016","HI","46082","SERFF","10","2015-10-29 11:27:21","2","46082","HI","Individual","Yes","99-0107971","46082HI0020003","HDS Preferred Dental Plan","46082HI002",,"HIN001","HIS001",,"Existing","PPO","Low",,"Both",,,,"Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply.",,"No","Allows Adult and Child-Only",,,,,"$31.20","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","For services received outside of the country, member will pay the claim in full at the time of service.  Member is responsible to submit the claim to HDS translated into English and U.S. Dollars.  HDS will reimburse the member based on a non participating dentist fee schedule.","Yes","Service area includes:  Hawaii, Guam and Saipan.  For services received on the Mainland (Continental U.S), HDS recommends visiting a Delta Dental participating dentist to receive the maximum benefit from the plan.   The Delta Dentist will submit claim directly to HDS.  Member out-of-pocket share will be in accordance to the plan benefits.","Yes","www.hawaiidentalservice.com/ddpahi/ffm_initial_payment.html","","46082HI0020003-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.hawaiidentalservice.com/ddpahi/Form_HDS_Preferred_Dental_Plan_0715.pdf",,"4"
"2016","HI","46082","SERFF","10","2015-10-29 11:27:21","2","46082","HI","Individual","Yes","99-0107971","46082HI0020003","HDS Preferred Dental Plan","46082HI002",,"HIN001","HIS001",,"Existing","PPO","Low",,"Both",,,,"Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply.",,"No","Allows Adult and Child-Only",,,,,"$31.20","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","For services received outside of the country, member will pay the claim in full at the time of service.  Member is responsible to submit the claim to HDS translated into English and U.S. Dollars.  HDS will reimburse the member based on a non participating dentist fee schedule.","Yes","Service area includes:  Hawaii, Guam and Saipan.  For services received on the Mainland (Continental U.S), HDS recommends visiting a Delta Dental participating dentist to receive the maximum benefit from the plan.   The Delta Dentist will submit claim directly to HDS.  Member out-of-pocket share will be in accordance to the plan benefits.","Yes","www.hawaiidentalservice.com/ddpahi/ffm_initial_payment.html","","46082HI0020003-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.hawaiidentalservice.com/ddpahi/Form_HDS_Preferred_Dental_Plan_0715.pdf",,"5"
"2016","HI","46082","SERFF","10","2015-10-29 11:27:21","3","46082","HI","Individual","Yes","99-0107971","46082HI0020004","HDS Classic Dental Plan","46082HI002",,"HIN001","HIS001",,"Existing","PPO","Low",,"Both",,,,"Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply.",,"No","Allows Adult and Child-Only",,,,,"$31.20","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","For services received outside of the country, member will pay the claim in full at the time of service.  Member is responsible to submit the claim to HDS translated into English and U.S. Dollars.  HDS will reimburse the member based on a non participating dentist fee schedule.","Yes","Service area includes:  Hawaii, Guam and Saipan.  For services received on the Mainland (Continental U.S), HDS recommends visiting a Delta Dental participating dentist to receive the maximum benefit from the plan.   The Delta Dentist will submit claim directly to HDS.  Member out-of-pocket share will be in accordance to the plan benefits.","Yes","www.hawaiidentalservice.com/ddpahi/ffm_initial_payment.html","","46082HI0020004-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.hawaiidentalservice.com/ddpahi/Form_HDS_Classic_Dental_Plan_0715.pdf",,"4"
"2016","HI","46082","SERFF","10","2015-10-29 11:27:21","3","46082","HI","Individual","Yes","99-0107971","46082HI0020004","HDS Classic Dental Plan","46082HI002",,"HIN001","HIS001",,"Existing","PPO","Low",,"Both",,,,"Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply.",,"No","Allows Adult and Child-Only",,,,,"$31.20","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","For services received outside of the country, member will pay the claim in full at the time of service.  Member is responsible to submit the claim to HDS translated into English and U.S. Dollars.  HDS will reimburse the member based on a non participating dentist fee schedule.","Yes","Service area includes:  Hawaii, Guam and Saipan.  For services received on the Mainland (Continental U.S), HDS recommends visiting a Delta Dental participating dentist to receive the maximum benefit from the plan.   The Delta Dentist will submit claim directly to HDS.  Member out-of-pocket share will be in accordance to the plan benefits.","Yes","www.hawaiidentalservice.com/ddpahi/ffm_initial_payment.html","","46082HI0020004-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.hawaiidentalservice.com/ddpahi/Form_HDS_Classic_Dental_Plan_0715.pdf",,"5"
"2016","HI","50397","SERFF","9","2015-10-29 11:27:21","3","50397","HI","Individual","Yes","75-1233841","50397HI0010006","Dentegra Dental PPO Family Basic Plan","50397HI001",,"HIN001","HIS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.63","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.dentegra.com/hx/checkout","","50397HI0010006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"dentegra.com/hcx/hi/50397hi0010006-16","4"
"2016","HI","50397","SERFF","9","2015-10-29 11:27:21","3","50397","HI","Individual","Yes","75-1233841","50397HI0010006","Dentegra Dental PPO Family Basic Plan","50397HI001",,"HIN001","HIS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.63","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.dentegra.com/hx/checkout","","50397HI0010006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","$75","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"dentegra.com/hcx/hi/50397hi0010006-16","5"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","9","60612","HI","Individual","No","94-1340523","60612HI0110001","KP Platinum $10 - Fit","60612HI011",,"HIN001","HIS001","HIF001","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.935737434730359",,,,"4","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110001-01","Standard Platinum On Exchange Plan","89.82%","0.897629678249359","Yes","Yes","No","100%",,"$0","$600","$400","$200","$0","$300","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","15%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.kpinhawaii.com/sbc/2016/if-10001-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","4"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","9","60612","HI","Individual","No","94-1340523","60612HI0110001","KP Platinum $10 - Fit","60612HI011",,"HIN001","HIS001","HIF001","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.935737434730359",,,,"4","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.kpinhawaii.com/sbc/2016/if-AI-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","5"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","9","60612","HI","Individual","No","94-1340523","60612HI0110001","KP Platinum $10 - Fit","60612HI011",,"HIN001","HIS001","HIF001","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.935737434730359",,,,"4","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110001-03","Limited Cost Sharing Plan Variation","89.82%","0.897629678249359","Yes","Yes","No","100%",,"$0","$600","$400","$200","$0","$300","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","15%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.kpinhawaii.com/sbc/2016/if-AI-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","6"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","9","60612","HI","Individual","No","94-1340523","60612HI0110002","KP Gold I $20 - Fit","60612HI011",,"HIN001","HIS001","HIF002","Existing","HMO","Gold","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.954094802108681",,,,"4","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110002-01","Standard Gold On Exchange Plan",,"0.804426312446594","Yes","Yes","No","100%",,"$0","$1,000","$400","$200","$0","$400","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.kpinhawaii.com/sbc/2016/if-10002-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","7"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","9","60612","HI","Individual","No","94-1340523","60612HI0110002","KP Gold I $20 - Fit","60612HI011",,"HIN001","HIS001","HIF002","Existing","HMO","Gold","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.954094802108681",,,,"4","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.kpinhawaii.com/sbc/2016/if-AI-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","8"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","9","60612","HI","Individual","No","94-1340523","60612HI0110002","KP Gold I $20 - Fit","60612HI011",,"HIN001","HIS001","HIF002","Existing","HMO","Gold","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.954094802108681",,,,"4","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110002-03","Limited Cost Sharing Plan Variation",,"0.804426312446594","Yes","Yes","No","100%",,"$0","$1,000","$400","$200","$0","$400","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.kpinhawaii.com/sbc/2016/if-AI-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","9"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","10","60612","HI","Individual","No","94-1340523","60612HI0110011","KP Gold III $20 - Fit","60612HI011",,"HIN001","HIS001","HIF003","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.952108486991334",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110011-01","Standard Gold On Exchange Plan","80.29%","0.80224609375","No","Yes","No","100%",,"$1,900","$500","$0","$200","$0","$500","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-10011-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","4"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","10","60612","HI","Individual","No","94-1340523","60612HI0110011","KP Gold III $20 - Fit","60612HI011",,"HIN001","HIS001","HIF003","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.952108486991334",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110011-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-AI-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","5"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","10","60612","HI","Individual","No","94-1340523","60612HI0110011","KP Gold III $20 - Fit","60612HI011",,"HIN001","HIS001","HIF003","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.952108486991334",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110011-03","Limited Cost Sharing Plan Variation","80.29%","0.80224609375","No","Yes","No","100%",,"$1,900","$500","$0","$200","$0","$500","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-AI-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","6"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","10","60612","HI","Individual","No","94-1340523","60612HI0110005","KP Bronze I $50 - Fit","60612HI011",,"HIN001","HIS001","HIF006","Existing","HMO","Bronze","Yes","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.945171123325043",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110005-01","Standard Bronze On Exchange Plan","61.81%","0.618270695209503","No","Yes","No","100%",,"$6,000","$20","$500","$200","$2,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-10005-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","7"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","10","60612","HI","Individual","No","94-1340523","60612HI0110005","KP Bronze I $50 - Fit","60612HI011",,"HIN001","HIS001","HIF006","Existing","HMO","Bronze","Yes","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.945171123325043",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-AI-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","8"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","10","60612","HI","Individual","No","94-1340523","60612HI0110005","KP Bronze I $50 - Fit","60612HI011",,"HIN001","HIS001","HIF006","Existing","HMO","Bronze","Yes","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.945171123325043",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110005-03","Limited Cost Sharing Plan Variation","61.81%","0.618270695209503","No","Yes","No","100%",,"$6,000","$20","$500","$200","$2,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-AI-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","9"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","11","60612","HI","Individual","No","94-1340523","60612HI0110004","KP Silver II $30 - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.949632139103913",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110004-01","Standard Silver On Exchange Plan",,"0.698754251003265","No","Yes","No","100%",,"$2,400","$20","$800","$200","$0","$600","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-10004-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","4"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","12","60612","HI","Individual","No","94-1340523","60612HI0110013","KP Silver III $30 - Fit","60612HI011",,"HIN001","HIS001","HIF005","Existing","HMO","Silver","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.948502370249805",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110013-03","Limited Cost Sharing Plan Variation",,"0.683236122131348","No","Yes","No","100%",,"$3,400","$30","$600","$200","$0","$1,000","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-AI-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","6"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","12","60612","HI","Individual","No","94-1340523","60612HI0110013","KP Silver III $30 - Fit","60612HI011",,"HIN001","HIS001","HIF005","Existing","HMO","Silver","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.948502370249805",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110013-04","73% AV Level Silver Plan",,"0.736586153507233","No","Yes","No","100%",,"$2,600","$30","$400","$200","$0","$900","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-1001304-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","7"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","12","60612","HI","Individual","No","94-1340523","60612HI0110013","KP Silver III $30 - Fit","60612HI011",,"HIN001","HIS001","HIF005","Existing","HMO","Silver","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.948502370249805",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110013-05","87% AV Level Silver Plan",,"0.876316249370575","No","Yes","No","100%",,"$0","$20","$400","$200","$0","$300","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-1001305-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","8"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","12","60612","HI","Individual","No","94-1340523","60612HI0110013","KP Silver III $30 - Fit","60612HI011",,"HIN001","HIS001","HIF005","Existing","HMO","Silver","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.948502370249805",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110013-06","94% AV Level Silver Plan",,"0.943382918834686","No","Yes","No","100%",,"$0","$20","$400","$200","$0","$300","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-1001306-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","9"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","13","60612","HI","Individual","No","94-1340523","60612HI0110006","KP Platinum $10 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF001","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.925773235642344",,,,"4","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110006-01","Standard Platinum On Exchange Plan","89.82%","0.897629678249359","Yes","Yes","No","100%",,"$0","$600","$400","$200","$0","$300","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","15%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.kpinhawaii.com/sbc/2016/if-10006-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","4"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","13","60612","HI","Individual","No","94-1340523","60612HI0110006","KP Platinum $10 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF001","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.925773235642344",,,,"4","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.kpinhawaii.com/sbc/2016/if-AI1-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","5"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","13","60612","HI","Individual","No","94-1340523","60612HI0110006","KP Platinum $10 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF001","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.925773235642344",,,,"4","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110006-03","Limited Cost Sharing Plan Variation","89.82%","0.897629678249359","Yes","Yes","No","100%",,"$0","$600","$400","$200","$0","$300","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","15%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.kpinhawaii.com/sbc/2016/if-AI1-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","6"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","13","60612","HI","Individual","No","94-1340523","60612HI0110007","KP Gold I $20 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF002","Existing","HMO","Gold","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.943521370179855",,,,"4","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110007-01","Standard Gold On Exchange Plan",,"0.804426312446594","Yes","Yes","No","100%",,"$0","$1,000","$400","$200","$0","$400","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.kpinhawaii.com/sbc/2016/if-10007-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","7"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","13","60612","HI","Individual","No","94-1340523","60612HI0110007","KP Gold I $20 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF002","Existing","HMO","Gold","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.943521370179855",,,,"4","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.kpinhawaii.com/sbc/2016/if-AI1-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","8"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","13","60612","HI","Individual","No","94-1340523","60612HI0110007","KP Gold I $20 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF002","Existing","HMO","Gold","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.943521370179855",,,,"4","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110007-03","Limited Cost Sharing Plan Variation",,"0.804426312446594","Yes","Yes","No","100%",,"$0","$1,000","$400","$200","$0","$400","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.kpinhawaii.com/sbc/2016/if-AI1-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","9"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","14","60612","HI","Individual","No","94-1340523","60612HI0110009","KP Silver II $30 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF004","Existing","HMO","Silver","No","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.937127150859816",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110009-06","94% AV Level Silver Plan",,"0.937346279621124","No","Yes","No","100%",,"$0","$20","$400","$200","$0","$300","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-1000906-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","9"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","15","60612","HI","Individual","No","94-1340523","60612HI0110010","KP Bronze I $50 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF006","Existing","HMO","Bronze","Yes","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.930735483631705",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110010-01","Standard Bronze On Exchange Plan","61.81%","0.618270695209503","No","Yes","No","100%",,"$6,000","$20","$500","$200","$2,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-10010-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","4"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","15","60612","HI","Individual","No","94-1340523","60612HI0110010","KP Bronze I $50 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF006","Existing","HMO","Bronze","Yes","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.930735483631705",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-AI1-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","5"
"2016","HI","60612","SERFF","10","2015-10-29 11:27:21","15","60612","HI","Individual","No","94-1340523","60612HI0110010","KP Bronze I $50 - ChiroAcuMassage - Fit","60612HI011",,"HIN001","HIS001","HIF006","Existing","HMO","Bronze","Yes","On the Exchange","No","Yes","Referral required for certain Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.930735483631705",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Services, Urgent Care, and Authorized Referrals","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfIjk1PzSlKLrJLzy1KLUlN0c1NTMpPB0sW6aflFuaU5iUWV-uH6UfpRRanpQGH9SA9HMDcvPyU1M0U_MjwgwMrKJ8jR1N3NMCpQvyA316LcUVERADej6Go!/","60612HI0110010-03","Limited Cost Sharing Plan Variation","61.81%","0.618270695209503","No","Yes","No","100%",,"$6,000","$20","$500","$200","$2,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.kpinhawaii.com/sbc/2016/if-AI1-sbc.htm","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/hawaii-health-plan-coverage-and-costs.html","6"
"2016","IA","11474","SERFF","1","2015-08-20 12:28:36","1","11474","IA","Individual","Yes","47-0397286","11474IA0010001","Delta Dental Individual PPO, EHB Certified","11474IA001",,"IAN002","IAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.71","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","11474IA0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IA","11474","SERFF","1","2015-08-20 12:28:36","1","11474","IA","SHOP (Small Group)","Yes","47-0397286","11474IA0030001","Renaissance Group Dental PPO, EHB Certified","11474IA003",,"IAN001","IAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.92","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","11474IA0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IA","11474","SERFF","1","2015-08-20 12:28:36","1","11474","IA","SHOP (Small Group)","Yes","47-0397286","11474IA0030002","Renaissance Group Dental PPO, EHB Certified","11474IA003",,"IAN001","IAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.22","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","11474IA0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IA","11474","SERFF","1","2015-08-20 12:28:36","1","11474","IA","Individual","Yes","47-0397286","11474IA0010002","Delta Dental Individual PPO, EHB Certified","11474IA001",,"IAN002","IAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.47","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","11474IA0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IA","11474","SERFF","1","2015-08-20 12:28:36","1","11474","IA","Individual","Yes","47-0397286","11474IA0020001","Renaissance Individual Dental PPO, EHB Certified","11474IA002",,"IAN001","IAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.93","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","11474IA0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","IA","11474","SERFF","1","2015-08-20 12:28:36","1","11474","IA","Individual","Yes","47-0397286","11474IA0020002","Renaissance Individual Dental PPO, EHB Certified","11474IA002",,"IAN001","IAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.74","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","11474IA0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","IA","11738","SERFF","3","2015-10-21 17:48:08","1","11738","IA","Individual","Yes","36-3757528","11738IA0010001","TruAssure Basic Adult or Child Dental Plan","11738IA001",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.31","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","11738IA0010001-00","Standard Low Off Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$115","$115 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IA","https://www.truassure.com/brochure?state=IA","4"
"2016","IA","11738","SERFF","3","2015-10-21 17:48:08","1","11738","IA","SHOP (Small Group)","Yes","36-3757528","11738IA0030001","TruAssure Dental Small Group Basic Plan","11738IA003",,"IAN001","IAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$45.91","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","11738IA0030001-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IA","11738","SERFF","3","2015-10-21 17:48:08","1","11738","IA","Individual","Yes","36-3757528","11738IA0010001","TruAssure Basic Adult or Child Dental Plan","11738IA001",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.31","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","11738IA0010001-01","Standard Low On Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$115","$115 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IA","https://www.truassure.com/brochure?state=IA","5"
"2016","IA","11738","SERFF","3","2015-10-21 17:48:08","1","11738","IA","SHOP (Small Group)","Yes","36-3757528","11738IA0040001","TruAssure Dental Small Group Preferred Plan","11738IA004",,"IAN001","IAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$45.91","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","11738IA0040001-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$60","$60 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IA","11738","SERFF","3","2015-10-21 17:48:08","2","11738","IA","Individual","Yes","36-3757528","11738IA0020001","TruAssure Preferred Adult or Child Dental Plan","11738IA002",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.36","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","11738IA0020001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IA","https://www.truassure.com/brochure?state=IA","4"
"2016","IA","11738","SERFF","3","2015-10-21 17:48:08","2","11738","IA","Individual","Yes","36-3757528","11738IA0020001","TruAssure Preferred Adult or Child Dental Plan","11738IA002",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.36","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","11738IA0020001-01","Standard High On Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=IA","https://www.truassure.com/brochure?state=IA","5"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0180003","Coventry Bronze $15 Copay CHI Health Omaha","18973IA018",,"IAN009","IAS009","IAF011","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0180003-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61556","http://www.coventryone.com/IAon2016","4"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0180003","Coventry Bronze $15 Copay CHI Health Omaha","18973IA018",,"IAN009","IAS009","IAF011","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0180003-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61328","http://www.coventryone.com/IAon2016","5"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0180003","Coventry Bronze $15 Copay CHI Health Omaha","18973IA018",,"IAN009","IAS009","IAF011","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0180003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61329","http://www.coventryone.com/IAon2016","6"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0180003","Coventry Bronze $15 Copay CHI Health Omaha","18973IA018",,"IAN009","IAS009","IAF011","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0180003-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61330","http://www.coventryone.com/IAon2016","7"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0160003","Coventry Bronze $15 Copay Methodist Health Partners","18973IA016",,"IAN010","IAS010","IAF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0160003-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61552","http://www.coventryone.com/IAon2016","8"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0160003","Coventry Bronze $15 Copay Methodist Health Partners","18973IA016",,"IAN010","IAS010","IAF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0160003-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61309","http://www.coventryone.com/IAon2016","9"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0160003","Coventry Bronze $15 Copay Methodist Health Partners","18973IA016",,"IAN010","IAS010","IAF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0160003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61310","http://www.coventryone.com/IAon2016","10"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0160003","Coventry Bronze $15 Copay Methodist Health Partners","18973IA016",,"IAN010","IAS010","IAF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0160003-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61311","http://www.coventryone.com/IAon2016","11"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0170003","Coventry Bronze $15 Copay MIPPA","18973IA017",,"IAN002","IAS002","IAF007","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0170003-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61548","http://www.coventryone.com/IAon2016","12"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0170003","Coventry Bronze $15 Copay MIPPA","18973IA017",,"IAN002","IAS002","IAF007","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0170003-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61347","http://www.coventryone.com/IAon2016","13"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0170003","Coventry Bronze $15 Copay MIPPA","18973IA017",,"IAN002","IAS002","IAF007","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0170003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61348","http://www.coventryone.com/IAon2016","14"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0170003","Coventry Bronze $15 Copay MIPPA","18973IA017",,"IAN002","IAS002","IAF007","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0170003-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61349","http://www.coventryone.com/IAon2016","15"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0190003","Coventry Bronze $15 Copay Patient Preferred","18973IA019",,"IAN003","IAS003","IAF015","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0190003-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61544","http://www.coventryone.com/IAon2016","16"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0190003","Coventry Bronze $15 Copay Patient Preferred","18973IA019",,"IAN003","IAS003","IAF015","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0190003-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61412","http://www.coventryone.com/IAon2016","17"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0190003","Coventry Bronze $15 Copay Patient Preferred","18973IA019",,"IAN003","IAS003","IAF015","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0190003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61413","http://www.coventryone.com/IAon2016","18"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0190003","Coventry Bronze $15 Copay Patient Preferred","18973IA019",,"IAN003","IAS003","IAF015","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0190003-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61414","http://www.coventryone.com/IAon2016","19"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220011","Coventry Bronze $15 Copay UnityPoint Health CR","18973IA022",,"IAN006","IAS006","IAF021","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220011-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61532","http://www.coventryone.com/IAon2016","20"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220011","Coventry Bronze $15 Copay UnityPoint Health CR","18973IA022",,"IAN006","IAS006","IAF021","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220011-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61450","http://www.coventryone.com/IAon2016","21"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220011","Coventry Bronze $15 Copay UnityPoint Health CR","18973IA022",,"IAN006","IAS006","IAF021","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220011-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61451","http://www.coventryone.com/IAon2016","22"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220011","Coventry Bronze $15 Copay UnityPoint Health CR","18973IA022",,"IAN006","IAS006","IAF021","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220011-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61452","http://www.coventryone.com/IAon2016","23"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0210011","Coventry Bronze $15 Copay UnityPoint Health Des Moines","18973IA021",,"IAN004","IAS004","IAF017","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0210011-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61536","http://www.coventryone.com/IAon2016","24"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0210011","Coventry Bronze $15 Copay UnityPoint Health Des Moines","18973IA021",,"IAN004","IAS004","IAF017","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0210011-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61431","http://www.coventryone.com/IAon2016","25"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0210011","Coventry Bronze $15 Copay UnityPoint Health Des Moines","18973IA021",,"IAN004","IAS004","IAF017","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0210011-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61432","http://www.coventryone.com/IAon2016","26"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0210011","Coventry Bronze $15 Copay UnityPoint Health Des Moines","18973IA021",,"IAN004","IAS004","IAF017","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0210011-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61433","http://www.coventryone.com/IAon2016","27"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220012","Coventry Bronze $15 Copay UnityPoint Health QC","18973IA022",,"IAN005","IAS005","IAF022","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220012-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61540","http://www.coventryone.com/IAon2016","28"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220012","Coventry Bronze $15 Copay UnityPoint Health QC","18973IA022",,"IAN005","IAS005","IAF022","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220012-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61469","http://www.coventryone.com/IAon2016","29"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220012","Coventry Bronze $15 Copay UnityPoint Health QC","18973IA022",,"IAN005","IAS005","IAF022","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220012-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61470","http://www.coventryone.com/IAon2016","30"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220012","Coventry Bronze $15 Copay UnityPoint Health QC","18973IA022",,"IAN005","IAS005","IAF022","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220012-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61471","http://www.coventryone.com/IAon2016","31"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220013","Coventry Bronze $15 Copay UnityPoint Health Waterloo","18973IA022",,"IAN007","IAS007","IAF023","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220013-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61524","http://www.coventryone.com/IAon2016","32"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220013","Coventry Bronze $15 Copay UnityPoint Health Waterloo","18973IA022",,"IAN007","IAS007","IAF023","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220013-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61488","http://www.coventryone.com/IAon2016","33"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220013","Coventry Bronze $15 Copay UnityPoint Health Waterloo","18973IA022",,"IAN007","IAS007","IAF023","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220013-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61489","http://www.coventryone.com/IAon2016","34"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220013","Coventry Bronze $15 Copay UnityPoint Health Waterloo","18973IA022",,"IAN007","IAS007","IAF023","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220013-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61490","http://www.coventryone.com/IAon2016","35"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0170005","Coventry Bronze Deductible Only HSA Eligible MIPPA","18973IA017",,"IAN002","IAS002","IAF008","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0170005-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61549","http://www.coventryone.com/IAon2016","36"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0170005","Coventry Bronze Deductible Only HSA Eligible MIPPA","18973IA017",,"IAN002","IAS002","IAF008","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0170005-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61350","http://www.coventryone.com/IAon2016","37"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0170005","Coventry Bronze Deductible Only HSA Eligible MIPPA","18973IA017",,"IAN002","IAS002","IAF008","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0170005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61351","http://www.coventryone.com/IAon2016","38"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0170005","Coventry Bronze Deductible Only HSA Eligible MIPPA","18973IA017",,"IAN002","IAS002","IAF008","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0170005-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61352","http://www.coventryone.com/IAon2016","39"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0180005","Coventry Bronze HSA Eligible CHI Health Omaha","18973IA018",,"IAN009","IAS009","IAF012","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0180005-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61557","http://www.coventryone.com/IAon2016","40"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0180005","Coventry Bronze HSA Eligible CHI Health Omaha","18973IA018",,"IAN009","IAS009","IAF012","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0180005-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61331","http://www.coventryone.com/IAon2016","41"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0180005","Coventry Bronze HSA Eligible CHI Health Omaha","18973IA018",,"IAN009","IAS009","IAF012","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0180005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61332","http://www.coventryone.com/IAon2016","42"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0180005","Coventry Bronze HSA Eligible CHI Health Omaha","18973IA018",,"IAN009","IAS009","IAF012","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0180005-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61333","http://www.coventryone.com/IAon2016","43"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0160005","Coventry Bronze HSA Eligible Methodist Health Partners","18973IA016",,"IAN010","IAS010","IAF004","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0160005-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61553","http://www.coventryone.com/IAon2016","44"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0160005","Coventry Bronze HSA Eligible Methodist Health Partners","18973IA016",,"IAN010","IAS010","IAF004","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0160005-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61312","http://www.coventryone.com/IAon2016","45"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0160005","Coventry Bronze HSA Eligible Methodist Health Partners","18973IA016",,"IAN010","IAS010","IAF004","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0160005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61313","http://www.coventryone.com/IAon2016","46"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0160005","Coventry Bronze HSA Eligible Methodist Health Partners","18973IA016",,"IAN010","IAS010","IAF004","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0160005-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61314","http://www.coventryone.com/IAon2016","47"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0190005","Coventry Bronze HSA Eligible Patient Preferred","18973IA019",,"IAN003","IAS003","IAF016","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0190005-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61545","http://www.coventryone.com/IAon2016","48"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0190005","Coventry Bronze HSA Eligible Patient Preferred","18973IA019",,"IAN003","IAS003","IAF016","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0190005-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61415","http://www.coventryone.com/IAon2016","49"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0190005","Coventry Bronze HSA Eligible Patient Preferred","18973IA019",,"IAN003","IAS003","IAF016","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0190005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61416","http://www.coventryone.com/IAon2016","50"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0190005","Coventry Bronze HSA Eligible Patient Preferred","18973IA019",,"IAN003","IAS003","IAF016","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0190005-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61417","http://www.coventryone.com/IAon2016","51"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220014","Coventry Bronze HSA Eligible UnityPoint Health CR","18973IA022",,"IAN006","IAS006","IAF024","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220014-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61533","http://www.coventryone.com/IAon2016","52"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220014","Coventry Bronze HSA Eligible UnityPoint Health CR","18973IA022",,"IAN006","IAS006","IAF024","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220014-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61453","http://www.coventryone.com/IAon2016","53"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220014","Coventry Bronze HSA Eligible UnityPoint Health CR","18973IA022",,"IAN006","IAS006","IAF024","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220014-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61454","http://www.coventryone.com/IAon2016","54"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220014","Coventry Bronze HSA Eligible UnityPoint Health CR","18973IA022",,"IAN006","IAS006","IAF024","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220014-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61455","http://www.coventryone.com/IAon2016","55"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0210012","Coventry Bronze HSA Eligible UnityPoint Health Des Moines","18973IA021",,"IAN004","IAS004","IAF018","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0210012-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61537","http://www.coventryone.com/IAon2016","56"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0210012","Coventry Bronze HSA Eligible UnityPoint Health Des Moines","18973IA021",,"IAN004","IAS004","IAF018","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0210012-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61434","http://www.coventryone.com/IAon2016","57"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0210012","Coventry Bronze HSA Eligible UnityPoint Health Des Moines","18973IA021",,"IAN004","IAS004","IAF018","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0210012-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61435","http://www.coventryone.com/IAon2016","58"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0210012","Coventry Bronze HSA Eligible UnityPoint Health Des Moines","18973IA021",,"IAN004","IAS004","IAF018","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0210012-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61436","http://www.coventryone.com/IAon2016","59"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220015","Coventry Bronze HSA Eligible UnityPoint Health QC","18973IA022",,"IAN005","IAS005","IAF025","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220015-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61541","http://www.coventryone.com/IAon2016","60"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220015","Coventry Bronze HSA Eligible UnityPoint Health QC","18973IA022",,"IAN005","IAS005","IAF025","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220015-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61472","http://www.coventryone.com/IAon2016","61"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220015","Coventry Bronze HSA Eligible UnityPoint Health QC","18973IA022",,"IAN005","IAS005","IAF025","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220015-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61473","http://www.coventryone.com/IAon2016","62"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220015","Coventry Bronze HSA Eligible UnityPoint Health QC","18973IA022",,"IAN005","IAS005","IAF025","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220015-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61474","http://www.coventryone.com/IAon2016","63"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220016","Coventry Bronze HSA Eligible UnityPoint Health Waterloo","18973IA022",,"IAN007","IAS007","IAF026","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220016-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61525","http://www.coventryone.com/IAon2016","64"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220016","Coventry Bronze HSA Eligible UnityPoint Health Waterloo","18973IA022",,"IAN007","IAS007","IAF026","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220016-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61491","http://www.coventryone.com/IAon2016","65"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220016","Coventry Bronze HSA Eligible UnityPoint Health Waterloo","18973IA022",,"IAN007","IAS007","IAF026","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220016-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61492","http://www.coventryone.com/IAon2016","66"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220016","Coventry Bronze HSA Eligible UnityPoint Health Waterloo","18973IA022",,"IAN007","IAS007","IAF026","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0220016-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61493","http://www.coventryone.com/IAon2016","67"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0250001","Coventry Gold $10 Copay","18973IA025",,"IAN001","IAS001","IAF033","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250001-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61517","http://www.coventryone.com/IAon2016","68"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0250001","Coventry Gold $10 Copay","18973IA025",,"IAN001","IAS001","IAF033","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250001-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61376","http://www.coventryone.com/IAon2016","69"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0250001","Coventry Gold $10 Copay","18973IA025",,"IAN001","IAS001","IAF033","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61377","http://www.coventryone.com/IAon2016","70"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0250001","Coventry Gold $10 Copay","18973IA025",,"IAN001","IAS001","IAF033","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250001-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61378","http://www.coventryone.com/IAon2016","71"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0180001","Coventry Gold $10 Copay CHI Health Omaha","18973IA018",,"IAN009","IAS009","IAF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0180001-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61554","http://www.coventryone.com/IAon2016","72"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0180001","Coventry Gold $10 Copay CHI Health Omaha","18973IA018",,"IAN009","IAS009","IAF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0180001-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61319","http://www.coventryone.com/IAon2016","73"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0180001","Coventry Gold $10 Copay CHI Health Omaha","18973IA018",,"IAN009","IAS009","IAF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0180001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61320","http://www.coventryone.com/IAon2016","74"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0180001","Coventry Gold $10 Copay CHI Health Omaha","18973IA018",,"IAN009","IAS009","IAF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0180001-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61321","http://www.coventryone.com/IAon2016","75"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0160001","Coventry Gold $10 Copay Methodist Health Partners","18973IA016",,"IAN010","IAS010","IAF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0160001-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61550","http://www.coventryone.com/IAon2016","76"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0160001","Coventry Gold $10 Copay Methodist Health Partners","18973IA016",,"IAN010","IAS010","IAF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0160001-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61300","http://www.coventryone.com/IAon2016","77"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0160001","Coventry Gold $10 Copay Methodist Health Partners","18973IA016",,"IAN010","IAS010","IAF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0160001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61301","http://www.coventryone.com/IAon2016","78"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0160001","Coventry Gold $10 Copay Methodist Health Partners","18973IA016",,"IAN010","IAS010","IAF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0160001-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61302","http://www.coventryone.com/IAon2016","79"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0170001","Coventry Gold $10 Copay MIPPA","18973IA017",,"IAN002","IAS002","IAF005","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0170001-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61546","http://www.coventryone.com/IAon2016","80"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0170001","Coventry Gold $10 Copay MIPPA","18973IA017",,"IAN002","IAS002","IAF005","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0170001-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61338","http://www.coventryone.com/IAon2016","81"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0170001","Coventry Gold $10 Copay MIPPA","18973IA017",,"IAN002","IAS002","IAF005","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0170001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61339","http://www.coventryone.com/IAon2016","82"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0170001","Coventry Gold $10 Copay MIPPA","18973IA017",,"IAN002","IAS002","IAF005","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0170001-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61340","http://www.coventryone.com/IAon2016","83"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0190001","Coventry Gold $10 Copay Patient Preferred","18973IA019",,"IAN003","IAS003","IAF013","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0190001-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61542","http://www.coventryone.com/IAon2016","84"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0190001","Coventry Gold $10 Copay Patient Preferred","18973IA019",,"IAN003","IAS003","IAF013","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0190001-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61403","http://www.coventryone.com/IAon2016","85"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0190001","Coventry Gold $10 Copay Patient Preferred","18973IA019",,"IAN003","IAS003","IAF013","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0190001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61404","http://www.coventryone.com/IAon2016","86"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0190001","Coventry Gold $10 Copay Patient Preferred","18973IA019",,"IAN003","IAS003","IAF013","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0190001-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61405","http://www.coventryone.com/IAon2016","87"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220017","Coventry Gold $10 Copay UnityPoint Health CR","18973IA022",,"IAN006","IAS006","IAF027","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220017-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61530","http://www.coventryone.com/IAon2016","88"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220017","Coventry Gold $10 Copay UnityPoint Health CR","18973IA022",,"IAN006","IAS006","IAF027","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220017-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61441","http://www.coventryone.com/IAon2016","89"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220017","Coventry Gold $10 Copay UnityPoint Health CR","18973IA022",,"IAN006","IAS006","IAF027","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220017-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61442","http://www.coventryone.com/IAon2016","90"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220017","Coventry Gold $10 Copay UnityPoint Health CR","18973IA022",,"IAN006","IAS006","IAF027","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220017-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61443","http://www.coventryone.com/IAon2016","91"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0210013","Coventry Gold $10 Copay UnityPoint Health Des Moines","18973IA021",,"IAN004","IAS004","IAF019","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0210013-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61534","http://www.coventryone.com/IAon2016","92"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0210013","Coventry Gold $10 Copay UnityPoint Health Des Moines","18973IA021",,"IAN004","IAS004","IAF019","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0210013-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61422","http://www.coventryone.com/IAon2016","93"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0210013","Coventry Gold $10 Copay UnityPoint Health Des Moines","18973IA021",,"IAN004","IAS004","IAF019","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0210013-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61423","http://www.coventryone.com/IAon2016","94"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0210013","Coventry Gold $10 Copay UnityPoint Health Des Moines","18973IA021",,"IAN004","IAS004","IAF019","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0210013-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61424","http://www.coventryone.com/IAon2016","95"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220018","Coventry Gold $10 Copay UnityPoint Health QC","18973IA022",,"IAN005","IAS005","IAF028","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220018-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61538","http://www.coventryone.com/IAon2016","96"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220018","Coventry Gold $10 Copay UnityPoint Health QC","18973IA022",,"IAN005","IAS005","IAF028","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220018-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61460","http://www.coventryone.com/IAon2016","97"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220018","Coventry Gold $10 Copay UnityPoint Health QC","18973IA022",,"IAN005","IAS005","IAF028","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220018-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61461","http://www.coventryone.com/IAon2016","98"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220018","Coventry Gold $10 Copay UnityPoint Health QC","18973IA022",,"IAN005","IAS005","IAF028","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220018-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61462","http://www.coventryone.com/IAon2016","99"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220019","Coventry Gold $10 Copay UnityPoint Health Waterloo","18973IA022",,"IAN007","IAS007","IAF029","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220019-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61522","http://www.coventryone.com/IAon2016","100"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220019","Coventry Gold $10 Copay UnityPoint Health Waterloo","18973IA022",,"IAN007","IAS007","IAF029","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220019-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61479","http://www.coventryone.com/IAon2016","101"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220019","Coventry Gold $10 Copay UnityPoint Health Waterloo","18973IA022",,"IAN007","IAS007","IAF029","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220019-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61480","http://www.coventryone.com/IAon2016","102"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","1","18973","IA","Individual","No","42-1244752","18973IA0220019","Coventry Gold $10 Copay UnityPoint Health Waterloo","18973IA022",,"IAN007","IAS007","IAF029","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220019-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61481","http://www.coventryone.com/IAon2016","103"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0250003","Coventry Bronze $15 Copay","18973IA025",,"IAN001","IAS001","IAF035","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0250003-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61519","http://www.coventryone.com/IAon2016","4"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0250003","Coventry Bronze $15 Copay","18973IA025",,"IAN001","IAS001","IAF035","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0250003-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61385","http://www.coventryone.com/IAon2016","5"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0250003","Coventry Bronze $15 Copay","18973IA025",,"IAN001","IAS001","IAF035","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0250003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61386","http://www.coventryone.com/IAon2016","6"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0250003","Coventry Bronze $15 Copay","18973IA025",,"IAN001","IAS001","IAF035","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0250003-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61387","http://www.coventryone.com/IAon2016","7"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0250011","Coventry Bronze $15 Copay Mercy Medical Center DM","18973IA025",,"IAN008","IAS008","IAF037","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0250011-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61528","http://www.coventryone.com/IAon2016","8"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0250011","Coventry Bronze $15 Copay Mercy Medical Center DM","18973IA025",,"IAN008","IAS008","IAF037","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0250011-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61507","http://www.coventryone.com/IAon2016","9"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0250011","Coventry Bronze $15 Copay Mercy Medical Center DM","18973IA025",,"IAN008","IAS008","IAF037","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0250011-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61508","http://www.coventryone.com/IAon2016","10"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0250011","Coventry Bronze $15 Copay Mercy Medical Center DM","18973IA025",,"IAN008","IAS008","IAF037","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0250011-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61509","http://www.coventryone.com/IAon2016","11"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0360001","Coventry Bronze $15 Copay Nebraska Health Network","18973IA036",,"IAN011","IAS011","IAF085","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0360001-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61560","http://www.coventryone.com/IAon2016","12"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0360001","Coventry Bronze $15 Copay Nebraska Health Network","18973IA036",,"IAN011","IAS011","IAF085","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0360001-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61366","http://www.coventryone.com/IAon2016","13"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0360001","Coventry Bronze $15 Copay Nebraska Health Network","18973IA036",,"IAN011","IAS011","IAF085","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0360001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61367","http://www.coventryone.com/IAon2016","14"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0360001","Coventry Bronze $15 Copay Nebraska Health Network","18973IA036",,"IAN011","IAS011","IAF085","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0360001-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61368","http://www.coventryone.com/IAon2016","15"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0250005","Coventry Bronze Deductible Only HSA Eligible","18973IA025",,"IAN001","IAS001","IAF036","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0250005-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61520","http://www.coventryone.com/IAon2016","16"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0250005","Coventry Bronze Deductible Only HSA Eligible","18973IA025",,"IAN001","IAS001","IAF036","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0250005-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61388","http://www.coventryone.com/IAon2016","17"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0250005","Coventry Bronze Deductible Only HSA Eligible","18973IA025",,"IAN001","IAS001","IAF036","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0250005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61389","http://www.coventryone.com/IAon2016","18"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0250005","Coventry Bronze Deductible Only HSA Eligible","18973IA025",,"IAN001","IAS001","IAF036","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0250005-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61390","http://www.coventryone.com/IAon2016","19"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0250012","Coventry Bronze HSA Eligible Mercy Medical Center DM","18973IA025",,"IAN008","IAS008","IAF038","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0250012-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61529","http://www.coventryone.com/IAon2016","20"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0250012","Coventry Bronze HSA Eligible Mercy Medical Center DM","18973IA025",,"IAN008","IAS008","IAF038","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0250012-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61510","http://www.coventryone.com/IAon2016","21"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0250012","Coventry Bronze HSA Eligible Mercy Medical Center DM","18973IA025",,"IAN008","IAS008","IAF038","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0250012-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61511","http://www.coventryone.com/IAon2016","22"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0250012","Coventry Bronze HSA Eligible Mercy Medical Center DM","18973IA025",,"IAN008","IAS008","IAF038","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0250012-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61512","http://www.coventryone.com/IAon2016","23"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0360002","Coventry Bronze HSA Eligible Nebraska Health Network","18973IA036",,"IAN011","IAS011","IAF086","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0360002-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61561","http://www.coventryone.com/IAon2016","24"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0360002","Coventry Bronze HSA Eligible Nebraska Health Network","18973IA036",,"IAN011","IAS011","IAF086","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0360002-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61369","http://www.coventryone.com/IAon2016","25"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0360002","Coventry Bronze HSA Eligible Nebraska Health Network","18973IA036",,"IAN011","IAS011","IAF086","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0360002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IA61370","http://www.coventryone.com/IAon2016","26"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0360002","Coventry Bronze HSA Eligible Nebraska Health Network","18973IA036",,"IAN011","IAS011","IAF086","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5188546992","18973IA0360002-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IA61371","http://www.coventryone.com/IAon2016","27"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0250013","Coventry Gold $10 Copay Mercy Medical Center DM","18973IA025",,"IAN008","IAS008","IAF039","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250013-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61526","http://www.coventryone.com/IAon2016","28"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0250013","Coventry Gold $10 Copay Mercy Medical Center DM","18973IA025",,"IAN008","IAS008","IAF039","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250013-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61498","http://www.coventryone.com/IAon2016","29"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0250013","Coventry Gold $10 Copay Mercy Medical Center DM","18973IA025",,"IAN008","IAS008","IAF039","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250013-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61499","http://www.coventryone.com/IAon2016","30"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0250013","Coventry Gold $10 Copay Mercy Medical Center DM","18973IA025",,"IAN008","IAS008","IAF039","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250013-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61500","http://www.coventryone.com/IAon2016","31"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0360003","Coventry Gold $10 Copay Nebraska Health Network","18973IA036",,"IAN011","IAS011","IAF087","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0360003-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61558","http://www.coventryone.com/IAon2016","32"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0360003","Coventry Gold $10 Copay Nebraska Health Network","18973IA036",,"IAN011","IAS011","IAF087","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0360003-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61357","http://www.coventryone.com/IAon2016","33"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0360003","Coventry Gold $10 Copay Nebraska Health Network","18973IA036",,"IAN011","IAS011","IAF087","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0360003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61358","http://www.coventryone.com/IAon2016","34"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","2","18973","IA","Individual","No","42-1244752","18973IA0360003","Coventry Gold $10 Copay Nebraska Health Network","18973IA036",,"IAN011","IAS011","IAF087","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0360003-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61359","http://www.coventryone.com/IAon2016","35"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0250002","Coventry Silver $10 Copay","18973IA025",,"IAN001","IAS001","IAF034","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250002-00","Standard Silver Off Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61518","http://www.coventryone.com/IAon2016","4"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0250002","Coventry Silver $10 Copay","18973IA025",,"IAN001","IAS001","IAF034","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250002-01","Standard Silver On Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61379","http://www.coventryone.com/IAon2016","5"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0250002","Coventry Silver $10 Copay","18973IA025",,"IAN001","IAS001","IAF034","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61383","http://www.coventryone.com/IAon2016","6"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0250002","Coventry Silver $10 Copay","18973IA025",,"IAN001","IAS001","IAF034","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250002-03","Limited Cost Sharing Plan Variation","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61384","http://www.coventryone.com/IAon2016","7"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0250002","Coventry Silver $10 Copay","18973IA025",,"IAN001","IAS001","IAF034","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250002-04","73% AV Level Silver Plan","72.09%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61382","http://www.coventryone.com/IAon2016","8"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0250002","Coventry Silver $10 Copay","18973IA025",,"IAN001","IAS001","IAF034","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250002-05","87% AV Level Silver Plan","86.14%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61381","http://www.coventryone.com/IAon2016","9"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0250002","Coventry Silver $10 Copay","18973IA025",,"IAN001","IAS001","IAF034","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250002-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61380","http://www.coventryone.com/IAon2016","10"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0180002","Coventry Silver $10 Copay CHI Health Omaha","18973IA018",,"IAN009","IAS009","IAF010","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0180002-00","Standard Silver Off Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61555","http://www.coventryone.com/IAon2016","11"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0180002","Coventry Silver $10 Copay CHI Health Omaha","18973IA018",,"IAN009","IAS009","IAF010","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0180002-01","Standard Silver On Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61322","http://www.coventryone.com/IAon2016","12"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0180002","Coventry Silver $10 Copay CHI Health Omaha","18973IA018",,"IAN009","IAS009","IAF010","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0180002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61326","http://www.coventryone.com/IAon2016","13"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0180002","Coventry Silver $10 Copay CHI Health Omaha","18973IA018",,"IAN009","IAS009","IAF010","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0180002-03","Limited Cost Sharing Plan Variation","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61327","http://www.coventryone.com/IAon2016","14"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0180002","Coventry Silver $10 Copay CHI Health Omaha","18973IA018",,"IAN009","IAS009","IAF010","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0180002-04","73% AV Level Silver Plan","72.09%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61325","http://www.coventryone.com/IAon2016","15"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0180002","Coventry Silver $10 Copay CHI Health Omaha","18973IA018",,"IAN009","IAS009","IAF010","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0180002-05","87% AV Level Silver Plan","86.14%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61324","http://www.coventryone.com/IAon2016","16"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0180002","Coventry Silver $10 Copay CHI Health Omaha","18973IA018",,"IAN009","IAS009","IAF010","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0180002-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61323","http://www.coventryone.com/IAon2016","17"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0250015","Coventry Silver $10 Copay Mercy Medical Center DM","18973IA025",,"IAN008","IAS008","IAF040","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250015-00","Standard Silver Off Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61527","http://www.coventryone.com/IAon2016","18"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0250015","Coventry Silver $10 Copay Mercy Medical Center DM","18973IA025",,"IAN008","IAS008","IAF040","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250015-01","Standard Silver On Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61501","http://www.coventryone.com/IAon2016","19"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0250015","Coventry Silver $10 Copay Mercy Medical Center DM","18973IA025",,"IAN008","IAS008","IAF040","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250015-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61505","http://www.coventryone.com/IAon2016","20"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0250015","Coventry Silver $10 Copay Mercy Medical Center DM","18973IA025",,"IAN008","IAS008","IAF040","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250015-03","Limited Cost Sharing Plan Variation","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61506","http://www.coventryone.com/IAon2016","21"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0250015","Coventry Silver $10 Copay Mercy Medical Center DM","18973IA025",,"IAN008","IAS008","IAF040","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250015-04","73% AV Level Silver Plan","72.09%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61504","http://www.coventryone.com/IAon2016","22"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0250015","Coventry Silver $10 Copay Mercy Medical Center DM","18973IA025",,"IAN008","IAS008","IAF040","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250015-05","87% AV Level Silver Plan","86.14%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61503","http://www.coventryone.com/IAon2016","23"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0250015","Coventry Silver $10 Copay Mercy Medical Center DM","18973IA025",,"IAN008","IAS008","IAF040","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0250015-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61502","http://www.coventryone.com/IAon2016","24"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0160002","Coventry Silver $10 Copay Methodist Health Partners","18973IA016",,"IAN010","IAS010","IAF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0160002-00","Standard Silver Off Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61551","http://www.coventryone.com/IAon2016","25"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0160002","Coventry Silver $10 Copay Methodist Health Partners","18973IA016",,"IAN010","IAS010","IAF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0160002-01","Standard Silver On Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61303","http://www.coventryone.com/IAon2016","26"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0160002","Coventry Silver $10 Copay Methodist Health Partners","18973IA016",,"IAN010","IAS010","IAF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0160002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61307","http://www.coventryone.com/IAon2016","27"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0160002","Coventry Silver $10 Copay Methodist Health Partners","18973IA016",,"IAN010","IAS010","IAF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0160002-03","Limited Cost Sharing Plan Variation","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61308","http://www.coventryone.com/IAon2016","28"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0160002","Coventry Silver $10 Copay Methodist Health Partners","18973IA016",,"IAN010","IAS010","IAF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0160002-04","73% AV Level Silver Plan","72.09%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61306","http://www.coventryone.com/IAon2016","29"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0160002","Coventry Silver $10 Copay Methodist Health Partners","18973IA016",,"IAN010","IAS010","IAF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0160002-05","87% AV Level Silver Plan","86.14%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61305","http://www.coventryone.com/IAon2016","30"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0160002","Coventry Silver $10 Copay Methodist Health Partners","18973IA016",,"IAN010","IAS010","IAF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0160002-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61304","http://www.coventryone.com/IAon2016","31"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0170002","Coventry Silver $10 Copay MIPPA","18973IA017",,"IAN002","IAS002","IAF006","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0170002-00","Standard Silver Off Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61547","http://www.coventryone.com/IAon2016","32"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0170002","Coventry Silver $10 Copay MIPPA","18973IA017",,"IAN002","IAS002","IAF006","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0170002-01","Standard Silver On Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61341","http://www.coventryone.com/IAon2016","33"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0170002","Coventry Silver $10 Copay MIPPA","18973IA017",,"IAN002","IAS002","IAF006","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0170002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61345","http://www.coventryone.com/IAon2016","34"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0170002","Coventry Silver $10 Copay MIPPA","18973IA017",,"IAN002","IAS002","IAF006","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0170002-03","Limited Cost Sharing Plan Variation","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61346","http://www.coventryone.com/IAon2016","35"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0170002","Coventry Silver $10 Copay MIPPA","18973IA017",,"IAN002","IAS002","IAF006","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0170002-04","73% AV Level Silver Plan","72.09%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61344","http://www.coventryone.com/IAon2016","36"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0170002","Coventry Silver $10 Copay MIPPA","18973IA017",,"IAN002","IAS002","IAF006","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0170002-05","87% AV Level Silver Plan","86.14%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61343","http://www.coventryone.com/IAon2016","37"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0170002","Coventry Silver $10 Copay MIPPA","18973IA017",,"IAN002","IAS002","IAF006","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0170002-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61342","http://www.coventryone.com/IAon2016","38"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0360004","Coventry Silver $10 Copay Nebraska Health Network","18973IA036",,"IAN011","IAS011","IAF088","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0360004-00","Standard Silver Off Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61559","http://www.coventryone.com/IAon2016","39"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0360004","Coventry Silver $10 Copay Nebraska Health Network","18973IA036",,"IAN011","IAS011","IAF088","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0360004-01","Standard Silver On Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61360","http://www.coventryone.com/IAon2016","40"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0360004","Coventry Silver $10 Copay Nebraska Health Network","18973IA036",,"IAN011","IAS011","IAF088","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0360004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61364","http://www.coventryone.com/IAon2016","41"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0360004","Coventry Silver $10 Copay Nebraska Health Network","18973IA036",,"IAN011","IAS011","IAF088","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0360004-03","Limited Cost Sharing Plan Variation","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61365","http://www.coventryone.com/IAon2016","42"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0360004","Coventry Silver $10 Copay Nebraska Health Network","18973IA036",,"IAN011","IAS011","IAF088","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0360004-04","73% AV Level Silver Plan","72.09%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61363","http://www.coventryone.com/IAon2016","43"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0360004","Coventry Silver $10 Copay Nebraska Health Network","18973IA036",,"IAN011","IAS011","IAF088","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0360004-05","87% AV Level Silver Plan","86.14%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61362","http://www.coventryone.com/IAon2016","44"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0360004","Coventry Silver $10 Copay Nebraska Health Network","18973IA036",,"IAN011","IAS011","IAF088","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0360004-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61361","http://www.coventryone.com/IAon2016","45"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0190002","Coventry Silver $10 Copay Patient Preferred","18973IA019",,"IAN003","IAS003","IAF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0190002-00","Standard Silver Off Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61543","http://www.coventryone.com/IAon2016","46"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0190002","Coventry Silver $10 Copay Patient Preferred","18973IA019",,"IAN003","IAS003","IAF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0190002-01","Standard Silver On Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61406","http://www.coventryone.com/IAon2016","47"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0190002","Coventry Silver $10 Copay Patient Preferred","18973IA019",,"IAN003","IAS003","IAF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0190002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61410","http://www.coventryone.com/IAon2016","48"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0190002","Coventry Silver $10 Copay Patient Preferred","18973IA019",,"IAN003","IAS003","IAF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0190002-03","Limited Cost Sharing Plan Variation","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61411","http://www.coventryone.com/IAon2016","49"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0190002","Coventry Silver $10 Copay Patient Preferred","18973IA019",,"IAN003","IAS003","IAF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0190002-04","73% AV Level Silver Plan","72.09%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61409","http://www.coventryone.com/IAon2016","50"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0190002","Coventry Silver $10 Copay Patient Preferred","18973IA019",,"IAN003","IAS003","IAF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0190002-05","87% AV Level Silver Plan","86.14%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61408","http://www.coventryone.com/IAon2016","51"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0190002","Coventry Silver $10 Copay Patient Preferred","18973IA019",,"IAN003","IAS003","IAF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0190002-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61407","http://www.coventryone.com/IAon2016","52"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0220020","Coventry Silver $10 Copay UnityPoint Health CR","18973IA022",,"IAN006","IAS006","IAF030","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220020-00","Standard Silver Off Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61531","http://www.coventryone.com/IAon2016","53"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0220020","Coventry Silver $10 Copay UnityPoint Health CR","18973IA022",,"IAN006","IAS006","IAF030","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220020-01","Standard Silver On Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61444","http://www.coventryone.com/IAon2016","54"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0220020","Coventry Silver $10 Copay UnityPoint Health CR","18973IA022",,"IAN006","IAS006","IAF030","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220020-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61448","http://www.coventryone.com/IAon2016","55"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0220020","Coventry Silver $10 Copay UnityPoint Health CR","18973IA022",,"IAN006","IAS006","IAF030","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220020-03","Limited Cost Sharing Plan Variation","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61449","http://www.coventryone.com/IAon2016","56"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0220020","Coventry Silver $10 Copay UnityPoint Health CR","18973IA022",,"IAN006","IAS006","IAF030","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220020-04","73% AV Level Silver Plan","72.09%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61447","http://www.coventryone.com/IAon2016","57"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0220020","Coventry Silver $10 Copay UnityPoint Health CR","18973IA022",,"IAN006","IAS006","IAF030","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220020-05","87% AV Level Silver Plan","86.14%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61446","http://www.coventryone.com/IAon2016","58"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0220020","Coventry Silver $10 Copay UnityPoint Health CR","18973IA022",,"IAN006","IAS006","IAF030","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220020-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61445","http://www.coventryone.com/IAon2016","59"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0210014","Coventry Silver $10 Copay UnityPoint Health Des Moines","18973IA021",,"IAN004","IAS004","IAF020","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0210014-00","Standard Silver Off Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61535","http://www.coventryone.com/IAon2016","60"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0210014","Coventry Silver $10 Copay UnityPoint Health Des Moines","18973IA021",,"IAN004","IAS004","IAF020","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0210014-01","Standard Silver On Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61425","http://www.coventryone.com/IAon2016","61"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0210014","Coventry Silver $10 Copay UnityPoint Health Des Moines","18973IA021",,"IAN004","IAS004","IAF020","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0210014-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61429","http://www.coventryone.com/IAon2016","62"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0210014","Coventry Silver $10 Copay UnityPoint Health Des Moines","18973IA021",,"IAN004","IAS004","IAF020","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0210014-03","Limited Cost Sharing Plan Variation","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61430","http://www.coventryone.com/IAon2016","63"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0210014","Coventry Silver $10 Copay UnityPoint Health Des Moines","18973IA021",,"IAN004","IAS004","IAF020","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0210014-04","73% AV Level Silver Plan","72.09%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61428","http://www.coventryone.com/IAon2016","64"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0210014","Coventry Silver $10 Copay UnityPoint Health Des Moines","18973IA021",,"IAN004","IAS004","IAF020","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0210014-05","87% AV Level Silver Plan","86.14%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61427","http://www.coventryone.com/IAon2016","65"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0210014","Coventry Silver $10 Copay UnityPoint Health Des Moines","18973IA021",,"IAN004","IAS004","IAF020","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0210014-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61426","http://www.coventryone.com/IAon2016","66"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0220021","Coventry Silver $10 Copay UnityPoint Health QC","18973IA022",,"IAN005","IAS005","IAF031","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220021-00","Standard Silver Off Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61539","http://www.coventryone.com/IAon2016","67"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0220021","Coventry Silver $10 Copay UnityPoint Health QC","18973IA022",,"IAN005","IAS005","IAF031","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220021-01","Standard Silver On Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61463","http://www.coventryone.com/IAon2016","68"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0220021","Coventry Silver $10 Copay UnityPoint Health QC","18973IA022",,"IAN005","IAS005","IAF031","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220021-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61467","http://www.coventryone.com/IAon2016","69"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0220021","Coventry Silver $10 Copay UnityPoint Health QC","18973IA022",,"IAN005","IAS005","IAF031","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220021-03","Limited Cost Sharing Plan Variation","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61468","http://www.coventryone.com/IAon2016","70"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0220021","Coventry Silver $10 Copay UnityPoint Health QC","18973IA022",,"IAN005","IAS005","IAF031","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220021-04","73% AV Level Silver Plan","72.09%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61466","http://www.coventryone.com/IAon2016","71"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0220021","Coventry Silver $10 Copay UnityPoint Health QC","18973IA022",,"IAN005","IAS005","IAF031","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220021-05","87% AV Level Silver Plan","86.14%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61465","http://www.coventryone.com/IAon2016","72"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0220021","Coventry Silver $10 Copay UnityPoint Health QC","18973IA022",,"IAN005","IAS005","IAF031","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220021-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61464","http://www.coventryone.com/IAon2016","73"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0220022","Coventry Silver $10 Copay UnityPoint Health Waterloo","18973IA022",,"IAN007","IAS007","IAF032","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220022-00","Standard Silver Off Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61523","http://www.coventryone.com/IAon2016","74"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0220022","Coventry Silver $10 Copay UnityPoint Health Waterloo","18973IA022",,"IAN007","IAS007","IAF032","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220022-01","Standard Silver On Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61482","http://www.coventryone.com/IAon2016","75"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0220022","Coventry Silver $10 Copay UnityPoint Health Waterloo","18973IA022",,"IAN007","IAS007","IAF032","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220022-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61486","http://www.coventryone.com/IAon2016","76"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0220022","Coventry Silver $10 Copay UnityPoint Health Waterloo","18973IA022",,"IAN007","IAS007","IAF032","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220022-03","Limited Cost Sharing Plan Variation","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61487","http://www.coventryone.com/IAon2016","77"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0220022","Coventry Silver $10 Copay UnityPoint Health Waterloo","18973IA022",,"IAN007","IAS007","IAF032","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220022-04","73% AV Level Silver Plan","72.09%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61485","http://www.coventryone.com/IAon2016","78"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0220022","Coventry Silver $10 Copay UnityPoint Health Waterloo","18973IA022",,"IAN007","IAS007","IAF032","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220022-05","87% AV Level Silver Plan","86.14%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61484","http://www.coventryone.com/IAon2016","79"
"2016","IA","18973","SERFF","3","2015-08-27 03:52:03","3","18973","IA","Individual","No","42-1244752","18973IA0220022","Coventry Silver $10 Copay UnityPoint Health Waterloo","18973IA022",,"IAN007","IAS007","IAF032","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5186124706","18973IA0220022-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IA61483","http://www.coventryone.com/IAon2016","80"
"2016","IA","23499","SERFF","1","2015-08-20 12:28:36","1","23499","IA","SHOP (Small Group)","Yes","41-0808596","23499IA0010002","Plan 2. Passive PPO $1000 Annual Maximum, Ortho","23499IA001",,"IAN001","IAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are the same in and out of network","Yes",,"","23499IA0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IA","23499","SERFF","1","2015-08-20 12:28:36","1","23499","IA","SHOP (Small Group)","Yes","41-0808596","23499IA0010005","Plan 5. Passive PPO, $2000 Annaul Maximum, Ortho","23499IA001",,"IAN001","IAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are the same in and out of network","Yes",,"","23499IA0010005-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IA","23499","SERFF","1","2015-08-20 12:28:36","1","23499","IA","SHOP (Small Group)","Yes","41-0808596","23499IA0010006","Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho","23499IA001",,"IAN001","IAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are the same in and out of network","Yes",,"","23499IA0010006-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","IA","23499","SERFF","1","2015-08-20 12:28:36","1","23499","IA","SHOP (Small Group)","Yes","41-0808596","23499IA0010009","Plan 9. MAC PPO, $1500 Annual Maximum, Ortho","23499IA001",,"IAN001","IAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$20.18","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are the same in and out of network","Yes",,"","23499IA0010009-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070001","Platinum $1000 - 0% $30 OV","27651IA007",,"IAN001","IAS001","IAF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993444192770197",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070001-00","Standard Platinum Off Exchange Plan",,"0.913640677928925","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8A&eff_date=01/01/2016&state=IA",,"4"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050001","Platinum $1000 - 0%","27651IA005",,"IAN002","IAS001","IAF005","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.996033725803233",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050001-00","Standard Platinum Off Exchange Plan",,"0.909313559532166","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2016&state=IA",,"4"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050001","Platinum $1000 - 0%","27651IA005",,"IAN002","IAS001","IAF005","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.996033725803233",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050001-01","Standard Platinum On Exchange Plan",,"0.909313559532166","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2016&state=IA",,"5"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070001","Platinum $1000 - 0% $30 OV","27651IA007",,"IAN001","IAS001","IAF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993444192770197",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070001-01","Standard Platinum On Exchange Plan",,"0.913640677928925","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8A&eff_date=01/01/2016&state=IA",,"5"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070002","Platinum $500 - 20% $15 OV","27651IA007",,"IAN001","IAS001","IAF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.99319012185091",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070002-00","Standard Platinum Off Exchange Plan",,"0.892076551914215","No","Yes","No","100%",,"$1,000","$0","$500","$150","$500","$340","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8B&eff_date=01/01/2016&state=IA",,"6"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050001","Platinum $1000 - 0%","27651IA005",,"IAN002","IAS001","IAF005","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.996033725803233",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZC&eff_date=01/01/2016&state=IA",,"6"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050001","Platinum $1000 - 0%","27651IA005",,"IAN002","IAS001","IAF005","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.996033725803233",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050001-03","Limited Cost Sharing Plan Variation",,"0.909313559532166","No","Yes","No","100%",,"$1,000","$0","$0","$150","$1,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZD&eff_date=01/01/2016&state=IA",,"7"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070002","Platinum $500 - 20% $15 OV","27651IA007",,"IAN001","IAS001","IAF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.99319012185091",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070002-01","Standard Platinum On Exchange Plan",,"0.892076551914215","No","Yes","No","100%",,"$1,000","$0","$500","$150","$500","$340","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8B&eff_date=01/01/2016&state=IA",,"7"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070003","Gold $2000 - 0%","27651IA007",,"IAN001","IAS001","IAF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.992424887224445",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070003-00","Standard Gold Off Exchange Plan",,"0.819067180156708","No","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8C&eff_date=01/01/2016&state=IA",,"8"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050002","Platinum $500 - 20%","27651IA005",,"IAN002","IAS001","IAF005","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.996011789051232",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050002-00","Standard Platinum Off Exchange Plan",,"0.911887168884277","No","Yes","No","100%",,"$1,000","$0","$0","$150","$500","$350","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2016&state=IA",,"8"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050002","Platinum $500 - 20%","27651IA005",,"IAN002","IAS001","IAF005","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.996011789051232",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050002-01","Standard Platinum On Exchange Plan",,"0.911887168884277","No","Yes","No","100%",,"$1,000","$0","$0","$150","$500","$350","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2016&state=IA",,"9"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070003","Gold $2000 - 0%","27651IA007",,"IAN001","IAS001","IAF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.992424887224445",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070003-01","Standard Gold On Exchange Plan",,"0.819067180156708","No","Yes","No","100%",,"$2,000","$0","$0","$150","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8C&eff_date=01/01/2016&state=IA",,"9"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070004","Gold $1000 - 20% $40 OV","27651IA007",,"IAN001","IAS001","IAF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.992662970672492",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070004-00","Standard Gold Off Exchange Plan",,"0.81262469291687","No","Yes","No","100%",,"$2,000","$10","$830","$150","$1,000","$460","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8D&eff_date=01/01/2016&state=IA",,"10"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050002","Platinum $500 - 20%","27651IA005",,"IAN002","IAS001","IAF005","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.996011789051232",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZA&eff_date=01/01/2016&state=IA",,"10"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050006","Silver $2500 - 50%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994999685514812",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050006-00","Standard Silver Off Exchange Plan",,"0.70468658208847","No","Yes","No","100%",,"$4,580","$20","$1,200","$150","$2,500","$440","$390","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2016&state=IA",,"27"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050002","Platinum $500 - 20%","27651IA005",,"IAN002","IAS001","IAF005","Existing","POS","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.996011789051232",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050002-03","Limited Cost Sharing Plan Variation",,"0.911887168884277","No","Yes","No","100%",,"$1,000","$0","$0","$150","$500","$350","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZB&eff_date=01/01/2016&state=IA",,"11"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070004","Gold $1000 - 20% $40 OV","27651IA007",,"IAN001","IAS001","IAF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.992662970672492",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070004-01","Standard Gold On Exchange Plan",,"0.81262469291687","No","Yes","No","100%",,"$2,000","$10","$830","$150","$1,000","$460","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8D&eff_date=01/01/2016&state=IA",,"11"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070005","Silver $2500 - 20%","27651IA007",,"IAN001","IAS001","IAF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.991489565155029",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070005-00","Standard Silver Off Exchange Plan",,"0.713462293148041","No","Yes","No","100%",,"$4,500","$0","$0","$150","$2,500","$240","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8E&eff_date=01/01/2016&state=IA",,"12"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050003","Gold $1500 - 30%","27651IA005",,"IAN002","IAS001","IAF006","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995493516615886",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050003-00","Standard Gold Off Exchange Plan",,"0.81634658575058","No","Yes","No","100%",,"$3,000","$0","$0","$150","$1,500","$290","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2016&state=IA",,"12"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050003","Gold $1500 - 30%","27651IA005",,"IAN002","IAS001","IAF006","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995493516615886",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050003-01","Standard Gold On Exchange Plan",,"0.81634658575058","No","Yes","No","100%",,"$3,000","$0","$0","$150","$1,500","$290","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2016&state=IA",,"13"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070005","Silver $2500 - 20%","27651IA007",,"IAN001","IAS001","IAF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.991489565155029",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070005-01","Standard Silver On Exchange Plan",,"0.713462293148041","No","Yes","No","100%",,"$4,500","$0","$0","$150","$2,500","$240","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8E&eff_date=01/01/2016&state=IA",,"13"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070006","Silver $2000 - 30% $40 OV","27651IA007",,"IAN001","IAS001","IAF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.991778480866493",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070006-00","Standard Silver Off Exchange Plan",,"0.718479096889496","No","Yes","No","100%",,"$4,000","$20","$950","$150","$2,000","$480","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8F&eff_date=01/01/2016&state=IA",,"14"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050003","Gold $1500 - 30%","27651IA005",,"IAN002","IAS001","IAF006","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995493516615886",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZE&eff_date=01/01/2016&state=IA",,"14"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050003","Gold $1500 - 30%","27651IA005",,"IAN002","IAS001","IAF006","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995493516615886",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050003-03","Limited Cost Sharing Plan Variation",,"0.81634658575058","No","Yes","No","100%",,"$3,000","$0","$0","$150","$1,500","$290","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZF&eff_date=01/01/2016&state=IA",,"15"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070006","Silver $2000 - 30% $40 OV","27651IA007",,"IAN001","IAS001","IAF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.991778480866493",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070006-01","Standard Silver On Exchange Plan",,"0.718479096889496","No","Yes","No","100%",,"$4,000","$20","$950","$150","$2,000","$480","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8F&eff_date=01/01/2016&state=IA",,"15"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070007","Silver $500 - 50%","27651IA007",,"IAN001","IAS001","IAF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.991342201901797",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070007-00","Standard Silver Off Exchange Plan",,"0.715292930603027","No","Yes","No","100%",,"$1,000","$20","$2,110","$150","$500","$380","$1,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8G&eff_date=01/01/2016&state=IA",,"16"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050004","Gold $3500 - 0%","27651IA005",,"IAN002","IAS001","IAF006","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995298709362665",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050004-00","Standard Gold Off Exchange Plan",,"0.783212602138519","No","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2016&state=IA",,"16"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050004","Gold $3500 - 0%","27651IA005",,"IAN002","IAS001","IAF006","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995298709362665",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050004-01","Standard Gold On Exchange Plan",,"0.783212602138519","No","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2016&state=IA",,"17"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070007","Silver $500 - 50%","27651IA007",,"IAN001","IAS001","IAF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.991342201901797",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070007-01","Standard Silver On Exchange Plan",,"0.715292930603027","No","Yes","No","100%",,"$1,000","$20","$2,110","$150","$500","$380","$1,100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8G&eff_date=01/01/2016&state=IA",,"17"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070008","Silver $3000 - 0%","27651IA007",,"IAN001","IAS001","IAF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.991900991900992",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070008-00","Standard Silver Off Exchange Plan",,"0.715704381465912","No","Yes","No","100%",,"$5,080","$20","$0","$150","$3,000","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8H&eff_date=01/01/2016&state=IA",,"18"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050004","Gold $3500 - 0%","27651IA005",,"IAN002","IAS001","IAF006","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995298709362665",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZG&eff_date=01/01/2016&state=IA",,"18"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050004","Gold $3500 - 0%","27651IA005",,"IAN002","IAS001","IAF006","Existing","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995298709362665",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050004-03","Limited Cost Sharing Plan Variation",,"0.783212602138519","No","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","45%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZH&eff_date=01/01/2016&state=IA",,"19"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070008","Silver $3000 - 0%","27651IA007",,"IAN001","IAS001","IAF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.991900991900992",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070008-01","Standard Silver On Exchange Plan",,"0.715704381465912","No","Yes","No","100%",,"$5,080","$20","$0","$150","$3,000","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8H&eff_date=01/01/2016&state=IA",,"19"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070009","Bronze $3500 - 30%","27651IA007",,"IAN001","IAS001","IAF004","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.989502241094598",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070009-00","Standard Bronze Off Exchange Plan",,"0.619468808174133","No","Yes","No","100%",,"$5,580","$20","$500","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8I&eff_date=01/01/2016&state=IA",,"20"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050005","Silver $3500 - 20%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994907273950226",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050005-00","Standard Silver Off Exchange Plan",,"0.70999950170517","No","Yes","No","100%",,"$5,000","$0","$0","$150","$3,500","$220","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2016&state=IA",,"20"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050005","Silver $3500 - 20%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994907273950226",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050005-01","Standard Silver On Exchange Plan",,"0.70999950170517","No","Yes","No","100%",,"$5,000","$0","$0","$150","$3,500","$220","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2016&state=IA",,"21"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070009","Bronze $3500 - 30%","27651IA007",,"IAN001","IAS001","IAF004","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.989502241094598",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070009-01","Standard Bronze On Exchange Plan",,"0.619468808174133","No","Yes","No","100%",,"$5,580","$20","$500","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8I&eff_date=01/01/2016&state=IA",,"21"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070010","Bronze $6350 - 0%","27651IA007",,"IAN001","IAS001","IAF004","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.989309309309309",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070010-00","Standard Bronze Off Exchange Plan",,"0.606652140617371","No","Yes","No","100%",,"$6,350","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8J&eff_date=01/01/2016&state=IA",,"22"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050005","Silver $3500 - 20%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994907273950226",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZM&eff_date=01/01/2016&state=IA",,"22"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050005","Silver $3500 - 20%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994907273950226",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050005-03","Limited Cost Sharing Plan Variation",,"0.70999950170517","No","Yes","No","100%",,"$5,000","$0","$0","$150","$3,500","$220","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZN&eff_date=01/01/2016&state=IA",,"23"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070010","Bronze $6350 - 0%","27651IA007",,"IAN001","IAS001","IAF004","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.989309309309309",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0070010-01","Standard Bronze On Exchange Plan",,"0.606652140617371","No","Yes","No","100%",,"$6,350","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8J&eff_date=01/01/2016&state=IA",,"23"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050005","Silver $3500 - 20%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994907273950226",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050005-04","73% AV Level Silver Plan",,"0.73432719707489","No","Yes","No","100%",,"$5,000","$0","$0","$150","$3,000","$300","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=9S&eff_date=01/01/2016&state=IA",,"24"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080001","Silver HSA $2500 - 20%","27651IA008",,"IAN001","IAS001","IAF009","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.99120053390019",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0080001-00","Standard Silver Off Exchange Plan",,"0.713323950767517","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,500","$0","$550","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6550 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=A8&eff_date=01/01/2016&state=IA",,"24"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080001","Silver HSA $2500 - 20%","27651IA008",,"IAN001","IAS001","IAF009","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.99120053390019",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0080001-01","Standard Silver On Exchange Plan",,"0.713323950767517","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,500","$0","$550","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6550 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=A8&eff_date=01/01/2016&state=IA",,"25"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050005","Silver $3500 - 20%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994907273950226",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050005-05","87% AV Level Silver Plan",,"0.870575726032257","No","Yes","No","100%",,"$1,750","$0","$0","$150","$1,250","$260","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8S&eff_date=01/01/2016&state=IA",,"25"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050005","Silver $3500 - 20%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994907273950226",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050005-06","94% AV Level Silver Plan",,"0.941182613372803","No","Yes","No","100%",,"$500","$0","$250","$150","$250","$200","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=7S&eff_date=01/01/2016&state=IA",,"26"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080002","Bronze HSA $3250 - 50%","27651IA008",,"IAN001","IAS001","IAF010","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.989215062558696",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0080002-00","Standard Bronze Off Exchange Plan",,"0.618900716304779","Yes","Yes","No","100%",,"$5,330","$0","$970","$150","$3,250","$0","$1,010","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=B8&eff_date=01/01/2016&state=IA",,"26"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080002","Bronze HSA $3250 - 50%","27651IA008",,"IAN001","IAS001","IAF010","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.989215062558696",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0080002-01","Standard Bronze On Exchange Plan",,"0.618900716304779","Yes","Yes","No","100%",,"$5,330","$0","$970","$150","$3,250","$0","$1,010","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=B8&eff_date=01/01/2016&state=IA",,"27"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050006","Silver $2500 - 50%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994999685514812",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050006-01","Standard Silver On Exchange Plan",,"0.70468658208847","No","Yes","No","100%",,"$4,580","$20","$1,200","$150","$2,500","$440","$390","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2016&state=IA",,"28"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080003","Bronze HSA $5000 - 30%","27651IA008",,"IAN001","IAS001","IAF011","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.988124624724798",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0080003-00","Standard Bronze Off Exchange Plan",,"0.612498223781586","Yes","Yes","No","100%",,"$6,350","$0","$0","$150","$5,000","$0","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6550 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=D8&eff_date=01/01/2016&state=IA",,"28"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080003","Bronze HSA $5000 - 30%","27651IA008",,"IAN001","IAS001","IAF011","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.988124624724798",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0080003-01","Standard Bronze On Exchange Plan",,"0.612498223781586","Yes","Yes","No","100%",,"$6,350","$0","$0","$150","$5,000","$0","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6550 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=D8&eff_date=01/01/2016&state=IA",,"29"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050006","Silver $2500 - 50%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994999685514812",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZK&eff_date=01/01/2016&state=IA",,"29"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050006","Silver $2500 - 50%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994999685514812",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050006-03","Limited Cost Sharing Plan Variation",,"0.70468658208847","No","Yes","No","100%",,"$4,580","$20","$1,200","$150","$2,500","$440","$390","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZL&eff_date=01/01/2016&state=IA",,"30"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080004","Bronze HSA $6300 - 0%","27651IA008",,"IAN001","IAS001","IAF012","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.988371713212478",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0080004-00","Standard Bronze Off Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$6,300","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6550 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6550 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=E8&eff_date=01/01/2016&state=IA",,"30"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080004","Bronze HSA $6300 - 0%","27651IA008",,"IAN001","IAS001","IAF012","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.988371713212478",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No",,"http://www.gundersenhealthplan.org/formulary","27651IA0080004-01","Standard Bronze On Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$6,300","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6550 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6550 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=E8&eff_date=01/01/2016&state=IA",,"31"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050006","Silver $2500 - 50%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994999685514812",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050006-04","73% AV Level Silver Plan",,"0.734668493270874","No","Yes","No","100%",,"$4,580","$0","$870","$150","$2,500","$340","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","40%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=6S&eff_date=01/01/2016&state=IA",,"31"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050006","Silver $2500 - 50%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994999685514812",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050006-05","87% AV Level Silver Plan",,"0.863643050193787","No","Yes","No","100%",,"$2,000","$0","$0","$150","$1,000","$290","$320","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=5S&eff_date=01/01/2016&state=IA",,"32"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050006","Silver $2500 - 50%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994999685514812",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050006-06","94% AV Level Silver Plan",,"0.941182613372803","No","Yes","No","100%",,"$500","$0","$250","$150","$250","$200","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=4S&eff_date=01/01/2016&state=IA",,"33"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050007","Silver $2500 - 20%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995126362089841",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050007-00","Standard Silver Off Exchange Plan",,"0.700389385223389","No","Yes","No","100%",,"$4,580","$220","$0","$150","$2,500","$240","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2016&state=IA",,"34"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050007","Silver $2500 - 20%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995126362089841",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050007-01","Standard Silver On Exchange Plan",,"0.700389385223389","No","Yes","No","100%",,"$4,580","$220","$0","$150","$2,500","$240","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2016&state=IA",,"35"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0050014","Catastrophic $6,850 - 0%","27651IA005",,"IAN002","IAS001","IAF012","Existing","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.991895404847465",,,,"0","0","3","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050014-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=CT&eff_date=01/01/2016&state=IA",,"30"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0050014","Catastrophic $6,850 - 0%","27651IA005",,"IAN002","IAS001","IAF012","Existing","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.991895404847465",,,,"0","0","3","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050014-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=CT&eff_date=01/01/2016&state=IA",,"31"
"2016","IA","50730","SERFF","2","2015-08-20 12:28:36","1","50730","IA","SHOP (Small Group)","Yes","13-5123390","50730IA0010003","Guardian Pediatric Advantage","50730IA001",,"IAN001","IAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$25.06","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","50730IA0010003-00","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","IA","50730","SERFF","2","2015-08-20 12:28:36","1","50730","IA","SHOP (Small Group)","Yes","13-5123390","50730IA0020003","Guardian Pediatric Essentials","50730IA002",,"IAN001","IAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$19.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","50730IA0020003-00","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","IA","50730","SERFF","2","2015-08-20 12:28:36","2","50730","IA","SHOP (Small Group)","Yes","13-5123390","50730IA0040003","Guardian Family Advantage","50730IA004",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.06","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","50730IA0040003-00","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","IA","50730","SERFF","2","2015-08-20 12:28:36","2","50730","IA","SHOP (Small Group)","Yes","13-5123390","50730IA0040003","Guardian Family Advantage","50730IA004",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.06","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","50730IA0040003-01","Standard High On Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060005","Bronze HSA $5000 - 20%","27651IA006",,"IAN002","IAS001","IAF009","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993347697843232",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060005-00","Standard Bronze Off Exchange Plan",,"0.613701462745667","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2016&state=IA",,"26"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060005","Bronze HSA $5000 - 20%","27651IA006",,"IAN002","IAS001","IAF009","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993347697843232",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060005-01","Standard Bronze On Exchange Plan",,"0.613701462745667","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2016&state=IA",,"27"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060005","Bronze HSA $5000 - 20%","27651IA006",,"IAN002","IAS001","IAF009","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993347697843232",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YC&eff_date=01/01/2016&state=IA",,"28"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060005","Bronze HSA $5000 - 20%","27651IA006",,"IAN002","IAS001","IAF009","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993347697843232",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060005-03","Limited Cost Sharing Plan Variation",,"0.613701462745667","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$6550 per person","$10000 per group","20%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YD&eff_date=01/01/2016&state=IA",,"29"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","1","51902","IA","Individual","No","47-0676824","51902IA0010004","Silver Compass HSA 3000","51902IA001",,"IAN001","IAS001","IAF008","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010004-01","Standard Silver On Exchange Plan",,"0.708311021327972","Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ia0010&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","5"
"2016","IA","50730","SERFF","2","2015-08-20 12:28:36","2","50730","IA","SHOP (Small Group)","Yes","13-5123390","50730IA0060003","Guardian Family Essentials","50730IA006",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","50730IA0060003-00","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","IA","50730","SERFF","2","2015-08-20 12:28:36","2","50730","IA","SHOP (Small Group)","Yes","13-5123390","50730IA0060003","Guardian Family Essentials","50730IA006",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","50730IA0060003-01","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","1","51902","IA","Individual","No","47-0676824","51902IA0010004","Silver Compass HSA 3000","51902IA001",,"IAN001","IAS001","IAF008","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010004-00","Standard Silver Off Exchange Plan",,"0.708311021327972","Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ia0010&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","4"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050007","Silver $2500 - 20%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995126362089841",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZI&eff_date=01/01/2016&state=IA",,"36"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050007","Silver $2500 - 20%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995126362089841",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050007-03","Limited Cost Sharing Plan Variation",,"0.700389385223389","No","Yes","No","100%",,"$4,580","$220","$0","$150","$2,500","$240","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZJ&eff_date=01/01/2016&state=IA",,"37"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050007","Silver $2500 - 20%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995126362089841",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050007-04","73% AV Level Silver Plan",,"0.731145799160004","No","Yes","No","100%",,"$4,000","$0","$0","$150","$2,000","$290","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=3S&eff_date=01/01/2016&state=IA",,"38"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050007","Silver $2500 - 20%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995126362089841",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050007-05","87% AV Level Silver Plan",,"0.871182441711426","No","Yes","No","100%",,"$1,250","$0","$0","$150","$1,000","$80","$170","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=2S&eff_date=01/01/2016&state=IA",,"39"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050007","Silver $2500 - 20%","27651IA005",,"IAN002","IAS001","IAF007","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.995126362089841",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050007-06","94% AV Level Silver Plan",,"0.943733274936676","No","Yes","No","100%",,"$500","$0","$0","$150","$250","$100","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=1S&eff_date=01/01/2016&state=IA",,"40"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050008","Bronze $3000 - 50%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993891663465233",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050008-00","Standard Bronze Off Exchange Plan",,"0.618284046649933","No","Yes","No","100%",,"$5,080","$20","$1,090","$150","$3,000","$300","$470","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2016&state=IA",,"41"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050008","Bronze $3000 - 50%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993891663465233",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050008-01","Standard Bronze On Exchange Plan",,"0.618284046649933","No","Yes","No","100%",,"$5,080","$20","$1,090","$150","$3,000","$300","$470","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2016&state=IA",,"42"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050008","Bronze $3000 - 50%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993891663465233",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZQ&eff_date=01/01/2016&state=IA",,"43"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050008","Bronze $3000 - 50%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993891663465233",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050008-03","Limited Cost Sharing Plan Variation",,"0.618284046649933","No","Yes","No","100%",,"$5,080","$20","$1,090","$150","$3,000","$300","$470","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZR&eff_date=01/01/2016&state=IA",,"44"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050009","Bronze $4000 - 30%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994022331666604",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050009-00","Standard Bronze Off Exchange Plan",,"0.610205709934235","No","Yes","No","100%",,"$6,080","$20","$350","$150","$4,000","$200","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2016&state=IA",,"45"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050009","Bronze $4000 - 30%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994022331666604",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050009-01","Standard Bronze On Exchange Plan",,"0.610205709934235","No","Yes","No","100%",,"$6,080","$20","$350","$150","$4,000","$200","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2016&state=IA",,"46"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050009","Bronze $4000 - 30%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994022331666604",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZO&eff_date=01/01/2016&state=IA",,"47"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050009","Bronze $4000 - 30%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994022331666604",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050009-03","Limited Cost Sharing Plan Variation",,"0.610205709934235","No","Yes","No","100%",,"$6,080","$20","$350","$150","$4,000","$200","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,500","$17500 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZP&eff_date=01/01/2016&state=IA",,"48"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050010","Bronze $6250 - 30%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.99432325324003",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050010-00","Standard Bronze Off Exchange Plan",,"0.618025720119476","No","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","30%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2016&state=IA",,"49"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050010","Bronze $6250 - 30%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.99432325324003",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050010-01","Standard Bronze On Exchange Plan",,"0.618025720119476","No","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","30%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2016&state=IA",,"50"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050010","Bronze $6250 - 30%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.99432325324003",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZS&eff_date=01/01/2016&state=IA",,"51"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","1","27651","IA","Individual","No","39-1807071","27651IA0050010","Bronze $6250 - 30%","27651IA005",,"IAN002","IAS001","IAF008","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.99432325324003",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0050010-03","Limited Cost Sharing Plan Variation",,"0.618025720119476","No","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","30%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZT&eff_date=01/01/2016&state=IA",,"52"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060001","Silver HSA $3500 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994582900362844",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060001-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6550 per person","$7000 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6550 per person","$7000 per group","0%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2016&state=IA",,"4"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060001","Silver HSA $3500 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994582900362844",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060001-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6550 per person","$7000 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6550 per person","$7000 per group","0%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2016&state=IA",,"5"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060001","Silver HSA $3500 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994582900362844",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZU&eff_date=01/01/2016&state=IA",,"6"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060001","Silver HSA $3500 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994582900362844",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060001-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6550 per person","$7000 per group",,,,"$17,500","$35000 per person","$35000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$6550 per person","$7000 per group","0%",,,,,"$12,500","$25000 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZV&eff_date=01/01/2016&state=IA",,"7"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060001","Silver HSA $3500 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994582900362844",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060001-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$150","$3,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$5450 per person","$6000 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","0%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S3&eff_date=01/01/2016&state=IA",,"8"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060001","Silver HSA $3500 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994582900362844",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060001-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$150","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2250 per person","$2500 per group",,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$2500 per person","$2500 per group","0%",,,,,"$5,000","$10000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S2&eff_date=01/01/2016&state=IA",,"9"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060001","Silver HSA $3500 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994582900362844",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060001-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$150","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group",,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group","0%",,,,,"$2,500","$5000 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S1&eff_date=01/01/2016&state=IA",,"10"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060002","Silver HSA $2000 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994422813848258",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060002-00","Standard Silver Off Exchange Plan",,"0.70052832365036","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,000","$0","$1,640","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6550 per person","$8000 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","50%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2016&state=IA",,"11"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060002","Silver HSA $2000 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994422813848258",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060002-01","Standard Silver On Exchange Plan",,"0.70052832365036","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,000","$0","$1,640","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6550 per person","$8000 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","50%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2016&state=IA",,"12"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060002","Silver HSA $2000 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994422813848258",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=ZY&eff_date=01/01/2016&state=IA",,"13"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060002","Silver HSA $2000 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994422813848258",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060002-03","Limited Cost Sharing Plan Variation",,"0.70052832365036","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,000","$0","$1,640","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$6550 per person","$8000 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","50%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=Z1&eff_date=01/01/2016&state=IA",,"14"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060002","Silver HSA $2000 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994422813848258",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060002-04","73% AV Level Silver Plan",,"0.730542242527008","Yes","Yes","No","100%",,"$3,250","$0","$0","$150","$2,000","$0","$1,250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$5450 per person","$6500 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","50%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S6&eff_date=01/01/2016&state=IA",,"15"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060002","Silver HSA $2000 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994422813848258",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060002-05","87% AV Level Silver Plan",,"0.873969435691834","Yes","Yes","No","100%",,"$1,000","$0","$500","$150","$500","$0","$950","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$2250 per person","$3000 per group",,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group","20%",,,,,"$5,000","$10000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S5&eff_date=01/01/2016&state=IA",,"16"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060002","Silver HSA $2000 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.994422813848258",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060002-06","94% AV Level Silver Plan",,"0.94617486000061","Yes","Yes","No","100%",,"$500","$0","$0","$150","$250","$0","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$1000 per person","$1000 per group",,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$500 per person","$500 per group","10%",,,,,"$2,500","$5000 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=S4&eff_date=01/01/2016&state=IA",,"17"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060003","Bronze HSA $3250 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993733249251143",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060003-00","Standard Bronze Off Exchange Plan",,"0.618900716304779","Yes","Yes","No","100%",,"$5,330","$0","$970","$150","$3,250","$0","$1,010","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group","50%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2016&state=IA",,"18"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060003","Bronze HSA $3250 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993733249251143",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060003-01","Standard Bronze On Exchange Plan",,"0.618900716304779","Yes","Yes","No","100%",,"$5,330","$0","$970","$150","$3,250","$0","$1,010","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group","50%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2016&state=IA",,"19"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060003","Bronze HSA $3250 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993733249251143",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YE&eff_date=01/01/2016&state=IA",,"20"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060003","Bronze HSA $3250 - 50%","27651IA006",,"IAN002","IAS001","IAF010","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993733249251143",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060003-03","Limited Cost Sharing Plan Variation",,"0.618900716304779","Yes","Yes","No","100%",,"$5,330","$0","$970","$150","$3,250","$0","$1,010","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$6500 per person","$6500 per group","50%",,,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YF&eff_date=01/01/2016&state=IA",,"21"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060004","Bronze HSA $6000 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993563925600599",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060004-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6550 per person","$12000 per group",,,,"$20,000","$40000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6550 per person","$12000 per group","0%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2016&state=IA",,"22"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060004","Bronze HSA $6000 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993563925600599",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060004-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6550 per person","$12000 per group",,,,"$20,000","$40000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6550 per person","$12000 per group","0%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2016&state=IA",,"23"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060004","Bronze HSA $6000 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993563925600599",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YA&eff_date=01/01/2016&state=IA",,"24"
"2016","IA","27651","SERFF","4","2016-01-26 09:59:26","2","27651","IA","Individual","No","39-1807071","27651IA0060004","Bronze HSA $6000 - 0%","27651IA006",,"IAN002","IAS001","IAF012","Existing","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes","0.993563925600599",,,,"0","0","0","2016-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","https://ww2.e-billexpress.com/ebpp/GHP2/OnExchange.aspx","http://www.gundersenhealthplan.org/formulary","27651IA0060004-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6550 per person","$12000 per group",,,,"$20,000","$40000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6550 per person","$12000 per group","0%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=YB&eff_date=01/01/2016&state=IA",,"25"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","1","51902","IA","Individual","No","47-0676824","51902IA0010004","Silver Compass HSA 3000","51902IA001",,"IAN001","IAS001","IAF008","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=ia0011&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","6"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","1","51902","IA","Individual","No","47-0676824","51902IA0010004","Silver Compass HSA 3000","51902IA001",,"IAN001","IAS001","IAF008","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010004-03","Limited Cost Sharing Plan Variation",,"0.708311021327972","Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ia0012&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","7"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","1","51902","IA","Individual","No","47-0676824","51902IA0010004","Silver Compass HSA 3000","51902IA001",,"IAN001","IAS001","IAF008","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010004-04","73% AV Level Silver Plan",,"0.737914025783539","Yes","Yes","No","100%",,"$2,500","$10","$0","$200","$2,500","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ia0013&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","8"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","1","51902","IA","Individual","No","47-0676824","51902IA0010004","Silver Compass HSA 3000","51902IA001",,"IAN001","IAS001","IAF008","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010004-05","87% AV Level Silver Plan",,"0.877197504043579","Yes","Yes","No","100%",,"$800","$10","$0","$200","$800","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ia0014&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","9"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","1","51902","IA","Individual","No","47-0676824","51902IA0010004","Silver Compass HSA 3000","51902IA001",,"IAN001","IAS001","IAF008","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010004-06","94% AV Level Silver Plan",,"0.942080080509186","Yes","Yes","No","100%",,"$200","$10","$0","$200","$200","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ia0015&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","10"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","1","51902","IA","Individual","No","47-0676824","51902IA0010009","Bronze Compass HSA 5500","51902IA001",,"IAN001","IAS001","IAF001","New","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010009-00","Standard Bronze Off Exchange Plan",,"0.618041276931763","Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ia0040&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","11"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","1","51902","IA","Individual","No","47-0676824","51902IA0010009","Bronze Compass HSA 5500","51902IA001",,"IAN001","IAS001","IAF001","New","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010009-01","Standard Bronze On Exchange Plan",,"0.618041276931763","Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ia0040&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","12"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","1","51902","IA","Individual","No","47-0676824","51902IA0010009","Bronze Compass HSA 5500","51902IA001",,"IAN001","IAS001","IAF001","New","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=ia0041&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","13"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","1","51902","IA","Individual","No","47-0676824","51902IA0010009","Bronze Compass HSA 5500","51902IA001",,"IAN001","IAS001","IAF001","New","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010009-03","Limited Cost Sharing Plan Variation",,"0.618041276931763","Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ia0042&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","14"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010001","Gold Compass 1000","51902IA001",,"IAN001","IAS001","IAF002","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010001-00","Standard Gold Off Exchange Plan","78.10%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0001&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","4"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010001","Gold Compass 1000","51902IA001",,"IAN001","IAS001","IAF002","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010001-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0001&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","5"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010001","Gold Compass 1000","51902IA001",,"IAN001","IAS001","IAF002","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0002&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","6"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010001","Gold Compass 1000","51902IA001",,"IAN001","IAS001","IAF002","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010001-03","Limited Cost Sharing Plan Variation","78.10%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0003&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","7"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010002","Gold Compass 500","51902IA001",,"IAN001","IAS001","IAF003","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010002-00","Standard Gold Off Exchange Plan","78.30%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0004&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","8"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010002","Gold Compass 500","51902IA001",,"IAN001","IAS001","IAF003","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010002-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0004&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","9"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010002","Gold Compass 500","51902IA001",,"IAN001","IAS001","IAF003","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0005&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","10"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010002","Gold Compass 500","51902IA001",,"IAN001","IAS001","IAF003","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010002-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0006&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","11"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010003","Gold Compass 0","51902IA001",,"IAN001","IAS001","IAF006","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010003-00","Standard Gold Off Exchange Plan","79.10%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0007&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","12"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010003","Gold Compass 0","51902IA001",,"IAN001","IAS001","IAF006","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010003-01","Standard Gold On Exchange Plan","79.10%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0007&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","13"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010003","Gold Compass 0","51902IA001",,"IAN001","IAS001","IAF006","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0008&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","14"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010003","Gold Compass 0","51902IA001",,"IAN001","IAS001","IAF006","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010003-03","Limited Cost Sharing Plan Variation","79.10%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0009&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","15"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010006","Silver Compass 2000","51902IA001",,"IAN001","IAS001","IAF007","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010006-00","Standard Silver Off Exchange Plan","69.30%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0022&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","16"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010006","Silver Compass 2000","51902IA001",,"IAN001","IAS001","IAF007","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010006-01","Standard Silver On Exchange Plan","69.30%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0022&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","17"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010006","Silver Compass 2000","51902IA001",,"IAN001","IAS001","IAF007","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010006-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0023&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","18"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010006","Silver Compass 2000","51902IA001",,"IAN001","IAS001","IAF007","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010006-03","Limited Cost Sharing Plan Variation","69.30%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0024&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","19"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010006","Silver Compass 2000","51902IA001",,"IAN001","IAS001","IAF007","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010006-04","73% AV Level Silver Plan","73.40%",,"No","Yes","No","100%",,"$1,200","$20","$1,500","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0025&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","20"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010006","Silver Compass 2000","51902IA001",,"IAN001","IAS001","IAF007","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010006-05","87% AV Level Silver Plan","87.90%",,"No","Yes","No","100%",,"$200","$10","$600","$200","$200","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0026&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","21"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010006","Silver Compass 2000","51902IA001",,"IAN001","IAS001","IAF007","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010006-06","94% AV Level Silver Plan","93.90%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0027&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","22"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010007","Silver Compass 3500","51902IA001",,"IAN001","IAS001","IAF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010007-00","Standard Silver Off Exchange Plan","68.00%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0028&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","23"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010007","Silver Compass 3500","51902IA001",,"IAN001","IAS001","IAF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010007-01","Standard Silver On Exchange Plan","68.00%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0028&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","24"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010007","Silver Compass 3500","51902IA001",,"IAN001","IAS001","IAF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0029&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","25"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010007","Silver Compass 3500","51902IA001",,"IAN001","IAS001","IAF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010007-03","Limited Cost Sharing Plan Variation","68.00%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0030&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","26"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010007","Silver Compass 3500","51902IA001",,"IAN001","IAS001","IAF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010007-04","73% AV Level Silver Plan","72.50%",,"No","Yes","No","100%",,"$2,500","$10","$800","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0031&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","27"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010007","Silver Compass 3500","51902IA001",,"IAN001","IAS001","IAF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010007-05","87% AV Level Silver Plan","87.90%",,"No","Yes","No","100%",,"$200","$10","$600","$200","$200","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0032&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","28"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010007","Silver Compass 3500","51902IA001",,"IAN001","IAS001","IAF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010007-06","94% AV Level Silver Plan","93.90%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0033&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","29"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010008","Silver Compass 4500","51902IA001",,"IAN001","IAS001","IAF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010008-00","Standard Silver Off Exchange Plan","68.30%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0034&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","30"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010008","Silver Compass 4500","51902IA001",,"IAN001","IAS001","IAF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010008-01","Standard Silver On Exchange Plan","68.30%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0034&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","31"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010008","Silver Compass 4500","51902IA001",,"IAN001","IAS001","IAF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010008-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0035&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","32"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010008","Silver Compass 4500","51902IA001",,"IAN001","IAS001","IAF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010008-03","Limited Cost Sharing Plan Variation","68.30%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0036&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","33"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010008","Silver Compass 4500","51902IA001",,"IAN001","IAS001","IAF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010008-04","73% AV Level Silver Plan","72.50%",,"No","Yes","No","100%",,"$3,200","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0037&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","34"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010008","Silver Compass 4500","51902IA001",,"IAN001","IAS001","IAF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010008-05","87% AV Level Silver Plan","86.10%",,"No","Yes","No","100%",,"$600","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0038&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","35"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010008","Silver Compass 4500","51902IA001",,"IAN001","IAS001","IAF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010008-06","94% AV Level Silver Plan","93.30%",,"No","Yes","No","100%",,"$100","$10","$0","$200","$100","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ia0039&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","36"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010010","Bronze Compass 6500","51902IA001",,"IAN001","IAS001","IAF001","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010010-00","Standard Bronze Off Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ia0043&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","37"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010010","Bronze Compass 6500","51902IA001",,"IAN001","IAS001","IAF001","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010010-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ia0043&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","38"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010010","Bronze Compass 6500","51902IA001",,"IAN001","IAS001","IAF001","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010010-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=ia0044&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","39"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","2","51902","IA","Individual","No","47-0676824","51902IA0010010","Bronze Compass 6500","51902IA001",,"IAN001","IAS001","IAF001","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010010-03","Limited Cost Sharing Plan Variation","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ia0045&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","40"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","3","51902","IA","Individual","No","47-0676824","51902IA0010005","Silver Compass 2000 1","51902IA001",,"IAN001","IAS001","IAF005","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010005-00","Standard Silver Off Exchange Plan","70.95%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ia0016&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","4"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","3","51902","IA","Individual","No","47-0676824","51902IA0010005","Silver Compass 2000 1","51902IA001",,"IAN001","IAS001","IAF005","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010005-01","Standard Silver On Exchange Plan","70.95%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ia0016&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","5"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","3","51902","IA","Individual","No","47-0676824","51902IA0010005","Silver Compass 2000 1","51902IA001",,"IAN001","IAS001","IAF005","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=ia0017&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","6"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","3","51902","IA","Individual","No","47-0676824","51902IA0010005","Silver Compass 2000 1","51902IA001",,"IAN001","IAS001","IAF005","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010005-03","Limited Cost Sharing Plan Variation","70.95%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ia0018&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","7"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","3","51902","IA","Individual","No","47-0676824","51902IA0010005","Silver Compass 2000 1","51902IA001",,"IAN001","IAS001","IAF005","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010005-04","73% AV Level Silver Plan","72.98%",,"Yes","Yes","No","100%",,"$1,800","$1,500","$0","$200","$1,800","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ia0019&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","8"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","3","51902","IA","Individual","No","47-0676824","51902IA0010005","Silver Compass 2000 1","51902IA001",,"IAN001","IAS001","IAF005","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010005-05","87% AV Level Silver Plan","86.20%",,"Yes","Yes","No","100%",,"$500","$800","$0","$200","$500","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ia0020&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","9"
"2016","IA","51902","SERFF","6","2015-10-21 17:48:08","3","51902","IA","Individual","No","47-0676824","51902IA0010005","Silver Compass 2000 1","51902IA001",,"IAN001","IAS001","IAF005","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ia0047&st=ia","51902IA0010005-06","94% AV Level Silver Plan","93.10%",,"Yes","Yes","No","100%",,"$200","$500","$0","$200","$200","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ia0021&st=ia","http://www.uhc.com/iex/doc?id=ia0046&st=ia","10"
"2016","IA","61284","SERFF","2","2015-08-20 12:28:36","1","61284","IA","Individual","Yes","75-1233841","61284IA0010007","Dentegra Dental PPO Pediatric Basic Plan","61284IA001",,"IAN001","IAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.31","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.dentegra.com/hx/checkout","","61284IA0010007-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"dentegra.com/hcx/ia/61284ia0010007-16","4"
"2016","IA","61284","SERFF","2","2015-08-20 12:28:36","1","61284","IA","SHOP (Small Group)","Yes","75-1233841","61284IA0020007","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","61284IA002",,"IAN001","IAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.48","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.dentegra.com/hx/checkout","","61284IA0020007-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"dentegra.com/hcx/ia/61284ia0020007-16","4"
"2016","IA","61284","SERFF","2","2015-08-20 12:28:36","2","61284","IA","SHOP (Small Group)","Yes","75-1233841","61284IA0020010","Dentegra Dental PPO for Small Businesses Family Preferred Plan","61284IA002",,"IAN001","IAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.34","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.dentegra.com/hx/checkout","","61284IA0020010-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"dentegra.com/hcx/ia/61284ia0020010-16","4"
"2016","IA","61284","SERFF","2","2015-08-20 12:28:36","2","61284","IA","Individual","Yes","75-1233841","61284IA0010010","Dentegra Dental PPO Family Preferred Plan","61284IA001",,"IAN001","IAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.11","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.dentegra.com/hx/checkout","","61284IA0010010-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"dentegra.com/hcx/ia/61284ia0010010-16","4"
"2016","IA","61284","SERFF","2","2015-08-20 12:28:36","3","61284","IA","Individual","Yes","75-1233841","61284IA0010009","Dentegra Dental PPO Family Basic Plan","61284IA001",,"IAN001","IAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.31","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.dentegra.com/hx/checkout","","61284IA0010009-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"dentegra.com/hcx/ia/61284ia0010009-16","4"
"2016","IA","61284","SERFF","2","2015-08-20 12:28:36","3","61284","IA","SHOP (Small Group)","Yes","75-1233841","61284IA0020009","Dentegra Dental PPO for Small Businesses Family Basic Plan","61284IA002",,"IAN001","IAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.48","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.dentegra.com/hx/checkout","","61284IA0020009-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"dentegra.com/hcx/ia/61284ia0020009-16","4"
"2016","IA","61284","SERFF","2","2015-08-20 12:28:36","3","61284","IA","SHOP (Small Group)","Yes","75-1233841","61284IA0020009","Dentegra Dental PPO for Small Businesses Family Basic Plan","61284IA002",,"IAN001","IAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.48","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.dentegra.com/hx/checkout","","61284IA0020009-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"dentegra.com/hcx/ia/61284ia0020009-16","5"
"2016","IA","61284","SERFF","2","2015-08-20 12:28:36","3","61284","IA","Individual","Yes","75-1233841","61284IA0010009","Dentegra Dental PPO Family Basic Plan","61284IA001",,"IAN001","IAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.31","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.dentegra.com/hx/checkout","","61284IA0010009-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"dentegra.com/hcx/ia/61284ia0010009-16","5"
"2016","IA","61549","SERFF","1","2015-08-20 12:28:36","1","61549","IA","SHOP (Small Group)","Yes","44-0308260","61549IA0010001","KCL EHB Low PPO","61549IA001",,"IAN001","IAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$40.26","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","61549IA0010001-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IA","61549","SERFF","1","2015-08-20 12:28:36","1","61549","IA","SHOP (Small Group)","Yes","44-0308260","61549IA0010003","KCL EHB Low MAC","61549IA001",,"IAN001","IAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$25.57","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","61549IA0010003-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IA","61549","SERFF","1","2015-08-20 12:28:36","1","61549","IA","SHOP (Small Group)","Yes","44-0308260","61549IA0010005","KCL Fam Low PPO","61549IA001",,"IAN001","IAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$40.26","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","61549IA0010005-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","IA","61549","SERFF","1","2015-08-20 12:28:36","1","61549","IA","SHOP (Small Group)","Yes","44-0308260","61549IA0010007","KCL Fam Low MAC","61549IA001",,"IAN001","IAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$25.57","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","61549IA0010007-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","IA","61549","SERFF","1","2015-08-20 12:28:36","2","61549","IA","SHOP (Small Group)","Yes","44-0308260","61549IA0010002","KCL EHB High PPO","61549IA001",,"IAN001","IAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$49.12","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","61549IA0010002-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","1","93078","IA","Individual","No","41-1490988","93078IA0010001","Medica Insure Gold Copay","93078IA001",,"IAN001","IAS001","IAF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010001-01","Standard Gold On Exchange Plan",,"0.795177459716797","Yes","Yes","No","100%",,"$300","$20","$1,500","$1,000","$300","$600","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGCIA&uid=FFM",,"5"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","1","93078","IA","Individual","No","41-1490988","93078IA0010001","Medica Insure Gold Copay","93078IA001",,"IAN001","IAS001","IAF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGCIAZ&uid=FFM",,"6"
"2016","IA","61549","SERFF","1","2015-08-20 12:28:36","2","61549","IA","SHOP (Small Group)","Yes","44-0308260","61549IA0010004","KCL EHB High MAC","61549IA001",,"IAN001","IAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$32.57","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","61549IA0010004-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IA","61549","SERFF","1","2015-08-20 12:28:36","2","61549","IA","SHOP (Small Group)","Yes","44-0308260","61549IA0010006","KCL Fam High PPO","61549IA001",,"IAN001","IAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$49.12","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","61549IA0010006-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","IA","61549","SERFF","1","2015-08-20 12:28:36","2","61549","IA","SHOP (Small Group)","Yes","44-0308260","61549IA0010008","KCL Fam High MAC","61549IA001",,"IAN001","IAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$32.57","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","61549IA0010008-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","IA","63366","SERFF","3","2015-08-25 12:56:34","1","63366","IA","Individual","Yes","42-0959302","63366IA0020001","Delta Dental PPO Plus Premier® Individual Choice - Preferred Plus","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","High",,"On the Exchange",,,,"Non-medically necessary orthodontia -Child, orthodontia-Adult",,"No","Allows Adult and Child-Only",,,,,"$41.04","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes","https://saml.deltadentalia.com/sp/ACS.saml2","","63366IA0020001-01","Standard High On Exchange Plan","84.00%",,,,"Yes","42%","58%",,,,,,,,,"$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IA","63366","SERFF","3","2015-08-25 12:56:34","1","63366","IA","Individual","Yes","42-0959302","63366IA0020003","Delta Dental PPO Plus Premier® Individual Choice - Preferred Plus","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Non-medically necessary orthodontia -Child, orthodontia-Adult",,"No","Allows Adult and Child-Only",,,,,"$41.04","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes","https://saml.deltadentalia.com/sp/ACS.saml2","","63366IA0020003-00","Standard High Off Exchange Plan","84.00%",,,,"Yes","42%","58%",,,,,,,,,"$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IA","63366","SERFF","3","2015-08-25 12:56:34","2","63366","IA","Individual","Yes","42-0959302","63366IA0020002","Delta Dental PPO Plus Premier® Individual Choice - Preventive Plus","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","Low",,"On the Exchange",,,,"Major Dental Care and Orthodntia - Adult, non-medically necessary orthodontia - Child",,"No","Allows Adult and Child-Only",,,,,"$34.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes","https://saml.deltadentalia.com/sp/ACS.saml2","","63366IA0020002-01","Standard Low On Exchange Plan","71.80%",,,,"Yes","33%","67%",,,,,,,,,"$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,"$75","$75 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IA","63366","SERFF","3","2015-08-25 12:56:34","2","63366","IA","Individual","Yes","42-0959302","63366IA0020004","Delta Dental PPO Plus Premier® Individual Choice - Preventive Plus","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Major Dental Care and Orthodntia - Adult, non-medically necessary orthodontia - Child",,"No","Allows Adult and Child-Only",,,,,"$34.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes","https://saml.deltadentalia.com/sp/ACS.saml2","","63366IA0020004-00","Standard Low Off Exchange Plan","71.80%",,,,"Yes","33%","67%",,,,,,,,,"$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,"$75","$75 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IA","63366","SERFF","3","2015-08-25 12:56:34","3","63366","IA","Individual","Yes","42-0959302","63366IA0020006","Delta Dental PPO Plus Premier® Individual Choice - Platinum Plus","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","High",,"On the Exchange",,,,"Non-medically necessary orthodontia -Child, orthodontia-Adult",,"No","Allows Adult and Child-Only",,,,,"$34.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes","https://saml.deltadentalia.com/sp/ACS.saml2","","63366IA0020006-01","Standard High On Exchange Plan","84.00%",,,,"Yes","42%","58%",,,,,,,,,"$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IA","63366","SERFF","3","2015-08-25 12:56:34","3","63366","IA","Individual","Yes","42-0959302","63366IA0020007","Delta Dental PPO Plus Premier® Individual Choice - Platinum Plus","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Non-medically necessary orthodontia -Child, orthodontia-Adult",,"No","Allows Adult and Child-Only",,,,,"$34.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes","https://saml.deltadentalia.com/sp/ACS.saml2","","63366IA0020007-00","Standard High Off Exchange Plan","84.00%",,,,"Yes","42%","58%",,,,,,,,,"$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IA","63366","SERFF","3","2015-08-25 12:56:34","4","63366","IA","Individual","Yes","42-0959302","63366IA0020005","Delta Dental PPO Plus Premier® Individual Comprehensive Plus","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Non-medically necessary orthodontia -Child, orthodontia-Adult",,"No","Allows Adult and Child-Only",,,,,"$41.04","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement","Yes","https://saml.deltadentalia.com/sp/ACS.saml2","","63366IA0020005-00","Standard High Off Exchange Plan","84.00%",,,,"Yes","52%","48%",,,,,,,,,"$350","per person not applicable","$700 per group","$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,"$25","$25 per person","per group not applicable",,"$225","$225 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IA","71051","SERFF","3","2015-08-27 03:52:03","1","71051","IA","Individual","Yes","95-6042390","71051IA0020003","BESTOne Advantage Gold","71051IA002",,"IAN001","IAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.32","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Advantage-Gold_Plan.pdf","https://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","IA","71051","SERFF","3","2015-08-27 03:52:03","1","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010007","BESTDental Premium","71051IA001",,"IAN001","IAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.44","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2015/IA_BESTDental_Premium_Plan.pdf","4"
"2016","IA","71051","SERFF","3","2015-08-27 03:52:03","1","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010007","BESTDental Premium","71051IA001",,"IAN001","IAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.44","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2015/IA_BESTDental_Premium_Plan.pdf","5"
"2016","IA","71051","SERFF","3","2015-08-27 03:52:03","1","71051","IA","Individual","Yes","95-6042390","71051IA0020003","BESTOne Advantage Gold","71051IA002",,"IAN001","IAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.32","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Advantage-Gold_Plan.pdf","https://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","IA","71051","SERFF","3","2015-08-27 03:52:03","1","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010008","BESTDental Standard - H","71051IA001",,"IAN001","IAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.44","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2015/IA_BESTDental_Standard-H_Plan.pdf","6"
"2016","IA","71051","SERFF","3","2015-08-27 03:52:03","1","71051","IA","Individual","Yes","95-6042390","71051IA0020004","BESTOne Plus Gold","71051IA002",,"IAN001","IAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.32","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Plus-Gold_Plan.pdf","https://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","IA","71051","SERFF","3","2015-08-27 03:52:03","1","71051","IA","Individual","Yes","95-6042390","71051IA0020004","BESTOne Plus Gold","71051IA002",,"IAN001","IAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.32","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Plus-Gold_Plan.pdf","https://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","IA","71051","SERFF","3","2015-08-27 03:52:03","1","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010008","BESTDental Standard - H","71051IA001",,"IAN001","IAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.44","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2015/IA_BESTDental_Standard-H_Plan.pdf","7"
"2016","IA","71051","SERFF","3","2015-08-27 03:52:03","1","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010010","BESTDental Choice - H","71051IA001",,"IAN001","IAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.44","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2015/IA_BESTDental_Choice-H_Plan.pdf","8"
"2016","IA","71051","SERFF","3","2015-08-27 03:52:03","1","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010010","BESTDental Choice - H","71051IA001",,"IAN001","IAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.44","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2015/IA_BESTDental_Choice-H_Plan.pdf","9"
"2016","IA","71051","SERFF","3","2015-08-27 03:52:03","2","71051","IA","Individual","Yes","95-6042390","71051IA0020005","BESTOne Dental Plus - Silver","71051IA002",,"IAN001","IAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.55","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Plus-Silver_Plan.pdf","https://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","IA","71051","SERFF","3","2015-08-27 03:52:03","2","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010009","BESTDental Standard - L","71051IA001",,"IAN001","IAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.25","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2015/IA_BESTDental_Standard-L_Plan.pdf","4"
"2016","IA","71051","SERFF","3","2015-08-27 03:52:03","2","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010009","BESTDental Standard - L","71051IA001",,"IAN001","IAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.25","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2015/IA_BESTDental_Standard-L_Plan.pdf","5"
"2016","IA","71051","SERFF","3","2015-08-27 03:52:03","2","71051","IA","Individual","Yes","95-6042390","71051IA0020005","BESTOne Dental Plus - Silver","71051IA002",,"IAN001","IAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.55","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Plus-Silver_Plan.pdf","https://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","IA","71051","SERFF","3","2015-08-27 03:52:03","2","71051","IA","Individual","Yes","95-6042390","71051IA0020006","BESTOne Dental Basic - Silver","71051IA002",,"IAN001","IAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.55","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Basic-Silver_Plan.pdf","https://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","IA","71051","SERFF","3","2015-08-27 03:52:03","2","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010011","BESTDental Choice - L","71051IA001",,"IAN001","IAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.25","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2015/IA_BESTDental_Choice-L_Plan.pdf","6"
"2016","IA","71051","SERFF","3","2015-08-27 03:52:03","2","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010011","BESTDental Choice - L","71051IA001",,"IAN001","IAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.25","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2015/IA_BESTDental_Choice-L_Plan.pdf","7"
"2016","IA","71051","SERFF","3","2015-08-27 03:52:03","2","71051","IA","Individual","Yes","95-6042390","71051IA0020006","BESTOne Dental Basic - Silver","71051IA002",,"IAN001","IAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.55","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Basic-Silver_Plan.pdf","https://www.bestlife.com/IA/2015/IA_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","IA","71051","SERFF","3","2015-08-27 03:52:03","2","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010012","BESTDental Value","71051IA001",,"IAN001","IAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.25","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2015/IA_BESTDental_Value_Plan.pdf","8"
"2016","IA","71051","SERFF","3","2015-08-27 03:52:03","2","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010012","BESTDental Value","71051IA001",,"IAN001","IAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.25","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","71051IA0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/IA/2015/IA_BESTDental_Value_Plan.pdf","9"
"2016","IA","74980","SERFF","3","2015-08-25 12:56:34","1","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010021","Avera $1,000 / 30% Coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF003","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","74980IA0010021-00","Standard Gold Off Exchange Plan",,"0.819881618022919","No","Yes","No","100%",,"$1,000","$20","$1,880","$150","$0","$1,650","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/57848/ia-avera-1000-30-coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","4"
"2016","IA","74980","SERFF","3","2015-08-25 12:56:34","1","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010021","Avera $1,000 / 30% Coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF003","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","74980IA0010021-01","Standard Gold On Exchange Plan",,"0.819881618022919","No","Yes","No","100%",,"$1,000","$20","$1,880","$150","$0","$1,650","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/57848/ia-avera-1000-30-coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","5"
"2016","IA","74980","SERFF","3","2015-08-25 12:56:34","1","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010022","Avera $1,500 / 20% Coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF002","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","74980IA0010022-00","Standard Gold Off Exchange Plan",,"0.796852707862854","No","Yes","No","100%",,"$150","$10","$1,150","$150","$0","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/57849/ia-avera-1500-20-coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","6"
"2016","IA","74980","SERFF","3","2015-08-25 12:56:34","1","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010022","Avera $1,500 / 20% Coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF002","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","74980IA0010022-01","Standard Gold On Exchange Plan",,"0.796852707862854","No","Yes","No","100%",,"$150","$10","$1,150","$150","$0","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/57849/ia-avera-1500-20-coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","7"
"2016","IA","74980","SERFF","3","2015-08-25 12:56:34","2","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010019","Avera $500 / 20% Coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF009","New","PPO","Platinum","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","74980IA0010019-00","Standard Platinum Off Exchange Plan",,"0.88515830039978","No","Yes","No","100%",,"$500","$10","$1,350","$150","$0","$740","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53378/Avera-500-20-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","4"
"2016","IA","74980","SERFF","3","2015-08-25 12:56:34","2","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010019","Avera $500 / 20% Coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF009","New","PPO","Platinum","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","74980IA0010019-01","Standard Platinum On Exchange Plan",,"0.88515830039978","No","Yes","No","100%",,"$500","$10","$1,350","$150","$0","$740","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53378/Avera-500-20-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","5"
"2016","IA","74980","SERFF","3","2015-08-25 12:56:34","2","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010020","Avera $2,000 / 30% Coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF004","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","74980IA0010020-00","Standard Gold Off Exchange Plan",,"0.78093147277832","No","Yes","No","100%",,"$2,000","$20","$1,580","$150","$0","$1,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53756/Avera-2016-2000-30-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","6"
"2016","IA","74980","SERFF","3","2015-08-25 12:56:34","2","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010020","Avera $2,000 / 30% Coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF004","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","74980IA0010020-01","Standard Gold On Exchange Plan",,"0.78093147277832","No","Yes","No","100%",,"$2,000","$20","$1,580","$150","$0","$1,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53756/Avera-2016-2000-30-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","7"
"2016","IA","74980","SERFF","3","2015-08-25 12:56:34","3","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010017","Avera $4,500","74980IA001","7942203176","IAN001","IAS001","IAF006","Existing","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","74980IA0010017-00","Standard Bronze Off Exchange Plan",,"0.598586618900299","Yes","Yes","No","100%",,"$4,500","$0","$1,390","$150","$4,500","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.avera.org/app/files/public/53760/Avera-2016-4500.pdf","https://www.avera.org/marketplace/plan-brochure/","4"
"2016","IA","74980","SERFF","3","2015-08-25 12:56:34","3","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010017","Avera $4,500","74980IA001","7942203176","IAN001","IAS001","IAF006","Existing","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","74980IA0010017-01","Standard Bronze On Exchange Plan",,"0.598586618900299","Yes","Yes","No","100%",,"$4,500","$0","$1,390","$150","$4,500","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.avera.org/app/files/public/53760/Avera-2016-4500.pdf","https://www.avera.org/marketplace/plan-brochure/","5"
"2016","IA","74980","SERFF","3","2015-08-25 12:56:34","3","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010023","Avera $3,500","74980IA001","7942203176","IAN001","IAS001","IAF012","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","74980IA0010023-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.avera.org/app/files/public/53759/Avera-2016-3500.pdf","https://www.avera.org/marketplace/plan-brochure/","6"
"2016","IA","74980","SERFF","3","2015-08-25 12:56:34","3","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010023","Avera $3,500","74980IA001","7942203176","IAN001","IAS001","IAF012","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","74980IA0010023-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.avera.org/app/files/public/53759/Avera-2016-3500.pdf","https://www.avera.org/marketplace/plan-brochure/","7"
"2016","IA","74980","SERFF","3","2015-08-25 12:56:34","3","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010024","Avera $2,500 / 30% coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF005","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","74980IA0010024-00","Standard Silver Off Exchange Plan",,"0.718204975128174","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$490","$1,440","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53757/Avera-2016-2500-30-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","8"
"2016","IA","74980","SERFF","3","2015-08-25 12:56:34","3","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010024","Avera $2,500 / 30% coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF005","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","74980IA0010024-01","Standard Silver On Exchange Plan",,"0.718204975128174","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$490","$1,440","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53757/Avera-2016-2500-30-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","9"
"2016","IA","74980","SERFF","3","2015-08-25 12:56:34","4","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010015","Avera $3,000 / 40% Coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF004","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","74980IA0010015-00","Standard Silver Off Exchange Plan",,"0.700923264026642","No","Yes","No","100%",,"$3,000","$0","$1,700","$150","$140","$2,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","40%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53758/Avera-2016-3000-40-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","4"
"2016","IA","74980","SERFF","3","2015-08-25 12:56:34","4","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010015","Avera $3,000 / 40% Coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF004","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","74980IA0010015-01","Standard Silver On Exchange Plan",,"0.700923264026642","No","Yes","No","100%",,"$3,000","$0","$1,700","$150","$140","$2,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","40%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53758/Avera-2016-3000-40-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","5"
"2016","IA","88678","SERFF","6","2015-08-30 09:33:32","5","88678","IA","SHOP (Small Group)","No","36-2739571","88678IA0010041","Gold Choice Plus 2000","88678IA001",,"IAN002","IAS001","IAF006","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=ia0002&st=ia","88678IA0010041-00","Standard Gold Off Exchange Plan","78.58%",,"No","Yes","No","100%",,"$2,000","$20","$700","$200","$200","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=ia0003&st=ia",,"9"
"2016","IA","88678","SERFF","6","2015-08-30 09:33:32","5","88678","IA","SHOP (Small Group)","No","36-2739571","88678IA0010041","Gold Choice Plus 2000","88678IA001",,"IAN002","IAS001","IAF006","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=ia0002&st=ia","88678IA0010041-01","Standard Gold On Exchange Plan","78.58%",,"No","Yes","No","100%",,"$2,000","$20","$700","$200","$200","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=ia0003&st=ia",,"10"
"2016","IA","74980","SERFF","3","2015-08-25 12:56:34","4","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010025","Avera $5,000 / 30% Coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF004","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","74980IA0010025-00","Standard Bronze Off Exchange Plan",,"0.613690793514252","No","Yes","No","100%",,"$5,000","$0","$680","$150","$140","$2,360","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53761/Avera-2016-5000-30-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","6"
"2016","IA","74980","SERFF","3","2015-08-25 12:56:34","4","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010025","Avera $5,000 / 30% Coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF004","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","74980IA0010025-01","Standard Bronze On Exchange Plan",,"0.613690793514252","No","Yes","No","100%",,"$5,000","$0","$680","$150","$140","$2,360","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53761/Avera-2016-5000-30-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","7"
"2016","IA","77847","SERFF","1","2015-09-27 20:37:48","1","77847","IA","SHOP (Small Group)","Yes","57-0523959","77847IA0020001","Group Dental Policy","77847IA002",,"IAN001","IAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.67","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","77847IA0020001-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IA","85930","SERFF","2","2015-08-27 03:52:03","1","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060005","Sanford Simplicity $6,000 Copay","85930IA006",,"IAN001","IAS001","IAF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060005-00","Standard Bronze Off Exchange Plan",,"0.619145750999451","Yes","Yes","No","100%",,"$3,600","$50","$300","$200","$600","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,000","$16000 per person","$24000 per group","$16,000","$16000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/sg_ia_simplicity_6000.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","4"
"2016","IA","85930","SERFF","2","2015-08-27 03:52:03","1","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060005","Sanford Simplicity $6,000 Copay","85930IA006",,"IAN001","IAS001","IAF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060005-01","Standard Bronze On Exchange Plan",,"0.619145750999451","Yes","Yes","No","100%",,"$3,600","$50","$300","$200","$600","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,000","$16000 per person","$24000 per group","$16,000","$16000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/sg_ia_simplicity_6000.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","5"
"2016","IA","85930","SERFF","2","2015-08-27 03:52:03","2","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060004","Sanford Simplicity $3,500","85930IA006",,"IAN001","IAS001","IAF004","New","HMO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060004-00","Standard Bronze Off Exchange Plan",,"0.618949711322784","Yes","Yes","No","100%",,"$3,500","$0","$400","$200","$3,500","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","40%",,,,,"$7,000","$7000 per person","$10500 per group","$7,000","$7000 per person","$10500 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/sg_ia_simplicity_3500_HDHP.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","4"
"2016","IA","85930","SERFF","2","2015-08-27 03:52:03","2","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060004","Sanford Simplicity $3,500","85930IA006",,"IAN001","IAS001","IAF004","New","HMO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060004-01","Standard Bronze On Exchange Plan",,"0.618949711322784","Yes","Yes","No","100%",,"$3,500","$0","$400","$200","$3,500","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","40%",,,,,"$7,000","$7000 per person","$10500 per group","$7,000","$7000 per person","$10500 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/sg_ia_simplicity_3500_HDHP.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","5"
"2016","IA","85930","SERFF","2","2015-08-27 03:52:03","3","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060001","Sanford Simplicity $500","85930IA006",,"IAN001","IAS001","IAF006","Existing","HMO","Platinum","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060001-00","Standard Platinum Off Exchange Plan",,"0.899335086345673","No","Yes","No","100%",,"$500","$0","$500","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/sg_ia_simplicity_500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","4"
"2016","IA","85930","SERFF","2","2015-08-27 03:52:03","3","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060001","Sanford Simplicity $500","85930IA006",,"IAN001","IAS001","IAF006","Existing","HMO","Platinum","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060001-01","Standard Platinum On Exchange Plan",,"0.899335086345673","No","Yes","No","100%",,"$500","$0","$500","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/sg_ia_simplicity_500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","5"
"2016","IA","85930","SERFF","2","2015-08-27 03:52:03","3","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060002","Sanford Simplicity $1,500","85930IA006",,"IAN001","IAS001","IAF001","Existing","HMO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060002-00","Standard Gold Off Exchange Plan",,"0.800386011600494","No","Yes","No","100%",,"$1,500","$30","$600","$200","$400","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/sg_ia_simplicity_1500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","6"
"2016","IA","85930","SERFF","2","2015-08-27 03:52:03","3","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060002","Sanford Simplicity $1,500","85930IA006",,"IAN001","IAS001","IAF001","Existing","HMO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060002-01","Standard Gold On Exchange Plan",,"0.800386011600494","No","Yes","No","100%",,"$1,500","$30","$600","$200","$400","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/sg_ia_simplicity_1500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","7"
"2016","IA","85930","SERFF","2","2015-08-27 03:52:03","3","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060003","Sanford Simplicity $2,000","85930IA006",,"IAN001","IAS001","IAF002","Existing","HMO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060003-00","Standard Silver Off Exchange Plan",,"0.718453586101532","No","Yes","No","100%",,"$2,000","$30","$1,000","$200","$400","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,000","$10000 per person","$16000 per group","$10,000","$10000 per person","$16000 per group","$2,000","$2000 per person","$4000 per group","40%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/sg_ia_simplicity_2000.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","8"
"2016","IA","85930","SERFF","2","2015-08-27 03:52:03","3","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060003","Sanford Simplicity $2,000","85930IA006",,"IAN001","IAS001","IAF002","Existing","HMO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060003-01","Standard Silver On Exchange Plan",,"0.718453586101532","No","Yes","No","100%",,"$2,000","$30","$1,000","$200","$400","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,000","$10000 per person","$16000 per group","$10,000","$10000 per person","$16000 per group","$2,000","$2000 per person","$4000 per group","40%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/sg_ia_simplicity_2000.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","9"
"2016","IA","85930","SERFF","2","2015-08-27 03:52:03","3","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060007","Sanford Simplicity $1,000","85930IA006",,"IAN001","IAS001","IAF005","Existing","HMO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060007-00","Standard Gold Off Exchange Plan",,"0.814424216747284","No","Yes","No","100%",,"$1,000","$20","$700","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/sg_ia_simplicity_1000.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","10"
"2016","IA","85930","SERFF","2","2015-08-27 03:52:03","3","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060007","Sanford Simplicity $1,000","85930IA006",,"IAN001","IAS001","IAF005","Existing","HMO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060007-01","Standard Gold On Exchange Plan",,"0.814424216747284","No","Yes","No","100%",,"$1,000","$20","$700","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/sg_ia_simplicity_1000.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","11"
"2016","IA","85930","SERFF","2","2015-08-27 03:52:03","4","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060006","Sanford Simplicity $2,500","85930IA006",,"IAN001","IAS001","IAF005","Existing","HMO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060006-00","Standard Silver Off Exchange Plan",,"0.717057228088379","No","Yes","No","100%",,"$2,500","$20","$600","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6000 per person","$13200 per group",,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/sg_ia_simplicity_2500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","4"
"2016","IA","85930","SERFF","2","2015-08-27 03:52:03","4","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060006","Sanford Simplicity $2,500","85930IA006",,"IAN001","IAS001","IAF005","Existing","HMO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060006-01","Standard Silver On Exchange Plan",,"0.717057228088379","No","Yes","No","100%",,"$2,500","$20","$600","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6000 per person","$13200 per group",,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/sg_ia_simplicity_2500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","5"
"2016","IA","85930","SERFF","2","2015-08-27 03:52:03","5","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060008","Sanford Simplicity $2,000 HDHP","85930IA006",,"IAN001","IAS001","IAF007","New","HMO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060008-00","Standard Silver Off Exchange Plan",,"0.718817114830017","Yes","Yes","No","100%",,"$2,000","$0","$700","$200","$2,000","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/sg_ia_simplicity_2000_HDHP.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","4"
"2016","IA","85930","SERFF","2","2015-08-27 03:52:03","5","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060008","Sanford Simplicity $2,000 HDHP","85930IA006",,"IAN001","IAS001","IAF007","New","HMO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","85930IA0060008-01","Standard Silver On Exchange Plan",,"0.718817114830017","Yes","Yes","No","100%",,"$2,000","$0","$700","$200","$2,000","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/IA/sg_ia_simplicity_2000_HDHP.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","5"
"2016","IA","88678","SERFF","6","2015-08-30 09:33:32","1","88678","IA","SHOP (Small Group)","No","36-2739571","88678IA0010147","Silver Choice Plus HSA 3500-3","88678IA001",,"IAN002","IAS001","IAF011","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=ia0002&st=ia","88678IA0010147-00","Standard Silver Off Exchange Plan","71.88%",,"Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$50.00","http://www.uhc.com/shop/doc?id=ia0005&st=ia",,"13"
"2016","IA","88678","SERFF","6","2015-08-30 09:33:32","1","88678","IA","SHOP (Small Group)","No","36-2739571","88678IA0010147","Silver Choice Plus HSA 3500-3","88678IA001",,"IAN002","IAS001","IAF011","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=ia0002&st=ia","88678IA0010147-01","Standard Silver On Exchange Plan","71.88%",,"Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$50.00","http://www.uhc.com/shop/doc?id=ia0005&st=ia",,"14"
"2016","IA","88678","SERFF","6","2015-08-30 09:33:32","5","88678","IA","SHOP (Small Group)","No","36-2739571","88678IA0010058","Silver Choice Plus 3500 -2","88678IA001",,"IAN002","IAS001","IAF006","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=ia0002&st=ia","88678IA0010058-00","Standard Silver Off Exchange Plan","71.69%",,"No","Yes","No","100%",,"$3,500","$20","$600","$200","$600","$1,700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=ia0004&st=ia",,"21"
"2016","IA","88678","SERFF","6","2015-08-30 09:33:32","5","88678","IA","SHOP (Small Group)","No","36-2739571","88678IA0010058","Silver Choice Plus 3500 -2","88678IA001",,"IAN002","IAS001","IAF006","Existing","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=ia0002&st=ia","88678IA0010058-01","Standard Silver On Exchange Plan","71.69%",,"No","Yes","No","100%",,"$3,500","$20","$600","$200","$600","$1,700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=ia0004&st=ia",,"22"
"2016","IA","88678","SERFF","6","2015-08-30 09:33:32","6","88678","IA","SHOP (Small Group)","No","36-2739571","88678IA0030005","Silver Navigate 3000","88678IA003",,"IAN001","IAS001","IAF007","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=ia0002&st=ia","88678IA0030005-00","Standard Silver Off Exchange Plan","70.20%",,"No","Yes","No","100%",,"$3,000","$20","$700","$200","$300","$1,800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=ia0001&st=ia",,"8"
"2016","IA","88678","SERFF","6","2015-08-30 09:33:32","6","88678","IA","SHOP (Small Group)","No","36-2739571","88678IA0030005","Silver Navigate 3000","88678IA003",,"IAN001","IAS001","IAF007","Existing","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=ia0002&st=ia","88678IA0030005-01","Standard Silver On Exchange Plan","70.20%",,"No","Yes","No","100%",,"$3,000","$20","$700","$200","$300","$1,800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=ia0001&st=ia",,"9"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","1","93078","IA","Individual","No","41-1490988","93078IA0010019","Medica Insure Gold Copay Plus","93078IA001",,"IAN001","IAS001","IAF003","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010019-03","Limited Cost Sharing Plan Variation",,"0.786018192768097","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGPCIAL&uid=FFM",,"15"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","1","93078","IA","Individual","No","41-1490988","93078IA0010007","Medica Insure Gold H S A","93078IA001",,"IAN001","IAS001","IAF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010007-00","Standard Gold Off Exchange Plan",,"0.790350794792175","Yes","Yes","No","100%",,"$1,300","$0","$1,200","$1,000","$1,300","$0","$1,200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7050 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGHIA&uid=FFM",,"16"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","1","93078","IA","Individual","No","41-1490988","93078IA0010007","Medica Insure Gold H S A","93078IA001",,"IAN001","IAS001","IAF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010007-01","Standard Gold On Exchange Plan",,"0.790350794792175","Yes","Yes","No","100%",,"$1,300","$0","$1,200","$1,000","$1,300","$0","$1,200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7050 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGHIA&uid=FFM",,"17"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","1","93078","IA","Individual","No","41-1490988","93078IA0010007","Medica Insure Gold H S A","93078IA001",,"IAN001","IAS001","IAF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGHIAZ&uid=FFM",,"18"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","1","93078","IA","Individual","No","41-1490988","93078IA0010007","Medica Insure Gold H S A","93078IA001",,"IAN001","IAS001","IAF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010007-03","Limited Cost Sharing Plan Variation",,"0.790350794792175","Yes","Yes","No","100%",,"$1,300","$0","$1,200","$1,000","$1,300","$0","$1,200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7050 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGHIAL&uid=FFM",,"19"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","2","93078","IA","Individual","No","41-1490988","93078IA0010003","Medica Insure Silver Copay","93078IA001",,"IAN001","IAS001","IAF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010003-00","Standard Silver Off Exchange Plan",,"0.699446320533752","Yes","Yes","No","100%",,"$2,600","$20","$1,100","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISCIA&uid=FFM",,"4"
"2016","IA","89617","SERFF","1","2015-08-20 12:28:36","1","89617","IA","SHOP (Small Group)","Yes","42-0127290","89617IA0040001","Principal Plan Dental 70","89617IA004",,"IAN001","IAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$28.02","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","89617IA0040001-00","Standard Low Off Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IA","89617","SERFF","1","2015-08-20 12:28:36","1","89617","IA","SHOP (Small Group)","Yes","42-0127290","89617IA0040002","Principal Plan Dental 85","89617IA004",,"IAN001","IAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$29.61","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","89617IA0040002-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","1","93078","IA","Individual","No","41-1490988","93078IA0010001","Medica Insure Gold Copay","93078IA001",,"IAN001","IAS001","IAF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010001-00","Standard Gold Off Exchange Plan",,"0.795177459716797","Yes","Yes","No","100%",,"$300","$20","$1,500","$1,000","$300","$600","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGCIA&uid=FFM",,"4"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","1","93078","IA","Individual","No","41-1490988","93078IA0010001","Medica Insure Gold Copay","93078IA001",,"IAN001","IAS001","IAF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010001-03","Limited Cost Sharing Plan Variation",,"0.795177459716797","Yes","Yes","No","100%",,"$300","$20","$1,500","$1,000","$300","$600","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGCIAL&uid=FFM",,"7"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","1","93078","IA","Individual","No","41-1490988","93078IA0010017","Medica Insure Gold Copay 100","93078IA001",,"IAN001","IAS001","IAF002","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010017-00","Standard Gold Off Exchange Plan",,"0.818332970142365","Yes","Yes","No","100%",,"$2,400","$0","$0","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IG100CIA&uid=FFM",,"8"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","1","93078","IA","Individual","No","41-1490988","93078IA0010017","Medica Insure Gold Copay 100","93078IA001",,"IAN001","IAS001","IAF002","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010017-01","Standard Gold On Exchange Plan",,"0.818332970142365","Yes","Yes","No","100%",,"$2,400","$0","$0","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IG100CIA&uid=FFM",,"9"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","1","93078","IA","Individual","No","41-1490988","93078IA0010017","Medica Insure Gold Copay 100","93078IA001",,"IAN001","IAS001","IAF002","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IG100CIAZ&uid=FFM",,"10"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","1","93078","IA","Individual","No","41-1490988","93078IA0010017","Medica Insure Gold Copay 100","93078IA001",,"IAN001","IAS001","IAF002","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010017-03","Limited Cost Sharing Plan Variation",,"0.818332970142365","Yes","Yes","No","100%",,"$2,400","$0","$0","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IG100CIAL&uid=FFM",,"11"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","1","93078","IA","Individual","No","41-1490988","93078IA0010019","Medica Insure Gold Copay Plus","93078IA001",,"IAN001","IAS001","IAF003","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010019-00","Standard Gold Off Exchange Plan",,"0.786018192768097","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGPCIA&uid=FFM",,"12"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","1","93078","IA","Individual","No","41-1490988","93078IA0010019","Medica Insure Gold Copay Plus","93078IA001",,"IAN001","IAS001","IAF003","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010019-01","Standard Gold On Exchange Plan",,"0.786018192768097","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGPCIA&uid=FFM",,"13"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","1","93078","IA","Individual","No","41-1490988","93078IA0010019","Medica Insure Gold Copay Plus","93078IA001",,"IAN001","IAS001","IAF003","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGPCIAZ&uid=FFM",,"14"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","2","93078","IA","Individual","No","41-1490988","93078IA0010003","Medica Insure Silver Copay","93078IA001",,"IAN001","IAS001","IAF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010003-01","Standard Silver On Exchange Plan",,"0.699446320533752","Yes","Yes","No","100%",,"$2,600","$20","$1,100","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISCIA&uid=FFM",,"5"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","2","93078","IA","Individual","No","41-1490988","93078IA0010003","Medica Insure Silver Copay","93078IA001",,"IAN001","IAS001","IAF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISCIAZ&uid=FFM",,"6"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","2","93078","IA","Individual","No","41-1490988","93078IA0010003","Medica Insure Silver Copay","93078IA001",,"IAN001","IAS001","IAF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010003-03","Limited Cost Sharing Plan Variation",,"0.699446320533752","Yes","Yes","No","100%",,"$2,600","$20","$1,100","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISCIAL&uid=FFM",,"7"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","2","93078","IA","Individual","No","41-1490988","93078IA0010003","Medica Insure Silver Copay","93078IA001",,"IAN001","IAS001","IAF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010003-04","73% AV Level Silver Plan",,"0.732776403427124","Yes","Yes","No","100%",,"$2,400","$20","$900","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISCIA73&uid=FFM",,"8"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","2","93078","IA","Individual","No","41-1490988","93078IA0010003","Medica Insure Silver Copay","93078IA001",,"IAN001","IAS001","IAF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010003-05","87% AV Level Silver Plan",,"0.87339198589325","Yes","Yes","No","100%",,"$400","$20","$1,000","$1,000","$400","$600","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","per person not applicable","$1200 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISCIA87&uid=FFM",,"9"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","2","93078","IA","Individual","No","41-1490988","93078IA0010003","Medica Insure Silver Copay","93078IA001",,"IAN001","IAS001","IAF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010003-06","94% AV Level Silver Plan",,"0.945424914360046","Yes","Yes","No","100%",,"$50","$20","$300","$1,000","$50","$600","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","$150 per group","5%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISCIA94&uid=FFM",,"10"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","2","93078","IA","Individual","No","41-1490988","93078IA0010021","Medica Insure Silver Copay Plus","93078IA001",,"IAN001","IAS001","IAF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010021-00","Standard Silver Off Exchange Plan",,"0.686831414699554","Yes","Yes","No","100%",,"$2,500","$800","$400","$1,000","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","35%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISPCIA&uid=FFM",,"11"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","2","93078","IA","Individual","No","41-1490988","93078IA0010021","Medica Insure Silver Copay Plus","93078IA001",,"IAN001","IAS001","IAF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010021-01","Standard Silver On Exchange Plan",,"0.686831414699554","Yes","Yes","No","100%",,"$2,500","$800","$400","$1,000","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","35%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISPCIA&uid=FFM",,"12"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","2","93078","IA","Individual","No","41-1490988","93078IA0010021","Medica Insure Silver Copay Plus","93078IA001",,"IAN001","IAS001","IAF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISPCIAZ&uid=FFM",,"13"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","2","93078","IA","Individual","No","41-1490988","93078IA0010021","Medica Insure Silver Copay Plus","93078IA001",,"IAN001","IAS001","IAF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010021-03","Limited Cost Sharing Plan Variation",,"0.686831414699554","Yes","Yes","No","100%",,"$2,500","$800","$400","$1,000","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","35%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISPCIAL&uid=FFM",,"14"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","2","93078","IA","Individual","No","41-1490988","93078IA0010021","Medica Insure Silver Copay Plus","93078IA001",,"IAN001","IAS001","IAF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010021-04","73% AV Level Silver Plan",,"0.722007930278778","Yes","Yes","No","100%",,"$1,500","$800","$400","$1,000","$1,500","$900","$30","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$4500 per group","35%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISPCIA73&uid=FFM",,"15"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","2","93078","IA","Individual","No","41-1490988","93078IA0010021","Medica Insure Silver Copay Plus","93078IA001",,"IAN001","IAS001","IAF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010021-05","87% AV Level Silver Plan",,"0.867308914661407","Yes","Yes","No","100%",,"$100","$700","$200","$1,000","$100","$700","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$300 per group","15%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISPCIA87&uid=FFM",,"16"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","2","93078","IA","Individual","No","41-1490988","93078IA0010021","Medica Insure Silver Copay Plus","93078IA001",,"IAN001","IAS001","IAF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010021-06","94% AV Level Silver Plan",,"0.932673752307892","Yes","Yes","No","100%",,"$0","$700","$50","$1,000","$0","$700","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","5%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISPCIA94&uid=FFM",,"17"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","2","93078","IA","Individual","No","41-1490988","93078IA0010009","Medica Insure Silver H S A","93078IA001",,"IAN001","IAS001","IAF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010009-00","Standard Silver Off Exchange Plan",,"0.697753369808197","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISHIA&uid=FFM",,"18"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","2","93078","IA","Individual","No","41-1490988","93078IA0010009","Medica Insure Silver H S A","93078IA001",,"IAN001","IAS001","IAF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010009-01","Standard Silver On Exchange Plan",,"0.697753369808197","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISHIA&uid=FFM",,"19"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","2","93078","IA","Individual","No","41-1490988","93078IA0010009","Medica Insure Silver H S A","93078IA001",,"IAN001","IAS001","IAF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISHIAZ&uid=FFM",,"20"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","2","93078","IA","Individual","No","41-1490988","93078IA0010009","Medica Insure Silver H S A","93078IA001",,"IAN001","IAS001","IAF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010009-03","Limited Cost Sharing Plan Variation",,"0.697753369808197","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISHIAL&uid=FFM",,"21"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","2","93078","IA","Individual","No","41-1490988","93078IA0010009","Medica Insure Silver H S A","93078IA001",,"IAN001","IAS001","IAF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010009-04","73% AV Level Silver Plan",,"0.736685276031494","Yes","Yes","No","100%",,"$1,050","$0","$1,300","$1,000","$1,050","$0","$1,300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","per person not applicable","$3150 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISHIA73&uid=FFM",,"22"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","2","93078","IA","Individual","No","41-1490988","93078IA0010009","Medica Insure Silver H S A","93078IA001",,"IAN001","IAS001","IAF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010009-05","87% AV Level Silver Plan",,"0.870106041431427","Yes","Yes","No","100%",,"$250","$0","$1,000","$1,000","$250","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","per person not applicable","$750 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISHIA87&uid=FFM",,"23"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","2","93078","IA","Individual","No","41-1490988","93078IA0010009","Medica Insure Silver H S A","93078IA001",,"IAN001","IAS001","IAF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010009-06","94% AV Level Silver Plan",,"0.939850509166718","Yes","Yes","No","100%",,"$150","$0","$300","$1,000","$150","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","per person not applicable","$450 per group","5%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISHIA94&uid=FFM",,"24"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","3","93078","IA","Individual","No","41-1490988","93078IA0010005","Medica Insure Bronze Copay","93078IA001",,"IAN001","IAS001","IAF008","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010005-00","Standard Bronze Off Exchange Plan",,"0.617384314537048","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBCIA&uid=FFM",,"4"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","3","93078","IA","Individual","No","41-1490988","93078IA0010005","Medica Insure Bronze Copay","93078IA001",,"IAN001","IAS001","IAF008","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010005-01","Standard Bronze On Exchange Plan",,"0.617384314537048","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBCIA&uid=FFM",,"5"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","3","93078","IA","Individual","No","41-1490988","93078IA0010005","Medica Insure Bronze Copay","93078IA001",,"IAN001","IAS001","IAF008","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBCIAZ&uid=FFM",,"6"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","3","93078","IA","Individual","No","41-1490988","93078IA0010005","Medica Insure Bronze Copay","93078IA001",,"IAN001","IAS001","IAF008","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010005-03","Limited Cost Sharing Plan Variation",,"0.617384314537048","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBCIAL&uid=FFM",,"7"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","3","93078","IA","Individual","No","41-1490988","93078IA0010011","Medica Insure Bronze H S A","93078IA001",,"IAN001","IAS001","IAF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010011-00","Standard Bronze Off Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","per person not applicable","$12700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBHIA&uid=FFM",,"8"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","3","93078","IA","Individual","No","41-1490988","93078IA0010011","Medica Insure Bronze H S A","93078IA001",,"IAN001","IAS001","IAF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010011-01","Standard Bronze On Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","per person not applicable","$12700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBHIA&uid=FFM",,"9"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","3","93078","IA","Individual","No","41-1490988","93078IA0010011","Medica Insure Bronze H S A","93078IA001",,"IAN001","IAS001","IAF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBHIAZ&uid=FFM",,"10"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","3","93078","IA","Individual","No","41-1490988","93078IA0010011","Medica Insure Bronze H S A","93078IA001",,"IAN001","IAS001","IAF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010011-03","Limited Cost Sharing Plan Variation",,"0.607437193393707","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","per person not applicable","$12700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBHIAL&uid=FFM",,"11"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","4","93078","IA","Individual","No","41-1490988","93078IA0010013","Medica Insure Catastrophic","93078IA001",,"IAN001","IAS001","IAF010","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010013-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICIA&uid=FFM",,"4"
"2016","IA","93078","SERFF","8","2016-03-31 13:35:32","4","93078","IA","Individual","No","41-1490988","93078IA0010013","Medica Insure Catastrophic","93078IA001",,"IAN001","IAS001","IAF010","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefit","Yes",,"http://www.medica.com/ifbpharmacy","93078IA0010013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICIA&uid=FFM",,"5"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","2","16724","IL","Individual","No","43-1361847","16724IL0010002","Bronze Compass HSA 5500","16724IL001",,"ILN001","ILS001","ILF008","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010002-01","Standard Bronze On Exchange Plan",,"0.618041276931763","Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=il0035&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","5"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","2","16724","IL","Individual","No","43-1361847","16724IL0010002","Bronze Compass HSA 5500","16724IL001",,"ILN001","ILS001","ILF008","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=il0087&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","6"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","2","16724","IL","Individual","No","43-1361847","16724IL0010002","Bronze Compass HSA 5500","16724IL001",,"ILN001","ILS001","ILF008","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010002-03","Limited Cost Sharing Plan Variation",,"0.618041276931763","Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=il0036&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","7"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","1","16724","IL","Individual","No","43-1361847","16724IL0010008","Silver Compass HSA 3000","16724IL001",,"ILN001","ILS001","ILF005","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010008-00","Standard Silver Off Exchange Plan",,"0.708311021327972","Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=il0010&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","4"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","1","16724","IL","Individual","No","43-1361847","16724IL0010008","Silver Compass HSA 3000","16724IL001",,"ILN001","ILS001","ILF005","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010008-01","Standard Silver On Exchange Plan",,"0.708311021327972","Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=il0010&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","5"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","1","16724","IL","Individual","No","43-1361847","16724IL0010008","Silver Compass HSA 3000","16724IL001",,"ILN001","ILS001","ILF005","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=il0082&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","6"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","1","16724","IL","Individual","No","43-1361847","16724IL0010008","Silver Compass HSA 3000","16724IL001",,"ILN001","ILS001","ILF005","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010008-03","Limited Cost Sharing Plan Variation",,"0.708311021327972","Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=il0011&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","7"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","1","16724","IL","Individual","No","43-1361847","16724IL0010008","Silver Compass HSA 3000","16724IL001",,"ILN001","ILS001","ILF005","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010008-04","73% AV Level Silver Plan",,"0.737914025783539","Yes","Yes","No","100%",,"$2,500","$10","$0","$200","$2,500","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=il0012&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","8"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","1","16724","IL","Individual","No","43-1361847","16724IL0010008","Silver Compass HSA 3000","16724IL001",,"ILN001","ILS001","ILF005","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010008-05","87% AV Level Silver Plan",,"0.877197504043579","Yes","Yes","No","100%",,"$800","$10","$0","$200","$800","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=il0013&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","9"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","1","16724","IL","Individual","No","43-1361847","16724IL0010008","Silver Compass HSA 3000","16724IL001",,"ILN001","ILS001","ILF005","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010008-06","94% AV Level Silver Plan",,"0.942080080509186","Yes","Yes","No","100%",,"$200","$10","$0","$200","$200","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=il0014&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","10"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","2","16724","IL","Individual","No","43-1361847","16724IL0010002","Bronze Compass HSA 5500","16724IL001",,"ILN001","ILS001","ILF008","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010002-00","Standard Bronze Off Exchange Plan",,"0.618041276931763","Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=il0035&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","4"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010003","Gold Compass 1000","16724IL001",,"ILN001","ILS001","ILF001","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010003-00","Standard Gold Off Exchange Plan","78.10%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0003&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","8"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010003","Gold Compass 1000","16724IL001",,"ILN001","ILS001","ILF001","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010003-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0003&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","9"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010003","Gold Compass 1000","16724IL001",,"ILN001","ILS001","ILF001","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0080&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","10"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010003","Gold Compass 1000","16724IL001",,"ILN001","ILS001","ILF001","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010003-03","Limited Cost Sharing Plan Variation","78.10%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0004&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","11"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010004","Gold Compass 500","16724IL001",,"ILN001","ILS001","ILF002","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010004-00","Standard Gold Off Exchange Plan","78.30%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0005&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","12"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010004","Gold Compass 500","16724IL001",,"ILN001","ILS001","ILF002","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010004-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0005&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","13"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010004","Gold Compass 500","16724IL001",,"ILN001","ILS001","ILF002","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0081&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","14"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010004","Gold Compass 500","16724IL001",,"ILN001","ILS001","ILF002","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010004-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0006&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","15"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010009","Gold Compass 0","16724IL001",,"ILN001","ILS001","ILF003","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010009-00","Standard Gold Off Exchange Plan","79.10%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0007&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","16"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010009","Gold Compass 0","16724IL001",,"ILN001","ILS001","ILF003","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010009-01","Standard Gold On Exchange Plan","79.10%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0007&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","17"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010009","Gold Compass 0","16724IL001",,"ILN001","ILS001","ILF003","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010009-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0008&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","18"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010009","Gold Compass 0","16724IL001",,"ILN001","ILS001","ILF003","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010009-03","Limited Cost Sharing Plan Variation","79.10%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0009&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","19"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010011","Silver Compass 2000 1","16724IL001",,"ILN001","ILS001","ILF006","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010011-00","Standard Silver Off Exchange Plan","70.80%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=il0015&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","20"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010011","Silver Compass 2000 1","16724IL001",,"ILN001","ILS001","ILF006","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010011-01","Standard Silver On Exchange Plan","70.80%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=il0015&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","21"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010011","Silver Compass 2000 1","16724IL001",,"ILN001","ILS001","ILF006","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010011-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=il0083&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","22"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010011","Silver Compass 2000 1","16724IL001",,"ILN001","ILS001","ILF006","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010011-03","Limited Cost Sharing Plan Variation","70.80%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=il0016&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","23"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010011","Silver Compass 2000 1","16724IL001",,"ILN001","ILS001","ILF006","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010011-04","73% AV Level Silver Plan","72.90%",,"Yes","Yes","No","100%",,"$1,800","$1,500","$0","$200","$1,800","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=il0017&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","24"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010011","Silver Compass 2000 1","16724IL001",,"ILN001","ILS001","ILF006","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010011-05","87% AV Level Silver Plan","86.20%",,"Yes","Yes","No","100%",,"$500","$800","$0","$200","$500","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=il0018&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","25"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010011","Silver Compass 2000 1","16724IL001",,"ILN001","ILS001","ILF006","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010011-06","94% AV Level Silver Plan","93.10%",,"Yes","Yes","No","100%",,"$200","$500","$0","$200","$200","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=il0019&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","26"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010007","Silver Compass 2000","16724IL001",,"ILN001","ILS001","ILF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010007-00","Standard Silver Off Exchange Plan","69.30%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0020&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","27"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010007","Silver Compass 2000","16724IL001",,"ILN001","ILS001","ILF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010007-01","Standard Silver On Exchange Plan","69.30%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0020&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","28"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010007","Silver Compass 2000","16724IL001",,"ILN001","ILS001","ILF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0084&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","29"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010007","Silver Compass 2000","16724IL001",,"ILN001","ILS001","ILF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010007-03","Limited Cost Sharing Plan Variation","69.30%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0021&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","30"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010007","Silver Compass 2000","16724IL001",,"ILN001","ILS001","ILF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010007-04","73% AV Level Silver Plan","73.40%",,"No","Yes","No","100%",,"$1,200","$20","$1,500","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0022&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","31"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010007","Silver Compass 2000","16724IL001",,"ILN001","ILS001","ILF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010007-05","87% AV Level Silver Plan","87.90%",,"No","Yes","No","100%",,"$200","$10","$600","$200","$200","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0023&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","32"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010007","Silver Compass 2000","16724IL001",,"ILN001","ILS001","ILF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010007-06","94% AV Level Silver Plan","93.90%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0024&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","33"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010010","Silver Compass 3500","16724IL001",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010010-00","Standard Silver Off Exchange Plan","68.00%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0025&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","34"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010010","Silver Compass 3500","16724IL001",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010010-01","Standard Silver On Exchange Plan","68.00%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0025&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","35"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010010","Silver Compass 3500","16724IL001",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010010-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0085&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","36"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010010","Silver Compass 3500","16724IL001",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010010-03","Limited Cost Sharing Plan Variation","68.00%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0026&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","37"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010010","Silver Compass 3500","16724IL001",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010010-04","73% AV Level Silver Plan","72.50%",,"No","Yes","No","100%",,"$2,500","$10","$800","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0027&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","38"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010010","Silver Compass 3500","16724IL001",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010010-05","87% AV Level Silver Plan","87.90%",,"No","Yes","No","100%",,"$200","$10","$600","$200","$200","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0028&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","39"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","3","16724","IL","Individual","No","43-1361847","16724IL0010010","Silver Compass 3500","16724IL001",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010010-06","94% AV Level Silver Plan","93.90%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0029&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","40"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","4","16724","IL","Individual","No","43-1361847","16724IL0010006","Silver Compass 4500","16724IL001",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010006-00","Standard Silver Off Exchange Plan","68.30%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0030&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","4"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","4","16724","IL","Individual","No","43-1361847","16724IL0010006","Silver Compass 4500","16724IL001",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010006-01","Standard Silver On Exchange Plan","68.30%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0030&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","5"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","4","16724","IL","Individual","No","43-1361847","16724IL0010006","Silver Compass 4500","16724IL001",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010006-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0086&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","6"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","4","16724","IL","Individual","No","43-1361847","16724IL0010006","Silver Compass 4500","16724IL001",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010006-03","Limited Cost Sharing Plan Variation","68.30%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0031&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","7"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","4","16724","IL","Individual","No","43-1361847","16724IL0010006","Silver Compass 4500","16724IL001",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010006-04","73% AV Level Silver Plan","72.50%",,"No","Yes","No","100%",,"$3,200","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0032&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","8"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","4","16724","IL","Individual","No","43-1361847","16724IL0010006","Silver Compass 4500","16724IL001",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010006-05","87% AV Level Silver Plan","86.10%",,"No","Yes","No","100%",,"$600","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0033&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","9"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","4","16724","IL","Individual","No","43-1361847","16724IL0010006","Silver Compass 4500","16724IL001",,"ILN001","ILS001","ILF004","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010006-06","94% AV Level Silver Plan","93.30%",,"No","Yes","No","100%",,"$100","$10","$0","$200","$100","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=il0034&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","10"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","4","16724","IL","Individual","No","43-1361847","16724IL0010001","Bronze Compass 6500","16724IL001",,"ILN001","ILS001","ILF008","Existing","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010001-00","Standard Bronze Off Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=il0037&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","11"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","4","16724","IL","Individual","No","43-1361847","16724IL0010001","Bronze Compass 6500","16724IL001",,"ILN001","ILS001","ILF008","Existing","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010001-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=il0037&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","12"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","4","16724","IL","Individual","No","43-1361847","16724IL0010001","Bronze Compass 6500","16724IL001",,"ILN001","ILS001","ILF008","Existing","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=il0088&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","13"
"2016","IL","16724","SERFF","6","2015-08-27 03:52:03","4","16724","IL","Individual","No","43-1361847","16724IL0010001","Bronze Compass 6500","16724IL001",,"ILN001","ILS001","ILF008","Existing","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=il0040&st=il","16724IL0010001-03","Limited Cost Sharing Plan Variation","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=il0038&st=il","http://www.uhc.com/iex/doc?id=il0039&st=il","14"
"2016","IL","17522","SERFF","9","2015-08-28 13:59:00","1","17522","IL","SHOP (Small Group)","Yes","47-0322111","17522IL0010001","Certified Dental Plan 1","17522IL001",,"ILN001","ILS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.97","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","17522IL0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IL","17522","SERFF","9","2015-08-28 13:59:00","1","17522","IL","SHOP (Small Group)","Yes","47-0322111","17522IL0010002","Certified Dental Plan 2","17522IL001",,"ILN001","ILS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.07","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","17522IL0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IL","17522","SERFF","9","2015-08-28 13:59:00","1","17522","IL","SHOP (Small Group)","Yes","47-0322111","17522IL0010003","Certified Dental Plan 3","17522IL001",,"ILN001","ILS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.91","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","17522IL0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","IL","17522","SERFF","9","2015-08-28 13:59:00","1","17522","IL","SHOP (Small Group)","Yes","47-0322111","17522IL0010004","Certified Dental Plan 4","17522IL001",,"ILN001","ILS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.29","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","17522IL0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","per person not applicable","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","IL","18715","SERFF","5","2015-08-27 03:52:03","1","18715","IL","Individual","Yes","75-1233841","18715IL0010010","Dentegra Dental PPO Pediatric Basic Plan","18715IL001",,"ILN001","ILS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","18715IL0010010-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"65","per person not applicable","per group not applicable",,,,,,"65","per person not applicable","per group not applicable","65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/il/18715il0010010-16","4"
"2016","IL","18715","SERFF","5","2015-08-27 03:52:03","1","18715","IL","SHOP (Small Group)","Yes","75-1233841","18715IL0020010","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","18715IL002",,"ILN001","ILS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.58","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","18715IL0020010-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/il/18715il0010010-16","4"
"2016","IL","18715","SERFF","5","2015-08-27 03:52:03","2","18715","IL","SHOP (Small Group)","Yes","75-1233841","18715IL0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","18715IL002",,"ILN001","ILS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.09","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","18715IL0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/il/18715il0020004-16","4"
"2016","IL","18715","SERFF","5","2015-08-27 03:52:03","2","18715","IL","Individual","Yes","75-1233841","18715IL0010004","Dentegra Dental PPO Family Preferred Plan","18715IL001",,"ILN001","ILS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.87","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","18715IL0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/il/18715il0010004-16","4"
"2016","IL","18715","SERFF","5","2015-08-27 03:52:03","2","18715","IL","Individual","Yes","75-1233841","18715IL0010004","Dentegra Dental PPO Family Preferred Plan","18715IL001",,"ILN001","ILS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.87","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","18715IL0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/il/18715il0010004-16","5"
"2016","IL","18715","SERFF","5","2015-08-27 03:52:03","2","18715","IL","SHOP (Small Group)","Yes","75-1233841","18715IL0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","18715IL002",,"ILN001","ILS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.09","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","18715IL0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/il/18715il0020004-16","5"
"2016","IL","18715","SERFF","5","2015-08-27 03:52:03","3","18715","IL","SHOP (Small Group)","Yes","75-1233841","18715IL0020009","Dentegra Dental PPO for Small Businesses Family Basic Plan","18715IL002",,"ILN001","ILS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.58","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","18715IL0020009-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/il/18715il0020009-16","4"
"2016","IL","18715","SERFF","5","2015-08-27 03:52:03","3","18715","IL","Individual","Yes","75-1233841","18715IL0010009","Dentegra Dental PPO Family Basic Plan","18715IL001",,"ILN001","ILS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","18715IL0010009-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/il/18715il0010009-16","4"
"2016","IL","18715","SERFF","5","2015-08-27 03:52:03","3","18715","IL","Individual","Yes","75-1233841","18715IL0010009","Dentegra Dental PPO Family Basic Plan","18715IL001",,"ILN001","ILS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","18715IL0010009-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/il/18715il0010009-16","5"
"2016","IL","18715","SERFF","5","2015-08-27 03:52:03","3","18715","IL","SHOP (Small Group)","Yes","75-1233841","18715IL0020009","Dentegra Dental PPO for Small Businesses Family Basic Plan","18715IL002",,"ILN001","ILS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.58","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","18715IL0020009-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/il/18715il0020009-16","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","1","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0320038","HMO 3250 Elite Network Bronze","20129IL032","7740283974","ILN001","ILS001","ILF003","New","HMO","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9901",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0320038-00","Standard Bronze Off Exchange Plan",,"0.619890987873077","Yes","Yes","No","100%",,"$3,250","$20","$1,400","$200","$3,250","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SBC_HMO_3250_EliteNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SOB_HMO_3250_EliteNetwork_Bronze.PDF","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","1","20129","IL","Individual","No","37-1260731","20129IL0300021","POS HSA 2100a Methodist Network Gold","20129IL030","7740283974","ILN002","ILS002","ILF020","New","POS","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0300021-00","Standard Gold Off Exchange Plan",,"0.799147665500641","Yes","Yes","No","100%",,"$2,100","$0","$0","$200","$2,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$8,400","$8400 per person","$16800 per group","$10,500","$10500 per person","$21000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0%",,,,,"$4,200","$4200 per person","$8400 per group","$6,300","$6300 per person","$12600 per group","Yes",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_POS_HSA_2100a_MethodistNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_POS_HSA_2100a_MethodistNetwork_Gold.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","1","20129","IL","Individual","No","37-1260731","20129IL0300021","POS HSA 2100a Methodist Network Gold","20129IL030","7740283974","ILN002","ILS002","ILF020","New","POS","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0300021-01","Standard Gold On Exchange Plan",,"0.799147665500641","Yes","Yes","No","100%",,"$2,100","$0","$0","$200","$2,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$8,400","$8400 per person","$16800 per group","$10,500","$10500 per person","$21000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0%",,,,,"$4,200","$4200 per person","$8400 per group","$6,300","$6300 per person","$12600 per group","Yes",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_HSA_2100a_MethodistNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_HSA_2100a_MethodistNetwork_Gold.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","1","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0320038","HMO 3250 Elite Network Bronze","20129IL032","7740283974","ILN001","ILS001","ILF003","New","HMO","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9901",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0320038-01","Standard Bronze On Exchange Plan",,"0.619890987873077","Yes","Yes","No","100%",,"$3,250","$20","$1,400","$200","$3,250","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SBC_HMO_3250_EliteNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SOB_HMO_3250_EliteNetwork_Bronze.PDF","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","1","20129","IL","Individual","No","37-1260731","20129IL0300021","POS HSA 2100a Methodist Network Gold","20129IL030","7740283974","ILN002","ILS002","ILF020","New","POS","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0300021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_HSA_2100a_MethodistNetwork_Gold_Indian-0PER-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_HSA_2100a_MethodistNetwork_Gold_Indian-0PER-CSR.pdf","6"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","1","20129","IL","Individual","No","37-1260731","20129IL0300021","POS HSA 2100a Methodist Network Gold","20129IL030","7740283974","ILN002","ILS002","ILF020","New","POS","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0300021-03","Limited Cost Sharing Plan Variation",,"0.799147665500641","Yes","Yes","No","100%",,"$2,100","$0","$0","$200","$2,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$8,400","$8400 per person","$16800 per group","$10,500","$10500 per person","$21000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0%",,,,,"$4,200","$4200 per person","$8400 per group","$6,300","$6300 per person","$12600 per group","Yes",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_HSA_2100a_MethodistNetwork_Gold_Indian-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_HSA_2100a_MethodistNetwork_Gold_Indian-CSR.pdf","7"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","2","20129","IL","Individual","No","37-1260731","20129IL0300013","POS HSA 2100a Elite Network Gold","20129IL030","7740283974","ILN001","ILS001","ILF020","Existing","POS","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994708680709333",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0300013-00","Standard Gold Off Exchange Plan",,"0.799147665500641","Yes","Yes","No","100%",,"$2,100","$0","$0","$200","$2,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$8,400","$8400 per person","$16800 per group","$10,500","$10500 per person","$21000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0%",,,,,"$4,200","$4200 per person","$8400 per group","$6,300","$6300 per person","$12600 per group","Yes",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_POS_HSA_2100a_EliteNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_POS_HSA_2100a_EliteNetwork_Gold.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","2","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310050","POS 3750c Elite Network Bronze","20129IL031","7740283974","ILN001","ILS001","ILF008","New","POS","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9907",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0310050-00","Standard Bronze Off Exchange Plan",,"0.612012326717377","Yes","Yes","No","100%",,"$3,750","$0","$1,000","$200","$3,750","$0","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$40500 per group","$20,250","$20250 per person","$54000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","45%",,,,,"$7,500","$7500 per person","$15000 per group","$11,250","$11250 per person","$22500 per group","No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SBC_POS_3750c_EliteNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SOB_POS_3750c_EliteNetwork_Bronze.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","2","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310050","POS 3750c Elite Network Bronze","20129IL031","7740283974","ILN001","ILS001","ILF008","New","POS","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9907",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0310050-01","Standard Bronze On Exchange Plan",,"0.612012326717377","Yes","Yes","No","100%",,"$3,750","$0","$1,000","$200","$3,750","$0","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$40500 per group","$20,250","$20250 per person","$54000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","45%",,,,,"$7,500","$7500 per person","$15000 per group","$11,250","$11250 per person","$22500 per group","No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_PUB_POS_3750c_EliteNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SOB_POS_3750c_EliteNetwork_Bronze.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","2","20129","IL","Individual","No","37-1260731","20129IL0300013","POS HSA 2100a Elite Network Gold","20129IL030","7740283974","ILN001","ILS001","ILF020","Existing","POS","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994708680709333",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0300013-01","Standard Gold On Exchange Plan",,"0.799147665500641","Yes","Yes","No","100%",,"$2,100","$0","$0","$200","$2,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$8,400","$8400 per person","$16800 per group","$10,500","$10500 per person","$21000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0%",,,,,"$4,200","$4200 per person","$8400 per group","$6,300","$6300 per person","$12600 per group","Yes",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_HSA_2100a_EliteNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_HSA_2100a_EliteNetwork_Gold.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","2","20129","IL","Individual","No","37-1260731","20129IL0300013","POS HSA 2100a Elite Network Gold","20129IL030","7740283974","ILN001","ILS001","ILF020","Existing","POS","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994708680709333",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0300013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_HSA_2100a_EliteNetwork_Gold_Indian-0PER-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_HSA_2100a_EliteNetwork_Gold_Indian-0PER-CSR.pdf","6"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","2","20129","IL","Individual","No","37-1260731","20129IL0300013","POS HSA 2100a Elite Network Gold","20129IL030","7740283974","ILN001","ILS001","ILF020","Existing","POS","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994708680709333",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0300013-03","Limited Cost Sharing Plan Variation",,"0.799147665500641","Yes","Yes","No","100%",,"$2,100","$0","$0","$200","$2,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$8,400","$8400 per person","$16800 per group","$10,500","$10500 per person","$21000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","0%",,,,,"$4,200","$4200 per person","$8400 per group","$6,300","$6300 per person","$12600 per group","Yes",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_HSA_2100a_EliteNetwork_Gold_Indian-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_HSA_2100a_EliteNetwork_Gold_Indian-CSR.pdf","7"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","3","20129","IL","Individual","No","37-1260731","20129IL0330026","HMO 3500 Elite Network Bronze","20129IL033","7740283974","ILN001","ILS001","ILF003","New","HMO","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.991786858242279",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330026-00","Standard Bronze Off Exchange Plan",,"0.618963301181793","Yes","Yes","No","100%",,"$3,500","$20","$1,100","$200","$3,500","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_HMO_3500_EliteNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_HMO_3500_EliteNetwork_Bronze.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","3","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0350027","PPO 3250b Elite Network Gold","20129IL035","7740283974","ILN001","ILS001","ILF017","New","PPO","Gold","No","Both","No","No",,"Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9938",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0350027-00","Standard Gold Off Exchange Plan",,"0.787434160709381","No","Yes","No","100%",,"$3,250","$10","$0","$200","$1,700","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"$12,000","$12000 per person","$24000 per group","$15,250","$15250 per person","$30500 per group","$3,250","$3250 per person","$6500 per group","0%",,,,,"$6,500","$6500 per person","$19500 per group","$9,750","$9750 per person","$26000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SBC_PPO_3250b_EliteNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SOB_PPO_3250b_EliteNetwork_Gold.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","3","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0350027","PPO 3250b Elite Network Gold","20129IL035","7740283974","ILN001","ILS001","ILF017","New","PPO","Gold","No","Both","No","No",,"Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9938",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0350027-01","Standard Gold On Exchange Plan",,"0.787434160709381","No","Yes","No","100%",,"$3,250","$10","$0","$200","$1,700","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"$12,000","$12000 per person","$24000 per group","$15,250","$15250 per person","$30500 per group","$3,250","$3250 per person","$6500 per group","0%",,,,,"$6,500","$6500 per person","$19500 per group","$9,750","$9750 per person","$26000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SBC_PPO_3250b_EliteNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SOB_PPO_3250b_EliteNetwork_Gold.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","3","20129","IL","Individual","No","37-1260731","20129IL0330026","HMO 3500 Elite Network Bronze","20129IL033","7740283974","ILN001","ILS001","ILF003","New","HMO","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.991786858242279",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330026-01","Standard Bronze On Exchange Plan",,"0.618963301181793","Yes","Yes","No","100%",,"$3,500","$20","$1,100","$200","$3,500","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_3500_EliteNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_3500_EliteNetwork_Bronze.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","3","20129","IL","Individual","No","37-1260731","20129IL0330026","HMO 3500 Elite Network Bronze","20129IL033","7740283974","ILN001","ILS001","ILF003","New","HMO","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.991786858242279",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_3500_EliteNetwork_Bronze_Indian-0PER-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_3500_EliteNetwork_Bronze_Indian-0PER-CSR.pdf","6"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","3","20129","IL","Individual","No","37-1260731","20129IL0330026","HMO 3500 Elite Network Bronze","20129IL033","7740283974","ILN001","ILS001","ILF003","New","HMO","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.991786858242279",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330026-03","Limited Cost Sharing Plan Variation",,"0.618963301181793","Yes","Yes","No","100%",,"$3,500","$20","$1,100","$200","$3,500","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_3500_EliteNetwork_Bronze_Indian-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_3500_EliteNetwork_Bronze_Indian-CSR.pdf","7"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","4","20129","IL","Individual","No","37-1260731","20129IL0370012","PPO 4500 Elite Network Bronze","20129IL037","7740283974","ILN001","ILS001","ILF007","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992007882948481",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0370012-00","Standard Bronze Off Exchange Plan",,"0.598586618900299","Yes","Yes","No","100%",,"$4,500","$20","$800","$200","$4,500","$300","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_PPO_4500_EliteNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_PPO_4500_EliteNetwork_Bronze.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","4","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310052","POS 2750 Methodist Network Gold","20129IL031","7740283974","ILN002","ILS002","ILF015","New","POS","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0310052-00","Standard Gold Off Exchange Plan",,"0.78244936466217","No","Yes","No","100%",,"$5,500","$10","$50","$200","$1,700","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$36000 per group","$2,750","$2750 per person","$5500 per group","10%",,,,,"$5,500","$5500 per person","$16500 per group","$8,250","$8250 per person","$22000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SBC_POS_2750_MethodistNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SOB_POS_2750_MethodistNetwork_Gold.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","4","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310052","POS 2750 Methodist Network Gold","20129IL031","7740283974","ILN002","ILS002","ILF015","New","POS","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0310052-01","Standard Gold On Exchange Plan",,"0.78244936466217","No","Yes","No","100%",,"$5,500","$10","$50","$200","$1,700","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$36000 per group","$2,750","$2750 per person","$5500 per group","10%",,,,,"$5,500","$5500 per person","$16500 per group","$8,250","$8250 per person","$22000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SBC_POS_2750_MethodistNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SOB_POS_2750_MethodistNetwork_Gold.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","4","20129","IL","Individual","No","37-1260731","20129IL0370012","PPO 4500 Elite Network Bronze","20129IL037","7740283974","ILN001","ILS001","ILF007","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992007882948481",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0370012-01","Standard Bronze On Exchange Plan",,"0.598586618900299","Yes","Yes","No","100%",,"$4,500","$20","$800","$200","$4,500","$300","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_PPO_4500_EliteNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_PPO_4500_EliteNetwork_Bronze.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","4","20129","IL","Individual","No","37-1260731","20129IL0370012","PPO 4500 Elite Network Bronze","20129IL037","7740283974","ILN001","ILS001","ILF007","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992007882948481",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0370012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_PPO_4500_Elite_Network_Bronze_Indian-0PER-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_PPO_4500_Elite_Network_Bronze_Indian-0PER-CSR.pdf","6"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","4","20129","IL","Individual","No","37-1260731","20129IL0370012","PPO 4500 Elite Network Bronze","20129IL037","7740283974","ILN001","ILS001","ILF007","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992007882948481",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0370012-03","Limited Cost Sharing Plan Variation",,"0.598586618900299","Yes","Yes","No","100%",,"$4,500","$20","$800","$200","$4,500","$300","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,850","$24850 per person","$49700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_PPO_4500_EliteNetwork_Bronze_Indian-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_PPO_4500_EliteNetwork_Bronze_Indian-CSR.pdf","7"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","5","20129","IL","Individual","No","37-1260731","20129IL0340017","POS 3750c Elite Network Bronze","20129IL034","7740283974","ILN001","ILS001","ILF008","New","POS","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992025366619661",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340017-00","Standard Bronze Off Exchange Plan",,"0.612012326717377","Yes","Yes","No","100%",,"$3,750","$0","$1,000","$200","$3,750","$0","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$40500 per group","$20,250","$20250 per person","$54000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","45%",,,,,"$7,500","$7500 per person","$15000 per group","$11,250","$11250 per person","$22500 per group","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_POS_3750c_EliteNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_POS_3750c_EliteNetwork_Bronze.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","5","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0320037","HMO 4200 Elite Network Bronze","20129IL032","7740283974","ILN001","ILS001","ILF009","New","HMO","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9899",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0320037-00","Standard Bronze Off Exchange Plan",,"0.600900828838348","Yes","Yes","No","100%",,"$4,200","$0","$900","$200","$4,200","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SBC_HMO_4200_EliteNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SOB_HMO_4200_EliteNetwork_Bronze.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","5","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0320037","HMO 4200 Elite Network Bronze","20129IL032","7740283974","ILN001","ILS001","ILF009","New","HMO","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9899",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0320037-01","Standard Bronze On Exchange Plan",,"0.600900828838348","Yes","Yes","No","100%",,"$4,200","$0","$900","$200","$4,200","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SBC_HMO_4200_EliteNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SOB_HMO_4200_EliteNetwork_Bronze.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","5","20129","IL","Individual","No","37-1260731","20129IL0340017","POS 3750c Elite Network Bronze","20129IL034","7740283974","ILN001","ILS001","ILF008","New","POS","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992025366619661",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340017-01","Standard Bronze On Exchange Plan",,"0.612012326717377","Yes","Yes","No","100%",,"$3,750","$0","$1,000","$200","$3,750","$0","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$40500 per group","$20,250","$20250 per person","$54000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","45%",,,,,"$7,500","$7500 per person","$15000 per group","$11,250","$11250 per person","$22500 per group","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_3750c_EliteNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_3750c_EliteNetwork_Bronze.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","5","20129","IL","Individual","No","37-1260731","20129IL0340017","POS 3750c Elite Network Bronze","20129IL034","7740283974","ILN001","ILS001","ILF008","New","POS","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992025366619661",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_3750c_EliteNetwork_Bronze_Indian-0PER-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_3750c_EliteNetwork_Bronze_Indian-0PER-CSR.pdf","6"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","5","20129","IL","Individual","No","37-1260731","20129IL0340017","POS 3750c Elite Network Bronze","20129IL034","7740283974","ILN001","ILS001","ILF008","New","POS","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992025366619661",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340017-03","Limited Cost Sharing Plan Variation",,"0.612012326717377","Yes","Yes","No","100%",,"$3,750","$0","$1,000","$200","$3,750","$0","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$40500 per group","$20,250","$20250 per person","$54000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","45%",,,,,"$7,500","$7500 per person","$15000 per group","$11,250","$11250 per person","$22500 per group","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_3750c_EliteNetwork_Bronze_Indian-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_3750c_EliteNetwork_Bronze_Indian-CSR.pdf","7"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","6","20129","IL","Individual","No","37-1260731","20129IL0330027","HMO 4000d Elite Network Bronze","20129IL033","7740283974","ILN001","ILS001","ILF009","New","HMO","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994129962465444",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330027-00","Standard Bronze Off Exchange Plan",,"0.602640450000763","Yes","Yes","No","100%",,"$4,000","$0","$1,000","$200","$4,000","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_HMO_4000d_EliteNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_HMO_4000d_EliteNetwork_Bronze.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","6","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310049","POS 5000a Elite Network Bronze","20129IL031","7740283794","ILN001","ILS001","ILF010","New","POS","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9905",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0310049-00","Standard Bronze Off Exchange Plan",,"0.608077585697174","Yes","Yes","No","100%",,"$5,000","$0","$200","$200","$4,800","$0","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$41100 per group","$20,550","$20550 per person","$54800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group","20%",,,,,"$12,700","$12700 per person","$25400 per group","$17,700","$17700 per person","$38100 per group","No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SBC_POS_5000a_EliteNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SOB_POS_5000a_EliteNetwork_Bronze.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","6","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310049","POS 5000a Elite Network Bronze","20129IL031","7740283794","ILN001","ILS001","ILF010","New","POS","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9905",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0310049-01","Standard Bronze On Exchange Plan",,"0.608077585697174","Yes","Yes","No","100%",,"$5,000","$0","$200","$200","$4,800","$0","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$41100 per group","$20,550","$20550 per person","$54800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group","20%",,,,,"$12,700","$12700 per person","$25400 per group","$17,700","$17700 per person","$38100 per group","No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SBC_POS_5000a_EliteNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SOB_POS_5000a_EliteNetwork_Bronze.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","6","20129","IL","Individual","No","37-1260731","20129IL0330027","HMO 4000d Elite Network Bronze","20129IL033","7740283974","ILN001","ILS001","ILF009","New","HMO","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994129962465444",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330027-01","Standard Bronze On Exchange Plan",,"0.602640450000763","Yes","Yes","No","100%",,"$4,000","$0","$1,000","$200","$4,000","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_4000d_EliteNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_4000d_EliteNetwork_Bronze.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","6","20129","IL","Individual","No","37-1260731","20129IL0330027","HMO 4000d Elite Network Bronze","20129IL033","7740283974","ILN001","ILS001","ILF009","New","HMO","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994129962465444",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330027-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_4000d_EliteNetwork_Bronze_Indian-0PER-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_4000d_EliteNetwork_Bronze_Indian-0PER-CSR.pdf","6"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","6","20129","IL","Individual","No","37-1260731","20129IL0330027","HMO 4000d Elite Network Bronze","20129IL033","7740283974","ILN001","ILS001","ILF009","New","HMO","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.994129962465444",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330027-03","Limited Cost Sharing Plan Variation",,"0.602640450000763","Yes","Yes","No","100%",,"$4,000","$0","$1,000","$200","$4,000","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_4000d_EliteNetwork_Bronze_Indian-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_4000d_EliteNetwork_Bronze_Indian-CSR.pdf","7"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","7","20129","IL","Individual","No","37-1260731","20129IL0340021","POS 5000a Methodist Network Bronze","20129IL034","7740283974","ILN002","ILS002","ILF010","New","POS","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.99177037794392",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340021-00","Standard Bronze Off Exchange Plan",,"0.608077585697174","Yes","Yes","No","100%",,"$5,000","$0","$200","$200","$5,000","$0","$20","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$41100 per group","$20,550","$20550 per person","$54800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group","20%",,,,,"$12,700","$12700 per person","$25400 per group","$17,700","$17700 per person","$38100 per group","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_POS_5000a_MethodistNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_POS_5000a_MethodistNetwork_Bronze.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","7","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0280040","POS HSA 6000 Elite Network Bronze","20129IL028","7740283974","ILN001","ILS001","ILF020","New","POS","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9906",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0280040-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","$21,000","$21000 per person","$42000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","Yes","Yes","$0.00","https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SBC_POS_HSA_6000_EliteNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SOB_POS_HSA_6000_EliteNetwork_Bronze.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","7","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0280040","POS HSA 6000 Elite Network Bronze","20129IL028","7740283974","ILN001","ILS001","ILF020","New","POS","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9906",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0280040-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","$21,000","$21000 per person","$42000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","Yes","Yes","$0.00","https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SBC_POS_HSA_6000_EliteNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SOB_POS_HSA_6000_EliteNetwork_Bronze.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","7","20129","IL","Individual","No","37-1260731","20129IL0340021","POS 5000a Methodist Network Bronze","20129IL034","7740283974","ILN002","ILS002","ILF010","New","POS","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.99177037794392",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340021-01","Standard Bronze On Exchange Plan",,"0.608077585697174","Yes","Yes","No","100%",,"$5,000","$0","$200","$200","$5,000","$0","$20","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$41100 per group","$20,550","$20550 per person","$54800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group","20%",,,,,"$12,700","$12700 per person","$25400 per group","$17,700","$17700 per person","$38100 per group","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_5000a_MethodistNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_5000a_MethodistNetwork_Bronze.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","11","20129","IL","Individual","No","37-1260731","20129IL0370008","PPO 4500b Elite Network Silver","20129IL037","7740283974","ILN001","ILS001","ILF012","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993751555517599",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0370008-03","Limited Cost Sharing Plan Variation",,"0.691514074802399","No","Yes","No","100%",,"$3,300","$300","$500","$200","$1,700","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$38100 per group","$19,050","$19050 per person","$50800 per group","$4,500","$4500 per person","$9000 per group","20%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$36000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_PPO_4500b_EliteNetwork_Silver_Indian-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_PPO_4500b_EliteNetwork_Silver_Indian-CSR.pdf","7"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","11","20129","IL","Individual","No","37-1260731","20129IL0370008","PPO 4500b Elite Network Silver","20129IL037","7740283974","ILN001","ILS001","ILF012","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993751555517599",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0370008-04","73% AV Level Silver Plan",,"0.731200695037842","No","Yes","No","100%",,"$3,300","$300","$500","$200","$1,700","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$12,700","$12700 per person","$38100 per group","$17,200","$17200 per person","$47100 per group","$4,000","$4000 per person","$8000 per group","20%",,,,,"$9,000","$9000 per person","$27000 per group","$13,000","$13000 per person","$35000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_PPO_4500b_EliteNetwork_Silver_CSR-73PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_PPO_4500b_EliteNetwork_Silver_CSR-73PER.pdf","8"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","11","20129","IL","Individual","No","37-1260731","20129IL0370008","PPO 4500b Elite Network Silver","20129IL037","7740283974","ILN001","ILS001","ILF012","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993751555517599",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0370008-05","87% AV Level Silver Plan",,"0.877019047737122","No","Yes","No","100%",,"$250","$300","$300","$200","$250","$500","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$12,000","$12000 per person","$36000 per group","$14,000","$14000 per person","$40000 per group","$250","$250 per person","$500 per group","5%",,,,,"$8,000","$8000 per person","$24000 per group","$8,250","$8250 per person","$24500 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_PPO_4500b_EliteNetwork_Silver_CSR-87PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_PPO_4500b_EliteNetwork_Silver_CSR-87PER.pdf","9"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","11","20129","IL","Individual","No","37-1260731","20129IL0370008","PPO 4500b Elite Network Silver","20129IL037","7740283974","ILN001","ILS001","ILF012","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993751555517599",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0370008-06","94% AV Level Silver Plan",,"0.931549668312073","No","Yes","No","100%",,"$250","$100","$100","$200","$250","$500","$20","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$2,500","$2500 per person","$7500 per group","$3,750","$3750 per person","$10000 per group","$0","$0 per person","$0 per group","2%",,,,,"$500","$500 per person","$1500 per group","$500","$500 per person","$1500 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_PPO_4500b_EliteNetwork_Silver_CSR-94PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_PPO_4500b_EliteNetwork_Silver_CSR-94PER.pdf","10"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","12","20129","IL","Individual","No","37-1260731","20129IL0330024","HMO 4500 Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF013","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993006588855641",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330024-00","Standard Silver Off Exchange Plan",,"0.680754780769348","No","Yes","No","100%",,"$4,500","$10","$300","$200","$1,700","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_HMO_4500_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_HMO_4500_EliteNetwork_Silver.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","7","20129","IL","Individual","No","37-1260731","20129IL0340021","POS 5000a Methodist Network Bronze","20129IL034","7740283974","ILN002","ILS002","ILF010","New","POS","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.99177037794392",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_5000a_MethodistNetwork_Bronze_Indian-0PER-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_5000a_MethodistNetwork_Bronze_Indian-0PER-CSR.pdf","6"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","7","20129","IL","Individual","No","37-1260731","20129IL0340021","POS 5000a Methodist Network Bronze","20129IL034","7740283974","ILN002","ILS002","ILF010","New","POS","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.99177037794392",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340021-03","Limited Cost Sharing Plan Variation",,"0.608077585697174","Yes","Yes","No","100%",,"$5,000","$0","$200","$200","$5,000","$0","$20","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$41100 per group","$20,550","$20550 per person","$54800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group","20%",,,,,"$12,700","$12700 per person","$25400 per group","$17,700","$17700 per person","$38100 per group","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_5000a_MethodistNetwork_Bronze_Indian-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_5000a_MethodistNetwork_Bronze_Indian-CSR.pdf","7"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","8","20129","IL","Individual","No","37-1260731","20129IL0340018","POS 5000a Elite Network Bronze","20129IL034","7740283974","ILN001","ILS001","ILF010","New","POS","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.99177037794392",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340018-00","Standard Bronze Off Exchange Plan",,"0.608077585697174","Yes","Yes","No","100%",,"$5,000","$0","$200","$200","$5,000","$0","$20","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$41100 per group","$20,550","$20550 per person","$54800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group","20%",,,,,"$12,700","$12700 per person","$25400 per group","$17,700","$17700 per person","$38100 per group","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_POS_5000a_EliteNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_POS_5000a_EliteNetwork_Bronze.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","8","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310043","POS 2700 Elite Network Silver","20129IL031","7740283974","ILN001","ILS001","ILF012","New","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0310043-00","Standard Silver Off Exchange Plan",,"0.697226464748383","No","Yes","No","100%",,"$2,700","$20","$1,000","$200","$1,400","$600","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$41000 per group","$20,550","$20550 per person","$54800 per group","$2,700","$2700 per person","$5400 per group","30%",,,,,"$5,400","$5400 per person","$10800 per group","$8,100","$8100 per person","$16200 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SBC_POS_2700_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SOB_POS_2700_EliteNetwork_Silver.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","8","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310043","POS 2700 Elite Network Silver","20129IL031","7740283974","ILN001","ILS001","ILF012","New","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0310043-01","Standard Silver On Exchange Plan",,"0.697226464748383","No","Yes","No","100%",,"$2,700","$20","$1,000","$200","$1,400","$600","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$41000 per group","$20,550","$20550 per person","$54800 per group","$2,700","$2700 per person","$5400 per group","30%",,,,,"$5,400","$5400 per person","$10800 per group","$8,100","$8100 per person","$16200 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SBC_POS_2700_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SOB_POS_2700_EliteNetwork_Silver.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","8","20129","IL","Individual","No","37-1260731","20129IL0340018","POS 5000a Elite Network Bronze","20129IL034","7740283974","ILN001","ILS001","ILF010","New","POS","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.99177037794392",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340018-01","Standard Bronze On Exchange Plan",,"0.608077585697174","Yes","Yes","No","100%",,"$5,000","$0","$200","$200","$5,000","$0","$20","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$41100 per group","$20,550","$20550 per person","$54800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group","20%",,,,,"$12,700","$12700 per person","$25400 per group","$17,700","$17700 per person","$38100 per group","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_5000a_EliteNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_5000a_EliteNetwork_Bronze.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","8","20129","IL","Individual","No","37-1260731","20129IL0340018","POS 5000a Elite Network Bronze","20129IL034","7740283974","ILN001","ILS001","ILF010","New","POS","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.99177037794392",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_5000a_EliteNetwork_Bronze_Indian-0PER-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_5000a_EliteNetwork_Bronze_Indian-0PER-CSR.pdf","6"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","8","20129","IL","Individual","No","37-1260731","20129IL0340018","POS 5000a Elite Network Bronze","20129IL034","7740283974","ILN001","ILS001","ILF010","New","POS","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.99177037794392",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340018-03","Limited Cost Sharing Plan Variation",,"0.608077585697174","Yes","Yes","No","100%",,"$5,000","$0","$200","$200","$5,000","$0","$20","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$41100 per group","$20,550","$20550 per person","$54800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group","20%",,,,,"$12,700","$12700 per person","$25400 per group","$17,700","$17700 per person","$38100 per group","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_5000a_EliteNetwork_Bronze_Indian-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_5000a_EliteNetwork_Bronze_Indian-CSR.pdf","7"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","9","20129","IL","Individual","No","37-1260731","20129IL0330023","HMO 3000b Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF014","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992923854693581",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330023-00","Standard Silver Off Exchange Plan",,"0.69011253118515","No","Yes","No","100%",,"$3,000","$20","$900","$200","$1,700","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_HMO_3000b_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_HMO_3000b_EliteNetwork_Silver.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","9","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0320035","HMO 3000a Elite Network Silver","20129IL032","7740283974","ILN001","ILS001","ILF014","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9918",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0320035-00","Standard Silver Off Exchange Plan",,"0.695319175720215","No","Yes","No","100%",,"$3,000","$20","$900","$200","$1,400","$600","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SBC_HMO_3000a_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SOB_HMO_3000a_EliteNetwork_Silver.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","9","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0320035","HMO 3000a Elite Network Silver","20129IL032","7740283974","ILN001","ILS001","ILF014","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9918",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0320035-01","Standard Silver On Exchange Plan",,"0.695319175720215","No","Yes","No","100%",,"$3,000","$20","$900","$200","$1,400","$600","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SBC_HMO_3000a_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SOB_HMO_3000a_EliteNetwork_Silver.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","9","20129","IL","Individual","No","37-1260731","20129IL0330023","HMO 3000b Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF014","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992923854693581",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330023-01","Standard Silver On Exchange Plan",,"0.69011253118515","No","Yes","No","100%",,"$3,000","$20","$900","$200","$1,700","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_3000b_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_3000b_EliteNetwork_Silver.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","9","20129","IL","Individual","No","37-1260731","20129IL0330023","HMO 3000b Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF014","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992923854693581",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330023-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_3000b_EliteNetwork_Silver_Indian-0PER-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_3000b_EliteNetwork_Silver_Indian-0PER-CSR.pdf","6"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","9","20129","IL","Individual","No","37-1260731","20129IL0330023","HMO 3000b Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF014","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992923854693581",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330023-03","Limited Cost Sharing Plan Variation",,"0.69011253118515","No","Yes","No","100%",,"$3,000","$20","$900","$200","$1,700","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_3000b_EliteNetwork_Silver_Indian-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_3000b_EliteNetwork_Silver_Indian-CSR.pdf","7"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","9","20129","IL","Individual","No","37-1260731","20129IL0330023","HMO 3000b Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF014","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992923854693581",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330023-04","73% AV Level Silver Plan",,"0.721410870552063","No","Yes","No","100%",,"$3,000","$20","$900","$200","$1,700","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_3000b_EliteNetwork_Silver_CSR-73PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_3000b_EliteNetwork_Silver_CSR-73PER.pdf","8"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","9","20129","IL","Individual","No","37-1260731","20129IL0330023","HMO 3000b Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF014","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992923854693581",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330023-05","87% AV Level Silver Plan",,"0.863129496574402","No","Yes","No","100%",,"$3,000","$20","$300","$200","$1,700","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_3000b_EliteNetwork_Silver_CSR-87PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_3000b_EliteNetwork_Silver_CSR-87PER.pdf","9"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","9","20129","IL","Individual","No","37-1260731","20129IL0330023","HMO 3000b Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF014","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992923854693581",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330023-06","94% AV Level Silver Plan",,"0.942348480224609","No","Yes","No","100%",,"$3,000","$20","$60","$200","$1,700","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","2%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_3000b_EliteNetwork_Silver_CSR-94PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_3000b_EliteNetwork_Silver_CSR-94PER.pdf","10"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","10","20129","IL","Individual","No","37-1260731","20129IL0330014","HMO 4000b Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF011","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993474389036403",,,,"3","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330014-00","Standard Silver Off Exchange Plan",,"0.696368396282196","No","Yes","No","100%",,"$3,000","$900","$0","$200","$1,500","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_HMO_4000b_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_HMO_4000b_EliteNetwork_Silver.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","10","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0320039","HMO 3000a Methodist Network Silver","20129IL032","7740283974","ILN002","ILS002","ILF014","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9918",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0320039-00","Standard Silver Off Exchange Plan",,"0.695319175720215","No","Yes","No","100%",,"$3,000","$20","$900","$200","$1,400","$600","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SBC_HMO_3000a_MethodistNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SOB_HMO_3000a_MethodistNetwork_Silver.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","10","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0320039","HMO 3000a Methodist Network Silver","20129IL032","7740283974","ILN002","ILS002","ILF014","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9918",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0320039-01","Standard Silver On Exchange Plan",,"0.695319175720215","No","Yes","No","100%",,"$3,000","$20","$900","$200","$1,400","$600","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SBC_HMO_3000a_MethodistNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SOB_HMO_3000a_MethodistNetwork_Silver.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","10","20129","IL","Individual","No","37-1260731","20129IL0330014","HMO 4000b Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF011","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993474389036403",,,,"3","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330014-01","Standard Silver On Exchange Plan",,"0.696368396282196","No","Yes","No","100%",,"$3,000","$900","$0","$200","$1,500","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_4000b_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_4000b_EliteNetwork_Silver.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","10","20129","IL","Individual","No","37-1260731","20129IL0330014","HMO 4000b Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF011","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993474389036403",,,,"3","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330014-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_4000b_EliteNetwork_Silver_Indian-0PER-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_4000b_EliteNetwork_Silver_Indian-0PER-CSR.pdf","6"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","10","20129","IL","Individual","No","37-1260731","20129IL0330014","HMO 4000b Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF011","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993474389036403",,,,"3","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330014-03","Limited Cost Sharing Plan Variation",,"0.696368396282196","No","Yes","No","100%",,"$3,000","$900","$0","$200","$1,500","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_4000b_EliteNetwork_Silver_Indian-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_4000b_EliteNetwork_Silver_Indian-CSR.pdf","7"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","10","20129","IL","Individual","No","37-1260731","20129IL0330014","HMO 4000b Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF011","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993474389036403",,,,"3","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330014-04","73% AV Level Silver Plan",,"0.731131076812744","No","Yes","No","100%",,"$3,000","$900","$0","$200","$1,500","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_4000b_EliteNetwork_Silver_CSR-73PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_4000b_EliteNetwork_Silver_CSR-73PER.pdf","8"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","10","20129","IL","Individual","No","37-1260731","20129IL0330014","HMO 4000b Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF011","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993474389036403",,,,"3","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330014-05","87% AV Level Silver Plan",,"0.861376821994781","No","Yes","No","100%",,"$200","$500","$60","$200","$200","$500","$20","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","2%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_4000b_EliteNetwork_Silver_CSR-87PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_4000b_EliteNetwork_Silver_CSR-87PER.pdf","9"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","10","20129","IL","Individual","No","37-1260731","20129IL0330014","HMO 4000b Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF011","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993474389036403",,,,"3","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330014-06","94% AV Level Silver Plan",,"0.930353045463562","No","Yes","No","100%",,"$0","$200","$60","$200","$0","$400","$20","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","2%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_4000b_EliteNetwork_Silver_CSR-94PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_4000b_EliteNetwork_Silver_CSR-94PER.pdf","10"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","11","20129","IL","Individual","No","37-1260731","20129IL0370008","PPO 4500b Elite Network Silver","20129IL037","7740283974","ILN001","ILS001","ILF012","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993751555517599",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0370008-00","Standard Silver Off Exchange Plan",,"0.691514074802399","No","Yes","No","100%",,"$3,300","$300","$500","$200","$1,700","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$38100 per group","$19,050","$19050 per person","$50800 per group","$4,500","$4500 per person","$9000 per group","20%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$36000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_PPO_4500b_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_PPO_4500b_EliteNetwork_Silver.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","11","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0350009","PPO 3750 Elite Network Silver","20129IL035","7740283974","ILN001","ILS001","ILF017","Existing","PPO","Silver","No","Both","No","No",,"Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9928",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0350009-00","Standard Silver Off Exchange Plan",,"0.693571448326111","No","Yes","No","100%",,"$3,750","$10","$500","$200","$1,700","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$39600 per group","$19,800","$19800 per person","$52800 per group","$3,750","$3750 per person","$6750 per group","20%",,,,,"$6,750","$6750 per person","$20250 per group","$10,500","$10500 per person","$27000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SBC_PPO_3750_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SOB_PPO_3750_EliteNetwork_Silver.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","11","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0350009","PPO 3750 Elite Network Silver","20129IL035","7740283974","ILN001","ILS001","ILF017","Existing","PPO","Silver","No","Both","No","No",,"Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9928",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0350009-01","Standard Silver On Exchange Plan",,"0.693571448326111","No","Yes","No","100%",,"$3,750","$10","$500","$200","$1,700","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$39600 per group","$19,800","$19800 per person","$52800 per group","$3,750","$3750 per person","$6750 per group","20%",,,,,"$6,750","$6750 per person","$20250 per group","$10,500","$10500 per person","$27000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SBC_PPO_3750_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SOB_PPO_3750_EliteNetwork_Silver.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","11","20129","IL","Individual","No","37-1260731","20129IL0370008","PPO 4500b Elite Network Silver","20129IL037","7740283974","ILN001","ILS001","ILF012","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993751555517599",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0370008-01","Standard Silver On Exchange Plan",,"0.691514074802399","No","Yes","No","100%",,"$3,300","$300","$500","$200","$1,700","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$38100 per group","$19,050","$19050 per person","$50800 per group","$4,500","$4500 per person","$9000 per group","20%",,,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$36000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_PPO_4500b_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_PPO_4500b_EliteNetwork_Silver.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","11","20129","IL","Individual","No","37-1260731","20129IL0370008","PPO 4500b Elite Network Silver","20129IL037","7740283974","ILN001","ILS001","ILF012","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993751555517599",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0370008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_PPO_4500b_EliteNetwork_Silver_Indian-0PER-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_PPO_4500b_EliteNetwork_Silver_Indian-0PER-CSR.pdf","6"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","12","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0350012","PPO 4500a Elite Network Silver","20129IL035","7740283974","ILN001","ILS001","ILF012","Existing","PPO","Silver","No","Both","No","No",,"Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0350012-00","Standard Silver Off Exchange Plan",,"0.696233987808228","No","Yes","No","100%",,"$2,400","$300","$700","$200","$1,400","$500","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$13200 per group",,,,"$15,000","$15000 per person","$45000 per group","$21,100","$21100 per person","$58200 per group","$4,500","$4500 per person","$12700 per group","20%",,,,,"$12,700","$12700 per person","$38100 per group","$17,200","$17200 per person","$50800 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SBC_PPO_4500a_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SOB_PPO_4500a_EliteNetwork_Silver.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","12","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0350012","PPO 4500a Elite Network Silver","20129IL035","7740283974","ILN001","ILS001","ILF012","Existing","PPO","Silver","No","Both","No","No",,"Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0350012-01","Standard Silver On Exchange Plan",,"0.696233987808228","No","Yes","No","100%",,"$2,400","$300","$700","$200","$1,400","$500","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$13200 per group",,,,"$15,000","$15000 per person","$45000 per group","$21,100","$21100 per person","$58200 per group","$4,500","$4500 per person","$12700 per group","20%",,,,,"$12,700","$12700 per person","$38100 per group","$17,200","$17200 per person","$50800 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SBC_PPO_4500a_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SOB_PPO_4500a_EliteNetwork_Silver.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","12","20129","IL","Individual","No","37-1260731","20129IL0330024","HMO 4500 Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF013","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993006588855641",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330024-01","Standard Silver On Exchange Plan",,"0.680754780769348","No","Yes","No","100%",,"$4,500","$10","$300","$200","$1,700","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_4500_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_4500_EliteNetwork_Silver.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","12","20129","IL","Individual","No","37-1260731","20129IL0330024","HMO 4500 Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF013","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993006588855641",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330024-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_4500_EliteNetwork_Silver_Indian-0PER-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_4500_EliteNetwork_Silver_Indian-0PER-CSR.pdf","6"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","12","20129","IL","Individual","No","37-1260731","20129IL0330024","HMO 4500 Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF013","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993006588855641",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330024-03","Limited Cost Sharing Plan Variation",,"0.680754780769348","No","Yes","No","100%",,"$4,500","$10","$300","$200","$1,700","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_4500_Elite_Network_Silver_CSR_Indian-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_4500_Elite_Network_Silver_CSR_Indian-CSR.pdf","7"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","12","20129","IL","Individual","No","37-1260731","20129IL0330024","HMO 4500 Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF013","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993006588855641",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330024-04","73% AV Level Silver Plan",,"0.730299115180969","No","Yes","No","100%",,"$2,750","$10","$700","$200","$1,700","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,750","$2750 per person","$5500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_4500_EliteNetwork_Silver_CSR-73PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_4500_EliteNetwork_Silver_CSR-73PER.pdf","8"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","12","20129","IL","Individual","No","37-1260731","20129IL0330024","HMO 4500 Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF013","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993006588855641",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330024-05","87% AV Level Silver Plan",,"0.863363444805145","No","Yes","No","100%",,"$500","$10","$1,100","$200","$500","$400","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_4500_EliteNetwork_Silver_CSR-87PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_4500_EliteNetwork_Silver_CSR-87PER.pdf","9"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","12","20129","IL","Individual","No","37-1260731","20129IL0330024","HMO 4500 Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF013","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993006588855641",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330024-06","94% AV Level Silver Plan",,"0.932228922843933","No","Yes","No","100%",,"$250","$10","$100","$200","$250","$300","$20","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","2%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_4500_EliteNetwork_Silver_CSR-94PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_4500_EliteNetwork_Silver_CSR-94PER.pdf","10"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","13","20129","IL","Individual","No","37-1260731","20129IL0330015","HMO 5000c Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF014","Existing","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992891503657089",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330015-00","Standard Silver Off Exchange Plan",,"0.682230651378632","No","Yes","No","100%",,"$5,000","$20","$300","$200","$1,700","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_HMO_5000c_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_HMO_5000c_EliteNetwork_Silver.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","16","20129","IL","Individual","No","37-1260731","20129IL0330017","HMO 1500a Elite Network Gold","20129IL033","7740283974","ILN001","ILS001","ILF011","Existing","HMO","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330017-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_1500a_EliteNetwork_Gold_Indian-0PER-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_1500a_EliteNetwork_Gold_Indian-0PER-CSR.pdf","6"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","16","20129","IL","Individual","No","37-1260731","20129IL0330017","HMO 1500a Elite Network Gold","20129IL033","7740283974","ILN001","ILS001","ILF011","Existing","HMO","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330017-03","Limited Cost Sharing Plan Variation",,"0.808999180793762","No","Yes","No","100%",,"$1,500","$200","$200","$200","$1,500","$400","$20","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_1500a_EliteNetwork_Gold_Indian-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_1500a_EliteNetwork_Gold_Indian-CSR.pdf","7"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","13","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310044","POS 6000a Elite Network Silver","20129IL031","7740283974","ILN001","ILS001","ILF017","New","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0310044-00","Standard Silver Off Exchange Plan",,"0.693467438220978","No","Yes","No","100%",,"$2,400","$300","$500","$200","$1,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$36000 per group","$18,000","$18000 per person","$48000 per group","$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$36000 per group","$18,000","$18000 per person","$48000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SBC_POS_6000a_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SOB_POS_6000a_EliteNetwork_Silver.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","13","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310044","POS 6000a Elite Network Silver","20129IL031","7740283974","ILN001","ILS001","ILF017","New","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0310044-01","Standard Silver On Exchange Plan",,"0.693467438220978","No","Yes","No","100%",,"$2,400","$300","$500","$200","$1,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$36000 per group","$18,000","$18000 per person","$48000 per group","$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$36000 per group","$18,000","$18000 per person","$48000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SBC_POS_6000a_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SOB_POS_6000a_EliteNetwork_Silver.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","13","20129","IL","Individual","No","37-1260731","20129IL0330015","HMO 5000c Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF014","Existing","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992891503657089",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330015-01","Standard Silver On Exchange Plan",,"0.682230651378632","No","Yes","No","100%",,"$5,000","$20","$300","$200","$1,700","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_5000c_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_5000c_EliteNetwork_Silver.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","13","20129","IL","Individual","No","37-1260731","20129IL0330015","HMO 5000c Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF014","Existing","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992891503657089",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330015-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_5000c_EliteNetwork_Silver_Indian-0PER-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_5000c_EliteNetwork_Silver_Indian-0PER-CSR.pdf","6"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","13","20129","IL","Individual","No","37-1260731","20129IL0330015","HMO 5000c Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF014","Existing","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992891503657089",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330015-03","Limited Cost Sharing Plan Variation",,"0.682230651378632","No","Yes","No","100%",,"$5,000","$20","$300","$200","$1,700","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_5000c_EliteNetwork_Silver_Indian-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_5000c_EliteNetwork_Silver_Indian-CSR.pdf","7"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","13","20129","IL","Individual","No","37-1260731","20129IL0330015","HMO 5000c Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF014","Existing","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992891503657089",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330015-04","73% AV Level Silver Plan",,"0.73603892326355","No","Yes","No","100%",,"$4,000","$20","$600","$200","$1,700","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_5000c_EliteNetwork_Silver_CSR-73PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_5000c_EliteNetwork_Silver_CSR-73PER.pdf","8"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","13","20129","IL","Individual","No","37-1260731","20129IL0330015","HMO 5000c Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF014","Existing","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992891503657089",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330015-05","87% AV Level Silver Plan",,"0.876030445098877","No","Yes","No","100%",,"$250","$20","$600","$200","$250","$500","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_5000c_EliteNetwork_Silver_CSR-87PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_5000c_EliteNetwork_Silver_CSR-87PER.pdf","9"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","13","20129","IL","Individual","No","37-1260731","20129IL0330015","HMO 5000c Elite Network Silver","20129IL033","7740283974","ILN001","ILS001","ILF014","Existing","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992891503657089",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330015-06","94% AV Level Silver Plan",,"0.930055141448975","No","Yes","No","100%",,"$0","$20","$100","$200","$0","$500","$20","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","2%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_5000c_EliteNetwork_Silver_CSR-94PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_5000c_EliteNetwork_Silver_CSR-94PER.pdf","10"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","14","20129","IL","Individual","No","37-1260731","20129IL0340022","POS 6000b Methodist Network Silver","20129IL034","7740283974","ILN002","ILS002","ILF017","New","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993180279089681",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340022-00","Standard Silver Off Exchange Plan",,"0.693467438220978","No","Yes","No","100%",,"$3,300","$300","$0","$200","$1,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$24,000","$24000 per person","$36000 per group","$30,000","$30000 per person","$48000 per group","$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_POS_6000b_MethodistNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_POS_6000b_MethodistNetwork_Silver.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","14","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310051","POS 6000a Methodist Network Silver","20129IL031","7740283974","ILN002","ILS002","ILF017","New","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0310051-00","Standard Silver Off Exchange Plan",,"0.693467438220978","No","Yes","No","100%",,"$2,400","$300","$500","$200","$1,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$36000 per group","$18,000","$18000 per person","$48000 per group","$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$36000 per group","$18,000","$18000 per person","$48000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SBC_POS_6000a_MethodistNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SOB_POS_6000a_MethodistNetwork_Silver.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","14","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310051","POS 6000a Methodist Network Silver","20129IL031","7740283974","ILN002","ILS002","ILF017","New","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0310051-01","Standard Silver On Exchange Plan",,"0.693467438220978","No","Yes","No","100%",,"$2,400","$300","$500","$200","$1,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$36000 per group","$18,000","$18000 per person","$48000 per group","$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$36000 per group","$18,000","$18000 per person","$48000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SBC_POS_6000a_MethodistNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SOB_POS_6000a_MethodistNetwork_Silver.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","14","20129","IL","Individual","No","37-1260731","20129IL0340022","POS 6000b Methodist Network Silver","20129IL034","7740283974","ILN002","ILS002","ILF017","New","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993180279089681",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340022-01","Standard Silver On Exchange Plan",,"0.693467438220978","No","Yes","No","100%",,"$3,300","$300","$0","$200","$1,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$24,000","$24000 per person","$36000 per group","$30,000","$30000 per person","$48000 per group","$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_6000b_MethodistNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_6000b_MethodistNetwork_Silver.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","14","20129","IL","Individual","No","37-1260731","20129IL0340022","POS 6000b Methodist Network Silver","20129IL034","7740283974","ILN002","ILS002","ILF017","New","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993180279089681",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340022-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_6000b_MethodistNetwork_Silver_Indian-0PER-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_6000b_MethodistNetwork_Silver_Indian-0PER-CSR.pdf","6"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","14","20129","IL","Individual","No","37-1260731","20129IL0340022","POS 6000b Methodist Network Silver","20129IL034","7740283974","ILN002","ILS002","ILF017","New","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993180279089681",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340022-03","Limited Cost Sharing Plan Variation",,"0.693467438220978","No","Yes","No","100%",,"$3,300","$300","$0","$200","$1,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$24,000","$24000 per person","$36000 per group","$30,000","$30000 per person","$48000 per group","$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_6000b_MethodistNetwork_Silver_Indian-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_6000b_MethodistNetwork_Silver_Indian-CSR.pdf","7"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","19","20129","IL","Individual","No","37-1260731","20129IL0330020","HMO 6850 Elite Network Catastrophic","20129IL033","7740283974","ILN001","ILS001","ILF005","Existing","HMO","Catastrophic","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330020-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_6850_EliteNetwork_Catastrophic.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_6850_EliteNetwork_Catastrophic.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","14","20129","IL","Individual","No","37-1260731","20129IL0340022","POS 6000b Methodist Network Silver","20129IL034","7740283974","ILN002","ILS002","ILF017","New","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993180279089681",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340022-04","73% AV Level Silver Plan",,"0.723194360733032","No","Yes","No","100%",,"$3,300","$300","$0","$200","$1,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$13,000","$13000 per person","$36000 per group","$18,000","$18000 per person","$48000 per group","$5,000","$5000 per person","$10000 per group","0%",,,,,"$11,500","$11500 per person","$23000 per group","$16,500","$16500 per person","$33000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_6000b_MethodistNetwork_Silver_CSR-73PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_6000b_MethodistNetwork_Silver_CSR-73PER.pdf","8"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","14","20129","IL","Individual","No","37-1260731","20129IL0340022","POS 6000b Methodist Network Silver","20129IL034","7740283974","ILN002","ILS002","ILF017","New","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993180279089681",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340022-05","87% AV Level Silver Plan",,"0.87574303150177","No","Yes","No","100%",,"$500","$100","$0","$200","$500","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$4,500","$4500 per person","$13500 per group","$6,750","$6750 per person","$18000 per group","$500","$500 per person","$1000 per group","0%",,,,,"$2,250","$2250 per person","$6750 per group","$2,750","$2750 per person","$7750 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_6000b_MethodistNetwork_Silver_CSR-87PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_6000b_MethodistNetwork_Silver_CSR-87PER.pdf","9"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","14","20129","IL","Individual","No","37-1260731","20129IL0340022","POS 6000b Methodist Network Silver","20129IL034","7740283974","ILN002","ILS002","ILF017","New","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993180279089681",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340022-06","94% AV Level Silver Plan",,"0.94541335105896","No","Yes","No","100%",,"$0","$100","$0","$200","$0","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$1,500","$1500 per person","$4500 per group","$2,250","$2250 per person","$6000 per group","$0","$0 per person","$0 per group","0%",,,,,"$500","$500 per person","$1500 per group","$500","$500 per person","$1500 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_6000b_MethodistNetwork_Silver_CSR-94PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_6000b_MethodistNetwork_Silver_CSR-94PER.pdf","10"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","15","20129","IL","Individual","No","37-1260731","20129IL0340012","POS 6000b Elite Network Silver","20129IL034","7740283974","ILN001","ILS001","ILF017","Existing","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993180279089681",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340012-00","Standard Silver Off Exchange Plan",,"0.693467438220978","No","Yes","No","100%",,"$3,300","$300","$0","$200","$1,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$24,000","$24000 per person","$36000 per group","$30,000","$30000 per person","$48000 per group","$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_POS_6000b_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_POS_6000b_EliteNetwork_Silver.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","15","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310045","POS 2000 Elite Network Gold","20129IL031","7740283974","ILN001","ILS001","ILF015","New","POS","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9938",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0310045-00","Standard Gold Off Exchange Plan",,"0.786648333072662","No","Yes","No","100%",,"$2,000","$10","$600","$200","$1,700","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$24000 per group","$12,000","$12000 per person","$32000 per group","$2,000","$2000 per person","$4000 per group","15%",,,,,"$4,000","$4000 per person","$12000 per group","$6,000","$6000 per person","$16000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SBC_POS_2000_EliteNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SOB_POS_2000_EliteNetwork_Gold.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","15","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310045","POS 2000 Elite Network Gold","20129IL031","7740283974","ILN001","ILS001","ILF015","New","POS","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9938",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0310045-01","Standard Gold On Exchange Plan",,"0.786648333072662","No","Yes","No","100%",,"$2,000","$10","$600","$200","$1,700","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$24000 per group","$12,000","$12000 per person","$32000 per group","$2,000","$2000 per person","$4000 per group","15%",,,,,"$4,000","$4000 per person","$12000 per group","$6,000","$6000 per person","$16000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SBC_POS_2000_EliteNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SOB_POS_2000_EliteNetwork_Gold.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","15","20129","IL","Individual","No","37-1260731","20129IL0340012","POS 6000b Elite Network Silver","20129IL034","7740283974","ILN001","ILS001","ILF017","Existing","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993180279089681",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340012-01","Standard Silver On Exchange Plan",,"0.693467438220978","No","Yes","No","100%",,"$3,300","$300","$0","$200","$1,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$24,000","$24000 per person","$36000 per group","$30,000","$30000 per person","$48000 per group","$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_6000b_EliteNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_6000b_EliteNetwork_Silver.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","15","20129","IL","Individual","No","37-1260731","20129IL0340012","POS 6000b Elite Network Silver","20129IL034","7740283974","ILN001","ILS001","ILF017","Existing","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993180279089681",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340012-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_6000b_EliteNetwork_Silver_Indian-0PER-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_6000b_EliteNetwork_Silver_Indian-0PER-CSR.pdf","6"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","15","20129","IL","Individual","No","37-1260731","20129IL0340012","POS 6000b Elite Network Silver","20129IL034","7740283974","ILN001","ILS001","ILF017","Existing","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993180279089681",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340012-03","Limited Cost Sharing Plan Variation",,"0.693467438220978","No","Yes","No","100%",,"$3,300","$300","$0","$200","$1,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$24,000","$24000 per person","$36000 per group","$30,000","$30000 per person","$48000 per group","$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_6000b_EliteNetwork_Silver_Indian-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_6000b_EliteNetwork_Silver_Indian-CSR.pdf","7"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","15","20129","IL","Individual","No","37-1260731","20129IL0340012","POS 6000b Elite Network Silver","20129IL034","7740283974","ILN001","ILS001","ILF017","Existing","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993180279089681",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340012-04","73% AV Level Silver Plan",,"0.723194360733032","No","Yes","No","100%",,"$3,300","$300","$0","$200","$1,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$13,000","$13000 per person","$36000 per group","$18,000","$18000 per person","$48000 per group","$5,000","$5000 per person","$10000 per group","0%",,,,,"$11,500","$11500 per person","$23000 per group","$16,500","$16500 per person","$33000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_6000b_EliteNetwork_Silver_CSR-73PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_6000b_EliteNetwork_Silver_CSR-73PER.pdf","8"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","15","20129","IL","Individual","No","37-1260731","20129IL0340012","POS 6000b Elite Network Silver","20129IL034","7740283974","ILN001","ILS001","ILF017","Existing","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993180279089681",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340012-05","87% AV Level Silver Plan",,"0.87574303150177","No","Yes","No","100%",,"$500","$100","$0","$200","$500","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$4,500","$4500 per person","$13500 per group","$6,750","$6750 per person","$18000 per group","$500","$500 per person","$1000 per group","0%",,,,,"$2,250","$2250 per person","$6750 per group","$2,750","$2750 per person","$7750 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_6000b_EliteNetwork_Silver_CSR-87PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_6000b_EliteNetwork_Silver_CSR-87PER.pdf","9"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","15","20129","IL","Individual","No","37-1260731","20129IL0340012","POS 6000b Elite Network Silver","20129IL034","7740283974","ILN001","ILS001","ILF017","Existing","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.993180279089681",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340012-06","94% AV Level Silver Plan",,"0.94541335105896","No","Yes","No","100%",,"$0","$100","$0","$200","$0","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$1,500","$1500 per person","$4500 per group","$2,250","$2250 per person","$6000 per group","$0","$0 per person","$0 per group","0%",,,,,"$500","$500 per person","$1500 per group","$500","$500 per person","$1500 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_6000b_EliteNetwork_Silver_CSR-94PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_6000b_EliteNetwork_Silver_CSR-94PER.pdf","10"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","16","20129","IL","Individual","No","37-1260731","20129IL0330017","HMO 1500a Elite Network Gold","20129IL033","7740283974","ILN001","ILS001","ILF011","Existing","HMO","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330017-00","Standard Gold Off Exchange Plan",,"0.808999180793762","No","Yes","No","100%",,"$1,500","$200","$200","$200","$1,500","$400","$20","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_HMO_1500a_EliteNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_HMO_1500a_EliteNetwork_Gold.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","16","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0320036","HMO 2000 Elite Network Gold","20129IL032","7740283974","ILN001","ILS001","ILF014","New","HMO","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9935",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0320036-00","Standard Gold Off Exchange Plan",,"0.785295963287354","No","Yes","No","100%",,"$2,000","$20","$400","$200","$1,400","$500","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SBC_HMO_2000_EliteNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SOB_HMO_2000_EliteNetwork_Gold.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","16","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0320036","HMO 2000 Elite Network Gold","20129IL032","7740283974","ILN001","ILS001","ILF014","New","HMO","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9935",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0320036-01","Standard Gold On Exchange Plan",,"0.785295963287354","No","Yes","No","100%",,"$2,000","$20","$400","$200","$1,400","$500","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SBC_HMO_2000_EliteNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SOB_HMO_2000_EliteNetwork_Gold.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","16","20129","IL","Individual","No","37-1260731","20129IL0330017","HMO 1500a Elite Network Gold","20129IL033","7740283974","ILN001","ILS001","ILF011","Existing","HMO","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330017-01","Standard Gold On Exchange Plan",,"0.808999180793762","No","Yes","No","100%",,"$1,500","$200","$200","$200","$1,500","$400","$20","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_1500a_EliteNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_1500a_EliteNetwork_Gold.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","17","20129","IL","Individual","No","37-1260731","20129IL0340015","POS 2000 Elite Network Gold","20129IL034","7740283974","ILN001","ILS001","ILF015","New","POS","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340015-00","Standard Gold Off Exchange Plan",,"0.786648333072662","No","Yes","No","100%",,"$2,000","$2,000","$0","$200","$1,700","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$24000 per group","$12,000","$12000 per person","$32000 per group","$2,000","$2000 per person","$4000 per group","15%",,,,,"$4,000","$4000 per person","$12000 per group","$6,000","$6000 per person","$16000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_POS_2000_EliteNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_POS_2000_EliteNetwork_Gold.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","17","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310037","POS 2750 Elite Network Gold","20129IL031","7740283974","ILN001","ILS001","ILF015","Existing","POS","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0310037-00","Standard Gold Off Exchange Plan",,"0.78244936466217","No","Yes","No","100%",,"$2,750","$10","$300","$200","$1,400","$300","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$36000 per group","$2,750","$2750 per person","$5500 per group","10%",,,,,"$5,500","$5500 per person","$16500 per group","$8,250","$8250 per person","$22000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SBC_POS_2750_EliteNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SOB_POS_2750_EliteNetwork_Gold.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","17","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310037","POS 2750 Elite Network Gold","20129IL031","7740283974","ILN001","ILS001","ILF015","Existing","POS","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9939",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0310037-01","Standard Gold On Exchange Plan",,"0.78244936466217","No","Yes","No","100%",,"$2,750","$10","$300","$200","$1,400","$300","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$27000 per group","$13,500","$13500 per person","$36000 per group","$2,750","$2750 per person","$5500 per group","10%",,,,,"$5,500","$5500 per person","$16500 per group","$8,250","$8250 per person","$22000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SBC_POS_2750_EliteNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SOB_POS_2750_EliteNetwork_Gold.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","17","20129","IL","Individual","No","37-1260731","20129IL0340015","POS 2000 Elite Network Gold","20129IL034","7740283974","ILN001","ILS001","ILF015","New","POS","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340015-01","Standard Gold On Exchange Plan",,"0.786648333072662","No","Yes","No","100%",,"$2,000","$2,000","$0","$200","$1,700","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$24000 per group","$12,000","$12000 per person","$32000 per group","$2,000","$2000 per person","$4000 per group","15%",,,,,"$4,000","$4000 per person","$12000 per group","$6,000","$6000 per person","$16000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_2000_EliteNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_2000_EliteNetwork_Gold.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","17","20129","IL","Individual","No","37-1260731","20129IL0340015","POS 2000 Elite Network Gold","20129IL034","7740283974","ILN001","ILS001","ILF015","New","POS","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340015-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_2000_EliteNetwork_Gold_Indian-0PER-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_2000_EliteNetwork_Gold_Indian-0PER-CSR.pdf","6"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","17","20129","IL","Individual","No","37-1260731","20129IL0340015","POS 2000 Elite Network Gold","20129IL034","7740283974","ILN001","ILS001","ILF015","New","POS","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340015-03","Limited Cost Sharing Plan Variation",,"0.786648333072662","No","Yes","No","100%",,"$2,000","$2,000","$0","$200","$1,700","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$24000 per group","$12,000","$12000 per person","$32000 per group","$2,000","$2000 per person","$4000 per group","15%",,,,,"$4,000","$4000 per person","$12000 per group","$6,000","$6000 per person","$16000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_2000_EliteNetwork_Gold_Indian-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_2000_EliteNetwork_Gold_Indian-CSR.pdf","7"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140002","Ambetter Balanced Care 1 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140002-00","Standard Silver Off Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140002-00.pdf","https://api.centene.com/Brochures/2016/27833IL0140002-00.pdf","8"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140002","Ambetter Balanced Care 1 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140002-01","Standard Silver On Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140002-01.pdf","https://api.centene.com/Brochures/2016/27833IL0140002-01.pdf","9"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","18","20129","IL","Individual","No","37-1260731","20129IL0370011","PPO 3250a Elite Network Gold","20129IL037","7740283974","ILN001","ILS001","ILF015","New","PPO","Gold","No","Both","No","No",,"Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0370011-00","Standard Gold Off Exchange Plan",,"0.786663770675659","No","Yes","No","100%",,"$3,250","$700","$0","$200","$1,700","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"$13,000","$13000 per person","$26000 per group","$16,250","$16250 per person","$32500 per group","$3,250","$3250 per person","$6500 per group","0%",,,,,"$6,500","$6500 per person","$19500 per group","$9,750","$9750 per person","$26000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_PPO_3250a_EliteNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_PPO_3250a_EliteNetwork_Gold.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","18","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0280041","POS HSA 6000 Methodist Network Bronze","20129IL028","7740283974","ILN002","ILS002","ILF020","New","POS","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9906",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0280041-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","$21,000","$21000 per person","$42000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","Yes","Yes","$0.00","https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SBC_POS_HSA_6000_MethodistNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_DIR_SOB_POS_HSA_6000_MethodistNetwork_Bronze.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","18","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0280041","POS HSA 6000 Methodist Network Bronze","20129IL028","7740283974","ILN002","ILS002","ILF020","New","POS","Bronze","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs",,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9906",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0280041-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","$21,000","$21000 per person","$42000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","Yes","Yes","$0.00","https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SBC_POS_HSA_6000_MethodistNetwork_Bronze.pdf","https://www.healthalliance.org/docs/2016_IL_GRP_PUB_SOB_POS_HSA_6000_MethodistNetwork_Bronze.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","18","20129","IL","Individual","No","37-1260731","20129IL0370011","PPO 3250a Elite Network Gold","20129IL037","7740283974","ILN001","ILS001","ILF015","New","PPO","Gold","No","Both","No","No",,"Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0370011-01","Standard Gold On Exchange Plan",,"0.786663770675659","No","Yes","No","100%",,"$3,250","$700","$0","$200","$1,700","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"$13,000","$13000 per person","$26000 per group","$16,250","$16250 per person","$32500 per group","$3,250","$3250 per person","$6500 per group","0%",,,,,"$6,500","$6500 per person","$19500 per group","$9,750","$9750 per person","$26000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_PPO_3250a_EliteNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_PPO_3250a_EliteNetwork_Gold.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","18","20129","IL","Individual","No","37-1260731","20129IL0370011","PPO 3250a Elite Network Gold","20129IL037","7740283974","ILN001","ILS001","ILF015","New","PPO","Gold","No","Both","No","No",,"Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0370011-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_PPO_3250a_EliteNetwork_Gold_Indian-0PER-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_PPO_3250a_EliteNetwork_Gold_Indian-0PER-CSR.pdf","6"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","18","20129","IL","Individual","No","37-1260731","20129IL0370011","PPO 3250a Elite Network Gold","20129IL037","7740283974","ILN001","ILS001","ILF015","New","PPO","Gold","No","Both","No","No",,"Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0370011-03","Limited Cost Sharing Plan Variation",,"0.786663770675659","No","Yes","No","100%",,"$3,250","$700","$0","$200","$1,700","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"$13,000","$13000 per person","$26000 per group","$16,250","$16250 per person","$32500 per group","$3,250","$3250 per person","$6500 per group","0%",,,,,"$6,500","$6500 per person","$19500 per group","$9,750","$9750 per person","$26000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_PPO_3250a_EliteNetwork_Gold_Indian-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_PPO_3250a_EliteNetwork_Gold_Indian-CSR.pdf","7"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","19","20129","IL","Individual","No","37-1260731","20129IL0330020","HMO 6850 Elite Network Catastrophic","20129IL033","7740283974","ILN001","ILS001","ILF005","Existing","HMO","Catastrophic","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330020-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_HMO_6850_EliteNetwork_Catastrophic.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_HMO_6850_EliteNetwork_Catastrophic.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","20","20129","IL","Individual","No","37-1260731","20129IL0330021","HMO 1500b Elite Network Gold","20129IL033","7740283974","ILN001","ILS001","ILF011","Existing","HMO","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330021-00","Standard Gold Off Exchange Plan",,"0.797321021556854","No","Yes","No","100%",,"$1,500","$200","$400","$200","$1,500","$300","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_HMO_1500b_EliteNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_HMO_1500b_EliteNetwork_Gold.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","20","20129","IL","Individual","No","37-1260731","20129IL0330021","HMO 1500b Elite Network Gold","20129IL033","7740283974","ILN001","ILS001","ILF011","Existing","HMO","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330021-01","Standard Gold On Exchange Plan",,"0.797321021556854","No","Yes","No","100%",,"$1,500","$200","$400","$200","$1,500","$300","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_1500b_EliteNetwork_Gold.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_1500b_EliteNetwork_Gold.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","20","20129","IL","Individual","No","37-1260731","20129IL0330021","HMO 1500b Elite Network Gold","20129IL033","7740283974","ILN001","ILS001","ILF011","Existing","HMO","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330021-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_1500b_EliteNetwork_Gold_Indian-0PER-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_1500b_EliteNetwork_Gold_Indian-0PER-CSR.pdf","6"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","20","20129","IL","Individual","No","37-1260731","20129IL0330021","HMO 1500b Elite Network Gold","20129IL033","7740283974","ILN001","ILS001","ILF011","Existing","HMO","Gold","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330021-03","Limited Cost Sharing Plan Variation",,"0.797321021556854","No","Yes","No","100%",,"$1,500","$200","$400","$200","$1,500","$300","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_1500b_EliteNetwork_Gold_Indian-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_1500b_EliteNetwork_Gold_Indian-CSR.pdf","7"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","21","20129","IL","Individual","No","37-1260731","20129IL0330022","HMO 6000 Riverside Network Silver","20129IL033","7740283974","ILN003","ILS003","ILF018","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992442926324984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330022-00","Standard Silver Off Exchange Plan",,"0.681524336338043","No","Yes","No","100%",,"$3,300","$200","$0","$200","$1,700","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_HMO_6000_RiversideNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_HMO_6000_RiversideNetwork_Silver.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","21","20129","IL","Individual","No","37-1260731","20129IL0330022","HMO 6000 Riverside Network Silver","20129IL033","7740283974","ILN003","ILS003","ILF018","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992442926324984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330022-01","Standard Silver On Exchange Plan",,"0.681524336338043","No","Yes","No","100%",,"$3,300","$200","$0","$200","$1,700","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_6000_RiversideNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_6000_RiversideNetwork_Silver.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","21","20129","IL","Individual","No","37-1260731","20129IL0330022","HMO 6000 Riverside Network Silver","20129IL033","7740283974","ILN003","ILS003","ILF018","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992442926324984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330022-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_6000_RiversideNetwork_Silver_Indian-0PER-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_6000_RiversideNetwork_Silver_Indian-0PER-CSR.pdf","6"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","21","20129","IL","Individual","No","37-1260731","20129IL0330022","HMO 6000 Riverside Network Silver","20129IL033","7740283974","ILN003","ILS003","ILF018","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992442926324984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330022-03","Limited Cost Sharing Plan Variation",,"0.681524336338043","No","Yes","No","100%",,"$3,300","$200","$0","$200","$1,700","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_6000_RiversideNetwork_Silver_Indian-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_6000_RiversideNetwork_Silver_Indian-CSR.pdf","7"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","21","20129","IL","Individual","No","37-1260731","20129IL0330022","HMO 6000 Riverside Network Silver","20129IL033","7740283974","ILN003","ILS003","ILF018","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992442926324984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330022-04","73% AV Level Silver Plan",,"0.731994688510895","No","Yes","No","100%",,"$3,300","$200","$0","$200","$1,700","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,100","$5100 per person","$10200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_6000_RiversideNetwork_Silver_CSR-73PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_6000_RiversideNetwork_Silver_CSR-73PER.pdf","8"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","21","20129","IL","Individual","No","37-1260731","20129IL0330022","HMO 6000 Riverside Network Silver","20129IL033","7740283974","ILN003","ILS003","ILF018","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992442926324984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330022-05","87% AV Level Silver Plan",,"0.868892908096313","No","Yes","No","100%",,"$1,750","$200","$0","$200","$1,700","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_6000_RiversideNetwork_Silver_CSR-87PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_6000_RiversideNetwork_Silver_CSR-87PER.pdf","9"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","21","20129","IL","Individual","No","37-1260731","20129IL0330022","HMO 6000 Riverside Network Silver","20129IL033","7740283974","ILN003","ILS003","ILF018","New","HMO","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992442926324984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0330022-06","94% AV Level Silver Plan",,"0.93266749382019","No","Yes","No","100%",,"$750","$200","$0","$200","$750","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_HMO_6000_RiversideNetwork_Silver_CSR-94PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_HMO_6000_RiversideNetwork_Silver_CSR-94PER.pdf","10"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","22","20129","IL","Individual","No","37-1260731","20129IL0340016","POS 6000 Riverside Network Silver","20129IL034","7740283974","ILN003","ILS003","ILF019","New","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992744769958004",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340016-00","Standard Silver Off Exchange Plan",,"0.681524336338043","No","Yes","No","100%",,"$3,300","$200","$0","$200","$1,700","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,700","$19700 per person","$39400 per group","$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_DIR_SBC_POS_6000_RiversideNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_IND_DIR_SOB_POS_6000_RiversideNetwork_Silver.pdf","4"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","22","20129","IL","Individual","No","37-1260731","20129IL0340016","POS 6000 Riverside Network Silver","20129IL034","7740283974","ILN003","ILS003","ILF019","New","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992744769958004",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340016-01","Standard Silver On Exchange Plan",,"0.681524336338043","No","Yes","No","100%",,"$3,300","$200","$0","$200","$1,700","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,700","$19700 per person","$39400 per group","$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_6000_RiversideNetwork_Silver.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_6000_RiversideNetwork_Silver.pdf","5"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","22","20129","IL","Individual","No","37-1260731","20129IL0340016","POS 6000 Riverside Network Silver","20129IL034","7740283974","ILN003","ILS003","ILF019","New","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992744769958004",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340016-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_6000_RiversideNetwork_Silver_Indian-0PER-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_6000_RiversideNetwork_Silver_Indian-0PER-CSR.pdf","6"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","22","20129","IL","Individual","No","37-1260731","20129IL0340016","POS 6000 Riverside Network Silver","20129IL034","7740283974","ILN003","ILS003","ILF019","New","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992744769958004",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340016-03","Limited Cost Sharing Plan Variation",,"0.681524336338043","No","Yes","No","100%",,"$3,300","$200","$0","$200","$1,700","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,200","$13200 per person","$26400 per group","$19,700","$19700 per person","$39400 per group","$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","$18,000","$18000 per person","$36000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_6000_RiversideNetwork_Silver_Indian-CSR.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_6000_RiversideNetwork_Silver_Indian-CSR.pdf","7"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","22","20129","IL","Individual","No","37-1260731","20129IL0340016","POS 6000 Riverside Network Silver","20129IL034","7740283974","ILN003","ILS003","ILF019","New","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992744769958004",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340016-04","73% AV Level Silver Plan",,"0.731994688510895","No","Yes","No","100%",,"$3,300","$200","$0","$200","$1,700","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","$15,300","$15300 per person","$30600 per group","$5,100","$5100 per person","$10200 per group","0%",,,,,"$10,200","$10200 per person","$20400 per group","$17,300","$17300 per person","$30600 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_6000_RiversideNetwork_Silver_CSR-73PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_6000_RiversideNetwork_Silver_CSR-73PER.pdf","8"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","22","20129","IL","Individual","No","37-1260731","20129IL0340016","POS 6000 Riverside Network Silver","20129IL034","7740283974","ILN003","ILS003","ILF019","New","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992744769958004",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340016-05","87% AV Level Silver Plan",,"0.868892908096313","No","Yes","No","100%",,"$1,750","$200","$0","$200","$1,700","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$3,500","$3500 per person","$7000 per group","$5,250","$5250 per person","$10500 per group","$1,750","$1750 per person","$3500 per group","0%",,,,,"$3,500","$3500 per person","$7000 per group","$5,250","$5250 per person","$10500 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_6000_RiversideNetwork_Silver_CSR-87PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_6000_RiversideNetwork_Silver_CSR-87PER.pdf","9"
"2016","IL","20129","SERFF","7","2015-09-25 06:20:33","22","20129","IL","Individual","No","37-1260731","20129IL0340016","POS 6000 Riverside Network Silver","20129IL034","7740283974","ILN003","ILS003","ILF019","New","POS","Silver","No","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupuncture, Custodial Care, Weight Loss Programs","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.992744769958004",,,,"0","0","0","2016-01-01",,"Yes","Out of Network Coverage Available","Yes","Out of Network Coverage Available","No","https://shop.healthalliancemarket.org/payment?source=ffe","http://www.healthalliance.org/content/pharmacy","20129IL0340016-06","94% AV Level Silver Plan",,"0.93266749382019","No","Yes","No","100%",,"$750","$200","$0","$200","$750","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$1,500","$1500 per person","$3000 per group","$2,250","$2250 per person","$4500 per group","$750","$750 per person","$1500 per group","0%",,,,,"$1,500","$1500 per person","$3000 per group","$2,250","$2250 per person","$4500 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.healthalliance.org/docs/2016_IL_IND_PUB_SBC_POS_6000_RiversideNetwork_Silver_CSR-94PER.pdf","https://www.healthalliance.org/docs/2016_IL_IND_PUB_SOB_POS_6000_RiversideNetwork_Silver_CSR-94PER.pdf","10"
"2016","IL","20545","SERFF","3","2015-08-27 15:13:29","1","20545","IL","SHOP (Small Group)","Yes","57-0523959","20545IL0030001","Group Dental Policy","20545IL003",,"ILN001","ILS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.52","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Traditional with inside maximum","Yes","Traditional with inside maximum","Yes",,"","20545IL0030001-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits: Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140001-00","Standard Gold Off Exchange Plan",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/27833IL0140001-00.pdf","https://api.centene.com/Brochures/2016/27833IL0140001-00.pdf","4"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits: Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140001-01","Standard Gold On Exchange Plan",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/27833IL0140001-01.pdf","https://api.centene.com/Brochures/2016/27833IL0140001-01.pdf","5"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits: Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/27833IL0140001-02.pdf","https://api.centene.com/Brochures/2016/27833IL0140001-02.pdf","6"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits: Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF001","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140001-03","Limited Cost Sharing Plan Variation",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/27833IL0140001-03.pdf","https://api.centene.com/Brochures/2016/27833IL0140001-03.pdf","7"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140002","Ambetter Balanced Care 1 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140002-02.pdf","https://api.centene.com/Brochures/2016/27833IL0140002-02.pdf","10"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140002","Ambetter Balanced Care 1 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140002-03","Limited Cost Sharing Plan Variation",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140002-03.pdf","https://api.centene.com/Brochures/2016/27833IL0140002-03.pdf","11"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140002","Ambetter Balanced Care 1 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140002-04","73% AV Level Silver Plan",,"0.737546384334564","Yes","Yes","No","100%",,"$3,500","$10","$300","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140002-04.pdf","https://api.centene.com/Brochures/2016/27833IL0140002-04.pdf","12"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140002","Ambetter Balanced Care 1 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140002-05","87% AV Level Silver Plan",,"0.879890024662018","Yes","Yes","No","100%",,"$400","$10","$1,000","$200","$400","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140002-05.pdf","https://api.centene.com/Brochures/2016/27833IL0140002-05.pdf","13"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140002","Ambetter Balanced Care 1 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140002-06","94% AV Level Silver Plan",,"0.948710560798645","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140002-06.pdf","https://api.centene.com/Brochures/2016/27833IL0140002-06.pdf","14"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140003","Ambetter Balanced Care 2 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140003-00","Standard Silver Off Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140003-00.pdf","https://api.centene.com/Brochures/2016/27833IL0140003-00.pdf","15"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140003","Ambetter Balanced Care 2 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140003-01","Standard Silver On Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140003-01.pdf","https://api.centene.com/Brochures/2016/27833IL0140003-01.pdf","16"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140003","Ambetter Balanced Care 2 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140003-02.pdf","https://api.centene.com/Brochures/2016/27833IL0140003-02.pdf","17"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140003","Ambetter Balanced Care 2 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140003-03","Limited Cost Sharing Plan Variation",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140003-03.pdf","https://api.centene.com/Brochures/2016/27833IL0140003-03.pdf","18"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140003","Ambetter Balanced Care 2 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140003-04","73% AV Level Silver Plan",,"0.739638686180115","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140003-04.pdf","https://api.centene.com/Brochures/2016/27833IL0140003-04.pdf","19"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140003","Ambetter Balanced Care 2 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140003-05","87% AV Level Silver Plan",,"0.873916625976563","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,700","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140003-05.pdf","https://api.centene.com/Brochures/2016/27833IL0140003-05.pdf","20"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140003","Ambetter Balanced Care 2 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140003-06","94% AV Level Silver Plan",,"0.9492227435112","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140003-06.pdf","https://api.centene.com/Brochures/2016/27833IL0140003-06.pdf","21"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140005","Ambetter Balanced Care 10 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140005-00","Standard Silver Off Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140005-00.pdf","https://api.centene.com/Brochures/2016/27833IL0140005-00.pdf","29"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140005","Ambetter Balanced Care 10 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140005-01","Standard Silver On Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140005-01.pdf","https://api.centene.com/Brochures/2016/27833IL0140005-01.pdf","30"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140005","Ambetter Balanced Care 10 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140005-02.pdf","https://api.centene.com/Brochures/2016/27833IL0140005-02.pdf","31"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140005","Ambetter Balanced Care 10 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140005-03","Limited Cost Sharing Plan Variation",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140005-03.pdf","https://api.centene.com/Brochures/2016/27833IL0140005-03.pdf","32"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140005","Ambetter Balanced Care 10 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140005-04","73% AV Level Silver Plan",,"0.738659501075745","Yes","Yes","No","100%",,"$4,000","$10","$200","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140005-04.pdf","https://api.centene.com/Brochures/2016/27833IL0140005-04.pdf","33"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140005","Ambetter Balanced Care 10 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140005-05","87% AV Level Silver Plan",,"0.874480485916138","Yes","Yes","No","100%",,"$1,000","$0","$800","$200","$1,000","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140005-05.pdf","https://api.centene.com/Brochures/2016/27833IL0140005-05.pdf","34"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140005","Ambetter Balanced Care 10 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140005-06","94% AV Level Silver Plan",,"0.946612775325775","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140005-06.pdf","https://api.centene.com/Brochures/2016/27833IL0140005-06.pdf","35"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140006","Ambetter Essential Care 1 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140006-00","Standard Bronze Off Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140006-00.pdf","https://api.centene.com/Brochures/2016/27833IL0140006-00.pdf","36"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140006","Ambetter Essential Care 1 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140006-01","Standard Bronze On Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140006-01.pdf","https://api.centene.com/Brochures/2016/27833IL0140006-01.pdf","37"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140006","Ambetter Essential Care 1 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140006-02.pdf","https://api.centene.com/Brochures/2016/27833IL0140006-02.pdf","38"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","1","27833","IL","Individual","No","06-0641618","27833IL0140006","Ambetter Essential Care 1 (2016): Sinai / IlliniCare Health Network","27833IL014",,"ILN001","ILS001","ILF005","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9994",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0140006-03","Limited Cost Sharing Plan Variation",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0140006-03.pdf","https://api.centene.com/Brochures/2016/27833IL0140006-03.pdf","39"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","2","27833","IL","Individual","No","06-0641618","27833IL0150001","Ambetter Balanced Care 1 (2016)  + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150001-00","Standard Silver Off Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0150001-00.pdf","https://api.centene.com/Brochures/2016/27833IL0150001-00.pdf","4"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","2","27833","IL","Individual","No","06-0641618","27833IL0150001","Ambetter Balanced Care 1 (2016)  + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150001-01","Standard Silver On Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0150001-01.pdf","https://api.centene.com/Brochures/2016/27833IL0150001-01.pdf","5"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","2","27833","IL","Individual","No","06-0641618","27833IL0150001","Ambetter Balanced Care 1 (2016)  + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0150001-02.pdf","https://api.centene.com/Brochures/2016/27833IL0150001-02.pdf","6"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","2","27833","IL","Individual","No","06-0641618","27833IL0150001","Ambetter Balanced Care 1 (2016)  + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150001-03","Limited Cost Sharing Plan Variation",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0150001-03.pdf","https://api.centene.com/Brochures/2016/27833IL0150001-03.pdf","7"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","2","27833","IL","Individual","No","06-0641618","27833IL0150001","Ambetter Balanced Care 1 (2016)  + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150001-04","73% AV Level Silver Plan",,"0.737546384334564","Yes","Yes","No","100%",,"$3,500","$10","$300","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0150001-04.pdf","https://api.centene.com/Brochures/2016/27833IL0150001-04.pdf","8"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","2","27833","IL","Individual","No","06-0641618","27833IL0150001","Ambetter Balanced Care 1 (2016)  + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150001-05","87% AV Level Silver Plan",,"0.879890024662018","Yes","Yes","No","100%",,"$400","$10","$1,000","$200","$400","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0150001-05.pdf","https://api.centene.com/Brochures/2016/27833IL0150001-05.pdf","9"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","2","27833","IL","Individual","No","06-0641618","27833IL0150001","Ambetter Balanced Care 1 (2016)  + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150001-06","94% AV Level Silver Plan",,"0.948710560798645","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0150001-06.pdf","https://api.centene.com/Brochures/2016/27833IL0150001-06.pdf","10"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","2","27833","IL","Individual","No","06-0641618","27833IL0150002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150002-00","Standard Silver Off Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0150002-00.pdf","https://api.centene.com/Brochures/2016/27833IL0150002-00.pdf","11"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","2","27833","IL","Individual","No","06-0641618","27833IL0150002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150002-01","Standard Silver On Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0150002-01.pdf","https://api.centene.com/Brochures/2016/27833IL0150002-01.pdf","12"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","2","27833","IL","Individual","No","06-0641618","27833IL0150002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0150002-02.pdf","https://api.centene.com/Brochures/2016/27833IL0150002-02.pdf","13"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","2","27833","IL","Individual","No","06-0641618","27833IL0150002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150002-03","Limited Cost Sharing Plan Variation",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0150002-03.pdf","https://api.centene.com/Brochures/2016/27833IL0150002-03.pdf","14"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","2","27833","IL","Individual","No","06-0641618","27833IL0150002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150002-04","73% AV Level Silver Plan",,"0.739638686180115","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0150002-04.pdf","https://api.centene.com/Brochures/2016/27833IL0150002-04.pdf","15"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","2","27833","IL","Individual","No","06-0641618","27833IL0150002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150002-05","87% AV Level Silver Plan",,"0.873916625976563","Yes","Yes","No","100%",,"$1,800","$0","$0","$200","$1,700","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0150002-05.pdf","https://api.centene.com/Brochures/2016/27833IL0150002-05.pdf","16"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","2","27833","IL","Individual","No","06-0641618","27833IL0150002","Ambetter Balanced Care 2 (2016) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150002-06","94% AV Level Silver Plan",,"0.9492227435112","Yes","Yes","No","100%",,"$600","$0","$0","$200","$600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0150002-06.pdf","https://api.centene.com/Brochures/2016/27833IL0150002-06.pdf","17"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","2","27833","IL","Individual","No","06-0641618","27833IL0150003","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF005","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150003-00","Standard Silver Off Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0150003-00.pdf","https://api.centene.com/Brochures/2016/27833IL0150003-00.pdf","18"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","2","27833","IL","Individual","No","06-0641618","27833IL0150003","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF005","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150003-01","Standard Silver On Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0150003-01.pdf","https://api.centene.com/Brochures/2016/27833IL0150003-01.pdf","19"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","2","27833","IL","Individual","No","06-0641618","27833IL0150003","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF005","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0150003-02.pdf","https://api.centene.com/Brochures/2016/27833IL0150003-02.pdf","20"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","2","27833","IL","Individual","No","06-0641618","27833IL0150003","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF005","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150003-03","Limited Cost Sharing Plan Variation",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0150003-03.pdf","https://api.centene.com/Brochures/2016/27833IL0150003-03.pdf","21"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","2","27833","IL","Individual","No","06-0641618","27833IL0150003","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF005","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150003-04","73% AV Level Silver Plan",,"0.738659501075745","Yes","Yes","No","100%",,"$4,000","$10","$200","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0150003-04.pdf","https://api.centene.com/Brochures/2016/27833IL0150003-04.pdf","22"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","2","27833","IL","Individual","No","06-0641618","27833IL0150003","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF005","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150003-05","87% AV Level Silver Plan",,"0.874480485916138","Yes","Yes","No","100%",,"$1,000","$0","$800","$200","$1,000","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0150003-05.pdf","https://api.centene.com/Brochures/2016/27833IL0150003-05.pdf","23"
"2016","IL","27833","SERFF","5","2015-11-17 16:15:02","2","27833","IL","Individual","No","06-0641618","27833IL0150003","Ambetter Balanced Care 10 (2016) + Vision + Adult Dental: Sinai / IlliniCare Health Network","27833IL015",,"ILN001","ILS001","ILF005","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9236",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.illinicare.com/payments","http://ambetter.illinicare.com/formulary","27833IL0150003-06","94% AV Level Silver Plan",,"0.946612775325775","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/27833IL0150003-06.pdf","https://api.centene.com/Brochures/2016/27833IL0150003-06.pdf","24"
"2016","IL","30680","SERFF","6","2015-08-27 03:52:03","1","30680","IL","SHOP (Small Group)","Yes","93-0242990","30680IL0040002","EHB High PPO","30680IL004",,"ILN001","ILS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.15","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","30680IL0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","IL","30680","SERFF","6","2015-08-27 03:52:03","1","30680","IL","SHOP (Small Group)","Yes","93-0242990","30680IL0040001","EHB Low PPO","30680IL004",,"ILN001","ILS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.58","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","30680IL0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","Yes","36-1236610","36096IL0830001","BlueCare Dental? 1A","36096IL083",,"ILN005","ILS005",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.35","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830001-01","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf","http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810039","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS012","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9964",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810039-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810039","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS012","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9964",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810039-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","9","35670","IL","Individual","No","75-1296086","35670IL0070010","Coventry Silver $15 Copay FocusedCare HPN","35670IL007",,"ILN003","ILS003","ILF012","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070010-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68235","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","30680","SERFF","6","2015-08-27 03:52:03","1","30680","IL","SHOP (Small Group)","Yes","93-0242990","30680IL0030002","EHB High Passive","30680IL003",,"ILN001","ILS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$45.76","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","30680IL0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","IL","30680","SERFF","6","2015-08-27 03:52:03","1","30680","IL","SHOP (Small Group)","Yes","93-0242990","30680IL0030001","EHB Low Passive","30680IL003",,"ILN001","ILS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.39","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","30680IL0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","1","35670","IL","Individual","No","75-1296086","35670IL0070003","Coventry Bronze $15 Copay Carelink PPO","35670IL007",,"ILN002","ILS002","ILF007","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0070003-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68258","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","1","35670","IL","Individual","No","75-1296086","35670IL0070003","Coventry Bronze $15 Copay Carelink PPO","35670IL007",,"ILN002","ILS002","ILF007","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0070003-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68224","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","1","35670","IL","Individual","No","75-1296086","35670IL0070003","Coventry Bronze $15 Copay Carelink PPO","35670IL007",,"ILN002","ILS002","ILF007","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0070003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68226","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","1","35670","IL","Individual","No","75-1296086","35670IL0070003","Coventry Bronze $15 Copay Carelink PPO","35670IL007",,"ILN002","ILS002","ILF007","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0070003-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68225","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","2","35670","IL","Individual","No","75-1296086","35670IL0060003","Coventry Bronze $20 Copay","35670IL006",,"ILN001","ILS001","ILF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0060003-00","Standard Bronze Off Exchange Plan","61.63%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68250","http://www.coventryhealthcare.com/SILon2016","4"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","2","35670","IL","Individual","No","75-1296086","35670IL0060003","Coventry Bronze $20 Copay","35670IL006",,"ILN001","ILS001","ILF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0060003-01","Standard Bronze On Exchange Plan","61.63%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68209","http://www.coventryhealthcare.com/SILon2016","5"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","2","35670","IL","Individual","No","75-1296086","35670IL0060003","Coventry Bronze $20 Copay","35670IL006",,"ILN001","ILS001","ILF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0060003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68211","http://www.coventryhealthcare.com/SILon2016","6"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","2","35670","IL","Individual","No","75-1296086","35670IL0060003","Coventry Bronze $20 Copay","35670IL006",,"ILN001","ILS001","ILF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0060003-03","Limited Cost Sharing Plan Variation","61.63%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68210","http://www.coventryhealthcare.com/SILon2016","7"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","3","35670","IL","Individual","No","75-1296086","35670IL0070006","Coventry Bronze $20 Copay FocusedCare HPN","35670IL007",,"ILN003","ILS003","ILF009","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0070006-00","Standard Bronze Off Exchange Plan","61.63%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68266","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","3","35670","IL","Individual","No","75-1296086","35670IL0070006","Coventry Bronze $20 Copay FocusedCare HPN","35670IL007",,"ILN003","ILS003","ILF009","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0070006-01","Standard Bronze On Exchange Plan","61.63%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68239","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","3","35670","IL","Individual","No","75-1296086","35670IL0070006","Coventry Bronze $20 Copay FocusedCare HPN","35670IL007",,"ILN003","ILS003","ILF009","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0070006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68241","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","3","35670","IL","Individual","No","75-1296086","35670IL0070006","Coventry Bronze $20 Copay FocusedCare HPN","35670IL007",,"ILN003","ILS003","ILF009","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0070006-03","Limited Cost Sharing Plan Variation","61.63%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68240","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","4","35670","IL","Individual","No","75-1296086","35670IL0060004","Coventry Bronze Deductible Only HSA Eligible","35670IL006",,"ILN001","ILS001","ILF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0060004-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68252","http://www.coventryhealthcare.com/SILon2016","4"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","4","35670","IL","Individual","No","75-1296086","35670IL0060004","Coventry Bronze Deductible Only HSA Eligible","35670IL006",,"ILN001","ILS001","ILF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0060004-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68212","http://www.coventryhealthcare.com/SILon2016","5"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","4","35670","IL","Individual","No","75-1296086","35670IL0060004","Coventry Bronze Deductible Only HSA Eligible","35670IL006",,"ILN001","ILS001","ILF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0060004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68214","http://www.coventryhealthcare.com/SILon2016","6"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","4","35670","IL","Individual","No","75-1296086","35670IL0060004","Coventry Bronze Deductible Only HSA Eligible","35670IL006",,"ILN001","ILS001","ILF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0060004-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68213","http://www.coventryhealthcare.com/SILon2016","7"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","5","35670","IL","Individual","No","75-1296086","35670IL0070004","Coventry Bronze Deductible Only HSA Eligible Carelink PPO","35670IL007",,"ILN002","ILS002","ILF008","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0070004-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68260","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","5","35670","IL","Individual","No","75-1296086","35670IL0070004","Coventry Bronze Deductible Only HSA Eligible Carelink PPO","35670IL007",,"ILN002","ILS002","ILF008","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0070004-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68227","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","5","35670","IL","Individual","No","75-1296086","35670IL0070004","Coventry Bronze Deductible Only HSA Eligible Carelink PPO","35670IL007",,"ILN002","ILS002","ILF008","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0070004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68229","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","5","35670","IL","Individual","No","75-1296086","35670IL0070004","Coventry Bronze Deductible Only HSA Eligible Carelink PPO","35670IL007",,"ILN002","ILS002","ILF008","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0070004-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68228","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","6","35670","IL","Individual","No","75-1296086","35670IL0070007","Coventry Bronze Deductible Only HSA Eligible FocusedCare HPN","35670IL007",,"ILN003","ILS003","ILF010","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0070007-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68268","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","6","35670","IL","Individual","No","75-1296086","35670IL0070007","Coventry Bronze Deductible Only HSA Eligible FocusedCare HPN","35670IL007",,"ILN003","ILS003","ILF010","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0070007-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68242","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","6","35670","IL","Individual","No","75-1296086","35670IL0070007","Coventry Bronze Deductible Only HSA Eligible FocusedCare HPN","35670IL007",,"ILN003","ILS003","ILF010","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0070007-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68244","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","6","35670","IL","Individual","No","75-1296086","35670IL0070007","Coventry Bronze Deductible Only HSA Eligible FocusedCare HPN","35670IL007",,"ILN003","ILS003","ILF010","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","35670IL0070007-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68243","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","7","35670","IL","Individual","No","75-1296086","35670IL0070002","Coventry Silver $10 Copay Carelink PPO","35670IL007",,"ILN002","ILS002","ILF006","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070002-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68256","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","7","35670","IL","Individual","No","75-1296086","35670IL0070002","Coventry Silver $10 Copay Carelink PPO","35670IL007",,"ILN002","ILS002","ILF006","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070002-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68218","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","7","35670","IL","Individual","No","75-1296086","35670IL0070002","Coventry Silver $10 Copay Carelink PPO","35670IL007",,"ILN002","ILS002","ILF006","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68220","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","7","35670","IL","Individual","No","75-1296086","35670IL0070002","Coventry Silver $10 Copay Carelink PPO","35670IL007",,"ILN002","ILS002","ILF006","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070002-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68219","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","7","35670","IL","Individual","No","75-1296086","35670IL0070002","Coventry Silver $10 Copay Carelink PPO","35670IL007",,"ILN002","ILS002","ILF006","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070002-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68223","http://www.coventryhealthcare.com/ILon2016","8"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","7","35670","IL","Individual","No","75-1296086","35670IL0070002","Coventry Silver $10 Copay Carelink PPO","35670IL007",,"ILN002","ILS002","ILF006","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070002-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68222","http://www.coventryhealthcare.com/ILon2016","9"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","7","35670","IL","Individual","No","75-1296086","35670IL0070002","Coventry Silver $10 Copay Carelink PPO","35670IL007",,"ILN002","ILS002","ILF006","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070002-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68221","http://www.coventryhealthcare.com/ILon2016","10"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","8","35670","IL","Individual","No","75-1296086","35670IL0060002","Coventry Silver $15 Copay","35670IL006",,"ILN001","ILS001","ILF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0060002-00","Standard Silver Off Exchange Plan","68.15%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68248","http://www.coventryhealthcare.com/SILon2016","4"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","8","35670","IL","Individual","No","75-1296086","35670IL0060002","Coventry Silver $15 Copay","35670IL006",,"ILN001","ILS001","ILF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0060002-01","Standard Silver On Exchange Plan","68.15%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68203","http://www.coventryhealthcare.com/SILon2016","5"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","8","35670","IL","Individual","No","75-1296086","35670IL0060002","Coventry Silver $15 Copay","35670IL006",,"ILN001","ILS001","ILF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0060002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68205","http://www.coventryhealthcare.com/SILon2016","6"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","8","35670","IL","Individual","No","75-1296086","35670IL0060002","Coventry Silver $15 Copay","35670IL006",,"ILN001","ILS001","ILF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0060002-03","Limited Cost Sharing Plan Variation","68.15%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68204","http://www.coventryhealthcare.com/SILon2016","7"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","8","35670","IL","Individual","No","75-1296086","35670IL0060002","Coventry Silver $15 Copay","35670IL006",,"ILN001","ILS001","ILF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0060002-04","73% AV Level Silver Plan","72.23%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68208","http://www.coventryhealthcare.com/SILon2016","8"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","8","35670","IL","Individual","No","75-1296086","35670IL0060002","Coventry Silver $15 Copay","35670IL006",,"ILN001","ILS001","ILF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0060002-05","87% AV Level Silver Plan","86.01%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68207","http://www.coventryhealthcare.com/SILon2016","9"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","8","35670","IL","Individual","No","75-1296086","35670IL0060002","Coventry Silver $15 Copay","35670IL006",,"ILN001","ILS001","ILF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0060002-06","94% AV Level Silver Plan","93.09%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68206","http://www.coventryhealthcare.com/SILon2016","10"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","9","35670","IL","Individual","No","75-1296086","35670IL0070010","Coventry Silver $15 Copay FocusedCare HPN","35670IL007",,"ILN003","ILS003","ILF012","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070010-00","Standard Silver Off Exchange Plan","68.15%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68264","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","9","35670","IL","Individual","No","75-1296086","35670IL0070010","Coventry Silver $15 Copay FocusedCare HPN","35670IL007",,"ILN003","ILS003","ILF012","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070010-01","Standard Silver On Exchange Plan","68.15%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68233","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","9","35670","IL","Individual","No","75-1296086","35670IL0070010","Coventry Silver $15 Copay FocusedCare HPN","35670IL007",,"ILN003","ILS003","ILF012","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070010-03","Limited Cost Sharing Plan Variation","68.15%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68234","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810054","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS022","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9966",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810054-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810054","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS022","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9966",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810054-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820007","Blue Precision Gold HMO? 001","36096IL082",,"ILN012","ILS012","ILF005","Existing","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820007-00","Standard Gold Off Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820007-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810058","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS072","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9963",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810058-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960001","BlueCare Direct Gold? 001 with Advocate","36096IL096",,"ILN013","ILS013","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960001-00","Standard Gold Off Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960001-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","Yes","36-1236610","36096IL0830003","BlueCare Dental 4 Kids? 1A","36096IL083",,"ILN005","ILS005",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$32.35","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830003-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf","http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810042","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS022","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810042-00","Standard Gold Off Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","9","35670","IL","Individual","No","75-1296086","35670IL0070010","Coventry Silver $15 Copay FocusedCare HPN","35670IL007",,"ILN003","ILS003","ILF012","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070010-04","73% AV Level Silver Plan","72.23%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68238","http://www.coventryhealthcare.com/ILon2016","8"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","9","35670","IL","Individual","No","75-1296086","35670IL0070010","Coventry Silver $15 Copay FocusedCare HPN","35670IL007",,"ILN003","ILS003","ILF012","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070010-05","87% AV Level Silver Plan","86.01%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68237","http://www.coventryhealthcare.com/ILon2016","9"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","9","35670","IL","Individual","No","75-1296086","35670IL0070010","Coventry Silver $15 Copay FocusedCare HPN","35670IL007",,"ILN003","ILS003","ILF012","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070010-06","94% AV Level Silver Plan","93.09%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68236","http://www.coventryhealthcare.com/ILon2016","10"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","10","35670","IL","Individual","No","75-1296086","35670IL0070001","Coventry Gold $10 Copay Carelink PPO","35670IL007",,"ILN002","ILS002","ILF005","Existing","PPO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070001-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68254","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","10","35670","IL","Individual","No","75-1296086","35670IL0070001","Coventry Gold $10 Copay Carelink PPO","35670IL007",,"ILN002","ILS002","ILF005","Existing","PPO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070001-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68215","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","10","35670","IL","Individual","No","75-1296086","35670IL0070001","Coventry Gold $10 Copay Carelink PPO","35670IL007",,"ILN002","ILS002","ILF005","Existing","PPO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68217","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","10","35670","IL","Individual","No","75-1296086","35670IL0070001","Coventry Gold $10 Copay Carelink PPO","35670IL007",,"ILN002","ILS002","ILF005","Existing","PPO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070001-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68216","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","11","35670","IL","Individual","No","75-1296086","35670IL0060001","Coventry Gold $15 Copay","35670IL006",,"ILN004","ILS004","ILF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0060001-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68246","http://www.coventryhealthcare.com/SILon2016","4"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","11","35670","IL","Individual","No","75-1296086","35670IL0060001","Coventry Gold $15 Copay","35670IL006",,"ILN004","ILS004","ILF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0060001-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68200","http://www.coventryhealthcare.com/SILon2016","5"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","11","35670","IL","Individual","No","75-1296086","35670IL0060001","Coventry Gold $15 Copay","35670IL006",,"ILN004","ILS004","ILF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0060001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68202","http://www.coventryhealthcare.com/SILon2016","6"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","11","35670","IL","Individual","No","75-1296086","35670IL0060001","Coventry Gold $15 Copay","35670IL006",,"ILN004","ILS004","ILF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0060001-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68201","http://www.coventryhealthcare.com/SILon2016","7"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","12","35670","IL","Individual","No","75-1296086","35670IL0070008","Coventry Gold $15 Copay FocusedCare HPN","35670IL007",,"ILN003","ILS003","ILF011","Existing","PPO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070008-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68262","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","12","35670","IL","Individual","No","75-1296086","35670IL0070008","Coventry Gold $15 Copay FocusedCare HPN","35670IL007",,"ILN003","ILS003","ILF011","Existing","PPO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070008-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68230","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","12","35670","IL","Individual","No","75-1296086","35670IL0070008","Coventry Gold $15 Copay FocusedCare HPN","35670IL007",,"ILN003","ILS003","ILF011","Existing","PPO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070008-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68232","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","35670","SERFF","5","2015-08-27 03:52:03","12","35670","IL","Individual","No","75-1296086","35670IL0070008","Coventry Gold $15 Copay FocusedCare HPN","35670IL007",,"ILN003","ILS003","ILF011","Existing","PPO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","35670IL0070008-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68231","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810039","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS012","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9964",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810039-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","Yes","36-1236610","36096IL0830001","BlueCare Dental? 1A","36096IL083",,"ILN005","ILS005",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.35","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830001-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf","http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820001","Blue Precision Gold HMO? 001","36096IL082",,"ILN012","ILS032","ILF005","Existing","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820001-00","Standard Gold Off Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820001-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820001","Blue Precision Gold HMO? 001","36096IL082",,"ILN012","ILS032","ILF005","Existing","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820001-01","Standard Gold On Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820001-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820002","Blue Precision Silver HMO? 002","36096IL082",,"ILN012","ILS012","ILF005","Existing","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820002-00","Standard Silver Off Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820002-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810038","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS012","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9969",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810038-01","Standard Silver On Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810049","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS032","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810049-06","94% AV Level Silver Plan","94.14%","0","Yes","Yes","No","100%",,"$300","$30","$80","$200","$200","$80","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810051","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS052","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9966",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810051-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980004","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS014","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980004-00","Standard Silver Off Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980004-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980031","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS074","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980031-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980031-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","35"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950005","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS023","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950005-01","Standard Gold On Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980039","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS034","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980039-01","Standard Gold On Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980039-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820002","Blue Precision Silver HMO? 002","36096IL082",,"ILN012","ILS012","ILF005","Existing","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820002-01","Standard Silver On Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820002-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810039","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS012","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9964",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810039-03","Limited Cost Sharing Plan Variation","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810054","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS022","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9966",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810054-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820006","Blue Precision Gold HMO? 001","36096IL082",,"ILN012","ILS022","ILF005","Existing","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820006-00","Standard Gold Off Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820006-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820006","Blue Precision Gold HMO? 001","36096IL082",,"ILN012","ILS022","ILF005","Existing","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820006-01","Standard Gold On Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820006-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820007","Blue Precision Gold HMO? 001","36096IL082",,"ILN012","ILS012","ILF005","Existing","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820007-01","Standard Gold On Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820007-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810054","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS022","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9966",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810054-03","Limited Cost Sharing Plan Variation","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810055","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS032","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9966",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810055-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820008","Blue Precision Gold HMO? 001","36096IL082",,"ILN012","ILS042","ILF005","Existing","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820008-00","Standard Gold Off Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820008-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820008","Blue Precision Gold HMO? 001","36096IL082",,"ILN012","ILS042","ILF005","Existing","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820008-01","Standard Gold On Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820008-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810055","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS032","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9966",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810055-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810055","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS032","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9966",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810055-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820009","Blue Precision Gold HMO? 001","36096IL082",,"ILN012","ILS052","ILF005","Existing","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820009-00","Standard Gold Off Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820009-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820009","Blue Precision Gold HMO? 001","36096IL082",,"ILN012","ILS052","ILF005","Existing","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820009-01","Standard Gold On Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820009-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810055","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS032","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9966",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810055-03","Limited Cost Sharing Plan Variation","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810056","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS042","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9965",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810056-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820010","Blue Precision Gold HMO? 001","36096IL082",,"ILN012","ILS072","ILF005","Existing","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820010-00","Standard Gold Off Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820010-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820010","Blue Precision Gold HMO? 001","36096IL082",,"ILN012","ILS072","ILF005","Existing","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820010-01","Standard Gold On Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820010-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810056","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS042","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9965",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810056-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810056","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS042","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9965",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810056-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820011","Blue Precision Silver HMO? 002","36096IL082",,"ILN012","ILS022","ILF005","Existing","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820011-00","Standard Silver Off Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820011-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820011","Blue Precision Silver HMO? 002","36096IL082",,"ILN012","ILS022","ILF005","Existing","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820011-01","Standard Silver On Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820011-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810056","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS042","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9965",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810056-03","Limited Cost Sharing Plan Variation","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810057","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS052","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9961",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810057-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820012","Blue Precision Silver HMO? 002","36096IL082",,"ILN012","ILS032","ILF005","Existing","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820012-00","Standard Silver Off Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820012-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820012","Blue Precision Silver HMO? 002","36096IL082",,"ILN012","ILS032","ILF005","Existing","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820012-01","Standard Silver On Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820012-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810057","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS052","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9961",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810057-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810057","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS052","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9961",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810057-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820013","Blue Precision Silver HMO? 002","36096IL082",,"ILN012","ILS042","ILF005","Existing","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820013-00","Standard Silver Off Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820013-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820013","Blue Precision Silver HMO? 002","36096IL082",,"ILN012","ILS042","ILF005","Existing","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820013-01","Standard Silver On Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820013-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810057","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS052","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9961",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810057-03","Limited Cost Sharing Plan Variation","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820014","Blue Precision Silver HMO? 002","36096IL082",,"ILN012","ILS052","ILF005","Existing","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820014-00","Standard Silver Off Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820014-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820014","Blue Precision Silver HMO? 002","36096IL082",,"ILN012","ILS052","ILF005","Existing","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820014-01","Standard Silver On Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820014-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810058","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS072","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9963",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810058-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810058","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS072","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9963",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810058-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820015","Blue Precision Silver HMO? 002","36096IL082",,"ILN012","ILS072","ILF005","Existing","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820015-00","Standard Silver Off Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820015-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820015","Blue Precision Silver HMO? 002","36096IL082",,"ILN012","ILS072","ILF005","Existing","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820015-01","Standard Silver On Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820015-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810058","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS072","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9963",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810058-03","Limited Cost Sharing Plan Variation","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810059","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS082","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9962",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810059-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820033","Blue Precision Bronze HMO? 008","36096IL082",,"ILN012","ILS012","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820033-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820033-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820033","Blue Precision Bronze HMO? 008","36096IL082",,"ILN012","ILS012","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820033-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820033-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810059","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS082","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9962",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810059-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810059","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS082","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9962",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810059-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","30"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820044","Blue Precision Bronze HMO? 008","36096IL082",,"ILN012","ILS022","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820044-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820044-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","30"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820044","Blue Precision Bronze HMO? 008","36096IL082",,"ILN012","ILS022","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820044-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820044-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","31"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810059","Blue Precision Bronze HMO?  103","36096IL081",,"ILN002","ILS082","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9962",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810059-03","Limited Cost Sharing Plan Variation","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810039-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","31"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810037","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS012","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810037-00","Standard Gold Off Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","32"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820045","Blue Precision Bronze HMO? 008","36096IL082",,"ILN012","ILS032","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820045-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820045-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","32"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820045","Blue Precision Bronze HMO? 008","36096IL082",,"ILN012","ILS032","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820045-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820045-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","33"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810037","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS012","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810037-01","Standard Gold On Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","33"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810037","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS012","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810037-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","34"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820046","Blue Precision Bronze HMO? 008","36096IL082",,"ILN012","ILS042","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820046-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820046-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","34"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820046","Blue Precision Bronze HMO? 008","36096IL082",,"ILN012","ILS042","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820046-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820046-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","35"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","Individual","No","36-1236610","36096IL0810037","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS012","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810037-03","Limited Cost Sharing Plan Variation","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","35"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820047","Blue Precision Bronze HMO? 008","36096IL082",,"ILN012","ILS052","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820047-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820047-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","36"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820047","Blue Precision Bronze HMO? 008","36096IL082",,"ILN012","ILS052","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820047-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820047-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","37"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820048","Blue Precision Bronze HMO? 008","36096IL082",,"ILN012","ILS072","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820048-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820048-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","38"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820048","Blue Precision Bronze HMO? 008","36096IL082",,"ILN012","ILS072","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820048-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820048-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","39"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810042","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS022","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810042-01","Standard Gold On Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","Yes","36-1236610","36096IL0830003","BlueCare Dental 4 Kids? 1A","36096IL083",,"ILN005","ILS005",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$32.35","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830003-01","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf","http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960001","BlueCare Direct Gold? 001 with Advocate","36096IL096",,"ILN013","ILS013","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960001-01","Standard Gold On Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960001-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960002","BlueCare Direct Silver? 002 with Advocate","36096IL096",,"ILN013","ILS013","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960002-00","Standard Silver Off Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960002-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960012","BlueCare Direct Silver? 002 with Advocate","36096IL096",,"ILN013","ILS033","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960012-01","Standard Silver On Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960012-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960013","BlueCare Direct Silver? 002 with Advocate","36096IL096",,"ILN013","ILS043","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960013-00","Standard Silver Off Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960013-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810046","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS072","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810046-00","Standard Gold Off Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980001","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS014","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980001-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980001-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810042","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS022","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810042-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810042","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS022","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810042-03","Limited Cost Sharing Plan Variation","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960002","BlueCare Direct Silver? 002 with Advocate","36096IL096",,"ILN013","ILS013","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960002-01","Standard Silver On Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960002-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960004","BlueCare Direct Bronze? 004 with Advocate","36096IL096",,"ILN013","ILS013","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960004-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960004-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810043","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS032","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810043-00","Standard Gold Off Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810043","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS032","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810043-01","Standard Gold On Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960004","BlueCare Direct Bronze? 004 with Advocate","36096IL096",,"ILN013","ILS013","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960004-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960004-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960008","BlueCare Direct Gold? 001 with Advocate","36096IL096",,"ILN013","ILS023","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960008-00","Standard Gold Off Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960008-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810043","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS032","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810043-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810043","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS032","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810043-03","Limited Cost Sharing Plan Variation","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960008","BlueCare Direct Gold? 001 with Advocate","36096IL096",,"ILN013","ILS023","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960008-01","Standard Gold On Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960008-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960009","BlueCare Direct Gold? 001 with Advocate","36096IL096",,"ILN013","ILS033","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960009-00","Standard Gold Off Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960009-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810044","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS042","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810044-00","Standard Gold Off Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810044","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS042","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810044-01","Standard Gold On Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960009","BlueCare Direct Gold? 001 with Advocate","36096IL096",,"ILN013","ILS033","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960009-01","Standard Gold On Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960009-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960010","BlueCare Direct Gold? 001 with Advocate","36096IL096",,"ILN013","ILS043","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960010-00","Standard Gold Off Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960010-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810044","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS042","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810044-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810044","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS042","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810044-03","Limited Cost Sharing Plan Variation","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960010","BlueCare Direct Gold? 001 with Advocate","36096IL096",,"ILN013","ILS043","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960010-01","Standard Gold On Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960010-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960011","BlueCare Direct Silver? 002 with Advocate","36096IL096",,"ILN013","ILS023","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960011-00","Standard Silver Off Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960011-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810045","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS052","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810045-00","Standard Gold Off Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810045","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS052","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810045-01","Standard Gold On Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960011","BlueCare Direct Silver? 002 with Advocate","36096IL096",,"ILN013","ILS023","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960011-01","Standard Silver On Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960011-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960012","BlueCare Direct Silver? 002 with Advocate","36096IL096",,"ILN013","ILS033","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960012-00","Standard Silver Off Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960012-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810045","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS052","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810045-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810045","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS052","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810045-03","Limited Cost Sharing Plan Variation","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810046","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS072","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810046-01","Standard Gold On Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960013","BlueCare Direct Silver? 002 with Advocate","36096IL096",,"ILN013","ILS043","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960013-01","Standard Silver On Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960013-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960017","BlueCare Direct Bronze? 004 with Advocate","36096IL096",,"ILN013","ILS023","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960017-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960017-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810046","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS072","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810046-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810046","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS072","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810046-03","Limited Cost Sharing Plan Variation","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960017","BlueCare Direct Bronze? 004 with Advocate","36096IL096",,"ILN013","ILS023","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960017-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960017-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960018","BlueCare Direct Bronze? 004 with Advocate","36096IL096",,"ILN013","ILS033","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960018-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960018-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810047","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS082","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810047-00","Standard Gold Off Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810047","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS082","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810047-01","Standard Gold On Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960018","BlueCare Direct Bronze? 004 with Advocate","36096IL096",,"ILN013","ILS033","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960018-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960018-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960019","BlueCare Direct Bronze? 004 with Advocate","36096IL096",,"ILN013","ILS043","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960019-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960019-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810047","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS082","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810047-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810047","Blue Precision Gold HMO?  101","36096IL081",,"ILN002","ILS082","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810047-03","Limited Cost Sharing Plan Variation","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810037-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0960019","BlueCare Direct Bronze? 004 with Advocate","36096IL096",,"ILN013","ILS043","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0960019-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0960019-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810038","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS012","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9969",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810038-00","Standard Silver Off Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810038","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS012","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9969",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810038-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","30"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810038","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS012","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9969",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810038-03","Limited Cost Sharing Plan Variation","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","31"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810038","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS012","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9969",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810038-04","73% AV Level Silver Plan","72.44%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","32"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810038","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS012","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9969",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810038-05","87% AV Level Silver Plan","86.78%","0","Yes","Yes","No","100%",,"$900","$200","$200","$200","$500","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","33"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810038","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS012","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9969",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810038-06","94% AV Level Silver Plan","94.14%","0","Yes","Yes","No","100%",,"$300","$30","$80","$200","$200","$80","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","34"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810048","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS022","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810048-00","Standard Silver Off Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","35"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810048","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS022","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810048-01","Standard Silver On Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","36"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810048","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS022","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810048-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","37"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810048","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS022","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810048-03","Limited Cost Sharing Plan Variation","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","38"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810048","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS022","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810048-04","73% AV Level Silver Plan","72.44%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","39"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810048","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS022","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810048-05","87% AV Level Silver Plan","86.78%","0","Yes","Yes","No","100%",,"$900","$200","$200","$200","$500","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","40"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","2","36096","IL","Individual","No","36-1236610","36096IL0810048","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS022","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810048-06","94% AV Level Silver Plan","94.14%","0","Yes","Yes","No","100%",,"$300","$30","$80","$200","$200","$80","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","41"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810049","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS032","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810049-00","Standard Silver Off Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","Yes","36-1236610","36096IL0830002","BlueCare Dental? 1B","36096IL083",,"ILN005","ILS005",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.23","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830002-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf","http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770001","Blue PPO Gold? 001","36096IL077",,"ILN014","ILS001","ILF001","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0770001-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0770001-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770001","Blue PPO Gold? 001","36096IL077",,"ILN014","ILS001","ILF001","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0770001-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0770001-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","Yes","36-1236610","36096IL0830002","BlueCare Dental? 1B","36096IL083",,"ILN005","ILS005",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.23","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830002-01","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf","http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810049","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS032","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810049-01","Standard Silver On Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810049","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS032","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810049-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770002","Blue PPO Gold? 002","36096IL077",,"ILN014","ILS001","ILF001","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0770002-00","Standard Gold Off Exchange Plan","80.24%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0770002-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770002","Blue PPO Gold? 002","36096IL077",,"ILN014","ILS001","ILF001","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0770002-01","Standard Gold On Exchange Plan","80.24%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0770002-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810049","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS032","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810049-03","Limited Cost Sharing Plan Variation","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810049","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS032","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810049-04","73% AV Level Silver Plan","72.44%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770003","Blue PPO Silver? 003","36096IL077",,"ILN014","ILS001","ILF001","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0770003-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0770003-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770003","Blue PPO Silver? 003","36096IL077",,"ILN014","ILS001","ILF001","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0770003-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$3,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0770003-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810049","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS032","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810049-05","87% AV Level Silver Plan","86.78%","0","Yes","Yes","No","100%",,"$900","$200","$200","$200","$500","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770004","Blue PPO Silver? 004","36096IL077",,"ILN014","ILS001","ILF002","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0770004-00","Standard Silver Off Exchange Plan","70.49%","0","No","Yes","Yes","60%","40%","$3,250","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0770004-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770004","Blue PPO Silver? 004","36096IL077",,"ILN014","ILS001","ILF002","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0770004-01","Standard Silver On Exchange Plan","70.49%","0","No","Yes","Yes","60%","40%","$3,250","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0770004-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810050","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS042","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810050-00","Standard Silver Off Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810050","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS042","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810050-01","Standard Silver On Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770020","Blue PPO Silver? 020","36096IL077",,"ILN014","ILS001","ILF002","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0770020-00","Standard Silver Off Exchange Plan","70.71%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0770020-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770020","Blue PPO Silver? 020","36096IL077",,"ILN014","ILS001","ILF002","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0770020-01","Standard Silver On Exchange Plan","70.71%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0770020-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810050","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS042","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810050-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810050","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS042","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810050-03","Limited Cost Sharing Plan Variation","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980001","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS014","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980001-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980001-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810050","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS042","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810050-04","73% AV Level Silver Plan","72.44%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980028","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS044","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980028-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980028-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980028","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS044","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980028-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980028-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980037","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS134","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980037-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980037-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980043","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS074","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980043-00","Standard Gold Off Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980043-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950007","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS043","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950007-00","Standard Gold Off Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$100","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950001-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980050","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS024","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980050-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980050-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","30"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950010","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS043","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","43"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810050","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS042","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810050-05","87% AV Level Silver Plan","86.78%","0","Yes","Yes","No","100%",,"$900","$200","$200","$200","$500","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980002","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS014","ILF002","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980002-00","Standard Gold Off Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980002-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980002","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS014","ILF002","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980002-01","Standard Gold On Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980002-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810050","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS042","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.997",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810050-06","94% AV Level Silver Plan","94.14%","0","Yes","Yes","No","100%",,"$300","$30","$80","$200","$200","$80","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810051","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS052","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9966",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810051-00","Standard Silver Off Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980003","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS014","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980003-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980003-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980003","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS014","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980003-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980003-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810051","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS052","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9966",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810051-01","Standard Silver On Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980004","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS014","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980004-01","Standard Silver On Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980004-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810051","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS052","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9966",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810051-03","Limited Cost Sharing Plan Variation","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810051","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS052","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9966",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810051-04","73% AV Level Silver Plan","72.44%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980008","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS014","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980008-00","Standard Silver Off Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980008-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980008","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS014","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980008-01","Standard Silver On Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980008-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810051","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS052","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9966",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810051-05","87% AV Level Silver Plan","86.78%","0","Yes","Yes","No","100%",,"$900","$200","$200","$200","$500","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810051","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS052","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9966",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810051-06","94% AV Level Silver Plan","94.14%","0","Yes","Yes","No","100%",,"$300","$30","$80","$200","$200","$80","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980026","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS024","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980026-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980026-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980026","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS024","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980026-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980026-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810052","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS072","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810052-00","Standard Silver Off Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810052","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS072","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810052-01","Standard Silver On Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980027","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS034","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980027-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980027-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980027","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS034","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980027-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980027-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810052","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS072","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810052-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810052","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS072","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810052-03","Limited Cost Sharing Plan Variation","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810052","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS072","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810052-04","73% AV Level Silver Plan","72.44%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810052","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS072","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810052-05","87% AV Level Silver Plan","86.78%","0","Yes","Yes","No","100%",,"$900","$200","$200","$200","$500","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","30"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980029","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS054","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980029-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980029-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","30"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980029","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS054","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980029-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980029-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","31"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810052","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS072","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9968",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810052-06","94% AV Level Silver Plan","94.14%","0","Yes","Yes","No","100%",,"$300","$30","$80","$200","$200","$80","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","31"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810053","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS082","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810053-00","Standard Silver Off Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","32"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980030","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS064","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980030-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980030-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","32"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980030","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS064","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980030-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980030-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","33"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810053","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS082","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810053-01","Standard Silver On Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","33"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810053","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS082","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810053-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","34"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980031","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS074","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980031-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980031-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","34"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810053","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS082","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810053-03","Limited Cost Sharing Plan Variation","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","35"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810053","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS082","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810053-04","73% AV Level Silver Plan","72.44%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","36"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980032","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS084","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980032-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980032-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","36"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980032","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS084","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980032-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980032-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","37"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810053","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS082","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810053-05","87% AV Level Silver Plan","86.78%","0","Yes","Yes","No","100%",,"$900","$200","$200","$200","$500","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","37"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","Individual","No","36-1236610","36096IL0810053","Blue Precision Silver HMO? 102","36096IL081",,"ILN002","ILS082","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0810053-06","94% AV Level Silver Plan","94.14%","0","Yes","Yes","No","100%",,"$300","$30","$80","$200","$200","$80","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0810038-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","38"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980033","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS094","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980033-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980033-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","38"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980033","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS094","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980033-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980033-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","39"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980034","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS104","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980034-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980034-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","40"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980034","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS104","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980034-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980034-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","41"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980035","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS114","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980035-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980035-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","42"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980035","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS114","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980035-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980035-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","43"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980036","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS124","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980036-00","Standard Gold Off Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980036-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","44"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980036","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS124","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980036-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980036-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","45"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","Yes","36-1236610","36096IL0830004","BlueCare Dental 4 Kids? 1B","36096IL083",,"ILN005","ILS005",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$25.23","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830004-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf","http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950001","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS013","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950001-00","Standard Gold Off Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$100","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950001-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950001","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS013","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950001-01","Standard Gold On Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","Yes","36-1236610","36096IL0830004","BlueCare Dental 4 Kids? 1B","36096IL083",,"ILN005","ILS005",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$25.23","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","","36096IL0830004-01","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf","http://www.bcbsil.com/PDF/bluecare-dental-individuals-and-families-il.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980037","Blue Choice Preferred Gold PPO? 001","36096IL098",,"ILN011","ILS134","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980037-01","Standard Gold On Exchange Plan","78.54%","0","No","Yes","Yes","60%","40%","$3,300","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","$3,250","$3250 per person","$9750 per group","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$9750 per group","0%","$3,250","$3250 per person","$9750 per group","0%","$6,500","$6500 per person","$19500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980037-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980038","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS024","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980038-00","Standard Gold Off Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980038-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950001","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS013","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950001","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS013","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950001-03","Limited Cost Sharing Plan Variation","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980038","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS024","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980038-01","Standard Gold On Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980038-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980039","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS034","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980039-00","Standard Gold Off Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980039-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950005","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS023","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950005-00","Standard Gold Off Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$100","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950001-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980040","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS044","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980040-00","Standard Gold Off Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980040-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950005","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS023","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950005","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS023","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950005-03","Limited Cost Sharing Plan Variation","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980040","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS044","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980040-01","Standard Gold On Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980040-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980041","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS054","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980041-00","Standard Gold Off Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980041-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950006","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS033","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950006-00","Standard Gold Off Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$100","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950001-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950006","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS033","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950006-01","Standard Gold On Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980041","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS054","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980041-01","Standard Gold On Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980041-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980042","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS064","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980042-00","Standard Gold Off Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980042-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950006","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS033","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950006","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS033","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950006-03","Limited Cost Sharing Plan Variation","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980042","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS064","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980042-01","Standard Gold On Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980042-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950007","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS043","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950007-01","Standard Gold On Exchange Plan","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980043","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS074","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980043-01","Standard Gold On Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980043-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980044","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS084","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980044-00","Standard Gold Off Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980044-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950007","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS043","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950007","BlueCare Direct Gold? 101 with Advocate","36096IL095",,"ILN003","ILS043","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950007-03","Limited Cost Sharing Plan Variation","78.52%","0","Yes","Yes","No","100%",,"$2,200","$200","$900","$200","$1,800","$30","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$5250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980044","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS084","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980044-01","Standard Gold On Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980044-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980045","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS094","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980045-00","Standard Gold Off Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980045-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950002","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS013","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9965",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950002-00","Standard Silver Off Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950002","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS013","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9965",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950002-01","Standard Silver On Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980045","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS094","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980045-01","Standard Gold On Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980045-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980046","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS104","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980046-00","Standard Gold Off Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980046-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950002","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS013","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9965",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950002","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS013","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9965",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950002-03","Limited Cost Sharing Plan Variation","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980046","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS104","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980046-01","Standard Gold On Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980046-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980047","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS114","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980047-00","Standard Gold Off Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980047-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980054","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS064","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980054-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980054-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","38"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980059","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS114","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980059-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980059-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","48"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950003","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS013","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.996",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950003-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950003-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","48"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990069","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS024","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990069-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990076","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS094","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990076-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980100","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS044","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980100-00","Standard Silver Off Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980100-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950002","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS013","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9965",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950002-04","73% AV Level Silver Plan","72.44%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950002","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS013","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9965",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950002-05","87% AV Level Silver Plan","86.78%","0","Yes","Yes","No","100%",,"$900","$200","$200","$200","$500","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980047","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS114","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980047-01","Standard Gold On Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980047-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980048","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS124","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980048-00","Standard Gold Off Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980048-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950002","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS013","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9965",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950002-06","94% AV Level Silver Plan","94.14%","0","Yes","Yes","No","100%",,"$300","$30","$80","$200","$200","$80","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950008","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS023","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950008-00","Standard Silver Off Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980048","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS124","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980048-01","Standard Gold On Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980048-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980049","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS134","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980049-00","Standard Gold Off Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980049-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950008","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS023","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950008-01","Standard Silver On Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950008","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS023","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980049","Blue Choice Preferred Gold PPO? 002","36096IL098",,"ILN011","ILS134","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980049-01","Standard Gold On Exchange Plan","80.16%","0","No","Yes","Yes","60%","40%","$1,700","$10","$1,000","$200","$1,500","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","$3,500","$3500 per person","$10500 per group","$7,000","$7000 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4000 per group","20%","$1,500","$1500 per person","$4000 per group","20%","$3,000","$3000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980049-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950008","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS023","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950008-03","Limited Cost Sharing Plan Variation","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","30"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950008","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS023","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950008-04","73% AV Level Silver Plan","72.44%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","31"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980050","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS024","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980050-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980050-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","31"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980051","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS034","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980051-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980051-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","32"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950008","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS023","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950008-05","87% AV Level Silver Plan","86.78%","0","Yes","Yes","No","100%",,"$900","$200","$200","$200","$500","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","32"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950008","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS023","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950008-06","94% AV Level Silver Plan","94.14%","0","Yes","Yes","No","100%",,"$300","$30","$80","$200","$200","$80","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","33"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980051","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS034","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980051-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980051-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","33"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980052","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS044","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980052-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980052-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","34"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950009","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS033","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950009-00","Standard Silver Off Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","34"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950009","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS033","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950009-01","Standard Silver On Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","35"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980052","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS044","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980052-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980052-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","35"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980053","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS054","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980053-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980053-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","36"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950009","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS033","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","36"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950009","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS033","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950009-03","Limited Cost Sharing Plan Variation","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","37"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980053","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS054","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980053-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980053-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","37"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950009","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS033","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950009-04","73% AV Level Silver Plan","72.44%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","38"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950009","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS033","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950009-05","87% AV Level Silver Plan","86.78%","0","Yes","Yes","No","100%",,"$900","$200","$200","$200","$500","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","39"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980054","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS064","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980054-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980054-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","39"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980055","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS074","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980055-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980055-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","40"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950009","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS033","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950009-06","94% AV Level Silver Plan","94.14%","0","Yes","Yes","No","100%",,"$300","$30","$80","$200","$200","$80","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","40"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950010","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS043","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950010-00","Standard Silver Off Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","41"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980055","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS074","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980055-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980055-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","41"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980056","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS084","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980056-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980056-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","42"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950010","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS043","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950010-01","Standard Silver On Exchange Plan","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","42"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980056","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS084","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980056-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980056-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","43"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950012","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS033","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9962",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950012-03","Limited Cost Sharing Plan Variation","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","59"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950013","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS043","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9962",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950013-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950003-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","60"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980067","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS074","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980067-01","Standard Silver On Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980067-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990070","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS034","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990070-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980098","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS024","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980098-00","Standard Silver Off Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980098-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980098","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS024","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980098-01","Standard Silver On Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980098-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980103","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS074","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980103-00","Standard Silver Off Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980103-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980057","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS094","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980057-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980057-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","44"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950010","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS043","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950010-03","Limited Cost Sharing Plan Variation","70.39%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","44"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950010","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS043","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950010-04","73% AV Level Silver Plan","72.44%","0","Yes","Yes","No","100%",,"$2,800","$200","$800","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","45"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980057","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS094","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980057-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980057-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","45"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980058","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS104","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980058-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980058-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","46"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950010","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS043","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950010-05","87% AV Level Silver Plan","86.78%","0","Yes","Yes","No","100%",,"$900","$200","$200","$200","$500","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","46"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950010","BlueCare Direct Silver? 102 with Advocate","36096IL095",,"ILN003","ILS043","ILF005","New","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950010-06","94% AV Level Silver Plan","94.14%","0","Yes","Yes","No","100%",,"$300","$30","$80","$200","$200","$80","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","47"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980058","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS104","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980058-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980058-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","47"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950003","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS013","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.996",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950003-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","49"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980059","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS114","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980059-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980059-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","49"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980060","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS124","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980060-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980060-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","50"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950003","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS013","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.996",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","50"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950003","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS013","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.996",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950003-03","Limited Cost Sharing Plan Variation","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","51"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980060","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS124","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980060-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980060-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","51"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980061","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS134","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980061-00","Standard Silver Off Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980061-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","52"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950011","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS023","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9962",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950011-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950003-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","52"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950011","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS023","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9962",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950011-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","53"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980061","Blue Choice Preferred Silver PPO? 003","36096IL098",,"ILN011","ILS134","ILF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980061-01","Standard Silver On Exchange Plan","68.60%","0","No","Yes","Yes","60%","40%","$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","$6,000","$6000 per person","$12700 per group","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12700 per group","0%","$6,000","$6000 per person","$12700 per group","0%","$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980061-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","53"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950011","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS023","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9962",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","54"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950011","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS023","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9962",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950011-03","Limited Cost Sharing Plan Variation","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","55"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950012","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS033","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9962",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950012-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950003-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","56"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950012","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS033","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9962",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950012-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","57"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950012","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS033","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9962",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","58"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950013","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS043","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9962",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950013-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","61"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950013","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS043","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9962",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","62"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","4","36096","IL","Individual","No","36-1236610","36096IL0950013","BlueCare Direct Bronze? 103 with Advocate","36096IL095",,"ILN003","ILS043","ILF005","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9962",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only.","No","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0950013-03","Limited Cost Sharing Plan Variation","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$300","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0950003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","63"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990005","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS014","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990005-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980062","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS024","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980062-00","Standard Silver Off Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980062-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980062","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS024","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980062-01","Standard Silver On Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980062-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990005","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS014","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990005-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990005","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS014","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980063","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS034","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980063-00","Standard Silver Off Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980063-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980063","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS034","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980063-01","Standard Silver On Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980063-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990005","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS014","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990005-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980064","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS044","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980064-00","Standard Silver Off Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980064-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980064","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS044","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980064-01","Standard Silver On Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980064-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990069","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS024","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990069-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990069","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS024","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990069-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980065","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS054","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980065-00","Standard Silver Off Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980065-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980065","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS054","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980065-01","Standard Silver On Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980065-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990069","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS024","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990069-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990070","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS034","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990070-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980066","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS064","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980066-00","Standard Silver Off Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980066-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980066","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS064","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980066-01","Standard Silver On Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980066-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990070","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS034","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990070-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990070","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS034","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990070-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980067","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS074","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980067-00","Standard Silver Off Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980067-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990071","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS044","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990071-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980068","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS084","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980068-00","Standard Silver Off Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980068-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980068","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS084","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980068-01","Standard Silver On Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980068-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990071","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS044","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990071-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990071","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS044","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990071-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980069","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS094","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980069-00","Standard Silver Off Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980069-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980069","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS094","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980069-01","Standard Silver On Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980069-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990071","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS044","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990071-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990072","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS054","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990072-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980070","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS104","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980070-00","Standard Silver Off Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980070-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980070","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS104","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980070-01","Standard Silver On Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980070-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990072","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS054","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990072-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990072","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS054","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990072-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980071","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS114","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980071-00","Standard Silver Off Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980071-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980071","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS114","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980071-01","Standard Silver On Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980071-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990072","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS054","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990072-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990073","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS064","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990073-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980072","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS124","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980072-00","Standard Silver Off Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980072-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980072","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS124","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980072-01","Standard Silver On Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980072-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990073","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS064","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990073-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990073","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS064","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990073-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980073","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS134","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980073-00","Standard Silver Off Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980073-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980073","Blue Choice Preferred Silver PPO? 004","36096IL098",,"ILN011","ILS134","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980073-01","Standard Silver On Exchange Plan","70.43%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$6,000","$6000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980073-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990073","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS064","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990073-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990074","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS074","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990074-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990074","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS074","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990074-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990074","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS074","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990074-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","30"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990074","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS074","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990074-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","31"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990075","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS084","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990075-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","32"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990075","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS084","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990075-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","33"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990075","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS084","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990075-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","34"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","5","36096","IL","Individual","No","36-1236610","36096IL0990075","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS084","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990075-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","35"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990076","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS094","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990076-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980099","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS034","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980099-00","Standard Silver Off Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980099-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980099","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS034","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980099-01","Standard Silver On Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980099-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990076","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS094","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990076-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980100","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS044","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980100-01","Standard Silver On Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980100-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990076","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS094","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990076-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990077","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS104","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990077-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990088","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS094","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990088-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990088","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS094","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990088-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990089","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS104","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990089-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980076","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS044","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980076-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980076-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980076","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS044","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980076-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980076-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980101","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS054","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980101-00","Standard Silver Off Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980101-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980101","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS054","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980101-01","Standard Silver On Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980101-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990077","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS104","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990077-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990077","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS104","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990077-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980102","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS064","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980102-00","Standard Silver Off Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980102-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980102","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS064","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980102-01","Standard Silver On Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980102-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990077","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS104","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990077-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990078","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS114","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990078-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980103","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS074","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980103-01","Standard Silver On Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980103-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990078","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS114","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990078-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990006","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS014","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990006-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990081","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS024","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990081-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990086","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS074","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990086-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990086","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS074","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990086-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","Individual","No","36-1236610","36096IL0990092","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS134","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990092-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980083","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS114","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980083-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980083-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","30"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990078","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS114","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990078-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980104","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS084","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980104-00","Standard Silver Off Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980104-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980104","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS084","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980104-01","Standard Silver On Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980104-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990078","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS114","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990078-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990079","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS124","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990079-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980105","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS094","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980105-00","Standard Silver Off Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980105-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980105","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS094","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980105-01","Standard Silver On Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980105-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990079","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS124","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990079-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990079","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS124","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990079-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980106","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS104","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980106-00","Standard Silver Off Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980106-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980106","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS104","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980106-01","Standard Silver On Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980106-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990079","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS124","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990079-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990080","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS134","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990080-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980107","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS114","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980107-00","Standard Silver Off Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980107-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980107","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS114","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980107-01","Standard Silver On Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980107-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990080","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS134","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990080-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990080","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS134","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990080-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980108","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS124","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980108-00","Standard Silver Off Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980108-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980108","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS124","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980108-01","Standard Silver On Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980108-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990080","Blue Choice Preferred Bronze PPO? 105","36096IL099",,"ILN001","ILS134","ILF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990080-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$4,500","$0","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$13100 per group","$6,450","$6450 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$13100 per group","30%","$4,500","$4500 per person","$13100 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990005-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990006","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS014","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990006-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980109","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS134","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980109-00","Standard Silver Off Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980109-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980109","Blue Choice Preferred Silver PPO? 008","36096IL098",,"ILN011","ILS134","ILF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980109-01","Standard Silver On Exchange Plan","70.63%","0","No","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$6750 per group","30%","$2,250","$2250 per person","$6750 per group","30%","$4,500","$4500 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980109-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990006","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS014","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990006-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990006","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS014","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990081","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS024","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990081-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990081","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS024","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990081-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","30"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990081","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS024","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990081-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","31"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990082","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS034","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990082-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","32"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990082","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS034","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990082-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","33"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990082","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS034","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990082-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","34"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","6","36096","IL","Individual","No","36-1236610","36096IL0990082","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS034","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990082-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","35"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990083","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS044","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990083-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820054","Blue Precision Gold HMO? 001","36096IL082",,"ILN012","ILS082","ILF005","Existing","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820054-00","Standard Gold Off Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820054-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820054","Blue Precision Gold HMO? 001","36096IL082",,"ILN012","ILS082","ILF005","Existing","HMO","Gold","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820054-01","Standard Gold On Exchange Plan","81.02%","0","No","Yes","No","100%",,"$2,200","$30","$900","$200","$2,000","$30","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820054-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990083","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS044","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990083-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990083","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS044","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990083-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820049","Blue Precision Silver HMO? 002","36096IL082",,"ILN012","ILS082","ILF005","Existing","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820049-00","Standard Silver Off Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820049-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820049","Blue Precision Silver HMO? 002","36096IL082",,"ILN012","ILS082","ILF005","Existing","HMO","Silver","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820049-01","Standard Silver On Exchange Plan","70.67%","0","No","Yes","No","100%",,"$5,300","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820049-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990083","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS044","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990083-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990084","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS054","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990084-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820053","Blue Precision Bronze HMO? 008","36096IL082",,"ILN012","ILS082","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820053-00","Standard Bronze Off Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820053-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820053","Blue Precision Bronze HMO? 008","36096IL082",,"ILN012","ILS082","ILF006","New","HMO","Bronze","Yes","Both","No","Yes","Referrals are required for some services. Please check with your Medical Group for details.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","Coverage outside our service area is available for Emergency and Urgent Care services only","No",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0820053-01","Standard Bronze On Exchange Plan","61.65%","0","Yes","Yes","No","100%",,"$6,800","$0","$100","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13700 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0820053-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990084","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS054","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990084-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990084","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS054","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990084-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990084","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS054","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990084-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990085","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS064","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990085-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990085","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS064","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990085-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990085","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS064","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990085-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990085","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS064","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990085-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990086","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS074","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990086-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990086","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS074","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990086-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990087","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS084","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990087-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990087","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS084","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990087-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990087","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS084","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990087-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990087","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS084","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990087-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990088","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS094","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990088-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990088","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS094","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990088-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990089","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS104","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990089-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990089","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS104","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990089-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","30"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990089","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS104","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990089-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","31"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990090","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS114","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990090-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","32"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990090","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS114","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990090-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","33"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990090","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS114","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990090-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","34"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","7","36096","IL","Individual","No","36-1236610","36096IL0990090","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS114","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990090-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","35"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","Individual","No","36-1236610","36096IL0990091","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS124","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990091-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770006","Blue PPO Bronze? 006","36096IL077",,"ILN014","ILS001","ILF003","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0770006-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0770006-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770006","Blue PPO Bronze? 006","36096IL077",,"ILN014","ILS001","ILF003","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0770006-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0770006-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","Individual","No","36-1236610","36096IL0990091","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS124","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990091-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","Individual","No","36-1236610","36096IL0990091","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS124","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990091-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770032","Blue PPO Bronze? 032","36096IL077",,"ILN014","ILS001","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0770032-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0770032-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770032","Blue PPO Bronze? 032","36096IL077",,"ILN014","ILS001","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0770032-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0770032-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","Individual","No","36-1236610","36096IL0990091","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS124","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990091-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980006","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS014","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980006-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980006-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980006","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS014","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980006-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980006-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","Individual","No","36-1236610","36096IL0990092","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS134","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990092-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","Individual","No","36-1236610","36096IL0990092","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS134","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990092-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980022","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS014","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980022-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980022-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980022","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS014","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980022-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980022-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","Individual","No","36-1236610","36096IL0990092","Blue Choice Preferred Bronze PPO? 106","36096IL099",,"ILN001","ILS134","ILF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990092-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$13100 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990006-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980074","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS024","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980074-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980074-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980074","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS024","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980074-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980074-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980075","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS034","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980075-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980075-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980075","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS034","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980075-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980075-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980077","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS054","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980077-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980077-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980077","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS054","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980077-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980077-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980147","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS034","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980147-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980147-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","38"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980147","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS034","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980147-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980147-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","39"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980148","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS044","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980148-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980148-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","40"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980148","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS044","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980148-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980148-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","41"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990093","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS024","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990093-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","10","36096","IL","Individual","No","36-1236610","36096IL0990101","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS104","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990101-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980078","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS064","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980078-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980078-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980078","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS064","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980078-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980078-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980079","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS074","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980079-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980079-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980079","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS074","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980079-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980079-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980080","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS084","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980080-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980080-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980080","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS084","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980080-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980080-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980081","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS094","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980081-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980081-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980081","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS094","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980081-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980081-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980082","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS104","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980082-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980082-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980082","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS104","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980082-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980082-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980083","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS114","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980083-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980083-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","31"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990097","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS064","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990097-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990097","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS064","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990097-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990097","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS064","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990097-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990098","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS074","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990098-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990098","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS074","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990098-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990025","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS064","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990025-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990026","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS074","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990026-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980084","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS124","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980084-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980084-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","32"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980084","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS124","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980084-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980084-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","33"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980085","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS134","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980085-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980085-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","34"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980085","Blue Choice Preferred Bronze PPO? 006","36096IL098",,"ILN011","ILS134","ILF003","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980085-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group",,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12700 per group","0%",,,,,"$12,000","$12000 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980085-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","35"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980146","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS024","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980146-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980146-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","36"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980146","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS024","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980146-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$2,500","$200","$1,400","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980146-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","37"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980149","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS054","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980149-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980149-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","42"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980149","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS054","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980149-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980149-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","43"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980150","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS064","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980150-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980150-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","44"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980150","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS064","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980150-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980150-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","45"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980151","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS074","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980151-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980151-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","46"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980151","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS074","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980151-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980151-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","47"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980152","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS084","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980152-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980152-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","48"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980152","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS084","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980152-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980152-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","49"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980153","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS094","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980153-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980153-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","50"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980153","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS094","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980153-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980153-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","51"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980154","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS104","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980154-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980154-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","52"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","8","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980154","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS104","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980154-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980154-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","53"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980155","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS114","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980155-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980155-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990007","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS014","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990007-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990007","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS014","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990007-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980155","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS114","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980155-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980155-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980156","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS124","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980156-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980156-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990007","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS014","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990007","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS014","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990007-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980156","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS124","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980156-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980156-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980157","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS134","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980157-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980157-00.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990093","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS024","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990093-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990093","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS024","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990093-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0980157","Blue Choice Preferred Bronze PPO? 022","36096IL098",,"ILN011","ILS134","ILF004","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0980157-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$5,000","$0","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$12900 per group","20%","$5,000","$5000 per person","$12900 per group","20%","$10,000","$10000 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsil.com/PDF/sbc/il/2016/36096IL0980157-01.pdf","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990093","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS024","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990093-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990094","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS034","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990094-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990094","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS034","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990094-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990094","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS034","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990094-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990094","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS034","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990094-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990095","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS044","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990095-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990095","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS044","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990095-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990095","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS044","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990095-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990095","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS044","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990095-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990096","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS054","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990096-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990096","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS054","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990096-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990096","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS054","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990096-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990096","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS054","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990096-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990097","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS064","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990097-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990098","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS074","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990098-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","30"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990098","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS074","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990098-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","31"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990099","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS084","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990099-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","32"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990099","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS084","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990099-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","33"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990099","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS084","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990099-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","34"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","9","36096","IL","Individual","No","36-1236610","36096IL0990099","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS084","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990099-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","35"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","10","36096","IL","Individual","No","36-1236610","36096IL0990100","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS094","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990100-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","10","36096","IL","Individual","No","36-1236610","36096IL0990100","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS094","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990100-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","10","36096","IL","Individual","No","36-1236610","36096IL0990100","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS094","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990100-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","10","36096","IL","Individual","No","36-1236610","36096IL0990100","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS094","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990100-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","10","36096","IL","Individual","No","36-1236610","36096IL0990101","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS104","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990101-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","10","36096","IL","Individual","No","36-1236610","36096IL0990101","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS104","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990101-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","10","36096","IL","Individual","No","36-1236610","36096IL0990101","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS104","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990101-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","10","36096","IL","Individual","No","36-1236610","36096IL0990102","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS114","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990102-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990023","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS044","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990023-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","12","36096","IL","Individual","No","36-1236610","36096IL0990029","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS104","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990029-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","12","36096","IL","Individual","No","36-1236610","36096IL0990029","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS104","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990029-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","12","36096","IL","Individual","No","36-1236610","36096IL0990029","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS104","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990029-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","12","36096","IL","Individual","No","36-1236610","36096IL0990029","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS104","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990029-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","10","36096","IL","Individual","No","36-1236610","36096IL0990102","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS114","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990102-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","10","36096","IL","Individual","No","36-1236610","36096IL0990102","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS114","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990102-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","10","36096","IL","Individual","No","36-1236610","36096IL0990102","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS114","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990102-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","10","36096","IL","Individual","No","36-1236610","36096IL0990103","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS124","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990103-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","10","36096","IL","Individual","No","36-1236610","36096IL0990103","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS124","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990103-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","10","36096","IL","Individual","No","36-1236610","36096IL0990103","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS124","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990103-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","10","36096","IL","Individual","No","36-1236610","36096IL0990103","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS124","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990103-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","10","36096","IL","Individual","No","36-1236610","36096IL0990104","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS134","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990104-00","Standard Bronze Off Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","10","36096","IL","Individual","No","36-1236610","36096IL0990104","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS134","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990104-01","Standard Bronze On Exchange Plan","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","10","36096","IL","Individual","No","36-1236610","36096IL0990104","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS134","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990104-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","10","36096","IL","Individual","No","36-1236610","36096IL0990104","Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit","36096IL099",,"ILN001","ILS134","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990104-03","Limited Cost Sharing Plan Variation","61.75%","0","Yes","Yes","Yes","60%","40%","$7,300","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13700 per group","20%","$6,800","$6800 per person","$13700 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990007-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990001","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS014","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990001-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990001","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS014","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990001-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990001","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS014","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990001","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS014","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990001-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990021","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS024","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990021-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990021","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS024","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990021-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990021","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS024","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990021-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990021","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS024","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990021-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990022","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS034","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990022-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990022","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS034","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990022-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990022","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS034","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990022-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990022","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS034","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990022-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990023","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS044","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990023-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990023","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS044","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990023-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990023","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS044","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990023-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990024","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS054","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990024-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990024","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS054","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990024-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990024","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS054","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990024-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990024","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS054","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990024-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990025","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS064","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990025-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990025","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS064","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990025-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990025","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS064","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990025-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990026","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS074","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990026-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990026","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS074","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990026-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","30"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990026","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS074","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990026-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","31"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","14","36096","IL","Individual","No","36-1236610","36096IL0990020","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS134","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990020-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990002","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS014","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990002-00","Standard Silver Off Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990002","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS014","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990002-01","Standard Silver On Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990002","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS014","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990002","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS014","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990002-03","Limited Cost Sharing Plan Variation","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990027","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS084","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990027-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","32"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990027","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS084","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990027-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","33"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990027","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS084","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990027-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","34"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","11","36096","IL","Individual","No","36-1236610","36096IL0990027","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS084","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990027-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","35"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","12","36096","IL","Individual","No","36-1236610","36096IL0990028","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS094","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990028-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","12","36096","IL","Individual","No","36-1236610","36096IL0990028","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS094","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990028-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","12","36096","IL","Individual","No","36-1236610","36096IL0990028","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS094","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990028-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","12","36096","IL","Individual","No","36-1236610","36096IL0990028","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS094","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990028-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","12","36096","IL","Individual","No","36-1236610","36096IL0990030","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS114","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990030-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","12","36096","IL","Individual","No","36-1236610","36096IL0990030","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS114","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990030-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","12","36096","IL","Individual","No","36-1236610","36096IL0990030","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS114","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990030-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","12","36096","IL","Individual","No","36-1236610","36096IL0990030","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS114","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990030-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","12","36096","IL","Individual","No","36-1236610","36096IL0990031","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS124","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990031-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","12","36096","IL","Individual","No","36-1236610","36096IL0990031","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS124","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990031-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","12","36096","IL","Individual","No","36-1236610","36096IL0990031","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS124","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990031-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","12","36096","IL","Individual","No","36-1236610","36096IL0990031","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS124","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990031-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","12","36096","IL","Individual","No","36-1236610","36096IL0990032","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS134","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990032-00","Standard Gold Off Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","12","36096","IL","Individual","No","36-1236610","36096IL0990032","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS134","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990032-01","Standard Gold On Exchange Plan","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","12","36096","IL","Individual","No","36-1236610","36096IL0990032","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS134","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990032-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","12","36096","IL","Individual","No","36-1236610","36096IL0990032","Blue Choice Preferred Gold PPO? 101","36096IL099",,"ILN001","ILS134","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990032-03","Limited Cost Sharing Plan Variation","78.48%","0","Yes","Yes","Yes","60%","40%","$800","$20","$1,400","$200","$500","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$13700 per group","$5,250","$5250 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","30%","$500","$500 per person","$1500 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990001-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","13","36096","IL","Individual","No","36-1236610","36096IL0990008","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS014","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990008-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","13","36096","IL","Individual","No","36-1236610","36096IL0990008","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS014","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990008-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","13","36096","IL","Individual","No","36-1236610","36096IL0990009","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS024","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990009-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","13","36096","IL","Individual","No","36-1236610","36096IL0990009","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS024","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990009-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","13","36096","IL","Individual","No","36-1236610","36096IL0990010","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS034","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990010-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","13","36096","IL","Individual","No","36-1236610","36096IL0990010","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS034","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990010-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","13","36096","IL","Individual","No","36-1236610","36096IL0990011","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS044","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990011-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","13","36096","IL","Individual","No","36-1236610","36096IL0990011","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS044","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990011-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","13","36096","IL","Individual","No","36-1236610","36096IL0990012","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS054","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990012-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","13","36096","IL","Individual","No","36-1236610","36096IL0990012","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS054","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990012-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","13","36096","IL","Individual","No","36-1236610","36096IL0990013","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS064","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990013-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","13","36096","IL","Individual","No","36-1236610","36096IL0990013","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS064","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","13","36096","IL","Individual","No","36-1236610","36096IL0990014","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS074","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990014-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","13","36096","IL","Individual","No","36-1236610","36096IL0990014","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS074","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990014-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990034","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS034","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990034-03","Limited Cost Sharing Plan Variation","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990034","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS034","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990034-04","73% AV Level Silver Plan","73.30%","0","Yes","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$3,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990034","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS034","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990034-05","87% AV Level Silver Plan","86.46%","0","Yes","Yes","Yes","60%","40%","$700","$10","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990034","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS034","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990034-06","94% AV Level Silver Plan","93.33%","0","Yes","Yes","Yes","60%","40%","$500","$10","$200","$200","$0","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990038","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS074","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990038-04","73% AV Level Silver Plan","73.30%","0","Yes","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$3,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","50"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990042","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS114","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990042-05","87% AV Level Silver Plan","86.46%","0","Yes","Yes","Yes","60%","40%","$700","$10","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990042","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS114","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990042-06","94% AV Level Silver Plan","93.33%","0","Yes","Yes","Yes","60%","40%","$500","$10","$200","$200","$0","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","13","36096","IL","Individual","No","36-1236610","36096IL0990015","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS084","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990015-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","13","36096","IL","Individual","No","36-1236610","36096IL0990015","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS084","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990015-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","14","36096","IL","Individual","No","36-1236610","36096IL0990016","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS094","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990016-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","14","36096","IL","Individual","No","36-1236610","36096IL0990016","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS094","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990016-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","14","36096","IL","Individual","No","36-1236610","36096IL0990017","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS104","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990017-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","14","36096","IL","Individual","No","36-1236610","36096IL0990017","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS104","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990017-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","14","36096","IL","Individual","No","36-1236610","36096IL0990018","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS114","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990018-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","14","36096","IL","Individual","No","36-1236610","36096IL0990018","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS114","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990018-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","14","36096","IL","Individual","No","36-1236610","36096IL0990019","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS124","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990019-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","14","36096","IL","Individual","No","36-1236610","36096IL0990019","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS124","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990019-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","14","36096","IL","Individual","No","36-1236610","36096IL0990020","Blue Choice Preferred Security PPO? 100","36096IL099",,"ILN001","ILS134","ILF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990020-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990008-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990002","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS014","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990002-04","73% AV Level Silver Plan","73.30%","0","Yes","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$3,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990002","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS014","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990002-05","87% AV Level Silver Plan","86.46%","0","Yes","Yes","Yes","60%","40%","$700","$10","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990002","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS014","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990002-06","94% AV Level Silver Plan","93.33%","0","Yes","Yes","Yes","60%","40%","$500","$10","$200","$200","$0","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990033","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS024","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990033-00","Standard Silver Off Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990033","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS024","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990033-01","Standard Silver On Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990033","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS024","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990033-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990033","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS024","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990033-03","Limited Cost Sharing Plan Variation","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990033","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS024","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990033-04","73% AV Level Silver Plan","73.30%","0","Yes","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$3,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990033","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS024","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990033-05","87% AV Level Silver Plan","86.46%","0","Yes","Yes","Yes","60%","40%","$700","$10","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990033","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS024","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990033-06","94% AV Level Silver Plan","93.33%","0","Yes","Yes","Yes","60%","40%","$500","$10","$200","$200","$0","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990034","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS034","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990034-00","Standard Silver Off Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990034","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS034","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990034-01","Standard Silver On Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990034","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS034","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990034-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990035","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS044","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990035-00","Standard Silver Off Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990035","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS044","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990035-01","Standard Silver On Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990035","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS044","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990035-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990035","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS044","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990035-03","Limited Cost Sharing Plan Variation","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990035","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS044","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990035-04","73% AV Level Silver Plan","73.30%","0","Yes","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$3,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990035","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS044","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990035-05","87% AV Level Silver Plan","86.46%","0","Yes","Yes","Yes","60%","40%","$700","$10","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","30"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990035","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS044","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990035-06","94% AV Level Silver Plan","93.33%","0","Yes","Yes","Yes","60%","40%","$500","$10","$200","$200","$0","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","31"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990036","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS054","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990036-00","Standard Silver Off Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","32"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990036","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS054","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990036-01","Standard Silver On Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","33"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990036","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS054","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990036-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","34"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990036","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS054","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990036-03","Limited Cost Sharing Plan Variation","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","35"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990036","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS054","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990036-04","73% AV Level Silver Plan","73.30%","0","Yes","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$3,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","36"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990036","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS054","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990036-05","87% AV Level Silver Plan","86.46%","0","Yes","Yes","Yes","60%","40%","$700","$10","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","37"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990036","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS054","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990036-06","94% AV Level Silver Plan","93.33%","0","Yes","Yes","Yes","60%","40%","$500","$10","$200","$200","$0","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","38"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990037","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS064","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990037-00","Standard Silver Off Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","39"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990037","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS064","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990037-01","Standard Silver On Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","40"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990037","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS064","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990037-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","41"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990037","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS064","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990037-03","Limited Cost Sharing Plan Variation","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","42"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990037","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS064","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990037-04","73% AV Level Silver Plan","73.30%","0","Yes","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$3,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","43"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990037","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS064","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990037-05","87% AV Level Silver Plan","86.46%","0","Yes","Yes","Yes","60%","40%","$700","$10","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","44"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990037","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS064","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990037-06","94% AV Level Silver Plan","93.33%","0","Yes","Yes","Yes","60%","40%","$500","$10","$200","$200","$0","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","45"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990038","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS074","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990038-00","Standard Silver Off Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","46"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990038","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS074","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990038-01","Standard Silver On Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","47"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990038","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS074","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990038-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","48"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990038","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS074","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990038-03","Limited Cost Sharing Plan Variation","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","49"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990038","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS074","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990038-05","87% AV Level Silver Plan","86.46%","0","Yes","Yes","Yes","60%","40%","$700","$10","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","51"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","15","36096","IL","Individual","No","36-1236610","36096IL0990038","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS074","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990038-06","94% AV Level Silver Plan","93.33%","0","Yes","Yes","Yes","60%","40%","$500","$10","$200","$200","$0","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","52"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990040","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS094","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990040-00","Standard Silver Off Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990040","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS094","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990040-01","Standard Silver On Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990040","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS094","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990040-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990040","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS094","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990040-03","Limited Cost Sharing Plan Variation","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990040","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS094","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990040-04","73% AV Level Silver Plan","73.30%","0","Yes","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$3,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990040","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS094","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990040-05","87% AV Level Silver Plan","86.46%","0","Yes","Yes","Yes","60%","40%","$700","$10","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990040","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS094","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990040-06","94% AV Level Silver Plan","93.33%","0","Yes","Yes","Yes","60%","40%","$500","$10","$200","$200","$0","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990041","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS104","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990041-00","Standard Silver Off Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990041","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS104","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990041-01","Standard Silver On Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990046","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS034","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990046-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990046","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS034","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990046-03","Limited Cost Sharing Plan Variation","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990046","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS034","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990046-04","73% AV Level Silver Plan","72.97%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990041","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS104","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990041-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990041","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS104","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990041-03","Limited Cost Sharing Plan Variation","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990041","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS104","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990041-04","73% AV Level Silver Plan","73.30%","0","Yes","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$3,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990041","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS104","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990041-05","87% AV Level Silver Plan","86.46%","0","Yes","Yes","Yes","60%","40%","$700","$10","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990041","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS104","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990041-06","94% AV Level Silver Plan","93.33%","0","Yes","Yes","Yes","60%","40%","$500","$10","$200","$200","$0","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990042","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS114","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990042-00","Standard Silver Off Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990042","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS114","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990042-01","Standard Silver On Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990042","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS114","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990042-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990042","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS114","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990042-03","Limited Cost Sharing Plan Variation","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990042","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS114","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990042-04","73% AV Level Silver Plan","73.30%","0","Yes","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$3,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990043","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS124","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990043-00","Standard Silver Off Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990043","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS124","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990043-01","Standard Silver On Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990003","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS014","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990003-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990048","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS054","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990048-00","Standard Silver Off Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","32"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990048","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS054","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990048-01","Standard Silver On Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","33"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990048","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS054","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990048-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","34"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990048","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS054","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990048-03","Limited Cost Sharing Plan Variation","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","35"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990053","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS104","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990053-01","Standard Silver On Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990043","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS124","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990043-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990043","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS124","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990043-03","Limited Cost Sharing Plan Variation","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990043","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS124","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990043-04","73% AV Level Silver Plan","73.30%","0","Yes","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$3,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990043","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS124","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990043-05","87% AV Level Silver Plan","86.46%","0","Yes","Yes","Yes","60%","40%","$700","$10","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","30"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990043","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS124","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990043-06","94% AV Level Silver Plan","93.33%","0","Yes","Yes","Yes","60%","40%","$500","$10","$200","$200","$0","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","31"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990044","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS134","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990044-00","Standard Silver Off Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","32"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990044","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS134","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990044-01","Standard Silver On Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","33"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990044","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS134","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990044-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","34"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990044","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS134","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990044-03","Limited Cost Sharing Plan Variation","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","35"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990044","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS134","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990044-04","73% AV Level Silver Plan","73.30%","0","Yes","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$3,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","36"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990044","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS134","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990044-05","87% AV Level Silver Plan","86.46%","0","Yes","Yes","Yes","60%","40%","$700","$10","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","37"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990044","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS134","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990044-06","94% AV Level Silver Plan","93.33%","0","Yes","Yes","Yes","60%","40%","$500","$10","$200","$200","$0","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","38"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990039","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS084","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990039-00","Standard Silver Off Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","39"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990039","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS084","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990039-01","Standard Silver On Exchange Plan","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","40"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990039","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS084","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990039-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","41"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990039","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS084","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990039-03","Limited Cost Sharing Plan Variation","71.27%","0","Yes","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","42"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990039","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS084","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990039-04","73% AV Level Silver Plan","73.30%","0","Yes","Yes","Yes","60%","40%","$3,100","$0","$0","$200","$3,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10900 per group","$5,400","$5400 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$6000 per group","30%","$2,000","$2000 per person","$6000 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","43"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990039","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS084","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990039-05","87% AV Level Silver Plan","86.46%","0","Yes","Yes","Yes","60%","40%","$700","$10","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4500 per group","$2,000","$2000 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$600 per group","30%","$200","$200 per person","$600 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","44"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","16","36096","IL","Individual","No","36-1236610","36096IL0990039","Blue Choice Preferred Silver PPO? 102","36096IL099",,"ILN001","ILS084","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990039-06","94% AV Level Silver Plan","93.33%","0","Yes","Yes","Yes","60%","40%","$500","$10","$200","$200","$0","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$2100 per group","$700","$700 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990002-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","45"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990003","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS014","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990003-00","Standard Silver Off Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990003","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS014","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990003-01","Standard Silver On Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990003","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS014","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990003","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS014","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990003-03","Limited Cost Sharing Plan Variation","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990003","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS014","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990003-04","73% AV Level Silver Plan","72.97%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990003","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS014","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990003-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990045","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS024","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990045-00","Standard Silver Off Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990045","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS024","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990045-01","Standard Silver On Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990045","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS024","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990045-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990045","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS024","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990045-03","Limited Cost Sharing Plan Variation","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990045","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS024","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990045-04","73% AV Level Silver Plan","72.97%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990045","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS024","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990045-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990045","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS024","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990045-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990046","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS034","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990046-00","Standard Silver Off Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990046","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS034","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990046-01","Standard Silver On Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990046","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS034","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990046-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990046","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS034","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990046-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990055","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS124","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990055-00","Standard Silver Off Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990055","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS124","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990055-01","Standard Silver On Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990055","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS124","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990055-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990055","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS124","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990055-03","Limited Cost Sharing Plan Variation","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990055","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS124","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990055-04","73% AV Level Silver Plan","72.97%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990065","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS104","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990065-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990047","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS044","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990047-00","Standard Silver Off Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990047","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS044","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990047-01","Standard Silver On Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990047","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS044","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990047-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990047","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS044","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990047-03","Limited Cost Sharing Plan Variation","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990047","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS044","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990047-04","73% AV Level Silver Plan","72.97%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990047","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS044","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990047-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","30"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990047","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS044","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990047-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","31"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990048","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS054","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990048-04","73% AV Level Silver Plan","72.97%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","36"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990048","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS054","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990048-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","37"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990048","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS054","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990048-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","38"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990049","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS064","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990049-00","Standard Silver Off Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","39"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990049","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS064","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990049-01","Standard Silver On Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","40"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990049","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS064","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990049-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","41"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990049","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS064","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990049-03","Limited Cost Sharing Plan Variation","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","42"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990049","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS064","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990049-04","73% AV Level Silver Plan","72.97%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","43"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990049","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS064","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990049-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","44"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990049","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS064","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990049-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","45"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990050","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS074","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990050-00","Standard Silver Off Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","46"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990050","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS074","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990050-01","Standard Silver On Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","47"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990050","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS074","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990050-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","48"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990050","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS074","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990050-03","Limited Cost Sharing Plan Variation","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","49"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990050","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS074","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990050-04","73% AV Level Silver Plan","72.97%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","50"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990050","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS074","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990050-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","51"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","17","36096","IL","Individual","No","36-1236610","36096IL0990050","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS074","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990050-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","52"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990052","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS094","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990052-00","Standard Silver Off Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990052","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS094","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990052-01","Standard Silver On Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990052","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS094","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990052-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990052","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS094","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990052-03","Limited Cost Sharing Plan Variation","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990052","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS094","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990052-04","73% AV Level Silver Plan","72.97%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990052","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS094","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990052-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990052","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS094","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990052-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990053","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS104","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990053-00","Standard Silver Off Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990053","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS104","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990053-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990053","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS104","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990053-03","Limited Cost Sharing Plan Variation","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990053","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS104","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990053-04","73% AV Level Silver Plan","72.97%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990053","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS104","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990053-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990053","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS104","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990053-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990054","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS114","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990054-00","Standard Silver Off Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990054","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS114","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990054-01","Standard Silver On Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990054","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS114","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990054-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990054","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS114","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990054-03","Limited Cost Sharing Plan Variation","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990054","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS114","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990054-04","73% AV Level Silver Plan","72.97%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990054","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS114","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990054-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990054","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS114","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990054-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990055","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS124","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990055-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","30"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990055","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS124","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990055-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","31"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990056","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS134","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990056-00","Standard Silver Off Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","32"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990056","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS134","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990056-01","Standard Silver On Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","33"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990056","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS134","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990056-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","34"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990056","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS134","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990056-03","Limited Cost Sharing Plan Variation","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","35"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990056","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS134","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990056-04","73% AV Level Silver Plan","72.97%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","36"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990056","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS134","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990056-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","37"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990056","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS134","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990056-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","38"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990051","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS084","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990051-00","Standard Silver Off Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","39"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990051","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS084","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990051-01","Standard Silver On Exchange Plan","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","40"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990051","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS084","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990051-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","41"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990051","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS084","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990051-03","Limited Cost Sharing Plan Variation","69.87%","0","Yes","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$9750 per group","20%","$3,250","$3250 per person","$9750 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","42"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990051","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS084","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990051-04","73% AV Level Silver Plan","72.97%","0","Yes","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10900 per group","$5,000","$5000 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$9000 per group","20%","$3,000","$3000 per person","$9000 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","43"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990051","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS084","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990051-05","87% AV Level Silver Plan","87.20%","0","Yes","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$4500 per group","$1,750","$1750 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","20%","$500","$500 per person","$1500 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","44"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","18","36096","IL","Individual","No","36-1236610","36096IL0990051","Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits","36096IL099",,"ILN001","ILS084","ILF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990051-06","94% AV Level Silver Plan","94.12%","0","Yes","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$2250 per group","$750","$750 per person","$2250 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990003-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","45"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990059","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS044","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990059-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990064","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS094","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990064-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990064","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS094","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990064-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990064","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS094","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990064-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990004","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS014","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990004-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990004","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS014","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990004-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","5"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990004","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS014","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","6"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990004","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS014","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990004-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","7"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990004","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS014","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990004-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990004","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS014","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990004-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990004","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS014","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990004-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990057","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS024","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990057-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990057","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS024","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990057-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","12"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990057","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS024","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990057-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990057","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS024","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990057-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990057","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS024","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990057-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990057","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS024","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990057-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990057","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS024","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990057-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990058","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS034","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990058-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990058","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS034","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990058-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990058","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS034","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990058-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990058","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS034","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990058-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990058","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS034","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990058-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990058","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS034","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990058-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990058","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS034","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990058-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990059","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS044","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990059-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990059","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS044","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990059-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990059","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS044","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990059-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990059","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS044","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990059-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990059","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS044","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990059-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","30"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990059","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS044","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990059-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","31"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990060","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS054","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990060-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","32"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990060","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS054","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990060-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","33"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990060","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS054","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990060-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","34"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990060","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS054","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990060-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","35"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990060","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS054","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990060-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","36"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990060","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS054","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990060-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","37"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990060","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS054","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990060-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","38"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990061","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS064","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990061-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","39"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990061","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS064","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990061-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","40"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990061","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS064","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990061-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","41"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990061","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS064","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990061-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","42"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990061","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS064","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990061-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","43"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990061","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS064","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990061-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","44"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990061","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS064","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990061-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","45"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990062","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS074","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990062-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","46"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990062","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS074","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990062-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","47"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990062","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS074","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990062-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","48"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990062","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS074","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990062-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","49"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990062","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS074","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990062-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","50"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990062","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS074","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990062-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","51"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","19","36096","IL","Individual","No","36-1236610","36096IL0990062","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS074","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990062-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","52"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990064","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS094","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990064-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","4"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990064","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS094","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990064-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","8"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990068","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS134","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990068-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","32"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380016","Humana Silver 3800/Chicago HMOx","58288IL038",,"ILN001","ILS002","ILF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380016-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2597647","http://apps.humana.com/marketing/documents.asp?file=2587793","4"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380016","Humana Silver 3800/Chicago HMOx","58288IL038",,"ILN001","ILS002","ILF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380016-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605746","http://apps.humana.com/marketing/documents.asp?file=2592109","5"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380016","Humana Silver 3800/Chicago HMOx","58288IL038",,"ILN001","ILS002","ILF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380016-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605746","http://apps.humana.com/marketing/documents.asp?file=2592109","6"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380016","Humana Silver 3800/Chicago HMOx","58288IL038",,"ILN001","ILS002","ILF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380016-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605785","http://apps.humana.com/marketing/documents.asp?file=2592109","7"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380016","Humana Silver 3800/Chicago HMOx","58288IL038",,"ILN001","ILS002","ILF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380016-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605798","http://apps.humana.com/marketing/documents.asp?file=2622971","8"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380016","Humana Silver 3800/Chicago HMOx","58288IL038",,"ILN001","ILS002","ILF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380016-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605811","http://apps.humana.com/marketing/documents.asp?file=2622984","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990064","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS094","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990064-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","9"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990064","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS094","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990064-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","10"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990065","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS104","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990065-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","11"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990065","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS104","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990065-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","13"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990065","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS104","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990065-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","14"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990065","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS104","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990065-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","15"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990065","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS104","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990065-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","16"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990065","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS104","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990065-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","17"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990063","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS084","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990063-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","42"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990063","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS084","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990063-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","43"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990063","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS084","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990063-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","44"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990066","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS114","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990066-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","18"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990066","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS114","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990066-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","19"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990066","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS114","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990066-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","20"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990066","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS114","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990066-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","21"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990066","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS114","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990066-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","22"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990066","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS114","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990066-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","23"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990066","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS114","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990066-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","24"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990067","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS124","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990067-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","25"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990067","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS124","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990067-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","26"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990067","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS124","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990067-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","27"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990067","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS124","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990067-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","28"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990067","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS124","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990067-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","29"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990067","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS124","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990067-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","30"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990067","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS124","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990067-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","31"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990068","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS134","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990068-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","33"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990068","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS134","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990068-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","34"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990068","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS134","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990068-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-03.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","35"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990068","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS134","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990068-04","73% AV Level Silver Plan",,"0.731833457946777","Yes","Yes","No","100%",,"$3,300","$0","$0","$200","$3,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,125","$3125 per person","$9375 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-04.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","36"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990068","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS134","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990068-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$200","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$3750 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-05.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","37"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990068","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS134","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990068-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","38"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990063","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS084","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990063-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-00.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","39"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990063","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS084","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990063-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$10500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-01.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","40"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990063","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS084","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990063-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-02.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","41"
"2016","IL","36096","SERFF","27","2016-01-29 07:27:50","20","36096","IL","Individual","No","36-1236610","36096IL0990063","Blue Choice Preferred Silver PPO? 104","36096IL099",,"ILN001","ILS084","ILF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/IL/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_IL_5T_EX.pdf","36096IL0990063-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1500 per group","0%",,,,,"$15,000","$15000 per person","$45000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsil.com/PDF/sbc/36096IL0990004-06.PDF","http://www.bcbsil.com/PDF/sbc/2016-illinois-plan-overview.pdf","45"
"2016","IL","39096","SERFF","6","2015-08-27 03:52:03","1","39096","IL","SHOP (Small Group)","Yes","44-0308260","39096IL0010001","KCL Fam Low PPO","39096IL001",,"ILN001","ILS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$50.88","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","39096IL0010001-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IL","39096","SERFF","6","2015-08-27 03:52:03","1","39096","IL","SHOP (Small Group)","Yes","44-0308260","39096IL0010003","KCL Fam Low MAC","39096IL001",,"ILN001","ILS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$36.64","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","39096IL0010003-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IL","39096","SERFF","6","2015-08-27 03:52:03","2","39096","IL","SHOP (Small Group)","Yes","44-0308260","39096IL0010002","KCL Fam High PPO","39096IL001",,"ILN001","ILS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$62.66","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","39096IL0010002-00","Standard High Off Exchange Plan","86.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IL","39096","SERFF","6","2015-08-27 03:52:03","2","39096","IL","SHOP (Small Group)","Yes","44-0308260","39096IL0010004","KCL Fam High MAC","39096IL001",,"ILN001","ILS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$46.74","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","39096IL0010004-00","Standard High Off Exchange Plan","86.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IL","40653","SERFF","4","2015-08-27 03:52:03","1","40653","IL","SHOP (Small Group)","Yes","42-0127290","40653IL0050001","Principal Plan Dental 70","40653IL005",,"ILN001","ILS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Child-Only",,,,,"$32.77","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as all other","Yes","Same as all other","Yes",,"","40653IL0050001-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IL","40653","SERFF","4","2015-08-27 03:52:03","1","40653","IL","SHOP (Small Group)","Yes","42-0127290","40653IL0050002","Principal Plan Dental 85","40653IL005",,"ILN001","ILS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Child-Only",,,,,"$35.12","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as all other","Yes","Same as all other","Yes",,"","40653IL0050002-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IL","45634","SERFF","6","2015-09-25 06:20:33","1","45634","IL","Individual","Yes","59-0397210","45634IL0010001","DentaQuest PPO  Pediatric High","45634IL001",,"ILN001","ILS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$46.80","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","45634IL0010001-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/","4"
"2016","IL","45634","SERFF","6","2015-09-25 06:20:33","1","45634","IL","SHOP (Small Group)","Yes","59-0397210","45634IL0020003","DentaQuest PPO Family High","45634IL002",,"ILN001","ILS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.39","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","45634IL0020003-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il","http://www.dentaquest.com/marketplace/il","4"
"2016","IL","45634","SERFF","6","2015-09-25 06:20:33","1","45634","IL","SHOP (Small Group)","Yes","59-0397210","45634IL0020003","DentaQuest PPO Family High","45634IL002",,"ILN001","ILS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.39","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","45634IL0020003-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il","http://www.dentaquest.com/marketplace/il","5"
"2016","IL","45634","SERFF","6","2015-09-25 06:20:33","1","45634","IL","Individual","Yes","59-0397210","45634IL0010001","DentaQuest PPO  Pediatric High","45634IL001",,"ILN001","ILS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$46.80","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","45634IL0010001-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/","5"
"2016","IL","45634","SERFF","6","2015-09-25 06:20:33","1","45634","IL","SHOP (Small Group)","Yes","59-0397210","45634IL0020004","DentaQuest PPO Family Low","45634IL002",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.81","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","45634IL0020004-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il","http://www.dentaquest.com/marketplace/il","6"
"2016","IL","45634","SERFF","6","2015-09-25 06:20:33","1","45634","IL","SHOP (Small Group)","Yes","59-0397210","45634IL0020004","DentaQuest PPO Family Low","45634IL002",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.81","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","45634IL0020004-01","Standard Low On Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il","http://www.dentaquest.com/marketplace/il","7"
"2016","IL","45634","SERFF","6","2015-09-25 06:20:33","2","45634","IL","Individual","Yes","59-0397210","45634IL0010003","DentaQuest PPO Family High","45634IL001",,"ILN001","ILS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$46.80","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","45634IL0010003-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/","4"
"2016","IL","45634","SERFF","6","2015-09-25 06:20:33","2","45634","IL","Individual","Yes","59-0397210","45634IL0010003","DentaQuest PPO Family High","45634IL001",,"ILN001","ILS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$46.80","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","45634IL0010003-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/","5"
"2016","IL","45634","SERFF","6","2015-09-25 06:20:33","2","45634","IL","Individual","Yes","59-0397210","45634IL0010004","DentaQuest PPO Family Low","45634IL001",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.51","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","45634IL0010004-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/","6"
"2016","IL","45634","SERFF","6","2015-09-25 06:20:33","2","45634","IL","Individual","Yes","59-0397210","45634IL0010004","DentaQuest PPO Family Low","45634IL001",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.51","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","45634IL0010004-01","Standard Low On Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/il/","http://www.dentaquest.com/marketplace/il/","7"
"2016","IL","46552","SERFF","5","2015-08-28 13:59:00","1","46552","IL","Individual","Yes","47-0397286","46552IL0010001","Delta Dental Individual PPO, EHB Certified","46552IL001",,"ILN002","ILS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.47","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","46552IL0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IL","46552","SERFF","5","2015-08-28 13:59:00","1","46552","IL","Individual","Yes","47-0397286","46552IL0010002","Delta Dental Individual PPO, EHB Certified","46552IL001",,"ILN002","ILS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.35","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","46552IL0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IL","46552","SERFF","5","2015-08-28 13:59:00","1","46552","IL","Individual","Yes","47-0397286","46552IL0020001","Renaissance Individual Dental PPO, EHB Certified","46552IL002",,"ILN001","ILS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.69","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","46552IL0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","IL","46552","SERFF","5","2015-08-28 13:59:00","1","46552","IL","Individual","Yes","47-0397286","46552IL0020002","Renaissance Individual Dental PPO, EHB Certified","46552IL002",,"ILN001","ILS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.16","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","46552IL0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","IL","53528","SERFF","4","2015-08-27 03:52:03","1","53528","IL","SHOP (Small Group)","Yes","23-1661402","53528IL0010001","Smile for Health-Certified Option 1","53528IL001",,"ILN001","ILS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$25.71","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","53528IL0010001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IL","53528","SERFF","4","2015-08-27 03:52:03","2","53528","IL","SHOP (Small Group)","Yes","23-1661402","53528IL0010002","Smile for Health-Certified Option 2","53528IL001",,"ILN001","ILS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$25.71","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","53528IL0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IL","53528","SERFF","4","2015-08-27 03:52:03","3","53528","IL","SHOP (Small Group)","Yes","23-1661402","53528IL0030001","Smile for Health-Certified Option 3","53528IL003",,"ILN001","ILS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$27.31","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","53528IL0030001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IL","53528","SERFF","4","2015-08-27 03:52:03","4","53528","IL","SHOP (Small Group)","Yes","23-1661402","53528IL0020001","Smile for Health-Certified Option 4","53528IL002",,"ILN001","ILS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$26.76","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","53528IL0020001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IL","53528","SERFF","4","2015-08-27 03:52:03","5","53528","IL","SHOP (Small Group)","Yes","23-1661402","53528IL0010003","Smile for Health-Certified Option 5","53528IL001",,"ILN001","ILS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$25.71","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","53528IL0010003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IL","53554","SERFF","3","2015-08-27 03:52:03","1","53554","IL","SHOP (Small Group)","Yes","81-0170040","53554IL0010001","Assurant Dental ACAFFO High","53554IL001",,"ILN001","ILS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$40.78","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","53554IL0010001-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IL","53554","SERFF","3","2015-08-27 03:52:03","1","53554","IL","SHOP (Small Group)","Yes","81-0170040","53554IL0010002","Assurant Dental ACAFFO Low","53554IL001",,"ILN001","ILS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$33.95","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","53554IL0010002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IL","53554","SERFF","3","2015-08-27 03:52:03","1","53554","IL","SHOP (Small Group)","Yes","81-0170040","53554IL0010003","Assurant Dental ACAFFO High Cosmetic","53554IL001",,"ILN001","ILS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$40.71","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","53554IL0010003-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","IL","53554","SERFF","3","2015-08-27 03:52:03","1","53554","IL","SHOP (Small Group)","Yes","81-0170040","53554IL0010004","Assurant Dental ACAFFO Low Cosmetic","53554IL001",,"ILN001","ILS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$33.89","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","53554IL0010004-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380016","Humana Silver 3800/Chicago HMOx","58288IL038",,"ILN001","ILS002","ILF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380016-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605824","http://apps.humana.com/marketing/documents.asp?file=2622997","10"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380017","Humana Gold 2250/Chicago HMOx","58288IL038",,"ILN001","ILS002","ILF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380017-00","Standard Gold Off Exchange Plan","78.08%","0.784791946411133","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2597660","http://apps.humana.com/marketing/documents.asp?file=2587806","11"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380017","Humana Gold 2250/Chicago HMOx","58288IL038",,"ILN001","ILS002","ILF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380017-01","Standard Gold On Exchange Plan","78.08%","0.784791946411133","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605837","http://apps.humana.com/marketing/documents.asp?file=2592122","12"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030004","Care Gold II","78463IL003",,"ILN001","ILS001","ILF002","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030004-03","Limited Cost Sharing Plan Variation","81.16%","0.814209818840027","No","Yes","Yes","73%","27%","$1,400","$10","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","$2,750","$2750 per person","$5500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,375","$1375 per person","$2750 per group","0%","$2,750","$2750 per person","$5500 per group","0%","$5,500","$5500 per person","$11000 per group","$9,625","$9625 per person","$19250 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareGoldII-AILInd.pdf",,"19"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030005","Care Silver I","78463IL003",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030005-00","Standard Silver Off Exchange Plan","68.24%","0.680068016052246","No","Yes","Yes","73%","27%","$3,700","$20","$0","$200","$600","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","0%","$6,200","$6200 per person","$12400 per group","0%","$12,400","$12400 per person","$24800 per group","$22,350","$22350 per person","$44700 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareSilverIInd.pdf",,"20"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030005","Care Silver I","78463IL003",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030005-01","Standard Silver On Exchange Plan","68.24%","0.680068016052246","No","Yes","Yes","73%","27%","$3,700","$20","$0","$200","$600","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","0%","$6,200","$6200 per person","$12400 per group","0%","$12,400","$12400 per person","$24800 per group","$22,350","$22350 per person","$44700 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareSilverIInd.pdf",,"21"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030005","Care Silver I","78463IL003",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","73%","27%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareSilverI-AIZInd.pdf",,"22"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030005","Care Silver I","78463IL003",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030005-03","Limited Cost Sharing Plan Variation","68.24%","0.680068016052246","No","Yes","Yes","73%","27%","$3,700","$20","$0","$200","$600","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","$6,200","$6200 per person","$12400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,750","$3750 per person","$7500 per group","0%","$6,200","$6200 per person","$12400 per group","0%","$12,400","$12400 per person","$24800 per group","$22,350","$22350 per person","$44700 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareSilverI-AILInd.pdf",,"23"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380017","Humana Gold 2250/Chicago HMOx","58288IL038",,"ILN001","ILS002","ILF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380017-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605850","http://apps.humana.com/marketing/documents.asp?file=2592122","13"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380017","Humana Gold 2250/Chicago HMOx","58288IL038",,"ILN001","ILS002","ILF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380017-03","Limited Cost Sharing Plan Variation","78.08%","0.784791946411133","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605863","http://apps.humana.com/marketing/documents.asp?file=2592122","14"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380028","Humana Silver 3800/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380028-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2620267","http://apps.humana.com/marketing/documents.asp?file=2595047","19"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380028","Humana Silver 3800/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380028-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2620397","http://apps.humana.com/marketing/documents.asp?file=2592265","20"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380028","Humana Silver 3800/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380028-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2620410","http://apps.humana.com/marketing/documents.asp?file=2592265","21"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","4","58288","IL","Individual","No","61-1013183","58288IL0380014","Humana Bronze 6450/Chicago HMOx","58288IL038",,"ILN001","ILS002","ILF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","58288IL0380014-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2605655","http://apps.humana.com/marketing/documents.asp?file=2592083","5"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","4","58288","IL","Individual","No","61-1013183","58288IL0380014","Humana Bronze 6450/Chicago HMOx","58288IL038",,"ILN001","ILS002","ILF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","58288IL0380014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2605668","http://apps.humana.com/marketing/documents.asp?file=2592083","6"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","4","58288","IL","Individual","No","61-1013183","58288IL0380014","Humana Bronze 6450/Chicago HMOx","58288IL038",,"ILN001","ILS002","ILF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","58288IL0380014-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2605681","http://apps.humana.com/marketing/documents.asp?file=2592083","7"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030006","Care Silver II","78463IL003",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030006-05","87% AV Level Silver Plan","87.56%","0.87743753194809","No","Yes","Yes","73%","27%","$700","$20","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","$1,400","$1400 per person","$2800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","0%","$1,400","$1400 per person","$2800 per group","0%","$5,000","$5000 per person","$10000 per group","$7,100","$7100 per person","$14200 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareSilverII-CSR87Ind.pdf",,"32"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030006","Care Silver II","78463IL003",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030006-06","94% AV Level Silver Plan","94.08%","0.942002236843109","No","Yes","Yes","73%","27%","$300","$10","$0","$200","$200","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%","$500","$500 per person","$1000 per group","0%","$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareSilverII-CSR94Ind.pdf",,"33"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030007","Care Bronze","78463IL003",,"ILN001","ILS001","ILF004","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030007-00","Standard Bronze Off Exchange Plan","61.76%","0.615315556526184","No","Yes","Yes","73%","27%","$6,300","$0","$0","$200","$4,700","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%","$6,850","$6850 per person","$13700 per group","0%","$13,700","$13700 per person","$27400 per group","$27,400","$27400 per person","$54800 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareBronzeInd.pdf",,"34"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380028","Humana Silver 3800/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380028-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2620423","http://apps.humana.com/marketing/documents.asp?file=2592265","22"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380028","Humana Silver 3800/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380028-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2620436","http://apps.humana.com/marketing/documents.asp?file=2623088","23"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380028","Humana Silver 3800/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380028-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2620449","http://apps.humana.com/marketing/documents.asp?file=2623101","24"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380028","Humana Silver 3800/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380028-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2620462","http://apps.humana.com/marketing/documents.asp?file=2623114","25"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380029","Humana Gold 2250/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380029-00","Standard Gold Off Exchange Plan","78.08%","0.784791946411133","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2620280","http://apps.humana.com/marketing/documents.asp?file=2595060","26"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380029","Humana Gold 2250/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380029-01","Standard Gold On Exchange Plan","78.08%","0.784791946411133","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2620475","http://apps.humana.com/marketing/documents.asp?file=2592278","27"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380029","Humana Gold 2250/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380029-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2620488","http://apps.humana.com/marketing/documents.asp?file=2592278","28"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","1","58288","IL","Individual","No","61-1013183","58288IL0380029","Humana Gold 2250/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380029-03","Limited Cost Sharing Plan Variation","78.08%","0.784791946411133","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2620501","http://apps.humana.com/marketing/documents.asp?file=2592278","29"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","2","58288","IL","Individual","No","61-1013183","58288IL0380013","Humana Basic 6850/Chicago HMOx","58288IL038",,"ILN001","ILS002","ILF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","58288IL0380013-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2597608","http://apps.humana.com/marketing/documents.asp?file=2587754","4"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","2","58288","IL","Individual","No","61-1013183","58288IL0380013","Humana Basic 6850/Chicago HMOx","58288IL038",,"ILN001","ILS002","ILF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","58288IL0380013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2605642","http://apps.humana.com/marketing/documents.asp?file=2592070","5"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","2","58288","IL","Individual","No","61-1013183","58288IL0380025","Humana Basic 6850/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","58288IL0380025-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2620228","http://apps.humana.com/marketing/documents.asp?file=2595008","6"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","2","58288","IL","Individual","No","61-1013183","58288IL0380025","Humana Basic 6850/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","58288IL0380025-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2620306","http://apps.humana.com/marketing/documents.asp?file=2592226","7"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","3","58288","IL","Individual","No","61-1013183","58288IL0380015","Humana Bronze 4850/Chicago HMOx","58288IL038",,"ILN001","ILS002","ILF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380015-00","Standard Bronze Off Exchange Plan","61.72%","0.621564447879791","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2597634","http://apps.humana.com/marketing/documents.asp?file=2587780","4"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","3","58288","IL","Individual","No","61-1013183","58288IL0380015","Humana Bronze 4850/Chicago HMOx","58288IL038",,"ILN001","ILS002","ILF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380015-01","Standard Bronze On Exchange Plan","61.72%","0.621564447879791","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605707","http://apps.humana.com/marketing/documents.asp?file=2592096","5"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","3","58288","IL","Individual","No","61-1013183","58288IL0380015","Humana Bronze 4850/Chicago HMOx","58288IL038",,"ILN001","ILS002","ILF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605694","http://apps.humana.com/marketing/documents.asp?file=2592096","6"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","3","58288","IL","Individual","No","61-1013183","58288IL0380015","Humana Bronze 4850/Chicago HMOx","58288IL038",,"ILN001","ILS002","ILF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380015-03","Limited Cost Sharing Plan Variation","61.72%","0.621564447879791","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2605720","http://apps.humana.com/marketing/documents.asp?file=2592096","7"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","3","58288","IL","Individual","No","61-1013183","58288IL0380027","Humana Bronze 4850/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380027-00","Standard Bronze Off Exchange Plan","61.72%","0.621564447879791","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2620254","http://apps.humana.com/marketing/documents.asp?file=2595034","8"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","3","58288","IL","Individual","No","61-1013183","58288IL0380027","Humana Bronze 4850/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380027-01","Standard Bronze On Exchange Plan","61.72%","0.621564447879791","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2620358","http://apps.humana.com/marketing/documents.asp?file=2592252","9"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","3","58288","IL","Individual","No","61-1013183","58288IL0380027","Humana Bronze 4850/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380027-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2620371","http://apps.humana.com/marketing/documents.asp?file=2592252","10"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","3","58288","IL","Individual","No","61-1013183","58288IL0380027","Humana Bronze 4850/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","58288IL0380027-03","Limited Cost Sharing Plan Variation","61.72%","0.621564447879791","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2620384","http://apps.humana.com/marketing/documents.asp?file=2592252","11"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","4","58288","IL","Individual","No","61-1013183","58288IL0380014","Humana Bronze 6450/Chicago HMOx","58288IL038",,"ILN001","ILS002","ILF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","58288IL0380014-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2597621","http://apps.humana.com/marketing/documents.asp?file=2587767","4"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","4","58288","IL","Individual","No","61-1013183","58288IL0380026","Humana Bronze 6450/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","58288IL0380026-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2620241","http://apps.humana.com/marketing/documents.asp?file=2595021","8"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","4","58288","IL","Individual","No","61-1013183","58288IL0380026","Humana Bronze 6450/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","58288IL0380026-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2620319","http://apps.humana.com/marketing/documents.asp?file=2592239","9"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","4","58288","IL","Individual","No","61-1013183","58288IL0380026","Humana Bronze 6450/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","58288IL0380026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2620332","http://apps.humana.com/marketing/documents.asp?file=2592239","10"
"2016","IL","58288","SERFF","8","2015-08-28 13:59:00","4","58288","IL","Individual","No","61-1013183","58288IL0380026","Humana Bronze 6450/Illinois HMOx","58288IL038",,"ILN002","ILS003","ILF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","58288IL0380026-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2620345","http://apps.humana.com/marketing/documents.asp?file=2592239","11"
"2016","IL","59928","SERFF","4","2015-08-27 03:52:03","1","59928","IL","SHOP (Small Group)","Yes","36-0883760","59928IL0040002","EHB High PPO","59928IL004",,"ILN001","ILS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.04","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","59928IL0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","IL","59928","SERFF","4","2015-08-27 03:52:03","1","59928","IL","SHOP (Small Group)","Yes","36-0883760","59928IL0040001","EHB Low PPO","59928IL004",,"ILN001","ILS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.52","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","59928IL0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","IL","59928","SERFF","4","2015-08-27 03:52:03","1","59928","IL","SHOP (Small Group)","Yes","36-0883760","59928IL0030002","EHB High Passive","59928IL003",,"ILN001","ILS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$45.62","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","59928IL0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","IL","59928","SERFF","4","2015-08-27 03:52:03","1","59928","IL","SHOP (Small Group)","Yes","36-0883760","59928IL0030001","EHB Low Passive","59928IL003",,"ILN001","ILS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.31","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","59928IL0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","IL","60600","SERFF","7","2015-08-28 13:59:00","1","60600","IL","Individual","Yes","36-2612058","60600IL0010002","Delta Dental Individual Kids Basic Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$25.99","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Benefits; Must see Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010002-00","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.deltadentalilexchange.com/dental-plans","www.deltadentalilexchange.com/dental-plans","4"
"2016","IL","60600","SERFF","7","2015-08-28 13:59:00","1","60600","IL","Individual","Yes","36-2612058","60600IL0030002","Delta Dental Individual Kids Preferred Plan","60600IL003",,"ILN001","ILS001",,"Existing","EPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$27.03","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Benefits; Must see a Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0030002-00","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.deltadentalilshop.com/dental-plans","www.deltadentalilshop.com/dental-plans","4"
"2016","IL","60600","SERFF","7","2015-08-28 13:59:00","1","60600","IL","Individual","Yes","36-2612058","60600IL0010002","Delta Dental Individual Kids Basic Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$25.99","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Benefits; Must see Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010002-01","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/","5"
"2016","IL","60600","SERFF","7","2015-08-28 13:59:00","1","60600","IL","Individual","Yes","36-2612058","60600IL0010001","Delta Dental Individual Kids Preferred Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$29.97","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Benefits; Must see Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010001-00","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/","6"
"2016","IL","60600","SERFF","7","2015-08-28 13:59:00","1","60600","IL","Individual","Yes","36-2612058","60600IL0010001","Delta Dental Individual Kids Preferred Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$29.97","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Benefits; Must see Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010001-01","Standard High On Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/","7"
"2016","IL","60600","SERFF","7","2015-08-28 13:59:00","2","60600","IL","Individual","Yes","36-2612058","60600IL0010004","Delta Dental Individual Basic Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.99","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Benefits; Must See Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010004-00","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/","4"
"2016","IL","60600","SERFF","7","2015-08-28 13:59:00","2","60600","IL","Individual","Yes","36-2612058","60600IL0010004","Delta Dental Individual Basic Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.99","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Benefits; Must See Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010004-01","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/","5"
"2016","IL","60600","SERFF","7","2015-08-28 13:59:00","2","60600","IL","Individual","Yes","36-2612058","60600IL0010003","Delta Dental Individual Preferred Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.97","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Benefits; Must See Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010003-00","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/","6"
"2016","IL","60600","SERFF","7","2015-08-28 13:59:00","2","60600","IL","Individual","Yes","36-2612058","60600IL0010003","Delta Dental Individual Preferred Plan","60600IL001",,"ILN001","ILS001",,"Existing","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.97","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Benefits; Must See Delta Dental PPO Provider","Yes","https://www.deltadentalil.me/payment","","60600IL0010003-01","Standard High On Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalilexchange.com/dental-plans/","http://www.deltadentalilexchange.com/dental-plans/","7"
"2016","IL","68303","SERFF","6","2015-08-27 03:52:03","1","68303","IL","Individual","Yes","39-1263473","68303IL0690001","Humana Dental Smart Choice","68303IL069",,"ILN002","ILS002",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.94","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","68303IL0690001-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612870","4"
"2016","IL","68303","SERFF","6","2015-08-27 03:52:03","1","68303","IL","Individual","Yes","39-1263473","68303IL0690001","Humana Dental Smart Choice","68303IL069",,"ILN002","ILS002",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.94","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","68303IL0690001-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612870","5"
"2016","IL","75159","SERFF","4","2015-08-27 15:13:29","1","75159","IL","SHOP (Small Group)","Yes","47-0098400","75159IL0040002","EHB High PPO","75159IL004",,"ILN001","ILS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.47","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","75159IL0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","IL","75159","SERFF","4","2015-08-27 15:13:29","1","75159","IL","SHOP (Small Group)","Yes","47-0098400","75159IL0040001","EHB Low PPO","75159IL004",,"ILN001","ILS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.22","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","75159IL0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","IL","75159","SERFF","4","2015-08-27 15:13:29","1","75159","IL","SHOP (Small Group)","Yes","47-0098400","75159IL0030002","EHB High Passive","75159IL003",,"ILN001","ILS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.99","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","75159IL0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","IL","75159","SERFF","4","2015-08-27 15:13:29","1","75159","IL","SHOP (Small Group)","Yes","47-0098400","75159IL0030001","EHB Low Passive","75159IL003",,"ILN001","ILS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.91","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","75159IL0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","IL","77956","SERFF","3","2015-08-27 03:52:03","1","77956","IL","SHOP (Small Group)","Yes","41-0808596","77956IL0010001","Plan 2. Passive PPO, $1000 Annual Maximum, Ortho","77956IL001",,"ILN001","ILS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are the same in and out of network","Yes",,"","77956IL0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030003","Care Gold I","78463IL003",,"ILN001","ILS001","ILF002","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030003-00","Standard Gold Off Exchange Plan","78.28%","0.785582065582275","No","Yes","Yes","73%","27%","$1,700","$10","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0%","$3,500","$3500 per person","$7000 per group","0%","$7,000","$7000 per person","$14000 per group","$12,250","$12250 per person","$24500 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareGoldIInd.pdf",,"12"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030003","Care Gold I","78463IL003",,"ILN001","ILS001","ILF002","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030003-01","Standard Gold On Exchange Plan","78.28%","0.785582065582275","No","Yes","Yes","73%","27%","$1,700","$10","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0%","$3,500","$3500 per person","$7000 per group","0%","$7,000","$7000 per person","$14000 per group","$12,250","$12250 per person","$24500 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareGoldIInd.pdf",,"13"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030003","Care Gold I","78463IL003",,"ILN001","ILS001","ILF002","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","73%","27%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareGoldI-AIZInd.pdf",,"14"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030003","Care Gold I","78463IL003",,"ILN001","ILS001","ILF002","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030003-03","Limited Cost Sharing Plan Variation","78.28%","0.785582065582275","No","Yes","Yes","73%","27%","$1,700","$10","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","0%","$3,500","$3500 per person","$7000 per group","0%","$7,000","$7000 per person","$14000 per group","$12,250","$12250 per person","$24500 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareGoldI-AILInd.pdf",,"15"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030004","Care Gold II","78463IL003",,"ILN001","ILS001","ILF002","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030004-00","Standard Gold Off Exchange Plan","81.16%","0.814209818840027","No","Yes","Yes","73%","27%","$1,400","$10","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","$2,750","$2750 per person","$5500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,375","$1375 per person","$2750 per group","0%","$2,750","$2750 per person","$5500 per group","0%","$5,500","$5500 per person","$11000 per group","$9,625","$9625 per person","$19250 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareGoldIIInd.pdf",,"16"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030004","Care Gold II","78463IL003",,"ILN001","ILS001","ILF002","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030004-01","Standard Gold On Exchange Plan","81.16%","0.814209818840027","No","Yes","Yes","73%","27%","$1,400","$10","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","$2,750","$2750 per person","$5500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,375","$1375 per person","$2750 per group","0%","$2,750","$2750 per person","$5500 per group","0%","$5,500","$5500 per person","$11000 per group","$9,625","$9625 per person","$19250 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareGoldIIInd.pdf",,"17"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030004","Care Gold II","78463IL003",,"ILN001","ILS001","ILF002","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","73%","27%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareGoldII-AIZInd.pdf",,"18"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030005","Care Silver I","78463IL003",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030005-04","73% AV Level Silver Plan","72.47%","0.722217440605164","No","Yes","Yes","73%","27%","$2,600","$10","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","0%","$5,200","$5200 per person","$10400 per group","0%","$10,400","$10400 per person","$20800 per group","$18,200","$18200 per person","$36400 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareSilverI-CSR73Ind.pdf",,"24"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030005","Care Silver I","78463IL003",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030005-05","87% AV Level Silver Plan","86.48%","0.866751790046692","No","Yes","Yes","73%","27%","$800","$10","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group","$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","0%","$1,600","$1600 per person","$3200 per group","0%","$5,000","$5000 per person","$10000 per group","$7,400","$7400 per person","$14800 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareSilverI-CSR87Ind.pdf",,"25"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030005","Care Silver I","78463IL003",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030005-06","94% AV Level Silver Plan","93.22%","0.933649718761444","No","Yes","Yes","73%","27%","$300","$10","$0","$200","$300","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","0%","$600","$600 per person","$1200 per group","0%","$5,000","$5000 per person","$10000 per group","$5,900","$5900 per person","$11800 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareSilverI-CSR94Ind.pdf",,"26"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030006","Care Silver II","78463IL003",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030006-00","Standard Silver Off Exchange Plan","70.44%","0.701829850673676","No","Yes","Yes","73%","27%","$3,000","$20","$0","$200","$600","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%","$6,000","$6000 per person","$12000 per group","0%","$12,000","$12000 per person","$24000 per group","$21,000","$21000 per person","$42000 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareSilverIIInd.pdf",,"27"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030006","Care Silver II","78463IL003",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030006-01","Standard Silver On Exchange Plan","70.44%","0.701829850673676","No","Yes","Yes","73%","27%","$3,000","$20","$0","$200","$600","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%","$6,000","$6000 per person","$12000 per group","0%","$12,000","$12000 per person","$24000 per group","$21,000","$21000 per person","$42000 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareSilverIIInd.pdf",,"28"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030006","Care Silver II","78463IL003",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","73%","27%","$3,000","$0","$0","$200","$600","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareSilverII-AIZInd.pdf",,"29"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030006","Care Silver II","78463IL003",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030006-03","Limited Cost Sharing Plan Variation","70.44%","0.701829850673676","No","Yes","Yes","73%","27%","$3,000","$20","$0","$200","$600","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%","$6,000","$6000 per person","$12000 per group","0%","$12,000","$12000 per person","$24000 per group","$21,000","$21000 per person","$42000 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareSilverII-AILInd.pdf",,"30"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030006","Care Silver II","78463IL003",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030006-04","73% AV Level Silver Plan","73.01%","0.727746307849884","No","Yes","Yes","73%","27%","$2,500","$20","$0","$200","$600","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%","$5,000","$5000 per person","$10000 per group","0%","$10,000","$10000 per person","$20000 per group","$17,500","$17500 per person","$35000 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareSilverII-CSR73Ind.pdf",,"31"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030007","Care Bronze","78463IL003",,"ILN001","ILS001","ILF004","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030007-01","Standard Bronze On Exchange Plan","61.76%","0.615315556526184","No","Yes","Yes","73%","27%","$6,300","$0","$0","$200","$4,700","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%","$6,850","$6850 per person","$13700 per group","0%","$13,700","$13700 per person","$27400 per group","$27,400","$27400 per person","$54800 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareBronzeInd.pdf",,"35"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030007","Care Bronze","78463IL003",,"ILN001","ILS001","ILF004","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","73%","27%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareBronze-AIZInd.pdf",,"36"
"2016","IL","78463","SERFF","7","2015-08-27 03:52:03","1","78463","IL","Individual","No","35-1279304","78463IL0030007","Care Bronze","78463IL003",,"ILN001","ILS001","ILF004","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care","Yes","With network provider, same as other network benefits","Yes","https://exchange.harkenhealth.com/payment/1096b1bf-cafb-489a-81b4-7369e773ee3d","http://www.harkenhealth.com/benefits/OurFormulary-Individual","78463IL0030007-03","Limited Cost Sharing Plan Variation","61.76%","0.615315556526184","No","Yes","Yes","73%","27%","$6,300","$0","$0","$200","$4,700","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","0%","$6,850","$6850 per person","$13700 per group","0%","$13,700","$13700 per person","$27400 per group","$27,400","$27400 per person","$54800 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.harkenhealth.com/benefits/ILCareBronze-AILInd.pdf",,"37"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","5","96601","IL","Individual","No","37-1241037","96601IL0170003","Coventry Bronze $20 Copay","96601IL017",,"ILN001","ILS001","ILF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0170003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68411","http://www.coventryhealthcare.com/CILon2016","6"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","5","96601","IL","Individual","No","37-1241037","96601IL0170003","Coventry Bronze $20 Copay","96601IL017",,"ILN001","ILS001","ILF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0170003-03","Limited Cost Sharing Plan Variation","61.63%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68410","http://www.coventryhealthcare.com/CILon2016","7"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","6","96601","IL","Individual","No","37-1241037","96601IL0200006","Coventry Bronze Ded Only HSAEligible UnityPointHealthQuadCities","96601IL020",,"ILN005","ILS005","ILF013","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0200006-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68709","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","6","96601","IL","Individual","No","37-1241037","96601IL0200006","Coventry Bronze Ded Only HSAEligible UnityPointHealthQuadCities","96601IL020",,"ILN005","ILS005","ILF013","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0200006-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68460","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","6","96601","IL","Individual","No","37-1241037","96601IL0200006","Coventry Bronze Ded Only HSAEligible UnityPointHealthQuadCities","96601IL020",,"ILN005","ILS005","ILF013","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0200006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68462","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","6","96601","IL","Individual","No","37-1241037","96601IL0200006","Coventry Bronze Ded Only HSAEligible UnityPointHealthQuadCities","96601IL020",,"ILN005","ILS005","ILF013","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0200006-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68461","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","7","96601","IL","Individual","No","37-1241037","96601IL0170004","Coventry Bronze Deductible Only HSA Eligible","96601IL017",,"ILN001","ILS001","ILF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0170004-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68481","http://www.coventryhealthcare.com/CILon2016","4"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","7","96601","IL","Individual","No","37-1241037","96601IL0170004","Coventry Bronze Deductible Only HSA Eligible","96601IL017",,"ILN001","ILS001","ILF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0170004-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68412","http://www.coventryhealthcare.com/CILon2016","5"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","7","96601","IL","Individual","No","37-1241037","96601IL0170004","Coventry Bronze Deductible Only HSA Eligible","96601IL017",,"ILN001","ILS001","ILF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0170004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68414","http://www.coventryhealthcare.com/CILon2016","6"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","7","96601","IL","Individual","No","37-1241037","96601IL0170004","Coventry Bronze Deductible Only HSA Eligible","96601IL017",,"ILN001","ILS001","ILF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0170004-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68413","http://www.coventryhealthcare.com/CILon2016","7"
"2016","IL","83350","SERFF","6","2015-08-27 03:52:03","1","83350","IL","SHOP (Small Group)","Yes","13-5581829","83350IL0170002","EHB Basic Dental Plan (Low)","83350IL017",,"ILN001","ILS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$14.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","83350IL0170002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$200","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IL","83350","SERFF","6","2015-08-27 03:52:03","2","83350","IL","SHOP (Small Group)","Yes","13-5581829","83350IL0190001","Family Basic Dental Plan (Low)","83350IL019",,"ILN001","ILS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$14.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","83350IL0190001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$200","$200 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49084","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49083","4"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","8","96601","IL","Individual","No","37-1241037","96601IL0200004","Coventry Bronze Deductible Only HSA Eligible Carelink Methodist","96601IL020",,"ILN003","ILS003","ILF012","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0200004-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68490","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","8","96601","IL","Individual","No","37-1241037","96601IL0200004","Coventry Bronze Deductible Only HSA Eligible Carelink Methodist","96601IL020",,"ILN003","ILS003","ILF012","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0200004-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68427","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","8","96601","IL","Individual","No","37-1241037","96601IL0200004","Coventry Bronze Deductible Only HSA Eligible Carelink Methodist","96601IL020",,"ILN003","ILS003","ILF012","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0200004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68429","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","8","96601","IL","Individual","No","37-1241037","96601IL0200004","Coventry Bronze Deductible Only HSA Eligible Carelink Methodist","96601IL020",,"ILN003","ILS003","ILF012","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0200004-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68428","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","9","96601","IL","Individual","No","37-1241037","96601IL0210004","Coventry Bronze Deductible Only HSA Eligible Carelink St. John's","96601IL021",,"ILN004","ILS004","ILF020","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0210004-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68498","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","9","96601","IL","Individual","No","37-1241037","96601IL0210004","Coventry Bronze Deductible Only HSA Eligible Carelink St. John's","96601IL021",,"ILN004","ILS004","ILF020","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0210004-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68442","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","83350","SERFF","6","2015-08-27 03:52:03","2","83350","IL","SHOP (Small Group)","Yes","13-5581829","83350IL0190001","Family Basic Dental Plan (Low)","83350IL019",,"ILN001","ILS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$14.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","83350IL0190001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$200","$200 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49084","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49083","5"
"2016","IL","83350","SERFF","6","2015-08-27 03:52:03","3","83350","IL","SHOP (Small Group)","Yes","13-5581829","83350IL0200001","Family Enhanced Dental Plan (High)","83350IL020",,"ILN001","ILS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$19.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","83350IL0200001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49086","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49085","4"
"2016","IL","83350","SERFF","6","2015-08-27 03:52:03","3","83350","IL","SHOP (Small Group)","Yes","13-5581829","83350IL0200001","Family Enhanced Dental Plan (High)","83350IL020",,"ILN001","ILS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$19.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","83350IL0200001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49086","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49085","5"
"2016","IL","84033","SERFF","4","2015-08-28 13:59:00","1","84033","IL","Individual","Yes","95-6042390","84033IL0020001","BESTOne Dental Plus-Silver","84033IL002",,"ILN001","ILS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.45","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","84033IL0020001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IL/2016/IL_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","IL","84033","SERFF","4","2015-08-28 13:59:00","1","84033","IL","Individual","Yes","95-6042390","84033IL0020001","BESTOne Dental Plus-Silver","84033IL002",,"ILN001","ILS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.45","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","84033IL0020001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/IL/2016/IL_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","IL","85099","SERFF","5","2015-08-27 03:52:03","1","85099","IL","Individual","Yes","13-5123390","85099IL0210001","Guardian Family Essentials","85099IL021",,"ILN002","ILS002",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","85099IL0210001-00","Standard Low Off Exchange Plan","68.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","4"
"2016","IL","85099","SERFF","5","2015-08-27 03:52:03","1","85099","IL","SHOP (Small Group)","Yes","13-5123390","85099IL0190003","Guardian Pediatric Advantage","85099IL019",,"ILN001","ILS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$22.11","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","85099IL0190003-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","IL","85099","SERFF","5","2015-08-27 03:52:03","1","85099","IL","SHOP (Small Group)","Yes","13-5123390","85099IL0200003","Guardian Pediatric Essentials","85099IL020",,"ILN001","ILS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$15.74","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","85099IL0200003-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","IL","85099","SERFF","5","2015-08-27 03:52:03","1","85099","IL","Individual","Yes","13-5123390","85099IL0210001","Guardian Family Essentials","85099IL021",,"ILN002","ILS002",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","85099IL0210001-01","Standard Low On Exchange Plan","68.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","5"
"2016","IL","85099","SERFF","5","2015-08-27 03:52:03","2","85099","IL","SHOP (Small Group)","Yes","13-5123390","85099IL0160003","Guardian Family Advantage","85099IL016",,"ILN001","ILS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.11","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","85099IL0160003-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","IL","85099","SERFF","5","2015-08-27 03:52:03","2","85099","IL","SHOP (Small Group)","Yes","13-5123390","85099IL0180003","Guardian Family Essentials","85099IL018",,"ILN001","ILS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.74","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","85099IL0180003-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","IL","85099","SERFF","5","2015-08-27 03:52:03","3","85099","IL","SHOP (Small Group)","Yes","13-5123390","85099IL0160004","Guardian Family Advantage","85099IL016",,"ILN001","ILS002",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.11","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","85099IL0160004-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","IL","85099","SERFF","5","2015-08-27 03:52:03","3","85099","IL","SHOP (Small Group)","Yes","13-5123390","85099IL0160004","Guardian Family Advantage","85099IL016",,"ILN001","ILS002",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.11","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","85099IL0160004-01","Standard High On Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","IL","85099","SERFF","5","2015-08-27 03:52:03","3","85099","IL","SHOP (Small Group)","Yes","13-5123390","85099IL0180004","Guardian Family Essentials","85099IL018",,"ILN001","ILS002",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.74","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","85099IL0180004-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","IL","85099","SERFF","5","2015-08-27 03:52:03","3","85099","IL","SHOP (Small Group)","Yes","13-5123390","85099IL0180004","Guardian Family Essentials","85099IL018",,"ILN001","ILS002",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.74","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","85099IL0180004-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","IL","86600","SERFF","4","2015-08-27 03:52:03","1","86600","IL","SHOP (Small Group)","Yes","35-0472300","86600IL0010001","Lincoln DentalConnect®","86600IL001","7063415294","ILN001","ILS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.67","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","86600IL0010001-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","IL","86600","SERFF","4","2015-08-27 03:52:03","1","86600","IL","SHOP (Small Group)","Yes","35-0472300","86600IL0010002","Lincoln DentalConnect®","86600IL001","7063415294","ILN001","ILS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.66","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","86600IL0010002-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","IL","86600","SERFF","4","2015-08-27 03:52:03","1","86600","IL","SHOP (Small Group)","Yes","35-0472300","86600IL0010003","Lincoln DentalConnect®","86600IL001","7063415294","ILN001","ILS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.16","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","86600IL0010003-00","Standard Low Off Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","IL","86600","SERFF","4","2015-08-27 03:52:03","1","86600","IL","SHOP (Small Group)","Yes","35-0472300","86600IL0010004","Lincoln DentalConnect®","86600IL001","7063415294","ILN001","ILS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.26","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","86600IL0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","IL","86600","SERFF","4","2015-08-27 03:52:03","1","86600","IL","SHOP (Small Group)","Yes","35-0472300","86600IL0010005","Lincoln DentalConnect®","86600IL001","7063415294","ILN001","ILS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.57","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","86600IL0010005-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","IL","86600","SERFF","4","2015-08-27 03:52:03","1","86600","IL","SHOP (Small Group)","Yes","35-0472300","86600IL0010006","Lincoln DentalConnect®","86600IL001","7063415294","ILN001","ILS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.08","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","86600IL0010006-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","IL","86600","SERFF","4","2015-08-27 03:52:03","1","86600","IL","SHOP (Small Group)","Yes","35-0472300","86600IL0010007","Lincoln DentalConnect®","86600IL001","7063415294","ILN001","ILS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.16","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","86600IL0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2016","IL","87304","SERFF","4","2015-08-23 14:39:40","1","87304","IL","Individual","Yes","36-4189451","87304IL0060002","Managed DentalGuard IL Essentials 1","87304IL006",,"ILN002","ILS002",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.90","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","87304IL0060002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","4"
"2016","IL","87304","SERFF","4","2015-08-23 14:39:40","1","87304","IL","SHOP (Small Group)","Yes","36-4189451","87304IL0030003","Managed DentalGuard IL10 Family Plan","87304IL003",,"ILN001","ILS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$14.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","87304IL0030003-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","IL","87304","SERFF","4","2015-08-23 14:39:40","1","87304","IL","SHOP (Small Group)","Yes","36-4189451","87304IL0030003","Managed DentalGuard IL10 Family Plan","87304IL003",,"ILN001","ILS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$14.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","87304IL0030003-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","IL","87304","SERFF","4","2015-08-23 14:39:40","1","87304","IL","Individual","Yes","36-4189451","87304IL0060002","Managed DentalGuard IL Essentials 1","87304IL006",,"ILN002","ILS002",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.90","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","87304IL0060002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","5"
"2016","IL","87304","SERFF","4","2015-08-23 14:39:40","1","87304","IL","SHOP (Small Group)","Yes","36-4189451","87304IL0040003","Managed DentalGuard IL20 Family Plan","87304IL004",,"ILN001","ILS001",,"Existing","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.70","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","87304IL0040003-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","IL","87304","SERFF","4","2015-08-23 14:39:40","1","87304","IL","SHOP (Small Group)","Yes","36-4189451","87304IL0050003","Managed DentalGuard IL30 Family Plan","87304IL005",,"ILN001","ILS001",,"Existing","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.48","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","87304IL0050003-00","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","1","96601","IL","Individual","No","37-1241037","96601IL0200003","Coventry Bronze $15 Copay Carelink Methodist","96601IL020",,"ILN003","ILS003","ILF011","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0200003-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68488","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","1","96601","IL","Individual","No","37-1241037","96601IL0200003","Coventry Bronze $15 Copay Carelink Methodist","96601IL020",,"ILN003","ILS003","ILF011","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0200003-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68424","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","1","96601","IL","Individual","No","37-1241037","96601IL0200003","Coventry Bronze $15 Copay Carelink Methodist","96601IL020",,"ILN003","ILS003","ILF011","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0200003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68426","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","1","96601","IL","Individual","No","37-1241037","96601IL0200003","Coventry Bronze $15 Copay Carelink Methodist","96601IL020",,"ILN003","ILS003","ILF011","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0200003-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68425","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","2","96601","IL","Individual","No","37-1241037","96601IL0210003","Coventry Bronze $15 Copay Carelink St. John's","96601IL021",,"ILN004","ILS004","ILF019","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0210003-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68493","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","2","96601","IL","Individual","No","37-1241037","96601IL0210003","Coventry Bronze $15 Copay Carelink St. John's","96601IL021",,"ILN004","ILS004","ILF019","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0210003-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68434","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","2","96601","IL","Individual","No","37-1241037","96601IL0210003","Coventry Bronze $15 Copay Carelink St. John's","96601IL021",,"ILN004","ILS004","ILF019","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0210003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68436","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","2","96601","IL","Individual","No","37-1241037","96601IL0210003","Coventry Bronze $15 Copay Carelink St. John's","96601IL021",,"ILN004","ILS004","ILF019","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0210003-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68435","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","3","96601","IL","Individual","No","37-1241037","96601IL0190003","Coventry Bronze $15 Copay Carelink SwedishAmerican","96601IL019",,"ILN002","ILS002","ILF007","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0190003-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68704","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","3","96601","IL","Individual","No","37-1241037","96601IL0190003","Coventry Bronze $15 Copay Carelink SwedishAmerican","96601IL019",,"ILN002","ILS002","ILF007","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0190003-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68454","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","3","96601","IL","Individual","No","37-1241037","96601IL0190003","Coventry Bronze $15 Copay Carelink SwedishAmerican","96601IL019",,"ILN002","ILS002","ILF007","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0190003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68456","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","3","96601","IL","Individual","No","37-1241037","96601IL0190003","Coventry Bronze $15 Copay Carelink SwedishAmerican","96601IL019",,"ILN002","ILS002","ILF007","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0190003-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68455","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","4","96601","IL","Individual","No","37-1241037","96601IL0200011","Coventry Bronze $15 Copay UnityPoint Health Quad Cities","96601IL020",,"ILN005","ILS005","ILF016","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0200011-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68707","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","4","96601","IL","Individual","No","37-1241037","96601IL0200011","Coventry Bronze $15 Copay UnityPoint Health Quad Cities","96601IL020",,"ILN005","ILS005","ILF016","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0200011-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68472","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","4","96601","IL","Individual","No","37-1241037","96601IL0200011","Coventry Bronze $15 Copay UnityPoint Health Quad Cities","96601IL020",,"ILN005","ILS005","ILF016","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0200011-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68474","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","4","96601","IL","Individual","No","37-1241037","96601IL0200011","Coventry Bronze $15 Copay UnityPoint Health Quad Cities","96601IL020",,"ILN005","ILS005","ILF016","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0200011-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68473","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","5","96601","IL","Individual","No","37-1241037","96601IL0170003","Coventry Bronze $20 Copay","96601IL017",,"ILN001","ILS001","ILF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0170003-00","Standard Bronze Off Exchange Plan","61.63%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68479","http://www.coventryhealthcare.com/CILon2016","4"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","5","96601","IL","Individual","No","37-1241037","96601IL0170003","Coventry Bronze $20 Copay","96601IL017",,"ILN001","ILS001","ILF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0170003-01","Standard Bronze On Exchange Plan","61.63%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68409","http://www.coventryhealthcare.com/CILon2016","5"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","9","96601","IL","Individual","No","37-1241037","96601IL0210004","Coventry Bronze Deductible Only HSA Eligible Carelink St. John's","96601IL021",,"ILN004","ILS004","ILF020","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0210004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68444","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","9","96601","IL","Individual","No","37-1241037","96601IL0210004","Coventry Bronze Deductible Only HSA Eligible Carelink St. John's","96601IL021",,"ILN004","ILS004","ILF020","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0210004-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68443","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","10","96601","IL","Individual","No","37-1241037","96601IL0190004","Coventry Bronze Deductible Only HSA Eligible Carelink SwedishAmerican","96601IL019",,"ILN002","ILS002","ILF008","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0190004-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68706","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","10","96601","IL","Individual","No","37-1241037","96601IL0190004","Coventry Bronze Deductible Only HSA Eligible Carelink SwedishAmerican","96601IL019",,"ILN002","ILS002","ILF008","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0190004-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68457","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","15","96601","IL","Individual","No","37-1241037","96601IL0170002","Coventry Silver $15 Copay","96601IL017",,"ILN001","ILS001","ILF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0170002-00","Standard Silver Off Exchange Plan","68.15%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68477","http://www.coventryhealthcare.com/CILon2016","4"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","15","96601","IL","Individual","No","37-1241037","96601IL0170002","Coventry Silver $15 Copay","96601IL017",,"ILN001","ILS001","ILF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0170002-01","Standard Silver On Exchange Plan","68.15%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68403","http://www.coventryhealthcare.com/CILon2016","5"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","15","96601","IL","Individual","No","37-1241037","96601IL0170002","Coventry Silver $15 Copay","96601IL017",,"ILN001","ILS001","ILF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0170002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68405","http://www.coventryhealthcare.com/CILon2016","6"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","15","96601","IL","Individual","No","37-1241037","96601IL0170002","Coventry Silver $15 Copay","96601IL017",,"ILN001","ILS001","ILF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0170002-03","Limited Cost Sharing Plan Variation","68.15%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68404","http://www.coventryhealthcare.com/CILon2016","7"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","15","96601","IL","Individual","No","37-1241037","96601IL0170002","Coventry Silver $15 Copay","96601IL017",,"ILN001","ILS001","ILF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0170002-04","73% AV Level Silver Plan","72.23%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68408","http://www.coventryhealthcare.com/CILon2016","8"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","15","96601","IL","Individual","No","37-1241037","96601IL0170002","Coventry Silver $15 Copay","96601IL017",,"ILN001","ILS001","ILF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0170002-05","87% AV Level Silver Plan","86.01%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68407","http://www.coventryhealthcare.com/CILon2016","9"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","10","96601","IL","Individual","No","37-1241037","96601IL0190004","Coventry Bronze Deductible Only HSA Eligible Carelink SwedishAmerican","96601IL019",,"ILN002","ILS002","ILF008","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0190004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/IL68459","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","10","96601","IL","Individual","No","37-1241037","96601IL0190004","Coventry Bronze Deductible Only HSA Eligible Carelink SwedishAmerican","96601IL019",,"ILN002","ILS002","ILF008","Existing","PPO","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8462360038","96601IL0190004-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/IL68458","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","11","96601","IL","Individual","No","37-1241037","96601IL0200002","Coventry Silver $10 Copay Carelink Methodist","96601IL020",,"ILN003","ILS003","ILF010","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200002-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68486","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","16","96601","IL","Individual","No","37-1241037","96601IL0200001","Coventry Gold $10 Copay Carelink Methodist","96601IL020",,"ILN003","ILS003","ILF009","Existing","PPO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200001-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68415","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","16","96601","IL","Individual","No","37-1241037","96601IL0200001","Coventry Gold $10 Copay Carelink Methodist","96601IL020",,"ILN003","ILS003","ILF009","Existing","PPO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68417","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","16","96601","IL","Individual","No","37-1241037","96601IL0200001","Coventry Gold $10 Copay Carelink Methodist","96601IL020",,"ILN003","ILS003","ILF009","Existing","PPO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200001-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68416","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","17","96601","IL","Individual","No","37-1241037","96601IL0210001","Coventry Gold $10 Copay Carelink St. John's","96601IL021",,"ILN004","ILS004","ILF017","Existing","PPO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0210001-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68495","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","17","96601","IL","Individual","No","37-1241037","96601IL0210001","Coventry Gold $10 Copay Carelink St. John's","96601IL021",,"ILN004","ILS004","ILF017","Existing","PPO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0210001-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68437","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","99129","SERFF","5","2015-10-21 17:48:08","4","99129","IL","Individual","No","23-2169745","99129IL0060001","Aetna Whole Health Chicago Gold $10 Copay","99129IL006",,"ILN001","ILS001","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8454906849","99129IL0060001-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/IL/IL_SBC_709345.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/il-on-booklet01-16.pdf","5"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","11","96601","IL","Individual","No","37-1241037","96601IL0200002","Coventry Silver $10 Copay Carelink Methodist","96601IL020",,"ILN003","ILS003","ILF010","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200002-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68418","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","11","96601","IL","Individual","No","37-1241037","96601IL0200002","Coventry Silver $10 Copay Carelink Methodist","96601IL020",,"ILN003","ILS003","ILF010","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68420","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","11","96601","IL","Individual","No","37-1241037","96601IL0200002","Coventry Silver $10 Copay Carelink Methodist","96601IL020",,"ILN003","ILS003","ILF010","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200002-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68419","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","11","96601","IL","Individual","No","37-1241037","96601IL0200002","Coventry Silver $10 Copay Carelink Methodist","96601IL020",,"ILN003","ILS003","ILF010","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200002-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68423","http://www.coventryhealthcare.com/ILon2016","8"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","11","96601","IL","Individual","No","37-1241037","96601IL0200002","Coventry Silver $10 Copay Carelink Methodist","96601IL020",,"ILN003","ILS003","ILF010","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200002-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68422","http://www.coventryhealthcare.com/ILon2016","9"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","11","96601","IL","Individual","No","37-1241037","96601IL0200002","Coventry Silver $10 Copay Carelink Methodist","96601IL020",,"ILN003","ILS003","ILF010","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200002-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68421","http://www.coventryhealthcare.com/ILon2016","10"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","12","96601","IL","Individual","No","37-1241037","96601IL0210002","Coventry Silver $10 Copay Carelink St. John's","96601IL021",,"ILN004","ILS004","ILF018","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0210002-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68491","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","12","96601","IL","Individual","No","37-1241037","96601IL0210002","Coventry Silver $10 Copay Carelink St. John's","96601IL021",,"ILN004","ILS004","ILF018","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0210002-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68440","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","12","96601","IL","Individual","No","37-1241037","96601IL0210002","Coventry Silver $10 Copay Carelink St. John's","96601IL021",,"ILN004","ILS004","ILF018","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0210002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68430","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","12","96601","IL","Individual","No","37-1241037","96601IL0210002","Coventry Silver $10 Copay Carelink St. John's","96601IL021",,"ILN004","ILS004","ILF018","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0210002-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68441","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","12","96601","IL","Individual","No","37-1241037","96601IL0210002","Coventry Silver $10 Copay Carelink St. John's","96601IL021",,"ILN004","ILS004","ILF018","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0210002-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68433","http://www.coventryhealthcare.com/ILon2016","8"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","12","96601","IL","Individual","No","37-1241037","96601IL0210002","Coventry Silver $10 Copay Carelink St. John's","96601IL021",,"ILN004","ILS004","ILF018","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0210002-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68432","http://www.coventryhealthcare.com/ILon2016","9"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","12","96601","IL","Individual","No","37-1241037","96601IL0210002","Coventry Silver $10 Copay Carelink St. John's","96601IL021",,"ILN004","ILS004","ILF018","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0210002-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68431","http://www.coventryhealthcare.com/ILon2016","10"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","13","96601","IL","Individual","No","37-1241037","96601IL0190002","Coventry Silver $10 Copay Carelink SwedishAmerican","96601IL019",,"ILN002","ILS002","ILF006","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0190002-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68702","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","13","96601","IL","Individual","No","37-1241037","96601IL0190002","Coventry Silver $10 Copay Carelink SwedishAmerican","96601IL019",,"ILN002","ILS002","ILF006","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0190002-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68448","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","13","96601","IL","Individual","No","37-1241037","96601IL0190002","Coventry Silver $10 Copay Carelink SwedishAmerican","96601IL019",,"ILN002","ILS002","ILF006","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0190002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68450","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","13","96601","IL","Individual","No","37-1241037","96601IL0190002","Coventry Silver $10 Copay Carelink SwedishAmerican","96601IL019",,"ILN002","ILS002","ILF006","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0190002-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68449","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","13","96601","IL","Individual","No","37-1241037","96601IL0190002","Coventry Silver $10 Copay Carelink SwedishAmerican","96601IL019",,"ILN002","ILS002","ILF006","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0190002-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68453","http://www.coventryhealthcare.com/ILon2016","8"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","13","96601","IL","Individual","No","37-1241037","96601IL0190002","Coventry Silver $10 Copay Carelink SwedishAmerican","96601IL019",,"ILN002","ILS002","ILF006","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0190002-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68452","http://www.coventryhealthcare.com/ILon2016","9"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","13","96601","IL","Individual","No","37-1241037","96601IL0190002","Coventry Silver $10 Copay Carelink SwedishAmerican","96601IL019",,"ILN002","ILS002","ILF006","Existing","PPO","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0190002-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68451","http://www.coventryhealthcare.com/ILon2016","10"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","14","96601","IL","Individual","No","37-1241037","96601IL0200008","Coventry Silver $10 Copay UnityPoint Health Quad Cities","96601IL020",,"ILN005","ILS005","ILF015","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200008-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68713","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","14","96601","IL","Individual","No","37-1241037","96601IL0200008","Coventry Silver $10 Copay UnityPoint Health Quad Cities","96601IL020",,"ILN005","ILS005","ILF015","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200008-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68466","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","14","96601","IL","Individual","No","37-1241037","96601IL0200008","Coventry Silver $10 Copay UnityPoint Health Quad Cities","96601IL020",,"ILN005","ILS005","ILF015","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200008-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68468","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","14","96601","IL","Individual","No","37-1241037","96601IL0200008","Coventry Silver $10 Copay UnityPoint Health Quad Cities","96601IL020",,"ILN005","ILS005","ILF015","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200008-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68467","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","14","96601","IL","Individual","No","37-1241037","96601IL0200008","Coventry Silver $10 Copay UnityPoint Health Quad Cities","96601IL020",,"ILN005","ILS005","ILF015","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200008-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68471","http://www.coventryhealthcare.com/ILon2016","8"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","14","96601","IL","Individual","No","37-1241037","96601IL0200008","Coventry Silver $10 Copay UnityPoint Health Quad Cities","96601IL020",,"ILN005","ILS005","ILF015","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200008-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68470","http://www.coventryhealthcare.com/ILon2016","9"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","14","96601","IL","Individual","No","37-1241037","96601IL0200008","Coventry Silver $10 Copay UnityPoint Health Quad Cities","96601IL020",,"ILN005","ILS005","ILF015","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200008-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68469","http://www.coventryhealthcare.com/ILon2016","10"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","15","96601","IL","Individual","No","37-1241037","96601IL0170002","Coventry Silver $15 Copay","96601IL017",,"ILN001","ILS001","ILF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0170002-06","94% AV Level Silver Plan","93.09%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68406","http://www.coventryhealthcare.com/CILon2016","10"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","16","96601","IL","Individual","No","37-1241037","96601IL0200001","Coventry Gold $10 Copay Carelink Methodist","96601IL020",,"ILN003","ILS003","ILF009","Existing","PPO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200001-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68484","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","17","96601","IL","Individual","No","37-1241037","96601IL0210001","Coventry Gold $10 Copay Carelink St. John's","96601IL021",,"ILN004","ILS004","ILF017","Existing","PPO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0210001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68439","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","17","96601","IL","Individual","No","37-1241037","96601IL0210001","Coventry Gold $10 Copay Carelink St. John's","96601IL021",,"ILN004","ILS004","ILF017","Existing","PPO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0210001-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68438","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","18","96601","IL","Individual","No","37-1241037","96601IL0190001","Coventry Gold $10 Copay Carelink SwedishAmerican","96601IL019",,"ILN002","ILS002","ILF005","Existing","PPO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0190001-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68700","http://www.coventryhealthcare.com/ILon2016","4"
"2016","KS","11339","SERFF","3","2015-08-27 03:52:03","2","11339","KS","Individual","Yes","75-1233841","11339KS0010004","Dentegra Dental PPO Family Preferred Plan","11339KS001",,"KSN001","KSS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.30","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","11339KS0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ks/11339ks0010004-16","4"
"2016","KS","11339","SERFF","3","2015-08-27 03:52:03","2","11339","KS","SHOP (Small Group)","Yes","75-1233841","11339KS0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","11339KS002",,"KSN001","KSS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.51","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","11339KS0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ks/11339ks0020004-16","4"
"2016","KS","11339","SERFF","3","2015-08-27 03:52:03","3","11339","KS","SHOP (Small Group)","Yes","75-1233841","11339KS0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","11339KS002",,"KSN001","KSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.91","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","11339KS0020006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ks/11339ks0020006-16","4"
"2016","KS","11339","SERFF","3","2015-08-27 03:52:03","3","11339","KS","Individual","Yes","75-1233841","11339KS0010006","Dentegra Dental PPO Family Basic Plan","11339KS001",,"KSN001","KSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.75","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","11339KS0010006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ks/11339ks0010006-16","4"
"2016","KS","11339","SERFF","3","2015-08-27 03:52:03","3","11339","KS","Individual","Yes","75-1233841","11339KS0010006","Dentegra Dental PPO Family Basic Plan","11339KS001",,"KSN001","KSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.75","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","11339KS0010006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ks/11339ks0010006-16","5"
"2016","KS","11339","SERFF","3","2015-08-27 03:52:03","3","11339","KS","SHOP (Small Group)","Yes","75-1233841","11339KS0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","11339KS002",,"KSN001","KSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.91","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","11339KS0020006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ks/11339ks0020006-16","5"
"2016","KS","12069","SERFF","6","2015-08-22 23:36:24","1","12069","KS","SHOP (Small Group)","Yes","86-0307623","12069KS0010001","Smile for Health - Certified Optimum Coverage","12069KS001",,"KSN001","KSS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","12069KS0010001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","12069","SERFF","6","2015-08-22 23:36:24","2","12069","KS","SHOP (Small Group)","Yes","86-0307623","12069KS0010002","Smile for Health - Certified Optimum Coverage","12069KS001",,"KSN002","KSS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","12069KS0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","2","18558","KS","Individual","No","48-0952857","18558KS0360021","BlueCare SaverPlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0360021-04","73% AV Level Silver Plan","73.04%","0.730439841747284","Yes","Yes","No","100%",,"$2,750","$20","$900","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20%",,,,,"$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0360021-04","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0360021-04","8"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","18","96601","IL","Individual","No","37-1241037","96601IL0190001","Coventry Gold $10 Copay Carelink SwedishAmerican","96601IL019",,"ILN002","ILS002","ILF005","Existing","PPO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0190001-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68445","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","18","96601","IL","Individual","No","37-1241037","96601IL0190001","Coventry Gold $10 Copay Carelink SwedishAmerican","96601IL019",,"ILN002","ILS002","ILF005","Existing","PPO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0190001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68447","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","18","96601","IL","Individual","No","37-1241037","96601IL0190001","Coventry Gold $10 Copay Carelink SwedishAmerican","96601IL019",,"ILN002","ILS002","ILF005","Existing","PPO","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0190001-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68446","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","19","96601","IL","Individual","No","37-1241037","96601IL0200007","Coventry Gold $10 Copay UnityPoint Health Quad Cities","96601IL020",,"ILN005","ILS005","ILF014","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200007-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68711","http://www.coventryhealthcare.com/ILon2016","4"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","19","96601","IL","Individual","No","37-1241037","96601IL0200007","Coventry Gold $10 Copay UnityPoint Health Quad Cities","96601IL020",,"ILN005","ILS005","ILF014","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200007-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68463","http://www.coventryhealthcare.com/ILon2016","5"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","19","96601","IL","Individual","No","37-1241037","96601IL0200007","Coventry Gold $10 Copay UnityPoint Health Quad Cities","96601IL020",,"ILN005","ILS005","ILF014","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68465","http://www.coventryhealthcare.com/ILon2016","6"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","19","96601","IL","Individual","No","37-1241037","96601IL0200007","Coventry Gold $10 Copay UnityPoint Health Quad Cities","96601IL020",,"ILN005","ILS005","ILF014","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0200007-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68464","http://www.coventryhealthcare.com/ILon2016","7"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","20","96601","IL","Individual","No","37-1241037","96601IL0170001","Coventry Gold $15 Copay","96601IL017",,"ILN001","ILS001","ILF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0170001-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68482","http://www.coventryhealthcare.com/CILon2016","4"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","20","96601","IL","Individual","No","37-1241037","96601IL0170001","Coventry Gold $15 Copay","96601IL017",,"ILN001","ILS001","ILF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0170001-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68400","http://www.coventryhealthcare.com/CILon2016","5"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","20","96601","IL","Individual","No","37-1241037","96601IL0170001","Coventry Gold $15 Copay","96601IL017",,"ILN001","ILS001","ILF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0170001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68402","http://www.coventryhealthcare.com/CILon2016","6"
"2016","IL","96601","SERFF","5","2015-08-27 03:52:03","20","96601","IL","Individual","No","37-1241037","96601IL0170001","Coventry Gold $15 Copay","96601IL017",,"ILN001","ILS001","ILF001","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8459937751","96601IL0170001-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/IL68401","http://www.coventryhealthcare.com/CILon2016","7"
"2016","IL","99129","SERFF","5","2015-10-21 17:48:08","1","99129","IL","Individual","No","23-2169745","99129IL0060003","Aetna Whole Health Chicago Bronze $15 Copay","99129IL006",,"ILN001","ILS001","ILF007","New","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8457515465","99129IL0060003-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/IL/IL_SBC_709358.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/il-on-booklet01-16.pdf","4"
"2016","IL","99129","SERFF","5","2015-10-21 17:48:08","1","99129","IL","Individual","No","23-2169745","99129IL0060003","Aetna Whole Health Chicago Bronze $15 Copay","99129IL006",,"ILN001","ILS001","ILF007","New","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8457515465","99129IL0060003-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/IL/IL_SBC_709358.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/il-on-booklet01-16.pdf","5"
"2016","IL","99129","SERFF","5","2015-10-21 17:48:08","1","99129","IL","Individual","No","23-2169745","99129IL0060003","Aetna Whole Health Chicago Bronze $15 Copay","99129IL006",,"ILN001","ILS001","ILF007","New","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8457515465","99129IL0060003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/IL/IL_SBC_709362.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/il-on-booklet01-16.pdf","6"
"2016","IL","99129","SERFF","5","2015-10-21 17:48:08","1","99129","IL","Individual","No","23-2169745","99129IL0060003","Aetna Whole Health Chicago Bronze $15 Copay","99129IL006",,"ILN001","ILS001","ILF007","New","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8457515465","99129IL0060003-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/IL/IL_SBC_709361.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/il-on-booklet01-16.pdf","7"
"2016","IL","99129","SERFF","5","2015-10-21 17:48:08","2","99129","IL","Individual","No","23-2169745","99129IL0060004","AetnaWholeHealth Chicago Bronze Deductible Only HSA Eligible","99129IL006",,"ILN001","ILS001","ILF008","New","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8457515465","99129IL0060004-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/IL/IL_SBC_709363.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/il-on-booklet01-16.pdf","4"
"2016","IL","99129","SERFF","5","2015-10-21 17:48:08","2","99129","IL","Individual","No","23-2169745","99129IL0060004","AetnaWholeHealth Chicago Bronze Deductible Only HSA Eligible","99129IL006",,"ILN001","ILS001","ILF008","New","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8457515465","99129IL0060004-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/IL/IL_SBC_709363.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/il-on-booklet01-16.pdf","5"
"2016","IL","99129","SERFF","5","2015-10-21 17:48:08","2","99129","IL","Individual","No","23-2169745","99129IL0060004","AetnaWholeHealth Chicago Bronze Deductible Only HSA Eligible","99129IL006",,"ILN001","ILS001","ILF008","New","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8457515465","99129IL0060004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/IL/IL_SBC_709367.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/il-on-booklet01-16.pdf","6"
"2016","IL","99129","SERFF","5","2015-10-21 17:48:08","2","99129","IL","Individual","No","23-2169745","99129IL0060004","AetnaWholeHealth Chicago Bronze Deductible Only HSA Eligible","99129IL006",,"ILN001","ILS001","ILF008","New","HMO","Bronze","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8457515465","99129IL0060004-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/IL/IL_SBC_709366.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/il-on-booklet01-16.pdf","7"
"2016","IL","99129","SERFF","5","2015-10-21 17:48:08","3","99129","IL","Individual","No","23-2169745","99129IL0060002","Aetna Whole Health Chicago Silver $10 Copay","99129IL006",,"ILN001","ILS001","ILF006","New","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8454906849","99129IL0060002-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/IL/IL_SBC_709350.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/il-on-booklet01-16.pdf","4"
"2016","IL","99129","SERFF","5","2015-10-21 17:48:08","3","99129","IL","Individual","No","23-2169745","99129IL0060002","Aetna Whole Health Chicago Silver $10 Copay","99129IL006",,"ILN001","ILS001","ILF006","New","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8454906849","99129IL0060002-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/IL/IL_SBC_709350.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/il-on-booklet01-16.pdf","5"
"2016","IL","99129","SERFF","5","2015-10-21 17:48:08","3","99129","IL","Individual","No","23-2169745","99129IL0060002","Aetna Whole Health Chicago Silver $10 Copay","99129IL006",,"ILN001","ILS001","ILF006","New","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8454906849","99129IL0060002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/IL/IL_SBC_709354.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/il-on-booklet01-16.pdf","6"
"2016","IL","99129","SERFF","5","2015-10-21 17:48:08","3","99129","IL","Individual","No","23-2169745","99129IL0060002","Aetna Whole Health Chicago Silver $10 Copay","99129IL006",,"ILN001","ILS001","ILF006","New","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8454906849","99129IL0060002-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/IL/IL_SBC_709353.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/il-on-booklet01-16.pdf","7"
"2016","IL","99129","SERFF","5","2015-10-21 17:48:08","3","99129","IL","Individual","No","23-2169745","99129IL0060002","Aetna Whole Health Chicago Silver $10 Copay","99129IL006",,"ILN001","ILS001","ILF006","New","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8454906849","99129IL0060002-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/IL/IL_SBC_709355.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/il-on-booklet01-16.pdf","8"
"2016","IL","99129","SERFF","5","2015-10-21 17:48:08","3","99129","IL","Individual","No","23-2169745","99129IL0060002","Aetna Whole Health Chicago Silver $10 Copay","99129IL006",,"ILN001","ILS001","ILF006","New","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8454906849","99129IL0060002-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/IL/IL_SBC_709356.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/il-on-booklet01-16.pdf","9"
"2016","IL","99129","SERFF","5","2015-10-21 17:48:08","3","99129","IL","Individual","No","23-2169745","99129IL0060002","Aetna Whole Health Chicago Silver $10 Copay","99129IL006",,"ILN001","ILS001","ILF006","New","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8454906849","99129IL0060002-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/IL/IL_SBC_709357.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/il-on-booklet01-16.pdf","10"
"2016","IL","99129","SERFF","5","2015-10-21 17:48:08","4","99129","IL","Individual","No","23-2169745","99129IL0060001","Aetna Whole Health Chicago Gold $10 Copay","99129IL006",,"ILN001","ILS001","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8454906849","99129IL0060001-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/IL/IL_SBC_709345.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/il-on-booklet01-16.pdf","4"
"2016","IL","99129","SERFF","5","2015-10-21 17:48:08","4","99129","IL","Individual","No","23-2169745","99129IL0060001","Aetna Whole Health Chicago Gold $10 Copay","99129IL006",,"ILN001","ILS001","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8454906849","99129IL0060001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/IL/IL_SBC_709349.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/il-on-booklet01-16.pdf","6"
"2016","IL","99129","SERFF","5","2015-10-21 17:48:08","4","99129","IL","Individual","No","23-2169745","99129IL0060001","Aetna Whole Health Chicago Gold $10 Copay","99129IL006",,"ILN001","ILS001","ILF005","New","HMO","Gold","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8454906849","99129IL0060001-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/IL/IL_SBC_709348.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/il-on-booklet01-16.pdf","7"
"2016","KS","11339","SERFF","3","2015-08-27 03:52:03","1","11339","KS","SHOP (Small Group)","Yes","75-1233841","11339KS0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","11339KS002",,"KSN001","KSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.91","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","11339KS0020001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ks/11339ks0020001-16","4"
"2016","KS","11339","SERFF","3","2015-08-27 03:52:03","1","11339","KS","Individual","Yes","75-1233841","11339KS0010001","Dentegra Dental PPO Pediatric Basic Plan","11339KS001",,"KSN001","KSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.75","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","11339KS0010001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ks/11339ks0010001-16","4"
"2016","KS","12069","SERFF","6","2015-08-22 23:36:24","3","12069","KS","SHOP (Small Group)","Yes","86-0307623","12069KS0010003","Smile for Health - Certified Optimum Coverage","12069KS001",,"KSN003","KSS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","12069KS0010003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","12069","SERFF","6","2015-08-22 23:36:24","4","12069","KS","SHOP (Small Group)","Yes","86-0307623","12069KS0010004","Smile for Health - Certified Optimum Coverage","12069KS001",,"KSN001","KSS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","12069KS0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","12069","SERFF","6","2015-08-22 23:36:24","5","12069","KS","SHOP (Small Group)","Yes","86-0307623","12069KS0010005","Smile for Health - Certified Optimum Coverage","12069KS001",,"KSN002","KSS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","12069KS0010005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","12069","SERFF","6","2015-08-22 23:36:24","6","12069","KS","SHOP (Small Group)","Yes","86-0307623","12069KS0010006","Smile for Health - Certified Optimum Coverage","12069KS001",,"KSN003","KSS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","12069KS0010006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","12069","SERFF","6","2015-08-22 23:36:24","7","12069","KS","SHOP (Small Group)","Yes","86-0307623","12069KS0020001","Smile for Health - Certified High Option","12069KS002",,"KSN001","KSS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","12069KS0020001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","12069","SERFF","6","2015-08-22 23:36:24","8","12069","KS","SHOP (Small Group)","Yes","86-0307623","12069KS0020002","Smile for Health - Certified High Option","12069KS002",,"KSN002","KSS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","12069KS0020002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","12069","SERFF","6","2015-08-22 23:36:24","9","12069","KS","SHOP (Small Group)","Yes","86-0307623","12069KS0020003","Smile for Health - Certified High Option","12069KS002",,"KSN003","KSS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","12069KS0020003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","12069","SERFF","6","2015-08-22 23:36:24","10","12069","KS","SHOP (Small Group)","Yes","86-0307623","12069KS0020004","Smile for Health - Certified High Option Plus","12069KS002",,"KSN001","KSS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","12069KS0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","12069","SERFF","6","2015-08-22 23:36:24","11","12069","KS","SHOP (Small Group)","Yes","86-0307623","12069KS0020005","Smile for Health - Certified High Option Plus","12069KS002",,"KSN002","KSS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","12069KS0020005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","12069","SERFF","6","2015-08-22 23:36:24","12","12069","KS","SHOP (Small Group)","Yes","86-0307623","12069KS0020006","Smile for Health - Certified High Option Plus","12069KS002",,"KSN003","KSS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","12069KS0020006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","1","18558","KS","SHOP (Small Group)","No","48-0952857","18558KS0370001","BlueCare PremierSHOP","18558KS037",,"KSN001","KSS001","KSF002","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9935",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0370001-00","Standard Gold Off Exchange Plan","79.44%","0.79439115524292","Yes","Yes","No","100%",,"$1,500","$50","$1,010","$150","$1,500","$700","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0370001-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0370001-00","4"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","1","18558","KS","SHOP (Small Group)","No","48-0952857","18558KS0370001","BlueCare PremierSHOP","18558KS037",,"KSN001","KSS001","KSF002","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9935",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0370001-01","Standard Gold On Exchange Plan","79.44%","0.79439115524292","Yes","Yes","No","100%",,"$1,500","$50","$1,010","$150","$1,500","$700","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0370001-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0370001-01","5"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","1","18558","KS","Individual","No","48-0952857","18558KS0360019","BlueCare Premier with pediatric dental","18558KS036",,"KSN001","KSS001","KSF002","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0360019-00","Standard Gold Off Exchange Plan","79.44%","0.79439115524292","Yes","Yes","No","100%",,"$1,500","$50","$1,010","$150","$1,500","$700","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0360019-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0360019-00","6"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","1","18558","KS","Individual","No","48-0952857","18558KS0360019","BlueCare Premier with pediatric dental","18558KS036",,"KSN001","KSS001","KSF002","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0360019-01","Standard Gold On Exchange Plan","79.44%","0.79439115524292","Yes","Yes","No","100%",,"$1,500","$50","$1,010","$150","$1,500","$700","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0360019-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0360019-01","7"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","1","18558","KS","SHOP (Small Group)","No","48-0952857","18558KS0370002","BlueCare SignatureSHOP","18558KS037",,"KSN001","KSS001","KSF003","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9935",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0370002-00","Standard Silver Off Exchange Plan",,"0.690296113491058","Yes","Yes","No","100%",,"$2,000","$40","$1,530","$150","$2,000","$40","$950","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0370002-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0370002-00","7"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","1","18558","KS","SHOP (Small Group)","No","48-0952857","18558KS0370002","BlueCare SignatureSHOP","18558KS037",,"KSN001","KSS001","KSF003","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9935",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0370002-01","Standard Silver On Exchange Plan",,"0.690296113491058","Yes","Yes","No","100%",,"$2,000","$40","$1,530","$150","$2,000","$40","$950","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0370002-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0370002-01","8"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","1","18558","KS","Individual","No","48-0952857","18558KS0360019","BlueCare Premier with pediatric dental","18558KS036",,"KSN001","KSS001","KSF002","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0360019-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0360019-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0360019-02","8"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","1","18558","KS","Individual","No","48-0952857","18558KS0360019","BlueCare Premier with pediatric dental","18558KS036",,"KSN001","KSS001","KSF002","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0360019-03","Limited Cost Sharing Plan Variation","79.44%","0.79439115524292","Yes","Yes","No","100%",,"$1,500","$50","$1,010","$150","$1,500","$700","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0360019-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0360019-03","9"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","1","18558","KS","Individual","No","48-0952857","18558KS0360031","BlueCare Essential with pediatric dental","18558KS036",,"KSN001","KSS001","KSF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0360031-00","Standard Bronze Off Exchange Plan",,"0.613283455371857","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0360031-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0360031-00","11"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","1","18558","KS","Individual","No","48-0952857","18558KS0360031","BlueCare Essential with pediatric dental","18558KS036",,"KSN001","KSS001","KSF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0360031-01","Standard Bronze On Exchange Plan",,"0.613283455371857","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0360031-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0360031-01","12"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","1","18558","KS","Individual","No","48-0952857","18558KS0360031","BlueCare Essential with pediatric dental","18558KS036",,"KSN001","KSS001","KSF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0360031-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0360031-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0360031-02","13"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","1","18558","KS","Individual","No","48-0952857","18558KS0360031","BlueCare Essential with pediatric dental","18558KS036",,"KSN001","KSS001","KSF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0360031-03","Limited Cost Sharing Plan Variation",,"0.613283455371857","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0360031-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0360031-03","14"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","2","18558","KS","SHOP (Small Group)","No","48-0952857","18558KS0370004","BlueCare SaverSHOP","18558KS037",,"KSN001","KSS001","KSF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9935",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0370004-00","Standard Bronze Off Exchange Plan",,"0.610934615135193","Yes","Yes","No","100%",,"$3,400","$0","$1,940","$150","$2,420","$0","$1,420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","50%",,,,,"$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0370004-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0370004-00","4"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","4","18558","KS","Individual","No","48-0952857","18558KS0390007","BlueCare Elite","18558KS039",,"KSN001","KSS001","KSF005","New","PPO","Platinum","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390007-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390007-02","5"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","2","18558","KS","Individual","No","48-0952857","18558KS0360021","BlueCare SaverPlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0360021-00","Standard Silver Off Exchange Plan","70.31%","0.70313435792923","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0360021-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0360021-00","4"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","2","18558","KS","Individual","No","48-0952857","18558KS0360021","BlueCare SaverPlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0360021-01","Standard Silver On Exchange Plan","70.31%","0.70313435792923","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0360021-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0360021-01","5"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","2","18558","KS","SHOP (Small Group)","No","48-0952857","18558KS0370004","BlueCare SaverSHOP","18558KS037",,"KSN001","KSS001","KSF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9935",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0370004-01","Standard Bronze On Exchange Plan",,"0.610934615135193","Yes","Yes","No","100%",,"$3,400","$0","$1,940","$150","$2,420","$0","$1,420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","50%",,,,,"$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0370004-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0370004-01","5"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","2","18558","KS","Individual","No","48-0952857","18558KS0360021","BlueCare SaverPlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0360021-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0360021-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0360021-02","6"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","2","18558","KS","Individual","No","48-0952857","18558KS0360021","BlueCare SaverPlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0360021-03","Limited Cost Sharing Plan Variation","70.31%","0.70313435792923","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0360021-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0360021-03","7"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","2","18558","KS","Individual","No","48-0952857","18558KS0360021","BlueCare SaverPlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0360021-05","87% AV Level Silver Plan","87.57%","0.875739932060242","Yes","Yes","No","100%",,"$750","$20","$730","$150","$750","$570","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0360021-05","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0360021-05","9"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","2","18558","KS","Individual","No","48-0952857","18558KS0360021","BlueCare SaverPlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0360021-06","94% AV Level Silver Plan","93.96%","0.939581751823425","Yes","Yes","No","100%",,"$250","$20","$230","$150","$250","$210","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0360021-06","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0360021-06","10"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","4","18558","KS","Individual","No","48-0952857","18558KS0390026","BlueCare SaverPlus","18558KS039",,"KSN001","KSS001","KSF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390026-03","Limited Cost Sharing Plan Variation","70.31%","0.70313435792923","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390026-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390026-03","9"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","3","27811","KS","Individual","No","80-0968685","27811KS0030003","BlueCare Solutions Bronze","27811KS003",,"KSN001","KSS001","KSF002","Existing","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","2","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0030003-03","Limited Cost Sharing Plan Variation",,"0.613283455371857","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0030003-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0030003-03","9"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","4","27811","KS","Individual","No","80-0968685","27811KS0030002","BlueCare Solutions Silver","27811KS003",,"KSN001","KSS001","KSF001","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0030002-01","Standard Silver On Exchange Plan","70.31%","0.70313435792923","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0030002-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0030002-01","4"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","4","27811","KS","Individual","No","80-0968685","27811KS0030002","BlueCare Solutions Silver","27811KS003",,"KSN001","KSS001","KSF001","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0030002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0030002-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0030002-02","5"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","4","27811","KS","Individual","No","80-0968685","27811KS0030002","BlueCare Solutions Silver","27811KS003",,"KSN001","KSS001","KSF001","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0030002-03","Limited Cost Sharing Plan Variation","70.31%","0.70313435792923","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0030002-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0030002-03","6"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","4","27811","KS","Individual","No","80-0968685","27811KS0030002","BlueCare Solutions Silver","27811KS003",,"KSN001","KSS001","KSF001","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0030002-04","73% AV Level Silver Plan","73.04%","0.730439841747284","Yes","Yes","No","100%",,"$2,750","$20","$900","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0030002-04","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0030002-04","7"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","2","18558","KS","Individual","No","48-0952857","18558KS0360001","BlueCare Elite with pediatric dental","18558KS036",,"KSN001","KSS001","KSF005","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0360001-00","Standard Platinum Off Exchange Plan",,"0.889324545860291","Yes","Yes","No","100%",,"$0","$0","$1,150","$150","$0","$0","$1,150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0360001-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0360001-00","14"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","2","18558","KS","Individual","No","48-0952857","18558KS0360001","BlueCare Elite with pediatric dental","18558KS036",,"KSN001","KSS001","KSF005","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0360001-01","Standard Platinum On Exchange Plan",,"0.889324545860291","Yes","Yes","No","100%",,"$0","$0","$1,150","$150","$0","$0","$1,150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0360001-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0360001-01","15"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","2","18558","KS","Individual","No","48-0952857","18558KS0360001","BlueCare Elite with pediatric dental","18558KS036",,"KSN001","KSS001","KSF005","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0360001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0360001-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0360001-02","16"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","2","18558","KS","SHOP (Small Group)","No","48-0952857","18558KS0370041","BlueCare Simple SilverSHOP","18558KS037",,"KSN001","KSS001","KSF005","New","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9935",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0370041-00","Standard Silver Off Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0370041-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0370041-00","16"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","2","18558","KS","SHOP (Small Group)","No","48-0952857","18558KS0370041","BlueCare Simple SilverSHOP","18558KS037",,"KSN001","KSS001","KSF005","New","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9935",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0370041-01","Standard Silver On Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0370041-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0370041-01","17"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","2","18558","KS","Individual","No","48-0952857","18558KS0360001","BlueCare Elite with pediatric dental","18558KS036",,"KSN001","KSS001","KSF005","Existing","PPO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0360001-03","Limited Cost Sharing Plan Variation",,"0.889324545860291","Yes","Yes","No","100%",,"$0","$0","$1,150","$150","$0","$0","$1,150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0360001-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0360001-03","17"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","2","18558","KS","SHOP (Small Group)","No","48-0952857","18558KS0370042","BlueCare Simple BronzeSHOP","18558KS037",,"KSN001","KSS001","KSF005","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9935",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0370042-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0370042-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0370042-00","18"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","2","18558","KS","SHOP (Small Group)","No","48-0952857","18558KS0370042","BlueCare Simple BronzeSHOP","18558KS037",,"KSN001","KSS001","KSF005","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9935",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0370042-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0370042-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0370042-01","19"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","3","18558","KS","Individual","No","48-0952857","18558KS0390016","BlueCare PremierPlus","18558KS039",,"KSN001","KSS001","KSF006","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390016-01","Standard Gold On Exchange Plan",,"0.78205406665802","No","Yes","No","100%",,"$770","$30","$1,010","$150","$850","$180","$1,470","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","50%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390016-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390016-01","4"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","3","18558","KS","Individual","No","48-0952857","18558KS0390016","BlueCare PremierPlus","18558KS039",,"KSN001","KSS001","KSF006","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390016-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390016-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390016-02","5"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","3","18558","KS","Individual","No","48-0952857","18558KS0390016","BlueCare PremierPlus","18558KS039",,"KSN001","KSS001","KSF006","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390016-03","Limited Cost Sharing Plan Variation",,"0.78205406665802","No","Yes","No","100%",,"$770","$30","$1,010","$150","$850","$180","$1,470","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","50%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390016-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390016-03","6"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","3","18558","KS","Individual","No","48-0952857","18558KS0390025","BlueCare Premier","18558KS039",,"KSN001","KSS001","KSF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390025-01","Standard Gold On Exchange Plan","79.44%","0.79439115524292","Yes","Yes","No","100%",,"$1,500","$50","$1,010","$150","$1,500","$700","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390025-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390025-01","7"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","3","18558","KS","Individual","No","48-0952857","18558KS0390025","BlueCare Premier","18558KS039",,"KSN001","KSS001","KSF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390025-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390025-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390025-02","8"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","3","18558","KS","Individual","No","48-0952857","18558KS0390025","BlueCare Premier","18558KS039",,"KSN001","KSS001","KSF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390025-03","Limited Cost Sharing Plan Variation","79.44%","0.79439115524292","Yes","Yes","No","100%",,"$1,500","$50","$1,010","$150","$1,500","$700","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390025-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390025-03","9"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","3","18558","KS","Individual","No","48-0952857","18558KS0390017","BlueCare Signature","18558KS039",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390017-01","Standard Silver On Exchange Plan",,"0.682855606079102","No","Yes","No","100%",,"$2,520","$0","$950","$150","$2,520","$0","$1,370","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","50%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390017-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390017-01","10"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","3","18558","KS","Individual","No","48-0952857","18558KS0390017","BlueCare Signature","18558KS039",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390017-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390017-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390017-02","11"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","3","18558","KS","Individual","No","48-0952857","18558KS0390017","BlueCare Signature","18558KS039",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390017-03","Limited Cost Sharing Plan Variation",,"0.682855606079102","No","Yes","No","100%",,"$2,520","$0","$950","$150","$2,520","$0","$1,370","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","50%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390017-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390017-03","12"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","3","18558","KS","Individual","No","48-0952857","18558KS0390017","BlueCare Signature","18558KS039",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390017-04","73% AV Level Silver Plan",,"0.720406591892242","No","Yes","No","100%",,"$2,020","$30","$1,010","$150","$2,100","$30","$1,440","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","50%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390017-04","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390017-04","13"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","3","18558","KS","Individual","No","48-0952857","18558KS0390017","BlueCare Signature","18558KS039",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390017-05","87% AV Level Silver Plan",,"0.863502383232117","No","Yes","No","100%",,"$600","$30","$570","$150","$650","$150","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","20%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390017-05","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390017-05","14"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","3","18558","KS","Individual","No","48-0952857","18558KS0390017","BlueCare Signature","18558KS039",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390017-06","94% AV Level Silver Plan",,"0.945658445358276","No","Yes","No","100%",,"$250","$20","$230","$150","$480","$0","$20","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$12,100","$12100 per person","$24200 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$50 per group","20%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390017-06","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390017-06","15"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","3","18558","KS","Individual","No","48-0952857","18558KS0390035","BlueCare Essential","18558KS039",,"KSN001","KSS001","KSF004","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390035-01","Standard Bronze On Exchange Plan",,"0.613283455371857","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390035-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390035-01","16"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","3","18558","KS","Individual","No","48-0952857","18558KS0390035","BlueCare Essential","18558KS039",,"KSN001","KSS001","KSF004","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390035-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390035-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390035-02","17"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","3","18558","KS","Individual","No","48-0952857","18558KS0390035","BlueCare Essential","18558KS039",,"KSN001","KSS001","KSF004","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390035-03","Limited Cost Sharing Plan Variation",,"0.613283455371857","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390035-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390035-03","18"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","4","18558","KS","Individual","No","48-0952857","18558KS0390007","BlueCare Elite","18558KS039",,"KSN001","KSS001","KSF005","New","PPO","Platinum","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390007-01","Standard Platinum On Exchange Plan",,"0.889324545860291","Yes","Yes","No","100%",,"$0","$0","$1,150","$150","$0","$0","$1,150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390007-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390007-01","4"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","4","18558","KS","Individual","No","48-0952857","18558KS0390007","BlueCare Elite","18558KS039",,"KSN001","KSS001","KSF005","New","PPO","Platinum","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390007-03","Limited Cost Sharing Plan Variation",,"0.889324545860291","Yes","Yes","No","100%",,"$0","$0","$1,150","$150","$0","$0","$1,150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","50%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390007-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390007-03","6"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","4","18558","KS","Individual","No","48-0952857","18558KS0390026","BlueCare SaverPlus","18558KS039",,"KSN001","KSS001","KSF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390026-01","Standard Silver On Exchange Plan","70.31%","0.70313435792923","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390026-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390026-01","7"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","4","18558","KS","Individual","No","48-0952857","18558KS0390026","BlueCare SaverPlus","18558KS039",,"KSN001","KSS001","KSF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390026-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390026-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390026-02","8"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","4","18558","KS","Individual","No","48-0952857","18558KS0390026","BlueCare SaverPlus","18558KS039",,"KSN001","KSS001","KSF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390026-04","73% AV Level Silver Plan","73.04%","0.730439841747284","Yes","Yes","No","100%",,"$2,750","$20","$900","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20%",,,,,"$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390026-04","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390026-04","10"
"2016","KS","25268","SERFF","3","2015-10-23 10:28:16","1","25268","KS","Individual","Yes","36-3757528","25268KS0010001","TruAssure Basic Adult or Child Dental Plan","25268KS001",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.52","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","25268KS0010001-01","Standard Low On Exchange Plan","68.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$105","$105 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=KS","https://www.truassure.com/brochure?state=KS","5"
"2016","KS","25268","SERFF","3","2015-10-23 10:28:16","1","25268","KS","SHOP (Small Group)","Yes","36-3757528","25268KS0040001","TruAssure Dental Small Group Preferred Plan","25268KS004",,"KSN001","KSS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.22","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","25268KS0040001-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","KS","25268","SERFF","3","2015-10-23 10:28:16","2","25268","KS","Individual","Yes","36-3757528","25268KS0020001","TruAssure Preferred Adult or Child Dental Plan","25268KS002",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.93","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","25268KS0020001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=KS","https://www.truassure.com/brochure?state=KS","4"
"2016","KS","25268","SERFF","3","2015-10-23 10:28:16","2","25268","KS","Individual","Yes","36-3757528","25268KS0020001","TruAssure Preferred Adult or Child Dental Plan","25268KS002",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.93","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","25268KS0020001-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=KS","https://www.truassure.com/brochure?state=KS","5"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","1","27811","KS","SHOP (Small Group)","No","80-0968685","27811KS0020001","BlueCare Solutions GoldSHOP","27811KS002",,"KSN001","KSS001","KSF001","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9918202996607",,,,"0","0","5","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0020001-00","Standard Gold Off Exchange Plan","79.44%","0.79439115524292","Yes","Yes","No","100%",,"$1,500","$50","$1,010","$150","$1,500","$700","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0020001-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0020001-00","4"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","1","27811","KS","SHOP (Small Group)","No","80-0968685","27811KS0020001","BlueCare Solutions GoldSHOP","27811KS002",,"KSN001","KSS001","KSF001","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9918202996607",,,,"0","0","5","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0020001-01","Standard Gold On Exchange Plan","79.44%","0.79439115524292","Yes","Yes","No","100%",,"$1,500","$50","$1,010","$150","$1,500","$700","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0020001-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0020001-01","5"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","4","18558","KS","Individual","No","48-0952857","18558KS0390026","BlueCare SaverPlus","18558KS039",,"KSN001","KSS001","KSF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390026-05","87% AV Level Silver Plan","87.57%","0.875739932060242","Yes","Yes","No","100%",,"$750","$20","$730","$150","$750","$570","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390026-05","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390026-05","11"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","4","18558","KS","Individual","No","48-0952857","18558KS0390026","BlueCare SaverPlus","18558KS039",,"KSN001","KSS001","KSF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390026-06","94% AV Level Silver Plan","93.96%","0.939581751823425","Yes","Yes","No","100%",,"$250","$20","$230","$150","$250","$210","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390026-06","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390026-06","12"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","4","18558","KS","Individual","No","48-0952857","18558KS0390043","BlueCare Simple Silver","18558KS039",,"KSN001","KSS001","KSF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390043-01","Standard Silver On Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390043-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390043-01","13"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","4","18558","KS","Individual","No","48-0952857","18558KS0390043","BlueCare Simple Silver","18558KS039",,"KSN001","KSS001","KSF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390043-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390043-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390043-02","14"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","4","18558","KS","Individual","No","48-0952857","18558KS0390043","BlueCare Simple Silver","18558KS039",,"KSN001","KSS001","KSF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390043-03","Limited Cost Sharing Plan Variation",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390043-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390043-03","15"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","4","18558","KS","Individual","No","48-0952857","18558KS0390043","BlueCare Simple Silver","18558KS039",,"KSN001","KSS001","KSF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390043-04","73% AV Level Silver Plan",,"0.724917531013489","Yes","Yes","No","100%",,"$3,250","$0","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390043-04","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390043-04","16"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","4","18558","KS","Individual","No","48-0952857","18558KS0390043","BlueCare Simple Silver","18558KS039",,"KSN001","KSS001","KSF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390043-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$150","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390043-05","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390043-05","17"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","4","18558","KS","Individual","No","48-0952857","18558KS0390043","BlueCare Simple Silver","18558KS039",,"KSN001","KSS001","KSF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390043-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$150","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390043-06","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390043-06","18"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","4","18558","KS","Individual","No","48-0952857","18558KS0390044","BlueCare Simple Bronze","18558KS039",,"KSN001","KSS001","KSF001","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390044-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390044-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390044-01","19"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","4","18558","KS","Individual","No","48-0952857","18558KS0390044","BlueCare Simple Bronze","18558KS039",,"KSN001","KSS001","KSF001","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390044-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390044-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390044-02","20"
"2016","KS","18558","SERFF","8","2016-01-29 07:27:50","4","18558","KS","Individual","No","48-0952857","18558KS0390044","BlueCare Simple Bronze","18558KS039",,"KSN001","KSS001","KSF001","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","18558KS0390044-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=18558KS0390044-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=18558KS0390044-03","21"
"2016","KS","25268","SERFF","3","2015-10-23 10:28:16","1","25268","KS","SHOP (Small Group)","Yes","36-3757528","25268KS0030001","TruAssure Dental Small Group Basic Plan","25268KS003",,"KSN001","KSS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.22","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","25268KS0030001-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","25268","SERFF","3","2015-10-23 10:28:16","1","25268","KS","Individual","Yes","36-3757528","25268KS0010001","TruAssure Basic Adult or Child Dental Plan","25268KS001",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.52","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","25268KS0010001-00","Standard Low Off Exchange Plan","68.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$105","$105 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=KS","https://www.truassure.com/brochure?state=KS","4"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","1","27811","KS","SHOP (Small Group)","No","80-0968685","27811KS0020002","BlueCare Solutions SilverSHOP","27811KS002",,"KSN001","KSS001","KSF002","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9918202996607",,,,"0","0","3","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0020002-00","Standard Silver Off Exchange Plan",,"0.690296113491058","Yes","Yes","No","100%",,"$2,000","$40","$1,520","$150","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0020002-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0020002-00","10"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","1","27811","KS","SHOP (Small Group)","No","80-0968685","27811KS0020002","BlueCare Solutions SilverSHOP","27811KS002",,"KSN001","KSS001","KSF002","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9918202996607",,,,"0","0","3","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0020002-01","Standard Silver On Exchange Plan",,"0.690296113491058","Yes","Yes","No","100%",,"$2,000","$40","$1,520","$150","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0020002-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0020002-01","11"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","2","27811","KS","SHOP (Small Group)","No","80-0968685","27811KS0020003","BlueCare Solutions BronzeSHOP","27811KS002",,"KSN001","KSS001","KSF003","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9918202996607",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0020003-00","Standard Bronze Off Exchange Plan",,"0.610934615135193","Yes","Yes","No","100%",,"$3,400","$0","$1,940","$150","$2,420","$0","$1,420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0020003-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0020003-00","4"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","2","27811","KS","SHOP (Small Group)","No","80-0968685","27811KS0020003","BlueCare Solutions BronzeSHOP","27811KS002",,"KSN001","KSS001","KSF003","Existing","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9918202996607",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0020003-01","Standard Bronze On Exchange Plan",,"0.610934615135193","Yes","Yes","No","100%",,"$3,400","$0","$1,940","$150","$2,420","$0","$1,420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0020003-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0020003-01","5"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","2","27811","KS","SHOP (Small Group)","No","80-0968685","27811KS0020013","BlueCare Solutions Simple SilverSHOP","27811KS002",,"KSN001","KSS001","KSF004","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9918202996607",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0020013-00","Standard Silver Off Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0020013-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0020013-00","10"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","2","27811","KS","SHOP (Small Group)","No","80-0968685","27811KS0020013","BlueCare Solutions Simple SilverSHOP","27811KS002",,"KSN001","KSS001","KSF004","New","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9918202996607",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0020013-01","Standard Silver On Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0020013-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0020013-01","11"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","2","27811","KS","SHOP (Small Group)","No","80-0968685","27811KS0020017","BlueCare Solutions Simple BronzeSHOP","27811KS002",,"KSN001","KSS001","KSF004","New","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9918202996607",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0020017-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0020017-00","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0020017-00","16"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","2","27811","KS","SHOP (Small Group)","No","80-0968685","27811KS0020017","BlueCare Solutions Simple BronzeSHOP","27811KS002",,"KSN001","KSS001","KSF004","New","HMO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9918202996607",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0020017-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0020017-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0020017-01","17"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","3","27811","KS","Individual","No","80-0968685","27811KS0030001","BlueCare Solutions Gold","27811KS003",,"KSN001","KSS001","KSF001","Existing","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0030001-01","Standard Gold On Exchange Plan","79.44%","0.79439115524292","Yes","Yes","No","100%",,"$1,500","$50","$1,010","$150","$1,500","$700","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0030001-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0030001-01","4"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","3","27811","KS","Individual","No","80-0968685","27811KS0030001","BlueCare Solutions Gold","27811KS003",,"KSN001","KSS001","KSF001","Existing","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0030001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0030001-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0030001-02","5"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","3","27811","KS","Individual","No","80-0968685","27811KS0030001","BlueCare Solutions Gold","27811KS003",,"KSN001","KSS001","KSF001","Existing","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0030001-03","Limited Cost Sharing Plan Variation","79.44%","0.79439115524292","Yes","Yes","No","100%",,"$1,500","$50","$1,010","$150","$1,500","$700","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0030001-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0030001-03","6"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","3","27811","KS","Individual","No","80-0968685","27811KS0030003","BlueCare Solutions Bronze","27811KS003",,"KSN001","KSS001","KSF002","Existing","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","2","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0030003-01","Standard Bronze On Exchange Plan",,"0.613283455371857","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0030003-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0030003-01","7"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","3","27811","KS","Individual","No","80-0968685","27811KS0030003","BlueCare Solutions Bronze","27811KS003",,"KSN001","KSS001","KSF002","Existing","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","2","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0030003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0030003-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0030003-02","8"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","4","27811","KS","Individual","No","80-0968685","27811KS0030002","BlueCare Solutions Silver","27811KS003",,"KSN001","KSS001","KSF001","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0030002-05","87% AV Level Silver Plan","87.57%","0.875739932060242","Yes","Yes","No","100%",,"$750","$20","$730","$150","$750","$570","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0030002-05","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0030002-05","8"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","4","27811","KS","Individual","No","80-0968685","27811KS0030002","BlueCare Solutions Silver","27811KS003",,"KSN001","KSS001","KSF001","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0030002-06","94% AV Level Silver Plan","93.96%","0.939581751823425","Yes","Yes","No","100%",,"$250","$20","$230","$150","$250","$210","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0030002-06","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0030002-06","9"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","4","27811","KS","Individual","No","80-0968685","27811KS0030007","BlueCare Solutions Simple Silver","27811KS003",,"KSN001","KSS001","KSF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0030007-01","Standard Silver On Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0030007-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0030007-01","10"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","4","27811","KS","Individual","No","80-0968685","27811KS0030007","BlueCare Solutions Simple Silver","27811KS003",,"KSN001","KSS001","KSF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0030007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0030007-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0030007-02","11"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","4","27811","KS","Individual","No","80-0968685","27811KS0030007","BlueCare Solutions Simple Silver","27811KS003",,"KSN001","KSS001","KSF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0030007-03","Limited Cost Sharing Plan Variation",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0030007-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0030007-03","12"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","4","27811","KS","Individual","No","80-0968685","27811KS0030007","BlueCare Solutions Simple Silver","27811KS003",,"KSN001","KSS001","KSF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0030007-04","73% AV Level Silver Plan",,"0.724917531013489","Yes","Yes","No","100%",,"$3,250","$0","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0030007-04","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0030007-04","13"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","4","27811","KS","Individual","No","80-0968685","27811KS0030007","BlueCare Solutions Simple Silver","27811KS003",,"KSN001","KSS001","KSF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0030007-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$150","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0030007-05","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0030007-05","14"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","4","27811","KS","Individual","No","80-0968685","27811KS0030007","BlueCare Solutions Simple Silver","27811KS003",,"KSN001","KSS001","KSF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0030007-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$150","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0030007-06","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0030007-06","15"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","4","27811","KS","Individual","No","80-0968685","27811KS0030008","BlueCare Solutions Simple Bronze","27811KS003",,"KSN001","KSS001","KSF003","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0030008-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0030008-01","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0030008-01","16"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","4","27811","KS","Individual","No","80-0968685","27811KS0030008","BlueCare Solutions Simple Bronze","27811KS003",,"KSN001","KSS001","KSF003","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0030008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0030008-02","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0030008-02","17"
"2016","KS","27811","SERFF","7","2016-01-29 07:27:50","4","27811","KS","Individual","No","80-0968685","27811KS0030008","BlueCare Solutions Simple Bronze","27811KS003",,"KSN001","KSS001","KSF003","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.bcbsks.com/BuyBlue/Exchange/PayNow","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_KS_6T_HealthInsuranceMarketplaceBlueCareML.pdf","27811KS0030008-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=s&hi=27811KS0030008-03","http://www.bcbsks.com/HealthPlans/sbc-index.htm?ex=1&py=2016&sb=b&hi=27811KS0030008-03","18"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030005","Silver Compass 3500","50274KS003",,"KSN001","KSS001","KSF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030005-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0020&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","21"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030005","Silver Compass 3500","50274KS003",,"KSN001","KSS001","KSF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030005-03","Limited Cost Sharing Plan Variation","68.0%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0021&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","22"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030005","Silver Compass 3500","50274KS003",,"KSN001","KSS001","KSF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030005-04","73% AV Level Silver Plan","72.5%",,"No","Yes","No","100%",,"$2,500","$10","$800","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0022&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","23"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030005","Silver Compass 3500","50274KS003",,"KSN001","KSS001","KSF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030005-05","87% AV Level Silver Plan","87.9%",,"No","Yes","No","100%",,"$200","$10","$600","$200","$200","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0023&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","24"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030005","Silver Compass 3500","50274KS003",,"KSN001","KSS001","KSF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030005-06","94% AV Level Silver Plan","93.9%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0024&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","25"
"2016","KS","31098","SERFF","2","2015-08-22 23:36:24","1","31098","KS","SHOP (Small Group)","Yes","47-0098400","31098KS0040002","EHB High PPO","31098KS004",,"KSN001","KSS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.80","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","31098KS0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","KS","31098","SERFF","2","2015-08-22 23:36:24","1","31098","KS","SHOP (Small Group)","Yes","47-0098400","31098KS0040001","EHB Low PPO","31098KS004",,"KSN001","KSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.60","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","31098KS0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","KS","31098","SERFF","2","2015-08-22 23:36:24","1","31098","KS","SHOP (Small Group)","Yes","47-0098400","31098KS0030002","EHB High Passive","31098KS003",,"KSN001","KSS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$45.09","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","31098KS0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","KS","31098","SERFF","2","2015-08-22 23:36:24","1","31098","KS","SHOP (Small Group)","Yes","47-0098400","31098KS0030001","EHB Low Passive","31098KS003",,"KSN001","KSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.92","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","31098KS0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","KS","38804","SERFF","2","2015-08-22 23:36:24","1","38804","KS","SHOP (Small Group)","Yes","81-0170040","38804KS0010001","Assurant Dental ACAFFO High","38804KS001",,"KSN001","KSS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$44.13","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","38804KS0010001-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","38804","SERFF","2","2015-08-22 23:36:24","1","38804","KS","SHOP (Small Group)","Yes","81-0170040","38804KS0010002","Assurant Dental ACAFFO Low","38804KS001",,"KSN001","KSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$36.78","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","38804KS0010002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","1","50274","KS","Individual","No","43-1361841","50274KS0030003","Silver Compass HSA 3000","50274KS003",,"KSN001","KSS001","KSF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030003-00","Standard Silver Off Exchange Plan",,"0.708311021327972","Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ks0007&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","4"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","1","50274","KS","Individual","No","43-1361841","50274KS0030003","Silver Compass HSA 3000","50274KS003",,"KSN001","KSS001","KSF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030003-01","Standard Silver On Exchange Plan",,"0.708311021327972","Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ks0007&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","5"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","1","50274","KS","Individual","No","43-1361841","50274KS0030003","Silver Compass HSA 3000","50274KS003",,"KSN001","KSS001","KSF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=ks0008&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","6"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","1","50274","KS","Individual","No","43-1361841","50274KS0030003","Silver Compass HSA 3000","50274KS003",,"KSN001","KSS001","KSF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030003-03","Limited Cost Sharing Plan Variation",,"0.708311021327972","Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ks0009&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","7"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","1","50274","KS","Individual","No","43-1361841","50274KS0030003","Silver Compass HSA 3000","50274KS003",,"KSN001","KSS001","KSF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030003-04","73% AV Level Silver Plan",,"0.737914025783539","Yes","Yes","No","100%",,"$2,500","$10","$0","$200","$2,500","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ks0010&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","8"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","1","50274","KS","Individual","No","43-1361841","50274KS0030003","Silver Compass HSA 3000","50274KS003",,"KSN001","KSS001","KSF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030003-05","87% AV Level Silver Plan",,"0.877197504043579","Yes","Yes","No","100%",,"$800","$10","$0","$200","$800","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ks0011&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","9"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","1","50274","KS","Individual","No","43-1361841","50274KS0030003","Silver Compass HSA 3000","50274KS003",,"KSN001","KSS001","KSF002","New","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030003-06","94% AV Level Silver Plan",,"0.942080080509186","Yes","Yes","No","100%",,"$200","$10","$0","$200","$200","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ks0012&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","10"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","1","50274","KS","Individual","No","43-1361841","50274KS0030007","Bronze Compass HSA 5500","50274KS003",,"KSN001","KSS001","KSF005","New","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030007-00","Standard Bronze Off Exchange Plan",,"0.618041276931763","Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ks0031&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","11"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","1","50274","KS","Individual","No","43-1361841","50274KS0030007","Bronze Compass HSA 5500","50274KS003",,"KSN001","KSS001","KSF005","New","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030007-01","Standard Bronze On Exchange Plan",,"0.618041276931763","Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ks0031&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","12"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","1","50274","KS","Individual","No","43-1361841","50274KS0030007","Bronze Compass HSA 5500","50274KS003",,"KSN001","KSS001","KSF005","New","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=ks0032&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","13"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","1","50274","KS","Individual","No","43-1361841","50274KS0030007","Bronze Compass HSA 5500","50274KS003",,"KSN001","KSS001","KSF005","New","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030007-03","Limited Cost Sharing Plan Variation",,"0.618041276931763","Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ks0033&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","14"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030001","Gold Compass 500","50274KS003",,"KSN001","KSS001","KSF006","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030001-00","Standard Gold Off Exchange Plan","78.3%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0001&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","4"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030001","Gold Compass 500","50274KS003",,"KSN001","KSS001","KSF006","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030001-01","Standard Gold On Exchange Plan","78.3%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0001&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","5"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030001","Gold Compass 500","50274KS003",,"KSN001","KSS001","KSF006","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030001-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0002&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","6"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030001","Gold Compass 500","50274KS003",,"KSN001","KSS001","KSF006","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030001-03","Limited Cost Sharing Plan Variation","78.3%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0003&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","7"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030002","Gold Compass 0","50274KS003",,"KSN001","KSS001","KSF001","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030002-00","Standard Gold Off Exchange Plan","79.1%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0004&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","8"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030002","Gold Compass 0","50274KS003",,"KSN001","KSS001","KSF001","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030002-01","Standard Gold On Exchange Plan","79.1%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0004&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","9"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030002","Gold Compass 0","50274KS003",,"KSN001","KSS001","KSF001","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030002-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0005&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","10"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030002","Gold Compass 0","50274KS003",,"KSN001","KSS001","KSF001","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030002-03","Limited Cost Sharing Plan Variation","79.1%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0006&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","11"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030004","Silver Compass 2000","50274KS003",,"KSN001","KSS001","KSF003","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030004-00","Standard Silver Off Exchange Plan","69.3%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0013&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","12"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030004","Silver Compass 2000","50274KS003",,"KSN001","KSS001","KSF003","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030004-01","Standard Silver On Exchange Plan","69.3%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0013&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","13"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030004","Silver Compass 2000","50274KS003",,"KSN001","KSS001","KSF003","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030004-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0014&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","14"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030004","Silver Compass 2000","50274KS003",,"KSN001","KSS001","KSF003","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030004-03","Limited Cost Sharing Plan Variation","69.3%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0015&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","15"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030004","Silver Compass 2000","50274KS003",,"KSN001","KSS001","KSF003","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030004-04","73% AV Level Silver Plan","73.4%",,"No","Yes","No","100%",,"$1,200","$20","$1,500","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0016&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","16"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030004","Silver Compass 2000","50274KS003",,"KSN001","KSS001","KSF003","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030004-05","87% AV Level Silver Plan","87.9%",,"No","Yes","No","100%",,"$200","$10","$600","$200","$200","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0017&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","17"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030004","Silver Compass 2000","50274KS003",,"KSN001","KSS001","KSF003","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030004-06","94% AV Level Silver Plan","93.9%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0018&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","18"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030005","Silver Compass 3500","50274KS003",,"KSN001","KSS001","KSF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030005-00","Standard Silver Off Exchange Plan","68.0%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0019&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","19"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030005","Silver Compass 3500","50274KS003",,"KSN001","KSS001","KSF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030005-01","Standard Silver On Exchange Plan","68.0%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0019&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","20"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030006","Silver Compass 4500","50274KS003",,"KSN001","KSS001","KSF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030006-00","Standard Silver Off Exchange Plan","68.3%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0025&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","26"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030006","Silver Compass 4500","50274KS003",,"KSN001","KSS001","KSF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030006-01","Standard Silver On Exchange Plan","68.3%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0025&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","27"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030006","Silver Compass 4500","50274KS003",,"KSN001","KSS001","KSF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030006-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0026&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","28"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030006","Silver Compass 4500","50274KS003",,"KSN001","KSS001","KSF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030006-03","Limited Cost Sharing Plan Variation","68.3%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0027&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","29"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030006","Silver Compass 4500","50274KS003",,"KSN001","KSS001","KSF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030006-04","73% AV Level Silver Plan","72.5%",,"No","Yes","No","100%",,"$3,200","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0028&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","30"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030006","Silver Compass 4500","50274KS003",,"KSN001","KSS001","KSF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030006-05","87% AV Level Silver Plan","86.1%",,"No","Yes","No","100%",,"$600","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0029&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","31"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030006","Silver Compass 4500","50274KS003",,"KSN001","KSS001","KSF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030006-06","94% AV Level Silver Plan","93.3%",,"No","Yes","No","100%",,"$100","$10","$0","$200","$100","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ks0030&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","32"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030008","Bronze Compass 6500","50274KS003",,"KSN001","KSS001","KSF005","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030008-00","Standard Bronze Off Exchange Plan","61.9%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ks0034&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","33"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030008","Bronze Compass 6500","50274KS003",,"KSN001","KSS001","KSF005","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030008-01","Standard Bronze On Exchange Plan","61.9%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ks0034&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","34"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030008","Bronze Compass 6500","50274KS003",,"KSN001","KSS001","KSF005","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030008-02","Zero Cost Sharing Plan Variation","100.0%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=ks0035&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","35"
"2016","KS","50274","SERFF","7","2015-08-27 03:52:03","2","50274","KS","Individual","No","43-1361841","50274KS0030008","Bronze Compass 6500","50274KS003",,"KSN001","KSS001","KSF005","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ks0038&st=ks","50274KS0030008-03","Limited Cost Sharing Plan Variation","61.9%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ks0036&st=ks","http://www.uhc.com/iex/doc?id=ks0037&st=ks","36"
"2016","KS","51687","SERFF","3","2015-08-22 23:36:24","1","51687","KS","SHOP (Small Group)","Yes","44-0308260","51687KS0010001","KCL EHB Low PPO","51687KS001",,"KSN001","KSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$41.20","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","51687KS0010001-00","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","51687","SERFF","3","2015-08-22 23:36:24","1","51687","KS","SHOP (Small Group)","Yes","44-0308260","51687KS0010003","KCL EHB Low MAC","51687KS001",,"KSN001","KSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$30.14","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","51687KS0010003-00","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","KS","86246","SERFF","4","2015-08-22 23:36:24","1","86246","KS","SHOP (Small Group)","Yes","93-0242990","86246KS0040001","EHB Low PPO","86246KS004",,"KSN001","KSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.99","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","86246KS0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","KS","86246","SERFF","4","2015-08-22 23:36:24","1","86246","KS","SHOP (Small Group)","Yes","93-0242990","86246KS0030002","EHB High Passive","86246KS003",,"KSN001","KSS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$45.86","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","86246KS0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","Individual","No","43-1257251","94248KS0150004","First Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF002","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","46%","54%","$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/firstselectsilver3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","14"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0140014","Saver PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF005","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140014-06","94% AV Level Silver Plan",,"0.945005118846893","Yes","Yes","No","100%",,"$200","$0","$200","$200","$200","$100","$60","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverpcbsilver7.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","12"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","4","94248","KS","Individual","No","43-1257251","94248KS0150034","Basic Select Silver","94248KS015","7023011258","KSN004","KSS001","KSF019","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","2","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, such services will be provided at the out-of-network benefit level.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150034-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/basicselectsilver3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","5"
"2016","ME","20974","SERFF","4","2015-08-23 14:39:40","2","20974","ME","Individual","Yes","75-1233841","20974ME0010004","Dentegra Dental PPO Family Preferred Plan","20974ME001",,"MEN001","MES001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","20974ME0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","$85","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/me/20974me0010004-16","4"
"2016","ME","20974","SERFF","4","2015-08-23 14:39:40","2","20974","ME","SHOP (Small Group)","Yes","75-1233841","20974ME0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","20974ME002",,"MEN001","MES001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.05","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","20974ME0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","$85","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/me/20974me0020004-16","4"
"2016","ME","20974","SERFF","4","2015-08-23 14:39:40","3","20974","ME","SHOP (Small Group)","Yes","75-1233841","20974ME0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","20974ME002",,"MEN001","MES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","20974ME0020006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","$85","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/me/20974me0020006-16","4"
"2016","ME","20974","SERFF","4","2015-08-23 14:39:40","3","20974","ME","Individual","Yes","75-1233841","20974ME0010006","Dentegra Dental PPO Family Basic Plan","20974ME001",,"MEN001","MES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.28","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","20974ME0010006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","$85","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/me/20974me0010006-16","4"
"2016","ME","20974","SERFF","4","2015-08-23 14:39:40","3","20974","ME","Individual","Yes","75-1233841","20974ME0010006","Dentegra Dental PPO Family Basic Plan","20974ME001",,"MEN001","MES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.28","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","20974ME0010006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","$85","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/me/20974me0010006-16","5"
"2016","ME","20974","SERFF","4","2015-08-23 14:39:40","3","20974","ME","SHOP (Small Group)","Yes","75-1233841","20974ME0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","20974ME002",,"MEN001","MES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","20974ME0020006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","$85","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/me/20974me0020006-16","5"
"2016","KS","51687","SERFF","3","2015-08-22 23:36:24","1","51687","KS","SHOP (Small Group)","Yes","44-0308260","51687KS0010005","KCL Fam Low PPO","51687KS001",,"KSN001","KSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$41.20","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","51687KS0010005-00","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","KS","51687","SERFF","3","2015-08-22 23:36:24","1","51687","KS","SHOP (Small Group)","Yes","44-0308260","51687KS0010007","KCL Fam Low MAC","51687KS001",,"KSN001","KSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$30.14","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","51687KS0010007-00","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","KS","51687","SERFF","3","2015-08-22 23:36:24","2","51687","KS","SHOP (Small Group)","Yes","44-0308260","51687KS0010002","KCL EHB High PPO","51687KS001",,"KSN001","KSS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$49.99","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","51687KS0010002-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","51687","SERFF","3","2015-08-22 23:36:24","2","51687","KS","SHOP (Small Group)","Yes","44-0308260","51687KS0010004","KCL EHB High MAC","51687KS001",,"KSN001","KSS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$37.59","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","51687KS0010004-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","KS","51687","SERFF","3","2015-08-22 23:36:24","2","51687","KS","SHOP (Small Group)","Yes","44-0308260","51687KS0010006","KCL Fam High PPO","51687KS001",,"KSN001","KSS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$49.99","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","51687KS0010006-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","KS","51687","SERFF","3","2015-08-22 23:36:24","2","51687","KS","SHOP (Small Group)","Yes","44-0308260","51687KS0010008","KCL Fam High MAC","51687KS001",,"KSN001","KSS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$37.59","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","51687KS0010008-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","KS","61779","SERFF","3","2015-08-22 23:36:24","1","61779","KS","SHOP (Small Group)","Yes","13-5123390","61779KS0010003","Guardian Pediatric Advantage","61779KS001",,"KSN001","KSS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$28.18","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","61779KS0010003-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","KS","61779","SERFF","3","2015-08-22 23:36:24","1","61779","KS","SHOP (Small Group)","Yes","13-5123390","61779KS0020003","Guardian Pediatric Essentials","61779KS002",,"KSN001","KSS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$22.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","61779KS0020003-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","KS","61779","SERFF","3","2015-08-22 23:36:24","2","61779","KS","SHOP (Small Group)","Yes","13-5123390","61779KS0040003","Guardian Family Advantage","61779KS004",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.18","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","61779KS0040003-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","KS","61779","SERFF","3","2015-08-22 23:36:24","2","61779","KS","SHOP (Small Group)","Yes","13-5123390","61779KS0040003","Guardian Family Advantage","61779KS004",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.18","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","61779KS0040003-01","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","KS","61779","SERFF","3","2015-08-22 23:36:24","2","61779","KS","SHOP (Small Group)","Yes","13-5123390","61779KS0060003","Guardian Family Essentials","61779KS006",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","61779KS0060003-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","KS","61779","SERFF","3","2015-08-22 23:36:24","2","61779","KS","SHOP (Small Group)","Yes","13-5123390","61779KS0060003","Guardian Family Essentials","61779KS006",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","61779KS0060003-01","Standard Low On Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","KS","63790","SERFF","4","2015-08-22 23:36:24","1","63790","KS","Individual","Yes","95-6042390","63790KS0020003","BESTOne Advantage Gold","63790KS002",,"KSN001","KSS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.37","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/2016/KS_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","KS","63790","SERFF","4","2015-08-22 23:36:24","1","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010007","BESTDental Premium","63790KS001",,"KSN001","KSS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.29","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","63790","SERFF","4","2015-08-22 23:36:24","1","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010007","BESTDental Premium","63790KS001",,"KSN001","KSS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.29","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","KS","63790","SERFF","4","2015-08-22 23:36:24","1","63790","KS","Individual","Yes","95-6042390","63790KS0020003","BESTOne Advantage Gold","63790KS002",,"KSN001","KSS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.37","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/2016/KS_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","KS","63790","SERFF","4","2015-08-22 23:36:24","1","63790","KS","Individual","Yes","95-6042390","63790KS0020004","BESTOne Plus Gold","63790KS002",,"KSN001","KSS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.37","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/2016/KS_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","KS","63790","SERFF","4","2015-08-22 23:36:24","1","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010008","BESTDental Standard - H","63790KS001",,"KSN001","KSS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.29","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","KS","63790","SERFF","4","2015-08-22 23:36:24","1","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010008","BESTDental Standard - H","63790KS001",,"KSN001","KSS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.29","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","KS","63790","SERFF","4","2015-08-22 23:36:24","1","63790","KS","Individual","Yes","95-6042390","63790KS0020004","BESTOne Plus Gold","63790KS002",,"KSN001","KSS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.37","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/2016/KS_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","KS","63790","SERFF","4","2015-08-22 23:36:24","1","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010010","BESTDental Choice - H","63790KS001",,"KSN001","KSS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.29","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","KS","63790","SERFF","4","2015-08-22 23:36:24","1","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010010","BESTDental Choice - H","63790KS001",,"KSN001","KSS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.29","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","KS","63790","SERFF","4","2015-08-22 23:36:24","2","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010009","BESTDental Standard - L","63790KS001",,"KSN001","KSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.36","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","63790","SERFF","4","2015-08-22 23:36:24","2","63790","KS","Individual","Yes","95-6042390","63790KS0020005","BESTOne Plus Silver","63790KS002",,"KSN001","KSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.71","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/2016/KS_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","KS","63790","SERFF","4","2015-08-22 23:36:24","2","63790","KS","Individual","Yes","95-6042390","63790KS0020005","BESTOne Plus Silver","63790KS002",,"KSN001","KSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.71","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/2016/KS_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","KS","63790","SERFF","4","2015-08-22 23:36:24","2","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010009","BESTDental Standard - L","63790KS001",,"KSN001","KSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.36","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","KS","63790","SERFF","4","2015-08-22 23:36:24","2","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010011","BESTDental Choice - L","63790KS001",,"KSN001","KSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.36","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","KS","63790","SERFF","4","2015-08-22 23:36:24","2","63790","KS","Individual","Yes","95-6042390","63790KS0020006","BESTOne Basic Silver","63790KS002",,"KSN001","KSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.71","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/2016/KS_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","KS","63790","SERFF","4","2015-08-22 23:36:24","2","63790","KS","Individual","Yes","95-6042390","63790KS0020006","BESTOne Basic Silver","63790KS002",,"KSN001","KSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.71","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/KS/2016/KS_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","KS","63790","SERFF","4","2015-08-22 23:36:24","2","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010011","BESTDental Choice - L","63790KS001",,"KSN001","KSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.36","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","KS","63790","SERFF","4","2015-08-22 23:36:24","2","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010012","BESTDental Value","63790KS001",,"KSN001","KSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.36","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","KS","63790","SERFF","4","2015-08-22 23:36:24","2","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010012","BESTDental Value","63790KS001",,"KSN001","KSS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.36","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","63790KS0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","KS","79684","SERFF","3","2015-08-28 13:59:00","1","79684","KS","SHOP (Small Group)","Yes","36-0883760","79684KS0040002","EHB High PPO","79684KS004",,"KSN001","KSS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.40","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","79684KS0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","KS","79684","SERFF","3","2015-08-28 13:59:00","1","79684","KS","SHOP (Small Group)","Yes","36-0883760","79684KS0040001","EHB Low PPO","79684KS004",,"KSN001","KSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.93","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","79684KS0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0150012","Saver Select Gold","94248KS015","7023011258","KSN002","KSS001","KSF006","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","46%","54%","$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverselectgold3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","17"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","3","94248","KS","Individual","No","43-1257251","94248KS0150010","Classic Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF004","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150010-04","73% AV Level Silver Plan",,"0.72242796421051","No","Yes","Yes","46%","54%","$1,100","$900","$0","$200","$0","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","10%","$3,000","$3000 per person","$6000 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/classicselectsilver5.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","19"
"2016","KS","79684","SERFF","3","2015-08-28 13:59:00","1","79684","KS","SHOP (Small Group)","Yes","36-0883760","79684KS0030002","EHB High Passive","79684KS003",,"KSN001","KSS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$45.73","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","79684KS0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","KS","79684","SERFF","3","2015-08-28 13:59:00","1","79684","KS","SHOP (Small Group)","Yes","36-0883760","79684KS0030001","EHB Low Passive","79684KS003",,"KSN001","KSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.29","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","79684KS0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","KS","81711","SERFF","6","2015-10-21 17:48:08","1","81711","KS","Individual","Yes","48-0793267","81711KS0010003","Delta Dental Individual & Family - Basic+POEHB","81711KS001","7427051660","KSN001","KSS001",,"Existing","PPO","Low",,"On the Exchange",,,,"Please see Plan Brochure",,"No","Allows Adult and Child-Only",,,,,"$28.17","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Allows services in the United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes",,"","81711KS0010003-01","Standard Low On Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","$255 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/plan-options/KS-plans","https://www.deltadentalcoversme.com/plan-options/KS-plans","4"
"2016","KS","81711","SERFF","6","2015-10-21 17:48:08","1","81711","KS","SHOP (Small Group)","Yes","48-0793267","81711KS0020009","Delta Dental PPO - Basic Family+POEHB","81711KS002","7427051660","KSN002","KSS001",,"Existing","PPO","Low",,"Both",,,,"Please see Plan Brochure",,"No","Allows Adult and Child-Only",,,,,"$30.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Allows services in the United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes",,"","81711KS0020009-00","Standard Low Off Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","$255 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalks.com/IndividualOptions/shop/","http://www.deltadentalks.com/IndividualOptions/shop/","4"
"2016","KS","81711","SERFF","6","2015-10-21 17:48:08","1","81711","KS","SHOP (Small Group)","Yes","48-0793267","81711KS0020009","Delta Dental PPO - Basic Family+POEHB","81711KS002","7427051660","KSN002","KSS001",,"Existing","PPO","Low",,"Both",,,,"Please see Plan Brochure",,"No","Allows Adult and Child-Only",,,,,"$30.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Allows services in the United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes",,"","81711KS0020009-01","Standard Low On Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","$255 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalks.com/IndividualOptions/shop/","http://www.deltadentalks.com/IndividualOptions/shop/","5"
"2016","KS","81711","SERFF","6","2015-10-21 17:48:08","2","81711","KS","SHOP (Small Group)","Yes","48-0793267","81711KS0020010","Delta Dental PPO - Preferred Family+POEHB","81711KS002","7427051660","KSN002","KSS001",,"Existing","PPO","High",,"Both",,,,"Please see Plan Brochure",,"No","Allows Adult and Child-Only",,,,,"$36.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Allows services in the United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes",,"","81711KS0020010-00","Standard High Off Exchange Plan","86.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","$90 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalks.com/IndividualOptions/shop/","http://www.deltadentalks.com/IndividualOptions/shop/","4"
"2016","KS","81711","SERFF","6","2015-10-21 17:48:08","2","81711","KS","Individual","Yes","48-0793267","81711KS0010004","Delta Dental Individual & Family - Preferred+POEHB","81711KS001","7427051660","KSN001","KSS001",,"Existing","PPO","High",,"On the Exchange",,,,"Please see Plan Brochure",,"No","Allows Adult and Child-Only",,,,,"$33.96","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Allows services in the United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes",,"","81711KS0010004-01","Standard High On Exchange Plan","86.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","$90 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/plan-options/KS-plans","https://www.deltadentalcoversme.com/plan-options/KS-plans","4"
"2016","KS","81711","SERFF","6","2015-10-21 17:48:08","2","81711","KS","SHOP (Small Group)","Yes","48-0793267","81711KS0020010","Delta Dental PPO - Preferred Family+POEHB","81711KS002","7427051660","KSN002","KSS001",,"Existing","PPO","High",,"Both",,,,"Please see Plan Brochure",,"No","Allows Adult and Child-Only",,,,,"$36.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Allows services in the United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes",,"","81711KS0020010-01","Standard High On Exchange Plan","86.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","$90 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalks.com/IndividualOptions/shop/","http://www.deltadentalks.com/IndividualOptions/shop/","5"
"2016","KS","81711","SERFF","6","2015-10-21 17:48:08","3","81711","KS","SHOP (Small Group)","Yes","48-0793267","81711KS0020011","Delta Dental PPO - Basic POEHB Addendum","81711KS002","7427051660","KSN002","KSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$30.02","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Provides Coverage in United States and Canada Only","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes",,"","81711KS0020011-00","Standard Low Off Exchange Plan","71.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","$255 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","81711","SERFF","6","2015-10-21 17:48:08","3","81711","KS","SHOP (Small Group)","Yes","48-0793267","81711KS0020013","Delta Dental Premier - Basic POEHB Addendum","81711KS002","7427051660","KSN003","KSS001",,"Existing","POS","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$32.79","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Provides Coverage in United States and Canada Only","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes",,"","81711KS0020013-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","KS","81711","SERFF","6","2015-10-21 17:48:08","4","81711","KS","SHOP (Small Group)","Yes","48-0793267","81711KS0020012","Delta Dental PPO - Preferred POEHB Addendum","81711KS002","7427051660","KSN002","KSS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$36.19","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Provides Coverage in United States and Canada Only","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes",,"","81711KS0020012-00","Standard High Off Exchange Plan","86.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$30","$30 per person","$90 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","81711","SERFF","6","2015-10-21 17:48:08","4","81711","KS","SHOP (Small Group)","Yes","48-0793267","81711KS0020014","Delta Dental Premier - Preferred POEHB Addendum","81711KS002","7427051660","KSN003","KSS001",,"Existing","POS","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$39.42","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Provides Coverage in United States and Canada Only","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes",,"","81711KS0020014-00","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","KS","86067","SERFF","3","2015-08-22 23:36:24","1","86067","KS","SHOP (Small Group)","Yes","57-0523959","86067KS0020001","Group Dental Policy","86067KS002",,"KSN001","KSS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.03","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","86067KS0020001-00","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","86246","SERFF","4","2015-08-22 23:36:24","1","86246","KS","SHOP (Small Group)","Yes","93-0242990","86246KS0040002","EHB High PPO","86246KS004",,"KSN001","KSS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.52","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","86246KS0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","KS","86246","SERFF","4","2015-08-22 23:36:24","1","86246","KS","SHOP (Small Group)","Yes","93-0242990","86246KS0030001","EHB Low Passive","86246KS003",,"KSN001","KSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.38","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","86246KS0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","KS","93384","SERFF","2","2015-08-22 23:36:24","1","93384","KS","SHOP (Small Group)","Yes","13-5581829","93384KS0090001","EHB Basic Dental Plan (Low)","93384KS009",,"KSN001","KSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$14.99","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","93384KS0090001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","Individual","No","43-1257251","94248KS0140004","First PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF018","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140004-01","Standard Silver On Exchange Plan",,"0.716360986232758","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$300","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","0%",,,,,"$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/firstpcbsilver.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","4"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","SHOP (Small Group)","No","43-1257251","94248KS0220001","First 1500 PCB Gold","94248KS022","7023011258","KSN001","KSS001","KSF010","Existing","PPO","Gold","No","Both","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes",,"http://www.bluekc.com/qhp/ksdruglist.html","94248KS0220001-00","Standard Gold Off Exchange Plan",,"0.813558757305145","Yes","Yes","No","100%",,"$1,500","$10","$800","$200","$300","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","15%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bluekc.com/qhp/2016/sg/ks/firstpcbgold1500.html","http://www.bluekc.com/qhp/2016/sgbrochure.html","4"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","SHOP (Small Group)","No","43-1257251","94248KS0220001","First 1500 PCB Gold","94248KS022","7023011258","KSN001","KSS001","KSF010","Existing","PPO","Gold","No","Both","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes",,"http://www.bluekc.com/qhp/ksdruglist.html","94248KS0220001-01","Standard Gold On Exchange Plan",,"0.813558757305145","Yes","Yes","No","100%",,"$1,500","$10","$800","$200","$300","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group",,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","15%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bluekc.com/qhp/2016/sg/ks/firstpcbgold1500.html","http://www.bluekc.com/qhp/2016/sgbrochure.html","5"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","Individual","No","43-1257251","94248KS0140004","First PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF018","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/firstpcbsilver3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","5"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","Individual","No","43-1257251","94248KS0140004","First PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF018","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140004-03","Limited Cost Sharing Plan Variation",,"0.716360986232758","Yes","Yes","No","100%",,"$5,100","$0","$0","$200","$300","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","0%",,,,,"$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/firstpcbsilver4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","6"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","SHOP (Small Group)","No","43-1257251","94248KS0220002","First 2200 PCB Silver","94248KS022","7023011258","KSN001","KSS001","KSF013","Existing","PPO","Silver","No","Both","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes",,"http://www.bluekc.com/qhp/ksdruglist.html","94248KS0220002-00","Standard Silver Off Exchange Plan",,"0.7109654545784","Yes","Yes","No","100%",,"$2,200","$10","$1,500","$200","$300","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","30%",,,,,"$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bluekc.com/qhp/2016/sg/ks/firstpcbsilver2000.html","http://www.bluekc.com/qhp/2016/sgbrochure.html","6"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","SHOP (Small Group)","No","43-1257251","94248KS0220002","First 2200 PCB Silver","94248KS022","7023011258","KSN001","KSS001","KSF013","Existing","PPO","Silver","No","Both","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes",,"http://www.bluekc.com/qhp/ksdruglist.html","94248KS0220002-01","Standard Silver On Exchange Plan",,"0.7109654545784","Yes","Yes","No","100%",,"$2,200","$10","$1,500","$200","$300","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","30%",,,,,"$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.bluekc.com/qhp/2016/sg/ks/firstpcbsilver2000.html","http://www.bluekc.com/qhp/2016/sgbrochure.html","7"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","Individual","No","43-1257251","94248KS0140004","First PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF018","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140004-04","73% AV Level Silver Plan",,"0.73830908536911","Yes","Yes","No","100%",,"$4,600","$0","$0","$200","$300","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group","0%",,,,,"$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/firstpcbsilver5.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","7"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","Individual","No","43-1257251","94248KS0140004","First PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF018","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140004-05","87% AV Level Silver Plan",,"0.876435101032257","Yes","Yes","No","100%",,"$1,500","$0","$0","$200","$300","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","0%",,,,,"$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/firstpcbsilver6.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","8"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","Individual","No","43-1257251","94248KS0140004","First PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF018","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140004-06","94% AV Level Silver Plan",,"0.933564722537994","Yes","Yes","No","100%",,"$600","$0","$0","$200","$300","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$625","$625 per person","$1250 per group",,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$625","$625 per person","$1250 per group","0%",,,,,"$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/firstpcbsilver7.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","9"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","Individual","No","43-1257251","94248KS0140006","First PCB Bronze","94248KS014","7023011258","KSN001","KSS001","KSF007","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140006-01","Standard Bronze On Exchange Plan",,"0.619477808475494","Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/firstpcbbronze.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","10"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","Individual","No","43-1257251","94248KS0140006","First PCB Bronze","94248KS014","7023011258","KSN001","KSS001","KSF007","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/firstpcbbronze3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","11"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","Individual","No","43-1257251","94248KS0140006","First PCB Bronze","94248KS014","7023011258","KSN001","KSS001","KSF007","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140006-03","Limited Cost Sharing Plan Variation",,"0.619477808475494","Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/firstpcbbronze4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","12"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","Individual","No","43-1257251","94248KS0150004","First Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF002","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150004-01","Standard Silver On Exchange Plan",,"0.714237093925476","Yes","Yes","Yes","46%","54%","$5,100","$0","$0","$200","$300","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","$5,100","$5100 per person","$10200 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","0%","$5,100","$5100 per person","$10200 per group","0%","$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/firstselectsilver.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","13"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","Individual","No","43-1257251","94248KS0150004","First Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF002","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150004-03","Limited Cost Sharing Plan Variation",,"0.714237093925476","Yes","Yes","Yes","46%","54%","$5,100","$0","$0","$200","$300","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","$5,100","$5100 per person","$10200 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","0%","$5,100","$5100 per person","$10200 per group","0%","$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/firstselectsilver4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","15"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","Individual","No","43-1257251","94248KS0150004","First Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF002","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150004-04","73% AV Level Silver Plan",,"0.736093878746033","Yes","Yes","Yes","46%","54%","$4,600","$0","$0","$200","$300","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group","$4,600","$4600 per person","$9200 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group","0%","$4,600","$4600 per person","$9200 per group","0%","$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/firstselectsilver5.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","16"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","Individual","No","43-1257251","94248KS0150004","First Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF002","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150004-05","87% AV Level Silver Plan",,"0.874118983745575","Yes","Yes","Yes","46%","54%","$1,500","$0","$0","$200","$300","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","0%","$1,500","$1500 per person","$3000 per group","0%","$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/firstselectsilver6.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","17"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","Individual","No","43-1257251","94248KS0150004","First Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF002","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150004-06","94% AV Level Silver Plan",,"0.936154246330261","Yes","Yes","Yes","46%","54%","$600","$0","$0","$200","$200","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$625","$625 per person","$1250 per group","$625","$625 per person","$1250 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$625","$625 per person","$1250 per group","0%","$625","$625 per person","$1250 per group","0%","$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/firstselectsilver7.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","18"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","Individual","No","43-1257251","94248KS0150006","First Select Bronze","94248KS015","7023011258","KSN003","KSS001","KSF017","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150006-01","Standard Bronze On Exchange Plan",,"0.619477808475494","Yes","Yes","Yes","46%","54%","$6,300","$0","$0","$200","$4,500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$6,800","$6800 per person","$13600 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%","$6,800","$6800 per person","$13600 per group","0%","$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/firstselectbronze.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","19"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","Individual","No","43-1257251","94248KS0150006","First Select Bronze","94248KS015","7023011258","KSN003","KSS001","KSF017","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","46%","54%","$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/firstselectbronze3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","20"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","1","94248","KS","Individual","No","43-1257251","94248KS0150006","First Select Bronze","94248KS015","7023011258","KSN003","KSS001","KSF017","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","4","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150006-03","Limited Cost Sharing Plan Variation",,"0.619477808475494","Yes","Yes","Yes","46%","54%","$6,300","$0","$0","$200","$4,500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$6,800","$6800 per person","$13600 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%","$6,800","$6800 per person","$13600 per group","0%","$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/firstselectbronze4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","21"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0140012","Saver PCB Gold","94248KS014","7023011258","KSN001","KSS001","KSF025","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140012-01","Standard Gold On Exchange Plan",,"0.814222693443298","Yes","Yes","No","100%",,"$1,500","$0","$500","$200","$1,500","$400","$20","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10%",,,,,"$1,500","$3000 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverpcbgold2.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","4"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0140012","Saver PCB Gold","94248KS014","7023011258","KSN001","KSS001","KSF025","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverpcbgold3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","5"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0140012","Saver PCB Gold","94248KS014","7023011258","KSN001","KSS001","KSF025","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140012-03","Limited Cost Sharing Plan Variation",,"0.814222693443298","Yes","Yes","No","100%",,"$1,500","$0","$500","$200","$1,500","$400","$20","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10%",,,,,"$1,500","$3000 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverpcbgold4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","6"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0140014","Saver PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF005","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140014-01","Standard Silver On Exchange Plan",,"0.687613606452942","Yes","Yes","No","100%",,"$3,000","$20","$400","$200","$3,000","$300","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverpcbsilver2.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","7"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0140014","Saver PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF005","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverpcbsilver3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","8"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0140014","Saver PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF005","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140014-03","Limited Cost Sharing Plan Variation",,"0.687613606452942","Yes","Yes","No","100%",,"$3,000","$20","$400","$200","$3,000","$300","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverpcbsilver4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","9"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0140014","Saver PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF005","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140014-04","73% AV Level Silver Plan",,"0.739520967006683","Yes","Yes","No","100%",,"$2,300","$20","$500","$200","$2,300","$400","$20","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverpcbsilver5.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","10"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0140014","Saver PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF005","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140014-05","87% AV Level Silver Plan",,"0.878679573535919","Yes","Yes","No","100%",,"$800","$0","$400","$200","$800","$200","$50","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","10%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverpcbsilver6.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","11"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0140016","Saver PCB Bronze","94248KS014","7023011258","KSN001","KSS001","KSF005","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140016-01","Standard Bronze On Exchange Plan",,"0.619273066520691","Yes","Yes","No","100%",,"$5,000","$20","$200","$200","$5,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverpcbbronze2.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","13"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0140016","Saver PCB Bronze","94248KS014","7023011258","KSN001","KSS001","KSF005","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverpcbbronze3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","14"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0140016","Saver PCB Bronze","94248KS014","7023011258","KSN001","KSS001","KSF005","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140016-03","Limited Cost Sharing Plan Variation",,"0.619273066520691","Yes","Yes","No","100%",,"$5,000","$20","$200","$200","$5,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverpcbbronze4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","15"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0150012","Saver Select Gold","94248KS015","7023011258","KSN002","KSS001","KSF006","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150012-01","Standard Gold On Exchange Plan",,"0.813935518264771","Yes","Yes","Yes","46%","54%","$1,500","$0","$500","$200","$1,500","$400","$20","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","$2,000","$4000 per person","$4000 per group","$25,000","$50000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10%","$1,500","$3000 per person","$3000 per group","10%","$1,500","$3000 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverselectgold2.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","16"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0150012","Saver Select Gold","94248KS015","7023011258","KSN002","KSS001","KSF006","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150012-03","Limited Cost Sharing Plan Variation",,"0.813935518264771","Yes","Yes","Yes","46%","54%","$1,500","$0","$500","$200","$1,500","$400","$20","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","$2,000","$4000 per person","$4000 per group","$25,000","$50000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10%","$1,500","$3000 per person","$3000 per group","10%","$1,500","$3000 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverselectgold4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","18"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0150014","Saver Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF006","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150014-01","Standard Silver On Exchange Plan",,"0.687755227088928","Yes","Yes","Yes","46%","54%","$3,000","$20","$400","$200","$3,000","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%","$3,000","$3000 per person","$6000 per group","10%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverselectsilver2.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","19"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0150014","Saver Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF006","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","46%","54%","$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverselectsilver3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","20"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0150014","Saver Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF006","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150014-03","Limited Cost Sharing Plan Variation",,"0.687755227088928","Yes","Yes","Yes","46%","54%","$3,000","$20","$400","$200","$3,000","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%","$3,000","$3000 per person","$6000 per group","10%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverselectsilver4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","21"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0150014","Saver Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF006","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150014-04","73% AV Level Silver Plan",,"0.739629447460175","Yes","Yes","Yes","46%","54%","$2,300","$20","$500","$200","$2,300","$500","$20","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group","$3,300","$3300 per person","$6600 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","10%","$2,300","$2300 per person","$4600 per group","10%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverselectsilver5.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","22"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0150014","Saver Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF006","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150014-05","87% AV Level Silver Plan",,"0.877653956413269","Yes","Yes","Yes","46%","54%","$800","$0","$400","$200","$800","$200","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","$1,200","$1200 per person","$2400 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","10%","$850","$850 per person","$1700 per group","10%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverselectsilver6.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","23"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0150014","Saver Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF006","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150014-06","94% AV Level Silver Plan",,"0.944293737411499","Yes","Yes","Yes","46%","54%","$200","$0","$200","$200","$200","$90","$50","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%","$250","$250 per person","$500 per group","10%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverselectsilver7.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","24"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0150016","Saver Select Bronze","94248KS015","7023011258","KSN002","KSS001","KSF006","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150016-01","Standard Bronze On Exchange Plan",,"0.619329929351807","Yes","Yes","Yes","46%","54%","$5,000","$20","$200","$200","$5,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverselectbronze2.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","25"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0150016","Saver Select Bronze","94248KS015","7023011258","KSN002","KSS001","KSF006","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","46%","54%","$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverselectbronze3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","26"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","2","94248","KS","Individual","No","43-1257251","94248KS0150016","Saver Select Bronze","94248KS015","7023011258","KSN002","KSS001","KSF006","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150016-03","Limited Cost Sharing Plan Variation",,"0.619329929351807","Yes","Yes","Yes","46%","54%","$5,000","$20","$200","$200","$5,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bluekc.com/qhp/2016/dp/ks/saverselectbronze4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","27"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","3","94248","KS","Individual","No","43-1257251","94248KS0140010","Classic PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF003","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140010-01","Standard Silver On Exchange Plan",,"0.684004902839661","No","Yes","Yes","30%","70%","$1,100","$1,100","$0","$200","$0","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","$6,200","$6200 per person","$12400 per group","$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/classicpcbsilver.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","7"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","3","94248","KS","Individual","No","43-1257251","94248KS0140010","Classic PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF003","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","30%","70%","$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/classicpcbsilver3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","8"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","3","94248","KS","Individual","No","43-1257251","94248KS0140010","Classic PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF003","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140010-03","Limited Cost Sharing Plan Variation",,"0.684004902839661","No","Yes","Yes","30%","70%","$1,100","$1,100","$0","$200","$0","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","$6,200","$6200 per person","$12400 per group","$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/classicpcbsilver4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","9"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","3","94248","KS","Individual","No","43-1257251","94248KS0140010","Classic PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF003","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140010-04","73% AV Level Silver Plan",,"0.725713431835175","No","Yes","Yes","30%","70%","$1,100","$900","$0","$200","$0","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","10%","$3,000","$3000 per person","$6000 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/classicpcbsilver5.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","10"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","3","94248","KS","Individual","No","43-1257251","94248KS0140010","Classic PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF003","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140010-05","87% AV Level Silver Plan",,"0.870932161808014","No","Yes","Yes","30%","70%","$1,000","$600","$10","$200","$0","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%","$1,000","$1000 per person","$2000 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/classicpcbsilver6.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","11"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","3","94248","KS","Individual","No","43-1257251","94248KS0140010","Classic PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF003","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0140010-06","94% AV Level Silver Plan",,"0.94286185503006","No","Yes","Yes","30%","70%","$200","$200","$80","$200","$0","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%","$250","$250 per person","$500 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/classicpcbsilver7.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","12"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","3","94248","KS","Individual","No","43-1257251","94248KS0150008","Classic Select Gold","94248KS015","7023011258","KSN002","KSS001","KSF004","Existing","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150008-01","Standard Gold On Exchange Plan",,"0.792778789997101","No","Yes","Yes","46%","54%","$1,100","$900","$0","$200","$0","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%","$1,500","$1500 per person","$3000 per group","10%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/classicselectgold.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","13"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","3","94248","KS","Individual","No","43-1257251","94248KS0150008","Classic Select Gold","94248KS015","7023011258","KSN002","KSS001","KSF004","Existing","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","46%","54%","$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/classicselectgold3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","14"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","3","94248","KS","Individual","No","43-1257251","94248KS0150008","Classic Select Gold","94248KS015","7023011258","KSN002","KSS001","KSF004","Existing","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150008-03","Limited Cost Sharing Plan Variation",,"0.792778789997101","No","Yes","Yes","46%","54%","$1,100","$900","$0","$200","$0","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","10%","$1,500","$1500 per person","$3000 per group","10%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/classicselectgold4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","15"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","3","94248","KS","Individual","No","43-1257251","94248KS0150010","Classic Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF004","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150010-01","Standard Silver On Exchange Plan",,"0.681210279464722","No","Yes","Yes","46%","54%","$1,100","$1,100","$0","$200","$0","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","$6,200","$6200 per person","$12400 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/classicselectsilver.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","16"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","3","94248","KS","Individual","No","43-1257251","94248KS0150010","Classic Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF004","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","46%","54%","$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/classicselectsilver3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","17"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","3","94248","KS","Individual","No","43-1257251","94248KS0150010","Classic Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF004","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150010-03","Limited Cost Sharing Plan Variation",,"0.681210279464722","No","Yes","Yes","46%","54%","$1,100","$1,100","$0","$200","$0","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","$6,200","$6200 per person","$12400 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/classicselectsilver4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","18"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","3","94248","KS","Individual","No","43-1257251","94248KS0150010","Classic Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF004","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150010-05","87% AV Level Silver Plan",,"0.864956557750702","No","Yes","Yes","46%","54%","$1,000","$700","$10","$200","$0","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%","$1,000","$1000 per person","$2000 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/classicselectsilver6.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","20"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","3","94248","KS","Individual","No","43-1257251","94248KS0150010","Classic Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF004","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150010-06","94% AV Level Silver Plan",,"0.939912140369415","No","Yes","Yes","46%","54%","$200","$200","$80","$200","$0","$600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%","$250","$250 per person","$500 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","10%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/classicselectsilver7.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","21"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","4","94248","KS","Individual","No","43-1257251","94248KS0150034","Basic Select Silver","94248KS015","7023011258","KSN004","KSS001","KSF019","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","2","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, such services will be provided at the out-of-network benefit level.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150034-01","Standard Silver On Exchange Plan",,"0.686936438083649","No","Yes","No","100%",,"$3,500","$0","$1,500","$200","$500","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/basicselectsilver.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","4"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","4","94248","KS","Individual","No","43-1257251","94248KS0150034","Basic Select Silver","94248KS015","7023011258","KSN004","KSS001","KSF019","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","2","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, such services will be provided at the out-of-network benefit level.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150034-03","Limited Cost Sharing Plan Variation",,"0.686936438083649","No","Yes","No","100%",,"$3,500","$0","$1,500","$200","$500","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","40%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","40%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/basicselectsilver4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","6"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","4","94248","KS","Individual","No","43-1257251","94248KS0150034","Basic Select Silver","94248KS015","7023011258","KSN004","KSS001","KSF019","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","2","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, such services will be provided at the out-of-network benefit level.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150034-04","73% AV Level Silver Plan",,"0.725371420383453","No","Yes","No","100%",,"$2,600","$0","$1,400","$200","$500","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$2,650","$2650 per person","$5300 per group","40%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","40%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/basicselectsilver5.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","7"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","4","94248","KS","Individual","No","43-1257251","94248KS0150034","Basic Select Silver","94248KS015","7023011258","KSN004","KSS001","KSF019","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","2","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, such services will be provided at the out-of-network benefit level.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150034-05","87% AV Level Silver Plan",,"0.868356823921204","No","Yes","No","100%",,"$600","$0","$800","$200","$500","$300","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","40%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/basicselectsilver6.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","8"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","4","94248","KS","Individual","No","43-1257251","94248KS0150034","Basic Select Silver","94248KS015","7023011258","KSN004","KSS001","KSF019","Existing","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","2","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, such services will be provided at the out-of-network benefit level.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150034-06","94% AV Level Silver Plan",,"0.931177973747253","No","Yes","No","100%",,"$300","$0","$200","$200","$300","$200","$50","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","40%",,,,,"$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","40%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/basicselectsilver7.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","9"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","4","94248","KS","Individual","No","43-1257251","94248KS0150036","Basic Select Bronze","94248KS015","7023011258","KSN004","KSS001","KSF020","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","2","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, such services will be provided at the out-of-network benefit level.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150036-01","Standard Bronze On Exchange Plan",,"0.612995028495789","No","Yes","No","100%",,"$6,000","$0","$300","$200","$500","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","40%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/basicselectbronze.html","http://www.bluekc.com/qhp/2016/dpbrochure.html","10"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","4","94248","KS","Individual","No","43-1257251","94248KS0150036","Basic Select Bronze","94248KS015","7023011258","KSN004","KSS001","KSF020","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","2","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, such services will be provided at the out-of-network benefit level.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150036-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/basicselectbronze3.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","11"
"2016","KS","94248","SERFF","9","2015-08-28 13:59:00","4","94248","KS","Individual","No","43-1257251","94248KS0150036","Basic Select Bronze","94248KS015","7023011258","KSN004","KSS001","KSF020","Existing","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","2","2016-01-01","2016-12-31","No",,"Yes","If You receive services outside of Our Service Area, such services will be provided at the out-of-network benefit level.","No","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/qhp/ksdruglist.html","94248KS0150036-03","Limited Cost Sharing Plan Variation",,"0.612995028495789","No","Yes","No","100%",,"$6,000","$0","$300","$200","$500","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$25,000","$25000 per person","$50000 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","40%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","40%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bluekc.com/qhp/2016/dp/ks/basicselectbronze4.html","http://www.bluekc.com/qhp/2016/dpvarbrochure.html","12"
"2016","KS","95038","SERFF","5","2015-08-28 13:59:00","1","95038","KS","Individual","Yes","47-0397286","95038KS0010001","Delta Dental Individual PPO, EHB Certified","95038KS001",,"KSN002","KSS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","95038KS0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","95038","SERFF","5","2015-08-28 13:59:00","1","95038","KS","SHOP (Small Group)","Yes","47-0397286","95038KS0030001","Renaissance Group Dental PPO, EHB Certified","95038KS003",,"KSN001","KSS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.70","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","95038KS0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","KS","95038","SERFF","5","2015-08-28 13:59:00","1","95038","KS","Individual","Yes","47-0397286","95038KS0010002","Delta Dental Individual PPO, EHB Certified","95038KS001",,"KSN002","KSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.45","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","95038KS0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","KS","95038","SERFF","5","2015-08-28 13:59:00","1","95038","KS","SHOP (Small Group)","Yes","47-0397286","95038KS0030002","Renaissance Group Dental PPO, EHB Certified","95038KS003",,"KSN001","KSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.45","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","95038KS0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","KS","95038","SERFF","5","2015-08-28 13:59:00","1","95038","KS","Individual","Yes","47-0397286","95038KS0020001","Renaissance Individual Dental PPO, EHB Certified","95038KS002",,"KSN001","KSS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.93","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","95038KS0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","KS","95038","SERFF","5","2015-08-28 13:59:00","1","95038","KS","Individual","Yes","47-0397286","95038KS0020002","Renaissance Individual Dental PPO, EHB Certified","95038KS002",,"KSN001","KSS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.13","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","95038KS0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","1","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0100005","Community Option","33653ME010",,"MEN001","MES001","MEF003","Existing","PPO","Bronze","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0100005-00","Standard Bronze Off Exchange Plan","61.98%","0.618232607841492","Yes","Yes","No","100%",,"$5,500","$0","$1,000","$0","$0","$0","$525","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Option_33653ME010050915-01.pdf",,"12"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","1","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0100005","Community Option","33653ME010",,"MEN001","MES001","MEF003","Existing","PPO","Bronze","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0100005-01","Standard Bronze On Exchange Plan","61.98%","0.618232607841492","Yes","Yes","No","100%",,"$5,500","$0","$1,000","$0","$0","$0","$525","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Option_33653ME010050915-01.pdf",,"13"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","1","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0100006","Community Choice","33653ME010",,"MEN001","MES001","MEF006","Existing","PPO","Silver","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0100006-00","Standard Silver Off Exchange Plan","69.02%","0.68623822927475","Yes","Yes","No","100%",,"$2,500","$0","$1,500","$0","$0","$0","$315","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Choice_33653ME010060915-01.pdf",,"14"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","1","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0100006","Community Choice","33653ME010",,"MEN001","MES001","MEF006","Existing","PPO","Silver","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0100006-01","Standard Silver On Exchange Plan","69.02%","0.68623822927475","Yes","Yes","No","100%",,"$2,500","$0","$1,500","$0","$0","$0","$315","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Choice_33653ME010060915-01.pdf",,"15"
"2016","ME","16205","SERFF","4","2015-08-25 12:56:34","1","16205","ME","SHOP (Small Group)","Yes","86-0307623","16205ME0010001","Smile for Health - Certified Optimum Coverage","16205ME001",,"MEN001","MES001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","16205ME0010001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ME","16205","SERFF","4","2015-08-25 12:56:34","2","16205","ME","SHOP (Small Group)","Yes","86-0307623","16205ME0010002","Smile for Health - Certified Optimum Coverage","16205ME001",,"MEN002","MES002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","16205ME0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ME","16205","SERFF","4","2015-08-25 12:56:34","3","16205","ME","SHOP (Small Group)","Yes","86-0307623","16205ME0010003","Smile for Health - Certified Optimum Coverage","16205ME001",,"MEN003","MES003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","16205ME0010003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ME","16205","SERFF","4","2015-08-25 12:56:34","4","16205","ME","SHOP (Small Group)","Yes","86-0307623","16205ME0010004","Smile for Health - Certified Optimum Coverage","16205ME001",,"MEN001","MES001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","16205ME0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ME","16205","SERFF","4","2015-08-25 12:56:34","5","16205","ME","SHOP (Small Group)","Yes","86-0307623","16205ME0010005","Smile for Health - Certified Optimum Coverage","16205ME001",,"MEN002","MES002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","16205ME0010005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ME","16205","SERFF","4","2015-08-25 12:56:34","6","16205","ME","SHOP (Small Group)","Yes","86-0307623","16205ME0010006","Smile for Health - Certified Optimum Coverage","16205ME001",,"MEN003","MES003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","16205ME0010006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ME","16205","SERFF","4","2015-08-25 12:56:34","7","16205","ME","SHOP (Small Group)","Yes","86-0307623","16205ME0020001","Smile for Health - Certified High Option","16205ME002",,"MEN001","MES001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","16205ME0020001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ME","16205","SERFF","4","2015-08-25 12:56:34","8","16205","ME","SHOP (Small Group)","Yes","86-0307623","16205ME0020002","Smile for Health - Certified High Option","16205ME002",,"MEN002","MES002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","16205ME0020002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ME","16205","SERFF","4","2015-08-25 12:56:34","9","16205","ME","SHOP (Small Group)","Yes","86-0307623","16205ME0020003","Smile for Health - Certified High Option","16205ME002",,"MEN003","MES003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","16205ME0020003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ME","16205","SERFF","4","2015-08-25 12:56:34","10","16205","ME","SHOP (Small Group)","Yes","86-0307623","16205ME0020004","Smile for Health - Certified High Option Plus","16205ME002",,"MEN001","MES001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","16205ME0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ME","16205","SERFF","4","2015-08-25 12:56:34","11","16205","ME","SHOP (Small Group)","Yes","86-0307623","16205ME0020005","Smile for Health - Certified High Option Plus","16205ME002",,"MEN002","MES002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","16205ME0020005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ME","16205","SERFF","4","2015-08-25 12:56:34","12","16205","ME","SHOP (Small Group)","Yes","86-0307623","16205ME0020006","Smile for Health - Certified High Option Plus","16205ME002",,"MEN003","MES003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","16205ME0020006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ME","20974","SERFF","4","2015-08-23 14:39:40","1","20974","ME","SHOP (Small Group)","Yes","75-1233841","20974ME0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","20974ME002",,"MEN001","MES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","20974ME0020001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","$85","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/me/20974me0020001-16","4"
"2016","ME","20974","SERFF","4","2015-08-23 14:39:40","1","20974","ME","Individual","Yes","75-1233841","20974ME0010001","Dentegra Dental PPO Pediatric Basic Plan","20974ME001",,"MEN001","MES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.28","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","20974ME0010001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","$85","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/me/20974me0010001-16","4"
"2016","ME","28804","SERFF","3","2015-08-23 14:39:40","1","28804","ME","SHOP (Small Group)","Yes","13-5581829","28804ME0100001","EHB Basic Dental Plan (Low)","28804ME010",,"MEN001","MES001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$20.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","28804ME0100001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","1","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0100001","Community Basic HSA","33653ME010",,"MEN001","MES001","MEF010","Existing","PPO","Bronze","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"0.988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0100001-00","Standard Bronze Off Exchange Plan","61.88%","0.618793725967407","Yes","Yes","No","100%",,"$4,300","$0","$960","$0","$4,300","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/SBC-for-BasicHSA_33653ME010010915-01.pdf",,"4"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","1","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0100001","Community Basic HSA","33653ME010",,"MEN001","MES001","MEF010","Existing","PPO","Bronze","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"0.988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0100001-01","Standard Bronze On Exchange Plan","61.88%","0.618793725967407","Yes","Yes","No","100%",,"$4,300","$0","$960","$0","$4,300","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/SBC-for-BasicHSA_33653ME010010915-01.pdf",,"5"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","1","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0100002","Community Access HSA","33653ME010",,"MEN001","MES001","MEF001","New","PPO","Bronze","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"0.988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0100002-00","Standard Bronze Off Exchange Plan","59.94%","0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/SBC-for-AccessHSA_33653ME010020915-01.pdf",,"6"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","1","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0100002","Community Access HSA","33653ME010",,"MEN001","MES001","MEF001","New","PPO","Bronze","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"0.988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0100002-01","Standard Bronze On Exchange Plan","59.94%","0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/SBC-for-AccessHSA_33653ME010020915-01.pdf",,"7"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","1","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0100003","Community Balance HSA","33653ME010",,"MEN001","MES001","MEF011","Existing","PPO","Silver","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"0.988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0100003-00","Standard Silver Off Exchange Plan","71.66%","0.712145209312439","Yes","Yes","No","100%",,"$2,600","$0","$510","$0","$2,600","$0","$560","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/SBC-for-BalanceHSA_33653ME010030915-01.pdf",,"8"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","1","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0100003","Community Balance HSA","33653ME010",,"MEN001","MES001","MEF011","Existing","PPO","Silver","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"0.988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0100003-01","Standard Silver On Exchange Plan","71.66%","0.712145209312439","Yes","Yes","No","100%",,"$2,600","$0","$510","$0","$2,600","$0","$560","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/SBC-for-BalanceHSA_33653ME010030915-01.pdf",,"9"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","1","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0100004","Community Core HSA","33653ME010",,"MEN001","MES001","MEF009","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"0.988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0100004-00","Standard Silver Off Exchange Plan","68.04%","0.680405020713806","Yes","Yes","No","100%",,"$3,000","$10","$1,290","$0","$2,400","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/SBC-for-CoreHSA_33653ME010040915-01.pdf",,"10"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710014","Anthem Silver X HMO 1500 35","48396ME071",,"MEN001","MES003","MEF009","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710014-00","Standard Silver Off Exchange Plan","70.71%","0.703965961933136","Yes","Yes","No","100%",,"$1,500","$0","$1,984","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRX","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_S_2016","22"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710014","Anthem Silver X HMO 1500 35","48396ME071",,"MEN001","MES003","MEF009","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710014-01","Standard Silver On Exchange Plan","70.71%","0.703965961933136","Yes","Yes","No","100%",,"$1,500","$0","$1,789","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J50","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","23"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720023","Anthem Bronze X POS 5500 30","48396ME072",,"MEN002","MES006","MEF017","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720023-00","Standard Bronze Off Exchange Plan","61.92%","0.618897080421448","Yes","Yes","No","100%",,"$5,500","$0","$500","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRE","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","16"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720023","Anthem Bronze X POS 5500 30","48396ME072",,"MEN002","MES006","MEF017","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720023-01","Standard Bronze On Exchange Plan","61.92%","0.618897080421448","Yes","Yes","No","100%",,"$5,500","$0","$333","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J35","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","17"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","1","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0100004","Community Core HSA","33653ME010",,"MEN001","MES001","MEF009","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"0.988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0100004-01","Standard Silver On Exchange Plan","68.04%","0.680405020713806","Yes","Yes","No","100%",,"$3,000","$10","$1,290","$0","$2,400","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/SBC-for-CoreHSA_33653ME010040915-01.pdf",,"11"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","1","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0100007","Community Preferred","33653ME010",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0100007-00","Standard Silver Off Exchange Plan","72.00%","0.717229008674622","Yes","Yes","No","100%",,"$2,450","$40","$1,455","$0","$0","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Preferred_33653ME010070915-01.pdf",,"16"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","1","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0100007","Community Preferred","33653ME010",,"MEN001","MES001","MEF004","Existing","PPO","Silver","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0100007-01","Standard Silver On Exchange Plan","72.00%","0.717229008674622","Yes","Yes","No","100%",,"$2,450","$40","$1,455","$0","$0","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Preferred_33653ME010070915-01.pdf",,"17"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","1","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0100008","Community Advantage","33653ME010",,"MEN001","MES001","MEF007","Existing","PPO","Gold","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0100008-00","Standard Gold Off Exchange Plan","80.57%","0.80264812707901","Yes","Yes","No","100%",,"$750","$30","$1,310","$0","$0","$150","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$8,250","$8250 per person","$16500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Advantage_33653ME010080915-01.pdf",,"18"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","1","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0100008","Community Advantage","33653ME010",,"MEN001","MES001","MEF007","Existing","PPO","Gold","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0100008-01","Standard Gold On Exchange Plan","80.57%","0.80264812707901","Yes","Yes","No","100%",,"$750","$30","$1,310","$0","$0","$150","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$8,250","$8250 per person","$16500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Advantage_33653ME010080915-01.pdf",,"19"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","1","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0100009","Community Prime","33653ME010",,"MEN001","MES001","MEF008","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0100009-00","Standard Gold Off Exchange Plan","78.48%","0.782675921916962","Yes","Yes","No","100%",,"$1,500","$30","$1,740","$0","$0","$150","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7400 per group",,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Prime_33653ME010090915-01.pdf",,"20"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","1","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0100009","Community Prime","33653ME010",,"MEN001","MES001","MEF008","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0100009-01","Standard Gold On Exchange Plan","78.48%","0.782675921916962","Yes","Yes","No","100%",,"$1,500","$30","$1,740","$0","$0","$150","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7400 per group",,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Prime_33653ME010090915-01.pdf",,"21"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","1","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0100010","Community Premier","33653ME010",,"MEN001","MES001","MEF005","Existing","PPO","Platinum","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0100010-00","Standard Platinum Off Exchange Plan","90.20%","0.900682151317596","Yes","Yes","No","100%",,"$500","$15","$680","$0","$0","$75","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Premier_33653ME010100915-01.pdf",,"22"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","1","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0100010","Community Premier","33653ME010",,"MEN001","MES001","MEF005","Existing","PPO","Platinum","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.988",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0100010-01","Standard Platinum On Exchange Plan","90.20%","0.900682151317596","Yes","Yes","No","100%",,"$500","$15","$680","$0","$0","$75","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Premier_33653ME010100915-01.pdf",,"23"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","Yes","31-1705652","48396ME0900003","Anthem Dental Pediatric","48396ME090",,"MEN005","MES008",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$25.30","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","48396ME0900003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/me/f0/s0/t0/pw_e214657.pdf",,"5"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","SHOP (Small Group)","No","31-1705652","48396ME0730004","Anthem Gold X HMO Maine 500 20  5000 Plus","48396ME073",,"MEN004","MES001","MEF001","Existing","HMO","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","No","Urgent/emergent coverage only","No",,"No",,"https://www.anthem.com/MESelectdrugtier4","48396ME0730004-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1LTG","http://sgplans.anthem.com/me/brochure/","5"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710011","Anthem Bronze X HMO 5700 50","48396ME071",,"MEN001","MES003","MEF043","Existing","HMO","Bronze","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J49","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","6"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710011","Anthem Bronze X HMO 5700 50","48396ME071",,"MEN001","MES003","MEF043","Existing","HMO","Bronze","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710011-03","Limited Cost Sharing Plan Variation","61.97%","0.619587957859039","Yes","Yes","No","100%",,"$5,700","$0","$455","$0","$424","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J48","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","7"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","2","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0110001","Community Option HSA","33653ME011",,"MEN001","MES001","MEF002","Existing","PPO","Bronze","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0110001-00","Standard Bronze Off Exchange Plan","60.40%","0.603138446807861","Yes","Yes","No","100%",,"$5,000","$0","$1,250","$0","$5,000","$0","$150","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/SBC-for-OptionHSA_33653ME011010915-01.pdf",,"4"
"2016","ME","33653","SERFF","7","2016-01-29 07:27:50","2","33653","ME","SHOP (Small Group)","No","34-3416923","33653ME0110001","Community Option HSA","33653ME011",,"MEN001","MES001","MEF002","Existing","PPO","Bronze","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","33653ME0110001-01","Standard Bronze On Exchange Plan","60.40%","0.603138446807861","Yes","Yes","No","100%",,"$5,000","$0","$1,250","$0","$5,000","$0","$150","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/SBC-for-OptionHSA_33653ME011010915-01.pdf",,"5"
"2016","ME","46874","SERFF","2","2015-08-23 14:39:40","1","46874","ME","SHOP (Small Group)","Yes","42-0127290","46874ME0040001","Principal Plan Dental 70","46874ME004",,"MEN001","MES001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$32.74","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","46874ME0040001-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ME","46874","SERFF","2","2015-08-23 14:39:40","1","46874","ME","SHOP (Small Group)","Yes","42-0127290","46874ME0040002","Principal Plan Dental 85","46874ME004",,"MEN001","MES001",,"Existing","PPO","High",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$34.53","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","46874ME0040002-00","Standard High Off Exchange Plan","86.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","ME","47540","SERFF","3","2015-08-23 14:39:40","1","47540","ME","SHOP (Small Group)","Yes","93-0242990","47540ME0040002","EHB High PPO","47540ME004",,"MEN001","MES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$49.99","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","47540ME0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","ME","47540","SERFF","3","2015-08-23 14:39:40","1","47540","ME","SHOP (Small Group)","Yes","93-0242990","47540ME0040001","EHB Low PPO","47540ME004",,"MEN001","MES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.19","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","47540ME0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","ME","47540","SERFF","3","2015-08-23 14:39:40","1","47540","ME","SHOP (Small Group)","Yes","93-0242990","47540ME0030002","EHB High Passive","47540ME003",,"MEN001","MES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$50.68","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","47540ME0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","ME","47540","SERFF","3","2015-08-23 14:39:40","1","47540","ME","SHOP (Small Group)","Yes","93-0242990","47540ME0030001","EHB Low Passive","47540ME003",,"MEN001","MES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.57","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","47540ME0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","SHOP (Small Group)","No","31-1705652","48396ME0730004","Anthem Gold X HMO Maine 500 20  5000 Plus","48396ME073",,"MEN004","MES001","MEF001","Existing","HMO","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","No","Urgent/emergent coverage only","No",,"No",,"https://www.anthem.com/MESelectdrugtier4","48396ME0730004-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1LTG","http://sgplans.anthem.com/me/brochure/","4"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","Yes","31-1705652","48396ME0840003","Anthem Dental Pediatric","48396ME084",,"MEN005","MES008",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$25.30","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","48396ME0840003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/me/f0/s0/t0/pw_e214657.pdf",,"4"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710011","Anthem Bronze X HMO 5700 50","48396ME071",,"MEN001","MES003","MEF043","Existing","HMO","Bronze","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710011-00","Standard Bronze Off Exchange Plan","61.97%","0.619587957859039","Yes","Yes","No","100%",,"$5,700","$0","$734","$0","$424","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRR","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_S_2016","4"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","SHOP (Small Group)","Yes","31-1705652","48396ME0870003","Anthem Dental Pediatric","48396ME087",,"MEN005","MES008",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$25.30","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","48396ME0870003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/me/f0/s0/t0/pw_e214657.pdf",,"4"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710011","Anthem Bronze X HMO 5700 50","48396ME071",,"MEN001","MES003","MEF043","Existing","HMO","Bronze","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710011-01","Standard Bronze On Exchange Plan","61.97%","0.619587957859039","Yes","Yes","No","100%",,"$5,700","$0","$455","$0","$424","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J48","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","5"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710012","Anthem Silver X HMO 3500 20","48396ME071",,"MEN001","MES003","MEF008","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710012-00","Standard Silver Off Exchange Plan","68.31%","0.680103957653046","Yes","Yes","No","100%",,"$3,500","$0","$734","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRU","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_S_2016","8"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710012","Anthem Silver X HMO 3500 20","48396ME071",,"MEN001","MES003","MEF008","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710012-01","Standard Silver On Exchange Plan","68.31%","0.680103957653046","Yes","Yes","No","100%",,"$3,500","$0","$622","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4E","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","9"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710012","Anthem Silver X HMO 3500 20","48396ME071",,"MEN001","MES003","MEF008","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J4F","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","10"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710012","Anthem Silver X HMO 3500 20","48396ME071",,"MEN001","MES003","MEF008","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710012-03","Limited Cost Sharing Plan Variation","68.31%","0.680103957653046","Yes","Yes","No","100%",,"$3,500","$0","$622","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4E","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","11"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710012","Anthem Silver X HMO 3500 20","48396ME071",,"MEN001","MES003","MEF008","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710012-04","73% AV Level Silver Plan","73.88%","0.736435413360596","Yes","Yes","No","100%",,"$2,500","$0","$822","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4G","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","12"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710012","Anthem Silver X HMO 3500 20","48396ME071",,"MEN001","MES003","MEF008","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710012-05","87% AV Level Silver Plan","87.77%","0.877166509628296","Yes","Yes","No","100%",,"$750","$0","$700","$0","$424","$30","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4H","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","13"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710012","Anthem Silver X HMO 3500 20","48396ME071",,"MEN001","MES003","MEF008","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710012-06","94% AV Level Silver Plan","94.03%","0.941158294677734","Yes","Yes","No","100%",,"$200","$0","$400","$0","$200","$20","$45","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4J","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","14"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720016","Anthem Bronze X POS 10 for HSA","48396ME072",,"MEN002","MES005","MEF011","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720016-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J34","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","6"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710013","Anthem Silver X HMO 1850 40","48396ME071",,"MEN001","MES003","MEF010","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710013-00","Standard Silver Off Exchange Plan","69.10%","0.688609600067139","Yes","Yes","No","100%",,"$1,850","$0","$2,127","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRW","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_S_2016","15"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710013","Anthem Silver X HMO 1850 40","48396ME071",,"MEN001","MES003","MEF010","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710013-01","Standard Silver On Exchange Plan","69.10%","0.688609600067139","Yes","Yes","No","100%",,"$1,850","$0","$1,904","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4V","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","16"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710013","Anthem Silver X HMO 1850 40","48396ME071",,"MEN001","MES003","MEF010","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J4W","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","17"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710013","Anthem Silver X HMO 1850 40","48396ME071",,"MEN001","MES003","MEF010","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710013-03","Limited Cost Sharing Plan Variation","69.10%","0.688609600067139","Yes","Yes","No","100%",,"$1,850","$0","$1,904","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4V","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","18"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710013","Anthem Silver X HMO 1850 40","48396ME071",,"MEN001","MES003","MEF010","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710013-04","73% AV Level Silver Plan","73.47%","0.733441174030304","Yes","Yes","No","100%",,"$1,750","$0","$1,944","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4X","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","19"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710013","Anthem Silver X HMO 1850 40","48396ME071",,"MEN001","MES003","MEF010","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710013-05","87% AV Level Silver Plan","87.72%","0.877156734466553","Yes","Yes","No","100%",,"$750","$0","$650","$0","$424","$30","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4Y","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","20"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710013","Anthem Silver X HMO 1850 40","48396ME071",,"MEN001","MES003","MEF010","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710013-06","94% AV Level Silver Plan","94.08%","0.941764116287231","Yes","Yes","No","100%",,"$200","$0","$350","$0","$200","$20","$67","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4Z","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","21"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710014","Anthem Silver X HMO 1500 35","48396ME071",,"MEN001","MES003","MEF009","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710014-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J51","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","24"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710014","Anthem Silver X HMO 1500 35","48396ME071",,"MEN001","MES003","MEF009","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710014-03","Limited Cost Sharing Plan Variation","70.71%","0.703965961933136","Yes","Yes","No","100%",,"$1,500","$0","$1,789","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J50","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","25"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710014","Anthem Silver X HMO 1500 35","48396ME071",,"MEN001","MES003","MEF009","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710014-04","73% AV Level Silver Plan","73.96%","0.737365305423737","Yes","Yes","No","100%",,"$1,500","$0","$1,789","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J52","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","26"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710014","Anthem Silver X HMO 1500 35","48396ME071",,"MEN001","MES003","MEF009","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710014-05","87% AV Level Silver Plan","87.60%","0.876119554042816","Yes","Yes","No","100%",,"$750","$0","$650","$0","$424","$30","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J53","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","27"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710014","Anthem Silver X HMO 1500 35","48396ME071",,"MEN001","MES003","MEF009","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710014-06","94% AV Level Silver Plan","94.02%","0.941028237342834","Yes","Yes","No","100%",,"$200","$0","$350","$0","$200","$20","$78","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J54","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","28"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710015","Anthem Gold X HMO 1400 10","48396ME071",,"MEN001","MES003","MEF037","Existing","HMO","Gold","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710015-00","Standard Gold Off Exchange Plan","78.07%","0.769727945327759","Yes","Yes","No","100%",,"$1,400","$0","$577","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRY","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_S_2016","29"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710015","Anthem Gold X HMO 1400 10","48396ME071",,"MEN001","MES003","MEF037","Existing","HMO","Gold","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710015-01","Standard Gold On Exchange Plan","78.07%","0.769727945327759","Yes","Yes","No","100%",,"$1,400","$0","$521","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J55","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","30"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710015","Anthem Gold X HMO 1400 10","48396ME071",,"MEN001","MES003","MEF037","Existing","HMO","Gold","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J56","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","31"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710015","Anthem Gold X HMO 1400 10","48396ME071",,"MEN001","MES003","MEF037","Existing","HMO","Gold","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710015-03","Limited Cost Sharing Plan Variation","78.07%","0.769727945327759","Yes","Yes","No","100%",,"$1,400","$0","$521","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J55","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","32"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710017","Anthem Bronze X HMO 25 for HSA","48396ME071",,"MEN001","MES003","MEF016","Existing","HMO","Bronze","No","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710017-00","Standard Bronze Off Exchange Plan",,"0.599315106868744","Yes","Yes","No","100%",,"$6,300","$0","$217","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JRP","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_S_2016","33"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710017","Anthem Bronze X HMO 25 for HSA","48396ME071",,"MEN001","MES003","MEF016","Existing","HMO","Bronze","No","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710017-01","Standard Bronze On Exchange Plan",,"0.599315106868744","Yes","Yes","No","100%",,"$6,300","$0","$78","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J44","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","34"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710017","Anthem Bronze X HMO 25 for HSA","48396ME071",,"MEN001","MES003","MEF016","Existing","HMO","Bronze","No","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J45","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","35"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710017","Anthem Bronze X HMO 25 for HSA","48396ME071",,"MEN001","MES003","MEF016","Existing","HMO","Bronze","No","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710017-03","Limited Cost Sharing Plan Variation",,"0.599315106868744","Yes","Yes","No","100%",,"$6,300","$0","$78","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J44","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","36"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710020","Anthem Bronze X HMO 30 for HSA","48396ME071",,"MEN001","MES003","MEF018","Existing","HMO","Bronze","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710020-00","Standard Bronze Off Exchange Plan","61.95%","0.618358790874481","Yes","Yes","No","100%",,"$4,200","$0","$890","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JRT","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_S_2016","37"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710020","Anthem Bronze X HMO 30 for HSA","48396ME071",,"MEN001","MES003","MEF018","Existing","HMO","Bronze","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710020-01","Standard Bronze On Exchange Plan","61.95%","0.618358790874481","Yes","Yes","No","100%",,"$4,200","$0","$723","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J4C","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","38"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710020","Anthem Bronze X HMO 30 for HSA","48396ME071",,"MEN001","MES003","MEF018","Existing","HMO","Bronze","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710020-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J4D","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","39"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710020","Anthem Bronze X HMO 30 for HSA","48396ME071",,"MEN001","MES003","MEF018","Existing","HMO","Bronze","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710020-03","Limited Cost Sharing Plan Variation","61.95%","0.618358790874481","Yes","Yes","No","100%",,"$4,200","$0","$723","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J4C","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","40"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710021","Anthem Silver X HMO 15 for HSA","48396ME071",,"MEN001","MES003","MEF013","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710021-00","Standard Silver Off Exchange Plan","68.63%","0.680962979793549","Yes","Yes","No","100%",,"$2,600","$0","$685","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JRV","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_S_2016","41"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710021","Anthem Silver X HMO 15 for HSA","48396ME071",,"MEN001","MES003","MEF013","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710021-01","Standard Silver On Exchange Plan","68.63%","0.680962979793549","Yes","Yes","No","100%",,"$2,600","$0","$602","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J4Q","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","42"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710021","Anthem Silver X HMO 15 for HSA","48396ME071",,"MEN001","MES003","MEF013","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710021-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J4R","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","43"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710021","Anthem Silver X HMO 15 for HSA","48396ME071",,"MEN001","MES003","MEF013","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710021-03","Limited Cost Sharing Plan Variation","68.63%","0.680962979793549","Yes","Yes","No","100%",,"$2,600","$0","$602","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J4Q","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","44"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710021","Anthem Silver X HMO 15 for HSA","48396ME071",,"MEN001","MES003","MEF013","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710021-04","73% AV Level Silver Plan","72.10%","0.719625771045685","Yes","Yes","No","100%",,"$2,600","$0","$602","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J4S","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","45"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710021","Anthem Silver X HMO 15 for HSA","48396ME071",,"MEN001","MES003","MEF013","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710021-05","87% AV Level Silver Plan","87.46%","0.874577879905701","Yes","Yes","No","100%",,"$1,150","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4T","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","46"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710021","Anthem Silver X HMO 15 for HSA","48396ME071",,"MEN001","MES003","MEF013","Existing","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710021-06","94% AV Level Silver Plan","93.96%","0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$0","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4U","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","47"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710031","Anthem Bronze X HMO 50 for HSA","48396ME071",,"MEN001","MES003","MEF021","New","HMO","Bronze","No","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710031-00","Standard Bronze Off Exchange Plan",,"0.599299788475037","Yes","Yes","No","100%",,"$6,200","$0","$350","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X4N","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_S_2016","48"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710031","Anthem Bronze X HMO 50 for HSA","48396ME071",,"MEN001","MES003","MEF021","New","HMO","Bronze","No","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710031-01","Standard Bronze On Exchange Plan",,"0.599299788475037","Yes","Yes","No","100%",,"$6,200","$0","$205","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X4L","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","49"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710031","Anthem Bronze X HMO 50 for HSA","48396ME071",,"MEN001","MES003","MEF021","New","HMO","Bronze","No","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710031-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X4M","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","50"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710031","Anthem Bronze X HMO 50 for HSA","48396ME071",,"MEN001","MES003","MEF021","New","HMO","Bronze","No","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710031-03","Limited Cost Sharing Plan Variation",,"0.599299788475037","Yes","Yes","No","100%",,"$6,200","$0","$205","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X4L","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","51"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710032","Anthem Silver X HMO 2200 50","48396ME071",,"MEN001","MES003","MEF035","New","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710032-00","Standard Silver Off Exchange Plan","68.04%","0.6790811419487","Yes","Yes","No","100%",,"$2,200","$0","$2,484","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4R","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_S_2016","52"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710032","Anthem Silver X HMO 2200 50","48396ME071",,"MEN001","MES003","MEF035","New","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710032-01","Standard Silver On Exchange Plan","68.04%","0.6790811419487","Yes","Yes","No","100%",,"$2,200","$0","$2,205","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4P","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","53"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710032","Anthem Silver X HMO 2200 50","48396ME071",,"MEN001","MES003","MEF035","New","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710032-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X4Q","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","54"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710032","Anthem Silver X HMO 2200 50","48396ME071",,"MEN001","MES003","MEF035","New","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710032-03","Limited Cost Sharing Plan Variation","68.04%","0.6790811419487","Yes","Yes","No","100%",,"$2,200","$0","$2,205","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,700","$6700 per person","$13400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4P","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","55"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710032","Anthem Silver X HMO 2200 50","48396ME071",,"MEN001","MES003","MEF035","New","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710032-04","73% AV Level Silver Plan","73.01%","0.729601860046387","Yes","Yes","No","100%",,"$2,100","$0","$2,255","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4S","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","56"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710032","Anthem Silver X HMO 2200 50","48396ME071",,"MEN001","MES003","MEF035","New","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710032-05","87% AV Level Silver Plan","86.10%","0.860756278038025","Yes","Yes","No","100%",,"$750","$0","$700","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4T","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","57"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","1","48396","ME","Individual","No","31-1705652","48396ME0710032","Anthem Silver X HMO 2200 50","48396ME071",,"MEN001","MES003","MEF035","New","HMO","Silver","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710032-06","94% AV Level Silver Plan","93.02%","0.930765688419342","Yes","Yes","No","100%",,"$150","$0","$450","$0","$150","$30","$137","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4U","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","58"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","2","48396","ME","Individual","No","31-1705652","48396ME0710016","Anthem Catastrophic X HMO 6850 0","48396ME071",,"MEN001","MES003","MEF004","Existing","HMO","Catastrophic","No","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710016-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRN","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_S_2016","4"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","2","48396","ME","SHOP (Small Group)","Yes","31-1705652","48396ME0830003","Anthem Dental Family","48396ME083",,"MEN005","MES008",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","48396ME0830003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/me/f0/s0/t0/pw_e214655.pdf",,"4"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","2","48396","ME","SHOP (Small Group)","No","31-1705652","48396ME0730008","Anthem Bronze X HMO Maine 5000 30  6600 Plus","48396ME073",,"MEN004","MES001","MEF002","Existing","HMO","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","No","Urgent/emergent coverage only","No",,"No",,"https://www.anthem.com/MESelectdrugtier4","48396ME0730008-00","Standard Bronze Off Exchange Plan","60.90%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1LRD","http://sgplans.anthem.com/me/brochure/","4"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","2","48396","ME","Individual","Yes","31-1705652","48396ME0860003","Anthem Dental Family","48396ME086",,"MEN005","MES008",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","48396ME0860003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/me/f0/s0/t0/pw_e214655.pdf",,"4"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","2","48396","ME","Individual","Yes","31-1705652","48396ME0920003","Anthem Dental Family","48396ME092",,"MEN005","MES008",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","48396ME0920003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/me/f0/s0/t0/pw_e214655.pdf",,"5"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","2","48396","ME","SHOP (Small Group)","No","31-1705652","48396ME0730008","Anthem Bronze X HMO Maine 5000 30  6600 Plus","48396ME073",,"MEN004","MES001","MEF002","Existing","HMO","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","No","Urgent/emergent coverage only","No",,"No",,"https://www.anthem.com/MESelectdrugtier4","48396ME0730008-01","Standard Bronze On Exchange Plan","60.90%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1LRD","http://sgplans.anthem.com/me/brochure/","5"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","2","48396","ME","SHOP (Small Group)","Yes","31-1705652","48396ME0890003","Anthem Dental Family","48396ME089",,"MEN005","MES008",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","48396ME0890003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/me/f0/s0/t0/pw_e214655.pdf",,"5"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","2","48396","ME","Individual","No","31-1705652","48396ME0710016","Anthem Catastrophic X HMO 6850 0","48396ME071",,"MEN001","MES003","MEF004","Existing","HMO","Catastrophic","No","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710016-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J43","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","5"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","2","48396","ME","Individual","No","31-1705652","48396ME0710018","Anthem Bronze X HMO 5850 20","48396ME071",,"MEN001","MES003","MEF014","Existing","HMO","Bronze","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710018-00","Standard Bronze Off Exchange Plan","61.32%","0.612455070018768","Yes","Yes","No","100%",,"$5,850","$0","$264","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRQ","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_S_2016","6"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","2","48396","ME","Individual","No","31-1705652","48396ME0710018","Anthem Bronze X HMO 5850 20","48396ME071",,"MEN001","MES003","MEF014","Existing","HMO","Bronze","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710018-01","Standard Bronze On Exchange Plan","61.32%","0.612455070018768","Yes","Yes","No","100%",,"$5,850","$0","$152","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J46","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","7"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","2","48396","ME","Individual","No","31-1705652","48396ME0710018","Anthem Bronze X HMO 5850 20","48396ME071",,"MEN001","MES003","MEF014","Existing","HMO","Bronze","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710018-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J47","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","8"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","2","48396","ME","Individual","No","31-1705652","48396ME0710018","Anthem Bronze X HMO 5850 20","48396ME071",,"MEN001","MES003","MEF014","Existing","HMO","Bronze","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710018-03","Limited Cost Sharing Plan Variation","61.32%","0.612455070018768","Yes","Yes","No","100%",,"$5,850","$0","$152","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J46","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","9"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","2","48396","ME","Individual","No","31-1705652","48396ME0710019","Anthem Bronze X HMO 4750 35","48396ME071",,"MEN001","MES003","MEF019","Existing","HMO","Bronze","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710019-00","Standard Bronze Off Exchange Plan","61.99%","0.619022130966187","Yes","Yes","No","100%",,"$4,750","$0","$846","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRS","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_S_2016","10"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","2","48396","ME","Individual","No","31-1705652","48396ME0710019","Anthem Bronze X HMO 4750 35","48396ME071",,"MEN001","MES003","MEF019","Existing","HMO","Bronze","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710019-01","Standard Bronze On Exchange Plan","61.99%","0.619022130966187","Yes","Yes","No","100%",,"$4,750","$0","$651","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4A","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","11"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","2","48396","ME","Individual","No","31-1705652","48396ME0710019","Anthem Bronze X HMO 4750 35","48396ME071",,"MEN001","MES003","MEF019","Existing","HMO","Bronze","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710019-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J4B","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","12"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","2","48396","ME","Individual","No","31-1705652","48396ME0710019","Anthem Bronze X HMO 4750 35","48396ME071",,"MEN001","MES003","MEF019","Existing","HMO","Bronze","Yes","Both","No","Yes","All specialists require referral with the exception of OB/GYN",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0710019-03","Limited Cost Sharing Plan Variation","61.99%","0.619022130966187","Yes","Yes","No","100%",,"$4,750","$0","$651","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J4A","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_S_2016","13"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720016","Anthem Bronze X POS 10 for HSA","48396ME072",,"MEN002","MES005","MEF011","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720016-00","Standard Bronze Off Exchange Plan","60.39%","0.602981328964233","Yes","Yes","No","100%",,"$5,900","$0","$127","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$17,700","$17700 per person","$35400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","10%",,,,,"$11,800","$11800 per person","$23600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JRD","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","4"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","SHOP (Small Group)","Yes","31-1705652","48396ME0830004","Anthem Dental Family Enhanced","48396ME083",,"MEN005","MES008",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.94","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","48396ME0830004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/me/f0/s0/t0/pw_e214656.pdf",,"4"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","SHOP (Small Group)","No","31-1705652","48396ME0730012","Anthem Silver X HMO Maine 2000 30  5500 Plus","48396ME073",,"MEN004","MES001","MEF001","Existing","HMO","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","No","Urgent/emergent coverage only","No",,"No",,"https://www.anthem.com/MESelectdrugtier4","48396ME0730012-00","Standard Silver Off Exchange Plan","71.19%","0","No","Yes","No","100%",,"$2,000","$500","$63","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1LRM","http://sgplans.anthem.com/me/brochure/","4"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","Yes","31-1705652","48396ME0860004","Anthem Dental Family Enhanced","48396ME086",,"MEN005","MES008",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.94","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","48396ME0860004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/me/f0/s0/t0/pw_e214656.pdf",,"4"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","SHOP (Small Group)","No","31-1705652","48396ME0730012","Anthem Silver X HMO Maine 2000 30  5500 Plus","48396ME073",,"MEN004","MES001","MEF001","Existing","HMO","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","No","Urgent/emergent coverage only","No",,"No",,"https://www.anthem.com/MESelectdrugtier4","48396ME0730012-01","Standard Silver On Exchange Plan","71.19%","0","No","Yes","No","100%",,"$2,000","$500","$63","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1LRM","http://sgplans.anthem.com/me/brochure/","5"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","Yes","31-1705652","48396ME0920004","Anthem Dental Family Enhanced","48396ME092",,"MEN005","MES008",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.94","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","48396ME0920004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/me/f0/s0/t0/pw_e214656.pdf",,"5"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","SHOP (Small Group)","Yes","31-1705652","48396ME0890004","Anthem Dental Family Enhanced","48396ME089",,"MEN005","MES008",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.94","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","48396ME0890004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/me/f0/s0/t0/pw_e214656.pdf",,"5"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720016","Anthem Bronze X POS 10 for HSA","48396ME072",,"MEN002","MES005","MEF011","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720016-01","Standard Bronze On Exchange Plan","60.39%","0.602981328964233","Yes","Yes","No","100%",,"$5,900","$0","$71","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$17,700","$17700 per person","$35400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","10%",,,,,"$11,800","$11800 per person","$23600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J33","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","5"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720016","Anthem Bronze X POS 10 for HSA","48396ME072",,"MEN002","MES005","MEF011","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720016-03","Limited Cost Sharing Plan Variation","60.39%","0.602981328964233","Yes","Yes","No","100%",,"$5,900","$0","$71","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$17,700","$17700 per person","$35400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","10%",,,,,"$11,800","$11800 per person","$23600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J33","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","7"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720030","Anthem Bronze X POS 10 for HSA","48396ME072",,"MEN002","MES006","MEF011","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720030-00","Standard Bronze Off Exchange Plan","60.39%","0.602981328964233","Yes","Yes","No","100%",,"$5,900","$0","$127","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$17,700","$17700 per person","$35400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","10%",,,,,"$11,800","$11800 per person","$23600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JRD","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","8"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720030","Anthem Bronze X POS 10 for HSA","48396ME072",,"MEN002","MES006","MEF011","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720030-01","Standard Bronze On Exchange Plan","60.39%","0.602981328964233","Yes","Yes","No","100%",,"$5,900","$0","$71","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$17,700","$17700 per person","$35400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","10%",,,,,"$11,800","$11800 per person","$23600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J33","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","9"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720030","Anthem Bronze X POS 10 for HSA","48396ME072",,"MEN002","MES006","MEF011","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720030-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J34","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","10"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720030","Anthem Bronze X POS 10 for HSA","48396ME072",,"MEN002","MES006","MEF011","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720030-03","Limited Cost Sharing Plan Variation","60.39%","0.602981328964233","Yes","Yes","No","100%",,"$5,900","$0","$71","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$17,700","$17700 per person","$35400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","10%",,,,,"$11,800","$11800 per person","$23600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J33","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","11"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720011","Anthem Bronze X POS 5500 30","48396ME072",,"MEN002","MES005","MEF017","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720011-00","Standard Bronze Off Exchange Plan","61.92%","0.625074625015259","Yes","Yes","No","100%",,"$5,500","$0","$500","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRE","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","12"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720011","Anthem Bronze X POS 5500 30","48396ME072",,"MEN002","MES005","MEF017","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720011-01","Standard Bronze On Exchange Plan","61.92%","0.625074625015259","Yes","Yes","No","100%",,"$5,500","$0","$333","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J35","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","13"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720011","Anthem Bronze X POS 5500 30","48396ME072",,"MEN002","MES005","MEF017","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J36","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","14"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720011","Anthem Bronze X POS 5500 30","48396ME072",,"MEN002","MES005","MEF017","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720011-03","Limited Cost Sharing Plan Variation","61.92%","0.625074625015259","Yes","Yes","No","100%",,"$5,500","$0","$333","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRE","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","15"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720023","Anthem Bronze X POS 5500 30","48396ME072",,"MEN002","MES006","MEF017","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720023-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J36","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","18"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720023","Anthem Bronze X POS 5500 30","48396ME072",,"MEN002","MES006","MEF017","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720023-03","Limited Cost Sharing Plan Variation","61.92%","0.618897080421448","Yes","Yes","No","100%",,"$5,500","$0","$333","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","30%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J35","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","19"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720018","Anthem Bronze X POS 40  for HSA","48396ME072",,"MEN002","MES005","MEF022","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720018-00","Standard Bronze Off Exchange Plan","61.84%","0.617435216903687","Yes","Yes","No","100%",,"$5,850","$0","$264","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","40%",,,,,"$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JRH","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","20"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720018","Anthem Bronze X POS 40  for HSA","48396ME072",,"MEN002","MES005","MEF022","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720018-01","Standard Bronze On Exchange Plan","61.84%","0.617435216903687","Yes","Yes","No","100%",,"$5,850","$0","$152","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","40%",,,,,"$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J3B","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","21"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720018","Anthem Bronze X POS 40  for HSA","48396ME072",,"MEN002","MES005","MEF022","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720018-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J3C","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","22"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720018","Anthem Bronze X POS 40  for HSA","48396ME072",,"MEN002","MES005","MEF022","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720018-03","Limited Cost Sharing Plan Variation","61.84%","0.617435216903687","Yes","Yes","No","100%",,"$5,850","$0","$152","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","40%",,,,,"$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J3B","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","23"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720032","Anthem Bronze X POS 40 for HSA","48396ME072",,"MEN002","MES006","MEF022","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720032-00","Standard Bronze Off Exchange Plan","61.84%","0.617435216903687","Yes","Yes","No","100%",,"$3,800","$0","$1,347","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","40%",,,,,"$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JRH","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","24"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720032","Anthem Bronze X POS 40 for HSA","48396ME072",,"MEN002","MES006","MEF022","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720032-01","Standard Bronze On Exchange Plan","61.84%","0.617435216903687","Yes","Yes","No","100%",,"$3,800","$0","$1,124","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","40%",,,,,"$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J3B","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","25"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720032","Anthem Bronze X POS 40 for HSA","48396ME072",,"MEN002","MES006","MEF022","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720032-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J3C","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","26"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720032","Anthem Bronze X POS 40 for HSA","48396ME072",,"MEN002","MES006","MEF022","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720032-03","Limited Cost Sharing Plan Variation","61.84%","0.617435216903687","Yes","Yes","No","100%",,"$3,800","$0","$1,124","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$11,400","$11400 per person","$22800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","40%",,,,,"$7,600","$7600 per person","$15200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J3B","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","27"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720020","Anthem Silver X POS 10 for HSA","48396ME072",,"MEN002","MES005","MEF011","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720020-00","Standard Silver Off Exchange Plan","68.42%","0.677821397781372","Yes","Yes","No","100%",,"$3,000","$0","$417","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JRJ","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","28"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720020","Anthem Silver X POS 10 for HSA","48396ME072",,"MEN002","MES005","MEF011","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720020-01","Standard Silver On Exchange Plan","68.42%","0.677821397781372","Yes","Yes","No","100%",,"$3,000","$0","$361","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J3D","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","29"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720020","Anthem Silver X POS 10 for HSA","48396ME072",,"MEN002","MES005","MEF011","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720020-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J3E","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","30"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720020","Anthem Silver X POS 10 for HSA","48396ME072",,"MEN002","MES005","MEF011","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720020-03","Limited Cost Sharing Plan Variation","68.42%","0.677821397781372","Yes","Yes","No","100%",,"$3,000","$0","$361","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J3D","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","31"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720020","Anthem Silver X POS 10 for HSA","48396ME072",,"MEN002","MES005","MEF011","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720020-04","73% AV Level Silver Plan","72.27%","0.719143629074097","Yes","Yes","No","100%",,"$2,600","$0","$401","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J3F","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","32"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720020","Anthem Silver X POS 10 for HSA","48396ME072",,"MEN002","MES005","MEF011","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720020-05","87% AV Level Silver Plan","87.46%","0.874577879905701","Yes","Yes","No","100%",,"$1,150","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3G","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","33"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720020","Anthem Silver X POS 10 for HSA","48396ME072",,"MEN002","MES005","MEF011","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720020-06","94% AV Level Silver Plan","93.96%","0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$0","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3H","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","34"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720033","Anthem Silver X POS 10 for HSA","48396ME072",,"MEN002","MES006","MEF011","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720033-00","Standard Silver Off Exchange Plan","68.42%","0.677821397781372","Yes","Yes","No","100%",,"$3,000","$0","$417","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JRJ","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","35"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720033","Anthem Silver X POS 10 for HSA","48396ME072",,"MEN002","MES006","MEF011","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720033-01","Standard Silver On Exchange Plan","68.42%","0.677821397781372","Yes","Yes","No","100%",,"$3,000","$0","$361","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J3D","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","36"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720033","Anthem Silver X POS 10 for HSA","48396ME072",,"MEN002","MES006","MEF011","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720033-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J3E","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","37"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720033","Anthem Silver X POS 10 for HSA","48396ME072",,"MEN002","MES006","MEF011","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720033-03","Limited Cost Sharing Plan Variation","68.42%","0.677821397781372","Yes","Yes","No","100%",,"$3,000","$0","$361","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J3D","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","38"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720033","Anthem Silver X POS 10 for HSA","48396ME072",,"MEN002","MES006","MEF011","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720033-04","73% AV Level Silver Plan","72.27%","0.719143629074097","Yes","Yes","No","100%",,"$2,600","$0","$401","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1J3F","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","39"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720033","Anthem Silver X POS 10 for HSA","48396ME072",,"MEN002","MES006","MEF011","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720033-05","87% AV Level Silver Plan","87.46%","0.874577879905701","Yes","Yes","No","100%",,"$1,150","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3G","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","40"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720033","Anthem Silver X POS 10 for HSA","48396ME072",,"MEN002","MES006","MEF011","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720033-06","94% AV Level Silver Plan","93.96%","0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$0","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3H","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","41"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720013","Anthem Silver X POS 2800 30","48396ME072",,"MEN002","MES005","MEF041","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720013-00","Standard Silver Off Exchange Plan","68.38%","0.6811164021492","Yes","Yes","No","100%",,"$2,800","$0","$1,310","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","30%",,,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRK","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","42"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720013","Anthem Silver X POS 2800 30","48396ME072",,"MEN002","MES005","MEF041","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720013-01","Standard Silver On Exchange Plan","68.38%","0.6811164021492","Yes","Yes","No","100%",,"$2,800","$0","$1,143","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","30%",,,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3J","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","43"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720013","Anthem Silver X POS 2800 30","48396ME072",,"MEN002","MES005","MEF041","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J3K","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","44"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720013","Anthem Silver X POS 2800 30","48396ME072",,"MEN002","MES005","MEF041","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720013-03","Limited Cost Sharing Plan Variation","68.38%","0.6811164021492","Yes","Yes","No","100%",,"$2,800","$0","$1,143","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","30%",,,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3J","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","45"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720013","Anthem Silver X POS 2800 30","48396ME072",,"MEN002","MES005","MEF041","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720013-04","73% AV Level Silver Plan","73.94%","0.737277328968048","Yes","Yes","No","100%",,"$2,000","$0","$1,383","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3L","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","46"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720013","Anthem Silver X POS 2800 30","48396ME072",,"MEN002","MES005","MEF041","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720013-05","87% AV Level Silver Plan","87.70%","0.876937806606293","Yes","Yes","No","100%",,"$700","$0","$700","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","30%",,,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3M","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","47"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","3","48396","ME","Individual","No","31-1705652","48396ME0720013","Anthem Silver X POS 2800 30","48396ME072",,"MEN002","MES005","MEF041","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720013-06","94% AV Level Silver Plan","94.10%","0.941895842552185","Yes","Yes","No","100%",,"$200","$0","$350","$0","$200","$20","$67","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30%",,,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3N","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","48"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","SHOP (Small Group)","No","31-1705652","48396ME0770001","Anthem Silver X Blue Choice PPO 2800 20  4000 Plus w HSA","48396ME077",,"MEN003","MES001","MEF003","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","Yes",,"https://www.anthem.com/MESelectdrugtier4","48396ME0770001-00","Standard Silver Off Exchange Plan",,"0.704441905021667","Yes","Yes","No","100%",,"$2,943","$0","$463","$0","$2,295","$0","$578","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20%",,,,,"$5,600","$5600 per person","$11200 per group","$8,400","$8400 per person","$16800 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1LUG","http://sgplans.anthem.com/me/brochure/","4"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720014","Anthem Silver X POS 1800 25","48396ME072",,"MEN002","MES005","MEF042","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720014-00","Standard Silver Off Exchange Plan","71.37%","0.70930689573288","Yes","Yes","No","100%",,"$1,800","$0","$1,342","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRL","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","4"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720014","Anthem Silver X POS 1800 25","48396ME072",,"MEN002","MES005","MEF042","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720014-01","Standard Silver On Exchange Plan","71.37%","0.70930689573288","Yes","Yes","No","100%",,"$1,800","$0","$1,203","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3U","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","5"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","SHOP (Small Group)","No","31-1705652","48396ME0770001","Anthem Silver X Blue Choice PPO 2800 20  4000 Plus w HSA","48396ME077",,"MEN003","MES001","MEF003","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","Yes",,"https://www.anthem.com/MESelectdrugtier4","48396ME0770001-01","Standard Silver On Exchange Plan",,"0.704441905021667","Yes","Yes","No","100%",,"$2,943","$0","$463","$0","$2,295","$0","$578","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$12,000","$12000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","20%",,,,,"$5,600","$5600 per person","$11200 per group","$8,400","$8400 per person","$16800 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1LUG","http://sgplans.anthem.com/me/brochure/","5"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720014","Anthem Silver X POS 1800 25","48396ME072",,"MEN002","MES005","MEF042","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720014-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J3V","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","6"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720014","Anthem Silver X POS 1800 25","48396ME072",,"MEN002","MES005","MEF042","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720014-03","Limited Cost Sharing Plan Variation","71.37%","0.70930689573288","Yes","Yes","No","100%",,"$1,800","$0","$1,203","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3U","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","7"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720014","Anthem Silver X POS 1800 25","48396ME072",,"MEN002","MES005","MEF042","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720014-04","73% AV Level Silver Plan","73.91%","0.73671418428421","Yes","Yes","No","100%",,"$1,750","$0","$1,215","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3W","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","8"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720014","Anthem Silver X POS 1800 25","48396ME072",,"MEN002","MES005","MEF042","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720014-05","87% AV Level Silver Plan","87.65%","0.876446545124054","Yes","Yes","No","100%",,"$750","$0","$650","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3X","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","9"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720014","Anthem Silver X POS 1800 25","48396ME072",,"MEN002","MES005","MEF042","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720014-06","94% AV Level Silver Plan","94.09%","0.941921830177307","Yes","Yes","No","100%",,"$200","$0","$350","$0","$200","$40","$56","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3Y","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","10"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720025","Anthem Silver X POS 2800 30","48396ME072",,"MEN002","MES006","MEF041","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720025-00","Standard Silver Off Exchange Plan","68.38%","0.6811164021492","Yes","Yes","No","100%",,"$2,800","$0","$1,310","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","30%",,,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRK","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","11"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720025","Anthem Silver X POS 2800 30","48396ME072",,"MEN002","MES006","MEF041","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720025-01","Standard Silver On Exchange Plan","68.38%","0.6811164021492","Yes","Yes","No","100%",,"$2,800","$0","$1,143","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","30%",,,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3J","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","12"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720025","Anthem Silver X POS 2800 30","48396ME072",,"MEN002","MES006","MEF041","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720025-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J3K","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","13"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720025","Anthem Silver X POS 2800 30","48396ME072",,"MEN002","MES006","MEF041","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720025-03","Limited Cost Sharing Plan Variation","68.38%","0.6811164021492","Yes","Yes","No","100%",,"$2,800","$0","$1,143","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","30%",,,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3J","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","14"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720025","Anthem Silver X POS 2800 30","48396ME072",,"MEN002","MES006","MEF041","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720025-04","73% AV Level Silver Plan","73.94%","0.737277328968048","Yes","Yes","No","100%",,"$2,000","$0","$1,383","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3L","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","15"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720025","Anthem Silver X POS 2800 30","48396ME072",,"MEN002","MES006","MEF041","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720025-05","87% AV Level Silver Plan","87.70%","0.876937806606293","Yes","Yes","No","100%",,"$700","$0","$700","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","30%",,,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3M","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","16"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720025","Anthem Silver X POS 2800 30","48396ME072",,"MEN002","MES006","MEF041","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720025-06","94% AV Level Silver Plan","94.10%","0.941895842552185","Yes","Yes","No","100%",,"$200","$0","$350","$0","$200","$20","$67","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30%",,,,,"$5,600","$5600 per person","$11200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3N","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","17"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720026","Anthem Silver X POS 1800 25","48396ME072",,"MEN002","MES006","MEF042","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720026-00","Standard Silver Off Exchange Plan","71.37%","0.70930689573288","Yes","Yes","No","100%",,"$1,800","$0","$1,342","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRL","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","18"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720026","Anthem Silver X POS 1800 25","48396ME072",,"MEN002","MES006","MEF042","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720026-01","Standard Silver On Exchange Plan","71.37%","0.70930689573288","Yes","Yes","No","100%",,"$1,800","$0","$1,203","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3U","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","19"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720026","Anthem Silver X POS 1800 25","48396ME072",,"MEN002","MES006","MEF042","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720026-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J3V","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","20"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720026","Anthem Silver X POS 1800 25","48396ME072",,"MEN002","MES006","MEF042","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720026-03","Limited Cost Sharing Plan Variation","71.37%","0.70930689573288","Yes","Yes","No","100%",,"$1,800","$0","$1,203","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRL","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","21"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720026","Anthem Silver X POS 1800 25","48396ME072",,"MEN002","MES006","MEF042","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720026-04","73% AV Level Silver Plan","73.91%","0.73671418428421","Yes","Yes","No","100%",,"$1,750","$0","$1,215","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3W","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","22"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720026","Anthem Silver X POS 1800 25","48396ME072",,"MEN002","MES006","MEF042","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720026-05","87% AV Level Silver Plan","87.65%","0.876446545124054","Yes","Yes","No","100%",,"$750","$0","$650","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3X","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","23"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720026","Anthem Silver X POS 1800 25","48396ME072",,"MEN002","MES006","MEF042","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720026-06","94% AV Level Silver Plan","94.09%","0.941921830177307","Yes","Yes","No","100%",,"$200","$0","$350","$0","$200","$40","$56","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","25%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J3Y","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","24"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720028","Anthem Gold X POS 1000 20","48396ME072",,"MEN002","MES005","MEF039","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720028-00","Standard Gold Off Exchange Plan","78.04%","0.774484157562256","Yes","Yes","No","100%",,"$1,000","$0","$1,234","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRM","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","25"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720028","Anthem Gold X POS 1000 20","48396ME072",,"MEN002","MES005","MEF039","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720028-01","Standard Gold On Exchange Plan","78.04%","0.774484157562256","Yes","Yes","No","100%",,"$1,000","$0","$1,122","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J41","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","26"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720028","Anthem Gold X POS 1000 20","48396ME072",,"MEN002","MES005","MEF039","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720028-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J42","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","27"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720028","Anthem Gold X POS 1000 20","48396ME072",,"MEN002","MES005","MEF039","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720028-03","Limited Cost Sharing Plan Variation","78.04%","0.774484157562256","Yes","Yes","No","100%",,"$1,000","$0","$1,122","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J41","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","28"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720029","Anthem Gold X POS 1000 20","48396ME072",,"MEN002","MES006","MEF039","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720029-00","Standard Gold Off Exchange Plan","78.04%","0.774484157562256","Yes","Yes","No","100%",,"$1,000","$0","$1,234","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRM","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","29"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720029","Anthem Gold X POS 1000 20","48396ME072",,"MEN002","MES006","MEF039","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720029-01","Standard Gold On Exchange Plan","78.04%","0.774484157562256","Yes","Yes","No","100%",,"$1,000","$0","$1,122","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J41","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","30"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720029","Anthem Gold X POS 1000 20","48396ME072",,"MEN002","MES006","MEF039","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720029-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J42","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","31"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720029","Anthem Gold X POS 1000 20","48396ME072",,"MEN002","MES006","MEF039","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720029-03","Limited Cost Sharing Plan Variation","78.04%","0.774484157562256","Yes","Yes","No","100%",,"$1,000","$0","$1,122","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J41","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","32"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720035","Anthem Bronze X POS 50 for HSA","48396ME072",,"MEN002","MES005","MEF020","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720035-00","Standard Bronze Off Exchange Plan","59.93%","0.599299788475037","Yes","Yes","No","100%",,"$6,200","$0","$350","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$18,600","$18600 per person","$37200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","50%",,,,,"$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X44","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","33"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720035","Anthem Bronze X POS 50 for HSA","48396ME072",,"MEN002","MES005","MEF020","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720035-01","Standard Bronze On Exchange Plan","59.93%","0.599299788475037","Yes","Yes","No","100%",,"$6,200","$0","$205","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$18,600","$18600 per person","$37200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","50%",,,,,"$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X42","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","34"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720035","Anthem Bronze X POS 50 for HSA","48396ME072",,"MEN002","MES005","MEF020","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720035-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X46","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","35"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720035","Anthem Bronze X POS 50 for HSA","48396ME072",,"MEN002","MES005","MEF020","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720035-03","Limited Cost Sharing Plan Variation","59.93%","0.599299788475037","Yes","Yes","No","100%",,"$6,200","$0","$205","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$18,600","$18600 per person","$37200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","50%",,,,,"$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X44","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","36"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720036","Anthem Bronze X POS 50 for HSA","48396ME072",,"MEN002","MES006","MEF020","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720036-00","Standard Bronze Off Exchange Plan","59.93%","0.599299788475037","Yes","Yes","No","100%",,"$6,200","$0","$350","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$18,600","$18600 per person","$37200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","50%",,,,,"$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X44","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","37"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720036","Anthem Bronze X POS 50 for HSA","48396ME072",,"MEN002","MES006","MEF020","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720036-01","Standard Bronze On Exchange Plan","59.93%","0.599299788475037","Yes","Yes","No","100%",,"$6,200","$0","$205","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$18,600","$18600 per person","$37200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","50%",,,,,"$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X42","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","38"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720036","Anthem Bronze X POS 50 for HSA","48396ME072",,"MEN002","MES006","MEF020","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720036-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X46","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","39"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720036","Anthem Bronze X POS 50 for HSA","48396ME072",,"MEN002","MES006","MEF020","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720036-03","Limited Cost Sharing Plan Variation","59.93%","0.599299788475037","Yes","Yes","No","100%",,"$6,200","$0","$205","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$18,600","$18600 per person","$37200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","50%",,,,,"$12,400","$12400 per person","$24800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X42","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","40"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720037","Anthem Silver X POS 2250 50","48396ME072",,"MEN002","MES005","MEF034","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720037-00","Standard Silver Off Exchange Plan","68.06%","0.679379880428314","Yes","Yes","No","100%",,"$2,250","$0","$2,459","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4G","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","41"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720037","Anthem Silver X POS 2250 50","48396ME072",,"MEN002","MES005","MEF034","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720037-01","Standard Silver On Exchange Plan","68.06%","0.679379880428314","Yes","Yes","No","100%",,"$2,250","$0","$2,180","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X48","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","42"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720037","Anthem Silver X POS 2250 50","48396ME072",,"MEN002","MES005","MEF034","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720037-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X4J","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","43"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720037","Anthem Silver X POS 2250 50","48396ME072",,"MEN002","MES005","MEF034","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720037-03","Limited Cost Sharing Plan Variation","68.06%","0.679379880428314","Yes","Yes","No","100%",,"$2,250","$0","$2,180","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X48","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","44"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720037","Anthem Silver X POS 2250 50","48396ME072",,"MEN002","MES005","MEF034","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720037-04","73% AV Level Silver Plan","72.13%","0.720591902732849","Yes","Yes","No","100%",,"$2,200","$0","$2,205","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4A","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","45"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720037","Anthem Silver X POS 2250 50","48396ME072",,"MEN002","MES005","MEF034","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720037-05","87% AV Level Silver Plan","86.09%","0.861017942428589","Yes","Yes","No","100%",,"$850","$0","$500","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4C","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","46"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720037","Anthem Silver X POS 2250 50","48396ME072",,"MEN002","MES005","MEF034","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720037-06","94% AV Level Silver Plan","93.15%","0.931689262390137","Yes","Yes","No","100%",,"$150","$0","$450","$0","$150","$30","$137","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4E","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","47"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720038","Anthem Silver X POS 2250 50","48396ME072",,"MEN002","MES006","MEF034","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720038-00","Standard Silver Off Exchange Plan","68.06%","0.679379880428314","Yes","Yes","No","100%",,"$2,250","$0","$2,459","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4G","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","48"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720038","Anthem Silver X POS 2250 50","48396ME072",,"MEN002","MES006","MEF034","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720038-01","Standard Silver On Exchange Plan","68.06%","0.679379880428314","Yes","Yes","No","100%",,"$2,250","$0","$2,180","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X48","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","49"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720038","Anthem Silver X POS 2250 50","48396ME072",,"MEN002","MES006","MEF034","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720038-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X4J","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","50"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720038","Anthem Silver X POS 2250 50","48396ME072",,"MEN002","MES006","MEF034","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720038-03","Limited Cost Sharing Plan Variation","68.06%","0.679379880428314","Yes","Yes","No","100%",,"$2,250","$0","$2,180","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X48","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","51"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720038","Anthem Silver X POS 2250 50","48396ME072",,"MEN002","MES006","MEF034","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720038-04","73% AV Level Silver Plan","72.13%","0.720591902732849","Yes","Yes","No","100%",,"$2,200","$0","$2,205","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4A","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","52"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720038","Anthem Silver X POS 2250 50","48396ME072",,"MEN002","MES006","MEF034","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720038-05","87% AV Level Silver Plan","86.09%","0.861017942428589","Yes","Yes","No","100%",,"$850","$0","$500","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4C","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","53"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","4","48396","ME","Individual","No","31-1705652","48396ME0720038","Anthem Silver X POS 2250 50","48396ME072",,"MEN002","MES006","MEF034","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720038-06","94% AV Level Silver Plan","93.15%","0.931689262390137","Yes","Yes","No","100%",,"$150","$0","$450","$0","$150","$30","$137","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4E","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","54"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720017","Anthem Bronze X POS 5150 25","48396ME072",,"MEN002","MES005","MEF015","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720017-00","Standard Bronze Off Exchange Plan","61.98%","0.61889922618866","Yes","Yes","No","100%",,"$5,150","$0","$505","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,450","$15450 per person","$30900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","25%",,,,,"$10,300","$10300 per person","$20600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRF","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","4"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720017","Anthem Bronze X POS 5150 25","48396ME072",,"MEN002","MES005","MEF015","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720017-01","Standard Bronze On Exchange Plan","61.98%","0.61889922618866","Yes","Yes","No","100%",,"$5,150","$0","$365","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,450","$15450 per person","$30900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","25%",,,,,"$10,300","$10300 per person","$20600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J37","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","5"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720017","Anthem Bronze X POS 5150 25","48396ME072",,"MEN002","MES005","MEF015","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720017-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J38","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","6"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720017","Anthem Bronze X POS 5150 25","48396ME072",,"MEN002","MES005","MEF015","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720017-03","Limited Cost Sharing Plan Variation","61.98%","0.61889922618866","Yes","Yes","No","100%",,"$5,150","$0","$365","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,450","$15450 per person","$30900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","25%",,,,,"$10,300","$10300 per person","$20600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J37","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","7"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720031","Anthem Bronze X POS 5150 25","48396ME072",,"MEN002","MES006","MEF015","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720031-00","Standard Bronze Off Exchange Plan","61.98%","0.61889922618866","Yes","Yes","No","100%",,"$5,150","$0","$505","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,450","$15450 per person","$30900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","25%",,,,,"$10,300","$10300 per person","$20600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRF","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","8"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720031","Anthem Bronze X POS 5150 25","48396ME072",,"MEN002","MES006","MEF015","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720031-01","Standard Bronze On Exchange Plan","61.98%","0.61889922618866","Yes","Yes","No","100%",,"$5,150","$0","$365","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,450","$15450 per person","$30900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","25%",,,,,"$10,300","$10300 per person","$20600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J37","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","9"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720031","Anthem Bronze X POS 5150 25","48396ME072",,"MEN002","MES006","MEF015","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720031-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J38","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","10"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720031","Anthem Bronze X POS 5150 25","48396ME072",,"MEN002","MES006","MEF015","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720031-03","Limited Cost Sharing Plan Variation","61.98%","0.61889922618866","Yes","Yes","No","100%",,"$5,150","$0","$365","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,450","$15450 per person","$30900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","25%",,,,,"$10,300","$10300 per person","$20600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J37","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","11"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720012","Anthem Bronze X POS 4200 50","48396ME072",,"MEN002","MES005","MEF020","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720012-00","Standard Bronze Off Exchange Plan","61.82%","0.617822527885437","Yes","Yes","No","100%",,"$4,200","$0","$1,484","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","50%",,,,,"$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRG","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","12"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720012","Anthem Bronze X POS 4200 50","48396ME072",,"MEN002","MES005","MEF020","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720012-01","Standard Bronze On Exchange Plan","61.82%","0.617822527885437","Yes","Yes","No","100%",,"$4,200","$0","$1,205","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","50%",,,,,"$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J39","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","13"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720012","Anthem Bronze X POS 4200 50","48396ME072",,"MEN002","MES005","MEF020","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J3A","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","14"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720012","Anthem Bronze X POS 4200 50","48396ME072",,"MEN002","MES005","MEF020","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720012-03","Limited Cost Sharing Plan Variation","61.82%","0.617822527885437","Yes","Yes","No","100%",,"$4,200","$0","$1,205","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","50%",,,,,"$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J39","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","15"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720024","Anthem Bronze X POS 4200 50","48396ME072",,"MEN002","MES006","MEF020","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720024-00","Standard Bronze Off Exchange Plan","61.82%","0.617822527885437","Yes","Yes","No","100%",,"$4,200","$0","$1,484","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","50%",,,,,"$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRG","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","16"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720024","Anthem Bronze X POS 4200 50","48396ME072",,"MEN002","MES006","MEF020","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720024-01","Standard Bronze On Exchange Plan","61.82%","0.617822527885437","Yes","Yes","No","100%",,"$4,200","$0","$1,205","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","50%",,,,,"$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J39","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","17"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720024","Anthem Bronze X POS 4200 50","48396ME072",,"MEN002","MES006","MEF020","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720024-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J3A","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","18"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720024","Anthem Bronze X POS 4200 50","48396ME072",,"MEN002","MES006","MEF020","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720024-03","Limited Cost Sharing Plan Variation","61.82%","0.617822527885437","Yes","Yes","No","100%",,"$4,200","$0","$1,205","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","50%",,,,,"$8,400","$8400 per person","$16800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J39","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","19"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720015","Anthem Bronze X POS 6100 15","48396ME072",,"MEN002","MES005","MEF012","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720015-00","Standard Bronze Off Exchange Plan","61.20%","0.611324191093445","Yes","Yes","No","100%",,"$6,100","$0","$160","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,300","$18300 per person","$36600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","15%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRC","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","20"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720015","Anthem Bronze X POS 6100 15","48396ME072",,"MEN002","MES005","MEF012","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720015-01","Standard Bronze On Exchange Plan","61.20%","0.611324191093445","Yes","Yes","No","100%",,"$6,100","$0","$77","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,300","$18300 per person","$36600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","15%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J31","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","21"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720015","Anthem Bronze X POS 6100 15","48396ME072",,"MEN002","MES005","MEF012","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J32","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","22"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720015","Anthem Bronze X POS 6100 15","48396ME072",,"MEN002","MES005","MEF012","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720015-03","Limited Cost Sharing Plan Variation","61.20%","0.611324191093445","Yes","Yes","No","100%",,"$6,100","$0","$77","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,300","$18300 per person","$36600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","15%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J31","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","23"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720022","Anthem Catastrophic X POS 6850 0","48396ME072",,"MEN002","MES005","MEF002","Existing","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720022-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRB","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","24"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720022","Anthem Catastrophic X POS 6850 0","48396ME072",,"MEN002","MES005","MEF002","Existing","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720022-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J30","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","25"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720027","Anthem Bronze X POS 6100 15","48396ME072",,"MEN002","MES006","MEF012","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720027-00","Standard Bronze Off Exchange Plan","61.20%","0.611324191093445","Yes","Yes","No","100%",,"$6,100","$0","$160","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,300","$18300 per person","$36600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","15%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRC","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","26"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720027","Anthem Bronze X POS 6100 15","48396ME072",,"MEN002","MES006","MEF012","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720027-01","Standard Bronze On Exchange Plan","61.20%","0.611324191093445","Yes","Yes","No","100%",,"$6,100","$0","$77","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,300","$18300 per person","$36600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","15%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J31","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","27"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720027","Anthem Bronze X POS 6100 15","48396ME072",,"MEN002","MES006","MEF012","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720027-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1J32","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","28"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720027","Anthem Bronze X POS 6100 15","48396ME072",,"MEN002","MES006","MEF012","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720027-03","Limited Cost Sharing Plan Variation","61.20%","0.611324191093445","Yes","Yes","No","100%",,"$6,100","$0","$77","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,300","$18300 per person","$36600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","15%",,,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J31","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","29"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720034","Anthem Catastrophic X POS 6850 0","48396ME072",,"MEN002","MES006","MEF002","Existing","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720034-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JRB","http://editiondigital.net/view/IU65/2016/OFF_HIX_ME_KIT_N_2016","30"
"2016","ME","48396","SERFF","8","2016-03-31 13:35:32","5","48396","ME","Individual","No","31-1705652","48396ME0720034","Anthem Catastrophic X POS 6850 0","48396ME072",,"MEN002","MES006","MEF002","Existing","POS","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=ME","https://www.anthem.com/MESelectdrugtier4","48396ME0720034-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1J30","http://editiondigital.net/view/IU65/2016/ON_HIX_ME_KIT_N_2016","31"
"2016","ME","50165","SERFF","6","2016-01-23 08:10:28","1","50165","ME","SHOP (Small Group)","Yes","01-0286541","50165ME0200001","Delta Dental PPO Family High Plan","50165ME020","7447253908","MEN001","MES001",,"Existing","PPO","High",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"$43.50","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Same Coverage","Yes","Same Coverage","Yes",,"","50165ME0200001-01","Standard High On Exchange Plan","84.89%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/me/oocme20165.pdf","4"
"2016","ME","50165","SERFF","6","2016-01-23 08:10:28","1","50165","ME","Individual","Yes","01-0286541","50165ME0160001","Delta Dental Family High Plan","50165ME016","7447253908","MEN001","MES001",,"Existing","PPO","High",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"$43.50","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","50165ME0160001-00","Standard High Off Exchange Plan","84.89%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme2016a","4"
"2016","ME","50165","SERFF","6","2016-01-23 08:10:28","1","50165","ME","Individual","Yes","01-0286541","50165ME0160001","Delta Dental Family High Plan","50165ME016","7447253908","MEN001","MES001",,"Existing","PPO","High",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"$43.50","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","50165ME0160001-01","Standard High On Exchange Plan","84.89%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme20161","5"
"2016","ME","50165","SERFF","6","2016-01-23 08:10:28","1","50165","ME","SHOP (Small Group)","Yes","01-0286541","50165ME0200002","Delta Dental PPO Family High  Plan","50165ME020","7447253908","MEN001","MES001",,"Existing","PPO","High",,"Off the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"$43.50","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Same Coverage","Yes","Same Coverage","Yes",,"","50165ME0200002-00","Standard High Off Exchange Plan","84.89%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/OFFHIX/oocme2016c.pdf","5"
"2016","ME","50165","SERFF","6","2016-01-23 08:10:28","1","50165","ME","SHOP (Small Group)","Yes","01-0286541","50165ME0210001","Delta Dental PPO Family Low Plan","50165ME021","7447253908","MEN001","MES001",,"Existing","PPO","Low",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"$33.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Same Coverage","Yes","Same Coverage","Yes",,"","50165ME0210001-01","Standard Low On Exchange Plan","71.98%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/me/oocme20166.pdf","6"
"2016","ME","50165","SERFF","6","2016-01-23 08:10:28","1","50165","ME","Individual","Yes","01-0286541","50165ME0170001","Delta Dental Family Low Plan","50165ME017","7447253908","MEN001","MES001",,"Existing","PPO","Low",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"$33.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","50165ME0170001-00","Standard Low Off Exchange Plan","71.98%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme2016b","6"
"2016","ME","50165","SERFF","6","2016-01-23 08:10:28","1","50165","ME","Individual","Yes","01-0286541","50165ME0170001","Delta Dental Family Low Plan","50165ME017","7447253908","MEN001","MES001",,"Existing","PPO","Low",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"$33.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","50165ME0170001-01","Standard Low On Exchange Plan","71.98%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme20162","7"
"2016","ME","50165","SERFF","6","2016-01-23 08:10:28","1","50165","ME","SHOP (Small Group)","Yes","01-0286541","50165ME0210002","Delta Dental PPO Family Low  Plan","50165ME021","7447253908","MEN001","MES001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"$33.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Same Coverage","Yes","Same Coverage","Yes",,"","50165ME0210002-00","Standard Low Off Exchange Plan","71.98%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/OFFHIX/oocme2016d.pdf","7"
"2016","ME","50165","SERFF","6","2016-01-23 08:10:28","2","50165","ME","Individual","Yes","01-0286541","50165ME0180001","Delta Dental Pediatric High Plan","50165ME018","7447253908","MEN001","MES001",,"Existing","PPO","High",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Child-Only",,,,,"$43.50","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","50165ME0180001-01","Standard High On Exchange Plan","84.89%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme20163","4"
"2016","ME","50165","SERFF","6","2016-01-23 08:10:28","2","50165","ME","Individual","Yes","01-0286541","50165ME0190001","Delta Dental Pediatric Low Plan","50165ME019","7447253908","MEN001","MES001",,"Existing","PPO","Low",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Child-Only",,,,,"$33.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","50165ME0190001-01","Standard Low On Exchange Plan","71.98%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","per person not applicable","per group not applicable",,,,,,"$150","per person not applicable","per group not applicable","$150","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme20164","5"
"2016","ME","69227","SERFF","3","2015-08-23 14:39:40","1","69227","ME","SHOP (Small Group)","Yes","13-5123390","69227ME0050003","Guardian Pediatric Advantage","69227ME005",,"MEN001","MES001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$28.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","69227ME0050003-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","ME","69227","SERFF","3","2015-08-23 14:39:40","1","69227","ME","SHOP (Small Group)","Yes","13-5123390","69227ME0060003","Guardian Pediatric Essentials","69227ME006",,"MEN001","MES001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$21.01","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","69227ME0060003-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","ME","69227","SERFF","3","2015-08-23 14:39:40","2","69227","ME","SHOP (Small Group)","Yes","13-5123390","69227ME0080003","Guardian Family Advantage","69227ME008",,"MEN001","MES001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","69227ME0080003-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","ME","69227","SERFF","3","2015-08-23 14:39:40","2","69227","ME","SHOP (Small Group)","Yes","13-5123390","69227ME0080003","Guardian Family Advantage","69227ME008",,"MEN001","MES001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","69227ME0080003-01","Standard High On Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","ME","69227","SERFF","3","2015-08-23 14:39:40","2","69227","ME","SHOP (Small Group)","Yes","13-5123390","69227ME0100003","Guardian Family Essentials","69227ME010",,"MEN001","MES001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.01","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","69227ME0100003-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","ME","69227","SERFF","3","2015-08-23 14:39:40","2","69227","ME","SHOP (Small Group)","Yes","13-5123390","69227ME0100003","Guardian Family Essentials","69227ME010",,"MEN001","MES001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.01","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","69227ME0100003-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","ME","70024","SERFF","3","2015-08-23 14:39:40","1","70024","ME","SHOP (Small Group)","Yes","36-0883760","70024ME0040002","EHB High PPO","70024ME004",,"MEN001","MES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$49.84","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","70024ME0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","ME","70024","SERFF","3","2015-08-23 14:39:40","1","70024","ME","SHOP (Small Group)","Yes","36-0883760","70024ME0040001","EHB Low PPO","70024ME004",,"MEN001","MES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.11","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","70024ME0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","ME","70024","SERFF","3","2015-08-23 14:39:40","1","70024","ME","SHOP (Small Group)","Yes","36-0883760","70024ME0030002","EHB High Passive","70024ME003",,"MEN001","MES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$50.53","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","70024ME0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","ME","70024","SERFF","3","2015-08-23 14:39:40","1","70024","ME","SHOP (Small Group)","Yes","36-0883760","70024ME0030001","EHB Low Passive","70024ME003",,"MEN001","MES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.47","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","70024ME0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","ME","76302","SERFF","3","2015-08-23 14:39:40","1","76302","ME","Individual","Yes","47-0397286","76302ME0010001","Delta Dental Individual PPO, EHB Certified","76302ME001",,"MEN002","MES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.47","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","76302ME0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ME","76302","SERFF","3","2015-08-23 14:39:40","1","76302","ME","SHOP (Small Group)","Yes","47-0397286","76302ME0030001","Renaissance Group Dental PPO, EHB Certified","76302ME003",,"MEN001","MES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.50","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","76302ME0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ME","76302","SERFF","3","2015-08-23 14:39:40","1","76302","ME","SHOP (Small Group)","Yes","47-0397286","76302ME0030002","Renaissance Group Dental PPO, EHB Certified","76302ME003",,"MEN001","MES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.93","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","76302ME0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","ME","76302","SERFF","3","2015-08-23 14:39:40","1","76302","ME","Individual","Yes","47-0397286","76302ME0010002","Delta Dental Individual PPO, EHB Certified","76302ME001",,"MEN002","MES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.22","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","76302ME0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","ME","76302","SERFF","3","2015-08-23 14:39:40","1","76302","ME","Individual","Yes","47-0397286","76302ME0020001","Renaissance Individual Dental PPO, EHB Certified","76302ME002",,"MEN001","MES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.78","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","76302ME0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","ME","76302","SERFF","3","2015-08-23 14:39:40","1","76302","ME","Individual","Yes","47-0397286","76302ME0020002","Renaissance Individual Dental PPO, EHB Certified","76302ME002",,"MEN001","MES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.45","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","76302ME0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","ME","78496","SERFF","3","2015-08-23 14:39:40","1","78496","ME","SHOP (Small Group)","Yes","57-0523959","78496ME0020001","Group Dental Policy","78496ME002",,"MEN001","MES001",,"New","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$50.32","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","78496ME0020001-00","Standard High Off Exchange Plan","86.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","ME","86432","SERFF","5","2015-08-23 14:39:40","1","86432","ME","SHOP (Small Group)","Yes","47-0098400","86432ME0040002","EHB High PPO","86432ME004",,"MEN001","MES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$49.15","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","86432ME0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","3","96667","ME","Individual","No","04-2452600","96667ME0240008","Bronze HMO 6000","96667ME024",,"MEN001","MES001","MEF005","New","HMO","Bronze","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0240008-01","Standard Bronze On Exchange Plan","60.89%",,"Yes","Yes","No","100%",,"$4,320","$20","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/9559550F0DA246419EB7FF2F1A622439","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003662","5"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","3","96667","ME","Individual","No","04-2452600","96667ME0240008","Bronze HMO 6000","96667ME024",,"MEN001","MES001","MEF005","New","HMO","Bronze","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0240008-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/A417432662104246AF388BEE55793F27","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003645","6"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","3","96667","ME","SHOP (Small Group)","No","04-2452600","96667ME0270004","Maine's Choice HMO 2000","96667ME027",,"MEN002","MES002","MEF001","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all Specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"$500","0","1","0","2016-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2016Value5T","96667ME0270004-00","Standard Silver Off Exchange Plan","70.97%","0.718885242938995","No","Yes","Yes","70%","30%","$2,000","$10","$460","$150","$140","$1,550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%","$5,000","$5000 per person","$10000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%","$5,000","$5000 per person","$10000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/6071874940154518983AF4C72CA2A88F","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003786","6"
"2016","ME","86432","SERFF","5","2015-08-23 14:39:40","1","86432","ME","SHOP (Small Group)","Yes","47-0098400","86432ME0040001","EHB Low PPO","86432ME004",,"MEN001","MES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.73","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","86432ME0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","ME","86432","SERFF","5","2015-08-23 14:39:40","1","86432","ME","SHOP (Small Group)","Yes","47-0098400","86432ME0030002","EHB High Passive","86432ME003",,"MEN001","MES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$49.84","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","86432ME0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","ME","86432","SERFF","5","2015-08-23 14:39:40","1","86432","ME","SHOP (Small Group)","Yes","47-0098400","86432ME0030001","EHB Low Passive","86432ME003",,"MEN001","MES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.04","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","86432ME0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","1","96667","ME","Individual","No","04-2452600","96667ME0240002","Gold HMO 1000","96667ME024",,"MEN001","MES001","MEF003","New","HMO","Gold","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0240002-00","Standard Gold Off Exchange Plan","78.76%",,"Yes","Yes","No","100%",,"$1,000","$20","$660","$150","$140","$2,760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/C9FED48E21264BADAA6BA1CD3E661A8A","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003653","4"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","1","96667","ME","SHOP (Small Group)","No","04-2452600","96667ME0250002","Maine Difference Deductible Tiered Copayment HMO 1500","96667ME025",,"MEN001","MES001","MEF001","New","HMO","Gold","Yes","Both","No","Yes","A referral is needed for all Specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"$300","0","0","0","2016-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2016Value5T","96667ME0250002-00","Standard Gold Off Exchange Plan","78.63%",,"No","Yes","No","100%",,"$1,500","$10","$560","$150","$140","$1,450","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/62253EF3BBCB4B93B2A98BED1C922696","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003647","4"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","1","96667","ME","SHOP (Small Group)","No","04-2452600","96667ME0250002","Maine Difference Deductible Tiered Copayment HMO 1500","96667ME025",,"MEN001","MES001","MEF001","New","HMO","Gold","Yes","Both","No","Yes","A referral is needed for all Specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"$300","0","0","0","2016-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2016Value5T","96667ME0250002-01","Standard Gold On Exchange Plan","78.63%",,"No","Yes","No","100%",,"$1,500","$10","$560","$150","$140","$1,450","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/62253EF3BBCB4B93B2A98BED1C922696","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003647","5"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","1","96667","ME","Individual","No","04-2452600","96667ME0240002","Gold HMO 1000","96667ME024",,"MEN001","MES001","MEF003","New","HMO","Gold","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0240002-01","Standard Gold On Exchange Plan","78.76%",,"Yes","Yes","No","100%",,"$1,000","$20","$660","$150","$140","$2,760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/C9FED48E21264BADAA6BA1CD3E661A8A","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003653","5"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","4","96667","ME","Individual","No","04-2452600","96667ME0240006","Best Buy HSA HMO 5000","96667ME024",,"MEN001","MES001","MEF008","New","HMO","Bronze","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0240006-01","Standard Bronze On Exchange Plan","61.63%",,"Yes","Yes","No","100%",,"$4,350","$0","$590","$150","$5,000","$190","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/8E4D42EFEAD2453D97BF7FC5381BC22C","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003660","5"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","4","96667","ME","SHOP (Small Group)","No","04-2452600","96667ME0270006","Maine's Choice Best Buy HSA HMO 2800","96667ME027",,"MEN002","MES002","MEF003","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all Specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"$500","0","0","0","2016-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2016Value5T","96667ME0270006-01","Standard Silver On Exchange Plan","68.16%","0.681536436080933","Yes","Yes","Yes","70%","30%","$2,800","$10","$150","$150","$2,800","$620","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","10%","$4,000","$4000 per person","$8000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/CF0D8E8567BE446D8C03B526C3225D70","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003789","5"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","4","96667","ME","Individual","No","04-2452600","96667ME0240006","Best Buy HSA HMO 5000","96667ME024",,"MEN001","MES001","MEF008","New","HMO","Bronze","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0240006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/A417432662104246AF388BEE55793F27","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003645","6"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","4","96667","ME","Individual","No","04-2452600","96667ME0240006","Best Buy HSA HMO 5000","96667ME024",,"MEN001","MES001","MEF008","New","HMO","Bronze","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0240006-03","Limited Cost Sharing Plan Variation","61.63%",,"Yes","Yes","No","100%",,"$4,350","$0","$590","$150","$5,000","$190","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/8E4D42EFEAD2453D97BF7FC5381BC22C","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003660","7"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","1","96667","ME","Individual","No","04-2452600","96667ME0240002","Gold HMO 1000","96667ME024",,"MEN001","MES001","MEF003","New","HMO","Gold","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0240002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/A417432662104246AF388BEE55793F27","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003645","6"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","1","96667","ME","SHOP (Small Group)","No","04-2452600","96667ME0250003","Maine Difference Deductible Tiered Copayment HMO 1000","96667ME025",,"MEN001","MES001","MEF001","New","HMO","Gold","Yes","Both","No","Yes","A referral is needed for all Specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"$300","0","0","0","2016-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2016Value5T","96667ME0250003-00","Standard Gold Off Exchange Plan","81.05%",,"No","Yes","No","100%",,"$1,000","$10","$660","$150","$140","$1,450","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/59646B36CAA94E938DD9274C23776169","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003646","6"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","1","96667","ME","SHOP (Small Group)","No","04-2452600","96667ME0250003","Maine Difference Deductible Tiered Copayment HMO 1000","96667ME025",,"MEN001","MES001","MEF001","New","HMO","Gold","Yes","Both","No","Yes","A referral is needed for all Specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"$300","0","0","0","2016-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2016Value5T","96667ME0250003-01","Standard Gold On Exchange Plan","81.05%",,"No","Yes","No","100%",,"$1,000","$10","$660","$150","$140","$1,450","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/59646B36CAA94E938DD9274C23776169","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003646","7"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","1","96667","ME","Individual","No","04-2452600","96667ME0240002","Gold HMO 1000","96667ME024",,"MEN001","MES001","MEF003","New","HMO","Gold","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0240002-03","Limited Cost Sharing Plan Variation","78.76%",,"Yes","Yes","No","100%",,"$1,000","$20","$660","$150","$140","$2,760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/C9FED48E21264BADAA6BA1CD3E661A8A","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003653","7"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","1","96667","ME","SHOP (Small Group)","No","04-2452600","96667ME0250009","Maine Difference Deductible Tiered Copayment HMO 2500","96667ME025",,"MEN001","MES001","MEF001","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all Specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"$300","0","0","0","2016-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2016Value5T","96667ME0250009-00","Standard Silver Off Exchange Plan","71.79%",,"No","Yes","No","100%",,"$2,500","$10","$550","$150","$140","$1,550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/DC9F88876C6D49B18754FE84680363F1","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003649","8"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","1","96667","ME","SHOP (Small Group)","No","04-2452600","96667ME0250009","Maine Difference Deductible Tiered Copayment HMO 2500","96667ME025",,"MEN001","MES001","MEF001","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all Specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"$300","0","0","0","2016-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2016Value5T","96667ME0250009-01","Standard Silver On Exchange Plan","71.79%",,"No","Yes","No","100%",,"$2,500","$10","$550","$150","$140","$1,550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/DC9F88876C6D49B18754FE84680363F1","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003649","9"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","2","96667","ME","SHOP (Small Group)","No","04-2452600","96667ME0250017","Best Buy HSA HMO 3000","96667ME025",,"MEN001","MES001","MEF003","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all Specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"$300","0","0","0","2016-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2016Value5T","96667ME0250017-00","Standard Silver Off Exchange Plan","68.44%",,"Yes","Yes","No","100%",,"$3,000","$10","$430","$150","$3,000","$580","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/33DBEC8FC2C34043846119D5C91428D4","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003658","4"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","2","96667","ME","Individual","No","04-2452600","96667ME0240003","Silver HMO","96667ME024",,"MEN001","MES001","MEF006","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0240003-00","Standard Silver Off Exchange Plan","69.36%",,"Yes","Yes","No","100%",,"$2,000","$20","$700","$150","$140","$2,810","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/1C8328342C9C469EBA66A5A9A5B5EE7E","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003656","4"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","2","96667","ME","Individual","No","04-2452600","96667ME0240003","Silver HMO","96667ME024",,"MEN001","MES001","MEF006","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0240003-01","Standard Silver On Exchange Plan","69.36%",,"Yes","Yes","No","100%",,"$2,000","$20","$700","$150","$140","$2,810","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/1C8328342C9C469EBA66A5A9A5B5EE7E","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003656","5"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","2","96667","ME","SHOP (Small Group)","No","04-2452600","96667ME0250017","Best Buy HSA HMO 3000","96667ME025",,"MEN001","MES001","MEF003","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all Specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"$300","0","0","0","2016-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2016Value5T","96667ME0250017-01","Standard Silver On Exchange Plan","68.44%",,"Yes","Yes","No","100%",,"$3,000","$10","$430","$150","$3,000","$580","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/33DBEC8FC2C34043846119D5C91428D4","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003658","5"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","2","96667","ME","SHOP (Small Group)","No","04-2452600","96667ME0250022","Best Buy HSA HMO 5000","96667ME025",,"MEN001","MES001","MEF003","New","HMO","Bronze","Yes","Both","No","Yes","A referral is needed for all Specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"$300","0","0","0","2016-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2016Value5T","96667ME0250022-00","Standard Bronze Off Exchange Plan","61.66%",,"Yes","Yes","No","100%",,"$4,350","$0","$590","$150","$5,000","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/D4B3E141364947839FA463B1C8E59DB8","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003661","6"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","2","96667","ME","Individual","No","04-2452600","96667ME0240003","Silver HMO","96667ME024",,"MEN001","MES001","MEF006","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0240003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/A417432662104246AF388BEE55793F27","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003645","6"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","2","96667","ME","Individual","No","04-2452600","96667ME0240003","Silver HMO","96667ME024",,"MEN001","MES001","MEF006","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0240003-03","Limited Cost Sharing Plan Variation","69.36%",,"Yes","Yes","No","100%",,"$2,000","$20","$700","$150","$140","$2,810","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/1C8328342C9C469EBA66A5A9A5B5EE7E","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003656","7"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","2","96667","ME","SHOP (Small Group)","No","04-2452600","96667ME0250022","Best Buy HSA HMO 5000","96667ME025",,"MEN001","MES001","MEF003","New","HMO","Bronze","Yes","Both","No","Yes","A referral is needed for all Specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"$300","0","0","0","2016-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2016Value5T","96667ME0250022-01","Standard Bronze On Exchange Plan","61.66%",,"Yes","Yes","No","100%",,"$4,350","$0","$590","$150","$5,000","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/D4B3E141364947839FA463B1C8E59DB8","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003661","7"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","2","96667","ME","SHOP (Small Group)","No","04-2452600","96667ME0250024","Best Buy HSA HMO 6100","96667ME025",,"MEN001","MES001","MEF003","New","HMO","Bronze","Yes","Both","No","Yes","A referral is needed for all Specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"$300","0","0","0","2016-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2016Value5T","96667ME0250024-00","Standard Bronze Off Exchange Plan","60.77%",,"Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/7FBA2B1FB39D40BDB26B4D5DC77062F9","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003663","8"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","2","96667","ME","Individual","No","04-2452600","96667ME0240003","Silver HMO","96667ME024",,"MEN001","MES001","MEF006","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0240003-04","73% AV Level Silver Plan","73.81%",,"Yes","Yes","No","100%",,"$1,800","$20","$500","$150","$140","$2,760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","20%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/34A63DA8E15145EBA9D4687E5EBCC98E","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003655","8"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","2","96667","ME","Individual","No","04-2452600","96667ME0240003","Silver HMO","96667ME024",,"MEN001","MES001","MEF006","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0240003-05","87% AV Level Silver Plan","86.98%",,"Yes","Yes","No","100%",,"$500","$20","$380","$150","$140","$1,890","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/AD6F9C67860149E8914758D05D74DBBD","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003652","9"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","2","96667","ME","SHOP (Small Group)","No","04-2452600","96667ME0250024","Best Buy HSA HMO 6100","96667ME025",,"MEN001","MES001","MEF003","New","HMO","Bronze","Yes","Both","No","Yes","A referral is needed for all Specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"$300","0","0","0","2016-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2016Value5T","96667ME0250024-01","Standard Bronze On Exchange Plan","60.77%",,"Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/7FBA2B1FB39D40BDB26B4D5DC77062F9","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003663","9"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","2","96667","ME","Individual","No","04-2452600","96667ME0240003","Silver HMO","96667ME024",,"MEN001","MES001","MEF006","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0240003-06","94% AV Level Silver Plan","93.90%",,"Yes","Yes","No","100%",,"$300","$10","$0","$150","$90","$710","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/3C184C120EF4427D90C5FD33B18F2C01","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003651","10"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","3","96667","ME","Individual","No","04-2452600","96667ME0240008","Bronze HMO 6000","96667ME024",,"MEN001","MES001","MEF005","New","HMO","Bronze","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0240008-00","Standard Bronze Off Exchange Plan","60.89%",,"Yes","Yes","No","100%",,"$4,320","$20","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/9559550F0DA246419EB7FF2F1A622439","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003662","4"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","3","96667","ME","SHOP (Small Group)","No","04-2452600","96667ME0270002","Maine's Choice HMO 1250","96667ME027",,"MEN002","MES002","MEF001","New","HMO","Gold","Yes","Both","No","Yes","A referral is needed for all Specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"$500","0","1","0","2016-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2016Value5T","96667ME0270002-00","Standard Gold Off Exchange Plan","78.40%","0.78706818819046","No","Yes","Yes","70%","30%","$1,250","$10","$610","$150","$140","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,000","$3000 per person","$6000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,000","$3000 per person","$6000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/F65E1C25F3FE4FC1806CF0D52F0FC18B","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003782","4"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","3","96667","ME","SHOP (Small Group)","No","04-2452600","96667ME0270002","Maine's Choice HMO 1250","96667ME027",,"MEN002","MES002","MEF001","New","HMO","Gold","Yes","Both","No","Yes","A referral is needed for all Specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"$500","0","1","0","2016-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2016Value5T","96667ME0270002-01","Standard Gold On Exchange Plan","78.40%","0.78706818819046","No","Yes","Yes","70%","30%","$1,250","$10","$610","$150","$140","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,000","$3000 per person","$6000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,000","$3000 per person","$6000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/F65E1C25F3FE4FC1806CF0D52F0FC18B","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003782","5"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","3","96667","ME","SHOP (Small Group)","No","04-2452600","96667ME0270004","Maine's Choice HMO 2000","96667ME027",,"MEN002","MES002","MEF001","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all Specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"$500","0","1","0","2016-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2016Value5T","96667ME0270004-01","Standard Silver On Exchange Plan","70.97%","0.718885242938995","No","Yes","Yes","70%","30%","$2,000","$10","$460","$150","$140","$1,550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%","$5,000","$5000 per person","$10000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%","$5,000","$5000 per person","$10000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/6071874940154518983AF4C72CA2A88F","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003786","7"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","3","96667","ME","Individual","No","04-2452600","96667ME0240008","Bronze HMO 6000","96667ME024",,"MEN001","MES001","MEF005","New","HMO","Bronze","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0240008-03","Limited Cost Sharing Plan Variation","60.89%",,"Yes","Yes","No","100%",,"$4,320","$20","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","30%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/9559550F0DA246419EB7FF2F1A622439","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003662","7"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","3","96667","ME","SHOP (Small Group)","No","04-2452600","96667ME0270008","Maine's Choice HMO 3500","96667ME027",,"MEN002","MES002","MEF001","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all Specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"$500","0","1","0","2016-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2016Value5T","96667ME0270008-00","Standard Silver Off Exchange Plan","69.16%","0.705364465713501","No","Yes","Yes","70%","30%","$3,500","$10","$160","$150","$140","$1,550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%","$5,500","$5500 per person","$11000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%","$5,500","$5500 per person","$11000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/67D09C4D311D468B88A041AC0741FDC4","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003793","8"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","3","96667","ME","SHOP (Small Group)","No","04-2452600","96667ME0270008","Maine's Choice HMO 3500","96667ME027",,"MEN002","MES002","MEF001","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all Specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"$500","0","1","0","2016-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2016Value5T","96667ME0270008-01","Standard Silver On Exchange Plan","69.16%","0.705364465713501","No","Yes","Yes","70%","30%","$3,500","$10","$160","$150","$140","$1,550","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%","$5,500","$5500 per person","$11000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%","$5,500","$5500 per person","$11000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/67D09C4D311D468B88A041AC0741FDC4","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003793","9"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","4","96667","ME","SHOP (Small Group)","No","04-2452600","96667ME0270006","Maine's Choice Best Buy HSA HMO 2800","96667ME027",,"MEN002","MES002","MEF003","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all Specialists except OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,"$500","0","0","0","2016-01-01","2050-12-31","No",,"No",,"No",,"https://www.harvardpilgrim.org/2016Value5T","96667ME0270006-00","Standard Silver Off Exchange Plan","68.16%","0.681536436080933","Yes","Yes","Yes","70%","30%","$2,800","$10","$150","$150","$2,800","$620","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,800","$2800 per person","$5600 per group","10%","$4,000","$4000 per person","$8000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/CF0D8E8567BE446D8C03B526C3225D70","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003789","4"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","4","96667","ME","Individual","No","04-2452600","96667ME0240006","Best Buy HSA HMO 5000","96667ME024",,"MEN001","MES001","MEF008","New","HMO","Bronze","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","0","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0240006-00","Standard Bronze Off Exchange Plan","61.63%",,"Yes","Yes","No","100%",,"$4,350","$0","$590","$150","$5,000","$190","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/8E4D42EFEAD2453D97BF7FC5381BC22C","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003660","4"
"2016","MI","11083","SERFF","3","2015-08-22 23:36:24","2","11083","MI","SHOP (Small Group)","Yes","13-5581829","11083MI0120001","Family Basic Dental Plan (Low)","11083MI012",,"MIN001","MIS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$17.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","11083MI0120001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$200","$200 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49090","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49089","5"
"2016","MI","11083","SERFF","3","2015-08-22 23:36:24","3","11083","MI","SHOP (Small Group)","Yes","13-5581829","11083MI0130001","Family Enhanced Dental Plan (High)","11083MI013",,"MIN001","MIS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$27.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","11083MI0130001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49092","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49091","4"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350003","Blue Cross® Premier Silver","15560MI035","7538162760","MIN001","MIS001","MIF052","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-na-less-than-300-sbc.pdf","16"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","5","96667","ME","Individual","No","04-2452600","96667ME0260004","Maine's Choice Gold HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Gold","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2016-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260004-00","Standard Gold Off Exchange Plan",,"0.795662820339203","Yes","Yes","Yes","70%","30%","$750","$20","$360","$150","$140","$2,610","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%","$2,000","$2000 per person","$4000 per group","40%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/3F5F9BC6995A4B5BADB0719506845F36","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003798","4"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","5","96667","ME","Individual","No","04-2452600","96667ME0260004","Maine's Choice Gold HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Gold","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2016-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260004-01","Standard Gold On Exchange Plan",,"0.795662820339203","Yes","Yes","Yes","70%","30%","$750","$20","$360","$150","$140","$2,610","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%","$2,000","$2000 per person","$4000 per group","40%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/3F5F9BC6995A4B5BADB0719506845F36","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003798","5"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","5","96667","ME","Individual","No","04-2452600","96667ME0260004","Maine's Choice Gold HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Gold","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2016-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/739D2390192349F49E32A6B55836A80E","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003802","6"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","5","96667","ME","Individual","No","04-2452600","96667ME0260004","Maine's Choice Gold HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Gold","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2016-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260004-03","Limited Cost Sharing Plan Variation",,"0.795662820339203","Yes","Yes","Yes","70%","30%","$750","$20","$360","$150","$140","$2,610","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%","$2,000","$2000 per person","$4000 per group","40%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/3F5F9BC6995A4B5BADB0719506845F36","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003798","7"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","6","96667","ME","Individual","No","04-2452600","96667ME0260002","Maine's Choice Casco Silver HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260002-00","Standard Silver Off Exchange Plan","71.98%",,"Yes","Yes","Yes","70%","30%","$1,500","$20","$850","$150","$1,500","$2,110","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%","$4,000","$4000 per person","$8000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/DA40927CA9DB4A0699A8AF243B582492","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003784","4"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","6","96667","ME","Individual","No","04-2452600","96667ME0260002","Maine's Choice Casco Silver HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260002-01","Standard Silver On Exchange Plan","71.98%",,"Yes","Yes","Yes","70%","30%","$1,500","$20","$850","$150","$1,500","$2,110","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%","$4,000","$4000 per person","$8000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/DA40927CA9DB4A0699A8AF243B582492","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003784","5"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","6","96667","ME","Individual","No","04-2452600","96667ME0260002","Maine's Choice Casco Silver HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","70%","30%","$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/739D2390192349F49E32A6B55836A80E","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003802","6"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","6","96667","ME","Individual","No","04-2452600","96667ME0260002","Maine's Choice Casco Silver HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260002-03","Limited Cost Sharing Plan Variation","71.98%",,"Yes","Yes","Yes","70%","30%","$1,500","$20","$850","$150","$1,500","$2,110","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,900","$5900 per person","$11800 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%","$4,000","$4000 per person","$8000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/DA40927CA9DB4A0699A8AF243B582492","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003784","7"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","6","96667","ME","Individual","No","04-2452600","96667ME0260002","Maine's Choice Casco Silver HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260002-04","73% AV Level Silver Plan","73.98%",,"Yes","Yes","Yes","70%","30%","$1,500","$20","$850","$150","$1,500","$2,110","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%","$4,000","$4000 per person","$8000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/273A9C2A12EC4C47B5607C3B5B3CB777","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003783","8"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","6","96667","ME","Individual","No","04-2452600","96667ME0260002","Maine's Choice Casco Silver HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260002-05","87% AV Level Silver Plan","87.71%",,"Yes","Yes","Yes","70%","30%","$500","$20","$570","$150","$500","$2,380","$20","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","15%","$1,200","$1200 per person","$2400 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/05999CFC6AEA46CDB75B3974C53614C1","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003795","9"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","6","96667","ME","Individual","No","04-2452600","96667ME0260002","Maine's Choice Casco Silver HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260002-06","94% AV Level Silver Plan","94.50%",,"Yes","Yes","Yes","70%","30%","$150","$10","$420","$150","$150","$1,240","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","$900","$900 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","10%","$500","$500 per person","$1000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/410FBF3E8D4644A8B0818CA2ACDEC23E","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003785","10"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","7","96667","ME","Individual","No","04-2452600","96667ME0260008","Maine's Choice Sebago Silver HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260008-00","Standard Silver Off Exchange Plan","70.92%","0.709169030189514","Yes","Yes","Yes","70%","30%","$1,500","$20","$850","$150","$140","$2,710","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%","$5,000","$5000 per person","$10000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/DDE409C6EC074D19A24B52AFFE3ABDF6","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003788","4"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","7","96667","ME","Individual","No","04-2452600","96667ME0260008","Maine's Choice Sebago Silver HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260008-01","Standard Silver On Exchange Plan","70.92%","0.709169030189514","Yes","Yes","Yes","70%","30%","$1,500","$20","$850","$150","$140","$2,710","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%","$5,000","$5000 per person","$10000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/DDE409C6EC074D19A24B52AFFE3ABDF6","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003788","5"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","7","96667","ME","Individual","No","04-2452600","96667ME0260008","Maine's Choice Sebago Silver HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/739D2390192349F49E32A6B55836A80E","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003802","6"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","7","96667","ME","Individual","No","04-2452600","96667ME0260008","Maine's Choice Sebago Silver HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260008-03","Limited Cost Sharing Plan Variation","70.92%","0.709169030189514","Yes","Yes","Yes","70%","30%","$1,500","$20","$850","$150","$140","$2,710","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%","$5,000","$5000 per person","$10000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/DDE409C6EC074D19A24B52AFFE3ABDF6","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003788","7"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","7","96667","ME","Individual","No","04-2452600","96667ME0260008","Maine's Choice Sebago Silver HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260008-04","73% AV Level Silver Plan","73.05%","0.730540812015533","Yes","Yes","Yes","70%","30%","$1,500","$20","$850","$150","$140","$2,710","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%","$5,000","$5000 per person","$10000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/7BA1B9681B8B4A0BBAB0A1FBBC3A8B4C","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003787","8"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","7","96667","ME","Individual","No","04-2452600","96667ME0260008","Maine's Choice Sebago Silver HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260008-05","87% AV Level Silver Plan","87.36%","0.873599827289581","Yes","Yes","Yes","70%","30%","$500","$20","$570","$150","$90","$960","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","15%","$1,200","$1200 per person","$2400 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/903D28C8AB384882AE7D8C2E4F238C73","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003796","9"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","7","96667","ME","Individual","No","04-2452600","96667ME0260008","Maine's Choice Sebago Silver HMO","96667ME026",,"MEN002","MES002","MEF003","New","HMO","Silver","Yes","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260008-06","94% AV Level Silver Plan","93.96%","0.939632773399353","Yes","Yes","Yes","70%","30%","$150","$0","$200","$150","$90","$260","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10%","$500","$500 per person","$1000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/CDB51FAC2E244C45BEBC0D4BB2B004F4","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003790","10"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","8","96667","ME","Individual","No","04-2452600","96667ME0260006","Maine's Choice Pemaquid Silver HMO","96667ME026",,"MEN002","MES002","MEF006","New","HMO","Silver","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260006-00","Standard Silver Off Exchange Plan",,"0.68446934223175","Yes","Yes","Yes","70%","30%","$4,000","$20","$60","$150","$140","$2,760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%","$6,250","$6250 per person","$12500 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/3068D79B3FDE4E55AED64EC0DE94C9F2","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003794","4"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","8","96667","ME","Individual","No","04-2452600","96667ME0260006","Maine's Choice Pemaquid Silver HMO","96667ME026",,"MEN002","MES002","MEF006","New","HMO","Silver","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260006-01","Standard Silver On Exchange Plan",,"0.68446934223175","Yes","Yes","Yes","70%","30%","$4,000","$20","$60","$150","$140","$2,760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%","$6,250","$6250 per person","$12500 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/3068D79B3FDE4E55AED64EC0DE94C9F2","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003794","5"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","8","96667","ME","Individual","No","04-2452600","96667ME0260006","Maine's Choice Pemaquid Silver HMO","96667ME026",,"MEN002","MES002","MEF006","New","HMO","Silver","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/739D2390192349F49E32A6B55836A80E","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003802","6"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","8","96667","ME","Individual","No","04-2452600","96667ME0260006","Maine's Choice Pemaquid Silver HMO","96667ME026",,"MEN002","MES002","MEF006","New","HMO","Silver","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260006-03","Limited Cost Sharing Plan Variation",,"0.68446934223175","Yes","Yes","Yes","70%","30%","$4,000","$20","$60","$150","$140","$2,760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%","$6,250","$6250 per person","$12500 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/3068D79B3FDE4E55AED64EC0DE94C9F2","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003794","7"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","8","96667","ME","Individual","No","04-2452600","96667ME0260006","Maine's Choice Pemaquid Silver HMO","96667ME026",,"MEN002","MES002","MEF006","New","HMO","Silver","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260006-04","73% AV Level Silver Plan",,"0.722989559173584","Yes","Yes","Yes","70%","30%","$3,250","$20","$210","$150","$140","$2,760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","20%","$4,500","$4500 per person","$9000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/433BAA2D1FE04C83A92EA75CBD67260F","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003792","8"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","8","96667","ME","Individual","No","04-2452600","96667ME0260006","Maine's Choice Pemaquid Silver HMO","96667ME026",,"MEN002","MES002","MEF006","New","HMO","Silver","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260006-05","87% AV Level Silver Plan",,"0.861654996871948","Yes","Yes","Yes","70%","30%","$700","$0","$700","$150","$90","$1,310","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20%","$1,200","$1200 per person","$2400 per group","40%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/8DC4340A5572422DB574A0547D80FA94","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003797","9"
"2016","ME","96667","SERFF","9","2016-07-13 14:35:16","8","96667","ME","Individual","No","04-2452600","96667ME0260006","Maine's Choice Pemaquid Silver HMO","96667ME026",,"MEN002","MES002","MEF006","New","HMO","Silver","No","Both","No","Yes","A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998",,,,"0","1","0","2016-01-01","2050-12-31","No",,"No",,"No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","96667ME0260006-06","94% AV Level Silver Plan",,"0.930047512054443","Yes","Yes","Yes","70%","30%","$250","$0","$250","$150","$90","$410","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$1,200","$1200 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%","$600","$600 per person","$1200 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/4F607D1AAD3D4353B627C57C7A896779","https://www.harvardpilgrim.org/pls/portal/portal.get_sob?pSOURCE=CONN&pCODE=5fwoB7g2N08sv&pMD=MD0000003791","10"
"2016","MI","11083","SERFF","3","2015-08-22 23:36:24","1","11083","MI","SHOP (Small Group)","Yes","13-5581829","11083MI0100001","EHB Basic Dental Plan (Low)","11083MI010",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$17.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","11083MI0100001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$200","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MI","11083","SERFF","3","2015-08-22 23:36:24","2","11083","MI","SHOP (Small Group)","Yes","13-5581829","11083MI0120001","Family Basic Dental Plan (Low)","11083MI012",,"MIN001","MIS001",,"Existing","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$17.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","11083MI0120001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$200","$200 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49090","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49089","4"
"2016","MI","11083","SERFF","3","2015-08-22 23:36:24","3","11083","MI","SHOP (Small Group)","Yes","13-5581829","11083MI0130001","Family Enhanced Dental Plan (High)","11083MI013",,"MIN001","MIS001",,"Existing","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$27.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","11083MI0130001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49092","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49091","5"
"2016","MI","11103","SERFF","4","2015-08-22 23:36:24","1","11103","MI","Individual","Yes","36-4117539","11103MI0060001","Managed DentalGuard MI Essentials 1","11103MI006",,"MIN002","MIS002",,"New","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.04","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","11103MI0060001-00","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","4"
"2016","MI","11103","SERFF","4","2015-08-22 23:36:24","1","11103","MI","SHOP (Small Group)","Yes","36-4117539","11103MI0030003","Managed DentalGuard MI10 Family Plan","11103MI003",,"MIN001","MIS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.74","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","11103MI0030003-00","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","MI","11103","SERFF","4","2015-08-22 23:36:24","1","11103","MI","SHOP (Small Group)","Yes","36-4117539","11103MI0030003","Managed DentalGuard MI10 Family Plan","11103MI003",,"MIN001","MIS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.74","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","11103MI0030003-01","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","MI","11103","SERFF","4","2015-08-22 23:36:24","1","11103","MI","Individual","Yes","36-4117539","11103MI0060001","Managed DentalGuard MI Essentials 1","11103MI006",,"MIN002","MIS002",,"New","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.04","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","11103MI0060001-01","Standard Low On Exchange Plan","70.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","5"
"2016","MI","11103","SERFF","4","2015-08-22 23:36:24","1","11103","MI","SHOP (Small Group)","Yes","36-4117539","11103MI0040003","Managed DentalGuard MI20 Family Plan","11103MI004",,"MIN001","MIS001",,"Existing","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.01","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","11103MI0040003-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","MI","11103","SERFF","4","2015-08-22 23:36:24","1","11103","MI","SHOP (Small Group)","Yes","36-4117539","11103MI0050003","Managed DentalGuard MI30 Family Plan","11103MI005",,"MIN001","MIS001",,"Existing","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.64","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","11103MI0050003-00","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","MI","12858","SERFF","4","2015-10-21 17:48:08","1","12858","MI","Individual","Yes","36-3757528","12858MI0010001","TruAssure Basic Adult or Child Dental Plan","12858MI001",,"MIN001","MIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.39","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12858MI0010001-00","Standard Low Off Exchange Plan","68.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$110","$110 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MI","https://www.truassure.com/brochure?state=MI","4"
"2016","MI","12858","SERFF","4","2015-10-21 17:48:08","1","12858","MI","SHOP (Small Group)","Yes","36-3757528","12858MI0030001","TruAssure Dental Small Group Basic Plan","12858MI003",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.87","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","12858MI0030001-00","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MI","12858","SERFF","4","2015-10-21 17:48:08","1","12858","MI","SHOP (Small Group)","Yes","36-3757528","12858MI0040001","TruAssure Dental Small Group Preferred Plan","12858MI004",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.87","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","12858MI0040001-00","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$65","$65 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MI","12858","SERFF","4","2015-10-21 17:48:08","1","12858","MI","Individual","Yes","36-3757528","12858MI0010001","TruAssure Basic Adult or Child Dental Plan","12858MI001",,"MIN001","MIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.39","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12858MI0010001-01","Standard Low On Exchange Plan","68.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$110","$110 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MI","https://www.truassure.com/brochure?state=MI","5"
"2016","MI","12858","SERFF","4","2015-10-21 17:48:08","2","12858","MI","Individual","Yes","36-3757528","12858MI0020001","TruAssure Preferred Adult or Child Dental Plan","12858MI002",,"MIN001","MIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.25","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12858MI0020001-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MI","https://www.truassure.com/brochure?state=MI","4"
"2016","MI","12858","SERFF","4","2015-10-21 17:48:08","2","12858","MI","Individual","Yes","36-3757528","12858MI0020001","TruAssure Preferred Adult or Child Dental Plan","12858MI002",,"MIN001","MIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.25","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","12858MI0020001-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","$40 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=MI","https://www.truassure.com/brochure?state=MI","5"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","Yes","38-2069753","15560MI0720001","Blue Dental PPO Standard","15560MI072","7538162760","MIN003","MIS004",,"Existing","PPO","Low",,"Both",,,,"$1,200 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"$18.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","http://www.bcbsm.com/index/plans/dental-insurance-michigan/ppo.html","","15560MI0720001-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/ppo.html","4"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0430001","Blue Dental PPO Plus 100/80/50/50 SG","15560MI043","7538162760","MIN003","MIS004",,"Existing","PPO","High",,"Off the Exchange",,,,"$1,500 annual benefit maximum for members age 19 or older when coverage begins. $1,500 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"$26.12","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0430001-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-plus-100-80-50-50-1500-sg.pdf","4"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350001","Blue Cross® Premier Value","15560MI035","7538162760","MIN001","MIS001","MIF051","Existing","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,170","$0","$0","$150","$4,970","$90","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-value-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/catastrophic/premier-ppo.html","4"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350001","Blue Cross® Premier Value","15560MI035","7538162760","MIN001","MIS001","MIF051","Existing","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,170","$0","$0","$150","$4,970","$90","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-value-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/catastrophic/premier-ppo.html","5"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0430002","Blue Dental PPO Plus 100/80/50/50 SG","15560MI043","7538162760","MIN003","MIS004",,"Existing","PPO","High",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"$26.12","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0430002-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-plus-100-80-50-50-1000-sg.pdf","5"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","Yes","38-2069753","15560MI0720001","Blue Dental PPO Standard","15560MI072","7538162760","MIN003","MIS004",,"Existing","PPO","Low",,"Both",,,,"$1,200 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"$18.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","http://www.bcbsm.com/index/plans/dental-insurance-michigan/ppo.html","","15560MI0720001-01","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/ppo.html","5"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","Yes","38-2069753","15560MI0710001","Blue Dental PPO Plus Standard","15560MI071","7538162760","MIN003","MIS004",,"Existing","PPO","Low",,"Both",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"$21.48","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","http://www.bcbsm.com/index/plans/dental-insurance-michigan/ppo-plus.html","","15560MI0710001-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/ppo-plus.html","6"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0450001","Blue Dental PPO 100/80/50/50 (80/50/50/50) SG","15560MI045","7538162760","MIN003","MIS004",,"Existing","PPO","High",,"Off the Exchange",,,,"$1,250 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.  $1,250 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"$21.64","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0450001-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-100-80-50-50-1250-sg.pdf","6"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350002","Blue Cross® Premier Bronze","15560MI035","7538162760","MIN001","MIS001","MIF051","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350002-00","Standard Bronze Off Exchange Plan","61.89%","0.605813801288605","Yes","Yes","No","100%",,"$5,670","$500","$0","$150","$5,260","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","0%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/premier-ppo.html","6"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350002","Blue Cross® Premier Bronze","15560MI035","7538162760","MIN001","MIS001","MIF051","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350002-01","Standard Bronze On Exchange Plan","61.89%","0.605813801288605","Yes","Yes","No","100%",,"$5,670","$500","$0","$150","$5,260","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","0%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/premier-ppo.html","7"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0450002","Blue Dental PPO 100/80/50/50 (50/50/50/50) SG","15560MI045","7538162760","MIN003","MIS004",,"Existing","PPO","High",,"Off the Exchange",,,,"$1,500 annual benefit maximum for members age 19 or older when coverage begins. $1,500 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"$19.72","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0450002-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-100-80-50-50-1500-sg.pdf","7"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","Yes","38-2069753","15560MI0710001","Blue Dental PPO Plus Standard","15560MI071","7538162760","MIN003","MIS004",,"Existing","PPO","Low",,"Both",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"$21.48","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","http://www.bcbsm.com/index/plans/dental-insurance-michigan/ppo-plus.html","","15560MI0710001-01","Standard Low On Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/ppo-plus.html","7"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","Yes","38-2069753","15560MI0730001","Blue Dental EPO Standard","15560MI073","7538162760","MIN003","MIS003",,"Existing","EPO","Low",,"Both",,,,"$1,200 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,"No","Allows Adult and Child-Only",,,,,"$16.67","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","No",,"Yes","http://www.bcbsm.com/index/plans/dental-insurance-michigan/epo.html","","15560MI0730001-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/epo.html","8"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0450003","Blue Dental PPO 100/80/50/50 (50/50/50/50) SG","15560MI045","7538162760","MIN003","MIS004",,"Existing","PPO","High",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"$19.72","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0450003-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-100-80-50-50-1000-sg.pdf","8"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350002","Blue Cross® Premier Bronze","15560MI035","7538162760","MIN001","MIS001","MIF051","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-bronze-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-bronze-na-less-than-300-sbc.pdf","8"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350002","Blue Cross® Premier Bronze","15560MI035","7538162760","MIN001","MIS001","MIF051","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350002-03","Limited Cost Sharing Plan Variation","61.89%","0.605813801288605","Yes","Yes","No","100%",,"$5,670","$500","$0","$150","$5,260","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","0%",,,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-bronze-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-bronze-na-more-than-300-sbc.pdf","9"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0450004","Blue Dental PPO  80/50/50/50 (50/50/50/50) SG","15560MI045","7538162760","MIN003","MIS004",,"Existing","PPO","Low",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"$16.84","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0450004-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-80-50-50-50-1000-sg.pdf","9"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","Yes","38-2069753","15560MI0730001","Blue Dental EPO Standard","15560MI073","7538162760","MIN003","MIS003",,"Existing","EPO","Low",,"Both",,,,"$1,200 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,"No","Allows Adult and Child-Only",,,,,"$16.67","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","No",,"Yes","http://www.bcbsm.com/index/plans/dental-insurance-michigan/epo.html","","15560MI0730001-01","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/epo.html","9"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","Yes","38-2069753","15560MI0720002","Blue Dental PPO Extra","15560MI072","7538162760","MIN003","MIS004",,"Existing","PPO","High",,"Both",,,,"$1,200 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $1,000 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"$24.25","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","http://www.bcbsm.com/index/plans/dental-insurance-michigan/ppo-extra.html","","15560MI0720002-00","Standard High Off Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/ppo-extra.html","10"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0450005","Blue Dental PPO  80/50/50/50 (50/50/50/50) SG","15560MI045","7538162760","MIN003","MIS004",,"Existing","PPO","Low",,"Off the Exchange",,,,"$800 annual benefit maximum for members age 19 or older when coverage begins. $800 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"$16.84","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0450005-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-80-50-50-50-800-sg.pdf","10"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350005","Blue Cross® Premier Bronze Saver","15560MI035","7538162760","MIN001","MIS001","MIF051","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350005-00","Standard Bronze Off Exchange Plan","59.02%","0.590237438678741","Yes","Yes","No","100%",,"$6,170","$0","$0","$150","$5,260","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/premier-ppo-saver.html","10"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350005","Blue Cross® Premier Bronze Saver","15560MI035","7538162760","MIN001","MIS001","MIF051","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350005-01","Standard Bronze On Exchange Plan","59.02%","0.590237438678741","Yes","Yes","No","100%",,"$6,170","$0","$0","$150","$5,260","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/premier-ppo-saver.html","11"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","Yes","38-2069753","15560MI0720002","Blue Dental PPO Extra","15560MI072","7538162760","MIN003","MIS004",,"Existing","PPO","High",,"Both",,,,"$1,200 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $1,000 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"$24.25","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","http://www.bcbsm.com/index/plans/dental-insurance-michigan/ppo-extra.html","","15560MI0720002-01","Standard High On Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/ppo-extra.html","11"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0470001","Blue Dental EPO 100/80/50/50 SG","15560MI047","7538162760","MIN003","MIS003",,"Existing","EPO","High",,"Off the Exchange",,,,"$1,250 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists. $1,250 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"$19.02","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","No",,"Yes",,"","15560MI0470001-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-epo-100-80-50-50-1250-sg.pdf","11"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0430005","Blue Dental  PPO Plus  80/50/50/50 SG","15560MI043","7538162760","MIN003","MIS004",,"Existing","PPO","Low",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"$19.85","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0430005-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-plus-80-50-50-50-1000-sg.pdf","12"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350005","Blue Cross® Premier Bronze Saver","15560MI035","7538162760","MIN001","MIS001","MIF051","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-bronze-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-bronze-saver-na-less-than-300-sbc.pdf","12"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350005","Blue Cross® Premier Bronze Saver","15560MI035","7538162760","MIN001","MIS001","MIF051","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350005-03","Limited Cost Sharing Plan Variation","59.02%","0.590237438678741","Yes","Yes","No","100%",,"$6,170","$0","$0","$150","$5,260","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-bronze-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-bronze-saver-na-more-than-300-sbc.pdf","13"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350003","Blue Cross® Premier Silver","15560MI035","7538162760","MIN001","MIS001","MIF052","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350003-00","Standard Silver Off Exchange Plan","71.80%","0.728568077087402","Yes","Yes","No","100%",,"$1,400","$500","$850","$150","$1,400","$90","$725","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","20%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-value-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/catastrophic/premier-ppo.html","14"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350003","Blue Cross® Premier Silver","15560MI035","7538162760","MIN001","MIS001","MIF052","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350003-01","Standard Silver On Exchange Plan","71.80%","0.728568077087402","Yes","Yes","No","100%",,"$1,400","$500","$850","$150","$1,400","$90","$725","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","20%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/premier-ppo.html","15"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350003","Blue Cross® Premier Silver","15560MI035","7538162760","MIN001","MIS001","MIF052","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350003-03","Limited Cost Sharing Plan Variation","71.80%","0.728568077087402","Yes","Yes","No","100%",,"$1,400","$500","$850","$150","$1,400","$90","$725","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","20%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-na-more-than-300-sbc.pdf","17"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350003","Blue Cross® Premier Silver","15560MI035","7538162760","MIN001","MIS001","MIF052","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350003-04","73% AV Level Silver Plan","73.80%","0.748178541660309","Yes","Yes","No","100%",,"$1,150","$500","$870","$150","$1,150","$150","$780","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","20%",,,,,"$2,300","$2300 per person","$4600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/premier-ppo.html?costshare=73","18"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350003","Blue Cross® Premier Silver","15560MI035","7538162760","MIN001","MIS001","MIF052","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350003-05","87% AV Level Silver Plan","86.32%","0.869654595851898","Yes","Yes","No","100%",,"$500","$500","$500","$150","$500","$180","$450","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$3,400","$3400 per person","$6800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/premier-ppo.html?costshare=87","19"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350003","Blue Cross® Premier Silver","15560MI035","7538162760","MIN001","MIS001","MIF052","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350003-06","94% AV Level Silver Plan","94.52%","0.947920799255371","Yes","Yes","No","100%",,"$175","$0","$325","$150","$175","$180","$145","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","10%",,,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/premier-ppo.html?costshare=94","20"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350006","Blue Cross® Premier Silver Saver","15560MI035","7538162760","MIN001","MIS001","MIF052","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350006-00","Standard Silver Off Exchange Plan","68.35%","0.684191584587097","Yes","Yes","No","100%",,"$3,500","$0","$500","$150","$3,500","$0","$210","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/premier-ppo-saver.html","21"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350006","Blue Cross® Premier Silver Saver","15560MI035","7538162760","MIN001","MIS001","MIF052","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350006-01","Standard Silver On Exchange Plan","68.35%","0.684191584587097","Yes","Yes","No","100%",,"$3,500","$0","$500","$150","$3,500","$0","$210","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/premier-ppo-saver.html","22"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350006","Blue Cross® Premier Silver Saver","15560MI035","7538162760","MIN001","MIS001","MIF052","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-saver-na-less-than-300-sbc.pdf","23"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350006","Blue Cross® Premier Silver Saver","15560MI035","7538162760","MIN001","MIS001","MIF052","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350006-03","Limited Cost Sharing Plan Variation","68.35%","0.684191584587097","Yes","Yes","No","100%",,"$3,500","$0","$500","$150","$3,500","$0","$210","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$8,500","$8500 per person","$17000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-saver-na-more-than-300-sbc.pdf","24"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350006","Blue Cross® Premier Silver Saver","15560MI035","7538162760","MIN001","MIS001","MIF052","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350006-04","73% AV Level Silver Plan","72.95%","0.730937361717224","Yes","Yes","No","100%",,"$1,150","$0","$980","$150","$1,150","$0","$810","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group",,,,"$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-saver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/premier-ppo-saver.html?costshare=73","25"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350006","Blue Cross® Premier Silver Saver","15560MI035","7538162760","MIN001","MIS001","MIF052","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350006-05","87% AV Level Silver Plan","86.25%","0.865958631038666","Yes","Yes","No","100%",,"$500","$0","$550","$150","$500","$180","$450","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10%",,,,,"$1,600","$1600 per person","$3200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-saver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/premier-ppo-saver.html?costshare=87","26"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350006","Blue Cross® Premier Silver Saver","15560MI035","7538162760","MIN001","MIS001","MIF052","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350006-06","94% AV Level Silver Plan","93.20%","0.934235036373138","Yes","Yes","No","100%",,"$175","$0","$325","$150","$175","$180","$145","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$1,200","$1200 per person","$2400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","10%",,,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-saver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/premier-ppo-saver.html?costshare=94","27"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350004","Blue Cross® Premier Gold","15560MI035","7538162760","MIN001","MIS001","MIF052","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350004-00","Standard Gold Off Exchange Plan","80.95%","0.824733197689056","Yes","Yes","No","100%",,"$150","$500","$1,100","$150","$150","$180","$890","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","20%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-gold-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/premier-ppo.html","28"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350004","Blue Cross® Premier Gold","15560MI035","7538162760","MIN001","MIS001","MIF052","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350004-01","Standard Gold On Exchange Plan","80.95%","0.824733197689056","Yes","Yes","No","100%",,"$150","$500","$1,100","$150","$150","$180","$890","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","20%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-gold-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/premier-ppo.html","29"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350004","Blue Cross® Premier Gold","15560MI035","7538162760","MIN001","MIS001","MIF052","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-gold-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-gold-na-less-than-300-sbc.pdf","30"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","1","15560","MI","Individual","No","38-2069753","15560MI0350004","Blue Cross® Premier Gold","15560MI035","7538162760","MIN001","MIS001","MIF052","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350004-03","Limited Cost Sharing Plan Variation","80.95%","0.824733197689056","Yes","Yes","No","100%",,"$150","$500","$1,100","$150","$150","$180","$890","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$10200 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","20%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-gold-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-gold-na-more-than-300-sbc.pdf","31"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","Individual","No","38-2069753","15560MI0860001","Blue Cross® Premier Bronze with Primary Care Visits","15560MI086","7538162760","MIN001","MIS001","MIF051","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0860001-00","Standard Bronze Off Exchange Plan","61.96%","0.592346847057343","Yes","Yes","No","100%",,"$6,170","$0","$0","$150","$4,535","$150","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","0%",,,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-bronze-primary-care-visits-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/premier-ppo-primary-care-visits.html","4"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","Individual","Yes","38-2069753","15560MI0740001","Blue Dental PPO Pediatric","15560MI074","7538162760","MIN003","MIS004",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$18.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","http://www.bcbsm.com/index/plans/dental-insurance-michigan/ppo-pediatric.html","","15560MI0740001-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/ppo-pediatric.html","4"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0420001","Blue Dental PPO Plus 100/80/50 SG","15560MI042","7538162760","MIN003","MIS004",,"Existing","PPO","High",,"Off the Exchange",,,,"$1,500 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"$26.12","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0420001-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-plus-100-80-50-1500-sg.pdf","4"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","3","15560","MI","Individual","No","38-2069753","15560MI0870002","Blue Cross® Premier Platinum with Dental and Vision","15560MI087","7538162760","MIN001","MIS001","MIF054","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.945",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0870002-03","Limited Cost Sharing Plan Variation","88.31%","0.884345829486847","Yes","Yes","No","100%",,"$0","$0","$620","$150","$0","$0","$530","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-platinum-dental-vision-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-platinum-dental-vision-na-more-than-300-sbc.pdf","7"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","4","15560","MI","Individual","No","38-2069753","15560MI0890001","Blue Cross® Metro Detroit EPO Bronze","15560MI089","7538162760","MIN002","MIS002","MIF051","Existing","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0890001-00","Standard Bronze Off Exchange Plan","61.89%","0.605813801288605","Yes","Yes","No","100%",,"$5,670","$500","$0","$150","$5,260","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/metro-detroit-epo.html","4"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","4","15560","MI","SHOP (Small Group)","No","38-2069753","15560MI0370015","Simply Blue Gold $1500","15560MI037",,"MIN001","MIS001","MIF007","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pain Management","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage provided through BlueCard Worldwide program","Yes","Out of service area coverage provided through BlueCard PPO program","Yes","http://www.bcbsm.com/employers/help/faqs/choosing-coverage/employer-enrollment.html","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0370015-00","Standard Gold Off Exchange Plan","80.14%","0.755629062652588","No","Yes","No","100%",,"$1,500","$20","$730","$150","$1,500","$680","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2016-employer/sbc/simply-blue-gold-370015.pdf","http://www.bcbsm.com/employers/products-services/health-insurance-plans.html","6"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","4","15560","MI","SHOP (Small Group)","No","38-2069753","15560MI0370015","Simply Blue Gold $1500","15560MI037",,"MIN001","MIS001","MIF007","Existing","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pain Management","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage provided through BlueCard Worldwide program","Yes","Out of service area coverage provided through BlueCard PPO program","Yes","http://www.bcbsm.com/employers/help/faqs/choosing-coverage/employer-enrollment.html","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0370015-01","Standard Gold On Exchange Plan","80.14%","0.755629062652588","No","Yes","No","100%",,"$1,500","$20","$730","$150","$1,500","$680","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$13200 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2016-employer/sbc/simply-blue-gold-370015.pdf","http://www.bcbsm.com/employers/products-services/health-insurance-plans.html","7"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","4","15560","MI","Individual","No","38-2069753","15560MI0890001","Blue Cross® Metro Detroit EPO Bronze","15560MI089","7538162760","MIN002","MIS002","MIF051","Existing","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0890001-03","Limited Cost Sharing Plan Variation","61.89%","0.605813801288605","Yes","Yes","No","100%",,"$5,670","$500","$0","$150","$5,260","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-bronze-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-bronze-na-more-than-300-sbc.pdf","7"
"2016","MI","27093","SERFF","3","2015-08-22 23:36:24","1","27093","MI","SHOP (Small Group)","Yes","44-0308260","27093MI0010007","KCL Fam Low MAC","27093MI001",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$33.28","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010007-00","Standard Low Off Exchange Plan","69.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","MI","27093","SERFF","3","2015-08-22 23:36:24","2","27093","MI","SHOP (Small Group)","Yes","44-0308260","27093MI0010002","KCL EHB High PPO","27093MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$55.39","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010002-00","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","2","29241","MI","Individual","No","20-1529553","29241MI0270068","MyPriority PPO HSA Silver 1500","29241MI027",,"MIN002","MIS001","MIF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29241MI0270068-00","Standard Silver Off Exchange Plan",,"0.710802912712097","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$20400 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30%",,,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/ACD7BB2C64474B6D9AA4CBDB41CEE45B.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA&utm_campaign=2016OEP","8"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","2","29241","MI","Individual","No","20-1529553","29241MI0270068","MyPriority PPO HSA Silver 1500","29241MI027",,"MIN002","MIS001","MIF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29241MI0270068-01","Standard Silver On Exchange Plan",,"0.710802912712097","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$20400 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30%",,,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/ACD7BB2C64474B6D9AA4CBDB41CEE45B.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA&utm_campaign=2016OEP","9"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","2","29241","MI","Individual","No","20-1529553","29241MI0270068","MyPriority PPO HSA Silver 1500","29241MI027",,"MIN002","MIS001","MIF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29241MI0270068-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/F2C364ED04B6410AA4F7377B17AD09C0.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA&utm_campaign=2016OEP","10"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","Individual","Yes","38-2069753","15560MI0740001","Blue Dental PPO Pediatric","15560MI074","7538162760","MIN003","MIS004",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$18.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes","http://www.bcbsm.com/index/plans/dental-insurance-michigan/ppo-pediatric.html","","15560MI0740001-01","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsm.com/index/plans/dental-insurance-michigan/ppo-pediatric.html","5"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0420002","Blue Dental PPO Plus 100/80/50 SG","15560MI042","7538162760","MIN003","MIS004",,"Existing","PPO","High",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"$26.12","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0420002-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-plus-100-80-50-1000-sg.pdf","5"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","Individual","No","38-2069753","15560MI0860001","Blue Cross® Premier Bronze with Primary Care Visits","15560MI086","7538162760","MIN001","MIS001","MIF051","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0860001-01","Standard Bronze On Exchange Plan","61.96%","0.592346847057343","Yes","Yes","No","100%",,"$6,170","$0","$0","$150","$4,535","$150","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","0%",,,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-bronze-primary-care-visits-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/premier-ppo-primary-care-visits.html","5"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","Individual","No","38-2069753","15560MI0860001","Blue Cross® Premier Bronze with Primary Care Visits","15560MI086","7538162760","MIN001","MIS001","MIF051","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0860001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-bronze-primary-care-visits-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-bronze-primary-care-visits-na-less-than-300-sbc.pdf","6"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0420005","Blue Dental  PPO Plus 80/50/50 SG","15560MI042","7538162760","MIN003","MIS004",,"Existing","PPO","Low",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"$19.85","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0420005-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-plus-80-50-50-sg.pdf","6"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0440001","Blue Dental PPO 100/80/50 (80/50/50) SG","15560MI044","7538162760","MIN003","MIS004",,"Existing","PPO","High",,"Off the Exchange",,,,"$1,250 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"$21.64","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0440001-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-10-80-50-1250-sg.pdf","7"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","Individual","No","38-2069753","15560MI0860001","Blue Cross® Premier Bronze with Primary Care Visits","15560MI086","7538162760","MIN001","MIS001","MIF051","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0860001-03","Limited Cost Sharing Plan Variation","61.96%","0.592346847057343","Yes","Yes","No","100%",,"$6,170","$0","$0","$150","$4,535","$150","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group","0%",,,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-bronze-primary-care-visits-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-bronze-primary-care-visits-na-more-than-300-sbc.pdf","7"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","Individual","No","38-2069753","15560MI0860002","Blue Cross® Premier Silver Extra","15560MI086","7538162760","MIN001","MIS001","MIF053","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0860002-00","Standard Silver Off Exchange Plan","71.96%","0.683212757110596","Yes","Yes","No","100%",,"$2,300","$0","$740","$150","$2,300","$300","$520","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"$11,600","$11600 per person","$23200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20%",,,,,"$4,600","$4600 per person","$9200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/premier-ppo-extra.html","8"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0440002","Blue Dental PPO 100/80/50 (50/50/50) SG","15560MI044","7538162760","MIN003","MIS004",,"Existing","PPO","High",,"Off the Exchange",,,,"$1,500 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"$19.72","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0440002-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-100-80-50-1500-sg.pdf","8"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0440003","Blue Dental PPO 100/80/50 (50/50/50) SG","15560MI044","7538162760","MIN003","MIS004",,"Existing","PPO","High",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"$19.72","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0440003-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-100-80-50-1000-sg.pdf","9"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","Individual","No","38-2069753","15560MI0860002","Blue Cross® Premier Silver Extra","15560MI086","7538162760","MIN001","MIS001","MIF053","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0860002-01","Standard Silver On Exchange Plan","71.96%","0.683212757110596","Yes","Yes","No","100%",,"$2,300","$0","$740","$150","$2,300","$300","$520","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"$11,600","$11600 per person","$23200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20%",,,,,"$4,600","$4600 per person","$9200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/premier-ppo-extra.html","9"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","Individual","No","38-2069753","15560MI0860002","Blue Cross® Premier Silver Extra","15560MI086","7538162760","MIN001","MIS001","MIF053","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0860002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-extra-na-less-than-300-sbc.pdf","10"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0440004","Blue Dental PPO 80/50/50 (50/50/50) SG","15560MI044","7538162760","MIN003","MIS004",,"Existing","PPO","Low",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"$16.84","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0440004-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-80-50-50-1000-sg.pdf","10"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0440005","Blue Dental PPO 80/50/50 (50/50/50) SG","15560MI044","7538162760","MIN003","MIS004",,"Existing","PPO","Low",,"Off the Exchange",,,,"$800 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"$16.84","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0440005-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-80-50-50-800-sg.pdf","11"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","Individual","No","38-2069753","15560MI0860002","Blue Cross® Premier Silver Extra","15560MI086","7538162760","MIN001","MIS001","MIF053","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0860002-03","Limited Cost Sharing Plan Variation","71.96%","0.683212757110596","Yes","Yes","No","100%",,"$2,300","$0","$740","$150","$2,300","$300","$520","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"$11,600","$11600 per person","$23200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20%",,,,,"$4,600","$4600 per person","$9200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-extra-na-more-than-300-sbc.pdf","11"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","Individual","No","38-2069753","15560MI0860002","Blue Cross® Premier Silver Extra","15560MI086","7538162760","MIN001","MIS001","MIF053","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0860002-04","73% AV Level Silver Plan","73.99%","0.709722518920898","Yes","Yes","No","100%",,"$1,850","$0","$830","$150","$1,850","$300","$610","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20%",,,,,"$3,700","$3700 per person","$7400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-extra-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/premier-ppo-extra.html?costshare=73","12"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0460001","Blue Dental EPO 100/80/50 SG","15560MI046","7538162760","MIN003","MIS003",,"Existing","EPO","High",,"Off the Exchange",,,,"$1,250 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,"No","Allows Adult and Child-Only",,,,,"$19.02","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","No",,"Yes",,"","15560MI0460001-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-epo-100-80-50-1250-sg.pdf","12"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","Individual","No","38-2069753","15560MI0860002","Blue Cross® Premier Silver Extra","15560MI086","7538162760","MIN001","MIS001","MIF053","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0860002-05","87% AV Level Silver Plan","87.27%","0.868770360946655","Yes","Yes","No","100%",,"$500","$0","$550","$150","$500","$300","$440","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$3,400","$3400 per person","$6800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-extra-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/premier-ppo-extra.html?costshare=87","13"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","Individual","No","38-2069753","15560MI0860002","Blue Cross® Premier Silver Extra","15560MI086","7538162760","MIN001","MIS001","MIF053","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0860002-06","94% AV Level Silver Plan","94.78%","0.948713839054108","Yes","Yes","No","100%",,"$150","$0","$590","$150","$150","$300","$50","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","10%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-silver-extra-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/premier-ppo-extra.html?costshare=94","14"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","Individual","No","38-2069753","15560MI0860003","Blue Cross® Premier Gold Extra","15560MI086","7538162760","MIN001","MIS001","MIF053","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0860003-00","Standard Gold Off Exchange Plan","81.75%","0.808060348033905","Yes","Yes","No","100%",,"$750","$0","$1,050","$150","$750","$300","$830","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-gold-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/premier-ppo-extra.html","15"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","Individual","No","38-2069753","15560MI0860003","Blue Cross® Premier Gold Extra","15560MI086","7538162760","MIN001","MIS001","MIF053","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0860003-01","Standard Gold On Exchange Plan","81.75%","0.808060348033905","Yes","Yes","No","100%",,"$750","$0","$1,050","$150","$750","$300","$830","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-gold-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/premier-ppo-extra.html","16"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","Individual","No","38-2069753","15560MI0860003","Blue Cross® Premier Gold Extra","15560MI086","7538162760","MIN001","MIS001","MIF053","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0860003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-gold-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-gold-extra-na-less-than-300-sbc.pdf","17"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","2","15560","MI","Individual","No","38-2069753","15560MI0860003","Blue Cross® Premier Gold Extra","15560MI086","7538162760","MIN001","MIS001","MIF053","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0860003-03","Limited Cost Sharing Plan Variation","81.75%","0.808060348033905","Yes","Yes","No","100%",,"$750","$0","$1,050","$150","$750","$300","$830","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-gold-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-gold-extra-na-more-than-300-sbc.pdf","18"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","3","15560","MI","Individual","No","38-2069753","15560MI0870002","Blue Cross® Premier Platinum with Dental and Vision","15560MI087","7538162760","MIN001","MIS001","MIF054","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.945",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0870002-00","Standard Platinum Off Exchange Plan","88.31%","0.884345829486847","Yes","Yes","No","100%",,"$0","$0","$620","$150","$0","$0","$530","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-platinum-dental-vision-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/platinum/premier-ppo.html","4"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","3","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0480002","Blue Dental PPO Plus 80/50/50 Pediatric SG","15560MI048","7538162760","MIN003","MIS004",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.78","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0480002-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-plus-80-50-50-pediatric-sg.pdf","4"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","3","15560","MI","Individual","No","38-2069753","15560MI0870002","Blue Cross® Premier Platinum with Dental and Vision","15560MI087","7538162760","MIN001","MIS001","MIF054","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.945",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0870002-01","Standard Platinum On Exchange Plan","88.31%","0.884345829486847","Yes","Yes","No","100%",,"$0","$0","$620","$150","$0","$0","$530","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-platinum-dental-vision-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/platinum/premier-ppo.html","5"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","3","15560","MI","Individual","No","38-2069753","15560MI0870002","Blue Cross® Premier Platinum with Dental and Vision","15560MI087","7538162760","MIN001","MIS001","MIF054","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.945",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All covered benefits","Yes","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0870002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-platinum-dental-vision-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/premier-platinum-dental-vision-na-less-than-300-sbc.pdf","6"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","4","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0650001","Blue Dental PPO Plus 100/80/50/50 Voluntary SG","15560MI065","7538162760","MIN003","MIS004",,"Existing","PPO","High",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"$30.20","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0650001-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-plus-100-80-50-50-1000-v-sg.pdf","4"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","4","15560","MI","Individual","No","38-2069753","15560MI0890001","Blue Cross® Metro Detroit EPO Bronze","15560MI089","7538162760","MIN002","MIS002","MIF051","Existing","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0890001-01","Standard Bronze On Exchange Plan","61.89%","0.605813801288605","Yes","Yes","No","100%",,"$5,670","$500","$0","$150","$5,260","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/metro-detroit-epo.html","5"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","4","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0650002","Blue Dental PPO Plus 80/50/50/50 Voluntary SG","15560MI065","7538162760","MIN003","MIS004",,"Existing","PPO","Low",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"$23.03","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0650002-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-plus-80-50-50-50-1000-v-sg.pdf","5"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","4","15560","MI","Individual","No","38-2069753","15560MI0890001","Blue Cross® Metro Detroit EPO Bronze","15560MI089","7538162760","MIN002","MIS002","MIF051","Existing","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0890001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-bronze-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-bronze-na-less-than-300-sbc.pdf","6"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","4","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0670001","Blue Dental PPO 100/80/50/50 (80/50/50/50) Voluntary SG","15560MI067","7538162760","MIN003","MIS004",,"Existing","PPO","High",,"Off the Exchange",,,,"$1,250 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.  $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"$25.07","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0670001-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-100-80-50-50-1250-v-sg.pdf","6"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","4","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0670002","Blue Dental PPO 100/80/50/50 (80/50/50/50) Voluntary SG","15560MI067","7538162760","MIN003","MIS004",,"Existing","PPO","High",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.  $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"$25.07","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0670002-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-100-80-50-50-1000-v-sg.pdf","7"
"2016","MI","27093","SERFF","3","2015-08-22 23:36:24","2","27093","MI","SHOP (Small Group)","Yes","44-0308260","27093MI0010004","KCL EHB High MAC","27093MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$42.80","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010004-00","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MI","27093","SERFF","3","2015-08-22 23:36:24","2","27093","MI","SHOP (Small Group)","Yes","44-0308260","27093MI0010006","KCL Fam High PPO","27093MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$55.39","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010006-00","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","MI","27093","SERFF","3","2015-08-22 23:36:24","2","27093","MI","SHOP (Small Group)","Yes","44-0308260","27093MI0010008","KCL Fam High MAC","27093MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$42.80","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010008-00","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270061","MyPriority PPO RxPlus Silver 1900","29241MI027",,"MIN002","MIS001","MIF003","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29241MI0270065","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270061-00","Standard Silver Off Exchange Plan","70.36%","0.709612250328064","No","Yes","No","100%",,"$1,900","$10","$980","$150","$1,900","$250","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","$1,900","$3800 per person","$3800 per group","30%",,,,,"$3,800","$7600 per person","$7600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$1000 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.priorityhealth.com/~/media/6088ADCFACCA4FF38A0DF0CADC8BBA41.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","4"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","4","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0670003","Blue Dental PPO 80/50/50/50 (50/50/50/50)  Voluntary SG","15560MI067","7538162760","MIN003","MIS004",,"Existing","PPO","Low",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.  $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"$19.60","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0670003-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-80-50-50-50-1000-v-sg.pdf","8"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","4","15560","MI","Individual","No","38-2069753","15560MI0890002","Blue Cross® Metro Detroit EPO Silver","15560MI089","7538162760","MIN002","MIS002","MIF052","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0890002-00","Standard Silver Off Exchange Plan","71.80%","0.728568077087402","Yes","Yes","No","100%",,"$1,400","$500","$850","$150","$1,400","$90","$725","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-epo.html","8"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","4","15560","MI","Individual","No","38-2069753","15560MI0890002","Blue Cross® Metro Detroit EPO Silver","15560MI089","7538162760","MIN002","MIS002","MIF052","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0890002-01","Standard Silver On Exchange Plan","71.80%","0.728568077087402","Yes","Yes","No","100%",,"$1,400","$500","$850","$150","$1,400","$90","$725","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-epo.html","9"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","4","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0690001","Blue Dental EPO 100/80/50/50 Voluntary SG","15560MI069","7538162760","MIN003","MIS003",,"Existing","EPO","High",,"Off the Exchange",,,,"$1,250 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists. $1,250 lifetime orthodontic benefit maximum for members up to age 19.",,"No","Allows Adult and Child-Only",,,,,"$22.08","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","No",,"Yes",,"","15560MI0690001-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-epo-100-80-50-50-1250-v-sg.pdf","9"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","4","15560","MI","Individual","No","38-2069753","15560MI0890002","Blue Cross® Metro Detroit EPO Silver","15560MI089","7538162760","MIN002","MIS002","MIF052","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0890002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-silver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-silver-na-less-than-300-sbc.pdf","10"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","4","15560","MI","Individual","No","38-2069753","15560MI0890002","Blue Cross® Metro Detroit EPO Silver","15560MI089","7538162760","MIN002","MIS002","MIF052","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0890002-03","Limited Cost Sharing Plan Variation","71.80%","0.728568077087402","Yes","Yes","No","100%",,"$1,400","$500","$850","$150","$1,400","$90","$725","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-silver-na-more-than-300.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-silver-na-more-than-300.pdf","11"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","4","15560","MI","Individual","No","38-2069753","15560MI0890002","Blue Cross® Metro Detroit EPO Silver","15560MI089","7538162760","MIN002","MIS002","MIF052","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0890002-04","73% AV Level Silver Plan","73.80%","0.748178541660309","Yes","Yes","No","100%",,"$1,150","$500","$870","$150","$1,150","$150","$780","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-silver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-epo.html?costshare=73","12"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","4","15560","MI","Individual","No","38-2069753","15560MI0890002","Blue Cross® Metro Detroit EPO Silver","15560MI089","7538162760","MIN002","MIS002","MIF052","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0890002-05","87% AV Level Silver Plan","86.32%","0.869654595851898","Yes","Yes","No","100%",,"$500","$500","$500","$150","$500","$180","$450","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-silver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-epo.html?costshare=87","13"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","4","15560","MI","Individual","No","38-2069753","15560MI0890002","Blue Cross® Metro Detroit EPO Silver","15560MI089","7538162760","MIN002","MIS002","MIF052","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0890002-06","94% AV Level Silver Plan","94.52%","0.947920799255371","Yes","Yes","No","100%",,"$175","$0","$325","$150","$175","$180","$145","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-silver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-epo.html?costshare=94","14"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","5","15560","MI","Individual","No","38-2069753","15560MI0900002","Blue Cross® Metro Detroit EPO Silver Extra","15560MI090","7538162760","MIN002","MIS002","MIF053","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0900002-00","Standard Silver Off Exchange Plan","71.96%","0.683212757110596","Yes","Yes","No","100%",,"$2,300","$0","$740","$150","$2,300","$300","$520","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-epo-extra.html","4"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","5","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0490001","Blue Dental PPO Plus 100/80/50 Voluntary SG","15560MI049","7538162760","MIN003","MIS004",,"Existing","PPO","High",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"$30.20","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0490001-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-plus-100-80-50-1000-v-sg.pdf","4"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","5","15560","MI","Individual","No","38-2069753","15560MI0900002","Blue Cross® Metro Detroit EPO Silver Extra","15560MI090","7538162760","MIN002","MIS002","MIF053","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0900002-01","Standard Silver On Exchange Plan","71.96%","0.683212757110596","Yes","Yes","No","100%",,"$2,300","$0","$740","$150","$2,300","$300","$520","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-epo-extra.html","5"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","5","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0490002","Blue Dental PPO Plus 80/50/50 Voluntary SG","15560MI049","7538162760","MIN003","MIS004",,"Existing","PPO","Low",,"Both",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"$23.03","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0490002-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-plus-80-50-50-1000-v-sg.pdf","5"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","5","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0490002","Blue Dental PPO Plus 80/50/50 Voluntary SG","15560MI049","7538162760","MIN003","MIS004",,"Existing","PPO","Low",,"Both",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,"No","Allows Adult and Child-Only",,,,,"$23.03","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0490002-01","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-plus-80-50-50-1000-v-sg.pdf","6"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","5","15560","MI","Individual","No","38-2069753","15560MI0900002","Blue Cross® Metro Detroit EPO Silver Extra","15560MI090","7538162760","MIN002","MIS002","MIF053","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0900002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-silver-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-silver-extra-na-less-than-300-sbc.pdf","6"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","5","15560","MI","Individual","No","38-2069753","15560MI0900002","Blue Cross® Metro Detroit EPO Silver Extra","15560MI090","7538162760","MIN002","MIS002","MIF053","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0900002-03","Limited Cost Sharing Plan Variation","71.96%","0.683212757110596","Yes","Yes","No","100%",,"$2,300","$0","$740","$150","$2,300","$300","$520","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-silver-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-silver-extra-na-more-than-300-sbc.pdf","7"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","5","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0660001","Blue Dental PPO 100/80/50 (80/50/50) Voluntary SG","15560MI066","7538162760","MIN003","MIS004",,"Existing","PPO","High",,"Off the Exchange",,,,"$1,250 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"$25.07","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0660001-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-100-80-50-1250-v-sg.pdf","7"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","5","15560","MI","Individual","No","38-2069753","15560MI0900002","Blue Cross® Metro Detroit EPO Silver Extra","15560MI090","7538162760","MIN002","MIS002","MIF053","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0900002-04","73% AV Level Silver Plan","73.99%","0.709722518920898","Yes","Yes","No","100%",,"$1,850","$0","$830","$150","$1,850","$300","$610","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-silver-extra-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-epo-extra.html?costshare=73","8"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","5","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0660002","Blue Dental PPO 100/80/50 (80/50/50) Voluntary SG","15560MI066","7538162760","MIN003","MIS004",,"Existing","PPO","High",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"$25.07","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0660002-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-100-80-50-1000-v-sg.pdf","8"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","5","15560","MI","Individual","No","38-2069753","15560MI0900002","Blue Cross® Metro Detroit EPO Silver Extra","15560MI090","7538162760","MIN002","MIS002","MIF053","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0900002-05","87% AV Level Silver Plan","87.27%","0.868770360946655","Yes","Yes","No","100%",,"$500","$0","$550","$150","$500","$300","$440","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-silver-extra-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-epo-extra.html?costshare=87","9"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","5","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0660003","Blue Dental PPO 80/50/50 (50/50/50) Voluntary SG","15560MI066","7538162760","MIN003","MIS004",,"Existing","PPO","Low",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,"No","Allows Adult and Child-Only",,,,,"$19.60","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay.","Yes",,"","15560MI0660003-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-ppo-80-50-50-1000-v-sg.pdf","9"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","5","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0680001","Blue Dental EPO 100/80/50 Voluntary SG","15560MI068","7538162760","MIN003","MIS003",,"Existing","EPO","High",,"Off the Exchange",,,,"$1,250 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,"No","Allows Adult and Child-Only",,,,,"$22.08","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency","No",,"Yes",,"","15560MI0680001-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://bcbsm.com/content/dam/public/marketplace/2016-employer/brochures/blue-dental-epo-100-80-50-1250-v-sg.pdf","10"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","5","15560","MI","Individual","No","38-2069753","15560MI0900002","Blue Cross® Metro Detroit EPO Silver Extra","15560MI090","7538162760","MIN002","MIS002","MIF053","Existing","EPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0900002-06","94% AV Level Silver Plan","94.78%","0.948713839054108","Yes","Yes","No","100%",,"$150","$0","$590","$150","$150","$300","$50","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","$300 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-silver-extra-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-epo-extra.html?costshare=94","10"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","5","15560","MI","Individual","No","38-2069753","15560MI0900003","Blue Cross® Metro Detroit EPO Gold Extra","15560MI090","7538162760","MIN002","MIS002","MIF053","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0900003-00","Standard Gold Off Exchange Plan","81.75%","0.808060348033905","Yes","Yes","No","100%",,"$750","$0","$1,050","$150","$750","$300","$830","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-gold-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/metro-detroit-epo-extra.html","11"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","5","15560","MI","Individual","No","38-2069753","15560MI0900003","Blue Cross® Metro Detroit EPO Gold Extra","15560MI090","7538162760","MIN002","MIS002","MIF053","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0900003-01","Standard Gold On Exchange Plan","81.75%","0.808060348033905","Yes","Yes","No","100%",,"$750","$0","$1,050","$150","$750","$300","$830","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-gold-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/metro-detroit-epo-extra.html","12"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","5","15560","MI","Individual","No","38-2069753","15560MI0900003","Blue Cross® Metro Detroit EPO Gold Extra","15560MI090","7538162760","MIN002","MIS002","MIF053","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0900003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-gold-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-gold-extra-na-less-than-300-sbc.pdf","13"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","5","15560","MI","Individual","No","38-2069753","15560MI0900003","Blue Cross® Metro Detroit EPO Gold Extra","15560MI090","7538162760","MIN002","MIS002","MIF053","Existing","EPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency only","Yes","Emergency only","No","https://paymentgateway.bcbsm.com/gateway/cmsinbound.do","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0900003-03","Limited Cost Sharing Plan Variation","81.75%","0.808060348033905","Yes","Yes","No","100%",,"$750","$0","$1,050","$150","$750","$300","$830","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-gold-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-epo-gold-extra-na-more-than-300-sbc.pdf","14"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","10","15560","MI","SHOP (Small Group)","No","38-2069753","15560MI0390003","Simply Blue HSA Silver $2700 ($0)","15560MI039",,"MIN001","MIS001","MIF019","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pain Management","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage provided through BlueCard Worldwide program","Yes","Out of service area coverage provided through BlueCard PPO program","Yes","http://www.bcbsm.com/employers/help/faqs/choosing-coverage/employer-enrollment.html","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0390003-00","Standard Silver Off Exchange Plan","68.45%","0.682496964931488","Yes","Yes","No","100%",,"$2,700","$20","$490","$150","$2,700","$350","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2016-employer/sbc/simply-blue-hsa-silver-390003.pdf","http://www.bcbsm.com/employers/products-services/health-insurance-plans.html","7"
"2016","MI","15560","SERFF","10","2016-01-28 08:29:40","10","15560","MI","SHOP (Small Group)","No","38-2069753","15560MI0390003","Simply Blue HSA Silver $2700 ($0)","15560MI039",,"MIN001","MIS001","MIF019","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pain Management","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage provided through BlueCard Worldwide program","Yes","Out of service area coverage provided through BlueCard PPO program","Yes","http://www.bcbsm.com/employers/help/faqs/choosing-coverage/employer-enrollment.html","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0390003-01","Standard Silver On Exchange Plan","68.45%","0.682496964931488","Yes","Yes","No","100%",,"$2,700","$20","$490","$150","$2,700","$350","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2016-employer/sbc/simply-blue-hsa-silver-390003.pdf","http://www.bcbsm.com/employers/products-services/health-insurance-plans.html","8"
"2016","MI","26380","SERFF","4","2015-08-22 23:36:24","1","26380","MI","SHOP (Small Group)","Yes","57-0523959","26380MI0020001","Group Dental Policy","26380MI002",,"MIN001","MIS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.60","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","26380MI0020001-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MI","27093","SERFF","3","2015-08-22 23:36:24","1","27093","MI","SHOP (Small Group)","Yes","44-0308260","27093MI0010001","KCL EHB Low PPO","27093MI001",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$44.64","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010001-00","Standard Low Off Exchange Plan","69.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MI","27093","SERFF","3","2015-08-22 23:36:24","1","27093","MI","SHOP (Small Group)","Yes","44-0308260","27093MI0010003","KCL EHB Low MAC","27093MI001",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$33.28","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010003-00","Standard Low Off Exchange Plan","69.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MI","27093","SERFF","3","2015-08-22 23:36:24","1","27093","MI","SHOP (Small Group)","Yes","44-0308260","27093MI0010005","KCL Fam Low PPO","27093MI001",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$44.64","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","27093MI0010005-00","Standard Low Off Exchange Plan","69.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270061","MyPriority PPO RxPlus Silver 1900","29241MI027",,"MIN002","MIS001","MIF003","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29241MI0270065","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270061-01","Standard Silver On Exchange Plan","70.36%","0.709612250328064","No","Yes","No","100%",,"$1,900","$10","$980","$150","$1,900","$250","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","$1,900","$3800 per person","$3800 per group","30%",,,,,"$3,800","$7600 per person","$7600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$1000 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.priorityhealth.com/~/media/6088ADCFACCA4FF38A0DF0CADC8BBA41.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","5"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270061","MyPriority PPO RxPlus Silver 1900","29241MI027",,"MIN002","MIS001","MIF003","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29241MI0270065","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270061-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.priorityhealth.com/~/media/89B3EC76D43C47689612679F9A3F56EE.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","6"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270061","MyPriority PPO RxPlus Silver 1900","29241MI027",,"MIN002","MIS001","MIF003","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29241MI0270065","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270061-03","Limited Cost Sharing Plan Variation","70.36%","0.709612250328064","No","Yes","No","100%",,"$1,900","$10","$980","$150","$1,900","$250","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable","$1,900","$3800 per person","$3800 per group","30%",,,,,"$3,800","$7600 per person","$7600 per group","Not Applicable","per person not applicable","per group not applicable","$500","$1000 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.priorityhealth.com/~/media/9DD98B665A8C42959B0EE82D3105A844.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","7"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270061","MyPriority PPO RxPlus Silver 1900","29241MI027",,"MIN002","MIS001","MIF003","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29241MI0270065","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270061-04","73% AV Level Silver Plan","73.73%","0.742594361305237","No","Yes","No","100%",,"$1,400","$10","$1,130","$150","$1,400","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$10,400","$20800 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$2800 per person","$2800 per group","30%",,,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","$250","$500 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.priorityhealth.com/~/media/308FDF8271DB42A7AF2B08229D463ED5.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","8"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270061","MyPriority PPO RxPlus Silver 1900","29241MI027",,"MIN002","MIS001","MIF003","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29241MI0270065","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270061-05","87% AV Level Silver Plan","87.81%","0.883365213871002","No","Yes","No","100%",,"$200","$10","$1,490","$150","$200","$400","$580","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$3,400","$6800 per person","$6800 per group","Not Applicable","per person not applicable","per group not applicable","$125","$250 per person","$250 per group","30%",,,,,"$250","$500 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable","$125","$250 per person","$250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.priorityhealth.com/~/media/89D9D586B39748698EB47F6649199B4C.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","9"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270061","MyPriority PPO RxPlus Silver 1900","29241MI027",,"MIN002","MIS001","MIF003","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29241MI0270065","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270061-06","94% AV Level Silver Plan","94.31%","0.945334017276764","No","Yes","No","100%",,"$100","$0","$400","$150","$100","$190","$2,250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$2000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","30%",,,,,"$200","$400 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.priorityhealth.com/~/media/B6CEA725928B4A6297E1CDB89E234A76.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","10"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270070","MyPriority PPO RxPlus Gold 200","29241MI027",,"MIN002","MIS001","MIF003","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270070-00","Standard Gold Off Exchange Plan","81.90%","0.822476387023926","Yes","Yes","No","100%",,"$200","$10","$990","$150","$200","$400","$560","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"$400","$800 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/3186241BDF4A4834878FF05EE56ADD67.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","11"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270070","MyPriority PPO RxPlus Gold 200","29241MI027",,"MIN002","MIS001","MIF003","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270070-01","Standard Gold On Exchange Plan","81.90%","0.822476387023926","Yes","Yes","No","100%",,"$200","$10","$990","$150","$200","$400","$560","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"$400","$800 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/3186241BDF4A4834878FF05EE56ADD67.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","12"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270070","MyPriority PPO RxPlus Gold 200","29241MI027",,"MIN002","MIS001","MIF003","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270070-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/09A9C4008D664127AD5A25F50A21E135.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","13"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270070","MyPriority PPO RxPlus Gold 200","29241MI027",,"MIN002","MIS001","MIF003","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270070-03","Limited Cost Sharing Plan Variation","81.90%","0.822476387023926","Yes","Yes","No","100%",,"$200","$10","$990","$150","$200","$400","$560","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"$400","$800 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/49A111C7C0254DDB96A404BEA5B6AAAF.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","14"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270065","MyPriority PPO RxPlus Silver 1800","29241MI027",,"MIN002","MIS001","MIF003","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270065-00","Standard Silver Off Exchange Plan","70.69%","0.710850715637207","Yes","Yes","No","100%",,"$1,800","$10","$1,010","$150","$1,800","$260","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30%",,,,,"$3,600","$7200 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/3C4D68A4417C41109608D6C1229177A7.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","15"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270065","MyPriority PPO RxPlus Silver 1800","29241MI027",,"MIN002","MIS001","MIF003","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270065-01","Standard Silver On Exchange Plan","70.69%","0.710850715637207","Yes","Yes","No","100%",,"$1,800","$10","$1,010","$150","$1,800","$260","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30%",,,,,"$3,600","$7200 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/3C4D68A4417C41109608D6C1229177A7.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","16"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270065","MyPriority PPO RxPlus Silver 1800","29241MI027",,"MIN002","MIS001","MIF003","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270065-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/D9CA53D5E9894DDAA1DB40E5A466E1A3.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","17"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270065","MyPriority PPO RxPlus Silver 1800","29241MI027",,"MIN002","MIS001","MIF003","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270065-03","Limited Cost Sharing Plan Variation","70.69%","0.710850715637207","Yes","Yes","No","100%",,"$1,800","$10","$1,010","$150","$1,800","$260","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30%",,,,,"$3,600","$7200 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/F7A7B64AF0E04B238EE28935B03BE89C.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","18"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270065","MyPriority PPO RxPlus Silver 1800","29241MI027",,"MIN002","MIS001","MIF003","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270065-04","73% AV Level Silver Plan","73.93%","0.743373513221741","Yes","Yes","No","100%",,"$1,300","$10","$1,160","$150","$1,300","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$10,800","$21600 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$2600 per person","$2600 per group","30%",,,,,"$2,600","$5200 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/4FF0281043FC4035A79D2D2C17DD9491.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","19"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270065","MyPriority PPO RxPlus Silver 1800","29241MI027",,"MIN002","MIS001","MIF003","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270065-05","87% AV Level Silver Plan","87.86%","0.880910098552704","Yes","Yes","No","100%",,"$50","$10","$1,540","$150","$50","$400","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$3,200","$6400 per person","$6400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30%",,,,,"$100","$200 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/C21A344A53A647899A896AA77312C358.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","20"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270065","MyPriority PPO RxPlus Silver 1800","29241MI027",,"MIN002","MIS001","MIF003","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270065-06","94% AV Level Silver Plan","94.51%","0.946319401264191","Yes","Yes","No","100%",,"$25","$0","$480","$150","$25","$190","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$2000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30%",,,,,"$50","$100 per person","$100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/12B543616D1F4444815707CB05C01605.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","21"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270072","MyPriority PPO RxPlus Silver 1400","29241MI027",,"MIN002","MIS001","MIF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270072-00","Standard Silver Off Exchange Plan","71.83%","0.722587764263153","Yes","Yes","No","100%",,"$1,400","$10","$1,130","$150","$1,400","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","30%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/E2BB5EBE977A48A3AB87610BEEF9D6D3.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","22"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270072","MyPriority PPO RxPlus Silver 1400","29241MI027",,"MIN002","MIS001","MIF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270072-01","Standard Silver On Exchange Plan","71.83%","0.722587764263153","Yes","Yes","No","100%",,"$1,400","$10","$1,130","$150","$1,400","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","30%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/E2BB5EBE977A48A3AB87610BEEF9D6D3.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","23"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270072","MyPriority PPO RxPlus Silver 1400","29241MI027",,"MIN002","MIS001","MIF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270072-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/26B80D283F0A421090F8C7CE498F1CD1.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","24"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270072","MyPriority PPO RxPlus Silver 1400","29241MI027",,"MIN002","MIS001","MIF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270072-03","Limited Cost Sharing Plan Variation","71.83%","0.722587764263153","Yes","Yes","No","100%",,"$1,400","$10","$1,130","$150","$1,400","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","30%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/B36F3F65A750492B94318029A897AD46.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","25"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270072","MyPriority PPO RxPlus Silver 1400","29241MI027",,"MIN002","MIS001","MIF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270072-04","73% AV Level Silver Plan","73.93%","0.743373513221741","Yes","Yes","No","100%",,"$1,300","$10","$1,160","$150","$1,300","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","30%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/8EDECC25343C4EB0B6F3A050B26A9E13.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","26"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270072","MyPriority PPO RxPlus Silver 1400","29241MI027",,"MIN002","MIS001","MIF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270072-05","87% AV Level Silver Plan","87.86%","0.880910098552704","Yes","Yes","No","100%",,"$50","$10","$1,540","$150","$50","$400","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$3,200","$3200 per person","$6400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","30%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/9379372538D34540B87EAEBCAFA83D7E.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","27"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","1","29241","MI","Individual","No","20-1529553","29241MI0270072","MyPriority PPO RxPlus Silver 1400","29241MI027",,"MIN002","MIS001","MIF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29241MI0270072-06","94% AV Level Silver Plan","94.51%","0.946319401264191","Yes","Yes","No","100%",,"$25","$0","$480","$150","$25","$190","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$50 per group","30%",,,,,"$50","$50 per person","$100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/02B6918A2CE8442C9E2266A1366DBE49.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","28"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","2","29241","MI","Individual","No","20-1529553","29241MI0270073","MyPriority PPO HSA Bronze 6550","29241MI027",,"MIN002","MIS001","MIF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29241MI0270073-00","Standard Bronze Off Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/82C440D9AAC14E0D9E580802CEC426A2.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA&utm_campaign=2016OEP","4"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","2","29241","MI","Individual","No","20-1529553","29241MI0270073","MyPriority PPO HSA Bronze 6550","29241MI027",,"MIN002","MIS001","MIF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29241MI0270073-01","Standard Bronze On Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/82C440D9AAC14E0D9E580802CEC426A2.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA&utm_campaign=2016OEP","5"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","2","29241","MI","Individual","No","20-1529553","29241MI0270073","MyPriority PPO HSA Bronze 6550","29241MI027",,"MIN002","MIS001","MIF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29241MI0270073-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/66D64DC2D8044866BE0DCEC576869025.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA&utm_campaign=2016OEP","6"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","2","29241","MI","Individual","No","20-1529553","29241MI0270073","MyPriority PPO HSA Bronze 6550","29241MI027",,"MIN002","MIS001","MIF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29241MI0270073-03","Limited Cost Sharing Plan Variation",,"0.5993931889534","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/7773A3A6F68E45C1A16EB775494264E8.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA&utm_campaign=2016OEP","7"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","2","29241","MI","Individual","No","20-1529553","29241MI0270068","MyPriority PPO HSA Silver 1500","29241MI027",,"MIN002","MIS001","MIF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29241MI0270068-03","Limited Cost Sharing Plan Variation",,"0.710802912712097","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$20400 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30%",,,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/0923CC9220BE4FBFA1D5CC84DF2F8736.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA&utm_campaign=2016OEP","11"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","2","29241","MI","Individual","No","20-1529553","29241MI0270068","MyPriority PPO HSA Silver 1500","29241MI027",,"MIN002","MIS001","MIF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29241MI0270068-04","73% AV Level Silver Plan",,"0.739672482013702","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$720","$740","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"$9,400","$18800 per person","$18800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$2000 per person","$2000 per group","30%",,,,,"$2,000","$4000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/CE6C158B26654A79A7314B3F3C4D0761.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA&utm_campaign=2016OEP","12"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","2","29241","MI","Individual","No","20-1529553","29241MI0270068","MyPriority PPO HSA Silver 1500","29241MI027",,"MIN002","MIS001","MIF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29241MI0270068-05","87% AV Level Silver Plan",,"0.87782233953476","Yes","Yes","No","100%",,"$500","$0","$900","$150","$500","$360","$540","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30%",,,,,"$100","$200 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/A901F7FAE2534AF985DCFEF7BF99A554.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA&utm_campaign=2016OEP","13"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540005","MyPriority HMO RxPlus Silver 1800","29698MI054",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540005-05","87% AV Level Silver Plan","87.86%","0.880910098552704","Yes","Yes","No","100%",,"$50","$10","$1,540","$150","$50","$400","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/1BA1311A979D47838A7F5A81F477C79E.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","20"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","2","29241","MI","Individual","No","20-1529553","29241MI0270068","MyPriority PPO HSA Silver 1500","29241MI027",,"MIN002","MIS001","MIF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29241MI0270068-06","94% AV Level Silver Plan",,"0.94932746887207","Yes","Yes","No","100%",,"$25","$0","$380","$150","$25","$80","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$800","$1600 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30%",,,,,"$50","$100 per person","$100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/EE289F3222544D288624C2A773CDF9DC.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA&utm_campaign=2016OEP","14"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","2","29241","MI","Individual","No","20-1529553","29241MI0270074","MyPriority PPO HSA Gold 1350","29241MI027",,"MIN002","MIS001","MIF002","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29241MI0270074-00","Standard Gold Off Exchange Plan",,"0.814683616161346","Yes","Yes","No","100%",,"$1,350","$0","$650","$150","$1,350","$340","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","20%",,,,,"$2,700","$5400 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/150906C8210F4AF08CAB83893868F2C1.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA&utm_campaign=2016OEP","15"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","2","29241","MI","Individual","No","20-1529553","29241MI0270074","MyPriority PPO HSA Gold 1350","29241MI027",,"MIN002","MIS001","MIF002","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29241MI0270074-01","Standard Gold On Exchange Plan",,"0.814683616161346","Yes","Yes","No","100%",,"$1,350","$0","$650","$150","$1,350","$340","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","20%",,,,,"$2,700","$5400 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/150906C8210F4AF08CAB83893868F2C1.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA&utm_campaign=2016OEP","16"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","2","29241","MI","Individual","No","20-1529553","29241MI0270074","MyPriority PPO HSA Gold 1350","29241MI027",,"MIN002","MIS001","MIF002","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29241MI0270074-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/1080647A18524383A1E9B440E81E22AE.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA&utm_campaign=2016OEP","17"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","2","29241","MI","Individual","No","20-1529553","29241MI0270074","MyPriority PPO HSA Gold 1350","29241MI027",,"MIN002","MIS001","MIF002","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29241MI0270074-03","Limited Cost Sharing Plan Variation",,"0.814683616161346","Yes","Yes","No","100%",,"$1,350","$0","$650","$150","$1,350","$340","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","20%",,,,,"$2,700","$5400 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/951A7EB626B74FE8A8BEDA69EF2038CF.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-hsa?utm_source=FFM&utm_content=PPO_HSA&utm_campaign=2016OEP","18"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","3","29241","MI","Individual","No","20-1529553","29241MI0270071","MyPriority PPO RxPlus Bronze 3975","29241MI027",,"MIN002","MIS001","MIF004","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","2","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29241MI0270071-00","Standard Bronze Off Exchange Plan",,"0.619416475296021","Yes","Yes","No","100%",,"$3,975","$20","$600","$150","$3,975","$430","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$27400 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,975","$7950 per person","$7950 per group","50%",,,,,"$7,950","$15900 per person","$15900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/64E6BEE4156849968792B7CDED15B1B3.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","4"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","3","29241","MI","Individual","No","20-1529553","29241MI0270071","MyPriority PPO RxPlus Bronze 3975","29241MI027",,"MIN002","MIS001","MIF004","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","2","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29241MI0270071-01","Standard Bronze On Exchange Plan",,"0.619416475296021","Yes","Yes","No","100%",,"$3,975","$20","$600","$150","$3,975","$430","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$27400 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,975","$7950 per person","$7950 per group","50%",,,,,"$7,950","$15900 per person","$15900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/64E6BEE4156849968792B7CDED15B1B3.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","5"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540019","MyPriority HMO RxPlus Silver 1400","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540019-04","73% AV Level Silver Plan","73.93%","0.743373513221741","Yes","Yes","No","100%",,"$1,300","$10","$1,160","$150","$1,300","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/680DFDF33A17410FA115B4ECB9BEC08E.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","33"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540019","MyPriority HMO RxPlus Silver 1400","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540019-05","87% AV Level Silver Plan","87.86%","0.880910098552704","Yes","Yes","No","100%",,"$50","$10","$1,540","$150","$50","$400","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/6BF5D5ABFB0540618C220AE58E535A51.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","34"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540019","MyPriority HMO RxPlus Silver 1400","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540019-06","94% AV Level Silver Plan","94.51%","0.946319401264191","Yes","Yes","No","100%",,"$25","$0","$480","$150","$25","$190","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$50 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/264BE9C9675B4D09AA10C4E5366F3CC8.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","35"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","2","29698","MI","Individual","No","38-2715520","29698MI0540020","MyPriority HMO HSA Bronze 6550","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No",,"http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540020-00","Standard Bronze Off Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,200","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/2D1AD88C420B4EAF96E481F3A5D08EE9.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA&utm_campaign=2016OEP","4"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","2","29698","MI","Individual","No","38-2715520","29698MI0540020","MyPriority HMO HSA Bronze 6550","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No",,"http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540020-01","Standard Bronze On Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,200","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/2D1AD88C420B4EAF96E481F3A5D08EE9.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA&utm_campaign=2016OEP","5"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","2","29698","MI","Individual","No","38-2715520","29698MI0540020","MyPriority HMO HSA Bronze 6550","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No",,"http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540020-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.priorityhealth.com/~/media/A51A4A2BCA2E488CAEB775DAB8E21CBE.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA&utm_campaign=2016OEP","6"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","3","29241","MI","Individual","No","20-1529553","29241MI0270071","MyPriority PPO RxPlus Bronze 3975","29241MI027",,"MIN002","MIS001","MIF004","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","2","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29241MI0270071-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/F652050CAB604553AB6C95F32FC7942D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","6"
"2016","MI","29241","SERFF","8","2016-01-29 07:27:50","3","29241","MI","Individual","No","20-1529553","29241MI0270071","MyPriority PPO RxPlus Bronze 3975","29241MI027",,"MIN002","MIS001","MIF004","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","2","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29241MI0270071-03","Limited Cost Sharing Plan Variation",,"0.619416475296021","Yes","Yes","No","100%",,"$3,975","$20","$600","$150","$3,975","$430","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$27400 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,975","$7950 per person","$7950 per group","50%",,,,,"$7,950","$15900 per person","$15900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/47AAD6F1C95D45699A7583EA4647B676.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-ppo-rxplus?utm_source=FFM&utm_content=PPO_RxPlus&utm_campaign=2016OEP","7"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540001","MyPriority HMO RxPlus Silver 1900","29698MI054",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540005","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540001-00","Standard Silver Off Exchange Plan","70.36%","0.709612250328064","No","Yes","No","100%",,"$1,900","$10","$980","$150","$1,900","$250","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,900","$3800 per person","$3800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$1000 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.priorityhealth.com/~/media/5989FA4AB55B4C2B99797816DE9D4482.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","4"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540001","MyPriority HMO RxPlus Silver 1900","29698MI054",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540005","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540001-01","Standard Silver On Exchange Plan","70.36%","0.709612250328064","No","Yes","No","100%",,"$1,900","$10","$980","$150","$1,900","$250","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,900","$3800 per person","$3800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$1000 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.priorityhealth.com/~/media/5989FA4AB55B4C2B99797816DE9D4482.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","5"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540001","MyPriority HMO RxPlus Silver 1900","29698MI054",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540005","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.priorityhealth.com/~/media/25CC3DDD9AF84466B4795969A9028502.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","6"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540001","MyPriority HMO RxPlus Silver 1900","29698MI054",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540005","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540001-03","Limited Cost Sharing Plan Variation","70.36%","0.709612250328064","No","Yes","No","100%",,"$1,900","$10","$980","$150","$1,900","$250","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,900","$3800 per person","$3800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$1000 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.priorityhealth.com/~/media/502D06CED05D4948A6368787D22BEA96.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","7"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540001","MyPriority HMO RxPlus Silver 1900","29698MI054",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540005","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540001-04","73% AV Level Silver Plan","73.73%","0.742594361305237","No","Yes","No","100%",,"$1,400","$10","$1,130","$150","$1,400","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$2800 per person","$2800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$500 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.priorityhealth.com/~/media/CD89C625524D4CF6ADA0EE9F255C5071.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","8"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540001","MyPriority HMO RxPlus Silver 1900","29698MI054",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540005","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540001-05","87% AV Level Silver Plan","87.81%","0.883365213871002","No","Yes","No","100%",,"$200","$10","$1,490","$150","$200","$400","$580","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$125","$250 per person","$250 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$125","$250 per person","$250 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.priorityhealth.com/~/media/0C962840BBA344DFBAFD3E9C81C35E7A.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","9"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540001","MyPriority HMO RxPlus Silver 1900","29698MI054",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540005","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540001-06","94% AV Level Silver Plan","94.31%","0.945334017276764","No","Yes","No","100%",,"$100","$0","$400","$150","$100","$190","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$200 per person","$200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.priorityhealth.com/~/media/16A5F70F19C047A3864411AD9FD7C469.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","10"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540016","MyPriority HMO RxPlus Gold 200","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540016-00","Standard Gold Off Exchange Plan","81.90%","0.822476387023926","Yes","Yes","No","100%",,"$200","$10","$990","$150","$200","$400","$560","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/7B9E4D6A9DB8440780EC3D76F8CA725B.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","11"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540016","MyPriority HMO RxPlus Gold 200","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540016-01","Standard Gold On Exchange Plan","81.90%","0.822476387023926","Yes","Yes","No","100%",,"$200","$10","$990","$150","$200","$400","$560","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/7B9E4D6A9DB8440780EC3D76F8CA725B.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","12"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540016","MyPriority HMO RxPlus Gold 200","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540016-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.priorityhealth.com/~/media/3DCEE0525488485E9D804FFE27574E46.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","13"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540016","MyPriority HMO RxPlus Gold 200","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540016-03","Limited Cost Sharing Plan Variation","81.90%","0.822476387023926","Yes","Yes","No","100%",,"$200","$10","$990","$150","$200","$400","$560","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/40C15A210BD44240B0072A2AA5EA145D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","14"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540005","MyPriority HMO RxPlus Silver 1800","29698MI054",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540005-00","Standard Silver Off Exchange Plan","70.69%","0.710850715637207","Yes","Yes","No","100%",,"$1,800","$10","$1,010","$150","$1,800","$260","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/F99BA2A9BABB414BB3E60C21DE279950.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","15"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540005","MyPriority HMO RxPlus Silver 1800","29698MI054",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540005-01","Standard Silver On Exchange Plan","70.69%","0.710850715637207","Yes","Yes","No","100%",,"$1,800","$10","$1,010","$150","$1,800","$260","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/F99BA2A9BABB414BB3E60C21DE279950.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","16"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540005","MyPriority HMO RxPlus Silver 1800","29698MI054",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.priorityhealth.com/~/media/93FF8D8384B747909082404400C5C652.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","17"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540005","MyPriority HMO RxPlus Silver 1800","29698MI054",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540005-03","Limited Cost Sharing Plan Variation","70.69%","0.710850715637207","Yes","Yes","No","100%",,"$1,800","$10","$1,010","$150","$1,800","$260","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/E4D1F6962FBD484B84C8D02A7697F55B.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","18"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540005","MyPriority HMO RxPlus Silver 1800","29698MI054",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540005-04","73% AV Level Silver Plan","73.93%","0.743373513221741","Yes","Yes","No","100%",,"$1,300","$10","$1,160","$150","$1,300","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$2600 per person","$2600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/E40D221BB8BA42C5991E3071D7B3E4B6.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","19"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540005","MyPriority HMO RxPlus Silver 1800","29698MI054",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540005-06","94% AV Level Silver Plan","94.51%","0.946319401264191","Yes","Yes","No","100%",,"$25","$0","$480","$150","$25","$190","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/F2D78B37D5A645D38707DCA859187ED9.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","21"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540018","MyPriority RxPlus - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540005","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540018-00","Standard Silver Off Exchange Plan","70.69%","0.710850715637207","Yes","Yes","No","100%",,"$1,800","$10","$1,010","$150","$1,800","$260","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/7E821ABE4B1F4932B371A47C6B96B729.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-rxplus-spectrum-health-partners?utm_source=FFM&utm_content=RxPlus_SHP&utm_campaign=2016OEP","22"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540018","MyPriority RxPlus - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540005","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540018-01","Standard Silver On Exchange Plan","70.69%","0.710850715637207","Yes","Yes","No","100%",,"$1,800","$10","$1,010","$150","$1,800","$260","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/7E821ABE4B1F4932B371A47C6B96B729.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-rxplus-spectrum-health-partners?utm_source=FFM&utm_content=RxPlus_SHP&utm_campaign=2016OEP","23"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540018","MyPriority RxPlus - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540005","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540018-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.priorityhealth.com/~/media/60FDC9C3E9754351A7615E06473BAFF8.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-rxplus-spectrum-health-partners?utm_source=FFM&utm_content=RxPlus_SHP&utm_campaign=2016OEP","24"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540018","MyPriority RxPlus - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540005","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540018-03","Limited Cost Sharing Plan Variation","70.69%","0.710850715637207","Yes","Yes","No","100%",,"$1,800","$10","$1,010","$150","$1,800","$260","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/7EA6710D91594711BCA2C34772D67E97.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-rxplus-spectrum-health-partners?utm_source=FFM&utm_content=RxPlus_SHP&utm_campaign=2016OEP","25"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540018","MyPriority RxPlus - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540005","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540018-04","73% AV Level Silver Plan","73.93%","0.743373513221741","Yes","Yes","No","100%",,"$1,300","$10","$1,160","$150","$1,300","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$2600 per person","$2600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/60AB70ECB63B4FFB80A41A60B20F89E7.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-rxplus-spectrum-health-partners?utm_source=FFM&utm_content=RxPlus_SHP&utm_campaign=2016OEP","26"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540018","MyPriority RxPlus - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540005","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540018-05","87% AV Level Silver Plan","87.86%","0.880910098552704","Yes","Yes","No","100%",,"$50","$10","$1,540","$150","$50","$400","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/D73DAB491D0A462EAEF4BCBEC752954D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-rxplus-spectrum-health-partners?utm_source=FFM&utm_content=RxPlus_SHP&utm_campaign=2016OEP","27"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540018","MyPriority RxPlus - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540005","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540018-06","94% AV Level Silver Plan","94.51%","0.946319401264191","Yes","Yes","No","100%",,"$25","$0","$480","$150","$25","$190","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/B87451B257E8469EA497B5673374AC55.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-rxplus-spectrum-health-partners?utm_source=FFM&utm_content=RxPlus_SHP&utm_campaign=2016OEP","28"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540019","MyPriority HMO RxPlus Silver 1400","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540019-00","Standard Silver Off Exchange Plan","71.83%","0.722587764263153","Yes","Yes","No","100%",,"$1,400","$10","$1,130","$150","$1,400","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/FBD5303051CC4D8A8E225C761A13E14B.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","29"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540019","MyPriority HMO RxPlus Silver 1400","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540019-01","Standard Silver On Exchange Plan","71.83%","0.722587764263153","Yes","Yes","No","100%",,"$1,400","$10","$1,130","$150","$1,400","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/FBD5303051CC4D8A8E225C761A13E14B.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","30"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540019","MyPriority HMO RxPlus Silver 1400","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540019-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.priorityhealth.com/~/media/B823FF848AA74839AFEE489D90A94091.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","31"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","1","29698","MI","Individual","No","38-2715520","29698MI0540019","MyPriority HMO RxPlus Silver 1400","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540019-03","Limited Cost Sharing Plan Variation","71.83%","0.722587764263153","Yes","Yes","No","100%",,"$1,400","$10","$1,130","$150","$1,400","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/9765B72F38A74B2E9D43A592A3CE0DAA.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","32"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","2","29698","MI","Individual","No","38-2715520","29698MI0540020","MyPriority HMO HSA Bronze 6550","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No",,"http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540020-03","Limited Cost Sharing Plan Variation",,"0.5993931889534","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,200","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/66E59D35D19F414C9BDC76D6204C988F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA&utm_campaign=2016OEP","7"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","2","29698","MI","Individual","No","38-2715520","29698MI0540021","MyPriority HMO HSA - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540020","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No",,"http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540021-00","Standard Bronze Off Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,200","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/EB1760C2C13942199E778B2D5801BC1A.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hsa-spectrum-health-partners?utm_source=FFM&utm_content=HSA_SHP&utm_campaign=2016OEP","8"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","2","29698","MI","Individual","No","38-2715520","29698MI0540021","MyPriority HMO HSA - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540020","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No",,"http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540021-01","Standard Bronze On Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,200","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/EB1760C2C13942199E778B2D5801BC1A.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hsa-spectrum-health-partners?utm_source=FFM&utm_content=HSA_SHP&utm_campaign=2016OEP","9"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","2","29698","MI","Individual","No","38-2715520","29698MI0540021","MyPriority HMO HSA - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540020","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No",,"http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.priorityhealth.com/~/media/FF499FD3E47C40E9935D0288655AE8B7.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hsa-spectrum-health-partners?utm_source=FFM&utm_content=HSA_SHP&utm_campaign=2016OEP","10"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","2","29698","MI","Individual","No","38-2715520","29698MI0540021","MyPriority HMO HSA - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540020","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No",,"http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540021-03","Limited Cost Sharing Plan Variation",,"0.5993931889534","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,200","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/70E9681F2C7447B0BE78AE016B63F5AB.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hsa-spectrum-health-partners?utm_source=FFM&utm_content=HSA_SHP&utm_campaign=2016OEP","11"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","2","29698","MI","Individual","No","38-2715520","29698MI0540008","MyPriority HMO HSA Silver 1500","29698MI054",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No",,"http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540008-00","Standard Silver Off Exchange Plan",,"0.710802912712097","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/178E258DEE454ED1A64BA90B8173523D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA&utm_campaign=2016OEP","12"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","2","29698","MI","Individual","No","38-2715520","29698MI0540008","MyPriority HMO HSA Silver 1500","29698MI054",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No",,"http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540008-01","Standard Silver On Exchange Plan",,"0.710802912712097","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/178E258DEE454ED1A64BA90B8173523D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA&utm_campaign=2016OEP","13"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","2","29698","MI","Individual","No","38-2715520","29698MI0540008","MyPriority HMO HSA Silver 1500","29698MI054",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No",,"http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.priorityhealth.com/~/media/468C7225B78B42DAB9AD7694D17F574E.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA&utm_campaign=2016OEP","14"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","2","29698","MI","Individual","No","38-2715520","29698MI0540008","MyPriority HMO HSA Silver 1500","29698MI054",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No",,"http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540008-03","Limited Cost Sharing Plan Variation",,"0.710802912712097","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/7D938F8466B0489880E8BF18FC2E5F5E.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA&utm_campaign=2016OEP","15"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","2","29698","MI","Individual","No","38-2715520","29698MI0540008","MyPriority HMO HSA Silver 1500","29698MI054",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No",,"http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540008-04","73% AV Level Silver Plan",,"0.739672482013702","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$720","$740","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$2000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/2A05CE3512BC461995DF075F7E1BE307.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA&utm_campaign=2016OEP","16"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","2","29698","MI","Individual","No","38-2715520","29698MI0540008","MyPriority HMO HSA Silver 1500","29698MI054",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No",,"http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540008-05","87% AV Level Silver Plan",,"0.87782233953476","Yes","Yes","No","100%",,"$500","$0","$900","$150","$500","$360","$540","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/2D4892191FB84EDC97E845908805B0D3.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA&utm_campaign=2016OEP","17"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","2","29698","MI","Individual","No","38-2715520","29698MI0540008","MyPriority HMO HSA Silver 1500","29698MI054",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No",,"http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540008-06","94% AV Level Silver Plan",,"0.94932746887207","Yes","Yes","No","100%",,"$25","$0","$380","$150","$25","$80","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/EF04710F8C624DCCBF1633E45F6628C5.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA&utm_campaign=2016OEP","18"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","2","29698","MI","Individual","No","38-2715520","29698MI0540022","MyPriority HMO HSA Gold 1350","29698MI054",,"MIN001","MIS001","MIF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No",,"http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540022-00","Standard Gold Off Exchange Plan",,"0.814683616161346","Yes","Yes","No","100%",,"$1,350","$0","$650","$150","$1,350","$340","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/F1663257E1ED4648B64A73A79E1D7CF2.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA&utm_campaign=2016OEP","19"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","2","29698","MI","Individual","No","38-2715520","29698MI0540022","MyPriority HMO HSA Gold 1350","29698MI054",,"MIN001","MIS001","MIF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No",,"http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540022-01","Standard Gold On Exchange Plan",,"0.814683616161346","Yes","Yes","No","100%",,"$1,350","$0","$650","$150","$1,350","$340","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/F1663257E1ED4648B64A73A79E1D7CF2.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA&utm_campaign=2016OEP","20"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","2","29698","MI","Individual","No","38-2715520","29698MI0540022","MyPriority HMO HSA Gold 1350","29698MI054",,"MIN001","MIS001","MIF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No",,"http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540022-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.priorityhealth.com/~/media/59F86A8587F44F2296E8D711FA3498AF.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA&utm_campaign=2016OEP","21"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","2","29698","MI","Individual","No","38-2715520","29698MI0540022","MyPriority HMO HSA Gold 1350","29698MI054",,"MIN001","MIS001","MIF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No",,"http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540022-03","Limited Cost Sharing Plan Variation",,"0.814683616161346","Yes","Yes","No","100%",,"$1,350","$0","$650","$150","$1,350","$340","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/6FF1B9666CE843EC824C278569B5F5BE.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-hsa?utm_source=FFM&utm_content=HMO_HSA&utm_campaign=2016OEP","22"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","3","29698","MI","Individual","No","38-2715520","29698MI0540023","MyPriority HMO Bronze 6450","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540023-00","Standard Bronze Off Exchange Plan",,"0.619651854038239","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$12900 per person","$12900 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/6051C6FC3FA048CC9A8D8EB7C1C85620.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo?utm_source=FFM&utm_content=HMO&utm_campaign=2016OEP","4"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","3","29698","MI","Individual","No","38-2715520","29698MI0540023","MyPriority HMO Bronze 6450","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540023-01","Standard Bronze On Exchange Plan",,"0.619651854038239","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$12900 per person","$12900 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/6051C6FC3FA048CC9A8D8EB7C1C85620.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo?utm_source=FFM&utm_content=HMO&utm_campaign=2016OEP","5"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","3","29698","MI","Individual","No","38-2715520","29698MI0540023","MyPriority HMO Bronze 6450","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540023-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/40EA3C0026FB43A4B82D0A0D7E2A063F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo?utm_source=FFM&utm_content=HMO&utm_campaign=2016OEP","6"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","3","29698","MI","Individual","No","38-2715520","29698MI0540023","MyPriority HMO Bronze 6450","29698MI054",,"MIN001","MIS001","MIF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540023-03","Limited Cost Sharing Plan Variation",,"0.619651854038239","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$12900 per person","$12900 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/C04356CF655D487EB50AD875ABF88968.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo?utm_source=FFM&utm_content=HMO&utm_campaign=2016OEP","7"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","3","29698","MI","Individual","No","38-2715520","29698MI0540014","MyPriority HMO Silver 1400","29698MI054",,"MIN001","MIS001","MIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540014-00","Standard Silver Off Exchange Plan",,"0.712793469429016","Yes","Yes","No","100%",,"$1,400","$20","$1,130","$150","$1,400","$810","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/AE44A200528F48AEAA99A12B28F9184D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo?utm_source=FFM&utm_content=HMO&utm_campaign=2016OEP","8"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","3","29698","MI","Individual","No","38-2715520","29698MI0540014","MyPriority HMO Silver 1400","29698MI054",,"MIN001","MIS001","MIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540014-01","Standard Silver On Exchange Plan",,"0.712793469429016","Yes","Yes","No","100%",,"$1,400","$20","$1,130","$150","$1,400","$810","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/AE44A200528F48AEAA99A12B28F9184D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo?utm_source=FFM&utm_content=HMO&utm_campaign=2016OEP","9"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","3","29698","MI","Individual","No","38-2715520","29698MI0540014","MyPriority HMO Silver 1400","29698MI054",,"MIN001","MIS001","MIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/0155881750A34E3E9F53CC88EA0F8021.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo?utm_source=FFM&utm_content=HMO&utm_campaign=2016OEP","10"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","3","29698","MI","Individual","No","38-2715520","29698MI0540014","MyPriority HMO Silver 1400","29698MI054",,"MIN001","MIS001","MIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540014-03","Limited Cost Sharing Plan Variation",,"0.712793469429016","Yes","Yes","No","100%",,"$1,400","$20","$1,130","$150","$1,400","$810","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/7B0783278A3541DAB75EF2B42D0DEDAE.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo?utm_source=FFM&utm_content=HMO&utm_campaign=2016OEP","11"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","3","29698","MI","Individual","No","38-2715520","29698MI0540014","MyPriority HMO Silver 1400","29698MI054",,"MIN001","MIS001","MIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540014-04","73% AV Level Silver Plan",,"0.734111845493317","Yes","Yes","No","100%",,"$1,200","$20","$1,190","$150","$1,200","$870","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2400 per person","$2400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/FE0A618A9A094F06B927EDC67D7ECDF4.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo?utm_source=FFM&utm_content=HMO&utm_campaign=2016OEP","12"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","3","29698","MI","Individual","No","38-2715520","29698MI0540014","MyPriority HMO Silver 1400","29698MI054",,"MIN001","MIS001","MIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540014-05","87% AV Level Silver Plan",,"0.874316334724426","Yes","Yes","No","100%",,"$50","$0","$1,450","$150","$50","$880","$570","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/D7A52C76797A45EDB64681471D29C623.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo?utm_source=FFM&utm_content=HMO&utm_campaign=2016OEP","13"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","3","29698","MI","Individual","No","38-2715520","29698MI0540014","MyPriority HMO Silver 1400","29698MI054",,"MIN001","MIS001","MIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540014-06","94% AV Level Silver Plan",,"0.949907243251801","Yes","Yes","No","100%",,"$25","$0","$480","$150","$25","$270","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/984A668C015B4517B7D06404BB9065F7.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo?utm_source=FFM&utm_content=HMO&utm_campaign=2016OEP","14"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","4","29698","MI","Individual","No","38-2715520","29698MI0540024","MyPriority HMO Holistic Bronze 5200","29698MI054",,"MIN001","MIS001","MIF006","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540024-00","Standard Bronze Off Exchange Plan","61.67%","0.628741979598999","Yes","Yes","No","100%",,"$5,200","$20","$90","$150","$5,200","$80","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$10400 per person","$10400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/D2A528317813412D9C8AE27B3C755947.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-holistic?utm_source=FFM&utm_content=HMO_Holistic&utm_campaign=2016OEP","4"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","4","29698","MI","Individual","No","38-2715520","29698MI0540024","MyPriority HMO Holistic Bronze 5200","29698MI054",,"MIN001","MIS001","MIF006","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540024-01","Standard Bronze On Exchange Plan","61.67%","0.628741979598999","Yes","Yes","No","100%",,"$5,200","$20","$90","$150","$5,200","$80","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$10400 per person","$10400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/D2A528317813412D9C8AE27B3C755947.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-holistic?utm_source=FFM&utm_content=HMO_Holistic&utm_campaign=2016OEP","5"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","4","29698","MI","Individual","No","38-2715520","29698MI0540024","MyPriority HMO Holistic Bronze 5200","29698MI054",,"MIN001","MIS001","MIF006","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540024-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/37054C7E9A5F4F099A477F87B25899B4.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-holistic?utm_source=FFM&utm_content=HMO_Holistic&utm_campaign=2016OEP","6"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","4","29698","MI","Individual","No","38-2715520","29698MI0540024","MyPriority HMO Holistic Bronze 5200","29698MI054",,"MIN001","MIS001","MIF006","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540024-03","Limited Cost Sharing Plan Variation","61.67%","0.628741979598999","Yes","Yes","No","100%",,"$5,200","$20","$90","$150","$5,200","$80","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$10400 per person","$10400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/16EAE927335D4F8AB757FB05D86772B8.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-holistic?utm_source=FFM&utm_content=HMO_Holistic&utm_campaign=2016OEP","7"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","4","29698","MI","Individual","No","38-2715520","29698MI0540025","MyPriority Holistic Bronze - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF006","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540024","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540025-00","Standard Bronze Off Exchange Plan","61.67%","0.628741979598999","Yes","Yes","No","100%",,"$5,200","$20","$90","$150","$5,000","$80","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$10400 per person","$10400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/C68100EAD5334F34A7D79B4E0A385513.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-holistic-spectrum-health-parnters?utm_source=FFM&utm_content=Holistic_SHP&utm_campaign=2016OEP","8"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","4","29698","MI","Individual","No","38-2715520","29698MI0540025","MyPriority Holistic Bronze - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF006","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540024","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540025-01","Standard Bronze On Exchange Plan","61.67%","0.628741979598999","Yes","Yes","No","100%",,"$5,200","$20","$90","$150","$5,000","$80","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$10400 per person","$10400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/C68100EAD5334F34A7D79B4E0A385513.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-holistic-spectrum-health-parnters?utm_source=FFM&utm_content=Holistic_SHP&utm_campaign=2016OEP","9"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","4","29698","MI","Individual","No","38-2715520","29698MI0540025","MyPriority Holistic Bronze - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF006","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540024","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540025-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/A104A8327C554571AA58B12AAF751467.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-holistic-spectrum-health-parnters?utm_source=FFM&utm_content=Holistic_SHP&utm_campaign=2016OEP","10"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","4","29698","MI","Individual","No","38-2715520","29698MI0540025","MyPriority Holistic Bronze - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF006","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540024","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540025-03","Limited Cost Sharing Plan Variation","61.67%","0.628741979598999","Yes","Yes","No","100%",,"$5,200","$20","$90","$150","$5,000","$80","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$10400 per person","$10400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/ED59DEDF3AC84D7BA8BDB763DAC023BE.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-holistic-spectrum-health-parnters?utm_source=FFM&utm_content=Holistic_SHP&utm_campaign=2016OEP","11"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570021","MyPriority POS RxPlus Gold 200","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570021-00","Standard Gold Off Exchange Plan","81.90%","0.822476387023926","Yes","Yes","No","100%",,"$200","$10","$990","$150","$200","$400","$560","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/4B1336F5BE2340E6B75FA3E26E0B689C.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","4"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570021","MyPriority POS RxPlus Gold 200","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570021-01","Standard Gold On Exchange Plan","81.90%","0.822476387023926","Yes","Yes","No","100%",,"$200","$10","$990","$150","$200","$400","$560","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/4B1336F5BE2340E6B75FA3E26E0B689C.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","5"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570021","MyPriority POS RxPlus Gold 200","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570021-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/AFC5EF3F0CBD402B819AF0EA3D0CE226.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","6"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570021","MyPriority POS RxPlus Gold 200","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570021-03","Limited Cost Sharing Plan Variation","81.90%","0.822476387023926","Yes","Yes","No","100%",,"$200","$10","$990","$150","$200","$400","$560","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/9152AD12BE624BF08F9FDB285C06279F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","7"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570003","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS003","MIF003","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570003-00","Standard Silver Off Exchange Plan","70.69%","0.710850715637207","Yes","Yes","No","100%",,"$1,800","$10","$1,010","$150","$1,800","$260","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30%",,,,,"$3,600","$7200 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/B5CB57ED3741419D96582A156F581FD5.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","8"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570003","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS003","MIF003","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570003-01","Standard Silver On Exchange Plan","70.69%","0.710850715637207","Yes","Yes","No","100%",,"$1,800","$10","$1,010","$150","$1,800","$260","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30%",,,,,"$3,600","$7200 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/B5CB57ED3741419D96582A156F581FD5.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","9"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570003","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS003","MIF003","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/DECBDE19B5344BA6B7158D59608A9202.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","10"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570003","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS003","MIF003","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570003-03","Limited Cost Sharing Plan Variation","70.69%","0.710850715637207","Yes","Yes","No","100%",,"$1,800","$10","$1,010","$150","$1,800","$260","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30%",,,,,"$3,600","$7200 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/1BB7440A274B499387AB93088D200B3E.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","11"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570003","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS003","MIF003","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570003-04","73% AV Level Silver Plan","73.93%","0.743373513221741","Yes","Yes","No","100%",,"$1,300","$10","$1,160","$150","$1,300","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$10,800","$21600 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$2600 per person","$2600 per group","30%",,,,,"$2,600","$5200 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/4E8B76F4FCFA48D08B6B7EA149653FB4.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","12"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570003","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS003","MIF003","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570003-05","87% AV Level Silver Plan","87.86%","0.880910098552704","Yes","Yes","No","100%",,"$50","$10","$1,540","$150","$50","$400","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$3,200","$6400 per person","$6400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30%",,,,,"$100","$200 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/DC61BA62AA564A54B3524E318A5415C4.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","13"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570003","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS003","MIF003","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570003-06","94% AV Level Silver Plan","94.51%","0.946319401264191","Yes","Yes","No","100%",,"$25","$0","$480","$150","$25","$190","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$2000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30%",,,,,"$50","$100 per person","$100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/67618EB6E7E74DA0A17AD1DA29376240.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","14"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570023","MyPriority POS RxPlus Silver 1400","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570023-00","Standard Silver Off Exchange Plan","71.83%","0.722587764263153","Yes","Yes","No","100%",,"$1,400","$10","$1,130","$150","$1,400","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","30%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/6444E20DB96E42BDA9998DA32FB7B39F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","15"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570023","MyPriority POS RxPlus Silver 1400","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570023-01","Standard Silver On Exchange Plan","71.83%","0.722587764263153","Yes","Yes","No","100%",,"$1,400","$10","$1,130","$150","$1,400","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","30%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/6444E20DB96E42BDA9998DA32FB7B39F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","16"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570023","MyPriority POS RxPlus Silver 1400","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570023-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/B6A3A23414C642939CF073B95892042A.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","17"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570023","MyPriority POS RxPlus Silver 1400","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570023-03","Limited Cost Sharing Plan Variation","71.83%","0.722587764263153","Yes","Yes","No","100%",,"$1,400","$10","$1,130","$150","$1,400","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","30%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/7A848452804047C7BD5AC922368CA1F1.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","18"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570023","MyPriority POS RxPlus Silver 1400","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570023-04","73% AV Level Silver Plan","73.93%","0.743373513221741","Yes","Yes","No","100%",,"$1,300","$10","$1,160","$150","$1,300","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","30%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/5F83D25F8485460AAFA3D9738ACC5DBE.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","19"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570023","MyPriority POS RxPlus Silver 1400","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570023-05","87% AV Level Silver Plan","87.86%","0.880910098552704","Yes","Yes","No","100%",,"$50","$10","$1,540","$150","$50","$400","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$3,200","$3200 per person","$6400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","30%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/D0F74D86328B4B96BE487CE07AFDAAA7.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","20"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570023","MyPriority POS RxPlus Silver 1400","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570023-06","94% AV Level Silver Plan","94.51%","0.946319401264191","Yes","Yes","No","100%",,"$25","$0","$480","$150","$25","$190","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$50 per group","30%",,,,,"$50","$50 per person","$100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/59F4C9AA257446BDAE1DD50CA1215E3D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","21"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570029","MyPriority POS RxPlus Gold 200","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570029-00","Standard Gold Off Exchange Plan","81.90%","0.822476387023926","Yes","Yes","No","100%",,"$200","$10","$990","$150","$200","$400","$560","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/4B1336F5BE2340E6B75FA3E26E0B689C.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","22"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570029","MyPriority POS RxPlus Gold 200","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570029-01","Standard Gold On Exchange Plan","81.90%","0.822476387023926","Yes","Yes","No","100%",,"$200","$10","$990","$150","$200","$400","$560","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/4B1336F5BE2340E6B75FA3E26E0B689C.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","23"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570029","MyPriority POS RxPlus Gold 200","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570029-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/AFC5EF3F0CBD402B819AF0EA3D0CE226.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","24"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570029","MyPriority POS RxPlus Gold 200","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570029-03","Limited Cost Sharing Plan Variation","81.90%","0.822476387023926","Yes","Yes","No","100%",,"$200","$10","$990","$150","$200","$400","$560","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/9152AD12BE624BF08F9FDB285C06279F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","25"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570013","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS002","MIF003","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570013-00","Standard Silver Off Exchange Plan","70.69%","0.710850715637207","Yes","Yes","No","100%",,"$1,800","$10","$1,010","$150","$1,800","$260","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30%",,,,,"$3,600","$7200 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/B5CB57ED3741419D96582A156F581FD5.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","26"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570013","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS002","MIF003","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570013-01","Standard Silver On Exchange Plan","70.69%","0.710850715637207","Yes","Yes","No","100%",,"$1,800","$10","$1,010","$150","$1,800","$260","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30%",,,,,"$3,600","$7200 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/B5CB57ED3741419D96582A156F581FD5.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","27"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570013","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS002","MIF003","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/DECBDE19B5344BA6B7158D59608A9202.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","28"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570013","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS002","MIF003","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570013-03","Limited Cost Sharing Plan Variation","70.69%","0.710850715637207","Yes","Yes","No","100%",,"$1,800","$10","$1,010","$150","$1,800","$260","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$3600 per person","$3600 per group","30%",,,,,"$3,600","$7200 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/1BB7440A274B499387AB93088D200B3E.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","29"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570013","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS002","MIF003","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570013-04","73% AV Level Silver Plan","73.93%","0.743373513221741","Yes","Yes","No","100%",,"$1,300","$10","$1,160","$150","$1,300","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$10,800","$21600 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$2600 per person","$2600 per group","30%",,,,,"$2,600","$5200 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/4E8B76F4FCFA48D08B6B7EA149653FB4.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","30"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570013","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS002","MIF003","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570013-05","87% AV Level Silver Plan","87.86%","0.880910098552704","Yes","Yes","No","100%",,"$50","$10","$1,540","$150","$50","$400","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$3,200","$6400 per person","$6400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30%",,,,,"$100","$200 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/DC61BA62AA564A54B3524E318A5415C4.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","31"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570013","MyPriority POS RxPlus Silver 1800","29698MI057",,"MIN001","MIS002","MIF003","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570013-06","94% AV Level Silver Plan","94.51%","0.946319401264191","Yes","Yes","No","100%",,"$25","$0","$480","$150","$25","$190","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$2000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30%",,,,,"$50","$100 per person","$100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/67618EB6E7E74DA0A17AD1DA29376240.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","32"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570031","MyPriority POS RxPlus Silver 1400","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570031-00","Standard Silver Off Exchange Plan","71.83%","0.722587764263153","Yes","Yes","No","100%",,"$1,400","$10","$1,130","$150","$1,400","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","30%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/6444E20DB96E42BDA9998DA32FB7B39F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","33"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570031","MyPriority POS RxPlus Silver 1400","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570031-01","Standard Silver On Exchange Plan","71.83%","0.722587764263153","Yes","Yes","No","100%",,"$1,400","$10","$1,130","$150","$1,400","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","30%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/6444E20DB96E42BDA9998DA32FB7B39F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","34"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570031","MyPriority POS RxPlus Silver 1400","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570031-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/B6A3A23414C642939CF073B95892042A.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","35"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570031","MyPriority POS RxPlus Silver 1400","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570031-03","Limited Cost Sharing Plan Variation","71.83%","0.722587764263153","Yes","Yes","No","100%",,"$1,400","$10","$1,130","$150","$1,400","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","30%",,,,,"$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/7A848452804047C7BD5AC922368CA1F1.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","36"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570031","MyPriority POS RxPlus Silver 1400","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570031-04","73% AV Level Silver Plan","73.93%","0.743373513221741","Yes","Yes","No","100%",,"$1,300","$10","$1,160","$150","$1,300","$280","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","30%",,,,,"$2,600","$2600 per person","$5200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/5F83D25F8485460AAFA3D9738ACC5DBE.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","37"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570031","MyPriority POS RxPlus Silver 1400","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570031-05","87% AV Level Silver Plan","87.86%","0.880910098552704","Yes","Yes","No","100%",,"$50","$10","$1,540","$150","$50","$400","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$3,200","$3200 per person","$6400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","30%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/D0F74D86328B4B96BE487CE07AFDAAA7.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","38"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","5","29698","MI","Individual","No","38-2715520","29698MI0570031","MyPriority POS RxPlus Silver 1400","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","4","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570031-06","94% AV Level Silver Plan","94.51%","0.946319401264191","Yes","Yes","No","100%",,"$25","$0","$480","$150","$25","$190","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$50 per group","30%",,,,,"$50","$50 per person","$100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/59F4C9AA257446BDAE1DD50CA1215E3D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","39"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","6","29698","MI","Individual","No","38-2715520","29698MI0570022","MyPriority POS RxPlus Bronze 3975","29698MI057",,"MIN001","MIS003","MIF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","2","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570022-00","Standard Bronze Off Exchange Plan",,"0.619416475296021","Yes","Yes","No","100%",,"$3,975","$20","$600","$150","$3,975","$430","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$27400 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,975","$7950 per person","$7950 per group","50%",,,,,"$7,950","$15900 per person","$15900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/0DEF32953230418F8AA7438D8B342D24.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","4"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570016","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS002","MIF002","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570016-04","73% AV Level Silver Plan",,"0.739672482013702","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$720","$740","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"$9,400","$18800 per person","$18800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$2000 per person","$2000 per group","30%",,,,,"$2,000","$4000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/1AAC3691D0924425BC7E8A19C8548960.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","27"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570016","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS002","MIF002","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570016-05","87% AV Level Silver Plan",,"0.87782233953476","Yes","Yes","No","100%",,"$500","$0","$900","$150","$500","$360","$540","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30%",,,,,"$100","$200 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/FDDD05A84D0A452AAF80D78FC4A84AED.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","28"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570016","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS002","MIF002","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570016-06","94% AV Level Silver Plan",,"0.94932746887207","Yes","Yes","No","100%",,"$25","$0","$380","$150","$25","$80","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$800","$1600 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30%",,,,,"$50","$100 per person","$100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/9DBFA5036FE9428CA3FE52193EDE6FAD.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","29"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570033","MyPriority POS HSA Gold 1350","29698MI057",,"MIN001","MIS002","MIF002","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570033-00","Standard Gold Off Exchange Plan",,"0.814683616161346","Yes","Yes","No","100%",,"$1,350","$0","$650","$150","$1,350","$340","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","20%",,,,,"$2,700","$5400 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/F79FDDFB0F1C4961ACD0E83DB410F012.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","30"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","6","29698","MI","Individual","No","38-2715520","29698MI0570022","MyPriority POS RxPlus Bronze 3975","29698MI057",,"MIN001","MIS003","MIF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","2","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570022-01","Standard Bronze On Exchange Plan",,"0.619416475296021","Yes","Yes","No","100%",,"$3,975","$20","$600","$150","$3,975","$430","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$27400 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,975","$7950 per person","$7950 per group","50%",,,,,"$7,950","$15900 per person","$15900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/0DEF32953230418F8AA7438D8B342D24.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","5"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","6","29698","MI","Individual","No","38-2715520","29698MI0570022","MyPriority POS RxPlus Bronze 3975","29698MI057",,"MIN001","MIS003","MIF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","2","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570022-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/CB18503369E040D1B9411EF5ACE49E92.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","6"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","6","29698","MI","Individual","No","38-2715520","29698MI0570022","MyPriority POS RxPlus Bronze 3975","29698MI057",,"MIN001","MIS003","MIF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","2","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570022-03","Limited Cost Sharing Plan Variation",,"0.619416475296021","Yes","Yes","No","100%",,"$3,975","$20","$600","$150","$3,975","$430","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$27400 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,975","$7950 per person","$7950 per group","50%",,,,,"$7,950","$15900 per person","$15900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/2BED3EB925E141BB811BE648315CB368.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","7"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","6","29698","MI","Individual","No","38-2715520","29698MI0570030","MyPriority POS RxPlus Bronze 3975","29698MI057",,"MIN001","MIS002","MIF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","2","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570030-00","Standard Bronze Off Exchange Plan",,"0.619416475296021","Yes","Yes","No","100%",,"$3,975","$20","$600","$150","$3,975","$430","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$27400 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,975","$7950 per person","$7950 per group","50%",,,,,"$7,950","$15900 per person","$15900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/0DEF32953230418F8AA7438D8B342D24.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","8"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","6","29698","MI","Individual","No","38-2715520","29698MI0570030","MyPriority POS RxPlus Bronze 3975","29698MI057",,"MIN001","MIS002","MIF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","2","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570030-01","Standard Bronze On Exchange Plan",,"0.619416475296021","Yes","Yes","No","100%",,"$3,975","$20","$600","$150","$3,975","$430","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$27400 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,975","$7950 per person","$7950 per group","50%",,,,,"$7,950","$15900 per person","$15900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/0DEF32953230418F8AA7438D8B342D24.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","9"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","6","29698","MI","Individual","No","38-2715520","29698MI0570030","MyPriority POS RxPlus Bronze 3975","29698MI057",,"MIN001","MIS002","MIF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","2","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570030-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/CB18503369E040D1B9411EF5ACE49E92.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","10"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","6","29698","MI","Individual","No","38-2715520","29698MI0570030","MyPriority POS RxPlus Bronze 3975","29698MI057",,"MIN001","MIS002","MIF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","2","2016-01-01",,"Yes","Emergency Care Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570030-03","Limited Cost Sharing Plan Variation",,"0.619416475296021","Yes","Yes","No","100%",,"$3,975","$20","$600","$150","$3,975","$430","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$27400 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,975","$7950 per person","$7950 per group","50%",,,,,"$7,950","$15900 per person","$15900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/2BED3EB925E141BB811BE648315CB368.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-rxplus?utm_source=FFM&utm_content=POS_RxPlus&utm_campaign=2016OEP","11"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570026","MyPriority POS Bronze 6450","29698MI057",,"MIN001","MIS003","MIF002","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570026-01","Standard Bronze On Exchange Plan",,"0.619651854038239","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$27400 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$12900 per person","$12900 per group","40%",,,,,"$12,900","$25800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/54797446399141E9B92B6EF888D46DC0.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","5"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570024","MyPriority POS HSA Bronze 6550","29698MI057",,"MIN001","MIS003","MIF005","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570024-00","Standard Bronze Off Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/5DC43299E84141FCA2891E9EC9DA3E7D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","4"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570024","MyPriority POS HSA Bronze 6550","29698MI057",,"MIN001","MIS003","MIF005","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570024-01","Standard Bronze On Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/5DC43299E84141FCA2891E9EC9DA3E7D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","5"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570024","MyPriority POS HSA Bronze 6550","29698MI057",,"MIN001","MIS003","MIF005","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570024-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/5DE04C324EDD461083AC1364C6420055.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","6"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570024","MyPriority POS HSA Bronze 6550","29698MI057",,"MIN001","MIS003","MIF005","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570024-03","Limited Cost Sharing Plan Variation",,"0.5993931889534","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/849B7A1C0F0245DE9E369233A1076DAD.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","7"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570006","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS003","MIF002","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570006-00","Standard Silver Off Exchange Plan",,"0.710802912712097","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$20400 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30%",,,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/FA5A079D7C634DE48C54C56A3161CE33.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","8"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570006","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS003","MIF002","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570006-01","Standard Silver On Exchange Plan",,"0.710802912712097","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$20400 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30%",,,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/FA5A079D7C634DE48C54C56A3161CE33.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","9"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570006","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS003","MIF002","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/0234C8FFB3BE4DBFAD8BCDE2265047AD.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","10"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570006","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS003","MIF002","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570006-03","Limited Cost Sharing Plan Variation",,"0.710802912712097","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$20400 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30%",,,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/918CE72469BF44D18B594B614D8EA8E1.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","11"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570006","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS003","MIF002","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570006-04","73% AV Level Silver Plan",,"0.739672482013702","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$720","$740","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"$9,400","$18800 per person","$18800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$2000 per person","$2000 per group","30%",,,,,"$2,000","$4000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/1AAC3691D0924425BC7E8A19C8548960.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","12"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570006","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS003","MIF002","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570006-05","87% AV Level Silver Plan",,"0.87782233953476","Yes","Yes","No","100%",,"$500","$0","$900","$150","$500","$360","$540","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30%",,,,,"$100","$200 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/FDDD05A84D0A452AAF80D78FC4A84AED.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","13"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570006","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS003","MIF002","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570006-06","94% AV Level Silver Plan",,"0.94932746887207","Yes","Yes","No","100%",,"$25","$0","$380","$150","$25","$80","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$800","$1600 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30%",,,,,"$50","$100 per person","$100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/9DBFA5036FE9428CA3FE52193EDE6FAD.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","14"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570025","MyPriority POS HSA Gold 1350","29698MI057",,"MIN001","MIS003","MIF002","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570025-00","Standard Gold Off Exchange Plan",,"0.814683616161346","Yes","Yes","No","100%",,"$1,350","$0","$650","$150","$1,350","$340","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","20%",,,,,"$2,700","$5400 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/F79FDDFB0F1C4961ACD0E83DB410F012.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","15"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570025","MyPriority POS HSA Gold 1350","29698MI057",,"MIN001","MIS003","MIF002","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570025-01","Standard Gold On Exchange Plan",,"0.814683616161346","Yes","Yes","No","100%",,"$1,350","$0","$650","$150","$1,350","$340","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","20%",,,,,"$2,700","$5400 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/F79FDDFB0F1C4961ACD0E83DB410F012.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","16"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570025","MyPriority POS HSA Gold 1350","29698MI057",,"MIN001","MIS003","MIF002","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570025-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/0150557EF5A04F39AFCDC9504A3CEA19.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","17"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570025","MyPriority POS HSA Gold 1350","29698MI057",,"MIN001","MIS003","MIF002","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570025-03","Limited Cost Sharing Plan Variation",,"0.814683616161346","Yes","Yes","No","100%",,"$1,350","$0","$650","$150","$1,350","$340","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","20%",,,,,"$2,700","$5400 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/CAE141B4BB0A48D1AD916A3A3E4051C2.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","18"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570032","MyPriority POS HSA Bronze 6550","29698MI057",,"MIN001","MIS002","MIF005","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570032-00","Standard Bronze Off Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/5DC43299E84141FCA2891E9EC9DA3E7D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","19"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570032","MyPriority POS HSA Bronze 6550","29698MI057",,"MIN001","MIS002","MIF005","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570032-01","Standard Bronze On Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/5DC43299E84141FCA2891E9EC9DA3E7D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","20"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570032","MyPriority POS HSA Bronze 6550","29698MI057",,"MIN001","MIS002","MIF005","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570032-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/5DE04C324EDD461083AC1364C6420055.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","21"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570032","MyPriority POS HSA Bronze 6550","29698MI057",,"MIN001","MIS002","MIF005","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570032-03","Limited Cost Sharing Plan Variation",,"0.5993931889534","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$15,000","$30000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/849B7A1C0F0245DE9E369233A1076DAD.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","22"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570016","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS002","MIF002","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570016-00","Standard Silver Off Exchange Plan",,"0.710802912712097","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$20400 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30%",,,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/FA5A079D7C634DE48C54C56A3161CE33.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","23"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570016","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS002","MIF002","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570016-01","Standard Silver On Exchange Plan",,"0.710802912712097","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$20400 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30%",,,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/FA5A079D7C634DE48C54C56A3161CE33.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","24"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570016","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS002","MIF002","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/0234C8FFB3BE4DBFAD8BCDE2265047AD.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","25"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570016","MyPriority POS HSA Silver 1500","29698MI057",,"MIN001","MIS002","MIF002","New","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570016-03","Limited Cost Sharing Plan Variation",,"0.710802912712097","Yes","Yes","No","100%",,"$1,500","$20","$1,100","$150","$1,500","$660","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$10,200","$20400 per person","$20400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30%",,,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/918CE72469BF44D18B594B614D8EA8E1.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","26"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570033","MyPriority POS HSA Gold 1350","29698MI057",,"MIN001","MIS002","MIF002","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570033-01","Standard Gold On Exchange Plan",,"0.814683616161346","Yes","Yes","No","100%",,"$1,350","$0","$650","$150","$1,350","$340","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","20%",,,,,"$2,700","$5400 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.priorityhealth.com/~/media/F79FDDFB0F1C4961ACD0E83DB410F012.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","31"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570033","MyPriority POS HSA Gold 1350","29698MI057",,"MIN001","MIS002","MIF002","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570033-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/0150557EF5A04F39AFCDC9504A3CEA19.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","32"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","7","29698","MI","Individual","No","38-2715520","29698MI0570033","MyPriority POS HSA Gold 1350","29698MI057",,"MIN001","MIS002","MIF002","New","POS","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570033-03","Limited Cost Sharing Plan Variation",,"0.814683616161346","Yes","Yes","No","100%",,"$1,350","$0","$650","$150","$1,350","$340","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$2700 per person","$2700 per group","20%",,,,,"$2,700","$5400 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/CAE141B4BB0A48D1AD916A3A3E4051C2.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-hsa?utm_source=FFM&utm_content=POS_HSA&utm_campaign=2016OEP","33"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570026","MyPriority POS Bronze 6450","29698MI057",,"MIN001","MIS003","MIF002","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570026-00","Standard Bronze Off Exchange Plan",,"0.619651854038239","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$27400 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$12900 per person","$12900 per group","40%",,,,,"$12,900","$25800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/54797446399141E9B92B6EF888D46DC0.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","4"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570026","MyPriority POS Bronze 6450","29698MI057",,"MIN001","MIS003","MIF002","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/9F84C00A901346528FED1678BB523B7C.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","6"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570026","MyPriority POS Bronze 6450","29698MI057",,"MIN001","MIS003","MIF002","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570026-03","Limited Cost Sharing Plan Variation",,"0.619651854038239","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$27400 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$12900 per person","$12900 per group","40%",,,,,"$12,900","$25800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/8A8407A355F84494AF3873B62401C55E.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","7"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570009","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS003","MIF002","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570009-00","Standard Silver Off Exchange Plan",,"0.712793469429016","Yes","Yes","No","100%",,"$1,400","$20","$1,130","$150","$1,400","$810","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30%",,,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/4E0C3124257045389E5DDE161D780363.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","8"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570009","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS003","MIF002","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570009-01","Standard Silver On Exchange Plan",,"0.712793469429016","Yes","Yes","No","100%",,"$1,400","$20","$1,130","$150","$1,400","$810","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30%",,,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/4E0C3124257045389E5DDE161D780363.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","9"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570009","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS003","MIF002","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/39CACB2C70144292AA311629F9CC656E.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","10"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570009","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS003","MIF002","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570009-03","Limited Cost Sharing Plan Variation",,"0.712793469429016","Yes","Yes","No","100%",,"$1,400","$20","$1,130","$150","$1,400","$810","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30%",,,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/198A2EFE249940EB97373BAD1351374F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","11"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570009","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS003","MIF002","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570009-04","73% AV Level Silver Plan",,"0.734111845493317","Yes","Yes","No","100%",,"$1,200","$20","$1,190","$150","$1,200","$870","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$21800 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2400 per person","$2400 per group","30%",,,,,"$2,400","$4800 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/20DB9C4435E24CE79D89D7A5D04A9065.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","12"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","11","29698","MI","Individual","No","38-2715520","29698MI0570028","MyPriority POS Holistic Silver 2000","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570028-04","73% AV Level Silver Plan","73.95%","0.743276596069336","Yes","Yes","No","100%",,"$1,400","$10","$1,130","$150","$1,400","$330","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30%",,,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/641C933DBD3249589BA7D0673F5AEDCB.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","8"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","11","29698","MI","Individual","No","38-2715520","29698MI0570028","MyPriority POS Holistic Silver 2000","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570028-05","87% AV Level Silver Plan","87.80%","0.879944622516632","Yes","Yes","No","100%",,"$50","$0","$1,150","$150","$50","$500","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$2,400","$4800 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30%",,,,,"$100","$200 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/F2F5CCFE7B944ADABCD3392CA47BC353.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","9"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","11","29698","MI","Individual","No","38-2715520","29698MI0570028","MyPriority POS Holistic Silver 2000","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570028-06","94% AV Level Silver Plan","94.18%","0.942819476127625","Yes","Yes","No","100%",,"$25","$0","$380","$150","$25","$190","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$800","$1600 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30%",,,,,"$50","$100 per person","$100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/849AC36A281644CAB5CA0AA24B59922F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","10"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","11","29698","MI","Individual","No","38-2715520","29698MI0570036","MyPriority POS Holistic Silver 2000","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570036-00","Standard Silver Off Exchange Plan","69.99%","0.703923523426056","Yes","Yes","No","100%",,"$2,000","$10","$950","$150","$2,000","$300","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$27000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/A13A710F42DD4293AEB75A9D489F732F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","11"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","11","29698","MI","Individual","No","38-2715520","29698MI0570036","MyPriority POS Holistic Silver 2000","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570036-01","Standard Silver On Exchange Plan","69.99%","0.703923523426056","Yes","Yes","No","100%",,"$2,000","$10","$950","$150","$2,000","$300","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$27000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/A13A710F42DD4293AEB75A9D489F732F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","12"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570009","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS003","MIF002","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570009-05","87% AV Level Silver Plan",,"0.874316334724426","Yes","Yes","No","100%",,"$50","$0","$1,450","$150","$50","$880","$570","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30%",,,,,"$100","$200 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/35A318303EE94CE9BABC00A3EB6929C6.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","13"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570009","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS003","MIF002","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570009-06","94% AV Level Silver Plan",,"0.949907243251801","Yes","Yes","No","100%",,"$25","$0","$480","$150","$25","$270","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$800","$1600 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30%",,,,,"$50","$100 per person","$100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/B0BBABACC9D54F43BB76E9947A3DC764.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","14"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570034","MyPriority POS Bronze 6450","29698MI057",,"MIN001","MIS002","MIF002","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570034-00","Standard Bronze Off Exchange Plan",,"0.619651854038239","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$27400 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$12900 per person","$12900 per group","40%",,,,,"$12,900","$25800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/54797446399141E9B92B6EF888D46DC0.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","15"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570034","MyPriority POS Bronze 6450","29698MI057",,"MIN001","MIS002","MIF002","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570034-01","Standard Bronze On Exchange Plan",,"0.619651854038239","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$27400 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$12900 per person","$12900 per group","40%",,,,,"$12,900","$25800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/54797446399141E9B92B6EF888D46DC0.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","16"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570034","MyPriority POS Bronze 6450","29698MI057",,"MIN001","MIS002","MIF002","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570034-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/9F84C00A901346528FED1678BB523B7C.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","17"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570034","MyPriority POS Bronze 6450","29698MI057",,"MIN001","MIS002","MIF002","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570034-03","Limited Cost Sharing Plan Variation",,"0.619651854038239","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$27400 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$12900 per person","$12900 per group","40%",,,,,"$12,900","$25800 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/8A8407A355F84494AF3873B62401C55E.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","18"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570019","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS002","MIF002","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570019-00","Standard Silver Off Exchange Plan",,"0.712793469429016","Yes","Yes","No","100%",,"$1,400","$20","$1,130","$150","$1,400","$810","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30%",,,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/4E0C3124257045389E5DDE161D780363.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","19"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","11","29698","MI","Individual","No","38-2715520","29698MI0570036","MyPriority POS Holistic Silver 2000","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570036-06","94% AV Level Silver Plan","94.18%","0.942819476127625","Yes","Yes","No","100%",,"$25","$0","$380","$150","$25","$190","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$800","$1600 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30%",,,,,"$50","$100 per person","$100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/849AC36A281644CAB5CA0AA24B59922F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","17"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","12","29698","MI","Individual","No","38-2715520","29698MI0540026","MyPriority HMO Holistic Silver 2000","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540026-00","Standard Silver Off Exchange Plan","69.99%","0.703923523426056","Yes","Yes","No","100%",,"$2,000","$10","$950","$150","$2,000","$300","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/9776A572B5A34CA4B3C3BA182AFA603F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-holistic?utm_source=FFM&utm_content=HMO_Holistic&utm_campaign=2016OEP","4"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570019","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS002","MIF002","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570019-01","Standard Silver On Exchange Plan",,"0.712793469429016","Yes","Yes","No","100%",,"$1,400","$20","$1,130","$150","$1,400","$810","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30%",,,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/4E0C3124257045389E5DDE161D780363.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","20"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570019","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS002","MIF002","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/39CACB2C70144292AA311629F9CC656E.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","21"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570019","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS002","MIF002","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570019-03","Limited Cost Sharing Plan Variation",,"0.712793469429016","Yes","Yes","No","100%",,"$1,400","$20","$1,130","$150","$1,400","$810","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","$26400 per person","$26400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30%",,,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/198A2EFE249940EB97373BAD1351374F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","22"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570019","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS002","MIF002","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570019-04","73% AV Level Silver Plan",,"0.734111845493317","Yes","Yes","No","100%",,"$1,200","$20","$1,190","$150","$1,200","$870","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$21800 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$2400 per person","$2400 per group","30%",,,,,"$2,400","$4800 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/20DB9C4435E24CE79D89D7A5D04A9065.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","23"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570019","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS002","MIF002","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570019-05","87% AV Level Silver Plan",,"0.874316334724426","Yes","Yes","No","100%",,"$50","$0","$1,450","$150","$50","$880","$570","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$6000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30%",,,,,"$100","$200 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/35A318303EE94CE9BABC00A3EB6929C6.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","24"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","8","29698","MI","Individual","No","38-2715520","29698MI0570019","MyPriority POS Silver 1400","29698MI057",,"MIN001","MIS002","MIF002","Existing","POS","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0570019-06","94% AV Level Silver Plan",,"0.949907243251801","Yes","Yes","No","100%",,"$25","$0","$480","$150","$25","$270","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$800","$1600 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30%",,,,,"$50","$100 per person","$100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/B0BBABACC9D54F43BB76E9947A3DC764.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos?utm_source=FFM&utm_content=POS&utm_campaign=2016OEP","25"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","9","29698","MI","Individual","No","38-2715520","29698MI0570027","MyPriority POS Holistic Bronze 5200","29698MI057",,"MIN001","MIS003","MIF006","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570027-00","Standard Bronze Off Exchange Plan","61.67%","0.628741979598999","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,200","$10","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$27400 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$10400 per person","$10400 per group","50%",,,,,"$10,400","$20800 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/C887E0E8153647EA970B8D946AF11F50.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","4"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","9","29698","MI","Individual","No","38-2715520","29698MI0570027","MyPriority POS Holistic Bronze 5200","29698MI057",,"MIN001","MIS003","MIF006","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570027-01","Standard Bronze On Exchange Plan","61.67%","0.628741979598999","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,200","$10","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$27400 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$10400 per person","$10400 per group","50%",,,,,"$10,400","$20800 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/C887E0E8153647EA970B8D946AF11F50.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","5"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","9","29698","MI","Individual","No","38-2715520","29698MI0570027","MyPriority POS Holistic Bronze 5200","29698MI057",,"MIN001","MIS003","MIF006","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570027-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/63312BFD5317415DAA6AF168A2AC9EE8.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","6"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","9","29698","MI","Individual","No","38-2715520","29698MI0570027","MyPriority POS Holistic Bronze 5200","29698MI057",,"MIN001","MIS003","MIF006","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570027-03","Limited Cost Sharing Plan Variation","61.67%","0.628741979598999","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,200","$10","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$27400 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$10400 per person","$10400 per group","50%",,,,,"$10,400","$20800 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/21C2F50B99AF40A2BFD57BE5164A4E1B.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","7"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","9","29698","MI","Individual","No","38-2715520","29698MI0570035","MyPriority POS Holistic Bronze 5200","29698MI057",,"MIN001","MIS002","MIF006","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570035-00","Standard Bronze Off Exchange Plan","61.67%","0.628741979598999","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,200","$10","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$27400 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$10400 per person","$10400 per group","50%",,,,,"$10,400","$20800 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/C887E0E8153647EA970B8D946AF11F50.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","8"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","9","29698","MI","Individual","No","38-2715520","29698MI0570035","MyPriority POS Holistic Bronze 5200","29698MI057",,"MIN001","MIS002","MIF006","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570035-01","Standard Bronze On Exchange Plan","61.67%","0.628741979598999","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,200","$10","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$27400 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$10400 per person","$10400 per group","50%",,,,,"$10,400","$20800 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/C887E0E8153647EA970B8D946AF11F50.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","9"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","9","29698","MI","Individual","No","38-2715520","29698MI0570035","MyPriority POS Holistic Bronze 5200","29698MI057",,"MIN001","MIS002","MIF006","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570035-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/63312BFD5317415DAA6AF168A2AC9EE8.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","10"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","9","29698","MI","Individual","No","38-2715520","29698MI0570035","MyPriority POS Holistic Bronze 5200","29698MI057",,"MIN001","MIS002","MIF006","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570035-03","Limited Cost Sharing Plan Variation","61.67%","0.628741979598999","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,200","$10","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$27400 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$10400 per person","$10400 per group","50%",,,,,"$10,400","$20800 per person","$20800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/21C2F50B99AF40A2BFD57BE5164A4E1B.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","11"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","10","29698","MI","Individual","No","38-2715520","29698MI0540017","MyPriority HMO RxPlus Bronze 3975","29698MI054",,"MIN001","MIS001","MIF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","2","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540017-00","Standard Bronze Off Exchange Plan",,"0.619416475296021","Yes","Yes","No","100%",,"$3,975","$20","$600","$150","$3,975","$430","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,975","$7950 per person","$7950 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/CF67EDEB543140A5AA595E338B05D7AD.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","4"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","10","29698","MI","Individual","No","38-2715520","29698MI0540017","MyPriority HMO RxPlus Bronze 3975","29698MI054",,"MIN001","MIS001","MIF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","2","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540017-01","Standard Bronze On Exchange Plan",,"0.619416475296021","Yes","Yes","No","100%",,"$3,975","$20","$600","$150","$3,975","$430","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,975","$7950 per person","$7950 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/CF67EDEB543140A5AA595E338B05D7AD.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","5"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","10","29698","MI","Individual","No","38-2715520","29698MI0540017","MyPriority HMO RxPlus Bronze 3975","29698MI054",,"MIN001","MIS001","MIF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","2","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/F71D750F1755423696535CD7CBE2EDD9.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","6"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","10","29698","MI","Individual","No","38-2715520","29698MI0540017","MyPriority HMO RxPlus Bronze 3975","29698MI054",,"MIN001","MIS001","MIF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$400","0","0","2","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/72DB01D097EB4330B0C672C88FD61592.pdf","29698MI0540017-03","Limited Cost Sharing Plan Variation",,"0.619416475296021","Yes","Yes","No","100%",,"$3,975","$20","$600","$150","$3,975","$430","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,975","$7950 per person","$7950 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/CBC7C795EFAB458C86E60BA827AF66DE.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-rxplus?utm_source=FFM&utm_content=HMO_RxPlus&utm_campaign=2016OEP","7"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","11","29698","MI","Individual","No","38-2715520","29698MI0570028","MyPriority POS Holistic Silver 2000","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570028-00","Standard Silver Off Exchange Plan","69.99%","0.703923523426056","Yes","Yes","No","100%",,"$2,000","$10","$950","$150","$2,000","$300","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$27000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/A13A710F42DD4293AEB75A9D489F732F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","4"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","11","29698","MI","Individual","No","38-2715520","29698MI0570028","MyPriority POS Holistic Silver 2000","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570028-01","Standard Silver On Exchange Plan","69.99%","0.703923523426056","Yes","Yes","No","100%",,"$2,000","$10","$950","$150","$2,000","$300","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$27000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/A13A710F42DD4293AEB75A9D489F732F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","5"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","11","29698","MI","Individual","No","38-2715520","29698MI0570028","MyPriority POS Holistic Silver 2000","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570028-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/7D98F791D325463C9DF459B5E0E4C71D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","6"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","11","29698","MI","Individual","No","38-2715520","29698MI0570028","MyPriority POS Holistic Silver 2000","29698MI057",,"MIN001","MIS003","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570028-03","Limited Cost Sharing Plan Variation","69.99%","0.703923523426056","Yes","Yes","No","100%",,"$2,000","$10","$950","$150","$2,000","$300","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$27000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/1B40F75844754CC2B486413F0C5090B5.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","7"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","11","29698","MI","Individual","No","38-2715520","29698MI0570036","MyPriority POS Holistic Silver 2000","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570036-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/7D98F791D325463C9DF459B5E0E4C71D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","13"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","11","29698","MI","Individual","No","38-2715520","29698MI0570036","MyPriority POS Holistic Silver 2000","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570036-03","Limited Cost Sharing Plan Variation","69.99%","0.703923523426056","Yes","Yes","No","100%",,"$2,000","$10","$950","$150","$2,000","$300","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"$13,500","$27000 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30%",,,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/1B40F75844754CC2B486413F0C5090B5.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","14"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","11","29698","MI","Individual","No","38-2715520","29698MI0570036","MyPriority POS Holistic Silver 2000","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570036-04","73% AV Level Silver Plan","73.95%","0.743276596069336","Yes","Yes","No","100%",,"$1,400","$10","$1,130","$150","$1,400","$330","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$20000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30%",,,,,"$2,800","$5600 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/641C933DBD3249589BA7D0673F5AEDCB.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","15"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","11","29698","MI","Individual","No","38-2715520","29698MI0570036","MyPriority POS Holistic Silver 2000","29698MI057",,"MIN001","MIS002","MIF003","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency services only","Yes","Alternate/Out of Network Benefit Coverage","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0570036-05","87% AV Level Silver Plan","87.80%","0.879944622516632","Yes","Yes","No","100%",,"$50","$0","$1,150","$150","$50","$500","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$2,400","$4800 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30%",,,,,"$100","$200 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/F2F5CCFE7B944ADABCD3392CA47BC353.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-pos-holistic?utm_source=FFM&utm_content=POS_Holistic&utm_campaign=2016OEP","16"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","12","29698","MI","Individual","No","38-2715520","29698MI0540026","MyPriority HMO Holistic Silver 2000","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540026-01","Standard Silver On Exchange Plan","69.99%","0.703923523426056","Yes","Yes","No","100%",,"$2,000","$10","$950","$150","$2,000","$300","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/9776A572B5A34CA4B3C3BA182AFA603F.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-holistic?utm_source=FFM&utm_content=HMO_Holistic&utm_campaign=2016OEP","5"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","12","29698","MI","Individual","No","38-2715520","29698MI0540026","MyPriority HMO Holistic Silver 2000","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540026-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/660E9F753AD14D4DB8A404B0F08BCE0E.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-holistic?utm_source=FFM&utm_content=HMO_Holistic&utm_campaign=2016OEP","6"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","12","29698","MI","Individual","No","38-2715520","29698MI0540026","MyPriority HMO Holistic Silver 2000","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540026-03","Limited Cost Sharing Plan Variation","69.99%","0.703923523426056","Yes","Yes","No","100%",,"$2,000","$10","$950","$150","$2,000","$300","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/F2CFDA1DE911406A936FE29BC3D5CF92.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-holistic?utm_source=FFM&utm_content=HMO_Holistic&utm_campaign=2016OEP","7"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","12","29698","MI","Individual","No","38-2715520","29698MI0540026","MyPriority HMO Holistic Silver 2000","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540026-04","73% AV Level Silver Plan","73.95%","0.743276596069336","Yes","Yes","No","100%",,"$1,400","$10","$1,130","$150","$1,400","$330","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/2CC151383CA44A19875C41791DDA7844.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-holistic?utm_source=FFM&utm_content=HMO_Holistic&utm_campaign=2016OEP","8"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","12","29698","MI","Individual","No","38-2715520","29698MI0540026","MyPriority HMO Holistic Silver 2000","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540026-05","87% AV Level Silver Plan","87.80%","0.879944622516632","Yes","Yes","No","100%",,"$50","$0","$1,150","$150","$50","$500","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/1DB2790D957049BAA9B23A60C78B256B.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-holistic?utm_source=FFM&utm_content=HMO_Holistic&utm_campaign=2016OEP","9"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","12","29698","MI","Individual","No","38-2715520","29698MI0540026","MyPriority HMO Holistic Silver 2000","29698MI054",,"MIN001","MIS001","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540026-06","94% AV Level Silver Plan","94.18%","0.942819476127625","Yes","Yes","No","100%",,"$25","$0","$380","$150","$25","$190","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/23BC0AB62E91435B84BAFD86D61C1D61.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-hmo-holistic?utm_source=FFM&utm_content=HMO_Holistic&utm_campaign=2016OEP","10"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","12","29698","MI","Individual","No","38-2715520","29698MI0540027","MyPriority Holistic Silver - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540026","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540027-00","Standard Silver Off Exchange Plan","69.99%","0.703923523426056","Yes","Yes","No","100%",,"$2,000","$10","$950","$150","$2,000","$300","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/C3C0F129CC58466BBBB300226EB69A0D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-holistic-spectrum-health-parnters?utm_source=FFM&utm_content=Holistic_SHP&utm_campaign=2016OEP","11"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","12","29698","MI","Individual","No","38-2715520","29698MI0540027","MyPriority Holistic Silver - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540026","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540027-01","Standard Silver On Exchange Plan","69.99%","0.703923523426056","Yes","Yes","No","100%",,"$2,000","$10","$950","$150","$2,000","$300","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/C3C0F129CC58466BBBB300226EB69A0D.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-holistic-spectrum-health-parnters?utm_source=FFM&utm_content=Holistic_SHP&utm_campaign=2016OEP","12"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","12","29698","MI","Individual","No","38-2715520","29698MI0540027","MyPriority Holistic Silver - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540026","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540027-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/FDEC0C8899E446FA91B7B73FBE5EF3AF.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-holistic-spectrum-health-parnters?utm_source=FFM&utm_content=Holistic_SHP&utm_campaign=2016OEP","13"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","12","29698","MI","Individual","No","38-2715520","29698MI0540027","MyPriority Holistic Silver - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540026","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540027-03","Limited Cost Sharing Plan Variation","69.99%","0.703923523426056","Yes","Yes","No","100%",,"$2,000","$10","$950","$150","$2,000","$300","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,750","$6750 per person","$13500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/9255A63E7417472F98D6F8016432A723.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-holistic-spectrum-health-parnters?utm_source=FFM&utm_content=Holistic_SHP&utm_campaign=2016OEP","14"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","12","29698","MI","Individual","No","38-2715520","29698MI0540027","MyPriority Holistic Silver - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540026","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540027-04","73% AV Level Silver Plan","73.95%","0.743276596069336","Yes","Yes","No","100%",,"$1,400","$10","$1,130","$150","$1,400","$330","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per person","$2800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/F63BF7D282E742599C8A90E7E5F16C53.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-holistic-spectrum-health-parnters?utm_source=FFM&utm_content=Holistic_SHP&utm_campaign=2016OEP","15"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","12","29698","MI","Individual","No","38-2715520","29698MI0540027","MyPriority Holistic Silver - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540026","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540027-05","87% AV Level Silver Plan","87.80%","0.879944622516632","Yes","Yes","No","100%",,"$50","$0","$1,150","$150","$50","$500","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$100 per person","$100 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/EF85682E4F2F4E24B8E71D93826C0998.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-holistic-spectrum-health-parnters?utm_source=FFM&utm_content=Holistic_SHP&utm_campaign=2016OEP","16"
"2016","MI","29698","SERFF","7","2016-01-29 07:27:50","12","29698","MI","Individual","No","38-2715520","29698MI0540027","MyPriority Holistic Silver - Spectrum Health Partners","29698MI054",,"MIN002","MIS004","MIF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult-Only","29698MI0540026","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9941",,,"$400","0","2","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/5313AA8EB3FD464AA2E4955B49C1E3F1.pdf","29698MI0540027-06","94% AV Level Silver Plan","94.18%","0.942819476127625","Yes","Yes","No","100%",,"$25","$0","$380","$150","$25","$190","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$25","$50 per person","$50 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.priorityhealth.com/~/media/51BFDB84CB074E529B9E938B321FDC82.pdf","http://www.priorityhealth.com/plans/individual-family/mypriority-insurance-plans/2016/mypriority-holistic-spectrum-health-parnters?utm_source=FFM&utm_content=Holistic_SHP&utm_campaign=2016OEP","17"
"2016","MI","31256","SERFF","7","2016-04-05 14:32:29","1","31256","MI","SHOP (Small Group)","Yes","38-2587320","31256MI0020001","DENCAP Choice Dental Plan 1 to 2 Lives","31256MI002",,"MIN001","MIS001",,"New","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$4.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.dencap.com","","31256MI0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$700 per person","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$700 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.com","http://www.dencap.com","4"
"2016","MI","31256","SERFF","7","2016-04-05 14:32:29","1","31256","MI","Individual","Yes","38-2587320","31256MI0010001","DENCAP Senior Value Dental Plan","31256MI001",,"MIN001","MIS001",,"New","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$4.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.dencap.com","","31256MI0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$700 per person","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$700 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.com","http://www.dencap.com","4"
"2016","MI","31256","SERFF","7","2016-04-05 14:32:29","1","31256","MI","SHOP (Small Group)","Yes","38-2587320","31256MI0020002","DENCAP Choice Dental Plan 3 + Lives","31256MI002",,"MIN001","MIS001",,"New","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$4.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.dencap.com","","31256MI0020002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$700 per person","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$700 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.com","http://www.dencap.com","5"
"2016","MI","31256","SERFF","7","2016-04-05 14:32:29","1","31256","MI","SHOP (Small Group)","Yes","38-2587320","31256MI0020003","DENCAP Hallmark Dental Plan","31256MI002",,"MIN001","MIS001",,"New","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$4.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.dencap.com","","31256MI0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$700 per person","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$700 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.com","http://www.dencap.com","6"
"2016","MI","31256","SERFF","7","2016-04-05 14:32:29","1","31256","MI","SHOP (Small Group)","Yes","38-2587320","31256MI0020004","DENCAP Grand Dental Plan","31256MI002",,"MIN001","MIS001",,"New","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$4.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.dencap.com","","31256MI0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$700 per person","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$700 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.com","http://www.dencap.com","7"
"2016","MI","31256","SERFF","7","2016-04-05 14:32:29","2","31256","MI","SHOP (Small Group)","Yes","38-2587320","31256MI0020005","DENCAP Freedom Dental Plan","31256MI002",,"MIN001","MIS001",,"New","HMO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$4.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.dencap.com","","31256MI0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$700 per person","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$700 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.com","http://www.dencap.com","4"
"2016","MI","31256","SERFF","7","2016-04-05 14:32:29","2","31256","MI","Individual","Yes","38-2587320","31256MI0010002","DENCAP Individual Value Dental Plan","31256MI001",,"MIN001","MIS001",,"New","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$4.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.dencap.com","","31256MI0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$700 per person","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$700 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.com","http://www.dencap.com","4"
"2016","MI","31256","SERFF","7","2016-04-05 14:32:29","2","31256","MI","Individual","Yes","38-2587320","31256MI0010003","DENCAP Student Individual Value Dental Plan","31256MI001",,"MIN001","MIS001",,"New","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$5.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.dencap.com","","31256MI0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$700 per person","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$700 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.com","http://www.dencap.com","5"
"2016","MI","31256","SERFF","7","2016-04-05 14:32:29","3","31256","MI","Individual","Yes","38-2587320","31256MI0010004","DENCAP Select Dental Plan","31256MI001",,"MIN001","MIS001",,"New","HMO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$4.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.dencap.com","","31256MI0010004-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$700 per person","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$700 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.com","http://www.dencap.com","4"
"2016","MI","31256","SERFF","7","2016-04-05 14:32:29","3","31256","MI","SHOP (Small Group)","Yes","38-2587320","31256MI0020006","DENCAP Freedom Plus Dental Plan","31256MI002",,"MIN001","MIS001",,"New","HMO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$4.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.dencap.com","","31256MI0020006-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$700 per person","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$700 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.com","http://www.dencap.com","4"
"2016","MI","31256","SERFF","7","2016-04-05 14:32:29","4","31256","MI","Individual","Yes","38-2587320","31256MI0010005","DENCAP Select Plus Dental Plan","31256MI001",,"MIN001","MIS001",,"New","HMO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$4.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.dencap.com","","31256MI0010005-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$700 per person","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$700 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dencap.com","http://www.dencap.com","4"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","1","34620","MI","Individual","No","38-3295207","34620MI0050001","Harbor Choice Gold","34620MI005",,"MIN001","MIS001","MIF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0050001-00","Standard Gold Off Exchange Plan",,"0.816502869129181","Yes","Yes","No","100%",,"$1,500","$4","$1,160","$0","$750","$108","$190","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harborhealthchoice.com/Gold-HMO","https://www.harborhealthchoice.com/brochure","4"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","1","34620","MI","Individual","No","38-3295207","34620MI0050001","Harbor Choice Gold","34620MI005",,"MIN001","MIS001","MIF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0050001-01","Standard Gold On Exchange Plan",,"0.816502869129181","Yes","Yes","No","100%",,"$1,500","$4","$1,160","$0","$750","$108","$190","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harborhealthchoice.com/Gold-HMO","https://www.harborhealthchoice.com/brochure","5"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","1","34620","MI","Individual","No","38-3295207","34620MI0050001","Harbor Choice Gold","34620MI005",,"MIN001","MIS001","MIF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0050001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harborhealthchoice.com/Gold-ZCS","https://www.harborhealthchoice.com/brochure","6"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","1","34620","MI","Individual","No","38-3295207","34620MI0050001","Harbor Choice Gold","34620MI005",,"MIN001","MIS001","MIF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0050001-03","Limited Cost Sharing Plan Variation",,"0.816502869129181","Yes","Yes","No","100%",,"$1,500","$4","$1,160","$0","$750","$108","$190","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harborhealthchoice.com/Gold-LCS","https://www.harborhealthchoice.com/brochure","7"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","1","34620","MI","Individual","No","38-3295207","34620MI0050002","Harbor Choice Silver","34620MI005",,"MIN001","MIS001","MIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0050002-00","Standard Silver Off Exchange Plan",,"0.689906895160675","Yes","Yes","No","100%",,"$4,400","$115","$440","$0","$1,600","$410","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harborhealthchoice.com/Silver-HMO","https://www.harborhealthchoice.com/brochure","8"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","1","34620","MI","Individual","No","38-3295207","34620MI0050002","Harbor Choice Silver","34620MI005",,"MIN001","MIS001","MIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0050002-01","Standard Silver On Exchange Plan",,"0.689906895160675","Yes","Yes","No","100%",,"$4,400","$115","$440","$0","$1,600","$410","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harborhealthchoice.com/Silver-HMO","https://www.harborhealthchoice.com/brochure","9"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","1","34620","MI","Individual","No","38-3295207","34620MI0050002","Harbor Choice Silver","34620MI005",,"MIN001","MIS001","MIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0050002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harborhealthchoice.com/Silver-ZCS","https://www.harborhealthchoice.com/brochure","10"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","1","34620","MI","Individual","No","38-3295207","34620MI0050002","Harbor Choice Silver","34620MI005",,"MIN001","MIS001","MIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0050002-03","Limited Cost Sharing Plan Variation",,"0.689906895160675","Yes","Yes","No","100%",,"$4,400","$115","$440","$0","$1,600","$410","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harborhealthchoice.com/Silver-LCS","https://www.harborhealthchoice.com/brochure","11"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","1","34620","MI","Individual","No","38-3295207","34620MI0050002","Harbor Choice Silver","34620MI005",,"MIN001","MIS001","MIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0050002-04","73% AV Level Silver Plan",,"0.739639163017273","Yes","Yes","No","100%",,"$3,200","$90","$680","$0","$1,600","$190","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harborhealthchoice.com/Silver-73-CSR","https://www.harborhealthchoice.com/brochure","12"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","1","34620","MI","Individual","No","38-3295207","34620MI0050002","Harbor Choice Silver","34620MI005",,"MIN001","MIS001","MIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0050002-05","87% AV Level Silver Plan",,"0.877873063087463","Yes","Yes","No","100%",,"$1,200","$0","$540","$0","$600","$0","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harborhealthchoice.com/Silver-87-CSR","https://www.harborhealthchoice.com/brochure","13"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","1","34620","MI","Individual","No","38-3295207","34620MI0050002","Harbor Choice Silver","34620MI005",,"MIN001","MIS001","MIF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0050002-06","94% AV Level Silver Plan",,"0.949792325496674","Yes","Yes","No","100%",,"$200","$0","$610","$0","$100","$0","$150","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$630","$630 per person","$1260 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harborhealthchoice.com/Silver-94-CSR","https://www.harborhealthchoice.com/brochure","14"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","1","34620","MI","Individual","No","38-3295207","34620MI0050003","Harbor Choice Bronze","34620MI005",,"MIN001","MIS001","MIF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9998",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0050003-00","Standard Bronze Off Exchange Plan",,"0.61615389585495","Yes","Yes","No","100%",,"$5,200","$25","$420","$0","$1,700","$480","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harborhealthchoice.com/Bronze-HMO","https://www.harborhealthchoice.com/brochure","15"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","1","34620","MI","Individual","No","38-3295207","34620MI0050003","Harbor Choice Bronze","34620MI005",,"MIN001","MIS001","MIF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9998",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0050003-01","Standard Bronze On Exchange Plan",,"0.61615389585495","Yes","Yes","No","100%",,"$5,200","$25","$420","$0","$1,700","$480","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harborhealthchoice.com/Bronze-HMO","https://www.harborhealthchoice.com/brochure","16"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","1","34620","MI","Individual","No","38-3295207","34620MI0050003","Harbor Choice Bronze","34620MI005",,"MIN001","MIS001","MIF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9998",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0050003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harborhealthchoice.com/Bronze-ZCS","https://www.harborhealthchoice.com/brochure","17"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","1","34620","MI","Individual","No","38-3295207","34620MI0050003","Harbor Choice Bronze","34620MI005",,"MIN001","MIS001","MIF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9998",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0050003-03","Limited Cost Sharing Plan Variation",,"0.61615389585495","Yes","Yes","No","100%",,"$5,200","$25","$420","$0","$1,700","$480","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harborhealthchoice.com/Bronze-LCS","https://www.harborhealthchoice.com/brochure","18"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","2","34620","MI","Individual","No","38-3295207","34620MI0060002","Harbor Choice Plus Silver","34620MI006",,"MIN002","MIS001","MIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.897",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0060002-00","Standard Silver Off Exchange Plan",,"0.689906895160675","Yes","Yes","No","100%",,"$4,400","$115","$440","$0","$1,600","$410","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harborhealthchoice.com/Plus-Silver-Standard","https://www.harborhealthchoice.com/brochure","4"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","2","34620","MI","Individual","No","38-3295207","34620MI0060002","Harbor Choice Plus Silver","34620MI006",,"MIN002","MIS001","MIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.897",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0060002-01","Standard Silver On Exchange Plan",,"0.689906895160675","Yes","Yes","No","100%",,"$4,400","$115","$440","$0","$1,600","$410","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harborhealthchoice.com/Plus-Silver-Standard","https://www.harborhealthchoice.com/brochure","5"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","2","34620","MI","Individual","No","38-3295207","34620MI0060002","Harbor Choice Plus Silver","34620MI006",,"MIN002","MIS001","MIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.897",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0060002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harborhealthchoice.com/Plus-Silver-Zero-Cost-Share","https://www.harborhealthchoice.com/brochure","6"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","2","34620","MI","Individual","No","38-3295207","34620MI0060002","Harbor Choice Plus Silver","34620MI006",,"MIN002","MIS001","MIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.897",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0060002-03","Limited Cost Sharing Plan Variation",,"0.689906895160675","Yes","Yes","No","100%",,"$4,400","$115","$440","$0","$1,600","$410","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harborhealthchoice.com/Plus-Silver-Limited-Cost-Share","https://www.harborhealthchoice.com/brochure","7"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","2","34620","MI","Individual","No","38-3295207","34620MI0060002","Harbor Choice Plus Silver","34620MI006",,"MIN002","MIS001","MIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.897",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0060002-04","73% AV Level Silver Plan",,"0.739639163017273","Yes","Yes","No","100%",,"$3,200","$90","$680","$0","$1,600","$190","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,300","$2300 per person","$4600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harborhealthchoice.com/Plus-Silver-73-AV","https://www.harborhealthchoice.com/brochure","8"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","2","34620","MI","Individual","No","38-3295207","34620MI0060002","Harbor Choice Plus Silver","34620MI006",,"MIN002","MIS001","MIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.897",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0060002-05","87% AV Level Silver Plan",,"0.877873063087463","Yes","Yes","No","100%",,"$1,200","$0","$540","$0","$600","$0","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harborhealthchoice.com/Plus-Silver-87-AV","https://www.harborhealthchoice.com/brochure","9"
"2016","MI","34620","SERFF","3","2015-08-22 23:36:24","2","34620","MI","Individual","No","38-3295207","34620MI0060002","Harbor Choice Plus Silver","34620MI006",,"MIN002","MIS001","MIF004","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.897",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://hix-enroll.healthconnectsystems.com/ffm/ffmpayment.aspx?state=MI","https://www.harborhealthchoice.com/Formulary","34620MI0060002-06","94% AV Level Silver Plan",,"0.949792325496674","Yes","Yes","No","100%",,"$200","$0","$610","$0","$100","$0","$150","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$630","$630 per person","$1260 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.harborhealthchoice.com/Plus-Silver-94-AV","https://www.harborhealthchoice.com/brochure","10"
"2016","MI","34930","SERFF","3","2015-08-22 23:36:24","1","34930","MI","Individual","Yes","38-1791480","34930MI0090001","Delta Dental Individual PPO, EHB Certified","34930MI009",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.51","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","34930MI0090001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MI","34930","SERFF","3","2015-08-22 23:36:24","1","34930","MI","SHOP (Small Group)","Yes","38-1791480","34930MI0100001","Delta Dental Group PPO, EHB Certified","34930MI010",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.08","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","34930MI0100001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MI","34930","SERFF","3","2015-08-22 23:36:24","1","34930","MI","Individual","Yes","38-1791480","34930MI0090002","Delta Dental Individual PPO, EHB Certified","34930MI009",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.70","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","34930MI0090002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MI","34930","SERFF","3","2015-08-22 23:36:24","1","34930","MI","SHOP (Small Group)","Yes","38-1791480","34930MI0100002","Delta Dental Group PPO, EHB Certified","34930MI010",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.06","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","34930MI0100002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MI","34930","SERFF","3","2015-08-22 23:36:24","1","34930","MI","SHOP (Small Group)","Yes","38-1791480","34930MI0100003","Delta Dental Group PPO, EHB Certified","34930MI010",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.08","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","34930MI0100003-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","MI","34930","SERFF","3","2015-08-22 23:36:24","1","34930","MI","Individual","Yes","38-1791480","34930MI0150001","Delta Dental Individual PPO, EHB Certified (Exchange)","34930MI015",,"MIN001","MIS001",,"New","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.51","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/34930","","34930MI0150001-01","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmi.com/MI_EHB_High_2016","http://www.deltadentalmi.com/MI_EHB_High_2016","6"
"2016","MI","34930","SERFF","3","2015-08-22 23:36:24","1","34930","MI","SHOP (Small Group)","Yes","38-1791480","34930MI0100004","Delta Dental Group PPO, EHB Certified","34930MI010",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.06","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","34930MI0100004-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","MI","34930","SERFF","3","2015-08-22 23:36:24","1","34930","MI","Individual","Yes","38-1791480","34930MI0150002","Delta Dental Individual PPO, EHB Certified (Exchange)","34930MI015",,"MIN001","MIS001",,"New","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.70","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/34930","","34930MI0150002-01","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmi.com/MI_EHB_Low_2016","http://www.deltadentalmi.com/MI_EHB_Low_2016","7"
"2016","MI","34930","SERFF","3","2015-08-22 23:36:24","1","34930","MI","SHOP (Small Group)","Yes","38-1791480","34930MI0160001","Delta Dental Group PPO, EHB Certified (Exchange)","34930MI016",,"MIN001","MIS001",,"New","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.78","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","34930MI0160001-01","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmi.com/MI_EHB_Group_High_2016","http://www.deltadentalmi.com/MI_EHB_Group_High_2016","8"
"2016","MI","34930","SERFF","3","2015-08-22 23:36:24","1","34930","MI","SHOP (Small Group)","Yes","38-1791480","34930MI0160002","Delta Dental Group PPO, EHB Certified (Exchange)","34930MI016",,"MIN001","MIS001",,"New","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.83","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","34930MI0160002-01","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmi.com/MI_EHB_Group_Low_2016","http://www.deltadentalmi.com/MI_EHB_Group_Low_2016","9"
"2016","MI","34930","SERFF","3","2015-08-22 23:36:24","2","34930","MI","Individual","Yes","38-1791480","34930MI0120001","Delta Dental Individual Pediatric-Only PPO, EHB Certified","34930MI012",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$31.26","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","34930MI0120001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MI","34930","SERFF","3","2015-08-22 23:36:24","2","34930","MI","SHOP (Small Group)","Yes","38-1791480","34930MI0110001","Delta Dental Group Pediatric-Only PPO, EHB Certified","34930MI011",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$31.62","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","34930MI0110001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MI","34930","SERFF","3","2015-08-22 23:36:24","2","34930","MI","SHOP (Small Group)","Yes","38-1791480","34930MI0110002","Delta Dental Group Pediatric-Only PPO, EHB Certified","34930MI011",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$26.10","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","34930MI0110002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MI","34930","SERFF","3","2015-08-22 23:36:24","2","34930","MI","Individual","Yes","38-1791480","34930MI0120002","Delta Dental Individual Pediatric-Only PPO, EHB Certified","34930MI012",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$23.00","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","34930MI0120002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MI","34930","SERFF","3","2015-08-22 23:36:24","2","34930","MI","Individual","Yes","38-1791480","34930MI0170001","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","34930MI017",,"MIN001","MIS001",,"New","PPO","High",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$31.26","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/34930","","34930MI0170001-01","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmi.com/MI_Ped_High_2016","http://www.deltadentalmi.com/MI_Ped_High_2016","6"
"2016","MI","34930","SERFF","3","2015-08-22 23:36:24","2","34930","MI","SHOP (Small Group)","Yes","38-1791480","34930MI0110003","Delta Dental Group Pediatric-Only PPO, EHB Certified","34930MI011",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$31.62","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","34930MI0110003-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","MI","34930","SERFF","3","2015-08-22 23:36:24","2","34930","MI","SHOP (Small Group)","Yes","38-1791480","34930MI0110004","Delta Dental Group Pediatric-Only PPO, EHB Certified","34930MI011",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$26.10","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","34930MI0110004-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","MI","34930","SERFF","3","2015-08-22 23:36:24","2","34930","MI","Individual","Yes","38-1791480","34930MI0170002","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","34930MI017",,"MIN001","MIS001",,"New","PPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$23.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/34930","","34930MI0170002-01","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalmi.com/MI_Ped_Low_2016","http://www.deltadentalmi.com/MI_Ped_Low_2016","7"
"2016","MI","35700","SERFF","3","2015-08-25 12:56:34","1","35700","MI","Individual","Yes","95-6042390","35700MI0020003","BESTOne Advantage Gold","35700MI002",,"MIN001","MIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.90","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MI/2016/MI_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","MI","35700","SERFF","3","2015-08-25 12:56:34","1","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010037","BESTDental Premium","35700MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"31.12","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes",,"","35700MI0010037-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MI/2015/MI_BESTDental_Premium_Plan.pdf","http://www.bestlife.com/MI/2015/MI_BESTDental_Premium_Plan.pdf","4"
"2016","MI","35700","SERFF","3","2015-08-25 12:56:34","1","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010037","BESTDental Premium","35700MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"31.12","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes",,"","35700MI0010037-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MI/2015/MI_BESTDental_Premium_Plan.pdf","http://www.bestlife.com/MI/2015/MI_BESTDental_Premium_Plan.pdf","5"
"2016","MI","35700","SERFF","3","2015-08-25 12:56:34","1","35700","MI","Individual","Yes","95-6042390","35700MI0020003","BESTOne Advantage Gold","35700MI002",,"MIN001","MIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.90","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MI/2016/MI_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","MI","35700","SERFF","3","2015-08-25 12:56:34","1","35700","MI","Individual","Yes","95-6042390","35700MI0020004","BESTOne Plus Gold","35700MI002",,"MIN001","MIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.90","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MI/2016/MI_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","MI","35700","SERFF","3","2015-08-25 12:56:34","1","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010038","BESTDental Standard - H","35700MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"31.12","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes",,"","35700MI0010038-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MI/2015/MI_BESTDental_Standard-H_Plan.pdf","http://www.bestlife.com/MI/2015/MI_BESTDental_Standard-H_Plan.pdf","6"
"2016","MI","35700","SERFF","3","2015-08-25 12:56:34","1","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010038","BESTDental Standard - H","35700MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"31.12","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes",,"","35700MI0010038-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MI/2015/MI_BESTDental_Standard-H_Plan.pdf","http://www.bestlife.com/MI/2015/MI_BESTDental_Standard-H_Plan.pdf","7"
"2016","MI","35700","SERFF","3","2015-08-25 12:56:34","1","35700","MI","Individual","Yes","95-6042390","35700MI0020004","BESTOne Plus Gold","35700MI002",,"MIN001","MIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.90","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/MI/2016/MI_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","MI","35700","SERFF","3","2015-08-25 12:56:34","1","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010040","BESTDental Choice - H","35700MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"31.12","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes",,"","35700MI0010040-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MI/2015/MI_BESTDental_Choice-H_Plan.pdf","http://www.bestlife.com/MI/2015/MI_BESTDental_Choice-H_Plan.pdf","8"
"2016","MI","35700","SERFF","3","2015-08-25 12:56:34","1","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010040","BESTDental Choice - H","35700MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"31.12","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes",,"","35700MI0010040-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MI/2015/MI_BESTDental_Choice-H_Plan.pdf","http://www.bestlife.com/MI/2015/MI_BESTDental_Choice-H_Plan.pdf","9"
"2016","MI","35700","SERFF","3","2015-08-25 12:56:34","2","35700","MI","Individual","Yes","95-6042390","35700MI0020005","BESTOne Plus Silver","35700MI002",,"MIN001","MIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.29","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MI/2016/MI_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","MI","35700","SERFF","3","2015-08-25 12:56:34","2","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010039","BEST Dental Standard-L","35700MI001",,"MIN001","MIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.83","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network and UCR","Yes",,"","35700MI0010039-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MI/2015/MI_BESTDental_Standard-L_Plan.pdf","4"
"2016","MI","35700","SERFF","3","2015-08-25 12:56:34","2","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010039","BEST Dental Standard-L","35700MI001",,"MIN001","MIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.83","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network and UCR","Yes",,"","35700MI0010039-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MI/2015/MI_BESTDental_Standard-L_Plan.pdf","5"
"2016","MI","35700","SERFF","3","2015-08-25 12:56:34","2","35700","MI","Individual","Yes","95-6042390","35700MI0020005","BESTOne Plus Silver","35700MI002",,"MIN001","MIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.29","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MI/2016/MI_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","MI","35700","SERFF","3","2015-08-25 12:56:34","2","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010041","BEST Dental Choice-L","35700MI001",,"MIN001","MIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.83","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network and UCR","Yes",,"","35700MI0010041-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MI/2015/MI_BESTDental_Choice-L_Plan.pdf","6"
"2016","MI","35700","SERFF","3","2015-08-25 12:56:34","2","35700","MI","Individual","Yes","95-6042390","35700MI0020006","BESTOne Basic Silver","35700MI002",,"MIN001","MIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.29","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MI/2016/MI_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","MI","35700","SERFF","3","2015-08-25 12:56:34","2","35700","MI","Individual","Yes","95-6042390","35700MI0020006","BESTOne Basic Silver","35700MI002",,"MIN001","MIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.29","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","35700MI0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MI/2016/MI_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","MI","35700","SERFF","3","2015-08-25 12:56:34","2","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010041","BEST Dental Choice-L","35700MI001",,"MIN001","MIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.83","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network and UCR","Yes",,"","35700MI0010041-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MI/2015/MI_BESTDental_Choice-L_Plan.pdf","7"
"2016","MI","35700","SERFF","3","2015-08-25 12:56:34","2","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010042","BEST Dental Value","35700MI001",,"MIN001","MIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.83","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network and UCR","Yes",,"","35700MI0010042-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MI/2015/MI_BESTDental_Value_Plan.pdf","8"
"2016","MI","35700","SERFF","3","2015-08-25 12:56:34","2","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010042","BEST Dental Value","35700MI001",,"MIN001","MIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.83","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network and UCR","Yes",,"","35700MI0010042-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/MI/2015/MI_BESTDental_Value_Plan.pdf","9"
"2016","MI","36380","SERFF","5","2016-01-27 11:15:49","1","36380","MI","SHOP (Small Group)","Yes","81-0170040","36380MI0010001","Assurant Dental ACAFFO High","36380MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$40.84","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","36380MI0010001-00","Standard High Off Exchange Plan","85.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MI","36380","SERFF","5","2016-01-27 11:15:49","1","36380","MI","SHOP (Small Group)","Yes","81-0170040","36380MI0010002","Assurant Dental ACAFFO Low","36380MI001",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$37.47","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","36380MI0010002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$80","$80 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","1","37651","MI","Individual","No","38-2242827","37651MI0150005","HAP Personal Alliance 2500 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150005-00","Standard Silver Off Exchange Plan",,"0.702309310436249","Yes","Yes","No","100%",,"$2,500","$130","$930","$150","$2,500","$600","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hap.org/sbc/2016-off-pa-2500hmo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","4"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","1","37651","MI","Individual","No","38-2242827","37651MI0150005","HAP Personal Alliance 2500 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150005-01","Standard Silver On Exchange Plan",,"0.702309310436249","Yes","Yes","No","100%",,"$2,500","$130","$930","$150","$2,500","$600","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500hmo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","5"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","3","37651","MI","Individual","No","38-2242827","37651MI0190007","HAP Personal Alliance 5000 HMO (HSA) Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF005","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-5000hmoHSA-HFH-naanzero.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","6"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","3","37651","MI","Individual","No","38-2242827","37651MI0190007","HAP Personal Alliance 5000 HMO (HSA) Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF005","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190007-03","Limited Cost Sharing Plan Variation",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,450","$6450 per person","$12900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-5000hmoHSA-HFH-naanltd.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","7"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","3","37651","MI","Individual","No","38-2242827","37651MI0300007","HAP Personal Alliance 5000 HMO (HSA) Genesys Choice","37651MI030",,"MIN003","MIS003","MIF005","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300007-00","Standard Bronze Off Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,450","$6450 per person","$12900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","Yes",,,"http://www.hap.org/sbc/2016-off-pa-5000hmoHSA-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","8"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","3","37651","MI","Individual","No","38-2242827","37651MI0300007","HAP Personal Alliance 5000 HMO (HSA) Genesys Choice","37651MI030",,"MIN003","MIS003","MIF005","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300007-01","Standard Bronze On Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,450","$6450 per person","$12900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","Yes",,,"http://www.hap.org/sbc/2016-on-pa-5000hmoHSA-genesyschoice.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","9"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","3","37651","MI","Individual","No","38-2242827","37651MI0300007","HAP Personal Alliance 5000 HMO (HSA) Genesys Choice","37651MI030",,"MIN003","MIS003","MIF005","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-5000hmoHSA-GEN-naanzero.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","10"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","1","37651","MI","Individual","No","38-2242827","37651MI0150005","HAP Personal Alliance 2500 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500hmo-naanzero.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","6"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","1","37651","MI","Individual","No","38-2242827","37651MI0150005","HAP Personal Alliance 2500 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150005-03","Limited Cost Sharing Plan Variation",,"0.702309310436249","Yes","Yes","No","100%",,"$2,500","$130","$930","$150","$2,500","$600","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500hmo-naanltd.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","7"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","1","37651","MI","Individual","No","38-2242827","37651MI0150005","HAP Personal Alliance 2500 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150005-04","73% AV Level Silver Plan",,"0.738075077533722","Yes","Yes","No","100%",,"$1,500","$410","$930","$150","$1,500","$790","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500hmo-73AV.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","8"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","1","37651","MI","Individual","No","38-2242827","37651MI0150005","HAP Personal Alliance 2500 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150005-05","87% AV Level Silver Plan",,"0.879010617733002","Yes","Yes","No","100%",,"$100","$400","$600","$150","$100","$880","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,100","$1100 per person","$2200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500hmo-87AV.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","9"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0300004","HAP Personal Alliance 2500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300004-05","87% AV Level Silver Plan",,"0.877389192581177","Yes","Yes","No","100%",,"$100","$70","$1,010","$150","$100","$1,050","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500hmo-87AV-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","20"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0300004","HAP Personal Alliance 2500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300004-06","94% AV Level Silver Plan",,"0.949455201625824","Yes","Yes","No","100%",,"$0","$20","$580","$150","$0","$350","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500hmo-94AV-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","21"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0190005","HAP Personal Alliance 3000 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190005-00","Standard Silver Off Exchange Plan",,"0.69841456413269","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$500","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.hap.org/sbc/2016-off-pa-3000hmo-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","22"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0190005","HAP Personal Alliance 3000 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190005-01","Standard Silver On Exchange Plan",,"0.69841456413269","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$500","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000hmo-henryfordchoice.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","23"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","1","37651","MI","Individual","No","38-2242827","37651MI0150005","HAP Personal Alliance 2500 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150005-06","94% AV Level Silver Plan",,"0.947145879268646","Yes","Yes","No","100%",,"$0","$320","$230","$150","$0","$410","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$550","$550 per person","$1100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500hmo-94AV.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","10"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","1","37651","MI","Individual","No","38-2242827","37651MI0150011","HAP Personal Alliance 3000 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150011-00","Standard Silver Off Exchange Plan",,"0.69841456413269","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$500","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.hap.org/sbc/2016-off-pa-3000hmo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","11"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","1","37651","MI","Individual","No","38-2242827","37651MI0150011","HAP Personal Alliance 3000 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150011-01","Standard Silver On Exchange Plan",,"0.69841456413269","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$500","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000hmo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","12"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","1","37651","MI","Individual","No","38-2242827","37651MI0150011","HAP Personal Alliance 3000 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000hmo-naanzero.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","13"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","1","37651","MI","Individual","No","38-2242827","37651MI0150011","HAP Personal Alliance 3000 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150011-03","Limited Cost Sharing Plan Variation",,"0.69841456413269","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$500","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000hmo-naanltd.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","14"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","1","37651","MI","Individual","No","38-2242827","37651MI0150011","HAP Personal Alliance 3000 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150011-04","73% AV Level Silver Plan",,"0.739835381507874","Yes","Yes","No","100%",,"$1,900","$70","$1,010","$150","$1,900","$700","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000hmo-73AV.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","15"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","1","37651","MI","Individual","No","38-2242827","37651MI0150011","HAP Personal Alliance 3000 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150011-05","87% AV Level Silver Plan",,"0.877389192581177","Yes","Yes","No","100%",,"$100","$70","$1,010","$150","$100","$1,050","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000hmo-87AV.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","16"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","1","37651","MI","Individual","No","38-2242827","37651MI0150011","HAP Personal Alliance 3000 HMO","37651MI015",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150011-06","94% AV Level Silver Plan",,"0.949455201625824","Yes","Yes","No","100%",,"$0","$20","$580","$150","$0","$350","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000hmo-94AV.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","17"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","2","37651","MI","Individual","No","38-2242827","37651MI0150012","HAP Personal Alliance 5000 HMO (HSA)","37651MI015",,"MIN001","MIS001","MIF005","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150012-00","Standard Bronze Off Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,450","$6450 per person","$12900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","Yes",,,"http://www.hap.org/sbc/2016-off-pa-5000hmoHSA.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","4"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","2","37651","MI","Individual","No","38-2242827","37651MI0150012","HAP Personal Alliance 5000 HMO (HSA)","37651MI015",,"MIN001","MIS001","MIF005","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150012-01","Standard Bronze On Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,450","$6450 per person","$12900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","Yes",,,"http://www.hap.org/sbc/2016-on-pa-5000hmoHSA.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","5"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","2","37651","MI","Individual","No","38-2242827","37651MI0150012","HAP Personal Alliance 5000 HMO (HSA)","37651MI015",,"MIN001","MIS001","MIF005","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-5000hmoHSA-naanzero.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","6"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","2","37651","MI","Individual","No","38-2242827","37651MI0150012","HAP Personal Alliance 5000 HMO (HSA)","37651MI015",,"MIN001","MIS001","MIF005","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150012-03","Limited Cost Sharing Plan Variation",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,450","$6450 per person","$12900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-5000hmoHSA-naanltd.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","7"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","3","37651","MI","Individual","No","38-2242827","37651MI0190007","HAP Personal Alliance 5000 HMO (HSA) Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF005","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190007-00","Standard Bronze Off Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,450","$6450 per person","$12900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","Yes",,,"http://www.hap.org/sbc/2016-off-pa-5000hmoHSA-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","4"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","3","37651","MI","Individual","No","38-2242827","37651MI0190007","HAP Personal Alliance 5000 HMO (HSA) Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF005","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190007-01","Standard Bronze On Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,450","$6450 per person","$12900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","Yes",,,"http://www.hap.org/sbc/2016-on-pa-5000hmoHSA-henryfordchoice.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","5"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","3","37651","MI","Individual","No","38-2242827","37651MI0300007","HAP Personal Alliance 5000 HMO (HSA) Genesys Choice","37651MI030",,"MIN003","MIS003","MIF005","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300007-03","Limited Cost Sharing Plan Variation",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,450","$6450 per person","$12900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","per person not applicable","$10000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-5000hmoHSA-GEN-naanltd.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","11"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0190002","HAP Personal Alliance 1500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Gold","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190002-00","Standard Gold Off Exchange Plan",,"0.784472823143005","Yes","Yes","No","100%",,"$1,500","$50","$1,010","$150","$1,500","$650","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"http://www.hap.org/sbc/2016-off-pa-1500hmo-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","4"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0190002","HAP Personal Alliance 1500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Gold","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190002-01","Standard Gold On Exchange Plan",,"0.784472823143005","Yes","Yes","No","100%",,"$1,500","$50","$1,010","$150","$1,500","$650","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-1500hmo-henryfordchoice.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","5"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0190002","HAP Personal Alliance 1500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Gold","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-1500hmo-naanzero-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","6"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0190002","HAP Personal Alliance 1500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Gold","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190002-03","Limited Cost Sharing Plan Variation",,"0.784472823143005","Yes","Yes","No","100%",,"$1,500","$50","$1,010","$150","$1,500","$650","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-1500hmo-naanltd-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","7"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0190004","HAP Personal Alliance 2500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190004-00","Standard Silver Off Exchange Plan",,"0.708672821521759","Yes","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$560","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hap.org/sbc/2016-off-pa-2500hmo-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","8"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0190004","HAP Personal Alliance 2500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190004-01","Standard Silver On Exchange Plan",,"0.708672821521759","Yes","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$560","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500hmo-henryfordchoice.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","9"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","5","37651","MI","Individual","No","38-2242827","37651MI0300006","HAP Personal Alliance 4500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF003","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300006-00","Standard Bronze Off Exchange Plan",,"0.617659449577332","No","Yes","No","100%",,"$4,500","$20","$830","$150","$4,500","$230","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2016-off-pa-4500hmo-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","8"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","5","37651","MI","Individual","No","38-2242827","37651MI0300006","HAP Personal Alliance 4500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF003","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300006-01","Standard Bronze On Exchange Plan",,"0.617659449577332","No","Yes","No","100%",,"$4,500","$20","$830","$150","$4,500","$230","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2016-on-pa-4500hmo-genesyschoice.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","9"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0190004","HAP Personal Alliance 2500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500hmo-naanzero-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","10"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0190004","HAP Personal Alliance 2500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190004-03","Limited Cost Sharing Plan Variation",,"0.708672821521759","Yes","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$560","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500hmo-naanltd-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","11"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0190004","HAP Personal Alliance 2500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190004-04","73% AV Level Silver Plan",,"0.739835381507874","Yes","Yes","No","100%",,"$1,900","$70","$1,010","$150","$1,900","$700","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500hmo-73AV-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","12"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0190004","HAP Personal Alliance 2500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190004-05","87% AV Level Silver Plan",,"0.877389192581177","Yes","Yes","No","100%",,"$100","$70","$1,010","$150","$100","$1,050","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500hmo-87AV-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","13"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0190004","HAP Personal Alliance 2500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190004-06","94% AV Level Silver Plan",,"0.949455201625824","Yes","Yes","No","100%",,"$0","$20","$580","$150","$0","$350","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500hmo-94AV-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","14"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0300004","HAP Personal Alliance 2500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300004-00","Standard Silver Off Exchange Plan",,"0.708672821521759","Yes","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$560","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hap.org/sbc/2016-off-pa-2500hmo-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","15"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0300004","HAP Personal Alliance 2500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300004-01","Standard Silver On Exchange Plan",,"0.708672821521759","Yes","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$560","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500hmo-genesyschoice.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","16"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0300004","HAP Personal Alliance 2500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500hmo-naanzero-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","17"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0300004","HAP Personal Alliance 2500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300004-03","Limited Cost Sharing Plan Variation",,"0.708672821521759","Yes","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$560","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500hmo-naanltd-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","18"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0300004","HAP Personal Alliance 2500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300004-04","73% AV Level Silver Plan",,"0.739835381507874","Yes","Yes","No","100%",,"$1,900","$70","$1,010","$150","$1,900","$700","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500hmo-73AV-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","19"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0190005","HAP Personal Alliance 3000 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000hmo-naanzero-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","24"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0190005","HAP Personal Alliance 3000 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190005-03","Limited Cost Sharing Plan Variation",,"0.69841456413269","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$500","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000hmo-naanltd-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","25"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0190005","HAP Personal Alliance 3000 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190005-04","73% AV Level Silver Plan",,"0.739835381507874","Yes","Yes","No","100%",,"$1,900","$70","$1,010","$150","$1,900","$700","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000hmo-73AV-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","26"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0190005","HAP Personal Alliance 3000 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190005-05","87% AV Level Silver Plan",,"0.877389192581177","Yes","Yes","No","100%",,"$100","$70","$1,010","$150","$100","$1,050","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000hmo-87AV-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","27"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0190005","HAP Personal Alliance 3000 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190005-06","94% AV Level Silver Plan",,"0.949455201625824","Yes","Yes","No","100%",,"$0","$20","$580","$150","$0","$350","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000hmo-94AV-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","28"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0300005","HAP Personal Alliance 3000 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300005-00","Standard Silver Off Exchange Plan",,"0.69841456413269","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$500","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.hap.org/sbc/2016-off-pa-3000hmo-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","29"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0300005","HAP Personal Alliance 3000 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300005-01","Standard Silver On Exchange Plan",,"0.69841456413269","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$500","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000hmo-genesyschoice.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","30"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0300005","HAP Personal Alliance 3000 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000hmo-naanzero-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","31"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0300005","HAP Personal Alliance 3000 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300005-03","Limited Cost Sharing Plan Variation",,"0.69841456413269","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$500","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000hmo-naanltd-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","32"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0300005","HAP Personal Alliance 3000 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300005-04","73% AV Level Silver Plan",,"0.739835381507874","Yes","Yes","No","100%",,"$1,900","$70","$1,010","$150","$1,900","$700","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000hmo-73AV-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","33"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0300005","HAP Personal Alliance 3000 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300005-05","87% AV Level Silver Plan",,"0.877389192581177","Yes","Yes","No","100%",,"$100","$70","$1,010","$150","$100","$1,050","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000hmo-87AV-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","34"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","4","37651","MI","Individual","No","38-2242827","37651MI0300005","HAP Personal Alliance 3000 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300005-06","94% AV Level Silver Plan",,"0.949455201625824","Yes","Yes","No","100%",,"$0","$20","$580","$150","$0","$350","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000hmo-94AV-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","35"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","5","37651","MI","Individual","No","38-2242827","37651MI0190006","HAP Personal Alliance 4500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF003","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190006-00","Standard Bronze Off Exchange Plan",,"0.617659449577332","No","Yes","No","100%",,"$4,500","$20","$830","$150","$4,500","$230","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2016-off-pa-4500hmo-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","4"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","5","37651","MI","Individual","No","38-2242827","37651MI0190006","HAP Personal Alliance 4500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF003","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190006-01","Standard Bronze On Exchange Plan",,"0.617659449577332","No","Yes","No","100%",,"$4,500","$20","$830","$150","$4,500","$230","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2016-on-pa-4500hmo-henryfordchoice.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","5"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","5","37651","MI","Individual","No","38-2242827","37651MI0190006","HAP Personal Alliance 4500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF003","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2016-on-pa-4500hmo-naanzero-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","6"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","5","37651","MI","Individual","No","38-2242827","37651MI0190006","HAP Personal Alliance 4500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF003","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190006-03","Limited Cost Sharing Plan Variation",,"0.617659449577332","No","Yes","No","100%",,"$4,500","$20","$830","$150","$4,500","$230","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2016-on-pa-4500hmo-naanltd-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","7"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","5","37651","MI","Individual","No","38-2242827","37651MI0300006","HAP Personal Alliance 4500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF003","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2016-on-pa-4500hmo-naanzero-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","10"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","5","37651","MI","Individual","No","38-2242827","37651MI0300006","HAP Personal Alliance 4500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF003","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300006-03","Limited Cost Sharing Plan Variation",,"0.617659449577332","No","Yes","No","100%",,"$4,500","$20","$830","$150","$4,500","$230","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2016-on-pa-4500hmo-naanzeroltd-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","11"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","5","37651","MI","Individual","No","38-2242827","37651MI0150007","HAP Personal Alliance 4500 HMO","37651MI015",,"MIN001","MIS001","MIF003","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150007-00","Standard Bronze Off Exchange Plan",,"0.614907264709473","No","Yes","No","100%",,"$4,500","$20","$550","$150","$4,500","$230","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2016-off-pa-4500hmo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","12"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","5","37651","MI","Individual","No","38-2242827","37651MI0150007","HAP Personal Alliance 4500 HMO","37651MI015",,"MIN001","MIS001","MIF003","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150007-01","Standard Bronze On Exchange Plan",,"0.614907264709473","No","Yes","No","100%",,"$4,500","$20","$550","$150","$4,500","$230","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2016-on-pa-4500hmo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","13"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","5","37651","MI","Individual","No","38-2242827","37651MI0150007","HAP Personal Alliance 4500 HMO","37651MI015",,"MIN001","MIS001","MIF003","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2016-on-pa-4500hmo-naanzero.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","14"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","5","37651","MI","Individual","No","38-2242827","37651MI0150007","HAP Personal Alliance 4500 HMO","37651MI015",,"MIN001","MIS001","MIF003","Existing","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150007-03","Limited Cost Sharing Plan Variation",,"0.614907264709473","No","Yes","No","100%",,"$4,500","$20","$550","$150","$4,500","$230","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2016-on-pa-4500hmo-naanltd.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","15"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","6","37651","MI","Individual","No","38-2242827","37651MI0190009","HAP Personal Alliance 3500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","New","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190009-00","Standard Silver Off Exchange Plan",,"0.681768476963043","Yes","Yes","No","100%",,"$3,500","$20","$1,130","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.hap.org/sbc/2016-off-pa-3500hmo-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","4"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","6","37651","MI","Individual","No","38-2242827","37651MI0190009","HAP Personal Alliance 3500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","New","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190009-01","Standard Silver On Exchange Plan",,"0.681768476963043","Yes","Yes","No","100%",,"$3,500","$20","$1,130","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500hmo-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","5"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","6","37651","MI","Individual","No","38-2242827","37651MI0190009","HAP Personal Alliance 3500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","New","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500hmo-naanzero-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","6"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","6","37651","MI","Individual","No","38-2242827","37651MI0190009","HAP Personal Alliance 3500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","New","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190009-03","Limited Cost Sharing Plan Variation",,"0.681768476963043","Yes","Yes","No","100%",,"$3,500","$20","$1,130","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500hmo-naanltd-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","7"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","6","37651","MI","Individual","No","38-2242827","37651MI0190009","HAP Personal Alliance 3500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","New","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190009-04","73% AV Level Silver Plan",,"0.739344596862793","Yes","Yes","No","100%",,"$1,750","$20","$1,650","$150","$1,750","$470","$420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500hmo-74AV-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","8"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","6","37651","MI","Individual","No","38-2242827","37651MI0190009","HAP Personal Alliance 3500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","New","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190009-05","87% AV Level Silver Plan",,"0.878916800022125","Yes","Yes","No","100%",,"$100","$0","$1,400","$150","$100","$600","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500hmo-87AV-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","9"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","6","37651","MI","Individual","No","38-2242827","37651MI0190009","HAP Personal Alliance 3500 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF002","New","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190009-06","94% AV Level Silver Plan",,"0.948300719261169","Yes","Yes","No","100%",,"$0","$0","$500","$150","$0","$90","$420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500hmo-94AV-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","10"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","6","37651","MI","Individual","No","38-2242827","37651MI0300009","HAP Personal Alliance 3500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","New","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300009-00","Standard Silver Off Exchange Plan",,"0.681768476963043","Yes","Yes","No","100%",,"$3,500","$20","$1,130","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.hap.org/sbc/2016-o55-pa-3500hmo-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","11"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","6","37651","MI","Individual","No","38-2242827","37651MI0300009","HAP Personal Alliance 3500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","New","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300009-01","Standard Silver On Exchange Plan",,"0.681768476963043","Yes","Yes","No","100%",,"$3,500","$20","$1,130","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500hmo-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","12"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","6","37651","MI","Individual","No","38-2242827","37651MI0300009","HAP Personal Alliance 3500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","New","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500hmo-naanzero-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","13"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","6","37651","MI","Individual","No","38-2242827","37651MI0300009","HAP Personal Alliance 3500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","New","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300009-03","Limited Cost Sharing Plan Variation",,"0.681768476963043","Yes","Yes","No","100%",,"$3,500","$20","$1,130","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500hmo-naanltd-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","14"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","6","37651","MI","Individual","No","38-2242827","37651MI0300009","HAP Personal Alliance 3500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","New","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300009-04","73% AV Level Silver Plan",,"0.739344596862793","Yes","Yes","No","100%",,"$1,750","$20","$1,650","$150","$1,750","$470","$420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500hmo-74AV-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","15"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","6","37651","MI","Individual","No","38-2242827","37651MI0300009","HAP Personal Alliance 3500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","New","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300009-05","87% AV Level Silver Plan",,"0.878916800022125","Yes","Yes","No","100%",,"$100","$0","$1,400","$150","$100","$600","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500hmo-87AV-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","16"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","6","37651","MI","Individual","No","38-2242827","37651MI0300009","HAP Personal Alliance 3500 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF002","New","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300009-06","94% AV Level Silver Plan",,"0.948300719261169","Yes","Yes","No","100%",,"$0","$0","$500","$150","$0","$90","$420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500hmo-94AV-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","17"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","6","37651","MI","Individual","No","38-2242827","37651MI0150014","HAP Personal Alliance 3500 HMO","37651MI015",,"MIN001","MIS001","MIF002","New","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150014-00","Standard Silver Off Exchange Plan",,"0.681768476963043","Yes","Yes","No","100%",,"$3,500","$20","$1,130","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.hap.org/sbc/2016-off-pa-3500hmo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","18"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","6","37651","MI","Individual","No","38-2242827","37651MI0150014","HAP Personal Alliance 3500 HMO","37651MI015",,"MIN001","MIS001","MIF002","New","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150014-01","Standard Silver On Exchange Plan",,"0.681768476963043","Yes","Yes","No","100%",,"$3,500","$20","$1,130","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500hmo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","19"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","6","37651","MI","Individual","No","38-2242827","37651MI0150014","HAP Personal Alliance 3500 HMO","37651MI015",,"MIN001","MIS001","MIF002","New","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500hmo-naanzero.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","20"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","6","37651","MI","Individual","No","38-2242827","37651MI0150014","HAP Personal Alliance 3500 HMO","37651MI015",,"MIN001","MIS001","MIF002","New","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150014-03","Limited Cost Sharing Plan Variation",,"0.681768476963043","Yes","Yes","No","100%",,"$3,500","$20","$1,130","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500hmo-naanltd.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","21"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","6","37651","MI","Individual","No","38-2242827","37651MI0150014","HAP Personal Alliance 3500 HMO","37651MI015",,"MIN001","MIS001","MIF002","New","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150014-04","73% AV Level Silver Plan",,"0.739344596862793","Yes","Yes","No","100%",,"$1,750","$20","$1,650","$150","$1,750","$470","$420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500hmo-73AV.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","22"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","6","37651","MI","Individual","No","38-2242827","37651MI0150014","HAP Personal Alliance 3500 HMO","37651MI015",,"MIN001","MIS001","MIF002","New","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150014-05","87% AV Level Silver Plan",,"0.878916800022125","Yes","Yes","No","100%",,"$100","$0","$1,400","$150","$100","$600","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500hmo-87AV.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","23"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","6","37651","MI","Individual","No","38-2242827","37651MI0150014","HAP Personal Alliance 3500 HMO","37651MI015",,"MIN001","MIS001","MIF002","New","HMO","Silver","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150014-06","94% AV Level Silver Plan",,"0.948300719261169","Yes","Yes","No","100%",,"$0","$0","$500","$150","$0","$90","$420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500hmo-94AV.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","24"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","7","37651","MI","Individual","No","38-2242827","37651MI0190010","HAP Personal Alliance 6850 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF004","New","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190010-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,720","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.hap.org/sbc/2016-off-pa-6850hmo-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","4"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","7","37651","MI","Individual","No","38-2242827","37651MI0190010","HAP Personal Alliance 6850 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF004","New","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190010-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,720","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-6850hmo-henryfordchoice.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","5"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","7","37651","MI","Individual","No","38-2242827","37651MI0190010","HAP Personal Alliance 6850 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF004","New","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-6850hmo-naanzero-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","6"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","7","37651","MI","Individual","No","38-2242827","37651MI0190010","HAP Personal Alliance 6850 HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF004","New","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190010-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,720","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-6850hmo-naanltd-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","7"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","7","37651","MI","Individual","No","38-2242827","37651MI0300010","HAP Personal Alliance 6850 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF004","New","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300010-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,720","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.hap.org/sbc/2016-off-pa-6850hmo-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","8"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","7","37651","MI","Individual","No","38-2242827","37651MI0300010","HAP Personal Alliance 6850 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF004","New","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300010-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,720","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-6850hmo-genesyschoice.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","9"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","7","37651","MI","Individual","No","38-2242827","37651MI0300010","HAP Personal Alliance 6850 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF004","New","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-6850hmo-naanzero-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","10"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","7","37651","MI","Individual","No","38-2242827","37651MI0300010","HAP Personal Alliance 6850 HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF004","New","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300010-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,720","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-6850hmo-naanzeroltd-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","11"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","7","37651","MI","Individual","No","38-2242827","37651MI0150015","HAP Personal Alliance 6850 HMO","37651MI015",,"MIN001","MIS001","MIF004","New","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150015-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,720","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.hap.org/sbc/2016-off-pa-6850hmo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","12"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","7","37651","MI","Individual","No","38-2242827","37651MI0150015","HAP Personal Alliance 6850 HMO","37651MI015",,"MIN001","MIS001","MIF004","New","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150015-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,720","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-6850hmo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","13"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","7","37651","MI","Individual","No","38-2242827","37651MI0150015","HAP Personal Alliance 6850 HMO","37651MI015",,"MIN001","MIS001","MIF004","New","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-6850hmo-naanzero.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","14"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","7","37651","MI","Individual","No","38-2242827","37651MI0150015","HAP Personal Alliance 6850 HMO","37651MI015",,"MIN001","MIS001","MIF004","New","HMO","Bronze","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150015-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,720","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-6850hmo-naanltd.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","15"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","8","37651","MI","Individual","No","38-2242827","37651MI0190008","HAP Personal Alliance 6850C HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF004","Existing","HMO","Catastrophic","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190008-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$3,500","$20","$1,130","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.hap.org/sbc/2016-off-pa-6850hmo-CAT-HFH.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","4"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","8","37651","MI","Individual","No","38-2242827","37651MI0190008","HAP Personal Alliance 6850C HMO Henry Ford Choice","37651MI019",,"MIN002","MIS002","MIF004","Existing","HMO","Catastrophic","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0190008-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$3,500","$20","$1,130","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-6850hmoHSA-henryfordchoice.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","5"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","8","37651","MI","Individual","No","38-2242827","37651MI0300008","HAP Personal Alliance 6850C HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF004","Existing","HMO","Catastrophic","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300008-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$3,500","$20","$1,130","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.hap.org/sbc/2016-off-pa-6850hmo-CAT-GEN.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","6"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","8","37651","MI","Individual","No","38-2242827","37651MI0300008","HAP Personal Alliance 6850C HMO Genesys Choice","37651MI030",,"MIN003","MIS003","MIF004","Existing","HMO","Catastrophic","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0300008-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$3,500","$20","$1,130","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-6850hmo-CAT-genesyschoice.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","7"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","8","37651","MI","Individual","No","38-2242827","37651MI0150013","HAP Personal Alliance 6850C HMO","37651MI015",,"MIN001","MIS001","MIF004","Existing","HMO","Catastrophic","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150013-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$3,500","$20","$1,130","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.hap.org/sbc/2016-off-pa-6850hmo-CAT.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","8"
"2016","MI","37651","SERFF","3","2015-08-25 12:56:34","8","37651","MI","Individual","No","38-2242827","37651MI0150013","HAP Personal Alliance 6850C HMO","37651MI015",,"MIN001","MIS001","MIF004","Existing","HMO","Catastrophic","No","Both","No","Yes","Varies based on service and provider network; visit hap.org for details.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No","Urgent and emergency services only","No","Urgent and emergency services only","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","37651MI0150013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$3,500","$20","$1,130","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-6850chmo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","9"
"2016","MI","38791","SERFF","3","2015-08-22 23:36:24","1","38791","MI","SHOP (Small Group)","Yes","47-0098400","38791MI0040002","EHB High PPO","38791MI004",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$37.43","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","38791MI0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","MI","38791","SERFF","3","2015-08-22 23:36:24","1","38791","MI","SHOP (Small Group)","Yes","47-0098400","38791MI0040001","EHB Low PPO","38791MI004",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$17.16","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","38791MI0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010003","Humana Silver 3800/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607592","http://apps.humana.com/marketing/documents.asp?file=2592746","6"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010019","Humana Gold 2250/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010019-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2619838","http://apps.humana.com/marketing/documents.asp?file=2592824","28"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010019","Humana Gold 2250/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010019-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2619851","http://apps.humana.com/marketing/documents.asp?file=2592824","29"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010020","Humana Platinum 500/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010020-00","Standard Platinum Off Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2619682","http://apps.humana.com/marketing/documents.asp?file=2615067","30"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010020","Humana Platinum 500/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010020-01","Standard Platinum On Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2619864","http://apps.humana.com/marketing/documents.asp?file=2592837","31"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010020","Humana Platinum 500/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010020-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2619877","http://apps.humana.com/marketing/documents.asp?file=2592837","32"
"2016","MI","38791","SERFF","3","2015-08-22 23:36:24","1","38791","MI","SHOP (Small Group)","Yes","47-0098400","38791MI0030002","EHB High Passive","38791MI003",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$40.61","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","38791MI0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","MI","38791","SERFF","3","2015-08-22 23:36:24","1","38791","MI","SHOP (Small Group)","Yes","47-0098400","38791MI0030001","EHB Low Passive","38791MI003",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$22.22","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","38791MI0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","MI","40047","SERFF","6","2016-01-27 11:15:49","1","40047","MI","Individual","No","38-3341599","40047MI0010001","Molina Marketplace Gold Plan","40047MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/mi/en/PDF/marketplace/formulary-2016.pdf","40047MI0010001-00","Standard Gold Off Exchange Plan",,"0.801033437252045","No","Yes","No","100%",,"$500","$240","$890","$150","$500","$770","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/summary-of-benefits-gold-2016.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/brochure-2016.pdf","4"
"2016","MI","40047","SERFF","6","2016-01-27 11:15:49","1","40047","MI","Individual","No","38-3341599","40047MI0010001","Molina Marketplace Gold Plan","40047MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/mi/en/PDF/marketplace/formulary-2016.pdf","40047MI0010001-01","Standard Gold On Exchange Plan",,"0.801033437252045","No","Yes","No","100%",,"$500","$240","$890","$150","$500","$770","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/summary-of-benefits-gold-2016.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/brochure-2016.pdf","5"
"2016","MI","40047","SERFF","6","2016-01-27 11:15:49","1","40047","MI","Individual","No","38-3341599","40047MI0010001","Molina Marketplace Gold Plan","40047MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/mi/en/PDF/marketplace/formulary-2016.pdf","40047MI0010001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/summary-of-benefits-gold-aian-2016.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/brochure-2016.pdf","6"
"2016","MI","40047","SERFF","6","2016-01-27 11:15:49","1","40047","MI","Individual","No","38-3341599","40047MI0010001","Molina Marketplace Gold Plan","40047MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/mi/en/PDF/marketplace/formulary-2016.pdf","40047MI0010001-03","Limited Cost Sharing Plan Variation",,"0.801033437252045","No","Yes","No","100%",,"$500","$240","$890","$150","$500","$770","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/summary-of-benefits-gold-2016.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/brochure-2016.pdf","7"
"2016","MI","40047","SERFF","6","2016-01-27 11:15:49","2","40047","MI","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/mi/en/PDF/marketplace/formulary-2016.pdf","40047MI0010002-00","Standard Silver Off Exchange Plan",,"0.714607775211334","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/summary-of-benefits-silver-250-2016.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/brochure-2016.pdf","4"
"2016","MI","40047","SERFF","6","2016-01-27 11:15:49","2","40047","MI","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/mi/en/PDF/marketplace/formulary-2016.pdf","40047MI0010002-01","Standard Silver On Exchange Plan",,"0.714607775211334","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/summary-of-benefits-silver-250-2016.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/brochure-2016.pdf","5"
"2016","MI","40047","SERFF","6","2016-01-27 11:15:49","2","40047","MI","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/mi/en/PDF/marketplace/formulary-2016.pdf","40047MI0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/summary-of-benefits-silver-aian-2016.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/brochure-2016.pdf","6"
"2016","MI","40047","SERFF","6","2016-01-27 11:15:49","2","40047","MI","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/mi/en/PDF/marketplace/formulary-2016.pdf","40047MI0010002-03","Limited Cost Sharing Plan Variation",,"0.714607775211334","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/summary-of-benefits-silver-250-2016.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/brochure-2016.pdf","7"
"2016","MI","40047","SERFF","6","2016-01-27 11:15:49","2","40047","MI","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/mi/en/PDF/marketplace/formulary-2016.pdf","40047MI0010002-04","73% AV Level Silver Plan",,"0.739822447299957","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/summary-of-benefits-silver-200-2016.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/brochure-2016.pdf","8"
"2016","MI","40047","SERFF","6","2016-01-27 11:15:49","2","40047","MI","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/mi/en/PDF/marketplace/formulary-2016.pdf","40047MI0010002-05","87% AV Level Silver Plan",,"0.878527700901031","No","Yes","No","100%",,"$450","$180","$890","$150","$450","$320","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$450","$450 per person","$900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/summary-of-benefits-silver-150-2016.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/brochure-2016.pdf","9"
"2016","MI","40047","SERFF","6","2016-01-27 11:15:49","2","40047","MI","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/mi/en/PDF/marketplace/formulary-2016.pdf","40047MI0010002-06","94% AV Level Silver Plan",,"0.947116374969482","No","Yes","No","100%",,"$0","$210","$450","$150","$0","$180","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/summary-of-benefits-silver-100-2016.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/brochure-2016.pdf","10"
"2016","MI","40047","SERFF","6","2016-01-27 11:15:49","3","40047","MI","Individual","No","38-3341599","40047MI0010003","Molina Marketplace Bronze Plan","40047MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/mi/en/PDF/marketplace/formulary-2016.pdf","40047MI0010003-00","Standard Bronze Off Exchange Plan",,"0.618895947933197","Yes","Yes","No","100%",,"$5,000","$20","$900","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/summary-of-benefits-bronze-2016.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/brochure-2016.pdf","4"
"2016","MI","40047","SERFF","6","2016-01-27 11:15:49","3","40047","MI","Individual","No","38-3341599","40047MI0010003","Molina Marketplace Bronze Plan","40047MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/mi/en/PDF/marketplace/formulary-2016.pdf","40047MI0010003-01","Standard Bronze On Exchange Plan",,"0.618895947933197","Yes","Yes","No","100%",,"$5,000","$20","$900","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/summary-of-benefits-bronze-2016.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/brochure-2016.pdf","5"
"2016","MI","40047","SERFF","6","2016-01-27 11:15:49","3","40047","MI","Individual","No","38-3341599","40047MI0010003","Molina Marketplace Bronze Plan","40047MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/mi/en/PDF/marketplace/formulary-2016.pdf","40047MI0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/summary-of-benefits-bronze-aian-2016.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/brochure-2016.pdf","6"
"2016","MI","40047","SERFF","6","2016-01-27 11:15:49","3","40047","MI","Individual","No","38-3341599","40047MI0010003","Molina Marketplace Bronze Plan","40047MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/mi/en/PDF/marketplace/formulary-2016.pdf","40047MI0010003-03","Limited Cost Sharing Plan Variation",,"0.618895947933197","Yes","Yes","No","100%",,"$5,000","$20","$900","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/summary-of-benefits-bronze-2016.pdf","http://www.molinahealthcare.com/members/mi/en-US/PDF/marketplace/brochure-2016.pdf","7"
"2016","MI","41183","SERFF","5","2015-08-24 05:58:52","1","41183","MI","SHOP (Small Group)","Yes","93-0242990","41183MI0040002","EHB High PPO","41183MI004",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$38.06","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","41183MI0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","MI","41183","SERFF","5","2015-08-24 05:58:52","1","41183","MI","SHOP (Small Group)","Yes","93-0242990","41183MI0040001","EHB Low PPO","41183MI004",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$17.45","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","41183MI0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","MI","41183","SERFF","5","2015-08-24 05:58:52","1","41183","MI","SHOP (Small Group)","Yes","93-0242990","41183MI0030002","EHB High Passive","41183MI003",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$41.31","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","41183MI0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","MI","41183","SERFF","5","2015-08-24 05:58:52","1","41183","MI","SHOP (Small Group)","Yes","93-0242990","41183MI0030001","EHB Low Passive","41183MI003",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$22.59","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","41183MI0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","MI","46016","SERFF","4","2015-08-23 14:39:40","1","46016","MI","SHOP (Small Group)","Yes","36-0883760","46016MI0040002","EHB High PPO","46016MI004",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$37.95","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","46016MI0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","MI","46016","SERFF","4","2015-08-23 14:39:40","1","46016","MI","SHOP (Small Group)","Yes","36-0883760","46016MI0040001","EHB Low PPO","46016MI004",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$17.40","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","46016MI0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","MI","46016","SERFF","4","2015-08-23 14:39:40","1","46016","MI","SHOP (Small Group)","Yes","36-0883760","46016MI0030002","EHB High Passive","46016MI003",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$41.18","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","46016MI0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","MI","46016","SERFF","4","2015-08-23 14:39:40","1","46016","MI","SHOP (Small Group)","Yes","36-0883760","46016MI0030001","EHB Low Passive","46016MI003",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$22.53","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","46016MI0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","1","46275","MI","Individual","No","27-3991410","46275MI0010001","Humana Basic 6850/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","46275MI0010001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2598739","http://apps.humana.com/marketing/documents.asp?file=2588456","4"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","1","46275","MI","Individual","No","27-3991410","46275MI0010001","Humana Basic 6850/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","46275MI0010001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2598739","http://apps.humana.com/marketing/documents.asp?file=2588456","5"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","1","46275","MI","Individual","No","27-3991410","46275MI0010016","Humana Basic 6850/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","46275MI0010016-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2619630","http://apps.humana.com/marketing/documents.asp?file=2615015","6"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","1","46275","MI","Individual","No","27-3991410","46275MI0010016","Humana Basic 6850/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","46275MI0010016-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2619695","http://apps.humana.com/marketing/documents.asp?file=2592785","7"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010003","Humana Silver 3800/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010003-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2598778","http://apps.humana.com/marketing/documents.asp?file=2588482","4"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010003","Humana Silver 3800/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010003-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607579","http://apps.humana.com/marketing/documents.asp?file=2592746","5"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010003","Humana Silver 3800/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010003-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607605","http://apps.humana.com/marketing/documents.asp?file=2592746","7"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010003","Humana Silver 3800/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010003-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607618","http://apps.humana.com/marketing/documents.asp?file=2623400","8"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010003","Humana Silver 3800/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010003-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607631","http://apps.humana.com/marketing/documents.asp?file=2623413","9"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","6","46275","MI","Individual","No","27-3991410","46275MI0010002","Humana Bronze 6450/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","46275MI0010002-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2607540","http://apps.humana.com/marketing/documents.asp?file=2592733","5"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","6","46275","MI","Individual","No","27-3991410","46275MI0010002","Humana Bronze 6450/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","46275MI0010002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2607553","http://apps.humana.com/marketing/documents.asp?file=2592733","6"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","6","46275","MI","Individual","No","27-3991410","46275MI0010002","Humana Bronze 6450/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","46275MI0010002-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2607566","http://apps.humana.com/marketing/documents.asp?file=2592733","7"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","4","58594","MI","Individual","No","38-3253977","58594MI0010005","Meridian Gold","58594MI001",,"MIN001","MIS001","MIF004","Existing","HMO","Gold","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010005-00","Standard Gold Off Exchange Plan",,"0.782054662704468","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$360","$360","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=rnVTFAToPFpvXHUyYJ4aRBDxKHtQwhK/P/+F77zXKVqFQgLsQq55drkWgi6NkiiTQe8/35AwGJZPdI43C2B8Xw==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","4"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","4","58594","MI","Individual","No","38-3253977","58594MI0010005","Meridian Gold","58594MI001",,"MIN001","MIS001","MIF004","Existing","HMO","Gold","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010005-01","Standard Gold On Exchange Plan",,"0.782054662704468","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$360","$360","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=rnVTFAToPFpvXHUyYJ4aRBDxKHtQwhK/P/+F77zXKVqFQgLsQq55drkWgi6NkiiTQe8/35AwGJZPdI43C2B8Xw==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","5"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010003","Humana Silver 3800/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010003-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607644","http://apps.humana.com/marketing/documents.asp?file=2623426","10"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010004","Humana Gold 2250/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010004-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2598791","http://apps.humana.com/marketing/documents.asp?file=2588495","11"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010004","Humana Gold 2250/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010004-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607657","http://apps.humana.com/marketing/documents.asp?file=2592759","12"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010004","Humana Gold 2250/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607670","http://apps.humana.com/marketing/documents.asp?file=2592759","13"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010004","Humana Gold 2250/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010004-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607683","http://apps.humana.com/marketing/documents.asp?file=2592759","14"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010005","Humana Platinum 500/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010005-00","Standard Platinum Off Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2598817","http://apps.humana.com/marketing/documents.asp?file=2588508","15"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010005","Humana Platinum 500/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010005-01","Standard Platinum On Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607696","http://apps.humana.com/marketing/documents.asp?file=2592772","16"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010005","Humana Platinum 500/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607709","http://apps.humana.com/marketing/documents.asp?file=2592772","17"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010005","Humana Platinum 500/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010005-03","Limited Cost Sharing Plan Variation","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2607722","http://apps.humana.com/marketing/documents.asp?file=2592772","18"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010018","Humana Silver 3800/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010018-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2619656","http://apps.humana.com/marketing/documents.asp?file=2615041","19"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010018","Humana Silver 3800/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010018-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2619747","http://apps.humana.com/marketing/documents.asp?file=2592811","20"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010018","Humana Silver 3800/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010018-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2619760","http://apps.humana.com/marketing/documents.asp?file=2592811","21"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010018","Humana Silver 3800/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010018-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2619773","http://apps.humana.com/marketing/documents.asp?file=2592811","22"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010018","Humana Silver 3800/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010018-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2619786","http://apps.humana.com/marketing/documents.asp?file=2623439","23"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010018","Humana Silver 3800/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010018-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2619799","http://apps.humana.com/marketing/documents.asp?file=2623452","24"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010018","Humana Silver 3800/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010018-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2619812","http://apps.humana.com/marketing/documents.asp?file=2623465","25"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010019","Humana Gold 2250/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010019-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2619669","http://apps.humana.com/marketing/documents.asp?file=2615054","26"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010019","Humana Gold 2250/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010019-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2619825","http://apps.humana.com/marketing/documents.asp?file=2592824","27"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","2","46275","MI","Individual","No","27-3991410","46275MI0010020","Humana Platinum 500/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","46275MI0010020-03","Limited Cost Sharing Plan Variation","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2619890","http://apps.humana.com/marketing/documents.asp?file=2592837","33"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","6","46275","MI","Individual","No","27-3991410","46275MI0010002","Humana Bronze 6450/Detroit HMOx","46275MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","46275MI0010002-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2598765","http://apps.humana.com/marketing/documents.asp?file=2588469","4"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","4","58594","MI","Individual","No","38-3253977","58594MI0010005","Meridian Gold","58594MI001",,"MIN001","MIS001","MIF004","Existing","HMO","Gold","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010005-03","Limited Cost Sharing Plan Variation",,"0.782054662704468","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$360","$360","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=rnVTFAToPFpvXHUyYJ4aRBDxKHtQwhK/P/+F77zXKVqFQgLsQq55drkWgi6NkiiTQe8/35AwGJZPdI43C2B8Xw==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","7"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","5","58594","MI","Individual","No","38-3253977","58594MI0010007","Meridian Healthy Bronze","58594MI001",,"MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010007-00","Standard Bronze Off Exchange Plan",,"0.611322641372681","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=HhvW/S6PL/7UqIJmVGcG17bpG78SggwMMrbkF/1N1I/YUgHQI6bo53FvUVx67ePHN3ZgMte8k2daHLysYTceTg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","4"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","5","58594","MI","Individual","No","38-3253977","58594MI0010007","Meridian Healthy Bronze","58594MI001",,"MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010007-01","Standard Bronze On Exchange Plan",,"0.611322641372681","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=HhvW/S6PL/7UqIJmVGcG17bpG78SggwMMrbkF/1N1I/YUgHQI6bo53FvUVx67ePHN3ZgMte8k2daHLysYTceTg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","5"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","5","58594","MI","Individual","No","38-3253977","58594MI0010007","Meridian Healthy Bronze","58594MI001",,"MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhplan.com/meridianchoice/members/index.php?location=member&page=benefits","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","6"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","5","58594","MI","Individual","No","38-3253977","58594MI0010007","Meridian Healthy Bronze","58594MI001",,"MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010007-03","Limited Cost Sharing Plan Variation",,"0.611322641372681","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=HhvW/S6PL/7UqIJmVGcG17bpG78SggwMMrbkF/1N1I/YUgHQI6bo53FvUVx67ePHN3ZgMte8k2daHLysYTceTg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","7"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","6","58594","MI","Individual","No","38-3253977","58594MI0010008","Meridian Healthy Silver","58594MI001",,"MIN001","MIS001","MIF006","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010008-00","Standard Silver Off Exchange Plan",,"0.680397927761078","No","Yes","No","100%",,"$5,020","$0","$450","$150","$5,220","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=DOvYTdlM/SNh2dtdbrNT+b0Cf62pkucs1Ahr/8VzLY+BNkMr87WQmGEgsHJmHqLyE5zZ97t+okM2mYMXZdvTWA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","4"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","6","46275","MI","Individual","No","27-3991410","46275MI0010017","Humana Bronze 6450/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","46275MI0010017-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2619643","http://apps.humana.com/marketing/documents.asp?file=2598765","8"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","6","46275","MI","Individual","No","27-3991410","46275MI0010017","Humana Bronze 6450/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","46275MI0010017-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2619708","http://apps.humana.com/marketing/documents.asp?file=2592798","9"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","6","46275","MI","Individual","No","27-3991410","46275MI0010017","Humana Bronze 6450/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","46275MI0010017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2619721","http://apps.humana.com/marketing/documents.asp?file=2592798","10"
"2016","MI","46275","SERFF","7","2016-01-27 11:15:49","6","46275","MI","Individual","No","27-3991410","46275MI0010017","Humana Bronze 6450/Michigan HMOx","46275MI001",,"MIN002","MIS002","MIF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","46275MI0010017-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2619734","http://apps.humana.com/marketing/documents.asp?file=2592798","11"
"2016","MI","47007","SERFF","4","2016-03-31 13:35:32","1","47007","MI","SHOP (Small Group)","Yes","42-0127290","47007MI0040001","Principal Plan Dental 70","47007MI004",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$27.83","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","47007MI0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MI","47007","SERFF","4","2016-03-31 13:35:32","1","47007","MI","SHOP (Small Group)","Yes","42-0127290","47007MI0040002","Principal Plan Dental 85","47007MI004",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$29.67","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","47007MI0040002-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MI","47638","SERFF","3","2015-08-22 23:36:24","1","47638","MI","SHOP (Small Group)","Yes","20-3805292","47638MI0010001","Retailers Insurance Company - EHB","47638MI001",,"MIN001","MIS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.27","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","47638MI0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MI","47638","SERFF","3","2015-08-22 23:36:24","1","47638","MI","SHOP (Small Group)","Yes","20-3805292","47638MI0010002","Retailers Insurance Company - EHB","47638MI001",,"MIN001","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.16","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","47638MI0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MI","47822","SERFF","5","2015-08-28 13:59:00","1","47822","MI","SHOP (Small Group)","Yes","41-1412669","47822MI0010001","Securian Dental with Essential Health Benefits - Employer Paid D-1","47822MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.00","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","47822MI0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MI","47822","SERFF","5","2015-08-28 13:59:00","1","47822","MI","SHOP (Small Group)","Yes","41-1412669","47822MI0010002","Securian Dental with Essential Health Benefits - Employer Paid D-2","47822MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.00","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","47822MI0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MI","47822","SERFF","5","2015-08-28 13:59:00","1","47822","MI","SHOP (Small Group)","Yes","41-1412669","47822MI0010003","Securian Dental with Essential Health Benefits - Employer Paid D-3","47822MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.00","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","47822MI0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","MI","47822","SERFF","5","2015-08-28 13:59:00","1","47822","MI","SHOP (Small Group)","Yes","41-1412669","47822MI0010004","Securian Dental with Essential Health Benefits - Employer Paid D-4","47822MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.00","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","47822MI0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","MI","47822","SERFF","5","2015-08-28 13:59:00","1","47822","MI","SHOP (Small Group)","Yes","41-1412669","47822MI0010005","Securian Dental with Essential Health Benefits - Employer Paid D-5","47822MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.00","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","47822MI0010005-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","MI","47822","SERFF","5","2015-08-28 13:59:00","1","47822","MI","SHOP (Small Group)","Yes","41-1412669","47822MI0010006","Securian Dental with Essential Health Benefits - Employer Paid D-6","47822MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.00","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","47822MI0010006-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","MI","47822","SERFF","5","2015-08-28 13:59:00","1","47822","MI","SHOP (Small Group)","Yes","41-1412669","47822MI0020001","Securian Dental with Essential Health Benefits -Voluntary D-1","47822MI002",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.00","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","47822MI0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2016","MI","47822","SERFF","5","2015-08-28 13:59:00","1","47822","MI","SHOP (Small Group)","Yes","41-1412669","47822MI0020002","Securian Dental with Essential Health Benefits -Voluntary D-2","47822MI002",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.00","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,"","47822MI0020002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2016","MI","53678","SERFF","4","2015-08-24 05:58:52","1","53678","MI","Individual","Yes","72-0977315","53678MI0010001","AlwaysCare All-Star Kids Dental Plan","53678MI001",,"MIN001","MIS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$22.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","53678MI0010001-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","MI","53678","SERFF","4","2015-08-24 05:58:52","1","53678","MI","SHOP (Small Group)","Yes","72-0977315","53678MI0040001","AlwaysCare Small Group – Child","53678MI004",,"MIN001","MIS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$21.36","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","53678MI0040001-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","MI","53678","SERFF","4","2015-08-24 05:58:52","1","53678","MI","SHOP (Small Group)","Yes","72-0977315","53678MI0040002","AlwaysCare Small Group – Child","53678MI004",,"MIN001","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$17.15","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","53678MI0040002-00","Standard Low Off Exchange Plan","68.03%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","MI","53678","SERFF","4","2015-08-24 05:58:52","1","53678","MI","Individual","Yes","72-0977315","53678MI0010002","AlwaysCare All-Star Kids Dental Plan","53678MI001",,"MIN001","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$17.77","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","53678MI0010002-00","Standard Low Off Exchange Plan","68.03%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","MI","53678","SERFF","4","2015-08-24 05:58:52","2","53678","MI","Individual","Yes","72-0977315","53678MI0020001","AlwaysCare All-Star Family Dental Plan","53678MI002",,"MIN001","MIS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$22.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","53678MI0020001-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","MI","53678","SERFF","4","2015-08-24 05:58:52","2","53678","MI","SHOP (Small Group)","Yes","72-0977315","53678MI0030001","AlwaysCare Small Group Dental – Adults","53678MI003",,"MIN001","MIS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$21.36","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","53678MI0030001-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","MI","53678","SERFF","4","2015-08-24 05:58:52","2","53678","MI","SHOP (Small Group)","Yes","72-0977315","53678MI0030002","AlwaysCare Small Group Dental – Adults","53678MI003",,"MIN001","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$17.15","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","53678MI0030002-00","Standard Low Off Exchange Plan","68.03%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","MI","53678","SERFF","4","2015-08-24 05:58:52","3","53678","MI","Individual","Yes","72-0977315","53678MI0020002","AlwaysCare All-Star Family Dental Plan","53678MI002",,"MIN001","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$17.77","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","53678MI0020002-00","Standard Low Off Exchange Plan","68.03%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","1","58594","MI","Individual","No","38-3253977","58594MI0010001","Meridian Catastrophic","58594MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=IKJ25dEKsHg0INidkhnV2hEBR2wMf25zNDcE1JjLmuQNWTG5S3genMZPpltOMMKJfsR+Bv2wzIKnyzo21UHzBA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","4"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","1","58594","MI","Individual","No","38-3253977","58594MI0010001","Meridian Catastrophic","58594MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=IKJ25dEKsHg0INidkhnV2hEBR2wMf25zNDcE1JjLmuQNWTG5S3genMZPpltOMMKJfsR+Bv2wzIKnyzo21UHzBA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","5"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","2","58594","MI","Individual","No","38-3253977","58594MI0010002","Meridian Bronze","58594MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010002-00","Standard Bronze Off Exchange Plan",,"0.590004444122314","Yes","Yes","No","100%",,"$6,400","$0","$350","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=xhIP7SUlPAvZViv360phpBJfqCexNH7YSxV7AEc05KNXnwSJgJY/OvhwZPjVekHiXxDUhwP6ku4q4jT9o6XVlg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","4"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","2","58594","MI","Individual","No","38-3253977","58594MI0010002","Meridian Bronze","58594MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010002-01","Standard Bronze On Exchange Plan",,"0.590004444122314","Yes","Yes","No","100%",,"$6,400","$0","$350","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=xhIP7SUlPAvZViv360phpBJfqCexNH7YSxV7AEc05KNXnwSJgJY/OvhwZPjVekHiXxDUhwP6ku4q4jT9o6XVlg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","5"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","2","58594","MI","Individual","No","38-3253977","58594MI0010002","Meridian Bronze","58594MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhplan.com/meridianchoice/members/index.php?location=member&page=benefits","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","6"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","2","58594","MI","Individual","No","38-3253977","58594MI0010002","Meridian Bronze","58594MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010002-03","Limited Cost Sharing Plan Variation",,"0.590004444122314","Yes","Yes","No","100%",,"$6,400","$0","$350","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=xhIP7SUlPAvZViv360phpBJfqCexNH7YSxV7AEc05KNXnwSJgJY/OvhwZPjVekHiXxDUhwP6ku4q4jT9o6XVlg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","7"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","3","58594","MI","Individual","No","38-3253977","58594MI0010004","Meridian Silver","58594MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010004-00","Standard Silver Off Exchange Plan",,"0.680737137794495","No","Yes","No","100%",,"$2,920","$0","$1,310","$150","$3,220","$360","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=e3OVOP9lFxL3Vx1GTGqSsYaHCGC9uMk3mNsqWbBc0TcrhCeTltEK0OmtsnVXc0Fjul2kmOW7zOB+B7nbiIOViA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","4"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","3","58594","MI","Individual","No","38-3253977","58594MI0010004","Meridian Silver","58594MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010004-01","Standard Silver On Exchange Plan",,"0.680737137794495","No","Yes","No","100%",,"$2,920","$0","$1,310","$150","$3,220","$360","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=e3OVOP9lFxL3Vx1GTGqSsYaHCGC9uMk3mNsqWbBc0TcrhCeTltEK0OmtsnVXc0Fjul2kmOW7zOB+B7nbiIOViA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","5"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","3","58594","MI","Individual","No","38-3253977","58594MI0010004","Meridian Silver","58594MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=0UrdEp5V8ryXYyyd0/Q1XlbToErDUJJn+Bc1OInoi+Oorab0C3iZ661gmqXag4czvXLyxcvoZWYQmO1ZA5/15w==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","6"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","3","58594","MI","Individual","No","38-3253977","58594MI0010004","Meridian Silver","58594MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010004-03","Limited Cost Sharing Plan Variation",,"0.680737137794495","No","Yes","No","100%",,"$2,920","$0","$1,310","$150","$3,220","$360","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=e3OVOP9lFxL3Vx1GTGqSsYaHCGC9uMk3mNsqWbBc0TcrhCeTltEK0OmtsnVXc0Fjul2kmOW7zOB+B7nbiIOViA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","7"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","3","58594","MI","Individual","No","38-3253977","58594MI0010004","Meridian Silver","58594MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010004-04","73% AV Level Silver Plan",,"0.739967584609985","No","Yes","No","100%",,"$1,320","$0","$1,790","$150","$1,650","$440","$340","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=kgQtQ1EjhnRDhvrt7AdBhIBX8ota8YHRziOZZO8Ypr+f9Q4tVnKxNXfl7AniExY7pIbbb0ZES68nmv2iVKP5EA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","8"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","3","58594","MI","Individual","No","38-3253977","58594MI0010004","Meridian Silver","58594MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010004-05","87% AV Level Silver Plan",,"0.879794299602509","No","Yes","No","100%",,"$300","$10","$1,390","$150","$300","$320","$420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=Ez0Iz8M+gXW0oVFP8x5bHmSA1k5LnpHavLmt7qIUC+qqO4QS10XE+iC3kaT2u/Sdd2MTAOTTbit2IeVDwFqZxQ==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","9"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","3","58594","MI","Individual","No","38-3253977","58594MI0010004","Meridian Silver","58594MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010004-06","94% AV Level Silver Plan",,"0.949905872344971","No","Yes","No","100%",,"$130","$10","$0","$150","$130","$160","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","$250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=hzroAITpmfJsyWLdneKrZ39kHWM/EUxzJzq2/RAlLNal3YquTeSXjBqQgjXmQTQMWhep0JxEMLIDcEZ+zmkGaQ==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","10"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","4","58594","MI","Individual","No","38-3253977","58594MI0010005","Meridian Gold","58594MI001",,"MIN001","MIS001","MIF004","Existing","HMO","Gold","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhplan.com/meridianchoice/members/index.php?location=member&page=benefits","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","6"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","6","58594","MI","Individual","No","38-3253977","58594MI0010008","Meridian Healthy Silver","58594MI001",,"MIN001","MIS001","MIF006","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010008-01","Standard Silver On Exchange Plan",,"0.680397927761078","No","Yes","No","100%",,"$5,020","$0","$450","$150","$5,220","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=DOvYTdlM/SNh2dtdbrNT+b0Cf62pkucs1Ahr/8VzLY+BNkMr87WQmGEgsHJmHqLyE5zZ97t+okM2mYMXZdvTWA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","5"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","6","58594","MI","Individual","No","38-3253977","58594MI0010008","Meridian Healthy Silver","58594MI001",,"MIN001","MIS001","MIF006","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=R2AHsUMdgkhBMEGnJJ8fGyzUqJLEeB1qiEX/Xuw6NQSnun6/dB4A0LWZgiNpsS4Of7J485sB8JLz0QXcECMJ9w==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","6"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","6","58594","MI","Individual","No","38-3253977","58594MI0010008","Meridian Healthy Silver","58594MI001",,"MIN001","MIS001","MIF006","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010008-03","Limited Cost Sharing Plan Variation",,"0.680397927761078","No","Yes","No","100%",,"$5,020","$0","$450","$150","$5,220","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=DOvYTdlM/SNh2dtdbrNT+b0Cf62pkucs1Ahr/8VzLY+BNkMr87WQmGEgsHJmHqLyE5zZ97t+okM2mYMXZdvTWA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","7"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","6","58594","MI","Individual","No","38-3253977","58594MI0010008","Meridian Healthy Silver","58594MI001",,"MIN001","MIS001","MIF006","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010008-04","73% AV Level Silver Plan",,"0.739104211330414","No","Yes","No","100%",,"$1,620","$0","$1,130","$150","$2,100","$590","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=2pogkqx4ad9PyM/JMHJYEA7ifdSTfcRjgpOHXVtjc9Ou1bf0YGDloCgOfweQeJgJ2v9hNqHz/PzoVXoCcPGj2A==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","8"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","6","58594","MI","Individual","No","38-3253977","58594MI0010008","Meridian Healthy Silver","58594MI001",,"MIN001","MIS001","MIF006","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010008-05","87% AV Level Silver Plan",,"0.879422843456268","No","Yes","No","100%",,"$420","$0","$690","$150","$500","$400","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=+9RUTAH3djmVzlCalNzs3E4vLpWcVNT+oVJA1bl908ClK/CBgRUqa79V0Bik3t0UNa3BUyiEopSlOsO/2+xFxg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","9"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","6","58594","MI","Individual","No","38-3253977","58594MI0010008","Meridian Healthy Silver","58594MI001",,"MIN001","MIS001","MIF006","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010008-06","94% AV Level Silver Plan",,"0.949847817420959","No","Yes","No","100%",,"$150","$10","$0","$150","$150","$160","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=uSuc8Jya8W5kyaBoLEDn+f0h3woXfREOrbEajPZOvBlMCGoxanAgcA4d1XDjPCWocGsLaYLZ/YPQ21MULkjdpA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","10"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","7","58594","MI","Individual","No","38-3253977","58594MI0010009","Meridian Healthy Gold","58594MI001",,"MIN001","MIS001","MIF007","New","HMO","Gold","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010009-00","Standard Gold Off Exchange Plan",,"0.7801433801651","No","Yes","No","100%",,"$2,020","$0","$1,050","$150","$2,500","$280","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=M5T8RGjBz8jC46YNZzT8U/i2NZGcc6zY1I+0vBPTgawcunzxQ+8+iGonioTPZ5uFWANacj+Cz6IjC1YMlG3HIA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","4"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","7","58594","MI","Individual","No","38-3253977","58594MI0010009","Meridian Healthy Gold","58594MI001",,"MIN001","MIS001","MIF007","New","HMO","Gold","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010009-01","Standard Gold On Exchange Plan",,"0.7801433801651","No","Yes","No","100%",,"$2,020","$0","$1,050","$150","$2,500","$280","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=M5T8RGjBz8jC46YNZzT8U/i2NZGcc6zY1I+0vBPTgawcunzxQ+8+iGonioTPZ5uFWANacj+Cz6IjC1YMlG3HIA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","5"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","7","58594","MI","Individual","No","38-3253977","58594MI0010009","Meridian Healthy Gold","58594MI001",,"MIN001","MIS001","MIF007","New","HMO","Gold","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mhplan.com/meridianchoice/members/index.php?location=member&page=benefits","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","6"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","7","58594","MI","Individual","No","38-3253977","58594MI0010009","Meridian Healthy Gold","58594MI001",,"MIN001","MIS001","MIF007","New","HMO","Gold","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0010009-03","Limited Cost Sharing Plan Variation",,"0.7801433801651","No","Yes","No","100%",,"$2,020","$0","$1,050","$150","$2,500","$280","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=M5T8RGjBz8jC46YNZzT8U/i2NZGcc6zY1I+0vBPTgawcunzxQ+8+iGonioTPZ5uFWANacj+Cz6IjC1YMlG3HIA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","7"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","8","58594","MI","Individual","No","38-3253977","58594MI0020001","Meridian Catastrophic","58594MI002",,"MIN002","MIS002","MIF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=IKJ25dEKsHg0INidkhnV2hEBR2wMf25zNDcE1JjLmuQNWTG5S3genMZPpltOMMKJfsR+Bv2wzIKnyzo21UHzBA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","4"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","8","58594","MI","Individual","No","38-3253977","58594MI0020001","Meridian Catastrophic","58594MI002",,"MIN002","MIS002","MIF001","New","HMO","Catastrophic","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=IKJ25dEKsHg0INidkhnV2hEBR2wMf25zNDcE1JjLmuQNWTG5S3genMZPpltOMMKJfsR+Bv2wzIKnyzo21UHzBA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=v9zMXHGbtmw3KWIBIRr+HtrDe6Z8QXo4jB9AgjZuXAxKE83o4pfwdXOFVGeBS38567AkMW8NvxKabeUcnZyAdQ==","5"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","9","58594","MI","Individual","No","38-3253977","58594MI0020002","Meridian Bronze","58594MI002",,"MIN002","MIS002","MIF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020002-00","Standard Bronze Off Exchange Plan",,"0.590004444122314","Yes","Yes","No","100%",,"$6,400","$0","$350","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=xhIP7SUlPAvZViv360phpBJfqCexNH7YSxV7AEc05KNXnwSJgJY/OvhwZPjVekHiXxDUhwP6ku4q4jT9o6XVlg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","4"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","9","58594","MI","Individual","No","38-3253977","58594MI0020002","Meridian Bronze","58594MI002",,"MIN002","MIS002","MIF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020002-01","Standard Bronze On Exchange Plan",,"0.590004444122314","Yes","Yes","No","100%",,"$6,400","$0","$350","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=xhIP7SUlPAvZViv360phpBJfqCexNH7YSxV7AEc05KNXnwSJgJY/OvhwZPjVekHiXxDUhwP6ku4q4jT9o6XVlg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","5"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","9","58594","MI","Individual","No","38-3253977","58594MI0020002","Meridian Bronze","58594MI002",,"MIN002","MIS002","MIF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhplan.com/meridianchoice/members/index.php?location=member&page=benefits","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","6"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","9","58594","MI","Individual","No","38-3253977","58594MI0020002","Meridian Bronze","58594MI002",,"MIN002","MIS002","MIF002","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020002-03","Limited Cost Sharing Plan Variation",,"0.590004444122314","Yes","Yes","No","100%",,"$6,400","$0","$350","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=xhIP7SUlPAvZViv360phpBJfqCexNH7YSxV7AEc05KNXnwSJgJY/OvhwZPjVekHiXxDUhwP6ku4q4jT9o6XVlg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","7"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","10","58594","MI","Individual","No","38-3253977","58594MI0020004","Meridian Silver","58594MI002",,"MIN002","MIS002","MIF003","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020004-00","Standard Silver Off Exchange Plan",,"0.680737137794495","No","Yes","No","100%",,"$2,920","$0","$1,310","$150","$3,220","$360","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=e3OVOP9lFxL3Vx1GTGqSsYaHCGC9uMk3mNsqWbBc0TcrhCeTltEK0OmtsnVXc0Fjul2kmOW7zOB+B7nbiIOViA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","4"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","10","58594","MI","Individual","No","38-3253977","58594MI0020004","Meridian Silver","58594MI002",,"MIN002","MIS002","MIF003","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020004-01","Standard Silver On Exchange Plan",,"0.680737137794495","No","Yes","No","100%",,"$2,920","$0","$1,310","$150","$3,220","$360","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=e3OVOP9lFxL3Vx1GTGqSsYaHCGC9uMk3mNsqWbBc0TcrhCeTltEK0OmtsnVXc0Fjul2kmOW7zOB+B7nbiIOViA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","5"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","10","58594","MI","Individual","No","38-3253977","58594MI0020004","Meridian Silver","58594MI002",,"MIN002","MIS002","MIF003","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=0UrdEp5V8ryXYyyd0/Q1XlbToErDUJJn+Bc1OInoi+Oorab0C3iZ661gmqXag4czvXLyxcvoZWYQmO1ZA5/15w==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","6"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","10","58594","MI","Individual","No","38-3253977","58594MI0020004","Meridian Silver","58594MI002",,"MIN002","MIS002","MIF003","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020004-03","Limited Cost Sharing Plan Variation",,"0.680737137794495","No","Yes","No","100%",,"$2,920","$0","$1,310","$150","$3,220","$360","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,900","$2900 per person","$5800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=e3OVOP9lFxL3Vx1GTGqSsYaHCGC9uMk3mNsqWbBc0TcrhCeTltEK0OmtsnVXc0Fjul2kmOW7zOB+B7nbiIOViA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","7"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","10","58594","MI","Individual","No","38-3253977","58594MI0020004","Meridian Silver","58594MI002",,"MIN002","MIS002","MIF003","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020004-04","73% AV Level Silver Plan",,"0.739967584609985","No","Yes","No","100%",,"$1,320","$0","$1,790","$150","$1,650","$440","$340","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=kgQtQ1EjhnRDhvrt7AdBhIBX8ota8YHRziOZZO8Ypr+f9Q4tVnKxNXfl7AniExY7pIbbb0ZES68nmv2iVKP5EA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","8"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","10","58594","MI","Individual","No","38-3253977","58594MI0020004","Meridian Silver","58594MI002",,"MIN002","MIS002","MIF003","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020004-05","87% AV Level Silver Plan",,"0.879794299602509","No","Yes","No","100%",,"$300","$10","$1,390","$150","$300","$320","$420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=Ez0Iz8M+gXW0oVFP8x5bHmSA1k5LnpHavLmt7qIUC+qqO4QS10XE+iC3kaT2u/Sdd2MTAOTTbit2IeVDwFqZxQ==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","9"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","10","58594","MI","Individual","No","38-3253977","58594MI0020004","Meridian Silver","58594MI002",,"MIN002","MIS002","MIF003","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020004-06","94% AV Level Silver Plan",,"0.949905872344971","No","Yes","No","100%",,"$130","$10","$0","$150","$130","$160","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","$250 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=hzroAITpmfJsyWLdneKrZ39kHWM/EUxzJzq2/RAlLNal3YquTeSXjBqQgjXmQTQMWhep0JxEMLIDcEZ+zmkGaQ==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","10"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","11","58594","MI","Individual","No","38-3253977","58594MI0020005","Meridian Gold","58594MI002",,"MIN002","MIS002","MIF004","New","HMO","Gold","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020005-00","Standard Gold Off Exchange Plan",,"0.782054662704468","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$360","$360","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=rnVTFAToPFpvXHUyYJ4aRBDxKHtQwhK/P/+F77zXKVqFQgLsQq55drkWgi6NkiiTQe8/35AwGJZPdI43C2B8Xw==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","4"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","11","58594","MI","Individual","No","38-3253977","58594MI0020005","Meridian Gold","58594MI002",,"MIN002","MIS002","MIF004","New","HMO","Gold","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020005-01","Standard Gold On Exchange Plan",,"0.782054662704468","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$360","$360","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=rnVTFAToPFpvXHUyYJ4aRBDxKHtQwhK/P/+F77zXKVqFQgLsQq55drkWgi6NkiiTQe8/35AwGJZPdI43C2B8Xw==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","5"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","11","58594","MI","Individual","No","38-3253977","58594MI0020005","Meridian Gold","58594MI002",,"MIN002","MIS002","MIF004","New","HMO","Gold","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhplan.com/meridianchoice/members/index.php?location=member&page=benefits","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","6"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","11","58594","MI","Individual","No","38-3253977","58594MI0020005","Meridian Gold","58594MI002",,"MIN002","MIS002","MIF004","New","HMO","Gold","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020005-03","Limited Cost Sharing Plan Variation",,"0.782054662704468","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$360","$360","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=rnVTFAToPFpvXHUyYJ4aRBDxKHtQwhK/P/+F77zXKVqFQgLsQq55drkWgi6NkiiTQe8/35AwGJZPdI43C2B8Xw==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","7"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","12","58594","MI","Individual","No","38-3253977","58594MI0020007","Meridian Healthy Bronze","58594MI002",,"MIN002","MIS002","MIF005","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020007-00","Standard Bronze Off Exchange Plan",,"0.611322641372681","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=HhvW/S6PL/7UqIJmVGcG17bpG78SggwMMrbkF/1N1I/YUgHQI6bo53FvUVx67ePHN3ZgMte8k2daHLysYTceTg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","4"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","12","58594","MI","Individual","No","38-3253977","58594MI0020007","Meridian Healthy Bronze","58594MI002",,"MIN002","MIS002","MIF005","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020007-01","Standard Bronze On Exchange Plan",,"0.611322641372681","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=HhvW/S6PL/7UqIJmVGcG17bpG78SggwMMrbkF/1N1I/YUgHQI6bo53FvUVx67ePHN3ZgMte8k2daHLysYTceTg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","5"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","12","58594","MI","Individual","No","38-3253977","58594MI0020007","Meridian Healthy Bronze","58594MI002",,"MIN002","MIS002","MIF005","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhplan.com/meridianchoice/members/index.php?location=member&page=benefits","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","6"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","12","58594","MI","Individual","No","38-3253977","58594MI0020007","Meridian Healthy Bronze","58594MI002",,"MIN002","MIS002","MIF005","New","HMO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020007-03","Limited Cost Sharing Plan Variation",,"0.611322641372681","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=HhvW/S6PL/7UqIJmVGcG17bpG78SggwMMrbkF/1N1I/YUgHQI6bo53FvUVx67ePHN3ZgMte8k2daHLysYTceTg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","7"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","13","58594","MI","Individual","No","38-3253977","58594MI0020008","Meridian Healthy Silver","58594MI002",,"MIN002","MIS002","MIF006","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020008-00","Standard Silver Off Exchange Plan",,"0.680397927761078","No","Yes","No","100%",,"$5,020","$0","$450","$150","$5,220","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=DOvYTdlM/SNh2dtdbrNT+b0Cf62pkucs1Ahr/8VzLY+BNkMr87WQmGEgsHJmHqLyE5zZ97t+okM2mYMXZdvTWA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","4"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","13","58594","MI","Individual","No","38-3253977","58594MI0020008","Meridian Healthy Silver","58594MI002",,"MIN002","MIS002","MIF006","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020008-01","Standard Silver On Exchange Plan",,"0.680397927761078","No","Yes","No","100%",,"$5,020","$0","$450","$150","$5,220","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=DOvYTdlM/SNh2dtdbrNT+b0Cf62pkucs1Ahr/8VzLY+BNkMr87WQmGEgsHJmHqLyE5zZ97t+okM2mYMXZdvTWA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","5"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","13","58594","MI","Individual","No","38-3253977","58594MI0020008","Meridian Healthy Silver","58594MI002",,"MIN002","MIS002","MIF006","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=R2AHsUMdgkhBMEGnJJ8fGyzUqJLEeB1qiEX/Xuw6NQSnun6/dB4A0LWZgiNpsS4Of7J485sB8JLz0QXcECMJ9w==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","6"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","13","58594","MI","Individual","No","38-3253977","58594MI0020008","Meridian Healthy Silver","58594MI002",,"MIN002","MIS002","MIF006","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020008-03","Limited Cost Sharing Plan Variation",,"0.680397927761078","No","Yes","No","100%",,"$5,020","$0","$450","$150","$5,220","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=DOvYTdlM/SNh2dtdbrNT+b0Cf62pkucs1Ahr/8VzLY+BNkMr87WQmGEgsHJmHqLyE5zZ97t+okM2mYMXZdvTWA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","7"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","13","58594","MI","Individual","No","38-3253977","58594MI0020008","Meridian Healthy Silver","58594MI002",,"MIN002","MIS002","MIF006","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020008-04","73% AV Level Silver Plan",,"0.739104211330414","No","Yes","No","100%",,"$1,620","$0","$1,130","$150","$2,100","$590","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,600","$1600 per person","$3200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=2pogkqx4ad9PyM/JMHJYEA7ifdSTfcRjgpOHXVtjc9Ou1bf0YGDloCgOfweQeJgJ2v9hNqHz/PzoVXoCcPGj2A==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","8"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","13","58594","MI","Individual","No","38-3253977","58594MI0020008","Meridian Healthy Silver","58594MI002",,"MIN002","MIS002","MIF006","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020008-05","87% AV Level Silver Plan",,"0.879422843456268","No","Yes","No","100%",,"$420","$0","$690","$150","$500","$400","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=+9RUTAH3djmVzlCalNzs3E4vLpWcVNT+oVJA1bl908ClK/CBgRUqa79V0Bik3t0UNa3BUyiEopSlOsO/2+xFxg==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","9"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","13","58594","MI","Individual","No","38-3253977","58594MI0020008","Meridian Healthy Silver","58594MI002",,"MIN002","MIS002","MIF006","New","HMO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020008-06","94% AV Level Silver Plan",,"0.949847817420959","No","Yes","No","100%",,"$150","$10","$0","$150","$150","$160","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=uSuc8Jya8W5kyaBoLEDn+f0h3woXfREOrbEajPZOvBlMCGoxanAgcA4d1XDjPCWocGsLaYLZ/YPQ21MULkjdpA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","10"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","14","58594","MI","Individual","No","38-3253977","58594MI0020009","Meridian Healthy Gold","58594MI002",,"MIN002","MIS002","MIF007","New","HMO","Gold","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020009-00","Standard Gold Off Exchange Plan",,"0.7801433801651","No","Yes","No","100%",,"$2,020","$0","$1,050","$150","$2,500","$280","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=M5T8RGjBz8jC46YNZzT8U/i2NZGcc6zY1I+0vBPTgawcunzxQ+8+iGonioTPZ5uFWANacj+Cz6IjC1YMlG3HIA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","4"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","14","58594","MI","Individual","No","38-3253977","58594MI0020009","Meridian Healthy Gold","58594MI002",,"MIN002","MIS002","MIF007","New","HMO","Gold","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020009-01","Standard Gold On Exchange Plan",,"0.7801433801651","No","Yes","No","100%",,"$2,020","$0","$1,050","$150","$2,500","$280","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=M5T8RGjBz8jC46YNZzT8U/i2NZGcc6zY1I+0vBPTgawcunzxQ+8+iGonioTPZ5uFWANacj+Cz6IjC1YMlG3HIA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","5"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","14","58594","MI","Individual","No","38-3253977","58594MI0020009","Meridian Healthy Gold","58594MI002",,"MIN002","MIS002","MIF007","New","HMO","Gold","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mhplan.com/meridianchoice/members/index.php?location=member&page=benefits","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","6"
"2016","MI","58594","SERFF","7","2016-03-31 13:35:32","14","58594","MI","Individual","No","38-3253977","58594MI0020009","Meridian Healthy Gold","58594MI002",,"MIN002","MIS002","MIF007","New","HMO","Gold","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent","No",,"http://www.mhplan.com/content/pdf/meridianchoice/choiceFormulary.pdf","58594MI0020009-03","Limited Cost Sharing Plan Variation",,"0.7801433801651","No","Yes","No","100%",,"$2,020","$0","$1,050","$150","$2,500","$280","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://corp.mhplan.com/ContentDocuments/default.aspx?x=M5T8RGjBz8jC46YNZzT8U/i2NZGcc6zY1I+0vBPTgawcunzxQ+8+iGonioTPZ5uFWANacj+Cz6IjC1YMlG3HIA==","https://corp.mhplan.com/ContentDocuments/default.aspx?x=EgvYEL/qaf/YpU9fN746m1cBSBJyUfRaAavP0S5T7INZTzj44Jjepk5lh0VApt5OXvKoqwquwz4Jxhb8qwa4rw==","7"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0220001","Sparrow PHP Silver HDHP Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF012","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0220001-00","Standard Silver Off Exchange Plan",,"0.704484343528748","Yes","Yes","No","100%",,"$2,700","$23","$885","$150","$2,700","$971","$77","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20HDHP%20Exclusive_SFY00100_Off.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20HDHP%20Exclusive_SFY00100_Off.pdf","4"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0220001","Sparrow PHP Silver HDHP Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF012","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0220001-01","Standard Silver On Exchange Plan",,"0.704484343528748","Yes","Yes","No","100%",,"$2,700","$23","$885","$150","$2,700","$971","$77","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20HDHP%20Exclusive_SNY00100_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20HDHP%20Exclusive_SNY00100_On.pdf","5"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0220001","Sparrow PHP Silver HDHP Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF012","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0220001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20HDHP%20Exclusive%20NA_SNY00300_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20HDHP%20Exclusive%20NA_SNY00300_On.pdf","6"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0220001","Sparrow PHP Silver HDHP Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF012","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0220001-03","Limited Cost Sharing Plan Variation",,"0.704484343528748","Yes","Yes","No","100%",,"$2,700","$23","$885","$150","$2,700","$971","$77","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20HDHP%20Exclusive%20NA%20Special_SNY00200_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20HDHP%20Exclusive%20NA%20Special_SNY00200_On.pdf","7"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0220001","Sparrow PHP Silver HDHP Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF012","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0220001-04","73% AV Level Silver Plan",,"0.727365434169769","Yes","Yes","No","100%",,"$1,900","$23","$1,045","$150","$1,900","$1,257","$97","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20HDHP%20Exclusive%20200-250_SNY00400_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20HDHP%20Exclusive%20200-250_SNY00400_On.pdf","8"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0220001","Sparrow PHP Silver HDHP Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF012","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0220001-05","87% AV Level Silver Plan",,"0.864729225635529","Yes","Yes","No","100%",,"$750","$20","$637","$150","$750","$664","$86","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20HDHP%20Exclusive%20150-200_SNY00500_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20HDHP%20Exclusive%20150-200_SNY00500_On.pdf","9"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0220001","Sparrow PHP Silver HDHP Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF012","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0220001-06","94% AV Level Silver Plan",,"0.938823580741882","Yes","Yes","No","100%",,"$250","$15","$0","$150","$250","$856","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20HDHP%20Exclusive%20100-150_SNY00600_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20HDHP%20Exclusive%20100-150_SNY00600_On.pdf","10"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190003","Sparrow PHP Platinum Practical Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190003-00","Standard Platinum Off Exchange Plan",,"0.88183468580246","No","Yes","No","100%",,"$750","$0","$450","$150","$268","$932","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$750","$750 per person","$1500 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Platinum%20Practical%20Exclusive_PFA00400_Off.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Platinum%20Practical%20Exclusive_PFA00400_Off.pdf","11"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190003","Sparrow PHP Platinum Practical Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190003-01","Standard Platinum On Exchange Plan",,"0.88183468580246","No","Yes","No","100%",,"$750","$0","$450","$150","$268","$932","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$750","$750 per person","$1500 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Platinum%20Practical%20Exclusive_PNA00400_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Platinum%20Practical%20Exclusive_PNA00400_On.pdf","12"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190003","Sparrow PHP Platinum Practical Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Platinum%20Practical%20Exclusive%20NA_PNA00600_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Platinum%20Practical%20Exclusive%20NA_PNA00600_On.pdf","13"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200002","Sparrow PHP Gold Premier","60829MI020","7639172866","MIN001","MIS001","MIF002","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200002-00","Standard Gold Off Exchange Plan",,"0.818377375602722","No","Yes","No","100%",,"$500","$23","$1,246","$150","$287","$1,659","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Gold%20Premier_GFA00100_Off.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Gold%20Premier_GFA00100_Off.pdf","44"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200002","Sparrow PHP Gold Premier","60829MI020","7639172866","MIN001","MIS001","MIF002","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200002-01","Standard Gold On Exchange Plan",,"0.818377375602722","No","Yes","No","100%",,"$500","$23","$1,246","$150","$287","$1,659","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Gold%20Premier_GNA00100_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Gold%20Premier_GNA00100_On.pdf","45"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200002","Sparrow PHP Gold Premier","60829MI020","7639172866","MIN001","MIS001","MIF002","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Gold%20Premier%20NA_GNA00300_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Gold%20Premier%20NA_GNA00300_On.pdf","46"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200002","Sparrow PHP Gold Premier","60829MI020","7639172866","MIN001","MIS001","MIF002","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200002-03","Limited Cost Sharing Plan Variation",,"0.818377375602722","No","Yes","No","100%",,"$500","$23","$1,246","$150","$287","$1,659","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Gold%20Premier%20NA%20Special_GNA00200_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Gold%20Premier%20NA%20Special_GNA00200_On.pdf","47"
"2016","MI","63641","SERFF","3","2015-08-27 03:52:03","3","63641","MI","SHOP (Small Group)","Yes","86-0307623","63641MI0020003","Smile for Health - Certified High Option","63641MI002",,"MIN003","MIS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","63641MI0020003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MI","66587","SERFF","4","2015-08-24 05:58:52","1","66587","MI","Individual","Yes","13-5123390","66587MI0070001","Guardian Family Essentials","66587MI007",,"MIN002","MIS002",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","66587MI0070001-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","4"
"2016","MI","66587","SERFF","4","2015-08-24 05:58:52","1","66587","MI","SHOP (Small Group)","Yes","13-5123390","66587MI0010003","Guardian Pediatric Advantage","66587MI001",,"MIN001","MIS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$28.58","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","66587MI0010003-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","MI","66587","SERFF","4","2015-08-24 05:58:52","1","66587","MI","SHOP (Small Group)","Yes","13-5123390","66587MI0020003","Guardian Pediatric Essentials","66587MI002",,"MIN001","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$20.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","66587MI0020003-00","Standard Low Off Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","MI","66587","SERFF","4","2015-08-24 05:58:52","1","66587","MI","Individual","Yes","13-5123390","66587MI0070001","Guardian Family Essentials","66587MI007",,"MIN002","MIS002",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the Service Area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","66587MI0070001-01","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","5"
"2016","MI","66587","SERFF","4","2015-08-24 05:58:52","2","66587","MI","SHOP (Small Group)","Yes","13-5123390","66587MI0040003","Guardian Family Advantage","66587MI004",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.58","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverge is available outside of the service area.","Yes",,"","66587MI0040003-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190003","Sparrow PHP Platinum Practical Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190003-03","Limited Cost Sharing Plan Variation",,"0.88183468580246","No","Yes","No","100%",,"$750","$0","$450","$150","$268","$932","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$750","$750 per person","$1500 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Platinum%20Practical%20Exclusive%20NA%20Special_PNA00500_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Platinum%20Practical%20Exclusive%20NA%20Special_PNA00500_On.pdf","14"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190004","Sparrow PHP Gold Practical Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190004-00","Standard Gold Off Exchange Plan",,"0.781622767448425","No","Yes","No","100%",,"$1,500","$23","$1,687","$150","$412","$1,679","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Gold%20Practical%20Exclusive_GFA00700_Off.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Gold%20Practical%20Exclusive_GFA00700_Off.pdf","15"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190004","Sparrow PHP Gold Practical Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190004-01","Standard Gold On Exchange Plan",,"0.781622767448425","No","Yes","No","100%",,"$1,500","$23","$1,687","$150","$412","$1,679","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Gold%20Practical%20Exclusive_GNA00700_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Gold%20Practical%20Exclusive_GNA00700_On.pdf","16"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190004","Sparrow PHP Gold Practical Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Gold%20Practical%20Exclusive%20NA_GNA00900_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Gold%20Practical%20Exclusive%20NA_GNA00900_On.pdf","17"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190004","Sparrow PHP Gold Practical Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190004-03","Limited Cost Sharing Plan Variation",,"0.781622767448425","No","Yes","No","100%",,"$1,500","$23","$1,687","$150","$412","$1,679","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Gold%20Practical%20Exclusive%20NA%20Special_GNA00800_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Gold%20Practical%20Exclusive%20NA%20Special_GNA00800_On.pdf","18"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190005","Sparrow PHP Silver Practical Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190005-00","Standard Silver Off Exchange Plan",,"0.683184862136841","No","Yes","No","100%",,"$4,500","$23","$787","$150","$412","$1,994","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20Practical%20Exclusive_SFA02000_Off.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20Practical%20Exclusive_SFA02000_Off.pdf","19"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190005","Sparrow PHP Silver Practical Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190005-01","Standard Silver On Exchange Plan",,"0.683184862136841","No","Yes","No","100%",,"$4,500","$23","$787","$150","$412","$1,994","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20Practical%20Exclusive_SNA02000_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20Practical%20Exclusive_SNA02000_On.pdf","20"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190005","Sparrow PHP Silver Practical Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20Practical%20Exclusive%20NA_SNA02200_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20Practical%20Exclusive%20NA_SNA02200_On.pdf","21"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190005","Sparrow PHP Silver Practical Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190005-03","Limited Cost Sharing Plan Variation",,"0.683184862136841","No","Yes","No","100%",,"$4,500","$23","$787","$150","$412","$1,994","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20Practical%20Exclusive%20NA%20Special_SNA02100_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20Practical%20Exclusive%20NA%20Special_SNA02100_On.pdf","22"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190005","Sparrow PHP Silver Practical Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190005-04","73% AV Level Silver Plan",,"0.734238505363464","No","Yes","No","100%",,"$2,500","$23","$1,387","$150","$412","$1,994","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20Practical%20Exclusive%20200-250_SNA02300_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20Practical%20Exclusive%20200-250_SNA02300_On.pdf","23"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190005","Sparrow PHP Silver Practical Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190005-05","87% AV Level Silver Plan",,"0.86423259973526","No","Yes","No","100%",,"$500","$23","$977","$150","$384","$1,116","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20Practical%20Exclusive%20150-200_SNA02400_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20Practical%20Exclusive%20150-200_SNA02400_On.pdf","24"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190005","Sparrow PHP Silver Practical Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190005-06","94% AV Level Silver Plan",,"0.933821082115173","No","Yes","No","100%",,"$0","$0","$500","$150","$0","$477","$23","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","10%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20Practical%20Exclusive%20100-150_SNA02500_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20Practical%20Exclusive%20100-150_SNA02500_On.pdf","25"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0220002","Sparrow PHP Bronze Practical Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF014","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0220002-00","Standard Bronze Off Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,240","$0","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Bronze%20Practical%20Exclusive_BFY00500_Off.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Bronze%20Practical%20Exclusive_BFY00500_Off.pdf","26"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0220002","Sparrow PHP Bronze Practical Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF014","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0220002-01","Standard Bronze On Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,240","$0","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Bronze%20Practical%20Exclusive_BNY00500_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Bronze%20Practical%20Exclusive_BNY00500_On.pdf","27"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0220002","Sparrow PHP Bronze Practical Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF014","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0220002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Bronze%20Practical%20Exclusive%20NA_BNY00700_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Bronze%20Practical%20Exclusive%20NA_BNY00700_On.pdf","28"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0220002","Sparrow PHP Bronze Practical Exclusive","60829MI022","7639172866","MIN002","MIS002","MIF014","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0220002-03","Limited Cost Sharing Plan Variation",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,240","$0","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Bronze%20Practical%20Exclusive%20NA%20Special_BNY00600_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Bronze%20Practical%20Exclusive%20NA%20Special_BNY00600_On.pdf","29"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0210003","Sparrow PHP Bronze Premier","60829MI021","7639172866","MIN001","MIS001","MIF013","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0210003-00","Standard Bronze Off Exchange Plan","61.99%","0.623766005039215","Yes","Yes","No","100%",,"$4,050","$23","$922","$150","$4,050","$598","$31","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,050","$4050 per person","$8100 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Bronze%20Premier_BFY00100_Off.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Bronze%20Premier_BFY00100_Off.pdf","30"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0210003","Sparrow PHP Bronze Premier","60829MI021","7639172866","MIN001","MIS001","MIF013","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0210003-01","Standard Bronze On Exchange Plan","61.99%","0.623766005039215","Yes","Yes","No","100%",,"$4,050","$23","$922","$150","$4,050","$598","$31","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,050","$4050 per person","$8100 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Bronze%20Premier_BNY00100_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Bronze%20Premier_BNY00100_On.pdf","31"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0210003","Sparrow PHP Bronze Premier","60829MI021","7639172866","MIN001","MIS001","MIF013","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0210003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Bronze%20Premier%20NA_BNY00800_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Bronze%20Premier%20NA_BNY00800_On.pdf","32"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0210003","Sparrow PHP Bronze Premier","60829MI021","7639172866","MIN001","MIS001","MIF013","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0210003-03","Limited Cost Sharing Plan Variation","61.99%","0.623766005039215","Yes","Yes","No","100%",,"$4,050","$23","$922","$150","$4,050","$598","$31","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,050","$4050 per person","$8100 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Bronze%20Premier%20NA%20Special_BNY00200_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Bronze%20Premier%20NA%20Special_BNY00200_On.pdf","33"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0210004","Sparrow PHP Bronze","60829MI021","7639172866","MIN001","MIS001","MIF006","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0210004-00","Standard Bronze Off Exchange Plan",,"0.614027082920074","Yes","Yes","No","100%",,"$5,000","$23","$849","$150","$5,000","$118","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Bronze_BFY00300_Off.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Bronze_BFY00300_Off.pdf","34"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0210004","Sparrow PHP Bronze","60829MI021","7639172866","MIN001","MIS001","MIF006","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0210004-01","Standard Bronze On Exchange Plan",,"0.614027082920074","Yes","Yes","No","100%",,"$5,000","$23","$849","$150","$5,000","$118","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Bronze_BNY00300_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Bronze_BNY00300_On.pdf","35"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200004","Sparrow PHP Silver","60829MI020","7639172866","MIN001","MIS001","MIF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20NA_SNA01500_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20NA_SNA01500_On.pdf","68"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200004","Sparrow PHP Silver","60829MI020","7639172866","MIN001","MIS001","MIF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200004-03","Limited Cost Sharing Plan Variation",,"0.709458649158478","No","Yes","No","100%",,"$3,000","$23","$1,120","$150","$287","$1,994","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20NA%20Special_SNA01400_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20NA%20Special_SNA01400_On.pdf","69"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200004","Sparrow PHP Silver","60829MI020","7639172866","MIN001","MIS001","MIF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200004-04","73% AV Level Silver Plan",,"0.730547249317169","No","Yes","No","100%",,"$2,500","$23","$846","$150","$287","$1,954","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$2,500","$2500 per person","$5000 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20200-250_SNA01600_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20200-250_SNA01600_On.pdf","70"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200004","Sparrow PHP Silver","60829MI020","7639172866","MIN001","MIS001","MIF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200004-05","87% AV Level Silver Plan",,"0.87012106180191","No","Yes","No","100%",,"$1,000","$15","$985","$150","$287","$909","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20150-200_SNA01700_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20150-200_SNA01700_On.pdf","71"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200004","Sparrow PHP Silver","60829MI020","7639172866","MIN001","MIS001","MIF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200004-06","94% AV Level Silver Plan",,"0.942048668861389","No","Yes","No","100%",,"$100","$10","$663","$150","$100","$519","$19","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$100","$100 per person","$200 per group","10%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20100-150_SNA01800_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20100-150_SNA01800_On.pdf","72"
"2016","MI","61465","SERFF","3","2015-08-22 23:36:24","1","61465","MI","SHOP (Small Group)","Yes","47-0322111","61465MI0010001","Certified Dental Plan 1","61465MI001",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.13","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","61465MI0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$700 per person","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MI","61465","SERFF","3","2015-08-22 23:36:24","1","61465","MI","SHOP (Small Group)","Yes","47-0322111","61465MI0010002","Certified Dental Plan 2","61465MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.10","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","61465MI0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$700 per person","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MI","61465","SERFF","3","2015-08-22 23:36:24","1","61465","MI","SHOP (Small Group)","Yes","47-0322111","61465MI0010003","Certified Dental Plan 3","61465MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.97","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","61465MI0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$700 per person","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","MI","61465","SERFF","3","2015-08-22 23:36:24","1","61465","MI","SHOP (Small Group)","Yes","47-0322111","61465MI0010004","Certified Dental Plan 4","61465MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.39","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","61465MI0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$700 per person","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0210004","Sparrow PHP Bronze","60829MI021","7639172866","MIN001","MIS001","MIF006","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0210004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Bronze%20NA_BNY00900_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Bronze%20NA_BNY00900_On.pdf","36"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0210004","Sparrow PHP Bronze","60829MI021","7639172866","MIN001","MIS001","MIF006","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0210004-03","Limited Cost Sharing Plan Variation",,"0.614027082920074","Yes","Yes","No","100%",,"$5,000","$23","$849","$150","$5,000","$118","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Bronze%20NA%20Special_BNY00400_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Bronze%20NA%20Special_BNY00400_On.pdf","37"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200005","Sparrow PHP Healthy","60829MI020","7639172866","MIN001","MIS001","MIF014","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200005-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,240","$0","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Healthy_XFY00100_Off.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Healthy_XFY00100_Off.pdf","38"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200005","Sparrow PHP Healthy","60829MI020","7639172866","MIN001","MIS001","MIF014","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,240","$0","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Healthy_XNY00100_On.pdf","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Healthy_XNY00100_On.pdf","39"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200001","Sparrow PHP Platinum Select","60829MI020","7639172866","MIN001","MIS001","MIF001","Existing","HMO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200001-00","Standard Platinum Off Exchange Plan",,"0.910504102706909","No","Yes","No","100%",,"$250","$15","$648","$150","$250","$746","$4","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","10%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Platinum%20Select_PFA00100_Off.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Platinum%20Select_PFA00100_Off.pdf","40"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200001","Sparrow PHP Platinum Select","60829MI020","7639172866","MIN001","MIS001","MIF001","Existing","HMO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200001-01","Standard Platinum On Exchange Plan",,"0.910504102706909","No","Yes","No","100%",,"$250","$15","$648","$150","$250","$746","$4","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","10%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Platinum%20Select_PNA00100_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Platinum%20Select_PNA00100_On.pdf","41"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200001","Sparrow PHP Platinum Select","60829MI020","7639172866","MIN001","MIS001","MIF001","Existing","HMO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Platinum%20Select_%20NA_PNA00300_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Platinum%20Select_%20NA_PNA00300_On.pdf","42"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200001","Sparrow PHP Platinum Select","60829MI020","7639172866","MIN001","MIS001","MIF001","Existing","HMO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200001-03","Limited Cost Sharing Plan Variation",,"0.910504102706909","No","Yes","No","100%",,"$250","$15","$648","$150","$250","$746","$4","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","10%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Platinum%20Select_%20NA%20Special_PNA00200_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Platinum%20Select_%20NA%20Special_PNA00200_On.pdf","43"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190001","Sparrow PHP Gold Select Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190001-00","Standard Gold Off Exchange Plan",,"0.814497649669647","No","Yes","No","100%",,"$1,000","$23","$1,146","$150","$287","$1,639","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Gold%20Select%20Exclusive_GFA00400_Off.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Gold%20Select%20Exclusive_GFA00400_Off.pdf","48"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190001","Sparrow PHP Gold Select Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190001-01","Standard Gold On Exchange Plan",,"0.814497649669647","No","Yes","No","100%",,"$1,000","$23","$1,146","$150","$287","$1,639","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Gold%20Select%20Exclusive_GNA00400_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Gold%20Select%20Exclusive_GNA00400_On.pdf","49"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190001","Sparrow PHP Gold Select Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Gold%20Select%20Exclusive%20NA_GNA00600_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Gold%20Select%20Exclusive%20NA_GNA00600_On.pdf","50"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190001","Sparrow PHP Gold Select Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF002","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190001-03","Limited Cost Sharing Plan Variation",,"0.814497649669647","No","Yes","No","100%",,"$1,000","$23","$1,146","$150","$287","$1,639","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Gold%20Select%20Exclusive%20NA%20Special_GNA00500_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Gold%20Select%20Exclusive%20NA%20Special_GNA00500_On.pdf","51"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200003","Sparrow PHP Silver Premier","60829MI020","7639172866","MIN001","MIS001","MIF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200003-00","Standard Silver Off Exchange Plan","71.81%","0.719393849372864","No","Yes","No","100%",,"$2,500","$23","$846","$150","$287","$2,014","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$2,500","$2500 per person","$5000 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20Premier_SFA00100_Off.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20Premier_SFA00100_Off.pdf","52"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200003","Sparrow PHP Silver Premier","60829MI020","7639172866","MIN001","MIS001","MIF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200003-01","Standard Silver On Exchange Plan","71.81%","0.719393849372864","No","Yes","No","100%",,"$2,500","$23","$846","$150","$287","$2,014","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$2,500","$2500 per person","$5000 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20Premier_SNA00100_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20Premier_SNA00100_On.pdf","53"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200003","Sparrow PHP Silver Premier","60829MI020","7639172866","MIN001","MIS001","MIF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20Premier%20NA_SNA00300_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20Premier%20NA_SNA00300_On.pdf","54"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200003","Sparrow PHP Silver Premier","60829MI020","7639172866","MIN001","MIS001","MIF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200003-03","Limited Cost Sharing Plan Variation","71.81%","0.719393849372864","No","Yes","No","100%",,"$2,500","$23","$846","$150","$287","$2,014","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$2,500","$2500 per person","$5000 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20Premier%20NA%20Special_SNA00200_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20Premier%20NA%20Special_SNA00200_On.pdf","55"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200003","Sparrow PHP Silver Premier","60829MI020","7639172866","MIN001","MIS001","MIF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200003-04","73% AV Level Silver Plan","73.91%","0.736254513263702","No","Yes","No","100%",,"$2,050","$23","$936","$150","$287","$2,014","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$2,050","$2050 per person","$4100 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20Premier%20200-250_SNA00400_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20Premier%20200-250_SNA00400_On.pdf","56"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200003","Sparrow PHP Silver Premier","60829MI020","7639172866","MIN001","MIS001","MIF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200003-05","87% AV Level Silver Plan","87.60%","0.875275373458862","No","Yes","No","100%",,"$500","$15","$1,246","$150","$287","$1,189","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20Premier%20150-200_SNA00500_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20Premier%20150-200_SNA00500_On.pdf","57"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200003","Sparrow PHP Silver Premier","60829MI020","7639172866","MIN001","MIS001","MIF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200003-06","94% AV Level Silver Plan","94.08%","0.941834688186646","No","Yes","No","100%",,"$250","$10","$0","$150","$250","$519","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$250","$250 per person","$500 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20Premier%20100-150_SNA00600_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20Premier%20100-150_SNA00600_On.pdf","58"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190002","Sparrow PHP Silver Select Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190002-00","Standard Silver Off Exchange Plan","71.92%","0.720730721950531","No","Yes","No","100%",,"$2,000","$23","$1,420","$150","$287","$2,014","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20Select%20Exclusive_SFA00700_Off.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20Select%20Exclusive_SFA00700_Off.pdf","59"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190002","Sparrow PHP Silver Select Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190002-01","Standard Silver On Exchange Plan","71.92%","0.720730721950531","No","Yes","No","100%",,"$2,000","$23","$1,420","$150","$287","$2,014","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20Select%20Exclusive_SNA00700_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20Select%20Exclusive_SNA00700_On.pdf","60"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190002","Sparrow PHP Silver Select Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20Select%20Exclusive%20NA_SNA00900_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20Select%20Exclusive%20NA_SNA00900_On.pdf","61"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190002","Sparrow PHP Silver Select Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190002-03","Limited Cost Sharing Plan Variation","71.92%","0.720730721950531","No","Yes","No","100%",,"$2,000","$23","$1,420","$150","$287","$2,014","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20Select%20Exclusive%20NA%20Special_SNA00800_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20Select%20Exclusive%20NA%20Special_SNA00800_On.pdf","62"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190002","Sparrow PHP Silver Select Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190002-04","73% AV Level Silver Plan","73.93%","0.740406215190887","No","Yes","No","100%",,"$2,000","$23","$1,420","$150","$287","$1,974","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20Select%20Exclusive%20200-250_SNA01000_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20Select%20Exclusive%20200-250_SNA01000_On.pdf","63"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190002","Sparrow PHP Silver Select Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190002-05","87% AV Level Silver Plan","87.60%","0.876017332077026","No","Yes","No","100%",,"$500","$15","$1,246","$150","$287","$969","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","20%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20Select%20Exclusive%20150-200_SNA01100_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20Select%20Exclusive%20150-200_SNA01100_On.pdf","64"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0190002","Sparrow PHP Silver Select Exclusive","60829MI019","7639172866","MIN002","MIS002","MIF004","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0190002-06","94% AV Level Silver Plan","94.04%","0.926323592662811","No","Yes","No","100%",,"$500","$10","$0","$150","$287","$519","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$500","$500 per person","$1000 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver%20Select%20Exclusive%20100-150_SNA01200_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver%20Select%20Exclusive%20100-150_SNA01200_On.pdf","65"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200004","Sparrow PHP Silver","60829MI020","7639172866","MIN001","MIS001","MIF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200004-00","Standard Silver Off Exchange Plan",,"0.709458649158478","No","Yes","No","100%",,"$3,000","$23","$1,120","$150","$287","$1,994","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver_SFA01300_Off.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver_SFA01300_Off.pdf","66"
"2016","MI","60829","SERFF","5","2015-08-24 05:58:52","1","60829","MI","Individual","No","38-2356288","60829MI0200004","Sparrow PHP Silver","60829MI020","7639172866","MIN001","MIS001","MIF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Coverage for emergency and urgent care only","Yes","Coverage for emergency and urgent care only","No",,"http://www.phpmichigan.com/upload/docs/Members/Commercial%20Member%20Prescription%20Drug%20List%20(PDL).PDF","60829MI0200004-01","Standard Silver On Exchange Plan",,"0.709458649158478","No","Yes","No","100%",,"$3,000","$23","$1,120","$150","$287","$1,994","$0","$97",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/SBC_2016_Sparrow%20PHP%20Silver_SNA01300_On.docx","http://www.phpmichigan.com/upload/docs/ChoosePHPMI/COCs/COC_2016_Sparrow%20PHP%20Silver_SNA01300_On.pdf","67"
"2016","MI","62294","SERFF","3","2015-08-22 23:36:24","1","62294","MI","Individual","Yes","39-1263473","62294MI0420001","Humana Dental Smart Choice","62294MI042",,"MIN001","MIS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.16","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","62294MI0420001-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612922","4"
"2016","MI","63631","SERFF","8","2016-07-13 14:35:16","1","63631","MI","SHOP (Small Group)","No","36-2739571","63631MI0010070","Bronze Choice Plus HSA 6300 -1","63631MI001",,"MIN002","MIS002","MIF005","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=MI0004&st=mi","63631MI0010070-00","Standard Bronze Off Exchange Plan",,"0.614746987819672","Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"$20,000","$20000 per person","$60000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"$10,000","$10000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$50.00","http://www.uhc.com/shop/doc?id=MI0003&st=mi",,"11"
"2016","MI","63631","SERFF","8","2016-07-13 14:35:16","1","63631","MI","SHOP (Small Group)","No","36-2739571","63631MI0010070","Bronze Choice Plus HSA 6300 -1","63631MI001",,"MIN002","MIS002","MIF005","Existing","POS","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=MI0004&st=mi","63631MI0010070-01","Standard Bronze On Exchange Plan",,"0.614746987819672","Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"$20,000","$20000 per person","$60000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"$10,000","$10000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$50.00","http://www.uhc.com/shop/doc?id=MI0003&st=mi",,"12"
"2016","MI","63631","SERFF","8","2016-07-13 14:35:16","3","63631","MI","SHOP (Small Group)","No","36-2739571","63631MI0060019","Gold Navigate 2000","63631MI006",,"MIN003","MIS003","MIF001","New","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=MI0004&st=mi","63631MI0060019-00","Standard Gold Off Exchange Plan","78.70%",,"No","Yes","No","100%",,"$2,000","$20","$700","$200","$200","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=MI0001&st=mi",,"7"
"2016","MI","63631","SERFF","8","2016-07-13 14:35:16","3","63631","MI","SHOP (Small Group)","No","36-2739571","63631MI0060019","Gold Navigate 2000","63631MI006",,"MIN003","MIS003","MIF001","New","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=MI0004&st=mi","63631MI0060019-01","Standard Gold On Exchange Plan","78.70%",,"No","Yes","No","100%",,"$2,000","$20","$700","$200","$200","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=MI0001&st=mi",,"8"
"2016","MI","63631","SERFF","8","2016-07-13 14:35:16","3","63631","MI","SHOP (Small Group)","No","36-2739571","63631MI0060021","Silver Navigate 4000","63631MI006",,"MIN003","MIS003","MIF001","New","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=MI0004&st=mi","63631MI0060021-00","Standard Silver Off Exchange Plan","68.50%",,"No","Yes","No","100%",,"$4,200","$20","$400","$200","$300","$1,700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=MI0002&st=mi",,"15"
"2016","MI","63631","SERFF","8","2016-07-13 14:35:16","3","63631","MI","SHOP (Small Group)","No","36-2739571","63631MI0060021","Silver Navigate 4000","63631MI006",,"MIN003","MIS003","MIF001","New","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","Yes",,"http://www.uhc.com/shop/doc?id=MI0004&st=mi","63631MI0060021-01","Standard Silver On Exchange Plan","68.50%",,"No","Yes","No","100%",,"$4,200","$20","$400","$200","$300","$1,700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=MI0002&st=mi",,"16"
"2016","MI","63631","SERFF","8","2016-07-13 14:35:16","3","63631","MI","SHOP (Small Group)","No","36-2739571","63631MI0060020","Gold Navigate 2000","63631MI006",,"MIN003","MIS004","MIF001","New","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=MI0004&st=mi","63631MI0060020-00","Standard Gold Off Exchange Plan","78.70%",,"No","Yes","No","100%",,"$2,000","$20","$700","$200","$200","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=MI0001&st=mi",,"20"
"2016","MI","63631","SERFF","8","2016-07-13 14:35:16","3","63631","MI","SHOP (Small Group)","No","36-2739571","63631MI0060020","Gold Navigate 2000","63631MI006",,"MIN003","MIS004","MIF001","New","EPO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=MI0004&st=mi","63631MI0060020-01","Standard Gold On Exchange Plan","78.70%",,"No","Yes","No","100%",,"$2,000","$20","$700","$200","$200","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=MI0001&st=mi",,"21"
"2016","MI","63631","SERFF","8","2016-07-13 14:35:16","3","63631","MI","SHOP (Small Group)","No","36-2739571","63631MI0060022","Silver Navigate 4000","63631MI006",,"MIN003","MIS004","MIF001","New","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=MI0004&st=mi","63631MI0060022-00","Standard Silver Off Exchange Plan","68.50%",,"No","Yes","No","100%",,"$4,200","$20","$400","$200","$300","$1,700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=MI0002&st=mi",,"28"
"2016","MI","63631","SERFF","8","2016-07-13 14:35:16","3","63631","MI","SHOP (Small Group)","No","36-2739571","63631MI0060022","Silver Navigate 4000","63631MI006",,"MIN003","MIS004","MIF001","New","EPO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes",,"http://www.uhc.com/shop/doc?id=MI0004&st=mi","63631MI0060022-01","Standard Silver On Exchange Plan","68.50%",,"No","Yes","No","100%",,"$4,200","$20","$400","$200","$300","$1,700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.uhc.com/shop/doc?id=MI0002&st=mi",,"29"
"2016","MI","63641","SERFF","3","2015-08-27 03:52:03","1","63641","MI","SHOP (Small Group)","Yes","86-0307623","63641MI0020001","Smile for Health - Certified High Option","63641MI002",,"MIN001","MIS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","63641MI0020001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MI","63641","SERFF","3","2015-08-27 03:52:03","2","63641","MI","SHOP (Small Group)","Yes","86-0307623","63641MI0020002","Smile for Health - Certified High Option","63641MI002",,"MIN002","MIS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","63641MI0020002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MI","66587","SERFF","4","2015-08-24 05:58:52","2","66587","MI","SHOP (Small Group)","Yes","13-5123390","66587MI0040003","Guardian Family Advantage","66587MI004",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.58","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverge is available outside of the service area.","Yes",,"","66587MI0040003-01","Standard High On Exchange Plan","85.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","MI","66587","SERFF","4","2015-08-24 05:58:52","2","66587","MI","SHOP (Small Group)","Yes","13-5123390","66587MI0060003","Guardian Family Essentials","66587MI006",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverge is available outside of the service area.","Yes",,"","66587MI0060003-00","Standard Low Off Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","MI","66587","SERFF","4","2015-08-24 05:58:52","2","66587","MI","SHOP (Small Group)","Yes","13-5123390","66587MI0060003","Guardian Family Essentials","66587MI006",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverge is available outside of the service area.","Yes",,"","66587MI0060003-01","Standard Low On Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010001","Total Platinum Premier","67183MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Platinum","No","Both","No","Yes","Podiatry, Chiropractic",,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9944",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No",,"https://thcmi.com/pharmacy/","67183MI0010001-00","Standard Platinum Off Exchange Plan",,"0.909500300884247","No","No","No","100%",,"$1,000","$20","$0","$150","$1,000","$250","$0","$80","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","per person not applicable","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0010001-00.pdf","http://brochure.thcmi.com/","4"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","Individual","No","38-3240485","67183MI0030001","Total HMO Standard","67183MI003",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9824",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030001-00","Standard Gold Off Exchange Plan",,"0.819298624992371","No","No","No","100%",,"$1,000","$80","$0","$150","$1,000","$1,150","$0","$80","$2,300","$2300 per person","$4600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","per person not applicable","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0030001-00.pdf","http://brochure.thcmi.com/","4"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","Individual","No","38-3240485","67183MI0030001","Total HMO Standard","67183MI003",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9824",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030001-01","Standard Gold On Exchange Plan",,"0.819298624992371","No","No","No","100%",,"$1,000","$80","$0","$150","$1,000","$1,150","$0","$80","$2,300","$2300 per person","$4600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","per person not applicable","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0030001-01.pdf","http://brochure.thcmi.com/","5"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010001","Total Platinum Premier","67183MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Platinum","No","Both","No","Yes","Podiatry, Chiropractic",,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9944",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No",,"https://thcmi.com/pharmacy/","67183MI0010001-01","Standard Platinum On Exchange Plan",,"0.909500300884247","No","No","No","100%",,"$1,000","$20","$0","$150","$1,000","$250","$0","$80","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","per person not applicable","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0010001-01.pdf","http://brochure.thcmi.com/","5"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010002","Total Platinum Ultimate","67183MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Platinum","No","Both","No","Yes","Podiatry, Chiropractic",,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.993",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No",,"https://thcmi.com/pharmacy/","67183MI0010002-00","Standard Platinum Off Exchange Plan",,"0.919882893562317","No","No","No","100%",,"$0","$480","$0","$150","$0","$680","$0","$80","$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0010002-00.pdf","http://brochure.thcmi.com/","6"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","Individual","No","38-3240485","67183MI0030001","Total HMO Standard","67183MI003",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9824",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","30%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0030001-02.pdf","http://brochure.thcmi.com/","6"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","Individual","No","38-3240485","67183MI0030001","Total HMO Standard","67183MI003",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9824",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030001-03","Limited Cost Sharing Plan Variation",,"0.819298624992371","No","No","No","100%",,"$1,000","$80","$0","$150","$1,000","$1,150","$0","$80","$2,300","$2300 per person","$4600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","per person not applicable","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0030001-03.pdf","http://brochure.thcmi.com/","7"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010002","Total Platinum Ultimate","67183MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Platinum","No","Both","No","Yes","Podiatry, Chiropractic",,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.993",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No",,"https://thcmi.com/pharmacy/","67183MI0010002-01","Standard Platinum On Exchange Plan",,"0.919882893562317","No","No","No","100%",,"$0","$480","$0","$150","$0","$680","$0","$80","$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0010002-01.pdf","http://brochure.thcmi.com/","7"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010003","Total Platinum Signature","67183MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Platinum","No","Both","No","Yes","Podiatry, Chiropractic",,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9943",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No",,"https://thcmi.com/pharmacy/","67183MI0010003-00","Standard Platinum Off Exchange Plan",,"0.914001941680908","No","No","No","100%",,"$500","$20","$0","$150","$500","$530","$0","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0010003-00.pdf","http://brochure.thcmi.com/","8"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9811",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030002-00","Standard Silver Off Exchange Plan",,"0.717926740646362","No","No","No","100%",,"$3,000","$20","$860","$150","$2,560","$1,000","$0","$80","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0030002-00.pdf","http://brochure.thcmi.com/","8"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9811",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030002-01","Standard Silver On Exchange Plan",,"0.717926740646362","No","No","No","100%",,"$3,000","$20","$860","$150","$2,560","$1,000","$0","$80","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0030002-01.pdf","http://brochure.thcmi.com/","9"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010003","Total Platinum Signature","67183MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Platinum","No","Both","No","Yes","Podiatry, Chiropractic",,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9943",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No",,"https://thcmi.com/pharmacy/","67183MI0010003-01","Standard Platinum On Exchange Plan",,"0.914001941680908","No","No","No","100%",,"$500","$20","$0","$150","$500","$530","$0","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0010003-01.pdf","http://brochure.thcmi.com/","9"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010004","Total Platinum Complete","67183MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Platinum","No","Both","No","Yes","Podiatry, Chiropractic",,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.993",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No",,"https://thcmi.com/pharmacy/","67183MI0010004-00","Standard Platinum Off Exchange Plan",,"0.914182841777802","No","No","No","100%",,"$0","$620","$30","$150","$0","$600","$10","$80","$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0010004-00.pdf","http://brochure.thcmi.com/","10"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9811",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0030002-02.pdf","http://brochure.thcmi.com/","10"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9811",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030002-03","Limited Cost Sharing Plan Variation",,"0.717926740646362","No","No","No","100%",,"$3,000","$20","$860","$150","$2,560","$1,000","$0","$80","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0030002-03.pdf","http://brochure.thcmi.com/","11"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010004","Total Platinum Complete","67183MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Platinum","No","Both","No","Yes","Podiatry, Chiropractic",,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.993",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No",,"https://thcmi.com/pharmacy/","67183MI0010004-01","Standard Platinum On Exchange Plan",,"0.914182841777802","No","No","No","100%",,"$0","$620","$30","$150","$0","$600","$10","$80","$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0010004-01.pdf","http://brochure.thcmi.com/","11"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010005","Total Gold Premier","67183MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","No","Both","No","Yes","Podiatry, Chiropractic",,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9936",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No",,"https://thcmi.com/pharmacy/","67183MI0010005-00","Standard Gold Off Exchange Plan",,"0.814180374145508","No","No","No","100%",,"$0","$20","$2,360","$150","$0","$700","$0","$80","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","per group not applicable","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0010005-00.pdf","http://brochure.thcmi.com/","12"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9811",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030002-04","73% AV Level Silver Plan",,"0.738618671894073","No","No","No","100%",,"$3,000","$20","$860","$150","$2,560","$1,000","$0","$80","$4,350","$4350 per person","$8700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0030002-04.pdf","http://brochure.thcmi.com/","12"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9811",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030002-05","87% AV Level Silver Plan",,"0.867064356803894","No","No","No","100%",,"$750","$20","$650","$150","$750","$660","$0","$80","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$750","per person not applicable","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0030002-05.pdf","http://brochure.thcmi.com/","13"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010005","Total Gold Premier","67183MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","No","Both","No","Yes","Podiatry, Chiropractic",,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9936",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No",,"https://thcmi.com/pharmacy/","67183MI0010005-01","Standard Gold On Exchange Plan",,"0.814180374145508","No","No","No","100%",,"$0","$20","$2,360","$150","$0","$700","$0","$80","$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","per group not applicable","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0010005-01.pdf","http://brochure.thcmi.com/","13"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","Existing","HMO","Silver","No","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9811",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","https://thcmi.com/pharmacy/","67183MI0030002-06","94% AV Level Silver Plan",,"0.94992983341217","No","No","No","100%",,"$0","$0","$50","$150","$0","$100","$0","$80","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$0","per person not applicable","$0 per group","1%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0030002-06.pdf","http://brochure.thcmi.com/","14"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010006","Total Gold Signature","67183MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","No","Both","No","Yes","Podiatry, Chiropractic",,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9947",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No",,"https://thcmi.com/pharmacy/","67183MI0010006-00","Standard Gold Off Exchange Plan",,"0.819564998149872","No","No","No","100%",,"$750","$20","$1,830","$150","$750","$580","$0","$80","$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$750","per person not applicable","$1500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0010006-00.pdf","http://brochure.thcmi.com/","14"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010006","Total Gold Signature","67183MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Gold","No","Both","No","Yes","Podiatry, Chiropractic",,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9947",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No",,"https://thcmi.com/pharmacy/","67183MI0010006-01","Standard Gold On Exchange Plan",,"0.819564998149872","No","No","No","100%",,"$750","$20","$1,830","$150","$750","$580","$0","$80","$3,750","$3750 per person","$7500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$750","per person not applicable","$1500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0010006-01.pdf","http://brochure.thcmi.com/","15"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010007","Total Gold Complete","67183MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Gold","No","Both","No","Yes","Podiatry, Chiropractic",,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9946",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No",,"https://thcmi.com/pharmacy/","67183MI0010007-00","Standard Gold Off Exchange Plan",,"0.814872682094574","No","No","No","100%",,"$2,020","$0","$0","$150","$2,250","$0","$0","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","per person not applicable","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0010007-00.pdf","http://brochure.thcmi.com/","16"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010007","Total Gold Complete","67183MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Gold","No","Both","No","Yes","Podiatry, Chiropractic",,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9946",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No",,"https://thcmi.com/pharmacy/","67183MI0010007-01","Standard Gold On Exchange Plan",,"0.814872682094574","No","No","No","100%",,"$2,020","$0","$0","$150","$2,250","$0","$0","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","per person not applicable","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0010007-01.pdf","http://brochure.thcmi.com/","17"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010008","Total Value Plus","67183MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","No","Both","No","Yes","Podiatry, Chiropractic",,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9947",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No",,"https://thcmi.com/pharmacy/","67183MI0010008-00","Standard Silver Off Exchange Plan",,"0.717770755290985","No","No","No","100%",,"$2,270","$0","$1,000","$150","$2,500","$0","$520","$80","$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,250","per person not applicable","$4500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","per person not applicable","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0010008-00.pdf","http://brochure.thcmi.com/","18"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010008","Total Value Plus","67183MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","No","Both","No","Yes","Podiatry, Chiropractic",,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9947",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No",,"https://thcmi.com/pharmacy/","67183MI0010008-01","Standard Silver On Exchange Plan",,"0.717770755290985","No","No","No","100%",,"$2,270","$0","$1,000","$150","$2,500","$0","$520","$80","$5,850","$5850 per person","$11700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$2,250","per person not applicable","$4500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","per person not applicable","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0010008-01.pdf","http://brochure.thcmi.com/","19"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010009","Total Value Complete","67183MI001",,"MIN001","MIS001","MIF004","Existing","HMO","Silver","No","Both","No","Yes","Podiatry, Chiropractic",,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9947",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No",,"https://thcmi.com/pharmacy/","67183MI0010009-00","Standard Silver Off Exchange Plan",,"0.716473698616028","No","No","No","100%",,"$1,800","$0","$2,730","$150","$1,800","$1,030","$0","$80","$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,800","per person not applicable","$3600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0010009-00.pdf","http://brochure.thcmi.com/","20"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010009","Total Value Complete","67183MI001",,"MIN001","MIS001","MIF004","Existing","HMO","Silver","No","Both","No","Yes","Podiatry, Chiropractic",,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9947",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No",,"https://thcmi.com/pharmacy/","67183MI0010009-01","Standard Silver On Exchange Plan",,"0.716473698616028","No","No","No","100%",,"$1,800","$0","$2,730","$150","$1,800","$1,030","$0","$80","$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,800","per person not applicable","$3600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0010009-01.pdf","http://brochure.thcmi.com/","21"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010012","Total Value Signature","67183MI001",,"MIN001","MIS001","MIF004","New","HMO","Silver","No","Both","No","Yes","Podiatry, Chiropractic",,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9947",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No",,"https://thcmi.com/pharmacy/","67183MI0010012-00","Standard Silver Off Exchange Plan",,"0.681987583637238","No","No","No","100%",,"$4,500","$20","$840","$150","$2,560","$1,000","$0","$80","$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0010012-00.pdf","http://brochure.thcmi.com/","22"
"2016","MI","67183","SERFF","4","2015-08-23 14:39:40","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010012","Total Value Signature","67183MI001",,"MIN001","MIS001","MIF004","New","HMO","Silver","No","Both","No","Yes","Podiatry, Chiropractic",,,"No","Allows Adult and Child-Only",,"No","Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9947",,,,"0","0","0","2016-01-01",,"Yes","Emergency","Yes","Emergency","No",,"https://thcmi.com/pharmacy/","67183MI0010012-01","Standard Silver On Exchange Plan",,"0.681987583637238","No","No","No","100%",,"$4,500","$20","$840","$150","$2,560","$1,000","$0","$80","$5,600","$5600 per person","$11200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://thcmi.com/PDF/members/PDF/SBC/67183MI0010012-01.pdf","http://brochure.thcmi.com/","23"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","1","67577","MI","Individual","No","38-3291563","67577MI0390001","HAP Personal Alliance 1500 PPO","67577MI039",,"MIN001","MIS001","MIF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390001-00","Standard Gold Off Exchange Plan",,"0.811804294586182","Yes","Yes","No","100%",,"$1,500","$540","$0","$150","$1,500","$690","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","$14,000","$14000 per person","$28000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","$6,500","$6500 per person","$13000 per group","No",,,"http://www.hap.org/sbc/2016-off-pa-1500ppo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","4"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","1","67577","MI","Individual","No","38-3291563","67577MI0390001","HAP Personal Alliance 1500 PPO","67577MI039",,"MIN001","MIS001","MIF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390001-01","Standard Gold On Exchange Plan",,"0.811804294586182","Yes","Yes","No","100%",,"$1,500","$540","$0","$150","$1,500","$690","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","$14,000","$14000 per person","$28000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","$6,500","$6500 per person","$13000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-1500ppo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","5"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","1","67577","MI","Individual","No","38-3291563","67577MI0390001","HAP Personal Alliance 1500 PPO","67577MI039",,"MIN001","MIS001","MIF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-1500ppo-naanzero.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","6"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","1","67577","MI","Individual","No","38-3291563","67577MI0390001","HAP Personal Alliance 1500 PPO","67577MI039",,"MIN001","MIS001","MIF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390001-03","Limited Cost Sharing Plan Variation",,"0.811804294586182","Yes","Yes","No","100%",,"$1,500","$540","$0","$150","$1,500","$690","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","$14,000","$14000 per person","$28000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","$6,500","$6500 per person","$13000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-1500ppo-naanltd.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","7"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","1","67577","MI","Individual","No","38-3291563","67577MI0390011","HAP Personal Alliance 2500 PPO","67577MI039",,"MIN001","MIS001","MIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390011-00","Standard Silver Off Exchange Plan",,"0.708672821521759","Yes","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$560","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$6,500","$6500 per person","$13000 per group","$9,000","$9000 per person","$18000 per group","No",,,"http://www.hap.org/sbc/2016-off-pa-2500ppo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","8"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","1","67577","MI","Individual","No","38-3291563","67577MI0390011","HAP Personal Alliance 2500 PPO","67577MI039",,"MIN001","MIS001","MIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390011-01","Standard Silver On Exchange Plan",,"0.708672821521759","Yes","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$560","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$6,500","$6500 per person","$13000 per group","$9,000","$9000 per person","$18000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500ppo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","9"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","1","67577","MI","Individual","No","38-3291563","67577MI0390011","HAP Personal Alliance 2500 PPO","67577MI039",,"MIN001","MIS001","MIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500ppo-naanzero.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","10"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","1","67577","MI","Individual","No","38-3291563","67577MI0390011","HAP Personal Alliance 2500 PPO","67577MI039",,"MIN001","MIS001","MIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390011-03","Limited Cost Sharing Plan Variation",,"0.708672821521759","Yes","Yes","No","100%",,"$2,500","$20","$950","$150","$2,500","$560","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"$6,500","$6500 per person","$13000 per group","$9,000","$9000 per person","$18000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500ppo-naanltd.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","11"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","1","67577","MI","Individual","No","38-3291563","67577MI0390011","HAP Personal Alliance 2500 PPO","67577MI039",,"MIN001","MIS001","MIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390011-04","73% AV Level Silver Plan",,"0.739835381507874","Yes","Yes","No","100%",,"$1,900","$70","$1,010","$150","$1,900","$700","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,450","$15450 per person","$30900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","$6,900","$6900 per person","$13800 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500ppo-73AV.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","12"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","1","71667","MI","Individual","No","38-3204052","71667MI0010004","Silver Compass HSA 3000","71667MI001",,"MIN001","MIS001","MIF005","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010004-04","73% AV Level Silver Plan","72.10%",,"Yes","Yes","No","100%",,"$2,500","$10","$0","$200","$2,500","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=MI0016&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","8"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","1","71667","MI","Individual","No","38-3204052","71667MI0010004","Silver Compass HSA 3000","71667MI001",,"MIN001","MIS001","MIF005","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010004-05","87% AV Level Silver Plan","86.30%",,"Yes","Yes","No","100%",,"$800","$10","$0","$200","$800","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=MI0017&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","9"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","1","71667","MI","Individual","No","38-3204052","71667MI0010004","Silver Compass HSA 3000","71667MI001",,"MIN001","MIS001","MIF005","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010004-06","94% AV Level Silver Plan","93.20%",,"Yes","Yes","No","100%",,"$300","$10","$0","$200","$300","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=MI0018&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","10"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","1","71667","MI","Individual","No","38-3204052","71667MI0010009","Bronze Compass HSA 5500","71667MI001",,"MIN001","MIS001","MIF008","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010009-00","Standard Bronze Off Exchange Plan","61.30%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=MI0043&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","11"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","1","71667","MI","Individual","No","38-3204052","71667MI0010009","Bronze Compass HSA 5500","71667MI001",,"MIN001","MIS001","MIF008","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010009-01","Standard Bronze On Exchange Plan","61.30%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=MI0043&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","12"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","1","71667","MI","Individual","No","38-3204052","71667MI0010009","Bronze Compass HSA 5500","71667MI001",,"MIN001","MIS001","MIF008","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010009-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=MI0044&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","13"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","1","67577","MI","Individual","No","38-3291563","67577MI0390011","HAP Personal Alliance 2500 PPO","67577MI039",,"MIN001","MIS001","MIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390011-05","87% AV Level Silver Plan",,"0.877389192581177","Yes","Yes","No","100%",,"$100","$70","$1,010","$150","$100","$1,050","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$10,000","$10000 per person","$20000 per group","$11,750","$11750 per person","$23500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","$5,100","$5100 per person","$10200 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500ppo-87AV.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","13"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","1","67577","MI","Individual","No","38-3291563","67577MI0390011","HAP Personal Alliance 2500 PPO","67577MI039",,"MIN001","MIS001","MIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390011-06","94% AV Level Silver Plan",,"0.949455201625824","Yes","Yes","No","100%",,"$0","$20","$580","$150","$0","$350","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$10,000","$10000 per person","$20000 per group","$10,600","$10600 per person","$21200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-2500ppo-94AV.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","14"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","1","67577","MI","Individual","No","38-3291563","67577MI0390004","HAP Personal Alliance 3000 PPO","67577MI039",,"MIN001","MIS001","MIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390004-00","Standard Silver Off Exchange Plan",,"0.695687592029572","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$500","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$7,000","$7000 per person","$14000 per group","$10,000","$10000 per person","$20000 per group","No",,,"http://www.hap.org/sbc/2016-off-pa-3000ppo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","15"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010003","Gold Compass 500","71667MI001",,"MIN001","MIS001","MIF002","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010003-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0007&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","13"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","1","67577","MI","Individual","No","38-3291563","67577MI0390004","HAP Personal Alliance 3000 PPO","67577MI039",,"MIN001","MIS001","MIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390004-01","Standard Silver On Exchange Plan",,"0.695687592029572","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$500","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$7,000","$7000 per person","$14000 per group","$10,000","$10000 per person","$20000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000ppo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","16"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","1","67577","MI","Individual","No","38-3291563","67577MI0390004","HAP Personal Alliance 3000 PPO","67577MI039",,"MIN001","MIS001","MIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000ppo-naanzero.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","17"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","1","67577","MI","Individual","No","38-3291563","67577MI0390004","HAP Personal Alliance 3000 PPO","67577MI039",,"MIN001","MIS001","MIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390004-03","Limited Cost Sharing Plan Variation",,"0.695687592029572","Yes","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$500","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"$7,000","$7000 per person","$14000 per group","$10,000","$10000 per person","$20000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000ppo-naanltd.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","18"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","1","67577","MI","Individual","No","38-3291563","67577MI0390004","HAP Personal Alliance 3000 PPO","67577MI039",,"MIN001","MIS001","MIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390004-04","73% AV Level Silver Plan",,"0.738075077533722","Yes","Yes","No","100%",,"$1,500","$410","$930","$150","$1,500","$790","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,450","$15450 per person","$30900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","$6,500","$6500 per person","$13000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000ppo-73AV.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","19"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","1","67577","MI","Individual","No","38-3291563","67577MI0390004","HAP Personal Alliance 3000 PPO","67577MI039",,"MIN001","MIS001","MIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390004-05","87% AV Level Silver Plan",,"0.879010617733002","Yes","Yes","No","100%",,"$100","$400","$600","$150","$100","$850","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$10,000","$10000 per person","$20000 per group","$11,100","$11100 per person","$22200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","$5,100","$5100 per person","$10200 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000ppo-87AV.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","20"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","1","67577","MI","Individual","No","38-3291563","67577MI0390004","HAP Personal Alliance 3000 PPO","67577MI039",,"MIN001","MIS001","MIF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390004-06","94% AV Level Silver Plan",,"0.947145879268646","Yes","Yes","No","100%",,"$0","$320","$230","$150","$0","$410","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"$10,000","$10000 per person","$20000 per group","$10,550","$10550 per person","$21100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3000ppo-94AV.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","21"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","2","67577","MI","Individual","No","38-3291563","67577MI0390006","HAP Personal Alliance 5000 PPO (HSA)","67577MI039",,"MIN001","MIS001","MIF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390006-00","Standard Bronze Off Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$15,000","$15000 per person","$30000 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","$15,000","per person not applicable","$30000 per group","Yes",,,"http://www.hap.org/sbc/2016-off-pa-5000ppoHSA.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","4"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","2","67577","MI","Individual","No","38-3291563","67577MI0390006","HAP Personal Alliance 5000 PPO (HSA)","67577MI039",,"MIN001","MIS001","MIF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390006-01","Standard Bronze On Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$15,000","$15000 per person","$30000 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","$15,000","per person not applicable","$30000 per group","Yes",,,"http://www.hap.org/sbc/2016-on-pa-5000ppoHSA.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","5"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","2","67577","MI","Individual","No","38-3291563","67577MI0390006","HAP Personal Alliance 5000 PPO (HSA)","67577MI039",,"MIN001","MIS001","MIF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-5000ppoHSA-naanzero.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","6"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","2","67577","MI","Individual","No","38-3291563","67577MI0390006","HAP Personal Alliance 5000 PPO (HSA)","67577MI039",,"MIN001","MIS001","MIF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","Yes","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390006-03","Limited Cost Sharing Plan Variation",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$15,000","$15000 per person","$30000 per group","$21,450","$21450 per person","$42900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","$15,000","per person not applicable","$30000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-5000ppoHSA-naanltd.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","7"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","3","67577","MI","Individual","No","38-3291563","67577MI0390013","HAP Personal Alliance 3500 PPO","67577MI039",,"MIN001","MIS001","MIF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390013-00","Standard Silver Off Exchange Plan",,"0.681768476963043","Yes","Yes","No","100%",,"$3,500","$20","$1,130","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","No",,,"http://www.hap.org/sbc/2016-off-pa-3500ppo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","4"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","3","67577","MI","Individual","No","38-3291563","67577MI0390013","HAP Personal Alliance 3500 PPO","67577MI039",,"MIN001","MIS001","MIF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390013-01","Standard Silver On Exchange Plan",,"0.681768476963043","Yes","Yes","No","100%",,"$3,500","$20","$1,130","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500ppo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","5"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","3","67577","MI","Individual","No","38-3291563","67577MI0390013","HAP Personal Alliance 3500 PPO","67577MI039",,"MIN001","MIS001","MIF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500ppo-naanzero.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","6"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","3","67577","MI","Individual","No","38-3291563","67577MI0390013","HAP Personal Alliance 3500 PPO","67577MI039",,"MIN001","MIS001","MIF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390013-03","Limited Cost Sharing Plan Variation",,"0.681768476963043","Yes","Yes","No","100%",,"$3,500","$20","$1,130","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500ppo-naanltd.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","7"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","3","67577","MI","Individual","No","38-3291563","67577MI0390013","HAP Personal Alliance 3500 PPO","67577MI039",,"MIN001","MIS001","MIF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390013-04","73% AV Level Silver Plan",,"0.739344596862793","Yes","Yes","No","100%",,"$1,750","$20","$1,650","$150","$1,750","$470","$420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","$6,750","$6750 per person","$13500 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500ppo-73AV.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","8"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","3","67577","MI","Individual","No","38-3291563","67577MI0390013","HAP Personal Alliance 3500 PPO","67577MI039",,"MIN001","MIS001","MIF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390013-05","87% AV Level Silver Plan",,"0.878916800022125","Yes","Yes","No","100%",,"$100","$0","$1,400","$150","$100","$600","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$10,000","$10000 per person","$20000 per group","$11,500","$11500 per person","$23000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","$5,100","$5100 per person","$10200 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500ppo-87AV.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","9"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","3","67577","MI","Individual","No","38-3291563","67577MI0390013","HAP Personal Alliance 3500 PPO","67577MI039",,"MIN001","MIS001","MIF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390013-06","94% AV Level Silver Plan",,"0.948300719261169","Yes","Yes","No","100%",,"$0","$0","$500","$150","$0","$90","$420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$10,000","$10000 per person","$20000 per group","$10,500","$10500 per person","$21000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-3500ppo-94AV.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","10"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","4","67577","MI","Individual","No","38-3291563","67577MI0390012","HAP Personal Alliance 4500 PPO","67577MI039",,"MIN001","MIS001","MIF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390012-00","Standard Bronze Off Exchange Plan",,"0.617659449577332","No","Yes","No","100%",,"$4,500","$20","$830","$150","$4,500","$230","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","$21,850","$21850 per person","$43700 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$14,500","$14500 per person","$29000 per group","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2016-off-pa-4500ppo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","4"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","4","67577","MI","Individual","No","38-3291563","67577MI0390012","HAP Personal Alliance 4500 PPO","67577MI039",,"MIN001","MIS001","MIF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390012-01","Standard Bronze On Exchange Plan",,"0.617659449577332","No","Yes","No","100%",,"$4,500","$20","$830","$150","$4,500","$230","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","$21,850","$21850 per person","$43700 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$14,500","$14500 per person","$29000 per group","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2016-on-pa-4500ppo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","5"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","4","67577","MI","Individual","No","38-3291563","67577MI0390012","HAP Personal Alliance 4500 PPO","67577MI039",,"MIN001","MIS001","MIF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390012-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2016-on-pa-4500ppo-naanzero.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","6"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","4","67577","MI","Individual","No","38-3291563","67577MI0390012","HAP Personal Alliance 4500 PPO","67577MI039",,"MIN001","MIS001","MIF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390012-03","Limited Cost Sharing Plan Variation",,"0.617659449577332","No","Yes","No","100%",,"$4,500","$20","$830","$150","$4,500","$230","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","$21,850","$21850 per person","$43700 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$14,500","$14500 per person","$29000 per group","$1,500","$1500 per person","$3000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,,,,,,,,,,,,"No",,,"http://www.hap.org/sbc/2016-on-pa-4500ppo-naanltd.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","7"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","5","67577","MI","Individual","No","38-3291563","67577MI0390014","HAP Personal Alliance 6850 PPO","67577MI039",,"MIN001","MIS001","MIF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390014-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,720","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","$26,850","$26850 per person","$53700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","$21,850","$21850 per person","$43700 per group","No",,,"http://www.hap.org/sbc/2016-off-pa-6850ppo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","4"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","5","67577","MI","Individual","No","38-3291563","67577MI0390014","HAP Personal Alliance 6850 PPO","67577MI039",,"MIN001","MIS001","MIF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390014-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,720","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","$26,850","$26850 per person","$53700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","$21,850","$21850 per person","$43700 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-6850ppo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","5"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","5","67577","MI","Individual","No","38-3291563","67577MI0390014","HAP Personal Alliance 6850 PPO","67577MI039",,"MIN001","MIS001","MIF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-6850ppo-naanzero.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","6"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","5","67577","MI","Individual","No","38-3291563","67577MI0390014","HAP Personal Alliance 6850 PPO","67577MI039",,"MIN001","MIS001","MIF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No","Urgent and emergency services only","No","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390014-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,720","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","$26,850","$26850 per person","$53700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$15,000","$15000 per person","$30000 per group","$21,850","$21850 per person","$43700 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-6850ppo-naanltd.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","7"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","6","67577","MI","Individual","No","38-3291563","67577MI0390008","HAP Personal Alliance 6850C PPO","67577MI039",,"MIN001","MIS001","MIF003","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","3","2016-01-01",,"No","Urgent and emergency services only","No","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390008-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$3,500","$20","$1,130","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","$21,850","$21850 per person","$43700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","$16,850","$16850 per person","$33700 per group","No",,,"http://www.hap.org/sbc/2016-off-pa-6850ppo-CAT.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","4"
"2016","MI","67577","SERFF","3","2015-08-25 12:56:34","6","67577","MI","Individual","No","38-3291563","67577MI0390008","HAP Personal Alliance 6850C PPO","67577MI039",,"MIN001","MIS001","MIF003","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","1",,,,"0","0","3","2016-01-01",,"No","Urgent and emergency services only","No","Out-of-network benefits apply","No","https://pay.hap.org/paymentRequest/ffm/saml/web","http://www.hap.org/prescriptions/docs/2016drugformulary.pdf","67577MI0390008-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$3,500","$20","$1,130","$150","$3,500","$260","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$15,000","$15000 per person","$30000 per group","$21,850","$21850 per person","$43700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","$16,850","$16850 per person","$33700 per group","No",,,"http://www.hap.org/sbc/2016-on-pa-6850cppo.pdf","http://www.hap.org/healthinsurance/personalalliance/pdf/2016sales.pdf","5"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","1","71667","MI","Individual","No","38-3204052","71667MI0010004","Silver Compass HSA 3000","71667MI001",,"MIN001","MIS001","MIF005","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010004-00","Standard Silver Off Exchange Plan","69.20%",,"Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=MI0013&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","4"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","1","71667","MI","Individual","No","38-3204052","71667MI0010004","Silver Compass HSA 3000","71667MI001",,"MIN001","MIS001","MIF005","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010004-01","Standard Silver On Exchange Plan","69.20%",,"Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=MI0013&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","5"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","1","71667","MI","Individual","No","38-3204052","71667MI0010004","Silver Compass HSA 3000","71667MI001",,"MIN001","MIS001","MIF005","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=MI0014&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","6"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","1","71667","MI","Individual","No","38-3204052","71667MI0010004","Silver Compass HSA 3000","71667MI001",,"MIN001","MIS001","MIF005","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010004-03","Limited Cost Sharing Plan Variation","69.20%",,"Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=MI0015&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","7"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","1","71667","MI","Individual","No","38-3204052","71667MI0010009","Bronze Compass HSA 5500","71667MI001",,"MIN001","MIS001","MIF008","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010009-03","Limited Cost Sharing Plan Variation","61.30%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=MI0045&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","14"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010002","Gold Compass 1000","71667MI001",,"MIN001","MIS001","MIF001","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010002-00","Standard Gold Off Exchange Plan","78.10%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0004&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","8"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010002","Gold Compass 1000","71667MI001",,"MIN001","MIS001","MIF001","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010002-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0004&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","9"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010002","Gold Compass 1000","71667MI001",,"MIN001","MIS001","MIF001","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0005&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","10"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010002","Gold Compass 1000","71667MI001",,"MIN001","MIS001","MIF001","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010002-03","Limited Cost Sharing Plan Variation","78.10%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0006&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","11"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010003","Gold Compass 500","71667MI001",,"MIN001","MIS001","MIF002","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010003-00","Standard Gold Off Exchange Plan","78.30%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0007&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","12"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010010","Bronze Compass 6500","71667MI001",,"MIN001","MIS001","MIF008","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010010-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=MI0046&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","45"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010010","Bronze Compass 6500","71667MI001",,"MIN001","MIS001","MIF008","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010010-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=MI0047&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","46"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010010","Bronze Compass 6500","71667MI001",,"MIN001","MIS001","MIF008","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010010-03","Limited Cost Sharing Plan Variation","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=MI0048&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","47"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010011","Gold Compass 0","71667MI001",,"MIN001","MIS001","MIF003","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010011-00","Standard Gold Off Exchange Plan","79.10%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0010&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","48"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010011","Gold Compass 0","71667MI001",,"MIN001","MIS001","MIF003","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010011-01","Standard Gold On Exchange Plan","79.10%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0010&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","49"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010003","Gold Compass 500","71667MI001",,"MIN001","MIS001","MIF002","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0008&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","14"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010003","Gold Compass 500","71667MI001",,"MIN001","MIS001","MIF002","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010003-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0009&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","15"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010005","Silver Compass 2000 1","71667MI001",,"MIN001","MIS001","MIF006","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010005-00","Standard Silver Off Exchange Plan","70.80%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=MI0019&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","16"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010005","Silver Compass 2000 1","71667MI001",,"MIN001","MIS001","MIF006","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010005-01","Standard Silver On Exchange Plan","70.80%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=MI0019&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","17"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010005","Silver Compass 2000 1","71667MI001",,"MIN001","MIS001","MIF006","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=MI0020&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","18"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010005","Silver Compass 2000 1","71667MI001",,"MIN001","MIS001","MIF006","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010005-03","Limited Cost Sharing Plan Variation","70.80%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=MI0021&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","19"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010005","Silver Compass 2000 1","71667MI001",,"MIN001","MIS001","MIF006","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010005-04","73% AV Level Silver Plan","72.90%",,"Yes","Yes","No","100%",,"$1,800","$1,500","$0","$200","$1,800","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=MI0022&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","20"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010005","Silver Compass 2000 1","71667MI001",,"MIN001","MIS001","MIF006","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010005-05","87% AV Level Silver Plan","86.20%",,"Yes","Yes","No","100%",,"$600","$800","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=MI0023&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","21"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010005","Silver Compass 2000 1","71667MI001",,"MIN001","MIS001","MIF006","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010005-06","94% AV Level Silver Plan","93.10%",,"Yes","Yes","No","100%",,"$200","$500","$0","$200","$200","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=MI0024&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","22"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010006","Silver Compass 2000","71667MI001",,"MIN001","MIS001","MIF007","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010006-00","Standard Silver Off Exchange Plan","69.30%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0025&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","23"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010006","Silver Compass 2000","71667MI001",,"MIN001","MIS001","MIF007","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010006-01","Standard Silver On Exchange Plan","69.30%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0025&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","24"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010006","Silver Compass 2000","71667MI001",,"MIN001","MIS001","MIF007","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010006-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0026&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","25"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010006","Silver Compass 2000","71667MI001",,"MIN001","MIS001","MIF007","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010006-03","Limited Cost Sharing Plan Variation","69.30%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0027&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","26"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010006","Silver Compass 2000","71667MI001",,"MIN001","MIS001","MIF007","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010006-04","73% AV Level Silver Plan","73.40%",,"No","Yes","No","100%",,"$1,200","$20","$1,500","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0028&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","27"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010006","Silver Compass 2000","71667MI001",,"MIN001","MIS001","MIF007","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010006-05","87% AV Level Silver Plan","87.90%",,"No","Yes","No","100%",,"$300","$10","$600","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0029&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","28"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010006","Silver Compass 2000","71667MI001",,"MIN001","MIS001","MIF007","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010006-06","94% AV Level Silver Plan","93.90%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0030&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","29"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010007","Silver Compass 3500","71667MI001",,"MIN001","MIS001","MIF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010007-00","Standard Silver Off Exchange Plan","68.00%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0031&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","30"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010007","Silver Compass 3500","71667MI001",,"MIN001","MIS001","MIF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010007-01","Standard Silver On Exchange Plan","68.00%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0031&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","31"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010007","Silver Compass 3500","71667MI001",,"MIN001","MIS001","MIF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0032&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","32"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010007","Silver Compass 3500","71667MI001",,"MIN001","MIS001","MIF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010007-03","Limited Cost Sharing Plan Variation","68.00%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0033&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","33"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","Individual","No","27-2204037","74917MI0020002","McLaren Rewards Gold","74917MI002",,"MIN001","MIS001","MIF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"https://4d.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMzU4","74917MI0020002-03","Limited Cost Sharing Plan Variation",,"0.810652375221252","No","Yes","Yes","75%","25%","$1,000","$50","$0","$0","$1,000","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","25%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_4102_Gold.pdf",,"11"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","Individual","No","27-2204037","74917MI0020003","McLaren Rewards Silver","74917MI002",,"MIN001","MIS001","MIF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"https://4d.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMzU4","74917MI0020003-00","Standard Silver Off Exchange Plan",,"0.708840250968933","No","Yes","Yes","75%","25%","$2,100","$50","$0","$0","$2,100","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","40%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_4103_Silver.pdf",,"12"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","Individual","No","27-2204037","74917MI0020003","McLaren Rewards Silver","74917MI002",,"MIN001","MIS001","MIF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"https://4d.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMzU4","74917MI0020003-01","Standard Silver On Exchange Plan",,"0.708840250968933","No","Yes","Yes","75%","25%","$2,100","$50","$0","$0","$2,100","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","40%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_4103_Silver.pdf",,"13"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","Individual","No","27-2204037","74917MI0020003","McLaren Rewards Silver","74917MI002",,"MIN001","MIS001","MIF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"https://4d.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMzU4","74917MI0020003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","75%","25%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_4103_Silver.pdf",,"14"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","Individual","No","27-2204037","74917MI0020003","McLaren Rewards Silver","74917MI002",,"MIN001","MIS001","MIF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"https://4d.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMzU4","74917MI0020003-03","Limited Cost Sharing Plan Variation",,"0.708840250968933","No","Yes","Yes","75%","25%","$2,100","$50","$0","$0","$2,100","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","40%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_4103_Silver.pdf",,"15"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","Individual","No","27-2204037","74917MI0020003","McLaren Rewards Silver","74917MI002",,"MIN001","MIS001","MIF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"https://4d.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMzU4","74917MI0020003-04","73% AV Level Silver Plan",,"0.7299684882164","No","Yes","Yes","75%","25%","$2,100","$50","$0","$0","$2,100","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,350","$5350 per person","$10700 per group","Not Applicable","per person not applicable","per group not applicable","40%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_4403_Silver73.pdf",,"16"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","Individual","No","27-2204037","74917MI0020003","McLaren Rewards Silver","74917MI002",,"MIN001","MIS001","MIF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"https://4d.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMzU4","74917MI0020003-05","87% AV Level Silver Plan",,"0.863301813602448","No","Yes","Yes","75%","25%","$500","$50","$0","$0","$500","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","20%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_4503_Silver87.pdf",,"17"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010007","Silver Compass 3500","71667MI001",,"MIN001","MIS001","MIF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010007-04","73% AV Level Silver Plan","72.50%",,"No","Yes","No","100%",,"$2,500","$10","$800","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0034&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","34"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010007","Silver Compass 3500","71667MI001",,"MIN001","MIS001","MIF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010007-05","87% AV Level Silver Plan","87.90%",,"No","Yes","No","100%",,"$300","$10","$600","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0035&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","35"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010007","Silver Compass 3500","71667MI001",,"MIN001","MIS001","MIF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010007-06","94% AV Level Silver Plan","93.90%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0036&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","36"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010008","Silver Compass 4500","71667MI001",,"MIN001","MIS001","MIF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010008-00","Standard Silver Off Exchange Plan","68.30%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0037&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","37"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010008","Silver Compass 4500","71667MI001",,"MIN001","MIS001","MIF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010008-01","Standard Silver On Exchange Plan","68.30%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0037&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","38"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010008","Silver Compass 4500","71667MI001",,"MIN001","MIS001","MIF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010008-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0038&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","39"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010008","Silver Compass 4500","71667MI001",,"MIN001","MIS001","MIF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010008-03","Limited Cost Sharing Plan Variation","68.30%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0039&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","40"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010008","Silver Compass 4500","71667MI001",,"MIN001","MIS001","MIF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010008-04","73% AV Level Silver Plan","72.50%",,"No","Yes","No","100%",,"$3,300","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0040&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","41"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010008","Silver Compass 4500","71667MI001",,"MIN001","MIS001","MIF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010008-05","87% AV Level Silver Plan","86.10%",,"No","Yes","No","100%",,"$600","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0041&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","42"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010008","Silver Compass 4500","71667MI001",,"MIN001","MIS001","MIF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010008-06","94% AV Level Silver Plan","93.30%",,"No","Yes","No","100%",,"$100","$10","$0","$200","$100","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0042&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","43"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010010","Bronze Compass 6500","71667MI001",,"MIN001","MIS001","MIF008","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010010-00","Standard Bronze Off Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=MI0046&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","44"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010011","Gold Compass 0","71667MI001",,"MIN001","MIS001","MIF003","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010011-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0011&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","50"
"2016","MI","71667","SERFF","5","2015-08-23 14:39:40","2","71667","MI","Individual","No","38-3204052","71667MI0010011","Gold Compass 0","71667MI001",,"MIN001","MIS001","MIF003","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=MI0050&st=mi","71667MI0010011-03","Limited Cost Sharing Plan Variation","79.10%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=MI0012&st=mi","http://www.uhc.com/iex/doc?id=MI0049&st=mi","51"
"2016","MI","74709","SERFF","5","2015-08-24 05:58:52","1","74709","MI","SHOP (Small Group)","Yes","35-0472300","74709MI0010001","Lincoln DentalConnect®","74709MI001","7063415294","MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.45","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","74709MI0010001-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MI","74709","SERFF","5","2015-08-24 05:58:52","1","74709","MI","SHOP (Small Group)","Yes","35-0472300","74709MI0010002","Lincoln DentalConnect®","74709MI001","7063415294","MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.63","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","74709MI0010002-00","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MI","74709","SERFF","5","2015-08-24 05:58:52","1","74709","MI","SHOP (Small Group)","Yes","35-0472300","74709MI0010003","Lincoln DentalConnect®","74709MI001","7063415294","MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.00","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","74709MI0010003-00","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","MI","74709","SERFF","5","2015-08-24 05:58:52","1","74709","MI","SHOP (Small Group)","Yes","35-0472300","74709MI0010004","Lincoln DentalConnect®","74709MI001","7063415294","MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.10","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","74709MI0010004-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","MI","74709","SERFF","5","2015-08-24 05:58:52","1","74709","MI","SHOP (Small Group)","Yes","35-0472300","74709MI0010005","Lincoln DentalConnect®","74709MI001","7063415294","MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.85","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","74709MI0010005-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","MI","74709","SERFF","5","2015-08-24 05:58:52","1","74709","MI","SHOP (Small Group)","Yes","35-0472300","74709MI0010006","Lincoln DentalConnect®","74709MI001","7063415294","MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.77","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","74709MI0010006-00","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","MI","74709","SERFF","5","2015-08-24 05:58:52","1","74709","MI","SHOP (Small Group)","Yes","35-0472300","74709MI0010007","Lincoln DentalConnect®","74709MI001","7063415294","MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.00","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","74709MI0010007-00","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2016","MI","74709","SERFF","5","2015-08-24 05:58:52","1","74709","MI","SHOP (Small Group)","Yes","35-0472300","74709MI0010008","Lincoln DentalConnect®","74709MI001","7063415294","MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.61","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","74709MI0010008-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","Individual","No","27-2204037","74917MI0020001","McLaren Rewards Platinum","74917MI002",,"MIN001","MIS001","MIF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"https://4d.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMzU4","74917MI0020001-00","Standard Platinum Off Exchange Plan",,"0.896978676319122","No","Yes","Yes","75%","25%","$500","$25","$0","$1,250","$500","$25","$0","$1,250",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","10%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_4101_Platinum.pdf",,"4"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","SHOP (Small Group)","No","27-2204037","74917MI0010001","McLaren Rewards Platinum","74917MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx","74917MI0010001-00","Standard Platinum Off Exchange Plan",,"0.896978676319122","No","Yes","Yes","75%","25%","$500","$25","$0","$0","$500","$25","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","10%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_1101_Platinum.pdf",,"4"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","SHOP (Small Group)","No","27-2204037","74917MI0010001","McLaren Rewards Platinum","74917MI001",,"MIN001","MIS001","MIF001","Existing","HMO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx","74917MI0010001-01","Standard Platinum On Exchange Plan",,"0.896978676319122","No","Yes","Yes","75%","25%","$500","$25","$0","$0","$500","$25","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","10%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_1101_Platinum.pdf",,"5"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","Individual","No","27-2204037","74917MI0020001","McLaren Rewards Platinum","74917MI002",,"MIN001","MIS001","MIF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"https://4d.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMzU4","74917MI0020001-01","Standard Platinum On Exchange Plan",,"0.896978676319122","No","Yes","Yes","75%","25%","$500","$25","$0","$1,250","$500","$25","$0","$1,250",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","10%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_4101_Platinum.pdf",,"5"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","Individual","No","27-2204037","74917MI0020001","McLaren Rewards Platinum","74917MI002",,"MIN001","MIS001","MIF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"https://4d.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMzU4","74917MI0020001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","75%","25%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_4101_Platinum.pdf",,"6"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","SHOP (Small Group)","No","27-2204037","74917MI0010002","McLaren Rewards Gold","74917MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx","74917MI0010002-00","Standard Gold Off Exchange Plan",,"0.810652375221252","No","Yes","Yes","75%","25%","$1,000","$50","$0","$0","$1,000","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","25%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_1102_Gold.pdf",,"6"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","SHOP (Small Group)","No","27-2204037","74917MI0010002","McLaren Rewards Gold","74917MI001",,"MIN001","MIS001","MIF002","Existing","HMO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx","74917MI0010002-01","Standard Gold On Exchange Plan",,"0.810652375221252","No","Yes","Yes","75%","25%","$1,000","$50","$0","$0","$1,000","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","25%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_1102_Gold.pdf",,"7"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","Individual","No","27-2204037","74917MI0020001","McLaren Rewards Platinum","74917MI002",,"MIN001","MIS001","MIF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"https://4d.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMzU4","74917MI0020001-03","Limited Cost Sharing Plan Variation",,"0.896978676319122","No","Yes","Yes","75%","25%","$500","$25","$0","$0","$500","$25","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","10%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_4101_Platinum.pdf",,"7"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","SHOP (Small Group)","No","27-2204037","74917MI0010003","McLaren Rewards Silver","74917MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx","74917MI0010003-00","Standard Silver Off Exchange Plan",,"0.714138448238373","No","Yes","Yes","75%","25%","$2,100","$50","$0","$0","$2,100","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","40%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_1103_Silver.pdf",,"8"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","Individual","No","27-2204037","74917MI0020002","McLaren Rewards Gold","74917MI002",,"MIN001","MIS001","MIF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"https://4d.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMzU4","74917MI0020002-00","Standard Gold Off Exchange Plan",,"0.810652375221252","No","Yes","Yes","75%","25%","$1,000","$50","$0","$0","$1,000","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","25%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_4102_Gold.pdf",,"8"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","Individual","No","27-2204037","74917MI0020002","McLaren Rewards Gold","74917MI002",,"MIN001","MIS001","MIF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"https://4d.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMzU4","74917MI0020002-01","Standard Gold On Exchange Plan",,"0.810652375221252","No","Yes","Yes","75%","25%","$1,000","$50","$0","$0","$1,000","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","25%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_4102_Gold.pdf",,"9"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","SHOP (Small Group)","No","27-2204037","74917MI0010003","McLaren Rewards Silver","74917MI001",,"MIN001","MIS001","MIF003","Existing","HMO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"http://www.mclarenhealthplan.org/McLarenHealthPlan/ForourCommercialMembersmhp.aspx","74917MI0010003-01","Standard Silver On Exchange Plan",,"0.714138448238373","No","Yes","Yes","75%","25%","$2,100","$50","$0","$0","$2,100","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","40%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_1103_Silver.pdf",,"9"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","Individual","No","27-2204037","74917MI0020002","McLaren Rewards Gold","74917MI002",,"MIN001","MIS001","MIF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"https://4d.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMzU4","74917MI0020002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","75%","25%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_4102_Gold.pdf",,"10"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","Individual","No","27-2204037","74917MI0020003","McLaren Rewards Silver","74917MI002",,"MIN001","MIS001","MIF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9984",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"https://4d.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMzU4","74917MI0020003-06","94% AV Level Silver Plan",,"0.936883330345154","No","Yes","Yes","75%","25%","$0","$50","$0","$0","$0","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","10%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_4603_Silver94.pdf",,"18"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","Individual","No","27-2204037","74917MI0020011","McLaren Bronze","74917MI002",,"MIN001","MIS001","MIF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"https://4d.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMzU4","74917MI0020011-00","Standard Bronze Off Exchange Plan",,"0.607995748519897","No","Yes","No","100%",,"$5,000","$0","$0","$0","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_4111_Bronze.pdf",,"19"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","Individual","No","27-2204037","74917MI0020011","McLaren Bronze","74917MI002",,"MIN001","MIS001","MIF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"https://4d.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMzU4","74917MI0020011-01","Standard Bronze On Exchange Plan",,"0.607995748519897","No","Yes","No","100%",,"$5,000","$0","$0","$0","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_4111_Bronze.pdf",,"20"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","Individual","No","27-2204037","74917MI0020011","McLaren Bronze","74917MI002",,"MIN001","MIS001","MIF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"https://4d.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMzU4","74917MI0020011-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_4111_Bronze.pdf",,"21"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","1","74917","MI","Individual","No","27-2204037","74917MI0020011","McLaren Bronze","74917MI002",,"MIN001","MIS001","MIF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9985",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","Yes",,"https://4d.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMzU4","74917MI0020011-03","Limited Cost Sharing Plan Variation",,"0.607995748519897","No","Yes","No","100%",,"$5,000","$0","$0","$0","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_4111_Bronze.pdf",,"22"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","2","74917","MI","Individual","No","27-2204037","74917MI0020004","McLaren Young Adult/Catastrophic","74917MI002",,"MIN001","MIS001","MIF001","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9982",,,,"0","0","0","2016-01-01",,"Yes","Emergency Treatment Only","Yes","Emergency Treatment Only","Yes",,"https://4d.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMzU4","74917MI0020004-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_4104_Catastrophic.pdf",,"4"
"2016","MI","74917","SERFF","7","2016-01-29 07:27:50","2","74917","MI","Individual","No","27-2204037","74917MI0020004","McLaren Young Adult/Catastrophic","74917MI002",,"MIN001","MIS001","MIF001","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"0.9982",,,,"0","0","0","2016-01-01",,"Yes","Emergency Treatment Only","Yes","Emergency Treatment Only","Yes",,"https://4d.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMzU4","74917MI0020004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.mclarenhealthplan.org/Uploads/Public/Documents/HealthPlan/documents/UserUploads/2015_SBC_4104_Catastrophic.pdf",,"5"
"2016","MI","75936","SERFF","4","2015-08-24 05:58:52","1","75936","MI","Individual","Yes","47-0397286","75936MI0010001","Delta Dental Individual PPO, EHB Certified","75936MI001",,"MIN002","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.86","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","75936MI0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MI","75936","SERFF","4","2015-08-24 05:58:52","1","75936","MI","SHOP (Small Group)","Yes","47-0397286","75936MI0030001","Renaissance Group Dental PPO, EHB Certified","75936MI003",,"MIN001","MIS002",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.06","Estimated Rate",,"0","0","0","2015-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","75936MI0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MI","75936","SERFF","4","2015-08-24 05:58:52","1","75936","MI","Individual","Yes","47-0397286","75936MI0010002","Delta Dental Individual PPO, EHB Certified","75936MI001",,"MIN002","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.75","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","75936MI0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MI","75936","SERFF","4","2015-08-24 05:58:52","1","75936","MI","SHOP (Small Group)","Yes","47-0397286","75936MI0030002","Renaissance Group Dental PPO, EHB Certified","75936MI003",,"MIN001","MIS002",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.99","Estimated Rate",,"0","0","0","2015-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","75936MI0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MI","75936","SERFF","4","2015-08-24 05:58:52","1","75936","MI","Individual","Yes","47-0397286","75936MI0020001","Renaissance Individual Dental PPO, EHB Certified","75936MI002",,"MIN001","MIS002",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.99","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","75936MI0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","MI","75936","SERFF","4","2015-08-24 05:58:52","1","75936","MI","Individual","Yes","47-0397286","75936MI0020002","Renaissance Individual Dental PPO, EHB Certified","75936MI002",,"MIN001","MIS002",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.27","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","75936MI0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","MI","79116","SERFF","5","2015-08-24 05:58:52","1","79116","MI","SHOP (Small Group)","Yes","41-0808596","79116MI0010002","Plan 2. Passive PPO $1000 Annual Maximum, Ortho","79116MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","79116MI0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MI","79116","SERFF","5","2015-08-24 05:58:52","1","79116","MI","SHOP (Small Group)","Yes","41-0808596","79116MI0010005","Plan 5. Passive PPO, $2000 Annaul Maximum, Ortho","79116MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","79116MI0010005-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MI","79116","SERFF","5","2015-08-24 05:58:52","1","79116","MI","SHOP (Small Group)","Yes","41-0808596","79116MI0010006","Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho","79116MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","79116MI0010006-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","MI","79116","SERFF","5","2015-08-24 05:58:52","1","79116","MI","SHOP (Small Group)","Yes","41-0808596","79116MI0010009","Plan 9. MAC PPO, $1500 Annual Maximum, Ortho","79116MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$20.18","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","79116MI0010009-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","MI","86217","SERFF","3","2015-08-22 23:36:24","1","86217","MI","Individual","Yes","38-2724203","86217MI0010001","Select Dental Healthy Family Max","86217MI001",,"MIN001","MIS001",,"Existing","EPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$45.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","http://www.goldendentalplans.com/plans/select/hfmax/buy","","86217MI0010001-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.goldendentalplans.com/plans/select/hfmax/summary","http://www.goldendentalplans.com/plans/select/hfmax","4"
"2016","MI","86217","SERFF","3","2015-08-22 23:36:24","2","86217","MI","Individual","Yes","38-2724203","86217MI0020001","Select Dental Healthy Family Value","86217MI002",,"MIN001","MIS001",,"Existing","EPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","http://www.goldendentalplans.com/plans/select/hfmax/buy","","86217MI0020001-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.goldendentalplans.com/plans/select/hfvalue/summary","http://www.goldendentalplans.com/plans/select/hfvalue","4"
"2016","MI","86217","SERFF","3","2015-08-22 23:36:24","3","86217","MI","Individual","Yes","38-2724203","86217MI0030001","Select Dental Healthy Kids Max","86217MI003",,"MIN001","MIS001",,"Existing","EPO","High",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$45.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","http://www.goldendentalplans.com/plans/select/hkmax/buy","","86217MI0030001-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.goldendentalplans.com/plans/select/hkmax/summary","http://www.goldendentalplans.com/plans/select/hkmax","4"
"2016","MI","86217","SERFF","3","2015-08-22 23:36:24","4","86217","MI","Individual","Yes","38-2724203","86217MI0040001","Select Dental Healthy Kids Value","86217MI004",,"MIN001","MIS001",,"Existing","EPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$36.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","http://www.goldendentalplans.com/plans/select/hkvalue/buy","","86217MI0040001-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.goldendentalplans.com/plans/select/hkvalue/summary","http://www.goldendentalplans.com/plans/select/hkvalue","4"
"2016","MI","86217","SERFF","3","2015-08-22 23:36:24","5","86217","MI","Individual","Yes","38-2724203","86217MI0070001","Select Dental Healthy Family Max","86217MI007",,"MIN001","MIS001",,"Existing","EPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$45.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","http://www.goldendentalplans.com/plans/select/oe/hfmax/buy","","86217MI0070001-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.goldendentalplans.com/plans/select/oe/hfmax/summary","http://www.goldendentalplans.com/plans/select/oe/hfmax","4"
"2016","MI","86217","SERFF","3","2015-08-22 23:36:24","6","86217","MI","Individual","Yes","38-2724203","86217MI0080001","Select Dental Healthy Family Value","86217MI008",,"MIN001","MIS001",,"Existing","EPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","http://www.goldendentalplans.com/plans/select/oe/hfvalue/buy","","86217MI0080001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.goldendentalplans.com/plans/select/oe/hfvalue/summary","http://www.goldendentalplans.com/plans/select/oe/hfvalue","4"
"2016","MI","86217","SERFF","3","2015-08-22 23:36:24","7","86217","MI","Individual","Yes","38-2724203","86217MI0090001","Select Dental Healthy Kids Max","86217MI009",,"MIN001","MIS001",,"Existing","EPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$45.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","http://www.goldendentalplans.com/plans/select/oe/hkmax/buy","","86217MI0090001-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.goldendentalplans.com/plans/select/oe/hkmax/summary","http://www.goldendentalplans.com/plans/select/oe/hkmax","4"
"2016","MI","86217","SERFF","3","2015-08-22 23:36:24","8","86217","MI","Individual","Yes","38-2724203","86217MI0100001","Select Dental Healthy Kids Value","86217MI010",,"MIN001","MIS001",,"Existing","EPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$36.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","http://www.goldendentalplans.com/plans/select/oe/hkvalue/buy","","86217MI0100001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.goldendentalplans.com/plans/select/oe/hkvalue/summary","http://www.goldendentalplans.com/plans/select/oe/hkvalue","4"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550001","Blue Cross® Select Silver Extra","98185MI055",,"MIN006","MIS004","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550001-05","87% AV Level Silver Plan","87.66%","0.872204780578613","Yes","Yes","No","100%",,"$700","$10","$600","$150","$700","$300","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-extra-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/select-hmo-extra.html?costshare=87","9"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550001","Blue Cross® Select Silver Extra","98185MI055",,"MIN006","MIS004","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550001-06","94% AV Level Silver Plan","94.85%","0.950899839401245","Yes","Yes","No","100%",,"$180","$0","$330","$150","$180","$130","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-extra-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/select-hmo-extra.html?costshare=94","10"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","SHOP (Small Group)","No","38-2359234","98185MI0130025","BCN Gold $1500","98185MI013","7457354687","MIN001","MIS001","MIF005","Existing","HMO","Gold","Yes","Both","No","Yes","All except for routine OB/GYN, behavioral health, and pediatric visits","Out-of-network services",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergent care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/customselectdruglist","98185MI0130025-00","Standard Gold Off Exchange Plan","80.08%","0.774567663669586","No","Yes","No","100%",,"$1,500","$10","$1,010","$150","$1,150","$160","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2016-employer/sbc/bcn-hmo-gold-130007.pdf","http://www.bcbsm.com/employer-hmo-plan-brochures","10"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","SHOP (Small Group)","No","38-2359234","98185MI0130025","BCN Gold $1500","98185MI013","7457354687","MIN001","MIS001","MIF005","Existing","HMO","Gold","Yes","Both","No","Yes","All except for routine OB/GYN, behavioral health, and pediatric visits","Out-of-network services",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergent care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/customselectdruglist","98185MI0130025-01","Standard Gold On Exchange Plan","80.08%","0.774567663669586","No","Yes","No","100%",,"$1,500","$10","$1,010","$150","$1,150","$160","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2016-employer/sbc/bcn-hmo-gold-130007.pdf","http://www.bcbsm.com/employer-hmo-plan-brochures","11"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550007","Blue Cross® Partnered Gold Extra","98185MI055",,"MIN003","MIS005","MIF021","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550007-00","Standard Gold Off Exchange Plan","81.84%","0.816021025180817","Yes","Yes","No","100%",,"$780","$10","$1,190","$150","$780","$300","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-gold-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/preferred-hmo-extra.html","40"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550007","Blue Cross® Partnered Gold Extra","98185MI055",,"MIN003","MIS005","MIF021","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550007-01","Standard Gold On Exchange Plan","81.84%","0.816021025180817","Yes","Yes","No","100%",,"$780","$10","$1,190","$150","$780","$300","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-gold-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/preferred-hmo-extra.html","41"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550007","Blue Cross® Partnered Gold Extra","98185MI055",,"MIN003","MIS005","MIF021","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-gold-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-gold-extra-na-less-than-300-sbc.pdf","42"
"2016","MI","94523","SERFF","4","2015-08-27 03:52:03","1","94523","MI","SHOP (Small Group)","Yes","75-1233841","94523MI0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","94523MI002",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.42","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","94523MI0020001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","$85","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mi/94523mi0020001-16","4"
"2016","MI","94523","SERFF","4","2015-08-27 03:52:03","1","94523","MI","Individual","Yes","75-1233841","94523MI0010001","Dentegra Dental PPO Pediatric Basic Plan","94523MI001",,"MIN001","MIS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.26","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","94523MI0010001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","$85","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mi/94523mi0010001-16","4"
"2016","MI","94523","SERFF","4","2015-08-27 03:52:03","2","94523","MI","Individual","Yes","75-1233841","94523MI0010004","Dentegra Dental PPO Family Preferred Plan","94523MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","94523MI0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","$35","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mi/94523mi0010004-16","4"
"2016","MI","94523","SERFF","4","2015-08-27 03:52:03","2","94523","MI","SHOP (Small Group)","Yes","75-1233841","94523MI0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","94523MI002",,"MIN001","MIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.98","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","94523MI0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","$35","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mi/94523mi0020004-16","4"
"2016","MI","94523","SERFF","4","2015-08-27 03:52:03","2","94523","MI","SHOP (Small Group)","Yes","75-1233841","94523MI0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","94523MI002",,"MIN001","MIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.98","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","94523MI0020004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","$35","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mi/94523mi0020004-16","5"
"2016","MI","94523","SERFF","4","2015-08-27 03:52:03","2","94523","MI","Individual","Yes","75-1233841","94523MI0010004","Dentegra Dental PPO Family Preferred Plan","94523MI001",,"MIN001","MIS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","94523MI0010004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","$35","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mi/94523mi0010004-16","5"
"2016","MI","94523","SERFF","4","2015-08-27 03:52:03","3","94523","MI","Individual","Yes","75-1233841","94523MI0010006","Dentegra Dental PPO Family Basic Plan","94523MI001",,"MIN001","MIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.26","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","94523MI0010006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","$85","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mi/94523mi0010006-16","4"
"2016","MI","94523","SERFF","4","2015-08-27 03:52:03","3","94523","MI","SHOP (Small Group)","Yes","75-1233841","94523MI0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","94523MI002",,"MIN001","MIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.42","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","94523MI0020006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","$85","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mi/94523mi0020006-16","4"
"2016","MI","94523","SERFF","4","2015-08-27 03:52:03","3","94523","MI","SHOP (Small Group)","Yes","75-1233841","94523MI0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","94523MI002",,"MIN001","MIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.42","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","94523MI0020006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","$85","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mi/94523mi0020006-16","5"
"2016","MI","94523","SERFF","4","2015-08-27 03:52:03","3","94523","MI","Individual","Yes","75-1233841","94523MI0010006","Dentegra Dental PPO Family Basic Plan","94523MI001",,"MIN001","MIS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.26","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","94523MI0010006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$85","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","$85","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/mi/94523mi0010006-16","5"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550001","Blue Cross® Select Silver Extra","98185MI055",,"MIN006","MIS004","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550001-00","Standard Silver Off Exchange Plan","71.82%","0.685801982879639","Yes","Yes","No","100%",,"$2,250","$10","$1,340","$150","$2,250","$190","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/select-hmo-extra.html","4"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550001","Blue Cross® Select Silver Extra","98185MI055",,"MIN006","MIS004","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550001-01","Standard Silver On Exchange Plan","71.82%","0.685801982879639","Yes","Yes","No","100%",,"$2,250","$10","$1,340","$150","$2,250","$190","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/select-hmo-extra.html","5"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550001","Blue Cross® Select Silver Extra","98185MI055",,"MIN006","MIS004","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-extra-na-less-than-300-sbc.pdf","6"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550001","Blue Cross® Select Silver Extra","98185MI055",,"MIN006","MIS004","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550001-03","Limited Cost Sharing Plan Variation","71.82%","0.685801982879639","Yes","Yes","No","100%",,"$2,250","$10","$1,340","$150","$2,250","$190","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-extra-na-more-than-300-sbc.pdf","7"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550001","Blue Cross® Select Silver Extra","98185MI055",,"MIN006","MIS004","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550001-04","73% AV Level Silver Plan","73.90%","0.713821530342102","Yes","Yes","No","100%",,"$1,800","$10","$1,480","$150","$1,800","$220","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-extra-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/select-hmo-extra.html?costshare=73","8"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550002","Blue Cross® Preferred Silver Extra","98185MI055",,"MIN005","MIS001","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550002-00","Standard Silver Off Exchange Plan","71.82%","0.685801982879639","Yes","Yes","No","100%",,"$2,250","$10","$1,340","$150","$2,250","$190","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/preferred-hmo-extra.html","11"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550002","Blue Cross® Preferred Silver Extra","98185MI055",,"MIN005","MIS001","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550002-01","Standard Silver On Exchange Plan","71.82%","0.685801982879639","Yes","Yes","No","100%",,"$2,250","$10","$1,340","$150","$2,250","$190","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/preferred-hmo-extra.html","12"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550002","Blue Cross® Preferred Silver Extra","98185MI055",,"MIN005","MIS001","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-silver-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-silver-extra-na-less-than-300-sbc.pdf","13"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550002","Blue Cross® Preferred Silver Extra","98185MI055",,"MIN005","MIS001","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550002-03","Limited Cost Sharing Plan Variation","71.82%","0.685801982879639","Yes","Yes","No","100%",,"$2,250","$10","$1,340","$150","$2,250","$190","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-silver-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-silver-extra-na-more-than-300-sbc.pdf","14"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550002","Blue Cross® Preferred Silver Extra","98185MI055",,"MIN005","MIS001","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550002-04","73% AV Level Silver Plan","73.90%","0.713821530342102","Yes","Yes","No","100%",,"$1,800","$10","$1,480","$150","$1,800","$220","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-silver-extra-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/preferred-hmo-extra.html?costshare=73","15"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","SHOP (Small Group)","No","38-2359234","98185MI0130033","BCN Silver $3000","98185MI013","7457354687","MIN001","MIS001","MIF007","Existing","HMO","Silver","Yes","Both","No","Yes","All except for routine OB/GYN, behavioral health, and pediatric visits","Out-of-network services",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergent care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/customselectdruglist","98185MI0130033-00","Standard Silver Off Exchange Plan","71.24%","0.715391337871552","No","Yes","No","100%",,"$3,000","$10","$850","$150","$1,150","$240","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2016-employer/sbc/bcn-hmo-silver-130015.pdf","http://www.bcbsm.com/employer-hmo-plan-brochures","15"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","SHOP (Small Group)","No","38-2359234","98185MI0130033","BCN Silver $3000","98185MI013","7457354687","MIN001","MIS001","MIF007","Existing","HMO","Silver","Yes","Both","No","Yes","All except for routine OB/GYN, behavioral health, and pediatric visits","Out-of-network services",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergent care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/customselectdruglist","98185MI0130033-01","Standard Silver On Exchange Plan","71.24%","0.715391337871552","No","Yes","No","100%",,"$3,000","$10","$850","$150","$1,150","$240","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2016-employer/sbc/bcn-hmo-silver-130015.pdf","http://www.bcbsm.com/employer-hmo-plan-brochures","16"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550002","Blue Cross® Preferred Silver Extra","98185MI055",,"MIN005","MIS001","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550002-05","87% AV Level Silver Plan","87.66%","0.872204780578613","Yes","Yes","No","100%",,"$700","$10","$600","$150","$700","$300","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-silver-extra-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/preferred-hmo-extra.html?costshare=87","16"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550002","Blue Cross® Preferred Silver Extra","98185MI055",,"MIN005","MIS001","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550002-06","94% AV Level Silver Plan","94.85%","0.950899839401245","Yes","Yes","No","100%",,"$180","$0","$330","$150","$180","$130","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-silver-extra-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/preferred-hmo-extra.html?costshare=94","17"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550003","Blue Cross® Partnered Silver Extra","98185MI055",,"MIN003","MIS005","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550003-00","Standard Silver Off Exchange Plan","71.82%","0.685801982879639","Yes","Yes","No","100%",,"$2,250","$10","$1,340","$150","$2,250","$190","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/partnered-hmo-extra.html","18"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550003","Blue Cross® Partnered Silver Extra","98185MI055",,"MIN003","MIS005","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550003-01","Standard Silver On Exchange Plan","71.82%","0.685801982879639","Yes","Yes","No","100%",,"$2,250","$10","$1,340","$150","$2,250","$190","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/partnered-hmo-extra.html","19"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550003","Blue Cross® Partnered Silver Extra","98185MI055",,"MIN003","MIS005","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-extra-na-less-than-300-sbc.pdf","20"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550003","Blue Cross® Partnered Silver Extra","98185MI055",,"MIN003","MIS005","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550003-03","Limited Cost Sharing Plan Variation","71.82%","0.685801982879639","Yes","Yes","No","100%",,"$2,250","$10","$1,340","$150","$2,250","$190","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-extra-na-more-than-300-sbc.pdf","21"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550003","Blue Cross® Partnered Silver Extra","98185MI055",,"MIN003","MIS005","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550003-04","73% AV Level Silver Plan","73.90%","0.713821530342102","Yes","Yes","No","100%",,"$1,800","$10","$1,480","$150","$1,800","$220","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-extra-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/partnered-hmo-extra.html?costshare=73","22"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550003","Blue Cross® Partnered Silver Extra","98185MI055",,"MIN003","MIS005","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550003-05","87% AV Level Silver Plan","87.66%","0.872204780578613","Yes","Yes","No","100%",,"$700","$10","$600","$150","$700","$300","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-extra-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/partnered-hmo-extra.html?costshare=87","23"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550003","Blue Cross® Partnered Silver Extra","98185MI055",,"MIN003","MIS005","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550003-06","94% AV Level Silver Plan","94.85%","0.950899839401245","Yes","Yes","No","100%",,"$180","$0","$330","$150","$180","$130","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-extra-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/partnered-hmo-extra.html?costshare=94","24"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550004","Blue Cross® Metro Detroit HMO Silver Extra","98185MI055",,"MIN004","MIS006","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550004-00","Standard Silver Off Exchange Plan","71.82%","0.685801982879639","Yes","Yes","No","100%",,"$2,250","$10","$1,340","$150","$2,250","$190","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-hmo-extra.html","25"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550004","Blue Cross® Metro Detroit HMO Silver Extra","98185MI055",,"MIN004","MIS006","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550004-01","Standard Silver On Exchange Plan","71.82%","0.685801982879639","Yes","Yes","No","100%",,"$2,250","$10","$1,340","$150","$2,250","$190","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-hmo-extra.html","26"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550004","Blue Cross® Metro Detroit HMO Silver Extra","98185MI055",,"MIN004","MIS006","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-extra-na-less-than-300-sbc.pdf","27"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550004","Blue Cross® Metro Detroit HMO Silver Extra","98185MI055",,"MIN004","MIS006","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550004-03","Limited Cost Sharing Plan Variation","71.82%","0.685801982879639","Yes","Yes","No","100%",,"$2,250","$10","$1,340","$150","$2,250","$190","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-extra-na-more-than-300-sbc.pdf","28"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550004","Blue Cross® Metro Detroit HMO Silver Extra","98185MI055",,"MIN004","MIS006","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550004-04","73% AV Level Silver Plan","73.90%","0.713821530342102","Yes","Yes","No","100%",,"$1,800","$10","$1,480","$150","$1,800","$220","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-extra-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-hmo-extra.html?costshare=73","29"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550004","Blue Cross® Metro Detroit HMO Silver Extra","98185MI055",,"MIN004","MIS006","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550004-05","87% AV Level Silver Plan","87.66%","0.872204780578613","Yes","Yes","No","100%",,"$700","$10","$600","$150","$700","$300","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-extra-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-hmo-extra.html?costshare=87","30"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550004","Blue Cross® Metro Detroit HMO Silver Extra","98185MI055",,"MIN004","MIS006","MIF021","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550004-06","94% AV Level Silver Plan","94.85%","0.950899839401245","Yes","Yes","No","100%",,"$180","$0","$330","$150","$180","$130","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-extra-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-hmo-extra.html?costshare=94","31"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550005","Blue Cross® Select Gold Extra","98185MI055",,"MIN006","MIS004","MIF021","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550005-00","Standard Gold Off Exchange Plan","81.84%","0.816021025180817","Yes","Yes","No","100%",,"$780","$10","$1,190","$150","$780","$300","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-gold-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/select-hmo-extra.html","32"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550005","Blue Cross® Select Gold Extra","98185MI055",,"MIN006","MIS004","MIF021","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550005-01","Standard Gold On Exchange Plan","81.84%","0.816021025180817","Yes","Yes","No","100%",,"$780","$10","$1,190","$150","$780","$300","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-gold-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/select-hmo-extra.html","33"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550005","Blue Cross® Select Gold Extra","98185MI055",,"MIN006","MIS004","MIF021","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-gold-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-gold-extra-na-less-than-300-sbc.pdf","34"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550005","Blue Cross® Select Gold Extra","98185MI055",,"MIN006","MIS004","MIF021","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550005-03","Limited Cost Sharing Plan Variation","81.84%","0.816021025180817","Yes","Yes","No","100%",,"$780","$10","$1,190","$150","$780","$300","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-gold-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-gold-extra-na-more-than-300-sbc.pdf","35"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550006","Blue Cross® Preferred Gold Extra","98185MI055",,"MIN005","MIS003","MIF021","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550006-00","Standard Gold Off Exchange Plan","81.84%","0.816021025180817","Yes","Yes","No","100%",,"$780","$10","$1,190","$150","$780","$300","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-gold-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/preferred-hmo-extra.html","36"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550006","Blue Cross® Preferred Gold Extra","98185MI055",,"MIN005","MIS003","MIF021","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550006-01","Standard Gold On Exchange Plan","81.84%","0.816021025180817","Yes","Yes","No","100%",,"$780","$10","$1,190","$150","$780","$300","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-gold-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/preferred-hmo-extra.html","37"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550006","Blue Cross® Preferred Gold Extra","98185MI055",,"MIN005","MIS003","MIF021","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-gold-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-gold-extra-na-less-than-300-sbc.pdf","38"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550006","Blue Cross® Preferred Gold Extra","98185MI055",,"MIN005","MIS003","MIF021","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550006-03","Limited Cost Sharing Plan Variation","81.84%","0.816021025180817","Yes","Yes","No","100%",,"$780","$10","$1,190","$150","$780","$300","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-gold-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-gold-extra-na-more-than-300-sbc.pdf","39"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550007","Blue Cross® Partnered Gold Extra","98185MI055",,"MIN003","MIS005","MIF021","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550007-03","Limited Cost Sharing Plan Variation","81.84%","0.816021025180817","Yes","Yes","No","100%",,"$780","$10","$1,190","$150","$780","$300","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-gold-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-gold-extra-na-more-than-300-sbc.pdf","43"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550008","Blue Cross® Metro Detroit HMO Gold Extra","98185MI055",,"MIN004","MIS006","MIF021","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550008-00","Standard Gold Off Exchange Plan","81.84%","0.816021025180817","Yes","Yes","No","100%",,"$780","$10","$1,190","$150","$780","$300","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-gold-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/metro-detroit-hmo-extra.html","44"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550008","Blue Cross® Metro Detroit HMO Gold Extra","98185MI055",,"MIN004","MIS006","MIF021","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550008-01","Standard Gold On Exchange Plan","81.84%","0.816021025180817","Yes","Yes","No","100%",,"$780","$10","$1,190","$150","$780","$300","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-gold-extra-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/metro-detroit-hmo-extra.html","45"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550008","Blue Cross® Metro Detroit HMO Gold Extra","98185MI055",,"MIN004","MIS006","MIF021","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-gold-extra-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-gold-extra-na-less-than-300-sbc.pdf","46"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","1","98185","MI","Individual","No","38-2359234","98185MI0550008","Blue Cross® Metro Detroit HMO Gold Extra","98185MI055",,"MIN004","MIS006","MIF021","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0550008-03","Limited Cost Sharing Plan Variation","81.84%","0.816021025180817","Yes","Yes","No","100%",,"$780","$10","$1,190","$150","$780","$300","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$775","$775 per person","$1550 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-gold-extra-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-gold-extra-na-more-than-300-sbc.pdf","47"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180001","Blue Cross® Select Value","98185MI018",,"MIN006","MIS004","MIF022","Existing","HMO","Catastrophic","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,750","$0","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-value-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/catastrophic/select-hmo.html","4"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180001","Blue Cross® Select Value","98185MI018",,"MIN006","MIS004","MIF022","Existing","HMO","Catastrophic","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,750","$0","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-value-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/catastrophic/select-hmo.html","5"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180004","Blue Cross® Select Silver","98185MI018",,"MIN006","MIS004","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180004-00","Standard Silver Off Exchange Plan","70.14%","0.703754901885986","Yes","Yes","No","100%",,"$1,650","$510","$1,020","$150","$1,650","$290","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/select-hmo.html","6"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180004","Blue Cross® Select Silver","98185MI018",,"MIN006","MIS004","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180004-01","Standard Silver On Exchange Plan","70.14%","0.703754901885986","Yes","Yes","No","100%",,"$1,650","$510","$1,020","$150","$1,650","$290","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/select-hmo.html","7"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180004","Blue Cross® Select Silver","98185MI018",,"MIN006","MIS004","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-na-less-than-300-sbc.pdf","8"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180004","Blue Cross® Select Silver","98185MI018",,"MIN006","MIS004","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180004-03","Limited Cost Sharing Plan Variation","70.14%","0.703754901885986","Yes","Yes","No","100%",,"$1,650","$510","$1,020","$150","$1,650","$290","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-na-more-than-300-sbc.pdf","9"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180004","Blue Cross® Select Silver","98185MI018",,"MIN006","MIS004","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180004-04","73% AV Level Silver Plan","73.84%","0.740071356296539","Yes","Yes","No","100%",,"$1,450","$510","$1,080","$150","$1,450","$290","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/select-hmo.html?costshare=73","10"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180004","Blue Cross® Select Silver","98185MI018",,"MIN006","MIS004","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180004-05","87% AV Level Silver Plan","87.44%","0.885320425033569","Yes","Yes","No","100%",,"$450","$510","$460","$150","$450","$340","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/select-hmo.html?costshare=87","11"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180004","Blue Cross® Select Silver","98185MI018",,"MIN006","MIS004","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180004-06","94% AV Level Silver Plan","94.60%","0.950954675674438","Yes","Yes","No","100%",,"$175","$0","$320","$150","$175","$190","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/select-hmo.html?costshare=94","12"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180005","Blue Cross® Preferred Silver","98185MI018",,"MIN005","MIS001","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180005-00","Standard Silver Off Exchange Plan","70.14%","0.703754901885986","Yes","Yes","No","100%",,"$1,650","$510","$1,020","$150","$1,650","$290","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/preferred-hmo.html","13"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180005","Blue Cross® Preferred Silver","98185MI018",,"MIN005","MIS001","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180005-01","Standard Silver On Exchange Plan","70.14%","0.703754901885986","Yes","Yes","No","100%",,"$1,650","$510","$1,020","$150","$1,650","$290","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/preferred-hmo.html","14"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180005","Blue Cross® Preferred Silver","98185MI018",,"MIN005","MIS001","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-silver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-silver-na-less-than-300-sbc.pdf","15"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180005","Blue Cross® Preferred Silver","98185MI018",,"MIN005","MIS001","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180005-03","Limited Cost Sharing Plan Variation","70.14%","0.703754901885986","Yes","Yes","No","100%",,"$1,650","$510","$1,020","$150","$1,650","$290","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-silver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-silver-na-more-than-300-sbc.pdf","16"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180005","Blue Cross® Preferred Silver","98185MI018",,"MIN005","MIS001","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180005-04","73% AV Level Silver Plan","73.84%","0.740071356296539","Yes","Yes","No","100%",,"$1,450","$510","$1,080","$150","$1,450","$290","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-silver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/preferred-hmo.html?costshare=73","17"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180005","Blue Cross® Preferred Silver","98185MI018",,"MIN005","MIS001","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180005-05","87% AV Level Silver Plan","87.44%","0.885320425033569","Yes","Yes","No","100%",,"$450","$510","$460","$150","$450","$340","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-silver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/preferred-hmo.html?costshare=87","18"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180005","Blue Cross® Preferred Silver","98185MI018",,"MIN005","MIS001","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180005-06","94% AV Level Silver Plan","94.60%","0.950954675674438","Yes","Yes","No","100%",,"$175","$0","$320","$150","$175","$190","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-silver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/preferred-hmo.html?costshare=94","19"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180007","Blue Cross® Partnered Silver","98185MI018",,"MIN003","MIS005","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180007-00","Standard Silver Off Exchange Plan","70.14%","0.703754901885986","Yes","Yes","No","100%",,"$1,650","$510","$1,020","$150","$1,650","$290","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/partnered-hmo.html","20"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180007","Blue Cross® Partnered Silver","98185MI018",,"MIN003","MIS005","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180007-01","Standard Silver On Exchange Plan","70.14%","0.703754901885986","Yes","Yes","No","100%",,"$1,650","$510","$1,020","$150","$1,650","$290","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/partnered-hmo.html","21"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180007","Blue Cross® Partnered Silver","98185MI018",,"MIN003","MIS005","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-na-less-than-300-sbc.pdf","22"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180007","Blue Cross® Partnered Silver","98185MI018",,"MIN003","MIS005","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180007-03","Limited Cost Sharing Plan Variation","70.14%","0.703754901885986","Yes","Yes","No","100%",,"$1,650","$510","$1,020","$150","$1,650","$290","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-na-more-than-300-sbc.pdf","23"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180007","Blue Cross® Partnered Silver","98185MI018",,"MIN003","MIS005","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180007-04","73% AV Level Silver Plan","73.84%","0.740071356296539","Yes","Yes","No","100%",,"$1,450","$510","$1,080","$150","$1,450","$290","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/partnered-hmo.html?costshare=73","24"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180007","Blue Cross® Partnered Silver","98185MI018",,"MIN003","MIS005","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180007-05","87% AV Level Silver Plan","87.44%","0.885320425033569","Yes","Yes","No","100%",,"$450","$510","$460","$150","$450","$340","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/partnered-hmo.html?costshare=87","25"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180007","Blue Cross® Partnered Silver","98185MI018",,"MIN003","MIS005","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180007-06","94% AV Level Silver Plan","94.60%","0.950954675674438","Yes","Yes","No","100%",,"$175","$0","$320","$150","$175","$190","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/partnered-hmo.html?costshare=94","26"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180008","Blue Cross® Select Gold","98185MI018",,"MIN006","MIS004","MIF020","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180008-00","Standard Gold Off Exchange Plan","79.56%","0.826290130615234","Yes","Yes","No","100%",,"$250","$510","$960","$150","$250","$340","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-gold-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/select-hmo.html","27"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180013","Blue Cross® Partnered Silver Saver","98185MI018",,"MIN003","MIS005","MIF020","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-saver-na-less-than-300-sbc.pdf","55"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180013","Blue Cross® Partnered Silver Saver","98185MI018",,"MIN003","MIS005","MIF020","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180013-03","Limited Cost Sharing Plan Variation","68.52%","0.658152222633362","Yes","Yes","No","100%",,"$4,000","$10","$820","$150","$4,000","$80","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-saver-na-more-than-300-sbc.pdf","56"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180013","Blue Cross® Partnered Silver Saver","98185MI018",,"MIN003","MIS005","MIF020","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180013-04","73% AV Level Silver Plan","72.87%","0.718701779842377","Yes","Yes","No","100%",,"$1,800","$10","$1,480","$150","$1,800","$270","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-saver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/partnered-hmo-saver.html?costshare=73","57"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180013","Blue Cross® Partnered Silver Saver","98185MI018",,"MIN003","MIS005","MIF020","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180013-05","87% AV Level Silver Plan","87.60%","0.875917434692383","Yes","Yes","No","100%",,"$600","$10","$610","$150","$600","$440","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-saver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/partnered-hmo-saver.html?costshare=87","58"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180008","Blue Cross® Select Gold","98185MI018",,"MIN006","MIS004","MIF020","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180008-01","Standard Gold On Exchange Plan","79.56%","0.826290130615234","Yes","Yes","No","100%",,"$250","$510","$960","$150","$250","$340","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-gold-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/select-hmo.html","28"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180008","Blue Cross® Select Gold","98185MI018",,"MIN006","MIS004","MIF020","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-gold-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-gold-na-less-than-300-sbc.pdf","29"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180008","Blue Cross® Select Gold","98185MI018",,"MIN006","MIS004","MIF020","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180008-03","Limited Cost Sharing Plan Variation","79.56%","0.826290130615234","Yes","Yes","No","100%",,"$250","$510","$960","$150","$250","$340","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-gold-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-gold-na-more-than-300-sbc.pdf","30"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180009","Blue Cross® Preferred Gold","98185MI018",,"MIN005","MIS003","MIF020","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180009-00","Standard Gold Off Exchange Plan","79.56%","0.826290130615234","Yes","Yes","No","100%",,"$250","$510","$960","$150","$250","$340","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-gold-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/preferred-hmo.html","31"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180009","Blue Cross® Preferred Gold","98185MI018",,"MIN005","MIS003","MIF020","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180009-01","Standard Gold On Exchange Plan","79.56%","0.826290130615234","Yes","Yes","No","100%",,"$250","$510","$960","$150","$250","$340","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-gold-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/preferred-hmo.html","32"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180009","Blue Cross® Preferred Gold","98185MI018",,"MIN005","MIS003","MIF020","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-gold-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-gold-na-less-than-300-sbc.pdf","33"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180009","Blue Cross® Preferred Gold","98185MI018",,"MIN005","MIS003","MIF020","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180009-03","Limited Cost Sharing Plan Variation","79.56%","0.826290130615234","Yes","Yes","No","100%",,"$250","$510","$960","$150","$250","$340","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-gold-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-gold-na-more-than-300-sbc.pdf","34"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180010","Blue Cross® Partnered Gold","98185MI018",,"MIN003","MIS005","MIF020","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180010-00","Standard Gold Off Exchange Plan","79.56%","0.826290130615234","Yes","Yes","No","100%",,"$250","$510","$960","$150","$250","$340","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-gold-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/preferred-hmo.html","35"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180010","Blue Cross® Partnered Gold","98185MI018",,"MIN003","MIS005","MIF020","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180010-01","Standard Gold On Exchange Plan","79.56%","0.826290130615234","Yes","Yes","No","100%",,"$250","$510","$960","$150","$250","$340","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-gold-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/preferred-hmo.html","36"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180010","Blue Cross® Partnered Gold","98185MI018",,"MIN003","MIS005","MIF020","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-gold-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-gold-na-less-than-300-sbc.pdf","37"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180010","Blue Cross® Partnered Gold","98185MI018",,"MIN003","MIS005","MIF020","Existing","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180010-03","Limited Cost Sharing Plan Variation","79.56%","0.826290130615234","Yes","Yes","No","100%",,"$250","$510","$960","$150","$250","$340","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-gold-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-gold-na-more-than-300-sbc.pdf","38"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180011","Blue Cross® Metro Detroit HMO Silver","98185MI018",,"MIN004","MIS006","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180011-00","Standard Silver Off Exchange Plan","70.14%","0.703754901885986","Yes","Yes","No","100%",,"$1,650","$510","$1,020","$150","$1,650","$290","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-hmo.html","39"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180011","Blue Cross® Metro Detroit HMO Silver","98185MI018",,"MIN004","MIS006","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180011-01","Standard Silver On Exchange Plan","70.14%","0.703754901885986","Yes","Yes","No","100%",,"$1,650","$510","$1,020","$150","$1,650","$290","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-hmo.html","40"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180011","Blue Cross® Metro Detroit HMO Silver","98185MI018",,"MIN004","MIS006","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-na-less-than-300-sbc.pdf","41"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180011","Blue Cross® Metro Detroit HMO Silver","98185MI018",,"MIN004","MIS006","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180011-03","Limited Cost Sharing Plan Variation","70.14%","0.703754901885986","Yes","Yes","No","100%",,"$1,650","$510","$1,020","$150","$1,650","$290","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-na-more-than-300-sbc.pdf","42"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180011","Blue Cross® Metro Detroit HMO Silver","98185MI018",,"MIN004","MIS006","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180011-04","73% AV Level Silver Plan","73.84%","0.740071356296539","Yes","Yes","No","100%",,"$1,450","$510","$1,080","$150","$1,450","$290","$310","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-hmo.html?costshare=73","43"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180011","Blue Cross® Metro Detroit HMO Silver","98185MI018",,"MIN004","MIS006","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180011-05","87% AV Level Silver Plan","87.44%","0.885320425033569","Yes","Yes","No","100%",,"$450","$510","$460","$150","$450","$340","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-hmo.html?costshare=87","44"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180011","Blue Cross® Metro Detroit HMO Silver","98185MI018",,"MIN004","MIS006","MIF020","Existing","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180011-06","94% AV Level Silver Plan","94.60%","0.950954675674438","Yes","Yes","No","100%",,"$175","$0","$320","$150","$175","$190","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-hmo.html?costshare=94","45"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180012","Blue Cross® Select Silver Saver","98185MI018",,"MIN006","MIS004","MIF020","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180012-00","Standard Silver Off Exchange Plan","68.52%","0.658152222633362","Yes","Yes","No","100%",,"$4,000","$10","$820","$150","$4,000","$80","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/select-hmo-saver.html","46"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180012","Blue Cross® Select Silver Saver","98185MI018",,"MIN006","MIS004","MIF020","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180012-01","Standard Silver On Exchange Plan","68.52%","0.658152222633362","Yes","Yes","No","100%",,"$4,000","$10","$820","$150","$4,000","$80","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/select-hmo-saver.html","47"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180012","Blue Cross® Select Silver Saver","98185MI018",,"MIN006","MIS004","MIF020","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-saver-na-less-than-300-sbc.pdf","48"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180012","Blue Cross® Select Silver Saver","98185MI018",,"MIN006","MIS004","MIF020","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180012-03","Limited Cost Sharing Plan Variation","68.52%","0.658152222633362","Yes","Yes","No","100%",,"$4,000","$10","$820","$150","$4,000","$80","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-saver-na-more-than-300-sbc.pdf","49"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440005","Blue Cross® Metro Detroit HMO Bronze","98185MI044",,"MIN004","MIS006","MIF020","Existing","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-bronze-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-bronze-na-less-than-300-sbc.pdf","18"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440005","Blue Cross® Metro Detroit HMO Bronze","98185MI044",,"MIN004","MIS006","MIF020","Existing","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440005-03","Limited Cost Sharing Plan Variation","61.24%","0.609258055686951","Yes","Yes","No","100%",,"$5,950","$140","$0","$150","$5,260","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-bronze-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-bronze-na-more-than-300-sbc.pdf","19"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440006","Blue Cross® Select Bronze Saver","98185MI044",,"MIN006","MIS004","MIF020","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440006-00","Standard Bronze Off Exchange Plan","60.26%","0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/select-hmo-saver.html","20"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440006","Blue Cross® Select Bronze Saver","98185MI044",,"MIN006","MIS004","MIF020","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440006-01","Standard Bronze On Exchange Plan","60.26%","0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/select-hmo-saver.html","21"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180012","Blue Cross® Select Silver Saver","98185MI018",,"MIN006","MIS004","MIF020","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180012-04","73% AV Level Silver Plan","72.87%","0.718701779842377","Yes","Yes","No","100%",,"$1,800","$10","$1,480","$150","$1,800","$270","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-saver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/select-hmo-saver.html?costshare=73","50"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180012","Blue Cross® Select Silver Saver","98185MI018",,"MIN006","MIS004","MIF020","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180012-05","87% AV Level Silver Plan","87.60%","0.875917434692383","Yes","Yes","No","100%",,"$600","$10","$610","$150","$600","$440","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-saver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/select-hmo-saver.html?costshare=87","51"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180012","Blue Cross® Select Silver Saver","98185MI018",,"MIN006","MIS004","MIF020","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180012-06","94% AV Level Silver Plan","93.43%","0.935514569282532","Yes","Yes","No","100%",,"$180","$0","$330","$150","$180","$130","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-silver-saver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/select-hmo-saver.html?costshare=94","52"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180013","Blue Cross® Partnered Silver Saver","98185MI018",,"MIN003","MIS005","MIF020","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180013-00","Standard Silver Off Exchange Plan","68.52%","0.658152222633362","Yes","Yes","No","100%",,"$4,000","$10","$820","$150","$4,000","$80","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/partnered-hmo-saver.html","53"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180013","Blue Cross® Partnered Silver Saver","98185MI018",,"MIN003","MIS005","MIF020","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180013-01","Standard Silver On Exchange Plan","68.52%","0.658152222633362","Yes","Yes","No","100%",,"$4,000","$10","$820","$150","$4,000","$80","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/partnered-hmo-saver.html","54"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180013","Blue Cross® Partnered Silver Saver","98185MI018",,"MIN003","MIS005","MIF020","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180013-06","94% AV Level Silver Plan","93.43%","0.935514569282532","Yes","Yes","No","100%",,"$180","$0","$330","$150","$180","$130","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-silver-saver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/partnered-hmo-saver.html?costshare=94","59"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180014","Blue Cross® Metro Detroit HMO Silver Saver","98185MI018",,"MIN004","MIS006","MIF020","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180014-00","Standard Silver Off Exchange Plan","68.52%","0.658152222633362","Yes","Yes","No","100%",,"$4,000","$10","$820","$150","$4,000","$80","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-hmo-saver.html","60"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180014","Blue Cross® Metro Detroit HMO Silver Saver","98185MI018",,"MIN004","MIS006","MIF020","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180014-01","Standard Silver On Exchange Plan","68.52%","0.658152222633362","Yes","Yes","No","100%",,"$4,000","$10","$820","$150","$4,000","$80","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-hmo-saver.html","61"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180014","Blue Cross® Metro Detroit HMO Silver Saver","98185MI018",,"MIN004","MIS006","MIF020","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180014-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-saver-na-less-than-300-sbc.pdf","62"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180014","Blue Cross® Metro Detroit HMO Silver Saver","98185MI018",,"MIN004","MIS006","MIF020","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180014-03","Limited Cost Sharing Plan Variation","68.52%","0.658152222633362","Yes","Yes","No","100%",,"$4,000","$10","$820","$150","$4,000","$80","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-saver-na-more-than-300-sbc.pdf","63"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180014","Blue Cross® Metro Detroit HMO Silver Saver","98185MI018",,"MIN004","MIS006","MIF020","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180014-04","73% AV Level Silver Plan","72.87%","0.718701779842377","Yes","Yes","No","100%",,"$1,800","$10","$1,480","$150","$1,800","$270","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-saver-73-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-hmo-saver.html?costshare=73","64"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180014","Blue Cross® Metro Detroit HMO Silver Saver","98185MI018",,"MIN004","MIS006","MIF020","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180014-05","87% AV Level Silver Plan","87.60%","0.875917434692383","Yes","Yes","No","100%",,"$600","$10","$610","$150","$600","$440","$460","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-saver-87-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-hmo-saver.html?costshare=87","65"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","2","98185","MI","Individual","No","38-2359234","98185MI0180014","Blue Cross® Metro Detroit HMO Silver Saver","98185MI018",,"MIN004","MIS006","MIF020","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0180014-06","94% AV Level Silver Plan","93.43%","0.935514569282532","Yes","Yes","No","100%",,"$180","$0","$330","$150","$180","$130","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-silver-saver-94-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/silver/metro-detroit-hmo-saver.html?costshare=94","66"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440001","Blue Cross® Select Bronze","98185MI044",,"MIN006","MIS004","MIF020","Existing","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440001-00","Standard Bronze Off Exchange Plan","61.24%","0.609258055686951","Yes","Yes","No","100%",,"$5,950","$140","$0","$150","$5,260","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/select-hmo.html","4"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440001","Blue Cross® Select Bronze","98185MI044",,"MIN006","MIS004","MIF020","Existing","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440001-01","Standard Bronze On Exchange Plan","61.24%","0.609258055686951","Yes","Yes","No","100%",,"$5,950","$140","$0","$150","$5,260","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/select-hmo.html","5"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440001","Blue Cross® Select Bronze","98185MI044",,"MIN006","MIS004","MIF020","Existing","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-bronze-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-bronze-na-less-than-300-sbc.pdf","6"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440001","Blue Cross® Select Bronze","98185MI044",,"MIN006","MIS004","MIF020","Existing","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440001-03","Limited Cost Sharing Plan Variation","61.24%","0.609258055686951","Yes","Yes","No","100%",,"$5,950","$140","$0","$150","$5,260","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-bronze-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-bronze-na-more-than-300-sbc.pdf","7"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440002","Blue Cross® Preferred Bronze","98185MI044",,"MIN005","MIS001","MIF020","Existing","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440002-00","Standard Bronze Off Exchange Plan","61.24%","0.609258055686951","Yes","Yes","No","100%",,"$5,950","$140","$0","$150","$5,260","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/preferred-hmo.html","8"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440002","Blue Cross® Preferred Bronze","98185MI044",,"MIN005","MIS001","MIF020","Existing","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440002-01","Standard Bronze On Exchange Plan","61.24%","0.609258055686951","Yes","Yes","No","100%",,"$5,950","$140","$0","$150","$5,260","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/preferred-hmo.html","9"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440002","Blue Cross® Preferred Bronze","98185MI044",,"MIN005","MIS001","MIF020","Existing","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-bronze-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-bronze-na-less-than-300-sbc.pdf","10"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440002","Blue Cross® Preferred Bronze","98185MI044",,"MIN005","MIS001","MIF020","Existing","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440002-03","Limited Cost Sharing Plan Variation","61.24%","0.609258055686951","Yes","Yes","No","100%",,"$5,950","$140","$0","$150","$5,260","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-bronze-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/preferred-bronze-na-more-than-300-sbc.pdf","11"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440004","Blue Cross® Partnered Bronze","98185MI044",,"MIN003","MIS005","MIF020","Existing","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440004-00","Standard Bronze Off Exchange Plan","61.24%","0.609258055686951","Yes","Yes","No","100%",,"$5,950","$140","$0","$150","$5,260","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/partnered-hmo.html","12"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440004","Blue Cross® Partnered Bronze","98185MI044",,"MIN003","MIS005","MIF020","Existing","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440004-01","Standard Bronze On Exchange Plan","61.24%","0.609258055686951","Yes","Yes","No","100%",,"$5,950","$140","$0","$150","$5,260","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/partnered-hmo.html","13"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440004","Blue Cross® Partnered Bronze","98185MI044",,"MIN003","MIS005","MIF020","Existing","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-bronze-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-bronze-na-less-than-300-sbc.pdf","14"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440004","Blue Cross® Partnered Bronze","98185MI044",,"MIN003","MIS005","MIF020","Existing","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440004-03","Limited Cost Sharing Plan Variation","61.24%","0.609258055686951","Yes","Yes","No","100%",,"$5,950","$140","$0","$150","$5,260","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-bronze-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-bronze-na-more-than-300-sbc.pdf","15"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440005","Blue Cross® Metro Detroit HMO Bronze","98185MI044",,"MIN004","MIS006","MIF020","Existing","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440005-00","Standard Bronze Off Exchange Plan","61.24%","0.609258055686951","Yes","Yes","No","100%",,"$5,950","$140","$0","$150","$5,260","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/metro-detroit-hmo.html","16"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440005","Blue Cross® Metro Detroit HMO Bronze","98185MI044",,"MIN004","MIS006","MIF020","Existing","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440005-01","Standard Bronze On Exchange Plan","61.24%","0.609258055686951","Yes","Yes","No","100%",,"$5,950","$140","$0","$150","$5,260","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-bronze-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/metro-detroit-hmo.html","17"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440006","Blue Cross® Select Bronze Saver","98185MI044",,"MIN006","MIS004","MIF020","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-bronze-saver-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-bronze-saver-less-than-300-sbc.pdf","22"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440006","Blue Cross® Select Bronze Saver","98185MI044",,"MIN006","MIS004","MIF020","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440006-03","Limited Cost Sharing Plan Variation","60.26%","0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-bronze-saver-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/select-bronze-saver-more-than-300-sbc.pdf","23"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440007","Blue Cross® Partnered Bronze Saver","98185MI044",,"MIN003","MIS005","MIF020","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440007-00","Standard Bronze Off Exchange Plan","60.26%","0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/partnered-hmo-saver.html","24"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440007","Blue Cross® Partnered Bronze Saver","98185MI044",,"MIN003","MIS005","MIF020","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440007-01","Standard Bronze On Exchange Plan","60.26%","0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/partnered-hmo-saver.html","25"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440007","Blue Cross® Partnered Bronze Saver","98185MI044",,"MIN003","MIS005","MIF020","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-bronze-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-bronze-saver-na-less-than-300-sbc.pdf","26"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440007","Blue Cross® Partnered Bronze Saver","98185MI044",,"MIN003","MIS005","MIF020","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440007-03","Limited Cost Sharing Plan Variation","60.26%","0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-bronze-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/partnered-bronze-saver-na-more-than-300-sbc.pdf","27"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440008","Blue Cross® Metro Detroit HMO Bronze Saver","98185MI044",,"MIN004","MIS006","MIF020","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440008-00","Standard Bronze Off Exchange Plan","60.26%","0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/metro-detroit-hmo-saver.html","28"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440008","Blue Cross® Metro Detroit HMO Bronze Saver","98185MI044",,"MIN004","MIS006","MIF020","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440008-01","Standard Bronze On Exchange Plan","60.26%","0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-bronze-saver-sbc.pdf","http://www.bcbsm.com/index/plans/michigan-health-insurance/bronze/metro-detroit-hmo-saver.html","29"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440008","Blue Cross® Metro Detroit HMO Bronze Saver","98185MI044",,"MIN004","MIS006","MIF020","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-bronze-saver-na-less-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-bronze-saver-na-less-than-300-sbc.pdf","30"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","3","98185","MI","Individual","No","38-2359234","98185MI0440008","Blue Cross® Metro Detroit HMO Bronze Saver","98185MI044",,"MIN004","MIS006","MIF020","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$300","1","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://paymentgateway.bcbsm.com/gateway/bcncmsinbound.do","http://www.bcbsm.com/customselectdruglist","98185MI0440008-03","Limited Cost Sharing Plan Variation","60.26%","0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-bronze-saver-na-more-than-300-sbc.pdf","http://www.bcbsm.com/content/dam/public/marketplace/2016-individual/sbc/metro-detroit-hmo-bronze-saver-na-more-than-300-sbc.pdf","31"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","19","98185","MI","SHOP (Small Group)","No","38-2359234","98185MI0160011","BCN HSA Bronze $4500 ($0)","98185MI016","7457354687","MIN001","MIS001","MIF003","Existing","HMO","Bronze","Yes","Both","No","Yes","All except for routine OB/GYN, behavioral health, and pediatric visits","Out-of-network services",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergent care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/customselectdruglist","98185MI0160011-00","Standard Bronze Off Exchange Plan","61.92%","0.618595957756042","Yes","Yes","No","100%",,"$4,500","$20","$830","$150","$2,420","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2016-employer/sbc/bcn-hsa-bronze-160011.pdf","http://www.bcbsm.com/employer-hmo-plan-brochures","9"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","19","98185","MI","SHOP (Small Group)","No","38-2359234","98185MI0160011","BCN HSA Bronze $4500 ($0)","98185MI016","7457354687","MIN001","MIS001","MIF003","Existing","HMO","Bronze","Yes","Both","No","Yes","All except for routine OB/GYN, behavioral health, and pediatric visits","Out-of-network services",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergent care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/customselectdruglist","98185MI0160011-01","Standard Bronze On Exchange Plan","61.92%","0.618595957756042","Yes","Yes","No","100%",,"$4,500","$20","$830","$150","$2,420","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2016-employer/sbc/bcn-hsa-bronze-160011.pdf","http://www.bcbsm.com/employer-hmo-plan-brochures","10"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","19","98185","MI","SHOP (Small Group)","No","38-2359234","98185MI0160007","BCN HSA Bronze $6350 ($0)","98185MI016","7457354687","MIN001","MIS001","MIF013","Existing","HMO","Bronze","Yes","Both","No","Yes","All except for routine OB/GYN, behavioral health, and pediatric visits","Out-of-network services",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergent care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/customselectdruglist","98185MI0160007-00","Standard Bronze Off Exchange Plan","60.58%","0.605813801288605","Yes","Yes","No","100%",,"$6,350","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2016-employer/sbc/bcn-hsa-bronze-160007.pdf","http://www.bcbsm.com/employer-hmo-plan-brochures","12"
"2016","MI","98185","SERFF","5","2016-01-28 08:29:40","19","98185","MI","SHOP (Small Group)","No","38-2359234","98185MI0160007","BCN HSA Bronze $6350 ($0)","98185MI016","7457354687","MIN001","MIS001","MIF013","Existing","HMO","Bronze","Yes","Both","No","Yes","All except for routine OB/GYN, behavioral health, and pediatric visits","Out-of-network services",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergent care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/customselectdruglist","98185MI0160007-01","Standard Bronze On Exchange Plan","60.58%","0.605813801288605","Yes","Yes","No","100%",,"$6,350","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsm.com/content/dam/public/marketplace/2016-employer/sbc/bcn-hsa-bronze-160007.pdf","http://www.bcbsm.com/employer-hmo-plan-brochures","13"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","1","23603","MT","Individual","No","93-0245545","23603MT0140003","PSN Catastrophic","23603MT014",,"MTN001","MTS001","MTF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","3","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0140003-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/catastrophic","http://www.PacificSource.com/montana/individual-brochure-2016","4"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","1","23603","MT","Individual","Yes","93-0245545","23603MT0260001","Dental Choice 0-20-50","23603MT026",,"MTN003","MTS002",,"Existing","Indemnity","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider.","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","","23603MT0260001-00","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/montana/individual-dental-brochure-2016","4"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","1","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0170013","PSN Value Bronze 6450","23603MT017",,"MTN001","MTS001","MTF002","Existing","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0170013-00","Standard Bronze Off Exchange Plan",,"0.602554976940155","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.PacificSource.com/montana/sg-psn-vb-6450","http://www.PacificSource.com/montana/small-group-brochure-2016","4"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","1","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0200002","Dental Choice Core","23603MT020",,"MTN003","MTS002",,"Existing","Indemnity","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0200002-00","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/montana/small-group-dental-brochure-2016","4"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","1","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0200002","Dental Choice Core","23603MT020",,"MTN003","MTS002",,"Existing","Indemnity","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0200002-01","Standard High On Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/montana/small-group-dental-brochure-2016","5"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","1","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0170013","PSN Value Bronze 6450","23603MT017",,"MTN001","MTS001","MTF002","Existing","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0170013-01","Standard Bronze On Exchange Plan",,"0.602554976940155","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.PacificSource.com/montana/sg-psn-vb-6450","http://www.PacificSource.com/montana/small-group-brochure-2016","5"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","1","23603","MT","Individual","Yes","93-0245545","23603MT0260001","Dental Choice 0-20-50","23603MT026",,"MTN003","MTS002",,"Existing","Indemnity","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider.","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","","23603MT0260001-01","Standard High On Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/montana/individual-dental-brochure-2016","5"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","1","23603","MT","Individual","No","93-0245545","23603MT0140003","PSN Catastrophic","23603MT014",,"MTN001","MTS001","MTF002","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","3","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0140003-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/catastrophic","http://www.PacificSource.com/montana/individual-brochure-2016","5"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","1","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0170014","SmartHealth Value Bronze 6450","23603MT017",,"MTN002","MTS001","MTF002","Existing","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0170014-00","Standard Bronze Off Exchange Plan",,"0.602554976940155","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.PacificSource.com/montana/sg-sh-vb-6450","http://www.PacificSource.com/montana/small-group-brochure-2016","6"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","1","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0170014","SmartHealth Value Bronze 6450","23603MT017",,"MTN002","MTS001","MTF002","Existing","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0170014-01","Standard Bronze On Exchange Plan",,"0.602554976940155","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.PacificSource.com/montana/sg-sh-vb-6450","http://www.PacificSource.com/montana/small-group-brochure-2016","7"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","1","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0170004","PSN Value Bronze 3500","23603MT017",,"MTN001","MTS001","MTF003","Existing","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0170004-00","Standard Bronze Off Exchange Plan",,"0.618300318717957","Yes","Yes","No","100%",,"$3,500","$0","$1,890","$150","$3,500","$0","$890","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.PacificSource.com/montana/sg-psn-vb-3500","http://www.PacificSource.com/montana/small-group-brochure-2016","8"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","1","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0170004","PSN Value Bronze 3500","23603MT017",,"MTN001","MTS001","MTF003","Existing","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0170004-01","Standard Bronze On Exchange Plan",,"0.618300318717957","Yes","Yes","No","100%",,"$3,500","$0","$1,890","$150","$3,500","$0","$890","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.PacificSource.com/montana/sg-psn-vb-3500","http://www.PacificSource.com/montana/small-group-brochure-2016","9"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","1","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0170007","SmartHealth Value Bronze 3500","23603MT017",,"MTN002","MTS001","MTF003","Existing","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0170007-00","Standard Bronze Off Exchange Plan",,"0.618300318717957","Yes","Yes","No","100%",,"$3,500","$0","$1,890","$150","$3,500","$0","$890","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.PacificSource.com/montana/sg-sh-vb-3500","http://www.PacificSource.com/montana/small-group-brochure-2016","10"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","1","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0170007","SmartHealth Value Bronze 3500","23603MT017",,"MTN002","MTS001","MTF003","Existing","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0170007-01","Standard Bronze On Exchange Plan",,"0.618300318717957","Yes","Yes","No","100%",,"$3,500","$0","$1,890","$150","$3,500","$0","$890","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.PacificSource.com/montana/sg-sh-vb-3500","http://www.PacificSource.com/montana/small-group-brochure-2016","11"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","1","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0170005","PSN Value Silver 3600","23603MT017",,"MTN001","MTS001","MTF002","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0170005-00","Standard Silver Off Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.PacificSource.com/montana/sg-psn-vs-3600","http://www.PacificSource.com/montana/small-group-brochure-2016","12"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","1","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0170005","PSN Value Silver 3600","23603MT017",,"MTN001","MTS001","MTF002","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0170005-01","Standard Silver On Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.PacificSource.com/montana/sg-psn-vs-3600","http://www.PacificSource.com/montana/small-group-brochure-2016","13"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","1","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0170008","SmartHealth Value Silver 3600","23603MT017",,"MTN002","MTS001","MTF002","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0170008-00","Standard Silver Off Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.PacificSource.com/montana/sg-sh-vs-3600","http://www.PacificSource.com/montana/small-group-brochure-2016","14"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","1","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0170008","SmartHealth Value Silver 3600","23603MT017",,"MTN002","MTS001","MTF002","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0170008-01","Standard Silver On Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.PacificSource.com/montana/sg-sh-vs-3600","http://www.PacificSource.com/montana/small-group-brochure-2016","15"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","Yes","93-0245545","23603MT0190001","Kids Dental Choice 20-40-50","23603MT019",,"MTN003","MTS002",,"Existing","Indemnity","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$30.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider.","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","","23603MT0190001-00","Standard Low Off Exchange Plan","68.18%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/montana/individual-dental-brochure-2016","4"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180030","PSN Balance Bronze 6850","23603MT018",,"MTN001","MTS001","MTF002","New","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","10","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180030-00","Standard Bronze Off Exchange Plan",,"0.615983009338379","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-psn-bb-6850","http://www.PacificSource.com/montana/small-group-brochure-2016","4"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150009","PSN Value Bronze 6450","23603MT015",,"MTN001","MTS001","MTF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150009-00","Standard Bronze Off Exchange Plan",,"0.602554976940155","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/montana/ind-psn-vb-6450","http://www.PacificSource.com/montana/individual-brochure-2016","4"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0200001","Dental Choice 0-20-50 750","23603MT020",,"MTN003","MTS002",,"Existing","Indemnity","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0200001-00","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/montana/small-group-dental-brochure-2016","4"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","Individual","No","93-0245545","23603MT0160011","PSN Balance Bronze 6850","23603MT016",,"MTN001","MTS001","MTF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","10","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160011-03","Limited Cost Sharing Plan Variation",,"0.615983009338379","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-psn-bb-6850-ai","http://www.PacificSource.com/montana/individual-brochure-2016-ai","11"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180032","PSN Balance Gold 1000","23603MT018",,"MTN001","MTS001","MTF006","New","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-llist/","23603MT0180032-00","Standard Gold Off Exchange Plan",,"0.813772678375244","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-psn-bg-1000","http://www.PacificSource.com/montana/small-group-brochure-2016","12"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180032","PSN Balance Gold 1000","23603MT018",,"MTN001","MTS001","MTF006","New","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-llist/","23603MT0180032-01","Standard Gold On Exchange Plan",,"0.813772678375244","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-psn-bg-1000","http://www.PacificSource.com/montana/small-group-brochure-2016","13"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180021","SmartHealth Balance Gold 1000","23603MT018",,"MTN002","MTS001","MTF006","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-llist/","23603MT0180021-00","Standard Gold Off Exchange Plan",,"0.813772678375244","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-sh-bg-1000","http://www.PacificSource.com/montana/small-group-brochure-2016","14"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180021","SmartHealth Balance Gold 1000","23603MT018",,"MTN002","MTS001","MTF006","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-llist/","23603MT0180021-01","Standard Gold On Exchange Plan",,"0.813772678375244","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-sh-bg-1000","http://www.PacificSource.com/montana/small-group-brochure-2016","15"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180034","PSN Balance Platinum 500","23603MT018",,"MTN001","MTS001","MTF006","New","PPO","Platinum","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-llist/","23603MT0180034-00","Standard Platinum Off Exchange Plan",,"0.882772624492645","Yes","Yes","No","100%",,"$500","$0","$1,000","$150","$500","$530","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-psn-bp-500","http://www.PacificSource.com/montana/small-group-brochure-2016","16"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180034","PSN Balance Platinum 500","23603MT018",,"MTN001","MTS001","MTF006","New","PPO","Platinum","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-llist/","23603MT0180034-01","Standard Platinum On Exchange Plan",,"0.882772624492645","Yes","Yes","No","100%",,"$500","$0","$1,000","$150","$500","$530","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-psn-bp-500","http://www.PacificSource.com/montana/small-group-brochure-2016","17"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180006","PSN Balance Silver 2500 VH","23603MT018",,"MTN001","MTS001","MTF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9768",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180006-00","Standard Silver Off Exchange Plan",,"0.70991724729538","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-psn-bs-2500-vh","http://www.PacificSource.com/montana/small-group-brochure-2016","4"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0200001","Dental Choice 0-20-50 750","23603MT020",,"MTN003","MTS002",,"Existing","Indemnity","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0200001-01","Standard High On Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/montana/small-group-dental-brochure-2016","5"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150009","PSN Value Bronze 6450","23603MT015",,"MTN001","MTS001","MTF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150009-01","Standard Bronze On Exchange Plan",,"0.602554976940155","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/montana/ind-psn-vb-6450","http://www.PacificSource.com/montana/individual-brochure-2016","5"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180030","PSN Balance Bronze 6850","23603MT018",,"MTN001","MTS001","MTF002","New","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","10","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180030-01","Standard Bronze On Exchange Plan",,"0.615983009338379","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-psn-bb-6850","http://www.PacificSource.com/montana/small-group-brochure-2016","5"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","Yes","93-0245545","23603MT0190002","Kids Dental Choice 0-20-50","23603MT019",,"MTN003","MTS002",,"Existing","Indemnity","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$36.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider.","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","","23603MT0190002-00","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/montana/individual-dental-brochure-2016","5"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","Yes","93-0245545","23603MT0190002","Kids Dental Choice 0-20-50","23603MT019",,"MTN003","MTS002",,"Existing","Indemnity","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$36.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider.","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","","23603MT0190002-01","Standard High On Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/montana/individual-dental-brochure-2016","6"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180010","SmartHealth Balance Bronze 6850","23603MT018",,"MTN002","MTS001","MTF002","Existing","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","10","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180010-00","Standard Bronze Off Exchange Plan",,"0.615983009338379","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-sh-bb-6850","http://www.PacificSource.com/montana/small-group-brochure-2016","6"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150009","PSN Value Bronze 6450","23603MT015",,"MTN001","MTS001","MTF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-psn-vb-6450-0","http://www.PacificSource.com/montana/individual-brochure-2016-ai","6"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150009","PSN Value Bronze 6450","23603MT015",,"MTN001","MTS001","MTF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150009-03","Limited Cost Sharing Plan Variation",,"0.602554976940155","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/montana/ind-psn-vb-6450-ai","http://www.PacificSource.com/montana/individual-brochure-2016-ai","7"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180010","SmartHealth Balance Bronze 6850","23603MT018",,"MTN002","MTS001","MTF002","Existing","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","10","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180010-01","Standard Bronze On Exchange Plan",,"0.615983009338379","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-sh-bb-6850","http://www.PacificSource.com/montana/small-group-brochure-2016","7"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150005","SmartHealth Value Bronze 6450","23603MT015",,"MTN002","MTS001","MTF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150005-00","Standard Bronze Off Exchange Plan",,"0.602554976940155","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/montana/ind-sh-vb-6450","http://www.PacificSource.com/montana/individual-brochure-2016","8"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150005","SmartHealth Value Bronze 6450","23603MT015",,"MTN002","MTS001","MTF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150005-01","Standard Bronze On Exchange Plan",,"0.602554976940155","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/montana/ind-sh-vb-6450","http://www.PacificSource.com/montana/individual-brochure-2016","9"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150005","SmartHealth Value Bronze 6450","23603MT015",,"MTN002","MTS001","MTF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-sh-vb-6450-0","http://www.PacificSource.com/montana/individual-brochure-2016-ai","10"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150005","SmartHealth Value Bronze 6450","23603MT015",,"MTN002","MTS001","MTF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150005-03","Limited Cost Sharing Plan Variation",,"0.602554976940155","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/montana/ind-sh-vb-6450-ai","http://www.PacificSource.com/montana/individual-brochure-2016-ai","11"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150007","SmartHealth Value Silver 3600","23603MT015",,"MTN002","MTS001","MTF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150007-00","Standard Silver Off Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/montana/ind-sh-vs-3600","http://www.PacificSource.com/montana/individual-brochure-2016","12"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150007","SmartHealth Value Silver 3600","23603MT015",,"MTN002","MTS001","MTF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150007-01","Standard Silver On Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/montana/ind-sh-vs-3600","http://www.PacificSource.com/montana/individual-brochure-2016","13"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150007","SmartHealth Value Silver 3600","23603MT015",,"MTN002","MTS001","MTF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-sh-vs-3600-0","http://www.PacificSource.com/montana/individual-brochure-2016-ai","14"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150007","SmartHealth Value Silver 3600","23603MT015",,"MTN002","MTS001","MTF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150007-03","Limited Cost Sharing Plan Variation",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/montana/ind-sh-vs-3600-ai","http://www.PacificSource.com/montana/individual-brochure-2016-ai","15"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150007","SmartHealth Value Silver 3600","23603MT015",,"MTN002","MTS001","MTF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150007-04","73% AV Level Silver Plan",,"0.727658689022064","Yes","Yes","No","100%",,"$3,200","$0","$0","$150","$3,200","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","0%",,,,,"$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-sh-vs-3600-73","http://www.PacificSource.com/montana/individual-brochure-2016","16"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150007","SmartHealth Value Silver 3600","23603MT015",,"MTN002","MTS001","MTF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150007-05","87% AV Level Silver Plan",,"0.870122313499451","Yes","Yes","No","100%",,"$1,200","$0","$0","$150","$1,200","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","0%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-sh-vs-3600-87","http://www.PacificSource.com/montana/individual-brochure-2016","17"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150007","SmartHealth Value Silver 3600","23603MT015",,"MTN002","MTS001","MTF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150007-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$150","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-sh-vs-3600-94","http://www.PacificSource.com/montana/individual-brochure-2016","18"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150010","PSN Value Silver 3600","23603MT015",,"MTN001","MTS001","MTF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150010-00","Standard Silver Off Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/montana/ind-psn-vs-3600","http://www.PacificSource.com/montana/individual-brochure-2016","19"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150010","PSN Value Silver 3600","23603MT015",,"MTN001","MTS001","MTF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150010-01","Standard Silver On Exchange Plan",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/montana/ind-psn-vs-3600","http://www.PacificSource.com/montana/individual-brochure-2016","20"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150010","PSN Value Silver 3600","23603MT015",,"MTN001","MTS001","MTF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-psn-vs-3600-0","http://www.PacificSource.com/montana/individual-brochure-2016-ai","21"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150010","PSN Value Silver 3600","23603MT015",,"MTN001","MTS001","MTF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150010-03","Limited Cost Sharing Plan Variation",,"0.706476628780365","Yes","Yes","No","100%",,"$3,600","$0","$0","$150","$3,600","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group","0%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/montana/ind-psn-vs-3600-ai","http://www.PacificSource.com/montana/individual-brochure-2016-ai","22"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150010","PSN Value Silver 3600","23603MT015",,"MTN001","MTS001","MTF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150010-04","73% AV Level Silver Plan",,"0.727658689022064","Yes","Yes","No","100%",,"$3,200","$0","$0","$150","$3,200","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group","0%",,,,,"$6,400","$6400 per person","$12800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-psn-vs-3600-73","http://www.PacificSource.com/montana/individual-brochure-2016","23"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150010","PSN Value Silver 3600","23603MT015",,"MTN001","MTS001","MTF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150010-05","87% AV Level Silver Plan",,"0.870122313499451","Yes","Yes","No","100%",,"$1,200","$0","$0","$150","$1,200","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","0%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-psn-vs-3600-87","http://www.PacificSource.com/montana/individual-brochure-2016","24"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150010","PSN Value Silver 3600","23603MT015",,"MTN001","MTS001","MTF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150010-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$150","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-psn-vs-3600-94","http://www.PacificSource.com/montana/individual-brochure-2016","25"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150006","SmartHealth Value Bronze 3500","23603MT015",,"MTN002","MTS001","MTF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150006-00","Standard Bronze Off Exchange Plan",,"0.618300318717957","Yes","Yes","No","100%",,"$3,500","$0","$1,890","$150","$3,500","$0","$890","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/montana/ind-sh-vb-3500","http://www.PacificSource.com/montana/individual-brochure-2016","26"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150006","SmartHealth Value Bronze 3500","23603MT015",,"MTN002","MTS001","MTF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150006-01","Standard Bronze On Exchange Plan",,"0.618300318717957","Yes","Yes","No","100%",,"$3,500","$0","$1,890","$150","$3,500","$0","$890","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/montana/ind-sh-vb-3500","http://www.PacificSource.com/montana/individual-brochure-2016","27"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150006","SmartHealth Value Bronze 3500","23603MT015",,"MTN002","MTS001","MTF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-sh-vb-3500-0","http://www.PacificSource.com/montana/individual-brochure-2016-ai","28"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150006","SmartHealth Value Bronze 3500","23603MT015",,"MTN002","MTS001","MTF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150006-03","Limited Cost Sharing Plan Variation",,"0.618300318717957","Yes","Yes","No","100%",,"$3,500","$0","$1,890","$150","$3,500","$0","$890","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/montana/ind-sh-vb-3500-ai","http://www.PacificSource.com/montana/individual-brochure-2016-ai","29"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150011","PSN Value Bronze 3500","23603MT015",,"MTN001","MTS001","MTF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150011-00","Standard Bronze Off Exchange Plan",,"0.618300318717957","Yes","Yes","No","100%",,"$3,500","$0","$1,890","$150","$3,500","$0","$890","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/montana/ind-psn-vb-3500","http://www.PacificSource.com/montana/individual-brochure-2016","30"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150011","PSN Value Bronze 3500","23603MT015",,"MTN001","MTS001","MTF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150011-01","Standard Bronze On Exchange Plan",,"0.618300318717957","Yes","Yes","No","100%",,"$3,500","$0","$1,890","$150","$3,500","$0","$890","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/montana/ind-psn-vb-3500","http://www.PacificSource.com/montana/individual-brochure-2016","31"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150011","PSN Value Bronze 3500","23603MT015",,"MTN001","MTS001","MTF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-psn-vb-3500-0","http://www.PacificSource.com/montana/individual-brochure-2016-ai","32"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","2","23603","MT","Individual","No","93-0245545","23603MT0150011","PSN Value Bronze 3500","23603MT015",,"MTN001","MTS001","MTF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0150011-03","Limited Cost Sharing Plan Variation",,"0.618300318717957","Yes","Yes","No","100%",,"$3,500","$0","$1,890","$150","$3,500","$0","$890","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/montana/ind-psn-vb-3500-ai","http://www.PacificSource.com/montana/individual-brochure-2016-ai","33"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","Individual","No","93-0245545","23603MT0160004","SmartHealth Balance Bronze 6850","23603MT016",,"MTN002","MTS001","MTF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","10","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160004-00","Standard Bronze Off Exchange Plan",,"0.615983009338379","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-sh-bb-6850","http://www.PacificSource.com/montana/individual-brochure-2016","4"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180033","PSN Balance Silver 2500","23603MT018",,"MTN001","MTS001","MTF004","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180033-00","Standard Silver Off Exchange Plan",,"0.70991724729538","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-psn-bs-2500","http://www.PacificSource.com/montana/small-group-brochure-2016","4"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0200009","Dental Choice 0-20-50 1000","23603MT020",,"MTN003","MTS002",,"New","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.94","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0200009-00","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/montana/small-group-dental-brochure-2016","4"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180033","PSN Balance Silver 2500","23603MT018",,"MTN001","MTS001","MTF004","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180033-01","Standard Silver On Exchange Plan",,"0.70991724729538","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-psn-bs-2500","http://www.PacificSource.com/montana/small-group-brochure-2016","5"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","Individual","No","93-0245545","23603MT0160004","SmartHealth Balance Bronze 6850","23603MT016",,"MTN002","MTS001","MTF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","10","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160004-01","Standard Bronze On Exchange Plan",,"0.615983009338379","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-sh-bb-6850","http://www.PacificSource.com/montana/individual-brochure-2016","5"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","Individual","No","93-0245545","23603MT0160004","SmartHealth Balance Bronze 6850","23603MT016",,"MTN002","MTS001","MTF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","10","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.PacificSource.com/montana/ind-sh-bb-6850-0","http://www.PacificSource.com/montana/individual-brochure-2016-ai","6"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180011","SmartHealth Balance Silver 2500","23603MT018",,"MTN002","MTS001","MTF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180011-00","Standard Silver Off Exchange Plan",,"0.70991724729538","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-sh-bs-2500","http://www.PacificSource.com/montana/small-group-brochure-2016","6"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180011","SmartHealth Balance Silver 2500","23603MT018",,"MTN002","MTS001","MTF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180011-01","Standard Silver On Exchange Plan",,"0.70991724729538","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-sh-bs-2500","http://www.PacificSource.com/montana/small-group-brochure-2016","7"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","Individual","No","93-0245545","23603MT0160004","SmartHealth Balance Bronze 6850","23603MT016",,"MTN002","MTS001","MTF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","10","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160004-03","Limited Cost Sharing Plan Variation",,"0.615983009338379","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-sh-bb-6850-ai","http://www.PacificSource.com/montana/individual-brochure-2016-ai","7"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","Individual","No","93-0245545","23603MT0160011","PSN Balance Bronze 6850","23603MT016",,"MTN001","MTS001","MTF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","10","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160011-00","Standard Bronze Off Exchange Plan",,"0.615983009338379","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-psn-bb-6850","http://www.PacificSource.com/montana/individual-brochure-2016","8"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180028","PSN Balance Silver 4000","23603MT018",,"MTN001","MTS001","MTF004","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180028-00","Standard Silver Off Exchange Plan",,"0.692033231258392","Yes","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$150","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-psn-bs-4000","http://www.PacificSource.com/montana/small-group-brochure-2016","8"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180028","PSN Balance Silver 4000","23603MT018",,"MTN001","MTS001","MTF004","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180028-01","Standard Silver On Exchange Plan",,"0.692033231258392","Yes","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$150","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-psn-bs-4000","http://www.PacificSource.com/montana/small-group-brochure-2016","9"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","Individual","No","93-0245545","23603MT0160011","PSN Balance Bronze 6850","23603MT016",,"MTN001","MTS001","MTF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","10","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160011-01","Standard Bronze On Exchange Plan",,"0.615983009338379","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-psn-bb-6850","http://www.PacificSource.com/montana/individual-brochure-2016","9"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","Individual","No","93-0245545","23603MT0160011","PSN Balance Bronze 6850","23603MT016",,"MTN001","MTS001","MTF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","10","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.PacificSource.com/montana/ind-psn-bb-6850-0","http://www.PacificSource.com/montana/individual-brochure-2016-ai","10"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180026","SmartHealth Balance Silver 4000","23603MT018",,"MTN002","MTS001","MTF004","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180026-00","Standard Silver Off Exchange Plan",,"0.692033231258392","Yes","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$150","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-sh-bs-4000","http://www.PacificSource.com/montana/small-group-brochure-2016","10"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","3","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180026","SmartHealth Balance Silver 4000","23603MT018",,"MTN002","MTS001","MTF004","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180026-01","Standard Silver On Exchange Plan",,"0.692033231258392","Yes","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$150","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-sh-bs-4000","http://www.PacificSource.com/montana/small-group-brochure-2016","11"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","Individual","No","93-0245545","23603MT0160007","SmartHealth Balance Gold 1000","23603MT016",,"MTN002","MTS001","MTF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160007-00","Standard Gold Off Exchange Plan",,"0.787351965904236","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-sh-bg-1000","http://www.PacificSource.com/montana/individual-brochure-2016","4"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0200010","Dental Choice 0-20-50 1500","23603MT020",,"MTN003","MTS002",,"New","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.94","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0200010-00","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/montana/small-group-dental-brochure-2016","4"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","Individual","No","93-0245545","23603MT0160007","SmartHealth Balance Gold 1000","23603MT016",,"MTN002","MTS001","MTF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160007-01","Standard Gold On Exchange Plan",,"0.787351965904236","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-sh-bg-1000","http://www.PacificSource.com/montana/individual-brochure-2016","5"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180006","PSN Balance Silver 2500 VH","23603MT018",,"MTN001","MTS001","MTF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9768",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180006-01","Standard Silver On Exchange Plan",,"0.70991724729538","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-psn-bs-2500-vh","http://www.PacificSource.com/montana/small-group-brochure-2016","5"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180015","SmartHealth Balance Silver 2500 VH","23603MT018",,"MTN002","MTS001","MTF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9746",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180015-00","Standard Silver Off Exchange Plan",,"0.70991724729538","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-sh-bs-2500-vh","http://www.PacificSource.com/montana/small-group-brochure-2016","6"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","Individual","No","93-0245545","23603MT0160007","SmartHealth Balance Gold 1000","23603MT016",,"MTN002","MTS001","MTF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-sh-bg-1000-0","http://www.PacificSource.com/montana/individual-brochure-2016-ai","6"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","Individual","No","93-0245545","23603MT0160007","SmartHealth Balance Gold 1000","23603MT016",,"MTN002","MTS001","MTF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160007-03","Limited Cost Sharing Plan Variation",,"0.787351965904236","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-sh-bg-1000-ai","http://www.PacificSource.com/montana/individual-brochure-2016-ai","7"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180015","SmartHealth Balance Silver 2500 VH","23603MT018",,"MTN002","MTS001","MTF004","Existing","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9746",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180015-01","Standard Silver On Exchange Plan",,"0.70991724729538","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-sh-bs-2500-vh","http://www.PacificSource.com/montana/small-group-brochure-2016","7"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180029","PSN Balance Silver 4000 VH","23603MT018",,"MTN001","MTS001","MTF004","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9753",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180029-00","Standard Silver Off Exchange Plan",,"0.692033231258392","Yes","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$150","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-psn-bs-4000-vh","http://www.PacificSource.com/montana/small-group-brochure-2016","8"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","Individual","No","93-0245545","23603MT0160009","PSN Balance Silver 2500","23603MT016",,"MTN001","MTS001","MTF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160009-00","Standard Silver Off Exchange Plan",,"0.70991724729538","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-psn-bs-2500","http://www.PacificSource.com/montana/individual-brochure-2016","8"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","Individual","No","93-0245545","23603MT0160009","PSN Balance Silver 2500","23603MT016",,"MTN001","MTS001","MTF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160009-01","Standard Silver On Exchange Plan",,"0.70991724729538","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-psn-bs-2500","http://www.PacificSource.com/montana/individual-brochure-2016","9"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180029","PSN Balance Silver 4000 VH","23603MT018",,"MTN001","MTS001","MTF004","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9753",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180029-01","Standard Silver On Exchange Plan",,"0.692033231258392","Yes","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$150","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-psn-bs-4000-vh","http://www.PacificSource.com/montana/small-group-brochure-2016","9"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180027","SmartHealth Balance Silver 4000 VH","23603MT018",,"MTN002","MTS001","MTF004","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.973",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180027-00","Standard Silver Off Exchange Plan",,"0.692033231258392","Yes","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$150","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-sh-bs-4000-vh","http://www.PacificSource.com/montana/small-group-brochure-2016","10"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","Individual","No","93-0245545","23603MT0160009","PSN Balance Silver 2500","23603MT016",,"MTN001","MTS001","MTF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-psn-bs-2500-0","http://www.PacificSource.com/montana/individual-brochure-2016-ai","10"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","Individual","No","93-0245545","23603MT0160009","PSN Balance Silver 2500","23603MT016",,"MTN001","MTS001","MTF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160009-03","Limited Cost Sharing Plan Variation",,"0.70991724729538","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-psn-bs-2500-ai","http://www.PacificSource.com/montana/individual-brochure-2016-ai","11"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180027","SmartHealth Balance Silver 4000 VH","23603MT018",,"MTN002","MTS001","MTF004","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.973",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-list/","23603MT0180027-01","Standard Silver On Exchange Plan",,"0.692033231258392","Yes","Yes","No","100%",,"$4,000","$20","$980","$150","$4,000","$150","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-sh-bs-4000-vh","http://www.PacificSource.com/montana/small-group-brochure-2016","11"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180019","PSN Balance Gold 1000 VH","23603MT018",,"MTN001","MTS001","MTF006","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9809",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-llist/","23603MT0180019-00","Standard Gold Off Exchange Plan",,"0.813772678375244","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-psn-bg-1000-vh","http://www.PacificSource.com/montana/small-group-brochure-2016","12"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","Individual","No","93-0245545","23603MT0160009","PSN Balance Silver 2500","23603MT016",,"MTN001","MTS001","MTF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160009-04","73% AV Level Silver Plan",,"0.737830102443695","Yes","Yes","No","100%",,"$2,000","$20","$1,580","$150","$2,000","$390","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-psn-bs-2500-73","http://www.PacificSource.com/montana/individual-brochure-2016","12"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","Individual","No","93-0245545","23603MT0160009","PSN Balance Silver 2500","23603MT016",,"MTN001","MTS001","MTF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160009-05","87% AV Level Silver Plan",,"0.869195282459259","Yes","Yes","No","100%",,"$500","$0","$1,100","$150","$500","$580","$350","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$3,200","$3200 per person","$6400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-psn-bs-2500-87","http://www.PacificSource.com/montana/individual-brochure-2016","13"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180019","PSN Balance Gold 1000 VH","23603MT018",,"MTN001","MTS001","MTF006","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9809",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-llist/","23603MT0180019-01","Standard Gold On Exchange Plan",,"0.813772678375244","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-psn-bg-1000-vh","http://www.PacificSource.com/montana/small-group-brochure-2016","13"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650006","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS032","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650006-04","73% AV Level Silver Plan","73.27%","0","No","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","$21,600","$21600 per person","$43200 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%","$2,000","$2000 per person","$4000 per group","30%","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650002-04.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","26"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180022","SmartHealth Balance Gold 1000 VH","23603MT018",,"MTN002","MTS001","MTF006","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9791",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-llist/","23603MT0180022-00","Standard Gold Off Exchange Plan",,"0.813772678375244","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-sh-bg-1000-vh","http://www.PacificSource.com/montana/small-group-brochure-2016","14"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","Individual","No","93-0245545","23603MT0160009","PSN Balance Silver 2500","23603MT016",,"MTN001","MTS001","MTF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160009-06","94% AV Level Silver Plan",,"0.936331272125244","Yes","Yes","No","100%",,"$250","$0","$250","$150","$250","$180","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-psn-bs-2500-94","http://www.PacificSource.com/montana/individual-brochure-2016","14"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","Individual","No","93-0245545","23603MT0160005","SmartHealth Balance Silver 2500","23603MT016",,"MTN002","MTS001","MTF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160005-00","Standard Silver Off Exchange Plan",,"0.70991724729538","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-sh-bs-2500","http://www.PacificSource.com/montana/individual-brochure-2016","15"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180022","SmartHealth Balance Gold 1000 VH","23603MT018",,"MTN002","MTS001","MTF006","Existing","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9791",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-llist/","23603MT0180022-01","Standard Gold On Exchange Plan",,"0.813772678375244","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$500","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-sh-bg-1000-vh","http://www.PacificSource.com/montana/small-group-brochure-2016","15"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180035","PSN Balance Platinum 500 VH","23603MT018",,"MTN001","MTS001","MTF006","New","PPO","Platinum","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.983",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-llist/","23603MT0180035-00","Standard Platinum Off Exchange Plan",,"0.882772624492645","Yes","Yes","No","100%",,"$500","$0","$1,000","$150","$500","$530","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-psn-bp-500-vh","http://www.PacificSource.com/montana/small-group-brochure-2016","16"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","Individual","No","93-0245545","23603MT0160005","SmartHealth Balance Silver 2500","23603MT016",,"MTN002","MTS001","MTF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160005-01","Standard Silver On Exchange Plan",,"0.70991724729538","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-sh-bs-2500","http://www.PacificSource.com/montana/individual-brochure-2016","16"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","Individual","No","93-0245545","23603MT0160005","SmartHealth Balance Silver 2500","23603MT016",,"MTN002","MTS001","MTF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-sh-bs-2500-0","http://www.PacificSource.com/montana/individual-brochure-2016-ai","17"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180035","PSN Balance Platinum 500 VH","23603MT018",,"MTN001","MTS001","MTF006","New","PPO","Platinum","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.983",,,,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/drug-llist/","23603MT0180035-01","Standard Platinum On Exchange Plan",,"0.882772624492645","Yes","Yes","No","100%",,"$500","$0","$1,000","$150","$500","$530","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.PacificSource.com/montana/sg-psn-bp-500-vh","http://www.PacificSource.com/montana/small-group-brochure-2016","17"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","Individual","No","93-0245545","23603MT0160005","SmartHealth Balance Silver 2500","23603MT016",,"MTN002","MTS001","MTF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160005-03","Limited Cost Sharing Plan Variation",,"0.70991724729538","Yes","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$320","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-sh-bs-2500-ai","http://www.PacificSource.com/montana/individual-brochure-2016-ai","18"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","Individual","No","93-0245545","23603MT0160005","SmartHealth Balance Silver 2500","23603MT016",,"MTN002","MTS001","MTF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160005-04","73% AV Level Silver Plan",,"0.737830102443695","Yes","Yes","No","100%",,"$2,000","$20","$1,580","$150","$2,000","$390","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-sh-bs-2500-73","http://www.PacificSource.com/montana/individual-brochure-2016","19"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","Individual","No","93-0245545","23603MT0160005","SmartHealth Balance Silver 2500","23603MT016",,"MTN002","MTS001","MTF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160005-05","87% AV Level Silver Plan",,"0.869195282459259","Yes","Yes","No","100%",,"$500","$0","$1,100","$150","$500","$580","$350","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$3,200","$3200 per person","$6400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-sh-bs-2500-87","http://www.PacificSource.com/montana/individual-brochure-2016","20"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","4","23603","MT","Individual","No","93-0245545","23603MT0160005","SmartHealth Balance Silver 2500","23603MT016",,"MTN002","MTS001","MTF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","23603MT0160005-06","94% AV Level Silver Plan",,"0.936331272125244","Yes","Yes","No","100%",,"$250","$0","$250","$150","$250","$180","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/montana/ind-sh-bs-2500-94","http://www.PacificSource.com/montana/individual-brochure-2016","21"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","5","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0210007","Dental Choice Plus 0-20-50 25-1000","23603MT021",,"MTN003","MTS002",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.94","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0210007-00","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","per person not applicable","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/montana/small-group-dental-brochure-2016","4"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","5","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0210008","Dental Choice Plus 0-20-50 50-1000","23603MT021",,"MTN003","MTS002",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.94","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0210008-00","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/montana/small-group-dental-brochure-2016","5"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","6","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0210009","Dental Choice Plus 0-20-50 25-1500","23603MT021",,"MTN003","MTS002",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.94","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0210009-00","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","per person not applicable","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/montana/small-group-dental-brochure-2016","4"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","6","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0210010","Dental Choice Plus 0-20-50 50-1500","23603MT021",,"MTN003","MTS002",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.94","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0210010-00","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/montana/small-group-dental-brochure-2016","5"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","7","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0220002","Kids Dental Choice 0-20-50","23603MT022",,"MTN003","MTS002",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$30.58","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0220002-00","Standard High Off Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/montana/small-group-dental-brochure-2016","4"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","7","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0220002","Kids Dental Choice 0-20-50","23603MT022",,"MTN003","MTS002",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$30.58","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0220002-01","Standard High On Exchange Plan","83.19%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/montana/small-group-dental-brochure-2016","5"
"2016","MT","23603","SERFF","14","2015-10-21 17:48:08","7","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0220001","Kids Dental Choice 20-40-50","23603MT022",,"MTN003","MTS002",,"Existing","Indemnity","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$24.86","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider","Yes","http://www.exchangepay.pacificsource.com/FFE/Employer/","","23603MT0220001-00","Standard Low Off Exchange Plan","68.18%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/montana/small-group-dental-brochure-2016","6"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","1","30751","MT","Individual","No","36-1236610","30751MT0550012","Blue Preferred Bronze PPO?  103","30751MT055",,"MTN001","MTS001","MTF014","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550012-01","Standard Bronze On Exchange Plan",,"0.613072514533997","No","Yes","Yes","60%","40%","$6,000","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","30%","$6,000","$6000 per person","$12000 per group","30%","$24,000","$24000 per person","$48000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550012-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","5"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","3","30751","MT","Individual","No","36-1236610","30751MT0550010","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS001","MTF014","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550010-03","Limited Cost Sharing Plan Variation","68.61%","0","No","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$26,400","$26400 per person","$52800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%","$3,000","$3000 per person","$6000 per group","20%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550010-03.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","7"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","3","30751","MT","Individual","No","36-1236610","30751MT0550010","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS001","MTF014","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550010-04","73% AV Level Silver Plan","72.55%","0","No","Yes","Yes","60%","40%","$3,400","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","$2,300","$2300 per person","$4600 per group","20%","$2,300","$2300 per person","$4600 per group","20%","$9,200","$9200 per person","$18400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550010-04.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","8"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","1","30751","MT","Individual","No","36-1236610","30751MT0550012","Blue Preferred Bronze PPO?  103","30751MT055",,"MTN001","MTS001","MTF014","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550012-00","Standard Bronze Off Exchange Plan",,"0.613072514533997","No","Yes","Yes","60%","40%","$6,000","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","30%","$6,000","$6000 per person","$12000 per group","30%","$24,000","$24000 per person","$48000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550012-00.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","4"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","1","30751","MT","Individual","Yes","36-1236610","30751MT0580001","BlueCare Dental? 1A","30751MT058",,"MTN003","MTS003",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.95","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580001-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf","http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf","4"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","1","30751","MT","SHOP (Small Group)","No","36-1236610","30751MT0560005","Blue Preferred Gold PPO? 005","30751MT056",,"MTN011","MTS001","MTF008","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0560005-00","Standard Gold Off Exchange Plan",,"0.791069328784943","No","Yes","Yes","60%","40%","$2,000","$30","$1,000","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","$3,250","$3250 per person","$6500 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","20%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsmt.com/PDF/sbc/30751MT0560005-00.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","4"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","1","30751","MT","SHOP (Small Group)","No","36-1236610","30751MT0560005","Blue Preferred Gold PPO? 005","30751MT056",,"MTN011","MTS001","MTF008","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0560005-01","Standard Gold On Exchange Plan",,"0.791069328784943","No","Yes","Yes","60%","40%","$2,000","$30","$1,000","$200","$2,000","$30","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","$3,250","$3250 per person","$6500 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","20%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsmt.com/PDF/sbc/30751MT0560005-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","5"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","1","30751","MT","Individual","Yes","36-1236610","30751MT0580001","BlueCare Dental? 1A","30751MT058",,"MTN003","MTS003",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.95","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580001-01","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf","http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf","5"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","1","30751","MT","Individual","No","36-1236610","30751MT0550012","Blue Preferred Bronze PPO?  103","30751MT055",,"MTN001","MTS001","MTF014","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550012-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550012-02.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","6"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","1","30751","MT","SHOP (Small Group)","No","36-1236610","30751MT0560007","Blue Preferred Gold PPO? 007","30751MT056",,"MTN011","MTS001","MTF007","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0560007-00","Standard Gold Off Exchange Plan",,"0.814670026302338","No","Yes","Yes","60%","40%","$1,000","$30","$1,000","$200","$1,000","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%","$1,000","$1000 per person","$2000 per group","20%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsmt.com/PDF/sbc/30751MT0560007-00.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","6"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","1","30751","MT","SHOP (Small Group)","No","36-1236610","30751MT0560007","Blue Preferred Gold PPO? 007","30751MT056",,"MTN011","MTS001","MTF007","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0560007-01","Standard Gold On Exchange Plan",,"0.814670026302338","No","Yes","Yes","60%","40%","$1,000","$30","$1,000","$200","$1,000","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%","$1,000","$1000 per person","$2000 per group","20%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsmt.com/PDF/sbc/30751MT0560007-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","7"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","1","30751","MT","Individual","No","36-1236610","30751MT0550012","Blue Preferred Bronze PPO?  103","30751MT055",,"MTN001","MTS001","MTF014","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550012-03","Limited Cost Sharing Plan Variation",,"0.613072514533997","No","Yes","Yes","60%","40%","$6,000","$0","$400","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","30%","$6,000","$6000 per person","$12000 per group","30%","$24,000","$24000 per person","$48000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550012-03.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","7"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","1","30751","MT","SHOP (Small Group)","No","36-1236610","30751MT0560014","Blue Preferred Silver PPO? 014","30751MT056",,"MTN011","MTS001","MTF007","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0560014-00","Standard Silver Off Exchange Plan",,"0.706652045249939","No","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%","$3,000","$3000 per person","$6000 per group","20%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsmt.com/PDF/sbc/30751MT0560014-00.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","8"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","1","30751","MT","SHOP (Small Group)","No","36-1236610","30751MT0560014","Blue Preferred Silver PPO? 014","30751MT056",,"MTN011","MTS001","MTF007","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0560014-01","Standard Silver On Exchange Plan",,"0.706652045249939","No","Yes","Yes","60%","40%","$3,000","$0","$900","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%","$3,000","$3000 per person","$6000 per group","20%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsmt.com/PDF/sbc/30751MT0560014-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","9"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","1","30751","MT","SHOP (Small Group)","No","36-1236610","30751MT0560020","Blue Preferred Silver PPO? 020","30751MT056",,"MTN011","MTS001","MTF007","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0560020-00","Standard Silver Off Exchange Plan",,"0.70941424369812","No","Yes","Yes","60%","40%","$2,300","$0","$1,500","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$6,800","$6800 per person","$13600 per group","$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","30%","$2,250","$2250 per person","$4500 per group","30%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsmt.com/PDF/sbc/30751MT0560020-00.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","10"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","1","30751","MT","SHOP (Small Group)","No","36-1236610","30751MT0560020","Blue Preferred Silver PPO? 020","30751MT056",,"MTN011","MTS001","MTF007","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0560020-01","Standard Silver On Exchange Plan",,"0.70941424369812","No","Yes","Yes","60%","40%","$2,300","$0","$1,500","$200","$2,300","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","$6,800","$6800 per person","$13600 per group","$13,600","$13600 per person","$27200 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","30%","$2,250","$2250 per person","$4500 per group","30%","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.bcbsmt.com/PDF/sbc/30751MT0560020-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","11"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","2","30751","MT","Individual","Yes","36-1236610","30751MT0580003","BlueCare Dental 4 Kids? 1A","30751MT058",,"MTN003","MTS003",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$39.95","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580003-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf","http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf","4"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","2","30751","MT","SHOP (Small Group)","No","36-1236610","30751MT0560018","Blue Preferred Bronze PPO? 018","30751MT056",,"MTN011","MTS001","MTF009","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0560018-00","Standard Bronze Off Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$5,000","$0","$500","$200","$2,400","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%","$5,000","$5000 per person","$10000 per group","20%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsmt.com/PDF/sbc/30751MT0560018-00.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","4"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","2","30751","MT","Individual","No","36-1236610","30751MT0550009","Blue Preferred Security PPO?  100","30751MT055",,"MTN001","MTS001","MTF001","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550009-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$5,200","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550009-00.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","4"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","2","30751","MT","Individual","No","36-1236610","30751MT0550009","Blue Preferred Security PPO?  100","30751MT055",,"MTN001","MTS001","MTF001","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550009-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550009-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","5"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","2","30751","MT","SHOP (Small Group)","No","36-1236610","30751MT0560018","Blue Preferred Bronze PPO? 018","30751MT056",,"MTN011","MTS001","MTF009","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0560018-01","Standard Bronze On Exchange Plan",,"0.615435659885406","Yes","Yes","Yes","60%","40%","$6,000","$0","$300","$200","$2,400","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%","$5,000","$5000 per person","$10000 per group","20%","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsmt.com/PDF/sbc/30751MT0560018-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","5"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","2","30751","MT","Individual","Yes","36-1236610","30751MT0580003","BlueCare Dental 4 Kids? 1A","30751MT058",,"MTN003","MTS003",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$39.95","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580003-01","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf","http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf","5"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","2","30751","MT","SHOP (Small Group)","No","36-1236610","30751MT0560019","Blue Preferred Bronze PPO? 019","30751MT056",,"MTN011","MTS001","MTF009","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0560019-00","Standard Bronze Off Exchange Plan",,"0.606523811817169","Yes","Yes","Yes","60%","40%","$6,000","$0","$300","$200","$2,400","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20%","$6,000","$6000 per person","$12000 per group","20%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsmt.com/PDF/sbc/30751MT0560019-00.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","6"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","2","30751","MT","SHOP (Small Group)","No","36-1236610","30751MT0560019","Blue Preferred Bronze PPO? 019","30751MT056",,"MTN011","MTS001","MTF009","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0560019-01","Standard Bronze On Exchange Plan",,"0.606523811817169","Yes","Yes","Yes","60%","40%","$6,000","$0","$300","$200","$2,400","$0","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20%","$6,000","$6000 per person","$12000 per group","20%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.bcbsmt.com/PDF/sbc/30751MT0560019-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","7"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","3","30751","MT","Individual","Yes","36-1236610","30751MT0580002","BlueCare Dental? 1B","30751MT058",,"MTN003","MTS003",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580002-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf","http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf","4"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","3","30751","MT","Individual","No","36-1236610","30751MT0550010","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS001","MTF014","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550010-00","Standard Silver Off Exchange Plan","68.61%","0","No","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$26,400","$26400 per person","$52800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%","$3,000","$3000 per person","$6000 per group","20%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550010-00.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","4"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","3","30751","MT","Individual","No","36-1236610","30751MT0550010","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS001","MTF014","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550010-01","Standard Silver On Exchange Plan","68.61%","0","No","Yes","Yes","60%","40%","$3,700","$0","$700","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$26,400","$26400 per person","$52800 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%","$3,000","$3000 per person","$6000 per group","20%","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550010-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","5"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","3","30751","MT","Individual","Yes","36-1236610","30751MT0580002","BlueCare Dental? 1B","30751MT058",,"MTN003","MTS003",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580002-01","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf","http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf","5"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","3","30751","MT","Individual","No","36-1236610","30751MT0550010","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS001","MTF014","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550010-02.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","6"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","3","30751","MT","Individual","No","36-1236610","30751MT0550010","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS001","MTF014","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550010-05","87% AV Level Silver Plan","86.86%","0","No","Yes","Yes","60%","40%","$500","$0","$1,300","$200","$500","$0","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550010-05.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","9"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650002","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS012","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650002-06","94% AV Level Silver Plan","94.00%","0","No","Yes","Yes","60%","40%","$500","$10","$200","$200","$0","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650002-06.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","10"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650003","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS012","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650003-00","Standard Silver Off Exchange Plan","68.34%","0","No","Yes","Yes","60%","40%","$4,300","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$3,850","$3850 per person","$7700 per group","20%","$3,850","$3850 per person","$7700 per group","20%","$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650003-00.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","11"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650003","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS012","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650003-01","Standard Silver On Exchange Plan","68.34%","0","No","Yes","Yes","60%","40%","$4,300","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$3,850","$3850 per person","$7700 per group","20%","$3,850","$3850 per person","$7700 per group","20%","$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650003-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","12"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650008","Blue Focus Gold POS? 101","30751MT065",,"MTN002","MTS032","MTF013","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650004-02.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","38"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","Individual","No","45-1295465","32225MT0010003","Access Care Bronze","32225MT001",,"MTN002","MTS001","MTF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0010003-03","Limited Cost Sharing Plan Variation",,"0.599591493606567","Yes","Yes","No","100%",,"$5,000","$20","$1,360","$150","$5,000","$80","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","60%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Native American_Access Care_BRZ_NALCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","18"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","Individual","No","45-1295465","32225MT0010004","Access Care Bronze Plus","32225MT001",,"MTN002","MTS001","MTF012","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0010004-00","Standard Bronze Off Exchange Plan",,"0.606358587741852","Yes","Yes","No","100%",,"$5,000","$20","$1,360","$150","$5,000","$80","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$19,350","$19350 per person","$38700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","60%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Access Care_Ind_BRZ_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","19"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","3","30751","MT","Individual","No","36-1236610","30751MT0550010","Blue Preferred Silver PPO?  101 - Three $0 PCP Visits","30751MT055",,"MTN001","MTS001","MTF014","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","3","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550010-06","94% AV Level Silver Plan","94.15%","0","No","Yes","Yes","60%","40%","$0","$0","$800","$200","$0","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","20%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550010-06.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","10"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","4","30751","MT","Individual","Yes","36-1236610","30751MT0580004","BlueCare Dental 4 Kids? 1B","30751MT058",,"MTN003","MTS003",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$29.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580004-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf","http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf","4"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","4","30751","MT","Individual","No","36-1236610","30751MT0650001","Blue Focus Bronze POS? 104 - One $0 PCP Visit","30751MT065",,"MTN002","MTS012","MTF012","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650001-00","Standard Bronze Off Exchange Plan","61.64%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%","$5,000","$5000 per person","$10000 per group","20%","$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650001-00.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","4"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","4","30751","MT","Individual","No","36-1236610","30751MT0650001","Blue Focus Bronze POS? 104 - One $0 PCP Visit","30751MT065",,"MTN002","MTS012","MTF012","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650001-01","Standard Bronze On Exchange Plan","61.64%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%","$5,000","$5000 per person","$10000 per group","20%","$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650001-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","5"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","4","30751","MT","Individual","Yes","36-1236610","30751MT0580004","BlueCare Dental 4 Kids? 1B","30751MT058",,"MTN003","MTS003",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$29.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","","30751MT0580004-01","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf","http://www.bcbsmt.com/pdf/bluecare-dental-individuals-and-families-mt.pdf","5"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","4","30751","MT","Individual","No","36-1236610","30751MT0650001","Blue Focus Bronze POS? 104 - One $0 PCP Visit","30751MT065",,"MTN002","MTS012","MTF012","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650001-02.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","6"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","4","30751","MT","Individual","No","36-1236610","30751MT0650001","Blue Focus Bronze POS? 104 - One $0 PCP Visit","30751MT065",,"MTN002","MTS012","MTF012","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650001-03","Limited Cost Sharing Plan Variation","61.64%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%","$5,000","$5000 per person","$10000 per group","20%","$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650001-03.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","7"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","4","30751","MT","Individual","No","36-1236610","30751MT0650005","Blue Focus Bronze POS? 104 - One $0 PCP Visit","30751MT065",,"MTN002","MTS032","MTF012","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650005-00","Standard Bronze Off Exchange Plan","61.64%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%","$5,000","$5000 per person","$10000 per group","20%","$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650001-00.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","8"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","4","30751","MT","Individual","No","36-1236610","30751MT0650005","Blue Focus Bronze POS? 104 - One $0 PCP Visit","30751MT065",,"MTN002","MTS032","MTF012","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650005-01","Standard Bronze On Exchange Plan","61.64%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%","$5,000","$5000 per person","$10000 per group","20%","$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650001-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","9"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","4","30751","MT","Individual","No","36-1236610","30751MT0650005","Blue Focus Bronze POS? 104 - One $0 PCP Visit","30751MT065",,"MTN002","MTS032","MTF012","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650001-02.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","10"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","4","30751","MT","Individual","No","36-1236610","30751MT0650005","Blue Focus Bronze POS? 104 - One $0 PCP Visit","30751MT065",,"MTN002","MTS032","MTF012","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","1","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650005-03","Limited Cost Sharing Plan Variation","61.64%","0","Yes","Yes","Yes","60%","40%","$6,900","$0","$0","$200","$2,400","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%","$5,000","$5000 per person","$10000 per group","20%","$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650001-03.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","11"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650002","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS012","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650002-00","Standard Silver Off Exchange Plan","71.17%","0","No","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%","$2,000","$2000 per person","$4000 per group","30%","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650002-00.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","4"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650002","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS012","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650002-01","Standard Silver On Exchange Plan","71.17%","0","No","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%","$2,000","$2000 per person","$4000 per group","30%","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650002-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","5"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650002","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS012","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650002-02.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","6"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650002","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS012","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650002-03","Limited Cost Sharing Plan Variation","71.17%","0","No","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%","$2,000","$2000 per person","$4000 per group","30%","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650002-03.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","7"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650002","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS012","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650002-04","73% AV Level Silver Plan","73.27%","0","No","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","$5,400","$5400 per person","$10800 per group","$21,600","$21600 per person","$43200 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%","$2,000","$2000 per person","$4000 per group","30%","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650002-04.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","8"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650002","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS012","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650002-05","87% AV Level Silver Plan","87.50%","0","No","Yes","Yes","60%","40%","$700","$10","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30%","$200","$200 per person","$400 per group","30%","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650002-05.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","9"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650003","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS012","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650003-02.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","13"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650003","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS012","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650003-03","Limited Cost Sharing Plan Variation","68.34%","0","No","Yes","Yes","60%","40%","$4,300","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$3,850","$3850 per person","$7700 per group","20%","$3,850","$3850 per person","$7700 per group","20%","$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650003-03.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","14"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650003","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS012","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650003-04","73% AV Level Silver Plan","72.51%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group","$21,800","$21800 per person","$43600 per group","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","20%","$2,800","$2800 per person","$5600 per group","20%","$11,200","$11200 per person","$22400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650003-04.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","15"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650003","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS012","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650003-05","87% AV Level Silver Plan","86.94%","0","No","Yes","Yes","60%","40%","$800","$10","$1,000","$200","$500","$100","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650003-05.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","16"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650003","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS012","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650003-06","94% AV Level Silver Plan","94.05%","0","No","Yes","Yes","60%","40%","$500","$10","$100","$200","$300","$100","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%","$250","$250 per person","$500 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650003-06.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","17"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650004","Blue Focus Gold POS? 101","30751MT065",,"MTN002","MTS012","MTF013","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650004-00","Standard Gold Off Exchange Plan","79.80%","0","No","Yes","Yes","60%","40%","$800","$40","$1,400","$200","$500","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%","$500","$500 per person","$1000 per group","30%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650004-00.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","18"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650004","Blue Focus Gold POS? 101","30751MT065",,"MTN002","MTS012","MTF013","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650004-01","Standard Gold On Exchange Plan","79.80%","0","No","Yes","Yes","60%","40%","$800","$40","$1,400","$200","$500","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%","$500","$500 per person","$1000 per group","30%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650004-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","19"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650004","Blue Focus Gold POS? 101","30751MT065",,"MTN002","MTS012","MTF013","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650004-02.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","20"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650004","Blue Focus Gold POS? 101","30751MT065",,"MTN002","MTS012","MTF013","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650004-03","Limited Cost Sharing Plan Variation","79.80%","0","No","Yes","Yes","60%","40%","$800","$40","$1,400","$200","$500","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%","$500","$500 per person","$1000 per group","30%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650004-03.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","21"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650006","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS032","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650006-00","Standard Silver Off Exchange Plan","71.17%","0","No","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%","$2,000","$2000 per person","$4000 per group","30%","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650002-00.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","22"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650006","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS032","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650006-01","Standard Silver On Exchange Plan","71.17%","0","No","Yes","Yes","60%","40%","$2,500","$0","$1,400","$200","$2,000","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%","$2,000","$2000 per person","$4000 per group","30%","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650002-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","23"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650006","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS032","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650002-02.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","24"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650006","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS032","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650006-03","Limited Cost Sharing Plan Variation","71.17%","0","No","Yes","Yes","60%","40%","$2,500","$40","$1,400","$200","$2,000","$40","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%","$2,000","$2000 per person","$4000 per group","30%","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650002-03.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","25"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650006","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS032","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650006-05","87% AV Level Silver Plan","87.50%","0","No","Yes","Yes","60%","40%","$700","$10","$1,300","$200","$200","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30%","$200","$200 per person","$400 per group","30%","$800","$800 per person","$1600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650002-05.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","27"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650006","Blue Focus Silver POS? 102","30751MT065",,"MTN002","MTS032","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650006-06","94% AV Level Silver Plan","94.00%","0","No","Yes","Yes","60%","40%","$500","$10","$200","$200","$0","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","$700","$700 per person","$1400 per group","$2,800","$2800 per person","$5600 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%","$0","$0 per person","$0 per group","30%","$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650002-06.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","28"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650007","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS032","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650007-00","Standard Silver Off Exchange Plan","68.34%","0","No","Yes","Yes","60%","40%","$4,300","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$3,850","$3850 per person","$7700 per group","20%","$3,850","$3850 per person","$7700 per group","20%","$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650003-00.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","29"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","Individual","No","45-1295465","32225MT0010001","Access Care Gold","32225MT001",,"MTN002","MTS001","MTF002","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0010001-03","Limited Cost Sharing Plan Variation",,"0.782401919364929","Yes","Yes","No","100%",,"$750","$20","$1,950","$150","$750","$760","$320","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Native American_Access Care_GLD_NALCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","7"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0040003","Access Care Bronze","32225MT004",,"MTN002","MTS001","MTF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/explore-plans/drug-list/","32225MT0040003-00","Standard Bronze Off Exchange Plan",,"0.599591493606567","Yes","Yes","No","100%",,"$5,000","$20","$1,360","$150","$5,000","$80","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","60%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2016/MT_2016_Access Care_Grp_BRZ_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Small-Group-Plan-Comparison.pdf","8"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","Individual","No","45-1295465","32225MT0010002","Access Care Silver","32225MT001",,"MTN002","MTS001","MTF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0010002-00","Standard Silver Off Exchange Plan",,"0.680972278118134","Yes","Yes","No","100%",,"$2,150","$20","$2,040","$150","$2,150","$550","$360","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","40%",,,,,"$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Access Care_Ind_SIL_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","8"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","Individual","No","45-1295465","32225MT0010002","Access Care Silver","32225MT001",,"MTN002","MTS001","MTF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0010002-01","Standard Silver On Exchange Plan",,"0.680972278118134","Yes","Yes","No","100%",,"$2,150","$20","$2,040","$150","$2,150","$550","$360","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","40%",,,,,"$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Access Care_Ind_SIL_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","9"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0040003","Access Care Bronze","32225MT004",,"MTN002","MTS001","MTF004","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/explore-plans/drug-list/","32225MT0040003-01","Standard Bronze On Exchange Plan",,"0.599591493606567","Yes","Yes","No","100%",,"$5,000","$20","$1,360","$150","$5,000","$80","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","60%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2016/MT_2016_Access Care_Grp_BRZ_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Small-Group-Plan-Comparison.pdf","9"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0040004","Access Care Bronze Plus","32225MT004",,"MTN002","MTS001","MTF012","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/explore-plans/drug-list/","32225MT0040004-00","Standard Bronze Off Exchange Plan",,"0.606358587741852","Yes","Yes","No","100%",,"$5,000","$20","$1,360","$150","$5,000","$80","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$19,350","$19350 per person","$38700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","60%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.mhc.coop/wp-content/uploads/2016/MT_2016_Access Care_Grp_BRZ_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Small-Group-Plan-Comparison.pdf","10"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650007","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS032","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650007-01","Standard Silver On Exchange Plan","68.34%","0","No","Yes","Yes","60%","40%","$4,300","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$3,850","$3850 per person","$7700 per group","20%","$3,850","$3850 per person","$7700 per group","20%","$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650003-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","30"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650007","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS032","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650003-02.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","31"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650007","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS032","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650007-03","Limited Cost Sharing Plan Variation","68.34%","0","No","Yes","Yes","60%","40%","$4,300","$0","$600","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable","$3,850","$3850 per person","$7700 per group","20%","$3,850","$3850 per person","$7700 per group","20%","$15,400","$15400 per person","$30800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650003-03.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","32"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650007","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS032","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650007-04","73% AV Level Silver Plan","72.51%","0","No","Yes","Yes","60%","40%","$3,300","$0","$800","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group","$21,800","$21800 per person","$43600 per group","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","20%","$2,800","$2800 per person","$5600 per group","20%","$11,200","$11200 per person","$22400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650003-04.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","33"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650007","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS032","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650007-05","87% AV Level Silver Plan","86.94%","0","No","Yes","Yes","60%","40%","$800","$10","$1,000","$200","$500","$100","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650003-05.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","34"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650007","Blue Focus Silver POS? 103","30751MT065",,"MTN002","MTS032","MTF013","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650007-06","94% AV Level Silver Plan","94.05%","0","No","Yes","Yes","60%","40%","$500","$10","$100","$200","$300","$100","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%","$250","$250 per person","$500 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650003-06.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","35"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650008","Blue Focus Gold POS? 101","30751MT065",,"MTN002","MTS032","MTF013","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650008-00","Standard Gold Off Exchange Plan","79.80%","0","No","Yes","Yes","60%","40%","$800","$40","$1,400","$200","$500","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%","$500","$500 per person","$1000 per group","30%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650004-00.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","36"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650008","Blue Focus Gold POS? 101","30751MT065",,"MTN002","MTS032","MTF013","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650008-01","Standard Gold On Exchange Plan","79.80%","0","No","Yes","Yes","60%","40%","$800","$40","$1,400","$200","$500","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%","$500","$500 per person","$1000 per group","30%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650004-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","37"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","5","30751","MT","Individual","No","36-1236610","30751MT0650008","Blue Focus Gold POS? 101","30751MT065",,"MTN002","MTS032","MTF013","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0650008-03","Limited Cost Sharing Plan Variation","79.80%","0","No","Yes","Yes","60%","40%","$800","$40","$1,400","$200","$500","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","$5,250","$5250 per person","$10500 per group","$21,000","$21000 per person","$42000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%","$500","$500 per person","$1000 per group","30%","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0650004-03.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","39"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","6","30751","MT","Individual","No","36-1236610","30751MT0550006","Blue Preferred Bronze PPO?  006","30751MT055",,"MTN001","MTS001","MTF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550006-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$24,000","$24000 per person","$48000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$24,000","$24000 per person","$48000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550006-00.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","4"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","6","30751","MT","Individual","No","36-1236610","30751MT0550006","Blue Preferred Bronze PPO?  006","30751MT055",,"MTN001","MTS001","MTF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550006-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$2,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$24,000","$24000 per person","$48000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$24,000","$24000 per person","$48000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550006-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","5"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","6","30751","MT","Individual","No","36-1236610","30751MT0550006","Blue Preferred Bronze PPO?  006","30751MT055",,"MTN001","MTS001","MTF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550006-02.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","6"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","6","30751","MT","Individual","No","36-1236610","30751MT0550006","Blue Preferred Bronze PPO?  006","30751MT055",,"MTN001","MTS001","MTF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550006-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$24,000","$24000 per person","$48000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$24,000","$24000 per person","$48000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550006-03.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","7"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","6","30751","MT","Individual","No","36-1236610","30751MT0550011","Blue Preferred Bronze PPO?  102","30751MT055",,"MTN001","MTS001","MTF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550011-00","Standard Bronze Off Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$2,400","$0","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%","$4,500","$4500 per person","$9000 per group","30%","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550011-00.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","8"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","6","30751","MT","Individual","No","36-1236610","30751MT0550011","Blue Preferred Bronze PPO?  102","30751MT055",,"MTN001","MTS001","MTF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550011-01","Standard Bronze On Exchange Plan",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$2,400","$0","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%","$4,500","$4500 per person","$9000 per group","30%","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550011-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","9"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","6","30751","MT","Individual","No","36-1236610","30751MT0550011","Blue Preferred Bronze PPO?  102","30751MT055",,"MTN001","MTS001","MTF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550011-02.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","10"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","6","30751","MT","Individual","No","36-1236610","30751MT0550011","Blue Preferred Bronze PPO?  102","30751MT055",,"MTN001","MTS001","MTF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550011-03","Limited Cost Sharing Plan Variation",,"0.616788148880005","Yes","Yes","Yes","60%","40%","$4,500","$0","$800","$200","$2,400","$0","$600","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","$6,450","$6450 per person","$12900 per group","$25,800","$25800 per person","$51600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%","$4,500","$4500 per person","$9000 per group","30%","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550011-03.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","11"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","7","30751","MT","Individual","No","36-1236610","30751MT0550013","Blue Preferred Gold PPO?  104","30751MT055",,"MTN001","MTS001","MTF014","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550013-00","Standard Gold Off Exchange Plan","78.41%","0","No","Yes","Yes","60%","40%","$2,050","$0","$1,000","$200","$1,800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$26,800","$26800 per person","$53600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%","$1,750","$1750 per person","$3500 per group","20%","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550013-00.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","4"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","7","30751","MT","Individual","No","36-1236610","30751MT0550013","Blue Preferred Gold PPO?  104","30751MT055",,"MTN001","MTS001","MTF014","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550013-01","Standard Gold On Exchange Plan","78.41%","0","No","Yes","Yes","60%","40%","$2,050","$0","$1,000","$200","$1,800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$26,800","$26800 per person","$53600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%","$1,750","$1750 per person","$3500 per group","20%","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550013-01.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","5"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","7","30751","MT","Individual","No","36-1236610","30751MT0550013","Blue Preferred Gold PPO?  104","30751MT055",,"MTN001","MTS001","MTF014","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550013-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550013-02.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","6"
"2016","MT","30751","SERFF","8","2016-01-29 07:27:50","7","30751","MT","Individual","No","36-1236610","30751MT0550013","Blue Preferred Gold PPO?  104","30751MT055",,"MTN001","MTS001","MTF014","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non","Yes","https://retailweb.hcsc.net/retailshoppingcart/MT/exchange_referred","https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_MT_5T_EX.pdf","30751MT0550013-03","Limited Cost Sharing Plan Variation","78.41%","0","No","Yes","Yes","60%","40%","$2,050","$0","$1,000","$200","$1,800","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","$3,350","$3350 per person","$6700 per group","$26,800","$26800 per person","$53600 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%","$1,750","$1750 per person","$3500 per group","20%","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.bcbsmt.com/PDF/sbc/30751MT0550013-03.pdf","https://www.bcbsmt.com/static/mt/pdf/sbc/2016-montana-plan-overview.pdf","7"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","Individual","No","45-1295465","32225MT0010001","Access Care Gold","32225MT001",,"MTN002","MTS001","MTF002","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0010001-00","Standard Gold Off Exchange Plan",,"0.782401919364929","Yes","Yes","No","100%",,"$750","$20","$1,950","$150","$750","$760","$320","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Access Care_Ind_GLD_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","4"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0040001","Access Care Gold","32225MT004",,"MTN002","MTS001","MTF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/explore-plans/drug-list/","32225MT0040001-00","Standard Gold Off Exchange Plan",,"0.782401919364929","Yes","Yes","No","100%",,"$750","$20","$1,950","$150","$750","$760","$320","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2016/MT_2016_Access Care_Grp_GLD_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Small-Group-Plan-Comparison.pdf","4"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0040001","Access Care Gold","32225MT004",,"MTN002","MTS001","MTF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/explore-plans/drug-list/","32225MT0040001-01","Standard Gold On Exchange Plan",,"0.782401919364929","Yes","Yes","No","100%",,"$750","$20","$1,950","$150","$750","$760","$320","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2016/MT_2016_Access Care_Grp_GLD_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Small-Group-Plan-Comparison.pdf","5"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","Individual","No","45-1295465","32225MT0010001","Access Care Gold","32225MT001",,"MTN002","MTS001","MTF002","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0010001-01","Standard Gold On Exchange Plan",,"0.782401919364929","Yes","Yes","No","100%",,"$750","$20","$1,950","$150","$750","$760","$320","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Access Care_Ind_GLD_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","5"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","Individual","No","45-1295465","32225MT0010001","Access Care Gold","32225MT001",,"MTN002","MTS001","MTF002","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0010001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Native American_Access Care_GLD_NAZCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","6"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0040002","Access Care Silver","32225MT004",,"MTN002","MTS001","MTF003","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/explore-plans/drug-list/","32225MT0040002-00","Standard Silver Off Exchange Plan",,"0.680972278118134","Yes","Yes","No","100%",,"$2,150","$20","$2,040","$150","$2,150","$550","$360","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","40%",,,,,"$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2016/MT_2016_Access Care_Grp_SIL_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Small-Group-Plan-Comparison.pdf","6"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0040002","Access Care Silver","32225MT004",,"MTN002","MTS001","MTF003","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/explore-plans/drug-list/","32225MT0040002-01","Standard Silver On Exchange Plan",,"0.680972278118134","Yes","Yes","No","100%",,"$2,150","$20","$2,040","$150","$2,150","$550","$360","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","40%",,,,,"$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2016/MT_2016_Access Care_Grp_SIL_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Small-Group-Plan-Comparison.pdf","7"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","Individual","No","45-1295465","32225MT0010002","Access Care Silver","32225MT001",,"MTN002","MTS001","MTF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0010002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Native American_Access Care_SIL_NAZCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","10"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","Individual","No","45-1295465","32225MT0010002","Access Care Silver","32225MT001",,"MTN002","MTS001","MTF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0010002-03","Limited Cost Sharing Plan Variation",,"0.680972278118134","Yes","Yes","No","100%",,"$2,150","$20","$2,040","$150","$2,150","$550","$360","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","40%",,,,,"$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Native American_Access Care_SIL_NALCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","11"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0040004","Access Care Bronze Plus","32225MT004",,"MTN002","MTS001","MTF012","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/explore-plans/drug-list/","32225MT0040004-01","Standard Bronze On Exchange Plan",,"0.606358587741852","Yes","Yes","No","100%",,"$5,000","$20","$1,360","$150","$5,000","$80","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$19,350","$19350 per person","$38700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","60%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.mhc.coop/wp-content/uploads/2016/MT_2016_Access Care_Grp_BRZ_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Small-Group-Plan-Comparison.pdf","11"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","Individual","No","45-1295465","32225MT0010002","Access Care Silver","32225MT001",,"MTN002","MTS001","MTF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0010002-04","73% AV Level Silver Plan",,"0.72032243013382","Yes","Yes","No","100%",,"$1,450","$20","$2,320","$150","$1,450","$660","$430","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$15,300","$15300 per person","$30600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group","40%",,,,,"$4,350","$4350 per person","$8700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Access Care_Ind_SIL73_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","12"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","Individual","No","45-1295465","32225MT0010002","Access Care Silver","32225MT001",,"MTN002","MTS001","MTF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0010002-05","87% AV Level Silver Plan",,"0.862073242664337","Yes","Yes","No","100%",,"$550","$10","$1,340","$150","$550","$290","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","20%",,,,,"$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Access Care_Ind_SIL87_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","13"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","Individual","No","45-1295465","32225MT0010002","Access Care Silver","32225MT001",,"MTN002","MTS001","MTF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0010002-06","94% AV Level Silver Plan",,"0.93513435125351","Yes","Yes","No","100%",,"$50","$10","$720","$150","$50","$300","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"$4,050","$4050 per person","$8100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group","10%",,,,,"$150","$150 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Access Care_Ind_SIL94_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","14"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","Individual","No","45-1295465","32225MT0010003","Access Care Bronze","32225MT001",,"MTN002","MTS001","MTF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0010003-00","Standard Bronze Off Exchange Plan",,"0.599591493606567","Yes","Yes","No","100%",,"$5,000","$20","$1,360","$150","$5,000","$80","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","60%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Access Care_Ind_BRZ_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","15"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","Individual","No","45-1295465","32225MT0010003","Access Care Bronze","32225MT001",,"MTN002","MTS001","MTF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0010003-01","Standard Bronze On Exchange Plan",,"0.599591493606567","Yes","Yes","No","100%",,"$5,000","$20","$1,360","$150","$5,000","$80","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","60%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Access Care_Ind_BRZ_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","16"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","Individual","No","45-1295465","32225MT0010003","Access Care Bronze","32225MT001",,"MTN002","MTS001","MTF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Native American_Access Care_BRZ_NAZCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","17"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","Individual","No","45-1295465","32225MT0010004","Access Care Bronze Plus","32225MT001",,"MTN002","MTS001","MTF012","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0010004-01","Standard Bronze On Exchange Plan",,"0.606358587741852","Yes","Yes","No","100%",,"$5,000","$20","$1,360","$150","$5,000","$80","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$19,350","$19350 per person","$38700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","60%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Access Care_Ind_BRZ_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","20"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","Individual","No","45-1295465","32225MT0010004","Access Care Bronze Plus","32225MT001",,"MTN002","MTS001","MTF012","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0010004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Native American_Access Care_BRZ_PLUS_NAZCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","21"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","Individual","No","45-1295465","32225MT0010004","Access Care Bronze Plus","32225MT001",,"MTN002","MTS001","MTF012","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0010004-03","Limited Cost Sharing Plan Variation",,"0.606358587741852","Yes","Yes","No","100%",,"$5,000","$20","$1,360","$150","$5,000","$80","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$19,350","$19350 per person","$38700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","60%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Native American_Access Care_BRZ_PLUS_NALCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","22"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","Individual","No","45-1295465","32225MT0030001","Access Care Catastrophic","32225MT003",,"MTN002","MTS001","MTF001","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0030001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Access Care_Ind_CAT_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","23"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","1","32225","MT","Individual","No","45-1295465","32225MT0030001","Access Care Catastrophic","32225MT003",,"MTN002","MTS001","MTF001","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0030001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Access Care_Ind_CAT_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","24"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020002","Connected Care Gold","32225MT002",,"MTN001","MTS002","MTF006","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020002-00","Standard Gold Off Exchange Plan",,"0.785783588886261","Yes","Yes","No","100%",,"750","20","1950","150","750","610","320","80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"$14,550","$14550 per person","$29100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Connected Care_Ind_GLD_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","4"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0050002","Connected Care Gold","32225MT005",,"MTN001","MTS002","MTF006","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes",,"http://www.mhc.coop/explore-plans/drug-list/","32225MT0050002-00","Standard Gold Off Exchange Plan",,"0.785783588886261","Yes","Yes","No","100%",,"$750","$20","$1,950","$150","$750","$610","$320","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"$14,550","$14550 per person","$29100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2016/MT_2016_Connected Care_Grp_GLD_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Small-Group-Plan-Comparison.pdf","4"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0050002","Connected Care Gold","32225MT005",,"MTN001","MTS002","MTF006","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes",,"http://www.mhc.coop/explore-plans/drug-list/","32225MT0050002-01","Standard Gold On Exchange Plan",,"0.785783588886261","Yes","Yes","No","100%",,"$750","$20","$1,950","$150","$750","$610","$320","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"$14,550","$14550 per person","$29100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2016/MT_2016_Connected Care_Grp_GLD_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Small-Group-Plan-Comparison.pdf","5"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020002","Connected Care Gold","32225MT002",,"MTN001","MTS002","MTF006","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020002-01","Standard Gold On Exchange Plan",,"0.785783588886261","Yes","Yes","No","100%",,"750","20","1950","150","750","610","320","80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"$14,550","$14550 per person","$29100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Connected Care_Ind_GLD_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","5"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020002","Connected Care Gold","32225MT002",,"MTN001","MTS002","MTF006","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"0","0","0","150","0","0","0","80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Native American_Connected Care_GLD_NAZCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","6"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0050003","Connected Care Silver","32225MT005",,"MTN001","MTS002","MTF007","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes",,"http://www.mhc.coop/explore-plans/drug-list/","32225MT0050003-00","Standard Silver Off Exchange Plan",,"0.681061029434204","Yes","Yes","No","100%",,"$2,150","$20","$2,040","$150","$2,150","$550","$360","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","40%",,,,,"$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2016/MT_2016_Connected Care_Grp_SIL_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Small-Group-Plan-Comparison.pdf","6"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0050003","Connected Care Silver","32225MT005",,"MTN001","MTS002","MTF007","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes",,"http://www.mhc.coop/explore-plans/drug-list/","32225MT0050003-01","Standard Silver On Exchange Plan",,"0.681061029434204","Yes","Yes","No","100%",,"$2,150","$20","$2,040","$150","$2,150","$550","$360","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","40%",,,,,"$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2016/MT_2016_Connected Care_Grp_SIL_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Small-Group-Plan-Comparison.pdf","7"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020002","Connected Care Gold","32225MT002",,"MTN001","MTS002","MTF006","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020002-03","Limited Cost Sharing Plan Variation",,"0.785783588886261","Yes","Yes","No","100%",,"750","20","1950","150","750","610","320","80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"$14,550","$14550 per person","$29100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Native American_Connected Care_GLD_NALCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","7"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020003","Connected Care Silver","32225MT002",,"MTN001","MTS002","MTF007","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020003-00","Standard Silver Off Exchange Plan",,"0.681061029434204","Yes","Yes","No","100%",,"2150","20","2040","150","2150","550","360","80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","40%",,,,,"$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Connected Care_Ind_SIL_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","8"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0050004","Connected Care Bronze","32225MT005",,"MTN001","MTS002","MTF008","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes",,"http://www.mhc.coop/explore-plans/drug-list/","32225MT0050004-00","Standard Bronze Off Exchange Plan",,"0.604670584201813","Yes","Yes","No","100%",,"$4,200","$20","$1,530","$150","$4,200","$340","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","50%",,,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2016/MT_2016_Connected Care_Grp_BRZ_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Small-Group-Plan-Comparison.pdf","8"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0050004","Connected Care Bronze","32225MT005",,"MTN001","MTS002","MTF008","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes",,"http://www.mhc.coop/explore-plans/drug-list/","32225MT0050004-01","Standard Bronze On Exchange Plan",,"0.604670584201813","Yes","Yes","No","100%",,"$4,200","$20","$1,530","$150","$4,200","$340","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","50%",,,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2016/MT_2016_Connected Care_Grp_BRZ_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Small-Group-Plan-Comparison.pdf","9"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020003","Connected Care Silver","32225MT002",,"MTN001","MTS002","MTF007","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020003-01","Standard Silver On Exchange Plan",,"0.681061029434204","Yes","Yes","No","100%",,"2150","20","2040","150","2150","550","360","80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","40%",,,,,"$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Connected Care_Ind_SIL_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","9"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020003","Connected Care Silver","32225MT002",,"MTN001","MTS002","MTF007","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"0","0","0","150","0","0","0","80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Native American_Connected Care_SIL_NAZCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","10"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0050005","Connected Care Gold Plus","32225MT005",,"MTN001","MTS002","MTF011","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes",,"http://www.mhc.coop/explore-plans/drug-list/","32225MT0050005-00","Standard Gold Off Exchange Plan",,"0.782013714313507","Yes","Yes","No","100%",,"$2,350","$0","$0","$150","$2,350","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$7,050","$7050 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","0%",,,,,"$7,050","$7050 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2016/MT_2016_Connected Care_Grp_GLD_PLUS_SBC.doc","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Small-Group-Plan-Comparison.pdf","10"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0050005","Connected Care Gold Plus","32225MT005",,"MTN001","MTS002","MTF011","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes",,"http://www.mhc.coop/explore-plans/drug-list/","32225MT0050005-01","Standard Gold On Exchange Plan",,"0.782013714313507","Yes","Yes","No","100%",,"$2,350","$0","$0","$150","$2,350","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$7,050","$7050 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","0%",,,,,"$7,050","$7050 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.mhc.coop/wp-content/uploads/2016/MT_2016_Connected Care_Grp_GLD_PLUS_SBC.doc","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Small-Group-Plan-Comparison.pdf","11"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020003","Connected Care Silver","32225MT002",,"MTN001","MTS002","MTF007","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020003-03","Limited Cost Sharing Plan Variation",,"0.681061029434204","Yes","Yes","No","100%",,"2150","20","2040","150","2150","550","360","80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","40%",,,,,"$6,450","$6450 per person","$12900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Native American_Connected Care_SIL_NALCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","11"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020003","Connected Care Silver","32225MT002",,"MTN001","MTS002","MTF007","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020003-04","73% AV Level Silver Plan",,"0.720216453075409","Yes","Yes","No","100%",,"2000","20","2100","150","2000","610","370","80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Connected Care_Ind_SIL73_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","12"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0050006","Connected Care Silver Plus","32225MT005",,"MTN001","MTS002","MTF010","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes",,"http://www.mhc.coop/explore-plans/drug-list/","32225MT0050006-00","Standard Silver Off Exchange Plan",,"0.682060480117798","Yes","Yes","No","100%",,"$4,100","$0","$0","$150","$4,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"$12,300","$12300 per person","$24600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group","0%",,,,,"$12,300","$12300 per person","$24600 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.mhc.coop/wp-content/uploads/2016/MT_2016_Connected Care_Grp_SIL_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Small-Group-Plan-Comparison.pdf","12"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0050006","Connected Care Silver Plus","32225MT005",,"MTN001","MTS002","MTF010","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes",,"http://www.mhc.coop/explore-plans/drug-list/","32225MT0050006-01","Standard Silver On Exchange Plan",,"0.682060480117798","Yes","Yes","No","100%",,"$4,100","$0","$0","$150","$4,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"$12,300","$12300 per person","$24600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group","0%",,,,,"$12,300","$12300 per person","$24600 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.mhc.coop/wp-content/uploads/2016/MT_2016_Connected Care_Grp_SIL_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Small-Group-Plan-Comparison.pdf","13"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020003","Connected Care Silver","32225MT002",,"MTN001","MTS002","MTF007","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020003-05","87% AV Level Silver Plan",,"0.864477217197418","Yes","Yes","No","100%",,"300","0","1450","150","300","550","350","80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","30%",,,,,"$900","$900 per person","$1800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Connected Care_Ind_SIL87_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","13"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020003","Connected Care Silver","32225MT002",,"MTN001","MTS002","MTF007","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020003-06","94% AV Level Silver Plan",,"0.933992743492126","Yes","Yes","No","100%",,"0","0","800","150","0","300","280","80",,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group",,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Connected Care_Ind_SIL94_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","14"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0050007","Connected Care Bronze Plus","32225MT005",,"MTN001","MTS002","MTF009","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes",,"http://www.mhc.coop/explore-plans/drug-list/","32225MT0050007-00","Standard Bronze Off Exchange Plan",,"0.614205718040466","Yes","Yes","No","100%",,"$4,200","$20","$1,530","$150","$4,200","$300","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$19,350","$19350 per person","$38700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","50%",,,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.mhc.coop/wp-content/uploads/2016/MT_2016_Connected Care_Grp_BRZ_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Small-Group-Plan-Comparison.pdf","14"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0050007","Connected Care Bronze Plus","32225MT005",,"MTN001","MTS002","MTF009","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes",,"http://www.mhc.coop/explore-plans/drug-list/","32225MT0050007-01","Standard Bronze On Exchange Plan",,"0.614205718040466","Yes","Yes","No","100%",,"$4,200","$20","$1,530","$150","$4,200","$300","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$19,350","$19350 per person","$38700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","50%",,,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.mhc.coop/wp-content/uploads/2016/MT_2016_Connected Care_Grp_BRZ_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Small-Group-Plan-Comparison.pdf","15"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020004","Connected Care Bronze","32225MT002",,"MTN001","MTS002","MTF008","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020004-00","Standard Bronze Off Exchange Plan",,"0.604670584201813","Yes","Yes","No","100%",,"4200","20","1530","150","4200","340","90","80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","50%",,,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Connected Care_Ind_BRZ_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","15"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020004","Connected Care Bronze","32225MT002",,"MTN001","MTS002","MTF008","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020004-01","Standard Bronze On Exchange Plan",,"0.604670584201813","Yes","Yes","No","100%",,"4200","20","1530","150","4200","340","90","80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","50%",,,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Connected Care_Ind_BRZ_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","16"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020004","Connected Care Bronze","32225MT002",,"MTN001","MTS002","MTF008","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"0","0","0","150","0","0","0","80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Native American_Connected Care_BRZ_NAZCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","17"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020004","Connected Care Bronze","32225MT002",,"MTN001","MTS002","MTF008","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020004-03","Limited Cost Sharing Plan Variation",,"0.604670584201813","Yes","Yes","No","100%",,"4200","20","1530","150","4200","340","90","80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","50%",,,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Native American_Connected Care_BRZ_NALCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","18"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020005","Connected Care Gold Plus","32225MT002",,"MTN001","MTS002","MTF011","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020005-00","Standard Gold Off Exchange Plan",,"0.782013714313507","Yes","Yes","No","100%",,"2350","0","0","150","2350","0","0","80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$7,050","$7050 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","0%",,,,,"$7,050","$7050 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Connected Care_Ind_GLD_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","19"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020005","Connected Care Gold Plus","32225MT002",,"MTN001","MTS002","MTF011","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020005-01","Standard Gold On Exchange Plan",,"0.782013714313507","Yes","Yes","No","100%",,"2350","0","0","150","2350","0","0","80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$7,050","$7050 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","0%",,,,,"$7,050","$7050 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Connected Care_Ind_GLD_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","20"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020005","Connected Care Gold Plus","32225MT002",,"MTN001","MTS002","MTF011","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"0","0","0","150","0","0","0","80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Native American_Connected Care_GLD_PLUS_NAZCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","21"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020005","Connected Care Gold Plus","32225MT002",,"MTN001","MTS002","MTF011","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020005-03","Limited Cost Sharing Plan Variation",,"0.782013714313507","Yes","Yes","No","100%",,"2350","0","0","150","2350","0","0","80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group",,,,"$7,050","$7050 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","0%",,,,,"$7,050","$7050 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Native American_Connected Care_GLD_PLUS_NALCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","22"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020006","Connected Care Silver Plus","32225MT002",,"MTN001","MTS002","MTF010","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020006-00","Standard Silver Off Exchange Plan",,"0.682060480117798","Yes","Yes","No","100%",,"4100","0","0","150","4100","0","0","80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"$12,300","$12300 per person","$24600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group","0%",,,,,"$12,300","$12300 per person","$24600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Connected Care_Ind_SIL_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","23"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020006","Connected Care Silver Plus","32225MT002",,"MTN001","MTS002","MTF010","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020006-01","Standard Silver On Exchange Plan",,"0.682060480117798","Yes","Yes","No","100%",,"4100","0","0","150","4100","0","0","80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"$12,300","$12300 per person","$24600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group","0%",,,,,"$12,300","$12300 per person","$24600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Connected Care_Ind_SIL_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","24"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020006","Connected Care Silver Plus","32225MT002",,"MTN001","MTS002","MTF010","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"0","0","0","150","0","0","0","80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Native American_Connected Care_SIL_PLUS_NAZCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","25"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020006","Connected Care Silver Plus","32225MT002",,"MTN001","MTS002","MTF010","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020006-03","Limited Cost Sharing Plan Variation",,"0.682060480117798","Yes","Yes","No","100%",,"4100","0","0","150","4100","0","0","80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group",,,,"$12,300","$12300 per person","$24600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group","0%",,,,,"$12,300","$12300 per person","$24600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Native American_Connected Care_SIL_PLUS_NALCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","26"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020006","Connected Care Silver Plus","32225MT002",,"MTN001","MTS002","MTF010","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020006-04","73% AV Level Silver Plan",,"0.722176313400269","Yes","Yes","No","100%",,"3300","0","0","150","3300","0","0","80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group",,,,"$9,900","$9900 per person","$19800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group","0%",,,,,"$9,900","$9900 per person","$19800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Connected Care_Ind_SIL73_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","27"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020006","Connected Care Silver Plus","32225MT002",,"MTN001","MTS002","MTF010","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020006-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"1250","0","0","150","1250","0","0","80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$3,750","$3750 per person","$7500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%",,,,,"$3,750","$3750 per person","$7500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Connected Care_Ind_SIL87_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","28"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020006","Connected Care Silver Plus","32225MT002",,"MTN001","MTS002","MTF010","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020006-06","94% AV Level Silver Plan",,"0.934249639511108","Yes","Yes","No","100%",,"550","0","0","150","550","0","0","80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Connected Care_Ind_SIL94_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","29"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020007","Connected Care Bronze Plus","32225MT002",,"MTN001","MTS002","MTF009","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020007-00","Standard Bronze Off Exchange Plan",,"0.614205718040466","Yes","Yes","No","100%",,"4200","20","1530","150","4200","300","140","80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$19,350","$19350 per person","$38700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","50%",,,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Connected Care_Ind_BRZ_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","30"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020007","Connected Care Bronze Plus","32225MT002",,"MTN001","MTS002","MTF009","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020007-01","Standard Bronze On Exchange Plan",,"0.614205718040466","Yes","Yes","No","100%",,"4200","20","1530","150","4200","300","140","80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$19,350","$19350 per person","$38700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","50%",,,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Connected Care_Ind_BRZ_PLUS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","31"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020007","Connected Care Bronze Plus","32225MT002",,"MTN001","MTS002","MTF009","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"0","0","0","150","0","0","0","80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Native American_Connected Care_BRZ_PLUS_NAZCS_SBC.pdf","http://www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","32"
"2016","MT","32225","SERFF","12","2015-10-21 17:48:08","3","32225","MT","Individual","No","45-1295465","32225MT0020007","Connected Care Bronze Plus","32225MT002",,"MTN001","MTS002","MTF009","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","https://service.healthplan.com/","http://www.mhc.coop/explore-plans/drug-list/","32225MT0020007-03","Limited Cost Sharing Plan Variation",,"0.614205718040466","Yes","Yes","No","100%",,"4200","20","1530","150","4200","300","140","80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$19,350","$19350 per person","$38700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","50%",,,,,"$12,600","$12600 per person","$25200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mhc.coop/wp-content/uploads/2016/2016_MT_Native American_Connected Care_BRZ_PLUS_NALCS_SBC.pdf","www.mhc.coop/wp-content /uploads/2016/MHC-MT-Ind-Plan-Comparison.pdf","33"
"2016","MT","46668","SERFF","4","2015-08-21 06:27:38","1","46668","MT","Individual","Yes","47-0397286","46668MT0070001","Renaissance Individual Dental Indemnity, EHB Certified","46668MT007",,"MTN001","MTS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.86","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","46668MT0070001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MT","46668","SERFF","4","2015-08-21 06:27:38","1","46668","MT","SHOP (Small Group)","Yes","47-0397286","46668MT0060001","Renaissance Group Dental Indemnity, EHB Certified","46668MT006",,"MTN001","MTS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.21","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","46668MT0060001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MT","46668","SERFF","4","2015-08-21 06:27:38","1","46668","MT","SHOP (Small Group)","Yes","47-0397286","46668MT0060002","Renaissance Group Dental Indemnity, EHB Certified","46668MT006",,"MTN001","MTS001",,"Existing","Indemnity","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.99","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","46668MT0060002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MT","46668","SERFF","4","2015-08-21 06:27:38","1","46668","MT","Individual","Yes","47-0397286","46668MT0070002","Renaissance Individual Dental Indemnity, EHB Certified","46668MT007",,"MTN001","MTS001",,"Existing","Indemnity","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.12","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","46668MT0070002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MT","59110","SERFF","3","2015-08-21 06:27:38","1","59110","MT","SHOP (Small Group)","Yes","57-0523959","59110MT0020001","Group Dental Policy","59110MT002",,"MTN001","MTS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","59110MT0020001-00","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MT","59968","SERFF","3","2015-08-21 06:27:38","1","59968","MT","SHOP (Small Group)","Yes","36-0883760","59968MT0030002","EHB High Passive","59968MT003",,"MTN001","MTS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$47.90","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","59968MT0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","MT","59968","SERFF","3","2015-08-21 06:27:38","1","59968","MT","SHOP (Small Group)","Yes","36-0883760","59968MT0030001","EHB Low Passive","59968MT003",,"MTN001","MTS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.47","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","59968MT0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","MT","62818","SERFF","4","2015-08-21 06:27:38","1","62818","MT","SHOP (Small Group)","Yes","13-5123390","62818MT0010002","Guardian Pediatric Advantage","62818MT001",,"MTN001","MTS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$45.22","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","62818MT0010002-00","Standard High Off Exchange Plan","85.30%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","MT","62818","SERFF","4","2015-08-21 06:27:38","1","62818","MT","SHOP (Small Group)","Yes","13-5123390","62818MT0020002","Guardian Pediatric Essentials","62818MT002",,"MTN001","MTS001",,"Existing","Indemnity","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$35.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","62818MT0020002-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","MT","62818","SERFF","4","2015-08-21 06:27:38","2","62818","MT","SHOP (Small Group)","Yes","13-5123390","62818MT0040002","Guardian Family Advantage","62818MT004",,"MTN001","MTS001",,"Existing","Indemnity","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$45.22","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","62818MT0040002-00","Standard High Off Exchange Plan","85.30%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","MT","62818","SERFF","4","2015-08-21 06:27:38","2","62818","MT","SHOP (Small Group)","Yes","13-5123390","62818MT0040002","Guardian Family Advantage","62818MT004",,"MTN001","MTS001",,"Existing","Indemnity","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$45.22","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","62818MT0040002-01","Standard High On Exchange Plan","85.30%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","MT","62818","SERFF","4","2015-08-21 06:27:38","2","62818","MT","SHOP (Small Group)","Yes","13-5123390","62818MT0060002","Guardian Family Essentials","62818MT006",,"MTN001","MTS001",,"Existing","Indemnity","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","62818MT0060002-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","MT","62818","SERFF","4","2015-08-21 06:27:38","2","62818","MT","SHOP (Small Group)","Yes","13-5123390","62818MT0060002","Guardian Family Essentials","62818MT006",,"MTN001","MTS001",,"Existing","Indemnity","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","62818MT0060002-01","Standard Low On Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","MT","70415","SERFF","3","2015-08-21 06:27:38","1","70415","MT","SHOP (Small Group)","Yes","47-0098400","70415MT0030002","EHB High Passive","70415MT003",,"MTN001","MTS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$47.24","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","70415MT0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","12","15438","NE","Individual","No","42-1308659","15438NE0170005","Coventry Bronze HSA Eligible CHI Health Omaha","15438NE017",,"NEN002","NES002","NEF012","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0170005-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NE61133","http://www.coventryone.com/NEon2016","7"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","14","15438","NE","Individual","No","42-1308659","15438NE0150005","Coventry Bronze HSA Eligible Methodist Health Partners","15438NE015",,"NEN004","NES004","NEF004","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0150005-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NE61231","http://www.coventryone.com/NEon2016","4"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","14","15438","NE","Individual","No","42-1308659","15438NE0150005","Coventry Bronze HSA Eligible Methodist Health Partners","15438NE015",,"NEN004","NES004","NEF004","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0150005-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NE61112","http://www.coventryone.com/NEon2016","5"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","14","15438","NE","Individual","No","42-1308659","15438NE0150005","Coventry Bronze HSA Eligible Methodist Health Partners","15438NE015",,"NEN004","NES004","NEF004","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0150005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61113","http://www.coventryone.com/NEon2016","6"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","14","15438","NE","Individual","No","42-1308659","15438NE0150005","Coventry Bronze HSA Eligible Methodist Health Partners","15438NE015",,"NEN004","NES004","NEF004","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0150005-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NE61114","http://www.coventryone.com/NEon2016","7"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","16","15438","NE","Individual","No","42-1308659","15438NE0160005","Coventry Bronze HSA Eligible MIPPA","15438NE016",,"NEN003","NES003","NEF008","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0160005-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NE61235","http://www.coventryone.com/NEon2016","4"
"2016","MT","70415","SERFF","3","2015-08-21 06:27:38","1","70415","MT","SHOP (Small Group)","Yes","47-0098400","70415MT0030001","EHB Low Passive","70415MT003",,"MTN001","MTS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.06","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","70415MT0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","MT","71788","SERFF","4","2015-08-27 03:52:03","1","71788","MT","SHOP (Small Group)","Yes","94-2761537","71788MT0020002","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","71788MT002",,"MTN001","MTS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","71788MT0020002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/mt/71788mt0020002-16","4"
"2016","MT","71788","SERFF","4","2015-08-27 03:52:03","1","71788","MT","Individual","Yes","94-2761537","71788MT0010002","Delta Dental PPO Pediatric Preferred Plan","71788MT001",,"MTN001","MTS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.74","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","71788MT0010002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/mt/71788mt0010002-16","4"
"2016","MT","71788","SERFF","4","2015-08-27 03:52:03","1","71788","MT","SHOP (Small Group)","Yes","94-2761537","71788MT0020001","Delta Dental PPO Pediatric Basic Plan for Small Businesses","71788MT002",,"MTN001","MTS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.25","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","71788MT0020001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/mt/71788mt0020001-16","5"
"2016","MT","71788","SERFF","4","2015-08-27 03:52:03","1","71788","MT","Individual","Yes","94-2761537","71788MT0010001","Delta Dental PPO Pediatric Basic Plan","71788MT001",,"MTN001","MTS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.06","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","71788MT0010001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/mt/71788mt0010001-16","5"
"2016","MT","71788","SERFF","4","2015-08-27 03:52:03","2","71788","MT","SHOP (Small Group)","Yes","94-2761537","71788MT0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","71788MT002",,"MTN001","MTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","71788MT0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/mt/71788mt0020004-16","4"
"2016","MT","71788","SERFF","4","2015-08-27 03:52:03","2","71788","MT","Individual","Yes","94-2761537","71788MT0010004","Delta Dental PPO Preferred Plan for Families","71788MT001",,"MTN001","MTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.74","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","71788MT0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/mt/71788mt0010004-16","4"
"2016","MT","71788","SERFF","4","2015-08-27 03:52:03","2","71788","MT","Individual","Yes","94-2761537","71788MT0010004","Delta Dental PPO Preferred Plan for Families","71788MT001",,"MTN001","MTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.74","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","71788MT0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/mt/71788mt0010004-16","5"
"2016","MT","71788","SERFF","4","2015-08-27 03:52:03","2","71788","MT","SHOP (Small Group)","Yes","94-2761537","71788MT0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","71788MT002",,"MTN001","MTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","71788MT0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$85","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/mt/71788mt0020004-16","5"
"2016","MT","71788","SERFF","4","2015-08-27 03:52:03","3","71788","MT","SHOP (Small Group)","Yes","94-2761537","71788MT0020009","Delta Dental PPO Basic Plan for Families for Small Businesses","71788MT002",,"MTN001","MTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.25","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","71788MT0020009-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/mt/71788mt0020009-16","4"
"2016","MT","71788","SERFF","4","2015-08-27 03:52:03","3","71788","MT","Individual","Yes","94-2761537","71788MT0010009","Delta Dental PPO Basic Plan for Families","71788MT001",,"MTN001","MTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.06","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","71788MT0010009-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/mt/71788mt0010009-16","4"
"2016","MT","71788","SERFF","4","2015-08-27 03:52:03","3","71788","MT","Individual","Yes","94-2761537","71788MT0010009","Delta Dental PPO Basic Plan for Families","71788MT001",,"MTN001","MTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.06","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","71788MT0010009-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/mt/71788mt0010009-16","5"
"2016","MT","71788","SERFF","4","2015-08-27 03:52:03","3","71788","MT","SHOP (Small Group)","Yes","94-2761537","71788MT0020009","Delta Dental PPO Basic Plan for Families for Small Businesses","71788MT002",,"MTN001","MTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.25","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.deltadentalins.com/hx/checkout","","71788MT0020009-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalins.com/hcx/mt/71788mt0020009-16","5"
"2016","MT","92216","SERFF","4","2015-08-21 06:27:38","1","92216","MT","SHOP (Small Group)","Yes","93-0242990","92216MT0030002","EHB High Passive","92216MT003",,"MTN001","MTS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$48.04","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","92216MT0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","MT","92216","SERFF","4","2015-08-21 06:27:38","1","92216","MT","SHOP (Small Group)","Yes","93-0242990","92216MT0030001","EHB Low Passive","92216MT003",,"MTN001","MTS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.56","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","92216MT0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","MT","93895","SERFF","4","2015-08-21 06:27:38","1","93895","MT","Individual","Yes","95-6042390","93895MT0020003","BESTOne Advantage Gold","93895MT002",,"MTN001","MTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$52.02","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MT","93895","SERFF","4","2015-08-21 06:27:38","1","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010007","BESTDental Premium","93895MT001",,"MTN001","MTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.64","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MT","93895","SERFF","4","2015-08-21 06:27:38","1","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010007","BESTDental Premium","93895MT001",,"MTN001","MTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.64","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MT","93895","SERFF","4","2015-08-21 06:27:38","1","93895","MT","Individual","Yes","95-6042390","93895MT0020003","BESTOne Advantage Gold","93895MT002",,"MTN001","MTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$52.02","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MT","93895","SERFF","4","2015-08-21 06:27:38","1","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010008","BESTDental Standard - H","93895MT001",,"MTN001","MTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.64","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","MT","93895","SERFF","4","2015-08-21 06:27:38","1","93895","MT","Individual","Yes","95-6042390","93895MT0020004","BESTOne Plus Gold","93895MT002",,"MTN001","MTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$52.02","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","MT","93895","SERFF","4","2015-08-21 06:27:38","1","93895","MT","Individual","Yes","95-6042390","93895MT0020004","BESTOne Plus Gold","93895MT002",,"MTN001","MTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$52.02","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","MT","93895","SERFF","4","2015-08-21 06:27:38","1","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010008","BESTDental Standard - H","93895MT001",,"MTN001","MTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.64","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","MT","93895","SERFF","4","2015-08-21 06:27:38","1","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010010","BESTDental Choice - H","93895MT001",,"MTN001","MTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.64","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","MT","93895","SERFF","4","2015-08-21 06:27:38","1","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010010","BESTDental Choice - H","93895MT001",,"MTN001","MTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.64","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","MT","93895","SERFF","4","2015-08-21 06:27:38","2","93895","MT","Individual","Yes","95-6042390","93895MT0020005","BESTOne Plus Silver","93895MT002",,"MTN001","MTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$47.05","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MT","93895","SERFF","4","2015-08-21 06:27:38","2","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010009","BESTDental Standard - L","93895MT001",,"MTN001","MTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.64","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","MT","93895","SERFF","4","2015-08-21 06:27:38","2","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010009","BESTDental Standard - L","93895MT001",,"MTN001","MTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.64","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MT","93895","SERFF","4","2015-08-21 06:27:38","2","93895","MT","Individual","Yes","95-6042390","93895MT0020005","BESTOne Plus Silver","93895MT002",,"MTN001","MTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$47.05","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","MT","93895","SERFF","4","2015-08-21 06:27:38","2","93895","MT","Individual","Yes","95-6042390","93895MT0020006","BESTOne Basic Silver","93895MT002",,"MTN001","MTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$47.05","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","MT","93895","SERFF","4","2015-08-21 06:27:38","2","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010011","BESTDental Choice - L","93895MT001",,"MTN001","MTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.64","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","MT","93895","SERFF","4","2015-08-21 06:27:38","2","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010011","BESTDental Choice - L","93895MT001",,"MTN001","MTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.64","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","MT","93895","SERFF","4","2015-08-21 06:27:38","2","93895","MT","Individual","Yes","95-6042390","93895MT0020006","BESTOne Basic Silver","93895MT002",,"MTN001","MTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$47.05","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","MT","93895","SERFF","4","2015-08-21 06:27:38","2","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010012","BESTDental Value","93895MT001",,"MTN001","MTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.64","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","MT","93895","SERFF","4","2015-08-21 06:27:38","2","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010012","BESTDental Value","93895MT001",,"MTN001","MTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.64","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","93895MT0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","1","15438","NE","Individual","No","42-1308659","15438NE0180003","Coventry Bronze $15 Copay","15438NE018",,"NEN001","NES001","NEF015","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0180003-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61226","http://www.coventryone.com/NEon2016","4"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","1","15438","NE","Individual","No","42-1308659","15438NE0180003","Coventry Bronze $15 Copay","15438NE018",,"NEN001","NES001","NEF015","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0180003-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61185","http://www.coventryone.com/NEon2016","5"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","1","15438","NE","Individual","No","42-1308659","15438NE0180003","Coventry Bronze $15 Copay","15438NE018",,"NEN001","NES001","NEF015","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0180003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61186","http://www.coventryone.com/NEon2016","6"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","1","15438","NE","Individual","No","42-1308659","15438NE0180003","Coventry Bronze $15 Copay","15438NE018",,"NEN001","NES001","NEF015","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0180003-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61187","http://www.coventryone.com/NEon2016","7"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","2","15438","NE","Individual","No","42-1308659","15438NE0170003","Coventry Bronze $15 Copay CHI Health Omaha","15438NE017",,"NEN002","NES002","NEF011","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0170003-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61222","http://www.coventryone.com/NEon2016","4"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","2","15438","NE","Individual","No","42-1308659","15438NE0170003","Coventry Bronze $15 Copay CHI Health Omaha","15438NE017",,"NEN002","NES002","NEF011","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0170003-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61128","http://www.coventryone.com/NEon2016","5"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","2","15438","NE","Individual","No","42-1308659","15438NE0170003","Coventry Bronze $15 Copay CHI Health Omaha","15438NE017",,"NEN002","NES002","NEF011","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0170003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61129","http://www.coventryone.com/NEon2016","6"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","2","15438","NE","Individual","No","42-1308659","15438NE0170003","Coventry Bronze $15 Copay CHI Health Omaha","15438NE017",,"NEN002","NES002","NEF011","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0170003-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61130","http://www.coventryone.com/NEon2016","7"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","4","15438","NE","Individual","No","42-1308659","15438NE0150003","Coventry Bronze $15 Copay Methodist Health Partners","15438NE015",,"NEN004","NES004","NEF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0150003-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61230","http://www.coventryone.com/NEon2016","4"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","4","15438","NE","Individual","No","42-1308659","15438NE0150003","Coventry Bronze $15 Copay Methodist Health Partners","15438NE015",,"NEN004","NES004","NEF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0150003-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61109","http://www.coventryone.com/NEon2016","5"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","4","15438","NE","Individual","No","42-1308659","15438NE0150003","Coventry Bronze $15 Copay Methodist Health Partners","15438NE015",,"NEN004","NES004","NEF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0150003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61110","http://www.coventryone.com/NEon2016","6"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","4","15438","NE","Individual","No","42-1308659","15438NE0150003","Coventry Bronze $15 Copay Methodist Health Partners","15438NE015",,"NEN004","NES004","NEF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0150003-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61111","http://www.coventryone.com/NEon2016","7"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","6","15438","NE","Individual","No","42-1308659","15438NE0160003","Coventry Bronze $15 Copay MIPPA","15438NE016",,"NEN003","NES003","NEF007","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0160003-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61234","http://www.coventryone.com/NEon2016","4"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","6","15438","NE","Individual","No","42-1308659","15438NE0160003","Coventry Bronze $15 Copay MIPPA","15438NE016",,"NEN003","NES003","NEF007","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0160003-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61147","http://www.coventryone.com/NEon2016","5"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","6","15438","NE","Individual","No","42-1308659","15438NE0160003","Coventry Bronze $15 Copay MIPPA","15438NE016",,"NEN003","NES003","NEF007","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0160003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61148","http://www.coventryone.com/NEon2016","6"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","6","15438","NE","Individual","No","42-1308659","15438NE0160003","Coventry Bronze $15 Copay MIPPA","15438NE016",,"NEN003","NES003","NEF007","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0160003-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61149","http://www.coventryone.com/NEon2016","7"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","8","15438","NE","Individual","No","42-1308659","15438NE0280001","Coventry Bronze $15 Copay Nebraska Health Network","15438NE028",,"NEN005","NES005","NEF041","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0280001-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61218","http://www.coventryone.com/NEon2016","4"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","8","15438","NE","Individual","No","42-1308659","15438NE0280001","Coventry Bronze $15 Copay Nebraska Health Network","15438NE028",,"NEN005","NES005","NEF041","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0280001-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61166","http://www.coventryone.com/NEon2016","5"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","8","15438","NE","Individual","No","42-1308659","15438NE0280001","Coventry Bronze $15 Copay Nebraska Health Network","15438NE028",,"NEN005","NES005","NEF041","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0280001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61167","http://www.coventryone.com/NEon2016","6"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","8","15438","NE","Individual","No","42-1308659","15438NE0280001","Coventry Bronze $15 Copay Nebraska Health Network","15438NE028",,"NEN005","NES005","NEF041","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0280001-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61168","http://www.coventryone.com/NEon2016","7"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","11","15438","NE","Individual","No","42-1308659","15438NE0180005","Coventry Bronze HSA Eligible","15438NE018",,"NEN001","NES001","NEF016","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0180005-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NE61227","http://www.coventryone.com/NEon2016","4"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","11","15438","NE","Individual","No","42-1308659","15438NE0180005","Coventry Bronze HSA Eligible","15438NE018",,"NEN001","NES001","NEF016","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0180005-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NE61188","http://www.coventryone.com/NEon2016","5"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","11","15438","NE","Individual","No","42-1308659","15438NE0180005","Coventry Bronze HSA Eligible","15438NE018",,"NEN001","NES001","NEF016","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0180005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61189","http://www.coventryone.com/NEon2016","6"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","11","15438","NE","Individual","No","42-1308659","15438NE0180005","Coventry Bronze HSA Eligible","15438NE018",,"NEN001","NES001","NEF016","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0180005-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NE61190","http://www.coventryone.com/NEon2016","7"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","12","15438","NE","Individual","No","42-1308659","15438NE0170005","Coventry Bronze HSA Eligible CHI Health Omaha","15438NE017",,"NEN002","NES002","NEF012","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0170005-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NE61223","http://www.coventryone.com/NEon2016","4"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","12","15438","NE","Individual","No","42-1308659","15438NE0170005","Coventry Bronze HSA Eligible CHI Health Omaha","15438NE017",,"NEN002","NES002","NEF012","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0170005-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NE61131","http://www.coventryone.com/NEon2016","5"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","12","15438","NE","Individual","No","42-1308659","15438NE0170005","Coventry Bronze HSA Eligible CHI Health Omaha","15438NE017",,"NEN002","NES002","NEF012","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0170005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61132","http://www.coventryone.com/NEon2016","6"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","16","15438","NE","Individual","No","42-1308659","15438NE0160005","Coventry Bronze HSA Eligible MIPPA","15438NE016",,"NEN003","NES003","NEF008","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0160005-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NE61150","http://www.coventryone.com/NEon2016","5"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","16","15438","NE","Individual","No","42-1308659","15438NE0160005","Coventry Bronze HSA Eligible MIPPA","15438NE016",,"NEN003","NES003","NEF008","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0160005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61151","http://www.coventryone.com/NEon2016","6"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","16","15438","NE","Individual","No","42-1308659","15438NE0160005","Coventry Bronze HSA Eligible MIPPA","15438NE016",,"NEN003","NES003","NEF008","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0160005-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NE61152","http://www.coventryone.com/NEon2016","7"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","18","15438","NE","Individual","No","42-1308659","15438NE0280003","Coventry Bronze HSA Eligible Nebraska Health Network","15438NE028",,"NEN005","NES005","NEF043","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0280003-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NE61219","http://www.coventryone.com/NEon2016","4"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","18","15438","NE","Individual","No","42-1308659","15438NE0280003","Coventry Bronze HSA Eligible Nebraska Health Network","15438NE028",,"NEN005","NES005","NEF043","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0280003-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NE61169","http://www.coventryone.com/NEon2016","5"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","18","15438","NE","Individual","No","42-1308659","15438NE0280003","Coventry Bronze HSA Eligible Nebraska Health Network","15438NE028",,"NEN005","NES005","NEF043","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0280003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/NE61170","http://www.coventryone.com/NEon2016","6"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","18","15438","NE","Individual","No","42-1308659","15438NE0280003","Coventry Bronze HSA Eligible Nebraska Health Network","15438NE028",,"NEN005","NES005","NEF043","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8494781408","15438NE0280003-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/NE61171","http://www.coventryone.com/NEon2016","7"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","21","15438","NE","Individual","No","42-1308659","15438NE0180002","Coventry Silver $10 Copay","15438NE018",,"NEN001","NES001","NEF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0180002-00","Standard Silver Off Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61225","http://www.coventryone.com/NEon2016","4"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","21","15438","NE","Individual","No","42-1308659","15438NE0180002","Coventry Silver $10 Copay","15438NE018",,"NEN001","NES001","NEF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0180002-01","Standard Silver On Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61179","http://www.coventryone.com/NEon2016","5"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","21","15438","NE","Individual","No","42-1308659","15438NE0180002","Coventry Silver $10 Copay","15438NE018",,"NEN001","NES001","NEF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0180002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61183","http://www.coventryone.com/NEon2016","6"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","21","15438","NE","Individual","No","42-1308659","15438NE0180002","Coventry Silver $10 Copay","15438NE018",,"NEN001","NES001","NEF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0180002-03","Limited Cost Sharing Plan Variation","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61184","http://www.coventryone.com/NEon2016","7"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","21","15438","NE","Individual","No","42-1308659","15438NE0180002","Coventry Silver $10 Copay","15438NE018",,"NEN001","NES001","NEF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0180002-04","73% AV Level Silver Plan","72.09%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61182","http://www.coventryone.com/NEon2016","8"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","21","15438","NE","Individual","No","42-1308659","15438NE0180002","Coventry Silver $10 Copay","15438NE018",,"NEN001","NES001","NEF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0180002-05","87% AV Level Silver Plan","86.14%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61181","http://www.coventryone.com/NEon2016","9"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","21","15438","NE","Individual","No","42-1308659","15438NE0180002","Coventry Silver $10 Copay","15438NE018",,"NEN001","NES001","NEF014","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0180002-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61180","http://www.coventryone.com/NEon2016","10"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","22","15438","NE","Individual","No","42-1308659","15438NE0170002","Coventry Silver $10 Copay CHI Health Omaha","15438NE017",,"NEN002","NES002","NEF010","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0170002-00","Standard Silver Off Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61221","http://www.coventryone.com/NEon2016","4"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","22","15438","NE","Individual","No","42-1308659","15438NE0170002","Coventry Silver $10 Copay CHI Health Omaha","15438NE017",,"NEN002","NES002","NEF010","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0170002-01","Standard Silver On Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61122","http://www.coventryone.com/NEon2016","5"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","22","15438","NE","Individual","No","42-1308659","15438NE0170002","Coventry Silver $10 Copay CHI Health Omaha","15438NE017",,"NEN002","NES002","NEF010","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0170002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61126","http://www.coventryone.com/NEon2016","6"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","22","15438","NE","Individual","No","42-1308659","15438NE0170002","Coventry Silver $10 Copay CHI Health Omaha","15438NE017",,"NEN002","NES002","NEF010","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0170002-03","Limited Cost Sharing Plan Variation","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61127","http://www.coventryone.com/NEon2016","7"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","22","15438","NE","Individual","No","42-1308659","15438NE0170002","Coventry Silver $10 Copay CHI Health Omaha","15438NE017",,"NEN002","NES002","NEF010","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0170002-04","73% AV Level Silver Plan","72.09%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61125","http://www.coventryone.com/NEon2016","8"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","22","15438","NE","Individual","No","42-1308659","15438NE0170002","Coventry Silver $10 Copay CHI Health Omaha","15438NE017",,"NEN002","NES002","NEF010","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0170002-05","87% AV Level Silver Plan","86.14%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61124","http://www.coventryone.com/NEon2016","9"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","22","15438","NE","Individual","No","42-1308659","15438NE0170002","Coventry Silver $10 Copay CHI Health Omaha","15438NE017",,"NEN002","NES002","NEF010","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0170002-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61123","http://www.coventryone.com/NEon2016","10"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","24","15438","NE","Individual","No","42-1308659","15438NE0150002","Coventry Silver $10 Copay Methodist Health Partners","15438NE015",,"NEN004","NES004","NEF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0150002-00","Standard Silver Off Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61229","http://www.coventryone.com/NEon2016","4"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","24","15438","NE","Individual","No","42-1308659","15438NE0150002","Coventry Silver $10 Copay Methodist Health Partners","15438NE015",,"NEN004","NES004","NEF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0150002-01","Standard Silver On Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61103","http://www.coventryone.com/NEon2016","5"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","24","15438","NE","Individual","No","42-1308659","15438NE0150002","Coventry Silver $10 Copay Methodist Health Partners","15438NE015",,"NEN004","NES004","NEF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0150002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61107","http://www.coventryone.com/NEon2016","6"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","24","15438","NE","Individual","No","42-1308659","15438NE0150002","Coventry Silver $10 Copay Methodist Health Partners","15438NE015",,"NEN004","NES004","NEF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0150002-03","Limited Cost Sharing Plan Variation","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61108","http://www.coventryone.com/NEon2016","7"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","24","15438","NE","Individual","No","42-1308659","15438NE0150002","Coventry Silver $10 Copay Methodist Health Partners","15438NE015",,"NEN004","NES004","NEF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0150002-04","73% AV Level Silver Plan","72.09%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61106","http://www.coventryone.com/NEon2016","8"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","24","15438","NE","Individual","No","42-1308659","15438NE0150002","Coventry Silver $10 Copay Methodist Health Partners","15438NE015",,"NEN004","NES004","NEF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0150002-05","87% AV Level Silver Plan","86.14%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61105","http://www.coventryone.com/NEon2016","9"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","24","15438","NE","Individual","No","42-1308659","15438NE0150002","Coventry Silver $10 Copay Methodist Health Partners","15438NE015",,"NEN004","NES004","NEF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0150002-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61104","http://www.coventryone.com/NEon2016","10"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","26","15438","NE","Individual","No","42-1308659","15438NE0160002","Coventry Silver $10 Copay MIPPA","15438NE016",,"NEN003","NES003","NEF006","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0160002-00","Standard Silver Off Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61233","http://www.coventryone.com/NEon2016","4"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","26","15438","NE","Individual","No","42-1308659","15438NE0160002","Coventry Silver $10 Copay MIPPA","15438NE016",,"NEN003","NES003","NEF006","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0160002-01","Standard Silver On Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61141","http://www.coventryone.com/NEon2016","5"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","26","15438","NE","Individual","No","42-1308659","15438NE0160002","Coventry Silver $10 Copay MIPPA","15438NE016",,"NEN003","NES003","NEF006","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0160002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61145","http://www.coventryone.com/NEon2016","6"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","26","15438","NE","Individual","No","42-1308659","15438NE0160002","Coventry Silver $10 Copay MIPPA","15438NE016",,"NEN003","NES003","NEF006","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0160002-03","Limited Cost Sharing Plan Variation","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61146","http://www.coventryone.com/NEon2016","7"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","26","15438","NE","Individual","No","42-1308659","15438NE0160002","Coventry Silver $10 Copay MIPPA","15438NE016",,"NEN003","NES003","NEF006","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0160002-04","73% AV Level Silver Plan","72.09%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61144","http://www.coventryone.com/NEon2016","8"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","26","15438","NE","Individual","No","42-1308659","15438NE0160002","Coventry Silver $10 Copay MIPPA","15438NE016",,"NEN003","NES003","NEF006","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0160002-05","87% AV Level Silver Plan","86.14%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61143","http://www.coventryone.com/NEon2016","9"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","26","15438","NE","Individual","No","42-1308659","15438NE0160002","Coventry Silver $10 Copay MIPPA","15438NE016",,"NEN003","NES003","NEF006","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0160002-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61142","http://www.coventryone.com/NEon2016","10"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","28","15438","NE","Individual","No","42-1308659","15438NE0280007","Coventry Silver $10 Copay Nebraska Health Network","15438NE028",,"NEN005","NES005","NEF047","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0280007-00","Standard Silver Off Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61217","http://www.coventryone.com/NEon2016","4"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","28","15438","NE","Individual","No","42-1308659","15438NE0280007","Coventry Silver $10 Copay Nebraska Health Network","15438NE028",,"NEN005","NES005","NEF047","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0280007-01","Standard Silver On Exchange Plan","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61160","http://www.coventryone.com/NEon2016","5"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","28","15438","NE","Individual","No","42-1308659","15438NE0280007","Coventry Silver $10 Copay Nebraska Health Network","15438NE028",,"NEN005","NES005","NEF047","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0280007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61164","http://www.coventryone.com/NEon2016","6"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","28","15438","NE","Individual","No","42-1308659","15438NE0280007","Coventry Silver $10 Copay Nebraska Health Network","15438NE028",,"NEN005","NES005","NEF047","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0280007-03","Limited Cost Sharing Plan Variation","68.05%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61165","http://www.coventryone.com/NEon2016","7"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","28","15438","NE","Individual","No","42-1308659","15438NE0280007","Coventry Silver $10 Copay Nebraska Health Network","15438NE028",,"NEN005","NES005","NEF047","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0280007-04","73% AV Level Silver Plan","72.09%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61163","http://www.coventryone.com/NEon2016","8"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","28","15438","NE","Individual","No","42-1308659","15438NE0280007","Coventry Silver $10 Copay Nebraska Health Network","15438NE028",,"NEN005","NES005","NEF047","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0280007-05","87% AV Level Silver Plan","86.14%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61162","http://www.coventryone.com/NEon2016","9"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","28","15438","NE","Individual","No","42-1308659","15438NE0280007","Coventry Silver $10 Copay Nebraska Health Network","15438NE028",,"NEN005","NES005","NEF047","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0280007-06","94% AV Level Silver Plan","93.06%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61161","http://www.coventryone.com/NEon2016","10"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","31","15438","NE","Individual","No","42-1308659","15438NE0180001","Coventry Gold $10 Copay","15438NE018",,"NEN001","NES001","NEF013","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0180001-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61224","http://www.coventryone.com/NEon2016","4"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","31","15438","NE","Individual","No","42-1308659","15438NE0180001","Coventry Gold $10 Copay","15438NE018",,"NEN001","NES001","NEF013","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0180001-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61176","http://www.coventryone.com/NEon2016","5"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","31","15438","NE","Individual","No","42-1308659","15438NE0180001","Coventry Gold $10 Copay","15438NE018",,"NEN001","NES001","NEF013","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0180001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61177","http://www.coventryone.com/NEon2016","6"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","31","15438","NE","Individual","No","42-1308659","15438NE0180001","Coventry Gold $10 Copay","15438NE018",,"NEN001","NES001","NEF013","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0180001-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61178","http://www.coventryone.com/NEon2016","7"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","32","15438","NE","Individual","No","42-1308659","15438NE0170001","Coventry Gold $10 Copay CHI Health Omaha","15438NE017",,"NEN002","NES002","NEF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0170001-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61220","http://www.coventryone.com/NEon2016","4"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","32","15438","NE","Individual","No","42-1308659","15438NE0170001","Coventry Gold $10 Copay CHI Health Omaha","15438NE017",,"NEN002","NES002","NEF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0170001-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61119","http://www.coventryone.com/NEon2016","5"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","32","15438","NE","Individual","No","42-1308659","15438NE0170001","Coventry Gold $10 Copay CHI Health Omaha","15438NE017",,"NEN002","NES002","NEF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0170001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61120","http://www.coventryone.com/NEon2016","6"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","32","15438","NE","Individual","No","42-1308659","15438NE0170001","Coventry Gold $10 Copay CHI Health Omaha","15438NE017",,"NEN002","NES002","NEF009","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0170001-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61121","http://www.coventryone.com/NEon2016","7"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","34","15438","NE","Individual","No","42-1308659","15438NE0150001","Coventry Gold $10 Copay Methodist Health Partners","15438NE015",,"NEN004","NES004","NEF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0150001-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61228","http://www.coventryone.com/NEon2016","4"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","34","15438","NE","Individual","No","42-1308659","15438NE0150001","Coventry Gold $10 Copay Methodist Health Partners","15438NE015",,"NEN004","NES004","NEF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0150001-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61100","http://www.coventryone.com/NEon2016","5"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","34","15438","NE","Individual","No","42-1308659","15438NE0150001","Coventry Gold $10 Copay Methodist Health Partners","15438NE015",,"NEN004","NES004","NEF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0150001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61101","http://www.coventryone.com/NEon2016","6"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","34","15438","NE","Individual","No","42-1308659","15438NE0150001","Coventry Gold $10 Copay Methodist Health Partners","15438NE015",,"NEN004","NES004","NEF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0150001-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61102","http://www.coventryone.com/NEon2016","7"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","36","15438","NE","Individual","No","42-1308659","15438NE0160001","Coventry Gold $10 Copay MIPPA","15438NE016",,"NEN003","NES003","NEF005","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0160001-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61232","http://www.coventryone.com/NEon2016","4"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","36","15438","NE","Individual","No","42-1308659","15438NE0160001","Coventry Gold $10 Copay MIPPA","15438NE016",,"NEN003","NES003","NEF005","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0160001-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61138","http://www.coventryone.com/NEon2016","5"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","36","15438","NE","Individual","No","42-1308659","15438NE0160001","Coventry Gold $10 Copay MIPPA","15438NE016",,"NEN003","NES003","NEF005","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0160001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61139","http://www.coventryone.com/NEon2016","6"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","36","15438","NE","Individual","No","42-1308659","15438NE0160001","Coventry Gold $10 Copay MIPPA","15438NE016",,"NEN003","NES003","NEF005","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0160001-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61140","http://www.coventryone.com/NEon2016","7"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","38","15438","NE","Individual","No","42-1308659","15438NE0280005","Coventry Gold $10 Copay Nebraska Health Network","15438NE028",,"NEN005","NES005","NEF045","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0280005-00","Standard Gold Off Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61216","http://www.coventryone.com/NEon2016","4"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","38","15438","NE","Individual","No","42-1308659","15438NE0280005","Coventry Gold $10 Copay Nebraska Health Network","15438NE028",,"NEN005","NES005","NEF045","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0280005-01","Standard Gold On Exchange Plan","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61157","http://www.coventryone.com/NEon2016","5"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","38","15438","NE","Individual","No","42-1308659","15438NE0280005","Coventry Gold $10 Copay Nebraska Health Network","15438NE028",,"NEN005","NES005","NEF045","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0280005-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61158","http://www.coventryone.com/NEon2016","6"
"2016","NE","15438","SERFF","5","2015-08-25 12:56:34","38","15438","NE","Individual","No","42-1308659","15438NE0280005","Coventry Gold $10 Copay Nebraska Health Network","15438NE028",,"NEN005","NES005","NEF045","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8492172792","15438NE0280005-03","Limited Cost Sharing Plan Variation","78.04%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/NE61159","http://www.coventryone.com/NEon2016","7"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","1","20305","NE","Individual","No","41-1490988","20305NE0010017","Medica Insure Gold Copay 100","20305NE001",,"NEN001","NES001","NEF002","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010017-00","Standard Gold Off Exchange Plan",,"0.818332970142365","Yes","Yes","No","100%",,"$2,400","$0","$0","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IG100CNE&uid=FFM",,"8"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","1","20305","NE","Individual","No","41-1490988","20305NE0010017","Medica Insure Gold Copay 100","20305NE001",,"NEN001","NES001","NEF002","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010017-01","Standard Gold On Exchange Plan",,"0.818332970142365","Yes","Yes","No","100%",,"$2,400","$0","$0","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IG100CNE&uid=FFM",,"9"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","1","20305","NE","Individual","No","41-1490988","20305NE0010017","Medica Insure Gold Copay 100","20305NE001",,"NEN001","NES001","NEF002","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IG100CNEZ&uid=FFM",,"10"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","1","20305","NE","Individual","No","41-1490988","20305NE0010017","Medica Insure Gold Copay 100","20305NE001",,"NEN001","NES001","NEF002","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010017-03","Limited Cost Sharing Plan Variation",,"0.818332970142365","Yes","Yes","No","100%",,"$2,400","$0","$0","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IG100CNEL&uid=FFM",,"11"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","1","20305","NE","Individual","No","41-1490988","20305NE0010019","Medica Insure Gold Copay Plus","20305NE001",,"NEN001","NES001","NEF003","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010019-00","Standard Gold Off Exchange Plan",,"0.786018192768097","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGPCNE&uid=FFM",,"12"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","1","20305","NE","Individual","No","41-1490988","20305NE0010001","Medica Insure Gold Copay","20305NE001",,"NEN001","NES001","NEF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010001-00","Standard Gold Off Exchange Plan",,"0.795177459716797","Yes","Yes","No","100%",,"$300","$20","$1,500","$1,000","$300","$600","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGCNE&uid=FFM",,"4"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","1","20305","NE","Individual","No","41-1490988","20305NE0010001","Medica Insure Gold Copay","20305NE001",,"NEN001","NES001","NEF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010001-01","Standard Gold On Exchange Plan",,"0.795177459716797","Yes","Yes","No","100%",,"$300","$20","$1,500","$1,000","$300","$600","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGCNE&uid=FFM",,"5"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","1","20305","NE","Individual","No","41-1490988","20305NE0010001","Medica Insure Gold Copay","20305NE001",,"NEN001","NES001","NEF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGCNEZ&uid=FFM",,"6"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","1","20305","NE","Individual","No","41-1490988","20305NE0010001","Medica Insure Gold Copay","20305NE001",,"NEN001","NES001","NEF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010001-03","Limited Cost Sharing Plan Variation",,"0.795177459716797","Yes","Yes","No","100%",,"$300","$20","$1,500","$1,000","$300","$600","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","per person not applicable","$900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGCNEL&uid=FFM",,"7"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","1","20305","NE","Individual","No","41-1490988","20305NE0010019","Medica Insure Gold Copay Plus","20305NE001",,"NEN001","NES001","NEF003","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010019-01","Standard Gold On Exchange Plan",,"0.786018192768097","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGPCNE&uid=FFM",,"13"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","1","20305","NE","Individual","No","41-1490988","20305NE0010019","Medica Insure Gold Copay Plus","20305NE001",,"NEN001","NES001","NEF003","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGPCNEZ&uid=FFM",,"14"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","1","20305","NE","Individual","No","41-1490988","20305NE0010019","Medica Insure Gold Copay Plus","20305NE001",,"NEN001","NES001","NEF003","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010019-03","Limited Cost Sharing Plan Variation",,"0.786018192768097","Yes","Yes","No","100%",,"$1,000","$500","$400","$1,000","$1,000","$500","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$3000 per group","25%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGPCNEL&uid=FFM",,"15"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","1","20305","NE","Individual","No","41-1490988","20305NE0010007","Medica Insure Gold H S A","20305NE001",,"NEN001","NES001","NEF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010007-00","Standard Gold Off Exchange Plan",,"0.786853492259979","Yes","Yes","No","100%",,"$1,300","$0","$1,200","$1,000","$1,300","$0","$1,200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7050 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGHNE&uid=FFM",,"16"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","1","20305","NE","Individual","No","41-1490988","20305NE0010007","Medica Insure Gold H S A","20305NE001",,"NEN001","NES001","NEF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010007-01","Standard Gold On Exchange Plan",,"0.786853492259979","Yes","Yes","No","100%",,"$1,300","$0","$1,200","$1,000","$1,300","$0","$1,200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7050 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGHNE&uid=FFM",,"17"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","1","20305","NE","Individual","No","41-1490988","20305NE0010007","Medica Insure Gold H S A","20305NE001",,"NEN001","NES001","NEF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGHNEZ&uid=FFM",,"18"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","1","20305","NE","Individual","No","41-1490988","20305NE0010007","Medica Insure Gold H S A","20305NE001",,"NEN001","NES001","NEF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010007-03","Limited Cost Sharing Plan Variation",,"0.786853492259979","Yes","Yes","No","100%",,"$1,300","$0","$1,200","$1,000","$1,300","$0","$1,200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$7050 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IGHNEL&uid=FFM",,"19"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","2","20305","NE","Individual","No","41-1490988","20305NE0010003","Medica Insure Silver Copay","20305NE001",,"NEN001","NES001","NEF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010003-00","Standard Silver Off Exchange Plan",,"0.699446320533752","Yes","Yes","No","100%",,"$2,600","$20","$1,100","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISCNE&uid=FFM",,"4"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","2","20305","NE","Individual","No","41-1490988","20305NE0010003","Medica Insure Silver Copay","20305NE001",,"NEN001","NES001","NEF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010003-01","Standard Silver On Exchange Plan",,"0.699446320533752","Yes","Yes","No","100%",,"$2,600","$20","$1,100","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISCNE&uid=FFM",,"5"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","2","20305","NE","Individual","No","41-1490988","20305NE0010003","Medica Insure Silver Copay","20305NE001",,"NEN001","NES001","NEF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISCNEZ&uid=FFM",,"6"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","2","20305","NE","Individual","No","41-1490988","20305NE0010003","Medica Insure Silver Copay","20305NE001",,"NEN001","NES001","NEF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010003-03","Limited Cost Sharing Plan Variation",,"0.699446320533752","Yes","Yes","No","100%",,"$2,600","$20","$1,100","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","per person not applicable","$7800 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISCNEL&uid=FFM",,"7"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","2","20305","NE","Individual","No","41-1490988","20305NE0010003","Medica Insure Silver Copay","20305NE001",,"NEN001","NES001","NEF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010003-04","73% AV Level Silver Plan",,"0.732776403427124","Yes","Yes","No","100%",,"$2,400","$20","$900","$1,000","$1,700","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","per person not applicable","$7200 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISCNE73&uid=FFM",,"8"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","2","20305","NE","Individual","No","41-1490988","20305NE0010003","Medica Insure Silver Copay","20305NE001",,"NEN001","NES001","NEF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010003-05","87% AV Level Silver Plan",,"0.87339198589325","Yes","Yes","No","100%",,"$400","$20","$1,000","$1,000","$400","$600","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$400","per person not applicable","$1200 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISCNE87&uid=FFM",,"9"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","2","20305","NE","Individual","No","41-1490988","20305NE0010003","Medica Insure Silver Copay","20305NE001",,"NEN001","NES001","NEF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010003-06","94% AV Level Silver Plan",,"0.945424914360046","Yes","Yes","No","100%",,"$50","$20","$300","$1,000","$50","$600","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","$150 per group","5%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISCNE94&uid=FFM",,"10"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","2","20305","NE","Individual","No","41-1490988","20305NE0010021","Medica Insure Silver Copay Plus","20305NE001",,"NEN001","NES001","NEF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010021-00","Standard Silver Off Exchange Plan",,"0.686831414699554","Yes","Yes","No","100%",,"$2,500","$800","$400","$1,000","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","35%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISPCNE&uid=FFM",,"11"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","2","20305","NE","Individual","No","41-1490988","20305NE0010021","Medica Insure Silver Copay Plus","20305NE001",,"NEN001","NES001","NEF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010021-01","Standard Silver On Exchange Plan",,"0.686831414699554","Yes","Yes","No","100%",,"$2,500","$800","$400","$1,000","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","35%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISPCNE&uid=FFM",,"12"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","2","20305","NE","Individual","No","41-1490988","20305NE0010021","Medica Insure Silver Copay Plus","20305NE001",,"NEN001","NES001","NEF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISPCNEZ&uid=FFM",,"13"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","2","20305","NE","Individual","No","41-1490988","20305NE0010021","Medica Insure Silver Copay Plus","20305NE001",,"NEN001","NES001","NEF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010021-03","Limited Cost Sharing Plan Variation",,"0.686831414699554","Yes","Yes","No","100%",,"$2,500","$800","$400","$1,000","$1,600","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$7500 per group","35%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISPCNEL&uid=FFM",,"14"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","2","20305","NE","Individual","No","41-1490988","20305NE0010021","Medica Insure Silver Copay Plus","20305NE001",,"NEN001","NES001","NEF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010021-04","73% AV Level Silver Plan",,"0.722007930278778","Yes","Yes","No","100%",,"$1,500","$800","$400","$1,000","$1,500","$900","$30","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$4500 per group","35%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISPCNE73&uid=FFM",,"15"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","2","20305","NE","Individual","No","41-1490988","20305NE0010021","Medica Insure Silver Copay Plus","20305NE001",,"NEN001","NES001","NEF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010021-05","87% AV Level Silver Plan",,"0.867308914661407","Yes","Yes","No","100%",,"$100","$700","$200","$1,000","$100","$700","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$300 per group","15%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISPCNE87&uid=FFM",,"16"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","2","20305","NE","Individual","No","41-1490988","20305NE0010021","Medica Insure Silver Copay Plus","20305NE001",,"NEN001","NES001","NEF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010021-06","94% AV Level Silver Plan",,"0.932673752307892","Yes","Yes","No","100%",,"$0","$700","$50","$1,000","$0","$700","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","$0 per group","5%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISPCNE94&uid=FFM",,"17"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","2","20305","NE","Individual","No","41-1490988","20305NE0010009","Medica Insure Silver H S A","20305NE001",,"NEN001","NES001","NEF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010009-00","Standard Silver Off Exchange Plan",,"0.697753369808197","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISHNE&uid=FFM",,"18"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","2","20305","NE","Individual","No","41-1490988","20305NE0010009","Medica Insure Silver H S A","20305NE001",,"NEN001","NES001","NEF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010009-01","Standard Silver On Exchange Plan",,"0.697753369808197","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISHNE&uid=FFM",,"19"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","2","20305","NE","Individual","No","41-1490988","20305NE0010009","Medica Insure Silver H S A","20305NE001",,"NEN001","NES001","NEF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISHNEZ&uid=FFM",,"20"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","2","20305","NE","Individual","No","41-1490988","20305NE0010009","Medica Insure Silver H S A","20305NE001",,"NEN001","NES001","NEF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010009-03","Limited Cost Sharing Plan Variation",,"0.697753369808197","Yes","Yes","No","100%",,"$1,300","$0","$1,600","$1,000","$1,300","$0","$1,600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","per person not applicable","$3900 per group","40%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISHNEL&uid=FFM",,"21"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","2","20305","NE","Individual","No","41-1490988","20305NE0010009","Medica Insure Silver H S A","20305NE001",,"NEN001","NES001","NEF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010009-04","73% AV Level Silver Plan",,"0.736685276031494","Yes","Yes","No","100%",,"$1,050","$0","$1,300","$1,000","$1,050","$0","$1,300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5250 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,050","per person not applicable","$3150 per group","30%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISHNE73&uid=FFM",,"22"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","2","20305","NE","Individual","No","41-1490988","20305NE0010009","Medica Insure Silver H S A","20305NE001",,"NEN001","NES001","NEF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010009-05","87% AV Level Silver Plan",,"0.869724869728088","Yes","Yes","No","100%",,"$250","$0","$1,000","$1,000","$250","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","per person not applicable","$750 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISHNE87&uid=FFM",,"23"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","2","20305","NE","Individual","No","41-1490988","20305NE0010009","Medica Insure Silver H S A","20305NE001",,"NEN001","NES001","NEF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010009-06","94% AV Level Silver Plan",,"0.940937519073486","Yes","Yes","No","100%",,"$150","$0","$300","$1,000","$150","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$150","per person not applicable","$450 per group","5%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ISHNE94&uid=FFM",,"24"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","3","20305","NE","Individual","No","41-1490988","20305NE0010005","Medica Insure Bronze Copay","20305NE001",,"NEN001","NES001","NEF008","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010005-00","Standard Bronze Off Exchange Plan",,"0.617384314537048","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBCNE&uid=FFM",,"4"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","3","20305","NE","Individual","No","41-1490988","20305NE0010005","Medica Insure Bronze Copay","20305NE001",,"NEN001","NES001","NEF008","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010005-01","Standard Bronze On Exchange Plan",,"0.617384314537048","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBCNE&uid=FFM",,"5"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","3","20305","NE","Individual","No","41-1490988","20305NE0010005","Medica Insure Bronze Copay","20305NE001",,"NEN001","NES001","NEF008","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBCNEZ&uid=FFM",,"6"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","3","20305","NE","Individual","No","41-1490988","20305NE0010005","Medica Insure Bronze Copay","20305NE001",,"NEN001","NES001","NEF008","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010005-03","Limited Cost Sharing Plan Variation",,"0.617384314537048","Yes","Yes","No","100%",,"$5,400","$20","$0","$1,000","$1,700","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBCNEL&uid=FFM",,"7"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","3","20305","NE","Individual","No","41-1490988","20305NE0010011","Medica Insure Bronze H S A","20305NE001",,"NEN001","NES001","NEF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010011-00","Standard Bronze Off Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","per person not applicable","$12700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBHNE&uid=FFM",,"8"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","3","20305","NE","Individual","No","41-1490988","20305NE0010011","Medica Insure Bronze H S A","20305NE001",,"NEN001","NES001","NEF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010011-01","Standard Bronze On Exchange Plan",,"0.607437193393707","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","per person not applicable","$12700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBHNE&uid=FFM",,"9"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","3","20305","NE","Individual","No","41-1490988","20305NE0010011","Medica Insure Bronze H S A","20305NE001",,"NEN001","NES001","NEF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$1,000","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBHNEZ&uid=FFM",,"10"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","3","20305","NE","Individual","No","41-1490988","20305NE0010011","Medica Insure Bronze H S A","20305NE001",,"NEN001","NES001","NEF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010011-03","Limited Cost Sharing Plan Variation",,"0.607437193393707","Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","per person not applicable","$12700 per group","0%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1IBHNEL&uid=FFM",,"11"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","4","20305","NE","Individual","No","41-1490988","20305NE0010013","Medica Insure Catastrophic","20305NE001",,"NEN001","NES001","NEF010","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010013-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICNE&uid=FFM",,"4"
"2016","NE","20305","SERFF","7","2016-03-04 06:56:29","4","20305","NE","Individual","No","41-1490988","20305NE0010013","Medica Insure Catastrophic","20305NE001",,"NEN001","NES001","NEF010","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","Yes",,"http://www.medica.com/IFBPharmacy","20305NE0010013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,400","$0","$0","$1,000","$5,000","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=1ICNE&uid=FFM",,"5"
"2016","NE","26099","SERFF","3","2015-08-22 23:36:24","1","26099","NE","SHOP (Small Group)","Yes","47-0322111","26099NE0010001","Certified Dental Plan 1","26099NE001",,"NEN001","NES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.25","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","26099NE0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","$700 per group",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NE","26099","SERFF","3","2015-08-22 23:36:24","1","26099","NE","SHOP (Small Group)","Yes","47-0322111","26099NE0010002","Certified Dental Plan 2","26099NE001",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.75","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","26099NE0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","$700 per group",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NE","26099","SERFF","3","2015-08-22 23:36:24","1","26099","NE","SHOP (Small Group)","Yes","47-0322111","26099NE0010003","Certified Dental Plan 3","26099NE001",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.78","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","26099NE0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","$700 per group",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","NE","26099","SERFF","3","2015-08-22 23:36:24","1","26099","NE","SHOP (Small Group)","Yes","47-0322111","26099NE0010004","Certified Dental Plan 4","26099NE001",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.10","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Allows for out of Service Area, if inside of Country","Yes",,"","26099NE0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","$700 per group",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1120001","BluePride Option 101 Gold","29678NE112",,"NEN001","NES001","NEF007","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_4T_HealthInsuranceMarketplaceSmallGroup.pdf","29678NE1120001-00","Standard Gold Off Exchange Plan",,"0.795444130897522","No","Yes","No","100%",,"$1,000","$20","$1,800","$200","$300","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","per person not applicable","per group not applicable","30%",,,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://nebraskablue.com/2016bp101gold_sbc","https://nebraskabluecom/2016bluepride_aca","4"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE0980004","SelectBlue 3750 Silver","29678NE098",,"NEN002","NES002","NEF005","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980004-05","87% AV Level Silver Plan","87.10%",,"No","Yes","Yes","80%","20%","$1,400","$0","$700","$200","$300","$1,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","$2,250","$2250 per person","$4500 per group","$13,700","$13700 per person","$27400 per group","$15,100","$15100 per person","$30200 per group","$700","$700 per person","$1400 per group","20%","$1,400","$1400 per person","$2800 per group","50%","$11,000","$11000 per person","$22000 per group","$11,700","$11700 per person","$23400 per group","Not Applicable","per person not applicable","per group not applicable","20%","Not Applicable","per person not applicable","per group not applicable","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016sb3750silver87_sbc","https://nebraskablue.com/2016selectblue_aca","24"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","1","44751","NE","Individual","No","47-0676824","44751NE0010003","Silver Compass HSA 3000","44751NE001",,"NEN001","NES001","NEF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010003-01","Standard Silver On Exchange Plan","69.20%",,"Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ne0007&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","5"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","1","44751","NE","Individual","No","47-0676824","44751NE0010003","Silver Compass HSA 3000","44751NE001",,"NEN001","NES001","NEF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=ne0008&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","6"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","1","44751","NE","Individual","No","47-0676824","44751NE0010003","Silver Compass HSA 3000","44751NE001",,"NEN001","NES001","NEF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010003-03","Limited Cost Sharing Plan Variation","69.20%",,"Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ne0009&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","7"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE1100008","BlueEssentials 1500 Gold","29678NE110",,"NEN001","NES003","NEF006","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100008-00","Standard Gold Off Exchange Plan","78.10%",,"No","Yes","No","100%",,"$2,400","$10","$1,000","$200","$300","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,350","$4350 per person","$8700 per group",,,,"$8,700","$8700 per person","$17400 per group","$13,050","$13050 per person","$26100 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016be1500gold_sbc","https://nebraskablue.com/2016blueessentials_aca","4"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE1100008","BlueEssentials 1500 Gold","29678NE110",,"NEN001","NES003","NEF006","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100008-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,"$2,400","$10","$1,000","$200","$300","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,350","$4350 per person","$8700 per group",,,,"$8,700","$8700 per person","$17400 per group","$13,050","$13050 per person","$26100 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016be1500gold_sbc","https://nebraskablue.com/2016blueessentials_aca","5"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1120001","BluePride Option 101 Gold","29678NE112",,"NEN001","NES001","NEF007","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_4T_HealthInsuranceMarketplaceSmallGroup.pdf","29678NE1120001-01","Standard Gold On Exchange Plan",,"0.795444130897522","No","Yes","No","100%",,"$1,000","$20","$1,800","$200","$300","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","$1,500","$1500 per person","$3000 per group","$0","per person not applicable","per group not applicable","30%",,,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://nebraskablue.com/2016bp101gold_sbc","https://nebraskabluecom/2016bluepride_aca","5"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010005","Silver Compass 3500","44751NE001",,"NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010005-03","Limited Cost Sharing Plan Variation","68.00%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0021&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","22"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010005","Silver Compass 3500","44751NE001",,"NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010005-04","73% AV Level Silver Plan","72.50%",,"No","Yes","No","100%",,"$2,500","$10","$800","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0022&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","23"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010005","Silver Compass 3500","44751NE001",,"NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010005-05","87% AV Level Silver Plan","87.90%",,"No","Yes","No","100%",,"$200","$10","$600","$200","$200","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0023&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","24"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE1100008","BlueEssentials 1500 Gold","29678NE110",,"NEN001","NES003","NEF006","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016be1500goldNAAN_sbc","https://nebraskablue.com/2016blueessentialsNAAN_aca","6"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE1100008","BlueEssentials 1500 Gold","29678NE110",,"NEN001","NES003","NEF006","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100008-03","Limited Cost Sharing Plan Variation","78.10%",,"No","Yes","No","100%",,"$2,400","$10","$1,000","$200","$300","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,350","$4350 per person","$8700 per group",,,,"$8,700","$8700 per person","$17400 per group","$13,050","$13050 per person","$26100 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016be1500gold_sbc","https://nebraskablue.com/2016blueessentials_aca","7"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1120007","BluePride Option 201 Silver","29678NE112",,"NEN001","NES001","NEF007","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_4T_HealthInsuranceMarketplaceSmallGroup.pdf","29678NE1120007-00","Standard Silver Off Exchange Plan",,"0.701607584953308","No","Yes","No","100%",,"$3,400","$20","$1,100","$200","$300","$1,800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$39000 per person","$39000 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$10000 per person","$10000 per group","$7,500","$15000 per person","$15000 per group","$0","per person not applicable","per group not applicable","30%",,,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://nebraskablue.com/2016bp201silver_sbc","https://nebraskabluecom/2016bluepride_aca","8"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE1100007","BlueEssentials 3000 Silver","29678NE110",,"NEN001","NES003","NEF003","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100007-00","Standard Silver Off Exchange Plan","68.11%",,"No","Yes","No","100%",,"$3,900","$10","$700","$200","$300","$1,800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016be3000silver_sbc","https://nebraskablue.com/2016blueessentials_aca","8"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE1100007","BlueEssentials 3000 Silver","29678NE110",,"NEN001","NES003","NEF003","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100007-01","Standard Silver On Exchange Plan","68.11%",,"No","Yes","No","100%",,"$3,900","$10","$700","$200","$300","$1,800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016be3000silver_sbc","https://nebraskablue.com/2016blueessentials_aca","9"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1120007","BluePride Option 201 Silver","29678NE112",,"NEN001","NES001","NEF007","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_4T_HealthInsuranceMarketplaceSmallGroup.pdf","29678NE1120007-01","Standard Silver On Exchange Plan",,"0.701607584953308","No","Yes","No","100%",,"$3,400","$20","$1,100","$200","$300","$1,800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","$19,500","$39000 per person","$39000 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","$7,500","$7500 per person","$15000 per group","$0","per person not applicable","per group not applicable","30%",,,,,"$0","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://nebraskablue.com/2016bp201silver_sbc","https://nebraskabluecom/2016bluepride_aca","9"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE1100007","BlueEssentials 3000 Silver","29678NE110",,"NEN001","NES003","NEF003","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016be3000silverNAAN_sbc","https://nebraskablue.com/2016blueessentialsNAAN_aca","10"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE1100007","BlueEssentials 3000 Silver","29678NE110",,"NEN001","NES003","NEF003","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100007-03","Limited Cost Sharing Plan Variation","68.11%",,"No","Yes","No","100%",,"$3,900","$10","$700","$200","$300","$1,800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016be3000silver_sbc","https://nebraskablue.com/2016blueessentials_aca","11"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE1100007","BlueEssentials 3000 Silver","29678NE110",,"NEN001","NES003","NEF003","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100007-04","73% AV Level Silver Plan","72.69%",,"No","Yes","No","100%",,"$3,100","$10","$800","$200","$300","$1,800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$13,700","$13700 per person","$27400 per group","$18,700","$18700 per person","$37400 per group","$2,250","$2250 per person","$4500 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$8,250","$8250 per person","$16500 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016be3000silver73_sbc","https://nebraskablue.com/2016blueessentials_aca","12"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE1100007","BlueEssentials 3000 Silver","29678NE110",,"NEN001","NES003","NEF003","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100007-05","87% AV Level Silver Plan","87.25%",,"No","Yes","No","100%",,"$1,600","$0","$800","$200","$300","$1,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"$13,700","$13700 per person","$27400 per group","$15,300","$15300 per person","$30600 per group","$800","$800 per person","$1600 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016be3000silver87_sbc","https://nebraskablue.com/2016blueessentials_aca","13"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE1100007","BlueEssentials 3000 Silver","29678NE110",,"NEN001","NES003","NEF003","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100007-06","94% AV Level Silver Plan","93.47%",,"No","Yes","No","100%",,"$700","$0","$400","$200","$200","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"$13,700","$13700 per person","$27400 per group","$14,350","$14350 per person","$28700 per group","$325","$325 per person","$650 per group","10%",,,,,"$6,000","$6000 per person","$12000 per group","$6,325","$6325 per person","$12650 per group","Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016be3000silver94_sbc","https://nebraskablue.com/2016blueessentials_aca","14"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE0980005","SelectBlue 1500 Gold","29678NE098",,"NEN002","NES002","NEF006","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980005-00","Standard Gold Off Exchange Plan","78.25%",,"No","Yes","Yes","80%","20%","$2,400","$10","$500","$200","$300","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","$6,000","$6000 per person","$12000 per group","$12,000","$12000 per person","$24000 per group","$15,250","$15250 per person","$30500 per group","$1,500","$1500 per person","$3000 per group","10%","$2,750","$2750 per person","$5500 per group","20%","$5,500","$5500 per person","$11000 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","10%","Not Applicable","per person not applicable","per group not applicable","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016sb1500gold_sbc","https://nebraskablue.com/2016selectblue_aca","15"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE0980005","SelectBlue 1500 Gold","29678NE098",,"NEN002","NES002","NEF006","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980005-01","Standard Gold On Exchange Plan","78.25%",,"No","Yes","Yes","80%","20%","$2,400","$10","$500","$200","$300","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","$6,000","$6000 per person","$12000 per group","$12,000","$12000 per person","$24000 per group","$15,250","$15250 per person","$30500 per group","$1,500","$1500 per person","$3000 per group","10%","$2,750","$2750 per person","$5500 per group","20%","$5,500","$5500 per person","$11000 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","10%","Not Applicable","per person not applicable","per group not applicable","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016sb1500gold_sbc","https://nebraskablue.com/2016selectblue_aca","16"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE0980005","SelectBlue 1500 Gold","29678NE098",,"NEN002","NES002","NEF006","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","80%","20%","$0","$0","$0","$200","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016sb1500goldNAAN_sbc","https://nebraskablue.com/2016selectblueNAAN_aca","17"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE0980005","SelectBlue 1500 Gold","29678NE098",,"NEN002","NES002","NEF006","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980005-03","Limited Cost Sharing Plan Variation","78.25%",,"No","Yes","Yes","80%","20%","$2,400","$10","$500","$200","$300","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","$6,000","$6000 per person","$12000 per group","$12,000","$12000 per person","$24000 per group","$15,250","$15250 per person","$30500 per group","$1,500","$1500 per person","$3000 per group","10%","$2,750","$2750 per person","$5500 per group","20%","$5,500","$5500 per person","$11000 per group","$7,000","$7000 per person","$14000 per group","Not Applicable","per person not applicable","per group not applicable","10%","Not Applicable","per person not applicable","per group not applicable","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016sb1500gold_sbc","https://nebraskablue.com/2016selectblue_aca","18"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE0980004","SelectBlue 3750 Silver","29678NE098",,"NEN002","NES002","NEF005","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980004-00","Standard Silver Off Exchange Plan","68.75%",,"No","Yes","Yes","80%","20%","$4,600","$10","$800","$200","$300","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","$19,700","$19700 per person","$39400 per group","$3,750","$3750 per person","$7500 per group","30%","$5,500","$5500 per person","$11000 per group","50%","$11,000","$11000 per person","$22000 per group","$14,750","$14750 per person","$29500 per group","Not Applicable","per person not applicable","per group not applicable","30%","Not Applicable","per person not applicable","per group not applicable","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016sb3750silver_sbc","https://nebraskablue.com/2016selectblue_aca","19"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE0980004","SelectBlue 3750 Silver","29678NE098",,"NEN002","NES002","NEF005","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980004-01","Standard Silver On Exchange Plan","68.75%",,"No","Yes","Yes","80%","20%","$4,600","$10","$800","$200","$300","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","$19,700","$19700 per person","$39400 per group","$3,750","$3750 per person","$7500 per group","30%","$5,500","$5500 per person","$11000 per group","50%","$11,000","$11000 per person","$22000 per group","$14,750","$14750 per person","$29500 per group","Not Applicable","per person not applicable","per group not applicable","30%","Not Applicable","per person not applicable","per group not applicable","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016sb3750silver_sbc","https://nebraskablue.com/2016selectblue_aca","20"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE0980004","SelectBlue 3750 Silver","29678NE098",,"NEN002","NES002","NEF005","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","80%","20%","$0","$0","$0","$200","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016sb3750silverNAAN_sbc","https://nebraskablue.com/2016selectblueNAAN_aca","21"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE0980004","SelectBlue 3750 Silver","29678NE098",,"NEN002","NES002","NEF005","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980004-03","Limited Cost Sharing Plan Variation","68.75%",,"No","Yes","Yes","80%","20%","$4,600","$10","$800","$200","$300","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,850","$6850 per person","$13700 per group","$13,700","$13700 per person","$27400 per group","$19,700","$19700 per person","$39400 per group","$3,750","$3750 per person","$7500 per group","30%","$5,500","$5500 per person","$11000 per group","50%","$11,000","$11000 per person","$22000 per group","$14,750","$14750 per person","$29500 per group","Not Applicable","per person not applicable","per group not applicable","30%","Not Applicable","per person not applicable","per group not applicable","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016sb3750silver_sbc","https://nebraskablue.com/2016selectblue_aca","22"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE0980004","SelectBlue 3750 Silver","29678NE098",,"NEN002","NES002","NEF005","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980004-04","73% AV Level Silver Plan","72.89%",,"No","Yes","Yes","80%","20%","$3,400","$10","$1,100","$200","$300","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,250","$5250 per person","$10500 per group","$13,700","$13700 per person","$27400 per group","$18,700","$18700 per person","$37400 per group","$2,500","$2500 per person","$5000 per group","30%","$4,000","$4000 per person","$8000 per group","50%","$11,000","$11000 per person","$22000 per group","$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable","30%","Not Applicable","per person not applicable","per group not applicable","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016sb3750silver73_sbc","https://nebraskablue.com/2016selectblue_aca","23"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","1","29678","NE","Individual","No","47-0095156","29678NE0980004","SelectBlue 3750 Silver","29678NE098",,"NEN002","NES002","NEF005","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980004-06","94% AV Level Silver Plan","94.43%",,"No","Yes","Yes","80%","20%","$500","$0","$400","$200","$100","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$450","$450 per person","$900 per group","$900","$900 per person","$1800 per group","$13,700","$13700 per person","$27400 per group","$14,150","$14150 per person","$28300 per group","$225","$225 per person","$450 per group","20%","$450","$450 per person","$900 per group","50%","$11,000","$11000 per person","$22000 per group","$11,225","$11225 per person","$22450 per group","Not Applicable","per person not applicable","per group not applicable","20%","Not Applicable","per person not applicable","per group not applicable","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://nebraskablue.com/2016sb3750silver94_sbc","https://nebraskablue.com/2016selectblue_aca","25"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE1100006","BlueEssentials 2700 HSA Silver","29678NE110",,"NEN001","NES003","NEF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100006-00","Standard Silver Off Exchange Plan",,"0.680127322673798","Yes","Yes","No","100%",,"$3,600","$0","$700","$200","$2,700","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"$11,200","$11200 per person","$22400 per group","$16,800","$16800 per person","$33600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","$8,100","$8100 per person","$16200 per group","Yes",,,"https://nebraskablue.com/2016be2700HSAsilver_sbc","https://nebraskablue.com/2016blueessentials_aca","4"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE1100006","BlueEssentials 2700 HSA Silver","29678NE110",,"NEN001","NES003","NEF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100006-01","Standard Silver On Exchange Plan",,"0.680127322673798","Yes","Yes","No","100%",,"$3,600","$0","$700","$200","$2,700","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"$11,200","$11200 per person","$22400 per group","$16,800","$16800 per person","$33600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","$8,100","$8100 per person","$16200 per group","Yes",,,"https://nebraskablue.com/2016be2700HSAsilver_sbc","https://nebraskablue.com/2016blueessentials_aca","5"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE1100006","BlueEssentials 2700 HSA Silver","29678NE110",,"NEN001","NES003","NEF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://nebraskablue.com/2016be2700HSAsilverNAAN_sbc","https://nebraskablue.com/2016blueessentialsNAAN_aca","6"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE1100006","BlueEssentials 2700 HSA Silver","29678NE110",,"NEN001","NES003","NEF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100006-03","Limited Cost Sharing Plan Variation",,"0.680127322673798","Yes","Yes","No","100%",,"$3,600","$0","$700","$200","$2,700","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,600","$5600 per person","$11200 per group",,,,"$11,200","$11200 per person","$22400 per group","$16,800","$16800 per person","$33600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","$8,100","$8100 per person","$16200 per group","Yes",,,"https://nebraskablue.com/2016be2700HSAsilver_sbc","https://nebraskablue.com/2016blueessentials_aca","7"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE1100006","BlueEssentials 2700 HSA Silver","29678NE110",,"NEN001","NES003","NEF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100006-04","73% AV Level Silver Plan",,"0.729994118213654","Yes","Yes","No","100%",,"$2,600","$0","$900","$200","$1,800","$0","$700","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$11,200","$11200 per person","$22400 per group","$16,200","$16200 per person","$32400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","$7,150","$7150 per person","$14300 per group","No",,,"https://nebraskablue.com/2016be2700HSAsilver73_sbc","https://nebraskablue.com/2016blueessentials_aca","8"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE1100006","BlueEssentials 2700 HSA Silver","29678NE110",,"NEN001","NES003","NEF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100006-05","87% AV Level Silver Plan",,"0.875413000583649","Yes","Yes","No","100%",,"$1,300","$0","$700","$200","$700","$0","$700","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$11,200","$11200 per person","$22400 per group","$12,500","$12500 per person","$25000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group","20%",,,,,"$5,400","$5400 per person","$10800 per group","$6,050","$6050 per person","$12100 per group","No",,,"https://nebraskablue.com/2016be2700HSAsilver87_sbc","https://nebraskablue.com/2016blueessentials_aca","9"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE1100006","BlueEssentials 2700 HSA Silver","29678NE110",,"NEN001","NES003","NEF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100006-06","94% AV Level Silver Plan",,"0.940306961536407","Yes","Yes","No","100%",,"$500","$0","$400","$200","$300","$0","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$11,200","$11200 per person","$22400 per group","$11,800","$11800 per person","$23600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"$5,400","$5400 per person","$10800 per group","$5,650","$5650 per person","$11300 per group","No",,,"https://nebraskablue.com/2016be2700HSAsilver94_sbc","https://nebraskablue.com/2016blueessentials_aca","10"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE1100001","BlueEssentials 3500 HSA Bronze","29678NE110",,"NEN001","NES001","NEF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100001-00","Standard Bronze Off Exchange Plan",,"0.618300259113312","Yes","Yes","No","100%",,"$4,400","$0","$1,400","$200","$3,500","$0","$900","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","$19,350","$19350 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","Yes",,,"https://nebraskablue.com/2016be3500HSABronze_sbc","https://nebraskablue.com/2016blueessentials_aca","11"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE1100001","BlueEssentials 3500 HSA Bronze","29678NE110",,"NEN001","NES001","NEF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100001-01","Standard Bronze On Exchange Plan",,"0.618300259113312","Yes","Yes","No","100%",,"$4,400","$0","$1,400","$200","$3,500","$0","$900","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","$19,350","$19350 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","Yes",,,"https://nebraskablue.com/2016be3500HSABronze_sbc","https://nebraskablue.com/2016blueessentials_aca","12"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE1100001","BlueEssentials 3500 HSA Bronze","29678NE110",,"NEN001","NES001","NEF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://nebraskablue.com/2016be3500HSABronzeNAAN_sbc","https://nebraskablue.com/2016blueessentialsNAAN_aca","13"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE1100001","BlueEssentials 3500 HSA Bronze","29678NE110",,"NEN001","NES001","NEF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100001-03","Limited Cost Sharing Plan Variation",,"0.618300259113312","Yes","Yes","No","100%",,"$4,400","$0","$1,400","$200","$3,500","$0","$900","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","$19,350","$19350 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","50%",,,,,"$7,000","$7000 per person","$14000 per group","$10,500","$10500 per person","$21000 per group","Yes",,,"https://nebraskablue.com/2016be3500HSABronze_sbc","https://nebraskablue.com/2016blueessentials_aca","14"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE1100005","BlueEssentials 4500 Bronze","29678NE110",,"NEN001","NES001","NEF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","2","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100005-00","Standard Bronze Off Exchange Plan",,"0.618725121021271","Yes","Yes","No","100%",,"$5,400","$0","$900","$200","$4,500","$0","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","No",,,"https://nebraskablue.com/2016be4500Bronze_sbc","https://nebraskablue.com/2016blueessentials_aca","15"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE1100005","BlueEssentials 4500 Bronze","29678NE110",,"NEN001","NES001","NEF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","2","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100005-01","Standard Bronze On Exchange Plan",,"0.618725121021271","Yes","Yes","No","100%",,"$5,400","$0","$900","$200","$4,500","$0","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","No",,,"https://nebraskablue.com/2016be4500Bronze_sbc","https://nebraskablue.com/2016blueessentials_aca","16"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE1100005","BlueEssentials 4500 Bronze","29678NE110",,"NEN001","NES001","NEF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","2","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://nebraskablue.com/2016be4500BronzeNAAN_sbc","https://nebraskablue.com/2016blueessentialsNAAN_aca","17"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE1100005","BlueEssentials 4500 Bronze","29678NE110",,"NEN001","NES001","NEF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","2","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100005-03","Limited Cost Sharing Plan Variation",,"0.618725121021271","Yes","Yes","No","100%",,"$5,400","$0","$900","$200","$4,500","$0","$400","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","No",,,"https://nebraskablue.com/2016be4500Bronze_sbc","https://nebraskablue.com/2016blueessentials_aca","18"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE1100004","BlueEssentials 6450 HSA Bronze","29678NE110",,"NEN001","NES001","NEF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100004-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","$19,350","$19350 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","$19,350","$19350 per person","$38700 per group","Yes",,,"https://nebraskablue.com/2016be6450Bronze_sbc","https://nebraskablue.com/2016blueessentials_aca","19"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE1100004","BlueEssentials 6450 HSA Bronze","29678NE110",,"NEN001","NES001","NEF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100004-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","$19,350","$19350 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","$19,350","$19350 per person","$38700 per group","Yes",,,"https://nebraskablue.com/2016be6450Bronze_sbc","https://nebraskablue.com/2016blueessentials_aca","20"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE1100004","BlueEssentials 6450 HSA Bronze","29678NE110",,"NEN001","NES001","NEF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://nebraskablue.com/2016be6450BronzeNAAN_sbc","https://nebraskablue.com/2016blueessentialsNAAN_aca","21"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE1100004","BlueEssentials 6450 HSA Bronze","29678NE110",,"NEN001","NES001","NEF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100004-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","$19,350","$19350 per person","$38700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","$19,350","$19350 per person","$38700 per group","Yes",,,"https://nebraskablue.com/2016be6450Bronze_sbc","https://nebraskablue.com/2016blueessentials_aca","22"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE0980003","SelectBlue 2700 HSA Silver","29678NE098",,"NEN002","NES002","NEF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980003-00","Standard Silver Off Exchange Plan",,"0.680459260940552","Yes","Yes","Yes","80%","20%","$3,600","$0","$700","$200","$2,700","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","$17,400","$17400 per person","$34800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%","$4,000","$4000 per person","$8000 per group","40%","$8,000","$8000 per person","$16000 per group","$10,700","$10700 per person","$21400 per group","Yes",,,"https://nebraskablue.com/2016sb2700HSAsilver_sbc","https://nebraskablue.com/2016selectblue_aca","23"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE0980003","SelectBlue 2700 HSA Silver","29678NE098",,"NEN002","NES002","NEF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980003-01","Standard Silver On Exchange Plan",,"0.680459260940552","Yes","Yes","Yes","80%","20%","$3,600","$0","$700","$200","$2,700","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","$17,400","$17400 per person","$34800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%","$4,000","$4000 per person","$8000 per group","40%","$8,000","$8000 per person","$16000 per group","$10,700","$10700 per person","$21400 per group","Yes",,,"https://nebraskablue.com/2016sb2700HSAsilver_sbc","https://nebraskablue.com/2016selectblue_aca","24"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE0980003","SelectBlue 2700 HSA Silver","29678NE098",,"NEN002","NES002","NEF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","80%","20%","$0","$0","$0","$200","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://nebraskablue.com/2016sb2700HSAsilver_sbc","https://nebraskablue.com/2016selectblueNAAN_aca","25"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE0980003","SelectBlue 2700 HSA Silver","29678NE098",,"NEN002","NES002","NEF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980003-03","Limited Cost Sharing Plan Variation",,"0.680459260940552","Yes","Yes","Yes","80%","20%","$3,600","$0","$700","$200","$2,700","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","$17,400","$17400 per person","$34800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group","20%","$4,000","$4000 per person","$8000 per group","40%","$8,000","$8000 per person","$16000 per group","$10,700","$10700 per person","$21400 per group","Yes",,,"https://nebraskablue.com/2016sb2700HSAsilverNAAN_sbc","https://nebraskablue.com/2016selectblue_aca","26"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE0980003","SelectBlue 2700 HSA Silver","29678NE098",,"NEN002","NES002","NEF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980003-04","73% AV Level Silver Plan",,"0.734153211116791","Yes","Yes","Yes","80%","20%","$2,600","$0","$900","$200","$1,800","$0","$700","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","$5,000","$5000 per person","$10000 per group","$12,900","$12900 per person","$25800 per group","$16,900","$16900 per person","$33800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","20%","$2,250","$2250 per person","$4500 per group","30%","$8,000","$8000 per person","$16000 per group","$9,750","$9750 per person","$19500 per group","No",,,"https://nebraskablue.com/2016sb2700HSAsilver73_sbc","https://nebraskablue.com/2016selectblue_aca","27"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE0980003","SelectBlue 2700 HSA Silver","29678NE098",,"NEN002","NES002","NEF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980003-05","87% AV Level Silver Plan",,"0.869911074638367","Yes","Yes","Yes","80%","20%","$1,500","$0","$500","$200","$800","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","$2,000","$2000 per person","$4000 per group","$12,900","$12900 per person","$25800 per group","$14,150","$14150 per person","$28300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%","$1,250","$1250 per person","$2500 per group","20%","$8,000","$8000 per person","$16000 per group","$8,750","$8750 per person","$17500 per group","No",,,"https://nebraskablue.com/2016sb2700HSAsilver87_sbc","https://nebraskablue.com/2016selectblue_aca","28"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE0980003","SelectBlue 2700 HSA Silver","29678NE098",,"NEN002","NES002","NEF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980003-06","94% AV Level Silver Plan",,"0.941198527812958","Yes","Yes","Yes","80%","20%","$500","$0","$300","$200","$300","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$800","$800 per person","$1600 per group","$12,900","$12900 per person","$25800 per group","$13,400","$13400 per person","$26800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%","$400","$400 per person","$800 per group","10%","$8,000","$8000 per person","$16000 per group","$8,250","$8250 per person","$16500 per group","No",,,"https://nebraskablue.com/2016sb2700HSAsilver94_sbc","https://nebraskablue.com/2016selectblue_aca","29"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE0980002","SelectBlue 5850 HSA Bronze","29678NE098",,"NEN002","NES002","NEF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980002-00","Standard Bronze Off Exchange Plan",,"0.618633806705475","Yes","Yes","Yes","80%","20%","$6,700","$0","$0","$200","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","$18,750","$18750 per person","$37500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","0%","$6,450","$6450 per person","$12900 per group","0%","$12,900","$12900 per person","$25800 per group","$18,750","$18750 per person","$37500 per group","Yes",,,"https://nebraskablue.com/2016sb5850HSAbronze_sbc","https://nebraskablue.com/2016selectblue_aca","30"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE0980002","SelectBlue 5850 HSA Bronze","29678NE098",,"NEN002","NES002","NEF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980002-01","Standard Bronze On Exchange Plan",,"0.618633806705475","Yes","Yes","Yes","80%","20%","$6,700","$0","$0","$200","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","$18,750","$18750 per person","$37500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","0%","$6,450","$6450 per person","$12900 per group","0%","$12,900","$12900 per person","$25800 per group","$18,750","$18750 per person","$37500 per group","Yes",,,"https://nebraskablue.com/2016sb5850HSAbronze_sbc","https://nebraskablue.com/2016selectblue_aca","31"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE0980002","SelectBlue 5850 HSA Bronze","29678NE098",,"NEN002","NES002","NEF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","80%","20%","$0","$0","$0","$200","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://nebraskablue.com/2016sb5850HSAbronzeNAAN_sbc","https://nebraskablue.com/2016selectblueNAAN_aca","32"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","2","29678","NE","Individual","No","47-0095156","29678NE0980002","SelectBlue 5850 HSA Bronze","29678NE098",,"NEN002","NES002","NEF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE0980002-03","Limited Cost Sharing Plan Variation",,"0.618633806705475","Yes","Yes","Yes","80%","20%","$6,700","$0","$0","$200","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","$6,450","$6450 per person","$12900 per group","$12,900","$12900 per person","$25800 per group","$18,750","$18750 per person","$37500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","0%","$6,450","$6450 per person","$12900 per group","0%","$12,900","$12900 per person","$25800 per group","$18,750","$18750 per person","$37500 per group","Yes",,,"https://nebraskablue.com/2016sb5850HSAbronze_sbc","https://nebraskablue.com/2016selectblue_aca","33"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","3","29678","NE","Individual","No","47-0095156","29678NE1100009","BlueEssentials 6850 Catastrophic","29678NE110",,"NEN001","NES001","NEF002","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100009-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"https://nebraskablue.com/2016be6850CAT_sbc","https://nebraskablue.com/2016blueessentials_aca","4"
"2016","NE","29678","SERFF","6","2016-01-29 07:27:50","3","29678","NE","Individual","No","47-0095156","29678NE1100009","BlueEssentials 6850 Catastrophic","29678NE110",,"NEN001","NES001","NEF002","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes",,"https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/IVL/2016/2016_NE_5T_HealthInsuranceMarketplaceEssentialIndividual.pdf","29678NE1100009-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$7,200","$0","$0","$200","$4,900","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"https://nebraskablue.com/2016be6850CAT_sbc","https://nebraskablue.com/2016blueessentials_aca","5"
"2016","NE","36768","SERFF","3","2015-08-22 23:36:24","1","36768","NE","SHOP (Small Group)","Yes","47-0098400","36768NE0040002","EHB High PPO","36768NE004",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.45","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","36768NE0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","NE","36768","SERFF","3","2015-08-22 23:36:24","1","36768","NE","SHOP (Small Group)","Yes","47-0098400","36768NE0040001","EHB Low PPO","36768NE004",,"NEN001","NES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.39","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","36768NE0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","NE","36768","SERFF","3","2015-08-22 23:36:24","1","36768","NE","SHOP (Small Group)","Yes","47-0098400","36768NE0030002","EHB High Passive","36768NE003",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.78","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","36768NE0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","NE","36768","SERFF","3","2015-08-22 23:36:24","1","36768","NE","SHOP (Small Group)","Yes","47-0098400","36768NE0030001","EHB Low Passive","36768NE003",,"NEN001","NES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.16","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","36768NE0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","1","44751","NE","Individual","No","47-0676824","44751NE0010003","Silver Compass HSA 3000","44751NE001",,"NEN001","NES001","NEF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010003-00","Standard Silver Off Exchange Plan","69.20%",,"Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ne0007&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","4"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","1","44751","NE","Individual","No","47-0676824","44751NE0010003","Silver Compass HSA 3000","44751NE001",,"NEN001","NES001","NEF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010003-04","73% AV Level Silver Plan","72.10%",,"Yes","Yes","No","100%",,"$2,500","$10","$0","$200","$2,500","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ne0010&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","8"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","1","44751","NE","Individual","No","47-0676824","44751NE0010003","Silver Compass HSA 3000","44751NE001",,"NEN001","NES001","NEF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010003-05","87% AV Level Silver Plan","86.30%",,"Yes","Yes","No","100%",,"$800","$10","$0","$200","$800","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ne0011&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","9"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","1","44751","NE","Individual","No","47-0676824","44751NE0010003","Silver Compass HSA 3000","44751NE001",,"NEN001","NES001","NEF004","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010003-06","94% AV Level Silver Plan","93.20%",,"Yes","Yes","No","100%",,"$200","$10","$0","$200","$200","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ne0012&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","10"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","1","44751","NE","Individual","No","47-0676824","44751NE0010007","Bronze Compass HSA 5500","44751NE001",,"NEN001","NES001","NEF006","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010007-00","Standard Bronze Off Exchange Plan","61.30%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ne0031&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","11"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","1","44751","NE","Individual","No","47-0676824","44751NE0010007","Bronze Compass HSA 5500","44751NE001",,"NEN001","NES001","NEF006","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010007-01","Standard Bronze On Exchange Plan","61.30%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ne0031&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","12"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","1","44751","NE","Individual","No","47-0676824","44751NE0010007","Bronze Compass HSA 5500","44751NE001",,"NEN001","NES001","NEF006","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010007-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=ne0032&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","13"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","1","44751","NE","Individual","No","47-0676824","44751NE0010007","Bronze Compass HSA 5500","44751NE001",,"NEN001","NES001","NEF006","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010007-03","Limited Cost Sharing Plan Variation","61.30%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=ne0033&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","14"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","1","45550","NE","Individual","Yes","47-0685003","45550NE0010001","Pediatric Dental A","45550NE001",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0010001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-a",,"5"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","2","45550","NE","Individual","Yes","47-0685003","45550NE0020001","Pediatric Dental A + Adult A","45550NE002",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0020001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-a-adult-a",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","2","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0180001","Pediatric Dental A + Adult A","45550NE018",,"NEN001","NES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0180001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","2","45550","NE","Individual","Yes","47-0685003","45550NE0020001","Pediatric Dental A + Adult A","45550NE002",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0020001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-a-adult-a",,"5"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","3","45550","NE","Individual","Yes","47-0685003","45550NE0030001","Pediatric Dental A + Adult B","45550NE003",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-a-adult-b",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","3","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0190001","Pediatric Dental A + Adult B","45550NE019",,"NEN001","NES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0190001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/",,"4"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010001","Gold Compass 500","44751NE001",,"NEN001","NES001","NEF001","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010001-00","Standard Gold Off Exchange Plan","78.30%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0001&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","4"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010001","Gold Compass 500","44751NE001",,"NEN001","NES001","NEF001","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0001&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","5"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010001","Gold Compass 500","44751NE001",,"NEN001","NES001","NEF001","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0002&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","6"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010001","Gold Compass 500","44751NE001",,"NEN001","NES001","NEF001","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,"$500","$10","$1,400","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0003&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","7"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010002","Gold Compass 0","44751NE001",,"NEN001","NES001","NEF002","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010002-00","Standard Gold Off Exchange Plan","79.10%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0004&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","8"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010002","Gold Compass 0","44751NE001",,"NEN001","NES001","NEF002","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010002-01","Standard Gold On Exchange Plan","79.10%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0004&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","9"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010002","Gold Compass 0","44751NE001",,"NEN001","NES001","NEF002","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0005&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","10"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010002","Gold Compass 0","44751NE001",,"NEN001","NES001","NEF002","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010002-03","Limited Cost Sharing Plan Variation","79.10%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0006&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","11"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010004","Silver Compass 2000","44751NE001",,"NEN001","NES001","NEF005","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010004-00","Standard Silver Off Exchange Plan","69.30%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0013&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","12"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010004","Silver Compass 2000","44751NE001",,"NEN001","NES001","NEF005","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010004-01","Standard Silver On Exchange Plan","69.30%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0013&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","13"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010004","Silver Compass 2000","44751NE001",,"NEN001","NES001","NEF005","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0014&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","14"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010004","Silver Compass 2000","44751NE001",,"NEN001","NES001","NEF005","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010004-03","Limited Cost Sharing Plan Variation","69.30%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0015&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","15"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010004","Silver Compass 2000","44751NE001",,"NEN001","NES001","NEF005","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010004-04","73% AV Level Silver Plan","73.40%",,"No","Yes","No","100%",,"$1,200","$20","$1,500","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0016&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","16"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010004","Silver Compass 2000","44751NE001",,"NEN001","NES001","NEF005","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010004-05","87% AV Level Silver Plan","87.90%",,"No","Yes","No","100%",,"$200","$10","$600","$200","$200","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0017&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","17"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010004","Silver Compass 2000","44751NE001",,"NEN001","NES001","NEF005","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010004-06","94% AV Level Silver Plan","93.90%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0018&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","18"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010005","Silver Compass 3500","44751NE001",,"NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010005-00","Standard Silver Off Exchange Plan","68.00%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0019&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","19"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010005","Silver Compass 3500","44751NE001",,"NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010005-01","Standard Silver On Exchange Plan","68.00%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0019&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","20"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010005","Silver Compass 3500","44751NE001",,"NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010005-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0020&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","21"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010005","Silver Compass 3500","44751NE001",,"NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010005-06","94% AV Level Silver Plan","93.90%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0024&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","25"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010006","Silver Compass 4500","44751NE001",,"NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010006-00","Standard Silver Off Exchange Plan","68.30%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0025&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","26"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010006","Silver Compass 4500","44751NE001",,"NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010006-01","Standard Silver On Exchange Plan","68.30%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0025&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","27"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010006","Silver Compass 4500","44751NE001",,"NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010006-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0026&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","28"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010006","Silver Compass 4500","44751NE001",,"NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010006-03","Limited Cost Sharing Plan Variation","68.30%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0027&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","29"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010006","Silver Compass 4500","44751NE001",,"NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010006-04","73% AV Level Silver Plan","72.50%",,"No","Yes","No","100%",,"$3,200","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0028&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","30"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010006","Silver Compass 4500","44751NE001",,"NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010006-05","87% AV Level Silver Plan","86.10%",,"No","Yes","No","100%",,"$600","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0029&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","31"
"2016","NE","50022","SERFF","3","2015-08-22 23:36:24","1","50022","NE","Individual","Yes","95-6042390","50022NE0020003","BESTOne Advantage Gold","50022NE002",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.02","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NE","50022","SERFF","3","2015-08-22 23:36:24","1","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010007","BESTDental Premium","50022NE001",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010006","Silver Compass 4500","44751NE001",,"NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010006-06","94% AV Level Silver Plan","93.30%",,"No","Yes","No","100%",,"$100","$10","$0","$200","$100","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=ne0030&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","32"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010008","Bronze Compass 6500","44751NE001",,"NEN001","NES001","NEF006","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010008-00","Standard Bronze Off Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ne0034&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","33"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010008","Bronze Compass 6500","44751NE001",,"NEN001","NES001","NEF006","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010008-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ne0034&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","34"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010008","Bronze Compass 6500","44751NE001",,"NEN001","NES001","NEF006","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010008-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=ne0035&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","35"
"2016","NE","44751","SERFF","5","2015-08-25 12:56:34","2","44751","NE","Individual","No","47-0676824","44751NE0010008","Bronze Compass 6500","44751NE001",,"NEN001","NES001","NEF006","New","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=ne0038&st=ne","44751NE0010008-03","Limited Cost Sharing Plan Variation","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=ne0036&st=ne","http://www.uhc.com/iex/doc?id=ne0037&st=ne","36"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","1","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0170001","Pediatric Dental A","45550NE017",,"NEN001","NES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0170001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","1","45550","NE","Individual","Yes","47-0685003","45550NE0010001","Pediatric Dental A","45550NE001",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-a",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","3","45550","NE","Individual","Yes","47-0685003","45550NE0030001","Pediatric Dental A + Adult B","45550NE003",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0030001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-a-adult-b",,"5"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","4","45550","NE","Individual","Yes","47-0685003","45550NE0040001","Pediatric Dental A + Adult C","45550NE004",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-a-adult-c",,"4"
"2016","NE","64117","SERFF","3","2015-08-22 23:36:24","1","64117","NE","Individual","Yes","47-0397286","64117NE0010001","Delta Dental Individual PPO, EHB Certified","64117NE001",,"NEN002","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.85","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","64117NE0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NE","64117","SERFF","3","2015-08-22 23:36:24","1","64117","NE","SHOP (Small Group)","Yes","47-0397286","64117NE0030001","Renaissance Group Dental PPO, EHB Certified","64117NE003",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.84","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","64117NE0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NE","64117","SERFF","3","2015-08-22 23:36:24","1","64117","NE","SHOP (Small Group)","Yes","47-0397286","64117NE0030002","Renaissance Group Dental PPO, EHB Certified","64117NE003",,"NEN001","NES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.15","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","64117NE0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NE","64117","SERFF","3","2015-08-22 23:36:24","1","64117","NE","Individual","Yes","47-0397286","64117NE0010002","Delta Dental Individual PPO, EHB Certified","64117NE001",,"NEN002","NES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.57","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","64117NE0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NE","64117","SERFF","3","2015-08-22 23:36:24","1","64117","NE","Individual","Yes","47-0397286","64117NE0020001","Renaissance Individual Dental PPO, EHB Certified","64117NE002",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.85","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","64117NE0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","NE","64117","SERFF","3","2015-08-22 23:36:24","1","64117","NE","Individual","Yes","47-0397286","64117NE0020002","Renaissance Individual Dental PPO, EHB Certified","64117NE002",,"NEN001","NES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.67","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","64117NE0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","NE","78502","SERFF","3","2015-08-22 23:36:24","1","78502","NE","SHOP (Small Group)","Yes","57-0523959","78502NE0020001","Group Dental Policy","78502NE002",,"NEN001","NES001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.29","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","78502NE0020001-00","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NE","88667","SERFF","3","2015-08-22 23:36:24","1","88667","NE","SHOP (Small Group)","Yes","13-5581829","88667NE0060001","EHB Basic Dental Plan (Low)","88667NE006",,"NEN001","NES001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$15.99","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","88667NE0060001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NE","95796","SERFF","3","2015-08-22 23:36:24","1","95796","NE","SHOP (Small Group)","Yes","93-0242990","95796NE0040002","EHB High PPO","95796NE004",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.17","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","95796NE0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","NE","95796","SERFF","3","2015-08-22 23:36:24","1","95796","NE","SHOP (Small Group)","Yes","93-0242990","95796NE0040001","EHB Low PPO","95796NE004",,"NEN001","NES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.76","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","95796NE0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","NH","36773","SERFF","3","2015-08-20 12:28:36","1","36773","NH","SHOP (Small Group)","Yes","36-0883760","36773NH0030002","EHB High Passive","36773NH003",,"NHN001","NHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$59.36","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","36773NH0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","NH","36773","SERFF","3","2015-08-20 12:28:36","1","36773","NH","SHOP (Small Group)","Yes","36-0883760","36773NH0030001","EHB Low Passive","36773NH003",,"NHN001","NHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.39","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","36773NH0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","NH","44500","SERFF","3","2015-08-21 06:27:38","1","44500","NH","SHOP (Small Group)","Yes","13-5581829","44500NH0080001","EHB Basic Dental Plan (Low)","44500NH008",,"NHN001","NHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$23.11","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","44500NH0080001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NH","57601","SERFF","4","2015-08-22 23:36:24","1","57601","NH","Individual","Yes","02-0510530","57601NH0400003","Anthem Dental Pediatric","57601NH040",,"NHN002","NHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$29.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","57601NH0400003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213906.pdf",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","4","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0200001","Pediatric Dental A + Adult C","45550NE020",,"NEN001","NES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0200001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","4","45550","NE","Individual","Yes","47-0685003","45550NE0040001","Pediatric Dental A + Adult C","45550NE004",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0040001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-a-adult-c",,"5"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","5","45550","NE","Individual","Yes","47-0685003","45550NE0050001","Pediatric Dental A + Adult D","45550NE005",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0050001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-a-adult-d",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","5","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0210001","Pediatric Dental A + Adult D","45550NE021",,"NEN001","NES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0210001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","5","45550","NE","Individual","Yes","47-0685003","45550NE0050001","Pediatric Dental A + Adult D","45550NE005",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0050001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-a-adult-d",,"5"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","6","45550","NE","Individual","Yes","47-0685003","45550NE0060001","Pediatric Dental A + Adult E","45550NE006",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0060001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-a-adult-e",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","6","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0220001","Pediatric Dental A + Adult E","45550NE022",,"NEN001","NES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0220001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","6","45550","NE","Individual","Yes","47-0685003","45550NE0060001","Pediatric Dental A + Adult E","45550NE006",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0060001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-a-adult-e",,"5"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","7","45550","NE","Individual","Yes","47-0685003","45550NE0070001","Pediatric Dental A + Adult F","45550NE007",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0070001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-a-adult-f",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","7","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0230001","Pediatric Dental A + Adult F","45550NE023",,"NEN001","NES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0230001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","7","45550","NE","Individual","Yes","47-0685003","45550NE0070001","Pediatric Dental A + Adult F","45550NE007",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0070001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-a-adult-f",,"5"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","8","45550","NE","Individual","Yes","47-0685003","45550NE0080001","Pediatric Dental A + Adult G","45550NE008",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0080001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-a-adult-g",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","8","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0240001","Pediatric Dental A + Adult G","45550NE024",,"NEN001","NES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0240001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","8","45550","NE","Individual","Yes","47-0685003","45550NE0080001","Pediatric Dental A + Adult G","45550NE008",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0080001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-a-adult-g",,"5"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","9","45550","NE","Individual","Yes","47-0685003","45550NE0090001","Pediatric Dental B","45550NE009",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0090001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-b",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","9","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0250001","Pediatric Dental B","45550NE025",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0250001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","9","45550","NE","Individual","Yes","47-0685003","45550NE0090001","Pediatric Dental B","45550NE009",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0090001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-b",,"5"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","10","45550","NE","Individual","Yes","47-0685003","45550NE0100001","Pediatric Dental B + Adult A","45550NE010",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0100001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-b-adult-a",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","10","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0260001","Pediatric Dental B + Adult A","45550NE026",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0260001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","10","45550","NE","Individual","Yes","47-0685003","45550NE0100001","Pediatric Dental B + Adult A","45550NE010",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0100001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-b-adult-a",,"5"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","11","45550","NE","Individual","Yes","47-0685003","45550NE0110001","Pediatric Dental B + Adult B","45550NE011",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0110001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-b-adult-b",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","11","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0270001","Pediatric Dental B + Adult B","45550NE027",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0270001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","11","45550","NE","Individual","Yes","47-0685003","45550NE0110001","Pediatric Dental B + Adult B","45550NE011",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0110001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-b-adult-b",,"5"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","12","45550","NE","Individual","Yes","47-0685003","45550NE0120001","Pediatric Dental B + Adult C","45550NE012",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0120001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-b-adult-c",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","12","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0280001","Pediatric Dental B + Adult C","45550NE028",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0280001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","12","45550","NE","Individual","Yes","47-0685003","45550NE0120001","Pediatric Dental B + Adult C","45550NE012",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0120001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-b-adult-c",,"5"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","13","45550","NE","Individual","Yes","47-0685003","45550NE0130001","Pediatric Dental B + Adult D","45550NE013",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0130001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-b-adult-d",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","13","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0290001","Pediatric Dental B + Adult D","45550NE029",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0290001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","13","45550","NE","Individual","Yes","47-0685003","45550NE0130001","Pediatric Dental B + Adult D","45550NE013",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0130001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-b-adult-d",,"5"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","14","45550","NE","Individual","Yes","47-0685003","45550NE0140001","Pediatric Dental B + Adult E","45550NE014",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0140001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-b-adult-e",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","14","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0300001","Pediatric Dental B + Adult E","45550NE030",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0300001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","14","45550","NE","Individual","Yes","47-0685003","45550NE0140001","Pediatric Dental B + Adult E","45550NE014",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0140001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-b-adult-e",,"5"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","15","45550","NE","Individual","Yes","47-0685003","45550NE0150001","Pediatric Dental B + Adult F","45550NE015",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0150001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-b-adult-f",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","15","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0310001","Pediatric Dental B + Adult F","45550NE031",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0310001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","15","45550","NE","Individual","Yes","47-0685003","45550NE0150001","Pediatric Dental B + Adult F","45550NE015",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0150001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-b-adult-f",,"5"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","16","45550","NE","Individual","Yes","47-0685003","45550NE0160001","Pediatric Dental B + Adult G","45550NE016",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0160001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-b-adult-g",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","16","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0320001","Pediatric Dental B + Adult G","45550NE032",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0320001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalne.org/",,"4"
"2016","NE","45550","SERFF","5","2015-10-21 17:48:08","16","45550","NE","Individual","Yes","47-0685003","45550NE0160001","Pediatric Dental B + Adult G","45550NE016",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.00","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only","Yes","Similar benefits as In Service Area","Yes",,"","45550NE0160001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"deltadentalne.org/individual-and-family-plans/hcr/ne/ped-b-adult-g",,"5"
"2016","NE","48282","SERFF","4","2015-10-21 17:48:08","1","48282","NE","Individual","Yes","36-3757528","48282NE0010001","TruAssure Basic Adult or Child Dental Plan","48282NE001",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.47","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","48282NE0010001-00","Standard Low Off Exchange Plan","68.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$105","$105 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NE","https://www.truassure.com/brochure?state=NE","4"
"2016","NE","48282","SERFF","4","2015-10-21 17:48:08","1","48282","NE","SHOP (Small Group)","Yes","36-3757528","48282NE0030001","TruAssure Dental Small Group Basic Plan","48282NE003",,"NEN001","NES001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","48282NE0030001-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NE","48282","SERFF","4","2015-10-21 17:48:08","1","48282","NE","SHOP (Small Group)","Yes","36-3757528","48282NE0040001","TruAssure Dental Small Group Preferred Plan","48282NE004",,"NEN001","NES001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","48282NE0040001-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$55","$55 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NE","48282","SERFF","4","2015-10-21 17:48:08","1","48282","NE","Individual","Yes","36-3757528","48282NE0010001","TruAssure Basic Adult or Child Dental Plan","48282NE001",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.47","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","48282NE0010001-01","Standard Low On Exchange Plan","68.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$105","$105 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NE","https://www.truassure.com/brochure?state=NE","5"
"2016","NE","48282","SERFF","4","2015-10-21 17:48:08","2","48282","NE","Individual","Yes","36-3757528","48282NE0020001","TruAssure Preferred Adult or Child Dental Plan","48282NE002",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.86","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","48282NE0020001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NE","https://www.truassure.com/brochure?state=NE","4"
"2016","NE","48282","SERFF","4","2015-10-21 17:48:08","2","48282","NE","Individual","Yes","36-3757528","48282NE0020001","TruAssure Preferred Adult or Child Dental Plan","48282NE002",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.86","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","48282NE0020001-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","$35 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=NE","https://www.truassure.com/brochure?state=NE","5"
"2016","NE","50022","SERFF","3","2015-08-22 23:36:24","1","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010007","BESTDental Premium","50022NE001",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NE","50022","SERFF","3","2015-08-22 23:36:24","1","50022","NE","Individual","Yes","95-6042390","50022NE0020003","BESTOne Advantage Gold","50022NE002",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.02","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NE","50022","SERFF","3","2015-08-22 23:36:24","1","50022","NE","Individual","Yes","95-6042390","50022NE0020004","BESTOne Plus Gold","50022NE002",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.02","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","NE","50022","SERFF","3","2015-08-22 23:36:24","1","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010008","BESTDental Standard - H","50022NE001",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","NE","50022","SERFF","3","2015-08-22 23:36:24","1","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010008","BESTDental Standard - H","50022NE001",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","NE","50022","SERFF","3","2015-08-22 23:36:24","1","50022","NE","Individual","Yes","95-6042390","50022NE0020004","BESTOne Plus Gold","50022NE002",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.02","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","NE","50022","SERFF","3","2015-08-22 23:36:24","1","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010010","BESTDental Choice - H","50022NE001",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","NE","50022","SERFF","3","2015-08-22 23:36:24","1","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010010","BESTDental Choice - H","50022NE001",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","NE","50022","SERFF","3","2015-08-22 23:36:24","2","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010009","BESTDental Standard - L","50022NE001",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.70","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NE","50022","SERFF","3","2015-08-22 23:36:24","2","50022","NE","Individual","Yes","95-6042390","50022NE0020005","BESTOne Plus Silver","50022NE002",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.11","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NE","50022","SERFF","3","2015-08-22 23:36:24","2","50022","NE","Individual","Yes","95-6042390","50022NE0020005","BESTOne Plus Silver","50022NE002",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.11","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NE","50022","SERFF","3","2015-08-22 23:36:24","2","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010009","BESTDental Standard - L","50022NE001",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.70","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NE","50022","SERFF","3","2015-08-22 23:36:24","2","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010011","BESTDental Choice - L","50022NE001",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.70","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","NE","50022","SERFF","3","2015-08-22 23:36:24","2","50022","NE","Individual","Yes","95-6042390","50022NE0020006","BESTOne Basic Silver","50022NE002",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.11","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","NE","50022","SERFF","3","2015-08-22 23:36:24","2","50022","NE","Individual","Yes","95-6042390","50022NE0020006","BESTOne Basic Silver","50022NE002",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.11","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","50022NE0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","NE","50022","SERFF","3","2015-08-22 23:36:24","2","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010011","BESTDental Choice - L","50022NE001",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.70","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","NE","50022","SERFF","3","2015-08-22 23:36:24","2","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010012","BESTDental Value","50022NE001",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.70","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","NE","50022","SERFF","3","2015-08-22 23:36:24","2","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010012","BESTDental Value","50022NE001",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.70","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","50022NE0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","NE","95796","SERFF","3","2015-08-22 23:36:24","1","95796","NE","SHOP (Small Group)","Yes","93-0242990","95796NE0030002","EHB High Passive","95796NE003",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$45.55","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","95796NE0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","NE","95796","SERFF","3","2015-08-22 23:36:24","1","95796","NE","SHOP (Small Group)","Yes","93-0242990","95796NE0030001","EHB Low Passive","95796NE003",,"NEN001","NES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.57","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","95796NE0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","NE","98048","SERFF","3","2015-08-22 23:36:24","1","98048","NE","SHOP (Small Group)","Yes","13-5123390","98048NE0010002","Guardian Pediatric Advantage","98048NE001",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$26.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","98048NE0010002-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","NE","98048","SERFF","3","2015-08-22 23:36:24","1","98048","NE","SHOP (Small Group)","Yes","13-5123390","98048NE0020002","Guardian Pediatric Essentials","98048NE002",,"NEN001","NES001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$20.57","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","98048NE0020002-00","Standard Low Off Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","NE","98048","SERFF","3","2015-08-22 23:36:24","2","98048","NE","SHOP (Small Group)","Yes","13-5123390","98048NE0040002","Guardian Family Advantage","98048NE004",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","98048NE0040002-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","NE","98048","SERFF","3","2015-08-22 23:36:24","2","98048","NE","SHOP (Small Group)","Yes","13-5123390","98048NE0040002","Guardian Family Advantage","98048NE004",,"NEN001","NES001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","98048NE0040002-01","Standard High On Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","NE","98048","SERFF","3","2015-08-22 23:36:24","2","98048","NE","SHOP (Small Group)","Yes","13-5123390","98048NE0060002","Guardian Family Essentials","98048NE006",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.57","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","98048NE0060002-00","Standard Low Off Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","NE","98048","SERFF","3","2015-08-22 23:36:24","2","98048","NE","SHOP (Small Group)","Yes","13-5123390","98048NE0060002","Guardian Family Essentials","98048NE006",,"NEN001","NES001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.57","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","98048NE0060002-01","Standard Low On Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","NE","99568","SERFF","3","2015-08-22 23:36:24","1","99568","NE","SHOP (Small Group)","Yes","41-0808596","99568NE0010002","Plan 2. Passive PPO $1000 Annual Maximum, Ortho","99568NE001",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","99568NE0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NE","99568","SERFF","3","2015-08-22 23:36:24","1","99568","NE","SHOP (Small Group)","Yes","41-0808596","99568NE0010005","Plan 5. Passive PPO, $2000 Annaul Maximum, Ortho","99568NE001",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","99568NE0010005-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NE","99568","SERFF","3","2015-08-22 23:36:24","1","99568","NE","SHOP (Small Group)","Yes","41-0808596","99568NE0010006","Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho","99568NE001",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","99568NE0010006-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","NE","99568","SERFF","3","2015-08-22 23:36:24","1","99568","NE","SHOP (Small Group)","Yes","41-0808596","99568NE0010009","Plan 9. MAC PPO, $1500 Annual Maximum, Ortho","99568NE001",,"NEN001","NES001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$20.18","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","99568NE0010009-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","1","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0100001","Community Basic HSA","19304NH010",,"NHN001","NHS001","NHF010","Existing","PPO","Bronze","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"0.9978",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0100001-00","Standard Bronze Off Exchange Plan","61.88%","0.618793725967407","Yes","Yes","No","100%",,"$4,300","$0","$960","$0","$4,300","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/SBC-for-BasicHSA_19304NH010010915-01.pdf",,"4"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","1","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0100001","Community Basic HSA","19304NH010",,"NHN001","NHS001","NHF010","Existing","PPO","Bronze","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"0.9978",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0100001-01","Standard Bronze On Exchange Plan","61.88%","0.618793725967407","Yes","Yes","No","100%",,"$4,300","$0","$960","$0","$4,300","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/SBC-for-BasicHSA_19304NH010010915-01.pdf",,"5"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","1","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0100002","Community Access HSA","19304NH010",,"NHN001","NHS001","NHF001","New","PPO","Bronze","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"0.9978",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0100002-00","Standard Bronze Off Exchange Plan","59.94%","0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/SBC-for-AccessHSA_19304NH010020915-01.pdf",,"6"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","1","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0100002","Community Access HSA","19304NH010",,"NHN001","NHS001","NHF001","New","PPO","Bronze","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"0.9978",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0100002-01","Standard Bronze On Exchange Plan","59.94%","0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/SBC-for-AccessHSA_19304NH010020915-01.pdf",,"7"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","1","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0100003","Community Balance HSA","19304NH010",,"NHN001","NHS001","NHF011","Existing","PPO","Silver","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0100003-00","Standard Silver Off Exchange Plan","71.66%","0.712145209312439","Yes","Yes","No","100%",,"$2,600","$0","$510","$0","$2,600","$0","$560","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/SBC-for-BalanceHSA_19304NH010030915-01.pdf",,"8"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","1","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0100003","Community Balance HSA","19304NH010",,"NHN001","NHS001","NHF011","Existing","PPO","Silver","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0100003-01","Standard Silver On Exchange Plan","71.66%","0.712145209312439","Yes","Yes","No","100%",,"$2,600","$0","$510","$0","$2,600","$0","$560","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/SBC-for-BalanceHSA_19304NH010030915-01.pdf",,"9"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","1","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0100004","Community Core HSA","19304NH010",,"NHN001","NHS001","NHF009","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0100004-00","Standard Silver Off Exchange Plan","68.04%","0.680405020713806","Yes","Yes","No","100%",,"$3,000","$10","$1,290","$0","$2,400","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/SBC-for-CoreHSA_19304NH010040915-01.pdf",,"10"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","1","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0100004","Community Core HSA","19304NH010",,"NHN001","NHS001","NHF009","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0100004-01","Standard Silver On Exchange Plan","68.04%","0.680405020713806","Yes","Yes","No","100%",,"$3,000","$10","$1,290","$0","$2,400","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/SBC-for-CoreHSA_19304NH010040915-01.pdf",,"11"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","1","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0100005","Community Option","19304NH010",,"NHN001","NHS001","NHF003","Existing","PPO","Bronze","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.9976",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0100005-00","Standard Bronze Off Exchange Plan","61.98%","0.61573052406311","Yes","Yes","No","100%",,"$5,500","$0","$1,000","$0","$0","$0","$525","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Option_19304NH010050915-01.pdf",,"12"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","1","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0100005","Community Option","19304NH010",,"NHN001","NHS001","NHF003","Existing","PPO","Bronze","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.9976",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0100005-01","Standard Bronze On Exchange Plan","61.98%","0.61573052406311","Yes","Yes","No","100%",,"$5,500","$0","$1,000","$0","$0","$0","$525","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Option_19304NH010050915-01.pdf",,"13"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","1","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0100006","Community Choice","19304NH010",,"NHN001","NHS001","NHF006","Existing","PPO","Silver","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0100006-00","Standard Silver Off Exchange Plan","69.02%","0.68623822927475","Yes","Yes","No","100%",,"$2,500","$0","$1,500","$0","$0","$0","$315","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Choice_19304NH010060915-01.pdf",,"14"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","1","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0100006","Community Choice","19304NH010",,"NHN001","NHS001","NHF006","Existing","PPO","Silver","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0100006-01","Standard Silver On Exchange Plan","69.02%","0.68623822927475","Yes","Yes","No","100%",,"$2,500","$0","$1,500","$0","$0","$0","$315","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,500","$5500 per person","$11000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Choice_19304NH010060915-01.pdf",,"15"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","1","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0100007","Community Preferred","19304NH010",,"NHN001","NHS001","NHF004","Existing","PPO","Silver","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0100007-00","Standard Silver Off Exchange Plan","72.00%","0.717229008674622","Yes","Yes","No","100%",,"$2,450","$40","$1,455","$0","$0","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Preferred_19304NH010070915-01.pdf",,"16"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","1","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0100007","Community Preferred","19304NH010",,"NHN001","NHS001","NHF004","Existing","PPO","Silver","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.9979",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0100007-01","Standard Silver On Exchange Plan","72.00%","0.717229008674622","Yes","Yes","No","100%",,"$2,450","$40","$1,455","$0","$0","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Preferred_19304NH010070915-01.pdf",,"17"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","1","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0100008","Community Advantage","19304NH010",,"NHN001","NHS001","NHF007","Existing","PPO","Gold","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0100008-00","Standard Gold Off Exchange Plan","80.57%","0.80264812707901","Yes","Yes","No","100%",,"$750","$30","$1,310","$0","$0","$150","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$8,250","$8250 per person","$16500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Advantage_19304NH010080915-01.pdf",,"18"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","1","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0100008","Community Advantage","19304NH010",,"NHN001","NHS001","NHF007","Existing","PPO","Gold","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0100008-01","Standard Gold On Exchange Plan","80.57%","0.80264812707901","Yes","Yes","No","100%",,"$750","$30","$1,310","$0","$0","$150","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$8,250","$8250 per person","$16500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Advantage_19304NH010080915-01.pdf",,"19"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","1","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0100009","Community Prime","19304NH010",,"NHN001","NHS001","NHF008","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0100009-00","Standard Gold Off Exchange Plan","78.48%","0.782675921916962","Yes","Yes","No","100%",,"$1,500","$30","$1,740","$0","$0","$150","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7400 per group",,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Prime_19304NH010090915-01.pdf",,"20"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","1","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0100009","Community Prime","19304NH010",,"NHN001","NHS001","NHF008","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.998",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0100009-01","Standard Gold On Exchange Plan","78.48%","0.782675921916962","Yes","Yes","No","100%",,"$1,500","$30","$1,740","$0","$0","$150","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,700","$3700 per person","$7400 per group",,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Prime_19304NH010090915-01.pdf",,"21"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","1","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0100010","Community Premier","19304NH010",,"NHN001","NHS001","NHF005","Existing","PPO","Platinum","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0100010-00","Standard Platinum Off Exchange Plan","90.20%","0.900682151317596","Yes","Yes","No","100%",,"$500","$15","$680","$0","$0","$75","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Premier_19304NH010100915-01.pdf",,"22"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","1","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0100010","Community Premier","19304NH010",,"NHN001","NHS001","NHF005","Existing","PPO","Platinum","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.9981",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0100010-01","Standard Platinum On Exchange Plan","90.20%","0.900682151317596","Yes","Yes","No","100%",,"$500","$15","$680","$0","$0","$75","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.healthoptions.org/Documents/SBC-for-Premier_19304NH010100915-01.pdf",,"23"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","2","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0110001","Community Option HSA","19304NH011",,"NHN001","NHS001","NHF002","Existing","PPO","Bronze","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0110001-00","Standard Bronze Off Exchange Plan","60.40%","0.603970229625702","Yes","Yes","No","100%",,"$5,000","$0","$1,250","$0","$5,000","$0","$150","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/SBC-for-OptionHSA_19304NH011010915-01.pdf",,"4"
"2016","NH","19304","SERFF","17","2016-07-07 17:21:34","2","19304","NH","SHOP (Small Group)","No","45-3416923","19304NH0110001","Community Option HSA","19304NH011",,"NHN001","NHS001","NHF002","Existing","PPO","Bronze","Yes","Both","Yes","No",,,,"No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency services only.","Yes","National wrap network provided by FirstHealth.","Yes","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","https://www.healthoptions.org/Documents/Maine-Comple-formulary","19304NH0110001-01","Standard Bronze On Exchange Plan","60.40%","0.603970229625702","Yes","Yes","No","100%",,"$5,000","$0","$1,250","$0","$5,000","$0","$150","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.healthoptions.org/Documents/SBC-for-OptionHSA_19304NH011010915-01.pdf",,"5"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","1","59025","NH","SHOP (Small Group)","No","04-2663394","59025NH0320004","ElevateHealth HMO 2000","59025NH032",,"NHN002","NHS002","NHF002","New","HMO","Gold","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987029505104",,,"$550","0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only.","Yes","Urgent and Emergency Services Only.","No",,"https://www.harvardpilgrim.org/2016Value5T","59025NH0320004-00","Standard Gold Off Exchange Plan","78.90%",,"No","Yes","No","100%",,"$2,000","$10","$230","$150","$140","$1,640","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$2,000","$2000 per person","$4000 per group","10%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","40%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/portal/page?_pageid=849,6478020&_dad=portal&_schema=PORTAL",,"4"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","1","59025","NH","SHOP (Small Group)","No","04-2663394","59025NH0320004","ElevateHealth HMO 2000","59025NH032",,"NHN002","NHS002","NHF002","New","HMO","Gold","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987029505104",,,"$550","0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only.","Yes","Urgent and Emergency Services Only.","No",,"https://www.harvardpilgrim.org/2016Value5T","59025NH0320004-01","Standard Gold On Exchange Plan","78.90%",,"No","Yes","No","100%",,"$2,000","$10","$230","$150","$140","$1,640","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$2,000","$2000 per person","$4000 per group","10%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","40%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/61F8914874984BE5A52B038355A37165","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004565.PDF","5"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","1","59025","NH","Individual","No","04-2663394","59025NH0330002","ElevateHealth Gold HMO","59025NH033",,"NHN002","NHS002","NHF004","New","HMO","Gold","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,"$500","0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330002-01","Standard Gold On Exchange Plan","81.84%",,"Yes","Yes","No","100%",,"$1,250","$20","$0","$150","$140","$2,660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/01_1957_PD0000004550_SBC_ELEVATEHEALTHGOLDHMO.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004550.PDF","5"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","1","59025","NH","Individual","No","04-2663394","59025NH0330002","ElevateHealth Gold HMO","59025NH033",,"NHN002","NHS002","NHF004","New","HMO","Gold","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,"$500","0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/02_2054_PD0000004672_SBC_HPHCELEVATEHEALTH.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004672.PDF","6"
"2016","NH","21709","SERFF","3","2015-08-20 12:28:36","1","21709","NH","SHOP (Small Group)","Yes","93-0242990","21709NH0040002","EHB High PPO","21709NH004",,"NHN001","NHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$55.23","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","21709NH0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","NH","21709","SERFF","3","2015-08-20 12:28:36","1","21709","NH","SHOP (Small Group)","Yes","93-0242990","21709NH0040001","EHB Low PPO","21709NH004",,"NHN001","NHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.15","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","21709NH0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","NH","21709","SERFF","3","2015-08-20 12:28:36","1","21709","NH","SHOP (Small Group)","Yes","93-0242990","21709NH0030002","EHB High Passive","21709NH003",,"NHN001","NHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$59.53","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","21709NH0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","NH","21709","SERFF","3","2015-08-20 12:28:36","1","21709","NH","SHOP (Small Group)","Yes","93-0242990","21709NH0030001","EHB Low Passive","21709NH003",,"NHN001","NHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.51","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","21709NH0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","NH","24847","SERFF","3","2015-08-21 06:27:38","1","24847","NH","SHOP (Small Group)","Yes","13-5123390","24847NH0090003","Guardian Pediatric Advantage","24847NH009",,"NHN001","NHS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$31.87","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","24847NH0090003-00","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","NH","24847","SERFF","3","2015-08-21 06:27:38","1","24847","NH","SHOP (Small Group)","Yes","13-5123390","24847NH0100003","Guardian Pediatric Essentials","24847NH010",,"NHN001","NHS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$23.61","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","24847NH0100003-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","NH","24847","SERFF","3","2015-08-21 06:27:38","2","24847","NH","SHOP (Small Group)","Yes","13-5123390","24847NH0060003","Guardian Family Advantage","24847NH006",,"NHN001","NHS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.87","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","24847NH0060003-00","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","NH","24847","SERFF","3","2015-08-21 06:27:38","2","24847","NH","SHOP (Small Group)","Yes","13-5123390","24847NH0060003","Guardian Family Advantage","24847NH006",,"NHN001","NHS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.87","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","24847NH0060003-01","Standard High On Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","NH","24847","SERFF","3","2015-08-21 06:27:38","2","24847","NH","SHOP (Small Group)","Yes","13-5123390","24847NH0080003","Guardian Family Essentials","24847NH008",,"NHN001","NHS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.61","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","24847NH0080003-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","NH","24847","SERFF","3","2015-08-21 06:27:38","2","24847","NH","SHOP (Small Group)","Yes","13-5123390","24847NH0080003","Guardian Family Essentials","24847NH008",,"NHN001","NHS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.61","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","24847NH0080003-01","Standard Low On Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","NH","36773","SERFF","3","2015-08-20 12:28:36","1","36773","NH","SHOP (Small Group)","Yes","36-0883760","36773NH0040002","EHB High PPO","36773NH004",,"NHN001","NHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$55.06","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","36773NH0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","NH","36773","SERFF","3","2015-08-20 12:28:36","1","36773","NH","SHOP (Small Group)","Yes","36-0883760","36773NH0040001","EHB Low PPO","36773NH004",,"NHN001","NHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.06","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","36773NH0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","NH","57601","SERFF","4","2015-08-22 23:36:24","1","57601","NH","SHOP (Small Group)","Yes","02-0510530","57601NH0370003","Anthem Dental Pediatric","57601NH037",,"NHN002","NHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$29.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","57601NH0370003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213906.pdf",,"4"
"2016","NH","57601","SERFF","4","2015-08-22 23:36:24","1","57601","NH","Individual","Yes","02-0510530","57601NH0400003","Anthem Dental Pediatric","57601NH040",,"NHN002","NHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$29.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","57601NH0400003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213906.pdf",,"5"
"2016","NH","57601","SERFF","4","2015-08-22 23:36:24","2","57601","NH","Individual","Yes","02-0510530","57601NH0420003","Anthem Dental Family","57601NH042",,"NHN002","NHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.34","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","57601NH0420003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213904.pdf",,"4"
"2016","NH","57601","SERFF","4","2015-08-22 23:36:24","2","57601","NH","SHOP (Small Group)","Yes","02-0510530","57601NH0390003","Anthem Dental Family","57601NH039",,"NHN002","NHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.34","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","57601NH0390003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213904.pdf",,"4"
"2016","NH","57601","SERFF","4","2015-08-22 23:36:24","2","57601","NH","SHOP (Small Group)","Yes","02-0510530","57601NH0390003","Anthem Dental Family","57601NH039",,"NHN002","NHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.34","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","57601NH0390003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213904.pdf",,"5"
"2016","NH","57601","SERFF","4","2015-08-22 23:36:24","2","57601","NH","Individual","Yes","02-0510530","57601NH0420003","Anthem Dental Family","57601NH042",,"NHN002","NHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.34","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","57601NH0420003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213904.pdf",,"5"
"2016","NH","57601","SERFF","4","2015-08-22 23:36:24","3","57601","NH","Individual","Yes","02-0510530","57601NH0420004","Anthem Dental Family Enhanced","57601NH042",,"NHN002","NHS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.66","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","57601NH0420004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213905.pdf",,"4"
"2016","NH","57601","SERFF","4","2015-08-22 23:36:24","3","57601","NH","SHOP (Small Group)","Yes","02-0510530","57601NH0390004","Anthem Dental Family Enhanced","57601NH039",,"NHN002","NHS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.66","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","57601NH0390004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213905.pdf",,"4"
"2016","NH","57601","SERFF","4","2015-08-22 23:36:24","3","57601","NH","SHOP (Small Group)","Yes","02-0510530","57601NH0390004","Anthem Dental Family Enhanced","57601NH039",,"NHN002","NHS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.66","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","57601NH0390004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213905.pdf",,"5"
"2016","NH","57601","SERFF","4","2015-08-22 23:36:24","3","57601","NH","Individual","Yes","02-0510530","57601NH0420004","Anthem Dental Family Enhanced","57601NH042",,"NHN002","NHS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.66","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","57601NH0420004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213905.pdf",,"5"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","1","59025","NH","Individual","No","04-2663394","59025NH0330002","ElevateHealth Gold HMO","59025NH033",,"NHN002","NHS002","NHF004","New","HMO","Gold","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,"$500","0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330002-00","Standard Gold Off Exchange Plan","81.84%",,"Yes","Yes","No","100%",,"$1,250","$20","$0","$150","$140","$2,660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","No",,,"https://www.harvardpilgrim.org/portal/page?_pageid=213,6480024&_dad=portal&_schema=PORTAL",,"4"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","1","59025","NH","Individual","No","04-2663394","59025NH0330002","ElevateHealth Gold HMO","59025NH033",,"NHN002","NHS002","NHF004","New","HMO","Gold","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,"$500","0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330002-03","Limited Cost Sharing Plan Variation","81.84%",,"Yes","Yes","No","100%",,"$1,250","$20","$0","$150","$140","$2,660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/23_1957_PD0000004551_SBC_ELEVATEHEALTHGOLDHMO.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004551.PDF","7"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","8","59025","NH","Individual","No","04-2663394","59025NH0340001","New Hampshire Network Silver HMO Premium","59025NH034",,"NHN003","NHS003","NHF014","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0340001-06","94% AV Level Silver Plan","95.00%","0.949418663978577","No","Yes","No","100%",,"$0","$10","$0","$150","$0","$620","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/21_1947_PD0000004535_SBC_NHNETWORKSILVERHMOPREMIUM.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004535.PDF","10"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","1","59025","NH","SHOP (Small Group)","No","04-2663394","59025NH0320008","ElevateHealth HMO 3000 Low Option","59025NH032",,"NHN002","NHS002","NHF001","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998708335296075",,,"$550","0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only.","Yes","Urgent and Emergency Services Only.","No",,"https://www.harvardpilgrim.org/2016Value5T","59025NH0320008-00","Standard Silver Off Exchange Plan","69.60%",,"No","Yes","No","100%",,"$3,020","$0","$260","$150","$640","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$500","$500 per person","per group not applicable","40%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/portal/page?_pageid=849,6478020&_dad=portal&_schema=PORTAL",,"7"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","1","59025","NH","SHOP (Small Group)","No","04-2663394","59025NH0320008","ElevateHealth HMO 3000 Low Option","59025NH032",,"NHN002","NHS002","NHF001","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998708335296075",,,"$550","0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only.","Yes","Urgent and Emergency Services Only.","No",,"https://www.harvardpilgrim.org/2016Value5T","59025NH0320008-01","Standard Silver On Exchange Plan","69.60%",,"No","Yes","No","100%",,"$3,020","$0","$260","$150","$640","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$500","$500 per person","per group not applicable","40%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/0E03C895DFAE4A3582E7311AFF774D61","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004598.PDF","8"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","1","59025","NH","SHOP (Small Group)","No","04-2663394","59025NH0320016","ElevateHealth HMO 4000","59025NH032",,"NHN002","NHS002","NHF002","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987029505104",,,"$550","0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only.","Yes","Urgent and Emergency Services Only.","No",,"https://www.harvardpilgrim.org/2016Value5T","59025NH0320016-00","Standard Silver Off Exchange Plan","69.70%",,"No","Yes","No","100%",,"$4,000","$10","$0","$150","$140","$1,840","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","40%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/portal/page?_pageid=849,6478020&_dad=portal&_schema=PORTAL",,"10"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","1","59025","NH","SHOP (Small Group)","No","04-2663394","59025NH0320016","ElevateHealth HMO 4000","59025NH032",,"NHN002","NHS002","NHF002","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987029505104",,,"$550","0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only.","Yes","Urgent and Emergency Services Only.","No",,"https://www.harvardpilgrim.org/2016Value5T","59025NH0320016-01","Standard Silver On Exchange Plan","69.70%",,"No","Yes","No","100%",,"$4,000","$10","$0","$150","$140","$1,840","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","40%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/8B00EA89648441E993388D57B47D0261","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004622.PDF","11"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","2","59025","NH","Individual","No","04-2663394","59025NH0330008","ElevateHealth Silver HMO","59025NH033",,"NHN002","NHS002","NHF014","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330008-00","Standard Silver Off Exchange Plan","70.00%","0.699684083461761","No","Yes","No","100%",,"$3,400","$940","$0","$150","$140","$2,710","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/portal/page?_pageid=213,6480024&_dad=portal&_schema=PORTAL",,"4"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","2","59025","NH","Individual","No","04-2663394","59025NH0330008","ElevateHealth Silver HMO","59025NH033",,"NHN002","NHS002","NHF014","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330008-01","Standard Silver On Exchange Plan","70.00%","0.699684083461761","No","Yes","No","100%",,"$3,400","$940","$0","$150","$140","$2,710","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/03_1998_PD0000004604_SBC_ELEVATEHEALTHSILVERHMO.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004604.PDF","5"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","2","59025","NH","SHOP (Small Group)","No","04-2663394","59025NH0320006","ElevateHealth HSA HMO 3000","59025NH032",,"NHN002","NHS002","NHF005","New","HMO","Silver","No","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987029505104",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only.","Yes","Urgent and Emergency Services Only.","No",,"https://www.harvardpilgrim.org/2016Value4T","59025NH0320006-00","Standard Silver Off Exchange Plan",,"0.709488272666931","Yes","Yes","No","100%",,"$3,000","$0","$0","$150","$3,000","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/portal/page?_pageid=849,6478020&_dad=portal&_schema=PORTAL",,"5"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","2","59025","NH","SHOP (Small Group)","No","04-2663394","59025NH0320006","ElevateHealth HSA HMO 3000","59025NH032",,"NHN002","NHS002","NHF005","New","HMO","Silver","No","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987029505104",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only.","Yes","Urgent and Emergency Services Only.","No",,"https://www.harvardpilgrim.org/2016Value4T","59025NH0320006-01","Standard Silver On Exchange Plan",,"0.709488272666931","Yes","Yes","No","100%",,"$3,000","$0","$0","$150","$3,000","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/754E4C1B058F40DBB1B1F40A67396DEE","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004585.PDF","6"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","2","59025","NH","Individual","No","04-2663394","59025NH0330008","ElevateHealth Silver HMO","59025NH033",,"NHN002","NHS002","NHF014","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/04_2247_PD0000004669_SBC_HPHCELEVATEHEALTH.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004669.PDF","6"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","2","59025","NH","Individual","No","04-2663394","59025NH0330008","ElevateHealth Silver HMO","59025NH033",,"NHN002","NHS002","NHF014","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330008-03","Limited Cost Sharing Plan Variation","70.00%","0.699684083461761","No","Yes","No","100%",,"$3,400","$940","$0","$150","$140","$2,710","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/24_1998_PD0000004605_SBC_ELEVATEHEALTHSILVERHMO.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004605.PDF","7"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","2","59025","NH","Individual","No","04-2663394","59025NH0330008","ElevateHealth Silver HMO","59025NH033",,"NHN002","NHS002","NHF014","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330008-04","73% AV Level Silver Plan","73.50%","0.72865754365921","No","Yes","No","100%",,"$3,000","$770","$0","$150","$140","$2,610","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/05-1986_PD0000004589_SBC_ELEVATEHEALTHSILVERHMO.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004589.PDF","8"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","2","59025","NH","Individual","No","04-2663394","59025NH0330008","ElevateHealth Silver HMO","59025NH033",,"NHN002","NHS002","NHF014","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330008-05","87% AV Level Silver Plan","86.10%","0.865796804428101","No","Yes","No","100%",,"$1,250","$10","$260","$150","$140","$1,540","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$1,250","$1250 per person","$2500 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/06-1953_PD0000004545_SBC_ELEVATEHEALTHSILVERHMO.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004545.PDF","9"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","2","59025","NH","SHOP (Small Group)","No","04-2663394","59025NH0320024","ElevateHealth HSA HMO 6250","59025NH032",,"NHN002","NHS002","NHF006","New","HMO","Bronze","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998708335296075",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only.","Yes","Urgent and Emergency Services Only.","No",,"https://www.harvardpilgrim.org/2016Value4T","59025NH0320024-00","Standard Bronze Off Exchange Plan","60.26%","0.602638840675354","Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/portal/page?_pageid=849,6478020&_dad=portal&_schema=PORTAL",,"9"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","2","59025","NH","SHOP (Small Group)","No","04-2663394","59025NH0320024","ElevateHealth HSA HMO 6250","59025NH032",,"NHN002","NHS002","NHF006","New","HMO","Bronze","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998708335296075",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only.","Yes","Urgent and Emergency Services Only.","No",,"https://www.harvardpilgrim.org/2016Value4T","59025NH0320024-01","Standard Bronze On Exchange Plan","60.26%","0.602638840675354","Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/4650C28862094461B9A3EA2008A9CB56","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004644.PDF","10"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","2","59025","NH","Individual","No","04-2663394","59025NH0330008","ElevateHealth Silver HMO","59025NH033",,"NHN002","NHS002","NHF014","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330008-06","94% AV Level Silver Plan","95.00%","0.949418663978577","No","Yes","No","100%",,"$0","$10","$0","$150","$0","$620","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/07_1948_PD0000004537_SBC_ELEVATEHEALTHSILVERHMO.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004537.PDF","10"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","3","59025","NH","Individual","No","04-2663394","59025NH0330012","ElevateHealth Bronze HMO","59025NH033",,"NHN002","NHS002","NHF005","New","HMO","Bronze","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,"$500","0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330012-00","Standard Bronze Off Exchange Plan","61.91%",,"Yes","Yes","No","100%",,"$4,320","$20","$0","$150","$1,150","$2,740","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","50%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","No",,,"https://www.harvardpilgrim.org/portal/page?_pageid=213,6480024&_dad=portal&_schema=PORTAL",,"4"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","3","59025","NH","Individual","No","04-2663394","59025NH0330012","ElevateHealth Bronze HMO","59025NH033",,"NHN002","NHS002","NHF005","New","HMO","Bronze","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,"$500","0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330012-01","Standard Bronze On Exchange Plan","61.91%",,"Yes","Yes","No","100%",,"$4,320","$20","$0","$150","$1,150","$2,740","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","50%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/08_2040_PD0000004656_SBC_ELEVATEHEALTHBRONZEHMO.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004656.PDF","5"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","3","59025","NH","SHOP (Small Group)","No","04-2663394","59025NH0300008","Best Buy Tiered Copayment HMO LP 2000","59025NH030",,"NHN001","NHS001","NHF002","New","HMO","Gold","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987029505104",,,"$550","0","0","0","2016-01-01","2050-12-31","Yes","URGENT CARE AND EMERGENCY SERVICES ONLY","Yes","URGENT CARE AND EMERGENCY SERVICES ONLY","No",,"https://www.harvardpilgrim.org/2016Value5T","59025NH0300008-00","Standard Gold Off Exchange Plan","78.90%",,"No","Yes","Yes","70%","30%","$2,000","$10","$160","$150","$0","$1,640","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$2,000","$2000 per person","$4000 per group","10%","$0","$0 per person","$0 per group","0%","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","40%","Not Applicable","per person not applicable","per group not applicable","0%","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/portal/page?_pageid=849,6478020&_dad=portal&_schema=PORTAL",,"5"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","3","59025","NH","SHOP (Small Group)","No","04-2663394","59025NH0300008","Best Buy Tiered Copayment HMO LP 2000","59025NH030",,"NHN001","NHS001","NHF002","New","HMO","Gold","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987029505104",,,"$550","0","0","0","2016-01-01","2050-12-31","Yes","URGENT CARE AND EMERGENCY SERVICES ONLY","Yes","URGENT CARE AND EMERGENCY SERVICES ONLY","No",,"https://www.harvardpilgrim.org/2016Value5T","59025NH0300008-01","Standard Gold On Exchange Plan","78.90%",,"No","Yes","Yes","70%","30%","$2,000","$10","$160","$150","$0","$1,640","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$2,000","$2000 per person","$4000 per group","10%","$0","$0 per person","$0 per group","0%","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","40%","$0","$0 per person","$0 per group","0%","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/DEC19C2A6CAC4EC1A5BCBAB30813AF80","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004568.PDF","6"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","3","59025","NH","Individual","No","04-2663394","59025NH0330012","ElevateHealth Bronze HMO","59025NH033",,"NHN002","NHS002","NHF005","New","HMO","Bronze","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,"$500","0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330012-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/25_2054_PD0000004671_SBC_HPHCELEVATEHEALTH.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004671.PDF","6"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","3","59025","NH","Individual","No","04-2663394","59025NH0330012","ElevateHealth Bronze HMO","59025NH033",,"NHN002","NHS002","NHF005","New","HMO","Bronze","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,"$500","0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330012-03","Limited Cost Sharing Plan Variation","61.91%",,"Yes","Yes","No","100%",,"$4,320","$20","$0","$150","$1,150","$2,740","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","50%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/26_2040_PD0000004657_SBC_ELEVATEHEALTHBRONZEHMO.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004657.PDF","7"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","3","59025","NH","SHOP (Small Group)","No","04-2663394","59025NH0300021","Best Buy Tiered Copayment HMO LP 3000  Low Option","59025NH030",,"NHN001","NHS001","NHF001","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998708335296075",,,"$550","0","0","0","2016-01-01","2050-12-31","Yes","URGENT CARE AND EMERGENCY SERVICES ONLY","Yes","URGENT CARE AND EMERGENCY SERVICES ONLY","No",,"https://www.harvardpilgrim.org/2016Value5T","59025NH0300021-00","Standard Silver Off Exchange Plan","69.60%",,"No","Yes","Yes","70%","30%","$3,020","$0","$120","$150","$500","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$0","$0 per person","$0 per group","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$3,000","$3000 per person","$6000 per group","20%","$0","$0 per person","$0 per group","0%","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$500","$500 per person","per group not applicable","40%","$0","$0 per person","$0 per group","0%","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/portal/page?_pageid=849,6478020&_dad=portal&_schema=PORTAL",,"7"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","3","59025","NH","SHOP (Small Group)","No","04-2663394","59025NH0300021","Best Buy Tiered Copayment HMO LP 3000  Low Option","59025NH030",,"NHN001","NHS001","NHF001","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998708335296075",,,"$550","0","0","0","2016-01-01","2050-12-31","Yes","URGENT CARE AND EMERGENCY SERVICES ONLY","Yes","URGENT CARE AND EMERGENCY SERVICES ONLY","No",,"https://www.harvardpilgrim.org/2016Value5T","59025NH0300021-01","Standard Silver On Exchange Plan","69.60%",,"No","Yes","Yes","70%","30%","$3,020","$0","$120","$150","$500","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$0","$0 per person","$0 per group","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$3,000","$3000 per person","$6000 per group","20%","$0","$0 per person","$0 per group","0%","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$500","$500 per person","per group not applicable","40%","$0","$0 per person","$0 per group","0%","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/EF401E96C4FF479AA6040307F28C4981","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004596.PDF","8"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","3","59025","NH","SHOP (Small Group)","No","04-2663394","59025NH0300033","Best Buy Tiered Copayment HMO LP 4000","59025NH030",,"NHN001","NHS001","NHF002","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987029505104",,,"$550","0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only.","Yes","Urgent and Emergency Services Only.","No",,"https://www.harvardpilgrim.org/2016Value5T","59025NH0300033-00","Standard Silver Off Exchange Plan","69.70%",,"No","Yes","Yes","70%","30%","$3,620","$10","$0","$150","$0","$1,840","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$0","$0 per person","$0 per group","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$4,000","$4000 per person","$8000 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","40%","$0","$0 per person","$0 per group","0%","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/portal/page?_pageid=849,6478020&_dad=portal&_schema=PORTAL",,"13"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","3","59025","NH","SHOP (Small Group)","No","04-2663394","59025NH0300033","Best Buy Tiered Copayment HMO LP 4000","59025NH030",,"NHN001","NHS001","NHF002","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987029505104",,,"$550","0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only.","Yes","Urgent and Emergency Services Only.","No",,"https://www.harvardpilgrim.org/2016Value5T","59025NH0300033-01","Standard Silver On Exchange Plan","69.70%",,"No","Yes","Yes","70%","30%","$3,620","$10","$0","$150","$0","$1,840","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$0","$0 per person","$0 per group","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$4,000","$4000 per person","$8000 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","40%","$0","$0 per person","$0 per group","0%","Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/56D7D7583E614B22A09C38031ECC35E4","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004625.PDF","14"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","4","59025","NH","Individual","No","04-2663394","59025NH0330004","Harvard Pilgrim ElevateHealth Gold HSA HMO","59025NH033",,"NHN002","NHS002","NHF008","New","HMO","Gold","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330004-00","Standard Gold Off Exchange Plan","78.05%","0.780476629734039","Yes","Yes","No","100%",,"$1,500","$20","$280","$150","$1,500","$1,700","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Yes",,,"https://www.harvardpilgrim.org/portal/page?_pageid=213,6480024&_dad=portal&_schema=PORTAL",,"4"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","4","59025","NH","Individual","No","04-2663394","59025NH0330004","Harvard Pilgrim ElevateHealth Gold HSA HMO","59025NH033",,"NHN002","NHS002","NHF008","New","HMO","Gold","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330004-01","Standard Gold On Exchange Plan","78.05%","0.780476629734039","Yes","Yes","No","100%",,"$1,500","$20","$280","$150","$1,500","$1,700","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/09_PD0000004558.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004558.PDF","5"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","4","59025","NH","Individual","No","04-2663394","59025NH0330004","Harvard Pilgrim ElevateHealth Gold HSA HMO","59025NH033",,"NHN002","NHS002","NHF008","New","HMO","Gold","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/27_2054_PD0000004665_SBC_HPHCELEVATEHEALTH.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004665.PDF","6"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","4","59025","NH","Individual","No","04-2663394","59025NH0330004","Harvard Pilgrim ElevateHealth Gold HSA HMO","59025NH033",,"NHN002","NHS002","NHF008","New","HMO","Gold","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330004-03","Limited Cost Sharing Plan Variation","78.05%","0.780476629734039","Yes","Yes","No","100%",,"$1,500","$20","$280","$150","$1,500","$1,700","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","10%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/28_1963_PD0000004559_SBC_ELEVATEHEALTHGOLDHSAHMO.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004559.PDF","7"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","5","59025","NH","Individual","No","04-2663394","59025NH0330006","Harvard Pilgrim ElevateHealth Silver HSA HMO","59025NH033",,"NHN002","NHS002","NHF009","New","HMO","Silver","No","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330006-00","Standard Silver Off Exchange Plan",,"0.680330812931061","Yes","Yes","No","100%",,"$3,000","$20","$200","$150","$3,000","$1,190","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Yes",,,"https://www.harvardpilgrim.org/portal/page?_pageid=213,6480024&_dad=portal&_schema=PORTAL",,"4"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","5","59025","NH","Individual","No","04-2663394","59025NH0330006","Harvard Pilgrim ElevateHealth Silver HSA HMO","59025NH033",,"NHN002","NHS002","NHF009","New","HMO","Silver","No","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330006-01","Standard Silver On Exchange Plan",,"0.680330812931061","Yes","Yes","No","100%",,"$3,000","$20","$200","$150","$3,000","$1,190","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/10_1985_PD0000004588_SBC_ELEVATEHEALTHSILVERHSAHMO.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004588.PDF","5"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","5","59025","NH","Individual","No","04-2663394","59025NH0330006","Harvard Pilgrim ElevateHealth Silver HSA HMO","59025NH033",,"NHN002","NHS002","NHF009","New","HMO","Silver","No","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/29_2054_PD0000004666_SBC_HPHCELEVATEHEALTH.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004666.PDF","6"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","5","59025","NH","Individual","No","04-2663394","59025NH0330006","Harvard Pilgrim ElevateHealth Silver HSA HMO","59025NH033",,"NHN002","NHS002","NHF009","New","HMO","Silver","No","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330006-03","Limited Cost Sharing Plan Variation",,"0.680330812931061","Yes","Yes","No","100%",,"$3,000","$20","$200","$150","$3,000","$1,190","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","15%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/30_1985_PD0000004587_SBC_ELEVATEHEALTHSILVERHSAHMO.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004787.PDF","7"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","5","59025","NH","Individual","No","04-2663394","59025NH0330006","Harvard Pilgrim ElevateHealth Silver HSA HMO","59025NH033",,"NHN002","NHS002","NHF009","New","HMO","Silver","No","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330006-04","73% AV Level Silver Plan",,"0.729318141937256","Yes","Yes","No","100%",,"$2,500","$20","$180","$150","$2,500","$960","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/11_1979_PD0000004579_SBC_ELEVATEHEALTHSILVERHSAHMO.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004579.PDF","8"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","5","59025","NH","Individual","No","04-2663394","59025NH0330006","Harvard Pilgrim ElevateHealth Silver HSA HMO","59025NH033",,"NHN002","NHS002","NHF009","New","HMO","Silver","No","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330006-05","87% AV Level Silver Plan",,"0.872367918491364","Yes","Yes","No","100%",,"$750","$10","$360","$150","$750","$660","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/12_1949_PD0000004539_SBC_ELEVATEHEALTHSILVERHSAHMO.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004539.PDF","9"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","5","59025","NH","Individual","No","04-2663394","59025NH0330006","Harvard Pilgrim ElevateHealth Silver HSA HMO","59025NH033",,"NHN002","NHS002","NHF009","New","HMO","Silver","No","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330006-06","94% AV Level Silver Plan",,"0.935301244258881","Yes","Yes","No","100%",,"$200","$10","$410","$150","$200","$470","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/13_1946_PD0000004533_SBC_ELEVATEHEALTHSILVERHSAHMO.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004533.PDF","10"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","6","59025","NH","Individual","No","04-2663394","59025NH0330010","Harvard Pilgrim ElevateHealth Bronze HSA HMO","59025NH033",,"NHN002","NHS002","NHF012","New","HMO","Bronze","No","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330010-00","Standard Bronze Off Exchange Plan",,"0.60219532251358","Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Yes",,,"https://www.harvardpilgrim.org/portal/page?_pageid=213,6480024&_dad=portal&_schema=PORTAL",,"4"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","6","59025","NH","Individual","No","04-2663394","59025NH0330010","Harvard Pilgrim ElevateHealth Bronze HSA HMO","59025NH033",,"NHN002","NHS002","NHF012","New","HMO","Bronze","No","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330010-01","Standard Bronze On Exchange Plan",,"0.60219532251358","Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/14_2038_PD0000004650_SBC_ELEVATEHEALTHBRONZEHSAHMO.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004650.PDF","5"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","6","59025","NH","SHOP (Small Group)","No","04-2663394","59025NH0300015","Best Buy HSA HMO 3000","59025NH030",,"NHN001","NHS001","NHF005","New","HMO","Silver","No","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987029505104",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only.","Yes","Urgent and Emergency Services Only.","No",,"https://www.harvardpilgrim.org/2016Value4T","59025NH0300015-00","Standard Silver Off Exchange Plan",,"0.709488272666931","Yes","Yes","No","100%",,"$3,000","$0","$0","$150","$3,000","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/portal/page?_pageid=849,6478020&_dad=portal&_schema=PORTAL",,"5"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","6","59025","NH","SHOP (Small Group)","No","04-2663394","59025NH0300015","Best Buy HSA HMO 3000","59025NH030",,"NHN001","NHS001","NHF005","New","HMO","Silver","No","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987029505104",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only.","Yes","Urgent and Emergency Services Only.","No",,"https://www.harvardpilgrim.org/2016Value4T","59025NH0300015-01","Standard Silver On Exchange Plan",,"0.709488272666931","Yes","Yes","No","100%",,"$3,000","$0","$0","$150","$3,000","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/78A8152D09F64F0CA6D8DEEA7724FC13","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004582.PDF","6"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","6","59025","NH","Individual","No","04-2663394","59025NH0330010","Harvard Pilgrim ElevateHealth Bronze HSA HMO","59025NH033",,"NHN002","NHS002","NHF012","New","HMO","Bronze","No","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/31_2054_PD0000004673_SBC_ELEVATEHEALTHBRONZEHSAHMO.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004673.PDF","6"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","6","59025","NH","Individual","No","04-2663394","59025NH0330010","Harvard Pilgrim ElevateHealth Bronze HSA HMO","59025NH033",,"NHN002","NHS002","NHF012","New","HMO","Bronze","No","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0330010-03","Limited Cost Sharing Plan Variation",,"0.60219532251358","Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/32_2038_PD0000004652_SBC_ELEVATEHEALTHBRONZEHSAHMO.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004652.PDF","7"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","6","59025","NH","SHOP (Small Group)","No","04-2663394","59025NH0300045","Best Buy HSA HMO 6250","59025NH030",,"NHN001","NHS001","NHF006","New","HMO","Bronze","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987029505104",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only.","Yes","Urgent and Emergency Services Only.","No",,"https://www.harvardpilgrim.org/2016Value4T","59025NH0300045-00","Standard Bronze Off Exchange Plan","60.26%","0.602638840675354","Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","25%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Yes","No",,"https://www.harvardpilgrim.org/portal/page?_pageid=849,6478020&_dad=portal&_schema=PORTAL",,"9"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","6","59025","NH","SHOP (Small Group)","No","04-2663394","59025NH0300045","Best Buy HSA HMO 6250","59025NH030",,"NHN001","NHS001","NHF006","New","HMO","Bronze","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9987029505104",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only.","Yes","Urgent and Emergency Services Only.","No",,"https://www.harvardpilgrim.org/2016Value4T","59025NH0300045-01","Standard Bronze On Exchange Plan","60.26%","0.602638840675354","Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","25%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Yes","No",,"https://www.harvardpilgrim.org/pls/portal/url/ITEM/E0756E38541E405CB1D57305D130257A","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004639.PDF","10"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","7","59025","NH","Individual","No","04-2663394","59025NH0340004","Harvard Pilgrim New Hampshire Network HMO Gold","59025NH034",,"NHN003","NHS003","NHF003","New","HMO","Gold","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,"$500","0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0340004-00","Standard Gold Off Exchange Plan","79.80%",,"Yes","Yes","No","100%",,"$1,000","$20","$330","$150","$140","$2,480","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","No",,,"https://www.harvardpilgrim.org/portal/page?_pageid=213,6480024&_dad=portal&_schema=PORTAL",,"4"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","7","59025","NH","Individual","No","04-2663394","59025NH0340004","Harvard Pilgrim New Hampshire Network HMO Gold","59025NH034",,"NHN003","NHS003","NHF003","New","HMO","Gold","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,"$500","0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0340004-01","Standard Gold On Exchange Plan","79.80%",,"Yes","Yes","No","100%",,"$1,000","$20","$330","$150","$140","$2,480","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/15_1952_PD0000004543_SBC_NHNETWORKHMOGOLD.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004543.PDF","5"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","7","59025","NH","Individual","No","04-2663394","59025NH0340004","Harvard Pilgrim New Hampshire Network HMO Gold","59025NH034",,"NHN003","NHS003","NHF003","New","HMO","Gold","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,"$500","0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0340004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/16_2053_PD0000004664_SBC_HPHCNHNETWORK.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004664.PDF","6"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","7","59025","NH","Individual","No","04-2663394","59025NH0340004","Harvard Pilgrim New Hampshire Network HMO Gold","59025NH034",,"NHN003","NHS003","NHF003","New","HMO","Gold","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,"$500","0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0340004-03","Limited Cost Sharing Plan Variation","79.80%",,"Yes","Yes","No","100%",,"$1,000","$20","$330","$150","$140","$2,480","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/33_1952_PD0000004544_SBC_NHNETWORKHMOGOLD.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004544.PDF","7"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","2","61163","NH","Individual","No","45-3596033","61163NH0350001","MyDoc HMO Bronze 6300","61163NH035",,"NHN001","NHS001","NHF010","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9994",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0350001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Bronze%20Zero%20(6300).pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","17"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","2","61163","NH","Individual","No","45-3596033","61163NH0350001","MyDoc HMO Bronze 6300","61163NH035",,"NHN001","NHS001","NHF010","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9994",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0350001-03","Limited Cost Sharing Plan Variation","59.60%",,"Yes","Yes","No","100%",,"$6,300","$520","$0","$30","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Bronze%206300%20Limited.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","18"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","3","61163","NH","Individual","No","45-3596033","61163NH0370001","MyDoc HMO Simple Care","61163NH037",,"NHN001","NHS001","NHF009","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9986",,,,"0","0","3","2016-01-01",,"No",,"No",,"No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0370001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,820","$0","$0","$30","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Simple%20Care.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","4"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","3","61163","NH","Individual","No","45-3596033","61163NH0370001","MyDoc HMO Simple Care","61163NH037",,"NHN001","NHS001","NHF009","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9986",,,,"0","0","3","2016-01-01",,"No",,"No",,"No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0370001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,820","$0","$0","$30","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Simple%20Care.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","5"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","8","59025","NH","Individual","No","04-2663394","59025NH0340001","New Hampshire Network Silver HMO Premium","59025NH034",,"NHN003","NHS003","NHF014","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0340001-00","Standard Silver Off Exchange Plan","71.20%","0.704073131084442","No","Yes","No","100%",,"$2,400","$1,020","$0","$150","$140","$2,760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$2,400","$2400 per person","$4800 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/portal/page?_pageid=213,6480024&_dad=portal&_schema=PORTAL",,"4"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","8","59025","NH","Individual","No","04-2663394","59025NH0340001","New Hampshire Network Silver HMO Premium","59025NH034",,"NHN003","NHS003","NHF014","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0340001-01","Standard Silver On Exchange Plan","71.20%","0.704073131084442","No","Yes","No","100%",,"$2,400","$1,020","$0","$150","$140","$2,760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$2,400","$2400 per person","$4800 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/17_1976_PD0000004575_SBC_NHNETWORKSILVERHMOPREMIUM.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004575.PDF","5"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","8","59025","NH","Individual","No","04-2663394","59025NH0340001","New Hampshire Network Silver HMO Premium","59025NH034",,"NHN003","NHS003","NHF014","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0340001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/18_2246_PD0000004667_SBC_HPHCNHNETWORK.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004667.PDF","6"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","8","59025","NH","Individual","No","04-2663394","59025NH0340001","New Hampshire Network Silver HMO Premium","59025NH034",,"NHN003","NHS003","NHF014","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0340001-03","Limited Cost Sharing Plan Variation","71.20%","0.704073131084442","No","Yes","No","100%",,"$2,400","$1,020","$0","$150","$140","$2,760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$2,400","$2400 per person","$4800 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/34_1976_PD0000004576_SBC_NHNETWORKSILVERHMOPREMIUM.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004576.PDF","7"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","8","59025","NH","Individual","No","04-2663394","59025NH0340001","New Hampshire Network Silver HMO Premium","59025NH034",,"NHN003","NHS003","NHF014","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0340001-04","73% AV Level Silver Plan","73.90%","0.738139927387238","No","Yes","No","100%",,"$1,750","$770","$0","$150","$140","$2,660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/19_1966_PD0000004562_SBC_NHNETWORKSILVERHMOPREMIUM.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004562.PDF","8"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","8","59025","NH","Individual","No","04-2663394","59025NH0340001","New Hampshire Network Silver HMO Premium","59025NH034",,"NHN003","NHS003","NHF014","New","HMO","Silver","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0340001-05","87% AV Level Silver Plan","86.80%","0.869143843650818","No","Yes","No","100%",,"$750","$270","$0","$150","$140","$1,590","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$750","$750 per person","$1500 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,"No",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/20_1950_PD0000004540_SBC_NHNETWORKSILVERHMOPREMIUM.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004540.PDF","9"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","9","59025","NH","Individual","No","04-2663394","59025NH0340006","New Hampshire Network Bronze HSA  HMO","59025NH034",,"NHN003","NHS003","NHF013","New","HMO","Bronze","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0340006-00","Standard Bronze Off Exchange Plan","61.74%","0.617626070976257","Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Yes",,,"https://www.harvardpilgrim.org/portal/page?_pageid=213,6480024&_dad=portal&_schema=PORTAL",,"4"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","9","59025","NH","Individual","No","04-2663394","59025NH0340006","New Hampshire Network Bronze HSA  HMO","59025NH034",,"NHN003","NHS003","NHF013","New","HMO","Bronze","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0340006-01","Standard Bronze On Exchange Plan","61.74%","0.617626070976257","Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/22_2018_PD0000004628_SBC_NHNETWORKBRONZEHSAHMO.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004628.PDF","5"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","9","59025","NH","Individual","No","04-2663394","59025NH0340006","New Hampshire Network Bronze HSA  HMO","59025NH034",,"NHN003","NHS003","NHF013","New","HMO","Bronze","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0340006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/35_2053_PD0000004674_SBC_HPHCNHNETWORK.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004674.PDF","6"
"2016","NH","59025","SERFF","16","2016-07-07 17:21:34","9","59025","NH","Individual","No","04-2663394","59025NH0340006","New Hampshire Network Bronze HSA  HMO","59025NH034",,"NHN003","NHS003","NHF013","New","HMO","Bronze","Yes","Both","No","Yes","A Referral is required for all specialist services, except OB\GYN Care, Chiropractic Care, Routine Eye Exams, and Mental Health Providers.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.998587239349444",,,,"0","0","0","2016-01-01","2050-12-31","Yes","Urgent and Emergency Services Only","Yes","Urgent and Emergency Services Only","No","https://harvardpilgrimhix.payspanhealth.com/binder","https://www.harvardpilgrim.org/2016Value4T","59025NH0340006-03","Limited Cost Sharing Plan Variation","61.74%","0.617626070976257","Yes","Yes","No","100%",,"$4,350","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person Not Applicable","per group Not Applicable","Not Applicable","per person Not Applicable","per group Not Applicable","Yes",,,"https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20INDIVIDUAL/36_2018_PD0000004629_SBC_NHNETWORKBRONZEHSAHMO.PDF","https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/2016%20PLAN%20DOCUMENTS%20-%20NH%20FILES/PD0000004629.PDF","7"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","1","61163","NH","Individual","No","45-3596033","61163NH0030001","MyDoc HMO Gold Basic 1000","61163NH003",,"NHN001","NHS001","NHF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0030001-00","Standard Gold Off Exchange Plan","80.50%",,"Yes","Yes","No","100%",,"$1,000","$80","$890","$30","$1,000","$540","$250","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Gold%20Basic%201000.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","4"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","1","61163","NH","Individual","No","45-3596033","61163NH0030001","MyDoc HMO Gold Basic 1000","61163NH003",,"NHN001","NHS001","NHF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0030001-01","Standard Gold On Exchange Plan","80.50%",,"Yes","Yes","No","100%",,"$1,000","$80","$890","$30","$1,000","$540","$250","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Gold%20Basic%201000.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","5"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","1","61163","NH","Individual","No","45-3596033","61163NH0030001","MyDoc HMO Gold Basic 1000","61163NH003",,"NHN001","NHS001","NHF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0030001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Gold%20Zero.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","6"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","1","61163","NH","Individual","No","45-3596033","61163NH0030001","MyDoc HMO Gold Basic 1000","61163NH003",,"NHN001","NHS001","NHF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0030001-03","Limited Cost Sharing Plan Variation","80.50%",,"Yes","Yes","No","100%",,"$1,000","$80","$890","$30","$1,000","$540","$250","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Gold%20Basic%20Limited.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","7"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","2","61163","NH","Individual","No","45-3596033","61163NH0150001","MyDoc HMO Silver Care","61163NH015",,"NHN001","NHS001","NHF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0150001-00","Standard Silver Off Exchange Plan","70.20%",,"Yes","Yes","No","100%",,"$3,000","$0","$470","$0","$3,000","$0","$1,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$6850 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20Care.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","4"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","2","61163","NH","Individual","No","45-3596033","61163NH0150001","MyDoc HMO Silver Care","61163NH015",,"NHN001","NHS001","NHF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0150001-01","Standard Silver On Exchange Plan","70.20%",,"Yes","Yes","No","100%",,"$3,000","$0","$470","$0","$3,000","$0","$1,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$6850 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20Care.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","5"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","2","61163","NH","Individual","No","45-3596033","61163NH0150001","MyDoc HMO Silver Care","61163NH015",,"NHN001","NHS001","NHF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0150001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20Zero%20(Care).pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","6"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","2","61163","NH","Individual","No","45-3596033","61163NH0150001","MyDoc HMO Silver Care","61163NH015",,"NHN001","NHS001","NHF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0150001-03","Limited Cost Sharing Plan Variation","70.20%",,"Yes","Yes","No","100%",,"$3,000","$0","$470","$0","$3,000","$0","$1,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$6850 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20Care%20Limited.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","7"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","2","61163","NH","Individual","No","45-3596033","61163NH0150001","MyDoc HMO Silver Care","61163NH015",,"NHN001","NHS001","NHF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0150001-04","73% AV Level Silver Plan","73.00%",,"Yes","Yes","No","100%",,"$2,500","$0","$470","$30","$2,500","$0","$1,500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$5450 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20Care%20(73).pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","8"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","2","61163","NH","Individual","No","45-3596033","61163NH0150001","MyDoc HMO Silver Care","61163NH015",,"NHN001","NHS001","NHF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0150001-05","87% AV Level Silver Plan","87.70%",,"Yes","Yes","No","100%",,"$675","$0","$470","$30","$675","$0","$1,325","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2250 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$675","$1350 per person","$1350 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20Care%20(87).pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","9"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","2","61163","NH","Individual","No","45-3596033","61163NH0150001","MyDoc HMO Silver Care","61163NH015",,"NHN001","NHS001","NHF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0150001-06","94% AV Level Silver Plan","94.20%",,"Yes","Yes","No","100%",,"$250","$0","$350","$30","$250","$0","$350","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$800 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$500 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20Care%20(94).pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","10"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","2","61163","NH","Individual","No","45-3596033","61163NH0330001","MyDoc HMO Bronze HSA 5800","61163NH033",,"NHN001","NHS001","NHF006","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0330001-00","Standard Bronze Off Exchange Plan","60.20%",,"Yes","Yes","No","100%",,"$5,800","$0","$720","$30","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$6000 per person","$11600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Bronze%20HSA%205800.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","11"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","2","61163","NH","Individual","No","45-3596033","61163NH0330001","MyDoc HMO Bronze HSA 5800","61163NH033",,"NHN001","NHS001","NHF006","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0330001-01","Standard Bronze On Exchange Plan","60.20%",,"Yes","Yes","No","100%",,"$5,800","$0","$720","$30","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$6000 per person","$11600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Bronze%20HSA%205800.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","12"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","2","61163","NH","Individual","No","45-3596033","61163NH0330001","MyDoc HMO Bronze HSA 5800","61163NH033",,"NHN001","NHS001","NHF006","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0330001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Bronze%20Zero%20(HSA%205800).pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","13"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","2","61163","NH","Individual","No","45-3596033","61163NH0330001","MyDoc HMO Bronze HSA 5800","61163NH033",,"NHN001","NHS001","NHF006","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0330001-03","Limited Cost Sharing Plan Variation","60.20%",,"Yes","Yes","No","100%",,"$5,800","$0","$720","$30","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$6000 per person","$11600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Bronze%20HSA%205800%20Limited.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","14"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","2","61163","NH","Individual","No","45-3596033","61163NH0350001","MyDoc HMO Bronze 6300","61163NH035",,"NHN001","NHS001","NHF010","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9994",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0350001-00","Standard Bronze Off Exchange Plan","59.60%",,"Yes","Yes","No","100%",,"$6,300","$520","$0","$30","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Bronze%206300.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","15"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","2","61163","NH","Individual","No","45-3596033","61163NH0350001","MyDoc HMO Bronze 6300","61163NH035",,"NHN001","NHS001","NHF010","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9994",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0350001-01","Standard Bronze On Exchange Plan","59.60%",,"Yes","Yes","No","100%",,"$6,300","$520","$0","$30","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Bronze%206300.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","16"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","4","61163","NH","Individual","No","45-3596033","61163NH0130001","MyDoc HMO Silver Basic","61163NH013",,"NHN001","NHS001","NHF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0130001-00","Standard Silver Off Exchange Plan","71.80%",,"Yes","Yes","No","100%",,"$2,000","$140","$1,340","$30","$2,000","$880","$380","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20Basic.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","4"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","4","61163","NH","Individual","No","45-3596033","61163NH0130001","MyDoc HMO Silver Basic","61163NH013",,"NHN001","NHS001","NHF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0130001-01","Standard Silver On Exchange Plan","71.80%",,"Yes","Yes","No","100%",,"$2,000","$140","$1,340","$30","$2,000","$880","$380","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20Basic.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","5"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","4","61163","NH","Individual","No","45-3596033","61163NH0130001","MyDoc HMO Silver Basic","61163NH013",,"NHN001","NHS001","NHF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0130001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20Zero%20(Basic).pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","6"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","4","61163","NH","Individual","No","45-3596033","61163NH0130001","MyDoc HMO Silver Basic","61163NH013",,"NHN001","NHS001","NHF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0130001-03","Limited Cost Sharing Plan Variation","71.80%",,"Yes","Yes","No","100%",,"$2,000","$140","$1,340","$30","$2,000","$880","$380","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20Basic%20Limited.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","7"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","4","61163","NH","Individual","No","45-3596033","61163NH0130001","MyDoc HMO Silver Basic","61163NH013",,"NHN001","NHS001","NHF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0130001-04","73% AV Level Silver Plan","73.80%",,"Yes","Yes","No","100%",,"$1,800","$140","$1,340","$30","$1,800","$880","$380","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20Basic%20(73).pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","8"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","4","61163","NH","Individual","No","45-3596033","61163NH0130001","MyDoc HMO Silver Basic","61163NH013",,"NHN001","NHS001","NHF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0130001-05","87% AV Level Silver Plan","87.90%",,"Yes","Yes","No","100%",,"$800","$0","$700","$30","$800","$360","$340","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20Basic%20(87).pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","9"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","4","61163","NH","Individual","No","45-3596033","61163NH0130001","MyDoc HMO Silver Basic","61163NH013",,"NHN001","NHS001","NHF002","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0130001-06","94% AV Level Silver Plan","94.50%",,"Yes","Yes","No","100%",,"$175","$0","$475","$30","$175","$175","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20Basic%20(94).pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","10"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","5","61163","NH","Individual","No","45-3596033","61163NH0250001","MyDoc HMO Bronze Value 3750","61163NH025",,"NHN001","NHS001","NHF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0250001-00","Standard Bronze Off Exchange Plan","61.80%",,"Yes","Yes","No","100%",,"$3,750","$1,140","$0","$30","$3,750","$1,280","$250","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Bronze%20Value%203750.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","4"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","5","61163","NH","Individual","No","45-3596033","61163NH0250001","MyDoc HMO Bronze Value 3750","61163NH025",,"NHN001","NHS001","NHF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0250001-01","Standard Bronze On Exchange Plan","61.80%",,"Yes","Yes","No","100%",,"$3,750","$1,140","$0","$30","$3,750","$1,280","$250","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Bronze%20Value%203750.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","5"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","5","61163","NH","Individual","No","45-3596033","61163NH0250001","MyDoc HMO Bronze Value 3750","61163NH025",,"NHN001","NHS001","NHF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0250001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Bronze%20Zero%20(Value%203750).pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","6"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","5","61163","NH","Individual","No","45-3596033","61163NH0250001","MyDoc HMO Bronze Value 3750","61163NH025",,"NHN001","NHS001","NHF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0250001-03","Limited Cost Sharing Plan Variation","61.80%",,"Yes","Yes","No","100%",,"$3,750","$1,140","$0","$30","$3,750","$1,280","$250","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Bronze%20Value%203750%20Limited.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","7"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","5","61163","NH","Individual","No","45-3596033","61163NH0310001","MyDoc HMO Bronze Basic 4500","61163NH031",,"NHN001","NHS001","NHF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9998",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0310001-00","Standard Bronze Off Exchange Plan","60.80%",,"Yes","Yes","No","100%",,"$4,500","$140","$1,340","$30","$4,000","$1,280","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Bronze%20Basic%204500.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","8"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","5","61163","NH","Individual","No","45-3596033","61163NH0310001","MyDoc HMO Bronze Basic 4500","61163NH031",,"NHN001","NHS001","NHF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9998",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0310001-01","Standard Bronze On Exchange Plan","60.80%",,"Yes","Yes","No","100%",,"$4,500","$140","$1,340","$30","$4,000","$1,280","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Bronze%20Basic%204500.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","9"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","5","61163","NH","Individual","No","45-3596033","61163NH0310001","MyDoc HMO Bronze Basic 4500","61163NH031",,"NHN001","NHS001","NHF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9998",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0310001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Bronze%20Zero%20(Basic%204500).pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","10"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","5","61163","NH","Individual","No","45-3596033","61163NH0310001","MyDoc HMO Bronze Basic 4500","61163NH031",,"NHN001","NHS001","NHF003","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9998",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0310001-03","Limited Cost Sharing Plan Variation","60.80%",,"Yes","Yes","No","100%",,"$4,500","$140","$1,340","$30","$4,000","$1,280","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Bronze%20Basic%204500%20Limited.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","11"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","6","61163","NH","Individual","No","45-3596033","61163NH0010001","MyDoc HMO Platinum","61163NH001",,"NHN001","NHS001","NHF004","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0010001-00","Standard Platinum Off Exchange Plan","88.30%",,"Yes","Yes","No","100%",,"$0","$140","$520","$30","$0","$880","$270","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Platinum.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","4"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","6","61163","NH","Individual","No","45-3596033","61163NH0010001","MyDoc HMO Platinum","61163NH001",,"NHN001","NHS001","NHF004","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0010001-01","Standard Platinum On Exchange Plan","88.30%",,"Yes","Yes","No","100%",,"$0","$140","$520","$30","$0","$880","$270","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Platinum.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","5"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","6","61163","NH","Individual","No","45-3596033","61163NH0010001","MyDoc HMO Platinum","61163NH001",,"NHN001","NHS001","NHF004","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0010001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Platinum%20Zero.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","6"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","6","61163","NH","Individual","No","45-3596033","61163NH0010001","MyDoc HMO Platinum","61163NH001",,"NHN001","NHS001","NHF004","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0010001-03","Limited Cost Sharing Plan Variation","88.30%",,"Yes","Yes","No","100%",,"$0","$140","$520","$30","$0","$880","$270","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Platinum%20Limited.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","7"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","10","61163","NH","Individual","No","45-3596033","61163NH0210001","MyDoc HMO Silver Assistance A","61163NH021",,"NHN001","NHS001","NHF010","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0210001-00","Standard Silver Off Exchange Plan","68.00%",,"Yes","Yes","No","100%",,"$3,500","$1,140","$0","$30","$1,400","$1,280","$250","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20Assistance%20A.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","4"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","10","61163","NH","SHOP (Small Group)","No","45-3596033","61163NH0360001","MyDoc HMO Gold Basic 1000","61163NH036",,"NHN001","NHS001","NHF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0360001-00","Standard Gold Off Exchange Plan","80.50%",,"Yes","Yes","No","100%",,"$1,000","$20","$890","$150","$1,000","$460","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Gold%20Basic%201000.pdf","http://minutemanhealth.org/members/sg-plans-new/con-NH-plans-2016","4"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","10","61163","NH","SHOP (Small Group)","No","45-3596033","61163NH0360001","MyDoc HMO Gold Basic 1000","61163NH036",,"NHN001","NHS001","NHF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0360001-01","Standard Gold On Exchange Plan","80.50%",,"Yes","Yes","No","100%",,"$1,000","$20","$890","$150","$1,000","$460","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Gold%20Basic%201000.pdf","http://minutemanhealth.org/members/sg-plans-new/con-NH-plans-2016","5"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","10","61163","NH","Individual","No","45-3596033","61163NH0210001","MyDoc HMO Silver Assistance A","61163NH021",,"NHN001","NHS001","NHF010","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0210001-01","Standard Silver On Exchange Plan","68.00%",,"Yes","Yes","No","100%",,"$3,500","$1,140","$0","$30","$1,400","$1,280","$250","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20Assistance%20A.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","5"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","10","61163","NH","Individual","No","45-3596033","61163NH0210001","MyDoc HMO Silver Assistance A","61163NH021",,"NHN001","NHS001","NHF010","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0210001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20Zero%20(Assistance%20A).pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","6"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","10","61163","NH","Individual","No","45-3596033","61163NH0210001","MyDoc HMO Silver Assistance A","61163NH021",,"NHN001","NHS001","NHF010","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0210001-03","Limited Cost Sharing Plan Variation","68.00%",,"Yes","Yes","No","100%",,"$3,500","$1,140","$0","$30","$1,400","$1,280","$250","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20Assistance%20A%20Limited.pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","7"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","10","61163","NH","Individual","No","45-3596033","61163NH0210001","MyDoc HMO Silver Assistance A","61163NH021",,"NHN001","NHS001","NHF010","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0210001-04","73% AV Level Silver Plan","73.40%",,"Yes","Yes","No","100%",,"$3,000","$520","$0","$30","$1,400","$600","$250","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20Assistance%20A%20(73).pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","8"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","10","61163","NH","Individual","No","45-3596033","61163NH0210001","MyDoc HMO Silver Assistance A","61163NH021",,"NHN001","NHS001","NHF010","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0210001-05","87% AV Level Silver Plan","87.19%",,"Yes","Yes","No","100%",,"$1,200","$390","$0","$30","$1,200","$400","$250","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20Assistance%20A%20(87).pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","9"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","10","61163","NH","Individual","No","45-3596033","61163NH0210001","MyDoc HMO Silver Assistance A","61163NH021",,"NHN001","NHS001","NHF010","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0210001-06","94% AV Level Silver Plan","94.94%",,"Yes","Yes","No","100%",,"$350","$330","$0","$30","$350","$140","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20Assistance%20A%20(94).pdf","http://minutemanhealth.org/MinutemanHealth/media/NH_Plan_Brochures/NH%20Plan%20Brochure%20HMO%20Ind%2020151031.pdf","10"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","11","61163","NH","SHOP (Small Group)","No","45-3596033","61163NH0380001","MyDoc HMO Silver HSA 3000","61163NH038",,"NHN001","NHS001","NHF008","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0380001-00","Standard Silver Off Exchange Plan","70.20%",,"Yes","Yes","No","100%",,"$3,000","$0","$450","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$6850 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20HSA%203000.pdf","http://minutemanhealth.org/members/sg-plans-new/con-NH-plans-2016","4"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","11","61163","NH","SHOP (Small Group)","No","45-3596033","61163NH0380001","MyDoc HMO Silver HSA 3000","61163NH038",,"NHN001","NHS001","NHF008","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0380001-01","Standard Silver On Exchange Plan","70.20%",,"Yes","Yes","No","100%",,"$3,000","$0","$450","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$6850 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Silver%20HSA%203000.pdf","http://minutemanhealth.org/members/sg-plans-new/con-NH-plans-2016","5"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","11","61163","NH","SHOP (Small Group)","No","45-3596033","61163NH0400001","MyDoc HMO Bronze HSA 6000","61163NH040",,"NHN001","NHS001","NHF007","New","HMO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0400001-00","Standard Bronze Off Exchange Plan","60.50%",,"Yes","Yes","No","100%",,"$6,000","$0","$700","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Bronze%20HSA%206000.pdf","http://minutemanhealth.org/members/sg-plans-new/con-NH-plans-2016","6"
"2016","NH","61163","SERFF","12","2016-07-14 13:48:17","11","61163","NH","SHOP (Small Group)","No","45-3596033","61163NH0400001","MyDoc HMO Bronze HSA 6000","61163NH040",,"NHN001","NHS001","NHF007","New","HMO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy","0.9999",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://mhi.nfphealth.com/secure/NewEnrollmentPayment.aspx","http://minutemanhealth.org/members/search-drug-list","61163NH0400001-01","Standard Bronze On Exchange Plan","60.50%",,"Yes","Yes","No","100%",,"$6,000","$0","$700","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6850 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://minutemanhealth.org/getattachment/Members/Plans-new/All-NH-Plans/MyDoc%20HMO%20Bronze%20HSA%206000.pdf","http://minutemanhealth.org/members/sg-plans-new/con-NH-plans-2016","7"
"2016","NH","72953","SERFF","4","2015-08-21 06:27:38","1","72953","NH","SHOP (Small Group)","Yes","47-0397286","72953NH0030001","Renaissance Group Dental PPO, EHB Certified","72953NH003",,"NHN001","NHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.03","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","72953NH0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NH","72953","SERFF","4","2015-08-21 06:27:38","1","72953","NH","Individual","Yes","47-0397286","72953NH0010001","Delta Dental Individual PPO, EHB Certified","72953NH001",,"NHN002","NHS002",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$48.90","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","72953NH0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NH","72953","SERFF","4","2015-08-21 06:27:38","1","72953","NH","Individual","Yes","47-0397286","72953NH0010002","Delta Dental Individual PPO, EHB Certified","72953NH001",,"NHN002","NHS002",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.63","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","72953NH0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NH","72953","SERFF","4","2015-08-21 06:27:38","1","72953","NH","SHOP (Small Group)","Yes","47-0397286","72953NH0030002","Renaissance Group Dental PPO, EHB Certified","72953NH003",,"NHN001","NHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.86","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","72953NH0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NH","72953","SERFF","4","2015-08-21 06:27:38","1","72953","NH","Individual","Yes","47-0397286","72953NH0020001","Renaissance Individual Dental PPO, EHB Certified","72953NH002",,"NHN001","NHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$48.17","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","72953NH0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","NH","72953","SERFF","4","2015-08-21 06:27:38","1","72953","NH","Individual","Yes","47-0397286","72953NH0020002","Renaissance Individual Dental PPO, EHB Certified","72953NH002",,"NHN001","NHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.07","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","72953NH0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","NH","74839","SERFF","3","2015-08-20 12:28:36","1","74839","NH","SHOP (Small Group)","Yes","42-0127290","74839NH0040001","Principal Plan Dental 70","74839NH004",,"NHN001","NHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$32.38","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","74839NH0040001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","NH","74839","SERFF","3","2015-08-20 12:28:36","1","74839","NH","SHOP (Small Group)","Yes","42-0127290","74839NH0040002","Principal Plan Dental 85","74839NH004",,"NHN001","NHS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$33.75","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","74839NH0040002-00","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","NH","75841","SERFF","6","2015-08-23 14:39:40","1","75841","NH","Individual","No","06-0641618","75841NH0090001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","75841NH009",,"NHN001","NHS001","NHF001","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090001-00","Standard Gold Off Exchange Plan",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/75841NH0090001-00.pdf","https://api.centene.com/Brochures/2016/75841NH0090001-00.pdf","4"
"2016","NH","75841","SERFF","6","2015-08-23 14:39:40","1","75841","NH","Individual","No","06-0641618","75841NH0090001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","75841NH009",,"NHN001","NHS001","NHF001","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090001-01","Standard Gold On Exchange Plan",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/75841NH0090001-01.pdf","https://api.centene.com/Brochures/2016/75841NH0090001-01.pdf","5"
"2016","NH","75841","SERFF","6","2015-08-23 14:39:40","1","75841","NH","Individual","No","06-0641618","75841NH0090001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","75841NH009",,"NHN001","NHS001","NHF001","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/75841NH0090001-02.pdf","https://api.centene.com/Brochures/2016/75841NH0090001-02.pdf","6"
"2016","NH","75841","SERFF","6","2015-08-23 14:39:40","1","75841","NH","Individual","No","06-0641618","75841NH0090001","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","75841NH009",,"NHN001","NHS001","NHF001","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090001-03","Limited Cost Sharing Plan Variation",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/75841NH0090001-03.pdf","https://api.centene.com/Brochures/2016/75841NH0090001-03.pdf","7"
"2016","NH","75841","SERFF","6","2015-08-23 14:39:40","1","75841","NH","Individual","No","06-0641618","75841NH0090002","Ambetter Balanced Care 8 (2016)","75841NH009",,"NHN001","NHS001","NHF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090002-00","Standard Silver Off Exchange Plan",,"0.697914004325867","No","Yes","No","100%",,"$3,500","$300","$0","$200","$2,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/75841NH0090002-00.pdf","https://api.centene.com/Brochures/2016/75841NH0090002-00.pdf","8"
"2016","NH","75841","SERFF","6","2015-08-23 14:39:40","1","75841","NH","Individual","No","06-0641618","75841NH0090002","Ambetter Balanced Care 8 (2016)","75841NH009",,"NHN001","NHS001","NHF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090002-01","Standard Silver On Exchange Plan",,"0.697914004325867","No","Yes","No","100%",,"$3,500","$300","$0","$200","$2,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/75841NH0090002-01.pdf","https://api.centene.com/Brochures/2016/75841NH0090002-01.pdf","9"
"2016","NH","75841","SERFF","6","2015-08-23 14:39:40","1","75841","NH","Individual","No","06-0641618","75841NH0090002","Ambetter Balanced Care 8 (2016)","75841NH009",,"NHN001","NHS001","NHF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/75841NH0090002-02.pdf","https://api.centene.com/Brochures/2016/75841NH0090002-02.pdf","10"
"2016","NH","75841","SERFF","6","2015-08-23 14:39:40","1","75841","NH","Individual","No","06-0641618","75841NH0090002","Ambetter Balanced Care 8 (2016)","75841NH009",,"NHN001","NHS001","NHF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090002-03","Limited Cost Sharing Plan Variation",,"0.697914004325867","No","Yes","No","100%",,"$3,500","$300","$0","$200","$2,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/75841NH0090002-03.pdf","https://api.centene.com/Brochures/2016/75841NH0090002-03.pdf","11"
"2016","NH","75841","SERFF","6","2015-08-23 14:39:40","1","75841","NH","Individual","No","06-0641618","75841NH0090002","Ambetter Balanced Care 8 (2016)","75841NH009",,"NHN001","NHS001","NHF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090002-04","73% AV Level Silver Plan",,"0.732398450374603","No","Yes","No","100%",,"$3,000","$40","$0","$200","$3,000","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/75841NH0090002-04.pdf","https://api.centene.com/Brochures/2016/75841NH0090002-04.pdf","12"
"2016","NH","75841","SERFF","6","2015-08-23 14:39:40","1","75841","NH","Individual","No","06-0641618","75841NH0090002","Ambetter Balanced Care 8 (2016)","75841NH009",,"NHN001","NHS001","NHF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090002-05","87% AV Level Silver Plan",,"0.870828092098236","No","Yes","No","100%",,"$1,000","$200","$0","$200","$1,000","$500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/75841NH0090002-05.pdf","https://api.centene.com/Brochures/2016/75841NH0090002-05.pdf","13"
"2016","NH","75841","SERFF","6","2015-08-23 14:39:40","1","75841","NH","Individual","No","06-0641618","75841NH0090002","Ambetter Balanced Care 8 (2016)","75841NH009",,"NHN001","NHS001","NHF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.nhhealthyfamilies.com/payments","http://ambetter.nhhealthyfamilies.com/formulary","75841NH0090002-06","94% AV Level Silver Plan",,"0.949418663978577","No","Yes","No","100%",,"$400","$200","$0","$200","$400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/75841NH0090002-06.pdf","https://api.centene.com/Brochures/2016/75841NH0090002-06.pdf","14"
"2016","NH","81787","SERFF","3","2015-08-20 12:28:36","1","81787","NH","SHOP (Small Group)","Yes","47-0098400","81787NH0040002","EHB High PPO","81787NH004",,"NHN001","NHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$54.31","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","81787NH0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","NH","81787","SERFF","3","2015-08-20 12:28:36","1","81787","NH","SHOP (Small Group)","Yes","47-0098400","81787NH0040001","EHB Low PPO","81787NH004",,"NHN001","NHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.66","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","81787NH0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","Individual","No","02-0494919","96751NH0150016","Anthem Bronze Pathway X Enhanced HMO 0  for HSA","96751NH015",,"NHN001","NHS001","NHF016","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9971",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150016-01","Standard Bronze On Exchange Plan",,"0.619503915309906","Yes","Yes","No","100%",,"$4,435","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GPH","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","9"
"2016","NH","81787","SERFF","3","2015-08-20 12:28:36","1","81787","NH","SHOP (Small Group)","Yes","47-0098400","81787NH0030002","EHB High Passive","81787NH003",,"NHN001","NHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$58.54","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","81787NH0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","NH","81787","SERFF","3","2015-08-20 12:28:36","1","81787","NH","SHOP (Small Group)","Yes","47-0098400","81787NH0030001","EHB Low Passive","81787NH003",,"NHN001","NHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.84","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","81787NH0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","Individual","No","02-0494919","96751NH0150020","Anthem Silver Pathway X Enhanced HMO 10 for HSA","96751NH015",,"NHN001","NHS001","NHF015","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9974",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150020-01","Standard Silver On Exchange Plan","68.49%","0.687728404998779","Yes","Yes","No","100%",,"$3,000","$0","$149","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GPL","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","13"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","Individual","No","02-0494919","96751NH0150020","Anthem Silver Pathway X Enhanced HMO 10 for HSA","96751NH015",,"NHN001","NHS001","NHF015","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9974",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150020-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GQ4","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","14"
"2016","NH","82708","SERFF","6","2015-08-20 12:28:36","1","82708","NH","Individual","Yes","75-1233841","82708NH0010001","Dentegra Dental PPO Pediatric Basic Plan","82708NH001",,"NHN001","NHS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.51","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.dentegra.com/hx/checkout","","82708NH0010001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","per person not applicable","per group not applicable",,,,,,"$125","per person not applicable","per group not applicable","$125","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"dentegra.com/hcx/nh/82708nh0010001-16","4"
"2016","NH","82708","SERFF","6","2015-08-20 12:28:36","1","82708","NH","SHOP (Small Group)","Yes","75-1233841","82708NH0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","82708NH002",,"NHN001","NHS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.81","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.dentegra.com/hx/checkout","","82708NH0020001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","per person not applicable","per group not applicable",,,,,,"$125","per person not applicable","per group not applicable","$125","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"dentegra.com/hcx/nh/82708nh0020001-16","4"
"2016","NH","82708","SERFF","6","2015-08-20 12:28:36","2","82708","NH","SHOP (Small Group)","Yes","75-1233841","82708NH0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","82708NH002",,"NHN001","NHS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$49.24","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.dentegra.com/hx/checkout","","82708NH0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"dentegra.com/hcx/nh/82708nh0020004-16","4"
"2016","NH","82708","SERFF","6","2015-08-20 12:28:36","2","82708","NH","Individual","Yes","75-1233841","82708NH0010004","Dentegra Dental PPO Family Preferred Plan","82708NH001",,"NHN001","NHS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$48.84","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.dentegra.com/hx/checkout","","82708NH0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"dentegra.com/hcx/nh/82708nh0010004-16","4"
"2016","NH","82708","SERFF","6","2015-08-20 12:28:36","3","82708","NH","Individual","Yes","75-1233841","82708NH0010006","Dentegra Dental PPO Family Basic Plan","82708NH001",,"NHN001","NHS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.51","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.dentegra.com/hx/checkout","","82708NH0010006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","per person not applicable","per group not applicable",,,,,,"$125","per person not applicable","per group not applicable","$125","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"dentegra.com/hcx/nh/82708nh0010006-16","4"
"2016","NH","82708","SERFF","6","2015-08-20 12:28:36","3","82708","NH","SHOP (Small Group)","Yes","75-1233841","82708NH0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","82708NH002",,"NHN001","NHS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.81","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.dentegra.com/hx/checkout","","82708NH0020006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","per person not applicable","per group not applicable",,,,,,"$125","per person not applicable","per group not applicable","$125","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"dentegra.com/hcx/nh/82708nh0020006-16","4"
"2016","NH","82708","SERFF","6","2015-08-20 12:28:36","3","82708","NH","SHOP (Small Group)","Yes","75-1233841","82708NH0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","82708NH002",,"NHN001","NHS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.81","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.dentegra.com/hx/checkout","","82708NH0020006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","per person not applicable","per group not applicable",,,,,,"$125","per person not applicable","per group not applicable","$125","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"dentegra.com/hcx/nh/82708nh0020006-16","5"
"2016","NH","82708","SERFF","6","2015-08-20 12:28:36","3","82708","NH","Individual","Yes","75-1233841","82708NH0010006","Dentegra Dental PPO Family Basic Plan","82708NH001",,"NHN001","NHS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.51","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","www.dentegra.com/hx/checkout","","82708NH0010006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","per person not applicable","per group not applicable",,,,,,"$125","per person not applicable","per group not applicable","$125","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"dentegra.com/hcx/nh/82708nh0010006-16","5"
"2016","NH","87701","SERFF","7","2016-01-27 11:15:49","1","87701","NH","Individual","Yes","02-0273013","87701NH0070001","Delta Dental Family High Plan","87701NH007","7992708454","NHN001","NHS001",,"Existing","PPO","High",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"$44.45","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","87701NH0070001-00","Standard High Off Exchange Plan","84.86%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/OFFHIX/oocnh2016a.pdf","4"
"2016","NH","87701","SERFF","7","2016-01-27 11:15:49","1","87701","NH","SHOP (Small Group)","Yes","02-0273013","87701NH0110001","Delta Dental PPO Family High Plan","87701NH011","7992708454","NHN001","NHS001",,"Existing","PPO","High",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"$44.45","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Same Coverage","Yes","Same Coverage","Yes",,"","87701NH0110001-01","Standard High On Exchange Plan","84.86%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/nh/oocnh20165.pdf","4"
"2016","NH","87701","SERFF","7","2016-01-27 11:15:49","1","87701","NH","Individual","Yes","02-0273013","87701NH0070001","Delta Dental Family High Plan","87701NH007","7992708454","NHN001","NHS001",,"Existing","PPO","High",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"$44.45","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","87701NH0070001-01","Standard High On Exchange Plan","84.86%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/nh/oocnh20161.pdf","5"
"2016","NH","87701","SERFF","7","2016-01-27 11:15:49","1","87701","NH","SHOP (Small Group)","Yes","02-0273013","87701NH0120001","Delta Dental PPO Family Low Plan","87701NH012","7992708454","NHN001","NHS001",,"Existing","PPO","Low",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"$33.65","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Same Coverage","Yes","Same Coverage","Yes",,"","87701NH0120001-01","Standard Low On Exchange Plan","71.97%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/nh/oocnh20166.pdf","5"
"2016","NH","87701","SERFF","7","2016-01-27 11:15:49","1","87701","NH","Individual","Yes","02-0273013","87701NH0080001","Delta Dental Family Low Plan","87701NH008","7992708454","NHN001","NHS001",,"Existing","PPO","Low",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"$33.65","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","87701NH0080001-00","Standard Low Off Exchange Plan","71.97%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/OFFHIX/oocnh2016b.pdf","6"
"2016","NH","87701","SERFF","7","2016-01-27 11:15:49","1","87701","NH","SHOP (Small Group)","Yes","02-0273013","87701NH0110002","Delta Dental PPO Family High Plan","87701NH011","7992708454","NHN001","NHS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"$44.45","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Same Coverage","Yes","Same Coverage","Yes",,"","87701NH0110002-00","Standard High Off Exchange Plan","84.86%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/OFFHIX/oocnh2016c.pdf","6"
"2016","NH","87701","SERFF","7","2016-01-27 11:15:49","1","87701","NH","Individual","Yes","02-0273013","87701NH0080001","Delta Dental Family Low Plan","87701NH008","7992708454","NHN001","NHS001",,"Existing","PPO","Low",,"Both",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"$33.65","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","87701NH0080001-01","Standard Low On Exchange Plan","71.97%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/nh/oocnh20162.pdf","7"
"2016","NH","87701","SERFF","7","2016-01-27 11:15:49","1","87701","NH","SHOP (Small Group)","Yes","02-0273013","87701NH0120002","Delta Dental PPO Family Low Plan","87701NH012","7992708454","NHN001","NHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Adult and Child-Only",,,,,"$33.65","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Same Coverage","Yes","Same Coverage","Yes",,"","87701NH0120002-00","Standard Low Off Exchange Plan","71.97%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/OFFHIX/oocnh2016d.pdf","7"
"2016","NH","87701","SERFF","7","2016-01-27 11:15:49","2","87701","NH","Individual","Yes","02-0273013","87701NH0090001","Delta Dental Pediatric High Plan","87701NH009","7992708454","NHN001","NHS001",,"Existing","PPO","High",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Child-Only",,,,,"$44.45","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","87701NH0090001-01","Standard High On Exchange Plan","84.86%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/nh/oocnh20163.pdf","4"
"2016","NH","87701","SERFF","7","2016-01-27 11:15:49","2","87701","NH","Individual","Yes","02-0273013","87701NH0100001","Delta Dental Pediatric Low Plan","87701NH010","7992708454","NHN001","NHS001",,"Existing","PPO","Low",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Medically necessary orthodontia is a covered benefit for pediatric enrollees only.  Certain covered services apply to treatment for specified teeth.  Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist.  Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist.  Other exclusions and limitations may apply.  Please refer to your Policy for details.",,"No","Allows Child-Only",,,,,"$33.65","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","87701NH0100001-01","Standard Low On Exchange Plan","71.97%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$150","$150 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/Exchange/nh/oocnh20164.pdf","5"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","Individual","No","02-0494919","96751NH0150015","Anthem Bronze Pathway X Enhanced HMO 25  for HSA","96751NH015",,"NHN001","NHS001","NHF013","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.997",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150015-00","Standard Bronze Off Exchange Plan","61.70%","0.618937313556671","Yes","Yes","No","100%",,"$4,500","$0","$137","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JYT","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","4"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","SHOP (Small Group)","No","02-0494919","96751NH0160011","Anthem Gold Pathway X HMO 1500 10  3000 w HSA","96751NH016",,"NHN003","NHS001","NHF007","New","HMO","Gold","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9964",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160011-00","Standard Gold Off Exchange Plan",,"0.79778265953064","Yes","Yes","No","100%",,"$1,500","$0","$567","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$6000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$3000 per person","$3000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P86","http://sgplans.anthem.com/nh/brochure/","4"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","SHOP (Small Group)","No","02-0494919","96751NH0160011","Anthem Gold Pathway X HMO 1500 10  3000 w HSA","96751NH016",,"NHN003","NHS001","NHF007","New","HMO","Gold","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9964",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160011-01","Standard Gold On Exchange Plan",,"0.79778265953064","Yes","Yes","No","100%",,"$1,500","$0","$567","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$6000 per person","$6000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$3000 per person","$3000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P86","http://sgplans.anthem.com/nh/brochure/","5"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","Individual","No","02-0494919","96751NH0150015","Anthem Bronze Pathway X Enhanced HMO 25  for HSA","96751NH015",,"NHN001","NHS001","NHF013","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.997",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150015-01","Standard Bronze On Exchange Plan","61.70%","0.618937313556671","Yes","Yes","No","100%",,"$4,491","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GPG","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","5"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","Individual","No","02-0494919","96751NH0150015","Anthem Bronze Pathway X Enhanced HMO 25  for HSA","96751NH015",,"NHN001","NHS001","NHF013","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.997",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GQ0","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","6"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","SHOP (Small Group)","No","02-0494919","96751NH0160012","Anthem Bronze Pathway X HMO 5000 30  6550 w HSA","96751NH016",,"NHN003","NHS001","NHF009","New","HMO","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9943",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160012-00","Standard Bronze Off Exchange Plan",,"0.608002007007599","Yes","Yes","No","100%",,"$5,000","$0","$650","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P87","http://sgplans.anthem.com/nh/brochure/","6"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","SHOP (Small Group)","No","02-0494919","96751NH0160012","Anthem Bronze Pathway X HMO 5000 30  6550 w HSA","96751NH016",,"NHN003","NHS001","NHF009","New","HMO","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9943",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160012-01","Standard Bronze On Exchange Plan",,"0.608002007007599","Yes","Yes","No","100%",,"$5,000","$0","$650","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,550","$6550 per person","$13100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P87","http://sgplans.anthem.com/nh/brochure/","7"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","Individual","No","02-0494919","96751NH0150015","Anthem Bronze Pathway X Enhanced HMO 25  for HSA","96751NH015",,"NHN001","NHS001","NHF013","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.997",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150015-03","Limited Cost Sharing Plan Variation","61.70%","0.618937313556671","Yes","Yes","No","100%",,"$4,491","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GPG","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","7"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","Individual","No","02-0494919","96751NH0150016","Anthem Bronze Pathway X Enhanced HMO 0  for HSA","96751NH015",,"NHN001","NHS001","NHF016","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9971",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150016-00","Standard Bronze Off Exchange Plan",,"0.619503915309906","Yes","Yes","No","100%",,"$4,993","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JYU","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","8"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","Individual","No","02-0494919","96751NH0150016","Anthem Bronze Pathway X Enhanced HMO 0  for HSA","96751NH015",,"NHN001","NHS001","NHF016","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9971",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GQ1","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","10"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","Individual","No","02-0494919","96751NH0150016","Anthem Bronze Pathway X Enhanced HMO 0  for HSA","96751NH015",,"NHN001","NHS001","NHF016","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9971",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150016-03","Limited Cost Sharing Plan Variation",,"0.619503915309906","Yes","Yes","No","100%",,"$4,435","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GPH","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","11"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","Individual","No","02-0494919","96751NH0150020","Anthem Silver Pathway X Enhanced HMO 10 for HSA","96751NH015",,"NHN001","NHS001","NHF015","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9974",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150020-00","Standard Silver Off Exchange Plan","68.49%","0.687728404998779","Yes","Yes","No","100%",,"$3,000","$0","$205","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1JYX","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","12"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","Individual","No","02-0494919","96751NH0150020","Anthem Silver Pathway X Enhanced HMO 10 for HSA","96751NH015",,"NHN001","NHS001","NHF015","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9974",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150020-03","Limited Cost Sharing Plan Variation","68.49%","0.687728404998779","Yes","Yes","No","100%",,"$3,000","$0","$149","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GPL","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","15"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","Individual","No","02-0494919","96751NH0150020","Anthem Silver Pathway X Enhanced HMO 10 for HSA","96751NH015",,"NHN001","NHS001","NHF015","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9974",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150020-04","73% AV Level Silver Plan","72.33%","0.725343465805054","Yes","Yes","No","100%",,"$2,600","$0","$189","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,950","$3950 per person","$7900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPM","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","16"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","Individual","No","02-0494919","96751NH0150020","Anthem Silver Pathway X Enhanced HMO 10 for HSA","96751NH015",,"NHN001","NHS001","NHF015","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9974",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150020-05","87% AV Level Silver Plan","87.46%","0.874577879905701","Yes","Yes","No","100%",,"$1,150","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPN","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","17"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","Individual","No","02-0494919","96751NH0150020","Anthem Silver Pathway X Enhanced HMO 10 for HSA","96751NH015",,"NHN001","NHS001","NHF015","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9974",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150020-06","94% AV Level Silver Plan","93.96%","0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$0","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPP","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","18"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","Individual","No","02-0494919","96751NH0150023","Anthem Gold Pathway X Enhanced HMO 1000 10","96751NH015",,"NHN001","NHS001","NHF005","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.998",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150023-00","Standard Gold Off Exchange Plan","81.34%","0.812341630458832","Yes","Yes","No","100%",,"$1,000","$500","$355","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,050","$4050 per person","$8100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JYZ","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","19"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","Individual","No","02-0494919","96751NH0150023","Anthem Gold Pathway X Enhanced HMO 1000 10","96751NH015",,"NHN001","NHS001","NHF005","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.998",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150023-01","Standard Gold On Exchange Plan","81.34%","0.812341630458832","Yes","Yes","No","100%",,"$1,000","$500","$299","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,050","$4050 per person","$8100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPY","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","20"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","Individual","No","02-0494919","96751NH0150023","Anthem Gold Pathway X Enhanced HMO 1000 10","96751NH015",,"NHN001","NHS001","NHF005","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.998",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150023-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JYZ","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","21"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","1","96751","NH","Individual","No","02-0494919","96751NH0150023","Anthem Gold Pathway X Enhanced HMO 1000 10","96751NH015",,"NHN001","NHS001","NHF005","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.998",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150023-03","Limited Cost Sharing Plan Variation","81.34%","0.812341630458832","Yes","Yes","No","100%",,"$1,000","$500","$299","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,050","$4050 per person","$8100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPY","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","22"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","2","96751","NH","Individual","No","02-0494919","96751NH0150017","Anthem Bronze Pathway X Enhanced HMO 5400 20","96751NH015",,"NHN001","NHS001","NHF014","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9969",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150017-00","Standard Bronze Off Exchange Plan","60.15%","0.617193222045898","Yes","Yes","No","100%",,"$5,049","$0","$0","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JYV","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","4"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","2","96751","NH","Individual","No","02-0494919","96751NH0150017","Anthem Bronze Pathway X Enhanced HMO 5400 20","96751NH015",,"NHN001","NHS001","NHF014","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9969",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150017-01","Standard Bronze On Exchange Plan","60.15%","0.617193222045898","Yes","Yes","No","100%",,"$4,491","$0","$0","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPJ","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","5"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","2","96751","NH","Individual","No","02-0494919","96751NH0150017","Anthem Bronze Pathway X Enhanced HMO 5400 20","96751NH015",,"NHN001","NHS001","NHF014","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9969",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150017-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GQ2","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","6"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","2","96751","NH","Individual","No","02-0494919","96751NH0150017","Anthem Bronze Pathway X Enhanced HMO 5400 20","96751NH015",,"NHN001","NHS001","NHF014","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9969",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150017-03","Limited Cost Sharing Plan Variation","60.15%","0.617193222045898","Yes","Yes","No","100%",,"$4,491","$0","$0","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPJ","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","7"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","2","96751","NH","Individual","No","02-0494919","96751NH0150018","Anthem Bronze Pathway X Enhanced HMO 5750 10","96751NH015",,"NHN001","NHS001","NHF015","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.997",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150018-00","Standard Bronze Off Exchange Plan","60.19%","0.616940498352051","Yes","Yes","No","100%",,"$5,049","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JYW","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","8"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","2","96751","NH","Individual","No","02-0494919","96751NH0150018","Anthem Bronze Pathway X Enhanced HMO 5750 10","96751NH015",,"NHN001","NHS001","NHF015","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.997",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150018-01","Standard Bronze On Exchange Plan","60.19%","0.616940498352051","Yes","Yes","No","100%",,"$4,491","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPK","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","9"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","2","96751","NH","Individual","No","02-0494919","96751NH0150018","Anthem Bronze Pathway X Enhanced HMO 5750 10","96751NH015",,"NHN001","NHS001","NHF015","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.997",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150018-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GQ3","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","10"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","2","96751","NH","Individual","No","02-0494919","96751NH0150018","Anthem Bronze Pathway X Enhanced HMO 5750 10","96751NH015",,"NHN001","NHS001","NHF015","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.997",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150018-03","Limited Cost Sharing Plan Variation","60.19%","0.616940498352051","Yes","Yes","No","100%",,"$4,491","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,750","$5750 per person","$11500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPK","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","11"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","3","96751","NH","Individual","No","02-0494919","96751NH0150022","Anthem Silver Pathway X Enhanced HMO 4000 0","96751NH015",,"NHN001","NHS001","NHF001","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9975",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150022-00","Standard Silver Off Exchange Plan","68.00%","0.695556044578552","Yes","Yes","No","100%",,"$4,000","$500","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JYY","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","4"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","3","96751","NH","Individual","No","02-0494919","96751NH0150022","Anthem Silver Pathway X Enhanced HMO 4000 0","96751NH015",,"NHN001","NHS001","NHF001","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9975",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150022-01","Standard Silver On Exchange Plan","68.00%","0.695556044578552","Yes","Yes","No","100%",,"$4,000","$259","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPU","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","5"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","3","96751","NH","Individual","No","02-0494919","96751NH0150022","Anthem Silver Pathway X Enhanced HMO 4000 0","96751NH015",,"NHN001","NHS001","NHF001","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9975",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150022-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GQ6","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","6"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","3","96751","NH","Individual","No","02-0494919","96751NH0150022","Anthem Silver Pathway X Enhanced HMO 4000 0","96751NH015",,"NHN001","NHS001","NHF001","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9975",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150022-03","Limited Cost Sharing Plan Variation","68.00%","0.695556044578552","Yes","Yes","No","100%",,"$4,000","$259","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPU","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","7"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","3","96751","NH","Individual","No","02-0494919","96751NH0150022","Anthem Silver Pathway X Enhanced HMO 4000 0","96751NH015",,"NHN001","NHS001","NHF001","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9975",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150022-04","73% AV Level Silver Plan","73.31%","0.743218839168549","Yes","Yes","No","100%",,"$2,900","$500","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPV","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","8"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","3","96751","NH","Individual","No","02-0494919","96751NH0150022","Anthem Silver Pathway X Enhanced HMO 4000 0","96751NH015",,"NHN001","NHS001","NHF001","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9975",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150022-05","87% AV Level Silver Plan","87.11%","0.873282432556152","Yes","Yes","No","100%",,"$800","$250","$0","$0","$800","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPW","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","9"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","3","96751","NH","Individual","No","02-0494919","96751NH0150022","Anthem Silver Pathway X Enhanced HMO 4000 0","96751NH015",,"NHN001","NHS001","NHF001","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9975",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150022-06","94% AV Level Silver Plan","94.82%","0.952005624771118","Yes","Yes","No","100%",,"$200","$100","$0","$0","$200","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPX","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","10"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","3","96751","NH","Individual","No","02-0494919","96751NH0150024","Anthem Catastrophic Pathway X Enhanced HMO 6850 0","96751NH015",,"NHN001","NHS001","NHF016","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9961",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150024-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$4,993","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JZ0","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","11"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","3","96751","NH","Individual","No","02-0494919","96751NH0150024","Anthem Catastrophic Pathway X Enhanced HMO 6850 0","96751NH015",,"NHN001","NHS001","NHF016","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","0.9961",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150024-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$4,435","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GPZ","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","12"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","5","96751","NH","SHOP (Small Group)","No","02-0494919","96751NH0160008","Anthem Bronze Pathway X HMO 6000 30  6850","96751NH016",,"NHN003","NHS001","NHF011","Existing","HMO","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9966",,,"$300","0","0","3","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160008-00","Standard Bronze Off Exchange Plan","60.15%","0.618229389190674","No","Yes","No","100%",,"$6,000","$0","$350","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$6,000","$6000 per person","$12000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD20VE","http://sgplans.anthem.com/nh/brochure/","4"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","5","96751","NH","SHOP (Small Group)","No","02-0494919","96751NH0160008","Anthem Bronze Pathway X HMO 6000 30  6850","96751NH016",,"NHN003","NHS001","NHF011","Existing","HMO","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9966",,,"$300","0","0","3","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160008-01","Standard Bronze On Exchange Plan","60.15%","0.618229389190674","No","Yes","No","100%",,"$6,000","$0","$350","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$6,000","$6000 per person","$12000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD20VE","http://sgplans.anthem.com/nh/brochure/","5"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","5","96751","NH","SHOP (Small Group)","No","02-0494919","96751NH0160005","Anthem Gold Pathway X HMO 1500 20  3000","96751NH016",,"NHN003","NHS001","NHF010","Existing","HMO","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"$300","0","0","3","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160005-00","Standard Gold Off Exchange Plan","78.53%","0.795790612697601","No","Yes","No","100%",,"$1,500","$0","$1,134","$0","$1,109","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD20VD","http://sgplans.anthem.com/nh/brochure/","6"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0310004","Individual HMO Silver 4 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF009","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9911",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310004-00","Standard Silver Off Exchange Plan",,"0.719508230686188","Yes","Yes","No","100%",,"$5,000","$300","$0","$0","$5,000","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","27"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0310004","Individual HMO Silver 4 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF009","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9911",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310004-01","Standard Silver On Exchange Plan",,"0.719508230686188","Yes","Yes","No","100%",,"$5,000","$300","$0","$0","$5,000","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","28"
"2016","NM","19722","SERFF","5","2015-11-19 07:02:40","3","19722","NM","Individual","No","85-0408506","19722NM0010003","Molina Marketplace Bronze Plan","19722NM001",,"NMN001","NMS001","NMF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency Service and Urgent Care Services are covered","Yes","Emergency Service and Urgent Care Services are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/nm/en/PDF/marketplace/formulary-2016.pdf","19722NM0010003-01","Standard Bronze On Exchange Plan",,"0.618895947933197","Yes","Yes","No","100%",,"$5,000","$20","$90","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/marketplace/summary-of-benefits-bronze-2016.pdf","http://www.molinahealthcare.com/nm/en/PDF/marketplace/brochure-2016.pdf","5"
"2016","NM","19722","SERFF","5","2015-11-19 07:02:40","3","19722","NM","Individual","No","85-0408506","19722NM0010003","Molina Marketplace Bronze Plan","19722NM001",,"NMN001","NMS001","NMF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency Service and Urgent Care Services are covered","Yes","Emergency Service and Urgent Care Services are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/nm/en/PDF/marketplace/formulary-2016.pdf","19722NM0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/marketplace/summary-of-benefits-bronze-aian-2016.pdf","http://www.molinahealthcare.com/nm/en/PDF/marketplace/brochure-2016.pdf","6"
"2016","NM","19722","SERFF","5","2015-11-19 07:02:40","3","19722","NM","Individual","No","85-0408506","19722NM0010003","Molina Marketplace Bronze Plan","19722NM001",,"NMN001","NMS001","NMF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency Service and Urgent Care Services are covered","Yes","Emergency Service and Urgent Care Services are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/nm/en/PDF/marketplace/formulary-2016.pdf","19722NM0010003-03","Limited Cost Sharing Plan Variation",,"0.618895947933197","Yes","Yes","No","100%",,"$5,000","$20","$90","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/marketplace/summary-of-benefits-bronze-2016.pdf","http://www.molinahealthcare.com/nm/en/PDF/marketplace/brochure-2016.pdf","7"
"2016","NM","26075","SERFF","4","2015-08-25 12:56:34","1","26075","NM","Individual","Yes","95-6042390","26075NM0020003","BESTOne Advantage Gold","26075NM002",,"NMN001","NMS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.13","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","NM","26075","SERFF","4","2015-08-25 12:56:34","1","26075","NM","Individual","Yes","95-6042390","26075NM0020003","BESTOne Advantage Gold","26075NM002",,"NMN001","NMS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.13","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","NM","26075","SERFF","4","2015-08-25 12:56:34","1","26075","NM","Individual","Yes","95-6042390","26075NM0020004","BESTOne Plus Gold","26075NM002",,"NMN001","NMS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.13","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","NM","26075","SERFF","4","2015-08-25 12:56:34","1","26075","NM","Individual","Yes","95-6042390","26075NM0020004","BESTOne Plus Gold","26075NM002",,"NMN001","NMS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.13","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","NM","26075","SERFF","4","2015-08-25 12:56:34","2","26075","NM","Individual","Yes","95-6042390","26075NM0020005","BESTOne Plus Silver","26075NM002",,"NMN001","NMS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.72","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","NM","26075","SERFF","4","2015-08-25 12:56:34","2","26075","NM","Individual","Yes","95-6042390","26075NM0020005","BESTOne Plus Silver","26075NM002",,"NMN001","NMS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.72","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","NM","26075","SERFF","4","2015-08-25 12:56:34","2","26075","NM","Individual","Yes","95-6042390","26075NM0020006","BESTOne Basic Silver","26075NM002",,"NMN001","NMS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.72","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","NM","26075","SERFF","4","2015-08-25 12:56:34","2","26075","NM","Individual","Yes","95-6042390","26075NM0020006","BESTOne Basic Silver","26075NM002",,"NMN001","NMS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.72","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","26075NM0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/NM/2016/NM_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0310004","Individual HMO Silver 4 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF009","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9911",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","29"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0310004","Individual HMO Silver 4 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF009","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9911",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310004-03","Limited Cost Sharing Plan Variation",,"0.719508230686188","Yes","Yes","No","100%",,"$5,000","$300","$0","$0","$5,000","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","30"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","5","96751","NH","SHOP (Small Group)","No","02-0494919","96751NH0160005","Anthem Gold Pathway X HMO 1500 20  3000","96751NH016",,"NHN003","NHS001","NHF010","Existing","HMO","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9977",,,"$300","0","0","3","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160005-01","Standard Gold On Exchange Plan","78.53%","0.795790612697601","No","Yes","No","100%",,"$1,500","$0","$1,134","$0","$1,109","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD20VD","http://sgplans.anthem.com/nh/brochure/","7"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","5","96751","NH","SHOP (Small Group)","No","02-0494919","96751NH0160006","Anthem Silver Pathway X HMO 3500 10  6000","96751NH016",,"NHN003","NHS001","NHF010","Existing","HMO","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,"$300","0","0","3","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160006-00","Standard Silver Off Exchange Plan","69.04%","0.688433706760406","No","Yes","No","100%",,"$3,500","$0","$367","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$3,500","$3500 per person","$7000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD20VF","http://sgplans.anthem.com/nh/brochure/","8"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","5","96751","NH","SHOP (Small Group)","No","02-0494919","96751NH0160006","Anthem Silver Pathway X HMO 3500 10  6000","96751NH016",,"NHN003","NHS001","NHF010","Existing","HMO","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9972",,,"$300","0","0","3","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160006-01","Standard Silver On Exchange Plan","69.04%","0.688433706760406","No","Yes","No","100%",,"$3,500","$0","$367","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$3,500","$3500 per person","$7000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD20VF","http://sgplans.anthem.com/nh/brochure/","9"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","6","96751","NH","SHOP (Small Group)","No","02-0494919","96751NH0160010","Anthem Silver Pathway X HMO 3000 0  5000 w HSA","96751NH016",,"NHN003","NHS001","NHF008","New","HMO","Silver","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9958",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160010-00","Standard Silver Off Exchange Plan",,"0.711673259735107","Yes","Yes","No","100%",,"$3,000","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P85","http://sgplans.anthem.com/nh/brochure/","4"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","6","96751","NH","SHOP (Small Group)","No","02-0494919","96751NH0160010","Anthem Silver Pathway X HMO 3000 0  5000 w HSA","96751NH016",,"NHN003","NHS001","NHF008","New","HMO","Silver","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9958",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","No",,"https://www.anthem.com/NHSelectdrugtier4","96751NH0160010-01","Standard Silver On Exchange Plan",,"0.711673259735107","Yes","Yes","No","100%",,"$3,000","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P85","http://sgplans.anthem.com/nh/brochure/","5"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","7","96751","NH","Individual","No","02-0494919","96751NH0150025","Anthem Silver Pathway X Enhanced HMO 4200 0","96751NH015",,"NHN001","NHS001","NHF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150025-00","Standard Silver Off Exchange Plan","70.46%","0.703166306018829","Yes","Yes","No","100%",,"$4,200","$500","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2901","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","4"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","7","96751","NH","Individual","No","02-0494919","96751NH0150025","Anthem Silver Pathway X Enhanced HMO 4200 0","96751NH015",,"NHN001","NHS001","NHF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150025-01","Standard Silver On Exchange Plan","70.46%","0.703166306018829","Yes","Yes","No","100%",,"$4,200","$59","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2904","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","5"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","7","96751","NH","Individual","No","02-0494919","96751NH0150025","Anthem Silver Pathway X Enhanced HMO 4200 0","96751NH015",,"NHN001","NHS001","NHF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150025-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2902","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","6"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","7","96751","NH","Individual","No","02-0494919","96751NH0150025","Anthem Silver Pathway X Enhanced HMO 4200 0","96751NH015",,"NHN001","NHS001","NHF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150025-03","Limited Cost Sharing Plan Variation","70.46%","0.703166306018829","Yes","Yes","No","100%",,"$4,200","$59","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2904","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","7"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","7","96751","NH","Individual","No","02-0494919","96751NH0150025","Anthem Silver Pathway X Enhanced HMO 4200 0","96751NH015",,"NHN001","NHS001","NHF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150025-04","73% AV Level Silver Plan","73.38%","0.734717130661011","Yes","Yes","No","100%",,"$3,300","$500","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,300","$3300 per person","$6600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2905","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","8"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","7","96751","NH","Individual","No","02-0494919","96751NH0150025","Anthem Silver Pathway X Enhanced HMO 4200 0","96751NH015",,"NHN001","NHS001","NHF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150025-05","87% AV Level Silver Plan","86.39%","0.865984261035919","Yes","Yes","No","100%",,"$1,000","$250","$0","$0","$1,000","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2906","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","9"
"2016","NH","96751","SERFF","13","2016-03-31 13:35:32","7","96751","NH","Individual","No","02-0494919","96751NH0150025","Anthem Silver Pathway X Enhanced HMO 4200 0","96751NH015",,"NHN001","NHS001","NHF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care Only","No","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NH","https://www.anthem.com/NHSelectdrugtier4","96751NH0150025-06","94% AV Level Silver Plan","94.94%","0.953954458236694","Yes","Yes","No","100%",,"$0","$125","$0","$0","$0","$6","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$950","$950 per person","$1900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd2903","http://editiondigital.net/view/IU65/2016/ON_HIX_NH_KIT_2016","10"
"2016","NM","14417","SERFF","4","2015-08-25 12:56:34","3","14417","NM","Individual","Yes","75-1233841","14417NM0010006","Dentegra Dental PPO Family Basic Plan","14417NM001",,"NMN001","NMS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","14417NM0010006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","$80","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nm/14417nm0010006-16","4"
"2016","NM","14417","SERFF","4","2015-08-25 12:56:34","3","14417","NM","Individual","Yes","75-1233841","14417NM0010006","Dentegra Dental PPO Family Basic Plan","14417NM001",,"NMN001","NMS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","14417NM0010006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","$80","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nm/14417nm0010006-16","5"
"2016","NM","17911","SERFF","4","2015-08-25 12:56:34","1","17911","NM","Individual","Yes","47-0397286","17911NM0060001","Delta Dental Individual PPO, EHB Certified (Exchange)","17911NM006",,"NMN002","NMS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/17911","","17911NM0060001-01","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnm.com/NM_EHB_High_2016","http://www.deltadentalnm.com/NM_EHB_High_2016","4"
"2016","NM","17911","SERFF","4","2015-08-25 12:56:34","1","17911","NM","Individual","Yes","47-0397286","17911NM0060002","Delta Dental Individual PPO, EHB Certified (Exchange)","17911NM006",,"NMN002","NMS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$14.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/17911","","17911NM0060002-01","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnm.com/NM_EHB_Low_2016","http://www.deltadentalnm.com/NM_EHB_Low_2016","5"
"2016","NM","17911","SERFF","4","2015-08-25 12:56:34","2","17911","NM","Individual","Yes","47-0397286","17911NM0090001","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","17911NM009",,"NMN002","NMS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$28.99","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/17911","","17911NM0090001-01","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnm.com/NM_Ped_High_2016","http://www.deltadentalnm.com/NM_Ped_High_2016","4"
"2016","NM","17911","SERFF","4","2015-08-25 12:56:34","2","17911","NM","Individual","Yes","47-0397286","17911NM0090002","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","17911NM009",,"NMN002","NMS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$24.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/17911","","17911NM0090002-01","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalnm.com/NM_Ped_Low_2016","http://www.deltadentalnm.com/NM_Ped_Low_2016","5"
"2016","NM","19722","SERFF","5","2015-11-19 07:02:40","1","19722","NM","Individual","No","85-0408506","19722NM0010001","Molina Marketplace Gold Plan","19722NM001",,"NMN001","NMS001","NMF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency Service and Urgent Care Services are covered","Yes","Emergency Service and Urgent Care Services are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/nm/en/PDF/marketplace/formulary-2016.pdf","19722NM0010001-00","Standard Gold Off Exchange Plan",,"0.801033437252045","No","Yes","No","100%",,"$500","$240","$890","$150","$550","$770","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/marketplace/summary-of-benefits-gold-off-exchange-2016.pdf","http://www.molinahealthcare.com/nm/en/PDF/marketplace/brochure-2016.pdf","4"
"2016","NM","19722","SERFF","5","2015-11-19 07:02:40","1","19722","NM","Individual","No","85-0408506","19722NM0010001","Molina Marketplace Gold Plan","19722NM001",,"NMN001","NMS001","NMF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency Service and Urgent Care Services are covered","Yes","Emergency Service and Urgent Care Services are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/nm/en/PDF/marketplace/formulary-2016.pdf","19722NM0010001-01","Standard Gold On Exchange Plan",,"0.801033437252045","No","Yes","No","100%",,"$500","$240","$890","$150","$550","$770","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/marketplace/summary-of-benefits-gold-2016.pdf","http://www.molinahealthcare.com/nm/en/PDF/marketplace/brochure-2016.pdf","5"
"2016","NM","19722","SERFF","5","2015-11-19 07:02:40","1","19722","NM","Individual","No","85-0408506","19722NM0010001","Molina Marketplace Gold Plan","19722NM001",,"NMN001","NMS001","NMF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency Service and Urgent Care Services are covered","Yes","Emergency Service and Urgent Care Services are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/nm/en/PDF/marketplace/formulary-2016.pdf","19722NM0010001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/marketplace/summary-of-benefits-gold-aian-2016.pdf","http://www.molinahealthcare.com/nm/en/PDF/marketplace/brochure-2016.pdf","6"
"2016","NM","19722","SERFF","5","2015-11-19 07:02:40","1","19722","NM","Individual","No","85-0408506","19722NM0010001","Molina Marketplace Gold Plan","19722NM001",,"NMN001","NMS001","NMF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency Service and Urgent Care Services are covered","Yes","Emergency Service and Urgent Care Services are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/nm/en/PDF/marketplace/formulary-2016.pdf","19722NM0010001-03","Limited Cost Sharing Plan Variation",,"0.801033437252045","No","Yes","No","100%",,"$500","$240","$890","$150","$550","$770","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/nm/en/PDF/marketplace/summary-of-benefits-gold-2016.pdf","http://www.molinahealthcare.com/nm/en/PDF/marketplace/brochure-2016.pdf","7"
"2016","NM","19722","SERFF","5","2015-11-19 07:02:40","2","19722","NM","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver Plan","19722NM001",,"NMN001","NMS001","NMF002","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency Service and Urgent Care Services are covered","Yes","Emergency Service and Urgent Care Services are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/nm/en/PDF/marketplace/formulary-2016.pdf","19722NM0010002-00","Standard Silver Off Exchange Plan",,"0.714607775211334","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/marketplace/summary-of-benefits-silver-off-exchange-2016.pdf","http://www.molinahealthcare.com/nm/en/PDF/marketplace/brochure-2016.pdf","4"
"2016","NM","19722","SERFF","5","2015-11-19 07:02:40","2","19722","NM","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver Plan","19722NM001",,"NMN001","NMS001","NMF002","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency Service and Urgent Care Services are covered","Yes","Emergency Service and Urgent Care Services are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/nm/en/PDF/marketplace/formulary-2016.pdf","19722NM0010002-01","Standard Silver On Exchange Plan",,"0.714607775211334","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/marketplace/summary-of-benefits-silver-250-2016.pdf","http://www.molinahealthcare.com/nm/en/PDF/marketplace/brochure-2016.pdf","5"
"2016","NM","19722","SERFF","5","2015-11-19 07:02:40","2","19722","NM","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver Plan","19722NM001",,"NMN001","NMS001","NMF002","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency Service and Urgent Care Services are covered","Yes","Emergency Service and Urgent Care Services are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/nm/en/PDF/marketplace/formulary-2016.pdf","19722NM0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/marketplace/summary-of-benefits-silver-aian-2016.pdf","http://www.molinahealthcare.com/nm/en/PDF/marketplace/brochure-2016.pdf","6"
"2016","NM","19722","SERFF","5","2015-11-19 07:02:40","2","19722","NM","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver Plan","19722NM001",,"NMN001","NMS001","NMF002","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency Service and Urgent Care Services are covered","Yes","Emergency Service and Urgent Care Services are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/nm/en/PDF/marketplace/formulary-2016.pdf","19722NM0010002-03","Limited Cost Sharing Plan Variation",,"0.714607775211334","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/marketplace/summary-of-benefits-silver-250-2016.pdf","http://www.molinahealthcare.com/nm/en/PDF/marketplace/brochure-2016.pdf","7"
"2016","NM","19722","SERFF","5","2015-11-19 07:02:40","2","19722","NM","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver Plan","19722NM001",,"NMN001","NMS001","NMF002","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency Service and Urgent Care Services are covered","Yes","Emergency Service and Urgent Care Services are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/nm/en/PDF/marketplace/formulary-2016.pdf","19722NM0010002-04","73% AV Level Silver Plan",,"0.739822447299957","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/marketplace/summary-of-benefits-silver-200-2016.pdf","http://www.molinahealthcare.com/nm/en/PDF/marketplace/brochure-2016.pdf","8"
"2016","NM","19722","SERFF","5","2015-11-19 07:02:40","2","19722","NM","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver Plan","19722NM001",,"NMN001","NMS001","NMF002","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency Service and Urgent Care Services are covered","Yes","Emergency Service and Urgent Care Services are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/nm/en/PDF/marketplace/formulary-2016.pdf","19722NM0010002-05","87% AV Level Silver Plan",,"0.878527700901031","No","Yes","No","100%",,"$450","$180","$890","$150","$450","$320","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$450","$450 per person","$900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/marketplace/summary-of-benefits-silver-150-2016.pdf","http://www.molinahealthcare.com/nm/en/PDF/marketplace/brochure-2016.pdf","9"
"2016","NM","19722","SERFF","5","2015-11-19 07:02:40","2","19722","NM","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver Plan","19722NM001",,"NMN001","NMS001","NMF002","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency Service and Urgent Care Services are covered","Yes","Emergency Service and Urgent Care Services are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/nm/en/PDF/marketplace/formulary-2016.pdf","19722NM0010002-06","94% AV Level Silver Plan",,"0.947116374969482","No","Yes","No","100%",,"$0","$210","$450","$150","$0","$180","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/marketplace/summary-of-benefits-silver-100-2016.pdf","http://www.molinahealthcare.com/nm/en/PDF/marketplace/brochure-2016.pdf","10"
"2016","NM","19722","SERFF","5","2015-11-19 07:02:40","3","19722","NM","Individual","No","85-0408506","19722NM0010003","Molina Marketplace Bronze Plan","19722NM001",,"NMN001","NMS001","NMF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Emergency Service and Urgent Care Services are covered","Yes","Emergency Service and Urgent Care Services are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/nm/en/PDF/marketplace/formulary-2016.pdf","19722NM0010003-00","Standard Bronze Off Exchange Plan",,"0.618895947933197","Yes","Yes","No","100%",,"$5,000","$20","$90","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.molinahealthcare.com/members/nm/en-US/PDF/marketplace/summary-of-benefits-bronze-off-exchange-2016.pdf","http://www.molinahealthcare.com/nm/en/PDF/marketplace/brochure-2016.pdf","4"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0300001","Individual HMO Gold 1 w/Gym Membership","57173NM030",,"NMN001","NMS001","NMF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9933",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No",,"http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0300001-00","Standard Gold Off Exchange Plan",,"0.802715837955475","Yes","Yes","No","100%",,"$0","$300","$0","$0","$0","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","4"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0300001","Individual HMO Gold 1 w/Gym Membership","57173NM030",,"NMN001","NMS001","NMF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9933",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No",,"http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0300001-01","Standard Gold On Exchange Plan",,"0.802715837955475","Yes","Yes","No","100%",,"$0","$300","$0","$0","$0","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","5"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0300001","Individual HMO Gold 1 w/Gym Membership","57173NM030",,"NMN001","NMS001","NMF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9933",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No",,"http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0300001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","6"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0300001","Individual HMO Gold 1 w/Gym Membership","57173NM030",,"NMN001","NMS001","NMF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9933",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No",,"http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0300001-03","Limited Cost Sharing Plan Variation",,"0.802715837955475","Yes","Yes","No","100%",,"$0","$300","$0","$0","$0","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","7"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0300002","Individual HMO Gold 2 w/Gym Membership","57173NM030",,"NMN001","NMS001","NMF003","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9932",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0300002-00","Standard Gold Off Exchange Plan",,"0.812368750572205","Yes","Yes","No","100%",,"$1,000","$300","$0","$0","$1,000","$25","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","8"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0310005","Individual HMO Silver 5 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF010","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","36"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0310005","Individual HMO Silver 5 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF010","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310005-03","Limited Cost Sharing Plan Variation",,"0.709260225296021","Yes","Yes","No","100%",,"$750","$300","$0","$0","$750","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","37"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0310005","Individual HMO Silver 5 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF010","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310005-04","73% AV Level Silver Plan",,"0.737287223339081","Yes","Yes","No","100%",,"$700","$300","$0","$0","$700","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","38"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0310005","Individual HMO Silver 5 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF010","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310005-05","87% AV Level Silver Plan",,"0.875322103500366","Yes","Yes","No","100%",,"$0","$300","$0","$0","$0","$5","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","39"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0300002","Individual HMO Gold 2 w/Gym Membership","57173NM030",,"NMN001","NMS001","NMF003","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9932",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0300002-01","Standard Gold On Exchange Plan",,"0.812368750572205","Yes","Yes","No","100%",,"$1,000","$300","$0","$0","$1,000","$25","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","9"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0300002","Individual HMO Gold 2 w/Gym Membership","57173NM030",,"NMN001","NMS001","NMF003","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9932",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0300002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","10"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0300002","Individual HMO Gold 2 w/Gym Membership","57173NM030",,"NMN001","NMS001","NMF003","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9932",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0300002-03","Limited Cost Sharing Plan Variation",,"0.812368750572205","Yes","Yes","No","100%",,"$1,000","$300","$0","$0","$1,000","$25","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","11"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0300003","Individual HMO Gold 3 w/Gym Membership","57173NM030",,"NMN001","NMS001","NMF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.993",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0300003-00","Standard Gold Off Exchange Plan",,"0.819892704486847","Yes","Yes","No","100%",,"$1,000","$300","$0","$0","$1,000","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","12"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0300003","Individual HMO Gold 3 w/Gym Membership","57173NM030",,"NMN001","NMS001","NMF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.993",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0300003-01","Standard Gold On Exchange Plan",,"0.819892704486847","Yes","Yes","No","100%",,"$1,000","$300","$0","$0","$1,000","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","13"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0300003","Individual HMO Gold 3 w/Gym Membership","57173NM030",,"NMN001","NMS001","NMF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.993",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0300003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","14"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0300003","Individual HMO Gold 3 w/Gym Membership","57173NM030",,"NMN001","NMS001","NMF004","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.993",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0300003-03","Limited Cost Sharing Plan Variation",,"0.819892704486847","Yes","Yes","No","100%",,"$1,000","$300","$0","$0","$1,000","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,600","$3600 per person","$7200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","15"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0300004","Individual HMO Gold 4 w/Gym Membership","57173NM030",,"NMN001","NMS001","NMF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9931",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0300004-00","Standard Gold Off Exchange Plan",,"0.81766140460968","Yes","Yes","No","100%",,"$500","$300","$0","$0","$500","$30","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","16"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0300004","Individual HMO Gold 4 w/Gym Membership","57173NM030",,"NMN001","NMS001","NMF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9931",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0300004-01","Standard Gold On Exchange Plan",,"0.81766140460968","Yes","Yes","No","100%",,"$500","$300","$0","$0","$500","$30","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","17"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0300004","Individual HMO Gold 4 w/Gym Membership","57173NM030",,"NMN001","NMS001","NMF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9931",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0300004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","18"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0300004","Individual HMO Gold 4 w/Gym Membership","57173NM030",,"NMN001","NMS001","NMF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9931",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0300004-03","Limited Cost Sharing Plan Variation",,"0.81766140460968","Yes","Yes","No","100%",,"$500","$300","$0","$0","$500","$30","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","19"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0310003","Individual HMO Silver 3 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF008","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9914",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310003-00","Standard Silver Off Exchange Plan",,"0.719592034816742","Yes","Yes","No","100%",,"$3,000","$300","$0","$0","$3,000","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","20"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0310003","Individual HMO Silver 3 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF008","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9914",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310003-01","Standard Silver On Exchange Plan",,"0.719592034816742","Yes","Yes","No","100%",,"$3,000","$300","$0","$0","$3,000","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","21"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0310003","Individual HMO Silver 3 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF008","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9914",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","22"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0310003","Individual HMO Silver 3 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF008","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9914",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310003-03","Limited Cost Sharing Plan Variation",,"0.719592034816742","Yes","Yes","No","100%",,"$3,000","$300","$0","$0","$3,000","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","23"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0310003","Individual HMO Silver 3 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF008","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9914",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310003-04","73% AV Level Silver Plan",,"0.739888429641724","Yes","Yes","No","100%",,"$3,000","$300","$0","$0","$3,000","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","24"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0310003","Individual HMO Silver 3 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF008","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9914",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310003-05","87% AV Level Silver Plan",,"0.875901460647583","Yes","Yes","No","100%",,"$1,200","$300","$0","$0","$1,200","$5","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","25"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0310003","Individual HMO Silver 3 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF008","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9914",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310003-06","94% AV Level Silver Plan",,"0.939547777175903","Yes","Yes","No","100%",,"$0","$300","$0","$0","$0","$5","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","26"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0310004","Individual HMO Silver 4 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF009","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9911",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310004-04","73% AV Level Silver Plan",,"0.739914000034332","Yes","Yes","No","100%",,"$5,000","$300","$0","$0","$5,000","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","31"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0170001","New Mexico Silver LD","72034NM017",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0170001-01","Standard Silver On Exchange Plan",,"0.710015058517456","Yes","Yes","No","100%",,"$3,000","$400","$0","$0","$1,000","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","28"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0170001","New Mexico Silver LD","72034NM017",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0170001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","29"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0170001","New Mexico Silver LD","72034NM017",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0170001-03","Limited Cost Sharing Plan Variation",,"0.710015058517456","Yes","Yes","No","100%",,"$3,000","$400","$0","$0","$1,000","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","30"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0170001","New Mexico Silver LD","72034NM017",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0170001-04","73% AV Level Silver Plan",,"0.738848507404327","Yes","Yes","No","100%",,"$3,000","$300","$0","$0","$1,000","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","31"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0170001","New Mexico Silver LD","72034NM017",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0170001-05","87% AV Level Silver Plan",,"0.878548920154572","Yes","Yes","No","100%",,"$500","$200","$0","$0","$500","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","32"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0170001","New Mexico Silver LD","72034NM017",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0170001-06","94% AV Level Silver Plan",,"0.948130488395691","Yes","Yes","No","100%",,"$0","$200","$0","$0","$0","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","33"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0180001","New Mexico Silver SLD","72034NM018",,"NMN001","NMS001","NMF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0180001-00","Standard Silver Off Exchange Plan",,"0.710015058517456","Yes","Yes","No","100%",,"$3,000","$400","$0","$0","$1,000","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","34"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0180001","New Mexico Silver SLD","72034NM018",,"NMN001","NMS001","NMF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0180001-01","Standard Silver On Exchange Plan",,"0.710015058517456","Yes","Yes","No","100%",,"$3,000","$400","$0","$0","$1,000","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","35"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0310004","Individual HMO Silver 4 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF009","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9911",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310004-05","87% AV Level Silver Plan",,"0.875901460647583","Yes","Yes","No","100%",,"$1,200","$300","$0","$0","$1,200","$5","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","32"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0310004","Individual HMO Silver 4 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF009","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9911",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310004-06","94% AV Level Silver Plan",,"0.939547777175903","Yes","Yes","No","100%",,"$0","$300","$0","$0","$0","$5","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","33"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0310005","Individual HMO Silver 5 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF010","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310005-00","Standard Silver Off Exchange Plan",,"0.709260225296021","Yes","Yes","No","100%",,"$750","$300","$0","$0","$750","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","34"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0310005","Individual HMO Silver 5 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF010","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310005-01","Standard Silver On Exchange Plan",,"0.709260225296021","Yes","Yes","No","100%",,"$750","$300","$0","$0","$750","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","35"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0310005","Individual HMO Silver 5 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF010","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9929",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310005-06","94% AV Level Silver Plan",,"0.933078467845917","Yes","Yes","No","100%",,"$0","$300","$0","$0","$0","$5","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","40"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0320001","Individual HMO Bronze 1 w/Gym Membership","57173NM032",,"NMN001","NMS001","NMF006","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9893",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0320001-00","Standard Bronze Off Exchange Plan",,"0.61950296163559","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","41"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0320001","Individual HMO Bronze 1 w/Gym Membership","57173NM032",,"NMN001","NMS001","NMF006","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9893",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0320001-01","Standard Bronze On Exchange Plan",,"0.61950296163559","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","42"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0010001","New Mexico Bronze HD","72034NM001",,"NMN001","NMS002","NMF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0010001-00","Standard Bronze Off Exchange Plan",,"0.606248557567596","Yes","Yes","No","100%",,"$5,800","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","8"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0010001","New Mexico Bronze HD","72034NM001",,"NMN001","NMS002","NMF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0010001-01","Standard Bronze On Exchange Plan",,"0.606248557567596","Yes","Yes","No","100%",,"$5,800","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","9"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0010001","New Mexico Bronze HD","72034NM001",,"NMN001","NMS002","NMF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0010001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","10"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0010001","New Mexico Bronze HD","72034NM001",,"NMN001","NMS002","NMF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0010001-03","Limited Cost Sharing Plan Variation",,"0.606248557567596","Yes","Yes","No","100%",,"$5,800","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","11"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0030001","New Mexico Bronze LD","72034NM003",,"NMN001","NMS002","NMF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0030001-00","Standard Bronze Off Exchange Plan",,"0.615943133831024","Yes","Yes","No","100%",,"$5,600","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","12"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0030001","New Mexico Bronze LD","72034NM003",,"NMN001","NMS002","NMF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0030001-01","Standard Bronze On Exchange Plan",,"0.615943133831024","Yes","Yes","No","100%",,"$5,600","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","13"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0320001","Individual HMO Bronze 1 w/Gym Membership","57173NM032",,"NMN001","NMS001","NMF006","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9893",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0320001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","43"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0320001","Individual HMO Bronze 1 w/Gym Membership","57173NM032",,"NMN001","NMS001","NMF006","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9893",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0320001-03","Limited Cost Sharing Plan Variation",,"0.61950296163559","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","44"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0340001","Individual Catastrophic HMO w/Gym Membership","57173NM034",,"NMN001","NMS001","NMF006","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0340001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","45"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0340001","Individual Catastrophic HMO w/Gym Membership","57173NM034",,"NMN001","NMS001","NMF006","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0340001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","46"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0200001","Individual HMO Platinum w/Gym Membership","57173NM020",,"NMN001","NMS001","NMF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9941",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0200001-00","Standard Platinum Off Exchange Plan",,"0.903859257698059","Yes","Yes","No","100%",,"$100","$300","$0","$0","$100","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","47"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0200001","Individual HMO Platinum w/Gym Membership","57173NM020",,"NMN001","NMS001","NMF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9941",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0200001-01","Standard Platinum On Exchange Plan",,"0.903859257698059","Yes","Yes","No","100%",,"$100","$300","$0","$0","$100","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","48"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0200001","Individual HMO Platinum w/Gym Membership","57173NM020",,"NMN001","NMS001","NMF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9941",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0200001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","49"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","1","57173","NM","Individual","No","94-3037165","57173NM0200001","Individual HMO Platinum w/Gym Membership","57173NM020",,"NMN001","NMS001","NMF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9941",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0200001-03","Limited Cost Sharing Plan Variation",,"0.903859257698059","Yes","Yes","No","100%",,"$100","$300","$0","$0","$100","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","50"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","2","57173","NM","Individual","No","94-3037165","57173NM0310001","Individual HMO HDHP Silver 1 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310001-00","Standard Silver Off Exchange Plan",,"0.716870069503784","Yes","Yes","No","100%",,"$3,400","$0","$0","$0","$3,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","4"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","2","57173","NM","Individual","No","94-3037165","57173NM0310001","Individual HMO HDHP Silver 1 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310001-01","Standard Silver On Exchange Plan",,"0.716870069503784","Yes","Yes","No","100%",,"$3,400","$0","$0","$0","$3,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","5"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","2","57173","NM","Individual","No","94-3037165","57173NM0310001","Individual HMO HDHP Silver 1 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","6"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","2","57173","NM","Individual","No","94-3037165","57173NM0310001","Individual HMO HDHP Silver 1 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310001-03","Limited Cost Sharing Plan Variation",,"0.716870069503784","Yes","Yes","No","100%",,"$3,400","$0","$0","$0","$3,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,400","$3400 per person","$6800 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","7"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","2","57173","NM","Individual","No","94-3037165","57173NM0310001","Individual HMO HDHP Silver 1 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310001-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","8"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","2","57173","NM","Individual","No","94-3037165","57173NM0310001","Individual HMO HDHP Silver 1 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310001-05","87% AV Level Silver Plan",,"0.870122313499451","Yes","Yes","No","100%",,"$1,200","$0","$0","$0","$1,200","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","9"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","2","57173","NM","Individual","No","94-3037165","57173NM0310001","Individual HMO HDHP Silver 1 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF006","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9922",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310001-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$0","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","10"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","2","57173","NM","Individual","No","94-3037165","57173NM0310002","Individual HMO HDHP Silver 2 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF007","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9917",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310002-00","Standard Silver Off Exchange Plan",,"0.704806685447693","Yes","Yes","No","100%",,"$1,400","$0","$0","$0","$1,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","per person not applicable","$2800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","11"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","2","57173","NM","Individual","No","94-3037165","57173NM0310002","Individual HMO HDHP Silver 2 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF007","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9917",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310002-01","Standard Silver On Exchange Plan",,"0.704806685447693","Yes","Yes","No","100%",,"$1,400","$0","$0","$0","$1,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","per person not applicable","$2800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","12"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","2","57173","NM","Individual","No","94-3037165","57173NM0310002","Individual HMO HDHP Silver 2 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF007","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9917",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","13"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","2","57173","NM","Individual","No","94-3037165","57173NM0310002","Individual HMO HDHP Silver 2 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF007","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9917",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310002-03","Limited Cost Sharing Plan Variation",,"0.704806685447693","Yes","Yes","No","100%",,"$1,400","$0","$0","$0","$1,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","per person not applicable","$2800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","14"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","2","57173","NM","Individual","No","94-3037165","57173NM0310002","Individual HMO HDHP Silver 2 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF007","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9917",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310002-04","73% AV Level Silver Plan",,"0.726016759872437","Yes","Yes","No","100%",,"$1,200","$0","$0","$0","$1,200","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","per person not applicable","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","per person not applicable","$2400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","15"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","2","57173","NM","Individual","No","94-3037165","57173NM0310002","Individual HMO HDHP Silver 2 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF007","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9917",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310002-05","87% AV Level Silver Plan",,"0.870122313499451","Yes","Yes","No","100%",,"$1,200","$0","$0","$0","$1,200","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","per person not applicable","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","per person not applicable","$2400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","16"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","2","57173","NM","Individual","No","94-3037165","57173NM0310002","Individual HMO HDHP Silver 2 w/Gym Membership","57173NM031",,"NMN001","NMS001","NMF007","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9917",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0310002-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$0","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","17"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","2","57173","NM","Individual","No","94-3037165","57173NM0320002","Individual HMO HDHP Bronze 2 w/Gym Membership","57173NM032",,"NMN001","NMS001","NMF011","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9903",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0320002-00","Standard Bronze Off Exchange Plan",,"0.618900716304779","Yes","Yes","No","100%",,"$3,250","$0","$0","$0","$3,250","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","18"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","2","57173","NM","Individual","No","94-3037165","57173NM0320002","Individual HMO HDHP Bronze 2 w/Gym Membership","57173NM032",,"NMN001","NMS001","NMF011","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9903",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0320002-01","Standard Bronze On Exchange Plan",,"0.618900716304779","Yes","Yes","No","100%",,"$3,250","$0","$0","$0","$3,250","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","19"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","2","57173","NM","Individual","No","94-3037165","57173NM0320002","Individual HMO HDHP Bronze 2 w/Gym Membership","57173NM032",,"NMN001","NMS001","NMF011","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9903",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0320002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","20"
"2016","NM","57173","SERFF","8","2016-01-27 11:15:49","2","57173","NM","Individual","No","94-3037165","57173NM0320002","Individual HMO HDHP Bronze 2 w/Gym Membership","57173NM032",,"NMN001","NMS001","NMF011","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol","0.9903",,,,"0","0","0","2016-01-01",,"Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","Yes","Emergency and Non-Emergency whe Prior Authorization is obtained.","No","https://prescoverage.phs.org/sps/prescoverage/saml20/login","http://docs.phs.org/idc/groups/public/documents/communication/pel_00199172.pdf","57173NM0320002-03","Limited Cost Sharing Plan Variation",,"0.618900716304779","Yes","Yes","No","100%",,"$3,250","$0","$0","$0","$3,250","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","$3250 per person","$6500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","https://www.phs.org/tools-resources/member/Pages/forms-and-documents.aspx","21"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0060001","New Mexico Catastrophic","72034NM006",,"NMN001","NMS002","NMF001","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0060001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","4"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0060001","New Mexico Catastrophic","72034NM006",,"NMN001","NMS002","NMF001","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0060001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","5"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0050001","New Mexico Catastrophic S","72034NM005",,"NMN001","NMS001","NMF001","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0050001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","6"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0050001","New Mexico Catastrophic S","72034NM005",,"NMN001","NMS001","NMF001","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0050001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$5,400","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","7"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0030001","New Mexico Bronze LD","72034NM003",,"NMN001","NMS002","NMF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0030001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","14"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0030001","New Mexico Bronze LD","72034NM003",,"NMN001","NMS002","NMF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0030001-03","Limited Cost Sharing Plan Variation",,"0.615943133831024","Yes","Yes","No","100%",,"$5,600","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","15"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0040001","New Mexico Bronze SLD","72034NM004",,"NMN001","NMS001","NMF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0040001-00","Standard Bronze Off Exchange Plan",,"0.615943133831024","Yes","Yes","No","100%",,"$5,600","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","16"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0040001","New Mexico Bronze SLD","72034NM004",,"NMN001","NMS001","NMF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0040001-01","Standard Bronze On Exchange Plan",,"0.615943133831024","Yes","Yes","No","100%",,"$5,600","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","17"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0040001","New Mexico Bronze SLD","72034NM004",,"NMN001","NMS001","NMF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0040001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","18"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0040001","New Mexico Bronze SLD","72034NM004",,"NMN001","NMS001","NMF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0040001-03","Limited Cost Sharing Plan Variation",,"0.615943133831024","Yes","Yes","No","100%",,"$5,600","$1,000","$0","$0","$1,300","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","19"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0130001","New Mexico Silver HD","72034NM013",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0130001-00","Standard Silver Off Exchange Plan",,"0.68300187587738","Yes","Yes","No","100%",,"$5,000","$400","$0","$0","$1,200","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","20"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0130001","New Mexico Silver HD","72034NM013",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0130001-01","Standard Silver On Exchange Plan",,"0.68300187587738","Yes","Yes","No","100%",,"$5,000","$400","$0","$0","$1,200","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","21"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0130001","New Mexico Silver HD","72034NM013",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0130001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","22"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0130001","New Mexico Silver HD","72034NM013",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0130001-03","Limited Cost Sharing Plan Variation",,"0.68300187587738","Yes","Yes","No","100%",,"$5,000","$400","$0","$0","$1,200","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","23"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0130001","New Mexico Silver HD","72034NM013",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0130001-04","73% AV Level Silver Plan",,"0.730326414108276","Yes","Yes","No","100%",,"$3,000","$300","$0","$0","$1,200","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","24"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0130001","New Mexico Silver HD","72034NM013",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0130001-05","87% AV Level Silver Plan",,"0.878548920154572","Yes","Yes","No","100%",,"$500","$200","$0","$0","$500","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","25"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0130001","New Mexico Silver HD","72034NM013",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0130001-06","94% AV Level Silver Plan",,"0.948130488395691","Yes","Yes","No","100%",,"$0","$200","$0","$0","$0","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","26"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0170001","New Mexico Silver LD","72034NM017",,"NMN001","NMS002","NMF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0170001-00","Standard Silver Off Exchange Plan",,"0.710015058517456","Yes","Yes","No","100%",,"$3,000","$400","$0","$0","$1,000","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","27"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0180001","New Mexico Silver SLD","72034NM018",,"NMN001","NMS001","NMF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0180001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","36"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0180001","New Mexico Silver SLD","72034NM018",,"NMN001","NMS001","NMF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0180001-03","Limited Cost Sharing Plan Variation",,"0.710015058517456","Yes","Yes","No","100%",,"$3,000","$400","$0","$0","$1,000","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","37"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0180001","New Mexico Silver SLD","72034NM018",,"NMN001","NMS001","NMF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0180001-04","73% AV Level Silver Plan",,"0.738848507404327","Yes","Yes","No","100%",,"$3,000","$300","$0","$0","$1,000","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","38"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0180001","New Mexico Silver SLD","72034NM018",,"NMN001","NMS001","NMF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0180001-05","87% AV Level Silver Plan",,"0.878548920154572","Yes","Yes","No","100%",,"$500","$200","$0","$0","$500","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","39"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0180001","New Mexico Silver SLD","72034NM018",,"NMN001","NMS001","NMF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0180001-06","94% AV Level Silver Plan",,"0.948130488395691","Yes","Yes","No","100%",,"$0","$200","$0","$0","$0","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","40"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0070001","New Mexico Gold HD","72034NM007",,"NMN001","NMS002","NMF004","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0070001-00","Standard Gold Off Exchange Plan",,"0.799455106258392","Yes","Yes","No","100%",,"$2,500","$300","$0","$0","$1,200","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","41"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0070001","New Mexico Gold HD","72034NM007",,"NMN001","NMS002","NMF004","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0070001-01","Standard Gold On Exchange Plan",,"0.799455106258392","Yes","Yes","No","100%",,"$2,500","$300","$0","$0","$1,200","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","42"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0070001","New Mexico Gold HD","72034NM007",,"NMN001","NMS002","NMF004","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0070001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","43"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0070001","New Mexico Gold HD","72034NM007",,"NMN001","NMS002","NMF004","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0070001-03","Limited Cost Sharing Plan Variation",,"0.799455106258392","Yes","Yes","No","100%",,"$2,500","$300","$0","$0","$1,200","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","44"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0080001","New Mexico Gold LD","72034NM008",,"NMN001","NMS002","NMF004","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0080001-00","Standard Gold Off Exchange Plan",,"0.803979277610779","Yes","Yes","No","100%",,"$1,500","$300","$0","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","45"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0080001","New Mexico Gold LD","72034NM008",,"NMN001","NMS002","NMF004","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0080001-01","Standard Gold On Exchange Plan",,"0.803979277610779","Yes","Yes","No","100%",,"$1,500","$300","$0","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","46"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0080001","New Mexico Gold LD","72034NM008",,"NMN001","NMS002","NMF004","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0080001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","47"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0080001","New Mexico Gold LD","72034NM008",,"NMN001","NMS002","NMF004","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0080001-03","Limited Cost Sharing Plan Variation",,"0.803979277610779","Yes","Yes","No","100%",,"$1,500","$300","$0","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","48"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0090001","New Mexico Gold SLD","72034NM009",,"NMN001","NMS001","NMF004","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0090001-00","Standard Gold Off Exchange Plan",,"0.803979277610779","Yes","Yes","No","100%",,"$1,500","$300","$0","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","49"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0090001","New Mexico Gold SLD","72034NM009",,"NMN001","NMS001","NMF004","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0090001-01","Standard Gold On Exchange Plan",,"0.803979277610779","Yes","Yes","No","100%",,"$1,500","$300","$0","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","50"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0090001","New Mexico Gold SLD","72034NM009",,"NMN001","NMS001","NMF004","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0090001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","51"
"2016","NM","72034","SERFF","3","2015-08-25 12:56:34","1","72034","NM","Individual","No","45-2106295","72034NM0090001","New Mexico Gold SLD","72034NM009",,"NMN001","NMS001","NMF004","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Sevices Only","No",,"No","http://www.christushealthplan.org/payment","www.christushealthplan.org","72034NM0090001-03","Limited Cost Sharing Plan Variation",,"0.803979277610779","Yes","Yes","No","100%",,"$1,500","$300","$0","$0","$1,000","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.christushealthplan.org/summaryofbenefitsnewmexico2016","http://www.christushealthplan.org/health-insurance-exchange-plan-information","52"
"2016","NM","75605","SERFF","8","2015-08-27 03:52:03","1","75605","NM","Individual","Yes","36-1236610","75605NM0430001","BlueCare Dental? 1A","75605NM043",,"NMN004","NMS004",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430001-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf","http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf","4"
"2016","NM","75605","SERFF","8","2015-08-27 03:52:03","1","75605","NM","Individual","Yes","36-1236610","75605NM0430001","BlueCare Dental? 1A","75605NM043",,"NMN004","NMS004",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430001-01","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf","http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf","5"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","7","93091","NM","Individual","No","45-1294709","93091NM0010009","Care Connect Silver HMO","93091NM001",,"NMN001","NMS006","NMF006","New","HMO","Silver","Yes","Both","No","No",,,"$64.48","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010009-01","Standard Silver On Exchange Plan","68.14%","0.707243800163269","Yes","Yes","No","100%",,"$4,020","$0","$1,090","$150","$1,030","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","5"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","7","93091","NM","Individual","No","45-1294709","93091NM0010009","Care Connect Silver HMO","93091NM001",,"NMN001","NMS006","NMF006","New","HMO","Silver","Yes","Both","No","No",,,"$64.48","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-$0-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","6"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","7","93091","NM","Individual","No","45-1294709","93091NM0010009","Care Connect Silver HMO","93091NM001",,"NMN001","NMS006","NMF006","New","HMO","Silver","Yes","Both","No","No",,,"$64.48","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010009-03","Limited Cost Sharing Plan Variation","68.14%","0.707243800163269","Yes","Yes","No","100%",,"$4,020","$0","$1,090","$150","$1,030","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-limited-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","7"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","7","93091","NM","Individual","No","45-1294709","93091NM0010009","Care Connect Silver HMO","93091NM001",,"NMN001","NMS006","NMF006","New","HMO","Silver","Yes","Both","No","No",,,"$64.48","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010009-04","73% AV Level Silver Plan","72.26%","0.753997445106506","Yes","Yes","No","100%",,"$2,500","$20","$1,270","$150","$2,500","$420","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-73%-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","8"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","7","93091","NM","Individual","No","45-1294709","93091NM0010009","Care Connect Silver HMO","93091NM001",,"NMN001","NMS006","NMF006","New","HMO","Silver","Yes","Both","No","No",,,"$64.48","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010009-05","87% AV Level Silver Plan","87.63%","0.88040429353714","Yes","Yes","No","100%",,"$500","$70","$1,340","$150","$500","$980","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-87%-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","9"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","7","93091","NM","Individual","No","45-1294709","93091NM0010009","Care Connect Silver HMO","93091NM001",,"NMN001","NMS006","NMF006","New","HMO","Silver","Yes","Both","No","No",,,"$64.48","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010009-06","94% AV Level Silver Plan","93.94%","0.935176372528076","Yes","Yes","No","100%",,"$100","$40","$890","$150","$100","$890","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-94%-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","10"
"2016","NV","12553","SERFF","5","2015-09-24 06:32:24","2","12553","NV","Individual","Yes","75-1233841","12553NV0010004","Delta Dental PPO Preferred Plan for Families","12553NV001",,"NVN001","NVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.17","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","12553NV0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/12553nv0010004-16","4"
"2016","NV","12553","SERFF","5","2015-09-24 06:32:24","2","12553","NV","SHOP (Small Group)","Yes","75-1233841","12553NV0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","12553NV002",,"NVN001","NVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.78","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","12553NV0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/12553nv0020004-16","4"
"2016","NV","12553","SERFF","5","2015-09-24 06:32:24","2","12553","NV","SHOP (Small Group)","Yes","75-1233841","12553NV0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","12553NV002",,"NVN001","NVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.78","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","12553NV0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/12553nv0020004-16","5"
"2016","NV","12553","SERFF","5","2015-09-24 06:32:24","2","12553","NV","Individual","Yes","75-1233841","12553NV0010004","Delta Dental PPO Preferred Plan for Families","12553NV001",,"NVN001","NVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.17","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","12553NV0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/12553nv0010004-16","5"
"2016","NV","12553","SERFF","5","2015-09-24 06:32:24","3","12553","NV","Individual","Yes","75-1233841","12553NV0010006","Delta Dental PPO Basic Plan for Families","12553NV001",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.74","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","12553NV0010006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/12553nv0010006-16","4"
"2016","NV","12553","SERFF","5","2015-09-24 06:32:24","3","12553","NV","SHOP (Small Group)","Yes","75-1233841","12553NV0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","12553NV002",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","12553NV0020006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/12553nv0020006-16","4"
"2016","NM","75605","SERFF","8","2015-08-27 03:52:03","2","75605","NM","Individual","Yes","36-1236610","75605NM0430003","BlueCare Dental 4 Kids? 1A","75605NM043",,"NMN004","NMS004",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$33.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430003-00","Standard High Off Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf","http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf","4"
"2016","NM","75605","SERFF","8","2015-08-27 03:52:03","2","75605","NM","Individual","Yes","36-1236610","75605NM0430003","BlueCare Dental 4 Kids? 1A","75605NM043",,"NMN004","NMS004",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$33.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430003-01","Standard High On Exchange Plan","84.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf","http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf","5"
"2016","NM","75605","SERFF","8","2015-08-27 03:52:03","3","75605","NM","Individual","Yes","36-1236610","75605NM0430002","BlueCare Dental? 1B","75605NM043",,"NMN004","NMS004",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.86","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430002-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf","http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf","4"
"2016","NM","75605","SERFF","8","2015-08-27 03:52:03","3","75605","NM","Individual","Yes","36-1236610","75605NM0430002","BlueCare Dental? 1B","75605NM043",,"NMN004","NMS004",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.86","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430002-01","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf","http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf","5"
"2016","NM","75605","SERFF","8","2015-08-27 03:52:03","4","75605","NM","Individual","Yes","36-1236610","75605NM0430004","BlueCare Dental 4 Kids? 1B","75605NM043",,"NMN004","NMS004",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$26.86","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430004-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf","http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf","4"
"2016","NM","75605","SERFF","8","2015-08-27 03:52:03","4","75605","NM","Individual","Yes","36-1236610","75605NM0430004","BlueCare Dental 4 Kids? 1B","75605NM043",,"NMN004","NMS004",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$26.86","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","https://retailweb.hcsc.net/retailshoppingcart/NM/exchange_referred","","75605NM0430004-01","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf","http://www.bcbsnm.com/pdf/bluecare-dental-individuals-and-families-nm.pdf","5"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","1","93091","NM","Individual","No","45-1294709","93091NM0170001","Healthy Connect Gold HMO","93091NM017",,"NMN001","NMS006","NMF004","Existing","HMO","Gold","Yes","Both","No","No",,,"$41.24","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9952",,,,"0","3","0","2016-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0170001-00","Standard Gold Off Exchange Plan","79.66%","0.824126839637756","Yes","Yes","No","100%",,"$1,000","$210","$890","$150","$1,000","$480","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/healthy-connect-gold-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","4"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","1","93091","NM","Individual","No","45-1294709","93091NM0170001","Healthy Connect Gold HMO","93091NM017",,"NMN001","NMS006","NMF004","Existing","HMO","Gold","Yes","Both","No","No",,,"$41.24","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9952",,,,"0","3","0","2016-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0170001-01","Standard Gold On Exchange Plan","79.66%","0.824126839637756","Yes","Yes","No","100%",,"$1,000","$210","$890","$150","$1,000","$480","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/healthy-connect-gold-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","5"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","1","93091","NM","Individual","No","45-1294709","93091NM0170001","Healthy Connect Gold HMO","93091NM017",,"NMN001","NMS006","NMF004","Existing","HMO","Gold","Yes","Both","No","No",,,"$41.24","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9952",,,,"0","3","0","2016-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0170001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://mynmhc.org/healthy-connect-gold-$0-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","6"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","1","93091","NM","Individual","No","45-1294709","93091NM0170001","Healthy Connect Gold HMO","93091NM017",,"NMN001","NMS006","NMF004","Existing","HMO","Gold","Yes","Both","No","No",,,"$41.24","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9952",,,,"0","3","0","2016-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0170001-03","Limited Cost Sharing Plan Variation","79.66%","0.824126839637756","Yes","Yes","No","100%",,"$1,000","$210","$890","$150","$1,000","$480","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/healthy-connect-gold-limited-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","7"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","1","93091","NM","Individual","No","45-1294709","93091NM0170003","Healthy Connect Bronze HMO","93091NM017",,"NMN001","NMS006","NMF005","Existing","HMO","Bronze","Yes","Both","No","No",,,"$78.75","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9952",,,,"0","3","0","2016-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0170003-00","Standard Bronze Off Exchange Plan","61.80%","0.617875099182129","Yes","Yes","No","100%",,"$5,500","$0","$630","$150","$1,010","$0","$1,420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/healthy-connect-bronze-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","8"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","1","93091","NM","Individual","No","45-1294709","93091NM0170003","Healthy Connect Bronze HMO","93091NM017",,"NMN001","NMS006","NMF005","Existing","HMO","Bronze","Yes","Both","No","No",,,"$78.75","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9952",,,,"0","3","0","2016-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0170003-01","Standard Bronze On Exchange Plan","61.80%","0.617875099182129","Yes","Yes","No","100%",,"$5,500","$0","$630","$150","$1,010","$0","$1,420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/healthy-connect-bronze-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","9"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","1","93091","NM","Individual","No","45-1294709","93091NM0170003","Healthy Connect Bronze HMO","93091NM017",,"NMN001","NMS006","NMF005","Existing","HMO","Bronze","Yes","Both","No","No",,,"$78.75","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9952",,,,"0","3","0","2016-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0170003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://mynmhc.org/healthy-connect-bronze-$0-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","10"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","1","93091","NM","Individual","No","45-1294709","93091NM0170003","Healthy Connect Bronze HMO","93091NM017",,"NMN001","NMS006","NMF005","Existing","HMO","Bronze","Yes","Both","No","No",,,"$78.75","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9952",,,,"0","3","0","2016-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0170003-03","Limited Cost Sharing Plan Variation","61.80%","0.617875099182129","Yes","Yes","No","100%",,"$5,500","$0","$630","$150","$1,010","$0","$1,420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/healthy-connect-bronze-limited-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","11"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","2","93091","NM","Individual","No","45-1294709","93091NM0010001","Care Connect Gold HMO","93091NM001",,"NMN001","NMS006","NMF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$39.70","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9962",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010001-00","Standard Gold Off Exchange Plan","78.30%","0.812783002853394","Yes","Yes","No","100%",,"$750","$1,230","$0","$150","$750","$800","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-gold-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","4"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","2","93091","NM","Individual","No","45-1294709","93091NM0010001","Care Connect Gold HMO","93091NM001",,"NMN001","NMS006","NMF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$39.70","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9962",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010001-01","Standard Gold On Exchange Plan","78.30%","0.812783002853394","Yes","Yes","No","100%",,"$750","$1,230","$0","$150","$750","$800","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-gold-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","5"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","2","93091","NM","Individual","No","45-1294709","93091NM0010001","Care Connect Gold HMO","93091NM001",,"NMN001","NMS006","NMF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$39.70","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9962",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://mynmhc.org/care-connect-gold-$0-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","6"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","2","93091","NM","Individual","No","45-1294709","93091NM0010001","Care Connect Gold HMO","93091NM001",,"NMN001","NMS006","NMF002","Existing","HMO","Gold","Yes","Both","No","No",,,"$39.70","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9962",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010001-03","Limited Cost Sharing Plan Variation","78.30%","0.812783002853394","Yes","Yes","No","100%",,"$750","$1,230","$0","$150","$750","$800","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-gold-limited-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","7"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","2","93091","NM","Individual","No","45-1294709","93091NM0010002","Care Connect Silver Plus HMO","93091NM001",,"NMN001","NMS006","NMF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$49.52","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9957",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010002-00","Standard Silver Off Exchange Plan","70.00%","0.726377129554749","Yes","Yes","No","100%",,"$2,000","$2,720","$0","$150","$2,000","$800","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-plus-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","8"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","2","93091","NM","Individual","No","45-1294709","93091NM0010002","Care Connect Silver Plus HMO","93091NM001",,"NMN001","NMS006","NMF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$49.52","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9957",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010002-01","Standard Silver On Exchange Plan","70.00%","0.726377129554749","Yes","Yes","No","100%",,"$2,000","$2,720","$0","$150","$2,000","$800","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-plus-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","9"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","2","93091","NM","Individual","No","45-1294709","93091NM0010002","Care Connect Silver Plus HMO","93091NM001",,"NMN001","NMS006","NMF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$49.52","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9957",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://mynmhc.org/care-connect-silver-plus-$0-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","10"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","2","93091","NM","Individual","No","45-1294709","93091NM0010002","Care Connect Silver Plus HMO","93091NM001",,"NMN001","NMS006","NMF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$49.52","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9957",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010002-03","Limited Cost Sharing Plan Variation","70.00%","0.726377129554749","Yes","Yes","No","100%",,"$2,000","$2,720","$0","$150","$2,000","$800","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-plus-limited-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","11"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","2","93091","NM","Individual","No","45-1294709","93091NM0010002","Care Connect Silver Plus HMO","93091NM001",,"NMN001","NMS006","NMF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$49.52","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9957",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010002-04","73% AV Level Silver Plan","73.54%","0.765525817871094","Yes","Yes","No","100%",,"$1,750","$2,220","$0","$150","$1,750","$880","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-plus-73%-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","12"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","2","93091","NM","Individual","No","45-1294709","93091NM0010002","Care Connect Silver Plus HMO","93091NM001",,"NMN001","NMS006","NMF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$49.52","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9957",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010002-05","87% AV Level Silver Plan","86.92%","0.882957994937897","Yes","Yes","No","100%",,"$500","$350","$0","$150","$500","$690","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-plus-87%-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","13"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","2","93091","NM","Individual","No","45-1294709","93091NM0010002","Care Connect Silver Plus HMO","93091NM001",,"NMN001","NMS006","NMF008","Existing","HMO","Silver","Yes","Both","No","No",,,"$49.52","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9957",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010002-06","94% AV Level Silver Plan","94.22%","0.956483840942383","Yes","Yes","No","100%",,"$0","$130","$0","$150","$0","$50","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-plus-94%-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","14"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","4","16698","NV","Individual","No","88-0293082","16698NV0450004","Prominence Health Plan Silver 10 Premier","16698NV045",,"NVN001","NVS001","NVF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450004-04","73% AV Level Silver Plan",,"0.734999418258667","No","Yes","No","100%",,"$0","$1,490","$0","$150","$0","$1,570","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","8"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","4","16698","NV","Individual","No","88-0293082","16698NV0450004","Prominence Health Plan Silver 10 Premier","16698NV045",,"NVN001","NVS001","NVF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450004-05","87% AV Level Silver Plan",,"0.875978589057922","No","Yes","No","100%",,"$0","$850","$0","$150","$0","$1,180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","9"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","4","16698","NV","Individual","No","88-0293082","16698NV0450004","Prominence Health Plan Silver 10 Premier","16698NV045",,"NVN001","NVS001","NVF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450004-06","94% AV Level Silver Plan",,"0.935558617115021","No","Yes","No","100%",,"$0","$480","$0","$150","$0","$750","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","$375 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","10"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","5","16698","NV","Individual","No","88-0293082","16698NV0450006","Prominence Health Plan Silver 20 Premier","16698NV045",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450006-00","Standard Silver Off Exchange Plan",,"0.718624293804169","No","Yes","No","100%",,"$0","$1,490","$0","$150","$0","$1,720","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","4"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","5","16698","NV","Individual","No","88-0293082","16698NV0450006","Prominence Health Plan Silver 20 Premier","16698NV045",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450006-01","Standard Silver On Exchange Plan",,"0.718624293804169","No","Yes","No","100%",,"$0","$1,490","$0","$150","$0","$1,720","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","5","16698","NV","Individual","No","88-0293082","16698NV0450006","Prominence Health Plan Silver 20 Premier","16698NV045",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","6"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","4","93091","NM","Individual","No","45-1294709","93091NM0010006","Care Connect Bronze","93091NM001",,"NMN001","NMS006","NMF005","Existing","HMO","Bronze","Yes","Both","No","No",,,"$72.23","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9946",,,,"0","0","0","2016-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010006-00","Standard Bronze Off Exchange Plan","61.89%","0.617518901824951","Yes","Yes","No","100%",,"$3,000","$0","$1,880","$150","$1,010","$0","$1,420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-bronze-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","4"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","4","93091","NM","Individual","No","45-1294709","93091NM0010006","Care Connect Bronze","93091NM001",,"NMN001","NMS006","NMF005","Existing","HMO","Bronze","Yes","Both","No","No",,,"$72.23","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9946",,,,"0","0","0","2016-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010006-01","Standard Bronze On Exchange Plan","61.89%","0.617518901824951","Yes","Yes","No","100%",,"$3,000","$0","$1,880","$150","$1,010","$0","$1,420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-bronze-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","5"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","4","93091","NM","Individual","No","45-1294709","93091NM0010006","Care Connect Bronze","93091NM001",,"NMN001","NMS006","NMF005","Existing","HMO","Bronze","Yes","Both","No","No",,,"$72.23","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9946",,,,"0","0","0","2016-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://mynmhc.org/care-connect-bronze-$0-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","6"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","4","93091","NM","Individual","No","45-1294709","93091NM0010006","Care Connect Bronze","93091NM001",,"NMN001","NMS006","NMF005","Existing","HMO","Bronze","Yes","Both","No","No",,,"$72.23","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.9946",,,,"0","0","0","2016-01-01",,"Yes","Emergency only","Yes","Emergency only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010006-03","Limited Cost Sharing Plan Variation","61.89%","0.617518901824951","Yes","Yes","No","100%",,"$3,000","$0","$1,880","$150","$1,010","$0","$1,420","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-bronze-limited-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","7"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","5","93091","NM","Individual","No","45-1294709","93091NM0010007","Care Connect Catastrophic HMO","93091NM001",,"NMN001","NMS006","NMF003","Existing","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010007-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,750","$0","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-catastrophic-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","4"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","5","93091","NM","Individual","No","45-1294709","93091NM0010007","Care Connect Catastrophic HMO","93091NM001",,"NMN001","NMS006","NMF003","Existing","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Diabetes","0.995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010007-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,750","$0","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-catastrophic-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","5"
"2016","NM","93091","SERFF","9","2016-01-29 07:27:50","7","93091","NM","Individual","No","45-1294709","93091NM0010009","Care Connect Silver HMO","93091NM001",,"NMN001","NMS006","NMF006","New","HMO","Silver","Yes","Both","No","No",,,"$64.48","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes","0.9961",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","https://shop.mynmhc.org/ehp/eapp/samlpaymentacs","http://www.mynmhc.org/Formulary.aspx","93091NM0010009-00","Standard Silver Off Exchange Plan","68.14%","0.707243800163269","Yes","Yes","No","100%",,"$4,020","$0","$1,090","$150","$1,030","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://mynmhc.org/care-connect-silver-hmo-ind-2016.pdf","http://mynmhc.org/plan-brochure-materials-2016.aspx","4"
"2016","NV","12553","SERFF","5","2015-09-24 06:32:24","3","12553","NV","SHOP (Small Group)","Yes","75-1233841","12553NV0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","12553NV002",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","12553NV0020006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/12553nv0020006-16","5"
"2016","NV","12553","SERFF","5","2015-09-24 06:32:24","3","12553","NV","Individual","Yes","75-1233841","12553NV0010006","Delta Dental PPO Basic Plan for Families","12553NV001",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.74","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","12553NV0010006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/12553nv0010006-16","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","1","16698","NV","Individual","No","88-0293082","16698NV0450014","Prominence Health Plan Bronze 4 Premier","16698NV045",,"NVN001","NVS001","NVF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450014-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","4"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","1","16698","NV","Individual","No","88-0293082","16698NV0450014","Prominence Health Plan Bronze 4 Premier","16698NV045",,"NVN001","NVS001","NVF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450014-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","1","16698","NV","Individual","No","88-0293082","16698NV0450014","Prominence Health Plan Bronze 4 Premier","16698NV045",,"NVN001","NVS001","NVF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","6"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","1","16698","NV","Individual","No","88-0293082","16698NV0450014","Prominence Health Plan Bronze 4 Premier","16698NV045",,"NVN001","NVS001","NVF001","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450014-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","7"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","2","16698","NV","Individual","No","88-0293082","16698NV0450015","Prominence Health Plan Bronze 5 Premier","16698NV045",,"NVN001","NVS001","NVF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450015-00","Standard Bronze Off Exchange Plan",,"0.5925013422966","No","Yes","No","100%",,"$6,350","$400","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","4"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","2","16698","NV","Individual","No","88-0293082","16698NV0450015","Prominence Health Plan Bronze 5 Premier","16698NV045",,"NVN001","NVS001","NVF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450015-01","Standard Bronze On Exchange Plan",,"0.5925013422966","No","Yes","No","100%",,"$6,350","$400","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","2","16698","NV","Individual","No","88-0293082","16698NV0450015","Prominence Health Plan Bronze 5 Premier","16698NV045",,"NVN001","NVS001","NVF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450015-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","6"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","2","16698","NV","Individual","No","88-0293082","16698NV0450015","Prominence Health Plan Bronze 5 Premier","16698NV045",,"NVN001","NVS001","NVF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450015-03","Limited Cost Sharing Plan Variation",,"0.5925013422966","No","Yes","No","100%",,"$6,350","$400","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","7"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","3","16698","NV","Individual","No","88-0293082","16698NV0450016","Prominence Health Plan Bronze 6 Premier","16698NV045",,"NVN001","NVS001","NVF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450016-00","Standard Bronze Off Exchange Plan",,"0.608551204204559","No","Yes","No","100%",,"$6,350","$500","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","4"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","3","16698","NV","Individual","No","88-0293082","16698NV0450016","Prominence Health Plan Bronze 6 Premier","16698NV045",,"NVN001","NVS001","NVF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450016-01","Standard Bronze On Exchange Plan",,"0.608551204204559","No","Yes","No","100%",,"$6,350","$500","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","3","16698","NV","Individual","No","88-0293082","16698NV0450016","Prominence Health Plan Bronze 6 Premier","16698NV045",,"NVN001","NVS001","NVF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450016-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","6"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","3","16698","NV","Individual","No","88-0293082","16698NV0450016","Prominence Health Plan Bronze 6 Premier","16698NV045",,"NVN001","NVS001","NVF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450016-03","Limited Cost Sharing Plan Variation",,"0.608551204204559","No","Yes","No","100%",,"$6,350","$500","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","7"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","4","16698","NV","Individual","No","88-0293082","16698NV0450004","Prominence Health Plan Silver 10 Premier","16698NV045",,"NVN001","NVS001","NVF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450004-00","Standard Silver Off Exchange Plan",,"0.692299067974091","No","Yes","No","100%",,"$0","$1,490","$0","$150","$0","$1,720","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","4"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","4","16698","NV","Individual","No","88-0293082","16698NV0450004","Prominence Health Plan Silver 10 Premier","16698NV045",,"NVN001","NVS001","NVF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450004-01","Standard Silver On Exchange Plan",,"0.692299067974091","No","Yes","No","100%",,"$0","$1,490","$0","$150","$0","$1,720","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","4","16698","NV","Individual","No","88-0293082","16698NV0450004","Prominence Health Plan Silver 10 Premier","16698NV045",,"NVN001","NVS001","NVF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","6"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","4","16698","NV","Individual","No","88-0293082","16698NV0450004","Prominence Health Plan Silver 10 Premier","16698NV045",,"NVN001","NVS001","NVF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450004-03","Limited Cost Sharing Plan Variation",,"0.692299067974091","No","Yes","No","100%",,"$0","$1,490","$0","$150","$0","$1,720","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","7"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","5","16698","NV","Individual","No","88-0293082","16698NV0450006","Prominence Health Plan Silver 20 Premier","16698NV045",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450006-03","Limited Cost Sharing Plan Variation",,"0.718624293804169","No","Yes","No","100%",,"$0","$1,490","$0","$150","$0","$1,720","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","7"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","5","16698","NV","Individual","No","88-0293082","16698NV0450006","Prominence Health Plan Silver 20 Premier","16698NV045",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450006-04","73% AV Level Silver Plan",,"0.739326000213623","No","Yes","No","100%",,"$0","$1,490","$0","$150","$0","$1,470","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","8"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","5","16698","NV","Individual","No","88-0293082","16698NV0450006","Prominence Health Plan Silver 20 Premier","16698NV045",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450006-05","87% AV Level Silver Plan",,"0.87594598531723","No","Yes","No","100%",,"$0","$760","$0","$150","$0","$1,180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","9"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","5","16698","NV","Individual","No","88-0293082","16698NV0450006","Prominence Health Plan Silver 20 Premier","16698NV045",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450006-06","94% AV Level Silver Plan",,"0.936555027961731","No","Yes","No","100%",,"$0","$420","$0","$150","$0","$750","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","10"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","6","16698","NV","Individual","No","88-0293082","16698NV0450005","Prominence Health Plan Silver 30 Premier","16698NV045",,"NVN001","NVS001","NVF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450005-00","Standard Silver Off Exchange Plan",,"0.714078068733215","No","Yes","No","100%",,"$0","$1,300","$0","$150","$0","$1,670","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","4"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","6","16698","NV","Individual","No","88-0293082","16698NV0450005","Prominence Health Plan Silver 30 Premier","16698NV045",,"NVN001","NVS001","NVF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450005-01","Standard Silver On Exchange Plan",,"0.714078068733215","No","Yes","No","100%",,"$0","$1,300","$0","$150","$0","$1,670","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","6","16698","NV","Individual","No","88-0293082","16698NV0450005","Prominence Health Plan Silver 30 Premier","16698NV045",,"NVN001","NVS001","NVF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","6"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","6","16698","NV","Individual","No","88-0293082","16698NV0450005","Prominence Health Plan Silver 30 Premier","16698NV045",,"NVN001","NVS001","NVF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450005-03","Limited Cost Sharing Plan Variation",,"0.714078068733215","No","Yes","No","100%",,"$0","$1,300","$0","$150","$0","$1,670","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","7"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","6","16698","NV","Individual","No","88-0293082","16698NV0450005","Prominence Health Plan Silver 30 Premier","16698NV045",,"NVN001","NVS001","NVF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450005-04","73% AV Level Silver Plan",,"0.739410281181335","No","Yes","No","100%",,"$0","$1,270","$0","$150","$0","$1,870","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$4500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","8"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","6","16698","NV","Individual","No","88-0293082","16698NV0450005","Prominence Health Plan Silver 30 Premier","16698NV045",,"NVN001","NVS001","NVF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450005-05","87% AV Level Silver Plan",,"0.871822059154511","No","Yes","No","100%",,"$0","$760","$0","$150","$0","$1,230","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","9"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","6","16698","NV","Individual","No","88-0293082","16698NV0450005","Prominence Health Plan Silver 30 Premier","16698NV045",,"NVN001","NVS001","NVF006","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450005-06","94% AV Level Silver Plan",,"0.938083350658417","No","Yes","No","100%",,"$0","$310","$0","$150","$0","$590","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","10"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","7","16698","NV","Individual","No","88-0293082","16698NV0450013","Prominence Health Plan Silver 50 Premier","16698NV045",,"NVN001","NVS001","NVF007","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450013-00","Standard Silver Off Exchange Plan",,"0.681947410106659","Yes","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,670","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","4"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","7","16698","NV","Individual","No","88-0293082","16698NV0450013","Prominence Health Plan Silver 50 Premier","16698NV045",,"NVN001","NVS001","NVF007","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450013-01","Standard Silver On Exchange Plan",,"0.681947410106659","Yes","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,670","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","7","16698","NV","Individual","No","88-0293082","16698NV0450013","Prominence Health Plan Silver 50 Premier","16698NV045",,"NVN001","NVS001","NVF007","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","6"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","7","16698","NV","Individual","No","88-0293082","16698NV0450013","Prominence Health Plan Silver 50 Premier","16698NV045",,"NVN001","NVS001","NVF007","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450013-03","Limited Cost Sharing Plan Variation",,"0.681947410106659","Yes","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,670","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","7"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","7","16698","NV","Individual","No","88-0293082","16698NV0450013","Prominence Health Plan Silver 50 Premier","16698NV045",,"NVN001","NVS001","NVF007","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450013-04","73% AV Level Silver Plan",,"0.727858304977417","Yes","Yes","No","100%",,"$4,000","$270","$70","$150","$0","$1,570","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","8"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","7","16698","NV","Individual","No","88-0293082","16698NV0450013","Prominence Health Plan Silver 50 Premier","16698NV045",,"NVN001","NVS001","NVF007","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450013-05","87% AV Level Silver Plan",,"0.863746464252472","Yes","Yes","No","100%",,"$1,000","$250","$350","$150","$0","$980","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","9"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","7","16698","NV","Individual","No","88-0293082","16698NV0450013","Prominence Health Plan Silver 50 Premier","16698NV045",,"NVN001","NVS001","NVF007","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450013-06","94% AV Level Silver Plan",,"0.938070297241211","Yes","Yes","No","100%",,"$350","$230","$130","$150","$0","$670","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","10"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","8","16698","NV","Individual","No","88-0293082","16698NV0450007","Prominence Health Plan Gold 1 Premier","16698NV045",,"NVN001","NVS001","NVF008","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450007-00","Standard Gold Off Exchange Plan",,"0.802799224853516","No","Yes","No","100%",,"$0","$1,280","$0","$150","$0","$2,020","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","4"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","8","16698","NV","Individual","No","88-0293082","16698NV0450007","Prominence Health Plan Gold 1 Premier","16698NV045",,"NVN001","NVS001","NVF008","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450007-01","Standard Gold On Exchange Plan",,"0.802799224853516","No","Yes","No","100%",,"$0","$1,280","$0","$150","$0","$2,020","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","8","16698","NV","Individual","No","88-0293082","16698NV0450007","Prominence Health Plan Gold 1 Premier","16698NV045",,"NVN001","NVS001","NVF008","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","6"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","8","16698","NV","Individual","No","88-0293082","16698NV0450007","Prominence Health Plan Gold 1 Premier","16698NV045",,"NVN001","NVS001","NVF008","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450007-03","Limited Cost Sharing Plan Variation",,"0.802799224853516","No","Yes","No","100%",,"$0","$1,280","$0","$150","$0","$2,020","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","7"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","9","16698","NV","Individual","No","88-0293082","16698NV0450008","Prominence Health Plan HSA 1 Premier","16698NV045",,"NVN001","NVS001","NVF009","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450008-00","Standard Bronze Off Exchange Plan",,"0.614009559154511","Yes","Yes","No","100%",,"$5,700","$20","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","4"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","9","16698","NV","Individual","No","88-0293082","16698NV0450008","Prominence Health Plan HSA 1 Premier","16698NV045",,"NVN001","NVS001","NVF009","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450008-01","Standard Bronze On Exchange Plan",,"0.614009559154511","Yes","Yes","No","100%",,"$5,700","$20","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","9","16698","NV","Individual","No","88-0293082","16698NV0450008","Prominence Health Plan HSA 1 Premier","16698NV045",,"NVN001","NVS001","NVF009","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","6"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","9","16698","NV","Individual","No","88-0293082","16698NV0450008","Prominence Health Plan HSA 1 Premier","16698NV045",,"NVN001","NVS001","NVF009","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450008-03","Limited Cost Sharing Plan Variation",,"0.614009559154511","Yes","Yes","No","100%",,"$5,700","$20","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","7"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","10","16698","NV","Individual","No","88-0293082","16698NV0450010","Prominence Health Plan Silver 20 ChoicePlus","16698NV045",,"NVN002","NVS001","NVF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450010-00","Standard Silver Off Exchange Plan",,"0.718624293804169","No","Yes","No","100%",,"$0","$1,490","$0","$150","$0","$1,720","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","4"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","10","16698","NV","Individual","No","88-0293082","16698NV0450010","Prominence Health Plan Silver 20 ChoicePlus","16698NV045",,"NVN002","NVS001","NVF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450010-01","Standard Silver On Exchange Plan",,"0.718624293804169","No","Yes","No","100%",,"$0","$1,490","$0","$150","$0","$1,720","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","10","16698","NV","Individual","No","88-0293082","16698NV0450010","Prominence Health Plan Silver 20 ChoicePlus","16698NV045",,"NVN002","NVS001","NVF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","6"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","10","16698","NV","Individual","No","88-0293082","16698NV0450010","Prominence Health Plan Silver 20 ChoicePlus","16698NV045",,"NVN002","NVS001","NVF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450010-03","Limited Cost Sharing Plan Variation",,"0.718624293804169","No","Yes","No","100%",,"$0","$1,490","$0","$150","$0","$1,720","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","7"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","10","16698","NV","Individual","No","88-0293082","16698NV0450010","Prominence Health Plan Silver 20 ChoicePlus","16698NV045",,"NVN002","NVS001","NVF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450010-04","73% AV Level Silver Plan",,"0.739326000213623","No","Yes","No","100%",,"$0","$1,490","$0","$150","$0","$1,470","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","8"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","10","16698","NV","Individual","No","88-0293082","16698NV0450010","Prominence Health Plan Silver 20 ChoicePlus","16698NV045",,"NVN002","NVS001","NVF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450010-05","87% AV Level Silver Plan",,"0.87594598531723","No","Yes","No","100%",,"$0","$760","$0","$150","$0","$1,180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","9"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","10","16698","NV","Individual","No","88-0293082","16698NV0450010","Prominence Health Plan Silver 20 ChoicePlus","16698NV045",,"NVN002","NVS001","NVF005","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450010-06","94% AV Level Silver Plan",,"0.936555027961731","No","Yes","No","100%",,"$0","$420","$0","$150","$0","$750","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","10"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","11","16698","NV","Individual","No","88-0293082","16698NV0450011","Prominence Health Plan Gold 1 ChoicePlus","16698NV045",,"NVN002","NVS001","NVF008","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450011-00","Standard Gold Off Exchange Plan",,"0.802799224853516","No","Yes","No","100%",,"$0","$1,280","$0","$150","$0","$2,020","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","4"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","11","16698","NV","Individual","No","88-0293082","16698NV0450011","Prominence Health Plan Gold 1 ChoicePlus","16698NV045",,"NVN002","NVS001","NVF008","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450011-01","Standard Gold On Exchange Plan",,"0.802799224853516","No","Yes","No","100%",,"$0","$1,280","$0","$150","$0","$2,020","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","11","16698","NV","Individual","No","88-0293082","16698NV0450011","Prominence Health Plan Gold 1 ChoicePlus","16698NV045",,"NVN002","NVS001","NVF008","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450011-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","6"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","11","16698","NV","Individual","No","88-0293082","16698NV0450011","Prominence Health Plan Gold 1 ChoicePlus","16698NV045",,"NVN002","NVS001","NVF008","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450011-03","Limited Cost Sharing Plan Variation",,"0.802799224853516","No","Yes","No","100%",,"$0","$1,280","$0","$150","$0","$2,020","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","7"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","12","16698","NV","Individual","No","88-0293082","16698NV0450017","Prominence Health Plan Bronze 4 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF001","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450017-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","4"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","12","16698","NV","Individual","No","88-0293082","16698NV0450017","Prominence Health Plan Bronze 4 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF001","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450017-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","12","16698","NV","Individual","No","88-0293082","16698NV0450017","Prominence Health Plan Bronze 4 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF001","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","6"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","12","16698","NV","Individual","No","88-0293082","16698NV0450017","Prominence Health Plan Bronze 4 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF001","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450017-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","7"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","13","16698","NV","Individual","No","88-0293082","16698NV0450018","Prominence Health Plan Bronze 5 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF002","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450018-00","Standard Bronze Off Exchange Plan",,"0.5925013422966","No","Yes","No","100%",,"$6,350","$400","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","4"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","13","16698","NV","Individual","No","88-0293082","16698NV0450018","Prominence Health Plan Bronze 5 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF002","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450018-01","Standard Bronze On Exchange Plan",,"0.5925013422966","No","Yes","No","100%",,"$6,350","$400","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","13","16698","NV","Individual","No","88-0293082","16698NV0450018","Prominence Health Plan Bronze 5 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF002","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450018-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","6"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","13","16698","NV","Individual","No","88-0293082","16698NV0450018","Prominence Health Plan Bronze 5 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF002","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450018-03","Limited Cost Sharing Plan Variation",,"0.5925013422966","No","Yes","No","100%",,"$6,350","$400","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","7"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","14","16698","NV","Individual","No","88-0293082","16698NV0450019","Prominence Health Plan Silver 10 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF004","Existing","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450019-00","Standard Silver Off Exchange Plan",,"0.692299067974091","No","Yes","No","100%",,"$0","$1,490","$0","$150","$0","$1,720","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","4"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","14","16698","NV","Individual","No","88-0293082","16698NV0450019","Prominence Health Plan Silver 10 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF004","Existing","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450019-01","Standard Silver On Exchange Plan",,"0.692299067974091","No","Yes","No","100%",,"$0","$1,490","$0","$150","$0","$1,720","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","14","16698","NV","Individual","No","88-0293082","16698NV0450019","Prominence Health Plan Silver 10 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF004","Existing","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450019-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","6"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","14","16698","NV","Individual","No","88-0293082","16698NV0450019","Prominence Health Plan Silver 10 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF004","Existing","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450019-03","Limited Cost Sharing Plan Variation",,"0.692299067974091","No","Yes","No","100%",,"$0","$1,490","$0","$150","$0","$1,720","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","7"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","14","16698","NV","Individual","No","88-0293082","16698NV0450019","Prominence Health Plan Silver 10 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF004","Existing","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450019-04","73% AV Level Silver Plan",,"0.734999418258667","No","Yes","No","100%",,"$0","$1,490","$0","$150","$0","$1,570","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","8"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","14","16698","NV","Individual","No","88-0293082","16698NV0450019","Prominence Health Plan Silver 10 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF004","Existing","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450019-05","87% AV Level Silver Plan",,"0.875978589057922","No","Yes","No","100%",,"$0","$850","$0","$150","$0","$1,180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","9"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","14","16698","NV","Individual","No","88-0293082","16698NV0450019","Prominence Health Plan Silver 10 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF004","Existing","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450019-06","94% AV Level Silver Plan",,"0.935558617115021","No","Yes","No","100%",,"$0","$480","$0","$150","$0","$750","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","$375 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","10"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","15","16698","NV","Individual","No","88-0293082","16698NV0450020","Prominence Health Plan Silver 50 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF007","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450020-00","Standard Silver Off Exchange Plan",,"0.681947410106659","Yes","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,670","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","4"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","15","16698","NV","Individual","No","88-0293082","16698NV0450020","Prominence Health Plan Silver 50 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF007","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450020-01","Standard Silver On Exchange Plan",,"0.681947410106659","Yes","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,670","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","15","16698","NV","Individual","No","88-0293082","16698NV0450020","Prominence Health Plan Silver 50 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF007","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450020-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","6"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","15","16698","NV","Individual","No","88-0293082","16698NV0450020","Prominence Health Plan Silver 50 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF007","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450020-03","Limited Cost Sharing Plan Variation",,"0.681947410106659","Yes","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,670","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","7"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","15","16698","NV","Individual","No","88-0293082","16698NV0450020","Prominence Health Plan Silver 50 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF007","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450020-04","73% AV Level Silver Plan",,"0.727858304977417","Yes","Yes","No","100%",,"$4,000","$270","$70","$150","$0","$1,570","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","8"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","15","16698","NV","Individual","No","88-0293082","16698NV0450020","Prominence Health Plan Silver 50 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF007","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450020-05","87% AV Level Silver Plan",,"0.863746464252472","Yes","Yes","No","100%",,"$1,000","$250","$350","$150","$0","$980","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","9"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","15","16698","NV","Individual","No","88-0293082","16698NV0450020","Prominence Health Plan Silver 50 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF007","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450020-06","94% AV Level Silver Plan",,"0.938070297241211","Yes","Yes","No","100%",,"$350","$230","$130","$150","$0","$670","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","10"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","16","16698","NV","Individual","No","88-0293082","16698NV0450021","Prominence Health Plan Gold 1 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF008","Existing","HMO","Gold","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450021-00","Standard Gold Off Exchange Plan",,"0.802799224853516","No","Yes","No","100%",,"$0","$1,280","$0","$150","$0","$2,020","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","4"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","16","16698","NV","Individual","No","88-0293082","16698NV0450021","Prominence Health Plan Gold 1 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF008","Existing","HMO","Gold","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450021-01","Standard Gold On Exchange Plan",,"0.802799224853516","No","Yes","No","100%",,"$0","$1,280","$0","$150","$0","$2,020","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","16","16698","NV","Individual","No","88-0293082","16698NV0450021","Prominence Health Plan Gold 1 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF008","Existing","HMO","Gold","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450021-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","6"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","16","16698","NV","Individual","No","88-0293082","16698NV0450021","Prominence Health Plan Gold 1 Health Care Partners","16698NV045",,"NVN003","NVS002","NVF008","Existing","HMO","Gold","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450021-03","Limited Cost Sharing Plan Variation",,"0.802799224853516","No","Yes","No","100%",,"$0","$1,280","$0","$150","$0","$2,020","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","7"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","17","16698","NV","Individual","No","88-0293082","16698NV0450022","Prominence Health Plan Bronze 4 WellHealth","16698NV045",,"NVN004","NVS002","NVF001","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450022-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","4"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","17","16698","NV","Individual","No","88-0293082","16698NV0450022","Prominence Health Plan Bronze 4 WellHealth","16698NV045",,"NVN004","NVS002","NVF001","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450022-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","17","16698","NV","Individual","No","88-0293082","16698NV0450022","Prominence Health Plan Bronze 4 WellHealth","16698NV045",,"NVN004","NVS002","NVF001","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450022-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","6"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","17","16698","NV","Individual","No","88-0293082","16698NV0450022","Prominence Health Plan Bronze 4 WellHealth","16698NV045",,"NVN004","NVS002","NVF001","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450022-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","7"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","18","16698","NV","Individual","No","88-0293082","16698NV0450023","Prominence Health Plan Bronze 5 WellHealth","16698NV045",,"NVN004","NVS002","NVF002","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450023-00","Standard Bronze Off Exchange Plan",,"0.5925013422966","No","Yes","No","100%",,"$6,350","$400","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","4"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","18","16698","NV","Individual","No","88-0293082","16698NV0450023","Prominence Health Plan Bronze 5 WellHealth","16698NV045",,"NVN004","NVS002","NVF002","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450023-01","Standard Bronze On Exchange Plan",,"0.5925013422966","No","Yes","No","100%",,"$6,350","$400","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","18","16698","NV","Individual","No","88-0293082","16698NV0450023","Prominence Health Plan Bronze 5 WellHealth","16698NV045",,"NVN004","NVS002","NVF002","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450023-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","6"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","18","16698","NV","Individual","No","88-0293082","16698NV0450023","Prominence Health Plan Bronze 5 WellHealth","16698NV045",,"NVN004","NVS002","NVF002","New","HMO","Bronze","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450023-03","Limited Cost Sharing Plan Variation",,"0.5925013422966","No","Yes","No","100%",,"$6,350","$400","$0","$150","$5,130","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","7"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","19","16698","NV","Individual","No","88-0293082","16698NV0450024","Prominence Health Plan Silver 10 WellHealth","16698NV045",,"NVN004","NVS002","NVF004","Existing","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450024-00","Standard Silver Off Exchange Plan",,"0.692299067974091","No","Yes","No","100%",,"$0","$1,490","$0","$150","$0","$1,720","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","4"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","19","16698","NV","Individual","No","88-0293082","16698NV0450024","Prominence Health Plan Silver 10 WellHealth","16698NV045",,"NVN004","NVS002","NVF004","Existing","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450024-01","Standard Silver On Exchange Plan",,"0.692299067974091","No","Yes","No","100%",,"$0","$1,490","$0","$150","$0","$1,720","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","19","16698","NV","Individual","No","88-0293082","16698NV0450024","Prominence Health Plan Silver 10 WellHealth","16698NV045",,"NVN004","NVS002","NVF004","Existing","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450024-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","6"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","19","16698","NV","Individual","No","88-0293082","16698NV0450024","Prominence Health Plan Silver 10 WellHealth","16698NV045",,"NVN004","NVS002","NVF004","Existing","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450024-03","Limited Cost Sharing Plan Variation",,"0.692299067974091","No","Yes","No","100%",,"$0","$1,490","$0","$150","$0","$1,720","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","7"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","19","16698","NV","Individual","No","88-0293082","16698NV0450024","Prominence Health Plan Silver 10 WellHealth","16698NV045",,"NVN004","NVS002","NVF004","Existing","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450024-04","73% AV Level Silver Plan",,"0.734999418258667","No","Yes","No","100%",,"$0","$1,490","$0","$150","$0","$1,570","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","8"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","19","16698","NV","Individual","No","88-0293082","16698NV0450024","Prominence Health Plan Silver 10 WellHealth","16698NV045",,"NVN004","NVS002","NVF004","Existing","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450024-05","87% AV Level Silver Plan",,"0.875978589057922","No","Yes","No","100%",,"$0","$850","$0","$150","$0","$1,180","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","9"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","19","16698","NV","Individual","No","88-0293082","16698NV0450024","Prominence Health Plan Silver 10 WellHealth","16698NV045",,"NVN004","NVS002","NVF004","Existing","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"5","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450024-06","94% AV Level Silver Plan",,"0.935558617115021","No","Yes","No","100%",,"$0","$480","$0","$150","$0","$750","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$125","$125 per person","$375 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","10"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","20","16698","NV","Individual","No","88-0293082","16698NV0450025","Prominence Health Plan Silver 50 WellHealth","16698NV045",,"NVN004","NVS002","NVF007","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450025-00","Standard Silver Off Exchange Plan",,"0.681947410106659","Yes","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,670","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","4"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","20","16698","NV","Individual","No","88-0293082","16698NV0450025","Prominence Health Plan Silver 50 WellHealth","16698NV045",,"NVN004","NVS002","NVF007","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450025-01","Standard Silver On Exchange Plan",,"0.681947410106659","Yes","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,670","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","20","16698","NV","Individual","No","88-0293082","16698NV0450025","Prominence Health Plan Silver 50 WellHealth","16698NV045",,"NVN004","NVS002","NVF007","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450025-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","6"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","20","16698","NV","Individual","No","88-0293082","16698NV0450025","Prominence Health Plan Silver 50 WellHealth","16698NV045",,"NVN004","NVS002","NVF007","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450025-03","Limited Cost Sharing Plan Variation",,"0.681947410106659","Yes","Yes","No","100%",,"$4,470","$270","$0","$150","$0","$1,670","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","7"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","20","16698","NV","Individual","No","88-0293082","16698NV0450025","Prominence Health Plan Silver 50 WellHealth","16698NV045",,"NVN004","NVS002","NVF007","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450025-04","73% AV Level Silver Plan",,"0.727858304977417","Yes","Yes","No","100%",,"$4,000","$270","$70","$150","$0","$1,570","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","8"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","20","16698","NV","Individual","No","88-0293082","16698NV0450025","Prominence Health Plan Silver 50 WellHealth","16698NV045",,"NVN004","NVS002","NVF007","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450025-05","87% AV Level Silver Plan",,"0.863746464252472","Yes","Yes","No","100%",,"$1,000","$250","$350","$150","$0","$980","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","9"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","20","16698","NV","Individual","No","88-0293082","16698NV0450025","Prominence Health Plan Silver 50 WellHealth","16698NV045",,"NVN004","NVS002","NVF007","New","HMO","Silver","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450025-06","94% AV Level Silver Plan",,"0.938070297241211","Yes","Yes","No","100%",,"$350","$230","$130","$150","$0","$670","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","10"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","21","16698","NV","Individual","No","88-0293082","16698NV0450026","Prominence Health Plan Gold 1 WellHealth","16698NV045",,"NVN004","NVS002","NVF008","Existing","HMO","Gold","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450026-00","Standard Gold Off Exchange Plan",,"0.802799224853516","No","Yes","No","100%",,"$0","$1,280","$0","$150","$0","$2,020","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","4"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","21","16698","NV","Individual","No","88-0293082","16698NV0450026","Prominence Health Plan Gold 1 WellHealth","16698NV045",,"NVN004","NVS002","NVF008","Existing","HMO","Gold","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450026-01","Standard Gold On Exchange Plan",,"0.802799224853516","No","Yes","No","100%",,"$0","$1,280","$0","$150","$0","$2,020","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","5"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","21","16698","NV","Individual","No","88-0293082","16698NV0450026","Prominence Health Plan Gold 1 WellHealth","16698NV045",,"NVN004","NVS002","NVF008","Existing","HMO","Gold","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450026-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","6"
"2016","NV","16698","SERFF","5","2015-08-20 12:28:36","21","16698","NV","Individual","No","88-0293082","16698NV0450026","Prominence Health Plan Gold 1 WellHealth","16698NV045",,"NVN004","NVS002","NVF008","Existing","HMO","Gold","No","Both","No","Yes","All Specialists",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.9995",,,,"2","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://prominencehealthplan.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://prominencehealthplan.com/members/products-and-services/pharmacy-services/","16698NV0450026-03","Limited Cost Sharing Plan Variation",,"0.802799224853516","No","Yes","No","100%",,"$0","$1,280","$0","$150","$0","$2,020","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","http://prominencehealthplan.com/individual-and-family-plans/nevada-health-link-individual-and-family-plans/","7"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050003","Anthem Silver Pathway X PPO 2250 20","33670NV105",,"NVN001","NVS006","NVF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050003-06","94% AV Level Silver Plan","93.00%","0.927288889884949","Yes","Yes","No","100%",,"$250","$150","$300","$0","$250","$60","$35","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$1,750","$1750 per person","$3500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"$625","$625 per person","$1250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8Q","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","22"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050010","Anthem Silver Pathway X PPO 4000 15","33670NV105",,"NVN001","NVS006","NVF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050010-00","Standard Silver Off Exchange Plan","68.04%","0.683639347553253","Yes","Yes","No","100%",,"$4,000","$315","$344","$0","$424","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,125","$17125 per person","$34250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8R","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","23"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","Yes","84-0747736","33670NV0960003","Anthem Dental Pediatric","33670NV096",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$23.62","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","33670NV0960003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214672.pdf",,"4"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050001","Anthem Bronze Pathway X PPO 20 for HSA","33670NV105",,"NVN001","NVS006","NVF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050001-00","Standard Bronze Off Exchange Plan","61.93%","0.619567692279816","Yes","Yes","No","100%",,"$4,650","$0","$392","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group","20%",,,,,"$11,625","$11625 per person","$23250 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G4A","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","4"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050001","Anthem Bronze Pathway X PPO 20 for HSA","33670NV105",,"NVN001","NVS006","NVF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050001-01","Standard Bronze On Exchange Plan","61.93%","0.619567692279816","Yes","Yes","No","100%",,"$4,650","$0","$392","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group","20%",,,,,"$11,625","$11625 per person","$23250 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X7Z","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","5"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","Yes","84-0747736","33670NV0960003","Anthem Dental Pediatric","33670NV096",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$23.62","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","33670NV0960003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214672.pdf",,"5"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050001","Anthem Bronze Pathway X PPO 20 for HSA","33670NV105",,"NVN001","NVS006","NVF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X80","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","6"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050001","Anthem Bronze Pathway X PPO 20 for HSA","33670NV105",,"NVN001","NVS006","NVF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050001-03","Limited Cost Sharing Plan Variation","61.93%","0.619567692279816","Yes","Yes","No","100%",,"$4,650","$0","$392","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$16,375","$16375 per person","$32750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group","20%",,,,,"$11,625","$11625 per person","$23250 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X7Z","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","7"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050003","Anthem Silver Pathway X PPO 2250 20","33670NV105",,"NVN001","NVS006","NVF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050003-00","Standard Silver Off Exchange Plan","71.74%","0.720735788345337","Yes","Yes","No","100%",,"$2,250","$500","$772","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,125","$17125 per person","$34250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20%",,,,,"$5,625","$5625 per person","$11250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4X","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","16"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050003","Anthem Silver Pathway X PPO 2250 20","33670NV105",,"NVN001","NVS006","NVF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050003-01","Standard Silver On Exchange Plan","71.74%","0.720735788345337","Yes","Yes","No","100%",,"$2,250","$500","$772","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,125","$17125 per person","$34250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20%",,,,,"$5,625","$5625 per person","$11250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8L","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","17"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050003","Anthem Silver Pathway X PPO 2250 20","33670NV105",,"NVN001","NVS006","NVF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X8M","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","18"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050003","Anthem Silver Pathway X PPO 2250 20","33670NV105",,"NVN001","NVS006","NVF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050003-03","Limited Cost Sharing Plan Variation","71.74%","0.720735788345337","Yes","Yes","No","100%",,"$2,250","$500","$772","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,125","$17125 per person","$34250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20%",,,,,"$5,625","$5625 per person","$11250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8L","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","19"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050003","Anthem Silver Pathway X PPO 2250 20","33670NV105",,"NVN001","NVS006","NVF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050003-04","73% AV Level Silver Plan","73.75%","0.740622162818909","Yes","Yes","No","100%",,"$2,150","$500","$792","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"$12,875","$12875 per person","$25750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","20%",,,,,"$5,375","$5375 per person","$10750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8N","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","20"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050003","Anthem Silver Pathway X PPO 2250 20","33670NV105",,"NVN001","NVS006","NVF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050003-05","87% AV Level Silver Plan","86.10%","0.858710587024689","Yes","Yes","No","100%",,"$750","$250","$750","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$4,375","$4375 per person","$8750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$1,875","$1875 per person","$3750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8P","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","21"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050010","Anthem Silver Pathway X PPO 4000 15","33670NV105",,"NVN001","NVS006","NVF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050010-01","Standard Silver On Exchange Plan","68.04%","0.683639347553253","Yes","Yes","No","100%",,"$4,000","$315","$344","$0","$424","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,125","$17125 per person","$34250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8S","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","24"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050010","Anthem Silver Pathway X PPO 4000 15","33670NV105",,"NVN001","NVS006","NVF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X8E","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","25"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050010","Anthem Silver Pathway X PPO 4000 15","33670NV105",,"NVN001","NVS006","NVF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050010-03","Limited Cost Sharing Plan Variation","68.04%","0.683639347553253","Yes","Yes","No","100%",,"$4,000","$315","$344","$0","$424","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,125","$17125 per person","$34250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","15%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8S","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","26"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050010","Anthem Silver Pathway X PPO 4000 15","33670NV105",,"NVN001","NVS006","NVF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050010-04","73% AV Level Silver Plan","72.12%","0.723615646362305","Yes","Yes","No","100%",,"$3,100","$500","$452","$0","$424","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group","15%",,,,,"$7,750","$7750 per person","$15500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8T","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","27"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050010","Anthem Silver Pathway X PPO 4000 15","33670NV105",,"NVN001","NVS006","NVF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050010-05","87% AV Level Silver Plan","86.04%","0.857976734638214","Yes","Yes","No","100%",,"$1,000","$250","$450","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$4,250","$4250 per person","$8500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8U","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","28"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050010","Anthem Silver Pathway X PPO 4000 15","33670NV105",,"NVN001","NVS006","NVF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050010-06","94% AV Level Silver Plan","93.01%","0.926090180873871","Yes","Yes","No","100%",,"$250","$150","$350","$0","$250","$50","$26","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$1,875","$1875 per person","$3750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15%",,,,,"$625","$625 per person","$1250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8V","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","29"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050015","Anthem Gold Pathway X PPO 1500 10","33670NV105",,"NVN001","NVS006","NVF014","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050015-00","Standard Gold Off Exchange Plan","81.09%","0.813309550285339","Yes","Yes","No","100%",,"$1,500","$350","$230","$0","$424","$30","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$8,750","$8750 per person","$17500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10%",,,,,"$3,750","$3750 per person","$7500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XLF","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","38"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050015","Anthem Gold Pathway X PPO 1500 10","33670NV105",,"NVN001","NVS006","NVF014","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050015-01","Standard Gold On Exchange Plan","81.09%","0.813309550285339","Yes","Yes","No","100%",,"$1,500","$350","$230","$0","$424","$30","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$8,750","$8750 per person","$17500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10%",,,,,"$3,750","$3750 per person","$7500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XLG","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","39"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050015","Anthem Gold Pathway X PPO 1500 10","33670NV105",,"NVN001","NVS006","NVF014","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1XLH","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","40"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","1","33670","NV","Individual","No","84-0747736","33670NV1050015","Anthem Gold Pathway X PPO 1500 10","33670NV105",,"NVN001","NVS006","NVF014","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050015-03","Limited Cost Sharing Plan Variation","81.09%","0.813309550285339","Yes","Yes","No","100%",,"$1,500","$350","$230","$0","$424","$30","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$8,750","$8750 per person","$17500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10%",,,,,"$3,750","$3750 per person","$7500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XLG","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","41"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","2","33670","NV","Individual","No","84-0747736","33670NV1050002","Anthem Bronze Pathway X PPO 4500 20","33670NV105",,"NVN001","NVS006","NVF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050002-00","Standard Bronze Off Exchange Plan","61.78%","0.632190227508545","Yes","Yes","No","100%",,"$4,500","$0","$422","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,125","$17125 per person","$34250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4B","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","4"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","2","33670","NV","Individual","Yes","84-0747736","33670NV0980003","Anthem Dental Family","33670NV098",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.10","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","33670NV0980003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214670.pdf",,"4"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","2","33670","NV","Individual","Yes","84-0747736","33670NV0980003","Anthem Dental Family","33670NV098",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.10","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","33670NV0980003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214670.pdf",,"5"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","4","33670","NV","Individual","No","84-0747736","33670NV1050006","Anthem Bronze Pathway X PPO 5200 20","33670NV105",,"NVN001","NVS006","NVF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050006-03","Limited Cost Sharing Plan Variation","61.99%","0.619862616062164","Yes","Yes","No","100%",,"$5,200","$0","$282","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,125","$17125 per person","$34250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X81","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","11"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","5","33670","NV","Individual","No","84-0747736","33670NV1050007","Anthem Catastrophic Pathway X PPO 6850 0","33670NV105",,"NVN001","NVS006","NVF001","New","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050007-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,125","$17125 per person","$34250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$17,125","$17125 per person","$34250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X86","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","4"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","5","33670","NV","Individual","No","84-0747736","33670NV1050007","Anthem Catastrophic Pathway X PPO 6850 0","33670NV105",,"NVN001","NVS006","NVF001","New","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050007-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,554","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,125","$17125 per person","$34250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$17,125","$17125 per person","$34250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X87","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","5"
"2016","NV","34962","SERFF","5","2015-09-24 06:32:24","2","34962","NV","SHOP (Small Group)","Yes","88-0244893","34962NV0020004","DeltaCare USA Preferred Plan for Families for Small Businesses","34962NV002",,"NVN001","NVS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.99","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","34962NV0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/34962nv0020004-16","4"
"2016","NV","34962","SERFF","5","2015-09-24 06:32:24","2","34962","NV","Individual","Yes","88-0244893","34962NV0010004","DeltaCare USA Preferred Plan for Families","34962NV001",,"NVN001","NVS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.53","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","34962NV0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/34962nv0010004-16","4"
"2016","NV","34962","SERFF","5","2015-09-24 06:32:24","2","34962","NV","Individual","Yes","88-0244893","34962NV0010004","DeltaCare USA Preferred Plan for Families","34962NV001",,"NVN001","NVS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.53","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","34962NV0010004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/34962nv0010004-16","5"
"2016","NV","34962","SERFF","5","2015-09-24 06:32:24","2","34962","NV","SHOP (Small Group)","Yes","88-0244893","34962NV0020004","DeltaCare USA Preferred Plan for Families for Small Businesses","34962NV002",,"NVN001","NVS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.99","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","34962NV0020004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/34962nv0020004-16","5"
"2016","NV","34962","SERFF","5","2015-09-24 06:32:24","3","34962","NV","SHOP (Small Group)","Yes","88-0244893","34962NV0020006","DeltaCare USA Basic Plan for Families for Small Businesses","34962NV002",,"NVN001","NVS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","34962NV0020006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/34962nv0020006-16","4"
"2016","NV","34962","SERFF","5","2015-09-24 06:32:24","3","34962","NV","Individual","Yes","88-0244893","34962NV0010006","DeltaCare USA Basic Plan for Families","34962NV001",,"NVN001","NVS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.84","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","34962NV0010006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/34962nv0010006-16","4"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","2","33670","NV","Individual","No","84-0747736","33670NV1050002","Anthem Bronze Pathway X PPO 4500 20","33670NV105",,"NVN001","NVS006","NVF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050002-01","Standard Bronze On Exchange Plan","61.78%","0.632190227508545","Yes","Yes","No","100%",,"$4,500","$0","$422","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,125","$17125 per person","$34250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X84","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","5"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","2","33670","NV","Individual","No","84-0747736","33670NV1050002","Anthem Bronze Pathway X PPO 4500 20","33670NV105",,"NVN001","NVS006","NVF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X85","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","6"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","2","33670","NV","Individual","No","84-0747736","33670NV1050002","Anthem Bronze Pathway X PPO 4500 20","33670NV105",,"NVN001","NVS006","NVF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050002-03","Limited Cost Sharing Plan Variation","61.78%","0.632190227508545","Yes","Yes","No","100%",,"$4,500","$0","$422","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,125","$17125 per person","$34250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X84","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","7"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","Yes","84-0747736","33670NV0980004","Anthem Dental Family Enhanced","33670NV098",,"NVN001","NVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","33670NV0980004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214671.pdf",,"4"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","No","84-0747736","33670NV1050004","Anthem Silver Pathway X PPO 3500 0","33670NV105",,"NVN001","NVS006","NVF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050004-00","Standard Silver Off Exchange Plan","71.40%","0.731213808059692","Yes","Yes","No","100%",,"$3,500","$500","$0","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$8,750","$8750 per person","$17500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G50","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","4"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","No","84-0747736","33670NV1050004","Anthem Silver Pathway X PPO 3500 0","33670NV105",,"NVN001","NVS006","NVF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050004-01","Standard Silver On Exchange Plan","71.40%","0.731213808059692","Yes","Yes","No","100%",,"$3,500","$500","$0","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$8,750","$8750 per person","$17500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8F","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","5"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","Yes","84-0747736","33670NV0980004","Anthem Dental Family Enhanced","33670NV098",,"NVN001","NVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","33670NV0980004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214671.pdf",,"5"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","No","84-0747736","33670NV1050004","Anthem Silver Pathway X PPO 3500 0","33670NV105",,"NVN001","NVS006","NVF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X8K","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","6"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","No","84-0747736","33670NV1050004","Anthem Silver Pathway X PPO 3500 0","33670NV105",,"NVN001","NVS006","NVF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050004-03","Limited Cost Sharing Plan Variation","71.40%","0.731213808059692","Yes","Yes","No","100%",,"$3,500","$500","$0","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$8,750","$8750 per person","$17500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8F","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","7"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","No","84-0747736","33670NV1050004","Anthem Silver Pathway X PPO 3500 0","33670NV105",,"NVN001","NVS006","NVF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050004-04","73% AV Level Silver Plan","73.43%","0.750313699245453","Yes","Yes","No","100%",,"$3,000","$500","$0","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8G","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","8"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","No","84-0747736","33670NV1050004","Anthem Silver Pathway X PPO 3500 0","33670NV105",,"NVN001","NVS006","NVF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050004-05","87% AV Level Silver Plan","87.01%","0.871904790401459","Yes","Yes","No","100%",,"$750","$250","$0","$0","$750","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$4,375","$4375 per person","$8750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","0%",,,,,"$1,875","$1875 per person","$3750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8H","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","9"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","No","84-0747736","33670NV1050004","Anthem Silver Pathway X PPO 3500 0","33670NV105",,"NVN001","NVS006","NVF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050004-06","94% AV Level Silver Plan","93.02%","0.929881036281586","Yes","Yes","No","100%",,"$250","$150","$0","$0","$250","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group",,,,"$2,125","$2125 per person","$4250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%",,,,,"$625","$625 per person","$1250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8J","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","10"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","No","84-0747736","33670NV1050012","Anthem Silver Pathway X PPO 2750 10","33670NV105",,"NVN001","NVS006","NVF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050012-00","Standard Silver Off Exchange Plan","71.40%","0.726447761058807","Yes","Yes","No","100%",,"$2,750","$500","$230","$0","$424","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$16,250","$16250 per person","$32500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10%",,,,,"$6,875","$6875 per person","$13750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XL3","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","11"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","No","84-0747736","33670NV1050012","Anthem Silver Pathway X PPO 2750 10","33670NV105",,"NVN001","NVS006","NVF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050012-01","Standard Silver On Exchange Plan","71.89%","0.726447761058807","Yes","Yes","No","100%",,"$2,750","$500","$230","$0","$424","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$16,250","$16250 per person","$32500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10%",,,,,"$6,875","$6875 per person","$13750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XL4","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","12"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","No","84-0747736","33670NV1050012","Anthem Silver Pathway X PPO 2750 10","33670NV105",,"NVN001","NVS006","NVF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1XL3","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","13"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","No","84-0747736","33670NV1050012","Anthem Silver Pathway X PPO 2750 10","33670NV105",,"NVN001","NVS006","NVF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050012-03","Limited Cost Sharing Plan Variation","71.89%","0.726447761058807","Yes","Yes","No","100%",,"$2,750","$500","$230","$0","$424","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$16,250","$16250 per person","$32500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","10%",,,,,"$6,875","$6875 per person","$13750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XL4","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","14"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","No","84-0747736","33670NV1050012","Anthem Silver Pathway X PPO 2750 10","33670NV105",,"NVN001","NVS006","NVF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050012-04","73% AV Level Silver Plan","73.91%","0.744544088840485","Yes","Yes","No","100%",,"$2,500","$500","$230","$0","$424","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"$12,750","$12750 per person","$25500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%",,,,,"$6,250","$6250 per person","$12500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XL0","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","15"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","No","84-0747736","33670NV1050012","Anthem Silver Pathway X PPO 2750 10","33670NV105",,"NVN001","NVS006","NVF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050012-05","87% AV Level Silver Plan","86.06%","0.863078832626343","Yes","Yes","No","100%",,"$800","$250","$230","$0","$424","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XL1","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","16"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","No","84-0747736","33670NV1050012","Anthem Silver Pathway X PPO 2750 10","33670NV105",,"NVN001","NVS006","NVF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050012-06","94% AV Level Silver Plan","93.12%","0.933833479881287","Yes","Yes","No","100%",,"$250","$150","$280","$0","$250","$50","$17","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$1,875","$1875 per person","$3750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"$625","$625 per person","$1250 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XL2","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","17"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","No","84-0747736","33670NV1050013","Anthem Silver Pathway X PPO 2500 15","33670NV105",,"NVN001","NVS006","NVF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050013-00","Standard Silver Off Exchange Plan","71.79%","0.72402423620224","Yes","Yes","No","100%",,"$2,500","$500","$344","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$15,625","$15625 per person","$31250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","15%",,,,,"$6,250","$6250 per person","$12500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XL9","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","18"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","No","84-0747736","33670NV1050013","Anthem Silver Pathway X PPO 2500 15","33670NV105",,"NVN001","NVS006","NVF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050013-01","Standard Silver On Exchange Plan","71.79%","0.72402423620224","Yes","Yes","No","100%",,"$2,500","$500","$344","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$15,625","$15625 per person","$31250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","15%",,,,,"$6,250","$6250 per person","$12500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XLB","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","19"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","No","84-0747736","33670NV1050013","Anthem Silver Pathway X PPO 2500 15","33670NV105",,"NVN001","NVS006","NVF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1XLA","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","20"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","No","84-0747736","33670NV1050013","Anthem Silver Pathway X PPO 2500 15","33670NV105",,"NVN001","NVS006","NVF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050013-03","Limited Cost Sharing Plan Variation","71.79%","0.72402423620224","Yes","Yes","No","100%",,"$2,500","$500","$344","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$15,625","$15625 per person","$31250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","15%",,,,,"$6,250","$6250 per person","$12500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XLA","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","21"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","No","84-0747736","33670NV1050013","Anthem Silver Pathway X PPO 2500 15","33670NV105",,"NVN001","NVS006","NVF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050013-04","73% AV Level Silver Plan","73.92%","0.743802130222321","Yes","Yes","No","100%",,"$2,250","$500","$344","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","15%",,,,,"$6,250","$6250 per person","$12500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XL6","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","22"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","No","84-0747736","33670NV1050013","Anthem Silver Pathway X PPO 2500 15","33670NV105",,"NVN001","NVS006","NVF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050013-05","87% AV Level Silver Plan","86.09%","0.861122250556946","Yes","Yes","No","100%",,"$750","$250","$344","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$4,375","$4375 per person","$8750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","15%",,,,,"$1,875","$1875 per person","$3750 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XL7","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","23"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","3","33670","NV","Individual","No","84-0747736","33670NV1050013","Anthem Silver Pathway X PPO 2500 15","33670NV105",,"NVN001","NVS006","NVF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050013-06","94% AV Level Silver Plan","93.05%","0.933339655399323","Yes","Yes","No","100%",,"$200","$150","$400","$0","$200","$50","$34","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$1,875","$1875 per person","$3750 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","15%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XL8","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","24"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","4","33670","NV","Individual","No","84-0747736","33670NV1050005","Anthem Bronze Pathway X PPO 6200 30","33670NV105",,"NVN001","NVS006","NVF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050005-00","Standard Bronze Off Exchange Plan","60.72%","0.606744766235352","Yes","Yes","No","100%",,"$6,200","$0","$123","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,125","$17125 per person","$34250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","30%",,,,,"$15,500","$15500 per person","$31000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G49","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","4"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","4","33670","NV","Individual","No","84-0747736","33670NV1050005","Anthem Bronze Pathway X PPO 6200 30","33670NV105",,"NVN001","NVS006","NVF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050005-01","Standard Bronze On Exchange Plan","60.72%","0.606744766235352","Yes","Yes","No","100%",,"$6,200","$0","$123","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,125","$17125 per person","$34250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","30%",,,,,"$15,500","$15500 per person","$31000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X7X","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","5"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","4","33670","NV","Individual","No","84-0747736","33670NV1050005","Anthem Bronze Pathway X PPO 6200 30","33670NV105",,"NVN001","NVS006","NVF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X7Y","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","6"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","4","33670","NV","Individual","No","84-0747736","33670NV1050005","Anthem Bronze Pathway X PPO 6200 30","33670NV105",,"NVN001","NVS006","NVF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050005-03","Limited Cost Sharing Plan Variation","60.72%","0.606744766235352","Yes","Yes","No","100%",,"$6,200","$0","$123","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,125","$17125 per person","$34250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,200","$6200 per person","$12400 per group","30%",,,,,"$15,500","$15500 per person","$31000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X7X","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","7"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","4","33670","NV","Individual","No","84-0747736","33670NV1050006","Anthem Bronze Pathway X PPO 5200 20","33670NV105",,"NVN001","NVS006","NVF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050006-00","Standard Bronze Off Exchange Plan","61.99%","0.619862616062164","Yes","Yes","No","100%",,"$5,200","$0","$282","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,125","$17125 per person","$34250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X83","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","8"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","4","33670","NV","Individual","No","84-0747736","33670NV1050006","Anthem Bronze Pathway X PPO 5200 20","33670NV105",,"NVN001","NVS006","NVF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050006-01","Standard Bronze On Exchange Plan","61.99%","0.619862616062164","Yes","Yes","No","100%",,"$5,200","$0","$282","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$17,125","$17125 per person","$34250 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X81","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","9"
"2016","NV","33670","SERFF","6","2015-08-21 06:27:38","4","33670","NV","Individual","No","84-0747736","33670NV1050006","Anthem Bronze Pathway X PPO 5200 20","33670NV105",,"NVN001","NVS006","NVF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Bluecard PPO Network","Yes","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","33670NV1050006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X82","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","10"
"2016","NV","34962","SERFF","5","2015-09-24 06:32:24","3","34962","NV","Individual","Yes","88-0244893","34962NV0010006","DeltaCare USA Basic Plan for Families","34962NV001",,"NVN001","NVS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.84","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","34962NV0010006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/34962nv0010006-16","5"
"2016","NV","34962","SERFF","5","2015-09-24 06:32:24","3","34962","NV","SHOP (Small Group)","Yes","88-0244893","34962NV0020006","DeltaCare USA Basic Plan for Families for Small Businesses","34962NV002",,"NVN001","NVS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","34962NV0020006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/nv/34962nv0020006-16","5"
"2016","NV","43126","SERFF","3","2015-08-21 06:27:38","1","43126","NV","Individual","Yes","26-3486277","43126NV0110001","NDB Nevada Kids Gold","43126NV011",,"NVN001","NVS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$20.13","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.nevadadentalbenefits.com/pay_online.php","","43126NV0110001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nevadadentalbenefits.com/nevada_health_link.php","http://www.nevadadentalbenefits.com/nevada_health_link.php","4"
"2016","NV","43126","SERFF","3","2015-08-21 06:27:38","1","43126","NV","Individual","Yes","26-3486277","43126NV0110001","NDB Nevada Kids Gold","43126NV011",,"NVN001","NVS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$20.13","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.nevadadentalbenefits.com/pay_online.php","","43126NV0110001-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nevadadentalbenefits.com/nevada_health_link.php","http://www.nevadadentalbenefits.com/nevada_health_link.php","5"
"2016","NV","43126","SERFF","3","2015-08-21 06:27:38","1","43126","NV","Individual","Yes","26-3486277","43126NV0110003","NDB Nevada Kids Silver","43126NV011",,"NVN001","NVS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$16.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.nevadadentalbenefits.com/pay_online.php","","43126NV0110003-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nevadadentalbenefits.com/nevada_health_link.php","http://www.nevadadentalbenefits.com/nevada_health_link.php","6"
"2016","NV","43126","SERFF","3","2015-08-21 06:27:38","1","43126","NV","Individual","Yes","26-3486277","43126NV0110003","NDB Nevada Kids Silver","43126NV011",,"NVN001","NVS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$16.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.nevadadentalbenefits.com/pay_online.php","","43126NV0110003-01","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nevadadentalbenefits.com/nevada_health_link.php","http://www.nevadadentalbenefits.com/nevada_health_link.php","7"
"2016","NV","43126","SERFF","3","2015-08-21 06:27:38","2","43126","NV","Individual","Yes","26-3486277","43126NV0120001","NDB Nevada Kids Gold","43126NV012",,"NVN002","NVS002",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$22.14","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.nevadadentalbenefits.com/pay_online.php","","43126NV0120001-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nevadadentalbenefits.com/nevada_health_link.php","http://www.nevadadentalbenefits.com/nevada_health_link.php","4"
"2016","NV","43126","SERFF","3","2015-08-21 06:27:38","2","43126","NV","Individual","Yes","26-3486277","43126NV0120001","NDB Nevada Kids Gold","43126NV012",,"NVN002","NVS002",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$22.14","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.nevadadentalbenefits.com/pay_online.php","","43126NV0120001-01","Standard High On Exchange Plan","84.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nevadadentalbenefits.com/nevada_health_link.php","http://www.nevadadentalbenefits.com/nevada_health_link.php","5"
"2016","NV","43126","SERFF","3","2015-08-21 06:27:38","2","43126","NV","Individual","Yes","26-3486277","43126NV0120003","NDB Nevada Kids Silver","43126NV012",,"NVN002","NVS002",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$18.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.nevadadentalbenefits.com/pay_online.php","","43126NV0120003-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nevadadentalbenefits.com/nevada_health_link.php","http://www.nevadadentalbenefits.com/nevada_health_link.php","6"
"2016","NV","43126","SERFF","3","2015-08-21 06:27:38","2","43126","NV","Individual","Yes","26-3486277","43126NV0120003","NDB Nevada Kids Silver","43126NV012",,"NVN002","NVS002",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$18.90","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.nevadadentalbenefits.com/pay_online.php","","43126NV0120003-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nevadadentalbenefits.com/nevada_health_link.php","http://www.nevadadentalbenefits.com/nevada_health_link.php","7"
"2016","NV","43126","SERFF","3","2015-08-21 06:27:38","3","43126","NV","Individual","Yes","26-3486277","43126NV0150001","NDB Nevada Kids + Adult","43126NV015",,"NVN001","NVS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$14.40","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.nevadadentalbenefits.com/pay_online.php","","43126NV0150001-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nevadadentalbenefits.com/nevada_health_link.php","http://www.nevadadentalbenefits.com/nevada_health_link.php","4"
"2016","NV","43126","SERFF","3","2015-08-21 06:27:38","3","43126","NV","Individual","Yes","26-3486277","43126NV0150001","NDB Nevada Kids + Adult","43126NV015",,"NVN001","NVS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$14.40","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.nevadadentalbenefits.com/pay_online.php","","43126NV0150001-01","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nevadadentalbenefits.com/nevada_health_link.php","http://www.nevadadentalbenefits.com/nevada_health_link.php","5"
"2016","NV","43126","SERFF","3","2015-08-21 06:27:38","4","43126","NV","Individual","Yes","26-3486277","43126NV0160001","NDB Nevada Kids + Adult","43126NV016",,"NVN002","NVS002",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.40","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.nevadadentalbenefits.com/pay_online.php","","43126NV0160001-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nevadadentalbenefits.com/nevada_health_link.php","http://www.nevadadentalbenefits.com/nevada_health_link.php","4"
"2016","NV","43126","SERFF","3","2015-08-21 06:27:38","4","43126","NV","Individual","Yes","26-3486277","43126NV0160001","NDB Nevada Kids + Adult","43126NV016",,"NVN002","NVS002",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.40","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","http://www.nevadadentalbenefits.com/pay_online.php","","43126NV0160001-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.nevadadentalbenefits.com/nevada_health_link.php","http://www.nevadadentalbenefits.com/nevada_health_link.php","5"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230032","Anthem Gold Pathway X HMO 1000 20","60156NV023",,"NVN001","NVS001","NVF015","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230032-03","Limited Cost Sharing Plan Variation","79.17%","0.793069422245026","Yes","Yes","No","100%",,"$1,000","$500","$459","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X9A","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","27"
"2016","NV","53694","SERFF","7","2015-08-20 12:28:36","3","53694","NV","SHOP (Small Group)","Yes","13-5123390","53694NV0040004","Guardian Family Advantage","53694NV004",,"NVN001","NVS001",,"New","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","53694NV0040004-01","Standard High On Exchange Plan","86.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","NV","53694","SERFF","7","2015-08-20 12:28:36","3","53694","NV","SHOP (Small Group)","Yes","13-5123390","53694NV0060004","Guardian Family Essentials","53694NV006",,"NVN001","NVS001",,"New","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","53694NV0060004-01","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","1","60156","NV","SHOP (Small Group)","No","84-1017384","60156NV0240007","Anthem Bronze Pathway X HMO 5000/30%/6850 Plus","60156NV024",,"NVN001","NVS001","NVF003","New","HMO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9921",,,"$500","0","0","3","2016-01-01",,"Yes","Urgent/emergent coverage only","No",,"No",,"https://www.anthem.com/NVSelectdrugtier4","60156NV0240007-00","Standard Bronze Off Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD20VK","http://sgplans.anthem.com/nv/brochure/","4"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","1","60156","NV","Individual","No","84-1017384","60156NV0230018","Anthem Catastrophic Pathway X HMO 6850 0","60156NV023",,"NVN001","NVS001","NVF001","Existing","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230018-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,554","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G37","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","4"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","1","60156","NV","Individual","No","84-1017384","60156NV0230018","Anthem Catastrophic Pathway X HMO 6850 0","60156NV023",,"NVN001","NVS001","NVF001","Existing","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230018-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,554","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G2V","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","5"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","1","60156","NV","SHOP (Small Group)","No","84-1017384","60156NV0240007","Anthem Bronze Pathway X HMO 5000/30%/6850 Plus","60156NV024",,"NVN001","NVS001","NVF003","New","HMO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9921",,,"$500","0","0","3","2016-01-01",,"Yes","Urgent/emergent coverage only","No",,"No",,"https://www.anthem.com/NVSelectdrugtier4","60156NV0240007-01","Standard Bronze On Exchange Plan","60.24%","0","No","Yes","No","100%",,"$5,000","$0","$25","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD20VK","http://sgplans.anthem.com/nv/brochure/","5"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","SHOP (Small Group)","No","84-1017384","60156NV0240008","Anthem Silver Pathway X HMO 3000/20%/6000 Plus","60156NV024",,"NVN001","NVS001","NVF003","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9932",,,"$500","0","0","0","2016-01-01",,"Yes","Urgent/emergent coverage only","No",,"No",,"https://www.anthem.com/NVSelectdrugtier4","60156NV0240008-00","Standard Silver Off Exchange Plan","69.42%","0","No","Yes","No","100%",,"$3,000","$500","$42","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD20VM","http://sgplans.anthem.com/nv/brochure/","4"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230019","Anthem Bronze Pathway X HMO 0 for HSA","60156NV023",,"NVN001","NVS001","NVF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230019-00","Standard Bronze Off Exchange Plan","60.74%","0.607437193393707","Yes","Yes","No","100%",,"$6,300","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G2Y","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","4"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230019","Anthem Bronze Pathway X HMO 0 for HSA","60156NV023",,"NVN001","NVS001","NVF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230019-01","Standard Bronze On Exchange Plan","60.74%","0.607437193393707","Yes","Yes","No","100%",,"$6,300","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G43","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","5"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","SHOP (Small Group)","No","84-1017384","60156NV0240008","Anthem Silver Pathway X HMO 3000/20%/6000 Plus","60156NV024",,"NVN001","NVS001","NVF003","New","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9932",,,"$500","0","0","0","2016-01-01",,"Yes","Urgent/emergent coverage only","No",,"No",,"https://www.anthem.com/NVSelectdrugtier4","60156NV0240008-01","Standard Silver On Exchange Plan","69.42%","0","No","Yes","No","100%",,"$3,000","$500","$42","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD20VM","http://sgplans.anthem.com/nv/brochure/","5"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230019","Anthem Bronze Pathway X HMO 0 for HSA","60156NV023",,"NVN001","NVS001","NVF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230019-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G4H","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","6"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230019","Anthem Bronze Pathway X HMO 0 for HSA","60156NV023",,"NVN001","NVS001","NVF001","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230019-03","Limited Cost Sharing Plan Variation","60.74%","0.607437193393707","Yes","Yes","No","100%",,"$6,300","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G43","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","7"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230020","Anthem Bronze Pathway X HMO 6150 20","60156NV023",,"NVN001","NVS001","NVF021","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230020-00","Standard Bronze Off Exchange Plan","61.91%","0.619677364826202","Yes","Yes","No","100%",,"$6,150","$0","$92","$0","$424","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G30","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","8"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230020","Anthem Bronze Pathway X HMO 6150 20","60156NV023",,"NVN001","NVS001","NVF021","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230020-01","Standard Bronze On Exchange Plan","61.91%","0.619677364826202","Yes","Yes","No","100%",,"$6,150","$0","$92","$0","$424","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G47","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","9"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230020","Anthem Bronze Pathway X HMO 6150 20","60156NV023",,"NVN001","NVS001","NVF021","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230020-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4G","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","10"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230020","Anthem Bronze Pathway X HMO 6150 20","60156NV023",,"NVN001","NVS001","NVF021","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230020-03","Limited Cost Sharing Plan Variation","61.91%","0.619677364826202","Yes","Yes","No","100%",,"$6,150","$0","$92","$0","$424","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,150","$6150 per person","$12300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G30","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","11"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230028","Anthem Bronze Pathway X HMO 5950 35","60156NV023",,"NVN001","NVS001","NVF022","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230028-00","Standard Bronze Off Exchange Plan","61.86%","0.618977248668671","Yes","Yes","No","100%",,"$5,950","$0","$231","$0","$424","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8X","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","12"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230028","Anthem Bronze Pathway X HMO 5950 35","60156NV023",,"NVN001","NVS001","NVF022","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230028-01","Standard Bronze On Exchange Plan","61.86%","0.618977248668671","Yes","Yes","No","100%",,"$5,950","$0","$231","$0","$424","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8Y","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","13"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230028","Anthem Bronze Pathway X HMO 5950 35","60156NV023",,"NVN001","NVS001","NVF022","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230028-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8W","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","14"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230028","Anthem Bronze Pathway X HMO 5950 35","60156NV023",,"NVN001","NVS001","NVF022","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230028-03","Limited Cost Sharing Plan Variation","61.86%","0.618977248668671","Yes","Yes","No","100%",,"$5,950","$0","$231","$0","$424","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8X","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","15"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230030","Anthem Gold Pathway X HMO 1450 25","60156NV023",,"NVN001","NVS001","NVF016","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230030-00","Standard Gold Off Exchange Plan","78.02%","0.779555320739746","Yes","Yes","No","100%",,"$1,450","$500","$574","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X93","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","16"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230030","Anthem Gold Pathway X HMO 1450 25","60156NV023",,"NVN001","NVS001","NVF016","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230030-01","Standard Gold On Exchange Plan","78.02%","0.779555320739746","Yes","Yes","No","100%",,"$1,450","$500","$574","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X94","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","17"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230030","Anthem Gold Pathway X HMO 1450 25","60156NV023",,"NVN001","NVS001","NVF016","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230030-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X92","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","18"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230030","Anthem Gold Pathway X HMO 1450 25","60156NV023",,"NVN001","NVS001","NVF016","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230030-03","Limited Cost Sharing Plan Variation","78.02%","0.779555320739746","Yes","Yes","No","100%",,"$1,450","$500","$574","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X93","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","19"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230031","Anthem Gold Pathway X HMO 1800 50","60156NV023",,"NVN001","NVS001","NVF019","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230031-00","Standard Gold Off Exchange Plan","78.10%","0.776080727577209","Yes","Yes","No","100%",,"$1,800","$500","$900","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X97","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","20"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230031","Anthem Gold Pathway X HMO 1800 50","60156NV023",,"NVN001","NVS001","NVF019","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230031-01","Standard Gold On Exchange Plan","78.10%","0.776080727577209","Yes","Yes","No","100%",,"$1,800","$500","$900","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X97","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","21"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230031","Anthem Gold Pathway X HMO 1800 50","60156NV023",,"NVN001","NVS001","NVF019","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230031-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X97","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","22"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230031","Anthem Gold Pathway X HMO 1800 50","60156NV023",,"NVN001","NVS001","NVF019","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230031-03","Limited Cost Sharing Plan Variation","78.10%","0.776080727577209","Yes","Yes","No","100%",,"$1,800","$500","$900","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X97","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","23"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230032","Anthem Gold Pathway X HMO 1000 20","60156NV023",,"NVN001","NVS001","NVF015","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230032-00","Standard Gold Off Exchange Plan","79.17%","0.793069422245026","Yes","Yes","No","100%",,"$1,000","$500","$459","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X9A","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","24"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230032","Anthem Gold Pathway X HMO 1000 20","60156NV023",,"NVN001","NVS001","NVF015","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230032-01","Standard Gold On Exchange Plan","79.17%","0.793069422245026","Yes","Yes","No","100%",,"$1,000","$500","$459","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X9A","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","25"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230032","Anthem Gold Pathway X HMO 1000 20","60156NV023",,"NVN001","NVS001","NVF015","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230032-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X9A","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","26"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230025","Anthem Silver Pathway X HMO 2350 15","60156NV023",,"NVN001","NVS001","NVF014","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230025-00","Standard Silver Off Exchange Plan","70.46%","0.711045026779175","Yes","Yes","No","100%",,"$2,350","$0","$639","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G2J","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","28"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230025","Anthem Silver Pathway X HMO 2350 15","60156NV023",,"NVN001","NVS001","NVF014","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230025-01","Standard Silver On Exchange Plan","70.46%","0.711045026779175","Yes","Yes","No","100%",,"$2,350","$0","$639","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G2J","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","29"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230025","Anthem Silver Pathway X HMO 2350 15","60156NV023",,"NVN001","NVS001","NVF014","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230025-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G2J","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","30"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230025","Anthem Silver Pathway X HMO 2350 15","60156NV023",,"NVN001","NVS001","NVF014","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230025-03","Limited Cost Sharing Plan Variation","70.46%","0.711045026779175","Yes","Yes","No","100%",,"$2,350","$0","$639","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G2J","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","31"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230025","Anthem Silver Pathway X HMO 2350 15","60156NV023",,"NVN001","NVS001","NVF014","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230025-04","73% AV Level Silver Plan","73.95%","0.742143154144287","Yes","Yes","No","100%",,"$2,150","$0","$669","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G2L","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","32"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230025","Anthem Silver Pathway X HMO 2350 15","60156NV023",,"NVN001","NVS001","NVF014","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230025-05","87% AV Level Silver Plan","87.65%","0.876660466194153","Yes","Yes","No","100%",,"$750","$0","$550","$0","$750","$0","$60","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G2M","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","33"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230025","Anthem Silver Pathway X HMO 2350 15","60156NV023",,"NVN001","NVS001","NVF014","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230025-06","94% AV Level Silver Plan","93.72%","0.937246322631836","Yes","Yes","No","100%",,"$200","$0","$400","$0","$200","$0","$142","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G2N","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","34"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230027","Anthem Silver Pathway X HMO 2250 20","60156NV023",,"NVN001","NVS001","NVF015","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230027-00","Standard Silver Off Exchange Plan","71.99%","0.724851489067078","Yes","Yes","No","100%",,"$2,250","$500","$772","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4P","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","35"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230027","Anthem Silver Pathway X HMO 2250 20","60156NV023",,"NVN001","NVS001","NVF015","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230027-01","Standard Silver On Exchange Plan","71.99%","0.724851489067078","Yes","Yes","No","100%",,"$2,250","$500","$772","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4P","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","36"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230027","Anthem Silver Pathway X HMO 2250 20","60156NV023",,"NVN001","NVS001","NVF015","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230027-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4P","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","37"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230027","Anthem Silver Pathway X HMO 2250 20","60156NV023",,"NVN001","NVS001","NVF015","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230027-03","Limited Cost Sharing Plan Variation","71.99%","0.724851489067078","Yes","Yes","No","100%",,"$2,250","$500","$772","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4P","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","38"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230027","Anthem Silver Pathway X HMO 2250 20","60156NV023",,"NVN001","NVS001","NVF015","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230027-04","73% AV Level Silver Plan","74.00%","0.740624487400055","Yes","Yes","No","100%",,"$2,150","$400","$812","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4R","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","39"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230027","Anthem Silver Pathway X HMO 2250 20","60156NV023",,"NVN001","NVS001","NVF015","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230027-05","87% AV Level Silver Plan","87.69%","0.873903095722198","Yes","Yes","No","100%",,"$750","$250","$500","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4S","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","40"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230027","Anthem Silver Pathway X HMO 2250 20","60156NV023",,"NVN001","NVS001","NVF015","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230027-06","94% AV Level Silver Plan","94.15%","0.938625693321228","Yes","Yes","No","100%",,"$175","$150","$275","$0","$175","$30","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4T","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","41"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230035","Anthem Silver Pathway X HMO 2500 40","60156NV023",,"NVN001","NVS001","NVF012","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230035-00","Standard Silver Off Exchange Plan","70.40%","0.702670753002167","Yes","Yes","No","100%",,"$2,500","$500","$1,444","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X9P","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","42"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230035","Anthem Silver Pathway X HMO 2500 40","60156NV023",,"NVN001","NVS001","NVF012","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230035-01","Standard Silver On Exchange Plan","70.40%","0.702670753002167","Yes","Yes","No","100%",,"$2,500","$500","$1,444","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1XJ1","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","43"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230035","Anthem Silver Pathway X HMO 2500 40","60156NV023",,"NVN001","NVS001","NVF012","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230035-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8Q","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","44"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230035","Anthem Silver Pathway X HMO 2500 40","60156NV023",,"NVN001","NVS001","NVF012","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230035-03","Limited Cost Sharing Plan Variation","70.40%","0.702670753002167","Yes","Yes","No","100%",,"$2,500","$500","$1,444","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X9P","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","45"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230035","Anthem Silver Pathway X HMO 2500 40","60156NV023",,"NVN001","NVS001","NVF012","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230035-04","73% AV Level Silver Plan","72.58%","0.72444474697113","Yes","Yes","No","100%",,"$2,000","$500","$1,644","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X9L","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","46"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230035","Anthem Silver Pathway X HMO 2500 40","60156NV023",,"NVN001","NVS001","NVF012","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230035-05","87% AV Level Silver Plan","86.06%","0.858529508113861","Yes","Yes","No","100%",,"$1,000","$250","$350","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X9M","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","47"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","2","60156","NV","Individual","No","84-1017384","60156NV0230035","Anthem Silver Pathway X HMO 2500 40","60156NV023",,"NVN001","NVS001","NVF012","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230035-06","94% AV Level Silver Plan","93.01%","0.927178978919983","Yes","Yes","No","100%",,"$250","$150","$300","$0","$250","$60","$70","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X9N","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","48"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","3","60156","NV","Individual","No","84-1017384","60156NV0230022","Anthem Bronze Pathway X HMO 5000 40","60156NV023",,"NVN001","NVS001","NVF002","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230022-00","Standard Bronze Off Exchange Plan","61.42%","0.611048996448517","Yes","Yes","No","100%",,"$5,000","$0","$644","$0","$1,049","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G38","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","4"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","3","60156","NV","SHOP (Small Group)","No","84-1017384","60156NV0240009","Anthem Gold Pathway X HMO 1000/10%/5500 Plus","60156NV024",,"NVN001","NVS001","NVF003","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9945",,,"$500","0","0","0","2016-01-01",,"Yes","Urgent/emergent coverage only","No",,"No",,"https://www.anthem.com/NVSelectdrugtier4","60156NV0240009-00","Standard Gold Off Exchange Plan","79.79%","0.784376204013824","No","Yes","No","100%",,"$1,000","$0","$408","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD20VP","http://sgplans.anthem.com/nv/brochure/","4"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","3","60156","NV","SHOP (Small Group)","No","84-1017384","60156NV0240009","Anthem Gold Pathway X HMO 1000/10%/5500 Plus","60156NV024",,"NVN001","NVS001","NVF003","New","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9945",,,"$500","0","0","0","2016-01-01",,"Yes","Urgent/emergent coverage only","No",,"No",,"https://www.anthem.com/NVSelectdrugtier4","60156NV0240009-01","Standard Gold On Exchange Plan","79.79%","0.784376204013824","No","Yes","No","100%",,"$1,000","$0","$408","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD20VP","http://sgplans.anthem.com/nv/brochure/","5"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","3","60156","NV","Individual","No","84-1017384","60156NV0230022","Anthem Bronze Pathway X HMO 5000 40","60156NV023",,"NVN001","NVS001","NVF002","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230022-01","Standard Bronze On Exchange Plan","61.42%","0.611048996448517","Yes","Yes","No","100%",,"$5,000","$0","$644","$0","$1,049","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G3Z","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","5"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","3","60156","NV","Individual","No","84-1017384","60156NV0230022","Anthem Bronze Pathway X HMO 5000 40","60156NV023",,"NVN001","NVS001","NVF002","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230022-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4E","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","6"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","3","60156","NV","Individual","No","84-1017384","60156NV0230022","Anthem Bronze Pathway X HMO 5000 40","60156NV023",,"NVN001","NVS001","NVF002","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230022-03","Limited Cost Sharing Plan Variation","61.42%","0.611048996448517","Yes","Yes","No","100%",,"$5,000","$0","$644","$0","$1,049","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G3Z","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","7"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","3","60156","NV","Individual","No","84-1017384","60156NV0230026","Anthem Silver Pathway X HMO 2250 30","60156NV023",,"NVN001","NVS001","NVF017","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230026-00","Standard Silver Off Exchange Plan","70.44%","0.704581201076508","Yes","Yes","No","100%",,"$2,250","$500","$688","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G31","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","8"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","3","60156","NV","Individual","No","84-1017384","60156NV0230026","Anthem Silver Pathway X HMO 2250 30","60156NV023",,"NVN001","NVS001","NVF017","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230026-01","Standard Silver On Exchange Plan","70.44%","0.704581201076508","Yes","Yes","No","100%",,"$2,250","$500","$688","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4J","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","9"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","3","60156","NV","Individual","No","84-1017384","60156NV0230026","Anthem Silver Pathway X HMO 2250 30","60156NV023",,"NVN001","NVS001","NVF017","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230026-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1Q1T","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","10"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","3","60156","NV","Individual","No","84-1017384","60156NV0230026","Anthem Silver Pathway X HMO 2250 30","60156NV023",,"NVN001","NVS001","NVF017","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230026-03","Limited Cost Sharing Plan Variation","70.44%","0.704581201076508","Yes","Yes","No","100%",,"$2,250","$500","$688","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4J","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","11"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","3","60156","NV","Individual","No","84-1017384","60156NV0230026","Anthem Silver Pathway X HMO 2250 30","60156NV023",,"NVN001","NVS001","NVF017","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230026-04","73% AV Level Silver Plan","73.86%","0.737795054912567","Yes","Yes","No","100%",,"$1,500","$500","$688","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4L","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","12"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","3","60156","NV","Individual","No","84-1017384","60156NV0230026","Anthem Silver Pathway X HMO 2250 30","60156NV023",,"NVN001","NVS001","NVF017","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230026-05","87% AV Level Silver Plan","87.25%","0.869486093521118","Yes","Yes","No","100%",,"$700","$250","$550","$0","$700","$30","$126","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4M","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","13"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","3","60156","NV","Individual","No","84-1017384","60156NV0230026","Anthem Silver Pathway X HMO 2250 30","60156NV023",,"NVN001","NVS001","NVF017","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230026-06","94% AV Level Silver Plan","93.89%","0.935437738895416","Yes","Yes","No","100%",,"$175","$150","$275","$0","$175","$10","$289","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$175","$175 per person","$350 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G4N","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","14"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","3","60156","NV","Individual","No","84-1017384","60156NV0230029","Anthem Bronze Pathway X HMO 4950 50","60156NV023",,"NVN001","NVS001","NVF004","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230029-00","Standard Bronze Off Exchange Plan","61.34%","0.615398168563843","Yes","Yes","No","100%",,"$4,950","$0","$830","$0","$424","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1ZYZ","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","15"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","3","60156","NV","Individual","No","84-1017384","60156NV0230029","Anthem Bronze Pathway X HMO 4950 50","60156NV023",,"NVN001","NVS001","NVF004","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230029-01","Standard Bronze On Exchange Plan","61.34%","0.615398168563843","Yes","Yes","No","100%",,"$4,950","$0","$830","$0","$424","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X91","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","16"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","3","60156","NV","Individual","No","84-1017384","60156NV0230029","Anthem Bronze Pathway X HMO 4950 50","60156NV023",,"NVN001","NVS001","NVF004","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230029-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X8Z","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","17"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","3","60156","NV","Individual","No","84-1017384","60156NV0230029","Anthem Bronze Pathway X HMO 4950 50","60156NV023",,"NVN001","NVS001","NVF004","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230029-03","Limited Cost Sharing Plan Variation","61.34%","0.615398168563843","Yes","Yes","No","100%",,"$4,950","$0","$830","$0","$424","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,950","$5950 per person","$11900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,950","$4950 per person","$9900 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X91","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","18"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","4","60156","NV","Individual","No","84-1017384","60156NV0230033","Anthem Gold Pathway X HMO 1800 50","60156NV023",,"NVN001","NVS001","NVF019","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230033-00","Standard Gold Off Exchange Plan","79.35%","0.791663587093353","Yes","Yes","No","100%",,"$1,800","$500","$450","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1ZZ3","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","4"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","4","60156","NV","Individual","No","84-1017384","60156NV0230033","Anthem Gold Pathway X HMO 1800 50","60156NV023",,"NVN001","NVS001","NVF019","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230033-01","Standard Gold On Exchange Plan","79.35%","0.791663587093353","Yes","Yes","No","100%",,"$1,800","$500","$450","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X9D","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","5"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","4","60156","NV","Individual","No","84-1017384","60156NV0230033","Anthem Gold Pathway X HMO 1800 50","60156NV023",,"NVN001","NVS001","NVF019","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230033-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X9B","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","6"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","4","60156","NV","Individual","No","84-1017384","60156NV0230033","Anthem Gold Pathway X HMO 1800 50","60156NV023",,"NVN001","NVS001","NVF019","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230033-03","Limited Cost Sharing Plan Variation","79.35%","0.791663587093353","Yes","Yes","No","100%",,"$1,800","$500","$450","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X9D","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","7"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","5","60156","NV","Individual","No","84-1017384","60156NV0230034","Anthem Silver Pathway X HMO 2000 40","60156NV023",,"NVN001","NVS001","NVF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230034-00","Standard Silver Off Exchange Plan","71.04%","0.719237387180328","Yes","Yes","No","100%",,"$2,000","$500","$918","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1ZZ4","http://editiondigital.net/view/IU65/2016/OFF_HIX_NV_KIT_2016","4"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","5","60156","NV","Individual","No","84-1017384","60156NV0230034","Anthem Silver Pathway X HMO 2000 40","60156NV023",,"NVN001","NVS001","NVF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230034-01","Standard Silver On Exchange Plan","71.04%","0.719237387180328","Yes","Yes","No","100%",,"$2,000","$500","$918","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X9J","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","5"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","5","60156","NV","Individual","No","84-1017384","60156NV0230034","Anthem Silver Pathway X HMO 2000 40","60156NV023",,"NVN001","NVS001","NVF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230034-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X9K","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","6"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","5","60156","NV","Individual","No","84-1017384","60156NV0230034","Anthem Silver Pathway X HMO 2000 40","60156NV023",,"NVN001","NVS001","NVF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230034-03","Limited Cost Sharing Plan Variation","71.04%","0.719237387180328","Yes","Yes","No","100%",,"$2,000","$500","$918","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X9J","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","7"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","5","60156","NV","Individual","No","84-1017384","60156NV0230034","Anthem Silver Pathway X HMO 2000 40","60156NV023",,"NVN001","NVS001","NVF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230034-04","73% AV Level Silver Plan","73.29%","0.741508781909943","Yes","Yes","No","100%",,"$2,000","$500","$918","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X9E","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","8"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","5","60156","NV","Individual","No","84-1017384","60156NV0230034","Anthem Silver Pathway X HMO 2000 40","60156NV023",,"NVN001","NVS001","NVF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230034-05","87% AV Level Silver Plan","86.01%","0.864673256874084","Yes","Yes","No","100%",,"$750","$250","$500","$0","$750","$50","$140","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X9F","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","9"
"2016","NV","60156","SERFF","13","2016-03-31 13:35:32","5","60156","NV","Individual","No","84-1017384","60156NV0230034","Anthem Silver Pathway X HMO 2000 40","60156NV023",,"NVN001","NVS001","NVF018","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","No","https://payment.anthem.com/sales/payment/exchange?state=NV","https://www.anthem.com/NVSelectdrugtier4","60156NV0230034-06","94% AV Level Silver Plan","93.01%","0.926245868206024","Yes","Yes","No","100%",,"$250","$150","$250","$0","$250","$30","$348","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X9G","http://editiondigital.net/view/IU65/2016/ON_HIX_NV_KIT_2016","10"
"2016","NV","75719","SERFF","8","2015-08-20 12:28:36","1","75719","NV","SHOP (Small Group)","Yes","95-6042390","75719NV0010007","BESTDental Premium","75719NV001",,"NVN001","NVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2015/NV_BESTDental_Premium_Plan.pdf","https://www.bestlife.com/nv/2015/NV_BESTDental_Premium_Plan.pdf","4"
"2016","NV","75719","SERFF","8","2015-08-20 12:28:36","1","75719","NV","Individual","Yes","95-6042390","75719NV0020003","BESTOne Advantage Gold","75719NV002",,"NVN001","NVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.72","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Advantage-Gold_Plan.pdf","https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","NV","75719","SERFF","8","2015-08-20 12:28:36","1","75719","NV","Individual","Yes","95-6042390","75719NV0020003","BESTOne Advantage Gold","75719NV002",,"NVN001","NVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.72","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75.00","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Advantage-Gold_Plan.pdf","https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","NV","75719","SERFF","8","2015-08-20 12:28:36","1","75719","NV","SHOP (Small Group)","Yes","95-6042390","75719NV0010007","BESTDental Premium","75719NV001",,"NVN001","NVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2015/NV_BESTDental_Premium_Plan.pdf","https://www.bestlife.com/nv/2015/NV_BESTDental_Premium_Plan.pdf","5"
"2016","NV","75719","SERFF","8","2015-08-20 12:28:36","1","75719","NV","SHOP (Small Group)","Yes","95-6042390","75719NV0010008","BESTDental Standard - H","75719NV001",,"NVN001","NVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2015/NV_BESTDental_Standard-H_Plan.pdf","https://www.bestlife.com/nv/2015/NV_BESTDental_Standard-H_Plan.pdf","6"
"2016","NV","75719","SERFF","8","2015-08-20 12:28:36","1","75719","NV","Individual","Yes","95-6042390","75719NV0020004","BESTOne Plus Gold","75719NV002",,"NVN001","NVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.72","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75.00","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Gold_Plan.pdf","https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","NV","75719","SERFF","8","2015-08-20 12:28:36","1","75719","NV","Individual","Yes","95-6042390","75719NV0020004","BESTOne Plus Gold","75719NV002",,"NVN001","NVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.72","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75.00","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Gold_Plan.pdf","https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","NV","75719","SERFF","8","2015-08-20 12:28:36","1","75719","NV","SHOP (Small Group)","Yes","95-6042390","75719NV0010008","BESTDental Standard - H","75719NV001",,"NVN001","NVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2015/NV_BESTDental_Standard-H_Plan.pdf","https://www.bestlife.com/nv/2015/NV_BESTDental_Standard-H_Plan.pdf","7"
"2016","NV","75719","SERFF","8","2015-08-20 12:28:36","1","75719","NV","SHOP (Small Group)","Yes","95-6042390","75719NV0010010","BESTDental Choice - H","75719NV001",,"NVN001","NVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2015/NV_BESTDental_Choice-H_Plan.pdf","https://www.bestlife.com/nv/2015/NV_BESTDental_Choice-H_Plan.pdf","8"
"2016","NV","75719","SERFF","8","2015-08-20 12:28:36","1","75719","NV","SHOP (Small Group)","Yes","95-6042390","75719NV0010010","BESTDental Choice - H","75719NV001",,"NVN001","NVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.73","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2015/NV_BESTDental_Choice-H_Plan.pdf","https://www.bestlife.com/nv/2015/NV_BESTDental_Choice-H_Plan.pdf","9"
"2016","NV","75719","SERFF","8","2015-08-20 12:28:36","2","75719","NV","Individual","Yes","95-6042390","75719NV0020005","BESTOne Plus Silver","75719NV002",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.44","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf","https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","NV","75719","SERFF","8","2015-08-20 12:28:36","2","75719","NV","SHOP (Small Group)","Yes","95-6042390","75719NV0010009","BESTDental Standard - L","75719NV001",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2015/NV_BESTDental_Standard-L_Plan.pdf","https://www.bestlife.com/nv/2015/NV_BESTDental_Standard-L_Plan.pdf","4"
"2016","NV","75719","SERFF","8","2015-08-20 12:28:36","2","75719","NV","SHOP (Small Group)","Yes","95-6042390","75719NV0010009","BESTDental Standard - L","75719NV001",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2015/NV_BESTDental_Standard-L_Plan.pdf","https://www.bestlife.com/nv/2015/NV_BESTDental_Standard-L_Plan.pdf","5"
"2016","NV","75719","SERFF","8","2015-08-20 12:28:36","2","75719","NV","Individual","Yes","95-6042390","75719NV0020005","BESTOne Plus Silver","75719NV002",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.44","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf","https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","NV","75719","SERFF","8","2015-08-20 12:28:36","2","75719","NV","SHOP (Small Group)","Yes","95-6042390","75719NV0010011","BESTDental Choice - L","75719NV001",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2015/NV_BESTDental_Choice-L_Plan.pdf","https://www.bestlife.com/nv/2015/NV_BESTDental_Choice-L_Plan.pdf","6"
"2016","NV","75719","SERFF","8","2015-08-20 12:28:36","2","75719","NV","Individual","Yes","95-6042390","75719NV0020006","BESTOne Basic Silver","75719NV002",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.44","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf","https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","NV","75719","SERFF","8","2015-08-20 12:28:36","2","75719","NV","Individual","Yes","95-6042390","75719NV0020006","BESTOne Basic Silver","75719NV002",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.44","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf","https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","NV","75719","SERFF","8","2015-08-20 12:28:36","2","75719","NV","SHOP (Small Group)","Yes","95-6042390","75719NV0010011","BESTDental Choice - L","75719NV001",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2015/NV_BESTDental_Choice-L_Plan.pdf","https://www.bestlife.com/nv/2015/NV_BESTDental_Choice-L_Plan.pdf","7"
"2016","NV","75719","SERFF","8","2015-08-20 12:28:36","2","75719","NV","SHOP (Small Group)","Yes","95-6042390","75719NV0010012","BESTDental Value","75719NV001",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2015/NV_BESTDental_Value_Plan.pdf","https://www.bestlife.com/nv/2015/NV_BESTDental_Value_Plan.pdf","8"
"2016","NV","75719","SERFF","8","2015-08-20 12:28:36","2","75719","NV","SHOP (Small Group)","Yes","95-6042390","75719NV0010012","BESTDental Value","75719NV001",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","75719NV0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/nv/2015/NV_BESTDental_Value_Plan.pdf","https://www.bestlife.com/nv/2015/NV_BESTDental_Value_Plan.pdf","9"
"2016","NV","88671","SERFF","6","2015-09-24 06:32:24","2","88671","NV","Individual","Yes","75-1233841","88671NV0020004","Dentegra Dental PPO Family Preferred Plan","88671NV002",,"NVN001","NVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.38","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","88671NV0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","$80","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nv/88671nv0020004-16","4"
"2016","NV","88671","SERFF","6","2015-09-24 06:32:24","2","88671","NV","SHOP (Small Group)","Yes","75-1233841","88671NV0030004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","88671NV003",,"NVN001","NVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.63","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","88671NV0030004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","$80","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nv/88671nv0030004-16","4"
"2016","NV","88671","SERFF","6","2015-09-24 06:32:24","2","88671","NV","SHOP (Small Group)","Yes","75-1233841","88671NV0030004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","88671NV003",,"NVN001","NVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.63","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","88671NV0030004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","$80","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nv/88671nv0030004-16","5"
"2016","NV","88671","SERFF","6","2015-09-24 06:32:24","2","88671","NV","Individual","Yes","75-1233841","88671NV0020004","Dentegra Dental PPO Family Preferred Plan","88671NV002",,"NVN001","NVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.38","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","88671NV0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$80","per person not applicable","per group not applicable",,,,,,"$80","per person not applicable","per group not applicable","$80","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nv/88671nv0020004-16","5"
"2016","NV","88671","SERFF","6","2015-09-24 06:32:24","3","88671","NV","Individual","Yes","75-1233841","88671NV0020006","Dentegra Dental PPO Family Basic Plan","88671NV002",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.94","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","88671NV0020006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nv/88671nv0020006-16","4"
"2016","NV","88671","SERFF","6","2015-09-24 06:32:24","3","88671","NV","SHOP (Small Group)","Yes","75-1233841","88671NV0030006","Dentegra Dental PPO for Small Businesses Family Basic Plan","88671NV003",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.98","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","88671NV0030006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nv/88671nv0030006-16","4"
"2016","NV","88671","SERFF","6","2015-09-24 06:32:24","3","88671","NV","SHOP (Small Group)","Yes","75-1233841","88671NV0030006","Dentegra Dental PPO for Small Businesses Family Basic Plan","88671NV003",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.98","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","88671NV0030006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nv/88671nv0030006-16","5"
"2016","NV","88671","SERFF","6","2015-09-24 06:32:24","3","88671","NV","Individual","Yes","75-1233841","88671NV0020006","Dentegra Dental PPO Family Basic Plan","88671NV002",,"NVN001","NVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.94","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","88671NV0020006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/nv/88671nv0020006-16","5"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030020","MyHPN Gold 3","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030020-01","Standard Gold On Exchange Plan","79.53%",,"No","Yes","No","100%",,"$1,000","$400","$900","$0","$0","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNGold3.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","29"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030020","MyHPN Gold 3","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030020-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNGold3_ZCS.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","30"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030020","MyHPN Gold 3","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030020-03","Limited Cost Sharing Plan Variation","79.53%",,"No","Yes","No","100%",,"$1,000","$400","$900","$0","$0","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNGold3.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","31"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030052","MyHPN Bronze 7","95865NV003",,"NVN001","NVS001","NVF001","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030052-00","Standard Bronze Off Exchange Plan","61.45%",,"No","Yes","No","100%",,"$5,600","$600","$0","$0","$0","$2,200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$250","$250 per person","$500 per group","0%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNBronze7.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","4"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030052","MyHPN Bronze 7","95865NV003",,"NVN001","NVS001","NVF001","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030052-01","Standard Bronze On Exchange Plan","61.45%",,"No","Yes","No","100%",,"$5,600","$600","$0","$0","$0","$2,200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$250","$250 per person","$500 per group","0%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNBronze7.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","5"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030052","MyHPN Bronze 7","95865NV003",,"NVN001","NVS001","NVF001","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030052-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNBronze7_ZCS.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","6"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030052","MyHPN Bronze 7","95865NV003",,"NVN001","NVS001","NVF001","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030052-03","Limited Cost Sharing Plan Variation","61.45%",,"No","Yes","No","100%",,"$5,600","$600","$0","$0","$0","$2,200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$250","$250 per person","$500 per group","0%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNBronze7.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","7"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030053","MyHPN Bronze 8","95865NV003",,"NVN001","NVS001","NVF001","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030053-00","Standard Bronze Off Exchange Plan","61.26%",,"No","Yes","No","100%",,"$6,300","$200","$0","$0","$100","$2,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$6,500","$6500 per person","$13000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$250","$250 per person","$500 per group","30%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNBronze8.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","8"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030053","MyHPN Bronze 8","95865NV003",,"NVN001","NVS001","NVF001","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030053-01","Standard Bronze On Exchange Plan","61.26%",,"No","Yes","No","100%",,"$6,300","$200","$0","$0","$100","$2,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$6,500","$6500 per person","$13000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$250","$250 per person","$500 per group","30%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNBronze8.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","9"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030053","MyHPN Bronze 8","95865NV003",,"NVN001","NVS001","NVF001","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030053-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNBronze8_ZCS.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","10"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030053","MyHPN Bronze 8","95865NV003",,"NVN001","NVS001","NVF001","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030053-03","Limited Cost Sharing Plan Variation","61.26%",,"No","Yes","No","100%",,"$6,300","$200","$0","$0","$100","$2,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$6,500","$6500 per person","$13000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","30%",,,,,"$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNBronze8.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","11"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030054","MyHPN Bronze 9","95865NV003",,"NVN001","NVS001","NVF001","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030054-00","Standard Bronze Off Exchange Plan","59.94%",,"No","Yes","No","100%",,"$6,300","$200","$0","$0","$100","$2,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$6,600","$6600 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$250","$250 per person","$500 per group","0%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNBronze9.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","12"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030054","MyHPN Bronze 9","95865NV003",,"NVN001","NVS001","NVF001","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030054-01","Standard Bronze On Exchange Plan","59.94%",,"No","Yes","No","100%",,"$6,300","$200","$0","$0","$100","$2,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$6,600","$6600 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$250","$250 per person","$500 per group","0%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNBronze9.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","13"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030054","MyHPN Bronze 9","95865NV003",,"NVN001","NVS001","NVF001","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030054-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNBronze9_ZCS.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","14"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030054","MyHPN Bronze 9","95865NV003",,"NVN001","NVS001","NVF001","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030054-03","Limited Cost Sharing Plan Variation","59.94%",,"No","Yes","No","100%",,"$6,300","$200","$0","$0","$100","$2,300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$6,600","$6600 per person","$13200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$250","$250 per person","$500 per group","0%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNBronze9.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","15"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030055","MyHPN Bronze 10","95865NV003",,"NVN001","NVS001","NVF001","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030055-00","Standard Bronze Off Exchange Plan","61.81%",,"No","Yes","No","100%",,"$5,500","$200","$0","$0","$100","$2,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$250","$250 per person","$500 per group","0%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNBronze10.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","16"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030055","MyHPN Bronze 10","95865NV003",,"NVN001","NVS001","NVF001","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030055-01","Standard Bronze On Exchange Plan","61.81%",,"No","Yes","No","100%",,"$5,500","$200","$0","$0","$100","$2,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$250","$250 per person","$500 per group","0%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNBronze10.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","17"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030055","MyHPN Bronze 10","95865NV003",,"NVN001","NVS001","NVF001","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030055-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNBronze10_ZCS.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","18"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030055","MyHPN Bronze 10","95865NV003",,"NVN001","NVS001","NVF001","New","HMO","Bronze","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030055-03","Limited Cost Sharing Plan Variation","61.81%",,"No","Yes","No","100%",,"$5,500","$200","$0","$0","$100","$2,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","$250","$250 per person","$500 per group","0%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNBronze10.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","19"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030022","MyHPN Gold 1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030022-00","Standard Gold Off Exchange Plan","81.15%",,"No","Yes","No","100%",,"$500","$400","$1,000","$0","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNGold1.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","20"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030022","MyHPN Gold 1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030022-01","Standard Gold On Exchange Plan","81.15%",,"No","Yes","No","100%",,"$500","$400","$1,000","$0","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNGold1.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","21"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030022","MyHPN Gold 1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030022-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNGold1_ZCS.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","22"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030022","MyHPN Gold 1","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030022-03","Limited Cost Sharing Plan Variation","81.15%",,"No","Yes","No","100%",,"$500","$400","$1,000","$0","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNGold1.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","23"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030021","MyHPN Gold 2","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030021-00","Standard Gold Off Exchange Plan","79.84%",,"No","Yes","No","100%",,"$750","$400","$1,000","$0","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNGold2.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","24"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030021","MyHPN Gold 2","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030021-01","Standard Gold On Exchange Plan","79.84%",,"No","Yes","No","100%",,"$750","$400","$1,000","$0","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNGold2.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","25"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030021","MyHPN Gold 2","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030021-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNGold2_ZCS.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","26"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030021","MyHPN Gold 2","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030021-03","Limited Cost Sharing Plan Variation","79.84%",,"No","Yes","No","100%",,"$750","$400","$1,000","$0","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNGold2.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","27"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030020","MyHPN Gold 3","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030020-00","Standard Gold Off Exchange Plan","79.53%",,"No","Yes","No","100%",,"$1,000","$400","$900","$0","$0","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNGold3.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","28"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030046","MyHPN Gold 4","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030046-00","Standard Gold Off Exchange Plan","80.77%",,"No","Yes","No","100%",,"$1,000","$400","$900","$0","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNGold4.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","32"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030046","MyHPN Gold 4","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030046-01","Standard Gold On Exchange Plan","80.77%",,"No","Yes","No","100%",,"$1,000","$400","$900","$0","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNGold4.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","33"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030046","MyHPN Gold 4","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030046-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNGold4_ZCS.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","34"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030046","MyHPN Gold 4","95865NV003",,"NVN001","NVS001","NVF003","Existing","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030046-03","Limited Cost Sharing Plan Variation","80.77%",,"No","Yes","No","100%",,"$1,000","$400","$900","$0","$0","$1,600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNGold4.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","35"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030045","MyHPN Gold 5","95865NV003",,"NVN001","NVS001","NVF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030045-00","Standard Gold Off Exchange Plan","78.28%",,"No","Yes","No","100%",,"$1,500","$400","$600","$0","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNGold5.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","36"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030045","MyHPN Gold 5","95865NV003",,"NVN001","NVS001","NVF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030045-01","Standard Gold On Exchange Plan","78.28%",,"No","Yes","No","100%",,"$1,500","$400","$600","$0","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNGold5.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","37"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030045","MyHPN Gold 5","95865NV003",,"NVN001","NVS001","NVF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030045-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNGold5_ZCS.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","38"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030045","MyHPN Gold 5","95865NV003",,"NVN001","NVS001","NVF003","New","HMO","Gold","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030045-03","Limited Cost Sharing Plan Variation","78.28%",,"No","Yes","No","100%",,"$1,500","$400","$600","$0","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNGold5.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","39"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030044","MyHPN Platinum 1","95865NV003",,"NVN001","NVS001","NVF004","Existing","HMO","Platinum","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030044-00","Standard Platinum Off Exchange Plan","89.97%",,"No","Yes","No","100%",,"$100","$300","$600","$0","$0","$1,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNPlatinum1.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","40"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030044","MyHPN Platinum 1","95865NV003",,"NVN001","NVS001","NVF004","Existing","HMO","Platinum","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030044-01","Standard Platinum On Exchange Plan","89.97%",,"No","Yes","No","100%",,"$100","$300","$600","$0","$0","$1,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNPlatinum1.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","41"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030044","MyHPN Platinum 1","95865NV003",,"NVN001","NVS001","NVF004","Existing","HMO","Platinum","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030044-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNPlatinum1_ZCS.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","42"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030044","MyHPN Platinum 1","95865NV003",,"NVN001","NVS001","NVF004","Existing","HMO","Platinum","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030044-03","Limited Cost Sharing Plan Variation","89.97%",,"No","Yes","No","100%",,"$100","$300","$600","$0","$0","$1,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNPlatinum1.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","43"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030018","MyHPN Silver 1.1","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030018-00","Standard Silver Off Exchange Plan","70.81%",,"No","Yes","No","100%",,"$3,000","$500","$800","$0","$0","$1,800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$250","$250 per person","$500 per group","30%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver1.1.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","44"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030018","MyHPN Silver 1.1","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030018-01","Standard Silver On Exchange Plan","70.81%",,"No","Yes","No","100%",,"$3,000","$500","$800","$0","$0","$1,800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$250","$250 per person","$500 per group","30%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver1.1.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","45"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030018","MyHPN Silver 1.1","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030018-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver1.1_ZCS.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","46"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030018","MyHPN Silver 1.1","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030018-03","Limited Cost Sharing Plan Variation","70.81%",,"No","Yes","No","100%",,"$3,000","$500","$800","$0","$0","$1,800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$250","$250 per person","$500 per group","30%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver1.1.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","47"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030018","MyHPN Silver 1.1","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030018-04","73% AV Level Silver Plan","72.85%",,"No","Yes","No","100%",,"$3,000","$500","$800","$0","$0","$1,800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$250","$250 per person","$500 per group","30%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver1.1_73.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","48"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030018","MyHPN Silver 1.1","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030018-05","87% AV Level Silver Plan","86.59%",,"No","Yes","No","100%",,"$0","$500","$1,200","$0","$0","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver1.1_87.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","49"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030018","MyHPN Silver 1.1","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030018-06","94% AV Level Silver Plan","94.12%",,"No","Yes","No","100%",,"$0","$500","$1,200","$0","$0","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver1.1_94.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","50"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030014","MyHPN Silver 3.1","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030014-00","Standard Silver Off Exchange Plan","68.72%",,"No","Yes","No","100%",,"$4,000","$500","$500","$0","$0","$2,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$250","$250 per person","$500 per group","30%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver3.1.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","51"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030014","MyHPN Silver 3.1","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030014-01","Standard Silver On Exchange Plan","68.72%",,"No","Yes","No","100%",,"$4,000","$500","$500","$0","$0","$2,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$250","$250 per person","$500 per group","30%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver3.1.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","52"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030014","MyHPN Silver 3.1","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030014-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver3.1_ZCS.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","53"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030014","MyHPN Silver 3.1","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030014-03","Limited Cost Sharing Plan Variation","68.72%",,"No","Yes","No","100%",,"$4,000","$500","$500","$0","$0","$2,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","$4,000","$4000 per person","$8000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$250","$250 per person","$500 per group","30%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver3.1.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","54"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030014","MyHPN Silver 3.1","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030014-04","73% AV Level Silver Plan","72.15%",,"No","Yes","No","100%",,"$3,000","$500","$800","$0","$0","$2,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$250","$250 per person","$500 per group","30%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver3.1_73.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","55"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030014","MyHPN Silver 3.1","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030014-05","87% AV Level Silver Plan","86.95%",,"No","Yes","No","100%",,"$0","$500","$900","$0","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver3.1_87.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","56"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030014","MyHPN Silver 3.1","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030014-06","94% AV Level Silver Plan","93.79%",,"No","Yes","No","100%",,"$0","$300","$400","$0","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver3.1_94.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","57"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030019","MyHPN Silver 4.1","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030019-00","Standard Silver Off Exchange Plan","70.54%",,"No","Yes","No","100%",,"$3,000","$500","$800","$0","$0","$2,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$250","$250 per person","$500 per group","30%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver4.1.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","58"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030019","MyHPN Silver 4.1","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030019-01","Standard Silver On Exchange Plan","70.54%",,"No","Yes","No","100%",,"$3,000","$500","$800","$0","$0","$2,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$250","$250 per person","$500 per group","30%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver4.1.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","59"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030019","MyHPN Silver 4.1","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030019-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver4.1_ZCS.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","60"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030019","MyHPN Silver 4.1","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030019-03","Limited Cost Sharing Plan Variation","70.54%",,"No","Yes","No","100%",,"$3,000","$500","$800","$0","$0","$2,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,250","$6250 per person","$12500 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$250","$250 per person","$500 per group","30%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver4.1.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","61"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030019","MyHPN Silver 4.1","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030019-04","73% AV Level Silver Plan","73.72%",,"No","Yes","No","100%",,"$3,000","$500","$800","$0","$0","$2,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","$250","$250 per person","$500 per group","30%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver4.1_73.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","62"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030019","MyHPN Silver 4.1","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030019-05","87% AV Level Silver Plan","87.86%",,"No","Yes","No","100%",,"$0","$500","$900","$0","$0","$1,500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver4.1_87.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","63"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030019","MyHPN Silver 4.1","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030019-06","94% AV Level Silver Plan","93.69%",,"No","Yes","No","100%",,"$0","$300","$400","$0","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver4.1_94.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","64"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030047","MyHPN Silver 5","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030047-00","Standard Silver Off Exchange Plan","69.21%",,"No","Yes","No","100%",,"$5,000","$500","$200","$0","$0","$2,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$250","$250 per person","$500 per group","30%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver5.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","65"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030047","MyHPN Silver 5","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030047-01","Standard Silver On Exchange Plan","69.21%",,"No","Yes","No","100%",,"$5,000","$500","$200","$0","$0","$2,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$250","$250 per person","$500 per group","30%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver5.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","66"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030047","MyHPN Silver 5","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030047-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver5_ZCS.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","67"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030047","MyHPN Silver 5","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030047-03","Limited Cost Sharing Plan Variation","69.21%",,"No","Yes","No","100%",,"$5,000","$500","$200","$0","$0","$2,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,600","$6600 per person","$13200 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","$250","$250 per person","$500 per group","30%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver5.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","68"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030047","MyHPN Silver 5","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030047-04","73% AV Level Silver Plan","73.36%",,"No","Yes","No","100%",,"$3,500","$500","$600","$0","$0","$2,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,900","$4900 per person","$9800 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$250","$250 per person","$500 per group","30%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver5_73.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","69"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030047","MyHPN Silver 5","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030047-05","87% AV Level Silver Plan","87.61%",,"No","Yes","No","100%",,"$0","$500","$1,200","$0","$0","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver5_87.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","70"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030047","MyHPN Silver 5","95865NV003",,"NVN001","NVS001","NVF005","Existing","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030047-06","94% AV Level Silver Plan","93.94%",,"No","Yes","No","100%",,"$0","$300","$400","$0","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver5_94.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","71"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030048","MyHPN Silver 6/Medicaid Transition Plan","95865NV003",,"NVN001","NVS001","NVF006","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030048-00","Standard Silver Off Exchange Plan","69.85%",,"No","Yes","No","100%",,"$4,500","$500","$300","$0","$0","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver6MT.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","72"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030048","MyHPN Silver 6/Medicaid Transition Plan","95865NV003",,"NVN001","NVS001","NVF006","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030048-01","Standard Silver On Exchange Plan","69.85%",,"No","Yes","No","100%",,"$4,500","$500","$300","$0","$0","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver6MT.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","73"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030048","MyHPN Silver 6/Medicaid Transition Plan","95865NV003",,"NVN001","NVS001","NVF006","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030048-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver6MT_ZCS.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","74"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030048","MyHPN Silver 6/Medicaid Transition Plan","95865NV003",,"NVN001","NVS001","NVF006","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030048-03","Limited Cost Sharing Plan Variation","69.85%",,"No","Yes","No","100%",,"$4,500","$500","$300","$0","$0","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver6MT.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","75"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030048","MyHPN Silver 6/Medicaid Transition Plan","95865NV003",,"NVN001","NVS001","NVF006","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030048-04","73% AV Level Silver Plan","72.49%",,"No","Yes","No","100%",,"$4,500","$500","$300","$0","$0","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver6MT_73.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","76"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030048","MyHPN Silver 6/Medicaid Transition Plan","95865NV003",,"NVN001","NVS001","NVF006","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030048-05","87% AV Level Silver Plan","87.10%",,"No","Yes","No","100%",,"$500","$500","$700","$0","$0","$1,700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver6MT_87.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","77"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","1","95865","NV","Individual","No","88-0201035","95865NV0030048","MyHPN Silver 6/Medicaid Transition Plan","95865NV003",,"NVN001","NVS001","NVF006","New","HMO","Silver","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030048-06","94% AV Level Silver Plan","94.18%",,"No","Yes","No","100%",,"$0","$300","$400","$0","$0","$700","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.myhpnonline.com/media/SBC/MyHPNSilver6MT_94.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","78"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","2","95865","NV","Individual","No","88-0201035","95865NV0030023","MyHPN Catastrophic","95865NV003",,"NVN001","NVS001","NVF002","New","HMO","Catastrophic","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030023-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$200","$0","$0","$800","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.myhpnonline.com/media/SBC/MyHPNCatastrophic.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","4"
"2016","NV","95865","SERFF","5","2015-08-20 12:28:36","2","95865","NV","Individual","No","88-0201035","95865NV0030023","MyHPN Catastrophic","95865NV003",,"NVN001","NVS001","NVF002","New","HMO","Catastrophic","Yes","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergent and Urgent Services","No","https://payhpn.com/payment/d0f33749-10b6-40a6-9a7e-cb036d37c974","http://www.myhpnonline.com/media/other/PreferredDrugList.pdf","95865NV0030023-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,300","$200","$0","$0","$800","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://www.myhpnonline.com/media/SBC/MyHPNCatastrophic.pdf","http://www.myhpnonline.com/media/other/2016PlanBrochure.pdf","5"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560001","Select Gold 250-70","20126OH056",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9836",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560001-00","Standard Gold Off Exchange Plan",,"0.803593873977661","Yes","Yes","No","100%",,"$250","$15","$2,100","$0","$100","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016Gold25070","http://www.healthspan.org/marketplace/2016Individual","4"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560001","Select Gold 250-70","20126OH056",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9836",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560001-01","Standard Gold On Exchange Plan",,"0.803593873977661","Yes","Yes","No","100%",,"$250","$15","$2,100","$0","$100","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016Gold25070","http://www.healthspan.org/marketplace/2016Individual","5"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560001","Select Gold 250-70","20126OH056",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9836",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016zerocostsharing","http://www.healthspan.org/marketplace/2016Individual","6"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560001","Select Gold 250-70","20126OH056",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9836",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560001-03","Limited Cost Sharing Plan Variation",,"0.803593873977661","Yes","Yes","No","100%",,"$250","$15","$2,100","$0","$100","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016Gold25070","http://www.healthspan.org/marketplace/2016Individual","7"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560002","Select Gold 1000-80","20126OH056",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9836",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560002-00","Standard Gold Off Exchange Plan",,"0.809406518936157","No","Yes","No","100%",,"$1,000","$15","$1,250","$0","$100","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016Gold100080","http://www.healthspan.org/marketplace/2016Individual","8"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560002","Select Gold 1000-80","20126OH056",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9836",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560002-01","Standard Gold On Exchange Plan",,"0.809406518936157","No","Yes","No","100%",,"$1,000","$15","$1,250","$0","$100","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016Gold100080","http://www.healthspan.org/marketplace/2016Individual","9"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560002","Select Gold 1000-80","20126OH056",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9836",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016zerocostsharing","http://www.healthspan.org/marketplace/2016Individual","10"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560002","Select Gold 1000-80","20126OH056",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9836",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560002-03","Limited Cost Sharing Plan Variation",,"0.809406518936157","No","Yes","No","100%",,"$1,000","$15","$1,250","$0","$100","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016Gold100080","http://www.healthspan.org/marketplace/2016Individual","11"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560008","Select Gold 2000-100","20126OH056",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9836",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560008-00","Standard Gold Off Exchange Plan",,"0.791869163513184","No","Yes","No","100%",,"$2,000","$15","$0","$0","$100","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016Gold2000100","http://www.healthspan.org/marketplace/2016Individual","12"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560008","Select Gold 2000-100","20126OH056",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9836",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560008-01","Standard Gold On Exchange Plan",,"0.791869163513184","No","Yes","No","100%",,"$2,000","$15","$0","$0","$100","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016Gold2000100","http://www.healthspan.org/marketplace/2016Individual","13"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560008","Select Gold 2000-100","20126OH056",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9836",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016zerocostsharing","http://www.healthspan.org/marketplace/2016Individual","14"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560008","Select Gold 2000-100","20126OH056",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9836",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560008-03","Limited Cost Sharing Plan Variation",,"0.791869163513184","No","Yes","No","100%",,"$2,000","$15","$0","$0","$100","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016Gold2000100","http://www.healthspan.org/marketplace/2016Individual","15"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560006","Select Silver 1500-70 HSA","20126OH056",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9856",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560006-00","Standard Silver Off Exchange Plan",,"0.718231022357941","Yes","Yes","No","100%",,"$1,500","$0","$1,740","$0","$1,500","$0","$1,150","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.healthspan.org/marketplace/2016Silver150070HSA","http://www.healthspan.org/marketplace/2016Individual","16"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560006","Select Silver 1500-70 HSA","20126OH056",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9856",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560006-01","Standard Silver On Exchange Plan",,"0.718231022357941","Yes","Yes","No","100%",,"$1,500","$0","$1,740","$0","$1,500","$0","$1,150","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.healthspan.org/marketplace/2016Silver150070HSA","http://www.healthspan.org/marketplace/2016Individual","17"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560006","Select Silver 1500-70 HSA","20126OH056",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9856",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016zerocostsharing","http://www.healthspan.org/marketplace/2016Individual","18"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560006","Select Silver 1500-70 HSA","20126OH056",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9856",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560006-03","Limited Cost Sharing Plan Variation",,"0.718231022357941","Yes","Yes","No","100%",,"$1,500","$0","$1,740","$0","$1,500","$0","$1,150","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.healthspan.org/marketplace/2016Silver150070HSA","http://www.healthspan.org/marketplace/2016Individual","19"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560006","Select Silver 1500-70 HSA","20126OH056",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9856",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560006-04","73% AV Level Silver Plan",,"0.738359868526459","Yes","Yes","No","100%",,"$1,300","$0","$1,800","$0","$1,300","$0","$1,150","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$2600 per person","$2600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.healthspan.org/marketplace/2016Silver150070HSAplanC","http://www.healthspan.org/marketplace/2016Individual","20"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560006","Select Silver 1500-70 HSA","20126OH056",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9856",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560006-05","87% AV Level Silver Plan",,"0.875510036945343","Yes","Yes","No","100%",,"$250","$0","$1,410","$0","$250","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016Silver150070HSAplanB","http://www.healthspan.org/marketplace/2016Individual","21"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560006","Select Silver 1500-70 HSA","20126OH056",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9856",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560006-06","94% AV Level Silver Plan",,"0.937820553779602","Yes","Yes","No","100%",,"$0","$0","$740","$0","$0","$0","$590","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016Silver150070HSAplanA","http://www.healthspan.org/marketplace/2016Individual","22"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560003","Select Silver 2500-70","20126OH056",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9855",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560003-00","Standard Silver Off Exchange Plan",,"0.716398894786835","No","Yes","No","100%",,"$2,500","$20","$1,430","$0","$100","$1,250","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/20162500-70","http://www.healthspan.org/marketplace/2016Individual","23"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560003","Select Silver 2500-70","20126OH056",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9855",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560003-01","Standard Silver On Exchange Plan",,"0.716398894786835","No","Yes","No","100%",,"$2,500","$20","$1,430","$0","$100","$1,250","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/20162500-70","http://www.healthspan.org/marketplace/2016Individual","24"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560003","Select Silver 2500-70","20126OH056",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9855",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016zerocostsharing","http://www.healthspan.org/marketplace/2016Individual","25"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560003","Select Silver 2500-70","20126OH056",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9855",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560003-03","Limited Cost Sharing Plan Variation",,"0.716398894786835","No","Yes","No","100%",,"$2,500","$20","$1,430","$0","$100","$1,250","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/20162500-70","http://www.healthspan.org/marketplace/2016Individual","26"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560003","Select Silver 2500-70","20126OH056",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9855",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560003-04","73% AV Level Silver Plan",,"0.737255573272705","No","Yes","No","100%",,"$2,500","$20","$1,430","$0","$100","$1,250","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/20162500-70planC","http://www.healthspan.org/marketplace/2016Individual","27"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560003","Select Silver 2500-70","20126OH056",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9855",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560003-05","87% AV Level Silver Plan",,"0.877739369869232","No","Yes","No","100%",,"$500","$20","$1,350","$0","$100","$850","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/20162500-70planB","http://www.healthspan.org/marketplace/2016Individual","28"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560003","Select Silver 2500-70","20126OH056",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9855",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560003-06","94% AV Level Silver Plan",,"0.943744421005249","No","Yes","No","100%",,"$0","$20","$1,450","$0","$0","$450","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/20162500-70planA","http://www.healthspan.org/marketplace/2016Individual","29"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560010","Select Silver 3500 HSA","20126OH056",,"OHN001","OHS001","OHF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9855",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560010-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$0","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.healthspan.org/marketplace/20163500HSA","http://www.healthspan.org/marketplace/2016Individual","30"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560010","Select Silver 3500 HSA","20126OH056",,"OHN001","OHS001","OHF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9855",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560010-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$0","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.healthspan.org/marketplace/20163500HSA","http://www.healthspan.org/marketplace/2016Individual","31"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560010","Select Silver 3500 HSA","20126OH056",,"OHN001","OHS001","OHF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9855",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016zerocostsharing","http://www.healthspan.org/marketplace/2016Individual","32"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560010","Select Silver 3500 HSA","20126OH056",,"OHN001","OHS001","OHF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9855",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560010-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$0","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.healthspan.org/marketplace/20163500HSA","http://www.healthspan.org/marketplace/2016Individual","33"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560010","Select Silver 3500 HSA","20126OH056",,"OHN001","OHS001","OHF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9855",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560010-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.healthspan.org/marketplace/20163500HSAplanC","http://www.healthspan.org/marketplace/2016Individual","34"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560010","Select Silver 3500 HSA","20126OH056",,"OHN001","OHS001","OHF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9855",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560010-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$0","$1,250","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/20163500HSAplanB","http://www.healthspan.org/marketplace/2016Individual","35"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560010","Select Silver 3500 HSA","20126OH056",,"OHN001","OHS001","OHF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9855",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560010-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$0","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/20163500HSAplanA","http://www.healthspan.org/marketplace/2016Individual","36"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560007","Select Bronze 4500-70 HSA","20126OH056",,"OHN001","OHS001","OHF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9876",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560007-00","Standard Bronze Off Exchange Plan",,"0.615526735782623","Yes","Yes","No","100%",,"$4,500","$0","$840","$0","$4,500","$0","$250","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.healthspan.org/marketplace/2016450070HSA","http://www.healthspan.org/marketplace/2016Individual","37"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560007","Select Bronze 4500-70 HSA","20126OH056",,"OHN001","OHS001","OHF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9876",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560007-01","Standard Bronze On Exchange Plan",,"0.615526735782623","Yes","Yes","No","100%",,"$4,500","$0","$840","$0","$4,500","$0","$250","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.healthspan.org/marketplace/2016450070HSA","http://www.healthspan.org/marketplace/2016Individual","38"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560007","Select Bronze 4500-70 HSA","20126OH056",,"OHN001","OHS001","OHF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9876",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016zerocostsharing","http://www.healthspan.org/marketplace/2016Individual","39"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560007","Select Bronze 4500-70 HSA","20126OH056",,"OHN001","OHS001","OHF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9876",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560007-03","Limited Cost Sharing Plan Variation",,"0.615526735782623","Yes","Yes","No","100%",,"$4,500","$0","$840","$0","$4,500","$0","$250","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.healthspan.org/marketplace/2016450070HSA","http://www.healthspan.org/marketplace/2016Individual","40"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560004","Select Bronze 5500-80","20126OH056",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9872",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560004-00","Standard Bronze Off Exchange Plan",,"0.616932034492493","No","Yes","No","100%",,"$5,500","$20","$350","$0","$1,200","$460","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016550080","http://www.healthspan.org/marketplace/2016Individual","41"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560004","Select Bronze 5500-80","20126OH056",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9872",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560004-01","Standard Bronze On Exchange Plan",,"0.616932034492493","No","Yes","No","100%",,"$5,500","$20","$350","$0","$1,200","$460","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016550080","http://www.healthspan.org/marketplace/2016Individual","42"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560004","Select Bronze 5500-80","20126OH056",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9872",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016zerocostsharing","http://www.healthspan.org/marketplace/2016Individual","43"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560004","Select Bronze 5500-80","20126OH056",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9872",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560004-03","Limited Cost Sharing Plan Variation",,"0.616932034492493","No","Yes","No","100%",,"$5,500","$20","$350","$0","$1,200","$460","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016550080","http://www.healthspan.org/marketplace/2016Individual","44"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560011","Select Bronze 6000 HSA","20126OH056",,"OHN001","OHS001","OHF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9876",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560011-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$0","$5,320","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.healthspan.org/marketplace/20166000HSA","http://www.healthspan.org/marketplace/2016Individual","45"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560011","Select Bronze 6000 HSA","20126OH056",,"OHN001","OHS001","OHF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9876",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560011-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$0","$5,320","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.healthspan.org/marketplace/20166000HSA","http://www.healthspan.org/marketplace/2016Individual","46"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560011","Select Bronze 6000 HSA","20126OH056",,"OHN001","OHS001","OHF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9876",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016zerocostsharing","http://www.healthspan.org/marketplace/2016Individual","47"
"2016","OH","20126","SERFF","9","2015-08-23 14:39:40","1","20126","OH","Individual","No","34-0922268","20126OH0560011","Select Bronze 6000 HSA","20126OH056",,"OHN001","OHS001","OHF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9876",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","20126OH0560011-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$0","$5,320","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.healthspan.org/marketplace/20166000HSA","http://www.healthspan.org/marketplace/2016Individual","48"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","1","23340","OH","Individual","No","21-0706531","23340OH0010001","Market HMO 1000 - Mercy","23340OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010001-00","Standard Gold Off Exchange Plan",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005370000000000",,"4"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","1","23340","OH","Individual","Yes","21-0706531","23340OH0030001","MedMutual Pediatric Dental","23340OH003",,"OHN003","OHS002",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$24.93","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","23340OH0030001-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","1","23340","OH","Individual","No","21-0706531","23340OH0010001","Market HMO 1000 - Mercy","23340OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010001-01","Standard Gold On Exchange Plan",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005370000000000",,"5"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","1","23340","OH","Individual","No","21-0706531","23340OH0010001","Market HMO 1000 - Mercy","23340OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005371000000000",,"6"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","1","23340","OH","Individual","No","21-0706531","23340OH0010001","Market HMO 1000 - Mercy","23340OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010001-03","Limited Cost Sharing Plan Variation",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005370000000000",,"7"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","1","23340","OH","Individual","No","21-0706531","23340OH0010002","Market Child Only HMO 1000 - Mercy","23340OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010002-00","Standard Gold Off Exchange Plan",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005370000000000",,"8"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","1","23340","OH","Individual","No","21-0706531","23340OH0010002","Market Child Only HMO 1000 - Mercy","23340OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010002-01","Standard Gold On Exchange Plan",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005370000000000",,"9"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","1","23340","OH","Individual","No","21-0706531","23340OH0010002","Market Child Only HMO 1000 - Mercy","23340OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005371000000000",,"10"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","1","23340","OH","Individual","No","21-0706531","23340OH0010002","Market Child Only HMO 1000 - Mercy","23340OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010002-03","Limited Cost Sharing Plan Variation",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005370000000000",,"11"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","2","23340","OH","Individual","No","21-0706531","23340OH0010003","Market HMO 1750 - Mercy","23340OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010004","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010003-00","Standard Silver Off Exchange Plan",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005374000000000",,"4"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","2","23340","OH","Individual","Yes","21-0706531","23340OH0030002","MedMutual Dental 1","23340OH003",,"OHN003","OHS002",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.93","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","23340OH0030002-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","2","23340","OH","Individual","No","21-0706531","23340OH0010003","Market HMO 1750 - Mercy","23340OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010004","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010003-01","Standard Silver On Exchange Plan",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005374000000000",,"5"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","2","23340","OH","Individual","No","21-0706531","23340OH0010003","Market HMO 1750 - Mercy","23340OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010004","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005375000000000",,"6"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","2","23340","OH","Individual","No","21-0706531","23340OH0010003","Market HMO 1750 - Mercy","23340OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010004","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010003-03","Limited Cost Sharing Plan Variation",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005374000000000",,"7"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","2","23340","OH","Individual","No","21-0706531","23340OH0010003","Market HMO 1750 - Mercy","23340OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010004","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010003-04","73% AV Level Silver Plan",,"0.732713162899017","No","Yes","No","100%",,"$1,500","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005376000000000",,"8"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","2","23340","OH","Individual","No","21-0706531","23340OH0010003","Market HMO 1750 - Mercy","23340OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010004","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010003-05","87% AV Level Silver Plan",,"0.864307463169098","No","Yes","No","100%",,"$800","$0","$400","$200","$100","$1,000","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005377000000000",,"9"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","2","23340","OH","Individual","No","21-0706531","23340OH0010003","Market HMO 1750 - Mercy","23340OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010004","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010003-06","94% AV Level Silver Plan",,"0.93464720249176","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$400","$30","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005378000000000",,"10"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","2","23340","OH","Individual","No","21-0706531","23340OH0010004","Market Child Only HMO 1750 - Mercy","23340OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010004-00","Standard Silver Off Exchange Plan",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005374000000000",,"11"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","2","23340","OH","Individual","No","21-0706531","23340OH0010004","Market Child Only HMO 1750 - Mercy","23340OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010004-01","Standard Silver On Exchange Plan",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005374000000000",,"12"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","2","23340","OH","Individual","No","21-0706531","23340OH0010004","Market Child Only HMO 1750 - Mercy","23340OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005375000000000",,"13"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","2","23340","OH","Individual","No","21-0706531","23340OH0010004","Market Child Only HMO 1750 - Mercy","23340OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010004-03","Limited Cost Sharing Plan Variation",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005374000000000",,"14"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","2","23340","OH","Individual","No","21-0706531","23340OH0010004","Market Child Only HMO 1750 - Mercy","23340OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010004-04","73% AV Level Silver Plan",,"0.732713162899017","No","Yes","No","100%",,"$1,500","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005376000000000",,"15"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","2","23340","OH","Individual","No","21-0706531","23340OH0010004","Market Child Only HMO 1750 - Mercy","23340OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010004-05","87% AV Level Silver Plan",,"0.864307463169098","No","Yes","No","100%",,"$800","$0","$400","$200","$100","$1,000","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005377000000000",,"16"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","2","23340","OH","Individual","No","21-0706531","23340OH0010004","Market Child Only HMO 1750 - Mercy","23340OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010004-06","94% AV Level Silver Plan",,"0.93464720249176","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$400","$30","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005378000000000",,"17"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","3","23340","OH","Individual","No","21-0706531","23340OH0010005","Market HMO 4000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010006","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010005-00","Standard Silver Off Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005379000000000",,"4"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","3","23340","OH","Individual","Yes","21-0706531","23340OH0030003","MedMutual Dental 2","23340OH003",,"OHN003","OHS002",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.93","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","23340OH0030003-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","3","23340","OH","Individual","No","21-0706531","23340OH0010005","Market HMO 4000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010006","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010005-01","Standard Silver On Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005379000000000",,"5"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","3","23340","OH","Individual","No","21-0706531","23340OH0010005","Market HMO 4000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010006","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005380000000000",,"6"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","3","23340","OH","Individual","No","21-0706531","23340OH0010005","Market HMO 4000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010006","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010005-03","Limited Cost Sharing Plan Variation",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005379000000000",,"7"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","3","23340","OH","Individual","No","21-0706531","23340OH0010005","Market HMO 4000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010006","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010005-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$3,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005381000000000",,"8"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","3","23340","OH","Individual","No","21-0706531","23340OH0010005","Market HMO 4000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010006","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010005-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,200","$0","$0","$200","$1,200","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005382000000000",,"9"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","3","23340","OH","Individual","No","21-0706531","23340OH0010005","Market HMO 4000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010006","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010005-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005383000000000",,"10"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","3","23340","OH","Individual","No","21-0706531","23340OH0010006","Market Child Only HMO 4000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010006-00","Standard Silver Off Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005379000000000",,"11"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","3","23340","OH","Individual","No","21-0706531","23340OH0010006","Market Child Only HMO 4000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010006-01","Standard Silver On Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005379000000000",,"12"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","3","23340","OH","Individual","No","21-0706531","23340OH0010006","Market Child Only HMO 4000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005380000000000",,"13"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","3","23340","OH","Individual","No","21-0706531","23340OH0010006","Market Child Only HMO 4000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010006-03","Limited Cost Sharing Plan Variation",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005379000000000",,"14"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","3","23340","OH","Individual","No","21-0706531","23340OH0010006","Market Child Only HMO 4000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010006-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$3,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005381000000000",,"15"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","3","23340","OH","Individual","No","21-0706531","23340OH0010006","Market Child Only HMO 4000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010006-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,200","$0","$0","$200","$1,200","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005382000000000",,"16"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","3","23340","OH","Individual","No","21-0706531","23340OH0010006","Market Child Only HMO 4000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010006-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005383000000000",,"17"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","4","23340","OH","Individual","No","21-0706531","23340OH0010007","Market HMO 6000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010008","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010007-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005384000000000",,"4"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","4","23340","OH","Individual","Yes","21-0706531","23340OH0030004","MedMutual Dental 3","23340OH003",,"OHN003","OHS002",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.93","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","23340OH0030004-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","4","23340","OH","Individual","No","21-0706531","23340OH0010007","Market HMO 6000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010008","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010007-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005384000000000",,"5"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","4","23340","OH","Individual","No","21-0706531","23340OH0010007","Market HMO 6000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010008","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005385000000000",,"6"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","4","23340","OH","Individual","No","21-0706531","23340OH0010007","Market HMO 6000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010008","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010007-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005384000000000",,"7"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","4","23340","OH","Individual","No","21-0706531","23340OH0010008","Market Child Only HMO 6000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010008-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005384000000000",,"8"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","4","23340","OH","Individual","No","21-0706531","23340OH0010008","Market Child Only HMO 6000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010008-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005384000000000",,"9"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","4","23340","OH","Individual","No","21-0706531","23340OH0010008","Market Child Only HMO 6000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005385000000000",,"10"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","4","23340","OH","Individual","No","21-0706531","23340OH0010008","Market Child Only HMO 6000 HSA - Mercy","23340OH001",,"OHN001","OHS001","OHF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010008-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005384000000000",,"11"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","5","23340","OH","Individual","No","21-0706531","23340OH0010009","Market HMO 1750 - ProMedica","23340OH001",,"OHN002","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010010","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010009-00","Standard Silver Off Exchange Plan",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005386000000000",,"4"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","5","23340","OH","Individual","No","21-0706531","23340OH0010009","Market HMO 1750 - ProMedica","23340OH001",,"OHN002","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010010","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010009-01","Standard Silver On Exchange Plan",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005386000000000",,"5"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","5","23340","OH","Individual","No","21-0706531","23340OH0010009","Market HMO 1750 - ProMedica","23340OH001",,"OHN002","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010010","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005387000000000",,"6"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","5","23340","OH","Individual","No","21-0706531","23340OH0010009","Market HMO 1750 - ProMedica","23340OH001",,"OHN002","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010010","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010009-03","Limited Cost Sharing Plan Variation",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005386000000000",,"7"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","5","23340","OH","Individual","No","21-0706531","23340OH0010009","Market HMO 1750 - ProMedica","23340OH001",,"OHN002","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010010","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010009-04","73% AV Level Silver Plan",,"0.732713162899017","No","Yes","No","100%",,"$1,500","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005388000000000",,"8"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","5","23340","OH","Individual","No","21-0706531","23340OH0010009","Market HMO 1750 - ProMedica","23340OH001",,"OHN002","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010010","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010009-05","87% AV Level Silver Plan",,"0.864307463169098","No","Yes","No","100%",,"$800","$0","$400","$200","$100","$1,000","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005389000000000",,"9"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","5","23340","OH","Individual","No","21-0706531","23340OH0010009","Market HMO 1750 - ProMedica","23340OH001",,"OHN002","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010010","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010009-06","94% AV Level Silver Plan",,"0.93464720249176","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$400","$30","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005390000000000",,"10"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","5","23340","OH","Individual","No","21-0706531","23340OH0010010","Market Child Only HMO 1750 - ProMedica","23340OH001",,"OHN002","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010010-00","Standard Silver Off Exchange Plan",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005386000000000",,"11"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","5","23340","OH","Individual","No","21-0706531","23340OH0010010","Market Child Only HMO 1750 - ProMedica","23340OH001",,"OHN002","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010010-01","Standard Silver On Exchange Plan",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005386000000000",,"12"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","5","23340","OH","Individual","No","21-0706531","23340OH0010010","Market Child Only HMO 1750 - ProMedica","23340OH001",,"OHN002","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005387000000000",,"13"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","5","23340","OH","Individual","No","21-0706531","23340OH0010010","Market Child Only HMO 1750 - ProMedica","23340OH001",,"OHN002","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010010-03","Limited Cost Sharing Plan Variation",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005386000000000",,"14"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","5","23340","OH","Individual","No","21-0706531","23340OH0010010","Market Child Only HMO 1750 - ProMedica","23340OH001",,"OHN002","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010010-04","73% AV Level Silver Plan",,"0.732713162899017","No","Yes","No","100%",,"$1,500","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005388000000000",,"15"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","5","23340","OH","Individual","No","21-0706531","23340OH0010010","Market Child Only HMO 1750 - ProMedica","23340OH001",,"OHN002","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010010-05","87% AV Level Silver Plan",,"0.864307463169098","No","Yes","No","100%",,"$800","$0","$400","$200","$100","$1,000","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005389000000000",,"16"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","5","23340","OH","Individual","No","21-0706531","23340OH0010010","Market Child Only HMO 1750 - ProMedica","23340OH001",,"OHN002","OHS001","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010010-06","94% AV Level Silver Plan",,"0.93464720249176","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$400","$30","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005390000000000",,"17"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","6","23340","OH","Individual","No","21-0706531","23340OH0010011","Market HMO 4000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010012","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010011-00","Standard Silver Off Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005391000000000",,"4"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","6","23340","OH","Individual","No","21-0706531","23340OH0010011","Market HMO 4000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010012","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010011-01","Standard Silver On Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005391000000000",,"5"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","6","23340","OH","Individual","No","21-0706531","23340OH0010011","Market HMO 4000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010012","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005392000000000",,"6"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","6","23340","OH","Individual","No","21-0706531","23340OH0010011","Market HMO 4000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010012","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010011-03","Limited Cost Sharing Plan Variation",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005391000000000",,"7"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","6","23340","OH","Individual","No","21-0706531","23340OH0010011","Market HMO 4000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010012","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010011-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$3,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005393000000000",,"8"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","6","23340","OH","Individual","No","21-0706531","23340OH0010011","Market HMO 4000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010012","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010011-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,200","$0","$0","$200","$1,200","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005394000000000",,"9"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","6","23340","OH","Individual","No","21-0706531","23340OH0010011","Market HMO 4000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010012","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010011-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005395000000000",,"10"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","6","23340","OH","Individual","No","21-0706531","23340OH0010012","Market Child Only HMO 4000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010012-00","Standard Silver Off Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005391000000000",,"11"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","6","23340","OH","Individual","No","21-0706531","23340OH0010012","Market Child Only HMO 4000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010012-01","Standard Silver On Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005391000000000",,"12"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","6","23340","OH","Individual","No","21-0706531","23340OH0010012","Market Child Only HMO 4000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005392000000000",,"13"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","6","23340","OH","Individual","No","21-0706531","23340OH0010012","Market Child Only HMO 4000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010012-03","Limited Cost Sharing Plan Variation",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005391000000000",,"14"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","6","23340","OH","Individual","No","21-0706531","23340OH0010012","Market Child Only HMO 4000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010012-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$3,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005393000000000",,"15"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","6","23340","OH","Individual","No","21-0706531","23340OH0010012","Market Child Only HMO 4000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010012-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,200","$0","$0","$200","$1,200","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005394000000000",,"16"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","6","23340","OH","Individual","No","21-0706531","23340OH0010012","Market Child Only HMO 4000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010012-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005395000000000",,"17"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","7","23340","OH","Individual","No","21-0706531","23340OH0010013","Market HMO 6000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010014","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010013-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005396000000000",,"4"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","7","23340","OH","Individual","No","21-0706531","23340OH0010013","Market HMO 6000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010014","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010013-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005396000000000",,"5"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","7","23340","OH","Individual","No","21-0706531","23340OH0010013","Market HMO 6000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010014","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005397000000000",,"6"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","7","23340","OH","Individual","No","21-0706531","23340OH0010013","Market HMO 6000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","23340OH0010014","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010013-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005396000000000",,"7"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","7","23340","OH","Individual","No","21-0706531","23340OH0010014","Market Child Only HMO 6000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010014-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005396000000000",,"8"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","7","23340","OH","Individual","No","21-0706531","23340OH0010014","Market Child Only HMO 6000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010014-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005396000000000",,"9"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","7","23340","OH","Individual","No","21-0706531","23340OH0010014","Market Child Only HMO 6000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005397000000000",,"10"
"2016","OH","23340","SERFF","11","2016-03-05 07:51:04","7","23340","OH","Individual","No","21-0706531","23340OH0010014","Market Child Only HMO 6000 HSA - ProMedica","23340OH001",,"OHN002","OHS001","OHF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","23340OH0010014-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005396000000000",,"11"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","1","26734","OH","Individual","No","46-3024049","26734OH0010001","Premier Health One Gold 1500","26734OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010001-00","Standard Gold Off Exchange Plan",,"0.806017220020294","Yes","Yes","No","100%",,"$1,500","$10","$530","$150","$1,500","$220","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Gold_1500.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","4"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","1","26734","OH","Individual","No","46-3024049","26734OH0010001","Premier Health One Gold 1500","26734OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010001-01","Standard Gold On Exchange Plan",,"0.806017220020294","Yes","Yes","No","100%",,"$1,500","$10","$530","$150","$1,500","$220","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Gold_1500.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","5"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","1","26734","OH","Individual","No","46-3024049","26734OH0010001","Premier Health One Gold 1500","26734OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Gold_1500_ZCS.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","6"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","1","26734","OH","Individual","No","46-3024049","26734OH0010001","Premier Health One Gold 1500","26734OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010001-03","Limited Cost Sharing Plan Variation",,"0.806017220020294","Yes","Yes","No","100%",,"$1,500","$10","$530","$150","$1,500","$220","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Gold_1500_LCS.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","7"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","2","26734","OH","Individual","No","46-3024049","26734OH0010002","Premier Health One Silver 4500/20","26734OH001",,"OHN001","OHS001","OHF006","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010002-00","Standard Silver Off Exchange Plan",,"0.685600638389587","No","Yes","No","100%",,"$4,520","$0","$550","$150","$3,420","$140","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_4500_20.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","4"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","2","26734","OH","Individual","No","46-3024049","26734OH0010002","Premier Health One Silver 4500/20","26734OH001",,"OHN001","OHS001","OHF006","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010002-01","Standard Silver On Exchange Plan",,"0.685600638389587","No","Yes","No","100%",,"$4,520","$0","$550","$150","$3,420","$140","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_4500_20.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","5"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","2","26734","OH","Individual","No","46-3024049","26734OH0010002","Premier Health One Silver 4500/20","26734OH001",,"OHN001","OHS001","OHF006","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_4500_20_ZCS.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","6"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","2","26734","OH","Individual","No","46-3024049","26734OH0010002","Premier Health One Silver 4500/20","26734OH001",,"OHN001","OHS001","OHF006","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010002-03","Limited Cost Sharing Plan Variation",,"0.685600638389587","No","Yes","No","100%",,"$4,520","$0","$550","$150","$3,420","$140","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_4500_20_LCS.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","7"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","2","26734","OH","Individual","No","46-3024049","26734OH0010002","Premier Health One Silver 4500/20","26734OH001",,"OHN001","OHS001","OHF006","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010002-04","73% AV Level Silver Plan",,"0.72056782245636","No","Yes","No","100%",,"$4,320","$0","$590","$150","$3,420","$140","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","$4,300","$4300 per person","$8600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,300","$4300 per person","$8600 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,"No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_4500_20_73CSR.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","8"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","2","26734","OH","Individual","No","46-3024049","26734OH0010002","Premier Health One Silver 4500/20","26734OH001",,"OHN001","OHS001","OHF006","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010002-05","87% AV Level Silver Plan",,"0.860487163066864","No","Yes","No","100%",,"$370","$0","$1,300","$150","$450","$340","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","$100","$100 per person","$200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,"No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_4500_20_87CSR.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","9"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","2","26734","OH","Individual","No","46-3024049","26734OH0010002","Premier Health One Silver 4500/20","26734OH001",,"OHN001","OHS001","OHF006","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010002-06","94% AV Level Silver Plan",,"0.930704474449158","No","Yes","No","100%",,"$90","$0","$670","$150","$90","$300","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","$70","$70 per person","$140 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$70","$70 per person","$140 per group","$20","$20 per person","$40 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$20","$20 per person","$40 per group",,,,,,,,,,,,,,,"No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_4500_20_94CSR.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","10"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","2","26734","OH","Individual","No","46-3024049","26734OH0010003","Premier Health One Silver 3000","26734OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010003-00","Standard Silver Off Exchange Plan",,"0.685454487800598","Yes","Yes","No","100%",,"$3,000","$0","$430","$150","$3,000","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_3000.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","11"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","2","26734","OH","Individual","No","46-3024049","26734OH0010003","Premier Health One Silver 3000","26734OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010003-01","Standard Silver On Exchange Plan",,"0.685454487800598","Yes","Yes","No","100%",,"$3,000","$0","$430","$150","$3,000","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_3000.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","12"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","2","26734","OH","Individual","No","46-3024049","26734OH0010003","Premier Health One Silver 3000","26734OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_3000_ZCS.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","13"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","2","26734","OH","Individual","No","46-3024049","26734OH0010003","Premier Health One Silver 3000","26734OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010003-03","Limited Cost Sharing Plan Variation",,"0.685454487800598","Yes","Yes","No","100%",,"$3,000","$0","$430","$150","$3,000","$0","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Yes",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_3000_LCS.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","14"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","2","26734","OH","Individual","No","46-3024049","26734OH0010003","Premier Health One Silver 3000","26734OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010003-04","73% AV Level Silver Plan",,"0.72093391418457","Yes","Yes","No","100%",,"$2,450","$0","$480","$150","$2,450","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,450","$2450 per person","$4900 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_3000_73CSR.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","15"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","2","26734","OH","Individual","No","46-3024049","26734OH0010003","Premier Health One Silver 3000","26734OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010003-05","87% AV Level Silver Plan",,"0.861187636852264","Yes","Yes","No","100%",,"$750","$0","$650","$150","$750","$0","$450","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,100","$2100 per person","$4200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_3000_87CSR.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","16"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","2","26734","OH","Individual","No","46-3024049","26734OH0010003","Premier Health One Silver 3000","26734OH001",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010003-06","94% AV Level Silver Plan",,"0.931407749652863","Yes","Yes","No","100%",,"$200","$0","$700","$150","$200","$0","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_3000_94CSR.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","17"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","3","26734","OH","Individual","No","46-3024049","26734OH0010004","Premier Health One Bronze 6000/40","26734OH001",,"OHN001","OHS001","OHF008","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010004-00","Standard Bronze Off Exchange Plan",,"0.607021570205688","Yes","Yes","No","100%",,"$6,000","$770","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Bronze_6000_40.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","4"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","3","26734","OH","Individual","No","46-3024049","26734OH0010004","Premier Health One Bronze 6000/40","26734OH001",,"OHN001","OHS001","OHF008","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010004-01","Standard Bronze On Exchange Plan",,"0.607021570205688","Yes","Yes","No","100%",,"$6,000","$770","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Bronze_6000_40.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","5"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","3","26734","OH","Individual","No","46-3024049","26734OH0010004","Premier Health One Bronze 6000/40","26734OH001",,"OHN001","OHS001","OHF008","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Bronze_6000_40_ZCS.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","6"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","3","26734","OH","Individual","No","46-3024049","26734OH0010004","Premier Health One Bronze 6000/40","26734OH001",,"OHN001","OHS001","OHF008","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010004-03","Limited Cost Sharing Plan Variation",,"0.607021570205688","Yes","Yes","No","100%",,"$6,000","$770","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Bronze_6000_40_LCS.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","7"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","3","26734","OH","Individual","No","46-3024049","26734OH0010005","Premier Health One Bronze 6500","26734OH001",,"OHN001","OHS001","OHF009","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010005-00","Standard Bronze Off Exchange Plan",,"0.600919127464294","Yes","Yes","No","100%",,"$6,500","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","Yes",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Bronze_6500.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","8"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","3","26734","OH","Individual","No","46-3024049","26734OH0010005","Premier Health One Bronze 6500","26734OH001",,"OHN001","OHS001","OHF009","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010005-01","Standard Bronze On Exchange Plan",,"0.600919127464294","Yes","Yes","No","100%",,"$6,500","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","Yes",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Bronze_6500.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","9"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","3","26734","OH","Individual","No","46-3024049","26734OH0010005","Premier Health One Bronze 6500","26734OH001",,"OHN001","OHS001","OHF009","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Bronze_6500_ZCS.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","10"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","3","26734","OH","Individual","No","46-3024049","26734OH0010005","Premier Health One Bronze 6500","26734OH001",,"OHN001","OHS001","OHF009","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010005-03","Limited Cost Sharing Plan Variation",,"0.600919127464294","Yes","Yes","No","100%",,"$6,500","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","Yes",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Bronze_6500_LCS.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","11"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","4","26734","OH","Individual","No","46-3024049","26734OH0010006","Premier Health One Silver 2500","26734OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010006-00","Standard Silver Off Exchange Plan",,"0.718543708324432","Yes","Yes","No","100%",,"$2,500","$10","$480","$150","$2,500","$280","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_2500.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","4"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","4","26734","OH","Individual","No","46-3024049","26734OH0010006","Premier Health One Silver 2500","26734OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010006-01","Standard Silver On Exchange Plan",,"0.718543708324432","Yes","Yes","No","100%",,"$2,500","$10","$480","$150","$2,500","$280","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_2500.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","5"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","4","26734","OH","Individual","No","46-3024049","26734OH0010006","Premier Health One Silver 2500","26734OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_2500_ZCS.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","6"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","4","26734","OH","Individual","No","46-3024049","26734OH0010006","Premier Health One Silver 2500","26734OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010006-03","Limited Cost Sharing Plan Variation",,"0.718543708324432","Yes","Yes","No","100%",,"$2,500","$10","$480","$150","$2,500","$280","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_2500_LCS.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","7"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","4","26734","OH","Individual","No","46-3024049","26734OH0010006","Premier Health One Silver 2500","26734OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010006-04","73% AV Level Silver Plan",,"0.739328861236572","Yes","Yes","No","100%",,"$2,200","$10","$510","$150","$2,200","$300","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,200","$2200 per person","$4400 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_2500_73CSR.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","8"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","4","26734","OH","Individual","No","46-3024049","26734OH0010006","Premier Health One Silver 2500","26734OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010006-05","87% AV Level Silver Plan",,"0.860197484493256","Yes","Yes","No","100%",,"$730","$10","$650","$150","$720","$580","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,900","$1900 per person","$3800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,900","$1900 per person","$3800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$725","$725 per person","$1450 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$725","$725 per person","$1450 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_2500_87CSR.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","9"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","4","26734","OH","Individual","No","46-3024049","26734OH0010006","Premier Health One Silver 2500","26734OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010006-06","94% AV Level Silver Plan",,"0.930285692214966","Yes","Yes","No","100%",,"$110","$10","$710","$150","$110","$350","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$110","$110 per person","$220 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$110","$110 per person","$220 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_2500_94CSR.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","10"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","4","26734","OH","Individual","No","46-3024049","26734OH0010007","Premier Health One Silver 4500/30","26734OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010007-00","Standard Silver Off Exchange Plan","68.87%","0.688672602176666","Yes","Yes","No","100%",,"$4,500","$10","$830","$150","$4,500","$50","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_4500_30.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","11"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","4","26734","OH","Individual","No","46-3024049","26734OH0010007","Premier Health One Silver 4500/30","26734OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010007-01","Standard Silver On Exchange Plan","68.87%","0.688672602176666","Yes","Yes","No","100%",,"$4,500","$10","$830","$150","$4,500","$50","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_4500_30.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","12"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","4","26734","OH","Individual","No","46-3024049","26734OH0010007","Premier Health One Silver 4500/30","26734OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_4500_30_ZCS.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","13"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","4","26734","OH","Individual","No","46-3024049","26734OH0010007","Premier Health One Silver 4500/30","26734OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010007-03","Limited Cost Sharing Plan Variation","68.87%","0.688672602176666","Yes","Yes","No","100%",,"$4,500","$10","$830","$150","$4,500","$50","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_4500_30_LCS.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","14"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","4","26734","OH","Individual","No","46-3024049","26734OH0010007","Premier Health One Silver 4500/30","26734OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010007-04","73% AV Level Silver Plan","72.05%","0.720550000667572","Yes","Yes","No","100%",,"$3,800","$10","$1,040","$150","$3,800","$90","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,800","$3800 per person","$7600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_4500_30_73CSR.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","15"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","4","26734","OH","Individual","No","46-3024049","26734OH0010007","Premier Health One Silver 4500/30","26734OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010007-05","87% AV Level Silver Plan","86.17%","0.861714780330658","Yes","Yes","No","100%",,"$1,000","$0","$800","$150","$1,000","$320","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,800","$1800 per person","$3600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_4500_30_87CSR.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","16"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","4","26734","OH","Individual","No","46-3024049","26734OH0010007","Premier Health One Silver 4500/30","26734OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010007-06","94% AV Level Silver Plan","93.01%","0.930095016956329","Yes","Yes","No","100%",,"$120","$10","$670","$150","$120","$350","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","$240 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$120","$120 per person","$240 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_4500_30_94CSR.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","17"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","4","26734","OH","Individual","No","46-3024049","26734OH0010008","Premier Health One Silver 4000","26734OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010008-00","Standard Silver Off Exchange Plan",,"0.699091732501984","Yes","Yes","No","100%",,"$4,000","$10","$650","$150","$4,000","$90","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_4000.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","18"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","4","26734","OH","Individual","No","46-3024049","26734OH0010008","Premier Health One Silver 4000","26734OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010008-01","Standard Silver On Exchange Plan",,"0.699091732501984","Yes","Yes","No","100%",,"$4,000","$10","$650","$150","$4,000","$90","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_4000.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","19"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","4","26734","OH","Individual","No","46-3024049","26734OH0010008","Premier Health One Silver 4000","26734OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_4000_ZCS.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","20"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","4","26734","OH","Individual","No","46-3024049","26734OH0010008","Premier Health One Silver 4000","26734OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010008-03","Limited Cost Sharing Plan Variation",,"0.699091732501984","Yes","Yes","No","100%",,"$4,000","$10","$650","$150","$4,000","$90","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_4000_LCS.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","21"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","4","26734","OH","Individual","No","46-3024049","26734OH0010008","Premier Health One Silver 4000","26734OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010008-04","73% AV Level Silver Plan",,"0.720800936222076","Yes","Yes","No","100%",,"$4,000","$10","$650","$150","$4,000","$90","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_4000_73CSR.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","22"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","4","26734","OH","Individual","No","46-3024049","26734OH0010008","Premier Health One Silver 4000","26734OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010008-05","87% AV Level Silver Plan",,"0.860405504703522","Yes","Yes","No","100%",,"$480","$10","$1,270","$150","$480","$400","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$475","$475 per person","$950 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$475","$475 per person","$950 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_4000_87CSR.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","23"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","4","26734","OH","Individual","No","46-3024049","26734OH0010008","Premier Health One Silver 4000","26734OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010008-06","94% AV Level Silver Plan",,"0.930095016956329","Yes","Yes","No","100%",,"$120","$10","$670","$150","$120","$350","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$120","$120 per person","$240 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$120","$120 per person","$240 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Silver_4000_94CSR.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","24"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","5","26734","OH","Individual","No","46-3024049","26734OH0010009","Premier Health One Bronze 6000/35","26734OH001",,"OHN001","OHS001","OHF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010009-00","Standard Bronze Off Exchange Plan",,"0.613831281661987","Yes","Yes","No","100%",,"$6,000","$20","$440","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Bronze_6000_35.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","4"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","5","26734","OH","Individual","No","46-3024049","26734OH0010009","Premier Health One Bronze 6000/35","26734OH001",,"OHN001","OHS001","OHF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010009-01","Standard Bronze On Exchange Plan",,"0.613831281661987","Yes","Yes","No","100%",,"$6,000","$20","$440","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Bronze_6000_35.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","5"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","5","26734","OH","Individual","No","46-3024049","26734OH0010009","Premier Health One Bronze 6000/35","26734OH001",,"OHN001","OHS001","OHF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Bronze_6000_35_ZCS.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","6"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","5","26734","OH","Individual","No","46-3024049","26734OH0010009","Premier Health One Bronze 6000/35","26734OH001",,"OHN001","OHS001","OHF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,"$300","1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010009-03","Limited Cost Sharing Plan Variation",,"0.613831281661987","Yes","Yes","No","100%",,"$6,000","$20","$440","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Bronze_6000_35_LCS.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","7"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","5","26734","OH","Individual","No","46-3024049","26734OH0010010","Premier Health One Bronze 6850","26734OH001",,"OHN001","OHS001","OHF010","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010010-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Bronze_6850.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","8"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","5","26734","OH","Individual","No","46-3024049","26734OH0010010","Premier Health One Bronze 6850","26734OH001",,"OHN001","OHS001","OHF010","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010010-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Bronze_6850.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","9"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","5","26734","OH","Individual","No","46-3024049","26734OH0010010","Premier Health One Bronze 6850","26734OH001",,"OHN001","OHS001","OHF010","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Bronze_6850_ZCS.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","10"
"2016","OH","26734","SERFF","10","2015-08-28 13:59:00","5","26734","OH","Individual","No","46-3024049","26734OH0010010","Premier Health One Bronze 6850","26734OH001",,"OHN001","OHS001","OHF010","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","1",,,,"1","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://secure.togetherforyourhealth.com/marketplace/Premier/FFM/pay.aspx","http://www.premierhealthplan.org/Individuals-and-Families/Member-Resources/Find-a-Medication/","26734OH0010010-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://premierhealthdocs.org/sbc/2016/SBC_Premier_Health_One_Bronze_6850_LCS.pdf","http://premierhealthdocs.com/OnOff-Exchange/PremierHealthOne_Plan_Brochure.pdf","11"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060048","AultCare Gold 750","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060048-03","Limited Cost Sharing Plan Variation",,"0.784754991531372","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6482016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","11"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","Yes","34-1624818","28162OH0200018","AultCare Pediatric Dental Low Plan OON 90 85","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","Low",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 90th percentile, patient responsible for amounts over the 90th percentile.  Employer premium contribution must be at least 85%.",,"Yes","Allows Child-Only",,,,,"$20.26","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200018-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2182016.pdf","19"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060045","AultCare Silver 1400","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060045-03","Limited Cost Sharing Plan Variation",,"0.71344655752182","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6452016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","19"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","Yes","34-1624818","28162OH0200019","AultCare Pediatric Dental Low Plan OON 90 50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","Low",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 90th percentile, patient responsible for amounts over the 90th percentile.  Employer premium contribution must be at least 50%.",,"Yes","Allows Child-Only",,,,,"$20.26","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200019-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2192016.pdf","20"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060045","AultCare Silver 1400","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060045-04","73% AV Level Silver Plan",,"0.736550152301788","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc645732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure645732016.pdf","20"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060041","AultCare Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060041-04","73% AV Level Silver Plan",,"0.723667442798615","No","Yes","No","100%",,"$4,000","$20","$480","$30","$1,850","$790","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641732016.pdf","34"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060049","AultCare Gold 350","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060049-00","Standard Gold Off Exchange Plan",,"0.789893627166748","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6492016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6492016.pdf","4"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090050","AultCare Platinum 200","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090050-00","Standard Platinum Off Exchange Plan",,"0.892351269721985","No","Yes","No","100%",,"$200","$20","$710","$30","$200","$710","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9502016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9502016.pdf","4"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","Yes","34-1624818","28162OH0200001","AultCare Pediatric Dental High Plan OON PPO 85","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","High",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the PPO Fee Schedule, patient responsible for amounts over PPO Fee Schedule.  Employer premium contribution must be at least 85%.",,"Yes","Allows Child-Only",,,,,"$27.80","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200001-00","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2012016.pdf","4"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","Yes","34-1624818","28162OH0200005","AultCare Pediatric Dental High Plan OON PPO 50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","High",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the PPO Fee Schedule, patient responsible for amounts over PPO Fee Schedule.  Employer premium contribution must be at least 50%.",,"Yes","Allows Child-Only",,,,,"$27.80","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200005-00","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2052016.pdf","5"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090050","AultCare Platinum 200","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090050-01","Standard Platinum On Exchange Plan",,"0.892351269721985","No","Yes","No","100%",,"$200","$20","$710","$30","$200","$710","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9502016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9502016.pdf","5"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060049","AultCare Gold 350","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060049-01","Standard Gold On Exchange Plan",,"0.789893627166748","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6492016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6492016.pdf","5"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060049","AultCare Gold 350","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060049-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","6"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090048","AultCare Platinum 500","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090048-00","Standard Platinum Off Exchange Plan",,"0.890003740787506","No","Yes","No","100%",,"$500","$20","$750","$30","$500","$710","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9482016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9482016.pdf","6"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","Yes","34-1624818","28162OH0200006","AultCare Pediatric Dental High Plan OON PPO <50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","High",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the PPO Fee Schedule, patient responsible for amounts over PPO Fee Schedule.  Employer premium contribution must be less than 50%.",,"Yes","Allows Child-Only",,,,,"$27.80","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200006-00","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2062016.pdf","6"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","Yes","34-1624818","28162OH0200007","AultCare Pediatric Dental High Plan OON 75 85","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","High",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 75th percentile, patient responsible for amounts over the 75th percentile.  Employer premium contribution must be at least 85%.",,"Yes","Allows Child-Only",,,,,"$27.80","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200007-00","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2072016.pdf","7"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090048","AultCare Platinum 500","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090048-01","Standard Platinum On Exchange Plan",,"0.890003740787506","No","Yes","No","100%",,"$500","$20","$750","$30","$500","$710","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9482016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9482016.pdf","7"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060049","AultCare Gold 350","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060049-03","Limited Cost Sharing Plan Variation",,"0.789893627166748","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6492016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","7"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060048","AultCare Gold 750","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060048-00","Standard Gold Off Exchange Plan",,"0.784754991531372","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6482016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6482016.pdf","8"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090047","AultCare Platinum 1000","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090047-00","Standard Platinum Off Exchange Plan",,"0.911625146865845","No","Yes","No","100%",,"$1,000","$20","$0","$30","$620","$380","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9472016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9472016.pdf","8"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","Yes","34-1624818","28162OH0200008","AultCare Pediatric Dental High Plan OON 75 50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","High",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 75th percentile, patient responsible for amounts over the 75th percentile.  Employer premium contribution must be at least 50%.",,"Yes","Allows Child-Only",,,,,"$27.80","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200008-00","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2082016.pdf","8"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090047","AultCare Platinum 1000","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090047-01","Standard Platinum On Exchange Plan",,"0.911625146865845","No","Yes","No","100%",,"$1,000","$20","$0","$30","$620","$380","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9472016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9472016.pdf","9"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","Yes","34-1624818","28162OH0200009","AultCare Pediatric Dental High Plan OON 75 <50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","High",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 75th percentile, patient responsible for amounts over the 75th percentile.  Employer premium contribution must be less than 50%.",,"Yes","Allows Child-Only",,,,,"$27.80","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200009-00","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2092016.pdf","9"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060048","AultCare Gold 750","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060048-01","Standard Gold On Exchange Plan",,"0.784754991531372","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6482016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6482016.pdf","9"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060048","AultCare Gold 750","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060048-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","10"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090043","AultCare Gold 500","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090043-00","Standard Gold Off Exchange Plan",,"0.816950798034668","No","Yes","No","100%",,"$500","$20","$2,030","$30","$500","$740","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9432016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9432016.pdf","10"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","Yes","34-1624818","28162OH0200010","AultCare Pediatric Dental High Plan OON 90 85","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","High",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 90th percentile, patient responsible for amounts over the 90th percentile.  Employer premium contribution must be at least 85%.",,"Yes","Allows Child-Only",,,,,"$27.80","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200010-00","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2102016.pdf","10"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","Yes","34-1624818","28162OH0200011","AultCare Pediatric Dental High Plan OON 90 50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","High",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 90th percentile, patient responsible for amounts over the 90th percentile.  Employer premium contribution must be at least 50%.",,"Yes","Allows Child-Only",,,,,"$27.80","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200011-00","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2112016.pdf","11"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090043","AultCare Gold 500","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090043-01","Standard Gold On Exchange Plan",,"0.816950798034668","No","Yes","No","100%",,"$500","$20","$2,030","$30","$500","$740","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9432016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9432016.pdf","11"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060046","AultCare Gold 1200","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060046-00","Standard Gold Off Exchange Plan",,"0.78000009059906","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6462016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6462016.pdf","12"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090042","AultCare Gold 750","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090042-00","Standard Gold Off Exchange Plan",,"0.784754991531372","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9422016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9422016.pdf","12"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","Yes","34-1624818","28162OH0200012","AultCare Pediatric Dental High Plan OON 90 <50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","High",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 90th percentile, patient responsible for amounts over the 90th percentile.  Employer premium contribution must be less than 50%.",,"Yes","Allows Child-Only",,,,,"$27.80","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200012-00","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2122016.pdf","12"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090042","AultCare Gold 750","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090042-01","Standard Gold On Exchange Plan",,"0.784754991531372","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9422016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9422016.pdf","13"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","Yes","34-1624818","28162OH0200002","AultCare Pediatric Dental Low Plan OON PPO 85","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","Low",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the PPO Fee Schedule, patient responsible for amounts over PPO Fee Schedule.  Employer premium contribution must be at least 85%.",,"Yes","Allows Child-Only",,,,,"$20.26","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200002-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2022016.pdf","13"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060046","AultCare Gold 1200","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060046-01","Standard Gold On Exchange Plan",,"0.78000009059906","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6462016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6462016.pdf","13"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060046","AultCare Gold 1200","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060046-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","14"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090041","AultCare Gold 1200","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090041-00","Standard Gold Off Exchange Plan",,"0.78000009059906","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9412016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9412016.pdf","14"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","Yes","34-1624818","28162OH0200013","AultCare Pediatric Dental Low Plan OON PPO 50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","Low",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the PPO Fee Schedule, patient responsible for amounts over PPO Fee Schedule.  Employer premium contribution must be at least 50%.",,"Yes","Allows Child-Only",,,,,"$20.26","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200013-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2132016.pdf","14"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090041","AultCare Gold 1200","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090041-01","Standard Gold On Exchange Plan",,"0.78000009059906","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9412016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9412016.pdf","15"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","Yes","34-1624818","28162OH0200014","AultCare Pediatric Dental Low Plan OON PPO <50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","Low",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the PPO Fee Schedule, patient responsible for amounts over PPO Fee Schedule.  Employer premium contribution must be less than 50%.",,"Yes","Allows Child-Only",,,,,"$20.26","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200014-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2142016.pdf","15"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060046","AultCare Gold 1200","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060046-03","Limited Cost Sharing Plan Variation",,"0.78000009059906","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6462016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","15"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060045","AultCare Silver 1400","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060045-00","Standard Silver Off Exchange Plan",,"0.71344655752182","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6452016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6452016.pdf","16"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","Yes","34-1624818","28162OH0200015","AultCare Pediatric Dental Low Plan OON 75 85","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","Low",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 75th percentile, patient responsible for amounts over the 75th percentile.  Employer premium contribution must be at least 85%.",,"Yes","Allows Child-Only",,,,,"$20.26","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200015-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2152016.pdf","16"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090058","AultCare Gold 2500","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090058-00","Standard Gold Off Exchange Plan",,"0.784746587276459","No","Yes","No","100%",,"$2,500","$20","$480","$30","$1,850","$660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9582016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9582016.pdf","16"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090058","AultCare Gold 2500","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090058-01","Standard Gold On Exchange Plan",,"0.784746587276459","No","Yes","No","100%",,"$2,500","$20","$480","$30","$1,850","$660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9582016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9582016.pdf","17"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","Yes","34-1624818","28162OH0200016","AultCare Pediatric Dental Low Plan OON 75 50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","Low",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 75th percentile, patient responsible for amounts over the 75th percentile.  Employer premium contribution must be at least 50%.",,"Yes","Allows Child-Only",,,,,"$20.26","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200016-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2162016.pdf","17"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060045","AultCare Silver 1400","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060045-01","Standard Silver On Exchange Plan",,"0.71344655752182","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6452016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6452016.pdf","17"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060045","AultCare Silver 1400","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060045-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","18"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","Yes","34-1624818","28162OH0200017","AultCare Pediatric Dental Low Plan OON 75 <50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","Low",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 75th percentile, patient responsible for amounts over the 75th percentile.  Employer premium contribution must be less than 50%.",,"Yes","Allows Child-Only",,,,,"$20.26","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200017-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2172016.pdf","18"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090038","AultCare Silver 1400","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090038-00","Standard Silver Off Exchange Plan",,"0.71344655752182","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9382016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9382016.pdf","18"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090038","AultCare Silver 1400","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090038-01","Standard Silver On Exchange Plan",,"0.71344655752182","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9382016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9382016.pdf","19"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090036","AultCare Silver 2000 75","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090036-00","Standard Silver Off Exchange Plan",,"0.717930614948273","No","Yes","No","100%",,"$2,000","$0","$1,310","$30","$1,850","$790","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9362016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9362016.pdf","20"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060030","AultCare Silver 1400 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060030-00","Standard Silver Off Exchange Plan",,"0.71344655752182","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6302016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6302016.pdf","56"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060030","AultCare Silver 1400 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060030-01","Standard Silver On Exchange Plan",,"0.71344655752182","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6302016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6302016.pdf","57"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060030","AultCare Silver 1400 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060030-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","58"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090049","AultCare Patinum 250","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090049-00","Standard Platinum Off Exchange Plan",,"0.887242078781128","Yes","Yes","No","100%",,"$250","$0","$710","$30","$250","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9492016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9492016.pdf","4"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090059","AultCare Silver 3500 100","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090059-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9592016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9592016.pdf","16"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090059","AultCare Silver 3500 100","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090059-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9592016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9592016.pdf","17"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060037","AultCare Bronze 6000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060037-01","Standard Bronze On Exchange Plan",,"0.607387959957123","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6372016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6372016.pdf","34"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090036","AultCare Silver 2000 75","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090036-01","Standard Silver On Exchange Plan",,"0.717930614948273","No","Yes","No","100%",,"$2,000","$0","$1,310","$30","$1,850","$790","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9362016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9362016.pdf","21"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","Yes","34-1624818","28162OH0200020","AultCare Pediatric Dental Low Plan OON 90 <50","28162OH020","7376546504","OHN003","OHS003",,"Existing","PPO","Low",,"Off the Exchange",,,,"Non-Network Reimbursment for this plan is paid at the 90th percentile, patient responsible for amounts over the 90th percentile.  Employer premium contribution must be less than 50%.",,"Yes","Allows Child-Only",,,,,"$20.26","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain dental care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","","28162OH0200020-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"N/A","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2202016.pdf","21"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060045","AultCare Silver 1400","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060045-05","87% AV Level Silver Plan",,"0.877351522445679","No","Yes","No","100%",,"$800","$20","$600","$30","$800","$810","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","50%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc645872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure645872016.pdf","21"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060045","AultCare Silver 1400","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060045-06","94% AV Level Silver Plan",,"0.937135100364685","No","Yes","No","100%",,"$680","$20","$0","$30","$560","$140","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","0%",,,,,"$2,100","$2100 per person","$4200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc645942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure645942016.pdf","22"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090060","AultCare Silver 3500 90","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090060-00","Standard Silver Off Exchange Plan",,"0.699882209300995","No","Yes","No","100%",,"$3,500","$20","$380","$30","$1,850","$740","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9602016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9602016.pdf","22"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090060","AultCare Silver 3500 90","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090060-01","Standard Silver On Exchange Plan",,"0.699882209300995","No","Yes","No","100%",,"$3,500","$20","$380","$30","$1,850","$740","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9602016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9602016.pdf","23"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060042","AultCare Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060042-00","Standard Silver Off Exchange Plan",,"0.698794364929199","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6422016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6422016.pdf","23"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060042","AultCare Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060042-01","Standard Silver On Exchange Plan",,"0.698794364929199","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6422016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6422016.pdf","24"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060042","AultCare Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060042-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","25"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060042","AultCare Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060042-03","Limited Cost Sharing Plan Variation",,"0.698794364929199","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6422016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","26"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060042","AultCare Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060042-04","73% AV Level Silver Plan",,"0.722373008728027","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,850","$740","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642732016.pdf","27"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060042","AultCare Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060042-05","87% AV Level Silver Plan",,"0.875184595584869","No","Yes","No","100%",,"$800","$20","$680","$30","$800","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","20%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642872016.pdf","28"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060042","AultCare Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060042-06","94% AV Level Silver Plan",,"0.945611596107483","No","Yes","No","100%",,"$230","$20","$280","$30","$200","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642942016.pdf","29"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060041","AultCare Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060041-00","Standard Silver Off Exchange Plan",,"0.680709600448608","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6412016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6412016.pdf","30"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060041","AultCare Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060041-01","Standard Silver On Exchange Plan",,"0.680709600448608","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6412016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6412016.pdf","31"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060041","AultCare Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060041-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","32"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060041","AultCare Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060041-03","Limited Cost Sharing Plan Variation",,"0.680709600448608","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6412016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","33"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060041","AultCare Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060041-05","87% AV Level Silver Plan",,"0.879495203495026","No","Yes","No","100%",,"$900","$20","$280","$30","$900","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641872016.pdf","35"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060030","AultCare Silver 1400 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060030-03","Limited Cost Sharing Plan Variation",,"0.71344655752182","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6302016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","59"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060070","AultCare Silver 6850 Select","28162OH006","7376546504","OHN002","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060070-05","87% AV Level Silver Plan",,"0.867335438728333","Yes","Yes","No","100%",,"$1,730","$20","$0","$30","$1,110","$640","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc670872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure670872016.pdf","82"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060070","AultCare Silver 6850 Select","28162OH006","7376546504","OHN002","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060070-06","94% AV Level Silver Plan",,"0.942824006080627","Yes","Yes","No","100%",,"$580","$20","$0","$30","$470","$130","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0%",,,,,"$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc670942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure670942016.pdf","83"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060043","AultCare Silver 1500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060043-04","73% AV Level Silver Plan",,"0.736606538295746","Yes","Yes","No","100%",,"$1,500","$0","$1,760","$30","$1,500","$0","$1,130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc643732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure643732016.pdf","15"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060028","AultCare Silver 1500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060028-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","52"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060028","AultCare Silver 1500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060028-03","Limited Cost Sharing Plan Variation",,"0.699192643165588","Yes","Yes","No","100%",,"$1,500","$0","$1,760","$30","$1,500","$0","$1,130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6282016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","53"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060028","AultCare Silver 1500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060028-04","73% AV Level Silver Plan",,"0.736606538295746","Yes","Yes","No","100%",,"$1,500","$0","$1,760","$30","$1,500","$0","$1,130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc628732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure628732016.pdf","54"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060041","AultCare Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060041-06","94% AV Level Silver Plan",,"0.942455589771271","No","Yes","No","100%",,"$250","$20","$130","$30","$250","$150","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641942016.pdf","36"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060068","AultCare Silver 6850","28162OH006","7376546504","OHN001","OHS001","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060068-00","Standard Silver Off Exchange Plan",,"0.700689315795898","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6682016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6682016.pdf","37"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060068","AultCare Silver 6850","28162OH006","7376546504","OHN001","OHS001","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060068-01","Standard Silver On Exchange Plan",,"0.700689315795898","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6682016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6682016.pdf","38"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060068","AultCare Silver 6850","28162OH006","7376546504","OHN001","OHS001","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060068-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","39"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060068","AultCare Silver 6850","28162OH006","7376546504","OHN001","OHS001","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060068-03","Limited Cost Sharing Plan Variation",,"0.700689315795898","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6682016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","40"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060068","AultCare Silver 6850","28162OH006","7376546504","OHN001","OHS001","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060068-04","73% AV Level Silver Plan",,"0.733445286750793","Yes","Yes","No","100%",,"$5,430","$20","$0","$30","$4,660","$660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","0%",,,,,"$16,350","$16350 per person","$32700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc668732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure668732016.pdf","41"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060068","AultCare Silver 6850","28162OH006","7376546504","OHN001","OHS001","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060068-05","87% AV Level Silver Plan",,"0.867335438728333","Yes","Yes","No","100%",,"$1,730","$20","$0","$30","$1,110","$640","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc668872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure668872016.pdf","42"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060068","AultCare Silver 6850","28162OH006","7376546504","OHN001","OHS001","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060068-06","94% AV Level Silver Plan",,"0.942824006080627","Yes","Yes","No","100%",,"$580","$20","$0","$30","$470","$130","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0%",,,,,"$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc668942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure668942016.pdf","43"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060034","AultCare Gold 350 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060034-00","Standard Gold Off Exchange Plan",,"0.789893627166748","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6342016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6342016.pdf","44"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060034","AultCare Gold 350 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060034-01","Standard Gold On Exchange Plan",,"0.789893627166748","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6342016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6342016.pdf","45"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060034","AultCare Gold 350 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060034-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","46"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060034","AultCare Gold 350 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060034-03","Limited Cost Sharing Plan Variation",,"0.789893627166748","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6342016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","47"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060033","AultCare Gold 750 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060033-00","Standard Gold Off Exchange Plan",,"0.784754991531372","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6332016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6332016.pdf","48"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060033","AultCare Gold 750 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060033-01","Standard Gold On Exchange Plan",,"0.784754991531372","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6332016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6332016.pdf","49"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060033","AultCare Gold 750 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060033-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","50"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060033","AultCare Gold 750 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060033-03","Limited Cost Sharing Plan Variation",,"0.784754991531372","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6332016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","51"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060031","AultCare Gold 1200 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060031-00","Standard Gold Off Exchange Plan",,"0.78000009059906","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6312016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6312016.pdf","52"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060031","AultCare Gold 1200 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060031-01","Standard Gold On Exchange Plan",,"0.78000009059906","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6312016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6312016.pdf","53"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060031","AultCare Gold 1200 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060031-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","54"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060031","AultCare Gold 1200 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060031-03","Limited Cost Sharing Plan Variation",,"0.78000009059906","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6312016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","55"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060030","AultCare Silver 1400 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060030-04","73% AV Level Silver Plan",,"0.736550152301788","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc630732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure630732016.pdf","60"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060030","AultCare Silver 1400 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060030-05","87% AV Level Silver Plan",,"0.877351522445679","No","Yes","No","100%",,"$800","$20","$600","$30","$800","$810","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","50%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc630872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure630872016.pdf","61"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060030","AultCare Silver 1400 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060030-06","94% AV Level Silver Plan",,"0.937135100364685","No","Yes","No","100%",,"$680","$20","$0","$30","$560","$140","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","0%",,,,,"$2,100","$2100 per person","$4200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc630942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure630942016.pdf","62"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060027","AultCare Silver 3000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060027-00","Standard Silver Off Exchange Plan",,"0.698794364929199","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6272016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6272016.pdf","63"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060027","AultCare Silver 3000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060027-01","Standard Silver On Exchange Plan",,"0.698794364929199","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6272016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6272016.pdf","64"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060027","AultCare Silver 3000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060027-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","65"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060027","AultCare Silver 3000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060027-03","Limited Cost Sharing Plan Variation",,"0.698794364929199","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6272016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","66"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060027","AultCare Silver 3000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060027-04","73% AV Level Silver Plan",,"0.722373008728027","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,850","$740","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627732016.pdf","67"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060027","AultCare Silver 3000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060027-05","87% AV Level Silver Plan",,"0.875184595584869","No","Yes","No","100%",,"$800","$20","$680","$30","$800","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","20%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627872016.pdf","68"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060027","AultCare Silver 3000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060027-06","94% AV Level Silver Plan",,"0.945611596107483","No","Yes","No","100%",,"$230","$20","$280","$30","$200","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627942016.pdf","69"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060026","AultCare Silver 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060026-00","Standard Silver Off Exchange Plan",,"0.680709600448608","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6262016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6262016.pdf","70"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060026","AultCare Silver 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060026-01","Standard Silver On Exchange Plan",,"0.680709600448608","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6262016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6262016.pdf","71"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060026","AultCare Silver 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060026-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","72"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060026","AultCare Silver 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060026-03","Limited Cost Sharing Plan Variation",,"0.680709600448608","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6262016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","73"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060026","AultCare Silver 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060026-04","73% AV Level Silver Plan",,"0.723667442798615","No","Yes","No","100%",,"$4,000","$20","$480","$30","$1,850","$790","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626732016.pdf","74"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060026","AultCare Silver 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060026-05","87% AV Level Silver Plan",,"0.879495203495026","No","Yes","No","100%",,"$900","$20","$280","$30","$900","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626872016.pdf","75"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060026","AultCare Silver 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060026-06","94% AV Level Silver Plan",,"0.942455589771271","No","Yes","No","100%",,"$250","$20","$130","$30","$250","$150","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626942016.pdf","76"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060070","AultCare Silver 6850 Select","28162OH006","7376546504","OHN002","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060070-00","Standard Silver Off Exchange Plan",,"0.700689315795898","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6702016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6702016.pdf","77"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060070","AultCare Silver 6850 Select","28162OH006","7376546504","OHN002","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060070-01","Standard Silver On Exchange Plan",,"0.700689315795898","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6702016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6702016.pdf","78"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060070","AultCare Silver 6850 Select","28162OH006","7376546504","OHN002","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060070-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","79"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060070","AultCare Silver 6850 Select","28162OH006","7376546504","OHN002","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060070-03","Limited Cost Sharing Plan Variation",,"0.700689315795898","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6702016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","80"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","1","28162","OH","Individual","No","34-1624818","28162OH0060070","AultCare Silver 6850 Select","28162OH006","7376546504","OHN002","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060070-04","73% AV Level Silver Plan",,"0.733445286750793","Yes","Yes","No","100%",,"$5,430","$20","$0","$30","$4,660","$660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","0%",,,,,"$16,350","$16350 per person","$32700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc670732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure670732016.pdf","81"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060044","AultCare Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060044-00","Standard Silver Off Exchange Plan",,"0.714037895202637","Yes","Yes","No","100%",,"$2,500","$0","$480","$30","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6442016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6442016.pdf","4"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090049","AultCare Patinum 250","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090049-01","Standard Platinum On Exchange Plan",,"0.887242078781128","Yes","Yes","No","100%",,"$250","$0","$710","$30","$250","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9492016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9492016.pdf","5"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060044","AultCare Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060044-01","Standard Silver On Exchange Plan",,"0.714037895202637","Yes","Yes","No","100%",,"$2,500","$0","$480","$30","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6442016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6442016.pdf","5"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060044","AultCare Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060044-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","6"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090046","AultCare Platinum 1500 Health Savings 500","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090046-00","Standard Platinum Off Exchange Plan",,"0.905663251876831","Yes","Yes","No","100%",,"$1,500","$0","$0","$30","$1,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","0%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$500.00","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9462016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9462016.pdf","6"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090046","AultCare Platinum 1500 Health Savings 500","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090046-01","Standard Platinum On Exchange Plan",,"0.905663251876831","Yes","Yes","No","100%",,"$1,500","$0","$0","$30","$1,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","0%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$500.00","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9462016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9462016.pdf","7"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060044","AultCare Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060044-03","Limited Cost Sharing Plan Variation",,"0.714037895202637","Yes","Yes","No","100%",,"$2,500","$0","$480","$30","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6442016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","7"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060044","AultCare Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060044-04","73% AV Level Silver Plan",,"0.736680865287781","Yes","Yes","No","100%",,"$2,500","$0","$480","$30","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644732016.pdf","8"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090040","AultCare Gold 1350","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090040-00","Standard Gold Off Exchange Plan",,"0.807322561740875","Yes","Yes","No","100%",,"$1,350","$0","$600","$30","$1,350","$0","$390","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","10%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9402016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9402016.pdf","8"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090040","AultCare Gold 1350","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090040-01","Standard Gold On Exchange Plan",,"0.807322561740875","Yes","Yes","No","100%",,"$1,350","$0","$600","$30","$1,350","$0","$390","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","10%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9402016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9402016.pdf","9"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060044","AultCare Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060044-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$30","$1,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","per person not applicable","$2200 per group","0%",,,,,"$3,300","per person not applicable","$6600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644872016.pdf","9"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060044","AultCare Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060044-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644942016.pdf","10"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090057","AultCare Gold 2000","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090057-00","Standard Gold Off Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$30","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9572016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9572016.pdf","10"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090057","AultCare Gold 2000","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090057-01","Standard Gold On Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$30","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9572016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9572016.pdf","11"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060043","AultCare Silver 1500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060043-00","Standard Silver Off Exchange Plan",,"0.699192643165588","Yes","Yes","No","100%",,"$1,500","$0","$1,760","$30","$1,500","$0","$1,130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6432016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6432016.pdf","11"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060043","AultCare Silver 1500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060043-01","Standard Silver On Exchange Plan",,"0.699192643165588","Yes","Yes","No","100%",,"$1,500","$0","$1,760","$30","$1,500","$0","$1,130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6432016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6432016.pdf","12"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090037","AultCare Silver 1350","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090037-00","Standard Silver Off Exchange Plan",,"0.706646502017975","Yes","Yes","No","100%",,"$1,350","$0","$1,810","$30","$1,350","$0","$1,180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","30%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9372016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9372016.pdf","12"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090037","AultCare Silver 1350","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090037-01","Standard Silver On Exchange Plan",,"0.706646502017975","Yes","Yes","No","100%",,"$1,350","$0","$1,810","$30","$1,350","$0","$1,180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","30%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9372016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9372016.pdf","13"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060043","AultCare Silver 1500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060043-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","13"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060043","AultCare Silver 1500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060043-03","Limited Cost Sharing Plan Variation",,"0.699192643165588","Yes","Yes","No","100%",,"$1,500","$0","$1,760","$30","$1,500","$0","$1,130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6432016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","14"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090035","AultCare Silver 2000 80","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090035-00","Standard Silver Off Exchange Plan",,"0.704120516777039","Yes","Yes","No","100%",,"$2,000","$0","$1,070","$30","$2,000","$0","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9352016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9352016.pdf","14"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090035","AultCare Silver 2000 80","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090035-01","Standard Silver On Exchange Plan",,"0.704120516777039","Yes","Yes","No","100%",,"$2,000","$0","$1,070","$30","$2,000","$0","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9352016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9352016.pdf","15"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060043","AultCare Silver 1500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060043-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$30","$1,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","per person not applicable","$2200 per group","0%",,,,,"$3,300","per person not applicable","$6600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc643872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure643872016.pdf","16"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060043","AultCare Silver 1500","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060043-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc643942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure643942016.pdf","17"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060067","AultCare Silver 4750","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060067-00","Standard Silver Off Exchange Plan",,"0.681628406047821","Yes","Yes","No","100%",,"$4,750","$0","$0","$30","$4,670","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","0%",,,,,"$14,250","$14250 per person","$28500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6672016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6672016.pdf","18"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090032","AultCare Bronze 3000","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090032-00","Standard Bronze Off Exchange Plan",,"0.617518901824951","Yes","Yes","No","100%",,"$3,000","$0","$2,140","$30","$3,000","$0","$1,140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9322016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9322016.pdf","18"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090032","AultCare Bronze 3000","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090032-01","Standard Bronze On Exchange Plan",,"0.617518901824951","Yes","Yes","No","100%",,"$3,000","$0","$2,140","$30","$3,000","$0","$1,140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9322016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9322016.pdf","19"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060067","AultCare Silver 4750","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060067-01","Standard Silver On Exchange Plan",,"0.681628406047821","Yes","Yes","No","100%",,"$4,750","$0","$0","$30","$4,670","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","0%",,,,,"$14,250","$14250 per person","$28500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6672016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6672016.pdf","19"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060067","AultCare Silver 4750","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060067-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","20"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090031","AultCare Bronze 4000","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090031-00","Standard Bronze Off Exchange Plan",,"0.618481576442719","Yes","Yes","No","100%",,"$4,000","$0","$980","$30","$4,000","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9312016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9312016.pdf","20"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090031","AultCare Bronze 4000","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090031-01","Standard Bronze On Exchange Plan",,"0.618481576442719","Yes","Yes","No","100%",,"$4,000","$0","$980","$30","$4,000","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9312016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9312016.pdf","21"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060067","AultCare Silver 4750","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060067-03","Limited Cost Sharing Plan Variation",,"0.681628406047821","Yes","Yes","No","100%",,"$4,750","$0","$0","$30","$4,670","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","0%",,,,,"$14,250","$14250 per person","$28500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6672016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","21"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060067","AultCare Silver 4750","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060067-04","73% AV Level Silver Plan",,"0.737281262874603","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,440","$60","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc667732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure667732016.pdf","22"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090062","AultCare Bronze 6250","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090062-00","Standard Bronze Off Exchange Plan",,"0.609101891517639","Yes","Yes","No","100%",,"$6,250","$0","$0","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","0%",,,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9622016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9622016.pdf","22"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090062","AultCare Bronze 6250","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090062-01","Standard Bronze On Exchange Plan",,"0.609101891517639","Yes","Yes","No","100%",,"$6,250","$0","$0","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","0%",,,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9622016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9622016.pdf","23"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060067","AultCare Silver 4750","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060067-05","87% AV Level Silver Plan",,"0.875540614128113","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,260","$40","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"$3,900","$3900 per person","$7800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc667872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure667872016.pdf","23"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060067","AultCare Silver 4750","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060067-06","94% AV Level Silver Plan",,"0.943330526351929","Yes","Yes","No","100%",,"$500","$0","$30","$530","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc667942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure667942016.pdf","24"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060039","AultCare Bronze 4000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060039-00","Standard Bronze Off Exchange Plan",,"0.618481576442719","Yes","Yes","No","100%",,"$4,000","$0","$980","$30","$4,000","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6392016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6392016.pdf","25"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060039","AultCare Bronze 4000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060039-01","Standard Bronze On Exchange Plan",,"0.618481576442719","Yes","Yes","No","100%",,"$4,000","$0","$980","$30","$4,000","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6392016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6392016.pdf","26"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060039","AultCare Bronze 4000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060039-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","27"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060039","AultCare Bronze 4000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060039-03","Limited Cost Sharing Plan Variation",,"0.618481576442719","Yes","Yes","No","100%",,"$4,000","$0","$980","$30","$4,000","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6392016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","28"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060038","AultCare Bronze 5000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060038-00","Standard Bronze Off Exchange Plan",,"0.617450714111328","Yes","Yes","No","100%",,"$5,000","$0","$460","$30","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6382016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6382016.pdf","29"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060038","AultCare Bronze 5000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060038-01","Standard Bronze On Exchange Plan",,"0.617450714111328","Yes","Yes","No","100%",,"$5,000","$0","$460","$30","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6382016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6382016.pdf","30"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060038","AultCare Bronze 5000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060038-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","31"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060038","AultCare Bronze 5000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060038-03","Limited Cost Sharing Plan Variation",,"0.617450714111328","Yes","Yes","No","100%",,"$5,000","$0","$460","$30","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6382016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","32"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060037","AultCare Bronze 6000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060037-00","Standard Bronze Off Exchange Plan",,"0.607387959957123","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6372016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6372016.pdf","33"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060037","AultCare Bronze 6000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060037-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","35"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060037","AultCare Bronze 6000","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060037-03","Limited Cost Sharing Plan Variation",,"0.607387959957123","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6372016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","36"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060075","AultCare Bronze 6600","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060075-00","Standard Bronze Off Exchange Plan",,"0.597867250442505","Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","0%",,,,,"$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6752016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6752016.pdf","37"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060075","AultCare Bronze 6600","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060075-01","Standard Bronze On Exchange Plan",,"0.597867250442505","Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","0%",,,,,"$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6752016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6752016.pdf","38"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060075","AultCare Bronze 6600","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060075-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","39"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060075","AultCare Bronze 6600","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060075-03","Limited Cost Sharing Plan Variation",,"0.597867250442505","Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","0%",,,,,"$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6752016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","40"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060036","AultCare Catastrophic","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060036-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$30","$4,940","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6362016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6362016.pdf","41"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060036","AultCare Catastrophic","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060036-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$30","$4,940","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6362016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6362016.pdf","42"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060029","AultCare Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060029-00","Standard Silver Off Exchange Plan",,"0.714037895202637","Yes","Yes","No","100%",,"$2,500","$0","$480","$30","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6292016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6292016.pdf","43"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060029","AultCare Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060029-01","Standard Silver On Exchange Plan",,"0.714037895202637","Yes","Yes","No","100%",,"$2,500","$0","$480","$30","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6292016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6292016.pdf","44"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060029","AultCare Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060029-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","45"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060029","AultCare Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060029-03","Limited Cost Sharing Plan Variation",,"0.714037895202637","Yes","Yes","No","100%",,"$2,500","$0","$480","$30","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6292016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","46"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060029","AultCare Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060029-04","73% AV Level Silver Plan",,"0.736680865287781","Yes","Yes","No","100%",,"$2,500","$0","$480","$30","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629732016.pdf","47"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060029","AultCare Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060029-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$30","$1,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","per person not applicable","$2200 per group","0%",,,,,"$3,300","per person not applicable","$6600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629872016.pdf","48"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060029","AultCare Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060029-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629942016.pdf","49"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060028","AultCare Silver 1500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060028-00","Standard Silver Off Exchange Plan",,"0.699192643165588","Yes","Yes","No","100%",,"$1,500","$0","$1,760","$30","$1,500","$0","$1,130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6282016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6282016.pdf","50"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060028","AultCare Silver 1500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060028-01","Standard Silver On Exchange Plan",,"0.699192643165588","Yes","Yes","No","100%",,"$1,500","$0","$1,760","$30","$1,500","$0","$1,130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6282016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6282016.pdf","51"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060028","AultCare Silver 1500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060028-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$30","$1,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","per person not applicable","$2200 per group","0%",,,,,"$3,300","per person not applicable","$6600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc628872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure628872016.pdf","55"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060028","AultCare Silver 1500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060028-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc628942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure628942016.pdf","56"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060069","AultCare Silver 4750 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060069-00","Standard Silver Off Exchange Plan",,"0.681628406047821","Yes","Yes","No","100%",,"$4,750","$0","$0","$30","$4,670","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","0%",,,,,"$14,250","$14250 per person","$28500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6692016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6692016.pdf","57"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060069","AultCare Silver 4750 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060069-01","Standard Silver On Exchange Plan",,"0.681628406047821","Yes","Yes","No","100%",,"$4,750","$0","$0","$30","$4,670","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","0%",,,,,"$14,250","$14250 per person","$28500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6692016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6692016.pdf","58"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060069","AultCare Silver 4750 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060069-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","59"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060069","AultCare Silver 4750 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060069-03","Limited Cost Sharing Plan Variation",,"0.681628406047821","Yes","Yes","No","100%",,"$4,750","$0","$0","$30","$4,670","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","0%",,,,,"$14,250","$14250 per person","$28500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6692016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","60"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060069","AultCare Silver 4750 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060069-04","73% AV Level Silver Plan",,"0.737281262874603","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,440","$60","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc669732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure669732016.pdf","61"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060071","AultCare Silver 4750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060071-03","Limited Cost Sharing Plan Variation",,"0.681628406047821","Yes","Yes","No","100%",,"$4,750","$0","$0","$30","$4,670","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","0%",,,,,"$14,250","$14250 per person","$28500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6712016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","21"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060012","AultCare Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060012-06","94% AV Level Silver Plan",,"0.945611596107483","No","Yes","No","100%",,"$230","$20","$280","$30","$200","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612942016.pdf","29"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060011","AultCare Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060011-00","Standard Silver Off Exchange Plan",,"0.680709600448608","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6112016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6112016.pdf","30"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060011","AultCare Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060011-01","Standard Silver On Exchange Plan",,"0.680709600448608","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6112016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6112016.pdf","31"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060057","AultCare Silver 1400 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060057-01","Standard Silver On Exchange Plan",,"0.71344655752182","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6572016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6572016.pdf","57"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060074","AultCare Silver 6850 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060074-04","73% AV Level Silver Plan",,"0.733445286750793","Yes","Yes","No","100%",,"$5,430","$20","$0","$30","$4,660","$660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","0%",,,,,"$16,350","$16350 per person","$32700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc674732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure674732016.pdf","81"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060069","AultCare Silver 4750 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060069-05","87% AV Level Silver Plan",,"0.875540614128113","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,260","$40","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"$3,900","$3900 per person","$7800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc669872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure669872016.pdf","62"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060069","AultCare Silver 4750 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060069-06","94% AV Level Silver Plan",,"0.943330526351929","Yes","Yes","No","100%",,"$500","$0","$30","$530","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc669942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure669942016.pdf","63"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060024","AultCare Bronze 4000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060024-00","Standard Bronze Off Exchange Plan",,"0.618481576442719","Yes","Yes","No","100%",,"$4,000","$0","$980","$30","$4,000","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6242016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6242016.pdf","64"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060024","AultCare Bronze 4000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060024-01","Standard Bronze On Exchange Plan",,"0.618481576442719","Yes","Yes","No","100%",,"$4,000","$0","$980","$30","$4,000","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6242016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6242016.pdf","65"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060024","AultCare Bronze 4000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060024-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","66"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060024","AultCare Bronze 4000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060024-03","Limited Cost Sharing Plan Variation",,"0.618481576442719","Yes","Yes","No","100%",,"$4,000","$0","$980","$30","$4,000","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6242016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","67"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060023","AultCare Bronze 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060023-00","Standard Bronze Off Exchange Plan",,"0.617450714111328","Yes","Yes","No","100%",,"$5,000","$0","$460","$30","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6232016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6232016.pdf","68"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060023","AultCare Bronze 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060023-01","Standard Bronze On Exchange Plan",,"0.617450714111328","Yes","Yes","No","100%",,"$5,000","$0","$460","$30","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6232016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6232016.pdf","69"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060023","AultCare Bronze 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060023-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","70"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060023","AultCare Bronze 5000 Select","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060023-03","Limited Cost Sharing Plan Variation",,"0.617450714111328","Yes","Yes","No","100%",,"$5,000","$0","$460","$30","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6232016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","71"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060022","AultCare Bronze 6000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060022-00","Standard Bronze Off Exchange Plan",,"0.607387959957123","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6222016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6222016.pdf","72"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060022","AultCare Bronze 6000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060022-01","Standard Bronze On Exchange Plan",,"0.607387959957123","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6222016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6222016.pdf","73"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060022","AultCare Bronze 6000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060022-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","74"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060022","AultCare Bronze 6000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060022-03","Limited Cost Sharing Plan Variation",,"0.607387959957123","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6222016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","75"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060076","AultCare Bronze 6600 Select","28162OH006","7376546504","OHN002","OHS004","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060076-00","Standard Bronze Off Exchange Plan",,"0.597867250442505","Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","0%",,,,,"$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6762016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6762016.pdf","76"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060076","AultCare Bronze 6600 Select","28162OH006","7376546504","OHN002","OHS004","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060076-01","Standard Bronze On Exchange Plan",,"0.597867250442505","Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","0%",,,,,"$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6762016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6762016.pdf","77"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060076","AultCare Bronze 6600 Select","28162OH006","7376546504","OHN002","OHS004","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060076-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","78"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060016","AultCare Gold 1200 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060016-01","Standard Gold On Exchange Plan",,"0.78000009059906","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6162016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6162016.pdf","13"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060016","AultCare Gold 1200 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060016-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","14"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060012","AultCare Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060012-03","Limited Cost Sharing Plan Variation",,"0.698794364929199","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6122016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","26"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060054","AultCare Gold 750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060054-00","Standard Gold Off Exchange Plan",,"0.784754991531372","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6542016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6542016.pdf","48"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060054","AultCare Gold 750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060054-01","Standard Gold On Exchange Plan",,"0.784754991531372","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6542016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6542016.pdf","49"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060061","AultCare Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060061-03","Limited Cost Sharing Plan Variation",,"0.680709600448608","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6612016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","73"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060076","AultCare Bronze 6600 Select","28162OH006","7376546504","OHN002","OHS004","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060076-03","Limited Cost Sharing Plan Variation",,"0.597867250442505","Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","0%",,,,,"$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6762016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","79"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060021","AultCare Catastrophic Select","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060021-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$30","$4,940","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6212016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6212016.pdf","80"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","2","28162","OH","Individual","No","34-1624818","28162OH0060021","AultCare Catastrophic Select","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060021-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$30","$4,940","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6212016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6212016.pdf","81"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060019","AultCare Gold 350 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060019-00","Standard Gold Off Exchange Plan",,"0.789893627166748","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6192016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6192016.pdf","4"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090030","AultCare Platinum 200 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090030-00","Standard Platinum Off Exchange Plan",,"0.892351269721985","No","Yes","No","100%",,"$200","$20","$710","$30","$200","$710","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9302016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9302016.pdf","4"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090030","AultCare Platinum 200 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090030-01","Standard Platinum On Exchange Plan",,"0.892351269721985","No","Yes","No","100%",,"$200","$20","$710","$30","$200","$710","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9302016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9302016.pdf","5"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060019","AultCare Gold 350 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060019-01","Standard Gold On Exchange Plan",,"0.789893627166748","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6192016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6192016.pdf","5"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060019","AultCare Gold 350 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060019-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","6"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090028","AultCare Platinum 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090028-00","Standard Platinum Off Exchange Plan",,"0.890003740787506","No","Yes","No","100%",,"$500","$20","$750","$30","$500","$710","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9282016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9282016.pdf","6"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090028","AultCare Platinum 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090028-01","Standard Platinum On Exchange Plan",,"0.890003740787506","No","Yes","No","100%",,"$500","$20","$750","$30","$500","$710","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9282016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9282016.pdf","7"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060019","AultCare Gold 350 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060019-03","Limited Cost Sharing Plan Variation",,"0.789893627166748","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6192016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","7"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060018","AultCare Gold 750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060018-00","Standard Gold Off Exchange Plan",,"0.784754991531372","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6182016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6182016.pdf","8"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090027","AultCare Platinum 1000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090027-00","Standard Platinum Off Exchange Plan",,"0.911625146865845","No","Yes","No","100%",,"$1,000","$20","$0","$30","$620","$380","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9272016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9272016.pdf","8"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090027","AultCare Platinum 1000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090027-01","Standard Platinum On Exchange Plan",,"0.911625146865845","No","Yes","No","100%",,"$1,000","$20","$0","$30","$620","$380","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9272016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9272016.pdf","9"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060018","AultCare Gold 750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060018-01","Standard Gold On Exchange Plan",,"0.784754991531372","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6182016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6182016.pdf","9"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060018","AultCare Gold 750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060018-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","10"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090023","AultCare Gold 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090023-00","Standard Gold Off Exchange Plan",,"0.816950798034668","No","Yes","No","100%",,"$500","$20","$2,030","$30","$500","$740","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9232016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9232016.pdf","10"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090023","AultCare Gold 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090023-01","Standard Gold On Exchange Plan",,"0.816950798034668","No","Yes","No","100%",,"$500","$20","$2,030","$30","$500","$740","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9232016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9232016.pdf","11"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060018","AultCare Gold 750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060018-03","Limited Cost Sharing Plan Variation",,"0.784754991531372","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6182016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","11"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060016","AultCare Gold 1200 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060016-00","Standard Gold Off Exchange Plan",,"0.78000009059906","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6162016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6162016.pdf","12"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090022","AultCare Gold 750 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090022-00","Standard Gold Off Exchange Plan",,"0.784754991531372","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9222016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9222016.pdf","12"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090022","AultCare Gold 750 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090022-01","Standard Gold On Exchange Plan",,"0.784754991531372","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9222016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9222016.pdf","13"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090021","AultCare Gold 1200 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090021-00","Standard Gold Off Exchange Plan",,"0.78000009059906","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9212016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9212016.pdf","14"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090021","AultCare Gold 1200 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090021-01","Standard Gold On Exchange Plan",,"0.78000009059906","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9212016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9212016.pdf","15"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060016","AultCare Gold 1200 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060016-03","Limited Cost Sharing Plan Variation",,"0.78000009059906","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6162016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","15"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060015","AultCare Silver 1400 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060015-00","Standard Silver Off Exchange Plan",,"0.71344655752182","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6152016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6152016.pdf","16"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090052","AultCare Gold 2500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090052-00","Standard Gold Off Exchange Plan",,"0.784746587276459","No","Yes","No","100%",,"$2,500","$20","$480","$30","$1,850","$660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9522016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9522016.pdf","16"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090052","AultCare Gold 2500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090052-01","Standard Gold On Exchange Plan",,"0.784746587276459","No","Yes","No","100%",,"$2,500","$20","$480","$30","$1,850","$660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$3200 per person","$6400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9522016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9522016.pdf","17"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060015","AultCare Silver 1400 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060015-01","Standard Silver On Exchange Plan",,"0.71344655752182","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6152016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6152016.pdf","17"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060015","AultCare Silver 1400 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060015-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","18"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090018","AultCare Silver 1400 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090018-00","Standard Silver Off Exchange Plan",,"0.71344655752182","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9182016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9182016.pdf","18"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090018","AultCare Silver 1400 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090018-01","Standard Silver On Exchange Plan",,"0.71344655752182","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9182016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9182016.pdf","19"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060015","AultCare Silver 1400 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060015-03","Limited Cost Sharing Plan Variation",,"0.71344655752182","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6152016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","19"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060015","AultCare Silver 1400 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060015-04","73% AV Level Silver Plan",,"0.736550152301788","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc615732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure615732016.pdf","20"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090016","AultCare Silver 2000 75 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090016-00","Standard Silver Off Exchange Plan",,"0.717930614948273","No","Yes","No","100%",,"$2,000","$0","$1,310","$30","$1,850","$790","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9162016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9162016.pdf","20"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090016","AultCare Silver 2000 75 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090016-01","Standard Silver On Exchange Plan",,"0.717930614948273","No","Yes","No","100%",,"$2,000","$0","$1,310","$30","$1,850","$790","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","25%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9162016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9162016.pdf","21"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060015","AultCare Silver 1400 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060015-05","87% AV Level Silver Plan",,"0.877351522445679","No","Yes","No","100%",,"$800","$20","$600","$30","$800","$810","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","50%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc615872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure615872016.pdf","21"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060015","AultCare Silver 1400 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060015-06","94% AV Level Silver Plan",,"0.937135100364685","No","Yes","No","100%",,"$680","$20","$0","$30","$560","$140","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","0%",,,,,"$2,100","$2100 per person","$4200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc615942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure615942016.pdf","22"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090054","AultCare Silver 3500 90 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090054-00","Standard Silver Off Exchange Plan",,"0.699882209300995","No","Yes","No","100%",,"$3,500","$20","$380","$30","$1,850","$740","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9542016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9542016.pdf","22"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090054","AultCare Silver 3500 90 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0090054-01","Standard Silver On Exchange Plan",,"0.699882209300995","No","Yes","No","100%",,"$3,500","$20","$380","$30","$1,850","$740","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","10%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9542016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9542016.pdf","23"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060012","AultCare Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060012-00","Standard Silver Off Exchange Plan",,"0.698794364929199","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6122016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6122016.pdf","23"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060012","AultCare Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060012-01","Standard Silver On Exchange Plan",,"0.698794364929199","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6122016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6122016.pdf","24"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060012","AultCare Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060012-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","25"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060012","AultCare Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060012-04","73% AV Level Silver Plan",,"0.722373008728027","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,850","$740","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612732016.pdf","27"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060012","AultCare Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060012-05","87% AV Level Silver Plan",,"0.875184595584869","No","Yes","No","100%",,"$800","$20","$680","$30","$800","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","20%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612872016.pdf","28"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060011","AultCare Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060011-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","32"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060011","AultCare Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060011-03","Limited Cost Sharing Plan Variation",,"0.680709600448608","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6112016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","33"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060011","AultCare Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060011-04","73% AV Level Silver Plan",,"0.723667442798615","No","Yes","No","100%",,"$4,000","$20","$480","$30","$1,850","$790","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611732016.pdf","34"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060011","AultCare Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060011-05","87% AV Level Silver Plan",,"0.879495203495026","No","Yes","No","100%",,"$900","$20","$280","$30","$900","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611872016.pdf","35"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060011","AultCare Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060011-06","94% AV Level Silver Plan",,"0.942455589771271","No","Yes","No","100%",,"$250","$20","$130","$30","$250","$150","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611942016.pdf","36"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060072","AultCare Silver 6850 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060072-00","Standard Silver Off Exchange Plan",,"0.700689315795898","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6722016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6722016.pdf","37"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060072","AultCare Silver 6850 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060072-01","Standard Silver On Exchange Plan",,"0.700689315795898","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6722016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6722016.pdf","38"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060072","AultCare Silver 6850 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060072-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","39"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060072","AultCare Silver 6850 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060072-03","Limited Cost Sharing Plan Variation",,"0.700689315795898","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6722016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","40"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060072","AultCare Silver 6850 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060072-04","73% AV Level Silver Plan",,"0.733445286750793","Yes","Yes","No","100%",,"$5,430","$20","$0","$30","$4,660","$660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","0%",,,,,"$16,350","$16350 per person","$32700 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc672732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure672732016.pdf","41"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060072","AultCare Silver 6850 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060072-05","87% AV Level Silver Plan",,"0.867335438728333","Yes","Yes","No","100%",,"$1,730","$20","$0","$30","$1,110","$640","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc672872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure672872016.pdf","42"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060072","AultCare Silver 6850 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060072-06","94% AV Level Silver Plan",,"0.942824006080627","Yes","Yes","No","100%",,"$580","$20","$0","$30","$470","$130","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0%",,,,,"$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc672942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure672942016.pdf","43"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060053","AultCare Gold 350 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060053-00","Standard Gold Off Exchange Plan",,"0.789893627166748","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6532016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6532016.pdf","44"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060053","AultCare Gold 350 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060053-01","Standard Gold On Exchange Plan",,"0.789893627166748","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6532016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6532016.pdf","45"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060053","AultCare Gold 350 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060053-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","46"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060053","AultCare Gold 350 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060053-03","Limited Cost Sharing Plan Variation",,"0.789893627166748","No","Yes","No","100%",,"$350","$20","$1,730","$30","$350","$740","$480","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","25%",,,,,"$1,050","$1050 per person","$2100 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6532016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","47"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060054","AultCare Gold 750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060054-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","50"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060054","AultCare Gold 750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060054-03","Limited Cost Sharing Plan Variation",,"0.784754991531372","No","Yes","No","100%",,"$750","$20","$1,300","$30","$750","$710","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6542016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","51"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060056","AultCare Gold 1200 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060056-00","Standard Gold Off Exchange Plan",,"0.78000009059906","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6562016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6562016.pdf","52"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060056","AultCare Gold 1200 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060056-01","Standard Gold On Exchange Plan",,"0.78000009059906","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6562016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6562016.pdf","53"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060056","AultCare Gold 1200 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060056-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","54"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060056","AultCare Gold 1200 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060056-03","Limited Cost Sharing Plan Variation",,"0.78000009059906","No","Yes","No","100%",,"$1,200","$20","$610","$30","$1,200","$710","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,700","$5700 per person","$11400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"$3,600","$3600 per person","$7200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6562016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","55"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060057","AultCare Silver 1400 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060057-00","Standard Silver Off Exchange Plan",,"0.71344655752182","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6572016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6572016.pdf","56"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060057","AultCare Silver 1400 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060057-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","58"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060057","AultCare Silver 1400 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060057-03","Limited Cost Sharing Plan Variation",,"0.71344655752182","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$270","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6572016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","59"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060057","AultCare Silver 1400 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060057-04","73% AV Level Silver Plan",,"0.736550152301788","No","Yes","No","100%",,"$1,400","$20","$2,930","$30","$1,400","$840","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","50%",,,,,"$4,200","$4200 per person","$8400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc657732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure657732016.pdf","60"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060057","AultCare Silver 1400 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060057-05","87% AV Level Silver Plan",,"0.877351522445679","No","Yes","No","100%",,"$800","$20","$600","$30","$800","$810","$530","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","50%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc657872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure657872016.pdf","61"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060057","AultCare Silver 1400 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060057-06","94% AV Level Silver Plan",,"0.937135100364685","No","Yes","No","100%",,"$680","$20","$0","$30","$560","$140","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","0%",,,,,"$2,100","$2100 per person","$4200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc657942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure657942016.pdf","62"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060060","AultCare Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060060-00","Standard Silver Off Exchange Plan",,"0.698794364929199","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6602016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6602016.pdf","63"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060060","AultCare Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060060-01","Standard Silver On Exchange Plan",,"0.698794364929199","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6602016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6602016.pdf","64"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060060","AultCare Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060060-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","65"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060060","AultCare Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060060-03","Limited Cost Sharing Plan Variation",,"0.698794364929199","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6602016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","66"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060060","AultCare Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060060-04","73% AV Level Silver Plan",,"0.722373008728027","No","Yes","No","100%",,"$3,000","$20","$1,280","$30","$1,850","$740","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc660732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure660732016.pdf","67"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060060","AultCare Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060060-05","87% AV Level Silver Plan",,"0.875184595584869","No","Yes","No","100%",,"$800","$20","$680","$30","$800","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","20%",,,,,"$2,400","$2400 per person","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc660872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure660872016.pdf","68"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060060","AultCare Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060060-06","94% AV Level Silver Plan",,"0.945611596107483","No","Yes","No","100%",,"$230","$20","$280","$30","$200","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","20%",,,,,"$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc660942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure660942016.pdf","69"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060061","AultCare Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060061-00","Standard Silver Off Exchange Plan",,"0.680709600448608","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6612016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6612016.pdf","70"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060061","AultCare Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060061-01","Standard Silver On Exchange Plan",,"0.680709600448608","No","Yes","No","100%",,"$5,000","$20","$900","$30","$1,700","$760","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6612016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6612016.pdf","71"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060061","AultCare Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060061-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","72"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060061","AultCare Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060061-04","73% AV Level Silver Plan",,"0.723667442798615","No","Yes","No","100%",,"$4,000","$20","$480","$30","$1,850","$790","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661732016.pdf","74"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060061","AultCare Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060061-05","87% AV Level Silver Plan",,"0.879495203495026","No","Yes","No","100%",,"$900","$20","$280","$30","$900","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%",,,,,"$2,700","$2700 per person","$5400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661872016.pdf","75"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060061","AultCare Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF001","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularya2016.aspx","28162OH0060061-06","94% AV Level Silver Plan",,"0.942455589771271","No","Yes","No","100%",,"$250","$20","$130","$30","$250","$150","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$400","$400 per person","$800 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661942016.pdf","76"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060074","AultCare Silver 6850 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060074-00","Standard Silver Off Exchange Plan",,"0.700689315795898","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6742016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6742016.pdf","77"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060074","AultCare Silver 6850 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060074-01","Standard Silver On Exchange Plan",,"0.700689315795898","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6742016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6742016.pdf","78"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060074","AultCare Silver 6850 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060074-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","79"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060074","AultCare Silver 6850 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060074-03","Limited Cost Sharing Plan Variation",,"0.700689315795898","Yes","Yes","No","100%",,"$6,830","$20","$0","$30","$4,660","$660","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6742016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","80"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060074","AultCare Silver 6850 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060074-05","87% AV Level Silver Plan",,"0.867335438728333","Yes","Yes","No","100%",,"$1,730","$20","$0","$30","$1,110","$640","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc674872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure674872016.pdf","82"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090015","AultCare Silver 2000 80 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090015-01","Standard Silver On Exchange Plan",,"0.704120516777039","Yes","Yes","No","100%",,"$2,000","$0","$1,070","$30","$2,000","$0","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9152016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9152016.pdf","15"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060009","AultCare Bronze 4000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060009-00","Standard Bronze Off Exchange Plan",,"0.618481576442719","Yes","Yes","No","100%",,"$4,000","$0","$980","$30","$4,000","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6092016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6092016.pdf","25"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060065","AultCare Bronze 6000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060065-03","Limited Cost Sharing Plan Variation",,"0.607387959957123","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6652016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","75"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740031","Anthem Bronze Pathway X PPO 5850 35","29276OH074",,"OHN001","OHS001","OHF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740031-00","Standard Bronze Off Exchange Plan","58.51%","0.588467657566071","Yes","Yes","Yes","70%","30%","$5,850","$0","$266","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35%","$5,850","$5850 per person","$11700 per group","35%","$17,550","$17550 per person","$35100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1WZN","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","12"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740031","Anthem Bronze Pathway X PPO 5850 35","29276OH074",,"OHN001","OHS001","OHF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740031-01","Standard Bronze On Exchange Plan","58.51%","0.588467657566071","Yes","Yes","Yes","70%","30%","$5,850","$0","$266","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35%","$5,850","$5850 per person","$11700 per group","35%","$17,550","$17550 per person","$35100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1WZP","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","13"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740031","Anthem Bronze Pathway X PPO 5850 35","29276OH074",,"OHN001","OHS001","OHF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740031-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group",,"$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1WZQ","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","14"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740031","Anthem Bronze Pathway X PPO 5850 35","29276OH074",,"OHN001","OHS001","OHF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740031-03","Limited Cost Sharing Plan Variation","58.51%","0.588467657566071","Yes","Yes","Yes","70%","30%","$5,850","$0","$266","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,850","$5850 per person","$11700 per group","35%","$5,850","$5850 per person","$11700 per group","35%","$17,550","$17550 per person","$35100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1WZP","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","15"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","3","28162","OH","Individual","No","34-1624818","28162OH0060074","AultCare Silver 6850 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyc2016.aspx","28162OH0060074-06","94% AV Level Silver Plan",,"0.942824006080627","Yes","Yes","No","100%",,"$580","$20","$0","$30","$470","$130","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","0%",,,,,"$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc674942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure674942016.pdf","83"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060014","AultCare Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060014-00","Standard Silver Off Exchange Plan",,"0.714037895202637","Yes","Yes","No","100%",,"$2,500","$0","$480","$30","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6142016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6142016.pdf","4"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090029","AultCare Platinum 250 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090029-00","Standard Platinum Off Exchange Plan",,"0.887242078781128","Yes","Yes","No","100%",,"$250","$0","$710","$30","$250","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9292016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9292016.pdf","4"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090029","AultCare Platinum 250 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090029-01","Standard Platinum On Exchange Plan",,"0.887242078781128","Yes","Yes","No","100%",,"$250","$0","$710","$30","$250","$0","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","10%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9292016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9292016.pdf","5"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060014","AultCare Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060014-01","Standard Silver On Exchange Plan",,"0.714037895202637","Yes","Yes","No","100%",,"$2,500","$0","$480","$30","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6142016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6142016.pdf","5"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060014","AultCare Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","6"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090026","AultCare Platinum 1500 Health Savings 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090026-00","Standard Platinum Off Exchange Plan",,"0.905663251876831","Yes","Yes","No","100%",,"$1,500","$0","$0","$30","$1,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","0%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$500.00","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9262016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9262016.pdf","6"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090026","AultCare Platinum 1500 Health Savings 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090026-01","Standard Platinum On Exchange Plan",,"0.905663251876831","Yes","Yes","No","100%",,"$1,500","$0","$0","$30","$1,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","0%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","Yes","$500.00","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9262016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9262016.pdf","7"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060014","AultCare Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060014-03","Limited Cost Sharing Plan Variation",,"0.714037895202637","Yes","Yes","No","100%",,"$2,500","$0","$480","$30","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6142016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","7"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060014","AultCare Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060014-04","73% AV Level Silver Plan",,"0.736680865287781","Yes","Yes","No","100%",,"$2,500","$0","$480","$30","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614732016.pdf","8"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090020","AultCare Gold 1350 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090020-00","Standard Gold Off Exchange Plan",,"0.807322561740875","Yes","Yes","No","100%",,"$1,350","$0","$600","$30","$1,350","$0","$390","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","10%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9202016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9202016.pdf","8"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090020","AultCare Gold 1350 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090020-01","Standard Gold On Exchange Plan",,"0.807322561740875","Yes","Yes","No","100%",,"$1,350","$0","$600","$30","$1,350","$0","$390","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","10%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9202016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9202016.pdf","9"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060014","AultCare Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060014-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$30","$1,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","per person not applicable","$2200 per group","0%",,,,,"$3,300","per person not applicable","$6600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614872016.pdf","9"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060014","AultCare Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060014-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614942016.pdf","10"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090051","AultCare Gold 2000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090051-00","Standard Gold Off Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$30","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9512016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9512016.pdf","10"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090051","AultCare Gold 2000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090051-01","Standard Gold On Exchange Plan",,"0.806294620037079","Yes","Yes","No","100%",,"$2,000","$0","$0","$30","$2,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","0%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9512016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9512016.pdf","11"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060013","AultCare Silver 1500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060013-00","Standard Silver Off Exchange Plan",,"0.699192643165588","Yes","Yes","No","100%",,"$1,500","$0","$1,760","$30","$1,500","$0","$1,130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6132016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6132016.pdf","11"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060013","AultCare Silver 1500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060013-01","Standard Silver On Exchange Plan",,"0.699192643165588","Yes","Yes","No","100%",,"$1,500","$0","$1,760","$30","$1,500","$0","$1,130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6132016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6132016.pdf","12"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090017","AultCare Silver 1350 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090017-00","Standard Silver Off Exchange Plan",,"0.706646502017975","Yes","Yes","No","100%",,"$1,350","$0","$1,810","$30","$1,350","$0","$1,180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","30%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9172016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9172016.pdf","12"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090017","AultCare Silver 1350 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090017-01","Standard Silver On Exchange Plan",,"0.706646502017975","Yes","Yes","No","100%",,"$1,350","$0","$1,810","$30","$1,350","$0","$1,180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","per person not applicable","$2700 per group","30%",,,,,"$4,050","per person not applicable","$8100 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9172016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9172016.pdf","13"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060013","AultCare Silver 1500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","13"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060013","AultCare Silver 1500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060013-03","Limited Cost Sharing Plan Variation",,"0.699192643165588","Yes","Yes","No","100%",,"$1,500","$0","$1,760","$30","$1,500","$0","$1,130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6132016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","14"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090015","AultCare Silver 2000 80 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090015-00","Standard Silver Off Exchange Plan",,"0.704120516777039","Yes","Yes","No","100%",,"$2,000","$0","$1,070","$30","$2,000","$0","$650","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9152016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9152016.pdf","14"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060013","AultCare Silver 1500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060013-04","73% AV Level Silver Plan",,"0.736606538295746","Yes","Yes","No","100%",,"$1,500","$0","$1,760","$30","$1,500","$0","$1,130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc613732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure613732016.pdf","15"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060013","AultCare Silver 1500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060013-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$30","$1,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","per person not applicable","$2200 per group","0%",,,,,"$3,300","per person not applicable","$6600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc613872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure613872016.pdf","16"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090053","AultCare Silver 3500 100 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090053-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9532016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9532016.pdf","16"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090053","AultCare Silver 3500 100 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090053-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9532016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9532016.pdf","17"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060013","AultCare Silver 1500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060013-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc613942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure613942016.pdf","17"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060071","AultCare Silver 4750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060071-00","Standard Silver Off Exchange Plan",,"0.681628406047821","Yes","Yes","No","100%",,"$4,750","$0","$0","$30","$4,670","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","0%",,,,,"$14,250","$14250 per person","$28500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6712016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6712016.pdf","18"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090012","AultCare Bronze 3000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090012-00","Standard Bronze Off Exchange Plan",,"0.617518901824951","Yes","Yes","No","100%",,"$3,000","$0","$2,140","$30","$3,000","$0","$1,140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9122016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9122016.pdf","18"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090012","AultCare Bronze 3000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090012-01","Standard Bronze On Exchange Plan",,"0.617518901824951","Yes","Yes","No","100%",,"$3,000","$0","$2,140","$30","$3,000","$0","$1,140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","50%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9122016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9122016.pdf","19"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060071","AultCare Silver 4750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060071-01","Standard Silver On Exchange Plan",,"0.681628406047821","Yes","Yes","No","100%",,"$4,750","$0","$0","$30","$4,670","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","0%",,,,,"$14,250","$14250 per person","$28500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6712016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6712016.pdf","19"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060071","AultCare Silver 4750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060071-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","20"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090011","AultCare Bronze 4000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090011-00","Standard Bronze Off Exchange Plan",,"0.618481576442719","Yes","Yes","No","100%",,"$4,000","$0","$980","$30","$4,000","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9112016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9112016.pdf","20"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090011","AultCare Bronze 4000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090011-01","Standard Bronze On Exchange Plan",,"0.618481576442719","Yes","Yes","No","100%",,"$4,000","$0","$980","$30","$4,000","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9112016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9112016.pdf","21"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060071","AultCare Silver 4750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060071-04","73% AV Level Silver Plan",,"0.737281262874603","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,440","$60","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc671732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure671732016.pdf","22"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090056","AultCare Bronze 6250 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090056-00","Standard Bronze Off Exchange Plan",,"0.609101891517639","Yes","Yes","No","100%",,"$6,250","$0","$0","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","0%",,,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9562016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9562016.pdf","22"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060058","AultCare Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060058-01","Standard Silver On Exchange Plan",,"0.714037895202637","Yes","Yes","No","100%",,"$2,500","$0","$480","$30","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6582016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6582016.pdf","44"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060063","AultCare Bronze 4000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060063-03","Limited Cost Sharing Plan Variation",,"0.618481576442719","Yes","Yes","No","100%",,"$4,000","$0","$980","$30","$4,000","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6632016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","67"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060064","AultCare Bronze 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060064-00","Standard Bronze Off Exchange Plan",,"0.617450714111328","Yes","Yes","No","100%",,"$5,000","$0","$460","$30","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6642016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6642016.pdf","68"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","1","29276","OH","Individual","No","31-1440175","29276OH0740023","Anthem Silver Pathway X PPO 3000 10","29276OH074",,"OHN001","OHS001","OHF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740023-06","94% AV Level Silver Plan","94.11%","0.939486801624298","Yes","Yes","Yes","70%","30%","$200","$150","$400","$0","$200","$30","$92","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10%","$200","$200 per person","$400 per group","10%","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GLA","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","12"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740018","Anthem Bronze Pathway X PPO 0 for HSA","29276OH074",,"OHN001","OHS001","OHF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740018-00","Standard Bronze Off Exchange Plan",,"0.5993931889534","Yes","Yes","Yes","70%","30%","$6,550","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%","$6,550","$6550 per person","$13100 per group","0%","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GKR","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","4"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","Yes","31-1440175","29276OH0830003","Anthem Dental Family","29276OH083",,"OHN004","OHS002",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","29276OH0830003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214673.pdf",,"4"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","SHOP (Small Group)","No","31-1440175","29276OH0750112","Anthem Silver Blue Access X PPO 2000 30  5000 Plus","29276OH075",,"OHN003","OHS001","OHF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0750112-00","Standard Silver Off Exchange Plan","70.01%","0.71945583820343","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1Z7C","http://sgplans.anthem.com/oh/brochure/","4"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090056","AultCare Bronze 6250 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0090056-01","Standard Bronze On Exchange Plan",,"0.609101891517639","Yes","Yes","No","100%",,"$6,250","$0","$0","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group","0%",,,,,"$18,750","$18750 per person","$37500 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc9562016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure9562016.pdf","23"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060071","AultCare Silver 4750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060071-05","87% AV Level Silver Plan",,"0.875540614128113","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,260","$40","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"$3,900","$3900 per person","$7800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc671872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure671872016.pdf","23"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060071","AultCare Silver 4750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060071-06","94% AV Level Silver Plan",,"0.943330526351929","Yes","Yes","No","100%",,"$500","$0","$30","$530","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc671942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure671942016.pdf","24"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060009","AultCare Bronze 4000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060009-01","Standard Bronze On Exchange Plan",,"0.618481576442719","Yes","Yes","No","100%",,"$4,000","$0","$980","$30","$4,000","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6092016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6092016.pdf","26"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060009","AultCare Bronze 4000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","27"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060009","AultCare Bronze 4000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060009-03","Limited Cost Sharing Plan Variation",,"0.618481576442719","Yes","Yes","No","100%",,"$4,000","$0","$980","$30","$4,000","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6092016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","28"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060008","AultCare Bronze 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060008-00","Standard Bronze Off Exchange Plan",,"0.617450714111328","Yes","Yes","No","100%",,"$5,000","$0","$460","$30","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6082016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6082016.pdf","29"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060008","AultCare Bronze 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060008-01","Standard Bronze On Exchange Plan",,"0.617450714111328","Yes","Yes","No","100%",,"$5,000","$0","$460","$30","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6082016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6082016.pdf","30"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060008","AultCare Bronze 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","31"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060008","AultCare Bronze 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060008-03","Limited Cost Sharing Plan Variation",,"0.617450714111328","Yes","Yes","No","100%",,"$5,000","$0","$460","$30","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6082016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","32"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060007","AultCare Bronze 6000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060007-00","Standard Bronze Off Exchange Plan",,"0.607387959957123","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6072016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6072016.pdf","33"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060007","AultCare Bronze 6000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060007-01","Standard Bronze On Exchange Plan",,"0.607387959957123","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6072016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6072016.pdf","34"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060007","AultCare Bronze 6000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","35"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060007","AultCare Bronze 6000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060007-03","Limited Cost Sharing Plan Variation",,"0.607387959957123","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6072016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","36"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060077","AultCare Bronze 6600 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060077-00","Standard Bronze Off Exchange Plan",,"0.597867250442505","Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","0%",,,,,"$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6772016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6772016.pdf","37"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060077","AultCare Bronze 6600 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060077-01","Standard Bronze On Exchange Plan",,"0.597867250442505","Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","0%",,,,,"$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6772016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6772016.pdf","38"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060077","AultCare Bronze 6600 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060077-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","39"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060077","AultCare Bronze 6600 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060077-03","Limited Cost Sharing Plan Variation",,"0.597867250442505","Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","0%",,,,,"$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6772016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","40"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060051","AultCare Catastrophic No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060051-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$30","$4,940","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6512016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6512016.pdf","41"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060051","AultCare Catastrophic No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060051-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$30","$4,940","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6512016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6512016.pdf","42"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060058","AultCare Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060058-00","Standard Silver Off Exchange Plan",,"0.714037895202637","Yes","Yes","No","100%",,"$2,500","$0","$480","$30","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6582016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6582016.pdf","43"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060058","AultCare Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060058-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","45"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060058","AultCare Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060058-03","Limited Cost Sharing Plan Variation",,"0.714037895202637","Yes","Yes","No","100%",,"$2,500","$0","$480","$30","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6582016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","46"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060058","AultCare Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060058-04","73% AV Level Silver Plan",,"0.736680865287781","Yes","Yes","No","100%",,"$2,500","$0","$480","$30","$2,500","$0","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","10%",,,,,"$7,500","per person not applicable","$15000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658732016.pdf","47"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060058","AultCare Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060058-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$30","$1,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","per person not applicable","$2200 per group","0%",,,,,"$3,300","per person not applicable","$6600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658872016.pdf","48"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060058","AultCare Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060058-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658942016.pdf","49"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060059","AultCare Silver 1500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060059-00","Standard Silver Off Exchange Plan",,"0.699192643165588","Yes","Yes","No","100%",,"$1,500","$0","$1,760","$30","$1,500","$0","$1,130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6592016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6592016.pdf","50"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060059","AultCare Silver 1500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060059-01","Standard Silver On Exchange Plan",,"0.699192643165588","Yes","Yes","No","100%",,"$1,500","$0","$1,760","$30","$1,500","$0","$1,130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6592016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6592016.pdf","51"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060059","AultCare Silver 1500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060059-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","52"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060059","AultCare Silver 1500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060059-03","Limited Cost Sharing Plan Variation",,"0.699192643165588","Yes","Yes","No","100%",,"$1,500","$0","$1,760","$30","$1,500","$0","$1,130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6592016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","53"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060059","AultCare Silver 1500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060059-04","73% AV Level Silver Plan",,"0.736606538295746","Yes","Yes","No","100%",,"$1,500","$0","$1,760","$30","$1,500","$0","$1,130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","30%",,,,,"$4,500","per person not applicable","$9000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc659732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure659732016.pdf","54"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060059","AultCare Silver 1500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060059-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$30","$1,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","per person not applicable","$2200 per group","0%",,,,,"$3,300","per person not applicable","$6600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc659872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure659872016.pdf","55"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060059","AultCare Silver 1500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060059-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$30","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc659942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure659942016.pdf","56"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060073","AultCare Silver 4750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060073-00","Standard Silver Off Exchange Plan",,"0.681628406047821","Yes","Yes","No","100%",,"$4,750","$0","$0","$30","$4,670","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","0%",,,,,"$14,250","$14250 per person","$28500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6732016.pdf","57"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060073","AultCare Silver 4750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060073-01","Standard Silver On Exchange Plan",,"0.681628406047821","Yes","Yes","No","100%",,"$4,750","$0","$0","$30","$4,670","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","0%",,,,,"$14,250","$14250 per person","$28500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6732016.pdf","58"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060073","AultCare Silver 4750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060073-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","59"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060073","AultCare Silver 4750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060073-03","Limited Cost Sharing Plan Variation",,"0.681628406047821","Yes","Yes","No","100%",,"$4,750","$0","$0","$30","$4,670","$80","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","0%",,,,,"$14,250","$14250 per person","$28500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","60"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060073","AultCare Silver 4750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060073-04","73% AV Level Silver Plan",,"0.737281262874603","Yes","Yes","No","100%",,"$3,500","$0","$0","$30","$3,440","$60","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc673732016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure673732016.pdf","61"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060073","AultCare Silver 4750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060073-05","87% AV Level Silver Plan",,"0.875540614128113","Yes","Yes","No","100%",,"$1,300","$0","$0","$30","$1,260","$40","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","0%",,,,,"$3,900","$3900 per person","$7800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc673872016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure673872016.pdf","62"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060073","AultCare Silver 4750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060073-06","94% AV Level Silver Plan",,"0.943330526351929","Yes","Yes","No","100%",,"$500","$0","$30","$530","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc673942016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure673942016.pdf","63"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060063","AultCare Bronze 4000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060063-00","Standard Bronze Off Exchange Plan",,"0.618481576442719","Yes","Yes","No","100%",,"$4,000","$0","$980","$30","$4,000","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6632016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6632016.pdf","64"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060063","AultCare Bronze 4000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060063-01","Standard Bronze On Exchange Plan",,"0.618481576442719","Yes","Yes","No","100%",,"$4,000","$0","$980","$30","$4,000","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","30%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6632016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6632016.pdf","65"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060063","AultCare Bronze 4000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060063-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","66"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060064","AultCare Bronze 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060064-01","Standard Bronze On Exchange Plan",,"0.617450714111328","Yes","Yes","No","100%",,"$5,000","$0","$460","$30","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6642016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6642016.pdf","69"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060064","AultCare Bronze 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060064-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","70"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060064","AultCare Bronze 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060064-03","Limited Cost Sharing Plan Variation",,"0.617450714111328","Yes","Yes","No","100%",,"$5,000","$0","$460","$30","$5,000","$0","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6642016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","71"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060065","AultCare Bronze 6000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060065-00","Standard Bronze Off Exchange Plan",,"0.607387959957123","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6652016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6652016.pdf","72"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060065","AultCare Bronze 6000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060065-01","Standard Bronze On Exchange Plan",,"0.607387959957123","Yes","Yes","No","100%",,"$6,000","$0","$130","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$19,050","$19050 per person","$38100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6652016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6652016.pdf","73"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060065","AultCare Bronze 6000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060065-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","74"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060078","AultCare Bronze 6600 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060078-00","Standard Bronze Off Exchange Plan",,"0.597867250442505","Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","0%",,,,,"$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6782016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6782016.pdf","76"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060078","AultCare Bronze 6600 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060078-01","Standard Bronze On Exchange Plan",,"0.597867250442505","Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","0%",,,,,"$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6782016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6782016.pdf","77"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060078","AultCare Bronze 6600 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060078-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbcZero2016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","78"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060078","AultCare Bronze 6600 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060078-03","Limited Cost Sharing Plan Variation",,"0.597867250442505","Yes","Yes","No","100%",,"$6,600","$0","$0","$30","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","0%",,,,,"$19,800","$19800 per person","$39600 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6782016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure2016.pdf","79"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060066","AultCare Catastrophic Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060066-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$30","$4,940","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6662016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6662016.pdf","80"
"2016","OH","28162","SERFF","14","2015-08-28 13:59:00","4","28162","OH","Individual","No","34-1624818","28162OH0060066","AultCare Catastrophic Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS004","OHF002","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01","2016-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","https://www.myaultcare.com/paymentListner.aspx","http://www.AultCAS.com/acformularyb2016.aspx","28162OH0060066-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$30","$4,940","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc6662016.pdf","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure6662016.pdf","81"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","1","29276","OH","SHOP (Small Group)","No","31-1440175","29276OH0750115","Anthem Gold Blue Access X PPO 1000 30  4500 Plus","29276OH075",,"OHN003","OHS001","OHF005","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0750115-00","Standard Gold Off Exchange Plan","78.29%","0.795714259147644","No","Yes","No","100%",,"$1,000","$0","$1,225","$0","$424","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","$1,000","$1000 per person","$3000 per group","30%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$9000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1PJN","http://sgplans.anthem.com/oh/brochure/","4"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","1","29276","OH","SHOP (Small Group)","Yes","31-1440175","29276OH0840003","Anthem Dental Pediatric","29276OH084",,"OHN004","OHS002",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$20.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level","Yes",,"","29276OH0840003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214675.pdf",,"4"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","1","29276","OH","Individual","Yes","31-1440175","29276OH0810003","Anthem Dental Pediatric","29276OH081",,"OHN004","OHS002",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$20.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","29276OH0810003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214675.pdf",,"4"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","1","29276","OH","Individual","No","31-1440175","29276OH0740017","Anthem Catastrophic Pathway X PPO 6850 0","29276OH074",,"OHN001","OHS001","OHF001","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740017-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","70%","30%","$6,554","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%","$6,850","$6850 per person","$13700 per group","0%","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GKP","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","4"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","1","29276","OH","Individual","No","31-1440175","29276OH0740017","Anthem Catastrophic Pathway X PPO 6850 0","29276OH074",,"OHN001","OHS001","OHF001","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740017-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","70%","30%","$6,554","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%","$6,850","$6850 per person","$13700 per group","0%","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GKQ","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","5"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","1","29276","OH","Individual","Yes","31-1440175","29276OH0870003","Anthem Dental Pediatric","29276OH087",,"OHN004","OHS002",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$20.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","29276OH0870003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214675.pdf",,"5"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","1","29276","OH","SHOP (Small Group)","No","31-1440175","29276OH0750115","Anthem Gold Blue Access X PPO 1000 30  4500 Plus","29276OH075",,"OHN003","OHS001","OHF005","New","PPO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0750115-01","Standard Gold On Exchange Plan","78.29%","0.795714259147644","No","Yes","No","100%",,"$1,000","$0","$1,225","$0","$424","$20","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","$13,500","$13500 per person","$27000 per group","$1,000","$1000 per person","$3000 per group","30%",,,,,"$2,000","$2000 per person","$6000 per group","$3,000","$3000 per person","$9000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1PJN","http://sgplans.anthem.com/oh/brochure/","5"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","1","29276","OH","SHOP (Small Group)","No","31-1440175","29276OH0750113","Anthem Bronze Blue Access X PPO 5000EC 20  6550 Plus w HSA","29276OH075",,"OHN003","OHS001","OHF001","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0750113-00","Standard Bronze Off Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1Z6M","http://sgplans.anthem.com/oh/brochure/","6"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","1","29276","OH","Individual","No","31-1440175","29276OH0740023","Anthem Silver Pathway X PPO 3000 10","29276OH074",,"OHN001","OHS001","OHF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740023-00","Standard Silver Off Exchange Plan","70.18%","0.704815626144409","Yes","Yes","Yes","70%","30%","$3,000","$500","$311","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%","$3,000","$3000 per person","$6000 per group","10%","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GL6","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","6"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","1","29276","OH","Individual","No","31-1440175","29276OH0740023","Anthem Silver Pathway X PPO 3000 10","29276OH074",,"OHN001","OHS001","OHF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740023-01","Standard Silver On Exchange Plan","70.18%","0.704815626144409","Yes","Yes","Yes","70%","30%","$3,000","$500","$311","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%","$3,000","$3000 per person","$6000 per group","10%","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GL6","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","7"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","1","29276","OH","SHOP (Small Group)","No","31-1440175","29276OH0750113","Anthem Bronze Blue Access X PPO 5000EC 20  6550 Plus w HSA","29276OH075",,"OHN003","OHS001","OHF001","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0750113-01","Standard Bronze On Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","$19,650","$19650 per person","$39300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1Z6M","http://sgplans.anthem.com/oh/brochure/","7"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","1","29276","OH","Individual","No","31-1440175","29276OH0740023","Anthem Silver Pathway X PPO 3000 10","29276OH074",,"OHN001","OHS001","OHF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740023-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GL6","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","8"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","1","29276","OH","Individual","No","31-1440175","29276OH0740023","Anthem Silver Pathway X PPO 3000 10","29276OH074",,"OHN001","OHS001","OHF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740023-03","Limited Cost Sharing Plan Variation","70.18%","0.704815626144409","Yes","Yes","Yes","70%","30%","$3,000","$500","$311","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%","$3,000","$3000 per person","$6000 per group","10%","$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GL6","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","9"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","1","29276","OH","Individual","No","31-1440175","29276OH0740023","Anthem Silver Pathway X PPO 3000 10","29276OH074",,"OHN001","OHS001","OHF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740023-04","73% AV Level Silver Plan","73.78%","0.73936527967453","Yes","Yes","Yes","70%","30%","$2,500","$500","$361","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$13,500","$13500 per person","$27000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%","$2,500","$2500 per person","$5000 per group","10%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GL8","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","10"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","1","29276","OH","Individual","No","31-1440175","29276OH0740023","Anthem Silver Pathway X PPO 3000 10","29276OH074",,"OHN001","OHS001","OHF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740023-05","87% AV Level Silver Plan","87.94%","0.878192663192749","Yes","Yes","Yes","70%","30%","$750","$250","$561","$0","$750","$60","$34","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","$1,650","$1650 per person","$3300 per group","$4,950","$4950 per person","$9900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%","$750","$750 per person","$1500 per group","10%","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GL9","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","11"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","SHOP (Small Group)","Yes","31-1440175","29276OH0800003","Anthem Dental Family","29276OH080",,"OHN004","OHS002",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level","Yes",,"","29276OH0800003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214673.pdf",,"4"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","SHOP (Small Group)","Yes","31-1440175","29276OH0860003","Anthem Dental Family","29276OH086",,"OHN004","OHS002",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level","Yes",,"","29276OH0860003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214673.pdf",,"5"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","SHOP (Small Group)","No","31-1440175","29276OH0750112","Anthem Silver Blue Access X PPO 2000 30  5000 Plus","29276OH075",,"OHN003","OHS001","OHF007","Existing","PPO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0750112-01","Standard Silver On Exchange Plan","70.01%","0.71945583820343","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","$6,000","$6000 per person","$12000 per group","$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1Z7C","http://sgplans.anthem.com/oh/brochure/","5"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","Yes","31-1440175","29276OH0890003","Anthem Dental Family","29276OH089",,"OHN004","OHS002",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","29276OH0890003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214673.pdf",,"5"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740018","Anthem Bronze Pathway X PPO 0 for HSA","29276OH074",,"OHN001","OHS001","OHF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740018-01","Standard Bronze On Exchange Plan",,"0.5993931889534","Yes","Yes","Yes","70%","30%","$6,550","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%","$6,550","$6550 per person","$13100 per group","0%","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GKS","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","5"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740018","Anthem Bronze Pathway X PPO 0 for HSA","29276OH074",,"OHN001","OHS001","OHF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group",,"$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GKT","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","6"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740018","Anthem Bronze Pathway X PPO 0 for HSA","29276OH074",,"OHN001","OHS001","OHF001","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740018-03","Limited Cost Sharing Plan Variation",,"0.5993931889534","Yes","Yes","Yes","70%","30%","$6,550","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%","$6,550","$6550 per person","$13100 per group","0%","$19,650","$19650 per person","$39300 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GKS","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","7"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740022","Anthem Bronze Pathway X PPO 5550 20","29276OH074",,"OHN001","OHS001","OHF018","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740022-00","Standard Bronze Off Exchange Plan","61.89%","0.619710326194763","Yes","Yes","Yes","70%","30%","$5,550","$0","$212","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$5550 per person","$11100 per group","20%","$5,550","$5550 per person","$11100 per group","20%","$16,650","$16650 per person","$33300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GL3","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","8"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740022","Anthem Bronze Pathway X PPO 5550 20","29276OH074",,"OHN001","OHS001","OHF018","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740022-01","Standard Bronze On Exchange Plan","61.89%","0.619710326194763","Yes","Yes","Yes","70%","30%","$5,550","$0","$212","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$5550 per person","$11100 per group","20%","$5,550","$5550 per person","$11100 per group","20%","$16,650","$16650 per person","$33300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GL4","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","9"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740022","Anthem Bronze Pathway X PPO 5550 20","29276OH074",,"OHN001","OHS001","OHF018","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740022-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group",,"$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GL5","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","10"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740022","Anthem Bronze Pathway X PPO 5550 20","29276OH074",,"OHN001","OHS001","OHF018","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740022-03","Limited Cost Sharing Plan Variation","61.89%","0.619710326194763","Yes","Yes","Yes","70%","30%","$5,550","$0","$212","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,550","$5550 per person","$11100 per group","20%","$5,550","$5550 per person","$11100 per group","20%","$16,650","$16650 per person","$33300 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GL4","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","11"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740024","Anthem Silver Pathway X PPO 10 for HSA","29276OH074",,"OHN001","OHS001","OHF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740024-00","Standard Silver Off Exchange Plan","71.40%","0.716186106204987","Yes","Yes","Yes","70%","30%","$2,600","$500","$351","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","10%","$2,600","$2600 per person","$5200 per group","10%","$7,800","$7800 per person","$15600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GLH","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","16"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740024","Anthem Silver Pathway X PPO 10 for HSA","29276OH074",,"OHN001","OHS001","OHF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740024-01","Standard Silver On Exchange Plan","71.40%","0.716186106204987","Yes","Yes","Yes","70%","30%","$2,600","$500","$351","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","10%","$2,600","$2600 per person","$5200 per group","10%","$7,800","$7800 per person","$15600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GLC","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","17"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740024","Anthem Silver Pathway X PPO 10 for HSA","29276OH074",,"OHN001","OHS001","OHF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740024-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group",,"$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GLD","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","18"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740024","Anthem Silver Pathway X PPO 10 for HSA","29276OH074",,"OHN001","OHS001","OHF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740024-03","Limited Cost Sharing Plan Variation","71.40%","0.716186106204987","Yes","Yes","Yes","70%","30%","$2,600","$500","$351","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","10%","$2,600","$2600 per person","$5200 per group","10%","$7,800","$7800 per person","$15600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GLC","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","19"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740024","Anthem Silver Pathway X PPO 10 for HSA","29276OH074",,"OHN001","OHS001","OHF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740024-04","73% AV Level Silver Plan","73.96%","0.742390751838684","Yes","Yes","Yes","70%","30%","$2,100","$500","$401","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","10%","$2,100","$2100 per person","$4200 per group","10%","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd28Z0","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","20"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740024","Anthem Silver Pathway X PPO 10 for HSA","29276OH074",,"OHN001","OHS001","OHF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740024-05","87% AV Level Silver Plan","87.46%","0.873577117919922","Yes","Yes","Yes","70%","30%","$1,150","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","$1,150","$1150 per person","$2300 per group","$3,450","$3450 per person","$6900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","0%","$1,150","$1150 per person","$2300 per group","0%","$3,450","$3450 per person","$6900 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GLF","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","21"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740024","Anthem Silver Pathway X PPO 10 for HSA","29276OH074",,"OHN001","OHS001","OHF002","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740024-06","94% AV Level Silver Plan","93.96%","0.938461005687714","Yes","Yes","Yes","70%","30%","$500","$0","$0","$0","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%","$500","$500 per person","$1000 per group","0%","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GLG","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","22"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740025","Anthem Silver Pathway X PPO 3750 0","29276OH074",,"OHN001","OHS001","OHF013","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740025-00","Standard Silver Off Exchange Plan","71.78%","0.718185484409332","Yes","Yes","Yes","70%","30%","$3,750","$500","$0","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0%","$3,750","$3750 per person","$7500 per group","0%","$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GLP","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","23"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740025","Anthem Silver Pathway X PPO 3750 0","29276OH074",,"OHN001","OHS001","OHF013","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740025-01","Standard Silver On Exchange Plan","71.78%","0.718185484409332","Yes","Yes","Yes","70%","30%","$3,750","$500","$0","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0%","$3,750","$3750 per person","$7500 per group","0%","$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GLP","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","24"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740025","Anthem Silver Pathway X PPO 3750 0","29276OH074",,"OHN001","OHS001","OHF013","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740025-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group",,"$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GLK","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","25"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740025","Anthem Silver Pathway X PPO 3750 0","29276OH074",,"OHN001","OHS001","OHF013","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740025-03","Limited Cost Sharing Plan Variation","71.78%","0.718185484409332","Yes","Yes","Yes","70%","30%","$3,750","$500","$0","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","$6,500","$6500 per person","$13000 per group","$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,750","$3750 per person","$7500 per group","0%","$3,750","$3750 per person","$7500 per group","0%","$11,250","$11250 per person","$22500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GLJ","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","26"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740025","Anthem Silver Pathway X PPO 3750 0","29276OH074",,"OHN001","OHS001","OHF013","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740025-04","73% AV Level Silver Plan","73.79%","0.738112092018127","Yes","Yes","Yes","70%","30%","$3,350","$500","$0","$0","$424","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","$15,600","$15600 per person","$31200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","0%","$3,350","$3350 per person","$6700 per group","0%","$10,050","$10050 per person","$20100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GLL","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","27"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740025","Anthem Silver Pathway X PPO 3750 0","29276OH074",,"OHN001","OHS001","OHF013","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740025-05","87% AV Level Silver Plan","87.91%","0.879418134689331","Yes","Yes","Yes","70%","30%","$1,000","$250","$0","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0%","$1,000","$1000 per person","$2000 per group","0%","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GLM","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","28"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740025","Anthem Silver Pathway X PPO 3750 0","29276OH074",,"OHN001","OHS001","OHF013","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740025-06","94% AV Level Silver Plan","94.70%","0.947157323360443","Yes","Yes","Yes","70%","30%","$250","$100","$0","$0","$250","$30","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%","$250","$250 per person","$500 per group","0%","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GLN","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","29"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740027","Anthem Silver Pathway X PPO 2500 10","29276OH074",,"OHN001","OHS001","OHF017","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740027-00","Standard Silver Off Exchange Plan","71.99%","0.718559384346008","Yes","Yes","Yes","70%","30%","$2,500","$500","$361","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%","$2,500","$2500 per person","$5000 per group","10%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GM1","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","30"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740027","Anthem Silver Pathway X PPO 2500 10","29276OH074",,"OHN001","OHS001","OHF017","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740027-01","Standard Silver On Exchange Plan","71.99%","0.718559384346008","Yes","Yes","Yes","70%","30%","$2,500","$500","$361","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%","$2,500","$2500 per person","$5000 per group","10%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GLW","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","31"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740027","Anthem Silver Pathway X PPO 2500 10","29276OH074",,"OHN001","OHS001","OHF017","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740027-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group",,"$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GLX","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","32"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740027","Anthem Silver Pathway X PPO 2500 10","29276OH074",,"OHN001","OHS001","OHF017","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740027-03","Limited Cost Sharing Plan Variation","71.99%","0.718559384346008","Yes","Yes","Yes","70%","30%","$2,500","$500","$361","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","10%","$2,500","$2500 per person","$5000 per group","10%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GLW","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","33"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740027","Anthem Silver Pathway X PPO 2500 10","29276OH074",,"OHN001","OHS001","OHF017","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740027-04","73% AV Level Silver Plan","73.99%","0.73633599281311","Yes","Yes","Yes","70%","30%","$2,350","$500","$376","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,150","$5150 per person","$10300 per group","$5,150","$5150 per person","$10300 per group","$15,450","$15450 per person","$30900 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","10%","$2,350","$2350 per person","$4700 per group","10%","$7,050","$7050 per person","$14100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GLY","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","34"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740027","Anthem Silver Pathway X PPO 2500 10","29276OH074",,"OHN001","OHS001","OHF017","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740027-05","87% AV Level Silver Plan","87.80%","0.875080823898315","Yes","Yes","Yes","70%","30%","$750","$250","$561","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$1,750","$1750 per person","$3500 per group","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%","$750","$750 per person","$1500 per group","10%","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GLZ","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","35"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740027","Anthem Silver Pathway X PPO 2500 10","29276OH074",,"OHN001","OHS001","OHF017","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740027-06","94% AV Level Silver Plan","94.73%","0.946843862533569","Yes","Yes","Yes","70%","30%","$200","$150","$250","$0","$200","$20","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10%","$200","$200 per person","$400 per group","10%","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GM0","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","36"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740028","Anthem Gold Pathway X PPO 1250 10","29276OH074",,"OHN001","OHS001","OHF014","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740028-00","Standard Gold Off Exchange Plan","79.28%","0.797184526920319","Yes","Yes","Yes","70%","30%","$1,250","$500","$486","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","10%","$1,250","$1250 per person","$2500 per group","10%","$3,750","$3750 per person","$7500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GM4","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","37"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","Individual","No","31-1440175","29276OH0740026","Anthem Silver Pathway X PPO 2000 20","29276OH074",,"OHN001","OHS001","OHF016","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740026-06","94% AV Level Silver Plan","94.15%","0.938885867595673","Yes","Yes","Yes","70%","30%","$200","$150","$250","$0","$200","$20","$186","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%","$200","$200 per person","$400 per group","20%","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GLU","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","22"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","4","29276","OH","Individual","No","31-1440175","29276OH0740029","Anthem Silver Pathway X PPO 3500 25","29276OH074",,"OHN001","OHS001","OHF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740029-00","Standard Silver Off Exchange Plan","68.22%","0.68629252910614","No","Yes","No","100%",,"$3,500","$500","$653","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","25%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1GM9","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","4"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740028","Anthem Gold Pathway X PPO 1250 10","29276OH074",,"OHN001","OHS001","OHF014","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740028-01","Standard Gold On Exchange Plan","79.28%","0.797184526920319","Yes","Yes","Yes","70%","30%","$1,250","$500","$486","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","10%","$1,250","$1250 per person","$2500 per group","10%","$3,750","$3750 per person","$7500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GM2","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","38"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740028","Anthem Gold Pathway X PPO 1250 10","29276OH074",,"OHN001","OHS001","OHF014","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740028-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group",,"$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GM3","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","39"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740028","Anthem Gold Pathway X PPO 1250 10","29276OH074",,"OHN001","OHS001","OHF014","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740028-03","Limited Cost Sharing Plan Variation","79.28%","0.797184526920319","Yes","Yes","Yes","70%","30%","$1,250","$500","$486","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","10%","$1,250","$1250 per person","$2500 per group","10%","$3,750","$3750 per person","$7500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GM2","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","40"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740030","Anthem Silver Pathway X PPO 2200 15","29276OH074",,"OHN001","OHS001","OHF015","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740030-00","Standard Silver Off Exchange Plan","71.19%","0.707388520240784","Yes","Yes","Yes","70%","30%","$2,200","$500","$587","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","15%","$2,200","$2200 per person","$4400 per group","15%","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMF","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","41"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740030","Anthem Silver Pathway X PPO 2200 15","29276OH074",,"OHN001","OHS001","OHF015","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740030-01","Standard Silver On Exchange Plan","71.19%","0.707388520240784","Yes","Yes","Yes","70%","30%","$2,200","$500","$587","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","15%","$2,200","$2200 per person","$4400 per group","15%","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMB","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","42"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740030","Anthem Silver Pathway X PPO 2200 15","29276OH074",,"OHN001","OHS001","OHF015","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740030-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group",,"$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GMG","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","43"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740030","Anthem Silver Pathway X PPO 2200 15","29276OH074",,"OHN001","OHS001","OHF015","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740030-03","Limited Cost Sharing Plan Variation","71.19%","0.707388520240784","Yes","Yes","Yes","70%","30%","$2,200","$500","$587","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,200","$2200 per person","$4400 per group","15%","$2,200","$2200 per person","$4400 per group","15%","$6,600","$6600 per person","$13200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMB","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","44"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740030","Anthem Silver Pathway X PPO 2200 15","29276OH074",,"OHN001","OHS001","OHF015","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740030-04","73% AV Level Silver Plan","73.78%","0.731524527072906","Yes","Yes","Yes","70%","30%","$2,000","$500","$617","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","15%","$2,000","$2000 per person","$4000 per group","15%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMC","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","45"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740030","Anthem Silver Pathway X PPO 2200 15","29276OH074",,"OHN001","OHS001","OHF015","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740030-05","87% AV Level Silver Plan","87.87%","0.872582733631134","Yes","Yes","Yes","70%","30%","$850","$250","$200","$0","$850","$0","$45","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","$1,300","$1300 per person","$2600 per group","$3,900","$3900 per person","$7800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group","15%","$850","$850 per person","$1700 per group","15%","$2,550","$2550 per person","$5100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GMD","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","46"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","2","29276","OH","Individual","No","31-1440175","29276OH0740030","Anthem Silver Pathway X PPO 2200 15","29276OH074",,"OHN001","OHS001","OHF015","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740030-06","94% AV Level Silver Plan","94.43%","0.941542148590088","Yes","Yes","Yes","70%","30%","$250","$200","$100","$0","$250","$0","$135","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","$550","$550 per person","$1100 per group","$1,650","$1650 per person","$3300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15%","$250","$250 per person","$500 per group","15%","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GME","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","47"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","Individual","No","31-1440175","29276OH0740019","Anthem Bronze Pathway X PPO 5000 25","29276OH074",,"OHN001","OHS001","OHF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740019-00","Standard Bronze Off Exchange Plan","61.90%","0.620672881603241","Yes","Yes","Yes","70%","30%","$5,000","$0","$403","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","25%","$5,000","$5000 per person","$10000 per group","25%","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GKW","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","4"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","Individual","Yes","31-1440175","29276OH0830004","Anthem Dental Family Enhanced","29276OH083",,"OHN004","OHS002",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.60","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","29276OH0830004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214674.pdf",,"4"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","SHOP (Small Group)","Yes","31-1440175","29276OH0800004","Anthem Dental Family Enhanced","29276OH080",,"OHN004","OHS002",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.60","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level","Yes",,"","29276OH0800004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214674.pdf",,"4"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","SHOP (Small Group)","Yes","31-1440175","29276OH0860004","Anthem Dental Family Enhanced","29276OH086",,"OHN004","OHS002",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.60","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level","Yes",,"","29276OH0860004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214674.pdf",,"5"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","Individual","Yes","31-1440175","29276OH0890004","Anthem Dental Family Enhanced","29276OH089",,"OHN004","OHS002",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.60","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","29276OH0890004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/oh/f0/s0/t0/pw_e214674.pdf",,"5"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","Individual","No","31-1440175","29276OH0740019","Anthem Bronze Pathway X PPO 5000 25","29276OH074",,"OHN001","OHS001","OHF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740019-01","Standard Bronze On Exchange Plan","61.90%","0.620672881603241","Yes","Yes","Yes","70%","30%","$5,000","$0","$403","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","25%","$5,000","$5000 per person","$10000 per group","25%","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GKU","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","5"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","Individual","No","31-1440175","29276OH0740019","Anthem Bronze Pathway X PPO 5000 25","29276OH074",,"OHN001","OHS001","OHF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740019-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GKV","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","6"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","Individual","No","31-1440175","29276OH0740019","Anthem Bronze Pathway X PPO 5000 25","29276OH074",,"OHN001","OHS001","OHF003","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740019-03","Limited Cost Sharing Plan Variation","61.90%","0.620672881603241","Yes","Yes","Yes","70%","30%","$5,000","$0","$403","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","25%","$5,000","$5000 per person","$10000 per group","25%","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GKU","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","7"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","Individual","No","31-1440175","29276OH0740020","Anthem Bronze Pathway X PPO 5000 30","29276OH074",,"OHN001","OHS001","OHF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740020-00","Standard Bronze Off Exchange Plan","61.67%","0.616430461406708","Yes","Yes","Yes","70%","30%","$5,000","$0","$483","$0","$1,039","$110","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%","$5,000","$5000 per person","$10000 per group","30%","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GKZ","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","8"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","Individual","No","31-1440175","29276OH0740020","Anthem Bronze Pathway X PPO 5000 30","29276OH074",,"OHN001","OHS001","OHF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740020-01","Standard Bronze On Exchange Plan","61.67%","0.616430461406708","Yes","Yes","Yes","70%","30%","$5,000","$0","$483","$0","$1,039","$110","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%","$5,000","$5000 per person","$10000 per group","30%","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GKX","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","9"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","Individual","No","31-1440175","29276OH0740020","Anthem Bronze Pathway X PPO 5000 30","29276OH074",,"OHN001","OHS001","OHF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740020-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GKY","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","10"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","Individual","No","31-1440175","29276OH0740020","Anthem Bronze Pathway X PPO 5000 30","29276OH074",,"OHN001","OHS001","OHF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740020-03","Limited Cost Sharing Plan Variation","61.67%","0.616430461406708","Yes","Yes","Yes","70%","30%","$5,000","$0","$483","$0","$1,039","$110","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%","$5,000","$5000 per person","$10000 per group","30%","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GKX","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","11"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","Individual","No","31-1440175","29276OH0740021","Anthem Bronze Pathway X PPO 6500 20","29276OH074",,"OHN001","OHS001","OHF018","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740021-00","Standard Bronze Off Exchange Plan","61.94%","0.620993971824646","Yes","Yes","Yes","70%","30%","$6,500","$0","$22","$0","$1,029","$120","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","20%","$6,500","$6500 per person","$13000 per group","20%","$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GL2","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","12"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","Individual","No","31-1440175","29276OH0740021","Anthem Bronze Pathway X PPO 6500 20","29276OH074",,"OHN001","OHS001","OHF018","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740021-01","Standard Bronze On Exchange Plan","61.94%","0.620993971824646","Yes","Yes","Yes","70%","30%","$6,500","$0","$22","$0","$1,029","$120","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","20%","$6,500","$6500 per person","$13000 per group","20%","$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GL0","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","13"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","Individual","No","31-1440175","29276OH0740021","Anthem Bronze Pathway X PPO 6500 20","29276OH074",,"OHN001","OHS001","OHF018","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740021-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GL1","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","14"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","Individual","No","31-1440175","29276OH0740021","Anthem Bronze Pathway X PPO 6500 20","29276OH074",,"OHN001","OHS001","OHF018","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740021-03","Limited Cost Sharing Plan Variation","61.94%","0.620993971824646","Yes","Yes","Yes","70%","30%","$6,500","$0","$22","$0","$1,029","$120","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","20%","$6,500","$6500 per person","$13000 per group","20%","$19,500","$19500 per person","$39000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GL0","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","15"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","Individual","No","31-1440175","29276OH0740026","Anthem Silver Pathway X PPO 2000 20","29276OH074",,"OHN001","OHS001","OHF016","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740026-00","Standard Silver Off Exchange Plan","71.59%","0.719685792922974","Yes","Yes","Yes","70%","30%","$2,000","$500","$822","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","20%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GLV","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","16"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","Individual","No","31-1440175","29276OH0740026","Anthem Silver Pathway X PPO 2000 20","29276OH074",,"OHN001","OHS001","OHF016","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740026-01","Standard Silver On Exchange Plan","71.59%","0.719685792922974","Yes","Yes","Yes","70%","30%","$2,000","$500","$822","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","20%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GLQ","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","17"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","Individual","No","31-1440175","29276OH0740026","Anthem Silver Pathway X PPO 2000 20","29276OH074",,"OHN001","OHS001","OHF016","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740026-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GLR","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","18"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","Individual","No","31-1440175","29276OH0740026","Anthem Silver Pathway X PPO 2000 20","29276OH074",,"OHN001","OHS001","OHF016","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740026-03","Limited Cost Sharing Plan Variation","71.59%","0.719685792922974","Yes","Yes","Yes","70%","30%","$2,000","$500","$822","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","20%","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GLQ","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","19"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","Individual","No","31-1440175","29276OH0740026","Anthem Silver Pathway X PPO 2000 20","29276OH074",,"OHN001","OHS001","OHF016","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740026-04","73% AV Level Silver Plan","73.99%","0.742067515850067","Yes","Yes","Yes","70%","30%","$1,850","$500","$852","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","$5,200","$5200 per person","$10400 per group","$15,600","$15600 per person","$31200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,850","$1850 per person","$3700 per group","20%","$1,850","$1850 per person","$3700 per group","20%","$5,550","$5550 per person","$11100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GLS","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","20"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","3","29276","OH","Individual","No","31-1440175","29276OH0740026","Anthem Silver Pathway X PPO 2000 20","29276OH074",,"OHN001","OHS001","OHF016","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740026-05","87% AV Level Silver Plan","87.72%","0.874523162841797","Yes","Yes","Yes","70%","30%","$750","$250","$500","$0","$750","$40","$72","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%","$750","$750 per person","$1500 per group","20%","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GLT","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","21"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","4","29276","OH","Individual","No","31-1440175","29276OH0740029","Anthem Silver Pathway X PPO 3500 25","29276OH074",,"OHN001","OHS001","OHF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740029-01","Standard Silver On Exchange Plan","68.22%","0.68629252910614","No","Yes","No","100%",,"$3,500","$500","$653","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","25%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1GM5","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","5"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","4","29276","OH","Individual","No","31-1440175","29276OH0740029","Anthem Silver Pathway X PPO 3500 25","29276OH074",,"OHN001","OHS001","OHF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740029-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1GMA","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","6"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","4","29276","OH","Individual","No","31-1440175","29276OH0740029","Anthem Silver Pathway X PPO 3500 25","29276OH074",,"OHN001","OHS001","OHF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740029-03","Limited Cost Sharing Plan Variation","68.22%","0.68629252910614","No","Yes","No","100%",,"$3,500","$500","$653","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$16,500","$16500 per person","$33000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","25%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","25%",,,,,"$10,500","$10500 per person","$21000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1GM5","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","7"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","4","29276","OH","Individual","No","31-1440175","29276OH0740029","Anthem Silver Pathway X PPO 3500 25","29276OH074",,"OHN001","OHS001","OHF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740029-04","73% AV Level Silver Plan","73.39%","0.730395615100861","No","Yes","No","100%",,"$2,250","$500","$965","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group",,,,"$13,950","$13950 per person","$27900 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","25%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","25%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1GM6","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","8"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","4","29276","OH","Individual","No","31-1440175","29276OH0740029","Anthem Silver Pathway X PPO 3500 25","29276OH074",,"OHN001","OHS001","OHF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740029-05","87% AV Level Silver Plan","87.23%","0.843626081943512","No","Yes","No","100%",,"$750","$250","$500","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","25%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","25%",,,,,"$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1GM7","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","9"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","4","29276","OH","Individual","No","31-1440175","29276OH0740029","Anthem Silver Pathway X PPO 3500 25","29276OH074",,"OHN001","OHS001","OHF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Full BlueCard at OON benefits if a Standard BlueCard PPO provider","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0740029-06","94% AV Level Silver Plan","93.43%","0.936715006828308","No","Yes","No","100%",,"$250","$150","$200","$0","$250","$40","$44","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$1,800","$1800 per person","$3600 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","25%",,,,,"$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1GM8","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","10"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920001","Anthem Bronze Pathway X HMO 5000 40","29276OH092",,"OHN002","OHS003","OHF034","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920001-00","Standard Bronze Off Exchange Plan","61.28%","0.611077845096588","Yes","Yes","No","100%",,"$5,000","$0","$644","$0","$1,049","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2F","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","4"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920001","Anthem Bronze Pathway X HMO 5000 40","29276OH092",,"OHN002","OHS003","OHF034","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920001-01","Standard Bronze On Exchange Plan","61.28%","0.611077845096588","Yes","Yes","No","100%",,"$5,000","$0","$644","$0","$1,049","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","5"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920001","Anthem Bronze Pathway X HMO 5000 40","29276OH092",,"OHN002","OHS003","OHF034","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2E","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","6"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920001","Anthem Bronze Pathway X HMO 5000 40","29276OH092",,"OHN002","OHS003","OHF034","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920001-03","Limited Cost Sharing Plan Variation","61.28%","0.611077845096588","Yes","Yes","No","100%",,"$5,000","$0","$644","$0","$1,049","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","7"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920002","Anthem Bronze Pathway X HMO 5200 20","29276OH092",,"OHN002","OHS003","OHF033","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920002-00","Standard Bronze Off Exchange Plan","60.34%","0.619024157524109","Yes","Yes","No","100%",,"$5,200","$0","$282","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2J","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","8"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920002","Anthem Bronze Pathway X HMO 5200 20","29276OH092",,"OHN002","OHS003","OHF033","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920002-01","Standard Bronze On Exchange Plan","60.34%","0.619024157524109","Yes","Yes","No","100%",,"$5,200","$0","$282","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","9"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920002","Anthem Bronze Pathway X HMO 5200 20","29276OH092",,"OHN002","OHS003","OHF033","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2H","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","10"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920002","Anthem Bronze Pathway X HMO 5200 20","29276OH092",,"OHN002","OHS003","OHF033","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920002-03","Limited Cost Sharing Plan Variation","60.34%","0.619024157524109","Yes","Yes","No","100%",,"$5,200","$0","$282","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","11"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920010","Anthem Bronze Pathway X HMO 5000 40","29276OH092",,"OHN002","OHS004","OHF034","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920010-00","Standard Bronze Off Exchange Plan","61.28%","0.611077845096588","Yes","Yes","No","100%",,"$5,000","$0","$644","$0","$1,049","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2F","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","12"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920010","Anthem Bronze Pathway X HMO 5000 40","29276OH092",,"OHN002","OHS004","OHF034","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920010-01","Standard Bronze On Exchange Plan","61.28%","0.611077845096588","Yes","Yes","No","100%",,"$5,000","$0","$644","$0","$1,049","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","13"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920010","Anthem Bronze Pathway X HMO 5000 40","29276OH092",,"OHN002","OHS004","OHF034","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2E","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","14"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920010","Anthem Bronze Pathway X HMO 5000 40","29276OH092",,"OHN002","OHS004","OHF034","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920010-03","Limited Cost Sharing Plan Variation","61.28%","0.611077845096588","Yes","Yes","No","100%",,"$5,000","$0","$644","$0","$1,049","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","15"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920011","Anthem Bronze Pathway X HMO 5000 40","29276OH092",,"OHN002","OHS005","OHF034","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920011-00","Standard Bronze Off Exchange Plan","61.28%","0.611077845096588","Yes","Yes","No","100%",,"$5,000","$0","$644","$0","$1,049","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2F","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","16"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920011","Anthem Bronze Pathway X HMO 5000 40","29276OH092",,"OHN002","OHS005","OHF034","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920011-01","Standard Bronze On Exchange Plan","61.28%","0.611077845096588","Yes","Yes","No","100%",,"$5,000","$0","$644","$0","$1,049","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","17"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920011","Anthem Bronze Pathway X HMO 5000 40","29276OH092",,"OHN002","OHS005","OHF034","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2E","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","18"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920011","Anthem Bronze Pathway X HMO 5000 40","29276OH092",,"OHN002","OHS005","OHF034","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920011-03","Limited Cost Sharing Plan Variation","61.28%","0.611077845096588","Yes","Yes","No","100%",,"$5,000","$0","$644","$0","$1,049","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2D","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","19"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920012","Anthem Bronze Pathway X HMO 5200 20","29276OH092",,"OHN002","OHS004","OHF033","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920012-00","Standard Bronze Off Exchange Plan","60.34%","0.619024157524109","Yes","Yes","No","100%",,"$5,200","$0","$282","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2J","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","20"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920012","Anthem Bronze Pathway X HMO 5200 20","29276OH092",,"OHN002","OHS004","OHF033","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920012-01","Standard Bronze On Exchange Plan","60.34%","0.619024157524109","Yes","Yes","No","100%",,"$5,200","$0","$282","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","21"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920012","Anthem Bronze Pathway X HMO 5200 20","29276OH092",,"OHN002","OHS004","OHF033","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2H","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","22"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920012","Anthem Bronze Pathway X HMO 5200 20","29276OH092",,"OHN002","OHS004","OHF033","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920012-03","Limited Cost Sharing Plan Variation","60.34%","0.619024157524109","Yes","Yes","No","100%",,"$5,200","$0","$282","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","23"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920013","Anthem Bronze Pathway X HMO 5200 20","29276OH092",,"OHN002","OHS005","OHF033","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920013-00","Standard Bronze Off Exchange Plan","60.34%","0.619024157524109","Yes","Yes","No","100%",,"$5,200","$0","$282","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2J","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","24"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920013","Anthem Bronze Pathway X HMO 5200 20","29276OH092",,"OHN002","OHS005","OHF033","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920013-01","Standard Bronze On Exchange Plan","60.34%","0.619024157524109","Yes","Yes","No","100%",,"$5,200","$0","$282","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","25"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920013","Anthem Bronze Pathway X HMO 5200 20","29276OH092",,"OHN002","OHS005","OHF033","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2H","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","26"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","5","29276","OH","Individual","No","31-1440175","29276OH0920013","Anthem Bronze Pathway X HMO 5200 20","29276OH092",,"OHN002","OHS005","OHF033","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","2","2016-01-01","2016-12-31","No","Emergency/Urgent Care","No","Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920013-03","Limited Cost Sharing Plan Variation","60.34%","0.619024157524109","Yes","Yes","No","100%",,"$5,200","$0","$282","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","27"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920003","Anthem Bronze Pathway X HMO 6850 0","29276OH092",,"OHN002","OHS003","OHF023","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent care","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920003-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,554","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","4"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920003","Anthem Bronze Pathway X HMO 6850 0","29276OH092",,"OHN002","OHS003","OHF023","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent care","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920003-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,554","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2L","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","5"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920003","Anthem Bronze Pathway X HMO 6850 0","29276OH092",,"OHN002","OHS003","OHF023","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent care","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2M","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","6"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920003","Anthem Bronze Pathway X HMO 6850 0","29276OH092",,"OHN002","OHS003","OHF023","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent care","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920003-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,554","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","7"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920007","Anthem Silver Pathway X HMO 2850 15","29276OH092",,"OHN002","OHS003","OHF035","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920007-00","Standard Silver Off Exchange Plan","69.56%","0.705475330352783","Yes","Yes","No","100%",,"$2,850","$500","$489","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X35","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","8"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920007","Anthem Silver Pathway X HMO 2850 15","29276OH092",,"OHN002","OHS003","OHF035","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920007-01","Standard Silver On Exchange Plan","69.56%","0.705475330352783","Yes","Yes","No","100%",,"$2,850","$500","$489","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","9"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920007","Anthem Silver Pathway X HMO 2850 15","29276OH092",,"OHN002","OHS003","OHF035","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X31","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","10"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920007","Anthem Silver Pathway X HMO 2850 15","29276OH092",,"OHN002","OHS003","OHF035","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920007-03","Limited Cost Sharing Plan Variation","69.56%","0.705475330352783","Yes","Yes","No","100%",,"$2,850","$500","$489","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","11"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920007","Anthem Silver Pathway X HMO 2850 15","29276OH092",,"OHN002","OHS003","OHF035","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920007-04","73% AV Level Silver Plan","72.71%","0.73084032535553","Yes","Yes","No","100%",,"$2,500","$500","$542","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X32","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","12"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920007","Anthem Silver Pathway X HMO 2850 15","29276OH092",,"OHN002","OHS003","OHF035","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920007-05","87% AV Level Silver Plan","86.02%","0.85769647359848","Yes","Yes","No","100%",,"$1,000","$250","$500","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X33","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","13"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920007","Anthem Silver Pathway X HMO 2850 15","29276OH092",,"OHN002","OHS003","OHF035","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920007-06","94% AV Level Silver Plan","93.18%","0.929505527019501","Yes","Yes","No","100%",,"$250","$150","$350","$0","$250","$20","$26","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X34","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","14"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920009","Anthem Gold Pathway HMO X 1150 10","29276OH092",,"OHN002","OHS003","OHF030","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920009-00","Standard Gold Off Exchange Plan","79.75%","0.805611431598663","Yes","Yes","No","100%",,"$1,150","$500","$496","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X3B","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","15"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920009","Anthem Gold Pathway HMO X 1150 10","29276OH092",,"OHN002","OHS003","OHF030","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920009-01","Standard Gold On Exchange Plan","79.75%","0.805611431598663","Yes","Yes","No","100%",,"$1,150","$500","$496","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X39","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","16"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920009","Anthem Gold Pathway HMO X 1150 10","29276OH092",,"OHN002","OHS003","OHF030","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X3A","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","17"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920009","Anthem Gold Pathway HMO X 1150 10","29276OH092",,"OHN002","OHS003","OHF030","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920009-03","Limited Cost Sharing Plan Variation","79.75%","0.805611431598663","Yes","Yes","No","100%",,"$1,150","$500","$496","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X39","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","18"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920014","Anthem Bronze Pathway X HMO 6850 0","29276OH092",,"OHN002","OHS004","OHF023","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920014-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,554","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","19"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920014","Anthem Bronze Pathway X HMO 6850 0","29276OH092",,"OHN002","OHS004","OHF023","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920014-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,554","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2L","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","20"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920014","Anthem Bronze Pathway X HMO 6850 0","29276OH092",,"OHN002","OHS004","OHF023","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2M","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","21"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920014","Anthem Bronze Pathway X HMO 6850 0","29276OH092",,"OHN002","OHS004","OHF023","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920014-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,554","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","22"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920015","Anthem Bronze Pathway X HMO 6850 0","29276OH092",,"OHN002","OHS005","OHF023","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920015-00","Standard Bronze Off Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,554","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","23"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920015","Anthem Bronze Pathway X HMO 6850 0","29276OH092",,"OHN002","OHS005","OHF023","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920015-01","Standard Bronze On Exchange Plan",,"0.590237438678741","Yes","Yes","No","100%",,"$6,554","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2L","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","24"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920015","Anthem Bronze Pathway X HMO 6850 0","29276OH092",,"OHN002","OHS005","OHF023","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2M","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","25"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920015","Anthem Bronze Pathway X HMO 6850 0","29276OH092",,"OHN002","OHS005","OHF023","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920015-03","Limited Cost Sharing Plan Variation",,"0.590237438678741","Yes","Yes","No","100%",,"$6,554","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2K","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","26"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920020","Anthem Silver Pathway X HMO 2850 15","29276OH092",,"OHN002","OHS004","OHF035","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920020-00","Standard Silver Off Exchange Plan","69.56%","0.705475330352783","Yes","Yes","No","100%",,"$2,850","$500","$489","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X35","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","27"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920020","Anthem Silver Pathway X HMO 2850 15","29276OH092",,"OHN002","OHS004","OHF035","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920020-01","Standard Silver On Exchange Plan","69.56%","0.705475330352783","Yes","Yes","No","100%",,"$2,850","$500","$489","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","28"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920020","Anthem Silver Pathway X HMO 2850 15","29276OH092",,"OHN002","OHS004","OHF035","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920020-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X31","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","29"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920020","Anthem Silver Pathway X HMO 2850 15","29276OH092",,"OHN002","OHS004","OHF035","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920020-03","Limited Cost Sharing Plan Variation","69.56%","0.705475330352783","Yes","Yes","No","100%",,"$2,850","$500","$489","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","30"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920020","Anthem Silver Pathway X HMO 2850 15","29276OH092",,"OHN002","OHS004","OHF035","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920020-04","73% AV Level Silver Plan","72.71%","0.73084032535553","Yes","Yes","No","100%",,"$2,500","$500","$542","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X32","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","31"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920020","Anthem Silver Pathway X HMO 2850 15","29276OH092",,"OHN002","OHS004","OHF035","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920020-05","87% AV Level Silver Plan","86.02%","0.85769647359848","Yes","Yes","No","100%",,"$1,000","$250","$500","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X33","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","32"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920020","Anthem Silver Pathway X HMO 2850 15","29276OH092",,"OHN002","OHS004","OHF035","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920020-06","94% AV Level Silver Plan","93.18%","0.929505527019501","Yes","Yes","No","100%",,"$250","$150","$350","$0","$250","$20","$26","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X34","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","33"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920021","Anthem Silver Pathway X HMO 2850 15","29276OH092",,"OHN002","OHS005","OHF035","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920021-00","Standard Silver Off Exchange Plan","69.56%","0.705475330352783","Yes","Yes","No","100%",,"$2,850","$500","$489","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X35","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","34"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920021","Anthem Silver Pathway X HMO 2850 15","29276OH092",,"OHN002","OHS005","OHF035","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920021-01","Standard Silver On Exchange Plan","69.56%","0.705475330352783","Yes","Yes","No","100%",,"$2,850","$500","$489","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","35"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920021","Anthem Silver Pathway X HMO 2850 15","29276OH092",,"OHN002","OHS005","OHF035","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920021-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X31","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","36"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920021","Anthem Silver Pathway X HMO 2850 15","29276OH092",,"OHN002","OHS005","OHF035","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920021-03","Limited Cost Sharing Plan Variation","69.56%","0.705475330352783","Yes","Yes","No","100%",,"$2,850","$500","$489","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,850","$2850 per person","$5700 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X30","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","37"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920021","Anthem Silver Pathway X HMO 2850 15","29276OH092",,"OHN002","OHS005","OHF035","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920021-04","73% AV Level Silver Plan","72.71%","0.73084032535553","Yes","Yes","No","100%",,"$2,500","$500","$542","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X32","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","38"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920021","Anthem Silver Pathway X HMO 2850 15","29276OH092",,"OHN002","OHS005","OHF035","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920021-05","87% AV Level Silver Plan","86.02%","0.85769647359848","Yes","Yes","No","100%",,"$1,000","$250","$500","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X33","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","39"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920021","Anthem Silver Pathway X HMO 2850 15","29276OH092",,"OHN002","OHS005","OHF035","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920021-06","94% AV Level Silver Plan","93.18%","0.929505527019501","Yes","Yes","No","100%",,"$250","$150","$350","$0","$250","$20","$26","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X34","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","40"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920024","Anthem Gold Pathway HMO X 1150 10","29276OH092",,"OHN002","OHS004","OHF030","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920024-00","Standard Gold Off Exchange Plan","79.75%","0.805611431598663","Yes","Yes","No","100%",,"$1,150","$500","$496","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X3B","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","41"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920024","Anthem Gold Pathway HMO X 1150 10","29276OH092",,"OHN002","OHS004","OHF030","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920024-01","Standard Gold On Exchange Plan","79.75%","0.805611431598663","Yes","Yes","No","100%",,"$1,150","$500","$496","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X39","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","42"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920024","Anthem Gold Pathway HMO X 1150 10","29276OH092",,"OHN002","OHS004","OHF030","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920024-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X3A","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","43"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920024","Anthem Gold Pathway HMO X 1150 10","29276OH092",,"OHN002","OHS004","OHF030","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920024-03","Limited Cost Sharing Plan Variation","79.75%","0.805611431598663","Yes","Yes","No","100%",,"$1,150","$500","$496","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X39","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","44"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920025","Anthem Gold Pathway HMO X 1150 10","29276OH092",,"OHN002","OHS005","OHF030","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920025-00","Standard Gold Off Exchange Plan","79.75%","0.805611431598663","Yes","Yes","No","100%",,"$1,150","$500","$496","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X3B","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","45"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920025","Anthem Gold Pathway HMO X 1150 10","29276OH092",,"OHN002","OHS005","OHF030","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920025-01","Standard Gold On Exchange Plan","79.75%","0.805611431598663","Yes","Yes","No","100%",,"$1,150","$500","$496","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X39","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","46"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920025","Anthem Gold Pathway HMO X 1150 10","29276OH092",,"OHN002","OHS005","OHF030","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920025-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X3A","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","47"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","6","29276","OH","Individual","No","31-1440175","29276OH0920025","Anthem Gold Pathway HMO X 1150 10","29276OH092",,"OHN002","OHS005","OHF030","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency care only","Yes",,"https://www.anthem.com/OHSelectdrugtier4","29276OH0920025-03","Limited Cost Sharing Plan Variation","79.75%","0.805611431598663","Yes","Yes","No","100%",,"$1,150","$500","$496","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,150","$1150 per person","$2300 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X39","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","48"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920005","Anthem Silver Pathway X HMO 4250 30","29276OH092",,"OHN002","OHS003","OHF032","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920005-00","Standard Silver Off Exchange Plan","68.20%","0.683710753917694","No","Yes","No","100%",,"$4,250","$65","$688","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","4"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920005","Anthem Silver Pathway X HMO 4250 30","29276OH092",,"OHN002","OHS003","OHF032","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920005-01","Standard Silver On Exchange Plan","68.20%","0.683710753917694","No","Yes","No","100%",,"$4,250","$65","$688","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","5"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920005","Anthem Silver Pathway X HMO 4250 30","29276OH092",,"OHN002","OHS003","OHF032","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","6"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920005","Anthem Silver Pathway X HMO 4250 30","29276OH092",,"OHN002","OHS003","OHF032","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920005-03","Limited Cost Sharing Plan Variation","68.20%","0.683710753917694","No","Yes","No","100%",,"$4,250","$65","$688","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","7"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920005","Anthem Silver Pathway X HMO 4250 30","29276OH092",,"OHN002","OHS003","OHF032","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920005-04","73% AV Level Silver Plan","72.05%","0.714979588985443","No","Yes","No","100%",,"$3,250","$500","$500","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2P","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","8"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920005","Anthem Silver Pathway X HMO 4250 30","29276OH092",,"OHN002","OHS003","OHF032","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920005-05","87% AV Level Silver Plan","86.19%","0.861658811569214","No","Yes","No","100%",,"$1,000","$250","$450","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2Q","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","9"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920005","Anthem Silver Pathway X HMO 4250 30","29276OH092",,"OHN002","OHS003","OHF032","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920005-06","94% AV Level Silver Plan","93.26%","0.930957317352295","No","Yes","No","100%",,"$200","$150","$250","$0","$200","$30","$67","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2R","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","10"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920008","Anthem Gold Pathway X HMO 1450 20","29276OH092",,"OHN002","OHS003","OHF026","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920008-00","Standard Gold Off Exchange Plan","79.54%","0.787188529968262","No","Yes","No","100%",,"$1,450","$500","$932","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,450","$1450 per person","$2900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","11"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920008","Anthem Gold Pathway X HMO 1450 20","29276OH092",,"OHN002","OHS003","OHF026","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920008-01","Standard Gold On Exchange Plan","79.54%","0.787188529968262","No","Yes","No","100%",,"$1,450","$500","$932","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,450","$1450 per person","$2900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","12"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920008","Anthem Gold Pathway X HMO 1450 20","29276OH092",,"OHN002","OHS003","OHF026","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","13"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920008","Anthem Gold Pathway X HMO 1450 20","29276OH092",,"OHN002","OHS003","OHF026","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920008-03","Limited Cost Sharing Plan Variation","79.54%","0.787188529968262","No","Yes","No","100%",,"$1,450","$500","$932","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,100.00","$3100 per person","$6200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,450","$1450 per person","$2900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","14"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920016","Anthem Silver Pathway X HMO 4250 30","29276OH092",,"OHN002","OHS004","OHF032","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920016-00","Standard Silver Off Exchange Plan","68.20%","0.683710753917694","No","Yes","No","100%",,"$4,250","$65","$688","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","15"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920016","Anthem Silver Pathway X HMO 4250 30","29276OH092",,"OHN002","OHS004","OHF032","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920016-01","Standard Silver On Exchange Plan","68.20%","0.683710753917694","No","Yes","No","100%",,"$4,250","$65","$688","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","16"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920016","Anthem Silver Pathway X HMO 4250 30","29276OH092",,"OHN002","OHS004","OHF032","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920016-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","17"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920016","Anthem Silver Pathway X HMO 4250 30","29276OH092",,"OHN002","OHS004","OHF032","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920016-03","Limited Cost Sharing Plan Variation","68.20%","0.683710753917694","No","Yes","No","100%",,"$4,250","$65","$688","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","18"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920016","Anthem Silver Pathway X HMO 4250 30","29276OH092",,"OHN002","OHS004","OHF032","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920016-04","73% AV Level Silver Plan","72.05%","0.714979588985443","No","Yes","No","100%",,"$3,250","$500","$500","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2P","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","19"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920016","Anthem Silver Pathway X HMO 4250 30","29276OH092",,"OHN002","OHS004","OHF032","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920016-05","87% AV Level Silver Plan","86.19%","0.861658811569214","No","Yes","No","100%",,"$1,000","$250","$450","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2Q","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","20"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920016","Anthem Silver Pathway X HMO 4250 30","29276OH092",,"OHN002","OHS004","OHF032","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920016-06","94% AV Level Silver Plan","93.26%","0.930957317352295","No","Yes","No","100%",,"$200","$150","$250","$0","$200","$30","$67","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2R","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","21"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920017","Anthem Silver Pathway X HMO 4250 30","29276OH092",,"OHN002","OHS005","OHF032","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920017-00","Standard Silver Off Exchange Plan","68.20%","0.683710753917694","No","Yes","No","100%",,"$4,250","$65","$688","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","22"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920017","Anthem Silver Pathway X HMO 4250 30","29276OH092",,"OHN002","OHS005","OHF032","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920017-01","Standard Silver On Exchange Plan","68.20%","0.683710753917694","No","Yes","No","100%",,"$4,250","$65","$688","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","23"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920017","Anthem Silver Pathway X HMO 4250 30","29276OH092",,"OHN002","OHS005","OHF032","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920017-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","24"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920017","Anthem Silver Pathway X HMO 4250 30","29276OH092",,"OHN002","OHS005","OHF032","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920017-03","Limited Cost Sharing Plan Variation","68.20%","0.683710753917694","No","Yes","No","100%",,"$4,250","$65","$688","$0","$424","$50","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,250","$4250 per person","$8500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2N","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","25"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920017","Anthem Silver Pathway X HMO 4250 30","29276OH092",,"OHN002","OHS005","OHF032","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920017-04","73% AV Level Silver Plan","72.05%","0.714979588985443","No","Yes","No","100%",,"$3,250","$500","$500","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2P","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","26"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920017","Anthem Silver Pathway X HMO 4250 30","29276OH092",,"OHN002","OHS005","OHF032","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920017-05","87% AV Level Silver Plan","86.19%","0.861658811569214","No","Yes","No","100%",,"$1,000","$250","$450","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2Q","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","27"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920017","Anthem Silver Pathway X HMO 4250 30","29276OH092",,"OHN002","OHS005","OHF032","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920017-06","94% AV Level Silver Plan","93.26%","0.930957317352295","No","Yes","No","100%",,"$200","$150","$250","$0","$200","$30","$67","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X2R","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","28"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920022","Anthem Gold Pathway X HMO 1450 20","29276OH092",,"OHN002","OHS004","OHF026","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920022-00","Standard Gold Off Exchange Plan","79.54%","0.787188529968262","No","Yes","No","100%",,"$1,450","$500","$932","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,450","$1450 per person","$2900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","29"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920022","Anthem Gold Pathway X HMO 1450 20","29276OH092",,"OHN002","OHS004","OHF026","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920022-01","Standard Gold On Exchange Plan","79.54%","0.787188529968262","No","Yes","No","100%",,"$1,450","$500","$932","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,450","$1450 per person","$2900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","30"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920022","Anthem Gold Pathway X HMO 1450 20","29276OH092",,"OHN002","OHS004","OHF026","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920022-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","31"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920022","Anthem Gold Pathway X HMO 1450 20","29276OH092",,"OHN002","OHS004","OHF026","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920022-03","Limited Cost Sharing Plan Variation","79.54%","0.787188529968262","No","Yes","No","100%",,"$1,450","$500","$932","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,100.00","$3100 per person","$6200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,450","$1450 per person","$2900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","32"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920023","Anthem Gold Pathway X HMO 1450 20","29276OH092",,"OHN002","OHS005","OHF026","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920023-00","Standard Gold Off Exchange Plan","79.54%","0.787188529968262","No","Yes","No","100%",,"$1,450","$500","$932","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,450","$1450 per person","$2900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","33"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920023","Anthem Gold Pathway X HMO 1450 20","29276OH092",,"OHN002","OHS005","OHF026","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920023-01","Standard Gold On Exchange Plan","79.54%","0.787188529968262","No","Yes","No","100%",,"$1,450","$500","$932","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,100","$3100 per person","$6200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,450","$1450 per person","$2900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","34"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920023","Anthem Gold Pathway X HMO 1450 20","29276OH092",,"OHN002","OHS005","OHF026","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920023-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","35"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","7","29276","OH","Individual","No","31-1440175","29276OH0920023","Anthem Gold Pathway X HMO 1450 20","29276OH092",,"OHN002","OHS005","OHF026","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent/Emergency care only","No","Emergency/Urgent Care","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920023-03","Limited Cost Sharing Plan Variation","79.54%","0.787188529968262","No","Yes","No","100%",,"$1,450","$500","$932","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,100.00","$3100 per person","$6200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,450","$1450 per person","$2900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.sbc.anthem.com/dps/ccd1X36","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","36"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","8","29276","OH","Individual","No","31-1440175","29276OH0920006","Anthem Silver Pathway X HMO 3000 10","29276OH092",,"OHN002","OHS003","OHF030","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Urgent/Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920006-00","Standard Silver Off Exchange Plan","68.60%","0.713833451271057","Yes","Yes","No","100%",,"$3,000","$500","$311","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2Z","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","4"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","8","29276","OH","Individual","No","31-1440175","29276OH0920006","Anthem Silver Pathway X HMO 3000 10","29276OH092",,"OHN002","OHS003","OHF030","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Urgent/Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920006-01","Standard Silver On Exchange Plan","68.60%","0.713833451271057","Yes","Yes","No","100%",,"$3,000","$500","$311","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2U","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","5"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","8","29276","OH","Individual","No","31-1440175","29276OH0920006","Anthem Silver Pathway X HMO 3000 10","29276OH092",,"OHN002","OHS003","OHF030","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Urgent/Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2Y","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","6"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","8","29276","OH","Individual","No","31-1440175","29276OH0920006","Anthem Silver Pathway X HMO 3000 10","29276OH092",,"OHN002","OHS003","OHF030","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Urgent/Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920006-03","Limited Cost Sharing Plan Variation","68.60%","0.713833451271057","Yes","Yes","No","100%",,"$3,000","$500","$311","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2X","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","7"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","8","29276","OH","Individual","No","31-1440175","29276OH0920006","Anthem Silver Pathway X HMO 3000 10","29276OH092",,"OHN002","OHS003","OHF030","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Urgent/Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920006-04","73% AV Level Silver Plan","72.48%","0.749987900257111","Yes","Yes","No","100%",,"$2,450","$500","$366","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2V","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","8"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","8","29276","OH","Individual","No","31-1440175","29276OH0920006","Anthem Silver Pathway X HMO 3000 10","29276OH092",,"OHN002","OHS003","OHF030","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Urgent/Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920006-05","87% AV Level Silver Plan","87.05%","0.87801206111908","Yes","Yes","No","100%",,"$750","$250","$500","$0","$750","$20","$38","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2W","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","9"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","8","29276","OH","Individual","No","31-1440175","29276OH0920006","Anthem Silver Pathway X HMO 3000 10","29276OH092",,"OHN002","OHS003","OHF030","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Urgent/Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920006-06","94% AV Level Silver Plan","94.04%","0.939049065113068","Yes","Yes","No","100%",,"$200","$100","$300","$0","$200","$20","$93","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2X","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","10"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","8","29276","OH","Individual","No","31-1440175","29276OH0920018","Anthem Silver Pathway X HMO 3000 10","29276OH092",,"OHN002","OHS004","OHF030","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Urgent/Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920018-00","Standard Silver Off Exchange Plan","68.60%","0.713833451271057","Yes","Yes","No","100%",,"$3,000","$500","$311","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2Z","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","11"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","8","29276","OH","Individual","No","31-1440175","29276OH0920018","Anthem Silver Pathway X HMO 3000 10","29276OH092",,"OHN002","OHS004","OHF030","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Urgent/Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920018-01","Standard Silver On Exchange Plan","68.60%","0.713833451271057","Yes","Yes","No","100%",,"$3,000","$500","$311","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2U","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","12"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","8","29276","OH","Individual","No","31-1440175","29276OH0920018","Anthem Silver Pathway X HMO 3000 10","29276OH092",,"OHN002","OHS004","OHF030","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Urgent/Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920018-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2Y","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","13"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","8","29276","OH","Individual","No","31-1440175","29276OH0920018","Anthem Silver Pathway X HMO 3000 10","29276OH092",,"OHN002","OHS004","OHF030","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Urgent/Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920018-03","Limited Cost Sharing Plan Variation","68.60%","0.713833451271057","Yes","Yes","No","100%",,"$3,000","$500","$311","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2X","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","14"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","8","29276","OH","Individual","No","31-1440175","29276OH0920018","Anthem Silver Pathway X HMO 3000 10","29276OH092",,"OHN002","OHS004","OHF030","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Urgent/Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920018-04","73% AV Level Silver Plan","72.48%","0.749987900257111","Yes","Yes","No","100%",,"$2,450","$500","$366","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2V","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","15"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","8","29276","OH","Individual","No","31-1440175","29276OH0920018","Anthem Silver Pathway X HMO 3000 10","29276OH092",,"OHN002","OHS004","OHF030","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Urgent/Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920018-05","87% AV Level Silver Plan","87.05%","0.87801206111908","Yes","Yes","No","100%",,"$750","$250","$500","$0","$750","$20","$38","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2W","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","16"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","8","29276","OH","Individual","No","31-1440175","29276OH0920018","Anthem Silver Pathway X HMO 3000 10","29276OH092",,"OHN002","OHS004","OHF030","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Urgent/Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920018-06","94% AV Level Silver Plan","94.04%","0.939049065113068","Yes","Yes","No","100%",,"$200","$100","$300","$0","$200","$20","$93","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2X","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","17"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","8","29276","OH","Individual","No","31-1440175","29276OH0920019","Anthem Silver Pathway X HMO 3000 10","29276OH092",,"OHN002","OHS005","OHF030","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Urgent/Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920019-00","Standard Silver Off Exchange Plan","68.60%","0.713833451271057","Yes","Yes","No","100%",,"$3,000","$500","$311","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2Z","http://editiondigital.net/view/IU65/2016/OFF_HIX_OH_KIT_2016","18"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","8","29276","OH","Individual","No","31-1440175","29276OH0920019","Anthem Silver Pathway X HMO 3000 10","29276OH092",,"OHN002","OHS005","OHF030","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Urgent/Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920019-01","Standard Silver On Exchange Plan","68.60%","0.713833451271057","Yes","Yes","No","100%",,"$3,000","$500","$311","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2U","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","19"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","8","29276","OH","Individual","No","31-1440175","29276OH0920019","Anthem Silver Pathway X HMO 3000 10","29276OH092",,"OHN002","OHS005","OHF030","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Urgent/Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920019-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X2Y","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","20"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","8","29276","OH","Individual","No","31-1440175","29276OH0920019","Anthem Silver Pathway X HMO 3000 10","29276OH092",,"OHN002","OHS005","OHF030","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Urgent/Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920019-03","Limited Cost Sharing Plan Variation","68.60%","0.713833451271057","Yes","Yes","No","100%",,"$3,000","$500","$311","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2X","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","21"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","8","29276","OH","Individual","No","31-1440175","29276OH0920019","Anthem Silver Pathway X HMO 3000 10","29276OH092",,"OHN002","OHS005","OHF030","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Urgent/Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920019-04","73% AV Level Silver Plan","72.48%","0.749987900257111","Yes","Yes","No","100%",,"$2,450","$500","$366","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,450","$2450 per person","$4900 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2V","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","22"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","8","29276","OH","Individual","No","31-1440175","29276OH0920019","Anthem Silver Pathway X HMO 3000 10","29276OH092",,"OHN002","OHS005","OHF030","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Urgent/Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920019-05","87% AV Level Silver Plan","87.05%","0.87801206111908","Yes","Yes","No","100%",,"$750","$250","$500","$0","$750","$20","$38","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2W","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","23"
"2016","OH","29276","SERFF","17","2016-07-13 14:35:16","8","29276","OH","Individual","No","31-1440175","29276OH0920019","Anthem Silver Pathway X HMO 3000 10","29276OH092",,"OHN002","OHS005","OHF030","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management","1",,,,"0","0","3","2016-01-01","2016-12-31","No","Emergency care only","No","Urgent/Emergency care only","Yes","https://payment.anthem.com/sales/payment/exchange?state=OH","https://www.anthem.com/OHSelectdrugtier4","29276OH0920019-06","94% AV Level Silver Plan","94.04%","0.939049065113068","Yes","Yes","No","100%",,"$200","$100","$300","$0","$200","$20","$93","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X2X","http://editiondigital.net/view/IU65/2016/ON_HIX_OH_KIT_2016","24"
"2016","OH","30042","SERFF","3","2015-08-20 12:28:36","1","30042","OH","SHOP (Small Group)","Yes","31-1119867","30042OH0010001","SDC-Kids Plan High","30042OH001",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$24.93","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Matches in County Coverage","Yes","Matches in County Coverage","No",,"","30042OH0010001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","30042","SERFF","3","2015-08-20 12:28:36","1","30042","OH","SHOP (Small Group)","Yes","31-1119867","30042OH0020001","SDC-Kids Plan Low","30042OH002",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$19.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Matches in County Coverage","Yes","Matches in County Coverage","No",,"","30042OH0020001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$150","per person not applicable","per group not applicable","$225","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","30042","SERFF","3","2015-08-20 12:28:36","2","30042","OH","SHOP (Small Group)","Yes","31-1119867","30042OH0030001","SDC-Preferred Kids Plan High","30042OH003",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Allows Adult and Child-Only",,"No","Allows Adult and Child-Only",,"Estimated Rate",,,"$24.93","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Matches in country coverage","Yes","Matches in Service Area Coverage","No",,"","30042OH0030001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","30042","SERFF","3","2015-08-20 12:28:36","2","30042","OH","SHOP (Small Group)","Yes","31-1119867","30042OH0040001","SDC-Preferred Kids Plan Low","30042OH004",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Allows Adult and Child-Only",,"No","Allows Adult and Child-Only",,"Estimated Rate",,,"$19.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Matches in country coverage","Yes","Matches in Service Area Coverage","No",,"","30042OH0040001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$150","per person not applicable","per group not applicable","$225","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","31410","SERFF","5","2015-08-20 12:28:36","1","31410","OH","Individual","Yes","72-0977315","31410OH0050001","AlwaysCare All-Star Kids Dental Plan 2016","31410OH005",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$21.77","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","31410OH0050001-00","Standard High Off Exchange Plan","86.35%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","OH","31410","SERFF","5","2015-08-20 12:28:36","1","31410","OH","SHOP (Small Group)","Yes","72-0977315","31410OH0080001","AlwaysCare Small Group Dental – Child 2016","31410OH008",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$26.45","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","31410OH0080001-00","Standard High Off Exchange Plan","86.35%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030011","Gold Compass 0","33931OH003",,"OHN001","OHS001","OHF004","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030011-03","Limited Cost Sharing Plan Variation","79.1%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0007&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","11"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030006","Silver Compass 2000","33931OH003",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030006-00","Standard Silver Off Exchange Plan","69.3%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0018&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","12"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030006","Silver Compass 2000","33931OH003",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030006-01","Standard Silver On Exchange Plan","69.3%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0018&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","13"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030006","Silver Compass 2000","33931OH003",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030006-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0086&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","14"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030006","Silver Compass 2000","33931OH003",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030006-03","Limited Cost Sharing Plan Variation","69.3%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0019&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","15"
"2016","OH","31410","SERFF","5","2015-08-20 12:28:36","1","31410","OH","Individual","Yes","72-0977315","31410OH0050002","AlwaysCare All-Star Kids Dental Plan 2016","31410OH005",,"OHN001","OHS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$17.74","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","31410OH0050002-00","Standard Low Off Exchange Plan","71.04%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","OH","31410","SERFF","5","2015-08-20 12:28:36","1","31410","OH","SHOP (Small Group)","Yes","72-0977315","31410OH0080002","AlwaysCare Small Group Dental – Child 2016","31410OH008",,"OHN001","OHS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Child-Only",,,,,"$21.76","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","31410OH0080002-00","Standard Low Off Exchange Plan","71.04%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030007","Silver Compass 3500","33931OH003",,"OHN001","OHS001","OHF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030007-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0087&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","21"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030007","Silver Compass 3500","33931OH003",,"OHN001","OHS001","OHF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030007-03","Limited Cost Sharing Plan Variation","68.0%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0024&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","22"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030007","Silver Compass 3500","33931OH003",,"OHN001","OHS001","OHF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030007-04","73% AV Level Silver Plan","72.5%",,"No","Yes","No","100%",,"$2,500","$10","$800","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0025&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","23"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030007","Silver Compass 3500","33931OH003",,"OHN001","OHS001","OHF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030007-05","87% AV Level Silver Plan","87.9%",,"No","Yes","No","100%",,"$200","$10","$600","$200","$200","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0026&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","24"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030007","Silver Compass 3500","33931OH003",,"OHN001","OHS001","OHF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030007-06","94% AV Level Silver Plan","93.9%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0027&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","25"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030008","Silver Compass 4500","33931OH003",,"OHN001","OHS001","OHF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030008-00","Standard Silver Off Exchange Plan","68.3%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0028&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","26"
"2016","OH","31410","SERFF","5","2015-08-20 12:28:36","2","31410","OH","Individual","Yes","72-0977315","31410OH0060001","AlwaysCare All-Star Family Dental Plan 2016","31410OH006",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$21.77","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","31410OH0060001-00","Standard High Off Exchange Plan","86.35%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","OH","31410","SERFF","5","2015-08-20 12:28:36","2","31410","OH","SHOP (Small Group)","Yes","72-0977315","31410OH0070001","AlwaysCare Small Group Dental – Adults 2016","31410OH007",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$26.45","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","31410OH0070001-00","Standard High Off Exchange Plan","86.35%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","OH","31410","SERFF","5","2015-08-20 12:28:36","2","31410","OH","SHOP (Small Group)","Yes","72-0977315","31410OH0070002","AlwaysCare Small Group Dental – Adults 2016","31410OH007",,"OHN001","OHS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$21.76","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","31410OH0070002-00","Standard Low Off Exchange Plan","71.04%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"5"
"2016","OH","31410","SERFF","5","2015-08-20 12:28:36","3","31410","OH","Individual","Yes","72-0977315","31410OH0060002","AlwaysCare All-Star Family Dental Plan 2016","31410OH006",,"OHN001","OHS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$17.74","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes","http://www.alwayscarebenefits.com/allstar","","31410OH0060002-00","Standard Low Off Exchange Plan","71.04%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.alwayscarebenefits.com/allstar",,"4"
"2016","OH","32795","SERFF","5","2015-08-20 12:28:36","1","32795","OH","SHOP (Small Group)","Yes","42-0127290","32795OH0040001","Principal Plan Dental 70","32795OH004",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$27.53","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","32795OH0040001-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","32795","SERFF","5","2015-08-20 12:28:36","1","32795","OH","SHOP (Small Group)","Yes","42-0127290","32795OH0040002","Principal Plan Dental 85","32795OH004",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$29.10","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","32795OH0040002-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","1","33931","OH","Individual","No","31-1142815","33931OH0030004","Silver Compass HSA 3000","33931OH003",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030004-00","Standard Silver Off Exchange Plan",,"0.708311021327972","Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=oh0008&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","4"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","1","33931","OH","Individual","No","31-1142815","33931OH0030004","Silver Compass HSA 3000","33931OH003",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030004-01","Standard Silver On Exchange Plan",,"0.708311021327972","Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=oh0008&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","5"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","1","33931","OH","Individual","No","31-1142815","33931OH0030004","Silver Compass HSA 3000","33931OH003",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=oh0084&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","6"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","1","33931","OH","Individual","No","31-1142815","33931OH0030004","Silver Compass HSA 3000","33931OH003",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030004-03","Limited Cost Sharing Plan Variation",,"0.708311021327972","Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=oh0009&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","7"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","1","33931","OH","Individual","No","31-1142815","33931OH0030004","Silver Compass HSA 3000","33931OH003",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030004-04","73% AV Level Silver Plan",,"0.737914025783539","Yes","Yes","No","100%",,"$2,500","$10","$0","$200","$2,500","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=oh0010&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","8"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","1","33931","OH","Individual","No","31-1142815","33931OH0030004","Silver Compass HSA 3000","33931OH003",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030004-05","87% AV Level Silver Plan",,"0.877197504043579","Yes","Yes","No","100%",,"$800","$10","$0","$200","$800","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=oh0011&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","9"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","1","33931","OH","Individual","No","31-1142815","33931OH0030004","Silver Compass HSA 3000","33931OH003",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030004-06","94% AV Level Silver Plan",,"0.942080080509186","Yes","Yes","No","100%",,"$200","$10","$0","$200","$200","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=oh0012&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","10"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","1","33931","OH","Individual","No","31-1142815","33931OH0030009","Bronze Compass HSA 5500","33931OH003",,"OHN001","OHS001","OHF008","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030009-00","Standard Bronze Off Exchange Plan",,"0.618041276931763","Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=oh0033&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","11"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","1","33931","OH","Individual","No","31-1142815","33931OH0030009","Bronze Compass HSA 5500","33931OH003",,"OHN001","OHS001","OHF008","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030009-01","Standard Bronze On Exchange Plan",,"0.618041276931763","Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=oh0033&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","12"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","1","33931","OH","Individual","No","31-1142815","33931OH0030009","Bronze Compass HSA 5500","33931OH003",,"OHN001","OHS001","OHF008","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=oh0089&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","13"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","1","33931","OH","Individual","No","31-1142815","33931OH0030009","Bronze Compass HSA 5500","33931OH003",,"OHN001","OHS001","OHF008","Existing","HMO","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030009-03","Limited Cost Sharing Plan Variation",,"0.618041276931763","Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=oh0034&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","14"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030002","Gold Compass 1000","33931OH003",,"OHN001","OHS001","OHF002","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030002-00","Standard Gold Off Exchange Plan","78.1%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0003&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","4"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030002","Gold Compass 1000","33931OH003",,"OHN001","OHS001","OHF002","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030002-01","Standard Gold On Exchange Plan","78.1%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0003&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","5"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030002","Gold Compass 1000","33931OH003",,"OHN001","OHS001","OHF002","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030002-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0083&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","6"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030002","Gold Compass 1000","33931OH003",,"OHN001","OHS001","OHF002","Existing","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030002-03","Limited Cost Sharing Plan Variation","78.1%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0004&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","7"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030011","Gold Compass 0","33931OH003",,"OHN001","OHS001","OHF004","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030011-00","Standard Gold Off Exchange Plan","79.1%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0005&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","8"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030011","Gold Compass 0","33931OH003",,"OHN001","OHS001","OHF004","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030011-01","Standard Gold On Exchange Plan","79.1%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0005&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","9"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030011","Gold Compass 0","33931OH003",,"OHN001","OHS001","OHF004","New","HMO","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030011-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0006&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","10"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030006","Silver Compass 2000","33931OH003",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030006-04","73% AV Level Silver Plan","73.4%",,"No","Yes","No","100%",,"$1,200","$20","$1,500","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0020&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","16"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030006","Silver Compass 2000","33931OH003",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030006-05","87% AV Level Silver Plan","87.9%",,"No","Yes","No","100%",,"$200","$10","$600","$200","$200","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0021&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","17"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030006","Silver Compass 2000","33931OH003",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030006-06","94% AV Level Silver Plan","93.9%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0022&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","18"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030007","Silver Compass 3500","33931OH003",,"OHN001","OHS001","OHF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030007-00","Standard Silver Off Exchange Plan","68.0%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0023&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","19"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030007","Silver Compass 3500","33931OH003",,"OHN001","OHS001","OHF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030007-01","Standard Silver On Exchange Plan","68.0%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0023&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","20"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030008","Silver Compass 4500","33931OH003",,"OHN001","OHS001","OHF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030008-01","Standard Silver On Exchange Plan","68.3%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0028&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","27"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030008","Silver Compass 4500","33931OH003",,"OHN001","OHS001","OHF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030008-02","Zero Cost Sharing Plan Variation","100.0%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0088&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","28"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030008","Silver Compass 4500","33931OH003",,"OHN001","OHS001","OHF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030008-03","Limited Cost Sharing Plan Variation","68.3%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0029&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","29"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030008","Silver Compass 4500","33931OH003",,"OHN001","OHS001","OHF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030008-04","73% AV Level Silver Plan","72.5%",,"No","Yes","No","100%",,"$3,200","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0030&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","30"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030008","Silver Compass 4500","33931OH003",,"OHN001","OHS001","OHF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030008-05","87% AV Level Silver Plan","86.1%",,"No","Yes","No","100%",,"$600","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0031&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","31"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030008","Silver Compass 4500","33931OH003",,"OHN001","OHS001","OHF007","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030008-06","94% AV Level Silver Plan","93.3%",,"No","Yes","No","100%",,"$100","$10","$0","$200","$100","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0032&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","32"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030010","Bronze Compass 6500","33931OH003",,"OHN001","OHS001","OHF008","Existing","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030010-00","Standard Bronze Off Exchange Plan","61.9%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=oh0035&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","33"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030010","Bronze Compass 6500","33931OH003",,"OHN001","OHS001","OHF008","Existing","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030010-01","Standard Bronze On Exchange Plan","61.9%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=oh0035&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","34"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030010","Bronze Compass 6500","33931OH003",,"OHN001","OHS001","OHF008","Existing","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030010-02","Zero Cost Sharing Plan Variation","100.0%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=oh0090&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","35"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","2","33931","OH","Individual","No","31-1142815","33931OH0030010","Bronze Compass 6500","33931OH003",,"OHN001","OHS001","OHF008","Existing","HMO","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030010-03","Limited Cost Sharing Plan Variation","61.9%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=oh0036&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","36"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","4","33931","OH","Individual","No","31-1142815","33931OH0030005","Silver Compass 2000 1","33931OH003",,"OHN001","OHS001","OHF006","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030005-00","Standard Silver Off Exchange Plan","70.80%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=oh0013&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","4"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","4","33931","OH","Individual","No","31-1142815","33931OH0030005","Silver Compass 2000 1","33931OH003",,"OHN001","OHS001","OHF006","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030005-01","Standard Silver On Exchange Plan","70.80%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=oh0013&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","5"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","4","33931","OH","Individual","No","31-1142815","33931OH0030005","Silver Compass 2000 1","33931OH003",,"OHN001","OHS001","OHF006","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=oh0085&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","6"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","4","33931","OH","Individual","No","31-1142815","33931OH0030005","Silver Compass 2000 1","33931OH003",,"OHN001","OHS001","OHF006","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030005-03","Limited Cost Sharing Plan Variation","70.80%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=oh0014&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","7"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","4","33931","OH","Individual","No","31-1142815","33931OH0030005","Silver Compass 2000 1","33931OH003",,"OHN001","OHS001","OHF006","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030005-04","73% AV Level Silver Plan","72.90%",,"Yes","Yes","No","100%",,"$1,800","$1,500","$0","$200","$1,800","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=oh0015&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","8"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","4","33931","OH","Individual","No","31-1142815","33931OH0030005","Silver Compass 2000 1","33931OH003",,"OHN001","OHS001","OHF006","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030005-05","87% AV Level Silver Plan","86.20%",,"Yes","Yes","No","100%",,"$500","$800","$0","$200","$500","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=oh0016&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","9"
"2016","OH","33931","SERFF","8","2015-08-28 13:59:00","4","33931","OH","Individual","No","31-1142815","33931OH0030005","Silver Compass 2000 1","33931OH003",,"OHN001","OHS001","OHF006","Existing","HMO","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency services only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","33931OH0030005-06","94% AV Level Silver Plan","93.10%",,"Yes","Yes","No","100%",,"$200","$500","$0","$200","$200","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=oh0017&st=oh","http://www.uhc.com/iex/doc?id=oh0079&st=oh","10"
"2016","OH","34964","SERFF","5","2015-08-20 12:28:36","1","34964","OH","Individual","Yes","59-0397210","34964OH0030001","DentaQuest PPO  Pediatric High","34964OH003",,"OHN002","OHS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$27.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","34964OH0030001-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/","4"
"2016","OH","34964","SERFF","5","2015-08-20 12:28:36","1","34964","OH","SHOP (Small Group)","Yes","59-0397210","34964OH0040003","DentaQuest PPO Family High","34964OH004",,"OHN002","OHS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.16","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","34964OH0040003-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/","4"
"2016","OH","34964","SERFF","5","2015-08-20 12:28:36","1","34964","OH","SHOP (Small Group)","Yes","59-0397210","34964OH0040003","DentaQuest PPO Family High","34964OH004",,"OHN002","OHS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.16","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","34964OH0040003-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/","5"
"2016","OH","34964","SERFF","5","2015-08-20 12:28:36","1","34964","OH","Individual","Yes","59-0397210","34964OH0030001","DentaQuest PPO  Pediatric High","34964OH003",,"OHN002","OHS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$27.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","34964OH0030001-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/","5"
"2016","OH","34964","SERFF","5","2015-08-20 12:28:36","1","34964","OH","SHOP (Small Group)","Yes","59-0397210","34964OH0040004","DentaQuest PPO Family Low","34964OH004",,"OHN002","OHS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$12.37","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","34964OH0040004-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/","6"
"2016","OH","34964","SERFF","5","2015-08-20 12:28:36","1","34964","OH","SHOP (Small Group)","Yes","59-0397210","34964OH0040004","DentaQuest PPO Family Low","34964OH004",,"OHN002","OHS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$12.37","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","34964OH0040004-01","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/","7"
"2016","OH","34964","SERFF","5","2015-08-20 12:28:36","2","34964","OH","Individual","Yes","59-0397210","34964OH0030003","DentaQuest PPO Family High","34964OH003",,"OHN002","OHS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","34964OH0030003-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/","4"
"2016","OH","34964","SERFF","5","2015-08-20 12:28:36","2","34964","OH","Individual","Yes","59-0397210","34964OH0030003","DentaQuest PPO Family High","34964OH003",,"OHN002","OHS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","34964OH0030003-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/","5"
"2016","OH","34964","SERFF","5","2015-08-20 12:28:36","2","34964","OH","Individual","Yes","59-0397210","34964OH0030004","DentaQuest PPO Family Low","34964OH003",,"OHN002","OHS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","34964OH0030004-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/","6"
"2016","OH","34964","SERFF","5","2015-08-20 12:28:36","2","34964","OH","Individual","Yes","59-0397210","34964OH0030004","DentaQuest PPO Family Low","34964OH003",,"OHN002","OHS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","34964OH0030004-01","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/oh/","http://www.dentaquest.com/marketplace/oh/","7"
"2016","OH","34968","SERFF","4","2015-08-20 12:28:36","1","34968","OH","SHOP (Small Group)","Yes","13-5581829","34968OH0150002","EHB Basic Dental Plan (Low)","34968OH015",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$17.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","34968OH0150002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","34968","SERFF","4","2015-08-20 12:28:36","2","34968","OH","SHOP (Small Group)","Yes","13-5581829","34968OH0170002","Family Basic Dental Plan (Low)","34968OH017",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$17.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","34968OH0170002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","34968","SERFF","4","2015-08-20 12:28:36","2","34968","OH","SHOP (Small Group)","Yes","13-5581829","34968OH0170001","Family Basic Dental Plan (Low)","34968OH017",,"OHN001","OHS001",,"Existing","PPO","Low",,"On the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$17.69","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","34968OH0170001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49116","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49115","5"
"2016","OH","34968","SERFF","4","2015-08-20 12:28:36","3","34968","OH","SHOP (Small Group)","Yes","13-5581829","34968OH0180001","Family Enhanced Dental Plan (High)","34968OH018",,"OHN001","OHS001",,"Existing","PPO","High",,"On the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$21.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","34968OH0180001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49118","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49117","4"
"2016","OH","34968","SERFF","4","2015-08-20 12:28:36","3","34968","OH","SHOP (Small Group)","Yes","13-5581829","34968OH0180002","Family Enhanced Dental Plan (High)","34968OH018",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Adult and Child-Only",,,,,"$21.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","34968OH0180002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010004","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","41047OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010004-00","Standard Gold Off Exchange Plan",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/41047OH0010004-00.pdf","https://api.centene.com/Brochures/2016/41047OH0010004-00.pdf","4"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010004","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","41047OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010004-01","Standard Gold On Exchange Plan",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/41047OH0010004-01.pdf","https://api.centene.com/Brochures/2016/41047OH0010004-01.pdf","5"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010004","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","41047OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/41047OH0010004-02.pdf","https://api.centene.com/Brochures/2016/41047OH0010004-02.pdf","6"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010004","Ambetter Secure Care 1 (2016) with 3 Free PCP Visits","41047OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,"$350","0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010004-03","Limited Cost Sharing Plan Variation",,"0.786682605743408","No","Yes","No","100%",,"$1,000","$20","$800","$200","$1,000","$400","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://api.centene.com/SBC/2016/41047OH0010004-03.pdf","https://api.centene.com/Brochures/2016/41047OH0010004-03.pdf","7"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010019","Ambetter Balanced Care 2 (2016)","41047OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010019-00","Standard Silver Off Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010019-00.pdf","https://api.centene.com/Brochures/2016/41047OH0010019-00.pdf","8"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010019","Ambetter Balanced Care 2 (2016)","41047OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010019-01","Standard Silver On Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010019-01.pdf","https://api.centene.com/Brochures/2016/41047OH0010019-01.pdf","9"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010019","Ambetter Balanced Care 2 (2016)","41047OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010019-02.pdf","https://api.centene.com/Brochures/2016/41047OH0010019-02.pdf","10"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010019","Ambetter Balanced Care 2 (2016)","41047OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010019-03","Limited Cost Sharing Plan Variation",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010019-03.pdf","https://api.centene.com/Brochures/2016/41047OH0010019-03.pdf","11"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010019","Ambetter Balanced Care 2 (2016)","41047OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010019-04","73% AV Level Silver Plan",,"0.739638686180115","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010019-04.pdf","https://api.centene.com/Brochures/2016/41047OH0010019-04.pdf","12"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010019","Ambetter Balanced Care 2 (2016)","41047OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010019-05","87% AV Level Silver Plan",,"0.873916625976563","Yes","Yes","No","100%",,"$1,700","$0","$0","$200","$1,700","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010019-05.pdf","https://api.centene.com/Brochures/2016/41047OH0010019-05.pdf","13"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010019","Ambetter Balanced Care 2 (2016)","41047OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010019-06","94% AV Level Silver Plan",,"0.9492227435112","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010019-06.pdf","https://api.centene.com/Brochures/2016/41047OH0010019-06.pdf","14"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010018","Ambetter Balanced Care 1 (2016)","41047OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010018-00","Standard Silver Off Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010018-00.pdf","https://api.centene.com/Brochures/2016/41047OH0010018-00.pdf","15"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010018","Ambetter Balanced Care 1 (2016)","41047OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010018-01","Standard Silver On Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010018-01.pdf","https://api.centene.com/Brochures/2016/41047OH0010018-01.pdf","16"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010018","Ambetter Balanced Care 1 (2016)","41047OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010018-02.pdf","https://api.centene.com/Brochures/2016/41047OH0010018-02.pdf","17"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010018","Ambetter Balanced Care 1 (2016)","41047OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010018-03","Limited Cost Sharing Plan Variation",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010018-03.pdf","https://api.centene.com/Brochures/2016/41047OH0010018-03.pdf","18"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010018","Ambetter Balanced Care 1 (2016)","41047OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010018-04","73% AV Level Silver Plan",,"0.737546384334564","Yes","Yes","No","100%",,"$3,500","$10","$300","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010018-04.pdf","https://api.centene.com/Brochures/2016/41047OH0010018-04.pdf","19"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010018","Ambetter Balanced Care 1 (2016)","41047OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010018-05","87% AV Level Silver Plan",,"0.879890024662018","Yes","Yes","No","100%",,"$300","$10","$1,000","$200","$300","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010018-05.pdf","https://api.centene.com/Brochures/2016/41047OH0010018-05.pdf","20"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010018","Ambetter Balanced Care 1 (2016)","41047OH001",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010018-06","94% AV Level Silver Plan",,"0.948710560798645","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010018-06.pdf","https://api.centene.com/Brochures/2016/41047OH0010018-06.pdf","21"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010017","Ambetter Essential Care 1 (2016)","41047OH001",,"OHN001","OHS001","OHF004","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010017-00","Standard Bronze Off Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010017-00.pdf","https://api.centene.com/Brochures/2016/41047OH0010017-00.pdf","22"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010017","Ambetter Essential Care 1 (2016)","41047OH001",,"OHN001","OHS001","OHF004","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010017-01","Standard Bronze On Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010017-01.pdf","https://api.centene.com/Brochures/2016/41047OH0010017-01.pdf","23"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010017","Ambetter Essential Care 1 (2016)","41047OH001",,"OHN001","OHS001","OHF004","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010017-02.pdf","https://api.centene.com/Brochures/2016/41047OH0010017-02.pdf","24"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010017","Ambetter Essential Care 1 (2016)","41047OH001",,"OHN001","OHS001","OHF004","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010017-03","Limited Cost Sharing Plan Variation",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010017-03.pdf","https://api.centene.com/Brochures/2016/41047OH0010017-03.pdf","25"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010021","Ambetter Balanced Care 10 (2016)","41047OH001",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010021-00","Standard Silver Off Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010021-00.pdf","https://api.centene.com/Brochures/2016/41047OH0010021-00.pdf","33"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010021","Ambetter Balanced Care 10 (2016)","41047OH001",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010021-01","Standard Silver On Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010021-01.pdf","https://api.centene.com/Brochures/2016/41047OH0010021-01.pdf","34"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010021","Ambetter Balanced Care 10 (2016)","41047OH001",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010021-02.pdf","https://api.centene.com/Brochures/2016/41047OH0010021-02.pdf","35"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010021","Ambetter Balanced Care 10 (2016)","41047OH001",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010021-03","Limited Cost Sharing Plan Variation",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010021-03.pdf","https://api.centene.com/Brochures/2016/41047OH0010021-03.pdf","36"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010021","Ambetter Balanced Care 10 (2016)","41047OH001",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010021-04","73% AV Level Silver Plan",,"0.738659501075745","Yes","Yes","No","100%",,"$4,000","$10","$200","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010021-04.pdf","https://api.centene.com/Brochures/2016/41047OH0010021-04.pdf","37"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010021","Ambetter Balanced Care 10 (2016)","41047OH001",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010021-05","87% AV Level Silver Plan",,"0.874480485916138","Yes","Yes","No","100%",,"$1,000","$0","$800","$200","$1,000","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010021-05.pdf","https://api.centene.com/Brochures/2016/41047OH0010021-05.pdf","38"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010021","Ambetter Balanced Care 10 (2016)","41047OH001",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010021-06","94% AV Level Silver Plan",,"0.946612775325775","Yes","Yes","No","100%",,"$200","$0","$300","$200","$200","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010021-06.pdf","https://api.centene.com/Brochures/2016/41047OH0010021-06.pdf","39"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010022","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","41047OH001",,"OHN001","OHS001","OHF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010022-00","Standard Bronze Off Exchange Plan",,"0.617502212524414","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010022-00.pdf","https://api.centene.com/Brochures/2016/41047OH0010022-00.pdf","40"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010022","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","41047OH001",,"OHN001","OHS001","OHF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010022-01","Standard Bronze On Exchange Plan",,"0.617502212524414","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010022-01.pdf","https://api.centene.com/Brochures/2016/41047OH0010022-01.pdf","41"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010022","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","41047OH001",,"OHN001","OHS001","OHF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010022-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010022-02.pdf","https://api.centene.com/Brochures/2016/41047OH0010022-02.pdf","42"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","1","41047","OH","Individual","No","32-0045282","41047OH0010022","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits","41047OH001",,"OHN001","OHS001","OHF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0010022-03","Limited Cost Sharing Plan Variation",,"0.617502212524414","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0010022-03.pdf","https://api.centene.com/Brochures/2016/41047OH0010022-03.pdf","43"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020019","Ambetter Balanced Care 2 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9766",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020019-00","Standard Silver Off Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020019-00.pdf","https://api.centene.com/Brochures/2016/41047OH0020019-00.pdf","4"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020019","Ambetter Balanced Care 2 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9766",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020019-01","Standard Silver On Exchange Plan",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020019-01.pdf","https://api.centene.com/Brochures/2016/41047OH0020019-01.pdf","5"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020019","Ambetter Balanced Care 2 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9766",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020019-02.pdf","https://api.centene.com/Brochures/2016/41047OH0020019-02.pdf","6"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020019","Ambetter Balanced Care 2 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9766",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020019-03","Limited Cost Sharing Plan Variation",,"0.680043816566467","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020019-03.pdf","https://api.centene.com/Brochures/2016/41047OH0020019-03.pdf","7"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020019","Ambetter Balanced Care 2 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9766",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020019-04","73% AV Level Silver Plan",,"0.739638686180115","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020019-04.pdf","https://api.centene.com/Brochures/2016/41047OH0020019-04.pdf","8"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020019","Ambetter Balanced Care 2 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9766",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020019-05","87% AV Level Silver Plan",,"0.873916625976563","Yes","Yes","No","100%",,"$1,700","$0","$0","$200","$1,700","$20","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020019-05.pdf","https://api.centene.com/Brochures/2016/41047OH0020019-05.pdf","9"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020019","Ambetter Balanced Care 2 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9766",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020019-06","94% AV Level Silver Plan",,"0.9492227435112","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020019-06.pdf","https://api.centene.com/Brochures/2016/41047OH0020019-06.pdf","10"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020018","Ambetter Balanced Care 1 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9766",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020018-00","Standard Silver Off Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020018-00.pdf","https://api.centene.com/Brochures/2016/41047OH0020018-00.pdf","11"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020018","Ambetter Balanced Care 1 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9766",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020018-01","Standard Silver On Exchange Plan",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020018-01.pdf","https://api.centene.com/Brochures/2016/41047OH0020018-01.pdf","12"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020018","Ambetter Balanced Care 1 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9766",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020018-02.pdf","https://api.centene.com/Brochures/2016/41047OH0020018-02.pdf","13"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020018","Ambetter Balanced Care 1 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9766",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020018-03","Limited Cost Sharing Plan Variation",,"0.681020498275757","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020018-03.pdf","https://api.centene.com/Brochures/2016/41047OH0020018-03.pdf","14"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020018","Ambetter Balanced Care 1 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9766",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020018-04","73% AV Level Silver Plan",,"0.737546384334564","Yes","Yes","No","100%",,"$3,500","$10","$300","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020018-04.pdf","https://api.centene.com/Brochures/2016/41047OH0020018-04.pdf","15"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020018","Ambetter Balanced Care 1 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9766",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020018-05","87% AV Level Silver Plan",,"0.879890024662018","Yes","Yes","No","100%",,"$300","$10","$1,000","$200","$300","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020018-05.pdf","https://api.centene.com/Brochures/2016/41047OH0020018-05.pdf","16"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020018","Ambetter Balanced Care 1 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF003","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9766",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020018-06","94% AV Level Silver Plan",,"0.948710560798645","Yes","Yes","No","100%",,"$0","$0","$700","$200","$0","$50","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020018-06.pdf","https://api.centene.com/Brochures/2016/41047OH0020018-06.pdf","17"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020017","Ambetter Essential Care 1 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF004","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9756",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020017-00","Standard Bronze Off Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020021-00.pdf","https://api.centene.com/Brochures/2016/41047OH0020021-00.pdf","18"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020017","Ambetter Essential Care 1 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF004","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9756",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020017-01","Standard Bronze On Exchange Plan",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020021-01.pdf","https://api.centene.com/Brochures/2016/41047OH0020021-01.pdf","19"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020017","Ambetter Essential Care 1 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF004","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9756",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020021-02.pdf","https://api.centene.com/Brochures/2016/41047OH0020021-02.pdf","20"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020017","Ambetter Essential Care 1 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF004","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9756",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020017-03","Limited Cost Sharing Plan Variation",,"0.601217031478882","Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020021-03.pdf","https://api.centene.com/Brochures/2016/41047OH0020021-03.pdf","21"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020020","Ambetter Balanced Care 10 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9766",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020020-00","Standard Silver Off Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020020-00.pdf","https://api.centene.com/Brochures/2016/41047OH0020020-00.pdf","22"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020020","Ambetter Balanced Care 10 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9766",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020020-01","Standard Silver On Exchange Plan",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020020-01.pdf","https://api.centene.com/Brochures/2016/41047OH0020020-01.pdf","23"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020020","Ambetter Balanced Care 10 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9766",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020020-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020020-02.pdf","https://api.centene.com/Brochures/2016/41047OH0020020-02.pdf","24"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020020","Ambetter Balanced Care 10 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9766",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020020-03","Limited Cost Sharing Plan Variation",,"0.695767104625702","Yes","Yes","No","100%",,"$4,500","$20","$100","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020020-03.pdf","https://api.centene.com/Brochures/2016/41047OH0020020-03.pdf","25"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020020","Ambetter Balanced Care 10 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9766",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020020-04","73% AV Level Silver Plan",,"0.738659501075745","Yes","Yes","No","100%",,"$4,000","$10","$200","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020020-04.pdf","https://api.centene.com/Brochures/2016/41047OH0020020-04.pdf","26"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020020","Ambetter Balanced Care 10 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9766",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020020-05","87% AV Level Silver Plan",,"0.874480485916138","Yes","Yes","No","100%",,"$1,000","$0","$800","$200","$1,000","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020020-05.pdf","https://api.centene.com/Brochures/2016/41047OH0020020-05.pdf","27"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020020","Ambetter Balanced Care 10 (2016) + Vision","41047OH002",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9766",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020020-06","94% AV Level Silver Plan",,"0.946612775325775","Yes","Yes","No","100%",,"$200","$0","$300","$200","$200","$50","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020020-06.pdf","https://api.centene.com/Brochures/2016/41047OH0020020-06.pdf","28"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020021","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","41047OH002",,"OHN001","OHS001","OHF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9756",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020021-00","Standard Bronze Off Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020017-00.pdf","https://api.centene.com/Brochures/2016/41047OH0020017-00.pdf","29"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020021","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","41047OH002",,"OHN001","OHS001","OHF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9756",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020021-01","Standard Bronze On Exchange Plan",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020017-01.pdf","https://api.centene.com/Brochures/2016/41047OH0020017-01.pdf","30"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020021","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","41047OH002",,"OHN001","OHS001","OHF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9756",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020017-02.pdf","https://api.centene.com/Brochures/2016/41047OH0020017-02.pdf","31"
"2016","OH","41047","SERFF","5","2015-08-27 03:52:03","2","41047","OH","Individual","No","32-0045282","41047OH0020021","Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision","41047OH002",,"OHN001","OHS001","OHF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9756",,,,"0","3","0","2016-01-01",,"No",,"No",,"No","http://ambetter.buckeyehealthplan.com/payments","http://ambetter.buckeyehealthplan.com/formulary","41047OH0020021-03","Limited Cost Sharing Plan Variation",,"0.617502152919769","Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://api.centene.com/SBC/2016/41047OH0020017-03.pdf","https://api.centene.com/Brochures/2016/41047OH0020017-03.pdf","32"
"2016","OH","47509","SERFF","10","2015-08-28 13:59:00","1","47509","OH","Individual","Yes","95-6042390","47509OH0020003","BESTOne Advantage Gold","47509OH002",,"OHN001","OHS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.42","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","47509","SERFF","10","2015-08-28 13:59:00","1","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010007","BESTDental Premium","47509OH001",,"OHN001","OHS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.95","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/2016/OH_BESTDental_Premium_Plan.pdf","4"
"2016","OH","47509","SERFF","10","2015-08-28 13:59:00","1","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010007","BESTDental Premium","47509OH001",,"OHN001","OHS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.95","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/2016/OH_BESTDental_Premium_Plan.pdf","5"
"2016","OH","47509","SERFF","10","2015-08-28 13:59:00","1","47509","OH","Individual","Yes","95-6042390","47509OH0020003","BESTOne Advantage Gold","47509OH002",,"OHN001","OHS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.42","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","47509","SERFF","10","2015-08-28 13:59:00","1","47509","OH","Individual","Yes","95-6042390","47509OH0020004","BESTOne Plus Gold","47509OH002",,"OHN001","OHS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.42","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","OH","47509","SERFF","10","2015-08-28 13:59:00","1","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010008","BESTDental Standard - H","47509OH001",,"OHN001","OHS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.95","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/2016/OH_BESTDental_Standard-H_Plan.pdf","6"
"2016","OH","47509","SERFF","10","2015-08-28 13:59:00","1","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010008","BESTDental Standard - H","47509OH001",,"OHN001","OHS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.95","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/2016/OH_BESTDental_Standard-H_Plan.pdf","7"
"2016","OH","47509","SERFF","10","2015-08-28 13:59:00","1","47509","OH","Individual","Yes","95-6042390","47509OH0020004","BESTOne Plus Gold","47509OH002",,"OHN001","OHS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.42","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","OH","47509","SERFF","10","2015-08-28 13:59:00","1","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010010","BESTDental Choice - H","47509OH001",,"OHN001","OHS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.95","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/2016/OH_BESTDental_Choice-H_Plan.pdf","8"
"2016","OH","47509","SERFF","10","2015-08-28 13:59:00","1","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010010","BESTDental Choice - H","47509OH001",,"OHN001","OHS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.95","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/2016/OH_BESTDental_Choice-H_Plan.pdf","9"
"2016","OH","47509","SERFF","10","2015-08-28 13:59:00","2","47509","OH","Individual","Yes","95-6042390","47509OH0020005","BESTOne Plus Silver","47509OH002",,"OHN001","OHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.84","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","47509","SERFF","10","2015-08-28 13:59:00","2","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010009","BESTDental Standard - L","47509OH001",,"OHN001","OHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.28","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/2016/OH_BESTDental_Standard-L_Plan.pdf","4"
"2016","OH","47509","SERFF","10","2015-08-28 13:59:00","2","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010009","BESTDental Standard - L","47509OH001",,"OHN001","OHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.28","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/2016/OH_BESTDental_Standard-L_Plan.pdf","5"
"2016","OH","47509","SERFF","10","2015-08-28 13:59:00","2","47509","OH","Individual","Yes","95-6042390","47509OH0020005","BESTOne Plus Silver","47509OH002",,"OHN001","OHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.84","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","47509","SERFF","10","2015-08-28 13:59:00","2","47509","OH","Individual","Yes","95-6042390","47509OH0020006","BESTOne Basic Silver","47509OH002",,"OHN001","OHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.84","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","OH","47509","SERFF","10","2015-08-28 13:59:00","2","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010011","BESTDental Choice - L","47509OH001",,"OHN001","OHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.28","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/2016/OH_BESTDental_Choice-L_Plan.pdf","6"
"2016","OH","47509","SERFF","10","2015-08-28 13:59:00","2","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010011","BESTDental Choice - L","47509OH001",,"OHN001","OHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.28","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/2016/OH_BESTDental_Choice-L_Plan.pdf","7"
"2016","OH","47509","SERFF","10","2015-08-28 13:59:00","2","47509","OH","Individual","Yes","95-6042390","47509OH0020006","BESTOne Basic Silver","47509OH002",,"OHN001","OHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.84","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","OH","47509","SERFF","10","2015-08-28 13:59:00","2","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010012","BESTDental Value","47509OH001",,"OHN001","OHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.28","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/2016/OH_BESTDental_Value_Plan.pdf","8"
"2016","OH","47509","SERFF","10","2015-08-28 13:59:00","2","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010012","BESTDental Value","47509OH001",,"OHN001","OHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.28","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","47509OH0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$700","$700 per person","$1400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/OH/2016/OH_BESTDental_Value_Plan.pdf","9"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490516","SummaCare Gold 2000-16 with SCSelect Network","52664OH149","7730182830","OHN002","OHS003","OHF002","New","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1490516-01","Standard Gold On Exchange Plan",,"0.79827618598938","No","Yes","No","100%",,"$2,000","$30","$970","$150","$2,000","$630","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$2,000","$2000 per person","$4000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$8,000","$8000 per person","$16000 per group","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareGold2000-16SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold2000-16SCSelectNetwork.sflb","17"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510033","SummaCare Silver 3000 with SCSelect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN002","OHS001","OHF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510033-06","94% AV Level Silver Plan",,"0.930048286914825","Yes","Yes","No","100%",,"$0","$20","$520","$150","$0","$250","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$10,000","$10000 per person","$20000 per group","$11,250","$11250 per person","$22500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","$5,100","$5100 per person","$10200 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3000-94SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3000-94SCSelectNetwork.sflb","17"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510038","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510038-00","Standard Silver Off Exchange Plan",,"0.681164503097534","No","Yes","No","100%",,"$5,000","$10","$680","$150","$5,000","$20","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$1,000","$1000 per person","per group not applicable","50%",,,,,"$3,000","$3000 per person","per group not applicable","$4,000","$4000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000SCConnectNetwork.sflb","18"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490517","SummaCare Gold 2000-16 with SCSelect Network","52664OH149","7730182830","OHN002","OHS004","OHF002","New","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1490517-00","Standard Gold Off Exchange Plan",,"0.79827618598938","No","Yes","No","100%",,"$2,000","$30","$970","$150","$2,000","$630","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$2,000","$2000 per person","$4000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$8,000","$8000 per person","$16000 per group","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareGold2000-16SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold2000-16SCSelectNetwork.sflb","18"
"2016","OH","48333","SERFF","4","2015-08-20 12:28:36","1","48333","OH","SHOP (Small Group)","Yes","93-0242990","48333OH0040002","EHB High PPO","48333OH004",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.87","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","48333OH0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","OH","48333","SERFF","4","2015-08-20 12:28:36","1","48333","OH","SHOP (Small Group)","Yes","93-0242990","48333OH0040001","EHB Low PPO","48333OH004",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.28","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","48333OH0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","OH","48333","SERFF","4","2015-08-20 12:28:36","1","48333","OH","SHOP (Small Group)","Yes","93-0242990","48333OH0030002","EHB High Passive","48333OH003",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.32","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","48333OH0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","OH","48333","SERFF","4","2015-08-20 12:28:36","1","48333","OH","SHOP (Small Group)","Yes","93-0242990","48333OH0030001","EHB Low Passive","48333OH003",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.20","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","48333OH0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510038","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510038-01","Standard Silver On Exchange Plan",,"0.681164503097534","No","Yes","No","100%",,"$5,000","$10","$680","$150","$5,000","$20","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$1,000","$1000 per person","per group not applicable","50%",,,,,"$3,000","$3000 per person","per group not applicable","$4,000","$4000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000SCConnectNetwork.sflb","19"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510038","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510038-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-100SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-100SCConnectNetwork.sflb","20"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510032","SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510032-00","Standard Silver Off Exchange Plan",,"0.697951793670654","Yes","Yes","No","100%",,"$3,000","$10","$1,280","$150","$3,000","$140","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"$20,000","$20000 per person","$40000 per group","$23,000","$23000 per person","$46000 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3000SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3000SCConnectNetwork.sflb","4"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490510","SummaCare Silver 3000-16 with SCSelect Network","52664OH149","7730182830","OHN002","OHS003","OHF002","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1490510-00","Standard Silver Off Exchange Plan",,"0.712260901927948","No","Yes","No","100%",,"$3,000","$25","$850","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","$27,400","$27400 per person","$54800 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3000-16SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3000-16SCSelectNetwork.sflb","4"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490510","SummaCare Silver 3000-16 with SCSelect Network","52664OH149","7730182830","OHN002","OHS003","OHF002","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1490510-01","Standard Silver On Exchange Plan",,"0.712260901927948","No","Yes","No","100%",,"$3,000","$25","$850","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","$27,400","$27400 per person","$54800 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3000-16SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3000-16SCSelectNetwork.sflb","5"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510032","SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510032-01","Standard Silver On Exchange Plan",,"0.697951793670654","Yes","Yes","No","100%",,"$3,000","$10","$1,280","$150","$3,000","$140","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"$20,000","$20000 per person","$40000 per group","$23,000","$23000 per person","$46000 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3000SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3000SCConnectNetwork.sflb","5"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510032","SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510032-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3000-100SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3000-100SCConnectNetwork.sflb","6"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490511","SummaCare Silver 3000-16 with SCSelect Network","52664OH149","7730182830","OHN002","OHS004","OHF002","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1490511-00","Standard Silver Off Exchange Plan",,"0.712260901927948","No","Yes","No","100%",,"$3,000","$25","$850","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","$27,400","$27400 per person","$54800 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3000-16SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3000-16SCSelectNetwork.sflb","6"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490511","SummaCare Silver 3000-16 with SCSelect Network","52664OH149","7730182830","OHN002","OHS004","OHF002","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1490511-01","Standard Silver On Exchange Plan",,"0.712260901927948","No","Yes","No","100%",,"$3,000","$25","$850","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","$27,400","$27400 per person","$54800 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3000-16SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3000-16SCSelectNetwork.sflb","7"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510032","SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510032-03","Limited Cost Sharing Plan Variation",,"0.697951793670654","Yes","Yes","No","100%",,"$3,000","$10","$1,280","$150","$3,000","$140","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"$20,000","$20000 per person","$40000 per group","$23,000","$23000 per person","$46000 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3000-LimitedSCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3000-LimitedSCConnectNetwork.sflb","7"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510032","SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510032-04","73% AV Level Silver Plan",,"0.7209193110466","Yes","Yes","No","100%",,"$3,000","$10","$1,280","$150","$3,000","$140","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$30,000","$30000 per person","$60000 per group","$35,450","$35450 per person","$70900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$13,000","$13000 per person","$26000 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3000-73SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3000-73SCConnectNetwork.sflb","8"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490512","SummaCare Silver 3000-16 with SCConnect Network","52664OH149","7730182830","OHN001","OHS002","OHF002","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1490512-00","Standard Silver Off Exchange Plan",,"0.712260901927948","No","Yes","No","100%",,"$3,000","$25","$850","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","$27,400","$27400 per person","$54800 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3000-16SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3000-16SCConnectNetwork.sflb","8"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490512","SummaCare Silver 3000-16 with SCConnect Network","52664OH149","7730182830","OHN001","OHS002","OHF002","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1490512-01","Standard Silver On Exchange Plan",,"0.712260901927948","No","Yes","No","100%",,"$3,000","$25","$850","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","$27,400","$27400 per person","$54800 per group","$3,000","$3000 per person","$6000 per group","20%",,,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3000-16SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3000-16SCConnectNetwork.sflb","9"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510032","SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510032-05","87% AV Level Silver Plan",,"0.864368498325348","Yes","Yes","No","100%",,"$750","$20","$1,010","$150","$750","$230","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$20,000","$20000 per person","$40000 per group","$22,250","$22250 per person","$44500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3000-87SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3000-87SCConnectNetwork.sflb","9"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510032","SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510032-06","94% AV Level Silver Plan",,"0.930048286914825","Yes","Yes","No","100%",,"$0","$20","$520","$150","$0","$250","$140","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$10,000","$10000 per person","$20000 per group","$11,250","$11250 per person","$22500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","$5,100","$5100 per person","$10200 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3000-94SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3000-94SCConnectNetwork.sflb","10"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490513","SummaCare Silver 4000-16 80 with SCSelect Network","52664OH149","7730182830","OHN002","OHS003","OHF003","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1490513-00","Standard Silver Off Exchange Plan",,"0.683651149272919","Yes","Yes","No","100%",,"$4,000","$25","$650","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,000","$24000 per person","$48000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$12,000","$12000 per person","$24000 per group","$16,000","$16000 per person","$32000 per group","No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver4000-1680SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver4000-1680SCSelectNetwork.sflb","10"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490513","SummaCare Silver 4000-16 80 with SCSelect Network","52664OH149","7730182830","OHN002","OHS003","OHF003","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1490513-01","Standard Silver On Exchange Plan",,"0.683651149272919","Yes","Yes","No","100%",,"$4,000","$25","$650","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,000","$24000 per person","$48000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$12,000","$12000 per person","$24000 per group","$16,000","$16000 per person","$32000 per group","No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver4000-1680SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver4000-1680SCSelectNetwork.sflb","11"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510033","SummaCare Silver 3000 with SCSelect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN002","OHS001","OHF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510033-00","Standard Silver Off Exchange Plan",,"0.697951793670654","Yes","Yes","No","100%",,"$3,000","$10","$1,280","$150","$3,000","$140","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"$20,000","$20000 per person","$40000 per group","$23,000","$23000 per person","$46000 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3000SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3000SCSelectNetwork.sflb","11"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510033","SummaCare Silver 3000 with SCSelect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN002","OHS001","OHF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510033-01","Standard Silver On Exchange Plan",,"0.697951793670654","Yes","Yes","No","100%",,"$3,000","$10","$1,280","$150","$3,000","$140","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"$20,000","$20000 per person","$40000 per group","$23,000","$23000 per person","$46000 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3000SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3000SCSelectNetwork.sflb","12"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490514","SummaCare Silver 4000-16 80 with SCSelect Network","52664OH149","7730182830","OHN002","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1490514-00","Standard Silver Off Exchange Plan",,"0.683651149272919","Yes","Yes","No","100%",,"$4,000","$25","$650","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,000","$24000 per person","$48000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$12,000","$12000 per person","$24000 per group","$16,000","$16000 per person","$32000 per group","No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver4000-1680SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver4000-1680SCSelectNetwork.sflb","12"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490514","SummaCare Silver 4000-16 80 with SCSelect Network","52664OH149","7730182830","OHN002","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1490514-01","Standard Silver On Exchange Plan",,"0.683651149272919","Yes","Yes","No","100%",,"$4,000","$25","$650","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,000","$24000 per person","$48000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$12,000","$12000 per person","$24000 per group","$16,000","$16000 per person","$32000 per group","No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver4000-1680SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver4000-1680SCSelectNetwork.sflb","13"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510033","SummaCare Silver 3000 with SCSelect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN002","OHS001","OHF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510033-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3000-100SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3000-100SCSelectNetwork.sflb","13"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510033","SummaCare Silver 3000 with SCSelect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN002","OHS001","OHF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510033-03","Limited Cost Sharing Plan Variation",,"0.697951793670654","Yes","Yes","No","100%",,"$3,000","$10","$1,280","$150","$3,000","$140","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"$20,000","$20000 per person","$40000 per group","$23,000","$23000 per person","$46000 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3000-LimitedSCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3000-LimitedSCSelectNetwork.sflb","14"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490515","SummaCare Silver 4000-16 80 with SCConnect Network","52664OH149","7730182830","OHN001","OHS002","OHF003","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1490515-00","Standard Silver Off Exchange Plan",,"0.683651149272919","Yes","Yes","No","100%",,"$4,000","$25","$650","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,000","$24000 per person","$48000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$12,000","$12000 per person","$24000 per group","$16,000","$16000 per person","$32000 per group","No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver4000-1680SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver4000-1680SCConnectNetwork.sflb","14"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490515","SummaCare Silver 4000-16 80 with SCConnect Network","52664OH149","7730182830","OHN001","OHS002","OHF003","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1490515-01","Standard Silver On Exchange Plan",,"0.683651149272919","Yes","Yes","No","100%",,"$4,000","$25","$650","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$18,000","$18000 per person","$36000 per group","$24,000","$24000 per person","$48000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","20%",,,,,"$12,000","$12000 per person","$24000 per group","$16,000","$16000 per person","$32000 per group","No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver4000-1680SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver4000-1680SCConnectNetwork.sflb","15"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510033","SummaCare Silver 3000 with SCSelect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN002","OHS001","OHF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510033-04","73% AV Level Silver Plan",,"0.7209193110466","Yes","Yes","No","100%",,"$3,000","$10","$1,280","$150","$3,000","$140","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$30,000","$30000 per person","$60000 per group","$35,450","$35450 per person","$70900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$13,000","$13000 per person","$26000 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3000-73SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3000-73SCSelectNetwork.sflb","15"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510033","SummaCare Silver 3000 with SCSelect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN002","OHS001","OHF006","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510033-05","87% AV Level Silver Plan",,"0.864368498325348","Yes","Yes","No","100%",,"$750","$20","$1,010","$150","$750","$230","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$20,000","$20000 per person","$40000 per group","$22,250","$22250 per person","$44500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3000-87SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3000-87SCSelectNetwork.sflb","16"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490516","SummaCare Gold 2000-16 with SCSelect Network","52664OH149","7730182830","OHN002","OHS003","OHF002","New","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1490516-00","Standard Gold Off Exchange Plan",,"0.79827618598938","No","Yes","No","100%",,"$2,000","$30","$970","$150","$2,000","$630","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$2,000","$2000 per person","$4000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$8,000","$8000 per person","$16000 per group","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareGold2000-16SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold2000-16SCSelectNetwork.sflb","16"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490517","SummaCare Gold 2000-16 with SCSelect Network","52664OH149","7730182830","OHN002","OHS004","OHF002","New","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1490517-01","Standard Gold On Exchange Plan",,"0.79827618598938","No","Yes","No","100%",,"$2,000","$30","$970","$150","$2,000","$630","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$2,000","$2000 per person","$4000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$8,000","$8000 per person","$16000 per group","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareGold2000-16SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold2000-16SCSelectNetwork.sflb","19"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490518","SummaCare Gold 2000-16 with SCConnect Network","52664OH149","7730182830","OHN001","OHS002","OHF002","New","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1490518-00","Standard Gold Off Exchange Plan",,"0.79827618598938","No","Yes","No","100%",,"$2,000","$30","$970","$150","$2,000","$630","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$2,000","$2000 per person","$4000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$8,000","$8000 per person","$16000 per group","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareGold2000-16SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold2000-16SCConnectNetwork.sflb","20"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490518","SummaCare Gold 2000-16 with SCConnect Network","52664OH149","7730182830","OHN001","OHS002","OHF002","New","PPO","Gold","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1490518-01","Standard Gold On Exchange Plan",,"0.79827618598938","No","Yes","No","100%",,"$2,000","$30","$970","$150","$2,000","$630","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$9,000","$9000 per person","$18000 per group","$12,000","$12000 per person","$24000 per group","$2,000","$2000 per person","$4000 per group","20%",,,,,"$6,000","$6000 per person","$12000 per group","$8,000","$8000 per person","$16000 per group","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareGold2000-16SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold2000-16SCConnectNetwork.sflb","21"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510038","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510038-03","Limited Cost Sharing Plan Variation",,"0.681164503097534","No","Yes","No","100%",,"$5,000","$10","$680","$150","$5,000","$20","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$1,000","$1000 per person","per group not applicable","50%",,,,,"$3,000","$3000 per person","per group not applicable","$4,000","$4000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000-LimitedSCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-LimitedSCConnectNetwork.sflb","21"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510038","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510038-04","73% AV Level Silver Plan",,"0.723468840122223","No","Yes","No","100%",,"$3,000","$10","$680","$150","$3,000","$140","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$30,000","$30000 per person","$60000 per group","$35,450","$35450 per person","$70900 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$13,000","$13000 per person","$26000 per group","$500","$500 per person","per group not applicable","50%",,,,,"$1,500","$1500 per person","per group not applicable","$2,000","$2000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000-73SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-73SCConnectNetwork.sflb","22"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510038","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510038-05","87% AV Level Silver Plan",,"0.862045049667358","No","Yes","No","100%",,"$750","$20","$1,010","$150","$750","$230","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$20,000","$20000 per person","$40000 per group","$22,250","$22250 per person","$44500 per group","$750","$750 per person","$1500 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","$200","$200 per person","per group not applicable","50%",,,,,"$600","$600 per person","per group not applicable","$800","$800 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000-87SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-87SCConnectNetwork.sflb","23"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510038","SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510038-06","94% AV Level Silver Plan",,"0.93082332611084","No","Yes","No","100%",,"$100","$20","$510","$150","$100","$250","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$10,000","$10000 per person","$20000 per group","$11,700","$11700 per person","$23400 per group","$100","$100 per person","$200 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","$5,100","$5100 per person","$10200 per group","$100","$100 per person","per group not applicable","50%",,,,,"$300","$300 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000-94SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-94SCConnectNetwork.sflb","24"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510039","SummaCare Silver 5000 with SCSelect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN002","OHS001","OHF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510039-00","Standard Silver Off Exchange Plan",,"0.681164503097534","No","Yes","No","100%",,"$5,000","$10","$680","$150","$5,000","$20","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$1,000","$1000 per person","per group not applicable","50%",,,,,"$3,000","$3000 per person","per group not applicable","$4,000","$4000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000SCSelectNetwork.sflb","25"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510039","SummaCare Silver 5000 with SCSelect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN002","OHS001","OHF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510039-01","Standard Silver On Exchange Plan",,"0.681164503097534","No","Yes","No","100%",,"$5,000","$10","$680","$150","$5,000","$20","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$1,000","$1000 per person","per group not applicable","50%",,,,,"$3,000","$3000 per person","per group not applicable","$4,000","$4000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000SCSelectNetwork.sflb","26"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510039","SummaCare Silver 5000 with SCSelect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN002","OHS001","OHF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510039-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000-100SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-100SCConnectNetwork.sflb","27"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510039","SummaCare Silver 5000 with SCSelect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN002","OHS001","OHF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510039-03","Limited Cost Sharing Plan Variation",,"0.681164503097534","No","Yes","No","100%",,"$5,000","$10","$680","$150","$5,000","$20","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group","$5,000","$5000 per person","$10000 per group","30%",,,,,"$20,000","$20000 per person","$40000 per group","$25,000","$25000 per person","$50000 per group","$1,000","$1000 per person","per group not applicable","50%",,,,,"$3,000","$3000 per person","per group not applicable","$4,000","$4000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000-LimitedSCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-LimitedSCSelectNetwork.sflb","28"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510039","SummaCare Silver 5000 with SCSelect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN002","OHS001","OHF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510039-04","73% AV Level Silver Plan",,"0.723468840122223","No","Yes","No","100%",,"$3,000","$10","$1,280","$150","$3,000","$140","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$30,000","$30000 per person","$60000 per group","$35,450","$35450 per person","$70900 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$13,000","$13000 per person","$26000 per group","$500","$500 per person","per group not applicable","50%",,,,,"$1,500","$1500 per person","per group not applicable","$2,000","$2000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000-73SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-73SCSelectNetwork.sflb","29"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510039","SummaCare Silver 5000 with SCSelect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN002","OHS001","OHF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510039-05","87% AV Level Silver Plan",,"0.862045049667358","No","Yes","No","100%",,"$750","$20","$1,010","$150","$750","$230","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$20,000","$20000 per person","$40000 per group","$22,250","$22250 per person","$44500 per group","$750","$750 per person","$1500 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","$200","$200 per person","per group not applicable","50%",,,,,"$600","$600 per person","per group not applicable","$800","$800 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000-87SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-87SCSelectNetwork.sflb","30"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510039","SummaCare Silver 5000 with SCSelect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN002","OHS001","OHF007","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510039-06","94% AV Level Silver Plan",,"0.93082332611084","No","Yes","No","100%",,"$100","$20","$510","$150","$100","$250","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"$10,000","$10000 per person","$20000 per group","$11,700","$11700 per person","$23400 per group","$100","$100 per person","$200 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","$5,100","$5100 per person","$10200 per group","$100","$100 per person","per group not applicable","50%",,,,,"$300","$300 per person","per group not applicable","$400","$400 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver5000-94SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver5000-94SCSelectNetwork.sflb","31"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510050","SummaCare Gold 750 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510050-00","Standard Gold Off Exchange Plan",,"0.785320580005646","Yes","Yes","No","100%",,"$750","$10","$680","$150","$750","$280","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$30,000","$30000 per person","$60000 per group","$36,850","$36850 per person","$73700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareGold750SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold750SCConnectNetwork.sflb","32"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510050","SummaCare Gold 750 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510050-01","Standard Gold On Exchange Plan",,"0.785320580005646","Yes","Yes","No","100%",,"$750","$10","$680","$150","$750","$280","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$30,000","$30000 per person","$60000 per group","$36,850","$36850 per person","$73700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareGold750SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold750SCConnectNetwork.sflb","33"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510050","SummaCare Gold 750 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510050-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareGold750-100SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold750-100SCConnectNetwork.sflb","34"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510050","SummaCare Gold 750 with SCConnect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN001","OHS002","OHF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510050-03","Limited Cost Sharing Plan Variation",,"0.785320580005646","Yes","Yes","No","100%",,"$750","$10","$680","$150","$750","$280","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$30,000","$30000 per person","$60000 per group","$36,850","$36850 per person","$73700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareGold750-LimitedSCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold750-LimitedSCConnectNetwork.sflb","35"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510051","SummaCare Gold 750 with SCSelect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN002","OHS001","OHF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510051-00","Standard Gold Off Exchange Plan",,"0.785320580005646","Yes","Yes","No","100%",,"$750","$10","$680","$150","$750","$280","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$30,000","$30000 per person","$60000 per group","$36,850","$36850 per person","$73700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareGold750SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold750SCSelectNetwork.sflb","36"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510051","SummaCare Gold 750 with SCSelect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN002","OHS001","OHF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510051-01","Standard Gold On Exchange Plan",,"0.785320580005646","Yes","Yes","No","100%",,"$750","$10","$680","$150","$750","$280","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$30,000","$30000 per person","$60000 per group","$36,850","$36850 per person","$73700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareGold750SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold750SCSelectNetwork.sflb","37"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510051","SummaCare Gold 750 with SCSelect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN002","OHS001","OHF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510051-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareGold750-100SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold750-100SCSelectNetwork.sflb","38"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","1","52664","OH","Individual","No","34-1809108","52664OH1510051","SummaCare Gold 750 with SCSelect Network and 3 Free PCP Visits","52664OH151","7730182830","OHN002","OHS001","OHF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1510051-03","Limited Cost Sharing Plan Variation",,"0.785320580005646","Yes","Yes","No","100%",,"$750","$10","$680","$150","$750","$280","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$30,000","$30000 per person","$60000 per group","$36,850","$36850 per person","$73700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","$5,750","$5750 per person","$11500 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareGold750-LimitedSCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareGold750-LimitedSCSelectNetwork.sflb","39"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","Individual","No","34-1809108","52664OH1520027","SummaCare Bronze 6850 with SCConnect Network and 3 Free PCP Visits","52664OH152","7730182830","OHN001","OHS002","OHF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1520027-00","Standard Bronze Off Exchange Plan",,"0.612251937389374","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","$26,850","$26850 per person","$53700 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze6850SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze6850SCConnectNetwork.sflb","4"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500115","SummaCare Bronze 5000 HSA-16 with SCSelect Network","52664OH150","7730182830","OHN002","OHS003","OHF001","New","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1500115-00","Standard Bronze Off Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$2,420","$0","$570","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$19,350","$19350 per person","$38700 per group","$25,800","$25800 per person","$51600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","$20,000","$20000 per person","$40000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCare5000HSA-16SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCare5000HSA-16SCSelectNetwork.sflb","4"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500115","SummaCare Bronze 5000 HSA-16 with SCSelect Network","52664OH150","7730182830","OHN002","OHS003","OHF001","New","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1500115-01","Standard Bronze On Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$2,420","$0","$570","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$19,350","$19350 per person","$38700 per group","$25,800","$25800 per person","$51600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","$20,000","$20000 per person","$40000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCare5000HSA-16SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCare5000HSA-16SCSelectNetwork.sflb","5"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","Individual","No","34-1809108","52664OH1520027","SummaCare Bronze 6850 with SCConnect Network and 3 Free PCP Visits","52664OH152","7730182830","OHN001","OHS002","OHF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1520027-01","Standard Bronze On Exchange Plan",,"0.612251937389374","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","$26,850","$26850 per person","$53700 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze6850SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze6850SCConnectNetwork.sflb","5"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","Individual","No","34-1809108","52664OH1520027","SummaCare Bronze 6850 with SCConnect Network and 3 Free PCP Visits","52664OH152","7730182830","OHN001","OHS002","OHF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1520027-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze6850-100SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze6850-100SCConnectNetwork.sflb","6"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500116","SummaCare Bronze 5000 HSA-16 with SCSelect Network","52664OH150","7730182830","OHN002","OHS004","OHF001","New","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1500116-00","Standard Bronze Off Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$2,420","$0","$570","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$19,350","$19350 per person","$38700 per group","$25,800","$25800 per person","$51600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","$20,000","$20000 per person","$40000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCare5000HSA-16SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCare5000HSA-16SCSelectNetwork.sflb","6"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500116","SummaCare Bronze 5000 HSA-16 with SCSelect Network","52664OH150","7730182830","OHN002","OHS004","OHF001","New","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1500116-01","Standard Bronze On Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$2,420","$0","$570","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$19,350","$19350 per person","$38700 per group","$25,800","$25800 per person","$51600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","$20,000","$20000 per person","$40000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCare5000HSA-16SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCare5000HSA-16SCSelectNetwork.sflb","7"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","Individual","No","34-1809108","52664OH1520027","SummaCare Bronze 6850 with SCConnect Network and 3 Free PCP Visits","52664OH152","7730182830","OHN001","OHS002","OHF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1520027-03","Limited Cost Sharing Plan Variation",,"0.612251937389374","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","$26,850","$26850 per person","$53700 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze6850-LimitedSCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze6850-LimitedSCConnectNetwork.sflb","7"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","Individual","No","34-1809108","52664OH1520028","SummaCare Bronze 6850 with SCSelect Network and 3 Free PCP Visits","52664OH152","7730182830","OHN002","OHS001","OHF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1520028-00","Standard Bronze Off Exchange Plan",,"0.612251937389374","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","$26,850","$26850 per person","$53700 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze6850SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze6850SCSelectNetwork.sflb","8"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500117","SummaCare Bronze 5000 HSA-16 with SCConnect Network","52664OH150","7730182830","OHN001","OHS002","OHF001","New","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1500117-00","Standard Bronze Off Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$2,420","$0","$570","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$19,350","$19350 per person","$38700 per group","$25,800","$25800 per person","$51600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","$20,000","$20000 per person","$40000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCare5000HSA-16SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCare5000HSA-16SCConnectNetwork.sflb","8"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500117","SummaCare Bronze 5000 HSA-16 with SCConnect Network","52664OH150","7730182830","OHN001","OHS002","OHF001","New","PPO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1500117-01","Standard Bronze On Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$460","$150","$2,420","$0","$570","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$19,350","$19350 per person","$38700 per group","$25,800","$25800 per person","$51600 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$15,000","$15000 per person","$30000 per group","$20,000","$20000 per person","$40000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCare5000HSA-16SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCare5000HSA-16SCConnectNetwork.sflb","9"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","Individual","No","34-1809108","52664OH1520028","SummaCare Bronze 6850 with SCSelect Network and 3 Free PCP Visits","52664OH152","7730182830","OHN002","OHS001","OHF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1520028-01","Standard Bronze On Exchange Plan",,"0.612251937389374","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","$26,850","$26850 per person","$53700 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze6850SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze6850SCSelectNetwork.sflb","9"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","Individual","No","34-1809108","52664OH1520028","SummaCare Bronze 6850 with SCSelect Network and 3 Free PCP Visits","52664OH152","7730182830","OHN002","OHS001","OHF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1520028-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze6850-100SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze6850-100SCSelectNetwork.sflb","10"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500118","SummaCare Silver 3500 HSA-16 with SCSelect Network","52664OH150","7730182830","OHN002","OHS003","OHF003","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1500118-00","Standard Silver Off Exchange Plan",,"0.684485912322998","Yes","Yes","No","100%",,"$3,500","$20","$0","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"$13,200","$13200 per person","$26400 per group","$17,600","$17600 per person","$35200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","$14,000","$14000 per person","$28000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3500HSA-16SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3500HSA-16SCSelectNetwork.sflb","10"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500118","SummaCare Silver 3500 HSA-16 with SCSelect Network","52664OH150","7730182830","OHN002","OHS003","OHF003","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1500118-01","Standard Silver On Exchange Plan",,"0.684485912322998","Yes","Yes","No","100%",,"$3,500","$20","$0","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"$13,200","$13200 per person","$26400 per group","$17,600","$17600 per person","$35200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","$14,000","$14000 per person","$28000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3500HSA-16SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3500HSA-16SCSelectNetwork.sflb","11"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","Individual","No","34-1809108","52664OH1520028","SummaCare Bronze 6850 with SCSelect Network and 3 Free PCP Visits","52664OH152","7730182830","OHN002","OHS001","OHF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1520028-03","Limited Cost Sharing Plan Variation",,"0.612251937389374","Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","$26,850","$26850 per person","$53700 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareBronze6850-LimitedSCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareBronze6850-LimitedSCSelectNetwork.sflb","11"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500154","SummaCare Silver 3500 HSA-16 with SCSelect Network","52664OH150","7730182830","OHN002","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1500154-00","Standard Silver Off Exchange Plan",,"0.684485912322998","Yes","Yes","No","100%",,"$3,500","$20","$0","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"$13,200","$13200 per person","$26400 per group","$17,600","$17600 per person","$35200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","$14,000","$14000 per person","$28000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3500HSA-16SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3500HSA-16SCConnectNetwork.sflb","12"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","Individual","No","34-1809108","52664OH1520029","SummaCare Value with SCConnect Network and 3 Free PCP Visits","52664OH152","7730182830","OHN001","OHS002","OHF004","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1520029-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","$26,850","$26850 per person","$53700 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareValueSCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareValueSCConnectNetwork.sflb","12"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","Individual","No","34-1809108","52664OH1520029","SummaCare Value with SCConnect Network and 3 Free PCP Visits","52664OH152","7730182830","OHN001","OHS002","OHF004","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1520029-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","$26,850","$26850 per person","$53700 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareValueSCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareValueSCConnectNetwork.sflb","13"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500154","SummaCare Silver 3500 HSA-16 with SCSelect Network","52664OH150","7730182830","OHN002","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1500154-01","Standard Silver On Exchange Plan",,"0.684485912322998","Yes","Yes","No","100%",,"$3,500","$20","$0","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"$13,200","$13200 per person","$26400 per group","$17,600","$17600 per person","$35200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","$14,000","$14000 per person","$28000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3500HSA-16SCConnectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3500HSA-16SCConnectNetwork.sflb","13"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","Individual","No","34-1809108","52664OH1520030","SummaCare Value with SCSelect Network and 3 Free PCP Visits","52664OH152","7730182830","OHN002","OHS001","OHF004","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1520030-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","$26,850","$26850 per person","$53700 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareValueSCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareValueSCSelectNetwork.sflb","14"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500120","SummaCare Silver 3500 HSA-16 with SCConnect Network","52664OH150","7730182830","OHN001","OHS002","OHF003","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1500120-00","Standard Silver Off Exchange Plan",,"0.684485912322998","Yes","Yes","No","100%",,"$3,500","$20","$0","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"$13,200","$13200 per person","$26400 per group","$17,600","$17600 per person","$35200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","$14,000","$14000 per person","$28000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3500HSA-16SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3500HSA-16SCSelectNetwork.sflb","14"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500120","SummaCare Silver 3500 HSA-16 with SCConnect Network","52664OH150","7730182830","OHN001","OHS002","OHF003","New","PPO","Silver","No","Both","No","No",,,,"Yes","Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network Benefits Apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary","52664OH1500120-01","Standard Silver On Exchange Plan",,"0.684485912322998","Yes","Yes","No","100%",,"$3,500","$20","$0","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"$13,200","$13200 per person","$26400 per group","$17,600","$17600 per person","$35200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$10,500","$10500 per person","$21000 per group","$14,000","$14000 per person","$28000 per group","Yes","No",,"http://www.summacare.com/Libraries/SBCs/SummaCareSilver3500HSA-16SCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareSilver3500HSA-16SCSelectNetwork.sflb","15"
"2016","OH","52664","SERFF","13","2016-04-06 10:26:32","2","52664","OH","Individual","No","34-1809108","52664OH1520030","SummaCare Value with SCSelect Network and 3 Free PCP Visits","52664OH152","7730182830","OHN002","OHS001","OHF004","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","0.9949",,,,"0","3","0","2016-01-01",,"Yes","Emergency coverage only","Yes","Out of Network benefits apply","No","https://summacare.insxcloud.com/payment/make-a-payment/index","http://www.summacare.com/Libraries/Formularies/2016Formulary.sflb","52664OH1520030-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$40,000","$40000 per person","$80000 per group","$46,850","$46850 per person","$93700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","$26,850","$26850 per person","$53700 per group","No",,,"http://www.summacare.com/Libraries/SBCs/SummaCareValueSCSelectNetwork.sflb","http://www.summacare.com/Libraries/SOBs/SummaCareValueSCSelectNetwork.sflb","15"
"2016","OH","55371","SERFF","5","2015-08-20 12:28:36","1","55371","OH","Individual","Yes","75-1233841","55371OH0010007","Dentegra Dental PPO Pediatric Basic Plan","55371OH001",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","55371OH0010007-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/oh/55371oh0010007-16","4"
"2016","OH","55371","SERFF","5","2015-08-20 12:28:36","1","55371","OH","SHOP (Small Group)","Yes","75-1233841","55371OH0020007","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","55371OH002",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","55371OH0020007-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/oh/55371oh0020007-16","4"
"2016","OH","55371","SERFF","5","2015-08-20 12:28:36","2","55371","OH","SHOP (Small Group)","Yes","75-1233841","55371OH0020010","Dentegra Dental PPO for Small Businesses Family Preferred Plan","55371OH002",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.42","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","55371OH0020010-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/oh/55371oh0020010-16","4"
"2016","OH","55371","SERFF","5","2015-08-20 12:28:36","2","55371","OH","Individual","Yes","75-1233841","55371OH0010010","Dentegra Dental PPO Family Preferred Plan","55371OH001",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.24","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","55371OH0010010-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/oh/55371oh0010010-16","4"
"2016","OH","55371","SERFF","5","2015-08-20 12:28:36","3","55371","OH","Individual","Yes","75-1233841","55371OH0010009","Dentegra Dental PPO Family Basic Plan","55371OH001",,"OHN001","OHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","55371OH0010009-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/oh/55371oh0010009-16","4"
"2016","OH","55371","SERFF","5","2015-08-20 12:28:36","3","55371","OH","SHOP (Small Group)","Yes","75-1233841","55371OH0020009","Dentegra Dental PPO for Small Businesses Family Basic Plan","55371OH002",,"OHN001","OHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","55371OH0020009-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/oh/55371oh0020009-16","4"
"2016","OH","55371","SERFF","5","2015-08-20 12:28:36","3","55371","OH","SHOP (Small Group)","Yes","75-1233841","55371OH0020009","Dentegra Dental PPO for Small Businesses Family Basic Plan","55371OH002",,"OHN001","OHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","55371OH0020009-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/oh/55371oh0020009-16","5"
"2016","OH","55371","SERFF","5","2015-08-20 12:28:36","3","55371","OH","Individual","Yes","75-1233841","55371OH0010009","Dentegra Dental PPO Family Basic Plan","55371OH001",,"OHN001","OHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","55371OH0010009-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/oh/55371oh0010009-16","5"
"2016","OH","64353","SERFF","11","2016-01-28 08:29:40","2","64353","OH","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/oh/en/PDF/marketplace/formulary-2016.pdf","64353OH0010002-04","73% AV Level Silver Plan",,"0.739822447299957","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/summary-of-benefits-silver-200-2016.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/brochure-2016.pdf","8"
"2016","OH","64353","SERFF","11","2016-01-28 08:29:40","2","64353","OH","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/oh/en/PDF/marketplace/formulary-2016.pdf","64353OH0010002-05","87% AV Level Silver Plan",,"0.878527700901031","No","Yes","No","100%",,"$450","$180","$890","$150","$450","$320","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$450","$450 per person","$900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/summary-of-benefits-silver-150-2016.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/brochure-2016.pdf","9"
"2016","OH","64353","SERFF","11","2016-01-28 08:29:40","2","64353","OH","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/oh/en/PDF/marketplace/formulary-2016.pdf","64353OH0010002-06","94% AV Level Silver Plan",,"0.947116374969482","No","Yes","No","100%",,"$0","$210","$450","$150","$0","$180","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/summary-of-benefits-silver-100-2016.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/brochure-2016.pdf","10"
"2016","OH","64353","SERFF","11","2016-01-28 08:29:40","3","64353","OH","Individual","No","20-0750134","64353OH0010003","Molina Marketplace Bronze Plan","64353OH001",,"OHN001","OHS002","OHF003","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/oh/en/PDF/marketplace/formulary-2016.pdf","64353OH0010003-00","Standard Bronze Off Exchange Plan",,"0.618895947933197","Yes","Yes","No","100%",,"$5,000","$20","$900","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/summary-of-benefits-bronze-2016.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/brochure-2016.pdf","4"
"2016","OH","64353","SERFF","11","2016-01-28 08:29:40","3","64353","OH","Individual","No","20-0750134","64353OH0010003","Molina Marketplace Bronze Plan","64353OH001",,"OHN001","OHS002","OHF003","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/oh/en/PDF/marketplace/formulary-2016.pdf","64353OH0010003-01","Standard Bronze On Exchange Plan",,"0.618895947933197","Yes","Yes","No","100%",,"$5,000","$20","$900","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/summary-of-benefits-bronze-2016.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/brochure-2016.pdf","5"
"2016","OH","64353","SERFF","11","2016-01-28 08:29:40","3","64353","OH","Individual","No","20-0750134","64353OH0010003","Molina Marketplace Bronze Plan","64353OH001",,"OHN001","OHS002","OHF003","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/oh/en/PDF/marketplace/formulary-2016.pdf","64353OH0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/summary-of-benefits-bronze-aian-2016.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/brochure-2016.pdf","6"
"2016","OH","64353","SERFF","11","2016-01-28 08:29:40","3","64353","OH","Individual","No","20-0750134","64353OH0010003","Molina Marketplace Bronze Plan","64353OH001",,"OHN001","OHS002","OHF003","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/oh/en/PDF/marketplace/formulary-2016.pdf","64353OH0010003-03","Limited Cost Sharing Plan Variation",,"0.618895947933197","Yes","Yes","No","100%",,"$5,000","$20","$900","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/summary-of-benefits-bronze-2016.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/brochure-2016.pdf","7"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610003","Humana Silver 3800/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610003-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609360","http://apps.humana.com/marketing/documents.asp?file=2624102","9"
"2016","OH","67129","SERFF","6","2016-01-28 08:29:40","3","67129","OH","Individual","No","06-6033492","67129OH0100009","Aetna Silver $10 Copay","67129OH010",,"OHN001","OHS001","OHF008","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5181093804","67129OH0100009-05","87% AV Level Silver Plan","86.13%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,150","$2150 per person","$4300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/OH/OH_SBC_710807.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/oh-on-booklet01-16.pdf","9"
"2016","OH","67129","SERFF","6","2016-01-28 08:29:40","3","67129","OH","Individual","No","06-6033492","67129OH0100009","Aetna Silver $10 Copay","67129OH010",,"OHN001","OHS001","OHF008","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5181093804","67129OH0100009-06","94% AV Level Silver Plan","93.13%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","10%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/OH/OH_SBC_710806.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/oh-on-booklet01-16.pdf","10"
"2016","OH","67129","SERFF","6","2016-01-28 08:29:40","4","67129","OH","Individual","No","06-6033492","67129OH0100007","Aetna Gold $10 Copay","67129OH010",,"OHN001","OHS001","OHF007","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5181093804","67129OH0100007-00","Standard Gold Off Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/OH/OH_SBC_710796.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/oh-on-booklet01-16.pdf","4"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610014","Humana Gold 2250/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610014-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609607","http://apps.humana.com/marketing/documents.asp?file=2593422","41"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610014","Humana Gold 2250/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610014-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609607","http://apps.humana.com/marketing/documents.asp?file=2593422","42"
"2016","OH","67129","SERFF","6","2016-01-28 08:29:40","4","67129","OH","Individual","No","06-6033492","67129OH0100007","Aetna Gold $10 Copay","67129OH010",,"OHN001","OHS001","OHF007","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5181093804","67129OH0100007-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/OH/OH_SBC_710797.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/oh-on-booklet01-16.pdf","7"
"2016","OH","58255","SERFF","6","2015-08-20 12:28:36","1","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0210001","Smile for Health - Certified Optimum Coverage","58255OH021",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","58255OH0210001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","58255","SERFF","6","2015-08-20 12:28:36","2","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0210002","Smile for Health - Certified Optimum Coverage","58255OH021",,"OHN002","OHS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","58255OH0210002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","58255","SERFF","6","2015-08-20 12:28:36","3","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0210003","Smile for Health - Certified Optimum Coverage","58255OH021",,"OHN003","OHS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","58255OH0210003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","58255","SERFF","6","2015-08-20 12:28:36","4","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0210004","Smile for Health - Certified Optimum Coverage","58255OH021",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","58255OH0210004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","58255","SERFF","6","2015-08-20 12:28:36","5","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0210005","Smile for Health - Certified Optimum Coverage","58255OH021",,"OHN002","OHS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","58255OH0210005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","58255","SERFF","6","2015-08-20 12:28:36","6","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0210006","Smile for Health - Certified Optimum Coverage","58255OH021",,"OHN003","OHS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.63","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","58255OH0210006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","58255","SERFF","6","2015-08-20 12:28:36","7","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0220001","Smile for Health - Certified High Option","58255OH022",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","58255OH0220001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","58255","SERFF","6","2015-08-20 12:28:36","8","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0220002","Smile for Health - Certified High Option","58255OH022",,"OHN002","OHS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","58255OH0220002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","58255","SERFF","6","2015-08-20 12:28:36","9","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0220003","Smile for Health - Certified High Option","58255OH022",,"OHN003","OHS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","58255OH0220003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","58255","SERFF","6","2015-08-20 12:28:36","10","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0220004","Smile for Health - Certified High Option Plus","58255OH022",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","58255OH0220004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","58255","SERFF","6","2015-08-20 12:28:36","11","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0220005","Smile for Health - Certified High Option Plus","58255OH022",,"OHN002","OHS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","58255OH0220005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","58255","SERFF","6","2015-08-20 12:28:36","12","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0220006","Smile for Health - Certified High Option Plus","58255OH022",,"OHN003","OHS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$4.41","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","58255OH0220006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","59401","SERFF","4","2015-08-20 12:28:36","1","59401","OH","SHOP (Small Group)","Yes","27-4326698","59401OH0030003","Managed DentalGuard OH10 Family Plan","59401OH003",,"OHN001","OHS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.75","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","59401OH0030003-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","OH","59401","SERFF","4","2015-08-20 12:28:36","1","59401","OH","SHOP (Small Group)","Yes","27-4326698","59401OH0030003","Managed DentalGuard OH10 Family Plan","59401OH003",,"OHN001","OHS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.75","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","59401OH0030003-01","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","OH","59401","SERFF","4","2015-08-20 12:28:36","1","59401","OH","SHOP (Small Group)","Yes","27-4326698","59401OH0040003","Managed DentalGuard OH20 Family Plan","59401OH004",,"OHN001","OHS001",,"Existing","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.31","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","59401OH0040003-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","OH","59401","SERFF","4","2015-08-20 12:28:36","1","59401","OH","SHOP (Small Group)","Yes","27-4326698","59401OH0050003","Managed DentalGuard OH30 Family Plan","59401OH005",,"OHN001","OHS001",,"Existing","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.09","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No",,"","59401OH0050003-00","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","OH","64156","SERFF","6","2015-08-20 12:28:36","1","64156","OH","SHOP (Small Group)","Yes","36-0883760","64156OH0040002","EHB High PPO","64156OH004",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.76","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","64156OH0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","OH","64156","SERFF","6","2015-08-20 12:28:36","1","64156","OH","SHOP (Small Group)","Yes","36-0883760","64156OH0040001","EHB Low PPO","64156OH004",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.23","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","64156OH0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","OH","64156","SERFF","6","2015-08-20 12:28:36","1","64156","OH","SHOP (Small Group)","Yes","36-0883760","64156OH0030002","EHB High Passive","64156OH003",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.20","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","64156OH0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","OH","64156","SERFF","6","2015-08-20 12:28:36","1","64156","OH","SHOP (Small Group)","Yes","36-0883760","64156OH0030001","EHB Low Passive","64156OH003",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.13","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","64156OH0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","OH","64353","SERFF","11","2016-01-28 08:29:40","1","64353","OH","Individual","No","20-0750134","64353OH0010001","Molina Marketplace Gold Plan","64353OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/oh/en/PDF/marketplace/formulary-2016.pdf","64353OH0010001-00","Standard Gold Off Exchange Plan",,"0.801033437252045","No","Yes","No","100%",,"$500","$240","$890","$150","$500","$770","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/summary-of-benefits-gold-2016.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/brochure-2016.pdf","4"
"2016","OH","64353","SERFF","11","2016-01-28 08:29:40","1","64353","OH","Individual","No","20-0750134","64353OH0010001","Molina Marketplace Gold Plan","64353OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/oh/en/PDF/marketplace/formulary-2016.pdf","64353OH0010001-01","Standard Gold On Exchange Plan",,"0.801033437252045","No","Yes","No","100%",,"$500","$240","$890","$150","$500","$770","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/summary-of-benefits-gold-2016.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/brochure-2016.pdf","5"
"2016","OH","64353","SERFF","11","2016-01-28 08:29:40","1","64353","OH","Individual","No","20-0750134","64353OH0010001","Molina Marketplace Gold Plan","64353OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/oh/en/PDF/marketplace/formulary-2016.pdf","64353OH0010001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/summary-of-benefits-gold-aian-2016.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/brochure-2016.pdf","6"
"2016","OH","64353","SERFF","11","2016-01-28 08:29:40","1","64353","OH","Individual","No","20-0750134","64353OH0010001","Molina Marketplace Gold Plan","64353OH001",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/oh/en/PDF/marketplace/formulary-2016.pdf","64353OH0010001-03","Limited Cost Sharing Plan Variation",,"0.801033437252045","No","Yes","No","100%",,"$500","$240","$890","$150","$500","$770","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/summary-of-benefits-gold-2016.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/brochure-2016.pdf","7"
"2016","OH","64353","SERFF","11","2016-01-28 08:29:40","2","64353","OH","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/oh/en/PDF/marketplace/formulary-2016.pdf","64353OH0010002-00","Standard Silver Off Exchange Plan",,"0.714607775211334","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/summary-of-benefits-silver-250-2016.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/brochure-2016.pdf","4"
"2016","OH","64353","SERFF","11","2016-01-28 08:29:40","2","64353","OH","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/oh/en/PDF/marketplace/formulary-2016.pdf","64353OH0010002-01","Standard Silver On Exchange Plan",,"0.714607775211334","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/summary-of-benefits-silver-250-2016.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/brochure-2016.pdf","5"
"2016","OH","64353","SERFF","11","2016-01-28 08:29:40","2","64353","OH","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/oh/en/PDF/marketplace/formulary-2016.pdf","64353OH0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/summary-of-benefits-silver-aian-2016.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/brochure-2016.pdf","6"
"2016","OH","64353","SERFF","11","2016-01-28 08:29:40","2","64353","OH","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent and emergent are covered","Yes","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/oh/en/PDF/marketplace/formulary-2016.pdf","64353OH0010002-03","Limited Cost Sharing Plan Variation",,"0.714607775211334","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/summary-of-benefits-silver-250-2016.pdf","http://www.molinahealthcare.com/members/oh/en-US/PDF/marketplace/brochure-2016.pdf","7"
"2016","OH","65869","SERFF","7","2015-08-20 12:28:36","1","65869","OH","Individual","Yes","47-0397286","65869OH0040001","Delta Dental Individual PPO, EHB Certified","65869OH004",,"OHN002","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","65869OH0040001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","65869","SERFF","7","2015-08-20 12:28:36","1","65869","OH","SHOP (Small Group)","Yes","47-0397286","65869OH0030001","Renaissance Group Dental PPO, EHB Certified","65869OH003",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.36","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","65869OH0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","65869","SERFF","7","2015-08-20 12:28:36","1","65869","OH","Individual","Yes","47-0397286","65869OH0040002","Delta Dental Individual PPO, EHB Certified","65869OH004",,"OHN002","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.56","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","65869OH0040002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","65869","SERFF","7","2015-08-20 12:28:36","1","65869","OH","SHOP (Small Group)","Yes","47-0397286","65869OH0030002","Renaissance Group Dental PPO, EHB Certified","65869OH003",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.39","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","65869OH0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","65869","SERFF","7","2015-08-20 12:28:36","1","65869","OH","SHOP (Small Group)","Yes","47-0397286","65869OH0030003","Renaissance Group Dental PPO, EHB Certified","65869OH003",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.36","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","65869OH0030003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","OH","65869","SERFF","7","2015-08-20 12:28:36","1","65869","OH","Individual","Yes","47-0397286","65869OH0020001","Renaissance Individual Dental PPO, EHB Certified","65869OH002",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.33","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","65869OH0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","OH","65869","SERFF","7","2015-08-20 12:28:36","1","65869","OH","Individual","Yes","47-0397286","65869OH0020002","Renaissance Individual Dental PPO, EHB Certified","65869OH002",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.66","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","65869OH0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","OH","65869","SERFF","7","2015-08-20 12:28:36","1","65869","OH","SHOP (Small Group)","Yes","47-0397286","65869OH0030004","Renaissance Group Dental PPO, EHB Certified","65869OH003",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.39","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","65869OH0030004-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","1","66083","OH","Individual","No","31-1154200","66083OH0610001","Humana Basic 6850/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2609256","http://apps.humana.com/marketing/documents.asp?file=2593253","4"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","1","66083","OH","Individual","No","31-1154200","66083OH0610001","Humana Basic 6850/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2609256","http://apps.humana.com/marketing/documents.asp?file=2593253","5"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610004","Humana Gold 2250/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610004-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609386","http://apps.humana.com/marketing/documents.asp?file=2593292","11"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610013","Humana Silver 3800/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610013-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609529","http://apps.humana.com/marketing/documents.asp?file=2593409","36"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","1","66083","OH","Individual","No","31-1154200","66083OH0610034","Humana Basic 6850/Cleveland HMOx","66083OH061",,"OHN003","OHS004","OHF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610034-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2630745","http://apps.humana.com/marketing/documents.asp?file=2593318","6"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","1","66083","OH","Individual","No","31-1154200","66083OH0610034","Humana Basic 6850/Cleveland HMOx","66083OH061",,"OHN003","OHS004","OHF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610034-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2630745","http://apps.humana.com/marketing/documents.asp?file=2593318","7"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","1","66083","OH","Individual","No","31-1154200","66083OH0610011","Humana Basic 6850/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610011-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2609464","http://apps.humana.com/marketing/documents.asp?file=2593383","8"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","1","66083","OH","Individual","No","31-1154200","66083OH0610011","Humana Basic 6850/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610011-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2609464","http://apps.humana.com/marketing/documents.asp?file=2593383","9"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","1","66083","OH","Individual","No","31-1154200","66083OH0610025","Humana Basic 6850/Dayton HMOx","66083OH061",,"OHN002","OHS003","OHF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610025-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2609464","http://apps.humana.com/marketing/documents.asp?file=2593383","10"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","1","66083","OH","Individual","No","31-1154200","66083OH0610025","Humana Basic 6850/Dayton HMOx","66083OH061",,"OHN002","OHS003","OHF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610025-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2609464","http://apps.humana.com/marketing/documents.asp?file=2593383","11"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","2","66083","OH","Individual","No","31-1154200","66083OH0610002","Humana Bronze 6450/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610002-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609269","http://apps.humana.com/marketing/documents.asp?file=2593266","4"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","2","66083","OH","Individual","No","31-1154200","66083OH0610002","Humana Bronze 6450/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610002-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609269","http://apps.humana.com/marketing/documents.asp?file=2593266","5"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","2","66083","OH","Individual","No","31-1154200","66083OH0610002","Humana Bronze 6450/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2609282","http://apps.humana.com/marketing/documents.asp?file=2593266","6"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","2","66083","OH","Individual","No","31-1154200","66083OH0610002","Humana Bronze 6450/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610002-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609295","http://apps.humana.com/marketing/documents.asp?file=2593266","7"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","2","66083","OH","Individual","No","31-1154200","66083OH0610035","Humana Bronze 6450/Cleveland HMOx","66083OH061",,"OHN003","OHS004","OHF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610035-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2630758","http://apps.humana.com/marketing/documents.asp?file=2593331","8"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","2","66083","OH","Individual","No","31-1154200","66083OH0610035","Humana Bronze 6450/Cleveland HMOx","66083OH061",,"OHN003","OHS004","OHF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610035-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2630758","http://apps.humana.com/marketing/documents.asp?file=2593331","9"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","2","66083","OH","Individual","No","31-1154200","66083OH0610035","Humana Bronze 6450/Cleveland HMOx","66083OH061",,"OHN003","OHS004","OHF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610035-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2630771","http://apps.humana.com/marketing/documents.asp?file=2593331","10"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","2","66083","OH","Individual","No","31-1154200","66083OH0610035","Humana Bronze 6450/Cleveland HMOx","66083OH061",,"OHN003","OHS004","OHF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610035-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2630784","http://apps.humana.com/marketing/documents.asp?file=2593331","11"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","2","66083","OH","Individual","No","31-1154200","66083OH0610012","Humana Bronze 6450/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610012-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609477","http://apps.humana.com/marketing/documents.asp?file=2593396","12"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","2","66083","OH","Individual","No","31-1154200","66083OH0610012","Humana Bronze 6450/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610012-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609477","http://apps.humana.com/marketing/documents.asp?file=2593396","13"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","2","66083","OH","Individual","No","31-1154200","66083OH0610012","Humana Bronze 6450/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2609490","http://apps.humana.com/marketing/documents.asp?file=2593396","14"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","2","66083","OH","Individual","No","31-1154200","66083OH0610012","Humana Bronze 6450/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610012-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609503","http://apps.humana.com/marketing/documents.asp?file=2593396","15"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","2","66083","OH","Individual","No","31-1154200","66083OH0610026","Humana Bronze 6450/Dayton HMOx","66083OH061",,"OHN002","OHS003","OHF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610026-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609477","http://apps.humana.com/marketing/documents.asp?file=2593396","16"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","2","66083","OH","Individual","No","31-1154200","66083OH0610026","Humana Bronze 6450/Dayton HMOx","66083OH061",,"OHN002","OHS003","OHF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610026-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609477","http://apps.humana.com/marketing/documents.asp?file=2593396","17"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","2","66083","OH","Individual","No","31-1154200","66083OH0610026","Humana Bronze 6450/Dayton HMOx","66083OH061",,"OHN002","OHS003","OHF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2609490","http://apps.humana.com/marketing/documents.asp?file=2593396","18"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","2","66083","OH","Individual","No","31-1154200","66083OH0610026","Humana Bronze 6450/Dayton HMOx","66083OH061",,"OHN002","OHS003","OHF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Plus","66083OH0610026-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2609503","http://apps.humana.com/marketing/documents.asp?file=2593396","19"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610003","Humana Silver 3800/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610003-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609308","http://apps.humana.com/marketing/documents.asp?file=2593279","4"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610003","Humana Silver 3800/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610003-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609308","http://apps.humana.com/marketing/documents.asp?file=2593279","5"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610003","Humana Silver 3800/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609321","http://apps.humana.com/marketing/documents.asp?file=2593279","6"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610003","Humana Silver 3800/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610003-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609334","http://apps.humana.com/marketing/documents.asp?file=2593279","7"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610003","Humana Silver 3800/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610003-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609347","http://apps.humana.com/marketing/documents.asp?file=2624089","8"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610003","Humana Silver 3800/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610003-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609373","http://apps.humana.com/marketing/documents.asp?file=2624115","10"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610004","Humana Gold 2250/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610004-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609386","http://apps.humana.com/marketing/documents.asp?file=2593292","12"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610004","Humana Gold 2250/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609399","http://apps.humana.com/marketing/documents.asp?file=2593292","13"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610004","Humana Gold 2250/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610004-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609412","http://apps.humana.com/marketing/documents.asp?file=2593292","14"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610005","Humana Platinum 500/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610005-00","Standard Platinum Off Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609425","http://apps.humana.com/marketing/documents.asp?file=2593305","15"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610005","Humana Platinum 500/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610005-01","Standard Platinum On Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609425","http://apps.humana.com/marketing/documents.asp?file=2593305","16"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610005","Humana Platinum 500/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609438","http://apps.humana.com/marketing/documents.asp?file=2593305","17"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610005","Humana Platinum 500/Cincinnati/Northern KY HMOx","66083OH061",,"OHN001","OHS001","OHF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610005-03","Limited Cost Sharing Plan Variation","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609451","http://apps.humana.com/marketing/documents.asp?file=2593305","18"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610036","Humana Silver 3800/Cleveland HMOx","66083OH061",,"OHN003","OHS004","OHF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610036-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2630797","http://apps.humana.com/marketing/documents.asp?file=2593344","19"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610036","Humana Silver 3800/Cleveland HMOx","66083OH061",,"OHN003","OHS004","OHF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610036-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2630797","http://apps.humana.com/marketing/documents.asp?file=2593344","20"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610036","Humana Silver 3800/Cleveland HMOx","66083OH061",,"OHN003","OHS004","OHF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610036-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2630810","http://apps.humana.com/marketing/documents.asp?file=2593344","21"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610036","Humana Silver 3800/Cleveland HMOx","66083OH061",,"OHN003","OHS004","OHF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610036-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2630823","http://apps.humana.com/marketing/documents.asp?file=2593344","22"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610036","Humana Silver 3800/Cleveland HMOx","66083OH061",,"OHN003","OHS004","OHF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610036-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2630836","http://apps.humana.com/marketing/documents.asp?file=2624128","23"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610036","Humana Silver 3800/Cleveland HMOx","66083OH061",,"OHN003","OHS004","OHF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610036-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2630849","http://apps.humana.com/marketing/documents.asp?file=2624141","24"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610036","Humana Silver 3800/Cleveland HMOx","66083OH061",,"OHN003","OHS004","OHF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610036-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2630862","http://apps.humana.com/marketing/documents.asp?file=2624154","25"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610037","Humana Gold 2250/Cleveland HMOx","66083OH061",,"OHN003","OHS004","OHF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610037-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2630875","http://apps.humana.com/marketing/documents.asp?file=2593357","26"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610037","Humana Gold 2250/Cleveland HMOx","66083OH061",,"OHN003","OHS004","OHF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610037-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2630875","http://apps.humana.com/marketing/documents.asp?file=2593357","27"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610037","Humana Gold 2250/Cleveland HMOx","66083OH061",,"OHN003","OHS004","OHF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610037-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2630888","http://apps.humana.com/marketing/documents.asp?file=2593357","28"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610037","Humana Gold 2250/Cleveland HMOx","66083OH061",,"OHN003","OHS004","OHF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610037-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2630901","http://apps.humana.com/marketing/documents.asp?file=2593357","29"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610013","Humana Silver 3800/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610013-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609516","http://apps.humana.com/marketing/documents.asp?file=2593409","34"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610013","Humana Silver 3800/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610013-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609516","http://apps.humana.com/marketing/documents.asp?file=2593409","35"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610013","Humana Silver 3800/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610013-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609542","http://apps.humana.com/marketing/documents.asp?file=2593409","37"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610013","Humana Silver 3800/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610013-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609568","http://apps.humana.com/marketing/documents.asp?file=2624167","38"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610013","Humana Silver 3800/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610013-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609581","http://apps.humana.com/marketing/documents.asp?file=2624180","39"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610013","Humana Silver 3800/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF002","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610013-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609594","http://apps.humana.com/marketing/documents.asp?file=2624193","40"
"2016","OH","67129","SERFF","6","2016-01-28 08:29:40","3","67129","OH","Individual","No","06-6033492","67129OH0100009","Aetna Silver $10 Copay","67129OH010",,"OHN001","OHS001","OHF008","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5181093804","67129OH0100009-04","73% AV Level Silver Plan","72.17%",,"No","Yes","No","100%",,"$3,000","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,900","$4900 per person","$9800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/OH/OH_SBC_710808.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/oh-on-booklet01-16.pdf","8"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610014","Humana Gold 2250/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610014-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609620","http://apps.humana.com/marketing/documents.asp?file=2593422","43"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610014","Humana Gold 2250/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610014-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609633","http://apps.humana.com/marketing/documents.asp?file=2593422","44"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610015","Humana Platinum 500/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610015-00","Standard Platinum Off Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609646","http://apps.humana.com/marketing/documents.asp?file=2593435","45"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610015","Humana Platinum 500/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610015-01","Standard Platinum On Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609646","http://apps.humana.com/marketing/documents.asp?file=2593435","46"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610015","Humana Platinum 500/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609659","http://apps.humana.com/marketing/documents.asp?file=2593435","47"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610015","Humana Platinum 500/Dayton HMOx","66083OH061",,"OHN002","OHS002","OHF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610015-03","Limited Cost Sharing Plan Variation","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609672","http://apps.humana.com/marketing/documents.asp?file=2593435","48"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610027","Humana Gold 2250/Dayton HMOx","66083OH061",,"OHN002","OHS003","OHF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610027-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609607","http://apps.humana.com/marketing/documents.asp?file=2593422","49"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610027","Humana Gold 2250/Dayton HMOx","66083OH061",,"OHN002","OHS003","OHF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610027-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609607","http://apps.humana.com/marketing/documents.asp?file=2593422","50"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610027","Humana Gold 2250/Dayton HMOx","66083OH061",,"OHN002","OHS003","OHF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610027-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609620","http://apps.humana.com/marketing/documents.asp?file=2593422","51"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610027","Humana Gold 2250/Dayton HMOx","66083OH061",,"OHN002","OHS003","OHF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610027-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609633","http://apps.humana.com/marketing/documents.asp?file=2593422","52"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610028","Humana Platinum 500/Dayton HMOx","66083OH061",,"OHN002","OHS003","OHF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610028-00","Standard Platinum Off Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609646","http://apps.humana.com/marketing/documents.asp?file=2593435","53"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610028","Humana Platinum 500/Dayton HMOx","66083OH061",,"OHN002","OHS003","OHF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610028-01","Standard Platinum On Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609646","http://apps.humana.com/marketing/documents.asp?file=2593435","54"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610028","Humana Platinum 500/Dayton HMOx","66083OH061",,"OHN002","OHS003","OHF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610028-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609659","http://apps.humana.com/marketing/documents.asp?file=2593435","55"
"2016","OH","66083","SERFF","10","2015-08-28 13:59:00","3","66083","OH","Individual","No","31-1154200","66083OH0610028","Humana Platinum 500/Dayton HMOx","66083OH061",,"OHN002","OHS003","OHF003","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Plus","66083OH0610028-03","Limited Cost Sharing Plan Variation","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2609672","http://apps.humana.com/marketing/documents.asp?file=2593435","56"
"2016","OH","67129","SERFF","6","2016-01-28 08:29:40","1","67129","OH","Individual","No","06-6033492","67129OH0100001","Aetna Bronze $15 Copay","67129OH010",,"OHN001","OHS001","OHF005","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5183702420","67129OH0100001-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/OH/OH_SBC_710809.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/oh-on-booklet01-16.pdf","4"
"2016","OH","67129","SERFF","6","2016-01-28 08:29:40","1","67129","OH","Individual","No","06-6033492","67129OH0100001","Aetna Bronze $15 Copay","67129OH010",,"OHN001","OHS001","OHF005","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5183702420","67129OH0100001-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/OH/OH_SBC_710809.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/oh-on-booklet01-16.pdf","5"
"2016","OH","67129","SERFF","6","2016-01-28 08:29:40","1","67129","OH","Individual","No","06-6033492","67129OH0100001","Aetna Bronze $15 Copay","67129OH010",,"OHN001","OHS001","OHF005","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5183702420","67129OH0100001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/OH/OH_SBC_710812.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/oh-on-booklet01-16.pdf","6"
"2016","OH","67129","SERFF","6","2016-01-28 08:29:40","1","67129","OH","Individual","No","06-6033492","67129OH0100001","Aetna Bronze $15 Copay","67129OH010",,"OHN001","OHS001","OHF005","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5183702420","67129OH0100001-03","Limited Cost Sharing Plan Variation","61.73%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/OH/OH_SBC_710810.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/oh-on-booklet01-16.pdf","7"
"2016","OH","67129","SERFF","6","2016-01-28 08:29:40","2","67129","OH","Individual","No","06-6033492","67129OH0100003","Aetna Bronze Deductible Only HSA Eligible","67129OH010",,"OHN001","OHS001","OHF006","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5183702420","67129OH0100003-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/OH/OH_SBC_710814.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/oh-on-booklet01-16.pdf","4"
"2016","OH","67129","SERFF","6","2016-01-28 08:29:40","2","67129","OH","Individual","No","06-6033492","67129OH0100003","Aetna Bronze Deductible Only HSA Eligible","67129OH010",,"OHN001","OHS001","OHF006","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5183702420","67129OH0100003-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/OH/OH_SBC_710814.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/oh-on-booklet01-16.pdf","5"
"2016","OH","67129","SERFF","6","2016-01-28 08:29:40","2","67129","OH","Individual","No","06-6033492","67129OH0100003","Aetna Bronze Deductible Only HSA Eligible","67129OH010",,"OHN001","OHS001","OHF006","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5183702420","67129OH0100003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/OH/OH_SBC_710817.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/oh-on-booklet01-16.pdf","6"
"2016","OH","67129","SERFF","6","2016-01-28 08:29:40","2","67129","OH","Individual","No","06-6033492","67129OH0100003","Aetna Bronze Deductible Only HSA Eligible","67129OH010",,"OHN001","OHS001","OHF006","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5183702420","67129OH0100003-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/OH/OH_SBC_710815.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/oh-on-booklet01-16.pdf","7"
"2016","OH","67129","SERFF","6","2016-01-28 08:29:40","3","67129","OH","Individual","No","06-6033492","67129OH0100009","Aetna Silver $10 Copay","67129OH010",,"OHN001","OHS001","OHF008","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5181093804","67129OH0100009-00","Standard Silver Off Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/OH/OH_SBC_710801.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/oh-on-booklet01-16.pdf","4"
"2016","OH","67129","SERFF","6","2016-01-28 08:29:40","3","67129","OH","Individual","No","06-6033492","67129OH0100009","Aetna Silver $10 Copay","67129OH010",,"OHN001","OHS001","OHF008","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5181093804","67129OH0100009-01","Standard Silver On Exchange Plan","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/OH/OH_SBC_710801.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/oh-on-booklet01-16.pdf","5"
"2016","OH","67129","SERFF","6","2016-01-28 08:29:40","3","67129","OH","Individual","No","06-6033492","67129OH0100009","Aetna Silver $10 Copay","67129OH010",,"OHN001","OHS001","OHF008","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5181093804","67129OH0100009-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/OH/OH_SBC_710804.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/oh-on-booklet01-16.pdf","6"
"2016","OH","67129","SERFF","6","2016-01-28 08:29:40","3","67129","OH","Individual","No","06-6033492","67129OH0100009","Aetna Silver $10 Copay","67129OH010",,"OHN001","OHS001","OHF008","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5181093804","67129OH0100009-03","Limited Cost Sharing Plan Variation","68.24%",,"No","Yes","No","100%",,"$3,500","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,250","$6250 per person","$12500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/OH/OH_SBC_710802.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/oh-on-booklet01-16.pdf","7"
"2016","OH","67129","SERFF","6","2016-01-28 08:29:40","4","67129","OH","Individual","No","06-6033492","67129OH0100007","Aetna Gold $10 Copay","67129OH010",,"OHN001","OHS001","OHF007","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5181093804","67129OH0100007-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","20%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/OH/OH_SBC_710796.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/oh-on-booklet01-16.pdf","5"
"2016","OH","67129","SERFF","6","2016-01-28 08:29:40","4","67129","OH","Individual","No","06-6033492","67129OH0100007","Aetna Gold $10 Copay","67129OH010",,"OHN001","OHS001","OHF007","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=5181093804","67129OH0100007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/OH/OH_SBC_710799.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/oh-on-booklet01-16.pdf","6"
"2016","OH","68158","SERFF","7","2015-08-20 12:28:36","1","68158","OH","SHOP (Small Group)","Yes","13-5123390","68158OH0130002","Guardian Pediatric Advantiage","68158OH013",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$23.36","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","68158OH0130002-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","OH","68158","SERFF","7","2015-08-20 12:28:36","1","68158","OH","Individual","Yes","13-5123390","68158OH0190001","Guardian Family Essentials","68158OH019",,"OHN002","OHS002",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.06","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","68158OH0190001-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","4"
"2016","OH","68158","SERFF","7","2015-08-20 12:28:36","1","68158","OH","Individual","Yes","13-5123390","68158OH0190001","Guardian Family Essentials","68158OH019",,"OHN002","OHS002",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.06","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","68158OH0190001-01","Standard Low On Exchange Plan","71.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","5"
"2016","OH","68158","SERFF","7","2015-08-20 12:28:36","1","68158","OH","SHOP (Small Group)","Yes","13-5123390","68158OH0140002","Guardian Pediatric Essentials","68158OH014",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$17.95","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","68158OH0140002-00","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","OH","68158","SERFF","7","2015-08-20 12:28:36","2","68158","OH","SHOP (Small Group)","Yes","13-5123390","68158OH0160002","Guardian Family Advantage","68158OH016",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.06","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","68158OH0160002-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","OH","68158","SERFF","7","2015-08-20 12:28:36","2","68158","OH","SHOP (Small Group)","Yes","13-5123390","68158OH0180002","Guardian Family Essentials","68158OH018",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","68158OH0180002-00","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","OH","68158","SERFF","7","2015-08-20 12:28:36","3","68158","OH","SHOP (Small Group)","Yes","13-5123390","68158OH0160003","Guardian Family Advantage","68158OH016",,"OHN001","OHS002",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.06","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","68158OH0160003-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","OH","68158","SERFF","7","2015-08-20 12:28:36","3","68158","OH","SHOP (Small Group)","Yes","13-5123390","68158OH0160003","Guardian Family Advantage","68158OH016",,"OHN001","OHS002",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.06","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","68158OH0160003-01","Standard High On Exchange Plan","83.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","OH","68158","SERFF","7","2015-08-20 12:28:36","3","68158","OH","SHOP (Small Group)","Yes","13-5123390","68158OH0180003","Guardian Family Essentials","68158OH018",,"OHN001","OHS002",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","68158OH0180003-00","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","OH","68158","SERFF","7","2015-08-20 12:28:36","3","68158","OH","SHOP (Small Group)","Yes","13-5123390","68158OH0180003","Guardian Family Essentials","68158OH018",,"OHN001","OHS002",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes",,"","68158OH0180003-01","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"
"2016","OH","70318","SERFF","5","2015-08-20 12:28:36","1","70318","OH","SHOP (Small Group)","Yes","81-0170040","70318OH0010001","Assurant Dental ACAFFO High","70318OH001",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$40.12","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","70318OH0010001-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","70318","SERFF","5","2015-08-20 12:28:36","1","70318","OH","SHOP (Small Group)","Yes","81-0170040","70318OH0010002","Assurant Dental ACAFFO Low","70318OH001",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$33.42","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","70318OH0010002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210007","Paramount Silver 3","74313OH021",,"OHN001","OHS001","OHF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210007-00","Standard Silver Off Exchange Plan",,"0.69899308681488","No","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$210","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Silver3.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","26"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020019","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN003","OHS001","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020019-03","Limited Cost Sharing Plan Variation","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","11"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020021","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN003","OHS003","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020021-00","Standard Gold Off Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","12"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020021","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN003","OHS003","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020021-01","Standard Gold On Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","13"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020021","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN003","OHS003","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020021-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","14"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020021","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN003","OHS003","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020021-03","Limited Cost Sharing Plan Variation","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","15"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020029","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN004","OHS002","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020029-00","Standard Gold Off Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","16"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210007","Paramount Silver 3","74313OH021",,"OHN001","OHS001","OHF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210007-01","Standard Silver On Exchange Plan",,"0.69899308681488","No","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$210","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Silver3.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","27"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210007","Paramount Silver 3","74313OH021",,"OHN001","OHS001","OHF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Silver3-ZeroCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","28"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020029","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN004","OHS002","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020029-03","Limited Cost Sharing Plan Variation","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","19"
"2016","OH","73292","SERFF","5","2015-08-20 12:28:36","1","73292","OH","SHOP (Small Group)","Yes","44-0308260","73292OH0010001","KCL EHB Low PPO","73292OH001",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$41.05","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010001-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","73292","SERFF","5","2015-08-20 12:28:36","1","73292","OH","SHOP (Small Group)","Yes","44-0308260","73292OH0010003","KCL EHB Low MAC","73292OH001",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$31.46","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010003-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","73292","SERFF","5","2015-08-20 12:28:36","1","73292","OH","SHOP (Small Group)","Yes","44-0308260","73292OH0010005","KCL Fam Low PPO","73292OH001",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$41.05","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010005-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","OH","73292","SERFF","5","2015-08-20 12:28:36","1","73292","OH","SHOP (Small Group)","Yes","44-0308260","73292OH0010007","KCL Fam Low MAC","73292OH001",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$31.46","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010007-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","OH","73292","SERFF","5","2015-08-20 12:28:36","2","73292","OH","SHOP (Small Group)","Yes","44-0308260","73292OH0010002","KCL EHB High PPO","73292OH001",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$49.77","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010002-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","73292","SERFF","5","2015-08-20 12:28:36","2","73292","OH","SHOP (Small Group)","Yes","44-0308260","73292OH0010004","KCL EHB High MAC","73292OH001",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$39.05","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010004-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","73292","SERFF","5","2015-08-20 12:28:36","2","73292","OH","SHOP (Small Group)","Yes","44-0308260","73292OH0010006","KCL Fam High PPO","73292OH001",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$49.77","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010006-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","OH","73292","SERFF","5","2015-08-20 12:28:36","2","73292","OH","SHOP (Small Group)","Yes","44-0308260","73292OH0010008","KCL Fam High MAC","73292OH001",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$39.05","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","73292OH0010008-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210001","Paramount Gold 1","74313OH021",,"OHN001","OHS001","OHF008","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$200","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210001-00","Standard Gold Off Exchange Plan",,"0.79940140247345","No","Yes","No","100%",,"$1,000","$40","$1,010","$150","$1,000","$320","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Gold1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","4"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210001","Paramount Gold 1","74313OH021",,"OHN001","OHS001","OHF008","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$200","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210001-01","Standard Gold On Exchange Plan",,"0.79940140247345","No","Yes","No","100%",,"$1,000","$40","$1,010","$150","$1,000","$320","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Gold1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","5"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210001","Paramount Gold 1","74313OH021",,"OHN001","OHS001","OHF008","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$200","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Gold1-ZeroCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","6"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210001","Paramount Gold 1","74313OH021",,"OHN001","OHS001","OHF008","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$200","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210001-03","Limited Cost Sharing Plan Variation",,"0.79940140247345","No","Yes","No","100%",,"$1,000","$40","$1,010","$150","$1,000","$320","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Gold1-LimitedCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","7"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210005","Paramount Gold 2","74313OH021",,"OHN001","OHS001","OHF007","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$200","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210005-00","Standard Gold Off Exchange Plan",,"0.802114725112915","No","Yes","No","100%",,"$1,500","$20","$1,010","$150","$1,500","$120","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Gold2.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","8"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210005","Paramount Gold 2","74313OH021",,"OHN001","OHS001","OHF007","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$200","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210005-01","Standard Gold On Exchange Plan",,"0.802114725112915","No","Yes","No","100%",,"$1,500","$20","$1,010","$150","$1,500","$120","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Gold2.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","9"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210005","Paramount Gold 2","74313OH021",,"OHN001","OHS001","OHF007","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$200","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Gold2-ZeroCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","10"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210005","Paramount Gold 2","74313OH021",,"OHN001","OHS001","OHF007","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$200","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210005-03","Limited Cost Sharing Plan Variation",,"0.802114725112915","No","Yes","No","100%",,"$1,500","$20","$1,010","$150","$1,500","$120","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Gold2-LimitedCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","11"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210002","Paramount Silver 1","74313OH021",,"OHN001","OHS001","OHF006","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210002-00","Standard Silver Off Exchange Plan",,"0.697446227073669","No","Yes","No","100%",,"$2,250","$20","$2,000","$150","$2,250","$410","$320","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Silver1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","12"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210002","Paramount Silver 1","74313OH021",,"OHN001","OHS001","OHF006","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210002-01","Standard Silver On Exchange Plan",,"0.697446227073669","No","Yes","No","100%",,"$2,250","$20","$2,000","$150","$2,250","$410","$320","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Silver1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","13"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210002","Paramount Silver 1","74313OH021",,"OHN001","OHS001","OHF006","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Silver1-ZeroCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","14"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210002","Paramount Silver 1","74313OH021",,"OHN001","OHS001","OHF006","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210002-03","Limited Cost Sharing Plan Variation",,"0.697446227073669","No","Yes","No","100%",,"$2,250","$20","$2,000","$150","$2,250","$410","$320","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Silver1-LimitedCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","15"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210002","Paramount Silver 1","74313OH021",,"OHN001","OHS001","OHF006","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210002-04","73% AV Level Silver Plan",,"0.739427387714386","No","Yes","No","100%",,"$2,000","$60","$2,030","$150","$2,000","$390","$370","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Silver1-CSR73.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","16"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210002","Paramount Silver 1","74313OH021",,"OHN001","OHS001","OHF006","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210002-05","87% AV Level Silver Plan",,"0.879255771636963","No","Yes","No","100%",,"$650","$30","$510","$150","$650","$280","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Silver1-CSR87.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","17"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210002","Paramount Silver 1","74313OH021",,"OHN001","OHS001","OHF006","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210002-06","94% AV Level Silver Plan",,"0.949543416500092","No","Yes","No","100%",,"$100","$20","$510","$150","$100","$130","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$850","$850 per person","$1700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Silver1-CSR94.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","18"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210006","Paramount Silver 2","74313OH021",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210006-00","Standard Silver Off Exchange Plan",,"0.710161328315735","No","Yes","No","100%",,"$3,000","$20","$1,280","$150","$3,000","$340","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Silver2.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","19"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210006","Paramount Silver 2","74313OH021",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210006-01","Standard Silver On Exchange Plan",,"0.710161328315735","No","Yes","No","100%",,"$3,000","$20","$1,280","$150","$3,000","$340","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Silver2.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","20"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210006","Paramount Silver 2","74313OH021",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Silver2-ZeroCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","21"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210006","Paramount Silver 2","74313OH021",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210006-03","Limited Cost Sharing Plan Variation",,"0.710161328315735","No","Yes","No","100%",,"$3,000","$20","$1,280","$150","$3,000","$340","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Silver2-LimitedCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","22"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210006","Paramount Silver 2","74313OH021",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210006-04","73% AV Level Silver Plan",,"0.738826870918274","No","Yes","No","100%",,"$2,400","$20","$1,460","$150","$2,400","$340","$240","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Silver2-CSR73.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","23"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210006","Paramount Silver 2","74313OH021",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210006-05","87% AV Level Silver Plan",,"0.875495731830597","No","Yes","No","100%",,"$750","$30","$1,010","$150","$750","$280","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Silver2-CSR87.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","24"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210006","Paramount Silver 2","74313OH021",,"OHN001","OHS001","OHF005","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210006-06","94% AV Level Silver Plan",,"0.949886620044708","No","Yes","No","100%",,"$150","$20","$510","$150","$150","$130","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Silver2-CSR94.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","25"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210007","Paramount Silver 3","74313OH021",,"OHN001","OHS001","OHF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210007-03","Limited Cost Sharing Plan Variation",,"0.69899308681488","No","Yes","No","100%",,"$3,500","$20","$750","$150","$3,500","$210","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Silver3-LimitedCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","29"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210007","Paramount Silver 3","74313OH021",,"OHN001","OHS001","OHF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210007-04","73% AV Level Silver Plan",,"0.729712665081024","No","Yes","No","100%",,"$3,000","$20","$850","$150","$3,000","$280","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Silver3-CSR73.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","30"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210007","Paramount Silver 3","74313OH021",,"OHN001","OHS001","OHF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210007-05","87% AV Level Silver Plan",,"0.873292028903961","No","Yes","No","100%",,"$900","$40","$510","$150","$900","$260","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Silver3-CSR87.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","31"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210007","Paramount Silver 3","74313OH021",,"OHN001","OHS001","OHF004","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,"$300","0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210007-06","94% AV Level Silver Plan",,"0.948349833488464","No","Yes","No","100%",,"$100","$20","$510","$150","$100","$130","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$900","$900 per person","$1800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Silver3-CSR94.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","32"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210008","Paramount Bronze 1 HSA","74313OH021",,"OHN001","OHS001","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210008-00","Standard Bronze Off Exchange Plan",,"0.600919127464294","Yes","Yes","No","100%",,"$6,500","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Bronze1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","33"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210008","Paramount Bronze 1 HSA","74313OH021",,"OHN001","OHS001","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210008-01","Standard Bronze On Exchange Plan",,"0.600919127464294","Yes","Yes","No","100%",,"$6,500","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Bronze1.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","34"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210008","Paramount Bronze 1 HSA","74313OH021",,"OHN001","OHS001","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Bronze1-ZeroCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","35"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210008","Paramount Bronze 1 HSA","74313OH021",,"OHN001","OHS001","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210008-03","Limited Cost Sharing Plan Variation",,"0.600919127464294","Yes","Yes","No","100%",,"$6,500","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Bronze1-LimitedCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","36"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210009","Paramount Bronze 2","74313OH021",,"OHN001","OHS001","OHF002","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210009-00","Standard Bronze Off Exchange Plan",,"0.619064331054688","Yes","Yes","No","100%",,"$6,000","$0","$510","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Bronze2.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","37"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210009","Paramount Bronze 2","74313OH021",,"OHN001","OHS001","OHF002","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210009-01","Standard Bronze On Exchange Plan",,"0.619064331054688","Yes","Yes","No","100%",,"$6,000","$0","$510","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Bronze2.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","38"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210009","Paramount Bronze 2","74313OH021",,"OHN001","OHS001","OHF002","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Bronze2-ZeroCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","39"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210009","Paramount Bronze 2","74313OH021",,"OHN001","OHS001","OHF002","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210009-03","Limited Cost Sharing Plan Variation",,"0.619064331054688","Yes","Yes","No","100%",,"$6,000","$0","$510","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Bronze2-LimitedCostShare.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","40"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210004","Paramount Catastrophic","74313OH021",,"OHN001","OHS001","OHF001","Existing","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210004-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Catastrophic.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","41"
"2016","OH","74313","SERFF","6","2015-08-23 14:39:40","1","74313","OH","Individual","No","01-0580404","74313OH0210004","Paramount Catastrophic","74313OH021",,"OHN001","OHS001","OHF001","Existing","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy","0.997465847808992",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","http://www.paramounthealthcare.com/marketplacepaymentredirect","http://www.paramounthealthcare.com/documents/marketplace/2016-Marketplace-Formulary.pdf","74313OH0210004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.paramounthealthcare.com/documents/marketplace/SBC2016-Catastrophic.pdf","http://www.paramounthealthcare.com/documents/Marketplace/MarketplaceBrochure_2016.pdf","42"
"2016","OH","76018","SERFF","5","2015-08-20 12:28:36","1","76018","OH","SHOP (Small Group)","Yes","35-0472300","76018OH0010001","Lincoln DentalConnect®","76018OH001","7063415294","OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.32","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","76018OH0010001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","76018","SERFF","5","2015-08-20 12:28:36","1","76018","OH","SHOP (Small Group)","Yes","35-0472300","76018OH0010002","Lincoln DentalConnect®","76018OH001","7063415294","OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.61","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","76018OH0010002-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","76018","SERFF","5","2015-08-20 12:28:36","1","76018","OH","SHOP (Small Group)","Yes","35-0472300","76018OH0010003","Lincoln DentalConnect®","76018OH001","7063415294","OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.56","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","76018OH0010003-00","Standard Low Off Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","OH","76018","SERFF","5","2015-08-20 12:28:36","1","76018","OH","SHOP (Small Group)","Yes","35-0472300","76018OH0010004","Lincoln DentalConnect®","76018OH001","7063415294","OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.67","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","76018OH0010004-00","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","OH","76018","SERFF","5","2015-08-20 12:28:36","1","76018","OH","SHOP (Small Group)","Yes","35-0472300","76018OH0010005","Lincoln DentalConnect®","76018OH001","7063415294","OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.70","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","76018OH0010005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","per person not applicable","per group not applicable",,,,,,"$25","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","OH","76018","SERFF","5","2015-08-20 12:28:36","1","76018","OH","SHOP (Small Group)","Yes","35-0472300","76018OH0010006","Lincoln DentalConnect®","76018OH001","7063415294","OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.43","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","76018OH0010006-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","per person not applicable","per group not applicable",,,,,,"$75","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","OH","76018","SERFF","5","2015-08-20 12:28:36","1","76018","OH","SHOP (Small Group)","Yes","35-0472300","76018OH0010007","Lincoln DentalConnect®","76018OH001","7063415294","OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.47","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","76018OH0010007-00","Standard Low Off Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2016","OH","76018","SERFF","5","2015-08-20 12:28:36","1","76018","OH","SHOP (Small Group)","Yes","35-0472300","76018OH0010008","Lincoln DentalConnect®","76018OH001","7063415294","OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.10","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network-cost sharing is based upon whether the provider is a Contracted Dentist.","Yes",,"","76018OH0010008-00","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020015","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN002","OHS006","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020015-00","Standard Gold Off Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","4"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020015","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN002","OHS006","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020015-01","Standard Gold On Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","5"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020015","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN002","OHS006","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","6"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020015","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN002","OHS006","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020015-03","Limited Cost Sharing Plan Variation","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","7"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020019","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN003","OHS001","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020019-00","Standard Gold Off Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","8"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020019","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN003","OHS001","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020019-01","Standard Gold On Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","9"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020019","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN003","OHS001","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020019-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","10"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020029","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN004","OHS002","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020029-01","Standard Gold On Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","17"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020029","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN004","OHS002","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020029-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","18"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020040","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN005","OHS004","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020040-00","Standard Gold Off Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","20"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020040","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN005","OHS004","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020040-01","Standard Gold On Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","21"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020040","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN005","OHS004","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020040-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","22"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020040","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN005","OHS004","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020040-03","Limited Cost Sharing Plan Variation","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","23"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020044","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN005","OHS008","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020044-00","Standard Gold Off Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","24"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020044","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN005","OHS008","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020044-01","Standard Gold On Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","25"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020044","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN005","OHS008","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020044-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","26"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020044","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN005","OHS008","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020044-03","Limited Cost Sharing Plan Variation","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","27"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020001","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN006","OHS009","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020001-00","Standard Gold Off Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","28"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020001","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN006","OHS009","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020001-01","Standard Gold On Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","29"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020001","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN006","OHS009","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","30"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","1","77552","OH","Individual","No","31-1143265","77552OH0020001","CareSource Just4Me Gold with Dental and Vision","77552OH002",,"OHN006","OHS009","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9311",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020001-03","Limited Cost Sharing Plan Variation","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","31"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010015","CareSource Just4Me Gold","77552OH001",,"OHN002","OHS006","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010015-00","Standard Gold Off Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","4"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010015","CareSource Just4Me Gold","77552OH001",,"OHN002","OHS006","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010015-01","Standard Gold On Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","5"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010015","CareSource Just4Me Gold","77552OH001",,"OHN002","OHS006","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldzero-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","6"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010015","CareSource Just4Me Gold","77552OH001",,"OHN002","OHS006","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010015-03","Limited Cost Sharing Plan Variation","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldltd-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","7"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010019","CareSource Just4Me Gold","77552OH001",,"OHN003","OHS001","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010019-00","Standard Gold Off Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","8"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010019","CareSource Just4Me Gold","77552OH001",,"OHN003","OHS001","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010019-01","Standard Gold On Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","9"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010019","CareSource Just4Me Gold","77552OH001",,"OHN003","OHS001","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010019-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldzero-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","10"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010019","CareSource Just4Me Gold","77552OH001",,"OHN003","OHS001","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010019-03","Limited Cost Sharing Plan Variation","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldltd-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","11"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010021","CareSource Just4Me Gold","77552OH001",,"OHN003","OHS003","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010021-00","Standard Gold Off Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","12"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010021","CareSource Just4Me Gold","77552OH001",,"OHN003","OHS003","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010021-01","Standard Gold On Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","13"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010021","CareSource Just4Me Gold","77552OH001",,"OHN003","OHS003","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010021-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldzero-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","14"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010021","CareSource Just4Me Gold","77552OH001",,"OHN003","OHS003","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010021-03","Limited Cost Sharing Plan Variation","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldltd-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","15"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010029","CareSource Just4Me Gold","77552OH001",,"OHN004","OHS002","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010029-00","Standard Gold Off Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","16"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010029","CareSource Just4Me Gold","77552OH001",,"OHN004","OHS002","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010029-01","Standard Gold On Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","17"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010029","CareSource Just4Me Gold","77552OH001",,"OHN004","OHS002","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010029-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldzero-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","18"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010029","CareSource Just4Me Gold","77552OH001",,"OHN004","OHS002","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010029-03","Limited Cost Sharing Plan Variation","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldltd-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","19"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010040","CareSource Just4Me Gold","77552OH001",,"OHN005","OHS004","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010040-00","Standard Gold Off Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","20"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010040","CareSource Just4Me Gold","77552OH001",,"OHN005","OHS004","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010040-01","Standard Gold On Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","21"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010040","CareSource Just4Me Gold","77552OH001",,"OHN005","OHS004","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010040-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldzero-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","22"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010040","CareSource Just4Me Gold","77552OH001",,"OHN005","OHS004","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010040-03","Limited Cost Sharing Plan Variation","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldltd-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","23"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010044","CareSource Just4Me Gold","77552OH001",,"OHN005","OHS008","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010044-00","Standard Gold Off Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","24"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010044","CareSource Just4Me Gold","77552OH001",,"OHN005","OHS008","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010044-01","Standard Gold On Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","25"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010044","CareSource Just4Me Gold","77552OH001",,"OHN005","OHS008","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010044-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldzero-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","26"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010044","CareSource Just4Me Gold","77552OH001",,"OHN005","OHS008","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010044-03","Limited Cost Sharing Plan Variation","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldltd-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","27"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010001","CareSource Just4Me Gold","77552OH001",,"OHN006","OHS009","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010001-00","Standard Gold Off Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","28"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010001","CareSource Just4Me Gold","77552OH001",,"OHN006","OHS009","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010001-01","Standard Gold On Exchange Plan","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-gold-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","29"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010001","CareSource Just4Me Gold","77552OH001",,"OHN006","OHS009","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldzero-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","30"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","2","77552","OH","Individual","No","31-1143265","77552OH0010001","CareSource Just4Me Gold","77552OH001",,"OHN006","OHS009","OHF001","Existing","HMO","Gold","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9923",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010001-03","Limited Cost Sharing Plan Variation","81.64%","0.825595617294312","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-goldltd-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","31"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020060","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN002","OHS006","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020060-00","Standard Silver Off Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","4"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020060","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN002","OHS006","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020060-01","Standard Silver On Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","5"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020060","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN002","OHS006","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020060-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","6"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020060","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN002","OHS006","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020060-03","Limited Cost Sharing Plan Variation","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","7"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020060","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN002","OHS006","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020060-04","73% AV Level Silver Plan","73.37%","0.733690559864044","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver1-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","8"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020060","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN002","OHS006","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020060-05","87% AV Level Silver Plan","87.97%","0.880108594894409","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver2-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","9"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020060","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN002","OHS006","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020060-06","94% AV Level Silver Plan","94.58%","0.94583922624588","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver3-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","10"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020064","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN003","OHS001","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020064-00","Standard Silver Off Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","11"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020064","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN003","OHS001","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020064-01","Standard Silver On Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","12"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020064","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN003","OHS001","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020064-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","13"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020064","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN003","OHS001","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020064-03","Limited Cost Sharing Plan Variation","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","14"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020064","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN003","OHS001","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020064-04","73% AV Level Silver Plan","73.37%","0.733690559864044","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver1-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","15"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020064","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN003","OHS001","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020064-05","87% AV Level Silver Plan","87.97%","0.880108594894409","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver2-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","16"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020064","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN003","OHS001","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020064-06","94% AV Level Silver Plan","94.58%","0.94583922624588","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver3-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","17"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020066","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN003","OHS003","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020066-00","Standard Silver Off Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","18"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020066","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN003","OHS003","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020066-01","Standard Silver On Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","19"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020066","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN003","OHS003","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020066-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","20"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020066","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN003","OHS003","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020066-03","Limited Cost Sharing Plan Variation","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","21"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020066","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN003","OHS003","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020066-04","73% AV Level Silver Plan","73.37%","0.733690559864044","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver1-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","22"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020066","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN003","OHS003","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020066-05","87% AV Level Silver Plan","87.97%","0.880108594894409","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver2-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","23"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020066","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN003","OHS003","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020066-06","94% AV Level Silver Plan","94.58%","0.94583922624588","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver3-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","24"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020074","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN004","OHS002","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020074-00","Standard Silver Off Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","25"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020074","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN004","OHS002","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020074-01","Standard Silver On Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","26"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020074","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN004","OHS002","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020074-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","27"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020074","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN004","OHS002","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020074-03","Limited Cost Sharing Plan Variation","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","28"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020074","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN004","OHS002","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020074-04","73% AV Level Silver Plan","73.37%","0.733690559864044","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver1-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","29"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020074","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN004","OHS002","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020074-05","87% AV Level Silver Plan","87.97%","0.880108594894409","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver2-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","30"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020074","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN004","OHS002","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020074-06","94% AV Level Silver Plan","94.58%","0.94583922624588","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver3-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","31"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020085","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN005","OHS004","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020085-00","Standard Silver Off Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","32"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020085","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN005","OHS004","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020085-01","Standard Silver On Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","33"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020085","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN005","OHS004","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020085-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","34"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020085","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN005","OHS004","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020085-03","Limited Cost Sharing Plan Variation","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","35"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020085","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN005","OHS004","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020085-04","73% AV Level Silver Plan","73.37%","0.733690559864044","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver1-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","36"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020085","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN005","OHS004","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020085-05","87% AV Level Silver Plan","87.97%","0.880108594894409","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver2-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","37"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020085","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN005","OHS004","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020085-06","94% AV Level Silver Plan","94.58%","0.94583922624588","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver3-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","38"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020089","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN005","OHS008","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020089-00","Standard Silver Off Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","39"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020089","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN005","OHS008","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020089-01","Standard Silver On Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","40"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020089","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN005","OHS008","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020089-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","41"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020089","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN005","OHS008","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020089-03","Limited Cost Sharing Plan Variation","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","42"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020089","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN005","OHS008","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020089-04","73% AV Level Silver Plan","73.37%","0.733690559864044","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver1-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","43"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020089","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN005","OHS008","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020089-05","87% AV Level Silver Plan","87.97%","0.880108594894409","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver2-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","44"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020089","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN005","OHS008","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020089-06","94% AV Level Silver Plan","94.58%","0.94583922624588","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver3-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","45"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020002","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN006","OHS009","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020002-00","Standard Silver Off Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","46"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020002","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN006","OHS009","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020002-01","Standard Silver On Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","47"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020002","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN006","OHS009","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","48"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020002","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN006","OHS009","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020002-03","Limited Cost Sharing Plan Variation","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","49"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020002","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN006","OHS009","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020002-04","73% AV Level Silver Plan","73.37%","0.733690559864044","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver1-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","50"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020002","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN006","OHS009","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020002-05","87% AV Level Silver Plan","87.97%","0.880108594894409","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver2-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","51"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020002","CareSource Just4Me  Silver with Dental and Vision","77552OH002",,"OHN006","OHS009","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9152",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020002-06","94% AV Level Silver Plan","94.58%","0.94583922624588","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver3-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","52"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020105","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN002","OHS006","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020105-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","53"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020105","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN002","OHS006","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020105-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","54"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020105","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN002","OHS006","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020105-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzezero-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","55"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020105","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN002","OHS006","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020105-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzeltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","56"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020109","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN003","OHS001","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020109-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","57"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020109","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN003","OHS001","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020109-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","58"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020109","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN003","OHS001","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020109-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzezero-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","59"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020109","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN003","OHS001","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020109-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzeltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","60"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020111","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN003","OHS003","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020111-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","61"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020111","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN003","OHS003","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020111-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","62"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020111","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN003","OHS003","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020111-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzezero-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","63"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020111","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN003","OHS003","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020111-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzeltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","64"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020119","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN004","OHS002","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020119-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","65"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020119","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN004","OHS002","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020119-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","66"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020119","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN004","OHS002","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020119-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzezero-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","67"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020119","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN004","OHS002","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020119-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzeltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","68"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020130","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN005","OHS004","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020130-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","69"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020130","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN005","OHS004","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020130-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","70"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020130","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN005","OHS004","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020130-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzezero-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","71"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020130","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN005","OHS004","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020130-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzeltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","72"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020134","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN005","OHS008","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020134-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","73"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020134","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN005","OHS008","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020134-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","74"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020134","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN005","OHS008","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020134-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzezero-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","75"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020134","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN005","OHS008","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020134-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzeltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","76"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020003","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN006","OHS009","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020003-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","77"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020003","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN006","OHS009","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020003-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","78"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020003","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN006","OHS009","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzezero-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","79"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","3","77552","OH","Individual","No","31-1143265","77552OH0020003","CareSource Just4Me  Bronze with Dental and Vision","77552OH002",,"OHN006","OHS009","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.8997",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0020003-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzeltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","80"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010060","CareSource Just4Me Silver","77552OH001",,"OHN002","OHS006","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010060-00","Standard Silver Off Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","4"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010060","CareSource Just4Me Silver","77552OH001",,"OHN002","OHS006","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010060-01","Standard Silver On Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","5"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010060","CareSource Just4Me Silver","77552OH001",,"OHN002","OHS006","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010060-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverzero-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","6"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010060","CareSource Just4Me Silver","77552OH001",,"OHN002","OHS006","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010060-03","Limited Cost Sharing Plan Variation","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverltd-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","7"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010060","CareSource Just4Me Silver","77552OH001",,"OHN002","OHS006","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010060-04","73% AV Level Silver Plan","73.37%","0.733690559864044","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver1-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","8"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010060","CareSource Just4Me Silver","77552OH001",,"OHN002","OHS006","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010060-05","87% AV Level Silver Plan","87.97%","0.880108594894409","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver2-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","9"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010060","CareSource Just4Me Silver","77552OH001",,"OHN002","OHS006","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010060-06","94% AV Level Silver Plan","94.58%","0.94583922624588","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver3-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","10"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010064","CareSource Just4Me Silver","77552OH001",,"OHN003","OHS001","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010064-00","Standard Silver Off Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","11"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010064","CareSource Just4Me Silver","77552OH001",,"OHN003","OHS001","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010064-01","Standard Silver On Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","12"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010064","CareSource Just4Me Silver","77552OH001",,"OHN003","OHS001","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010064-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverzero-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","13"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010064","CareSource Just4Me Silver","77552OH001",,"OHN003","OHS001","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010064-03","Limited Cost Sharing Plan Variation","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverltd-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","14"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010064","CareSource Just4Me Silver","77552OH001",,"OHN003","OHS001","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010064-04","73% AV Level Silver Plan","73.37%","0.733690559864044","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver1-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","15"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010064","CareSource Just4Me Silver","77552OH001",,"OHN003","OHS001","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010064-05","87% AV Level Silver Plan","87.97%","0.880108594894409","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver2-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","16"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010064","CareSource Just4Me Silver","77552OH001",,"OHN003","OHS001","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010064-06","94% AV Level Silver Plan","94.58%","0.94583922624588","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver3-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","17"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010066","CareSource Just4Me Silver","77552OH001",,"OHN003","OHS003","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010066-00","Standard Silver Off Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","18"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010066","CareSource Just4Me Silver","77552OH001",,"OHN003","OHS003","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010066-01","Standard Silver On Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","19"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010066","CareSource Just4Me Silver","77552OH001",,"OHN003","OHS003","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010066-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverzero-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","20"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010066","CareSource Just4Me Silver","77552OH001",,"OHN003","OHS003","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010066-03","Limited Cost Sharing Plan Variation","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverltd-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","21"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010066","CareSource Just4Me Silver","77552OH001",,"OHN003","OHS003","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010066-04","73% AV Level Silver Plan","73.37%","0.733690559864044","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver1-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","22"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010066","CareSource Just4Me Silver","77552OH001",,"OHN003","OHS003","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010066-05","87% AV Level Silver Plan","87.97%","0.880108594894409","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver2-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","23"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010066","CareSource Just4Me Silver","77552OH001",,"OHN003","OHS003","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010066-06","94% AV Level Silver Plan","94.58%","0.94583922624588","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver3-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","24"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010074","CareSource Just4Me Silver","77552OH001",,"OHN004","OHS002","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010074-00","Standard Silver Off Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","25"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010074","CareSource Just4Me Silver","77552OH001",,"OHN004","OHS002","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010074-01","Standard Silver On Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","26"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010074","CareSource Just4Me Silver","77552OH001",,"OHN004","OHS002","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010074-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverzero-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","27"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010074","CareSource Just4Me Silver","77552OH001",,"OHN004","OHS002","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010074-03","Limited Cost Sharing Plan Variation","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverltd-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","28"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010074","CareSource Just4Me Silver","77552OH001",,"OHN004","OHS002","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010074-04","73% AV Level Silver Plan","73.37%","0.733690559864044","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver1-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","29"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010074","CareSource Just4Me Silver","77552OH001",,"OHN004","OHS002","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010074-05","87% AV Level Silver Plan","87.97%","0.880108594894409","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver2-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","30"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010074","CareSource Just4Me Silver","77552OH001",,"OHN004","OHS002","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010074-06","94% AV Level Silver Plan","94.58%","0.94583922624588","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver3-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","31"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010085","CareSource Just4Me Silver","77552OH001",,"OHN005","OHS004","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010085-00","Standard Silver Off Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","32"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010085","CareSource Just4Me Silver","77552OH001",,"OHN005","OHS004","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010085-01","Standard Silver On Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","33"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010085","CareSource Just4Me Silver","77552OH001",,"OHN005","OHS004","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010085-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverzero-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","34"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010085","CareSource Just4Me Silver","77552OH001",,"OHN005","OHS004","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010085-03","Limited Cost Sharing Plan Variation","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverltd-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","35"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010085","CareSource Just4Me Silver","77552OH001",,"OHN005","OHS004","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010085-04","73% AV Level Silver Plan","73.37%","0.733690559864044","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver1-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","36"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010085","CareSource Just4Me Silver","77552OH001",,"OHN005","OHS004","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010085-05","87% AV Level Silver Plan","87.97%","0.880108594894409","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver2-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","37"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010085","CareSource Just4Me Silver","77552OH001",,"OHN005","OHS004","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010085-06","94% AV Level Silver Plan","94.58%","0.94583922624588","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver3-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","38"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010089","CareSource Just4Me Silver","77552OH001",,"OHN005","OHS008","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010089-00","Standard Silver Off Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","39"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010089","CareSource Just4Me Silver","77552OH001",,"OHN005","OHS008","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010089-01","Standard Silver On Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","40"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010089","CareSource Just4Me Silver","77552OH001",,"OHN005","OHS008","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010089-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverzero-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","41"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010089","CareSource Just4Me Silver","77552OH001",,"OHN005","OHS008","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010089-03","Limited Cost Sharing Plan Variation","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverltd-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","42"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010089","CareSource Just4Me Silver","77552OH001",,"OHN005","OHS008","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010089-04","73% AV Level Silver Plan","73.37%","0.733690559864044","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver1-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","43"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010089","CareSource Just4Me Silver","77552OH001",,"OHN005","OHS008","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010089-05","87% AV Level Silver Plan","87.97%","0.880108594894409","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver2-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","44"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010089","CareSource Just4Me Silver","77552OH001",,"OHN005","OHS008","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010089-06","94% AV Level Silver Plan","94.58%","0.94583922624588","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver3-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","45"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010002","CareSource Just4Me Silver","77552OH001",,"OHN006","OHS009","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010002-00","Standard Silver Off Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","46"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010002","CareSource Just4Me Silver","77552OH001",,"OHN006","OHS009","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010002-01","Standard Silver On Exchange Plan","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","47"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010002","CareSource Just4Me Silver","77552OH001",,"OHN006","OHS009","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverzero-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","48"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010002","CareSource Just4Me Silver","77552OH001",,"OHN006","OHS009","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010002-03","Limited Cost Sharing Plan Variation","70.50%","0.704971671104431","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silverltd-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","49"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010002","CareSource Just4Me Silver","77552OH001",,"OHN006","OHS009","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010002-04","73% AV Level Silver Plan","73.37%","0.733690559864044","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver1-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","50"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010002","CareSource Just4Me Silver","77552OH001",,"OHN006","OHS009","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010002-05","87% AV Level Silver Plan","87.97%","0.880108594894409","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver2-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","51"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010002","CareSource Just4Me Silver","77552OH001",,"OHN006","OHS009","OHF002","Existing","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9903",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010002-06","94% AV Level Silver Plan","94.58%","0.94583922624588","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-oh-silver3-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","52"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010105","CareSource Just4Me Bronze","77552OH001",,"OHN002","OHS006","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010105-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","53"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010105","CareSource Just4Me Bronze","77552OH001",,"OHN002","OHS006","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010105-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","54"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010105","CareSource Just4Me Bronze","77552OH001",,"OHN002","OHS006","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010105-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzezero-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","55"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010105","CareSource Just4Me Bronze","77552OH001",,"OHN002","OHS006","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010105-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzeltd-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","56"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010109","CareSource Just4Me Bronze","77552OH001",,"OHN003","OHS001","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010109-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","57"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010109","CareSource Just4Me Bronze","77552OH001",,"OHN003","OHS001","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010109-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","58"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010109","CareSource Just4Me Bronze","77552OH001",,"OHN003","OHS001","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010109-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzezero-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","59"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010109","CareSource Just4Me Bronze","77552OH001",,"OHN003","OHS001","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010109-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzeltd-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","60"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010111","CareSource Just4Me Bronze","77552OH001",,"OHN003","OHS003","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010111-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","61"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010111","CareSource Just4Me Bronze","77552OH001",,"OHN003","OHS003","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010111-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","62"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010111","CareSource Just4Me Bronze","77552OH001",,"OHN003","OHS003","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010111-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzezero-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","63"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010111","CareSource Just4Me Bronze","77552OH001",,"OHN003","OHS003","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010111-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzeltd-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","64"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010119","CareSource Just4Me Bronze","77552OH001",,"OHN004","OHS002","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010119-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","65"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010119","CareSource Just4Me Bronze","77552OH001",,"OHN004","OHS002","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010119-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","66"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010119","CareSource Just4Me Bronze","77552OH001",,"OHN004","OHS002","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010119-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzezero-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","67"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010119","CareSource Just4Me Bronze","77552OH001",,"OHN004","OHS002","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010119-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzeltd-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","68"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010130","CareSource Just4Me Bronze","77552OH001",,"OHN005","OHS004","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010130-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","69"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010130","CareSource Just4Me Bronze","77552OH001",,"OHN005","OHS004","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010130-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","70"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010130","CareSource Just4Me Bronze","77552OH001",,"OHN005","OHS004","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010130-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzezero-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","71"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010130","CareSource Just4Me Bronze","77552OH001",,"OHN005","OHS004","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010130-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzeltd-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","72"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010134","CareSource Just4Me Bronze","77552OH001",,"OHN005","OHS008","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010134-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","73"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010134","CareSource Just4Me Bronze","77552OH001",,"OHN005","OHS008","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010134-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","74"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010134","CareSource Just4Me Bronze","77552OH001",,"OHN005","OHS008","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010134-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzezero-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","75"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010134","CareSource Just4Me Bronze","77552OH001",,"OHN005","OHS008","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010134-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzeltd-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","76"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010003","CareSource Just4Me Bronze","77552OH001",,"OHN006","OHS009","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010003-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","77"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010003","CareSource Just4Me Bronze","77552OH001",,"OHN006","OHS009","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010003-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","78"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010003","CareSource Just4Me Bronze","77552OH001",,"OHN006","OHS009","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzezero-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","79"
"2016","OH","77552","SERFF","11","2015-10-21 17:48:08","4","77552","OH","Individual","No","31-1143265","77552OH0010003","CareSource Just4Me Bronze","77552OH001",,"OHN006","OHS009","OHF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9884",,,"$300","0","0","0","2016-01-01","2016-12-31","No","Emergency Services","No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/oh/pharmacy","77552OH0010003-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-oh-bronzeltd-basic-sum","https://www.caresource.com/documents/j4m2016-oh-plan-brochure","80"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","1","78726","OH","Individual","No","35-1665915","78726OH0020003","Silver Navigate Plus HSA 3000","78726OH002",,"OHN001","OHS001","OHF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020003-00","Standard Silver Off Exchange Plan",,"0.708311021327972","Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=oh0043&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","4"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","1","78726","OH","Individual","No","35-1665915","78726OH0020003","Silver Navigate Plus HSA 3000","78726OH002",,"OHN001","OHS001","OHF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020003-01","Standard Silver On Exchange Plan",,"0.708311021327972","Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=oh0043&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","5"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","1","78726","OH","Individual","No","35-1665915","78726OH0020003","Silver Navigate Plus HSA 3000","78726OH002",,"OHN001","OHS001","OHF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=oh0044&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","6"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","1","78726","OH","Individual","No","35-1665915","78726OH0020003","Silver Navigate Plus HSA 3000","78726OH002",,"OHN001","OHS001","OHF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020003-03","Limited Cost Sharing Plan Variation",,"0.708311021327972","Yes","Yes","No","100%",,"$3,000","$10","$0","$200","$3,000","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=oh0045&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","7"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","1","78726","OH","Individual","No","35-1665915","78726OH0020003","Silver Navigate Plus HSA 3000","78726OH002",,"OHN001","OHS001","OHF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020003-04","73% AV Level Silver Plan",,"0.737914025783539","Yes","Yes","No","100%",,"$2,500","$10","$0","$200","$2,500","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=oh0046&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","8"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","1","78726","OH","Individual","No","35-1665915","78726OH0020003","Silver Navigate Plus HSA 3000","78726OH002",,"OHN001","OHS001","OHF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020003-05","87% AV Level Silver Plan",,"0.877197504043579","Yes","Yes","No","100%",,"$800","$10","$0","$200","$800","$700","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$800","$800 per person","$1600 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=oh0047&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","9"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","1","78726","OH","Individual","No","35-1665915","78726OH0020003","Silver Navigate Plus HSA 3000","78726OH002",,"OHN001","OHS001","OHF003","New","POS","Silver","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020003-06","94% AV Level Silver Plan",,"0.942080080509186","Yes","Yes","No","100%",,"$200","$10","$0","$200","$200","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=oh0048&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","10"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","1","78726","OH","Individual","No","35-1665915","78726OH0020008","Bronze Navigate Plus HSA 5500","78726OH002",,"OHN001","OHS001","OHF007","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020008-00","Standard Bronze Off Exchange Plan",,"0.618041276931763","Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=oh0073&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","11"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","1","78726","OH","Individual","No","35-1665915","78726OH0020008","Bronze Navigate Plus HSA 5500","78726OH002",,"OHN001","OHS001","OHF007","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020008-01","Standard Bronze On Exchange Plan",,"0.618041276931763","Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=oh0073&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","12"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","1","78726","OH","Individual","No","35-1665915","78726OH0020008","Bronze Navigate Plus HSA 5500","78726OH002",,"OHN001","OHS001","OHF007","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=oh0074&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","13"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","1","78726","OH","Individual","No","35-1665915","78726OH0020008","Bronze Navigate Plus HSA 5500","78726OH002",,"OHN001","OHS001","OHF007","New","POS","Bronze","No","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020008-03","Limited Cost Sharing Plan Variation",,"0.618041276931763","Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=oh0075&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","14"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020001","Gold Navigate Plus 1000","78726OH002",,"OHN001","OHS001","OHF001","New","POS","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020001-00","Standard Gold Off Exchange Plan","78.10%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0037&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","4"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020001","Gold Navigate Plus 1000","78726OH002",,"OHN001","OHS001","OHF001","New","POS","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020001-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0037&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","5"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020001","Gold Navigate Plus 1000","78726OH002",,"OHN001","OHS001","OHF001","New","POS","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0038&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","6"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020001","Gold Navigate Plus 1000","78726OH002",,"OHN001","OHS001","OHF001","New","POS","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020001-03","Limited Cost Sharing Plan Variation","78.10%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0039&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","7"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020002","Gold Navigate Plus 0","78726OH002",,"OHN001","OHS001","OHF002","New","POS","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020002-00","Standard Gold Off Exchange Plan","79.10%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0040&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","8"
"2016","OH","79539","SERFF","5","2015-08-20 12:28:36","1","79539","OH","SHOP (Small Group)","Yes","47-0098400","79539OH0040002","EHB High PPO","79539OH004",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.22","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","79539OH0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","OH","79539","SERFF","5","2015-08-20 12:28:36","1","79539","OH","SHOP (Small Group)","Yes","47-0098400","79539OH0040001","EHB Low PPO","79539OH004",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.96","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","79539OH0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","OH","79539","SERFF","5","2015-08-20 12:28:36","1","79539","OH","SHOP (Small Group)","Yes","47-0098400","79539OH0030002","EHB High Passive","79539OH003",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.62","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","79539OH0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","OH","79539","SERFF","5","2015-08-20 12:28:36","1","79539","OH","SHOP (Small Group)","Yes","47-0098400","79539OH0030001","EHB Low Passive","79539OH003",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.79","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","79539OH0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","1","80627","OH","Individual","Yes","34-0648820","80627OH0140005","MedMutual Pediatric Dental","80627OH014",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$24.93","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0140005-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","1","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150015","Pediatric Dental - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$24.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150015-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020002","Gold Navigate Plus 0","78726OH002",,"OHN001","OHS001","OHF002","New","POS","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020002-01","Standard Gold On Exchange Plan","79.10%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0040&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","9"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020002","Gold Navigate Plus 0","78726OH002",,"OHN001","OHS001","OHF002","New","POS","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0041&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","10"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020002","Gold Navigate Plus 0","78726OH002",,"OHN001","OHS001","OHF002","New","POS","Gold","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020002-03","Limited Cost Sharing Plan Variation","79.10%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","0%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0042&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","11"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020004","Silver Navigate Plus 2000 1","78726OH002",,"OHN001","OHS001","OHF004","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020004-00","Standard Silver Off Exchange Plan","70.80%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=oh0049&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","12"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020004","Silver Navigate Plus 2000 1","78726OH002",,"OHN001","OHS001","OHF004","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020004-01","Standard Silver On Exchange Plan","70.80%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=oh0049&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","13"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020004","Silver Navigate Plus 2000 1","78726OH002",,"OHN001","OHS001","OHF004","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=oh0050&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","14"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020004","Silver Navigate Plus 2000 1","78726OH002",,"OHN001","OHS001","OHF004","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020004-03","Limited Cost Sharing Plan Variation","70.80%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=oh0051&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","15"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020004","Silver Navigate Plus 2000 1","78726OH002",,"OHN001","OHS001","OHF004","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020004-04","73% AV Level Silver Plan","72.90%",,"Yes","Yes","No","100%",,"$1,800","$1,500","$0","$200","$1,800","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","$1800 per person","$3600 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=oh0052&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","16"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020004","Silver Navigate Plus 2000 1","78726OH002",,"OHN001","OHS001","OHF004","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020004-05","87% AV Level Silver Plan","86.20%",,"Yes","Yes","No","100%",,"$500","$800","$0","$200","$500","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=oh0053&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","17"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020004","Silver Navigate Plus 2000 1","78726OH002",,"OHN001","OHS001","OHF004","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020004-06","94% AV Level Silver Plan","93.10%",,"Yes","Yes","No","100%",,"$200","$500","$0","$200","$200","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=oh0054&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","18"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020005","Silver Navigate Plus 2000","78726OH002",,"OHN001","OHS001","OHF005","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020005-00","Standard Silver Off Exchange Plan","69.30%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0055&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","19"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020005","Silver Navigate Plus 2000","78726OH002",,"OHN001","OHS001","OHF005","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020005-01","Standard Silver On Exchange Plan","69.30%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0055&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","20"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020005","Silver Navigate Plus 2000","78726OH002",,"OHN001","OHS001","OHF005","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020005-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0056&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","21"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020005","Silver Navigate Plus 2000","78726OH002",,"OHN001","OHS001","OHF005","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020005-03","Limited Cost Sharing Plan Variation","69.30%",,"No","Yes","No","100%",,"$2,000","$20","$1,300","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0057&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","22"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020005","Silver Navigate Plus 2000","78726OH002",,"OHN001","OHS001","OHF005","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020005-04","73% AV Level Silver Plan","73.40%",,"No","Yes","No","100%",,"$1,200","$20","$1,500","$200","$300","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0058&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","23"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020005","Silver Navigate Plus 2000","78726OH002",,"OHN001","OHS001","OHF005","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020005-05","87% AV Level Silver Plan","87.90%",,"No","Yes","No","100%",,"$200","$10","$600","$200","$200","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"$250","$250 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0059&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","24"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020005","Silver Navigate Plus 2000","78726OH002",,"OHN001","OHS001","OHF005","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020005-06","94% AV Level Silver Plan","93.90%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0060&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","25"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020006","Silver Navigate Plus 3500","78726OH002",,"OHN001","OHS001","OHF006","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020006-00","Standard Silver Off Exchange Plan","68.00%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0061&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","26"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020006","Silver Navigate Plus 3500","78726OH002",,"OHN001","OHS001","OHF006","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020006-01","Standard Silver On Exchange Plan","68.00%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0061&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","27"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","4","80627","OH","Individual","Yes","34-0648820","80627OH0140008","MedMutual Dental 3","80627OH014",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.93","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0140008-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","4","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150023","Dental Plan 6 with Ortho Rider - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150023-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020006","Silver Navigate Plus 3500","78726OH002",,"OHN001","OHS001","OHF006","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020006-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0062&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","28"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020006","Silver Navigate Plus 3500","78726OH002",,"OHN001","OHS001","OHF006","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020006-03","Limited Cost Sharing Plan Variation","68.00%",,"No","Yes","No","100%",,"$3,500","$10","$600","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0063&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","29"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020006","Silver Navigate Plus 3500","78726OH002",,"OHN001","OHS001","OHF006","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020006-04","73% AV Level Silver Plan","72.50%",,"No","Yes","No","100%",,"$2,500","$10","$800","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"$500","$500 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0064&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","30"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020006","Silver Navigate Plus 3500","78726OH002",,"OHN001","OHS001","OHF006","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020006-05","87% AV Level Silver Plan","87.90%",,"No","Yes","No","100%",,"$200","$10","$600","$200","$200","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"$250","$250 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0065&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","31"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020006","Silver Navigate Plus 3500","78726OH002",,"OHN001","OHS001","OHF006","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020006-06","94% AV Level Silver Plan","93.90%",,"No","Yes","No","100%",,"$100","$0","$500","$200","$100","$400","$10","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0066&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","32"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020007","Silver Navigate Plus 4500","78726OH002",,"OHN001","OHS001","OHF006","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020007-00","Standard Silver Off Exchange Plan","68.30%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0067&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","33"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020007","Silver Navigate Plus 4500","78726OH002",,"OHN001","OHS001","OHF006","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020007-01","Standard Silver On Exchange Plan","68.30%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0067&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","34"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020007","Silver Navigate Plus 4500","78726OH002",,"OHN001","OHS001","OHF006","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0068&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","35"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020007","Silver Navigate Plus 4500","78726OH002",,"OHN001","OHS001","OHF006","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020007-03","Limited Cost Sharing Plan Variation","68.30%",,"No","Yes","No","100%",,"$4,500","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0069&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","36"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020007","Silver Navigate Plus 4500","78726OH002",,"OHN001","OHS001","OHF006","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020007-04","73% AV Level Silver Plan","72.50%",,"No","Yes","No","100%",,"$3,200","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0070&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","37"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020007","Silver Navigate Plus 4500","78726OH002",,"OHN001","OHS001","OHF006","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020007-05","87% AV Level Silver Plan","86.10%",,"No","Yes","No","100%",,"$600","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","0%",,,,,"$250","$250 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0071&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","38"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020007","Silver Navigate Plus 4500","78726OH002",,"OHN001","OHS001","OHF006","New","POS","Silver","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020007-06","94% AV Level Silver Plan","93.30%",,"No","Yes","No","100%",,"$100","$10","$0","$200","$100","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=oh0072&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","39"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020009","Bronze Navigate Plus 6500","78726OH002",,"OHN001","OHS001","OHF007","New","POS","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020009-00","Standard Bronze Off Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=oh0076&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","40"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020009","Bronze Navigate Plus 6500","78726OH002",,"OHN001","OHS001","OHF007","New","POS","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020009-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=oh0076&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","41"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020009","Bronze Navigate Plus 6500","78726OH002",,"OHN001","OHS001","OHF007","New","POS","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020009-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=oh0077&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","42"
"2016","OH","78726","SERFF","7","2015-08-28 13:59:00","2","78726","OH","Individual","No","35-1665915","78726OH0020009","Bronze Navigate Plus 6500","78726OH002",,"OHN001","OHS001","OHF007","New","POS","Bronze","Yes","Both","No","Yes","All, except OBGYN and as state mandated",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","0.9995",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as out of network benefits","Yes","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=oh0081&st=oh","78726OH0020009-03","Limited Cost Sharing Plan Variation","61.90%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=oh0078&st=oh","http://www.uhc.com/iex/doc?id=oh0080&st=oh","43"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","1","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150032","Pediatric Dental - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$25.28","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150032-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","2","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150017","Dental Plan 3 - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150017-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","2","80627","OH","Individual","Yes","34-0648820","80627OH0140006","MedMutual Dental 1","80627OH014",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.93","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0140006-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","2","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150018","Dental Plan 3 (Voluntary) - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150018-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","2","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150021","Dental Plan 5 - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150021-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","2","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150034","Dental Plan 3 - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.28","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150034-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","2","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150035","Dental Plan 3 (Voluntary) - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.28","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150035-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","2","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150038","Dental Plan 5 - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.28","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150038-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","3","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150019","Dental Plan 4 - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150019-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","3","80627","OH","Individual","Yes","34-0648820","80627OH0140007","MedMutual Dental 2","80627OH014",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.93","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0140007-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","3","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150022","Dental Plan 6 - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150022-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","3","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150024","Dental Plan 6 (Voluntary) - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150024-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","3","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150025","Dental Plan 7 - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150025-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","3","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150027","Dental Plan 7 (Voluntary) - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150027-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","3","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150028","Dental Plan 8 - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150028-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","3","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150030","Dental Plan 9 - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150030-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","3","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150036","Dental Plan 4 - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.28","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150036-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","3","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150039","Dental Plan 6 - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.28","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150039-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","3","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150041","Dental Plan 6 (Voluntary) - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.28","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150041-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","3","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150042","Dental Plan 7 - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.28","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150042-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"14"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","3","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150044","Dental Plan 7 (Voluntary) - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.28","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150044-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"15"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","3","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150045","Dental Plan 8 - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.28","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150045-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"16"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","3","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150047","Dental Plan 9 - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.28","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150047-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"17"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","4","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150020","Dental Plan 4 with Ortho Rider - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150020-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","4","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150026","Dental Plan 7 with Ortho Rider - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150026-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","4","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150029","Dental Plan 8 with Ortho Rider - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150029-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","4","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150031","Dental Plan 9 with Ortho Rider - Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.89","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150031-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","4","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150037","Dental Plan 4 with Ortho Rider - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.28","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150037-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","4","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150040","Dental Plan 6 with Ortho Rider - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.28","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150040-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","4","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150043","Dental Plan 7 with Ortho Rider - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.28","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150043-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","4","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150046","Dental Plan 8 with Ortho Rider - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.28","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150046-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2016","OH","80627","SERFF","4","2015-08-20 12:28:36","4","80627","OH","SHOP (Small Group)","Yes","34-0648820","80627OH0150048","Dental Plan 9 with Ortho Rider - Non-Alliance","80627OH015",,"OHN001","OHS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.28","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","80627OH0150048-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","1","86728","OH","SHOP (Small Group)","Yes","31-0685339","86728OH0290001","Delta Dental Group PPO, EHB Certified","86728OH029",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"22.54","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","86728OH0290001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","1","86728","OH","Individual","Yes","31-0685339","86728OH0260001","Delta Dental Individual PPO, EHB Certified","86728OH026",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.71","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","86728OH0260001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","1","86728","OH","Individual","Yes","31-0685339","86728OH0260002","Delta Dental Individual PPO, EHB Certified","86728OH026",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.93","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","86728OH0260002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","1","86728","OH","SHOP (Small Group)","Yes","31-0685339","86728OH0290002","Delta Dental Group PPO, EHB Certified","86728OH029",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"19.43","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","86728OH0290002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","1","86728","OH","Individual","Yes","31-0685339","86728OH0340001","Delta Dental Individual PPO, EHB Certified (Exchange)","86728OH034",,"OHN001","OHS001",,"New","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/86728","","86728OH0340001-01","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaloh.com/OH_EHB_High_2016","http://www.deltadentaloh.com/OH_EHB_High_2016","6"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","1","86728","OH","SHOP (Small Group)","Yes","31-0685339","86728OH0290003","Delta Dental Group PPO, EHB Certified","86728OH029",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"22.54","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","86728OH0290003-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","1","86728","OH","Individual","Yes","31-0685339","86728OH0340002","Delta Dental Individual PPO, EHB Certified (Exchange)","86728OH034",,"OHN001","OHS001",,"New","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/86728","","86728OH0340002-01","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaloh.com/OH_EHB_Low_2016","http://www.deltadentaloh.com/OH_EHB_Low_2016","7"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","1","86728","OH","SHOP (Small Group)","Yes","31-0685339","86728OH0290004","Delta Dental Group PPO, EHB Certified","86728OH029",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"19.43","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","86728OH0290004-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","1","86728","OH","SHOP (Small Group)","Yes","31-0685339","86728OH0290005","Delta Dental Group PPO, EHB Certified","86728OH029",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"25.26","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","86728OH0290005-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","1","86728","OH","SHOP (Small Group)","Yes","31-0685339","86728OH0290006","Delta Dental Group PPO, EHB Certified","86728OH029",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"21.15","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","86728OH0290006-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","1","86728","OH","SHOP (Small Group)","Yes","31-0685339","86728OH0290007","Delta Dental Group PPO, EHB Certified","86728OH029",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"25.26","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","86728OH0290007-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","1","86728","OH","SHOP (Small Group)","Yes","31-0685339","86728OH0290008","Delta Dental Group PPO, EHB Certified","86728OH029",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"21.15","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","86728OH0290008-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","1","86728","OH","SHOP (Small Group)","Yes","31-0685339","86728OH0350001","Delta Dental Group PPO, EHB Certified (Exchange)","86728OH035",,"OHN001","OHS001",,"New","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","86728OH0350001-01","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaloh.com/OH_EHB_Group_High_2016","http://www.deltadentaloh.com/OH_EHB_Group_High_2016","12"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","1","86728","OH","SHOP (Small Group)","Yes","31-0685339","86728OH0350002","Delta Dental Group PPO, EHB Certified (Exchange)","86728OH035",,"OHN001","OHS001",,"New","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$14.56","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","86728OH0350002-01","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaloh.com/OH_EHB_Group_Low_2016","http://www.deltadentaloh.com/OH_EHB_Group_Low_2016","13"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","2","86728","OH","Individual","Yes","31-0685339","86728OH0310001","Delta Dental Individual Pediatric-Only PPO, EHB Certified","86728OH031",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$25.74","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","86728OH0310001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","2","86728","OH","SHOP (Small Group)","Yes","31-0685339","86728OH0300001","Delta Dental Group Pediatric-Only, EHB Certified","86728OH030",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$25.26","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","86728OH0300001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","2","86728","OH","Individual","Yes","31-0685339","86728OH0310002","Delta Dental Individual Pediatric-Only PPO, EHB Certified","86728OH031",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$19.96","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","86728OH0310002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","2","86728","OH","SHOP (Small Group)","Yes","31-0685339","86728OH0300002","Delta Dental Group Pediatric-Only, EHB Certified","86728OH030",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$21.15","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","86728OH0300002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","2","86728","OH","SHOP (Small Group)","Yes","31-0685339","86728OH0300003","Delta Dental Group Pediatric-Only, EHB Certified","86728OH030",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$22.54","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","86728OH0300003-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","2","86728","OH","Individual","Yes","31-0685339","86728OH0360001","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","86728OH036",,"OHN001","OHS001",,"New","PPO","High",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$25.74","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/86728","","86728OH0360001-01","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaloh.com/OH_Ped_High_2016","http://www.deltadentaloh.com/OH_Ped_High_2016","6"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","2","86728","OH","Individual","Yes","31-0685339","86728OH0360002","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","86728OH036",,"OHN001","OHS001",,"New","PPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$19.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/86728","","86728OH0360002-01","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentaloh.com/OH_Ped_Low_2016","http://www.deltadentaloh.com/OH_Ped_Low_2016","7"
"2016","OH","86728","SERFF","9","2015-08-20 12:28:36","2","86728","OH","SHOP (Small Group)","Yes","31-0685339","86728OH0300004","Delta Dental Group Pediatric-Only, EHB Certified","86728OH030",,"OHN001","OHS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$19.43","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","86728OH0300004-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","OH","89819","SERFF","7","2015-10-21 17:48:08","1","89819","OH","Individual","Yes","36-3757528","89819OH0010001","TruAssure Basic Adult or Child Dental Plan","89819OH001",,"OHN001","OHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.57","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","89819OH0010001-00","Standard Low Off Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OH","https://www.truassure.com/brochure?state=OH","4"
"2016","OH","89819","SERFF","7","2015-10-21 17:48:08","1","89819","OH","SHOP (Small Group)","Yes","36-3757528","89819OH0030001","TruAssure Dental Small Group Basic Plan","89819OH003",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.74","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","89819OH0030001-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","89819","SERFF","7","2015-10-21 17:48:08","1","89819","OH","SHOP (Small Group)","Yes","36-3757528","89819OH0040001","TruAssure Dental Small Group Preferred Plan","89819OH004",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.74","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","89819OH0040001-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","89819","SERFF","7","2015-10-21 17:48:08","1","89819","OH","Individual","Yes","36-3757528","89819OH0010001","TruAssure Basic Adult or Child Dental Plan","89819OH001",,"OHN001","OHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.57","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","89819OH0010001-01","Standard Low On Exchange Plan","68.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OH","https://www.truassure.com/brochure?state=OH","5"
"2016","OH","89819","SERFF","7","2015-10-21 17:48:08","2","89819","OH","Individual","Yes","36-3757528","89819OH0020001","TruAssure Preferred Adult or Child Dental Plan","89819OH002",,"OHN001","OHS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.02","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","89819OH0020001-00","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OH","https://www.truassure.com/brochure?state=OH","4"
"2016","OH","89819","SERFF","7","2015-10-21 17:48:08","2","89819","OH","Individual","Yes","36-3757528","89819OH0020001","TruAssure Preferred Adult or Child Dental Plan","89819OH002",,"OHN001","OHS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.02","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","89819OH0020001-01","Standard High On Exchange Plan","83.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$30","$30 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=OH","https://www.truassure.com/brochure?state=OH","5"
"2016","OH","91261","SERFF","3","2015-08-20 12:28:36","1","91261","OH","SHOP (Small Group)","Yes","57-0523959","91261OH0020001","Group Dental Policy","91261OH002",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$38.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","91261OH0020001-00","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530001","Select Gold 250-70","92036OH053",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9877",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530001-00","Standard Gold Off Exchange Plan",,"0.803593873977661","Yes","Yes","No","100%",,"$250","$15","$2,100","$0","$100","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016Gold25070","http://www.healthspan.org/marketplace/2016Individual","4"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530001","Select Gold 250-70","92036OH053",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9877",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530001-01","Standard Gold On Exchange Plan",,"0.803593873977661","Yes","Yes","No","100%",,"$250","$15","$2,100","$0","$100","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016Gold25070","http://www.healthspan.org/marketplace/2016Individual","5"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530001","Select Gold 250-70","92036OH053",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9877",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthspan.org/marketplace/2016zerocostsharing","http://www.healthspan.org/marketplace/2016Individual","6"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530001","Select Gold 250-70","92036OH053",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9877",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530001-03","Limited Cost Sharing Plan Variation",,"0.803593873977661","Yes","Yes","No","100%",,"$250","$15","$2,100","$0","$100","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016Gold25070","http://www.healthspan.org/marketplace/2016Individual","7"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530002","Select Gold 1000-80","92036OH053",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9878",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530002-00","Standard Gold Off Exchange Plan",,"0.809406518936157","No","Yes","No","100%",,"$1,000","$15","$1,250","$0","$100","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016Gold100080","http://www.healthspan.org/marketplace/2016Individual","8"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530002","Select Gold 1000-80","92036OH053",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9878",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530002-01","Standard Gold On Exchange Plan",,"0.809406518936157","No","Yes","No","100%",,"$1,000","$15","$1,250","$0","$100","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016Gold100080","http://www.healthspan.org/marketplace/2016Individual","9"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530002","Select Gold 1000-80","92036OH053",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9878",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016zerocostsharing","http://www.healthspan.org/marketplace/2016Individual","10"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530002","Select Gold 1000-80","92036OH053",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9878",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530002-03","Limited Cost Sharing Plan Variation",,"0.809406518936157","No","Yes","No","100%",,"$1,000","$15","$1,250","$0","$100","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016Gold100080","http://www.healthspan.org/marketplace/2016Individual","11"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530003","Select Gold 2000-100","92036OH053",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9877",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530003-00","Standard Gold Off Exchange Plan",,"0.791869163513184","No","Yes","No","100%",,"$2,000","$15","$0","$0","$100","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016Gold2000100","http://www.healthspan.org/marketplace/2016Individual","12"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530003","Select Gold 2000-100","92036OH053",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9877",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530003-01","Standard Gold On Exchange Plan",,"0.791869163513184","No","Yes","No","100%",,"$2,000","$15","$0","$0","$100","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016Gold2000100","http://www.healthspan.org/marketplace/2016Individual","13"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530003","Select Gold 2000-100","92036OH053",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9877",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016zerocostsharing","http://www.healthspan.org/marketplace/2016Individual","14"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530003","Select Gold 2000-100","92036OH053",,"OHN001","OHS001","OHF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9877",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530003-03","Limited Cost Sharing Plan Variation",,"0.791869163513184","No","Yes","No","100%",,"$2,000","$15","$0","$0","$100","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016Gold2000100","http://www.healthspan.org/marketplace/2016Individual","15"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530004","Select Silver 1500-70 HSA","92036OH053",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9892",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530004-00","Standard Silver Off Exchange Plan",,"0.718231022357941","Yes","Yes","No","100%",,"$1,500","$0","$1,740","$0","$1,500","$0","$1,150","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016Silver150070HSA","http://www.healthspan.org/marketplace/2016Individual","16"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530004","Select Silver 1500-70 HSA","92036OH053",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9892",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530004-01","Standard Silver On Exchange Plan",,"0.718231022357941","Yes","Yes","No","100%",,"$1,500","$0","$1,740","$0","$1,500","$0","$1,150","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016Silver150070HSA","http://www.healthspan.org/marketplace/2016Individual","17"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530004","Select Silver 1500-70 HSA","92036OH053",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9892",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthspan.org/marketplace/2016zerocostsharing","http://www.healthspan.org/marketplace/2016Individual","18"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530004","Select Silver 1500-70 HSA","92036OH053",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9892",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530004-03","Limited Cost Sharing Plan Variation",,"0.718231022357941","Yes","Yes","No","100%",,"$1,500","$0","$1,740","$0","$1,500","$0","$1,150","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016Silver150070HSA","http://www.healthspan.org/marketplace/2016Individual","19"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530004","Select Silver 1500-70 HSA","92036OH053",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9892",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530004-04","73% AV Level Silver Plan",,"0.738359868526459","Yes","Yes","No","100%",,"$1,300","$0","$1,800","$0","$1,300","$0","$1,150","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$2600 per person","$2600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016Silver150070HSAplanC","http://www.healthspan.org/marketplace/2016Individual","20"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530004","Select Silver 1500-70 HSA","92036OH053",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9892",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530004-05","87% AV Level Silver Plan",,"0.875510036945343","Yes","Yes","No","100%",,"$250","$0","$1,410","$0","$250","$0","$1,000","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016Silver150070HSAplanB","http://www.healthspan.org/marketplace/2016Individual","21"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530004","Select Silver 1500-70 HSA","92036OH053",,"OHN001","OHS001","OHF002","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9892",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530004-06","94% AV Level Silver Plan",,"0.937820553779602","Yes","Yes","No","100%",,"$0","$0","$740","$0","$0","$0","$590","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016Silver150070HSAplanA","http://www.healthspan.org/marketplace/2016Individual","22"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530005","Select Silver 2500-70","92036OH053",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9891",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530005-00","Standard Silver Off Exchange Plan",,"0.716398894786835","No","Yes","No","100%",,"$2,500","$20","$1,430","$0","$100","$1,250","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/20162500-70","http://www.healthspan.org/marketplace/2016Individual","23"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530005","Select Silver 2500-70","92036OH053",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9891",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530005-01","Standard Silver On Exchange Plan",,"0.716398894786835","No","Yes","No","100%",,"$2,500","$20","$1,430","$0","$100","$1,250","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/20162500-70","http://www.healthspan.org/marketplace/2016Individual","24"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530005","Select Silver 2500-70","92036OH053",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9891",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016zerocostsharing","http://www.healthspan.org/marketplace/2016Individual","25"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530005","Select Silver 2500-70","92036OH053",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9891",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530005-03","Limited Cost Sharing Plan Variation",,"0.716398894786835","No","Yes","No","100%",,"$2,500","$20","$1,430","$0","$100","$1,250","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/20162500-70","http://www.healthspan.org/marketplace/2016Individual","26"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530005","Select Silver 2500-70","92036OH053",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9891",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530005-04","73% AV Level Silver Plan",,"0.737255573272705","No","Yes","No","100%",,"$2,500","$20","$1,430","$0","$100","$1,250","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/20162500-70planC","http://www.healthspan.org/marketplace/2016Individual","27"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530005","Select Silver 2500-70","92036OH053",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9891",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530005-05","87% AV Level Silver Plan",,"0.877739369869232","No","Yes","No","100%",,"$500","$20","$1,350","$0","$100","$850","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/20162500-70planB","http://www.healthspan.org/marketplace/2016Individual","28"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530005","Select Silver 2500-70","92036OH053",,"OHN001","OHS001","OHF003","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9891",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530005-06","94% AV Level Silver Plan",,"0.943744421005249","No","Yes","No","100%",,"$0","$20","$1,450","$0","$0","$450","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/20162500-70planA","http://www.healthspan.org/marketplace/2016Individual","29"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530007","Select Silver 3500 HSA","92036OH053",,"OHN001","OHS001","OHF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9891",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530007-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$0","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/20163500HSA","http://www.healthspan.org/marketplace/2016Individual","30"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530007","Select Silver 3500 HSA","92036OH053",,"OHN001","OHS001","OHF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9891",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530007-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$0","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/20163500HSA","http://www.healthspan.org/marketplace/2016Individual","31"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530007","Select Silver 3500 HSA","92036OH053",,"OHN001","OHS001","OHF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9891",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthspan.org/marketplace/2016zerocostsharing","http://www.healthspan.org/marketplace/2016Individual","32"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530007","Select Silver 3500 HSA","92036OH053",,"OHN001","OHS001","OHF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9891",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530007-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$0","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/20163500HSA","http://www.healthspan.org/marketplace/2016Individual","33"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530007","Select Silver 3500 HSA","92036OH053",,"OHN001","OHS001","OHF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9891",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530007-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/20163500HSAplanC","http://www.healthspan.org/marketplace/2016Individual","34"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530007","Select Silver 3500 HSA","92036OH053",,"OHN001","OHS001","OHF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9891",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530007-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$0","$1,250","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/20163500HSAplanB","http://www.healthspan.org/marketplace/2016Individual","35"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530007","Select Silver 3500 HSA","92036OH053",,"OHN001","OHS001","OHF004","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9891",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530007-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$0","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/20163500HSAplanA","http://www.healthspan.org/marketplace/2016Individual","36"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530008","Select Bronze 4500-70 HSA","92036OH053",,"OHN001","OHS001","OHF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9907",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530008-00","Standard Bronze Off Exchange Plan",,"0.615526735782623","Yes","Yes","No","100%",,"$4,500","$0","$840","$0","$4,500","$0","$250","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016450070HSA","http://www.healthspan.org/marketplace/2016Individual","37"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530008","Select Bronze 4500-70 HSA","92036OH053",,"OHN001","OHS001","OHF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9907",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530008-01","Standard Bronze On Exchange Plan",,"0.615526735782623","Yes","Yes","No","100%",,"$4,500","$0","$840","$0","$4,500","$0","$250","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016450070HSA","http://www.healthspan.org/marketplace/2016Individual","38"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530008","Select Bronze 4500-70 HSA","92036OH053",,"OHN001","OHS001","OHF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9907",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.healthspan.org/marketplace/2016zerocostsharing","http://www.healthspan.org/marketplace/2016Individual","39"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530008","Select Bronze 4500-70 HSA","92036OH053",,"OHN001","OHS001","OHF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9907",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530008-03","Limited Cost Sharing Plan Variation",,"0.615526735782623","Yes","Yes","No","100%",,"$4,500","$0","$840","$0","$4,500","$0","$250","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016450070HSA","http://www.healthspan.org/marketplace/2016Individual","40"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530009","Select Bronze 5500-80","92036OH053",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9904",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530009-00","Standard Bronze Off Exchange Plan",,"0.616932034492493","No","Yes","No","100%",,"$5,500","$20","$350","$0","$1,200","$460","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016550080","http://www.healthspan.org/marketplace/2016Individual","41"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530009","Select Bronze 5500-80","92036OH053",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9904",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530009-01","Standard Bronze On Exchange Plan",,"0.616932034492493","No","Yes","No","100%",,"$5,500","$20","$350","$0","$1,200","$460","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016550080","http://www.healthspan.org/marketplace/2016Individual","42"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530009","Select Bronze 5500-80","92036OH053",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9904",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016zerocostsharing","http://www.healthspan.org/marketplace/2016Individual","43"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530009","Select Bronze 5500-80","92036OH053",,"OHN001","OHS001","OHF005","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9904",,,"$200","0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530009-03","Limited Cost Sharing Plan Variation",,"0.616932034492493","No","Yes","No","100%",,"$5,500","$20","$350","$0","$1,200","$460","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","33%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.healthspan.org/marketplace/2016550080","http://www.healthspan.org/marketplace/2016Individual","44"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530010","Select Bronze 6000 HSA","92036OH053",,"OHN001","OHS001","OHF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9907",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530010-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$0","$5,320","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.healthspan.org/marketplace/20166000HSA","http://www.healthspan.org/marketplace/2016Individual","45"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530010","Select Bronze 6000 HSA","92036OH053",,"OHN001","OHS001","OHF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9907",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530010-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$0","$5,320","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.healthspan.org/marketplace/20166000HSA","http://www.healthspan.org/marketplace/2016Individual","46"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530010","Select Bronze 6000 HSA","92036OH053",,"OHN001","OHS001","OHF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9907",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.healthspan.org/marketplace/2016zerocostsharing","http://www.healthspan.org/marketplace/2016Individual","47"
"2016","OH","92036","SERFF","11","2015-08-28 13:59:00","1","92036","OH","Individual","No","31-1431434","92036OH0530010","Select Bronze 6000 HSA","92036OH053",,"OHN001","OHS001","OHF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy, Weight Loss Programs","0.9907",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","https://healthspan.insxcloud.com/payment","http://www.healthspan.org/formulary","92036OH0530010-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$0","$5,320","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.healthspan.org/marketplace/20166000HSA","http://www.healthspan.org/marketplace/2016Individual","48"
"2016","OH","95466","SERFF","3","2015-08-20 12:28:36","1","95466","OH","SHOP (Small Group)","Yes","41-0808596","95466OH0010002","Plan 2. Passive PPO $1000 Annual Maximum, Ortho","95466OH001",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","95466OH0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","95466","SERFF","3","2015-08-20 12:28:36","1","95466","OH","SHOP (Small Group)","Yes","41-0808596","95466OH0010005","Plan 5. Passive PPO, $2000 Annaul Maximum, Ortho","95466OH001",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","95466OH0010005-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","2","99969","OH","Individual","No","34-1442712","99969OH0040022","Market 1750","99969OH004",,"OHN001","OHS003","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040023","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040022-01","Standard Silver On Exchange Plan",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25%",,,,,"$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505640000000000",,"5"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","2","99969","OH","SHOP (Small Group)","No","34-1442712","99969OH0050013","Market Silver 3530-2500","99969OH005",,"OHN001","OHS001","OHF004","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0050013-01","Standard Silver On Exchange Plan",,"0.706804931163788","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$100","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505652000000000",,"5"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","2","99969","OH","Individual","No","34-1442712","99969OH0040022","Market 1750","99969OH004",,"OHN001","OHS003","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040023","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040022-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505655000000000",,"6"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","2","99969","OH","Individual","No","34-1442712","99969OH0040022","Market 1750","99969OH004",,"OHN001","OHS003","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040023","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040022-03","Limited Cost Sharing Plan Variation",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25%",,,,,"$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505640000000000",,"7"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","2","99969","OH","Individual","No","34-1442712","99969OH0040022","Market 1750","99969OH004",,"OHN001","OHS003","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040023","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040022-04","73% AV Level Silver Plan",,"0.732713162899017","No","Yes","No","100%",,"$1,500","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","25%",,,,,"$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505656000000000",,"8"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","2","99969","OH","Individual","No","34-1442712","99969OH0040022","Market 1750","99969OH004",,"OHN001","OHS003","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040023","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040022-05","87% AV Level Silver Plan",,"0.864307463169098","No","Yes","No","100%",,"$800","$0","$400","$200","$100","$1,000","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10%",,,,,"$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505657000000000",,"9"
"2016","OH","95466","SERFF","3","2015-08-20 12:28:36","1","95466","OH","SHOP (Small Group)","Yes","41-0808596","95466OH0010006","Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho","95466OH001",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","95466OH0010006-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","OH","95466","SERFF","3","2015-08-20 12:28:36","1","95466","OH","SHOP (Small Group)","Yes","41-0808596","95466OH0010009","Plan 9. MAC PPO, $1500 Annual Maximum, Ortho","95466OH001",,"OHN001","OHS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$20.18","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","95466OH0010009-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","OH","97596","SERFF","5","2015-08-20 12:28:36","1","97596","OH","Individual","Yes","39-1263473","97596OH0580001","Humana Dental Smart Choice","97596OH058",,"OHN001","OHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.18","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","97596OH0580001-00","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612961","4"
"2016","OH","97596","SERFF","5","2015-08-20 12:28:36","1","97596","OH","Individual","Yes","39-1263473","97596OH0580001","Humana Dental Smart Choice","97596OH058",,"OHN001","OHS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.18","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","97596OH0580001-01","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$35","per person not applicable","per group not applicable",,,,,,"$35","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2612961","5"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","1","99734","OH","Individual","Yes","31-1185262","99734OH0050005","Ohio DentaTrust PPO - Pediatric High Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$29.97","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0050005-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsboh.dentalcareplus.com","https://hixindsboh.dentalcareplus.com","4"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","1","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0040005","DentaSpan Dental-Family High Option","99734OH004","7083617077","OHN003","OHS001",,"Existing","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$25.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0040005-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsboh.dentalcareplus.com","https://hixsgsboh.dentalcareplus.com","4"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","1","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0040005","DentaSpan Dental-Family High Option","99734OH004","7083617077","OHN003","OHS001",,"Existing","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$25.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0040005-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsboh.dentalcareplus.com","https://hixsgsboh.dentalcareplus.com","5"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","1","99734","OH","Individual","Yes","31-1185262","99734OH0050005","Ohio DentaTrust PPO - Pediatric High Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$29.97","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0050005-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsboh.dentalcareplus.com","https://hixindsboh.dentalcareplus.com","5"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","1","99734","OH","Individual","Yes","31-1185262","99734OH0050006","Ohio DentaTrust PPO - Pediatric Low Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$26.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0050006-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsboh.dentalcareplus.com","https://hixindsboh.dentalcareplus.com","6"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","1","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0040006","DentaSpan Dental-Family Low Option","99734OH004","7083617077","OHN003","OHS001",,"Existing","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$23.29","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0040006-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsboh.dentalcareplus.com","https://hixsgsboh.dentalcareplus.com","6"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","1","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0040006","DentaSpan Dental-Family Low Option","99734OH004","7083617077","OHN003","OHS001",,"Existing","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$23.29","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0040006-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsboh.dentalcareplus.com","https://hixsgsboh.dentalcareplus.com","7"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","1","99734","OH","Individual","Yes","31-1185262","99734OH0050006","Ohio DentaTrust PPO - Pediatric Low Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$26.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0050006-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsboh.dentalcareplus.com","https://hixindsboh.dentalcareplus.com","7"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","1","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0040011","DentaSpan Dental-Family High Option-Off Exchange","99734OH004","7083617077","OHN003","OHS001",,"New","PPO","High",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$18.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0040011-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsboh.dentalcareplus.com","https://hixsgsboh.dentalcareplus.com","8"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","1","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0040012","DentaSpan Dental-Family Low Option-Off Exchange","99734OH004","7083617077","OHN003","OHS001",,"New","PPO","Low",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$16.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0040012-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixsgsboh.dentalcareplus.com","https://hixsgsboh.dentalcareplus.com","9"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","2","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0040009","DentaSpan Dental-Child Only High Option-Off Exchange","99734OH004","7083617077","OHN003","OHS001",,"New","PPO","High",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$25.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0040009-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","2","99734","OH","Individual","Yes","31-1185262","99734OH0050007","Ohio DentaTrust PPO - Family High Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$21.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0050007-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsboh.dentalcareplus.com","https://hixindsboh.dentalcareplus.com","4"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","2","99734","OH","Individual","Yes","31-1185262","99734OH0050007","Ohio DentaTrust PPO - Family High Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","High",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$21.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0050007-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsboh.dentalcareplus.com","https://hixindsboh.dentalcareplus.com","5"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","2","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0040010","DentaSpan Dental-Child Only Low Option-Off Exchange","99734OH004","7083617077","OHN003","OHS001",,"New","PPO","Low",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$23.29","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0040010-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","2","99734","OH","Individual","Yes","31-1185262","99734OH0050008","Ohio DentaTrust PPO - Family Low Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$18.51","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0050008-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsboh.dentalcareplus.com","https://hixindsboh.dentalcareplus.com","6"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","2","99734","OH","Individual","Yes","31-1185262","99734OH0050008","Ohio DentaTrust PPO - Family Low Option","99734OH005","7083617077","OHN003","OHS001",,"Existing","PPO","Low",,"Both",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,"No","Allows Adult and Child-Only",,,,,"$18.51","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","https://hixenroll.insxcloud.com/payment","","99734OH0050008-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://hixindsboh.dentalcareplus.com","https://hixindsboh.dentalcareplus.com","7"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","3","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0010016","HMO - Plan #016","99734OH001","7083617077","OHN002","OHS002",,"New","HMO","High",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$36.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is limited to relief of pain, bleeding, swelling or other acute conditions.","No",,"","99734OH0010016-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","3","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0010017","HMO - Plan #017","99734OH001","7083617077","OHN002","OHS002",,"New","HMO","Low",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$31.60","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is limited to relief of pain, bleeding, swelling or other acute conditions.","No",,"","99734OH0010017-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","3","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0020021","PPO - Plan #017 - 900","99734OH002","7083617077","OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$38.75","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020021-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","3","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0020022","PPO - Plan #018 - 900","99734OH002","7083617077","OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$38.23","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020022-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","3","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0020023","PPO - Plan #019 - 900","99734OH002","7083617077","OHN001","OHS001",,"New","PPO","Low",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$33.67","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020023-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","3","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0020024","PPO - Plan #020 - 900","99734OH002","7083617077","OHN001","OHS001",,"New","PPO","Low",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$33.25","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020024-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","3","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0020025","PPO - Plan #017 - 600","99734OH002","7083617077","OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$37.26","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020025-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","3","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0020026","PPO - Plan #018 - 600","99734OH002","7083617077","OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$36.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020026-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","3","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0020027","PPO - Plan #019 - 600","99734OH002","7083617077","OHN001","OHS001",,"New","PPO","Low",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$32.46","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020027-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2016","OH","99734","SERFF","5","2015-08-20 12:28:36","3","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0020028","PPO - Plan #020 - 600","99734OH002","7083617077","OHN001","OHS001",,"New","PPO","Low",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,"No","Allows Child-Only",,,,,"$32.07","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,"","99734OH0020028-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","1","99969","OH","SHOP (Small Group)","Yes","34-1442712","99969OH0070002","Pediatric Dental","99969OH007",,"OHN004","OHS006",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$27.15","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","99969OH0070002-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","1","99969","OH","Individual","No","34-1442712","99969OH0040001","Market 1000","99969OH004",,"OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040001-00","Standard Gold Off Exchange Plan",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505638000000000",,"4"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","1","99969","OH","Individual","Yes","34-1442712","99969OH0060002","MedMutual Pediatric Dental","99969OH006",,"OHN004","OHS006",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$24.93","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","99969OH0060002-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","1","99969","OH","SHOP (Small Group)","No","34-1442712","99969OH0050017","Market Gold 2520-1000","99969OH005",,"OHN001","OHS001","OHF004","New","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0050017-00","Standard Gold Off Exchange Plan",,"0.79566764831543","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505651000000000",,"4"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","1","99969","OH","SHOP (Small Group)","No","34-1442712","99969OH0050017","Market Gold 2520-1000","99969OH005",,"OHN001","OHS001","OHF004","New","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0050017-01","Standard Gold On Exchange Plan",,"0.79566764831543","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505651000000000",,"5"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","1","99969","OH","Individual","No","34-1442712","99969OH0040001","Market 1000","99969OH004",,"OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040001-01","Standard Gold On Exchange Plan",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505638000000000",,"5"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","1","99969","OH","Individual","No","34-1442712","99969OH0040001","Market 1000","99969OH004",,"OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505653000000000",,"6"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","1","99969","OH","Individual","No","34-1442712","99969OH0040001","Market 1000","99969OH004",,"OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040001-03","Limited Cost Sharing Plan Variation",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505638000000000",,"7"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","1","99969","OH","Individual","No","34-1442712","99969OH0040002","Market Child Only 1000","99969OH004",,"OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040002-00","Standard Gold Off Exchange Plan",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","20%",,,,,"$3,000","$3000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505638000000000",,"8"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","1","99969","OH","Individual","No","34-1442712","99969OH0040002","Market Child Only 1000","99969OH004",,"OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040002-01","Standard Gold On Exchange Plan",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","20%",,,,,"$3,000","$3000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505638000000000",,"9"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","1","99969","OH","Individual","No","34-1442712","99969OH0040002","Market Child Only 1000","99969OH004",,"OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505653000000000",,"10"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","1","99969","OH","Individual","No","34-1442712","99969OH0040002","Market Child Only 1000","99969OH004",,"OHN001","OHS002","OHF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040002-03","Limited Cost Sharing Plan Variation",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","20%",,,,,"$3,000","$3000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505638000000000",,"11"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","2","99969","OH","SHOP (Small Group)","No","34-1442712","99969OH0050013","Market Silver 3530-2500","99969OH005",,"OHN001","OHS001","OHF004","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0050013-00","Standard Silver Off Exchange Plan",,"0.706804931163788","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$100","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505652000000000",,"4"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","2","99969","OH","Individual","Yes","34-1442712","99969OH0060003","MedMutual Dental 1","99969OH006",,"OHN004","OHS006",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.93","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","99969OH0060003-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","2","99969","OH","Individual","No","34-1442712","99969OH0040022","Market 1750","99969OH004",,"OHN001","OHS003","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040023","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040022-00","Standard Silver Off Exchange Plan",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25%",,,,,"$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505640000000000",,"4"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","2","99969","OH","Individual","No","34-1442712","99969OH0040022","Market 1750","99969OH004",,"OHN001","OHS003","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040023","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040022-06","94% AV Level Silver Plan",,"0.93464720249176","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$400","$30","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505658000000000",,"10"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","2","99969","OH","Individual","No","34-1442712","99969OH0040023","Market Child Only 1750","99969OH004",,"OHN001","OHS003","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040023-00","Standard Silver Off Exchange Plan",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","per group not applicable","25%",,,,,"$5,250","$5250 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505640000000000",,"11"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","2","99969","OH","Individual","No","34-1442712","99969OH0040023","Market Child Only 1750","99969OH004",,"OHN001","OHS003","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040023-01","Standard Silver On Exchange Plan",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","per group not applicable","25%",,,,,"$5,250","$5250 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505640000000000",,"12"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","2","99969","OH","Individual","No","34-1442712","99969OH0040023","Market Child Only 1750","99969OH004",,"OHN001","OHS003","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040023-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505655000000000",,"13"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","2","99969","OH","Individual","No","34-1442712","99969OH0040023","Market Child Only 1750","99969OH004",,"OHN001","OHS003","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040023-03","Limited Cost Sharing Plan Variation",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","per group not applicable","25%",,,,,"$5,250","$5250 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505640000000000",,"14"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","2","99969","OH","Individual","No","34-1442712","99969OH0040023","Market Child Only 1750","99969OH004",,"OHN001","OHS003","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040023-04","73% AV Level Silver Plan",,"0.732713162899017","No","Yes","No","100%",,"$1,500","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","per group not applicable","25%",,,,,"$5,250","$5250 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505656000000000",,"15"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","2","99969","OH","Individual","No","34-1442712","99969OH0040023","Market Child Only 1750","99969OH004",,"OHN001","OHS003","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040023-05","87% AV Level Silver Plan",,"0.864307463169098","No","Yes","No","100%",,"$800","$0","$400","$200","$100","$1,000","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","per group not applicable","10%",,,,,"$5,250","$5250 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505657000000000",,"16"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","2","99969","OH","Individual","No","34-1442712","99969OH0040023","Market Child Only 1750","99969OH004",,"OHN001","OHS003","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040023-06","94% AV Level Silver Plan",,"0.93464720249176","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$400","$30","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","10%",,,,,"$5,250","$5250 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505658000000000",,"17"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","3","99969","OH","Individual","Yes","34-1442712","99969OH0060004","MedMutual Dental 2","99969OH006",,"OHN004","OHS006",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.93","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","99969OH0060004-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","3","99969","OH","Individual","No","34-1442712","99969OH0040016","Market 2400","99969OH004",,"OHN001","OHS001","OHF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040017","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040016-00","Standard Silver Off Exchange Plan",,"0.68081796169281","Yes","Yes","No","100%",,"$2,400","$0","$1,000","$200","$2,400","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505642000000000",,"4"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","3","99969","OH","Individual","No","34-1442712","99969OH0040016","Market 2400","99969OH004",,"OHN001","OHS001","OHF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040017","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040016-01","Standard Silver On Exchange Plan",,"0.68081796169281","Yes","Yes","No","100%",,"$2,400","$0","$1,000","$200","$2,400","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505642000000000",,"5"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","3","99969","OH","Individual","No","34-1442712","99969OH0040016","Market 2400","99969OH004",,"OHN001","OHS001","OHF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040017","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505942000000000",,"6"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","3","99969","OH","Individual","No","34-1442712","99969OH0040016","Market 2400","99969OH004",,"OHN001","OHS001","OHF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040017","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040016-03","Limited Cost Sharing Plan Variation",,"0.68081796169281","Yes","Yes","No","100%",,"$2,400","$0","$1,000","$200","$2,400","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","$4800 per group","20%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505642000000000",,"7"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","3","99969","OH","Individual","No","34-1442712","99969OH0040016","Market 2400","99969OH004",,"OHN001","OHS001","OHF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040017","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040016-04","73% AV Level Silver Plan",,"0.739117741584778","Yes","Yes","No","100%",,"$1,500","$0","$1,200","$200","$1,500","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505943000000000",,"8"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","3","99969","OH","Individual","No","34-1442712","99969OH0040016","Market 2400","99969OH004",,"OHN001","OHS001","OHF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040017","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040016-05","87% AV Level Silver Plan",,"0.861671566963196","Yes","Yes","No","100%",,"$350","$0","$1,400","$200","$350","$0","$700","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","$700 per group","20%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505665000000000",,"9"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","3","99969","OH","Individual","No","34-1442712","99969OH0040016","Market 2400","99969OH004",,"OHN001","OHS001","OHF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040017","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040016-06","94% AV Level Silver Plan",,"0.93737930059433","Yes","Yes","No","100%",,"$100","$0","$700","$200","$100","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"$7,200","$7200 per person","$14400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505666000000000",,"10"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","3","99969","OH","Individual","No","34-1442712","99969OH0040017","Market Child Only 2400","99969OH004",,"OHN001","OHS001","OHF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040017-00","Standard Silver Off Exchange Plan",,"0.68081796169281","Yes","Yes","No","100%",,"$2,400","$0","$1,000","$200","$2,400","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","per group not applicable","20%",,,,,"$7,200","$7200 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505642000000000",,"11"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","3","99969","OH","Individual","No","34-1442712","99969OH0040017","Market Child Only 2400","99969OH004",,"OHN001","OHS001","OHF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040017-01","Standard Silver On Exchange Plan",,"0.68081796169281","Yes","Yes","No","100%",,"$2,400","$0","$1,000","$200","$2,400","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","per group not applicable","20%",,,,,"$7,200","$7200 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505642000000000",,"12"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","3","99969","OH","Individual","No","34-1442712","99969OH0040017","Market Child Only 2400","99969OH004",,"OHN001","OHS001","OHF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505942000000000",,"13"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","3","99969","OH","Individual","No","34-1442712","99969OH0040017","Market Child Only 2400","99969OH004",,"OHN001","OHS001","OHF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040017-03","Limited Cost Sharing Plan Variation",,"0.68081796169281","Yes","Yes","No","100%",,"$2,400","$0","$1,000","$200","$2,400","$0","$300","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,400","$2400 per person","per group not applicable","20%",,,,,"$7,200","$7200 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505642000000000",,"14"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","3","99969","OH","Individual","No","34-1442712","99969OH0040017","Market Child Only 2400","99969OH004",,"OHN001","OHS001","OHF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040017-04","73% AV Level Silver Plan",,"0.739117741584778","Yes","Yes","No","100%",,"$1,500","$0","$1,200","$200","$1,500","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","per group not applicable","20%",,,,,"$7,200","$7200 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505943000000000",,"15"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","3","99969","OH","Individual","No","34-1442712","99969OH0040017","Market Child Only 2400","99969OH004",,"OHN001","OHS001","OHF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040017-05","87% AV Level Silver Plan",,"0.861671566963196","Yes","Yes","No","100%",,"$350","$0","$1,400","$200","$350","$0","$700","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","$350 per person","per group not applicable","20%",,,,,"$7,200","$7200 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505665000000000",,"16"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","3","99969","OH","Individual","No","34-1442712","99969OH0040017","Market Child Only 2400","99969OH004",,"OHN001","OHS001","OHF006","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040017-06","94% AV Level Silver Plan",,"0.93737930059433","Yes","Yes","No","100%",,"$100","$0","$700","$200","$100","$0","$400","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable","10%",,,,,"$7,200","$7200 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505666000000000",,"17"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","4","99969","OH","Individual","Yes","34-1442712","99969OH0060005","MedMutual Dental 3","99969OH006",,"OHN004","OHS006",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.93","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes",,"","99969OH0060005-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","4","99969","OH","Individual","No","34-1442712","99969OH0040018","Market 4000 HSA","99969OH004",,"OHN001","OHS003","OHF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040019","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040018-00","Standard Silver Off Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505644000000000",,"4"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","4","99969","OH","Individual","No","34-1442712","99969OH0040018","Market 4000 HSA","99969OH004",,"OHN001","OHS003","OHF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040019","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040018-01","Standard Silver On Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505644000000000",,"5"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","4","99969","OH","Individual","No","34-1442712","99969OH0040018","Market 4000 HSA","99969OH004",,"OHN001","OHS003","OHF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040019","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505671000000000",,"6"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","4","99969","OH","Individual","No","34-1442712","99969OH0040018","Market 4000 HSA","99969OH004",,"OHN001","OHS003","OHF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040019","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040018-03","Limited Cost Sharing Plan Variation",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505644000000000",,"7"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","4","99969","OH","Individual","No","34-1442712","99969OH0040018","Market 4000 HSA","99969OH004",,"OHN001","OHS003","OHF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040019","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040018-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$3,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505672000000000",,"8"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","4","99969","OH","Individual","No","34-1442712","99969OH0040018","Market 4000 HSA","99969OH004",,"OHN001","OHS003","OHF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040019","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040018-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,200","$0","$0","$200","$1,200","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505673000000000",,"9"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","4","99969","OH","Individual","No","34-1442712","99969OH0040018","Market 4000 HSA","99969OH004",,"OHN001","OHS003","OHF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040019","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040018-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505674000000000",,"10"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","4","99969","OH","Individual","No","34-1442712","99969OH0040019","Market Child Only 4000 HSA","99969OH004",,"OHN001","OHS003","OHF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040019-00","Standard Silver Off Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","per group not applicable","0%",,,,,"$12,000","$12000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505644000000000",,"11"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","4","99969","OH","Individual","No","34-1442712","99969OH0040019","Market Child Only 4000 HSA","99969OH004",,"OHN001","OHS003","OHF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040019-01","Standard Silver On Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","per group not applicable","0%",,,,,"$12,000","$12000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505644000000000",,"12"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","4","99969","OH","Individual","No","34-1442712","99969OH0040019","Market Child Only 4000 HSA","99969OH004",,"OHN001","OHS003","OHF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505671000000000",,"13"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","4","99969","OH","Individual","No","34-1442712","99969OH0040019","Market Child Only 4000 HSA","99969OH004",,"OHN001","OHS003","OHF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040019-03","Limited Cost Sharing Plan Variation",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","per group not applicable","0%",,,,,"$12,000","$12000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505644000000000",,"14"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","4","99969","OH","Individual","No","34-1442712","99969OH0040019","Market Child Only 4000 HSA","99969OH004",,"OHN001","OHS003","OHF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040019-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$3,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","per group not applicable","0%",,,,,"$12,000","$12000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505672000000000",,"15"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","4","99969","OH","Individual","No","34-1442712","99969OH0040019","Market Child Only 4000 HSA","99969OH004",,"OHN001","OHS003","OHF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040019-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,200","$0","$0","$200","$1,200","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","per group not applicable","0%",,,,,"$12,000","$12000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505673000000000",,"16"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","4","99969","OH","Individual","No","34-1442712","99969OH0040019","Market Child Only 4000 HSA","99969OH004",,"OHN001","OHS003","OHF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040019-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","per group not applicable","0%",,,,,"$12,000","$12000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505674000000000",,"17"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","5","99969","OH","Individual","No","34-1442712","99969OH0040020","Market 5000","99969OH004",,"OHN001","OHS001","OHF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040021","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040020-00","Standard Bronze Off Exchange Plan",,"0.61008095741272","No","Yes","No","100%",,"$5,000","$0","$20","$200","$900","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505646000000000",,"4"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","5","99969","OH","Individual","No","34-1442712","99969OH0040020","Market 5000","99969OH004",,"OHN001","OHS001","OHF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040021","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040020-01","Standard Bronze On Exchange Plan",,"0.61008095741272","No","Yes","No","100%",,"$5,000","$0","$20","$200","$900","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505646000000000",,"5"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","5","99969","OH","Individual","No","34-1442712","99969OH0040020","Market 5000","99969OH004",,"OHN001","OHS001","OHF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040021","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040020-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505679000000000",,"6"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","5","99969","OH","Individual","No","34-1442712","99969OH0040020","Market 5000","99969OH004",,"OHN001","OHS001","OHF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040021","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040020-03","Limited Cost Sharing Plan Variation",,"0.61008095741272","No","Yes","No","100%",,"$5,000","$0","$20","$200","$900","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","40%",,,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505646000000000",,"7"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","5","99969","OH","Individual","No","34-1442712","99969OH0040021","Market Child Only 5000","99969OH004",,"OHN001","OHS001","OHF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040021-00","Standard Bronze Off Exchange Plan",,"0.61008095741272","No","Yes","No","100%",,"$5,000","$0","$20","$200","$900","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","per group not applicable","40%",,,,,"$15,000","$15000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505646000000000",,"8"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","5","99969","OH","Individual","No","34-1442712","99969OH0040021","Market Child Only 5000","99969OH004",,"OHN001","OHS001","OHF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040021-01","Standard Bronze On Exchange Plan",,"0.61008095741272","No","Yes","No","100%",,"$5,000","$0","$20","$200","$900","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","per group not applicable","40%",,,,,"$15,000","$15000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505646000000000",,"9"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","5","99969","OH","Individual","No","34-1442712","99969OH0040021","Market Child Only 5000","99969OH004",,"OHN001","OHS001","OHF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040021-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505679000000000",,"10"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","5","99969","OH","Individual","No","34-1442712","99969OH0040021","Market Child Only 5000","99969OH004",,"OHN001","OHS001","OHF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040021-03","Limited Cost Sharing Plan Variation",,"0.61008095741272","No","Yes","No","100%",,"$5,000","$0","$20","$200","$900","$1,500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","per group not applicable","40%",,,,,"$15,000","$15000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"$0","$0 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505646000000000",,"11"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","6","99969","OH","Individual","No","34-1442712","99969OH0040011","Market 6000 HSA","99969OH004",,"OHN001","OHS001","OHF005","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040012","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040011-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505648000000000",,"4"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","6","99969","OH","Individual","No","34-1442712","99969OH0040011","Market 6000 HSA","99969OH004",,"OHN001","OHS001","OHF005","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040012","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040011-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505648000000000",,"5"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","6","99969","OH","Individual","No","34-1442712","99969OH0040011","Market 6000 HSA","99969OH004",,"OHN001","OHS001","OHF005","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040012","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505681000000000",,"6"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","6","99969","OH","Individual","No","34-1442712","99969OH0040011","Market 6000 HSA","99969OH004",,"OHN001","OHS001","OHF005","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0040012","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040011-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505648000000000",,"7"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","6","99969","OH","Individual","No","34-1442712","99969OH0040012","Market Child Only 6000 HSA","99969OH004",,"OHN001","OHS001","OHF005","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040012-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","per group not applicable","0%",,,,,"$18,000","$18000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505648000000000",,"8"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","6","99969","OH","Individual","No","34-1442712","99969OH0040012","Market Child Only 6000 HSA","99969OH004",,"OHN001","OHS001","OHF005","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040012-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","per group not applicable","0%",,,,,"$18,000","$18000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505648000000000",,"9"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","6","99969","OH","Individual","No","34-1442712","99969OH0040012","Market Child Only 6000 HSA","99969OH004",,"OHN001","OHS001","OHF005","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505681000000000",,"10"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","6","99969","OH","Individual","No","34-1442712","99969OH0040012","Market Child Only 6000 HSA","99969OH004",,"OHN001","OHS001","OHF005","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040012-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","per group not applicable","0%",,,,,"$18,000","$18000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505648000000000",,"11"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","7","99969","OH","Individual","No","34-1442712","99969OH0040013","Market Young Adult Essentials","99969OH004",,"OHN001","OHS001","OHF005","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040013-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$3,300","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505650000000000",,"4"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","7","99969","OH","Individual","No","34-1442712","99969OH0040013","Market Young Adult Essentials","99969OH004",,"OHN001","OHS001","OHF005","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","3","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0040013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,900","$0","$0","$200","$3,300","$200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$100,000","$100000 per person","$200000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,550","$20550 per person","$41100 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001505650000000000",,"5"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","8","99969","OH","Individual","No","34-1442712","99969OH0080009","Market HMO 1000 - ProMedica","99969OH008",,"OHN003","OHS004","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080010","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080009-00","Standard Gold Off Exchange Plan",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005412000000000",,"4"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","8","99969","OH","Individual","No","34-1442712","99969OH0080009","Market HMO 1000 - ProMedica","99969OH008",,"OHN003","OHS004","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080010","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080009-01","Standard Gold On Exchange Plan",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005412000000000",,"5"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","8","99969","OH","Individual","No","34-1442712","99969OH0080009","Market HMO 1000 - ProMedica","99969OH008",,"OHN003","OHS004","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080010","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005413000000000",,"6"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","8","99969","OH","Individual","No","34-1442712","99969OH0080009","Market HMO 1000 - ProMedica","99969OH008",,"OHN003","OHS004","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080010","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080009-03","Limited Cost Sharing Plan Variation",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005412000000000",,"7"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","8","99969","OH","Individual","No","34-1442712","99969OH0080010","Market Child Only HMO 1000 - ProMedica","99969OH008",,"OHN003","OHS004","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080010-00","Standard Gold Off Exchange Plan",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005412000000000",,"8"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","8","99969","OH","Individual","No","34-1442712","99969OH0080010","Market Child Only HMO 1000 - ProMedica","99969OH008",,"OHN003","OHS004","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080010-01","Standard Gold On Exchange Plan",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005412000000000",,"9"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","8","99969","OH","Individual","No","34-1442712","99969OH0080010","Market Child Only HMO 1000 - ProMedica","99969OH008",,"OHN003","OHS004","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005413000000000",,"10"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","8","99969","OH","Individual","No","34-1442712","99969OH0080010","Market Child Only HMO 1000 - ProMedica","99969OH008",,"OHN003","OHS004","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080010-03","Limited Cost Sharing Plan Variation",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005412000000000",,"11"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","9","99969","OH","Individual","No","34-1442712","99969OH0080001","Market HMO 1000 - Mercy","99969OH008",,"OHN002","OHS005","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080001-00","Standard Gold Off Exchange Plan",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005398000000000",,"4"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","9","99969","OH","Individual","No","34-1442712","99969OH0080001","Market HMO 1000 - Mercy","99969OH008",,"OHN002","OHS005","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080001-01","Standard Gold On Exchange Plan",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005398000000000",,"5"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","9","99969","OH","Individual","No","34-1442712","99969OH0080001","Market HMO 1000 - Mercy","99969OH008",,"OHN002","OHS005","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005399000000000",,"6"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","9","99969","OH","Individual","No","34-1442712","99969OH0080001","Market HMO 1000 - Mercy","99969OH008",,"OHN002","OHS005","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080001-03","Limited Cost Sharing Plan Variation",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005398000000000",,"7"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","9","99969","OH","Individual","No","34-1442712","99969OH0080002","Market Child Only HMO 1000 - Mercy","99969OH008",,"OHN002","OHS005","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080002-00","Standard Gold Off Exchange Plan",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005398000000000",,"8"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","9","99969","OH","Individual","No","34-1442712","99969OH0080002","Market Child Only HMO 1000 - Mercy","99969OH008",,"OHN002","OHS005","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080002-01","Standard Gold On Exchange Plan",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005398000000000",,"9"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","9","99969","OH","Individual","No","34-1442712","99969OH0080002","Market Child Only HMO 1000 - Mercy","99969OH008",,"OHN002","OHS005","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005399000000000",,"10"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","9","99969","OH","Individual","No","34-1442712","99969OH0080002","Market Child Only HMO 1000 - Mercy","99969OH008",,"OHN002","OHS005","OHF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080002-03","Limited Cost Sharing Plan Variation",,"0.780430257320404","No","Yes","No","100%",,"$1,000","$20","$1,300","$200","$100","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005398000000000",,"11"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","10","99969","OH","Individual","No","34-1442712","99969OH0080003","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS005","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080004","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080003-00","Standard Silver Off Exchange Plan",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005400000000000",,"4"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","10","99969","OH","Individual","No","34-1442712","99969OH0080003","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS005","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080004","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080003-01","Standard Silver On Exchange Plan",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005400000000000",,"5"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","10","99969","OH","Individual","No","34-1442712","99969OH0080003","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS005","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080004","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005401000000000",,"6"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","10","99969","OH","Individual","No","34-1442712","99969OH0080003","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS005","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080004","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080003-03","Limited Cost Sharing Plan Variation",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","$3500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005400000000000",,"7"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","10","99969","OH","Individual","No","34-1442712","99969OH0080003","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS005","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080004","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080003-04","73% AV Level Silver Plan",,"0.732713162899017","No","Yes","No","100%",,"$1,500","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005402000000000",,"8"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","10","99969","OH","Individual","No","34-1442712","99969OH0080003","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS005","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080004","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080003-05","87% AV Level Silver Plan",,"0.864307463169098","No","Yes","No","100%",,"$800","$0","$400","$200","$100","$1,000","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005403000000000",,"9"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","10","99969","OH","Individual","No","34-1442712","99969OH0080003","Market HMO 1750 - Mercy","99969OH008",,"OHN002","OHS005","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080004","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080003-06","94% AV Level Silver Plan",,"0.93464720249176","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$400","$30","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005404000000000",,"10"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","10","99969","OH","Individual","No","34-1442712","99969OH0080004","Market Child Only HMO 1750 - Mercy","99969OH008",,"OHN002","OHS005","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080004-00","Standard Silver Off Exchange Plan",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005400000000000",,"11"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","10","99969","OH","Individual","No","34-1442712","99969OH0080004","Market Child Only HMO 1750 - Mercy","99969OH008",,"OHN002","OHS005","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080004-01","Standard Silver On Exchange Plan",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005400000000000",,"12"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","10","99969","OH","Individual","No","34-1442712","99969OH0080004","Market Child Only HMO 1750 - Mercy","99969OH008",,"OHN002","OHS005","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005401000000000",,"13"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","10","99969","OH","Individual","No","34-1442712","99969OH0080004","Market Child Only HMO 1750 - Mercy","99969OH008",,"OHN002","OHS005","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080004-03","Limited Cost Sharing Plan Variation",,"0.71038430929184","No","Yes","No","100%",,"$1,800","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,750","$1750 per person","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005400000000000",,"14"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","10","99969","OH","Individual","No","34-1442712","99969OH0080004","Market Child Only HMO 1750 - Mercy","99969OH008",,"OHN002","OHS005","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080004-04","73% AV Level Silver Plan",,"0.732713162899017","No","Yes","No","100%",,"$1,500","$20","$1,400","$200","$100","$1,400","$120","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005402000000000",,"15"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","10","99969","OH","Individual","No","34-1442712","99969OH0080004","Market Child Only HMO 1750 - Mercy","99969OH008",,"OHN002","OHS005","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080004-05","87% AV Level Silver Plan",,"0.864307463169098","No","Yes","No","100%",,"$800","$0","$400","$200","$100","$1,000","$40","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005403000000000",,"16"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","10","99969","OH","Individual","No","34-1442712","99969OH0080004","Market Child Only HMO 1750 - Mercy","99969OH008",,"OHN002","OHS005","OHF002","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,"$350","0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080004-06","94% AV Level Silver Plan",,"0.93464720249176","No","Yes","No","100%",,"$100","$0","$400","$200","$100","$400","$30","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005404000000000",,"17"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","11","99969","OH","Individual","No","34-1442712","99969OH0080005","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080006","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080005-00","Standard Silver Off Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005405000000000",,"4"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","11","99969","OH","Individual","No","34-1442712","99969OH0080005","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080006","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080005-01","Standard Silver On Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005405000000000",,"5"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","11","99969","OH","Individual","No","34-1442712","99969OH0080005","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080006","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005406000000000",,"6"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","11","99969","OH","Individual","No","34-1442712","99969OH0080005","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080006","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080005-03","Limited Cost Sharing Plan Variation",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005405000000000",,"7"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","11","99969","OH","Individual","No","34-1442712","99969OH0080005","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080006","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080005-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$3,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005407000000000",,"8"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","11","99969","OH","Individual","No","34-1442712","99969OH0080005","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080006","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080005-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,200","$0","$0","$200","$1,200","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005408000000000",,"9"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","11","99969","OH","Individual","No","34-1442712","99969OH0080005","Market HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080006","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080005-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005409000000000",,"10"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","11","99969","OH","Individual","No","34-1442712","99969OH0080006","Market Child Only HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080006-00","Standard Silver Off Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005405000000000",,"11"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","11","99969","OH","Individual","No","34-1442712","99969OH0080006","Market Child Only HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080006-01","Standard Silver On Exchange Plan",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005405000000000",,"12"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","11","99969","OH","Individual","No","34-1442712","99969OH0080006","Market Child Only HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005406000000000",,"13"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","11","99969","OH","Individual","No","34-1442712","99969OH0080006","Market Child Only HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080006-03","Limited Cost Sharing Plan Variation",,"0.686785042285919","Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005405000000000",,"14"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","11","99969","OH","Individual","No","34-1442712","99969OH0080006","Market Child Only HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080006-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$3,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005407000000000",,"15"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","11","99969","OH","Individual","No","34-1442712","99969OH0080006","Market Child Only HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080006-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,200","$0","$0","$200","$1,200","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005408000000000",,"16"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","11","99969","OH","Individual","No","34-1442712","99969OH0080006","Market Child Only HMO 4000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080006-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005409000000000",,"17"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","12","99969","OH","Individual","No","34-1442712","99969OH0080007","Market HMO 6000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080008","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080007-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005410000000000",,"4"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","12","99969","OH","Individual","No","34-1442712","99969OH0080007","Market HMO 6000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080008","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080007-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005410000000000",,"5"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","12","99969","OH","Individual","No","34-1442712","99969OH0080007","Market HMO 6000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080008","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005411000000000",,"6"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","12","99969","OH","Individual","No","34-1442712","99969OH0080007","Market HMO 6000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult-Only","99969OH0080008","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080007-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005410000000000",,"7"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","12","99969","OH","Individual","No","34-1442712","99969OH0080008","Market Child Only HMO 6000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080008-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005410000000000",,"8"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","12","99969","OH","Individual","No","34-1442712","99969OH0080008","Market Child Only HMO 6000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080008-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005410000000000",,"9"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","12","99969","OH","Individual","No","34-1442712","99969OH0080008","Market Child Only HMO 6000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005411000000000",,"10"
"2016","OH","99969","SERFF","12","2016-03-05 07:51:04","12","99969","OH","Individual","No","34-1442712","99969OH0080008","Market Child Only HMO 6000 HSA - Mercy","99969OH008",,"OHN002","OHS005","OHF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Covered as Non-Network","Yes","https://mmenroll.medmutual.com/payment/home/ffmpayment","https://www.medmutual.com/~/media/46857AF483D94EA49ADA66A2EAE7A784.ashx","99969OH0080008-03","Limited Cost Sharing Plan Variation",,"0.617518126964569","Yes","Yes","No","100%",,"$6,000","$0","$0","$200","$4,000","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=005005410000000000",,"11"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","1","10091","OR","Individual","Yes","93-0245545","10091OR0480001","Dental Advantage Essentials Core","10091OR048",,"ORN003","ORS004",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$33.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.exchangepay.pacificsource.com/FFE/Individual/","","10091OR0480001-01","Standard High On Exchange Plan","84.66%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/oregon/individual-dental-brochure-2016","4"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","1","10091","OR","Individual","No","93-0245545","10091OR0370003","PSN Catastrophic","10091OR037",,"ORN001","ORS002","ORF007","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","3","2016-01-01",,"Yes","Emergency care only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0370003-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/oregon/catastrophic-OUT","http://www.PacificSource.com/oregon/individual-brochure-2016","4"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","1","10091","OR","Individual","No","93-0245545","10091OR0370003","PSN Catastrophic","10091OR037",,"ORN001","ORS002","ORF007","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","3","2016-01-01",,"Yes","Emergency care only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0370003-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/oregon/catastrophic","http://www.PacificSource.com/oregon/individual-brochure-2016","5"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","2","10091","OR","Individual","Yes","93-0245545","10091OR0490001","Dental Advantage 0-20-50","10091OR049",,"ORN004","ORS003",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","No","http://www.exchangepay.pacificsource.com/FFE/Individual/","","10091OR0490001-00","Standard High Off Exchange Plan","86.53%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/oregon/individual-dental-brochure-2016","4"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","2","10091","OR","Individual","No","93-0245545","10091OR0360004","PacificSource Oregon Standard Bronze Plan PSN","10091OR036",,"ORN001","ORS002","ORF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0360004-00","Standard Bronze Off Exchange Plan",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$20","$1,130","$150","$5,000","$60","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/oregon/ind-psn-sb-OUT","http://www.PacificSource.com/oregon/individual-brochure-2016","4"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","2","10091","OR","Individual","No","93-0245545","10091OR0360004","PacificSource Oregon Standard Bronze Plan PSN","10091OR036",,"ORN001","ORS002","ORF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0360004-01","Standard Bronze On Exchange Plan",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$20","$1,130","$150","$5,000","$60","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/oregon/ind-psn-sb","http://www.PacificSource.com/oregon/individual-brochure-2016","5"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","2","10091","OR","Individual","Yes","93-0245545","10091OR0490001","Dental Advantage 0-20-50","10091OR049",,"ORN004","ORS003",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Non-participating providers","No","http://www.exchangepay.pacificsource.com/FFE/Individual/","","10091OR0490001-01","Standard High On Exchange Plan","86.53%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/oregon/individual-dental-brochure-2016","5"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","2","10091","OR","Individual","No","93-0245545","10091OR0360004","PacificSource Oregon Standard Bronze Plan PSN","10091OR036",,"ORN001","ORS002","ORF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0360004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.PacificSource.com/oregon/ind-psn-sb-0","http://www.PacificSource.com/oregon/individual-brochure-2016","6"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","2","10091","OR","Individual","No","93-0245545","10091OR0360004","PacificSource Oregon Standard Bronze Plan PSN","10091OR036",,"ORN001","ORS002","ORF004","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0360004-03","Limited Cost Sharing Plan Variation",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$20","$1,130","$150","$5,000","$60","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/oregon/ind-psn-sb-AI","http://www.PacificSource.com/oregon/individual-brochure-2016","7"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","2","10091","OR","Individual","No","93-0245545","10091OR0360005","PacificSource Oregon Standard Silver Plan PSN","10091OR036",,"ORN001","ORS002","ORF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0360005-00","Standard Silver Off Exchange Plan",,"0.696861922740936","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.PacificSource.com/oregon/ind-psn-ss-OUT","http://www.PacificSource.com/oregon/individual-brochure-2016","8"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","2","10091","OR","Individual","No","93-0245545","10091OR0360005","PacificSource Oregon Standard Silver Plan PSN","10091OR036",,"ORN001","ORS002","ORF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0360005-01","Standard Silver On Exchange Plan",,"0.696861922740936","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.PacificSource.com/oregon/ind-psn-ss","http://www.PacificSource.com/oregon/individual-brochure-2016","9"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","2","10091","OR","Individual","No","93-0245545","10091OR0360005","PacificSource Oregon Standard Silver Plan PSN","10091OR036",,"ORN001","ORS002","ORF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0360005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.PacificSource.com/oregon/ind-psn-ss-0","http://www.PacificSource.com/oregon/individual-brochure-2016","10"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","2","10091","OR","Individual","No","93-0245545","10091OR0360005","PacificSource Oregon Standard Silver Plan PSN","10091OR036",,"ORN001","ORS002","ORF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0360005-03","Limited Cost Sharing Plan Variation",,"0.696861922740936","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.PacificSource.com/oregon/ind-psn-ss-AI","http://www.PacificSource.com/oregon/individual-brochure-2016","11"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","2","10091","OR","Individual","No","93-0245545","10091OR0360005","PacificSource Oregon Standard Silver Plan PSN","10091OR036",,"ORN001","ORS002","ORF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0360005-04","73% AV Level Silver Plan",,"0.73930150270462","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.PacificSource.com/oregon/ind-psn-ss-73","http://www.PacificSource.com/oregon/individual-brochure-2016","12"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","2","10091","OR","Individual","No","93-0245545","10091OR0360005","PacificSource Oregon Standard Silver Plan PSN","10091OR036",,"ORN001","ORS002","ORF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0360005-05","87% AV Level Silver Plan",,"0.87958174943924","No","Yes","No","100%",,"$800","$20","$650","$150","$800","$500","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.PacificSource.com/oregon/ind-psn-ss-87","http://www.PacificSource.com/oregon/individual-brochure-2016","13"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","2","10091","OR","Individual","No","93-0245545","10091OR0360005","PacificSource Oregon Standard Silver Plan PSN","10091OR036",,"ORN001","ORS002","ORF003","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0360005-06","94% AV Level Silver Plan",,"0.944462716579437","No","Yes","No","100%",,"$100","$0","$650","$150","$100","$300","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.PacificSource.com/oregon/ind-psn-ss-94","http://www.PacificSource.com/oregon/individual-brochure-2016","14"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","2","10091","OR","Individual","No","93-0245545","10091OR0360009","PacificSource Oregon Standard Gold Plan PSN","10091OR036",,"ORN001","ORS002","ORF002","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0360009-00","Standard Gold Off Exchange Plan",,"0.783612370491028","No","Yes","No","100%",,"$1,250","$20","$600","$150","$1,250","$460","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.PacificSource.com/oregon/ind-psn-sg-OUT","http://www.PacificSource.com/oregon/individual-brochure-2016","15"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","2","10091","OR","Individual","No","93-0245545","10091OR0360009","PacificSource Oregon Standard Gold Plan PSN","10091OR036",,"ORN001","ORS002","ORF002","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0360009-01","Standard Gold On Exchange Plan",,"0.783612370491028","No","Yes","No","100%",,"$1,250","$20","$600","$150","$1,250","$460","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.PacificSource.com/oregon/ind-psn-sg","http://www.PacificSource.com/oregon/individual-brochure-2016","16"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","2","10091","OR","Individual","No","93-0245545","10091OR0360009","PacificSource Oregon Standard Gold Plan PSN","10091OR036",,"ORN001","ORS002","ORF002","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0360009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.PacificSource.com/oregon/ind-psn-sg-0","http://www.PacificSource.com/oregon/individual-brochure-2016","17"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","2","10091","OR","Individual","No","93-0245545","10091OR0360009","PacificSource Oregon Standard Gold Plan PSN","10091OR036",,"ORN001","ORS002","ORF002","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0360009-03","Limited Cost Sharing Plan Variation",,"0.783612370491028","No","Yes","No","100%",,"$1,250","$20","$600","$150","$1,250","$460","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.PacificSource.com/oregon/ind-psn-sg-AI","http://www.PacificSource.com/oregon/individual-brochure-2016","18"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","3","10091","OR","Individual","No","93-0245545","10091OR0390003","PSN Balance Bronze 6850","10091OR039",,"ORN001","ORS002","ORF007","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","10","2016-01-01",,"Yes","Emergency Care Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0390003-00","Standard Bronze Off Exchange Plan",,"0.615982830524445","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/oregon/ind-psn-bb-6850-OUT","http://www.PacificSource.com/oregon/individual-brochure-2016","4"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","3","10091","OR","Individual","No","93-0245545","10091OR0390003","PSN Balance Bronze 6850","10091OR039",,"ORN001","ORS002","ORF007","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","10","2016-01-01",,"Yes","Emergency Care Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0390003-01","Standard Bronze On Exchange Plan",,"0.615982830524445","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/oregon/ind-psn-bb-6850","http://www.PacificSource.com/oregon/individual-brochure-2016","5"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","3","10091","OR","Individual","No","93-0245545","10091OR0390003","PSN Balance Bronze 6850","10091OR039",,"ORN001","ORS002","ORF007","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","10","2016-01-01",,"Yes","Emergency Care Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0390003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.PacificSource.com/oregon/ind-psn-bb-6850-0","http://www.PacificSource.com/oregon/individual-brochure-2016","6"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","3","10091","OR","Individual","No","93-0245545","10091OR0390003","PSN Balance Bronze 6850","10091OR039",,"ORN001","ORS002","ORF007","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","10","2016-01-01",,"Yes","Emergency Care Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0390003-03","Limited Cost Sharing Plan Variation",,"0.615982830524445","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/oregon/ind-psn-bb-6850-AI","http://www.PacificSource.com/oregon/individual-brochure-2016","7"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","3","10091","OR","Individual","No","93-0245545","10091OR0390012","SmartChoice Balance Bronze 6850","10091OR039",,"ORN002","ORS001","ORF007","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","10","2016-01-01",,"Yes","Emergency Care Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0390012-00","Standard Bronze Off Exchange Plan",,"0.615982830524445","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/oregon/ind-scn-bb-6850-OUT","http://www.PacificSource.com/oregon/individual-brochure-2016","8"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","3","10091","OR","Individual","No","93-0245545","10091OR0390012","SmartChoice Balance Bronze 6850","10091OR039",,"ORN002","ORS001","ORF007","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","10","2016-01-01",,"Yes","Emergency Care Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0390012-01","Standard Bronze On Exchange Plan",,"0.615982830524445","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/oregon/ind-scn-bb-6850","http://www.PacificSource.com/oregon/individual-brochure-2016","9"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","3","10091","OR","Individual","No","93-0245545","10091OR0390012","SmartChoice Balance Bronze 6850","10091OR039",,"ORN002","ORS001","ORF007","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","10","2016-01-01",,"Yes","Emergency Care Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0390012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.PacificSource.com/oregon/ind-scn-bb-6850-0","http://www.PacificSource.com/oregon/individual-brochure-2016","10"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","3","10091","OR","Individual","No","93-0245545","10091OR0390012","SmartChoice Balance Bronze 6850","10091OR039",,"ORN002","ORS001","ORF007","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","10","2016-01-01",,"Yes","Emergency Care Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual","http://www.pacificsource.com/drug-list/","10091OR0390012-03","Limited Cost Sharing Plan Variation",,"0.615982830524445","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.PacificSource.com/oregon/ind-scn-bb-6850-AI","http://www.PacificSource.com/oregon/individual-brochure-2016","11"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","4","10091","OR","Individual","Yes","93-0245545","10091OR0470002","Kids Dental Advantage 0-20-50","10091OR047",,"ORN004","ORS003",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$38.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Non-participatiing providers","No","http://www.exchangepay.pacificsource.com/FFE/Individual/","","10091OR0470002-00","Standard High Off Exchange Plan","86.53%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/oregon/individual-dental-brochure-2016","4"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","4","10091","OR","Individual","Yes","93-0245545","10091OR0470002","Kids Dental Advantage 0-20-50","10091OR047",,"ORN004","ORS003",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$38.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Non-participatiing providers","No","http://www.exchangepay.pacificsource.com/FFE/Individual/","","10091OR0470002-01","Standard High On Exchange Plan","86.53%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","per person not applicable","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.pacificsource.com/oregon/individual-dental-brochure-2016","5"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","5","10091","OR","Individual","No","93-0245545","10091OR0380003","PSN Value Bronze 6450","10091OR038",,"ORN001","ORS002","ORF007","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0380003-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/oregon/ind-psn-vb-6450-OUT","http://www.PacificSource.com/oregon/individual-brochure-2016","4"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","5","10091","OR","Individual","No","93-0245545","10091OR0380003","PSN Value Bronze 6450","10091OR038",,"ORN001","ORS002","ORF007","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0380003-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/oregon/ind-psn-vb-6450","http://www.PacificSource.com/oregon/individual-brochure-2016","5"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","5","10091","OR","Individual","No","93-0245545","10091OR0380003","PSN Value Bronze 6450","10091OR038",,"ORN001","ORS002","ORF007","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0380003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.PacificSource.com/oregon/ind-psn-vb-6450-0","http://www.PacificSource.com/oregon/individual-brochure-2016","6"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","5","10091","OR","Individual","No","93-0245545","10091OR0380003","PSN Value Bronze 6450","10091OR038",,"ORN001","ORS002","ORF007","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0380003-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/oregon/ind-psn-vb-6450-AI","http://www.PacificSource.com/oregon/individual-brochure-2016","7"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","5","10091","OR","Individual","No","93-0245545","10091OR0380011","SmartChoice Value Bronze 6450","10091OR038",,"ORN002","ORS001","ORF007","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0380011-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/oregon/ind-scn-vb-6450-OUT","http://www.PacificSource.com/oregon/individual-brochure-2016","15"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","5","10091","OR","Individual","No","93-0245545","10091OR0380011","SmartChoice Value Bronze 6450","10091OR038",,"ORN002","ORS001","ORF007","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0380011-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/oregon/ind-scn-vb-6450","http://www.PacificSource.com/oregon/individual-brochure-2016","16"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","5","10091","OR","Individual","No","93-0245545","10091OR0380011","SmartChoice Value Bronze 6450","10091OR038",,"ORN002","ORS001","ORF007","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0380011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.PacificSource.com/oregon/ind-scn-vb-6450-0","http://www.PacificSource.com/oregon/individual-brochure-2016","17"
"2016","OR","10091","SERFF","11","2016-01-26 09:59:26","5","10091","OR","Individual","No","93-0245545","10091OR0380011","SmartChoice Value Bronze 6450","10091OR038",,"ORN002","ORS001","ORF007","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9992",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Travel Network and Non-participating providers","Yes","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/drug-list/","10091OR0380011-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.PacificSource.com/oregon/ind-scn-vb-6450-AI","http://www.PacificSource.com/oregon/individual-brochure-2016","18"
"2016","OR","25486","SERFF","7","2015-08-21 06:27:38","1","25486","OR","Individual","Yes","93-0896677","25486OR0020001","SmartSmile","25486OR002",,"ORN001","ORS001",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.80","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only - for the relief of pain, swellling, and bleeding.","Yes","Emergency coverage only - for the relief of pain, swellling, and bleeding.","No","https://www.dentalhealthservices.com/or/payment.cfm","","25486OR0020001-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentalhealthservices.com/OR/","http://www.dentalhealthservices.com/OR/","4"
"2016","OR","25486","SERFF","7","2015-08-21 06:27:38","1","25486","OR","Individual","Yes","93-0896677","25486OR0020001","SmartSmile","25486OR002",,"ORN001","ORS001",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.80","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only - for the relief of pain, swellling, and bleeding.","Yes","Emergency coverage only - for the relief of pain, swellling, and bleeding.","No","https://www.dentalhealthservices.com/or/payment.cfm","","25486OR0020001-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentalhealthservices.com/OR/","http://www.dentalhealthservices.com/OR/","5"
"2016","OR","25486","SERFF","7","2015-08-21 06:27:38","1","25486","OR","Individual","Yes","93-0896677","25486OR0020002","Super SmartSmile","25486OR002",,"ORN001","ORS001",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.80","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only - for the relief of pain, swellling, and bleeding.","Yes","Emergency coverage only - for the relief of pain, swellling, and bleeding.","No","https://www.dentalhealthservices.com/or/payment.cfm","","25486OR0020002-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentalhealthservices.com/OR/","http://www.dentalhealthservices.com/OR/","6"
"2016","OR","25486","SERFF","7","2015-08-21 06:27:38","1","25486","OR","Individual","Yes","93-0896677","25486OR0020002","Super SmartSmile","25486OR002",,"ORN001","ORS001",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$18.80","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only - for the relief of pain, swellling, and bleeding.","Yes","Emergency coverage only - for the relief of pain, swellling, and bleeding.","No","https://www.dentalhealthservices.com/or/payment.cfm","","25486OR0020002-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentalhealthservices.com/OR/","http://www.dentalhealthservices.com/OR/","7"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","8","30969","OR","Individual","No","46-3220666","30969OR0210001","Zoom Silver 5000","30969OR021",,"ORN001","ORS001","ORF001","New","EPO","Silver","Yes","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9934",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0210001-00","Standard Silver Off Exchange Plan","70.50%","0.695171535015106","Yes","Yes","No","100%",,"$5,000","$0","$0","$0","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/izsv5k00","https://www.zoomcare.com/plusyou","4"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","8","30969","OR","Individual","No","46-3220666","30969OR0210001","Zoom Silver 5000","30969OR021",,"ORN001","ORS001","ORF001","New","EPO","Silver","Yes","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9934",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0210001-01","Standard Silver On Exchange Plan","70.50%","0.695171535015106","Yes","Yes","No","100%",,"$5,000","$0","$0","$0","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/izsv5k01","https://www.zoomcare.com/plusyou","5"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020010","ATRIO Silver Choice 3000","32536OR002",,"ORN001","ORS001","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020010-05","87% AV Level Silver Plan",,"0.860092163085938","No","Yes","No","100%",,"$1,000","$20","$630","$150","$1,000","$360","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020010-05-ATRIO-SILVER-CHOICE-3000-CSR200-PLAN.pdf",,"20"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020010","ATRIO Silver Choice 3000","32536OR002",,"ORN001","ORS001","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020010-06","94% AV Level Silver Plan",,"0.939779698848724","No","Yes","No","100%",,"$100","$0","$650","$150","$100","$200","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020010-06-ATRIO-SILVER-CHOICE-3000-CSR150-PLAN.pdf",,"21"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020011","ATRIO Silver Choice 3030","32536OR002",,"ORN001","ORS001","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020011-00","Standard Silver Off Exchange Plan",,"0.708768010139465","No","Yes","No","100%",,"$3,000","$20","$1,290","$150","$3,000","$300","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020011-01-ATRIO-SILVER-CHOICE-3030-PLAN.pdf",,"22"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020011","ATRIO Silver Choice 3030","32536OR002",,"ORN001","ORS001","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020011-01","Standard Silver On Exchange Plan",,"0.708768010139465","No","Yes","No","100%",,"$3,000","$20","$1,290","$150","$3,000","$300","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020011-01-ATRIO-SILVER-CHOICE-3030-PLAN.pdf",,"23"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020011","ATRIO Silver Choice 3030","32536OR002",,"ORN001","ORS001","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020011-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020011-01-ATRIO-SILVER-CHOICE-3030-PLAN.pdf",,"24"
"2016","OR","25486","SERFF","7","2015-08-21 06:27:38","1","25486","OR","Individual","Yes","93-0896677","25486OR0020003","SmartSmile Plus","25486OR002",,"ORN001","ORS001",,"Existing","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only - for the relief of pain, swellling, and bleeding.","Yes","Emergency coverage only - for the relief of pain, swellling, and bleeding.","No","https://www.dentalhealthservices.com/or/payment.cfm","","25486OR0020003-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentalhealthservices.com/OR/","http://www.dentalhealthservices.com/OR/","8"
"2016","OR","25486","SERFF","7","2015-08-21 06:27:38","1","25486","OR","Individual","Yes","93-0896677","25486OR0020003","SmartSmile Plus","25486OR002",,"ORN001","ORS001",,"Existing","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency coverage only - for the relief of pain, swellling, and bleeding.","Yes","Emergency coverage only - for the relief of pain, swellling, and bleeding.","No","https://www.dentalhealthservices.com/or/payment.cfm","","25486OR0020003-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentalhealthservices.com/OR/","http://www.dentalhealthservices.com/OR/","9"
"2016","OR","28415","SERFF","6","2015-08-20 12:28:36","1","28415","OR","Individual","Yes","93-0438772","28415OR0210001","Delta Dental Premier","28415OR021",,"ORN002","ORS001",,"New","Indemnity","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network","Yes",,"","28415OR0210001-00","Standard High Off Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPremier_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPremier_2016_OR.pdf","4"
"2016","OR","28415","SERFF","6","2015-08-20 12:28:36","1","28415","OR","Individual","Yes","93-0438772","28415OR0210001","Delta Dental Premier","28415OR021",,"ORN002","ORS001",,"New","Indemnity","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network","Yes",,"","28415OR0210001-01","Standard High On Exchange Plan","83.70%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPremier_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPremier_2016_OR.pdf","5"
"2016","OR","28415","SERFF","6","2015-08-20 12:28:36","2","28415","OR","Individual","Yes","93-0438772","28415OR0010001","Delta Dental PPO","28415OR001",,"ORN001","ORS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network","Yes",,"","28415OR0010001-00","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO_2016_OR.pdf","4"
"2016","OR","28415","SERFF","6","2015-08-20 12:28:36","2","28415","OR","Individual","Yes","93-0438772","28415OR0010001","Delta Dental PPO","28415OR001",,"ORN001","ORS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network","Yes",,"","28415OR0010001-01","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO_2016_OR.pdf","5"
"2016","OR","28415","SERFF","6","2015-08-20 12:28:36","3","28415","OR","Individual","Yes","93-0438772","28415OR0010002","Delta Dental Exclusive","28415OR001",,"ORN001","ORS001",,"Existing","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network","Yes",,"","28415OR0010002-00","Standard High Off Exchange Plan","86.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalExclusive_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalExclusive_2016_OR.pdf","4"
"2016","OR","28415","SERFF","6","2015-08-20 12:28:36","3","28415","OR","Individual","Yes","93-0438772","28415OR0010002","Delta Dental Exclusive","28415OR001",,"ORN001","ORS001",,"Existing","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.00","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","National Network","Yes",,"","28415OR0010002-01","Standard High On Exchange Plan","86.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalExclusive_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalExclusive_2016_OR.pdf","5"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","1","30969","OR","Individual","No","46-3220666","30969OR0010001","Zoom Health Plan - Zoom Oregon Standard Bronze Plan","30969OR001",,"ORN001","ORS001","ORF001","New","EPO","Bronze","Yes","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9962",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0010001-00","Standard Bronze Off Exchange Plan","61.91%","0.563266813755035","Yes","Yes","No","100%",,"$5,000","$0","$1,270","$0","$5,000","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/isbz00","https://www.zoomcare.com/plusyou","4"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","1","30969","OR","Individual","No","46-3220666","30969OR0010001","Zoom Health Plan - Zoom Oregon Standard Bronze Plan","30969OR001",,"ORN001","ORS001","ORF001","New","EPO","Bronze","Yes","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9962",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0010001-01","Standard Bronze On Exchange Plan","61.91%","0.563266813755035","Yes","Yes","No","100%",,"$5,000","$0","$1,270","$0","$5,000","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/isbz01","https://www.zoomcare.com/plusyou","5"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","1","30969","OR","Individual","No","46-3220666","30969OR0010001","Zoom Health Plan - Zoom Oregon Standard Bronze Plan","30969OR001",,"ORN001","ORS001","ORF001","New","EPO","Bronze","Yes","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9962",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0010001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.zoomcare.com/sbc/isbz02","https://www.zoomcare.com/plusyou","6"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","1","30969","OR","Individual","No","46-3220666","30969OR0010001","Zoom Health Plan - Zoom Oregon Standard Bronze Plan","30969OR001",,"ORN001","ORS001","ORF001","New","EPO","Bronze","Yes","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9962",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0010001-03","Limited Cost Sharing Plan Variation","61.91%","0.563266813755035","Yes","Yes","No","100%",,"$5,000","$0","$1,270","$0","$5,000","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/isbz03","https://www.zoomcare.com/plusyou","7"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","2","30969","OR","Individual","No","46-3220666","30969OR0020001","Zoom Bronze Plan","30969OR002",,"ORN001","ORS001","ORF001","New","EPO","Bronze","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9924",,,,"0","3","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0020001-00","Standard Bronze Off Exchange Plan",,"0.61712259054184","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/izbz00","https://www.zoomcare.com/plusyou","4"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","2","30969","OR","Individual","No","46-3220666","30969OR0020001","Zoom Bronze Plan","30969OR002",,"ORN001","ORS001","ORF001","New","EPO","Bronze","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9924",,,,"0","3","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0020001-01","Standard Bronze On Exchange Plan",,"0.61712259054184","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/izbz01","https://www.zoomcare.com/plusyou","5"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","2","30969","OR","Individual","No","46-3220666","30969OR0020001","Zoom Bronze Plan","30969OR002",,"ORN001","ORS001","ORF001","New","EPO","Bronze","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9924",,,,"0","3","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0020001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.zoomcare.com/sbc/izbz02","https://www.zoomcare.com/plusyou","6"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","2","30969","OR","Individual","No","46-3220666","30969OR0020001","Zoom Bronze Plan","30969OR002",,"ORN001","ORS001","ORF001","New","EPO","Bronze","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9924",,,,"0","3","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0020001-03","Limited Cost Sharing Plan Variation",,"0.61712259054184","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$6,850","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/izbz03","https://www.zoomcare.com/plusyou","7"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","3","30969","OR","Individual","No","46-3220666","30969OR0030001","Zoom Health Plan - Zoom Oregon Standard Silver Plan","30969OR003",,"ORN001","ORS001","ORF001","New","EPO","Silver","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9969",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0030001-00","Standard Silver Off Exchange Plan",,"0.694302797317505","No","Yes","No","100%",,"$2,500","$0","$1,512","$0","$2,500","$0","$870","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.zoomcare.com/sbc/issv00","https://www.zoomcare.com/plusyou","4"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","3","30969","OR","Individual","No","46-3220666","30969OR0030001","Zoom Health Plan - Zoom Oregon Standard Silver Plan","30969OR003",,"ORN001","ORS001","ORF001","New","EPO","Silver","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9969",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0030001-01","Standard Silver On Exchange Plan",,"0.694302797317505","No","Yes","No","100%",,"$2,500","$0","$1,512","$0","$2,500","$0","$870","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.zoomcare.com/sbc/issv01","https://www.zoomcare.com/plusyou","5"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","3","30969","OR","Individual","No","46-3220666","30969OR0030001","Zoom Health Plan - Zoom Oregon Standard Silver Plan","30969OR003",,"ORN001","ORS001","ORF001","New","EPO","Silver","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9969",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0030001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.zoomcare.com/sbc/issv02","https://www.zoomcare.com/plusyou","6"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","3","30969","OR","Individual","No","46-3220666","30969OR0030001","Zoom Health Plan - Zoom Oregon Standard Silver Plan","30969OR003",,"ORN001","ORS001","ORF001","New","EPO","Silver","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9969",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0030001-03","Limited Cost Sharing Plan Variation",,"0.694302797317505","No","Yes","No","100%",,"$2,500","$0","$1,512","$0","$2,500","$0","$870","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.zoomcare.com/sbc/issv03","https://www.zoomcare.com/plusyou","7"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","3","30969","OR","Individual","No","46-3220666","30969OR0030001","Zoom Health Plan - Zoom Oregon Standard Silver Plan","30969OR003",,"ORN001","ORS001","ORF001","New","EPO","Silver","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9969",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0030001-04","73% AV Level Silver Plan",,"0.737293779850006","No","Yes","No","100%",,"$2,500","$0","$1,512","$0","$2,500","$0","$870","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.zoomcare.com/sbc/issv73","https://www.zoomcare.com/plusyou","8"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","3","30969","OR","Individual","No","46-3220666","30969OR0030001","Zoom Health Plan - Zoom Oregon Standard Silver Plan","30969OR003",,"ORN001","ORS001","ORF001","New","EPO","Silver","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9969",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0030001-05","87% AV Level Silver Plan",,"0.87954580783844","No","Yes","No","100%",,"$800","$0","$674","$0","$800","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.zoomcare.com/sbc/issv87","https://www.zoomcare.com/plusyou","9"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","3","30969","OR","Individual","No","46-3220666","30969OR0030001","Zoom Health Plan - Zoom Oregon Standard Silver Plan","30969OR003",,"ORN001","ORS001","ORF001","New","EPO","Silver","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9969",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0030001-06","94% AV Level Silver Plan",,"0.943891525268555","No","Yes","No","100%",,"$100","$0","$744","$0","$100","$0","$530","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.zoomcare.com/sbc/issv94","https://www.zoomcare.com/plusyou","10"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","1","32536","OR","Individual","No","43-2071108","32536OR0020004","ATRIO Oregon Standard Silver Plan","32536OR002",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020004-03","Limited Cost Sharing Plan Variation",,"0.694179058074951","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$360","$340","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020004-01-ATRIO-OREGON-STANDARD-SILVER-PLAN.pdf",,"11"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","1","32536","OR","Individual","No","43-2071108","32536OR0020004","ATRIO Oregon Standard Silver Plan","32536OR002",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020004-04","73% AV Level Silver Plan",,"0.737363398075104","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$360","$340","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$4,300","$4300 per person","$8600 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020004-04-ATRIO-OREGON-STANDARD-SILVER-PLAN.pdf",,"12"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","1","32536","OR","Individual","No","43-2071108","32536OR0020004","ATRIO Oregon Standard Silver Plan","32536OR002",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020004-05","87% AV Level Silver Plan",,"0.87899649143219","No","Yes","No","100%",,"$850","$10","$640","$150","$850","$360","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020004-05-ATRIO-OREGON-STANDARD-SILVER-PLAN.pdf",,"13"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","1","32536","OR","Individual","No","43-2071108","32536OR0020004","ATRIO Oregon Standard Silver Plan","32536OR002",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020004-06","94% AV Level Silver Plan",,"0.943853676319122","No","Yes","No","100%",,"$100","$0","$650","$150","$100","$200","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020004-06-ATRIO-OREGON-STANDARD-SILVER-PLAN.pdf",,"14"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","5","30969","OR","Individual","No","46-3220666","30969OR0040001","Zoom Silver Plan","30969OR004",,"ORN001","ORS001","ORF001","New","EPO","Silver","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0040001-00","Standard Silver Off Exchange Plan",,"0.7115438580513","Yes","Yes","No","100%",,"$0","$0","$3,393","$0","$0","$0","$2,430","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/izsv00","https://www.zoomcare.com/plusyou","4"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","5","30969","OR","Individual","No","46-3220666","30969OR0040001","Zoom Silver Plan","30969OR004",,"ORN001","ORS001","ORF001","New","EPO","Silver","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0040001-01","Standard Silver On Exchange Plan",,"0.7115438580513","Yes","Yes","No","100%",,"$0","$0","$3,393","$0","$0","$0","$2,430","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/izsv01","https://www.zoomcare.com/plusyou","5"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","5","30969","OR","Individual","No","46-3220666","30969OR0040001","Zoom Silver Plan","30969OR004",,"ORN001","ORS001","ORF001","New","EPO","Silver","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0040001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.zoomcare.com/sbc/izsv02","https://www.zoomcare.com/plusyou","6"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","5","30969","OR","Individual","No","46-3220666","30969OR0040001","Zoom Silver Plan","30969OR004",,"ORN001","ORS001","ORF001","New","EPO","Silver","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0040001-03","Limited Cost Sharing Plan Variation",,"0.7115438580513","Yes","Yes","No","100%",,"$0","$0","$3,393","$0","$0","$0","$2,430","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/izsv03","https://www.zoomcare.com/plusyou","7"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","5","30969","OR","Individual","No","46-3220666","30969OR0040001","Zoom Silver Plan","30969OR004",,"ORN001","ORS001","ORF001","New","EPO","Silver","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0040001-04","73% AV Level Silver Plan",,"0.737612009048462","Yes","Yes","No","100%",,"$0","$0","$3,393","$0","$0","$0","$2,430","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/izsv73","https://www.zoomcare.com/plusyou","8"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","5","30969","OR","Individual","No","46-3220666","30969OR0040001","Zoom Silver Plan","30969OR004",,"ORN001","ORS001","ORF001","New","EPO","Silver","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0040001-05","87% AV Level Silver Plan",,"0.878039717674255","Yes","Yes","No","100%",,"$0","$0","$1,350","$0","$0","$0","$1,350","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/izsv87","https://www.zoomcare.com/plusyou","9"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","5","30969","OR","Individual","No","46-3220666","30969OR0040001","Zoom Silver Plan","30969OR004",,"ORN001","ORS001","ORF001","New","EPO","Silver","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9937",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0040001-06","94% AV Level Silver Plan",,"0.934971928596497","Yes","Yes","No","100%",,"$0","$0","$650","$0","$0","$0","$650","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","45%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/izsv94","https://www.zoomcare.com/plusyou","10"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","6","30969","OR","Individual","No","46-3220666","30969OR0050001","Zoom Health Plan Zoom Oregon Standard Gold Plan","30969OR005",,"ORN001","ORS001","ORF001","New","EPO","Gold","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9974",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0050001-00","Standard Gold Off Exchange Plan",,"0.781106114387512","No","Yes","No","100%",,"$1,250","$0","$629","$0","$1,250","$0","$415","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.zoomcare.com/sbc/isgd00","https://www.zoomcare.com/plusyou","4"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","6","30969","OR","Individual","No","46-3220666","30969OR0050001","Zoom Health Plan Zoom Oregon Standard Gold Plan","30969OR005",,"ORN001","ORS001","ORF001","New","EPO","Gold","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9974",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0050001-01","Standard Gold On Exchange Plan",,"0.781106114387512","No","Yes","No","100%",,"$1,250","$0","$629","$0","$1,250","$0","$415","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.zoomcare.com/sbc/isgd01","https://www.zoomcare.com/plusyou","5"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","6","30969","OR","Individual","No","46-3220666","30969OR0050001","Zoom Health Plan Zoom Oregon Standard Gold Plan","30969OR005",,"ORN001","ORS001","ORF001","New","EPO","Gold","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9974",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0050001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.zoomcare.com/sbc/isgd02","https://www.zoomcare.com/plusyou","6"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","6","30969","OR","Individual","No","46-3220666","30969OR0050001","Zoom Health Plan Zoom Oregon Standard Gold Plan","30969OR005",,"ORN001","ORS001","ORF001","New","EPO","Gold","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9974",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0050001-03","Limited Cost Sharing Plan Variation",,"0.781106114387512","No","Yes","No","100%",,"$1,250","$0","$629","$0","$1,250","$0","$415","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","100%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.zoomcare.com/sbc/isgd03","https://www.zoomcare.com/plusyou","7"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","7","30969","OR","Individual","No","46-3220666","30969OR0060001","Zoom Gold Plan","30969OR006",,"ORN001","ORS001","ORF001","New","EPO","Gold","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9943",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0060001-00","Standard Gold Off Exchange Plan",,"0.810090303421021","Yes","Yes","No","100%",,"$0","$0","$1,885","$0","$0","$0","$1,350","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/izgd00","https://www.zoomcare.com/plusyou","4"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","7","30969","OR","Individual","No","46-3220666","30969OR0060001","Zoom Gold Plan","30969OR006",,"ORN001","ORS001","ORF001","New","EPO","Gold","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9943",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0060001-01","Standard Gold On Exchange Plan",,"0.810090303421021","Yes","Yes","No","100%",,"$0","$0","$1,885","$0","$0","$0","$1,350","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/izgd01","https://www.zoomcare.com/plusyou","5"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","7","30969","OR","Individual","No","46-3220666","30969OR0060001","Zoom Gold Plan","30969OR006",,"ORN001","ORS001","ORF001","New","EPO","Gold","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9943",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0060001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.zoomcare.com/sbc/izgd02","https://www.zoomcare.com/plusyou","6"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","7","30969","OR","Individual","No","46-3220666","30969OR0060001","Zoom Gold Plan","30969OR006",,"ORN001","ORS001","ORF001","New","EPO","Gold","No","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9943",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0060001-03","Limited Cost Sharing Plan Variation",,"0.810090303421021","Yes","Yes","No","100%",,"$0","$0","$1,885","$0","$0","$0","$1,350","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/izgd03","https://www.zoomcare.com/plusyou","7"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","8","30969","OR","Individual","No","46-3220666","30969OR0210001","Zoom Silver 5000","30969OR021",,"ORN001","ORS001","ORF001","New","EPO","Silver","Yes","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9934",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0210001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.zoomcare.com/sbc/izsv5k02","https://www.zoomcare.com/plusyou","6"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","8","30969","OR","Individual","No","46-3220666","30969OR0210001","Zoom Silver 5000","30969OR021",,"ORN001","ORS001","ORF001","New","EPO","Silver","Yes","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9934",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0210001-03","Limited Cost Sharing Plan Variation","70.50%","0.695171535015106","Yes","Yes","No","100%",,"$5,000","$0","$0","$0","$5,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/izsv5k03","https://www.zoomcare.com/plusyou","7"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","8","30969","OR","Individual","No","46-3220666","30969OR0210001","Zoom Silver 5000","30969OR021",,"ORN001","ORS001","ORF001","New","EPO","Silver","Yes","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9934",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0210001-04","73% AV Level Silver Plan","73.00%","0.714150607585907","Yes","Yes","No","100%",,"$4,500","$0","$0","$0","$4,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/izsv5k73","https://www.zoomcare.com/plusyou","8"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","8","30969","OR","Individual","No","46-3220666","30969OR0210001","Zoom Silver 5000","30969OR021",,"ORN001","ORS001","ORF001","New","EPO","Silver","Yes","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9934",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0210001-05","87% AV Level Silver Plan","87.00%","0.855057775974274","Yes","Yes","No","100%",,"$1,700","$0","$0","$0","$1,700","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/izsv5k87","https://www.zoomcare.com/plusyou","9"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","8","30969","OR","Individual","No","46-3220666","30969OR0210001","Zoom Silver 5000","30969OR021",,"ORN001","ORS001","ORF001","New","EPO","Silver","Yes","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9934",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0210001-06","94% AV Level Silver Plan","94.00%","0.928917586803436","Yes","Yes","No","100%",,"$725","$0","$0","$0","$725","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$725","$725 per person","$1450 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$725","$725 per person","$1450 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/izsv5k94","https://www.zoomcare.com/plusyou","10"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","9","30969","OR","Individual","No","46-3220666","30969OR0220001","Zoom Gold 3000","30969OR022",,"ORN001","ORS001","ORF001","New","EPO","Gold","Yes","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9941",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0220001-00","Standard Gold Off Exchange Plan","78.70%","0.778047382831573","Yes","Yes","No","100%",,"$3,000","$0","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/izgd3k00","https://www.zoomcare.com/plusyou","4"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","9","30969","OR","Individual","No","46-3220666","30969OR0220001","Zoom Gold 3000","30969OR022",,"ORN001","ORS001","ORF001","New","EPO","Gold","Yes","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9941",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0220001-01","Standard Gold On Exchange Plan","78.70%","0.778047382831573","Yes","Yes","No","100%",,"$3,000","$0","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/izgd3k01","https://www.zoomcare.com/plusyou","5"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","9","30969","OR","Individual","No","46-3220666","30969OR0220001","Zoom Gold 3000","30969OR022",,"ORN001","ORS001","ORF001","New","EPO","Gold","Yes","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9941",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0220001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.zoomcare.com/sbc/izgd3k02","https://www.zoomcare.com/plusyou","6"
"2016","OR","30969","SERFF","7","2015-09-27 20:37:48","9","30969","OR","Individual","No","46-3220666","30969OR0220001","Zoom Gold 3000","30969OR022",,"ORN001","ORS001","ORF001","New","EPO","Gold","Yes","Both","No","Yes","All Specialists that are not Zoom Specialists.",,"$0.00","No","Allows Adult and Child-Only",,"No","Depression, Diabetes, High Blood Pressure & High Cholesterol, Weight Loss Programs","0.9941",,,,"0","0","0","2016-01-01",,"No",,"Yes","First Choice Health Network and First Health Network","Yes",,"https://www.zoomcare.com/medlist","30969OR0220001-03","Limited Cost Sharing Plan Variation","78.70%","0.778047382831573","Yes","Yes","No","100%",,"$3,000","$0","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.zoomcare.com/sbc/izgd3k03","https://www.zoomcare.com/plusyou","7"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","1","32536","OR","Individual","No","43-2071108","32536OR0020002","ATRIO Oregon Standard Gold Plan","32536OR002",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020002-00","Standard Gold Off Exchange Plan",,"0.781555771827698","No","Yes","No","100%",,"$1,250","$20","$600","$150","$1,250","$360","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020002-01-ATRIO-OREGON-STANDARD-GOLD-PLAN.pdf",,"4"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","1","32536","OR","Individual","No","43-2071108","32536OR0020002","ATRIO Oregon Standard Gold Plan","32536OR002",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020002-01","Standard Gold On Exchange Plan",,"0.781555771827698","No","Yes","No","100%",,"$1,250","$20","$600","$150","$1,250","$360","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020002-01-ATRIO-OREGON-STANDARD-GOLD-PLAN.pdf",,"5"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","1","32536","OR","Individual","No","43-2071108","32536OR0020002","ATRIO Oregon Standard Gold Plan","32536OR002",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020002-01-ATRIO-OREGON-STANDARD-GOLD-PLAN.pdf",,"6"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","1","32536","OR","Individual","No","43-2071108","32536OR0020002","ATRIO Oregon Standard Gold Plan","32536OR002",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020002-03","Limited Cost Sharing Plan Variation",,"0.781555771827698","No","Yes","No","100%",,"$1,250","$20","$600","$150","$1,250","$360","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020002-01-ATRIO-OREGON-STANDARD-GOLD-PLAN.pdf",,"7"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","1","32536","OR","Individual","No","43-2071108","32536OR0020004","ATRIO Oregon Standard Silver Plan","32536OR002",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020004-00","Standard Silver Off Exchange Plan",,"0.694179058074951","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$360","$340","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020004-01-ATRIO-OREGON-STANDARD-SILVER-PLAN.pdf",,"8"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","1","32536","OR","Individual","No","43-2071108","32536OR0020004","ATRIO Oregon Standard Silver Plan","32536OR002",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020004-01","Standard Silver On Exchange Plan",,"0.694179058074951","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$360","$340","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020004-01-ATRIO-OREGON-STANDARD-SILVER-PLAN.pdf",,"9"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","1","32536","OR","Individual","No","43-2071108","32536OR0020004","ATRIO Oregon Standard Silver Plan","32536OR002",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020004-01-ATRIO-OREGON-STANDARD-SILVER-PLAN.pdf",,"10"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","1","32536","OR","Individual","No","43-2071108","32536OR0020006","ATRIO Oregon Standard Bronze Plan","32536OR002",,"ORN001","ORS001","ORF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020006-00","Standard Bronze Off Exchange Plan",,"0.619174301624298","Yes","Yes","No","100%",,"$5,000","$20","$1,150","$150","$5,000","$80","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020006-01-ATRIO-OREGON-STANDARD-BRONZE-PLAN.pdf",,"15"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","1","32536","OR","Individual","No","43-2071108","32536OR0020006","ATRIO Oregon Standard Bronze Plan","32536OR002",,"ORN001","ORS001","ORF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020006-01","Standard Bronze On Exchange Plan",,"0.619174301624298","Yes","Yes","No","100%",,"$5,000","$20","$1,150","$150","$5,000","$80","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020006-01-ATRIO-OREGON-STANDARD-BRONZE-PLAN.pdf",,"16"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","1","32536","OR","Individual","No","43-2071108","32536OR0020006","ATRIO Oregon Standard Bronze Plan","32536OR002",,"ORN001","ORS001","ORF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020006-01-ATRIO-OREGON-STANDARD-BRONZE-PLAN.pdf",,"17"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","1","32536","OR","Individual","No","43-2071108","32536OR0020006","ATRIO Oregon Standard Bronze Plan","32536OR002",,"ORN001","ORS001","ORF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020006-03","Limited Cost Sharing Plan Variation",,"0.619174301624298","Yes","Yes","No","100%",,"$5,000","$20","$1,150","$150","$5,000","$80","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020006-01-ATRIO-OREGON-STANDARD-BRONZE-PLAN.pdf",,"18"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020008","ATRIO Gold Premium 1000","32536OR002",,"ORN001","ORS001","ORF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020008-00","Standard Gold Off Exchange Plan",,"0.796001732349396","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$360","$360","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020008-01-ATRIO-GOLD-PREMIUM-1000-PLAN.pdf",,"4"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020008","ATRIO Gold Premium 1000","32536OR002",,"ORN001","ORS001","ORF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020008-01","Standard Gold On Exchange Plan",,"0.796001732349396","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$360","$360","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020008-01-ATRIO-GOLD-PREMIUM-1000-PLAN.pdf",,"5"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020008","ATRIO Gold Premium 1000","32536OR002",,"ORN001","ORS001","ORF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020008-01-ATRIO-GOLD-PREMIUM-1000-PLAN.pdf",,"6"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020008","ATRIO Gold Premium 1000","32536OR002",,"ORN001","ORS001","ORF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020008-03","Limited Cost Sharing Plan Variation",,"0.796001732349396","No","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$360","$360","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020008-01-ATRIO-GOLD-PREMIUM-1000-PLAN.pdf",,"7"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020009","ATRIO Silver Choice 2000","32536OR002",,"ORN001","ORS001","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020009-00","Standard Silver Off Exchange Plan",,"0.719970166683197","No","Yes","No","100%",,"$2,000","$20","$1,050","$150","$2,000","$440","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020009-01-ATRIO-SILVER-CHOICE-2000-PLAN.pdf",,"8"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020009","ATRIO Silver Choice 2000","32536OR002",,"ORN001","ORS001","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020009-01","Standard Silver On Exchange Plan",,"0.719970166683197","No","Yes","No","100%",,"$2,000","$20","$1,050","$150","$2,000","$440","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020009-01-ATRIO-SILVER-CHOICE-2000-PLAN.pdf",,"9"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020009","ATRIO Silver Choice 2000","32536OR002",,"ORN001","ORS001","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020009-01-ATRIO-SILVER-CHOICE-2000-PLAN.pdf",,"10"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020009","ATRIO Silver Choice 2000","32536OR002",,"ORN001","ORS001","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020009-03","Limited Cost Sharing Plan Variation",,"0.719970166683197","No","Yes","No","100%",,"$2,000","$20","$1,050","$150","$2,000","$440","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020009-01-ATRIO-SILVER-CHOICE-2000-PLAN.pdf",,"11"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020009","ATRIO Silver Choice 2000","32536OR002",,"ORN001","ORS001","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020009-04","73% AV Level Silver Plan",,"0.739992141723633","No","Yes","No","100%",,"$2,000","$20","$1,050","$150","$2,000","$440","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$5,400","$5400 per person","$10800 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020009-04-ATRIO-SILVER-CHOICE-2000-CSR250-PLAN.pdf",,"12"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020009","ATRIO Silver Choice 2000","32536OR002",,"ORN001","ORS001","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020009-05","87% AV Level Silver Plan",,"0.863260269165039","No","Yes","No","100%",,"$1,000","$20","$630","$150","$1,000","$360","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020009-05-ATRIO-SILVER-CHOICE-2000-CSR200-PLAN.pdf",,"13"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020009","ATRIO Silver Choice 2000","32536OR002",,"ORN001","ORS001","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020009-06","94% AV Level Silver Plan",,"0.938074588775635","No","Yes","No","100%",,"$100","$0","$650","$150","$100","$200","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020009-06-ATRIO-SILVER-CHOICE-2000-CSR150-PLAN.pdf",,"14"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020010","ATRIO Silver Choice 3000","32536OR002",,"ORN001","ORS001","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020010-00","Standard Silver Off Exchange Plan",,"0.710542857646942","No","Yes","No","100%",,"$3,000","$20","$860","$150","$3,000","$300","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020010-01-ATRIO-SILVER-CHOICE-3000-PLAN.pdf",,"15"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020010","ATRIO Silver Choice 3000","32536OR002",,"ORN001","ORS001","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020010-01","Standard Silver On Exchange Plan",,"0.710542857646942","No","Yes","No","100%",,"$3,000","$20","$860","$150","$3,000","$300","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020010-01-ATRIO-SILVER-CHOICE-3000-PLAN.pdf",,"16"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020010","ATRIO Silver Choice 3000","32536OR002",,"ORN001","ORS001","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020010-01-ATRIO-SILVER-CHOICE-3000-PLAN.pdf",,"17"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020010","ATRIO Silver Choice 3000","32536OR002",,"ORN001","ORS001","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020010-03","Limited Cost Sharing Plan Variation",,"0.710542857646942","No","Yes","No","100%",,"$3,000","$20","$860","$150","$3,000","$300","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020010-01-ATRIO-SILVER-CHOICE-3000-PLAN.pdf",,"18"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020010","ATRIO Silver Choice 3000","32536OR002",,"ORN001","ORS001","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020010-04","73% AV Level Silver Plan",,"0.737129926681519","No","Yes","No","100%",,"$3,000","$20","$860","$150","$3,000","$300","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$5,250","$5250 per person","$10500 per group","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020010-04-ATRIO-SILVER-CHOICE-3000-CSR250-PLAN.pdf",,"19"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020011","ATRIO Silver Choice 3030","32536OR002",,"ORN001","ORS001","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020011-03","Limited Cost Sharing Plan Variation",,"0.708768010139465","No","Yes","No","100%",,"$3,000","$20","$1,290","$150","$3,000","$300","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020011-01-ATRIO-SILVER-CHOICE-3030-PLAN.pdf",,"25"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020011","ATRIO Silver Choice 3030","32536OR002",,"ORN001","ORS001","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020011-04","73% AV Level Silver Plan",,"0.734179437160492","No","Yes","No","100%",,"$3,000","$20","$1,290","$150","$3,000","$300","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020011-04-ATRIO-SILVER-CHOICE-3030-CSR250-PLAN.pdf",,"26"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020011","ATRIO Silver Choice 3030","32536OR002",,"ORN001","ORS001","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020011-05","87% AV Level Silver Plan",,"0.860092163085938","No","Yes","No","100%",,"$1,000","$20","$630","$150","$1,000","$360","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020011-05-ATRIO-SILVER-CHOICE-3030-CSR200-PLAN.pdf",,"27"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020011","ATRIO Silver Choice 3030","32536OR002",,"ORN001","ORS001","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020011-06","94% AV Level Silver Plan",,"0.939779698848724","No","Yes","No","100%",,"$100","$0","$650","$150","$100","$200","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020011-06-ATRIO-SILVER-CHOICE-3030-CSR150-PLAN.pdf",,"28"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020012","ATRIO Bronze 6350 HSA","32536OR002",,"ORN001","ORS001","ORF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020012-00","Standard Bronze Off Exchange Plan",,"0.605813801288605","Yes","Yes","No","100%",,"$6,350","$0","$0","$150","$5,410","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Yes",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020012-01-ATRIO-BRONZE-6350-HSA-PLAN.pdf",,"29"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020012","ATRIO Bronze 6350 HSA","32536OR002",,"ORN001","ORS001","ORF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020012-01","Standard Bronze On Exchange Plan",,"0.605813801288605","Yes","Yes","No","100%",,"$6,350","$0","$0","$150","$5,410","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Yes",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020012-01-ATRIO-BRONZE-6350-HSA-PLAN.pdf",,"30"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020012","ATRIO Bronze 6350 HSA","32536OR002",,"ORN001","ORS001","ORF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020012-01-ATRIO-BRONZE-6350-HSA-PLAN.pdf",,"31"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020012","ATRIO Bronze 6350 HSA","32536OR002",,"ORN001","ORS001","ORF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020012-03","Limited Cost Sharing Plan Variation",,"0.605813801288605","Yes","Yes","No","100%",,"$6,350","$0","$0","$150","$5,410","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Yes",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020012-01-ATRIO-BRONZE-6350-HSA-PLAN.pdf",,"32"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020013","ATRIO Bronze 6850","32536OR002",,"ORN001","ORS001","ORF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020013-00","Standard Bronze Off Exchange Plan",,"0.584969341754913","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,410","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020013-01-ATRIO-BRONZE-SAVER-6850-PLAN.pdf",,"33"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020013","ATRIO Bronze 6850","32536OR002",,"ORN001","ORS001","ORF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020013-01","Standard Bronze On Exchange Plan",,"0.584969341754913","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,410","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020013-01-ATRIO-BRONZE-SAVER-6850-PLAN.pdf",,"34"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020013","ATRIO Bronze 6850","32536OR002",,"ORN001","ORS001","ORF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020013-01-ATRIO-BRONZE-SAVER-6850-PLAN.pdf",,"35"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","2","32536","OR","Individual","No","43-2071108","32536OR0020013","ATRIO Bronze 6850","32536OR002",,"ORN001","ORS001","ORF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Nationwide","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0020013-03","Limited Cost Sharing Plan Variation",,"0.584969341754913","Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,410","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Standard-Plans-English/32536OR0020013-01-ATRIO-BRONZE-SAVER-6850-PLAN.pdf",,"36"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","3","32536","OR","Individual","No","43-2071108","32536OR0040001","ATRIO Gold Pioneer","32536OR004",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Urgent and Emergency Care","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0040001-00","Standard Gold Off Exchange Plan",,"0.781555771827698","No","Yes","No","100%",,"$1,250","$20","$600","$150","$1,250","$360","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0040001-01-ATRIO-GOLD-PIONEER-PLAN.pdf",,"4"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","3","32536","OR","Individual","No","43-2071108","32536OR0040001","ATRIO Gold Pioneer","32536OR004",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Urgent and Emergency Care","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0040001-01","Standard Gold On Exchange Plan",,"0.781555771827698","No","Yes","No","100%",,"$1,250","$20","$600","$150","$1,250","$360","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0040001-01-ATRIO-GOLD-PIONEER-PLAN.pdf",,"5"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","3","32536","OR","Individual","No","43-2071108","32536OR0040001","ATRIO Gold Pioneer","32536OR004",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Urgent and Emergency Care","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0040001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0040001-01-ATRIO-GOLD-PIONEER-PLAN.pdf",,"6"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","3","32536","OR","Individual","No","43-2071108","32536OR0040001","ATRIO Gold Pioneer","32536OR004",,"ORN001","ORS001","ORF001","Existing","EPO","Gold","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Urgent and Emergency Care","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0040001-03","Limited Cost Sharing Plan Variation",,"0.781555771827698","No","Yes","No","100%",,"$1,250","$20","$600","$150","$1,250","$360","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0040001-01-ATRIO-GOLD-PIONEER-PLAN.pdf",,"7"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","3","32536","OR","Individual","No","43-2071108","32536OR0040002","ATRIO Silver Pioneer","32536OR004",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Urgent and Emergency Care","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0040002-00","Standard Silver Off Exchange Plan",,"0.694179058074951","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$360","$340","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0040002-01-ATRIO-SILVER-PIONEER-PLAN.pdf",,"8"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","3","32536","OR","Individual","No","43-2071108","32536OR0040002","ATRIO Silver Pioneer","32536OR004",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Urgent and Emergency Care","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0040002-01","Standard Silver On Exchange Plan",,"0.694179058074951","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$360","$340","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0040002-01-ATRIO-SILVER-PIONEER-PLAN.pdf",,"9"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","3","32536","OR","Individual","No","43-2071108","32536OR0040002","ATRIO Silver Pioneer","32536OR004",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Urgent and Emergency Care","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0040002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0040002-01-ATRIO-SILVER-PIONEER-PLAN.pdf",,"10"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","3","32536","OR","Individual","No","43-2071108","32536OR0040002","ATRIO Silver Pioneer","32536OR004",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Urgent and Emergency Care","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0040002-03","Limited Cost Sharing Plan Variation",,"0.694179058074951","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$360","$340","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0040002-01-ATRIO-SILVER-PIONEER-PLAN.pdf",,"11"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","3","32536","OR","Individual","No","43-2071108","32536OR0040002","ATRIO Silver Pioneer","32536OR004",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Urgent and Emergency Care","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0040002-04","73% AV Level Silver Plan",,"0.737363398075104","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$360","$340","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$4,300","$4300 per person","$8600 per group","Not Applicable","per person not applicable","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0040002-04-ATRIO-SILVER-PIONEER-PLAN.pdf",,"12"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","3","32536","OR","Individual","No","43-2071108","32536OR0040002","ATRIO Silver Pioneer","32536OR004",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Urgent and Emergency Care","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0040002-05","87% AV Level Silver Plan",,"0.87899649143219","No","Yes","No","100%",,"$850","$10","$640","$150","$850","$360","$190","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0040002-05-ATRIO-SILVER-PIONEER-PLAN.pdf",,"13"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","3","32536","OR","Individual","No","43-2071108","32536OR0040002","ATRIO Silver Pioneer","32536OR004",,"ORN001","ORS001","ORF002","Existing","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Urgent and Emergency Care","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0040002-06","94% AV Level Silver Plan",,"0.943853676319122","No","Yes","No","100%",,"$100","$0","$650","$150","$100","$200","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0040002-06-ATRIO-SILVER-PIONEER-PLAN.pdf",,"14"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","3","32536","OR","Individual","No","43-2071108","32536OR0040003","ATRIO Bronze Pioneer","32536OR004",,"ORN001","ORS001","ORF003","Existing","EPO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Urgent and Emergency Care","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0040003-00","Standard Bronze Off Exchange Plan",,"0.619174301624298","Yes","Yes","No","100%",,"$5,000","$20","$1,150","$150","$5,000","$80","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0040003-01-ATRIO-BRONZE-PIONEER-PLAN.pdf",,"15"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","3","32536","OR","Individual","No","43-2071108","32536OR0040003","ATRIO Bronze Pioneer","32536OR004",,"ORN001","ORS001","ORF003","Existing","EPO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Urgent and Emergency Care","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0040003-01","Standard Bronze On Exchange Plan",,"0.619174301624298","Yes","Yes","No","100%",,"$5,000","$20","$1,150","$150","$5,000","$80","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0040003-01-ATRIO-BRONZE-PIONEER-PLAN.pdf",,"16"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","3","32536","OR","Individual","No","43-2071108","32536OR0040003","ATRIO Bronze Pioneer","32536OR004",,"ORN001","ORS001","ORF003","Existing","EPO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Urgent and Emergency Care","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0040003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0040003-01-ATRIO-BRONZE-PIONEER-PLAN.pdf",,"17"
"2016","OR","32536","SERFF","4","2015-08-21 06:27:38","3","32536","OR","Individual","No","43-2071108","32536OR0040003","ATRIO Bronze Pioneer","32536OR004",,"ORN001","ORS001","ORF003","Existing","EPO","Bronze","No","Both","No","Yes","All",,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.9975",,,,"0","0","0","2016-01-01",,"Yes","Urgent and Emergency Care","Yes","Urgent and Emergency Care","Yes","https://atriohp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.atriohp.com/ATRIO-Exchange/Formulary-Drug-List-.aspx","32536OR0040003-03","Limited Cost Sharing Plan Variation",,"0.619174301624298","Yes","Yes","No","100%",,"$5,000","$20","$1,150","$150","$5,000","$80","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://atriohp.com/documents/Exchange/Benefit-Info/Individual-Pioneer-Plans-English/32536OR0040003-01-ATRIO-BRONZE-PIONEER-PLAN.pdf",,"18"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","1","39424","OR","Individual","No","93-0989307","39424OR1240001","Moda Health Oregon Standard Gold (Beacon)","39424OR124",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997869675122837",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1240001-00","Standard Gold Off Exchange Plan",,"0.783612370491028","No","Yes","No","100%",,"$1,250","$20","$600","$200","$1,250","$600","$20","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_2016_OR.pdf","4"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","1","39424","OR","Individual","No","93-0989307","39424OR1240001","Moda Health Oregon Standard Gold (Beacon)","39424OR124",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997869675122837",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1240001-01","Standard Gold On Exchange Plan",,"0.783612370491028","No","Yes","No","100%",,"$1,250","$20","$600","$200","$1,250","$600","$20","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_2016_OR.pdf","5"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","1","39424","OR","Individual","No","93-0989307","39424OR1240001","Moda Health Oregon Standard Gold (Beacon)","39424OR124",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997869675122837",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1240001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_CSV0_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_CSV0_2016_OR.pdf","6"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","1","39424","OR","Individual","No","93-0989307","39424OR1240001","Moda Health Oregon Standard Gold (Beacon)","39424OR124",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997869675122837",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1240001-03","Limited Cost Sharing Plan Variation",,"0.783612370491028","No","Yes","No","100%",,"$1,250","$20","$600","$200","$1,250","$600","$20","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardGold_2016_OR.pdf","7"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","1","39424","OR","Individual","No","93-0989307","39424OR1240002","Moda Health Oregon Standard Silver (Beacon)","39424OR124",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997451076119936",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1240002-00","Standard Silver Off Exchange Plan",,"0.696861922740936","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$1,270","$1,000","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_2016_OR.pdf","8"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","1","39424","OR","Individual","No","93-0989307","39424OR1240002","Moda Health Oregon Standard Silver (Beacon)","39424OR124",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997451076119936",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1240002-01","Standard Silver On Exchange Plan",,"0.696861922740936","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$1,270","$1,000","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_2016_OR.pdf","9"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","1","39424","OR","Individual","No","93-0989307","39424OR1240002","Moda Health Oregon Standard Silver (Beacon)","39424OR124",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997451076119936",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1240002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV0_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV0_2016_OR.pdf","10"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","1","39424","OR","Individual","No","93-0989307","39424OR1240002","Moda Health Oregon Standard Silver (Beacon)","39424OR124",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997451076119936",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1240002-03","Limited Cost Sharing Plan Variation",,"0.696861922740936","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$1,270","$1,000","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_2016_OR.pdf","11"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","1","39424","OR","Individual","No","93-0989307","39424OR1240002","Moda Health Oregon Standard Silver (Beacon)","39424OR124",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997451076119936",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1240002-04","73% AV Level Silver Plan",,"0.73930150270462","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$1,270","$1,000","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV1_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV1_2016_OR.pdf","12"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","1","39424","OR","Individual","No","93-0989307","39424OR1240002","Moda Health Oregon Standard Silver (Beacon)","39424OR124",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997451076119936",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1240002-05","87% AV Level Silver Plan",,"0.87958174943924","No","Yes","No","100%",,"$850","$10","$600","$200","$850","$600","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","50%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV2_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV2_2016_OR.pdf","13"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","1","39424","OR","Individual","No","93-0989307","39424OR1240002","Moda Health Oregon Standard Silver (Beacon)","39424OR124",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997451076119936",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1240002-06","94% AV Level Silver Plan",,"0.944462716579437","No","Yes","No","100%",,"$100","$0","$600","$200","$100","$300","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","25%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV3_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardSilver_CSV3_2016_OR.pdf","14"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","2","39424","OR","Individual","No","93-0989307","39424OR1500001","Moda Health Beacon HSA","39424OR150",,"ORN001","ORS001","ORF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997109617658955",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1500001-00","Standard Bronze Off Exchange Plan",,"0.618900716304779","Yes","Yes","No","100%",,"$3,250","$0","$2,000","$200","$3,250","$0","$1,000","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","per person not applicable","$6500 per group","50%",,,,,"$6,500","per person not applicable","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_HSA_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_HSA_2016_OR.pdf","4"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","2","39424","OR","Individual","No","93-0989307","39424OR1500001","Moda Health Beacon HSA","39424OR150",,"ORN001","ORS001","ORF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997109617658955",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1500001-01","Standard Bronze On Exchange Plan",,"0.618900716304779","Yes","Yes","No","100%",,"$3,250","$0","$2,000","$200","$3,250","$0","$1,000","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","per person not applicable","$6500 per group","50%",,,,,"$6,500","per person not applicable","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_HSA_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_HSA_2016_OR.pdf","5"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","2","39424","OR","Individual","No","93-0989307","39424OR1500001","Moda Health Beacon HSA","39424OR150",,"ORN001","ORS001","ORF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997109617658955",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1500001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_HSA_CSV0_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_HSA_CSV0_2016_OR.pdf","6"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","2","39424","OR","Individual","No","93-0989307","39424OR1500001","Moda Health Beacon HSA","39424OR150",,"ORN001","ORS001","ORF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997109617658955",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1500001-03","Limited Cost Sharing Plan Variation",,"0.618900716304779","Yes","Yes","No","100%",,"$3,250","$0","$2,000","$200","$3,250","$0","$1,000","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,250","per person not applicable","$6500 per group","50%",,,,,"$6,500","per person not applicable","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_HSA_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_HSA_2016_OR.pdf","7"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","3","39424","OR","Individual","No","93-0989307","39424OR1260001","Moda Health Beacon Be Protected","39424OR126",,"ORN001","ORS001","ORF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993816511118612",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1260001-00","Standard Gold Off Exchange Plan",,"0.795609176158905","Yes","Yes","No","100%",,"$1,000","$20","$900","$200","$1,000","$600","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtected_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtected_2016_OR.pdf","4"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","3","39424","OR","Individual","No","93-0989307","39424OR1260001","Moda Health Beacon Be Protected","39424OR126",,"ORN001","ORS001","ORF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993816511118612",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1260001-01","Standard Gold On Exchange Plan",,"0.795609176158905","Yes","Yes","No","100%",,"$1,000","$20","$900","$200","$1,000","$600","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtected_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtected_2016_OR.pdf","5"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","3","39424","OR","Individual","No","93-0989307","39424OR1260001","Moda Health Beacon Be Protected","39424OR126",,"ORN001","ORS001","ORF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993816511118612",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1260001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtected_CSV0_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtected_CSV0_2016_OR.pdf","6"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","3","39424","OR","Individual","No","93-0989307","39424OR1260001","Moda Health Beacon Be Protected","39424OR126",,"ORN001","ORS001","ORF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993816511118612",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1260001-03","Limited Cost Sharing Plan Variation",,"0.795609176158905","Yes","Yes","No","100%",,"$1,000","$20","$900","$200","$1,000","$600","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","15%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtected_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeProtected_2016_OR.pdf","7"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","3","39424","OR","Individual","No","93-0989307","39424OR1260002","Moda Health Beacon Be Prepared","39424OR126",,"ORN001","ORS001","ORF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993500391856655",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1260002-00","Standard Silver Off Exchange Plan",,"0.719665706157684","Yes","Yes","No","100%",,"$1,550","$20","$1,700","$200","$1,270","$1,100","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group","30%",,,,,"$3,100","$3100 per person","$6200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_2016_OR.pdf","8"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","3","39424","OR","Individual","No","93-0989307","39424OR1260002","Moda Health Beacon Be Prepared","39424OR126",,"ORN001","ORS001","ORF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993500391856655",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1260002-01","Standard Silver On Exchange Plan",,"0.719665706157684","Yes","Yes","No","100%",,"$1,550","$20","$1,700","$200","$1,270","$1,100","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group","30%",,,,,"$3,100","$3100 per person","$6200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_2016_OR.pdf","9"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","3","39424","OR","Individual","No","93-0989307","39424OR1260002","Moda Health Beacon Be Prepared","39424OR126",,"ORN001","ORS001","ORF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993500391856655",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1260002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_CSV0_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_CSV0_2016_OR.pdf","10"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","3","39424","OR","Individual","No","93-0989307","39424OR1260002","Moda Health Beacon Be Prepared","39424OR126",,"ORN001","ORS001","ORF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993500391856655",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1260002-03","Limited Cost Sharing Plan Variation",,"0.719665706157684","Yes","Yes","No","100%",,"$1,550","$20","$1,700","$200","$1,270","$1,100","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group","30%",,,,,"$3,100","$3100 per person","$6200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_2016_OR.pdf","11"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","3","39424","OR","Individual","No","93-0989307","39424OR1260002","Moda Health Beacon Be Prepared","39424OR126",,"ORN001","ORS001","ORF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993500391856655",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1260002-04","73% AV Level Silver Plan",,"0.739829182624817","Yes","Yes","No","100%",,"$1,550","$20","$1,700","$200","$1,270","$1,100","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,425","$5425 per person","$10850 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,550","$1550 per person","$3100 per group","30%",,,,,"$3,100","$3100 per person","$6200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_CSV1_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_CSV1_2016_OR.pdf","12"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","3","39424","OR","Individual","No","93-0989307","39424OR1260002","Moda Health Beacon Be Prepared","39424OR126",,"ORN001","ORS001","ORF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993500391856655",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1260002-05","87% AV Level Silver Plan",,"0.867769718170166","Yes","Yes","No","100%",,"$750","$0","$700","$200","$750","$600","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"$3,100","$3100 per person","$6200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_CSV2_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_CSV2_2016_OR.pdf","13"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","3","39424","OR","Individual","No","93-0989307","39424OR1260002","Moda Health Beacon Be Prepared","39424OR126",,"ORN001","ORS001","ORF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.993500391856655",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1260002-06","94% AV Level Silver Plan",,"0.944543898105621","Yes","Yes","No","100%",,"$100","$0","$400","$200","$100","$300","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","30%",,,,,"$3,100","$3100 per person","$6200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_CSV3_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BePrepared_CSV3_2016_OR.pdf","14"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460001","Moda Health CCN Be Integrated","39424OR146",,"ORN002","ORS003","ORF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997831898827124",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460001-00","Standard Gold Off Exchange Plan",,"0.791958153247833","Yes","Yes","No","100%",,"$500","$20","$1,400","$200","$500","$600","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeIntegrated_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeIntegrated_2016_OR.pdf","4"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460001","Moda Health CCN Be Integrated","39424OR146",,"ORN002","ORS003","ORF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997831898827124",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460001-01","Standard Gold On Exchange Plan",,"0.791958153247833","Yes","Yes","No","100%",,"$500","$20","$1,400","$200","$500","$600","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeIntegrated_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeIntegrated_2016_OR.pdf","5"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460001","Moda Health CCN Be Integrated","39424OR146",,"ORN002","ORS003","ORF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997831898827124",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeIntegrated_CSV0_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeIntegrated_CSV0_2016_OR.pdf","6"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460001","Moda Health CCN Be Integrated","39424OR146",,"ORN002","ORS003","ORF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997831898827124",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460001-03","Limited Cost Sharing Plan Variation",,"0.791958153247833","Yes","Yes","No","100%",,"$500","$20","$1,400","$200","$500","$600","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeIntegrated_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeIntegrated_2016_OR.pdf","7"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460002","Moda Health Rose City Be Integrated","39424OR146",,"ORN003","ORS004","ORF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997716755769058",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460002-00","Standard Gold Off Exchange Plan",,"0.791958153247833","Yes","Yes","No","100%",,"$500","$20","$1,400","$200","$500","$600","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeIntegrated_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeIntegrated_2016_OR.pdf","8"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460002","Moda Health Rose City Be Integrated","39424OR146",,"ORN003","ORS004","ORF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997716755769058",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460002-01","Standard Gold On Exchange Plan",,"0.791958153247833","Yes","Yes","No","100%",,"$500","$20","$1,400","$200","$500","$600","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeIntegrated_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeIntegrated_2016_OR.pdf","9"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460002","Moda Health Rose City Be Integrated","39424OR146",,"ORN003","ORS004","ORF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997716755769058",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeIntegrated_CSV0_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeIntegrated_CSV0_2016_OR.pdf","10"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460002","Moda Health Rose City Be Integrated","39424OR146",,"ORN003","ORS004","ORF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997716755769058",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460002-03","Limited Cost Sharing Plan Variation",,"0.791958153247833","Yes","Yes","No","100%",,"$500","$20","$1,400","$200","$500","$600","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeIntegrated_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeIntegrated_2016_OR.pdf","11"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460003","Moda Health CCN Be Supported","39424OR146",,"ORN002","ORS003","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997290101684139",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460003-00","Standard Silver Off Exchange Plan",,"0.704799473285675","Yes","Yes","No","100%",,"$2,500","$20","$1,700","$200","$1,270","$700","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeSupported_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeSupported_2016_OR.pdf","12"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460003","Moda Health CCN Be Supported","39424OR146",,"ORN002","ORS003","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997290101684139",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460003-01","Standard Silver On Exchange Plan",,"0.704799473285675","Yes","Yes","No","100%",,"$2,500","$20","$1,700","$200","$1,270","$700","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeSupported_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeSupported_2016_OR.pdf","13"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460003","Moda Health CCN Be Supported","39424OR146",,"ORN002","ORS003","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997290101684139",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeSupported_CSV0_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeSupported_CSV0_2016_OR.pdf","14"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460003","Moda Health CCN Be Supported","39424OR146",,"ORN002","ORS003","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997290101684139",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460003-03","Limited Cost Sharing Plan Variation",,"0.704799473285675","Yes","Yes","No","100%",,"$2,500","$20","$1,700","$200","$1,270","$700","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeSupported_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeSupported_2016_OR.pdf","15"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460003","Moda Health CCN Be Supported","39424OR146",,"ORN002","ORS003","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997290101684139",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460003-04","73% AV Level Silver Plan",,"0.734450161457062","Yes","Yes","No","100%",,"$1,500","$20","$2,000","$200","$1,270","$700","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeSupported_CSV1_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeSupported_CSV1_2016_OR.pdf","16"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460003","Moda Health CCN Be Supported","39424OR146",,"ORN002","ORS003","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997290101684139",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460003-05","87% AV Level Silver Plan",,"0.86527556180954","Yes","Yes","No","100%",,"$750","$0","$700","$200","$750","$500","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeSupported_CSV2_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeSupported_CSV2_2016_OR.pdf","17"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460003","Moda Health CCN Be Supported","39424OR146",,"ORN002","ORS003","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997290101684139",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460003-06","94% AV Level Silver Plan",,"0.936167478561401","Yes","Yes","No","100%",,"$250","$0","$300","$200","$250","$200","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeSupported_CSV3_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeSupported_CSV3_2016_OR.pdf","18"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460004","Moda Health Rose City Be Supported","39424OR146",,"ORN003","ORS004","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997150918175468",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460004-00","Standard Silver Off Exchange Plan",,"0.704799473285675","Yes","Yes","No","100%",,"$2,500","$20","$1,700","$200","$1,270","$700","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeSupported_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeSupported_2016_OR.pdf","19"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460004","Moda Health Rose City Be Supported","39424OR146",,"ORN003","ORS004","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997150918175468",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460004-01","Standard Silver On Exchange Plan",,"0.704799473285675","Yes","Yes","No","100%",,"$2,500","$20","$1,700","$200","$1,270","$700","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeSupported_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeSupported_2016_OR.pdf","20"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460004","Moda Health Rose City Be Supported","39424OR146",,"ORN003","ORS004","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997150918175468",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeSupported_CSV0_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeSupported_CSV0_2016_OR.pdf","21"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460004","Moda Health Rose City Be Supported","39424OR146",,"ORN003","ORS004","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997150918175468",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460004-03","Limited Cost Sharing Plan Variation",,"0.704799473285675","Yes","Yes","No","100%",,"$2,500","$20","$1,700","$200","$1,270","$700","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeSupported_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeSupported_2016_OR.pdf","22"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460004","Moda Health Rose City Be Supported","39424OR146",,"ORN003","ORS004","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997150918175468",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460004-04","73% AV Level Silver Plan",,"0.734450161457062","Yes","Yes","No","100%",,"$1,500","$20","$2,000","$200","$1,270","$700","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeSupported_CSV1_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeSupported_CSV1_2016_OR.pdf","23"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460004","Moda Health Rose City Be Supported","39424OR146",,"ORN003","ORS004","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997150918175468",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460004-05","87% AV Level Silver Plan",,"0.86527556180954","Yes","Yes","No","100%",,"$750","$0","$700","$200","$750","$500","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeSupported_CSV2_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeSupported_CSV2_2016_OR.pdf","24"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","4","39424","OR","Individual","No","93-0989307","39424OR1460004","Moda Health Rose City Be Supported","39424OR146",,"ORN003","ORS004","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.997150918175468",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1460004-06","94% AV Level Silver Plan",,"0.936167478561401","Yes","Yes","No","100%",,"$250","$0","$300","$200","$250","$200","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","35%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeSupported_CSV3_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeSupported_CSV3_2016_OR.pdf","25"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","5","39424","OR","Individual","No","93-0989307","39424OR1480001","Moda Health Beacon Be Lively","39424OR148",,"ORN001","ORS002","ORF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.992776464609005",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1480001-00","Standard Bronze Off Exchange Plan",,"0.619855761528015","Yes","Yes","No","100%",,"$4,470","$0","$1,100","$200","$1,270","$800","$1,200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeLively_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeLively_2016_OR.pdf","4"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","5","39424","OR","Individual","No","93-0989307","39424OR1480001","Moda Health Beacon Be Lively","39424OR148",,"ORN001","ORS002","ORF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.992776464609005",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1480001-01","Standard Bronze On Exchange Plan",,"0.619855761528015","Yes","Yes","No","100%",,"$4,470","$0","$1,100","$200","$1,270","$800","$1,200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeLively_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeLively_2016_OR.pdf","5"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","5","39424","OR","Individual","No","93-0989307","39424OR1480001","Moda Health Beacon Be Lively","39424OR148",,"ORN001","ORS002","ORF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.992776464609005",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1480001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeLively_CSV0_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeLively_CSV0_2016_OR.pdf","6"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","5","39424","OR","Individual","No","93-0989307","39424OR1480001","Moda Health Beacon Be Lively","39424OR148",,"ORN001","ORS002","ORF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.992776464609005",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1480001-03","Limited Cost Sharing Plan Variation",,"0.619855761528015","Yes","Yes","No","100%",,"$4,470","$0","$1,100","$200","$1,270","$800","$1,200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeLively_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeLively_2016_OR.pdf","7"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","5","39424","OR","Individual","No","93-0989307","39424OR1480002","Moda Health CCN Be Lively","39424OR148",,"ORN002","ORS003","ORF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.992548785342125",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1480002-00","Standard Bronze Off Exchange Plan",,"0.619855761528015","Yes","Yes","No","100%",,"$4,470","$0","$1,100","$200","$1,270","$800","$1,200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeLively_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeLively_2016_OR.pdf","8"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","5","39424","OR","Individual","No","93-0989307","39424OR1480002","Moda Health CCN Be Lively","39424OR148",,"ORN002","ORS003","ORF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.992548785342125",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1480002-01","Standard Bronze On Exchange Plan",,"0.619855761528015","Yes","Yes","No","100%",,"$4,470","$0","$1,100","$200","$1,270","$800","$1,200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeLively_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeLively_2016_OR.pdf","9"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","5","39424","OR","Individual","No","93-0989307","39424OR1480002","Moda Health CCN Be Lively","39424OR148",,"ORN002","ORS003","ORF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.992548785342125",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1480002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeLively_CSV0_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeLively_CSV0_2016_OR.pdf","10"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","5","39424","OR","Individual","No","93-0989307","39424OR1480002","Moda Health CCN Be Lively","39424OR148",,"ORN002","ORS003","ORF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.992548785342125",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1480002-03","Limited Cost Sharing Plan Variation",,"0.619855761528015","Yes","Yes","No","100%",,"$4,470","$0","$1,100","$200","$1,270","$800","$1,200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeLively_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_CCN_BeLively_2016_OR.pdf","11"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","5","39424","OR","Individual","No","93-0989307","39424OR1480003","Moda Health Rose City Be Lively","39424OR148",,"ORN003","ORS004","ORF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.992217895117009",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1480003-00","Standard Bronze Off Exchange Plan",,"0.619855761528015","Yes","Yes","No","100%",,"$4,470","$0","$1,100","$200","$1,270","$800","$1,200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeLively_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeLively_2016_OR.pdf","12"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","5","39424","OR","Individual","No","93-0989307","39424OR1480003","Moda Health Rose City Be Lively","39424OR148",,"ORN003","ORS004","ORF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.992217895117009",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1480003-01","Standard Bronze On Exchange Plan",,"0.619855761528015","Yes","Yes","No","100%",,"$4,470","$0","$1,100","$200","$1,270","$800","$1,200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeLively_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeLively_2016_OR.pdf","13"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","5","39424","OR","Individual","No","93-0989307","39424OR1480003","Moda Health Rose City Be Lively","39424OR148",,"ORN003","ORS004","ORF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.992217895117009",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1480003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeLively_CSV0_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeLively_CSV0_2016_OR.pdf","14"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","5","39424","OR","Individual","No","93-0989307","39424OR1480003","Moda Health Rose City Be Lively","39424OR148",,"ORN003","ORS004","ORF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.992217895117009",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1480003-03","Limited Cost Sharing Plan Variation",,"0.619855761528015","Yes","Yes","No","100%",,"$4,470","$0","$1,100","$200","$1,270","$800","$1,200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeLively_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_RC_BeLively_2016_OR.pdf","15"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","6","39424","OR","Individual","No","93-0989307","39424OR1470001","Moda Health Beacon Be Steady","39424OR147",,"ORN001","ORS001","ORF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.993184202081127",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1470001-00","Standard Silver Off Exchange Plan",,"0.718186676502228","Yes","Yes","No","100%",,"$3,000","$20","$1,300","$200","$1,270","$800","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_2016_OR.pdf","4"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","6","39424","OR","Individual","No","93-0989307","39424OR1470001","Moda Health Beacon Be Steady","39424OR147",,"ORN001","ORS001","ORF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.993184202081127",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1470001-01","Standard Silver On Exchange Plan",,"0.718186676502228","Yes","Yes","No","100%",,"$3,000","$20","$1,300","$200","$1,270","$800","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_2016_OR.pdf","5"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","6","39424","OR","Individual","No","93-0989307","39424OR1470001","Moda Health Beacon Be Steady","39424OR147",,"ORN001","ORS001","ORF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.993184202081127",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1470001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_CSV0_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_CSV0_2016_OR.pdf","6"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","6","39424","OR","Individual","No","93-0989307","39424OR1470001","Moda Health Beacon Be Steady","39424OR147",,"ORN001","ORS001","ORF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.993184202081127",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1470001-03","Limited Cost Sharing Plan Variation",,"0.718186676502228","Yes","Yes","No","100%",,"$3,000","$20","$1,300","$200","$1,270","$800","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_2016_OR.pdf","7"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","6","39424","OR","Individual","No","93-0989307","39424OR1470001","Moda Health Beacon Be Steady","39424OR147",,"ORN001","ORS001","ORF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.993184202081127",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1470001-04","73% AV Level Silver Plan",,"0.739209055900574","Yes","Yes","No","100%",,"$2,500","$20","$1,400","$200","$1,270","$800","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_CSV1_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_CSV1_2016_OR.pdf","8"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","6","39424","OR","Individual","No","93-0989307","39424OR1470001","Moda Health Beacon Be Steady","39424OR147",,"ORN001","ORS001","ORF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.993184202081127",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1470001-05","87% AV Level Silver Plan",,"0.868554949760437","Yes","Yes","No","100%",,"$750","$0","$700","$200","$750","$400","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_CSV2_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_CSV2_2016_OR.pdf","9"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","6","39424","OR","Individual","No","93-0989307","39424OR1470001","Moda Health Beacon Be Steady","39424OR147",,"ORN001","ORS001","ORF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.993184202081127",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1470001-06","94% AV Level Silver Plan",,"0.935464382171631","Yes","Yes","No","100%",,"$250","$0","$300","$200","$250","$60","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$250","$250 per person","$500 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_CSV3_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeSteady_CSV3_2016_OR.pdf","10"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","7","39424","OR","Individual","No","93-0989307","39424OR1310001","Moda Health Oregon Standard Bronze (Beacon)","39424OR131",,"ORN001","ORS001","ORF007","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996891608425023",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1310001-00","Standard Bronze Off Exchange Plan",,"0.619022488594055","Yes","Yes","No","100%",,"$4,470","$20","$1,400","$200","$1,270","$1,400","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_2016_OR.pdf","4"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","7","39424","OR","Individual","No","93-0989307","39424OR1310001","Moda Health Oregon Standard Bronze (Beacon)","39424OR131",,"ORN001","ORS001","ORF007","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996891608425023",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1310001-01","Standard Bronze On Exchange Plan",,"0.619022488594055","Yes","Yes","No","100%",,"$4,470","$20","$1,400","$200","$1,270","$1,400","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_2016_OR.pdf","5"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","7","39424","OR","Individual","No","93-0989307","39424OR1310001","Moda Health Oregon Standard Bronze (Beacon)","39424OR131",,"ORN001","ORS001","ORF007","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996891608425023",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1310001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_CSV0_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_CSV0_2016_OR.pdf","6"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","7","39424","OR","Individual","No","93-0989307","39424OR1310001","Moda Health Oregon Standard Bronze (Beacon)","39424OR131",,"ORN001","ORS001","ORF007","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996891608425023",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1310001-03","Limited Cost Sharing Plan Variation",,"0.619022488594055","Yes","Yes","No","100%",,"$4,470","$20","$1,400","$200","$1,270","$1,400","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_2016_OR.pdf","7"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","8","39424","OR","Individual","No","93-0989307","39424OR1320001","Moda Health Beacon Be Bold","39424OR132",,"ORN001","ORS001","ORF008","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996018911012211",,,,"0","0","3","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1320001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$4,470","$0","$0","$200","$1,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeBold_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeBold_2016_OR.pdf","4"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","8","39424","OR","Individual","No","93-0989307","39424OR1320001","Moda Health Beacon Be Bold","39424OR132",,"ORN001","ORS001","ORF008","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996018911012211",,,,"0","0","3","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1320001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$4,470","$0","$0","$200","$1,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeBold_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeBold_2016_OR.pdf","5"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","9","39424","OR","Individual","No","93-0989307","39424OR1490001","Moda Health Beacon Be Resilient","39424OR149",,"ORN001","ORS001","ORF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996817223574524",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1490001-00","Standard Bronze Off Exchange Plan",,"0.618471264839172","Yes","Yes","No","100%",,"$4,470","$20","$0","$200","$1,270","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeResilient_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeResilient_2016_OR.pdf","4"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","9","39424","OR","Individual","No","93-0989307","39424OR1490001","Moda Health Beacon Be Resilient","39424OR149",,"ORN001","ORS001","ORF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996817223574524",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1490001-01","Standard Bronze On Exchange Plan",,"0.618471264839172","Yes","Yes","No","100%",,"$4,470","$20","$0","$200","$1,270","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeResilient_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeResilient_2016_OR.pdf","5"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","9","39424","OR","Individual","No","93-0989307","39424OR1490001","Moda Health Beacon Be Resilient","39424OR149",,"ORN001","ORS001","ORF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996817223574524",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1490001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeResilient_CSV0_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeResilient_CSV0_2016_OR.pdf","6"
"2016","OR","39424","SERFF","6","2016-01-26 09:59:26","9","39424","OR","Individual","No","93-0989307","39424OR1490001","Moda Health Beacon Be Resilient","39424OR149",,"ORN001","ORS001","ORF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996817223574524",,,,"0","0","0","2016-01-01",,"No",,"Yes","Travel Network","No",,"http://www.modahealth.com/pdl?type=IND&state=OR","39424OR1490001-03","Limited Cost Sharing Plan Variation",,"0.618471264839172","Yes","Yes","No","100%",,"$4,470","$20","$0","$200","$1,270","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"$13,000","$13000 per person","$26000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeResilient_SBC_2016_OR.pdf","https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_BeResilient_2016_OR.pdf","7"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","5","56707","OR","Individual","No","93-0863097","56707OR0850008","Balance 6800 Bronze","56707OR085",,"ORN001","ORS001","ORF003","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850008-00","Standard Bronze Off Exchange Plan",,"0.616643607616425","Yes","Yes","No","100%",,"$6,800","$0","$50","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","per person not applicable","$13600 per group","50%",,,,,"$13,600","per person not applicable","$27200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/direct/2016%20OR%20IND%20BAL%20085000800.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","16"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","5","56707","OR","Individual","No","93-0863097","56707OR0850008","Balance 6800 Bronze","56707OR085",,"ORN001","ORS001","ORF003","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850008-01","Standard Bronze On Exchange Plan",,"0.616643607616425","Yes","Yes","No","100%",,"$6,800","$0","$50","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","per person not applicable","$13600 per group","50%",,,,,"$13,600","per person not applicable","$27200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20BAL%20085000801.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","17"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","1","56707","OR","Individual","No","93-0863097","56707OR0990002","Providence Oregon Standard Gold Plan","56707OR099",,"ORN001","ORS001","ORF005","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes",,"https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0990002-00","Standard Gold Off Exchange Plan",,"0.784055233001709","No","Yes","No","100%",,"$1,250","$20","$600","$150","$1,250","$460","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/direct/2016%20OR%20IND%20STN%20099000200.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","4"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","1","56707","OR","Individual","No","93-0863097","56707OR0990002","Providence Oregon Standard Gold Plan","56707OR099",,"ORN001","ORS001","ORF005","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes",,"https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0990002-01","Standard Gold On Exchange Plan",,"0.784055233001709","No","Yes","No","100%",,"$1,250","$20","$600","$150","$1,250","$460","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20STN%20099000201.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","5"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","1","56707","OR","Individual","No","93-0863097","56707OR0990002","Providence Oregon Standard Gold Plan","56707OR099",,"ORN001","ORS001","ORF005","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes",,"https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0990002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20STN%20099000202.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","6"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","1","56707","OR","Individual","No","93-0863097","56707OR0990002","Providence Oregon Standard Gold Plan","56707OR099",,"ORN001","ORS001","ORF005","Existing","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes",,"https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0990002-03","Limited Cost Sharing Plan Variation",,"0.784055233001709","No","Yes","No","100%",,"$1,250","$20","$600","$150","$1,250","$460","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20STN%20099000203.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","7"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","2","56707","OR","Individual","No","93-0863097","56707OR0870002","Providence Oregon Standard Silver Plan","56707OR087",,"ORN001","ORS001","ORF006","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870002-00","Standard Silver Off Exchange Plan",,"0.696986019611359","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/direct/2016%20OR%20IND%20STN%20087000200.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","4"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","2","56707","OR","Individual","No","93-0863097","56707OR0870002","Providence Oregon Standard Silver Plan","56707OR087",,"ORN001","ORS001","ORF006","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870002-01","Standard Silver On Exchange Plan",,"0.696986019611359","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20STN%20087000201.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","5"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","2","56707","OR","Individual","No","93-0863097","56707OR0870002","Providence Oregon Standard Silver Plan","56707OR087",,"ORN001","ORS001","ORF006","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20STN%20087000202.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","6"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","2","56707","OR","Individual","No","93-0863097","56707OR0870002","Providence Oregon Standard Silver Plan","56707OR087",,"ORN001","ORS001","ORF006","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870002-03","Limited Cost Sharing Plan Variation",,"0.696986019611359","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20STN%20087000203.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","7"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","2","56707","OR","Individual","No","93-0863097","56707OR0870002","Providence Oregon Standard Silver Plan","56707OR087",,"ORN001","ORS001","ORF006","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870002-04","73% AV Level Silver Plan",,"0.739232897758484","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$2,500","$500","$230","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"$8,600","$8600 per person","$17200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20STN%20087000204.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","8"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","2","56707","OR","Individual","No","93-0863097","56707OR0870002","Providence Oregon Standard Silver Plan","56707OR087",,"ORN001","ORS001","ORF006","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870002-05","87% AV Level Silver Plan",,"0.879479050636292","No","Yes","No","100%",,"$850","$10","$640","$150","$850","$500","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10%",,,,,"$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20STN%20087000205.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","9"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","2","56707","OR","Individual","No","93-0863097","56707OR0870002","Providence Oregon Standard Silver Plan","56707OR087",,"ORN001","ORS001","ORF006","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0870002-06","94% AV Level Silver Plan",,"0.944502472877502","No","Yes","No","100%",,"$100","$0","$650","$150","$100","$300","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"$200","$200 per person","$400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20STN%20087000206.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","10"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","3","56707","OR","Individual","No","93-0863097","56707OR1000002","Providence Oregon Standard Bronze","56707OR100",,"ORN001","ORS001","ORF007","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1000002-00","Standard Bronze Off Exchange Plan",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$20","$1,130","$150","$5,000","$60","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","50%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/direct/2016%20OR%20IND%20STN%20100000200.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","4"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","3","56707","OR","Individual","No","93-0863097","56707OR1000002","Providence Oregon Standard Bronze","56707OR100",,"ORN001","ORS001","ORF007","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1000002-01","Standard Bronze On Exchange Plan",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$20","$1,130","$150","$5,000","$60","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","50%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20STN%20100000201.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","5"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","3","56707","OR","Individual","No","93-0863097","56707OR1000002","Providence Oregon Standard Bronze","56707OR100",,"ORN001","ORS001","ORF007","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1000002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20STN%20100000202.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","6"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","3","56707","OR","Individual","No","93-0863097","56707OR1000002","Providence Oregon Standard Bronze","56707OR100",,"ORN001","ORS001","ORF007","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR1000002-03","Limited Cost Sharing Plan Variation",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$20","$1,130","$150","$5,000","$60","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","50%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20STN%20100000203.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","7"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","4","56707","OR","Individual","No","93-0863097","56707OR0880002","Providence Essential","56707OR088",,"ORN001","ORS001","ORF014","Existing","EPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0880002-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,370","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/direct/2016%20OR%20IND%20CAT%20088000200.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","4"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","4","56707","OR","Individual","No","93-0863097","56707OR0880002","Providence Essential","56707OR088",,"ORN001","ORS001","ORF014","Existing","EPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0880002-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,370","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20CAT%20088000201.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","5"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","5","56707","OR","Individual","No","93-0863097","56707OR0850005","Balance 1000 Gold","56707OR085",,"ORN001","ORS001","ORF001","New","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9921",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850005-00","Standard Gold Off Exchange Plan",,"0.802284598350525","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$650","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$2000 per group","20%",,,,,"$1,000","per person not applicable","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/direct/2016%20OR%20IND%20BAL%20085000500.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","4"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","5","56707","OR","Individual","No","93-0863097","56707OR0850005","Balance 1000 Gold","56707OR085",,"ORN001","ORS001","ORF001","New","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9921",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850005-01","Standard Gold On Exchange Plan",,"0.802284598350525","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$650","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$2000 per group","20%",,,,,"$1,000","per person not applicable","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20BAL%20085000501.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","5"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","5","56707","OR","Individual","No","93-0863097","56707OR0850005","Balance 1000 Gold","56707OR085",,"ORN001","ORS001","ORF001","New","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9921",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20BAL%20085000502.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","6"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","5","56707","OR","Individual","No","93-0863097","56707OR0850005","Balance 1000 Gold","56707OR085",,"ORN001","ORS001","ORF001","New","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9921",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850005-03","Limited Cost Sharing Plan Variation",,"0.802284598350525","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$650","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$2000 per group","20%",,,,,"$1,000","per person not applicable","$2000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20BAL%20085000503.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","7"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","5","56707","OR","Individual","No","93-0863097","56707OR0850006","Balance 2000 Silver","56707OR085",,"ORN001","ORS001","ORF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9932",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850006-00","Standard Silver Off Exchange Plan",,"0.710186898708344","Yes","Yes","No","100%",,"$2,000","$20","$1,580","$150","$2,000","$560","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/direct/2016%20OR%20IND%20BAL%20085000600.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","8"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","5","56707","OR","Individual","No","93-0863097","56707OR0850006","Balance 2000 Silver","56707OR085",,"ORN001","ORS001","ORF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9932",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850006-01","Standard Silver On Exchange Plan",,"0.710186898708344","Yes","Yes","No","100%",,"$2,000","$20","$1,580","$150","$2,000","$560","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20BAL%20085000601.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","9"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","5","56707","OR","Individual","No","93-0863097","56707OR0850006","Balance 2000 Silver","56707OR085",,"ORN001","ORS001","ORF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9932",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20BAL%20085000602.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","10"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","5","56707","OR","Individual","No","93-0863097","56707OR0850006","Balance 2000 Silver","56707OR085",,"ORN001","ORS001","ORF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9932",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850006-03","Limited Cost Sharing Plan Variation",,"0.710186898708344","Yes","Yes","No","100%",,"$2,000","$20","$1,580","$150","$2,000","$560","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20BAL%20085000603.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","11"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","5","56707","OR","Individual","No","93-0863097","56707OR0850006","Balance 2000 Silver","56707OR085",,"ORN001","ORS001","ORF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9932",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850006-04","73% AV Level Silver Plan",,"0.732836246490479","Yes","Yes","No","100%",,"$2,000","$20","$1,580","$150","$2,000","$560","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20BAL%20085000604.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","12"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","5","56707","OR","Individual","No","93-0863097","56707OR0850006","Balance 2000 Silver","56707OR085",,"ORN001","ORS001","ORF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9932",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850006-05","87% AV Level Silver Plan",,"0.870436549186707","Yes","Yes","No","100%",,"$750","$20","$650","$150","$750","$640","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","per person not applicable","$1500 per group","10%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20BAL%20085000605.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","13"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","5","56707","OR","Individual","No","93-0863097","56707OR0850006","Balance 2000 Silver","56707OR085",,"ORN001","ORS001","ORF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9932",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850006-06","94% AV Level Silver Plan",,"0.948917031288147","Yes","Yes","No","100%",,"$100","$20","$360","$150","$100","$450","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group","5%",,,,,"$200","per person not applicable","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20BAL%20085000606.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","14"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","5","56707","OR","Individual","No","93-0863097","56707OR0850008","Balance 6800 Bronze","56707OR085",,"ORN001","ORS001","ORF003","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20BAL%20085000802.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","18"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","5","56707","OR","Individual","No","93-0863097","56707OR0850008","Balance 6800 Bronze","56707OR085",,"ORN001","ORS001","ORF003","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9945",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","National network or out of network benefit","Yes","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0850008-03","Limited Cost Sharing Plan Variation",,"0.616643607616425","Yes","Yes","No","100%",,"$6,800","$0","$50","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","per person not applicable","$13600 per group","50%",,,,,"$13,600","per person not applicable","$27200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20BAL%20085000803.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","19"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","7","56707","OR","Individual","No","93-0863097","56707OR0900008","Choice 1000 Gold","56707OR090",,"ORN002","ORS002","ORF001","New","EPO","Gold","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900008-00","Standard Gold Off Exchange Plan",,"0.802284598350525","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$650","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$2000 per group","20%",,,,,"$2,000","per person not applicable","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/direct/2016%20OR%20IND%20CHC%20090000800.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","4"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","7","56707","OR","Individual","No","93-0863097","56707OR0900008","Choice 1000 Gold","56707OR090",,"ORN002","ORS002","ORF001","New","EPO","Gold","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900008-01","Standard Gold On Exchange Plan",,"0.802284598350525","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$650","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$2000 per group","20%",,,,,"$2,000","per person not applicable","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20CHC%20090000801.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","5"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","7","56707","OR","Individual","No","93-0863097","56707OR0900008","Choice 1000 Gold","56707OR090",,"ORN002","ORS002","ORF001","New","EPO","Gold","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20CHC%20090000802.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","6"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","7","56707","OR","Individual","No","93-0863097","56707OR0900008","Choice 1000 Gold","56707OR090",,"ORN002","ORS002","ORF001","New","EPO","Gold","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9926",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900008-03","Limited Cost Sharing Plan Variation",,"0.802284598350525","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$650","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$2000 per group","20%",,,,,"$2,000","per person not applicable","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20CHC%20090000803.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","7"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","7","56707","OR","Individual","No","93-0863097","56707OR0900009","Choice 2000 Silver","56707OR090",,"ORN002","ORS002","ORF002","New","EPO","Silver","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9936",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900009-00","Standard Silver Off Exchange Plan",,"0.710186898708344","Yes","Yes","No","100%",,"$2,000","$20","$1,580","$150","$2,000","$560","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/direct/2016%20OR%20IND%20CHC%20090000900.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","8"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","7","56707","OR","Individual","No","93-0863097","56707OR0900009","Choice 2000 Silver","56707OR090",,"ORN002","ORS002","ORF002","New","EPO","Silver","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9936",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900009-01","Standard Silver On Exchange Plan",,"0.710186898708344","Yes","Yes","No","100%",,"$2,000","$20","$1,580","$150","$2,000","$560","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20CHC%20090000901.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","9"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","7","56707","OR","Individual","No","93-0863097","56707OR0900009","Choice 2000 Silver","56707OR090",,"ORN002","ORS002","ORF002","New","EPO","Silver","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9936",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20CHC%20090000902.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","10"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","7","56707","OR","Individual","No","93-0863097","56707OR0900009","Choice 2000 Silver","56707OR090",,"ORN002","ORS002","ORF002","New","EPO","Silver","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9936",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900009-03","Limited Cost Sharing Plan Variation",,"0.710186898708344","Yes","Yes","No","100%",,"$2,000","$20","$1,580","$150","$2,000","$560","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20CHC%20090000903.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","11"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","7","56707","OR","Individual","No","93-0863097","56707OR0900009","Choice 2000 Silver","56707OR090",,"ORN002","ORS002","ORF002","New","EPO","Silver","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9936",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900009-04","73% AV Level Silver Plan",,"0.732836246490479","Yes","Yes","No","100%",,"$2,000","$20","$1,580","$150","$2,000","$560","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20CHC%20090000904.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","12"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","7","56707","OR","Individual","No","93-0863097","56707OR0900009","Choice 2000 Silver","56707OR090",,"ORN002","ORS002","ORF002","New","EPO","Silver","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9936",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900009-05","87% AV Level Silver Plan",,"0.870436549186707","Yes","Yes","No","100%",,"$750","$20","$650","$150","$750","$640","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","per person not applicable","$1500 per group","10%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20CHC%20090000905.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","13"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","7","56707","OR","Individual","No","93-0863097","56707OR0900009","Choice 2000 Silver","56707OR090",,"ORN002","ORS002","ORF002","New","EPO","Silver","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9936",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900009-06","94% AV Level Silver Plan",,"0.948917031288147","Yes","Yes","No","100%",,"$100","$20","$360","$150","$100","$450","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group","5%",,,,,"$200","per person not applicable","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20CHC%20090000906.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","14"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","7","56707","OR","Individual","No","93-0863097","56707OR0900011","Choice 6800 Bronze","56707OR090",,"ORN002","ORS002","ORF003","New","EPO","Bronze","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9948",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900011-00","Standard Bronze Off Exchange Plan",,"0.616643607616425","Yes","Yes","No","100%",,"$6,800","$0","$50","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","per person not applicable","$13600 per group","50%",,,,,"$13,600","per person not applicable","$27200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/direct/2016%20OR%20IND%20CHC%20090001100.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","16"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","7","56707","OR","Individual","No","93-0863097","56707OR0900011","Choice 6800 Bronze","56707OR090",,"ORN002","ORS002","ORF003","New","EPO","Bronze","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9948",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900011-01","Standard Bronze On Exchange Plan",,"0.616643607616425","Yes","Yes","No","100%",,"$6,800","$0","$50","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","per person not applicable","$13600 per group","50%",,,,,"$13,600","per person not applicable","$27200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20CHC%20090001101.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","17"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","1","63474","OR","Individual","No","87-0388069","63474OR0010002","BridgeSpan Oregon Standard Silver Plan Value PPO","63474OR001",,"ORN001","ORS003","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987648139945382",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0010002-05","87% AV Level Silver Plan",,"0.879479050636292","No","Yes","No","100%",,"$850","$20","$640","$150","$420","$830","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$12,700","$12700 per person","$25400 per group","$14,200","$14200 per person","$28400 per group","$850","$850 per person","$1700 per group","10%",,,,,"$10,000","$10000 per person","$20000 per group","$10,850","$10850 per person","$21700 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-Value-PPO-87.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","13"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","1","63474","OR","Individual","No","87-0388069","63474OR0010002","BridgeSpan Oregon Standard Silver Plan Value PPO","63474OR001",,"ORN001","ORS003","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987648139945382",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0010002-06","94% AV Level Silver Plan",,"0.944502472877502","No","Yes","No","100%",,"$100","$10","$720","$150","$100","$470","$30","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$12,700","$12700 per person","$25400 per group","$13,450","$13450 per person","$26900 per group","$100","$100 per person","$200 per group","10%",,,,,"$10,000","$10000 per person","$20000 per group","$10,100","$10100 per person","$20200 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-Value-PPO-94.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","14"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","2","63474","OR","Individual","No","87-0388069","63474OR0310001","Silver HDHP 2000 Value PPO","63474OR031",,"ORN001","ORS001","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987478629595135",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0310001-00","Standard Silver Off Exchange Plan",,"0.689664602279663","Yes","Yes","No","100%",,"2000","0","1060","150","2000","0","660","40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"$19,650","per person not applicable","$39300 per group","$26,200","per person not applicable","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","$12,000","per person not applicable","$24000 per group","Yes",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Silver-HDHP-2000-Value-PPO.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","4"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","2","63474","OR","Individual","No","87-0388069","63474OR0310001","Silver HDHP 2000 Value PPO","63474OR031",,"ORN001","ORS001","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987478629595135",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0310001-01","Standard Silver On Exchange Plan",,"0.689664602279663","Yes","Yes","No","100%",,"2000","0","1060","150","2000","0","660","40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"$19,650","per person not applicable","$39300 per group","$26,200","per person not applicable","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","$12,000","per person not applicable","$24000 per group","Yes",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Silver-HDHP-2000-Value-PPO.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","5"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","2","63474","OR","Individual","No","87-0388069","63474OR0310001","Silver HDHP 2000 Value PPO","63474OR031",,"ORN001","ORS001","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987478629595135",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0310001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Silver-HDHP-2000-Value-PPO-Less-than-300.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","6"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","2","63474","OR","Individual","No","87-0388069","63474OR0310001","Silver HDHP 2000 Value PPO","63474OR031",,"ORN001","ORS001","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987478629595135",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0310001-03","Limited Cost Sharing Plan Variation",,"0.689664602279663","Yes","Yes","No","100%",,"2000","0","1060","150","2000","0","660","40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"$19,650","per person not applicable","$39300 per group","$26,200","per person not applicable","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","$12,000","per person not applicable","$24000 per group","Yes",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Silver-HDHP-2000-Value-PPO.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","7"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","7","56707","OR","Individual","No","93-0863097","56707OR0900011","Choice 6800 Bronze","56707OR090",,"ORN002","ORS002","ORF003","New","EPO","Bronze","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9948",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20CHC%20090001102.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","18"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","7","56707","OR","Individual","No","93-0863097","56707OR0900011","Choice 6800 Bronze","56707OR090",,"ORN002","ORS002","ORF003","New","EPO","Bronze","No","Both","No","Yes","Specialists outside of your medical home",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9948",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0900011-03","Limited Cost Sharing Plan Variation",,"0.616643607616425","Yes","Yes","No","100%",,"$6,800","$0","$50","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","per person not applicable","$13600 per group","50%",,,,,"$13,600","per person not applicable","$27200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20CHC%20090001103.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","19"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","8","56707","OR","Individual","No","93-0863097","56707OR0910008","Connect 1000 Gold","56707OR091",,"ORN003","ORS003","ORF001","New","EPO","Gold","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910008-00","Standard Gold Off Exchange Plan",,"0.802282333374023","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$650","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$2000 per group","20%",,,,,"$2,000","per person not applicable","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/direct/2016%20OR%20IND%20CNC%20091000800.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","4"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","8","56707","OR","Individual","No","93-0863097","56707OR0910008","Connect 1000 Gold","56707OR091",,"ORN003","ORS003","ORF001","New","EPO","Gold","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910008-01","Standard Gold On Exchange Plan",,"0.802282333374023","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$650","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$2000 per group","20%",,,,,"$2,000","per person not applicable","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20CNC%20091000801.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","5"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","8","56707","OR","Individual","No","93-0863097","56707OR0910008","Connect 1000 Gold","56707OR091",,"ORN003","ORS003","ORF001","New","EPO","Gold","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20CNC%20091000802.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","6"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","8","56707","OR","Individual","No","93-0863097","56707OR0910008","Connect 1000 Gold","56707OR091",,"ORN003","ORS003","ORF001","New","EPO","Gold","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9967",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910008-03","Limited Cost Sharing Plan Variation",,"0.802282333374023","Yes","Yes","No","100%",,"$1,000","$20","$1,250","$150","$1,000","$650","$220","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","per person not applicable","$2000 per group","20%",,,,,"$2,000","per person not applicable","$4000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20CNC%20091000803.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","7"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","8","56707","OR","Individual","No","93-0863097","56707OR0910009","Connect 2000 Silver","56707OR091",,"ORN003","ORS003","ORF002","New","EPO","Silver","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910009-00","Standard Silver Off Exchange Plan",,"0.710186898708344","Yes","Yes","No","100%",,"$2,000","$20","$1,580","$150","$2,000","$560","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/direct/2016%20OR%20IND%20CNC%20091000900.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","8"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","8","56707","OR","Individual","No","93-0863097","56707OR0910009","Connect 2000 Silver","56707OR091",,"ORN003","ORS003","ORF002","New","EPO","Silver","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910009-01","Standard Silver On Exchange Plan",,"0.710186898708344","Yes","Yes","No","100%",,"$2,000","$20","$1,580","$150","$2,000","$560","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20CNC%20091000901.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","9"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","8","56707","OR","Individual","No","93-0863097","56707OR0910009","Connect 2000 Silver","56707OR091",,"ORN003","ORS003","ORF002","New","EPO","Silver","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20CNC%20091000902.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","10"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","8","56707","OR","Individual","No","93-0863097","56707OR0910009","Connect 2000 Silver","56707OR091",,"ORN003","ORS003","ORF002","New","EPO","Silver","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910009-03","Limited Cost Sharing Plan Variation",,"0.710186898708344","Yes","Yes","No","100%",,"$2,000","$20","$1,580","$150","$2,000","$560","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20CNC%20091000903.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","11"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","8","56707","OR","Individual","No","93-0863097","56707OR0910009","Connect 2000 Silver","56707OR091",,"ORN003","ORS003","ORF002","New","EPO","Silver","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910009-04","73% AV Level Silver Plan",,"0.732836246490479","Yes","Yes","No","100%",,"$2,000","$20","$1,580","$150","$2,000","$560","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,900","$10900 per person","$21800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","30%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20CNC%20091000904.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","12"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","8","56707","OR","Individual","No","93-0863097","56707OR0910009","Connect 2000 Silver","56707OR091",,"ORN003","ORS003","ORF002","New","EPO","Silver","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910009-05","87% AV Level Silver Plan",,"0.870436549186707","Yes","Yes","No","100%",,"$750","$20","$650","$150","$750","$640","$110","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","per person not applicable","$1500 per group","10%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20CNC%20091000905.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","13"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","8","56707","OR","Individual","No","93-0863097","56707OR0910009","Connect 2000 Silver","56707OR091",,"ORN003","ORS003","ORF002","New","EPO","Silver","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9972",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910009-06","94% AV Level Silver Plan",,"0.948917031288147","Yes","Yes","No","100%",,"$100","$20","$360","$150","$100","$450","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$200 per group","5%",,,,,"$200","per person not applicable","$400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20CNC%20091000906.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","14"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","8","56707","OR","Individual","No","93-0863097","56707OR0910011","Connect 6800 Bronze","56707OR091",,"ORN003","ORS003","ORF003","New","EPO","Bronze","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910011-00","Standard Bronze Off Exchange Plan",,"0.616643607616425","Yes","Yes","No","100%",,"$6,800","$0","$50","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","per person not applicable","$13600 per group","50%",,,,,"$13,600","per person not applicable","$27200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/direct/2016%20OR%20IND%20CNC%20091001100.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","16"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","8","56707","OR","Individual","No","93-0863097","56707OR0910011","Connect 6800 Bronze","56707OR091",,"ORN003","ORS003","ORF003","New","EPO","Bronze","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910011-01","Standard Bronze On Exchange Plan",,"0.616643607616425","Yes","Yes","No","100%",,"$6,800","$0","$50","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","per person not applicable","$13600 per group","50%",,,,,"$13,600","per person not applicable","$27200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/ffm/2016%20OR%20IND%20CNC%20091001101.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","17"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","8","56707","OR","Individual","No","93-0863097","56707OR0910011","Connect 6800 Bronze","56707OR091",,"ORN003","ORS003","ORF003","New","EPO","Bronze","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20CNC%20091001102.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","18"
"2016","OR","56707","SERFF","11","2015-08-21 06:27:38","8","56707","OR","Individual","No","93-0863097","56707OR0910011","Connect 6800 Bronze","56707OR091",,"ORN003","ORS003","ORF003","New","EPO","Bronze","No","Both","No","Yes","Specialists outside of your medical neighborhood",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9977",,,,"0","0","0","2016-01-01",,"Yes","Out of network benefit","Yes","Out of network benefit","No","https://fedexchange.providence.org","https://healthplans.providence.org/members/pharmacy-resources/Pages/default.aspx","56707OR0910011-03","Limited Cost Sharing Plan Variation",,"0.616643607616425","Yes","Yes","No","100%",,"$6,800","$0","$50","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","per person not applicable","$13600 per group","50%",,,,,"$13,600","per person not applicable","$27200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/sbc/tribal/2016%20OR%20IND%20CNC%20091001103.pdf","https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/Documents/2016/Plan%20overview.pdf","19"
"2016","OR","60013","SERFF","6","2015-08-20 12:28:36","1","60013","OR","Individual","Yes","93-1171647","60013OR0020002","Willamette Dental ProCare Oregon Plan 1","60013OR002",,"ORN001","ORS001",,"Existing","EPO","Low",,"Both",,,,"Services that are not dentally appropriate are not covered.  Services that are not listed as covered in the policy are not covered.",,"No","Allows Adult and Child-Only",,,,,"$29.43","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","The enrollee may seek treatment for a dental emergency from a mon-participating provider if the enrollee is 50-miles or more from the nearest participating provider’s office.  The company will reimburse the enrollee up to $100 toward covered services provided for treatment of the dental emergency, minus applicable copayments.","No",,"","60013OR0020002-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://willamettedental.gelfuzion.net/_literature_225953/2016_ProCare_Oregon_Plan_1_Benefit_Summary","https://www.willamettedental.com/procare-oregon","4"
"2016","OR","60013","SERFF","6","2015-08-20 12:28:36","1","60013","OR","Individual","Yes","93-1171647","60013OR0020002","Willamette Dental ProCare Oregon Plan 1","60013OR002",,"ORN001","ORS001",,"Existing","EPO","Low",,"Both",,,,"Services that are not dentally appropriate are not covered.  Services that are not listed as covered in the policy are not covered.",,"No","Allows Adult and Child-Only",,,,,"$29.43","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","The enrollee may seek treatment for a dental emergency from a mon-participating provider if the enrollee is 50-miles or more from the nearest participating provider’s office.  The company will reimburse the enrollee up to $100 toward covered services provided for treatment of the dental emergency, minus applicable copayments.","No",,"","60013OR0020002-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://willamettedental.gelfuzion.net/_literature_225953/2016_ProCare_Oregon_Plan_1_Benefit_Summary","https://www.willamettedental.com/procare-oregon","5"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","4","63474","OR","Individual","No","87-0388069","63474OR0320001","Bronze Essential 6850 Value PPO","63474OR032",,"ORN001","ORS001","ORF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987230039570661",,,,"0","0","2","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0320001-00","Standard Bronze Off Exchange Plan",,"0.615954756736755","Yes","Yes","No","100%",,"6850","20","0","150","3440","760","0","40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","$27,400","$27400 per person","$54800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Bronze-Essential-6850-Value-PPO.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","4"
"2016","OR","60013","SERFF","6","2015-08-20 12:28:36","1","60013","OR","Individual","Yes","93-1171647","60013OR0020003","Willamette Dental ProCare Oregon Plan 2","60013OR002",,"ORN001","ORS001",,"Existing","EPO","High",,"Both",,,,"Services that are not dentally appropriate are not covered.  Services that are not listed as covered in the policy are not covered.",,"No","Allows Adult and Child-Only",,,,,"$33.94","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","The enrollee may seek treatment for a dental emergency from a mon-participating provider if the enrollee is 50-miles or more from the nearest participating provider’s office.  The company will reimburse the enrollee up to $100 toward covered services provided for treatment of the dental emergency, minus applicable copayments.","No",,"","60013OR0020003-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://willamettedental.gelfuzion.net/_literature_225954/2016_ProCare_Oregon_Plan_2_Benefit_Summary","https://www.willamettedental.com/procare-oregon","6"
"2016","OR","60013","SERFF","6","2015-08-20 12:28:36","1","60013","OR","Individual","Yes","93-1171647","60013OR0020003","Willamette Dental ProCare Oregon Plan 2","60013OR002",,"ORN001","ORS001",,"Existing","EPO","High",,"Both",,,,"Services that are not dentally appropriate are not covered.  Services that are not listed as covered in the policy are not covered.",,"No","Allows Adult and Child-Only",,,,,"$33.94","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","The enrollee may seek treatment for a dental emergency from a mon-participating provider if the enrollee is 50-miles or more from the nearest participating provider’s office.  The company will reimburse the enrollee up to $100 toward covered services provided for treatment of the dental emergency, minus applicable copayments.","No",,"","60013OR0020003-01","Standard High On Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,"$350","per person not applicable","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://willamettedental.gelfuzion.net/_literature_225954/2016_ProCare_Oregon_Plan_2_Benefit_Summary","https://www.willamettedental.com/procare-oregon","7"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","1","63474","OR","Individual","No","87-0388069","63474OR0010001","BridgeSpan Oregon Standard Gold Plan Value PPO","63474OR001",,"ORN001","ORS003","ORF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988081438919666",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0010001-00","Standard Gold Off Exchange Plan",,"0.784055233001709","No","Yes","No","100%",,"$1,250","$20","$600","$150","$420","$860","$220","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$1,250","$1250 per person","$2500 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","$6,250","$6250 per person","$12500 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Gold-Plan-Value-PPO.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","4"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","1","63474","OR","Individual","No","87-0388069","63474OR0010001","BridgeSpan Oregon Standard Gold Plan Value PPO","63474OR001",,"ORN001","ORS003","ORF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988081438919666",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0010001-01","Standard Gold On Exchange Plan",,"0.784055233001709","No","Yes","No","100%",,"$1,250","$20","$600","$150","$420","$860","$220","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$1,250","$1250 per person","$2500 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","$6,250","$6250 per person","$12500 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Gold-Plan-Value-PPO.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","5"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","1","63474","OR","Individual","No","87-0388069","63474OR0010001","BridgeSpan Oregon Standard Gold Plan Value PPO","63474OR001",,"ORN001","ORS003","ORF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988081438919666",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0010001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$150",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Gold-Plan-Value-PPO-Less-than-300.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","6"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","1","63474","OR","Individual","No","87-0388069","63474OR0010001","BridgeSpan Oregon Standard Gold Plan Value PPO","63474OR001",,"ORN001","ORS003","ORF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988081438919666",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0010001-03","Limited Cost Sharing Plan Variation",,"0.784055233001709","No","Yes","No","100%",,"$1,250","$20","$600","$150","$420","$860","$220","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$1,250","$1250 per person","$2500 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","$6,250","$6250 per person","$12500 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Gold-Plan-Value-PPO.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","7"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","1","63474","OR","Individual","No","87-0388069","63474OR0010002","BridgeSpan Oregon Standard Silver Plan Value PPO","63474OR001",,"ORN001","ORS003","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987648139945382",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0010002-00","Standard Silver Off Exchange Plan",,"0.696986019611359","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$420","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-Value-PPO.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","8"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","1","63474","OR","Individual","No","87-0388069","63474OR0010002","BridgeSpan Oregon Standard Silver Plan Value PPO","63474OR001",,"ORN001","ORS003","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987648139945382",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0010002-01","Standard Silver On Exchange Plan",,"0.696986019611359","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$420","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-Value-PPO.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","9"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","1","63474","OR","Individual","No","87-0388069","63474OR0010002","BridgeSpan Oregon Standard Silver Plan Value PPO","63474OR001",,"ORN001","ORS003","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987648139945382",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$150",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-Value-PPO-Less-than-300.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","10"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","1","63474","OR","Individual","No","87-0388069","63474OR0010002","BridgeSpan Oregon Standard Silver Plan Value PPO","63474OR001",,"ORN001","ORS003","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987648139945382",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0010002-03","Limited Cost Sharing Plan Variation",,"0.696986019611359","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$420","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-Value-PPO.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","11"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","1","63474","OR","Individual","No","87-0388069","63474OR0010002","BridgeSpan Oregon Standard Silver Plan Value PPO","63474OR001",,"ORN001","ORS003","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987648139945382",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0010002-04","73% AV Level Silver Plan",,"0.739232897758484","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$420","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"$12,700","$12700 per person","$25400 per group","$17,000","$17000 per person","$34000 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-Value-PPO-73.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","12"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","2","63474","OR","Individual","No","87-0388069","63474OR0310001","Silver HDHP 2000 Value PPO","63474OR031",,"ORN001","ORS001","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987478629595135",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0310001-04","73% AV Level Silver Plan",,"0.725129663944244","Yes","Yes","No","100%",,"2000","0","1060","150","2000","0","660","40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$5450 per person","$8000 per group",,,,"$19,650","per person not applicable","$39300 per group","$24,400","per person not applicable","$48800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","$12,000","per person not applicable","$24000 per group","Yes",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Silver-HDHP-2000-Value-PPO-73.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","8"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","2","63474","OR","Individual","No","87-0388069","63474OR0310001","Silver HDHP 2000 Value PPO","63474OR031",,"ORN001","ORS001","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987478629595135",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0310001-05","87% AV Level Silver Plan",,"0.867526829242706","Yes","Yes","No","100%",,"500","0","680","150","500","0","600","40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2250 per person","$4000 per group",,,,"$19,650","per person not applicable","$39300 per group","$22,400","per person not applicable","$44800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","10%",,,,,"$10,000","per person not applicable","$20000 per group","$10,500","per person not applicable","$21000 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Silver-HDHP-2000-Value-PPO-87.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","9"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","2","63474","OR","Individual","No","87-0388069","63474OR0310001","Silver HDHP 2000 Value PPO","63474OR031",,"ORN001","ORS001","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987478629595135",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0310001-06","94% AV Level Silver Plan",,"0.934662759304047","Yes","Yes","No","100%",,"200","0","710","150","200","0","630","40",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$1500 per person","$1500 per group",,,,"$19,650","per person not applicable","$39300 per group","$21,150","per person not applicable","$22650 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","per person not applicable","$400 per group","10%",,,,,"$10,000","per person not applicable","$20000 per group","$10,200","per person not applicable","$20400 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Silver-HDHP-2000-Value-PPO-94.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","10"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","3","63474","OR","Individual","No","87-0388069","63474OR0030003","BridgeSpan Oregon Standard Bronze Plan Value PPO","63474OR003",,"ORN001","ORS003","ORF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987141495500016",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","No",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0030003-00","Standard Bronze Off Exchange Plan",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$20","$1,130","$150","$420","$1,600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Bronze-Plan-Value-PPO.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","4"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","3","63474","OR","Individual","No","87-0388069","63474OR0030003","BridgeSpan Oregon Standard Bronze Plan Value PPO","63474OR003",,"ORN001","ORS003","ORF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987141495500016",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","No",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0030003-01","Standard Bronze On Exchange Plan",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$20","$1,130","$150","$420","$1,600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Bronze-Plan-Value-PPO.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","5"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","3","63474","OR","Individual","No","87-0388069","63474OR0030003","BridgeSpan Oregon Standard Bronze Plan Value PPO","63474OR003",,"ORN001","ORS003","ORF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987141495500016",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","No",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0030003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$150",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Bronze-Plan-Value-PPO-Less-than-300.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","6"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","3","63474","OR","Individual","No","87-0388069","63474OR0030003","BridgeSpan Oregon Standard Bronze Plan Value PPO","63474OR003",,"ORN001","ORS003","ORF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987141495500016",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","No",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0030003-03","Limited Cost Sharing Plan Variation",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$20","$1,130","$150","$420","$1,600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Bronze-Plan-Value-PPO.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","7"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","4","63474","OR","Individual","No","87-0388069","63474OR0320001","Bronze Essential 6850 Value PPO","63474OR032",,"ORN001","ORS001","ORF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987230039570661",,,,"0","0","2","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0320001-01","Standard Bronze On Exchange Plan",,"0.615954756736755","Yes","Yes","No","100%",,"6850","20","0","150","3440","760","0","40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","$27,400","$27400 per person","$54800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Bronze-Essential-6850-Value-PPO.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","5"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","4","63474","OR","Individual","No","87-0388069","63474OR0320001","Bronze Essential 6850 Value PPO","63474OR032",,"ORN001","ORS001","ORF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987230039570661",,,,"0","0","2","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0320001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"0","0","0","150","0","0","0","150",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Bronze-Essential-6850-Value-PPO-Less-than-300.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","6"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","4","63474","OR","Individual","No","87-0388069","63474OR0320001","Bronze Essential 6850 Value PPO","63474OR032",,"ORN001","ORS001","ORF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987230039570661",,,,"0","0","2","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0320001-03","Limited Cost Sharing Plan Variation",,"0.615954756736755","Yes","Yes","No","100%",,"6850","20","0","150","3440","760","0","40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$20,550","$20550 per person","$41100 per group","$27,400","$27400 per person","$54800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","$20,550","$20550 per person","$41100 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Bronze-Essential-6850-Value-PPO.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","7"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","5","63474","OR","Individual","No","87-0388069","63474OR0330001","Bronze HDHP 6550 Value PPO","63474OR033",,"ORN001","ORS001","ORF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.98685959477654",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0330001-00","Standard Bronze Off Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"6550","0","0","150","5310","0","0","40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"$19,650","per person not applicable","$39300 per group","$26,200","per person not applicable","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","per person not applicable","$13100 per group","0%",,,,,"$13,100","per person not applicable","$26200 per group","$19,650","per person not applicable","$39300 per group","Yes",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Bronze-HDHP-6550-Value-PPO.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","4"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","5","63474","OR","Individual","No","87-0388069","63474OR0330001","Bronze HDHP 6550 Value PPO","63474OR033",,"ORN001","ORS001","ORF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.98685959477654",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0330001-01","Standard Bronze On Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"6550","0","0","150","5310","0","0","40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"$19,650","per person not applicable","$39300 per group","$26,200","per person not applicable","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","per person not applicable","$13100 per group","0%",,,,,"$13,100","per person not applicable","$26200 per group","$19,650","per person not applicable","$39300 per group","Yes",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Bronze-HDHP-6550-Value-PPO.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","5"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","5","63474","OR","Individual","No","87-0388069","63474OR0330001","Bronze HDHP 6550 Value PPO","63474OR033",,"ORN001","ORS001","ORF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.98685959477654",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0330001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"0","0","0","150","0","0","0","150",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Bronze-HDHP-6550-Value-PPO-Less-than-300.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","6"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","5","63474","OR","Individual","No","87-0388069","63474OR0330001","Bronze HDHP 6550 Value PPO","63474OR033",,"ORN001","ORS001","ORF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No",,"0.98685959477654",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0330001-03","Limited Cost Sharing Plan Variation",,"0.5993931889534","Yes","Yes","No","100%",,"6550","0","0","150","5310","0","0","40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"$19,650","per person not applicable","$39300 per group","$26,200","per person not applicable","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","per person not applicable","$13100 per group","0%",,,,,"$13,100","per person not applicable","$26200 per group","$19,650","per person not applicable","$39300 per group","Yes",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Bronze-HDHP-6550-Value-PPO.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","7"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","10","63474","OR","Individual","No","87-0388069","63474OR0500001","BridgeSpan Oregon Standard Gold Plan Legacy Health","63474OR050",,"ORN002","ORS002","ORF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988134596927143",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0500001-03","Limited Cost Sharing Plan Variation",,"0.784055233001709","No","Yes","No","100%",,"$1,250","$20","$600","$150","$420","$860","$220","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$1,250","$1250 per person","$2500 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","$6,250","$6250 per person","$12500 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Gold-Plan-Legacy-Health.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","7"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","10","63474","OR","Individual","No","87-0388069","63474OR0510001","BridgeSpan Oregon Standard Silver Plan Legacy Health","63474OR051",,"ORN002","ORS002","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987712382370091",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0510001-00","Standard Silver Off Exchange Plan",,"0.696986019611359","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$420","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-Legacy-Health.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","8"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","10","63474","OR","Individual","No","87-0388069","63474OR0510001","BridgeSpan Oregon Standard Silver Plan Legacy Health","63474OR051",,"ORN002","ORS002","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987712382370091",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0510001-01","Standard Silver On Exchange Plan",,"0.696986019611359","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$420","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-Legacy-Health.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","9"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","10","63474","OR","Individual","No","87-0388069","63474OR0510001","BridgeSpan Oregon Standard Silver Plan Legacy Health","63474OR051",,"ORN002","ORS002","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987712382370091",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0510001-03","Limited Cost Sharing Plan Variation",,"0.696986019611359","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$420","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-Legacy-Health.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","11"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","6","63474","OR","Individual","No","87-0388069","63474OR0130001","BridgeSpan Oregon Standard Gold Plan MyChoice Northwest","63474OR013",,"ORN003","ORS002","ORF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987774328456372",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0130001-00","Standard Gold Off Exchange Plan",,"0.784055233001709","No","Yes","No","100%",,"$1,250","$20","$600","$150","$420","$860","$220","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$1,250","$1250 per person","$2500 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","$6,250","$6250 per person","$12500 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Gold-Plan-MyChoice-Northwest.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","4"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","6","63474","OR","Individual","No","87-0388069","63474OR0130001","BridgeSpan Oregon Standard Gold Plan MyChoice Northwest","63474OR013",,"ORN003","ORS002","ORF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987774328456372",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0130001-01","Standard Gold On Exchange Plan",,"0.784055233001709","No","Yes","No","100%",,"$1,250","$20","$600","$150","$420","$860","$220","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$1,250","$1250 per person","$2500 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","$6,250","$6250 per person","$12500 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Gold-Plan-MyChoice-Northwest.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","5"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","10","63474","OR","Individual","No","87-0388069","63474OR0510001","BridgeSpan Oregon Standard Silver Plan Legacy Health","63474OR051",,"ORN002","ORS002","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987712382370091",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0510001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$150",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-Legacy-Health-Less-than-300.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","10"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","6","63474","OR","Individual","No","87-0388069","63474OR0130001","BridgeSpan Oregon Standard Gold Plan MyChoice Northwest","63474OR013",,"ORN003","ORS002","ORF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987774328456372",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0130001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$150",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Gold-Plan-MyChoice-Northwest-Less-than-300.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","6"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","6","63474","OR","Individual","No","87-0388069","63474OR0130001","BridgeSpan Oregon Standard Gold Plan MyChoice Northwest","63474OR013",,"ORN003","ORS002","ORF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987774328456372",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0130001-03","Limited Cost Sharing Plan Variation",,"0.784055233001709","No","Yes","No","100%",,"$1,250","$20","$600","$150","$420","$860","$220","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$1,250","$1250 per person","$2500 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","$6,250","$6250 per person","$12500 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Gold-Plan-MyChoice-Northwest.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","7"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","6","63474","OR","Individual","No","87-0388069","63474OR0140001","BridgeSpan Oregon Standard Silver Plan MyChoice Northwest","63474OR014",,"ORN003","ORS002","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987275259019111",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0140001-00","Standard Silver Off Exchange Plan",,"0.696986019611359","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$420","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-MyChoice-Northwest.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","8"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","6","63474","OR","Individual","No","87-0388069","63474OR0140001","BridgeSpan Oregon Standard Silver Plan MyChoice Northwest","63474OR014",,"ORN003","ORS002","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987275259019111",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0140001-01","Standard Silver On Exchange Plan",,"0.696986019611359","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$420","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-MyChoice-Northwest.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","9"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","6","63474","OR","Individual","No","87-0388069","63474OR0140001","BridgeSpan Oregon Standard Silver Plan MyChoice Northwest","63474OR014",,"ORN003","ORS002","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987275259019111",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0140001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$150",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-MyChoice-Northwest-Less-than-300.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","10"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","6","63474","OR","Individual","No","87-0388069","63474OR0140001","BridgeSpan Oregon Standard Silver Plan MyChoice Northwest","63474OR014",,"ORN003","ORS002","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987275259019111",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0140001-03","Limited Cost Sharing Plan Variation",,"0.696986019611359","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$420","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-MyChoice-Northwest.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","11"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","6","63474","OR","Individual","No","87-0388069","63474OR0140001","BridgeSpan Oregon Standard Silver Plan MyChoice Northwest","63474OR014",,"ORN003","ORS002","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987275259019111",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0140001-04","73% AV Level Silver Plan",,"0.739232897758484","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$420","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"$12,700","$12700 per person","$25400 per group","$17,000","$17000 per person","$34000 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-MyChoice-Northwest-73.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","12"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","6","63474","OR","Individual","No","87-0388069","63474OR0140001","BridgeSpan Oregon Standard Silver Plan MyChoice Northwest","63474OR014",,"ORN003","ORS002","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987275259019111",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0140001-05","87% AV Level Silver Plan",,"0.879479050636292","No","Yes","No","100%",,"$850","$20","$640","$150","$420","$830","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$12,700","$12700 per person","$25400 per group","$14,200","$14200 per person","$28400 per group","$850","$850 per person","$1700 per group","10%",,,,,"$10,000","$10000 per person","$20000 per group","$10,850","$10850 per person","$21700 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-MyChoice-Northwest-87.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","13"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","6","63474","OR","Individual","No","87-0388069","63474OR0140001","BridgeSpan Oregon Standard Silver Plan MyChoice Northwest","63474OR014",,"ORN003","ORS002","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987275259019111",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0140001-06","94% AV Level Silver Plan",,"0.944502472877502","No","Yes","No","100%",,"$100","$10","$720","$150","$100","$470","$30","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$12,700","$12700 per person","$25400 per group","$13,450","$13450 per person","$26900 per group","$100","$100 per person","$200 per group","10%",,,,,"$10,000","$10000 per person","$20000 per group","$10,100","$10100 per person","$20200 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-MyChoice-Northwest-94.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","14"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","7","63474","OR","Individual","No","87-0388069","63474OR0480001","Silver HDHP 2000 MyChoice Northwest","63474OR048",,"ORN003","ORS002","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987080288797618",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0480001-00","Standard Silver Off Exchange Plan",,"0.689664602279663","Yes","Yes","No","100%",,"2000","0","1060","150","2000","0","660","40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"$19,650","per person not applicable","$39300 per group","$26,200","per person not applicable","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","$12,000","per person not applicable","$24000 per group","Yes",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Silver-HDHP-2000-MyChoice-Northwest.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","4"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","7","63474","OR","Individual","No","87-0388069","63474OR0480001","Silver HDHP 2000 MyChoice Northwest","63474OR048",,"ORN003","ORS002","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987080288797618",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0480001-01","Standard Silver On Exchange Plan",,"0.689664602279663","Yes","Yes","No","100%",,"2000","0","1060","150","2000","0","660","40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"$19,650","per person not applicable","$39300 per group","$26,200","per person not applicable","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","$12,000","per person not applicable","$24000 per group","Yes",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Silver-HDHP-2000-MyChoice-Northwest.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","5"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","7","63474","OR","Individual","No","87-0388069","63474OR0480001","Silver HDHP 2000 MyChoice Northwest","63474OR048",,"ORN003","ORS002","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987080288797618",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0480001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"0","0","0","150","0","0","0","150",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Silver-HDHP-2000-MyChoice-Northwest-Less-than-300.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","6"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","7","63474","OR","Individual","No","87-0388069","63474OR0480001","Silver HDHP 2000 MyChoice Northwest","63474OR048",,"ORN003","ORS002","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987080288797618",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0480001-03","Limited Cost Sharing Plan Variation",,"0.689664602279663","Yes","Yes","No","100%",,"2000","0","1060","150","2000","0","660","40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"$19,650","per person not applicable","$39300 per group","$26,200","per person not applicable","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","$12,000","per person not applicable","$24000 per group","Yes",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Silver-HDHP-2000-MyChoice-Northwest.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","7"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","7","63474","OR","Individual","No","87-0388069","63474OR0480001","Silver HDHP 2000 MyChoice Northwest","63474OR048",,"ORN003","ORS002","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987080288797618",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0480001-04","73% AV Level Silver Plan",,"0.725129663944244","Yes","Yes","No","100%",,"2000","0","1060","150","2000","0","660","40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$5450 per person","$8000 per group",,,,"$19,650","per person not applicable","$39300 per group","$24,400","per person not applicable","$48800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","$12,000","per person not applicable","$24000 per group","Yes",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Silver-HDHP-2000-MyChoice-Northwest-73.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","8"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","7","63474","OR","Individual","No","87-0388069","63474OR0480001","Silver HDHP 2000 MyChoice Northwest","63474OR048",,"ORN003","ORS002","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987080288797618",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0480001-05","87% AV Level Silver Plan",,"0.867526829242706","Yes","Yes","No","100%",,"500","0","680","150","500","0","600","40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2250 per person","$4000 per group",,,,"$19,650","per person not applicable","$39300 per group","$22,400","per person not applicable","$44800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","10%",,,,,"$10,000","per person not applicable","$20000 per group","$10,500","per person not applicable","$21000 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Silver-HDHP-2000-MyChoice-Northwest-87.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","9"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","7","63474","OR","Individual","No","87-0388069","63474OR0480001","Silver HDHP 2000 MyChoice Northwest","63474OR048",,"ORN003","ORS002","ORF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987080288797618",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0480001-06","94% AV Level Silver Plan",,"0.934662759304047","Yes","Yes","No","100%",,"200","0","710","150","200","0","630","40",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$1500 per person","$1500 per group",,,,"$19,650","per person not applicable","$39300 per group","$21,150","per person not applicable","$22650 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","per person not applicable","$400 per group","10%",,,,,"$10,000","per person not applicable","$20000 per group","$10,200","per person not applicable","$20400 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Silver-HDHP-2000-MyChoice-Northwest-94.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","10"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","8","63474","OR","Individual","No","87-0388069","63474OR0160001","BridgeSpan Oregon Standard Bronze Plan MyChoice Northwest","63474OR016",,"ORN003","ORS002","ORF003","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.98669151424108",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0160001-00","Standard Bronze Off Exchange Plan",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$20","$1,130","$150","$420","$1,600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Bronze-Plan-MyChoice-Northwest.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","4"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","8","63474","OR","Individual","No","87-0388069","63474OR0160001","BridgeSpan Oregon Standard Bronze Plan MyChoice Northwest","63474OR016",,"ORN003","ORS002","ORF003","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.98669151424108",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0160001-01","Standard Bronze On Exchange Plan",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$20","$1,130","$150","$420","$1,600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Bronze-Plan-MyChoice-Northwest.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","5"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","8","63474","OR","Individual","No","87-0388069","63474OR0160001","BridgeSpan Oregon Standard Bronze Plan MyChoice Northwest","63474OR016",,"ORN003","ORS002","ORF003","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.98669151424108",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0160001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$150",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Bronze-Plan-MyChoice-Northwest-Less-than-300.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","6"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","8","63474","OR","Individual","No","87-0388069","63474OR0160001","BridgeSpan Oregon Standard Bronze Plan MyChoice Northwest","63474OR016",,"ORN003","ORS002","ORF003","Existing","PPO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.98669151424108",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0160001-03","Limited Cost Sharing Plan Variation",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$20","$1,130","$150","$420","$1,600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Bronze-Plan-MyChoice-Northwest.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","7"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","9","63474","OR","Individual","No","87-0388069","63474OR0490001","Bronze HDHP 6550 MyChoice Northwest","63474OR049",,"ORN003","ORS002","ORF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.986366712859345",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0490001-00","Standard Bronze Off Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"6550","0","0","150","5310","0","0","40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"$19,650","per person not applicable","$39300 per group","$26,200","per person not applicable","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","per person not applicable","$13100 per group","0%",,,,,"$13,100","per person not applicable","$26200 per group","$19,650","per person not applicable","$39300 per group","Yes",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Bronze-HDHP-6550-MyChoice-Northwest.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","4"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","9","63474","OR","Individual","No","87-0388069","63474OR0490001","Bronze HDHP 6550 MyChoice Northwest","63474OR049",,"ORN003","ORS002","ORF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.986366712859345",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0490001-01","Standard Bronze On Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"6550","0","0","150","5310","0","0","40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"$19,650","per person not applicable","$39300 per group","$26,200","per person not applicable","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","per person not applicable","$13100 per group","0%",,,,,"$13,100","per person not applicable","$26200 per group","$19,650","per person not applicable","$39300 per group","Yes",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Bronze-HDHP-6550-MyChoice-Northwest.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","5"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","9","63474","OR","Individual","No","87-0388069","63474OR0490001","Bronze HDHP 6550 MyChoice Northwest","63474OR049",,"ORN003","ORS002","ORF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.986366712859345",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0490001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"0","0","0","150","0","0","0","150",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Bronze-HDHP-6550-MyChoice-Northwest-Less-than-300.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","6"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","9","63474","OR","Individual","No","87-0388069","63474OR0490001","Bronze HDHP 6550 MyChoice Northwest","63474OR049",,"ORN003","ORS002","ORF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.986366712859345",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0490001-03","Limited Cost Sharing Plan Variation",,"0.5993931889534","Yes","Yes","No","100%",,"6550","0","0","150","5310","0","0","40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6850 per person","$13100 per group",,,,"$19,650","per person not applicable","$39300 per group","$26,200","per person not applicable","$52400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","per person not applicable","$13100 per group","0%",,,,,"$13,100","per person not applicable","$26200 per group","$19,650","per person not applicable","$39300 per group","Yes",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/Bronze-HDHP-6550-MyChoice-Northwest.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","7"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","10","63474","OR","Individual","No","87-0388069","63474OR0500001","BridgeSpan Oregon Standard Gold Plan Legacy Health","63474OR050",,"ORN002","ORS002","ORF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988134596927143",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0500001-00","Standard Gold Off Exchange Plan",,"0.784055233001709","No","Yes","No","100%",,"$1,250","$20","$600","$150","$420","$860","$220","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$1,250","$1250 per person","$2500 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","$6,250","$6250 per person","$12500 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Gold-Plan-Legacy-Health.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","4"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","10","63474","OR","Individual","No","87-0388069","63474OR0500001","BridgeSpan Oregon Standard Gold Plan Legacy Health","63474OR050",,"ORN002","ORS002","ORF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988134596927143",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0500001-01","Standard Gold On Exchange Plan",,"0.784055233001709","No","Yes","No","100%",,"$1,250","$20","$600","$150","$420","$860","$220","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$1,250","$1250 per person","$2500 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","$6,250","$6250 per person","$12500 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Gold-Plan-Legacy-Health.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","5"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","10","63474","OR","Individual","No","87-0388069","63474OR0500001","BridgeSpan Oregon Standard Gold Plan Legacy Health","63474OR050",,"ORN002","ORS002","ORF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988134596927143",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0500001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$150",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Gold-Plan-Legacy-Health-Less-than-300.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","6"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","10","63474","OR","Individual","No","87-0388069","63474OR0510001","BridgeSpan Oregon Standard Silver Plan Legacy Health","63474OR051",,"ORN002","ORS002","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987712382370091",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0510001-04","73% AV Level Silver Plan",,"0.739232897758484","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$420","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"$12,700","$12700 per person","$25400 per group","$17,000","$17000 per person","$34000 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-Legacy-Health-73.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","12"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","10","63474","OR","Individual","No","87-0388069","63474OR0510001","BridgeSpan Oregon Standard Silver Plan Legacy Health","63474OR051",,"ORN002","ORS002","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987712382370091",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0510001-05","87% AV Level Silver Plan",,"0.879479050636292","No","Yes","No","100%",,"$850","$20","$640","$150","$420","$830","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$12,700","$12700 per person","$25400 per group","$14,200","$14200 per person","$28400 per group","$850","$850 per person","$1700 per group","10%",,,,,"$10,000","$10000 per person","$20000 per group","$10,850","$10850 per person","$21700 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-Legacy-Health-87.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","13"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","10","63474","OR","Individual","No","87-0388069","63474OR0510001","BridgeSpan Oregon Standard Silver Plan Legacy Health","63474OR051",,"ORN002","ORS002","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987712382370091",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0510001-06","94% AV Level Silver Plan",,"0.944502472877502","No","Yes","No","100%",,"$100","$10","$720","$150","$100","$470","$30","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$12,700","$12700 per person","$25400 per group","$13,450","$13450 per person","$26900 per group","$100","$100 per person","$200 per group","10%",,,,,"$10,000","$10000 per person","$20000 per group","$10,100","$10100 per person","$20200 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-Legacy-Health-94.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","14"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","11","63474","OR","Individual","No","87-0388069","63474OR0520001","BridgeSpan Oregon Standard Bronze Plan Legacy Health","63474OR052",,"ORN002","ORS002","ORF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987219514043414",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0520001-00","Standard Bronze Off Exchange Plan",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$20","$1,130","$150","$420","$1,600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Bronze-Plan-Legacy-Health.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","4"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","11","63474","OR","Individual","No","87-0388069","63474OR0520001","BridgeSpan Oregon Standard Bronze Plan Legacy Health","63474OR052",,"ORN002","ORS002","ORF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987219514043414",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0520001-01","Standard Bronze On Exchange Plan",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$20","$1,130","$150","$420","$1,600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Bronze-Plan-Legacy-Health.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","5"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","11","63474","OR","Individual","No","87-0388069","63474OR0520001","BridgeSpan Oregon Standard Bronze Plan Legacy Health","63474OR052",,"ORN002","ORS002","ORF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987219514043414",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0520001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$150",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Bronze-Plan-Legacy-Health-Less-than-300.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","6"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","11","63474","OR","Individual","No","87-0388069","63474OR0520001","BridgeSpan Oregon Standard Bronze Plan Legacy Health","63474OR052",,"ORN002","ORS002","ORF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987219514043414",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0520001-03","Limited Cost Sharing Plan Variation",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$20","$1,130","$150","$420","$1,600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Bronze-Plan-Legacy-Health.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","7"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","3","71287","OR","Individual","Yes","93-0798039","71287OR0590003","KP OR Dental 80L","71287OR059",,"ORN002","ORS001",,"New","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.29","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","71287OR0590003-00","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","3","71287","OR","Individual","Yes","93-0798039","71287OR0590003","KP OR Dental 80L","71287OR059",,"ORN002","ORS001",,"New","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.29","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","71287OR0590003-01","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","12","63474","OR","Individual","No","87-0388069","63474OR0530001","BridgeSpan Oregon Standard Gold Plan Willamette Valley Health Solutions","63474OR053",,"ORN004","ORS002","ORF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987747459337126",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0530001-00","Standard Gold Off Exchange Plan",,"0.784055233001709","No","Yes","No","100%",,"$1,250","$20","$600","$150","$420","$860","$220","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$1,250","$1250 per person","$2500 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","$6,250","$6250 per person","$12500 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Gold-Plan-Willamette-Valley-Health-Solutions.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","4"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","12","63474","OR","Individual","No","87-0388069","63474OR0530001","BridgeSpan Oregon Standard Gold Plan Willamette Valley Health Solutions","63474OR053",,"ORN004","ORS002","ORF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987747459337126",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0530001-01","Standard Gold On Exchange Plan",,"0.784055233001709","No","Yes","No","100%",,"$1,250","$20","$600","$150","$420","$860","$220","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$1,250","$1250 per person","$2500 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","$6,250","$6250 per person","$12500 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Gold-Plan-Willamette-Valley-Health-Solutions.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","5"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","12","63474","OR","Individual","No","87-0388069","63474OR0530001","BridgeSpan Oregon Standard Gold Plan Willamette Valley Health Solutions","63474OR053",,"ORN004","ORS002","ORF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987747459337126",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0530001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$150",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Gold-Plan-Willamette-Valley-Health-Solutions-Less-than-300.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","6"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","2","71287","OR","Individual","No","93-0798039","71287OR0420002","Kaiser Permanente Oregon Standard Gold Plan","71287OR042",,"ORN001","ORS001","ORF006","Existing","EPO","Gold","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9969",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","No","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420002-01","Standard Gold On Exchange Plan",,"0.784055233001709","No","Yes","No","100%",,"$1,250","$20","$600","$200","$311","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_003_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","5"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","2","71287","OR","Individual","No","93-0798039","71287OR0420002","Kaiser Permanente Oregon Standard Gold Plan","71287OR042",,"ORN001","ORS001","ORF006","Existing","EPO","Gold","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9969",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","No","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_803_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","6"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","7","71287","OR","Individual","No","93-0798039","71287OR0420014","KP OR Bronze 4500/50","71287OR042",,"ORN001","ORS001","ORF017","New","EPO","Bronze","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9939",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420014-03","Limited Cost Sharing Plan Variation",,"0.619799137115479","Yes","Yes","No","100%",,"$4,500","$20","$1,100","$200","$469","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-OFF-Exchange/PLNSBC_KNW_20004_008_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","7"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","12","63474","OR","Individual","No","87-0388069","63474OR0530001","BridgeSpan Oregon Standard Gold Plan Willamette Valley Health Solutions","63474OR053",,"ORN004","ORS002","ORF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987747459337126",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0530001-03","Limited Cost Sharing Plan Variation",,"0.784055233001709","No","Yes","No","100%",,"$1,250","$20","$600","$150","$420","$860","$220","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$1,250","$1250 per person","$2500 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","$6,250","$6250 per person","$12500 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Gold-Plan-Willamette-Valley-Health-Solutions.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","7"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","12","63474","OR","Individual","No","87-0388069","63474OR0540001","BridgeSpan Oregon Standard Silver Plan Willamette Valley Health Solutions","63474OR054",,"ORN004","ORS002","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987241974945865",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0540001-00","Standard Silver Off Exchange Plan",,"0.696986019611359","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$420","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-Willamette-Valley-Health-Solutions.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","8"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","12","63474","OR","Individual","No","87-0388069","63474OR0540001","BridgeSpan Oregon Standard Silver Plan Willamette Valley Health Solutions","63474OR054",,"ORN004","ORS002","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987241974945865",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0540001-01","Standard Silver On Exchange Plan",,"0.696986019611359","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$420","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-Willamette-Valley-Health-Solutions.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","9"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","12","63474","OR","Individual","No","87-0388069","63474OR0540001","BridgeSpan Oregon Standard Silver Plan Willamette Valley Health Solutions","63474OR054",,"ORN004","ORS002","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987241974945865",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0540001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$150",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-Willamette-Valley-Health-Solutions-Less-than-300.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","10"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","12","63474","OR","Individual","No","87-0388069","63474OR0540001","BridgeSpan Oregon Standard Silver Plan Willamette Valley Health Solutions","63474OR054",,"ORN004","ORS002","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987241974945865",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0540001-03","Limited Cost Sharing Plan Variation",,"0.696986019611359","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$420","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-Willamette-Valley-Health-Solutions.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","11"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","12","63474","OR","Individual","No","87-0388069","63474OR0540001","BridgeSpan Oregon Standard Silver Plan Willamette Valley Health Solutions","63474OR054",,"ORN004","ORS002","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987241974945865",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0540001-04","73% AV Level Silver Plan",,"0.739232897758484","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$420","$1,200","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"$12,700","$12700 per person","$25400 per group","$17,000","$17000 per person","$34000 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$10,000","$10000 per person","$20000 per group","$12,500","$12500 per person","$25000 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-Willamette-Valley-Health-Solutions-73.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","12"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","12","63474","OR","Individual","No","87-0388069","63474OR0540001","BridgeSpan Oregon Standard Silver Plan Willamette Valley Health Solutions","63474OR054",,"ORN004","ORS002","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987241974945865",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0540001-05","87% AV Level Silver Plan",,"0.879479050636292","No","Yes","No","100%",,"$850","$20","$640","$150","$420","$830","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$12,700","$12700 per person","$25400 per group","$14,200","$14200 per person","$28400 per group","$850","$850 per person","$1700 per group","10%",,,,,"$10,000","$10000 per person","$20000 per group","$10,850","$10850 per person","$21700 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-Willamette-Valley-Health-Solutions-87.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","13"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","12","63474","OR","Individual","No","87-0388069","63474OR0540001","BridgeSpan Oregon Standard Silver Plan Willamette Valley Health Solutions","63474OR054",,"ORN004","ORS002","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.987241974945865",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0540001-06","94% AV Level Silver Plan",,"0.944502472877502","No","Yes","No","100%",,"$100","$10","$720","$150","$100","$470","$30","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$12,700","$12700 per person","$25400 per group","$13,450","$13450 per person","$26900 per group","$100","$100 per person","$200 per group","10%",,,,,"$10,000","$10000 per person","$20000 per group","$10,100","$10100 per person","$20200 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Silver-Plan-Willamette-Valley-Health-Solutions-94.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","14"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","13","63474","OR","Individual","No","87-0388069","63474OR0550001","BridgeSpan Oregon Standard Bronze Plan Willamette Valley Health Solutions","63474OR055",,"ORN004","ORS002","ORF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.986652328054471",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0550001-00","Standard Bronze Off Exchange Plan",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$20","$1,130","$150","$420","$1,600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Bronze-Plan-Willamette-Valley-Health-Solutions.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","4"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","13","63474","OR","Individual","No","87-0388069","63474OR0550001","BridgeSpan Oregon Standard Bronze Plan Willamette Valley Health Solutions","63474OR055",,"ORN004","ORS002","ORF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.986652328054471",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0550001-01","Standard Bronze On Exchange Plan",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$20","$1,130","$150","$420","$1,600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Bronze-Plan-Willamette-Valley-Health-Solutions.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","5"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","13","63474","OR","Individual","No","87-0388069","63474OR0550001","BridgeSpan Oregon Standard Bronze Plan Willamette Valley Health Solutions","63474OR055",,"ORN004","ORS002","ORF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.986652328054471",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0550001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$150",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Bronze-Plan-Willamette-Valley-Health-Solutions-Less-than-300.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","6"
"2016","OR","63474","SERFF","8","2016-01-23 08:10:28","13","63474","OR","Individual","No","87-0388069","63474OR0550001","BridgeSpan Oregon Standard Bronze Plan Willamette Valley Health Solutions","63474OR055",,"ORN004","ORS002","ORF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.986652328054471",,,,"0","0","0","2016-01-01",,"No",,"Yes","Out of Service Area benefits are covered at in-network benefits within the provider network","Yes",,"https://www.bridgespanhealth.com/web/bridgespan_individual/drug-list","63474OR0550001-03","Limited Cost Sharing Plan Variation",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$20","$1,130","$150","$420","$1,600","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","$19,050","$19050 per person","$38100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","$15,000","$15000 per person","$30000 per group","No",,,"https://www.bridgespanhealth.com/portal-resource/portal-theme/web/pdfs/bsh/2016/or/BridgeSpan-Oregon-Standard-Bronze-Plan-Willamette-Valley-Health-Solutions.pdf","https://www.bridgespanhealth.com/web/bridgespan_individual/producer-resources","7"
"2016","OR","68420","SERFF","4","2015-08-20 12:28:36","2","68420","OR","Individual","Yes","75-1233841","68420OR0010004","Dentegra Dental PPO Family Preferred Plan","68420OR001",,"ORN001","ORS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.98","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","68420OR0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/or/68420or0010004-16","4"
"2016","OR","68420","SERFF","4","2015-08-20 12:28:36","2","68420","OR","Individual","Yes","75-1233841","68420OR0010004","Dentegra Dental PPO Family Preferred Plan","68420OR001",,"ORN001","ORS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.98","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","68420OR0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/or/68420or0010004-16","5"
"2016","OR","68420","SERFF","4","2015-08-20 12:28:36","3","68420","OR","Individual","Yes","75-1233841","68420OR0010006","Dentegra Dental PPO Family Basic Plan","68420OR001",,"ORN001","ORS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.45","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","68420OR0010006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/or/68420or0010006-16","4"
"2016","OR","68420","SERFF","4","2015-08-20 12:28:36","3","68420","OR","Individual","Yes","75-1233841","68420OR0010006","Dentegra Dental PPO Family Basic Plan","68420OR001",,"ORN001","ORS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.45","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","68420OR0010006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/or/68420or0010006-16","5"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","1","71287","OR","Individual","No","93-0798039","71287OR0420001","KP OR Gold 0/20","71287OR042",,"ORN001","ORS001","ORF006","Existing","EPO","Gold","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.982",,,,"4","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420001-00","Standard Gold Off Exchange Plan",,"0.808491826057434","Yes","Yes","No","100%",,"$0","$500","$200","$200","$0","$800","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-OFF-Exchange/PLNSBC_KNW_20004_001_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","4"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","1","71287","OR","Individual","Yes","93-0798039","71287OR0590001","KP OR Dental 100","71287OR059",,"ORN002","ORS001",,"New","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.99","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","71287OR0590001-00","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","1","71287","OR","Individual","Yes","93-0798039","71287OR0590001","KP OR Dental 100","71287OR059",,"ORN002","ORS001",,"New","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.99","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","71287OR0590001-01","Standard High On Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","1","71287","OR","Individual","No","93-0798039","71287OR0420001","KP OR Gold 0/20","71287OR042",,"ORN001","ORS001","ORF006","Existing","EPO","Gold","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.982",,,,"4","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420001-01","Standard Gold On Exchange Plan",,"0.808491826057434","Yes","Yes","No","100%",,"$0","$500","$200","$200","$0","$800","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_001_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","5"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","1","71287","OR","Individual","No","93-0798039","71287OR0420001","KP OR Gold 0/20","71287OR042",,"ORN001","ORS001","ORF006","Existing","EPO","Gold","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.982",,,,"4","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_801_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","6"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","1","71287","OR","Individual","No","93-0798039","71287OR0420001","KP OR Gold 0/20","71287OR042",,"ORN001","ORS001","ORF006","Existing","EPO","Gold","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.982",,,,"4","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420001-03","Limited Cost Sharing Plan Variation",,"0.808491826057434","Yes","Yes","No","100%",,"$0","$500","$200","$200","$0","$800","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-OFF-Exchange/PLNSBC_KNW_20004_001_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","7"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","2","71287","OR","Individual","No","93-0798039","71287OR0420002","Kaiser Permanente Oregon Standard Gold Plan","71287OR042",,"ORN001","ORS001","ORF006","Existing","EPO","Gold","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9969",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","No","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420002-00","Standard Gold Off Exchange Plan",,"0.784055233001709","No","Yes","No","100%",,"$1,250","$20","$600","$200","$311","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-OFF-Exchange/PLNSBC_KNW_20004_003_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","4"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","2","71287","OR","Individual","Yes","93-0798039","71287OR0590002","KP OR Dental 80H","71287OR059",,"ORN002","ORS001",,"New","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.83","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","71287OR0590002-00","Standard Low Off Exchange Plan","68.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","2","71287","OR","Individual","Yes","93-0798039","71287OR0590002","KP OR Dental 80H","71287OR059",,"ORN002","ORS001",,"New","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.83","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","","71287OR0590002-01","Standard Low On Exchange Plan","68.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","2","71287","OR","Individual","No","93-0798039","71287OR0420002","Kaiser Permanente Oregon Standard Gold Plan","71287OR042",,"ORN001","ORS001","ORF006","Existing","EPO","Gold","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9969",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","No","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420002-03","Limited Cost Sharing Plan Variation",,"0.784055233001709","No","Yes","No","100%",,"$1,250","$20","$600","$200","$311","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-OFF-Exchange/PLNSBC_KNW_20004_003_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","7"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","3","71287","OR","Individual","No","93-0798039","71287OR0420003","Kaiser Permanente Oregon Standard Silver Plan","71287OR042",,"ORN001","ORS001","ORF008","Existing","EPO","Silver","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9964",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","No","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420003-00","Standard Silver Off Exchange Plan",,"0.696986019611359","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$311","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-OFF-Exchange/PLNSBC_KNW_20004_005_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","4"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","3","71287","OR","Individual","No","93-0798039","71287OR0420003","Kaiser Permanente Oregon Standard Silver Plan","71287OR042",,"ORN001","ORS001","ORF008","Existing","EPO","Silver","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9964",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","No","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420003-01","Standard Silver On Exchange Plan",,"0.696986019611359","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$311","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_005_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","5"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","9","71287","OR","Individual","No","93-0798039","71287OR0420012","KP OR Silver 3000/30","71287OR042",,"ORN001","ORS001","ORF009","New","EPO","Silver","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420012-03","Limited Cost Sharing Plan Variation",,"0.68811047077179","Yes","Yes","No","100%",,"$3,000","$20","$1,300","$200","$311","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_016_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","7"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","9","71287","OR","Individual","No","93-0798039","71287OR0420012","KP OR Silver 3000/30","71287OR042",,"ORN001","ORS001","ORF009","New","EPO","Silver","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420012-04","73% AV Level Silver Plan",,"0.73848694562912","Yes","Yes","No","100%",,"$1,500","$20","$1,700","$200","$470","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_116_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","8"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","2","85804","OR","Individual","No","93-0931709","85804OR0560001","LifeWise Oregon Standard Silver Plan Exclusive Provider 2500","85804OR056",,"ORN003","ORS001","ORF006","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9975",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0560001-01","Standard Silver On Exchange Plan",,"0.694179058074951","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$2,500","$500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.lifewiseor.com/documents/031150_2016.pdf","https://www.lifewiseor.com/documents/031534_2016.pdf","9"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","2","85804","OR","Individual","No","93-0931709","85804OR0560001","LifeWise Oregon Standard Silver Plan Exclusive Provider 2500","85804OR056",,"ORN003","ORS001","ORF006","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9975",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0560001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.lifewiseor.com/documents/033252_2016.pdf","https://www.lifewiseor.com/documents/031795_2016.pdf","10"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","2","85804","OR","Individual","No","93-0931709","85804OR0560001","LifeWise Oregon Standard Silver Plan Exclusive Provider 2500","85804OR056",,"ORN003","ORS001","ORF006","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9975",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0560001-03","Limited Cost Sharing Plan Variation",,"0.694179058074951","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$2,500","$500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.lifewiseor.com/documents/033253_2016.pdf","https://www.lifewiseor.com/documents/031795_2016.pdf","11"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","2","85804","OR","Individual","No","93-0931709","85804OR0560001","LifeWise Oregon Standard Silver Plan Exclusive Provider 2500","85804OR056",,"ORN003","ORS001","ORF006","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9975",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0560001-04","73% AV Level Silver Plan",,"0.737363398075104","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$2,500","$500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.lifewiseor.com/documents/033254_2016.pdf","https://www.lifewiseor.com/documents/031534_2016.pdf","12"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","2","85804","OR","Individual","No","93-0931709","85804OR0560001","LifeWise Oregon Standard Silver Plan Exclusive Provider 2500","85804OR056",,"ORN003","ORS001","ORF006","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9975",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0560001-05","87% AV Level Silver Plan",,"0.87899649143219","No","Yes","No","100%",,"$900","$10","$600","$200","$900","$500","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10%",,,,,"$1,700","$1700 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.lifewiseor.com/documents/033255_2016.pdf","https://www.lifewiseor.com/documents/031534_2016.pdf","13"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","3","71287","OR","Individual","No","93-0798039","71287OR0420003","Kaiser Permanente Oregon Standard Silver Plan","71287OR042",,"ORN001","ORS001","ORF008","Existing","EPO","Silver","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9964",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","No","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_803_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","6"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","3","71287","OR","Individual","No","93-0798039","71287OR0420003","Kaiser Permanente Oregon Standard Silver Plan","71287OR042",,"ORN001","ORS001","ORF008","Existing","EPO","Silver","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9964",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","No","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420003-03","Limited Cost Sharing Plan Variation",,"0.696986019611359","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$311","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-OFF-Exchange/PLNSBC_KNW_20004_005_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","7"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","3","71287","OR","Individual","No","93-0798039","71287OR0420003","Kaiser Permanente Oregon Standard Silver Plan","71287OR042",,"ORN001","ORS001","ORF008","Existing","EPO","Silver","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9964",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","No","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420003-04","73% AV Level Silver Plan",,"0.739232897758484","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$311","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_102_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","8"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","3","71287","OR","Individual","No","93-0798039","71287OR0420003","Kaiser Permanente Oregon Standard Silver Plan","71287OR042",,"ORN001","ORS001","ORF008","Existing","EPO","Silver","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9964",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","No","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420003-05","87% AV Level Silver Plan",,"0.879479050636292","No","Yes","No","100%",,"$850","$0","$600","$200","$174","$300","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_202_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","9"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","3","71287","OR","Individual","No","93-0798039","71287OR0420003","Kaiser Permanente Oregon Standard Silver Plan","71287OR042",,"ORN001","ORS001","ORF008","Existing","EPO","Silver","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9964",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","No","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420003-06","94% AV Level Silver Plan",,"0.94490510225296","No","Yes","No","100%",,"$100","$10","$700","$200","$100","$400","$20","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_302_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","10"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","4","71287","OR","Individual","No","93-0798039","71287OR0420004","Kaiser Permanente Oregon Standard Bronze Plan","71287OR042",,"ORN001","ORS001","ORF016","Existing","EPO","Bronze","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9951",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420004-00","Standard Bronze Off Exchange Plan",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$20","$1,100","$200","$5,000","$60","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-OFF-Exchange/PLNSBC_KNW_20004_011_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","4"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","4","71287","OR","Individual","No","93-0798039","71287OR0420004","Kaiser Permanente Oregon Standard Bronze Plan","71287OR042",,"ORN001","ORS001","ORF016","Existing","EPO","Bronze","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9951",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420004-01","Standard Bronze On Exchange Plan",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$20","$1,100","$200","$5,000","$60","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_011_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","5"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","4","71287","OR","Individual","No","93-0798039","71287OR0420004","Kaiser Permanente Oregon Standard Bronze Plan","71287OR042",,"ORN001","ORS001","ORF016","Existing","EPO","Bronze","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9951",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_803_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","6"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","4","71287","OR","Individual","No","93-0798039","71287OR0420004","Kaiser Permanente Oregon Standard Bronze Plan","71287OR042",,"ORN001","ORS001","ORF016","Existing","EPO","Bronze","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9951",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420004-03","Limited Cost Sharing Plan Variation",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$20","$1,100","$200","$5,000","$60","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-OFF-Exchange/PLNSBC_KNW_20004_011_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","7"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","5","71287","OR","Individual","No","93-0798039","71287OR0420005","KP OR Gold 1000/20","71287OR042",,"ORN001","ORS001","ORF006","Existing","EPO","Gold","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9817",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420005-00","Standard Gold Off Exchange Plan",,"0.783680498600006","Yes","Yes","No","100%",,"$1,250","$20","$1,200","$200","$1,008","$600","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-OFF-Exchange/PLNSBC_KNW_20004_002_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","4"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","5","71287","OR","Individual","No","93-0798039","71287OR0420005","KP OR Gold 1000/20","71287OR042",,"ORN001","ORS001","ORF006","Existing","EPO","Gold","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9817",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420005-01","Standard Gold On Exchange Plan",,"0.783680498600006","Yes","Yes","No","100%",,"$1,250","$20","$1,200","$200","$1,008","$600","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_002_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","5"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","5","71287","OR","Individual","No","93-0798039","71287OR0420005","KP OR Gold 1000/20","71287OR042",,"ORN001","ORS001","ORF006","Existing","EPO","Gold","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9817",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_801_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","6"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","5","71287","OR","Individual","No","93-0798039","71287OR0420005","KP OR Gold 1000/20","71287OR042",,"ORN001","ORS001","ORF006","Existing","EPO","Gold","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9817",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420005-03","Limited Cost Sharing Plan Variation",,"0.783680498600006","Yes","Yes","No","100%",,"$1,250","$20","$1,200","$200","$1,008","$600","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-OFF-Exchange/PLNSBC_KNW_20004_002_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","7"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","6","71287","OR","Individual","No","93-0798039","71287OR0420011","KP OR Silver 1500/30","71287OR042",,"ORN001","ORS001","ORF009","New","EPO","Silver","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9814",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420011-00","Standard Silver Off Exchange Plan",,"0.718288242816925","Yes","Yes","No","100%",,"$1,500","$20","$1,700","$200","$311","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-OFF-Exchange/PLNSBC_KNW_20004_004_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","4"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","6","71287","OR","Individual","No","93-0798039","71287OR0420011","KP OR Silver 1500/30","71287OR042",,"ORN001","ORS001","ORF009","New","EPO","Silver","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9814",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420011-01","Standard Silver On Exchange Plan",,"0.718288242816925","Yes","Yes","No","100%",,"$1,500","$20","$1,700","$200","$311","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_004_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","5"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","6","71287","OR","Individual","No","93-0798039","71287OR0420011","KP OR Silver 1500/30","71287OR042",,"ORN001","ORS001","ORF009","New","EPO","Silver","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9814",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_801_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","6"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","6","71287","OR","Individual","No","93-0798039","71287OR0420011","KP OR Silver 1500/30","71287OR042",,"ORN001","ORS001","ORF009","New","EPO","Silver","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9814",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420011-03","Limited Cost Sharing Plan Variation",,"0.718288242816925","Yes","Yes","No","100%",,"$1,500","$20","$1,700","$200","$311","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_004_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","7"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","6","71287","OR","Individual","No","93-0798039","71287OR0420011","KP OR Silver 1500/30","71287OR042",,"ORN001","ORS001","ORF009","New","EPO","Silver","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9814",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420011-04","73% AV Level Silver Plan",,"0.73848694562912","Yes","Yes","No","100%",,"$1,500","$20","$1,700","$200","$469","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_101_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","8"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","6","71287","OR","Individual","No","93-0798039","71287OR0420011","KP OR Silver 1500/30","71287OR042",,"ORN001","ORS001","ORF009","New","EPO","Silver","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9814",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420011-05","87% AV Level Silver Plan",,"0.86421138048172","Yes","Yes","No","100%",,"$0","$20","$2,200","$200","$0","$1,000","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_201_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","9"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","6","71287","OR","Individual","No","93-0798039","71287OR0420011","KP OR Silver 1500/30","71287OR042",,"ORN001","ORS001","ORF009","New","EPO","Silver","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9814",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420011-06","94% AV Level Silver Plan",,"0.932425975799561","Yes","Yes","No","100%",,"$0","$10","$700","$200","$0","$400","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_301_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","10"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","7","71287","OR","Individual","No","93-0798039","71287OR0420014","KP OR Bronze 4500/50","71287OR042",,"ORN001","ORS001","ORF017","New","EPO","Bronze","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9939",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420014-00","Standard Bronze Off Exchange Plan",,"0.619799137115479","Yes","Yes","No","100%",,"$4,500","$20","$1,100","$200","$469","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-OFF-Exchange/PLNSBC_KNW_20004_008_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","4"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","7","71287","OR","Individual","No","93-0798039","71287OR0420014","KP OR Bronze 4500/50","71287OR042",,"ORN001","ORS001","ORF017","New","EPO","Bronze","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9939",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420014-01","Standard Bronze On Exchange Plan",,"0.619799137115479","Yes","Yes","No","100%",,"$4,500","$20","$1,100","$200","$469","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_008_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","5"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","7","71287","OR","Individual","No","93-0798039","71287OR0420014","KP OR Bronze 4500/50","71287OR042",,"ORN001","ORS001","ORF017","New","EPO","Bronze","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9939",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_801_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","6"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","9","71287","OR","Individual","No","93-0798039","71287OR0420012","KP OR Silver 3000/30","71287OR042",,"ORN001","ORS001","ORF009","New","EPO","Silver","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420012-00","Standard Silver Off Exchange Plan",,"0.68811047077179","Yes","Yes","No","100%",,"$3,000","$20","$1,300","$200","$311","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-OFF-Exchange/PLNSBC_KNW_20004_016_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","4"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","9","71287","OR","Individual","No","93-0798039","71287OR0420012","KP OR Silver 3000/30","71287OR042",,"ORN001","ORS001","ORF009","New","EPO","Silver","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420012-01","Standard Silver On Exchange Plan",,"0.68811047077179","Yes","Yes","No","100%",,"$3,000","$20","$1,300","$200","$311","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_016_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","5"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","9","71287","OR","Individual","No","93-0798039","71287OR0420012","KP OR Silver 3000/30","71287OR042",,"ORN001","ORS001","ORF009","New","EPO","Silver","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_801_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","6"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","9","71287","OR","Individual","No","93-0798039","71287OR0420012","KP OR Silver 3000/30","71287OR042",,"ORN001","ORS001","ORF009","New","EPO","Silver","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420012-05","87% AV Level Silver Plan",,"0.86421138048172","Yes","Yes","No","100%",,"$0","$20","$2,200","$200","$0","$1,000","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_216_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","9"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","9","71287","OR","Individual","No","93-0798039","71287OR0420012","KP OR Silver 3000/30","71287OR042",,"ORN001","ORS001","ORF009","New","EPO","Silver","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420012-06","94% AV Level Silver Plan",,"0.932425975799561","Yes","Yes","No","100%",,"$0","$10","$700","$200","$0","$400","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_316_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","10"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","10","71287","OR","Individual","No","93-0798039","71287OR0420010","KP OR Catastrophic 6850/0","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Catastrophic","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9936",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420010-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$200","$469","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-OFF-Exchange/PLNSBC_KNW_20004_013_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","4"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","10","71287","OR","Individual","No","93-0798039","71287OR0420010","KP OR Catastrophic 6850/0","71287OR042",,"ORN001","ORS001","ORF001","Existing","EPO","Catastrophic","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9936",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency Services","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420010-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$200","$469","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_013_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","5"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","11","71287","OR","Individual","No","93-0798039","71287OR0420015","KP OR Bronze 6000/50","71287OR042",,"ORN001","ORS001","ORF002","New","EPO","Bronze","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9938",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420015-00","Standard Bronze Off Exchange Plan",,"0.607900321483612","Yes","Yes","No","100%",,"$6,000","$0","$600","$200","$469","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-OFF-Exchange/PLNSBC_KNW_20004_019_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","4"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","11","71287","OR","Individual","No","93-0798039","71287OR0420015","KP OR Bronze 6000/50","71287OR042",,"ORN001","ORS001","ORF002","New","EPO","Bronze","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9938",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420015-01","Standard Bronze On Exchange Plan",,"0.607900321483612","Yes","Yes","No","100%",,"$6,000","$0","$600","$200","$469","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_019_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","5"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","11","71287","OR","Individual","No","93-0798039","71287OR0420015","KP OR Bronze 6000/50","71287OR042",,"ORN001","ORS001","ORF002","New","EPO","Bronze","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9938",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_801_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","6"
"2016","OR","71287","SERFF","9","2015-10-21 17:48:08","11","71287","OR","Individual","No","93-0798039","71287OR0420015","KP OR Bronze 6000/50","71287OR042",,"ORN001","ORS001","ORF002","New","EPO","Bronze","No","Both","No","Yes","A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.9938",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency","Yes","20% COINSURANCE OF THE ACTUAL FEE CHARGED FOR THE SERVICE; ALLOWANCE OF 5 OV, 5 DIAG XRAY(EXCL SPEC SCANS) AND 5 PRESCRIPTIONS","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.kp.org","71287OR0420015-03","Limited Cost Sharing Plan Variation",,"0.607900321483612","Yes","Yes","No","100%",,"$6,000","$0","$600","$200","$469","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://info.kaiserpermanente.org/healthplans/oregon/individual/pdfs/2016-ON-Exchange/PLNSBC_KNW_20004_019_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/oregon-health-plan-coverage-and-costs.html","7"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0530001","Essential Gold Exchange 500","85804OR053",,"ORN001","ORS001","ORF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9981",,,,"0","2","0","2016-01-01",,"Yes","Covered as any other non-contracted provider","Yes","LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0530001-00","Standard Gold Off Exchange Plan",,"0.819690108299255","Yes","Yes","No","100%",,"$500","$20","$1,400","$200","$500","$500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/029192_2016.pdf","https://www.lifewiseor.com/documents/008701_2016.pdf","4"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","Yes","93-0931709","85804OR0440001","LifeWise Kids Dental Plan","85804OR044",,"ORN002","ORS002",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$28.00","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","The out of country provision applies if the member is outside of the US.  For all providers, the member has to pay the provider at the time of service, and send the claim to the insurer along with any other supporting documents.  The insurer provides benefits at the out-of-network benefit level","Yes","If the member is outside of Oregon, but still in the US, and visit a dentist not in the nationwide network, the insurer pays out of network.  Member has to pay the provider in full, and submit a claim for reimbursement.","Yes",,"","85804OR0440001-00","Standard Low Off Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.lifewiseor.com/documents/031145_2016.pdf","https://www.lifewiseor.com/documents/031557_2016.pdf","4"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","Yes","93-0931709","85804OR0440001","LifeWise Kids Dental Plan","85804OR044",,"ORN002","ORS002",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$28.00","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","The out of country provision applies if the member is outside of the US.  For all providers, the member has to pay the provider at the time of service, and send the claim to the insurer along with any other supporting documents.  The insurer provides benefits at the out-of-network benefit level","Yes","If the member is outside of Oregon, but still in the US, and visit a dentist not in the nationwide network, the insurer pays out of network.  Member has to pay the provider in full, and submit a claim for reimbursement.","Yes",,"","85804OR0440001-01","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.lifewiseor.com/documents/031145_2016.pdf","https://www.lifewiseor.com/documents/031557_2016.pdf","5"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0530001","Essential Gold Exchange 500","85804OR053",,"ORN001","ORS001","ORF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9981",,,,"0","2","0","2016-01-01",,"Yes","Covered as any other non-contracted provider","Yes","LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0530001-01","Standard Gold On Exchange Plan",,"0.819690108299255","Yes","Yes","No","100%",,"$500","$20","$1,400","$200","$500","$500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/029192_2016.pdf","https://www.lifewiseor.com/documents/031534_2016.pdf","5"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0530001","Essential Gold Exchange 500","85804OR053",,"ORN001","ORS001","ORF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9981",,,,"0","2","0","2016-01-01",,"Yes","Covered as any other non-contracted provider","Yes","LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0530001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.lifewiseor.com/documents/033228_2016.pdf","https://www.lifewiseor.com/documents/031795_2016.pdf","6"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0530001","Essential Gold Exchange 500","85804OR053",,"ORN001","ORS001","ORF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9981",,,,"0","2","0","2016-01-01",,"Yes","Covered as any other non-contracted provider","Yes","LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0530001-03","Limited Cost Sharing Plan Variation",,"0.819690108299255","Yes","Yes","No","100%",,"$500","$20","$1,400","$200","$500","$500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/033229_2016.pdf","https://www.lifewiseor.com/documents/031795_2016.pdf","7"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0530002","Essential Gold Exchange 1000","85804OR053",,"ORN001","ORS001","ORF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,,"0","2","0","2016-01-01",,"Yes","Covered as any other non-contracted provider","Yes","LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0530002-00","Standard Gold Off Exchange Plan",,"0.794678568840027","Yes","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/031146_2016.pdf","https://www.lifewiseor.com/documents/008701_2016.pdf","8"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0530002","Essential Gold Exchange 1000","85804OR053",,"ORN001","ORS001","ORF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,,"0","2","0","2016-01-01",,"Yes","Covered as any other non-contracted provider","Yes","LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0530002-01","Standard Gold On Exchange Plan",,"0.794678568840027","Yes","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/031146_2016.pdf","https://www.lifewiseor.com/documents/031534_2016.pdf","9"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0530002","Essential Gold Exchange 1000","85804OR053",,"ORN001","ORS001","ORF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,,"0","2","0","2016-01-01",,"Yes","Covered as any other non-contracted provider","Yes","LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0530002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.lifewiseor.com/documents/033235_2016.pdf","https://www.lifewiseor.com/documents/031795_2016.pdf","10"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0530002","Essential Gold Exchange 1000","85804OR053",,"ORN001","ORS001","ORF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,,"0","2","0","2016-01-01",,"Yes","Covered as any other non-contracted provider","Yes","LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0530002-03","Limited Cost Sharing Plan Variation",,"0.794678568840027","Yes","Yes","No","100%",,"$1,000","$20","$1,300","$200","$1,000","$400","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/033236_2016.pdf","https://www.lifewiseor.com/documents/031795_2016.pdf","11"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0530003","Essential Silver Exchange 2000","85804OR053",,"ORN001","ORS001","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9977",,,,"0","2","0","2016-01-01",,"Yes","Covered as any other non-contracted provider","Yes","LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0530003-00","Standard Silver Off Exchange Plan",,"0.719214737415314","Yes","Yes","No","100%",,"$2,000","$20","$1,600","$200","$2,000","$800","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/029193_2016.pdf","https://www.lifewiseor.com/documents/008701_2016.pdf","12"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0530003","Essential Silver Exchange 2000","85804OR053",,"ORN001","ORS001","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9977",,,,"0","2","0","2016-01-01",,"Yes","Covered as any other non-contracted provider","Yes","LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0530003-01","Standard Silver On Exchange Plan",,"0.719214737415314","Yes","Yes","No","100%",,"$2,000","$20","$1,600","$200","$2,000","$800","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/029193_2016.pdf","https://www.lifewiseor.com/documents/031534_2016.pdf","13"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0530003","Essential Silver Exchange 2000","85804OR053",,"ORN001","ORS001","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9977",,,,"0","2","0","2016-01-01",,"Yes","Covered as any other non-contracted provider","Yes","LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0530003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.lifewiseor.com/documents/033230_2016.pdf","https://www.lifewiseor.com/documents/031795_2016.pdf","14"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0530003","Essential Silver Exchange 2000","85804OR053",,"ORN001","ORS001","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9977",,,,"0","2","0","2016-01-01",,"Yes","Covered as any other non-contracted provider","Yes","LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0530003-03","Limited Cost Sharing Plan Variation",,"0.719214737415314","Yes","Yes","No","100%",,"$2,000","$20","$1,600","$200","$2,000","$800","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/033231_2016.pdf","https://www.lifewiseor.com/documents/031795_2016.pdf","15"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0530003","Essential Silver Exchange 2000","85804OR053",,"ORN001","ORS001","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9977",,,,"0","2","0","2016-01-01",,"Yes","Covered as any other non-contracted provider","Yes","LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0530003-04","73% AV Level Silver Plan",,"0.739947557449341","Yes","Yes","No","100%",,"$2,000","$20","$1,600","$200","$2,000","$800","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/033232_2016.pdf","https://www.lifewiseor.com/documents/031534_2016.pdf","16"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0530003","Essential Silver Exchange 2000","85804OR053",,"ORN001","ORS001","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9977",,,,"0","2","0","2016-01-01",,"Yes","Covered as any other non-contracted provider","Yes","LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0530003-05","87% AV Level Silver Plan",,"0.877022683620453","Yes","Yes","No","100%",,"$500","$0","$1,100","$200","$500","$700","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,600","$1600 per person","$3200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/033233_2016.pdf","https://www.lifewiseor.com/documents/031534_2016.pdf","17"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0530003","Essential Silver Exchange 2000","85804OR053",,"ORN001","ORS001","ORF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9977",,,,"0","2","0","2016-01-01",,"Yes","Covered as any other non-contracted provider","Yes","LifeWise Members have access to a nationwide network of providers when outside the Service Area. Our Service Area is Oregon. These providers will not charge You for amounts over the allowed amount and they will submit Claims directly to Us.","Yes",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0530003-06","94% AV Level Silver Plan",,"0.948970317840576","Yes","Yes","No","100%",,"$200","$0","$300","$200","$200","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","30%",,,,,"$400","$400 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/033234_2016.pdf","https://www.lifewiseor.com/documents/031534_2016.pdf","18"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0540001","Essential Silver Exchange 3000 EPO","85804OR054",,"ORN003","ORS001","ORF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9976",,,,"0","2","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0540001-00","Standard Silver Off Exchange Plan",,"0.719403028488159","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$500","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/031148_2016.pdf","https://www.lifewiseor.com/documents/008701_2016.pdf","19"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0540001","Essential Silver Exchange 3000 EPO","85804OR054",,"ORN003","ORS001","ORF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9976",,,,"0","2","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0540001-01","Standard Silver On Exchange Plan",,"0.719403028488159","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$500","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/031148_2016.pdf","https://www.lifewiseor.com/documents/031534_2016.pdf","20"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0540001","Essential Silver Exchange 3000 EPO","85804OR054",,"ORN003","ORS001","ORF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9976",,,,"0","2","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0540001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/033245_2016.pdf","https://www.lifewiseor.com/documents/031795_2016.pdf","21"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0540001","Essential Silver Exchange 3000 EPO","85804OR054",,"ORN003","ORS001","ORF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9976",,,,"0","2","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0540001-03","Limited Cost Sharing Plan Variation",,"0.719403028488159","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$500","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/033246_2016.pdf","https://www.lifewiseor.com/documents/031795_2016.pdf","22"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0540001","Essential Silver Exchange 3000 EPO","85804OR054",,"ORN003","ORS001","ORF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9976",,,,"0","2","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0540001-04","73% AV Level Silver Plan",,"0.739614307880402","Yes","Yes","No","100%",,"$3,000","$20","$900","$200","$3,000","$500","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/033247_2016.pdf","https://www.lifewiseor.com/documents/031534_2016.pdf","23"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0540001","Essential Silver Exchange 3000 EPO","85804OR054",,"ORN003","ORS001","ORF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9976",,,,"0","2","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0540001-05","87% AV Level Silver Plan",,"0.878502130508423","Yes","Yes","No","100%",,"$1,000","$0","$500","$200","$1,000","$400","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/033248_2016.pdf","https://www.lifewiseor.com/documents/031534_2016.pdf","24"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","1","85804","OR","Individual","No","93-0931709","85804OR0540001","Essential Silver Exchange 3000 EPO","85804OR054",,"ORN003","ORS001","ORF003","New","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9976",,,,"0","2","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0540001-06","94% AV Level Silver Plan",,"0.942597687244415","Yes","Yes","No","100%",,"$300","$0","$300","$200","$300","$200","$80","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$300","$300 per person","$600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/033249_2016.pdf","https://www.lifewiseor.com/documents/031534_2016.pdf","25"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","2","85804","OR","Individual","No","93-0931709","85804OR0570002","LifeWise Oregon Standard Gold Plan Exclusive Provider 1250","85804OR057",,"ORN003","ORS001","ORF005","New","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0570002-00","Standard Gold Off Exchange Plan",,"0.781555771827698","No","Yes","No","100%",,"$1,300","$20","$600","$200","$1,300","$500","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.lifewiseor.com/documents/033240_2016.pdf","https://www.lifewiseor.com/documents/008701_2016.pdf","4"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","2","85804","OR","Individual","No","93-0931709","85804OR0570002","LifeWise Oregon Standard Gold Plan Exclusive Provider 1250","85804OR057",,"ORN003","ORS001","ORF005","New","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0570002-01","Standard Gold On Exchange Plan",,"0.781555771827698","No","Yes","No","100%",,"$1,300","$20","$600","$200","$1,300","$500","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.lifewiseor.com/documents/033240_2016.pdf","https://www.lifewiseor.com/documents/031534_2016.pdf","5"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","2","85804","OR","Individual","No","93-0931709","85804OR0570002","LifeWise Oregon Standard Gold Plan Exclusive Provider 1250","85804OR057",,"ORN003","ORS001","ORF005","New","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0570002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.lifewiseor.com/documents/033241_2016.pdf","https://www.lifewiseor.com/documents/031795_2016.pdf","6"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","2","85804","OR","Individual","No","93-0931709","85804OR0570002","LifeWise Oregon Standard Gold Plan Exclusive Provider 1250","85804OR057",,"ORN003","ORS001","ORF005","New","EPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.998",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0570002-03","Limited Cost Sharing Plan Variation",,"0.781555771827698","No","Yes","No","100%",,"$1,300","$20","$600","$200","$1,300","$500","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.lifewiseor.com/documents/033242_2016.pdf","https://www.lifewiseor.com/documents/031795_2016.pdf","7"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","2","85804","OR","Individual","No","93-0931709","85804OR0560001","LifeWise Oregon Standard Silver Plan Exclusive Provider 2500","85804OR056",,"ORN003","ORS001","ORF006","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9975",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0560001-00","Standard Silver Off Exchange Plan",,"0.694179058074951","No","Yes","No","100%",,"$2,500","$20","$1,400","$200","$2,500","$500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.lifewiseor.com/documents/031150_2016.pdf","https://www.lifewiseor.com/documents/008701_2016.pdf","8"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","2","85804","OR","Individual","No","93-0931709","85804OR0560001","LifeWise Oregon Standard Silver Plan Exclusive Provider 2500","85804OR056",,"ORN003","ORS001","ORF006","Existing","EPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9975",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0560001-06","94% AV Level Silver Plan",,"0.943853676319122","No","Yes","No","100%",,"$100","$0","$700","$200","$100","$300","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"$200","$200 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.lifewiseor.com/documents/033256_2016.pdf","https://www.lifewiseor.com/documents/031534_2016.pdf","14"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","2","95417","OR","Individual","No","42-1694349","95417OR0200001","Trillium Oregon Standard Bronze Plan Vital","95417OR020",,"ORN001","ORS001","ORF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy","0.995232874100205",,,,"0","0","0","2016-01-01",,"No",,"Yes","This PPO plan will cover out-of-area services for out-of-network providers.","No"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.trilliumchp.com/Marketplace/pdfs/2016/2016-Marketplace-Drug-Formulary.pdf","95417OR0200001-03","Limited Cost Sharing Plan Variation",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$140","$700","$0","$1,700","$1,220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/FFM/EXCH_SBC09V3-2016-95417OR0200001-03-Trillium-Vital-Bronze-03.pdf",,"7"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","2","95417","OR","Individual","No","42-1694349","95417OR0240001","Trillium Fit Catastrophic Plan","95417OR024",,"ORN001","ORS001","ORF004","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","3","0","2016-01-01",,"No",,"Yes","This PPO plan will cover out-of-area services for out-of-network providers.","No"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.trilliumchp.com/Marketplace/pdfs/2016/2016-Marketplace-Drug-Formulary.pdf","95417OR0240001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/OUTIND/OUTIND_SBC13V3-2016-95417OR0240001-00-Trillium-Vital-Fit-00.pdf",,"8"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","1","31195","SD","Individual","No","91-1842494","31195SD0080009","Sanford TRUE $5,000 HDHP","31195SD008",,"SDN002","SDS002","SDF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080009-01","Standard Bronze On Exchange Plan",,"0.610491871833801","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$4,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_5000_HDHP.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","9"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","1","31195","SD","Individual","No","91-1842494","31195SD0080009","Sanford TRUE $5,000 HDHP","31195SD008",,"SDN002","SDS002","SDF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_5000_HDHP_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","10"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","1","31195","SD","Individual","No","91-1842494","31195SD0080009","Sanford TRUE $5,000 HDHP","31195SD008",,"SDN002","SDS002","SDF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080009-03","Limited Cost Sharing Plan Variation",,"0.610491871833801","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$4,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_5000_HDHP_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","11"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","1","31195","SD","Individual","No","91-1842494","31195SD0080010","Sanford TRUE $3,500 HDHP","31195SD008",,"SDN002","SDS002","SDF009","New","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080010-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_3500_HDHP.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","12"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","1","31195","SD","Individual","No","91-1842494","31195SD0080010","Sanford TRUE $3,500 HDHP","31195SD008",,"SDN002","SDS002","SDF009","New","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080010-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_3500_HDHP.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","13"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080006","Sanford Simplicity $3,500","31195SD008",,"SDN001","SDS001","SDF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080006-03","Limited Cost Sharing Plan Variation",,"0.700566470623016","No","Yes","No","100%",,"$3,500","$20","$300","$200","$400","$1,100","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$14,000","$14000 per person","$20000 per group","$14,000","$14000 per person","$20000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_3500_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","18"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","2","85804","OR","Individual","No","93-0931709","85804OR0570001","LifeWise Oregon Standard Bronze Plan Exclusive Provider 5000","85804OR057",,"ORN003","ORS001","ORF007","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9967",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0570001-00","Standard Bronze Off Exchange Plan",,"0.619174301624298","Yes","Yes","No","100%",,"$5,000","$20","$1,200","$200","$5,000","$80","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/029195_2016.pdf","https://www.lifewiseor.com/documents/008701_2016.pdf","15"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","2","85804","OR","Individual","No","93-0931709","85804OR0570001","LifeWise Oregon Standard Bronze Plan Exclusive Provider 5000","85804OR057",,"ORN003","ORS001","ORF007","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9967",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0570001-01","Standard Bronze On Exchange Plan",,"0.619174301624298","Yes","Yes","No","100%",,"$5,000","$20","$1,200","$200","$5,000","$80","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/029195_2016.pdf","https://www.lifewiseor.com/documents/031534_2016.pdf","16"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","2","85804","OR","Individual","No","93-0931709","85804OR0570001","LifeWise Oregon Standard Bronze Plan Exclusive Provider 5000","85804OR057",,"ORN003","ORS001","ORF007","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9967",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0570001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/033237_2016.pdf","https://www.lifewiseor.com/documents/031795_2016.pdf","17"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","2","85804","OR","Individual","No","93-0931709","85804OR0570001","LifeWise Oregon Standard Bronze Plan Exclusive Provider 5000","85804OR057",,"ORN003","ORS001","ORF007","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9967",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0570001-03","Limited Cost Sharing Plan Variation",,"0.619174301624298","Yes","Yes","No","100%",,"$5,000","$20","$1,200","$200","$5,000","$80","$70","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/033238_2016.pdf","https://www.lifewiseor.com/documents/031795_2016.pdf","18"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","3","85804","OR","Individual","No","93-0931709","85804OR0550001","Essential Bronze Exchange 5250 HSA EPO","85804OR055",,"ORN003","ORS001","ORF004","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9967",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0550001-00","Standard Bronze Off Exchange Plan",,"0.618741571903229","Yes","Yes","No","100%",,"$5,300","$0","$400","$200","$5,300","$0","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.lifewiseor.com/documents/031149_2016.pdf","https://www.lifewiseor.com/documents/008701_2016.pdf","4"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","3","85804","OR","Individual","No","93-0931709","85804OR0550001","Essential Bronze Exchange 5250 HSA EPO","85804OR055",,"ORN003","ORS001","ORF004","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9967",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0550001-01","Standard Bronze On Exchange Plan",,"0.618741571903229","Yes","Yes","No","100%",,"$5,300","$0","$400","$200","$5,300","$0","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.lifewiseor.com/documents/031149_2016.pdf","https://www.lifewiseor.com/documents/031534_2016.pdf","5"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","3","85804","OR","Individual","No","93-0931709","85804OR0550001","Essential Bronze Exchange 5250 HSA EPO","85804OR055",,"ORN003","ORS001","ORF004","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9967",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0550001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/033250_2016.pdf","https://www.lifewiseor.com/documents/031795_2016.pdf","6"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","3","85804","OR","Individual","No","93-0931709","85804OR0550001","Essential Bronze Exchange 5250 HSA EPO","85804OR055",,"ORN003","ORS001","ORF004","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9967",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0550001-03","Limited Cost Sharing Plan Variation",,"0.618741571903229","Yes","Yes","No","100%",,"$5,300","$0","$400","$200","$5,300","$0","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.lifewiseor.com/documents/033251_2016.pdf","https://www.lifewiseor.com/documents/031795_2016.pdf","7"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","4","85804","OR","Individual","No","93-0931709","85804OR0540002","Essential Bronze Exchange 6350 EPO","85804OR054",,"ORN003","ORS001","ORF004","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9968",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0540002-00","Standard Bronze Off Exchange Plan",,"0.618917405605316","Yes","Yes","No","100%",,"$6,400","$0","$200","$200","$5,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/031147_2016.pdf","https://www.lifewiseor.com/documents/008701_2016.pdf","4"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","4","85804","OR","Individual","No","93-0931709","85804OR0540002","Essential Bronze Exchange 6350 EPO","85804OR054",,"ORN003","ORS001","ORF004","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9968",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0540002-01","Standard Bronze On Exchange Plan",,"0.618917405605316","Yes","Yes","No","100%",,"$6,400","$0","$200","$200","$5,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/031147_2016.pdf","https://www.lifewiseor.com/documents/031534_2016.pdf","5"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","4","85804","OR","Individual","No","93-0931709","85804OR0540002","Essential Bronze Exchange 6350 EPO","85804OR054",,"ORN003","ORS001","ORF004","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9968",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0540002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/033243_2016.pdf","https://www.lifewiseor.com/documents/031795_2016.pdf","6"
"2016","OR","85804","SERFF","10","2015-08-27 03:52:03","4","85804","OR","Individual","No","93-0931709","85804OR0540002","Essential Bronze Exchange 6350 EPO","85804OR054",,"ORN003","ORS001","ORF004","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes","0.9968",,,,"0","0","0","2016-01-01",,"No","Emergency services only","Yes","LifeWise Members have access to the LifeWise network of providers when outside the Service Area. Our Service Area is Oregon. Our network includes providers in Washington and Alaska. Benefits are not provided for out-of network providers.","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","85804OR0540002-03","Limited Cost Sharing Plan Variation",,"0.618917405605316","Yes","Yes","No","100%",,"$6,400","$0","$200","$200","$5,400","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.lifewiseor.com/documents/033244_2016.pdf","https://www.lifewiseor.com/documents/031795_2016.pdf","7"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","1","95417","OR","Individual","No","42-1694349","95417OR0190001","Trillium Oregon Standard Silver Plan Vital","95417OR019",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy","0.996090543023574",,,,"0","0","0","2016-01-01",,"No",,"Yes","This PPO plan will cover out-of-area services for out-of-network providers.","No"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.trilliumchp.com/Marketplace/pdfs/2016/2016-Marketplace-Drug-Formulary.pdf","95417OR0190001-00","Standard Silver Off Exchange Plan",,"0.696861922740936","No","Yes","No","100%",,"$2,500","$105","$1,170","$0","$1,700","$865","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/OUTIND/OUTIND_SBC02V3-2016-95417OR0190001-00-Trillium-Vital-Silver-00.pdf",,"4"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","1","95417","OR","Individual","Yes","42-1694349","95417OR0090001","Trillium Bright Pediatric - Low","95417OR009",,"ORN001","ORS001",,"Existing","PPO","Low",,"Both",,,,"All supplies or services not specifically listed as covered. General exclusions We will NOT cover: •       Services covered under worker’s compensation or employer’s liability laws and services covered by any federal state, county, municipality or other governmental agency, except Medicaid. • Services with respect to congenital or developmental malformations or cosmetic reasons; including but not limited to, enamel hypoplasia, fluorosis and disturbance of the temporomandibular joint. • Services for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion or for stabilizing teeth. • Services started prior to the eligibility date of this plan. • Hypnosis, prescribed drugs, premedications or analgesia (e.g. nitrous oxide) or any other euphoric drugs. • Hospital costs or any additional fees charged by the dentist because the patient is hospitalized. • General anesthesia and/or IV sedation except when administered by a dentist in conjunction with covered oral surgery in his or her office. • Experimental procedures. • Missed or broken appointments. • Precision attachments. • Orthodontic services (other than those listed as covered benefits). • Services for cosmetic reasons. • Claims submitted more than 12 months after the date of service are not covered. • All other services or supplies, not specifically covered.  Exclusion periods The following services are not covered during the first six months* under this plan: • Crowns • Replacement of an existing prosthetic device • Cast partial, full, immediate or overdenture • Fixed bridges or removable cast partials   *If you were covered under another health insurance plan before enrolling in this plan, you can receive credit for prior coverage. See the Credit for Prior Coverage section, on the next page .",,"No","Allows Child-Only",,,,,"$27.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Nationwide","Yes"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","","95417OR0090001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/IndDen/IND_SB21-2016-Trillium-Bright-Off-Exchange-Peds-Low-SOB.pdf",,"4"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","1","95417","OR","Individual","Yes","42-1694349","95417OR0090001","Trillium Bright Pediatric - Low","95417OR009",,"ORN001","ORS001",,"Existing","PPO","Low",,"Both",,,,"All supplies or services not specifically listed as covered. General exclusions We will NOT cover: •       Services covered under worker’s compensation or employer’s liability laws and services covered by any federal state, county, municipality or other governmental agency, except Medicaid. • Services with respect to congenital or developmental malformations or cosmetic reasons; including but not limited to, enamel hypoplasia, fluorosis and disturbance of the temporomandibular joint. • Services for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion or for stabilizing teeth. • Services started prior to the eligibility date of this plan. • Hypnosis, prescribed drugs, premedications or analgesia (e.g. nitrous oxide) or any other euphoric drugs. • Hospital costs or any additional fees charged by the dentist because the patient is hospitalized. • General anesthesia and/or IV sedation except when administered by a dentist in conjunction with covered oral surgery in his or her office. • Experimental procedures. • Missed or broken appointments. • Precision attachments. • Orthodontic services (other than those listed as covered benefits). • Services for cosmetic reasons. • Claims submitted more than 12 months after the date of service are not covered. • All other services or supplies, not specifically covered.  Exclusion periods The following services are not covered during the first six months* under this plan: • Crowns • Replacement of an existing prosthetic device • Cast partial, full, immediate or overdenture • Fixed bridges or removable cast partials   *If you were covered under another health insurance plan before enrolling in this plan, you can receive credit for prior coverage. See the Credit for Prior Coverage section, on the next page .",,"No","Allows Child-Only",,,,,"$27.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Nationwide","Yes"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","","95417OR0090001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/ExchDen/EXCH_SB21V4-2016-Trillium-Bright-Peds-Low-SOB.pdf",,"5"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","1","95417","OR","Individual","No","42-1694349","95417OR0190001","Trillium Oregon Standard Silver Plan Vital","95417OR019",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy","0.996090543023574",,,,"0","0","0","2016-01-01",,"No",,"Yes","This PPO plan will cover out-of-area services for out-of-network providers.","No"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.trilliumchp.com/Marketplace/pdfs/2016/2016-Marketplace-Drug-Formulary.pdf","95417OR0190001-01","Standard Silver On Exchange Plan",,"0.696861922740936","No","Yes","No","100%",,"$2,500","$105","$1,170","$0","$1,700","$865","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/FFM/EXCH_SBC01V4-2016-95417OR0190001-01-Trillium-Vital-Silver-01.pdf",,"5"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","1","95417","OR","Individual","No","42-1694349","95417OR0190001","Trillium Oregon Standard Silver Plan Vital","95417OR019",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy","0.996090543023574",,,,"0","0","0","2016-01-01",,"No",,"Yes","This PPO plan will cover out-of-area services for out-of-network providers.","No"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.trilliumchp.com/Marketplace/pdfs/2016/2016-Marketplace-Drug-Formulary.pdf","95417OR0190001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/FFM/EXCH_SBC02V3-2016-95417OR0190001-02-Trillium-Vital-Silver-02.pdf",,"6"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","1","95417","OR","Individual","Yes","42-1694349","95417OR0110001","Trillium Bright Pediatric - High","95417OR011",,"ORN001","ORS001",,"Existing","PPO","High",,"Both",,,,"All supplies or services not specifically listed as covered. General exclusions We will NOT cover: •       Services covered under worker’s compensation or employer’s liability laws and services covered by any federal state, county, municipality or other governmental agency, except Medicaid. • Services with respect to congenital or developmental malformations or cosmetic reasons; including but not limited to, enamel hypoplasia, fluorosis and disturbance of the temporomandibular joint. • Services for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion or for stabilizing teeth. • Services started prior to the eligibility date of this plan. • Hypnosis, prescribed drugs, premedications or analgesia (e.g. nitrous oxide) or any other euphoric drugs. • Hospital costs or any additional fees charged by the dentist because the patient is hospitalized. • General anesthesia and/or IV sedation except when administered by a dentist in conjunction with covered oral surgery in his or her office. • Experimental procedures. • Missed or broken appointments. • Precision attachments. • Orthodontic services (other than those listed as covered benefits). • Services for cosmetic reasons. • Claims submitted more than 12 months after the date of service are not covered. • All other services or supplies, not specifically covered.  Exclusion periods The following services are not covered during the first six months* under this plan: • Crowns • Replacement of an existing prosthetic device • Cast partial, full, immediate or overdenture • Fixed bridges or removable cast partials   *If you were covered under another health insurance plan before enrolling in this plan, you can receive credit for prior coverage. See the Credit for Prior Coverage section, on the next page .",,"No","Allows Child-Only",,,,,"$35.43","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Nationwide","Yes"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","","95417OR0110001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/IndDen/IND_SB24-2016-Trillium-Bright-Off-Exchange-Family-High-SOB.pdf",,"6"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","1","95417","OR","Individual","Yes","42-1694349","95417OR0110001","Trillium Bright Pediatric - High","95417OR011",,"ORN001","ORS001",,"Existing","PPO","High",,"Both",,,,"All supplies or services not specifically listed as covered. General exclusions We will NOT cover: •       Services covered under worker’s compensation or employer’s liability laws and services covered by any federal state, county, municipality or other governmental agency, except Medicaid. • Services with respect to congenital or developmental malformations or cosmetic reasons; including but not limited to, enamel hypoplasia, fluorosis and disturbance of the temporomandibular joint. • Services for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion or for stabilizing teeth. • Services started prior to the eligibility date of this plan. • Hypnosis, prescribed drugs, premedications or analgesia (e.g. nitrous oxide) or any other euphoric drugs. • Hospital costs or any additional fees charged by the dentist because the patient is hospitalized. • General anesthesia and/or IV sedation except when administered by a dentist in conjunction with covered oral surgery in his or her office. • Experimental procedures. • Missed or broken appointments. • Precision attachments. • Orthodontic services (other than those listed as covered benefits). • Services for cosmetic reasons. • Claims submitted more than 12 months after the date of service are not covered. • All other services or supplies, not specifically covered.  Exclusion periods The following services are not covered during the first six months* under this plan: • Crowns • Replacement of an existing prosthetic device • Cast partial, full, immediate or overdenture • Fixed bridges or removable cast partials   *If you were covered under another health insurance plan before enrolling in this plan, you can receive credit for prior coverage. See the Credit for Prior Coverage section, on the next page .",,"No","Allows Child-Only",,,,,"$35.43","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Nationwide","Yes"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","","95417OR0110001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/ExchDen/EXCH_SB22V4-2016-Trillium-Bright-Peds-High-SOB.pdf",,"7"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","1","95417","OR","Individual","No","42-1694349","95417OR0190001","Trillium Oregon Standard Silver Plan Vital","95417OR019",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy","0.996090543023574",,,,"0","0","0","2016-01-01",,"No",,"Yes","This PPO plan will cover out-of-area services for out-of-network providers.","No"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.trilliumchp.com/Marketplace/pdfs/2016/2016-Marketplace-Drug-Formulary.pdf","95417OR0190001-03","Limited Cost Sharing Plan Variation",,"0.696861922740936","No","Yes","No","100%",,"$2,500","$105","$1,170","$0","$1,700","$865","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/FFM/EXCH_SBC03V4-2016-95417OR0190001-03-Trillium-Vital-Silver-03.pdf",,"7"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","1","95417","OR","Individual","No","42-1694349","95417OR0190001","Trillium Oregon Standard Silver Plan Vital","95417OR019",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy","0.996090543023574",,,,"0","0","0","2016-01-01",,"No",,"Yes","This PPO plan will cover out-of-area services for out-of-network providers.","No"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.trilliumchp.com/Marketplace/pdfs/2016/2016-Marketplace-Drug-Formulary.pdf","95417OR0190001-04","73% AV Level Silver Plan",,"0.73930150270462","No","Yes","No","100%",,"$2,500","$105","$1,170","$0","$1,700","$865","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"$8,600","$8600 per person","$17200 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/FFM/EXCH_SBC04V4-2016-95417OR0190001-04-Trillium-Vital-Silver-04.pdf",,"8"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","1","95417","OR","Individual","No","42-1694349","95417OR0190001","Trillium Oregon Standard Silver Plan Vital","95417OR019",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy","0.996090543023574",,,,"0","0","0","2016-01-01",,"No",,"Yes","This PPO plan will cover out-of-area services for out-of-network providers.","No"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.trilliumchp.com/Marketplace/pdfs/2016/2016-Marketplace-Drug-Formulary.pdf","95417OR0190001-05","87% AV Level Silver Plan",,"0.87958174943924","No","Yes","No","100%",,"$800","$70","$655","$0","$800","$510","$95","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$3,000","$3000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","$1700 per group","10%",,,,,"$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$1,700","$1700 per person","$3400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/FFM/EXCH_SBC05V4-2016-95417OR0190001-05-Trillium-Vital-Silver-05.pdf",,"9"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","1","95417","OR","Individual","No","42-1694349","95417OR0190001","Trillium Oregon Standard Silver Plan Vital","95417OR019",,"ORN001","ORS001","ORF002","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy","0.996090543023574",,,,"0","0","0","2016-01-01",,"No",,"Yes","This PPO plan will cover out-of-area services for out-of-network providers.","No"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.trilliumchp.com/Marketplace/pdfs/2016/2016-Marketplace-Drug-Formulary.pdf","95417OR0190001-06","94% AV Level Silver Plan",,"0.948715090751648","No","Yes","No","100%",,"$50","$35","$725","$0","$50","$275","$165","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","10%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$100","$100 per person","$200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/FFM/EXCH_SBC06V4-2016-95417OR0190001-06-Trillium-Vital-Silver-06.pdf",,"10"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","1","95417","OR","Individual","No","42-1694349","95417OR0180001","Trillium Oregon Standard Gold Plan Vital","95417OR018",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy","0.996595281059549",,,,"0","0","0","2016-01-01",,"No",,"Yes","This PPO plan will cover out-of-area services for out-of-network providers.","No"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.trilliumchp.com/Marketplace/pdfs/2016/2016-Marketplace-Drug-Formulary.pdf","95417OR0180001-00","Standard Gold Off Exchange Plan",,"0.783612370491028","No","Yes","No","100%",,"$1,250","$70","$600","$0","$1,250","$550","$40","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/OUTIND/OUTIND_SBC03V2-2016-95417OR0180001-00-Trillium-Vital-Gold-00.pdf",,"11"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","1","95417","OR","Individual","No","42-1694349","95417OR0180001","Trillium Oregon Standard Gold Plan Vital","95417OR018",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy","0.996595281059549",,,,"0","0","0","2016-01-01",,"No",,"Yes","This PPO plan will cover out-of-area services for out-of-network providers.","No"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.trilliumchp.com/Marketplace/pdfs/2016/2016-Marketplace-Drug-Formulary.pdf","95417OR0180001-01","Standard Gold On Exchange Plan",,"0.783612370491028","No","Yes","No","100%",,"$1,250","$70","$600","$0","$1,250","$550","$40","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/FFM/EXCH_SBC10V4-2016-95417OR0180001-01-Trillium-Vital-Gold-01.pdf",,"12"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","1","95417","OR","Individual","No","42-1694349","95417OR0180001","Trillium Oregon Standard Gold Plan Vital","95417OR018",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy","0.996595281059549",,,,"0","0","0","2016-01-01",,"No",,"Yes","This PPO plan will cover out-of-area services for out-of-network providers.","No"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.trilliumchp.com/Marketplace/pdfs/2016/2016-Marketplace-Drug-Formulary.pdf","95417OR0180001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/FFM/EXCH_SBC11V3-2016-95417OR0180001-02-Trillium-Vital-Gold-02.pdf",,"13"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","1","95417","OR","Individual","No","42-1694349","95417OR0180001","Trillium Oregon Standard Gold Plan Vital","95417OR018",,"ORN001","ORS001","ORF001","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy","0.996595281059549",,,,"0","0","0","2016-01-01",,"No",,"Yes","This PPO plan will cover out-of-area services for out-of-network providers.","No"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.trilliumchp.com/Marketplace/pdfs/2016/2016-Marketplace-Drug-Formulary.pdf","95417OR0180001-03","Limited Cost Sharing Plan Variation",,"0.783612370491028","No","Yes","No","100%",,"$1,250","$70","$600","$0","$1,250","$550","$40","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","10%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%",,,,,"$2,500","$2500 per person","$5000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/FFM/EXCH_SBC12V4-2016-95417OR0180001-03-Trillium-Vital-Gold-03.pdf",,"14"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","2","95417","OR","Individual","No","42-1694349","95417OR0200001","Trillium Oregon Standard Bronze Plan Vital","95417OR020",,"ORN001","ORS001","ORF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy","0.995232874100205",,,,"0","0","0","2016-01-01",,"No",,"Yes","This PPO plan will cover out-of-area services for out-of-network providers.","No"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.trilliumchp.com/Marketplace/pdfs/2016/2016-Marketplace-Drug-Formulary.pdf","95417OR0200001-00","Standard Bronze Off Exchange Plan",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$140","$700","$0","$1,700","$1,220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/OUTIND/OUTIND_SBC01V3-2016-95417OR0200001-00-Trillium-Vital-Bronze-00.pdf",,"4"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","2","95417","OR","Individual","Yes","42-1694349","95417OR0140001","Trillium Bright Family Dental - Low","95417OR014",,"ORN001","ORS001",,"Existing","PPO","Low",,"Both",,,,"All supplies or services not specifically listed as covered.  $750 annual maximum for adult dental benefits.  The maximum out of pocket for dental benefits is $350 per member applied only to pediatric benefits/members. General exclusions We will NOT cover: •       Services covered under worker’s compensation or employer’s liability laws and services covered by any federal state, county, municipality or other governmental agency, except Medicaid. • Services with respect to congenital or developmental malformations or cosmetic reasons; including but not limited to, enamel hypoplasia, fluorosis and disturbance of the temporomandibular joint. • Services for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion or for stabilizing teeth. • Services started prior to the eligibility date of this plan. • Hypnosis, prescribed drugs, premedications or analgesia (e.g. nitrous oxide) or any other euphoric drugs. • Hospital costs or any additional fees charged by the dentist because the patient is hospitalized. • General anesthesia and/or IV sedation except when administered by a dentist in conjunction with covered oral surgery in his or her office. • Experimental procedures. • Missed or broken appointments. • Precision attachments. • Orthodontic services (other than those listed as covered benefits). • Services for cosmetic reasons. • Claims submitted more than 12 months after the date of service are not covered. • All other services or supplies, not specifically covered.  Exclusion periods The following services are not covered during the first six months* under this plan: • Crowns • Replacement of an existing prosthetic device • Cast partial, full, immediate or overdenture • Fixed bridges or removable cast partials   *If you were covered under another health insurance plan before enrolling in this plan, you can receive credit for prior coverage. See the Credit for Prior Coverage section, on the next page .",,"No","Allows Adult and Child-Only",,,,,"$27.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Nationwide","Yes"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","","95417OR0140001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/IndDen/IND_SB23-2016-Trillium-Bright-Off-Exchange-Family-Low-SOB.pdf",,"4"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","2","95417","OR","Individual","Yes","42-1694349","95417OR0140001","Trillium Bright Family Dental - Low","95417OR014",,"ORN001","ORS001",,"Existing","PPO","Low",,"Both",,,,"All supplies or services not specifically listed as covered.  $750 annual maximum for adult dental benefits.  The maximum out of pocket for dental benefits is $350 per member applied only to pediatric benefits/members. General exclusions We will NOT cover: •       Services covered under worker’s compensation or employer’s liability laws and services covered by any federal state, county, municipality or other governmental agency, except Medicaid. • Services with respect to congenital or developmental malformations or cosmetic reasons; including but not limited to, enamel hypoplasia, fluorosis and disturbance of the temporomandibular joint. • Services for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion or for stabilizing teeth. • Services started prior to the eligibility date of this plan. • Hypnosis, prescribed drugs, premedications or analgesia (e.g. nitrous oxide) or any other euphoric drugs. • Hospital costs or any additional fees charged by the dentist because the patient is hospitalized. • General anesthesia and/or IV sedation except when administered by a dentist in conjunction with covered oral surgery in his or her office. • Experimental procedures. • Missed or broken appointments. • Precision attachments. • Orthodontic services (other than those listed as covered benefits). • Services for cosmetic reasons. • Claims submitted more than 12 months after the date of service are not covered. • All other services or supplies, not specifically covered.  Exclusion periods The following services are not covered during the first six months* under this plan: • Crowns • Replacement of an existing prosthetic device • Cast partial, full, immediate or overdenture • Fixed bridges or removable cast partials   *If you were covered under another health insurance plan before enrolling in this plan, you can receive credit for prior coverage. See the Credit for Prior Coverage section, on the next page .",,"No","Allows Adult and Child-Only",,,,,"$27.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Nationwide","Yes"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","","95417OR0140001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","$225 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/ExchDen/EXCH_SB23V4-2016-Trillium-Bright-Family-Low-SOB.pdf",,"5"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","2","95417","OR","Individual","No","42-1694349","95417OR0200001","Trillium Oregon Standard Bronze Plan Vital","95417OR020",,"ORN001","ORS001","ORF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy","0.995232874100205",,,,"0","0","0","2016-01-01",,"No",,"Yes","This PPO plan will cover out-of-area services for out-of-network providers.","No"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.trilliumchp.com/Marketplace/pdfs/2016/2016-Marketplace-Drug-Formulary.pdf","95417OR0200001-01","Standard Bronze On Exchange Plan",,"0.619022488594055","Yes","Yes","No","100%",,"$5,000","$140","$700","$0","$1,700","$1,220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","50%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/FFM/EXCH_SBC07V4-2016-95417OR0200001-01-Trillium-Vital-Bronze-01.pdf",,"5"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","2","95417","OR","Individual","No","42-1694349","95417OR0200001","Trillium Oregon Standard Bronze Plan Vital","95417OR020",,"ORN001","ORS001","ORF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy","0.995232874100205",,,,"0","0","0","2016-01-01",,"No",,"Yes","This PPO plan will cover out-of-area services for out-of-network providers.","No"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.trilliumchp.com/Marketplace/pdfs/2016/2016-Marketplace-Drug-Formulary.pdf","95417OR0200001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/FFM/EXCH_SBC08V3-2016-95417OR0200001-02-Trillium-Vital-Bronze-02.pdf",,"6"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","2","95417","OR","Individual","No","42-1694349","95417OR0240001","Trillium Fit Catastrophic Plan","95417OR024",,"ORN001","ORS001","ORF004","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","3","0","2016-01-01",,"No",,"Yes","This PPO plan will cover out-of-area services for out-of-network providers.","No"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://www.trilliumchp.com/Marketplace/pdfs/2016/2016-Marketplace-Drug-Formulary.pdf","95417OR0240001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","100%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/FFM/EXCH_SBC13V4-2016-95417OR0240001-01-Trillium-Vital-Fit-01.pdf",,"9"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","3","95417","OR","Individual","Yes","42-1694349","95417OR0150001","Trillium Bright Family Dental - High","95417OR015",,"ORN001","ORS001",,"Existing","PPO","High",,"Both",,,,"All supplies or services not specifically listed as covered.  $1,000 annual maximum for adult dental benefits.  The maximum out of pocket for dental benefits is $350 per member applied only to pediatric benefits/members. General exclusions We will NOT cover: •       Services covered under worker’s compensation or employer’s liability laws and services covered by any federal state, county, municipality or other governmental agency, except Medicaid. • Services with respect to congenital or developmental malformations or cosmetic reasons; including but not limited to, enamel hypoplasia, fluorosis and disturbance of the temporomandibular joint. • Services for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion or for stabilizing teeth. • Services started prior to the eligibility date of this plan. • Hypnosis, prescribed drugs, premedications or analgesia (e.g. nitrous oxide) or any other euphoric drugs. • Hospital costs or any additional fees charged by the dentist because the patient is hospitalized. • General anesthesia and/or IV sedation except when administered by a dentist in conjunction with covered oral surgery in his or her office. • Experimental procedures. • Missed or broken appointments. • Precision attachments. • Orthodontic services (other than those listed as covered benefits). • Services for cosmetic reasons. • Claims submitted more than 12 months after the date of service are not covered. • All other services or supplies, not specifically covered.  Exclusion periods The following services are not covered during the first six months* under this plan: • Crowns • Replacement of an existing prosthetic device • Cast partial, full, immediate or overdenture • Fixed bridges or removable cast partials   *If you were covered under another health insurance plan before enrolling in this plan, you can receive credit for prior coverage. See the Credit for Prior Coverage section, on the next page .",,"No","Allows Adult and Child-Only",,,,,"$35.43","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Nationwide","Yes"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","","95417OR0150001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/IndDen/IND_SB24-2016-Trillium-Bright-Off-Exchange-Family-High-SOB.pdf",,"4"
"2016","OR","95417","SERFF","11","2016-01-26 09:59:26","3","95417","OR","Individual","Yes","42-1694349","95417OR0150001","Trillium Bright Family Dental - High","95417OR015",,"ORN001","ORS001",,"Existing","PPO","High",,"Both",,,,"All supplies or services not specifically listed as covered.  $1,000 annual maximum for adult dental benefits.  The maximum out of pocket for dental benefits is $350 per member applied only to pediatric benefits/members. General exclusions We will NOT cover: •       Services covered under worker’s compensation or employer’s liability laws and services covered by any federal state, county, municipality or other governmental agency, except Medicaid. • Services with respect to congenital or developmental malformations or cosmetic reasons; including but not limited to, enamel hypoplasia, fluorosis and disturbance of the temporomandibular joint. • Services for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion or for stabilizing teeth. • Services started prior to the eligibility date of this plan. • Hypnosis, prescribed drugs, premedications or analgesia (e.g. nitrous oxide) or any other euphoric drugs. • Hospital costs or any additional fees charged by the dentist because the patient is hospitalized. • General anesthesia and/or IV sedation except when administered by a dentist in conjunction with covered oral surgery in his or her office. • Experimental procedures. • Missed or broken appointments. • Precision attachments. • Orthodontic services (other than those listed as covered benefits). • Services for cosmetic reasons. • Claims submitted more than 12 months after the date of service are not covered. • All other services or supplies, not specifically covered.  Exclusion periods The following services are not covered during the first six months* under this plan: • Crowns • Replacement of an existing prosthetic device • Cast partial, full, immediate or overdenture • Fixed bridges or removable cast partials   *If you were covered under another health insurance plan before enrolling in this plan, you can receive credit for prior coverage. See the Credit for Prior Coverage section, on the next page .",,"No","Allows Adult and Child-Only",,,,,"$35.43","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Nationwide","Yes"," https://trilliumchp.softheon.com/Marketplace/PaymentCenter/Payment.aspx","","95417OR0150001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.trilliumchp.com/Marketplace/PDFS/2016/ExchDen/EXCH_SB24V4-2016-Trillium-Bright-Family-High-SOB.pdf",,"5"
"2016","SD","11782","SERFF","2","2015-08-22 23:36:24","1","11782","SD","SHOP (Small Group)","Yes","36-0883760","11782SD0040002","EHB High PPO","11782SD004",,"SDN001","SDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.26","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","11782SD0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","SD","11782","SERFF","2","2015-08-22 23:36:24","1","11782","SD","SHOP (Small Group)","Yes","36-0883760","11782SD0040001","EHB Low PPO","11782SD004",,"SDN001","SDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.45","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","11782SD0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","2","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090004","Sanford Simplicity $3,500","31195SD009",,"SDN001","SDS001","SDF004","New","HMO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090004-00","Standard Bronze Off Exchange Plan",,"0.618949711322784","Yes","Yes","No","100%",,"$3,500","$0","$400","$200","$3,500","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","40%",,,,,"$7,000","$7000 per person","$10500 per group","$7,000","$7000 per person","$10500 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/sg_sd_simplicity_3500_HDHP.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","4"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","2","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090004","Sanford Simplicity $3,500","31195SD009",,"SDN001","SDS001","SDF004","New","HMO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090004-01","Standard Bronze On Exchange Plan",,"0.618949711322784","Yes","Yes","No","100%",,"$3,500","$0","$400","$200","$3,500","$0","$700","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","40%",,,,,"$7,000","$7000 per person","$10500 per group","$7,000","$7000 per person","$10500 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/sg_sd_simplicity_3500_HDHP.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","5"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","2","31195","SD","Individual","No","91-1842494","31195SD0080007","Sanford TRUE $6,000 Copay","31195SD008",,"SDN002","SDS002","SDF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080007-01","Standard Bronze On Exchange Plan",,"0.619145750999451","Yes","Yes","No","100%",,"$3,600","$50","$300","$200","$600","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","5"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","2","31195","SD","Individual","No","91-1842494","31195SD0080007","Sanford TRUE $6,000 Copay","31195SD008",,"SDN002","SDS002","SDF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_6000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","6"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","2","31195","SD","Individual","No","91-1842494","31195SD0080007","Sanford TRUE $6,000 Copay","31195SD008",,"SDN002","SDS002","SDF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080007-03","Limited Cost Sharing Plan Variation",,"0.619145750999451","Yes","Yes","No","100%",,"$3,600","$50","$300","$200","$600","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_6000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","7"
"2016","SD","11782","SERFF","2","2015-08-22 23:36:24","1","11782","SD","SHOP (Small Group)","Yes","36-0883760","11782SD0030002","EHB High Passive","11782SD003",,"SDN001","SDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$45.29","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","11782SD0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","SD","11782","SERFF","2","2015-08-22 23:36:24","1","11782","SD","SHOP (Small Group)","Yes","36-0883760","11782SD0030001","EHB Low Passive","11782SD003",,"SDN001","SDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.38","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","11782SD0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","SD","13380","SERFF","2","2015-08-22 23:36:24","1","13380","SD","SHOP (Small Group)","Yes","47-0098400","13380SD0040002","EHB High PPO","13380SD004",,"SDN001","SDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.66","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","13380SD0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","SD","13380","SERFF","2","2015-08-22 23:36:24","1","13380","SD","SHOP (Small Group)","Yes","47-0098400","13380SD0040001","EHB Low PPO","13380SD004",,"SDN001","SDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.14","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","13380SD0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","SD","13380","SERFF","2","2015-08-22 23:36:24","1","13380","SD","SHOP (Small Group)","Yes","47-0098400","13380SD0030002","EHB High Passive","13380SD003",,"SDN001","SDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.67","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","13380SD0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","SD","13380","SERFF","2","2015-08-22 23:36:24","1","13380","SD","SHOP (Small Group)","Yes","47-0098400","13380SD0030001","EHB Low Passive","13380SD003",,"SDN001","SDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.99","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","13380SD0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","SD","14186","SERFF","2","2015-08-22 23:36:24","1","14186","SD","SHOP (Small Group)","Yes","47-0397286","14186SD0030001","Renaissance Group Dental PPO, EHB Certified","14186SD003",,"SDN001","SDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$31.71","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","14186SD0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SD","14186","SERFF","2","2015-08-22 23:36:24","1","14186","SD","Individual","Yes","47-0397286","14186SD0010001","Delta Dental Individual PPO, EHB Certified","14186SD001",,"SDN002","SDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.12","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","14186SD0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SD","14186","SERFF","2","2015-08-22 23:36:24","1","14186","SD","Individual","Yes","47-0397286","14186SD0010002","Delta Dental Individual PPO, EHB Certified","14186SD001",,"SDN002","SDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.45","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","14186SD0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","SD","14186","SERFF","2","2015-08-22 23:36:24","1","14186","SD","SHOP (Small Group)","Yes","47-0397286","14186SD0030002","Renaissance Group Dental PPO, EHB Certified","14186SD003",,"SDN001","SDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.86","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","14186SD0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","SD","14186","SERFF","2","2015-08-22 23:36:24","1","14186","SD","Individual","Yes","47-0397286","14186SD0020001","Renaissance Individual Dental PPO, EHB Certified","14186SD002",,"SDN001","SDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.62","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","14186SD0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","SD","14186","SERFF","2","2015-08-22 23:36:24","1","14186","SD","Individual","Yes","47-0397286","14186SD0020002","Renaissance Individual Dental PPO, EHB Certified","14186SD002",,"SDN001","SDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.08","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","14186SD0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","SD","25868","SERFF","3","2015-08-22 23:36:24","1","25868","SD","SHOP (Small Group)","Yes","46-0309258","25868SD0020003","Delta Dental Small Group Low","25868SD002","7164425200","SDN001","SDS001",,"Existing","Indemnity","Low",,"Off the Exchange",,,,"EHB Pediatric coverage not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"$29.67","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","https://secure.deltadentalsd.com/ffm/default.aspx","","25868SD0020003-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalsd.com/documents/d125461.aspx?type=view","http://www.deltadentalsd.com/documents/d125461.aspx?type=view","4"
"2016","SD","25868","SERFF","3","2015-08-22 23:36:24","1","25868","SD","Individual","Yes","46-0309258","25868SD0010003","Delta Dental Individual and Family Low","25868SD001","7164425200","SDN001","SDS001",,"Existing","Indemnity","Low",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"$33.97","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","https://secure.deltadentalsd.com/ffm/default.aspx","","25868SD0010003-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalsd.com/documents/d125459.aspx?type=view","http://www.deltadentalsd.com/documents/d125459.aspx?type=view","4"
"2016","SD","25868","SERFF","3","2015-08-22 23:36:24","1","25868","SD","Individual","Yes","46-0309258","25868SD0010003","Delta Dental Individual and Family Low","25868SD001","7164425200","SDN001","SDS001",,"Existing","Indemnity","Low",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"$33.97","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","https://secure.deltadentalsd.com/ffm/default.aspx","","25868SD0010003-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalsd.com/documents/d125459.aspx?type=view","http://www.deltadentalsd.com/documents/d125459.aspx?type=view","5"
"2016","SD","25868","SERFF","3","2015-08-22 23:36:24","2","25868","SD","Individual","Yes","46-0309258","25868SD0010004","Delta Dental Individual & Family High","25868SD001","7164425200","SDN001","SDS001",,"Existing","Indemnity","High",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"$45.96","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","https://secure.deltadentalsd.com/ffm/default.aspx","","25868SD0010004-00","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalsd.com/documents/d125460.aspx?type=view","http://www.deltadentalsd.com/documents/d125460.aspx?type=view","4"
"2016","SD","25868","SERFF","3","2015-08-22 23:36:24","2","25868","SD","SHOP (Small Group)","Yes","46-0309258","25868SD0020004","Delta Dental Small Group High","25868SD002","7164425200","SDN001","SDS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,"EHB Pediatric coverage not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"$37.68","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","https://secure.deltadentalsd.com/ffm/default.aspx","","25868SD0020004-00","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalsd.com/documents/d125462.aspx?type=view","http://www.deltadentalsd.com/documents/d125462.aspx?type=view","4"
"2016","SD","25868","SERFF","3","2015-08-22 23:36:24","2","25868","SD","Individual","Yes","46-0309258","25868SD0010004","Delta Dental Individual & Family High","25868SD001","7164425200","SDN001","SDS001",,"Existing","Indemnity","High",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18",,"No","Allows Adult and Child-Only",,,,,"$45.96","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","https://secure.deltadentalsd.com/ffm/default.aspx","","25868SD0010004-01","Standard High On Exchange Plan","84.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.deltadentalsd.com/documents/d125460.aspx?type=view","http://www.deltadentalsd.com/documents/d125460.aspx?type=view","5"
"2016","SD","26240","SERFF","2","2015-08-22 23:36:24","1","26240","SD","SHOP (Small Group)","Yes","57-0523959","26240SD0030001","Group Dental Policy","26240SD003",,"SDN001","SDS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","26240SD0030001-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SD","26240","SERFF","2","2015-08-22 23:36:24","2","26240","SD","SHOP (Small Group)","Yes","57-0523959","26240SD0020001","Pediatric Only Group Dental Policy","26240SD002",,"SDN001","SDS001",,"Existing","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$41.13","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","26240SD0020001-00","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SD","26240","SERFF","2","2015-08-22 23:36:24","2","26240","SD","SHOP (Small Group)","Yes","57-0523959","26240SD0020002","Pediatric Only Group Dental Policy","26240SD002",,"SDN001","SDS001",,"Existing","Indemnity","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$34.09","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","26240SD0020002-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","SD","28583","SERFF","2","2015-08-22 23:36:24","1","28583","SD","SHOP (Small Group)","Yes","44-0308260","28583SD0010001","KCL EHB Low PPO","28583SD001",,"SDN001","SDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$40.29","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","28583SD0010001-00","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SD","28583","SERFF","2","2015-08-22 23:36:24","1","28583","SD","SHOP (Small Group)","Yes","44-0308260","28583SD0010003","KCL EHB Low MAC","28583SD001",,"SDN001","SDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$30.66","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","28583SD0010003-00","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","SD","28583","SERFF","2","2015-08-22 23:36:24","1","28583","SD","SHOP (Small Group)","Yes","44-0308260","28583SD0010005","KCL Fam Low PPO","28583SD001",,"SDN001","SDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$40.29","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","28583SD0010005-00","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","SD","28583","SERFF","2","2015-08-22 23:36:24","1","28583","SD","SHOP (Small Group)","Yes","44-0308260","28583SD0010007","KCL Fam Low MAC","28583SD001",,"SDN001","SDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$30.66","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","28583SD0010007-00","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","SD","28583","SERFF","2","2015-08-22 23:36:24","2","28583","SD","SHOP (Small Group)","Yes","44-0308260","28583SD0010002","KCL EHB High PPO","28583SD001",,"SDN001","SDS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$49.12","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","28583SD0010002-00","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","SD","28583","SERFF","2","2015-08-22 23:36:24","2","28583","SD","SHOP (Small Group)","Yes","44-0308260","28583SD0010004","KCL EHB High MAC","28583SD001",,"SDN001","SDS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$37.91","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","28583SD0010004-00","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","SD","28583","SERFF","2","2015-08-22 23:36:24","2","28583","SD","SHOP (Small Group)","Yes","44-0308260","28583SD0010006","KCL Fam High PPO","28583SD001",,"SDN001","SDS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$49.12","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","28583SD0010006-00","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","SD","28583","SERFF","2","2015-08-22 23:36:24","2","28583","SD","SHOP (Small Group)","Yes","44-0308260","28583SD0010008","KCL Fam High MAC","28583SD001",,"SDN001","SDS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$37.91","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","28583SD0010008-00","Standard High Off Exchange Plan","85.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","1","31195","SD","Individual","No","91-1842494","31195SD0080003","Sanford Simplicity $5,000 HDHP","31195SD008",,"SDN001","SDS001","SDF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080003-00","Standard Bronze Off Exchange Plan",,"0.610491871833801","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$4,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_5000_HDHP.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","4"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","1","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090005","Sanford Simplicity $6,000 Copay","31195SD009",,"SDN001","SDS001","SDF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090005-00","Standard Bronze Off Exchange Plan",,"0.619145750999451","Yes","Yes","No","100%",,"$3,600","$50","$300","$200","$600","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,000","$16000 per person","$24000 per group","$16,000","$16000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/sg_sd_simplicity_6000_copay.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","4"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","1","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090005","Sanford Simplicity $6,000 Copay","31195SD009",,"SDN001","SDS001","SDF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090005-01","Standard Bronze On Exchange Plan",,"0.619145750999451","Yes","Yes","No","100%",,"$3,600","$50","$300","$200","$600","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,000","$16000 per person","$24000 per group","$16,000","$16000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group","No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/sg_sd_simplicity_6000_copay.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","5"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","1","31195","SD","Individual","No","91-1842494","31195SD0080003","Sanford Simplicity $5,000 HDHP","31195SD008",,"SDN001","SDS001","SDF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080003-01","Standard Bronze On Exchange Plan",,"0.610491871833801","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$4,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_5000_HDHP.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","5"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","1","31195","SD","Individual","No","91-1842494","31195SD0080003","Sanford Simplicity $5,000 HDHP","31195SD008",,"SDN001","SDS001","SDF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_5000_HDHP_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","6"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","1","31195","SD","Individual","No","91-1842494","31195SD0080003","Sanford Simplicity $5,000 HDHP","31195SD008",,"SDN001","SDS001","SDF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080003-03","Limited Cost Sharing Plan Variation",,"0.610491871833801","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$4,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_5000_HDHP_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","7"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","1","31195","SD","Individual","No","91-1842494","31195SD0080009","Sanford TRUE $5,000 HDHP","31195SD008",,"SDN002","SDS002","SDF004","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080009-00","Standard Bronze Off Exchange Plan",,"0.610491871833801","Yes","Yes","No","100%",,"$3,600","$0","$300","$200","$4,800","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_5000_HDHP.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","8"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","1","31195","SD","Individual","No","91-1842494","31195SD0080010","Sanford TRUE $3,500 HDHP","31195SD008",,"SDN002","SDS002","SDF009","New","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_3500_HDHP_ZCS.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","14"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","1","31195","SD","Individual","No","91-1842494","31195SD0080010","Sanford TRUE $3,500 HDHP","31195SD008",,"SDN002","SDS002","SDF009","New","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080010-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_3500_HDHP_LCS.prg","http://www.sanfordhealthplan.org/shopforhealthinsurance/","15"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","1","31195","SD","Individual","No","91-1842494","31195SD0080010","Sanford TRUE $3,500 HDHP","31195SD008",,"SDN002","SDS002","SDF009","New","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080010-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$200","$3,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_3500_HDHP_73.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","16"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","1","31195","SD","Individual","No","91-1842494","31195SD0080010","Sanford TRUE $3,500 HDHP","31195SD008",,"SDN002","SDS002","SDF009","New","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080010-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,300","$0","$0","$200","$1,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_3500_HDHP_87.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","17"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","1","31195","SD","Individual","No","91-1842494","31195SD0080010","Sanford TRUE $3,500 HDHP","31195SD008",,"SDN002","SDS002","SDF009","New","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080010-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$200","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_3500_HDHP_94.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","18"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","2","31195","SD","Individual","No","91-1842494","31195SD0080007","Sanford TRUE $6,000 Copay","31195SD008",,"SDN002","SDS002","SDF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080007-00","Standard Bronze Off Exchange Plan",,"0.619145750999451","Yes","Yes","No","100%",,"$3,600","$50","$300","$200","$600","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","4"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","2","31195","SD","Individual","No","91-1842494","31195SD0080005","Sanford Simplicity $6,000 Copay","31195SD008",,"SDN001","SDS001","SDF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080005-00","Standard Bronze Off Exchange Plan",,"0.619145750999451","Yes","Yes","No","100%",,"$3,600","$50","$300","$200","$600","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,000","$16000 per person","$24000 per group","$16,000","$16000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","8"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","2","31195","SD","Individual","No","91-1842494","31195SD0080005","Sanford Simplicity $6,000 Copay","31195SD008",,"SDN001","SDS001","SDF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080005-01","Standard Bronze On Exchange Plan",,"0.619145750999451","Yes","Yes","No","100%",,"$3,600","$50","$300","$200","$600","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,000","$16000 per person","$24000 per group","$16,000","$16000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_6000.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","9"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","2","31195","SD","Individual","No","91-1842494","31195SD0080005","Sanford Simplicity $6,000 Copay","31195SD008",,"SDN001","SDS001","SDF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_6000_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","10"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","2","31195","SD","Individual","No","91-1842494","31195SD0080005","Sanford Simplicity $6,000 Copay","31195SD008",,"SDN001","SDS001","SDF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080005-03","Limited Cost Sharing Plan Variation",,"0.619145750999451","Yes","Yes","No","100%",,"$3,600","$50","$300","$200","$600","$2,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$16,000","$16000 per person","$24000 per group","$16,000","$16000 per person","$24000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","40%",,,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_6000_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","11"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080001","Sanford Simplicity $1,500","31195SD008",,"SDN001","SDS001","SDF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080001-00","Standard Gold Off Exchange Plan",,"0.800386011600494","No","Yes","No","100%",,"$1,500","$30","$600","$200","$400","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_1500.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","4"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090001","Sanford Simplicity $500","31195SD009",,"SDN001","SDS001","SDF006","Existing","HMO","Platinum","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090001-00","Standard Platinum Off Exchange Plan",,"0.899335086345673","No","Yes","No","100%",,"$500","$0","$500","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/sg_sd_simplicity_500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","4"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090001","Sanford Simplicity $500","31195SD009",,"SDN001","SDS001","SDF006","Existing","HMO","Platinum","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090001-01","Standard Platinum On Exchange Plan",,"0.899335086345673","No","Yes","No","100%",,"$500","$0","$500","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/sg_sd_simplicity_500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","5"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080001","Sanford Simplicity $1,500","31195SD008",,"SDN001","SDS001","SDF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080001-01","Standard Gold On Exchange Plan",,"0.800386011600494","No","Yes","No","100%",,"$1,500","$30","$600","$200","$400","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_1500.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","5"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080001","Sanford Simplicity $1,500","31195SD008",,"SDN001","SDS001","SDF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_1500_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","6"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","4","31195","SD","Individual","No","91-1842494","31195SD0080004","Sanford Simplicity $6,850","31195SD008",,"SDN001","SDS001","SDF009","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$4,900","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_6850.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","5"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","5","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090008","Sanford Simplicity $2,000 HDHP","31195SD009",,"SDN001","SDS001","SDF007","New","HMO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090008-00","Standard Silver Off Exchange Plan",,"0.718817114830017","Yes","Yes","No","100%",,"$2,000","$0","$700","$200","$2,000","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/sg_sd_simplicity_2000_HDHP.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","4"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090002","Sanford Simplicity $1,500","31195SD009",,"SDN001","SDS001","SDF001","Existing","HMO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090002-00","Standard Gold Off Exchange Plan",,"0.800386011600494","No","Yes","No","100%",,"$1,500","$30","$600","$200","$400","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/sg_sd_simplicity_1500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","6"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090002","Sanford Simplicity $1,500","31195SD009",,"SDN001","SDS001","SDF001","Existing","HMO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090002-01","Standard Gold On Exchange Plan",,"0.800386011600494","No","Yes","No","100%",,"$1,500","$30","$600","$200","$400","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/sg_sd_simplicity_1500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","7"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080001","Sanford Simplicity $1,500","31195SD008",,"SDN001","SDS001","SDF001","Existing","HMO","Gold","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080001-03","Limited Cost Sharing Plan Variation",,"0.800386011600494","No","Yes","No","100%",,"$1,500","$30","$600","$200","$400","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","7"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080002","Sanford Simplicity $2,500","31195SD008",,"SDN001","SDS001","SDF011","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080002-00","Standard Silver Off Exchange Plan",,"0.701222121715546","No","Yes","No","100%",,"$2,500","$30","$800","$200","$400","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,000","$10000 per person","$16000 per group","$10,000","$10000 per person","$16000 per group","$2,500","$2500 per person","$5000 per group","40%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_2500.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","8"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090003","Sanford Simplicity $2,000","31195SD009",,"SDN001","SDS001","SDF002","Existing","HMO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090003-00","Standard Silver Off Exchange Plan",,"0.718453586101532","No","Yes","No","100%",,"$2,000","$30","$1,000","$200","$400","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,000","$10000 per person","$16000 per group","$10,000","$10000 per person","$16000 per group","$2,000","$2000 per person","$4000 per group","40%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/sg_sd_simplicity_2000.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","8"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090003","Sanford Simplicity $2,000","31195SD009",,"SDN001","SDS001","SDF002","Existing","HMO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090003-01","Standard Silver On Exchange Plan",,"0.718453586101532","No","Yes","No","100%",,"$2,000","$30","$1,000","$200","$400","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,000","$10000 per person","$16000 per group","$10,000","$10000 per person","$16000 per group","$2,000","$2000 per person","$4000 per group","40%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/sg_sd_simplicity_2000.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","9"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080002","Sanford Simplicity $2,500","31195SD008",,"SDN001","SDS001","SDF011","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080002-01","Standard Silver On Exchange Plan",,"0.701222121715546","No","Yes","No","100%",,"$2,500","$30","$800","$200","$400","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,000","$10000 per person","$16000 per group","$10,000","$10000 per person","$16000 per group","$2,500","$2500 per person","$5000 per group","40%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_2500.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","9"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080002","Sanford Simplicity $2,500","31195SD008",,"SDN001","SDS001","SDF011","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_2500_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","10"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090007","Sanford Simplicity $1,000","31195SD009",,"SDN001","SDS001","SDF005","Existing","HMO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090007-00","Standard Gold Off Exchange Plan",,"0.814424216747284","No","Yes","No","100%",,"$1,000","$20","$700","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/sg_sd_simplicity_1000.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","10"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090007","Sanford Simplicity $1,000","31195SD009",,"SDN001","SDS001","SDF005","Existing","HMO","Gold","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090007-01","Standard Gold On Exchange Plan",,"0.814424216747284","No","Yes","No","100%",,"$1,000","$20","$700","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","$2,000","$2000 per person","$4000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/sg_sd_simplicity_1000.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","11"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080002","Sanford Simplicity $2,500","31195SD008",,"SDN001","SDS001","SDF011","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080002-03","Limited Cost Sharing Plan Variation",,"0.701222121715546","No","Yes","No","100%",,"$2,500","$30","$800","$200","$400","$1,700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$10,000","$10000 per person","$16000 per group","$10,000","$10000 per person","$16000 per group","$2,500","$2500 per person","$5000 per group","40%",,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_2500_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","11"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080002","Sanford Simplicity $2,500","31195SD008",,"SDN001","SDS001","SDF011","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080002-04","73% AV Level Silver Plan",,"0.733876168727875","No","Yes","No","100%",,"$1,500","$30","$600","$200","$400","$1,600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","$3000 per person","$6000 per group","$3,000","$3000 per person","$6000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_2500_73.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","12"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080002","Sanford Simplicity $2,500","31195SD008",,"SDN001","SDS001","SDF011","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080002-05","87% AV Level Silver Plan",,"0.878047585487366","No","Yes","No","100%",,"$600","$0","$400","$200","$300","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$600","$600 per person","$1200 per group","20%",,,,,"$1,200","$1200 per person","$2400 per group","$1,200","$1200 per person","$2400 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_2500_87.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","13"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080002","Sanford Simplicity $2,500","31195SD008",,"SDN001","SDS001","SDF011","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080002-06","94% AV Level Silver Plan",,"0.949147522449493","No","Yes","No","100%",,"$300","$0","$300","$200","$200","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","$250","$250 per person","$500 per group","20%",,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_2500_94.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","14"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080006","Sanford Simplicity $3,500","31195SD008",,"SDN001","SDS001","SDF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080006-00","Standard Silver Off Exchange Plan",,"0.700566470623016","No","Yes","No","100%",,"$3,500","$20","$300","$200","$400","$1,100","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$14,000","$14000 per person","$20000 per group","$14,000","$14000 per person","$20000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","15"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080006","Sanford Simplicity $3,500","31195SD008",,"SDN001","SDS001","SDF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080006-01","Standard Silver On Exchange Plan",,"0.700566470623016","No","Yes","No","100%",,"$3,500","$20","$300","$200","$400","$1,100","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$14,000","$14000 per person","$20000 per group","$14,000","$14000 per person","$20000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,000","$7000 per person","$14000 per group","$7,000","$7000 per person","$14000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","16"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080006","Sanford Simplicity $3,500","31195SD008",,"SDN001","SDS001","SDF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_3500_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","17"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080006","Sanford Simplicity $3,500","31195SD008",,"SDN001","SDS001","SDF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080006-04","73% AV Level Silver Plan",,"0.734143972396851","No","Yes","No","100%",,"$3,000","$20","$400","$200","$400","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$3,000","$3000 per person","$6000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_3500_73.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","19"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080006","Sanford Simplicity $3,500","31195SD008",,"SDN001","SDS001","SDF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080006-05","87% AV Level Silver Plan",,"0.875889778137207","No","Yes","No","100%",,"$500","$20","$800","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","$1,000","$1000 per person","$2000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_3500_87.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","20"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080006","Sanford Simplicity $3,500","31195SD008",,"SDN001","SDS001","SDF010","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080006-06","94% AV Level Silver Plan",,"0.949147522449493","No","Yes","No","100%",,"$300","$0","$300","$200","$200","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$6,600","$6600 per person","$13200 per group","$6,600","$6600 per person","$13200 per group","$250","$250 per person","$500 per group","20%",,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_3500_94.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","21"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080008","Sanford TRUE $3,500","31195SD008",,"SDN002","SDS002","SDF007","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080008-00","Standard Silver Off Exchange Plan",,"0.700566470623016","No","Yes","No","100%",,"$3,500","$20","$300","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","22"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080008","Sanford TRUE $3,500","31195SD008",,"SDN002","SDS002","SDF007","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080008-01","Standard Silver On Exchange Plan",,"0.700566470623016","No","Yes","No","100%",,"$3,500","$20","$300","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_3500.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","23"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080008","Sanford TRUE $3,500","31195SD008",,"SDN002","SDS002","SDF007","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_3500_ZCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","24"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080008","Sanford TRUE $3,500","31195SD008",,"SDN002","SDS002","SDF007","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080008-03","Limited Cost Sharing Plan Variation",,"0.700566470623016","No","Yes","No","100%",,"$3,500","$20","$300","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_3500_LCS.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","25"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080008","Sanford TRUE $3,500","31195SD008",,"SDN002","SDS002","SDF007","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080008-04","73% AV Level Silver Plan",,"0.734143972396851","No","Yes","No","100%",,"$3,000","$20","$400","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_3500_73.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","26"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080008","Sanford TRUE $3,500","31195SD008",,"SDN002","SDS002","SDF007","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080008-05","87% AV Level Silver Plan",,"0.875889778137207","No","Yes","No","100%",,"$500","$20","$800","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_3500_87.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","27"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","3","31195","SD","Individual","No","91-1842494","31195SD0080008","Sanford TRUE $3,500","31195SD008",,"SDN002","SDS002","SDF007","Existing","HMO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080008-06","94% AV Level Silver Plan",,"0.949147522449493","No","Yes","No","100%",,"$300","$0","$300","$200","$200","$300","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_true_3500_94.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","28"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","4","31195","SD","Individual","No","91-1842494","31195SD0080004","Sanford Simplicity $6,850","31195SD008",,"SDN001","SDS001","SDF009","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","https://hix.sanfordhealthplan.org","http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0080004-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$3,600","$0","$0","$200","$4,900","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$18,000","$18000 per person","$36000 per group","$18,000","$18000 per person","$36000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","$9,000","$9000 per person","$18000 per group","No",,,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/i_sd_simplicity_6850.pdf","http://www.sanfordhealthplan.com/policy/HP-0341.pdf","4"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","4","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090006","Sanford Simplicity $2,500","31195SD009",,"SDN001","SDS001","SDF005","Existing","HMO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090006-00","Standard Silver Off Exchange Plan",,"0.717057228088379","No","Yes","No","100%",,"$2,500","$20","$600","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/sg_sd_simplicity_2500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","4"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","4","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090006","Sanford Simplicity $2,500","31195SD009",,"SDN001","SDS001","SDF005","Existing","HMO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090006-01","Standard Silver On Exchange Plan",,"0.717057228088379","No","Yes","No","100%",,"$2,500","$20","$600","$200","$400","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$12,000","$12000 per person","$18000 per group","$12,000","$12000 per person","$18000 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"$6,000","$6000 per person","$12000 per group","$6,000","$6000 per person","$12000 per group","$0","$0 per person","per group not applicable","40%",,,,,"$0","$0 per person","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/sg_sd_simplicity_2500.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","5"
"2016","SD","31195","SERFF","7","2016-01-29 07:27:50","5","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090008","Sanford Simplicity $2,000 HDHP","31195SD009",,"SDN001","SDS001","SDF007","New","HMO","Silver","No","Both","No","No",,,,"Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes",,"http://www.sanfordhealthplan.org/shopforhealthinsurance/foryouandyourfamily/formulary/","31195SD0090008-01","Standard Silver On Exchange Plan",,"0.718817114830017","Yes","Yes","No","100%",,"$2,000","$0","$700","$200","$2,000","$0","$900","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","$4,000","$4000 per person","$8000 per group","Yes","No",,"http://www.sanfordhealthplan.com/images/data/files/SBCs/SD/sg_sd_simplicity_2000_HDHP.pdf","http://www.sanfordhealthplan.org/shopforhealthinsurance/","5"
"2016","SD","34765","SERFF","4","2015-08-22 23:36:24","1","34765","SD","SHOP (Small Group)","Yes","75-1233841","34765SD0020011","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","34765SD002",,"SDN001","SDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.38","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","34765SD0020011-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sd/34765sd0020011-16","4"
"2016","SD","34765","SERFF","4","2015-08-22 23:36:24","1","34765","SD","Individual","Yes","75-1233841","34765SD0010011","Dentegra Dental PPO Pediatric Basic Plan","34765SD001",,"SDN001","SDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.17","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","34765SD0010011-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sd/34765sd0010011-16","4"
"2016","SD","34765","SERFF","4","2015-08-22 23:36:24","2","34765","SD","Individual","Yes","75-1233841","34765SD0010014","Dentegra Dental PPO Family Preferred Plan","34765SD001",,"SDN001","SDS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.40","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","34765SD0010014-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sd/34765sd0010014-16","4"
"2016","SD","34765","SERFF","4","2015-08-22 23:36:24","2","34765","SD","SHOP (Small Group)","Yes","75-1233841","34765SD0020014","Dentegra Dental PPO for Small Businesses Family Preferred Plan","34765SD002",,"SDN001","SDS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","34765SD0020014-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$65","per person not applicable","per group not applicable",,,,,,"$65","per person not applicable","per group not applicable","$65","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sd/34765sd0020014-16","4"
"2016","SD","34765","SERFF","4","2015-08-22 23:36:24","3","34765","SD","SHOP (Small Group)","Yes","75-1233841","34765SD0020013","Dentegra Dental PPO for Small Businesses Family Basic Plan","34765SD002",,"SDN001","SDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.38","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","34765SD0020013-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sd/34765sd0020013-16","4"
"2016","SD","34765","SERFF","4","2015-08-22 23:36:24","3","34765","SD","Individual","Yes","75-1233841","34765SD0010013","Dentegra Dental PPO Family Basic Plan","34765SD001",,"SDN001","SDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.17","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","34765SD0010013-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sd/34765sd0010013-16","4"
"2016","SD","34765","SERFF","4","2015-08-22 23:36:24","3","34765","SD","Individual","Yes","75-1233841","34765SD0010013","Dentegra Dental PPO Family Basic Plan","34765SD001",,"SDN001","SDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.17","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","34765SD0010013-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sd/34765sd0010013-16","5"
"2016","SD","34765","SERFF","4","2015-08-22 23:36:24","3","34765","SD","SHOP (Small Group)","Yes","75-1233841","34765SD0020013","Dentegra Dental PPO for Small Businesses Family Basic Plan","34765SD002",,"SDN001","SDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.38","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","34765SD0020013-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","per person not applicable","per group not applicable",,,,,,"$70","per person not applicable","per group not applicable","$70","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/sd/34765sd0020013-16","5"
"2016","SD","59141","SERFF","2","2015-08-22 23:36:24","1","59141","SD","SHOP (Small Group)","Yes","93-0242990","59141SD0040002","EHB High PPO","59141SD004",,"SDN001","SDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.39","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","59141SD0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020006","Avera MyPlan $1,500 /  20% Coinsurance","60536SD002","7942203176","SDN001","SDS001","SDF008","Existing","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020006-01","Standard Gold On Exchange Plan",,"0.801521956920624","No","Yes","No","100%",,"$1,500","$0","$1,140","$0","$140","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53704/SD-Avera-MyPlan-1500-20-Coinsurance.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","9"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020006","Avera MyPlan $1,500 /  20% Coinsurance","60536SD002","7942203176","SDN001","SDS001","SDF008","Existing","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53704/SD-Avera-MyPlan-1500-20-Coinsurance.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","10"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020006","Avera MyPlan $1,500 /  20% Coinsurance","60536SD002","7942203176","SDN001","SDS001","SDF008","Existing","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020006-03","Limited Cost Sharing Plan Variation",,"0.801521956920624","No","Yes","No","100%",,"$1,500","$0","$1,140","$0","$140","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53704/SD-Avera-MyPlan-1500-20-Coinsurance.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","11"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020025","Avera MyPlan $2,000 / 20% Coinsurance","60536SD002","7942203176","SDN001","SDS001","SDF010","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020025-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/54480/Avera-MyPlan-2000-20-Coinsurance-Zero-Cost-Share.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","14"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020025","Avera MyPlan $2,000 / 20% Coinsurance","60536SD002","7942203176","SDN001","SDS001","SDF010","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020025-03","Limited Cost Sharing Plan Variation",,"0.782289683818817","No","Yes","No","100%",,"$2,000","$20","$1,050","$150","$140","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53671/Avera-MyPlan-2000-20-Coinsurance.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","15"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020009","Avera MyPlan $2,500 / $6,350 Out-of-Pocket","60536SD002","7942203176","SDN001","SDS001","SDF013","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020009-00","Standard Silver Off Exchange Plan",,"0.701500535011292","No","Yes","No","100%",,"$2,500","$0","$1,400","$0","$140","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53706/SD-Avera-MyPlan-2500-6350-Out-of-Pocket.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","16"
"2016","SD","59141","SERFF","2","2015-08-22 23:36:24","1","59141","SD","SHOP (Small Group)","Yes","93-0242990","59141SD0040001","EHB Low PPO","59141SD004",,"SDN001","SDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.51","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","59141SD0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","SD","59141","SERFF","2","2015-08-22 23:36:24","1","59141","SD","SHOP (Small Group)","Yes","93-0242990","59141SD0030002","EHB High Passive","59141SD003",,"SDN001","SDS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$45.43","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","59141SD0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","SD","59141","SERFF","2","2015-08-22 23:36:24","1","59141","SD","SHOP (Small Group)","Yes","93-0242990","59141SD0030001","EHB Low Passive","59141SD003",,"SDN001","SDS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.45","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","59141SD0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","1","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010021","Avera $1,000 / 30% Coinsurance","60536SD001","7942203176","SDN001","SDS001","SDF003","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","60536SD0010021-00","Standard Gold Off Exchange Plan",,"0.819881618022919","No","Yes","No","100%",,"$1,000","$20","$1,880","$150","$0","$1,650","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53755/Avera-2016-1000-30-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","4"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","1","60536","SD","Individual","No","46-0451539","60536SD0020021","Avera MyPlan $3,000 / 30% Coinsurance","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020021-00","Standard Silver Off Exchange Plan",,"0.686937808990479","No","Yes","No","100%",,"$3,000","$0","$1,280","$150","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53679/Avera-MyPlan-3000-30-Coinsurance.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","4"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","1","60536","SD","Individual","No","46-0451539","60536SD0020021","Avera MyPlan $3,000 / 30% Coinsurance","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020021-01","Standard Silver On Exchange Plan",,"0.686937808990479","No","Yes","No","100%",,"$3,000","$0","$1,280","$150","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53679/Avera-MyPlan-3000-30-Coinsurance.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","5"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","1","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010021","Avera $1,000 / 30% Coinsurance","60536SD001","7942203176","SDN001","SDS001","SDF003","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","60536SD0010021-01","Standard Gold On Exchange Plan",,"0.819881618022919","No","Yes","No","100%",,"$1,000","$20","$1,880","$150","$0","$1,650","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53755/Avera-2016-1000-30-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","5"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","1","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010022","Avera $1,500 / 20% Coinsurance","60536SD001","7942203176","SDN001","SDS001","SDF002","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","60536SD0010022-00","Standard Gold Off Exchange Plan",,"0.796852707862854","No","Yes","No","100%",,"$1,500","$10","$1,150","$150","$0","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53754/Avera-2016-1500-20-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","6"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","1","60536","SD","Individual","No","46-0451539","60536SD0020021","Avera MyPlan $3,000 / 30% Coinsurance","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020021-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/54485/Avera-MyPlan-3000-30-Coinsurance-Zero-Cost-Share.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","6"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","1","60536","SD","Individual","No","46-0451539","60536SD0020021","Avera MyPlan $3,000 / 30% Coinsurance","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020021-03","Limited Cost Sharing Plan Variation",,"0.686937808990479","No","Yes","No","100%",,"$3,000","$0","$1,280","$150","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53679/Avera-MyPlan-3000-30-Coinsurance.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","7"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","1","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010022","Avera $1,500 / 20% Coinsurance","60536SD001","7942203176","SDN001","SDS001","SDF002","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","60536SD0010022-01","Standard Gold On Exchange Plan",,"0.796852707862854","No","Yes","No","100%",,"$1,500","$10","$1,150","$150","$0","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53754/Avera-2016-1500-20-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","7"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","1","60536","SD","Individual","No","46-0451539","60536SD0020021","Avera MyPlan $3,000 / 30% Coinsurance","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020021-04","73% AV Level Silver Plan",,"0.739205658435822","No","Yes","No","100%",,"$2,500","$0","$1,430","$150","$140","$1,550","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53675/Avera-MyPlan-2500-30-Coinsurance.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","8"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","1","60536","SD","Individual","No","46-0451539","60536SD0020021","Avera MyPlan $3,000 / 30% Coinsurance","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020021-05","87% AV Level Silver Plan",,"0.873207211494446","No","Yes","No","100%",,"$1,000","$0","$1,000","$150","$140","$730","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53667/Avera-MyPlan-1000-30-Coinsurance.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","9"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","1","60536","SD","Individual","No","46-0451539","60536SD0020021","Avera MyPlan $3,000 / 30% Coinsurance","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020021-06","94% AV Level Silver Plan",,"0.947678983211517","No","Yes","No","100%",,"$400","$0","$400","$150","$140","$240","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53664/Avera-MyPlan-400-30-Coinsurance.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","10"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","1","60536","SD","Individual","No","46-0451539","60536SD0020012","Avera MyPlan $5,000 / 30% Coinsurance","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020012-00","Standard Bronze Off Exchange Plan",,"0.613690793514252","No","Yes","No","100%",,"$5,000","$150","$650","$150","$970","$2,020","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53707/SD-Avera-MyPlan-5000-30-Coinsurance.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","11"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","1","60536","SD","Individual","No","46-0451539","60536SD0020012","Avera MyPlan $5,000 / 30% Coinsurance","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020012-01","Standard Bronze On Exchange Plan",,"0.613690793514252","No","Yes","No","100%",,"$5,000","$150","$650","$150","$970","$2,020","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53707/SD-Avera-MyPlan-5000-30-Coinsurance.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","12"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","1","60536","SD","Individual","No","46-0451539","60536SD0020012","Avera MyPlan $5,000 / 30% Coinsurance","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020012-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/54485/Avera-MyPlan-3000-30-Coinsurance-Zero-Cost-Share.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","13"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","1","60536","SD","Individual","No","46-0451539","60536SD0020012","Avera MyPlan $5,000 / 30% Coinsurance","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020012-03","Limited Cost Sharing Plan Variation",,"0.613690793514252","No","Yes","No","100%",,"$5,000","$150","$650","$150","$970","$2,020","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53707/SD-Avera-MyPlan-5000-30-Coinsurance.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","14"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010020","Avera $2,000 / 30% Coinsurance","60536SD001","7942203176","SDN001","SDS001","SDF004","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","60536SD0010020-00","Standard Gold Off Exchange Plan",,"0.78093147277832","No","Yes","No","100%",,"$2,000","$20","$1,580","$150","$0","$1,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53756/Avera-2016-2000-30-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","4"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010020","Avera $2,000 / 30% Coinsurance","60536SD001","7942203176","SDN001","SDS001","SDF004","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","60536SD0010020-01","Standard Gold On Exchange Plan",,"0.78093147277832","No","Yes","No","100%",,"$2,000","$20","$1,580","$150","$0","$1,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53756/Avera-2016-2000-30-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","5"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010019","Avera $500 / 20% Coinsurance","60536SD001","7942203176","SDN001","SDS001","SDF009","New","PPO","Platinum","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","60536SD0010019-00","Standard Platinum Off Exchange Plan",,"0.88515830039978","No","Yes","No","100%",,"$500","$10","$1,350","$150","$0","$740","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/14600/2015-Avera-250-10-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","6"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010019","Avera $500 / 20% Coinsurance","60536SD001","7942203176","SDN001","SDS001","SDF009","New","PPO","Platinum","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","60536SD0010019-01","Standard Platinum On Exchange Plan",,"0.88515830039978","No","Yes","No","100%",,"$500","$10","$1,350","$150","$0","$740","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/14600/2015-Avera-250-10-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","7"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020006","Avera MyPlan $1,500 /  20% Coinsurance","60536SD002","7942203176","SDN001","SDS001","SDF008","Existing","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020006-00","Standard Gold Off Exchange Plan",,"0.801521956920624","No","Yes","No","100%",,"$1,500","$0","$1,140","$0","$140","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53704/SD-Avera-MyPlan-1500-20-Coinsurance.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","8"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020025","Avera MyPlan $2,000 / 20% Coinsurance","60536SD002","7942203176","SDN001","SDS001","SDF010","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020025-00","Standard Gold Off Exchange Plan",,"0.782289683818817","No","Yes","No","100%",,"$2,000","$20","$1,050","$150","$140","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53671/Avera-MyPlan-2000-20-Coinsurance.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","12"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","Individual","No","46-0451539","60536SD0020007","Avera MyPlan $1,500 / 20% Coinsurance, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF008","Existing","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/54477/Avera-MyPlan-1500-20-Coinsurance-with-Pediatric-Dental-Zero-Cost-Share.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","6"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","5","60536","SD","Individual","No","46-0451539","60536SD0020022","Avera MyPlan $3,000 / 30% Coinsurance, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020022-01","Standard Silver On Exchange Plan",,"0.686937808990479","No","Yes","No","100%",,"$3,000","$0","$1,280","$150","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53678/Avera-MyPlan-3000-30-Coinsurance-Pediatric-Dental.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","5"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020025","Avera MyPlan $2,000 / 20% Coinsurance","60536SD002","7942203176","SDN001","SDS001","SDF010","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020025-01","Standard Gold On Exchange Plan",,"0.782289683818817","No","Yes","No","100%",,"$2,000","$20","$1,050","$150","$140","$1,400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53671/Avera-MyPlan-2000-20-Coinsurance.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","13"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020009","Avera MyPlan $2,500 / $6,350 Out-of-Pocket","60536SD002","7942203176","SDN001","SDS001","SDF013","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020009-01","Standard Silver On Exchange Plan",,"0.701500535011292","No","Yes","No","100%",,"$2,500","$0","$1,400","$0","$140","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53706/SD-Avera-MyPlan-2500-6350-Out-of-Pocket.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","17"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020009","Avera MyPlan $2,500 / $6,350 Out-of-Pocket","60536SD002","7942203176","SDN001","SDS001","SDF013","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/57624/Avera-MyPlan-2500-6350-Out-of-Pocket-Zero-Cost-Share.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","18"
"2016","UT","18167","SERFF","7","2016-01-28 08:29:40","3","18167","UT","Individual","No","33-0617992","18167UT0010003","Molina Marketplace Bronze Plan","18167UT001",,"UTN001","UTS001","UTF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/ut/en/PDF/marketplace/formulary-2016.pdf","18167UT0010003-01","Standard Bronze On Exchange Plan",,"0.618895947933197","Yes","Yes","No","100%",,"$5,000","$20","$900","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/marketplace/summary-of-benefits-bronze-2016.pdf","http://www.molinahealthcare.com/ut/en/PDF/marketplace/brochure-2016.pdf","5"
"2016","UT","18167","SERFF","7","2016-01-28 08:29:40","3","18167","UT","Individual","No","33-0617992","18167UT0010003","Molina Marketplace Bronze Plan","18167UT001",,"UTN001","UTS001","UTF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/ut/en/PDF/marketplace/formulary-2016.pdf","18167UT0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/marketplace/summary-of-benefits-bronze-aian-2016.pdf","http://www.molinahealthcare.com/ut/en/PDF/marketplace/brochure-2016.pdf","6"
"2016","UT","18167","SERFF","7","2016-01-28 08:29:40","3","18167","UT","Individual","No","33-0617992","18167UT0010003","Molina Marketplace Bronze Plan","18167UT001",,"UTN001","UTS001","UTF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/ut/en/PDF/marketplace/formulary-2016.pdf","18167UT0010003-03","Limited Cost Sharing Plan Variation",,"0.618895947933197","Yes","Yes","No","100%",,"$5,000","$20","$900","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/marketplace/summary-of-benefits-bronze-2016.pdf","http://www.molinahealthcare.com/ut/en/PDF/marketplace/brochure-2016.pdf","7"
"2016","UT","40335","SERFF","3","2015-08-27 03:52:03","1","40335","UT","Individual","Yes","20-4023720","40335UT0010001","EMI Health Choice PPO (High)","40335UT001",,"UTN001","UTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$8.22","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","PPO network or out-of-network coverage at PPO fee","Yes","http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","","40335UT0010001-00","Standard High Off Exchange Plan","87.00%",,,,"Yes","55%","45%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","4"
"2016","UT","40335","SERFF","3","2015-08-27 03:52:03","1","40335","UT","Individual","Yes","20-4023720","40335UT0010001","EMI Health Choice PPO (High)","40335UT001",,"UTN001","UTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$8.22","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","PPO network or out-of-network coverage at PPO fee","Yes","http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","","40335UT0010001-01","Standard High On Exchange Plan","87.00%",,,,"Yes","55%","45%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,"$50","$50 per person","$150 per group",,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","5"
"2016","UT","40335","SERFF","3","2015-08-27 03:52:03","2","40335","UT","Individual","Yes","20-4023720","40335UT0030001","EMI Health Choice PPO","40335UT003",,"UTN001","UTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$7.73","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","PPO network or out-of-network coverage at PPO fee","Yes","http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","","40335UT0030001-00","Standard High Off Exchange Plan","87.00%",,,,"Yes","60%","40%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,"$50","$50 per person","$150 per group",,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","4"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020009","Avera MyPlan $2,500 / $6,350 Out-of-Pocket","60536SD002","7942203176","SDN001","SDS001","SDF013","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020009-03","Limited Cost Sharing Plan Variation",,"0.701500535011292","No","Yes","No","100%",,"$2,500","$0","$1,400","$0","$140","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53706/SD-Avera-MyPlan-2500-6350-Out-of-Pocket.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","19"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020009","Avera MyPlan $2,500 / $6,350 Out-of-Pocket","60536SD002","7942203176","SDN001","SDS001","SDF013","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020009-04","73% AV Level Silver Plan",,"0.73964661359787","No","Yes","No","100%",,"$2,250","$0","$1,400","$0","$140","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53672/Avera-MyPlan-2250-5300-Out-of-Pocket.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","20"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020009","Avera MyPlan $2,500 / $6,350 Out-of-Pocket","60536SD002","7942203176","SDN001","SDS001","SDF013","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020009-05","87% AV Level Silver Plan",,"0.86902517080307","No","Yes","No","100%",,"$1,000","$0","$1,000","$150","$140","$750","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53669/Avera-MyPlan-1000-2000-Out-of-Pocket.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","21"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020009","Avera MyPlan $2,500 / $6,350 Out-of-Pocket","60536SD002","7942203176","SDN001","SDS001","SDF013","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020009-06","94% AV Level Silver Plan",,"0.94223165512085","No","Yes","No","100%",,"$350","$0","$350","$150","$140","$450","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53662/Avera-MyPlan-350-700-Out-of-Pocket.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","22"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020013","Avera MyPlan $2,500 / $5,800 Out-of-Pocket","60536SD002","7942203176","SDN001","SDS001","SDF010","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020013-00","Standard Silver Off Exchange Plan",,"0.716940224170685","No","Yes","No","100%",,"$2,500","$80","$1,400","$0","$140","$1,480","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53677/Avera-MyPlan-2500-5800-Out-of-Pocket.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","23"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020013","Avera MyPlan $2,500 / $5,800 Out-of-Pocket","60536SD002","7942203176","SDN001","SDS001","SDF010","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020013-01","Standard Silver On Exchange Plan",,"0.716940224170685","No","Yes","No","100%",,"$2,500","$80","$1,400","$0","$140","$1,480","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53677/Avera-MyPlan-2500-5800-Out-of-Pocket.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","24"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020013","Avera MyPlan $2,500 / $5,800 Out-of-Pocket","60536SD002","7942203176","SDN001","SDS001","SDF010","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020013-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/54481/Avera-MyPlan-2500-5800-Out-off-Pocket-Zero-Cost-Share.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","25"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020013","Avera MyPlan $2,500 / $5,800 Out-of-Pocket","60536SD002","7942203176","SDN001","SDS001","SDF010","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020013-03","Limited Cost Sharing Plan Variation",,"0.716940224170685","No","Yes","No","100%",,"$2,500","$80","$1,400","$0","$140","$1,480","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53677/Avera-MyPlan-2500-5800-Out-of-Pocket.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","26"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020013","Avera MyPlan $2,500 / $5,800 Out-of-Pocket","60536SD002","7942203176","SDN001","SDS001","SDF010","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020013-04","73% AV Level Silver Plan",,"0.73964661359787","No","Yes","No","100%",,"$2,250","$0","$1,400","$0","$140","$1,340","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53672/Avera-MyPlan-2250-5300-Out-of-Pocket.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","27"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020013","Avera MyPlan $2,500 / $5,800 Out-of-Pocket","60536SD002","7942203176","SDN001","SDS001","SDF010","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020013-05","87% AV Level Silver Plan",,"0.86902517080307","No","Yes","No","100%",,"$1,000","$0","$1,000","$150","$140","$1,170","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53669/Avera-MyPlan-1000-2000-Out-of-Pocket.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","28"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020013","Avera MyPlan $2,500 / $5,800 Out-of-Pocket","60536SD002","7942203176","SDN001","SDS001","SDF010","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020013-06","94% AV Level Silver Plan",,"0.94223165512085","No","Yes","No","100%",,"$350","$0","$350","$150","$140","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53662/Avera-MyPlan-350-700-Out-of-Pocket.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","29"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020011","Avera MyPlan $3,500","60536SD002","7942203176","SDN001","SDS001","SDF012","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","0","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020011-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$0","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.avera.org/app/files/public/53681/Avera-MyPlan-3500.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","30"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020011","Avera MyPlan $3,500","60536SD002","7942203176","SDN001","SDS001","SDF012","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","0","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020011-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$0","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.avera.org/app/files/public/53681/Avera-MyPlan-3500.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","31"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020011","Avera MyPlan $3,500","60536SD002","7942203176","SDN001","SDS001","SDF012","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","0","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.avera.org/app/files/public/54486/Avera-MyPlan-3500-Zero-Cost-Share.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","32"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020011","Avera MyPlan $3,500","60536SD002","7942203176","SDN001","SDS001","SDF012","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","0","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020011-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$0","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/53681/Avera-MyPlan-3500.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","33"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020011","Avera MyPlan $3,500","60536SD002","7942203176","SDN001","SDS001","SDF012","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","0","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020011-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$0","$3,000","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/53680/Avera-MyPlan-3000.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","34"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020011","Avera MyPlan $3,500","60536SD002","7942203176","SDN001","SDS001","SDF012","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","0","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020011-05","87% AV Level Silver Plan",,"0.879033446311951","Yes","Yes","No","100%",,"$1,100","$0","$0","$0","$1,100","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/53670/Avera-MyPlan-1100.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","35"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020011","Avera MyPlan $3,500","60536SD002","7942203176","SDN001","SDS001","SDF012","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","0","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020011-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$0","$500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/53665/Avera-MyPlan-500.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","36"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020024","Avera MyPlan $6,500","60536SD002","7942203176","SDN001","SDS001","SDF012","Existing","HMO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020024-00","Standard Bronze Off Exchange Plan",,"0.600919127464294","Yes","Yes","No","100%",,"$6,200","$0","$0","$150","$5,350","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.avera.org/app/files/public/53683/Avera-MyPlan-6500.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","44"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020024","Avera MyPlan $6,500","60536SD002","7942203176","SDN001","SDS001","SDF012","Existing","HMO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020024-01","Standard Bronze On Exchange Plan",,"0.600919127464294","Yes","Yes","No","100%",,"$6,200","$0","$0","$150","$5,350","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.avera.org/app/files/public/53683/Avera-MyPlan-6500.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","45"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020024","Avera MyPlan $6,500","60536SD002","7942203176","SDN001","SDS001","SDF012","Existing","HMO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020024-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.avera.org/app/files/public/54489/Avera-MyPlan-6500-Zero-Cost-Share.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","46"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","2","60536","SD","Individual","No","46-0451539","60536SD0020024","Avera MyPlan $6,500","60536SD002","7942203176","SDN001","SDS001","SDF012","Existing","HMO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020024-03","Limited Cost Sharing Plan Variation",,"0.600919127464294","Yes","Yes","No","100%",,"$6,200","$0","$0","$150","$5,350","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/53683/Avera-MyPlan-6500.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","47"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","3","60536","SD","Individual","No","46-0451539","60536SD0020018","Avera MyPlan $6,850","60536SD002","7942203176","SDN001","SDS001","SDF012","Existing","HMO","Catastrophic","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","3","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020018-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,350","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/53684/Avera-MyPlan-6850.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","4"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","3","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010025","Avera $2,500 / 30% Coinsurance","60536SD001","7942203176","SDN001","SDS001","SDF004","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","60536SD0010025-00","Standard Silver Off Exchange Plan",,"0.718204975128174","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$490","$1,440","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53757/Avera-2016-2500-30-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","4"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","3","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010025","Avera $2,500 / 30% Coinsurance","60536SD001","7942203176","SDN001","SDS001","SDF004","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","60536SD0010025-01","Standard Silver On Exchange Plan",,"0.718204975128174","No","Yes","No","100%",,"$2,500","$20","$1,430","$150","$490","$1,440","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53757/Avera-2016-2500-30-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","5"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","3","60536","SD","Individual","No","46-0451539","60536SD0020018","Avera MyPlan $6,850","60536SD002","7942203176","SDN001","SDS001","SDF012","Existing","HMO","Catastrophic","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","3","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020018-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,350","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.avera.org/app/files/public/53684/Avera-MyPlan-6850.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","5"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","3","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010023","Avera $3,500","60536SD001","7942203176","SDN001","SDS001","SDF012","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","60536SD0010023-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.avera.org/app/files/public/53759/Avera-2016-3500.pdf","https://www.avera.org/marketplace/plan-brochure/","6"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","3","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010023","Avera $3,500","60536SD001","7942203176","SDN001","SDS001","SDF012","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","60536SD0010023-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.avera.org/app/files/public/53759/Avera-2016-3500.pdf","https://www.avera.org/marketplace/plan-brochure/","7"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","3","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010017","Avera $4,500","60536SD001","7942203176","SDN001","SDS001","SDF006","Existing","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","60536SD0010017-00","Standard Bronze Off Exchange Plan",,"0.598586618900299","Yes","Yes","No","100%",,"$4,500","$0","$1,390","$150","$4,500","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.avera.org/app/files/public/53760/Avera-2016-4500.pdf","https://www.avera.org/marketplace/plan-brochure/","8"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","3","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010017","Avera $4,500","60536SD001","7942203176","SDN001","SDS001","SDF006","Existing","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","60536SD0010017-01","Standard Bronze On Exchange Plan",,"0.598586618900299","Yes","Yes","No","100%",,"$4,500","$0","$1,390","$150","$4,500","$0","$460","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","50%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.avera.org/app/files/public/53760/Avera-2016-4500.pdf","https://www.avera.org/marketplace/plan-brochure/","9"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010015","Avera $3,000 / 40% Coinsurance","60536SD001","7942203176","SDN001","SDS001","SDF004","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","60536SD0010015-00","Standard Silver Off Exchange Plan",,"0.700923264026642","No","Yes","No","100%",,"$3,000","$0","$1,700","$150","$140","$2,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","40%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53758/Avera-2016-3000-40-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","4"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","Individual","No","46-0451539","60536SD0020007","Avera MyPlan $1,500 / 20% Coinsurance, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF008","Existing","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020007-00","Standard Gold Off Exchange Plan",,"0.801521956920624","No","Yes","No","100%",,"$1,500","$0","$1,140","$0","$140","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53703/SD-Avera-MyPlan-1500-20-Coinsurance-Pediatric-Dental.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","4"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","Individual","No","46-0451539","60536SD0020007","Avera MyPlan $1,500 / 20% Coinsurance, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF008","Existing","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020007-01","Standard Gold On Exchange Plan",,"0.801521956920624","No","Yes","No","100%",,"$1,500","$0","$1,140","$0","$140","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53703/SD-Avera-MyPlan-1500-20-Coinsurance-Pediatric-Dental.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","5"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010015","Avera $3,000 / 40% Coinsurance","60536SD001","7942203176","SDN001","SDS001","SDF004","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","60536SD0010015-01","Standard Silver On Exchange Plan",,"0.700923264026642","No","Yes","No","100%",,"$3,000","$0","$1,700","$150","$140","$2,100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","40%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53758/Avera-2016-3000-40-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","5"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010026","Avera $5,000 / 30% Coinsurance","60536SD001","7942203176","SDN001","SDS001","SDF011","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","60536SD0010026-00","Standard Bronze Off Exchange Plan",,"0.613690793514252","No","Yes","No","100%",,"$5,000","$0","$680","$150","$1,150","$2,360","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53761/Avera-2016-5000-30-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","6"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","Individual","No","46-0451539","60536SD0020007","Avera MyPlan $1,500 / 20% Coinsurance, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF008","Existing","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020007-03","Limited Cost Sharing Plan Variation",,"0.801521956920624","No","Yes","No","100%",,"$1,500","$0","$1,140","$0","$140","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53703/SD-Avera-MyPlan-1500-20-Coinsurance-Pediatric-Dental.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","7"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010026","Avera $5,000 / 30% Coinsurance","60536SD001","7942203176","SDN001","SDS001","SDF011","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.",,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No",,"http://www.avera.org/marketplace/drug-formulary/","60536SD0010026-01","Standard Bronze On Exchange Plan",,"0.613690793514252","No","Yes","No","100%",,"$5,000","$0","$680","$150","$1,150","$2,360","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.avera.org/app/files/public/53761/Avera-2016-5000-30-Coinsurance.pdf","https://www.avera.org/marketplace/plan-brochure/","7"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","Individual","No","46-0451539","60536SD0020010","Avera MyPlan $2,500 / $6,350 Out-of-Pocket, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF013","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020010-00","Standard Silver Off Exchange Plan",,"0.701500535011292","No","Yes","No","100%",,"$2,500","$0","$1,400","$0","$140","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53705/SD-Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","8"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","Individual","No","46-0451539","60536SD0020010","Avera MyPlan $2,500 / $6,350 Out-of-Pocket, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF013","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020010-01","Standard Silver On Exchange Plan",,"0.701500535011292","No","Yes","No","100%",,"$2,500","$0","$1,400","$0","$140","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53705/SD-Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","9"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","Individual","No","46-0451539","60536SD0020010","Avera MyPlan $2,500 / $6,350 Out-of-Pocket, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF013","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/54483/Avera-MyPlan-2500-6350-Out-off-Pocket-with-Pediatric-Dental-Zero-Cost-Share.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","10"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","Individual","No","46-0451539","60536SD0020010","Avera MyPlan $2,500 / $6,350 Out-of-Pocket, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF013","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020010-03","Limited Cost Sharing Plan Variation",,"0.701500535011292","No","Yes","No","100%",,"$2,500","$0","$1,400","$0","$140","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53705/SD-Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","11"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","Individual","No","46-0451539","60536SD0020010","Avera MyPlan $2,500 / $6,350 Out-of-Pocket, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF013","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020010-04","73% AV Level Silver Plan",,"0.73964661359787","No","Yes","No","100%",,"$2,250","$0","$1,400","$0","$140","$1,350","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53770/Avera-MyPlan-2250-5300-Out-of-Pocket-with-Pediatric-Dental-Coverage.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","12"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","Individual","No","46-0451539","60536SD0020010","Avera MyPlan $2,500 / $6,350 Out-of-Pocket, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF013","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020010-05","87% AV Level Silver Plan",,"0.86902517080307","No","Yes","No","100%",,"$1,000","$0","$1,000","$0","$140","$750","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53668/Avera-MyPlan-1000-2000-Out-of-Pocket-Pediatric-Dental.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","13"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","Individual","No","46-0451539","60536SD0020010","Avera MyPlan $2,500 / $6,350 Out-of-Pocket, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF013","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020010-06","94% AV Level Silver Plan",,"0.94223165512085","No","Yes","No","100%",,"$350","$0","$350","$0","$140","$450","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53661/Avera-MyPlan-350-700-Out-of-Pocket-Pediatric-Dental.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","14"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","Individual","No","46-0451539","60536SD0020014","Avera MyPlan $2,500 / $5,800 Out-of-Pocket, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF010","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020014-00","Standard Silver Off Exchange Plan",,"0.716940224170685","No","Yes","No","100%",,"$2,500","$80","$1,400","$0","$140","$1,480","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53673/Avera-MyPlan-2250-5800-Out-of-Pocket-Pediatric-Dental.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","15"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","Individual","No","46-0451539","60536SD0020014","Avera MyPlan $2,500 / $5,800 Out-of-Pocket, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF010","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020014-01","Standard Silver On Exchange Plan",,"0.716940224170685","No","Yes","No","100%",,"$2,500","$80","$1,400","$0","$140","$1,480","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53673/Avera-MyPlan-2250-5800-Out-of-Pocket-Pediatric-Dental.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","16"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","Individual","No","46-0451539","60536SD0020014","Avera MyPlan $2,500 / $5,800 Out-of-Pocket, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF010","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020014-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/57630/Avera-MyPlan-2500-5800-Out-of-Pocket-with-Pediatric-Dental-Zero-Cost-Share.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","17"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","Individual","No","46-0451539","60536SD0020014","Avera MyPlan $2,500 / $5,800 Out-of-Pocket, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF010","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020014-03","Limited Cost Sharing Plan Variation",,"0.716940224170685","No","Yes","No","100%",,"$2,500","$80","$1,400","$0","$140","$1,480","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53673/Avera-MyPlan-2250-5800-Out-of-Pocket-Pediatric-Dental.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","18"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","Individual","No","46-0451539","60536SD0020014","Avera MyPlan $2,500 / $5,800 Out-of-Pocket, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF010","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020014-04","73% AV Level Silver Plan",,"0.73964661359787","No","Yes","No","100%",,"$2,250","$0","$1,400","$0","$140","$1,340","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53770/Avera-MyPlan-2250-5300-Out-of-Pocket-with-Pediatric-Dental-Coverage.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","19"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","Individual","No","46-0451539","60536SD0020014","Avera MyPlan $2,500 / $5,800 Out-of-Pocket, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF010","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020014-05","87% AV Level Silver Plan",,"0.86902517080307","No","Yes","No","100%",,"$1,000","$0","$1,000","$150","$140","$1,170","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53668/Avera-MyPlan-1000-2000-Out-of-Pocket-Pediatric-Dental.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","20"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","4","60536","SD","Individual","No","46-0451539","60536SD0020014","Avera MyPlan $2,500 / $5,800 Out-of-Pocket, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF010","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020014-06","94% AV Level Silver Plan",,"0.94223165512085","No","Yes","No","100%",,"$350","$0","$350","$150","$140","$220","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53661/Avera-MyPlan-350-700-Out-of-Pocket-Pediatric-Dental.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","21"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","5","60536","SD","Individual","No","46-0451539","60536SD0020022","Avera MyPlan $3,000 / 30% Coinsurance, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020022-00","Standard Silver Off Exchange Plan",,"0.686937808990479","No","Yes","No","100%",,"$3,000","$0","$1,280","$150","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53678/Avera-MyPlan-3000-30-Coinsurance-Pediatric-Dental.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","4"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","5","60536","SD","Individual","No","46-0451539","60536SD0020022","Avera MyPlan $3,000 / 30% Coinsurance, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020022-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/54484/Avera-MyPlan-3000-30-Coinsurance-with-Pediatric-Dental-Zero-Cost-Share.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","6"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","5","60536","SD","Individual","No","46-0451539","60536SD0020022","Avera MyPlan $3,000 / 30% Coinsurance, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020022-03","Limited Cost Sharing Plan Variation",,"0.686937808990479","No","Yes","No","100%",,"$3,000","$0","$1,280","$150","$140","$1,540","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53678/Avera-MyPlan-3000-30-Coinsurance-Pediatric-Dental.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","7"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","5","60536","SD","Individual","No","46-0451539","60536SD0020022","Avera MyPlan $3,000 / 30% Coinsurance, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020022-04","73% AV Level Silver Plan",,"0.739205658435822","No","Yes","No","100%",,"$2,500","$0","$1,430","$150","$140","$1,550","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,300","$5300 per person","$10600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53674/Avera-MyPlan-2500-30-Coinsurance-Pediatric-Dental.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","8"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","5","60536","SD","Individual","No","46-0451539","60536SD0020022","Avera MyPlan $3,000 / 30% Coinsurance, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020022-05","87% AV Level Silver Plan",,"0.873207211494446","No","Yes","No","100%",,"$1,000","$0","$1,000","$150","$140","$730","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53666/Avera-MyPlan-1000-30-Coinsurance-Pediatric-Dental.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","9"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","5","60536","SD","Individual","No","46-0451539","60536SD0020022","Avera MyPlan $3,000 / 30% Coinsurance, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF007","Existing","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020022-06","94% AV Level Silver Plan",,"0.947678983211517","No","Yes","No","100%",,"$400","$0","$400","$150","$140","$240","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53663/Avera-MyPlan-400-30-Coinsurance-Pediatric.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","10"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","5","60536","SD","Individual","No","46-0451539","60536SD0020023","Avera MyPlan $5,000 / 30% Coinsurance, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020023-00","Standard Bronze Off Exchange Plan",,"0.613690793514252","No","Yes","No","100%",,"$5,000","$150","$650","$0","$970","$2,020","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53682/Avera-MyPlan-5000-30-Coinsurance-Pediatric-Dental.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","11"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","5","60536","SD","Individual","No","46-0451539","60536SD0020023","Avera MyPlan $5,000 / 30% Coinsurance, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020023-01","Standard Bronze On Exchange Plan",,"0.613690793514252","No","Yes","No","100%",,"$5,000","$150","$650","$0","$970","$2,020","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53682/Avera-MyPlan-5000-30-Coinsurance-Pediatric-Dental.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","12"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","5","60536","SD","Individual","No","46-0451539","60536SD0020023","Avera MyPlan $5,000 / 30% Coinsurance, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020023-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/54487/Avera-MyPlan-5000-30-Coinsurance-with-Pediatric-Dental-Zero-Cost-Share.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","13"
"2016","SD","60536","SERFF","7","2016-01-28 08:29:40","5","60536","SD","Individual","No","46-0451539","60536SD0020023","Avera MyPlan $5,000 / 30% Coinsurance, Pediatric Dental","60536SD002","7942203176","SDN001","SDS001","SDF011","Existing","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults, infertility treatment, non-emergency care when traveling outside the United States and weight loss programs.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy","1",,,,"0","2","0","2016-01-01",,"No",,"Yes","Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.","No","https://www.avera.org/marketplace/payment-reminder/","http://www.avera.org/marketplace/drug-formulary/","60536SD0020023-03","Limited Cost Sharing Plan Variation",,"0.613690793514252","No","Yes","No","100%",,"$5,000","$150","$650","$0","$970","$2,020","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","30%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$100 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.avera.org/app/files/public/53682/Avera-MyPlan-5000-30-Coinsurance-Pediatric-Dental.pdf","https://www.avera.org/app/files/public/59423/2016-ind-brochure-avhp.pdf","14"
"2016","SD","61214","SERFF","3","2015-09-24 06:32:24","1","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010007","BESTDental Premium","61214SD001",,"SDN001","SDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2016/SD_BESTDental_Premium_Plan.pdf","4"
"2016","SD","61214","SERFF","3","2015-09-24 06:32:24","1","61214","SD","Individual","Yes","95-6042390","61214SD0020003","BESTOne Advantage Gold","61214SD002",,"SDN001","SDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.45","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2016/SD_BESTOne_Dental_Advantage-Gold_Plan.pdf","4"
"2016","SD","61214","SERFF","3","2015-09-24 06:32:24","1","61214","SD","Individual","Yes","95-6042390","61214SD0020003","BESTOne Advantage Gold","61214SD002",,"SDN001","SDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.45","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2016/SD_BESTOne_Dental_Advantage-Gold_Plan.pdf","5"
"2016","SD","61214","SERFF","3","2015-09-24 06:32:24","1","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010007","BESTDental Premium","61214SD001",,"SDN001","SDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2016/SD_BESTDental_Premium_Plan.pdf","5"
"2016","SD","61214","SERFF","3","2015-09-24 06:32:24","1","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010008","BESTDental Standard - H","61214SD001",,"SDN001","SDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2016/SD_BESTDental_Standard-H_Plan.pdf","6"
"2016","SD","61214","SERFF","3","2015-09-24 06:32:24","1","61214","SD","Individual","Yes","95-6042390","61214SD0020004","BESTOne Plus Gold","61214SD002",,"SDN001","SDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.45","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2016/SD_BESTOne_Dental_Plus-Gold_Plan.pdf","6"
"2016","SD","61214","SERFF","3","2015-09-24 06:32:24","1","61214","SD","Individual","Yes","95-6042390","61214SD0020004","BESTOne Plus Gold","61214SD002",,"SDN001","SDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.45","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2016/SD_BESTOne_Dental_Plus-Gold_Plan.pdf","7"
"2016","SD","61214","SERFF","3","2015-09-24 06:32:24","1","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010008","BESTDental Standard - H","61214SD001",,"SDN001","SDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2016/SD_BESTDental_Standard-H_Plan.pdf","7"
"2016","SD","61214","SERFF","3","2015-09-24 06:32:24","1","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010010","BESTDental Choice - H","61214SD001",,"SDN001","SDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010010-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2016/SD_BESTDental_Choice-H_Plan.pdf","8"
"2016","SD","61214","SERFF","3","2015-09-24 06:32:24","1","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010010","BESTDental Choice - H","61214SD001",,"SDN001","SDS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.96","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","YEs","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2016/SD_BESTDental_Choice-H_Plan.pdf","9"
"2016","SD","61214","SERFF","3","2015-09-24 06:32:24","2","61214","SD","Individual","Yes","95-6042390","61214SD0020005","BESTOne Plus Silver","61214SD002",,"SDN001","SDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.98","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2016/SD_BESTOne_Dental_Plus-Silver_Plan.pdf","4"
"2016","SD","61214","SERFF","3","2015-09-24 06:32:24","2","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010009","BESTDental Standard - L","61214SD001",,"SDN001","SDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2016/SD_BESTDental_Standard-L_Plan.pdf","4"
"2016","SD","61214","SERFF","3","2015-09-24 06:32:24","2","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010009","BESTDental Standard - L","61214SD001",,"SDN001","SDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2016/SD_BESTDental_Standard-L_Plan.pdf","5"
"2016","SD","61214","SERFF","3","2015-09-24 06:32:24","2","61214","SD","Individual","Yes","95-6042390","61214SD0020005","BESTOne Plus Silver","61214SD002",,"SDN001","SDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.98","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2016/SD_BESTOne_Dental_Plus-Silver_Plan.pdf","5"
"2016","SD","61214","SERFF","3","2015-09-24 06:32:24","2","61214","SD","Individual","Yes","95-6042390","61214SD0020006","BESTOne Basic Silver","61214SD002",,"SDN001","SDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.98","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2016/SD_BESTOne_Dental_Basic-Silver_Plan.pdf","6"
"2016","SD","61214","SERFF","3","2015-09-24 06:32:24","2","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010011","BESTDental Choice - L","61214SD001",,"SDN001","SDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2016/SD_BESTDental_Choice-L_Plan.pdf","6"
"2016","SD","61214","SERFF","3","2015-09-24 06:32:24","2","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010011","BESTDental Choice - L","61214SD001",,"SDN001","SDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2016/SD_BESTDental_Choice-L_Plan.pdf","7"
"2016","SD","61214","SERFF","3","2015-09-24 06:32:24","2","61214","SD","Individual","Yes","95-6042390","61214SD0020006","BESTOne Basic Silver","61214SD002",,"SDN001","SDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$28.98","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2016/SD_BESTOne_Dental_Basic-Silver_Plan.pdf","7"
"2016","SD","61214","SERFF","3","2015-09-24 06:32:24","2","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010012","BESTDental Value","61214SD001",,"SDN001","SDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010012-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2016/SD_BESTDental_Value_Plan.pdf","8"
"2016","SD","61214","SERFF","3","2015-09-24 06:32:24","2","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010012","BESTDental Value","61214SD001",,"SDN001","SDS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.19","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","61214SD0010012-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.bestlife.com/SD/2016/SD_BESTDental_Value_Plan.pdf","9"
"2016","UT","14948","SERFF","3","2015-08-27 15:13:29","1","14948","UT","Individual","Yes","86-0672505","14948UT0010002","DeltaCare USA Pediatric Preferred Plan","14948UT001",,"UTN001","UTS001",,"Existing","HMO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","14948UT0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/14948ut0010002-16","4"
"2016","UT","14948","SERFF","3","2015-08-27 15:13:29","1","14948","UT","Individual","Yes","86-0672505","14948UT0010001","DeltaCare USA Pediatric Basic Plan","14948UT001",,"UTN001","UTS001",,"Existing","HMO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$11.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","14948UT0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/14948ut0010001-16","5"
"2016","UT","14948","SERFF","3","2015-08-27 15:13:29","2","14948","UT","Individual","Yes","86-0672505","14948UT0010004","DeltaCare USA Preferred Plan for Families","14948UT001",,"UTN001","UTS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","14948UT0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://https://deltadentalins.com/hcx/ut/14948ut0010004-16","4"
"2016","UT","14948","SERFF","3","2015-08-27 15:13:29","2","14948","UT","Individual","Yes","86-0672505","14948UT0010004","DeltaCare USA Preferred Plan for Families","14948UT001",,"UTN001","UTS001",,"Existing","HMO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","14948UT0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://https://deltadentalins.com/hcx/ut/14948ut0010004-16","5"
"2016","UT","14948","SERFF","3","2015-08-27 15:13:29","3","14948","UT","Individual","Yes","86-0672505","14948UT0010006","DeltaCare USA Basic Plan for Families","14948UT001",,"UTN001","UTS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$11.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","14948UT0010006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://https://deltadentalins.com/hcx/ut/14948ut0010004-16","4"
"2016","UT","14948","SERFF","3","2015-08-27 15:13:29","3","14948","UT","Individual","Yes","86-0672505","14948UT0010006","DeltaCare USA Basic Plan for Families","14948UT001",,"UTN001","UTS001",,"Existing","HMO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$11.49","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"No",,"No","https://www.deltadentalins.com/hx/checkout","","14948UT0010006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://https://deltadentalins.com/hcx/ut/14948ut0010004-16","5"
"2016","UT","18167","SERFF","7","2016-01-28 08:29:40","1","18167","UT","Individual","No","33-0617992","18167UT0010001","Molina Marketplace Gold Plan","18167UT001",,"UTN001","UTS001","UTF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/ut/en/PDF/marketplace/formulary-2016.pdf","18167UT0010001-00","Standard Gold Off Exchange Plan",,"0.801033437252045","No","Yes","No","100%",,"$500","$240","$890","$150","$500","$770","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/marketplace/summary-of-benefits-gold-off-exchange-2016.pdf","http://www.molinahealthcare.com/ut/en/PDF/marketplace/brochure-2016.pdf","4"
"2016","UT","18167","SERFF","7","2016-01-28 08:29:40","1","18167","UT","Individual","No","33-0617992","18167UT0010001","Molina Marketplace Gold Plan","18167UT001",,"UTN001","UTS001","UTF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/ut/en/PDF/marketplace/formulary-2016.pdf","18167UT0010001-01","Standard Gold On Exchange Plan",,"0.801033437252045","No","Yes","No","100%",,"$500","$240","$890","$150","$500","$770","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/marketplace/summary-of-benefits-gold-2016.pdf","http://www.molinahealthcare.com/ut/en/PDF/marketplace/brochure-2016.pdf","5"
"2016","UT","18167","SERFF","7","2016-01-28 08:29:40","1","18167","UT","Individual","No","33-0617992","18167UT0010001","Molina Marketplace Gold Plan","18167UT001",,"UTN001","UTS001","UTF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/ut/en/PDF/marketplace/formulary-2016.pdf","18167UT0010001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/marketplace/summary-of-benefits-gold-aian-2016.pdf","http://www.molinahealthcare.com/ut/en/PDF/marketplace/brochure-2016.pdf","6"
"2016","UT","18167","SERFF","7","2016-01-28 08:29:40","1","18167","UT","Individual","No","33-0617992","18167UT0010001","Molina Marketplace Gold Plan","18167UT001",,"UTN001","UTS001","UTF001","Existing","HMO","Gold","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/ut/en/PDF/marketplace/formulary-2016.pdf","18167UT0010001-03","Limited Cost Sharing Plan Variation",,"0.801033437252045","No","Yes","No","100%",,"$500","$240","$890","$150","$500","$770","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$500","$500 per person","$1000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/ut/en/PDF/marketplace/summary-of-benefits-gold-2016.pdf","http://www.molinahealthcare.com/ut/en/PDF/marketplace/brochure-2016.pdf","7"
"2016","UT","18167","SERFF","7","2016-01-28 08:29:40","2","18167","UT","Individual","No","33-0617992","18167UT0010002","Molina Marketplace Silver Plan","18167UT001",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/ut/en/PDF/marketplace/formulary-2016.pdf","18167UT0010002-00","Standard Silver Off Exchange Plan",,"0.714607775211334","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/marketplace/summary-of-benefits-silver-off-exchange-2016.pdf","http://www.molinahealthcare.com/ut/en/PDF/marketplace/brochure-2016.pdf","4"
"2016","UT","18167","SERFF","7","2016-01-28 08:29:40","2","18167","UT","Individual","No","33-0617992","18167UT0010002","Molina Marketplace Silver Plan","18167UT001",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/ut/en/PDF/marketplace/formulary-2016.pdf","18167UT0010002-01","Standard Silver On Exchange Plan",,"0.714607775211334","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/marketplace/summary-of-benefits-silver-250-2016.pdf","http://www.molinahealthcare.com/ut/en/PDF/marketplace/brochure-2016.pdf","5"
"2016","UT","18167","SERFF","7","2016-01-28 08:29:40","2","18167","UT","Individual","No","33-0617992","18167UT0010002","Molina Marketplace Silver Plan","18167UT001",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/ut/en/PDF/marketplace/formulary-2016.pdf","18167UT0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/marketplace/summary-of-benefits-silver-aian-2016.pdf","http://www.molinahealthcare.com/ut/en/PDF/marketplace/brochure-2016.pdf","6"
"2016","UT","18167","SERFF","7","2016-01-28 08:29:40","2","18167","UT","Individual","No","33-0617992","18167UT0010002","Molina Marketplace Silver Plan","18167UT001",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/ut/en/PDF/marketplace/formulary-2016.pdf","18167UT0010002-03","Limited Cost Sharing Plan Variation",,"0.714607775211334","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/marketplace/summary-of-benefits-silver-250-2016.pdf","http://www.molinahealthcare.com/ut/en/PDF/marketplace/brochure-2016.pdf","7"
"2016","UT","18167","SERFF","7","2016-01-28 08:29:40","2","18167","UT","Individual","No","33-0617992","18167UT0010002","Molina Marketplace Silver Plan","18167UT001",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/ut/en/PDF/marketplace/formulary-2016.pdf","18167UT0010002-04","73% AV Level Silver Plan",,"0.739822447299957","No","Yes","No","100%",,"$2,000","$380","$1,340","$150","$2,000","$420","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","$2,000","$2000 per person","$4000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/marketplace/summary-of-benefits-silver-200-2016.pdf","http://www.molinahealthcare.com/ut/en/PDF/marketplace/brochure-2016.pdf","8"
"2016","UT","18167","SERFF","7","2016-01-28 08:29:40","2","18167","UT","Individual","No","33-0617992","18167UT0010002","Molina Marketplace Silver Plan","18167UT001",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/ut/en/PDF/marketplace/formulary-2016.pdf","18167UT0010002-05","87% AV Level Silver Plan",,"0.878527700901031","No","Yes","No","100%",,"$450","$180","$890","$150","$450","$320","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$450","$450 per person","$900 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$450","$450 per person","$900 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/marketplace/summary-of-benefits-silver-150-2016.pdf","http://www.molinahealthcare.com/ut/en/PDF/marketplace/brochure-2016.pdf","9"
"2016","UT","18167","SERFF","7","2016-01-28 08:29:40","2","18167","UT","Individual","No","33-0617992","18167UT0010002","Molina Marketplace Silver Plan","18167UT001",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/ut/en/PDF/marketplace/formulary-2016.pdf","18167UT0010002-06","94% AV Level Silver Plan",,"0.947116374969482","No","Yes","No","100%",,"$0","$210","$450","$150","$0","$180","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/marketplace/summary-of-benefits-silver-100-2016.pdf","http://www.molinahealthcare.com/ut/en/PDF/marketplace/brochure-2016.pdf","10"
"2016","UT","18167","SERFF","7","2016-01-28 08:29:40","3","18167","UT","Individual","No","33-0617992","18167UT0010003","Molina Marketplace Bronze Plan","18167UT001",,"UTN001","UTS001","UTF003","Existing","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","https://billpay.molinahealthcare.com/Payment/Login","http://www.molinahealthcare.com/ut/en/PDF/marketplace/formulary-2016.pdf","18167UT0010003-00","Standard Bronze Off Exchange Plan",,"0.618895947933197","Yes","Yes","No","100%",,"$5,000","$20","$900","$150","$2,420","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","No",,,"http://www.molinahealthcare.com/members/ut/en-US/PDF/marketplace/summary-of-benefits-bronze-off-exchange-2016.pdf","http://www.molinahealthcare.com/ut/en/PDF/marketplace/brochure-2016.pdf","4"
"2016","UT","40335","SERFF","3","2015-08-27 03:52:03","2","40335","UT","Individual","Yes","20-4023720","40335UT0030001","EMI Health Choice PPO","40335UT003",,"UTN001","UTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$7.73","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","PPO network or out-of-network coverage at PPO fee","Yes","http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","","40335UT0030001-01","Standard High On Exchange Plan","87.00%",,,,"Yes","60%","40%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,"$50","$50 per person","$150 per group",,"$75","$75 per person","$225 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","5"
"2016","UT","40335","SERFF","3","2015-08-27 03:52:03","3","40335","UT","Individual","Yes","20-4023720","40335UT0020001","EMI Health Advantage Co-Pay","40335UT002",,"UTN002","UTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$7.87","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","PPO network or out-of-network coverage at PPO fee","Yes","http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","","40335UT0020001-00","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","4"
"2016","UT","40335","SERFF","3","2015-08-27 03:52:03","3","40335","UT","Individual","Yes","20-4023720","40335UT0020001","EMI Health Advantage Co-Pay","40335UT002",,"UTN002","UTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$7.87","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","PPO network or out-of-network coverage at PPO fee","Yes","http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","","40335UT0020001-01","Standard High On Exchange Plan","87.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","$75 per group",,,,,,"$25","$25 per person","$75 per group","$25","$25 per person","$75 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","5"
"2016","UT","40335","SERFF","3","2015-08-27 03:52:03","4","40335","UT","Individual","Yes","20-4023720","40335UT0110001","EMI Health EHB Pediatric Plan – Advantage Network","40335UT011",,"UTN002","UTS001",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$9.40","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"Yes","http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","","40335UT0110001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","4"
"2016","UT","40335","SERFF","3","2015-08-27 03:52:03","4","40335","UT","Individual","Yes","20-4023720","40335UT0110001","EMI Health EHB Pediatric Plan – Advantage Network","40335UT011",,"UTN002","UTS001",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$9.40","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"Yes","http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","","40335UT0110001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","5"
"2016","UT","40335","SERFF","3","2015-08-27 03:52:03","4","40335","UT","Individual","Yes","20-4023720","40335UT0120001","EMI Health EHB Pediatric Plan – Premier Network","40335UT012",,"UTN001","UTS001",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$11.50","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"Yes","http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","","40335UT0120001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","6"
"2016","UT","40335","SERFF","3","2015-08-27 03:52:03","4","40335","UT","Individual","Yes","20-4023720","40335UT0120001","EMI Health EHB Pediatric Plan – Premier Network","40335UT012",,"UTN001","UTS001",,"Existing","EPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$11.50","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"No",,"Yes","http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","","40335UT0120001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","http://www.emihealth.com/emi/products/utah-products/federal-marketplace-dental.aspx","7"
"2016","UT","42261","SERFF","5","2015-08-27 03:52:03","1","42261","UT","Individual","No","47-2293857","42261UT0050001","Healthy Premier Gold","42261UT005",,"UTN001","UTS001","UTF002","New","PPO","Gold","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9956",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent Only","Yes","Out-of-Network providers covered at 50% of billed","No","http://uhealthplan.utah.edu/individual/index.php","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050001-00","Standard Gold Off Exchange Plan",,"0.781910955905914","No","Yes","No","100%",,"$1,200","$0","$630","$0","$1,250","$175","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-gold.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-gold.pdf","4"
"2016","UT","42261","SERFF","5","2015-08-27 03:52:03","1","42261","UT","Individual","No","47-2293857","42261UT0050001","Healthy Premier Gold","42261UT005",,"UTN001","UTS001","UTF002","New","PPO","Gold","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9956",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent Only","Yes","Out-of-Network providers covered at 50% of billed","No","http://uhealthplan.utah.edu/individual/index.php","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050001-01","Standard Gold On Exchange Plan",,"0.781910955905914","No","Yes","No","100%",,"$1,200","$0","$630","$0","$1,250","$175","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-gold.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-gold.pdf","5"
"2016","UT","42261","SERFF","5","2015-08-27 03:52:03","1","42261","UT","Individual","No","47-2293857","42261UT0050001","Healthy Premier Gold","42261UT005",,"UTN001","UTS001","UTF002","New","PPO","Gold","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9956",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent Only","Yes","Out-of-Network providers covered at 50% of billed","No","http://uhealthplan.utah.edu/individual/index.php","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-gold.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-gold.pdf","6"
"2016","UT","42261","SERFF","5","2015-08-27 03:52:03","1","42261","UT","Individual","No","47-2293857","42261UT0050001","Healthy Premier Gold","42261UT005",,"UTN001","UTS001","UTF002","New","PPO","Gold","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9956",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent Only","Yes","Out-of-Network providers covered at 50% of billed","No","http://uhealthplan.utah.edu/individual/index.php","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050001-03","Limited Cost Sharing Plan Variation",,"0.781910955905914","No","Yes","No","100%",,"$1,200","$0","$630","$0","$1,250","$175","$600","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-gold.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-gold.pdf","7"
"2016","UT","42261","SERFF","5","2015-08-27 03:52:03","2","42261","UT","Individual","No","47-2293857","42261UT0050002","Healthy Premier Silver","42261UT005",,"UTN001","UTS001","UTF002","New","PPO","Silver","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent Only","Yes","Out-of-Network providers covered at 50% of billed","No","http://uhealthplan.utah.edu/individual/index.php","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050002-00","Standard Silver Off Exchange Plan",,"0.680676162242889","No","Yes","No","100%",,"$3,700","$0","$1,140","$0","$2,000","$210","$520","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","20%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-silver250.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-silver250.pdf","4"
"2016","UT","42261","SERFF","5","2015-08-27 03:52:03","2","42261","UT","Individual","No","47-2293857","42261UT0050002","Healthy Premier Silver","42261UT005",,"UTN001","UTS001","UTF002","New","PPO","Silver","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent Only","Yes","Out-of-Network providers covered at 50% of billed","No","http://uhealthplan.utah.edu/individual/index.php","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050002-01","Standard Silver On Exchange Plan",,"0.680676162242889","No","Yes","No","100%",,"$3,700","$0","$1,140","$0","$2,000","$210","$520","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","20%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-silver250.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-silver250.pdf","5"
"2016","UT","42261","SERFF","5","2015-08-27 03:52:03","2","42261","UT","Individual","No","47-2293857","42261UT0050002","Healthy Premier Silver","42261UT005",,"UTN001","UTS001","UTF002","New","PPO","Silver","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent Only","Yes","Out-of-Network providers covered at 50% of billed","No","http://uhealthplan.utah.edu/individual/index.php","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-silver250.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-silver250.pdf","6"
"2016","UT","42261","SERFF","5","2015-08-27 03:52:03","2","42261","UT","Individual","No","47-2293857","42261UT0050002","Healthy Premier Silver","42261UT005",,"UTN001","UTS001","UTF002","New","PPO","Silver","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent Only","Yes","Out-of-Network providers covered at 50% of billed","No","http://uhealthplan.utah.edu/individual/index.php","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050002-03","Limited Cost Sharing Plan Variation",,"0.680676162242889","No","Yes","No","100%",,"$3,700","$0","$1,140","$0","$2,000","$210","$520","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","20%",,,,,"$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-silver250.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-silver250.pdf","7"
"2016","UT","42261","SERFF","5","2015-08-27 03:52:03","2","42261","UT","Individual","No","47-2293857","42261UT0050002","Healthy Premier Silver","42261UT005",,"UTN001","UTS001","UTF002","New","PPO","Silver","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent Only","Yes","Out-of-Network providers covered at 50% of billed","No","http://uhealthplan.utah.edu/individual/index.php","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050002-04","73% AV Level Silver Plan",,"0.73211795091629","No","Yes","No","100%",,"$2,700","$0","$1,440","$0","$1,950","$105","$530","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"$250","$250 per person","$500 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-silver200.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-silver200.pdf","8"
"2016","UT","42261","SERFF","5","2015-08-27 03:52:03","2","42261","UT","Individual","No","47-2293857","42261UT0050002","Healthy Premier Silver","42261UT005",,"UTN001","UTS001","UTF002","New","PPO","Silver","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent Only","Yes","Out-of-Network providers covered at 50% of billed","No","http://uhealthplan.utah.edu/individual/index.php","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050002-05","87% AV Level Silver Plan",,"0.862501204013824","No","Yes","No","100%",,"$550","$0","$1,700","$0","$550","$70","$875","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$400","$400 per person","$800 per group","25%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","15%",,,,,"$150","$150 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-silver150.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-silver150.pdf","9"
"2016","UT","42261","SERFF","5","2015-08-27 03:52:03","2","42261","UT","Individual","No","47-2293857","42261UT0050002","Healthy Premier Silver","42261UT005",,"UTN001","UTS001","UTF002","New","PPO","Silver","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9949",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent Only","Yes","Out-of-Network providers covered at 50% of billed","No","http://uhealthplan.utah.edu/individual/index.php","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050002-06","94% AV Level Silver Plan",,"0.933926224708557","No","Yes","No","100%",,"$0","$0","$770","$0","$0","$0","$750","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-silver100.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-silver100.pdf","10"
"2016","UT","42261","SERFF","5","2015-08-27 03:52:03","3","42261","UT","Individual","No","47-2293857","42261UT0050003","Healthy Premier Bronze","42261UT005",,"UTN001","UTS001","UTF003","New","PPO","Bronze","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent Only","Yes","Out-of-Network providers covered at 50% of billed","No","http://uhealthplan.utah.edu/individual/index.php","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050003-00","Standard Bronze Off Exchange Plan",,"0.610496699810028","No","Yes","No","100%",,"$2,200","$0","$3,975","$0","$2,500","$0","$2,100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","75%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","75%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-bronze.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-bronze.pdf","4"
"2016","UT","42261","SERFF","5","2015-08-27 03:52:03","3","42261","UT","Individual","No","47-2293857","42261UT0050003","Healthy Premier Bronze","42261UT005",,"UTN001","UTS001","UTF003","New","PPO","Bronze","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent Only","Yes","Out-of-Network providers covered at 50% of billed","No","http://uhealthplan.utah.edu/individual/index.php","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050003-01","Standard Bronze On Exchange Plan",,"0.610496699810028","No","Yes","No","100%",,"$2,200","$0","$3,975","$0","$2,500","$0","$2,100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","75%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","75%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-bronze.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-bronze.pdf","5"
"2016","UT","42261","SERFF","5","2015-08-27 03:52:03","3","42261","UT","Individual","No","47-2293857","42261UT0050003","Healthy Premier Bronze","42261UT005",,"UTN001","UTS001","UTF003","New","PPO","Bronze","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent Only","Yes","Out-of-Network providers covered at 50% of billed","No","http://uhealthplan.utah.edu/individual/index.php","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-bronze.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-bronze.pdf","6"
"2016","UT","42261","SERFF","5","2015-08-27 03:52:03","3","42261","UT","Individual","No","47-2293857","42261UT0050003","Healthy Premier Bronze","42261UT005",,"UTN001","UTS001","UTF003","New","PPO","Bronze","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.994",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent Only","Yes","Out-of-Network providers covered at 50% of billed","No","http://uhealthplan.utah.edu/individual/index.php","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050003-03","Limited Cost Sharing Plan Variation",,"0.610496699810028","No","Yes","No","100%",,"$2,200","$0","$3,975","$0","$2,500","$0","$2,100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","75%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","75%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-bronze.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-bronze.pdf","7"
"2016","UT","42261","SERFF","5","2015-08-27 03:52:03","4","42261","UT","Individual","No","47-2293857","42261UT0050004","Healthy Premier Catastrophic","42261UT005",,"UTN001","UTS001","UTF004","New","PPO","Catastrophic","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9937",,,,"0","0","3","2016-01-01","2016-12-31","No","Urgent and Emergent Only","Yes","Out-of-Network providers covered at 50% of billed","No","http://uhealthplan.utah.edu/individual/index.php","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050004-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$5,000","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-catastrophic.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-catastrophic.pdf","4"
"2016","UT","42261","SERFF","5","2015-08-27 03:52:03","4","42261","UT","Individual","No","47-2293857","42261UT0050004","Healthy Premier Catastrophic","42261UT005",,"UTN001","UTS001","UTF004","New","PPO","Catastrophic","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9937",,,,"0","0","3","2016-01-01","2016-12-31","No","Urgent and Emergent Only","Yes","Out-of-Network providers covered at 50% of billed","No","http://uhealthplan.utah.edu/individual/index.php","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$5,000","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-catastrophic.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-catastrophic.pdf","5"
"2016","UT","42261","SERFF","5","2015-08-27 03:52:03","5","42261","UT","Individual","No","47-2293857","42261UT0050005","Healthy Premier Platinum","42261UT005",,"UTN001","UTS002","UTF001","New","PPO","Platinum","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent Only","Yes","Out-of-Network providers covered at 50% of billed","No","http://uhealthplan.utah.edu/individual/index.php","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050005-00","Standard Platinum Off Exchange Plan",,"0.886472940444946","No","Yes","Yes","80%","20%","$400","$0","$600","$0","$400","$70","$530","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$5,500","$5500 per person","$11000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%","$1,000","$1000 per person","$2000 per group","20%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","10%","$300","$300 per person","$600 per group","10%","$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-platinum.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-platinum.pdf","4"
"2016","UT","42261","SERFF","5","2015-08-27 03:52:03","5","42261","UT","Individual","No","47-2293857","42261UT0050005","Healthy Premier Platinum","42261UT005",,"UTN001","UTS002","UTF001","New","PPO","Platinum","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent Only","Yes","Out-of-Network providers covered at 50% of billed","No","http://uhealthplan.utah.edu/individual/index.php","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050005-01","Standard Platinum On Exchange Plan",,"0.886472940444946","No","Yes","Yes","80%","20%","$400","$0","$600","$0","$400","$70","$530","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$5,500","$5500 per person","$11000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%","$1,000","$1000 per person","$2000 per group","20%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","10%","$300","$300 per person","$600 per group","10%","$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-platinum.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-platinum.pdf","5"
"2016","UT","42261","SERFF","5","2015-08-27 03:52:03","5","42261","UT","Individual","No","47-2293857","42261UT0050005","Healthy Premier Platinum","42261UT005",,"UTN001","UTS002","UTF001","New","PPO","Platinum","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent Only","Yes","Out-of-Network providers covered at 50% of billed","No","http://uhealthplan.utah.edu/individual/index.php","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","80%","20%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-platinum.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-platinum.pdf","6"
"2016","UT","42261","SERFF","5","2015-08-27 03:52:03","5","42261","UT","Individual","No","47-2293857","42261UT0050005","Healthy Premier Platinum","42261UT005",,"UTN001","UTS002","UTF001","New","PPO","Platinum","No","Both","No","No",,"See Plan Document","$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01","2016-12-31","No","Urgent and Emergent Only","Yes","Out-of-Network providers covered at 50% of billed","No","http://uhealthplan.utah.edu/individual/index.php","http://uhealthplan.utah.edu/individual/pdf/coveredrx.pdf","42261UT0050005-03","Limited Cost Sharing Plan Variation",,"0.886472940444946","No","Yes","Yes","80%","20%","$400","$0","$600","$0","$400","$70","$530","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","$5,500","$5500 per person","$11000 per group","$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","10%","$1,000","$1000 per person","$2000 per group","20%","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","10%","$300","$300 per person","$600 per group","10%","$300","$300 per person","$600 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://uhealthplan.utah.edu/individual/pdf/sbc/healthypremier-platinum.pdf","http://uhealthplan.utah.edu/individual/pdf/plan-brochure/healthypremier-platinum.pdf","7"
"2016","UT","42757","SERFF","5","2015-10-21 17:48:08","1","42757","UT","Individual","Yes","95-6042390","42757UT0020003","BESTOne Advantage High","42757UT002",,"UTN001","UTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.38","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$35","$35 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2016/UT_BESTOne_Dental_Advantage-High_Plan.pdf","https://www.bestlife.com/ut/2016/UT_BESTOne_Dental_Advantage-High_Plan.pdf","4"
"2016","UT","42757","SERFF","5","2015-10-21 17:48:08","1","42757","UT","Individual","Yes","95-6042390","42757UT0020003","BESTOne Advantage High","42757UT002",,"UTN001","UTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.38","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$35","$35 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2016/UT_BESTOne_Dental_Advantage-High_Plan.pdf","https://www.bestlife.com/ut/2016/UT_BESTOne_Dental_Advantage-High_Plan.pdf","5"
"2016","UT","42757","SERFF","5","2015-10-21 17:48:08","1","42757","UT","Individual","Yes","95-6042390","42757UT0020004","BESTOne Plus High","42757UT002",,"UTN001","UTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.38","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$35","$35 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2016/UT_BESTOne_Dental_Plus-High_Plan.pdf","https://www.bestlife.com/ut/2016/UT_BESTOne_Dental_Plus-High_Plan.pdf","6"
"2016","UT","42757","SERFF","5","2015-10-21 17:48:08","1","42757","UT","Individual","Yes","95-6042390","42757UT0020004","BESTOne Plus High","42757UT002",,"UTN001","UTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.38","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$35","$35 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2016/UT_BESTOne_Dental_Plus-High_Plan.pdf","https://www.bestlife.com/ut/2016/UT_BESTOne_Dental_Plus-High_Plan.pdf","7"
"2016","UT","42757","SERFF","5","2015-10-21 17:48:08","2","42757","UT","Individual","Yes","95-6042390","42757UT0020005","BESTOne Plus","42757UT002",,"UTN001","UTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.04","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2016/UT_BESTOne_Dental_Plus-Low_Plan.pdf","https://www.bestlife.com/ut/2016/UT_BESTOne_Dental_Plus-Low_Plan.pdf","4"
"2016","UT","42757","SERFF","5","2015-10-21 17:48:08","2","42757","UT","Individual","Yes","95-6042390","42757UT0020005","BESTOne Plus","42757UT002",,"UTN001","UTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.04","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2016/UT_BESTOne_Dental_Plus-Low_Plan.pdf","https://www.bestlife.com/ut/2016/UT_BESTOne_Dental_Plus-Low_Plan.pdf","5"
"2016","UT","42757","SERFF","5","2015-10-21 17:48:08","2","42757","UT","Individual","Yes","95-6042390","42757UT0020006","BESTOne Basic","42757UT002",,"UTN001","UTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.04","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2016/UT_BESTOne_Dental_Basic-Low_Plan.pdf","https://www.bestlife.com/ut/2016/UT_BESTOne_Dental_Basic-Low_Plan.pdf","6"
"2016","UT","42757","SERFF","5","2015-10-21 17:48:08","2","42757","UT","Individual","Yes","95-6042390","42757UT0020006","BESTOne Basic","42757UT002",,"UTN001","UTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.04","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Network or UCR","Yes","http://www.bestlife.com/exchange/payment_option.html","","42757UT0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$75","$75 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.bestlife.com/ut/2016/UT_BESTOne_Dental_Basic-Low_Plan.pdf","https://www.bestlife.com/ut/2016/UT_BESTOne_Dental_Basic-Low_Plan.pdf","7"
"2016","UT","46958","SERFF","3","2015-08-27 03:52:03","1","46958","UT","Individual","Yes","39-1263473","46958UT0470001","Humana Dental Smart Choice Basic","46958UT047",,"UTN001","UTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.12","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","","46958UT0470001-01","Standard Low On Exchange Plan","70.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://apps.humana.com/marketing/documents.asp?file=2613013","4"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","1","56764","UT","Individual","No","20-8411422","56764UT0010001","Humana Basic 6850/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Value","56764UT0010001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2612402","http://apps.humana.com/marketing/documents.asp?file=2594553","4"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","1","56764","UT","Individual","No","20-8411422","56764UT0010001","Humana Basic 6850/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF001","Existing","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Value","56764UT0010001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://apps.humana.com/marketing/documents.asp?file=2612402","http://apps.humana.com/marketing/documents.asp?file=2594553","5"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","2","56764","UT","Individual","No","20-8411422","56764UT0010002","Humana Bronze 6450/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Value","56764UT0010002-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2612415","http://apps.humana.com/marketing/documents.asp?file=2594566","4"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","2","56764","UT","Individual","No","20-8411422","56764UT0010002","Humana Bronze 6450/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Value","56764UT0010002-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2612415","http://apps.humana.com/marketing/documents.asp?file=2594566","5"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","2","56764","UT","Individual","No","20-8411422","56764UT0010002","Humana Bronze 6450/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Value","56764UT0010002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://apps.humana.com/marketing/documents.asp?file=2612428","http://apps.humana.com/marketing/documents.asp?file=2594566","6"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","2","56764","UT","Individual","No","20-8411422","56764UT0010002","Humana Bronze 6450/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF001","Existing","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-HDHP-Value","56764UT0010002-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$150","$5,320","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2612441","http://apps.humana.com/marketing/documents.asp?file=2594566","7"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","3","56764","UT","Individual","No","20-8411422","56764UT0010003","Humana Bronze 4850/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Value","56764UT0010003-00","Standard Bronze Off Exchange Plan","61.72%","0.621564447879791","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612454","http://apps.humana.com/marketing/documents.asp?file=2594579","4"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","3","56764","UT","Individual","No","20-8411422","56764UT0010003","Humana Bronze 4850/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Value","56764UT0010003-01","Standard Bronze On Exchange Plan","61.72%","0.621564447879791","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612454","http://apps.humana.com/marketing/documents.asp?file=2594579","5"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","3","56764","UT","Individual","No","20-8411422","56764UT0010003","Humana Bronze 4850/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Value","56764UT0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612467","http://apps.humana.com/marketing/documents.asp?file=2594579","6"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","3","56764","UT","Individual","No","20-8411422","56764UT0010003","Humana Bronze 4850/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF002","Existing","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","3","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Value","56764UT0010003-03","Limited Cost Sharing Plan Variation","61.72%","0.621564447879791","No","Yes","Yes","97%","3%","$4,850","$0","$60","$150","$4,850","$210","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group","$6,350","$6350 per person","$12700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","20%","$4,850","$4850 per person","$9700 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","50%","$1,500","$1500 per person","$3000 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612480","http://apps.humana.com/marketing/documents.asp?file=2594579","7"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","4","56764","UT","Individual","No","20-8411422","56764UT0010004","Humana Silver 3800/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Value","56764UT0010004-00","Standard Silver Off Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612493","http://apps.humana.com/marketing/documents.asp?file=2594592","4"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","4","56764","UT","Individual","No","20-8411422","56764UT0010004","Humana Silver 3800/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Value","56764UT0010004-01","Standard Silver On Exchange Plan","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612493","http://apps.humana.com/marketing/documents.asp?file=2594592","5"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","4","56764","UT","Individual","No","20-8411422","56764UT0010004","Humana Silver 3800/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Value","56764UT0010004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612506","http://apps.humana.com/marketing/documents.asp?file=2594592","6"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","4","56764","UT","Individual","No","20-8411422","56764UT0010004","Humana Silver 3800/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Value","56764UT0010004-03","Limited Cost Sharing Plan Variation","68.21%","0.686572968959808","No","Yes","Yes","97%","3%","$3,800","$20","$270","$150","$3,800","$160","$90","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,300","$6300 per person","$12600 per group","$6,300","$6300 per person","$12600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%","$3,800","$3800 per person","$7600 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612519","http://apps.humana.com/marketing/documents.asp?file=2594592","7"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","4","56764","UT","Individual","No","20-8411422","56764UT0010004","Humana Silver 3800/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Value","56764UT0010004-04","73% AV Level Silver Plan","72.87%","0.732124745845795","No","Yes","Yes","97%","3%","$3,250","$20","$380","$150","$3,250","$220","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","$4,750","$4750 per person","$9500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","20%","$3,250","$3250 per person","$6500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612532","http://apps.humana.com/marketing/documents.asp?file=2624947","8"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","4","56764","UT","Individual","No","20-8411422","56764UT0010004","Humana Silver 3800/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Value","56764UT0010004-05","87% AV Level Silver Plan","87.86%","0.880870759487152","No","Yes","Yes","97%","3%","$900","$0","$600","$150","$900","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$900","$900 per person","$1800 per group","20%","$900","$900 per person","$1800 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612545","http://apps.humana.com/marketing/documents.asp?file=2624960","9"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","4","56764","UT","Individual","No","20-8411422","56764UT0010004","Humana Silver 3800/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF003","Existing","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Value","56764UT0010004-06","94% AV Level Silver Plan","93.14%","0.932019531726837","No","Yes","Yes","97%","3%","$500","$0","$250","$150","$500","$200","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","$750","$750 per person","$1500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","50%","$0","$0 per person","$0 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612558","http://apps.humana.com/marketing/documents.asp?file=2624973","10"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","4","56764","UT","Individual","No","20-8411422","56764UT0010005","Humana Gold 2250/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Value","56764UT0010005-00","Standard Gold Off Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612571","http://apps.humana.com/marketing/documents.asp?file=2594605","11"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","4","56764","UT","Individual","No","20-8411422","56764UT0010005","Humana Gold 2250/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Value","56764UT0010005-01","Standard Gold On Exchange Plan","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612571","http://apps.humana.com/marketing/documents.asp?file=2594605","12"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","4","56764","UT","Individual","No","20-8411422","56764UT0010005","Humana Gold 2250/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Value","56764UT0010005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612584","http://apps.humana.com/marketing/documents.asp?file=2594605","13"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","4","56764","UT","Individual","No","20-8411422","56764UT0010005","Humana Gold 2250/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Value","56764UT0010005-03","Limited Cost Sharing Plan Variation","78.03%","0.784300982952118","No","Yes","Yes","97%","3%","$2,250","$20","$580","$150","$2,250","$350","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","$3,500","$3500 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612597","http://apps.humana.com/marketing/documents.asp?file=2594605","14"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","4","56764","UT","Individual","No","20-8411422","56764UT0010006","Humana Platinum 500/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Value","56764UT0010006-00","Standard Platinum Off Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612610","http://apps.humana.com/marketing/documents.asp?file=2594618","15"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","4","56764","UT","Individual","No","20-8411422","56764UT0010006","Humana Platinum 500/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Value","56764UT0010006-01","Standard Platinum On Exchange Plan","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612610","http://apps.humana.com/marketing/documents.asp?file=2594618","16"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","4","56764","UT","Individual","No","20-8411422","56764UT0010006","Humana Platinum 500/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Value","56764UT0010006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","97%","3%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612623","http://apps.humana.com/marketing/documents.asp?file=2594618","17"
"2016","UT","56764","SERFF","5","2015-08-27 15:13:29","4","56764","UT","Individual","No","20-8411422","56764UT0010006","Humana Platinum 500/Salt Lake City HMOx","56764UT001",,"UTN001","UTS001","UTF004","Existing","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy","0.9898",,,,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://www.humana.com/2016-Rx5-Value","56764UT0010006-03","Limited Cost Sharing Plan Variation","88.47%","0.888283371925354","No","Yes","Yes","97%","3%","$500","$20","$1,030","$150","$500","$600","$280","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","35%","$0","$0 per person","$0 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://apps.humana.com/marketing/documents.asp?file=2612636","http://apps.humana.com/marketing/documents.asp?file=2594618","18"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010001","Select Value Preference Gold 250","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010001-00","Standard Gold Off Exchange Plan",,"0.814819753170013","No","Yes","No","100%",,"$250","$20","$1,320","$150","$250","$650","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0812","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_250&csr=standard_gold_off_exchange_plan&id=I40A0812","4"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","1","10207","VA","Individual","No","52-1358219","10207VA0400002","BlueChoice Plus Silver $2,500","10207VA040",,"VAN004","VAS001","VAF012","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995184278770746",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"https://www.carefirst.com/acarx","10207VA0400002-03","Limited Cost Sharing Plan Variation","69.62%",,"No","Yes","No","100%",,"$2,525","$500","$0","$30","$2,580","$390","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/ATNVBN6ARXXVBN6LN012016.pdf",,"7"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","1","10207","VA","Individual","No","52-1358219","10207VA0400002","BlueChoice Plus Silver $2,500","10207VA040",,"VAN004","VAS001","VAF012","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995184278770746",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"https://www.carefirst.com/acarx","10207VA0400002-04","73% AV Level Silver Plan","72.11%",,"No","Yes","No","100%",,"$1,725","$500","$0","$30","$1,950","$420","$106","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,700","$1700 per person","$3400 per group","0%",,,,,"$3,400","$3400 per person","$6800 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/ATNVBN6DRXXVBN6QN012016.pdf",,"8"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","1","10207","VA","Individual","No","52-1358219","10207VA0400002","BlueChoice Plus Silver $2,500","10207VA040",,"VAN004","VAS001","VAF012","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995184278770746",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"https://www.carefirst.com/acarx","10207VA0400002-05","87% AV Level Silver Plan","86.29%",,"No","Yes","No","100%",,"$0","$215","$0","$30","$0","$480","$244","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/ATPVBN6CRXXVBN6NN012016.pdf",,"9"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","1","10207","VA","Individual","No","52-1358219","10207VA0400002","BlueChoice Plus Silver $2,500","10207VA040",,"VAN004","VAS001","VAF012","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995184278770746",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"https://www.carefirst.com/acarx","10207VA0400002-06","94% AV Level Silver Plan","93.36%",,"No","Yes","No","100%",,"$0","$100","$0","$30","$0","$80","$244","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/ATPVBN6BRXXVBN6MN012016.pdf",,"10"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","1","10207","VA","Individual","No","52-1358219","10207VA0400005","HealthyBlue Plus Gold $750","10207VA040",,"VAN005","VAS001","VAF013","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995176366039031",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"https://www.carefirst.com/acarx","10207VA0400005-00","Standard Gold Off Exchange Plan","80.57%",,"No","Yes","No","100%",,"$750","$450","$0","$30","$750","$0","$94","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/HCUVBN7DRXXVBN7LN012016.pdf",,"11"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","1","10207","VA","Individual","No","52-1358219","10207VA0400005","HealthyBlue Plus Gold $750","10207VA040",,"VAN005","VAS001","VAF013","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995176366039031",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"https://www.carefirst.com/acarx","10207VA0400005-01","Standard Gold On Exchange Plan","80.57%",,"No","Yes","No","100%",,"$750","$450","$0","$30","$750","$0","$94","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/HCUVBN7CRXXVBN7LN012016.pdf",,"12"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","1","10207","VA","Individual","No","52-1358219","10207VA0400005","HealthyBlue Plus Gold $750","10207VA040",,"VAN005","VAS001","VAF013","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995176366039031",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"https://www.carefirst.com/acarx","10207VA0400005-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/HCUVBN7ARXXVBN71N012016.pdf",,"13"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380001","BlueChoice HMO Silver $2,000","10207VA038",,"VAN001","VAS001","VAF012","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995180603508448",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/AHAVCN6DRXXVCN65N012016.pdf",,"6"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380001","BlueChoice HMO Silver $2,000","10207VA038",,"VAN001","VAS001","VAF012","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995180603508448",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380001-03","Limited Cost Sharing Plan Variation","70.89%",,"No","Yes","No","100%",,"$2,025","$500","$0","$30","$1,500","$390","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/AHNVCN6ARXXVCN6NN012016.pdf",,"7"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010001","Select Value Preference Gold 250","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010001-01","Standard Gold On Exchange Plan",,"0.814819753170013","No","Yes","No","100%",,"$250","$20","$1,320","$150","$250","$650","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0813","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_250&csr=standard_gold_on_exchange_plan&id=I40A0813","5"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010001","Select Value Preference Gold 250","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0814","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_250&csr=zero_cost_sharing_plan_variation&id=I40A0814","6"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010001","Select Value Preference Gold 250","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010001-03","Limited Cost Sharing Plan Variation",,"0.814819753170013","No","Yes","No","100%",,"$250","$20","$1,320","$150","$250","$650","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0815","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_250&csr=limited_cost_sharing_plan_variation&id=I40A0815","7"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010003","Select Value Preference Gold 500","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010003-00","Standard Gold Off Exchange Plan",,"0.800042450428009","No","Yes","No","100%",,"$500","$20","$1,270","$150","$500","$630","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0820","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_500&csr=standard_gold_off_exchange_plan&id=I40A0820","8"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010003","Select Value Preference Gold 500","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010003-01","Standard Gold On Exchange Plan",,"0.800042450428009","No","Yes","No","100%",,"$500","$20","$1,270","$150","$500","$630","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0821","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_500&csr=standard_gold_on_exchange_plan&id=I40A0821","9"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010003","Select Value Preference Gold 500","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0822","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_500&csr=zero_cost_sharing_plan_variation&id=I40A0822","10"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010003","Select Value Preference Gold 500","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010003-03","Limited Cost Sharing Plan Variation",,"0.800042450428009","No","Yes","No","100%",,"$500","$20","$1,270","$150","$500","$630","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0823","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_500&csr=limited_cost_sharing_plan_variation&id=I40A0823","11"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010005","Select Value Preference Silver 1250","68781UT001",,"UTN003","UTS003","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010005-00","Standard Silver Off Exchange Plan",,"0.704492330551147","No","Yes","No","100%",,"$1,250","$20","$2,790","$150","$1,250","$540","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0828","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_1250&csr=standard_silver_off_exchange_plan&id=I40A0828","12"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010005","Select Value Preference Silver 1250","68781UT001",,"UTN003","UTS003","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010005-01","Standard Silver On Exchange Plan",,"0.704492330551147","No","Yes","No","100%",,"$1,250","$20","$2,790","$150","$1,250","$540","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0829","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_1250&csr=standard_silver_on_exchange_plan&id=I40A0829","13"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010005","Select Value Preference Silver 1250","68781UT001",,"UTN003","UTS003","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0830","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_1250&csr=zero_cost_sharing_plan_variation&id=I40A0830","14"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010005","Select Value Preference Silver 1250","68781UT001",,"UTN003","UTS003","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010005-03","Limited Cost Sharing Plan Variation",,"0.704492330551147","No","Yes","No","100%",,"$1,250","$20","$2,790","$150","$1,250","$540","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0831","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_1250&csr=limited_cost_sharing_plan_variation&id=I40A0831","15"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010005","Select Value Preference Silver 1250","68781UT001",,"UTN003","UTS003","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010005-04","73% AV Level Silver Plan",,"0.734081983566284","No","Yes","No","100%",,"$1,150","$20","$1,420","$150","$1,150","$570","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0832","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_1250&csr=73_av_level_silver_plan&id=I40A0832","16"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010005","Select Value Preference Silver 1250","68781UT001",,"UTN003","UTS003","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010005-05","87% AV Level Silver Plan",,"0.875379264354706","No","Yes","No","100%",,"$250","$20","$990","$150","$250","$550","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0833","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_1250&csr=87_av_level_silver_plan&id=I40A0833","17"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010005","Select Value Preference Silver 1250","68781UT001",,"UTN003","UTS003","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010005-06","94% AV Level Silver Plan",,"0.946483731269836","No","Yes","No","100%",,"$0","$10","$340","$150","$0","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0834","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_1250&csr=94_av_level_silver_plan&id=I40A0834","18"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010006","Select Value Preference Gold 1000","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010006-00","Standard Gold Off Exchange Plan",,"0.781731724739075","No","Yes","No","100%",,"$1,000","$20","$1,170","$150","$1,000","$540","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0835","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_1000_&csr=standard_gold_off_exchange_plan&id=I40A0835","19"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010006","Select Value Preference Gold 1000","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010006-01","Standard Gold On Exchange Plan",,"0.781731724739075","No","Yes","No","100%",,"$1,000","$20","$1,170","$150","$1,000","$540","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0836","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_1000_&csr=standard_gold_on_exchange_plan&id=I40A0836","20"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010006","Select Value Preference Gold 1000","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0837","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_1000_&csr=zero_cost_sharing_plan_variation&id=I40A0837","21"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010006","Select Value Preference Gold 1000","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010006-03","Limited Cost Sharing Plan Variation",,"0.781731724739075","No","Yes","No","100%",,"$1,000","$20","$1,170","$150","$1,000","$540","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0838","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_1000_&csr=limited_cost_sharing_plan_variation&id=I40A0838","22"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010008","Select Value Preference Silver 2500","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010008-00","Standard Silver Off Exchange Plan",,"0.693124175071716","No","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$340","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0843","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_2500&csr=standard_silver_off_exchange_plan&id=I40A0843","23"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010008","Select Value Preference Silver 2500","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010008-01","Standard Silver On Exchange Plan",,"0.693124175071716","No","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$340","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0844","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_2500&csr=standard_silver_on_exchange_plan&id=I40A0844","24"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010008","Select Value Preference Silver 2500","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0845","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_2500&csr=zero_cost_sharing_plan_variation&id=I40A0845","25"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010008","Select Value Preference Silver 2500","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010008-03","Limited Cost Sharing Plan Variation",,"0.693124175071716","No","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$340","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0846","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_2500&csr=limited_cost_sharing_plan_variation&id=I40A0846","26"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010008","Select Value Preference Silver 2500","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010008-04","73% AV Level Silver Plan",,"0.721792638301849","No","Yes","No","100%",,"$2,500","$0","$650","$150","$2,500","$340","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$3150 per person","$6300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0847","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_2500&csr=73_av_level_silver_plan&id=I40A0847","27"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010008","Select Value Preference Silver 2500","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010008-05","87% AV Level Silver Plan",,"0.875379264354706","No","Yes","No","100%",,"$250","$20","$990","$150","$250","$550","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0848","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_2500&csr=87_av_level_silver_plan&id=I40A0848","28"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010008","Select Value Preference Silver 2500","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010008-06","94% AV Level Silver Plan",,"0.946483731269836","No","Yes","No","100%",,"$0","$10","$340","$150","$0","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0849","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_2500&csr=94_av_level_silver_plan&id=I40A0849","29"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010010","Select Value Preference Bronze 5000","68781UT001",,"UTN003","UTS003","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010010-00","Standard Bronze Off Exchange Plan",,"0.617345809936523","No","Yes","No","100%",,"$5,000","$20","$230","$150","$5,000","$50","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0857","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_bronze_5000&csr=standard_bronze_off_exchange_plan&id=I40A0857","30"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010010","Select Value Preference Bronze 5000","68781UT001",,"UTN003","UTS003","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010010-01","Standard Bronze On Exchange Plan",,"0.617345809936523","No","Yes","No","100%",,"$5,000","$20","$230","$150","$5,000","$50","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0858","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_bronze_5000&csr=standard_bronze_on_exchange_plan&id=I40A0858","31"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010010","Select Value Preference Bronze 5000","68781UT001",,"UTN003","UTS003","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0859","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_bronze_5000&csr=zero_cost_sharing_plan_variation&id=I40A0859","32"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0010010","Select Value Preference Bronze 5000","68781UT001",,"UTN003","UTS003","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010010-03","Limited Cost Sharing Plan Variation",,"0.617345809936523","No","Yes","No","100%",,"$5,000","$20","$230","$150","$5,000","$50","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0860","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_bronze_5000&csr=limited_cost_sharing_plan_variation&id=I40A0860","33"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020001","Select Med Preference Gold 250","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020001-00","Standard Gold Off Exchange Plan",,"0.814819753170013","No","Yes","No","100%",,"$250","$20","$1,320","$150","$250","$650","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0670","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_250&csr=standard_gold_off_exchange_plan&id=I30A0670","34"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020001","Select Med Preference Gold 250","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020001-01","Standard Gold On Exchange Plan",,"0.814819753170013","No","Yes","No","100%",,"$250","$20","$1,320","$150","$250","$650","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0671","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_250&csr=standard_gold_on_exchange_plan&id=I30A0671","35"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020001","Select Med Preference Gold 250","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0672","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_250&csr=zero_cost_sharing_plan_variation&id=I30A0672","36"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020001","Select Med Preference Gold 250","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020001-03","Limited Cost Sharing Plan Variation",,"0.814819753170013","No","Yes","No","100%",,"$250","$20","$1,320","$150","$250","$650","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0673","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_250&csr=limited_cost_sharing_plan_variation&id=I30A0673","37"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020003","Select Med Preference Gold 500","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020003-00","Standard Gold Off Exchange Plan",,"0.800042450428009","No","Yes","No","100%",,"$500","$20","$1,270","$150","$500","$630","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0678","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_500&csr=standard_gold_off_exchange_plan&id=I30A0678","38"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020003","Select Med Preference Gold 500","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020003-01","Standard Gold On Exchange Plan",,"0.800042450428009","No","Yes","No","100%",,"$500","$20","$1,270","$150","$500","$630","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0679","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_500&csr=standard_gold_on_exchange_plan&id=I30A0679","39"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020003","Select Med Preference Gold 500","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0680","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_500&csr=zero_cost_sharing_plan_variation&id=I30A0680","40"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020003","Select Med Preference Gold 500","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020003-03","Limited Cost Sharing Plan Variation",,"0.800042450428009","No","Yes","No","100%",,"$500","$20","$1,270","$150","$500","$630","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0681","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_500&csr=limited_cost_sharing_plan_variation&id=I30A0681","41"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020005","Select Med Preference Silver 1250","68781UT002",,"UTN002","UTS002","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020005-00","Standard Silver Off Exchange Plan",,"0.704492330551147","No","Yes","No","100%",,"$1,250","$20","$2,790","$150","$1,250","$540","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0686","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_1250&csr=standard_silver_off_exchange_plan&id=I30A0686","42"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020005","Select Med Preference Silver 1250","68781UT002",,"UTN002","UTS002","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020005-01","Standard Silver On Exchange Plan",,"0.704492330551147","No","Yes","No","100%",,"$1,250","$20","$2,790","$150","$1,250","$540","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0687","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_1250&csr=standard_silver_on_exchange_plan&id=I30A0687","43"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020005","Select Med Preference Silver 1250","68781UT002",,"UTN002","UTS002","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0688","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_1250&csr=zero_cost_sharing_plan_variation&id=I30A0688","44"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020005","Select Med Preference Silver 1250","68781UT002",,"UTN002","UTS002","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020005-03","Limited Cost Sharing Plan Variation",,"0.704492330551147","No","Yes","No","100%",,"$1,250","$20","$2,790","$150","$1,250","$540","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0689","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_1250&csr=limited_cost_sharing_plan_variation&id=I30A0689","45"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020005","Select Med Preference Silver 1250","68781UT002",,"UTN002","UTS002","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020005-04","73% AV Level Silver Plan",,"0.734081983566284","No","Yes","No","100%",,"$1,150","$20","$1,420","$150","$1,150","$570","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0690","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_1250&csr=73_av_level_silver_plan&id=I30A0690","46"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020005","Select Med Preference Silver 1250","68781UT002",,"UTN002","UTS002","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020005-05","87% AV Level Silver Plan",,"0.875379264354706","No","Yes","No","100%",,"$250","$20","$990","$150","$250","$550","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0691","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_1250&csr=87_av_level_silver_plan&id=I30A0691","47"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020005","Select Med Preference Silver 1250","68781UT002",,"UTN002","UTS002","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020005-06","94% AV Level Silver Plan",,"0.946483731269836","No","Yes","No","100%",,"$0","$10","$340","$150","$0","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0692","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_1250&csr=94_av_level_silver_plan&id=I30A0692","48"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020006","Select Med Preference Gold 1000","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020006-00","Standard Gold Off Exchange Plan",,"0.781731724739075","No","Yes","No","100%",,"$1,000","$20","$1,170","$150","$1,000","$540","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0693","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_1000_&csr=standard_gold_off_exchange_plan&id=I30A0693","49"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020006","Select Med Preference Gold 1000","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020006-01","Standard Gold On Exchange Plan",,"0.781731724739075","No","Yes","No","100%",,"$1,000","$20","$1,170","$150","$1,000","$540","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0694","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_1000_&csr=standard_gold_on_exchange_plan&id=I30A0694","50"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020006","Select Med Preference Gold 1000","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0695","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_1000_&csr=zero_cost_sharing_plan_variation&id=I30A0695","51"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020006","Select Med Preference Gold 1000","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020006-03","Limited Cost Sharing Plan Variation",,"0.781731724739075","No","Yes","No","100%",,"$1,000","$20","$1,170","$150","$1,000","$540","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0696","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_1000_&csr=limited_cost_sharing_plan_variation&id=I30A0696","52"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020008","Select Med Preference Silver 2500","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020008-00","Standard Silver Off Exchange Plan",,"0.693124175071716","No","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$340","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0701","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_2500&csr=standard_silver_off_exchange_plan&id=I30A0701","53"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020008","Select Med Preference Silver 2500","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020008-01","Standard Silver On Exchange Plan",,"0.693124175071716","No","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$340","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0702","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_2500&csr=standard_silver_on_exchange_plan&id=I30A0702","54"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020008","Select Med Preference Silver 2500","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0703","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_2500&csr=zero_cost_sharing_plan_variation&id=I30A0703","55"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020008","Select Med Preference Silver 2500","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020008-03","Limited Cost Sharing Plan Variation",,"0.693124175071716","No","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$340","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0704","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_2500&csr=limited_cost_sharing_plan_variation&id=I30A0704","56"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020008","Select Med Preference Silver 2500","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020008-04","73% AV Level Silver Plan",,"0.721792638301849","No","Yes","No","100%",,"$2,500","$0","$650","$150","$2,500","$340","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$3150 per person","$6300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0705","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_2500&csr=73_av_level_silver_plan&id=I30A0705","57"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020008","Select Med Preference Silver 2500","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020008-05","87% AV Level Silver Plan",,"0.875379264354706","No","Yes","No","100%",,"$250","$20","$990","$150","$250","$550","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0706","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_2500&csr=87_av_level_silver_plan&id=I30A0706","58"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020008","Select Med Preference Silver 2500","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020008-06","94% AV Level Silver Plan",,"0.946483731269836","No","Yes","No","100%",,"$0","$10","$340","$150","$0","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0707","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_2500&csr=94_av_level_silver_plan&id=I30A0707","59"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020010","Select Med Preference Bronze 5000","68781UT002",,"UTN002","UTS002","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020010-00","Standard Bronze Off Exchange Plan",,"0.617345809936523","No","Yes","No","100%",,"$5,000","$20","$230","$150","$5,000","$50","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0715","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_bronze_5000&csr=standard_bronze_off_exchange_plan&id=I30A0715","60"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020010","Select Med Preference Bronze 5000","68781UT002",,"UTN002","UTS002","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020010-01","Standard Bronze On Exchange Plan",,"0.617345809936523","No","Yes","No","100%",,"$5,000","$20","$230","$150","$5,000","$50","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0716","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_bronze_5000&csr=standard_bronze_on_exchange_plan&id=I30A0716","61"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020010","Select Med Preference Bronze 5000","68781UT002",,"UTN002","UTS002","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0717","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_bronze_5000&csr=zero_cost_sharing_plan_variation&id=I30A0717","62"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0020010","Select Med Preference Bronze 5000","68781UT002",,"UTN002","UTS002","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020010-03","Limited Cost Sharing Plan Variation",,"0.617345809936523","No","Yes","No","100%",,"$5,000","$20","$230","$150","$5,000","$50","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0718","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_bronze_5000&csr=limited_cost_sharing_plan_variation&id=I30A0718","63"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030001","Select Care Preference Gold 250","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030001-00","Standard Gold Off Exchange Plan",,"0.814819753170013","No","Yes","No","100%",,"$250","$20","$1,320","$150","$250","$650","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0587","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_250&csr=standard_gold_off_exchange_plan&id=I20A0587","64"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030001","Select Care Preference Gold 250","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030001-01","Standard Gold On Exchange Plan",,"0.814819753170013","No","Yes","No","100%",,"$250","$20","$1,320","$150","$250","$650","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0588","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_250&csr=standard_gold_on_exchange_plan&id=I20A0588","65"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030001","Select Care Preference Gold 250","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0589","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_250&csr=zero_cost_sharing_plan_variation&id=I20A0589","66"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030001","Select Care Preference Gold 250","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030001-03","Limited Cost Sharing Plan Variation",,"0.814819753170013","No","Yes","No","100%",,"$250","$20","$1,320","$150","$250","$650","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0590","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_250&csr=limited_cost_sharing_plan_variation&id=I20A0590","67"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030003","Select Care Preference Gold 500","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030003-00","Standard Gold Off Exchange Plan",,"0.800042450428009","No","Yes","No","100%",,"$500","$20","$1,270","$150","$500","$630","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0595","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_500&csr=standard_gold_off_exchange_plan&id=I20A0595","68"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030003","Select Care Preference Gold 500","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030003-01","Standard Gold On Exchange Plan",,"0.800042450428009","No","Yes","No","100%",,"$500","$20","$1,270","$150","$500","$630","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0596","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_500&csr=standard_gold_on_exchange_plan&id=I20A0596","69"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030003","Select Care Preference Gold 500","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0597","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_500&csr=zero_cost_sharing_plan_variation&id=I20A0597","70"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030003","Select Care Preference Gold 500","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030003-03","Limited Cost Sharing Plan Variation",,"0.800042450428009","No","Yes","No","100%",,"$500","$20","$1,270","$150","$500","$630","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0598","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_500&csr=limited_cost_sharing_plan_variation&id=I20A0598","71"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030005","Select Care Preference Silver 1250","68781UT003",,"UTN001","UTS001","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030005-00","Standard Silver Off Exchange Plan",,"0.704492330551147","No","Yes","No","100%",,"$1,250","$20","$2,790","$150","$1,250","$540","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0603","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_1250&csr=standard_silver_off_exchange_plan&id=I20A0603","72"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030005","Select Care Preference Silver 1250","68781UT003",,"UTN001","UTS001","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030005-01","Standard Silver On Exchange Plan",,"0.704492330551147","No","Yes","No","100%",,"$1,250","$20","$2,790","$150","$1,250","$540","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0604","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_1250&csr=standard_silver_on_exchange_plan&id=I20A0604","73"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030005","Select Care Preference Silver 1250","68781UT003",,"UTN001","UTS001","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0605","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_1250&csr=zero_cost_sharing_plan_variation&id=I20A0605","74"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030005","Select Care Preference Silver 1250","68781UT003",,"UTN001","UTS001","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030005-03","Limited Cost Sharing Plan Variation",,"0.704492330551147","No","Yes","No","100%",,"$1,250","$20","$2,790","$150","$1,250","$540","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0606","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_1250&csr=limited_cost_sharing_plan_variation&id=I20A0606","75"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030005","Select Care Preference Silver 1250","68781UT003",,"UTN001","UTS001","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030005-04","73% AV Level Silver Plan",,"0.734081983566284","No","Yes","No","100%",,"$1,150","$20","$1,420","$150","$1,150","$570","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0607","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_1250&csr=73_av_level_silver_plan&id=I20A0607","76"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030005","Select Care Preference Silver 1250","68781UT003",,"UTN001","UTS001","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030005-05","87% AV Level Silver Plan",,"0.875379264354706","No","Yes","No","100%",,"$250","$20","$990","$150","$250","$550","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0608","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_1250&csr=87_av_level_silver_plan&id=I20A0608","77"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030005","Select Care Preference Silver 1250","68781UT003",,"UTN001","UTS001","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030005-06","94% AV Level Silver Plan",,"0.946483731269836","No","Yes","No","100%",,"$0","$10","$340","$150","$0","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0609","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_1250&csr=94_av_level_silver_plan&id=I20A0609","78"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030006","Select Care Preference Gold 1000","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030006-00","Standard Gold Off Exchange Plan",,"0.781731724739075","No","Yes","No","100%",,"$1,000","$20","$1,170","$150","$1,000","$540","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0610","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_1000&csr=standard_gold_off_exchange_plan&id=I20A0610","79"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030006","Select Care Preference Gold 1000","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030006-01","Standard Gold On Exchange Plan",,"0.781731724739075","No","Yes","No","100%",,"$1,000","$20","$1,170","$150","$1,000","$540","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0611","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_1000&csr=standard_gold_on_exchange_plan&id=I20A0611","80"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030006","Select Care Preference Gold 1000","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0612","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_1000&csr=zero_cost_sharing_plan_variation&id=I20A0612","81"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030006","Select Care Preference Gold 1000","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030006-03","Limited Cost Sharing Plan Variation",,"0.781731724739075","No","Yes","No","100%",,"$1,000","$20","$1,170","$150","$1,000","$540","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0613","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_1000&csr=limited_cost_sharing_plan_variation&id=I20A0613","82"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030008","Select Care Preference Silver 2500","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030008-00","Standard Silver Off Exchange Plan",,"0.693124175071716","No","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$340","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0618","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_2500&csr=standard_silver_off_exchange_plan&id=I20A0618","83"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030008","Select Care Preference Silver 2500","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030008-01","Standard Silver On Exchange Plan",,"0.693124175071716","No","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$340","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0619","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_2500&csr=standard_silver_on_exchange_plan&id=I20A0619","84"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030008","Select Care Preference Silver 2500","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0620","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_2500&csr=zero_cost_sharing_plan_variation&id=I20A0620","85"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030008","Select Care Preference Silver 2500","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030008-03","Limited Cost Sharing Plan Variation",,"0.693124175071716","No","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$340","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0621","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_2500&csr=limited_cost_sharing_plan_variation&id=I20A0621","86"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030008","Select Care Preference Silver 2500","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030008-04","73% AV Level Silver Plan",,"0.721792638301849","No","Yes","No","100%",,"$2,500","$0","$650","$150","$2,500","$340","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,150","$3150 per person","$6300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0622","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_2500&csr=73_av_level_silver_plan&id=I20A0622","87"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030008","Select Care Preference Silver 2500","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030008-05","87% AV Level Silver Plan",,"0.875379264354706","No","Yes","No","100%",,"$250","$20","$990","$150","$250","$550","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0623","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_2500&csr=87_av_level_silver_plan&id=I20A0623","88"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030008","Select Care Preference Silver 2500","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030008-06","94% AV Level Silver Plan",,"0.946483731269836","No","Yes","No","100%",,"$0","$10","$340","$150","$0","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0624","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_2500&csr=94_av_level_silver_plan&id=I20A0624","89"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030010","Select Care Preference Bronze 5000","68781UT003",,"UTN001","UTS001","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030010-00","Standard Bronze Off Exchange Plan",,"0.617345809936523","No","Yes","No","100%",,"$5,000","$20","$230","$150","$5,000","$50","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0632","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_bronze_5000&csr=standard_bronze_off_exchange_plan&id=I20A0632","90"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030010","Select Care Preference Bronze 5000","68781UT003",,"UTN001","UTS001","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030010-01","Standard Bronze On Exchange Plan",,"0.617345809936523","No","Yes","No","100%",,"$5,000","$20","$230","$150","$5,000","$50","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0633","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_bronze_5000&csr=standard_bronze_on_exchange_plan&id=I20A0633","91"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030010","Select Care Preference Bronze 5000","68781UT003",,"UTN001","UTS001","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0634","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_bronze_5000&csr=zero_cost_sharing_plan_variation&id=I20A0634","92"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","1","68781","UT","Individual","No","87-0409820","68781UT0030010","Select Care Preference Bronze 5000","68781UT003",,"UTN001","UTS001","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030010-03","Limited Cost Sharing Plan Variation",,"0.617345809936523","No","Yes","No","100%",,"$5,000","$20","$230","$150","$5,000","$50","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0635","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_bronze_5000&csr=limited_cost_sharing_plan_variation&id=I20A0635","93"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0010002","Select Value Preference Gold 250 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010002-00","Standard Gold Off Exchange Plan",,"0.817227482795715","No","Yes","No","100%",,"$250","$20","$1,300","$150","$250","$650","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0816","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_250_w/no_deductible_for_office_visits&csr=standard_gold_off_exchange_plan&id=I40A0816","4"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0010002","Select Value Preference Gold 250 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010002-01","Standard Gold On Exchange Plan",,"0.817227482795715","No","Yes","No","100%",,"$250","$20","$1,300","$150","$250","$650","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0817","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_250_w/no_deductible_for_office_visits&csr=standard_gold_on_exchange_plan&id=I40A0817","5"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0010002","Select Value Preference Gold 250 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0818","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_250_w/no_deductible_for_office_visits&csr=zero_cost_sharing_plan_variation&id=I40A0818","6"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0010002","Select Value Preference Gold 250 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010002-03","Limited Cost Sharing Plan Variation",,"0.817227482795715","No","Yes","No","100%",,"$250","$20","$1,300","$150","$250","$650","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0819","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_250_w/no_deductible_for_office_visits&csr=limited_cost_sharing_plan_variation&id=I40A0819","7"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0010004","Select Value Preference Gold 500 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010004-00","Standard Gold Off Exchange Plan",,"0.804993987083435","No","Yes","No","100%",,"$500","$20","$1,250","$150","$500","$630","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0824","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_500_w/no_deductible_for_office_visits&csr=standard_gold_off_exchange_plan&id=I40A0824","8"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0010004","Select Value Preference Gold 500 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010004-01","Standard Gold On Exchange Plan",,"0.804993987083435","No","Yes","No","100%",,"$500","$20","$1,250","$150","$500","$630","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0825","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_500_w/no_deductible_for_office_visits&csr=standard_gold_on_exchange_plan&id=I40A0825","9"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0010004","Select Value Preference Gold 500 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0826","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_500_w/no_deductible_for_office_visits&csr=zero_cost_sharing_plan_variation&id=I40A0826","10"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0010004","Select Value Preference Gold 500 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010004-03","Limited Cost Sharing Plan Variation",,"0.804993987083435","No","Yes","No","100%",,"$500","$20","$1,250","$150","$500","$630","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0827","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_500_w/no_deductible_for_office_visits&csr=limited_cost_sharing_plan_variation&id=I40A0827","11"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0010007","Select Value Preference Gold 1000 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010007-00","Standard Gold Off Exchange Plan",,"0.810697734355927","No","Yes","No","100%",,"$1,000","$20","$1,150","$150","$1,000","$510","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0839","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_1000_w/no_deductible_for_office_visits&csr=standard_gold_off_exchange_plan&id=I40A0839","12"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0010007","Select Value Preference Gold 1000 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010007-01","Standard Gold On Exchange Plan",,"0.810697734355927","No","Yes","No","100%",,"$1,000","$20","$1,150","$150","$1,000","$510","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0840","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_1000_w/no_deductible_for_office_visits&csr=standard_gold_on_exchange_plan&id=I40A0840","13"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0010007","Select Value Preference Gold 1000 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0841","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_1000_w/no_deductible_for_office_visits&csr=zero_cost_sharing_plan_variation&id=I40A0841","14"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0010007","Select Value Preference Gold 1000 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010007-03","Limited Cost Sharing Plan Variation",,"0.810697734355927","No","Yes","No","100%",,"$1,000","$20","$1,150","$150","$1,000","$510","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0842","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_gold_1000_w/no_deductible_for_office_visits&csr=limited_cost_sharing_plan_variation&id=I40A0842","15"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0020002","Select Med Preference Gold 250 w/no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020002-00","Standard Gold Off Exchange Plan",,"0.817227482795715","No","Yes","No","100%",,"$250","$20","$1,300","$150","$250","$650","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0674","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_250_w/no_deductible_for_office_visits&csr=standard_gold_off_exchange_plan&id=I30A0674","16"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0020002","Select Med Preference Gold 250 w/no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020002-01","Standard Gold On Exchange Plan",,"0.817227482795715","No","Yes","No","100%",,"$250","$20","$1,300","$150","$250","$650","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0675","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_250_w/no_deductible_for_office_visits&csr=standard_gold_on_exchange_plan&id=I30A0675","17"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0020002","Select Med Preference Gold 250 w/no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0676","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_250_w/no_deductible_for_office_visits&csr=zero_cost_sharing_plan_variation&id=I30A0676","18"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0020002","Select Med Preference Gold 250 w/no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020002-03","Limited Cost Sharing Plan Variation",,"0.817227482795715","No","Yes","No","100%",,"$250","$20","$1,300","$150","$250","$650","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0677","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_250_w/no_deductible_for_office_visits&csr=limited_cost_sharing_plan_variation&id=I30A0677","19"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0020004","Select Med Preference Gold 500 w/no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020004-00","Standard Gold Off Exchange Plan",,"0.804993987083435","No","Yes","No","100%",,"$500","$20","$1,250","$150","$500","$630","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0682","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_500_w/no_deductible_for_office_visits&csr=standard_gold_off_exchange_plan&id=I30A0682","20"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0020004","Select Med Preference Gold 500 w/no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020004-01","Standard Gold On Exchange Plan",,"0.804993987083435","No","Yes","No","100%",,"$500","$20","$1,250","$150","$500","$630","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0683","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_500_w/no_deductible_for_office_visits&csr=standard_gold_on_exchange_plan&id=I30A0683","21"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0020004","Select Med Preference Gold 500 w/no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0684","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_500_w/no_deductible_for_office_visits&csr=zero_cost_sharing_plan_variation&id=I30A0684","22"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0020004","Select Med Preference Gold 500 w/no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020004-03","Limited Cost Sharing Plan Variation",,"0.804993987083435","No","Yes","No","100%",,"$500","$20","$1,250","$150","$500","$630","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0685","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_500_w/no_deductible_for_office_visits&csr=limited_cost_sharing_plan_variation&id=I30A0685","23"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0020007","Select Med Preference Gold 1000 w/no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020007-00","Standard Gold Off Exchange Plan",,"0.810697734355927","No","Yes","No","100%",,"$1,000","$20","$1,150","$150","$1,000","$510","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0697","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_1000_w/no_deductible_for_office_visits&csr=standard_gold_off_exchange_plan&id=I30A0697","24"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0020007","Select Med Preference Gold 1000 w/no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020007-01","Standard Gold On Exchange Plan",,"0.810697734355927","No","Yes","No","100%",,"$1,000","$20","$1,150","$150","$1,000","$510","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0698","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_1000_w/no_deductible_for_office_visits&csr=standard_gold_on_exchange_plan&id=I30A0698","25"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0020007","Select Med Preference Gold 1000 w/no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0699","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_1000_w/no_deductible_for_office_visits&csr=zero_cost_sharing_plan_variation&id=I30A0699","26"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0020007","Select Med Preference Gold 1000 w/no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020007-03","Limited Cost Sharing Plan Variation",,"0.810697734355927","No","Yes","No","100%",,"$1,000","$20","$1,150","$150","$1,000","$510","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0700","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_gold_1000_w/no_deductible_for_office_visits&csr=limited_cost_sharing_plan_variation&id=I30A0700","27"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0030002","Select Care Preference Gold 250 w/no deductible for office visits","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030002-00","Standard Gold Off Exchange Plan",,"0.817227482795715","No","Yes","No","100%",,"$250","$20","$1,300","$150","$250","$650","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0591","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_250_w/no_deductible_for_office_visits&csr=standard_gold_off_exchange_plan&id=I20A0591","28"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0030002","Select Care Preference Gold 250 w/no deductible for office visits","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030002-01","Standard Gold On Exchange Plan",,"0.817227482795715","No","Yes","No","100%",,"$250","$20","$1,300","$150","$250","$650","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0592","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_250_w/no_deductible_for_office_visits&csr=standard_gold_on_exchange_plan&id=I20A0592","29"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0030002","Select Care Preference Gold 250 w/no deductible for office visits","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0593","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_250_w/no_deductible_for_office_visits&csr=zero_cost_sharing_plan_variation&id=I20A0593","30"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0030002","Select Care Preference Gold 250 w/no deductible for office visits","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030002-03","Limited Cost Sharing Plan Variation",,"0.817227482795715","No","Yes","No","100%",,"$250","$20","$1,300","$150","$250","$650","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0594","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_250_w/no_deductible_for_office_visits&csr=limited_cost_sharing_plan_variation&id=I20A0594","31"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0030004","Select Care Preference Gold 500 w/no deductible for office visits","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030004-00","Standard Gold Off Exchange Plan",,"0.804993987083435","No","Yes","No","100%",,"$500","$20","$1,250","$150","$500","$630","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0599","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_500_w/no_deductible_for_office_visits&csr=standard_gold_off_exchange_plan&id=I20A0599","32"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0030004","Select Care Preference Gold 500 w/no deductible for office visits","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030004-01","Standard Gold On Exchange Plan",,"0.804993987083435","No","Yes","No","100%",,"$500","$20","$1,250","$150","$500","$630","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0600","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_500_w/no_deductible_for_office_visits&csr=standard_gold_on_exchange_plan&id=I20A0600","33"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0030004","Select Care Preference Gold 500 w/no deductible for office visits","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0601","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_500_w/no_deductible_for_office_visits&csr=zero_cost_sharing_plan_variation&id=I20A0601","34"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0030004","Select Care Preference Gold 500 w/no deductible for office visits","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030004-03","Limited Cost Sharing Plan Variation",,"0.804993987083435","No","Yes","No","100%",,"$500","$20","$1,250","$150","$500","$630","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0602","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_500_w/no_deductible_for_office_visits&csr=limited_cost_sharing_plan_variation&id=I20A0602","35"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0030007","Select Care Preference Gold 1000 w/no deductible for office visits","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030007-00","Standard Gold Off Exchange Plan",,"0.810697734355927","No","Yes","No","100%",,"$1,000","$20","$1,150","$150","$1,000","$510","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0614","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_1000_w/no_deductible_for_office_visits&csr=standard_gold_off_exchange_plan&id=I20A0614","36"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0030007","Select Care Preference Gold 1000 w/no deductible for office visits","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030007-01","Standard Gold On Exchange Plan",,"0.810697734355927","No","Yes","No","100%",,"$1,000","$20","$1,150","$150","$1,000","$510","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0615","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_1000_w/no_deductible_for_office_visits&csr=standard_gold_on_exchange_plan&id=I20A0615","37"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0030007","Select Care Preference Gold 1000 w/no deductible for office visits","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0616","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_1000_w/no_deductible_for_office_visits&csr=zero_cost_sharing_plan_variation&id=I20A0616","38"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","2","68781","UT","Individual","No","87-0409820","68781UT0030007","Select Care Preference Gold 1000 w/no deductible for office visits","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030007-03","Limited Cost Sharing Plan Variation",,"0.810697734355927","No","Yes","No","100%",,"$1,000","$20","$1,150","$150","$1,000","$510","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0617","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_gold_1000_w/no_deductible_for_office_visits&csr=limited_cost_sharing_plan_variation&id=I20A0617","39"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0010009","Select Value Preference Silver 2500 w/limited office visit waiver","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010009-00","Standard Silver Off Exchange Plan",,"0.68352347612381","No","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$340","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0850","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_2500_w/4_deductible-free_office_visits&csr=standard_silver_off_exchange_plan&id=I40A0850","4"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0010009","Select Value Preference Silver 2500 w/limited office visit waiver","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010009-01","Standard Silver On Exchange Plan",,"0.68352347612381","No","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$340","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0851","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_2500_w/4_deductible-free_office_visits&csr=standard_silver_on_exchange_plan&id=I40A0851","5"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0010009","Select Value Preference Silver 2500 w/limited office visit waiver","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0852","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_2500_w/4_deductible-free_office_visits&csr=zero_cost_sharing_plan_variation&id=I40A0852","6"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0010009","Select Value Preference Silver 2500 w/limited office visit waiver","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010009-03","Limited Cost Sharing Plan Variation",,"0.68352347612381","No","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$340","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0853","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_2500_w/4_deductible-free_office_visits&csr=limited_cost_sharing_plan_variation&id=I40A0853","7"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0010009","Select Value Preference Silver 2500 w/limited office visit waiver","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010009-04","73% AV Level Silver Plan",,"0.721684157848358","No","Yes","No","100%",,"$2,000","$20","$970","$150","$2,000","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0854","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_2500_w/4_deductible-free_office_visits&csr=73_av_level_silver_plan&id=I40A0854","8"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0010009","Select Value Preference Silver 2500 w/limited office visit waiver","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010009-05","87% AV Level Silver Plan",,"0.875379264354706","No","Yes","No","100%",,"$250","$20","$990","$150","$250","$550","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0855","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_2500_w/4_deductible-free_office_visits&csr=87_av_level_silver_plan&id=I40A0855","9"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0010009","Select Value Preference Silver 2500 w/limited office visit waiver","68781UT001",,"UTN003","UTS003","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010009-06","94% AV Level Silver Plan",,"0.946483731269836","No","Yes","No","100%",,"$0","$10","$340","$150","$0","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0856","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_2500_w/4_deductible-free_office_visits&csr=94_av_level_silver_plan&id=I40A0856","10"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0010011","Select Value Preference Bronze 6000 w/limited office visit waiver","68781UT001",,"UTN003","UTS003","UTF004","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010011-00","Standard Bronze Off Exchange Plan",,"0.594992458820343","No","Yes","No","100%",,"$6,000","$20","$250","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0861","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_bronze_6000_w/4_deductible-free_office_visits&csr=standard_bronze_off_exchange_plan&id=I40A0861","11"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0010011","Select Value Preference Bronze 6000 w/limited office visit waiver","68781UT001",,"UTN003","UTS003","UTF004","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010011-01","Standard Bronze On Exchange Plan",,"0.594992458820343","No","Yes","No","100%",,"$6,000","$20","$250","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0862","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_bronze_6000_w/4_deductible-free_office_visits&csr=standard_bronze_on_exchange_plan&id=I40A0862","12"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0010011","Select Value Preference Bronze 6000 w/limited office visit waiver","68781UT001",,"UTN003","UTS003","UTF004","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010011-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0863","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_bronze_6000_w/4_deductible-free_office_visits&csr=zero_cost_sharing_plan_variation&id=I40A0863","13"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0010011","Select Value Preference Bronze 6000 w/limited office visit waiver","68781UT001",,"UTN003","UTS003","UTF004","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010011-03","Limited Cost Sharing Plan Variation",,"0.594992458820343","No","Yes","No","100%",,"$6,000","$20","$250","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0864","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_bronze_6000_w/4_deductible-free_office_visits&csr=limited_cost_sharing_plan_variation&id=I40A0864","14"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0020009","Select Med Preference Silver 2500 w/limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020009-00","Standard Silver Off Exchange Plan",,"0.68352347612381","No","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$340","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0708","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_2500_w/4_deductible-free_office_visits&csr=standard_silver_off_exchange_plan&id=I30A0708","15"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0020009","Select Med Preference Silver 2500 w/limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020009-01","Standard Silver On Exchange Plan",,"0.68352347612381","No","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$340","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0709","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_2500_w/4_deductible-free_office_visits&csr=standard_silver_on_exchange_plan&id=I30A0709","16"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0020009","Select Med Preference Silver 2500 w/limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0710","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_2500_w/4_deductible-free_office_visits&csr=zero_cost_sharing_plan_variation&id=I30A0710","17"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0020009","Select Med Preference Silver 2500 w/limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020009-03","Limited Cost Sharing Plan Variation",,"0.68352347612381","No","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$340","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0711","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_2500_w/4_deductible-free_office_visits&csr=limited_cost_sharing_plan_variation&id=I30A0711","18"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0020009","Select Med Preference Silver 2500 w/limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020009-04","73% AV Level Silver Plan",,"0.721684157848358","No","Yes","No","100%",,"$2,000","$20","$970","$150","$2,000","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0712","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_2500_w/4_deductible-free_office_visits&csr=73_av_level_silver_plan&id=I30A0712","19"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0020009","Select Med Preference Silver 2500 w/limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020009-05","87% AV Level Silver Plan",,"0.875379264354706","No","Yes","No","100%",,"$250","$20","$990","$150","$250","$550","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0713","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_2500_w/4_deductible-free_office_visits&csr=87_av_level_silver_plan&id=I30A0713","20"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0020009","Select Med Preference Silver 2500 w/limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020009-06","94% AV Level Silver Plan",,"0.946483731269836","No","Yes","No","100%",,"$0","$10","$340","$150","$0","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0714","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_2500_w/4_deductible-free_office_visits&csr=94_av_level_silver_plan&id=I30A0714","21"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0020011","Select Med Preference Bronze 6000 w/limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF004","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020011-00","Standard Bronze Off Exchange Plan",,"0.594992458820343","No","Yes","No","100%",,"$6,000","$20","$250","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0719","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_bronze_6000_w/4_deductible-free_office_visits&csr=standard_bronze_off_exchange_plan&id=I30A0719","22"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0020011","Select Med Preference Bronze 6000 w/limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF004","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020011-01","Standard Bronze On Exchange Plan",,"0.594992458820343","No","Yes","No","100%",,"$6,000","$20","$250","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0720","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_bronze_6000_w/4_deductible-free_office_visits&csr=standard_bronze_on_exchange_plan&id=I30A0720","23"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0020011","Select Med Preference Bronze 6000 w/limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF004","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020011-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0721","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_bronze_6000_w/4_deductible-free_office_visits&csr=zero_cost_sharing_plan_variation&id=I30A0721","24"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0020011","Select Med Preference Bronze 6000 w/limited office visit waiver","68781UT002",,"UTN002","UTS002","UTF004","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020011-03","Limited Cost Sharing Plan Variation",,"0.594992458820343","No","Yes","No","100%",,"$6,000","$20","$250","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0722","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_bronze_6000_w/4_deductible-free_office_visits&csr=limited_cost_sharing_plan_variation&id=I30A0722","25"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0030009","Select Care Preference Silver 2500 w/limited office visit waiver","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030009-00","Standard Silver Off Exchange Plan",,"0.68352347612381","No","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$340","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0625","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_2500_w/4_deductible-free_office_visits&csr=standard_silver_off_exchange_plan&id=I20A0625","26"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0030009","Select Care Preference Silver 2500 w/limited office visit waiver","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030009-01","Standard Silver On Exchange Plan",,"0.68352347612381","No","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$340","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0626","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_2500_w/4_deductible-free_office_visits&csr=standard_silver_on_exchange_plan&id=I20A0626","27"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0030009","Select Care Preference Silver 2500 w/limited office visit waiver","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0627","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_2500_w/4_deductible-free_office_visits&csr=zero_cost_sharing_plan_variation&id=I20A0627","28"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0030009","Select Care Preference Silver 2500 w/limited office visit waiver","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030009-03","Limited Cost Sharing Plan Variation",,"0.68352347612381","No","Yes","No","100%",,"$2,500","$20","$930","$150","$2,500","$340","$150","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0628","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_2500_w/4_deductible-free_office_visits&csr=limited_cost_sharing_plan_variation&id=I20A0628","29"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0030009","Select Care Preference Silver 2500 w/limited office visit waiver","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030009-04","73% AV Level Silver Plan",,"0.721684157848358","No","Yes","No","100%",,"$2,000","$20","$970","$150","$2,000","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0629","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_2500_w/4_deductible-free_office_visits&csr=73_av_level_silver_plan&id=I20A0629","30"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0030009","Select Care Preference Silver 2500 w/limited office visit waiver","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030009-05","87% AV Level Silver Plan",,"0.875379264354706","No","Yes","No","100%",,"$250","$20","$990","$150","$250","$550","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0630","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_2500_w/4_deductible-free_office_visits&csr=87_av_level_silver_plan&id=I20A0630","31"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0030009","Select Care Preference Silver 2500 w/limited office visit waiver","68781UT003",,"UTN001","UTS001","UTF002","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030009-06","94% AV Level Silver Plan",,"0.946483731269836","No","Yes","No","100%",,"$0","$10","$340","$150","$0","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0631","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_2500_w/4_deductible-free_office_visits&csr=94_av_level_silver_plan&id=I20A0631","32"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0030011","Select Care Preference Bronze 6000 w/limited office visit waiver","68781UT003",,"UTN001","UTS001","UTF004","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030011-00","Standard Bronze Off Exchange Plan",,"0.594992458820343","No","Yes","No","100%",,"$6,000","$20","$250","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0636","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_bronze_6000_w/4_deductible-free_office_visits&csr=standard_bronze_off_exchange_plan&id=I20A0636","33"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0030011","Select Care Preference Bronze 6000 w/limited office visit waiver","68781UT003",,"UTN001","UTS001","UTF004","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030011-01","Standard Bronze On Exchange Plan",,"0.594992458820343","No","Yes","No","100%",,"$6,000","$20","$250","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0637","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_bronze_6000_w/4_deductible-free_office_visits&csr=standard_bronze_on_exchange_plan&id=I20A0637","34"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0030011","Select Care Preference Bronze 6000 w/limited office visit waiver","68781UT003",,"UTN001","UTS001","UTF004","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030011-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0638","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_bronze_6000_w/4_deductible-free_office_visits&csr=zero_cost_sharing_plan_variation&id=I20A0638","35"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","3","68781","UT","Individual","No","87-0409820","68781UT0030011","Select Care Preference Bronze 6000 w/limited office visit waiver","68781UT003",,"UTN001","UTS001","UTF004","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030011-03","Limited Cost Sharing Plan Variation",,"0.594992458820343","No","Yes","No","100%",,"$6,000","$20","$250","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$850","$850 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0639","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_bronze_6000_w/4_deductible-free_office_visits&csr=limited_cost_sharing_plan_variation&id=I20A0639","36"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","4","68781","UT","Individual","No","87-0409820","68781UT0010012","Select Value Preference Silver 3800 Copay Plan","68781UT001",,"UTN003","UTS003","UTF005","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"3","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010012-00","Standard Silver Off Exchange Plan",,"0.688470661640167","No","Yes","No","100%",,"$3,800","$520","$0","$150","$3,800","$310","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0865","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_3800_copay_plan&csr=standard_silver_off_exchange_plan&id=I40A0865","4"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","4","68781","UT","Individual","No","87-0409820","68781UT0010012","Select Value Preference Silver 3800 Copay Plan","68781UT001",,"UTN003","UTS003","UTF005","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"3","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010012-01","Standard Silver On Exchange Plan",,"0.688470661640167","No","Yes","No","100%",,"$3,800","$520","$0","$150","$3,800","$310","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0866","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_3800_copay_plan&csr=standard_silver_on_exchange_plan&id=I40A0866","5"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","4","68781","UT","Individual","No","87-0409820","68781UT0010012","Select Value Preference Silver 3800 Copay Plan","68781UT001",,"UTN003","UTS003","UTF005","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"3","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010012-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0867","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_3800_copay_plan&csr=zero_cost_sharing_plan_variation&id=I40A0867","6"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","4","68781","UT","Individual","No","87-0409820","68781UT0010012","Select Value Preference Silver 3800 Copay Plan","68781UT001",,"UTN003","UTS003","UTF005","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"3","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010012-03","Limited Cost Sharing Plan Variation",,"0.688470661640167","No","Yes","No","100%",,"$3,800","$520","$0","$150","$3,800","$310","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0868","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_3800_copay_plan&csr=limited_cost_sharing_plan_variation&id=I40A0868","7"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","4","68781","UT","Individual","No","87-0409820","68781UT0010012","Select Value Preference Silver 3800 Copay Plan","68781UT001",,"UTN003","UTS003","UTF005","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"3","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010012-04","73% AV Level Silver Plan",,"0.732775866985321","No","Yes","No","100%",,"$3,100","$520","$0","$150","$3,100","$230","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0869","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_3800_copay_plan&csr=73_av_level_silver_plan&id=I40A0869","8"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","4","68781","UT","Individual","No","87-0409820","68781UT0010012","Select Value Preference Silver 3800 Copay Plan","68781UT001",,"UTN003","UTS003","UTF005","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"3","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010012-05","87% AV Level Silver Plan",,"0.878679931163788","No","Yes","No","100%",,"$250","$1,020","$30","$150","$250","$550","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0870","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_3800_copay_plan&csr=87_av_level_silver_plan&id=I40A0870","9"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","4","68781","UT","Individual","No","87-0409820","68781UT0010012","Select Value Preference Silver 3800 Copay Plan","68781UT001",,"UTN003","UTS003","UTF005","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"3","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010012-06","94% AV Level Silver Plan",,"0.942700088024139","No","Yes","No","100%",,"$0","$310","$10","$150","$0","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0871","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_silver_3800_copay_plan&csr=94_av_level_silver_plan&id=I40A0871","10"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","4","68781","UT","Individual","No","87-0409820","68781UT0020012","Select Med Preference Silver 3800 Copay Plan","68781UT002",,"UTN002","UTS002","UTF005","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"3","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020012-00","Standard Silver Off Exchange Plan",,"0.688470661640167","No","Yes","No","100%",,"$3,800","$520","$0","$150","$3,800","$310","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0723","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_3800_copay_plan&csr=standard_silver_off_exchange_plan&id=I30A0723","11"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","4","68781","UT","Individual","No","87-0409820","68781UT0020012","Select Med Preference Silver 3800 Copay Plan","68781UT002",,"UTN002","UTS002","UTF005","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"3","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020012-01","Standard Silver On Exchange Plan",,"0.688470661640167","No","Yes","No","100%",,"$3,800","$520","$0","$150","$3,800","$310","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0724","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_3800_copay_plan&csr=standard_silver_on_exchange_plan&id=I30A0724","12"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","4","68781","UT","Individual","No","87-0409820","68781UT0020012","Select Med Preference Silver 3800 Copay Plan","68781UT002",,"UTN002","UTS002","UTF005","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"3","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020012-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0725","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_3800_copay_plan&csr=zero_cost_sharing_plan_variation&id=I30A0725","13"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","4","68781","UT","Individual","No","87-0409820","68781UT0020012","Select Med Preference Silver 3800 Copay Plan","68781UT002",,"UTN002","UTS002","UTF005","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"3","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020012-03","Limited Cost Sharing Plan Variation",,"0.688470661640167","No","Yes","No","100%",,"$3,800","$520","$0","$150","$3,800","$310","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0726","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_3800_copay_plan&csr=limited_cost_sharing_plan_variation&id=I30A0726","14"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","4","68781","UT","Individual","No","87-0409820","68781UT0020012","Select Med Preference Silver 3800 Copay Plan","68781UT002",,"UTN002","UTS002","UTF005","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"3","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020012-04","73% AV Level Silver Plan",,"0.732775866985321","No","Yes","No","100%",,"$3,100","$520","$0","$150","$3,100","$230","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0727","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_3800_copay_plan&csr=73_av_level_silver_plan&id=I30A0727","15"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","4","68781","UT","Individual","No","87-0409820","68781UT0020012","Select Med Preference Silver 3800 Copay Plan","68781UT002",,"UTN002","UTS002","UTF005","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"3","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020012-05","87% AV Level Silver Plan",,"0.878679931163788","No","Yes","No","100%",,"$250","$1,020","$30","$150","$250","$550","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0728","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_3800_copay_plan&csr=87_av_level_silver_plan&id=I30A0728","16"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","4","68781","UT","Individual","No","87-0409820","68781UT0020012","Select Med Preference Silver 3800 Copay Plan","68781UT002",,"UTN002","UTS002","UTF005","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"3","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020012-06","94% AV Level Silver Plan",,"0.942700088024139","No","Yes","No","100%",,"$0","$310","$10","$150","$0","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0729","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_silver_3800_copay_plan&csr=94_av_level_silver_plan&id=I30A0729","17"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","4","68781","UT","Individual","No","87-0409820","68781UT0030012","Select Care Preference Silver 3800 Copay Plan","68781UT003",,"UTN001","UTS001","UTF005","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"3","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030012-00","Standard Silver Off Exchange Plan",,"0.688470661640167","No","Yes","No","100%",,"$3,800","$520","$0","$150","$3,800","$310","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0640","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_3800_copay_plan&csr=standard_silver_off_exchange_plan&id=I20A0640","18"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","4","68781","UT","Individual","No","87-0409820","68781UT0030012","Select Care Preference Silver 3800 Copay Plan","68781UT003",,"UTN001","UTS001","UTF005","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"3","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030012-01","Standard Silver On Exchange Plan",,"0.688470661640167","No","Yes","No","100%",,"$3,800","$520","$0","$150","$3,800","$310","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0641","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_3800_copay_plan&csr=standard_silver_on_exchange_plan&id=I20A0641","19"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","4","68781","UT","Individual","No","87-0409820","68781UT0030012","Select Care Preference Silver 3800 Copay Plan","68781UT003",,"UTN001","UTS001","UTF005","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"3","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030012-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0642","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_3800_copay_plan&csr=zero_cost_sharing_plan_variation&id=I20A0642","20"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","4","68781","UT","Individual","No","87-0409820","68781UT0030012","Select Care Preference Silver 3800 Copay Plan","68781UT003",,"UTN001","UTS001","UTF005","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"3","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030012-03","Limited Cost Sharing Plan Variation",,"0.688470661640167","No","Yes","No","100%",,"$3,800","$520","$0","$150","$3,800","$310","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,800","$3800 per person","$7600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0643","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_3800_copay_plan&csr=limited_cost_sharing_plan_variation&id=I20A0643","21"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","4","68781","UT","Individual","No","87-0409820","68781UT0030012","Select Care Preference Silver 3800 Copay Plan","68781UT003",,"UTN001","UTS001","UTF005","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"3","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030012-04","73% AV Level Silver Plan",,"0.732775866985321","No","Yes","No","100%",,"$3,100","$520","$0","$150","$3,100","$230","$120","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0644","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_3800_copay_plan&csr=73_av_level_silver_plan&id=I20A0644","22"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","4","68781","UT","Individual","No","87-0409820","68781UT0030012","Select Care Preference Silver 3800 Copay Plan","68781UT003",,"UTN001","UTS001","UTF005","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"3","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030012-05","87% AV Level Silver Plan",,"0.878679931163788","No","Yes","No","100%",,"$250","$1,020","$30","$150","$250","$550","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0645","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_3800_copay_plan&csr=87_av_level_silver_plan&id=I20A0645","23"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","4","68781","UT","Individual","No","87-0409820","68781UT0030012","Select Care Preference Silver 3800 Copay Plan","68781UT003",,"UTN001","UTS001","UTF005","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"3","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030012-06","94% AV Level Silver Plan",,"0.942700088024139","No","Yes","No","100%",,"$0","$310","$10","$150","$0","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0646","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_silver_3800_copay_plan&csr=94_av_level_silver_plan&id=I20A0646","24"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010014","Select Value HealthSave Silver 1500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010014-00","Standard Silver Off Exchange Plan",,"0.710766315460205","Yes","Yes","No","100%",,"$1,500","$20","$1,330","$150","$1,500","$510","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0873","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_1500_(hsa_qualified)_&csr=standard_silver_off_exchange_plan&id=I40A0873","4"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010014","Select Value HealthSave Silver 1500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010014-01","Standard Silver On Exchange Plan",,"0.710766315460205","Yes","Yes","No","100%",,"$1,500","$20","$1,330","$150","$1,500","$510","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0875","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_1500_(hsa_qualified)_&csr=standard_silver_on_exchange_plan&id=I40A0875","5"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010014","Select Value HealthSave Silver 1500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0877","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_1500_(hsa_qualified)_&csr=zero_cost_sharing_plan_variation&id=I40A0877","6"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010014","Select Value HealthSave Silver 1500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010014-03","Limited Cost Sharing Plan Variation",,"0.710766315460205","Yes","Yes","No","100%",,"$1,500","$20","$1,330","$150","$1,500","$510","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0879","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_1500_(hsa_qualified)_&csr=limited_cost_sharing_plan_variation&id=I40A0879","7"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010014","Select Value HealthSave Silver 1500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010014-04","73% AV Level Silver Plan",,"0.739325642585754","Yes","Yes","No","100%",,"$1,400","$20","$1,090","$150","$1,400","$470","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","per person not applicable","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0881","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_1500_(hsa_qualified)_&csr=73_av_level_silver_plan&id=I40A0881","8"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010014","Select Value HealthSave Silver 1500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010014-05","87% AV Level Silver Plan",,"0.872800230979919","Yes","Yes","No","100%",,"$350","$20","$970","$150","$350","$550","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","per person not applicable","$875 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0883","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_1500_(hsa_qualified)_&csr=87_av_level_silver_plan&id=I40A0883","9"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010014","Select Value HealthSave Silver 1500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010014-06","94% AV Level Silver Plan",,"0.940327286720276","Yes","Yes","No","100%",,"$100","$10","$340","$150","$100","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$250 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0885","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_1500_(hsa_qualified)_&csr=94_av_level_silver_plan&id=I40A0885","10"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010015","Select Value HealthSave Silver 2000 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010015-00","Standard Silver Off Exchange Plan",,"0.696931302547455","Yes","Yes","No","100%",,"$2,000","$20","$970","$150","$2,000","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0887","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_2000_(hsa_qualified)_&csr=standard_silver_off_exchange_plan&id=I40A0887","11"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010015","Select Value HealthSave Silver 2000 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010015-01","Standard Silver On Exchange Plan",,"0.696931302547455","Yes","Yes","No","100%",,"$2,000","$20","$970","$150","$2,000","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0889","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_2000_(hsa_qualified)_&csr=standard_silver_on_exchange_plan&id=I40A0889","12"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010015","Select Value HealthSave Silver 2000 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0891","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_2000_(hsa_qualified)_&csr=zero_cost_sharing_plan_variation&id=I40A0891","13"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010015","Select Value HealthSave Silver 2000 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010015-03","Limited Cost Sharing Plan Variation",,"0.696931302547455","Yes","Yes","No","100%",,"$2,000","$20","$970","$150","$2,000","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0893","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_2000_(hsa_qualified)_&csr=limited_cost_sharing_plan_variation&id=I40A0893","14"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010015","Select Value HealthSave Silver 2000 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010015-04","73% AV Level Silver Plan",,"0.738318860530853","Yes","Yes","No","100%",,"$1,500","$20","$1,070","$150","$1,500","$460","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0895","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_2000_(hsa_qualified)_&csr=73_av_level_silver_plan&id=I40A0895","15"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010015","Select Value HealthSave Silver 2000 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010015-05","87% AV Level Silver Plan",,"0.872800230979919","Yes","Yes","No","100%",,"$350","$20","$970","$150","$350","$550","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","per person not applicable","$875 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0897","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_2000_(hsa_qualified)_&csr=87_av_level_silver_plan&id=I40A0897","16"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010015","Select Value HealthSave Silver 2000 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010015-06","94% AV Level Silver Plan",,"0.93768185377121","Yes","Yes","No","100%",,"$100","$10","$340","$150","$100","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$250 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0899","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_2000_(hsa_qualified)_&csr=94_av_level_silver_plan&id=I40A0899","17"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010016","Select Value HealthSave Bronze 4500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF007","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010016-00","Standard Bronze Off Exchange Plan",,"0.618812620639801","Yes","Yes","No","100%",,"$4,500","$20","$830","$150","$4,500","$90","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0901","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_bronze_4500_(hsa_qualified)_&csr=standard_bronze_off_exchange_plan&id=I40A0901","18"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010016","Select Value HealthSave Bronze 4500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF007","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010016-01","Standard Bronze On Exchange Plan",,"0.618812620639801","Yes","Yes","No","100%",,"$4,500","$20","$830","$150","$4,500","$90","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0903","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_bronze_4500_(hsa_qualified)_&csr=standard_bronze_on_exchange_plan&id=I40A0903","19"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010016","Select Value HealthSave Bronze 4500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF007","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0905","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_bronze_4500_(hsa_qualified)_&csr=zero_cost_sharing_plan_variation&id=I40A0905","20"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010016","Select Value HealthSave Bronze 4500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF007","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010016-03","Limited Cost Sharing Plan Variation",,"0.618812620639801","Yes","Yes","No","100%",,"$4,500","$20","$830","$150","$4,500","$90","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0907","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_bronze_4500_(hsa_qualified)_&csr=limited_cost_sharing_plan_variation&id=I40A0907","21"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010017","Select Value HealthSave Silver 3500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF008","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010017-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0909","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_3500_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=standard_silver_off_exchange_plan&id=I40A0909","22"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010017","Select Value HealthSave Silver 3500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF008","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010017-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0911","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_3500_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=standard_silver_on_exchange_plan&id=I40A0911","23"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010017","Select Value HealthSave Silver 3500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF008","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0913","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_3500_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=zero_cost_sharing_plan_variation&id=I40A0913","24"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010017","Select Value HealthSave Silver 3500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF008","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010017-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0915","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_3500_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=limited_cost_sharing_plan_variation&id=I40A0915","25"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010017","Select Value HealthSave Silver 3500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF008","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010017-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$150","$3,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0917","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_3500_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=73_av_level_silver_plan&id=I40A0917","26"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010017","Select Value HealthSave Silver 3500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF008","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010017-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$150","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","per person not applicable","$2500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0919","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_3500_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=87_av_level_silver_plan&id=I40A0919","27"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010017","Select Value HealthSave Silver 3500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF008","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010017-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$150","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0921","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_silver_3500_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=94_av_level_silver_plan&id=I40A0921","28"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010018","Select Value HealthSave Bronze 6550 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF008","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010018-00","Standard Bronze Off Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","per person not applicable","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0923","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_bronze_6600_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=standard_bronze_off_exchange_plan&id=I40A0923","29"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010018","Select Value HealthSave Bronze 6550 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF008","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010018-01","Standard Bronze On Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","per person not applicable","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0925","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_bronze_6600_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=standard_bronze_on_exchange_plan&id=I40A0925","30"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010018","Select Value HealthSave Bronze 6550 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF008","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0927","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_bronze_6600_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=zero_cost_sharing_plan_variation&id=I40A0927","31"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0010018","Select Value HealthSave Bronze 6550 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF008","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010018-03","Limited Cost Sharing Plan Variation",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","per person not applicable","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0929","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_healthsave_bronze_6600_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=limited_cost_sharing_plan_variation&id=I40A0929","32"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020014","Select Med HealthSave Silver 1500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020014-00","Standard Silver Off Exchange Plan",,"0.710766315460205","Yes","Yes","No","100%",,"$1,500","$20","$1,330","$150","$1,500","$510","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0731","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_1500_(hsa_qualified)_&csr=standard_silver_off_exchange_plan&id=I30A0731","33"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020014","Select Med HealthSave Silver 1500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020014-01","Standard Silver On Exchange Plan",,"0.710766315460205","Yes","Yes","No","100%",,"$1,500","$20","$1,330","$150","$1,500","$510","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0733","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_1500_(hsa_qualified)_&csr=standard_silver_on_exchange_plan&id=I30A0733","34"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020014","Select Med HealthSave Silver 1500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0735","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_1500_(hsa_qualified)_&csr=zero_cost_sharing_plan_variation&id=I30A0735","35"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020014","Select Med HealthSave Silver 1500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020014-03","Limited Cost Sharing Plan Variation",,"0.710766315460205","Yes","Yes","No","100%",,"$1,500","$20","$1,330","$150","$1,500","$510","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0737","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_1500_(hsa_qualified)_&csr=limited_cost_sharing_plan_variation&id=I30A0737","36"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020014","Select Med HealthSave Silver 1500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020014-04","73% AV Level Silver Plan",,"0.739325642585754","Yes","Yes","No","100%",,"$1,400","$20","$1,090","$150","$1,400","$470","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","per person not applicable","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0739","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_1500_(hsa_qualified)_&csr=73_av_level_silver_plan&id=I30A0739","37"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020014","Select Med HealthSave Silver 1500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020014-05","87% AV Level Silver Plan",,"0.872800230979919","Yes","Yes","No","100%",,"$350","$20","$970","$150","$350","$550","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","per person not applicable","$875 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0741","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_1500_(hsa_qualified)_&csr=87_av_level_silver_plan&id=I30A0741","38"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020014","Select Med HealthSave Silver 1500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020014-06","94% AV Level Silver Plan",,"0.940327286720276","Yes","Yes","No","100%",,"$100","$10","$340","$150","$100","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$250 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0743","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_1500_(hsa_qualified)_&csr=94_av_level_silver_plan&id=I30A0743","39"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020015","Select Med HealthSave Silver 2000 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020015-00","Standard Silver Off Exchange Plan",,"0.696931302547455","Yes","Yes","No","100%",,"$2,000","$20","$970","$150","$2,000","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0745","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_2000_(hsa_qualified)_&csr=standard_silver_off_exchange_plan&id=I30A0745","40"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020015","Select Med HealthSave Silver 2000 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020015-01","Standard Silver On Exchange Plan",,"0.696931302547455","Yes","Yes","No","100%",,"$2,000","$20","$970","$150","$2,000","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0747","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_2000_(hsa_qualified)_&csr=standard_silver_on_exchange_plan&id=I30A0747","41"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020015","Select Med HealthSave Silver 2000 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0749","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_2000_(hsa_qualified)_&csr=zero_cost_sharing_plan_variation&id=I30A0749","42"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020015","Select Med HealthSave Silver 2000 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020015-03","Limited Cost Sharing Plan Variation",,"0.696931302547455","Yes","Yes","No","100%",,"$2,000","$20","$970","$150","$2,000","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0751","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_2000_(hsa_qualified)_&csr=limited_cost_sharing_plan_variation&id=I30A0751","43"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020015","Select Med HealthSave Silver 2000 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020015-04","73% AV Level Silver Plan",,"0.738318860530853","Yes","Yes","No","100%",,"$1,500","$20","$1,070","$150","$1,500","$460","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0753","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_2000_(hsa_qualified)_&csr=73_av_level_silver_plan&id=I30A0753","44"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020015","Select Med HealthSave Silver 2000 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020015-05","87% AV Level Silver Plan",,"0.872800230979919","Yes","Yes","No","100%",,"$350","$20","$970","$150","$350","$550","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","per person not applicable","$875 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0755","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_2000_(hsa_qualified)_&csr=87_av_level_silver_plan&id=I30A0755","45"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020015","Select Med HealthSave Silver 2000 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020015-06","94% AV Level Silver Plan",,"0.93768185377121","Yes","Yes","No","100%",,"$100","$10","$340","$150","$100","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$250 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0757","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_2000_(hsa_qualified)_&csr=94_av_level_silver_plan&id=I30A0757","46"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020016","Select Med HealthSave Bronze 4500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF007","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020016-00","Standard Bronze Off Exchange Plan",,"0.618812620639801","Yes","Yes","No","100%",,"$4,500","$20","$830","$150","$4,500","$90","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0759","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_bronze_4500_(hsa_qualified)_&csr=standard_bronze_off_exchange_plan&id=I30A0759","47"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020016","Select Med HealthSave Bronze 4500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF007","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020016-01","Standard Bronze On Exchange Plan",,"0.618812620639801","Yes","Yes","No","100%",,"$4,500","$20","$830","$150","$4,500","$90","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0761","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_bronze_4500_(hsa_qualified)_&csr=standard_bronze_on_exchange_plan&id=I30A0761","48"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020016","Select Med HealthSave Bronze 4500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF007","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0763","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_bronze_4500_(hsa_qualified)_&csr=zero_cost_sharing_plan_variation&id=I30A0763","49"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020016","Select Med HealthSave Bronze 4500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF007","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020016-03","Limited Cost Sharing Plan Variation",,"0.618812620639801","Yes","Yes","No","100%",,"$4,500","$20","$830","$150","$4,500","$90","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0765","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_bronze_4500_(hsa_qualified)_&csr=limited_cost_sharing_plan_variation&id=I30A0765","50"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020017","Select Med HealthSave Silver 3500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF008","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020017-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0767","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_3500_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=standard_silver_off_exchange_plan&id=I30A0767","51"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020017","Select Med HealthSave Silver 3500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF008","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020017-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0769","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_3500_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=standard_silver_on_exchange_plan&id=I30A0769","52"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020017","Select Med HealthSave Silver 3500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF008","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0771","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_3500_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=zero_cost_sharing_plan_variation&id=I30A0771","53"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020017","Select Med HealthSave Silver 3500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF008","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020017-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0773","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_3500_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=limited_cost_sharing_plan_variation&id=I30A0773","54"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020017","Select Med HealthSave Silver 3500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF008","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020017-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$150","$3,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0775","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_3500_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=73_av_level_silver_plan&id=I30A0775","55"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020017","Select Med HealthSave Silver 3500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF008","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020017-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$150","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","per person not applicable","$2500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0777","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_3500_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=87_av_level_silver_plan&id=I30A0777","56"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020017","Select Med HealthSave Silver 3500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF008","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020017-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$150","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0779","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_silver_3500_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=94_av_level_silver_plan&id=I30A0779","57"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020018","Select Med HealthSave Bronze 6550 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF008","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020018-00","Standard Bronze Off Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","per person not applicable","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0781","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_bronze_6600_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=standard_bronze_off_exchange_plan&id=I30A0781","58"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020018","Select Med HealthSave Bronze 6550 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF008","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020018-01","Standard Bronze On Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","per person not applicable","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0783","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_bronze_6600_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=standard_bronze_on_exchange_plan&id=I30A0783","59"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020018","Select Med HealthSave Bronze 6550 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF008","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0785","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_bronze_6600_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=zero_cost_sharing_plan_variation&id=I30A0785","60"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0020018","Select Med HealthSave Bronze 6550 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF008","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020018-03","Limited Cost Sharing Plan Variation",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","per person not applicable","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0787","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_healthsave_bronze_6600_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=limited_cost_sharing_plan_variation&id=I30A0787","61"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030014","Select Care HealthSave Silver 1500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030014-00","Standard Silver Off Exchange Plan",,"0.710766315460205","Yes","Yes","No","100%",,"$1,500","$20","$1,330","$150","$1,500","$510","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0648","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_silver_1500_(hsa_qualified)_&csr=standard_silver_off_exchange_plan&id=I20A0648","62"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030014","Select Care HealthSave Silver 1500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030014-01","Standard Silver On Exchange Plan",,"0.710766315460205","Yes","Yes","No","100%",,"$1,500","$20","$1,330","$150","$1,500","$510","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0650","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_silver_1500_(hsa_qualified)_&csr=standard_silver_on_exchange_plan&id=I20A0650","63"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030014","Select Care HealthSave Silver 1500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0652","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_silver_1500_(hsa_qualified)_&csr=zero_cost_sharing_plan_variation&id=I20A0652","64"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030014","Select Care HealthSave Silver 1500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030014-03","Limited Cost Sharing Plan Variation",,"0.710766315460205","Yes","Yes","No","100%",,"$1,500","$20","$1,330","$150","$1,500","$510","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0654","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_silver_1500_(hsa_qualified)_&csr=limited_cost_sharing_plan_variation&id=I20A0654","65"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030014","Select Care HealthSave Silver 1500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030014-04","73% AV Level Silver Plan",,"0.739325642585754","Yes","Yes","No","100%",,"$1,400","$20","$1,090","$150","$1,400","$470","$210","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","per person not applicable","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0656","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_silver_1500_(hsa_qualified)_&csr=73_av_level_silver_plan&id=I20A0656","66"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030014","Select Care HealthSave Silver 1500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030014-05","87% AV Level Silver Plan",,"0.872800230979919","Yes","Yes","No","100%",,"$350","$20","$970","$150","$350","$550","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","per person not applicable","$875 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0658","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_silver_1500_(hsa_qualified)_&csr=87_av_level_silver_plan&id=I20A0658","67"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030014","Select Care HealthSave Silver 1500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030014-06","94% AV Level Silver Plan",,"0.940327286720276","Yes","Yes","No","100%",,"$100","$10","$340","$150","$100","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,700","$1700 per person","$3400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$250 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0660","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_silver_1500_(hsa_qualified)_&csr=94_av_level_silver_plan&id=I20A0660","68"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030015","Select Care HealthSave Silver 2000 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030015-00","Standard Silver Off Exchange Plan",,"0.696931302547455","Yes","Yes","No","100%",,"$2,000","$20","$970","$150","$2,000","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0662","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_silver_2000_(hsa_qualified)_&csr=standard_silver_off_exchange_plan&id=I20A0662","69"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030015","Select Care HealthSave Silver 2000 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030015-01","Standard Silver On Exchange Plan",,"0.696931302547455","Yes","Yes","No","100%",,"$2,000","$20","$970","$150","$2,000","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0664","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_silver_2000_(hsa_qualified)_&csr=standard_silver_on_exchange_plan&id=I20A0664","70"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030015","Select Care HealthSave Silver 2000 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0666","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_silver_2000_(hsa_qualified)_&csr=zero_cost_sharing_plan_variation&id=I20A0666","71"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030015","Select Care HealthSave Silver 2000 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030015-03","Limited Cost Sharing Plan Variation",,"0.696931302547455","Yes","Yes","No","100%",,"$2,000","$20","$970","$150","$2,000","$420","$180","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0668","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_silver_2000_(hsa_qualified)_&csr=limited_cost_sharing_plan_variation&id=I20A0668","72"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030015","Select Care HealthSave Silver 2000 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030015-04","73% AV Level Silver Plan",,"0.738318860530853","Yes","Yes","No","100%",,"$1,500","$20","$1,070","$150","$1,500","$460","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","per person not applicable","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0670","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_silver_2000_(hsa_qualified)_&csr=73_av_level_silver_plan&id=I20A0670","73"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030015","Select Care HealthSave Silver 2000 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030015-05","87% AV Level Silver Plan",,"0.872800230979919","Yes","Yes","No","100%",,"$350","$20","$970","$150","$350","$550","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$350","per person not applicable","$875 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0672","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_silver_2000_(hsa_qualified)_&csr=87_av_level_silver_plan&id=I20A0672","74"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030015","Select Care HealthSave Silver 2000 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF006","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030015-06","94% AV Level Silver Plan",,"0.93768185377121","Yes","Yes","No","100%",,"$100","$10","$340","$150","$100","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","$250 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0674","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_silver_2000_(hsa_qualified)_&csr=94_av_level_silver_plan&id=I20A0674","75"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030016","Select Care HealthSave Bronze 4500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF007","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030016-00","Standard Bronze Off Exchange Plan",,"0.618812620639801","Yes","Yes","No","100%",,"$4,500","$20","$830","$150","$4,500","$90","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0676","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_bronze_4500_(hsa_qualified)_&csr=standard_bronze_off_exchange_plan&id=I20A0676","76"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030016","Select Care HealthSave Bronze 4500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF007","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030016-01","Standard Bronze On Exchange Plan",,"0.618812620639801","Yes","Yes","No","100%",,"$4,500","$20","$830","$150","$4,500","$90","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0678","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_bronze_4500_(hsa_qualified)_&csr=standard_bronze_on_exchange_plan&id=I20A0678","77"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030016","Select Care HealthSave Bronze 4500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF007","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0680","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_bronze_4500_(hsa_qualified)_&csr=zero_cost_sharing_plan_variation&id=I20A0680","78"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030016","Select Care HealthSave Bronze 4500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF007","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030016-03","Limited Cost Sharing Plan Variation",,"0.618812620639801","Yes","Yes","No","100%",,"$4,500","$20","$830","$150","$4,500","$90","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0682","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_bronze_4500_(hsa_qualified)_&csr=limited_cost_sharing_plan_variation&id=I20A0682","79"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030017","Select Care HealthSave Silver 3500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF008","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030017-00","Standard Silver Off Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0684","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_silver_3500_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=standard_silver_off_exchange_plan&id=I20A0684","80"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030017","Select Care HealthSave Silver 3500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF008","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030017-01","Standard Silver On Exchange Plan",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0686","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_silver_3500_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=standard_silver_on_exchange_plan&id=I20A0686","81"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030017","Select Care HealthSave Silver 3500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF008","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0688","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_silver_3500_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=zero_cost_sharing_plan_variation&id=I20A0688","82"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030017","Select Care HealthSave Silver 3500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF008","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030017-03","Limited Cost Sharing Plan Variation",,"0.711643576622009","Yes","Yes","No","100%",,"$3,500","$0","$0","$150","$3,500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","per person not applicable","$7000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0690","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_silver_3500_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=limited_cost_sharing_plan_variation&id=I20A0690","83"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030017","Select Care HealthSave Silver 3500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF008","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030017-04","73% AV Level Silver Plan",,"0.738955080509186","Yes","Yes","No","100%",,"$3,000","$0","$0","$150","$3,000","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0692","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_silver_3500_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=73_av_level_silver_plan&id=I20A0692","84"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030017","Select Care HealthSave Silver 3500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF008","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030017-05","87% AV Level Silver Plan",,"0.865775346755981","Yes","Yes","No","100%",,"$1,250","$0","$0","$150","$1,250","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","$1250 per person","$2500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,250","per person not applicable","$2500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0694","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_silver_3500_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=87_av_level_silver_plan&id=I20A0694","85"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030017","Select Care HealthSave Silver 3500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF008","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030017-06","94% AV Level Silver Plan",,"0.939565420150757","Yes","Yes","No","100%",,"$500","$0","$0","$150","$500","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","per person not applicable","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0696","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_silver_3500_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=94_av_level_silver_plan&id=I20A0696","86"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030018","Select Care HealthSave Bronze 6550 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF008","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030018-00","Standard Bronze Off Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","per person not applicable","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0698","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_bronze_6600_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=standard_bronze_off_exchange_plan&id=I20A0698","87"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030018","Select Care HealthSave Bronze 6550 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF008","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030018-01","Standard Bronze On Exchange Plan",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","per person not applicable","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0700","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_bronze_6600_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=standard_bronze_on_exchange_plan&id=I20A0700","88"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030018","Select Care HealthSave Bronze 6550 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF008","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0702","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_bronze_6600_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=zero_cost_sharing_plan_variation&id=I20A0702","89"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","5","68781","UT","Individual","No","87-0409820","68781UT0030018","Select Care HealthSave Bronze 6550 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF008","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030018-03","Limited Cost Sharing Plan Variation",,"0.5993931889534","Yes","Yes","No","100%",,"$6,550","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","per person not applicable","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0704","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_healthsave_bronze_6600_(hsa_qualified_and_no_coinsurance_after_deductible)_&csr=limited_cost_sharing_plan_variation&id=I20A0704","90"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0120005","Select Value Preference Benchmark Silver 1250","68781UT012",,"UTN003","UTS003","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0120005-00","Standard Silver Off Exchange Plan",,"0.704492330551147","No","Yes","No","100%",,"$1,250","$20","$2,790","$150","$1,250","$540","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0934","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_silver_1250&csr=standard_silver_off_exchange_plan&id=I40A0934","4"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0120005","Select Value Preference Benchmark Silver 1250","68781UT012",,"UTN003","UTS003","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0120005-01","Standard Silver On Exchange Plan",,"0.704492330551147","No","Yes","No","100%",,"$1,250","$20","$2,790","$150","$1,250","$540","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0935","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_silver_1250&csr=standard_silver_on_exchange_plan&id=I40A0935","5"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0120005","Select Value Preference Benchmark Silver 1250","68781UT012",,"UTN003","UTS003","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0120005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0936","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_silver_1250&csr=zero_cost_sharing_plan_variation&id=I40A0936","6"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0120005","Select Value Preference Benchmark Silver 1250","68781UT012",,"UTN003","UTS003","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0120005-03","Limited Cost Sharing Plan Variation",,"0.704492330551147","No","Yes","No","100%",,"$1,250","$20","$2,790","$150","$1,250","$540","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0937","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_silver_1250&csr=limited_cost_sharing_plan_variation&id=I40A0937","7"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0120005","Select Value Preference Benchmark Silver 1250","68781UT012",,"UTN003","UTS003","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0120005-04","73% AV Level Silver Plan",,"0.734081983566284","No","Yes","No","100%",,"$1,150","$20","$1,420","$150","$1,150","$570","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0938","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_silver_1250&csr=73_av_level_silver_plan&id=I40A0938","8"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0120005","Select Value Preference Benchmark Silver 1250","68781UT012",,"UTN003","UTS003","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0120005-05","87% AV Level Silver Plan",,"0.875379264354706","No","Yes","No","100%",,"$250","$20","$990","$150","$250","$550","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0939","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_silver_1250&csr=87_av_level_silver_plan&id=I40A0939","9"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0120005","Select Value Preference Benchmark Silver 1250","68781UT012",,"UTN003","UTS003","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0120005-06","94% AV Level Silver Plan",,"0.946483731269836","No","Yes","No","100%",,"$0","$10","$340","$150","$0","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0940","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_silver_1250&csr=94_av_level_silver_plan&id=I40A0940","10"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0120010","Select Value Preference Benchmark Bronze 5000","68781UT012",,"UTN003","UTS003","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0120010-00","Standard Bronze Off Exchange Plan",,"0.617345809936523","No","Yes","No","100%",,"$5,000","$20","$230","$150","$5,000","$50","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0941","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_bronze_5000&csr=standard_bronze_off_exchange_plan&id=I40A0941","11"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0120010","Select Value Preference Benchmark Bronze 5000","68781UT012",,"UTN003","UTS003","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0120010-01","Standard Bronze On Exchange Plan",,"0.617345809936523","No","Yes","No","100%",,"$5,000","$20","$230","$150","$5,000","$50","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0942","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_bronze_5000&csr=standard_bronze_on_exchange_plan&id=I40A0942","12"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0120010","Select Value Preference Benchmark Bronze 5000","68781UT012",,"UTN003","UTS003","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0120010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0943","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_bronze_5000&csr=zero_cost_sharing_plan_variation&id=I40A0943","13"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0120010","Select Value Preference Benchmark Bronze 5000","68781UT012",,"UTN003","UTS003","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0120010-03","Limited Cost Sharing Plan Variation",,"0.617345809936523","No","Yes","No","100%",,"$5,000","$20","$230","$150","$5,000","$50","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0944","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_preference_benchmark_bronze_5000&csr=limited_cost_sharing_plan_variation&id=I40A0944","14"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0130005","Select Med Preference Benchmark Silver 1250","68781UT013",,"UTN002","UTS002","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130005-00","Standard Silver Off Exchange Plan",,"0.704492330551147","No","Yes","No","100%",,"$1,250","$20","$2,790","$150","$1,250","$540","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0792","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_silver_1250&csr=standard_silver_off_exchange_plan&id=I30A0792","15"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0130005","Select Med Preference Benchmark Silver 1250","68781UT013",,"UTN002","UTS002","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130005-01","Standard Silver On Exchange Plan",,"0.704492330551147","No","Yes","No","100%",,"$1,250","$20","$2,790","$150","$1,250","$540","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0793","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_silver_1250&csr=standard_silver_on_exchange_plan&id=I30A0793","16"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0130005","Select Med Preference Benchmark Silver 1250","68781UT013",,"UTN002","UTS002","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0794","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_silver_1250&csr=zero_cost_sharing_plan_variation&id=I30A0794","17"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0130005","Select Med Preference Benchmark Silver 1250","68781UT013",,"UTN002","UTS002","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130005-03","Limited Cost Sharing Plan Variation",,"0.704492330551147","No","Yes","No","100%",,"$1,250","$20","$2,790","$150","$1,250","$540","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0795","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_silver_1250&csr=limited_cost_sharing_plan_variation&id=I30A0795","18"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0130005","Select Med Preference Benchmark Silver 1250","68781UT013",,"UTN002","UTS002","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130005-04","73% AV Level Silver Plan",,"0.734081983566284","No","Yes","No","100%",,"$1,150","$20","$1,420","$150","$1,150","$570","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0796","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_silver_1250&csr=73_av_level_silver_plan&id=I30A0796","19"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0130005","Select Med Preference Benchmark Silver 1250","68781UT013",,"UTN002","UTS002","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130005-05","87% AV Level Silver Plan",,"0.875379264354706","No","Yes","No","100%",,"$250","$20","$990","$150","$250","$550","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0797","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_silver_1250&csr=87_av_level_silver_plan&id=I30A0797","20"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0130005","Select Med Preference Benchmark Silver 1250","68781UT013",,"UTN002","UTS002","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130005-06","94% AV Level Silver Plan",,"0.946483731269836","No","Yes","No","100%",,"$0","$10","$340","$150","$0","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0798","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_silver_1250&csr=94_av_level_silver_plan&id=I30A0798","21"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0130010","Select Med Preference Benchmark Bronze 5000","68781UT013",,"UTN002","UTS002","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130010-00","Standard Bronze Off Exchange Plan",,"0.617345809936523","No","Yes","No","100%",,"$5,000","$20","$230","$150","$5,000","$50","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0799","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_bronze_5000&csr=standard_bronze_off_exchange_plan&id=I30A0799","22"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0130010","Select Med Preference Benchmark Bronze 5000","68781UT013",,"UTN002","UTS002","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130010-01","Standard Bronze On Exchange Plan",,"0.617345809936523","No","Yes","No","100%",,"$5,000","$20","$230","$150","$5,000","$50","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0800","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_bronze_5000&csr=standard_bronze_on_exchange_plan&id=I30A0800","23"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0130010","Select Med Preference Benchmark Bronze 5000","68781UT013",,"UTN002","UTS002","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0801","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_bronze_5000&csr=zero_cost_sharing_plan_variation&id=I30A0801","24"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0130010","Select Med Preference Benchmark Bronze 5000","68781UT013",,"UTN002","UTS002","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0130010-03","Limited Cost Sharing Plan Variation",,"0.617345809936523","No","Yes","No","100%",,"$5,000","$20","$230","$150","$5,000","$50","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0802","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_preference_benchmark_bronze_5000&csr=limited_cost_sharing_plan_variation&id=I30A0802","25"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0140005","Select Care Preference Benchmark Silver 1250","68781UT014",,"UTN001","UTS001","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0140005-00","Standard Silver Off Exchange Plan",,"0.704492330551147","No","Yes","No","100%",,"$1,250","$20","$2,790","$150","$1,250","$540","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0709","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_benchmark_silver_1250&csr=standard_silver_off_exchange_plan&id=I20A0709","26"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0140005","Select Care Preference Benchmark Silver 1250","68781UT014",,"UTN001","UTS001","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0140005-01","Standard Silver On Exchange Plan",,"0.704492330551147","No","Yes","No","100%",,"$1,250","$20","$2,790","$150","$1,250","$540","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0710","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_benchmark_silver_1250&csr=standard_silver_on_exchange_plan&id=I20A0710","27"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0140005","Select Care Preference Benchmark Silver 1250","68781UT014",,"UTN001","UTS001","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0140005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0711","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_benchmark_silver_1250&csr=zero_cost_sharing_plan_variation&id=I20A0711","28"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0140005","Select Care Preference Benchmark Silver 1250","68781UT014",,"UTN001","UTS001","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0140005-03","Limited Cost Sharing Plan Variation",,"0.704492330551147","No","Yes","No","100%",,"$1,250","$20","$2,790","$150","$1,250","$540","$520","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0712","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_benchmark_silver_1250&csr=limited_cost_sharing_plan_variation&id=I20A0712","29"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0140005","Select Care Preference Benchmark Silver 1250","68781UT014",,"UTN001","UTS001","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0140005-04","73% AV Level Silver Plan",,"0.734081983566284","No","Yes","No","100%",,"$1,150","$20","$1,420","$150","$1,150","$570","$260","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,150","$1150 per person","$2300 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0713","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_benchmark_silver_1250&csr=73_av_level_silver_plan&id=I20A0713","30"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0140005","Select Care Preference Benchmark Silver 1250","68781UT014",,"UTN001","UTS001","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0140005-05","87% AV Level Silver Plan",,"0.875379264354706","No","Yes","No","100%",,"$250","$20","$990","$150","$250","$550","$160","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$750 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0714","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_benchmark_silver_1250&csr=87_av_level_silver_plan&id=I20A0714","31"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0140005","Select Care Preference Benchmark Silver 1250","68781UT014",,"UTN001","UTS001","UTF001","Existing","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0140005-06","94% AV Level Silver Plan",,"0.946483731269836","No","Yes","No","100%",,"$0","$10","$340","$150","$0","$300","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0715","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_benchmark_silver_1250&csr=94_av_level_silver_plan&id=I20A0715","32"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0140010","Select Care Preference Benchmark Bronze 5000","68781UT014",,"UTN001","UTS001","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0140010-00","Standard Bronze Off Exchange Plan",,"0.617345809936523","No","Yes","No","100%",,"$5,000","$20","$230","$150","$5,000","$50","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0716","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_benchmark_bronze_5000&csr=standard_bronze_off_exchange_plan&id=I20A0716","33"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0140010","Select Care Preference Benchmark Bronze 5000","68781UT014",,"UTN001","UTS001","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0140010-01","Standard Bronze On Exchange Plan",,"0.617345809936523","No","Yes","No","100%",,"$5,000","$20","$230","$150","$5,000","$50","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0717","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_benchmark_bronze_5000&csr=standard_bronze_on_exchange_plan&id=I20A0717","34"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0140010","Select Care Preference Benchmark Bronze 5000","68781UT014",,"UTN001","UTS001","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0140010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$150","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0718","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_benchmark_bronze_5000&csr=zero_cost_sharing_plan_variation&id=I20A0718","35"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","6","68781","UT","Individual","No","87-0409820","68781UT0140010","Select Care Preference Benchmark Bronze 5000","68781UT014",,"UTN001","UTS001","UTF003","Existing","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Adult preventive eye exams; Bariatric Surgery; Biofeedback/Neurofeedback; Birthing Centers/Home Childbirth; Blood Storage; Cardiac Rehab (phases 3 and 4); Circumcision; Certain Cancer Therapies; Certain Illegal Activities; Chiropractic Services; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Infertility; Certain Pain Management Services; Pervasive Developmental Disorder (except autism spectrum disorder); Certain Prescription/Injectable Drugs and Specialty Medications; Private Duty Nursing; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Sleep Studies; Certain Specialty Services; Stereotactic Radiosurgery; Telephone/E-mail Consultations; Temporomandibular Joint (TMJ) and Orthognathic; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99",,,,"0","0","0","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0140010-03","Limited Cost Sharing Plan Variation",,"0.617345809936523","No","Yes","No","100%",,"$5,000","$20","$230","$150","$5,000","$50","$10","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0719","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_preference_benchmark_bronze_5000&csr=limited_cost_sharing_plan_variation&id=I20A0719","36"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","7","68781","UT","Individual","No","87-0409820","68781UT0010019","Select Value Millennial 6850 (Catastrophic Plan)","68781UT001",,"UTN003","UTS003","UTF008","Existing","HMO","Catastrophic","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","3","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010019-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0931","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_millennial_6600_(catastrophic_plan)&csr=standard_catastrophic_off_exchange_plan&id=I40A0931","4"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","7","68781","UT","Individual","No","87-0409820","68781UT0010019","Select Value Millennial 6850 (Catastrophic Plan)","68781UT001",,"UTN003","UTS003","UTF008","Existing","HMO","Catastrophic","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","3","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0010019-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I40A0933","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_value_millennial_6600_(catastrophic_plan)&csr=standard_catastrophic_on_exchange_plan&id=I40A0933","5"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","7","68781","UT","Individual","No","87-0409820","68781UT0020019","Select Med Millennial 6850 (Catastrophic Plan)","68781UT002",,"UTN002","UTS002","UTF008","Existing","HMO","Catastrophic","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","3","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020019-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0789","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_millennial_6600_(catastrophic_plan)&csr=standard_catastrophic_off_exchange_plan&id=I30A0789","6"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","7","68781","UT","Individual","No","87-0409820","68781UT0020019","Select Med Millennial 6850 (Catastrophic Plan)","68781UT002",,"UTN002","UTS002","UTF008","Existing","HMO","Catastrophic","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","3","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0020019-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I30A0791","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_med_millennial_6600_(catastrophic_plan)&csr=standard_catastrophic_on_exchange_plan&id=I30A0791","7"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","7","68781","UT","Individual","No","87-0409820","68781UT0030019","Select Care Millennial 6850 (Catastrophic Plan)","68781UT003",,"UTN001","UTS001","UTF008","Existing","HMO","Catastrophic","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","3","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030019-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0706","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_millennial_6600_(catastrophic_plan)&csr=standard_catastrophic_off_exchange_plan&id=I20A0706","8"
"2016","UT","68781","SERFF","4","2015-08-27 03:52:03","7","68781","UT","Individual","No","87-0409820","68781UT0030019","Select Care Millennial 6850 (Catastrophic Plan)","68781UT003",,"UTN001","UTS001","UTF008","Existing","HMO","Catastrophic","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9782",,,,"0","0","3","2016-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","https://selecthealth.org/ffmpayment/medical.aspx","http://www.selecthealth.org/prescriptions/default.aspx?st=ut&plan=core","68781UT0030019-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$150","$5,270","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.selecthealth.org/sbc/default.aspx?state=ut&id=I20A0708","http://www.selecthealth.org/plan-brochure.aspx?state=ut&name=select_care_millennial_6600_(catastrophic_plan)&csr=standard_catastrophic_on_exchange_plan&id=I20A0708","9"
"2016","UT","68809","SERFF","4","2016-01-28 08:29:40","1","68809","UT","Individual","Yes","91-1857813","68809UT0010009","PLUS Family Plan with EHB PLUS","68809UT001",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.91","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes",,"","68809UT0010009-00","Standard Low Off Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.premierlife.com/exchangeplans","https://www.premierlife.com/exchangeplans","4"
"2016","UT","68809","SERFF","4","2016-01-28 08:29:40","1","68809","UT","Individual","Yes","91-1857813","68809UT0010009","PLUS Family Plan with EHB PLUS","68809UT001",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.91","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes",,"","68809UT0010009-01","Standard Low On Exchange Plan","70.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.premierlife.com/exchangeplans","https://www.premierlife.com/exchangeplans","5"
"2016","UT","71246","SERFF","3","2015-08-27 15:13:29","1","71246","UT","Individual","Yes","94-2761537","71246UT0010002","Delta Dental PPO Pediatric Preferred Plan","71246UT001",,"UTN001","UTS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.12","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","71246UT0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/71246ut0010002-16","4"
"2016","UT","71246","SERFF","3","2015-08-27 15:13:29","1","71246","UT","Individual","Yes","94-2761537","71246UT0010001","Delta Dental PPO Pediatric Basic Plan","71246UT001",,"UTN001","UTS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$9.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","71246UT0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/71246ut0010001-16","5"
"2016","UT","71246","SERFF","3","2015-08-27 15:13:29","2","71246","UT","Individual","Yes","94-2761537","71246UT0010004","Delta Dental PPO Preferred Plan for Families","71246UT001",,"UTN001","UTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.12","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","71246UT0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/71246ut0010004-16","4"
"2016","UT","71246","SERFF","3","2015-08-27 15:13:29","2","71246","UT","Individual","Yes","94-2761537","71246UT0010004","Delta Dental PPO Preferred Plan for Families","71246UT001",,"UTN001","UTS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.12","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","71246UT0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/71246ut0010004-16","5"
"2016","UT","71246","SERFF","3","2015-08-27 15:13:29","3","71246","UT","Individual","Yes","94-2761537","71246UT0010006","Delta Dental PPO Basic Plan for Families","71246UT001",,"UTN001","UTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$9.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","71246UT0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/71246ut0010006-16","4"
"2016","UT","71246","SERFF","3","2015-08-27 15:13:29","3","71246","UT","Individual","Yes","94-2761537","71246UT0010006","Delta Dental PPO Basic Plan for Families","71246UT001",,"UTN001","UTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$9.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","71246UT0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/ut/71246ut0010006-16","5"
"2016","UT","72660","SERFF","3","2015-08-27 15:13:29","1","72660","UT","Individual","Yes","75-1233841","72660UT0010001","Dentegra Dental PPO Pediatric Basic Plan","72660UT001",,"UTN001","UTS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$9.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","72660UT0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ut/72660ut0010001-16","4"
"2016","UT","72660","SERFF","3","2015-08-27 15:13:29","2","72660","UT","Individual","Yes","75-1233841","72660UT0010004","Dentegra Dental PPO Family Preferred Plan","72660UT001",,"UTN001","UTS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","72660UT0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ut/72660ut0010004-16","4"
"2016","UT","72660","SERFF","3","2015-08-27 15:13:29","2","72660","UT","Individual","Yes","75-1233841","72660UT0010004","Dentegra Dental PPO Family Preferred Plan","72660UT001",,"UTN001","UTS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$13.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","72660UT0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ut/72660ut0010004-16","5"
"2016","UT","72660","SERFF","3","2015-08-27 15:13:29","3","72660","UT","Individual","Yes","75-1233841","72660UT0010006","Dentegra Dental PPO Family Basic Plan","72660UT001",,"UTN001","UTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$10.04","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","72660UT0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ut/72660ut0010006-16","4"
"2016","UT","72660","SERFF","3","2015-08-27 15:13:29","3","72660","UT","Individual","Yes","75-1233841","72660UT0010006","Dentegra Dental PPO Family Basic Plan","72660UT001",,"UTN001","UTS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$10.04","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","72660UT0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/ut/72660ut0010006-16","5"
"2016","UT","80251","SERFF","4","2015-08-27 03:52:03","1","80251","UT","Individual","Yes","95-2371728","80251UT0010001","Co-Pay 85","80251UT001",,"UTN001","UTS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$13.47","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Any service received outside of the state of Utah","Yes",,"","80251UT0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","UT","80251","SERFF","4","2015-08-27 03:52:03","1","80251","UT","Individual","Yes","95-2371728","80251UT0010002","Co-Pay 70","80251UT001",,"UTN001","UTS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$17.44","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Any service received outside of the state of Utah","Yes",,"","80251UT0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","UT","80251","SERFF","4","2015-08-27 03:52:03","2","80251","UT","Individual","Yes","95-2371728","80251UT0010003","PPO MAC 85  No Deductible","80251UT001",,"UTN001","UTS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$19.97","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Any service received outside of the state of Utah","Yes",,"","80251UT0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","UT","80251","SERFF","4","2015-08-27 03:52:03","2","80251","UT","Individual","Yes","95-2371728","80251UT0010004","PPO MAC 70 No Deductible","80251UT001",,"UTN001","UTS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$15.42","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Any service received outside of the state of Utah","Yes",,"","80251UT0010004-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","UT","80251","SERFF","4","2015-08-27 03:52:03","3","80251","UT","Individual","Yes","95-2371728","80251UT0010005","PPO MAC 85 100% Preventive","80251UT001",,"UTN001","UTS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$20.20","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Any service received outside of the state of Utah","Yes",,"","80251UT0010005-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","UT","80251","SERFF","4","2015-08-27 03:52:03","3","80251","UT","Individual","Yes","95-2371728","80251UT0010006","PPO MAC 70 100% Preventive","80251UT001",,"UTN001","UTS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$16.05","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Any service received outside of the state of Utah","Yes",,"","80251UT0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$300 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","1","10207","VA","SHOP (Small Group)","No","52-1358219","10207VA0440004","BlueChoice Advantage 90%/70%","10207VA044",,"VAN003","VAS001","VAF008","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9951",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"https://www.carefirst.com/acarx","10207VA0440004-00","Standard Platinum Off Exchange Plan","89.87%",,"No","Yes","No","100%",,"$0","$15","$523","$30","$0","$400","$233","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group",,,,"$3,500","$7000 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://content.carefirst.com/sbc/AAVVB68BRXXVBB8CN012016.pdf",,"4"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","1","10207","VA","Individual","No","52-1358219","10207VA0400002","BlueChoice Plus Silver $2,500","10207VA040",,"VAN004","VAS001","VAF012","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995184278770746",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"https://www.carefirst.com/acarx","10207VA0400002-00","Standard Silver Off Exchange Plan","69.62%",,"No","Yes","No","100%",,"$2,525","$500","$0","$30","$2,580","$390","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/ATNVBN6CRXXVBN6LN012016.pdf",,"4"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","1","10207","VA","Individual","No","52-1358219","10207VA0400002","BlueChoice Plus Silver $2,500","10207VA040",,"VAN004","VAS001","VAF012","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995184278770746",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"https://www.carefirst.com/acarx","10207VA0400002-01","Standard Silver On Exchange Plan","69.62%",,"No","Yes","No","100%",,"$2,525","$500","$0","$30","$2,580","$390","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/ATNVBN6BRXXVBN6LN012016.pdf",,"5"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","1","10207","VA","SHOP (Small Group)","No","52-1358219","10207VA0440004","BlueChoice Advantage 90%/70%","10207VA044",,"VAN003","VAS001","VAF008","Existing","POS","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9951",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"https://www.carefirst.com/acarx","10207VA0440004-01","Standard Platinum On Exchange Plan","89.87%",,"No","Yes","No","100%",,"$0","$15","$523","$30","$0","$400","$233","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per person","$5000 per group",,,,"$3,500","$7000 per person","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://content.carefirst.com/sbc/AAVVB68CRXXVBB8CN012016.pdf",,"5"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","1","10207","VA","Individual","No","52-1358219","10207VA0400002","BlueChoice Plus Silver $2,500","10207VA040",,"VAN004","VAS001","VAF012","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995184278770746",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"https://www.carefirst.com/acarx","10207VA0400002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/ATPVBN6ARXXVBN65N012016.pdf",,"6"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","1","10207","VA","Individual","No","52-1358219","10207VA0400005","HealthyBlue Plus Gold $750","10207VA040",,"VAN005","VAS001","VAF013","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995176366039031",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"https://www.carefirst.com/acarx","10207VA0400005-03","Limited Cost Sharing Plan Variation","80.57%",,"No","Yes","No","100%",,"$750","$450","$0","$30","$750","$0","$94","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","0%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/HCUVBN7BRXXVBN7LN012016.pdf",,"14"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","2","10207","VA","Individual","No","52-1358219","10207VA0380004","BlueChoice HMO Young Adult $6,850","10207VA038",,"VAN002","VAS001","VAF011","Existing","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995179036432798",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380004-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,250","$0","$0","$30","$4,230","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://content.carefirst.com/sbc/AHHVCN9BRXCVCN9LN012016.pdf",,"4"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","2","10207","VA","SHOP (Small Group)","No","52-1358219","10207VA0430003","BlueChoice HMO 1000","10207VA043",,"VAN002","VAS001","VAF007","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9951",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0430003-00","Standard Gold Off Exchange Plan","80.31%",,"Yes","Yes","No","100%",,"$1,000","$15","$845","$30","$1,000","$360","$338","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$2000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://content.carefirst.com/sbc/AHHVC67BRXCVCB7EN012016.pdf",,"4"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","2","10207","VA","SHOP (Small Group)","No","52-1358219","10207VA0430003","BlueChoice HMO 1000","10207VA043",,"VAN002","VAS001","VAF007","Existing","HMO","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9951",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0430003-01","Standard Gold On Exchange Plan","80.31%",,"Yes","Yes","No","100%",,"$1,000","$15","$845","$30","$1,000","$360","$338","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$6000 per person","$6000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$2000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://content.carefirst.com/sbc/AHHVC67CRXCVCB7EN012016.pdf",,"5"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","2","10207","VA","Individual","No","52-1358219","10207VA0380004","BlueChoice HMO Young Adult $6,850","10207VA038",,"VAN002","VAS001","VAF011","Existing","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995179036432798",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,250","$0","$0","$30","$4,230","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://content.carefirst.com/sbc/AHHVCN9ARXCVCN9LN012016.pdf",,"5"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","2","10207","VA","SHOP (Small Group)","No","52-1358219","10207VA0430006","BlueChoice HMO HSA/HRA 2000","10207VA043",,"VAN002","VAS001","VAF007","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9951",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0430006-00","Standard Silver Off Exchange Plan","71.99%",,"Yes","Yes","No","100%",,"$2,000","$15","$645","$30","$2,000","$290","$246","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://content.carefirst.com/sbc/AHHVC66ERXCVCB6GN012016.pdf",,"6"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","2","10207","VA","SHOP (Small Group)","No","52-1358219","10207VA0430006","BlueChoice HMO HSA/HRA 2000","10207VA043",,"VAN002","VAS001","VAF007","Existing","HMO","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9951",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0430006-01","Standard Silver On Exchange Plan","71.99%",,"Yes","Yes","No","100%",,"$2,000","$15","$645","$30","$2,000","$290","$246","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://content.carefirst.com/sbc/AHHVC66FRXCVCB6GN012016.pdf",,"7"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","2","10207","VA","SHOP (Small Group)","No","52-1358219","10207VA0560004","BlueChoice HMO Referral HSA/HRA 4500","10207VA056",,"VAN001","VAS001","VAF007","Existing","HMO","Bronze","Yes","Both","No","Yes","All specialists require referral except covered services rendered by a contracting obstetrician/gynecologist; covered services rendered at contracting provider radiologist offices; covered services rendered by a contracting provider laboratory; and covered services rendered by a contracting provider ophthalmologist.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9951",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0560004-00","Standard Bronze Off Exchange Plan","61.89%",,"Yes","Yes","No","100%",,"$4,500","$15","$218","$30","$4,500","$90","$51","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://content.carefirst.com/sbc/ACHVC65BRXCVCB5DN012016.pdf",,"8"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","2","10207","VA","SHOP (Small Group)","No","52-1358219","10207VA0560004","BlueChoice HMO Referral HSA/HRA 4500","10207VA056",,"VAN001","VAS001","VAF007","Existing","HMO","Bronze","Yes","Both","No","Yes","All specialists require referral except covered services rendered by a contracting obstetrician/gynecologist; covered services rendered at contracting provider radiologist offices; covered services rendered by a contracting provider laboratory; and covered services rendered by a contracting provider ophthalmologist.",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9951",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0560004-01","Standard Bronze On Exchange Plan","61.89%",,"Yes","Yes","No","100%",,"$4,500","$15","$218","$30","$4,500","$90","$51","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://content.carefirst.com/sbc/ACHVC65CRXCVCB5DN012016.pdf",,"9"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","3","10207","VA","Individual","No","52-1358219","10207VA0400001","BlueChoice Plus Bronze $5,500","10207VA040",,"VAN004","VAS001","VAF010","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99516819038825",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"https://www.carefirst.com/acarx","10207VA0400001-00","Standard Bronze Off Exchange Plan","61.95%",,"No","Yes","No","100%",,"$5,250","$0","$0","$30","$2,480","$390","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/ATNVBN5CRXXVBN5LN012016.pdf",,"4"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","3","10207","VA","Individual","No","52-1358219","10207VA0400001","BlueChoice Plus Bronze $5,500","10207VA040",,"VAN004","VAS001","VAF010","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99516819038825",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"https://www.carefirst.com/acarx","10207VA0400001-01","Standard Bronze On Exchange Plan","61.95%",,"No","Yes","No","100%",,"$5,250","$0","$0","$30","$2,480","$390","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/ATNVBN5BRXXVBN5LN012016.pdf",,"5"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","3","10207","VA","Individual","No","52-1358219","10207VA0400001","BlueChoice Plus Bronze $5,500","10207VA040",,"VAN004","VAS001","VAF010","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99516819038825",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"https://www.carefirst.com/acarx","10207VA0400001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/ATPVBN5ARXXVBN50N012016.pdf",,"6"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","3","10207","VA","Individual","No","52-1358219","10207VA0400001","BlueChoice Plus Bronze $5,500","10207VA040",,"VAN004","VAS001","VAF010","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.99516819038825",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services out of network only","Yes","All covered services","Yes",,"https://www.carefirst.com/acarx","10207VA0400001-03","Limited Cost Sharing Plan Variation","61.95%",,"No","Yes","No","100%",,"$5,250","$0","$0","$30","$2,480","$390","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$5,500","$5500 per person","$11000 per group","0%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/ATNVBN5ARXXVBN5LN012016.pdf",,"7"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380001","BlueChoice HMO Silver $2,000","10207VA038",,"VAN001","VAS001","VAF012","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995180603508448",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380001-00","Standard Silver Off Exchange Plan","70.89%",,"No","Yes","No","100%",,"$2,025","$500","$0","$30","$1,500","$390","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/AHNVCN6CRXXVCN6NN012016.pdf",,"4"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380001","BlueChoice HMO Silver $2,000","10207VA038",,"VAN001","VAS001","VAF012","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995180603508448",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380001-01","Standard Silver On Exchange Plan","70.89%",,"No","Yes","No","100%",,"$2,025","$500","$0","$30","$1,500","$390","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/AHNVCN6BRXXVCN6NN012016.pdf",,"5"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380001","BlueChoice HMO Silver $2,000","10207VA038",,"VAN001","VAS001","VAF012","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995180603508448",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380001-04","73% AV Level Silver Plan","73.63%",,"No","Yes","No","100%",,"$1,275","$500","$0","$30","$1,400","$390","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/AHNVCN6DRXXVCN6RN012016.pdf",,"8"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380001","BlueChoice HMO Silver $2,000","10207VA038",,"VAN001","VAS001","VAF012","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995180603508448",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380001-05","87% AV Level Silver Plan","87.35%",,"No","Yes","No","100%",,"$0","$215","$0","$30","$0","$400","$244","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/AHAVCN6FRXXVCN6QN012016.pdf",,"9"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380001","BlueChoice HMO Silver $2,000","10207VA038",,"VAN001","VAS001","VAF012","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995180603508448",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380001-06","94% AV Level Silver Plan","94.36%",,"No","Yes","No","100%",,"$0","$100","$0","$30","$0","$0","$244","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/AHAVCN6ERXXVCN6PN012016.pdf",,"10"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380002","HealthyBlue HMO Gold $250","10207VA038",,"VAN003","VAS001","VAF013","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995166134782408",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380002-00","Standard Gold Off Exchange Plan","81.84%",,"No","Yes","No","100%",,"$250","$560","$0","$30","$250","$30","$198","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/HEUVCN7DRXXVCN7MN012016.pdf",,"11"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380002","HealthyBlue HMO Gold $250","10207VA038",,"VAN003","VAS001","VAF013","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995166134782408",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380002-01","Standard Gold On Exchange Plan","81.84%",,"No","Yes","No","100%",,"$250","$560","$0","$30","$250","$30","$198","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/HEUVCN7CRXXVCN7MN012016.pdf",,"12"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380002","HealthyBlue HMO Gold $250","10207VA038",,"VAN003","VAS001","VAF013","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995166134782408",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/HEUVCN7ARXXVCN71N012016.pdf",,"13"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380002","HealthyBlue HMO Gold $250","10207VA038",,"VAN003","VAS001","VAF013","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995166134782408",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380002-03","Limited Cost Sharing Plan Variation","81.84%",,"No","Yes","No","100%",,"$250","$560","$0","$30","$250","$30","$198","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/HEUVCN7BRXXVCN7MN012016.pdf",,"14"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380003","HealthyBlue HMO Gold $1,000","10207VA038",,"VAN003","VAS001","VAF013","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995166134782408",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380003-00","Standard Gold Off Exchange Plan","78.14%",,"No","Yes","No","100%",,"$1,000","$450","$0","$30","$1,000","$0","$70","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/HENVCN7DRXXVCN7LN012016.pdf",,"15"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380003","HealthyBlue HMO Gold $1,000","10207VA038",,"VAN003","VAS001","VAF013","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995166134782408",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380003-01","Standard Gold On Exchange Plan","78.14%",,"No","Yes","No","100%",,"$1,000","$450","$0","$30","$1,000","$0","$70","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/HENVCN7CRXXVCN7LN012016.pdf",,"16"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380003","HealthyBlue HMO Gold $1,000","10207VA038",,"VAN003","VAS001","VAF013","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995166134782408",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/HENVCN7ARXXVCN71N012016.pdf",,"17"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380003","HealthyBlue HMO Gold $1,000","10207VA038",,"VAN003","VAS001","VAF013","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995166134782408",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380003-03","Limited Cost Sharing Plan Variation","78.14%",,"No","Yes","No","100%",,"$1,000","$450","$0","$30","$1,000","$0","$70","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://content.carefirst.com/sbc/HENVCN7BRXXVCN7LN012016.pdf",,"18"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380009","BlueChoice HMO HSA Bronze $6,000","10207VA038",,"VAN001","VAS001","VAF011","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995179036432798",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380009-00","Standard Bronze Off Exchange Plan","61.75%",,"Yes","Yes","No","100%",,"$5,250","$0","$0","$30","$5,210","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://content.carefirst.com/sbc/AHHVCN5FRXCVCN5PN012016.pdf",,"19"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380009","BlueChoice HMO HSA Bronze $6,000","10207VA038",,"VAN001","VAS001","VAF011","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995179036432798",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380009-01","Standard Bronze On Exchange Plan","61.75%",,"Yes","Yes","No","100%",,"$5,250","$0","$0","$30","$5,210","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://content.carefirst.com/sbc/AHHVCN5ERXCVCN5PN012016.pdf",,"20"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380009","BlueChoice HMO HSA Bronze $6,000","10207VA038",,"VAN001","VAS001","VAF011","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995179036432798",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380009-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://content.carefirst.com/sbc/AHAVCN5BRXXVCN50N012016.pdf",,"21"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380009","BlueChoice HMO HSA Bronze $6,000","10207VA038",,"VAN001","VAS001","VAF011","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995179036432798",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380009-03","Limited Cost Sharing Plan Variation","61.75%",,"Yes","Yes","No","100%",,"$5,250","$0","$0","$30","$5,210","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://content.carefirst.com/sbc/AHHVCN5ERXCVCN5PN012016.pdf",,"22"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380011","BlueChoice HMO HSA Silver $1,350","10207VA038",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995169468482558",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380011-00","Standard Silver Off Exchange Plan","70.46%",,"Yes","Yes","No","100%",,"$1,350","$515","$0","$30","$1,350","$495","$196","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://content.carefirst.com/sbc/AHHVCN6CRXCVCN6LN012016.pdf",,"23"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380011","BlueChoice HMO HSA Silver $1,350","10207VA038",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995169468482558",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380011-01","Standard Silver On Exchange Plan","70.46%",,"Yes","Yes","No","100%",,"$1,350","$515","$0","$30","$1,350","$495","$196","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://content.carefirst.com/sbc/AHHVCN6BRXCVCN6LN012016.pdf",,"24"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380011","BlueChoice HMO HSA Silver $1,350","10207VA038",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995169468482558",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380011-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://content.carefirst.com/sbc/AHAVCN6ARXXVCN65N012016.pdf",,"25"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380011","BlueChoice HMO HSA Silver $1,350","10207VA038",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995169468482558",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380011-03","Limited Cost Sharing Plan Variation","70.46%",,"Yes","Yes","No","100%",,"$1,350","$515","$0","$30","$1,350","$495","$196","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://content.carefirst.com/sbc/AHHVCN6ARXCVCN6LN012016.pdf",,"26"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380011","BlueChoice HMO HSA Silver $1,350","10207VA038",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995169468482558",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380011-04","73% AV Level Silver Plan","73.59%",,"Yes","Yes","No","100%",,"$1,000","$515","$0","$30","$1,000","$565","$198","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://content.carefirst.com/sbc/AHHVCN6DRXCVCN6MN012016.pdf",,"27"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380011","BlueChoice HMO HSA Silver $1,350","10207VA038",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995169468482558",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380011-05","87% AV Level Silver Plan","86.73%",,"Yes","Yes","No","100%",,"$0","$215","$0","$30","$0","$440","$244","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://content.carefirst.com/sbc/AHAVCN6CRXXVCN6MN012016.pdf",,"28"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380011","BlueChoice HMO HSA Silver $1,350","10207VA038",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995169468482558",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380011-06","94% AV Level Silver Plan","93.83%",,"Yes","Yes","No","100%",,"$0","$100","$0","$30","$0","$0","$244","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://content.carefirst.com/sbc/AHAVCN6BRXXVCN6LN012016.pdf",,"29"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380013","BlueChoice HMO HSA Bronze $6,550","10207VA038",,"VAN001","VAS001","VAF011","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995185024758194",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380013-00","Standard Bronze Off Exchange Plan","59.94%",,"Yes","Yes","No","100%",,"$5,250","$0","$0","$30","$5,210","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://content.carefirst.com/sbc/AHHVCN5CRXCVCN5LN012016.pdf",,"30"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380013","BlueChoice HMO HSA Bronze $6,550","10207VA038",,"VAN001","VAS001","VAF011","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995185024758194",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380013-01","Standard Bronze On Exchange Plan","59.94%",,"Yes","Yes","No","100%",,"$5,250","$0","$0","$30","$5,210","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://content.carefirst.com/sbc/AHHVCN5BRXCVCN5LN012016.pdf",,"31"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380013","BlueChoice HMO HSA Bronze $6,550","10207VA038",,"VAN001","VAS001","VAF011","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995185024758194",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380013-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://content.carefirst.com/sbc/AHAVCN5ARXXVCN50N012016.pdf",,"32"
"2016","VA","10207","SERFF","13","2015-10-21 17:48:08","4","10207","VA","Individual","No","52-1358219","10207VA0380013","BlueChoice HMO HSA Bronze $6,550","10207VA038",,"VAN001","VAS001","VAF011","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.995185024758194",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Services only","Yes","Emergency Services only","Yes",,"https://www.carefirst.com/acarx","10207VA0380013-03","Limited Cost Sharing Plan Variation","59.94%",,"Yes","Yes","No","100%",,"$5,250","$0","$0","$30","$5,210","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://content.carefirst.com/sbc/AHHVCN5ARXCVCN5LN012016.pdf",,"33"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","1","12028","VA","Individual","No","46-0674828","12028VA0120028","Innovation Health Leap Bronze Basic","12028VA012",,"VAN001","VAS001","VAF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120028-00","Standard Bronze Off Exchange Plan","59.02%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_BronzeBasic_OFF.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_OFF.pdf","4"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","1","12028","VA","Individual","No","46-0674828","12028VA0120028","Innovation Health Leap Bronze Basic","12028VA012",,"VAN001","VAS001","VAF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120028-01","Standard Bronze On Exchange Plan","59.02%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_BronzeBasic_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","5"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","1","12028","VA","Individual","No","46-0674828","12028VA0120028","Innovation Health Leap Bronze Basic","12028VA012",,"VAN001","VAS001","VAF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120028-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_BronzeBasicAIAN0CS_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","6"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","1","12028","VA","Individual","No","46-0674828","12028VA0120028","Innovation Health Leap Bronze Basic","12028VA012",,"VAN001","VAS001","VAF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120028-03","Limited Cost Sharing Plan Variation","59.02%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_BronzeBasicAIANLimitedCS_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","7"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","2","12028","VA","Individual","No","46-0674828","12028VA0120019","Innovation Health Leap Bronze HSA","12028VA012",,"VAN001","VAS001","VAF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120019-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_BronzeHSA_OFF.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_OFF.pdf","4"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","2","12028","VA","Individual","No","46-0674828","12028VA0120019","Innovation Health Leap Bronze HSA","12028VA012",,"VAN001","VAS001","VAF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120019-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_BronzeHSA_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","5"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","2","12028","VA","Individual","No","46-0674828","12028VA0120019","Innovation Health Leap Bronze HSA","12028VA012",,"VAN001","VAS001","VAF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120019-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_BronzeHSAAIAN0CS_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","6"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","2","12028","VA","Individual","No","46-0674828","12028VA0120019","Innovation Health Leap Bronze HSA","12028VA012",,"VAN001","VAS001","VAF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120019-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_BronzeHSAAIANLimitedCS_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","7"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","3","12028","VA","Individual","No","46-0674828","12028VA0120001","Innovation Health Leap Bronze Plus","12028VA012",,"VAN001","VAS001","VAF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120001-00","Standard Bronze Off Exchange Plan","60.81%",,"Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_BronzePlus_OFF.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_OFF.pdf","4"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","3","12028","VA","Individual","No","46-0674828","12028VA0120001","Innovation Health Leap Bronze Plus","12028VA012",,"VAN001","VAS001","VAF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120001-01","Standard Bronze On Exchange Plan","60.81%",,"Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_BronzePlus_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","5"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","3","12028","VA","Individual","No","46-0674828","12028VA0120001","Innovation Health Leap Bronze Plus","12028VA012",,"VAN001","VAS001","VAF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_BronzePlusAIAN0CS_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","6"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","3","12028","VA","Individual","No","46-0674828","12028VA0120001","Innovation Health Leap Bronze Plus","12028VA012",,"VAN001","VAS001","VAF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120001-03","Limited Cost Sharing Plan Variation","60.81%",,"Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_BronzePlusAIANLimitedCS_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","7"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","4","12028","VA","Individual","No","46-0674828","12028VA0120015","Innovation Health Leap Silver Basic","12028VA012",,"VAN001","VAS001","VAF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120015-00","Standard Silver Off Exchange Plan","68.09%",,"Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_SilverBasic_OFF.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_OFF.pdf","4"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","4","12028","VA","Individual","No","46-0674828","12028VA0120015","Innovation Health Leap Silver Basic","12028VA012",,"VAN001","VAS001","VAF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120015-01","Standard Silver On Exchange Plan","68.09%",,"Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_SilverBasic_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","5"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","4","12028","VA","Individual","No","46-0674828","12028VA0120015","Innovation Health Leap Silver Basic","12028VA012",,"VAN001","VAS001","VAF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120015-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_SilverBasicAIAN0CS_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","6"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","4","12028","VA","Individual","No","46-0674828","12028VA0120015","Innovation Health Leap Silver Basic","12028VA012",,"VAN001","VAS001","VAF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120015-03","Limited Cost Sharing Plan Variation","68.09%",,"Yes","Yes","No","100%",,"$5,200","$20","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,250","$5250 per person","$10500 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_SilverBasicAIANLimitedCS_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","7"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","4","12028","VA","Individual","No","46-0674828","12028VA0120015","Innovation Health Leap Silver Basic","12028VA012",,"VAN001","VAS001","VAF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120015-04","73% AV Level Silver Plan","72.06%",,"Yes","Yes","No","100%",,"$4,200","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,210","$4210 per person","$8420 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,210","$4210 per person","$8420 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_SilverBasicCSR73_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","8"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","4","12028","VA","Individual","No","46-0674828","12028VA0120015","Innovation Health Leap Silver Basic","12028VA012",,"VAN001","VAS001","VAF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120015-05","87% AV Level Silver Plan","86.03%",,"Yes","Yes","No","100%",,"$1,600","$0","$0","$200","$1,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,570","$1570 per person","$3140 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,570","$1570 per person","$3140 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_SilverBasicCSR87_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","9"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","4","12028","VA","Individual","No","46-0674828","12028VA0120015","Innovation Health Leap Silver Basic","12028VA012",,"VAN001","VAS001","VAF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120015-06","94% AV Level Silver Plan","93.09%",,"Yes","Yes","No","100%",,"$700","$0","$0","$200","$600","$40","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$680","$680 per person","$1360 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$680","$680 per person","$1360 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_SilverBasicCSR94_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","10"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","5","12028","VA","Individual","No","46-0674828","12028VA0120027","Innovation Health Leap Silver Plus","12028VA012",,"VAN001","VAS001","VAF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120027-00","Standard Silver Off Exchange Plan","71.79%",,"Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,510","$4510 per person","$9020 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,510","$4510 per person","$9020 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_SilverPlus_OFF.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_OFF.pdf","4"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","5","12028","VA","Individual","No","46-0674828","12028VA0120027","Innovation Health Leap Silver Plus","12028VA012",,"VAN001","VAS001","VAF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120027-01","Standard Silver On Exchange Plan","71.79%",,"Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,510","$4510 per person","$9020 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,510","$4510 per person","$9020 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_SilverPlus_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","5"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","5","12028","VA","Individual","No","46-0674828","12028VA0120027","Innovation Health Leap Silver Plus","12028VA012",,"VAN001","VAS001","VAF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120027-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_SilverPlusAIAN0CS_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","6"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","5","12028","VA","Individual","No","46-0674828","12028VA0120027","Innovation Health Leap Silver Plus","12028VA012",,"VAN001","VAS001","VAF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120027-03","Limited Cost Sharing Plan Variation","71.79%",,"Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,510","$4510 per person","$9020 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,510","$4510 per person","$9020 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_SilverPlusAIANLimitedCS_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","7"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","5","12028","VA","Individual","No","46-0674828","12028VA0120027","Innovation Health Leap Silver Plus","12028VA012",,"VAN001","VAS001","VAF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120027-04","73% AV Level Silver Plan","73.83%",,"Yes","Yes","No","100%",,"$4,000","$0","$0","$200","$2,400","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_SilverPlusCSR73_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","8"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","5","12028","VA","Individual","No","46-0674828","12028VA0120027","Innovation Health Leap Silver Plus","12028VA012",,"VAN001","VAS001","VAF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120027-05","87% AV Level Silver Plan","86.00%",,"Yes","Yes","No","100%",,"$1,700","$0","$0","$200","$1,500","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,650","$1650 per person","$3300 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_SilverPlusCSR87_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","9"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","5","12028","VA","Individual","No","46-0674828","12028VA0120027","Innovation Health Leap Silver Plus","12028VA012",,"VAN001","VAS001","VAF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120027-06","94% AV Level Silver Plan","94.38%",,"Yes","Yes","No","100%",,"$600","$0","$0","$200","$500","$40","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_SilverPlusCSR94_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","10"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","6","12028","VA","Individual","No","46-0674828","12028VA0120022","Innovation Health Leap Gold Basic","12028VA012",,"VAN001","VAS001","VAF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120022-00","Standard Gold Off Exchange Plan","78.34%",,"Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_GoldBasic_OFF.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_OFF.pdf","4"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","6","12028","VA","Individual","No","46-0674828","12028VA0120022","Innovation Health Leap Gold Basic","12028VA012",,"VAN001","VAS001","VAF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120022-01","Standard Gold On Exchange Plan","78.34%",,"Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_GoldBasic_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","5"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","6","12028","VA","Individual","No","46-0674828","12028VA0120022","Innovation Health Leap Gold Basic","12028VA012",,"VAN001","VAS001","VAF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120022-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_GoldBasicAIAN0CS_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","6"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","6","12028","VA","Individual","No","46-0674828","12028VA0120022","Innovation Health Leap Gold Basic","12028VA012",,"VAN001","VAS001","VAF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120022-03","Limited Cost Sharing Plan Variation","78.34%",,"Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_GoldBasicAIANLimitedCS_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","7"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","7","12028","VA","Individual","No","46-0674828","12028VA0120029","Innovation Health Leap Gold Diabetes","12028VA012",,"VAN001","VAS001","VAF007","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120029-00","Standard Gold Off Exchange Plan","78.36%",,"Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_GoldDiabetes_OFF.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_OFF.pdf","4"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","7","12028","VA","Individual","No","46-0674828","12028VA0120029","Innovation Health Leap Gold Diabetes","12028VA012",,"VAN001","VAS001","VAF007","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120029-01","Standard Gold On Exchange Plan","78.36%",,"Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_GoldDiabetes_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","5"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","7","12028","VA","Individual","No","46-0674828","12028VA0120029","Innovation Health Leap Gold Diabetes","12028VA012",,"VAN001","VAS001","VAF007","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120029-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_GoldDiabetesAIAN0CS_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","6"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","7","12028","VA","Individual","No","46-0674828","12028VA0120029","Innovation Health Leap Gold Diabetes","12028VA012",,"VAN001","VAS001","VAF007","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9959",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120029-03","Limited Cost Sharing Plan Variation","78.36%",,"Yes","Yes","No","100%",,"$3,500","$0","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_GoldDiabetesAIANLimitedCS_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","7"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","8","12028","VA","Individual","No","46-0674828","12028VA0120007","Innovation Health Leap Catastrophic","12028VA012",,"VAN001","VAS001","VAF008","New","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120007-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_Catastrophic_OFF.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_OFF.pdf","4"
"2016","VA","12028","SERFF","10","2015-08-25 12:56:34","8","12028","VA","Individual","No","46-0674828","12028VA0120007","Innovation Health Leap Catastrophic","12028VA012",,"VAN001","VAS001","VAF008","New","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=0641299824","12028VA0120007-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$20,000","$20000 per person","$40000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_Catastrophic_ON.pdf","http://innovation-health.s3.amazonaws.com/PlanBrochure_2016_VA_IVL_ON.pdf","5"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130037","Silver Preferred 3400/35/60","15668VA013","7205839435","VAN001","VAS001","VAF002","Existing","PPO","Silver","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9992",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130037-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130037-02.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","21"
"2016","VA","16064","SERFF","6","2015-08-25 12:56:34","3","16064","VA","Individual","Yes","54-0357120","16064VA1330004","Anthem Dental Family Enhanced","16064VA133",,"VAN001","VAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","16064VA1330004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e213908.pdf",,"5"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170001","OptimaFit Gold 1000","20507VA117","7487657612","VAN001","VAS001","VAF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170001-00","Standard Gold Off Exchange Plan","78.10%","0.737944602966309","No","Yes","No","100%",,"$1,000","$30","$600","$0","$300","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1432|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","4"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170001","OptimaFit Gold 1000","20507VA117","7487657612","VAN001","VAS001","VAF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170001-01","Standard Gold On Exchange Plan","78.10%","0.737944602966309","No","Yes","No","100%",,"$1,000","$30","$600","$0","$300","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1432|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","5"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170001","OptimaFit Gold 1000","20507VA117","7487657612","VAN001","VAS001","VAF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1571|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","6"
"2016","VA","13756","SERFF","7","2016-04-05 14:32:29","1","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0300001","Smile for Health - Certified Optimum Coverage","13756VA030",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","13756VA0300001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","VA","13756","SERFF","7","2016-04-05 14:32:29","2","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0300002","Smile for Health - Certified Optimum Coverage","13756VA030",,"VAN002","VAS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","13756VA0300002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","VA","13756","SERFF","7","2016-04-05 14:32:29","3","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0300003","Smile for Health - Certified Optimum Coverage","13756VA030",,"VAN003","VAS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.72","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","13756VA0300003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","VA","13756","SERFF","7","2016-04-05 14:32:29","4","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0310001","Smile for Health - Certified High Option","13756VA031",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","13756VA0310001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","VA","13756","SERFF","7","2016-04-05 14:32:29","5","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0310002","Smile for Health - Certified High Option","13756VA031",,"VAN002","VAS002",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","13756VA0310002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","VA","13756","SERFF","7","2016-04-05 14:32:29","6","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0310003","Smile for Health - Certified High Option","13756VA031",,"VAN003","VAS003",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Child-Only",,,,,"$7.35","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","13756VA0310003-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","VA","13756","SERFF","7","2016-04-05 14:32:29","7","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0320001","Smile for Health - Family Premier PPO","13756VA032",,"VAN003","VAS003",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$27.96","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","13756VA0320001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.unitedconcordia.com/docs/hcr/benefits-summary-va-sfh-family-premier-ppo.pdf","https://www.unitedconcordia.com/docs/hcr/product-brochure-va-sfh-family-premier-ppo.pdf","4"
"2016","VA","13756","SERFF","7","2016-04-05 14:32:29","7","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0320001","Smile for Health - Family Premier PPO","13756VA032",,"VAN003","VAS003",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$27.96","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","13756VA0320001-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.unitedconcordia.com/docs/hcr/benefits-summary-va-sfh-family-premier-ppo.pdf","https://www.unitedconcordia.com/docs/hcr/product-brochure-va-sfh-family-premier-ppo.pdf","5"
"2016","VA","13756","SERFF","7","2016-04-05 14:32:29","8","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0330001","Smile for Health - Family Value PPO","13756VA033",,"VAN003","VAS003",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$27.96","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","13756VA0330001-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.unitedconcordia.com/docs/hcr/benefits-summary-va-sfh-family-value-ppo.pdf","https://www.unitedconcordia.com/docs/hcr/product-brochure-va-sfh-family-value-ppo.pdf","4"
"2016","VA","13756","SERFF","7","2016-04-05 14:32:29","8","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0330001","Smile for Health - Family Value PPO","13756VA033",,"VAN003","VAS003",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$27.96","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","13756VA0330001-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.unitedconcordia.com/docs/hcr/benefits-summary-va-sfh-family-value-ppo.pdf","https://www.unitedconcordia.com/docs/hcr/product-brochure-va-sfh-family-value-ppo.pdf","5"
"2016","VA","13756","SERFF","7","2016-04-05 14:32:29","9","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0340001","Smile for Health - Family Core PPO","13756VA034",,"VAN003","VAS003",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$22.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","13756VA0340001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$700 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"$0","per person not applicable","per group not applicable","$350","$350 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.unitedconcordia.com/docs/hcr/benefits-summary-va-sfh-family-core-ppo.pdf","https://www.unitedconcordia.com/docs/hcr/product-brochure-va-sfh-family-core-ppo.pdf","4"
"2016","VA","13756","SERFF","7","2016-04-05 14:32:29","9","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0340001","Smile for Health - Family Core PPO","13756VA034",,"VAN003","VAS003",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures).  2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.  3) For orthodontic Services for individuals/members ages 19 and older or for orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. 4) For services specifically listed on the Schedule of Benefits as “Not Covered” or “Plan Pays 0%”.  For additional detail on full exclusions, please refer to your plan documents.",,"No","Allows Adult and Child-Only",,,,,"$22.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Same Coverage as In-Service","Yes",,"","13756VA0340001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$700 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"$0","per person not applicable","per group not applicable","$350","$350 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.unitedconcordia.com/docs/hcr/benefits-summary-va-sfh-family-core-ppo.pdf","https://www.unitedconcordia.com/docs/hcr/product-brochure-va-sfh-family-core-ppo.pdf","5"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130031","Gold Basic 750/40/60","15668VA013","7205839435","VAN001","VAS001","VAF001","Existing","PPO","Gold","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9993",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130031-00","Standard Gold Off Exchange Plan",,"0.781300246715546","No","Yes","No","100%",,"$750","$15","$1,000","$200","$300","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","25%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130031-00.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","4"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130031","Gold Basic 750/40/60","15668VA013","7205839435","VAN001","VAS001","VAF001","Existing","PPO","Gold","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9993",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130031-01","Standard Gold On Exchange Plan",,"0.781300246715546","No","Yes","No","100%",,"$750","$15","$1,000","$200","$300","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","25%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130031-01.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","5"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130031","Gold Basic 750/40/60","15668VA013","7205839435","VAN001","VAS001","VAF001","Existing","PPO","Gold","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9993",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130031-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130031-02.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","6"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130031","Gold Basic 750/40/60","15668VA013","7205839435","VAN001","VAS001","VAF001","Existing","PPO","Gold","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9993",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130031-03","Limited Cost Sharing Plan Variation",,"0.781300246715546","No","Yes","No","100%",,"$750","$15","$1,000","$200","$300","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","30%",,,,,"$1,500","$1500 per person","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","25%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130031-03.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","7"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130033","Gold Preferred 1000/35/50","15668VA013","7205839435","VAN001","VAS001","VAF001","Existing","PPO","Gold","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9993",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130033-00","Standard Gold Off Exchange Plan",,"0.783075511455536","No","Yes","No","100%",,"$1,000","$0","$500","$200","$300","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","25%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130033-00.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","8"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130033","Gold Preferred 1000/35/50","15668VA013","7205839435","VAN001","VAS001","VAF001","Existing","PPO","Gold","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9993",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130033-01","Standard Gold On Exchange Plan",,"0.783075511455536","No","Yes","No","100%",,"$1,000","$0","$500","$200","$300","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","25%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130033-01.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","9"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130033","Gold Preferred 1000/35/50","15668VA013","7205839435","VAN001","VAS001","VAF001","Existing","PPO","Gold","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9993",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130033-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130033-02.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","10"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130033","Gold Preferred 1000/35/50","15668VA013","7205839435","VAN001","VAS001","VAF001","Existing","PPO","Gold","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9993",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130033-03","Limited Cost Sharing Plan Variation",,"0.783075511455536","No","Yes","No","100%",,"$1,000","$0","$500","$200","$300","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","$2000 per person","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","25%",,,,,"$400","$400 per person","$800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130033-03.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","11"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130035","Silver Preferred 2500/35/60","15668VA013","7205839435","VAN001","VAS001","VAF002","Existing","PPO","Silver","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9992",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130035-00","Standard Silver Off Exchange Plan",,"0.706211626529694","No","Yes","No","100%",,"$2,500","$0","$600","$200","$400","$1,900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130035-00.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","12"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130035","Silver Preferred 2500/35/60","15668VA013","7205839435","VAN001","VAS001","VAF002","Existing","PPO","Silver","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9992",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130035-01","Standard Silver On Exchange Plan",,"0.706211626529694","No","Yes","No","100%",,"$2,500","$0","$600","$200","$400","$1,900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130035-01.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","13"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130035","Silver Preferred 2500/35/60","15668VA013","7205839435","VAN001","VAS001","VAF002","Existing","PPO","Silver","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9992",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130035-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130035-02.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","14"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130035","Silver Preferred 2500/35/60","15668VA013","7205839435","VAN001","VAS001","VAF002","Existing","PPO","Silver","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9992",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130035-03","Limited Cost Sharing Plan Variation",,"0.706211626529694","No","Yes","No","100%",,"$2,500","$0","$600","$200","$400","$1,900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130035-03.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","15"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130035","Silver Preferred 2500/35/60","15668VA013","7205839435","VAN001","VAS001","VAF002","Existing","PPO","Silver","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9992",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130035-04","73% AV Level Silver Plan",,"0.733839750289917","No","Yes","No","100%",,"$2,400","$0","$700","$200","$400","$1,800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,400","$4400 per person","$8800 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130035-04.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","16"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130035","Silver Preferred 2500/35/60","15668VA013","7205839435","VAN001","VAS001","VAF002","Existing","PPO","Silver","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9992",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130035-05","87% AV Level Silver Plan",,"0.861308693885803","No","Yes","No","100%",,"$700","$0","$700","$200","$300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","35%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130035-05.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","17"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130035","Silver Preferred 2500/35/60","15668VA013","7205839435","VAN001","VAS001","VAF002","Existing","PPO","Silver","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9992",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130035-06","94% AV Level Silver Plan",,"0.937200784683228","No","Yes","No","100%",,"$350","$0","$300","$200","$250","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"$12,700","$12700 per person","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","20%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","35%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130035-06.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","18"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130037","Silver Preferred 3400/35/60","15668VA013","7205839435","VAN001","VAS001","VAF002","Existing","PPO","Silver","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9992",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130037-00","Standard Silver Off Exchange Plan",,"0.692887485027313","No","Yes","No","100%",,"$3,400","$0","$400","$200","$400","$1,900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","$3,400","$3400 per person","$6800 per group","20%",,,,,"$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130037-00.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","19"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130037","Silver Preferred 3400/35/60","15668VA013","7205839435","VAN001","VAS001","VAF002","Existing","PPO","Silver","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9992",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130037-01","Standard Silver On Exchange Plan",,"0.692887485027313","No","Yes","No","100%",,"$3,400","$0","$400","$200","$400","$1,900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","$3,400","$3400 per person","$6800 per group","20%",,,,,"$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130037-01.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","20"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130037","Silver Preferred 3400/35/60","15668VA013","7205839435","VAN001","VAS001","VAF002","Existing","PPO","Silver","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9992",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130037-03","Limited Cost Sharing Plan Variation",,"0.692887485027313","No","Yes","No","100%",,"$3,400","$0","$400","$200","$400","$1,900","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,400","$5400 per person","$10800 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","$3,400","$3400 per person","$6800 per group","20%",,,,,"$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130037-03.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","22"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130037","Silver Preferred 3400/35/60","15668VA013","7205839435","VAN001","VAS001","VAF002","Existing","PPO","Silver","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9992",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130037-04","73% AV Level Silver Plan",,"0.734468758106232","No","Yes","No","100%",,"$2,350","$0","$700","$200","$400","$1,800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","$2,350","$2350 per person","$4700 per group","20%",,,,,"$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","35%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130037-04.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","23"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130037","Silver Preferred 3400/35/60","15668VA013","7205839435","VAN001","VAS001","VAF002","Existing","PPO","Silver","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9992",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130037-05","87% AV Level Silver Plan",,"0.861308693885803","No","Yes","No","100%",,"$700","$0","$700","$200","$300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","$700","$700 per person","$1400 per group","20%",,,,,"$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","35%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130037-05.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","24"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130037","Silver Preferred 3400/35/60","15668VA013","7205839435","VAN001","VAS001","VAF002","Existing","PPO","Silver","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9992",,,"$500","0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130037-06","94% AV Level Silver Plan",,"0.937200784683228","No","Yes","No","100%",,"$350","$0","$300","$200","$250","$400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"$10,800","$10800 per person","$21600 per group","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","20%",,,,,"$6,800","$6800 per person","$13600 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","35%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130037-06.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","25"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130047","Silver Basic 2250","15668VA013","7205839435","VAN001","VAS001","VAF003","New","PPO","Silver","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","3","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130047-00","Standard Silver Off Exchange Plan",,"0.686036705970764","No","Yes","No","100%",,"$2,250","$20","$1,000","$200","$1,100","$1,200","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","30%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130047-00.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","26"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170002","OptimaFit Silver 4000 20","20507VA117","7487657612","VAN001","VAS001","VAF001","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1572|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","10"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170002","OptimaFit Silver 4000 20","20507VA117","7487657612","VAN001","VAS001","VAF001","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170002-03","Limited Cost Sharing Plan Variation","68.07%","0.65552431344986","No","Yes","No","100%",,"$4,000","$30","$600","$0","$400","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1564|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","11"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130047","Silver Basic 2250","15668VA013","7205839435","VAN001","VAS001","VAF003","New","PPO","Silver","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","3","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130047-01","Standard Silver On Exchange Plan",,"0.686036705970764","No","Yes","No","100%",,"$2,250","$20","$1,000","$200","$1,100","$1,200","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","30%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130047-01.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","27"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130047","Silver Basic 2250","15668VA013","7205839435","VAN001","VAS001","VAF003","New","PPO","Silver","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","3","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130047-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130047-02.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","28"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130047","Silver Basic 2250","15668VA013","7205839435","VAN001","VAS001","VAF003","New","PPO","Silver","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","3","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130047-03","Limited Cost Sharing Plan Variation",,"0.686036705970764","No","Yes","No","100%",,"$2,250","$20","$1,000","$200","$1,100","$1,200","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","30%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130047-03.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","29"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130047","Silver Basic 2250","15668VA013","7205839435","VAN001","VAS001","VAF003","New","PPO","Silver","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","3","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130047-04","73% AV Level Silver Plan",,"0.721571087837219","No","Yes","No","100%",,"$2,250","$20","$1,000","$200","$1,100","$1,200","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","30%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130047-04.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","30"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130047","Silver Basic 2250","15668VA013","7205839435","VAN001","VAS001","VAF003","New","PPO","Silver","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","3","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130047-05","87% AV Level Silver Plan",,"0.86110645532608","No","Yes","No","100%",,"$650","$0","$650","$200","$300","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","30%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130047-05.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","31"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","1","15668","VA","Individual","No","31-1592932","15668VA0130047","Silver Basic 2250","15668VA013","7205839435","VAN001","VAS001","VAF003","New","PPO","Silver","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","3","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130047-06","94% AV Level Silver Plan",,"0.930038511753082","No","Yes","No","100%",,"$200","$0","$400","$200","$250","$350","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30%",,,,,"$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","30%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/15668va0130047-06.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","32"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","2","15668","VA","Individual","No","31-1592932","15668VA0130039","Bronze 4850","15668VA013","7205839435","VAN001","VAS001","VAF004","Existing","PPO","Bronze","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.999",,,"$500","0","0","3","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130039-00","Standard Bronze Off Exchange Plan",,"0.619210839271545","Yes","Yes","No","100%",,"$4,850","$0","$20","$200","$4,850","$120","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","35%",,,,,"$9,700","$9700 per person","$19400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130039-00.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","4"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","2","15668","VA","Individual","No","31-1592932","15668VA0130039","Bronze 4850","15668VA013","7205839435","VAN001","VAS001","VAF004","Existing","PPO","Bronze","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.999",,,"$500","0","0","3","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130039-01","Standard Bronze On Exchange Plan",,"0.619210839271545","Yes","Yes","No","100%",,"$4,850","$0","$20","$200","$4,850","$120","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","35%",,,,,"$9,700","$9700 per person","$19400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130039-01.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","5"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","2","15668","VA","Individual","No","31-1592932","15668VA0130039","Bronze 4850","15668VA013","7205839435","VAN001","VAS001","VAF004","Existing","PPO","Bronze","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.999",,,"$500","0","0","3","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130039-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/15668va0130039-02.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","6"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","2","15668","VA","Individual","No","31-1592932","15668VA0130039","Bronze 4850","15668VA013","7205839435","VAN001","VAS001","VAF004","Existing","PPO","Bronze","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.999",,,"$500","0","0","3","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130039-03","Limited Cost Sharing Plan Variation",,"0.619210839271545","Yes","Yes","No","100%",,"$4,850","$0","$20","$200","$4,850","$120","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","35%",,,,,"$9,700","$9700 per person","$19400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130039-03.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","7"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","2","15668","VA","Individual","No","31-1592932","15668VA0130041","Bronze 5800","15668VA013","7205839435","VAN001","VAS001","VAF005","Existing","PPO","Bronze","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9989",,,"$500","0","0","3","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130041-00","Standard Bronze Off Exchange Plan",,"0.612453818321228","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$4,860","$120","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","25%",,,,,"$11,600","$11600 per person","$23200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130041-00.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","8"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","2","15668","VA","Individual","No","31-1592932","15668VA0130041","Bronze 5800","15668VA013","7205839435","VAN001","VAS001","VAF005","Existing","PPO","Bronze","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9989",,,"$500","0","0","3","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130041-01","Standard Bronze On Exchange Plan",,"0.612453818321228","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$4,860","$120","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","25%",,,,,"$11,600","$11600 per person","$23200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130041-01.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","9"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","2","15668","VA","Individual","No","31-1592932","15668VA0130041","Bronze 5800","15668VA013","7205839435","VAN001","VAS001","VAF005","Existing","PPO","Bronze","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9989",,,"$500","0","0","3","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130041-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.pchp.net/index.php/15668va0130041-02.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","10"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","2","15668","VA","Individual","No","31-1592932","15668VA0130041","Bronze 5800","15668VA013","7205839435","VAN001","VAS001","VAF005","Existing","PPO","Bronze","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9989",,,"$500","0","0","3","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130041-03","Limited Cost Sharing Plan Variation",,"0.612453818321228","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$4,860","$120","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","25%",,,,,"$11,600","$11600 per person","$23200 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130041-03.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","11"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","2","15668","VA","Individual","No","31-1592932","15668VA0130043","Bronze HSA 4750","15668VA013","7205839435","VAN001","VAS001","VAF005","Existing","PPO","Bronze","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130043-00","Standard Bronze Off Exchange Plan",,"0.616587162017822","Yes","Yes","No","100%",,"$4,750","$0","$40","$200","$4,750","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","25%",,,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/15668va0130043-00.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","12"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","2","15668","VA","Individual","No","31-1592932","15668VA0130043","Bronze HSA 4750","15668VA013","7205839435","VAN001","VAS001","VAF005","Existing","PPO","Bronze","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130043-01","Standard Bronze On Exchange Plan",,"0.616587162017822","Yes","Yes","No","100%",,"$4,750","$0","$40","$200","$4,750","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","25%",,,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/15668va0130043-01.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","13"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","2","15668","VA","Individual","No","31-1592932","15668VA0130043","Bronze HSA 4750","15668VA013","7205839435","VAN001","VAS001","VAF005","Existing","PPO","Bronze","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130043-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.pchp.net/index.php/15668va0130043-02.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","14"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","2","15668","VA","Individual","No","31-1592932","15668VA0130043","Bronze HSA 4750","15668VA013","7205839435","VAN001","VAS001","VAF005","Existing","PPO","Bronze","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130043-03","Limited Cost Sharing Plan Variation",,"0.616587162017822","Yes","Yes","No","100%",,"$4,750","$0","$40","$200","$4,750","$0","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group","25%",,,,,"$9,500","$9500 per person","$19000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/15668va0130043-03.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","15"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","2","15668","VA","Individual","No","31-1592932","15668VA0130045","Bronze HSA 5500","15668VA013","7205839435","VAN001","VAS001","VAF006","Existing","PPO","Bronze","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130045-00","Standard Bronze Off Exchange Plan",,"0.610359847545624","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$5,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","15%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/15668va0130045-00.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","16"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","2","15668","VA","Individual","No","31-1592932","15668VA0130045","Bronze HSA 5500","15668VA013","7205839435","VAN001","VAS001","VAF006","Existing","PPO","Bronze","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130045-01","Standard Bronze On Exchange Plan",,"0.610359847545624","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$5,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","15%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/15668va0130045-01.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","17"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","2","15668","VA","Individual","No","31-1592932","15668VA0130045","Bronze HSA 5500","15668VA013","7205839435","VAN001","VAS001","VAF006","Existing","PPO","Bronze","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130045-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.pchp.net/index.php/15668va0130045-02.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","18"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","2","15668","VA","Individual","No","31-1592932","15668VA0130045","Bronze HSA 5500","15668VA013","7205839435","VAN001","VAS001","VAF006","Existing","PPO","Bronze","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.999",,,,"0","0","0","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130045-03","Limited Cost Sharing Plan Variation",,"0.610359847545624","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$5,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","15%",,,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/15668va0130045-03.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","19"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","2","15668","VA","Individual","No","31-1592932","15668VA0130029","Catastrophic 6850","15668VA013","7205839435","VAN001","VAS001","VAF007","Existing","PPO","Catastrophic","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9981",,,,"0","0","3","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130029-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$4,860","$120","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130029-00.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","20"
"2016","VA","15668","SERFF","7","2015-08-25 12:56:34","2","15668","VA","Individual","No","31-1592932","15668VA0130029","Catastrophic 6850","15668VA013","7205839435","VAN001","VAS001","VAF007","Existing","PPO","Catastrophic","No","Both","No","No",,"Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9981",,,,"0","0","3","2016-01-01",,"No",,"Yes","If a Participant chooses to receive Covered Services outside of Piedmont's Service Area from non-participating Providers (Out-of-Network) without a pre-authorization from Piedmont, services will be subject to a reduced level of benefits called Out-of-Network benefits. This does not apply to Emergency services.","No","http://www.pchp.net/index.php/initial-enrollment-payment-ppo.html","http://www.pchp.net/index.php/prescription-drug-formulary-ppo.html","15668VA0130029-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$4,860","$120","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$27,400","$27400 per person","$54800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/15668va0130029-01.html","http://www.pchp.net/index.php/plan-brochure-ppo.html","21"
"2016","VA","16064","SERFF","6","2015-08-25 12:56:34","1","16064","VA","Individual","Yes","54-0357120","16064VA1250003","Anthem Dental Pediatric","16064VA125",,"VAN001","VAS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Child-Only",,,,,"$22.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","16064VA1250003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e213909.pdf",,"4"
"2016","VA","16064","SERFF","6","2015-08-25 12:56:34","1","16064","VA","SHOP (Small Group)","Yes","54-0357120","16064VA1280003","Anthem Dental Pediatric","16064VA128",,"VAN001","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$22.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","16064VA1280003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e213909.pdf",,"4"
"2016","VA","16064","SERFF","6","2015-08-25 12:56:34","1","16064","VA","Individual","Yes","54-0357120","16064VA1310003","Anthem Dental Pediatric","16064VA131",,"VAN001","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$22.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","16064VA1310003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e213909.pdf",,"5"
"2016","VA","16064","SERFF","6","2015-08-25 12:56:34","2","16064","VA","Individual","Yes","54-0357120","16064VA1270003","Anthem Dental Family","16064VA127",,"VAN001","VAS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.37","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","16064VA1270003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e213907.pdf",,"4"
"2016","VA","16064","SERFF","6","2015-08-25 12:56:34","2","16064","VA","SHOP (Small Group)","Yes","54-0357120","16064VA1240003","Anthem Dental Family","16064VA124",,"VAN001","VAS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.37","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","16064VA1240003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e213907.pdf",,"4"
"2016","VA","16064","SERFF","6","2015-08-25 12:56:34","2","16064","VA","SHOP (Small Group)","Yes","54-0357120","16064VA1300003","Anthem Dental Family","16064VA130",,"VAN001","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.37","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","16064VA1300003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e213907.pdf",,"5"
"2016","VA","16064","SERFF","6","2015-08-25 12:56:34","2","16064","VA","Individual","Yes","54-0357120","16064VA1330003","Anthem Dental Family","16064VA133",,"VAN001","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.37","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","16064VA1330003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e213907.pdf",,"5"
"2016","VA","16064","SERFF","6","2015-08-25 12:56:34","3","16064","VA","Individual","Yes","54-0357120","16064VA1270004","Anthem Dental Family Enhanced","16064VA127",,"VAN001","VAS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","16064VA1270004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e213908.pdf",,"4"
"2016","VA","16064","SERFF","6","2015-08-25 12:56:34","3","16064","VA","SHOP (Small Group)","Yes","54-0357120","16064VA1240004","Anthem Dental Family Enhanced","16064VA124",,"VAN001","VAS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","16064VA1240004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e213908.pdf",,"4"
"2016","VA","16064","SERFF","6","2015-08-25 12:56:34","3","16064","VA","SHOP (Small Group)","Yes","54-0357120","16064VA1300004","Anthem Dental Family Enhanced","16064VA130",,"VAN001","VAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Out of Country Coverage Description","Yes","If a member does not use a network dentist, services will be reimburse at the out-of-network level","Yes",,"","16064VA1300004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$25","$25 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.anthem.com/agent/va/f0/s0/t0/pw_e213908.pdf",,"5"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170001","OptimaFit Gold 1000","20507VA117","7487657612","VAN001","VAS001","VAF001","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170001-03","Limited Cost Sharing Plan Variation","78.10%","0.737944602966309","No","Yes","No","100%",,"$1,000","$30","$600","$0","$300","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1563|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","7"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170002","OptimaFit Silver 4000 20","20507VA117","7487657612","VAN001","VAS001","VAF001","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170002-00","Standard Silver Off Exchange Plan","68.07%","0.65552431344986","No","Yes","No","100%",,"$4,000","$30","$600","$0","$400","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1541|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","8"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170002","OptimaFit Silver 4000 20","20507VA117","7487657612","VAN001","VAS001","VAF001","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170002-01","Standard Silver On Exchange Plan","68.07%","0.65552431344986","No","Yes","No","100%",,"$4,000","$30","$600","$0","$400","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1541|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","9"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170002","OptimaFit Silver 4000 20","20507VA117","7487657612","VAN001","VAS001","VAF001","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170002-04","73% AV Level Silver Plan","72.90%","0.697209060192108","No","Yes","No","100%",,"$2,500","$30","$700","$0","$400","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1550|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP3.aspx","12"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170002","OptimaFit Silver 4000 20","20507VA117","7487657612","VAN001","VAS001","VAF001","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170002-05","87% AV Level Silver Plan","86.35%","0.876751601696014","No","Yes","No","100%",,"$500","$30","$700","$0","$400","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1552|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP3.aspx","13"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170002","OptimaFit Silver 4000 20","20507VA117","7487657612","VAN001","VAS001","VAF001","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170002-06","94% AV Level Silver Plan","93.50%","0.933060109615326","No","Yes","No","100%",,"$200","$10","$400","$0","$300","$800","$10","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1546|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP3.aspx","14"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170006","OptimaFit Silver 2600 25 20","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170006-00","Standard Silver Off Exchange Plan","70.00%","0.670966506004334","No","Yes","No","100%",,"$2,600","$0","$930","$150","$2,670","$590","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1543|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","15"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170006","OptimaFit Silver 2600 25 20","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170006-01","Standard Silver On Exchange Plan","70.00%","0.670966506004334","No","Yes","No","100%",,"$30","$30","$900","$0","$700","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1543|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","16"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170006","OptimaFit Silver 2600 25 20","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1573|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","17"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170006","OptimaFit Silver 2600 25 20","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170006-03","Limited Cost Sharing Plan Variation","70.00%","0.670966506004334","No","Yes","No","100%",,"$30","$30","$900","$0","$700","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1565|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","18"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170006","OptimaFit Silver 2600 25 20","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170006-04","73% AV Level Silver Plan","73.50%","0.695900917053223","No","Yes","No","100%",,"$2,000","$30","$800","$0","$700","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1551|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP3.aspx","19"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170006","OptimaFit Silver 2600 25 20","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170006-05","87% AV Level Silver Plan","88.00%","0.874850928783417","No","Yes","No","100%",,"$800","$30","$500","$0","$700","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$800","$800 per person","$1600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1553|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP3.aspx","20"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170006","OptimaFit Silver 2600 25 20","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170006-06","94% AV Level Silver Plan","93.54%","0.931448876857758","No","Yes","No","100%",,"$200","$10","$400","$0","$300","$700","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1547|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP3.aspx","21"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170021","OptimaFit Bronze 6500 25","20507VA117","7487657612","VAN001","VAS001","VAF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170021-00","Standard Bronze Off Exchange Plan",,"0.612679183483124","Yes","Yes","No","100%",,"$6,500","$30","$200","$0","$3,100","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1542|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","22"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170021","OptimaFit Bronze 6500 25","20507VA117","7487657612","VAN001","VAS001","VAF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170021-01","Standard Bronze On Exchange Plan",,"0.612679183483124","Yes","Yes","No","100%",,"$6,500","$30","$200","$0","$3,100","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1542|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","23"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170021","OptimaFit Bronze 6500 25","20507VA117","7487657612","VAN001","VAS001","VAF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1574|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","24"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170021","OptimaFit Bronze 6500 25","20507VA117","7487657612","VAN001","VAS001","VAF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170021-03","Limited Cost Sharing Plan Variation",,"0.612679183483124","Yes","Yes","No","100%",,"$6,500","$30","$200","$0","$3,100","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1566|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","25"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1180001","OptimaFit Bronze 4500 HSA","20507VA118","7487657612","VAN001","VAS001","VAF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1180001-00","Standard Bronze Off Exchange Plan",,"0.610529780387878","Yes","Yes","No","100%",,"$4,500","$20","$800","$0","$3,600","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1544|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","26"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1180001","OptimaFit Bronze 4500 HSA","20507VA118","7487657612","VAN001","VAS001","VAF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1180001-01","Standard Bronze On Exchange Plan",,"0.610529780387878","Yes","Yes","No","100%",,"$4,500","$20","$800","$0","$3,600","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1544|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","27"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1180001","OptimaFit Bronze 4500 HSA","20507VA118","7487657612","VAN001","VAS001","VAF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1180001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1575|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","28"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1180001","OptimaFit Bronze 4500 HSA","20507VA118","7487657612","VAN001","VAS001","VAF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1180001-03","Limited Cost Sharing Plan Variation",,"0.610529780387878","Yes","Yes","No","100%",,"$4,500","$20","$800","$0","$3,600","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1567|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","29"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1180002","OptimaFit Bronze 5000 HSA","20507VA118","7487657612","VAN001","VAS001","VAF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1180002-00","Standard Bronze Off Exchange Plan",,"0.60757851600647","Yes","Yes","No","100%",,"$5,000","$20","$400","$0","$3,600","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1545|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","30"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1180002","OptimaFit Bronze 5000 HSA","20507VA118","7487657612","VAN001","VAS001","VAF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1180002-01","Standard Bronze On Exchange Plan",,"0.60757851600647","Yes","Yes","No","100%",,"$5,000","$20","$400","$0","$3,600","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1545|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","31"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1180002","OptimaFit Bronze 5000 HSA","20507VA118","7487657612","VAN001","VAS001","VAF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1180002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1576|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","32"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1180002","OptimaFit Bronze 5000 HSA","20507VA118","7487657612","VAN001","VAS001","VAF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1180002-03","Limited Cost Sharing Plan Variation",,"0.60757851600647","Yes","Yes","No","100%",,"$5,000","$20","$400","$0","$3,600","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1568|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","33"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1180003","OptimaFit Bronze 5500 HSA","20507VA118","7487657612","VAN001","VAS001","VAF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1180003-00","Standard Bronze Off Exchange Plan",,"0.604059100151062","Yes","Yes","No","100%",,"$5,500","$20","$200","$0","$3,600","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1548|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","34"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1180003","OptimaFit Bronze 5500 HSA","20507VA118","7487657612","VAN001","VAS001","VAF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1180003-01","Standard Bronze On Exchange Plan",,"0.604059100151062","Yes","Yes","No","100%",,"$5,500","$20","$200","$0","$3,600","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1548|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","35"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1180003","OptimaFit Bronze 5500 HSA","20507VA118","7487657612","VAN001","VAS001","VAF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1180003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1577|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","36"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1180003","OptimaFit Bronze 5500 HSA","20507VA118","7487657612","VAN001","VAS001","VAF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1180003-03","Limited Cost Sharing Plan Variation",,"0.604059100151062","Yes","Yes","No","100%",,"$5,500","$20","$200","$0","$3,600","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1569|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","37"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170019","OptimaFit Bronze 6850","20507VA117","7487657612","VAN001","VAS001","VAF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170019-00","Standard Bronze Off Exchange Plan",,"0.618612051010132","Yes","Yes","No","100%",,"$6,850","$30","$0","$0","$3,100","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1549|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","38"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170019","OptimaFit Bronze 6850","20507VA117","7487657612","VAN001","VAS001","VAF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170019-01","Standard Bronze On Exchange Plan",,"0.618612051010132","Yes","Yes","No","100%",,"$6,850","$30","$0","$0","$3,100","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1549|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","39"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170019","OptimaFit Bronze 6850","20507VA117","7487657612","VAN001","VAS001","VAF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1578|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","40"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","1","20507","VA","Individual","No","54-1283337","20507VA1170019","OptimaFit Bronze 6850","20507VA117","7487657612","VAN001","VAS001","VAF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,,"0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170019-03","Limited Cost Sharing Plan Variation",,"0.618612051010132","Yes","Yes","No","100%",,"$6,850","$30","$0","$0","$3,100","$100","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1570|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1.aspx","41"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170007","OptimaFit Gold 1200 Direct","20507VA117","7487657612","VAN002","VAS002","VAF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170007-00","Standard Gold Off Exchange Plan",,"0.78292191028595","Yes","Yes","Yes","80%","20%","$1,200","$30","$1,200","$0","$100","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$6850 per person","$6850 per group","$3,425","$6850 per person","$6850 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","per person not applicable","$2400 per group","20%","$1,200","per person not applicable","$2400 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1582|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1Direct.aspx","4"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170007","OptimaFit Gold 1200 Direct","20507VA117","7487657612","VAN002","VAS002","VAF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170007-01","Standard Gold On Exchange Plan",,"0.78292191028595","Yes","Yes","Yes","80%","20%","$1,200","$30","$1,200","$0","$100","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$6850 per person","$6850 per group","$3,425","$6850 per person","$6850 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","per person not applicable","$2400 per group","20%","$1,200","per person not applicable","$2400 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1582|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1Direct.aspx","5"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170007","OptimaFit Gold 1200 Direct","20507VA117","7487657612","VAN002","VAS002","VAF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","80%","20%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1591|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1Direct.aspx","6"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170007","OptimaFit Gold 1200 Direct","20507VA117","7487657612","VAN002","VAS002","VAF001","New","HMO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170007-03","Limited Cost Sharing Plan Variation",,"0.78292191028595","Yes","Yes","Yes","80%","20%","$1,200","$30","$1,200","$0","$100","$1,000","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,425","$6850 per person","$6850 per group","$3,425","$6850 per person","$6850 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","per person not applicable","$2400 per group","20%","$1,200","per person not applicable","$2400 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1588|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1Direct.aspx","7"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170008","OptimaFit Silver 2600 25 20 Direct","20507VA117","7487657612","VAN002","VAS002","VAF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170008-00","Standard Silver Off Exchange Plan","68.66%","0.657867968082428","No","Yes","Yes","80%","20%","$2,600","$30","$900","$0","$700","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","20%","$2,600","$2600 per person","$5200 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","50%","$250","$250 per person","per group not applicable","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1583|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1Direct.aspx","8"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170008","OptimaFit Silver 2600 25 20 Direct","20507VA117","7487657612","VAN002","VAS002","VAF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170008-01","Standard Silver On Exchange Plan","68.66%","0.657867968082428","No","Yes","Yes","80%","20%","$2,600","$30","$900","$0","$700","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","20%","$2,600","$2600 per person","$5200 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","50%","$250","$250 per person","per group not applicable","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1583|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1Direct.aspx","9"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170008","OptimaFit Silver 2600 25 20 Direct","20507VA117","7487657612","VAN002","VAS002","VAF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","80%","20%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1592|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1Direct.aspx","10"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170008","OptimaFit Silver 2600 25 20 Direct","20507VA117","7487657612","VAN002","VAS002","VAF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170008-03","Limited Cost Sharing Plan Variation","68.66%","0.657867968082428","No","Yes","Yes","80%","20%","$2,600","$30","$900","$0","$700","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","20%","$2,600","$2600 per person","$5200 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","50%","$250","$250 per person","per group not applicable","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1589|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1Direct.aspx","11"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170008","OptimaFit Silver 2600 25 20 Direct","20507VA117","7487657612","VAN002","VAS002","VAF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170008-04","73% AV Level Silver Plan","72.25%","0.681858360767365","No","Yes","Yes","80%","20%","$2,000","$30","$800","$0","$700","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","50%","$250","$250 per person","per group not applicable","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1585|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP3Direct.aspx","12"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170008","OptimaFit Silver 2600 25 20 Direct","20507VA117","7487657612","VAN002","VAS002","VAF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170008-05","87% AV Level Silver Plan","87.47%","0.869079351425171","No","Yes","Yes","80%","20%","$800","$30","$500","$0","$700","$800","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","$1,300","$1300 per person","$2600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%","$750","$750 per person","$1500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","50%","$250","$250 per person","per group not applicable","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1586|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP3Direct.aspx","13"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170008","OptimaFit Silver 2600 25 20 Direct","20507VA117","7487657612","VAN002","VAS002","VAF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","4","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170008-06","94% AV Level Silver Plan","93.71%","0.93458366394043","No","Yes","Yes","80%","20%","$200","$10","$300","$0","$300","$700","$20","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","10%","$200","$200 per person","$400 per group","10%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable","50%","$250","$250 per person","per group not applicable","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1587|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP3Direct.aspx","14"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170009","OptimaFit Bronze 4500 HSA Direct","20507VA117","7487657612","VAN002","VAS002","VAF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170009-00","Standard Bronze Off Exchange Plan",,"0.611095726490021","Yes","Yes","Yes","80%","20%","$4,500","$20","$800","$0","$3,600","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%","$4,500","$4500 per person","$9000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1584|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1Direct.aspx","15"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170009","OptimaFit Bronze 4500 HSA Direct","20507VA117","7487657612","VAN002","VAS002","VAF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170009-01","Standard Bronze On Exchange Plan",,"0.611095726490021","Yes","Yes","Yes","80%","20%","$4,500","$20","$800","$0","$3,600","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%","$4,500","$4500 per person","$9000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1584|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1Direct.aspx","16"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170009","OptimaFit Bronze 4500 HSA Direct","20507VA117","7487657612","VAN002","VAS002","VAF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","80%","20%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1593|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1Direct.aspx","17"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170009","OptimaFit Bronze 4500 HSA Direct","20507VA117","7487657612","VAN002","VAS002","VAF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170009-03","Limited Cost Sharing Plan Variation",,"0.611095726490021","Yes","Yes","Yes","80%","20%","$4,500","$20","$800","$0","$3,600","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%","$4,500","$4500 per person","$9000 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1590|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1Direct.aspx","18"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170011","OptimaFit Gold 1000 Select","20507VA117","7487657612","VAN003","VAS003","VAF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170011-00","Standard Gold Off Exchange Plan","78.10%","0.737944602966309","No","Yes","No","100%",,"$1,000","$30","$600","$0","$300","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1557|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1Select.aspx","19"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170011","OptimaFit Gold 1000 Select","20507VA117","7487657612","VAN003","VAS003","VAF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170011-01","Standard Gold On Exchange Plan","78.10%","0.737944602966309","No","Yes","No","100%",,"$1,000","$30","$600","$0","$300","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1557|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1Select.aspx","20"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170011","OptimaFit Gold 1000 Select","20507VA117","7487657612","VAN003","VAS003","VAF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170011-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1561|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1Select.aspx","21"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170011","OptimaFit Gold 1000 Select","20507VA117","7487657612","VAN003","VAS003","VAF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170011-03","Limited Cost Sharing Plan Variation","78.10%","0.737944602966309","No","Yes","No","100%",,"$1,000","$30","$600","$0","$300","$900","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1559|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1Select.aspx","22"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170017","OptimaFit Bronze 5500 HSA Select","20507VA117","7487657612","VAN003","VAS003","VAF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170017-00","Standard Bronze Off Exchange Plan",,"0.604059100151062","Yes","Yes","No","100%",,"$5,500","$20","$200","$0","$3,600","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1558|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1Select.aspx","23"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170017","OptimaFit Bronze 5500 HSA Select","20507VA117","7487657612","VAN003","VAS003","VAF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170017-01","Standard Bronze On Exchange Plan",,"0.604059100151062","Yes","Yes","No","100%",,"$5,500","$20","$200","$0","$3,600","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1558|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1Select.aspx","24"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170017","OptimaFit Bronze 5500 HSA Select","20507VA117","7487657612","VAN003","VAS003","VAF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1562|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1Select.aspx","25"
"2016","VA","20507","SERFF","17","2016-03-04 06:56:29","2","20507","VA","Individual","No","54-1283337","20507VA1170017","OptimaFit Bronze 5500 HSA Select","20507VA117","7487657612","VAN003","VAS003","VAF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.989",,,"$250","0","0","0","2016-01-01",,"Yes","emergency only","Yes","emergency only","No","https://pay.instamed.com/Forms/SSO/ACS_SAML2.aspx?idP=FFM&accountID=optimahealth@instamed.net&ssoAlias=OPTIMAHEALTHSSO&id=OPTIMA_HMO_PREM","http://www.optimahealth.com/exchangesbc/HIX4TierclosedExchangeformulary.pdf","20507VA1170017-03","Limited Cost Sharing Plan Variation",,"0.604059100151062","Yes","Yes","No","100%",,"$5,500","$20","$200","$0","$3,600","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.optimahealth.com/SBC/Pages/DisplaySBCDoc.aspx?SBCFile=1560|False|1","http://www.optimahealth.com/exchange/pages/012016HIXBrochureIFP1Select.aspx","26"
"2016","VA","24832","SERFF","6","2015-08-27 03:52:03","1","24832","VA","SHOP (Small Group)","Yes","47-0397286","24832VA0030001","Renaissance Group Dental PPO, EHB Certified","24832VA003",,"VAN001","VAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.66","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","24832VA0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","VA","24832","SERFF","6","2015-08-27 03:52:03","1","24832","VA","Individual","Yes","47-0397286","24832VA0010001","Delta Dental Individual PPO, EHB Certified","24832VA001",,"VAN002","VAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.73","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","24832VA0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","VA","24832","SERFF","6","2015-08-27 03:52:03","1","24832","VA","Individual","Yes","47-0397286","24832VA0010002","Delta Dental Individual PPO, EHB Certified","24832VA001",,"VAN002","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.71","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","24832VA0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","VA","24832","SERFF","6","2015-08-27 03:52:03","1","24832","VA","SHOP (Small Group)","Yes","47-0397286","24832VA0030002","Renaissance Group Dental PPO, EHB Certified","24832VA003",,"VAN001","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.65","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","24832VA0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","VA","24832","SERFF","6","2015-08-27 03:52:03","1","24832","VA","Individual","Yes","47-0397286","24832VA0020001","Renaissance Individual Dental PPO, EHB Certified","24832VA002",,"VAN001","VAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.65","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","24832VA0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","VA","24832","SERFF","6","2015-08-27 03:52:03","1","24832","VA","Individual","Yes","47-0397286","24832VA0020002","Renaissance Individual Dental PPO, EHB Certified","24832VA002",,"VAN001","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.94","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","24832VA0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","VA","31319","SERFF","11","2015-10-22 14:49:03","1","31319","VA","Individual","Yes","54-0844477","31319VA0010004","Delta Dental Individual and Family Basic plus Major Plan","31319VA001",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.50","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","31319VA0010004-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,"Not Applicable","per person not applicable","per group not applicable",,"$50","$50 per person","$150 per group","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/DDVA_Individual_Basic_Plus_Major_Plan.pdf",,"4"
"2016","VA","31319","SERFF","11","2015-10-22 14:49:03","1","31319","VA","Individual","Yes","54-0844477","31319VA0010004","Delta Dental Individual and Family Basic plus Major Plan","31319VA001",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.50","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","31319VA0010004-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,"Not Applicable","per person not applicable","per group not applicable",,"$50","$50 per person","$150 per group","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/DDVA_Individual_Basic_Plus_Major_Plan.pdf",,"5"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010005","Silver Basic 2250 HMO","37204VA001","7407850644","VAN001","VAS001","VAF003","New","HMO","Silver","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","3","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010005-04","73% AV Level Silver Plan",,"0.721530079841614","No","Yes","No","100%",,"$2,250","$20","$1,000","$200","$1,000","$1,200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,200","$4200 per person","$8400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010005-04.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","30"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010005","Silver Basic 2250 HMO","37204VA001","7407850644","VAN001","VAS001","VAF003","New","HMO","Silver","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","3","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010005-05","87% AV Level Silver Plan",,"0.861087083816528","No","Yes","No","100%",,"$650","$0","$650","$200","$850","$1,000","$250","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010005-05.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","31"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010005","Silver Basic 2250 HMO","37204VA001","7407850644","VAN001","VAS001","VAF003","New","HMO","Silver","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","3","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010005-06","94% AV Level Silver Plan",,"0.930036604404449","No","Yes","No","100%",,"$200","$0","$400","$200","$350","$900","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010005-06.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","32"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","2","37204","VA","Individual","No","47-3163409","37204VA0010006","Bronze 4850 HMO","37204VA001","7407850644","VAN001","VAS001","VAF004","New","HMO","Bronze","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9989",,,"$500","0","0","3","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010006-00","Standard Bronze Off Exchange Plan",,"0.619210839271545","Yes","Yes","No","100%",,"$4,850","$0","$20","$200","$4,850","$120","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010006-00.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","4"
"2016","VA","31319","SERFF","11","2015-10-22 14:49:03","2","31319","VA","Individual","Yes","54-0844477","31319VA0010003","Delta Dental Individual and Family Basic Plan","31319VA001",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","31319VA0010003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,"Not Applicable","per person not applicable","per group not applicable",,"$50","$50 per person","$150 per group","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/DDVA_Individual_Basic_Plan.pdf",,"4"
"2016","VA","31319","SERFF","11","2015-10-22 14:49:03","2","31319","VA","Individual","Yes","54-0844477","31319VA0010003","Delta Dental Individual and Family Basic Plan","31319VA001",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.00","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes","https://auth.deltadentalcoversme.com/sp/ACS.saml2","","31319VA0010003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,"Not Applicable","per person not applicable","per group not applicable",,"$50","$50 per person","$150 per group","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.deltadentalcoversme.com/enrollment/pdfs/DDVA_Individual_Basic_Plan.pdf",,"5"
"2016","VA","34587","SERFF","4","2015-08-25 12:56:34","1","34587","VA","SHOP (Small Group)","Yes","42-0127290","34587VA0060001","Principal Plan Dental 70","34587VA006",,"VAN001","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$35.28","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","34587VA0060001-00","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","VA","34587","SERFF","4","2015-08-25 12:56:34","1","34587","VA","SHOP (Small Group)","Yes","42-0127290","34587VA0060002","Principal Plan Dental 85","34587VA006",,"VAN001","VAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,,,,"$37.67","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","34587VA0060002-00","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","VA","35801","SERFF","3","2015-08-25 12:56:34","1","35801","VA","SHOP (Small Group)","Yes","93-0242990","35801VA0040002","EHB High PPO","35801VA004",,"VAN001","VAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.28","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","35801VA0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","4"
"2016","VA","35801","SERFF","3","2015-08-25 12:56:34","1","35801","VA","SHOP (Small Group)","Yes","93-0242990","35801VA0040001","EHB Low PPO","35801VA004",,"VAN001","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.43","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","35801VA0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","5"
"2016","VA","35801","SERFF","3","2015-08-25 12:56:34","1","35801","VA","SHOP (Small Group)","Yes","93-0242990","35801VA0030002","EHB High Passive","35801VA003",,"VAN001","VAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.71","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","35801VA0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","6"
"2016","VA","35801","SERFF","3","2015-08-25 12:56:34","1","35801","VA","SHOP (Small Group)","Yes","93-0242990","35801VA0030001","EHB Low Passive","35801VA003",,"VAN001","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.74","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.standard.com","","35801VA0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.standard.com","http://www.standard.com","7"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010001","Gold Preferred 750/30/50 HMO","37204VA001","7407850644","VAN001","VAS001","VAF001","New","HMO","Gold","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9993",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010001-00","Standard Gold Off Exchange Plan",,"0.786084234714508","No","Yes","No","100%",,"$750","$20","$1,000","$200","$300","$1,400","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010001-00.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","4"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010001","Gold Preferred 750/30/50 HMO","37204VA001","7407850644","VAN001","VAS001","VAF001","New","HMO","Gold","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9993",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010001-01","Standard Gold On Exchange Plan",,"0.786084234714508","No","Yes","No","100%",,"$750","$20","$1,000","$200","$300","$1,400","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010001-01.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","5"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010001","Gold Preferred 750/30/50 HMO","37204VA001","7407850644","VAN001","VAS001","VAF001","New","HMO","Gold","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9993",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010001-02.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","6"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010001","Gold Preferred 750/30/50 HMO","37204VA001","7407850644","VAN001","VAS001","VAF001","New","HMO","Gold","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9993",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010001-03","Limited Cost Sharing Plan Variation",,"0.786084234714508","No","Yes","No","100%",,"$750","$20","$1,000","$200","$300","$1,400","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,750","$4750 per person","$9500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010001-03.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","7"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010002","Gold Preferred 1000/25/50 HMO","37204VA001","7407850644","VAN001","VAS001","VAF001","New","HMO","Gold","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9993",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010002-00","Standard Gold Off Exchange Plan",,"0.783215880393982","No","Yes","No","100%",,"$1,000","$20","$900","$200","$300","$1,400","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010002-00.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","8"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010002","Gold Preferred 1000/25/50 HMO","37204VA001","7407850644","VAN001","VAS001","VAF001","New","HMO","Gold","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9993",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010002-01","Standard Gold On Exchange Plan",,"0.783215880393982","No","Yes","No","100%",,"$1,000","$20","$900","$200","$300","$1,400","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010002-01.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","9"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010002","Gold Preferred 1000/25/50 HMO","37204VA001","7407850644","VAN001","VAS001","VAF001","New","HMO","Gold","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9993",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010002-02.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","10"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010002","Gold Preferred 1000/25/50 HMO","37204VA001","7407850644","VAN001","VAS001","VAF001","New","HMO","Gold","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9993",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010002-03","Limited Cost Sharing Plan Variation",,"0.783215880393982","No","Yes","No","100%",,"$1,000","$20","$900","$200","$300","$1,400","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010002-03.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","11"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010003","Silver Preferred 2800/35/60 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","New","HMO","Silver","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010003-00","Standard Silver Off Exchange Plan",,"0.689386188983917","No","Yes","No","100%",,"$2,800","$20","$600","$200","$300","$1,500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010003-00.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","12"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010003","Silver Preferred 2800/35/60 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","New","HMO","Silver","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010003-01","Standard Silver On Exchange Plan",,"0.689386188983917","No","Yes","No","100%",,"$2,800","$20","$600","$200","$300","$1,500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010003-01.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","13"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010003","Silver Preferred 2800/35/60 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","New","HMO","Silver","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010003-02.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","14"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010003","Silver Preferred 2800/35/60 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","New","HMO","Silver","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010003-03","Limited Cost Sharing Plan Variation",,"0.689386188983917","No","Yes","No","100%",,"$2,800","$20","$600","$200","$300","$1,500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,800","$2800 per person","$5600 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010003-03.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","15"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010003","Silver Preferred 2800/35/60 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","New","HMO","Silver","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010003-04","73% AV Level Silver Plan",,"0.720965266227722","No","Yes","No","100%",,"$2,600","$20","$600","$200","$300","$1,500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,300","$4300 per person","$8600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,600","$2600 per person","$5200 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010003-04.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","16"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010003","Silver Preferred 2800/35/60 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","New","HMO","Silver","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010003-05","87% AV Level Silver Plan",,"0.871010303497314","No","Yes","No","100%",,"$750","$0","$750","$200","$300","$1,500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010003-05.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","17"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010003","Silver Preferred 2800/35/60 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","New","HMO","Silver","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010003-06","94% AV Level Silver Plan",,"0.930127203464508","No","Yes","No","100%",,"$350","$0","$350","$200","$300","$1,200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010003-06.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","18"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010004","Silver Preferred 3500/40/65 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","New","HMO","Silver","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010004-00","Standard Silver Off Exchange Plan",,"0.686812341213226","No","Yes","No","100%",,"$3,500","$20","$400","$200","$300","$1,500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010004-00.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","19"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010004","Silver Preferred 3500/40/65 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","New","HMO","Silver","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010004-01","Standard Silver On Exchange Plan",,"0.686812341213226","No","Yes","No","100%",,"$3,500","$20","$400","$200","$300","$1,500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010004-01.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","20"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010004","Silver Preferred 3500/40/65 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","New","HMO","Silver","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010004-02.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","21"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010004","Silver Preferred 3500/40/65 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","New","HMO","Silver","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010004-03","Limited Cost Sharing Plan Variation",,"0.686812341213226","No","Yes","No","100%",,"$3,500","$20","$400","$200","$300","$1,500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010004-03.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","22"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010004","Silver Preferred 3500/40/65 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","New","HMO","Silver","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010004-04","73% AV Level Silver Plan",,"0.723410844802856","No","Yes","No","100%",,"$2,400","$20","$600","$200","$300","$1,500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,600","$4600 per person","$9200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,400","$2400 per person","$4800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010004-04.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","23"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010004","Silver Preferred 3500/40/65 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","New","HMO","Silver","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010004-05","87% AV Level Silver Plan",,"0.871780037879944","No","Yes","No","100%",,"$750","$0","$750","$200","$300","$1,500","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$200","$200 per person","$400 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010004-05.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","24"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010004","Silver Preferred 3500/40/65 HMO","37204VA001","7407850644","VAN001","VAS001","VAF002","New","HMO","Silver","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010004-06","94% AV Level Silver Plan",,"0.930127203464508","No","Yes","No","100%",,"$350","$0","$350","$200","$300","$1,200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","$300 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010004-06.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","25"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010005","Silver Basic 2250 HMO","37204VA001","7407850644","VAN001","VAS001","VAF003","New","HMO","Silver","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","3","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010005-00","Standard Silver Off Exchange Plan",,"0.685991287231445","No","Yes","No","100%",,"$2,250","$20","$1,000","$200","$1,000","$1,200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010005-00.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","26"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010005","Silver Basic 2250 HMO","37204VA001","7407850644","VAN001","VAS001","VAF003","New","HMO","Silver","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","3","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010005-01","Standard Silver On Exchange Plan",,"0.685991287231445","No","Yes","No","100%",,"$2,250","$20","$1,000","$200","$1,000","$1,200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010005-01.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","27"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010005","Silver Basic 2250 HMO","37204VA001","7407850644","VAN001","VAS001","VAF003","New","HMO","Silver","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","3","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010005-02.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","28"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","1","37204","VA","Individual","No","47-3163409","37204VA0010005","Silver Basic 2250 HMO","37204VA001","7407850644","VAN001","VAS001","VAF003","New","HMO","Silver","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9991",,,"$500","0","0","3","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010005-03","Limited Cost Sharing Plan Variation",,"0.685991287231445","No","Yes","No","100%",,"$2,250","$20","$1,000","$200","$1,000","$1,200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.pchp.net/index.php/37204va0010005-03.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","29"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","2","37204","VA","Individual","No","47-3163409","37204VA0010006","Bronze 4850 HMO","37204VA001","7407850644","VAN001","VAS001","VAF004","New","HMO","Bronze","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9989",,,"$500","0","0","3","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010006-01","Standard Bronze On Exchange Plan",,"0.619210839271545","Yes","Yes","No","100%",,"$4,850","$0","$20","$200","$4,850","$120","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010006-01.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","5"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","2","37204","VA","Individual","No","47-3163409","37204VA0010006","Bronze 4850 HMO","37204VA001","7407850644","VAN001","VAS001","VAF004","New","HMO","Bronze","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9989",,,"$500","0","0","3","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010006-02.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","6"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","2","37204","VA","Individual","No","47-3163409","37204VA0010006","Bronze 4850 HMO","37204VA001","7407850644","VAN001","VAS001","VAF004","New","HMO","Bronze","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9989",,,"$500","0","0","3","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010006-03","Limited Cost Sharing Plan Variation",,"0.619210839271545","Yes","Yes","No","100%",,"$4,850","$0","$20","$200","$4,850","$120","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group","35%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010006-03.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","7"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","2","37204","VA","Individual","No","47-3163409","37204VA0010007","Bronze 5800 HMO","37204VA001","7407850644","VAN001","VAS001","VAF005","New","HMO","Bronze","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9989",,,"$500","0","0","3","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010007-00","Standard Bronze Off Exchange Plan",,"0.612453818321228","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$4,860","$120","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010007-00.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","8"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","2","37204","VA","Individual","No","47-3163409","37204VA0010007","Bronze 5800 HMO","37204VA001","7407850644","VAN001","VAS001","VAF005","New","HMO","Bronze","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9989",,,"$500","0","0","3","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010007-01","Standard Bronze On Exchange Plan",,"0.612453818321228","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$4,860","$120","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010007-01.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","9"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","2","37204","VA","Individual","No","47-3163409","37204VA0010007","Bronze 5800 HMO","37204VA001","7407850644","VAN001","VAS001","VAF005","New","HMO","Bronze","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9989",,,"$500","0","0","3","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010007-02.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","10"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","2","37204","VA","Individual","No","47-3163409","37204VA0010007","Bronze 5800 HMO","37204VA001","7407850644","VAN001","VAS001","VAF005","New","HMO","Bronze","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9989",,,"$500","0","0","3","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010007-03","Limited Cost Sharing Plan Variation",,"0.612453818321228","Yes","Yes","No","100%",,"$4,900","$0","$0","$200","$4,860","$120","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,800","$5800 per person","$11600 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010007-03.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","11"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","2","37204","VA","Individual","No","47-3163409","37204VA0010009","Bronze HSA 5000 HMO","37204VA001","7407850644","VAN001","VAS001","VAF006","New","HMO","Bronze","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010009-00","Standard Bronze Off Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$100","$200","$5,000","$0","$21","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/37204va0010009-00.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","12"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","2","37204","VA","Individual","No","47-3163409","37204VA0010009","Bronze HSA 5000 HMO","37204VA001","7407850644","VAN001","VAS001","VAF006","New","HMO","Bronze","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010009-01","Standard Bronze On Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$100","$200","$5,000","$0","$21","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/37204va0010009-01.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","13"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","2","37204","VA","Individual","No","47-3163409","37204VA0010009","Bronze HSA 5000 HMO","37204VA001","7407850644","VAN001","VAS001","VAF006","New","HMO","Bronze","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/37204va0010009-02.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","14"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","2","37204","VA","Individual","No","47-3163409","37204VA0010009","Bronze HSA 5000 HMO","37204VA001","7407850644","VAN001","VAS001","VAF006","New","HMO","Bronze","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010009-03","Limited Cost Sharing Plan Variation",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$100","$200","$5,000","$0","$21","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/37204va0010009-03.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","15"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","2","37204","VA","Individual","No","47-3163409","37204VA0010010","Bronze HSA 6000 HMO","37204VA001","7407850644","VAN001","VAS001","VAF007","New","HMO","Bronze","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010010-00","Standard Bronze Off Exchange Plan",,"0.604302883148193","Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$5,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/37204va0010010-00.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","16"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","2","37204","VA","Individual","No","47-3163409","37204VA0010010","Bronze HSA 6000 HMO","37204VA001","7407850644","VAN001","VAS001","VAF007","New","HMO","Bronze","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010010-01","Standard Bronze On Exchange Plan",,"0.604302883148193","Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$5,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/37204va0010010-01.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","17"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","2","37204","VA","Individual","No","47-3163409","37204VA0010010","Bronze HSA 6000 HMO","37204VA001","7407850644","VAN001","VAS001","VAF007","New","HMO","Bronze","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/37204va0010010-02.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","18"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","2","37204","VA","Individual","No","47-3163409","37204VA0010010","Bronze HSA 6000 HMO","37204VA001","7407850644","VAN001","VAS001","VAF007","New","HMO","Bronze","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.9989",,,,"0","0","0","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010010-03","Limited Cost Sharing Plan Variation",,"0.604302883148193","Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$5,100","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","15%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.pchp.net/index.php/37204va0010010-03.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","19"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","2","37204","VA","Individual","No","47-3163409","37204VA0010008","Catastrophic 6850 HMO","37204VA001","7407850644","VAN001","VAS001","VAF008","New","HMO","Catastrophic","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.998",,,"$500","0","0","3","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010008-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$4,860","$120","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010008-00.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","20"
"2016","VA","37204","SERFF","7","2015-08-25 12:56:34","2","37204","VA","Individual","No","47-3163409","37204VA0010008","Catastrophic 6850 HMO","37204VA001","7407850644","VAN001","VAS001","VAF008","New","HMO","Catastrophic","No","Both","No","Yes","All Specialists require a referral","Pediatric Dental benefits are NOT included in this plan; they are available separately on or off the Exchange. No coverage for morbid obesity.","$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy","0.998",,,"$500","0","0","3","2016-01-01",,"No",,"No",,"No","http://www.pchp.net/index.php/initial-enrollment-payment-hmo.html","http://www.pchp.net/index.php/prescription-drug-formulary-hmo.html","37204VA0010008-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,700","$0","$0","$200","$4,860","$120","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.pchp.net/index.php/37204va0010008-01.html","http://www.pchp.net/index.php/plan-brochure-hmo.html","21"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","1","38234","VA","Individual","No","06-6033492","38234VA0060025","Aetna Coastal VA HP Bronze $30 Copay","38234VA006",,"VAN001","VAS001","VAF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8502793585","38234VA0060025-00","Standard Bronze Off Exchange Plan","61.97%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709017.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","4"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","1","38234","VA","Individual","No","06-6033492","38234VA0060025","Aetna Coastal VA HP Bronze $30 Copay","38234VA006",,"VAN001","VAS001","VAF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8502793585","38234VA0060025-01","Standard Bronze On Exchange Plan","61.97%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709017.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","5"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","1","38234","VA","Individual","No","06-6033492","38234VA0060025","Aetna Coastal VA HP Bronze $30 Copay","38234VA006",,"VAN001","VAS001","VAF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8502793585","38234VA0060025-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709020.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","6"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","1","38234","VA","Individual","No","06-6033492","38234VA0060025","Aetna Coastal VA HP Bronze $30 Copay","38234VA006",,"VAN001","VAS001","VAF004","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8502793585","38234VA0060025-03","Limited Cost Sharing Plan Variation","61.97%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709018.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","7"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","2","38234","VA","Individual","No","06-6033492","38234VA0060027","Aetna Coastal VA HP Bronze Deductible Only HSA Eligible","38234VA006",,"VAN001","VAS001","VAF006","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8502793585","38234VA0060027-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709022.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","4"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","2","38234","VA","Individual","No","06-6033492","38234VA0060027","Aetna Coastal VA HP Bronze Deductible Only HSA Eligible","38234VA006",,"VAN001","VAS001","VAF006","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8502793585","38234VA0060027-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709022.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","5"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","2","38234","VA","Individual","No","06-6033492","38234VA0060027","Aetna Coastal VA HP Bronze Deductible Only HSA Eligible","38234VA006",,"VAN001","VAS001","VAF006","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8502793585","38234VA0060027-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709025.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","6"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","2","38234","VA","Individual","No","06-6033492","38234VA0060027","Aetna Coastal VA HP Bronze Deductible Only HSA Eligible","38234VA006",,"VAN001","VAS001","VAF006","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8502793585","38234VA0060027-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709023.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","7"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","3","38234","VA","Individual","No","06-6033492","38234VA0060043","Aetna Whole Health Bronze $30 Copay","38234VA006",,"VAN002","VAS002","VAF019","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8502793585","38234VA0060043-00","Standard Bronze Off Exchange Plan","61.97%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708986.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","4"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","3","38234","VA","Individual","No","06-6033492","38234VA0060043","Aetna Whole Health Bronze $30 Copay","38234VA006",,"VAN002","VAS002","VAF019","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8502793585","38234VA0060043-01","Standard Bronze On Exchange Plan","61.97%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708986.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","5"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","3","38234","VA","Individual","No","06-6033492","38234VA0060043","Aetna Whole Health Bronze $30 Copay","38234VA006",,"VAN002","VAS002","VAF019","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8502793585","38234VA0060043-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708989.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","6"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","3","38234","VA","Individual","No","06-6033492","38234VA0060043","Aetna Whole Health Bronze $30 Copay","38234VA006",,"VAN002","VAS002","VAF019","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8502793585","38234VA0060043-03","Limited Cost Sharing Plan Variation","61.97%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708987.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","7"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","4","38234","VA","Individual","No","06-6033492","38234VA0060045","Aetna Whole Health Bronze Deductible Only HSA Eligible","38234VA006",,"VAN002","VAS002","VAF021","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8502793585","38234VA0060045-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708991.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","4"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","4","38234","VA","Individual","No","06-6033492","38234VA0060045","Aetna Whole Health Bronze Deductible Only HSA Eligible","38234VA006",,"VAN002","VAS002","VAF021","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8502793585","38234VA0060045-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708991.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","5"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","4","38234","VA","Individual","No","06-6033492","38234VA0060045","Aetna Whole Health Bronze Deductible Only HSA Eligible","38234VA006",,"VAN002","VAS002","VAF021","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8502793585","38234VA0060045-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708994.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","6"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","4","38234","VA","Individual","No","06-6033492","38234VA0060045","Aetna Whole Health Bronze Deductible Only HSA Eligible","38234VA006",,"VAN002","VAS002","VAF021","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8502793585","38234VA0060045-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708992.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","7"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","5","38234","VA","Individual","No","06-6033492","38234VA0060033","Aetna Coastal VA HP Silver $10 Copay","38234VA006",,"VAN001","VAS001","VAF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060033-00","Standard Silver Off Exchange Plan","68.15%",,"No","Yes","No","100%",,"$3,600","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","30%",,,,,"$8,200","$8200 per person","$16400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709001.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","4"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","5","38234","VA","Individual","No","06-6033492","38234VA0060033","Aetna Coastal VA HP Silver $10 Copay","38234VA006",,"VAN001","VAS001","VAF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060033-01","Standard Silver On Exchange Plan","68.15%",,"No","Yes","No","100%",,"$3,600","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","30%",,,,,"$8,200","$8200 per person","$16400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709001.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","5"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","5","38234","VA","Individual","No","06-6033492","38234VA0060033","Aetna Coastal VA HP Silver $10 Copay","38234VA006",,"VAN001","VAS001","VAF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060033-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709004.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","6"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","5","38234","VA","Individual","No","06-6033492","38234VA0060033","Aetna Coastal VA HP Silver $10 Copay","38234VA006",,"VAN001","VAS001","VAF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060033-03","Limited Cost Sharing Plan Variation","68.15%",,"No","Yes","No","100%",,"$3,600","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","30%",,,,,"$8,200","$8200 per person","$16400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709002.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","7"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","5","38234","VA","Individual","No","06-6033492","38234VA0060033","Aetna Coastal VA HP Silver $10 Copay","38234VA006",,"VAN001","VAS001","VAF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060033-04","73% AV Level Silver Plan","72.09%",,"No","Yes","No","100%",,"$3,100","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","30%",,,,,"$8,200","$8200 per person","$16400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709008.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","8"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","5","38234","VA","Individual","No","06-6033492","38234VA0060033","Aetna Coastal VA HP Silver $10 Copay","38234VA006",,"VAN001","VAS001","VAF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060033-05","87% AV Level Silver Plan","86.19%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709007.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","9"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","5","38234","VA","Individual","No","06-6033492","38234VA0060033","Aetna Coastal VA HP Silver $10 Copay","38234VA006",,"VAN001","VAS001","VAF012","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060033-06","94% AV Level Silver Plan","93.15%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709006.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","10"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","6","38234","VA","Individual","No","06-6033492","38234VA0060035","Aetna Coastal VA HP Silver $10 Copay $2750","38234VA006",,"VAN001","VAS001","VAF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060035-00","Standard Silver Off Exchange Plan","68.04%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709009.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","4"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","6","38234","VA","Individual","No","06-6033492","38234VA0060035","Aetna Coastal VA HP Silver $10 Copay $2750","38234VA006",,"VAN001","VAS001","VAF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060035-01","Standard Silver On Exchange Plan","68.04%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709009.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","5"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","6","38234","VA","Individual","No","06-6033492","38234VA0060035","Aetna Coastal VA HP Silver $10 Copay $2750","38234VA006",,"VAN001","VAS001","VAF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060035-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709012.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","6"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","6","38234","VA","Individual","No","06-6033492","38234VA0060035","Aetna Coastal VA HP Silver $10 Copay $2750","38234VA006",,"VAN001","VAS001","VAF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060035-03","Limited Cost Sharing Plan Variation","68.04%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709010.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","7"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","6","38234","VA","Individual","No","06-6033492","38234VA0060035","Aetna Coastal VA HP Silver $10 Copay $2750","38234VA006",,"VAN001","VAS001","VAF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060035-04","73% AV Level Silver Plan","72.03%",,"Yes","Yes","No","100%",,"$2,700","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709016.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","8"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","6","38234","VA","Individual","No","06-6033492","38234VA0060035","Aetna Coastal VA HP Silver $10 Copay $2750","38234VA006",,"VAN001","VAS001","VAF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060035-05","87% AV Level Silver Plan","86.10%",,"Yes","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709015.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","9"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","6","38234","VA","Individual","No","06-6033492","38234VA0060035","Aetna Coastal VA HP Silver $10 Copay $2750","38234VA006",,"VAN001","VAS001","VAF014","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060035-06","94% AV Level Silver Plan","93.15%",,"Yes","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709014.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","10"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","7","38234","VA","Individual","No","06-6033492","38234VA0060051","Aetna Whole Health Silver $10 Copay","38234VA006",,"VAN002","VAS002","VAF027","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060051-00","Standard Silver Off Exchange Plan","68.15%",,"No","Yes","No","100%",,"$3,600","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","30%",,,,,"$8,200","$8200 per person","$16400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708970.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","4"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","7","38234","VA","Individual","No","06-6033492","38234VA0060051","Aetna Whole Health Silver $10 Copay","38234VA006",,"VAN002","VAS002","VAF027","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060051-01","Standard Silver On Exchange Plan","68.15%",,"No","Yes","No","100%",,"$3,600","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","30%",,,,,"$8,200","$8200 per person","$16400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708970.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","5"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","7","38234","VA","Individual","No","06-6033492","38234VA0060051","Aetna Whole Health Silver $10 Copay","38234VA006",,"VAN002","VAS002","VAF027","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060051-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708973.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","6"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","7","38234","VA","Individual","No","06-6033492","38234VA0060051","Aetna Whole Health Silver $10 Copay","38234VA006",,"VAN002","VAS002","VAF027","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060051-03","Limited Cost Sharing Plan Variation","68.15%",,"No","Yes","No","100%",,"$3,600","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","30%",,,,,"$8,200","$8200 per person","$16400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708971.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","7"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","7","38234","VA","Individual","No","06-6033492","38234VA0060051","Aetna Whole Health Silver $10 Copay","38234VA006",,"VAN002","VAS002","VAF027","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060051-04","73% AV Level Silver Plan","72.09%",,"No","Yes","No","100%",,"$3,100","$500","$0","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","30%",,,,,"$8,200","$8200 per person","$16400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708977.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","8"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","7","38234","VA","Individual","No","06-6033492","38234VA0060051","Aetna Whole Health Silver $10 Copay","38234VA006",,"VAN002","VAS002","VAF027","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060051-05","87% AV Level Silver Plan","86.19%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708976.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","9"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","7","38234","VA","Individual","No","06-6033492","38234VA0060051","Aetna Whole Health Silver $10 Copay","38234VA006",,"VAN002","VAS002","VAF027","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060051-06","94% AV Level Silver Plan","93.15%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708975.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","10"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","8","38234","VA","Individual","No","06-6033492","38234VA0060053","Aetna Whole Health Silver $10 Copay $2750","38234VA006",,"VAN002","VAS002","VAF029","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060053-00","Standard Silver Off Exchange Plan","68.04%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708978.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","4"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","8","38234","VA","Individual","No","06-6033492","38234VA0060053","Aetna Whole Health Silver $10 Copay $2750","38234VA006",,"VAN002","VAS002","VAF029","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060053-01","Standard Silver On Exchange Plan","68.04%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708978.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","5"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","8","38234","VA","Individual","No","06-6033492","38234VA0060053","Aetna Whole Health Silver $10 Copay $2750","38234VA006",,"VAN002","VAS002","VAF029","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060053-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708981.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","6"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","8","38234","VA","Individual","No","06-6033492","38234VA0060053","Aetna Whole Health Silver $10 Copay $2750","38234VA006",,"VAN002","VAS002","VAF029","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060053-03","Limited Cost Sharing Plan Variation","68.04%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708979.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","7"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","8","38234","VA","Individual","No","06-6033492","38234VA0060053","Aetna Whole Health Silver $10 Copay $2750","38234VA006",,"VAN002","VAS002","VAF029","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060053-04","73% AV Level Silver Plan","72.03%",,"Yes","Yes","No","100%",,"$2,700","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708985.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","8"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","8","38234","VA","Individual","No","06-6033492","38234VA0060053","Aetna Whole Health Silver $10 Copay $2750","38234VA006",,"VAN002","VAS002","VAF029","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060053-05","87% AV Level Silver Plan","86.10%",,"Yes","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708984.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","9"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","8","38234","VA","Individual","No","06-6033492","38234VA0060053","Aetna Whole Health Silver $10 Copay $2750","38234VA006",,"VAN002","VAS002","VAF029","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060053-06","94% AV Level Silver Plan","93.15%",,"Yes","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708983.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","10"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","9","38234","VA","Individual","No","06-6033492","38234VA0060031","Aetna Coastal VA HP Gold $10 Copay","38234VA006",,"VAN001","VAS001","VAF010","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060031-00","Standard Gold Off Exchange Plan","78.13%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708996.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","4"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","9","38234","VA","Individual","No","06-6033492","38234VA0060031","Aetna Coastal VA HP Gold $10 Copay","38234VA006",,"VAN001","VAS001","VAF010","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060031-01","Standard Gold On Exchange Plan","78.13%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708996.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","5"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","9","38234","VA","Individual","No","06-6033492","38234VA0060031","Aetna Coastal VA HP Gold $10 Copay","38234VA006",,"VAN001","VAS001","VAF010","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060031-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708999.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","6"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","9","38234","VA","Individual","No","06-6033492","38234VA0060031","Aetna Coastal VA HP Gold $10 Copay","38234VA006",,"VAN001","VAS001","VAF010","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060031-03","Limited Cost Sharing Plan Variation","78.13%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708997.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","7"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","10","38234","VA","Individual","No","06-6033492","38234VA0060049","Aetna Whole Health Gold $10 Copay","38234VA006",,"VAN002","VAS002","VAF025","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060049-00","Standard Gold Off Exchange Plan","78.13%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708965.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","4"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","10","38234","VA","Individual","No","06-6033492","38234VA0060049","Aetna Whole Health Gold $10 Copay","38234VA006",,"VAN002","VAS002","VAF025","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060049-01","Standard Gold On Exchange Plan","78.13%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708965.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","5"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","10","38234","VA","Individual","No","06-6033492","38234VA0060049","Aetna Whole Health Gold $10 Copay","38234VA006",,"VAN002","VAS002","VAF025","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060049-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708968.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","6"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","10","38234","VA","Individual","No","06-6033492","38234VA0060049","Aetna Whole Health Gold $10 Copay","38234VA006",,"VAN002","VAS002","VAF025","Existing","PPO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8500371299","38234VA0060049-03","Limited Cost Sharing Plan Variation","78.13%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_708966.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","7"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","11","38234","VA","Individual","No","06-6033492","38234VA0060029","Aetna Coastal VA HP Catastrophic 100%","38234VA006",,"VAN001","VAS001","VAF008","Existing","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8502793585","38234VA0060029-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709837.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","4"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","11","38234","VA","Individual","No","06-6033492","38234VA0060029","Aetna Coastal VA HP Catastrophic 100%","38234VA006",,"VAN001","VAS001","VAF008","Existing","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8502793585","38234VA0060029-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709837.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","5"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","12","38234","VA","Individual","No","06-6033492","38234VA0060047","Aetna Whole Health Catastrophic 100%","38234VA006",,"VAN002","VAS002","VAF023","Existing","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8502793585","38234VA0060047-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709834.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","4"
"2016","VA","38234","SERFF","9","2015-08-23 14:39:40","12","38234","VA","Individual","No","06-6033492","38234VA0060047","Aetna Whole Health Catastrophic 100%","38234VA006",,"VAN002","VAS002","VAF023","Existing","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8502793585","38234VA0060047-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.aetna.com/individuals-families/document-library/SBC/2016/ON/VA/VA_SBC_709834.pdf","http://www.aetna.com/individuals-families/document-library/plan-brochure/2016/va-on-booklet01-16.pdf","5"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","1","38599","VA","Individual","No","52-1130183","38599VA0040003","Silver Compass HSA 2000","38599VA004",,"VAN001","VAS001","VAF004","New","HMO","Silver","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040003-00","Standard Silver Off Exchange Plan","71.10%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=va0007&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","4"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","1","38599","VA","Individual","No","52-1130183","38599VA0040003","Silver Compass HSA 2000","38599VA004",,"VAN001","VAS001","VAF004","New","HMO","Silver","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040003-01","Standard Silver On Exchange Plan","71.10%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=va0007&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","5"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","1","38599","VA","Individual","No","52-1130183","38599VA0040003","Silver Compass HSA 2000","38599VA004",,"VAN001","VAS001","VAF004","New","HMO","Silver","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.uhc.com/iex/doc?id=va0008&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","6"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","1","38599","VA","Individual","No","52-1130183","38599VA0040003","Silver Compass HSA 2000","38599VA004",,"VAN001","VAS001","VAF004","New","HMO","Silver","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040003-03","Limited Cost Sharing Plan Variation","71.10%",,"Yes","Yes","No","100%",,"$2,000","$1,500","$0","$200","$2,000","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6850 per person","$6850 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","per person not applicable","$6000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=va0009&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","7"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","1","38599","VA","Individual","No","52-1130183","38599VA0040003","Silver Compass HSA 2000","38599VA004",,"VAN001","VAS001","VAF004","New","HMO","Silver","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040003-04","73% AV Level Silver Plan","73.10%",,"Yes","Yes","No","100%",,"$1,800","$1,500","$0","$200","$1,800","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5450 per person","$5450 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,800","per person not applicable","$5400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=va0010&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","8"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","1","38599","VA","Individual","No","52-1130183","38599VA0040003","Silver Compass HSA 2000","38599VA004",,"VAN001","VAS001","VAF004","New","HMO","Silver","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040003-05","87% AV Level Silver Plan","86.30%",,"Yes","Yes","No","100%",,"$600","$800","$0","$200","$600","$800","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$2250 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$550","per person not applicable","$1100 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=va0011&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","9"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","1","38599","VA","Individual","No","52-1130183","38599VA0040003","Silver Compass HSA 2000","38599VA004",,"VAN001","VAS001","VAF004","New","HMO","Silver","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040003-06","94% AV Level Silver Plan","93.10%",,"Yes","Yes","No","100%",,"$200","$500","$0","$200","$200","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$700","$1400 per person","$1400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","per person not applicable","$400 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=va0012&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","10"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","1","38599","VA","Individual","No","52-1130183","38599VA0040005","Bronze Compass HSA 5500","38599VA004",,"VAN001","VAS001","VAF005","New","HMO","Bronze","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040005-00","Standard Bronze Off Exchange Plan","61.30%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=va0019&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","11"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","1","38599","VA","Individual","No","52-1130183","38599VA0040005","Bronze Compass HSA 5500","38599VA004",,"VAN001","VAS001","VAF005","New","HMO","Bronze","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040005-01","Standard Bronze On Exchange Plan","61.30%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=va0019&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","12"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","1","38599","VA","Individual","No","52-1130183","38599VA0040005","Bronze Compass HSA 5500","38599VA004",,"VAN001","VAS001","VAF005","New","HMO","Bronze","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Yes",,,"http://www.uhc.com/iex/doc?id=va0020&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","13"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","1","38599","VA","Individual","No","52-1130183","38599VA0040005","Bronze Compass HSA 5500","38599VA004",,"VAN001","VAS001","VAF005","New","HMO","Bronze","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040005-03","Limited Cost Sharing Plan Variation","61.30%",,"Yes","Yes","No","100%",,"$5,500","$20","$0","$200","$5,100","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.uhc.com/iex/doc?id=va0021&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","14"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","2","38599","VA","Individual","No","52-1130183","38599VA0040001","Gold Compass 0-1","38599VA004",,"VAN001","VAS001","VAF002","New","HMO","Gold","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040001-00","Standard Gold Off Exchange Plan","81.40%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0001&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","4"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","2","38599","VA","Individual","No","52-1130183","38599VA0040001","Gold Compass 0-1","38599VA004",,"VAN001","VAS001","VAF002","New","HMO","Gold","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040001-01","Standard Gold On Exchange Plan","81.40%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0001&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","5"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","2","38599","VA","Individual","No","52-1130183","38599VA0040001","Gold Compass 0-1","38599VA004",,"VAN001","VAS001","VAF002","New","HMO","Gold","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0002&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","6"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","2","38599","VA","Individual","No","52-1130183","38599VA0040001","Gold Compass 0-1","38599VA004",,"VAN001","VAS001","VAF002","New","HMO","Gold","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040001-03","Limited Cost Sharing Plan Variation","81.40%",,"No","Yes","No","100%",,"$0","$10","$1,900","$200","$0","$1,100","$90","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0003&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","7"
"2016","VA","42808","SERFF","4","2015-08-25 12:56:34","1","42808","VA","SHOP (Small Group)","Yes","13-5123390","42808VA0210003","Guardian Pediatric Essentials","42808VA021",,"VAN001","VAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$19.48","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","42808VA0210003-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","VA","42808","SERFF","4","2015-08-25 12:56:34","1","42808","VA","Individual","Yes","13-5123390","42808VA0260001","Guardian Family Essentials","42808VA026",,"VAN002","VAS002",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.13","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","42808VA0260001-01","Standard Low On Exchange Plan","68.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","5"
"2016","VA","42808","SERFF","4","2015-08-25 12:56:34","2","42808","VA","SHOP (Small Group)","Yes","13-5123390","42808VA0230003","Guardian Family Advantage","42808VA023",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","42808VA0230003-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","VA","42808","SERFF","4","2015-08-25 12:56:34","2","42808","VA","SHOP (Small Group)","Yes","13-5123390","42808VA0250003","Guardian Family Essentials","42808VA025",,"VAN001","VAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.48","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","42808VA0250003-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","VA","42808","SERFF","4","2015-08-25 12:56:34","3","42808","VA","SHOP (Small Group)","Yes","13-5123390","42808VA0230004","Guardian Family Advantage","42808VA023",,"VAN001","VAS002",,"New","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the Service Area.","Yes",,"","42808VA0230004-01","Standard High On Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","VA","42808","SERFF","4","2015-08-25 12:56:34","3","42808","VA","SHOP (Small Group)","Yes","13-5123390","42808VA0250004","Guardian Family Essentials","42808VA025",,"VAN001","VAS002",,"New","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.48","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the Service Area.","Yes",,"","42808VA0250004-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730050","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS005","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730050-00","Standard Bronze Off Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","30"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730050","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS005","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730050-01","Standard Bronze On Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","31"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730051","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS006","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730051-00","Standard Bronze Off Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","32"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","2","38599","VA","Individual","No","52-1130183","38599VA0040002","Gold Compass 1000-1","38599VA004",,"VAN001","VAS001","VAF001","New","HMO","Gold","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040002-00","Standard Gold Off Exchange Plan","80.00%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0004&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","8"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","2","38599","VA","Individual","No","52-1130183","38599VA0040002","Gold Compass 1000-1","38599VA004",,"VAN001","VAS001","VAF001","New","HMO","Gold","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040002-01","Standard Gold On Exchange Plan","80.00%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0004&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","9"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","2","38599","VA","Individual","No","52-1130183","38599VA0040002","Gold Compass 1000-1","38599VA004",,"VAN001","VAS001","VAF001","New","HMO","Gold","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0005&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","10"
"2016","VA","51207","SERFF","3","2015-08-25 12:56:34","1","51207","VA","SHOP (Small Group)","Yes","36-0883760","51207VA0030002","EHB High Passive","51207VA003",,"VAN001","VAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$44.58","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","51207VA0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","6"
"2016","VA","51207","SERFF","3","2015-08-25 12:56:34","1","51207","VA","SHOP (Small Group)","Yes","36-0883760","51207VA0030001","EHB Low Passive","51207VA003",,"VAN001","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.66","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","51207VA0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","7"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","2","38599","VA","Individual","No","52-1130183","38599VA0040002","Gold Compass 1000-1","38599VA004",,"VAN001","VAS001","VAF001","New","HMO","Gold","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040002-03","Limited Cost Sharing Plan Variation","80.00%",,"No","Yes","No","100%",,"$1,000","$10","$1,100","$200","$300","$900","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0006&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","11"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","2","38599","VA","Individual","No","52-1130183","38599VA0040004","Silver Compass 4500-1","38599VA004",,"VAN001","VAS001","VAF003","New","HMO","Silver","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040004-00","Standard Silver Off Exchange Plan","68.40%",,"No","Yes","No","100%",,"$4,500","$0","$0","$200","$300","$100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0013&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","12"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","2","38599","VA","Individual","No","52-1130183","38599VA0040004","Silver Compass 4500-1","38599VA004",,"VAN001","VAS001","VAF003","New","HMO","Silver","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040004-01","Standard Silver On Exchange Plan","68.40%",,"No","Yes","No","100%",,"$4,500","$0","$0","$200","$300","$100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0013&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","13"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","2","38599","VA","Individual","No","52-1130183","38599VA0040004","Silver Compass 4500-1","38599VA004",,"VAN001","VAS001","VAF003","New","HMO","Silver","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0014&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","14"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","2","38599","VA","Individual","No","52-1130183","38599VA0040004","Silver Compass 4500-1","38599VA004",,"VAN001","VAS001","VAF003","New","HMO","Silver","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040004-03","Limited Cost Sharing Plan Variation","68.40%",,"No","Yes","No","100%",,"$4,500","$0","$0","$200","$300","$100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0015&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","15"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","2","38599","VA","Individual","No","52-1130183","38599VA0040004","Silver Compass 4500-1","38599VA004",,"VAN001","VAS001","VAF003","New","HMO","Silver","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040004-04","73% AV Level Silver Plan","72.70%",,"No","Yes","No","100%",,"$3,200","$10","$0","$200","$300","$1,000","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,250","$3250 per person","$6500 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0016&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","16"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","2","38599","VA","Individual","No","52-1130183","38599VA0040004","Silver Compass 4500-1","38599VA004",,"VAN001","VAS001","VAF003","New","HMO","Silver","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040004-05","87% AV Level Silver Plan","86.20%",,"No","Yes","No","100%",,"$600","$10","$0","$200","$300","$1,100","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$600","$600 per person","$1200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0017&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","17"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","2","38599","VA","Individual","No","52-1130183","38599VA0040004","Silver Compass 4500-1","38599VA004",,"VAN001","VAS001","VAF003","New","HMO","Silver","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040004-06","94% AV Level Silver Plan","93.30%",,"No","Yes","No","100%",,"$100","$10","$0","$200","$100","$500","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$550","$550 per person","$1100 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.uhc.com/iex/doc?id=va0018&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","18"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","2","38599","VA","Individual","No","52-1130183","38599VA0040006","Bronze Compass 6500-1","38599VA004",,"VAN001","VAS001","VAF005","New","HMO","Bronze","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040006-00","Standard Bronze Off Exchange Plan","61.80%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=va0022&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","19"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","2","38599","VA","Individual","No","52-1130183","38599VA0040006","Bronze Compass 6500-1","38599VA004",,"VAN001","VAS001","VAF005","New","HMO","Bronze","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040006-01","Standard Bronze On Exchange Plan","61.80%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=va0022&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","20"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","2","38599","VA","Individual","No","52-1130183","38599VA0040006","Bronze Compass 6500-1","38599VA004",,"VAN001","VAS001","VAF005","New","HMO","Bronze","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"http://www.uhc.com/iex/doc?id=va0023&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","21"
"2016","VA","38599","SERFF","12","2015-08-25 12:56:34","2","38599","VA","Individual","No","52-1130183","38599VA0040006","Bronze Compass 6500-1","38599VA004",,"VAN001","VAS001","VAF005","New","HMO","Bronze","Yes","Both","No","Yes","All except OBGYN and as state mandated.",,"$0.00","No","Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, Pregnancy","1",,,,"0","0","0","2016-01-01",,"Yes","Emergency Only","Yes","Emergency Services Only","No","https://exchange.uhone.com/payment/dcd04de5-660e-4e36-9255-581f0a3cb143","http://www.uhc.com/iex/doc?id=va0026&st=va","38599VA0040006-03","Limited Cost Sharing Plan Variation","61.80%",,"Yes","Yes","No","100%",,"$6,300","$0","$0","$200","$4,400","$400","$0","$40",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.uhc.com/iex/doc?id=va0024&st=va","http://www.uhc.com/iex/doc?id=va0025&st=va","22"
"2016","VA","40198","SERFF","5","2015-08-25 12:56:34","1","40198","VA","SHOP (Small Group)","Yes","59-0397210","40198VA0030001","DentaQuest EPO Family High","40198VA003",,"VAN003","VAS002",,"New","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.55","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","40198VA0030001-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/","4"
"2016","VA","40198","SERFF","5","2015-08-25 12:56:34","1","40198","VA","Individual","Yes","59-0397210","40198VA0020002","DentaQuest EPO  Pediatric High","40198VA002",,"VAN003","VAS002",,"New","EPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$42.37","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","40198VA0020002-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/","4"
"2016","VA","40198","SERFF","5","2015-08-25 12:56:34","1","40198","VA","Individual","Yes","59-0397210","40198VA0020002","DentaQuest EPO  Pediatric High","40198VA002",,"VAN003","VAS002",,"New","EPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$42.37","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","40198VA0020002-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/","5"
"2016","VA","40198","SERFF","5","2015-08-25 12:56:34","1","40198","VA","SHOP (Small Group)","Yes","59-0397210","40198VA0030001","DentaQuest EPO Family High","40198VA003",,"VAN003","VAS002",,"New","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$30.55","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","40198VA0030001-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/","5"
"2016","VA","40198","SERFF","5","2015-08-25 12:56:34","1","40198","VA","SHOP (Small Group)","Yes","59-0397210","40198VA0030002","DentaQuest EPO Family Low","40198VA003",,"VAN003","VAS002",,"New","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.27","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","40198VA0030002-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/","6"
"2016","VA","40198","SERFF","5","2015-08-25 12:56:34","1","40198","VA","SHOP (Small Group)","Yes","59-0397210","40198VA0030002","DentaQuest EPO Family Low","40198VA003",,"VAN003","VAS002",,"New","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.27","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","40198VA0030002-01","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/","7"
"2016","VA","40198","SERFF","5","2015-08-25 12:56:34","2","40198","VA","Individual","Yes","59-0397210","40198VA0020003","DentaQuest EPO Family High","40198VA002",,"VAN003","VAS002",,"New","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.37","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","40198VA0020003-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/","4"
"2016","VA","40198","SERFF","5","2015-08-25 12:56:34","2","40198","VA","Individual","Yes","59-0397210","40198VA0020003","DentaQuest EPO Family High","40198VA002",,"VAN003","VAS002",,"New","EPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$42.37","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","40198VA0020003-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/","5"
"2016","VA","40198","SERFF","5","2015-08-25 12:56:34","2","40198","VA","Individual","Yes","59-0397210","40198VA0020004","DentaQuest EPO Family Low","40198VA002",,"VAN003","VAS002",,"New","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.28","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","40198VA0020004-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/","6"
"2016","VA","40198","SERFF","5","2015-08-25 12:56:34","2","40198","VA","Individual","Yes","59-0397210","40198VA0020004","DentaQuest EPO Family Low","40198VA002",,"VAN003","VAS002",,"New","EPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$32.28","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","40198VA0020004-01","Standard Low On Exchange Plan","70.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.dentaquest.com/marketplace/va/","http://www.dentaquest.com/marketplace/va/","7"
"2016","VA","40308","SERFF","17","2015-10-23 11:47:06","1","40308","VA","Individual","No","53-0078070","40308VA0240003","BluePreferred PPO HSA Bronze $4,500","40308VA024",,"VAN001","VAS001","VAF008","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996945325620599",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"https://www.carefirst.com/acarx","40308VA0240003-00","Standard Bronze Off Exchange Plan","61.79%",,"Yes","Yes","No","100%",,"$4,500","$515","$0","$30","$4,500","$90","$34","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://content.carefirst.com/sbc/APHVBN5CRXCVBN5LN012016.pdf",,"4"
"2016","VA","40308","SERFF","17","2015-10-23 11:47:06","1","40308","VA","Individual","Yes","53-0078070","40308VA0320001","BlueDental Preferred High Option (ON EXCH)","40308VA032",,"VAN010","VAS002",,"Existing","PPO","High",,"On the Exchange",,,,"Frequency and age limitations may apply based on type of service received.",,"No","Allows Adult and Child-Only",,,,,"$30.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,"","40308VA0320001-01","Standard High On Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","$180 per group",,,,,,"$120","$120 per person","$360 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.carefirst.com/bluedentalpreferredhighoptionva","4"
"2016","VA","40308","SERFF","17","2015-10-23 11:47:06","1","40308","VA","SHOP (Small Group)","No","53-0078070","40308VA0270015","BluePreferred PPO HSA/HRA 4500","40308VA027",,"VAN001","VAS001","VAF006","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9974",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services","Yes","All covered services","Yes",,"https://www.carefirst.com/acarx","40308VA0270015-00","Standard Bronze Off Exchange Plan","61.89%",,"Yes","Yes","No","100%",,"$4,500","$15","$218","$30","$4,500","$90","$51","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://content.carefirst.com/sbc/APHVB65BRXCVBB5DN012016.pdf",,"4"
"2016","VA","40308","SERFF","17","2015-10-23 11:47:06","1","40308","VA","SHOP (Small Group)","Yes","53-0078070","40308VA0330002","BlueDental Preferred","40308VA033",,"VAN010","VAS002",,"Existing","PPO","High",,"Off the Exchange",,,,"Frequency and age limitations may apply based on type of service received.",,"No","Allows Adult and Child-Only",,,,,"$26.71","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","All Covered Services","Yes","All Covered Services","No",,"","40308VA0330002-00","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","$180 per group",,,,,,"$120","$120 per person","$360 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"www.carefirst.com/bluedentalpreferredhighoptionva","4"
"2016","VA","40308","SERFF","17","2015-10-23 11:47:06","1","40308","VA","SHOP (Small Group)","No","53-0078070","40308VA0270015","BluePreferred PPO HSA/HRA 4500","40308VA027",,"VAN001","VAS001","VAF006","Existing","PPO","Bronze","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9974",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services","Yes","All covered services","Yes",,"https://www.carefirst.com/acarx","40308VA0270015-01","Standard Bronze On Exchange Plan","61.89%",,"Yes","Yes","No","100%",,"$4,500","$15","$218","$30","$4,500","$90","$51","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","30%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://content.carefirst.com/sbc/APHVB65BRXCVBB5DN012016.pdf",,"5"
"2016","VA","40308","SERFF","17","2015-10-23 11:47:06","1","40308","VA","SHOP (Small Group)","Yes","53-0078070","40308VA0340002","BlueDental Traditional","40308VA034",,"VAN011","VAS002",,"Existing","PPO","High",,"Off the Exchange",,,,"Frequency and age limitations may apply based on type of service received.",,"No","Allows Adult and Child-Only",,,,,"$28.08","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","All Covered Services","Yes","All Covered Services","No",,"","40308VA0340002-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$70","$70 per person","$210 per group",,,,,,"Not Applicable","per person not applicable","per group not applicable","$70","$70 per person","$210 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,," www.carefirst.com/bluedentaltraditionalva","5"
"2016","VA","40308","SERFF","17","2015-10-23 11:47:06","1","40308","VA","Individual","No","53-0078070","40308VA0240003","BluePreferred PPO HSA Bronze $4,500","40308VA024",,"VAN001","VAS001","VAF008","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996945325620599",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"https://www.carefirst.com/acarx","40308VA0240003-01","Standard Bronze On Exchange Plan","61.79%",,"Yes","Yes","No","100%",,"$4,500","$515","$0","$30","$4,500","$90","$34","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://content.carefirst.com/sbc/APHVBN5BRXCVBN5LN012016.pdf",,"5"
"2016","VA","40308","SERFF","17","2015-10-23 11:47:06","1","40308","VA","Individual","Yes","53-0078070","40308VA0320003","BlueDental Preferred High Option (OFF EXCH)","40308VA032",,"VAN010","VAS002",,"Existing","PPO","High",,"Off the Exchange",,,,"Frequency and age limitations may apply based on type of service received.",,"No","Allows Adult and Child-Only",,,,,"$30.93","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,"","40308VA0320003-00","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","$60 per person","$180 per group",,,,,,"$120","$120 per person","$360 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.carefirst.com/bluedentalpreferredhighoptionva","5"
"2016","VA","40308","SERFF","17","2015-10-23 11:47:06","1","40308","VA","Individual","No","53-0078070","40308VA0240003","BluePreferred PPO HSA Bronze $4,500","40308VA024",,"VAN001","VAS001","VAF008","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996945325620599",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"https://www.carefirst.com/acarx","40308VA0240003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$30","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://content.carefirst.com/sbc/APPVBN5ARXXVBN50N012016.pdf",,"6"
"2016","VA","40308","SERFF","17","2015-10-23 11:47:06","1","40308","VA","SHOP (Small Group)","No","53-0078070","40308VA0270007","BluePreferred PPO 100%/80%","40308VA027",,"VAN001","VAS001","VAF007","Existing","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9974",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services","Yes","All covered services","Yes",,"https://www.carefirst.com/acarx","40308VA0270007-00","Standard Platinum Off Exchange Plan","91.63%",,"No","Yes","No","100%",,"$0","$265","$0","$30","$0","$560","$244","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$1,000","$2000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://content.carefirst.com/sbc/APPVB68BRXXVBB8DN012016.pdf",,"6"
"2016","VA","40308","SERFF","17","2015-10-23 11:47:06","1","40308","VA","SHOP (Small Group)","No","53-0078070","40308VA0270007","BluePreferred PPO 100%/80%","40308VA027",,"VAN001","VAS001","VAF007","Existing","PPO","Platinum","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.9974",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All covered services","Yes","All covered services","Yes",,"https://www.carefirst.com/acarx","40308VA0270007-01","Standard Platinum On Exchange Plan","91.63%",,"No","Yes","No","100%",,"$0","$265","$0","$30","$0","$560","$244","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$4000 per person","$4000 per group",,,,"$4,000","$8000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$1,000","$2000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://content.carefirst.com/sbc/APPVB68BRXXVBB8DN012016.pdf",,"7"
"2016","VA","40308","SERFF","17","2015-10-23 11:47:06","1","40308","VA","Individual","No","53-0078070","40308VA0240003","BluePreferred PPO HSA Bronze $4,500","40308VA024",,"VAN001","VAS001","VAF008","Existing","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.996945325620599",,,,"0","0","0","2016-01-01","2016-12-31","Yes","All Covered Services","Yes","All Covered Services","Yes",,"https://www.carefirst.com/acarx","40308VA0240003-03","Limited Cost Sharing Plan Variation","61.79%",,"Yes","Yes","No","100%",,"$4,500","$515","$0","$30","$4,500","$90","$34","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","0%",,,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://content.carefirst.com/sbc/APHVBN5ARXCVBN5LN012016.pdf",,"7"
"2016","VA","40308","SERFF","17","2015-10-23 11:47:06","2","40308","VA","Individual","Yes","53-0078070","40308VA0320002","BlueDental Preferred Low Option (ON EXCH)","40308VA032",,"VAN010","VAS002",,"Existing","PPO","Low",,"On the Exchange",,,,"Frequency and age limitations may apply based on type of service received.",,"No","Allows Adult and Child-Only",,,,,"$25.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,"","40308VA0320002-01","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$150","$150 per person","$450 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.carefirst.com/bluedentalpreferredlowoptionva","4"
"2016","VA","40308","SERFF","17","2015-10-23 11:47:06","2","40308","VA","Individual","Yes","53-0078070","40308VA0320004","BlueDental Preferred Low Option (OFF EXCH)","40308VA032",,"VAN010","VAS002",,"Existing","PPO","Low",,"Off the Exchange",,,,"Frequency and age limitations may apply based on type of service received.",,"No","Allows Adult and Child-Only",,,,,"$25.68","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,"","40308VA0320004-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","$225 per group",,,,,,"$150","$150 per person","$450 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.carefirst.com/bluedentalpreferredlowoptionva","5"
"2016","VA","42808","SERFF","4","2015-08-25 12:56:34","1","42808","VA","Individual","Yes","13-5123390","42808VA0260001","Guardian Family Essentials","42808VA026",,"VAN002","VAS002",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.13","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside the service area.","Yes","https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSPaymentRedirect.aspx","","42808VA0260001-00","Standard Low Off Exchange Plan","68.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$75","$75 per person","per group not applicable",,,,,,"$150","$150 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentalexchange.guardianlife.com/learn-more/our-plans","https://dentalexchange.guardianlife.com/learn-more/our-plans","4"
"2016","VA","42808","SERFF","4","2015-08-25 12:56:34","1","42808","VA","SHOP (Small Group)","Yes","13-5123390","42808VA0200003","Guardian Pediatric Advantage","42808VA020",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$25.21","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","42808VA0200003-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","VA","51207","SERFF","3","2015-08-25 12:56:34","1","51207","VA","SHOP (Small Group)","Yes","36-0883760","51207VA0040002","EHB High PPO","51207VA004",,"VAN001","VAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$41.15","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","51207VA0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","4"
"2016","VA","51207","SERFF","3","2015-08-25 12:56:34","1","51207","VA","SHOP (Small Group)","Yes","36-0883760","51207VA0040001","EHB Low PPO","51207VA004",,"VAN001","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.37","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.rsli.com","","51207VA0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.rsli.com","http://www.rsli.com","5"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","1","54965","VA","Individual","Yes","54-1808292","54965VA0030005","PPO Elite Basic Kids","54965VA003",,"VAN003","VAS003",,"New","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$18.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030005-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBLINDPEDEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBLINDPEDEHB.PDF","4"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","1","54965","VA","SHOP (Small Group)","Yes","54-1808292","54965VA0050004","Access PPO Basic","54965VA005",,"VAN002","VAS002",,"New","PPO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$22.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0050004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBLSMGFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBLSMGFAMEHB.PDF","4"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","1","54965","VA","SHOP (Small Group)","Yes","54-1808292","54965VA0050004","Access PPO Basic","54965VA005",,"VAN002","VAS002",,"New","PPO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$22.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0050004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBLSMGFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBLSMGFAMEHB.PDF","5"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","1","54965","VA","Individual","Yes","54-1808292","54965VA0030005","PPO Elite Basic Kids","54965VA003",,"VAN003","VAS003",,"New","PPO","Low",,"Both",,,,,,"No","Allows Child-Only",,,,,"$18.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030005-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBLINDPEDEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBLINDPEDEHB.PDF","5"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","1","54965","VA","Individual","Yes","54-1808292","54965VA0030003","PPO Elite Premium Kids","54965VA003",,"VAN003","VAS003",,"New","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$22.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030003-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBHINDPEDEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBHINDPEDEHB.PDF","6"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","1","54965","VA","SHOP (Small Group)","Yes","54-1808292","54965VA0050005","Access PPO Premium","54965VA005",,"VAN002","VAS002",,"New","PPO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$22.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0050005-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBHSMGFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBHSMGFAMEHB.PDF","6"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","1","54965","VA","SHOP (Small Group)","Yes","54-1808292","54965VA0050005","Access PPO Premium","54965VA005",,"VAN002","VAS002",,"New","PPO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$22.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0050005-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBHSMGFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBHSMGFAMEHB.PDF","7"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","1","54965","VA","Individual","Yes","54-1808292","54965VA0030003","PPO Elite Premium Kids","54965VA003",,"VAN003","VAS003",,"New","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$22.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030003-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBHINDPEDEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBHINDPEDEHB.PDF","7"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","1","54965","VA","Individual","Yes","54-1808292","54965VA0020001","Select Plan Basic Kids","54965VA002",,"VAN001","VAS001",,"Existing","HMO","Low",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"$14.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","54965VA0020001-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16DBLINDPEDEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16DBLINDPEDEHB.PDF","8"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","1","54965","VA","Individual","Yes","54-1808292","54965VA0020001","Select Plan Basic Kids","54965VA002",,"VAN001","VAS001",,"Existing","HMO","Low",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"$14.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","54965VA0020001-01","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16DBLINDPEDEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16DBLINDPEDEHB.PDF","9"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","1","54965","VA","Individual","Yes","54-1808292","54965VA0020005","Select Plan Premium Kids","54965VA002",,"VAN001","VAS001",,"New","HMO","High",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"$19.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","54965VA0020005-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16DBHINDPEDEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16DBHINDPEDEHB.PDF","10"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","1","54965","VA","Individual","Yes","54-1808292","54965VA0020005","Select Plan Premium Kids","54965VA002",,"VAN001","VAS001",,"New","HMO","High",,"Both",,,,"Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Child-Only",,,,,"$19.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","54965VA0020005-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16DBHINDPEDEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16DBHINDPEDEHB.PDF","11"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","2","54965","VA","SHOP (Small Group)","Yes","54-1808292","54965VA0040004","Select Plan Premium","54965VA004",,"VAN001","VAS001",,"New","HMO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"$19.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","54965VA0040004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16DBHSMGFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16DBHSMGFAMEHB.PDF","4"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","2","54965","VA","Individual","Yes","54-1808292","54965VA0030004","PPO Elite Basic","54965VA003",,"VAN003","VAS003",,"New","PPO","Low",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$18.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030004-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBLINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBLINDFAMEHB.PDF","4"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","2","54965","VA","Individual","Yes","54-1808292","54965VA0030004","PPO Elite Basic","54965VA003",,"VAN003","VAS003",,"New","PPO","Low",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$18.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030004-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBLINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBLINDFAMEHB.PDF","5"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","2","54965","VA","SHOP (Small Group)","Yes","54-1808292","54965VA0040004","Select Plan Premium","54965VA004",,"VAN001","VAS001",,"New","HMO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"$19.95","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","54965VA0040004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16DBHSMGFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16DBHSMGFAMEHB.PDF","5"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","2","54965","VA","Individual","Yes","54-1808292","54965VA0030006","PPO Elite Premium","54965VA003",,"VAN003","VAS003",,"New","PPO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$22.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030006-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBHINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBHINDFAMEHB.PDF","6"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","2","54965","VA","Individual","Yes","54-1808292","54965VA0030006","PPO Elite Premium","54965VA003",,"VAN003","VAS003",,"New","PPO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$22.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030006-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$100 per group",,,,,,"$50","$50 per person","$100 per group","$50","$50 per person","$100 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBHINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16SBHINDFAMEHB.PDF","7"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","3","54965","VA","Individual","Yes","54-1808292","54965VA0030007","PPO Elite Plus","54965VA003",,"VAN003","VAS003",,"New","PPO","Low",,"Off the Exchange",,,,"Out of Pocket Maximum applies to children only. Adults have separate deductible and plan payment maximum, refer to plan document for details.",,"No","Allows Adult and Child-Only",,,,,"$18.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Standard Out of Network PPO Benefits","Yes","Standard Out of Network PPO Benefits","Yes",,"","54965VA0030007-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group",,,,,,"$100","$100 per person","$200 per group","$100","$100 per person","$200 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","4","54965","VA","Individual","Yes","54-1808292","54965VA0020002","Select Plan Basic","54965VA002",,"VAN001","VAS001",,"Existing","HMO","Low",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"$14.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","54965VA0020002-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16DBLINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16DBLINDFAMEHB.PDF","4"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","4","54965","VA","Individual","Yes","54-1808292","54965VA0020002","Select Plan Basic","54965VA002",,"VAN001","VAS001",,"Existing","HMO","Low",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"$14.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","54965VA0020002-01","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16DBLINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16DBLINDFAMEHB.PDF","5"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","4","54965","VA","Individual","Yes","54-1808292","54965VA0020006","Select Plan Premium","54965VA002",,"VAN001","VAS001",,"New","HMO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"$19.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","54965VA0020006-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16DBHINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16DBHINDFAMEHB.PDF","6"
"2016","VA","54965","SERFF","7","2015-08-25 12:56:34","4","54965","VA","Individual","Yes","54-1808292","54965VA0020006","Select Plan Premium","54965VA002",,"VAN001","VAS001",,"New","HMO","High",,"Both",,,,"Out of Pocket Maximum applies to children only. Co-insurance equivalent percentages displayed. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist.",,"No","Allows Adult and Child-Only",,,,,"$19.95","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No",,"","54965VA0020006-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16DBHINDFAMEHB.PDF","https://www.dominiondental.com/files/plan/FEDVIP/DDSVA16DBHINDFAMEHB.PDF","7"
"2016","VA","66599","SERFF","4","2015-08-25 12:56:34","1","66599","VA","SHOP (Small Group)","Yes","47-0098400","66599VA0040002","EHB High PPO","66599VA004",,"VAN001","VAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$40.58","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","66599VA0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","4"
"2016","VA","66599","SERFF","4","2015-08-25 12:56:34","1","66599","VA","SHOP (Small Group)","Yes","47-0098400","66599VA0040001","EHB Low PPO","66599VA004",,"VAN001","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.09","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","66599VA0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","5"
"2016","VA","66599","SERFF","4","2015-08-25 12:56:34","1","66599","VA","SHOP (Small Group)","Yes","47-0098400","66599VA0030002","EHB High Passive","66599VA003",,"VAN001","VAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$43.97","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","66599VA0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","6"
"2016","VA","66599","SERFF","4","2015-08-25 12:56:34","1","66599","VA","SHOP (Small Group)","Yes","47-0098400","66599VA0030001","EHB Low Passive","66599VA003",,"VAN001","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.31","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","http://www.ameritas.com","","66599VA0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.ameritas.com","http://www.ameritas.com","7"
"2016","VA","72006","SERFF","3","2015-08-25 12:56:34","1","72006","VA","SHOP (Small Group)","Yes","13-5581829","72006VA0160001","EHB Basic Dental Plan (Low)","72006VA016",,"VAN001","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but when paired with one of MetLife’s group certificates, the amount paid by the Plan upon claims adjudication will be greater of either the traditional group certificate or the EHB certificate.",,"No","Allows Child-Only",,,,,"$20.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","72006VA0160001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","VA","72006","SERFF","3","2015-08-25 12:56:34","2","72006","VA","SHOP (Small Group)","Yes","13-5581829","72006VA0180001","Family Basic Dental Plan (Low)","72006VA018",,"VAN001","VAS001",,"Existing","PPO","Low",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.76","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","72006VA0180001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$300 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49132","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49131","4"
"2016","VA","72006","SERFF","3","2015-08-25 12:56:34","3","72006","VA","SHOP (Small Group)","Yes","13-5581829","72006VA0190001","Family Enhanced Dental Plan (High)","72006VA019",,"VAN001","VAS001",,"Existing","PPO","High",,"On the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$25.64","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","72006VA0190001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$50","$50 per person","$150 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49134","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49133","4"
"2016","VA","72804","SERFF","5","2015-08-25 12:56:34","1","72804","VA","SHOP (Small Group)","Yes","81-0170040","72804VA0010001","Assurant Dental ACAFFO High","72804VA001",,"VAN001","VAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$44.72","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","72804VA0010001-00","Standard High Off Exchange Plan","85.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","VA","72804","SERFF","5","2015-08-25 12:56:34","1","72804","VA","SHOP (Small Group)","Yes","81-0170040","72804VA0010002","Assurant Dental ACAFFO Low","72804VA001",,"VAN001","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$37.21","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same coverage as in service area","Yes",,"","72804VA0010002-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$90","$90 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","VA","72869","SERFF","3","2015-08-25 12:56:34","1","72869","VA","SHOP (Small Group)","Yes","57-0523959","72869VA0020001","Group Dental Policy","72869VA002",,"VAN001","VAS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$49.17","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","72869VA0020001-00","Standard High Off Exchange Plan","86.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","VA","77146","SERFF","4","2015-08-25 12:56:34","1","77146","VA","SHOP (Small Group)","Yes","41-0808596","77146VA0010002","Plan 2. Passive PPO $1000 Annual Maximum, Ortho","77146VA001",,"VAN001","VAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","77146VA0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","VA","77146","SERFF","4","2015-08-25 12:56:34","1","77146","VA","SHOP (Small Group)","Yes","41-0808596","77146VA0010005","Plan 5. Passive PPO, $2000 Annaul Maximum, Ortho","77146VA001",,"VAN001","VAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","77146VA0010005-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","VA","77146","SERFF","4","2015-08-25 12:56:34","1","77146","VA","SHOP (Small Group)","Yes","41-0808596","77146VA0010006","Plan 6. Graded Passive PPO, $1500 Annual Maximum, no Ortho","77146VA001",,"VAN001","VAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$27.03","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","77146VA0010006-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","VA","77146","SERFF","4","2015-08-25 12:56:34","1","77146","VA","SHOP (Small Group)","Yes","41-0808596","77146VA0010009","Plan 9. MAC PPO, $1500 Annual Maximum, Ortho","77146VA001",,"VAN001","VAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"Yes","Allows Adult and Child-Only",,,,,"$20.18","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","No",,"Yes","Benefits are same in and out of network","Yes",,"","77146VA0010009-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,"Not Applicable","per person not applicable","per group not applicable","$350","$350 per person","$700 per group",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","VA","78800","SERFF","4","2015-08-25 12:56:34","1","78800","VA","SHOP (Small Group)","Yes","44-0308260","78800VA0010001","KCL EHB Low PPO","78800VA001",,"VAN001","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$46.20","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","78800VA0010001-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","VA","78800","SERFF","4","2015-08-25 12:56:34","1","78800","VA","SHOP (Small Group)","Yes","44-0308260","78800VA0010003","KCL EHB Low MAC","78800VA001",,"VAN001","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$34.52","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","78800VA0010003-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","VA","78800","SERFF","4","2015-08-25 12:56:34","1","78800","VA","SHOP (Small Group)","Yes","44-0308260","78800VA0010005","KCL Fam Low PPO","78800VA001",,"VAN001","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$46.20","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","78800VA0010005-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","VA","78800","SERFF","4","2015-08-25 12:56:34","1","78800","VA","SHOP (Small Group)","Yes","44-0308260","78800VA0010007","KCL Fam Low MAC","78800VA001",,"VAN001","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$34.52","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","78800VA0010007-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$125","$125 per person","per group not applicable",,,,,,"$125","$125 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","VA","78800","SERFF","4","2015-08-25 12:56:34","2","78800","VA","SHOP (Small Group)","Yes","44-0308260","78800VA0010002","KCL EHB High PPO","78800VA001",,"VAN001","VAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$57.30","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","78800VA0010002-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730048","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS020","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730048-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","26"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730048","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS020","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730048-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","27"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730049","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS002","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730049-00","Standard Bronze Off Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","28"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730049","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS002","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730049-01","Standard Bronze On Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","29"
"2016","VA","78800","SERFF","4","2015-08-25 12:56:34","2","78800","VA","SHOP (Small Group)","Yes","44-0308260","78800VA0010004","KCL EHB High MAC","78800VA001",,"VAN001","VAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Child-Only",,,,,"$44.15","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","78800VA0010004-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","VA","78800","SERFF","4","2015-08-25 12:56:34","2","78800","VA","SHOP (Small Group)","Yes","44-0308260","78800VA0010006","KCL Fam High PPO","78800VA001",,"VAN001","VAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$57.30","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","78800VA0010006-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","VA","78800","SERFF","4","2015-08-25 12:56:34","2","78800","VA","SHOP (Small Group)","Yes","44-0308260","78800VA0010008","KCL Fam High MAC","78800VA001",,"VAN001","VAS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Care or services not accepted by the ADA; services payable under another plan; injury or sickness covered under Workers Comp or similar law.  This list is not all inclusive, see the Master Policy for details.",,"Yes","Allows Adult and Child-Only",,,,,"$44.15","Estimated Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Same as in-network service there are no limits","Yes",,"","78800VA0010008-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","per group not applicable",,,,,,"$50","$50 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","VA","86443","SERFF","9","2015-08-25 12:56:34","1","86443","VA","SHOP (Small Group)","No","46-0682197","86443VA0060002","IH Signature Silver HMO 2000 100","86443VA006",,"VAN001","VAS001","VAF026","New","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=5153889666","86443VA0060002-00","Standard Silver Off Exchange Plan","71.30%",,"No","Yes","No","100%",,"$2,000","$500","$0","$200","$2,000","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,,,"4"
"2016","VA","86443","SERFF","9","2015-08-25 12:56:34","1","86443","VA","SHOP (Small Group)","No","46-0682197","86443VA0060002","IH Signature Silver HMO 2000 100","86443VA006",,"VAN001","VAS001","VAF026","New","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=5153889666","86443VA0060002-01","Standard Silver On Exchange Plan","71.30%",,"No","Yes","No","100%",,"$2,000","$500","$0","$200","$2,000","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_IHSignatureSilverHMO2000100_ON.pdf",,"5"
"2016","VA","86443","SERFF","9","2015-08-25 12:56:34","2","86443","VA","SHOP (Small Group)","No","46-0682197","86443VA0060003","IH Signature Silver HMO 2500 70 HSA T","86443VA006",,"VAN001","VAS001","VAF027","New","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=5153889666","86443VA0060003-00","Standard Silver Off Exchange Plan","71.28%",,"Yes","Yes","No","100%",,"$2,500","$0","$700","$200","$2,500","$70","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$6400 per person","$6400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,,,"4"
"2016","VA","86443","SERFF","9","2015-08-25 12:56:34","2","86443","VA","SHOP (Small Group)","No","46-0682197","86443VA0060003","IH Signature Silver HMO 2500 70 HSA T","86443VA006",,"VAN001","VAS001","VAF027","New","HMO","Silver","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=5153889666","86443VA0060003-01","Standard Silver On Exchange Plan","71.28%",,"Yes","Yes","No","100%",,"$2,500","$0","$700","$200","$2,500","$70","$500","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,200","$6400 per person","$6400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","per person not applicable","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_IHSignatureSilverHMO250070HSAT_ON.pdf",,"5"
"2016","VA","86443","SERFF","9","2015-08-25 12:56:34","3","86443","VA","SHOP (Small Group)","No","46-0682197","86443VA0060001","IH Signature Gold HMO 1000 100","86443VA006",,"VAN001","VAS001","VAF025","New","HMO","Gold","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=5153889666","86443VA0060001-00","Standard Gold Off Exchange Plan","80.24%",,"No","Yes","No","100%",,"$1,000","$10","$0","$200","$1,000","$300","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,,,"4"
"2016","VA","86443","SERFF","9","2015-08-25 12:56:34","3","86443","VA","SHOP (Small Group)","No","46-0682197","86443VA0060001","IH Signature Gold HMO 1000 100","86443VA006",,"VAN001","VAS001","VAF025","New","HMO","Gold","Yes","Both","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,,"No","Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"No","Except for Emergencies","No",,"http://client.formularynavigator.com/Search.aspx?siteCode=5153889666","86443VA0060001-01","Standard Gold On Exchange Plan","80.24%",,"No","Yes","No","100%",,"$1,000","$10","$0","$200","$1,000","$300","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://innovation-health.s3.amazonaws.com/SBC_2016_VA_IHSignatureGoldHMO1000100_ON.pdf",,"5"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","Individual","No","54-1356687","88380VA0720015","Anthem HealthKeepers Catastrophic X 6850 0","88380VA072",,"VAN001","VAS001","VAF001","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720015-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","70%","30%","$6,554","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GBK","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","4"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730037","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS002","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730037-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","4"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730037","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS002","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730037-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","5"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","Individual","No","54-1356687","88380VA0720015","Anthem HealthKeepers Catastrophic X 6850 0","88380VA072",,"VAN001","VAS001","VAF001","Existing","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720015-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","70%","30%","$6,554","$0","$0","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%","$6,850","$6850 per person","$13700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G9R","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","5"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730038","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS005","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730038-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","6"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730038","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS005","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730038-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","7"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730039","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS006","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730039-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","8"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730039","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS006","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730039-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","9"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730040","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS009","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730040-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","10"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730040","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS009","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730040-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","11"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730041","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS012","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730041-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","12"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730041","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS012","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730041-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","13"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730042","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS013","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730042-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","14"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730042","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS013","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730042-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","15"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730043","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS015","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730043-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","16"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730043","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS015","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730043-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","17"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730044","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS016","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730044-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","18"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730044","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS016","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730044-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","19"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730045","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS017","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730045-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","20"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730045","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS017","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730045-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","21"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730046","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS018","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730046-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","22"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730046","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS018","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730046-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","23"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730047","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS019","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730047-00","Standard Bronze Off Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","24"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730047","Anthem HealthKeepers Bronze Pathway X POS 6000E 0  6000 Plus w HSA","88380VA073",,"VAN001","VAS019","VAF008","Existing","POS","Bronze","No","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730047-01","Standard Bronze On Exchange Plan",,"0.617518126964569","Yes","Yes","No","100%",,"$5,084","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%",,,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD2062","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","25"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730051","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS006","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730051-01","Standard Bronze On Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","33"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730052","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS009","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730052-00","Standard Bronze Off Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","34"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730052","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS009","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730052-01","Standard Bronze On Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","35"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730053","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS012","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730053-00","Standard Bronze Off Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","36"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730053","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS012","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730053-01","Standard Bronze On Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","37"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730054","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS013","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730054-00","Standard Bronze Off Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","38"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730054","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS013","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730054-01","Standard Bronze On Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","39"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730055","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS015","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730055-00","Standard Bronze Off Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","40"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730055","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS015","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730055-01","Standard Bronze On Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","41"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730056","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS016","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730056-00","Standard Bronze Off Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","42"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730056","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS016","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730056-01","Standard Bronze On Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","43"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730057","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS017","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730057-00","Standard Bronze Off Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","44"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730057","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS017","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730057-01","Standard Bronze On Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","45"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730058","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS018","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730058-00","Standard Bronze Off Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","46"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730016","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS009","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730016-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","10"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730016","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS009","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730016-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","11"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730058","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS018","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730058-01","Standard Bronze On Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","47"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730059","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS019","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730059-00","Standard Bronze Off Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","48"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730059","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS019","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730059-01","Standard Bronze On Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","49"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730060","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS020","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730060-00","Standard Bronze Off Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","50"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","1","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730060","Anthem HealthKeepers Bronze Pathway X POS 5000E 20  6550 Plus w HSA","88380VA073",,"VAN001","VAS020","VAF017","New","POS","Bronze","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/ Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730060-01","Standard Bronze On Exchange Plan","61.62%","0.617632150650024","Yes","Yes","No","100%",,"$5,000","$0","$17","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group",,,,"$13,100","$13100 per person","$26200 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","20%",,,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"http://www.sbc.anthem.com/dps/CCD1P66","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","51"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","2","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730061","Anthem HealthKeepers Silver X POS 2500 0  5000","88380VA073",,"VAN002","VAS001","VAF005","New","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730061-00","Standard Silver Off Exchange Plan","68.37%","0","Yes","Yes","No","100%",,"$2,500","$845","$0","$0","$1,012","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.sbc.anthem.com/dps/CCD1P7D","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","4"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","2","88380","VA","Individual","No","54-1356687","88380VA0720018","Anthem HealthKeepers Bronze X 4650 35","88380VA072",,"VAN001","VAS001","VAF007","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720018-00","Standard Bronze Off Exchange Plan","62.00%","0.620368361473084","Yes","Yes","Yes","70%","30%","$4,650","$0","$686","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group","35%","$4,650","$4650 per person","$9300 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GBN","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","4"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","2","88380","VA","Individual","No","54-1356687","88380VA0720018","Anthem HealthKeepers Bronze X 4650 35","88380VA072",,"VAN001","VAS001","VAF007","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720018-01","Standard Bronze On Exchange Plan","62.00%","0.620368361473084","Yes","Yes","Yes","70%","30%","$4,650","$0","$686","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group","35%","$4,650","$4650 per person","$9300 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G9W","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","5"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","2","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730061","Anthem HealthKeepers Silver X POS 2500 0  5000","88380VA073",,"VAN002","VAS001","VAF005","New","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,"0","0","0","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730061-01","Standard Silver On Exchange Plan","68.37%","0","Yes","Yes","No","100%",,"$2,500","$845","$0","$0","$1,012","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","0%",,,,,"$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"http://www.sbc.anthem.com/dps/CCD1P7D","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","5"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","2","88380","VA","Individual","No","54-1356687","88380VA0720018","Anthem HealthKeepers Bronze X 4650 35","88380VA072",,"VAN001","VAS001","VAF007","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720018-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G9X","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","6"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","2","88380","VA","Individual","No","54-1356687","88380VA0720018","Anthem HealthKeepers Bronze X 4650 35","88380VA072",,"VAN001","VAS001","VAF007","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720018-03","Limited Cost Sharing Plan Variation","62.00%","0.620368361473084","Yes","Yes","Yes","70%","30%","$4,650","$0","$686","$0","$1,059","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,650","$4650 per person","$9300 per group","35%","$4,650","$4650 per person","$9300 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G9W","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","7"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","2","88380","VA","Individual","No","54-1356687","88380VA0720022","Anthem HealthKeepers Silver X 2600 20","88380VA072",,"VAN001","VAS001","VAF023","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720022-00","Standard Silver Off Exchange Plan","69.37%","0.69409441947937","Yes","Yes","Yes","70%","30%","$2,600","$0","$802","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%","$2,600","$2600 per person","$5200 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JFH","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","8"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","2","88380","VA","Individual","No","54-1356687","88380VA0720022","Anthem HealthKeepers Silver X 2600 20","88380VA072",,"VAN001","VAS001","VAF023","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720022-01","Standard Silver On Exchange Plan","69.37%","0.69409441947937","Yes","Yes","Yes","70%","30%","$2,600","$0","$802","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%","$2,600","$2600 per person","$5200 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA9","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","9"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","2","88380","VA","Individual","No","54-1356687","88380VA0720022","Anthem HealthKeepers Silver X 2600 20","88380VA072",,"VAN001","VAS001","VAF023","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720022-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GAA","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","10"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","2","88380","VA","Individual","No","54-1356687","88380VA0720022","Anthem HealthKeepers Silver X 2600 20","88380VA072",,"VAN001","VAS001","VAF023","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720022-03","Limited Cost Sharing Plan Variation","69.37%","0.69409441947937","Yes","Yes","Yes","70%","30%","$2,600","$0","$802","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","20%","$2,600","$2600 per person","$5200 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA9","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","11"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","2","88380","VA","Individual","No","54-1356687","88380VA0720022","Anthem HealthKeepers Silver X 2600 20","88380VA072",,"VAN001","VAS001","VAF023","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720022-04","73% AV Level Silver Plan","73.95%","0.740807116031647","Yes","Yes","Yes","70%","30%","$2,500","$0","$822","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,350","$4350 per person","$8700 per group","$4,350","$4350 per person","$8700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%","$2,500","$2500 per person","$5000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAB","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","12"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","2","88380","VA","Individual","No","54-1356687","88380VA0720022","Anthem HealthKeepers Silver X 2600 20","88380VA072",,"VAN001","VAS001","VAF023","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720022-05","87% AV Level Silver Plan","87.42%","0.877006471157074","Yes","Yes","Yes","70%","30%","$750","$0","$700","$0","$750","$50","$70","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group","$1,450","$1450 per person","$2900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","20%","$750","$750 per person","$1500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAC","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","13"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","2","88380","VA","Individual","No","54-1356687","88380VA0720022","Anthem HealthKeepers Silver X 2600 20","88380VA072",,"VAN001","VAS001","VAF023","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","3","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720022-06","94% AV Level Silver Plan","93.77%","0.941222786903381","Yes","Yes","Yes","70%","30%","$200","$0","$400","$0","$200","$20","$186","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%","$200","$200 per person","$400 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAD","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","14"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720016","Anthem HealthKeepers Bronze X 15 for HSA","88380VA072",,"VAN001","VAS001","VAF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720016-00","Standard Bronze Off Exchange Plan",,"0.601103067398071","Yes","Yes","Yes","70%","30%","$6,000","$0","$92","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","15%","$6,000","$6000 per person","$12000 per group","15%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GBL","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","4"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730013","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS002","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730013-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","4"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730013","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS002","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730013-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","5"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720016","Anthem HealthKeepers Bronze X 15 for HSA","88380VA072",,"VAN001","VAS001","VAF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720016-01","Standard Bronze On Exchange Plan",,"0.601103067398071","Yes","Yes","Yes","70%","30%","$6,000","$0","$92","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","15%","$6,000","$6000 per person","$12000 per group","15%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G9S","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","5"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720016","Anthem HealthKeepers Bronze X 15 for HSA","88380VA072",,"VAN001","VAS001","VAF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G9T","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","6"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730014","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS005","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730014-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","6"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730014","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS005","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730014-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","7"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720016","Anthem HealthKeepers Bronze X 15 for HSA","88380VA072",,"VAN001","VAS001","VAF002","Existing","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720016-03","Limited Cost Sharing Plan Variation",,"0.601103067398071","Yes","Yes","Yes","70%","30%","$6,000","$0","$92","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","15%","$6,000","$6000 per person","$12000 per group","15%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1G9S","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","7"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720020","Anthem HealthKeepers Bronze X 35 for HSA","88380VA072",,"VAN001","VAS001","VAF006","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720020-00","Standard Bronze Off Exchange Plan","61.86%","0.619019329547882","Yes","Yes","Yes","70%","30%","$4,000","$0","$914","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","35%","$4,000","$4000 per person","$8000 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GBR","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","8"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730015","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS006","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730015-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","8"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730015","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS006","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730015-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","9"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720020","Anthem HealthKeepers Bronze X 35 for HSA","88380VA072",,"VAN001","VAS001","VAF006","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720020-01","Standard Bronze On Exchange Plan","61.86%","0.619019329547882","Yes","Yes","Yes","70%","30%","$4,000","$0","$914","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","35%","$4,000","$4000 per person","$8000 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GA2","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","9"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720020","Anthem HealthKeepers Bronze X 35 for HSA","88380VA072",,"VAN001","VAS001","VAF006","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720020-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GA3","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","10"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720020","Anthem HealthKeepers Bronze X 35 for HSA","88380VA072",,"VAN001","VAS001","VAF006","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720020-03","Limited Cost Sharing Plan Variation","61.86%","0.619019329547882","Yes","Yes","Yes","70%","30%","$4,000","$0","$914","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","35%","$4,000","$4000 per person","$8000 per group","35%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1GA2","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","11"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720021","Anthem HealthKeepers Silver X 3350 15","88380VA072",,"VAN001","VAS001","VAF022","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720021-00","Standard Silver Off Exchange Plan","68.62%","0.686509191989899","Yes","Yes","Yes","70%","30%","$3,350","$0","$489","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","15%","$3,350","$3350 per person","$6700 per group","15%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JFG","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","12"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730017","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS012","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730017-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","12"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730017","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS012","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730017-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","13"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720021","Anthem HealthKeepers Silver X 3350 15","88380VA072",,"VAN001","VAS001","VAF022","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720021-01","Standard Silver On Exchange Plan","68.62%","0.686509191989899","Yes","Yes","Yes","70%","30%","$3,350","$0","$489","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","15%","$3,350","$3350 per person","$6700 per group","15%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA4","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","13"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720021","Anthem HealthKeepers Silver X 3350 15","88380VA072",,"VAN001","VAS001","VAF022","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720021-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GA5","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","14"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730018","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS013","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730018-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","14"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730018","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS013","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730018-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","15"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720021","Anthem HealthKeepers Silver X 3350 15","88380VA072",,"VAN001","VAS001","VAF022","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720021-03","Limited Cost Sharing Plan Variation","68.62%","0.686509191989899","Yes","Yes","Yes","70%","30%","$3,350","$0","$489","$0","$424","$90","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,350","$3350 per person","$6700 per group","15%","$3,350","$3350 per person","$6700 per group","15%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA4","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","15"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720021","Anthem HealthKeepers Silver X 3350 15","88380VA072",,"VAN001","VAS001","VAF022","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720021-04","73% AV Level Silver Plan","73.71%","0.737996101379395","Yes","Yes","Yes","70%","30%","$2,350","$0","$639","$0","$424","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group","$5,100","$5100 per person","$10200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,350","$2350 per person","$4700 per group","15%","$2,350","$2350 per person","$4700 per group","15%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA6","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","16"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730019","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS015","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730019-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","16"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730019","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS015","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730019-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","17"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720021","Anthem HealthKeepers Silver X 3350 15","88380VA072",,"VAN001","VAS001","VAF022","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720021-05","87% AV Level Silver Plan","87.74%","0.880352258682251","Yes","Yes","Yes","70%","30%","$750","$0","$700","$0","$424","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group","$1,450","$1450 per person","$2900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group","15%","$750","$750 per person","$1500 per group","15%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA7","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","17"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720021","Anthem HealthKeepers Silver X 3350 15","88380VA072",,"VAN001","VAS001","VAF022","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720021-06","94% AV Level Silver Plan","93.96%","0.943103730678558","Yes","Yes","Yes","70%","30%","$200","$0","$400","$0","$200","$30","$34","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","15%","$200","$200 per person","$400 per group","15%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA8","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","18"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730020","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS016","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730020-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","18"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730020","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS016","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730020-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","19"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720023","Anthem HealthKeepers Silver X 2250 20","88380VA072",,"VAN001","VAS001","VAF026","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720023-00","Standard Silver Off Exchange Plan","70.33%","0.703790187835693","Yes","Yes","Yes","70%","30%","$2,250","$0","$872","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JFJ","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","19"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720023","Anthem HealthKeepers Silver X 2250 20","88380VA072",,"VAN001","VAS001","VAF026","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720023-01","Standard Silver On Exchange Plan","70.33%","0.703790187835693","Yes","Yes","Yes","70%","30%","$2,250","$0","$872","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAE","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","20"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730021","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS017","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730021-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","20"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730021","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS017","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730021-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","21"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720023","Anthem HealthKeepers Silver X 2250 20","88380VA072",,"VAN001","VAS001","VAF026","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720023-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GAF","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","21"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720023","Anthem HealthKeepers Silver X 2250 20","88380VA072",,"VAN001","VAS001","VAF026","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720023-03","Limited Cost Sharing Plan Variation","70.33%","0.703790187835693","Yes","Yes","Yes","70%","30%","$2,250","$0","$872","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","20%","$2,250","$2250 per person","$4500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAE","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","22"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730022","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS018","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730022-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","22"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730022","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS018","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730022-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","23"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720023","Anthem HealthKeepers Silver X 2250 20","88380VA072",,"VAN001","VAS001","VAF026","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720023-04","73% AV Level Silver Plan","73.89%","0.740089476108551","Yes","Yes","Yes","70%","30%","$2,100","$0","$902","$0","$424","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,000","$5000 per person","$10000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","20%","$2,100","$2100 per person","$4200 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAG","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","23"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720023","Anthem HealthKeepers Silver X 2250 20","88380VA072",,"VAN001","VAS001","VAF026","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720023-05","87% AV Level Silver Plan","87.54%","0.878441333770752","Yes","Yes","Yes","70%","30%","$700","$0","$750","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,450","$1450 per person","$2900 per group","$1,450","$1450 per person","$2900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20%","$700","$700 per person","$1400 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAH","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","24"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730023","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS019","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730023-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","24"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730023","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS019","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730023-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","25"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720023","Anthem HealthKeepers Silver X 2250 20","88380VA072",,"VAN001","VAS001","VAF026","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720023-06","94% AV Level Silver Plan","93.86%","0.941833198070526","Yes","Yes","Yes","70%","30%","$200","$0","$400","$0","$200","$20","$45","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%","$200","$200 per person","$400 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAJ","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","25"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720025","Anthem HealthKeepers Gold X 1100 15","88380VA072",,"VAN001","VAS022","VAF018","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720025-00","Standard Gold Off Exchange Plan","78.90%","0.790517210960388","Yes","Yes","Yes","70%","30%","$1,100","$0","$827","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","15%","$1,100","$1100 per person","$2200 per group","15%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JFM","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","26"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730024","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS020","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730024-00","Standard Gold Off Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","26"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730024","Anthem HealthKeepers Gold Pathway X POS 500 20  5000 Plus","88380VA073",,"VAN001","VAS020","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730024-01","Standard Gold On Exchange Plan","80.64%","0.812706470489502","No","Yes","No","100%",,"$500","$0","$917","$0","$500","$40","$122","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","$10000 per person","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1500 per group","20%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2064","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","27"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720025","Anthem HealthKeepers Gold X 1100 15","88380VA072",,"VAN001","VAS022","VAF018","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720025-01","Standard Gold On Exchange Plan","78.90%","0.790517210960388","Yes","Yes","Yes","70%","30%","$1,100","$0","$827","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","15%","$1,100","$1100 per person","$2200 per group","15%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GB0","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","27"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720025","Anthem HealthKeepers Gold X 1100 15","88380VA072",,"VAN001","VAS022","VAF018","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720025-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GB1","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","28"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730025","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS002","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730025-00","Standard Silver Off Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","28"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730025","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS002","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730025-01","Standard Silver On Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","29"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720025","Anthem HealthKeepers Gold X 1100 15","88380VA072",,"VAN001","VAS022","VAF018","Existing","HMO","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720025-03","Limited Cost Sharing Plan Variation","78.90%","0.790517210960388","Yes","Yes","Yes","70%","30%","$1,100","$0","$827","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","15%","$1,100","$1100 per person","$2200 per group","15%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GB0","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","29"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720026","Anthem HealthKeepers Bronze X 50 for HSA","88380VA072",,"VAN001","VAS001","VAF008","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720026-00","Standard Bronze Off Exchange Plan",,"0.599389731884003","Yes","Yes","Yes","70%","30%","$6,100","$0","$255","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","50%","$6,100","$6100 per person","$12200 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X4Y","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","30"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730035","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS019","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730035-00","Standard Silver Off Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","48"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730035","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS019","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730035-01","Standard Silver On Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","49"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730026","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS005","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730026-00","Standard Silver Off Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","30"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730026","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS005","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730026-01","Standard Silver On Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","31"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720026","Anthem HealthKeepers Bronze X 50 for HSA","88380VA072",,"VAN001","VAS001","VAF008","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720026-01","Standard Bronze On Exchange Plan",,"0.599389731884003","Yes","Yes","Yes","70%","30%","$6,100","$0","$255","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","50%","$6,100","$6100 per person","$12200 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X4V","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","31"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720026","Anthem HealthKeepers Bronze X 50 for HSA","88380VA072",,"VAN001","VAS001","VAF008","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X4W","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","32"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730065","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS005","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730065-01","Standard Gold On Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","7"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","Individual","No","54-1356687","88380VA0720017","Anthem HealthKeepers Bronze X 5500 25","88380VA072",,"VAN001","VAS001","VAF005","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720017-03","Limited Cost Sharing Plan Variation","61.24%","0.613050639629364","Yes","Yes","Yes","70%","30%","$5,500","$0","$278","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","25%","$5,500","$5500 per person","$11000 per group","25%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G9U","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","7"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730066","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS006","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730066-00","Standard Gold Off Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","8"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730066","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS006","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730066-01","Standard Gold On Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","9"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730067","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS009","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730067-00","Standard Gold Off Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","10"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730067","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS009","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730067-01","Standard Gold On Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","11"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730027","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS006","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730027-00","Standard Silver Off Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","32"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730027","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS006","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730027-01","Standard Silver On Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","33"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720026","Anthem HealthKeepers Bronze X 50 for HSA","88380VA072",,"VAN001","VAS001","VAF008","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720026-03","Limited Cost Sharing Plan Variation",,"0.599389731884003","Yes","Yes","Yes","70%","30%","$6,100","$0","$255","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,100","$6100 per person","$12200 per group","50%","$6,100","$6100 per person","$12200 per group","50%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X4V","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","33"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720027","Anthem HealthKeepers Bronze X 0 for HSA","88380VA072",,"VAN001","VAS022","VAF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720027-00","Standard Bronze Off Exchange Plan",,"0.619393169879913","Yes","Yes","Yes","70%","30%","$5,350","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group","0%","$5,350","$5350 per person","$10700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X52","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","34"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730028","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS009","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730028-00","Standard Silver Off Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","34"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730028","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS009","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730028-01","Standard Silver On Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","35"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720027","Anthem HealthKeepers Bronze X 0 for HSA","88380VA072",,"VAN001","VAS022","VAF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720027-01","Standard Bronze On Exchange Plan",,"0.619393169879913","Yes","Yes","Yes","70%","30%","$5,350","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group","0%","$5,350","$5350 per person","$10700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X4Z","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","35"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720027","Anthem HealthKeepers Bronze X 0 for HSA","88380VA072",,"VAN001","VAS022","VAF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720027-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1X50","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","36"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730029","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS012","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730029-00","Standard Silver Off Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","36"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730029","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS012","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730029-01","Standard Silver On Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","37"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","Individual","No","54-1356687","88380VA0720027","Anthem HealthKeepers Bronze X 0 for HSA","88380VA072",,"VAN001","VAS022","VAF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720027-03","Limited Cost Sharing Plan Variation",,"0.619393169879913","Yes","Yes","Yes","70%","30%","$5,350","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group","0%","$5,350","$5350 per person","$10700 per group","0%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X4Z","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","37"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730030","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS013","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730030-00","Standard Silver Off Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","38"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730030","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS013","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730030-01","Standard Silver On Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","39"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730031","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS015","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730031-00","Standard Silver Off Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","40"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730031","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS015","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730031-01","Standard Silver On Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","41"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730032","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS016","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730032-00","Standard Silver Off Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","42"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730032","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS016","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730032-01","Standard Silver On Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","43"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730033","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS017","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730033-00","Standard Silver Off Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","44"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730033","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS017","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730033-01","Standard Silver On Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","45"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730034","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS018","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730034-00","Standard Silver Off Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","46"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730034","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS018","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730034-01","Standard Silver On Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","47"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730036","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS020","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730036-00","Standard Silver Off Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","50"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","3","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730036","Anthem HealthKeepers Silver Pathway X POS 2000 30  5500 Plus","88380VA073",,"VAN001","VAS020","VAF001","Existing","POS","Silver","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730036-01","Standard Silver On Exchange Plan","70.93%","0.726191759109497","No","Yes","No","100%",,"$2,000","$0","$925","$0","$1,089","$60","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group",,,,"$11,000","$11000 per person","$22000 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","30%",,,,,"$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD2060","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","51"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730064","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS002","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730064-00","Standard Gold Off Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","4"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","Individual","No","54-1356687","88380VA0720017","Anthem HealthKeepers Bronze X 5500 25","88380VA072",,"VAN001","VAS001","VAF005","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720017-00","Standard Bronze Off Exchange Plan","61.24%","0.613050639629364","Yes","Yes","Yes","70%","30%","$5,500","$0","$278","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","25%","$5,500","$5500 per person","$11000 per group","25%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GBM","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","4"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","Individual","No","54-1356687","88380VA0720017","Anthem HealthKeepers Bronze X 5500 25","88380VA072",,"VAN001","VAS001","VAF005","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720017-01","Standard Bronze On Exchange Plan","61.24%","0.613050639629364","Yes","Yes","Yes","70%","30%","$5,500","$0","$278","$0","$1,069","$80","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","25%","$5,500","$5500 per person","$11000 per group","25%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G9U","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","5"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730064","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS002","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730064-01","Standard Gold On Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","5"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","Individual","No","54-1356687","88380VA0720017","Anthem HealthKeepers Bronze X 5500 25","88380VA072",,"VAN001","VAS001","VAF005","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","2","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720017-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G9V","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","6"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730065","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS005","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730065-00","Standard Gold Off Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","6"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730068","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS012","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730068-00","Standard Gold Off Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","12"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730068","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS012","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730068-01","Standard Gold On Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","13"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730069","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS013","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730069-00","Standard Gold Off Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","14"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730063","Anthem HealthKeepers Gold X OAPOS 3000 0  4000","88380VA073",,"VAN003","VAS001","VAF013","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$250","0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","Yes",,"https://www.anthem.com/national4tier","88380VA0730063-01","Standard Gold On Exchange Plan","78.10%","0.74348396062851","No","Yes","No","100%",,"$3,000","$0","$0","$0","$424","$30","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7K","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","5"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890001","Anthem HealthKeepers Bronze X POS 4100 30","88380VA089",,"VAN001","VAS007","VAF028","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890001-01","Standard Bronze On Exchange Plan","61.95%","0.640334248542786","Yes","Yes","Yes","70%","30%","$4,100","$0","$753","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group","30%","$4,100","$4100 per person","$8200 per group","30%","$8,200","$8200 per person","$16400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA0","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","5"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890001","Anthem HealthKeepers Bronze X POS 4100 30","88380VA089",,"VAN001","VAS007","VAF028","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GA1","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","6"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890001","Anthem HealthKeepers Bronze X POS 4100 30","88380VA089",,"VAN001","VAS007","VAF028","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890001-03","Limited Cost Sharing Plan Variation","61.95%","0.640334248542786","Yes","Yes","Yes","70%","30%","$4,100","$0","$753","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group","30%","$4,100","$4100 per person","$8200 per group","30%","$8,200","$8200 per person","$16400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA0","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","7"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890002","Anthem HealthKeepers Silver X POS 2000 20","88380VA089",,"VAN001","VAS007","VAF024","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890002-00","Standard Silver Off Exchange Plan","69.59%","0.715918838977814","Yes","Yes","Yes","70%","30%","$2,000","$0","$922","$0","$1,109","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","20%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JFL","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","8"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730069","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS013","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730069-01","Standard Gold On Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","15"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730070","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS015","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730070-00","Standard Gold Off Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","16"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890002","Anthem HealthKeepers Silver X POS 2000 20","88380VA089",,"VAN001","VAS007","VAF024","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890002-01","Standard Silver On Exchange Plan","69.59%","0.715918838977814","Yes","Yes","Yes","70%","30%","$2,000","$0","$922","$0","$1,109","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","20%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAQ","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","9"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890002","Anthem HealthKeepers Silver X POS 2000 20","88380VA089",,"VAN001","VAS007","VAF024","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GAR","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","10"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890002","Anthem HealthKeepers Silver X POS 2000 20","88380VA089",,"VAN001","VAS007","VAF024","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890002-03","Limited Cost Sharing Plan Variation","69.59%","0.715918838977814","Yes","Yes","Yes","70%","30%","$2,000","$0","$922","$0","$1,109","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","20%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAQ","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","11"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730070","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS015","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730070-01","Standard Gold On Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","17"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730071","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS016","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730071-00","Standard Gold Off Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","18"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730071","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS016","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730071-01","Standard Gold On Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","19"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730072","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS017","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730072-00","Standard Gold Off Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","20"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730072","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS017","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730072-01","Standard Gold On Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","21"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730073","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS018","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730073-00","Standard Gold Off Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","22"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730073","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS018","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730073-01","Standard Gold On Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","23"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730074","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS019","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730074-00","Standard Gold Off Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","24"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730074","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS019","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730074-01","Standard Gold On Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","25"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730075","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS020","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730075-00","Standard Gold Off Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","26"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","4","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730075","Anthem HealthKeepers Gold Pathway X POS 1000 20  2900 Plus","88380VA073",,"VAN001","VAS020","VAF001","New","POS","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$500","0","0","3","2016-01-01","2016-12-31","Yes","Urgent/Emergent Only","Yes","Follows OON Coverage","No",,"https://www.anthem.com/VASelectdrugtier4","88380VA0730075-01","Standard Gold On Exchange Plan","80.60%","0.816531777381897","No","Yes","No","100%",,"$1,000","$0","$817","$0","$1,000","$40","$22","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,900","$2900 per person","$5800 per group",,,,"$5,800","$5800 per person","$11600 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$3000 per group","20%",,,,,"$2,000","$2000 per person","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7L","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","27"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","5","88380","VA","Individual","No","54-1356687","88380VA0720019","Anthem HealthKeepers Bronze X 4100 30","88380VA072",,"VAN001","VAS022","VAF027","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720019-00","Standard Bronze Off Exchange Plan","61.95%","0.640162527561188","Yes","Yes","Yes","70%","30%","$4,100","$0","$753","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group","30%","$4,100","$4100 per person","$8200 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GBP","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","4"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","5","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730062","Anthem HealthKeepers Silver X OAPOS 4500E 0  6000","88380VA073",,"VAN003","VAS001","VAF011","New","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$250","0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","Yes",,"https://www.anthem.com/national4tier","88380VA0730062-00","Standard Silver Off Exchange Plan","68.44%","0.648546636104584","No","Yes","No","100%",,"$4,500","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7J","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","4"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","5","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730062","Anthem HealthKeepers Silver X OAPOS 4500E 0  6000","88380VA073",,"VAN003","VAS001","VAF011","New","POS","Silver","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$250","0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","Yes",,"https://www.anthem.com/national4tier","88380VA0730062-01","Standard Silver On Exchange Plan","68.44%","0.648546636104584","No","Yes","No","100%",,"$4,500","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","0%",,,,,"$9,000","$9000 per person","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7J","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","5"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","5","88380","VA","Individual","No","54-1356687","88380VA0720019","Anthem HealthKeepers Bronze X 4100 30","88380VA072",,"VAN001","VAS022","VAF027","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720019-01","Standard Bronze On Exchange Plan","61.95%","0.640162527561188","Yes","Yes","Yes","70%","30%","$4,100","$0","$753","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group","30%","$4,100","$4100 per person","$8200 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G9Y","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","5"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","5","88380","VA","Individual","No","54-1356687","88380VA0720019","Anthem HealthKeepers Bronze X 4100 30","88380VA072",,"VAN001","VAS022","VAF027","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720019-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1G9Z","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","6"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","5","88380","VA","Individual","No","54-1356687","88380VA0720019","Anthem HealthKeepers Bronze X 4100 30","88380VA072",,"VAN001","VAS022","VAF027","Existing","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720019-03","Limited Cost Sharing Plan Variation","61.95%","0.640162527561188","Yes","Yes","Yes","70%","30%","$4,100","$0","$753","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group","30%","$4,100","$4100 per person","$8200 per group","30%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1G9Y","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","7"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","5","88380","VA","Individual","No","54-1356687","88380VA0720024","Anthem HealthKeepers Silver X 2000 20","88380VA072",,"VAN001","VAS022","VAF023","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720024-00","Standard Silver Off Exchange Plan","69.59%","0.71552562713623","Yes","Yes","Yes","70%","30%","$2,000","$0","$922","$0","$1,109","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JFK","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","8"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","5","88380","VA","Individual","No","54-1356687","88380VA0720024","Anthem HealthKeepers Silver X 2000 20","88380VA072",,"VAN001","VAS022","VAF023","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720024-01","Standard Silver On Exchange Plan","69.59%","0.71552562713623","Yes","Yes","Yes","70%","30%","$2,000","$0","$922","$0","$1,109","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAK","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","9"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","5","88380","VA","Individual","No","54-1356687","88380VA0720024","Anthem HealthKeepers Silver X 2000 20","88380VA072",,"VAN001","VAS022","VAF023","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720024-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GAL","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","10"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","5","88380","VA","Individual","No","54-1356687","88380VA0720024","Anthem HealthKeepers Silver X 2000 20","88380VA072",,"VAN001","VAS022","VAF023","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720024-03","Limited Cost Sharing Plan Variation","69.59%","0.71552562713623","Yes","Yes","Yes","70%","30%","$2,000","$0","$922","$0","$1,109","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAK","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","11"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","5","88380","VA","Individual","No","54-1356687","88380VA0720024","Anthem HealthKeepers Silver X 2000 20","88380VA072",,"VAN001","VAS022","VAF023","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720024-04","73% AV Level Silver Plan","73.92%","0.758830308914185","Yes","Yes","Yes","70%","30%","$1,750","$0","$972","$0","$1,109","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","20%","$1,750","$1750 per person","$3500 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAM","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","12"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","5","88380","VA","Individual","No","54-1356687","88380VA0720024","Anthem HealthKeepers Silver X 2000 20","88380VA072",,"VAN001","VAS022","VAF023","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720024-05","87% AV Level Silver Plan","87.63%","0.887721717357636","Yes","Yes","Yes","70%","30%","$700","$0","$600","$0","$700","$30","$84","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","$1,300","$1300 per person","$2600 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20%","$700","$700 per person","$1400 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAN","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","13"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","5","88380","VA","Individual","No","54-1356687","88380VA0720024","Anthem HealthKeepers Silver X 2000 20","88380VA072",,"VAN001","VAS022","VAF023","Existing","HMO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","Emergency/Urgent Care Only","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0720024-06","94% AV Level Silver Plan","93.67%","0.940353095531464","Yes","Yes","Yes","70%","30%","$200","$0","$400","$0","$200","$20","$186","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%","$200","$200 per person","$400 per group","20%","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAP","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","14"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890001","Anthem HealthKeepers Bronze X POS 4100 30","88380VA089",,"VAN001","VAS007","VAF028","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890001-00","Standard Bronze Off Exchange Plan","61.95%","0.640334248542786","Yes","Yes","Yes","70%","30%","$4,100","$0","$753","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group","30%","$4,100","$4100 per person","$8200 per group","30%","$8,200","$8200 per person","$16400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GBQ","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","4"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730063","Anthem HealthKeepers Gold X OAPOS 3000 0  4000","88380VA073",,"VAN003","VAS001","VAF013","New","POS","Gold","Yes","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,"$250","0","0","0","2016-01-01","2016-12-31","Yes","Follows OON Coverage","Yes","Follows OON Coverage","Yes",,"https://www.anthem.com/national4tier","88380VA0730063-00","Standard Gold Off Exchange Plan","78.10%","0.74348396062851","No","Yes","No","100%",,"$3,000","$0","$0","$0","$424","$30","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","$3000 per person","$6000 per group","0%",,,,,"$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","25%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group",,,,,,,,,,,,,,,"No","No",,"http://www.sbc.anthem.com/dps/CCD1P7K","https://www.anthem.com/agent/va/f0/s0/t0/pw_e232586.pdf","4"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890002","Anthem HealthKeepers Silver X POS 2000 20","88380VA089",,"VAN001","VAS007","VAF024","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890002-04","73% AV Level Silver Plan","73.92%","0.759038329124451","Yes","Yes","Yes","70%","30%","$1,750","$0","$972","$0","$1,109","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","20%","$1,750","$1750 per person","$3500 per group","20%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAS","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","12"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890002","Anthem HealthKeepers Silver X POS 2000 20","88380VA089",,"VAN001","VAS007","VAF024","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890002-05","87% AV Level Silver Plan","87.63%","0.887845396995544","Yes","Yes","Yes","70%","30%","$700","$0","$600","$0","$700","$30","$84","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","$1,300","$1300 per person","$2600 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20%","$700","$700 per person","$1400 per group","20%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAT","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","13"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890002","Anthem HealthKeepers Silver X POS 2000 20","88380VA089",,"VAN001","VAS007","VAF024","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890002-06","94% AV Level Silver Plan","93.67%","0.940407693386078","Yes","Yes","Yes","70%","30%","$200","$0","$400","$0","$200","$20","$186","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%","$200","$200 per person","$400 per group","20%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAU","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","14"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890004","Anthem HealthKeepers Bronze X POS 4100 30","88380VA089",,"VAN001","VAS018","VAF028","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890004-00","Standard Bronze Off Exchange Plan","61.95%","0.640162527561188","Yes","Yes","Yes","70%","30%","$4,100","$0","$753","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group","30%","$4,100","$4100 per person","$8200 per group","30%","$8,200","$8200 per person","$16400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GBQ","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","15"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890004","Anthem HealthKeepers Bronze X POS 4100 30","88380VA089",,"VAN001","VAS018","VAF028","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890004-01","Standard Bronze On Exchange Plan","61.95%","0.640162527561188","Yes","Yes","Yes","70%","30%","$4,100","$0","$753","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group","30%","$4,100","$4100 per person","$8200 per group","30%","$8,200","$8200 per person","$16400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA0","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","16"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890004","Anthem HealthKeepers Bronze X POS 4100 30","88380VA089",,"VAN001","VAS018","VAF028","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GA1","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","17"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890004","Anthem HealthKeepers Bronze X POS 4100 30","88380VA089",,"VAN001","VAS018","VAF028","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890004-03","Limited Cost Sharing Plan Variation","61.95%","0.640162527561188","Yes","Yes","Yes","70%","30%","$4,100","$0","$753","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group","30%","$4,100","$4100 per person","$8200 per group","30%","$8,200","$8200 per person","$16400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA0","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","18"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890005","Anthem HealthKeepers Silver X POS 2000 20","88380VA089",,"VAN001","VAS018","VAF024","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890005-00","Standard Silver Off Exchange Plan","69.59%","0.71552562713623","Yes","Yes","Yes","70%","30%","$2,000","$0","$922","$0","$1,109","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","20%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JFL","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","19"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890005","Anthem HealthKeepers Silver X POS 2000 20","88380VA089",,"VAN001","VAS018","VAF024","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890005-01","Standard Silver On Exchange Plan","69.59%","0.71552562713623","Yes","Yes","Yes","70%","30%","$2,000","$0","$922","$0","$1,109","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","20%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAQ","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","20"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890005","Anthem HealthKeepers Silver X POS 2000 20","88380VA089",,"VAN001","VAS018","VAF024","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GAR","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","21"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890005","Anthem HealthKeepers Silver X POS 2000 20","88380VA089",,"VAN001","VAS018","VAF024","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890005-03","Limited Cost Sharing Plan Variation","69.59%","0.71552562713623","Yes","Yes","Yes","70%","30%","$2,000","$0","$922","$0","$1,109","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","20%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAQ","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","22"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890005","Anthem HealthKeepers Silver X POS 2000 20","88380VA089",,"VAN001","VAS018","VAF024","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890005-04","73% AV Level Silver Plan","73.92%","0.758830308914185","Yes","Yes","Yes","70%","30%","$1,750","$0","$972","$0","$1,109","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","20%","$1,750","$1750 per person","$3500 per group","20%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAS","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","23"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890005","Anthem HealthKeepers Silver X POS 2000 20","88380VA089",,"VAN001","VAS018","VAF024","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890005-05","87% AV Level Silver Plan","87.63%","0.887721717357636","Yes","Yes","Yes","70%","30%","$700","$0","$600","$0","$700","$30","$84","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","$1,300","$1300 per person","$2600 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20%","$700","$700 per person","$1400 per group","20%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAT","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","24"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890005","Anthem HealthKeepers Silver X POS 2000 20","88380VA089",,"VAN001","VAS018","VAF024","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890005-06","94% AV Level Silver Plan","93.67%","0.940353095531464","Yes","Yes","Yes","70%","30%","$200","$0","$400","$0","$200","$20","$186","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%","$200","$200 per person","$400 per group","20%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAU","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","25"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890010","Anthem HealthKeepers Bronze X POS 4100 30","88380VA089",,"VAN001","VAS021","VAF028","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890010-00","Standard Bronze Off Exchange Plan","61.95%","0.640162527561188","Yes","Yes","Yes","70%","30%","$4,100","$0","$753","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group","30%","$4,100","$4100 per person","$8200 per group","30%","$8,200","$8200 per person","$16400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GBQ","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","26"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890010","Anthem HealthKeepers Bronze X POS 4100 30","88380VA089",,"VAN001","VAS021","VAF028","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890010-01","Standard Bronze On Exchange Plan","61.95%","0.640162527561188","Yes","Yes","Yes","70%","30%","$4,100","$0","$753","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group","30%","$4,100","$4100 per person","$8200 per group","30%","$8,200","$8200 per person","$16400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA0","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","27"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890010","Anthem HealthKeepers Bronze X POS 4100 30","88380VA089",,"VAN001","VAS021","VAF028","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GA1","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","28"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890010","Anthem HealthKeepers Bronze X POS 4100 30","88380VA089",,"VAN001","VAS021","VAF028","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890010-03","Limited Cost Sharing Plan Variation","61.95%","0.640162527561188","Yes","Yes","Yes","70%","30%","$4,100","$0","$753","$0","$1,079","$70","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$15,000","$15000 per person","$30000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,100","$4100 per person","$8200 per group","30%","$4,100","$4100 per person","$8200 per group","30%","$8,200","$8200 per person","$16400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GA0","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","29"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890011","Anthem HealthKeepers Silver X POS 2000 20","88380VA089",,"VAN001","VAS021","VAF024","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890011-00","Standard Silver Off Exchange Plan","69.59%","0.71552562713623","Yes","Yes","Yes","70%","30%","$2,000","$0","$922","$0","$1,109","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","20%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JFL","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","30"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890011","Anthem HealthKeepers Silver X POS 2000 20","88380VA089",,"VAN001","VAS021","VAF024","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890011-01","Standard Silver On Exchange Plan","69.59%","0.71552562713623","Yes","Yes","Yes","70%","30%","$2,000","$0","$922","$0","$1,109","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","20%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAQ","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","31"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890011","Anthem HealthKeepers Silver X POS 2000 20","88380VA089",,"VAN001","VAS021","VAF024","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GAR","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","32"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890011","Anthem HealthKeepers Silver X POS 2000 20","88380VA089",,"VAN001","VAS021","VAF024","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890011-03","Limited Cost Sharing Plan Variation","69.59%","0.71552562713623","Yes","Yes","Yes","70%","30%","$2,000","$0","$922","$0","$1,109","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group","20%","$2,000","$2000 per person","$4000 per group","20%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAQ","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","33"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890011","Anthem HealthKeepers Silver X POS 2000 20","88380VA089",,"VAN001","VAS021","VAF024","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890011-04","73% AV Level Silver Plan","73.92%","0.758830308914185","Yes","Yes","Yes","70%","30%","$1,750","$0","$972","$0","$1,109","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$4,500","$4500 per person","$9000 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","20%","$1,750","$1750 per person","$3500 per group","20%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAS","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","34"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890011","Anthem HealthKeepers Silver X POS 2000 20","88380VA089",,"VAN001","VAS021","VAF024","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890011-05","87% AV Level Silver Plan","87.63%","0.887721717357636","Yes","Yes","Yes","70%","30%","$700","$0","$600","$0","$700","$30","$84","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,300","$1300 per person","$2600 per group","$1,300","$1300 per person","$2600 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$700","$700 per person","$1400 per group","20%","$700","$700 per person","$1400 per group","20%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAT","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","35"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","6","88380","VA","Individual","No","54-1356687","88380VA0890011","Anthem HealthKeepers Silver X POS 2000 20","88380VA089",,"VAN001","VAS021","VAF024","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","5","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890011-06","94% AV Level Silver Plan","93.67%","0.940353095531464","Yes","Yes","Yes","70%","30%","$200","$0","$400","$0","$200","$20","$186","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","$600","$600 per person","$1200 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$200","$200 per person","$400 per group","20%","$200","$200 per person","$400 per group","20%","$4,000","$4000 per person","$8000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GAU","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","36"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","7","88380","VA","Individual","No","54-1356687","88380VA0890003","Anthem HealthKeepers Gold X POS 1100 15","88380VA089",,"VAN001","VAS007","VAF019","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890003-00","Standard Gold Off Exchange Plan","78.90%","0.790517210960388","Yes","Yes","Yes","70%","30%","$1,100","$0","$827","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","15%","$1,100","$1100 per person","$2200 per group","15%","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JFN","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","4"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","7","88380","VA","Individual","No","54-1356687","88380VA0890003","Anthem HealthKeepers Gold X POS 1100 15","88380VA089",,"VAN001","VAS007","VAF019","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890003-01","Standard Gold On Exchange Plan","78.90%","0.790517210960388","Yes","Yes","Yes","70%","30%","$1,100","$0","$827","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","15%","$1,100","$1100 per person","$2200 per group","15%","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GB2","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","5"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","7","88380","VA","Individual","No","54-1356687","88380VA0890003","Anthem HealthKeepers Gold X POS 1100 15","88380VA089",,"VAN001","VAS007","VAF019","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GB3","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","6"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","7","88380","VA","Individual","No","54-1356687","88380VA0890003","Anthem HealthKeepers Gold X POS 1100 15","88380VA089",,"VAN001","VAS007","VAF019","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890003-03","Limited Cost Sharing Plan Variation","78.90%","0.790517210960388","Yes","Yes","Yes","70%","30%","$1,100","$0","$827","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","15%","$1,100","$1100 per person","$2200 per group","15%","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GB2","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","7"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","7","88380","VA","Individual","No","54-1356687","88380VA0890006","Anthem HealthKeepers Gold X POS 1100 15","88380VA089",,"VAN001","VAS018","VAF019","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890006-00","Standard Gold Off Exchange Plan","78.90%","0.790517210960388","Yes","Yes","Yes","70%","30%","$1,100","$0","$827","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","15%","$1,100","$1100 per person","$2200 per group","15%","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JFN","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","8"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","7","88380","VA","Individual","No","54-1356687","88380VA0890006","Anthem HealthKeepers Gold X POS 1100 15","88380VA089",,"VAN001","VAS018","VAF019","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890006-01","Standard Gold On Exchange Plan","78.90%","0.790517210960388","Yes","Yes","Yes","70%","30%","$1,100","$0","$827","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","15%","$1,100","$1100 per person","$2200 per group","15%","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GB2","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","9"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","7","88380","VA","Individual","No","54-1356687","88380VA0890006","Anthem HealthKeepers Gold X POS 1100 15","88380VA089",,"VAN001","VAS018","VAF019","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GB3","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","10"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","7","88380","VA","Individual","No","54-1356687","88380VA0890006","Anthem HealthKeepers Gold X POS 1100 15","88380VA089",,"VAN001","VAS018","VAF019","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890006-03","Limited Cost Sharing Plan Variation","78.90%","0.790517210960388","Yes","Yes","Yes","70%","30%","$1,100","$0","$827","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","15%","$1,100","$1100 per person","$2200 per group","15%","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GB2","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","11"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","2","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500015","KP VA Gold 500/20/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500015-01","Standard Gold On Exchange Plan","81.65%","0.815722048282623","No","Yes","No","100%",,"$500","$500","$0","$200","$500","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0.00","$0 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Gold_500_20_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","7"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","2","95185","VA","Individual","No","52-0954463","95185VA0530002","KP VA Gold 1000/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF002","Existing","HMO","Gold","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530002-03","Limited Cost Sharing Plan Variation",,"0.793140769004822","No","Yes","No","100%",,"$1,000","$20","$700","$200","$1,000","$800","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_45000_1201_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","7"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","2","95185","VA","Individual","No","52-0954463","95185VA0530006","KP VA Bronze 4500/50/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF005","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530006-00","Standard Bronze Off Exchange Plan",,"0.617136478424072","No","Yes","No","100%",,"$4,500","$20","$0","$200","$1,400","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$750","$750 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_2400_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","8"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","2","95185","VA","Individual","No","52-0954463","95185VA0530006","KP VA Bronze 4500/50/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF005","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530006-01","Standard Bronze On Exchange Plan",,"0.617136478424072","No","Yes","No","100%",,"$4,500","$20","$0","$200","$1,400","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$750","$750 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_2400_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","9"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","2","95185","VA","Individual","No","52-0954463","95185VA0530006","KP VA Bronze 4500/50/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF005","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_45000_1200_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","10"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","2","95185","VA","Individual","No","52-0954463","95185VA0530006","KP VA Bronze 4500/50/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF005","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530006-03","Limited Cost Sharing Plan Variation",,"0.617136478424072","No","Yes","No","100%",,"$4,500","$20","$0","$200","$1,400","$1,500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$750","$750 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_45000_1201_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","11"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","3","95185","VA","Individual","No","52-0954463","95185VA0530003","KP VA Silver 1500/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530003-00","Standard Silver Off Exchange Plan",,"0.713474988937378","No","Yes","No","100%",,"$1,500","$20","$900","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_2300_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","4"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","7","88380","VA","Individual","No","54-1356687","88380VA0890012","Anthem HealthKeepers Gold X POS 1100 15","88380VA089",,"VAN001","VAS021","VAF019","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890012-00","Standard Gold Off Exchange Plan","78.90%","0.790517210960388","Yes","Yes","Yes","70%","30%","$1,100","$0","$827","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","15%","$1,100","$1100 per person","$2200 per group","15%","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1JFN","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","12"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","7","88380","VA","Individual","No","54-1356687","88380VA0890012","Anthem HealthKeepers Gold X POS 1100 15","88380VA089",,"VAN001","VAS021","VAF019","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890012-01","Standard Gold On Exchange Plan","78.90%","0.790517210960388","Yes","Yes","Yes","70%","30%","$1,100","$0","$827","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","15%","$1,100","$1100 per person","$2200 per group","15%","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GB2","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","13"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","3","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500005","KP VA Gold 1000/30/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF005","Existing","HMO","Gold","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500005-01","Standard Gold On Exchange Plan",,"0.797191262245178","No","Yes","No","100%",,"$1,000","$20","$300","$200","$1,000","$1,100","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Gold%201000_30_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","5"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","5","95185","VA","Individual","No","52-0954463","95185VA0530007","KP VA Bronze 5000/50/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF007","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"4","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530007-01","Standard Bronze On Exchange Plan",,"0.611874759197235","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$5,000","$60","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,450","$6450 per person","$12900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Yes",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_3400_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","5"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","5","95185","VA","Individual","No","52-0954463","95185VA0530007","KP VA Bronze 5000/50/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF007","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"4","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_45000_1200_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","6"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","5","95185","VA","Individual","No","52-0954463","95185VA0530007","KP VA Bronze 5000/50/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF007","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"4","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530007-03","Limited Cost Sharing Plan Variation",,"0.611874759197235","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$5,000","$60","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,450","$6450 per person","$12900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Yes",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_45000_1201_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","7"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","5","95185","VA","Individual","No","52-0954463","95185VA0530008","KP VA Bronze 6000/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF008","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530008-00","Standard Bronze Off Exchange Plan",,"0.605445504188538","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,450","$6450 per person","$12900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_3402_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","8"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","5","95185","VA","Individual","No","52-0954463","95185VA0530008","KP VA Bronze 6000/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF008","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530008-01","Standard Bronze On Exchange Plan",,"0.605445504188538","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,450","$6450 per person","$12900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_3402_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","9"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","7","88380","VA","Individual","No","54-1356687","88380VA0890012","Anthem HealthKeepers Gold X POS 1100 15","88380VA089",,"VAN001","VAS021","VAF019","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1GB3","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","14"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","7","88380","VA","Individual","No","54-1356687","88380VA0890012","Anthem HealthKeepers Gold X POS 1100 15","88380VA089",,"VAN001","VAS021","VAF019","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890012-03","Limited Cost Sharing Plan Variation","78.90%","0.790517210960388","Yes","Yes","Yes","70%","30%","$1,100","$0","$827","$0","$424","$40","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,800","$4800 per person","$9600 per group","$4,800","$4800 per person","$9600 per group","$12,000","$12000 per person","$24000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,100","$1100 per person","$2200 per group","15%","$1,100","$1100 per person","$2200 per group","15%","$2,200","$2200 per person","$4400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.sbc.anthem.com/dps/ccd1GB2","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","15"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","8","88380","VA","Individual","No","54-1356687","88380VA0890007","Anthem HealthKeepers Bronze POS X 0 for HSA","88380VA089",,"VAN001","VAS021","VAF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890007-00","Standard Bronze Off Exchange Plan",,"0.619393169879913","Yes","Yes","Yes","70%","30%","$5,350","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group","0%","$5,350","$5350 per person","$10700 per group","0%","$10,700","$10700 per person","$21400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X56","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","4"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","8","88380","VA","Individual","No","54-1356687","88380VA0890007","Anthem HealthKeepers Bronze POS X 0 for HSA","88380VA089",,"VAN001","VAS021","VAF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890007-01","Standard Bronze On Exchange Plan",,"0.619393169879913","Yes","Yes","Yes","70%","30%","$5,350","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group","0%","$5,350","$5350 per person","$10700 per group","0%","$10,700","$10700 per person","$21400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X53","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","5"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","8","88380","VA","Individual","No","54-1356687","88380VA0890007","Anthem HealthKeepers Bronze POS X 0 for HSA","88380VA089",,"VAN001","VAS021","VAF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X54","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","6"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","8","88380","VA","Individual","No","54-1356687","88380VA0890007","Anthem HealthKeepers Bronze POS X 0 for HSA","88380VA089",,"VAN001","VAS021","VAF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890007-03","Limited Cost Sharing Plan Variation",,"0.619393169879913","Yes","Yes","Yes","70%","30%","$5,350","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group","0%","$5,350","$5350 per person","$10700 per group","0%","$10,700","$10700 per person","$21400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X53","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","7"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","8","88380","VA","Individual","No","54-1356687","88380VA0890008","Anthem HealthKeepers Bronze POS X 0 for HSA","88380VA089",,"VAN001","VAS007","VAF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890008-00","Standard Bronze Off Exchange Plan",,"0.619393169879913","Yes","Yes","Yes","70%","30%","$5,350","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group","0%","$5,350","$5350 per person","$10700 per group","0%","$10,700","$10700 per person","$21400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X56","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","8"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","8","88380","VA","Individual","No","54-1356687","88380VA0890008","Anthem HealthKeepers Bronze POS X 0 for HSA","88380VA089",,"VAN001","VAS007","VAF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890008-01","Standard Bronze On Exchange Plan",,"0.619393169879913","Yes","Yes","Yes","70%","30%","$5,350","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group","0%","$5,350","$5350 per person","$10700 per group","0%","$10,700","$10700 per person","$21400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X53","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","9"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","8","88380","VA","Individual","No","54-1356687","88380VA0890008","Anthem HealthKeepers Bronze POS X 0 for HSA","88380VA089",,"VAN001","VAS007","VAF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X54","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","10"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","8","88380","VA","Individual","No","54-1356687","88380VA0890008","Anthem HealthKeepers Bronze POS X 0 for HSA","88380VA089",,"VAN001","VAS007","VAF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890008-03","Limited Cost Sharing Plan Variation",,"0.619393169879913","Yes","Yes","Yes","70%","30%","$5,350","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group","0%","$5,350","$5350 per person","$10700 per group","0%","$10,700","$10700 per person","$21400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X53","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","11"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","8","88380","VA","Individual","No","54-1356687","88380VA0890009","Anthem HealthKeepers Bronze POS X 0 for HSA","88380VA089",,"VAN001","VAS018","VAF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890009-00","Standard Bronze Off Exchange Plan",,"0.619393169879913","Yes","Yes","Yes","70%","30%","$5,350","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group","0%","$5,350","$5350 per person","$10700 per group","0%","$10,700","$10700 per person","$21400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X56","http://editiondigital.net/view/IU65/2016/OFF_HIX_VA_KIT_2016","12"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","8","88380","VA","Individual","No","54-1356687","88380VA0890009","Anthem HealthKeepers Bronze POS X 0 for HSA","88380VA089",,"VAN001","VAS018","VAF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890009-01","Standard Bronze On Exchange Plan",,"0.619393169879913","Yes","Yes","Yes","70%","30%","$5,350","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group","0%","$5,350","$5350 per person","$10700 per group","0%","$10,700","$10700 per person","$21400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X53","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","13"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","8","88380","VA","Individual","No","54-1356687","88380VA0890009","Anthem HealthKeepers Bronze POS X 0 for HSA","88380VA089",,"VAN001","VAS018","VAF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","70%","30%","$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.sbc.anthem.com/dps/ccd1X54","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","14"
"2016","VA","88380","SERFF","29","2016-07-07 17:21:34","8","88380","VA","Individual","No","54-1356687","88380VA0890009","Anthem HealthKeepers Bronze POS X 0 for HSA","88380VA089",,"VAN001","VAS018","VAF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","1",,,,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency/Urgent Care Only","Yes","TradPar BlueCard w OON Cost Share","Yes","https://payment.anthem.com/sales/payment/exchange?state=VA","https://www.anthem.com/VASelectdrugtier4","88380VA0890009-03","Limited Cost Sharing Plan Variation",,"0.619393169879913","Yes","Yes","Yes","70%","30%","$5,350","$0","$0","$0","$1,149","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,550","$6550 per person","$13100 per group","$6,550","$6550 per person","$13100 per group","$18,000","$18000 per person","$36000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,350","$5350 per person","$10700 per group","0%","$5,350","$5350 per person","$10700 per group","0%","$10,700","$10700 per person","$21400 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"https://www.sbc.anthem.com/dps/ccd1X53","http://editiondigital.net/view/IU65/2016/ON_HIX_VA_KIT_2016","15"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","1","95185","VA","Individual","No","52-0954463","95185VA0530001","KP VA Gold 0/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF001","Existing","HMO","Gold","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"4","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530001-00","Standard Gold Off Exchange Plan",,"0.812198638916016","Yes","Yes","No","100%",,"$0","$500","$0","$200","$0","$700","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_1200_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","4"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","1","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500001","KP VA Platinum 0/20/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF001","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500001-00","Standard Platinum Off Exchange Plan","91.92%","0.91858983039856","Yes","Yes","No","100%",,"$0","$200","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Platinum_0_20_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","4"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","1","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500001","KP VA Platinum 0/20/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF001","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500001-01","Standard Platinum On Exchange Plan","91.92%","0.91858983039856","Yes","Yes","No","100%",,"$0","$200","$0","$200","$0","$500","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","per group not applicable","No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Platinum_0_20_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","5"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","1","95185","VA","Individual","No","52-0954463","95185VA0530001","KP VA Gold 0/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF001","Existing","HMO","Gold","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"4","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530001-01","Standard Gold On Exchange Plan",,"0.812198638916016","Yes","Yes","No","100%",,"$0","$500","$0","$200","$0","$700","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_1200_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","5"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","1","95185","VA","Individual","No","52-0954463","95185VA0530001","KP VA Gold 0/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF001","Existing","HMO","Gold","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"4","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_45000_1200_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","6"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","1","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500004","KP VA Gold 0/20/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","3","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500004-00","Standard Gold Off Exchange Plan","81.84%","0.819057524204254","No","Yes","No","100%",,"$0","$300","$0","$200","$0","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$100","$100 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Gold_0_20_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","6"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","1","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500004","KP VA Gold 0/20/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF003","Existing","HMO","Gold","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","3","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500004-01","Standard Gold On Exchange Plan","81.84%","0.819057524204254","No","Yes","No","100%",,"$0","$300","$0","$200","$0","$1,200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$100","$100 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Gold_0_20_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","7"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","1","95185","VA","Individual","No","52-0954463","95185VA0530001","KP VA Gold 0/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF001","Existing","HMO","Gold","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"4","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530001-03","Limited Cost Sharing Plan Variation",,"0.812198638916016","Yes","Yes","No","100%",,"$0","$500","$0","$200","$0","$700","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_45000_1201_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","7"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","2","95185","VA","Individual","No","52-0954463","95185VA0530002","KP VA Gold 1000/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF002","Existing","HMO","Gold","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530002-00","Standard Gold Off Exchange Plan",,"0.793140769004822","No","Yes","No","100%",,"$1,000","$20","$700","$200","$1,000","$800","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_2200_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","4"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","2","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500002","KP VA Platinum 500/20/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF001","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500002-00","Standard Platinum Off Exchange Plan","88.77%","0.886972308158875","No","Yes","No","100%",,"$500","$100","$0","$200","$500","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Platinum_500_20_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","4"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","2","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500002","KP VA Platinum 500/20/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF001","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500002-01","Standard Platinum On Exchange Plan","88.77%","0.886972308158875","No","Yes","No","100%",,"$500","$100","$0","$200","$500","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0.00","$0 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Platinum_500_20_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","5"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","2","95185","VA","Individual","No","52-0954463","95185VA0530002","KP VA Gold 1000/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF002","Existing","HMO","Gold","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530002-01","Standard Gold On Exchange Plan",,"0.793140769004822","No","Yes","No","100%",,"$1,000","$20","$700","$200","$1,000","$800","$50","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,350","$6350 per person","$12700 per group","$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_2200_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","5"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","2","95185","VA","Individual","No","52-0954463","95185VA0530002","KP VA Gold 1000/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF002","Existing","HMO","Gold","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_45000_1200_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","6"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","2","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500015","KP VA Gold 500/20/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF004","Existing","HMO","Gold","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500015-00","Standard Gold Off Exchange Plan","81.65%","0.815722048282623","No","Yes","No","100%",,"$500","$500","$0","$200","$500","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","$500","$500 per person","$1000 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","$0","$0 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Gold_500_20_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","6"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","3","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500005","KP VA Gold 1000/30/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF005","Existing","HMO","Gold","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500005-00","Standard Gold Off Exchange Plan",,"0.797191262245178","No","Yes","No","100%",,"$1,000","$20","$300","$200","$1,000","$1,100","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Gold%201000_30_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","4"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","5","95185","VA","Individual","No","52-0954463","95185VA0530008","KP VA Bronze 6000/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF008","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_45000_1200_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","10"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","3","95185","VA","Individual","No","52-0954463","95185VA0530003","KP VA Silver 1500/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530003-01","Standard Silver On Exchange Plan",,"0.713474988937378","No","Yes","No","100%",,"$1,500","$20","$900","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_2300_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","5"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","3","95185","VA","Individual","No","52-0954463","95185VA0530003","KP VA Silver 1500/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_45000_1200_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","6"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","3","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500012","KP VA Bronze 4500/50/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF012","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500012-00","Standard Bronze Off Exchange Plan",,"0.617744863033295","No","Yes","No","100%",,"$4,500","$20","$0","$200","$1,700","$1,600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$300","$300 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Bronze_4500_50_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","6"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","3","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500012","KP VA Bronze 4500/50/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF012","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500012-01","Standard Bronze On Exchange Plan",,"0.617744863033295","No","Yes","No","100%",,"$4,500","$20","$0","$200","$1,700","$1,600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$4,500","$4500 per person","$9000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$4,500","$4500 per person","$9000 per group","$300","$300 per person","per group not applicable","50%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Bronze_4500_50_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","7"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","3","95185","VA","Individual","No","52-0954463","95185VA0530003","KP VA Silver 1500/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530003-03","Limited Cost Sharing Plan Variation",,"0.713474988937378","No","Yes","No","100%",,"$1,500","$20","$900","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$1,500","$1500 per person","$3000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_45000_1201_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","7"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","3","95185","VA","Individual","No","52-0954463","95185VA0530003","KP VA Silver 1500/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530003-04","73% AV Level Silver Plan",,"0.737813591957092","No","Yes","No","100%",,"$1,300","$20","$1,000","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","$1,300","$1300 per person","$2600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","$250","$250 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_2301_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","8"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","3","95185","VA","Individual","No","52-0954463","95185VA0530003","KP VA Silver 1500/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530003-05","87% AV Level Silver Plan",,"0.878468871116638","No","Yes","No","100%",,"$0","$20","$900","$200","$0","$800","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_2302_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","9"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","3","95185","VA","Individual","No","52-0954463","95185VA0530003","KP VA Silver 1500/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530003-06","94% AV Level Silver Plan",,"0.942389130592346","No","Yes","No","100%",,"$0","$10","$400","$200","$0","$300","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_2303_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","10"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","3","95185","VA","Individual","No","52-0954463","95185VA0530004","KP VA Silver 2500/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530004-00","Standard Silver Off Exchange Plan",,"0.688683152198792","No","Yes","No","100%",,"$2,500","$20","$600","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_2304_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","11"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","3","95185","VA","Individual","No","52-0954463","95185VA0530004","KP VA Silver 2500/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530004-01","Standard Silver On Exchange Plan",,"0.688683152198792","No","Yes","No","100%",,"$2,500","$20","$600","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_2304_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","12"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","3","95185","VA","Individual","No","52-0954463","95185VA0530004","KP VA Silver 2500/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_45000_1200_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","13"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","3","95185","VA","Individual","No","52-0954463","95185VA0530004","KP VA Silver 2500/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530004-03","Limited Cost Sharing Plan Variation",,"0.688683152198792","No","Yes","No","100%",,"$2,500","$20","$600","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","$2,500","$2500 per person","$5000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","$500","$500 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_45000_1201_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","14"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","3","95185","VA","Individual","No","52-0954463","95185VA0530004","KP VA Silver 2500/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530004-04","73% AV Level Silver Plan",,"0.737813591957092","No","Yes","No","100%",,"$1,300","$20","$1,000","$200","$1,300","$1,100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,450","$5450 per person","$10900 per group","$1,300","$1300 per person","$2600 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,300","$1300 per person","$2600 per group","$250","$250 per person","per group not applicable","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_2301_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","15"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","3","95185","VA","Individual","No","52-0954463","95185VA0530004","KP VA Silver 2500/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530004-05","87% AV Level Silver Plan",,"0.878468871116638","No","Yes","No","100%",,"$0","$20","$900","$200","$0","$800","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$0","$0 per person","$0 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","per group not applicable","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_2302_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","16"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","3","95185","VA","Individual","No","52-0954463","95185VA0530004","KP VA Silver 2500/30/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF003","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530004-06","94% AV Level Silver Plan",,"0.942389130592346","No","Yes","No","100%",,"$0","$10","$400","$200","$0","$300","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group","$0","$0 per person","$0 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","$0","$0 per person","per group not applicable","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_2303_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","17"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","4","95185","VA","Individual","No","52-0954463","95185VA0530005","KP VA Silver 2750/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF004","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530005-00","Standard Silver Off Exchange Plan",,"0.682452499866486","Yes","Yes","No","100%",,"$2,800","$20","$300","$200","$2,800","$300","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,750","$2750 per person","$5500 per group","Yes",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_3300_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","4"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","4","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500008","KP VA Silver 1250/35/DENTAL/Ped Dental","95185VA050",,"VAN001","VAS001","VAF008","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500008-00","Standard Silver Off Exchange Plan",,"0.717561483383179","No","Yes","No","100%",,"$1,300","$20","$600","$200","$1,300","$1,400","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","$1,250","$1250 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Silver_1250_35_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","4"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","4","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500008","KP VA Silver 1250/35/DENTAL/Ped Dental","95185VA050",,"VAN001","VAS001","VAF008","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500008-01","Standard Silver On Exchange Plan",,"0.717561483383179","No","Yes","No","100%",,"$1,300","$20","$600","$200","$1,300","$1,400","$30","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","$1,250","$1250 per person","$2500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","$0","$0 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Silver_1250_35_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","5"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","4","95185","VA","Individual","No","52-0954463","95185VA0530005","KP VA Silver 2750/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF004","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530005-01","Standard Silver On Exchange Plan",,"0.682452499866486","Yes","Yes","No","100%",,"$2,800","$20","$300","$200","$2,800","$300","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,750","$2750 per person","$5500 per group","Yes",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_3300_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","5"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","4","95185","VA","Individual","No","52-0954463","95185VA0530005","KP VA Silver 2750/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF004","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_45000_1200_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","6"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","4","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500009","KP VA Silver 2000/35/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500009-00","Standard Silver Off Exchange Plan",,"0.699834227561951","No","Yes","No","100%",,"$2,000","$20","$500","$200","$1,400","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Silver_2000_35_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","6"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","4","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500009","KP VA Silver 2000/35/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF009","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500009-01","Standard Silver On Exchange Plan",,"0.699834227561951","No","Yes","No","100%",,"$2,000","$20","$500","$200","$1,400","$1,400","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,800","$6800 per person","$13600 per group","$2,000","$2000 per person","$4000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$0","$0 per person","per group not applicable","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","per group not applicable",,,,,,,,,,,,,,,"No","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Silver_2000_35_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","7"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","4","95185","VA","Individual","No","52-0954463","95185VA0530005","KP VA Silver 2750/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF004","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530005-03","Limited Cost Sharing Plan Variation",,"0.682452499866486","Yes","Yes","No","100%",,"$2,800","$20","$300","$200","$2,800","$300","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,750","$2750 per person","$5500 per group","Yes",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_45000_1201_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","7"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","4","95185","VA","Individual","No","52-0954463","95185VA0530005","KP VA Silver 2750/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF004","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530005-04","73% AV Level Silver Plan",,"0.738887190818787","Yes","Yes","No","100%",,"$1,400","$20","$600","$200","$1,400","$500","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,400","$1400 per person","$2800 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_3302_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","8"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","4","95185","VA","Individual","No","52-0954463","95185VA0530005","KP VA Silver 2750/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF004","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530005-05","87% AV Level Silver Plan",,"0.870208024978638","Yes","Yes","No","100%",,"$500","$20","$400","$200","$500","$400","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_3304_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","9"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","4","95185","VA","Individual","No","52-0954463","95185VA0530005","KP VA Silver 2750/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF004","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530005-06","94% AV Level Silver Plan",,"0.945868194103241","Yes","Yes","No","100%",,"$100","$10","$200","$200","$100","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,250","$2250 per person","$4500 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","5%",,,,,"Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_3306_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","10"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","5","95185","VA","Individual","No","52-0954463","95185VA0530007","KP VA Bronze 5000/50/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF007","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"4","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530007-00","Standard Bronze Off Exchange Plan",,"0.611874759197235","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$5,000","$60","$40","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,450","$6450 per person","$12900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Yes",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_3400_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","4"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","5","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500003","KP VA Platinum 1350/10/HSA/HRA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF002","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500003-00","Standard Platinum Off Exchange Plan","89.99%","0.899866104125977","Yes","Yes","No","100%",,"$1,400","$100","$0","$200","$1,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,700","$2700 per person","$5400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","Yes","Yes","$625.00","http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Platinum_1350_10_HRA_HSA_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","4"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","5","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500003","KP VA Platinum 1350/10/HSA/HRA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF002","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500003-01","Standard Platinum On Exchange Plan","89.99%","0.899866104125977","Yes","Yes","No","100%",,"$1,400","$100","$0","$200","$1,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,700","$2700 per person","$5400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","Yes","Yes","$625.00","http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Platinum_1350_10_HRA_HSA_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","5"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","5","95185","VA","Individual","No","52-0954463","95185VA0530008","KP VA Bronze 6000/20%/HSA/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF008","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530008-03","Limited Cost Sharing Plan Variation",,"0.605445504188538","Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,450","$6450 per person","$12900 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_45000_1201_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","11"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","6","95185","VA","Individual","No","52-0954463","95185VA0530009","KP VA Catastrophic 6850/0/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF006","Existing","HMO","Catastrophic","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","3","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530009-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_2500_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","4"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","6","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500006","KP VA Gold 1350/0%/HSA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF006","Existing","HMO","Gold","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500006-00","Standard Gold Off Exchange Plan",,"0.815913021564484","Yes","Yes","No","100%",,"$1,400","$20","$0","$200","$1,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,700","$2700 per person","$5400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Gold_1350_0_HSA_Dental_Ped%20Dental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","4"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","6","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500006","KP VA Gold 1350/0%/HSA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF006","Existing","HMO","Gold","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500006-01","Standard Gold On Exchange Plan",,"0.815913021564484","Yes","Yes","No","100%",,"$1,400","$20","$0","$200","$1,400","$600","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,700","$2700 per person","$5400 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,700","$2700 per person","$5400 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,350","$1350 per person","$2700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,350","$1350 per person","$2700 per group","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Gold_1350_0_HSA_Dental_Ped%20Dental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","5"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","6","95185","VA","Individual","No","52-0954463","95185VA0530009","KP VA Catastrophic 6850/0/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF006","Existing","HMO","Catastrophic","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"0","0","3","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530009-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$4,500","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_2500_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","5"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","6","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500007","KP VA Gold 1500/30/HSA/HRA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF007","Existing","HMO","Gold","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500007-00","Standard Gold Off Exchange Plan",,"0.818171560764313","Yes","Yes","No","100%",,"$1,500","$20","$300","$200","$1,500","$1,100","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","Yes","Yes","$600.00","http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Gold_1500_30_HSA_HRA_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","6"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","6","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500007","KP VA Gold 1500/30/HSA/HRA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF007","Existing","HMO","Gold","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500007-01","Standard Gold On Exchange Plan",,"0.818171560764313","Yes","Yes","No","100%",,"$1,500","$20","$300","$200","$1,500","$1,100","$60","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","Yes","Yes","$600.00","http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Gold_1500_30_HSA_HRA_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","7"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","2","99663","VA","Individual","No","54-1576305","99663VA0140008","Coventry Bronze $35 Copay Bon Secours","99663VA014",,"VAN003","VAS003","VAF003","Existing","POS","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140008-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%","$6,750","$6750 per person","$13500 per group","0%","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51303","http://www.coventryone.com/VAon2016","5"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","7","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500010","KP VA Silver 1500/30/HSA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF010","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500010-00","Standard Silver Off Exchange Plan",,"0.715090811252594","Yes","Yes","No","100%",,"$1,500","$20","$600","$200","$1,500","$1,100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Silver_1500_30_HSA_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","4"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","7","95185","VA","Individual","No","52-0954463","95185VA0530010","KP VA Platinum 0/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF001","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"4","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530010-00","Standard Platinum Off Exchange Plan","90.47%","0.90422135591507","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_1100_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","4"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","7","95185","VA","Individual","No","52-0954463","95185VA0530010","KP VA Platinum 0/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF001","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"4","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530010-01","Standard Platinum On Exchange Plan","90.47%","0.90422135591507","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_42000_1100_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","5"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","7","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500010","KP VA Silver 1500/30/HSA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF010","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500010-01","Standard Silver On Exchange Plan",,"0.715090811252594","Yes","Yes","No","100%",,"$1,500","$20","$600","$200","$1,500","$1,100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Silver_1500_30_HSA_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","5"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","7","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500011","KP VA Silver 2500/30/HSA/HRA/Dental/Ped dental","95185VA050",,"VAN001","VAS001","VAF011","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500011-00","Standard Silver Off Exchange Plan",,"0.71947580575943","Yes","Yes","No","100%",,"$2,500","$20","$400","$200","$2,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Yes","Yes","$450.00","http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Silver_2500_30_HSA_HRA_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","6"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","7","95185","VA","Individual","No","52-0954463","95185VA0530010","KP VA Platinum 0/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF001","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"4","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_45000_1200_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","6"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","7","95185","VA","Individual","No","52-0954463","95185VA0530010","KP VA Platinum 0/20/Dental/Ped Dental","95185VA053",,"VAN001","VAS001","VAF001","Existing","HMO","Platinum","Yes","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,,"4","0","0","2016-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","https://ssoprod.healthplan.com/sp/ACS.saml2","https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0530010-03","Limited Cost Sharing Plan Variation","90.47%","0.90422135591507","Yes","Yes","No","100%",,"$0","$400","$0","$200","$0","$700","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","No",,,"http://info.kaiserpermanente.org/healthplans/virginia/individual/pdfs/2016-ON-Exchange/PLNSBC_MAS_45000_1201_20160101_20120501_en.pdf","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/plans/mas/60309620_EnrlGd_KPIF_MAS-VA_2016_Bklt_ATV_sgk_ADA_FNL.pdf","7"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","7","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500011","KP VA Silver 2500/30/HSA/HRA/Dental/Ped dental","95185VA050",,"VAN001","VAS001","VAF011","Existing","HMO","Silver","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500011-01","Standard Silver On Exchange Plan",,"0.71947580575943","Yes","Yes","No","100%",,"$2,500","$20","$400","$200","$2,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,500","$2500 per person","$5000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","Yes","Yes","$450.00","http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Silver_2500_30_HSA_HRA_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","7"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","8","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500013","KP VA Bronze 6000/30/10%/HSA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF013","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500013-00","Standard Bronze Off Exchange Plan",,"0.608784139156342","Yes","Yes","No","100%",,"$4,500","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Bronze_6000_30_HSA_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","4"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","8","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500013","KP VA Bronze 6000/30/10%/HSA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF013","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500013-01","Standard Bronze On Exchange Plan",,"0.608784139156342","Yes","Yes","No","100%",,"$4,500","$20","$0","$200","$2,400","$800","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,000","$6000 per person","$12000 per group","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Bronze_6000_30_HSA_Dental_PedDental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","5"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","8","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500014","KP VA Bronze 5000/20/HSA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF014","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500014-00","Standard Bronze Off Exchange Plan",,"0.617487192153931","Yes","Yes","No","100%",,"$4,500","$20","$0","$200","$2,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Bronze_5000_20_HSA_Dental_Ped%20Dental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","6"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","7","99663","VA","Individual","No","54-1576305","99663VA0140039","Coventry Silver $10 Copay","99663VA014",,"VAN001","VAS001","VAF015","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140039-06","94% AV Level Silver Plan","93.08%",,"No","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51266","http://www.coventryone.com/VAon2016","10"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","8","99663","VA","Individual","No","54-1576305","99663VA0140040","Coventry Silver $10 Copay $2750","99663VA014",,"VAN001","VAS001","VAF016","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140040-00","Standard Silver Off Exchange Plan","68.19%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51332","http://www.coventryone.com/VAon2016","4"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","8","99663","VA","Individual","No","54-1576305","99663VA0140040","Coventry Silver $10 Copay $2750","99663VA014",,"VAN001","VAS001","VAF016","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140040-01","Standard Silver On Exchange Plan","68.19%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51269","http://www.coventryone.com/VAon2016","5"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","8","99663","VA","Individual","No","54-1576305","99663VA0140040","Coventry Silver $10 Copay $2750","99663VA014",,"VAN001","VAS001","VAF016","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140040-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51271","http://www.coventryone.com/VAon2016","6"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","8","99663","VA","Individual","No","54-1576305","99663VA0140040","Coventry Silver $10 Copay $2750","99663VA014",,"VAN001","VAS001","VAF016","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140040-03","Limited Cost Sharing Plan Variation","68.19%",,"Yes","Yes","No","100%",,"$2,800","$10","$1,000","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","40%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51270","http://www.coventryone.com/VAon2016","7"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","8","99663","VA","Individual","No","54-1576305","99663VA0140040","Coventry Silver $10 Copay $2750","99663VA014",,"VAN001","VAS001","VAF016","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140040-04","73% AV Level Silver Plan","72.13%",,"Yes","Yes","No","100%",,"$2,700","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,450","$5450 per person","$10900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,650","$2650 per person","$5300 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51274","http://www.coventryone.com/VAon2016","8"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","8","99663","VA","Individual","No","54-1576305","99663VA0140040","Coventry Silver $10 Copay $2750","99663VA014",,"VAN001","VAS001","VAF016","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140040-05","87% AV Level Silver Plan","86.08%",,"Yes","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51273","http://www.coventryone.com/VAon2016","9"
"2016","VA","95185","SERFF","13","2016-01-27 11:15:49","8","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500014","KP VA Bronze 5000/20/HSA/Dental/Ped Dental","95185VA050",,"VAN001","VAS001","VAF014","Existing","HMO","Bronze","No","Both","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs","0.988",,,"$300","0","0","0","2016-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No",,"https://healthy.kaiserpermanente.org/static/health/pdfs/formulary/mid/mid_exchange_formulary.pdf","95185VA0500014-01","Standard Bronze On Exchange Plan",,"0.617487192153931","Yes","Yes","No","100%",,"$4,500","$20","$0","$200","$2,400","$1,000","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,400","$6400 per person","$12800 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,400","$6400 per person","$12800 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$5,000","$5000 per person","$10000 per group","Yes","No",,"http://info.kaiserpermanente.org/healthplans/virginia/smallbusiness/pdfs/2016/KPVA_Bronze_5000_20_HSA_Dental_Ped%20Dental_SIG_ON.pdf","https://account.kp.org/broker-employer/poc?uri=center:support-materials-employers&article=A3422724-6AB0-11E4-B49F-95F64D40B8B9&region=MID","7"
"2016","VA","97762","SERFF","9","2015-08-28 13:59:00","1","97762","VA","Individual","Yes","75-1233841","97762VA0010001","Dentegra Dental PPO Pediatric Basic Plan","97762VA001",,"VAN001","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.57","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","97762VA0010001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/va/97762va0010001-16","4"
"2016","VA","97762","SERFF","9","2015-08-28 13:59:00","1","97762","VA","SHOP (Small Group)","Yes","75-1233841","97762VA0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","97762VA002",,"VAN001","VAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","97762VA0020001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/va/97762va0020001-16","4"
"2016","VA","97762","SERFF","9","2015-08-28 13:59:00","2","97762","VA","SHOP (Small Group)","Yes","75-1233841","97762VA0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","97762VA002",,"VAN001","VAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","97762VA0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/va/97762va0020004-16","4"
"2016","VA","97762","SERFF","9","2015-08-28 13:59:00","2","97762","VA","Individual","Yes","75-1233841","97762VA0010004","Dentegra Dental PPO Family Preferred Plan","97762VA001",,"VAN001","VAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","97762VA0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/va/97762va0010004-16","4"
"2016","VA","97762","SERFF","9","2015-08-28 13:59:00","2","97762","VA","Individual","Yes","75-1233841","97762VA0010004","Dentegra Dental PPO Family Preferred Plan","97762VA001",,"VAN001","VAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.53","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","97762VA0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/va/97762va0010004-16","5"
"2016","VA","97762","SERFF","9","2015-08-28 13:59:00","2","97762","VA","SHOP (Small Group)","Yes","75-1233841","97762VA0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","97762VA002",,"VAN001","VAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","97762VA0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/va/97762va0020004-16","5"
"2016","VA","97762","SERFF","9","2015-08-28 13:59:00","3","97762","VA","SHOP (Small Group)","Yes","75-1233841","97762VA0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","97762VA002",,"VAN001","VAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","97762VA0020006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/va/97762va0020006-16","4"
"2016","VA","97762","SERFF","9","2015-08-28 13:59:00","3","97762","VA","Individual","Yes","75-1233841","97762VA0010006","Dentegra Dental PPO Family Basic Plan","97762VA001",,"VAN001","VAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.57","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","97762VA0010006-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/va/97762va0010006-16","4"
"2016","VA","97762","SERFF","9","2015-08-28 13:59:00","3","97762","VA","Individual","Yes","75-1233841","97762VA0010006","Dentegra Dental PPO Family Basic Plan","97762VA001",,"VAN001","VAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.57","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","97762VA0010006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/va/97762va0010006-16","5"
"2016","VA","97762","SERFF","9","2015-08-28 13:59:00","3","97762","VA","SHOP (Small Group)","Yes","75-1233841","97762VA0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","97762VA002",,"VAN001","VAS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$19.72","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","97762VA0020006-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$60","per person not applicable","per group not applicable",,,,,,"$60","per person not applicable","per group not applicable","$60","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/va/97762va0020006-16","5"
"2016","VA","97927","SERFF","3","2015-08-25 12:56:34","1","97927","VA","Individual","Yes","52-2016912","97927VA0030002","DentaQuest Choice PPO Pediatric High","97927VA003","7700889935","VAN002","VAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$68.20","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","97927VA0030002-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.Dentaquest.com/marketplace/va","http://www.Dentaquest.com/marketplace/va","6"
"2016","VA","97927","SERFF","3","2015-08-25 12:56:34","1","97927","VA","Individual","Yes","52-2016912","97927VA0030002","DentaQuest Choice PPO Pediatric High","97927VA003","7700889935","VAN002","VAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Child-Only",,,,,"$68.20","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","97927VA0030002-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.Dentaquest.com/marketplace/va","http://www.Dentaquest.com/marketplace/va","7"
"2016","VA","97927","SERFF","3","2015-08-25 12:56:34","1","97927","VA","SHOP (Small Group)","Yes","52-2016912","97927VA0040003","DentaQuest Choice PPO  Family Low","97927VA004","7700889935","VAN002","VAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","97927VA0040003-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.Dentaquest.com/marketplace/va","http://www.Dentaquest.com/marketplace/va","8"
"2016","VA","97927","SERFF","3","2015-08-25 12:56:34","1","97927","VA","SHOP (Small Group)","Yes","52-2016912","97927VA0040003","DentaQuest Choice PPO  Family Low","97927VA004","7700889935","VAN002","VAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","97927VA0040003-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.Dentaquest.com/marketplace/va","http://www.Dentaquest.com/marketplace/va","9"
"2016","VA","97927","SERFF","3","2015-08-25 12:56:34","1","97927","VA","SHOP (Small Group)","Yes","52-2016912","97927VA0040004","DentaQuest Choice PPO  Family High","97927VA004","7700889935","VAN002","VAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$48.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","97927VA0040004-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.Dentaquest.com/marketplace/va","http://www.Dentaquest.com/marketplace/va","10"
"2016","VA","97927","SERFF","3","2015-08-25 12:56:34","1","97927","VA","SHOP (Small Group)","Yes","52-2016912","97927VA0040004","DentaQuest Choice PPO  Family High","97927VA004","7700889935","VAN002","VAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$48.14","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","97927VA0040004-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.Dentaquest.com/marketplace/va","http://www.Dentaquest.com/marketplace/va","11"
"2016","VA","97927","SERFF","3","2015-08-25 12:56:34","2","97927","VA","Individual","Yes","52-2016912","97927VA0030003","DentaQuest Choice PPO  Family Low","97927VA003","7700889935","VAN002","VAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$53.59","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","97927VA0030003-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.Dentaquest.com/marketplace/va","http://www.Dentaquest.com/marketplace/va","8"
"2016","VA","97927","SERFF","3","2015-08-25 12:56:34","2","97927","VA","Individual","Yes","52-2016912","97927VA0030003","DentaQuest Choice PPO  Family Low","97927VA003","7700889935","VAN002","VAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$53.59","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","97927VA0030003-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.Dentaquest.com/marketplace/va","http://www.Dentaquest.com/marketplace/va","9"
"2016","VA","97927","SERFF","3","2015-08-25 12:56:34","2","97927","VA","Individual","Yes","52-2016912","97927VA0030004","DentaQuest Choice PPO  Family High","97927VA003","7700889935","VAN002","VAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$68.20","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","97927VA0030004-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.Dentaquest.com/marketplace/va","http://www.Dentaquest.com/marketplace/va","10"
"2016","VA","97927","SERFF","3","2015-08-25 12:56:34","2","97927","VA","Individual","Yes","52-2016912","97927VA0030004","DentaQuest Choice PPO  Family High","97927VA003","7700889935","VAN002","VAS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$68.20","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","No",,"","97927VA0030004-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","$50 per person","$150 per group",,,,,,"$100","$100 per person","$300 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"http://www.Dentaquest.com/marketplace/va","http://www.Dentaquest.com/marketplace/va","11"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","1","99663","VA","Individual","No","54-1576305","99663VA0140031","Coventry Bronze $30 Copay","99663VA014",,"VAN001","VAS001","VAF007","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140031-00","Standard Bronze Off Exchange Plan","61.97%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51335","http://www.coventryone.com/VAon2016","4"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","1","99663","VA","Individual","No","54-1576305","99663VA0140031","Coventry Bronze $30 Copay","99663VA014",,"VAN001","VAS001","VAF007","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140031-01","Standard Bronze On Exchange Plan","61.97%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51275","http://www.coventryone.com/VAon2016","5"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","1","99663","VA","Individual","No","54-1576305","99663VA0140031","Coventry Bronze $30 Copay","99663VA014",,"VAN001","VAS001","VAF007","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140031-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51282","http://www.coventryone.com/VAon2016","6"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","1","99663","VA","Individual","No","54-1576305","99663VA0140031","Coventry Bronze $30 Copay","99663VA014",,"VAN001","VAS001","VAF007","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140031-03","Limited Cost Sharing Plan Variation","61.97%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,800","$6800 per person","$13600 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51281","http://www.coventryone.com/VAon2016","7"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","2","99663","VA","Individual","No","54-1576305","99663VA0140008","Coventry Bronze $35 Copay Bon Secours","99663VA014",,"VAN003","VAS003","VAF003","Existing","POS","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140008-00","Standard Bronze Off Exchange Plan","61.90%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%","$6,750","$6750 per person","$13500 per group","0%","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51341","http://www.coventryone.com/VAon2016","4"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","2","99663","VA","Individual","No","54-1576305","99663VA0140008","Coventry Bronze $35 Copay Bon Secours","99663VA014",,"VAN003","VAS003","VAF003","Existing","POS","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140008-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51305","http://www.coventryone.com/VAon2016","6"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","2","99663","VA","Individual","No","54-1576305","99663VA0140008","Coventry Bronze $35 Copay Bon Secours","99663VA014",,"VAN003","VAS003","VAF003","Existing","POS","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140008-03","Limited Cost Sharing Plan Variation","61.90%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%","$6,750","$6750 per person","$13500 per group","0%","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51304","http://www.coventryone.com/VAon2016","7"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","3","99663","VA","Individual","No","54-1576305","99663VA0140011","Coventry Bronze $35 Copay Southside","99663VA014",,"VAN005","VAS005","VAF006","Existing","POS","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140011-00","Standard Bronze Off Exchange Plan","61.90%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%","$6,750","$6750 per person","$13500 per group","0%","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51347","http://www.coventryone.com/VAon2016","4"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","3","99663","VA","Individual","No","54-1576305","99663VA0140011","Coventry Bronze $35 Copay Southside","99663VA014",,"VAN005","VAS005","VAF006","Existing","POS","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140011-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%","$6,750","$6750 per person","$13500 per group","0%","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51325","http://www.coventryone.com/VAon2016","5"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","3","99663","VA","Individual","No","54-1576305","99663VA0140011","Coventry Bronze $35 Copay Southside","99663VA014",,"VAN005","VAS005","VAF006","Existing","POS","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140011-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51327","http://www.coventryone.com/VAon2016","6"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","3","99663","VA","Individual","No","54-1576305","99663VA0140011","Coventry Bronze $35 Copay Southside","99663VA014",,"VAN005","VAS005","VAF006","Existing","POS","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140011-03","Limited Cost Sharing Plan Variation","61.90%",,"Yes","Yes","Yes","75%","25%","$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,000","$6000 per person","$12000 per group","0%","$6,750","$6750 per person","$13500 per group","0%","$12,500","$12500 per person","$25000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51326","http://www.coventryone.com/VAon2016","7"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","4","99663","VA","Individual","No","54-1576305","99663VA0140032","Coventry Bronze Deductible Only HSA Eligible","99663VA014",,"VAN001","VAS001","VAF008","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140032-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/VA51336","http://www.coventryone.com/VAon2016","4"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","4","99663","VA","Individual","No","54-1576305","99663VA0140032","Coventry Bronze Deductible Only HSA Eligible","99663VA014",,"VAN001","VAS001","VAF008","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140032-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/VA51283","http://www.coventryone.com/VAon2016","5"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","4","99663","VA","Individual","No","54-1576305","99663VA0140032","Coventry Bronze Deductible Only HSA Eligible","99663VA014",,"VAN001","VAS001","VAF008","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140032-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51285","http://www.coventryone.com/VAon2016","6"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","4","99663","VA","Individual","No","54-1576305","99663VA0140032","Coventry Bronze Deductible Only HSA Eligible","99663VA014",,"VAN001","VAS001","VAF008","Existing","POS","Bronze","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140032-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/VA51284","http://www.coventryone.com/VAon2016","7"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","5","99663","VA","Individual","No","54-1576305","99663VA0140033","Coventry Bronze Deductible Only HSA Eligible Bon Secours","99663VA014",,"VAN002","VAS002","VAF009","Existing","POS","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140033-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/VA51342","http://www.coventryone.com/VAon2016","4"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","5","99663","VA","Individual","No","54-1576305","99663VA0140033","Coventry Bronze Deductible Only HSA Eligible Bon Secours","99663VA014",,"VAN002","VAS002","VAF009","Existing","POS","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140033-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/VA51306","http://www.coventryone.com/VAon2016","5"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","5","99663","VA","Individual","No","54-1576305","99663VA0140033","Coventry Bronze Deductible Only HSA Eligible Bon Secours","99663VA014",,"VAN002","VAS002","VAF009","Existing","POS","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140033-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51308","http://www.coventryone.com/VAon2016","6"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","5","99663","VA","Individual","No","54-1576305","99663VA0140033","Coventry Bronze Deductible Only HSA Eligible Bon Secours","99663VA014",,"VAN002","VAS002","VAF009","Existing","POS","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140033-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/VA51307","http://www.coventryone.com/VAon2016","7"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","6","99663","VA","Individual","No","54-1576305","99663VA0140034","Coventry Bronze Deductible Only HSA Eligible Southside","99663VA014",,"VAN004","VAS004","VAF010","Existing","POS","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140034-00","Standard Bronze Off Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/VA51348","http://www.coventryone.com/VAon2016","4"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","6","99663","VA","Individual","No","54-1576305","99663VA0140034","Coventry Bronze Deductible Only HSA Eligible Southside","99663VA014",,"VAN004","VAS004","VAF010","Existing","POS","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140034-01","Standard Bronze On Exchange Plan","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/VA51328","http://www.coventryone.com/VAon2016","5"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","6","99663","VA","Individual","No","54-1576305","99663VA0140034","Coventry Bronze Deductible Only HSA Eligible Southside","99663VA014",,"VAN004","VAS004","VAF010","Existing","POS","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140034-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51330","http://www.coventryone.com/VAon2016","6"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","6","99663","VA","Individual","No","54-1576305","99663VA0140034","Coventry Bronze Deductible Only HSA Eligible Southside","99663VA014",,"VAN004","VAS004","VAF010","Existing","POS","Bronze","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140034-03","Limited Cost Sharing Plan Variation","60.26%",,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","$12900 per person","$25800 per group","Not Applicable","per person not applicable","per group not applicable","Yes",,,"http://www.coventryone.com/VA51329","http://www.coventryone.com/VAon2016","7"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","7","99663","VA","Individual","No","54-1576305","99663VA0140039","Coventry Silver $10 Copay","99663VA014",,"VAN001","VAS001","VAF015","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140039-00","Standard Silver Off Exchange Plan","68.16%",,"No","Yes","No","100%",,"$3,500","$10","$500","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51334","http://www.coventryone.com/VAon2016","4"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","7","99663","VA","Individual","No","54-1576305","99663VA0140039","Coventry Silver $10 Copay","99663VA014",,"VAN001","VAS001","VAF015","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140039-01","Standard Silver On Exchange Plan","68.16%",,"No","Yes","No","100%",,"$3,500","$10","$500","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51278","http://www.coventryone.com/VAon2016","5"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","7","99663","VA","Individual","No","54-1576305","99663VA0140039","Coventry Silver $10 Copay","99663VA014",,"VAN001","VAS001","VAF015","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140039-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51280","http://www.coventryone.com/VAon2016","6"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","7","99663","VA","Individual","No","54-1576305","99663VA0140039","Coventry Silver $10 Copay","99663VA014",,"VAN001","VAS001","VAF015","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140039-03","Limited Cost Sharing Plan Variation","68.16%",,"No","Yes","No","100%",,"$3,500","$10","$500","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51279","http://www.coventryone.com/VAon2016","7"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","7","99663","VA","Individual","No","54-1576305","99663VA0140039","Coventry Silver $10 Copay","99663VA014",,"VAN001","VAS001","VAF015","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140039-04","73% AV Level Silver Plan","72.01%",,"No","Yes","No","100%",,"$3,100","$10","$600","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,100","$3100 per person","$6200 per group","30%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","30%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51268","http://www.coventryone.com/VAon2016","8"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","7","99663","VA","Individual","No","54-1576305","99663VA0140039","Coventry Silver $10 Copay","99663VA014",,"VAN001","VAS001","VAF015","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140039-05","87% AV Level Silver Plan","86.20%",,"No","Yes","No","100%",,"$1,000","$10","$400","$200","$1,000","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%",,,,,"$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51267","http://www.coventryone.com/VAon2016","9"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","8","99663","VA","Individual","No","54-1576305","99663VA0140040","Coventry Silver $10 Copay $2750","99663VA014",,"VAN001","VAS001","VAF016","Existing","POS","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140040-06","94% AV Level Silver Plan","93.08%",,"Yes","Yes","No","100%",,"$0","$10","$400","$200","$0","$200","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%",,,,,"$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51272","http://www.coventryone.com/VAon2016","10"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","9","99663","VA","Individual","No","54-1576305","99663VA0140041","Coventry Silver $10 Copay 2750 Bon Secours","99663VA014",,"VAN003","VAS003","VAF017","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140041-00","Standard Silver Off Exchange Plan","68.15%",,"Yes","Yes","Yes","80%","20%","$2,800","$10","$700","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30%","$6,250","$6250 per person","$12500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51340","http://www.coventryone.com/VAon2016","4"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","9","99663","VA","Individual","No","54-1576305","99663VA0140041","Coventry Silver $10 Copay 2750 Bon Secours","99663VA014",,"VAN003","VAS003","VAF017","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140041-01","Standard Silver On Exchange Plan","68.15%",,"Yes","Yes","Yes","80%","20%","$2,800","$10","$700","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30%","$6,250","$6250 per person","$12500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51297","http://www.coventryone.com/VAon2016","5"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","9","99663","VA","Individual","No","54-1576305","99663VA0140041","Coventry Silver $10 Copay 2750 Bon Secours","99663VA014",,"VAN003","VAS003","VAF017","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140041-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","80%","20%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51301","http://www.coventryone.com/VAon2016","6"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","9","99663","VA","Individual","No","54-1576305","99663VA0140041","Coventry Silver $10 Copay 2750 Bon Secours","99663VA014",,"VAN003","VAS003","VAF017","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140041-03","Limited Cost Sharing Plan Variation","68.15%",,"Yes","Yes","Yes","80%","20%","$2,800","$10","$700","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30%","$6,250","$6250 per person","$12500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51302","http://www.coventryone.com/VAon2016","7"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","13","99663","VA","Individual","No","54-1576305","99663VA0140038","Coventry Gold $10 Copay","99663VA014",,"VAN001","VAS001","VAF014","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140038-03","Limited Cost Sharing Plan Variation","78.18%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51276","http://www.coventryone.com/VAon2016","7"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","14","99663","VA","Individual","No","54-1576305","99663VA0140006","Coventry Gold $5 Copay Bon Secours","99663VA014",,"VAN003","VAS003","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140006-00","Standard Gold Off Exchange Plan","78.05%",,"No","Yes","Yes","80%","20%","$1,300","$10","$800","$200","$1,300","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%","Not Applicable","per person not applicable","per group not applicable","40%","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51338","http://www.coventryone.com/VAon2016","4"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","14","99663","VA","Individual","No","54-1576305","99663VA0140006","Coventry Gold $5 Copay Bon Secours","99663VA014",,"VAN003","VAS003","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140006-01","Standard Gold On Exchange Plan","78.05%",,"No","Yes","Yes","80%","20%","$1,300","$10","$800","$200","$1,300","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%","Not Applicable","per person not applicable","per group not applicable","40%","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51288","http://www.coventryone.com/VAon2016","5"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","14","99663","VA","Individual","No","54-1576305","99663VA0140006","Coventry Gold $5 Copay Bon Secours","99663VA014",,"VAN003","VAS003","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140006-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51289","http://www.coventryone.com/VAon2016","6"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","14","99663","VA","Individual","No","54-1576305","99663VA0140006","Coventry Gold $5 Copay Bon Secours","99663VA014",,"VAN003","VAS003","VAF001","Existing","POS","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140006-03","Limited Cost Sharing Plan Variation","78.05%",,"No","Yes","Yes","80%","20%","$1,300","$10","$800","$200","$1,300","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%","Not Applicable","per person not applicable","per group not applicable","40%","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51290","http://www.coventryone.com/VAon2016","7"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","9","99663","VA","Individual","No","54-1576305","99663VA0140041","Coventry Silver $10 Copay 2750 Bon Secours","99663VA014",,"VAN003","VAS003","VAF017","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140041-04","73% AV Level Silver Plan","72.08%",,"Yes","Yes","Yes","80%","20%","$2,600","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","30%","$4,500","$4500 per person","$9000 per group","40%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51300","http://www.coventryone.com/VAon2016","8"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","9","99663","VA","Individual","No","54-1576305","99663VA0140041","Coventry Silver $10 Copay 2750 Bon Secours","99663VA014",,"VAN003","VAS003","VAF017","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140041-05","87% AV Level Silver Plan","86.13%",,"Yes","Yes","Yes","80%","20%","$0","$10","$1,600","$200","$0","$200","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$1,500","$1500 per person","$3000 per group","40%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51299","http://www.coventryone.com/VAon2016","9"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","9","99663","VA","Individual","No","54-1576305","99663VA0140041","Coventry Silver $10 Copay 2750 Bon Secours","99663VA014",,"VAN003","VAS003","VAF017","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140041-06","94% AV Level Silver Plan","93.17%",,"Yes","Yes","Yes","80%","20%","$0","$10","$400","$200","$0","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","20%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51298","http://www.coventryone.com/VAon2016","10"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","10","99663","VA","Individual","No","54-1576305","99663VA0140042","Coventry Silver $10 Copay 2750 Southside","99663VA014",,"VAN005","VAS005","VAF018","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140042-00","Standard Silver Off Exchange Plan","68.15%",,"Yes","Yes","Yes","80%","20%","$2,800","$10","$700","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30%","$6,250","$6250 per person","$12500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51346","http://www.coventryone.com/VAon2016","4"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","10","99663","VA","Individual","No","54-1576305","99663VA0140042","Coventry Silver $10 Copay 2750 Southside","99663VA014",,"VAN005","VAS005","VAF018","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140042-01","Standard Silver On Exchange Plan","68.15%",,"Yes","Yes","Yes","80%","20%","$2,800","$10","$700","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30%","$6,250","$6250 per person","$12500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51319","http://www.coventryone.com/VAon2016","5"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","10","99663","VA","Individual","No","54-1576305","99663VA0140042","Coventry Silver $10 Copay 2750 Southside","99663VA014",,"VAN005","VAS005","VAF018","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140042-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","80%","20%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51323","http://www.coventryone.com/VAon2016","6"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","10","99663","VA","Individual","No","54-1576305","99663VA0140042","Coventry Silver $10 Copay 2750 Southside","99663VA014",,"VAN005","VAS005","VAF018","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140042-03","Limited Cost Sharing Plan Variation","68.15%",,"Yes","Yes","Yes","80%","20%","$2,800","$10","$700","$200","$2,400","$200","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group","$6,850","$6850 per person","$13700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,750","$2750 per person","$5500 per group","30%","$6,250","$6250 per person","$12500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51324","http://www.coventryone.com/VAon2016","7"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","10","99663","VA","Individual","No","54-1576305","99663VA0140042","Coventry Silver $10 Copay 2750 Southside","99663VA014",,"VAN005","VAS005","VAF018","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140042-04","73% AV Level Silver Plan","72.08%",,"Yes","Yes","Yes","80%","20%","$2,600","$10","$800","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,450","$5450 per person","$10900 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,600","$2600 per person","$5200 per group","30%","$4,500","$4500 per person","$9000 per group","40%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51322","http://www.coventryone.com/VAon2016","8"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","10","99663","VA","Individual","No","54-1576305","99663VA0140042","Coventry Silver $10 Copay 2750 Southside","99663VA014",,"VAN005","VAS005","VAF018","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140042-05","87% AV Level Silver Plan","86.13%",,"Yes","Yes","Yes","80%","20%","$0","$10","$1,600","$200","$0","$200","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","30%","$1,500","$1500 per person","$3000 per group","40%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51321","http://www.coventryone.com/VAon2016","9"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","10","99663","VA","Individual","No","54-1576305","99663VA0140042","Coventry Silver $10 Copay 2750 Southside","99663VA014",,"VAN005","VAS005","VAF018","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140042-06","94% AV Level Silver Plan","93.17%",,"Yes","Yes","Yes","80%","20%","$0","$10","$400","$200","$0","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","20%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51320","http://www.coventryone.com/VAon2016","10"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","11","99663","VA","Individual","No","54-1576305","99663VA0140007","Coventry Silver $10 Copay Bon Secours","99663VA014",,"VAN003","VAS003","VAF002","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140007-00","Standard Silver Off Exchange Plan","68.06%",,"No","Yes","Yes","75%","25%","$3,600","$10","$300","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","20%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","40%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51339","http://www.coventryone.com/VAon2016","4"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","11","99663","VA","Individual","No","54-1576305","99663VA0140007","Coventry Silver $10 Copay Bon Secours","99663VA014",,"VAN003","VAS003","VAF002","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140007-01","Standard Silver On Exchange Plan","68.06%",,"No","Yes","Yes","75%","25%","$3,600","$10","$300","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","20%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","40%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51291","http://www.coventryone.com/VAon2016","5"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","11","99663","VA","Individual","No","54-1576305","99663VA0140007","Coventry Silver $10 Copay Bon Secours","99663VA014",,"VAN003","VAS003","VAF002","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51293","http://www.coventryone.com/VAon2016","6"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","11","99663","VA","Individual","No","54-1576305","99663VA0140007","Coventry Silver $10 Copay Bon Secours","99663VA014",,"VAN003","VAS003","VAF002","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140007-03","Limited Cost Sharing Plan Variation","68.06%",,"No","Yes","Yes","75%","25%","$3,600","$10","$300","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","20%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","40%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51292","http://www.coventryone.com/VAon2016","7"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","11","99663","VA","Individual","No","54-1576305","99663VA0140007","Coventry Silver $10 Copay Bon Secours","99663VA014",,"VAN003","VAS003","VAF002","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140007-04","73% AV Level Silver Plan","72.15%",,"No","Yes","Yes","75%","25%","$3,200","$10","$400","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,350","$5350 per person","$10700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","20%","$4,500","$4500 per person","$9000 per group","40%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","40%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51296","http://www.coventryone.com/VAon2016","8"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","11","99663","VA","Individual","No","54-1576305","99663VA0140007","Coventry Silver $10 Copay Bon Secours","99663VA014",,"VAN003","VAS003","VAF002","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140007-05","87% AV Level Silver Plan","86.03%",,"No","Yes","Yes","75%","25%","$500","$10","$900","$200","$500","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$1,500","$1500 per person","$3000 per group","40%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","40%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51295","http://www.coventryone.com/VAon2016","9"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","11","99663","VA","Individual","No","54-1576305","99663VA0140007","Coventry Silver $10 Copay Bon Secours","99663VA014",,"VAN003","VAS003","VAF002","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140007-06","94% AV Level Silver Plan","93.17%",,"No","Yes","Yes","75%","25%","$0","$10","$400","$200","$0","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","20%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51294","http://www.coventryone.com/VAon2016","10"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","12","99663","VA","Individual","No","54-1576305","99663VA0140010","Coventry Silver $10 Copay Southside","99663VA014",,"VAN005","VAS005","VAF005","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140010-00","Standard Silver Off Exchange Plan","68.06%",,"No","Yes","Yes","75%","25%","$3,600","$10","$300","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","20%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","40%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51345","http://www.coventryone.com/VAon2016","4"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","12","99663","VA","Individual","No","54-1576305","99663VA0140010","Coventry Silver $10 Copay Southside","99663VA014",,"VAN005","VAS005","VAF005","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140010-01","Standard Silver On Exchange Plan","68.06%",,"No","Yes","Yes","75%","25%","$3,600","$10","$300","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","20%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","40%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51313","http://www.coventryone.com/VAon2016","5"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","12","99663","VA","Individual","No","54-1576305","99663VA0140010","Coventry Silver $10 Copay Southside","99663VA014",,"VAN005","VAS005","VAF005","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140010-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","75%","25%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51314","http://www.coventryone.com/VAon2016","6"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","12","99663","VA","Individual","No","54-1576305","99663VA0140010","Coventry Silver $10 Copay Southside","99663VA014",,"VAN005","VAS005","VAF005","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140010-03","Limited Cost Sharing Plan Variation","68.06%",,"No","Yes","Yes","75%","25%","$3,600","$10","$300","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","$6,500","$6500 per person","$13000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,600","$3600 per person","$7200 per group","20%","$5,750","$5750 per person","$11500 per group","40%","$11,500","$11500 per person","$23000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","40%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51315","http://www.coventryone.com/VAon2016","7"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","3","31274","WV","Individual","No","55-0624615","31274WV0330005","Shared Cost Blue PPO 1500","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096480291_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","21"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","5","31274","WV","Individual","No","55-0624615","31274WV0350002","Comprehensive Care Blue PPO 1500","31274WV035",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0350002-06","94% AV Level Silver Plan","93.70%","0.923721075057983","No","Yes","No","100%",,"$100","$50","$500","$0","$100","$100","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095432256_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","10"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","12","99663","VA","Individual","No","54-1576305","99663VA0140010","Coventry Silver $10 Copay Southside","99663VA014",,"VAN005","VAS005","VAF005","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140010-04","73% AV Level Silver Plan","72.15%",,"No","Yes","Yes","75%","25%","$3,200","$10","$400","$200","$2,400","$100","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group","$5,350","$5350 per person","$10700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$3,200","$3200 per person","$6400 per group","20%","$4,500","$4500 per person","$9000 per group","40%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$500","$500 per person","$1000 per group","40%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51318","http://www.coventryone.com/VAon2016","8"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","12","99663","VA","Individual","No","54-1576305","99663VA0140010","Coventry Silver $10 Copay Southside","99663VA014",,"VAN005","VAS005","VAF005","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140010-05","87% AV Level Silver Plan","86.03%",,"No","Yes","Yes","75%","25%","$500","$10","$900","$200","$500","$200","$200","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,100","$2100 per person","$4200 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%","$1,500","$1500 per person","$3000 per group","40%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%","$0","$0 per person","$0 per group","40%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51317","http://www.coventryone.com/VAon2016","9"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","12","99663","VA","Individual","No","54-1576305","99663VA0140010","Coventry Silver $10 Copay Southside","99663VA014",,"VAN005","VAS005","VAF005","Existing","POS","Silver","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140010-06","94% AV Level Silver Plan","93.17%",,"No","Yes","Yes","75%","25%","$0","$10","$400","$200","$0","$100","$100","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$1,750","$1750 per person","$3500 per group","$2,250","$2250 per person","$4500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","20%","$7,500","$7500 per person","$15000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","10%","$0","$0 per person","$0 per group","20%","$1,000","$1000 per person","$2000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51316","http://www.coventryone.com/VAon2016","10"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","13","99663","VA","Individual","No","54-1576305","99663VA0140038","Coventry Gold $10 Copay","99663VA014",,"VAN001","VAS001","VAF014","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140038-00","Standard Gold Off Exchange Plan","78.18%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51333","http://www.coventryone.com/VAon2016","4"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","13","99663","VA","Individual","No","54-1576305","99663VA0140038","Coventry Gold $10 Copay","99663VA014",,"VAN001","VAS001","VAF014","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140038-01","Standard Gold On Exchange Plan","78.18%",,"No","Yes","No","100%",,"$1,400","$10","$800","$200","$1,400","$200","$300","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$5,100","$5100 per person","$10200 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,400","$1400 per person","$2800 per group","20%",,,,,"$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","$250","$250 per person","$500 per group","20%",,,,,"$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51287","http://www.coventryone.com/VAon2016","5"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","13","99663","VA","Individual","No","54-1576305","99663VA0140038","Coventry Gold $10 Copay","99663VA014",,"VAN001","VAS001","VAF014","Existing","POS","Gold","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140038-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,"$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51277","http://www.coventryone.com/VAon2016","6"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","15","99663","VA","Individual","No","54-1576305","99663VA0140009","Coventry Gold $5 Copay Southside","99663VA014",,"VAN005","VAS005","VAF004","Existing","POS","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140009-00","Standard Gold Off Exchange Plan","78.05%",,"No","Yes","Yes","80%","20%","$1,300","$10","$800","$200","$1,300","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%","Not Applicable","per person not applicable","per group not applicable","40%","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51344","http://www.coventryone.com/VAon2016","4"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","15","99663","VA","Individual","No","54-1576305","99663VA0140009","Coventry Gold $5 Copay Southside","99663VA014",,"VAN005","VAS005","VAF004","Existing","POS","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140009-01","Standard Gold On Exchange Plan","78.05%",,"No","Yes","Yes","80%","20%","$1,300","$10","$800","$200","$1,300","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%","Not Applicable","per person not applicable","per group not applicable","40%","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51310","http://www.coventryone.com/VAon2016","5"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","3","31274","WV","Individual","No","55-0624615","31274WV0330002","Shared Cost Blue PPO 4750","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330002-04","73% AV Level Silver Plan",,"0.720811367034912","No","Yes","No","100%",,"$4,000","$10","$500","$0","$1,700","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,200","$5200 per person","$10400 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","20%",,,,,"$9,500","per person not applicable","$19000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095502633_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","8"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","3","31274","WV","Individual","No","55-0624615","31274WV0330002","Shared Cost Blue PPO 4750","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330002-05","87% AV Level Silver Plan",,"0.870044052600861","No","Yes","No","100%",,"$500","$10","$500","$0","$500","$300","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"$9,500","per person not applicable","$19000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095591578_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","9"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","3","31274","WV","Individual","No","55-0624615","31274WV0330002","Shared Cost Blue PPO 4750","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330002-06","94% AV Level Silver Plan",,"0.949489951133728","No","Yes","No","100%",,"$100","$0","$400","$0","$100","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"$9,500","per person not applicable","$19000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095594671_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","10"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","4","31274","WV","Individual","No","55-0624615","31274WV0340002","Health Savings Blue PPO 3000","31274WV034",,"WVN001","WVS001","WVF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0340002-05","87% AV Level Silver Plan",,"0.87151837348938","Yes","Yes","No","100%",,"$600","$0","$700","$0","$600","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$600","$600 per person","$1200 per group","10%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096198990_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","13"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","4","31274","WV","Individual","No","55-0624615","31274WV0340002","Health Savings Blue PPO 3000","31274WV034",,"WVN001","WVS001","WVF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0340002-06","94% AV Level Silver Plan",,"0.944762587547302","Yes","Yes","No","100%",,"$100","$0","$700","$0","$100","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$750","$750 per person","$1500 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","$200 per group","10%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096200148_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","14"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","5","31274","WV","Individual","No","55-0624615","31274WV0350002","Comprehensive Care Blue PPO 1500","31274WV035",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0350002-00","Standard Silver Off Exchange Plan","70.17%","0.70173966884613","No","Yes","No","100%",,"$1,500","$10","$1,200","$0","$1,500","$100","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095319704_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","4"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","15","99663","VA","Individual","No","54-1576305","99663VA0140009","Coventry Gold $5 Copay Southside","99663VA014",,"VAN005","VAS005","VAF004","Existing","POS","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140009-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%","$0","$0","$0","$200","$0","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","0%","$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51311","http://www.coventryone.com/VAon2016","6"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","15","99663","VA","Individual","No","54-1576305","99663VA0140009","Coventry Gold $5 Copay Southside","99663VA014",,"VAN005","VAS005","VAF004","Existing","POS","Gold","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs","1",,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8505215872","99663VA0140009-03","Limited Cost Sharing Plan Variation","78.05%",,"No","Yes","Yes","80%","20%","$1,300","$10","$800","$200","$1,300","$100","$400","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group","$6,000","$6000 per person","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,250","$1250 per person","$2500 per group","20%","$3,500","$3500 per person","$7000 per group","40%","$6,750","$6750 per person","$13500 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","20%","Not Applicable","per person not applicable","per group not applicable","40%","$500","$500 per person","$1000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"http://www.coventryone.com/VA51312","http://www.coventryone.com/VAon2016","7"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","16","99663","VA","Individual","No","54-1576305","99663VA0140037","Coventry Catastrophic 100%","99663VA014",,"VAN001","VAS001","VAF013","Existing","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140037-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51337","http://www.coventryone.com/VAon2016","4"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","16","99663","VA","Individual","No","54-1576305","99663VA0140037","Coventry Catastrophic 100%","99663VA014",,"VAN001","VAS001","VAF013","Existing","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140037-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51286","http://www.coventryone.com/VAon2016","5"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","17","99663","VA","Individual","No","54-1576305","99663VA0140035","Coventry Catastrophic 100% Bon Secours","99663VA014",,"VAN002","VAS002","VAF011","Existing","POS","Catastrophic","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140035-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51343","http://www.coventryone.com/VAon2016","4"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","17","99663","VA","Individual","No","54-1576305","99663VA0140035","Coventry Catastrophic 100% Bon Secours","99663VA014",,"VAN002","VAS002","VAF011","Existing","POS","Catastrophic","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140035-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51309","http://www.coventryone.com/VAon2016","5"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","18","99663","VA","Individual","No","54-1576305","99663VA0140036","Coventry Catastrophic 100% Southside","99663VA014",,"VAN004","VAS004","VAF012","Existing","POS","Catastrophic","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140036-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51349","http://www.coventryone.com/VAon2016","4"
"2016","VA","99663","SERFF","10","2015-08-27 03:52:03","18","99663","VA","Individual","No","54-1576305","99663VA0140036","Coventry Catastrophic 100% Southside","99663VA014",,"VAN004","VAS004","VAF012","Existing","POS","Catastrophic","Yes","Both","No","Yes","This requirement does not apply to Emergency Services, obstetrical and gynecological care from an In-Network Provider and mental health and substance abuse services from an In-Network Provider.",,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Weight Loss Programs",,,,,"0","0","0","2016-01-01",,"No",,"Yes","Covered with Limitations","No","https://ssoprod.healthplan.com/sp/ACS.saml2","http://client.formularynavigator.com/Search.aspx?siteCode=8507824487","99663VA0140036-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$5,200","$0","$0","$200","$5,300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","$13700 per person","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"http://www.coventryone.com/VA51331","http://www.coventryone.com/VAon2016","5"
"2016","WV","17919","SERFF","4","2015-08-20 12:28:36","1","17919","WV","Individual","Yes","47-0397286","17919WV0010001","Delta Dental Individual PPO, EHB Certified","17919WV001",,"WVN002","WVS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$26.79","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","17919WV0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WV","17919","SERFF","4","2015-08-20 12:28:36","1","17919","WV","SHOP (Small Group)","Yes","47-0397286","17919WV0030001","Renaissance Group Dental PPO, EHB Certified","17919WV003",,"WVN001","WVS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.31","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","17919WV0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WV","17919","SERFF","4","2015-08-20 12:28:36","1","17919","WV","SHOP (Small Group)","Yes","47-0397286","17919WV0030002","Renaissance Group Dental PPO, EHB Certified","17919WV003",,"WVN001","WVS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.26","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","17919WV0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","WV","17919","SERFF","4","2015-08-20 12:28:36","1","17919","WV","Individual","Yes","47-0397286","17919WV0010002","Delta Dental Individual PPO, EHB Certified","17919WV001",,"WVN002","WVS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$20.85","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","17919WV0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%",,,,,,,,,"$350","$350 per person","$700 per group","$350","$350 per person","$700 per group","Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable",,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","WV","17919","SERFF","4","2015-08-20 12:28:36","1","17919","WV","Individual","Yes","47-0397286","17919WV0020001","Renaissance Individual Dental PPO, EHB Certified","17919WV002",,"WVN001","WVS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$29.77","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","17919WV0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2016","WV","17919","SERFF","4","2015-08-20 12:28:36","1","17919","WV","Individual","Yes","47-0397286","17919WV0020002","Renaissance Individual Dental PPO, EHB Certified","17919WV002",,"WVN001","WVS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.10","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,"","17919WV0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","$150 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","1","31274","WV","Individual","No","55-0624615","31274WV0320001","Major Events Blue PPO 6850","31274WV032",,"WVN001","WVS001","WVF001","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","3","3","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0320001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096053925_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","4"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","1","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0450002","Balance Blue PPO 2000","31274WV045",,"WVN001","WVS001","WVF008","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.998234",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0450002-00","Standard Silver Off Exchange Plan",,"0.706856191158295","No","Yes","No","100%",,"$2,000","$200","$900","$0","$1,600","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","per person not applicable","$26400 per group","$13,200","$13200 per person","$26400 per group","$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/sbc/bcbswv","http://www.discoverhighmark.com/","4"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","1","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0450002","Balance Blue PPO 2000","31274WV045",,"WVN001","WVS001","WVF008","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.998234",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0450002-01","Standard Silver On Exchange Plan",,"0.706856191158295","No","Yes","No","100%",,"$2,000","$200","$900","$0","$1,600","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,600","$6600 per person","$13200 per group",,,,"$13,200","per person not applicable","$26400 per group","$13,200","$13200 per person","$26400 per group","$2,000","per person not applicable","$4000 per group","20%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","5"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","1","31274","WV","Individual","No","55-0624615","31274WV0320001","Major Events Blue PPO 6850","31274WV032",,"WVN001","WVS001","WVF001","Existing","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes",,"1",,,,"0","3","3","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0320001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group","0%",,,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096053925_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","5"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","2","31274","WV","Individual","No","55-0624615","31274WV0330001","Shared Cost Blue PPO 5500","31274WV033",,"WVN001","WVS001","WVF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0330001-00","Standard Bronze Off Exchange Plan",,"0.619823575019836","Yes","Yes","No","100%",,"$5,500","$100","$400","$0","$4,600","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"$11,000","per person not applicable","$22000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095484725_20160101_SBC.pdf","http://www.discoverhighmark.com/individuals-families/insurance/product-information/westvirginia","4"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","2","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0450001","Balance Blue PPO 1000","31274WV045",,"WVN001","WVS001","WVF008","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0450001-00","Standard Gold Off Exchange Plan",,"0.784440040588379","No","Yes","No","100%",,"$1,000","$200","$1,100","$0","$1,000","$500","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group","$1,000","per person not applicable","$2000 per group","20%",,,,,"$2,000","per person not applicable","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","4"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","2","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0450001","Balance Blue PPO 1000","31274WV045",,"WVN001","WVS001","WVF008","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0450001-01","Standard Gold On Exchange Plan",,"0.784440040588379","No","Yes","No","100%",,"$1,000","$200","$1,100","$0","$1,000","$500","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","$8000 per person","$16000 per group","$8,000","$8000 per person","$16000 per group","$1,000","per person not applicable","$2000 per group","20%",,,,,"$2,000","per person not applicable","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","per person not applicable","$0 per group","0%",,,,,"$0","per person not applicable","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","5"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","2","31274","WV","Individual","No","55-0624615","31274WV0330001","Shared Cost Blue PPO 5500","31274WV033",,"WVN001","WVS001","WVF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0330001-01","Standard Bronze On Exchange Plan",,"0.619823575019836","Yes","Yes","No","100%",,"$5,500","$100","$400","$0","$4,600","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"$11,000","per person not applicable","$22000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095484725_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","5"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","2","31274","WV","Individual","No","55-0624615","31274WV0330001","Shared Cost Blue PPO 5500","31274WV033",,"WVN001","WVS001","WVF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0330001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095503755_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","6"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","2","31274","WV","Individual","No","55-0624615","31274WV0330001","Shared Cost Blue PPO 5500","31274WV033",,"WVN001","WVS001","WVF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0330001-03","Limited Cost Sharing Plan Variation",,"0.619823575019836","Yes","Yes","No","100%",,"$5,500","$100","$400","$0","$4,600","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,500","$5500 per person","$11000 per group","40%",,,,,"$11,000","per person not applicable","$22000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095589807_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","7"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","3","31274","WV","Individual","No","55-0624615","31274WV0330002","Shared Cost Blue PPO 4750","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330002-00","Standard Silver Off Exchange Plan",,"0.681462049484253","No","Yes","No","100%",,"$4,750","$10","$500","$0","$1,700","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","20%",,,,,"$9,500","per person not applicable","$19000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095460806_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","4"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","3","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0440051","Shared Cost Blue PPO 3000","31274WV044",,"WVN001","WVS001","WVF008","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0440051-00","Standard Silver Off Exchange Plan",,"0.706732332706451","No","Yes","No","100%",,"$3,000","$10","$900","$0","$1,700","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","per person not applicable","$6000 per group","20%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","4"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","3","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0440051","Shared Cost Blue PPO 3000","31274WV044",,"WVN001","WVS001","WVF008","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0440051-01","Standard Silver On Exchange Plan",,"0.706732332706451","No","Yes","No","100%",,"$3,000","$10","$900","$0","$1,700","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,350","$6350 per person","$12700 per group",,,,"$12,700","per person not applicable","$25400 per group","Not Applicable","per person not applicable","per group not applicable","$3,000","per person not applicable","$6000 per group","20%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","5"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","3","31274","WV","Individual","No","55-0624615","31274WV0330002","Shared Cost Blue PPO 4750","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330002-01","Standard Silver On Exchange Plan",,"0.681462049484253","No","Yes","No","100%",,"$4,750","$10","$500","$0","$1,700","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","20%",,,,,"$9,500","per person not applicable","$19000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095460806_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","5"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","3","31274","WV","Individual","No","55-0624615","31274WV0330002","Shared Cost Blue PPO 4750","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095599564_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","6"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","3","31274","WV","Individual","No","55-0624615","31274WV0330002","Shared Cost Blue PPO 4750","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330002-03","Limited Cost Sharing Plan Variation",,"0.681462049484253","No","Yes","No","100%",,"$4,750","$10","$500","$0","$1,700","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$4,750","$4750 per person","$9500 per group","20%",,,,,"$9,500","per person not applicable","$19000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095501772_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","7"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","3","31274","WV","Individual","No","55-0624615","31274WV0330003","Shared Cost Blue PPO 500","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330003-00","Standard Gold Off Exchange Plan",,"0.794655561447144","No","Yes","No","100%",,"$500","$10","$1,400","$0","$500","$400","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","per person not applicable","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096588603_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","11"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","3","31274","WV","Individual","No","55-0624615","31274WV0330003","Shared Cost Blue PPO 500","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330003-01","Standard Gold On Exchange Plan",,"0.794655561447144","No","Yes","No","100%",,"$500","$10","$1,400","$0","$500","$400","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","per person not applicable","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096588603_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","12"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","3","31274","WV","Individual","No","55-0624615","31274WV0330003","Shared Cost Blue PPO 500","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096589639_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","13"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","3","31274","WV","Individual","No","55-0624615","31274WV0330003","Shared Cost Blue PPO 500","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330003-03","Limited Cost Sharing Plan Variation",,"0.794655561447144","No","Yes","No","100%",,"$500","$10","$1,400","$0","$500","$400","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","per person not applicable","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096589351_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","14"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","3","31274","WV","Individual","No","55-0624615","31274WV0330004","Shared Cost Blue PPO 1000","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330004-00","Standard Gold Off Exchange Plan",,"0.808771371841431","No","Yes","No","100%",,"$1,000","$10","$1,300","$0","$1,000","$400","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","per person not applicable","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","per person not applicable","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096649950_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","15"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","3","31274","WV","Individual","No","55-0624615","31274WV0330004","Shared Cost Blue PPO 1000","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330004-01","Standard Gold On Exchange Plan",,"0.808771371841431","No","Yes","No","100%",,"$1,000","$10","$1,300","$0","$1,000","$400","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","per person not applicable","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","per person not applicable","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096649950_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","16"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","3","31274","WV","Individual","No","55-0624615","31274WV0330004","Shared Cost Blue PPO 1000","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096651691_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","17"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","3","31274","WV","Individual","No","55-0624615","31274WV0330004","Shared Cost Blue PPO 1000","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330004-03","Limited Cost Sharing Plan Variation",,"0.808771371841431","No","Yes","No","100%",,"$1,000","$10","$1,300","$0","$1,000","$400","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,500","$3500 per person","$7000 per group",,,,"$7,000","per person not applicable","$14000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","20%",,,,,"$2,000","per person not applicable","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096650713_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","18"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","3","31274","WV","Individual","No","55-0624615","31274WV0330005","Shared Cost Blue PPO 1500","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330005-00","Standard Gold Off Exchange Plan",,"0.784537136554718","No","Yes","No","100%",,"$1,500","$10","$1,200","$0","$1,500","$400","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096469755_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","19"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","3","31274","WV","Individual","No","55-0624615","31274WV0330005","Shared Cost Blue PPO 1500","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330005-01","Standard Gold On Exchange Plan",,"0.784537136554718","No","Yes","No","100%",,"$1,500","$10","$1,200","$0","$1,500","$400","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096469755_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","20"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","3","31274","WV","Individual","No","55-0624615","31274WV0330005","Shared Cost Blue PPO 1500","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330005-03","Limited Cost Sharing Plan Variation",,"0.784537136554718","No","Yes","No","100%",,"$1,500","$10","$1,200","$0","$1,500","$400","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096479297_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","22"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","4","31274","WV","Individual","No","55-0624615","31274WV0340001","Health Savings Blue PPO 4000","31274WV034",,"WVN001","WVS001","WVF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0340001-00","Standard Bronze Off Exchange Plan",,"0.617886602878571","Yes","Yes","No","100%",,"$4,000","$0","$1,300","$0","$4,000","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","per person not applicable","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095635233_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","4"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","4","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0440022","Shared Cost Blue PPO 2000","31274WV044",,"WVN001","WVS001","WVF008","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0440022-00","Standard Silver Off Exchange Plan",,"0.717772245407104","No","Yes","No","100%",,"$2,000","$200","$1,400","$0","$1,600","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","30%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","4"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","4","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0440022","Shared Cost Blue PPO 2000","31274WV044",,"WVN001","WVS001","WVF008","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0440022-01","Standard Silver On Exchange Plan",,"0.717772245407104","No","Yes","No","100%",,"$2,000","$200","$1,400","$0","$1,600","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,000","per person not applicable","$4000 per group","30%",,,,,"$4,000","per person not applicable","$8000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","5"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","4","31274","WV","Individual","No","55-0624615","31274WV0340001","Health Savings Blue PPO 4000","31274WV034",,"WVN001","WVS001","WVF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0340001-01","Standard Bronze On Exchange Plan",,"0.617886602878571","Yes","Yes","No","100%",,"$4,000","$0","$1,300","$0","$4,000","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","per person not applicable","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095635233_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","5"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","4","31274","WV","Individual","No","55-0624615","31274WV0340001","Health Savings Blue PPO 4000","31274WV034",,"WVN001","WVS001","WVF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0340001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095637488_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","6"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","4","31274","WV","Individual","No","55-0624615","31274WV0340001","Health Savings Blue PPO 4000","31274WV034",,"WVN001","WVS001","WVF002","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0340001-03","Limited Cost Sharing Plan Variation",,"0.617886602878571","Yes","Yes","No","100%",,"$4,000","$0","$1,300","$0","$4,000","$0","$500","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","per person not applicable","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group","40%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095639822_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","7"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","4","31274","WV","Individual","No","55-0624615","31274WV0340002","Health Savings Blue PPO 3000","31274WV034",,"WVN001","WVS001","WVF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0340002-00","Standard Silver Off Exchange Plan",,"0.69658088684082","Yes","Yes","No","100%",,"$3,000","$0","$400","$0","$3,000","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096176012_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","8"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","4","31274","WV","Individual","No","55-0624615","31274WV0340002","Health Savings Blue PPO 3000","31274WV034",,"WVN001","WVS001","WVF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0340002-01","Standard Silver On Exchange Plan",,"0.69658088684082","Yes","Yes","No","100%",,"$3,000","$0","$400","$0","$3,000","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096176012_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","9"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","4","31274","WV","Individual","No","55-0624615","31274WV0340002","Health Savings Blue PPO 3000","31274WV034",,"WVN001","WVS001","WVF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0340002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096204401_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","10"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","4","31274","WV","Individual","No","55-0624615","31274WV0340002","Health Savings Blue PPO 3000","31274WV034",,"WVN001","WVS001","WVF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0340002-03","Limited Cost Sharing Plan Variation",,"0.69658088684082","Yes","Yes","No","100%",,"$3,000","$0","$400","$0","$3,000","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group","10%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096193919_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","11"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","4","31274","WV","Individual","No","55-0624615","31274WV0340002","Health Savings Blue PPO 3000","31274WV034",,"WVN001","WVS001","WVF005","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","Yes","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0340002-04","73% AV Level Silver Plan",,"0.739209413528442","Yes","Yes","No","100%",,"$2,250","$0","$500","$0","$2,250","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,250","$2250 per person","$4500 per group","10%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096194327_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","12"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","5","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0420021","Shared Cost Blue PPO 1750","31274WV042",,"WVN001","WVS001","WVF008","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0420021-00","Standard Silver Off Exchange Plan",,"0.718914866447449","No","Yes","No","100%",,"$1,750","$300","$1,400","$0","$1,600","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","per person not applicable","$3500 per group","30%",,,,,"$3,500","per person not applicable","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","4"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","5","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0420021","Shared Cost Blue PPO 1750","31274WV042",,"WVN001","WVS001","WVF008","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0420021-01","Standard Silver On Exchange Plan",,"0.718914866447449","No","Yes","No","100%",,"$1,750","$300","$1,400","$0","$1,600","$600","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,750","per person not applicable","$3500 per group","30%",,,,,"$3,500","per person not applicable","$7000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","5"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","5","31274","WV","Individual","No","55-0624615","31274WV0350002","Comprehensive Care Blue PPO 1500","31274WV035",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0350002-01","Standard Silver On Exchange Plan","70.17%","0.70173966884613","No","Yes","No","100%",,"$1,500","$10","$1,200","$0","$1,500","$100","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095319704_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","5"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","5","31274","WV","Individual","No","55-0624615","31274WV0350002","Comprehensive Care Blue PPO 1500","31274WV035",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0350002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095451571_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","6"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","5","31274","WV","Individual","No","55-0624615","31274WV0350002","Comprehensive Care Blue PPO 1500","31274WV035",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0350002-03","Limited Cost Sharing Plan Variation","70.17%","0.70173966884613","No","Yes","No","100%",,"$1,500","$10","$1,200","$0","$1,500","$100","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095450223_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","7"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","5","31274","WV","Individual","No","55-0624615","31274WV0350002","Comprehensive Care Blue PPO 1500","31274WV035",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0350002-04","73% AV Level Silver Plan","73.51%","0.735050797462463","No","Yes","No","100%",,"$1,500","$10","$1,200","$0","$1,500","$300","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,250","$4250 per person","$8500 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group","20%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095332570_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","8"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","5","31274","WV","Individual","No","55-0624615","31274WV0350002","Comprehensive Care Blue PPO 1500","31274WV035",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","Yes","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0350002-05","87% AV Level Silver Plan","87.06%","0.85949045419693","No","Yes","No","100%",,"$500","$30","$700","$0","$500","$200","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,500","$1500 per person","$3000 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095335140_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","9"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","6","31274","WV","Individual","No","55-0624615","31274WV0350001","Comprehensive Care Blue PPO 4000","31274WV035",,"WVN001","WVS001","WVF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0350001-00","Standard Bronze Off Exchange Plan",,"0.617475271224976","No","Yes","No","100%",,"$4,100","$0","$1,600","$0","$2,700","$0","$1,300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","50%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095595939_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","4"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","6","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0440041","Shared Cost Blue PPO 100","31274WV044",,"WVN001","WVS001","WVF008","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0440041-00","Standard Platinum Off Exchange Plan",,"0.916930675506592","No","Yes","No","100%",,"$100","$10","$1,200","$0","$100","$300","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$2,400","per person not applicable","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$100","per person not applicable","$200 per group","20%",,,,,"$200","per person not applicable","$400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","4"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","8","31274","WV","Individual","No","55-0624615","31274WV0470003","Balance Blue PPO 750","31274WV047",,"WVN001","WVS001","WVF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0470003-01","Standard Gold On Exchange Plan",,"0.787737369537354","No","Yes","No","100%",,"$0","$1,700","$0","$0","$750","$400","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096660341_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","9"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","8","31274","WV","Individual","No","55-0624615","31274WV0470003","Balance Blue PPO 750","31274WV047",,"WVN001","WVS001","WVF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0470003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096664042_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","10"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","8","31274","WV","Individual","No","55-0624615","31274WV0470003","Balance Blue PPO 750","31274WV047",,"WVN001","WVS001","WVF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0470003-03","Limited Cost Sharing Plan Variation",,"0.787737369537354","No","Yes","No","100%",,"$0","$1,700","$0","$0","$750","$400","$80","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096663576_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","11"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","12","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0420012","Shared Cost Blue PPO 6850","31274WV042",,"WVN001","WVS001","WVF001","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0420012-01","Standard Bronze On Exchange Plan",,"0.61640727519989","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$4,600","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","5"
"2016","WV","47107","SERFF","2","2015-08-20 12:28:36","1","47107","WV","SHOP (Small Group)","Yes","42-0127290","47107WV0040001","Principal Plan Dental 70","47107WV004",,"WVN001","WVS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,"Allows Adult and Child-Only",,,"$25.27","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","47107WV0040001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WV","47107","SERFF","2","2015-08-20 12:28:36","1","47107","WV","SHOP (Small Group)","Yes","42-0127290","47107WV0040002","Principal Plan Dental 85","47107WV004",,"WVN001","WVS001",,"Existing","PPO","High",,"Off the Exchange",,,,"Only services listed in the contract are covered.",,"No","Allows Adult and Child-Only",,"Allows Adult and Child-Only",,,"$26.91","Estimated Rate",,"0","0","0","2016-01-01",,"Yes","Same as any other","Yes","Same as any other","Yes",,"","47107WV0040002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","1","50328","WV","Individual","No","47-3028244","50328WV0010001","CareSource Just4Me Gold","50328WV001",,"WVN001","WVS001","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.978062974030917",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010001-00","Standard Gold Off Exchange Plan",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-gold-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","4"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","6","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0440041","Shared Cost Blue PPO 100","31274WV044",,"WVN001","WVS001","WVF008","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0440041-01","Standard Platinum On Exchange Plan",,"0.916930675506592","No","Yes","No","100%",,"$100","$10","$1,200","$0","$100","$300","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,200","$1200 per person","$2400 per group",,,,"$2,400","per person not applicable","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$100","per person not applicable","$200 per group","20%",,,,,"$200","per person not applicable","$400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","5"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","6","31274","WV","Individual","No","55-0624615","31274WV0350001","Comprehensive Care Blue PPO 4000","31274WV035",,"WVN001","WVS001","WVF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0350001-01","Standard Bronze On Exchange Plan",,"0.617475271224976","No","Yes","No","100%",,"$4,100","$0","$1,600","$0","$2,700","$0","$1,300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","50%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095595939_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","5"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","6","31274","WV","Individual","No","55-0624615","31274WV0350001","Comprehensive Care Blue PPO 4000","31274WV035",,"WVN001","WVS001","WVF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0350001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095600038_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","6"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","6","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0440033","Shared Cost Blue PPO 1500","31274WV044",,"WVN001","WVS001","WVF008","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0440033-00","Standard Gold Off Exchange Plan",,"0.789039075374603","No","Yes","No","100%",,"$1,500","$10","$1,200","$0","$1,500","$300","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","per person not applicable","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","per person not applicable","$3000 per group","20%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","6"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","6","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0440033","Shared Cost Blue PPO 1500","31274WV044",,"WVN001","WVS001","WVF008","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0440033-01","Standard Gold On Exchange Plan",,"0.789039075374603","No","Yes","No","100%",,"$1,500","$10","$1,200","$0","$1,500","$300","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","$4500 per person","$9000 per group",,,,"$9,000","per person not applicable","$18000 per group","Not Applicable","per person not applicable","per group not applicable","$1,500","per person not applicable","$3000 per group","20%",,,,,"$3,000","per person not applicable","$6000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","7"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","6","31274","WV","Individual","No","55-0624615","31274WV0350001","Comprehensive Care Blue PPO 4000","31274WV035",,"WVN001","WVS001","WVF003","Existing","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0350001-03","Limited Cost Sharing Plan Variation",,"0.617475271224976","No","Yes","No","100%",,"$4,100","$0","$1,600","$0","$2,700","$0","$1,300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","$4000 per person","$8000 per group","50%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095602890_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","7"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","7","31274","WV","Individual","No","55-0624615","31274WV0330006","Shared Cost Blue PPO 2500","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.  .","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330006-00","Standard Silver Off Exchange Plan",,"0.71783846616745","No","Yes","No","100%",,"$2,500","$10","$1,000","$0","$1,700","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096024497_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","4"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","7","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0420031","Shared Cost Blue PPO 1000","31274WV042",,"WVN001","WVS001","WVF008","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0420031-00","Standard Gold Off Exchange Plan",,"0.811043977737427","No","Yes","No","100%",,"$1,000","$10","$1,300","$0","$1,000","$400","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","20%",,,,,"$2,000","per person not applicable","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","4"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","7","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0420031","Shared Cost Blue PPO 1000","31274WV042",,"WVN001","WVS001","WVF008","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0420031-01","Standard Gold On Exchange Plan",,"0.811043977737427","No","Yes","No","100%",,"$1,000","$10","$1,300","$0","$1,000","$400","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$1,000","per person not applicable","$2000 per group","20%",,,,,"$2,000","per person not applicable","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","5"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","7","31274","WV","Individual","No","55-0624615","31274WV0330006","Shared Cost Blue PPO 2500","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.  .","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330006-01","Standard Silver On Exchange Plan",,"0.71783846616745","No","Yes","No","100%",,"$2,500","$10","$1,000","$0","$1,700","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096024497_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","5"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","7","31274","WV","Individual","No","55-0624615","31274WV0330006","Shared Cost Blue PPO 2500","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.  .","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096049632_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","6"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","7","31274","WV","Individual","No","55-0624615","31274WV0330006","Shared Cost Blue PPO 2500","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.  .","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330006-03","Limited Cost Sharing Plan Variation",,"0.71783846616745","No","Yes","No","100%",,"$2,500","$10","$1,000","$0","$1,700","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096031163_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","7"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","7","31274","WV","Individual","No","55-0624615","31274WV0330006","Shared Cost Blue PPO 2500","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.  .","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330006-04","73% AV Level Silver Plan",,"0.73945939540863","No","Yes","No","100%",,"$2,500","$10","$1,000","$0","$1,700","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,050","$5050 per person","$10100 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$2,500","$2500 per person","$5000 per group","20%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096033677_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","8"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","7","31274","WV","Individual","No","55-0624615","31274WV0330006","Shared Cost Blue PPO 2500","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.  .","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330006-05","87% AV Level Silver Plan",,"0.866662621498108","No","Yes","No","100%",,"$750","$10","$700","$0","$750","$200","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096035676_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","9"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","7","31274","WV","Individual","No","55-0624615","31274WV0330006","Shared Cost Blue PPO 2500","31274WV033",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.  .","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0330006-06","94% AV Level Silver Plan",,"0.949491500854492","No","Yes","No","100%",,"$100","$0","$400","$0","$100","$200","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"$5,000","per person not applicable","$10000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096046028_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","10"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","8","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0420041","Shared Cost Blue PPO 500","31274WV042",,"WVN001","WVS001","WVF008","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0420041-00","Standard Platinum Off Exchange Plan",,"0.912135541439056","No","Yes","No","100%",,"$500","$10","$1,000","$0","$500","$300","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$2,000","per person not applicable","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$500","per person not applicable","$1000 per group","20%",,,,,"$1,000","per person not applicable","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","4"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","8","31274","WV","Individual","No","55-0624615","31274WV0470001","Balance Blue PPO 500","31274WV047",,"WVN001","WVS001","WVF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0470001-00","Standard Gold Off Exchange Plan",,"0.805006742477417","No","Yes","No","100%",,"$500","$200","$1,200","$0","$500","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","per person not applicable","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096657549_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","4"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","8","31274","WV","Individual","No","55-0624615","31274WV0470001","Balance Blue PPO 500","31274WV047",,"WVN001","WVS001","WVF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0470001-01","Standard Gold On Exchange Plan",,"0.805006742477417","No","Yes","No","100%",,"$500","$200","$1,200","$0","$500","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","per person not applicable","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096657549_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","5"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","8","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0420041","Shared Cost Blue PPO 500","31274WV042",,"WVN001","WVS001","WVF008","Existing","PPO","Platinum","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0420041-01","Standard Platinum On Exchange Plan",,"0.912135541439056","No","Yes","No","100%",,"$500","$10","$1,000","$0","$500","$300","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$2,000","per person not applicable","$4000 per group","Not Applicable","per person not applicable","per group not applicable","$500","per person not applicable","$1000 per group","20%",,,,,"$1,000","per person not applicable","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","20%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","5"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","8","31274","WV","Individual","No","55-0624615","31274WV0470001","Balance Blue PPO 500","31274WV047",,"WVN001","WVS001","WVF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0470001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096659694_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","6"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","8","31274","WV","Individual","No","55-0624615","31274WV0470001","Balance Blue PPO 500","31274WV047",,"WVN001","WVS001","WVF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0470001-03","Limited Cost Sharing Plan Variation",,"0.805006742477417","No","Yes","No","100%",,"$500","$200","$1,200","$0","$500","$200","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","$3000 per person","$6000 per group",,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","20%",,,,,"$1,000","per person not applicable","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096659494_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","7"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","8","31274","WV","Individual","No","55-0624615","31274WV0470003","Balance Blue PPO 750","31274WV047",,"WVN001","WVS001","WVF004","Existing","PPO","Gold","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0470003-00","Standard Gold Off Exchange Plan",,"0.787737369537354","No","Yes","No","100%",,"$0","$1,700","$0","$0","$750","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","$750","$750 per person","$1500 per group","10%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096660341_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","8"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","8","31274","WV","Individual","No","55-0624615","31274WV0470004","Balance Blue PPO 1200","31274WV047",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0470004-00","Standard Silver Off Exchange Plan",,"0.718323886394501","No","Yes","No","100%",,"$0","$1,100","$0","$0","$1,200","$600","$40","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"$2,400","per person not applicable","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095639882_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","12"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","8","31274","WV","Individual","No","55-0624615","31274WV0470004","Balance Blue PPO 1200","31274WV047",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0470004-01","Standard Silver On Exchange Plan",,"0.718323886394501","No","Yes","No","100%",,"$0","$1,100","$0","$0","$1,200","$600","$40","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"$2,400","per person not applicable","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095639882_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","13"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","8","31274","WV","Individual","No","55-0624615","31274WV0470004","Balance Blue PPO 1200","31274WV047",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0470004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096023557_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","14"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","8","31274","WV","Individual","No","55-0624615","31274WV0470004","Balance Blue PPO 1200","31274WV047",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0470004-03","Limited Cost Sharing Plan Variation",,"0.718323886394501","No","Yes","No","100%",,"$0","$1,100","$0","$0","$1,200","$600","$40","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"$2,400","per person not applicable","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095642410_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","15"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","8","31274","WV","Individual","No","55-0624615","31274WV0470004","Balance Blue PPO 1200","31274WV047",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0470004-04","73% AV Level Silver Plan",,"0.739796042442322","No","Yes","No","100%",,"$0","$1,100","$0","$0","$1,200","$600","$40","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,700","$4700 per person","$9400 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$1,200","$1200 per person","$2400 per group","10%",,,,,"$2,400","per person not applicable","$4800 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095656663_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","16"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","8","31274","WV","Individual","No","55-0624615","31274WV0470004","Balance Blue PPO 1200","31274WV047",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0470004-05","87% AV Level Silver Plan",,"0.878173351287842","No","Yes","No","100%",,"$0","$500","$0","$0","$500","$400","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$500","$500 per person","$1000 per group","10%",,,,,"$1,000","per person not applicable","$2000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095657336_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","17"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","8","31274","WV","Individual","No","55-0624615","31274WV0470004","Balance Blue PPO 1200","31274WV047",,"WVN001","WVS001","WVF004","Existing","PPO","Silver","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,"$500","3","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=4815439887","31274WV0470004-06","94% AV Level Silver Plan",,"0.934604346752167","No","Yes","No","100%",,"$0","$300","$0","$0","$100","$300","$100","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$500","$500 per person","$1000 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$100","$100 per person","$200 per group","10%",,,,,"$200","per person not applicable","$400 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2095666124_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","18"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","9","31274","WV","Individual","No","55-0624615","31274WV0340004","Health Savings Blue PPO 6450","31274WV034",,"WVN001","WVS001","WVF001","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0340004-00","Standard Bronze Off Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","per person not applicable","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","per person not applicable","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096081752_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","4"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","9","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0440031","Shared Cost Blue PPO 750","31274WV044",,"WVN001","WVS001","WVF008","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0440031-00","Standard Gold Off Exchange Plan",,"0.814541876316071","No","Yes","No","100%",,"$750","$10","$2,000","$0","$750","$400","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$750","per person not applicable","$1500 per group","30%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","4"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","9","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0440031","Shared Cost Blue PPO 750","31274WV044",,"WVN001","WVS001","WVF008","Existing","PPO","Gold","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0440031-01","Standard Gold On Exchange Plan",,"0.814541876316071","No","Yes","No","100%",,"$750","$10","$2,000","$0","$750","$400","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$4,000","$4000 per person","$8000 per group",,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$750","per person not applicable","$1500 per group","30%",,,,,"$1,500","per person not applicable","$3000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","5"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","1","50328","WV","Individual","No","47-3028244","50328WV0010005","CareSource Just4Me Gold","50328WV001",,"WVN005","WVS005","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.978062974030917",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010005-03","Limited Cost Sharing Plan Variation",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-goldltd-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","19"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","1","50328","WV","Individual","No","47-3028244","50328WV0010006","CareSource Just4Me Gold","50328WV001",,"WVN006","WVS006","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.978062974030917",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010006-00","Standard Gold Off Exchange Plan",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-gold-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","20"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","1","50328","WV","Individual","No","47-3028244","50328WV0010006","CareSource Just4Me Gold","50328WV001",,"WVN006","WVS006","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.978062974030917",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010006-01","Standard Gold On Exchange Plan",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-gold-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","21"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","1","50328","WV","Individual","No","47-3028244","50328WV0010006","CareSource Just4Me Gold","50328WV001",,"WVN006","WVS006","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.978062974030917",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010006-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-goldzero-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","22"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","1","50328","WV","Individual","No","47-3028244","50328WV0010006","CareSource Just4Me Gold","50328WV001",,"WVN006","WVS006","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.978062974030917",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010006-03","Limited Cost Sharing Plan Variation",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-goldltd-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","23"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010007","CareSource Just4Me Silver","50328WV001",,"WVN001","WVS001","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010007-00","Standard Silver Off Exchange Plan","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","4"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010007","CareSource Just4Me Silver","50328WV001",,"WVN001","WVS001","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010007-01","Standard Silver On Exchange Plan","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","5"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","9","31274","WV","Individual","No","55-0624615","31274WV0340004","Health Savings Blue PPO 6450","31274WV034",,"WVN001","WVS001","WVF001","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0340004-01","Standard Bronze On Exchange Plan",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","per person not applicable","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","per person not applicable","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096081752_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","5"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","9","31274","WV","Individual","No","55-0624615","31274WV0340004","Health Savings Blue PPO 6450","31274WV034",,"WVN001","WVS001","WVF001","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0340004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096089712_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","6"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","9","31274","WV","Individual","No","55-0624615","31274WV0340004","Health Savings Blue PPO 6450","31274WV034",,"WVN001","WVS001","WVF001","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy","0.9979",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0340004-03","Limited Cost Sharing Plan Variation",,"0.602554798126221","Yes","Yes","No","100%",,"$6,450","$0","$0","$0","$5,300","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","per person not applicable","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group","0%",,,,,"$12,900","per person not applicable","$25800 per group","Not Applicable","per person not applicable","per group not applicable","No",,,"https://www.highmarkbcbswv.com/sbc/pdf/bcbswv/I_2096095091_20160101_SBC.pdf","http://discoverhighmark.com/individuals-families/content/pdfs/brochures/WV_2016_Product%20Brochure_508.PDF","7"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","10","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0420011","Shared Cost Blue PPO 4000","31274WV042",,"WVN001","WVS001","WVF008","New","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0420011-00","Standard Silver Off Exchange Plan",,"0.687231183052063","No","Yes","No","100%",,"$4,000","$10","$700","$0","$1,700","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","per person not applicable","$8000 per group","20%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","4"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","10","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0420011","Shared Cost Blue PPO 4000","31274WV042",,"WVN001","WVS001","WVF008","New","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,"$500","0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0420011-01","Standard Silver On Exchange Plan",,"0.687231183052063","No","Yes","No","100%",,"$4,000","$10","$700","$0","$1,700","$500","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","$4,000","per person not applicable","$8000 per group","20%",,,,,"$8,000","per person not applicable","$16000 per group","Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,"No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","5"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","11","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0410011","Health Savings Blue PPO 4500","31274WV041",,"WVN001","WVS001","WVF006","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0410011-00","Standard Bronze Off Exchange Plan",,"0.617401421070099","Yes","Yes","No","100%",,"$4,500","$0","$800","$0","$4,500","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","per person not applicable","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"$9,000","per person not applicable","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","4"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","11","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0410011","Health Savings Blue PPO 4500","31274WV041",,"WVN001","WVS001","WVF006","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0410011-01","Standard Bronze On Exchange Plan",,"0.617401421070099","Yes","Yes","No","100%",,"$4,500","$0","$800","$0","$4,500","$0","$300","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","per person not applicable","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$4,500","per person not applicable","$9000 per group","30%",,,,,"$9,000","per person not applicable","$18000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","5"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","11","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0430021","Health Savings Blue PPO 3000","31274WV043",,"WVN001","WVS001","WVF005","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0430021-00","Standard Silver Off Exchange Plan",,"0.69658088684082","Yes","Yes","No","100%",,"$3,000","$0","$400","$0","$3,000","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","6"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","11","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0430021","Health Savings Blue PPO 3000","31274WV043",,"WVN001","WVS001","WVF005","Existing","PPO","Silver","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0430021-01","Standard Silver On Exchange Plan",,"0.69658088684082","Yes","Yes","No","100%",,"$3,000","$0","$400","$0","$3,000","$0","$200","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","$5000 per person","$10000 per group",,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$3,000","per person not applicable","$6000 per group","10%",,,,,"$6,000","per person not applicable","$12000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","7"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","11","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0430012","Health Savings Blue PPO 5000","31274WV043",,"WVN001","WVS001","WVF007","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0430012-00","Standard Bronze Off Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$500","$0","$5,000","$0","$70","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","per person not applicable","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","8"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","11","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0430012","Health Savings Blue PPO 5000","31274WV043",,"WVN001","WVS001","WVF007","Existing","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0430012-01","Standard Bronze On Exchange Plan",,"0.615576088428497","Yes","Yes","No","100%",,"$5,000","$0","$500","$0","$5,000","$0","$70","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,450","$6450 per person","$12900 per group",,,,"$12,900","per person not applicable","$25800 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$5,000","per person not applicable","$10000 per group","20%",,,,,"$10,000","per person not applicable","$20000 per group","Not Applicable","per person not applicable","per group not applicable","Yes","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","9"
"2016","WV","31274","SERFF","12","2016-01-28 08:29:40","12","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0420012","Shared Cost Blue PPO 6850","31274WV042",,"WVN001","WVS001","WVF001","New","PPO","Bronze","No","Both","No","No",,,,"No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs","0.9982",,,,"0","0","0","2016-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member may have to pay the difference between the amount that the non-participating health care provider bills and payment the Plan will make for the covered services.","Yes","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://client.formularynavigator.com/Search.aspx?siteCode=1158840676","31274WV0420012-00","Standard Bronze Off Exchange Plan",,"0.61640727519989","Yes","Yes","No","100%",,"$6,850","$0","$0","$0","$4,600","$400","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","per person not applicable","$13700 per group","0%",,,,,"$13,700","per person not applicable","$27400 per group","Not Applicable","per person not applicable","per group not applicable","No","No",,"https://www.highmark.com/SBC","http://discoverhighmark.com/employer/insurance/plans/small-group-SHOP?region=westvirginia","4"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","1","50328","WV","Individual","No","47-3028244","50328WV0010001","CareSource Just4Me Gold","50328WV001",,"WVN001","WVS001","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.978062974030917",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010001-01","Standard Gold On Exchange Plan",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-gold-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","5"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","1","50328","WV","Individual","No","47-3028244","50328WV0010001","CareSource Just4Me Gold","50328WV001",,"WVN001","WVS001","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.978062974030917",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-goldzero-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","6"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","1","50328","WV","Individual","No","47-3028244","50328WV0010001","CareSource Just4Me Gold","50328WV001",,"WVN001","WVS001","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.978062974030917",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010001-03","Limited Cost Sharing Plan Variation",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-goldltd-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","7"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","1","50328","WV","Individual","No","47-3028244","50328WV0010002","CareSource Just4Me Gold","50328WV001",,"WVN002","WVS002","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.978062974030917",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010002-00","Standard Gold Off Exchange Plan",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-gold-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","8"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","1","50328","WV","Individual","No","47-3028244","50328WV0010002","CareSource Just4Me Gold","50328WV001",,"WVN002","WVS002","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.978062974030917",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010002-01","Standard Gold On Exchange Plan",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-gold-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","9"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","1","50328","WV","Individual","No","47-3028244","50328WV0010002","CareSource Just4Me Gold","50328WV001",,"WVN002","WVS002","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.978062974030917",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-goldzero-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","10"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","1","50328","WV","Individual","No","47-3028244","50328WV0010002","CareSource Just4Me Gold","50328WV001",,"WVN002","WVS002","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.978062974030917",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010002-03","Limited Cost Sharing Plan Variation",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-goldltd-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","11"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","1","50328","WV","Individual","No","47-3028244","50328WV0010004","CareSource Just4Me Gold","50328WV001",,"WVN004","WVS004","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.978062974030917",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010004-00","Standard Gold Off Exchange Plan",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-gold-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","12"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","1","50328","WV","Individual","No","47-3028244","50328WV0010004","CareSource Just4Me Gold","50328WV001",,"WVN004","WVS004","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.978062974030917",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010004-01","Standard Gold On Exchange Plan",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-gold-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","13"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","1","50328","WV","Individual","No","47-3028244","50328WV0010004","CareSource Just4Me Gold","50328WV001",,"WVN004","WVS004","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.978062974030917",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010004-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-goldzero-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","14"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","1","50328","WV","Individual","No","47-3028244","50328WV0010004","CareSource Just4Me Gold","50328WV001",,"WVN004","WVS004","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.978062974030917",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010004-03","Limited Cost Sharing Plan Variation",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-goldltd-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","15"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","1","50328","WV","Individual","No","47-3028244","50328WV0010005","CareSource Just4Me Gold","50328WV001",,"WVN005","WVS005","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.978062974030917",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010005-00","Standard Gold Off Exchange Plan",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-gold-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","16"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","1","50328","WV","Individual","No","47-3028244","50328WV0010005","CareSource Just4Me Gold","50328WV001",,"WVN005","WVS005","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.978062974030917",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010005-01","Standard Gold On Exchange Plan",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-gold-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","17"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","1","50328","WV","Individual","No","47-3028244","50328WV0010005","CareSource Just4Me Gold","50328WV001",,"WVN005","WVS005","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.978062974030917",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010005-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-goldzero-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","18"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010007","CareSource Just4Me Silver","50328WV001",,"WVN001","WVS001","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silverzero-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","6"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010007","CareSource Just4Me Silver","50328WV001",,"WVN001","WVS001","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010007-03","Limited Cost Sharing Plan Variation","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silverltd-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","7"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010007","CareSource Just4Me Silver","50328WV001",,"WVN001","WVS001","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010007-04","73% AV Level Silver Plan","73.37%","0.733670771121979","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver1-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","8"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010007","CareSource Just4Me Silver","50328WV001",,"WVN001","WVS001","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010007-05","87% AV Level Silver Plan","87.97%","0.880022585391998","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver2-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","9"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010007","CareSource Just4Me Silver","50328WV001",,"WVN001","WVS001","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010007-06","94% AV Level Silver Plan","94.58%","0.945825636386871","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver3-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","10"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010008","CareSource Just4Me Silver","50328WV001",,"WVN002","WVS002","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010008-00","Standard Silver Off Exchange Plan","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","11"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010008","CareSource Just4Me Silver","50328WV001",,"WVN002","WVS002","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010008-01","Standard Silver On Exchange Plan","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","12"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010008","CareSource Just4Me Silver","50328WV001",,"WVN002","WVS002","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silverzero-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","13"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010008","CareSource Just4Me Silver","50328WV001",,"WVN002","WVS002","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010008-03","Limited Cost Sharing Plan Variation","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silverltd-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","14"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010008","CareSource Just4Me Silver","50328WV001",,"WVN002","WVS002","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010008-04","73% AV Level Silver Plan","73.37%","0.733670771121979","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver1-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","15"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010008","CareSource Just4Me Silver","50328WV001",,"WVN002","WVS002","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010008-05","87% AV Level Silver Plan","87.97%","0.880022585391998","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver2-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","16"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010008","CareSource Just4Me Silver","50328WV001",,"WVN002","WVS002","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010008-06","94% AV Level Silver Plan","94.58%","0.945825636386871","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver3-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","17"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010010","CareSource Just4Me Silver","50328WV001",,"WVN004","WVS004","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010010-00","Standard Silver Off Exchange Plan","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","18"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010010","CareSource Just4Me Silver","50328WV001",,"WVN004","WVS004","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010010-01","Standard Silver On Exchange Plan","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","19"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010010","CareSource Just4Me Silver","50328WV001",,"WVN004","WVS004","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silverzero-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","20"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010010","CareSource Just4Me Silver","50328WV001",,"WVN004","WVS004","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010010-03","Limited Cost Sharing Plan Variation","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silverltd-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","21"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010010","CareSource Just4Me Silver","50328WV001",,"WVN004","WVS004","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010010-04","73% AV Level Silver Plan","73.37%","0.733670771121979","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver1-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","22"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010010","CareSource Just4Me Silver","50328WV001",,"WVN004","WVS004","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010010-05","87% AV Level Silver Plan","87.97%","0.880022585391998","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver2-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","23"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010010","CareSource Just4Me Silver","50328WV001",,"WVN004","WVS004","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010010-06","94% AV Level Silver Plan","94.58%","0.945825636386871","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver3-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","24"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010011","CareSource Just4Me Silver","50328WV001",,"WVN005","WVS005","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010011-00","Standard Silver Off Exchange Plan","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","25"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010011","CareSource Just4Me Silver","50328WV001",,"WVN005","WVS005","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010011-01","Standard Silver On Exchange Plan","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","26"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010011","CareSource Just4Me Silver","50328WV001",,"WVN005","WVS005","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010011-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silverzero-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","27"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010011","CareSource Just4Me Silver","50328WV001",,"WVN005","WVS005","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010011-03","Limited Cost Sharing Plan Variation","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silverltd-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","28"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010011","CareSource Just4Me Silver","50328WV001",,"WVN005","WVS005","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010011-04","73% AV Level Silver Plan","73.37%","0.733670771121979","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver1-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","29"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010011","CareSource Just4Me Silver","50328WV001",,"WVN005","WVS005","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010011-05","87% AV Level Silver Plan","87.97%","0.880022585391998","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver2-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","30"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010011","CareSource Just4Me Silver","50328WV001",,"WVN005","WVS005","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010011-06","94% AV Level Silver Plan","94.58%","0.945825636386871","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver3-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","31"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010012","CareSource Just4Me Silver","50328WV001",,"WVN006","WVS006","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010012-00","Standard Silver Off Exchange Plan","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","32"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010012","CareSource Just4Me Silver","50328WV001",,"WVN006","WVS006","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010012-01","Standard Silver On Exchange Plan","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","33"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010012","CareSource Just4Me Silver","50328WV001",,"WVN006","WVS006","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010012-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silverzero-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","34"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010012","CareSource Just4Me Silver","50328WV001",,"WVN006","WVS006","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010012-03","Limited Cost Sharing Plan Variation","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silverltd-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","35"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010012","CareSource Just4Me Silver","50328WV001",,"WVN006","WVS006","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010012-04","73% AV Level Silver Plan","73.37%","0.733670771121979","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver1-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","36"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010012","CareSource Just4Me Silver","50328WV001",,"WVN006","WVS006","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010012-05","87% AV Level Silver Plan","87.97%","0.880022585391998","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver2-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","37"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010012","CareSource Just4Me Silver","50328WV001",,"WVN006","WVS006","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.964925586648376",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010012-06","94% AV Level Silver Plan","94.58%","0.945825636386871","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver3-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","38"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010013","CareSource Just4Me Bronze","50328WV001",,"WVN001","WVS001","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.952408863236663",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010013-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","39"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010013","CareSource Just4Me Bronze","50328WV001",,"WVN001","WVS001","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.952408863236663",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010013-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","40"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010013","CareSource Just4Me Bronze","50328WV001",,"WVN001","WVS001","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.952408863236663",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronzezero-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","41"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010013","CareSource Just4Me Bronze","50328WV001",,"WVN001","WVS001","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.952408863236663",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010013-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronzeltd-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","42"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010014","CareSource Just4Me Bronze","50328WV001",,"WVN002","WVS002","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.952408863236663",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010014-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","43"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010014","CareSource Just4Me Bronze","50328WV001",,"WVN002","WVS002","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.952408863236663",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010014-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","44"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010014","CareSource Just4Me Bronze","50328WV001",,"WVN002","WVS002","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.952408863236663",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronzezero-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","45"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010014","CareSource Just4Me Bronze","50328WV001",,"WVN002","WVS002","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.952408863236663",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010014-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronzeltd-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","46"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010016","CareSource Just4Me Bronze","50328WV001",,"WVN004","WVS004","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.952408863236663",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010016-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","47"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010016","CareSource Just4Me Bronze","50328WV001",,"WVN004","WVS004","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.952408863236663",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010016-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","48"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010016","CareSource Just4Me Bronze","50328WV001",,"WVN004","WVS004","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.952408863236663",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronzezero-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","49"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010016","CareSource Just4Me Bronze","50328WV001",,"WVN004","WVS004","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.952408863236663",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010016-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronzeltd-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","50"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010017","CareSource Just4Me Bronze","50328WV001",,"WVN005","WVS005","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.952408863236663",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010017-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","51"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010017","CareSource Just4Me Bronze","50328WV001",,"WVN005","WVS005","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.952408863236663",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010017-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","52"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010017","CareSource Just4Me Bronze","50328WV001",,"WVN005","WVS005","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.952408863236663",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronzezero-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","53"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010017","CareSource Just4Me Bronze","50328WV001",,"WVN005","WVS005","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.952408863236663",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010017-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronzeltd-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","54"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010018","CareSource Just4Me Bronze","50328WV001",,"WVN006","WVS006","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.952408863236663",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010018-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","55"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010018","CareSource Just4Me Bronze","50328WV001",,"WVN006","WVS006","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.952408863236663",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010018-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronze-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","56"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010018","CareSource Just4Me Bronze","50328WV001",,"WVN006","WVS006","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.952408863236663",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronzezero-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","57"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","2","50328","WV","Individual","No","47-3028244","50328WV0010018","CareSource Just4Me Bronze","50328WV001",,"WVN006","WVS006","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.952408863236663",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0010018-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronzeltd-basic-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","58"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","3","50328","WV","Individual","No","47-3028244","50328WV0020001","CareSource Just4Me Gold with Dental and Vision","50328WV002",,"WVN001","WVS001","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.907349021008481",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020001-00","Standard Gold Off Exchange Plan",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","4"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","3","50328","WV","Individual","No","47-3028244","50328WV0020001","CareSource Just4Me Gold with Dental and Vision","50328WV002",,"WVN001","WVS001","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.907349021008481",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020001-01","Standard Gold On Exchange Plan",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","5"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","3","50328","WV","Individual","No","47-3028244","50328WV0020001","CareSource Just4Me Gold with Dental and Vision","50328WV002",,"WVN001","WVS001","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.907349021008481",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-goldzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","6"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","3","50328","WV","Individual","No","47-3028244","50328WV0020001","CareSource Just4Me Gold with Dental and Vision","50328WV002",,"WVN001","WVS001","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.907349021008481",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020001-03","Limited Cost Sharing Plan Variation",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-goldltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","7"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","3","50328","WV","Individual","No","47-3028244","50328WV0020002","CareSource Just4Me Gold with Dental and Vision","50328WV002",,"WVN002","WVS002","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.907349021008481",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020002-00","Standard Gold Off Exchange Plan",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","8"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","3","50328","WV","Individual","No","47-3028244","50328WV0020002","CareSource Just4Me Gold with Dental and Vision","50328WV002",,"WVN002","WVS002","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.907349021008481",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020002-01","Standard Gold On Exchange Plan",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","9"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","3","50328","WV","Individual","No","47-3028244","50328WV0020002","CareSource Just4Me Gold with Dental and Vision","50328WV002",,"WVN002","WVS002","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.907349021008481",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-goldzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","10"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","3","50328","WV","Individual","No","47-3028244","50328WV0020002","CareSource Just4Me Gold with Dental and Vision","50328WV002",,"WVN002","WVS002","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.907349021008481",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020002-03","Limited Cost Sharing Plan Variation",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-goldltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","11"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","3","50328","WV","Individual","No","47-3028244","50328WV0020004","CareSource Just4Me Gold with Dental and Vision","50328WV002",,"WVN004","WVS004","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.907349021008481",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020004-00","Standard Gold Off Exchange Plan",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","12"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","3","50328","WV","Individual","No","47-3028244","50328WV0020004","CareSource Just4Me Gold with Dental and Vision","50328WV002",,"WVN004","WVS004","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.907349021008481",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020004-01","Standard Gold On Exchange Plan",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","13"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","3","50328","WV","Individual","No","47-3028244","50328WV0020004","CareSource Just4Me Gold with Dental and Vision","50328WV002",,"WVN004","WVS004","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.907349021008481",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020004-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-goldzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","14"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","3","50328","WV","Individual","No","47-3028244","50328WV0020004","CareSource Just4Me Gold with Dental and Vision","50328WV002",,"WVN004","WVS004","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.907349021008481",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020004-03","Limited Cost Sharing Plan Variation",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-goldltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","15"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","3","50328","WV","Individual","No","47-3028244","50328WV0020005","CareSource Just4Me Gold with Dental and Vision","50328WV002",,"WVN005","WVS005","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.907349021008481",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020005-00","Standard Gold Off Exchange Plan",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","16"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","3","50328","WV","Individual","No","47-3028244","50328WV0020005","CareSource Just4Me Gold with Dental and Vision","50328WV002",,"WVN005","WVS005","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.907349021008481",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020005-01","Standard Gold On Exchange Plan",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","17"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","3","50328","WV","Individual","No","47-3028244","50328WV0020005","CareSource Just4Me Gold with Dental and Vision","50328WV002",,"WVN005","WVS005","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.907349021008481",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020005-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-goldzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","18"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","3","50328","WV","Individual","No","47-3028244","50328WV0020005","CareSource Just4Me Gold with Dental and Vision","50328WV002",,"WVN005","WVS005","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.907349021008481",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020005-03","Limited Cost Sharing Plan Variation",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-goldltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","19"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","3","50328","WV","Individual","No","47-3028244","50328WV0020006","CareSource Just4Me Gold with Dental and Vision","50328WV002",,"WVN006","WVS006","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.907349021008481",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020006-00","Standard Gold Off Exchange Plan",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","20"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","3","50328","WV","Individual","No","47-3028244","50328WV0020006","CareSource Just4Me Gold with Dental and Vision","50328WV002",,"WVN006","WVS006","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.907349021008481",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020006-01","Standard Gold On Exchange Plan",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-gold-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","21"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","3","50328","WV","Individual","No","47-3028244","50328WV0020006","CareSource Just4Me Gold with Dental and Vision","50328WV002",,"WVN006","WVS006","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.907349021008481",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020006-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-goldzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","22"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","3","50328","WV","Individual","No","47-3028244","50328WV0020006","CareSource Just4Me Gold with Dental and Vision","50328WV002",,"WVN006","WVS006","WVF001","New","HMO","Gold","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.907349021008481",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020006-03","Limited Cost Sharing Plan Variation",,"0.816664099693298","No","No","No","100%",,"$700","$300","$0","$150","$1,000","$250","$190","$80","$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable","$1,500","$1500 per person","$3000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,"$1,000","$1000 per person","$2000 per group","20%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-goldltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","23"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020007","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN001","WVS001","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020007-00","Standard Silver Off Exchange Plan","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","4"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020007","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN001","WVS001","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020007-01","Standard Silver On Exchange Plan","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","5"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020007","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN001","WVS001","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silverzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","6"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020007","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN001","WVS001","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020007-03","Limited Cost Sharing Plan Variation","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silverltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","7"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020007","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN001","WVS001","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020007-04","73% AV Level Silver Plan","73.37%","0.733670771121979","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver1-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","8"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020007","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN001","WVS001","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020007-05","87% AV Level Silver Plan","87.97%","0.880022585391998","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver2-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","9"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020007","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN001","WVS001","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020007-06","94% AV Level Silver Plan","94.58%","0.945825636386871","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver3-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","10"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020008","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN002","WVS002","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020008-00","Standard Silver Off Exchange Plan","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","11"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020008","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN002","WVS002","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020008-01","Standard Silver On Exchange Plan","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","12"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020008","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN002","WVS002","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silverzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","13"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020008","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN002","WVS002","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020008-03","Limited Cost Sharing Plan Variation","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silverltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","14"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020008","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN002","WVS002","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020008-04","73% AV Level Silver Plan","73.37%","0.733670771121979","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver1-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","15"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020008","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN002","WVS002","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020008-05","87% AV Level Silver Plan","87.97%","0.880022585391998","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver2-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","16"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020008","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN002","WVS002","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020008-06","94% AV Level Silver Plan","94.58%","0.945825636386871","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver3-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","17"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020010","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN004","WVS004","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020010-00","Standard Silver Off Exchange Plan","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","18"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020010","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN004","WVS004","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020010-01","Standard Silver On Exchange Plan","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","19"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020010","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN004","WVS004","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silverzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","20"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020010","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN004","WVS004","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020010-03","Limited Cost Sharing Plan Variation","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silverltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","21"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020010","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN004","WVS004","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020010-04","73% AV Level Silver Plan","73.37%","0.733670771121979","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver1-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","22"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020010","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN004","WVS004","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020010-05","87% AV Level Silver Plan","87.97%","0.880022585391998","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver2-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","23"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020010","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN004","WVS004","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020010-06","94% AV Level Silver Plan","94.58%","0.945825636386871","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver3-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","24"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020011","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN005","WVS005","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020011-00","Standard Silver Off Exchange Plan","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","25"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020011","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN005","WVS005","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020011-01","Standard Silver On Exchange Plan","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","26"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020011","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN005","WVS005","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020011-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silverzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","27"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020011","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN005","WVS005","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020011-03","Limited Cost Sharing Plan Variation","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silverltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","28"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020011","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN005","WVS005","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020011-04","73% AV Level Silver Plan","73.37%","0.733670771121979","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver1-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","29"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020011","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN005","WVS005","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020011-05","87% AV Level Silver Plan","87.97%","0.880022585391998","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver2-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","30"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020011","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN005","WVS005","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020011-06","94% AV Level Silver Plan","94.58%","0.945825636386871","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver3-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","31"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020012","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN006","WVS006","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020012-00","Standard Silver Off Exchange Plan","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","32"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020012","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN006","WVS006","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020012-01","Standard Silver On Exchange Plan","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","33"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020012","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN006","WVS006","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020012-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silverzero-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","34"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020012","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN006","WVS006","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020012-03","Limited Cost Sharing Plan Variation","70.50%","0.704984962940216","No","Yes","No","100%",,"$700","$550","$0","$150","$2,420","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,500","$6500 per person","$13000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,500","$6500 per person","$13000 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silverltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","35"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020012","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN006","WVS006","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020012-04","73% AV Level Silver Plan","73.37%","0.733670771121979","No","Yes","No","100%",,"$700","$350","$0","$150","$1,150","$0","$380","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$4,850","$4850 per person","$9700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$4,850","$4850 per person","$9700 per group","$3,500","$3500 per person","$7000 per group","30%",,,,,"Not Applicable","per person not applicable","per group not applicable","$3,500","$3500 per person","$7000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver1-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","36"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020012","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN006","WVS006","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020012-05","87% AV Level Silver Plan","87.97%","0.880022585391998","No","Yes","No","100%",,"$700","$300","$0","$150","$1,000","$0","$130","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$2,000","$2000 per person","$4000 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$2,000","$2000 per person","$4000 per group","$1,000","$1000 per person","$2000 per group","10%",,,,,"Not Applicable","per person not applicable","per group not applicable","$1,000","$1000 per person","$2000 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver2-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","37"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020012","CareSource Just4Me Silver with Dental and Vision","50328WV002",,"WVN006","WVS006","WVF002","New","HMO","Silver","Yes","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.895161466733698",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020012-06","94% AV Level Silver Plan","94.58%","0.945825636386871","No","Yes","No","100%",,"$300","$300","$0","$150","$300","$0","$0","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$650","$650 per person","$1300 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$650","$650 per person","$1300 per group","$300","$300 per person","$600 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$300","$300 per person","$600 per group","$0","$0 per person","$0 per group","0%",,,,,"Not Applicable","per person not applicable","per group not applicable","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,"No",,,"https://www.caresource.com/documents/j4m2016-wv-silver3-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","38"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020013","CareSource Just4Me Bronze with Dental and Vision","50328WV002",,"WVN001","WVS001","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.883549702424652",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020013-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","39"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020013","CareSource Just4Me Bronze with Dental and Vision","50328WV002",,"WVN001","WVS001","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.883549702424652",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020013-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","40"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020013","CareSource Just4Me Bronze with Dental and Vision","50328WV002",,"WVN001","WVS001","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.883549702424652",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronzezero-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","41"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020013","CareSource Just4Me Bronze with Dental and Vision","50328WV002",,"WVN001","WVS001","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.883549702424652",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020013-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronzeltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","42"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020014","CareSource Just4Me Bronze with Dental and Vision","50328WV002",,"WVN002","WVS002","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.883549702424652",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020014-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","43"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020014","CareSource Just4Me Bronze with Dental and Vision","50328WV002",,"WVN002","WVS002","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.883549702424652",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020014-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","44"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020014","CareSource Just4Me Bronze with Dental and Vision","50328WV002",,"WVN002","WVS002","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.883549702424652",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronzezero-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","45"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020014","CareSource Just4Me Bronze with Dental and Vision","50328WV002",,"WVN002","WVS002","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.883549702424652",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020014-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronzeltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","46"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020016","CareSource Just4Me Bronze with Dental and Vision","50328WV002",,"WVN004","WVS004","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.883549702424652",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020016-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","47"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020016","CareSource Just4Me Bronze with Dental and Vision","50328WV002",,"WVN004","WVS004","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.883549702424652",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020016-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","48"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020016","CareSource Just4Me Bronze with Dental and Vision","50328WV002",,"WVN004","WVS004","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.883549702424652",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronzezero-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","49"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020016","CareSource Just4Me Bronze with Dental and Vision","50328WV002",,"WVN004","WVS004","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.883549702424652",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020016-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronzeltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","50"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020017","CareSource Just4Me Bronze with Dental and Vision","50328WV002",,"WVN005","WVS005","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.883549702424652",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020017-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","51"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020017","CareSource Just4Me Bronze with Dental and Vision","50328WV002",,"WVN005","WVS005","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.883549702424652",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020017-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","52"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020017","CareSource Just4Me Bronze with Dental and Vision","50328WV002",,"WVN005","WVS005","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.883549702424652",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronzezero-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","53"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020017","CareSource Just4Me Bronze with Dental and Vision","50328WV002",,"WVN005","WVS005","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.883549702424652",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020017-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronzeltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","54"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020018","CareSource Just4Me Bronze with Dental and Vision","50328WV002",,"WVN006","WVS006","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.883549702424652",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020018-00","Standard Bronze Off Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","55"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020018","CareSource Just4Me Bronze with Dental and Vision","50328WV002",,"WVN006","WVS006","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.883549702424652",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020018-01","Standard Bronze On Exchange Plan",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronze-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","56"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020018","CareSource Just4Me Bronze with Dental and Vision","50328WV002",,"WVN006","WVS006","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.883549702424652",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group",,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$0","$0 per person","$0 per group","0%",,,,,"$0","$0 per person","$0 per group","$0","$0 per person","$0 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronzezero-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","57"
"2016","WV","50328","SERFF","7","2016-01-26 09:59:26","4","50328","WV","Individual","No","47-3028244","50328WV0020018","CareSource Just4Me Bronze with Dental and Vision","50328WV002",,"WVN006","WVS006","WVF003","New","HMO","Bronze","No","Both","Yes","No",,,"0","No","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy","0.883549702424652",,,"300","0","0","0","2016-01-01","2016-12-31","No",,"No",,"No","https://www.caresource.com/just4me/enroll/","https://www.caresource.com/Just4Me/wv/pharmacy","50328WV0020018-03","Limited Cost Sharing Plan Variation",,"0.619536638259888","Yes","Yes","No","100%",,"$700","$100","$1,790","$150","$1,150","$800","$510","$80",,,,,,,,,,,,,,,,,,,,,,,,,"$6,850","$6850 per person","$13700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","$6,850","$6850 per person","$13700 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"$6,650","$6650 per person","$13300 per group","40%",,,,,"Not Applicable","per person not applicable","per group not applicable","$6,650","$6650 per person","$13300 per group","No",,,"https://www.caresource.com/documents/j4m2016-wv-bronzeltd-enhanced-sum","https://www.caresource.com/documents/j4m2016-wv-plan-brochure","58"
"2016","WV","53843","SERFF","6","2015-08-20 12:28:36","1","53843","WV","Individual","Yes","75-1233841","53843WV0010001","Dentegra Dental PPO Pediatric Basic Plan","53843WV001",,"WVN001","WVS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","53843WV0010001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wv/53843wv0010001-16","4"
"2016","WV","53843","SERFF","6","2015-08-20 12:28:36","1","53843","WV","SHOP (Small Group)","Yes","75-1233841","53843WV0020001","Dentegra Dental PPO for Small Businesses Pediatric Basic Plan","53843WV002",,"WVN001","WVS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.55","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","53843WV0020001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wv/53843wv0020001-16","4"
"2016","WV","53843","SERFF","6","2015-08-20 12:28:36","2","53843","WV","SHOP (Small Group)","Yes","75-1233841","53843WV0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","53843WV002",,"WVN001","WVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","53843WV0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wv/53843wv0020004-16","4"
"2016","WV","53843","SERFF","6","2015-08-20 12:28:36","2","53843","WV","Individual","Yes","75-1233841","53843WV0010004","Dentegra Dental PPO Family Preferred Plan","53843WV001",,"WVN001","WVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.84","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","53843WV0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wv/53843wv0010004-16","4"
"2016","WV","53843","SERFF","6","2015-08-20 12:28:36","2","53843","WV","Individual","Yes","75-1233841","53843WV0010004","Dentegra Dental PPO Family Preferred Plan","53843WV001",,"WVN001","WVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.84","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","53843WV0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wv/53843wv0010004-16","5"
"2016","WV","53843","SERFF","6","2015-08-20 12:28:36","2","53843","WV","SHOP (Small Group)","Yes","75-1233841","53843WV0020004","Dentegra Dental PPO for Small Businesses Family Preferred Plan","53843WV002",,"WVN001","WVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.02","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","53843WV0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$55","per person not applicable","per group not applicable",,,,,,"$55","per person not applicable","per group not applicable","$55","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wv/53843wv0020004-16","5"
"2016","WV","53843","SERFF","6","2015-08-20 12:28:36","3","53843","WV","SHOP (Small Group)","Yes","75-1233841","53843WV0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","53843WV002",,"WVN001","WVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.55","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","53843WV0020006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wv/53843wv0020006-16","4"
"2016","WV","53843","SERFF","6","2015-08-20 12:28:36","3","53843","WV","Individual","Yes","75-1233841","53843WV0010006","Dentegra Dental PPO Family Basic Plan","53843WV001",,"WVN001","WVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","53843WV0010006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wv/53843wv0010006-16","4"
"2016","WV","53843","SERFF","6","2015-08-20 12:28:36","3","53843","WV","Individual","Yes","75-1233841","53843WV0010006","Dentegra Dental PPO Family Basic Plan","53843WV001",,"WVN001","WVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.41","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","53843WV0010006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wv/53843wv0010006-16","5"
"2016","WV","53843","SERFF","6","2015-08-20 12:28:36","3","53843","WV","SHOP (Small Group)","Yes","75-1233841","53843WV0020006","Dentegra Dental PPO for Small Businesses Family Basic Plan","53843WV002",,"WVN001","WVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.55","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.dentegra.com/hx/checkout","","53843WV0020006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$50","per person not applicable","per group not applicable",,,,,,"$50","per person not applicable","per group not applicable","$50","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://dentegra.com/hcx/wv/53843wv0020006-16","5"
"2016","WV","55565","SERFF","3","2015-08-20 12:28:36","1","55565","WV","SHOP (Small Group)","Yes","36-0883760","55565WV0040002","EHB High PPO","55565WV004",,"WVN001","WVS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.39","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","rsli.com","","55565WV0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"rsli.com","rsli.com","4"
"2016","WV","55565","SERFF","3","2015-08-20 12:28:36","1","55565","WV","SHOP (Small Group)","Yes","36-0883760","55565WV0040001","EHB Low PPO","55565WV004",,"WVN001","WVS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.82","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","rsli.com","","55565WV0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"rsli.com","rsli.com","5"
"2016","WV","55565","SERFF","3","2015-08-20 12:28:36","1","55565","WV","SHOP (Small Group)","Yes","36-0883760","55565WV0030002","EHB High Passive","55565WV003",,"WVN001","WVS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.93","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","rsli.com","","55565WV0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"rsli.com","rsli.com","6"
"2016","WV","55565","SERFF","3","2015-08-20 12:28:36","1","55565","WV","SHOP (Small Group)","Yes","36-0883760","55565WV0030001","EHB Low Passive","55565WV003",,"WVN001","WVS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.19","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","rsli.com","","55565WV0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"rsli.com","rsli.com","7"
"2016","WV","63300","SERFF","3","2015-08-20 12:28:36","1","63300","WV","SHOP (Small Group)","Yes","47-0098400","63300WV0040002","EHB High PPO","63300WV004",,"WVN001","WVS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$34.90","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritas.com","","63300WV0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"ameritas.com","ameritas.com","4"
"2016","WV","63300","SERFF","3","2015-08-20 12:28:36","1","63300","WV","SHOP (Small Group)","Yes","47-0098400","63300WV0040001","EHB Low PPO","63300WV004",,"WVN001","WVS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.57","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritas.com","","63300WV0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"ameritas.com","ameritas.com","5"
"2016","WV","63300","SERFF","3","2015-08-20 12:28:36","1","63300","WV","SHOP (Small Group)","Yes","47-0098400","63300WV0030002","EHB High Passive","63300WV003",,"WVN001","WVS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$36.42","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritas.com","","63300WV0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"ameritas.com","ameritas.com","6"
"2016","WV","63300","SERFF","3","2015-08-20 12:28:36","1","63300","WV","SHOP (Small Group)","Yes","47-0098400","63300WV0030001","EHB Low Passive","63300WV003",,"WVN001","WVS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$21.88","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritas.com","","63300WV0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"ameritas.com","ameritas.com","7"
"2016","WV","67072","SERFF","3","2015-08-20 12:28:36","1","67072","WV","SHOP (Small Group)","Yes","93-0242990","67072WV0040002","EHB High PPO","67072WV004",,"WVN001","WVS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$35.49","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","standard.com","","67072WV0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"standard.com","standard.com","4"
"2016","WV","67072","SERFF","3","2015-08-20 12:28:36","1","67072","WV","SHOP (Small Group)","Yes","93-0242990","67072WV0040001","EHB Low PPO","67072WV004",,"WVN001","WVS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.87","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","standard.com","","67072WV0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"standard.com","standard.com","5"
"2016","WV","67072","SERFF","3","2015-08-20 12:28:36","1","67072","WV","SHOP (Small Group)","Yes","93-0242990","67072WV0030002","EHB High Passive","67072WV003",,"WVN001","WVS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$37.04","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","standard.com","","67072WV0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"standard.com","standard.com","6"
"2016","WV","67072","SERFF","3","2015-08-20 12:28:36","1","67072","WV","SHOP (Small Group)","Yes","93-0242990","67072WV0030001","EHB Low Passive","67072WV003",,"WVN001","WVS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$22.25","Estimated Rate",,"0","0","0","2016-01-01","2017-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","standard.com","","67072WV0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"standard.com","standard.com","7"
"2016","WV","72479","SERFF","3","2015-10-21 17:48:08","1","72479","WV","Individual","Yes","36-3757528","72479WV0010001","TruAssure Basic Adult or Child Dental Plan","72479WV001",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.60","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72479WV0010001-00","Standard Low Off Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WV","https://www.truassure.com/brochure?state=WV","4"
"2016","WV","72479","SERFF","3","2015-10-21 17:48:08","1","72479","WV","SHOP (Small Group)","Yes","36-3757528","72479WV0030001","TruAssure Dental Small Group Basic Plan","72479WV003",,"WVN001","WVS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.39","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","72479WV0030001-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WV","72479","SERFF","3","2015-10-21 17:48:08","1","72479","WV","SHOP (Small Group)","Yes","36-3757528","72479WV0040001","TruAssure Dental Small Group Preferred Plan","72479WV004",,"WVN001","WVS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$39.39","Estimated Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes",,"","72479WV0040001-00","Standard High Off Exchange Plan","83.60%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$45","$45 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2016","WV","72479","SERFF","3","2015-10-21 17:48:08","1","72479","WV","Individual","Yes","36-3757528","72479WV0010001","TruAssure Basic Adult or Child Dental Plan","72479WV001",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.60","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72479WV0010001-01","Standard Low On Exchange Plan","68.70%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$85","$85 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WV","https://www.truassure.com/brochure?state=WV","5"
"2016","WV","72479","SERFF","3","2015-10-21 17:48:08","2","72479","WV","Individual","Yes","36-3757528","72479WV0020001","TruAssure Preferred Adult or Child Dental Plan","72479WV002",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.96","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72479WV0020001-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WV","https://www.truassure.com/brochure?state=WV","4"
"2016","WV","72479","SERFF","3","2015-10-21 17:48:08","2","72479","WV","Individual","Yes","36-3757528","72479WV0020001","TruAssure Preferred Adult or Child Dental Plan","72479WV002",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$27.96","Guaranteed Rate",,"0","0","0","2016-01-01","2016-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","https://www.truassure.com/payment","","72479WV0020001-01","Standard High On Exchange Plan","83.40%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$25","$25 per person","per group not applicable",,,,,,"$75","$75 per person","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.truassure.com/plan-information2?state=WV","https://www.truassure.com/brochure?state=WV","5"
"2016","WV","75441","SERFF","2","2015-08-20 12:28:36","1","75441","WV","SHOP (Small Group)","Yes","57-0523959","75441WV0020001","Group Dental Policy","75441WV002",,"WVN001","WVS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$24.65","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Traditional with inside maximums","Yes","Traditional with inside maximums","Yes",,"","75441WV0020001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","$100 per person","per group not applicable",,,,,,"$100","$100 per person","per group not applicable","$100","$100 per person","$350 per group",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WV","76526","SERFF","4","2015-08-20 12:28:36","1","76526","WV","SHOP (Small Group)","Yes","55-0523124","76526WV0020002","Delta Dental PPO Pediatric Preferred Plan for Small Businesses","76526WV002",,"WVN001","WVS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0020002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0020002-16","4"
"2016","WV","76526","SERFF","4","2015-08-20 12:28:36","1","76526","WV","Individual","Yes","55-0523124","76526WV0010002","Delta Dental PPO Pediatric Preferred Plan","76526WV001",,"WVN001","WVS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0010002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0010002-16","4"
"2016","WV","76526","SERFF","4","2015-08-20 12:28:36","1","76526","WV","Individual","Yes","55-0523124","76526WV0010001","Delta Dental PPO Pediatric Basic Plan","76526WV001",,"WVN001","WVS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$12.70","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0010001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0010001-16","5"
"2016","WV","76526","SERFF","4","2015-08-20 12:28:36","1","76526","WV","SHOP (Small Group)","Yes","55-0523124","76526WV0020001","Delta Dental PPO Pediatric Basic Plan for Small Businesses","76526WV002",,"WVN001","WVS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Adult and Child-Only",,,,,"$12.70","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0020001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0020001-16","5"
"2016","WV","76526","SERFF","4","2015-08-20 12:28:36","2","76526","WV","SHOP (Small Group)","Yes","55-0523124","76526WV0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","76526WV002",,"WVN001","WVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0020004-16","4"
"2016","WV","76526","SERFF","4","2015-08-20 12:28:36","2","76526","WV","Individual","Yes","55-0523124","76526WV0010004","Delta Dental PPO Preferred Plan for Families","76526WV001",,"WVN001","WVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0010004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0010004-16","4"
"2016","WV","76526","SERFF","4","2015-08-20 12:28:36","2","76526","WV","Individual","Yes","55-0523124","76526WV0010004","Delta Dental PPO Preferred Plan for Families","76526WV001",,"WVN001","WVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$15.88","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0010004-16","5"
"2016","WV","76526","SERFF","4","2015-08-20 12:28:36","2","76526","WV","SHOP (Small Group)","Yes","55-0523124","76526WV0020004","Delta Dental PPO Preferred Plan for Families for Small Businesses","76526WV002",,"WVN001","WVS001",,"Existing","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$16.33","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0020004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$40","per person not applicable","per group not applicable",,,,,,"$40","per person not applicable","per group not applicable","$40","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0020004-16","5"
"2016","WV","76526","SERFF","4","2015-08-20 12:28:36","3","76526","WV","SHOP (Small Group)","Yes","55-0523124","76526WV0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","76526WV002",,"WVN001","WVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$12.70","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0020006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0020006-16","4"
"2016","WV","76526","SERFF","4","2015-08-20 12:28:36","3","76526","WV","Individual","Yes","55-0523124","76526WV0010006","Delta Dental PPO Basic Plan for Families","76526WV001",,"WVN001","WVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$12.70","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0010006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0010006-16","4"
"2016","WV","76526","SERFF","4","2015-08-20 12:28:36","3","76526","WV","Individual","Yes","55-0523124","76526WV0010006","Delta Dental PPO Basic Plan for Families","76526WV001",,"WVN001","WVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$12.70","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0010006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0010006-16","5"
"2016","WV","76526","SERFF","4","2015-08-20 12:28:36","3","76526","WV","SHOP (Small Group)","Yes","55-0523124","76526WV0020006","Delta Dental PPO Basic Plan for Families for Small Businesses","76526WV002",,"WVN001","WVS001",,"Existing","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$12.70","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Nationwide Coverage","Yes","https://www.deltadentalins.com/hx/checkout","","76526WV0020006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$45","per person not applicable","per group not applicable",,,,,,"$45","per person not applicable","per group not applicable","$45","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://deltadentalins.com/hcx/wv/76526wv0020006-16","5"
"2016","WV","94562","SERFF","2","2015-08-20 12:28:36","1","94562","WV","SHOP (Small Group)","Yes","13-5581829","94562WV0080001","EHB Basic Dental Plan (Low)","94562WV008",,"WVN001","WVS001",,"Existing","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,"No","Allows Child-Only",,,,,"$15.89","Guaranteed Rate",,"0","0","0","2016-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,"","94562WV0080001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"$100","per person not applicable","per group not applicable",,,,,,"$100","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2016","WV","96480","SERFF","2","2015-08-20 12:28:36","1","96480","WV","SHOP (Small Group)","Yes","13-5123390","96480WV0100003","Guardian Pediatric Advantage","96480WV010",,"WVN001","WVS001",,"New","PPO","High",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$23.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","96480WV0100003-00","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","WV","96480","SERFF","2","2015-08-20 12:28:36","1","96480","WV","SHOP (Small Group)","Yes","13-5123390","96480WV0110003","Guardian Pediatric Essentials","96480WV011",,"WVN001","WVS001",,"New","PPO","Low",,"Off the Exchange",,,,,,"No","Allows Child-Only",,,,,"$17.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","96480WV0110003-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","WV","96480","SERFF","2","2015-08-20 12:28:36","2","96480","WV","SHOP (Small Group)","Yes","13-5123390","96480WV0070003","Guardian Family Advantage","96480WV007",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","96480WV0070003-00","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","4"
"2016","WV","96480","SERFF","2","2015-08-20 12:28:36","2","96480","WV","SHOP (Small Group)","Yes","13-5123390","96480WV0070003","Guardian Family Advantage","96480WV007",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$23.27","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","96480WV0070003-01","Standard High On Exchange Plan","83.30%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$50","$50 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","5"
"2016","WV","96480","SERFF","2","2015-08-20 12:28:36","2","96480","WV","SHOP (Small Group)","Yes","13-5123390","96480WV0090003","Guardian Family Essentials","96480WV009",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","96480WV0090003-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","6"
"2016","WV","96480","SERFF","2","2015-08-20 12:28:36","2","96480","WV","SHOP (Small Group)","Yes","13-5123390","96480WV0090003","Guardian Family Essentials","96480WV009",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,"No","Allows Adult and Child-Only",,,,,"$17.77","Guaranteed Rate",,"0","0","0","2016-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes",,"","96480WV0090003-01","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,,,,,,,,,"$350","$350 per person","$700 per group",,,,"Not Applicable","per person not applicable","per group not applicable","Not Applicable","per person not applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,"Not Applicable","per person not applicable","per group not applicable",,,,,,"Not Applicable","per person not applicable","per group not applicable","$150","$150 per person","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"https://www.guardiananytime.com/dental-health-insurance-exchanges/","https://www.guardiananytime.com/dental-health-insurance-exchanges/","7"